Always Heartbreaking News When Seniors Can't Afford Their Medications

By Coleen Elkins

We are in the business of helping people with their Medicare options and we get the opportunity to really listen to what is important. It is heartbreaking to meet with an aging member of our community and have them tell us they can't fill their prescriptions. Not taking prescriptions can be life threatening or shorten someone's life.

It is very stressful to be sick. It is even more stressful to be on a fixed and/or limited income and not being able to afford your medications.

How does a senior decide between paying their rent or mortgage and paying for their medications?

More than 300,000 American's are now taking medication with an annual cost of $50,000.00. Many  of the the Cancer medications cost $10,000.00 per month. Even with a Part D prescription plan the cost sharing is unaffordable. Then there is the "gap or the donut hole" where the burden is shifted back to the insured. They won't see any relief until they have spent $4700.00 out of pocket. Many of the newer drugs are not found on drug plan formularies meaning the are not covered by the plan at all.

Some can get extra help from VA benefits. Drug manufactures are offering financial assistance and often free medications to those who are the most needy. Those are not unlimited funds though and the benefits can be depleted quickly.

Many people don't know the true cost of their medications in the initial coverage stage because they are paying a copay. They are learning the hard way when they suddenly end up in the "gap".

We urge consumers that are unable to pay for their medications to let their legislators know. Call or write your Congressman. Speak out and be heard. If you don't tell them they don't know. If you don't know how to do that ask a family member or friend to help.

Going Without Health Insurance Could Have A Huge Price Tag

By Coleen Elkins



Whether you choose to call it a "tax penalty" or a "fine" in the year 2015 going without health insurance is going to be costly. The price tag is $325.00 for each adult or 2 percent of your family income, which ever is greater. This could cost a family $1,000.00 or more.

It has come down to going without health insurance is not only financially risky it is costly. The law has a mandate that the IRS is overseeing. You will answer questions on your tax return inquiring about the status of your health insurance. If you have children dental insurance is also mandatory and will automatically be added to your coverage.

There are hardship exemptions for those that fit the criteria to request an exemption. Completing forms are required to receive an exemption.

It seems that the general public is still very confused about the criteria of fulling the requirements of the law.

If you have questions about the law you can seek the services of a licensed insurance specialist focused the Affordable Care Act.  Since some of the law is related to tax penalties your tax advisor will be able to talk to you about the tax requirements of the law.


To learn more about the law visit our website 

Slowing Of Healthcare Spending Does Not Help Most Americans

By Coleen Elkins

If you noticing the cost of your health insurance increasing you are not alone. The reported slowing of healthcare cost spending is proving to not be related to the cost of health insurance. As American's are learning what their health insurance is going to cost for 2015 they are becoming more and more angry. 

American's receiving employer based benefits are spending a larger portion of their paychecks paying for it. Family health insurance costs jumped a whopping 73 percent in a ten year span from 2003 to 2013. It is similar for individuals paying for their own health insurance. At the same time deductible have more than doubled. In fact they have increased over 300 percent in the last year. 

The structure of health plans has also changed most no longer have fixed copays for doctors visit and prescription drug benefits. 

At the same time cost is going up for the consumer it is also going up for the employer and the employer is shifting cost on to the employee. If an employer plan does not meet the criteria for affordability and minimum essential coverage under The Affordable Care Act the employee may be eligible for coverage through an exchange. 

150 million Americans receive benefits from their employer. Only 7 million people have enrolled through exchanges as a result of the Affordable Care Act. That is a large contrast and somewhat dims the light of the Affordable Care and it's cost to administrate it. 

If the cost continues to rise for Americans to have benefits people may find themselves in a quandary. Purchasing health insurance that doesn't actually help pay for out pocket expenses for chronic medical conditions and prescription drugs doesn't make sense to most people. 

The Supreme Court Will Hear Challenges On ACA Subsidies

By Coleen Elkins

Only thirty seconds was given to this piece of news on the television on Friday so if you blinked you may have missed it. It was however widely covered in print.

The Supreme Court will be hearing challenges to the Affordable Care Act for a second time after determining it Constitutional in a previous hearing.

This is very serious as the challengers say that the administration is violating the plain language of the law. In question is if subsidies should have only been available to those purchasing insurance through their state exchanges.  The language in the law being challenged is where it states subsidies offered in the form of tax credits, will be offered in exchanges "established by the states". In other words it is unlawful for the federal health insurance exchange to offer subsidies.

There is not just one challenge to the law but four separate challenges.

The federal government operates more than two-thirds of the exchanges.

In July the D.C. appeals panel ruled that as written the healthcare law allows tax credits to be offered only in state-run exchanges. The administration had expected states to create their own exchanges but only 14 states did so. The court said the IRS went to far in allowing participants in other states seeking benefits from the federal exchange to qualify for billions of dollars in government assistance.

The Court will be hearing the case in the June session.


Read more here

Medicare Cuts Payments To Home Health Care By $60M

By Coleen Elkins



Home health care offers peace of mind and increases your ability to heal after an illness or procedure. Home based medical services are received by approximately 3.5 million Medicare beneficiaries each year.

Medicare recently finalized a $60 million cut to the agencies that provide this valuable service. Groups representing home health care providers unsuccessfully lobbied to stop the cuts.

Medicare says the cuts will will advance the goal of delivering better healthcare at lower costs. As part of the changes Medicare now requires a face to face appointment with a physician for a patient to receive home health care benefits.

