Health Insurance and You!!

A nice article on health care reform and what it means for individuals and families that need to buy health insurance.

It is originally written in the context of the consumers in the state of Texas, but most of the article is applicable anywhere across the country.

To your health,
Chini

The attached article is a good primer on how to avoid fraud with health insurance.

The problem? Its not completely accurate.

1. It is correct to say that many unscrupulous brokers often position discount cards ad health insurance. This is a scam of the first order.

2. However, there are plans available in the market with simplified issue capabilities – notably Assurant’s Health Access product. There are also guaranteed issue health insurance products from specialty players such as Fairmont. These products are not meant for everyone. But they do allow consumer’s with pre-existing conditions to have some coverage as opposed to none at all and for a good price. A second type of plans — short-term plans also have simplified issue capabilities.

For the most part, consumers ought to be extremely careful about such plans — we only recommend them as a last resort and when a customer fully understands why they are buying a plan with lesser benefits than a major medical plan.

Talk to your licensed health insurance expert.

To your health,
Chini

It seems like all individual health insurance plans in Colorado will soon be required to carry maternity health insurance.

Our own viewpoint — regulation of this sort is sometimes necessary to ensure access to necessary services. But all regulation comes at a cost. Our hope is that addition of this mandate will not raise premiums by so much that affordability becomes an issue. Health Plans in Colorado right now for a 38 year old woman begin in Denver begin at about $66/month for a high deductible plan.

To your health,
Chini

Another NPR article discusses how it is difficult for new graduates to find health insurance, although reform is now passed.

If you are a new graduate, below are some quick thoughts on how to be smart about your health insurance:

1. If you have a condition like Asthma, as one of the new graduates in this article does, you are clearly best off being in a group plan offered by a parent even if you have to wait for a few months. Individual plans that you can buy on the market are under-written, which means that there are a range of health conditions which will cause you to be declined. If you have a pre-existing condition, please check out the feature title “Will you qualify?” next to each plan at getinsured.com health insurance plan selector.

2. If you are healthy and would qualify for individual health insurance easily, usually you can save money by shopping — again it will take you less than 5 minutes to find if a health insurance quote will save you $$. Some times, it can be several hundred dollars a month.

3. If your parent’s employer offers you health insurance regardless as a free benefit — you should absolutely consider it when it is offered. Free trumps paying money

To your health,
Chini

We often speak with consumers every day that are struggling to make sense out of health insurance pricing. Today, I thought I would illustrate it with a small example. I encourage you to try it for yourself.

I went to the getinsured health insurance quoting site and tried to obtain quotes for myself — zip code 94303, 40 years old with no health conditions.

Then, I looked for plans with a medium sized deductible (generally about $2,500) that support doctor visits, wellness and benefits for both generic and branded drugs.

The variation in pricing can be quite dramatic. The cheapest plan offered by Anthem was $686/month while the cheapest plan offered by Blue Shield of California was about $190/month.

Now bear in mind — both carriers offer excellent networks in California and are generally quite competitive. Yet there was almost a 3x difference in pricing — why?

It turns out that the Anthem plan offers both mental health and maternity benefits while the Blue Shield of California does not.

The lesson here? Not all plans are created equal and it helps to carefully evaluate what you really need. Perhaps you really need maternity and mental health benefits and can afford
$686/month. In that case the Anthem health insurance plan is right for you.

However, the vast majority of our customers, with stretched household budgets would likely opt for the Blue Shield plan with a premium of $190/month.

To your health,
Chini

I just came across this rather heart-rending tale of the risks of being under-insured.

Families like the Martins (depicted in the story above) are struggling to make ends meet. I’m hopeful that reform would help families like the Martins afford better health insurance plans. But for now (and pretty much until 2014), families with stretched budgets are very likely to accept the insurance plan offered by one of their part-term employers, even if it is not the plan that is perfect for their family situation. In this case, it came back to bite them, in the form of health bills that they are needing to pay for expenses incurred — about $400/month.

