Captain Health USA

Making Health Insurance Great Again!


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Why It Is More Important Than Ever To Have A Knowledgeable and Reputable Health Insurance Agent

In an article I recently read, entitled “ObamaCare Advocates:  Hole Too Deep to Make Up Outreach Cuts” it states that the Trump Administration has cut 90% of the funding set aside for educating the population on their options for health care coverage.  What does this mean for you?  In short, you may be losing out on critical information you need to make an informed decision about health care coverage for you and your family.

It is speculated that this cut could result in fewer people getting the health care coverage needed due to not knowing or being aware of the open enrollment periods and deadlines, what types of coverage is available, how health care coverage works and how to navigate the system.  A recipe for disaster for the average American.

With this new cut, it is more important than ever to have a knowledgeable and reputable health insurance agent represent you to ensure you are getting the health care coverage you need and deserve, on time!  Not all agents are created equal!  When selecting an agent, select someone who is:

  • Professional and who is responsive and available to take your phone
  • Well educated when it comes to the Affordable Care Act
  • Informed and stays on top of Affordable Care Act current events
  • Understands the law
  • Will listen to your needs and will consult with you about your best options

If you are concerned about the upcoming open enrollment period, how much health care coverage you need for you and your family and how to avoid potential fines, I can help!  Visit my website for FREE valuable tools like “Dave’s Doctor Search” and a list of resource links.  Follow me on Facebook to learn about your healthcare options, breaking news and to get connected!

Do you have questions or need help navigating the health insurance system?  I am happy to help! Schedule your FREE consultation: (813) 391-3448

Doing my part in Making Healthcare Great Again!

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Are You Taking Advantage of Your 2017 Health Plan?

If not, you should be!  The Affordable Care Act is in place to help you be healthy and remain healthy throughout your life!  A BIG part of helping you stay healthy is through preventative health care practices.  The Affordable Care Act provides several preventative services as well as 1 wellness visit each and every year.

In this blog post, we are going to explore what is included in your well visit and showcase why it is important to take advantage of your it through real life stories.  The stories we share with you will illustrate how preventative care and well visits stopped devastating illness in its tracks.  The key to preventative health care is catching illness and disease before they manifest and fester into a larger more chronic or fatal outcomes.

So what exactly is “Preventative Care”?  It is the practice of evaluating your health when you are not sick or experiencing any sort of symptoms, providing a baseline or what is normal for you.  Once you have a baseline established for yourself, it makes it easier for healthcare professionals to identify illness and disease earlier.  This makes it easier to establish when something serious is brewing within your body.

Did you know there are at least 10 preventative services and 1 well care visit available to you during the calendar year under The Affordable Care Act?  Many people don’t!  These preventative services are made up of one well care visit as well as things like immunizations, tests, physical exams and lab work.

Captain Health USA Stat: The Affordable Care Act allows for 47 million women with private insurance to schedule mammograms without being charged a co-pay

Curious what you could expect during your annual well care visit?

Under The Affordable Care Act it is required by law that you have access to 10 main preventative care services.  Below is what is included in the “Adult” list.  Keep in mind, there are even more listed for women, children and seniors!

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Blood Pressure screening for all adults
  3. Lab Tests such as Cholesterol screening and others
  4. Colo-rectal Cancer screening for adults over 50
  5. Depression screening for adults
  6. Diabetes (Type 2) screening for adults with high blood pressure
  7. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  8. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus
    • Influenza (Flu Shot)
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    • Varicella
  9. Obesity screening and counseling for all adults
  10. Tobacco Use screening for all adults and cessation interventions for tobacco users

Real Life Stories… (all Names Changed)

John……    Didn’t have insurance for many years due to the cost.  About 2 years ago he got coverage and decided to go for his physical.  The first physical in about 10 years.  At first all seamed well.  Then the lab work came back.  The labs showed that his blood sugar was way off from what it should be.  Turns out John was a diabetic and didn’t know it.  He simply ignored the symptoms.  Over time it could have been a huge medical issue however, since it was caught fairly soon, John got on medicine and should live a normal life.

