Your Rights: “Surprise” Medical Bills

I have been hearing over the past several months about a new law that reduces the likelihood that we consumers would get medical bills saying we owed more than our normal co-payment or deductible because a health provider was not part of our insurance plan’s network. The law is called the “No Surprises Act.” It went into effect January 1, but I haven’t had a chance to study it like I would wish.

This morning’s issue of Kaiser Health News (which is a highly-reputable source of information on health policy and the health industry) linked to a podcast where the No Surprises Act was discussed. It’s an 18-minute listen — I scanned the transcript, and pulled out a few key points. Please note that I am not including everything — just some highlights. I’d encourage you to check it out yourself to get the full story.

The No Surprises Act is good news — it is designed to protect us from the extra costs we might incur when an out-of-network provider gets involved in our care, even though our initial contact for care was with an in-network provider. Examples? It could be that our doctor sends our blood samples to an out-of-network lab for testing, or the anesthesiologist our hospital brings in to assist is an out-of-network provider — situations like that.

Of course, nothing is perfect, including this law. There are still things we need to know in order to protect ourselves.

  1. The No Surprises Bill applies mostly* to hospital care. If you are getting care at a clinic or doctor’s office, you are likely not protected from surprise out-of-network bills. That means you still need to ASK.
    *Why did I say mostly? Because there are some urgent care clinics that might be covered, but it is hard to find out. So it’s safer to assume a clinic is not covered.
  2. The law does NOT cover ground ambulance trips, so we may still get big bills for those. (Happily, it does cover air ambulance rides).
  3. When asking if a provider is in network, the correct question is: “Are you in-network for my insurance plan?” And be sure they know the detailed name of your plan.
    Note: the WRONG question to ask is “do you take my insurance?” They might accept your insurance, but still be out of network.
  4. Be cautious if a hospital asks you to sign a “Surprise Billing Protection Form.” The name makes it sound helpful, but you need to read the details. This form is used if the hospital is bringing in a provider who is not in your network. By giving you the form, they are disclosing the out-of-network provider, giving you an estimate of the extra cost you’ll incur, AND telling you the names of in-network providers you could use instead. If you sign the form, you are agreeing to pay the extra charge for an out-of-network provider.

This is a starting point for understanding your rights under the new law. Since it is new, everyone (including providers and insurance companies) will need to be learning new processes and rules. The law creates a hotline for reporting or appealing violations: 800-985-3059. The staff on this line will also be learning, but it’s still wise to report and appeal. Just recognize it may not be a fast or easy process to resolve disputes.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Trials of a New Homeowner: Mail!

My daughter recently bought her first home – very exciting! I was there visiting about a week after she moved in (yes, I did miss all the hard work!), and every day I was there she asked me to look at suspicious-looking items that came in the day’s mail. She was right – they were ALL things she should ignore, even though they had language that made them sound really urgent, like there was something needed for her loan. In one case she was even worried enough that she contacted her loan officer to make sure it wasn’t real.

I’m not suggesting that you ignore mail… that can get us in trouble. But it is always important to read unsolicited mail carefully – even skeptically. And her experience reminded me that when you take a major financial action (such as buying a house, in her case), you may draw the attention of marketers and even scammers.

What did she receive?

  • Several offers of mortgage protection life insurance, which she didn’t need. In fact, extra life insurance to pay off your mortgage if something happens to you is a low or non-priority item for most families. What was especially disconcerting to her was the fact that these marketers knew who her lender was and the amount of the loan. In one case they even had the loan number in their letter.
    How could they do that? Well, property purchases are filed at the courthouse (or in her case, city hall); the new owner is shown, and it also shows that a lender has a lien on the property. That’s how they knew.
  • A more disturbing mailing was simply an “important notice” stating that “we need you to call us about an important matter regarding this loan.” That was the one that caused her to call her lender, just to be safe. She never called the marketer, of course, so we have no way of knowing what they were going to tell her.

Not all the letters she received were actually scams – in fact it’s possible that none of them were scams. But they were certainly marketing unneeded products, and they could cause some consumers to spend money on something of little or no value to them.

I suggest two take-aways from this little story: 

  1. Read your mail but do not assume everything you receive is as important as they want  you to think it is; and
  2. If you take a major financial action like buying a house, be prepared for a deluge of unwanted mail.

What other take-aways would you add?

