Why should I carry health insurance?
Why should I carry life insurance?
The answer to these questions are as varied as there are people in the world. No one answer is meaningful to everyone. There are many articles published every day that cover these issues, and my opinion is just that. However, sometimes a new viewpoint is useful.
First, why should you have health insurance?
It depends, are you single? do you have a family? do you own a business? what is your current health condition?
Let's look at two extremes:
Marty is a 23 year old female, healthy and physically fit. She goes to the doctor once a year and never has any issues. Does she need health insurance? Need is a grey area, yes with no insurance coverage her doctor appointment probably runs under $150. Her premiums for a health plan would be around $100/month without tax credits. If we only factor this in the equation, then it just doesn't make sense to pay for coverage. However, one thing to consider is an accident. At the very least I would recommend accident coverage to a young, active, and in-shape person. Statistically, the chances of a young person contracting a debilitating illness is low and the chances of an accident is high. Accident-only plans are very inexpensive, and WHEN an accident does happen, can be the difference of having a lifelong debt and being able to quickly jump back into the saddle.
Jim is a 42 year old male. Business owner, family man with 3 children. No insurance coverage because he prefers to pay out of pocket for the kids and wife's annual visit even though he hasn't seen a doctor in 10 years. Sound familiar? Listen, business owner with a family you need the right types of insurance in order to #1- protect your family and #2- protect your business. I have seen time and time again people wait until it is too late, either an accident or critical illness is introduced into the scene and the entire world crumbles. This example is a no-brainer but most people would be surprised how many business owners, busy with their daily routine, forget about the basics. It is heartbreaking when people do realize that insurance is not for after-the-fact.
Second, why should you have life insurance?
Life insurance is an interesting beast. When I first started in this business, my primary clients were young couples with a family and Federal job. This is the best time to get coverage because it is cheaper in the long run. It's also a great time to build your future which includes a long-term financial plan.
People enroll into life insurance plans for several reasons: 1) replace lost income 2) create an estate 3) uncertainty
Again, if Jim in the example above does not make it home from work, imagine the impact on the family. In more than one way, it is tragic. Therefore, we're not talking about replacing a person - that's not possible. But, we can make sure that in the event an uncertainty becomes a reality, then that family will continue to make its way through life.
An area that business owners don't think about, unless they are privileged to have a large company and already had a consultant come in to discuss the future of his company, is what happens to the business if the owner doesn't make it back into the office? Too many times, a small business owner hasn't had the opportunity to discuss these things with anyone. There needs to be a plan in place, it's the responsible thing to do. With a business you have more than just your family. You have many people's families to consider. A good plan is essential, and insurance can help to find or to fund a replacement in the event of a tragedy.
Important: if you own a business and do not have some type of Key-Man or Business Buy-Sell agreement, you should do everyone a favor and look into it.
What about Marty in the example above? Young but still an uncertain future as is the case with all of us. Its a great time to build something for the future. A small plan to begin building is a great start, but I would want to know more about the person before I could make a recommendation of any type.
Everyone needs some type of PLAN. I'm not talking about an insurance plan, everyone needs a PLAN of action. When something happens, what is the plan?
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Thursday, August 28, 2014
Friday, August 22, 2014
Things that are just NOT true about the Affordable Care Act (PPACA)
Here are some thing that I've heard that just are not true:
1) Obama took my insurance away.
First of all, since President Obama has been in office, he's been blamed for everything from taking people's insurance to causing the drought in California. He must be a really busy guy who gets no sleep at all, because I don't even have time to balance my checkbook, let alone manipulate the price of gasoline single-handed.
Facts:
1- Your state Insurance Commissioner authorizes health plans in your area after the insurer has submitted them for review.
2- HHS manages which plans will be offered through the exchange after the insurer has submitted them for review.
3- Congress made the PPACA a reality. Since insurance is actually regulated by the states, the President is a great go-between for State Governors and Congress. The President was highly proactive in arranging exceptions that would ease the blunt-trauma caused by an ineffective system. Some things couldn't be avoided and no other President has gone to the great lengths to make transitions like this easier to swallow and at the end of the day, it kinda worked.
The health insurance plans that were either cancelled or just non-renewable did not fit into being compliant with new regulations. The fact is, people who had plans that they could not keep had plans that would really not serve them well if something major happened, even if they were called major medical. Some people were perfectly happy with them, great. The reality is that a person would pay in good money for a plan they thought was great, but when the time came they would find out otherwise. This has been controlled in more ways than one.
