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Healthcare and The Incoming Administration

The attached article – Donald Trump Walks Back His Stance On Obamacare shows a possible change in direction of the incoming administration and it’s not totally unexpected.


YOCG Tuesday 2 2 16 CANVAThere are so many people covered by insurance now that were never covered before it would almost be impossible to unwind what’s already been done and put something else in place that does not look like just about the same thing.  You know that old saying…if it looks like a duck and quacks like a duck…its a duck.   Maybe its a Trump duck instead of an Obama duck….but its still a duck.  
 

The affordable care act (Obamacare) was based on a few core principles. The most important ones in my opinion are…

1. No one should be turned down for any pre-existing medical condition

2. People who could not afford insurance would get subsidies or some kind of assistance to help with the cost

3. Everyone would be required to have insurance that consists of what is called MEC (Minimum Essential Coverage). This is also called the “Individual mandate”

It’s these principles that define Obamacare. Everything else in my opinion, surrounds these principles and if changed, really does not effect the basic core principles.  Some examples of things that could be changed that would lower the cost of coverage to most people include….

 – Should pregnancy coverage be included in all policies?

 – Should mental health coverage be included in all policies?

 – Should rehab coverage be included in all policies?

YOCG Tuesday 11 24 15 CANVAMaybe these coverage’s should be options like when you buy a car.  Everyone gets the basic car but if you want a radio it’s extra, if you want bigger tires it’s extra, if you want a sunroof it’s extra, you get the point.

I think we need to bring healthcare coverage back to its original intent, to cover you for what you want to be covered for and not what the government says that you should be covered for.  Of course everyone should have at least basic well-care and hospitalization coverage but should everyone have to pay for all the options? 

Read the article HERE


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2017 Open Enrollment…Are you READY?

It’s that time of year again!  Get ready to start thinking about open enrollment and what you need to do to make sure you and your family have health insurance coverage.

Here is what you need to know!

2016:

Open enrollment for 2016 is CLOSED.  BUT, If you still need coverage for the rest of 2016, you can get it but, only if you qualify. 

To qualify you need to meet one of these two criteria:

  • Special Enrollment Period due to a life event — like losing health coverage, getting married, or having a baby.
  • You qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

You can apply for these programs any time throughout the year.

Let’s Brush Up On The Marketplace

About The Marketplace:

Who is it for?  The Marketplace is for individuals who do not have health coverage for the coming year.  That means, you do not have coverage through:

  • Your employment
  • Medicare
  • Medicaid
  • The Children’s Insurance Program (CHIP)
  • Another source providing qualifying coverage

How Much It Costs:

Health insurance through the Marketplace depends on your estimated income for the coverage year.  Did you know?  In 2017, roughly 8 out of 10 of uninsured people who are eligible for Marketplace coverage will qualify for financial assistance.*  The financial assistance  provided goes towards lowering the cost of the monthly premiums and in some cases is can also help with things like deductibles and copays.  Get an idea of what that could mean for you HERE.

Discover What The Marketplace Insurance Covers:

Essential health benefits – Every plan must include the following:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
  • Pre-existing conditions, including pregnancy
  • Preventive care
  • Birth control coverage
  • Breastfeeding coverage

Pre-existing conditions, including pregnancy

Preventive care

Get a list of what that includes for:

What If You Do Not Get Health Insurance?

If you can afford health insurance and fail to obtain qualifying health coverage for the 2017 year, you may be fined.  This fine is referred to the “individual shared responsibility payment”. 

Fees are calculated in two different ways.  They are:

  • A percentage of your house hold income
  • Per person

You will be required to the highest rate calculated.

Fines for 2017 have not been released as of yet.

Do you have questions about your health insurance coverage for 2017?  I can help!  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com

* source:  http://www.HealthCare.gove/quickguide


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Open Enrollment & Obamacare Changes YOU Need to Know About!

Healthcare Open Enrollment is RIGHT Around the Corner! 

There are LOTS of Changes YOU Need to Know About!

yocg-tuesday-9-6-16-canvaHealthcare open enrollment begins on November 1, 2016 and runs until January 31, 2017 and it won’t be business as usual.  There will be several carrier changes for 2017. 

