Category Archive - Advice

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Impact of Affordable Health Insurance Reform on Farming Families

Monday, September 27th, 2010

Image: AJay Tallam under CC 3.0

Although agriculture currently employs under 2% of American workers, farmers play a significant role in feeding the nation. How will affordable health insurance reform affect them?

For farming families, the impact is mixed.

On the positive side:

  • Health insurance exchanges will be created in 2014, which are meant to make prices more competitive for farmers and others.
  • A family of four that earns up to $88,000 will be eligible for subsidies to help them purchase health insurance. Most small farmers fall under this threshold.

Unfortunately, there is also bad news. Most significant is the individual mandate, which will require everyone to buy an individual health insurance plan. However, the annual penalty for not purchasing it is fairly minor.

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Healthcare Reform Provisions and Obesity Treatment

Wednesday, September 22nd, 2010

Image: Combined Media under CC 3.0

Tomorrow, several of the earliest provisions of the healthcare reform law will go into effect. Many of these involve preventative care.

The paradox with a lot of health insurance plans is that they typically do not pay for medically supervised diets or nutritional counseling for the overweight and obese. (They may cover gastric bypass or other weight loss surgery, but some patients are not considered morbidly obese enough to be eligible for reimbursement.) However, they will cover the more expensive cost of treating related conditions like type 2 diabetes or sleep apnea when they are later developed.

The legislation looks to change that. Here is how it will change:

  • Recommended preventative care treatments are covered without co-payments or co-insurance percentages for policyholders, including behavioral counseling and obesity screening.
  • Public health initiatives will make calorie counts more visible, making it easier for people to eat healthily and lose/maintain their weight.
  • Comparative effectiveness research will be undertaken to determine if insurers will be required to cover gym memberships, therapy, or special meal programs.
  • An advisory group will look into the effectiveness and risks of weight loss drugs and surgery, possibly requiring coverage of those deemed more effective than harmful.
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Most Health Insurance Plans Don’t Cover Fertility Treatments

Monday, August 30th, 2010
health insurance plans
Image: Daquella manera under CC 3.0

Treatments for infertility can be very expensive. The average cost of one round of in-vitro fertilization is $12,400; it often takes several cycles in order for it to be successful. Meanwhile, many women choose to implant multiple embryos for greater chances of success.

Not only are the actual treatments expensive, but they can lead to high-risk pregnancies and the complications that often result from multiple births. Due to the high cost, most health insurance plans don’t cover fertility treatments. The number of plans that include infertility coverage has decreased over the past decade.

Those that do are typically larger employers. In those cases, oral medications that promote fertility are more likely to be covered except for a nominal co-payment.

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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

Image: anomalous4 under CC 3.0

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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Facts About Health Insurance Rescission

Tuesday, July 6th, 2010

Image: bobster855 under CC 3.0

One of the worst things that can happen to a person affordable health insurance-wise is having their policy rescinded. In many cases, they are kicked off their plan through no fault of their own.

The good news is that reform will both prevent the practice of unfair rescission and make it easier to gain justice.

The facts about the new regulatory climate:

  • Insurance companies now have little legal justification for dropping people: they will only be allowed to do so due to nonpayment or fraud.
  • The definition of fraud is also clarified. It consists of actively lying about any pre-existing medical conditions or diagnoses you may know have. Having a condition you don’t know about (even if it’s in your medical records, but a doctor hasn’t informed you of it) doesn’t count.
  • For consumers, the appeals process is also strengthened. Health insurance companies must give them at least 30 days advanced notice before canceling a policy.
  • The new rules take effect in late September.

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Can You Buy A Health Insurance Policy If You Don’t Speak English?

Thursday, June 10th, 2010

Image: Daquella manera under CC 3.0

Immigrants looking to buy a health insurance plan face several challenges. One of the most striking is the language barrier in terms of the actual policy. Most of those terms are written in English. Even those who are fluent in the language may be more comfortable and secure interpreting legal contracts in their native tongue.

Many insurance agents speak foreign languages, and they can explain the provisions to you. Due to the demographics of immigrants in the United States, it is most common to find a Spanish-speaking agent. However, they are also available in Haitian Creole, as well as other languages depending on the area. Otherwise, you may choose to seek a translator (either a family member, friend, or professional) to help you purchase health insurance.

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Make Sure Your Health Insurance Covers Surgery

Wednesday, June 2nd, 2010

Image: schnaars under CC 3.0

As strange as it sounds, health insurance companies won’t automatically cover every surgery you undergo, even if it’s involuntary. That’s why you should do your research prior to entering the operating room.

For example, experimental treatments such as spinal fusion may not be covered. Purely cosmetic plastic surgery is usually not covered, even if a medical problem or accident caused the disfigurement.

In most cases, doctors and hospitals should know whether or not a procedure is covered, and if it needs pre-authorization under your health insurance plan. Just in case, it’s important to confirm that by checking with your insurer.

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