Archive for the ‘Fallon health plans’ Category

Massachusetts Consumers Receive 2nd Highest Health Insurance Refunds in the U.S.

Thursday, July 24th, 2014

You could be one of the millions of Americans getting a refund from your health insurance company soon.  The Affordable Care Act has a law called the 80/20 rule, where insurance companies have to spend at least 80% of total premium costs on medical care or improving the quality of health care for consumers.  In The Boston Globe’s “Health Insurance Companies Refund $15B to Mass. Consumers,” Chelsea Rice talks about the refunds going out and the companies who will be paying them.  The U.S. Department of Health & Human Services released this data showing that Massachusetts consumers will be getting the second highest amount of refunds in the United States.  The total refund amount for the U.S. is $332 million, which will pay around $80 a family those those receiving refunds.  Florida health insurance companies will be paying the most refunds with $41.5 million owed.  Massachusetts residents will be paid out $15 million, which amounts to $133 per family getting a refund.

Almost all of Massachusetts’ residents have health insurance, most through their employer, but 1/4 of them still struggle with the burden of high health insurance costs.  The ACA’s 80/20 rule brings transparency and competition to the health insurance marketplace.  It also offers greater value to consumers in their health insurance plans.  Large group plans have to follow an 80/15 rule.  Insurance companies operate more efficiently when they are following this rule by cutting out unnecessary expenses.  They have been able to lower premiums throughout the U.S. by $3.8 billion.  Companies who do not follow the 80/20 rule during their fiscal year have to refund the excess they spent to consumers in their health insurance plan.  Those receiving refunds will get them by August 1 either by check, a discount in next years premium, an account reimbursement or a direct reimbursement through their company.

In Massachusetts, more than 208,000 consumers will be receiving an average refund of $133 per family.  This new 80/20 rule has made quite a shift in the amount of upfront value that consumers receive from their health insurance plans.  The biggest shift by far has been in the individual health insurance market.  Back in 2011, the HHS found that 61% of consumers in the individual market received upfront value from their plans.  Just two years later, 81% of people are receiving upfront value from their individual health insurance plans.  Ten health insurance companies in Massachusetts will be sending out refunds, including Fallon Community Health Plan, Neighborhood Health Plan Inc. and Tufts Associated HMO.  If you are one of the Americans receiving a refund from your health insurance company, look for that in the next week.

Fallon Health Plans Etc: Medicare Changes for Seniors

Monday, September 13th, 2010

Even if seniors weren’t planning to change their Medicare drug plans this fall, they may be forced to because the number of available plans is decreasing.  This could effect three million seniors, according to the Associated Press article “More than 3M seniors may have to switch drug plans.”  Ricardo Alonso-Zaldivar’s article says that the government’s goal by reducing the number of plan offerings is to simplify and streamline Medicare.  Seniors with drug plans through Medicare and a private insurer like Fallon Health Plans might have to pick a new drug plan if theirs is discontinued.  It is possible that their insurance company will automatically reassign them to a new plan though, saving the headache of switching and possibly saving them money.

While most states currently offer around forty different choices for Medicare drug plans, this change will lower that number to around thirty per state.  The government hopes that this will decrease the confusion felt by some Medicare recipients.  It is possible that when seniors compare health insurance changes they could see differences in their premiums or copayments.  The changes could be better or worse.  While some current Medicare recipients may have a small disruption, these changes should make it much easier for new recipients to join Medicare in the future.  Many Republicans are arguing that this is just what President Obama said he wouldn’t do, reduce the number of choices that citizens have regarding their health insurance.  But consumer advocates say that these changes have been needed for years and will only benefit the population by reducing confusion.

Fallon Health Plans Appeals State’s Caps

Friday, July 23rd, 2010

bostonMassachusetts state regulators are trying to get skyrocketing health care costs under control.  According to The Boston Globe article “State caps more health insurance rates” by Robert Weisman, 137 health insurance companies had their rates capped at 2009 levels.  Fallon Health Plans and two others filed appeals on the decision; they will wait until later in the summer to find out what will come of their appeals.

Four companies in the small group market did have premium increases in the single-digits approved.  Three insurers will be providing more information to the state before a decision is made on their requested double-digit increases.  This latest decision is for the three-month period ending in September and is quite a different outcome than the last three-month period where nearly all of the premium increases were rejected.

