Health Insurance Archives - Page 35 of 52

Can You Get Health Insurance at Any Time?

If you are unhappy with your current health insurance policy, then it might be time to shop for a different plan. But can you purchase a new plan at any time? Yes, and no. For marketplace plans, once the open enrollment period (November 10 to December 15) is over, you generally cannot get a new plan. The open enrollment period for employer-based insurance might be at a different time of year, but you will still only be able to change your plan during that enrollment period. In most cases, if you want to get health insurance or change your plan outside of the open enrollment period, you will need to qualify for a Special Enrollment Period (SEP). SEPs open up when you experience what is known as a qualifying life event.

Qualifying Life Events

caucasian couple hlding a baby girl in the middle while both are kissing each cheek — *You can get health insurance outside of open enrollment if you qualify for SEP such as getting married or having a baby.*

You have 60 days to change your plan if you:

Got married
Had a baby, adopted a child, or took in a foster child
Got divorced or legally separated. However, if you do not lose coverage due to divorce or legal separation, then you do not qualify for a Special Enrollment Period.
Had someone on your marketplace plan die
Changed residence. If you move to a new home in a new ZIP code or county, move to attend school, are a seasonal worker and move between job and home, or move from a shelter or other transitional housing to a permanent residence, you will qualify for an SEP.
Lost your health insurance. This includes losing job-based coverage, losing a plan you bought yourself, losing eligibility for Medicaid or Medicare, and losing coverage through a family member.
Gained membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Became newly eligible for Marketplace coverage because you became a U.S. citizen
Left incarceration
Started or ended service as an AmeriCorps State and National, VISTA, or NCCC member

Short-Term Medical Plans

If you do not qualify for any of the life events listed above, all hope is not lost. You can enroll in a short-term medical plan. Short-term health insurance provides fast, flexible insurance with many benefits. These plans can be extended up to 3 years, and you can pick your deductible amount from many options. You are also able to drop coverage without a penalty if you want to change to a long term insurance option. Premiums are lower than ACA health insurance plans, and you get coverage as soon as a day after applying.

It is important to understand that short-term insurance is temporary and not ideal for those who require more comprehensive coverage or have health conditions. Short term plans are not guaranteed-issue, meaning they do not cover pre-existing conditions. They only cover the basics.

Do you qualify for a special enrollment period? If not, are you considering a short-term health insurance plan to hold you over until open enrollment begins? EZ.Insure can help. We offer accurate health insurance quotes based on your specific region, free of charge. That’s right. We will provide you with an agent who will compare all available plans for you, and help you choose a health insurance plan that is based on your health needs and budget, for free. To get your free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Is My Provider In-Network? What If They Aren’t?

Having health insurance is the best way to help keep healthcare costs manageable. When you are signed up for a health insurance plan, you have the peace of knowing that you are covered for many medical services. However, there are some cases when you may not be covered, and you may have to pay for care out of pocket. One example is receiving care from an out-of-network provider.

What Does Out-Of-Network Mean?

red arrow going up in a graph. — *If you agree to have treatment or services from this provider, then you will have to pay more out of pocket.*

A “network” in health insurance speak refers to the healthcare providers whose services are covered by your plan. Health insurance companies make agreements with providers, and these providers then participate in the insurance company’s plan with negotiated rates for services.

Being “out-of-network simply means that a doctor, or provider, does not participate, or have a contract, with your insurer. If you agree to have treatment or services from this provider, then you will have to pay more than you would have if you had gone to an in-network provider. Most plans offer some out-of-network coverage. HMO plans, for example, will usually cover out-of-network emergencies. Some plans may also offer limited reimbursement, but generally you should be careful about receiving out-of-network care, as you could end up with a giant bill.

What To Do If You Are Not Sure

Always check with your insurance company if you are uncertain whether a specialist or hospital is in-network. In some cases, your primary care physician may send you to a specialist who is out-of-network. If you don’t check ahead of time, then you may be left with a hefty bill after receiving care you assumed you were covered for.

What To Do If You See A Doctor Out-Of-Network

caucasian womans hands holding a white cell phone. — *You can request a network gap exception from your insurance company.*

There is something you can do if there is a specific out-of-network specialist that you need to see, or if you are out of town and need to go to a hospital that is not in your network. You can request a network gap exception from your insurance company. This basically means that you are asking your insurer to cover an out-of-network service as if it were in-network.

If your network gap exception is approved, then you will only have to pay your usual copays and deductible for the out-of-network care you receive. However, you will only be granted one of these exceptions if your insurance company agrees that there is no other way you can get the care you need because their network is too narrow. It is rare for insurance companies to approve these requests because they will end up paying for the extra costs.

