Group Health Insurance
Health care reform
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08-15-2011by 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 happened, you don’t need insurance, you need financing and insurance companies don’t 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.
That’s an issue that has come up with ‘child only’ plans. Under age 19, due to health care reform, all kids have to be accepted regardless of pre-existing conditions. They can be charged above standard rates, but the carriers have to take them. One thing that is starting to happen is carriers are putting a 15 day delay in place from the time an application is submitted to when it can become effective, to avoid this jumping in, jumping out thing. At first carriers said okay,we just won’t write any ‘child only’ policies, we don’t know the risk. California then passed legislation saying okay fine, you don’t write ‘child only’ policies, you don’t write any individual health plans in California for 5 years. More on this in another article.
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!...read more
04-14-2011by Colleen King
Okay, many people are really unhappy with health insurance right now. People either don’t have because it’s unaffordable or they are uninsurable. Or they do, but their rates are going up. So it’s time to call your agent, see what else is available.
Well, here’s the problem. The carriers can’t even agree on what needs to change when. Or actually, what to do about it. Last quarter of 2010 was outrageous. Anthem had rates available through 9/22. Blue Shield’s rates were good through 9/30. Kaiser, they’re fine, ain’t changing a thing. Cigna only does 1st and 15th of the month effective dates. And there’s more, but you get the idea. It’s continuing to happen, changes all the time, it’s causing a lot of extra work for everyone.
So big deal–so what? Well here’s the thing. As you may have heard, things are tight for many people these days. So a jump in expenses of $50-$100 a month, maybe more, maybe less, is a big deal. And normally when the rate changes come in, I can give information that is solid. So can any good agent. But now, with the variation in rates and effective dates, and new information popping up every day, it’s frustrating.
I’m trying to help people make a move to avoid their increases and easier said than done. So if you have an agent you’ve worked with for a while, and they seem like they have a new onset of ADD, there’s a legit reason. You have to dodge a series of rates. You want to advise people to request specific effective dates so that they get the current rates. But I know for me, my phone is ringing off the hook and email is overwhelming. So hang in there, we can get you changed most likely–have faith!...read more
03-23-2011by Colleen King
When you change health insurance plans, or just drop coverage, your previous carrier will send you what’s called a Letter of Creditable Coverage. This will show the start and end day of your coverage with them. So what, what does this mean?
This could be very important especially if you are moving to a different policy as many people are doing right now, in order to cut their premium. If you have a condition you need care for, and you did not have prior coverage, the new carrier could see it as a pre-existing condition and not be obligated to cover it for the first six months of your new policy. And this is legitimate, it’s not just insurance companies looking to not pay claims. They are looking to not pay claims they are not obligated to. Isn’t that what you are looking for when credit card bills or cell phone bills show up, charges that aren’t yours to pay?
This came to mind recently when a client of mine told me she needed proof of prior coverage as her new carrier was asking for it. She had a procedure, the new carrier wanted to make sure there was no lapse in coverage over 63 days (that’s the magic number, have no idea how they came up with it) so we had to contact the old carrier.
Carriers vary in their ‘workability’ so if you get one of these letters, keep it. One carrier I work with reguarly, I called to get one for a client and even though I wasn’t the agent of record on that old policy, but being able to give certain identifying information, they emailed me what we needed within 10 minutes. This client’s old carrier had to snail mail the letter to her, and it took two weeks.
Most of the time you won’t need it, but when you get one, keep it to make SURE you won’t need it (Murphy’s Law). Unless of course you won the Mega Millions lottery, but even then, why spend it on something you don’t have to!
03-19-2011by Colleen King
This past week, after much controversy, Blue Shield of California canceled it’s rate increase set for May. It was supposed to be in March, they were asked to delay it 60 days by the insurance commissioner, which they did. So after already having two rate increases since October of last year, Blue Shield canceled this current rate increase and has said no more ‘rate actions’ through the end of the year. Click here for the details.
Basically, it appears that one reason this was able to happen was expenditures for health care services late 2010 were less than anticipated. SO, does that mean everything’s okay?
Not sure; what if expenditures exceed what is expected? Conventional thinking is that when times are tough, people skip care that is not essential. This is either because they have no insurance or their insurance puts more of the initial costs on the member. That’s how you keep insurance premiums down, especially when you hear about rate increases like these.
I’m concerned about what happens next year, wondering if rates will fly up to a ridiculous level. Carriers are being expected to do things and cover services in ways not previously experienced, and don’t know how to price for it, so they shoot rates up. And it’s not just Blue Shield, it’s happening with all the carriers.
So to all of you who said to me ‘hey, I thought health care reform was supposed to drop rates,’ I told you it wasn’t going to happen any time soon. Believe me, I’m sorry I was right!...read more
03-01-2011by Colleen King
Okay, so it’s one reason that insurance premiums are so high, but it’s a big one.
On AOL today there was an article about several drugs that will be coming off patent–big name drugs like Lipitor. Drug companies, in order to recoup their ‘research and development’ costs have exclusive rights to a drug they develop for several years. Read here for more. And check out the BILLIONS in sales each of these generates!
Is your drug on this list? Well, if you take Lipitor, Protonix, Zyprexa, Concerta or several others, over the next 2-3 years you’ll see a drop in costs. If you don’t have health insurance, one thing that I’ve told my clients to do is check at Costco. You don’t have to be a member for prescription purchases necessarily. They have a ‘price checker’ on their site that I refer to often. Prices can vary by location, and the pricing here is based on buying from Costco.com. Check your local Costco to see what the cost actually is. The one in Northridge near me is usually pretty close.
Point is, to bring down the cost of health care in general and insurance too, you have to be a saavy consumer. Many studies show that people spend more time researching an auto or TV purchase that things related to their health care. Enough of ‘buyer beware,’ time make smart choices. You can start with your drug purchases....read more