Monday, February 25, 2013

Obamacare: Nothing to Brag About



The president’s health-care law increasingly does less and costs more.

During last week’s State of the Union address, one item curiously went almost unmentioned. We heard all about President Obama’s past triumphs and future plans, but his health-care-reform law was strangely missing. Sure, there was one throwaway line about how Obamacare was reducing health-care costs, but the seminal achievement of the president’s first term was almost ignored.

Perhaps that is because the Patient Protection and Affordable Care Act has brought little good news of late.

Insurance premiums are set to explode. Already health insurers, citing the increased cost of various Obamacare provisions, are seeking and winning double-digit premium hikes. For example, California health insurers are proposing increases for some customers of 20 percent or more: 26 percent by Blue Cross, 22 percent by Aetna, and 20 percent by Blue Shield.

Young people are especially likely to face higher premiums. Obamacare’s “community rating” provisions prohibit changing premiums based on health status and limit the degree to which insurers can charge based on age. Thus, premiums will rise more slowly for older and sicker individuals, but will shoot up for young people. According to a survey by the American Action Forum, healthy young people in the individual or small-group insurance markets can look forward to rate increases averaging 169 percent.

Further, a study in the American Academy of Actuaries’ magazine found that 80 percent of young adults aged 18–29 not eligible for Medicaid will face higher costs, and that 20- to 29-year-olds on the individual market not eligible for subsidies will see their premiums increase 42 percent.

New federal subsidies will offset rising premiums to some degree. But that will only further drive up the law’s already rising price tag. The cost of the average exchange subsidy per person is now projected to be $5,510 in 2014, $700 more than it was projected to be last year.

And those subsidies might not exactly make exchange plans affordable. The IRS recently estimated that in 2016, for a family of five, a policy available through the exchange would cost roughly $20,000. At the same time, the IRS has decided that subsidy eligibility will be based whether one’s employer offers an “affordable” individual plan (meaning the employee-paid premium is less than 9.5 percent of his income), whatever the cost of a family plan might be.

That’s become a theme for Obamacare: costs more, does less.

For example, the Congressional Budget Office has again lowered its estimate for the number of people who will gain insurance coverage as a result of Obamacare. Just 27 million more Americans will be covered by 2023 than would be otherwise, leaving 30 million Americans still uninsured. And roughly 12 million of the 27 million newly insured won’t actually get a real health-insurance plan but will simply be dumped into Medicaid.

At the same time, the CBO now estimates that 7 million Americans can expect to lose their current insurance because their employer will decide to pay the penalty/fine/tax rather than provide Obamacare-compliant insurance (this number is up from 4 million). Not only does that belie the president’s oft-stated promise that “if you have health insurance today, and you like it, you can keep it,” it means that as many as 11 million fewer Americans will have private unsubsidized insurance than before Obamacare, making it look more and more like a government takeover of the insurance industry.

Then again, one has to wonder if Obamacare will ever get off the ground at all. For example, the administration once confidently predicted that governors and state lawmakers would quickly fall into line, establishing exchanges and expanding their Medicaid programs. But 26 states have refused to set up exchanges, and seven will require the federal government to operate at least part of the exchanges in their states. (And in at least two states, Idaho and Michigan, state legislators are challenging their governor’s decision to establish exchanges.)

Those exchanges need to be set up by this October if they are to be operational by January 1, 2014, as the law mandates.

Yet there is little evidence that HHS has the money, manpower, or expertise to meet this deadline. While HHS insists that everything is on schedule, they have refused to disclose their plans or release their implementation schedule. Even Democratic Senate Finance Committee chairman Max Baucus is alarmed: He recently ordered detailed accounting of the efforts to set up the federal exchanges by February 26. At the same time, industry groups and others have quietly begun to talk about the possibility that the opening of the exchanges, and therefore the commencement of other key Obamacare provisions, may have to be postponed.

The law’s Medicaid expansion is not going much better. Obamacare advocates were once certain that even Republican governors would not be able to resist the promise of “free” federal money provided by the expansion. Yet, while a handful of high-profile Republicans, such as John Kasich of Ohio, have indeed folded, the vast majority, most recently Wisconsin’s Scott Walker and Tom Corbett of Pennsylvania, have resisted the siren song of federal dollars.

Even the president’s one State of the Union mention for Obamacare, boasting of lower health-care costs, is suspect. It is true that health-care costs have risen more slowly over the past couple of years. But the vast majority of health-care economists attribute that to the recession rather than to a law that has barely begun to be implemented. Indeed, the administration’s own actuaries predict that in the future health-care costs will grow faster than they would have in the absence of Obamacare.

No wonder the president had so little to say about Obamacare. It increasingly looks to be nothing to brag about.

Original article: http://www.nationalreview.com/articles/341074/obamacare-nothing-brag-about-michael-tanner
— Michael Tanner is a senior fellow at the Cato Institute and author of Leviathan on the Right: How Big-Government Conservatism Brought Down the Republican Revolution.

Thursday, February 21, 2013

Insurance Providers Not Buying Into ObamaCare

How insurance providers' reluctance to support the Affordable Care Act could have an impact on you and your health care
 

Rate Shock: How ObamaCare Is Causing A Surge In Insurance Premiums



  • HealthCareCosts.jpg

Over the past couple of weeks, many insurance companies have provided guidance in their investor calls that premiums for insurance plans being sold in the individual market could go up as much as 50 percent on average.

One has to wonder how this is even possible when ObamaCare was passed under the promise of affordability and access. While some may argue that “rate shock” has become a mechanism for insurance companies to scare the market, the reality is that economics really leave the insurance market with no other choice.

ObamaCare requires insurers to offer benefit plans on the new exchanges that are relatively generous and would include coverage for maternity, prescription drugs and treatment of mental illness. These are clearly important areas to cover.

In order to get this level of coverage, however, many people in their 20s, who are used to buying basic coverage, will now be required to pay more for these required benefits in the exchanges. In fact, it is expected that more than 75-85 percent of individuals in this age group could end up spending more for insurance in these exchanges than they do currently.

Some argue that the annual price tag of $1,600 to $2,000 for an insurance plan is still an attractive deal, but if the penalty for not having coverage can be as low as $95 per year, the question remains whether many people will decide to opt out until they absolutely need insurance.

A key reason why insurance premiums are going up is because insurance companies will no longer be able to turn away or charge people more with pre-existing conditions. Even more significant is that these companies would only be able to charge its oldest customers three times as much as their youngest.

