Archive for the ‘Individual Health Insurance’ 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.

You Could Lose Your Health Insurance When Your Parent Dies

Sunday, July 13th, 2014

The last thing you are worried about when a parent dies is what will happen to your health insurance coverage.  But unfortunately for many young people, they also lose their health insurance coverage when their spouse dies.  This also holds true for spouses, including those with young children.  In the U.S. News & World Report Health article “What to Do When You Lose Your Health Insurance,” Geoff Williams offers up options for those who lose their health insurance unexpectedly.  The article gives the example of a 30-year old woman who lost her health insurance coverage when her father passed away in April.  She has ulcerative collitis, a bowel disease that could cause serious complications without her medication and doctor visits.  She found out that she had lost her health insurance when she tried to fill a prescription and her insurance was declined.  It cost her $200 out of pocket just to buy the four pills that she needs for one day.

It’s not common for a 30 year old to have health insurance coverage under her Dad’s plan, so the woman in the example was lucky to have such a perk.  In this particular instance, her Dad had carried individual health insurance with his carrier for so long that they allowed him to keep his daughter on his plan to age 31.  She would have had to search for health insurance soon anyways, so she was likely already researching her options.  If you don’t have health insurance coverage, you can shop for it at any time.  The Health Insurance Marketplace open enrollment period is from November 15 to February 15, but the government dates aren’t necessarily written in stone.  You can apply for a health insurance plan at any time when you have had a life change that took away your health insurance.  You can also apply for health insurance with an individual health insurance company at any time during the year.  Most companies have open enrollment periods similar to the government, but for a shorter period of time.  You can make changes to your plan during that time, unless you have a life changing event some other time during the year.

Life changing events include death, the birth of a child, marriage, divorce, a change of income, relocation, or the sudden loss of health insurance.  If any of these events happen to you, the government gives you a 60 day grace period to obtain health insurance in the exchange.  You can get health insurance quotes from multiple companies here.  You can also use an agent that works for one health insurance company or a broker that shops the health insurance marketplace for you.  The last option is similar to shopping the market for health insurance with comparehealthrates.com.  Medicaid and the Children’s Health Insurance Program are available to those with low income.  COBRA is a health insurance option for people who have just lost their jobs, and therefore their health insurance coverage.  If your parent dies and you lose your health insurance, there are options for you to find health insurance coverage.  The woman in the article was able to get her insurance plan extended until August 1 so that her daily medication is covered, so she had a couple months to search for her own health insurance plan.

 

Hobby Lobby Employees Could Lose Health Insurance Coverage

Monday, June 30th, 2014

Hobby Lobby is one of many companies who claim that the Affordable Care Act, aka “Obamacare”, is forcing them to do something they believe is unethical.  In the article “Hobby Lobby: The Cost of Not Offering Health Insurance,” Andrew Abela and Irene Kim discuss the Supreme Court case Sebelius v. Hobby Lobby.  Hobby Lobby’s argument is that the federal law has forced them to make what they call an impossible decision.  They can either offer health insurance with coverage that they believe is unethical or they can pay fines to the government that they say could ruin their finances.  A couple Justices have suggested that the company does have a third option which they haven’t considered.  They could pay a $2,000 per employee fine and simply not offer their employees health insurance coverage at all.  The Justices argue that the company wouldn’t be any worse off than with the first two options.

Hobby Lobby argues that in addition to paying the per employee fine they would also have to increase employee wages so that their employees could go out and purchase individual health insurance plans.  But Justice Kagan said that whether the company chooses to offer health insurance plans that are against their religious beliefs or chooses not to offer health insurance to their employees and pay a fine, their costs will be just about the same.  That is certainly debatable.

