• The Coverage Corner

May is National Bike Month

This is the first we’re hearing of this, but apparently National Bike Month has been a “thing” for fifty-five years. According to the League of American Bicyclists, who developed the concept, National Bike Month is “an opportunity to celebrate the unique power of the bicycle and the many reasons we ride”.

And there are plenty of reasons to ride, indeed. If you haven’t been on a bike in awhile, here are just a few positive things about two-wheelin’ it:

  • Great exercise
  • Saves money on gas
  • No environmental impact
  • It’s a proven stress-reliever
  • It’s just straight-up fun

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Here at GoHealthInsurance, we totally agree with National Bike Month’s mission. In fact, our entire staff has access to our super cool GoHealth bikes! As overprotective health insurance gurus, however, we do hope our employees wear a helmet.

There are events and festivities being held in cities all over the country to celebrate. For more information than you could ever possibly hope for on National Bike Month, click here.

Here’s a list of some of the most important dates:

    May 8

    Bike to School Day

    May 14-18

    Bike to Work Week

    May 18

    Bike to Work Day

This whole idea is really exciting – a sure sign that summer has arrived. Get out there and ride, folks, and remember to stay off the sidewalks. Also, even if you don’t plan on popping any wheelies, make sure you’re covered by health insurance!

General Healthcare |

Bring Me Back a Souvenir from Your Surgery!

airplaneGetting sick or injured while on vacation is most people’s idea of a worst nightmare. But, what about going on vacation because you are sick or injured?

That’s right, as a response to the high cost of health care in America, “medical tourism” is a growing trend these days. Nearly 650,000 people per year travel outside of the United States to undergo medical procedures.

We’re not talking about flying over to Columbia to get plastic surgery on the cheap (although, that’s still done quite frequently); we’re talking about Americans without
health insurance who are saving on necessary treatments by going abroad.

Is it worth it?

According to The Deloitte Center for Health Solutions, a health service research organization, patients can save up to 80 percent over the cost of having the same procedure in the United States.

  • Without health insurance, heart bypass surgery in the U.S. can cost $145,000. In Thailand, the same surgery costs $25,000.
  • Hip replacement in the U.S. without health insurance is around $100,000. In Thailand it will just set you back $22,000.

Health Insurance and Medical Tourism

A very limited number of health insurance providers will cover a medical procedure performed overseas. Medical tourism planning organizations argue that health insurance companies will gain a competitive edge on competition by offering coverage outside of the United States. This is rooted in their belief that employees are attracted to the idea of having the freedom to decide where they receive treatment. In recent years, a few major health insurance carriers have begun offering medical tourism insurance in test markets.

How is the quality of care?

Contrary to popular belief, the United States does not have the world’s best health care system; just the most expensive. The World Health Organization ranks the U.S. health care system at number 37, just a step above Slovenia and Cuba. Traveling for a major medical procedure does not necessarily mean inadequate or sub-par care.

General Healthcare, Group Health Insurance, Individual Health Insurance |

Supreme Court’s Decision will Take Us Down One of Three Roads

gavelBy late June, the Supreme Court of the United States (SCOTUS) is expected to have a decision regarding the constitutionality of health care reform.

If you’re anything like us, listening to the audio tapes of the hearings on health care reform really was your idea of a good time! We found the arguments not only compelling, but easy to dance to.

However, we realize that there is a small portion of the population that does not eat, sleep and breathe health insurance. For you folks, we have broken down the basics of what the Supreme Court is deciding on and the three possible outcomes of their decision.

Outcome Number One: The Law is Accepted and Deemed Totally Constitutional

Come 2014, this thing goes live! This means all of the changes (even the controversial ones) will take effect. For a complete, comprehensive look at all aspects of health care reform, click here. We’ve listed a few of the main changes below.

  • Businesses with more than 50 employees will be required to provide health insurance or pay a penalty.
  • Businesses that provided coverage will benefit from substantial tax credits.
  • Individuals not covered by employers will be required to purchase health insurance or pay a small penalty.
  • Individuals who purchase health insurance for themselves will receive a substantial tax credit.
  • No one will be denied health insurance coverage, even if they have a pre-existing condition.