If younger individuals decide to wait until they get sick enough to require health insurance, this will obviously skew the insurance market where the sickest individuals will be the ones who are in the system, thus raising rates for everyone else. Many insurance companies are pushing the government to regulations that would charge higher rates for individuals who don’t sign up for insurance within a certain timeframe.
 
What many people also fail to recognize is the income they earn this year will impact the amount of subsidy and/or penalty that will be calculated for 2014. A recent survey indicated more than 70 to 80 percent of Americans had no idea how this year’s income reporting will impact the calculation of their benefits for next year, and as much as 40 percent of people between the ages of 18 to 34 were unaware that there was even a penalty for not having coverage.
  
Supporters of the law have downplayed the notion of rate increases with the idea that the new competitive markets will force insurers to provide competitive rates. History will tell us, however, that in the days of managed care it is very difficult to ultimately contain costs in the long-term, especially when you factor in community rating and guaranteed issue.

The other complicating factor in the equation is that, as of Friday, February 15, 2013, only about half of the states have agreed to proceed with setting up the insurance exchanges, while the other half is deferring to the federal government. What remains to be seen is how effective this dichotomy of market places will be in driving competitive advantage, and how insurance premiums will vary between these two systems.

The Congressional Budget Office indicated in its estimates that insurance premiums for those buying coverage in the marketplaces would probably be 10 to 13 percent in 2016 because the health plans would be more comprehensive. The likely outcome from the current effects of ObamaCare is that while rates come down for older people, they may increase for consumers in their 20s, which could leave an older, sicker population now, and an even sicker population down the road.

The idea that federal subsidies will help shelter the cost of those individuals who need to find affordable coverage is worrisome in light of recent findings. Several high-risk pools were established to provide assistance for those individuals with pre-existing conditions who needed help in finding coverage. As recent as last week, it was reported these high-risk pools were running out of money and are underfunded.

The harsh reality is with an aging population that has a growing need for care of their chronic conditions, the cost for providing adequate coverage will not be cheap, and the biggest fear among employers, states, insurance companies, providers and the consumer is how we will afford the price tag to provide for what has been proposed.

As premiums continue to rise out of control, the jury is still out as to whether the promises of ObamaCare will actually be able to reel these trends in, or whether it is a balloon that continues to drift away.


Read more: http://www.foxnews.com/health/2013/02/19/rate-shock-how-obamacare-is-causing-surge-in-insurance-premiums/#ixzz2LY6l1NNo

HHS Leaves Autism Hot Potato In State Hands


Kathleen Sebelius (AP photo/Charles Dharapak)
Kathleen Sebelius (AP photo/Charles Dharapak)

A state can decide for itself how it wants its official "essential health benefits" (EHB) package to handle services for children with developmental disorders.

A state also will have at least two options for deciding how it wants to handle pediatric dental and vision benefits in the EHB package.

The U.S. Department of Health and Human Services (HHS) has confirmed that it will be taking that approach to running the EHB program in an advance version of a new final rule, "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation" (CMS-9980-F).

The final rule is set to appear in the Federal Register Feb. 25. The rule will take effect 60 days after the publication date.

PPACA

PPACA opponents are still trying to repeal PPACA or block implementation of the law, and HHS or other departments could postpone implementation of parts of the law. If the law takes effect on schedule and works as expected, it will create a new system of exchanges, or Web-based health insurance supermarkets, starting Oct. 1.

In an effort to help consumers shop for coverage on an apples-to-apples basis, PPACA will require all non-grandfathered individual or small group insurance plans to cover the EHB package.

The plans will have to cover the EHB package whether the plans are sold through an exchange or outside the exchange system.

The EHB package requirements will not apply to grandfathered plans, self-insured plans or large group plans.

HHS is giving each state some ability to adjust its EHB requirements, by creating a state EHB benchmark based on the list of benefits offered by a popular plan sold in that state. But a state's EHB benchmark also must meet PPACA guidelines. PPACA requires each EHB package to include 10 classes of benefits.

Consultants at Milliman found that most EHB benchmark candidate plans offer similar benefits, and benefits similar to those required by PPACA, with three major exceptions: pediatric vision benefits, pediatric dental benefits, and "habilitative benefits," or rehabilitative benefits for children or adults with developmental delays who may need help with acquiring basic life skills.

The sponsors of many benchmark candidate plans have offered pediatric dental and pediatric vision benefits through separate insurance policies, analysts have found.

States, insurers, employers and groups representing parents of children facing developmental delays have spent years fighting emotional battles over whether states should mandate that plans provide coverage for expensive habilitative services, such as applied behavioral analysis (ABA) for people with autism. ABA therapy and similar types of therapy can cost $30,000 a year or more.

EHB

In an EHB bulletin issued in December 2011, and in documents released in January 2012, February 2012 and July 2012, HHS suggested that it would let states decide to handle habilitative services for themselves.

HHS has proposed letting states handle gaps in a proposed benchmark plan's pediatric and vision benefits by adopting either the benefits that federal employees who pay for dental and vision coverage get, or the dental and vision benefits that the state's Children's Health Insurance Plan program provides.

HHS received about 11,000 comments on the proposals.

Many commenters asked HHS to use a state's Medicaid plan as the benchmark for habilitation, pediatric dental and pediatric vision benefits.

"In order to maintain the states’ role in defining required benefits in their markets, we will finalize the regulations to provide for state flexibility in determining how to define habilitation services and to offer other options for supplementing based-benchmark plans that do not include coverage for pediatric dental and vision services," officials said.

If the EHB benchmark plan a state chooses does not cover habilitative services, the state can use the Medicaid definition of habilitative services or the National Association of Insurance Commissioners definition.

If a state chooses not to define habilitative benefits, the issuers can choose how to define the term, officials said.

"This is a transitional policy," officials said. "HHS intends to monitor available data regarding coverage of habilitative services."

Mental parity

In another section, officials have stated that HHS Secretary Kathleen Sebelius will use PPACA authority to require that any insurance plan subject to the EHB requirements must meet the mental health and substance abuse treatment parity standards included in the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

MHPAEA itself applies only to employers with 50 or more employees that choose to offer mental health or substance abuse benefits. If an employer offers mental health care benefits, the coverage rules can be no more restrictive than the typical requirements for other types of care.
PPACA will require states that impose extra benefits mandates to cover any costs associated with providing the extra mandated benefits. Some PPACA watchers have speculated that states that required individual and small group plans to comply with MHPAEA to cover the cost of MHPAEA compliance.