Our recommendation is this — when you’re backed into a corner with a stretched family budget — and you know your health plan is not perfect, please do consider targeted forms of health insurance coverage. An accident medical plan would pay for any medical expenses incurred in virtually any form of accidents. An E.R. plan would pay for E.R. visits. Usually, such plans pay for coverage in addition to your usual health insurance plan. Also, they can be quite affordable, under $50/month.

To your health,
Chini

If you are buying health insurance for the first time, be sure to consider the entirety of your potential medical expenses.  It is easy to be wooed by entry-level premiums, but you may end up spending more in the end. 

For example, a healthy family of four may be offered plans with premiums as low as $3,200 and as high as $19,000 per year, but it is not clear that the bargain-basement policy is best.  In addition to considerations such as their overall risk tolerance and budget, this family needs to calculate its total out-of-pocket expenses.  Total out-of-pocket-expenses include deductibles, coinsurance, copays and any medical treatments and pharmaceuticals not covered by the insurance plan.  

When evaluating health care plans here are the variables to compare:

Premiums – your monthly payment to your insurer

Deductible – the amount for which you are responsible before the insurer begins coverage

Coinsurance – The percentage of your medical bills for which you are responsible after you’ve met the deductible

Copay – a flat fee you pay for doctor visits, emergency room visits and prescriptions

Out-of-pocket maximum – The maximum amount for which you are responsible in a given year.  After hitting this limit, the insurer pays 100% of approved expenses.

Services covered – for example, if you require mental health coverage and prescriptions or plan to get pregnant, make sure your policy covers these needs.

Providers in-network – make sure you like the doctors and hospitals in the plan’s network.  Out-of-network care can be very pricey.

Taxes – The effect on income taxes

Personal control – The degree to which you can control your own expenditures

The chart below compares two representative plans that might be available to a healthy family of four.  Both are actual plans available at GetInsured.com.  Plan A offers a low premium of $3,540 and has no coinsurance or copays once the deductible is met.  The deductible however is very high — $20,000.  In addition to these outlays, the family has to pay for its own prescriptions, mental health and other non-covered expenses.  Based on average medical expenses identified in the 2009 Milliman Medical Index , their expected out-of-pocket expenses could range from $7,000 to $27,000 depending on the medical expenses they actually incur.  Plan B has a premium of $12,216 and a deductible of $7,000.  It includes pharmacy coverage, but has 30% coinsurance and $40 copays for doctor visits.  The minimum expected outlay is about $16,000, and the maximum out-of-pocket should be $23,000.  Plan A could be either less expensive or more expensive than Plan B depending on the family’s health care needs for that year*.

Additionally, the buyers have to consider their tax burden. Many insurers now offer high-deductible plans with Health Savings Accounts (HSA’s).  Beneficiaries can place a designated amount of their salaries into a tax-free account from which they pay their medical expenses.  As with coinsurance rates, HSA’s motivate beneficiaries to save.  So, while you may end up paying more of your own medical bills, not only your premiums but also your income taxes may be lower.

Whether you are a first time buyer of individual insurance, are re-enrolling in a group plan or have had the same health insurance for years, it is worthwhile to take some time to consider the total amount you spend annually on health care.  Even if you are happy with your current situation, new products and new laws warrant that you conduct such a review.  Additionally, as you begin filing 2009 tax returns you want to make sure that you’ve asked for the appropriate deduction for medical expenses. 

GetInsured.com can help you choose from an enormous number of health plans, taking into account your total health care budget, so that you get the plan that is most cost-effective for your family.

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Assumptions are based on Milliman Medical Index, May 2009.  This index shows the average medical expenses for a family of four.   

*       Plan A assumes an average pharmacy expense of $2,484, plus $1,000 of mental health expenses.

*       Plan B assumes 30% coinsurance for average inpatient and outpatient expenses of  $7, 860 = $2,358, plus 16 doctor visits at $40 each, plus mental health expenses of $1,000.

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As the health care debate rages on in Washington I remain optimistic. I think that the legislature will succeed in improving access to health care for many people. But, I’ve said this before, it is imperative that each of us takes action now to sustain our own good health. We cannot and should not wait for legislation that can take years to implement. Here are some things every person should do to take control of his or her own health. The first three are well known, and I won’t expound on them, rather I will refer you to some informative sites. Points 4 and 5 are the keys to taking control of your medical future.