Read more here: Home health care cuts

Affordable Care Act Insurer's New Contracts Contain An "Opt Out Clause"

By Coleen Elkins

The Supreme Court has been asked to determine if subsidies are legal in the Federal health insurance exchange. There have been multiple challenges to the way the law was written. Many read the law to say that subsidies are only legal in the state run exchanges. 

These challenges to the language in the law are coming to the attention of many who follow the law. If the Supreme Court rules that those whom receive reduced premiums and increased benefits through Federal subsidies can no longer do so their policies will revert to the retail price. People qualify for subsidies if they are low or moderate income households and paying retail may not be an option.

The insurers participating in the exchanges are being cautious as they know that most receiving subsidies will be unable to pay the retail price and will cancel coverage. Insurers are asking for the opportunity to opt out of offering benefits if that is the case. In some states they may still be forced to keep the policies in place.

It is important for the public to know and understand that these challenges could change their premiums and level of benefits.

Wait Don’t Throw That Away!

By Coleen Elkins


Medicare open enrollment period also known as AEP is almost here!  It is from October 15^th until December 7^th.

Your mailbox will soon be overstuff with more information than you brain will be able to handle. There is one piece of mail you MUST SAVE! Before you open that recycle bin and make a large contribution sort through the mail. 

What are you watching for???  Your ANNUAL NOTICE OF CHANGE it is coming from your current Medicare Advantage or Prescription Drug Plan. It is your crystal ball to your benefits for 2015. 

Medicare changes are on the horizon and 2015 this could be a pivotal year. Shifts are occurring in medical and RX benefits. Some are so small they may not register on your Richter scale, but could make a large impact on your personal benefits.  You need to be watching for changes that would impact your annual out of pocket expenses. In other words look to things that affect your “bottom line”. 

If you don’t know how to decipher what is changing call your Medicare agent. If you don’t have one consider finding one, because an agent can guide you at no extra cost to you. 

Coleen Elkins is an independent health insurance agent

Visit our websites:

For Medicare in Arizona, Nevada and Texas http://www.yourmedicaremarketplace.com

For Under 65 health insurance in Arizona, Nevada and Texas http://www.yourhealthbenefitmarketplace.com 

What Do You Mean I Owe You 1,000 Dollars!?!

                                                                   By Coleen Elkins

You have health insurance right? You know what your deductible and potential out pockets are right? We hope so.  

Do you know what balance billing is?  If not you need to.

Some doctors do not contract with insurance companies typically anesthesiologists do not. What does that mean to you? Imagine you are scheduled for an elective surgery. You visit the surgeon who is in your network and they carefully schedule you for the surgery at a hospital in your PPO insurance company’s network. It’s all good right? No so fast!  Just because your hospital is “in network” does not mean the doctors providing services within that hospital are!  You could very well end up with a large unexpected bill in your mailbox. 

How do you protect yourself? One way would be to speak to the person scheduling your surgery and ask them to make sure everyone on your surgical team is in network. If it turns out they are not it is important to ask them if they are willing to accept payment from your insurance company without balance billing you. Make sure you have the name of every person the scheduler spoke with regarding your surgery about NOT balance billing for out of network services. This way you have no surprises. 

The second scenario may be more difficult. Most emergency room doctors are not contracted with insurance companies. You will be covered for the emergency room visit to the hospital and typically have a co-pay for that visit. The doctor in the emergency room may very well not be a contracted physician and could send you a bill for the short fall after billing your insurance company.  

Make sure to share this information with your friends and family members so they can ask questions about fees for services regarding treatment of a loved one during an emergency. 

Be insurance SAAVY! You wouldn’t walk into a big box store lay down your favorite credit card and tell them you want a big screen without knowing the price of the TV would you? Of course not! 

Make sure you don’t make that mistake with your insurance card either! If you do you may end up with “sticker shock” and high blood pressure! 

How Much Time Do You Devote To Insuring Your Health?

By Coleen Elkins





Choosing the wrong health plan can cause catastrophic damage to your bottom line and ultimately your credit score. Most people are not comfortable shopping for health insurance and look forward to it about as much as they look forward to doing their taxes.

A recent survey by AFLAC a supplemental insurance company found that even though health insurance is a significant portion of a persons budget they spend about 15 minutes or less researching their options. Research shows people spend significantly more time researching electronic purchases, automobile insurance and where they will vacation.

Often when people look for health insurance they are looking for the cheapest rate. They may be selling themselves short on the benefit side and only realize it when they need to use their benefits. They also may end not covering the medications they need the most. Remember if you are on a Medicare Advantage Plan or you are under 65 you are locked into your plan at certain times of the year.

Did you know using the services of a licensed insurance agent or broker costs you nothing extra? Experienced agents will take the time to find out what is important to you and assist you in finding the benefits that best meet your personal needs.

As we approach the new year and open enrollment for Medicare and the Affordable Care Act are almost here it is time for EVERYONE to review their options. You need to make sure you are getting the best benefits for the best price.

If you live in Arizona, Nevada or Texas visit our websites and bookmark them to learn more www.yourmedicaremarketplace.com and www.yourhealthbenefitsmarketplace.com.

Your Doctor's World Is Evolving How Will It Impact You?

By Coleen Elkins



Have you recently visited a doctors office that is located in a building attached to a hospital? Doctors often situate themselves near a hospital but now more around found at the hospital.


