Tag Individual Health Insurance

RateShock1Ohio reveals high exchange rates under the Patient Protection and Affordable Care Act, according to this article from BenefitsPro.

The state of Ohio just released their projected health insurance increases under the new health care reform.  As Hoosiers, we should look at those price increases closely as we may be in the same situation soon. The Ohio Department of Insurance stated that health insurance premiums will go from $223 a month to $420. which is an 88% increase in cost.

Most people thought that the Affordable Care Act would lower premiums. Under the law, health plans now have to have richer benefits and much less limitations.  These mandates all lead to higher premiums. The way the law plans to help people is by giving them subsidies through the exchange. You can find out more about subsidies at our sister site, Indianapolis Health Insurance Exchange.

If you make less than 400% of the federal poverty level and do not have access to group health insurance, then you may qualify for subsidies. If you get the subsidies then you will pay a percentage of your household income in premium. This ranges from 2.3%-9.5%.  The subsidies are how the law plans to reduce premium costs.

If you are above that 400% of FPL, then you should prepare yourself for what is now being called rate shock.



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The Indianapolis State House
The Indianapolis State House

The next Governor of Indianapolis is going to have a huge impact on health insurance in the state.

The first decision the Governor will have to make is on the Essential Benefits. It is the responsibility of each state to form the Essential Benefits.  The essential benefits are a set of health care service categories that must be covered by health insurance plan in 2014. The essential benefits will have a huge impact on health insurance premiums.   For example, if the state decided one of the essential benefits is that fertility treatment must be covered.  This would be a great benefit for Hoosiers that needed that coverage but everyone would pay a higher premium.

The 2nd big decision by the Governor is on establishing a state based exchange. Under the new health care law, a state based exchange can be established for people to buy health insurance policies from.  This is a very big decision. The cost of running a state based exchange is anywhere from $66-$88 Million a year.  The Department of Insurance has not clarified where this money would come from. If the state chooses  not set up a state based exchange then the federal exchange will operate in Indianapolis. The Federal Government has not released a lot of information on how that exchange will operate. It is fair to say the department of insurance will have little control over the federal exchange.

The next Governor of Indianapolis, will make health insurance decisions that will effect every Indianapolis resident.

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Walgreen’s rejoins Anthems Network

Anthem just announced that Express scripts and Walgreen’s have reached an agreement.  Anthem members can use the Walgreen’s pharmacy as they will be considered a in network provider.

Walgreen’s is a great provider of pharmacy benefit in the area. It is important to remember to check local pharmacies for the most competitive prices on medications.  The large pharmacies can sometime have the most expensive prices. If you are on a Health Savings Account it makes sense to be a consumer shopper for RX.  Comparing prices of local pharmacies might bring large savings to you.

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Countdown to Health Care Reform
Countdown to Health Care Reform (Photo credit: Truthout.org)

The insurance landscape is changing. But the shifts won’t just affect consumers – brokers are also looking at an alteration in the way they currently do business.

The new healthcare reform law requires states to create insurance exchanges so people not covered by an employer plan can shop for affordable coverage. Some industry analysts believe that consumers faced with a larger menu of options from which to choose will seek a provider that can offer comprehensive support. If that opinion becomes reality, there is concern that insurance brokers who operate smaller outfits may find themselves unable to compete.

On the other hand, the broker might be needed more than ever. A good broker could have significant value in translating the complexities of an exchange versus the private market. In Indianapolis alone, some predictions estimate that more than 800,000 people will move over to some type of exchange. Brokers will play a critical role in making these transitions happen smoothly.

For all the supposed simplicity, the exchanges are still an unfamiliar commodity. Individuals and small businesses will still need to figure out which coverage best suits their needs. Brokers and agents can act as guides for determining the appropriate coverage. In addition, employers that currently offer benefits to employees might feel intimidated by all the new regulations. A broker, using an existing relationship with an employer, can help identify new insurance opportunities available through an exchange.

