Posts Tagged ‘health insurance’

Pre-existing Conditions and California Residents

Thursday, July 8th, 2010

Startling news shows that one in five California residents (under the age of 65) have a “pre-existing” condition, which could render them ineligible for coverage, or offered premiums at inflated rates. Though health care reform promises all Americans coverage by 2014, this still leaves many without the coverage they need for years. What is considered a pre-existing condition? Pretty much anything you have been treated for, or are currently under treatment for prior to applying for coverage. While not all conditions will result in your denial for coverage, it can result in an increase in the monthly premiums from 20% – 100% higher. If you had a lapse in coverage, but are approved for coverage on a new plan, there may be a waiting period of 6 months before anything relating to your pre-existing condition will be covered by your insurance plan. The good news is as of September of this year, children under the age of 19 cannot be denied coverage due to their pre-existing conditions.

As your full service agency, we are happy to answer any of your questions relating to eligibility for a plan due to pre-existing conditions, what kind of rate increases you may be looking at due to your health history, as well as determining whether or not the six month waiting period applies to your situation.

Healthcare Reform and the Prevention of Chronic Illnesses

Thursday, July 1st, 2010

However you may feel about health care reform and the changes it will bring, one major outcome will be the mandatory implementation of preventative care on all policies. It is proposed that preventive care will be covered without any co pays or deductibles. Considering it is thought that half the conditions we treat in our health care system could be avoidable, the expansion of preventive screenings and vaccinations should help to bring down the number of chronic conditions that we see today.

It is estimated that 75% of our health care spending in on such chronic health conditions. If these illnesses could be treated and diagnosed in the earliest stages, the better the outcome for the patient. Plus, it would result in less financial strain on our health care system. While opponents to the bill state that “unnecessary screenings” will ultimately cost us more, you can’t argue that prevention yields a longer, healthier, and more productive life.

Modernized Medicare Supplement Plans

Thursday, June 24th, 2010

As of June 1, 2010 major changes will be made to the Medicare Supplement industry. This comes via HR 6331, also known as the Medicare Improvements for Patients and Providers Act, which was passed on July 9, 2008. This act intends to modernize the current Medicare market by dropping some coverage options and adding others to streamline the plans. Here is an overview of some of these changes:

“At-Home Recovery” benefit will be dropped from all 2010 Medicare Supplement plans
Medigap Plans I and J will no longer be available for new sales
Plan G will be modified to increase excess charges from 80% to 100%
New Hospice Benefit will be added to all plans
Two new Medigap Plans M & N will be available in 2010

The new plans will include the following choices – A, B, C, D, F, High Deductible Plan F, G, K, L, M, and N. Though some current plans will no longer be offered for sale, current enrollees can either choose to remain on these “frozen” plans, or consider moving to one of the new modified versions.

Many Important Health Care Reform Changes for Young Adults

Thursday, June 17th, 2010

While many young adults faced losing coverage as they aged off their parent’s plan, had no coverage in the case of an unexpected pregnancy, or merely had the bare necessities covered by their school plans, all can breathe a sigh of relief as health care reform promises to end their fears.

As mentioned in earlier posts, the most immediate change is coverage will be extended to overage dependents, as long as they are not offered other employer sponsored coverage, up through their 26th birthday. This helps ease the burden of uninsured claims, as many of these adult children would wait over two years before attempting to obtain their own coverage.

Another helpful option for these previously uninsured individuals is the fact that more than half of them will be eligible for either Medicaid in 2014, as their income is expected to be less than 133% or qualify for government subsidies if they decide to purchase private insurance through an exchange if they are earning 400% of the poverty level.

More relief serves in the fact that maternity coverage will be a mandatory inclusion on the plans, something that is either excluded completely or greatly restricted, depending on what state you reside in. This is most important during young adulthood, as is the need for access to contraceptives, which will also be covered.

The fact that lifetime maximums will be eliminated also sheds light on the current state of most university based plans. Many tend to cover only the most basic of health needs, and offer only limited protection for conditions that are considered eligible medical expenses. With the implementation of comprehensive coverage for all adult children, in spite of of any pre-existing conditions, we can breathe easy that coverage is in place should they need it. Regardless of how you feel about health care reform, we can all agree that all youths of our nation deserve health care coverage!

Health Care Reform – where it is headed?

Monday, May 17th, 2010

We are now well into the first year following the passing of the health care reform bill. However, we still are not completely sure of what the changes are going to be, and how it will affect all of us. While some portions of the bill are clear cut, such as extending coverage to overage dependents, many of the larger concepts remain to be fully explained. How are small and large businesses going to be able to afford coverage for their employees? How will the tax breaks help or hurt? How can coverage for all Americans remain affordable?

We have yet to see where this will take us, but we are going to do our best to keep up with each passing moment in the world of health care reform, and pass on the information to you. It will be a lengthy learning process, but we are jumping in headfirst to the plethora of information out there. It is our ultimate goal to get the answers you need!

Lack of Pediatric Specialists a Growing Concern

Wednesday, May 12th, 2010

  Health Care Reform promises to ensure that all Americans have access to medical coverage. The most pressing concern is the fact that many children are without coverage and the care they need now, so the bill states that by September 23rd, 2010, no child can be denied coverage due to pre-existing conditions. While this is well needed, it does bring to light the fact that there is an increasing shortage of Pediatric Specialists. With an influx of new patients entering the system, and the demand for both medically necessary and non-medically necessary treatments rising, will there be enough physicians to handle the load?  