It's not an issue of 'being a fan' or not. It's irrelevant.
2) ACA compliant plans have a higher deductible.
In some cases this is true. But in many cases it's an example of comparing apples to oranges. The question I always ask is, "what did you have before?" Oh, nothing?
It is TRUE that some family plans in some counties would have a high ($12,600) max out of pocket with some insurers. If we were to compare apples to apples, a similar catastrophic plan pre-2014 could have a $20k max out of pocket quite easily). On the other side of the coin, if you are Native American or Alaska Native, you have a $0 copay, $0 coinsurance, $0 deductible plan. Many people who I've been able to help also qualified for 'Reduced Cost' plans. These plans have very low deductibles and out of pocket maximums, at times a $250 deductible and a $750 max out of pocket with $20 copays for someone who last year was not able to get coverage due to health conditions and wouldn't be able to afford it if they could.
3) My doctor doesn't take 'Obamacare'.
Your doctor doesn't know what Obamacare is, because it's fictitious. The fact is, he is just not in the network that your health plan is also associated with. This would be true with an off-exchange plan also and has no relevance to it being on or off exchange.
Leading up to the Marketplace opening, most insurance companies adjusted their networks. Many networks invited doctors to become part of networks which would be offered on the Marketplace. If the doctor did not accept, then they were out. Doctors pick and choose and so did the networks. Doctors are part of networks, not insurance companies, unless they actually work for an insurance company or an exclusive provider, which is not the norm.
TRUE, your doctor may not be in the network that your insurance plan uses. Solution = 1) change doctors or 2) find a plan/network that will be accepted by your doctor. Don't want to change doctors but still want to get a tax credit? Well, that itself can be a challenge again, because of the network membership. You could, though, pay full premium for an off-exchange plan. It's all about weighing the options. THE entire reason for the changes in legislation is to attempt to control healthcare costs, which most people would agree is out of control. Therefore, the network memberships are a way of controlling these costs.
Some insurance companies offered plans with different networks On-Exchange (Marketplace), such as an HMO (HMOx) or EPO, and other networks off-exchange. Some did not and kept their current HMO/PPO networks. I've seen both occur within the same insurer and is normally dictated by the area which the insured person lives. The doctor is also NOT able to pick and choose who he/she sees based on the plan the person has. It is the network, either they are part of it or they are not. It is an agreement between the doctor and the insurance network that is the issue.
Example: Let's say I have ABC insurance and am in the XYZ network. The doctor is in the XYZ network and I go for a visit. I tell him I just got an ACA plan with tax credits. The doctor cannot change the way he bills based on this. He is in the network and must abide by the network agreement. He can't refuse to see me based on the plan I have if he is in the network that the plan provides.
However, are some doctors upset that the claim payments have been reduced for them based on the new networks? Sure, but they agreed to be part of that network. Just like Medicaid and Medicare, doctors normally make less money for routine items. So sorry, but you also get more business and normally patients who also will require more treatment. The smart doctor will make more money accepting these networks in the long run due to economies of scale.
IMPORTANT- I've seen this more than once... A person calls up for an appointment and tells the doctor they have new insurance, and good news, it's the Gold plan. Dr replies, "I don't take the Gold plan, but I do take ABC Insurance" The doctor thinks you are referring to a Medicare plan and takes the Silver plan but not the Gold. Doctors and their Biller/Coder don't generally know about the specific plan nor the carrier, but they do understand the network, ask about the network.
4) The government is making me get insurance.
Nobody is making anyone get insurance. There is a tax penalty under the 'Individual Mandate' that was voted on by Congress for anyone that is not exempt or does not carry 'Creditable Coverage' for 3/4 of the year or more. During 2014, the exemptions are quite liberal. The penalties are also relatively low. But, as time goes on the penalties will increase and the exemptions will be more conservative.
So, you don't 'have to get covered'. You may face a tax penalty and you may be exempt.
Here's an argument... Joe says he doesn't like the new law because it penalizes him for not getting health coverage. So, he refuses any type of insurance. He doesn't 'like socialized medicine' or 'that a-hole in Washington'. Two months later he's cleaning leaves from the gutter, gets electrocuted, ends up in the hospital. Who could foresee that? The bill is $50,000, who pays? Joe won't because he can't afford it, so who does? He has permanent injuries needing treatment and now realizes he needs insurance. The doctors aren't very willing to provide treatment for free. So, Joe, what are you going to do? If this happened in 2010, the pre-existing condition clause would ensure that no company would help with his future bills either, again who would pay? In 2015, he would be able to get covered during open enrollment and get treated. In the end, we all pay regardless. However, now at least Joe can get coverage and treatment.
