JustCare

Tag: Affordable Care Act

  • Four tips for keeping your health plan costs down

    Four tips for keeping your health plan costs down

    There are a bunch of reasons why you should not think you can choose a health plan “that’s right” for you. If you have Medicare, you can budget for your care with traditional Medicare, though you will need supplemental coverage to protect yourself from financial risk. And, if you are not yet eligible for Medicare, you can do some homework to keep your health plan costs down.
    1. Choice of doctors and hospitals: Each health plan has different networks of doctors and hospitals. Many people choose plans with narrow networks, which tend to have lower premiums. Ask your doctors about which health plan’s network they are in and then call the health plan to confirm. (Sometimes, the same insurance company will offer different plans, with different doctors in their networks.) Also, find out if the hospital you want to use is in the network.
    2. Costs: Before enrolling, understand all of your costs. On top of your monthly premium, some health plans charge a deductible, the amount you must pay before the plan begins covering your care. And, you will likely have a copay, a fixed amount you pay every time you see an in-network doctor, or coinsurance, a percentage of the cost you must pay. If you see out-of-network providers, you’re likely to be stuck with huge doctor and hospital bills.  Most health plans will pay only a tiny portion of those bills, and many won’t pay anything. 
    3. Access: Before receiving services, make sure you understand the health plan’s rules. Even if you use in-network doctors and hospitals, the health plan might require you to get a referral from your primary care doctor or prior authorization from the plan before it will cover your care.  If the plan denies your care, be aware that you have appeal rights.
    4. Coverage: Each health plan has different rules about what it covers and under what conditions.  Different health plans may offer different benefits. If you travel or live in another area during parts of the year, make sure your plan covers your care while you are away and what it will pay.

    Here’s more from Just Care:

  • A crash course in 5 important health insurance terms

    A crash course in 5 important health insurance terms

    As if you didn’t already have enough to think about, you need to understand a sea of insurance concepts to keep your health care costs down. Here are five terms you should definitely know.

    1. Premium—what you have to pay each month for your health insurance.
      • If you have Medicare and are receiving Social Security benefits, the government will take your Part B premium out of your Social Security check—nothing to think about there.  But, if you have Part D drug coverage, you’ll likely have to pay that premium by check directly to the insurance company.  And, if you’re buying your own supplemental insurance, you’ll need to pay that premium as well.
      • If you’re in a Medicare Advantage plan, you’ll probably need to pay an additional premium to the insurance company offering that plan.
      • If you have coverage through the Affordable Care Act (ACA), you’ll have to pay that premium but may be eligible for a government subsidy based on your income.  Use this tool from the Kaiser Family Foundation to calculate the amount of your premium that the government will pay for.
    2. Deductible—what you have to pay out-of-pocket for your care before the insurance starts paying. 
      • If you have traditional Medicare, there is a small deductible for your Part B coverage for medical services and a large hospital deductible as well, both of which you’ll have to pay unless your supplemental coverage picks those up.
      • If you’re in a Medicare Advantage plan, an ACA plan, or an employer HMO or PPO, you’ll need to check on deductibles.  Often, insurers charge a deductible for in-network care and a separate deductible for out-of-network care.  And, if you’re premium is very low, your deductibles could be very high.
    3. Copay—a fixed fee that you pay for a particular service.
      • If you’re in a Medicare Advantage plan or an ACA or employer plan and seeing an in-network doctor, your copay will be a set amount of money that represents your share of the doctor’s charge.
    4. Coinsurance—a fixed percentage that you pay, based on the amount your insurer pays. 
      • If you have traditional Medicare and supplemental insurance, the supplemental insurer will pick up the coinsurance for all the services it covers.
      • If you are in a Medicare Advantage plan or an ACA or employer plan and seeing an  out-of-network doctor, your coinsurance will be a percentage of the doctor’s bill.
    5. Covered services: Insurers only pay for the services they cover.  Before you see a doctor, go to a hospital or use an ambulance, check to make sure that the insurer covers services from those providers and under what conditions.
      • Traditional Medicare covers services from most doctors and hospitals anywhere in America.
      • But, if you are in a Medicare Advantage plan or an ACA HMO or PPO, your coverage for routine care may be limited to your providers in your community. Sometimes, you will need prior approval from the insurer or a referral from your doctor in order for your services to be covered.
    If you like this, you might like these:
    Many Americans do not have a good understanding of how their health insurance works 
    How to keep your out-of-pocket costs down if your income is low and you have Medicare
    How to choose between traditional Medicare and a private Medicare Advantage plan
    What’s your Medicare Part B premium and deductible?
    What’s your Medicare Part A deductible?
  • Beware of discriminatory pricing by health plans

