RI Insurers Are Sharing Health Insurance Claims Data

May 3rd, 2014

There is an interesting development when it comes to your health insurance and your privacy.  According to Rhode Island news station WPRI, health insurance companies in Rhode Island are preparing to send your personal health care information to the state.  This is happening in twelve other states as well in an effort to better understand health care trends and costs.  The goal of this information sharing is to make the entire health care system in Rhode Island, and the other states participating in this program, run more smoothly.  All sharing of information is said to be anonymous, so you shouldn’t have to worry about personal consequences related to your health insurance company sharing your health care information with state or federal agencies.

This program in Rhode Island is called the All-Payer Claims Database Project and is a collaboration between multiple agencies.  Rhode Island’s Department of Health, Office of the Health Insurance Commissioner, their health benefits exchange and their health and human services department will be sharing health care information and compiling data related to both medical and pharmacy claims.  The project assures residents that names, addresses and any other personal information will be removed before the health insurance data is shared.  Claims information will be used to help the Rhode Island health care system improve overall.  They also seek to improve the quality of health care.  Companies started gathering data at the beginning of this year.  Starting May 1, companies are now submitting their data to the project.

A representative from the ACLU fears that the information sharing will not be as anonymous as the program promises.  He thinks that people would be able to put a name to the indirect information given if they truly wanted to.  Sharing your personal health information could hurt you in a job hunt or in other areas as well.  But you truly should be safe because the agencies involved assure Rhode Island residents that their information is safe.  Keep in mind that you can opt out of having your health insurance claim information shared for this project.  You can opt out online through a special website, but there have been complaints that is wasn’t working.  Some people worry that those who opt out might actually be targeted though, so that’s something to think about.  If the anonymous sharing of your health, dental and pharmacy claims helps improve the overall health care system in your state, would you support it?

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Pennsylvania Health Insurers Offer Low Cost Non-Compliant Plans Through 2017

April 27th, 2014

Pennsylvania is one of nine states that is giving health insurance customers a break before forcing them to adhere to Affordable Care Act guidelines.  According to the Pittsburgh Business Times’ Kris B. Mamula, Highmark health insurance is the latest company offering renewals that don’t meet all of the new insurance mandates.  In “Highmark prepares new renewal plan health insurance,” we learn that Highmark is following in the footsteps of UPMC Health Plan with their new renewal options.  UPMC was the first company in western Pennsylvania to offer these non-compliant health insurance plan renewals that are lower cost.  They started offering these plans four months ago.  Highmark Inc. will be offering new renewal plans to employers who provide health insurance coverage.  The options will be available during both the July and December enrollment periods.

Plans were introduced during an insurance broker meeting last week.  Although minor details were not yet given to the public, Highmark is calling the plans “grandmothered plans”.  These lower cost plan options do not meet the requirements of the Affordable Care Act.  Insurance companies in Pennsylvania and eight other states have a three-year window where they can continue to offer their existing health insurance plans without penalty.  They will have to meet the Affordable Care Act guidelines in 2017, but the added three years gives employers some time to plan out their course of action.  More details are expected to be released by Highmark soon.

When UPMC started offering their lower cost plans, premium increases were between 0 and 48%.  Plans that incorporate the mandated coverage from the ACA had premium increases 100% and greater.  Insurance brokers who were at the recent meeting said that Highmark will be offering more flexibility with their non-compliant health insurance renewal plans.  Highmark is also likely to see a large increase in sales of their Community Blue plans, which limit the network of providers available.  It’s good news to employers and others who will benefit from the three year reprieve given in Pennsylvania and eight other states.  But eventually they will all have to meet the new guidelines put into place by the Affordable Care Act.  They will save money and have added time to determine their best plan options starting in 2017.  But in other states, health insurance companies will already be settled into their new health plans and insurers in these nine states will have to play catch up.

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Hard to Find Health Insurance Anywhere After March 15 Deadline

April 24th, 2014

The deadline to sign up for health insurance and meet the Affordable Care Act requirements has come and gone.  Health insurance exchanges will not start offering plans until later this year for the next enrollment period.  But most people were not expecting some private health insurance companies to stop selling health insurance plans after March 31 as well.  According to Health Day’s Karen Pallarito, “Suddenly Health Insurance Is Not For Sale“.  One Tennessee insurance broker said that many health insurance companies in her area are not selling insurance plans until the exchanges open again later this year.  One of the main reasons that some health insurers have made this decision is because they believe they will attract healthier, younger people when the government exchanges are open as well.  Insurance companies can no longer reject sick people or those recently diagnosed with a disease.  They are hoping that they will be able to attract the young, healthy individuals that will keep their costs lower.

