May Day Tips For Maximizing And Maintaining Your Health Insurance

By Coleen Elkins    24-7 Health Insurance

The role of your health insurance agent is much more than quoting and enrolling you in your health plan. Once you have chosen the plan that meets your needs your agent now becomes your customer service representative. If your agent’s phone number isn’t in your contacts add it. If you are uncertain about your benefits, your subsidy or your provider network call your agent and ask for help.  If you are our current client please call on us for guidance. We are here to help you maximize your benefits!  For those of you on under 65 health insurance or Medicare. Do you know where your health insurance policy is? Have your read it? What are your wellness benefits? Wellness benefits are typically based on your age and have a specific time line for certain exams based on your health history or family health history. Use your wellness benefits as they are listed as prevention.   Please review your policy to understand your out of pocket costs such as deductibles and co-insurance. Know what the pages labeled limitations and exclusions say. Do you have any supplemental policies to reduce your potential out of pockets ? If you don’t ask us about Wellness Link . Wellness Link provides you Teledoc services (this saves you the cost of an office visit), Advocacy services such as negotiating outstanding medical bills. Dental Discounts with Aetna’s nationwide network. RX Discounts sometimes better than the discount your insurance card provides. Some Wellness Link Plans even provided discounted veterinarian services for your pets including exotic animals. There are more benefits for members than we have listed here. Wellness Link has 4 plans offering rates as low as $14.00 per month per household.   *Note -These plans are available whether you are on Medicare or under age 65 health insurance.  If you are on under age 65 health insurance . Are you receiving a tax credit aka a premium subsidy? If you are DO NOT ignore notifications from healthcare.gov or your health insurance carrier asking you for additional information. There is a timeline to respond and not responding could cost you your benefits. If you have sent the requested information do not ignore follow requests or assume the information was received . Send all information with a tracking number. If you have set up an account at healthcare.gov and need to make changes be 100 percent certain you understand how to navigate your account. If you don’t and you are our client please call us for assistance. Making a mistake while navigating the account could cause you to lose your tax credit or worse yet your benefits.  If you are our client please call us before calling healthcare.gov we have access to your information and can make the call with you or provide with guidance before you make the call.  It appears 2017 is going to be another year of change for health insurance and Medicare. Please put a note on your calendar to contact us prior to 2017 open enrollment.

Two Reasons Obamacare Premiums Will Spike In 2017

By Coleen Elkins         24-7healthinsurance

In March of 2010 when the Affordable Care Act became law government financial assistance was promised to the health insurers. This was to guarantee the insurers they would not lose money insuring American's without underwriting them.

The assistance is referred to as the "3R's".  They are Risk Adjustment, Reinsurance, Risk Corridors. The 2014 Kaiser Foundation Table below explains the functionality of each program.

A 2015 article from "The Hill" explains the financial health of reinsurance this way. "Nearly all of the 484 health insurers that paid into the pool will be receiving some money back. About 50 plans did not qualify. With the extra money from 2014, health companies can now split a $1.8 billion pool of reinsurance money through 2016". 

Both the Reinsurance and Risk Corridor Program end at on December 31st 2016. These two programs were designed to stabilize health insurance premiums along with Risk Adjustment which will remain. This means moving forward in 2017 plans that experience lower claim payments will have to pay money to those that have experienced higher claims. This will be the only stabilizing force for insurance premiums.

To put numbers into perspective in 2010 a female in their mid 50's paid premiums under $200 per month for a $5000 deductible PPO with nationwide coverage in the state of Texas. Six years later a $5000 deductible PPO plan with limited coverage outside the service area will cost over $600.00 per month for the same 50 year old female without a government subsidy.

Reading the above paragraph makes it clear health insurance premiums will not go down in the future. What remains to be seen is how much the health insurance premiums will rise in 2017.  Will health insurers be financially solvent without the Reinsurance and Risk Corridor Programs? 

One State Requiring Beneficiaries Contribute To Their Medicaid Benefits

By Coleen Elkins      website: 24-7 Health Insurance

Following the mandate of the Affordable Care Act some states have expanded their Medicaid program. The expansion allows those earning 138 percent of the federal poverty eligible for State Medicaid. Indiana has taken the program a step further expanding the benefits to vision and dental.

