Renewal for 2017 individual health insurance plans is just around the corner, and you’ve probably noticed that your rates might be increasing quite substantially next year. For example, in California alone, individual health insurance policies are expected to rise more than 13% in 2017 (that’s 3 times the increase over the past two years).

So… why is this happening? And… what can you do about it? To answer the first question: healthcare reform is a big part of the reason your rates are going up. We’ll explain what you can do about it later in this article.

In case you’re not familiar, changes to the individual health insurance marketplace were at the core of Obamacare. There were a number of different provisions that went into place, but the two big ones were:

  • A) Guaranteed Issue,
  • And B) Essential Health Benefits.

“Guaranteed Issue” is the requirement that if you apply for health coverage, you have to be accepted. In other words, if you have a preexisting condition, you cannot be denied coverage. Since this concept took effect on January 1st of 2014, thousands and thousands of people with existing health conditions have enrolled in individual health insurance plans nationwide. Many of these people have had a substantial need for various treatments: prescription drug coverage, surgeries, hospitalizations, and other kinds of medical services. As a result, costs to the insurance companies have gone up, and those costs are now finally catching-up to the consumer (you) in the form of premium increases.

Additionally, “Essential Health Benefits” are new benefits that are now mandated by Obamacare, and must be included in all individual health insurance policies. Prior to 2014, individual health plans were not required to include these “essential benefits” (examples: things like maternity, mental health benefits, and others). As a result, the addition of these benefits has caused prices to increase because there are more health services that need to be covered.

Given the combination of the two concepts listed above, we’re now starting to see substantial increases in premiums in 2017, in order to conform. In fact, in many cases, the cost of providing healthcare services under healthcare reform has been more than what was originally anticipated. As a result, certain insurance companies throughout the country have decided to exit the health insurance exchanges altogether, because of heavy financial losses.

So what can you do if your individual/family health insurance plan is increasing this year? Here are some ideas:

  1. Shop. Make sure to take a good look at all of the available options within your zip code this year. There may be new (and/or alternative) plans available in your area that can save you money. Find a good health insurance broker who can assist you.
  2. Leverage the Strength of Small Business Plans. If you’re a small business owner (especially a SMALL business owner of like 2-3 employees), consider setting up a small group health insurance plan with your partners so you can exit the individual marketplace. Small group plans are not seeing price increases at nearly the same rate as individual plans. One big reason why, is that small group plans haven’t been affected as much by having to “on-board” so many people with preexisting conditions like the individual marketplace has. You could reduce your costs substantially with this strategy.
  3. Consumer Direct. Consumer directed healthcare is when you participate in a higher deductible plan, and then pair it up with an HSA (Health Savings Account). This can help you lower your premium, and then retain funds in your HSA that would normally go to the insurance companies.
  4. Look into the “Little Guy” Insurance Companies. In California (especially Southern California), there are many smaller regional insurance companies that are participating on the Obamacare health insurance exchange. In many cases, these smaller insurance companies are actually thriving under the conditions created by healthcare reform. You might be pleasantly surprised that the prices, service, and plans are actually pretty good. Check with your broker for local recommendations.
  5. Don’t Panic. 2017 could be the “big year” for price increases, and they may stabilize again next year. Just because there are big increases this year, doesn’t necessarily mean there will be again next year. If your increase this year is manageable (ie: not breaking the bank) and you like your current plan, consider sticking with it for another year. You can always change it next year.

Be sure to contact us at PolicyAdvantage.com if we can assist you with your current individual health plan this year (Phone: 800-617-0089, Email: info@policyadvantage.com). We may have recommendations that can help you improve coverage and save money. 

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

Pinterest: http://www.pinterest.com/PolicyAdvantage

Word Press: http://www.policyadvantage.wordpress.com

 

 

 

RXPrescription drug coverage in health insurance plans can sometimes be confusing. We’ve put together a simple, short guide that outlines the four “tiers” of prescription drug coverage found in most individual health insurance plans, so that you can understand your options better. 

Most individual health insurance plans will have four (4) different tiers of prescription drug coverage. It’s important to understand the difference between these four tiers, and how the deductibles and co-payments work within them. 

We’ll briefly explain the different tiers, and how they function. Keep in mind that this is just a general overview, and if you have questions about your specific plan, contact us. *Remember: most individual health insurance plans will contain these four tiers of coverage. Here are the four tiers:

  1. Tier 1 Prescription Drugs: these are usually what are called “generic” prescription drugs. They typically have the lowest co-payments, and most of the time there is not a deductible involved. 
  2. Tier 2 Prescription Drugs: these are what are called “preferred brand name” prescription drugs. This tier moves out of generic prescription coverage, and into brand name drugs. “Preferred” means that they are preferred by the insurance companies because of their lower cost. Certain generic drugs can also sometimes be included in this tier. Co-payments are usually higher (compared to tier 1 generic drugs), and sometimes there is an additional annual deducible involved (depending on your plan).
  3. Tier 3 Prescription Drugs: these are usually referred to as “NON preferred brand-name” prescription drugs. They are considered higher cost pharmaceuticals, and are therefore “non preferred” by the insurance companies. Many times, your insurer will try to find alternatives in the lower two tiers. Co-payments are usually higher, prior authorizations (doctor approvals) are more prevalent, and sometimes there are additional deductibles involved. Certain specialty drugs (Tier 4 drugs) can also be included in this list. 
  4. Tier 4 Prescription Drugs: these are usually what are called “specialty” prescription drugs. They are considered the highest-cost pharmaceuticals, and are most often highly expensive specialty drugs. Prior authorizations (doctor approvals) are highly prevalent, and cost-sharing is the highest. Typically there is what is called co-insurance at this point, where you pay a percentage of the entire cost of the drug, and the insurance company pays the remainder. 

Prescription drug coverage is an important concept to understand. Having a good handle on the concepts above can help you improve coverage, save time, and save money.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

Pinterest: http://www.pinterest.com/PolicyAdvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

EROne of the biggest questions we get at Policy Advantage Insurance Services is:

  • What’s the difference between the Emergency Room (ER) and the Urgent Care Center?

This is an important question for everyone to understand, because there are big differences between the two when it comes to treatments and costs.

Here’s when you should go to the Emergency Room (ER):

If a medical condition is life or limb threatening, and involves severe wounds or amputations.

These are examples of reasons you may need to visit the Emergency Room:

  • Signs of stroke
  • Severe shortness of breath
  • Poisoning
  • Signs of heart attach/chest pain
  • Severe wounds or amputation
  • Coughing up or vomiting blood
  • Suicidal or homicidal feelings

Here’s when you should go to the Urgent Care Center:

If a medical condition is NOT life or limb threatening.

These are examples of reasons you may need to visit the Urgent Care Center:

  • Stomach bugs (flu)
  • Fever
  • Sprains
  • Dislocations
  • Minor cuts (stitches)
  • Minor broken bones

At an Urgent Care Center, you can receive prompt treatment for your minor injury or illness, and the costs (co-payments) are much less expensive than the Emergency Room. 

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com