For coverage that will start in 2015, the next open enrollment period starts on November 15.  Penalties for not obtaining insurance coverage yet won’t be issued until tax time next year, but those who waited might just be ready to purchase insurance come November.  Healthy and young individuals are most likely to plan in advance when shopping for health insurance.  That is why it makes sense economically for health insurance companies to only offer plans during open enrollment times.  Individuals who have recently become sick or need some type of care right away are the most likely to search for health insurance at any time of the year.  Open enrollment periods were designed to deter people from waiting until they are sick to shop for health insurance.  When that happens, insurance can become unaffordable all around.

Health insurance companies offering plans outside of the exchanges can choose whether or not to sell health insurance year round or not.  One survey of 180 health insurance companies found that one or more health insurers will be offering plans after March 15 in only 14 states.  Some of those plans will only be offered through the end of April.  You will be able to find health insurance in some places though.  Arizona’s non-profit insurer Meritus plans to continue offering health insurance plans year round.  They are currently working with the Arizona Department of Insurance.  In Nevada, their Health Coop will continue offering insurance plans to consumers around Las Vegas.  There may be some states where it is difficult to find health insurance before November 15.  If you are looking for a plan, you will probably have to work a little harder than before the deadline.

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Strong Support for Mandatory Birth Control Coverage

April 22nd, 2014

Back in 2010, the Affordable Care Act mandated that private health insurance companies cover birth control for their plan participants.  It is one of the so-called 10 essential benefits that must be covered by insurers.  Some of the other benefits include screenings for cancer and vaccines.  You don’t even have to pay co-pays for these 10 essential benefits and often don’t have to pay anything for the contraception either.  A recent study at the University of Michigan found that the majority of Americans strongly support the mandate for birth control coverage by insurance companies.  They surveyed more than 2,000 people for the study and found that 69% of them were in support of this mandatory contraception coverage.  Not surprisingly, women were among the strongest supporters of the mandate.  Black and Hispanic respondents also supported the mandate in higher percentages.

This information comes from NBC News’ Maggie Fox in the article “Most support birth control mandate, survey shows“.  While most Americans support the mandate for health insurance companies to cover birth control, there is strong opposition to this mandate as well.  Religious groups, employers with conservative beliefs, and outspoken conservatives don’t believe that companies should have to pay for contraception when it is against their personal beliefs.  Two employers filed a lawsuit against the mandate, saying that it is against their religious beliefs to support some kinds of birth control.  The Supreme Court will rule on that lawsuit in June of this year.  Health insurance companies had to revamp a lot of their health plans with this change in contraception coverage, as well as other mandates that have been coming into law since 2010.  The majority of Americans support the mandated birth control coverage, so you will continue to find this available when searching for health insurance plans.

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7 Health Insurance Issues to Follow This Year

April 6th, 2014

Kaiser Health News and USA Today collaborated on an article asking “What Happens Next On The Health Law?“.  Julie Appleby, Mary Agnes Carey, and Phil Galewitz gave us seven things to watch for between the end of enrollment on March 31 and the beginning of the next enrollment period in November.  This health care reform has been hotly debated for the length of a presidential term already and will likely continue to be a hot topic into the future.  Now that the first enrollment period has come to an end, we can finally start to measure some of the successes, failures, and changes that have actually occurred.  Before that, it was just speculation.

Everyone wants to know how many people actually signed up for health insurance plans after the law took effect.  We certainly don’t have any concrete answers yet, but President Obama says that early indications show 6 million people signed up.  This doesn’t take into account those Americans who got health insurance outside of the government agencies or with insurance companies.  The March deadline was also loosened for people who tried to sign up and had website issues.  It could be a month or so before we get concrete numbers.  For the law to work ideally, young and healthy individuals needed to sign up.  So who actually did enroll?  Around one-quarter of them were in the targeted demographic of 18 to 34.  The majority of new enrollees were aged 35 and up and were female.  Health insurance rates are based on state enrollment though, so it’s more important to determine who signed up in each state.  Those states who had more older, sicker individuals sign up might see increasing health insurance rates.