    Beware of discriminatory pricing by health plans

    Under the health care law, insurers must cover everyone who wants to enroll in their health plans, but they can and might use discriminatory pricing or narrow networks to keep you from enrolling or try to push you out if you need a lot of health care services.  They stand to make a lot more money from people who are healthy than from people who are sick and need a lot of services.

    There are two key ways insurers might get you to switch to a different plan:

    1. They might not have doctors in their network who are skilled to treat your health condition.  There are “network adequacy” rules that require health plans to have in-network doctors to treat you. But, you might disagree with them about the skills of their doctors. Or the in-network doctors might not be taking new patients, might have long waits for their services or be located far away.
    2. They might charge high copays to people with costly needs.  Humana, Coventry, Preferred Health and CIGNA did just that in Florida for patients with AIDS.  CIGNA has settled a complaint filed by advocates there and is reducing its HIV drug costs, which the advocates said were discriminatory. 

    If you experience these kinds of practices from you health plan, please let us know, and we will do our best to get you help.

  • Did you know that your local non-profit hospital must work with people in the community to prioritize health care needs?

    Did you know that your local non-profit hospital must work with people in the community to prioritize health care needs?

    A report by the Hilltop Institute explains that non-profit hospitals are legally obligated to deliver community benefits, and they do. Back in 2002, the Congress’ Joint Committee on Taxation determined that non-profit hospitals delivered benefits to their communities–such as lower prices, charity care and health education–to the tune of more than $12 billion.  Thanks to the Affordable Care Act, they now must work with individuals, public health experts and community groups to identify ways to improve the care they deliver and better meet the needs of vulnerable individuals.

    Every three years, hospitals must undertake a Community Health Needs Assessment (“CHNA”) in partnership with organizations and individuals working to meet the health needs of the community. The needs assessment identifies and prioritizes the greatest needs, as well as the community resources to address them and ways in which the hospital can meet them.

    Of note, the law states that hospitals must engage “medically underserved, low-income, and minority populations” in their assessments. Community Catalyst has a new toolkit and resources to assist community organizations in working with their local hospitals and engaging vulnerable older adults in the needs assessment.

     

    flickr//evablue

  • It’s time to enroll in a health plan if you are under 65

    It’s time to enroll in a health plan if you are under 65

    Open enrollment in state health exchanges begins on November 15 and lasts through February 15.  You can enroll in a health plan or switch health plans even if you have costly health care needs.  Health plans cannot cancel your coverage if you need costly health care. Here are four things to keep in mind:
    1. Help with premiums: If your income is no more than four times the federal poverty level (between $11,670 and $46,680 for an individual or $23,850 and $95,400 for a family of four), you are eligible for help with the premiums.
    2.  Automatic reenrollment: If you have health insurance through an exchange and do nothing, you will be reenrolled in the same health plan.  But, if you’re smart, you’ll visit healthcare.gov to see whether there are any new plans in your area and what your current health plan is offering in terms of costs and benefits as compared to other health plans in your area.  Read these tips for choosing a health plan.
    3. Expanded Medicaid eligibility: If your income is at or below 138 percent of the federal poverty level ($16,105 for an individual and $32,913 for a family of four) in many states you are likely eligible for Medicaid
    4. Penalty if you go without health insurance: If you did not have insurance in 2014 or if you don’t have insurance in 2015, you will pay a penalty when you file your federal taxes.  In 2014, the penalty is $95 or 1% of your income, whichever is higher.  In 2015, the penalty is $395 or 2% of your income, whichever is higher.

