Health insurance

Posts Tagged: Health insurance


In with the New, Out with the Old: A Quick Comparison of 2013 & 2014’s Health Plan Costs

It’s time to say good-bye to 2013’s insurance and hello to 2014.

How did you fare in 2013? Some new research from eHealth looked at the average amount that Americans paid towards health insurance this last year. We tried to compare this to the plans available in the insurance exchanges for 2014.

According to eHealth, in 2013, the average individual premium was $197 for a basic plan, and $247 for a comprehensive plan.

And the average annual deductible for an individual was $3,319.


So can you expect to do better or worse in 2014?

There aren’t a lot of solid numbers on the 2014 plans being offered on the exchanges. But even if there were, there are a couple things to keep in mind: For one thing, the plans being sold on the exchanges are generally better than those that were sold up until now: they must meet some minimum standards by covering a set of basic Essential Health Benefits. In addition, many people will be eligible for a tax subsidy, which will help offset their premium (you can calculate your subsidy here).

Some research found that the average premium for a health exchange plan is $328. But that doesn’t really tell us much when it’s averaged across all plans, in all geographies, and for all ages.

For example, for a 27-year-old, that plan would be $163 for a basic Bronze plan or $240 for more comprehensive Silver plan.

And across all states, the average premium for a pretty comprehensive Silver plan ranges from $192 to $516.

When it comes to deductibles, the plans on the exchanges range from an average deductible of $4,300 (for a Bronze plan) to $2,500 (for a Silver plan). Or if you wanted to get the best of plans (Platinum) your deductible could be as low as $167.


Well, that’s a lot of numbers. So what’s the moral for 2014?

We’d probably sum it up to say that some people may end up with more costly insurance. But most of them will probably enjoy having better coverage or even getting a subsidy on their premium. And either way, you’re likely to be amongst the crowd that has a high-deductible plan – this seems like a trend that isn’t going away soon.

Let us know how your 2014 is shaping up – and how Simplee can help you manage your costs in the New Year!




Tips to Avoid Getting Scammed on the Health Insurance Exchange

Between all the hype over the Federal Government’s insurance exchange website and the tempting business opportunities popping up in health care, a lot of fake sites selling insurance are making their way into the market. Here are some essential tips to help protect your information and make sure you’re buying the right thing!

  • Never give out your social security number or bank/credit card information. You do not need these things to enroll in a health plan.
  • Don’t provide any health information. Health plans sold on the exchanges cannot ask for this or use it to determine your coverage.
  • Make sure you’re not being charged more. There are only 3 ways health plans on the exchanges can vary your premium: age, geography, and family size. If your premium is being raised for other reasons, like gender, race, or health history, that’s a red flag.
  • Check a few sources for links to the place where you’re applying for insurance. If a lot of public agencies and credible organizations are pointing to the site, it’s probably good.
  • Don’t get caught by scare tactics over what might happen if you don’t have insurance. Yes, there is a penalty of $95 or 1 percent of family income (whichever is greater) if you do not have coverage in 2014, which you’ll want to avoid. But some scams exaggerate the penalties to get you to buy insurance.

If you think you’ve found a bad site or experienced fraud, report it to the Insurance Marketplace Call Center: 1-800-318-2596.



The Health Insurance Exchanges – What Your Next 3 Months Should Look Like

By now you’ve heard the news that the long-awaited health insurance exchanges are open for enrollment October 1st, 2013. Is the hype making you feel you need to cruise over to the Exchange website right this minute to sign up for a plan? Or so confused you want to avoid it all?

Our tip: walk, don’t run, over to the Exchanges, but make sure you do do it before the year ends. The deadline to enroll is December 15th if you want your plan to start as early as possible (January 1st 2014).

So there’s no rush to enroll but here’s what you should make sure to do before open enrollment closes:

Early October – Determine whether you need to get coverage through the Exchange.

Not everyone does. If you already have coverage through your employer or Medicare, you don’t need to sign up for the Exchange. After all, the idea isn’t to get everyone on the Exchanges, it’s to give everyone an option. So if you’re one of those people who has an incredibly expensive plan, are uninsured, or you’ve been denied coverage because you’re sick, this is for you. Otherwise, this might be something to skip.