If your insurer will not grant you the network gap exception, then you should first find out how much your out-of-network costs will be before you go seek the necessary care. You can then try to negotiate a discount or payment plan with the out-of-network doctor. If you are looking to treat a chronic condition and will need to see a particular specialist that is not in your network, then it might be time to consider another health insurance company or plan.

Shopping around is your best option to save money on necessary health services. EZ.insure can compare all the available plans within your region, and provide you with quotes within seconds. We will provide you with an agent who will search all the plans and help you find the one that covers any special care you need, for free! This will help you save more money, while still receiving the care you need. To get started, enter your zip code in the bar above, or to speak with an agent directly, call 888-350-1890.

Out-Of-Pocket Costs Result In Fewer People Visiting Primary Doctors

The cost of health care continues to rise every year, making it harder for many people to afford their medical bills. Data collected over the years shows that doctor visits for people under 65 years of age have dropped over 25%. In the years 2008 to 2016, up to 46% of the adults went at least a year without visiting their primary care doctor. Why? Well due to the rising health care costs, people are opting out of going to see their primary care doctor.

The majority of people just cannot afford the out-of-pocket expenses that accompany a visit to the doctor. Costs for things such as copays or lab work can become prohibitively high for many people to afford. However, primary care is effective in prevention of disease, and going without seeing your doctor can exacerbate an existing health condition.

stacks of money in a silver suitcase. — *“There is a lot of data showing that when you raise health care costs, people will receive less care.”*

More Money, More Problems

When things go up in price, people tend to shy away from spending the extra money. This does not exclude health care costs. The more money people have to pay, the less likely they are going to go to seek medical attention.

“There is a lot of data showing that when you raise health care costs, people will receive less care,” Dr. Kimberly Rask, chief data officer at Alliant Health Solutions, wrote in an editorial accompanying the study. “But it doesn’t mean that they only stop unnecessary care. They will reduce both necessary and unnecessary care.”

“When patients have to pay more, they may pause, and they may not go in if they don’t think it’s that urgent,” says Nadereh Pourat, a professor of health policy and management at UCLA’s Fielding School of Public Health. But health problems can worsen, she adds. “You don’t want them to wait til things get really bad.”

The Benefits of Primary Doctor Visits

caucasian doctor checking a mans blood pressure. — *Going to your primary doctor has many health benefits. They keep your health on the right track and help manage conditions.*

A primary care doctor may be able to pick up on, and test for, an underlying problem that a person is unaware of. It can be harmful for people not to see their doctors at least one a year, especially if they have a chronic condition that needs to be managed, such as high blood pressure.

During your annual physical, your doctor will also go over your current medications. This is to determine whether they are working or whether changes need to be made to them. Doctors will also keep you from making the mistake of taking two medications together, which could cause a dangerous drug interaction.

“Primary care has all kinds of benefits,” says Dr. Ishani Ganguli, Harvard assistant professor of medicine and physician in general internal medicine and primary care at Brigham and Women’s Hospital. “Both for patients but also for populations,” Ganguli says. The research shows that people are more healthy when they see a primary care doctor for routine care. Where there are more primary care providers per capita, death rates drop for heart disease, cancer, stroke, and other illnesses. Not only do the death rates decrease, but life expectancy goes up.

Although health care costs are on the rise, it is still very important to visit your primary care doctor at least once a year. It is necessary to stay on top of your health, and live a longer life. At the very least, an annual visit will bring you peace of mind. In the most extreme cases, it could save your life.

Are Health Insurance Premiums Tax-Deductible?

Some people are unaware of all the tax deductions available to them, and might be missing out on great tax-savings opportunities. Remember, the more you can deduct, the better your income tax refund check will be. Medical bills can add up to a lot of money spent throughout the year, and are often overlooked as a tax deduction. But are health insurance premiums tax deductible? It depends on if you meet certain qualifications.

Employer’s Insurance

When you have a health insurance plan through an employer, your premiums are most likely already tax-free. In other words, you will not be able to write off your health insurance premiums.

caucasian man sitting in front of a lptop with money going into a suitcase on the screen, — *Most self-employed individuals can take a deduction for health insurance premiums.*

Self-Employed Insurance

Most self-employed individuals can take a deduction for health insurance premiums they pay for themselves and their dependents. So, if you own your own business, you can deduct the entirety of your premium payments. You can only do so as long as you are not eligible to get insurance from another employer’s plan.

