Monthly Archives: September 2017

Increased Health Insurance Rate and Health Plan

Everybody is getting large health insurance rate increases this year. The size of the increase is making many people look for alternative health insurance plans. One type of plan is being especially hard hit with double digit increases, and those are grandfathered health plans. We’ll cover what’s happening and what you can do to protect yourself from the rate increases that are taking place.

You may be thinking, “What’s a grandfathered health insurance plan?” The answer is, if you have a health insurance plan that was in place on March 23rd of 2010, and you haven’t made any changes to your plan, you’re still in the same plan, then you have a grandfathered health insurance plan. If you’ve been in the same plan for 5, 10, 15 years, then you have a grandfathered health insurance plan.

Grandfathered plans have some special exemptions and characteristics, so we need to go over those in a little bit more detail. The easiest way to do that is to tell you a story about a recent client. That client’s name is Barry.

Barry and his wife are 52, and they have two daughters; one 21, and one that’s 16. Barry shared with me that their letter basically told them their new rate was going up almost 24% and they would be paying $1389 a month. They were in an Anthem PPO Share 5000 plan, and they’d been in that plan so long, he didn’t even remember when they actually started it. The rates had increased progressively from one year to the next.

But this year, the rates were finally high enough that he said he didn’t want to pay that much anymore, he wanted to find an alternative. So he called his agent, and then he called Anthem Blue Cross directly. In both cases, they told him to “just ride it out” and wait to see what happened in 2014, after the Affordable Care Act kicked in. That wasn’t an answer Barry was willing to live with because he wanted a solution today.

So when Barry called he shared the above information and his fear that he would have to pay higher rates. When queried about the health characteristics of his family, he said they were all healthy, and that other than one or two colds, they did preventive care and that was pretty much it. Their current plan was very rich in benefits that they weren’t making use of, based on what he’d described.

After running a set of quotes for the family, and scanning all of the different options, it became clear that one of the best options for them was the Health Net PPO Advantage 3500 plan. The reason is because it gave them two office visits for a simple copayment, and then all of the preventive care was free. That’s not something that they had in their PPO Share plan. They actually have to pay for their preventive care as part of their deductible costs in that plan.

The monthly premium on that Health Net plan was only $480 a month, so they were saving a little over $900 per month, or $10,900 per year. Barry really liked that. But he said, “There’s a big difference in benefits between these two plans. Can you show me a plan that’s a little bit closer to the benefits we have in our grandfathered plan, but at a lower cost?”

So looking through the list again, the closest match was the Cigna Open Access 5000/100% plan. It has a $5000 deductible and has unlimited office visits, which is very similar to the plan they currently have. But the monthly premium is only $928 a month. They could still save almost $500 per month, and $5500 in savings over the course of a year. Now, I don’t know about you, but saving $5500 to $10,900 is a pretty substantial amount of money for any family. Barry loved the heck out of that.

But he was still a little bit concerned. He said, “I like those plans, and I’m glad that there is an option that looks like it could save us a ton of money. But what am I giving up if I leave this grandfathered plan?” He needed to know what the advantages and disadvantage of a grandfathered plan are.

Advantages Of Grandfathered Health Plans

The advantage is that it’s outside of the Affordable Care Act. It’s not regulated, so it doesn’t have to have all the essential health benefits, and it doesn’t have to add all the extra benefits required by the Affordable Care Act. So hopefully, it’s going to have a lower cost. But that’s the only advantage of a grandfathered plan.

Disadvantages Of Grandfathered Health Plans

There are a number of disadvantages to grandfathered plans. First of all, they don’t free preventive care. For a family that has people over 50, that can actually be pretty substantial when you start looking at colonoscopies once every few years or so.

Secondly, in all health insurance plans, when it initially starts and gets to its largest size, there’s a pool of people that are inside of that plan. The premiums that the pool of people pay, covers all of the medical expenses for everyone in the plan. But over the years, as people leave that plan and move to lower cost plans or plans that better fit what they currently need, the number of people in the plan shrinks. This the typical lifecycle of a health insurance plan. At some point, the people that are left in the plan are either people that just never bothered to leave, or people that have health conditions that prevent them from being able to leave the plan. At that point in time, the rates for the plan start to climb much faster than the rates in other plans.

The last nail in the coffin for grandfathered plans is that because it is outside of the Affordable Care Act, come 2014 when the rates go up yet again, people on the grandfathered plans are not going to be able to qualify for subsidies. So they’re going to get no financial assistance at all, they’re going to have to pay for all their preventive care, and the rates on their grandfathered plan will increase again, so it probably isn’t going to make a whole lot of sense to stay in the old plan.