Not really sure? Read about how you can benefit from the insurance exchange or the penalty for having no insurance

Late October – Start shopping for plans & gathering the info you need.

If you’ve decided you want to buy coverage from the Exchanges, click on over to to start. You’ll be able to enter your income information too to see if you’re eligible for either a premium subsidy or assistance with co-pays & co-insurance.

November – Do your final comparison and enroll.

Before you choose a plan, always make sure you understand the cost sharing and limitations. Fortunately, the health reform act makes this much easier by introducing standardized tiers of plans (Bronze, Silver, Gold, & Platinum) so you can compare across these plans.

You can breathe a sigh of relief that all the plans on the Exchanges must cover a list of basic “essential health benefits”. But you’ll want to check whether your plan has a provider network and that all of your current doctors and hospitals are part of that network.

When you think you’ve found the plan you want, complete your enrollment online or over the phone. While the deadline isn’t until December 15th, you’ll be glad you got it out of the way before the holidays.

December – Kick back and relax!

Congrats, you just completed enrolling in a new health plan. And just as an epilogue…

January – Starting using your new plan.

February & March – Enroll (for real this time!) if you missed your chance earlier on.

Since it’s the first year for this Exchange business, there is a grace period through March 31st. But beware, next year the deadline is December 15th, period. That means you will be unable to purchase insurance until the next open enrollment in October 2014.

Ready? Set… walk!



2014: What’s the Penalty for Not Having Health Insurance?

By 2014, it’s required that all Americans have some form of health insurance coverage. If you don’t, you will probably have to pay a fine. While that sounds scary, most people are surprised to learn how much they’d actually owe. But before you get excited about skipping out on coverage to save money, make sure you know what you could be missing out on (and what could cost you more in the long run).

How much is the penalty?

The fee for not having health insurance in 2014 will be whatever is higher for you: $95 or 1% of your household income. In 2015, it increases to $325 and by 2016 it will be $695. And if you have kids and don’t insure them, the fine is $47.50 per child.

Who has to pay the penalty?

Pretty much everyone is subject to the penalty, except for a few groups. Some examples of exceptions are:

  • If your income is below the threshold for filing taxes
  • You would be eligible for Medicaid but your state isn’t expanding the program to be available to you
  • You were only uninsured for a small portion of the year (three months or less)
  • You belong to a religion that abstains from medical care or insurance
  • You’re a member of a federally-recognized Indian tribe

What kind of insurance do I need to have?

It’s gotta be real coverage (no skimpy discount plans, or partial coverage such as worker’s compensation or critical disease insurance). Aside from this, pretty much any employer, government, or health benefits exchange coverage will qualify. If you currently have coverage, it will most likely count.

Why not just pay the fine?

There are a couple reasons it might not be smart to go without coverage.

First, you can’t just change your mind and buy it at any time. When the health benefits exchanges open in 2014, they will have open enrollment periods (until March 31st the first year, and then Oct 15th-Dec 15th following years). That means that if you don’t buy coverage during open enrollment, and you don’t have any other options, you won’t be able to buy it for the rest of the year.

Second, you’ll be responsible for the full cost of any health care that you get if you end up needing it. With medical debt as the leading cause of bankruptcy, there was after all, a reason behind the effort to get everyone covered.

At the end of the day (or, perhaps we should say, at the end of March), it will be up to you to decide whether going without insurance is worth the small (but growing) penalty.


Annual & Lifetime Limits – Can your Plan Refuse to Pay?

Good news for patients that get a lot of health care — under new rules from the Affordable Care Act, health plans cannot set annual or lifetime limits on the how much they’ll spend on your care. Before these changes, you could easily reach a limit with a diagnosis like cancer and your plan would stop paying for any of your care.

But there are still a few catches. Here’s what you need to know to make sure you’ll be covered.

Wait for 2014

Lifetime limits aren’t allowed today. But the ban on annual limits starts for plan years that begin January 2014. So that means if your plan year begins at another time (for example, schools and universities often have years that begin in the fall) you may have to wait until then for the benefit to become effective. Until then, the allowed limit is $2 million per year.