The problem lies in the way these specialists are compensated. Since the majority of their reimbursement comes from Medicaid, and is only covering about 67% of the cost, many new physicians decide to pursue alternate fields of specialty. With limited doctors, the average wait time to see a specialist can be as long as 114 days. This may cause parent’s to turn to the emergency room instead of waiting for a pediatric visit, putting the child at risk with inferior medical care. Hope lies in requiring Medicaid to pay Medicare rates, assisting new doctors with outstanding medical school loans, and funding for continued training. If we lose our pediatric specialists, we put our future at risk.

Maternity Coverage – Important Notice

Thursday, April 15th, 2010

 Important news for our Anthem Blue Cross clients in California who are on non-maternity plans! Prior to June 1st, 2010, if you became pregnant while on a plan with no maternity benefits, you would be offered their high deductible PPO Share 5000 plan. However, now that this is no longer the case, it is extremely important we evaluate your current situation to ensure coverage is in place when you need it.  

Did you know that a C-section can cost around $30,000? Or that a premature baby can run up hospital bills in the $600,000 range? This only demonstrates the importance of making certain you are covered before becoming pregnant.  

Please contact us today to go over your options, Phone us, or click on our Live Chat option and we will be happy to assist you.

The Balance Between Age and Health Insurance Coverage

Thursday, April 8th, 2010

Recent polls show an interesting correlation between age and health insurance coverage. Though many other factors, such as income, also play a major role in who obtains coverage, and who chooses to go without does depend greatly on the age group of that individual. According to a newly released
Gallup Poll:  
• 84% of 18 year old children have coverage  
• Once these individuals reach the age of 22, the percentage drops to 66%. Currently, as these older dependants reach this age, or graduate college, they no longer qualify to be covered under their parent’s coverage (note – with the implementation of health care reform, these numbers will be expected to drop as the eligible dependant age is extended to 26)  
• This number rises only slightly through the remaining years, until Medicare age is reached. At this point, 95% of American’s are covered  
These statistics are startling, as more and more young adults find it next to impossible to find a job with benefits, or feel that they are too healthy to need the burden of monthly premiums. These individuals risk financial ruin for themselves, and their families. Therefore, obtaining some sort of coverage, even if it is hospitalization only coverage, remains a vital priority.  
These numbers also play an important role in the passing and implementation of the health care reform bill. Opponents state that even though coverage will be extended to all Americans, the cost will rise as much as 17% for younger individuals, while dropping slightly the cost for older Americans. Proponents find that the number of currently uninsured younger (healthier) clients is the reason that premium pricing is so skewed. By increasing the number of healthy individuals in the pool, the overall “risk” for everyone will be reduced.

The First Year for Health Care Reform – Step One

Thursday, March 25th, 2010

Though some fine tuning will be taking place, the plan for implementing the Health Care Reform Bill during the first year will (most likely) look something like this:

  • Dependent children will be eligible to stay covered under their parent’s plan until their 26th birthday. The House is still pushing to make this coverage last through their 26th birthday.
  • Insurers can no longer impose exclusions on pre-existing conditions in children. Children are considered exempt from this until their 19th birthday 
  • Lifetime maximums on benefits and annual limits on coverage will be discontinued 
  • A “high risk pool” will be created for people who cannot otherwise obtain individual coverage due to pre-existing conditions 
  • Seniors will receive a $250 rebate for help them cover the costs of their medication while in the “doughnut hole” (between $2700.00 and $6154.00) 
  • The implementation of covered preventative care services requiring no co pays

Though the final outcome is still yet to be known, these are some of the highlights of the plan of action for health care reform in 2010. Though changes will be made, and battles will be fought, we can expect some of these changes to take shape in less than 6 months from now. From then on? No one knows for sure. We do know, however, that every American will be watching and waiting to see what happens next.

Health Care Reform is here! What does this mean for you?

Monday, March 22nd, 2010

No one really knows! It seems that revisions are made by the hour, and nothing is quite set in stone as of yet. Also (as of this hour) 11 states have filed lawsuits stating that the bill is unconstitutional, in that it forces people to pay for coverage or face financial penalties. Does it promise to cover all Americans? Supposedly, by 2014, after spending the next few years inching towards this goal by means of guaranteed issue policies, no lifetime maximum amounts, the cessation of policy rescission’s, etc. Once this is in place, individual policies would be purchased via an exchange:

 Health Benefit Exchanges. Effective in 2014, state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges are established, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. States are permitted to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017. States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. (Funding available to states to establish Exchanges within one year of enactment and until January 1, 2015)

 We will see some changes right away, such as offering coverage to all children regardless of pre-existing conditions, and the creation of high risk health pools. Others will take more time, such as the adult pre-existing conditions being a non-issue when it comes to obtaining medical coverage.

 Proponents of the bill claim this will save us trillions over the years, while opponents can’t see how that is possible. Guaranteeing and requiring that all obtain health insurance coverage cannot be without a hefty price tag, can it?

 Stay tuned………


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