https://www.mainstreet.com/article/premiums-for-employer-sponsored-health-insurance-plans-to-rise-in-2016
Two more Obamacare health insurance plans collapse.
October 17, 2015 by
https://www.washingtonpost.com/national/health-science/two-more-obamacare-health-insurance-plans-collapse/2015/10/16/cc324fd0-7449-11e5-8d93-0af317ed58c9_story.html
Medicare Open Enrollment: Are You Ready?
September 15, 2015 by
More than 50 million people receive Medicare; but you have to be smart about the choices you make.
Source: Medicare.
Medicare covers more than 50 million recipients, with the vast majority 65 or older and relying heavily on the healthcare coverage it provides in their retirement years. Yet, Medicare actually involves some serious choices and, once a year, Medicare open enrollment allows participants to reconsider choices they’ve made about their coverage. This year, Medicare open enrollment runs from Oct. 15 to Dec. 7, with any changes you make taking effect on Jan. 1, 2016. Let’s take a look at some of the facts you should know when considering your best strategy for Medicare going forward.
1. Medicare doesn’t involve as many choices as private health plans
For many workers who get coverage from their employers during their careers, open enrollment is a stressful time in which you have to consider just about every aspect of health-insurance coverage. Different plans can vary in how they cover anything from routine doctors’ visits and basic medical services to high-cost hospital stays and chronic disease treatment. Choosing among all those options can be a tough call to make, with huge consequences if you’re wrong.
With Medicare, though, most of the basic benefits of the program are locked in if you choose traditional coverage rather than Medicare Advantage plans. Traditional Part A coverage of inpatient hospital care, skilled nursing facilities, and certain other intensive care tends to be straightforward, and Part B coverage for outpatient care, doctors’ visits, and other medical services also has fixed provisions. Unless you decide to seek alternatives to traditional Medicare coverage, you won’t have to do much with those key elements of the program.
2. Medicare Advantage plans have gotten more popular
Despite the coverage that traditional Medicare offers, it doesn’t cover all of your healthcare costs. That’s one reason why Medicare Advantage plans have gotten more popular, with about 30% of all Medicare beneficiaries participating in these types of plans. Some believed that Medicare Advantage plans would end up being uneconomical in light of healthcare reform; but, despite some regional squeezes, the overall number of plans available hasn’t fallen at a steep rate thus far.
Offered by private healthcare companies like UnitedHealth (NYSE:UNH), and WellPoint (NYSE:ANTM), Medicare Advantage plans typically offer managed care solutions. Integrated with prescription drug coverage under Part D, Medicare Advantage plans often require additional premium payments above what Medicare alone would charge; but, in exchange, recipients can get more extensive benefits under some policies.
Source: Medicare.
Participants can switch from traditional Medicare to Medicare Advantage, from Medicare Advantage back to Medicare, or among different Medicare Advantage plans throughout the open enrollment period. But because Medicare Advantage plans can be location-specific, you can also get permission to switch plans during certain special election periods if you move out of the service area that your current plan covers. By looking at your particular health needs, you can assess the best Medicare Advantage plans available to you, and often save money in healthcare costs as a result.
3. Be sure to look at Part D prescription drug coverage
Even if you’re covered by traditional Medicare, Part D prescription drug plans are still available. These plans can vary greatly in cost and services provided, with various plans even covering different individual drugs.
Because of the detail in which many Part D prescription drug plans go in describing covered drugs, it’s extremely important to look closely at the prescriptions you have, and make sure that they’re included in your current plan. Otherwise, you could be paying money for coverage that doesn’t give you the benefits you deserve. In addition, many Part D plans are eliminating features like zero deductibles and filling in gaps in coverage, which reduces premiums, but also forces you to pay more of your healthcare costs yourself.
Most older Americans rely on Medicare to cover most of their healthcare costs; so making the most of your benefits under the program is vital to your financial security. By knowing as much as you can about your options under Medicare open enrollment, you’ll be best able to get the most in benefits at the lowest possible cost.
The Real Cost of Being Uninsured.