Essential Health Benefits Only

Both lifetime and annual limits only apply to what are called Essential Health Benefits. That would be policy-speak for a pre-determined list of standard, basic benefits. This lists prevent plans from trying to include big gaps in the coverage they offer, because all plans sold in the health insurance exchanges will be required to cover them.

Don’t worry, all the basics from outpatient to hospital to preventive care are included. Just remember that any care that you get that is not an Essential Health Benefit can still be capped with a limit.

Find a complete list of the Essential Health Benefits here.

Grandfathered Plans Are Out

Some health plans have been grandfathered out of having to comply with any new requirements in the Affordable Care Act. Plans that were created before March 23, 2010 may have been grandfathered. If you have a plan through your employer, it still may be grandfathered even if you joined the plan yourself after March 23, 2010. You should be able to find out by asking your HR department or plan administrator or looking on your plan documents.

Unfortunately, if you have one of these plans, the lifetime and annual limits are still allowed. If you are anticipating a lot of medical bills, you may want to consider switching to a non-grandfathered plan before 2014.


What will Happen to Health Benefits for Same Sex Couples without DOMA?

Last week, the Supreme Court ruled that the Defense of Marriage Act, DOMA is unconstitutional, and same sex couples should be afforded the same health benefits as any other married couple.

That means a lot of changes (and potential savings) are on the way for same sex couples. One study by the Center for American Progress and the Williams Institute in 2007 estimated that the average married same-sex couple paid over $1,000 more in taxes each year.

Not only will the government begin allowing its own employees to enroll their partners in the Federal Employees Health Benefits Plan, but couples all over the country will face a new set of rules–that may or may not end up being a good deal.

Some of the immediate benefits:

Tax-free health benefits
Money paid towards employer-sponsored health insurance is all pre-tax. Yet for same sex couples, the money spent on the employee’s partner would be counted as income and subject to income taxes. This could add up to thousands of dollars of taxable income over a year.

Special enrollment rights
Opposite sex couples have always been able to add their spouse to their health plan right away if the partner left their job, lost their own benefits, the couple was newly married, or they adopted a child. These are benefits under the federal regulations HIPAA. But same sex couples would have to wait until the plan’s annual open enrollment, if they were eligible at all.

Access to Medicare, Medicaid, & Tricare
Same sex couples have always been denied coverage for Medicare and Medicaid through their partner, the federal safety-net health benefits for the elderly, disabled, and low-income. They also could not get coverage under their partner’s Tricare benefits, the government’s insurance for military personnel. Now, all of these benefits will be available with the same eligibility criteria as opposite sex couples.

Shared HSA, FSA, and HRA spending
Previously, if one member of a same sex couple had any kind of health savings account or flexible spending account, the funds couldn’t necessarily be spent on their partner’s medical expenses. The partner would have to be an IRS designated tax dependent to be able to use the funds.

But there are also some possible disadvantages:

Insurance Exchange subsidies
Under the federal health insurance exchanges, set to open January 1, 2014, some couples may no longer be eligible for subsidies and tax credits that they could have gotten individually. For example, if each person had an annual income of $35,000, they would each qualify for a federal subsidy on their insurance premiums, separately. But with a combined income of $70,000 they now earn too much money to qualify for a subsidy.

Medicaid Eligibility
In the same way, the combining of family income to determine eligibility could also disqualify some couples for Medicaid (ironically, since now same sex couples just gained access to Medicaid via their spouse). So at the end of the day, it’s couples who have similar and relatively low income who might lose out.

But all told, there is a lot yet to be determined as states and the federal government iron out policies and procedures, especially, with gay-marriage laws still differing by the state. With thousands of pages of regulations related to marriage and health benefits, it could take awhile for regulators to figure everything out.


5 Ways You Could Benefit from the Health Insurance Exchanges

The news is everywhere about the insurance exchanges! With all the hype, what should you know? And should you care?

With over 10 million people expected to be eligible for the exchanges, there’s actually a good chance that you should care… The exchanges will be online marketplace where individuals or employees of small businesses can go to compare and buy health insurance. Enrollment starts October 2013 and the plans go live January 2014.

