Medicare's open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 - Dec. 7. This is the time when you can enroll in a new plan or sign up for coverage.
If you need assistance understanding your options, we have trained volunteers in your community. Our Statewide Health Insurance Benefits Advisors (SHIBA) program offers free help to people with Medicare questions and can help you search for plans online. We even have free Medicare workshops across the state.
Remember, if you want to enroll in new plan, you must contact Medicare. You cannot sign up through the state's new health benefit exchange, www.wahealthplanfinder.org.
If you have limited income and need help paying prescription drugs, check out Medicare's "Extra Help" program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov.
For more help, contact a local SHIBA office in your area.
Kamis, 17 Oktober 2013
Rabu, 16 Oktober 2013
Job seekers - We're looking for a legislative liaison and a policy/rules manager
Two jobs at the Insurance Commissioner's office just posted this week - a Legislative Liaison and a Policy and Rules Manager. Both positions are exempt, open until filled and salary depends on experience.
The Legislative Liaison is responsible for developing and managing our legislative and policy strategy, including developing our legislative agenda, legislative testimony, bill analysis, and stakeholder management. They're also the principal policy advisor to the executive management team on legislative and budget proposals impacting the agency.
The Policy and Rules Manager supervises staff in our Policy and Legislative Affairs division, prepares position briefs, decision memos, reports, coordinates rule-making for the agency, and drafts and adopts rules on behalf of the agency.
If you're interested or know someone who might be, encourage them to apply soon!
The Legislative Liaison is responsible for developing and managing our legislative and policy strategy, including developing our legislative agenda, legislative testimony, bill analysis, and stakeholder management. They're also the principal policy advisor to the executive management team on legislative and budget proposals impacting the agency.
The Policy and Rules Manager supervises staff in our Policy and Legislative Affairs division, prepares position briefs, decision memos, reports, coordinates rule-making for the agency, and drafts and adopts rules on behalf of the agency.
If you're interested or know someone who might be, encourage them to apply soon!
See most recent earthquakes in our area - are you ready for the big one?
We're getting ready for tomorrow's Great ShakeOut Earthquake Drill by cleaning out all the stuff under our desk - how about you? It's been a long time since the Nisqually Quake, but if you lived in Washington state then, you probably remember where you were and what it felt like.
Some of us here in Olympia - only miles from the epicenter - heard what sounded like a freight train. Others saw the ground move like water. Are you ready for the next one?
Check out the earthquake tracker on KIRO's mynorthwest.com. It'll show you the most recent quake, how big it was and where it occurred.
Senin, 14 Oktober 2013
How to report insurance fraud in Washington state
Our agency -- Washington state's insurance regulator -- handles a wide variety of complaints about insurance fraud by individuals and by businesses.
To report insurance fraud or scams, please see our online reporting form.
We also offer tips to avoid insurance scams, starting with the old-but-true advice that if it sounds too good to be true, it probably is.
We also have some tips on how to identify and report Medicare fraud and abuse, such as being billed for services you didn't receive.
To report insurance fraud or scams, please see our online reporting form.
We also offer tips to avoid insurance scams, starting with the old-but-true advice that if it sounds too good to be true, it probably is.
We also have some tips on how to identify and report Medicare fraud and abuse, such as being billed for services you didn't receive.
Rabu, 09 Oktober 2013
I know the new health subsidies are based on your household income, but how do they define 'household'?
“Household” only includes you, your spouse, and anyone you can legally claim as a dependent on your tax return.
It generally wouldn’t include a non-marital relationship (such as a boyfriend or girlfriend), except under very limited circumstances.
To get more details, see page 16 of the IRS instructions for filling out Form 1040 or call the IRS (after the government shutdown ends) at 1-800-829-1040.
Selasa, 08 Oktober 2013
When your insurance renews, remember to look at the statement
When you get a new insurance policy or your current policy renews, be sure to review the statement. You need to be sure that you're getting the type and level of coverage you asked for.
Most people simply file away the information -- or toss it. But take a few minutes to look it over first. You really don't want to find out after the fact that a) you were paying for coverage you didn't want or need, or b) worse, that you didn't have coverage for something important.
