Consumer Driven Health Insurance Plans

June 22nd, 2012 by Navid J. No comments »

Below are some key health insurance plans that drive results.  Many take advantage of these plans but its first important to understand what they do and how it affects your health care.

High-Deductible Health Plan – As an alternative to traditional self-funded and managed care plans, more companies are considering implementing a high deductible health plan, known as an HDHP, alongside an HSA or HRA. Its purpose is to lower health care premiums by pushing plan members to analyse their health care decisions. An HSA or HRA would be used with the HDHP to help pay for the deductible costs.

Health Reimbursement Arrangement – A HRA is when an employer agrees to provide reimbursement for certain employee medical expenses. This process has always enjoyed a tax favored status as employer payments for reimbursement of IRS qualified medical expenses are deductible to the employer and not considered taxable income to the employee.

Health Savings Account – A Health Savings Account (HSA) is one of the newest and best ways for many to set aside money for inevitable health care expenses. There are many benefits for the employers and the employees when they use HSAs. They create tax-free money for un-reimbursed medical expenses and also earn tax-deferred growth. HSAs are also excellent ways to create supplemental retirement income.

Difference Between A PPO And HMO Plan

June 19th, 2012 by Navid J. No comments »

HMO stands for Health Maintenance Organization.  These types of plans are one of the most affordable in the marketplace.  This is primarily because of the managed network structure that is in place.  Individuals who have this type of coverage have to designate a primary care physician, which will be the starting point for all medical services that might be needed through out the year.  HMO plans are  starting to become more expensive than PPO plans in the private insurance  market.  If having the flexibility of choosing your own doctor for all types of  medical services is preferred, than maybe a PPO plan is a better option for you.

PPO stands for Preferred Provider Organization.  This is also another affordable individual health insurance plan that gives people access to all health care providers within the network.  Additionally, you can also go out of network and most plans will cover you for care as well.  This type of health insurance is flexible and affordable.  Additionally, PPO plans are becoming the cheaper alternative to HMO plans.  All the major carriers such as Anthem Blue Cross of California, Blue Shield of California, Aetna and Kaiser have many PPO plans to choose from.

How Office Visit Costs Can Alter Your Health Decisions

June 14th, 2012 by Navid J. No comments »

Some plans in the marketplace do not offer the best health coverage when it comes to visiting the doctor.  In fact, many health insurance plans have limitations when you visit your doctor.  For instance, some health insurance plans give you a limit, for instance 3 visits per year.  Then after those three visits, you will pay usually 100 percent of the negotiated rate.  That is when it can become quite expensive to visit the doctor.  The health carriers primarily did this because many individuals were over utilizing their health insurance, and eventually that would drive up the cost of health insurance.

Another option that carriers offer is a percentage rate for office visits.  This can also be very expensive.  For instance, some plans have a 50 percent charge every time you visit the doctor.  Depending on how much your particular doctor charges, it can become very costly.  It is important to point out thought that these health insurance plans mentioned usually have lower health insurance premiums per month.  So it is a trade-off.  How much do you want to pay to have the coverage versus how much you want to pay when you actually want to use the coverage.

Getting The Most Out Of Your Insurance

June 11th, 2012 by Navid J. No comments »

Many Americans currently do not have health insurance.  The main reason, of course, is because that it is very expensive to afford the monthly premium.  Additionally, each year these premiums tend to rise making it even more difficult to hold onto.  However, there are some ways to help fight this problem.  For one, know what type of insurance you need.  If are already a healthy person but want the insurance to prevent large financial loss, then a higher deductible plan would be best for you.  If you take on more of the risk as far as the deductible, the monthly premium will be lower and more affordable for you.  Also, if you are not particular about which doctor you want, then choosing a carrier with a smaller network will also lower your premium.

The health reform will also bring more changes as the law progresses.  Meaning, if the health insurance exchanges happen in 2014, that should also make health insurance more affordable for the consumer.  Another idea to lower your insurance premium is to choose plans with medication benefits only if you need them.  Prescription coverage is very expensive for a carrier, so only choose plans with that coverage if you truly need it.

