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Frequently Asked Questions
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What is Medicare Advantage Dual?A Medicare Advantage Dual plan is a type of Medicare Advantage plan that is specifically designed for people who are eligible for both Medicare and Medicaid. These plans are also known as "dual eligible special needs plans" or "SNPs". Medicare Advantage Dual plans are required to provide the same level of hospital and medical coverage as Original Medicare (Medicare Part A and Part B), but they may also offer additional benefits such as coverage for prescription drugs, vision, hearing, and dental services. These plans are typically offered by private insurance companies that contract with Medicare to provide these benefits to eligible beneficiaries. Medicare Advantage Dual plans are available to people who are eligible for both Medicare and Medicaid due to a disability, being aged 65 or older, or having end-stage renal disease (ESRD). These plans are designed to provide coordinated care and additional benefits to help meet the needs of dual eligible beneficiaries.
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What is Medicare?Medicare is a health insurance program for people age 65 and older, people under 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant). Medicare is run by the government and is divided into four parts: Part A, Part B, Part C, and Part D. Part A covers hospital stays, including inpatient care and some home health care services. Part B covers medical services and supplies, such as doctor visits and preventive care. Part C, also known as Medicare Advantage, is an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies and are approved by Medicare. Part D covers prescription drugs. Together, these four parts of Medicare help cover a wide range of healthcare services and supplies.
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What does Medicare Advantage Cover?Medicare Advantage plans (also known as Medicare Part C) are private insurance plans that are approved by Medicare and are an alternative way to receive your Medicare benefits. These plans provide all the same hospital and medical coverage as Original Medicare (Medicare Part A and Part B), but they may also offer additional benefits such as: - Prescription drugs - Vision - Hearing - Deental services. Some Medicare Advantage plans may also offer home health care, transportation to medical appointments, and wellness programs. Each Medicare Advantage plan is different, so it's important to review the specific coverage and benefits offered by the plan you're considering. You can use the Medicare Plan Finder tool on the Medicare website to compare different Medicare Advantage plans available in your area and see which ones might be a good fit for you.
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What does Medicare Part B Cover?One important part of Medicare is Medicare Part B, which covers a wide range of medical services and supplies that are deemed medically necessary. Some of the things that Medicare Part B covers include: Doctor's visits Laboratory services Durable medical equipment (like wheelchairs and walkers) Mental health services Outpatient hospital care So if you need to visit the doctor or need medical equipment to help you get around, Medicare Part B can help you. And with Medicare Solutions on your side, you can feel confident that you're getting the best coverage for your needs. So don't stress about navigating the complicated world of healthcare - let Medicare Solutions take the wheel and steer you towards the coverage you deserve!
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What is Open Enrollment?Open enrollment is the period of time each year when individuals who are enrolled in Medicare or Medicare Advantage can make changes to their coverage. During open enrollment, individuals can switch from Original Medicare to a Medicare Advantage plan, or vice versa, and they can also switch between different Medicare Advantage plans or prescription drug plans.
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What is Medicare Advantage?Medicare Advantage, also known as Medicare Part C, is a type of Medicare health plan offered by private insurance companies. It provides the same coverage as Original Medicare (Part A and Part B) and often includes additional benefits such as prescription drug coverage, routine dental and vision care, and even fitness memberships. With Medicare Advantage, you have the flexibility to choose from a variety of plan options to find the one that best fits your needs and budget. And with the added benefits, you can save money on out-of-pocket costs and have peace of mind knowing you have comprehensive coverage.
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What does Medicare Part A Cover?Medicare Part A covers a variety of inpatient medical services, including: Inpatient hospital stays Inpatient care in a skilled nursing facility (not custodial or long-term care) Hospice care Home health care (if medically necessary and ordered by a doctor) Part A is primarily designed to cover the cost of medical treatment and care that requires a person to be admitted to a hospital or other inpatient facility. It helps to pay for things like a private room, meals, nursing care, and other hospital services and supplies. It's important to note that Part A has a deductible that must be met before coverage begins, and beneficiaries are generally responsible for paying a portion of the cost of the covered services and supplies, known as the coinsurance or copayment. Part A is premium-free for most people, meaning that most people do not have to pay a monthly premium to have this coverage. However, if you do not qualify for premium-free Part A, you may be required to pay a premium for this coverage.
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What is Special Event Period?Special Enrollment Periods (SEP), also know as Special circumstances, is a specific time frame during which individuals who are eligible for Medicare can enroll in or make changes to their coverage outside of the regular enrollment period. SEPs are typically triggered by certain life events, such as moving to a new area, losing employer coverage, or qualifying for Medicaid. Individuals who qualify for a SEP have a limited amount of time to enroll in or make changes to their coverage, so it's important to be aware of the specific guidelines and deadlines for each SEP.
