• The Coverage Corner

Nutrition Labels for Health Insurance Plans

| February 10, 2012

nutritionfactsThe Department of Health and Human Services (HHS) has released final rules about creating nutrition labels for health plans. These labels will be used to describe every health insurance plan in a uniform and easy to read format.

All employers and health insurance companies that offer individual or group plans will have to comply with the rules by September 23, 2012 — giving health insurers and employers only six months to adopt the changes.

Health plan labels will include six pages of information for consumers to review including price estimates for health care services, maximum out-of-pocket costs and a glossary.

The labels will not include the monthly premium amounts but consumers will know what the baseline of the premium is before they look at the plan details. Premiums are subject to underwriting and can change based on that process.

Here are six steps to compare plans with the new labels:

  1. Figure out how much you can afford to spend every month to pay the monthly premium.
  2. Review deductibles and find one that you would be comfortable with — if you can match the deductible in case of an emergency then it should be a good fit.
  3. Does the plan cover in-network and out-of-network visits? Is that important to you and your family?
  4. Do you have a primary care physician? If so, is that physician covered with the plan?
  5. Highlight any out-of-pocket health care costs are you susceptible to and determine if you can afford them.
  6. Read the complete health plan nutrition label to have a complete understanding of what you are buying.
Group Health Insurance, Health Care Reform, Individual Health Insurance |

Massachusetts Innovates Health Insurance Again

| February 9, 2012

capecod2In 2006, Massachusetts was the first state to initiate a health insurance mandate which required individuals to purchase insurance. Sadly, although the plan was intended to make insurance available and affordable to all, it increased spending across the state.

To battle these increased costs, many representatives and health insurance companies are working hard to initiate new programs and to lower costs for consumers.

One such idea is the move to ‘global payment’ plans. With global payment plans, networks such as BlueCross Blue Shield receive a flat yearly fee to cover their insured clients, regardless of the actual cost for each patient.

Part of the idea behind the global payment plan is that physicians will be cautious when ordering expensive and potentially unnecessary testing. Financial incentives are in place to help ensure that patients continue to receive the highest quality of care. Patients are more empowered to manage their own health care and they are free to seek medical professionals of their choice.

Although it is still early in the global payment plan, the initial success is encouraging. In fact, The Children’s Hospital of Massachusetts predicts that it will save $83 million in just the next two years. The savings will benefit patients and physicians alike, and if the plan continues to well, global payment plans could be adopted across the country.

By continuing to brainstorm new ideas and implement reform plans, we can find a way to fix the health insurance issue in this country and still receive amazing health care from talented and devoted professionals.

Group Health Insurance, Individual Health Insurance |

Calling All Freelancers Who Need Health Insurance

| February 8, 2012

dandelionThere are many perks that accompany freelance work, and many enjoy the freedom and creativity that comes from working outside the traditional office environment. However, the work also comes with complications, particularly when it comes to health insurance. Many freelancers struggle with health care costs and still others believe that they cannot afford an insurance plan.

Luckily, there are a number of health insurance plans which are affordable (and offer great coverage) for freelancers. Consider the following options:

Individual Health Insurance: You can take health insurance coverage into your own hands by buying individual health insurance. There are a variety of options for your budget and health needs. For those with a tight budget consider a high deductible plan with low monthly payments.

Chamber of Commerce: Most people do not realize that their local chamber of commerce could be a good option for insurance. Many chambers of commerce offer small business plans that might be a potential option for you. Visit your local branch to learn more about this type of plan.

Freelancers Union: Freelancers seeking health insurance might find what they are looking for with the Freelancers Union. The organization is free to join and its sole purpose is to support freelancers across the country. You can even opt for dental and disability insurance.

COBRA: COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985 and it offers health insurance options for those individuals who recently resigned or were fired from their position. If you are leaving your current office to become a freelancer, COBRA could be a good option for you. But, keep in mind, it is not a long-term solution. Once you sign up for COBRA, you have 18 months to utilize the plan, and after that, you will need to seek a more permanent solution like individual health insurance.

Ultimately, there a number of health insurance options available to freelancers. With a little research, you can consider your options and then choose the plan that best suits you.

Group Health Insurance, Individual Health Insurance |

Five Common Reasons for Group Rate Increases

| February 7, 2012

jobsEvery year as individuals go through open enrollment they learn whether or not their group health insurance rates have changed. Unfortunately they may not fully understand the explanation behind the increases or decreases.

Here are five common reasons for rate increases:

1. As a whole the company filed a lot of claims. The more claims a company files, the more likely their health insurance rates are going to increase.

2. Company is insuring fewer employees. If a company downsizes then it could be subject to higher health insurance costs. In general the bigger the pool of employees — the better — because the risk of those who frequently use health care services are balanced with those who do not use it very often.

3. Group plan had to comply with health care reform provisions. Certain health care provisions require companies to add benefits which could lead to greater costs. One of the most popular reform provisions requires new plans to provide health insurance to dependents until the age of 26, which can lead to higher costs.

