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This is the most asked question regarding health insurance:

by Brooke Jarchow

There seem to be endless questions regarding health insurance and health care terminology. However, understanding the difference between deductibles, copayments, coinsurance, and cost-sharing can help you understand when and how much you will have to pay for health care.

Not-so-coincidentally, the most common question regarding health care coverage is, “What is my deductible and how does it work?”

When you and your health insurance company each pay part of your medical expenses, it’s called cost sharing. Deductibles are part of cost sharing.

A deductible is the amount you pay for health care services before your health insurance begins to help you pay expenses. Once you meet your deductible, your insurer begins paying more health care costs through copayments or coinsurance.

For example, if your deductible is $1,000, that means you’ll pay for all of your medical and pharmacy bills up front and out-of-pocket until the amount you’ve paid in total reaches $1,000. At that point, you can then share future costs with your insurance plan for the remainder of the year.

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So, if you expect to visit the doctor often (maybe you have a chronic illness or are planning to become pregnant or have surgery), you might consider a plan with a lower deductible and higher monthly premiums. When choosing this type of plan, your frequent doctor visits will likely help you reach your deductible faster than someone who does not need a doctor as often. Paying higher monthly premiums allows for more predictable, monthly costs.

If you are healthy and do not expect the need for significant health care, you could
benefit financially from choosing a plan with lower monthly premium payments. . However,  if you do end up needing to see a doctor, you will have to meet your potentially-higher deductible before your insurance starts to help with medical costs. In this case, you may benefit from setting up a Health Savings Account (HSA).

In the end, there are many health plans to choose from and many factors to consider  before making your final decision. The key to finding the right plan is to understand your current and future health care needs.

 

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New Year, new coverage: How to secure coverage before Open Enrollment ends

by Brooke Jarchow

If you have not yet signed up for health insurance, the deadline to sign up for coverage that begins January 1, 2017 has passed. However, Open Enrollment continues until January 31, 2017 so you can still enroll in coverage. jan31reminder

While your coverage may not begin until at least February depending on when you enroll, it is important to enroll before Open Enrollment ends to avoid the tax penalty, or the fine for going uninsured. You can be charged a tax penalty if you are able to afford health insurance coverage but chose not to enroll in a health plan. Despite the uncertainty at the federal level surrounding the Affordable Care Act, it remains the law, so individuals should secure coverage now to avoid a potential tax penalty in the future.

If you had a 2016 Marketplace health plan and did not choose a new plan by December 15, 2016, you were likely re-enrolled in the same plan for 2017. However, new plans may be available that could be more affordable or your old plan may not be available for the upcoming year, so take time to compare your options for 2017 before Open Enrollment ends.

For those who have not yet signed up for health insurance and were not re-enrolled in a plan, there is no planned deadline extension for Open Enrollment, so your final deadline for Open Enrollment is January 31, 2017.

Ready to find coverage or need help getting started? Visit GoHealth.com to find a 2017 plan that is right for you.

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Your basic introduction to Medicare Supplement plans

by Lauren Mandel

According to a survey recently conducted by GoHealth, 72 percent of Medicare-eligible Americans want more information about Medigap to help them better shop for coverage.

You talked; we listened.

In this blog post, we’re sharing information that will hopefully help Americans better understand Medicare Supplement plans, often referred to as Medigap.

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To start, what is a Medicare Supplement plan? Medicare Supplement plans are sold by private insurance companies and can help close any gaps in Medicare coverage. For example, Medicare Supplement plans can be used to help pay for certain health care costs, such as copayments, coinsurance, and travel insurance costs. Some of these costs may not be covered without a Medicare Supplement plan.

How much will a Medicare Supplement plan cost? There are 10 different kinds of Medigap policies, and costs for these plans can vary based on things like what type of plan you choose and where you live. If you’re considering a Medicare Supplement plan, it’s best to consider your health care needs and all of your plan options before enrolling. Payments are made through a monthly premium, similar to individual health insurance plans.

