Blog Archive

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Immediate steps to take after you have enrolled in health insurance

You are enrolled in health insurance, so what is next? If you have chosen an individual health insurance plan or a group health insurance plan and completed your health insurance application these are important steps to take:

  1. Make you’re your health insurance first month’s premium payment. Typically, your first month’s premium payment is collected at the time you complete your health insurance application, however some insurance carriers will allow you to make the initial premium payment after you submit your application. Contact your insurance carrier to pay your first month’s premium immediately. Your individual health insurance policy WILL NOT go into effect until the initial payment is received and processed. Confirm that your bank records show that your health insurance premium payments have been received by your health insurance carrier.
    1. Initial premium payments MUST BE received before the effective date for your policy to be issued. Health insurance carriers will not send insurance cards until they have received the first premium payment. Keep in mind that during the annual open enrollment period processing times are longer. This means it takes longer to process your payment and longer for you to receive your insurance cards.
    2. Your monthly health insurance premium payments must be received and processed prior to the month that you want coverage. This means that if you go to see your in-network doctor on April 1st, then your premium for April must be submitted and processed by your health insurance carrier no later than March 31st. If you do not make payments on time you take the risk of not being able to verify your insurance when you need to use it and potentially take the risk that your insurance policy will be terminated for non-payment.
  2. Terminate other insurance. Just because you received a letter that your plan is going away or premiums are going up does not mean that your other insurance will automatically cancel and that they won’t draft your account.
    1. If you are on automatic payments call the insurance carrier or login to your online member portal and cancel those immediately. Usually this request must be received several days before the draft date in order to cancel the automatic payments.
    2. Cancel your old policy with your previous health insurance carrier for the day prior to your new health insurance effective date. For example: if your new health insurance policy with Blue Cross Blue Shield of Texas starts January 1st then you need to cancel your old Blue Cross Blue Shield of Texas health insurance policy and make sure they have stopped any automatic payments.
    3. Some carriers will automatically renew your policy into something similar, so it is important to make sure that they are not “mapping” you into another plan. You may need to request that they cancel the policy they are “mapping” you into as well.
    4. If your health insurance is through healthcare.gov, also known as the Marketplace or the Exchange then depending on your application selections you may be automatically rolled into another plan each year. This plan may or may not meet your medical needs, so we advise that you actively reviewing your health insurance every year. Your application answers may also affect tax credits received. It is important that you are updating your application each year to ensure it is correct and current.
  3. Create an online account. Most insurance carriers have a member website or member phone app where you can create an account. Member online accounts allow you to access you and your family’s health insurance information. This information can be temporary ID cards, provider networks, online payment options, and claims information. Providers like Blue Cross Blue Shield have even added a “call a doctor” benefit through MD LIVE that you can access online. It may seem like a pain to add another account to your array of accounts, but these online health insurance tools are truly beneficial. You have almost everything regarding your health insurance at your fingertips. This allows you to avoid long hold times to contact the insurance carrier.
  4. Not truly happy with your health insurance? You have until January 31st to make changes to your health insurance. Be certain you know how your insurance works, your benefits and your coverage area. If your insurance does not meet your needs, we can help you explore alternatives. Call us at (512)847-3164.
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Know how to use your insurance

You have enrolled in a health insurance plan, now what? Health insurance can be confusing and overwhelming, so here are a few tips to help you use your health insurance correctly.

  1. KNOW YOUR NETWORK! Check doctors, hospitals, and urgent care in-network. Be proactive about your medical needs and check for the doctor’s and facilities that are close to you that are in your health insurance network. Each insurance carrier has an online tool where you can search providers by name, specialty, location. This is useful to have so that you know exactly where you can go in the event of an emergency.
    1. Each carrier has a multiple “networks”, so know what network you are in i.e. Blue Cross Blue Shield Blue Advantage HMO, Aetna Rosebud EPO or HMO, Memorial Hermann HMO or PPO, United Healthcare Choice, PHCS, Humana HMOx San Antonio/Houston, etc.
    2. When confirming your network with your provider ensure that you are using the specific network to confirm. Sometimes it may be best to speak to a providers billing or managed care representative (the person that handles their insurance contracts) to ensure you are receiving the correct information.
  2. Get established with a primary doctor. If you are having to switch doctors or have not established a relationship with a primary doctor in your network get an appointment now.
    1. Some doctor’s will only see new patients on certain days, so it can take a while to get an appointment. You want to be certain that you your doctor is the right fit for you.
    2. If you have enrolled in an HMO we recommend that you find out what your primary doctor’s referral process is like if you need to be referred to a specialist.
  3. CHECK THE FORMULARY FOR YOUR MEDICATIONS!
    1. Make sure that you review your health insurance carrier’s prescription drug formulary for any medications you take. This will give you an idea of what your costs will be.
    2. Make sure that you are also going to pharmacy’s that are in your health insurance carriers network.
  4. Not truly happy with your health insurance? You have until January 31st to make changes to your health insurance. Be certain you know how your insurance works, your benefits and your coverage area. If your insurance does not meet your needs, we can help you explore alternatives. Call us at (512) 847-3164.
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Medicare Announces 2017 Premiums and Deductibles

The Centers for Medicare and Medicaid Services announced Thursday, new premiums and out of pocket costs for 2017. This information comes after some beneficiaries have already made plan choices for 2017 based upon 2016 figures for out of pocket costs and premiums. Medicare is notorious for announcing changes late in the game, well after the year’s OEP/AEP (Open Enrollment Period/ Annual Election Period) have already begun.

The annual Medicare Part B deductible for all Medicare beneficiaries for 2017 will increase to $183, up from $166 in 2016. This is the deductible that anyone with a Standard Medicare Supplement Plan G is responsible for before their supplement plan’s benefits are triggered. For those who have Medicare Supplement Plan F, the plan will continue to cover the Part B deductible in full for the member.

The Part B premium rates will increase for about 30 percent of beneficiaries. The new monthly Medicare Part B premium for 2017 will be $134, up from $121.80 in 2016; an increase of 10 percent. Most beneficiaries will be protected from the hold harmless provision which locks in their Part B rate. Those protected are beneficiaries are those already receiving Social Security, and dual eligible participants having their premiums paid by Medicaid. Seniors that are newly eligible for Medicare in 2017 and those that are not receiving Social Security and being billed directly for Medicare will have to pay the higher premium.

In addition to increased Part B premiums and Part B annual deductible, Medicare has also increased other out of pocket costs such as the Part A deductible and per day costs for skilled nursing and Part A coinsurance. People with Medicare Supplement plans typically have benefits to cover these costs. The agents at Texas Medical Plans can review your Medicare Supplement policy benefits to see if you are effected by some or all of these changes. A Licensed agent can help you make an informed decision about you supplement policy and review it regularly to help you stay ahead of Medicare changes for years to come.

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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

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

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

Get a Consultation, Call Now
Phone: (888)750-3164
Fax: (512) 847-3663