Before we get into the specific changes, there are some dates you need to put on your calendar for the open enrollment period:

  • November 1, 2016:  Open Enrollment Begins
  • December 15, 2016:  Meet this enrollment deadline to ensure coverage begins on January 1, 2017
  • December 31, 2016:  Coverage ends on this date.  If you have NO changes to your plan, your plan will be auto-renewed
  • January 31, 2017:  This is the VERY LAST day you can apply for 2017 healthcare coverage

If you miss these deadlines, you cannot enroll again until November 1, 2017 unless you have special “life event” changes take place.  Life event changes include:  having a baby or losing your job.

Did you know?

If you do not enroll in Obamacare or have an approved form of health insurance during 2017, you will be fined 2.5% of your income or $695 per adult – whichever is higher.  Please note that the amounted listed is only an estimation as the higher 2017 dollar amount has not been released as of yet.

Those living at poverty levels can enroll at any time in the Medicaid or CHIP (Children’s Health Insurance Program).  These programs do not have a specific enrollment period or timeframe to adhere to.  Please note, there are some restrictions to adhere to such as income restrictions.

Changes…

yocg-wednesday-9-1-16-canvaAt the beginning of this article, I noted there were going to be changes in the Florida Marketplace.  There will be some carriers leaving and some new additions too!

Let’s first say good-bye to:

  • United-Healthcare
  • Aetna

Say Hello to:

  • Cigna – they exited the Florida Exchange in 2015 but are coming back in 2017
  • Molina – They are expanding from South Florida to the Tampa Bay area
  • Harken Health (a subsidiary of United Healthcare) is planning to enter the exchange in the Miami and and Fort Lauderdale area

Of Note:

Humana plans to scale back it’s participation in the Marketplace but will remain in the Florida Exchange system. 

Other changes coming down the pike in 2017 include rate changes that have not been approved by the state yet.   

Other Obamacare changes people can expect to see in 2017 are:

MORE INFO!

When you select a healthcare plan, there are usually two things you ask:

1)  How much is it going to cost me

2)  Is my doctor or the hospital I prefer in my plan

A common complaint last year was inaccurate doctor and hospital information.  The new rules mandate that:

  • Insurance providers are required to give consumers a 30-day notice when a doctor is being removed from a network
  • If a doctor/provider is being removed from a network and a patient is in active care/treatment with the physician being removed, the insurance company must allow for up to 90 days treatment under the physician’s care

Reduction in “Surprise” medical bills from out-of-network providers

Many patients have complained about receiving unexpected invoices and bills from out-of-network doctors, even when the patient thought the doctor was in network.  The new rule calls for:

  • Ancillary care amounts to be applied towards a patient’s yearly out of pocket maximum expenses

Note, this rule only applies to those instances where the insurer has not given patients the correct notification that they will be receiving care from individuals outside of the network.  The general rule is that a patient must be notified that they will receive care from an out of network provider within 48 hours.

Better Explanation of Out-Of-Pocket Expenses/Costs

During 2017, insurers are to offer plans with a standard set of coverage costs (deductibles and copays).  With this information easily attainable, the patients will better understand the out-of-pocket fees associated with the plan they select.

Do you have specific questions about open enrollment and how the 2017 marketplace changes could affect you?  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com


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SureMed…It’s What You Have Been Waiting For!

SureMed…It’s What You Have Been Waiting For!

YOCG Wednesday 5 4 16 CanvaWhat if I told you there was a healthcare solution allowing you the opportunity where your entire family can talk to a physician anytime, for only $20 a month!?!  It’s true!  Without any other additional or hidden charges either!  20 dollars…that’s it!

Great news!  This plan IS a reality!!!  PLUS…your own health insurance plan may cover prescriptions if one is called in!

Interested?  Read on!

SureMed offers a unique service that gives you access to a physician by phone 24/7 without being charged an additional consultation fee.

This service completely revolutionizes visiting the doctor!  Imagine…

  • Speaking to a U.S. licensed, board certified physician and getting your questions answered from the comfort of your own home!
  • Receiving advice and consultation from knowledgeable, board certified physicians with an average of 15 years practice experience!
  • Being diagnosed via the phone or video consultation!
  • The pleasure of avoiding crowded waiting rooms, busy walk-in clinics and additional germs found in those places!
  • Quick response time!  Call backs from qualified physicians take place within an average just 16 minutes!