If the company were to stop offering health insurance plans to their employees, they would have to increase employees’ after tax pay by the approximate amount that it would cost for them to purchase their own health insurance.  Premiums will cost more for a lot of individual and family plans than the discounted rate that Hobby Lobby would have received for a large group health insurance plan.  In addition to higher premiums, individual plans typically have higher deductibles that they company will have to account for in their salary increases.  Between the salary increases and the $2,000 per person penalty for 13,000 employees, the article estimates that Hobby Lobby will pay $60 million each year if they choose this option.  That estimate is quite a bit more than the company would pay to offer their employees health insurance.  But finances are not the only thing the company needs to consider.  A loss of health insurance could decrease employee morale, even with a salary increase to pay for individual health insurance.  The company also has a religious belief that they need to take care of their employees.  Hobby Lobby will likely continue their fight against the federal government forcing them to offer insurance coverage for birth control that is against their religious beliefs.

Health Insurance Mistakes to Avoid

Thursday, June 19th, 2014

Whether you are looking for a new health insurance plan or already have one, there are some typical mistakes people make that you should try to avoid.  MSN Money just posted the article “Don’t make these 10 health insurance mistakes,” by Allison Martin of Money Talks News.  It’s wise to consider these ten things even if you are not shopping for individual health insurance coverage because you are likely contributing some of your health care costs even in an employer sponsored plan.  It’s rarely the best decision to simply choose the cheapest health insurance plan.  You should consider much more than just cost.  The first mistake that people make when it comes to health insurance is basing their policy decision solely on the premium and deductible costs.  Keep in mind that if your plan covers 80% of hospital or surgical procedures, the 20% that you owe could add up to a large chunk of money.

Also make sure that you read the fine print in any potential health insurance policy.  Some of the most important things to look for are in-network or out-of-network coverage, HMOs, PPOs, different coverage options and whether referrals are needed.  If there is coverage that you know you need or doctors that you don’t want to leave, check that before getting a new plan.  It’s a big mistake not to shop around for health insurance from different health insurance companies.  Read reviews from customers and others who have worked with the company.  Believe it or not, purchasing COBRA coverage is often a big mistake.  You pay more than 100% of the plan cost, when you paid around 25% with your employer sponsored coverage for the same plan.  It pays to shop for a less expensive health insurance option, even if it only ends up being temporary.

Some people make the mistake of purchasing too much insurance coverage.  If you don’t see the doctor often, a platinum level plan might be too much coverage for you.  In the health insurance exchanges, as well as with private health insurance plans, there are lower levels of coverage options from which to choose.  Health insurance plans are not one size fits all.  Many coworkers just choose what their friends in the company have chosen, even though their insurance needs might be very different.  Do not make the mistake of not getting health insurance because you are healthy.  You never know when you will need coverage and many hospitals no longer treat those without insurance.  Make sure to ask for discounts for things like quitting smoking or being in a wellness program.  It costs a lot of money to see a provider who is not in your network, so think carefully before seeing an out of network provider.  Some people opt for health insurance plans that do not have prescription drug coverage.  This is one of the most common items that people regret when choosing a health insurance policy.  Avoiding these ten health insurance mistakes could save you thousands of dollars in the long run, so do your homework.

Health Insurance Premiums Have Been Increasing for Years

Saturday, June 7th, 2014

A recent study done by the Commonwealth Fund found that health insurance premiums have been increasing for years.  The nonprofit group performed this study to determine what had been happening in the health insurance industry before the implementation of the Affordable Care Act changes.  They wanted to show the public the whole picture so that people aren’t blaming all of the health insurance increases on Obamacare.  This information comes from Maggie Fox’s NBC News article, “Health Insurance Premiums Have Been Increasing Since 2008.”  They studied health insurance premiums in the private health insurance markets.  Those are the individual and family health insurance plans that Americans find and pay for out of their own pocket, not through a group or employer.  The study found that health insurance premiums have been steadily increasing since 2008.

Individual insurance premiums increased by at least 10% per year from 2008-2010.  We are still waiting to see what the premium prices will be for 2015, but most experts agree that they will be higher than this year’s prices.  The study results point out that premium increases really cannot solely be attributed to mandatory changes brought about by the Affordable Care Act because premium prices were rising 10% per year before the law took effect.  Premiums almost have to increase because health insurance companies have to cover much more than they covered before the ACA took effect.  Insurers can no longer deny coverage to people with preexisting conditions either, so it costs them much more money to offer insurance plans.  They can’t exclude maternity coverage from plans or charge cancer patients more for their insurance policies, so premium prices across the board are likely to increase.

