Health Insurance Archives - Page 28 of 52

Protect Those You Love! Let EZ Find You A New Plan If You’ve Added A Family Member

Adding a new member to the family is exciting! Whether you are getting married, adopting children, or having a baby, a lot will change in your life, including your health insurance needs. To make sure that your loved one is protected, you’ll have to add them to your health insurance plan, but you’ll only have 60 days after the marriage, adoption, or birth to either add them to your current plan, or find a new plan that meets your new needs and budget. This might seem overwhelming, but EZ will make the process easy.

Getting Married

Getting married is a joyous occasion, and once you are settled in with your loved one, one of the things you need to consider is health insurance. You can only add your spouse to your health insurance plan within 60 days of getting married, so don’t put it off for too long!

Because getting married is considered a “qualifying life event,” you also have the option to enroll in a new plan if your current plan does not meet both of your needs. If you decide to go this route, EZ will compare all available plans in your area in minutes and provide you with the quotes without any obligation. We understand how frustrating it can be researching and comparing, which is why we provide you with a licensed agent who will do it all for you.

Having A Baby

Having a baby is also considered a qualifying life event. Newborns are covered under your plan for their first 31 days. After 31 days, whether you have employer-based or individual insurance, you will have to fill out an enrollment application to continue coverage.

adoption application with another paper with a drawing of a house and parents holding a kids hand — *Adopting children counts as a qualifying life event for a Special Enrollment Period.*

Adding Children

Any children who become part of your household can be added to your coverage, including:

Stepchildren
Foster children
Adopted children
Relatives who have lived in your home for at least a year and who you are financially responsible for. This means you must provide more than half of the financial support they rely on.

To qualify to be added to your coverage, the child must:

Be under the age of 26
Have lived with you for at least 6 months
Have an income of less than half the cost of their support expenses to qualify as your dependent
Not be claimed as a dependent by any other household

If you have a Marketplace plan, you’ll need to add the child to your plan within 60 days of the qualifying event. If you have an employer-based group plan, you will be given at least 30 days to enroll the new dependent in your plan.

Have The Proper Paperwork Ready

a green piece of paper in a blue circle — *Before you add a new family member, make sure you have the proper paperwork necessary first.*

When you are adding a new family member to your plan, you need to make sure that you have the necessary paperwork ready to show proof of your qualifying life event. If you just got married, you will need your marriage certificate. If you are adopting a child, you will need to provide the finalized adoption papers. And if you have a baby, be ready to provide the birth certificate as proof.

If you have an employer-based plan, you’ll need to show your employer the necessary paperwork, and make sure that your tax withholdings are changed.

Make Sure You Have Enough Coverage

Adding a new member to your family is exciting, but making sure that your health insurance plan is right for the new addition is, well, not so exciting. It takes a lot of research and comparing to make sure that you get the right plan that meets everyone’s needs, and your budget. Adding a family member to your household can also be a very hectic time, so you could end up missing your opportunity to change your plan. But if you come to EZ.Insure, we can compare plans instantly so you don’t have to worry about doing it at the last minute. We will find you the best plan so you don’t have to. No hassles, just free quotes and guidance to help you find a great plan. To get free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Federal Drug Rule Directs Insurers to Reveal What They Pay for Prescription Drugs

Prescription drugs have become so expensive that one in ten Americans opts not to get a prescription filled because of its cost. In an effort to help control the cost of prescription medications, the Trump administration issued a rule last year that will force health insurance companies to give customers estimated out-of-pocket costs for prescription drugs. Not only that, but insurance companies will also have to provide the negotiated prices that they pay for prescription drugs. The hope is that this will create more competition and help customers make better medical decisions that will save them money.

a crack in the ground dividing different colored groups — *There is a division between groups on whether it will drive costs down or disrupt the market.*

Division

There is some division among policy experts about how much this rule will actually save people; in fact, many groups who represent drug manufacturers argue it will decrease market competition and raise the prices of drugs. Commercial insurers and pharmacy benefit managers are also not in favor of the new rule.

“This rule will disrupt the marketplace dynamics and undermine the highly competitive negotiations that kept net prices for brand medicines at a growth rate of just 1.7% in 2019,” said Katie Koziara, a spokesperson for the Pharmaceutical Research and Manufacturers of America. She wouldn’t say whether her group would sue to block the rule.

But advocates for the new rule say it will help patients with private health plans save on prescription drugs. According to them, the rule will allow doctors to choose less expensive medications, and help health plans buy drugs more cheaply.

When the New Rule Goes Into Effect

These new drug price provisions are not estimated to go into effect until 2022 at the earliest. In 2022, private plans will have to publish online the prices that drug companies and benefit management companies negotiate with each other. And then, starting in 2024, insurance plan members will be able to request and receive estimates for out-of-pocket costs of medications.