Instead of doctors having a single office with there name on the door and their own staff there may be a list of 20 physicians on the sign outside the door. These are doctors have made the decision to join  large health network and become "employees" instead of "employers". Fortunately this could be good news because it puts his or her focus back on you.

Why is this happening? Doctors are being paid less for their services by insurance companies. They have been asked to do more with less money. Physicians are being required to produce more data and documentation than ever before which takes valuable time and man power and upgraded technology. All these required changes drives up their cost of doing business. Sole practitioners or a handful of doctors in a small office setting can only see so many patients in a day. They have had no choice but to evolve their practice to change with the times or burn out trying to keep up.

Those that decide to stay independent are finding ways to replace the income lost due to contractual cuts the insurance companies have imposed on them. One way of doing that is by making a part of their practice a concierge service. Under this model you pay a monthly fee such as $150 per month for unlimited access to your physician.This means your are promised same day appointments, a direct phone line to your doctor and the ability to text them even when they are away from the office.

Read more here

How Did We Come To Celebrate Labor Day?

                                                                       By Coleen Elkins

Legislatively Labor Day did not become a holiday at the Federal level first. In fact it took a good while for it to become a National holiday. Labor Day took the path of municipal ordinances passed in 1885 and 1886. New York was the first to introduce a bill, but the first state to make Labor Day a holiday by passing a law was Oregon on February 21, 1887. Oregon as followed by Colorado, Massachusetts, New Jersey and New York creating a holiday celebrating their work force. As a new decade was approaching Connecticut, Nebraska, and Pennsylvania were also celebrating Labor Day!

On June 28th of 1894 Congress passed an act making the first Monday in September a legal holiday in the District of Columbia and the territories.

The idea of Labor Day came from Labor Union workers as they adopted a proposal and appointed a committee for a demonstration and picnic. It said it was the idea of one of two workers but it is still unclear who was the founder some say it was Peter J. McGuire the general secretary of the Brotherhood of Carpenters and Joiners others give credit to Matthew Maguire a machinist.

The Federal observance and celebration of Labor Day is outlined to hold a street parade to the public "the strength and esprit de corps of the trade and labor organizations" of the community. A festival was to follow for the amusement of the workers and their families. Speeches would be given by prominent community members.

Over the years this nation has paid tribute to the backbone and strength of this nations leadership, strength the American worker!

Happy Labor Day to all!

Yoga For Healthier Aging

By Coleen Elkins

As we age we lose our flexibility and our balance. Yoga may be a solution for some of us to maintain flexibility and stability. Always talk to your doctor before beginning something new.

Yoga is adaptable for the very young and the aging population and for those with specific needs and abilities. Just because you are nearing retirement or are retired doesn't mean you need to become sedentary. Yoga classes are now available in senior centers, community centers and even store fronts.

Yoga has helped people with arthritis with muscle tone and flexibility. There are many types of Yoga to consider including water Yoga and chair Yoga. There are many ways to learn besides attending class. There are books on Yoga, videos on Yoga, and internet classes.

Yoga can help improve your mood, balance, strength and possibly even sleep better. It may take a while for you to feel comfortable learning Yoga so after speaking to your doctor and deciding to give it a try remember to go slowly but be consistent in practicing.

Back To The Future - Doctors Home Visits On The Rise

                                                                 By Coleen Elkins

In the 1960's doctors making house calls was not all that uncommon. It appears those visits are on the rise and could save millions of dollars in ER visits. Sometimes for seniors just getting to a doctors office is more than they can endure. Now with portable technology doctors, physicians assistance, nurse practitioners can preform portable EKG's, echocardiograms right in the patients home. Same day urgent visits can be arranged as well.

Medicare paid for 2.8 million house calls in 2012 a number that nearly doubled in a decade. The house call visits on a study of two groups revealed a 17 percent cost decrease in those receiving home healthcare.

The idea of bringing peace of mind to seniors and caregivers and saving money is very appealing and welcomed at a time when we see medical costs rising.

You can read more here 

How Much More Will You Pay For Health Insurance Next Year?

By Coleen Elkins

Whether you have health benefits from an individual plan through a private insurance company, employer benefits from your job, or you have purchase insurance through an exchange your rates are going to increase for 2015. The question is how much more will you be paying?

There are many variables considered to find the answer. Health plans are still filing for rate increase through their state department of insurance. According to data research from PricewaterhouseCoopers the national average to date for increases is 8.2 percent. In Arizona the average is 11.2 and said to be one of the lower premium increases reported with an average of $331 matching Michigan as the lowest currently reported. Other variables are network size, benefit options chosen plan level selected.

Open enrollment for 2015 begins on November 15th 2014 and ends February 15, 2015. 

Read more here

Therapy Dogs Healing Powers

By Coleen Elkins

Have you ever been in the hospital as a patient or visiting someone and notice dogs walking down the halls and into rooms with there owners?  The look of joy and surprise on a patients face when the dog and owner are standing in the doorway will warm your heart. At one hospital in Waco Texas the dogs are even dressed in cheerful attire. In this particular hospital they also visit the ICU surgery unit.

The visits are short and the dogs have been trained how to behave when visiting patients. You will see them in hospitals, nursing homes, assisted living facilities and senior centers.  They have been found very therapeutic for those with autism.  