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Teachable Moments

I enjoyed a story shared by a gentleman who as a teen loved the challenge of rolling into a gas station with barely a drop of gas left in his tank…despite the warnings of his father, “be sure to keep at least a quarter tank of gas in the car.” Thirty years later, as he passed through a very rural area of Iowa, the gas pump on his car left him stranded for a couple of days while he waited for the delivery of a new one. When he asked the mechanic what he could do to prevent this in the future, he learned that keeping at least a quarter tank of gas in a car prevented the pump from having to work so hard. 

Seventeen years ago, when I first learned to prepare taxes at a VITA site, I was blessed to have two very good mentors…one was retired from the IRS and the other was retired from the department of Social Security. Each year, during the two and a half months we were together preparing returns, there were opportunities for rich discussion where they would share with me, what they would have done differently, regarding finances and investing, had they known what the know now, in retirement. 

Preparing tax returns for others has been a rewarding experience and is an opportunity to share information with individuals at a “teachable moment”; when they are most ready to receive, hear and apply information that can change their lives. Obviously, as an adult, a broken gas pump creates a greater teachable moment compared to his teenage self, listening to a nagging parent. But learning a financial lesson AT THE TIME of retirement doesn’t leave much time to apply and benefit from a lessons learned.

At my free tax sites, I see individuals who make money “on the side” who are paid in cash and want to omit the income from their tax return. One immediate consequence to this action might be a loss of Earned Income Tax Credit. But what they fail to see is the long-term consequence.  While it may feel good to have income that you did NOT pay taxes on, not reporting it is illegal AND affects the amount of your Social Security check in retirement which is based on your 40 highest quarters of income.

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Talking with Children about Money

Guest blogger Carol Ehlers is a Human Sciences Specialist with Iowa State University Extension and Outreach.

Wondering about the right time to talk to your kids about money? Children learn about money from many sources. Long before they enter school, they see adults using money and buying things. They see thousands of commercials each year. Like it or not, money is a part of your preschooler’s life.

What children witness affects their attitudes and how they value money. Some of these beliefs will help them as adult consumers and some will not. For example, they might get the message that saving is important or they might not.

As a parent or guardian, you will not be the only influence on what your child learns about using money. But when you daily reflect on basic lessons about money, you increase the chance that your child’s values will be similar to yours.

Simple activities and other resources, which are parent and child tested, can give ideas for:

  • Teaching how money works and what it can do;
  • Talking about how your family uses money; and
  • Modeling good money management.

Here are some tips and ideas for parents to use with their preschoolers to begin increasing their money management skills:

  • Encourage play that helps preschoolers think about money. This helps children learn about daily consumer choices. For example, play restaurant, supermarket, post office, bank, gas station or car wash.
  • Use games to help your child identify coins and values. Ask the preschooler to help you count out the money as you purchase items together.
  • Talk about work. Preschoolers can learn that some family members go to work to earn money for family needs such as food, clothes and the home. Preschoolers can learn that other family members work at home so that the family does not have to buy some good and services like laundry, cooking and yard work.
  • Share information. Talk with your child about how money is earned, paying for expenses and saving money. A good gift for a preschoolers to start learning this concept is a three part container with slots that are labeled SAVE, SPEND, And GIVE. There are some great examples on the internet.
Carol Ehlers

Money as You Grow, from the CFPB (Consumer Financial Protection Bureau) offers wonderful research-based guidance and financial learning activities for parents and caregivers of young children, and older children too.

The FDIC provides a range of resources for consumers, including free parent guides for four different age groups, including Pre-K through Grade 2, Grades 3-5, Grades 6-8, and Grades 9-12. Their page also features podcasts and games. (The parent guides are two-thirds of the way down the page).

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Planning for 2022 and Beyond

A new year provides many of us with the opportunity to try something different or reflect upon what we accomplished during the previous year, but it is also a great time to revisit our plans for the future. This could not be more relevant for my family as we have spent the past week mourning the loss of a loved one, while concurrently going through the painstaking process of executing a will, finding proper long-term care for a disabled surviving spouse, and carrying out final wishes for a family spread out all over the country.

And while this certainly is a difficult time, I cannot express how much easier it has been due to the basic estate planning conversations we coincidentally had earlier in 2021. Talking about the end of life’s journey is never fun; however, we were able to take care of a lot over the past few days because of these prior conversations, and with very little legal assistance.