The rule will not apply to Medicare or Medicaid. In addition, it will not require plans to disclose rebates and other discounts negotiated with drugmakers. That’s a disappointment to employers who provide health insurance for their workers. “We’d like a much clearer idea of how much we’re paying for every drug every time it’s dispensed,” said James Gelfand, senior vice president for health policy at the ERISA Industry Committee, which represents large self-insured employers. “We want to know where every cent in rebates and discounts is going. We’ll at least begin peeling back the onion. You have to start somewhere.”

The reason that manufacturers will not disclose the discount information is that other health plans will then ask for the same rebates. “Insurers and pharmacy benefit managers currently use rebates that are hidden from view to drive prices lower,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard University who studies prescription drug policy. “If you make that transparent, you kind of reduce the main strategy payers have to lower drug prices.”

The Biden administration favors increased price transparency and therefore plans to keep the new price disclosure rule in place.

Want More Coverage Than Your Employer’s Plan Provides? EZ Can Help!

For many people, one of the biggest perks of their job is the health benefits. Being offered group health insurance can take a huge weight off of your shoulders. But what if you don’t have enough coverage, are paying too much, or are just not happy with your plan? You can opt for an individual health insurance plan. In fact, an individual plan might be cheaper than an employer-based health plan, and you could end up with more coverage for less money if you use EZ.Insure.

When You Can Change Plans

Most Americans get their health insurance through their employer, but these plans can be limited in their coverage or too expensive. If you want to look elsewhere for your insurance, individual health plans are available through the Marketplace or through private insurance companies. But before switching from your employer’s plan to an individual plan that you should know that:

You can only enroll in a private plan during the Open Enrollment Period from November 1- December 15, unless you qualify for a Special Enrollment Period. You qualify for a SEP if you experience a qualifying life event, such as getting married, adding a family member, getting divorced, or losing employer-based insurance.
Some companies require you to stay on their plan if you agreed to take part; if this is the case, then you are stuck with the plan for the year until your workplace’s Open Enrollment.
If your employer offers coverage that meets “minimum value” standards set by the Affordable Care Act and is deemed “affordable,” you will not qualify for a government subsidy on coverage purchased through your state exchange.

Your Plan Choices

If your employer does not help pay your premiums, or if they do not contribute enough, then it is definitely worth finding your own plan. In addition, if you choose to purchase individual insurance, you will no longer be limited in your choice of plans. If you are unsure which plan might be right for you, EZ.Insure can help you sift through all the available options in your area at no cost to you.

There are a number of different individual plans to choose from; for example, the ACA Marketplace divides its plans into 4 metal tiers. The metal tiers do not indicate the quality of care, but the percentage of care that each plan covers. The more the plan pays, the higher your premium will be. 3 medals with medicine pills in the center, one gold, one silver and one bronze

Bronze – Plan pays 60% of your health care costs, you pay 40%.
Silver – Plan pays 70% of your health care costs, you pay 30%.
Gold – Plan pays 80% of your health care costs, you pay 20%.
Platinum – Plan pays 90% of your health care costs, you pay 10%.

There are also a variety of plan designs to consider:

HMOs– Health maintenance organization plans have restricted provider networks and require referrals to see a specialist.
EPOs– Exclusive provider organization plans require that you stay in-network, but you do not need a referral to see a specialist.
PPOs– Preferred provider organization plans are more flexible and allow you to see doctors in and out of your network, with no referrals required.

EZ.Insure will help you understand all the different types of plans and, because we understand that keeping your doctor is important, we will make sure your doctor is included in your plan’s network.

illustration of a male doctor — *One of the advantages is the ability to choose a plan that covers your doctor and hospital.*

What Individual Plans Cover & Their Advantages

Just like employer-based plans, individual plans cover the 10 essential health benefits, and they cannot charge you more for, or deny you coverage because of, pre-existing conditions. The advantages to an individual plan include:

You can choose the best insurance company and plan to meet your needs.
Your health insurance isn’t tied to your job, so you can change jobs without losing coverage.
You can choose a plan that includes your preferred doctors and hospital.
If eligible, you can get a subsidy from the government.

