Monday, December 15, 2014

Missed the January 1st deadline. What happens now?

December 15th was the last day to enroll in the health insurance exchange to be guaranteed coverage on January 1st. You didn't enroll in time? You didn't need coverage January 1st but might sometime this year? What happens now.

If you did not enroll in time to get coverage on January 1st you are still able to get coverage through the exchange. The marketplace is "open" until February 15th. If you enroll between the 16th and end of the month, your coverage is not eligible until the second following month. So for instance, if you enroll December 16th- December 31st, coverage will not start until February 1st. If you were to enroll on January 16th, your coverage would not start until March 1st. Enrolling in Coverage between February 1st and February 15th will guarantee coverage effective March 1st.
You are able to enroll in Medicaid or CHIP (Children's Health Insurance Program) can be done at any time.

If you do not have coverage in 2015 you will be penalized. The fees are either $325 or per person for the year ($16.50 per child under 18) or 2% of your yearly household income, whichever is more.

Sometimes our situations change and we may need coverage outside of the open enrollment period. You are able to get coverage outside of the deadline, but you would need to have a qualifying life event. Qualifying events such as, getting married, adopting a baby, or losing your job and health insurance would allow you to sign up for coverage.

Having a gap in coverage doesn't necessarily mean you will be responsible for the penalty. If the gap in coverage is less than 3 months you can avoid the fine.

Having health insurance coverage is one of the most important things you can insure yourself with. If you are not offered coverage through your employer, finding a plan that fits your needs is important. The penalty might seem low, but having unforeseen medical expenses can jeopardize your financial future.

Thursday, December 4, 2014

HMO vs PPO...do you know the difference?

Here we go with the acronyms again...HMO vs PPO...let me break it down for you. It may be a short abbreviation but the differences are big. When choosing a plan through the Health Insurance Exchange, you'll find that HMO's could be a little cheaper and when you choose an on exchange plan, the choices will be HMO's, so it's important if you are shopping for insurance to know the difference.

A PPO, (Preferred Provider Organization) and an HMO, (Health Maintenance Organization) both use a network of physicians and hospitals to give you the highest quality of care. However, the main difference is how you use those networks.

In a HMO, you go through your main primary care physician for all other types of services. So you need to choose a PCP that is in your network and you will get referrals for other providers through your chosen PCP. In the case of an emergency you would not need a referral. Ideally, this is to help lower health care costs. So with a HMO you are not necessarily limited to care, you just need to get a referral first. Typically, doctors outside of your network are not covered at all.

With a PPO, you will have more flexibility. No referrals and you can see any doctors you choose, selecting from a larger list of in network providers. Even if you choose to go out of network, there are out of network benefits. You won't get the benefits of contracted rates but you are free to see out of network providers. Just be careful of balance billing by out of network providers.

So in summary, you'll have more flexibility, out of network benefits and a larger network with PPO's but could possibly have cheaper premiums with HMO's. HMO's help streamline care with the referral to trusted physicians from your own trusted physician.



Thursday, November 20, 2014

Using your health plan...tips and tricks, including $4 prescriptions!

Unless you work in health insurance or use your plan on a daily basis, you might not know the ins and outs of using your coverage. I always like to get the biggest bang for my buck, we might as well, we pay enough for our coverage! So here are a few tips and tricks to using your health plan. Health care costs are not going down, so let's save money where we can!

Preventive care is now covered at 100%. Meaning it is very important that you do get that annual physical because for one, it's free! And two, is very important that we get an annual screening each year. But when you go, make sure you are completely healthy and that you are just there for your annual screening. If you mention to the doctor you have a cough or cold, or aren't feeling well, he'll write that in his notes and the billing code will include an "illness". Then you'll get a bill! So if you aren't feeling well, make another sick appointment. That way your preventive screening is covered at 100%.

Always check that your doctor is in-network. Seeing a new doctor? Make sure to log on your carriers website and check to see if the doctor is listed as participating. Most carriers have apps now and you can check quickly, even on your way there! Using a participating provider vs non par provider can save you lots of money! I like to double check, out of network medical bills are NOT cheap, so if you aren't sure, call the doctors office and ask if they are contracted with your carrier (or give them the details of your health insurance card, for example PPO/HMO). They should be able to tell you if they have a contract with that carrier. The reason I say double check, our pediatrician participated with Anthem but didn't take our specific plan. So I just assumed our plan was in network and we were left with hundreds of dollars in denied claims! Seeing an in network doctor means the contracted rates for services are much lower, saving you and your plan money!

When we are sick and we just can't wait it's easy to run to urgent care rather than waiting on an appointment with your primary care doctor. But if it's not urgent, try to wait until the next day if you can. Urgent care visits are much cheaper than emergency room visits but more expensive than primary care visits. It's going to cost you a higher co-pay or out of pocket amount depending on how your plan pays, and it costs your health plan more in the long run. Sometimes when we know we have an ear infection, strep throat or a simple illness we can ask to see a nurse practitioner. It costs less to see them, even if it's in the same office as your doctor.