Rick……  Rick had not had insurance for about 5 years.  Rick got a physical at the first chance he could and it was a good thing he did.  An issue with his prostate was caught in the early stages and was able to be treated with out major surgery.  Had it not been caught it could have cost him his life.

Joan…… To make a long story short, the non-compliant health plan Joan was on did not cover the cost of a mammogram .  Once she got good coverage, Joan had a mammogram (that cost nothing)  for this first time in 4 years.  A very small abnormality was found and removed.  Had it not been found early on, the treatment and results could have been much worse.

Health insurance is not just for when your sick, its also there to keep you well.


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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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Physician Referrals, YOU Have A Choice!

Physician Referrals, YOU Have A Choice!

Health care and visiting the doctor has become increasingly complicated to navigate. Rules are always changing.  Life is busy which makes it hard to keep up with the changes.  Good news!  I am here to help!  So, let’s dive in!!!

Wednesday 7 6 16When do I need a referral?

Referrals are generally required when you need to see a specialist for a condition that your regular primary care physician cannot treat.  Not all specialists need a referral.  The services that DO NOT require referrals are:

  • In network:
    • Obstetrician/gynecologist
    • Urgent care centers or walk in clinics
    • Eye examinations
    • Mental health disorder and substance abuse services
    • Pathologist
    • Radiologist
    • Anesthesiologist
    • Emergency room visits/admissions
    • Non-physician services such as:
      • Outpatient labs
      • Diagnostics
      • Physical Therapy
      • Durable medical equipment

How do I obtain a referral for a specialist?

Once your primary care physician determines a specialist is needed, to help you with your condition, a referral is given.

A Referral is an authorization for you to see a specialist.

In some cases, your physician may give you a recommendation of who to see along with his referral.  A recommendation is exactly what it sounds like.  It is a suggestion of who you might want to consider seeing for treatment, not a mandate.  This is great news!  Why?  For many reasons!  Check them out:

  • Many times, your primary physician may recommend a specialist who is not in your network.  This can be a very expensive option for you.
  • You have the opportunity to research and find the perfect specialist for you within your health insurance network
  • In some cases, referrals are generated due to a quid pro quo arrangement between doctors.

Now that you have your referral in hand, it is time to select your specialist.  One of the first things you should do is fire up your computer and search for the doctor in your insurance plan’s database.  Not sure who is in your carrier’s database or where to even find the database?  No worries, use this handy tool:  Dave’s Doctor Search.  Here you will find all of the doctor’s listed in the each of the major health insurance carriers.

Select at least three specialists you are interested in possibly using for treatment and learn more about them.  Some of the things you will want to look for are:

  • Is the doctor licensed?  You can verify this by visiting your state’s physician licensing board
  • Is the physician board certified?  A board certified physician is one who demonstrates exceptional expertise in a specialty or subspecialty.  They are certified and recognized by the ABMS Member Board.  Qualifications to be recognized by this board includes rigorous testing and peer evaluations.  These evaluations and tests are engineered and administrated by other specialists in the same field of specialty.
  • Consider the age of the doctor.  Are they older and considering retirement, are they younger and have a passion for cutting edge technology and techniques or have they been practicing a long time giving them ample experience to treat your condition well?
  • Discover how long the doctor has been practicing by visiting online doctor listing sites.
  • Have there been interruptions in their practice and why?
  • What hospitals is the doctor affiliated with and how are those hospitals ranked?
  • Has the doctor experienced any reprimands or malpractice suits?
  • Consider researching doctor ratings sites and review sites.
  • Has the doctor authored any papers, studies or conducted research in the field you are looking to get treatment in?

There is so much to consider when selecting a doctor and a specialist!  The most important thing to remember is that YOU get to make the choice on who treats you.  Take control of your health and your healthcare by selecting the physician that makes the most sense for you and your health goals.

Remember, the referral you receive from your primary care physician (PCP) is the authorization you need to go to the specialist.  The name of a doctor they give is a recommendation only.  Do your homework and find the right fit for you.

Do you need help navigating your way through today’s healthcare arena?  I can help!  Contact Dave, Your ObamaCare Guy for more information at: (813) 391-3448 or email me at 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.