When Was The Last Time You Looked At Your Health Insurance Options?

There is no denying that medical insurance is expensive. The self-employed, independent contractors, sole proprietors and others with no access to an employer-sponsored plan have had few choices. But that has started to change.

Without getting on our soapbox too much, Americans have gotten used to a very rich level of medical coverage in this country. It used to be (somewhat) affordable. But with advances in technology, introduction of new prescription drugs, mandated health coverages, and a host of other reasons, perhaps it is time to get back to health insurance that covers the “big stuff” while having some coverage for the little stuff if you want it.

One of the results of the spiraling health care costs is that carriers have been coming out with new health plans. Many of these new health plans have been designed to accommodate a growing demand in the marketplace – a return to a more traditional plan design with a smaller premium. These new plans have less first-dollar coverage, but still have solid coverage for the "big stuff".

To give you an example of the broad range of policies and premiums available, here are some sample monthly premiums (click on the the image for a larger version):

Are these plans right for you? Contact us and let's talk about your situation. We can briefly describe the plans and explain the differences in these (and other) plans, and you can decide if they are right for you and your situation. Can we help you reduce your premiums? We don't know. Can we help you understand your options so you can make an informed decision? You bet.

NOTE: We are trying to illustrate the broad range of premiums available. We should probably have a disclaimer three pages long here, so just understand that the plan premiums shown above are from the same carrier, so they have the same network, but there are differences in their coverage benefits, limits, and exclusions. And they are for illustrative purposes only. Oh yeah, and your rates could be different based on your age, health, options selected, where you live, etc.

Some HSA's Need To Change To Stay Compliant

If you have an HSA medical plan with a relatively small deductible, you may need to make a change to stay compliant with federal law. Every year the IRS releases new limits on a myriad of items that are affected by Cost-of-Living changes. Among the items that are affected are the minimum allowable deductibles for HSA’s. The minimum deductibles for 2009 are $1,150 for individual coverage and $2,300 for family coverage. If your deductible is less than those amounts, you may need to make a change.

What options do you have?

1. If you have an HSA eligible medical plan but do not have a Health Savings Account, you don’t have to do anything. You plan will not change.
2. If you have an HSA eligible medical plan AND have a Health Savings Account AND want to continue to contribute to the Savings Account after January 1, 2009, you will need to change to a plan with a higher deductible. Generally, you can do this without any underwriting.
3. If you have an HSA eligible medical plan AND have a Health Savings Account AND DO NOT want to change to a higher deductible plan, after January 1, 2009, you will not be able to make contributions to your Savings Account.

Confused? Not a problem. Contact us and we can walk you through it. If you want to see the new 2009 HSA limits that were announced earlier this year, you can find them here.

When A Check-Up Is Not A Check-Up - Part 1

It is not unusual to see health insurance plans that have 'preventive services covered before the deductible.' This is especially prevalent in the world of HSA's and other high deductible health plans. Typically, it works like this: when you go to a physician for certain preventive services, the health insurance company waives the deductible for those procedures. The idea is that the carrier does not want you to forgo the preventive check-ups because of the cost involved. They would prefer you get check-ups regularly so you can catch (or prevent) a larger problem from occurring down the road. They see it as a good investment to encourage you to get those preventive services/visits done on a regular basis.

The problem comes when your definition of a check-up is not in agreement with their definition of a check-up. And since we want the health insurance carrier to pay the claim, their definition is important. Here are some examples we have recently seen that, on the surface, seem like a ‘check-up’.

• Annual visit to your dermatologist to have him/her look for sun spots because of a history of skin cancer.
• Annual visit to your cardiologist for a check-up because of a past condition.

In both cases, the visits were based on the recommendation of the physician to ‘check-up’ on a previous condition. The carrier, however, did not consider the visits ‘covered preventive services’. To understand why, you have to read the insurance contract. And let’s face it, how many of us read insurance contracts? We may look at the benefit summary which is usually 3-5 pages long, but even with that, our eyes start to glaze over at the insurance mumbo –jumbo. Trust me, I know. The actual contract can be 50+ pages, and somewhere in there is a list of what they consider to be ‘preventive services’ that are covered before the deductible.

Benefit summaries and all employee communications regarding benefits are a balancing act. We are constantly asking ourselves how much information is enough and how much information is too much. Is a one page summary enough information? Three pages? Fifteen pages? How much time do we spend in employee meetings going over the benefits? Ten minutes? 30 minutes? Two hours?

Bottom line: Read your contract or call your carrier to see if the service you think should be covered is actually covered. Most customer service departments can help you determine if the service is considered a ‘covered preventive service.'

In a later article we will look at instances where there was a legitimate 'preventive service,' but the carrier still did not pay. Before you start breaking out the torches and ptichforks, it is not completely the fault of the carriers.

COBRA - Is it your best option if you are laid off?

We recently received an email from an online insurance company that was soliciting business. They were using the recent spurt of layoffs as the marketing hook. While on the surface that may appear to be similar to ambulance chasing, they brought up a point we feel needs to be addressed - the COBRA option from your employer may not be the best option for you if you are laid off.