"Because compliance with EHB would requirement compliance with the parity standards, states would not have to defray any costs associated with bringing plans into compliance, because any benefits added to ensure parity would be considered part of the EHB package," officials said.

Actuarial Value

The EHB program is just one of many parts of the Patient Protection and Affordable Care Act of 2010 (PPACA).

In addition to the section on the EHB program, the upcoming final rule also includes regulations on calculating a plan's minimum value and actuarial value.

PPACA will require large employers to offer a health plan that covers a minimum percentage of the value of the EHB or else pay a penalty.

Issuers that sell individual or small group coverage will have to classify their plans in one of four "metal levels" -- bronze, silver, gold or platinum -- based on actuarial value, or the percentage of the EHB that the plan covers.

HHS released a preliminary version of an actuarial value calculator months ago,
HHS said in the preamble to the new final rule that it has tried to use technical comments on an actuarial value calculator it created to improve the calculator. If the calculator does not accommodate a plan's cost-sharing structure, the plan can use another method along with actuarial certification of the results, officials said.

HHS also reported that it has developed the long-awaited minimum value calculator.
 
The minimum value calculator is similar to the actuarial value calculator, but issuers cannot simply use the actuarial value calculator to determine minimum value, because the actuarial calculator is based on individual and small group claims data, and the minimum value calculator is based on employer-sponsored plan claims data, officials said.

In a discussion of the value regulations, officials noted that HHS, the U.S. Labor Department and the U.S. Treasury Department believe that self-insured plans are exempt from a new PPACA limit on deductibles.

But the departments believe self-insured plans do have to comply with a new PPACA annual limit on total cost-sharing amounts, or the total cost of the deductibles, co-payments and coinsurance amounts that enrollees must pay.

"The departments are concerned about the operational and timing issues raised by commenters, and find that some transitional relief is appropriate," officials said in a preamble to the final rule.

"Accordingly, the three departments are issuing concurrent sub-regulatory guidance identifying an enforcement safe harbor for large and self-insured group health plans to address those operational concerns."

Other matters

Also in the preamble to the final rule, officials said:

- They will let plans tinker with the EHB by substituting benefits, or sets of benefits, that fit into one of the 10 PPACA EHB categories and are actuarially equivalent to the benefits being replaced.
- A plan with a provider network can exclude out-of-network bills when determining whether an enrollee has reached a PPACA deductible or cost-sharing limit. But a plan can voluntarily establish cost-sharing limits for out-of-network care, and a state can require issuers to do so, officials said.

Read More: Original Article: http://www.lifehealthpro.com/2013/02/20/hhs-leaves-autism-hot-potato-in-state-hands?eNL=5125339aca9f8086530000e3&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=141697675&t=employee-benefits

Monday, February 18, 2013

BCBS Rate 2-Digit Increases For 2013 In NY, CA, TX, PLUS ...IS TN and MS Next??


Health Insurers Raise Some Rates by Double Digits

 
Bob Chamberlin/Los Angeles Times
Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.                           
 
Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.
      
In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.
      
In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.
       
The proposed increases compare with about 4 percent for families with employer-based policies.
Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.
      
The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.
      
New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.
      
The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.
      
Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.
      
“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.
      
While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.
      
The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.
      
Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.
      
“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.
      
Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.
      
“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.
      
As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.
      
In New York, for example, state regulators recently approved increases that were much lower than insurers initially requested for 2013, taking into account the insurers’ medical costs, how much money went to administrative expenses and profit and how exactly the companies were allocating costs among offerings. “This is critical to holding down health care costs and holding insurance companies accountable,” Gov. Andrew M. Cuomo said.
      
While insurers in New York, on average, requested a 9.5 percent increase for individual policies, they were granted an increase of just 4.5 percent, according to the latest state averages, which have not yet been made public. In the small group market, insurers asked for an increase of 15.8 percent but received approvals averaging only 9.6 percent.
      
But many people elsewhere have experienced significant jumps in the premiums they pay. According to the federal analysis, 36 percent of the requests to raise rates by 10 percent or more were found to be reasonable. Insurers withdrew 12 percent of those requests, 26 percent were modified and another 26 percent were found to be unreasonable.
      
And, in some cases, consumer advocates say insurers have gone ahead and charged what regulators described as unreasonable rates because the state had no ability to deny the increases.
       
Two insurers cited by federal officials last year for raising rates excessively in nine states appear to have proceeded with their plans, said Carmen Balber, the Washington director for Consumer Watchdog, an advocacy group. While the publicity surrounding the rate requests may have drawn more attention to what the insurers were doing, regulators “weren’t getting any results by doing that,” she said.
      
Some consumer advocates and policy experts say the insurers may be increasing rates for fear of charging too little, and they may be less afraid of having to refund some of the money than risk losing money.
      
Many insurance regulators say the high rates are caused by rising health care costs. In Iowa, for example, Wellmark Blue Cross Blue Shield, a nonprofit insurer, has requested a 12 to 13 percent increase for some customers. Susan E. Voss, the state’s insurance commissioner, said there might not be any reason for regulators to deny the increase as unjustified. Last year, after looking at actuarial reviews, Ms. Voss approved a 9 percent increase requested by the same insurer.
      
“There’s a four-letter word called math,” Ms. Voss said, referring to the underlying medical costs that help determine what an insurer should charge in premiums. Health costs are rising, especially in Iowa, she said, where hospital mergers allow the larger systems to use their size to negotiate higher prices. “It’s justified.”
      
Some consumer advocates say the continued double-digit increases are a sign that the insurance industry needs to operate under new rules. Often, rates soar because insurers are operating plans that are closed to new customers, creating a pool of people with expensive medical conditions that become increasingly costly to insure.
      
While employers may be able to raise deductibles or co-payments as a way of reducing the cost of premiums, the insurer typically does not have that flexibility. And because insurers now take into account someone’s health, age and sex in deciding how much to charge, and whether to offer coverage at all, people with existing medical conditions are frequently unable to shop for better policies.
      
In many of these cases, the costs are increasing significantly, and the rates therefore cannot be determined to be unreasonable. “When you’re allowed medical underwriting and to close blocks of business, rate review will not affect this,” said Lynn Quincy, senior health policy analyst for Consumers Union.
      
The practice of medical underwriting — being able to consider the health of a prospective policy holder before deciding whether to offer coverage and what rate to charge — will no longer be permitted after 2014 under the health care law.
 

How To Find Affordable Private Health Insurance --- BCBS, Aetna, Humana, etc. Aren't The ONLY RIGHT Answers ---FIND YOURS!

