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Colleen King - Blogs

Health Savings Accounts (HSAs)



"OMG, have you seen my rates?" Yes, I have, and it's ugly.

11-15-2017 by Colleen King

This year, individual plan rates have exploded this year, and it's awful. And that's on top of increases the past 3 years that each year have shocked people. There are a couple of things that are happening that are contributing to this.

1. Anthem Blue Cross has pulled out of most of the California individual market. Their management said they were losing money in the California market so the pulled out of most California. There are 3 regions of Northern California they remain and there are 2 reasons for it (In my opinion). First, they are trying to be good eggs and help services an under served area. Not sure if those 3 regions were more profitable or not. The other reason, which I think is a big part of a strategic move, if they had totally pulled out, it would have been five years before they could come back into Covered California. You can choose your preference as to what happened, I think it's a combination.

2. Blue Shield is statewide, and in many areas they were the only PPO. PPOs versus EPOs are an issue because EPOs don't have out of network coverage unless it's an emergency. Lots of doctors and other types of providers are dropping their insurance contracts, so having out of network coverage is important to many people. But when they take advantage of that, this drives carrier costs way up. So that's why this year, not only are Shield's rates going up but their out of network coverage, the deductibles and out of pocket maximums are shooting up sky high. Shield has been hit according to what they have said, with a lot of higher dollar claims because of their situation.

So I just keep churning out quotes. I'm being asked for bronze level plans more than usual because of the rate increases. I try to steer people toward silver because of the huge deductibles on Bronze ($6300+) but people got to eat too. Sure hope Washington figures something out quickly....

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Trick or treat--Open Enrollment for individual plans starts November 1st

10-31-2017 by Colleen King

Okay, so here we are on 'All Hallows Eve'--what does this year's open enrollment for the individual market hold ?

Rate increases, yes--confusion, yes--do we all still need to be insured, yes. So far none of the 'repeal and replace' bills have gone anywhere, Trump has told the IRS not to enforce the penalties for being uninsured, but that's not official, so who knows? Of course we insurance agents will tell you you need to be insured, not just because that's how we make a living, but because we know that if something of any significance happens, you don't want to be stuck with a bill for thousands of dollars. So here goes...

The Tricks--There are a few things, not exactly tricks, but I'm using this as a 'label' for potentially negative things. Rates for the most part are going up. Anthem Blue Cross has pulled out of most of the California individual market for 2018. Three regions in northern California, they are still around. This does NOT affect anything group health insurance related or Medicare related.  This will impact most regions but particularly Ventura County, because that leaves only Blue Shield and Kaiser.

The Treats--okay, this may be a stretch, but it's a Halloween theme. Health Net in some areas is adding a 'narrow network' PPO. That could be helpful, we'll have to see as these things are case by case. 2017 they had no PPO in most of the LA area, so I'm hopeful. Oscar, the newer kid on the block, already in Los Angeles County, is expanding into Orange and San Francisco counties. This is an EPO plan, which means no out of network coverage outside of an emergency. The past couple of years they have had a very specific network, using mainly UCLA and Providence providers and facilities, but they are expanding their network. We always need to check to see who's contracted where but this could be food.

Anthem members--you MUST choose a new plan by December 15th in order to be covered January 1. If you have an older, grandfathered plan, you're fine, that's not going away yet.

Open enrollment overall will run through January 31, 2018 so if you miss the December deadline, you aren't totally out of luck. But seriously consider using an independent agent for your insurance shopping needs. There's no extra cost versus buying directly from the carrier, and we can help you figure this stuff out. And you only have one person calling to follow up, instead of one person from each carrier.

Happy Halloween!

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"I'm healthy, I'll just get a high deductible health plan"--there are pitfalls with this theory.

10-29-2017 by Colleen King

I hear this often, people will say they just want to go with a high deductible plan, especially since rates are getting so outrageous---we're still waiting for the 'more affordable, easier to understand' piece of Obamacare. But I digress.

We used to have higher deductible plans that would still offer office visit coverage and prescription drug coverage prior to meeting the deductible. But when you now look at a 'high' deductible medical plan, you're looking at a $6300 deductible, if not higher. You have office visit coverage at a copay, 3 per year before meeting the deductible, but that covers just the basic office visit. Lab and Xray, any other procedure, is still an additional cost. Okay, so you may still think this is the way to go, and for some it will be. I still find it astonishing that the 'standard' bronze plan design, 'blessed' by the federal government, is $6300. Without a reasonable premium to go with it.

I had a family a few years ago, pre-Obamacare, that was trying to lower their premium so they went with a plan that had a $6000 deductible. The husband chose this plan. Then I got a call one day from the wife, a family member needed surgery, and she was upset that the deductible was so high, that they were going to have to pay that. This was a situation that was totally unanticipated, like most health care issues.

May of my clients especially in their 50s and 60s are looking for higher deductible plans to cut the cost of health insurance. I totally get that. They have savings, they could absorb something like this if they needed to. I've heard from many people over the years, 'I just don't want to lose my house if something major happens.'  It makes sense. But keep in mind that IF something happens, the deductible is what you pay before the insurance company kicks in. I know this is going to seem like I'm stating the obvious, but I've had this conversation enough, I want to make sure people get this.

I encourage people to consider the silver level plans instead, but pricing can still be tough. I get it. I see this every day, and am not thrilled about it. So keep in mind if you decide to go with a 'HIGH' deductible health plan, you may need to come up with that money at some point. But let's hope not.

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Short term health insurance--good new or bad news?

06-16-2017 by Colleen King

Short term plans are under fire, or at least were under fire, by the previous administration. They didn't meet Affordable (?) Care Act standards, they were medically underwritten, meaning people could be declined for pre-existing conditions, and the don't cover pre-existing conditions.

I call these 'accident and illness' plans--sure they don't cover any of the aforementioned issues, but if you missed open enrollment, if you lost your job and maybe missed the 'special enrollment period' to pick up an indivdiual plan, these are good for the short term. But the 'powers at be' have decided these are BAD--I think they are better than nothing. If you had one of these, at least if you got sick or were injured, then you'd be covered subject to the deductible.

And wasn't that the point of the ACA, getting more people covered? But apparently we need to have only what the government wants. If you go uninsured for more than 90 days, then you are subject to the penalties for being uninsured. And these plans, because they don't contain the 'minimum essential benefits,' do not exempt one from the penalties for being uninsured. But I still like them on a limited basis. Something is better than nothing for emergencies. I only have one carrier offering these now, and I like the way they do it, they are guaranteed issue. BUT, they don't cover anything pre-existing which is defined as something you were treated for, or saw a provider for, within the past 12 months.

We can only do these for a maximum of 3 months, and they can be paid for either as a lump sum or month to month. We can do with this one carrier a maximum of 4 three month terms. Would I encourage someone to drop a compliant plan for one of these, of course not. But as with anything, there is a time and a place for short term medical--call me if you want to check it out.

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Okay, it is the day after--now what?

11-10-2016 by Colleen King

In a word, NOTHING.  It's November 9th, day after THE election. Sun came up, most birds were still singing, but as far as health insurance and the god awful rates we're looking at for 2017, nothing will change right now.

First of all, Trump doesn't take office until January. When he does I hope he will have been spending a lot of time on building teams to look at many areas, especially health care and how to fix the Unaffordable Care Act. In case he or any of his team catch my blog, I have some opinions of what could help. And no, I don't have the stats to back how much could be saved, or insurance costs could be cut--this is just gut instinct:

  • Modify the 'actuarial values' structure--this is where the law says a Platinum plan has to cover 90% of your costs, Gold covers 80%, Silver covers 70% and Bronze covers 60%. This needs to be modified, especially the Gold and Platinum levels, because these structure are unsustainable. Gold and Platinum plans usually have no deductible. Great, but that makes these plans really expensive.
  • We used to have plans that would offer generic drug coverage only. Government said that wasn't good enough. But what if that's all you wanted, and you were willing to chance it? Shouldn't that be your choice? That would help.
  • Maternity coverage is required on all plans. And to the guys that say 'they' don't need it, 1. you're usually involved when a woman gets pregnant, and 2. I have coverage for prostate exams I don't need. I would like to see it permissible to have a few plans without Maternity coverage, but require carriers to have it on the majority of their plans, like 75-80%--that spreads the cost out, otherwise plans with maternity are ridiculously expensive.
  • Revamp the exchanges--how did they expect to add a whole NEW bureaucratic layer in health insurance administration and bring the cost of insurance down? Shrink the exchange concept down to where they help administer/answer questions about that kind of eligibility. Agents at least in California have been involved in the majority of insurance plan sales on Covered CA. Maybe expand their ability to answer questions about the MediCal side, since it's 'hands off' for them once one is eligible for MediCal and the case goes to the 'Local County Office'--yikes!

That's it for now. I'm sure there's more, like oh, cost containment in the pharmaceutical industry? I'm done....for now....

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But I have a PPO--what do you mean I have a PCP now?

11-02-2016 by Colleen King

One of the main reasons people tend to like PPOs, unless they've had a good HMO experience, is the freedom to choose which doctors they go to. You can see someone contracted with your health plan, or not. If they aren't contracted, you pay more of the cost. And there is no 'discounted,' contracted rate to help contain your costs.