The biggest question to be answered is whether or not the law actually affected the number of uninsured Americans overall.  There are no clear statistics to answer this question just yet.  The Kaiser Family Foundation says that they are pretty sure the uninsured rate has gone down, based on a Gallup poll and McKinsey phone survey.  That last survey found that 27% of those who signed up for health insurance previously did not have any.  Everyone will be closely tracking final figures on this topic.  You will not find the same plans and prices when the next enrollment period begins on November 15.  Insurance companies will have to go over all of the costs and figures before they release their new selections next fall.  It’s too early to determine whether Medicaid participation will grow, but that is something that a lot of people are watching this year.  There has been a lot of political fighting over Medicaid expansion, so it is being closely monitored.

Many of us are wondering what might happen with employer sponsored health insurance.  Employers who already offer it will continue to do so, but will likely pass cost increases onto employees through increasing deductibles and co-pays.  Employers with less than 50 employees do not have to offer them health insurance.  Those with 50-99 employees have to offer 70% of them insurance plans by 2016.  Companies with 100 or more workers have to offer 70% of them health insurance by next year.  Look out for coverage options relatively soon if you work for one of those companies.  Congressional elections will likely be affected by these health care issues in the near future.  You’ll probably see a lot of advertising and news time dedicated to health care reform issues this year.  If you are looking for a health insurance plan, find an affordable option here.  The next enrollment period for the government exchanges begins on November 15.

 

 

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

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.

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High Number of Americans are Underinsured

March 26th, 2014

The country has been very focused on uninsured Americans over the past couple of years.  Another important issue that is rarely discussed is how many people are actually underinsured.  U.S. News & World Report’s Kimberly Leonard discussed research from the Commonwealth Fund in her article, “Report Highlights Underinsured by State”.  The Commonwealth Fund’s report is called “America’s Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions”.  When looking at Americans under the age of 65, one out of every eight is underinsured.  This means that although they do have health insurance, they still pay a high percentage out of pocket for health care costs.  Many underinsured Americans end up filing for bankruptcy because of their health care bills.  They are also at a high risk of ignoring symptoms and avoiding the doctor.

States with the lowest rates of underinsured Americans were in the Northeast and the upper Midwest.  The Southern and Western states had the highest rates.  New Hampshire’s underinsured rate of 8% was the lowest in the nation.  Some of the other states with low rates include Minnesota, Maryland, and Massachusetts.  The highest underinsured rate of 17% belongs to both Idaho and Utah.  Both Tennessee and Mississippi had underinsured rates of 16%.  When the report looked at the combination of uninsured and underinsured Americans, the highest numbers of uninsured and underinsured Americans were in New Mexico and Texas.  Middle income Americans in Wyoming and Alaska suffer the most from being uninsured or underinsured.  One-third of the middle income population in those states falls into the uninsured or underinsured category.  The lowest uninsured and underinsured rates were in Connecticut, Massachusetts, Minnesota, and the District of Columbia.  These states had combined rates less than 20%.

Deductibles, premiums, household income, and insurance status were taken into account for the report results.  Lower income households, earning less than $47,000 per year for a family of four, are considered underinsured if they spend more than 5% of their yearly income on health care costs.  Middle income households, earning between $47,000 and $95,000 per year, are underinsured if more than 10% of their annual income is spent on health care.  The Commonwealth Fund report found that $32 million Americans are underinsured, $4 million of whom come from middle income families.  It also showed that 47 million Americans were uninsured in 2012.  Obviously this data was collected before the Affordable Care Act went into effect.  It will be a good comparison for the next few years to see if the ACA makes the changes that it set out to make in “fixing” our health care system.  The number of uninsured Americans has certainly gone down, and the number of underinsured Americans should as well.  Since insurance companies can no longer discriminate against those with preexisting conditions and they must offer affordable plan choices, fewer Americans may be underinsured in the future.

 

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Out-of-Network Insurance Costs Can Be Sky High

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.

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Latinos React Differently to Health Insurance Marketing

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.

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Individuals Paying More for Health Insurance Without Government Subsidies

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.

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