7 tips for lowering your medical bills— even if you have health insurance.

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.

READ MORE: What Exactly Is an HSA?

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.

READ MORE: What’s Covered Under the ACA’s Free Preventive Care?

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.

READ MORE: How to Save on Prescription Drug Costs

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 bill more manageable.

READ MORE: A Guide to Negotiating Your Own Medical Bills

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

How to keep 2016 health insurance premiums in check.

http://www.cbsnews.com/news/how-to-keep-2016-health-insurance-premiums-in-check/

When Is Open Enrollment on Health Insurance Exchanges?

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.”

 

 

Why Health Insurance is Important.

Why Health Insurance is Important

 

If you’re a relatively healthy individual, you may find yourself occasionally asking, “Do I even need to have health insurance?” Don’t be foolish though—having health insurance is incredibly important, not to mention it’s the law!

 

A health emergency can be expensive. A hospital stay in Washington state can costs as much as $3,000 a day!1 Aside from unplanned emergencies, health insurance provides you with a wealth of preventive services that will help you maintain your health and well-being long-term.

Apart from the health aspect, there are also financial implications if you don’t have a health plan.

PENALTIES

Under the Affordable Care Art, most people are now required by law to have health insurance either through their employer, Medicare, Medicaid, or by purchasing their own coverage.

Don’t have any of the above? You could be subjecting yourself to an annual penalty that could cost you nearly as much as buying insurance.

Penalties were relatively low in 2014, but are increasing in 2015 and will continue to go up each year, thereafter.

Penalties are assessed in one of two ways and you will pay whichever is greater of the two amounts:

• 2% of your yearly household income. For example, if you make $50,000 and don’t have a health plan, you would be subject to paying a $794 penalty for 2015 according to a calculator from the Tax Policy Center. The maximum penalty is the national average premium for a bronze plan. In addition to the penalty, you will also be responsible for 100% of your medical bills during the year.

• $325 per adult and $162.50 per child under 18 years of age, with a maximum penalty of $975 per family for the year.

Note: In 2016, it will be 2.5% of your household income or $695 per person with a maximum of $2,085 per family.

If you do end up having to pay a penalty for not having health insurance, you will be required to pay it when you file your federal income tax return. If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you are uninsured. If you’re uninsured for less than three months, however, you won’t have to pay a penalty.

Using Health Savings Accounts (HSAs) to Reduce Insurance Costs.

Health Savings Accounts, or HSAs, and their attendant high-deductible health plans (HDHPs), have been embraced by over 10 million Americans. Consumers are looking for ways to keep premiums affordable, while businesses are looking for ways to control health care expenses. HSA/HDHP combinations have been immensely successful at containing the rate of growth in health care costs, reducing the rate of increase in medical insurance expenses to 2% per year, compared to the 12% rate of inflation in traditional major medical plans since 2000.

In return, however, workers and policy owners have had to pick up more of the risk – you can only use HSAs if your plan qualifies with a minimum deductible of $1,200 (or $2,400 for family plans.)

What is an HSA?

An HSA is a tax-exempt account that is created for the purpose of paying qualified medical expenses. The HSA can be funded by the employer and/or the employee. To be eligible to create an HSA, you must be an individual who has a high-deductible health plan (HDHP). An HDHP is one in which a single individual has a yearly deductible of no less than $1,250 (2014). Further requirements are as follows:

  • HSA holders can choose to save up to $3,300 for an individual and $6,550 for a family (HSA holders 55 and older get to save an extra $1,000 which means $4,300 for an individual and $7,550 for a family) – and these contributions are 100% tax deductible from gross income.
  • Minimum annual deductibles are $1,250 for self-only coverage or $2,500 for family coverage.
  • Annual out-of-pocket expenses (deductibles, co-payments and other amounts, but not premiums) cannot exceed $6,350 for self-only coverage and $12,700 for family coverage.
  • You must not be covered under any other insurance plan that is not an HDHP.
  • You must not be entitled to Medicare benefits.
  • You cannot be claimed as a dependent on another person’s return.

If you meet all of the above requirements, you are an “eligible individual” for a Health Savings Account.

The benefits of an HSA

Employee benefits
An HSA has many benefits for employees. The first benefit is that 100 percent of the annual deductible for the individual or family can be contributed to an HSA. However, this amount cannot exceed $3,300 for an individual, and $6,550 for family coverage. People ages 55 to 64 can make additional contributions to “catch up” in 2014 of $1,000.

The contribution to the HSA is tax-free to the employee. The employee can take a deduction for any amount he contributes to the HSA. This deduction is an “Above-the-Line” deduction, and therefore directly reduces an employee’s taxable income.

An HSA is held in an account for the benefit of the individual, his spouse or children. This account is invested, and any gain on the investment is also tax-free. In addition, if an employee changes jobs, the account goes with him, as the employee is allowed to transfer the entire fund balance to his new job.

Employer benefits
There are also benefits to the employer. An employer is not taxed on the amounts he contributes to the account, and these amounts are also not subject to withholding for income tax, FICA, or FUTA. Therefore, an employer obtains a direct write off for the amounts paid not only for the health insurance premiums, but for the HSA as well.