So when Covered CA came out this year and dictated that even if you have a PPO you will be assigned to a primary care provider (PCP) agents were very alarmed, because we knew the phone would start ringing. No, you still have a PPO, you just have a PCP to go with it. Here are the points, good, bad or indifferent, that you need to know about this new thing for 2017:

  • You will automatically be assigned to a PCP. Maybe it's someone you know, maybe not. The carriers are saying they may review claim info to try to assign you to someone that you've been using.
  • You don't have to use that doctor EVER--the theory is, maybe there will be a higher utilization of preventive services if a member has someone to go to, since a lot of people don't have a regular doctor. If you want to change your assigned PCP, just like with an HMO, you can at any time.
  • You can still go to anyone you want, you don't need a referral for a specialist--BIG difference from an HMO PCP.
  • This doctor supposedly is NOT being paid to be your PCP. With HMOs your PCP is paid 'capitation'--$X amount per member, per month, whether they see you or not. So the new PPO PCP, they will be compensated like they are now, when they see a patient.

So, is this going to make a difference, will it increase the use of preventive services? Dunno. Is it going to improve the quality of care? Maybe. Are patients and doctors going to like this? Remains to be seen. Just another change in our health care system that supposedly wasn't going to change once the ACA hit. So stay tuned....

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Whats the reality of the increases for indivdiual health plans this year?

10-27-2016 by Colleen King

Okay, it's hit the news, yes my phone is ringing, and yes the email volume is definitely up. Nightly news came out yesterday talking about how rates were going to be going up 25% in 2017. This is true, and some are going up more--I have clients whose rates are going up as much as 35%. So now what?

Covered California, the health benefits exchange here it the Golden State, has been saying that the average rate increase is just over 13%, but that's okay, because about 90% of consumers received financial assistance. That's not what I'm seeing, nor my peers. While Covered CA is putting out a good effort, the reason why there's such a high number of enrollees that are subsidized is that most agents only put cases through Covered CA if their clients are potentially eligible for assistance. Otherwise, it's a more lengthy application to do, and there have been problems. Definitely an improvement over the fall of 2013 when this insanity started, but there are problems.

I'm being challenged on that statement by some, about subsidies, but I know how I do things, and a lot of my agent peers. And I've not seen the math on this 13% 'average' number. Is that factoring in the new MediCal enrollees, most of whom don't have a payment, not sure. But when you have a plan that is offered both on and off Covered CA, by state law, it has to be 'the same'--meaning same benefits, same network and same rate. So why are the 'off exchange' plans so high? Whether they are on and off exchange plans, or off exchange only, things are shooting up.

Long story short, you have to 'shop' your plan. We have fewer choices, but check with an independent agent in order to be sure you aren't paying more than you have to.

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How fast can you get me health insurance?

10-19-2016 by 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!


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Why work with an independent insurance agent instead of doing it on your own? Read on...

10-16-2016 by 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.


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CalPERS looking to raise premium on their long term care coverage 75%–why?

10-04-2012 by 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?

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Health care reform is already messing things up, even the simple health insurance rate changes

04-14-2011 by 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!

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Health care reform compliance, and the IRS is going to be the monitor?

01-14-2011 by Colleen King

I came across an article recently published by USA Today that reminded me of the big wake up call we have coming in 2014 when the bulk of the health care reform measures go into effect. Check out this article by Sandra Block, “IRS lack clout to enforce mandatory health insurance.”

This article lists estimates of needing 16,000+ IRS agents to enforce this eventually. The Congressional Budget Office is estimating the cost at $5-10 billion to administer this. And that’s just the start.

My concern along with other agents in California is the price tag on all the changes. Even though people aren’t happy with rates in LA and Ventura counties, you are definitely paying less than places like Massachussettes, New York and New Jersey. And now that you are looking at eventually subsidizing people, not excluding for pre-existing conditions, rates will soar. But the IRS can’t apparently enforce these new provisions in the law.

For example–30 year old male in New York City, hospital only plan would run $176/month. No deductible, but no coverage for office visits, most outpatient care or prescriptions. Which is more of what a 30 year old would need. You could get something comparable in the SFV area for $78-99/month, but there would be a deductible.

The same 30 year old, wanting a more comprehensive plan, opts for a $2000 deductible, $30 office visits, 80/20 coverage, sounds great right? Are you willing to pay $529.06/month for that? That’s a real figure for the 10009 zip code. I can find $2500 deductible, 70/30 plans with three office visits per year with generic and brand coverage for $111/month here in the Los Angeles area.

So you might want to look for coverage now, while it’s affordable in California. No one really knows what will happen once all this starts to kick in. Pretty scary!

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What? The plan for ‘uninsurables’ is filling up? What now?

01-01-2011 by Colleen King

Geez, now this is a drag–the Pre-existing Condition Insurance Plan (PCIP) which was supposed to be such a panacea for the uninsurable apparently was too popular–in 2 months, the program might be stopping enrollment because, get this–the claim costs were 3 times higher than anticipated. Big surprise! You have to realize that when you offer ...read more






Did you hear–Anthem to postpone March 1 rate hike; but how do I save on premiums after that?

03-22-2010 by Colleen King

Now that I’ve heard this from three different sources, I believe it. Because of all the flack from Anthem Blue Cross has received from the impending rate increase on individual health insurance policies. At the request of State Insurance Commissioner Steve Poizner Anthem will hold off this current round of increases until May 1. During this time period an outside actuarial firm will come in and review everything to make sure the increase overall complies with state law that requires that a  minimum of 70 cents of each dollar is spend on medical care.


Well wait a minute–shouldn’t the commissioner have required this outside audit/review last November when Anthem filed the proposed rate increases with the state? Why wasn’t this a big deal then? You see, it’s not like this totally came out of nowhere. Rate increases are submitted by all carriers to the Department of Insurance, and they are ‘approved.’ Generally speaking. As it stands now, apparently the DOI can’t decline to approve rates. Oh that’s right, Poizner’s running for Governor. Maybe that was it.


It sounds like maybe this wasn’t reviewed line by line, or they looked at an aggregate compilation of the increases. So what can you do about your premiums as they go up?


Call your agent and see what else is available. Even if you have pre-exsting conditions and can’t change carriers, you often times can downgrade your policy. But be sure it makes sense to do so. If you have an ‘expensive’ condition, it might be worth staying on the more expensive plan to keep your medical costs manageable.

See if it’s less to put family members on other policies. Not everyone may as high a level of coverage. And couples wanting to have children? Many times I put the husband and wife on separate plans because plans that cover maternity are much more expensive, and they don’t both need maternity.

Consider a health savings account eligible (HSA) plan–often these are less expensive and if you’re open to paying for the occasionally office visit they work well. Plus there are tax benefits to having the HSA.

And there are other things to consider, but first and foremost, start with your agent. And if you don’t have one, I’m always around.

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Health savings accounts and tax time–how do they go together?

03-10-2010 by Colleen King

When people understand them, many like the idea of health savings accounts. They aren’t for everyone, but no one type of health care coverage is. Otherwise, we’d all have the same plan, and health care reform would have hit by now.


What does a health savings account (HSA) have to do with tax time? Well, if you’ve maxed out all the places you can stash pre-tax money, this is one more place to consider, IF you opened the account before the end of 2009. You have up until April 15th, like you do with IRAs, to make contributions and designate them for 2009.


My tax guy is not a huge fan of HSAs. We have this discussion every year; he’d rather see me put more into retirement over an HSA. But the way I contribute to my HSA makes sense to me. You can look at the maximum amount for the year and drop that in. In 2009 it was $3000 if you had an individual HSA eligible health plan. Or, you could do a monthly automatic bank transfer so the account grows slowly over time. The way I do it, I anticipate what expenses are coming up and deposit accordingly. When I know my annual optometry visit is coming up, I put money in for that. HSA money can also be used for long term care insurance premiums, so I’ll be putting money in for that soon–they’re due AGAIN!


Since most people, especially entrepreneurs and self employed people have higher deductible health plans to save on the premium, to me is makes sense to have a plan that can be used with an HSA because the money you put into an HSA is deductible on your federal tax return. And, at the end of the year it’s not ‘use it or lose it.’ It rolls over, stays with you, until you do need it.


You can use the money for all sort of things, click here for a list of allowable expenses. There are many other details on the ins and outs of HSAs, but I’ll save those for another time. Main thing today, if you have one, and you need a place to stash some money to cut your tax obligation, consult your tax professional and see if this might be one thing to consider.


Lots of banks and credit unions in California offer HSAs. Check out this web site, www.hsainsider.com as a ‘clearing house’ of sorts to see what’s available.


Be well!

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If you think a 39% increase in California health premiums are bad, did you hear about Georgia?

02-24-2010 by Colleen King

Anthem Blue Cross should thank Blue Cross/Blue Shield of Georgia for coming up with something causing even more outrage than they did. An article in today’s Atlanta Journal-Constitution tells the story of a gentleman who had a 72% increase in premium. On the surface it looks like maybe one of the reasons was because he turned 60. That’s usually a big ‘bumping point’ in premium. But it’s on a policy with a $10,000 deductible?  Like any other article on this type of subject, it went on to say that most increases weren’t nearly that high. But it only takes one to catch a headline.


The president of the National Association of Health Underwriters (NAHU) said he didn’t think the carrier was gouging with this rate increase. I sure hope not, and that they can back up the reasoning for it. As an agent, I view my/our relationship with insurance companies is a partnership. Hopefully neither of us throws the other under the bus. But if this and other significant increases aren’t justified, it gets hard to defend.