Insurance is meant to protect against 'unforeseen circumstances'. That's the purpose. Just like automobile insurance, house insurance, business indemnity insurance, etc. How important is insuring your body? It's the only one you're going to get. Many people, including myself, complained when automobile insurance became mandatory. It's the same thing here. But, with health insurance, we all won't continue to pick up the tab for Joe.
5) The insurance says my Preventative benefits are free, but my doctor just billed me $800.
Again, your doctor was likely mistaken. He either 1) didn't include the fact that the visit was preventative, or 2) ran a bundle of tests that you didn't understand or approve. Go back to your doctor and have him/her fix it ! Seriously.
This is happening quite often, due to one of 3 things:
1) ICD 10 coding. Doctors send their billing to a 3rd party in many cases. The billing codes are changing changed from ICD 9 to ICD 10, which reclassifies everything. Smaller offices have in-house billing. They may not be properly trained in the new codes.
2) Doctor knowledge. Here, I'll say it: Doctors don't know everything. They may not understand how the preventative benefits work. They can't possibly know what all of your insurance benefits are, because everyone is different. They can't just run a barrage of tests just to see if they may be able to find something worth treating. And, they SHOULD disclose to their patient what tests are necessary and which ones aren't.
3) Greed. A doctor may know that your preventative visit will net him about $65-85. Not bad for 15 minutes of work. But, if he/she can add some tests, they can increase the amount they make. Maybe even add some unnecessary prescriptions for something called 'pre-diabetes' and make that distributor that buys lunch once a week some money. If the insurer notices that they are not necessary nor preventative, they may not be willing to pay. These things happen no doubt, this is why it is important to have a good rapport with your doctor and understand what they are doing to help you.
6) The coverage under my Obama-plan is inferior to commercial insurance.
Again, there is no 'Obama-plan' and the policy you have, if you have an On-Exchange (Marketplace) plan, is most likely no different than one that is Off-Exchange. Treatment should be no different, and if it is, change doctors. Any differences will be very small if any. All of these plans are issued by a commercial insurance company, not the government. The government only supplies a tax credit (APTC - Applied Premium Tax Credit) which you either ARE or ARE NOT eligible for.
HMO plans are not inferior to PPO plans, just better cost control and more limited networks. However, most insurers recognize that there are times when one needs to go outside the network, and in that case, as long as your PCP recommends the treatment, you should be good.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
1) Obama took my insurance away.
First of all, since President Obama has been in office, he's been blamed for everything from taking people's insurance to causing the drought in California. He must be a really busy guy who gets no sleep at all, because I don't even have time to balance my checkbook, let alone manipulate the price of gasoline single-handed.
Facts:
1- Your state Insurance Commissioner authorizes health plans in your area after the insurer has submitted them for review.
2- HHS manages which plans will be offered through the exchange after the insurer has submitted them for review.
3- Congress made the PPACA a reality. Since insurance is actually regulated by the states, the President is a great go-between for State Governors and Congress. The President was highly proactive in arranging exceptions that would ease the blunt-trauma caused by an ineffective system. Some things couldn't be avoided and no other President has gone to the great lengths to make transitions like this easier to swallow and at the end of the day, it kinda worked.
The health insurance plans that were either cancelled or just non-renewable did not fit into being compliant with new regulations. The fact is, people who had plans that they could not keep had plans that would really not serve them well if something major happened, even if they were called major medical. Some people were perfectly happy with them, great. The reality is that a person would pay in good money for a plan they thought was great, but when the time came they would find out otherwise. This has been controlled in more ways than one.
It's not an issue of 'being a fan' or not. It's irrelevant.
2) ACA compliant plans have a higher deductible.
In some cases this is true. But in many cases it's an example of comparing apples to oranges. The question I always ask is, "what did you have before?" Oh, nothing?
It is TRUE that some family plans in some counties would have a high ($12,600) max out of pocket with some insurers. If we were to compare apples to apples, a similar catastrophic plan pre-2014 could have a $20k max out of pocket quite easily). On the other side of the coin, if you are Native American or Alaska Native, you have a $0 copay, $0 coinsurance, $0 deductible plan. Many people who I've been able to help also qualified for 'Reduced Cost' plans. These plans have very low deductibles and out of pocket maximums, at times a $250 deductible and a $750 max out of pocket with $20 copays for someone who last year was not able to get coverage due to health conditions and wouldn't be able to afford it if they could.
