Health Insurance Archives - Page 33 of 52

Domestic Violence & Health Insurance

According to the National Coalition Against Domestic Violence (NCADV), around 20 people are physically abused every minute in the United States by their partners. That equates to over 10 million women and men each year. During the recent pandemic, domestic abuse reports rose by over 100,000 cases in just two months.

Each of these statistics is someone who might face the difficult situation of picking up and starting over, finding a new place to live, finding a job, repairing their credit, and getting health insurance. Health insurance may not be the first thing people think of when they think of the things that survivors of domestic violence need, but it is extremely important. Domestic violence survivors battle psychological and emotional scars and even PTSD stemming from their experiences. They need health insurance to get treatment, and for their children.

Up until 2014, being a survivor of domestic violence was actually considered a pre-existing condition. This meant anyone who had a documented history of this type of abuse could be denied insurance during the underwriting process, or could have to pay a lot more for their policy. Now, the ACA allows any domestic violence survivor to get health insurance at any time without worrying about being denied or paying extra.

The Definition of Domestic Violence

According to the NCADV, domestic violence can include any of the following:

- Physical abuse– hitting, biting, slapping, battering, shoving, punching, burning, cutting, etc. This also includes denying someone medical treatment, and/or forcing drug/alcohol use.
- Sexual abuse– being forced into having sexual contact or sexual behavior without consent. This includes marital rape, and physical violence after sex.
- Emotional abuse– making the victim feel worthless or lowering their self esteem by criticising and name-calling.
- Economic abuse– making someone financially reliant on their abuser. The abuser takes over financial resources or keeps the victim from accessing funds. It also includes being kept from going to school or work.
- Psychological abuse- using fear and intimidation tactics such as threatening to physically hurt themselves, the victim, children, or loved ones.
- Threats
- Stalking and cyberstalking

If you or someone you know is experiencing domestic violence, you can call the National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233) or 1-800-787-3224 for anonymous, confidential help. If you are in immediate danger, call 911.

Getting Insured After Escaping Domestic Violence

woman with her head down and another womans hands on her shoulders — *ACA-approved plans must cover essential health benefits including mental health services for domestic abuse survivors.*

All ACA-approved plans must cover essential health benefits including mental health services for domestic violence survivors. This includes counseling and screening for domestic violence. Survivors of domestic violence are eligible for a Special Enrollment Period (SEP), which gives survivors a 60-day window outside of the annual Open Enrollment Period to sign up for a Marketplace plan. This Special Enrollment Period is available to both men and women, whether or not they are still married to their abuser, and no documentation is required to prove domestic violence.

If you are living at or below 138% of the federal poverty line, you will qualify for free Medicaid coverage. If your income is not low enough to qualify for Medicaid, but low enough that you cannot afford a Marketplace plan, there are subsidies available to help you.

Getting out of an abusive relationship takes a lot of courage and strength, and it can leave long lasting scars. Looking for health insurance, or worrying about getting treatment for you and your children can just bring on more stress. EZ cares and knows the importance of getting the healthcare you need for your recovery. We will provide you with an agent who will go over all the plans and find subsidies for you so you can find an affordable plan for yourself and your children. Our services are completely free, because we want to help you get insurance without the stress. To get free quotes, enter your zip code in the bar bove, or to speak to one of our trained agents, call 888-350-1890.

Out-of-Pocket Maximum Explained

Medical bills can be a huge source of stress. They can seem like they are never ending, but there is actually a limit on how much you can spend on out-of-pocket healthcare costs. The out-of-pocket maximum, which is the annual limit that you are required to pay for covered health services, is your financial saving grace. Each health insurance plan has different out-of-pocket maximums. Understanding yours will help you get a better handle on how much you will be paying out-of-pocket with your policy.

What Is an Out-of-Pocket Maximum?

An out-of-pocket maximum is the amount that you will have to pay for covered health services. Once you reach that amount, your insurance will pay for all covered services. All copayments, deductibles, and coinsurance count towards your out-of-pocket maximum. However, your monthly premium payments do not go towards your out-of-pocket maximum.

