2012 > September

Monthly Archives: September 2012

Why Understanding Your Health Plan Just Got a Bit Easier

Wouldn’t it be great if overnight, understanding health insurance magically became easier?

That was the aim September 23, 2012, but whether it actually happened is still in question.

On the 23rd, a new benefit from Health Reform kicked in, aimed at making it easier for consumers to understand insurance and compare plans.

It’s called the Uniform Summary of Benefits and Coverage (SBC). Right now, health plans already send you long, complicated SBCs. But the problem is, every one is different (ever tried to compare two of these?).

But now, every plan will be required to present their information in a standardized way, using the same definitions, so you can compare apples to apples.

Think of nutrition labeling—we can see instantly exactly how much more sodium is in one bag of chips versus another. That’s the goal behind the Uniform SBCs. And the “labels” actually don’t look that different from what’s on your food…

Even better, the new document also include “coverage examples,” or a theoretical breakdown of costs for some common medical conditions. See example SBCs here.

It’s a step forward, but here at Simplee, we know it’s not enough to make shopping for health insurance as easy as shopping for sweet potato chips. For example, it’s still difficult to compare 70% and 80% co-insurance when you don’t know the full cost of a service.

Basically, the new SBC will make is easier for consumers to choose between health plans, but after that, it’s still a challenge to understand claims and bills once you start using the plan.

Everyone with a private health plan will see this benefit. Look for it when you receive your plan documents each year or on your health plan’s website.



65 Free Preventive Care Benefits to Take Advantage Of

It’s been said that nothing is free – even with health coverage.

But if you’ve already paid your premiums, now is the time to take advantage of all the 100% covered benefits.

Health plans are required to completely cover 16 free preventive services for adults, 22 for women, and 27 for children. That means you won’t pay any co-pays, co-insurance, or deductibles on any of these 65 services.

Here’s how you can make the most of those free benefits.

Get your basics done.

Aim to get an all-around profile of your health with screenings or wellness counseling.

  • Breast & colon cancer screenings
  • Diabetes, blood pressure, cholesterol, STD, HPV, & depression screenings
  • Vaccines for flu, pneumonia, measles, polio, meningitis
  • Annual check-ups for women
  • Counseling to quit smoking, lose weight, stop drinking, or on HIV and STDs, domestic violence, or breastfeeding.

Here is a complete list of services.

Tell your doctor

The next time you see your doctor, mention that you want to take advantage of your preventive care benefits.

If your doctor has record of you asking about them, they’ll not only be able to start you off, but they’ll see it in their notes whenever you come in and follow-up with you.

Basically, put it on the record: You’ll be more likely to get things done when someone else is part of the plan.

Know the limits

“Free” doesn’t necessarily mean, “always free.” The key is the word “preventive.”

If you’ve had a past medical history that now requires care that would normally be free, it doesn’t count.

For example, if you had a breast cyst, a mammogram would no longer be considered a preventive care benefit.

The same thing happens if the service is aimed at diagnosing a specific illness: if your doctor orders a colonoscopy because you’re having stabbing abdominal pain, the preventive care benefit wouldn’t apply.

Check your bills

For your health plan to treat a claim as a free preventive benefit, it needs to be coded with the right medical billing codes.

For example, a mammogram for a breast cancer patient will have a different code than a mammogram for a perfectly healthy woman.

Doctors and insurance companies make mistakes, so you should review your bills to make sure you weren’t charged. If you’re billed for a service you think should be free, call your health plan or ask your doctor about it.


This post first appeared on Mint.com. 


Long-Term Care Insurance: When Health Insurance Doesn’t Cover It

Providing care for an aging parent or loved one is truly a full-time job, as caregivers play a number of roles – from hands-on health provider and friend to surrogate decision-maker and advocate. When these roles are assumed in addition to typical workplace and family duties, they can prove very costly to both individuals and their employers. But until people experience it firsthand, most of us don’t realize the dramatic impact it can have on our finances, career, health and family. I certainly didn’t.

Planning for Long-Term Care

With limited information, I moved my father into my home when he was 75-years old. As his health declined, I missed more critical work time and it started costing more and more to support him. My husband and I worked extensive hours to provide for his growing need for care which was challenging since we also needed to care for two teenage kids.  The increased costs of caregiving inevitably altered our plans for retirement. Looking back, I understand how not being fully prepared to provide care can impact a family. I’m also convinced that planning for my own later years is a must for me and my family.

A hard truth that families often fail to realize is that government programs like Medicare and Medicaid will not fully meet their long-term care needs. The general intent of health care is to return a person to good health, so its focus is on restoring health. In contrast, long-term care focuses more on caring than on curing. Generally, long-term care provides custodial care. An easy way to remember is “Care vs. Cure.”

Medicare only covers limited skilled care if it improves a person’s health condition and no coverage is available for custodial care. Medicaid covers nursing home stays for poor and low-income citizens, which often requires a person to deplete his or her assets before qualifying for coverage.

The harsh reality is that health insurance may not cover all of the necessary expenses to meet your needs. According to the MetLife Mature Market Institute, the number of adults providing care for an aging parent more than tripled over the past 15 years. And as baby boomers continue to age, the need for long term carewill soon reach unprecedented levels. Long term care insurance policies offer options to help cover in-home care by a nurse or family member or to help pay for care in an assisted living facility. With more people falling into the “sandwich generation” – adults caught in the middle of caring for both their children and their parents – they will find value in the opportunity to plan ahead and prepare for their long-term care needs.

The demand for long term care insurance is on the rise and the cost of being unprepared is extremely high for both individuals and businesses. Now is the right time for you to do your research and sit down with your family to discuss the best plans to ensure your family has the best coverage possible.


This post was provided by guest author Dan S. at “Health Insurance Doesn’t Cover It.”

Health Insurance Doesn’t Cover It is a comprehensive website that provides tools and information to help people research the different types of supplemental coverages available to help pay for unexpected and unwelcomed surprises.