Outcome Number Two: The Law Gets Paired Down

In this scenario, certain aspects of reform will be ruled unconstitutional and others will remain in place. The individual mandate is the piece of the reform puzzle that is most likely to be struck down. This would mean that individuals would not be required to purchase health insurance if they did not want to and they would be exempt from any sort of penalty.

Outcome Number Three: Scrap the Whole Thing

If the Supreme Court decides that the individual mandate and all the other parts of reform are unconstitutional, we turn back time and the health insurance companies will revert back to doing business like they did in 2009. This means that the even well-received changes such as the extension of parents’ coverage for young adults under the age of 26 would be in jeopardy. In addition, insurers could once again deny coverage based on pre-existing conditions.

General Healthcare, Group Health Insurance, Health Care Reform, Individual Health Insurance, Politics and Legislation, Uncategorized |

Mental Health and Health Insurance

questionmarkSome would argue that physical health and mental health are not mutually exclusive conditions, but highly interrelated. A recent study found that 5 percent of American adults have a serious mental illness (SMI) that affects their life in a chronic, debilitating way. More than a quarter of adults with SMI also had substance abuse issues.

Less severe, yet life altering mental health issues such as mild to moderate depression, anxiety, and post traumatic stress are much more prevalent.

Regardless of where one falls on the wide spectrum of mental health, treatment of some sort is extremely important if you are having difficulty coping in everyday life. Depending on your unique situation, a medical doctor or psychiatrist might be the right people to turn to. Or, maybe you are just going through a difficult time and need to speak with a therapist for awhile. Whatever the case, you want to be sure that your health insurance coverage does not make this difficult time any worse. Here are some questions and answers that may speak to your concerns.

What will my health insurance plan cover?

This, of course depends on your provider and specific plan. The majority of insurance carriers will cover issues related to depression, anxiety, and social phobias.

If I see a therapist, how many visits will be covered?

Usually, patients are covered for 20 to 30 sessions a year. A session can cost anywhere from $75 to $175, depending on your location and the credentials of the person you are seeing. Patients will pay anywhere from 20 to 50 percent of the bill, depending on what health insurance plan they have.

Will any necessary medications be covered?

Yes. Your usual co-pay will apply. Keep in mind that only a physician or psychiatrist may prescribe medicine to treat mental illness-related issues. Therapists may not.

How should I choose a therapist?

The course of action varies depending on what type of health insurance you have.

  • Health Maintenance Organization (HMO): You will be required to choose from a limited number of mental health care professionals who are included in your network. While this may make it impossible for you to pick the therapist of your choice, there are sure to be several reputable options to choose from. Your first step will be contacting your primary care physician and asking for guidance. They will get the ball rolling from there.
  • Preferred Provider Organization (PPO): With this type of plan, you still choose from a limited number of in-network therapists. If you decide to see someone out-of-network, a portion of the fees will be still be covered.
  • Fee for Service (FFS): You may see any therapist you choose, anywhere in the country.
General Healthcare, Group Health Insurance, Individual Health Insurance |

Giving Birth in Your Rec Room? Make Sure Health Insurance Covers It

pregnant_woman_1These days, you don’t have to be kickin’ it pioneer style to give birth to your baby at home. The notion has become more and more popular in recent years. The most current government data shows that home births increased by 29 percent between 2004 and 2009. In fact, 29,650 births were at home, which is the highest number since records began being kept in 1989.

When opting for an at-home birth, there are many things to take into careful consideration. Cost and health insurance coverage are two of the big ones. The average cost of a typical, hospital birth is $5,000 to $10,000. An at home birth without complications costs much less – between $1,500 and $5,000.

Will health insurance cover your at-home birth?

Coverage for at-home births varies widely depending on what state you live in and what insurance carrier you have.

Some health insurance carriers offer a limited amount of coverage as long as a midwife is overseeing the delivery. Other carriers would deem an at-home birth “medically inappropriate” and not cover it at all. Then there are carriers who will fully cover your mid-wife attended birth regardless of whether it occurs in a hospital, your home, or your neighbor’s pool!