    If you enroll after the 15th of the month, your coverage will not begin until a month and a half later.  If you enroll between the 1st and 15th of the month, your coverage will begin on the 1st of the following month. For more information, check out the Kaiser Family Foundation’s Consumer Guide.

    If you like this post, you might also like these:
    Four tips for keeping your costs down in a private health plan or Medicare Advantage plan
    A crash course in five important health insurance terms

  • Drug and device companies paid doctors and hospitals nearly $3.5 billion in the last five months of 2013

    Drug and device companies paid doctors and hospitals nearly $3.5 billion in the last five months of 2013

    New federal data reveals that drug and device companies paid doctors and hospitals significant amounts of money to help promote their products in 2013. Thanks to health care reform, which requires much more accountability and transparency in health care, the Center for Medicare and Medicare Services has just released data showing that in the five months between August and December 2013, 546,000 physicians and 1,360 teaching hospitals received almost $3.5 billion from these medical industries.  To be clear, this does not include money from medical device and drug companies to members of Congress to help ensure that the U.S. government continues to allow them to charge Americans rates for their products twice as high as what other wealthy nations allow.

    To view the Open Payments data for yourself, click here.  It is intended to help the public understand how much money is going to doctors and teaching hospitals from drug and device manufacturers.

    If you like this story, you might also like these:

  • With Affordable Care Act, more Latinos insured

    With Affordable Care Act, more Latinos insured

    A new report from the Commonwealth Fund reveals that thanks to the Affordable Care Act, many more Latinos are insured.

    Overall, there has been a 13 point increase in the Latino population with health insurance since last year.  As of a few months ago, 23 percent of the Latino population is uninsured as compared with last year when 36 percent of the Latino population was uninsured.

    Young Latinos between the ages of 19 and 34 have seen the greatest drop—20 points–in their uninsured rate.  Between July and September 2013, 43 percent of the Latino population between 19 and 34 was uninsured.  Nine months later, between April and June 2014, 23 percent of the Latino young adult population was uninsured.

    States that have expanded Medicaid coverage have cut by half the percentage of uninsured Latinos from 35 percent to 17 percent.  States that have not expanded Medicaid coverage still have 33 percent of their Latino population uninsured.

    For decades, Latinos had the highest uninsured rate in America.

    If you like this post, you might also like this:
    If you need health insurance, where you live could matter a lot 

  • People with Medicare are paying less for their drugs

    People with Medicare are paying less for their drugs

    People with Medicare are paying less for their drugs. The US Department of Health and Human Services just reported $11.5 billion dollars in prescription drug savings for 8.2 million older adults and people with disabilities since 2010.  Sylvia Burwell, HHS Secretary, credits the Affordable Care Act for these savings. People with Medicare are saving more and more on their prescription drugs since passage of the ACA.  The average savings is $1407 as a result of drug discounts for people without coverage in the Part D prescription drug “donut hole” and drug rebates.  For a state by state breakdown of savings, click here.
    Overall, drug savings are up $4.5 billion since last year.  Drug savings will continue to grow over the next six years until the donut hole closes in 2020.
  • New survey finds that health reform is helping millions of Americans get needed care

    New survey finds that health reform is helping millions of Americans get needed care

    Health reform is helping millions of Americans. As a result of health care reform, 15 percent of Americans lack health insurance today, down from 20 percent a year ago, according to a new survey by The Commonwealth Fund. Almost six million more young adults between 19 and 34 have insurance.  And, all in, nine and a half million more adults are now insured.

    Consumer satisfaction with their new health insurance coverage is also relatively high, with 78 percent either somewhat or very satisfied with their coverage.  Of those who are somewhat satisfied or very satisfied, 74 percent are Republicans and 85 percent are Democrats.  And, six out of ten people with new coverage have used it already to see a doctor or fill a prescription.

    Close to six out of ten people with new coverage (58 percent) say they are better off with their coverage than they were before.  And, 27 percent report no effect in their situation.  Only nine percent say they are worse off.

    Uninsurance varies by race and ethnicity.  Since last year, the percentage of uninsured White Americans dropped from 16 to 12 percent.  The percentage of uninsured Latinos dropped from 36 to 23 percent.  The percentage of uninsured African Americans dropped from 21 to 20 percent.