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Who to Include in Your HouseholdTax filer + spouse + tax dependents = household Follow these basic rules when including members of your household: Include your spouse if you’re legally married. If you plan to claim someone as a tax dependent for the year you want coverage, do include them on your application. If you won’t claim them as a tax dependent, don’t include them. Include your spouse and tax dependents even if they don’t need health coverage. See the limited exceptions to these basic rules in the chart below. Learn more about who you can claim as a tax dependent from the IRS. Information retrieved from https://www.healthcare.gov/
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Who can shop on GCNJ?Get Covered New Jersey is a source of affordable health insurance for New Jersey residents who do not have health coverage from their employer or access to other health care programs. Financial help is available to help lower the cost of premiums and out-of-pocket costs for those who qualify. Get Covered New Jersey can also help residents to learn if they qualify for NJ FamilyCare, New Jersey’s publicly funded health insurance program. Individuals who are not eligible to buy health insurance through Get Covered New Jersey can still apply for other members of their household who are eligible. For example, parents who are not lawfully present can still enroll their children in health insurance through Get Covered New Jersey if their chil-dren are eligible.
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What are GCNJ Metal Tiers?Get Covered NJ uses metal tiers to categorize the different health insurance plans available through the Affordable Care Act (ACA) marketplace. The four metal tiers are: Bronze: These plans have the lowest monthly premiums, but the highest out-of-pocket costs when you receive care. Silver: These plans have slightly higher monthly premiums than Bronze plans, but lower out-of-pocket costs. Gold: These plans have higher monthly premiums than Silver plans, but the lowest out-of-pocket costs when you receive care. Platinum: These plans have the highest monthly premiums, but the lowest out-of-pocket costs when you receive care. The metal tier system is intended to help people understand the trade-offs between monthly costs and out-of-pocket costs, so they can find a plan that fits their budget and healthcare needs.
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If I have a pre-existing health condition, will I be denied coverage or pay more for my premium?No. A pre-existing condition will not keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition. Once you have insurance, the plan can’t refuse to cover treatment for pre-existing conditions.
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What do I need to enroll in GCNJ?You will need the following information for yourself and anyone in your household applying for cover-age: Birth dates Social Security numbers Home and/or mailing addresses Document information for legal immigrants, if applicable Your best estimate of what your household income will be (Current year) Policy numbers for any current health plans covering members of your household Employer and income information for every member of your household (for example, pay stubs or W-2 forms)
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What is Get Covered NJ?Get Covered NJ (GCNJ) is a program that helps people in New Jersey find and enroll in health insurance plans. It provides information and tools to make the process of finding and enrolling in a plan easier, and also gives you access to in-person assistance and events to help you understand your options. The program is useful because it helps people in New Jersey find health insurance that they can afford, which is important for staying healthy and financially secure.
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Is there financial help available to lower the cost of my plan?Nearly 8 in 10 New Jerseyans purchasing coverage on the marketplace will qualify for financial help to lower the cost of their plan. In New Jersey, a family of four earning up to about $104,800 a year and an individual earning up to about $51,040 a year can qualify for financial assistance. You can browse plans now and see if you may qualify for help. It takes only a minute to check and it is free. You may qualify for: premium tax credits, cost-sharing reductions and NJ Health Plan Savings, a new state subsidy offered by the state of New Jersey. Premium tax credits and the state subsidy help lower your monthly premium payments. Cost-sharing reductions help lower your out-of-pocket costs like deductibles and co-pays for doctor visits.
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Who is Eligible for Medicaid?In general, an individual must have a low income and few assets to qualify for Medicaid. The specific income and asset limits vary depending on the individual's household size and other factors, but in general, an individual must have an income that is below 138% of the federal poverty level to be eligible for Medicaid in New Jersey. Individuals must also be a resident of the state and a U.S. citizen or qualified non-citizen, and must not be eligible for Medicare or other health coverage.
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What is the Income and Household Size?Children under 19 are eligible with higher incomes up to 355% of the Federal Poverty Level (FPL) ($8,210/month for a family of four). Parents still need to renew the coverage each year. Children can qualify regardless of their immigration status. Adults age 19-64 with income up to 138% FPL ($1,563/month for a single person and $2,106/month for a couple). Immigrant adults must have Legal Permanent Resident status in the US for at least five years in order to be eligible for NJ FamilyCare. Some immigrant adults can be eligible if they are lawfully present, regardless of when they entered the US. Examples are refugees and asylees, and there are others. Immigrants age 19 and 20 who are lawfully present and have very low income ($509/month for a single person and $805/month for a family of 2) can also be eligible. Pregnant people up to 205% FPL ($4,741/month for a family of four). Pregnant people who are lawfully admitted can be eligible even if they have lived in this country fewer than five years. People over 65, blind or permanently disabled, including long term care click here.