The Patient Protection and Affordable Care Act

In March 23rd, the US health care system underwent the beginning of a major reform, which may have changed the way many people go about getting health cover. The Patient Protection and Affordable Care Act included a mandate that every American must have medical provision, or pay a fine. Some details of the Act are still awaiting a Supreme Court ruling.

The provisions of the Act roll out over the next few years. Some provisions came into effect within months of the Act being signed into law. Most of the changes so far have affected seniors, children, those with pre-existing conditions, and young adults. Within the next few years, there will be new programs that include co-ops and online exchanges.

In 2014 a provision comes into effect, called Promoting Individual Responsibility, which says that the majority of citizens must purchase health insurance - if they don't, they could face having to pay a fine.

Buying Health Insurance On Your Own


Health insurance documents
 
If you are not covered through your employer, or part of a COOP, and are not eligible to state funded programs, you will probably have to buy health insurance as an individual.

When selecting the right insurance option, the purchaser needs to be aware of various factors. For example, should the plan include prescription coverage or not? A female of childbearing age is more likely to opt for a plan that covers pre-natal visits.

Pre-existing conditions - there are now government-assistance programs, as well as new provisions in the new legislation to help those with pre-existing conditions get cover. Pre-existing conditions, for people aged under 19, are no longer permissible reasons refuse coverage in family plans. If you want to enroll somebody under 19 on their own, in some cases they need to be part of an open enrollment period.

Major insurance companies today are required to spend a good portion of the money they collect from their insured contributors on health care.

For those who cannot afford the price of health care insurance, there is currently financial assistance.

How To Find Private Health Insurance

Private health insurance is the main source of health coverage for the majority of people in the United States. Approximately 58% of all Americans have private health care coverage. For elderly citizens and eligible children and families from low-income households, public programs are the primary source of health cover. Public programs include Medicare, Medicaid, and SCHIP. TRICARE and the Veterans programs also provide some coverage.

If you are not covered by a publicly funded program, or if your coverage is only partial, you will need to have some kind of private health insurance. Such companies as USHealthGroup, America's Choice For Health Insurance, BCBS, Aetna, United Health Care, etc. 

Since the turn of the millennia, millions of Americans have found themselves with no health cover at all. Most studies place the number of "uninsured" at over 46 million. Tens of millions more have inadequate insurance.


U.S. Uninsured and Uninsured Rate (1987 to 2008)
Source: US Census Bureau

Offspring over the age of 19 and under 26 may now be added to their parents' insurance plan.

Matching Your Needs With What Is Available

Deciding on what best suits you, your current circumstances, plus those of your family's, may seem confusing and daunting. Experts advise purchasers to think carefully about what is ideal for them before proceeding with a purchase. The following points need to be considered carefully:
  • One plan or separate plans - adding a spouse or offspring to a plan may be ideal, but not always so. In some cases, shoppers may find better deals by checking what is around first. It is important to balance to benefits offered against the amount that has to be paid out in premiums, in every case.
  • Is your doctor included? - if you are considering an interesting plan, make sure your doctor or clinic is listed in their network of healthcare professionals. Otherwise, you may either have to change doctors, or pay out-of-pocket for the one you prefer.
  • Only choose relevant options - do not choose a plan with options you do not need, in order to keep your premium costs to a minimum. If the purchaser or spouse is a female over 45, it is unlikely maternity coverage is a top priority. Even prescription plan coverage most likely will not cover all drugs, especially the newer, more expensive ones.
  • Big premiums today, or in the future? - if you have little disposable income and enjoy good health, you might find it more convenient to opt for a high-deductible plan to start with, that has progressively lower monthly premiums with the passing of time. If your health care requirements are high now, a low-deductible plan to start with may be a better choice.
An important decision as such should not be handled alone unless you fully understand what you are getting for you and your family. Consider an advisor with USHealth Group, America's Choice For Health Insurance. Nannette Bean is an award-winning insurance advisor with USHealth Group.

Original Article Comes From:http://www.medicalnewstoday.com/info/health-insurance/find-private-health-insurance.php

Thursday, February 14, 2013

FoxNews Reports: ObamaCare's "affordability glitch" Could Leave Your Family Without Health Care!!--- Stay Informed-MUST READ!

Could ObamaCare's 'affordability glitch' leave your family without health care?

 
  • ObamaCare-health-care-AP.jpg

The “Affordable Care Act” is turning out to be anything but. Slogans reminiscent of the government doublespeak of George Orwell’s 1984 are taking the place of real access to real care.

Advocates for the poor are now suddenly concerned about a new oxymoron, the so-called “affordability glitch,” where your employer can no longer afford to cover you and your family, and you will be forced to go to the state exchanges for your health insurance only to discover that you can’t afford the rising premiums there and don’t qualify for a federal subsidy. The only “good news” about this glitch is that new IRS regulations may exempt you from paying the 2.5% tax for non-compliance, which is hardly a consolation when you still lack insurance.

Employers simply can’t afford to pay these health insurance premiums, especially for family plans, and remain in business. And you are no longer allowed to pick up the slack. Consider that ObamaCare will allow you to pay only 9.5% of your income towards an employer plan.
 According to new estimates just released by the Congressional Budget Office, at least 7 million people who now receive health insurance from their employer will not be covered by their jobs a decade from now. This is double the number the CBO previously predicted.
So what will your employer do? It is becoming more and more likely that he or she will drop your policy and pay the penalty, or reduce you to part time hours to avoid the penalty. According to new estimates just released by the Congressional Budget Office, at least 7 million people who now receive health insurance from their employer will not be covered by their jobs a decade from now. This is double the number the CBO previously predicted.

Twenty-three million of us will go to the state exchanges, according to the CBO, leaving 30 million non-elderly people still lacking health insurance by 2023.

How ironic are these estimates when you consider that ObamaCare’s stated purpose is to provide affordable insurance for all. So why the glitch? The answer is that premiums are rising to the point of unaffordability, something that the new law should have anticipated given its taste for comprehensive plans with low co-pays and limited deductibles ($2000 for an individual, $4000 per family maximum).

Consider the state exchanges, where beginning this October ObamaCare will offer four basic types of plans; Bronze, Silver, Gold, or Platinum. Bronze is considered a basic, catastrophic-type plan, but this is simply false advertising by the Obama administration when you consider what the plan must cover; ambulatory and emergency patient services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation, laboratory, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

Sounds great until you consider the cost of all these non-catastrophic services. Traditionally, high deductibles have kept premiums down by promoting cost-sharing; you pay out of pocket for basic well care and utilize a health savings accounts to provide you with a tax deduction for most or all of these payments. ObamaCare doesn’t believe in this kind of common-sense cost sharing and is trying to decrease out of pocket payments. When you take away these proven disincentives for overuse, you are left with an entitlement behemoth.