Does your dog have the "Midas touch"? There are many training courses both in person and on the web for owners and their dogs. The dogs are expected to be non-aggressive, obedient and not bark or jump on anyone. Volunteering your dog can be very rewarding for both of you. Spending a few moments petting a dog is known to lowers ones blood pressure. If you are spending a couple days a week volunteering you are getting some exercise yourself. The feeling of putting joy in another person's heart will leaving you feeling in a good mood for the rest of the day and beyond. The training courses will cost you, but the return is well worth the money spent.

If you have a little time you can commit each week here are some websites that offer training.

Therapy Dogs International 

American Kennel Club - Therapy Dogs

Is A Copper Plan On The Way?

By Coleen Elkins

It is anticipated that in some regions health plans will experience double digit rate increases for 2015. So how will the Affordable Care Act react to the increases? Will people drop their benefits because they have become unaffordable?

One health insurance carrier announced of the 700,000 they enrolled during the enrollment period they have lost nearly 200,000. Once the increases are announced in September how many more will just quit paying? Having an alternative to switch them to would be a solution but it would have to be implemented by Congress. There is not enough time to get that accomplished for 2015.

If a Copper plan is put in place it would have a 50 percent cost sharing. It would reduce premiums and lower the governments cost by about 18 percent. It would also reduce revenue which might hurt the Affordable Care Act's financial stability.

The Copper plan would look very much like a current catastrophic plan for those under age 30. Will that be attractive to consumers or will they only be enrolling because they are left with no alternative other than to pay the "penalty"?

Look for the Copper plan to arrive in 2016 pending a vote.

Hosptials Revisit Charity Programs Under ACA Regulations

By Coleen Elkins


Hospitals are revisiting their charity programs under ACA. Most hospitals offer discounts for those that are on a cash basis.

There are charitable organizations and foundations that offer assistance to those that can not afford to pay for their hospital stay. Applications for assistance must be submitted for consideration. The income qualification guidelines varied greatly from less than 200 percent of the federal poverty level to 400 percent of the federal poverty level.

Now under ACA it is mandated that hospitals make these programs public. The hospitals are now changing the applications requirements. If someone would qualify for a subsidy under ACA and they did not apply during open enrollment or at the time they became qualified they are disqualified for  financial assistance through the benevolence programs. The hospitals are hoping this will spark enrollments for the 2015 plan year. Some hospitals are considering eliminating the charity programs completely.

Large Employers Reducing Benefits And Raising Employees Contributions Toward Health Insurance

                    By Coleen Elkins

Employees are beginning to take notice to the changes in their benefits especially those working for large employers. Employers such as hotels and restaurants are taking steps to reduce costs for themselves and shifting more cost to the employees. The only way they can manage this is is to reduce benefits by offering plans that raise deductibles and out of pocket expenses. The employers are offering two-tiered benefit levels. One very expensive benefit rich plan much like they have always offered in the past and an alternative lower benefit "skinny plan".   

Four years from now an employer that offers a plan to employees that costs more than $10,200 per employee will be accessed a forty percent tax. Knowing that is coming employers are preparing for a shift in benefits now. This tax is driving a big change for both employers and employees. 

Employers offering a plan that is ACA-compliant plan avoids tax penalties and disqualify the employees from getting subsidized benefits from a state or federal exchange. The Affordable Care says a plan offered by an employer is "affordable" if it costs the employee 9.5 percent or less of their income. 

The shift toward consumer directed health plans allows employees to build their own benefit package to meet their personal needs. These plans will be high deductible plans with variations of benefit structure. 

Read more here

Tax Forms Expected To Become More Complicated Because Of The Affordable Care Act

By Coleen Elkins

Making it through the healthcare system last year was not a pleasant task for most. It is time to prepare yourself for the next big challenge which is the IRS required forms and documentation related to enrollment in your new healthcare plan.

The papers you will be shuffling before April 15th 2015 are uncharted and unfamiliar. The level of complexity has been raised a good bit. The drafts of the forms have been released recently and some have called them "daunting".  Most middle and low income folks don't normally deal with complicated taxes forms. Even though these forms will come with practical instructions it may not be enough help for some taxpayers.

Some people applying for exemptions from the law will also have to complete forms related to their request. If questions are ignored by taxpayers on the tax forms that opens up pandora's box. How that will handled by the IRS and what their response to tax filers will be in not known at this time.

Before you can even file your taxes you will have to receive the necessary forms from your state or federal exchange or employer about your current plan and level of subsidy you received if any.

Remember to avoid any unforeseen problems you are to report changes that would impact your health  plan to healthcare.gov or your state exchange throughout the year. These changes would things like income changes, marital status, birth of child just to name a few.



Read more: 

Walmart - Shop For Your Groceries, See The Doctor And Fill Your Prescriptions

By Coleen Elkins

Walmart and some groceries stores already have "walk in" medical clinics in there retail businesses. 

Walmart is gearing up to expand this concept to treat chronic medical conditions. The doctors in the clinics will more than likely be "on staff" which means you will see whomever is on duty. You will pay cash as they will only be accepting insurance from their own health plan offered to employees and Medicare. An office visit at the clinics is currently set at $40.00.  This will make the system more efficient by eliminating processing claims to insurance companies. 

With medical technology on the forefront of many in the IT business today you won't necessarily have to have medical file in that clinic. They will be able to access your records electronically. 