At that point in time, Barry was pretty much ready to change plans. He understood why his plan was going up so much; he liked the fact that there was a solution for him; and he actually started to get kind of frustrated. He said, “My agent and the Anthem Blue Cross representative both told me I should ride this out. Why did they do that? That doesn’t make any sense.” Not wanting to say something bad about somebody else, I told him that if he had asked the same question a year ago, I would’ve said to let it ride. Just stay in there and wait for more information, because nobody knew what the Affordable Care Act plans were going to be, and nobody knew what the rates were going to look like on the new plans.

However, a lot has changed since January of last year. During the summer and fall, the Affordable Care Act “metal” plans were described. Not the specific benefits, but what they’re going to look like in terms of benefit levels. The insurance companies, have given indications about what the pricing is going to look like for these new Affordable Care Act plans. What they’re saying is that the average cost is probably going to be anywhere from $300 to $500 per person each month. So for a family like Barry’s, it’s anywhere from $1200 to $2000 per month. The cost of the Affordable Care Act plans and his current grandfathered plan are pretty much even right now, and his plan is going to go up even more next year.

Barry decided there’s really no benefit to staying in his grandfathered plan, because he’s not going to get any subsidy help, and he’s not going to get free preventive care in the grandfathered plan.

The end of the story is that Barry’s family was accepted, and they were going to take a dream vacation this year, using some of that $11,000 they’re no longer paying to a health insurance company.

As you can see from this case study, it’s really important that you stay on top of what’s happening with the Affordable Care Act, because things are going to start moving very quickly this year. States and the feds are beginning to quickly build the exchanges, and the insurance companies are creating the new metal plans to go inside and outside the exchanges. Knowing what steps you should take to position yourself and your family to be able to make a smooth transition to the new Affordable Care Act plans is important.

If you have a grandfathered health plan there are some exemptions that you have to consider, along with determining where your grandfathered plan is in its lifecycle, to determine if it makes sense to stay with the plan you currently have, or if making a change is a better option. There’s no sense going down with the ship if you don’t have to.

Tim Thompson is the founder of SPF Insurance Services in San Diego, CA.

At SPF Insurance, we’re Affordable Care Act experts. We analyze the health insurance plans from the major California insurance companies in making our recommendations. We analyze the regulatory changes to determine what strategies our clients should use to protect themselves. You won’t find boilerplate information at the SPF website. For more information about health insurance rate increases, see the post “Health Insurance Rate Increases A Regulatory Tsunami”.

Child Health Insurance Plan

Finding Affordable or No Cost Insurance For Your Child

Every child needs dependable health insurance. However, not all parents can afford the full cost of private medical insurance. As a result, there are a variety of programs offered by the state of California and private organizations that can provide health care to financially strapped families. Through these programs, there should be no child in California that doesn’t have health insurance.

In the sections below we will give an overview of the child health insurance programs that are available in California. Some of these plans provide complete coverage for children at no cost, and others provide just the basic services. Then we’ll outline the steps parents should take to find the best program for their children.

Medi-Cal

This is the name for California’s Medicaid program. The program is administered by California, and is financed equally by the Federal and State government. Medi-Cal provides no cost health insurance to low-income families, seniors, and people with disabilities. People that qualify for Medi-Cal can receive free preventive care, treatment for injuries and illnesses, dental care, vision screening, and mental health treatment.

This program is one of the cornerstones of the Affordable Care Act, and will expand considerably to take in new people in 2014.

Healthy Families

The healthy families program provides low cost health insurance to the children of low income families. This program provides a variety of services such as medical, dental, visions, and preventive care.

The Healthy Families program is being rolled into the Medi-Cal program during 2013. The transition plan will ensure that families do not see a disruption in services, and will increase the benefits that children receive once inside of Medi-Cal. Healthy Families is still accepting applications for new children.

Child Health and Disability Prevention Program (CHDP)

This is not an insurance program. However, the program does assist low income families in obtaining preventive care and health assessments for their children. CHDP provides checkups, nutrition evaluations and guidance, immunizations, hearing, and vision screenings. This program is administered by the state Department of Health Care Services (DHCS). The program helps families determine their eligibility for assistance programs, and enroll in the appropriate care program, such as Healthy Families and Medi-Cal.

Children’s Health Initiative (CHI)

Children’s Health initiative is run by an independent non-profit known as The Institute For Health Policy Solutions (IHPS). CHI works with many counties to reach the low-income families with children that don’t have health insurance. CHI works with families whose income is less than 300% of the Federal Povery Level. By providing technical support and guidance, programs are created in each county to create “Healthy Kids” insurance plans in a partnership with the local communities and businesses.