Rising premiums automatically accompany comprehensive insurance plans in an age of expensive medical technology. Insurers transfer costs to the consumer. The bronze and silver plans on the state exchanges will limit the amount you can pay for premiums to 9.5% of your income if your income is 300-400% of the poverty line, but on average, the IRS estimates that a family of 5 will be paying $20,000 for a bronze plan. This is simply unaffordable to most families.

There’s that glitch again. And here’s the main oxymoron; The unaffordable affordable act.


Read more: http://www.foxnews.com/opinion/2013/02/11/could-obamacare-affordability-glitch-leave-your-family-without-health-care/#ixzz2KtNMUcsw Original Article By ; Published February 11, 2013 via FoxNews.com

ObamaCare policies will cost MORE; Cover far fewer than promised!! - MUST READ!!

Wheels coming off... LITERALLY!

 

The central parts of ObamaCare don’t roll out until 2014, but the wheels are already falling off this clunker. The latest news from four federal agencies is that 1) insurance will be a lot less affordable than Americans were led to expect, 2) fewer people than promised will get insurance and 3) millions of people who have coverage through a job now will lose it, thanks to the president’s “reforms.” Oh, and children are the biggest victims.

The Affordable Care Act is looking less and less affordable.

Start with the IRS’s new estimate for what the cheapest family plan will cost by 2016: $20,000 a year to cover two adults and three kids. And that will only cover 60 percent of medical bills, so add hefty out-of-pocket costs, too.
The next surprise is for parents who thought their kids would be covered by an employer. Sloppy wording in the law left that unclear until last week, when the IRS ruled that kids won’t be covered.
Starting in 2014, the law will require employers with 50 or more full-time employees to offer coverage or pay a penalty. “Affordable” coverage, that is — meaning the employee can’t be told to contribute more than 9.5 percent of his salary. For example, a worker earning $40,000 a year cannot be required to pay more than $3.800.

But the law doesn’t specifically mandate family coverage — and now the administration says that won’t be required.

You can see why: If the lowest-cost family plan (again, two adults and three kids) is to run a whopping $20,000, and if the employee’s contribution is limited to $3,800, the employer’s tab would be $16,200 — adding about $7.40 an hour to the cost of that employee. Wisely, the IRS announced on Jan. 30 that employers won’t have to pay for dependents.

But the Congressional Budget Office’s much-cited prediction that ObamaCare would leave only 30 million people uninsured by 2016 was based on the assumption that kids would be covered by employers. At the very least, employers insuring their workers for the first time to avoid the penalty are unlikely to do that.

So how will the kids be covered? They won’t. The IRS shocked the law’s advocates by announcing that the insurance exchanges won’t provide subsidies for a child whose parent is covered at work.
Nor will these parents be penalized for not insuring their children — the IRS will kindly consider the kids exempt from the mandate.

Also exempt are millions of people who’ll stay uninsured because their state is wisely choosing not to loosen Medicaid eligibility.

Some background: Despite President Obama’s promises to help solve the problem of the uninsured by making private health plans more affordable, the law expands coverage mainly by forcing states to loosen their Medicaid eligibility rules. But the Supreme Court ruled that the feds can’t command states in this way.

At first, the CBO said that ruling would only prevent 4 million people from gaining coverage — but more states than it expected are refusing to go along; it could well be 8 million more without coverage.

Oh, and the CBO last week also doubled its previous estimate on how many people will lose the health coverage they now get through work, upping the figure to 8 million by 2016 and 12 million by 2019. Several top consulting firms put the figures even higher.

Yet the biggest setback is that most states are refusing to set up insurance exchanges. The exchanges are supposed to sell the government-mandated plans and hand out taxpayer-funded subsidies to most enrollees.

Here’s the glitch. The law says that in states that refuse, the federal government can set up an exchange. But the law empowers only state exchanges, not federal ones, to hand out subsidies. The Obama administration says it will disregard the law and offer subsidies in all 50 states anyway, but the case will likely go to the Supreme Court.

If the courts uphold the clear language of the law, then some 8 million people in the affected states won’t be eligible for subsidies to cover that $20,000 (or more) insurance bill. That’s another 8 million without coverage.

All in all, at least 40 million people could be uninsured in 2016, only 9 million fewer than before the law was passed.

Expect the momentum for repealing this law to grow as its flaws, perverse incentives and faulty predictions come to light.

Betsy McCaughey is the author of “Beating ObamaCare.” Article from: http://www.nypost.com/p/news/opinion/opedcolumnists/wheels_coming_off_QPojjZX0Bd8BU80hDpcKZP

Monday, February 11, 2013

Feds Reject Mississippi's Plan For Insurance Exchange

The heath exchange Mississippi Insurance Commissioner Mike Chaney had in mind got turned down by the federal government.
The heath exchange Mississippi Insurance Commissioner Mike Chaney had in mind got turned down by the federal government.Rogelio V. Solis/AP
 
The heath exchange Mississippi Insurance Commissioner Mike Chaney had in mind got turned down by the federal government.
Rogelio V. Solis/AP
 
Mississippi Insurance Commissioner Mike Chaney, who has been the driving force behind the creation of a state-based exchange, got his answer from the feds: Sure can't.

The U.S. Department of Health and Human Services rejected the plan Thursday, making Mississippi the only state to have its exchange blueprint nixed by the federal government.

Instead, Mississippi will have a federal exchange, just like more than two dozen other states that balked at implementing the health law provision on their own.

The decision follows more than a month of delay from the federal government over the future of Mississippi's proposal. Chaney pushed ahead even though Mississippi Gov. Phil Bryant opposed a state-based exchange.

That infighting proved to be a big problem. The federal government said the split between Chaney and Bryant is at the heart of its decision.

Chaney began building the exchange in Mississippi based on his authority to run the state's high-risk insurance pool. One problem with that approach: It has nothing to do with Medicaid, only subsidized private insurance.

Chaney said the state had taken the federal agencies overseeing the exchanges at face value. "But I fear that we have been unable to trust them at this point. And Americans need to be able to trust their government. I feel that I have been betrayed at this point," he said during a news conference Thursday evening.

The Affordable Care Act says that the exchanges have to be one-stop shops for both private insurance and Medicaid. As insurance commissioner, Chaney doesn't have authority over Mississippi's complicated Medicaid enrollment processes.