3) My doctor doesn't take 'Obamacare'.
Your doctor doesn't know what Obamacare is, because it's fictitious. The fact is, he is just not in the network that your health plan is also associated with. This would be true with an off-exchange plan also and has no relevance to it being on or off exchange.
Leading up to the Marketplace opening, most insurance companies adjusted their networks. Many networks invited doctors to become part of networks which would be offered on the Marketplace. If the doctor did not accept, then they were out. Doctors pick and choose and so did the networks. Doctors are part of networks, not insurance companies, unless they actually work for an insurance company or an exclusive provider, which is not the norm.
TRUE, your doctor may not be in the network that your insurance plan uses. Solution = 1) change doctors or 2) find a plan/network that will be accepted by your doctor. Don't want to change doctors but still want to get a tax credit? Well, that itself can be a challenge again, because of the network membership. You could, though, pay full premium for an off-exchange plan. It's all about weighing the options. THE entire reason for the changes in legislation is to attempt to control healthcare costs, which most people would agree is out of control. Therefore, the network memberships are a way of controlling these costs.
Some insurance companies offered plans with different networks On-Exchange (Marketplace), such as an HMO (HMOx) or EPO, and other networks off-exchange. Some did not and kept their current HMO/PPO networks. I've seen both occur within the same insurer and is normally dictated by the area which the insured person lives. The doctor is also NOT able to pick and choose who he/she sees based on the plan the person has. It is the network, either they are part of it or they are not. It is an agreement between the doctor and the insurance network that is the issue.
Example: Let's say I have ABC insurance and am in the XYZ network. The doctor is in the XYZ network and I go for a visit. I tell him I just got an ACA plan with tax credits. The doctor cannot change the way he bills based on this. He is in the network and must abide by the network agreement. He can't refuse to see me based on the plan I have if he is in the network that the plan provides.
However, are some doctors upset that the claim payments have been reduced for them based on the new networks? Sure, but they agreed to be part of that network. Just like Medicaid and Medicare, doctors normally make less money for routine items. So sorry, but you also get more business and normally patients who also will require more treatment. The smart doctor will make more money accepting these networks in the long run due to economies of scale.
IMPORTANT- I've seen this more than once... A person calls up for an appointment and tells the doctor they have new insurance, and good news, it's the Gold plan. Dr replies, "I don't take the Gold plan, but I do take ABC Insurance" The doctor thinks you are referring to a Medicare plan and takes the Silver plan but not the Gold. Doctors and their Biller/Coder don't generally know about the specific plan nor the carrier, but they do understand the network, ask about the network.
4) The government is making me get insurance.
Nobody is making anyone get insurance. There is a tax penalty under the 'Individual Mandate' that was voted on by Congress for anyone that is not exempt or does not carry 'Creditable Coverage' for 3/4 of the year or more. During 2014, the exemptions are quite liberal. The penalties are also relatively low. But, as time goes on the penalties will increase and the exemptions will be more conservative.
So, you don't 'have to get covered'. You may face a tax penalty and you may be exempt.
Here's an argument... Joe says he doesn't like the new law because it penalizes him for not getting health coverage. So, he refuses any type of insurance. He doesn't 'like socialized medicine' or 'that a-hole in Washington'. Two months later he's cleaning leaves from the gutter, gets electrocuted, ends up in the hospital. Who could foresee that? The bill is $50,000, who pays? Joe won't because he can't afford it, so who does? He has permanent injuries needing treatment and now realizes he needs insurance. The doctors aren't very willing to provide treatment for free. So, Joe, what are you going to do? If this happened in 2010, the pre-existing condition clause would ensure that no company would help with his future bills either, again who would pay? In 2015, he would be able to get covered during open enrollment and get treated. In the end, we all pay regardless. However, now at least Joe can get coverage and treatment.
Insurance is meant to protect against 'unforeseen circumstances'. That's the purpose. Just like automobile insurance, house insurance, business indemnity insurance, etc. How important is insuring your body? It's the only one you're going to get. Many people, including myself, complained when automobile insurance became mandatory. It's the same thing here. But, with health insurance, we all won't continue to pick up the tab for Joe.
5) The insurance says my Preventative benefits are free, but my doctor just billed me $800.
Again, your doctor was likely mistaken. He either 1) didn't include the fact that the visit was preventative, or 2) ran a bundle of tests that you didn't understand or approve. Go back to your doctor and have him/her fix it ! Seriously.
