Health Insurance Archives - Page 30 of 52

8 Million People Could Get A Health Insurance Rebate This Year

Health insurance companies are projected to owe rebates to almost 8 million people this year. Are you one of them? According to the Kaiser Family Foundation, 7.9 million policyholders will receive some money back from an estimated $2.7 billion in premium rebates. This year’s rebate for those with individual policies or who participated in small or large group plans is twice what it was last year, but it is unclear whether the amount will continue to rise.

Why The Rebates?

Insurance companies that sell individual or group policies are required by law to spend a certain percentage of the premiums they collect on healthcare costs, as opposed to on their own administrative costs. This “medical loss ratio” is usually 80/20, meaning insurance companies are allowed to put only 20% of premiums paid by enrollees towards their own marketing, administration, and profits. The rest has to go towards medical costs and quality improvements. If insurance companies do not meet this standard, then they must give a rebate to their policyholders.

How Much Will The Rebate Be?

Each year, the medical loss ratio rebate is calculated based on a three-year average of insurance companies’ financial data. The rebates this year are based on data collected from 2017, 2018, and 2019. Insurance companies who were not in compliance with the 80/20 rule during these years will either send a check to policyholders or deduct a rebate from premiums. The average rebate for 2019 was $208, depending on the state and the insurance company.

So will rebates remain the same for next year or will they be affected by the coronavirus pandemic? Right now, it’s unclear, because it’s unclear how the health crisis will end up affecting the price of insurance premiums. According to Karen Pollitz, a senior fellow with the Kaiser Family Foundation, “Insurance companies aren’t having a bad year, profit-wise. While they’ve paid out for claims related to treatment of coronavirus patients, they’ve paid far less than projected on claims related to elective medical procedures.”

Pollitz suggested that early estimates by insurers have been all over the board as to how much monthly 2021 premiums will cost. So far, insurers have changed their cost-sharing structures in order to reduce the amount that policyholders will have to pay out-of-pocket. “The thought was that people who are struggling during the economic crisis would appreciate this relief and help some to maintain coverage they might not otherwise be able to afford,” Pollitz said.

It is estimated that next year there will be an even bigger rebate due to the pandemic, but “if insurers do reduce their premiums now, then the medical loss ratio looks better,” meaning that there is still a chance that the rebate will be smaller next year.

How Moving Impacts Your Health Insurance

Whether it’s for a job, to attend school, or just to start a new life, moving is a life-changing event. Changing locations impacts a lot of things in your life, including your current health insurance plan. In many cases, you will not be able to keep your plan if you move. Depending on whether you are moving in state or out of state, you might need to either find a new plan, or take steps to update your insurance company. If you’re planning a move, make sure that you know how to stay properly insured, so you don’t experience any unexpected medical bills.

Moving To A Different State

Health insurance plans vary across the country because plans from different carriers are tied to specific states. Some insurance carriers allow you to keep your plan if you move out of state; others do not. In most cases, even if you are able to keep your current plan, you probably won’t want to. For example, PPO or POS plans allow you to seek medical care outside of your current home state, but if you do, you will be considered out-of-network, and you will have to pay a percentage of your bills. This can be quite expensive; out-of-network care in general is very expensive.

If you’re moving out of state, you’ll most likely need – or want – to get a new health insurance plan. Moving is considered a qualifying life event, so as long as you had coverage for 60 days before your move, you will be eligible for a Special Enrollment Period. This means that you will be able to enroll in a new plan outside of the annual Open Enrollment Period. You will have a 60-day window from the date of your move to get a new plan. Report your out-of-state move to your health insurance company as soon as possible, so that you can enroll in a new plan without a break in coverage.

caucasian hand holding a california state map — *If you move within the same state, then you have to update your insurance company.*

Moving To Another State For Work

If you work for a large employer that has locations throughout the country, and your job requires you to relocate, you might find that your coverage remains the same. Prior to moving, though, you should make sure that your current health insurance plan is offered in the new state; if it is not, you will need to take the necessary steps to get insured. If this is the case, you will qualify for a Special Enrollment Period and will be able to search for a new plan.