Individual Plans Offer Maternity Coverage

June 8th, 2012 by Navid J. No comments »

Before July of this year, many individual health insurance plans did not offer maternity coverage.  And if you picked a particular plan that had some type of maternity coverage, the coverage was limited and the plan was very expensive.  Now, the marketplace has changed a little bit.  Whether a direct result of the health reform or not, all carriers are offering plans that cover maternity and it is not at a hefty price.

Many individual health insurance plans have actually become more affordable while offering better benefits.  This is usually not the case in the individual health insurance market.  Usually when carriers offer better benefits for their health insurance plans, they usually charge you more per month.  Many are taking advantage of these great benefits, especially since there is uncertainty because the Supreme Court is scheduled to rule on the health reform any day now.

Supreme Court Decision Drawing Near

June 4th, 2012 by Navid J. No comments »

The health reform was passed well over two years ago and has not gone without debate.  Many parts of the reform have already been implemented and have had a positive impact.  For instance, the lifetime maximum was lifted so no one can be limited by the amount of medical services they can receive.  This is very important for those patients who are terminally ill and rely of medical services to keep them alive.  Also, the age was increased for dependents to be on their parents’ health insurance to age 26.  As the economy continues to struggle, many are relying on others to pay their health insurance premiums.

However, the most important part of the reform is still being debated, and that is whether or not the individual mandate is constitutional.  Starting in 2014, the reform says that everyone must have health insurance and they will face a penalty from the government.  The Supreme Court is ruling on this and the results will have a huge impact on health care and the economy as a whole.

Small Business Health Insurance – The Wise Choice

May 30th, 2012 by Navid J. No comments »

Many employers offer group health insurance for their employees.  It is a great way to attract good talent to your company, and also to create strong loyalty.  Over 90 percent of companies with 100 or more employees offer group health insurance.  However, many smaller employers are struggling to offer health insurance to their staff because it is expensive.

As the economy continues to struggle, employers are looking for ways to cut their health insurance costs.  Many are either opting to reduce the benefits so the monthly premiums come down or not health insurance at all.  In order to offer group health insurance for your staff, you must have the majority of your staff participate in the insurance program.  Most carriers require around 75% participation in order to offer group health insurance.  Employers are also required to contribute to the monthly premiums.  Usually at least 50 percent of the employee cost.  This is why many prefer to get health insurance through their company because it is more affordable.

Health Insurance In Texas Anyone?

May 23rd, 2012 by Navid J. No comments »

There are over 30 million Americans currently without health insurance.  That is a very high figure and it is not seeming to get any better.  The health care reform passed over two years ago will help lower the number of uninsured because there will be a penalty otherwise.  Starting in 2014, all Americans are required to have health insurance, either through an employer, individual market, government program or Medicare.  Some states have a larger hill to climb than others.  In Texas, there is the most uninsured individuals than any other state.  Currently, over 6 million people in Texas do not have health insurance.  Additionally, about 12% of the population is on Medicare.

Also starting in 2014 is the health care exchanges.  Each state will have an online site where consumers can shop for affordable health insurance.  The theory and hope behind these exchanges is that is will drive up competition and then drive down the cost of health insurance.  The big issue here is that will these exchanges and health reform changes actually start to drive the cost of insurance higher.

Getting The Most From Your Drug Benefits

May 18th, 2012 by Navid J. No comments »

What can of medications do you take every year?  Do you have a monthly or weekly need when it comes to prescription drugs?  Do you take more generic or brand medications?  These questions are very important to think about before you start researching individual health insurance plans.  Many plans offer prescription coverage, but some do not.  Also, it is important to research the plan details and especially the limitations, if any, on the drug coverage.

Carriers, to keep the monthly premium low, will offer plans with weaker drug benefits.  For instance, some individual health insurance plans will have large brand deductibles on their medication coverage.  Some are even as high as $7,500 for their brand deductible.  So this is essentially saying that you will have to pay for most of your brand drugs yourself.  Other plans have lower brand deductibles but will cost you more per month.