While officials with the state argue that they are using these rate caps to help small businesses and working families struggling in a tough economy, insurance companies say that the rates officials are forcing upon them are wreaking financial havoc by making them operate at a loss.  Insurers were given the ability to prove their case for increasing customers’ rates.  If they can’t prove necessity, their rate increases will not be approved.

Premature Births: Fallon Health Plans

Saturday, June 12th, 2010

preemieWith half a million premature babies born each year in the United States, it’s amazing that the cause of many of these early births is still a mystery in the medical world.  In “Premature births still a medical mystery” by Rachael Rettner of Live Science, Rettner discusses recent developments about the combination of factors leading to premature labor and delivery.  A traditional pregnancy lasts between 38 and 42 weeks, or approximately 9 months.  Any birth at 37 weeks or before is considered a premature baby, often resulting in underdeveloped systems and medical issues.

Around half of premature deliveries can be easily explained.  When a mother is carrying multiple children at once, there is a much greater chance that she will not carry the babies full term.  Many labors are also induced or c-sections performed because of complications with the pregnancy.  In those early labors that don’t fall into either of these categories though, science is working to determine what is causing them.  The three things that they believe are important to further research are genetics, infections, and a woman’s social and lifestyle environment.

Pathogenic infections are believed to cause preterm births because they make a pregnant woman’s immune system work in overdrive, which can trigger labor.  Scientists think that infections may actually cause up to a quarter of premature births.  It’s also believed that a woman’s genetics may play a significant role in determining whether they will have a premature labor and delivery.  Premature births run in some families and women are more likely to have subsequent premature births if they already have had one.  Environmental factors also play a role in premature birth rates.  Areas with high poverty levels tend to have more women delivering prematurely based on healthcare availability, housing, their jobs, and social norms.  Income, stress levels, and eating and drinking habits may also play a role.

As scientists learn more about normal pregnancies and labor, they will better be able to translate that knowledge to premature labor and birth cases.  The main goal is avoiding premature births to help babies and children be healthier and reduce insurance costs for Fallon Health Plans and other health insurance companies.

Fallon Health Plans & Pregnancy

Wednesday, May 19th, 2010

mom and babyThere is a lot of planning to do for having a baby before you even become pregnant, according to the article “Pregnancy,” from Health Key.  While most potential moms are thinking about what they’ll need to buy for baby and how to decorate the nursery, there are physical steps you should take before even becoming pregnant.  Make sure that you have health insurance from a company like Fallon Health Plans.  Have an exam with a doctor to discuss medications you take and any immunizations you may need.  Don’t take medicine like ibuprofen or aspirin, but do start taking a prenatal or multivitamin.  Take care of any dental work you need done.  Keep track of your menstrual cycle because it will help you get pregnant and help your doctor figure out your due date.  Live a healthy lifestyle through your diet and regular exercise, along with avoiding caffeine, alcohol, tobacco, illegal drugs and unnecessary medications.

Once you become pregnant, continue with all of the healthy lifestyle changes you’ve already made.  Also, get regular checkups from a doctor or midwife.  Your first exam will probably be the longest and include blood work, a pelvic exam and urine test, weight and blood pressure check and a listen for the baby’s heartbeat.  At your following appointments, your belly and weight will be measured and your blood pressure and urine tested.  It is important to go to all recommended prenatal visits because doctor’s are working to make sure nothing is wrong with you or your baby.  There are optional screenings you can do to test for Down Syndrome and other birth defects.  Near the end of your second trimester, you will be tested for gestational diabetes.  Some of the warning signs that should immediately lead you to call your doctor include bleeding, cramping, stomach or back pain that doesn’t go away, painful urination, bad headaches, a fever, blurred vision, or sudden swelling in your extremities.

Coming Soon: Compare Health Insurance Pools

Tuesday, April 6th, 2010

861559957_1d2a7ccdd0_mStates need to decide whether or not they are going to participate in President Obama’s new high-risk health care pools, according to the Chicago Sun-Times article “High-risk health insurance pools set to begin in June.”  Monifa Thomas’ article explains that not all states will even participate, but they have to make their decision within 90 days of the health bill signing on March 23.  Compare health insurance in some states and you find that these high-risk insurance pools already exist in 35 states, although some of their rules will surely change.  These high-risk insurance pools are for people who can’t get other, affordable insurance coverage because of pre-existing conditions.  They are temporary until 2014, when insurance exchanges where consumers can shop for heath insurance will replace the pools.

