Health Insurance Archives - Page 38 of 52

Proposed Health Coverage Transparency Rule

A new transparency rule is coming, pushed forward by the current administration. It is focused on your health insurance, and how much information is revealed to you.

With health insurance, you definitely don’t want information hidden, and this goes double for fees or anything that’ll cost you money. For the most part, insurance agents work hard to make sure you’re well-informed to make decisions regarding your policy, but they can only say so much.

people sitting at a table talking about the transparency rule — *Changes are coming to teams from insurance companies to hospitals. Everyone will have to be on board.*

What the Rule Will Do

If it goes through as proposed, the rule will change the way prices are available, thus creating a better environment for people to comparison-shop for their medical work. Under this rule, both group and individual insurance markets will have to change the administration of their information. This will affect three things:

Give cost-sharing information to enrolled individuals online or in paper form. Online information will be accessed through a tool on company websites.
Disperse both in-network and out-of-network negotiated rates plus allowed amounts. These will be available in two machine-readable files.
Insurers could access “shared savings” by offering lower-cost plans and claiming the credit their enrollee’s saved by choosing the cheaper provider.

Under this rule, the disclosed information will come with seven different items:

Estimated cost-sharing liability– An averaged amount for the patient’s payment, not including premiums or otherwise. It will show cost-sharing savings or be eligible for their market plans.
Accumulated amounts– The amounts already paid (deductibles, out-of-pocket maximums, etc.)
Negotiated rates– The payments (and how much) made by the insurers, third-parties, or otherwise to in-network providers
Out-of-network allowed amounts– The maximum amount your plan/insurer covers for a specified medical expense if it’s out-of-network
Bundled payment for listed items/services- A list of covered items/services for the cost-sharing estimate. Helps with your payment
Coverage Prerequisites- A note for enrollees to see what requirements they need to meet before their expenses will be covered. Ex. step therapy
Disclosure notice– Basically anything that needs to be told to the person. Ex. an item not shown in an earlier document, differing final prices, etc.
We’ll have to learn more about our own insurance with this rule. Better visibility means more choice for the policyholder.

The outcome everyone is hoping for is that with visibility comes competition. Hospitals will have to compete with others for their price list, hopefully driving prices down. However, the hospitals fighting this rule believe that insurers will covertly come together to rig the prices. They also aren’t happy about an increase in administrative costs. Unfortunately, we won’t be seeing any changes until 2021 with most hospitals asking for extra time to prepare for the changes. We remain hopeful that this transparency rule will bring positive changes.

If you are looking to get more coverage for your company, EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

Does Medicare Cover Dental?

Medicare provides seniors with the necessary care they need. However, this is not the case when it comes to dental coverage. People 60 years old, and older often face dental issues. At least 20% of them deal with untreated decay.

Why such a high rate? Medicare does not cover dental examinations, dentures, annual cleanings, crowns, or fillings. This can leave you in a penny-pinch, because these procedures can get expensive. There are a few exceptions though!

Accidents Happen

Medicare Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures–even though dental care isn’t covered. This means while they don’t exactly cover “dental” work, if your teeth are involved in an emergency procedure, it can be included in the overall payment.

These covered services have to specifically be “emergency or complicated dental procedures.” Once they are deemed as such by a medical professional, Medicare Part A will assist in payments.

dental care with two toothbrushes in a cup — *Dental health starts at home. Make sure you’re brushing and flossing twice a day, and use mouthwash!*

For example, if you were in an accident and needed to have your jaw reconstructed, then Medicare will cover it because it is within your hospital stay. It’s still dental work but under a different umbrella.

The same goes for if a disease causes issues with your teeth or your entire mouth. As long as it is approved by a hospital or doctor as “medically necessary,” then Medicare Part A will cover the costs. More example services that are covered include:

Oral exams in the hospital before a kidney transplant.
Dental splints and wiring after jaw surgery.
Dental services for radiation treatment for certain jaw-related diseases, such as oral cancer.
Jaw reconstruction when a facial tumor is removed.
Surgery to treat fractures of the jaw or face.
Oral exam in a rural clinic or Federally Qualified Health Care Center before a heart valve replacement.

People don’t take into account how important dental care is. Not only does it play a huge part in your overall digestive health, but it can also lead to serious problems if you don’t brush and floss.