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What is Medicaid?Medicaid is a government program that provides health insurance to low-income individuals and families. Medicaid in New Jersey covers a wide range of services, including hospital stays, doctor visits, and prescription drugs, as well as other services such as dental care and mental health treatment. To be eligible for Medicaid in New Jersey, an individual must meet certain income and asset limits, as well as other criteria set by the state.
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What is the Open Enrollment For Medicaid?Open enrollment for Medicaid in the state of New Jersey is year-round, which means that individuals can apply for Medicaid at any time. However, there may be certain limited enrollment periods during which individuals who are already enrolled in Medicaid can make changes to their coverage, such as switching to a different Medicaid plan or adding or dropping coverage for certain benefits.
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What is Form 1095-B, Health Coverage?Form 1095-B is a tax document used to report information about an individual's health coverage to the Internal Revenue Service (IRS) and to the individual. This form includes details on the type and length of coverage during a tax year, and helps determine if the individual had the required minimum essential coverage under the Affordable Care Act (ACA). Employers, insurance companies, and other providers of minimum essential coverage are responsible for issuing and filing Form 1095-B with the IRS. Form 1095-B is an important document that you should keep with your tax records. Here are a few things you should do with the form: • Verify its accuracy: Ensure the information on the Form 1095-B is correct. If there are any inaccuracies, contact the number on the form to have them corrected. • Use it for tax return purposes: When you file your federal income tax return, you will need to provide information from the Form 1095-B, including whether you had minimum essential health coverage and if you were eligible for employer-sponsored coverage. • Keep it for your records: You should keep the form with your tax records for at least three years in case the IRS needs to verify your health coverage information. • Maintain it for future reference: You should store Form 1095-B with your other important tax documents for potential future reference. Note: If you received Form 1095-B from your employer or insurance company, you do not need to attach it to your tax return. However, you may need to provide information from the form when you file your taxes. If you have questions about how to use the form or what to do with it, you should consult with a tax professional or the IRS.
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What is Form 1095-A, Health Insurance Marketplace Statement?Form 1095-A is a tax form used to report information about individuals who enrolled in a health insurance marketplace and received financial assistance in the form of premium tax credits. In New Jersey, if you enrolled in a health insurance plan through the marketplace and received a premium tax credit, you should receive a Form 1095-A from the marketplace. The form provides information about the coverage you had during the year, the monthly premium for that coverage, and the amount of financial assistance you received. You'll use this information when you file your taxes to reconcile the premium tax credit you received with the actual premium tax credit you're eligible for based on your income. Form 1095-A is an important document that you should keep with your tax records. Here are a few things you should do with the form: Verify its accuracy: Ensure the information on the Form 1095-A is correct. If there are any inaccuracies, contact the number on the form to have them corrected. Use it for tax return purposes: When you file your federal income tax return, you will need to provide information from the Form 1095-A, including whether you had minimum essential health coverage and if you were eligible for employer-sponsored coverage. Keep it for your records: You should keep the form with your tax records for at least three years in case the IRS needs to verify your health coverage information. Maintain it for future reference: You should store Form 1095-A with your other important tax documents for potential future reference.
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What is Form 1095-C, Employer-Provided Health Insurance Offer and Coverage?Form 1095-C is a tax form that provides information about employer-sponsored health insurance coverage to both the employee and the Internal Revenue Service (IRS). Employers with 50 or more full-time employees must supply this form annually to their employees, indicating the details of the health insurance coverage offered, including the months the employee was eligible for coverage. Employees use the information to determine their eligibility for the premium tax credit, which can assist in paying for health insurance purchased through the marketplace. Form 1095-C is an important document that you should keep with your tax records. Here are a few things you should do with the form: • Verify its accuracy: Ensure the information on the Form 1095-C is correct. If there are any inaccuracies, contact your employer to have them corrected. • Use it for tax return purposes: When you file your federal income tax return, you will need to provide information from the Form 1095-C, including whether you had minimum essential health coverage and if you were eligible for employer-sponsored coverage. • Keep it for your records: You should keep the form with your tax records for at least three years in case the IRS needs to verify your health coverage information. • Maintain it for future reference: You should store Form 1095-C with your other important tax documents for potential future reference. Note: If you do not receive Form 1095-C and believe you should have, reach out to your employer for additional information.
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