State and federal run health insurance exchanges started offering plans this year.  Before these exchange plans were an option, an estimated 14 million people bought individual health insurance plans outside of the workplace.  This is either because they don’t have a job or their employer doesn’t offer them health insurance coverage.  Eight million people have bought insurance plans through the exchanges this year, according to the President’s administration.  A Gallup poll found that the number of Americans without health insurance went from 18% in December to 13.4% in May.  It’s going to take years before we know the true effect of the Affordable Care Act on the health insurance industry, especially because of the plans that have been allowed to continue offering sub-standard policies for two more years.  It will just be important to keep in mind that health insurance plans were rising before the ACA as well.  Increases in 2008, 2009 and 2010 were 9.9%, 10.8% and 11.7%, respectively.

It’s March Madness for Health Insurance Sign-Ups As Well

Saturday, March 29th, 2014

Not only is it a big weekend for March Madness basketball, it’s a big weekend for the health insurance industry as well.  March 31 is the deadline to sign up for health insurance or else risk receiving a penalty by the government when you file your taxes next year.  As long as you have started filling out a health insurance application, there is a grace period until April 7 to finish filing your paperwork.  The Associated Press offered important information in their article, “Monday is the deadline to sign up for health law”.  Government reports say that more than 6 million people have already signed up for health insurance through the newly created marketplaces since they opened October 1.  That number doesn’t even take into account the number of people who have signed up for new health insurance plans outside of the marketplaces since the new law took effect.  Four out of five of the people signing up in the marketplace have gotten a government tax credit to help pay for their premium cost.

The federal government’s website has a deadline of midnight on March 31, but states that are running their own marketplaces might have different deadlines in place.  You can sign up online, by phone, or even in person because many local areas have sign-up centers.  Since we are down to the wire with sign-up time, there will probably be long wait times no matter which way to choose to sign up through Monday.  If you don’t qualify for a government tax subsidy, but want to get health insurance to follow the law, there are many more options for finding health insurance.  You can compare health rates for individual or family insurance plans here.

In Tennessee, there is a “Local push underway to get health insurance before (the) deadline“.  Local ABC News affiliate WATE reporter Kayla Strayer posted a list of locations where people in East Tennessee can receive free help from insurance agents.  One out of six people in Tennessee has been living without health insurance.  Most of these people say that they simply can’t afford it.  Insurance experts are helping many of these Tennesseans determine whether they qualify for government subsidies as well as helping them with the application process.  One volunteer says that you can see the relief on people’s faces when they find a health insurance plan that they can afford.  Many have been going without health insurance, and in turn doctor visits and tests, even though they know they need treatment.  Americans have to sign up for health insurance by March 31, or risk being charged a fee.  Fees are equal to 1% of your income, or $95 per adult and $50 per child.  Some Americans will be exempt from this insurance mandate.

Out-of-Network Insurance Costs Can Be Sky High

Tuesday, March 18th, 2014

Unless you’re made of money, it’s really important to pay attention to the health care providers you see.  In-network and out-of-network may just seem like insurance terms, but if you you make the decision to seek health care that is out of the network established by your health insurance plan, you might end up paying a lot of money out of pocket.  In the Kaiser Health News article, “Warning: Opting Out Of Your Insurance Plan’s Provider Network Is Risky,” Michelle Andrews gives us the run down on what to expect out-of-network.  There are a lot of health insurance plans, especially in the new health insurance marketplaces, that offer consumers lower premium costs if they choose a network of health care providers that is more limited.  Some people opt for these plans with the assumption that they will simply go out-of-network if necessary and pay the added costs.  They may not know just how much those added costs will be though.