While federal health officials are unsure how much premiums will cost in these new pools or how many people will now have coverage that didn’t, they are confident that the pools will help many of the uninsured.  Consumers will only have to pay premiums that are 35% of the program cost, compared to Illinois’ current program where consumers pay 2/3 of the cost in premiums.  For six months, certain pre-existing conditions cannot be excluded from coverage.  Most states that already have high-risk pools in place will most likely transition those consumers into the new federal high-risk pools, although that will take time.  Whether you have an easier time getting affordable coverage from companies like Fallon Health Plans or state run high-risk insurance pools, the general idea of the health care reform is for more Americans to be insured.  States opting out of running their own pools will have the Department of Health and Human Services run one for them.

Health Insurance with Maternity Coverage from Fallon Health Plans

Thursday, March 11th, 2010

pregnantMaternity coverage is often an optional rider with health insurance, so if you are thinking of becoming pregnant or are a woman in her childbearing years, it is important to look for health insurance with maternity coverage.  Most employer sponsored plans have maternity coverage included, but you have to be specific with individual plans to choose the right coverage.  Having a baby in a hospital averages $6,000-$10,000 and can be even higher depending on whether you have a c-section or the baby has to have extra care.  You want your maternity coverage to include visits to your doctor during pregnancy, lab work, hospital stays, sonograms and ultrasounds, prescriptions for pre-natal vitamins and any other medications you need, and care for your newborn.

Some individual health plans have a waiting period before you start receiving maternity coverage.  If you have health insurance from a company like Fallon Health Plans, contact them to see what your coverage includes.  For women who become pregnant before they have obtained health insurance, it is best to contact state or federal government agencies to see what help they can offer you.  Unfortunately there are many risks associated with pregnancy for both the mother and child.  Health insurance with maternity coverage is the best way to take the burden of the financial side of things away.  Fallon Health Plans of Massachusetts is one of the best insurers in the US.  You can look online to determine coverage and available doctors or call and speak with one of their customer service representatives.  Most coverage plans will include everything you need for your pregnancy.

Fallon Health Plans Gets Great Ranking

Sunday, February 28th, 2010

Fallon Health Plans was named one of the top ten commercial, Medicare, and Medicaid health plans in the United States last year, according to company press release “Fallon Community Health Plan achieves national top 10 ranking.”  U.S. News & World Report ranked the health plans in a joint report with the National Committee for Quality Assurance.  Fallon Health Plans was the only health plan in America to be included on the Honor Roll in all three product categories.  The Honor Roll looks at the commercial, Medicare, and Medicaid managed care plans and picks the very best.

The FCHP commercial HMO plan was ranked 7th out of 239 plans.  FCHP’s Medicare plan was ranked 2nd out of 166 similar plans and their Medicaid plan was ranked 3rd out of 82.  These rankings made Fallon Health Plans the top Medicare health plan in Massachusetts.  When you compare health insurance plans, especially those in Massachusetts, you are bound to find Fallon Health Plans as one of the best.  The President and CEO of FCHP is pleased to be recognized for their hard work.  Their goal is always to give their members the highest quality of care and services.

If You Didn’t Compare Health Insurance Plans, You May Need “Healthcare Watchdog”

Sunday, January 31st, 2010

watch dogAccording to company press release “Healthcare Watchdog Launches, Promises Everyone a Fighting Chance Against Greedy Health Insurance Companies,” Healthcare Watchdog is there to help consumers.  It is important to compare health insurance plans and coverage before selecting the plan that is right for you.  Unfortunately though, sometimes the plan doesn’t cover everything that was intended and consumers find themselves with a mountain of health insurance bills.  Healthcare Watchdog is a company founded in 2009 whose purpose is getting your valid health insurance claims covered, obtaining reimbursements when providers pay less than promised, and other health insurance dilemmas.

Shockingly, the press release states that over half of bankruptcies are due to medical costs and 3/4 of those who filed actually did have health insurance.  Healthcare Watchdog charges a monthly fee to customers to provide their consumer advocacy services.  Interesting concept, but a cost that could be avoided by finding great health insurance.  Fallon Health Plans in Massachusetts work hard to meet their goal of developing healthy communities.  They strive to improve the quality of their participants’ lives through great communication, wellness programs, and innovative online technology.  Fallon strives to meet their customers’ needs daily and hopes that you won’t ever need a service like Healthcare Watchdog.  But if you’re looking for an extra insurance against unwanted health care costs, the service might be right for you.