Moving Within The Same State

If you move within the same state, odds are that your coverage options won’t change. You will have to update your address with your insurance company; while you’re contacting them, it would be a good idea to check if there are any different plans available in your new location that could save you money. As long as you have moved to a new zip code, you will still qualify for a Special Enrollment Period.

When Your New Plan Will Begin

the number one surrounded by a red square. — *When you sign up for a plan before the 15th, it will begin on the first of the next month.*

Whether you are moving out of state or somewhere within the same state, you should take advantage of your Special Enrollment Period and look for an affordable plan. As soon as you get your new address, sign up for a new plan as quickly as you can – otherwise, you might have a gap in coverage. Try to enroll in a plan in the first half of the month if you can: if you enroll between the 1st and 15th of the month your new plan will start on the first day of the next month. If you apply after the 15th, then your new plan will not begin until the first day of the second month after you enrolled.

Packing up your whole life and moving house is very stressful and expensive, and health insurance is probably not at the top of your list when you’re getting ready to make such a huge life change. Instead of worrying about your plan options and doing all the researching and comparing on your own, let us take the burden off of you. EZ will instantly compare plans for the new address you are moving to in minutes. Our services are always free, so you won’t have to worry about spending any extra money.

We want you to focus on getting to your new destination, so we’ll find the best insurance plan for you while you worry about your move. We will assess your needs and find a plan with the most coverage and the most savings. To instantly compare quotes, enter your zip code in the bar above, or to speak to one of our licensed agents, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: Employer Checklist for Open Enrollment

Open Enrollment for health insurance has begun. This period gives employers and employees the opportunity to change their benefit options, and many companies use this time to review their employees’ health insurance plans to see if they can find ways to save money or improve coverage. The opportunity for business owners to save money during Open Enrollment is especially important this year because the coronavirus has hit many companies hard financially. Now is the time to speak to an EZ agent to see if you should renew your current plan or switch to a more affordable plan that offers just as many benefits.

As you review your options, you also have to be aware of any legal changes affecting the design and administration of your current plan or any other plan you choose. Go through the following checklist, share it with your employees, and use it to help you choose your plan for the coming year.

change written on many freen arrow signs pointing in different directions. — *Healthcare plans change every year, including the price and coverage, so you need to be aware to be better prepared.*

Plan Design Changes

Healthcare plans and the rules surrounding them change every year. The cost of your plan may go up, so you need to be aware of changes to your costs. But you also need to be aware of changes to certain limits in your plan. Some changes to know for 2021 include:

Affordable Care Act (ACA) affordability standard– The affordability percentage for 2021 is 9.83%. Employer-sponsored coverage for next year’s plan will be considered affordable under the employer shared responsibility rule if the employee’s required contribution for self-only coverage does not exceed 9.83% of the employee’s household income for the tax year.
Out-of-pocket maximum– The annual out-of-pocket maximum limit for 2021 is $8,550 for self-only coverage and $17,100 for family coverage.
FSA contribution limit: This has not been announced yet, so watch for IRS guidance on the FSA contribution limit for the 2021 plan year.
High deductible health plan (HDHP) and health savings account (HSA) rules for 2021:
- HSA contribution limits: $3,600 for individuals and $7,200 for families
- HDHP minimum deductible: $1,400 for individuals and $2,800 for families
- HDHP out-of-pocket-maximum: $7,000 for individuals and $14,000 for families

Make sure to confirm that your plan’s out-of-pocket maximum complies with the ACA’s limits for next year. If you offer a HDHP, make sure that the plan’s deductible and out-of-pocket maximum are also in compliance with next year’s rules. Remember to communicate these changes to your employees.

