Tag Archives: Health insurance

5 Ways You Could Benefit from the Health Insurance Exchanges

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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

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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

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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

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 This post originally appeared on the Mint.com 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.

 

 

Do you Need Supplemental Health Coverage?

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With more and more people signing up for high deductible health plans, supplemental health policies have also become more popular. According to America’s Health Insurance Plans, high deductible health plan enrollment has grown by over 18% since 2011. Since these plans have deductibles of anywhere from $1,200 to $8,000, a supplemental policy to pad your plan can look very tempting.

Supplemental plans can either help pay your deductible and out-of-pocket costs, or they can pay out a lump sum of money either at one time or each day that you qualify for benefits.

The plans can be pretty inexpensive—as low as $12 a month for an individual and $20 to $30 a month for a family. But the benefits can vary drastically so make sure you know what you’re buying.

Considering supplemental health coverage? Ask these questions.

How much would an emergency would cost you?

Add up your deductible and the out-of-pocket you would owe for a few days in the hospital. Of course, you can’t be sure without knowing the actual costs, unless your plan has only fixed co-pays. But you can estimate: assume any major event would cost well over $10,000—how much would your co-insurance be?

Getting a rough idea will help you understand how useful a supplement might be.

Would you have other (non-medical) costs?

In an emergency, you might find yourself with other financial hardships such as lost wages, living expenses, or transportation costs. A supplemental policy can cover these expenses. Usually, the plan pays you a cash sum and you can decide how to spend it. One advantage of this type of policy is that it can help cover expenses that are not HSA-eligible.

What are the plan’s benefits?

Will the benefits cover enough of your likely costs to be worth it? A typical accident or injury plan may pay out $250 for each day you’re in the hospital, while a critical illness policy will pay a lump sum if you are diagnosed with cancer or have a stroke. If your day to day costs would far exceed the daily benefit, the policy is not worth the money.

How do you qualify for benefits?

It’s important to read the fine print here. A policy may only start paying benefits if an illness or injury reaches a certain degree of severity or may limit the days of benefits it pays. It may also pay much lower benefits for more common diseases—the times your most likely to need it. For example, one consumer was told his policy would pay $5,000 for cancer, but in reality, the $5,000 was only for internal cancer (breast or lung) and skin cancer was paid at $100.

The bottom line is, weigh the costs and benefits of supplemental health insurance carefully. If you have a typical health plan, you probably do not need an additional policy. But if you have a very skimpy or high deductible plan, you’re more likely to find a supplement to be helpful.

And most importantly, remember that these plans are meant to be what the name suggests—a supplement—and not a replacement for full health insurance.

 

Health Care gets Cheaper for Women

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Beginning August 1st 2012, women can expect to pay a lot less for preventive care, thanks to the Affordable Care Act, the health reform law. Plans were already required to cover a list of fourteen preventive services under the Act, such as mammograms and cervical cancer screenings. But now eight additional services will be covered at no out-of-pocket.

That means women will no longer pay deductibles or co-pays on:

  • Annual women’s exams
  • Contraception and sterilization
  • STD screening and counseling
  • HIV screening and counseling
  • Testing for HPV
  • Breastfeeding support and supplies
  • Diabetes screenings while pregnant (gestational diabetes)
  • Domestic violence screening and counseling

About 47 million women are expected to be eligible for these additional benefits—great news because right now, one out of three insured women have such high out-of-pocket costs, they avoid getting needed medical care.

When will I see the benefits?

The benefits don’t exactly kick in immediately: They’ll go into effect when your health plan renews. For most people, this means the first of the new year or the start of an academic year.

Does this include all health plans?

There are a few exceptions: Some health plans that were created before March 23, 2010 are exempt as “grandfathered” plans. And some religious organizations (such as churches or schools) do not have to offer their employees the same benefits.

How do I find out if my health plan is included?

Call your health plan and ask if you have a grandfathered plan.

The Women’s Law Center has a nice script on what to say if you like having all the details. If you work for a religious organization, ask your employer.