I encourage you to take action soon to ensure that you have made appropriate preparations for your own death, as well as to encourage or assist those you care about to do the same. At the bare minimum, the following documents should be in place for each individual:

  • Advance Medical Directive – this allows a person to decide in advance who will make health care decisions for them if they become incapacitated and are unable to make their own decisions.
  • Durable Power of Attorney – in this document, the writer appoints an individual he/she trusts to make other legal decisions, primarily financial, on their behalf if they become incapacitated.
  • Last Will and Testament – this document provides key information and instructions regarding the distribution of assets, disposition of remains, and other final wishes on behalf of a deceased individual. It also can include instruction on who should be the guardian of any minor children of the individual who has died.
  • Beneficiary Designations – perhaps the simplest part of the estate planning process, setting up beneficiaries for life insurance policies, retirement accounts, etc. allows account owners to predetermine the distribution of those assets after their death, and also to avoid the probate process for those assets.

This is not meant to be an exhaustive list of things that need to be taken care of; however, having the above protections in place ahead of time will save your loved ones a lot of time, money, and stress when the unfortunate time of a loved one’s passing ultimately arrives. You can learn more by visiting the Iowa Legal Aid website, or by attending one of the many Iowa State University Extension and Outreach programs available for Aging and Caregiving. The Iowa Concern Hotline (800-447-1985) has an attorney on staff who can provide information on legal topics as well.

Ryan Stuart

Ryan is a Human Sciences Specialist in Family Wellbeing and an Accredited Financial Counselor®. He focuses on educating and empowering all Iowans to independently make positive financial decisions throughout their life course.

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Inflation: Choose Your Changes

Someone asked me a couple weeks ago whether I had written a blog post yet on inflation, which has certainly been in the news lately. My first thought was “Well no – there’s nothing we can do about inflation, and we can’t foresee the future… so what could I write?” It dawned on me later that in fact there ARE some points I can share to help us all deal with higher prices.

If prices go up and our income doesn’t increase enough to keep pace, it’s a lot like getting a pay cut. Our normal patterns of spending and saving no longer work – something has to change. For some people the change involves minor sacrifice – perhaps eating out fewer times a week, or at less-expensive restaurants. For other people, higher prices may mean much more challenging changes.  The good news is that at least YOU are the one who gets to decide what changes to make. Ideas for making the changes less painful:

  1. You may be able to use non-monetary resources to meet some of your needs. For example, if you usually buy birthday cakes for your family, perhaps you can make them instead. OR perhaps you have a friend who could make the cake in exchange for you watching her children one Saturday.  Think about ways in which you can use your own time and energy and skills to accomplish things that you usually pay for. And remember that your friends also have skills they may be willing to share. Common examples include: cooking from scratch rather than using convenience foods, shoveling your own snow instead of paying someone else, learning to cut family members’ hair to avoid the cost of regular haircuts, giving gift certificates for your time and talent (I’ll bake you a pie!) in place of purchased gifts.
  2. Make use of community resources that are available. Even if you have never before applied for energy assistance or used the free tax preparation available in your community, when times are tight, using these services and others can make a big difference.
  3. Careful shopping can make limited funds stretch further. Even with increased prices, retailers still have sales, and generics are still less expensive than brand names. Sometimes changing where we shop and what brand we buy makes it possible to save money even without severely cutting back our shopping list.
  4. When the reality is that we are going to need to “do without” something, we can consider our priorities and choose what to keep and what to give up. One person might “give up” their morning stop at a coffee shop, so they could continue to pay for their streaming services or premium cable; another person might make the opposite choice.
    Recognizing that we have a choice can help our attitude: we don’t “have to” give up anything; instead, we choose what to give up. For example, instead of feeling deprived about not going out for lunch every day, we can feel proud about bringing lunch to work so that we can continue to use funds for something more important.

This short list is only a starting point. We would love to have you share your strategies for dealing with inflation! Please share in the comments!

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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The App Economy and Your Taxes

Like everything else, the pandemic also shifted how individuals earn income through various “side hustles.” Uber, Lyft, and other commonly used digital services took a temporary break during the shutdowns, while newer app-based options such as Robinhood (investing), Coinbase (cryptocurrency), and FanDuel (sports betting) – just to name a few – gained more and more attention. Much of that attention was focused on the ability to make money without ever leaving your couch; however, one little important detail is often left out – you will likely be responsible to pay taxes on some, or all, of that potential income. If you think you might be in that boat for 2021, then keep reading!

  • Investment and speculation apps have been significantly increasing in popularity, but the tax implications are among the least understood. The taxes are very similar whether you are dabbling in individual stocks, ETFs, or Bitcoin, with the big one being capital gains and losses. Other taxes may be due on investments that produce interest and dividends, or hold collectibles, real estate, and foreign property as the underlying asset. You may receive the proper tax forms if you use a more traditional brokerage company; however, you may be responsible for keeping track of your own cryptocurrency transactions.
  • Gambling and sports betting is not a new phenomenon; however, a recent Iowa law permitted the use of online sports betting apps without the need to visit a casino. This change increased sports betting across the state, but consumers may be unfamiliar with the tax consequences of betting on their favorite teams.