This model could change how we look at having a relationship with a "primary care physician".  

Things are changing so stay tuned and visit us often so you can change with it. 

Read more here

Are You Asking How Much Your Medical Care Is Costing?

By Coleen Elkins

Would you go into one of those big box stores and tell them you want to take home this big screen without knowing the price?

Probably not you would not only know the exact price you would have decided how you are going to pay for it. You would know the dimensions and if it has high definition, is it an LED? You would know if it was going to fit in your car or if you will have to borrow a friends truck to get it home.

Why do we shop with such detail when we are taking home our "goodies and toys", but we don't do the same when we are taking care of our health?

Folks be savvy!

Let's say your physician is recommending a CT scan. Do you know how much they cost? They can cost upwards of $6,000.00. Who is ultimately paying for that? YOU! You will pay both directly and indirectly with  deductibles, co-insurance and higher premiums over all.

What would happen if you said to your doctor how much is this going to cost and is it medically necessary? What would happen if you asked for a list of facilities offering CT scans and started shopping price? One shopper discovered this when he started asking questions an abdominal CT would cost $4,423 the insurance carriers negotiated rate is about $2,400.00 and that its cash price would be $250.00. Which would you rather pay?

Legislation to force medical cost transpariency never makes it to a vote. Why? Lobbyists!

Be savvy! Start asking questions and become part of the driving force to bring medical costs down! Push for transparency of medical cost every time you visit a doctor or medical facility!

Read more here

Medicare's Financial Situation Reported To Be Improving

By Coleen Elkins

Like social security the financial stability of Medicare has been an unknown factor for many years. As baby boomers age they worry if the benefits will be there for them. It seems of late reports are showing Medicare's situation may be improving. The confusing part is no one can explain why. The latest data shows that Medicare has enough reserves in it's trust fund to last through 2030. That is four years longer than was projected last year.

In 2009 reports reflected Medicare's trust fund would expire in 2018.  The idea that Medicare would ever run out of funds is still frightening to most, and since the reason for the improvement can't be explained no one is breathing a sigh of relief yet.

A host of experts are setting on ready to rework the entire system, but is now the time to start altering a path with so many unknown factors?

Read more here

                                                     

More Options In The 2015 Insurance Exchanges Is A Good Thing

By Coleen Elkins

Competition in any industry is a very good thing. In 2015 more insurance carriers will be participating in the federal and state exchanges. The creative juices will flow with benefit designs and supplemental benefit offerings to entice you to insure with "them". It will also help pricing be a little more competitive. Don't expect too much variance on the pricing though as the government has strict margins set for the medical loss ratio. 

Hopefully another improvement you will see is access to customer service. Because there was little competition this year for the carriers participating they were overwhelmed for the most part. Customers calling in experienced extremely long hold times and disconnected calls and some short tempers. Issues took weeks and even months to resolve. Some are still waiting. 

Last year insurance carriers were fighting a headwind of unknown factors. We expect 2015 to be calmer. 

The marketplace can be confusing especially if you are participating in the subsidy program. The best thing you can do is seek the services of a licensed agent certified to assist you with the insurance exchange. Agents will know who the new players are and their strength and offerings for 2015. You can find an agent in your area by visiting The National Association of Health Underwriters website here. 

Average Cost Of Medicare Part D Drug Plans To Rise In 2015

AVERAGE COST OF MEDICARE PART D PREMIUMS INCREASE FOR 2015

By Coleen Elkins

Part D Prescription Drug Plan premiums will rise slightly in 2015. The average cost of Medicare Part D Plans has remained stable for the last 3 years at between $30 to $31. In 2015 it will be $32.00.

One of the attributing factors is the rising cost of medications. One medication mentioned is the drug that cures Hepatitis C Sovladi it rings up at $1,000 per pill. Low enrollment in Medicare Part D Plans has also been cited as a cause.

It is very important that seniors and those under 65 with disabilities on Medicare check their Part D Plans renewal packet when it arrives sometime around October 1st. Don't throw it in the stack of pending mail and ignore it!

At the very beginning of your renewal packet you will see your plans changes for 2015. It will tell you what the cost will be and just as importantly if your drugs will remain in the same tier it was in for 2014. Will the drug copays remain the same? Get your prescriptions out and make comparison notes.  Then you can make an informed decision about keeping your current plan or shopping for another.

Those on Medicare benefit greatly from the Medicare prescription drug plans also known as Part D. If you have never enrolled in a plan learn more and see how it may benefit you! Become "Medicare Savvy"!

If you need help seek the services of a licensed health insurance agent specializing in Medicare. If you do not have an agent a list of agents can be found for your area on the website
National Association of Health Underwriters look under find an agent click here.

GOA Signs Up 11 Fictitious People For Heathcare

By Coleen Elkins


A Government Accountability Officer Report states GOA officials successfully enrolled eleven fictions people up for the health exchange. This was done by using fake immigration and income documents, and they were able to obtain subsidies for these people that do not exist.


Republican Senators are pressing the new HHS Secretary to take action in response to the report. The Center For Medicare and Medicaid Services is aware there are problems with the system. They have admitted that a million people may be at risk of paying back a portion of their subsidies because there were not eligible for them.

The administrations response is they are catching up to fix problems that plagued the system early on.


