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Making Health Insurance Great Again!


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What is a Catastrophic Plan and are you Eligible?

When selecting health insurance during open enrollment, you may decide to select a “Catastrophic Plan.”  To do so, you must meet certain criteria in order to be eligible for this type of plan.

Defining a Catastrophic Plan

Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case health scenarios, like getting seriously sick or injured.

Most routine medical expenses are paid by you if you elect this type of plan.

You are only eligible for this plan if:

You are under 30 OR you are of any age and you have a hardship exemption or affordability exemption. These exemptions are based on Marketplace or job-based insurance is unaffordable.

What’s Covered?

  • Catastrophic plans cover the same essential health benefits as other Marketplace plans.
  • Catastrophic plans cover certain preventive services at no cost.
  • Catastrophic plans cover at least 3 primary care visits per year before you’ve met your deductible.

How much do they cost?

  • Monthly premiums for this type of plan are usually low,
  • Deductibles:  Deductibles are the amount you have to pay on your own for most services before the plan starts to pay anything.  These can be very high for this type of plan.  For example, the deductible for this plan during 2017, for all Catastrophic plans is $7,150. After you spend that amount, your insurance company pays for all covered services, with no copayment or coinsurance.

This can be very confusing and it may be difficult to make the best choice for you and your family.  The good news is, I am here to help!  Let me help guide you through the open enrollment process this year so that you can make an informed decision.

Schedule your FREE consultation by calling:  (813) 391-3448

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Making Open Enrollment An Easy Process

Open enrollment for 2018 health insurance coverage is right around the corner.  The enrollment dates are November 1, 2017, through to December 15, 2017.  All health insurance coverage, decisions, and selections you make during the open enrollment period will be valid beginning January 1, 2018.

Before open enrollment begins on November 1, 2017, there are some things you will want to gather before you speak with a qualified agent.  Your agent will need to know who will be covered under your plan and the type of insurance required.  

Below is a comprehensive list of the items you will need in order to make a sound and educated decision on your health care coverage.  

If you already are covered then it’s very easy. You just need to advise your agent if any of the items below have changed over the past year.

Pre-Open Enrollment Checklist:

  • Household size:  Make a list of the people in your household that will be needing health insurance during 2018
  • Current mailing address for everyone who is applying for coverage
  • Birth dates for all household members
  • Social security numbers for everyone who will be getting coverage
  • Information about how you file your taxes
  • Estimate of what your household income will be for 2018
  • A list of any major life changes for each member of your household getting coverage such as  Marriage, Income, Moving, Births, Divorce, etc.

After you have gathered all of the information listed above, call a health insurance agent who is well versed in the Affordable Care Act and understands the laws that surround it. If you do not have an agent and need help in making the best healthcare coverage decisions for you and your family, I am here to help!  Schedule your FREE consultation by calling:  (813) 391-3448


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Do you really need an annual well visit and why is it so important?

What is the purpose of an annual well visit?

Your annual well visit or check up is something you should have each and every year.  Why?  Because it gives both you and your physician a baseline reading of your overall health while you are symptom free.  Having this baseline measurement can help your doctor detect potential health concerns before they progress – think of it as a warning system for your overall health. 

“An ounce of prevention is worth a pound of cure”

What can you expect during your annual well visit?

You can expect your physician to check the following during your next well visit

  • Health history
  • Height measurement
  • Weight measurement
  • Blood pressure reading
  • Body mass index assessment (BMI)
  • Counseling for obesity
  • Skin cancer and safety
  • Depression screening

During the overall visit with your doctor, he or she will determine if there is a need for additional tests, lab work, x-rays and other medially appropriate health screenings based on what the baseline measures report.

Embrace the opportunity you have to go for an annual well visit every year.  These visits can help you avoid potentially serious health conditions.  They can also provide early diagnosis for diseases that can be easily treatable if caught early enough – things like diabetes.  Allowing health concerns like diabetes to go unchecked for a prolonged amount of time can do serious, irreversible damage.

Curious to know how the Affordable Care Act’s annual check up has helped real people?  Check out the stories below!

All names have been changed.

Rich had not had a checkup in many years and after getting insurance for the first time in as many years he went for a checkup.  The doctor saw something irregular on his EKG and sent Rich for further testing. Turns out Rich had a blockage in a small artery and needed a procedure to open it up.  What was an outpatient procedure could have been life threatening if it went on undiscovered.

Samantha has had insurance for many years but had not had a checkup in about 4 years.  When she went this past February a small nodule was found in her breast that needed further study.  The nodule turned out to be nothing to worry about but its very important to have these things checked.

Don also had insurance for many years and had not been to a doctor in about 5 years.  After showing the doctor a mark on his leg, the doctor sent him for additional tests.  The spot turned out to be skin cancer that was easily removed at the stage that it was in.  Had it gone on longer, it could have been an issue.

Tips to make your upcoming well visit productive:

  • Be very specific when you call to schedule your appointment – indicate that you need an appointment for your annual well visit
  • Make sure the doctor’s office codes your visit properly so you do not get charged erroneously
  • If you think you have been charged incorrectly, ask to see the codes your doctor’s office uses for well visits
  • Make a list of questions and concerns you would like addressed during your visit
  • Know what is included in your annual well visit – visit a blog post I wrote earlier this year that outlines what is included HERE

Here’s to continued health!


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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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Protect Your Income!

YOCG Wednesday 6 1 16 CanvaYour Income is One of Your Biggest Assets – Protect It!

What happens if you can’t go to work for a few months?

Let’s say you trip over the cat and break your arm.  Oh, and by the way, you cut hair for a living!!!   OR…………………..

You get sick and can’t go into the office for 2 months…………….

How do you pay the bills?

There has always been coverage for situations like this, but, it has been notoriously expensive!!!  That is, until NOW!

What used to be called Disability Insurance has since changed a bit and re-born as Income Protection Insurance.

The sole purpose of Income Protection Insurance is to now replace most of your take home income so you can survive and not worry about how the bills will be paid.

Let’s take a closer look at Income Protection Insurance:

Specifically, Income Protection Insurance is a long term policy structured to help you if you are seriously ill, injured or disabled.  These circumstances can either be long term situations or short term.

YOCG Tuesday 5 31 16 CanvaSome of the AMAZING benefits included in a policy like this are:

  • The assurance of income!  You read correctly!  This type of insurance is designed to pay a portion of your income to you in the event you are too sick, injured or disabled to work.
  • The CONTINUED assurance of income!  This type of plan can be structured to continue to pay you a portion of your income until one of the following occurs,
    •  The policy term you choose is reached
    •  You get back to work
  • You can make a claim as many times as you need to as long as you are covered on the policy.

Some factors regarding this type of insurance you need to be aware of include:

  • Waiting periods.  There is a waiting period that takes place before income payments begin to happen.
    • You can choose 30, 60, or 90 day waiting periods.

Understanding What Income Protection Insurance is NOT

Income Protection Insurance is not the same thing as critical illness insurance.  Critical illness insurance typically administers one large sum of money at one time, depending on the type of serious illness you may have.

YOCG Thursday 6 2 16 CanvaShould YOU Consider Income Protection Insurance?

You should if you:

  • Cannot survive on your sick pay benefits as provided by your employer
  • Do not have a large amount of savings put aside for a serious illness, injury or disability
  • Are not in the position to take an early retirement or retire at all
  • Are unable to survive on the income of your partner

Curious about learning more?  Contact Dave, Your ObamaCare Guy for more information at: (813) 391-3448 or email me at dave@YourObamacareGuy.com.


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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!