Who can get a Medicare Supplement plan? If you are eligible for Medicare, you may have the option to purchase a Medicare Supplement plan. However, there is an additional requirement to be eligible for a Medicare Supplement plan: you must already have Medicare Parts A & B. Remember that you have until 6 months after your 65th birthday to find a Medicare Supplement plan. While you may be able to get a Medigap policy after this time period,  your options may be more limited and prices may increase.

Have additional questions about Medicare Supplement plans? We’d love to hear from you! Leave your questions in the comments section below.

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What it would mean to lose the pre-existing conditions provision of Obamacare

by Brooke Jarchow

Under the Affordable Care Act, those with pre-existing conditions cannot be denied health coverage or charged more for coverage. However, before January 1, 2014, those with pre-existing conditions (health-related problems that exist before applying for health insurance or enrolling in a new plan) could be denied coverage or charged higher premiums based on their health.

Pre-existing conditions range from life-threatening illnesses, such diabetes, HIV/AIDS, or cancer to more manageable illnesses, like migraines and bronchitis. Even if you have a relatively minor condition, such as an accidental knee injury, it is still considered a pre-existing condition that could have impacted your coverage in the past.doctor

In 2013, 49 percent of American people under the age of 65 reported that they or a family member had a pre-existing medical condition. Before the Affordable Care Act and the corresponding provision, more than 18 percent of applicants were denied coverage due to pre-existing conditions and over one million of those denied were uninsurable children.  Even if a child overcame their illness, insurance companies were able to refuse coverage in the future due to the past pre-existing illness.

Before the law, women could also be denied or charged more for individual insurance policies because of their gender. In fact, pregnancy is considered a pre-existing condition, and women were once able to be denied coverage simply for being pregnant. A one-day stay in an American hospital can cost as much as $4,000 and a C-section can cost up to $15,000 without insurance. Under the Affordable Care Act, women cannot be denied or charged more for coverage and women can also receive preventive care services – like mammograms and birth control – with no out-of-pocket costs.

But now, the future the health law is uncertain. President-elect Trump has vowed to repeal and replace the Affordable Care Act. Should Trump completely repeal the law, millions could be denied coverage, including those with pre-existing conditions who are often women and children.

A study from the Urban Institute shows that if the Affordable Care Act were completely repealed, the number of uninsured Americans would rise to over 58 million (a jump of almost 30 million). However, Trump has stated that he “does not believe health insurance carriers should be able to refuse coverage to individuals due to pre-existing conditions.” If Trump maintains this core component of the Affordable Care Act, he will likely have to implement a way to take care of the costs, as it is “one of the most costly elements of the law,” according to health insurance carriers and experts in the health insurance industry.

Again, it is important to remember that if these changes were set into motion, they would not be implemented overnight. Nonetheless, it is important to look back on our country’s history and understand how people would be affected without the pre-existing conditions provision in place.

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Get involved (and get covered!) on National Youth Enrollment Day

by Lauren Mandel

Did you know 1 out of every 5 young adults still doesn’t have health insurance? That statistic seems alarming, especially considering the help and tax credits currently available to most Americans.

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If you’re like us – and Get Covered America – and you want to see more young adults enrolled in health coverage, now is the time to take action. National Youth Enrollment Day is this Saturday, December 10, which means there’s no better time for millennials – and all Americans – to get enrolled in the right health plan.

Not sure which plan to choose? Not to worry: there’s personalized help available. Licensed agents can guide you through the enrollment process and help you find the right plan. Think health coverage is too expensive? The Department of Health and Human Services (HHS) announced more than 2.5 million covered Americans are missing out on lower costs, and most individuals could find coverage for $75 a month or less once they take advantage of tax credits.

We understand the uncertainty surrounding the future of Obamacare. However, we’re here to remind you that major policy change takes time, meaning it’s still important to plan for your 2017 health coverage. If you don’t enroll in a plan by December 15,  you will not have active coverage once the New Year begins. And you most definitely do not want to miss the final Open Enrollment deadline on January 31, 2017; if you do, you may have to wait until the next Open Enrollment Period starts to enroll in a health plan.