Prescription drugs can be expensive, especially if you are taking several maintenance meds each month. Depending on how your plan pays you probably pay a co-pay for each of those prescriptions. Depending on which tier it's on, depends on the co-pay you will pay. Co-pays for a one month supply of blood pressure medicine or an antibiotic can add up, add that to several members in your family and you might spend more on prescriptions than groceries.
It's not exactly "new" news but a few years ago pharmacies started offering $4 Generic prescription drug lists. Meaning if you were prescribed a drug that was considered "generic" it might be on this $4 drug list and instead of using your health insurance to get that prescription the pharmacy would ring you up for FOUR dollars! Genius in my opinion! The wholesale value of these common generic drugs is rather low, so if you are paying your copay through your health plan and it's on that drug list, you are overpaying.
My suggestion, when the doctor writes you a generic script, before you head to the pharmacy, check that list. If it's on there, make sure to tell them not to run it through your insurance and you'll get the $4 prescription. Hopefully they offer that to you anyways but it's always worth asking. You can also ask your doctor for a generic drug that you know is on that list. I'd much rather pay $4 than my $15 copay. Or, carry those handy $4 drug lists with you everywhere you go!



Saturday, November 15, 2014

What's our role?

The industry is changing, the language is changing and its becoming more confusing than ever before. Gone are the days of $10 co-pays to have a baby! When the Affordable Care Act was first introduced, there were many misconceptions. There were laws and regulations that were established without a good understanding of exactly what was trying to be accomplished. Not only are consumers confused with all the recent changes, but so many consumers don't understand basic insurance terminology, how to read an explanation of benefits or how to calculate their portion of medical bills. Add the government to the equation and the confusion level rises!

As a broker, our role is more important than ever. Our job is to educate, help find you the best plans, help you understand the basics and beyond. Not only is the language confusing but health care costs are rising. We are getting bills from providers higher than we've ever seen. That adds to the confusion and frustration of using your health insurance. We all know it doesn't come cheap, but it is an absolute necessity, in my opinion. Health care bills are one of the leading causes of bankruptcy. A couple days in the hospital can lead to thousands, upon thousands of dollars in medical bills if you are not insured. My daughter had to have an MRI when she was about 2 years old, the charged amount was $3,200. Thankfully, we only owed a portion of that, but could imagine if you were not insured? That was just a quick test, we were only at the hospital for an hour. Imagine something much more serious.

Not only do we need the insurance, we need to understand what we are looking at. When you go out to dinner you always look at the bill and make sure you were charged correctly, right? I know I do! Health insurance bills and EOB's should be reviewed very carefully as well. Sometimes we just assume it's all balanced correctly because doctors and insurance companies always know what they are doing, right?! Not exactly. But it affects our pocketbook directly, and we need to make sure they match, we need to make sure we are getting charged for the right procedures. There are codes they use and trust me, they can use the wrong codes! I know I'm not going to pay for something I didn't eat at the restaurant, so I am definitely not going to pay for medicine, tests or procedures that weren't done.

The terminology can be extremely confusing as well. We love our acronyms in the health insurance industry. HSA, EOB, FSA, HRA, ACA, FMLA, its enough to make your head spin! That's why we are here. We want to make sure you understand what you have in front of you. We want to educate and re-educate. Bring your concerns to us.

Using a broker doesn't increase you premium, it's already built into the rates. By using a broker, you gain an advocate, a partner and someone to call directly when you have an issue. You won't be bounced around from one customer service agent to another. Open Enrollment is a great time to educate, and that time is now.

Wednesday, November 12, 2014

2015 Health Insurance Exchange: What you need to know


You can easily become overwhelmed with all the information about the health insurance exchanges. Here is a brief overview and some important dates.

What is the health insurance exchange?  The exchange is a public marketplace for health care consumers, providers, and insurers. The goal of the exchange is to increase access to care and provide affordable care.

Open Enrollment begins November 15th. You must be enrolled by December 15th for a January 1st effective date.

February 15th is the last day to enroll for coverage through the exchange for 2015. This will give you a March 1st effective date. If you miss this deadline, you cannot enroll for 2015 coverage without a qualifying event.

If you are not enrolled in coverage in 2015, you may have to pay a fee. Don’t wait to enroll.

If you have Medicare coverage, you are not eligible to get medical or dental coverage through the exchange.

Does your employer offer health insurance? If not, you could be eligible for subsidized exchange coverage. Use our calculator to find out if you qualify.

Pre-existing conditions cannot be denied.  No insurer can reject you, charge you more, or refuse to pay for benefits.

All insurance plans offered through the exchange must cover the same set of essential benefits.

Children up to age 26 can stay on their parents plan.

Questions,  contact us!

Monday, November 10, 2014

Welcome to Health and Life Navigators!

Welcome to Health and Life Navigators! Thank you for visiting!

As an independent insurance broker with over 32 years providing insurance and employee benefit solutions to our clients, we strive to stay on top of the ever changing insurance marketplace and provide you with the best program to fit your needs.

Our mission is to help you through the 2015 Health Insurance Exchange, keep you as informed as possible with all the changes going on and to make the process as painless as possible! Not only can we help you through the open enrollment period, but we can also help you enroll in coverage off of the exchange as well.

Things in the health insurance industry have changed and will continue to change. We will keep you up to date on the most important changes and topics. Health insurance is one of those things that you don't exactly realize every detail of your plan until you need to use it. Our goal is to help you find the right plan for you and to answer any questions you may have.

The 2015 open enrollment period begins November 15th. Will you be re-enrolling? Is this your first time getting coverage through the exchange? Do you qualify for the subsidy? We know you have questions, we have answers!

 Visit our website www.healthandlifenavigator.com to apply for coverage and use our ACA estimator to see if you qualify for the subsidy.

Any questions you may have, we can help. Contact us today!

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