As the healthcare reform law crawls closer to full implementation in 2014, it’s important to remember that most consumers will still seek an expert to guide them through the process. Large healthcare distributors may find themselves with greater levels of influence, but the tools they offer to consumers need to keep pace. If they are unable to meet those demands, the role of the broker becomes a tremendous necessity.

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English: Accrington Pals Medical Health Care C...

One significant downside to a high-deductible health plan (HDHP) is that you’re responsible for paying everything out-of-pocket until you reach your deductible (which typically ranges from $1,000 to $5,000 on these plans).

You’ll pay 100 percent of the cost of prescriptions, doctor visits and emergency room visits. You’ll also pay for the cost of surgeries and out-patient procedures.

If you’re considering a pregnancy, make sure there’s maternity coverage on your policy. There usually isn’t.

While a high-deductible plan can lower your overall health insurance costs while protecting you from unexpected and large medical bills, make sure you have your own plan to pay those initial out-of-pocket expenses. You’ll need a tax-deductible health savings account or your own savings plan to satisfy the deductible.

Research shows that people with high-deductible plans do cut their overall health care expenses. But they also tend to cut back on preventive health care such as childhood immunizations, cancer screenings and routine tests. This “penny wise and pound foolish” approach to medical care can be dangerous.

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A high-deductible health insurance plan can provide affordable coverage for unexpected major health and medical expenses.

Essentially a form of catastrophic insurance, these plans charge a high annual deductible – from $1,000 to $5,000 and higher – in exchange for lower monthly premiums.

You’ll have to pay out-of-pocket costs for routine doctor’s office visits or trips to the emergency room until you hit your deductible. The insurance covers everything after that.

To help pay these out of pocket costs, it’s both wise and typical to pair your high-deductible plan with an IRS-qualified health savings account. You can make tax-free deposits into this account (even if you take the standard deductions and don’t itemize), up to $3,050 annually for individuals or $6,150 for family coverage. If you’re 55 or older, you can contribute an extra $1,000 a year.

This money is yours to withdraw, tax free, at any time, to pay for medical expenses that aren’t covered by your high-deductible policy.

High-deductible insurance is considered a consumer-driven health plan, giving the patients control over how to spend and invest their money.

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There’s good news for children with pre-existing conditions who are below the age of 19.

Under the Affordable Care Act passed in 2010, they can’t be denied coverage under group plans and most individual family or child-only policies. This applies even if your child has a potentially life-threatening medical condition like asthma or diabetes.

This rule applies to all job-related health plans and individual health insurance policies issued after March 23, 2010.

Children account for nearly 9 percent of the estimated 57.2 million Americans under age 65 with pre-existing medical conditions, ranging from deadly cancers to routine chronic conditions.

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House Dem rips new insurance rule  Rep. Robert Andrews  (D-N.J.) spoke to the NAHU about the effects of the Medical Loss Ratio on Agents.

With the Medical Loss Ratio in the new health care law 80%-85% of premium has to go to claims. That leaves just 20% for the insurance company to spend on administration. HHS chose to include broker compensation in the administration. On large cases this does not have a  major impact but on the individual market it has been devastating. The carriers have cut the commission by 50% for individual health insurance throughout the country.  This new commission structure has forced many agents to reevaluate their individual health insurance sales.

Rep. Andrews is the first pro health care reform politician to address this issue in favor of the brokers and agents.   For many health insurance agents the new law devalues the services that we provide to the individual health markets.

Here at Nefouse & Associates we continue to proved the very highest level of services for all our individual health insurance customers.

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Most people that have an individual health policy has premium payments set with an electric fund transfer from a bank account. The health insurance industry like many others has really shifted to paperless. In fact if you want a monthly bill mailed it could cost you anywhere from $5-$25.

These EFT are good and bad. The good thing about it is your premium is always paid on time and you don’t really have to address the premium until renewal. The bad is if you switch to a new carrier and forget to inform the previous you wish to cancel you will have a very hard time getting your money back. The carriers have become notorious for keeping the money.

So remember if you switch your individual policy make sure your new effective give  you time to cancel the old one.

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