4. Experience rating is used to identify premium amounts. The age and the utilization of health care services are taken into account along with the overall health of the employees. If the health of the company declines and the average age or utilization of services increases, then the company plan could be subject to changes.

5. State has issued new mandates for coverage which can include autism coverage, changes in mental health or maternity benefits. Any time there are mandates requiring additional coverage, it is likely that health insurance rates will increase.

Group Health Insurance, Health Care Reform |

Most and Least Expensive States to Purchase Health Insurance

| February 6, 2012

usaAs consumers move between states they typically consider the cost of living, the housing market and how much they will be paid but they may not think about the cost of health insurance.

Unfortunately, the cost of health insurance coverage varies greatly between states.

In the individual health insurance market the following are the five most expensive states to get coverage (most expensive to least expensive):

  1. Massachusetts
  2. Vermont
  3. New Jersey
  4. New York
  5. Rhode Island

The five least expensive states to get individual coverage include (least expensive to most expensive):

  1. Alabama
  2. California
  3. Arkansas
  4. Idaho
  5. Delaware

In Massachusetts the average individual monthly premium is $437 or $5,244 per year. For a family of four, this number would grow pretty quickly compared to states with more affordable coverage. In Alabama the average individual premium is $136 per month or $1,632 per year — much more affordable than the states on the east coast.

Why do health insurance rates vary from state to state?

The rates depend on the state and the number of coverage mandates. For instance, Massachusetts has an individual mandate requiring all residents to purchase health insurance and it is a guaranteed issue state. New York is also a guaranteed issue state which means that individuals are guaranteed coverage regardless of pre-existing conditions.

Some states also have mandates for particular coverage or benefit levels. Those levels could include maternity coverage, infertility treatment, autism coverage, mental health benefits and many more. Typically the more coverage that is mandated, the more expensive health insurance is in that state.

Group Health Insurance, Individual Health Insurance |

Health Care Costs Stop Rising as People Can’t Afford to See Their Doctors

| February 3, 2012

scissorsIn 2011, health care costs across the country decreased, meaning that people were not spending as much at the doctor or utilizing their health insurance coverage to the same degree that they did in previous years. Additionally, in 2010, the health expenditure rate only increased 0.1 percent from the previous year, implying that far less people are making claims on their insurance.

While a decrease in cost always sounds like a good idea, the truth is that this downward trend might promise trouble in the future. In terms of diagnosis and treatment, those who have avoided making claims can not only increase future expenses, but can put their health at risk. When people put their medical issues to the side and ignore those little aches and pains, these important red flags go ignored which means that health problems can fester and worsen over time.

Yet, due to past economic downturn, going to the doctor sadly wasn’t an option for many people. As such, insurance claims went down and the cost of health care did as well. But this stagnancy won’t last for long. Now that the economy is showing slight signs of improvement, coupled with the health care reform that will kick in 2014, health insurance claims promise to rise in the future.

Come 2014, the company-based health insurance model that the majority of insured individuals have become comfortable with will be flipped upside down, transitioning to individual-based models instead. Defined benefit models will also transition to defined contribution models. Because employees will have more control when it comes to deciding which insurance plan is best for them, it is now more important than ever for employees to educate themselves when it comes to their health care wants and needs.

Also, the individual mandate will require every individual to purchase health insurance or pay a fine starting in 2014. At this time, many consumers will be finding health for the first time or through an insurance exchange.

General Healthcare, Health Care Reform, Individual Health Insurance |

Tips to Help Same-Sex Couples Receive Health Insurance Benefits

| February 2, 2012

michigan Recently, a poll performed in Michigan discovered that 54 percent of voters opposed domestic partnership health insurance benefits for public employees. The results of this survey come on the heels of the shocking ban Michigan Gov. Rick Snyder implemented against domestic benefits for same-sex partners in his state.

While the ACLU challenges this ban in federal court, the issue raises many questions and fears for same-sex partners across the country. Many couples might wonder how they can afford the insurance they need and what steps they should take to ensure their right to adequate and affordable health care. Luckily, the number of companies which offer their employees same-sex partnership benefits is on the rise, and many are hopeful that the future will offer equal benefits to all citizens.

However, even if your company does offer same-sex benefits, the reality is that achieving such benefits can be difficult and frustrating. Fortunately, there are a few things you can do which will make the process easier. Consider the following:

Look into your state’s policy. Currently, there is no national definition of what it means to be in a domestic partnership, and therefore the definition is determined on a state-by-state basis. Education equals empowerment, and with the right information, you can be sure that you are getting the right benefits for you and your partner.

Evidence of partnership is almost always required. While it might be troubling to have to ‘prove’ your relationship with your partner, particularly to those in your workplace, it is a necessary part of the process. Since many states still do not recognize same-sex marriage, it isn’t as simple as handing over a marriage certificate. In some cases, you might be able to offer a domestic partnership certificate (which can be acquired at your local courthouse or city clerk’s office), but in other cases you might be asked to share receipts, leases, or bills — essentially anything that can prove that you and your partner share fiscal responsibilities together. Length of relationship as well as age might come into play (for instance, Illinois health insurance rules require that someone must be 19 years of age or older to receive same-sex benefits).