The deduction for self-employed people is limited by the amount of your business income. You cannot deduct more than the amount of income your company makes.

figure sitting on top of "10%" sign — *You are allowed to deduct any unreimbursed healthcare expenses you paid for yourself or your family, as long as it is 10% your adjusted income.*

Self-employed people can deduct health insurance premiums directly on Form 1040 (Line 29 on returns). You deduct all other qualified medical expenses on Schedule A, Line 1.

The 10% Rule Of Medical Deductions

Whether you are on an employer’s insurance or your own, you can itemize medical expenses when you are doing your taxes, but there are some rules. The main rule is the 10% rule. If you paid for insurance on your own using after-tax dollars, then you can deduct some of your premiums paid. You are allowed to deduct any unreimbursed healthcare expenses you paid for yourself or your family. However, you can only do this if it is greater than 10% of your adjusted gross income.

So, you can deduct premiums paid, and out-of-pocket costs such as doctor visits, deductibles, surgeries, and dental and vision care. If your income for the year was $40,000, then you can deduct qualified expenses that exceed $4,000 (10% of your income). If your medical expenses were, for example, $7,000, then you can deduct $3,000 from your taxable income.

To reiterate, generally if you have your employer’s insurance plan, then you are paying for premiums tax-free already. This means that you cannot deduct health insurance premiums. But, you are eligible to deduct them if your total healthcare costs go over 10% of your adjusted gross income, or if you are self-employed.

Should You Go for Gold?

Silver or gold? If given the option, which would you choose? You’d probably be tempted to immediately answer gold. But when it comes to group health insurance, it’s not that easy. It turns out that the group health plans known as “Silver plans” are far more popular than “Gold plans.” So when is it worth it to go for gold?

The ACA Marketplace

family of 4 in a bubble being held by caucasian hands. — *People can now go to this “marketplace” and shop for the plan that is right for them,*

The Affordable Care Act, otherwise known as the ACA or Obamacare, was signed into law in 2010. It mandated that health insurance exchanges be created in each state. It changed the way insurance worked. People can now go to this “marketplace” and shop for the plan that is right for them, choosing between different metal tiers of coverage (Bronze, Silver, Gold, and Platinum).

Under the ACA, small employers (businesses with 1- 50 employees) can also benefit from this marketplace. In the past, it could be challenging for small business owners to find multiple options for group insurance. But now they can shop around to choose between the same metal tiers as individuals can.

What is a “Metal Tier”?

Just like with individual plans, the metal tier options available to small businesses are Bronze, Silver, Gold, and Platinum. While it may sound like it, the different tiers do not indicate different levels of care.. After all, under the ACA, all plans must cover at least the 10 essential health benefits. What the metal tier actually represents is the cost-sharing split between the employee and the insurance company, meaning how much they will pay versus how much the insurance company will pay for medical care.

Employees with Bronze plans will pay the lowest monthly premiums, while those with Platinum plans will pay the highest premiums. However, premiums are not the only cost to consider: there are cost-sharing requirements, as well, including:

Deductibles – the amount you need to pay for medical care before insurance “kicks in”
Coinsurance – the percentage the insurance company will pay for services after you have met your deductible
Copays – the amount of money you are responsible for, over and above what your insurance company pays – for example, it may cost you a flat copay of $35 to visit your doctor

The metal tier offers coverage within different premiums, copays, and deductibles. Usually the silver plan is preferred.

Because Bronze plans are the lowest tier and have the lowest monthly premiums, they have the highest cost-sharing requirements, while Platinum plans, on the other hand, have the lowest out-of-pocket costs. The cost of premiums and these cost-sharing requirements varies between the metal tiers: for example, with a Bronze plan, employees will pay 40% of costs (with the insurance company paying 60%), while with a Platinum plan, the split is 10% / 90%. That being said, there is an out-of-pocket limit for every plan, which for 2020 is $8,200 for individuals and $16,400 for families. The out-of-pocket limit varies and will probably be highest for those with Bronze plans.

Silver Versus Gold Plans

The most popular plan among employers is the Silver plan, around 50% of employers choose this type of plan. Coming in second is the Gold plan, with almost 30% of employers choosing that type of plan. Leaving out Bronze plans with their high out-of-pocket costs, and Platinum plans, with their high premiums, let’s look at Silver and Gold plans.

With a Silver plan, employees will pay 30% of costs, and with a Gold plan they will pay 20%. These numbers are really dependent on how much healthcare they need throughout the year. For example, if an employee only uses their plan to see the doctor for an annual visit plus one or two other minor visits, they will be paying far less than 20% or 30%. But if they end up with a serious illness and need hospitalization or long-term care, they will be paying far more.

a pile of blocks of gold stacked on top of each other. — *Gold plans are perfect for people with chronic conditions or are in higher risk categories or have children in sports.*

It is understandable, then, that many employers choose Silver plans as a one-size-fits-all option. The premiums are lower, and you might be banking on an able-bodied, working-age group of employees who will use medical services an “average” amount. In this case, the 30% cost sharing doesn’t seem too daunting.