1) Eat right. eatright.org is the home site of the American Dietetic Association. The site provides informative articles and referrals to registered dieticians in your area. mypyramid.gov offers a personalized eating plan based on your height, age, weight and activity level.

2) Be active. The National Institute of Health (NIH) has an easy to use site that will help motivate you and get you moving in the right direction. If you haven’t exercised in a while, use good judgment; start slowly and check with your doctor.

3) Quit smoking. www.smokefree.gov, developed by the National Cancer Institute, is the best place to find online guidance and support services in your area.

4) Get insured. And get your family insured. Visit our site, www.getinsured.com or call our experts. We will work with you to find a plan that meets your needs. Everyday we are helping to insure people regardless of pre-existing conditions, tight budgets or complicated situations. Having insurance has a real affect on a person’s health. A recent Kaiser Family Foundation Study compared the health of people with insurance to those without insurance. The uninsured were significantly more likely to have no usual source of care, no preventive care, could not afford needed prescriptions and went without needed care. Ultimately insured people are healthier.

5) Have a Health Care Proxy. I know it sounds morbid and may be difficult to think about much less discuss with your loved ones. But, having a living will is the ultimate way to take control of your own health. Have the discussion. Write down your wishes. Be sure to designate someone you trust to make decisions on your behalf. For help you can go to www.engagewithgrace.org.

Here is a story I heard from a friend, an adult with a chronic illness. During an appointment with her Primary Care Physician last week she inquired about her flu vaccination status. He told her that she needed the seasonal flu vaccine and if possible, the H1N1 (swine flu) vaccine. He provided the seasonal flu vaccine, but said he did not have the H1N1 and had no idea about when or if it might come. The next evening, the doctor’s assistant called my friend and told her to go to his office right away for her H1N1 vaccine. He had just received a batch and was saving a shot for her.

The story made me think about how many people may be confused about all the information floating around about seasonal and H1N1 vaccines. I did my own informal research and found several sites helpful.

The CDC has two very informative and easy to understand sites, posted just a couple of days ago. The first one provides answers to frequently asked questions about seasonal flu, and the second provides answers for H1N1 related questions including who should and should NOT get the shot, where and when it is available and more.

I am convinced that getting vaccinated as soon as possible is a far better alternative to suffering from either flu. But not everyone is similarly inclined. In fact, I have heard that there are some celebrities advising people not to get a shot. Please, don’t listen to them, and for that matter, don’t listen to me. Ask a doctor or nurse whom you trust and get his or her opinion.

It’s Free…
Because the government feels strongly that this is a public health issue, it is paying for H1N1 vaccine. Other than a possible service charge that may be covered by your insurance provider it’s free. But even if you do have to pay a $25 fee to a clinic, isn’t that ultimately more cost effective than getting sick, paying for medicine and missing work?

…and it is Available
According to the CDC, the US government has procured 250 million doses of H1N1 vaccine, enough for everyone who wants it. Vaccine is being shipped to clinics every day. I looked online for a flu clinic near my home and found a list of locations, dates and phone numbers. Appointments are required and preference is given to people in high-risk groups. You can also go to www.flu.gov for a list of both seasonal and H1N1 flu clinics in your area and for the answers to most frequently asked questions.

Have you had trouble getting information? Will you get vaccinated? Do you have other sources of reliable information to share? Please share your story with us.

Before you finalize your health plan decisions take the time to inquire about the extra benefits that may be available. Supplemental benefits may include dental expenses, vision care, Medicare supplemental insurance, alternative medicine and other health-related expenses not covered by your health insurance.

To be adequately insured you need to assess your medical priorities. Do you think you might need extra care? If there is a particular expense you are concerned about, make sure to ask about it.

Understanding the benefits you will receive with your new policy will not only help you determine what, if any supplemental products you need, but will also help you take full advantage of the benefits to which you are entitled. Find out if you are eligible for a discount on fitness club membership, glasses or physical therapy for example, and then be sure to use it!