How It Works

If you need a medical procedure, generally you and your insurance company will each pay a portion of the cost. You will pay enough to meet your annual deductible, and your insurance company will pay for the rest of the procedure, unless you have to pay coinsurance as part of your policy. If your plan does require you to pay coinsurance then you will also have to pay 20% (usually) of the cost of the procedure, even after meeting your deductible.

After you have met your deductible, you will continue to pay copays and coinsurance until you meet your out-of-pocket maximum. After you meet your maximum, insurance will then pay 100% of any medical costs. You will not have to pay for copays or coinsurance after meeting your maximum.

calculator on paper with a pen sitting on top of it in the paper. — *After you have met your deductible, you will continue to pay copays and coinsurance until you meet your out-of-pocket maximum.*

Here’s an example to illustrate how out-of-pocket maximums work. Let’s say Mary has a health insurance plan with a $2,000 deductible, a 20% coinsurance requirement for all care after meeting the deductible, and a $5,000 out-of-pocket maximum. She has to have surgery and the total hospital bill is $20,000. The costs will break down like this:

Mary will pay her $2,000 deductible, leaving $18,000 of the bill.
Her coinsurance requirement is 20% of the $18,000, which is $5400. But because Mary’s plan has an out-of-pocket maximum, she and her insurance company will end up each paying part of this cost.
Mary has already paid $2,000 to meet her deductible, and her out-of-pocket maximum is $5,000 so instead of owing $5,400 in coinsurance payments, she only owes $3,000 ($2,000 deductible + $3,000 coinsurance = $5,000 maximum out-of-pocket payment).
Her insurance company will now cover the remaining $13,000 of the cost of the procedure.

Do All Plans Have a Maximum?

All plans that meet ACA standards have out-of-pocket maximums. For 2020, that number is $8,2000 for individuals and $16,400 for families. Some plans may have a lower maximum, but none will be higher than those amounts. Plans with higher monthly premiums generally have lower out-of-pocket maximums, while plans with lower monthly premium plans, like catastrophic or high-deductible health plans, have higher out-of-pocket maximums.

In order to find the right plan for your needs and budget, you have to take into account everything that it has to offer, including things like out-of-pocket maximums. Doing all the research alone is time-consuming and can cause confusion and missed opportunities. EZ will make the process quick and painless; we’ll explain everything clearly, give you real-world examples of how the plan would work for you, compare quotes, and calculate costs for you. We will set you up with one agent that will help you find the right plan for your medical and financial needs. To start saving, enter your zip code in the bar above, or to speak to one of our licensed agents, call 888-350-1890.

Qualify For A Special Enrollment Period? Find Out What Documents You Need

The Affordable Care Act (ACA) changed a lot of things about the way healthcare works in the U.S. One of the changes it made was to create an open enrollment period for everyone shopping for a health insurance policy on the Marketplace. In most cases, you can only enroll in a health insurance plan, or change your plan, during this period, which runs from November 1 to December 15. If you miss open enrollment, then you cannot enroll in a plan, unless you have what is known as a qualifying life event. Experiencing one of these life events opens up a Special Enrollment Period (SEP) for you, meaning that you will be able to sign up for a new plan. Different types of qualifying life events require you to produce different documentation proving your eligibility for a SEP.

Qualifying Life Events

illustration of people moving with a truck and boxes and people carrying boxes. — One of the qualifying life events is moving to another county or state.

A Special Enrollment Period is only available to those who have a qualifying life event, including:

Change in residence (moving to different zip code or county)
Change in household size (having a baby or adopting a child, getting married, or getting divorced.)
Loss of health insurance (losing employment, turning 26 and getting kicked off of a parent’s plan, or death in the family.)
Changes in income

The Different Documents Required

If you lose health insurance or need a new plan, and you want to use a Special Enrollment Period to shop for a new plan, you will generally be notified of what documents are needed in your Eligibility Results Notice. You will then have 30 days to submit these documents by mail or by uploading them to healthcare.gov. There are different forms of documentation required depending on the life event.

