The

SMP NJ Advocate Issue #5 3/28/2013

New Jersey Advocate

When key parts of the health care law take effect in 2014, therell be a new way to get health insurance: the Health Insurance Marketplace. The Marketplace is designed to help you find affordable health insurance. Every health insurance plan in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare your insurance options based on price, benefits, quality, and other features that may be important to you. This October, youll be able to get information about all the plans available in your geographic area. Youll be able to enroll yourself, directly through the website, or call a toll-free telephone hotline. If you have difficulty finding a plan that meets your needs and budget, therell be navigators available to give you personalized help with your choices. Navigators arent associated with any particular plan, and they arent on any type of commission, so the help they offer will be completely unbiased, similar to State Health Insurance Assistance Programs (SHIP) counselors. These insurances, sold through the Marketplace, will have certain consumer protections, which include: Guaranteed Availability. Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because he or she has or had an illness. Fair Health Insurance Premiums. Health insurance companies offering coverage to individuals and small employers will be allowed to vary premiums based on only age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims,

Health Insurance Marketplace

SMP of New Jersey Advisory Committee

Daniel Breeman Communications Specialist Healthcare Quality Stratetgies Edward S. Campell, O.D. SMP NJ Volunteer Charles Clarkson, Esq. SMP NJ Project Director Grace Egan Executive Director NJ Foundation for Aging Rita Harris Manager Business Development VNA Health Group Eric M. Joice Executive Director The Family Resource Network Jean M. Kelahan, R.D. CDR, U.S. Public Health Service Regional External Affairs, Region II Centers for Medicare & Medicaid Services

gender, occupation, length of time having a policy, and size of the small employer. Guaranteed Renewability. Health insurance companies can no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option. Single Risk Pool. Health insurance companies will no longer be able to charge higher premiums to higher-cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single statewide risk pool for the individual market and a single statewide risk pool for the smallgroup market. Catastrophic Plans. Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally have lower premiums, protect against high out-ofpocket costs, and cover recommended preventive services without cost sharing. Lifetime and Annual Limits. The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also restricts the annual dollar limits a health plan can place on most of your benefits and does away with these limits entirely in 2014. The Affordable Care Act also fills in gaps in coverage for the poorest Americans by giving states the option to expand Medicaid to individuals under 65 years of age with incomes below 133% of the federal poverty level (approximately $14,000 for an individual and $29,000 for a family of four) beginning in January 2014. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. In addition, Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the Marketplace. For in-depth information about the Affordable Care Act check out www.healthcare.gov.
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Mary McGeary John Krayniak Assistant Attorney General Antitrust Section, Division of Criminal Justice State of New Jersey Sara Levine Executive Director Jewish Family and Vocational Service of Middlesex County Mary McGeary Director SHIP State Health Insurance Assistance Programs NJ Division of Aging Services Dennis J. McGowan Public Awareness Coordinator NJ Division of Aging Services Barbara ONeill, Ph.D. Extension Specialist Financial Resource Management, Professor II Rutgers Cooperative Extension Dr. Harry M. Paraison, MPA Executive Director DH/Perfil Latino TV, Inc. Maureen A. Ruane, Esq. c/o United States Attorneys Office Michael T. Ruane Executive Director Monmouth County Division on Aging Disabilities & Veterans Services Ken Wessel Executive Director HomeCare Options Coordinator NJ Division of Aging Services Executive Director DH/Perfil Latino TV, Inc. Maureen A. Ruane, Esq. c/o United States Attorneys Office Michael T. Ruane Executive Director Monmouth County Division on Aging

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Ask Charles
1. What is the difference between observation status and inpatient status, and why is it important? In simple terms, a patient who is on observation status is in a hospital setting and is being observed to determine if that patient should be admitted as an in-patient or discharged. Under Medicare, a patient can be receiving in-patient services, i.e., is in a hospital bed, being fed and receiving standard hospital treatment, even though that patient is considered on observation status. Its important to know your status. If you are discharged from a hospital and your doctor recommends therapy (such as physical or occupational therapy for your condition), Medicare will pay for therapy (100% for the first 21 days) if you have been an in-patient for 3 days, not including the day of discharge. If your doctor or hospital has listed you on observation status, notwithstanding that you have been in the hospital for over 3 days, you will not qualify for therapy under the Medicare rules and will be fully responsible to pay for these services. 2. As a retiree who is not receiving any continuing medical benefits, when can I enroll in Medicare? If you didnt sign up for Part A and/or Part B when you were first eligible because you were covered by your employer or your spouses employer, you can sign up (i) anytime youre covered by your employer or your spouses employer or (ii) during the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first. Also, every year there is a General Enrollment Period that runs from January 1 through March 31. Remember that if you dont enroll in Medicare when you are first eligible and dont have a special enrollment period, as stated above, you may be subject to a late-enrollment penalty for Part B.