Always be sure to check with a tax professional, or contact your local VITA tax site, if you participate in the App Economy and are unsure about the tax implications!

Reminders: 1) If you have a sizable amount of income for which taxes are not withheld, you are supposed to pay quarterly installments to the IRS, and may face a penalty if you have not submitted enough tax payments throughout the year; and 2) For income earned from independent work, your earnings will be subject to self-employment tax as well as income tax.

Ryan Stuart

Ryan is a Human Sciences Specialist in Family Wellbeing and an Accredited Financial Counselor®. He focuses on educating and empowering all Iowans to independently make positive financial decisions throughout their life course.

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Health Insurance Decision Time

Once again it is time to make health insurance decisions. If you are insured through your workplace, your deadlines will be determined by your employer. If you are insured through Medicare (including Medicare Advantage plans), you have between now and December 7 to make changes; your best resource for unbiased assistance in Iowa is the Senior Health Insurance Information Program. Similar resources are available in other states, as well.

If you are not yet eligible for Medicare, and do not have affordable insurance available through an employer, then the Health Care Marketplace is the place to turn for quality health insurance plans* that do not consider pre-existing conditions. The base premium for plans in the Marketplace is affected by your location, your age, and use of tobacco. That is because health care costs vary by location, and are higher for people who are older and who use tobacco. Two other factors also affect your cost:

  • Type of plan (bronze, silver, gold, platinum) you choose. All of these plans are quality* plans, but it is valuable to understand the difference. Bronze plans have the lowest premiums, because they have higher deductibles and co-payments. Premiums increase as you go up in metal value. Platinum plans have the highest premiums, but lower deductibles and co-pays. This post from 2014, when the Health Care Marketplace was new, provides more detail.
  • Your income. That’s right. Two people might pay different premiums even if they are both 30-year-old non-smokers who live in the same county and both chose a silver plan. The Marketplace is designed to provide more help in paying for health insurance to people who need it more. So when you enroll in a Marketplace plan, you will estimate what your household’s income will be for 2022. Based on that estimate, the system determines what your share of the premium for a silver plan should be, and the remaining amount will be covered by an Advance Premium Tax Credit, which is an estimate of how much help you are eligible for. All this is based on a baseline silver plan; you will get the same amount of help toward your premiums regardless of what “metal color” plan you choose. At the end of they year, your tax return will show your actual total income for the year. The actual income will be used to determine your final Premium Tax Credit amount. If you received too much or too little in advance, the difference will be taken care of on your tax return, by either increasing or decreasing your tax refund or the amount of tax you owe when you file. The Kaiser Family Foundation offers a useful tool to give you an idea of how much help you may be able to receive.

Open enrollment for 2022 health plans in the Marketplace continues through January 15, but if you want your coverage to begin as early as possible (January 1) then you need to enroll by December 15. Enrolling between December 16 and January 15 will get you coverage that begins February 1. Enroll online at OR call 800-318-2596. A link is also available to find local help. You have the option to choose (filter) whether you wish to find an agent/broker OR would rather get help only from an assister.

*What do I mean by “quality” plans? The biggest factor is that a quality plan covers all ten essential types of health care. By contrast there are plans (sometimes referred to as “junk plans”) that purport to provide health coverage, but exclude certain categories. I’ve heard of situations where people are excited to get health insurance, but then when need arises they discover it doesn’t cover hospitalization, or it only pays $100/day toward hospital care, or has some other substantial limitation. In addition marketplace do not have annual or lifetime limits on what they will pay for an individual’s care. Another key “quality” factor is that the plans have been actuarially evaluated as providing appropriate coverage for an appropriate cost. In other words, they are not set up to make big profits for the company.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Confused about recent Federal Student Loan changes? Look no further!

