Posts Tagged - ‘health insurance’

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Health Insurance Plan Agents May Suffer Under Reform

Friday, August 27th, 2010
health insurance plan
Image: Jennifer Feuchter under CC 3.0

Although healthcare reform tries to help many, it will end up hurting at least some. For example, the business model of many health insurance brokerages and agencies is in danger.

Provisions involving medical loss ratios, which include agent commissions in the “administrative” category that will be regulated and limited, will have a negative effect. In addition, brokerages may be made redundant by the state insurance exchanges and accompanying websites that must be launched by 2014. On the bright side for them, the National Association of Insurance Commissioners passed a resolution that affirmed the importance of licensed insurance professionals.

With the possibility of a double-dip recession looming, more job losses is obviously a downside. However, industry experts predict that these companies have several options for adaptation. Hopefully, their experience in navigating the complexity of the market and helping people decide on a health insurance plan will still be in demand. Their compensation model may also be adjusted in favor of flat fees instead of commissions.

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Inflation of Health Insurance Plans Continued in 2009

Thursday, August 26th, 2010
health insurance plans
Image: Paolo Camera under CC 3.0

2009 had the American economy in the throes of recession. Inflation was very low, while the Federal Reserve cut the interest rate to almost zero. So why did the cost of health insurance plans continue to rise?

To be exact, United Benefit Advisors found that health insurance rates increased by an average of 7.3% for employers. That’s almost three times the inflation in general consumer prices.

Insurers tend to blame an increase in medical expenses. Meanwhile, companies are using consumer-directed health plans to pass more of the cost of group health insurance coverage onto their employees.

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No Fee on Health Insurance Plans to Pay For Okla. Medicaid

Wednesday, August 25th, 2010
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Image: KB35 under CC 3.0

Recently, the Oklahoma state legislature attempted to implement a one percent fee on the sale of health insurance plans. The proceeds were supposed to help pay for the state’s Medicare program.

However, the state’s Supreme Court just ruled that such a fee is unconstitutional, agreeing with Insurance Commissioner Kim Holland’s objections. Six out of nine justices decided that since the law was passed during the final week of the legislative session with less than three quarters of the legislature in favor, it could not stand.

The fee was to be charged to employers that offer health insurance coverage to their employees. It was supposed to raise $78 million for the fiscal year beginning July 1st.

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Health Insurance Scammers Prey on Healthcare Reform Confusion

Wednesday, August 11th, 2010
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Image: B Rosen under CC 3.0

Over the past several months, the American public has been wrestling with the advent of healthcare reform and what it will mean for them. For many, it will require them to purchase a health insurance plan.

Unfortunately, scammers in 24 states are taking advantage of this uncertainty. They are advertising medical discount plans as full-fledged health insurance, which they are not. Unlike standard insurance, these limited plans aren’t accepted by doctors and hospitals to cover most or all of a person’s medical bills.

The Federal Trade Commission has joined in the fight to crack down on these misleading marketing tactics. They hope to eliminate them before the mandate provision of the law goes into effect in 2014.

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Health Coverage and HIV/AIDS

Tuesday, July 13th, 2010

Image: Sully Pixel under CC 3.0

With its affordable health insurance legislation under its belt, the Obama administration has begun tackling a new health issue: the HIV/AIDS crisis. Although new infections have slowed since their peak in the ’80s, many people are still affected.

It is a two-pronged effort, aimed at reducing new infections while increasing access to health care for those who already have it. Instead of allocating significant amounts of new funding, existing funding will be redirected to high-risk populations like African-Americans and gay/bisexual men.

Some fear that the new comprehensive strategy won’t be enough, however. The economy has resulted in many people losing their jobs, which for many also means losing health coverage. Although there are medications that allow HIV patients to live longer and healthier lives, they are still very expensive. The out-of-pocket cost is almost out of reach for the uninsured. In addition, a person with HIV or AIDS would find it almost impossible to buy health insurance on the open market for the next several years.

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Federal Grant To Review Illinois Health Insurance Premiums?