Looking for ways to get involved this Saturday? Click here for more information, volunteer opportunities, and more.

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Your first health insurance deadline for 2017

by Brooke Jarchow

Open Enrollment, the period of time when Americans can get health insurance regardless of their health history, officially ends January 31, 2017. However, December 15, 2016 is the most important date to remember for securing coverage in 2017. If you enroll in a health plan on or before December 15, your coverage can start as early as January 1, 2017.

However, those who enroll any time after December 15 will not be covered immediately in the New Year. If you enroll or makes changes to your plan after December 15, your new plan may not take effect until as late as March 2017. You can shop for and compare plans and renew or change coverage for 2017 now.

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Just as important as securing coverage before December 15 is to make sure you pay your first premium. In order to activate coverage, you must pay your premium. In order to pay your premium, first confirm that your insurance application is complete. Once you have completed your application, you must pay your first month’s premium to your insurance provider. It is acceptable to pay your first month’s premium with a credit card, but you will also need to provide banking information for future premium payments.

If you fail to make your monthly premium payments, you could lose coverage for the rest of the year. Usually, there is a 90-day grace period for a missed premium payment depending on the plan. If you lose coverage because of a missed premium payment, it is important to remember that you will not qualify for the Special Enrollment Period.

The only other way to enroll or change your plan after the January 31 deadline is if you qualify for the Special Enrollment Period. The Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period where individuals who have experienced certain life events can sign up for health insurance. Qualifying Life Events include losing health coverage, moving, getting married, having a baby, or adopting a child. Typically, an individual has 60 days following the Qualifying Life Event to enroll in an a plan.

In short, to ensure you and your family are covered immediately, enroll and pay your first month’s premium before December 15, 2016.

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6 Tweets that illustrate potential risks of repealing Obamacare

by Lauren Mandel

While much about the future of Obamacare is still unknown, President-elect Donald Trump and the Republicans have continued to make one thing clear: the health law will be repealed or drastically changed.

But after the election and Trump’s announcements about Obamacare, some Americans have come out in support of the health law and how it has helped them. We took to Twitter to find a few of those people, understand their reasons for valuing the health law, and outline how their lives could potentially change if the law is eventually repealed.

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Laura (above) and her husband are just two of millions – about 22 million, to be exact – who could lose their health coverage if Obamacare is repealed. The main reason? Tax credits, or the government subsidies that help millions of Americans afford their monthly premium payments. Even if Trump does not repeal the entire health law, he may choose to defund certain provisions, including the government-funded tax credits. Without them, millions will be unable to afford health insurance.

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Currently under the Affordable Care Act, prescription drugs are covered as one of the 10 Essential Health Benefits. Tara (above) is concerned that if the health law is repealed under a Trump presidency, she will no longer be able to afford her asthma medication. This is a real concern for the 60 percent of American adults who take prescription drugs every day.
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Similar to prescription drug coverage, mental health coverage is an Essential Health Benefit. This means that all health plans must cover this type of mental health care – including addiction treatment – under the Affordable Care Act. Nearly 1 in 20 Americans lives with a serious mental illness, so Joey (above) and his wife are hardly alone in their worries. If Obamacare is repealed, mental health care may become more difficult to access.

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Trump has expressed interest in repealing much about Obamacare, but there are two details about the law he’s said he’d like to keep. The first is that no one with a pre-existing condition can be charged more or denied coverage, and the second is that kids can stay on their parent’s health plan until age 26. So if Trump doesn’t repeal the entire health law, Cherie (above) should still be able to keep her coverage.

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Another Essential Health Benefit under the Affordable Care Act: hospitalization. Pyro (above) says that she would not have been able to afford a week-long stay in the Intensive Care Unit without her Obamacare coverage. In 2010, the average length of a hospital stay was about 5 days and cost more than $4,000. If Obamacare is repealed, many Americans who can no longer afford their health coverage would be forced to pay for this type of cost out of pocket.