September 15, 2015 by
Life insurance, disability insurance, long-term care insurance—if you are like most people, when your insurance agent starts talking about coverage you ought to consider, all you can think about is what it’s going to cost you. And even though it may seem like the economy is getting better, many people are still struggling with the impact the recession has had on their budget and what expenses they can put off until tomorrow.
According to the 2013 Insurance Barometer Study, conducted by LIFE and LIMRA the majority of consumers are concerned about having enough money for a comfortable retirement, with paying for long-term care and medical expenses next in line in terms of worries—all legitimate issues.
At the same time, it can be challenging to find the money to insure against a possible future event such as a major 
illness or debilitating accident when you’re facing real expenses or dealing with an insufficient income right now. In situations like that, it can be tempting to metaphorically cross your fingers and hope for the best, putting insurance on the “deal with it later” list. But before you choose that option, you need to know the real cost of being uninsured.
Life Insurance
Imagine that you were to die today. Would your family be able to pay your final expenses and continue to meet ongoing living expenses without your income? Or, if you are a stay-at-home parent, would your partner be able to afford to pay someone to perform all the duties and responsibilities you handled? What about long-term plans—will your children be able to attend college or your spouse retire as planned? With adequate life insurance, your family will be provided for when you are no longer there.
And, depending on the type of policy you choose and the option added to the plan, your insurance can be increasing in value or even, in the case of a terminal illness, provide funds to pay bills even before you die, relieving you and your family of at least one major worry.
Worried about the cost of insurance? While the vast majority of underinsured middle-income consumers include cost as one of the reasons for not purchasing life insurance, even when they believe they need it, the reality is that most people grossly overestimate how much a policy premium would be. For example, a 20-year, $250,000 level-term life policy for a healthy 30-year-old has an actual yearly premium cost of $150. Those surveyed estimated the same coverage at $350 to $500.
Disability Insurance
You don’t need disability insurance, you think. After all, isn’t that what Worker’s Compensation is for? Yes — and no. If the injury occurs on the job, then Worker’s Comp does come into play. However, only 5% of disability claims are work-related—and, according to the Council for Disability Awareness, approximately 90% of disabilities are caused by illnesses rather than accidents.
For example, if you are diagnosed with cancer or sustain major injuries in an auto accident and are unable to work, what will be the source of your income? How will you cover your living expenses and the additional cost of medical care? In this scenario, half of working Americans couldn’t make it one month before experiencing financial difficulties and nearly one fourth wouldn’t make it a week, according to a LIFE study. With disability insurance, however, you would have a source of replacement income to cover costs until you’re able to return to work. Fortunately, there are several options for getting disability insurance coverage.
Long-Term Care Insurance
We’d like to think that we will be able to live life on our own terms until it’s time to go, but the reality is that two-thirds of people will actually need some type of long-term care, either in their homes or at a facility. Where will the money come from if you fall into that majority? From Medicare or your existing health insurance? Not likely, since health insurance only pays for doctor and hospital bills, Medicare covers only short-term skilled nursing home care, and Medicaid only comes into play if your assets are very limited.
Will your savings be able to cover the expense? A home health aide three days a week will cost more than $20,000 a year and full-time nursing home care can be over $78,000 annually.
Maybe you think long-term care is something only the elderly have to worry about. But anyone at any age can suffer from an accident or debilitating injury that requires long-term care. As a matter of fact, 40 percent of patients receiving long-term care are under age 65.
For a comprehensive look at what long-term care insurance contact your agent who specializes in long-term care insurance.
The Bottom Line
There are a lot of factors to weigh when purchasing insurance, but be certain to have all the facts before making a decision. As you can see, both buying insurance and not buying insurance comes at a price. Be sure you know what the cost is—short-term and long-term.
Co-Pay? Deductible? Premium? What Does it all Mean? Health Plan Terms to Know Before you Choose a Plan.
September 15, 2015 by
Whether you are familiar with health plans or are shopping for one for the first time, deciphering different plans cans be confusing. Understanding the right terms is especially helpful when considering which plan is right for you, as many have cost implications associated with them. Here’s a rundown on the terms you’ll need to know to keep it all straight:
Affordable Care Act (ACA): The federal healthcare reform law passed in March 2010. Also known as Obamacare or healthcare reform.