Keep in mind there are a few limitations—some services are only covered annually (HIV, STD, and domestic violence screenings) or have other restrictions (HPV screening is covered after age 30). For a full list of all the benefits click here.

 

 

Insurance Companies Are Courting You

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Have you noticed your health insurance company getting a little warmer and friendlier lately?

A trend of insurers “putting customers first” has definitely begun. Whether it will translate to real savings for consumers is the question.

In a great, recent blog in the New York Times, author Tanzina Vega talks about how insurers have been ramping up their PR campaigns, trying to combat the reputation the industry has picked up for bad service over the years. Now, many of the largest companies are trying to put more of a focus on their customers, in a variety of forms: discounts and rewards for losing weight or quitting smoking, consumer-friendly cost comparison tools, or just slick campaigns branding themselves as not just insurance, but family friendly health care solutions.

So this got us thinking. How do health insurers rank when it comes to customer satisfaction? Are they really that bad? Are they getting better?

We looked up ratings from the American Customer Satisfaction Index—a national scoring of major service sectors (ranging from 0 to 100). Turns out Americans’ opinion of health insurance companies has generally been getting better over the last 10 years. Though they are still near the bottom of the pack with an average score of 71: just a bit worse than the US Postal Service, which averaged 73, but still lagging far behind internet retail, at 81. However, most of us think calling our health plan is better than calling the airline we’re flying.

ACSI Health Insurance 2012
To compare other industries, visit http://www.theacsi.org/

 

Why the big push to please consumers now?

Much of it relates to the health reform bill, which is expected to make almost 20 million Americans newly eligible for private insurance coverage. So what better way to start competing for new customers?

So we might expect the score for health insurance companies to continue to rise, but is customer satisfaction the same as good health care coverage? Or could it be a distraction from increasing out-of-pocket costs? Reward programs are nice but when it comes down to needing a surgery covered, they’re no substitute.

We have yet to see, but one thing seems promising: insurance companies are paying more attention to you than ever before.

Tell us what your health plan has done for you that you love, and how you’d rank them on the Customer Satisfaction Survey.

 

 

 

When Does my Pre-existing Condition Matter?

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“Pre-existing condition” is sometimes a phrase that everyone is afraid of. Can you be denied health insurance? Can your health plan refuse to pay? Should you avoid the doctor so it’s not in your record? Here are the facts.

What is a pre-existing condition?

A pre-existing condition can be any health issue that you had before applying for health insurance. It could be anything—such as an abnormal pap smear, high blood pressure, asthma, cancer, or an old sports injury. However plans cannot consider pregnancy or any genetic information as a pre-existing condition, as well as conditions in a newborn or newly adopted baby, as long as the child had health insurance within 30 days of birth.

When does having a pre-existing condition matter?

Applying for individual health insurance

Depending on how serious the condition is, a plan CAN

  • Deny you coverage completely or
  • Decide to only cover the pre-existing condition after an exclusion period. You’ll still pay premiums and get coverage for other health issues, but the plan won’t pay for any care related to the pre-existing condition. The exclusion period can be between 6 to 18 months.

However a plan CANNOT

  • Deny you coverage if you had COBRA and your coverage is running out, and you apply for the new plan within 63 days. This does not count if you voluntarily disenroll from COBRA before the benefits run out, for example, because it’s too expensive.
  • Deny coverage to children under age 19 on their parent’s plan.
  • Impose an exclusion period if you had another source of health insurance for at least the last year, and you didn’t have a break in your coverage longer than 63 days.

Joining an employer group plan

A group plan CAN

  • Impose a waiting period before it covers you at all. 3 month waiting periods are common.
  • Impose an exclusion period before it covers your pre-existing condition (like that described above). However, unlike individual plans, the waiting period cannot be more than 12 months and can only be applied to conditions that you had treated in the last 6 months.
  • Impose both a waiting period and an exclusion period. If the plan does this, the waiting period and exclusion period must run concurrently—or in other words, one can’t start after the other ends.