The Affordable Care Act has put limits on the out of pocket costs that Americans will have to pay each year.  For 2014, the limits are $6,350 for individuals and $12,700 for families.  These maximum out of pocket costs are only for in-network care though.  Most health insurance plans can charge you much more if you go out-of-network.  Some companies don’t even have a cap on your out of pocket costs when you go out-of-network.  Annual check-ups, vaccines, cancer screenings and other preventative care are now free for most Americans with health insurance plans.  But if you choose to receive these services from a provider out of your network, you will likely pay for these otherwise “free” services.  Health insurance companies often charge consumers higher co-payments and coinsurance for care that they receive out of their network.  In addition to that, doctors and hospitals can charge you what is known as “balance billing” when they are out of your insurance company’s network.  Since they aren’t in a contract with your insurer, many out of network doctors and hospitals will send you a bill for any charges that your insurance did not cover.

This in-network versus out-of-network cost structure holds true for Americans who purchased health insurance through the marketplaces, those with individual health insurance plans, and even workers who receive health insurance plans through their employer.  You would be hard pressed to find a health insurance plan that covers care at any doctor or hospital.  The four levels of plans in the health insurance marketplace are bronze, silver, gold and platinum.  They cover 60, 70, 80 and 90% of your medical services, respectively.  But those percentages only account for in-network care, something you have to keep in mind when choosing providers.  When taking a look at the silver plans specifically, 70% of them are considered narrow network, which means that 30% of the largest hospitals in your area will not be in-network.  With ultra narrow network plans, 70% of the largest hospitals in your area are out-of-network.  Emergency care will be covered because of a stipulation in the health care law, regardless of where you receive care.  Insurance companies cannot charge you higher co-payments or coinsurance if you are out-of-network, which is probably why most emergency room co-payments are so high to begin with.  But if you end up being admitted to an out-of-network hospital after your emergency room visit, you might want to seek a transfer to an in-network provider because you are no longer protected by the emergency care stipulation.

A Kaiser Family Foundation study found that more than half of people who purchase their own health insurance plan are willing to take a smaller network of providers in exchange for lower premium costs.  They also found that there is little standardization when it comes to individual and marketplace health insurance plans.  Do your research and call your insurer with every visit if you need to, just to make sure that your health care will be covered.  If you are looking for health insurance quotes, compare health rates offers quotes from multiple insurers all over the United States.

Latinos React Differently to Health Insurance Marketing

Saturday, March 8th, 2014

While we are the United States of America, we are made up of a wealth of different cultures and backgrounds.  Some health insurance marketing fails to take that fact into account.  In “Selling Health Care To California’s Latinos Got Lost In Translation,” NPR Station WCAI discusses the nuances with the Latino culture and health care.  The article specifically looks at California because 30% of the state speaks Spanish.  Unfortunately for many advertisers and health insurance companies, simply translating an English slogan or commercial to Spanish does not work.  Covered California, the state insurance exchange, started advertising benefits of the new health insurance laws that don’t actually appeal to many Hispanics.  Advertising the importance of not being denied coverage for pre-existing conditions is great for most Americans.  Many people have been denied individual health insurance or know someone who has.  But this article says that the majority of Hispanics in California not only have never even been insured, they also haven’t even shopped around for health insurance because they didn’t consider it.  Having health insurance isn’t typically a norm in their culture.

Another problem with the Covered California Spanish advertising is that the commercials end by listing a website to visit, but no phone number or address.  Latinos are all over the internet, but research has shown that they don’t prefer to do transactions online.  They would rather speak to someone on the phone or in person.  This especially holds true for purchasing health insurance because it can be complex, confusing, and many of them have never had health insurance before.  Officials say that they have been working on offering more locations for Latinos, as well as other residents, to be able to physically go somewhere and speak with someone about their health insurance options.