Yesterday, Leslie Margolin appeared before the Assembly Health Committee to explain Anthem’s position and has promised to work with lawmakers to try and bring down costs. But it’s not a matter of just insurance companies and the cost structure, it’s all parties–physicians, hospitals, drug makers, device makers, you name it.


I”m spending a lot of time these days helping my clients look for more affordable coverage. But you can only move people around so much. If one carrier has an increase the others will too at some point. Until the day comes when we truly have suitable reform, that’s the best we can do. I think. Hope so!

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I’ve got insurance, why does care for the indigent or uninsured matter to me?

02-20-2010 by Colleen King

I know I’m not a political or social services writer, but our pals at the L.A Times Wednesday had an interesting article on how the County of Los Angeles reimburses physicians when they care for the uninsured.


How does this affect your health insurance premiujms? The Physicians Services for Indigents Program in L.A. County was paying doctors 29% of their estimated fees until last January when they cut it to 27%. Now, this week the rate will be reduced to 18% effective July 1. Can you imagine doing your job for less than 1/5 of what you normally earned?


If you think this doesn’t affect your health insurance premiums, think again. This is one of the biggest reasons for health care reform. You have people who need care and can’t afford it, and physicians (and others) who are willing to provide it, but something has to give. Cost shifting to insured patients happens when physicians and hospitals have to get costs handled somewhere.


And speaking of hospitals, the article by Molly Hennessey-Fiske and Ron Lin points out that physicians may go to hospitals for reimbursement. I know back in the day when I was an emergency nurse in downtown LA and Hollywood, the emergency physicians would try to negotiate something with the hospital when they saw the obligatory uninsured. Which downtown, was a vast majority of the patients. But that was back in the day when reimbursement was better and more people had jobs with health insurance provided.


All this to say, be kind to your local emergency physician and keep your policy current. Or get one if you can. The costs you incur can be disasterous if you aren’t insured. And until there’s a more palatable way to handle health care reform, well, enough said.


Have a great weekend, stay dry and stay out of the ER.

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And the Anthem rate increase debate rages on–still?

02-15-2010 by Colleen King

Well, it’s been just over a week since the rate increase heard around the world hit and people are still going


Anthem Blue Cross, Woodland Hills, CAAnthem Blue Cross, Woodland Hills, CA

nuts. President Obama has expressed outrage. Kathleen Sebelius isn’t satisfied. California Department of Insurance Commissioner Steve Poizner allegedly said that people shouldn’t buy from Anthem Blue Cross (I say allegedly because another agent told me this, I didn’t see it myself in writing.) If that last one is true, personally, I feel it’s reckless for the Commissioner to make a statement like that unless he’s seen the documentation. But, he’s running for governor so it’s another chance to get in the media.


I really hope that all this screaming and chest beating gets us somewhere. Most people need relief from their health insurance premiums that’s for sure. Anthem’s defense is that despite ‘profits’ of $2.7 billion in Q4 2009, they lost money on their individual health insurance policy unit overall in 2009. They say they paid out more in claims than they took in. And that’s entirely possible, we’ll never know until the investigations are done. And I would LOVE to see the results of any audits. Think about it–they have to be able to justify what they are doing, because anyone can call rate changes into action at any time. There has to be some justification for what they are doing, and since 30-39% increases aren’t hitting everybody, you know there’s more to the story.


Don’t get me wrong. Just because I sell insurance doesn’t mean I agree with everything they do. BUT, having worked in a national level operations unit I know how stories get twisted. And you do too, just from your everyday consumption of the media. Remember if it bleeds, it leads. This time it’s just bleeding Anthem blue.


So while everyone is going nuts, what do YOU to help your situation. First, I will tell you to keep in mind, the more you want from a plan, the more it will cost. So next, tune in tomorrow and I’ll give you some suggestions to help cut your health insurance premiums. Not all of my suggestions work for everyone, but there may be one or two for you. Or at least it will help you understand better how this all works.


Be well!

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Anthem Blue Cross is raising individual policy rates–it’s that time again?

02-10-2010 by Colleen King

I would have gotten to writing this sooner but I’ve been talking/emailing with many of my clients today about the Los Angeles Times story today talking about Anthem Blue Cross’s March 1 rate increase. The story is claiming an average of 30-39% in increases.


First of all, we all know the media loves controversy and shock value. As usual, they skipped a couple of things. Don’t get me wrong, just because I sell health insurance doesn’t mean I agree with all the carriers say and do. Independent agents like myself want to see some changes in how health insurance works because we spend a lot of time trying to get people covered, trying to appeal above standard rate increases and declines, then we have to take cover when the increases hit.


I pulled out my Anthem list of March 1 increases to see how many of my people are in the 30-39% range–none of them. Anthem has gone to ‘anniversary date’ ratings recently so that the increases don’t all hit on March1; it’s tough for them and for agents trying to help their clients. Otherwise I would have had about 60 people calling me. So out of my 12 people getting increases this month, three are dental plans only, and those increases are from 5-13%. But that’s dental you say, so what?  How much were the medical increases you ask?

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Health Savings Accounts–the 2010 figures are in!

09-14-2009 by Colleen King

Health Savings Accounts (HSAs) remain a popular adjunct to qualified high deductible health plans in finding ways to save on health insurance premiums. There are individual health plans and group health plans that you can get that will allow you to open an HSA. For a list of what you can and can’t use the money for, click here.


Every year the IRS sets the figures for maximum contributions, minimum deductibles and few other things that govern health savings accounts. Here are the numbers for 2010:


Maximum individual contribution to an HSA–$3050

Maximum family contribution to an HSA–$6150

Policy out of pocket maximum for individuals–$5950

Policy out of pocket maximum for families–$11,900

Minimum deductibles on plans for individuals–$1100

Minimum deductibles on plans for families–$2400

Catch up contribution for those over 55–$1000



That last one is potentially really important–for people over 55, if you have some extra cash floating around, you can put an additional $1000 in your HSA, above the annual maximum. This is another potential advantage to a couple both opening up an HSA. For 2009, you could both deposit the $3000 maximum AND an additional $1000. If you only have one account, it is an individual account so you could put the 2009 family max of $5950 plus $1000 for a total of $6950 for the year. If you each have separate HSAs, based on the 2009 figures, you could each put in $3000 to your accounts, plus another $1000 each, for a total of $8000.


But that only works if you are drowning in cash. I don’t consider an HSA to be the first place to stash extra money, most of us would rather put it in a retirement account. But if you’ve maxed out all your ‘pre-tax’ options, here’s one more place. And, it’s deductible on your federal tax return.  Be well!


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Health Savings Accounts and their impact on the cost of care–is there one?

08-26-2009 by Colleen King

Health insurance is on everyone’s mind these days–either you don’t have it, can’t get it and want it, you’re upset about what you are paying for it, or you turned on the daily news and there it is, the topic is right in your face again.


A Health Savings Account (HSA) is an account that you are eligible to open if you have a specific type of health plan, also known as a qualified high deductible health plan. Generally the only benefits you have prior to meeting the deductible are preventive, but check the benefits before you buy–some plans now are not offering preventive coverage prior to meeting the deductible. I think they should, but they didn’t ask me.  These types of plans are available in both the individual health insurance market and the group health insurance market.


Anyway, I’ve included in this article an excerpt from a study that United Healthcare relating to ‘transparency’ of health care costs when people have what’s referred to as consumer driven health plans.  What it boils down to is if you you see how much things cost, you are more prone to looking at less expensive alternatives, just like any other area you might spend  money:


“Study Reveals HSA Plan Effects on Cost and Utilization


The latest UnitedHealthcare study is among the first to examine the impact of plans eligible for health savings accounts (HSAs) on health care costs and utilization among both large and small employers. Some highlights of the study:


The positive impact of HSA plans continued through the second year of enrollment.

This is meaningful because some first year differences in cost and use may have been attributable to a redistribution of elective care services as employees rushed to get care in the baseline year before an anticipated change in their benefits. This dynamic typically levels out in year two, providing a better view of consumer decision-making.

Employers who implemented HSAs showed greater declines in hospital admissions and emergency room visits. At the same time, the number of prescriptions increased over time in the HSA. However, pharmacy costs decreased in the HSA population. This suggests that HSA members are making more prudent health care choices, such as using lower-cost drugs.

Full replacement strategies appear to deepen the impact of HSA plans. When comparing cost and use across employers’ full populations (including traditional plan enrollees when the HSA was offered as an option), employers adopting a full replacement HSA had better cost results for both medical and pharmacy than employers offering an HSA option.

The utilization analysis suggests that large full replacement employers realize lower costs due to a decrease in emergency room visits and lab usage. This highlights the possibility that full replacement members are making more appropriate use of emergency room and lab services.

The study results are consistent with other cross-sectional studies done by UnitedHealthcare on CDH plans. HSAs, especially those with a full replacement strategy, have great potential to slow the growth in health care costs compared to more traditional plans, even after adjusting for the better health found among those with an HSA. The study also confirms that we see a favorable impact for smaller companies.


Consumerism in Health: Insights from Experience

The positive impact of CDH plans has been widely documented, largely based on the experience of health reimbursement account (HRA) and HSA programs. Over the last nine years, UnitedHealthcare has compiled a body of work that measures if and how CDH strategies deliver on their promise – to provide lower costs through better consumer decisions – when compared to more traditional plans. Similarly, UnitedHealthcare has investigated market concerns that threaten to slow the adoption of CDH plans.”