If you see something that doesn't look correct, contact your agent or insurer immediately, before a loss occurs. If you wait until afterward, you'll likely be stuck with whatever coverage was in force at the time of the loss.
It's also a good idea to periodically review your coverage with your agent or insurer. You may want to add or eliminate coverage as changes occur in your life situation.
Jumat, 04 Oktober 2013
Hole-in-one insurer pleads guilty to three felonies
Kevin Kolenda, a Connecticut businessman who insurers golf tournament hole-in-one prizes but has a history of not paying, pleaded guilty today in King County Superior Court to two counts of selling insurance without a license and one count of first-degree theft.
Kolenda started Golf Marketing in 1995 and sold hole-in-one insurance coverage to charity golf tournaments across the country including in Washington state. He repeatedly failed to pay winning golfers, leaving charities to come up with the prize money. To skirt prosecution, he also changed the name of his business several times.
Other states where Kolenda sold bogus insurance including: Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.
Kolenda paid $10,000 in restitution today. He will pay another $5,000 in four months, when he returns to Seattle for sentencing.
Kolenda started Golf Marketing in 1995 and sold hole-in-one insurance coverage to charity golf tournaments across the country including in Washington state. He repeatedly failed to pay winning golfers, leaving charities to come up with the prize money. To skirt prosecution, he also changed the name of his business several times.
Other states where Kolenda sold bogus insurance including: Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.
Kolenda paid $10,000 in restitution today. He will pay another $5,000 in four months, when he returns to Seattle for sentencing.
Kamis, 03 Oktober 2013
What to do if your Medicare Advantage plan is going away
Medicare open enrollment starts Oct. 15. Some people may have already received a notice saying their Medicare Advantage plan is going away. If you or someone you know has received a notice, here's some steps to take:
Need more help? Contact our free Statewide Health Insurance Benefits Advisors (SHIBA), They can help your evaluate and compare plans.
- Check with your medical providers and find out what Medicare Advantage plans they accept in 2014.
- Read about your rights
- Avoid a gap in coverage by selecting a new plan before Dec. 31
- If you can't decide between a Medicare Advantage plan or returning to Original Medicare, see page 59 of the Medicare and You 2014 booklet for help
Need more help? Contact our free Statewide Health Insurance Benefits Advisors (SHIBA), They can help your evaluate and compare plans.
Rabu, 02 Oktober 2013
WAhealthplanfinder will be down tonight for system improvements
Washington's Exchange - the Wahealthplanfinder.org - is up and running, but some people are still experiencing slow loading times and difficulty submitting their applications. The Exchange is taking the website down tonight starting at 10 p.m. until 6 a.m. tomorrow morning to work on system improvements. Want an update on their progress? Check www.wahbexchange.org often.
I hear new health plans must meet 'actuarial value' standards - what's that mean?
All individual and small employer health plans sold inside and outside the new Health Benefit Exchange - Wahealthplanfinder.org - must have an actuarial value of at least 60 percent.
This means the plan must pay for least 60 percent of your medical costs for essential health benefits. Sixty percent is the standard for the new 'bronze level' plans. You also can choose from a silver level or gold metal level plan. Silver plans pay for 70 percent of your costs and gold pay for 80 percent.
Here's answers to additional questions about how the new 'actuarial value' works:
This means the plan must pay for least 60 percent of your medical costs for essential health benefits. Sixty percent is the standard for the new 'bronze level' plans. You also can choose from a silver level or gold metal level plan. Silver plans pay for 70 percent of your costs and gold pay for 80 percent.
Here's answers to additional questions about how the new 'actuarial value' works:
If my plan has an actuarial value of 70 percent does that mean I will not have to pay more than 30 percent of my entire insurance costs?
No, the actuarial value is only based on the level of coverage the plan provides for essential health benefits. If your plan has an actuarial value of 60 percent, for example, that means that the plan will pay 60 percent of your covered expenses for essential health benefits and you pay 40 percent of the covered expenses for essential health benefits.
Although the actuarial value of your covered expenses for essential health benefits will be covered, you may have other costs such as deductibles, copays and coinsurance, as well as costs for services that are excluded or are not covered benefits. Make sure you read your policy to see what services are excluded services. Benefits that are not covered would be subject to the terms of your insurance policy, so it is important to read your policy before getting the service or treatment.