For change in residence you will need to have moved in the past 60 days and have had health insurance at least one day in the 60 days before your move. To prove this, you will need to submit:

Documents proving that you moved, such as rental agreements, mortgage bills, or utility bills, as well as documents proving your new address and the date of your move.
Documents proving you had insurance prior to your move, such as a letter from an insurance company or employer.

For change in household size you will need:

Legal or government-issued documents of an adoption or a birth certificate
Marriage license or certificate.
Divorce certificate.

For loss of health insurance you must show that you had qualifying health insurance coverage in the past 60 days and that you will be losing coverage in the next 60 days. You will need:

A letter from your insurance company showing termination date.
A loss of health insurance coverage letter from your employer.

For change in income, you will need:

Proof of a reduction in income which makes your current plan unaffordable for you, such as a past and current paycheck or W-2 forms.

Special Enrollment Period Coverage

After you submit your documentation and prove that you qualify for a Special Enrollment Period, you can get on the Marketplace and pick a health insurance plan. Coverage for your new plan will either begin the first day of the month after you pick your plan or the first day of the second month after you pick your plan, depending on the qualifying life event. Some types of coverage will be active sooner than others; for example, if you have a baby or adopt a child, coverage is retroactive to the date of the birth or adoption, as long as you pick a plan within 60 days.

Need Help?

If you still have questions on how this all works, contact one of our agents. Our highly trained agents will take the time to talk with you, and will go over all of your documents for you as well as thoroughly explain all of your options. Once you are ready to enroll, they will search through all the plans in your area and find the right plan for you, making sure the plan fits your needs and budget. EZ always provides you with your own personal agent, so there’s never any need to worry about bouncing around from agent to agent or getting hassled by endless sales calls. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 888-350-1890.

Why Do Health Insurance Premiums Go Up Every Year?

Health insurance is worth the cost. Paying your monthly premiums can mean the difference between having your medical emergencies or chronic conditions covered, or being hit with huge medical bills and possibly even bankruptcy. As with many things that are worth having, healthcare doesn’t come cheap, and almost every year health insurance companies raise insurance premiums and other rates. Multiple factors go into how insurance companies calculate your premiums, and there are multiple reasons that rate rise.

How Premiums Are Calculated

different analytics with calculator and graphs and a hand holding a pen. — *Insurance companies will first develop a profile of all their consumers to calculate costs.*

To determine how much they will charge for premiums, insurance companies have to figure out how much it will cost them to cover their customers’ healthcare costs, plus how much it will cost them to run their business. Your premiums will go towards both of these costs. But while they generally know how much their administrative costs (such as employee salaries) will be, they need to calculate how much it will cost to pay for their customers’ healthcare needs. To do this, an insurance company will first develop a profile of all their consumers. Then they figure out how much each patient group will cost to cover, factoring in doctor visits, vaccines, and any future medical expenses.

For example, insurance companies might group women in their late 50s and 60s together, and take into account their need for mammograms and yearly checkups with lab tests. They will also consider that older women might need medications for cholesterol or heart problems, might possibly need surgeries, or have accidents. They do these calculations for all patient groups. After all the calculations are complete, health insurance companies will multiply these costs by the number of patients that they are insuring in each profile group and estimate how much costs will be.

Ultimately, your health insurance premiums will be calculated based on your profile group. Your insurance company will look at:

Your age– the older you are, the higher your premium.
If you or your spouse smokes– if you are a regular smoker, or were one within the last 12 months, an insurance company can increase your premium rate. Some companies charge a tobacco surcharge, which can be as high as 50%.
How many children you have to insure and their ages– health insurance companies take into consideration your children’s ages and account for things like stitches, falls, and sports injuries that they may need care for as they grow.
Your location– the more health insurance companies there are competing for business in your area, the lower your premiums will be.