Know the facts

  • In 2009, more than 60 percent of at-home births were attended by a midwife. Only 5 percent were attended by a physician.
  • When a physician is present, the cost of the at-home birth escalates significantly.
  • Only a handful of states require insurers to cover at-home births, including New Hampshire, New Mexico, New York and Vermont.
  • If your insurer covers at-home birth, the amount of coverage depends on who provides the needed equipment. In most cases, the midwife will already be supplying the fetal monitor. However, things such as rubber sheets for the bed or birthing tubs will most likely not be covered.
  • Some states require midwives to carry malpractice insurance in order to be eligible for reimbursement from health insurance plans.

If this information has caused you to do premature Lamaze breathing, don’t fear. There are a variety of resources available online that can take this conversation further. One excellent source for expectant mothers who are considering an at-home birth is TheBigPushforMidwives.org.

General Healthcare, Group Health Insurance, Individual Health Insurance |

Texas Health Insurance Costs

GoHealth will be taking a close look at health insurance rates across the country to help consumers understand the cost of health insurance in their area compared to states across the nation. Texas is the first stop.

texasmapThe cost of living in an area can directly impact the cost of health insurance. How does this work? If health care providers in a city have expensive real estate and daily operational expenses, then those costs are passed on to the consumer. In the suburbs, rent may be more affordable and reduce the operating expenses for a hospital or doctor’s office which can help keep the cost of care down. Overall, there are many factors that directly impact the costs of health care and insurance in a state or city.

Texas has a little higher cost of living compared to the national average, which is also seen with health insurance costs. When compared to the national average, Texas health insurance premiums are higher for 30, 40, 50 and 60 year old males.

dallas-health-insurance-costs

When looking at health insurance premiums across Texas, rates vary based on the city. Six of the ten largest cities in Texas have lower than average cost of living than the state of Texas including San Antonio, Fort Worth, El Paso, Arlington, Corpus Christi and Laredo. Houston, Dallas, Austin and Plano have higher than average cost of living than the state of Texas.

texas-health-insurance-costs

General Healthcare, Individual Health Insurance |

Health Insurance Exchanges – a Major Part of Reform

redcrossThe Patient Protection and Affordable Care Act (PPACA) is a bit of a mystery to many Americans. It’s safe to say that very few people have sat down to read the whole thing. At GoHealth, we consider it required reading! Heck, we’d go as far as to call it a real “page turner!” We are making it our business to explain the changes that are expected to go into effect as of 2014 one step at a time.

Today we will discuss the concept of health insurance exchanges. These exchanges are new concepts created by the Affordable Care Act and will be key players in the new way Americans buy health insurance coverage. There are a few different types of exchanges – state run, multi-state and consumer operated and oriented plans. No idea what we’re talking about? No worries, you’re not alone. Let’s discuss.

What are health insurance exchanges?

Exchanges are new state run organizations that will be created in order to provide a more organized and competitive way to purchase health insurance. Consumers will be able to see several different options and compare rates and coverage details easily (much like GoHealth.com does).

In addition, exchanges will act as information resources for consumers of health insurance, providing information about all the different options and answers to any questions that buyers may have.

What type of consumer will use a health exchange?

U.S. citizens and legal immigrants who are not imprisoned are eligible. Exchanges will serve individuals, families and small businesses with up to 100 employees. If you have health insurance through your employer, you can either keep it or shop around through an exchange and pick a new plan.

What is a Multi-State Health Exchange?

Some states may choose to not operate their own health insurance exchanges, but to become part of a multi-state or regional exchange. Enrolling in a multi-state exchange would give you access to health care in all the different states that are included in your plan.

What is a Consumer Operated and Oriented Plan?

Certain organizations are expected to want to set up non-profit, member-run health insurance companies. If they meet eligibility requirements, these organizations will receive federal funds to operate. Many key requirements will determine eligibility to become a Consumer Operated and Oriented Plan (CO-OP). The most distinct requirement is that all profits must be used to lower premiums, improve benefits or improve the quality of health care to members.

General Healthcare, Health Care Reform, Individual Health Insurance |

GoHealth’s Student Health Insurance Survival Guide

booksWe know how much college kids are stoked about the topic of health insurance coverage for young adults. It’s all they can ever talk about, right? As the school year comes to an end and graduation day inches closer, GoHealth gets excited and inspired… you guessed it – to talk about health insurance! We just want to fit in with the cool kids.

