Quantcast

Choosing the Right Health Plan

With the recently passed health care reform legislation, millions of Americans will find themselves having to “purchase” health care coverage. Whether you’re getting coverage for the first time, evaluating Medicare options, shopping for individual insurance, or choosing a plan from options offered by your employer, the process can be complicated and confusing. Start by evaluating the following:

Your Budget

Even if you qualify for a subsidy, determine how much you can pay for health care on an annual basis. Questions to ask yourself:

  • Who will be on the plan? Just you? You and a spouse? What about children? The new bill allows for adult children up to age 26 to stay on a parent’s plan. This decision affects premium rates.
  • Which works better for you: a lower monthly premium with an upfront deductible or a higher premium with no upfront deductible?
  • What about co-pays? If you go to the doctor frequently, you might want a plan with lower co-pays, a higher monthly premium and little, to no, upfront deductible.
  • Think in terms of surgery and preventative care (physicals, colonoscopy, etc). Check the plan for out-of-pocket (meaning your dollars) costs for these services. Many benefit plans include preventative services. Explore this carefully as it could have significant impact when you need care.

The Network
Once you’ve determined budget issues, consider the network. Make a list of all the doctors and health care providers you and your covered family members have seen in the last 12 months. If you currently have coverage, register for and use the plan’s website to review your claims history. Using this information, assess your needs by answering these questions:

  • Do see certain primary care or specialty doctors on a regular basis?
  • Do you prefer a particular hospital?
  • Do you want to be able to obtain second opinions outside of your local area? If so, you might want a health plan that includes some level of coverage for non participating doctors.

When evaluating your needs, be sure to include health care professionals such as physical therapists, chiropractors or optometrists.

Next week Health Champion will explain how to evaluate benefit designs. If you have any questions — or issues you’d like covered — please leave a comment and we’ll address your concerns in an upcoming blog.

March 24, 2010 | Tags: , , , , | 3 Comments »

Renewing Your Individual Health Plan Policy

Do you carry your own health insurance policy?

Is it time to renew?

If so, don’t do it blindly. And don’t take anything for granted.

Before signing on the dotted line or sending in that premium, you need to know what, if any, policy changes will take place in the coming year. Specifically, check for the following:

  • Provider networks & physicians: have hospitals been removed from the list of participating facilities; is your doctor still in the network?
  • Co-pays: will you have higher coinsurance or deductibles?
  • Benefits: check for benefits that are important to you, whether it’s mental health coverage, physical therapy or visits to specialists. What’s changed? Can you live with the changes?
  • Pharmacy Benefits:  what drugs have been added or changed tiers? Will you be paying more for your meds?
  • Lifetime maximums: If you’ve been in the plan for awhile, are you hitting up against lifetime maximums? Often your expenses against lifetime maximums are not easily discerned from the Explanation of Benefits you receive when a claim is paid. Find out how much you have used and what’s left for specific services. Better to know upfront than find out too late you’ve had treatments that are no longer covered.

Buyer be aware. You may be glad just to have the coverage and assume that year after year changes will be minimal. Caveat Emptor – that isn’t always the case.

And if you’re having trouble figuring out your coverage, call your plan’s representative; be persistent or turn to a specialist who can help you understand your benefits.

February 24, 2010 | Tags: , , , , , | No Comments »

C is for COBRA — Critical Coverage During Hard Times

If you’re on Cobra, coverage information is as critical to your wallet as it is to your well-being. But, like most folks, you probably have so much on your plate these days, you’re missing important updates.

Last week, for instance, we received a call from one of our small business clients. Their office manager thought she read that COBRA received another extension. But she wasn’t sure. Was it true?

The answer is YES. On December 22, 2009, President Obama extended federal subsidy of COBRA for an additional six months.

Some Background:

The first federal subsidy, signed into law earlier in 2009 as part of the economic stimulus package, helped fund COBRA premiums for employees who were laid off between September 1 and December 31, 2008 — “involuntarily terminated” was the eligibility language. Eligible employees paid 35%  of the COBRA premium, while employers paid the remaining 65% and received a tax credit.

The premium reduction was also made available for group health insurance, which is required by State law to provide comparable continuation coverage (such as some “mini-COBRA” laws).

Good News. The Recent Extension . . .

  • Adds two months to the COBRA premium reduction eligibility period, which now ends February 28, 2010.
  • Increases the maximum period for receiving the subsidy, adding an additional six months, taking it from nine to fifteen months.
  • Allows for an extension of the typical grace period for those individuals whose subsidy ended before this extension was passed and couldn’t afford COBRA without it. You must pay your portion of the COBRA premium at the reduced rate by the new grace period. (Contact your carrier or speak to your Human Resource Department for specific information.)

Important Considerations. . .

  • If you paid 100% of the COBRA premium in December, after your subsidy expired, you are eligible for a credit or reimbursement of the overpayment. Contact your plan administrator for further information.
  • Be on the lookout for “notice” requirements that must be provided by plan administrators to all individuals who have qualifying events from September 1, 2008 through February 28, 2010.

Information changes rapidly and it comes at us from all sides. That’s why it’s helpful to have a reliable resource, like this Blog. We’ll work hard to give you critical, updated news and helpful links. For additional COBRA information, including helpful questions and answers, check out the Department of Labor’s website at:

http://www.dol.gov/ebsa/faqs/faq-cobra-premiumreductionEE.html

January 13, 2010 | Tags: , , , , , , | No Comments »