What are essential health benefits? As of Jan. 1, 2014, all individual and small employer health plans must cover these 10 benefits: - ambulatory patient services
- emergency services
- hospitalization
- maternity and newborn car
- mental health and substance use disorder services including behavioral health treatment
- prescription drugs
- rehabilitative and habilitative services and devices
- laboratory services
- preventive and wellness services, chronic disease management
- pediatric services ‐ including oral and vision care
Selasa, 01 Oktober 2013
Washington's Healthplanfinder now up and running
After a few hours of technical difficulties earlier today, Wahealthplanfinder.org is now up and running. There may be a few more glitches as additional issues are fixed, so if you're filling out an application, be sure to save your information. Also, the website will be down temporarily tonight at 8 p.m.
Eight health insurers have been approved to sell 46 different plans inside the Exchange. Remember, the Exchange is the only place you can go to receive federal tax subsidies to help lower your monthly premium - and there's only one official Exchange for our state - www.wahealthplanfinder.org.
If you earn more than the cut-off for a subsidy (about $46,000 for an individual and $94,200 for a family of four), you also can shop for insurance outside the Exchange. To see all of the plans available in your county - both inside and outside the new Exchange - check out this map.
Eight health insurers have been approved to sell 46 different plans inside the Exchange. Remember, the Exchange is the only place you can go to receive federal tax subsidies to help lower your monthly premium - and there's only one official Exchange for our state - www.wahealthplanfinder.org.
If you earn more than the cut-off for a subsidy (about $46,000 for an individual and $94,200 for a family of four), you also can shop for insurance outside the Exchange. To see all of the plans available in your county - both inside and outside the new Exchange - check out this map.
Senin, 30 September 2013
Five things you should know about flood insurance
1) Your homeowners policy doesn't cover floods. Flood damage is not a covered peril on standard homeowners policies and most commercial policies, although many people assume that it is. That can be a costly assumption.
2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."
3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")
4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.
5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.
2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."
3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")
4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.
5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.
Rabu, 25 September 2013
We're looking for a communications and social media manager
Please help us spread the word - do you know a communications expert who's looking for a new challenge? We're currently recruiting for a Public Affairs Communications and Social Media Manager.
This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.
Here's the full job announcement. Please share with anyone you think might be interested.
We're taking applications through Oct.8.
This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.
Here's the full job announcement. Please share with anyone you think might be interested.
We're taking applications through Oct.8.
How to contact Washington's Health Benefits Exchange
The Healthplanfinder can also help you find other people -- a broker in your local community, say, or a nearby in-person assister -- to help you through the process. Click on the link or image above to find out more.
Jumat, 20 September 2013
"I'm on Medicare Part A and B. I want to drop Part B and buy a health plan through the Exchange so that I can get a subsidy"
Don't do it.
That's worth saying again: Do Not Do This.
Here's why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you're eligible for Medicare and will drop you.
Then, if you go back onto Medicare Part B, you'll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B.
And that's not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)
That's worth saying again: Do Not Do This.
Here's why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you're eligible for Medicare and will drop you.
Then, if you go back onto Medicare Part B, you'll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B.
And that's not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)
Rabu, 18 September 2013
"I just got a letter from my insurer saying that I have to switch health plans because of Obamacare. What can I do?"
Tens of thousands of Washingtonians are -- or will be soon -- getting letters from their health insurers telling them that their plans are going away and that they'll need to pick a new one.
In some cases, those benefits mean that the premiums for the new plans will cost more, or that deductibles will be higher.
So what can you do?
1) Remember that as part of health care reform, many consumers will now qualify for subsidies to help offset costs. If your household income is less than 400 percent of the federal poverty level (e.g. $62,040 for a family of two, or $94,200 for a family of four), you may qualify for those subsidies. Also, expanded Medicaid coverage will be available -- for free -- for households that are at less than 138 percent of the federal poverty level ($21,404 for a family of two).
In other to get the subsidy, which is technically a tax credit, you would need to buy your health coverage through the Washington Health Benefit Exchange. Enrollment begins Oct. 1, with coverage starting Jan. 1, 2014. Here's a map with links to the rates for health insurance in the Exchange.