What can be diagnosed over the phone or by video consultation?

YOCG Thursday 5 5 16 CanvaSureMed has made it easy for you to receive consultation, diagnoses, and prescriptions over the phone for common illnesses like:

  • Colds
  • Flu
  • Poison Ivy
  • Respiratory Infections
  • Bronchitis
  • Allergies
  • Pink eye
  • Sinus Problems
  • Urinary Tract Infections
  • Ear Infections
  • Non-emergency illnesses

Treatment Recommendations

The doctor can advise patients on the treatment actions to be taken and may even prescribe medications such as antibiotics and other substances not controlled by the DEA or other medications which are susceptible to abuse.  If a prescription is required to treat the illness diagnosed, the doctor can have it called in to the local pharmacy of your choice.

Check out what else is included…

The $20/month program includes ALL of these amazing benefits:

  • Doctors by phone
  • Counselors by phone
  • Dental discounts
  • Vision discounts
  • Prescription discounts
  • Retail health clinic discounts
  • Medical bill saver – medical billing advice and negotiation help
  • Vitamin discounts and price comparison
  • Lab discounts
  • Diabetic supplies discounts
  • MRI & CT Scan discounts
  • Hearing aid discounts
  • Durable medical equipment discounts

It almost sounds too good to be true but it is!

If you have questions about this plan and want more details, call me!  I would love to talk you about this incredible opportunity for you and your family!

Call me, Your Obamacare Guy at (813) 391-3448 or email me at dave@YourObamacareGuy.com.


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Emergency Room VS Walk -In Clinic and Your Insurance

Emergency Room VS Walk -In Clinic and Your Insurance

YOCG Tuesday 1 5 2016We all like options right?  Today we have lots of options when it comes to healthcare.  We can choose our doctor from a list of network physicians, select generic prescriptions versus brand name, and we can even choose whether or not we want to go to the Emergency Room or a Walk-In Clinic in urgent but non life-threatening circumstances.  The last option may mean a big difference in dollars you need to pay!  Read on to learn more!

 

Lower Copays
If you had the opportunity to pay lower copays, would you jump at the chance?  I know I would!  Did you know that your may have the opportunity for lower copays if you choose to get care at an in-network walk-in clinic instead of an emergency room?  That’s right!  Your insurance may reward you with a lower copay when you elect to get treatment in a walk-in clinic rather than an ER for non life threatening illnesses or injuries.  In some instances, you may only need to pay $25 to $50 in copay fees when visiting an in network walk-in clinic as opposed to thousands of dollars in Emergency Room bills.

What Type of Services Can You Expect From A Walk-In Clinic?

You may be surprised at the vast amount of services a Walk-In Clinic or Urgent Care facility can provide.  Check out our table below for details of what may be treated in an urgent care facility.

Urgent Care Services

Emergency Room Fees Add Up…Quickly!

YOCG Tuesday 2 2 16 CANVAEmergency room fees tend to add up fast, even before you get there, especially if an ambulance was called.  Depending on your insurance, you could be charged anywhere from as low as $25 but as high as $1,200.

Once you arrive to the Emergency Room, there is a chance that you will need x-rays, special diagnostic testing, medicine and more. Below is my list of tips for monitoring your emergency room bill:

  • Make sure you have a trusted friend or family member with you to help you do some legwork
  • Ask for an itemized list of your bill and scrutinize it for procedures not done or medication not given
  • Talk to the billing department.  Find out if there are different sets of costs for procedures done and select one that fits your budget if you can
  • Discuss a payment plan.  Typically hospitals do not want a bill to go to collection agencies.  See if they will work out a reasonable payment plan with you
  • Discover if there are financial aid programs available to you or if there are any not-for-profit organizations that can help with paying the bill

When Should You Go To An Emergency Room?