We put together a comprehensive, easy-to-navigate Student Health Insurance Survival Guide filled with important information that students should really know. Young adults have many health insurance options to choose from, and that’s good news. Choosing between them can be the confusing part.

Below are the different topics our guide explores in detail:

  • New Student Orientation – all the basics about the health insurance options for students
  • Comparing and Contrasting Student Health Insurance Options
  • How Health Care Reform will Affect Student Health Insurance Plans
  • 5 Things Graduating Students Need to Know about Health Insurance After Graduation

To check out our Student Health Insurance Survival Guide in its entirety, click this link:

Student Health Insurance Survival Guide

General Healthcare, Health Care Reform, Individual Health Insurance |

Age and Health Insurance – A GoHealth Study

stethoscope2Not surprisingly, most people don’t have a detailed understanding of how health insurance premiums are set by insurance companies. Many risk factors go into consideration such as weight, smoking history and pre-existing conditions. In addition to these, age is often factored in. For example, in some states, an elderly person could be charged a premium over five times more than a young person, solely based on age.

GoHealth conducted a study in order to closely examine how the price of health insurance premiums change between the ages of 20 and 60. Below are some of the key facts and findings.

Monthly premiums grow exponentially with age.

  • Between ages 20 and 60, health insurance premiums for a plan with similar benefits for men increase 288.3 percent on average and increase as much as 421.9 percent.
  • A 60 year old male will pay more than $4,000 a year on average in the individual health insurance market – while a 20 year old male will pay around $1,050 a year on average.
  • Few states have standards to limit age rating and only 7 states currently meet future requirements set by the Affordable Care Act.
  • percent-difference-average-premiums

How Will the Affordable Care Act Affect Age Rating?

Under the Affordable Care Act, health insurance issuers will be allowed to vary rates based on age, but by no more than a 3:1 ratio. In other words, the ratio limits the amount an older person will pay to no more than three times that of a younger person. Few states have an age rating ban in place currently, so this is positive news for older adults concerned about their rates increasing. By spreading premium costs over a large range of age groups, the plan aims to ensure that health insurance rates remain affordable across the board. However, younger Americans who typically pay very low monthly premiums will see their monthly payment increase as they become part of a wider, higher risk pool.

To view our study in its entirety, click here.

General Healthcare, Health Care Reform, Individual Health Insurance |

What’s the Deal with Urgent Care Centers?

hospitalIn case you haven’t noticed, Urgent Care Centers have been popping up in office buildings and strip malls all over the place. There are more than 8,700 urgent-care centers nationwide and the number is expected to continue growing around 5 percent annually.

What is an urgent care center?

These are convenient and potentially less expensive facilities for treating ailments and injuries that need immediate attention but are not life-threatening emergencies. Urgent care centers do not require appointments and they are staffed by physicians and nurses who are able to offer more care and services than most walk-in clinics, but not as many as an emergency room. The centers usually have x-rays and electrocardiograms on-site. Some urgent care centers offer lab services, as well.

What are some examples of ailments treated at urgent care facilities?

The list is expansive and includes basically anything that is not immediately threatening your life: sprains, broken bones, muscle spasms, lacerations, sore throat, bronchitis, urinary tract infections, abscesses and many more. Unlike emergency rooms, urgent care centers cannot admit patients who need life-saving interventions immediately.

Why are urgent care centers growing so rapidly?

They are an excellent alternative to having to wait for hours on end in an emergency room to receive treatment. They also are an attractive option if you do not want to make a doctor appointment weeks in advance for some minor issue.

Are urgent care centers affiliated with hospitals?

Only in some cases. The majority are independent or part of a chain of urgent care centers.

Do urgent care centers accept health insurance?

Urgent care centers accept a wide variety of health insurance. Always check with your health insurance provider first, of course. But also check to see how much coverage your insurance will provide for visits to urgent care centers. If a health insurance plan provides less coverage for urgent care centers then visiting a doctor or emergency room, it may not be the best option.

General Healthcare, Health Care Reform, Individual Health Insurance |