Getting The Right Drug Benefits

May 11th, 2012 by Navid J. No comments »

Many health insurance plans have drug benefits.  It is important to research all the benefit details so you know what type of coverage each plan offers.  Most individual health insurance plans come in the PPO form, and most come with some type of prescription coverage.  However, not all of them cover the full range of drug types.  For instance, generic drugs for the most parts are always covered if plans cover prescription medications.  Brand and tier 3 drugs are sometimes not covered.  Also, the level of coverage is not always the same.

For brand medication, which is the most common type of medications purchased, usually have a deductible portion on the insurance plan.  Meaning, you have to first meet the brand deductible before you can start paying the co-pay amounts.  And these deductibles vary greatly.  If you take a lot of medication on a frequent basis, consider choosing a health insurance plan with a low brand deductible.  Or, see if the drugs you take come in generic form.

What Is Next For Health Insurance?

May 8th, 2012 by Navid J. No comments »

Starting in 2014, many people will be forced to getting health insurance.  This is because of the health reform and the news rules that came out two years ago.  It is currently in the Supreme Court and they are ruling whether or not the health reform laws are constitutional.  The ruling should come out in June of this year and it will have a huge implication on the health care industry.  Currently, there are over 4 million people with no health insurance in California.  Many of these individuals will be searching for health insurance in the next two years.  As the economy continues to struggle, many are forced to buy individual coverage as the group insurance market is still weak.  Another concern though is the affordability of health insurance.  The monthly cost is still very high and many are wondering if they would rather be without insurance.  If your healthy, many will not need it because they won’t use it, and if your unhealthy chances are you will not be approved.

The health reform makes it that no one will be denied health insurance in 2014.  The health insurance exchanges in each state will make an online marketplace where people can shop for affordable individual health insurance.  It still remains to be seen how many will actually use this channel to get health insurance.

How To Save On Individual Health Insurance

May 7th, 2012 by Navid J. No comments »

There are many different types of California health insurance plans in the marketplace.  Before you decide on which plan is right for you, here are some helpful tips to save you some money.

1) Comparison shop across all the health insurance plans

It is very important for you to shop the health insurance market to find the right plan and save  money.  There are literally hundreds of plans with different benefits for each.  Based on your affordability, see what plans make sense for your health history.  If you are a healthier person, maybe a higher deductible plan will be the right route for you.  Additionally, some health insurance carriers could be more
competitive from a pricing standpoint than others, and that can save you some
money in your wallet.

2) Choose a health insurance plan with a smaller network

If network size is not an important factor for you, then
maybe picking a health insurance plan with a smaller network might be your best
option.  This will instantly save you money because health insurance carriers
will always charge you a premium if the network is large.  Research to see if
your doctor is in the network you are choosing.

3) Increase your deductible on your health insurance plan

The easiest way to make your health
premiums go down and save you money is to increase your
deductible.  The deductible is the money you have to pay out of your own pocket
first before the insurance carrier will start paying benefits.  If you have a
higher deductible, you are taking on more risk so the carriers will give you a
break.  If you are a healthy person, consider choosing a plan with a higher
premium to save you some money on your health insurance.

4) Consider your health history and how old you are

Knowing your own health history is very important when
choosing a health insurance plan.  Health insurance plans have all different
kind of benefits.  For instance, if you do not have a history of taking
prescription drugs, then pick a plan with lower drug benefits and that will
lower your health insurance premium.  On the other hand, if you have certain
needs that you know will require rich benefits, then picking a plan with a
little bit higher monthly premium will save you money in the long run.

5) Ask your employer if they offer health insurance

For the most part, group insurance through your employer
will have lower monthly premiums.  This is also because employers are required
to contribute towards your health coverage and that will always save you money.
Additionally, group insurance plans usually have better benefits than individual
plans so that can also lead to savings in your pocket.

6) Consider HSAs to maximize your tax

Health Savings Accounts (HSAs) are great ways to spend your tax dollars
wisely.  These health insurance plans are meant for people who have recurring or
predictable health care needs. The dollars are put into an account that is tax
sheltered and you can pay down your medical bills using those dollars.