So doesn’t it make sense? How can you save money on your health care, if appropriate, if you think a $5 co-pay is all it costs to see a doctor?  Be well!

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Health Care reform, or health insurance reform–be careful what you ask for

07-25-2009 by Colleen King

This article was put out by the Associated Press on July 4 and it brings out a lot of points that people aren’t aware of within the European health care systems. You know, the ‘free’ ones that everyone thinks we should go to. Well, I’ve tried to edit it down a bit because it’s long, but I think you’ll find it really enlightening!


July 4: London – As President Barack Obama pushes to overhaul the American health care system, the role of government is at the heart of the debate. In Europe, free, state-run health care is a given.


The concept has been enshrined in Europe for generations. Health systems are built so inclusive that even illegal immigrants are entitled to free treatment beyond just emergency care. Europeans have some of the world’s best hospitals and have made great strides in fighting problems like obesity and heart disease.


But the system is far from perfect. In Britain, France, Switzerland and elsewhere, public health systems have become political punching bags for opposition parties, costs have skyrocketed and in some cases, patients have needlessly suffered and died. Obama has pointedly said he does not want to bring European-style health care to the U.S. and that he intends to introduce a government-run plan to compete with private insurance, not replace it.


Critics fear Obama’s reforms will lead to more government control over health care and cite problems faced by European health systems as examples of what not to do. Other experts say Americans could learn from countries like Germany, the Netherlands and Switzerland, especially in the debate on how to reorganize health insurance.


“These countries are in some way an inspiration for our reforms,” said Uwe Reinhardt, a health economist at Princeton University. “All of these countries somehow manage to assess risk and compensate for it … we could learn from that.”


Many European health officials applaud Obama’s attempt to provide health care to millions more Americans, but they also advise him to proceed with caution.


“What we can be proud of in Europe is the ground rules, that everyone has the right to health care,” said Jose Martin-Moreno, a health expert at the University of Valencia in Spain. “But the implementation has been difficult and one size does not fit all.”


Private health care is also available in Europe, creating in some instances a two-tier system that critics say defeats the egalitarian impulse on which national systems were built. When Britain’s National Health System was founded 61 years ago, it pledged that with few exceptions, patients would not be charged for anything. All prescription drugs are covered, and the government regularly sets health targets, like maximum waiting times in emergency rooms or for having an operation.


Critics say the policies are often driven more by politics than science. Last week, Prime Minister Gordon Brown promised that patients unable to see cancer experts within two weeks would get cash to pay for private care. Brown had previously argued against paying for private providers and some say the reversal may be a gimmick to boost his sagging popularity.


More serious problems in Britain’s health care were reported last month, when cancer researchers announced that as many as 15,000 people over age 75 were dying prematurely from cancer every year. Experts said those deaths could have been avoided if those patients had been diagnosed and treated earlier. “There is nothing inherently different about cancer in the U.S. and Britain to explain why more people are dying here,” said Dr. Karol Sikora, of Cancer Partners UK.


The U.S. already spends the most worldwide on health care. According to the Organization for Economic Co-operation and Development, the U.S. spent $7,290 per person in 2007, while Britain spent $2,992 and France spent $3,601.


Still, experts say that before committing the U.S. to footing the bill for universal health care, Obama should consider it has cost Europe. A World Health Organization survey in 2000 found that France had the world’s best health system. But that has come at a high price; health budgets have been in the red since 1988. In 1996, France introduced targets for health insurance spending. But a decade later, the deficit had doubled to 49 billion euros ($69 billion).


“I would warn Americans that once the government gets its nose into health care, it’s hard to stop the dangerous effects later,” said Valentin Petkantchin, of the Institut Economique Molinari in France. He said many private providers have been pushed out, forcing a dependence on an overstretched public system.


Similar scenarios have been unfolding in the Netherlands and Switzerland, where everyone must buy health insurance. “The minute you make health insurance mandatory, people start overusing it,” said Dr. Alphonse Crespo, an orthopedic surgeon and research director at Switzerland’s Institut Constant de Rebecque. “If I have a cold, I might go see a doctor because I am already paying a health insurance premium.”


Cost-cutting has also hit Switzerland. The numbers of beds have dropped, hospitals have merged, and specialist care has become harder to find. A 2007 survey found that in some hospitals in Geneva and Lausanne, the rates of medical mistakes had jumped by up to 40 percent. Long ranked among the world’s top four health systems, Switzerland dropped to 8th place in a Europe-wide survey last year.


Government influence in health care may also stifle innovation, other experts warn. Bureaucracies are slow to adopt new medical technologies. In Britain and Germany, even after new drugs are approved, access to them is complicated because independent agencies must decide if they are worth buying.


When the breast cancer drug Herceptin was proven to be effective in 1998, it was available almost immediately in the U.S. But it took another four years for the U.K. to start buying it for British breast cancer patients.


“Government control of health care is not a panacea,” said Philip Stevens, of International Policy Network, a London think-tank. “The U.S. health system is a bit of a mess, but based on what’s happened in some countries in Europe, I’d be nervous about recommending more government involvement.”


And that’s coming from someone without a vested interest in US health care reform–Be Well!

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When buying health insurance, let your agent help decide what in your health history is relevant.

06-29-2009 by Colleen King

Health insurance remains one of those things that most people still find confusing. For group health insurance, disclosing your health history helps determine the rates your employer gets. For individual health insurance, it determines not only rates, but whether or not you will even be accepted!




Focusing on individual health insurance, all carriers ask about whether you’ve taken medication, been treated for or had symptoms of anything in the past  ten years. One carrier, it used to be the past twenty years. There’s a rumor that one is going to drop it to the past five years. Whatever the number, talk to your insurance agent about anything you’ve been treated for, because carriers look at things differently than you and I do. I recently did a policy with a nice guy who was on no medication, not under the care of a doctor or anything. When I saw his online application though, he had stopped taking an antidepressant 3 months ago.  He did end up getting approved but at an above standard rate because of this. Why does it matter? He isn’t on anything! This is one of those cases where depending on the carrier, an applicant needed to be off medications between 6-12 months in order to qualify for a standard rate. Recently stopping some medications, they are concerned that you haven’t been off of it long enough and may need to go back on it. Basically, don’t let common sense and logic get in the way of reality.


Another dicey situation is when women have had breast implants. Now, consider this. When you first start working with a health insurance agent, it’s not unusual for them to be someone you found on the internet, pretty much a total stranger. They are going to be asking all sorts of personal questions, and you don’t know them from adam. Women often think they don’t need to disclose their implants, after all, it was cosmetic and insurance didn’t cover them before, so what does it matter? Well, it does. Some carriers, silicone implants are an automatic decline. Others, depending on how long ago they were inserted, will accept you but at an above standard rate because of the high likelihood of someone developing contractures, encapsulation that hardens and causes pain necessitating removal. And the carrier may be on the hook for it. I finally figured out a less direct, more tactful way of asking the question so I run into that ‘surprise’ less often.


I could go on, but I think you get the idea. Even if you think an old health issue is irrelevant, talk to your insurance agent about it when considering making a change. If you don’t disclose and there’s an issue down the line, your policy could be rescinded and new coverage tough to obtain. And if you aren’t comfortable with the agent you are talking to, talk so another one or two. There are tons of us out there, we all want your business but you’re the consumer, so find someone you like dealing with!


Be well!

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Talking about Health Insurance–What’s coinsurance?

06-21-2009 by Colleen King

Here is another term in Health Insurance, both Group Health Insurance and Individual Health Insurance that people don’t always understand. I would have posted this sooner, but it’s been a busy month!




(“Help, I don’t understand!”)


Coinsurance might be easier read with a hyphen; co-insurance. This is one of the three main questions people should ask (in my opinion) in looking at a health insurance plan. You have the deductible, the out of pocket maximum and then that step in the middle, co-insurance. ‘What’s my co-pay’ is a good one too, but not as important as the ‘big figure’ numbers.


Generally the deductible is what you pay before the coverage kicks in. If you have something big hit, the out of pocket maximum, or co-insurance maximum is the part that keeps you from going broke. Once you hit your out of pocket maximum, that is generally all you pay on eligible health care expenses for the remainder of the calendar except for office visit co-pays and prescription drug co-pays, depending on your plan. The key word here being, eligible.


How do you reach your out of pocket maximum? That’s where co-insurance comes in. Once you hit your deductible, then the carrier starts to pay. Co-insurance is what percentage of eligible charges they pay and what percentage you pay. 80/20 used to be pretty common, with the carrier paying the 80% part. Now we are seeing all kinds of splits. There are a few (very few) 90/10 plans, but they are really expensive. In the individual market we mainly have 70/30 plans in California, but now there are 60/40 and even 50/50 plans.


Some people balk at a 60/40 or 50/50 plan–what’s the point in having insurance, they ask. That brings me back to the out of pocket maximum. You may be paying 30, 40 or 50% of the bill, but once you hit the out of pocket maximum the carrier pretty much comes into play at 100%. It’s a matter of how soon do you want the carrier to come into play.


All plans are not created equal. The more you want from a plan, the more it will cost. If you want more coverage sooner, it will cost you more. In reality, you’ll either pay in advance (premium) or you’ll pay at the time you need help (medical bills). So if you can handle more of the expense of health care, buy a plan with a lower premium, especially if you’re basically healthy. There’s no rebate for low utilization if you have a ‘healthy’ year as opposed to a ‘sick’ year.