Notices To Pass On To Employees

You should provide certain benefits notices to your employees during the Open Enrollment Period. Benefit notices that you should review and provide to your employees include:

Summary of Benefits and Coverage– The ACA requires healthcare plans and health insurance issuers to provide a summary of benefits and coverage to enrollees. This has to be given to your employees who enroll or re-enroll during Open Enrollment.
Summary Plan Description (SPD)– Plan administrators have to provide a SPD to new participants within 90 days after plan coverage begins. In addition, any changes that are made to the plan should be communicated to employees in an updated SPD booklet.
COBRA General Notice– Group health plan administrators have to provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. It can be included in the SPD.
Grandfathered Plan Notice– If you have a grandfathered plan, then make sure that you provide any information about the plan’s status and any changes to the plan.
Children’s Health Insurance Program (CHIP) Notice– Group health plans that cover residents in a state that provides assistance subsidies under a Medicaid plan or CHIP have to send an annual notice about the available assistance to all employees residing in that state.
Notice of Patient Protections– This notice needs to be provided if you are offering non-grandfathered group health plans that require designation of a participating primary care provider. If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice.
Individual coverage HRA (ICHRA)– This applies to employers who sponsor ICHRAs for specific classes of employees, or all employees. You must provide the written notice to each participant at least 90 days before the beginning of each plan year.
HIPAA Privacy Notice– Employers with self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Wellness Program Notices- There are 2 notices that you will need to provide employees if you offer a workplace wellness program:
- HIPAA Wellness Program Notice– HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards.
- Americans with Disabilities Act (ADA) Wellness Program Notice– Employers with 15 or more employees are subject to the ADA. Wellness programs that include health-related questions or medical exams must comply with the ADA’s requirements, including an employee notice requirement.

shopping cart with money held in a paperclip inside of it. — *Comparing plans with an EZ agent can help you save hundreds of dollars a year!*

Finding An Affordable Plan

Whether you are considering renewing your current group plan, or finding a new plan or insurance company to work with, you will have to do some researching and comparing. There are hundreds of group insurance plans to compare in order to find the one that best suits you and your employees. By combing through these plans, you will be able to save hundreds, and maybe even thousands of dollars a year! The first step in figuring out what kind of plan to look for is to conduct an employee health survey.

Next, you should speak to an EZ agent. It can be time consuming to sit down and compare plans, and with Open Enrollment coming to an end soon, the whole process can become overwhelming. Running a business means that you have a lot on your plate, so let EZ.Insure do all the work for you. You can speak to one of our agents free of charge. They will ask you questions regarding your budget and employees, and will then begin comparing quotes. EZ will present you with the best option that will offer the most benefits and savings. To get instant quotes, simply enter your zip code in the bar above, or to speak directly to a licensed agent, call 888-998-2027.

Understanding Emergency Care Vs Urgent Care & Telehealth

It’s 6 PM and your child is running a high fever. The pediatrician’s office is closed, but you want to speak to a doctor immediately. Should you go to the emergency room? Use telehealth services? Or should you head to an urgent care center? When you are faced with an unexpected illness or injury, it is important to understand the difference between emergency care, urgent care, and telehealth services. This knowledge can make a huge difference in the type of care that you receive and in how much money you could end up paying.

Emergency Room

Emergency departments provide medical care at any time, day or night, for anyone experiencing serious injuries and life-threatening medical issues. While your first instinct might be to rush to the emergency room when illness strikes, it isn’t the best place to handle every bump, bruise, burn, cut, or fever. The less serious the condition is, the longer you will end up waiting for treatment at the emergency room. You should consider going to the emergency room when experiencing:

little girl with ice bag on her head and scratch on her shin with a doctor pointing 4 fingers up towards her — *The emergency room is ideal when experiencing major issue such as a head injury.*

Head or eye injuries
Slurred speech
Chest pain or difficulty breathing
Serious burns
Loss of vision
Stroke symptoms
Mental illness concerns
Concussion or confusion
Fever with a rash
Fainting
Facial laceration
Seizures
Vaginal bleeding during pregnancy
Weakness or numbness on one side

When visiting the emergency room, you will most likely end up paying a larger co-payment, and more coinsurance than after a visit to an urgent care facility. You will also have to meet your deductible before your healthcare plan begins paying for your costs.