Gov. Bryant sent letters to HHS expressing his opposition to state-based exchanges and questioning the commissioner's legal authority to run one. Chaney insisted he had the authority and was backed up in a ruling by the state's Democratic attorney general.

In a statement, Bryant praised the ruling from the federal government. "I have said repeatedly that the health insurance exchanges mandated by Obamacare are not free-market exchanges," he said. "Instead, they are a portal to a massive and unaffordable new federal entitlement program. They trigger new taxes on businesses and will ultimately drive more people onto Medicaid rolls. I firmly maintain my position that Mississippi will not willfully implement a mechanism that will compromise our state's financial stability," Bryant said.

Mississippi would have been the only Republican-led state in the South with a health insurance exchange not run by the feds.

But a spokesman for HHS said the state's approach wasn't feasible. "With the Governor's refusal to work with us or the insurance commissioner, there is no way to coordinate strategy with other agencies that he's in charge of," an HHS spokesman told KHN.

Work has been underway on an insurance exchange for years, and Chaney isn't sure what will become of it. The Web portal for the state's exchange already exists at OneMississippi.com.
The commissioner is leaving the door open for Mississippi to run a state-based exchange exclusively for small businesses. HHS wants Mississippi to consider a partnership.

"Given the work the insurance department has done, Mississippi is an excellent candidate for a state partnership marketplace. We encourage Mississippi to apply to operate parts of its marketplace by the February 15, 2013 deadline," the HHS spokesman said.

This story is part of a collaboration that includes Mississippi Public Radio, NPR and Kaiser Health News. by Jeffrey Hess fromMPB via http://www.npr.org/blogs/health/2013/02/08/171485790/feds-reject-mississippis-plan-for-insurance-exchange

Friday, February 8, 2013

Health Insurance for New Startup Businesses

“I’m think about getting a first time health insurance policy, where do I start?”
 
Purchasing a health insurance policy for the first time can appear to be very overwhelming, especially in today’s marketplace. Below are some key points to keep in mind to help you simplify and better manage the process to ensure the best results possible in today’s market.
 
Before you even pick up the phone to call a broker, you must make sure to gather the following information:
  • Census of your current employees – This means collecting the name, home zip code, date of birth, and coverage status of the employee (employee only, employee spouse, employee children, and family - ages, current health conditions and previous health related issues is information that would need to be gathered for all members). All brokers will need this information in order to get back rates from the carriers.
  • Know your budget – Figure out how much money you are looking to spend on a health insurance policy for your business. Knowing how much you want to send allows you to work with the broker to find a policy and/or supplemental health products that can help you meet your objectives.
  • Familiarize yourself with plan options – Have an idea of what types of plans you would like to offer your employees. Even if these plans may not be feasible, they will allow you to frame the conversation with your broker. Make sure to check out our blog post on which plan options may be best for your business.
  • Know what you currently have when comparing – If you are looking to match benefits or to an existing or previous plan, make sure to provide this to your broker as well. This will help streamline the options that your broker brings back streamlined options that look to meet your objectives.
  • Identify your long term goals – You expect your clients, and employees to work with you for a long time, and you should make sure to lay out a comparable plan for your benefits. Figure out the average age of your group, what you want to offer them in future years, and what information you think you will need to provide them in order to understand your vision.
  • Try a Comprehensive Health Insurance - These plans are almost the exact mirror imagine of a traditional major medical plan, only the coverage is head to toe, tons of health relate freebies and the customer receives tons of payback from one company. With these plans, it is very important to check the PPO network because this could be the fine line between your plan being trash or treasure.
Original Article can be viewed at: http://www.forbes.com/sites/thesba/2013/02/08/health-insurance-for-new-startup-businesses/

Tuesday, February 5, 2013

Health Insurance Brokers Prepare Clients For Obamacare Sticker Shock


WASHINGTON, DC - MARCH 27:  People participate...
WASHINGTON, DC - MARCH 27: People participate in a protest on the second day of oral arguments for the Patient Protection and Affordable Care Act in front of the U.S. Supreme Court building on March 27, 2012 in Washington, DC. Today is the second of three days the high court has set aside to hear six hours of arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act. (Image credit: Getty Images North America via @daylife
A California insurance broker, who sells health plans to individuals and small businesses, told me that she’s prepping her clients for a sticker shock. Her local carriers are hinting to her that premiums may triple this fall, when the plans unveil how they’ll billet the full brunt of Obamacare’s new regulations and mandates.
 
California is hardly alone. Around the country, insurers are fixing to raise rates by double digits. They’re privately briefing politicians in Washington on what’s in store. Those briefings are leaving a lot of folks up and down Pennsylvania Avenue jumpy.
 
What’s gives? President Obama, after all, said he’d prevent these sorts of prices. His new health law gave state regulators the power to block premium increases. It even created a federal agency to oversee insurance rates. But these bureaucrats are spectators to the price hikes. They’re mere wallflowers. Even in the bluest of states.
 
Their silence is the best evidence of who is culpable for the increases. It’s the policymakers. It’s Obamacare. The President is accepting the premium hikes as an allowable consequence of his healthcare policies.
 
There’s buzz in Washington that to ease the price hikes, the Obama team may slow down some of the most expensive regulations. This might include the law’s mandatory community rating. One approach they’re said to be considering is allowing some of the historically based underwriting to stay in place for a time.
 
But premiums will still rise because, in the end, everything has a price. The law’s prohibition against traditional insurance underwriting is just one of its costly provisions. Washington can try to force health plans to price insurance below the cost of these mandates. But then the health plans will simply lose money and move out of markets. To keep the insurers whole, and accommodate new rules, the cost of insurance must get re-priced higher. That re-pricing is what’s coming this fall.
 
This lesson was learned by Massachusetts, after it adopted its own skinny version of Obamacare. To meet the law’s costs, insurers hiked premiums. Massachusetts’s regulators blocked the increases. All the plans reported losses the very next quarter.
 
This simple economic axiom doesn’t mean the higher premiums were tolerated in Massachusetts, or will be embraced by Washington. What Massachusetts did afterwards is a lesson for where the entire nation is heading under Obamacare.
 
Massachusetts regulators went after the underlying source of spending – peoples’ use of medical services. First and foremost, that meant taking on the providers. Massachusetts moved to regulate the prices that doctors and hospitals could charge and the kind of services that they could offer. Rates are rising nationally because, like Massachusetts, Obamacare guarantees more free medical services while doing nothing to make the market for these things more efficient, or competitive. Like Massachusetts, some form of price controls is the next political chapter.
 