In addition, most employers will see a reduction in the monthly premiums they pay for their employees due to the increase in deductibles (if the employer does not already have an HDHP).

The reduction in the premiums, and the tax deduction, will help to offset the cost of the employer funding a portion of the HSA, if they so wish to assist their employees with funding the HSA.

The disadvantages of an HSA

Disadvantages for employees
The disadvantages of an HSA are few and far between. First of all, once you reach the age of 65, you can no longer contribute to an HSA. If you do contribute, all amounts will be taxable to you in addition to a penalty of 6 percent. This also occurs if you are considered an “eligible individual” and exceed the allowable amounts that can be contributed if you are less than 65 years of age.

If you do not use the funds for “qualified medical expenses,” the funds that are used are included in your gross income, and a penalty of 10 percent is imposed. The 10 percent penalty is eliminated in the case of a distribution after the account beneficiary’s death, disability, or once you have attained the age of 65.

An HSA can be transferred to a spouse tax free, but when an HSA is transferred to a person other than your spouse, it ceases to exist as an HSA. It is then included in the person’s taxable income. This amount, however, is reduced by any amount paid by the HSA for the decedent’s qualified medical expenses paid up to one year after their death.

Change in health care coverage

Disadvantages for an employer
One disadvantage for an employer is that a “comparability” rule applies. An employer must make comparable contributions to each individual’s HSA. They must be either the same amount or same percentage of the deductible of an HDHP for each employee. No discrimination is allowed as to employees.

A second disadvantage is that the employee is deemed the owner of the HSA, and therefore if they were to quit or be terminated from employment, all employer-funded amounts remain the property of the employee. The employee is free to transfer their HSA to another employer, including all payments made by their former employer and all interest accumulated on those payments.

The employer can contribute throughout the year, as he pays the medical premiums for his employees. Thus, an employer can save on the cost of the premiums, spread the payment amount over the year and save payroll taxes on the money contributed. This is in addition to making the employee happy.

Who can administer an HSA?

An HSA must be administered by a qualified HSA trustee or custodian. This includes an insurance company, bank, or a person approved by the IRS (approval may be difficult to obtain). The Trustee can be different than the company that provides the HDHP, but you should first check with your insurance carrier to determine if they carry HSAs, and the cost of such plans.

A refreshing option

Health Savings Accounts (HSA) are as good as they sound. Decreasing the cost of health insurance is a refreshing option in today’s rising inflationary economy. Small and large employers alike can now benefit from a quality health program. It is not often that we have the ability to reduce our health insurance costs. Therefore, it is imperative to reassess your employer-sponsored health insurance plan, and determine if an HSA is appropriate for your company.

Tips for selecting the right comprehensive health insurance plan.

Today, with medical costs at all-time high, emergencies such as sickness, disease and accidents which may result in prolonged hospitalisation, can leave you in severe financial crisis unless you have a comprehensive medical insurance policy which takes care of all your required expenses. So how do you choose a plan that’s perfectly suitable for you and your family?

There are a lot of factors to consider when choosing an insurance plan, most importantly: what your health care needs are, and what you can afford to spend? Once you are aware of your financial strength, the next step is to identify the “ought-to-have” with anticipating certain medical needs. With the right insurance, you could save thousands, perhaps even tens of thousands, if you or a family member gets sick.

Here are some critical clauses that needs your attention to detail while buying a health insurance policy:

• Sum insured limits

The main limit in health insurance is the sum insured. Any medical expenses incurred over and above the sum insured are not payable. It is advisable to take adequate cover from an early age, particularly because it may not be easy to increase the sum insured after a claim occurs or when the age increases.

• Individual/floater policies

Most buyers often struggle to make a decision on whether to buy an “individual” policy for each family member or a “family floater policies”. While an individual policy works best in all situations, it can be an expensive option. The family floater plan on the other hand offers flexibility in terms of utilising the overall insurance coverage among the family as a group. While an individual opts for a family floater cover, the sum insured opted should be sufficiently high considering a situation where more than one person in a family needs hospitalization in the same year.

• Extent of coverage

When you are paying for a comprehensive cover, it is important to make sure that the risk covered is comprehensive as well. One should not buy a plan just because it’s cheaper than the rest but should be measured in terms of premium versus benefit comparison. Benefits such as pre and post hospitalization, day care procedures, OPD cover, maternity extensions or ambulance service, should be taken into consideration.

• Waiting period for pre-existing disease exclusions

Many individuals have health related problems that exist before you apply for a health insurance policy or enroll in a new health plan. Pre-existing condition imposes a waiting period which is also called the cooling period. Therefore, apart from the insurance premium being charged by various insurers, you also need to compare the waiting periods stipulated in the policies for covering pre-existing ailments. Some policies specify a waiting period of two years, while in case of some, it could extend to four years. Similarly, there are waiting periods for certain listed conditions like hysterectomies, cataract, kidney stones and knee replacement surgeries which may vary from one year to four years and these also need to be compared.