While this part of the process can be frustrating, remember, it will be worth it in the end when you and your partner both have the health insurance coverage that you need.

Do your homework. By now, most people know that all health insurance companies are not created equal, and neither is every health plan. Do some research online and look throughout GoHealthInsurance.com in order to learn more about what plan is right for you and your partner. Remember, your health comes first!

Group Health Insurance, Individual Health Insurance, Politics and Legislation |

Marriage and Health Insurance

| February 1, 2012

Whether you have recently tied the knot or plan to this year, this infographic will help you understand what you should consider when thinking about changing your health insurance coverage. More dependents are being added to plans as states pass same-sex marriage legislation and large employers start offering domestic partnership coverage.

Unfortunately, women are more likely to go without health insurance coverage than men – leaving them more susceptible to being denied coverage or going without completely. Receiving health insurance through marriage is a large source of where women get their coverage but this can create additional problems during divorce or a split.

Before you get married or enter a domestic partnership, talk about your health insurance options. Does it make sense to join a group plan? How much does it cost to add a dependent or spouse to a group plan? Is it more affordable to have separate individual plans or join one as a family?

Marriage and health insurance

Group Health Insurance, Individual Health Insurance |

Why Patients Should Negotiate During Their Check-Up

| January 31, 2012

doctortoysWhen it comes to medical care, most tend to take their doctor’s word when it comes to undergoing necessary procedures, medications, and treatment protocol. The thought of questioning the doctor or inquiring more into an advised treatment seems foreign to most people. After all, we were always taught the doctor knows best. Yet, in today’s current health care climate and down economy, patients everywhere can benefit from getting more proactive when it comes to their own health insurance costs and treatment plans.

Over 50 million Americans are uninsured in this country, and that staggering number doesn’t include the millions of Americans who are vastly underinsured or those who are struggling with hefty health care costs. And, while most doctors do have their patient’s health and best interests at heart, the truth is that it behooves all of us to be more involved with our health care decisions.

Instead of blindly accepting your doctor’s diagnosis or paying thousands of dollars for a big-ticket procedure, put the brakes on for a moment and do your research. Ask questions and get involved. Any good doctor will be happy to answer your questions and explain the procedure to you.

Whether it is a routine checkup or treating an injury, remember that you have the right (and the responsibility) to be proactive when faced with the possibility of a new prescription, procedure, or treatment. Below are a few examples of helpful questions to ask next time you meet with your doctor:

  • How will this test/procedure affect my treatment?
  • How accurate is the test/procedure? Will it need to be performed again?
  • What is the downside if I choose to opt out of the treatment?
  • Are there lifestyle changes I can make first that may work instead?
  • Are there any cost-effective alternatives?
  • Is there a generic form of this prescription available?

Asking questions such as these and staying involved is one of the most important steps to take when it comes to saving money on health care and health insurance coverage. Many patients are often surprised to learn that asking a few simple questions can lead to helpful information that may potentially save you hundreds. Of course, health must always come first, but in this economy, saving any amount of money can go a long way in protecting you and your family’s future, so don’t be afraid to speak up and get involved.

General Healthcare, Group Health Insurance, Individual Health Insurance |

Florida Works to Control Health Care Costs

| January 30, 2012

floridaFlorida Legislature is considering a bill that would require doctors and health care centers to post prices of their services.

This bill is being applauded by consumer advocates as many patients are perplexed by the cost of health care services and how much health insurance will pay for a service.

Why is posting the costs of health care services such a good idea?

  • No surprises. With the costs of services posted, you will know what you are paying for out-of-pocket. There are no surprises later when you get the bill and allow you to budget appropriately.
  • Ability to shop around. When you are shopping for clothes, groceries or anything else, you typically shop around to find out where to get the best deal. If health care costs were posted, then you would have the opportunity to find a place that offers health care that you can afford.
  • More competition. If every physician is required to post costs, it could create competition to keep prices low.

Of course doctors aren’t very happy with the legislation because it would create a lot more work for them. Also, it could get confusing to the price of a service for people who are uninsured and insured. Currently health insurance companies negotiate prices for health care services to get their customers a good deal with that physician.

Florida is the only state besides Massachusetts to consider this innovative idea. Massachusetts created an individual health insurance mandate in 2006 but it has yet to reduce health insurance costs. In fact, health insurance costs are extremely expensive in the state. To help battle the rising costs, Massachusetts politicians have been considering passing a similar bill to this Florida legislation.

Many consumers probably think that health care reform is supposed to control escalating health care costs but it actually falls short of that. Reform does more to control the costs of health insurance than health care — prompting states to take action.

Group Health Insurance, Health Care Reform, Individual Health Insurance |