The Covered California name itself doesn’t really translate to something exciting and the ads have been perceived as “dry”, exactly the opposite of the Latino culture.  It’s seems simple as an outsider to see that you need to market your insurance plans differently to different cultures.  And in California, when 30% of the population is Spanish speaking, you have to account for that and the differences in the Latino culture.  It matters to the general population if Latinos sign up for health insurance coverage.  Why?  Latinos are younger and healthier, on average, so when they are in health insurance pools overall premium costs are lower for everyone else.  Only 6% of those who have signed up for the new California health insurance speak Spanish as their first language.  While the March 31 deadline for coverage sign-ups is fast approaching, an overall improvement in marketing strategy will help Latinos and the health care industry as a whole.

Individuals Paying More for Health Insurance Without Government Subsidies

Friday, February 28th, 2014

On the heels of the Office of the Actuary of the Centers for Medicare and Medicaid Services report detailing premium increases for many small businesses, there is another report saying that individuals are paying more for health insurance as well.  According to The Business Journal’s Kent Hoover in his article “Take out subsidies and Obamacare is Really Expensive,” those Americans who are not receiving government subsidies are paying significantly more in health insurance costs.  Some Americans qualify for government tax subsidies when they buy an individual or family health insurance plan in the health insurance exchanges.  Low and middle income Americans can buy insurance plans through the government website or individual state health insurance exchanges and receive a tax break based on their income level.

But eHealth Inc. just performed a study to see how much health insurance plans cost for those who don’t qualify for the government subsidies.  They compared data from before the Affordable Care Act went into effect with plan costs as of February 24 of this year, after the ACA prices took effect.  Average individual health insurance plans now are $274 per month.  That is a 39% increase from average plan costs before the ACA requirements changed health care.  Family plan monthly average costs increased to $663 per month.  This is up 56% from the same time last year.  The company performing the study sells an array of health insurance plans and wants to highlight what they perceive as the negative changes brought about by the Affordable Care Act.  Those who already had affordable health insurance may be negatively affected, while those people who didn’t have health insurance or with very high plan costs receive the benefits of the health care law.

Compare health rates from multiple insurance companies to find the most affordable premiums for you or your family.  If you don’t qualify for a government subsidy or have health insurance through your employer, there are countless health insurance plan options available from an array of health insurance companies.

Health Insurance Is Going the Way of Retirement Plans

Sunday, February 16th, 2014

Just a couple decades ago, American retirement plans made a big shift from pensions to 401k’s.  Instead of receiving a defined benefit pension, workers started contributing to plans and making their own decisions about how they would receive their money.  A lot of people are forecasting a similar change in the health insurance industry over the next 5-10 years.  Right now many employers offer health insurance in a defined benefit way.  They choose the exact health insurance options and you can choose to pay for the plan or opt to buy your own individual health insurance.  Insurance News Net posted an article from The Pittsburgh Post-Gazette’s Bill Toland which says that “In 2020, Workers Will Decide (their own) Health Benefits.”

Many experts believe that the face of health insurance will change dramatically.  They forecast that people will shop online and choose the specific health insurance options that they want for themselves from private exchanges.  Companies will pay a certain stipend to their employees via a health account and that will go towards their health insurance plan costs.  If people choose a health insurance plan that is more than their employer stipend, they will have to pay the rest of the bill themselves.  They will shop in online private health insurance exchanges run by health insurers, like Highmark, or benefits consultants or brokers..  If an insurance company is running the exchange, all of the plans will be from them.  But if the exchange is run by benefits consultants or brokers, there will be plans from multiple insurance companies.  Plans will differ in prices and coverage.  Each exchange will likely offer around 6-10 different plans.

It was easier for large companies to make the pensions switch because they almost immediately saw huge cost savings.  It is a little different with the health insurance plans because although they will not see huge cost savings, they will see a large reduction in the amount of administration.  They are also offering better benefits to their employees, making them more competitive as employers.  But small and mid-sized employers will see even more benefits initially than the larger companies.  Experts predict that many smaller companies will make this switch to private exchanges in the next year and a half.  Larger companies will switch as well, but it will take a large employer like McDonalds or WalMart making the big move before many other make the jump as well.