Senior Medicare Patrol of New Jersey

Charles Clarkson, Esq. Project Director Ext. 1117 Email: CharlesC@jfvs.org Joanne Bartosik Coordinator of Volunteers Ext. 1154 Email: JoanneB@jfvs.org Tunde Akinrolabu Outreach Specialist Ext. 1110 Email: TundeA@jfvs.org Antonio Goyanes Hispanic Outreach Specialist Ext. 1152 Email: AntonioG@jfvs.org Francesca Seborowski Administrative Assistant Ext. 1157 Email: FrancescaS@jfvs.org Molly J. Liskow SMP NJ Volunteer Editor, The SMP New Jersey Advocate Email: SMP@jfvs.org [Editor's note: Bill Swift will be taking a hiatus from writing for The Advocate while he pursues other volunteer work with the SMP. Bill reports it has been a pleasure and a privilege to work on the first several issues of The Advocate.]

Volunteer Spotlight Richard Satyavan

The volunteer spotlight shines on Richard Satyavan in this issue of The Advocate. Richard comes to SMP with a wealth of knowledge from his extensive work history in engineering and information technology. He was already very active in his volunteer work before approaching Joanne about volunteering for the SMP, as he is a tax counselor with the AARP tax volunteer program and a trained and certified SHIP counselor. He has now added the role of SMP volunteer! When asked about his three volunteer activities, Richard was modest, but he stated, "in volunteering, I think you have to have three important qualifications passion, passion and passion! You have to have a passion for listening to people, a passion for analyzing what they tell you, and a passion for communicating your analysis to them in a way that people can understand and accept." Richard's background would seem to give him the qualifications needed to fulfill these three challenging roles. An engineer by training in his native India, Richard did additional post-graduate work in computer science and information systems. He spent his early career in India working on information systems development with major companies. Richard emigrated to the United States from India in 1980, and he continued to work with and consult for major US corporations, such as Johnson & Johnson and IBM. He also established his own company and employed staff to consult with major clients in information technology. Middlesex County residents, Richard and his wife are the proud parents of two daughters and grandparents of six grandchildren! Richard explained that his range of volunteer activities happened in a natural and satisfying progression. He became aware of the AARP Tax program, and he enjoyed working with retirees on their tax problems during the income tax season. He was looking for an opportunity for after tax season, and he found the SHIP program. He attended training, and he began seeing people in senior centers through the SHIP program and helping them to enroll in Medicare and/or Medicaid. When his SHIP clients then came back to him with problems and questions, he followed his SHIP training and referred them to SMP. That led him to volunteer with the SMP, so he could help people on Medicare with their questions and problems. Richard now feels that he is a "one stop shop" in that he can help people file their taxes, guide them to Medicare or Medicaid, and then, if they have problems or questions with Medicare, use his SMP training to assist or refer them. Richard feels that he has gotten a great deal from his volunteer work. He states, "I have gotten as much or more from the people I have counseled and the other volunteers I have worked with as I have given. I have met a marvelous range of people, and I feel fortunate to have had the opportunity to assist them and I learn much from them." Richard is a delightful and charming person who quietly "gives back" to his community on a daily basis. The SMP is fortunate to have his willing and able assistance.

Senior Medicare Patrol (SMP) New Jersey is a program of: Jewish Family and Vocational Service of Middlesex County 32 Ford Avenue, Second Floor Milltown, NJ 08850 Tel. 732-777-1940 Fax 732-777-1889 SMP NJ Toll Free Hotline 877-SMP-4359 www.JFVS.org Email: SMP@jfvs.org

Funded by the U.S. Administration for Community Living, Administration on Aging, Washington, D.C.