Why Dental Care Is So Necessary

Irreversible diseases are your biggest worry. Not taking care of your teeth can lead to serious illness because bacteria will build up, and find its way into your bloodstream. This includes heart disease, dementia, diabetes, cancer, rheumatoid arthritis, and respiratory infections.

Worse yet, studies have linked gingivitis to Dementia and Alzheimer’s. The bacteria from the gum disease can enter your brain through nerve channels, or your bloodstream. The brain is then exposed to the bacteria which can lead to nerve cell damage and brain cell loss. When your brain nerves are damaged or die, memory loss and early dementia can occur.

Dental Options To Consider

Just because Medicare does not cover dental work, does not mean you are out of luck or have to suffer. Instead of paying for expensive dental work out of pocket (routine dental exams can cost you anywhere from $400-$500), these are the options you can consider:

dentist performing oral surgery on patient for dental care — *By taking care of your teeth, you can avoid expensive dentistry bills. If you have to pay them though, make sure your coverage can help.*

Medicare Advantage Plan– There are several advantage plans, like Part C, which cover preventative services. This includes cleanings, fillings, extractions, X-rays, root canals, and crowns.
Dental Insurance– There are stand-alone dental insurances that you can purchase. You would pay a monthly premium, and you would have to see an in-network dentist.
Discount Dental Plan– This plan requires a membership fee. It is usually cheaper than insurance and will give you discounted rates at certain dentists. The discounts normally range anywhere from 25-50%.

Your dental health is connected to your mental and physical health. If you do not take care of your teeth and gums, dire issues can arise. Dental issues aren’t given enough attention, and they can be just as bad as other diseases.

You can develop dementia and Alzheimer’s due to bad oral hygiene. It is linked to heart issues, cancer, and more. Make sure you brush and floss every day. Just because Medicare does not cover dental, does not mean you can not seek other options to make sure your oral hygiene is up to par.

HSAs: What They Are, and Why You Should Be Using Them.

Do you know about Health Savings Accounts (HSAs)? According to surveys, about half of Americans have no idea what they are, or what to use them for. This situation isn’t good considering how present medical expenses have a crippling effect on the average person. If your employees are hospitalized from a serious injury, the resulting bill can equal the cost of a family sedan. Help them understand what these are, so they’ll opt into your group health plan.

HSAs are a great solution for these high payments, but not if people don’t know how to use them.

What is an HSA?

blue piggy bank for a health savings account — *Saving money is good just in case something happens, but what if you had an account that was ALSO tax-advantaged?*

HSAs were created to help pay for medical expenses that your health insurance plan doesn’t cover. These savings accounts are only compatible with high deductible health plans that are specifically tagged “HSA-eligible.”HSAs are tax-advantaged, giving you more of a reason to use them. On this note, if you make a withdrawal from the account to pay for a qualified expense, then the amount will not be taxed.

If their deductible is $1500, and your medical expense is $4500, then you will be expected to pay the $1500 deductible, and your insurance company will take care of the rest. For some, $1500 is still a lot of money. With an HSA in place, you can cover that as well.

Either you, or your employee, or both, will put money into the account. While HSAs can be opened by yourself, starting one with an employer will help it grow faster with you both making contributions. These are saved up to pay for things like dental work or prescription drugs to make you feel better.

How Do You Start One?

Before starting an account, your employees have to meet the requirements. This is easier if you have a high-deductible health plan (HDHP). With the HDHP, they often are bundled with an HSA, or at least give you the option.

Besides the basic stuff, you won’t qualify if you:

Have other health coverage
Are considered a dependent
Are enrolled in Medicare

How Do You Use It?

Let’s say an employee started their HSA, saved money with it, but now an urgent medical need arises.

We’ll say this urgent need is the medicine to help their recovery. Thankfully, the IRS approves this for HSA spending. Make sure to double-check though. No one wants to pay a 20% surprise tax when you file your taxes later.

stack of coins for HSAs — *If you open up an HSA with your employer, they can help put money in the account too. That’s twice the contributions!*

That being said, they have options with spending your HSA. They can either get a debit card for it from your bank or insurance company, or you can ask for a reimbursement.