Read more here

Blue Cross Of Louisiana Blames Affordable Care Act For Rate Increases

By Coleen Elkins

State insurance carriers are in the process of announcing rates for 2015. It appears the normal increase is going to be double digit amounts, but how much will consumers be expected to pay next year? Health and Human Services says they expect enrollment to double under the Affordable Care Act from 2014 to 2015. This new enrollment is expected to bring on "healthier people".  They project this will lower premiums in the future.

Each states insurance department will review the proposed rate increases to make sure increases are inline with expected claims.

Blue Cross and Blue Shield of Louisiana services primarily individual enrollees rather than those insured through employee benefits. Three of the four Louisiana Insurance companies will be asking to increase rates by double digits on certain plans.

Read more here

Insurer Bailout - Taxpayers Could Be On The Hook For $725 Million In 2014

 By Coleen Elkins

Is there light at the end of the tunnel for health insurers? Some insurance carriers became fearful when they began to realize their premiums may have to rise as high as 20 percent in 2015.

The Affordable Care Act created a risk corridor to protect the insurance companies that take on the sickest patients. Keep in mind risk corridors protect profits not patients. The intent of the program was to pool payments from insurers and redistribute the funding to the companies that enrolled the chronically ill and the higher cost patients. This would pass the bill off the the companies with higher profits.

The administration has eased the minds of insurance carriers by issuing rules that permit taxpayer funding to be paid out through the "risk corridor program" which was supposed to balance itself.

Premiums are still rising by double digits in some states and the laws reinsurance and risk corridor are set to expire in 2016. What consumers see for rate in 2017 may be shocking as a result.


Read more here

Annual Health Insurance Rebates Will Be Paid Out Soon

By Coleen Elkins

Under the Affordable Care Insurance carriers can only keep a certain amount for profit. This results in reconciling their profits and rebating to the consumer if they are over the allowable amount.

Nationally the rebates will average $49 totaling  $332,000,000.00 for 6.8 million insured. Not all will receive a rebate check and amounts will vary. It will be determined by reconciliation of each carriers premiums received and claims paid out. The rebates occur when an insurance carrier fails to spend 80 percent of premiums received on medical care. Each year it is projected the rebate checks will get smaller and fewer will be receiving them.

Anger Over Narrow Networks Under Obamacare Is Growing

By Coleen Elkins

Is you doctor going to be there for you under your new healthcare plan? Consumers are learning they have new network restrictions that they were not told about when enrolling in their new plan and they are very upset. Some patients in rural areas are having to drive great distances to see a primary care doctor or specialist. So how do insurance carriers keep cost down and still provide access?

Insurers have been directed under the affordable care act to include enough doctors and hospitals to provide timely access to care. Even though the directive has been issued there are now specific guidelines for the insurers to operate under. Some states are working to raise their standards. More than 70 bills have been introduces in 22 states to clarify network rules.

There is another big question not addressed in this article. What if the doctors do not want to participate in the new networks under the affordable care act? What if the law has reduced their pay or does not guarantee payment if an insured skips out on their premiums after the new "90 day grace period"?


You can read more here

A Pilot Study Will Exempt Some Seniors From Medicare's 3 Day Rule

By Coleen Elkins

There is a Medicare rule that a beneficiary must spend 3 days in the hospital prior to being admitted to a nursing home. This rule has left many seniors with denied claims and large out of pocket costs. If a hospital does not admit a person but holds them for observation the clock does not start ticking on the 3 days. Seniors are very frustrated by this.

For example if someone is held for observation for 24 hours and then admitted for 48 hours they have only spent two days in the hospital. If they are transferred to a nursing home the after the 2 day stay that nursing home stay will not be covered by Medicare.

The number of observations patients ineligible for Medicare-covered nursing home care has shot up by eighty eight percent in the last 6 years to 1.8 million in 2012.

Only Congress can change this rule. As always we encourage you to contact your local Legislatures
regarding changes to laws that are important or may impact you.

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Preparation Begins For Nevada To Connect To The Federal Health Insurance Marketplace

By Coleen Elkins

The state of Nevada had a rocky start with their state health insurance exchange for 2014. This has triggered some major changes for 2015. Xerox the contractor responsible for facilitating the state exchange was fired in May.

An audit preformed by Deloitte (an accounting firm) recommended Nevada tie it's Medicaid software into the federal system. Nevada accepted the recommendation and hired Deloitte to complete the task.

In order to do this Nevada amended their existing $28 million dollar contract with Deloitte which is the 9th amendment to the contract. The amendment adds a 16 million dollar payout to Deloitte. The contract was issued without competitive bidding for the services. Even though competitive bidding saves tax payers money the reason for not seeking bids was "there was not enough time". A hand full of blue chip companies have been awarded contracts in 17 other states.

Oregon, Minnesota and Maryland are three other states that have hired Deloitte for more than $63 million combined. Deloitte certainly has grown in the health insurance industry. Hopefully the money spent will iron out the wrinkles and make 2015 easier on consumers seeking to enroll.

Colon Cancer Survivors Challenge Medicare Loophole

By Coleen Elkins


Having a colonoscopy as part of a wellness exam can save your life. Most colonoscopies are preformed every 10 years and at shorter intervals for those at risk. Often in the course of the procedure polyps are found and removed.

For Medicare beneficiaries the "no cost" wellness exam just became a surgical procedure and in no longer considered wellness. Many patients are surprised when an unexpected  billing statement arrives in the mailbox.

