Important information for Aetna and Coventry clients:

Aetna and Coventry left the northern Illinois market for individuals and families at the end of last year. Here is their news for 2018.

As a result of financial risk and an uncertain outlook for the Individual marketplace, Aetna (including Coventry) has decided that we will no longer offer individual health products in the following states AR, AZ, CT, FL, GA, IL, KS, KY, LA, ME, MI, MO, NC, OH, PA, SC, TN, TX, UT, and WV for 2018.

Your clients' existing coverage in these states will continue until their policy period ends on December 31, 2017. They will not be able to renew their plan when their policy term ends.

Member outreach will take place by July.

We will continue to keep you updated on the latest news affecting individual and family health insurance.


ACA Changes for Special Enrollment Begin June 23

The changes impact whether you can buy health insurance for the rest of 2017, what information you need to apply and when the insurance will start. While we are providing this overview, it is best to call us at 847-362-8888 to discuss your individual circumstances and options.

The federal government, under the Affordable Care Act, regulates when individuals can buy health insurance for themselves and their families.

Open Enrollment for 2017 ended January 31st of this year.

You may qualify for Special Enrollment if you:

  1. lose group (employer, college, Medicaid) health insurance
  2. reach the end of COBRA
  3. move to a new home in a new zip code, county or country.
  4. turn 26
  5. are adding dependents to your insurance
  6. are receiving government assistance with your premiums and have a change of circumstance
  7. experience miscellaneous other qualifying events

You have 60 days from the date of the qualifying event in which to apply.

You must apply by the 15th of the month for your insurance to start the 1st of the month after the qualifying event.

A document that verifies your qualifying event (notice of cancellation from an employer or insurer, permanent change of address card filed with USPS, marriage license, divorce decree, birth or adoption certificate) must accompany the application or be submitted within 30 days of application for new insurance.

Coverage will not begin until verification of the qualifying event has been received.

We work directly with insurers like Blue Cross. We work with the federal marketplace for clients who qualify for premium assistance. We are fully aware of and educated in current requirements and what they mean to you who need to get your own health insurance.

We urge you not to buy health insurance online at this time.

Call Jerry or Rebecca (847-362-8888) to discuss your situation. The call is free, confidential and without obligation.


You need 15 for LIFE

Term Life Insurance ended so you have no benefits after you paid premiums for 10 or 15 or 20 years?
Has the stock market plummeted taking with it the gains you were depending on?
Must you pay federal taxes or penalties to get needed cash from 401K or IRAs?

You need 15 for LIFE

15 for LIFE is a practical, dependable platform that combines Life Insurance+ Long-term Care Insurance+ Cash growth at a guaranteed rate.

And here’s the kicker: you can choose to pay premiums for just 15 years.

Even if you stop paying premiums after 15 years

your death benefit continues to grow
money for Long-term Care continues to grow
money accrued through guaranteed annual dividend payments continues to grow

The cash you’ve earned is always available – as a loan or a withdrawal – without penalty and without paying federal taxes.

We all have to make decisions about insurance for protecting our families, leaving a legacy, being taken care of if we’re not able to do it alone, having tax-free money for a long and wonderful life.

Have the conversation to know if 15 for LIFE is right for you. Call us at 847-362-8888.

We’ll work with you using Pearlstein Principle #1: Never Run Out of Money.


LONG-TERM CARE: Who Pays for What?

WHAT IS LONG-TERM CARE?
Long-term = beyond 100 days
Care= help because health or mental impairment cause an inability to do at least two of the Activities of Daily Living

  1. Ability to get up out of a bed or chair
  2. Ability to transfer (walk) from one place to another
  3. Ability to use the toilet or deal with continence
  4. Ability to bathe yourself
  5. Ability to dress yourself
  6. Ability to feed yourself

Underlying medical issues may be addressed in a hospital. The above issues are addressed through a Skilled Nursing Facility, Assisted Living Facility, Home Care, Adult Day Care Center. Where will the money come to pay for them?