Urgent Care

young caucasian girl holding her hear with her hand — *Urgent care will treat minor illnesses and injuries, such as an ear ache.*

Urgent care is not the same as emergency care, but these offices are a great backup for when your regular doctor is not available. They can handle a variety of medical problems that need to be treated right away, but are not considered true emergencies. They will perform basic lab tests and treat minor illnesses and injuries such as:

Minor fractures, sprains, and strains
Fever without a rash
Cough, sore throat, or sinus pain
General cold and flu symptoms
Nausea and vomiting
Diarrhea
Ear pain
Dehydration
Wheezing or shortness of breath
Abdominal pain
Small cuts that require stitches

Urgent care facilities offer fast, convenient access to medical care, and are normally staffed by nurse practitioners and physician’s assistants. You will generally pay less for treatment at an urgent care facility than you would at an ER, and most accept insurance. Make sure to ask if they accept your insurance before you go to the urgent care facility or accept treatment. The best part of urgent care is that they work hand-in-hand with emergency rooms, so if they cannot treat your condition, then they will refer you to the closest emergency room.

Telehealth

Telemedicine is usually the most convenient option for immediate help. If you are feeling ill, you can call and speak to a doctor over the phone from the comfort of your own home. During a virtual visit, a doctor will help with the same things that you would normally have to wait days or weeks to discuss with your primary care physician.

young african american girl holding a thermometer in her hand with a doctor on the laptop screen. — *Telehealth is convenient for cough, cold, or flu symptoms, and more.*

Consider using a telehealth visit when you have one of the following concerns:

Cough, cold, flu, or other respiratory infections
Headache
Nausea and vomiting
Sore throat
Allergy and asthma flare-ups
Joint aches and pain
Rashes or insect bites
Small wounds or infections

Not everything can be treated during a video or telephone visit with your doctor. If you actually need in-person care, then you should consider going to an urgent care facility to be treated.

Your primary care physician knows your history, and knows best how to take care of your health concerns. But during times of emergencies when you or a loved one is sick or injured, and your doctor’s office is closed, you need to seek help elsewhere. Understanding the difference between emergency room care, urgent care, and telehealth will help you save time and money.

Tips To Avoid Surprise Medical Bills

Getting hit with an unexpected medical bill can be scary. It can happen to anyone; in fact, surprise medical bills have affected more than half of all Americans. Even if you have health insurance, there’s no guarantee that you will not get an unexpected bill from your healthcare provider. This is usually because your health insurance policy does not cover as much as you thought it did. There are ways that you can avoid receiving a surprise medical bill in the mail, and EZ has provided some helpful tips to keep you from being blindsided.

network of people connected to each other — *Call ahead and make sure a doctor is in network before going to the appointment.*

Stay In Network

If your primary care physician refers you to a specialist, check to see if they are in your policy’s network before making an appointment. Seeing a specialist who is not in your network will mean having to pay a hefty bill for any services you receive from them. To avoid a surprise medical bill from a specialist that is not covered under your plan, call your insurance company and ask them to find a provider that is in your network. Or you can ask how much you’ll have to pay for the services so you can be financially prepared.

Ask Questions

Recent surveys show that people most often receive surprise medical bills after a visit to the emergency room. The next most common unexpected charges came from diagnostic tests and appointments with specialists. Why? Because these visits usually involve medical care that is more advanced than what is covered by your plan. While all ACA-approved health insurance plans cover 100% of preventive care, some services and tests are considered above and beyond preventive, and you could end up being billed for them. If possible, try to ask questions about any care and tests you are receiving at an emergency room or from a specialist.

For example, if you are scheduled for a mammogram, which should be covered by your plan, call your health insurance company and ask for the billing code that they use for mammograms. Then when you go to the doctor’s office for the test, make sure that they are using that billing code. If they use more advanced reading methods such as a 3D mammography, which you might have to pay for out-of-pocket.

Keep Records

When you plan to have any kind of tests or procedures done, such as lab work or surgery, see if you can get a cost estimate from the hospital or healthcare provider beforehand. It is important to keep records so that if you get a surprise bill later, you can use that paperwork to justify your appeal.

Beware Facility Fees

Large healthcare facilities, including hospitals, add a charge for the use of their space and equipment, called facility fees. You could be charged a facility fee, which could be a few hundred dollars, just for visiting a doctor that is in a hospital complex or an urgent care office. Ask your provider ahead of time if there will be a facility fee, especially if it’s not an emergency situation and you do not need to visit a hospital.

