Blog Archive

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How will a Trump Presidency affect Obamacare and health insurance?

Donald Trump has promised that he will repeal and replace the Affordable Care Act, Obamacare, as the Unites States President. This change is possible, but to get a true repeal and replace he needs 60 votes in the Senate. It may be more plausible that he will implement the series of measures he proposed during his campaign through smaller legislative changes.

Even if Trump moves to change the Affordable Care Act and repeal Obamacare this will not happen overnight. The Affordable Care Act was written into law two years and three months after President Barak Obama took office. It took another four years for the Affordable Care Act to be implemented into individual health insurance and group health insurance.

In January 2011 pieces of the Affordable Care Act were implemented into new health insurance plans. Amongst the first of the changes we saw were adding preventative / wellness benefits, the elimination of coverage caps, and the ability to leave children on a parents individual health insurance or group health insurance policy until they are twenty-six years of age.

Other pieces of the Affordable Care Act that were implemented in 2014 were that individual health insurance plans and group health insurance plans removed waiting periods, they covered pre-existing conditions, and the medical loss ratio (MLR). Pieces of the Affordable Care Act are still not implemented today. More than seven years after the law was written we are still in the implementation phase.

People want to know; will President Donald Trump get rid of Obamacare and will insurance go back to the way it was. The simple answer is there is no way to know. Even if he does make changes to Obamacare we may not see those changes until years later.

The GOP has a replacement plan to Obamacare detailed out in their A Better Way – Health Care Policy Paper, By The Numbers, and Fact Sheet.

What we at Texas Medical Plans have seen is that for most people looking at individual health insurance plans have fewer health insurance companies to choose from, monthly health insurance premiums have increased, and the health care provider networks continue to change. We have worked hard in 2016 to explore all the available options for your health insurance needs in 2017. There are other options available outside of Obamacare. If you are healthy it may be better to pay the health insurance tax penalty and get medical insurance that covers less than Obamacare. A Healthcare sharing ministry or accident plan may be a better fit for you in 2017. If you are a small business owner or our self-employed then you might be able to set up health insurance through your business as a group health insurance plan. It is now simple to set up a group with one or two people. Group health insurance plans can offer you a PPO again and access to a Nationwide network at possibly a better price than individual health insurance.

We welcome the opportunity to review all your options and will make recommendations to fit your budget. Call us at (512)847-3164. See more on our YouTube, Facebook, or Instagram pages.

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Insurance and Health Plan Options Grid

  Cost Covers Pre Existing Covers Pregnancy Satisfies Insurance Mandate Can have Subsidized Premiums PPO HMO Details
Affordable Care Act Indivudal & Family $-$$$ check-markYes check-markYes check-markNo Penalty check-markMust Qualify x-markNo check-markYes ObamaCare
Qualified Health Plan (QHP)
Group Employer or Small Business $$$ check-markYes check-markYes check-markNo Penalty x-markNo, but may be deductible check-markYes check-markYes Qualified Health Plan (QHP)
Major Medical – Short Term $$ x-markNo x-markNo x-markPenalty x-markNo check-markYes x-markNo Covers Major Occurrences
NON-Qualified Health Plan
Limited Benefit $$ x-markNo x-markNo x-markPenalty x-markNo check-markYes x-markNo Covers Minor Occurrences
NON-Qualified Health Plan
Accident Only $ x-markNo x-markNo x-markPenalty x-markNo dollar-signCash dollar-signCash Covers Accidents Only
NON-Qualified Health Plan
Specified Disease
(Cancer/ Heart Attack/Stroke)
$ x-markNo x-markNo x-markPenalty x-markNo dollar-signCash dollar-signCash  Covers Specified Diseases Only
NON-Qualified Health Plan
Healthcare Sharing Ministry $$ x-markWaiting Period check-markRestrictions Apply check-markReligious Exemption x-markNo check-markYes x-markNo Must abide by religious principles
NON-Qualified Health Plan
Not Insurance, No Guarantees

 

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ObamaCare is falling apart

The next ObamaCare Open Enrollment Period begins one week before the presidential election, and it ends about a week after our next president is inaugurated. November 1st is going to bring more bad news for Obamacare with even higher rate increases than we have seen in the past years. The next president is going to inherit this crisis.

Many insurers are already proposing substantial increases or others say they are going to leave the market all together. With all of the uncertainty you should know that there are alternatives to the ObamaCare marketplace exchanges for some. These options include short-term major medical plans, health care sharing ministries and small group employer plans.