California Children’s Services (CCS)

CCS is a state program that provides health care assistance to children up to age 21 with special health problems. The program works with Medi-Cal and Healthy Families to provide case management and ensure that children receive the right care and see the right physicians for their special health needs. Examples of special health problems are cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, and traumatic injuries.

Steps You Should Take To Find Affordable Child Health Insurance

If the mother of a baby is enrolled in Medi-Cal or the Aid for Infants and Mothers (AIM) program, then the steps below will not apply for getting baby health insurance after birth. In this situation, the baby will be transferred into Medi-Cal with the mother, or into Healthy Families or Medi-Cal if the mother is in the AIM program. For all other situations, use the steps outlined below.

  1. The first step is to look at the coverage map for the Children’s Health Initiative above. If CHI has an active program in your area, then this program can act as your partner in helping you get into the correct health program.
  2. If CHI is not active in your county, then contact the Child Health and Disability Prevention Program. This office can help you through the process of finding the correct program and assist you in filling out the necessary forms, or they will put you in contact with a local office for assistance.
  3. If neither of the steps above works, then you should contact your local Medi-Cal office. Medi-Cal will be your lowest cost solution, so start with this program
  4. If you do not qualify for Medi-Cal, then contact the Healthy Families program.

No child in California should be left without health insurance. By providing the proper care and nurturing, we ensure a better future for our state. The programs we have outlined above can provide families with financial difficulties, the health care their children need. The first move is to follow the outlined path, taking one step at a time, and enrolling your child or children.

Tim Thompson is the founder of SPF Insurance Services in San Diego, CA and has been writing about insurance topics for over 10 years.

What makes SPF unique in the health insurance industry is the updated analysis we provide to the website visitors. If you need to know what the “Best” plans are for your situation, we done that analysis and published a report. The website provides a search function so you can quickly get the information you need.

Is It Really Cheaper Health Insurance If You Are Healthy?

Insurance companies have various ways of determining health insurance premiums. The laws which regulate these practices vary from state to state. Currently many insurance companies charge rates according to the health of each applicant for individual policies. Generally the person’s age, gender and occupation are factors in determining rates. Current and pre-existing conditions are also factors in establishing prices.

The Health Status Rating is a rating system which charges higher premiums to people who have medical conditions or a history of medical conditions. Oftentimes, a health status rating is used for people who are joining a health plan for the first time. This is primarily used for individual and small group health plans.

The Health Status Rating system specifies certain conditions which could increase the likelihood that new clients may need health care. In these cases a person who might need health care could pay more than one who does not indicate a need for health care. Currently insurance companies can decide to offer or decline insurance coverage to people with certain underlying conditions. However, beginning in 2014 under the new health care insurance law they may not be able to do this.

Employers seeing their health insurance costs increase are raising rates. They can do this by requiring some workers to either pay higher deductibles or increase the costs of their policies. Individuals and families who don’t have employer-provided health insurance are particularly vulnerable to high rates because they must pay for the total insurance bill on their own.

One national company has requested that employees must reveal their weight, height, body fat and blood pressure. The company referred to this as a “health screening and wellness review.” Employees who refuse to provide the information will be required to pay an extra $50.00 per month for their health insurance.

Let take a look at this requested information. First of all the company wants to know the height, weight and body fat levels. This means they want to know the percentage of body fat relative to your overall height and weight. Your body fat percentage is calculated by taking your age, height, weight, gender and waist measurement into account. This will determine if you have too much or too little body fat. Body fat levels affect the immune system. Too much or too little can increase the risk of developing health problems.

High levels of body fat can be dangerous to your health because excess body fat increases your risk of developing serious health problems. High blood pressure is one of the primary risk factors. Excess amounts of body fat also increases your risk of developing high cholesterol, cancer and diabetes.

Low levels of body fat can be detrimental to health in numerous ways. Extreme low levels of body fat decrease the function of the immune system. This increases the body’s susceptibility to illness. It can also deprive the body of stored energy and lead to a loss of bone density which can increase the risk of stress fractures.

Your health insurance costs may definitely be cheaper if you are in good health. Therefore, your best option to avoid an increase in your cost of future health insurance is to be as healthy as you can be. In general, eating right and exercising will go a long way towards achieving this goal.

Go to Truckingsos.com to read more articles about health insurance and truck driver issues such as health insurance for truck drivers and health insurance costs. Trucking sos.com is your premiere source for trucking industry information.