Some conditions that should be seen by an Emergency Room staff include:

  • Severe chest pain or difficulty breathing
  • Compound fracture (bone protrudes through skin)
  • Convulsions, seizures or loss of consciousness
  • Fever in newborn (less than 3 months old)
  • Heavy, uncontrollable bleeding
  • Deep knife wounds or gunshot wounds
  • Moderate to severe burns
  • Poisoning
  • Serious head, neck or back injury
  • Pregnancy-related problems
  • Severe abdominal pain
  • (Signs of) Heart attack (i.e.. chest pain lasting longer than two minutes)
  • (Signs of)Stroke (e.g. loss of vision, sudden numbness, weakness, slurred speech, or confusion)
  • Suicidal or homicidal feelings

When in doubt, get to the nearest emergency room and get the treatment you need.

Before an emergency happens, take the time to understand your policy and what is included and required during an emergency

If you have questions about your coverage and need assistance understanding your policy, contact me, Your Obamacare Guy at (813) 391-3448 or dave@YourObamacareGuy.com.  It is my pleasure to help people get the coverage they need to live the healthiest life possible!


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In-Network? Out-of-Network? Get the Facts and Understand How it Affects YOU!

In-Network? Out-of-Network? Get the Facts and Understand How it Affects YOU!

What Is an Insurance Network?

An insurance network is a term used to describe a group of: Doctors, Hospitals, pharmacies, labs and various other health care providers who have all agreed to provide services to members of a health insurance plan at a negotiated rate.  These health care providers are called Network Providers, more specifically, “in-network providers”.

When visiting in-network practitioners or facilities, usually, the standard copay fees and deductible amounts apply.

YOCG Wednesday 12 16 15Out-of-Network providers are those doctors and facilities who do not participate in your insurance plan’s network agreement.  Using providers who do not participate in your plan’s network may cost you in various ways.  For example they may:

  • Charge more that the negotiated rate your insurance plan negotiated with the in-network providers,
  • Require higher copays, deductibles and co-insurance fees
  • Or your plan may not cover anything related to out-of-network care

HMOs and PPOs

Now that you understand the difference between in-network and out-of-network, it is important to understand what HMOs are versus a PPO.

HMO is an acronym for Health Maintenance Organization.  Here re some quick facts about HMOs:

  • HMOs usually provide lower premium payments and copays
  • You are required to choose a primary care physician
  • You may choose a doctor from a list that is provided to you by the HMO. Most times there are no out of network benefits.
  • The doctor you select will help you manage your healthcare by referring you to specialists when needed

YOCG Tuesday 12 29 15 CANVAPPO is an acronym for Preferred Provider Organization.  Quick facts about PPOs are

  • You are not required to designate a primary care physician
  • You have more choices about who you can pick as a healthcare provider
  • If will cost you more for having the ability to choose your healthcare provider
  • Higher costs come in forms of higher premiums, deductibles and copays
  • PPOs also require you to select providers within a network and sometimes there are out of network benefits.

What are Referrals and When are they Necessary?

Referrals are a key part of HMO programs.  They assist your primary care physician (PCP) track your health care and ensure that you are receiving the proper care for your health condition.

Referrals are required when you need to see a specialist. The specialist your PCP sends you to, is usually a part of a circle of providers he trusts to give you the care that is outside of his practice capabilities.  It is always important to make sure that the specialist in in your HMO’s network.  Once you have a referral, you also have the ability to choose your own specialist to go to as long as they are in the network.

What About Emergencies?

What happens if you are in an emergency and need medical care right away?  There are some key points you need to know:

  • All plans include emergencies into to their coverage, even if you happen to be out of network when the emergency happens.
  • Once your condition is stable, you will then be transferred to an in-network provider for follow up care.
  • ER visits may incur an additional fee or cost in addition to your deductible.  Walk-in clinics are a good alternative and will save money is many situations.

YOCG Thursday 1 28 16 CANVADid You Know?

When navigating HMOs and PPOs there are some interesting facts and tidbits you need to be aware of so you are not caught off guard:

  • Did you know that your Doctor can choose to leave the insurance companies network at any time?  You may not even be notified of the change until your next visit.
  • Did you know that if you choose to get care out of network, you may not be covered for the treatment you elected to receive and the treatment could cost significantly more money?
  • Did you know that referrals in an HMO may not be needed for certain specialists?  Check with your insurance company for which specialties these are.