Many analysts have said that the first five years of ObamaCare would be a struggle. They warned that the market could take years to balance out to a point that we would start really seeing reduced costs for health care and better outcomes for patients. They were right, as we enter the fourth year of open public and federal exchanges; things are still only getting worse.

As ObamaCare continues to fall apart, agents and brokers are working harder than ever to present clients with viable alternatives to the Affordable Care Act (ACA) plans that more and more people just cannot see as an affordable option anymore.

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Health Insurance Changes for 2017

Health Insurance rate increases for 2017 are estimated to be the highest yet with Blue Cross Blue Shield reporting a potential 58% health insurance premium rate increase and Humana a 45% potential health insurance rate increase on their individual market plans. Since the Affordable Care Act (ACA) was signed into law in 2014 we have seen health insurance premiums quickly rise, health insurance plans become limited, and health care provider networks shrink. Some companies, like United Healthcare, have opted to leave the individual health insurance market all together in Texas; that includes plans on and off the health insurance Marketplace also known as the health care exchange or HealthCare.gov. You can read more about the 2017 health insurance changes here

What does this mean for you? 

You need to shop plans every year. We tell our clients that they need to create a reoccurring event in their calendar to be talking to us about their health insurance options around the end of November/beginning of December every year. We also caution our clients about health insurance plans that seem too good to be true because more than likely they are. 

 

As the changes keep coming, so do the “alternative” health insurance options other agents offer called limited benefit plans. They are simply that – plans offering limited benefits. Sometimes we enroll clients in these plans because they are the best fit for them, but often times they are not the best option and leave people paying tax penalties at the end of the year for not having the required insurance (Qualified Health Plan). 

What are we doing? 

Right now, outside of the open enrollment period (November 1st through January 31st), we are moving as many clients as possible to a Humana Group/Employer sponsored health insurance plan. Humana is leading the group health insurance industry by removing the group health insurance employee participation requirements and the group health insurance employer contribution requirements for small groups that the other group health insurance carriers have in place. Humana has made it so easy to enroll as a group that you simply need a Tax ID and one employee in addition to the owner. Humana’s group health insurance premium rates are usually better than what we see on the individual health insurance market and Humana offers incentives to start saving an additional 10% by your second month of coverage. 

 

To gear up for the 2017 health insurance open enrollment period November 1st throughJanuary 31st we are contracting with every health insurance carrier in Texas in order to offer our clients the best possible health insurance coverage, staying current on health care changes, and maintaining transparency with our clients. Things in the health insurance industry are constantly changing and we continue to adapt. What makes us different from most insurance agents is that we are a collaborative team that works to solve obstacles before they even come up. We have daily strategy meetings to ensure that we are doing the best for our clients. Our clients have been trusting us since 1983. That trust is in our actions. Even though the health insurance premiums go up, the insurance carriers continue to bring our income down and sometimes don’t pay us at all . . .  We continue to survive the health insurance changes alongside our clients because of the hard work and integrity we put into doing business. We truly value our client relationships and our clients truly value our expertise. 

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Are You Sure About Your Insurance?

The Washington Examiner (7/7) reports that a study published in Health Affairs revealed that “health insurance plans offered both on and off the Obamacare marketplaces fall far short in helping patients access doctors.” Researchers directed “secret shoppers” to call physicians “listed on directories provided by California Blue Cross Blue Shield” and found that the shoppers “were unable to set up appointments with nearly three in four of the providers.” The callers were not able to reach about 20 percent of 743 physicians listed. According to the Examiner, “in another 30 percent of the cases, the specialty listed in the provider directory didn’t match the specialty stated by the receptionist at the practice.” The findings support “complaints that insurance plans provided through the Affordable Care Act’s online marketplaces offer limited choices of doctors.

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UnitedHealth to Exit Obamacare in 16 States to Stem Losses

UnitedHealth Group Inc. will drop out of government-organized health insurance markets in at least 16 states as the U.S. industry leader tries to stem losses from participating in Obamacare, the healthcare overhaul that has brought coverage to millions of people. Read more here.