MEDICARE
Medicare is health insurance for most US citizens over the age of 65.

Medicare does not pay for Assisted Living, Adult Day Care Centers, transportation services..

It provides a maximum of 100 days of skilled care in a Skilled Nursing Facility or at home under the following circumstances:

  • A physician has designed a plan of care for the patient that is approved by Medicare.
  • The plan of care has included 3 days and nights in the hospital.
  • The patient cannot do at least two of the Activities of Daily Living.
  • The plan of care calls for skilled help with the goal of getting the patient capable of doing those activities. When it is determined the goal has been met or the goal cannot be met, Medicare will cease paying for services.

AN EXCEPTION TO THE 100-DAY LIMIT: MEDICARE HOSPICE

If a doctor has determined the condition of the patient is terminal (life expectancy is not more than six months), Medicare will pay for hospice care to the end of life.
The care is “palliative”, it is not meant to treat the condition, it is meant to keep the patient comfortable through the passing.
Care may be in a facility or in home.
Medicare pays for prescription medicine, nurse/doctor monitoring, medical equipment, skilled care for the Activities of Daily Living, social services for the patient and family.
It does not pay for unskilled caregiving.

MEDICAID

Medicaid is a federal/state entitlement providing care based on economic need.

PACE (Program of All-inclusive Care for the Elderly) is a state/federal program of Medicaid with the purpose of keeping frail, elderly persons in their homes rather than in facilities.

Granting of benefits by the state is based on:

  1. Medical criteria certified by a doctor
  2. Strict limits on personal (including spousal) income and asset holdings. Examination of finances is strict. There is a 5-year look-back from the time of application confirming eligibility and transfer of assets.
  3. Availability of services. Long-term Care providers paid by Medicaid are dependent on state/federal funding. When that funding is cut, services are usually cut as well. Care providers and facilities are not required to take clients paid for by Medicaid. Since that payment is about 72% of market, not all long-term care providers will take Medicaid recipients.

VETERAN’S BENEFITS
The VA offers health care to persons with military service related injuries within Priority Levels based on the percentage of disability the injury causes.

The VA encourages citizens over 65 who have served in the military to have Medicare for health insurance as well.

VA Nursing Home is available for person’s whose service related injury causes 70% disability or more.

Aid and Assistance Pensions are available to those who have served and their spouses based on economic need and regardless of service related injury.

The VA suggests contacting the Social Work Department at the nearest VA facility for information.

LONG-TERM CARE INSURANCE
Long-term Care insurance is not health insurance. It provides money for care of an individual needed after 100 days and because the individual cannot do two of the Activities of Daily Living. The individual pays for the insurance based on age, health, family history and the amount of money made available.

Long-Term Care insurance plans can be freestanding. Many of these plans pay directly to Assisted Living or Skilled Nursing Facilities or on a schedule for skilled services.

Long-Term Care insurance plans can be based on a whole life insurance policy. They’re

designed to provide money to the policyholder which they can spend on any care.

We are experts in Long-Term Care planning and insurance.

Jerry S. Pearlstein Insurance partner, Rebecca Bloomfield, has earned a national Certification in Long-Term Care. She delivers a free program: Long Term Care. Who pays for What? to groups throughout the Northshore and Chicago.

Designing a Long-Term Care Insurance plan to meet your needs requires a thorough and confidential conversation. Call us to begin: 847-362-8888.

A note: If you are single, believe you will be the surviving spouse or that your family will be scattered, Long-Term Care Insurance is an essential investment in yourself.


Health Insurance and Required Federal Tax Reporting

The Affordable Care Act requires almost all US citizens and legal residents 26 – 65 years old and their dependents to have ACA compliant health insurance.

You are required to let the government know if you did or did not comply with the law when you file your federal tax return for 2016.

If you had health care coverage through your employer, Medicaid or Medicare
You may simply need to check a box on your federal tax return.

