Monthly Archives: June 2017

Aetna Health Insurance

Aetna Health Insurance announced they are leaving the California marketplace for individual and family plans. The end date of all their plans is December 31, 2013. All 49,000 Aetna clients still have six months to figure out what health plan they should move to. In this article we’ll give you a simple mapping that recommends which plans you should move to based upon the Aetna health plan you currently have, a “gotcha” to watch out for, and a couple of silver linings to feel good about.

The simplest way to replace your Aetna Health Insurance is to simply look for an alternative plan with the same (or similar) deductible amount. The recommendations below will make that easy to do. With just a little more effort, you could re-think what you need in yearly medical benefits and pick a plan the is a better fit for your current needs. Either way, you should be able to find a good solution listed below.

Aetna Health Insurance Underwriting Is More Lenient

This will be the gotcha for some people. Aetna has always been more willing to accept people with some health conditions. I know a number of my clients are in Aetna plans because they had specific health conditions that the other carriers either would not accept, or would “rate” much higher than Aetna. So this is something you have to be aware of and be careful about.

If you have existing health conditions, or are “too short” (okay… a little over-weight), or have a rated plan with Aetna, then you should definitely talk to a broker before you apply with another health insurance company. You’ll want to have the broker do Pre-Screen Requests for you to see how the other insurance companies will treat your application.

It’s important to do the pre-screen step first, because if you just pick a health plan, apply for it, and then get declined or rated even higher, it will be very hard to get other insurance companies to consider your application.

Let’s start mapping replacement plans…

Aetna Open Access MC Value Plan Alternatives

The Aetna Open Access Value plans are Aetna’s low-cost option. The Value plans offer a number of different deductibles, $8,000, $5,000, $2,500, and provide 3 office visits for a simple copay, and coverage for Generic prescriptions.

This plan description matches very closely to what is offered in the Anthem Blue Cross SmartSense plans. If you only need two office visits rather than three, then the best choices are the Health Net PPO Advantage plans and the ClearProtection plan from Anthem Blue Cross.

If cost of the plan is one of your major factors, then here is how the alternative plans above should be used.

  1. Health Net PPO Advantage 3500 – offers the best overall value (cost vs benefits)
  2. Health Net PPO Advantage 6500 – is usually the lowest cost option
  3. Anthem Blue Cross ClearProtection 3300 – Anthem’s lowest cost solution
  4. Anthem Blue Cross SmartSense 6000 – closest match to Aetna’s Open Access Value 8000, but lower cost
  5. Anthem Blue Cross SmartSense 3500, 2000, 1000 – if you feel more comfortable with lower deductibles

In the majority of cases, the alternative plans from Anthem and Health Net will be lower cost than the comparable Aetna Value plans. You’ll need to review health insurance quotes to see how the pricing looks for your location in California.

Aetna alternative plans from all major health insurance companies in California. The best plans!

Aetna Open Access MC Plan Alternatives

The Open Access plans are Aetna’s high-end offerings. These plans offered unlimited office visits for just a copay, provided both Generic and Brand name prescription coverage, and offered deductibles of 5,000, 3,500, 2,750, and 1,750.

The best mappings of the Open Access plans are the following:

  1. Cigna Open Access Value plans – Cigna’s entry plans, but very similar to the Aetna plans but without brand name prescription coverage
  2. Anthem Blue Cross Premier plans – these plans are the top of the line from Anthem
  3. Cigna Open Access plans – the high-end Cigna plans
  4. Blue Shield Shield Secure Plus plans – Blue Shield’s top end plans

Health Net does not have any plans that provide unlimited office visits and coverage of brand name prescriptions, so there are no options listed.

Aetna Open Access MC High Deductible Plan (HSA Compatible) Alternatives

These are Aetna’s entry in the Health Savings Account (HSA) compatible market. Like all HSA plans, they provide no benefits except zero-cost preventive care until after you reach the deductible. The plans come with two deductibles, either 5,500 or $3,500.

The mappings for these HSA plans is the following:

  1. Health Net CFB HSA 4500 plan – this is the best value HSA plan in the market
  2. Health Net CFB HSA 6000 plan – this is the overall lowest cost HSA plan
  3. Blue Shield Saver HSA plans – these are lower cost than the other non-Health Net HSA plans
  4. Cigna Health Savings 4900 plan – good general purpose plan
  5. Anthem Blue Cross Lumenos 5950 plan – Anthem’s last remaining HSA plan

Are You Looking For Lower Out Of Pocket Risk?