Tuesday, July 13th, 2010

Image: woody1778a under CC 3.0

Over the past several years, Illinois health insurance rates have risen significantly. Like many other states, their insurance department has been overburdened and unable to investigate premium increases.

States have been criticized for rubber-stamping health insurers’ requests in the past. Illinois is looking for a $1 million federal grant from the healthcare reform law to analyze and collect information about health insurance premiums in the state. Their intention is to better determine which would be considered reasonable, and which should be deemed unconscionable–higher than both the medical inflation rate and national averages.

If the state’s application is approved, they’ll receive the funding next month.

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Is There Precedent To Uphold Healthcare Reform?

Monday, July 12th, 2010

Image: BAR Photography under CC 3.0

One of the main arguments against the legality of healthcare reform is the contention that it is unconstitutional. Many opponents believe that the individual health insurance mandate, in particular, violates the 10th Amendment. That amendment says that all rights not specifically given to the federal government in the Constitution or its amendments are left to each state.

However, a competing interpretation–accepted by some conservative justices, no less–states that at times, the national government can exercise powers not expressly mentioned in the document. A recent Supreme Court decision (approved by seven out of the nine members) upheld the federal government’s right to indefinitely detain sex offenders after serving their sentences. Surely, the specifics of ankle monitoring or house arrest for child molesters and others were not on the founding fathers’ minds.

Granted, U.S. vs. Comstock is relatively less controversial an issue than affordable health insurance reform. Still, it’s a sign that the highest court is willing to consider the application of the “elastic clause”, which states that the federal government is allowed to pass laws to help it execute the powers it was expressly given.

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Co-Payments Vs. Co-Insurance

Monday, July 12th, 2010

Image: db*Photography under CC 3.0

When trying to find affordable health insurance, it can be difficult to find the right policy. One of the most confusing aspects is the out-of-pocket cost you are expected to pay, above and beyond the monthly premium.

Most health coverage options include co-payments, co-insurance, or both. What’s the difference?

  • Co-insurance is a percentage of the fee charged for an item or service. For example, if you have a 30% co-insurance percentage under your policy and a doctor normally charges $100 per visit, you will be responsible for paying $30 upfront. In many cases, this is the more expensive option. However, it is becoming more common among group health insurance plans, due to employers trying to reduce their cost burden.
  • On the other hand, co-payments are a fixed amount. If your insurance company specifies a $15 co-payment for prescription medications, that is the amount you’ll pay the pharmacy each time you fill the prescription–regardless of how much the medicine actually costs. Sometimes, insurers have multiple tiers of co-payments: depending on the type of medication, doctor visit, or hospitalization, the copayment will be higher or lower.
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Don’t Delay Filing Out-Of-Network Health Insurance Claims

Monday, July 12th, 2010

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Some health insurance plans–especially high-deductible ones such as health savings accounts–allow patients to go outside of their provider networks to utilize the doctors and hospitals of their choice. Normally, this costs more to consumers; however, the increased freedom is nearly priceless to some.

In most cases, your health insurance will cover at least a portion of the cost of out-of-network care. Unfortunately, you are responsible for submitting the claim paperwork yourself. Check your policy for information about deadlines–if you miss the timely filing limit, you may end up having to pay the whole bill out-of-pocket!

While it’s usually possible to file a dispute or appeal with your insurer, doing so can have a negative impact on your credit rating.

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Your Health Coverage Can Be Canceled for One Penny

Friday, July 9th, 2010


Image: stevendepolo under CC 3.0

In order for your coverage to remain secure, it is essential to pay every single penny of your health insurance premium–literally.

A woman with cancer lost her job, but got COBRA to continue her group health insurance benefits. Last year’s stimulus package gave her a 35% subsidy to help cover the cost. However, her insurance company never sent her the reduced bill.

Therefore, she calculated the smaller amount herself and sent in the premium. Unfortunately, the insurer’s calculations didn’t agree: they said her payment should be one cent higher. As a result, they canceled her plan entirely for nonpayment! She was unable to send a check for $0.01 because she was in the hospital undergoing chemotherapy at the time.

The good news is that they eventually overturned their decision and reinstated her coverage.

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