Be Prepared In Case Of Emergency

In the event of an emergency, you could need an ambulance ride to the hospital. These rides are very pricey, costing several thousand dollars for just a few miles. Be prepared for emergencies by calling the ambulance providers in your area and making sure they are in-network. In the worst case scenario, if you need an ambulance ride and receive a large bill because they were not in-network, you can try to negotiate with the ambulance service or your health insurance company to reduce the price. You can even ask them to create a monthly payment plan for you.

Avoid Balance Billing

Balance billing is when a provider bills you for the difference between the amount they charge and the amount that your insurance pays. For example, if the provider’s charge is $200 and your plan’s allowed amount is $150, the provider may bill you for the remaining $50. Balance billing often happens when people go to a hospital or emergency room that is in their network, but see an out-of-network provider while there. If this happens to you, you can negotiate with the hospital billing manager or the doctor who billed you, and ask them to either pay the cost themselves or lower the bill for you. You can also call your health insurance company and ask them to waive the fees because you were in a hospital that was in your network.

two hands shaking with a red heart in the background — *An EZ agent will provide you with the most affordable plan that offers the most coverage, at no cost.*

Finally, and most importantly, if your medical needs have changed due to an addition to your family or a new chronic condition that you are managing, for example, then it might be time to look for a better health insurance plan. EZ will compare all available plans in your area, and find you the plan that best fits your financial and medical needs. Instead of settling for a health insurance plan with surprise medical bills, allow us to find you a plan with more coverage and a lower price tag.

To compare plans for free in minutes, enter your zip code in the bar above, or to speak to a trained licensed agent in your area, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: 2021 ACA Premium Rates

Open Enrollment begins on November 1, and the 2021 premium rates for ACA plans have now been announced. Rates will be increasing slightly, because insurance companies have had to shoulder the costs of the free coronavirus testing and treatments mandated by Congress. This no-cost testing and treatment has left insurers with a $103 billion dollar bill. The rate increase may not be very large for some, though, because of the medical loss ratio rebate that will be incorporated into their premiums next year. If you’re looking for a new plan, or want to change plans, we’ve broken down what your costs could look like, and how you can still find affordable health insurance that fits your budget and coverage needs.

The ACA Premium Increase

black chalkboard with two white lines forming a line graph, with a red line going upwards in the graph. — *ACA premium rates are increasing slightly for some, while others might see a 20-50% increase.*

The average cost of ACA premiums is increasing by only a few percentage points, with very few states experiencing a decrease. The increase will vary depending on the state, and will also be affected by whether each individual insurer has met the legal standard of spending 80% of revenue on direct medical care. If they have not met the standard over the last three years, then they must issue medical loss ratio rebates back to the policyholders. Many are doing this by putting the rebates towards premiums for next year to help keep them from spiking too much.

Despite projections of slight increases, some policyholders have been posting letters from their insurance carriers on Twitter that say their premiums will increase anywhere from 20 to 48%! In addition, according to one study, commercial insurers like Blue Cross Blue Shield, Aetna, Cigna, and Oscar Health could increase premiums anywhere from 4% to 40%.

So far, the highest increase for individual health plans has been proposed by Oscar Health in New York at 19.1%. For small group plans (employer-sponsored plans), Oscar Health also has the highest proposed increase of 29.1%, followed by Emblem at 20.9%.

More Affordable Options

Now that Open Enrollment is approaching, you should reassess your current insurance plan, if you have one (and if you don’t, now is the time to start looking!) It’s possible that different insurers have expanded into your state or county, and you might have more options available to you than you did before. Take advantage of this time and consider all of your options!

Because premiums vary by state or region, it is important to get some help determining what the increases to your premiums could look like. You should also get help finding the best plans available in your area. The best way to do this is by speaking with an EZ agent. Our agents are trained in your region and work with the top-rated companies in the country, so they have quick and easy access to all plans in your area. They will go over your medical and financial needs, and then compare all plans, including their coverage, premiums, deductibles, and other costs of each plan. We will help find an affordable plan, and maybe even lower your health insurance cost!

To compare plans in your area for free, enter your zip code in the bar above, or to speak to one of our highly trained, licensed agents, call 888-350-1890.

Tag: Health Insurance