Why Premiums Go Up

When your insurance rates go up, inflation is usually the culprit. Recent rises, though, have been due to other factors. One of these factors is that, because of advances in medicine and technology, people are living longer now than in the past. Not only are there more people to cover, but these people may be older and more in need of medical care.

caucasian mans hand holding a prescription pill bottle pouring meds into his hand — *People who receive treatment and live longer consume more healthcare dollars.*

People who receive treatment and live longer consume more healthcare dollars, meaning that everyone else has to throw more money into the pot to help insurance companies cover costs for older people. In addition, while the ACA’s rule that insurance companies cannot turn someone down due to pre-existing conditions was great for expanding coverage, it also meant that more people with ongoing health issues joined the insurance pool.

Recent rate raises are not only due to who is being covered, but also how insurance companies cover their costs. The government had been supplying subsidies to insurers to help reduce their costs and these subsidies are ending. Because insurance companies will have to make up the difference, they have been raising premiums by 4-7%.

How You Can Lower Your Premiums

You should review your coverage every year during the health insurance open enrollment period. Calculate the cost of premiums, copays, and deductibles and see if you could save money with another plan. Also check for any tax incentives that can help you save money.

If you are relatively healthy, and under 30 or in need of financial assistance, then a catastrophic plan might work best for you. These plans have high deductibles and low monthly premiums. If you need a more comprehensive plan, there might be one in your area that will provide the right coverage at a better price than you’re paying now.

You could be saving hundreds of dollars just by switching to a different plan. When you’re ready to compare all the health insurance options in your area, EZ.Insure is here to make the process quick and easy. We go over all available plans and direct you to a quality plan that will not only cover your needs, but also save you more money than your current plan. Our trained licensed agents will do all the work for you, for free. No need to worry or stress yourself out researching and comparing. To get your free quotes, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Mental Health Issues On The Rise

Mental illness does not discriminate. It affects people of all ages, genders, ethnicities, and socio-economic classes. Health insurance claims for the treatment of depression, anxiety, and other mental disorders have been steadily rising over the years. Recent job losses and stay-at-home orders have made things even worse, with federal agencies and experts warning that a wave of depression, substance abuse, PTSD, and suicide is on its way. Our already underfunded mental health system is at risk of being overwhelmed.

“If we don’t do something about it now, people are going to be suffering from these mental-health impacts for years to come,” said Paul Gionfriddo, president of the advocacy group Mental Health America. “That could further harm the economy as stress and anxiety debilitate some workers and further strain the medical system as people go to emergency rooms with panic attacks, overdoses and depression.”

High Numbers Among Young Adults & Adolescents

While mental health claims among all Americans have been going up, data reported by FAIR health, a nonprofit database of more than 28 billion private healthcare claim records, shows that they are shockingly high among young adults and adolescents, Between 2007 and 2017, mental health claims relating to depression and anxiety in young people were especially high.

In 2007, young people accounted for 15% of all claims tied to serious depression. By 2017, they accounted for 23%. Claims for anxiety also grew more common among young people. Between 2007 and 2017, claim lines for generalized anxiety disorder rose 441% among young people ages 19-22. The report also found that behavioral health diagnoses rose 108% from 2007 to 2017.

Suicide Numbers Rising

Suicide rates are also on the rise, with many worried that an increase in mental health issues combined with our current stressful environment could make things worse. A report issued by the CDC found that suicides are up 30% since 1999, and only half of those who died were diagnosed with a mental health disorder prior to their deaths. Unfortunately, many people suffer in silence, and added stresses such as job loss, or relationship, financial, or health problems, can lead to disastrous consequences.

Meadows Mental Health Policy Institute, a Texas nonprofit, created models estimating that if unemployment rates continue to rise to a level similar to the Great Recession, then an additional 4,000 people could die by suicide and an additional 4,800 could die from drug overdoses.

