Group Health Insurance
Health care reform
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Long Term Care Insurance
Medicare related coverage
10-19-2016by Colleen King
When a call starts like this, it’s rarely good. This usually means someone has something wrong, or someone’s pregnant.
Problem is, the intent of Health Insurance is in case something goes wrong. If something has already happened, you don’t need insurance, you need financing and insurance companies don’t classically do that. This whole idea is why requiring people to buy insurance unfortunately is going to be important if health care reform is going to work. Otherwise, what will happen is people will only apply when they have an issue, then drop coverage when all’s well. The concept of insurance, all types of insurance, is that people have to pay in whether they need it or not then there is money in the risk pool for when something is needed. And a risk pool is never something you want to be in the shallow end of, that’s for sure.
This makes the open enrollment season more important than ever. Before 2014 we didn't have this in individual health insurance, just group health insurance with your employer. Now, you can enroll between November 1st and January 31st, but that's it. Unless you have a 'qualifying life event,' like getting married or divorced, having a baby, moving into a new service area where you existing plan won't work, losing a job or your company dropping their group health plan. Those situations, and few more obscure, give you a 'special enrollment period,' where you can enroll outside of open enrollment, but generally you only have a 60 day window.
My main point is, we can’t close the barn door after the horse is out, so that’s why you need health insurance. Before something happens!
10-16-2016by Colleen King
Well, okay so your broker doesn’t have to be physically down the
street, but it’s looking more and more like getting some help in sorting
out options from someone when shopping for health insurance, available
to you at no cost, makes sense. Seriously--agents are paid by the carriers they place the business with, you aren't charged for it.
Several articles talk about rates had shooting up and and people looking for new coverage. Often people found working with an independent broker helped find something manageable. You can go to the big major online sites but honestly, the past few years, I’ve helped people change plans several times after they bought something online then found it didn’t work the way they expected.
The California Small Business Association (CSBA) which I’m a member of has a program titled Buy California Small Business First which is aimed at drawing attention to doing business with people and companies within California. The reason to do this is to keep more money/revenue in the state; it’s not necessarily more expensive to do business with local smaller stores. Now obviously not all insurance companies are based within California, but the local broker is. You will most of the time end up with more personal service when working with a broker. And if you don’t, then you need to look elsewhere; there are thousands of us.
The point is with health care reform in full bloom, there is way too much to keep track of and relying on your broker to help you where needed can be a real plus. Rate increases are hitting–and HARD this year. we don’t have all the information yet like we have in years past but do you want to sit on hold with Anthem Blue Cross or any other carrier for 20-30 minutes? I’m already doing it, so just add you question to my list. It’s all about trying to save clients money on their health care coverage where we can while making sure as close as we can that your needs are met-–that what we do.
10-14-2016by Colleen King
It's that time again, the Medicare Annual Election Period (AEP) where you can make changes to the plans that augment your Medicare--which one is best, which one will do the most for you, how do you decide? All of those blasted Medicare related commercials, what are you to believe?
The Medicare AEP is when you can make changes to your Medicare Advantage plans or Part D drug plans. AEP starts October 15th, ends December 7th, with any changes you make taking effect January 1. This does not apply to Medicare Supplements, not sure why, but they are regulated differently--my opinion wasn't sought. We'll talk about that in another article.
Medicare Advantage plans--These will fill in some of the gaps on your Medicare, and most will include your Part D drug coverage. Most of these are HMO plans if you're in Southern California, and if you're in Los Angeles County, several of the Medicare HMOs have no premium above your Part B premium. These can be really cost effective options--some have no office visit or hospitalization copays--wow! The potential drawback? They are HMOs, so you have to stay within a network. If you are used to commercial (under age 65) HMOs, these could be a good way to go if your preferred doctors are contracted. Medicare HMO network can be larger than commercial HMOs because doctors are realizing their patients are getting older.
Medicare PPOs--there are some but they are fewer and farther between. These are part of the Medicare Advantage series of plans. And most of the time, like commercial PPOs, you can count on more out of pocket expenses, even if you stay 'in network,' that's just the nature of the beast.
Part D drug plans (PDPs)--If you have a Medicare Advantage plan (HMO or PPO) you usually do NOT need a drug plan, it's included in the plan. In fact if you try to enroll in one, it will kick you out of your Medicare Advantage plan. You will need a PDP if you have a Medicare Supplement because those do not cover drugs. There are about 25 PDPs in California, and which ones will fit your needs best depends on your medications and your preferred pharmacy. It's definitely case by case.
Bottom line--work with an independent agent. There is no cost to you with an independent agent. In order to make recommendations, we do the work of checking out who your doctors are contacted with, which plans will cover your medications best, at least that's what I do and my agent peers as well. You can do it all on your own, call each carrier, try to decipher all the information and pick a plan. And while the carrier reps are nice people for the most part, they will all try to call you back to follow up. Aetna, Anthem, Blue Shield, Silver Script, Health Net, AARP/United Healthcare, Humana and SCAN--all will call you back. Work with an agent you like and trust, and just have one person calling you back rather than several. After all, you have better things to do with your time!
10-04-2012by Colleen King
On a good day, long term care insurance is not cheap but it can be reasonable for what you get if you get it when you’re younger. But in this article CalPERS is looking to potentially raise rates 75%? Is that reasonable, can they do that?
Yes they can do that–even though they offer a ‘Partnership’ plan. These offers asset protection for people who exhaust their policy then need to potentially qualify for MediCal, and have certain parameters in place especially around rate increases. But the CalPERS plan is exempt from this because they are what is referred to as ‘self funded.’
Normally one buys insurance (this applies to health insurance also) and the insurance company pays for care. When a long term care or health insurance plan is ‘self funded,’ that means there is a ‘check book’ figuratively speaking, and the plan sponsor, which in this case is CalPERS, pays the claims. The CalPERS plan has been closed to new enrollment for at least a couple of years now, so you have no new, young blood (or money) coming in.
So that’s why I urge my clients who are eligible under CalPERS to consider long term care insurance outside of the State’s plan. There are no restrictions on rate increases, there are other limitations in the duration of the of the plans offered, and it’s starting to look like there could be a sustainability problem. Ya think?...read more
09-12-2012by Colleen King
There have been multiple articles in the Los Angeles Times and different online sources about rate increases, health care reform and what it all means. The kicker is, on the health care reform front, no one really knows because it hasn’t all been figured out.
David Lazarus’s article in the Times yesterday about a woman’s rates increasing with Blue Shield is happening all over. Blue Shield, Anthem, Aetna, Cigna, Health Net, they are all having ‘rate actions.’ And since most of my business is with the first three, I’m busy trying to move my folks around.
What makes it difficult at this point is that big unknown called health care reform. Anthem is not quoting anything after September 22, because the reform rules are taking effect September 23. Other carriers are saying according t one of my sources, that they don’t have to comply until either October 1 or January 1. So who are you to believe?
Aetna and Cigna have come out and said they won’t be doing ‘child only’ policies after October 1 because the rule about ‘no pre-existing conditions’ goes into place September 23 if you are under age 19. I’m very curious to see what that is going to do to rates for people with kids on their plans. Supposedly, you wouldn’t be able to ask any health related questions which determines conditions, which determines whether they will be accepted and at what rates. And you don’t think the carriers are really going to ‘low ball’ this, do you?...read more