Allowable charge: Also referred to as an ‘allowable amount’. The negotiated amount for which an in-network provider agrees to provide services. This amount is usually lower than the amount you would pay for the same service if you did not have health coverage.
Coinsurance: Your share of the fee for a service after you’ve met your deductible and before you’ve reached your out-of-pocket maximum. If your plan’s coinsurance share is 20%, you pay 20% of the allowable charge, and your plan pays the other 80% of the allowable charge.
Copay: A flat fee you pay at the time of service, such as an office visit. Copays apply toward out-of-pocket maximum.
Cost shares (or out-of-pocket costs): Costs that you pay for out of your own pocket for medical services, even if you have health coverage. Cost shares include deductibles, copays, and coinsurance.
Covered in full: Services your health plan pays for in full, at 100% of the allowable charges, and not subject to your deductible or coinsurance. For example, most preventive care is covered in full by many health plans.
Deductible: The amount you pay every year before the plan begins to pay for most services. This is similar to the deductible you pay for your car or homeowners insurance.
Exchange or marketplace: Another way to shop for health insurance, with a government (state or federal) website where you can compare plans from multiple companies and find out if you qualify for financial assistance. You can purchase your health coverage through the exchange or directly from Premera.
Formulary: A list of drugs for specific uses that the health plan covers.
Health savings account (HSA): Certain plans with higher deductibles allow you to open a special savings account to pay for many of your health care expenses. The money contributed to your account, by you or your employer, is not subject to federal income taxes when used for allowable healthcare costs, so the accounts offer tax advantages to some people. You generally have higher cost shares with these types of plans, so you should make sure you understand how they work before you consider them.
Network: A group of doctors, dentists, hospitals, and other healthcare providers that contract with your health plan to provide healthcare services at negotiated amounts, which are called allowable charges. Your costs are almost always lower when you get care from in-network providers.
Open enrollment period: The annual time period when you can apply for a new individual health plan or make changes to your current health plan. The open enrollment period for 2015 individual coverage is November 15, 2014 through February 15, 2015. If you experience certain life events, such as getting married, having a child, moving, or losing your employer’s health coverage, you can apply for coverage outside these dates.
Out-of-pocket maximum: A preset limit after which your plan pays 100% of the allowable charge.
Preferred provider organization (PPO): A health plan contracts with specific medical providers, such as doctors and hospitals, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use providers outside of the network, but you’ll pay a greater share of the cost.
Premium: The amount you and/or your employer pay (usually each month) for health coverage, regardless of whether you use any medical services.
Primary care physician (PCP): Your main or regular doctor or other healthcare provider. Some plans offer lower office visit copays if you notify them of your designated PCP.
Producer: A person or business that can help you shop for and choose health coverage. Often referred to as a broker or agent.
Your Employer Health Insurance Plan May Change in 2016.
September 14, 2015 by
Most employers are passing along at least some of the premium hikes. But you may see more generous incentives if you participate in wellness programs.
What changes can I expect from my employer’s health insurance plan during open enrollment for 2016?
Employers are just starting to announce their health insurance options for 2016, and you may need to make your decisions during open enrollment in the next month or two. The National Business Group on Health recently came out with its annual survey of large employers, which offers the first glimpse of the changes employees are likely to see in their health plans for 2016.
1. Higher premiums. Large employers expect their health care costs to increase by about 5% for 2016 – the same size increase they expected in 2014 and 2015. They plan to pass along some of the extra cost to employees but more of it to dependents, with employees contributing 20% of their own premiums and 24% of the premiums for dependents (higher-income employees may pay more). About one-third of the companies plan to add a surcharge for spouses who could get coverage elsewhere but don’t. But very few (only 4%) plan to exclude spouses who have similar coverage available through their own employer.
2. More high-deductible health plans. Employers are continuing to try to contain rising costs by forcing employees to take more control of their health care: 83% of large employers plan to offer a consumer-directed health insurance plan in 2016 (primarily high-deductible health insurance paired with a health savings account). Half of the employers plan to offer the high-deductible plan as an option, and 33% plan to offer it as the only option. More than half contribute to employees’ HSAs, giving them tax-free money for medical expenses; some add more if you participate in a wellness program or take a health risk assessment.