2) Shop around for a better deal. You do not need to stay with the insurance company you're with now, although that fact isn't necessarily trumpeted by the insurers in the letters they're sending out. So go on the Exchange -- you can still shop there, even if you don't qualify for a subsidy -- or check with a broker to see what else is available, and what it costs.
What if you have a pre-existing condition and have been turned down for health coverage in the past? It no longer matters. As part of health care reform, insurers must take all applicants. No more health screenings or questionnaires.
3) Remember that the premium is only part of the cost of insurance, particularly if you use the coverage. Your actual out of pocket costs are determined by how much of a deductible you have to meet, how much the co-pays or coinsurance charges are, what drugs are covered, etc. We calculate, for example, that the preventive care included in these policies without any copays, etc. is worth about $500.
"In order to comply with the new health care law, your current health plan will be discontinued on Dec. 31, 2013," reads one of the letters, which are being sent out by about half a dozen insurers. "But don't worry. You have lots of options."What's going on? Under health care reform, each health plan has to cover 10 essential benefits. Some of those benefits -- such as prescription drug coverage -- aren't included in many health individual health plans today. The new plans also have to include numerous preventive services, and meet standards for what they'll cover.
In some cases, those benefits mean that the premiums for the new plans will cost more, or that deductibles will be higher.
So what can you do?
1) Remember that as part of health care reform, many consumers will now qualify for subsidies to help offset costs. If your household income is less than 400 percent of the federal poverty level (e.g. $62,040 for a family of two, or $94,200 for a family of four), you may qualify for those subsidies. Also, expanded Medicaid coverage will be available -- for free -- for households that are at less than 138 percent of the federal poverty level ($21,404 for a family of two).
In other to get the subsidy, which is technically a tax credit, you would need to buy your health coverage through the Washington Health Benefit Exchange. Enrollment begins Oct. 1, with coverage starting Jan. 1, 2014. Here's a map with links to the rates for health insurance in the Exchange.
2) Shop around for a better deal. You do not need to stay with the insurance company you're with now, although that fact isn't necessarily trumpeted by the insurers in the letters they're sending out. So go on the Exchange -- you can still shop there, even if you don't qualify for a subsidy -- or check with a broker to see what else is available, and what it costs.
What if you have a pre-existing condition and have been turned down for health coverage in the past? It no longer matters. As part of health care reform, insurers must take all applicants. No more health screenings or questionnaires.
3) Remember that the premium is only part of the cost of insurance, particularly if you use the coverage. Your actual out of pocket costs are determined by how much of a deductible you have to meet, how much the co-pays or coinsurance charges are, what drugs are covered, etc. We calculate, for example, that the preventive care included in these policies without any copays, etc. is worth about $500.
"I was turned down for life insurance due to my health. Does this mean I can't get life insurance at all?"
Not necessarily. Different life insurers have different underwriting standards, so another company might insure someone with your health condition.
So try a different company, or try going through a broker, who might know more about which companies might be the best match for your individual situation.
Also, it's a good idea to check with your employer. Some employers offer some life insurance coverage (say $25,000 or $50,000) to their employees without requiring employees to answer health questions.
So try a different company, or try going through a broker, who might know more about which companies might be the best match for your individual situation.
Also, it's a good idea to check with your employer. Some employers offer some life insurance coverage (say $25,000 or $50,000) to their employees without requiring employees to answer health questions.
Selasa, 17 September 2013
Pierce County man charged with insurance fraud and attempted theft
A University Place man, Leandre Garner, has been charged by the attorney general's office with felony insurance fraud and second-degree attempted theft for filing a bogus claim with State Farm.
On Nov. 8, 2012, Garner got coverage online with the company for his 2007 Chrysler 300. Prior to that date, the vehicle was uninsured.
On Nov. 9, 2012, Garner said, he returned home from an appointment and discovered that his car had been hit by an unknown vehicle. The damage was estimated at $4,339. Garner filed a claim.
The problem: half a dozen people subsequently told investigators from State Farm and our Special Investigations Unit that Garner's car was damaged well before November. His ex-girlfriend said it happened around September, not November. A nearby tenant, an apartment office worker and an apartment groundskeeper also said the accident happened well before Nov. 8. So did the body shop that did the estimate.