The Obama team can’t merely squeeze the insurers. That’s why our political elite will tolerate many of the looming premium hikes. In the end, health plans are mostly just passing along the costs of the underlying services. That’s even truer today now that Washington is directly regulating insurance company profit margins.
 
To try and get a handle on rising costs, the Obama Administration will start to go after the healthcare providers. The President seemed to hint about all this when he referenced the need to “lower the cost” of healthcare in his inaugural address.
 
Simply cutting payment rates has consequences, or course. It reduces reimbursement without regard to value or need. But indiscriminate cuts to fixed rate schedules for everything from doctor visits to hospital stays are Washington’s standard approach for sanding down Medicare costs. The Affordable Care Act will institutionalize these same political tactics across the rest of the healthcare market.
This is the next iteration of healthcare reform. Call it Obamacare 2.0. Doctors will become the next bogyman in Washington. The target is already being fixed to their hide. As for the rest of us, our health insurance will become increasingly illusory.
 
The prices Washington pays for medical services will gradually fall below the rates where things will be readily supplied. That’s the legacy of Medicaid, and increasingly Medicare as well. Don’t worry, though. The medical services that you’ll have a hard time accessing are mostly the stuff you’ll only need if you get really sick.
 
By Dr. Scott Gottlieb, M.D. via:http://www.forbes.com/sites/realspin/2013/01/22/health-insurance-brokers-prepare-clients-for-obamacare-sticker-shock/ Dr. Gottlieb is a physician and Resident Fellow at the American Enterprise Institute.

Dental Discount Plans Beat Dental Insurance... MUST READ!


Everyone wants to sell you dental insurance. But a discount plan is a better bet.


image
 
With drug costs now (mostly) covered by Medicare, dental care is the largest out-of-pocket medical expense for many a retiree. Count on spending some significant bucks if you like the idea of using your own teeth. Whereas a cheap set of dentures costs $395, saving a single diseased molar can run $2,000 ($1,000 for a root canal plus $1,000 for a crown).

Insurers see an opportunity here. Only 30% of old people are now covered by a dental plan, compared with 54% of working age adults and 80% of children. "Aging boomers are accustomed to having coverage," points out Evelyn Ireland, executive director of the National Association of Dental Plans.

With dental insurance plans everywhere now from United HealthCare to Aetna ( AET - news - people ),  Cigna ( CI - news - people ), AARP, etc. its much like a shopping mall frenzy when deciding on a single plan.

Should you buy individual dental insurance? Probably not, unless you need insurance as a spur to get yourself to the dentist for regular checkups and cleanings.

Instead, consider a dental discount plan, if you can find a good one in your area. For about $100 a year you get access to a network of dentists who have agreed to work for the sort of reduced fees they accept when they sign up for an insurance plan's preferred provider network. Cigna says 82% of the dentists in its group dental network also participate in its discount plans and accept the same rate for both. In its Miami plan an exam might be $36 instead of $69; a crown $535 instead of $981.

Discount plans may not be an option if you live in the boondocks. You can find out the story in your state by searching at INeedDentalBenefits.com, maintained by the dental plans' trade association. Searching Florida, we found 19 discount plans serving Miami, including Aetna and Cigna plans offered through Dentalplans.com. The plans cost $80 to $140 a year for a single person. Picking one can be tricky, since each has different providers and discounts. But you can switch plans every year if the discounts don't add up as advertised or your otherwise pricey periodontist switches plans.

The same Florida search found 21 insurance plans for a Miami resident. One problem is that stand-alone dental insurance has a surprisingly low annual limit on benefits--typically $1,200, not counting preventive care. A Miami resident pays $478 a year for AARP's basic plan with a $1,000 cap or $664 for a plan with a $1,350 cap.

Nor is AARP unusual. The average individual dental insurance plan costs $554--and that's for a limited network of providers, meaning full coverage at only certain dentists. The premium will vary depending on where you live but not based on your age. Even using one of the plan's chosen (i.e., cheapie) dentists, you'll have a 20% copay for routine fillings and a 50% copay for crowns and bridges.

Benefit: You typically get free twice-a-year cleanings and exams, and these don't count toward the coverage limit. So what you're doing is prepaying preventive dental expenses and buying a little bit of insurance for other ones. That little bit of insurance, however, comes with annoying gotchas. You may find that some big-dollar items--implants under certain conditions--aren't covered at all. (Read the fine print.) Plus, there are usually waiting periods--as long as 18 months--before you're covered beyond a basic exam, X-rays and extractions.

Still, some financial advisors favor insurance as a way to manage continuing high dental costs. Thomas Rogers, a financial planner in Portland, Me., helped his own mother pick a plan that costs $588 a year, with a $1,500 cap. So far in 2009 she's had $2,056 in dental expenses, with $1,104 paid by insurance. "I realize now that anything at all can happen, even to those who think they have great teeth," says Rogers' mom, Ann Carman, a 71-year-old retired professor of Japanese language and literature.

Another approach to cutting dental bills: a tax deduction. One of Rogers' clients, a 64-year-old retiree in Florida without insurance, was hit by $30,000 in dental bills over four years. She was able to knock $3,000 off her taxes over that period by taking the dental work as a medical-expense deduction.

Note that you can deduct dental and other medical expenses only to the extent that they exceed 7.5% of your adjusted gross income. That means that if you are going to claim a tax break, you want to get all your expensive work done in a calendar year; if you're relying on insurance, you'll want to spread the work out, if possible, to get the maximum covered over several years.