But a group plan CANNOT

  • Completely deny you coverage or give you different coverage than other members of the group.
  • Impose an exclusion period if you had another source of health insurance for at least the last year, and you didn’t have a break in your coverage longer than 63 days.

I thought Health Reform was supposed to fix all this.

You’re right! Starting in 2014, health plans will no longer be allowed to deny coverage to anyone because of pre-existing conditions, regardless of age. Plans will also be required to renew your coverage at a reasonable rate if you develop a medical condition, as long as your premiums are paid.

Then what should I do when I apply for coverage?

You should be honest. A health plan does have the right to rescind (cancel) your coverage if you intentionally left information off your application.

And while it’s never a good idea to put off medical care when you need it, if you expect to get group coverage in the next few months, you might be able to avoid any waiting periods by refraining from getting any advice or treatment for a condition six months before the coverage will begin.

If you’re denied coverage

You can apply for the Pre-Existing Conditions Insurance Plan (PCIP). This plan provides affordable benefits that are just as good as private individual plans and cannot deny you coverage or charge you more based on your health condition.

So the bottom line? Pre-existing conditions will still matter until 2014. The best thing you can do is to try to never let more than 63 days elapse between coverage—get COBRA or a private plan as soon as you can. But if this happens, and you can’t find coverage, the PCIP is always an option you can fall back on.

 

Accessing Specialty Care: Are you Covered?

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It’s time to see a specialist. Will your health plan cover it? And how much will they pay? These questions are pretty familiar to most of us. Many people end up either getting care they thought was covered and then getting hit with a big bill, or spending so much time getting the right referrals and authorizations that they give up.

How can you avoid these two situations? A little bit of homework and a few phone calls may be all you need.

 

Step One is finding out what type of plan you have: HMO, PPO, or POS? This will tell you how to navigate physician networks and referrals.

-    If you have an HMO, you’ll need to get a referral from your Primary Care Physician (PCP) before you can get care from any specialist.

-    If you have a PPO, you can go to any specialist you like without a referral. However, if you see an in-network provider, your plan will pay a bigger portion of the bill. For example, your share might be 20% for an in-network specialist but 50% out-of-network.

-    If you have a POS plan, you do not have to have a PCP, but if you do, he or she can refer you to both in-network and out-of-network providers. You do have the option to go out-of-network without a referral, but you would pay more. POS plans are basically a hybrid between HMOs and PPOs.   

 

Step Two is finding a provider. Now that you know what type of plan you have, you know whether you need a referral to see any kind of specialist. Your PCP might be able to give you referrals, but it’s your job to make sure that the physician is part of the plan’s network.

Asking the question “What providers are covered?” will usually get you farther than the question “What type of specialist is covered?” This gets back to the importance of your plan’s network. Let’s say you need to see an allergist. Your plan can’t say whether it always or never covers allergy testing, only whether it covers a certain allergist.

If you don’t already have a specialist in mind, start with the plan’s website, where you can usually filter your provider search by specialty. If you don’t see what you need, find out what Physician Groups or Medical Groups the plan works with. This will usually be in your Summary of Benefits or you can call the plan to ask. Then try searching on the Physician Group’s website. Sometimes this gives you more current information than going through the health plan.

 

Step Three is calling the provider. Once you’ve found a provider you want to see, it’s always a good idea to call them to make sure they take your plan, even if the homework you did in Step Two says they do. Doctors can join and leave networks at any time so the plan’s information may not be up to date.

Ask about the specific name of your plan, not just the insurance company—for example “The Purple Preferred PPO” rather than “Blue Cross”. Providers might accept some Blue Cross plans, but not all of them.

 

Step Four is finding out the rules before you get the care. Often times, the physician’s office staff can help you with this. Before you leave the office, ask them to check on coverage for tests and procedures that your doctor has prescribed. This is also a good time to ask about coverage for other needs like medical equipment, prescription drugs, or additional referrals and authorizations. These staff are often more familiar with the language and have the specific medical codes to get more exact answers than you might be able to on your own.