Asked if he'd taken photos of the damage, Garner showed a State Farm investigator cell phone images he'd taken. He was surprised when the investigator pointed out that the metadata embedded in the images showed that they'd been taken Sept. 19, 2012.
When asked about this, Garner said that the must be a problem with the phone.
Arraignment is scheduled for Pierce County Superior Court on Sept. 24, 2013.
On Nov. 8, 2012, Garner got coverage online with the company for his 2007 Chrysler 300. Prior to that date, the vehicle was uninsured.
On Nov. 9, 2012, Garner said, he returned home from an appointment and discovered that his car had been hit by an unknown vehicle. The damage was estimated at $4,339. Garner filed a claim.
The problem: half a dozen people subsequently told investigators from State Farm and our Special Investigations Unit that Garner's car was damaged well before November. His ex-girlfriend said it happened around September, not November. A nearby tenant, an apartment office worker and an apartment groundskeeper also said the accident happened well before Nov. 8. So did the body shop that did the estimate.
Asked if he'd taken photos of the damage, Garner showed a State Farm investigator cell phone images he'd taken. He was surprised when the investigator pointed out that the metadata embedded in the images showed that they'd been taken Sept. 19, 2012.
When asked about this, Garner said that the must be a problem with the phone.
Arraignment is scheduled for Pierce County Superior Court on Sept. 24, 2013.
Senin, 16 September 2013
"I heard I can keep my adult child on my health insurance until age 26. But do I have to?"
Q: I heard I can keep my adult children on my health insurance until they turn 26. But what if I don't want to?
A: Then don't. Health care reform permits -- but doesn't require -- parents to keep their adult children on the parent's health plan up to age 26, unless the children have coverage through their own employer.
That said, you may want to provide coverage if you can afford it. No one is immune from bad luck, and rates for medical care when a person has no insurance can be very high indeed.
Also: if your child doesn't have a job or has a job that doesn't offer health coverage, you may be able to extend your coverage to him/her more cheaply than they could buy an individual policy on their own.
A: Then don't. Health care reform permits -- but doesn't require -- parents to keep their adult children on the parent's health plan up to age 26, unless the children have coverage through their own employer.
That said, you may want to provide coverage if you can afford it. No one is immune from bad luck, and rates for medical care when a person has no insurance can be very high indeed.
Also: if your child doesn't have a job or has a job that doesn't offer health coverage, you may be able to extend your coverage to him/her more cheaply than they could buy an individual policy on their own.
Rabu, 11 September 2013
Woman who pretended to be employer in lost-wage claim pleads guilty to insurance fraud
A woman who pretended to be an employer to help her son allegedly file a fake lost-wages insurance claim has pleaded guilty to insurance fraud.
Sherryl Rose Brongil pleaded guilty on Monday in King County Superior Court to one count of insurance fraud.
According to an investigation by State Farm and our Special Investigations Unit, Brongil's son, Larry Kwant, was accelerating out of a parking lot in her Cadillac when he lost control of the car and caused $26,000 in damage to it. He filed a claim, including 23 days of lost wages at $25 an hour. The form was signed by a "Linda Lee."
Linda Lee turned out to be Sherryl Brongil. Not only did she sign the form, purportedly showing that her son had worked at a company where he'd never worked. She'd also pretended to be administrative assistant "Linda Lee" when contacted by a claims adjuster.
She was sentenced to three months in jail.
As for Kwant, he's been charged with insurance fraud and identity theft.
Sherryl Rose Brongil pleaded guilty on Monday in King County Superior Court to one count of insurance fraud.
According to an investigation by State Farm and our Special Investigations Unit, Brongil's son, Larry Kwant, was accelerating out of a parking lot in her Cadillac when he lost control of the car and caused $26,000 in damage to it. He filed a claim, including 23 days of lost wages at $25 an hour. The form was signed by a "Linda Lee."
Linda Lee turned out to be Sherryl Brongil. Not only did she sign the form, purportedly showing that her son had worked at a company where he'd never worked. She'd also pretended to be administrative assistant "Linda Lee" when contacted by a claims adjuster.
She was sentenced to three months in jail.
As for Kwant, he's been charged with insurance fraud and identity theft.
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