Claims Plus Insurance Solutions

2016 gavinfarrington.com

I have heard people very unhappy about the rise in their premiums. This article addresses the high cost of claims when you are not in a government program. This high cost of claims directly affects your premium. So it is not just the insurance company at fault. We need to rein in the costs of providers. http://nyti.ms/29wZXIy

It is now 6 months into the year. Do you have an HSA (Health Savings account)? If so, make sure to open your health savings account through your preferred financial institution and pay your medical expenses out of it. (not your premiums) Otherwise you will lose the tax exemption on that money. In 2016 an individual may place up to $3350; a family $6750. As long as you place it in your HSA you will save on your income taxes even if you do not use the money. Call us if you have any questions.

Do you have a short term health insurance policy? Or are you considering a short term health insurance policy instead of a regular policy because the premium is low? If you replied yes to either of these questions please read this article. (http://time.com/money/3907780/health-insurance-temporary/ ) Short term policies do not fulfill the Affordable Care requirements: they still have preexisting condition clauses, lifetime maximums, do not offer preventative care or some of ...the essential health benefits. And, because they do not fulfill the requirements, you will receive the penalty of $325 or 2% of your 2015 income on your taxes next year. I recommend short term health insurance policies only in the following scenarios: you missed the open enrollment; you were laid off the last quarter of the year. The last is due to the loophole in the Affordable Care Act. If you do not have health insurance for 3 months of the year or less you do not receive the penalty. See more

Please see http://observer.com//underinsurance-equals-less-preventi/ The attached article addresses some very good points. But I would like to point out a couple of omissions, misconceptions and misinformation. This article states that people are not proactive when it comes to their annual physicals and preventative screenings. The writer cites cost as the reason. This is a fallacy. Under the Affordable Care Act, whether you chose the lowest premium Bronze plan or highest ...premium Platinum plan, all annual physicals and age appropriate preventive diagnostic work is paid at 100% by the insurance company. There is no cost to the member. The caveat is that you must go to an in network provider. The real reason why folks do not go for their physical and preventative work is that they do not understand their plan. Their broker did not explain it to them. Out of pocket medical expenses on some plans may reach as high as $6350. When you add this to the premium it is even higher. However, because of the Affordable Care Act, those with low incomes may obtain subsidies to help them with their out of pocket costs. There is no such help for those of us who are middle income or above. But I want to hearken back to the days before the Affordable Care Act. There was not a ceiling on out of pocket costs. The out of pocket costs ranged anywhere from $25,000 to an unlimited amount, depending on your plan. At that time over 60% of bankruptcies were due to medical costs. While $6350 is difficult to contend with, it better than the previous alternative. And, again, those below 400% of the National Poverty Income will receive help paying for their out of pocket costs from the government. The final item I want to address is the comment, much of the issue is out of our control and in the hands of corporate America, health insurance providers and politicians. I don’t like to harp on the same subject as my last posting but, what about the healthcare providers? It is also in the hands of the doctors, hospitals, etc. The fees that they charge is part of this mix. Higher fees make for higher premiums. I like to cite the example of a specialist who treated me. I was in his office for 45 minutes, saw the doctor for 30, and they charged $675 for the specialist visit. It is unconscionable what some healthcare providers charge. The Affordable Care Act mandates that at least 80% of premiums are used for claims payment. The companies must submit a report that reflects this before they may increase our premium. The higher the healthcare provider’s charge, the higher the claims payment which, in the end, equals a higher premium for us all.

The White House is addressing 2 of the weaknesses in the Affordable Care Act: inaccurate provider directories and the out of pocket costs of consumers. (www.nytimes.com//health-care-law-consumer-complaints-to-ge ) These two issues are the most common consumer complaints. For today I will address inaccurate provider directories. To help my clients, I research carrier websites to ensure that their doctors are in the network of the insurance company of their choice. However, w...hen they visit their doctor some of them find that their doctors left the network and are faced with higher out of pocket costs. The White House is working to alleviate this problem by requiring insurance companies to update the provider networks once a month. If a company fails to do so they will face financial penalties. While this will help, this will not eliminate the problem. The impetus is to hold the insurance companies accountable. The reason this will not eliminate the problem is that it fails to address the doctors’ and facility’s responsibility. Doctor’s and facilities may leave a network when their contract is up. If you are in the middle of a cancer treatment and your oncologist decides to leave your insurance company’s network, you are forced to find another oncologist. We need is a federal mandate for doctors and facilities to grandfather a patient. This would mean the patient continues treatment and the doctor/facility accepts the contract payment until treatment is completed. This, unfortunately, does not help those who do not have a serious condition. Your doctor may be in the network this month and decide to leave the next. There is no easy solution to this problem. The White House action is a good first step. To protect yourself as much as possible work with a health insurance agent to research your providers before choosing an insurance company. Then ask your provider if he intends to stay within the network. And when you are planning major work, ask the question again.

I had 2 people contact me today for individual coverage. They were not aware that the open enrollment period for individual health insurance applied to both the Covered California Exchange and the private market. One person was quite upset and blamed the Affordable Care Act. In one sense, this is true. One of the primary reasons for a set individual open enrollment time is due to the removal of the preexisting clause that went into effect 1/1/2014. Before then health insura...nce companies had the right to refuse coverage to anyone who they determined to be a poor risk due to health problems. The ACA removed that right. Health Insurance companies must accept all applicants regardless of health status. The Open Enrollment period went into effect partly so that people would not buy a rich plan, take care of all their high cost services, and then change to a lesser plan. This would wreak havoc on everyone’s health premiums. If you do not have health insurance at this point you will need to obtain short term insurance. However, short term insurance coverage does not fulfill the Affordable Care Act's minimum coverage requirements.

I been out of the loop due to a health issue. But I a BAACK! This post refers to employer groups based in SF who have had more than 19 employees in the last quarter. If you do not offer group health make sure to submit your 2014 Employer Annual Report by April 30th. Otherwise you face a penalty of $500 per quarter. If you have questions or want to complete your reporting online go to www.sfgsa.org/index.aspx?page=418.