How EZ Can Help

You do not have to settle for your employer’s health insurance plan if it is limited or too expensive. EZ.Insure wants to make sure that you and your family are completely covered, and we also want to put money back in your wallet! With us you won’t have to worry about spending time searching for a plan that meets all of your needs – we will do all the heavy lifting for you. We will compare all available plans and present them to you, and will help guide you through the process of finding the right one for your needs and budget. We will even help you sign up for a plan at no cost to you. To get instant quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Health Insurance Coverage After Policy Owner Passes

When a loved one passes away, the last thing on your mind is your health insurance plan. But once you are ready to look into it, you might find that, unfortunately, there isn’t a lot of information about what to do with your plan after someone passes away. You should know that the death of either the policy owner or a dependent will affect your health plan. The plan might no longer meet your needs or could be too expensive for you to afford on your own; it could even be cancelled due to non-payment if you cannot afford it.

a stopwatch with the number 60 in red in front of it — *When a policy owner passes, you have a 60 day special enrollment period to enroll in a new plan or change plans.*

You do have the opportunity to change your plan, though: the death of the policy holder (or a dependent) is considered a Qualifying Life Event and will open up a Special Enrollment Period for you. This means that you will not have to worry about the affordability of your plan or about losing your health insurance coverage amid the tragedy. It is important to know all of your options so you can make the best decision about your healthcare plan.

What Is a Special Enrollment Period (SEP)?

In most cases, you can only change your health insurance plan or purchase a new one during the Open Enrollment Period from November 1 through December 15. Outside of the OEP, you can no longer enroll or change your plan unless you experience a life event that qualifies you for a Special Enrollment Period. If you do experience a qualifying life event, you will have 60 days from the event to enroll in a plan. If you miss the 60 day window, you will have to wait until the next Open Enrollment Period.

Death Of A Policy Owner/Spouse

Having health insurance is important for you and your family, and it does not have to end with the unfortunate loss of your spouse. If you were on your spouse’s individual health insurance (NOT an employer-based plan), you can keep your policy even after the passing of your spouse. But if the plan is too expensive and you do not qualify for any subsidies, you can shop around for a new plan. The death of your spouse qualifies you for a Special Enrollment Period, so you will be able to shop for a new plan, or change your existing coverage. You will have 60 days after the death to purchase a plan.

COBRA Insurance

If your spouse passes away, and you were on their employer-based plan, you can look into COBRA insurance through your spouse’s employer. With COBRA health insurance, you can keep the plan you had through your spouse’s employer for 36 months. One thing to be aware of is that you will need to pay 100% of the plan’s premiums, plus a 2% administrative fee. This means that you will be paying more for the same coverage, because your spouse’s employer will no longer pay a portion of the monthly premium.

Remember, you do not have to stay on your late spouse’s employer-based insurance plan. It is just an option to continue coverage, if need be. You can also decide to shop for a new plan on the Marketplace or through a private insurer.

Death Of A Dependent

The death of a dependent also qualifies your family for a Special Enrollment Period, as long as the dependent was on your health insurance plan. This applies even if your dependent did not contribute any income to your household. As with any qualifying life event, you will have 60 days to enroll in or change your health insurance plan after the death.

Losing a loved one is a tragic time that brings up not only a lot of emotions, but also a lot of questions. One of the questions you might have after dealing with the grief is what will happen to your health insurance coverage. Fortunately, you will have the opportunity to find a plan that meets your family’s needs during the 60-day Special Enrollment Period window.

EZ.Insure cares about you and wants to make the process of staying insured as easy as possible for you during this tough time. One of our licensed agents will compare plans within your area, and review all available options to find the best and most affordable plan for your family. You will not have to worry about health insurance because we will guide you and help you to figure it all out. Our services are always free, because we just want to help you. To get started, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

What Is Risk Sharing?

Health insurance can seem expensive if you’re only looking at the cost of premiums, copays, and deductibles, and not looking at how insurance works to actually help save you money. To understand how having health insurance is the most cost-effective way to pay for medical care, you first have to understand the concept of risk sharing, also known as “risk distribution.” Risk sharing means you share the “risk” with everyone else who purchases health insurance from the same company as you. Sharing the risk means lowered costs for services, so everyone can get the care they need at a more affordable price.

How Risk Sharing Works

The whole concept of health insurance is based on a risk-sharing model. This means that the premiums and medical costs of each member of a group of policyholders are spread out among the group based on a predetermined formula. Sharing risk with others who have also purchased a policy from your insurance company lowers your premiums and other costs for care. The more people in a plan, the better your plan will be.

a percentage sign on a block with a hand flippin another block next it with a red arrow and green up arrow — *When you share the risk with others, it can help bring down costs.*

In health insurance, risk is shared in 3 different ways. It can be shared by:

The insurance company and the members who buy plans from them.
The insurance company and the healthcare providers who see their members.
Everyone who buys a plan from the same insurance company.

For a health insurance plan to work, there needs to be a mix of healthy individuals and people who need more care. If only less healthy people sign up, everyone involved will end up paying more because everyone in the plan will have higher medical costs. But when the risk is shared among both types of individuals, the costs can be spread out, meaning you will not have to pay all of the costs for those who need a lot of care throughout the year.