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The above Tweet from Claire summarizes much of what could be lost if Obamacare was repealed. Preventive care, such as cancer screenings and immunizations, could no longer be free. Contraception would no longer be free, as we discussed in another recent blog post. And the list goes on. While still nothing is certain, it’s important to be aware of how the health law – and your health care future – could change.

Image credits: Twitter

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How Trump could affect Obamacare’s birth control provision

by Brooke Jarchow

Throughout his campaign, President-elect Donald Trump vowed to repeal and replace the Affordable Care Act. The health law, along with government regulations, requires insurers to cover birth control at no additional costs to insured women. In 2012, 15 percent of American women were getting free contraception; in 2015, it was 67 percent. Although Trump appears to be compromising on some aspects of the law, the future of accessible and affordable contraceptives remains uncertain. Below, we share what we know so far and what women should know following the election.

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Should Trump repeal the provision of the law that requires insurers to provide free access to contraceptives, women could be forced to pay out of pocket for birth control at significantly higher costs. For example, an IUD, currently covered under the law on the list of readily available contraceptives, can cost up to $1,000 out of pocket.

 

If Trump were to cut off the federal funding of Planned Parenthood as he promised during his campaign, millions of uninsured and low-income families that rely on Planned Parenthood for free and low cost health services may be unable to access contraceptives. Since the election, Planned Parenthood has received thousands of donations, but its future is still uncertain.

 

Women are now voicing their concerns across social media and to their health care providers. Across social media, women are urging each other to purchase mass amounts of birth control now, or to seek alternative long-term forms of birth control, like an IUD, that could outlast Trump’s presidency. Like other health care providers, Lisa Masterson, MD said she has received an influx of calls regarding the IUD after the election. The IUD can last three to 10 years depending on the type of IUD (there are three). The trending idea is that if a woman gets the IUD now, she could potentially avoid paying high costs for necessary birth control in the future during a Trump presidency.

 

However, it is important to remember that these changes to women’s rights would not happen overnight and may not even be implemented in 2017. This fortunately gives women time to look into their options, talk with their doctor, and choose a birth control and health plan that aligns with their personal circumstances. This is another important reason why women should secure health coverage now and stay educated on the decisions made by their government.

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5 ways you could be causing diabetes without knowing it

by Sam Kraft

November is National Diabetes Month, and a global spotlight is shining on a deadly disease that affects more than 29 million people in the United States.

Which makes today an opportune time to ask yourself: Could you be causing (or living with) type 2 diabetes…and not even know it?

Before you dismiss that notion, look at the facts:

  • 1 out of 4 people don’t know they have diabetes
  • At least 1 out of 3 people will develop diabetes in their lifetime
  • Most cases of type 2 diabetes can be prevented or delayed by adopting a healthier lifestyle

The goal of National Diabetes Month is to help promote the importance of type 2 diabetes screenings, which help ensure early diagnosis and treatment to reduce the risk of serious complications.

To help you decide whether you should book a screening, we’ve outlined five ways you could be putting yourself at greater risk.

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You have a major sweet tooth.

As a response to the low-fat “revolution” launched in the 1970s, sugar – particularly added sugar – became a staple of America’s food industry. The result? Millions of Americans have been unknowingly eating and drinking massive amounts of sugar for decades.

Those extra servings of sugar have taken their toll. In this case specifically, research shows that regularly drinking sugar-sweetened beverages increases your risk of type 2 diabetes.

Worried your sugar intake may be too high? For starters, start avoiding products with added sugar near the top of the ingredient list, such as fruit juices, soda, sweetened yogurt, baked goods, processed foods, and anything including the dreaded high-fructose corn syrup.

You’re stressed out.