3. Restrictions on expensive drugs. Employers identified the cost of specialty drugs as one of the major causes for health care cost increases, and they’re imposing more restrictions on coverage. More than three-quarters of the employers surveyed plan to use prior authorization for some of these specialty medications – requiring physicians to fill out forms explaining why you need the specific drug. Three-quarters plan to use step therapy, covering the drug only after you’ve tried a list of less-expensive medications first.
4. New telemedicine options. Nearly three-quarters of the employers will offer telemedicine, which provides virtual visits with a doctor, as an option. “It’s still primarily phone-based, but the video component is starting to take off,” says Karen Marlo, vice president of benchmarking and analysis for the National Business Group on Health. “You can take a picture of a rash with your phone and e-mail it to someone who can look at it, for example. It’s a good way to provide good quality care at a lower cost, and it improves access in parts of the country where you have to travel a long distance to go to a physician.” A telemedicine doctor’s appointment may cost $40 or $50, while an actual office visit may cost $150.
5. Cash for wellness programs. Employers continue to focus on plans to improve your health, which they hope will ultimately help lower their medical expenses, and they’re giving employees more incentives to participate. Thirty-nine percent plan to offer a break on health insurance premiums or cost sharing for employees who participate in a wellness program, health assessment or biometric exam. Thirteen percent plan to offer breaks for participating in a disease management program, which provides special care and resources for people with complex conditions, such as diabetes. You may also get more money in your HSA: Nearly one-third of employers plan to contribute to an HSA for employees who complete a wellness or health education program, and 8% plan to make HSA contributions if you achieve a health goal
When Is Open Enrollment on Health Insurance Exchanges?
September 10, 2015 by
Don’t let the next Obamacare open enrollment slip by without signing up for health insurance on your health insurance exchange.
You can’t sign up for an Obamacare health plan on your state’s Affordable Care Act health insurance exchange whenever you want. Instead, there’s a limited open enrollment period during which you can sign up for a new plan or change your current plan.
If you miss Obamacare open enrollment, you may have to wait until the next year’s open enrollment period to sign up for health insurance.
So, When Is My Next Chance to Get Health Insurance?
The open enrollment period for 2015 health insurance coverage from the Affordable Care Act health insurance exchanges ended February 15, 2015.
However, the federal exchange at HealthCare.gov is permitting a one-time special enrollment opportunity for those who discover they must pay the penalty for being uninsured in 2014 and didn’t know about it. This one-time special enrollment period coincides with tax-filing season and runs from March 15, 2015 through April 30, 2015. Some, but not all, state-run health insurance exchanges have opted to provide this same special enrollment period.
Open enrollment for 2016 begins November 1, 2015 and ends January 31, 2016.
Open enrollment for 2017 and beyond runs from October 1 through December 15 of the year before.
For example, if you want health insurance coverage starting January 1, 2018, you can sign up for that coverage anytime between October 1, 2017 and December 15, 2017.
When Will My Coverage Start If I Sign Up During Next Open Enrollment?
For 2016:
- Sign up by December 15, 2015; coverage starts January 1, 2016.
- Sign up December 16, 2015 to January 15, 2016; coverage starts February 1, 2016
- Sign up January 16, 2016 to January 31, 2016; coverage starts March 1, 2016.
For 2017 and beyond, sign up any time during open enrollment and your coverage will start on January 1 of the following year.
What If I Miss Open Enrollment?
If you miss open enrollment on your health insurance exchange, you won’t be able to sign up until the next open enrollment period unless you qualify for a special enrollment period. Learn how to qualify for a special enrollment period, and learn what you’re in for if you don’t get a special enrollment period in “I Missed Obamacare Open Enrollment. What Now?”
If you’re losing your current health insurance and it’s not Obamacare open enrollment, you don’t have to go without health insurance. To learn your options, check out “Lost Your Health Insurance? Not Obamacare Open Enrollment? What Now?”