And you’ll most likely benefit the most from them if…

1. You’re uninsured

If you’re shopping for insurance on a federal or state exchange, you can’t be denied health insurance because of your medical history. The plans are guaranteed issue for anyone (as long as you’re a US citizen or legal US resident). You’ll also be protected from the plan suddenly canceling the plan on you if they discover anything about your health history later on.

2. You’re currently paying a ton for your health care

If you’re insured but sinking half your paycheck into your health insurance, the good news is that pricing rules on the exchanges will keep premiums in check. There are only a few ways premiums will be allowed to vary:

  • Overall: the most expensive plan can only be 4.5 times the cost of the least pricey plan
  • By age: the price for older members can only be three times that of younger members
  • By geography
  • By family size

Sliding scale subsidies will also be available depending on your income. And they’re pretty generous: You’ll qualify if your income is up to four times the poverty line (about $45,000 for an individual). And the average annual subsidy is expected to be $4,600 in 2014.

3. You’re older but not old enough for Medicare

Both guaranteed issue and the premium pricing rules work out really well for you if you are older but haven’t quite reached 65. This is typically the most difficult age group to be in for finding affordable insurance. Health plans on the exchanges will have to sell you coverage and it can only be three times the price for younger members (today, that ratio is much more extreme).

4. You have really high medical costs

Starting in 2014, annual and lifetime limits on coverage will no longer be allowed by any health plan. Right now, it’s easy to reach one of these limits if you have ongoing health issues, which leaves you without coverage exactly when you need it. But plans will soon be banned from setting any of these limits.

5. You get confused comparing health plans

All plans sold on the exchanges will be standardized, with the goal of making them easy to compare. There will be four tiers of plans, with Bronze plans being the most basic, and Platinum the most comprehensive (and Silver and Gold in between). And all plans will have to cover a list of Essential Health Benefits so there should be no big surprises about what’s covered and what’s not.


Before 2013: Squeeze Extra Dollars Out of Your Health Benefits

Before the new year rolls around, putting some attention towards your health benefits can save you a lot of money. Quick! You have limited time to make the most out of your health plan for 2012, and then to get ready for 2013.

Spend down your FSA or HRA 

If you have a Flexible Spending Account or Health Reimbursement Account, check on the date it rolls over (for most of them, it’s January). You’ll lose the funds if you don’t spend them in time. Some employers offer a grace period until March 15th, but after that date, the money disappears. See what expenses can be counted.

Don’t confuse your HSA. These funds stay with you year after year!

Take advantage of your deductible

Most plan deductibles also roll over at the end of the year. If you have already met your deductible, think about whether there are any other services or procedures you need to do soon. Scheduling them before the year ends might save you from having to pay completely out of pocket in the new year.

Fund your HSA

If you have an HSA, you already know that the money that goes into it is free from taxes. Did you also know that you can keep depositing up until April 15th and your contributions will count towards your 2012 income? That means you can add more funds if you didn’t deposit enough this year or aim for the maximum contribution to get the most tax savings.

Review next year’s plan

It’s time to look at what’s new for your health plan (or all the important details if you switched plans!). The top benefits to focus on? The deductibles (individual and family, as well as in-network and out-of-network), any changes to the drug formulary, and any changes to the provider networks. These last two rule changes often surprise consumers who think their plan will be the same as it was last year.


Costly Medicare Mistakes to Avoid if you’re Still Working

Age 65 is kind of a magic time where the health insurance world changes. But many people are continuing to work beyond 65 these days. What should you do when you become eligible for Medicare but you’re still covered by your employer’s health insurance?

 Avoid these common mistakes that can lead to higher premiums, penalties, or missed enrollment opportunities.

1)   Paying for Part B when you don’t need it

While Medicare Part A is free if you have been working in the U.S. for most of your life, Part B comes for a monthly premium (in 2012 it was $99 for most people). If you have health insurance through your employer, you’re allowed to defer Part B. Otherwise, there is a late enrollment penalty (10% of the premium for each year you didn’t have Part B). Contact Social Security to delay Part B but remember to sign up as soon as you retire or you could be hit with the penalty.