If the Federal Student Loan changes over the past 18 months weren’t confusing enough, the U.S. Department of Education recently announced several more that may leave you wondering how you are affected this time around. The original COVID-19 Emergency Relief measures are tentatively set to expire on January 31, 2022, but the new provisions are either permanent, expire on October 31, 2022, and/or impact a smaller group of borrowers:

  • On August 20, the U.S. Department of Education announced that eligible Servicemembers would automatically, and retroactively, receive a 0% interest-rate benefit if they deployed to areas qualifying for imminent danger or hostile fire pay. This is not a new benefit; however, Servicemembers previously needed to submit a form, with supporting documentation, to find out if their loans and deployment qualified for the 0% interest waiver. 
  • Several updates have been made over the past few months regarding Federal Student Loan Servicers. PHEAA (FedLoan Servicing), Granite State, and Navient will no longer service U.S Dept of Ed-owned loans when their contract expires. Current borrowers will receive numerous notifications throughout the loan transfer process. Watch for those notifications: be sure to save the information or respond as requested.
  • The often-troubled Public Service Loan Forgiveness (PSLF) Program is receiving a giant makeover. Some of the provisions are temporary, while some remain unchanged. Regardless, these changes are significant and remain in effect until October 31, 2022. 

Are you still unsure of how these changes affect you? Contact an Iowa State University Extension and Outreach Financial Educator today! 

The information provided is educational in nature to help you make your own informed decisions and is not intended to substitute for professional advice or serve as an endorsement of any financial product or service. Consult with licensed professionals prior to implementing any of the information provided to determine the course of action is best for you. 

Ryan Stuart is a Human Sciences Specialist, Family Wellbeing, with Iowa State University Extension and Outreach. Ryan will be joining the regular blog team soon, so watch for more posts from him.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Medicare Open Enrollment – So What?

Medicare’s annual open enrollment period for 2022 coverage began last Friday and continues through December 7. But why does it matter? Most people enroll in Medicare when they turn 65 — doesn’t that take care of it? The answer is: probably not.

NOTE: Even if you are too young for Medicare, this blog post may be worth your attention if there are people you care about who are enrolled in Medicare. I’d encourage you to touch base with them to make sure they understand their options, and the mailings they are receiving, and help them get help if they need it.

During open enrollment each year, consumers have options to make changes. They also may receive a small deluge of marketing mail, email, and perhaps even phone calls. It’s important that they understand what their options are, and that they pay attention to mailings — especially those from Medicare itself (CMS – The Center for Medicare and Medicaid Services) AND from their current insurance company(ies). There are generally three types of choices consumers make during Open Enrollment:

  • Prescription Drug (Part D) Plan. This may be the most common decision people make during open enrollment. Most Medicare participants also enroll in a separate insurance plan to help cover prescription costs. These plans are offered by CMS in partnership with private insurance companies, and you may literally have dozens of plans to choose from. Some people make the mistake of assuming that if they like their current plan, they should just stay with it. The reason that’s a mistake is that plans can change substantially from one year to the next. Maybe this year, your plan covered your medications nicely, with low co-pays; but next year, they could choose to drop one of your medications or attach a much higher co-pay. So even if your own medications haven’t changed, it is smart to use the Medicare on-line tool to see which plans offered in your area will cover your medications at the lowest cost to you. (SHIIP can help with this — see below)
  • Medicare Advantage Plan. Some consumers choose Medicare Part C (Advantage) plans instead of traditional Medicate Part A and B. These are managed care plans operated by private insurance companies in partnership with CMS; they generally have a defined network of participating hospitals, doctors and other medical providers. They often cover services not covered by traditional Medicare (including vision or dental care), but may also have more restrictive coverage on some services as compared to traditional Medicare. Many Advantage plans also have prescription drug coverage built in. These plans can change from year to year as well, and open enrollment is the time to make a change if you wish to.
  • Medicare Supplement Plans. Many consumers who use traditional Medicare Part A and B also enroll in a supplemental insurance plan, sometimes referred to as Medigap insurance (because it covers gaps – including deductibles and co-pays – that Medicare does not cover). These plans are offered by private insurance companies. Open enrollment is also a time to evaluate your supplement coverage.

Health insurance is complicated for people of any age. Fortunately, excellent help and information is available through the Senior Health Insurance Information Program (SHIIP). SHIIP is an office within the Iowa Insurance Division, so it is completely non-commercial and not sales-oriented. Note: similar agencies are available in other states too. The SHIIP website offers a wealth of information. In addition, they have a helpline during business hours at 800-351-4664 (TTY 800-735-2942). Most valuable of all, however, is the corps of highly-trained volunteers located in counties across the state. Find SHIIP volunteers near you! These SHIIP volunteers kick into high gear during fall open enrollment, typically offering appointments to help consumers understand their options for Part D (Prescription coverage) and other coverage.

If you, or someone you care about, need help during Medicare Open Enrollment, I urge you to connect with your local SHIIP resource today! For general information about Medicare, the annual “Medicare and You” handbook is the best starting point.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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