Learn About Medicare

May 4th, 2012 by Navid J. No comments »

As baby boomers continue to retire, Medicare will play a vital role in their health care and the overall care of the U.S..  Once you reach the age of 65, you have the option of going on Medicare.  The government provides the insurance for those who qualify.  As you earned income throughout your life, some of your tax dollars has been going towards Medicare.  When you do turn 65, you can immediately enroll in Medicare.  However, if you do not enroll when you turn 65, then the only time to enroll in Medicare is during the annual enrollment period that is every December.  Some people, however, work for another company that offers health insurance and they choose to stay on that plan.  If that is the case, Medicare benefits may still help you.  If the company has over 20 employees then Medicare benefits will still be applied to most situations.

The Medicare benefits are mostly for hospitalization and basic services.  To further beef up your benefits, you can purchase additional insurance that will work with your Medicare coverage.  This additional insurance is sometimes known as supplemental insurance.  The additional insurance covers benefits such as prescription drugs and doctor visits.  Medicare is a much cheaper option to getting traditional insurance in the open market.

What Is Out-of-Pocket Maximum?

May 2nd, 2012 by Navid J. No comments »

Each health insurance plans has unique benefits and some vary by what they give you.  Obviously, the more you are willing to spend in monthly premium the better your benefits tend to be.  Most individual health insurance are offered through the PPO channel.  Additionally, these benefits are driven by three major factors: deductible, prescription benefits and out of pocket maximum.  The deductible is the amount of money the member is responsible for before the insurance carrier will start to help with expenses.  Once you reach your deductible, you will be paying your coinsurance rate until you reach your out of pocket maximum.  This is an important number.  Because generally, it is your ceiling, basically your worst case scenario for the calendar year.  The lower the out of pocket maximum, the higher your monthly premium will be.  So you have to make a trade off and ask yourself how much you are willing to pay and what the probability is of the worst case scenario.

Most health insurance plans have a out of pocket maximum around $3,000 to $7,000.  It is important to know your health history before making this decision.  If your generally a healthier person, then maybe choosing a health insurance plan with a higher deductible and out of pocket maximum makes the most sense for you.  And also, will save you the most amount of money.

Saving On Health Insurance

April 30th, 2012 by Navid J. No comments »

There are a few ways to save on individual health insurance.  For one, make sure you know what you need as far as medical services.  What I mean by that is, know your health history and also your current health.  Many people can save money if they know what is necessary and what benefits would be a waste of money.  For instance, prescription coverage is very costly for both the health insurance carrier and the consumer.  If you know that you do not have a history of taking medications, then choose a health insurance plan that does not have rich prescription coverage.

Also, if you are generally a healthier person, then selecting a health insurance plan with a higher deductible can also save you some money.  Why?  Because health insurance carriers will give you a discount if they know you have more skin in the game.  If you are responsible for more of the upfront bills, then they will try charge you less per month.

The Future Of Healthcare Looks Cloudy

April 26th, 2012 by Navid J. No comments »

Many people are still wondering what the real effects of the health reform will be.  Since its inception a couple of years back, there have been some changes that people have noticed.  For one, the qualifications for Medicaid have changed.  Many are now getting coverage where as before, they would not qualify.  And as a result, many now have health insurance and can get the medical services they need.  Other changes such as raising the age limit for dependents to 26 has benefited many.  Since unemployment still remains high, many are without a job and thus, can not get on an employer’s group policy.  Therefore, many younger adults are forced to stay on their parents policy until they can get health insurance on their own.  Also, the lifetime maximum has been lifted.  Meaning, that now there is no maximum amount one individual can receive in health insurance benefits.  Before, if someone had a terminal illness they would sometimes reach their lifetime maximum and would receive no further health insurance benefits.

In next few months, we should be hearing the ruling from the Supreme Court on whether they are going to let the health reform stand.  It is a big ruling as the health insurance exchanges are waiting in the balance.  Assuming the health reform stays in tact, by 2014 states are required to have exchanges up so consumers can easily shop for affordable health insurance.