COBRA (the acronym for a federal law) allows an employee to keep certain benefits after they leave their employer. Medical insurance is the one that gets the most press. Since the employee is responsible for the full cost of the medical coverage during COBRA (remember, your employer was subsidizing the cost while you worked there), they are often surprised at the high cost of the COBRA coverage.

But many people are not aware of their health insurance options. There are quality individual and family health insurance plans available from companies like Aetna, Anthem, Assurant, Coventry (Southern Health), and Optima Health. And depending on the coverage selected, these plans could be substantially less than the cost of COBRA.

Options
If you or someone you know was recently laid off, the loss of employer health insurance may be one of the biggest challenges you face. So what can you do? What are your options?

1. Accept COBRA
2. Research different local companies and plans available and try to do it yourself
3. Use one of the internet sites to get quotes. But where is the person to whom you are talking? How much experience do they have? Do they know the local market (much less can they find your city or state on a map)?
4. Talk to a local agent you trust who knows YOUR area's market and works with all of the major health insurance carriers in the area

Obviously, we like option #4. And there are very good reasons for you to consider that option. First, there are lots of good local agents you can contact (we like to think we fall into that category). Second, the price is the same whether you pick options #2, 3, or 4. Why not lean on the experience of someone you know and trust. Third, a good agent can evaluate your situation and help you determine if you should stick with option #1 and accept COBRA.

A couple of important notes:

• COBRA coverage may be the best option for some people - especially for those with certain pre-existing medical conditions, or those who are pregnant.
• You have some very definite time frames in which you can exercise your COBRA option. It is important that you know these time frames and make your decisions appropriately.

If you are considering COBRA or looking for affordable coverage, click here to contact us to learn more about your options and how we can help.

And if you know someone who has lost their job, feel free to direct them to this article to help inform them of the COBRA alternatives available.

* Individual and family health insurance is a local product. Based on where you live, there are differences in coverage, price, and companies doing business in that area. This certainly applies from state-to-state and even within states. Here in Virginia for instance, the markets in Lynchburg, Virginia Beach and Fairfax are as different as they can be. So if you are reading this and you live outside of Virginia, we may be limited in what we can do for you. But that goes back to one of the benefits of option #4 above - there are lots of good local agents you can contact.

Medicare Part D Notice

It is that time of year again when employers need to make sure they have distributed the Notice of Creditable Coverage required under Medicare Part D. Employers who sponsor a health plan offering prescription drug benefits must provide an annual notice to all Medicare-eligible participants that explains whether the prescription drug benefits offered under the plan are at least as good as the benefits offered under the Medicare Part D plan. This is referred to as 'creditable' (at least as good as Medicare Part D), or 'noncreditable' (not as good as Medicare Part D) coverage.

Knowing which employees are eligible for Medicare benefits is relatively straightforward. But it is difficult to keep track of which employee's spouse or dependents may be eligible for Medicare benefits. Therefore, we recommend that you give the notice to everyone in your medical plan(s). The general guidance has not been updated since last year, however CMS has updated the model individual and personalized notice forms. The guidance and updated forms can be found on the CMS website by clicking here.

The Notice of Creditable Coverage must be provided:

• At least once a year before November 15 (the start of the annual Medicare Part D enrollment period)
• Whenever a Medicare-eligible employee enrolls in your health plan
• Whenever there is a change in the creditable or non-creditable status of your health plan(s) prescription drug coverage
• Whenever an individual requests the notice

Employers - don't forget you must also submit a Disclosure to CMS Form each year, reporting whether your prescription drug coverage is creditable or noncreditable coverage. This form must be submitted electronically within 60 days of the beginning of each plan year. The form is available on the CMS website, or you can get it by clicking here.

Totally confused? We understand. Just contact us. We can walk you through all of this.

Special thanks to Bob Johnson of Corporate Insurance Concepts for his help with this information.

Call Me Cynical...

One of the reasons for doing this blog and the newsletter (click here to get on the mailing list) we send out is that it makes us read and stay current with what is going on in the industry. But like most things, that pesky 80/20 rule comes into play. In this case, 80% of what we read is not worthwhile, and 20% is worthwhile (and less than 20% of that makes it 'to print').

We are always a little cynical when it comes to surveys, polls, and articles in general - so much depends on the source. It is like the old TV commercial that said, "4 out of 5 dentists recommend sugarless gum..." You remember the commercial - it was for Trident Sugarless Gum. Imagine that. I ran across one today that was similar in its obvious bias. Here is the unedited blurb that led you to the complete story;

Cards make loyal clients

By Marc Wagenheim, Product Marketing Director, Hallmark Business Expressions

In a recent national consumer attitude study by Hallmark Business Expressions, 66 percent of respondents indicated a greeting card sent to show appreciation for a purchase or referral makes them more likely to do future business with the sender. For insurance agents, taking a few moments to choose a card, write a quick note and send it to a client can make a big impression and increase customer loyalty.

It's nice to know a greeting card company thinks sending out greeting cards is a good business decision for me.