When to Go for Gold

If lower monthly premiums are important to you as a small business owner in order to attract employees, then Silver may be the way to go. But when is Gold worth it?

Simply stated, a Gold plan is worth it for people who expect to use their health insurance. They are perfect for people with (or who have dependents with) chronic conditions or are in higher risk categories for things like the flu – or even those with very young children or children who play sports.

Remember, because of HIPAA (Health Insurance and Portability Act), you cannot directly ask employees about any specific health conditions they may have. You can, however, send out an anonymous survey and ask your employees what they are looking for generally in a healthcare plan. You may find that they are willing to pay more for premiums in order to lower their out-of-pocket costs. If they are worried about being faced with high bills when they need care, then a gold plan might be the right option.

Remember, if you are at a loss at where to begin in choosing group health insurance, EZ.Insure can help. You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at [email protected] or call 888-998-2027.

The New Telehealth Guidelines For COVID-19

On March 6,2020, Congress signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provides emergency relief to the nation during the current COVID-19 health emergency. In order to protect Americans and get ahead of the spread of the virus, the bill allows for expanded use of telemedicine services. The bill also includes waivers to certain Medicare restrictions to protect vulnerable seniors, allowing everyone to receive telehealth care covered by Medicare throughout this crisis.

caucasian man in bed with a tissue in one hand and thermomter in the other with a laptop on the bed and a doctor on the screen. — *Telehealth can be useful in many situations, especially when patients cannot get to their doctor’s office.*

What Is Telehealth?

Telehealth refers to the exchange of medical information using some form of real-time video chat. It can be useful in many situations, especially when patients cannot get to their doctor’s office. Health insurance companies and Medicare do normally cover some telehealth services, including doctor’s visits and consultations, but only in limited circumstances. Prior to the waiver signed in March, patients generally needed to live in a rural area to have their telehealth care covered. They also needed to be at one of the following locations:

A doctor’s office
A hospital
A critical access hospital (CAH)
A rural health clinic
A federally qualified health center
A hospital-based dialysis facility
A skilled nursing facility
A community mental health center

These restrictions obviously meant that patients would often have to leave their homes in order to access telehealth services, which is not ideal during a pandemic.

Changes to Telehealth Services

Not only will insurance providers now cover these visits, but there are other key changes that extend coverage during this crisis.

The Health and Human Services (HHS) Inspector General is allowing healthcare providers to waive cost-sharing requirements for COVID-19-related telehealth visits.
The CMS has waived reimbursement restrictions on practicing across state lines. However, doctors will still need a state licensure to deliver care in that state.
The US Drug Enforcement Administration (DEA) has eased restrictions on the types of controlled substances providers can prescribe during a telehealth visit.

Medicare will pay for brief (5-10 minute) “virtual check-ins.”
Medicare will pay for brief (5-10 minute) “virtual check-ins” with a patient’s normal doctor, no matter where they are located. The usual copay and deductible for these check-ins will be waived.
Providers can use popular apps for video chats, such as Apple FaceTime, Good Hangouts video, Skype, and Facebook Messenger video chat.
The HHS Office of Civil Rights will waive penalties for HIPAA (Health Insurance Portability and Accountability Act) violations against healthcare providers who use video chatting apps with their patients “in good faith.” This means they will not be held responsible for any claims of violations of privacy.

Temporary Medicare Regulations

As discussed above, telehealth coverage is limited under normal circumstances. However, we are now in the middle of a global pandemic and it is very important that seniors stay at home and avoid contact with others. COVID-19 is highly contagious and more deadly for older adults (as well as those with compromised immune systems), so going to a doctor’s office now can present serious health risks for people over 65.

The new legislation signed in March allows the Centers for Medicare and Medicaid Services (CMS) to expand telehealth services available to Medicare beneficiaries so that they do not have to travel to their doctor’s office. According to Medicare.gov, now “doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities.” These visits will be covered at the same rates as face-to-face visits for the time being.

Telehealth services are being extended during the current COVID-19 pandemic in order to reduce the risk of infection in doctors’ offices. These changes will allow doctors to provide care without worrying about packing their offices with vulnerable patients, and patients to stay home and receive care without worrying about an unexpected bill.

Tag: Health Insurance