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Figuring out if your Doctor is in-network can be a CHALLENGE

We here at Texas Medical Plans, continuously hear from our clients that they have difficulty verifying whether or not their doctor is in-network with their health insurance provider. We hear things like: “I found my doctor on the health insurance company’s website, but the doctor’s office says they do not take it” or “My doctor is in-network but the hospital that they are preforming my procedure at is out-of-network” or our favorite “My doctor’s office says they do not take Obamacare” (NOTE: All the health insurance plans offered now, the health insurance plans that keep you from having to pay a tax penalty, are “Obamacare”. This means that the plans now meet the regulations set forth by the Affordable Care Act (ACA)).

Changes in the health care industry have people confused, misinformed, and FRUSTRATED! I know you may not want to hear this but WE UNDERSTAND! I could write a book about all of the difficulties I have had with my own health insurance. Yes, you would think that a health insurance agent would not have insurance issues, but that is not the nature of the individual health insurance industry these days.

Just one example: I took to my daughter to a doctor, whom I confirmed was in-network with my health insurance carrier and the doctor’s office prior to the visit. I paid the specialist copay as usual. I later received a bill for the office visit. Keep in mind this was an initial visit to examine my daughter and discuss treatment options. No testing was done in this visit. We saw the doctor in his office, which was in a building right next to the hospital, but it was billed out-patient. Apparently, because we did not see the doctor in the hospital it was out-patient and went towards the deductible verses the specialist copay as previously confirmed.

I think that if we had seen the doctor in the hospital as in-patient that we would have seen an additional bill from the hospital/facility. A lot of times you will see a doctor that is in-network, but the facility/hospital the doctor performed the procedure in was out-of-network. The only explanation I can offer you is that they are separate entities and they have separate contracts with different health insurance companies.

So, what does this all mean for you? You have to do your best to be educated and proactive. We suggest the following:

  1. Know your health insurance plan. Know if you have copays, coinsurance, what your deductible is and your out-of-pocket maximum. Do you have an HMO or a PPO network? Did you know that an HMO network requires prior authorization from your primary doctor before you can see a specialist? Health insurance can be confusing! The health insurance agents at Texas Medical Plans do our best to make health insurance simple for our clients.
  1. Check with your insurance provider. Call your health insurance company to confirm a doctor, facility, lab, anesthesiologist, the person that pokes their head in for 5 minutes to check on you while you are in the hospital, etc. is in-network. Keep detailed notes about your conversation with the representative, including who you spoke to, their department, get a reference number if possible, the more information you can record the better. Get pre-authorization when possible. If you have an upcoming procedure find out how each party (doctor, facility, etc.) codes it on their bills and check those codes with your insurance company. Does that procedure go towards your deductible and can they give you an idea of how much it will cost you? This keeps you from being surprised and also helps you to check the bill later for errors.
  1. Communicate with your doctor! Ask your doctor questions like are you in-network. How is this billed? What codes do you use when billing? Is this preventative? Sometimes we see where a client goes in for their physical (covered 100% under preventative care) but then they ask about a medical issue . . . now the doctor is addressing an issue and the visit is no longer preventative. Every doctor is different though. The list of questions can be endless and it really depends on the situation. The health insurance agents here at Texas Medical Plans encourage our clients to have open communication with their doctors and get an idea of what their billing process looks like.
  1. Check your Explanation of Benefits (EOB) and your bill. Compare your EOB and bill to see if they look correct. There are so many medical codes out there now that we constantly see errors in the way people are billed and errors in how health insurance companies process claims. Everyone is doing their best to process things correctly, but nothing is perfect. If you don’t understand something, ask your doctor’s billing department and ask your health insurance carrier. At the end of the day it is your money being spent so do your best to know exactly what it is being spent on.

It can seem like a full time job staying on top of your health insurance. Do your best and remember there are health insurance agents like us here at Texas Medical Plans that can help you to understand your health insurance and how it can work for you.

Courtney Mecklenburg

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Insurance and Being Prepared for a Natural Disaster

Risks Associated With Natural Disasters

When people consider insurance for a natural disaster it is generally about home and contents insurance, but it is important to consider life, health, and disability insurance as well. Some insurance risks associated with natural disasters include:

  • Underinsurance. Make sure you have the right level of coverage when it comes to home and contents.
  • Life insurance. It is important that you have financial protection in place in case something were to happen to you. Having a life insurance policy that protects you in the event of a natural disaster can help to secure your family’s financial future.
  • Effects on your health. It is important to have health coverage in the event you are injured. Even if you are unable to afford a comprehensive plan you should at least have a plan that covers catastrophic or severe injury or illness.
  • Having no income. If you were injured during the disaster and are unable to work, there is the challenge of rebuilding the damages and taking care of your family. Try to find a disability or life policy that offers income protection either as a standalone policy or an optional extra.