This is happening quite often, due to one of 3 things:
1) ICD 10 coding. Doctors send their billing to a 3rd party in many cases. The billing codes are changing changed from ICD 9 to ICD 10, which reclassifies everything. Smaller offices have in-house billing. They may not be properly trained in the new codes.
2) Doctor knowledge. Here, I'll say it: Doctors don't know everything. They may not understand how the preventative benefits work. They can't possibly know what all of your insurance benefits are, because everyone is different. They can't just run a barrage of tests just to see if they may be able to find something worth treating. And, they SHOULD disclose to their patient what tests are necessary and which ones aren't.
3) Greed. A doctor may know that your preventative visit will net him about $65-85. Not bad for 15 minutes of work. But, if he/she can add some tests, they can increase the amount they make. Maybe even add some unnecessary prescriptions for something called 'pre-diabetes' and make that distributor that buys lunch once a week some money. If the insurer notices that they are not necessary nor preventative, they may not be willing to pay. These things happen no doubt, this is why it is important to have a good rapport with your doctor and understand what they are doing to help you.
6) The coverage under my Obama-plan is inferior to commercial insurance.
Again, there is no 'Obama-plan' and the policy you have, if you have an On-Exchange (Marketplace) plan, is most likely no different than one that is Off-Exchange. Treatment should be no different, and if it is, change doctors. Any differences will be very small if any. All of these plans are issued by a commercial insurance company, not the government. The government only supplies a tax credit (APTC - Applied Premium Tax Credit) which you either ARE or ARE NOT eligible for.
HMO plans are not inferior to PPO plans, just better cost control and more limited networks. However, most insurers recognize that there are times when one needs to go outside the network, and in that case, as long as your PCP recommends the treatment, you should be good.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Thursday, August 21, 2014
How can I get a Major Medical plan or Obamacare plan today ?
Prior to 01/01/2014, individuals and families could get major medical coverage anytime. Now, not so much. There are, however many alternatives to major medical available. Just contact me to go over those options.
Starting in 2014, a Special Enrollment Period (SEP) is necessary in order to get major medical coverage within or outside of the Marketplace. As an example, outside of the Marketplace, an insurer may ask for proof of the Qualified Life Event before coverage is accepted.
In order to qualify for an SEP, below is an overview of Qualified Life Events:
Did you or anyone in your household lose health coverage in the last 60 days OR do you expect to lose it in the next 60 days?
Examples of coverage loss that qualify you for a special enrollment period:
(Voluntarily giving up coverage does not qualify you for a special enrollment period.)
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Starting in 2014, a Special Enrollment Period (SEP) is necessary in order to get major medical coverage within or outside of the Marketplace. As an example, outside of the Marketplace, an insurer may ask for proof of the Qualified Life Event before coverage is accepted.
In order to qualify for an SEP, below is an overview of Qualified Life Events:
Did you or anyone in your household lose health coverage in the last 60 days OR do you expect to lose it in the next 60 days?
Examples of coverage loss that qualify you for a special enrollment period:
(Voluntarily giving up coverage does not qualify you for a special enrollment period.)
- Did you or anyone in your household lose health coverage in the last 60 days OR do you expect to lose it in the next 60 days?
- Losing work coverage for any reason
- Lost coverage due to divorce or other changes in family status
- Policy or plan year ended for policy you bought yourself
- COBRA coverage expired
- Turned 26 and aged off a parent's health plan
- Lost eligibility for Medicaid or CHIP
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Tuesday, August 19, 2014
Mailing your documents to the Health Insurance Marketplace (Exchange)
If you received a notification from the Marketplace to submit documentation for your health insurance plan, below is the information you need to know:
Deadline:
September 5, 2014
Address:
Attn: Supporting Documents
Health Insurance Marketplace
DHHS
465 Industrial Blvd.
London, KY 40750-0001
Normally documentation includes:
Make sure to include as much information as possible:
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Deadline:
September 5, 2014
Address:
Attn: Supporting Documents
Health Insurance Marketplace
DHHS
465 Industrial Blvd.
London, KY 40750-0001
Normally documentation includes:
- Proof of income
- Proof of citizenship
- Proof of membership of Native American tribe
Make sure to include as much information as possible:
- Full name
- SSN
- Application ID number
- Full page with bar-code included with notice
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Thursday, August 14, 2014
Pre 2014 Major Medical vs Post 2014 Major Medical
One of the reasons I got back into this industry is due to the major change going on in the Health Insurance industry. Understanding the changes has proven quite a task, and with my background as an educator, I feel that I can assist people in a way that few other agents can. You can request a link to my LinkedIn account by contacting me.