240,000 Indiana residents gained Medicaid health benefits under the expansion. Even those who have income under the Federal poverty level are expected to contribute to their benefits. In that category if the beneficiary fails to contribute they lose the dental and vision benefit. Those with income at or over 100 percent of the Federal poverty level can lose all their benefits if they do not contribute financially to their benefits. For some the contribution is as low as $1.00.

The Obama Administration has made it clear that Indiana is a test case. The administration has made the statement that much testing must occur before other states will be allowed to consider this model.
Anthem a private insurer participating in Indiana's Medicaid program is calling it a success.

Read more here: Indiana Medicaid Expansion

What Is Driving Up The Cost Of Our Prescriptions?

By Coleen Elkins      24-7 Health Insurance 

Health and Human Services estimate Americans spent about $457 in 2015. Meaning 16.7 percent was spent overall for personal health care services. For comparison in 2009 total expenditures were $354 Billion the percentage of usage was exactly the same. In 2018 projected spending is $535 billion with a percentage of 16.8. These number are much higher than the 10 percent the pharmaceutical industry estimates.

The government is looking at ways to regulate costs by adding ways to encourage physicians to prescribe to most effective drugs and reward the best results for patients.

Consumers rarely know the true cost of their prescriptions since it is cost shared by their insurance. Why isn't there a visible price on each prescription dispensed?  Why do we ask the costs of other things we purchase but not our medications?

Pharmaceutical company drug pricing is not regulated in any way. They are advertising daily on television to sell their products to Americans. The advertising is very expensive. Would the cost and usage of pharmaceuticals drop if the government regulated their advertising like they have for other products in the past?

BCBSTN Joins Other Carriers Announcing Large Losses Under The Affordable Care Act

Coleen Elkins      Visit our website 24-7 Health Insurance

Blue Cross Blue Shield of Tennessee joins other carriers announcing large losses under ACA for 2015.

The major issue for BCBST and all insurers is the average age of enrollees is 42. Fifty three percent of enrollees are female. The "young invincibles" age 18 to 34 are still choosing not to enroll.

The average rate increase for BCBST for 2016 is 36.3 percent. All of this has equated to a financial loss of $300M in two years. In 2015 83 percent of enrollees received a tax credit this year that number increased to 87 percent. Does this mean that those not qualifying for a subsidy are not insuring by finding exemptions or alternatives?

People are enrolling in multiple plans and then dropping or not paying for one. In 2015 BCBST enrolled 164,000 but by November 1st insured about 143,000.

The question all carriers are facing is how do the create a sustainable market for themselves facing these numbers?

Federal Government Suspends ACA Tax Paid By Insurance Carriers

By Coleen Elkins    Visit our website 24-7 Health Insurance

Costing the Federal government $13.9 million Congress made the decision to suspend the Affordable Care Act tax on health insurance companies for one year. As a result the Center For Medicare and Medicaid Services expects insurance companies to keep their premiums "in check" when they file for 2017. The tax has compelled insurers to raise premiums passing the cost on to their insureds.

Will this be enough to hold premiums or will carrier losses raise premiums higher?

Insurers blame rising premiums on prescription drug costs and ACA fees imposed on them. Harvard Pilgrim reported an operating loss of nearly $79 million for 2015 and a net loss after factoring in other income of almost $55 million. Health and Human Services said recently stated they will look into the losses reported by many insurers for 2015.

Health Insurers Struggling With Large Losses

Coleen Elkins   visit us at 24-7 Health Insurance 

The Affordable Care is facing more threats than just political uncertainty. Health insurance exchanges and co-ops are facing large losses. Many have had to close for this reason.

UnitedHealthcare said last November they may not participate in the market for 2017. They are reporting a potential $475M loss on their exchange business this year. The CEO of Aetna wrote in an article stating he foresees major issues with the law moving forward.

Many Americans have found ways to use the 21 available exemptions to avoid enrollment altogether. Others have found ways to enroll from a hospital bed. The Montana Co-Op stated a critically ill woman signed up from the hospital last October just by simply changing zip codes. This left the Co-Op with a $250,000 bill.

Insurers blame the the liberal and lax laws for enrollment . The federal funds supporting start up insurers is winding down. At the same time premiums are rising along with the deductibles and out of pockets.


Read more here