If you currently have health insurance you bought on your health insurance exchange, but missed open enrollment for the upcoming year, you’ve neglected to sign up for health insurance next year. You could be in luck, though; your current health plan might be automatically renewed, preventing you from being uninsured next year. Learn more about this in “What Is Automatic Renewal of Health Insurance & How Does It Work?” and “Weighing the Pros & Cons of Automatic Health Insurance Renewal.”
Tips For Lowering Your Medical Bills.
September 10, 2015 by
Having insurance may make it easier to get health care, but that doesn’t always translate to medical bills you can afford. High deductibles, copayments and coinsurance mean some people are avoiding medical care altogether to save money. But regular medical care is important, and you shouldn’t have to sacrifice your health to save money. By tackling your health care strategically, you may be able to avoid that tough decision.
More than 90 percent of Americans have health insurance, leaving 29 million still without coverage, according to the latest data from the federal government. But in a 2014 Associated Press survey of insured adults, one in four said they were not confident they could afford care if they or someone in their family had an unexpected medical need.
If you fear that a future medical expense may too steep, the following steps may help:
1. Find the right plan.
Saving on health care begins with selecting the right insurance plan. Consider how much the monthly premium will cost, but don’t choose your plan based on that factor alone. Instead, evaluate all of your options.
A plan that trades lower premiums for higher out-of-pocket cost — like a high deductible health plan (HDHP)— may make sense for someone with relatively few expected medical needs. Someone with a chronic condition, however, could save more with a plan that has higher premiums and lower deductibles, copays and coinsurance, as he or she will be going to the doctor more often.
Consider your medical needs for the coming year, and use them to estimate how much you’d spend with a few different plans.
2. Visit only in-network providers.
Insurance plans contract with groups of doctors and facilities to form a network that offers lower rates for members. When you use providers within that network, your care is covered at a higher rate. If you venture outside, you’ll have to pay more.
For example, one visit to an in-network family doctor for acute illness could result in a $35 copay, with your insurance picking up the remainder. A visit to an out-of-network doctor for that same illness could cost about $150, or the entire billable cost.
Always check your insurer’s website and search for doctors under your specific plan’s network.
3. Take advantage of FSA and HSA offerings.
Flexible spending accounts (FSAs) and Health Savings Accounts (HSAs) can help you budget for medical expenses while providing tax benefits. If your employer offers one, sign up. When deciding how much to contribute, estimate your medical expenses for the year and go from there. If you have a deductible, set aside at least that much.
A few important points:
● FSAs are— with few exceptions— “use it or lose it” accounts, so estimate your contribution carefully because if there are funds left at the end of the year, you may lose that money.
● HSAs are only available for people with qualifying high-deductible health plans. If you have such a plan, but your employer doesn’t offer an HSA, you can open one yourself through an outside financial institution.
● Unlike FSAs, an HSA is your account and the balance can be carried over from year to year, and even follow you as you change jobs.
4. Know what’s covered under free preventive care.
Under the Affordable Care Act (ACA), insured Americans are allowed certain free preventive services and screenings. These include immunizations and screenings for some types of cancer. Take advantage of this care because it can help you stay healthy and save you money.
5. Save on prescription drug costs.
Prescription drugs can be a major expense, particularly if you need recurring prescriptions.
Save on your medication costs by:
● Choosing generics over brand names whenever possible.
● Asking about a therapeutic alternative when your doctor recommends a brand name with no generic available.
● Asking your doctor for samples.
● Visiting the drug maker’s website for coupons or patient assistance programs.
● Getting your medicine in larger doses and splitting the pills.
● Refilling multiple months at a time.
A money-saving example: A one-month supply of the cholesterol drug Crestor could carry a $65 copay under some plans if a generic is not available. A one-month supply of Zocor— a different brand-name drug that treats the same condition— would cost $215, as insurance wouldn’t cover the brand name because there is a generic available. The cost of a one-month supply of simvastatin, the generic version of Zocor: $15 copay.
6. Negotiate high medical bills.
When you receive a medical bill, don’t automatically accept the balance as the final amount due. Contact the provider’s billing office to ask if they can reduce the cost. If the person on the phone won’t offer to lower the bill, ask to speak with a supervisor. Also, ask if a monthly payment plan is possible to make the
7. Carry lessons into the next year.
You may find the plan you chose for this year wasn’t the best for your situation. Make sure you learn from your experience and choose a more suitable plan during your next open enrollment period
Medicare Open Enrollment.