Some colon cancer survivors feel there should be no cost for the polyp removal.  Reason being removal of those polyps can prevent the patient from getting colon cancer. Prevention and early detection by biopsy of the polyp can save lives and as a result save Medicare money in treatment of the disease.

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Survey Shows 89% Of Seniors Say They Are Optimistic About The Future

By Coleen Elkins


Despite some financial uncertainty todays aging population are feeling positive about their future. The reasons vary and at the top of the list is friends and family. The second reason is their living situation followed by being well prepared financially and being in good health. A phone survey polled 2000 adults half of whom are over the age of 60.

The USA Today article goes on to say that Baby Boomers have a lot going for them. They are in better health, better educated and more active.

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Should You Be Monitoring Your Blood Pressure At Home?

By Coleen Elkins

Blood pressure is the pressure of the blood in your arteries as it is pumped around your body by your heart. Hypertension or high blood pressure usually does not have symptoms. It can however lead to serious health issues. High blood pressure is a known factor in developing cardiovascular disease.

Measuring your blood pressure at home is easy and relatively inexpensive as a reliable machine can be purchased at drug store and other retail outlets. It is best to be relaxed an sitting when taking your blood pressure. Blood pressure is recorded in two numbers such as 120/80. The larger number (systolic pressure)indicates to pressure in the arteries as the heart pumps out blood during each beat. The lower number (diastolic pressure) indicates the pressure as the heart relaxes before the next beat.

Studies are finding those that monitor their blood pressure at home can reduce their healthcare costs and it is also saving insurance companies money in paid out claims. This is raising the question should home monitors be covered by health insurance for those at risk?

Inspector General Reports Medicare Made $1.7 Billion In Suspect Payments

By Coleen Elkins

A recent report by the Inspector General indicates that Medicare made suspect payments to more than 1,000 laboratories in California and Florida in 2010.

The total amount of the payout was $1.7 billion dollars. Medicare was suspucious of the claims as the came from ineligible physicians but they paid the claims anyway. In many cases the claims where filed for patients residing more than 150 miles away from the prescribing doctor.

Labs represent less that 2 percent of Medicare spending.

The investigation will be looking into whether anti-kickback laws have been violated.

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California Policy Holders Sue Anthem Over Narrowing Networks

By Coleen Elkins

Anthem Blue Cross of CA has been sued by policy holders for narrowing networks under Obamacare. This is the second suit in California in less than a month by insureds.

Policy holders were moved by Anthem from their existing non-compliant plans to a new plan that meets the mandates of the law. In the process they have lost their doctors. Additionally state regulators are investigating whether Anthem provided members with inaccurate provider lists. Both Anthem and Blue Shield cut available providers on marketplace plans to reduce premium rates.

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Poll Finds Many Insurance Brokers Consider Leaving Their Career After ACA

By Coleen Elkins

BUT NOT US!


There is no doubt health insurance brokers jobs have become more difficult. What used to take an hour or so can now take 3 hours or longer. It can also involve return trips to see a client because of unforseen obstacles in achieving the goal of getting them insured.

After years of working in an industry we have awaken in a new world which is at times confusing and literally dysfunctional. The newly required certifications do not prepare us for the obstacles we face in helping a client obtain health insurance.

If the process is uncharted for us I can imagine how a consumer feels. Even if they are "tech savvy" that does not make them "insurance savvy". Often they find that what they thought they bought they did not receive. Those seeking subsidies don't understand the qualification and income requirement process. Even after the enrollment is complete further documentation may be required, and if they don't respond their coverage will be cancelled by the government.

All of this makes me even more determined to stay the course. People need someone who listens because they care. They need someone who can point them in the right direction and give them guidance so they can make an informed decision. Consumers want and need confidence that when they walk into a doctors office their insurance card is going to be accepted and their claim paid.

We are here to help our clients understand and maximize their benefits! We are staying the course!

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Supplemental Insurance Provides An Extra Layer Of Coverage

By Coleen Elkins

Having health insurance is a good thing but, it often leaves you with large out of pocket costs should you have an accident or a catastrophic illness. Most policies today have deductibles ranging from $3600 to $6300 per year.

Some health providers are requiring deductibles be met at the time services are rendered unless it is a medical emergency. If you don't have the cash on hand you may be left scrambling to come up with the cash to continue diagnostics or treatment.

Supplemental Insurance may be the protection most need to cover the shortfalls. These plans provide cash in the event of an accident or critical illness. The cash can help with covering your deductible or just paying the household bills.

These policies typical have a small monthly premium cost and can offer peace of mind.
A health insurance agent or broker can share your supplemental options with you.

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Thousand Of Florida Seniors Caught Off Guard

By Coleen Elkins

Thousands of Florida Seniors were caught by surprise when CMS (Centers for Medicaid and Medicare Services) changed their Medicare.

Their Medicare Advantage Plan Physicians United was declared insolvent and they were returned to original Medicare without notification back to June 1st 2014. This has resulted in large out of pocket costs for many insured. The Florida based insurer served 38,000 members in 17 counties.

Seniors have been given until August 31st to select a new Medicare Advantage plan.

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An AARP Report On Nursing Homes Gave Texas Poor Marks

By Coleen Elkins

A 2010 AARP report on quality of nursing homes left Texas in nearly last place. Texas rates 49th of the 51 the District of Columbia was included in the nursing home quality of care report.