Some shoppers may be looking to lower premiums AND lower the OOPM’s they have had in the past. If this is your wish, then here are a couple of options you should explore:

  1. Health Net CFB PPO Standard plans – the OOPM in these plans is equal to the deductible, and 2 office visits for a copay
  2. Cigna Open Access Value 5000/100% – the OOPM is the same as the deductible, and the plan offers unlimited office visits

These alternative plans will cost a little more than the direct replacement options listed in the sections above. However, the attractiveness of having lower risk if an accident or a medical condition starts is very compelling.

Silver Linings In The California Aetna Health Insurance Decision

I believe that Aetna is just the first in a line of large and small health insurance companies that will leave the California individual and family health insurance marketplace over the next 3-5 years. Aetna had a very small market share, and would have a hard time competing with the insurance companies that dominate the California market. So having Aetna leave now will reduce the turbulence we see during the Health Care Reform roll-out later this fall.

The first silver lining in all of this is that Aetna plans tend to have very high Out-Of-Pocket Maximums (OOPM). As an example, for a family, the Open Access Value 8000 plan has an OOPM of $25,000, while the Anthem Blue Cross SmartSense 6000 plan and the ealth Net PPO Advantage 6500 have a $19,000 OOPM.

This is one of the reasons people have stayed away from new Aetna plans unless no other health insurance company would accept them. There are plenty of plans from Health Net, Anthem Blue Cross, Cigna, and Blue Shield that will have lower OOPM’s than the Aetna plans.

The last silver lining of this change at Aetna, is that Aetna plans have not been very competitive the last couple of years. So changing to comparable plans will give you a reduction in premiums. With the information we’ve given you above, you should be able to find a good Aetna replacement plan, now go forth and prosper.

Health Habits and How to Stop

We commonly hear about “yo-yo” dieting, but in fact people are tempted to approach many other health habits in that up and down style. What is yo-yoing? When you try dieting or getting healthy in an all or nothing fashion, then you’re yo-yoing. These health habits feel great when you’re on the upswing, successfully performing all the rules that you’ve set in place. Once you run out of motivation to practice health habits at such a stringent level, then you enter the yucky downswing of this practice. All the progress you made can seem to vanish overnight. How do you break this vicious cycle?

Yo-yo habits place a burden on your body by not letting health settle into a steady rhythm. With so many ups and downs, the body doesn’t feel rested or truly taken care of. The habits are also intertwined with mental-emotional ups and downs. To break the cycle, this style of healthiness has to be recognized for what it really is—a diversion rather than true self care. When you decide to go from nothing to everything, from total neglect to constantly pressuring your mind and body to do one thing, real health habits don’t get a chance to develop.

Which health habits are you used to yo-yoing? Are they related to diet, exercise, sleep, or something else? Think about why you approach your health habits in this manner. Sometimes fear can infiltrate a natural urge to get healthy and make you feel like if you’re not doing everything, then it’s not worth the effort. This mindset can make you feel more deficient than it does provide you with effective motivation, support, and momentum toward health. Feelings of fear and deficiency then become the foundation for new health habits, and they don’t offer a very steady foundation at that.

This pendulum mindset obviously tells you that putting in smaller amounts of effort more consistently is not good enough. But does that make sense? When you watch an athlete practicing a sport, someone who goes all or nothing doesn’t get a chance to regularly practice good habits for performance. Your health is the same way. Consistent habits, even if they’re on a smaller scale will go a lot farther than large efforts that only last a few days to a week. When you focus on quality over quantity in health, you’re taking a more realistic approach and one that your body will welcome more openly and sustain over a longer period of time.

Take a look at your health habits and figure out whether they’re in danger of the chaotic yo-yo experience or whether they’re actually sustainable. Think about which of your habits have never lasted past the short-term and why that may be. If you notice some yo-yoing going on, brainstorm on how you can re-frame these habits into more lasting and quality expressions of health.

As you resist the urge to yo-yo and you settle into more realistic and consistent health care routines, you’ll be amazed at how much farther your efforts take you. The fears will be easier to face when you’re not riding a health roller coaster, and feelings of deficiency will be less frequent and instead be replaced with more natural confidence and motivation surrounding your health.

Your Health and Your Inner Master

When you travel the halls of your memory, who do you remember as your most influential teachers? How did these teachers influence your life and change it for the better? Great teachers spark more than math, literature, or science in your life. They spark something else as well, something deeper and long-lasting that stays with you. As an individual living your life, you have another teacher you may not have touched on in your memory. That teacher is you! When you’re trying to get healthy and support your body and mind better, your inner teacher is key toward achieving what you want.

Health involves learning. You learn about your body and which lifestyle habits foster balanced health, versus which habits derail health. But you also learn something else. You learn about yourself as a person, how you face challenges, and which obstacles are blocking your road to health. The journey toward health involves more than regimens for diet, exercise, and sleep. The journey is unique to who you are and where you’re at in life too.