Article via: http://www.forbes.com/forbes/2009/1116/investing-dentist-medicare-dental-discount-plans-beat-insurance.html By: Ashlea Ebeling,

Top 10 Healthcare Planning Considerations For Small Business

 

  1. Structure of your health plan: The traditional structure of health plans are a thing of the past, and in order to remain competitive, businesses must embrace new plan structures and products in the market place (H.S.A plans, cost sharing plans, consumer driven plans)
  2. Understand the penalties of the law and how they will impact your business – Make sure you are complying with all of the provisions of the PPAHCA. Specific provisions to make note of are the individual mandate, essential health benefit package requirement, and employer penalties.
  1. Engage Employees – Employees should be apart of the health insurance process and their feedback should help determine the plans you put in place. If your employees are not interested in participating in a health plan due to cost, use that information to put a plan in place that will align coverage and cost and with the their budgets and goals.
  1. Apply for Available Tax Credits – In the PPAHCA there are many tax credits that are available to small business to help pay for the health plans. Tax credits range from 25% – 50% of health plan costs by 2016.
  1. Make sure you and your employees understand how your plan works – There are a number of different players involved in the health insurance market. Understand what your plan covers, and how it works. Employees should reach out to their carrier’s member services and use them as a resource to make sure that plans and claims are handled correctly. This will be taken into consideration at renewal and can help keep costs down over the long term.
  1. Find a benefits partner – Look for a benefits broker that can help you lay out a long term goal for your employee benefits program. With healthcare costs rising over the long term, make sure you are working with someone who not only has product knowledge but the expertise to place plans that will help with costs down the road. Also, look for partners that not only save on cost, but also administration through multi-product offerings.
  1. Institute Wellness Plans – Studies show that instituting wellness plans not only put employees on the right track towards meting health related goals, and help achieve healthier behavior, but as an added bonus, they build on camaraderie and teamwork in the office. This can lead to increased productivity, healthier employees, and lower health insurance premiums down the road.
  1. Understand the importance of a health plan – Healthcare plans should not only be seen as an expense, but also seen as an important management tool. Health plans should also be geared to increase productivity, minimize absenteeism (which hurts sales) and improve office morale. When employees feel good, they work better, and the less time that they are out of the office due to illness, the more profitable the company will be.
  1. Cost Sharing – Employees need to be able to share in the cost when it comes to health care plans. Seeing as it is their coverage, their health, and your money on the line, cost sharing techniques will reinforce the importance of living healthier and managing the costs. By sharing a portion of the costs, employees will understand the importance of reducing costs and see where their behaviors will affect the overall cost of their health insurance.
  1. Market your plans, Do Not Settle – Do not be afraid of marketing your health insurance plans at renewal with other carriers. Take your time to review the plan and pricing options that are available, and speak with other carriers about that they will do to help you lower your overall healthcare costs. Many businesses do not look at options fearing change, and unsure of what to do.
Article via: http://www.forbes.com/sites/thesba/2012/07/02/top-10-healthcare-planning-considerations-for-small-business/

Health Insurance Application Denied? Here Are 5 Options!

 

options after your health insurance application is rejectedMore than one fifth of people seeking health coverage are denied by insurers, with Montana, Alabama and Arkansas among the states having the respective highest rejection rates, according to a new study.

 
Twenty-two percent of applicants nationwide aren't approved for individual and family health plans, usually because of pre-existing medical conditions, says the HealthPocket report.

"That's clearly the most obvious reason," says Steve Zaleznick, HealthPocket's executive director of consumer strategy and development. "Carriers are certainly taking that into consideration when they are doing their underwriting and determining what they want to take on in terms of risk."

He says that health reform provisions under the Patient Protection and Affordable Care Act that take effect in 2014 will prevent insurers from rejecting applicants with pre-existing health conditions, even those with major physical problems that could incur high hospital costs. But until then, consumers should be aware of what challenges they may face securing coverage in their home states.

"We want to promote consumer research and get people to ask the right questions when seeking health insurance," says Zaleznick. "That's the prime reason for the report."

HealthPocket, a Sunnyvale, Calif.,-based group that analyzes medical insurance firms across the country, based its study on Department of Health & Human Services data for more than 9,400 insurance plans. The report listed several states where insurers frequently decline applicants:
  • Montana, with a 45 percent rejection rate for health coverage
  • Alabama, 40 percent
  • District of Columbia, 37 percent
  • Arkansas, 35 percent
  • Alaska, 34 percent
  • New Mexico, 30 percent
  • North Dakota, 29 percent
  • Oregon, 29 percent
  • Maryland, 29 percent
  • Pennsylvania, 27 percent
  • Delaware, 27 percent
  • West Virginia, 27 percent
The report  doesn't specify why it's harder to gain coverage in these states. But Zaleznick notes that fewer health insurers tend to operate in these states and may be able to impose tighter approval guidelines because they face less competition.

As for the states that don't reject any applicants -- Zaleznick points to New York and Massachusetts as two of the better known -- the reason is simple: they already have laws mandating that insurers provide coverage, regardless of a person's medical issues.

The study also named the individual insurers with the highest rejection rates and in which states:
  • John Alden Life Insurance Company - declining 73 percent of applications in South Dakota
  • Assurant Health - 71 percent in Utah
  • Assurant Health - 58 percent in North Dakota
  • Time Insurance Company - 56 percent in Kentucky
  • Assurant Health - 56 percent in Idaho
But Assurant told USA Today that the figures can be misleading because the insurer often offers rejected applicants an alternative policy that usually includes pre-existing conditions. That coverage, they said, may be more expensive than the coverage they originally applied for.

Steps to take until health reform is law in 2014

Zaleznick advises those with pre-existing conditions to research insurers and to ask questions of their representatives. If an insurer says it can't cover you, then check out the next one. It's frustrating, especially when you're struggling with overwhelming health issues, says Zaleznick, but some insurers are more flexible than others in providing coverage.

But what if you're still rejected? Zaleznick suggests these options:

Try A Comprehensive Health Insurance Plan : US Health Advisors has award-winning status and offers comprehensive plans that bet most major medicals hands down because of the expectional coverage through their Cigna Great West PPO Network and the reimbursement benefits offered to clients. There is no wonder the company has literally grown over a 111% since 2011.

Insurers of last resort: Check your state's designated insurer that's required to provide coverage to everybody. Created under healt reform, pre-existing condition insurance plans (PCIPs) provide federally administered insurance coverage to people who previously have been denied insurance because of a pre-existing condition. But be aware that it could be costly. "The expenses may be high," says Zaleznick, "but if you really need medical care, it could be extremely valuable for right now."

High-risk pools: Currently, there are 35 states that ensure people get health insurance, regardless of their physical condition. The National Association of State Comprehensive Health Insurance Plan provides a list and other information at its website. Again, you may have to pay quite a bit more for coverage.

Government help: Government programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) offer coverage to some low and moderate-income families. To see what's available and if you qualify, visit GovBenefits.gov.
WebMD, the health website, also had a pair of novel approaches:

Open a business: Some people with pre-existing conditions get group insurance by opening a business and listing themselves as the sole employee. "Using this 'group of one' approach, you have the protections of any group insurance -- and can't get turned down because of a pre-existing condition," says WebMD. But not all states allow this so check with your state department of insurance.

Join a professional group: Some professional organizations, chambers of commerce and unions offer insurance that can be cheaper than regular health insurance. And, in some instances, may be more lenient when approving an application, according to WebMD.