THOMAS SHRETT, JOHN ALLEN CASH, KYLE IVERSON
My husband is on Medicare with a supplement through Blue Shield. He is very sick and needs medical and personal supplies every month. I wanted to see if these supplies were included in his plan.
When I called Blue Shield they told me that we would have to change his supplement plan to an advantage plan in order for them to be covered. I didn’t want to write it down for anything until I got back to you. What gives?
Kyle: One of the big differences between a supplement and a benefit plan is that with a supplement, the bill goes to Medicare first and then to the insurance company; with an Advantage plan, the account remains “internal”. In addition to the drug plan, many benefit plans include “extras” such as dental, vision, hearing, etc.
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Tom: Many Advantage plans also include deductibles, copayments, coinsurance, out-of-pocket maximums. They also tend to have limited supplier networks and geographies.
Al: Advantage plans can also leave a specific area on an annual basis. SCAN is an Advantage plan that was available in the Napa-Sonoma area but is leaving at the end of this year. We have signed up a number of former SCAN members for both add-on and benefit plans.
Kyle: We’ve all seen the ferocious advertising campaign promoting benefit plans: “Just enter your zip code and see if you get ALL Medicare Part C benefits!” (A licensed insurance agent will answer your questions!).
Al: I think our reader contacted a sales office instead of the Blue Shield membership number. At least I hope they don’t grab our customers and force them into a plan they didn’t understand.
To answer Betty’s question, if Medicare covers her husband’s medical supplies, his Blue Shield plan should also cover them.
Kyle: Speaking of Blue Shield, we just heard that the company’s contract with Adventist Health expired on December 1, 2023. This does not affect the Blue Shield Medicare supplement, but it could definitely impact Individual/Family Plans (IFP) and group insurance plans.
We’re also told that doctors affiliated with Adventist Health are under contract with Blue Shield through next April. For those under 65, Blue Shield is a popular choice because it’s the only Preferred Provider Organization (PPO) we have. All others are health maintenance organizations (HMOs) or exclusive provider organizations (EPOs). Anthem Blue Cross offers EPOs, Kaiser and Western Health Advantage HMOs.
Al: When I first started in health insurance, Blue Shield did not have a contract with St. Helena. Since both organizations must agree, it would be a surprise if they did not achieve a meeting of the minds. In the meantime, open enrollment continues through Covered California, so we’ll be reaching out to our current list of Blue Shield customers to offer alternatives until needed!
How health insurance coverage affects children’s access to mental health care
How health insurance coverage affects children’s access to mental health care
Emergency rooms see nearly half a million children a year for mental illness, according to the American Academy of Pediatrics — and that number is growing.
Children ages 6 to 17 have a growing need for mental health services, with 1 in 6 reporting at least one mental health disorder, according to a 2019 paper by University of Michigan researchers. And that was before the COVID-19 pandemic hit children’s mental health hard. High school students increasingly report persistent feelings of sadness or hopelessness. According to the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey, 42 percent of high school students experienced these feelings in 2021, up five percentage points from 2019 and up 14 points from 2011 .
However, about half of youth who need professional mental health services do not receive them, according to the same Michigan researchers. Among the barriers to accessing children’s mental health care: health insurance coverage.
CounselingSchools.com examined how insurance does not guarantee mental health coverage and the differences between youth covered by Medicaid versus private plans, incorporating data from the Kaiser Family Foundation.
Getting the help children need covered by insurance can be difficult for parents, even with laws requiring equality in mental and physical health coverage. Historically, health insurers have offered few mental health benefits. In 1996, federal law introduced the idea of covering mental health to the same extent as physical health services, but not for all health plans. This concept expanded with the Mental Health Equity and Addiction Justice Act of 2008, which required insurers to treat mental and physical health coverage similarly.
However, NPR reported that insurance companies tend to be lax about providing equal coverage for mental health care, often treating mental illness as an acute condition instead of a chronic condition that may require longer-term care.
The laws apply to most health plans, but there are several types of exceptions, the Kaiser Family Foundation reports. NPR reports on one example where an Ohio family had to pay $40,000 out of pocket to treat their daughter for chronic suicidality after their insurer dropped coverage. The family eventually dealt with the red tape to continue treatment and receive reimbursement.
Schools try to provide support because untreated mental illness can harm students’ learning and development. In 2019, the Office of Substance Abuse and Mental Health Services found that 15% of adolescents received mental health services at school. But this is not enough to meet the need.
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How mental health coverage for children in Medicaid differs from that in private insurance
Medicaid and the Children’s Health Insurance Program, or CHIP, provide youth up to age 21 in Medicaid and up to age 19 in CHIP with a wide range of comprehensive mental health services through reimbursement for early and periodic screening, diagnosis, and treatment. according to KFF.
Under this benefit, young people can receive mental health, behavioral health, and developmental screenings—along with physical health screenings—and receive any services needed to treat any mental health and behavioral diagnosis, even if the state Medicaid program does not cover servicing. According to The Commonwealth Fund, the benefit allows youth on Medicaid to receive better, more comprehensive mental health services than youth covered by commercial insurance.
Many states use Medicaid programs to reach children through school-based services – 21 states have laws that expand Medicaid to cover school-based health care, including mental health services. For example, youth covered by Medicaid in Colorado can access mental health services without a formal diagnosis, allowing for earlier intervention, according to a report by Education Week.
Story editing by Jeff Inglis and Kelly Glass. Copy editing by Tim Bruns.
This story originally appeared on CounselingSchools.com and was produced and distributed in partnership with Stacker Studio.
CounselingSchools.com
Many people assume that they have to put in 40 hours a week of their time to qualify for benefits like retirement plans, health insurance, and even tuition reimbursement…but that’s not true! Experts say there are a variety of employers with part-time job options and benefits available!
ZMG – Buzz60