Prior to January 1, 2014, Major Medical plans had to conform to state guidelines. It was an insurance company's job to provide the state insurance commissioner with the details of their plan. Once approved, they could sell their insurance plan within that state.
This meant that across the country, health plans could vary greatly, even under the same carrier. Generally though, insurance carriers would have a specific product and make them available in certain areas where they were competitive. In each state across the county, the laws differ and one would find that the plans available are much different also. Pennsylvania has a very different selection of health plans than Florida.
After January 1, 2014, Major Medical plans (that are considered ACA-compliant OR QHP - Qualified Health Plans) have to conform to BOTH state and federal guidelines. The guidelines define 10 essential benefits that are required of ACA-compliant plans. Some of these benefits may be subject to deductible/coinsurance amounts.
These essential health benefits include at least the following items and services:
As we move forward, access to network providers will be the main difference in plans. Again, if you are healthy you may not need to have access to the Mayo Clinic as an example. If you do have some medical issues, you may need access to specific types of facilities. The expansiveness of these networks also may be a factor in the premium calculation.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Prior to January 1, 2014, Major Medical plans had to conform to state guidelines. It was an insurance company's job to provide the state insurance commissioner with the details of their plan. Once approved, they could sell their insurance plan within that state.
This meant that across the country, health plans could vary greatly, even under the same carrier. Generally though, insurance carriers would have a specific product and make them available in certain areas where they were competitive. In each state across the county, the laws differ and one would find that the plans available are much different also. Pennsylvania has a very different selection of health plans than Florida.
After January 1, 2014, Major Medical plans (that are considered ACA-compliant OR QHP - Qualified Health Plans) have to conform to BOTH state and federal guidelines. The guidelines define 10 essential benefits that are required of ACA-compliant plans. Some of these benefits may be subject to deductible/coinsurance amounts.
These essential health benefits include at least the following items and services:
- Outpatient care—the kind you get without being admitted to a hospital
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Care before and after your baby is born
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
- Your prescription drugs
- Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests
- Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
- Pediatric services: This includes dental care and vision care for kids
As we move forward, access to network providers will be the main difference in plans. Again, if you are healthy you may not need to have access to the Mayo Clinic as an example. If you do have some medical issues, you may need access to specific types of facilities. The expansiveness of these networks also may be a factor in the premium calculation.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Wednesday, August 13, 2014
Exchange vs Marketplace vs Obamacare vs ACA
What's the difference?
To keep people confused, they are all parts of the same thing.
The Exchange / Marketplace - Same thing, kinda. Healthcare.gov is the website that is used to 1) get tax credits for health coverage, and 2) apply those credits to an insurer's health plan. An individual does not need to go through this website in order to get enrolled, a licensed agent may have a method to do this primarily through an insurer. However, at some point, the Marketplace will become involved if tax credits are involved. This is only true if an individual is seeking a tax credit. Tax credits are based primarily on income and family size. Without a tax credit, no information is shared with the government and a health plan enrollment can be done entirely through a licensed agent. Most people I've spoken with, including insurance agents, were overwhelmed with the complexity of this process. If you don't do your own taxes, you shouldn't attempt this on your own either. Have someone familiar with the process and licensed to do so assist you.
Obamacare - There is no such thing. What ? It's branding. The term 'Obamacare' is used to make people think that the President created this in its entirety and if there are any negative connotations this term will be used. You will typically only hear this in a negative connotation. However, the laws were written and approved by Congress and actually initiated by President Clinton in 1993.
ACA - Patient Protection and Affordable Care Act (PPACA) is the proper term. In 'the biz', we define certain plans by saying if they 'are ACA' or 'are not ACA'. This just means that they are or are not compliant with the Act.
Non-ACA health plans still exist, some of which are major medical plans that have been 'grandfathered'. These are slowly going away but some people were able to keep their plans. (Obama didn't 'take away your plan') Other non-ACA plans are fixed benefit plans, temporary major medical plans, as well as a number of ancillaries and government insurance like Medicare and Medicaid.
ACA plans are also known as 'compliant plans' as in compliant with the Act. They are major medical plans and provide a certain set of benefits as required by law. They are more comprehensive than major medical plans of the past and are normally a higher monthly premium if tax credits aren't applied.
FYI: For good protection, if you are healthy you may find that going with a non-ACA plan and paying the IRS penalty is actually cheaper in the long-run.