No matter which place they go to, they will have experts to help explain everything. After they use these accounts to save money, they can withdraw from it to pay for qualified medical expenses. In the long run, these expenses will cost less because the HSAs are tax-advantaged.

HSAs seem fairly easy, but most people have no idea how to use them. Many insurance providers will not give HSAs the time of day, just throwing them in like a less useful option. As savings accounts go, they are specific to medical expenses, and those are restricted even more by the IRS.

We can only assume that their extreme restrictions and mystery are a cause for people not using HSAs properly, if at all. Don’t miss out on the opportunity to help your employees pay for hefty medical expenses without going bankrupt. Do some research and ask your insurance company or bank about these benefits.

If you are stuck, don’t know where to start, or have issues, don’t worry. EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

PA’s ACA Health Insurance Rates Go Up

A new year means new rates. This is especially true for health insurance, and more so in the state of Pennsylvania. The ACA Marketplace individual plan costs are going up for PA next year by 4%, according to data. Small group market plans are increasing by about 9.6%. Although there is an increase within the rates, about 19 counties will see more insurance plans to choose from.

“It’s a slight increase, but it’s not double-digit increases,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network. The group helps consumers find plans with state-approved navigators. “Pennsylvania has actually really worked hard to shield consumers from those steep rate hikes that happened in other parts of the country for the past few years.”

ACA insurance increases on an ipad — *Thankfully, the increase isn’t that big. It should be something everyone can accommodate.*

State Insurance Commissioner Jessica Altman said more insurers have entered PA’s ACA marketplace, and returning insurers have provided more options and flexibility in their benefits. Altman believes the increase in rates in the state are in line with the average rate increases nationwide. “Our expanding marketplace encourages consumers to shop around and generates lower costs through competition,” Altman said.

The biggest concern is that people will opt for plans that do not comply with the ACA standards such as the 10 essential health benefits:

Ambulatory patient services
Prescription drugs
Emergency care
Mental health services
Hospitalization
Rehabilitative services
Preventative and wellness services
Laboratory services
Pediatric care
Maternity and newborn care

A company new to the state, Oscar Health, will be an option in Bucks, Chester, Delaware, Philadelphia, and Montgomery counties. This will bring more options to consumers shopping for plans.

And Highmark, another company seeing change, is now offering plans within 14 new central PA counties, including in Fayette and Greene counties. Prior to this, all these counties operated with one insurer. This will put Highmark head-to-head with UPMC Health Plan. UPMC is in 53 counties in the western and central regions of the state.

Mark Nave, Highmark’s senior vice president of individual and small group markets, said Thursday the insurer will be introducing a new ACA plan called Together Blue EPO Silver 2900. This will be available in 2020.

doctors looking at a scan and talking about marketplace rates — *Costs for healthcare can build it, so make sure you know which premiums are affected by these changes.*

For a 40-year-old, the plan would carry:

a $349 or so premium
a $40 copayment for physician office visits after two free visits
a $25 copayment for Tier 1 prescription drugs
a $2,900 yearly deductible

“Only about 9,000 Pennsylvanians live in counties that only offer one health insurer option in ACA plans, down from nearly 180,000 people who lived in counties without multiple insurers in 2018,” Altman said. PA’s governor, Tom Wolf, added, “The state has an uninsured rate of just 5.5%, which is the lowest ever in Pennsylvania.”

With all the new companies and plans coming into the state, there should be expanded health insurance options for many Pennsylvanians. In turn, this would hopefully increase the number of people insured. The Affordable Care Act exchange enrollment period for 2020 coverage is from November 1 until Dec. 15 to sign up for a plan.

Giant Underwriters Sale Makes California Uncomfortable

Like most businesses, the insurance world can’t avoid stepping on any toes, especially when it comes to “campaign contributions,” a sticky subject in and of itself. The concept is simple enough. One entity donates money to support their chosen candidate for elections, but when the elected candidate favors the company, it can seem an awful lot like bribery.

On top of this, what happens when a business deal violates state law? It’s also not unheard of for trades to go under the radar if they can save a little money on the side.

golden gate bridge in California for underwriters sale — *What is the state of California going to do? The law is supposed to be black and white.*

What Happened?