Mental Health Coverage

two men sitting down, one man with a hand on his chin and the other man with his hands on his head. — *All ACA-approved plans must cover behavioral health treatment, such as psychotherapy and counseling.*

Some experts point out that it’s unclear whether more people are suffering from mental illnesses, or whether we’re getting better at talking about it, recognizing it, and treating it. According to Dr. Stephen Strakowski, a psychiatrist at the University of Texas at Austin’s medical school, “It’s very hard to disentangle [increased prevalence] from increased recognition, more people accessing care, and people being willing to fill out forms more honestly.”

Research shows that people who need mental health care are more likely to get it now than they were at any time in the past, but things are not perfect. There are still many people who aren’t getting the help they need because they don’t have mental health insurance coverage. Fortunately, as of 2014, the ACA requires all Marketplace healthcare plans to cover mental health and substance abuse services.

All ACA-approved plans must cover:

Behavioral health treatment, such as psychotherapy and counseling
Mental and behavioral health inpatient services
Substance use/abuse disorder treatment

Employer-based health insurance, Medicaid and Medicare all offer mental health and substance abuse coverage. It is important that people are encouraged to use this coverage to get screened for suicidal thoughts, to treat any underlying mental conditions, and to access therapy. Seeking help makes a difference.

If you or someone you know is showing warning signs of suicide, help is one call away. For free 24/7 crisis support:

Call the National Suicide Prevention Lifeline: 1-800-273-8255.
Text Crisis Text Line: Text HOME to 741741
Call Substance Abuse and Mental Health Services Administration: 1-800-662-4357

Can Your Health Insurance Company Drop You?

Insurance companies are businesses, and, like most businesses, they have terms and conditions of service. It is possible for your health insurance to legally drop you, but only under certain circumstances. If this happens to you, don’t worry! EZ.Insure will help you find a new plan, for free. We know that you have a lot on your plate and might be feeling overwhelmed, so we will take that weight off your shoulders and help you to get back on your feet.

Reasons You Can Be Dropped

persons head with a mask on in a circle with the word "fraud" underneath it — *Insurance fraud is one of the reasons that your health insurance company can drop you.*

Insurance companies cannot drop you for any reason; there needs to be just cause. Here are some circumstances when you can be legally dropped:

Insurance Fraud– If you misuse your insurance policy in any way, then you have broken your contract with the company. Fraud can include faking your identity, or filing false claims.
Failure To Pay– Obviously, if you fail to pay your premiums, then you will be in breach of your contract with the insurance company. If you have employer-based insurance that is not automatically deducted from your paycheck, then make sure to pay your premiums on time. If you are lucky, you will have a grace period for unpaid premiums, although most insurance companies do not offer this.
Losing/Quitting Your Job – If you receive your health insurance through an employer, and lose your job, then your health insurance company has a right to drop you. You also forfeit your coverage if you voluntarily leave your job.

While some people may think that you can get denied for filing too many claims, that is a myth. As long as your claims are legitimate, then you don’t have to worry. Health insurance companies in the U.S. are regulated by many laws on both the state and federal levels, so you can be sure that you won’t lose coverage just for making claims on your policy.

picture with a road and 2 arrows poiting to an orange box with possibility written above it — *EZ will find you an insurance plan after your company drops you. You have other possibilities.*

There Is Hope

If you do end up losing your health insurance, don’t worry, you have options, and time. When a health insurance company drops you, they must give you 30 day’s notice before terminating your plan. You also qualify for a special enrollment period when you lose health insurance, so take this time to compare other plans and sign up for a new one. If your plan was employer-based, then check to see if your employer offers COBRA plans to temporarily replace your old plan.

Finding a plan can be overwhelming, especially after losing coverage, but we’re here to help. If you are lost, then EZ will provide you with a personal agent who will compare all the available options in your area, for free. Our highly trained agents will listen to your healthcare needs and budget, and advise you on which plan checks all of your boxes. To get free instant quotes on all plans, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890. No hassle, no obligation.

Tag: Health Insurance