A 'good agent' will help protect you while still staying within your budget.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
To keep people confused, they are all parts of the same thing.
The Exchange / Marketplace - Same thing, kinda. Healthcare.gov is the website that is used to 1) get tax credits for health coverage, and 2) apply those credits to an insurer's health plan. An individual does not need to go through this website in order to get enrolled, a licensed agent may have a method to do this primarily through an insurer. However, at some point, the Marketplace will become involved if tax credits are involved. This is only true if an individual is seeking a tax credit. Tax credits are based primarily on income and family size. Without a tax credit, no information is shared with the government and a health plan enrollment can be done entirely through a licensed agent. Most people I've spoken with, including insurance agents, were overwhelmed with the complexity of this process. If you don't do your own taxes, you shouldn't attempt this on your own either. Have someone familiar with the process and licensed to do so assist you.
Obamacare - There is no such thing. What ? It's branding. The term 'Obamacare' is used to make people think that the President created this in its entirety and if there are any negative connotations this term will be used. You will typically only hear this in a negative connotation. However, the laws were written and approved by Congress and actually initiated by President Clinton in 1993.
ACA - Patient Protection and Affordable Care Act (PPACA) is the proper term. In 'the biz', we define certain plans by saying if they 'are ACA' or 'are not ACA'. This just means that they are or are not compliant with the Act.
Non-ACA health plans still exist, some of which are major medical plans that have been 'grandfathered'. These are slowly going away but some people were able to keep their plans. (Obama didn't 'take away your plan') Other non-ACA plans are fixed benefit plans, temporary major medical plans, as well as a number of ancillaries and government insurance like Medicare and Medicaid.
ACA plans are also known as 'compliant plans' as in compliant with the Act. They are major medical plans and provide a certain set of benefits as required by law. They are more comprehensive than major medical plans of the past and are normally a higher monthly premium if tax credits aren't applied.
FYI: For good protection, if you are healthy you may find that going with a non-ACA plan and paying the IRS penalty is actually cheaper in the long-run.
A 'good agent' will help protect you while still staying within your budget.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Monday, August 11, 2014
2014 Healthcare Exchange Summary
Here's a summary of the Marketplace 2014 from an agent's perspective.
2014 was an interesting year for health insurance. This is why I got involved in the first place. As a bit of a background, I was a Department Chair at a local college running the IT programs. I've also been a licensed Insurance Agent since about 1996. I was hearing about the PPACA (Patient Protection and Affordable Care Act) and I thought, 'how interesting, there's probably not going to be another time in this industry that will actually be exciting and interesting with all of the changes going on.' This turned out to be a very true thought. Anyway, I trained my new replacements at the college and found a company that I fit in with and started the adventure.
The Exchanges opened and worked the day of December 9th, 2013. A bit late. As I remember, October 1st was the designated start date for the Exchange for Open Enrollment. Put over-simply, the Exchange is Healthcare.gov, a platform to handle the process of qualifying and enrolling an individual or family for tax credits and matching that to a health plan. An individual can do the entire process themselves, but most that I spoke to found this to be a daunting challenge. For that reason, there are navigators and agents like myself here to assist in the process.
December 9th, the entire process was not perfected and of several applications attempted, we were only able to get one through the system. Every other time, the system would crash. This would continue for several weeks, sometimes it would work and sometimes not. If my memory works, it wasn't until February that we were able to reliably begin enrolling people from start to finish without problems. During this time, we were give 4 methods of applying for health coverage. None of them worked half of the time.
March 31st, the end of open enrollment. Systems were down the entire day. The deadline was extended to April 15th, 2004 for people who experienced glitches, and the last day to get covered for major medical plans under the new regulations. Though there are many other options for health coverage, major medical plans are the only plans available where an individual or family's tax credits are applied. There are other options, contact me to find out what is available in your area. Anyway, the final day was the madhouse that I assumed it would be, and somehow I remember April 20 being the new final deadline. Many people waited until the last moment, system crashes were prominent during the final week, and the deadline was extended several times. This is a good thing, it's fair in my opinion, so I was able to get several clients taken care of right at the last minute.
The entire reason for this blog, is that I wanted to be able to share this information with others. For whatever reason I'm not sure. But, let me go over some of the good and bad.