Which Carrier Has The Strongest Network?

April 25th, 2012 by Navid J. No comments »

Obviously depending on where you live, this answer may vary greatly.  However, in most parts of the United States, you will find coverage with the major health insurance carriers.  In California, the largest health insurance carrier is Anthem Blue Cross.  They have the most volume of new applications and have the most members.  The largest HMO provider in California is Kaiser.  They have the most members on the HMO side but there PPO is very weak.  In the United States, Anthem Blue Cross and United Healthcare have the largest networks.  United has the most volume and while Anthem Blue Cross has the most members.

There are some parts of the USA where carriers such as Aetna and Healthnet have large networks.  However, sometimes going with a smaller carrier can save you money.  Carriers will most times give you a discount if you go with their reduced networks.  If you do not have a particular doctor that you must have, then sometimes that is the best option to save some money.

Paying For Office Co-Pays

April 20th, 2012 by Navid J. No comments »

Many health insurance plans have similar benefits, however, it is important to always pay attention to the benefit detail for each plan.  Some plans are stronger for medications, while others are stronger when you visit the emergency room.  A common question we always get is how much will it cost when I visit the general doctor.  Many health insurance plans cover office visits.  However, it is important to know that the benefits are not all the same.

For instance, some of the health insurance plans that have lower premiums will place limitations on visiting the doctor.  The plan might cover the first three visits, and then you pay 100% of the negotiated fee.  This may be an important thing for you to consider.  If you regularly visit the doctor, then plans that have those limitations will not work.  When you start to research and purchase plans with higher monthly premiums, then they usually give better benefits for visiting the doctor.  Some plans have unlimited visits for a fixed dollar amount.  Also be careful though that you know what the costs are for out of network visits as it can be a lot more costly.

Knowing Which Plans To Choose Is Vital

April 17th, 2012 by Navid J. No comments »

Many consumers assume that each plan with each carrier works the same.  It is actually very untrue.  One plan that has a $5000 deductible could be very different then another plan with the same deductible.  Each carrier has different benefits within each plan that helps them differentiate from the competition.  For instance, Anthem Blue Cross usually has very competitive rates for individual health insurance plans.  However, many of their health insurance plans do not have strong medication coverage.  Some of their lower plans have huge brand deductibles that you first have to meet before you can start getting covered for medications.

Others carriers may have strong prescription coverage, but might have limitations on doctor visits.  That can get very pricey.  It is very important when researching health insurance plans that you look very closely at the benefit details of each plan.  To make matters more complicated, each carrier has their own underwriting standards.  So that means that one carrier might approve you while another may not.

Most Difficult Decisions About Health Insurance

April 16th, 2012 by Navid J. No comments »

Most people that have started researching health insurance plans have realized that many plans are expensive.  Especially if you have recently come off a group insurance plan where your employer was contributing towards the plan, it can be quite shocking.  The best approach to this is finding out what you truly need.

It is important to not pay for things that you do not need and only find the health insurance plans that fit your health history.  For instance, some plans will charge a lot per month if the drug benefits are rich.  If you do not have a history of taking medications, then why get a health insurance plan with heavy drug benefits.  Or, on the flip side, if you need a health insurance plan with good outpatient benefits, then make sure you read the benefit detail page for each plan.  It will save you more money in the long run if you pay a little bit more per month for the health insurance plan but save when you actually start to use the medical services.  If you still can not find the right health insurance plan, then give one of our agents a call and then can assist you in finding the right plan.

Is Dental Included With Most Medical Plans?

April 12th, 2012 by Navid J. No comments »

The fast answer here is no.  Most major medical insurance plans are stand-alone and do not include dental insurance.  There are some plans that do offer dental and the price is usually included in the monthly premium.  Medical insurance works a lot differently than dental insurance.  When applying for medical insurance, the underwriting process is much more complex.  Many people get denied for medical insurance because they may have pre-existing conditions or other complications in which the carrier thought was too risky for them to insure.  Of course, starting in 2014, no individual can be denied health insurance.  This is assuming that the Supreme Court decision in June will not throw out the reform laws.