Be well!

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Oh boy, Junior’s almost out of college–Oops, what do we do about health insurance?

06-04-2009 by Colleen King

It’s getting to be that time of year when the four years of college (or five, or six) is about to wind up. At last. That tuition bill is going to be gone and the kid(s) will be out of the house. Then it occurs to mom and dad (not usually to the new grad) that their young adult can’t stay on their insurance policy any longer.


Carriers allow full time college students to stay on their parents’ coverage until age 23, 24, or even 25. As the hassle with pre-existing conditions continues to increase, some carriers are talking about increasing the age a kid can stay on their parents’ policy, even if they aren’t in college. But we aren’t quite there yet.




This little detail can easily escape everyone since finals and planning for graduation are a lot more interesting. I had this situation come up last year with a family, and there are a couple ways to do it. It was a Friday, college graduation was Saturday, the new grad was turning 24 on Sunday so as of Sunday, she was going to be uninsured and Mom was panicking.


We could have done a regular policy, but since that usually takes 2-4 weeks, the young woman wouldn’t have been covered. Instead, we elected to do a short term health plan. These will vary from state to state, so what I’m relating here pertains specifically to California.  These plans I refer to as ‘accident and illness’ policies. They don’t cover anything routine, they don’t cover pre-existing conditions or maternity, but if you get sick or have an injury you have coverage. And, because it doesn’t cover anything pre-existing the underwriting, or review of the application, is much quicker. We can usually get a response in a couple of days.




So the short term health plan was how we handled it. These can be kept on a month to month basis, up to a maximum of 6 months, and if you’ve not had any claims, you can renew it for up to another six months. These plans are also really useful in situations where you get a new job, you don’t have benefits for the first 90 days of employment and you don’t want to pay the exorbitant cost of COBRA. I’ve used these many times and while they aren’t ideal due to the fact that they are short term, they sure can be a great stop gap. And the carrier I use most, if you go to an emergency room for an injury, the deductible is waived. I wish all policies would do that!


So congratulations, and good luck to the class of 2009!


Be well!


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Health Insurance and COBRA–what should I do now that there’s a subsidy?

05-10-2009 by Colleen King

A couple of months ago I did an article on COBRA coverage: how it works, and why you should or shouldn’t take it.


Now that there’s a subsidy of 65% for people involuntarily terminated after September 1, 2008, the picture changes somewhat. Depending on how much the 35% you have to pay is, that 65% can be pretty tough to turn down. But I still have a couple of caveats for you.


This only lasts 9 months. With any luck, during that time you will have another job, with benefits, and you don’t have to think about this any further. Normally when someone is offered COBRA I suggest they look at an individual plan if they are potentially insurable because anyone can have something develop or happen to them that could render them uninsurable.


I still think you have to give that serious consideration but I know that subsidy is REALLY tempting. Here is what I think you should consider. If buying the coverage is on your own is less than the 35% you’d need to pay, then look at individual plans. Whenever someone elects to take COBRA for a family, but not everyone needs to be on COBRA, meaning they are insurable, look at individual plans. Especially if you don’t qualify for the subsidy. You need to look at all options for your situation, which is why an independent agent in addition to your HR person at work is important.


If the cost issue with the subsidy is close, maybe the plan on your own is slightly more than your COBRA cost, consider getting your own coverage, again, just in case. It’s all a matter of what’s going to make things easiest for you to handle.


Be well!

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Health Insurance–why should I go through you instead of directly to a company like Kaiser or Anthem Blue Cross?

04-28-2009 by Colleen King

It’s so nice to have people that keep you on your toes. Health Insurance questions abound when you ask for topics for this blog. Thanks to Lisa Nicole Bell again, www.adivinebook.com for this one.


The plus for you, the consumer, whether it’s for individual health insurance of group health insurance is that the rates are the rates. No one has special ‘deals’ to get you something better, it’s a matter of service. When you go directly to an insurance company, a carrier, they can only give you information on what they offer. And that’s fine, but if you want information on multiple carriers, you have to call each one. That also means you have multiple people following up with you trying to gain your business. If you have the time to do that, great. Some people would rather do it that way, so there’s no right or wrong.




But by going to an independent agent, which is what I am, you can talk to one person, for FREE, and get all the information on several carriers from an unbiased source, theoretically. Some agents are more partial to certain carriers, so you may even want to talk to a couple different agents to see who you are most comfortable with. But basically you can have one contact for multiple companies.


Agents are paid on a commission basis by the insurance carrier they place the business with. You can talk to one of us for hours, never do anything, and there is no charge to you. One of my group cases, I spoke with the contact for 2 1/2 years before they did anything. The situation was such that they didn’t need to start a group plan right away. But when they finally did, it absolutely was worth the wait. One of the two partners in this group has referred 3 family members to me because she liked working with me.


An even more important reason to have an independent agent is if there is an issue after the sale. Agents working for a carrier will certainly do all they can to help you if there’s an issue, usually. But, if an outside agent is pressing an issue, carrier reps (the people inside the company that an independent agent can call for problems) know you can move that business by next month if the client is really unhappy.


So again, there’s no exact answer because everyone will have different opinions. But if you have a good independent agent, you may end up doing less of the leg work yourself which many people prefer in this busy day and age.


Be Well!

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With Health Insurance, what kind of coverage is good for recent grads and young professionals under 35?

03-31-2009 by Colleen King

A few weeks ago a delightful young woman asked me about health insurance, and what was good for a young professional or new grad, or people in general under 35. This answer is for you, Lisa Nicole Bell (http://wwwadivinebook.com). You really need to check her site out, she has a lot to offer in these crazy times.


Anyway, The answer to Lisa’s question could take a lot of space, but here goes. If you’re lucky enough to land a job out of school, or a job anytime that offers health insurance, you absolutely should sign up for them. Many times you only have one plan to choose from so that makes it easy. Other times you may have a choice between an HMO plan and a PPO plan. HMOs are good because even though they generally have smaller doctor networks, your financial outlay if you need care tends to be a lot less. AND, in group plans the HMOs usually cost less than PPOs so your contribution to the premium might be lower . With PPOs though, you have more doctors to chose from.




If you have to fend for yourself and get an individual health plan, which happens more and more these days, things change somewhat. In the last couple of years there have been a lot of individual plans that are really cost effective, but the reason they are is that they don’t cover maternity. This concerns me because even when young women aren’t planning on a baby anytime soon, things happen. Then, you can’t change plans to get maternity coverage because if you are pregnant, it’s an automatic decline when you apply. So I urge women in their 20s and 30s to have something with maternity just in case. But ultimately it’s their decision. There is one insurance carrier in California that will allow you to switch to their $5000 deductible plan that covers maternity, but wow.


I suggest when you are looking for an insurance plan that doesn’t cost a fortune that you consider one that does one or more of the following:


Offers a limited number of office visits per year for a fixed co-pay. You can still see a doctor, but the deductible then comes in to play. Since most younger people don’t see a doctor more than 1-2 times a year, this usually works.

Consider a plan that offers only generic prescription drug coverage. My preference is for everyone to have full coverage, just because I’m cautious, but many times you would be fine with just generic.

Consider a qualified high deductible health plan that you can use with a health savings account (HSA). These are definitely less expensive, and some offer maternity coverage. The thing you have to understand about these types of plans is that the only benefits you have prior to meeting the deductible are preventive. You pay for everything until you meet the deductible. BUT, when you have an eligible plan you can open an HSA, put money into that to save for future health care costs and the money deposited in the account is deductible on your federal tax return. And in some states too.

People often ask about ‘catastrophic’ plans. There isn’t really a clear definition on that, but these are generally considered to be the PPO plans with $5000 deductible or higher, maybe they have office visit coverage, maybe they have prescription drug coverage. There is also a set of plans that  are hospitalization only, and those really scare me because that’s exactly what they are–hospitalization ONLY. No prescriptions, no office visits and usually no coverage for outpatient care which can be costly.


So to answer the question, what kind of coverage should people in their 20s and 30s get? Call an independent agent and discuss your situation. It’s a matter of what will fit in your budget, how extensive you want the coverage to be and your overall health situation. Calling an independent agent is really helpful because they can help you compare companies instead of you calling all of them. AND, their services are free to you. You will get the same rates whether you go to an outside agent or directly to the carrier. Just do something; medical costs aren’t dropping any time soon!


Be well!

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COBRA and Health Insurance–Do you have to pay through the nose, or is there a way to save?

03-06-2009 by Colleen King

COBRA–good news or bad news? These days people are either losing their jobs, their health insurance or both. What do you do? I know people aren’t always thrilled with their group health insurance plans but it’s scarier to think of being uninsured if you’ve ever heard the costs one can incur. But then you find out how much your COBRA coverage will be and wow–you need it at least long enough to get out of the CCU from your heart attack.




When COBRA, the option to be able to continue your health coverage when leaving a job first started years ago, people generally thought it was great. This applies to companies with more than 20 employees. But the cost of many group plans is extremely high; most didn’t realize how much their employer was paying to cover them. With COBRA, you pay the entire amount of the premium plus 2-4% administrative costs. In California, we have CalCOBRA which functions similarly but with administrative costs of about 10%.