2)   Using your Medicare first

As long as you’re working and covered by your employer’s plan (or your spouse’s plan), Medicare considers that coverage to be your primary insurance.* That means Medicare won’t pay for anything that your primary plan doesn’t cover. They’ll only pay a portion of the bill after the primary plan pays a portion (yes, odd Medicare rules, right?).

So let’s say your employee plan is an HMO, and you go outside your physician network. Don’t expect Medicare to cover anything. However, if you do go to a network doctor, your primary insurance will pay first, and then Medicare will pay a portion, up to the Medicare benefit level. Bottom line? The two sources of coverage aren’t interchangeable. Rely on your employer insurance, and think of Medicare as a bonus, not an alternative.

3)   Not Getting Part D when you should

A lot of people put off enrolling in Part D when they have prescription drug coverage through their employer. And that’s usually just fine. You’ll run into trouble however, if your drug plan is not considered “creditable coverage.” That means Medicare has decided the plan meets certain standards of being equivalent to a Medicare Part D plan. Most employer plans are creditable, but you should still check with your HR department. If your plan isn’t creditable, you’ll end up paying a late enrollment fee  for every month you didn’t have Part D as long as you have Medicare.

You’ve probably noticed by now that Medicare is pretty strict when it comes to how employer health insurance coordinates. And that means little forgiveness if you don’t follow the rules. Questions? Contact Medicare Coordination of Benefits.

Or need more individualized help with Medicare?  SHIP, the State Health Insurance Assistance Program, is a federal program that provides free one-on-one Medicare assistance. Search for the one in your area through Medicare.


* If you work for a small employer (20 or fewer employees), the rules are a bit different for you. Medicare is always your primary insurance!


5 Mistakes To Avoid During Open Enrollment

 This post originally appeared on the blog. 

The last few months of the year usually mean time to think about choosing new health benefits. Some people think about Open Enrollment as an opportunity—it’s your chance to switch plans! But for most, it’s a looming headache: time to stress about choosing the right benefits.

It could be that there are just so many more options today than ever before. Several years ago, most employers just gave you a choice between a low-cost HMO and a more expensive PPO. Now the options have multiplied into an extended family of acronyms. To make things worse, employers and health insurance companies are pushing more costs onto consumers, so it’s even more important to make sure you’re getting your money’s worth.

As you approach your Open Enrollment period, here are 5 common mistakes, and how to avoid them.

1)   Doing nothing

Almost 9 out of 10 of us just keep the same benefits we had last year. That’s not necessarily a problem, especially if you’ve done your research and your needs haven’t changed. Just make sure nothing substantial has changed about the plan either. Sometimes premiums increase or  benefits get cut, and over time, the plan that was once a good deal may not be the best one for you anymore.

2)   Shopping only by the premium

It’s easy to focus on how much health insurance will cost you each month because it’s a clear, predictable expense. But don’t overlook what you’re paying for or you may find yourself facing big costs later on, such as high deductibles or co-insurance.

3)   Over-insuring

It’s possible to have more insurance than you need. While good-for-you from a health perspective, this might not be that great from a financial perspective.

This doesn’t necessarily mean choosing the cheapest plan if you are a healthy individual—because we are all at risk for those unexpected medical events. But it might mean choosing a plan that has a more limited network, like an HMO if you are not seeing any specialists. Or choosing a high-deductible plan if most of your visits are routine preventive care.

4)   Under-insuring 

Of course, you don’t want to go too far in the other direction choosing too minimal of a plan either. If you choose a high deductible plan, you should be able to pay the deductible at any time if needed. In an ideal world, you’d have lots of time to save up cash to cover your deductible in an HSA linked to the plan. But if you enroll in a high deductible plan, and suddenly have some medical bills before you’ve accumulated enough in your HSA, you could be in trouble.

5)   Ignoring the savings accounts

FSAs (Flexible spending accounts) and HRAs (Health reimbursement accounts) pretty much mean free money on the table. But there are estimates that as few as 20% of people set up an FSA when it’s offered.

If you’re turned off by the idea of keeping receipts and faxing photocopies, give these savings accounts another chance. Now, most issue debit-like cards and many merchants are set up to automatically recognize FSA or HRA eligible expenses—so you can spend easily. You should still keep receipts as proof, and you might still need them for certain expenses. But the tax savings are well worth the work.