Twenty seven percent of the long-stay patients in Texas received anti-physchotic medications compared to the national average of 20.2 percent this is quite high. The number of nursing home workers that left their jobs in 2010 was 72 percent. That is nearly twice the national average of 38 percent.

Families that make the decision to place a loved one in a nursing expect a high level of care for their family member. It is very disheartening to learn that may not be the case. This report came to light just days before DADS (Department of Aging and Disability Services) is scheduled to appear before the state Sunset Advisory Committee.

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Is Medicare In Need Of An Overhaul?

By Coleen Elkins

As we look at all the changes to health care in the United States over the last few years could Medicare be next?

A Medicare overhaul has been kicked around Washington for a very long time. There have been proposals that would reportedly reduce the deficit. One suggests unifying Medicare benefits under a single deductible with a cap on senior's out of pocket expenses. The fear is that could increase costs for seniors not utilizing hospital benefits.

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Government Paying 76 Percent Of Premium Under Healthcare Law

By Coleen Elkins

If you look at the photo it represents 75 percent of a pie.

Seventy six percent of people that applied for health insurance received assistance paying for their benefits. The assistance is provided by the Federal Government.

The Federal exchange is responsible for 36 of the 50 states as only 14 states have their own exchange. Only 24 percent of those enrolling did not receive a subsidy. The average premium is $346.00 what that means is typically an enrollee pays just $82.00 per month for their health insurance. In Mississippi the average premium paid by the enrollee is $23.00. It is unclear if the data on the 14 states running their own exchanges will impact these numbers in any way.

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Study Finds The United States Ranking Last In Health Care

By Coleen Elkins



A study finds the United States healthcare system spends the most money with the poorest results. The study was concluded prior to full implementation of the Affordable Care Act, and goes on to say the law should improve the U.S. standings.

Some of the measures were health outcomes, quality and efficiency. It seems we lack coordination of care, and dealing with administrative issues. Interestingly Canada is right behind the U.S. at number 10 with a Nationalized health plan.

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Medicare Wades Through 357,000 Disputed Claims

By Coleen Elkins


Medicare has fixed dollar amount limits they will allow for certain services. One of those services is physical therapy. If a Medicare patient has a stroke there are many physical therapy components that are usually needed by the patient. They need to work on mobility and speech and improving their daily living. If a small provider has been paid by Medicare for services rendered it can really impact their bottom-line when they are asked to pay it back because the amount exceeded the Medicare limit.

A provider can wait up to 2 years for a case to be heard because of the back-log. Medicare has suspended hearings for the year as the renew contracts with third party vendors.

Read more about Medicare's back-log here

Is Your Smart Phone Or Tablet Making You Healthier?

     

 By Coleen Elkins

Mobile Medical apps can have many functions and serve many purposes. They can help us become healthier and stay healthy. They can provide information on certain medical conditions, monitor caloric intake. They can help nursing mom's know the effects of certain medications while nursing their babies. They can help doctors have research at their finger tips. Some apps can diagnose Cancer or Irregular heart rhythm.

Companies such as Weightwatchers offers an app to help you track your daily food intake and exercise. Apple is introducing more health programs to their operating system this fall.

The FDA has a website dedicated to medical apps here

Who Makes Your Healthcare Decisions?

By Coleen Elkins







Should you be proactive in your healthcare decisions? Growing up we learned to be respectful of those who are of "authority". With sixteen years of training and years of experience a doctor certainly does hold a position of "authority".  Of course you want to give your doctor the respect they deserve. Do you want to give them the ultimate decision making power over your healthcare?

A study finds that in some instances such as a medical condition that is a threat to public health the doctor should have ultimate authority. Another example is should a patient decide on a treatment that may be harmful to them?

Should you have a chance to weigh in as well under "normal" circumstances?

Conversations with your doctor will educate you on your medical condition and could improve your health. It may be good to show up at your doctor's appointment with a note pad and be prepared to take notes. Those notes may generate more questions for a later visit. Your questions may lead you to treatment options.

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Healthcare Law's Application Inconsistencies Affect 2.1 Million

By Coleen Elkins

Many weeks have passed since the open enrollment for the Affordable Care Act has ended. We are now learning that many people have been left in limbo.

A government document provided to the Associated Press on May 8th indicates that at least 2 million people that enrolled in tax-payer subsidized plans have some sort of "data discrepancies" in their applications.

Consumers being notified about problems with their accounts need to respond immediately. If they do not respond and the issue remains unresolved it could leave them in a bad situations.

Some of things that could go wrong for the applicants are higher premiums, lapse in coverage, or even their legal right to benefits. Health and Human Services state that the vast majority of the discrepancies are been resolved in favor of the applicant.

If you have received a notice it is very important to respond.  If you used the services of a licensed insurance agent call on your agent to assist you immediately.

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Health and Human Services Awarding $300 To Community Health Centers

By Coleen Elkins

"HHS" The Department of Health and Human Services is offering $300M to assist community health centers. The money will help the centers treat newly insured patients. Those that enrolled as a result of the Affordable Care Act will see expanded service hours and less waiting time because of more health care providers being hired. Those needing oral health and behavioral health will also be able to be treated at the community health centers.

The community centers were instrumental in helping 4.7 million people enroll in Obamacare. HHS reports there are nearly 1300 health centers that run more than 9,000 facilities and care for over 21 million patients through out the U.S.

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