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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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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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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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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.


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2016 Healthcare Open Enrollment FACTS & FIGURES!

2016 Healthcare Open Enrollment FACTS & FIGURES!

Obamacare Guy 9 29 15 Canva2016 Open Enrollment is fast approaching.  Hurry!  Grab your calendar!  It is time for you to mark some VERY important dates on your calendars.  If you miss these dates, it could mean the difference between paying healthcare penalty fees or not.

The following dates relating to obtaining health insurance coverage have been posted by healthcare.gov:

Late October:

Prices for health insurance plan rates purchased in the Health Insurance Marketplace will be published late October.

November 1, 2015:

This day marks the FIRST day of Open Enrollment.  Starting on November first you can obtain healthcare coverage through the Health Insurance Marketplace.  Coverage can start as early as January 1, 2016.

December 15, 2015:

This is the very last day to enroll or change plans and still have them be in effect for January 1, 2016.

January 1, 2016:

This is the first day of coverage for those who purchased plans and enrolled by December 15, 2015.

January 15, 2016:

There is still time to get covered!  This is the last day for you to obtain coverage or make changes to coverage and have them be in effect for February 2, 2016.

January 31, 2016:

This is the LAST day of open enrollment.  All enrollments and changes administered between January 16 and January 31, 2016 will be in effect on March 1, 2016.

I Recorded the Dates and Deadlines, Now What?

Obamacare 9 1 15 CANVA-2Now that you know WHEN you need to get coverage by, it is important for you to know how much coverage you need in order to qualify.

There is a specific list of plans or policies that are NOT considered as “minimum essential coverage”.  Those plans or services include:

  • Vision Care
  • Dental Care
  • Workers’ Compensation
  • Disease specific coverage
  • Plans offering discounts on medical services

 

Below is a list of plans or options you can use and qualify as “covered” by health insurance:

  • Purchase of any Marketplace health insurance plan
  • Individual health insurance plans you may already have in place
  • Health insurance offered by an employer
  • Retirement plans
  • COBRA Coverage
  • Medicare Part A
  • Medicare Part C
  • Children’s Health Insurance Program (CHIP)
  • Coverage on a parental plan if you are a dependent aged 26 years or younger
  • Self-funded healthcare plans for students offered by universities*
  • Peace Corps volunteers health coverage
  • Certain veterans plans offered by the Department of Veterans Affairs
  • Most TRICARE plans
  • Department of Defense Non-appropriated Fund programs
  • Refugee Medical Assistance
  • State high risk pools**

For a more detailed list, visit:  http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage

*These plans are specific to policy years that began on or before December 31, 2014.  Please check with the university for clarification and more information as to whether or not the plan is in line with “Minimum Essential Coverage” policies.

**Plans eligible are those that commenced on or before December 31, 2014.

What if I Don’t Get Health Insurance

Failure to Get Health Insurance Could Cost YOU!
What happens if you don’t enroll in a health insurance plan by January 31, 2016?  You may have to pay a fee for failing to get health insurance coverage.  The fee for not having health insurance in 2016 has INCREASED since 2015.

Here are some facts and figures you must consider before Open Enrollment Ends on January 31, 2016:

If you fail to get coverage in 2016 you could end up paying the higher of the two amounts listed below:

Dollar Amount #1:  2.5% of your annual household income

Dollar Amount #2:  $695 per person (children under 18 are calculated at $347.50/child)

There are some other timing circumstances to take into consideration when talking about failure to have health insurance coverage.  See the Q & A segment below:

Q: What if I was uncovered for a portion of the year?

A: You would pay 1/12 of the annual penalty for each month you were not insured.

NOTE:  if you did not carry insurance for 2 months or less, you would not have to make a payment

Q: What if I was unemployed?

A: Penalty fees for not carrying insurance is based on your household income.  If it is determined that healthcare insurance was unaffordable based on your income, you could possibly qualify for an exemption.

Other Important Questions You May Have…

How will I pay?

This payment will take place when you file your taxes.  More specifically, it will be included on the tax return for the year you did not have health care insurance coverage.  For example, if you did not have health insurance during 2015, you would pay the penalty fee when you file your taxes on or before April 15, 2016.

What will happen if I fail to pay the penalty fee for not having healthcare insurance?

The Internal Revenue Service will withhold the amount you owe from any tax refunds you may get in the future.  You will NOT experience any:

  • Liens
  • Levies
  • Criminal penalties

Now that you know, what is considered as minimal essential healthcare coverage, who needs it and by when, it’s time to get you covered!  As “Your Obamacare Guy”, I am dedicated to help you get the best and most affordable health insurance plan for both you and your family.  If you are confused, have questions or need help navigating through the Marketplace, call me!  You can reach me at:  (813) 391-3448 or email me:  dave@YourObamacareGuy.com.

Sources:  healthcare.gov