Parlous Community Health Insurance in Australia

With the introduction of the original Medicare scheme by Gough Whitlam in the early seventies, it was the general hope that Australia would be ushered into a new era of public health insurance for all, met by a levy on all tax payers, this, it was hoped, would ensure that no-one in Australia would experience sub standard access to necessary health care. With the defeat of the original Labor government, successive liberal and labor governments have meddled with the original scheme, so that today we now find ourselves with a two tier scheme consisting of a minimal health insurance scheme for the uninsured public, and a private health insurance scheme targeting that proportion of the population that can afford it, which by and large is run as a profit making enterprise by various companies. At the time undoubtedly vigorous lobbying by companies in the industry set the tone of how the system would be run to ensure that it would operate to the benefit of the industry first and foremost, while paying lip service to the needs of the Australian public. What began as a noble and just cause by Whitlam was soon dismantled and degraded by the self interest of the free enterprise cowboys.

Today, we are faced with a two tier system of private health insurance cover which is supposed to guarantee that a person has access to the best possible medical facilities and a long line of people who are just as much in need of those facilities, but who simply do not have the financial power to access them, and are therefore, faced with long public health queues. Scaremongering continues to drive more working Australians into the arms of private health insurers and any attempt to reign in the excesses of companies in the sector was abandoned long ago when the Government privatised its insurer, Medibank. The current state of affairs is tantamount to a cynical exploitation by private enterprise, to bleed as many members of the Australian public as possible whilst offering as little as possible, in return.

The reason for this is two-fold. People are encouraged to take out health insurance at an age when they become members of the workforce and by and large in good health, a time when they, have, statistically, very little need for the insurance the companies provide. However, once these people retire just at a time when their access to the health services will start to increase, they are no longer able to afford the premiums, and are, therefore, denied the insurance they have paid for so many years. This leads to the interesting situation of someone who may have worked thirty plus years, during which time they made relatively little use of the insurance scheme, then find themselves debarred from accessing it because of their inability to afford the premiums in retirement.

Of course, the insurance companies will tell you that their mission in life is to ensure the best possible health coverage for their members, but they normally gloss over the fact that once you are no longer able to pay your premiums, you are automatically no longer a member either, and therefore, their concern for your health and wellbeing, evaporates. Undoubtedly, these companies who have enriched themselves in this system are also influencing governments to increasingly raise premiums because it is in their own economic interest to do so, and as we have seen in recent rises, they are able to do so beyond the increase in the CPI, which in itself hints at a cynical exploitation of their members. Furthermore, even those of us fortunate enough to be able to afford the highest premiums, and would therefore expect to be fully covered, will find that a percentage of the costs associated with any medical treatment will still be sheeted home to themselves, as the insurance companies seldom, if at all, cover one hundred percent of all medical expenses incurred.

One needs to ask the question, when increases in health insurance premiums are announced, to what extent companies in the industry influence the determination of these premiums? Can they be traced back to the profit making organisations in the health insurance industry, in other words, are the government bureaucrats who determine that the permissible rise in health premiums unduly influenced by the commercial interests of the profit making health insurance companies?

Whether this is occurring or not, is more difficult to find out than one could imagine. Try Googling who sets health insurance premiums in Australia and your search query will come back with zero results. Try any combination of these or try to look through the Health Insurance Act, to determine how actual details of how insurance premiums are set, (supposedly in the interest of all Australians); it is simply not readily available. It begs the question, whether we ought to look at the post Public Service careers of some of our health bureaucrats?

Similarly, not all companies offering health insurance are run for a profit, there are some middle funds etc., which purport to be non profit, and are run for their members. This is all well and good; however, when we look at premium movements, even these organisations tend to follow fairly closely the premium rises put forward by the profit based health insurance companies. They may well argue that by doing so, they can better support their members, but again, one needs to bear in mind that one can only be a member of these funds, as long as you have the capacity to pay. Once that finishes, you revert back to the public health system, whether you have been a lifelong diligent member of the fund, or not.

For any person starting out in the Australian workforce, I would urge you to set up a savings account and into that account pay the premium you would normally pay to your insurance company religiously. You will find that by doing this, not only will you accumulate quite a large amount, it will earn you interest, and once you have a reasonable sum in there, accessing the short term deposit market will ensure that you earn even higher interest, and then at the end of your working life, start drawing on this nest egg, to provide for the medical necessities you will face towards the end of your life. Meanwhile, during your years in the workforce, access the public health system as much as possible, and only touch your nest egg at those times where you have no alternative. I would argue that by and large, you will be better off following this course of action than to throw your money at an insurance company which will simply disown you the moment you are unable to maintain your premiums.