Dental insurance does not have as much strict underwriting guidelines.  However, there are other ways insurance carriers protect themselves.  Many dental plans have 6 or 12 month waiting periods for major service.  This is to prevent people for just getting dental insurance for a surgery and then canceling right after.  Also, the benefits are also very limited when it comes to dental insurance.  The carriers will set an annual benefit maximums for each plan.

What Is Group Health Insurance?

April 9th, 2012 by Navid J. No comments »

There are two main ways to get health insurance, one is through your employer and one is the individual or family market.  Many companies offer group health insurance to their employees.  Usually, it is more advantageous to get health insurance through your employer because the company is required to contribute to the premium.  Also, group health insurance plans are usually better in benefits than individual plans by themselves.  Another important factor to consider is the underwriting process.  With group health insurance, each individual does not have to go through underwriting and get approved.  As long as your employer meets the requirements of participation, then you are approved for your health insurance in California.  However, when you apply for individual health insurance, each applicant goes through underwriting and you may get denied.

Group health insurance plans are offered to companies of at least 2 people and you usually have to be in business for a few months.  Basic documentation is required from the corporation and then you can start to apply.  Each company has to have most of their eligible employees participate on the insurance plan.  For most carriers in California, 75% of the eligible employees must enroll in the health insurance.


Am I Paying Too Much For My Health Insurance Plan?

April 4th, 2012 by Navid J. No comments »

We get this question a lot.  In fact, it might not be as easy as you might think to answer this question.  It is very important to consider the monthly cost when you are choosing a health insurance plan.  However, it is also very crucial to look at your health needs and also your families’.

When considering which health insurance plans to choose, taking a deep look into the plan benefits is important so you can fully understand what you are getting.  For instance, if medications are an important benefit for your health needs, then make sure the brand deductible is not too high when you purchase the health insurance.  Many individual health insurance plans have high brand deductibles if you want to pay little per month for the plan.  Also, if you have a history of needing certain types of surgeries, then maybe getting a plan with a low coinsurance would make the most sense.  Make sure you do the full research necessary when considering which health insurance plan to purchase.

Where Is Health Care Going?

April 2nd, 2012 by Navid J. No comments »

Many people have been wondering what the fate of health care will be next year, or even five years from now.  The Obama administration did what many presidents before failed to do; overhauling the health care system.  For decades now, many people have been complaining about the health care system, its overly expensive cost and the inadequate management of the whole system.  The health care reform was passed two years ago with the ultimate goal of making health insurance more affordable for all consumers.  The supreme court met this week to see whether or not the health care reform is constitutional.  Many critics of the health care reform are saying that it is unconstitutional to make everyone get health insurance against their will.  Also, many critics are saying that the government management of the health care system will raise prices, not decrease them.

The supreme court decision will not be known for another couple of months.  Moreover, no one really knows if health care will ever be affordable.  The healthy are not getting insurance because they feel they do not need it.  And those who want it, can not afford to get health insurance.

California Gov. Jerry Brown Wants Health Care Changes Regardless of Supreme Court Decision

March 30th, 2012 by Navid J. No comments »

The Supreme Court met this week to make a decision, or at least hear both sides, to whether or not the health reform law should be thrown out.  The main issue at bar is whether or not the government can force all Americans to get health insurance against their will.  Many consumers can not afford health insurance because the monthly premiums are simply to high.  Also, many of those same people can not qualify for public programs to obtain health insurance.  Another big issue the Supreme Court will be ruling on is the expansion of Medicaid.  The federal government is expanding its qualifications of getting Medicaid and is forcing each state to follow their new guidelines.

The judges that will be deciding on the ruling consists of nine judges, 4 democratic and 5 republican.  If all the republican judges decide against the health reform, then the law will not stand.  There has to be a majority ruling.  The decision, however, will not be known until late June.  Many state officials are waiting very anxiously on their decision.  California states that they will move forward regardless of the ruling.  The state government wants to make health insurance affordable for all Californians.  They will try to proceed with the state exchange and to try to provide insurance to the currently 2 million uninsured.