What Risk Sharing Means for You

So how does all of this affect you and your healthcare choices? Well, let’s say you are healthy and don’t think you need to purchase a health insurance plan. You might think that it’s more cost-effective to go without insurance, and not pay a monthly premium, but you could end up facing thousands of dollars in medical bills if the unexpected happens. The concept of risk-sharing means that, for the cost of a monthly premium, any care you seek will be cheaper, including for any emergencies or unexpected illnesses. You should know that approximately 3 in 5 bankruptcies in the U.S. are due to medical bills, so your best bet is to sign up for a healthcare plan and share the risk of medical expenses with a large pool of people.

One more thing to note: thanks to the Affordable Care Act (ACA), risk-sharing does not mean that less healthy individuals will pay more for insurance. The ACA bans insurance companies from charging people with pre-existing conditions more money. In general, insurance companies charge everyone the same amount for the same plan based on where they live.

illustration of a hand holding up a balance with one side a clock and the other side money — *An EZ agent will save you time and money by finding an affordable plan within minutes.*

Finding An Affordable Plan

Health insurance is important, and it does not have to cost you an arm and a leg, because risk sharing spreads the cost out among a large pool of people. There are ways to find affordable plans that will protect you and your family when you need it most. EZ.Insure will provide you with an agent who can review your financial and medical needs and easily access and compare all plans in your area. We work with you to find the most affordable plan with the right coverage for you. Health insurance shouldn’t be a burden! All of our services are free and there is no obligation to sign up.

To get free instant quotes, simply enter your zip code in the bar above, or to speak directly to an agent, call 888-350-1890.

Mental Health Insurance For Children

Children’s Mental Health Awareness Week is February 1st – 7th, and we want to take this time to focus on the mental health of children. The CDC estimates that approximately 1 in 5 children are dealing with mental, emotional, or behavioral disorders, and unfortunately only 20% receive care. Untreated mental disorders and mental illness in children can lead to dropping out of school, substance abuse and even suicide. Early diagnosis and treatment are vital for avoiding these outcomes, so finding a comprehensive health plan is an important step towards keeping your children safe and healthy, both physically and mentally.

A Growing Problem

Mental health claims have been on the rise since 2017. The pandemic has been making the problem worse, and even causing an increase in suicides. Children have been just as affected as adults by current events: they are now glued to screens for school, and are dealing with increases in cyberbullying and anxiety. Being isolated in their homes could be the reason behind a sharp increase in mental health crises among children. In fact, the CDC has reported that, from March through October of this year, the share of mental health-related hospital emergency department visits rose 24% for children ages 5 to 11, and 31% among adolescents ages 12 to 17, when compared to the same period in 2019.

ACA Mental Health Coverage

All Affordable Care Act (ACA)- approved health plans must cover essential mental health benefits, including:

Screening for mental health conditions
Behavioral treatment
Mental and behavioral health inpatient hospital services
Pre-existing mental and behavioral conditions
Substance use disorder treatment

The Mental Health Parity Act of 1996 requires that insurance coverage cannot have more restrictive requirements for behavioral health coverage than it does for physical health like medical and surgical services. This means that you or your child can seek treatment such as group therapy, psychotherapy, and medications to help treat mental health issues in the same way that you would seek treatment for a physical ailment.

Employer-Based Coverage

paper in folder that says employee benefits package with a highlighter — *Employer coverage must have mental health health benefits, and you can check exactly what is covered in your summary of benefits.*

All employer-based plans must comply with ACA requirements for mental and behavioral health, including parity protection laws. If you have employer-based coverage, look at your plan’s summary of benefits to see what level of coverage you have for mental and behavioral health. If you find that your plan does not provide enough coverage, you can opt out of your employer’s plan and choose to purchase an individual health insurance plan instead.

You can also ask your employer about Employer Assistance Programs (EAPs), which can include mental health counseling and support. Some programs are available at no cost, and some employers might cover the fees if their health plan does not.

Individual Coverage

The ACA Marketplace or private insurance plans are great options for affordable coverage that meets your medical needs. All plans comply with ACA regulations on mental and behavioral health coverage, and it is possible to find a plan that offers more coverage or has lower copays if you speak with an EZ agent.

Unfortunately some families cannot find mental health care because of lack of providers in their area, or some cannot afford the cost of services. If you come to EZ, one of our agents will check each available plan’s network of doctors and medication costs to find a plan that is affordable and meets your needs. We will work with you to find an in-network mental health provider close to your area, and we will make sure that your medications are covered under your plan’s formulary. To get free instant quotes, simply enter your zip code in the bar above, or to speak with an agent, call 888-350-1890.

Tag: Health Insurance