So now, what’s the big deal?  Why is COBRA so great? Well if you are insurable on an individual plan you don’t need to stick with the COBRA offering. But if you aren’t insurable, all of a sudden it’s usually the best deal in town.  You need to decide within 63 days of when your coverage ended whether or not to take it. What I’ve done with several families is help them select individual health insurance plans for the members of the family that are insurable and leave the ones that aren’t on the COBRA plan. And it doesn’t always have to be the former employee that stays on the plan, you need to find that out from your former employer.


So check out your options. You might be surprised at the possibilities. Contact an independent agent, like me, before you throw in the towel.


Be well!

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Your Health Insurance and a couple of ways to use it to help you save money

02-27-2009 by Colleen King

Health Insurance–group health insurance or Individual health, it’s the bane of most peoples’ existence. One way you can save money is on how you use your prescription drug benefit.




Most of you will already know that many brand name drugs have generic equivalents. Whenever you can get a generic, with or without insurance, generics are usually significantly less. For example, I was looking on the Costco web site (great source for lower cost prescriptions) at a drug one of my clients is taking, finasteride. A 30 day supply is $33, the brand equivalent is $94. And these days most individual health and group health plans have brand drug deductibles which are a pain. But the design is to nudge you to the generics and help keep their costs down.


Prescription drug costs are one of the main drivers of health care costs escalating. The insurance companies can get discounts but it won’t drive the brand price down to the generic price, so it costs them more too. And guess who ends up paying? There is debate on whether they are as effective; the vast majority of the time they are, so why not give it a try.




Another way to save on drug costs is not to request the ‘latest and greatest’ that you just saw on TV. I recently had a sinus infection, saw an urgent care doctor and wanted the same major league antibiotic I had a couple of years ago that knocked it out in a couple of days. He said he didn’t want to give me that, rather wanted to give me an older antibiotic that I would take for 14 days.  Argh! Well, I listened to him (sometimes hard for us RNs) and my prescription was about $7 instead of the $90 I paid before. And I was feeling better in a couple of days anyway.




Last, both individual and group health plans usually have mail order drug service available. Look into it by calling the Member Services number on the back of your ID card.  When a health insurance plan offers mail order service, usually you can get a three month supply for the cost of a two month supply. Mail order doesn’t really work for something you need now, like an antibiotic, but if you have maintenance medications you take daily for your heart, blood pressure or asthma, a little planning will save you money and help decrease the cost of health care.


Of course, just staying healthy is the best option of all; Be Well!

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Insurance, insurance everywhere–why do I have to deal with so many companies?

02-12-2009 by Colleen King

Health insurance, life insurance, business liability, homeowners, auto, rental property coverage, umbrella policies, long term care insurance–Wow! And of course, there are more types.


A lovely woman named Rose recently posed that question to me. There are a lot of detailed reasons, but I’ll try and make it brief. First, you have to differentiate between insurance companies and insurance agencies. Insurance companies are the entity with the really big buildings in most downtown areas and they write the checks. Insurance agencies can have big buildings too, but agencies represent insurance companies and sell to the public. Insurance companies usually choose to focus on a few areas rather than all areas.  Life and health carriers also may offer Medicare related coverage, disability, long term care insurance, more ‘people’ oriented coverage. Other carriers focus on the property and casualty types of coverage; auto, homeowners, boat, umbrella policies, business liability, basically more along the lines of ‘stuff.’




Even if a company offers things from both sides of the table, there may be subsidiaries that handle it so you still aren’t going to get ‘one bill.’ From there, you have agents and agencies. There are two main licenses insurance agents hold in California, a Life Agent license or a Property and Casualty license. As a Life Agent, I can’t sell homeowners, and a P&C agent can sell homeowners but not usually health insurance. Interestingly, they can sell life insurance, but that doesn’t mean they will. Some P&C agents focus on the personal lines, but don’t do business liability and workers compensation.


If you want to narrow down who you are dealing with, it helps to find agents that handle more than one line of insurance. There are agents that carry both licenses, but that is a LOT to learn and keep up with.


Personally, I feel there is often an advantage of going to an independent agent or agency over going directly to a specific company. You select one insurance company, they generally will only be able to show you their product line. With an independent you can get a variety of options with just one person to deal with. You can still do multiple policies with one agent, and if they can bundle most or all of what you want with one carrier, you can often get multiple policy discounts.


So find a good multiple line agent, or one good Life Agent coupled with a good P&C Agent, that that should help narrow down some of your hassles. Hopefully! You could go to one doctor for all your needs, but do you really want your gynecologist performing your brain surgery? They won’t be thrilled with doing it.


Be well!

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How badly do you want health insurance reform?

01-22-2009 by Colleen King

Now that we have our new president in place and we’re all hoping things financially will improve, let’s talk about the reform of the health care/insurance system.


It’s not going to be free, in fact it could be quite costly. Are you will to do it? Here is an excerpt from an article the Associate Press ran on January 19th:


“Washington – Prospects for health reform drop significantly when Americans hear potential financial trade-offs associated with expanding health insurance coverage, a poll indicates.


For example, nearly seven in 10 people say they favor the concept of requiring employers to provide their workers with health insurance or contribute into a fund that pays to cover the uninsured. President-elect Barack Obama has called for such an employer mandate for medium and large businesses.


But what if they heard the mandate would cause some employers to lay off workers? Support falls dramatically to about three in 10 people, according to a new national survey conducted by the Kaiser Family Foundation and the Harvard School of Public Health.


Similarly, about two out of three people favor requiring all Americans to have health insurance. But when told some people may be required to buy insurance that’s too expensive or it’s something they don’t want, support for the individual mandate falls to 19 percent.


“As we have learned from past debates, public support looms for health reform largest at the beginning of the debate, but it’s relatively easy to chip away at that support with arguments about trade-offs,” said Mollyann Brodie, a Kaiser vice president.


Researchers said the economy is the overwhelming top concern in the United States, cited by nearly three quarters of the public. Health care is a top domestic concern too. But the survey suggests the public is split when it comes to a willingness to sacrifice financially to get more people insured.


About 47 percent were willing to pay higher insurance premiums or taxes, while 49 percent were not. The study is based on a telephone survey of 1,628 adults conducted in early and mid-December. The margin of error was plus or minus 3 percentage points.”


Me again–So as you might suspect, once there is a suggestion that people break out a check book, interest generally wanes. You don’t want the government paying for it necessarily, because that means us in taxes. Remember the $600 toilet seats? They aren’t big on cutting costs. But maybe this time will be different, I’ve got my fingers crossed!


In California when the cry for decreasing the number of uninsured was big early last year, and about 6 million people were uninsured, there was an estimate of nearly 2 million people that could afford coverage but they didn’t want to pay for it. So we’re potentially going to raise taxes for everyone so those who don’t want to buy coverage are covered? Talk about expensive!


So we’ve got to find a way, we just have to be watchful of upcoming proposals. Be well, and Happy 2009!

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Health insurance with vision care–how much is it, and what is it?

01-13-2009 by Colleen King

First of all, Happy New Year! Here’s hoping 2009 treats people better than 2008.


In the individual health and group health insurance arenas, medical insurance covers medical problems only. The thing we used to debate when I worked for a carrier years ago, is what’s the difference between what is and is not covered under the medical plan when it comes to eye related problems.


Basically, vision care refers to glasses, contact lenses and the exams to figure out how well you do or do not see. Your health plan would cover illness or injury to the eye, like conjunctivitis, a corneal abrasion or cataract removal. If you can’t see because the lenses in your eyes are opaque, the surgery would be covered under medical and usually the eyeglasses associated with it would be as well. If you can’t see because you’re near sighted or far sighted, that fall under vision care.


When looking for a vision plan on an individual basis, there’s not a lot available. VSP offers a plan that you have to buy directly from them, they won’t let agents sell it and it’s about $200/year. Think about it; how much are your glasses or contacts and exam going to cost? It’s hard to market a vision plan that’s affordable because, who is going to buy it? People that WILL use it. Whereas with medical insurance, you may or may not use it but most people acknowledge they should have it, just in case.


Group health insurance parameters are similar as to what is covered how. But, group vision plans may be something to consider as there are so many more of them available and fairly reasonably priced.  But for individuals, I usually ask if the have the Auto Club, AAA. Many retail places like Lenscrafters, Pennys or Sears optical offer discount. And you’ve already bought that card!


Be well, and all the best for 2009!

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Insurance? Not today

12-31-2008 by Colleen King

Health Insurance, life insurance, annuities, long term care insurance–okay, my usual topics are in. But today’s article is not to talk about insurance, I just want to wish everyone a Happy New Year.


2008 was a lousy year for many people, so kick it to the curb and get ready for 2009. As far as insurance, we’ll see what actually changes in the health care arena. It won’t be fast or ‘all curing’ but I hope there will be some positive action. 


Especially if it doesn’t mean me losing my source of income! 


So, I wish you all a Happy NYE, and we’ll be ringing it in from the Caribbean. Hope that bodes well for smoother sailing in 2009! I look forward to answering your questions again…..


Be well!

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Health Savings Accounts–One Account or Two?

11-16-2008 by Colleen King

Health Savings Accounts (HSAs) are a great way to handle health care coverage for many people. In order to have one you need to have a specific type of health plan, referred to as a Qualified High Deductible Health Plan (HDHP). In order to qualify as an HSA eligible HDHP in 2008, plans for a single individual must have a the deductible of at least $1100 and the only benefits available prior to meeting the deductible are preventive services. For a family plan the minimum deductible in 2008 is $2200.