• Any internal sub-limits like room rent curbs, sub-limits on specific procedures

In order to avoid inflated charges that hospitals levy on patients with an insurance cover, some policies have sub-limits on room rents or certain procedures and this becomes the most critical feature when evaluating a health insurance policy. Typically the insurer places two kinds of limits, on the hospital room rent and the liability for specific diseases. Classically the room rent expenses are capped at 1% of the sum assured for a day, while ICU charges have a ceiling of 2% of the sum assured. Plans free of sub-limits are preferred as it prevents surprises at the time of claims. These sub-limits are generally seen in plans with lower overall sums insured.

• Deductibles/co-payments

Sub-limits can also take the form of co-payments, where the insurer will be asked to pay a predetermined percentage of the claim amount or deductibles, where the insurer will have a cut-off cost which you will have to bear and the insurer will come into the picture only when the bill goes beyond this limit. It is advisable to go for plans that come devoid of restrictive options, such as co-payments, limits on room rents and treatment-specific limits. They may cost a little more but evade financial risk during emergencies.

• List of exclusions

While your health insurance policy can provide relief in times of emergencies, there may also be times of trouble in case you are not aware about the ailments that are covered and those that aren’t. It is important to know the list of exclusions in your health insurance policy to avoid instances when you end up paying additionally for a service already covered in your policy or in worst case scenario, post treatment you realise that your policy did not cover the treatment of that particular illness.

• In-house claims servicing or use of TPA and service levels/market feedback

It is important to know whether the insurance company has its own in-house servicing unit or uses a TPA for servicing the policies.

Insurance companies having their in-house servicing units have a better turnaround time for claims servicing and cashless processing.

A hospital or medical institution which has an agreement with the insurance company or TPA (Third Party Administrator) to provide cashless treatment is a network hospital. While buying a health plan, make sure of the proximity of the network hospital from your place of residence or work. Opt for an insurer who has more network hospitals in geographical locations where you are likely to need medical care.

Ensure that the facilities and repute of the hospitals in the network are worthy.

• Reputation of the insurer

Traditionally, we all are inclined to go for plans that our friends and family suggest as we trust their experience and judgment.

But the market is flooded with products and marketing gimmicks to lure customers. While deciding on a health plan, it’s important to conduct a due diligence on the insurance company — keeping track of how smooth their claim settlement is, how many claims have been settled, time efficiency and network.

Health Insurance for the Self Employed .

Medicine BottlesBeing self-employed is a liberating feeling for those who make it a part of their lifestyle. These people have the autonomy to set their own schedule, and enhance their careers as much as possible without having to deal with mundane office politics. A self-employed person can manage their own career, without having to wait to be promoted. There is one thing however, that is tough to manage, which is health insurance.

When first starting out in a new career, it can be especially difficult to carry health insurance. Although many people would love to become self-employed, and plan carefully for such an event, most do not realize the actual monthly expense of health insurance. Before you make this decision, it is crucial to figure out exactly how much you will be paying for health insurance. Collect as much information as possible, for example the rates you need to pay to cover yourself and possible dependents, and how that fits into your budget.

Being self-employed does not allow you to take advantage of bulk rates that are normally set aside for employers paying to cover their employee’s health insurance costs. This is one of the reasons why the insurance rates are so high. Through careful research, you may find you have access to low bulk insurance rates through a non-corporate affiliation. Possible solutions include programs related to educational institutions you may be associated with, or perhaps your religious background will allow you to get a discount from certain organizations.

Consider joining a group that can help get you an affordable insurance rate. The Freelancer’s Union was formed partly to help the self-employed get health insurance at discounted rates by bringing freelancers together. Take into account nationwide organizations like the Freelancer’s Union as well as local community organizations that will give you options for insurance rates. It’s just a matter of being resourceful and creative to find health insurance as a self-employed person.

Individual Health Insurance

Frank West Insurance Services | Individual Health Insurance, Family Health Insurance, HTH Travel Insurance, CA Medical Insurance, Affordable San Diego Health Insurance, Insurance Quotes, Whole & Term Life Insurance Policies, Medicare Supplement Insurance, Medigap Plans, San Diego Medical Insurance, Medical Coverage, Health Care Reform & Affordable Care Act Assistance, CA Health Insurance Exchange, Group Health Insurance, Business Health Plans, Health Care Insurance, Long Term Care, Group Health Insurance, Employee Benefits, Dental Insurance, Disability Insurance, San Diego Life Insurance, Anthem Blue Cross, Aetna, Blue Shield of CA, Cigna, Health Net, Kaiser Permanente, San Diego, Coronado, La Jolla, Pacific Beach, Rancho Penasquitos, Poway, Rancho Bernardo, Oceanside, Solano Beach, Pacific Beach, Cardiff-by-the-Sea, Encinitas, Carlsbad, Carmel Valley, Del Mar, Olivenhain, Rancho Santa Fe, Aviara, Lakeside, San Diego County CA, Southern California | 309 Miami Trail, Oxford OH 45056 | (858) 484-1894