If you have questions about your coverage and need assistance understanding your policy, contact me, Your Obamacare Guy at (813) 391-3448 or dave@YourObamacareGuy.com.  It is my pleasure to help people get the coverage they need to live the healthiest life possible!


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The Plain English Guide to Understanding Health Insurance Deductibles, Coinsurance and Maximum Out-of-Pocket Expenses

YOCG Tuesday 11 24 15 CANVAWhether you just enrolled or you are getting ready to enroll in a new health care plan there are 3 things you need to clearly understand regarding your new policy.  They are:

  1. Deductibles
  2. Coinsurance
  3. Maximum Out of Pocket Expenses

Many times the policy you have is written in industry jargon that it is hard to understand just what is exactly being said.  We are going to cut through the jargon for you and simplify the terms so you completely understand this portion of your health insurance policy.

Deductibles:

A deductible is the amount you pay for healthcare services before your health insurance policy begins to pay.  Below is an example:

  • Jane’s health insurance deductible is $1,000.
  • In most cases, other then the items below, Jane will need to pay 100% of her medical and pharmacy bills until she has paid out $1,000 ….
    • Doctor co-pays
    • Medication co-pays
    • Annual wellness checkup
  • Once Jane has met her deductible amount of $1,000 she shares the cost of her plan by paying coinsurance.

Coinsurance:

Coinsurance is your portion or share of the costs of healthcare.   Depending on the type of health insurance plan you have, your percentages may vary.

Below is an example:

Jane enrolled in a health insurance plan that included a coinsurance program.  The coinsurance program Jane’s health insurance carrier provided was an 80/20 plan.  The 80/20 plan means that after Jane meets her deductible of $1,000, the insurance company will pay 80% of healthcare services.  Jane will be responsible for 20% of the costs up to her maximum out of pocket limit.

For example:

After Jane meets her $1,000 deductible, she makes an appointment to see her doctor.  Since Jane has met her deductible, coinsurance is now available for Jane to use.  Jane’s health insurance offers an 80/20 coinsurance plan.

For simplicity sake, let’s say it costs $1000 for a medical procedure.  Based on Jane’s 80/20 coinsurance plan, this is how much Jane and the insurance company will each pay to cover the cost of her visit to the doctor.

  • Jane’s health insurance company will pay 80% = $800
  • Jane will pay 20% = $200

Its important to note that once Jane hits her maximum out of pocket limit the insurance company pays 100%

Sometimes people use the terms co-insurance and co-pay interchangeably.

Please know, they are two very different things.

A co-pay is a specific, fixed dollar amount you must pay every time you visit a doctor.  It is not a percentage of doctor fees as described above. To find out what your plan requires, call the customer service number on the back of your insurance card or the insurance agent who services the policy.


YOCG Monday 11 23 15 Canva-2Maximum Out-Of-Pocket Expenses:

An out-of-pocket expense is a non-reimbursable expense paid by the patient.  This is most you will pay for covered services during a health insurance policy period.   A health insurance policy period is usually a year.  The year is usually based on the calendar year starting January 1 and ends December 31.

What IS Included in Maximum Out-Of-Pocket Expenses:  

All of these items go toward your Maximum Out-Of-Pocket Expenses.  Please note that if your plan does not cover a particular service, or the service is not an essential benefit, it may not count toward your maximum.  You would need to clarify this with your health insurance plan.

  • Your yearly deductible
  • Includes cost sharing after the deductible is met
  • In most cases the co-pays

What is NOT Included in Maximum Out-Of-Pocket Expenses

  • Premiums
  • Healthcare services your health insurance does not cover

The maximum out-of-pocket limit for those on Obamacare compliant Plans:

  • Individual: $6,850
  • Family: $13,700
  • In many cases the amounts are lower based on income and family size.

Hopefully our guide gave you more clarity about deductibles, Coinsurance and Maximum Out-of-Pocket Expenses.  The best advice for you to follow is; talk to a professional about health insurance and get the guidance you need to ensure you are selecting the plan that is the best for you and your family’s situation.

Are you unsure who you should talk to?  Call me, Your Obamacare Guy!   You can reach me at:  (813) 391-3448 or email me:  dave@YourObamacareGuy.com.