But the question I want to address in this article is one aspect of setting up the actual HSA. When a family has an HSA eligible plan, should they set up one HSA or two? Well, when you set up an HSA for your family there can only be one account holder listed, but the money in the account can be used for all members covered by their family health plan. In 2008 the maximum contribution for an individual is $2900 and for a family is $5800. So, no big difference at this point whether you need one account or two? Maybe if you file your taxes separately, you could each use the deduction of what you’ve contributed during the year.


Here’s where the potential benefit comes in; after age 55, people with HSAs are eligible for ‘catch up’ contributions! In 2008, that would be an additional $900. If you have one account, there can only be one catch up contribution. But if you and your spouse have separate accounts, you could both take advantage of the catch up contribution. So,with a family HSA allowable contribution of $5800 (if you choose to make the maximum contribution) plus $900, that would give you $6300 in the account. With separate accounts you could each make the maximum contribution of $2900, plus $900, times 2, giving you a total of $7200 that you could put away. Something to think about!


Every year these numbers are adjusted for the coming year; see below for the HSA numbers for 2009:


Maximum HSA contribution–individuals $3000, families $5950

Catch up contributions for account holders over age 55–$1000

Minimum health plan deductible–individuals $1150, families $2300

Maximum out of pocket max on a plan–individual plans $5800, family plans $11,600

Whatever you do, you need to have health insurance these days. HSA eligible plans can be less expensive than conventional PPO plans and you are basically are ‘self insuring’ for the smaller issues. Look at it further to see if it’s a fit for you.


Be well!


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I refuse to participate in the recession.

10-09-2008 by Colleen King

I recently heard this statement at a sales training session, and it’s become my new mantra. Health insurance and most other types of insurance for that matter, can be really expensive and now’s not the time to be absorbing rate increases.


Even though I sell insurance for a living I don’t like to see people pay more than they need to. That doesn’t mean the least expensive coverage is the best way to go either. But there is a happy medium often times.


Life insurance rates overall have come down over the past few years so if you purchased life insurance more than 4-5 years ago, it might be time to see if there is something less expensive for you. Why not? You also have to see if what you have is sufficient. If you’ve had another child or two since you last bought a policy, it’s time to make sure that is still okay.


Long Term Care insurance–well, none of us are getting any younger, so if you are in your late 40s and up, you might consider at least learning about it. Maybe get a quote too. The old thinking was that this is something you buy in your late 60s, early 70s. By then, rates can be at least double what they would be in your 50s. Plus there’s the risk of developing a health condition that could either keep you from getting a 10% preferred health discount or rendering you uninsurable in general.


Annuities–see my September 30th post on annuities. They can be a great move in this economy if you don’t need the money right away and there aren’t enough antacids in your house to withstand the stock market volatility.


So don’t participate in the recession. If you are a business owner, you still need to market. Those that stop, their businesses don’t grow. You might not grow as much, but growth of any kind is good right now.


Be Well!

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Health Insurance–what do you think of Supplemental Plans?

09-25-2008 by Colleen King

Health Insurance is treated differently by people as opposed to homeowners or auto insurance, because unfortunately we tend to need to use it more often. Individual health insurance plans generally over 70% (or less) after you meet the deductible. So until you hit the out of pocket maximum, which is like a stop loss, your 30% adds up. Thank goodness for the out of pocket max, because that’s the part that keeps you from going broke, or paying that 30% forever.


I was asking my business partner about these in light of the current economy. His only response was on the economy, and to quote him, ‘Ruff” (see picture at the bottom of this post). Supplemental insurance can be sold in a few ways, and whether or not it makes sense depends on your personal philosophy on insurance. And yes, some people outside of this industry have insurance philosophies. These are plans you will hear about that provide extra coverage for cancer, accidents, hospitalization, critical illnesses such as strokes and heart attacks.


These may be helpful to you, but you really need to evaluate the cost versus what you get, IF you have an occurrence. The main thing that bothers me about the way I hear a lot of agents sell them, and only sell supplements, is that they describe them as ‘paying you money for what your main health insurance doesn’t cover.’ It often sounds like they make up the entire difference, and they don’t generally.


They don’t coordinate with your main insurance most of the time. They send you the specified amount after you file a claim if it meets the criteria. Then it’s up to you, if you spend it on non-medical expenses, which could be helpful, or you use it to pay medical costs.


Some employer groups will offer these to employees at the employees’ expense to enhance the benefit package. Depending on what you buy, it could be paid on a pre-tax basis, which is good for the employer and the employee. Before you go forward with it, ask the following questions:


Is there a limit to the number of times I can file a claim?

Will the rates ever go up?

What does this cost each month, and what is the potential payout?

These are just a few of the questions you need to ask. These types of plans are mostly offered in conjunction with group health insurance, but some can be offered on an individual basis. Wherever you are buying it, make sure you understand what you are getting and keep asking questions until you are satisfied.


Of course, there is always the alternative–Be well!

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Health Insurance–Should I use an independent agent or go ‘direct’?

09-16-2008 by Colleen King

Health insurance tends to be confusing to most people, so going to a big, national web site to decipher what all is available might be okay for some. If you really understand it, then go for it. I can understand wanting to do it on your own and not risk being pressured into buying more than you want.




However, whether you are looking for an individual plan for you and/or your family or a group health plan, if this isn’t your forte, seriously consider using an independent agent. I’ve dealt with several people during my time in business that had gone to a major site to pick their own, then they were unhappy with it. There are several things that can be phrased in different ways, and if you don’t know all the nuances you might end up with something other than you thought. Many of these huge national sites also have agents available by phone you can call for help, but from what some of my clients have told me, trying to get the same person a second time especially if it’s a couple of months or more after you bought the policy can be tough.


By going to an independent agent, whether they are down the street or just established with a private agency in your state, if you have selected a good agent, they will be there if down the line you have a problem. I tell my clients that I don’t disappear after a sale, that I remain available to them in case there is an issue. I also tell them that I return phone calls usually the same day. That may sound like pompous horn blowing over a dumb little thing, but it you’ve ever had an agent evaporate on you, you’ll agree that it’s not.




I also tell my clients that I ‘do the shopping’ for them. On my web site I post the pricing and benefits of all the available carriers that I represent. So you could certainly go to my web site, find information, select a plan and apply online without ever talking to me. But I like to talk to people, so if you do go to my web site, let’s talk about what you have found and see if it will really fit what you are looking for. I look at the nonsense of individual health insurance and group health insurance plans day in and day out, so sometimes I can point out small things you might have missed. My goal is to help people find what fits their needs, not mine, and frequently I talk people down in price, spending less than they would have on their own.


Sometimes people think that by going to a carrier (insurance company) directly, then can save money. My services and those of any other independent agent, are free, whether you end up buying from us or not. We are paid by the carrier we place the business with. So our consultative services work for you–you don’t have to call a bunch of carriers to see what’s available, because I promise you–they all think they have the best thing going and it’s not always true. They won’t tell you about the ‘comparative pitfalls.’ So deal with an independent agent, and get objective information on your plans.


We also know about the subtle differences between carriers when it comes to underwriting health issues. They don’t tell us everything, because honestly, with some agents that would be like giving away the answers to the quiz. But there are some carriers that are certainly easier to work with than others.


So use our expertise and willingness to help you if something goes awry–Be well!

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Health Insurance–California and the U.S. aren’t the only places with problems.

09-03-2008 by Colleen King

I was on vacation last week, and even though I was out of cell phone and computer/wireless range, there’s always someone talking about health insurance.


I was in a cab on the island of Aruba, which is beautiful. My boyfriend and I with another couple had gone to a great beach and in the cab on the way back, we were asking the gentleman driving us to tell us a bit about Aruba (other than what we knew about Natalie Holloway!)




He was of Dutch origin and had lived there most of his life. Said it was beautiful and safe, but like anywhere, things were changing. Health care coverage was free (remember, that always means higher taxation!) but they were having a huge influx of Colombians which was a burden on their system. He groused that when one comes, the whole family comes and often times they aren’t working, ergo they aren’t paying taxes or contributing to the system. Just draining it. Sound like familiar complaints?


In California, it’s the Central Americans who are often blamed as a problem. Several years ago when I spent a lot of time in Italy, it was the Tamils, the people from Sri Lanka that were ‘draining’ the economy. Every country has it’s problems, and part of it seems to evolve from people in poorer nations striving to make a better life for themselves and their families in a better place.


Health care is only one piece of a ‘better life’ and it costs money. What do we do about it? There are so many ideas, but whatever you think is a great way to change our current system, it won’t happen quickly. The more people that buy health insurance, healthy people rather than just those who are ill, the more money that goes into ameliorating the risk–right now, who buys it? People anticipating needs whether it’s planning a family and all the care costs that come with having babies, people getting older fearing illness, and so on. Younger healthy people also need to get on the band wagon, even though they ‘don’t need it.’ You may not develop asthma or high blood pressure in your 20s, but what about that snowboarding accident or amateur sports injury? Running down the stairs in a hurry and either badly spraining or breaking an ankle. That costs too, and those are the kinds of things that can saddle a young person with a ton of bills that would have been avoided with a decent health plan.