The state of California has an uncomfortable situation on their hands. A large insurance company was denied a sale because it violates one of their laws. Under California law, a company based in the state can’t be sold or “transferred” without the approval of the California Insurance Commissioner.

This is written specifically to protect the policyholders, and it says so in the state’s law. The Commissioner is there to oversee any trades going through so that the people of California can trust in the insurance policies they take out. State boundaries matter when it comes to insurance.

The problem is, the company in question is only a subsidiary to a larger business model, and the sale is quite costly, running up to $920 million.

Allegedly, the sale was made anyway, and the deal was closed without the proper procedures done.

Who Is Involved?

The business in question is California Insurance Co.(CIC), a subsidiary of Applied Underwriters. If the acquisition goes through, the CIC will become part of a bigger insurance group, serving America in the North American Casualty Co.

The second major player is the California Department of Insurance, with its commissioner, Ricardo Lara. Because of the department’s lack of approval, the sale is technically in limbo.

pen for signed documents with the california underwriters sale — *No matter which way the case swings, things are going to change in the industry.*

The main point of contention here is that California laws should be followed. However, the CIC is technically based in New Mexico as a branch of a larger company. So, should the laws be followed, or should the state respect that their company is technically placed elsewhere?

Regardless of these questions, the CIC’s certificate of authority will be removed if the deal continues, meaning they won’t be able to do business in California any longer.

To make matters even murkier, Lara pledged in his campaigns not to accept contributions from the insurance industry. This, unfortunately, did not happen. He’s known to have engaged in talks with Applied, as they offered him support to look favorably on their future business dealings.

Whether the deal will go through, and the contributions will take effect, we have yet to see. However this plays out, there will be changes to either the insurance industry or a state’s laws regarding it.

New Probe on Group Health Insurance

Governor Charlie Baker of Massachusetts ordered a new probe into the health insurance market. Under executive order 589, the new Merged Market Advisory Council will gather and verify information about insurance rates, producing a helpful report for lawmakers to adjust insurance legislation.

The report is due on April 30, 2020.

council meeting for group health probe — *The first step in any decision is to research, and that’s just what’s happening now.*

The Council

The newly formed council consists of 13 members, 10 of them experts in the health insurance industry. This report’s entire purpose is to give an overview of the merged market based on analysis to “ensure the long-term stability of coverage for individuals and small employers in the merged market and the affordability of insured health benefit plan products offered therein.” (No. 589 Merged Market Advisory Council)

To help balance the report and keep it truthful, the council members will operate by considering:

The general stability of the merged market risk pool
Trends correlating with the risk pool and their impacts on premiums
What drives health care costs to increase
Policies that threaten market stability
Strategies to help keep market costs down

Why It Was Formed

Baker supported his own recommendation for a fact-finding committee by arguing for the complex nature that the market presents. No two people have the same view of it, and it gets even murkier as you talk to both providers and the people purchasing the premiums.

group health probe meeting between two industry professionals — *With better information, we can see some better changes for health insurance in the future.*

Essentially, Massachusetts’ hospitals, physician groups, and insurers will report their spending on primary care and behavioral health to the state agency. The projected spending increase in these areas is 30% over the next three years, an unreal amount considering the state’s cap on spending is 3.1% annually.

Hospitals are already in a losing situation here, with those two healthcare options losing money for them, especially behavioral health. They just don’t provide the same insurance reimbursement as the more sensational options like cancer.

The bill will also touch on drug prices. After review, state representatives can place regulations on predatory prescription drug practices like:

Gag rules, preventing patients from hearing about cheaper drug options
Drugmakers who charge more annually than the 2% inflation can keep up with
Any drug that costs someone $50,000 or more

The Results

If lawmakers are to better understand ways to improve insurance legislation (specifically to help with rapidly increasing healthcare costs), the first step is to compile accurate information for how the market is affected.

The creation of this council instills hope in Massachusetts’ citizens. Informed decisions are how our government should operate. With such a convoluted case like insurance, an advisory council will provide verified facts to create a better healthcare system, with more satisfied individuals.

With all the constant insurance changes occurring, there might be some confusion as to what the rates will be, and if it is affordable. If it is too much, we can help. EZ.Insure will compare plans within your region and assess which fits your needs and budget. You will be connected with your own highly trained agent that will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

Tag: Health Insurance