So, the BAD: Insurance companies for the most part were successful in matching clients to their health plans and payments about 80% of the time, due to my calculations. System failures are still being sorted out. The Navigators at Healthcare.gov as well as the customer service reps at the insurance companies were not largely aware of the issues and therefore weren't enthusiastically helpful. Sorting out all the problems was a full-time job for myself and one other person in the office until about the end of June. The Exchange still wasn't talking to the insurers and the insurers didn't understand that what was designed on paper wasn't the way it actually worked. The frustration was more that I would allow for my clients, I will be frustrated, but I don't want my clients to deal with that, so I fix it and let them know when it is fixed. I don't leave my clients hanging. I finish the job.
So, the GOOD: Insurance companies for the most part were successful in matching clients to their health plans and payments about 80% of the time, due to my calculations. That's a 'B' in college. An untried, untested system worked most of the time. Here's the real net-effect... I have several clients who, prior to 2014, either 1) couldn't afford Major Medical or 2) had health conditions that would prevent them from purchasing Major Medical. The new regulations saved lives. Regardless of anything else, people were able to get covered and get treated. I have several stories as examples, but due to HIPAA, they will stay confidential between my clients and myself. We can sort out the rest later, but the important thing is that lives have been saved. This is in the end, my purpose for being here.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
2014 was an interesting year for health insurance. This is why I got involved in the first place. As a bit of a background, I was a Department Chair at a local college running the IT programs. I've also been a licensed Insurance Agent since about 1996. I was hearing about the PPACA (Patient Protection and Affordable Care Act) and I thought, 'how interesting, there's probably not going to be another time in this industry that will actually be exciting and interesting with all of the changes going on.' This turned out to be a very true thought. Anyway, I trained my new replacements at the college and found a company that I fit in with and started the adventure.
The Exchanges opened and worked the day of December 9th, 2013. A bit late. As I remember, October 1st was the designated start date for the Exchange for Open Enrollment. Put over-simply, the Exchange is Healthcare.gov, a platform to handle the process of qualifying and enrolling an individual or family for tax credits and matching that to a health plan. An individual can do the entire process themselves, but most that I spoke to found this to be a daunting challenge. For that reason, there are navigators and agents like myself here to assist in the process.
December 9th, the entire process was not perfected and of several applications attempted, we were only able to get one through the system. Every other time, the system would crash. This would continue for several weeks, sometimes it would work and sometimes not. If my memory works, it wasn't until February that we were able to reliably begin enrolling people from start to finish without problems. During this time, we were give 4 methods of applying for health coverage. None of them worked half of the time.
March 31st, the end of open enrollment. Systems were down the entire day. The deadline was extended to April 15th, 2004 for people who experienced glitches, and the last day to get covered for major medical plans under the new regulations. Though there are many other options for health coverage, major medical plans are the only plans available where an individual or family's tax credits are applied. There are other options, contact me to find out what is available in your area. Anyway, the final day was the madhouse that I assumed it would be, and somehow I remember April 20 being the new final deadline. Many people waited until the last moment, system crashes were prominent during the final week, and the deadline was extended several times. This is a good thing, it's fair in my opinion, so I was able to get several clients taken care of right at the last minute.
The entire reason for this blog, is that I wanted to be able to share this information with others. For whatever reason I'm not sure. But, let me go over some of the good and bad.
So, the BAD: Insurance companies for the most part were successful in matching clients to their health plans and payments about 80% of the time, due to my calculations. System failures are still being sorted out. The Navigators at Healthcare.gov as well as the customer service reps at the insurance companies were not largely aware of the issues and therefore weren't enthusiastically helpful. Sorting out all the problems was a full-time job for myself and one other person in the office until about the end of June. The Exchange still wasn't talking to the insurers and the insurers didn't understand that what was designed on paper wasn't the way it actually worked. The frustration was more that I would allow for my clients, I will be frustrated, but I don't want my clients to deal with that, so I fix it and let them know when it is fixed. I don't leave my clients hanging. I finish the job.
So, the GOOD: Insurance companies for the most part were successful in matching clients to their health plans and payments about 80% of the time, due to my calculations. That's a 'B' in college. An untried, untested system worked most of the time. Here's the real net-effect... I have several clients who, prior to 2014, either 1) couldn't afford Major Medical or 2) had health conditions that would prevent them from purchasing Major Medical. The new regulations saved lives. Regardless of anything else, people were able to get covered and get treated. I have several stories as examples, but due to HIPAA, they will stay confidential between my clients and myself. We can sort out the rest later, but the important thing is that lives have been saved. This is in the end, my purpose for being here.
For assistance in navigating the complexity of the new health options, please contact me through psyberquote.com .
Subscribe to:
Posts (Atom)