So until the ‘big reform’ (lord help us all!) takes place, covering yourself and your family, if it can be done without costing a fortune, seriously look at doing it. That’s not just a sales ploy on my part, it’s reality. Significant reform will take a few years at best. Meantime, help avoid the potential pitfall of financial ruin by seeking some sort of coverage. A good agent will help you find what fits you best.   Be well!

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Individual health insurance–explain guaranteed issue plans?

08-29-2008 by Colleen King

When dealing with Individual Health Insurance, depending on your personal health history, it can be dicey to apply because you don’t know whether you’ll be accepted or not and if you are, and are offered coverage at an above standard rate, will it be affordable? Depending on your situation there are some options in California, so we’ll look at a few of them. You can see this poor guy is trying to figure it all out in a song….


Light picture to get you through this subject...


If you are coming off a group health plan and have health issues, you are eligible for Federal COBRA for usually up to 18 months as a result of the Health Insurance Portability and Accountability Act (HIPAA). Problem is, if you’ve ever looked at the cost, if you didn’t have a heart condition before, you will now. You get to keep your exact same coverage, not subject to underwriting review, but you are now paying the full cost plus a 2-4% administration fee. NOW you understand the true cost of health insurance. Federal COBRA applies to businesses with more than 20 employees, but California, being the way we are, instituted CalCOBRA for companies with less than 19 employees. Similar rules around this, you can keep it for 18 months but you pay the full cost plus about a 10% administrative cost. And if you work for a 20+ company, you can take advantage of Federal and CalCOBRA for a total of 36 months coverage, if you can afford it.


What do you do when COBRA ends, or if you can’t afford COBRA and are uninsurable? Once you complete the full run of COBRA, the insurance carriers have guaranteed issue health plans you can apply for. But, the cost is often comparable to your COBRA coverage.


Option of last resort are a type of plan called a ‘mini med’ plan. These are not the first line of plans that I as an agent offer but when there is nothing else, it can help keep the wolf from the door. I work with one company that offers 3 different level plans and I usually try to encourage people to look at the highest level, contrary to what I usually advise. The carrier pays a fixed amount per day for hospitalization, a specific amount for office visits, they will help with some physicians and surgical charges and offer several discounts on other types of services such as vision, prescriptions, hearing aids, and so on. The monthly cost on these can often be better than your COBRA offering but not as comprehensive a type of coverage. But, it will help.


Again, not the first type of plan in my arsenal but when properly explained, there is a place for the mini med plan. They tend to be more popular outside of California and can also be found in the group health insurance arena as well when an employer wants to offer something but doesn’t want to break the bank.


Reform of the health care and health care reimbursement has been talked about intensely for well over a year in California. Don’t plan on it happening too soon, we can’t even get a budget passed. You need to be responsible for your own wellbeing so seriously consider looking into at least a high deductible health plan in case something major happens. Because comprehensive reform ain’t happening soon. Be well!

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Health Insurance–what good is it when you have such a high deductible? You’re paying for everything!

08-15-2008 by Colleen King

In order to save money on insurance premiums, many people whether in an individual health plan or group health plan will select a health insurance plan with a higher deductible. They figure they are normally healthy, aren’t going to a doctor very often, so why spend a fortune on health insurance premiums? This is how I generally direct people to go.  But then they go to a doctor, pay for the visit and associated costs, and wonder, ‘why the heck am I paying premiums if I’m paying for care too?’


A couple of months ago I had something come up with a client reinforced what I tell people all the time. When you have a higher deductible plan, it’s true, you are paying for a lot of your expenses. But, when you see a doctor or other type of provider that is contracted with the insurance carrier you have your health insurance with, you pay the contracted or ‘negotiated’ rate. Big deal? It sure can be.




My client had a lap band procedure done for weight loss. A couple of weeks after it was done, she received a call from the facility saying her insurance claim had been denied because her coverage had lapsed, and she owed approximately $22,000 for the procedure. Wow! Well, there had been a problem with payment and her group plan was terminated. She and I both called the carrier and got it straightened out, as the coverage was not supposed to be canceled. The facility needed to resubmit the claim, and it would be paid.


The next day I received a very nice call from a claim rep at this carrier saying that the claim had been recalculated and a check in the amount of $3804 would be sent that day. That was the ‘negotiated’ rate, down from $22,000. My client may have been able to negotiate a few thousand off herself, but one reason the insurance companies get strong rates overall is volume. Individuals can try but rarely do they have the ‘volume’ to get the better rates.


Just recently I had something similar happen. I went in for a physical and had the usual plethora of blood tests done. The lab bill alone was $484.50! But the ‘insurance discount’ was $385.25, so I ended up paying $99.25. You can’t tell me the lab isn’t making some kind of profit on this. So when you hear about all the debates in health care reform need to find a way to contain costs, keep these two examples in mind. Remember, it’s not only the insurance companies that are in this for the money–Be well!

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Health insurance–What’s a Deductible?

07-31-2008 by Colleen King

I always feel bad for people who find health insurance confusing–the things that really make it hard to understand, most people don’t even encounter. Most initial questions revolve around ‘what’s a deductible?’ Right after ‘what’s the difference between an HMO and a PPO (see my other post about that).


When evaluating a health insurance plan, either individual health insurance or a group health insurance plans, the one thing most people look at is ‘what’s my co-pay?’ It’s a good thing to know that, but more importantly (to me) are the following three items:


The Deductible

Co-insurance

Out of Pocket maximum

The deductible generally is what you pay before your coverage kicks in. Some benefits will be available prior to meeting the deductible, like the office visit co-pay. Deductibles are generally involved with PPO plans but in order to drive costs down HMO plans, particularly individual HMO health plans, are starting to have deductibles. I try to get my clients to look at the higher deductible health plans in order to save money on their monthly premium, but it all boils down to what people are comfortable with.


Co-insurance refers to what the insurance company pays versus what you pay once the deductible is met. you hear about 80/20, 70/30, 60/40 even 50/50 plans. The insurance companies pay the larger number.


The out of pocket maximum is really important because if something big happens to you, this is the number that keeps you from going broke. When a major health issue hits once you’ve met your deductible, and the 70/30 co-insurance kicks in, once your ’30% s’ hit the out of pocket maximum that is generally it for the rest of the calendar year. You may still have office visit co-pays and prescription co-pays, but other costs are pretty much taken care of until January 1 the next year. On a lot of PPO plans these can be $7500 or more, which isn’t chump change, but when you put that up against a surgery costing $100,000 or more, then it becomes a bargain.




Of course there are many other things to look at. Many individual health insurance plans in California, in an effort to come up with affordable plans, don’t cover maternity. Some plans offer generic drug coverage only, there’s all sorts of combinations coming up so you really need to look at what you are considering purchasing. That’s where an independent agent can come in handy.


Independent agents can help you sort through all of what’s available and help you decide which options will fit your situation best. AND, best of all, it doesn’t cost you anything to use an agent. The rates are the rates, and independent agents are paid by the carrier you place your business with. And a good agent will be there after the sale to hep you with any issues that come up. Be well!

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Health Insurance–what’s the difference between an HMO and a PPO?

07-18-2008 by Colleen King

Health insurance is never a simple thing, but the things that really make in complicated (in my mind) most people never encounter. The difference between an HMO and a PPO is pretty simple, but NOT if you don’t deal with it regularly.


  


Health Maintenance Organizations (HMOs) are where you select a primary care physician (PCP) and they coordinate your care, whether it’s hospitalization, referrals to specialists, you name it. They hospitalize you in the medical group’s hospital, refer you to specialists within in their medical group, and only go outside the ‘network’ if there isn’t a specialist that can handle something very complex.


Preferred Provider Organizations (PPOs) also have a network of doctors and hospitals, but you aren’t tied to a selected or assigned PCP. You choose who you see, and when. You can see non-network doctors and go to non-contracted hospitals but you pay a larger share of the cost.


Which kind of plan is better? Depends on your perspective. Many think HMOs don’t cover ‘anything,’ when in reality, from a financial perspective they cover more than a PPO. You just have a smaller network to choose from because that’s part of the cost containment mechanism.


People burn through the $$ often time with PPOs, but they have more latitude in who they see. In individual health insurance, at least in California, HMOs are more expensive than PPOs. But in group health insurance HMOs are less expensive.


So again, which is better? Ask 10 people, you’ll probably get 7 different answers. There’s a lot to consider specific to your situation. A good agent can help you evaluate your needs and make recommendations. If you’re in California and you don’t have an agent, feel free to drop me a note.


Be well!

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Group Health Insurance in California

07-12-2008 by Colleen King

Group health insurance is a HUGE discussion in California. It has been over the past 2-3 years as concerns rise over the uninsured. As well as the cost of health care–wow, it’s all exploding.


The beauty of small group health insurance (2-50 employees) in California is that when a company is set up within certain parameters, group health insurance is guaranteed issue regardless of the health status of the enrolling members. One of the things that has been fun about setting up group health plans for me is that I’ve been able to help people get insurance they need, legitimately, and frequently they didn’t know this was an option. Love doing that! Does that mean it will cost a fortune? Well, it isn’t cheap but the plans tend to have richer benefits than individual health insurance plans so that make it cost more. BUT, even with disastrous health problems, a two person group will never pay more than 10% about standard rates.


So when you think every group health case sold in California is profitable, it’s not. The carriers know they won’t make money on every plan sold, but that’s the way the game is set up in California. At the risk of sounding too ‘salesy,’ if you are having trouble recruiting and retaining employees, having a group health plan can help you get and keep the people you want.


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