Bringing out your inner teacher to learn about your health isn’t always easy. Everyone wants to believe they are perfectly healthy, and sometimes facing the reality that your health needs more support can be challenging. It means admitting that you’re not perfect and that you still have more to learn. It takes knowing that supplements, medications, or doctor’s visits alone can’t keep you healthy. You as a person are an essential part of your health, and acknowledging this fact takes honesty and courage.

When you call forth your inner teacher in an open and honest way, you can explore your physical and mental-emotional health through a unique lens. You can ask yourself if there are societal and personal expectations that are burdening you and blocking your health. You can explore whether some part of your past unfairly has a hold on your health and who you are today. You can explore your relationships with yourself and other people to see whether they are supporting or hindering health. You can also notice how you manage stress and emotions and whether your current approach could use some adjustment for better health.

Good teachers both challenge you out of your comfort zone and patiently support you through the discomfort that can result. Getting healthier can feel strange and uncomfortable at times. The body and mind are used to doing what they always do—in other words, homeostasis or equilibrium. They will maintain states of health, but they also maintain states of unbalanced health. To get healthy, your inner teacher has to push you beyond comfortably unhealthy habits. On the other hand, your inner teacher also has to patiently help you through these potentially awkward transition periods and regularly remind you: “I can do this!”

What steps have you taken lately to bring out your inner teacher on the road to better health? If you feel that it’s been a while since you’ve listened to your inner teacher, that’s okay. He or she is always there and you can turn to that side of yourself when your health feels neglected or stuck. Remember to give your inner teacher the same respect that you would any other great teacher in your life.

As you head into the autumn season, a period of time that is infused with transition in the air around you, encourage your inner teacher by asking yourself the following questions:

1) What are current strengths in my health?

2) What are some weaker points of my health that require more attention and learning?

3) Without focusing too much on the past or the future, what steps can I take today toward better health?

4) What are my obstacles to health in the present moment?

5) How can I create space in my life for my inner teacher to express itself and help me with health?

As you ask yourself these questions, you’ll find that your body and mind naturally know which direction to go in—if you listen to them. By paying attention to your inner teacher, you’ll learn new things about your health and how better to support it. And you’ll enter your own hall of fame of great teachers.

Affordable Health Explained

Telemedicine is an important component of the robust and technology driven Affordable Care Act system (Obama care) and provides avenues for reducing costs in the new healthcare structure, because it offers options in how to access healthcare services.

The Affordable Care Act is the most comprehensive overhaul of the nation’s health care system in decades and it’s implementation and sign-ups will all be processed through marketplace exchanges.

What is the Meaning of Telemedicine?

Telemedicine is the use of telecommunication and information technology to provide clinical health care without a traditional face-to face consultation. It helps eliminate distance barriers and can improve access to supplementary medical services for people with:

  • Basic or No Insurance
  • High Deductible (HDHP) Insurance
  • Traditional Insurance

Tele-health Vs Telemedicine

‘Tele-health’ is an older, broader term for services such as health education and is not limited to clinical services, while ‘Telemedicine’ narrowly focuses on the actual curative aspect between the patient and healthcare professional. Examples of Tele-health are health professionals discussing a case over the telephone or conducting robotic surgery between facilities at different ends of the world.

Tele-Health has a broader scope than telemedicine and is sometimes called e-health, e-medicine, or telemedicine. Health care professional use tools like e-mails, e-visits, e-prescribing, after-hours care, e-reminders, health assessments, self-management tools, health coaching etc.

The State of the Market

The Affordable Care Act (Obama Care) Health Insurance Exchange (HIX) opens on Oct 1st, 2013. and goes into operation on Jan 1st, 2014. The Obama Care exchanges, are State, Federal or joint-run online marketplaces for health insurance. Americans can use their State’s “Affordable” Insurance Exchange marketplace to get coverage from competing private health care providers.

Steps to Sign up for Health Care Plans

  • Participants enter personal information into a web portal
  • Learn their eligibility for subsidies based on income, state-determined criteria or employer-based options.
  • Use a price calculator to shop, compare and choose a best benefit health plan.

Several major health companies have programs like TelaDoc in Aetna, KP-OnCall in Kaiser etc, trying to set up footholds in a market that is widely expected to grow rapidly. All participants have to do is research for telemedicine benefits through their health insurance plans or sign up for independent programs.

How Health Care Professionals Administer Telemedicine

Doctors can treat most everyday health needs by phone or a scheduled video consultation. A study by the American Medical Association shows that 4 out of 5 visits to a primary care doctor could have been treated over the phone instead. After each consultation, patients will receive a clinical report which can be emailed to a primary care physician.