Look, we’re all stressed. Jobs, families, money problems – no one’s immune. A little stress is normal, but research indicates that chronic stress can cause high blood pressure, blood sugars, and cholesterol, all of which are linked to type 2 diabetes.

On the same note, a Dutch study concluded that depression increases the risk for type 2 diabetes by 37 percent.

Stress can certainly seem overwhelming, but there are proven methods to build up control. Check out this post from Diabetes Self-Management for some helpful tips on stress relief.

You’re unknowingly triggering inflammation.

Though it may not be a direct cause, we can say for certain that internal inflammation plays a role in the development of type 2 diabetes.

If you’ve ever sprained your ankle or been bitten by a mosquito, you know how inflammation works. However, you may not be aware that certain behaviors can cause inflammation within your body, which sometimes lead to insulin resistance.

As people with type 2 diabetes already have issues producing enough insulin and using it properly, inflammation can create a vicious cycle inside your body if you’re at risk for the disease.

The best ways to fight off inflammation? Get regular exercise, adopt an anti-inflammatory diet, and practice good oral hygiene.

You’re on the couch too much.

Obesity is widely recognized as a primary risk factor for diabetes, as are the primary contributors to obesity like poor diet and lack of exercise.

But this may surprise you: a University of Missouri study concluded that people who lead sedentary lifestyles are at increased risk of developing type 2 diabetes, regardless of diet or weight.

My advice is simple: get off your couch, ditch your office chair, and move around. Not only does physical activity help with weight control, but it also uses up glucose as energy and makes your cells more sensitive to insulin.

You’re not getting your full 8 hours.

According to NIDDK, you’re at greater risk for type 2 diabetes if you’re living with untreated sleep problems, especially sleep apnea.

Like diabetes, sleep apnea often goes undiagnosed, which is why you may not even know you’re at risk. So if you’re frequently feeling bleary-eyed, read up on common sleep disorders and what you can do to prevent them.

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What we know so far about Trump, Republicans, and the future of Obamacare

by Lauren Mandel

Over the past year – and now, over the past few days – President-elect Donald Trump has made his intentions concerning Obamacare relatively clear. However, the Republicans do not hold the necessary 60 seats in the Senate for a full repeal of the health law, so while that is unlikely, changes are sure to come.

Below, we’re sharing what we know so far, and most importantly, what you can do now to make sure you’re as protected as possible for the future.

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No matter what the changes may be, they won’t happen immediately.

Last year, the Senate passed a reconciliation bill that was also passed in the House and then eventually vetoed by President Obama. But with Trump now set to take office in January, that bill could come back into play. The bill may be a good indication of which Obamacare provisions could eventually be eliminated, but these things take time. Even if this is the path the new administration chooses to take, it will take months for anything to be finalized.

Certain provisions of the health law will very likely remain in tact.

Even if Trump does revive this bill, certain provisions of the Affordable Care Act cannot be repealed with reconciliation. For example, those with pre-existing conditions (like cancer, diabetes, and other chronic illnesses) should know that health insurers will likely still be required to cover you, regardless of your health history. The same goes for young adults still on their parent’s health plan; you will most likely still be able to keep this coverage until age 26.

Even still, it wouldn’t hurt for women to look into birth control options.

Under the Affordable Care Act (and according to regulations more recently issued by the government), insurers are required to cover birth control at no additional cost to the individual. However, Trump could end up repealing this part of the health law, ending access to free contraceptives. So what are your options right now? Many women will choose to start paying for their birth control out-of-pocket, while others are seeking out alternatives that could outlast a Trump presidency. No matter your decision, we encourage you to consult with your doctor to find an option that makes sense for your health.

No matter what, get a health plan now to ensure you’re covered for the immediate future.

It’s clear changes are coming, but for now, it’s still important to get health insurance for 2017. As we said above, there’s no telling when exactly these changes to Obamacare might happen. And even with these changes, you could still have the option to hold on to your current coverage, so it’s arguably more important than ever to secure health coverage now.

Health Care Reform, Politics and Legislation | | Leave a comment