September 9, 2015 by
You only have one chance a year to make changes to your Medicare coverage. The annual Medicare open enrollment period is that chance.
Whether this is your first Medicare open enrollment or you’ve been doing it for years, it pays to take time each autumn and study your options. The number and types of plans available in your area change each year, bringing new options and eliminating previous options.
The benefits and costs associated with a plan you’ve had for years can change. This is your chance to do something about it.
When Is Medicare Open Enrollment?
Medicare open enrollment starts October 15 and ends December 7, Pearl Harbor Day. The changes you make during open enrollment take effect January 1 the following year.
You don’t have to wait until October 15 to start planning for open enrollment. You can start doing research on plan options when you get each year’s “Medicare & You” booklet in the U.S. mail or by email. The booklet alerts you to changes in Medicare that might impact your coverage or plan choices.
You’ll likely get information from you current Medicare Advantage and Medicare Part D drug plans as well as Social Security in the mail around that same time.
What You Can Do During Open Enrollment
- Switch back and forth between Original Medicare and a Medicare Advantage Plan.
- Switch from one Medicare Advantage plan to another.
- Enroll in a Medicare Part D drug plan.
- Switch from one Medicare Part D drug plan to another
- Drop your Medicare Part D drug plan completely, perhaps because you switched to a Medicare Advantage plan that includes drug coverage.
What if You Miss Open Enrollment?
If you miss open enrollment, you won’t be allowed to make changes to your Medicare coverage until next year’s open enrollment. Your current Medicare coverage choices will roll over to next year.
There are a few exceptions that will allow you to make coverage changes outside of open enrollment. Some things, such as moving outside of your Medicare Advantage plan’s service area, trigger a special enrollment period allowing you a brief period to make changes even though it’s not open enrollment.
From January 1 through February 14, you can change your mind about your Medicare Advantage plan and switch back to Original Medicare. You can’t switch to another Medicare Advantage plan or join an Advantage plan you don’t already belong to, though.
How To Prepare for Open Enrollment
- Gather information about your current coverage so you’ll be able to compare and contrast the new offerings with what you have now. You’ll need information on the premiums, deductibles, copay or coinsurance amounts, which of your drugs are on your plan’s drug formulary and how much they cost.
- Go to the Plan Finder tool at Medicare.gov to get information about which plans will be offered in your area next year, what they’ll cost and how their quality scores stack up.
- Compare what you have now with what you’d have next year if you kept the same coverage. Are your premiums or cost-sharing going up? Are your drugs all still covered at the same level on the plan’s drug formulary? Are your doctor and hospital still in-network if you have a Medicare Advantage plan?
- Look at the other Medicare coverage options in your community. Check the drug formulary of each plan you’re interested in. Do any of them have better coverage for your particular drugs? Can you find a plan with a lower premium but similar coverage? Can you find a plan with a similar premium but better coverage? Do the plans you’re considering have good quality scores? Make sure to check out Medicare Advantage and Medicare Part D provider networks to make sure you’ll be satisfied with the doctor, hospital and pharmacy choices.
How To Make Changes During Open Enrollment
If you decide to change your Medicare coverage during open enrollment, you have several options for how to do that.
You can sign up for most plans on the Medicare.gov website.
You can sign up with the plan directly by:
- Visiting its website
- Telephone
- Filling out a paper application and mailing or faxing it to the health plan
- Attending a community meeting put on by the health plan to educate Medicare recipients—and to market the health plan to them. Often, these plans will allow you to enroll in the plan during the meeting. Not all plans hold community meetings, and some communities don’t have any meetings.
How to Get Help
If you’re having difficulty understanding the rules of Medicare open enrollment, how to accomplish your Medicare open enrollment goals, or comparing plans, you have several resources for help. Learn more in “Get Help With Medicare Problems & Medicare questions.”
If you’re having trouble understanding how Medicare Advantage plan types differ, learn more in “HMO, PPO, EPO & POS—What’s the Difference & Which Is Best?”
If you need clarification about what a particular plan does or doesn’t offer, contact the health plan.