Ways You Can Plan Ahead of a Natural Disaster

It is imperative to be prepared for these situations in order to minimize the risks you and your family could face should disaster strike. There are a few simple things you can do to make sure your family is protected in the event of a natural disaster:

  • Check your health insurance: Know your options if you need medical care away from home. HMO plans may have area limitations to where you can seek medical attention, know what they are. Spend some time now gathering your health history and benefits information. And you’ll save yourself a lot of time and headaches if you’re ever forced to leave your home. Try filling out this Personal Health Information Record document. You can list doctors, medications, allergies and more – for you, your family and your pets, too. You can also attach copies of insurance cards, plan policies, prescriptions and immunization records for the whole family.
  • Check your life insurance: Review your plan to make sure that you are covered against natural disasters. Make sure you have sufficient coverage in place and a clear understanding of what will and will not be covered. Similar to your policy features , it is important to understand that policy exclusions also vary between providers.
  • Prepare for income loss: If you are injured during a natural disaster how will you support yourself and your family? Have disability coverage in place to cover you in the event you are not able to work.
  • Check which disasters your home and contents insurance covers you for: Policies vary, so knowing exactly what you’re covered for will help you avoid nasty surprises.

Prepare for the worst situation

Expect the best, but prepare for the toughest situation Mother Nature can throw at you. Prepare an evacuation box. It should be fireproof, with a lock. And small enough to grab it on the go. In it, store all your important financial documents, including legal papers, bank account information and insurance policies.

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You can still get 2015 health coverage until April 30, 2015

Open Enrollment for a 2015 Marketplace plan ended February 15, 2015, but you may still be able to get coverage.

DO YOU OWE THE FEE FOR NOT HAVING COVERAGE IN 2014? YOU MAY STILL BE ABLE TO ENROLL IN 2015 COVERAGE IF:

  • You didn’t know until after Open Enrollment ended on February 15, 2015 that the health care law required you and your household to have health coverage, or you didn’t understand how the requirement would impact you and your household
  • You owe the fee for not having coverage for one or more months in 2014
  • You are not already enrolled in 2015 coverage through the Health Insurance Marketplace or outside the Marketplace

Please note:

  • Even if you get coverage through this Special Enrollment Period (SEP), you may have to pay the 2014 fee for the months you didn’t have qualified health insurance
  • You don’t need to have filed your 2014 taxes before enrolling with this SEP—you just have to owe the fee
  • If any person in a household meets the criteria for this SEP, everyone in the household can enroll with it

If you have certain life changes you may qualify for a Special Enrollment Period. If you do, you can enroll in a Marketplace plan outside the annual Open Enrollment period.

Life events that may qualify you for a Special Enrollment Period:

  • Getting married or divorced
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Losing other health coverage
  • Permanently moving outside your plan’s coverage area
  • Gaining citizenship or lawful presence in the U.S.
  • Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder.
  • Leaving incarceration
  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

You may be able to enroll in coverage through Medicaid and the Children’s Health Insurance Program (CHIP). There’s no limited enrollment period for these programs, which provide free or low-cost health coverage to millions of these groups, and they can change plans as often as once a month.

If none of these work for you there are other options like short term and accident only plans that can give you a safety net if you cannot get or do not want a qualified health plan. You can also enroll in 2016 health coverage during the next Open Enrollment period. The Open Enrollment period for 2016 is November 1, 2015 to January 31, 2016.

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Countdown to Enrollment- 8 days

8 days until open enrollment. Sign up for insurance 11/15-12/15 in order to get a 1/1/15 effective date. All Affordable Care Act (ACA) plans include these essential health benefits:
1. Outpatient care—the kind you get without being admitted to a hospital
2. Trips to the emergency room
3. Treatment in the hospital for inpatient care
4. Care before and after your baby is born
5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
6. Your prescription drugs
7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
8. Your lab tests
9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
10. Pediatric services: This includes dental care and vision care for kids

Certified on Healthcare.gov – The Federal Facilitated Market Place
FFM User ID: homerg NPN: 1127503

PO Box 1270 Wimberley, TX, 78676
15577 RR 12 Wimberley, TX, 78676

Get in touch with us at
TexasMedicalPlans@health-quotes.com

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Phone: (888)750-3164
Fax: (512) 847-3663