If you had health coverage ON Exchange (through the Marketplace or healthcare.gov)
The Marketplace will send you a 1095-A form to send in with your federal tax return. You can also find a copy by logging into your Marketplace account at healthcare.gov if you have one.

If you had health coverage OFF Exchange (through an agent or the health insurance provider)
The health insurance company is sending your 1095-B form to arrive by March 2, 2017. If you haven’t received your form my March2, 2017, call the number on the back of your health insurance card.

If you didn’t have Affordable Care Act compliant health insurance for yourself and your dependents
You will provide this information on your federal tax return.You may qualify for an exemption. You may need to pay a fee.

Blue Cross offers answers to Frequently Answered Questions: Click Here to view.


When and Why to Seek Family Counseling

An elderly woman decided to have her portrait painted. She told the artist” Paint me with diamond earrings, a diamond necklace, emerald bracelets, a ruby broach, and gold Rolex.”

“But you are not wearing any of those things” replied the artist.

“I know,” she said. “It’s in case I should die before my husband. I’m sure he will remarry right away, and I want his new wife to go crazy looking for the jewelry.”

Our guest blogger this month is Edie Sue Sutker. She is a clinical supervisor and clinician at Jewish Child & Family Services. Edie has been with the agency for more than 13 years and regularly works with families. In addition, she specializes in working with individuals suffering from depression, anxiety and grief. She can be reached at 847-412-4374.

When and Why to Seek Family Counseling

At some point, nearly everybody asks, “Should my family be in counseling?”

The fact is that life presents us with challenging situations, whether it’s facing the loss of a loved one, coping with depression or dealing with an unexpected crisis. Sometimes we can address these on our own or with the help of friends. Other times, however, a professional therapist can bring skill and insight to your situation and support you through these difficult times.

How do you know if you should seek family counseling? You don’t need to wait for a crisis to seek help. Here are some questions to consider:

  • Is a family member exhibiting unhealthy behaviors such as excessive drinking, drug use or self-injury?
  • Do family members have difficulty communicating with one another?
  • Do you have secrets that you haven’t shared?
  • Does someone have a medical or psychological illness putting pressure on the family?
  • Is your child acting out at home or in school?
  • Are you responsible for an aging parent?

If the answer to any of these questions is “yes,” Jewish Child & Family Services can help. JCFS works with families throughout the lifespan, from young children to the elderly. We provide high-quality therapeutic services to families of all religions, races, ethnicities, sexual orientations and gender identities throughout Chicago and the suburbs. JCFS accepts most major insurance plans.

At your first appointment, a counselor will ask questions about your family situation and what brings you to therapy now. The counselor will determine whether to meet with you individually, as a couple or as an entire family, and will use proven therapeutic approaches to meet your family’s specific needs.

For more information, or to schedule an appointment, call 855-275-5237.

It is more important than ever to coordinate your family’s health, life and long-term care insurance with your lifetime savings plan. Call us for a free financial counseling for your family. 847-362-8888.


Expanded Blue Cross Coverage for NorthShore and Northwestern

Blue Cross has announced that doctors in the NorthShore University Health System NorthShore Medical Group are accepting the Blue Cross Blue Precision HMO plan.

Call 847-570-4202 to find out if your NorthShore doctor accepts Blue Precision HMO insurance. They can refer you to a doctor who does.

Blue Cross has announced that doctors at Northwestern Medicine are accepting the Blue Cross Precision HMO card.

Call 312-926-8400 to find out if your Northwestern doctor accepts Blue Precision HMO insurance. They can refer you to a doctor who does.

Blue Cross notified agents that healthcare.gov and even their online provider list is not up-to-date at this time. They encourage you to call.

Call us for quotes on prices for this plan: 847-362-8888.


Blue Cross Blue Precision HMO Hospitals 2017

Blue Cross is in the process of expanding your options under the Blue Precision HMO health insurance plan. In addition to the existing providers on this list, approximately 100 Northshore Medical Group (Northshore University Heath System) primary care physicians will participate in 2017.

Click Here to view chart.