Health Insurance: Time to Decide

Making a decision about health insurance coverage is not easy. Most of us rely on our employer to wade through the details of policy coverage and negotiation of rates. We gladly accept what is offered, choosing between 2-3 options that personalize the coverage.  HR sends a letter or hosts a meeting for questions and answers. If we don’t do anything, the policy we have continues into the new year.

It’s not quite as easy when you are purchasing insurance on your own: some parts of Medicare, the Marketplace, and plans offered from private insurance agencies can be more confusing. The options for coverage have experienced a period of volatility.  Assistance with enrollment varies. Here is an overview of the open enrollment time frame, who can help you sort through the options, and major changes to be aware of in 2019:

Medicare:  Open enrollment for Medicare Advantage and Prescription Drug coverage (Medicare D) began on October 15th and closes on December 7th.  SHIIP volunteers are excellent resources to help sort coverage and find plans that will meet your needs. Medicare is also providing assistance through an online education program, Medicare Plan Finder.  Advantage plans are increasing in numbers and are being heavily marketed this season.  Individuals enrolled in supplemental coverage (Medigap) and prescription drug (Medicare D) plans should open and read any notices they received in the past 30-60  days.  Your coverage may have changed.

Marketplace Coverage:  Open enrollment began on November 1 and closes on December 15th. Iowans may call 1-800-318-2596 or visit healthcare.gov for information. Independent insurance agents may be able to assist. If you received assistance last year, try contacting the agency that sponsored the service. Medica and Wellmark will be offering ACA-compliant individual health insurance plans to Iowans statewide for plan year 2019. If you currently have coverage through the exchange and do not choose a plan for 2019 by the end of open enrollment, you will be re-enrolled into the same plan offered by Medica. Reminder: if you want to use Premium Tax Credits to help cover the cost of your insurance, you must purchase it in the marketplace.

Private Plan Coverage: Enrollment is not limited to a set period of time for most policies. The Iowa Insurance Division provides a listing of licensed agents.  New this year for individuals who do not qualify for premium tax credits are association benefits plans.

Children’s’ Health insurance Plans (known in Iowa as HAWK-I): Enrollment is not limited to a set period of time. Contact the Department of Human Services for applications and program details.

Medicaid: Enrollment is not limited to a set period of time.  Individuals may qualify based on income or specific health issues.  Contact the Department of Human Services for applications and program details.

Iowa State University Extension and Outreach has available education programs that can help with understanding choices and coverage.  Contact your local extension office to request delivery for your community.

Joyce Lash

Joyce Lash

Joyce Lash is a Human Sciences Specialist in Family Finance who wants to keep you ahead of the curve on financial information.

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Confused about health insurance?

Today, November 1, is the beginning of open enrollment for those who buy health insurance on the individual market. Over the last several months there has been a lot of confusing news about health insurance, so we want to help clear up some of the confusion.

Enrollment Process

  • www.healthcare.gov is still the place where Iowans can find health insurance plans where eligible consumers can use premium tax credits to help them pay their health insurance premiums. To enroll over the phone, the phone number is still 800-318-2596.
  • This year, the open enrollment period has been shortened: it goes from November 1 – December 15, 2017. During that time anyone can purchase a health insurance policy for 2018.
  • The enrollment site will be closed for maintenance for 12 hours (midnight till noon) every Sunday during the enrollment period, with the exception of the last Sunday, December 10.
  • To find local help with enrolling, do a zip code search at Get Covered America.

Plans and Costs

  • There has been a lot of news about premiums rising, and it is true. However, if you are eligible for a premium tax credit to help pay your premium, the higher premiums are not a major concern.
    Why? With the premium tax credit, you only pay a certain percentage of your income; the tax credit pays the rest of the premium.  That means your premium costs for 2018 will be similar to 2017 if your income is similar.
  • Find out if you are eligible for a premium tax credit at https://www.healthcare.gov/lower-costs/save-on-monthly-premiums/. Income guidelines vary by family size: for a single individual, the maximum 2018 income is $48,240; for a family of 4, it is $98,400.
  • For most of Iowa, there is only one insurance company offering plans through healthcare.gov. Be sure to find out if your medical providers are participating in the plan before signing up. You will be able to find that information during the enrollment process before you enroll. The network appears to be quite broad, but it is still important to know if the company’s provider network will meet your needs; no one wants to be caught by surprise after they have enrolled.
  • If you are not eligible for a premium tax credit, you can still use healthcare.gov to purchase health insurance, but you will need to pay the full premium. Before making a decision, it would be wise to compare other options, perhaps through one or more local insurance agents. Health insurance purchased elsewhere may provide reduced coverage, and may be a challenge for people with pre-existing conditions, but it is always wise to check multiple options before making a decision.
  • If you are under 30, you may be eligible to purchase a lower-cost, very-high-deductible catastrophic plan.  An earlier blog post describes these plans.
Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Breaking news: Health Enrollment Extended for those with Penalties

HI Marketplace logoPeople who didn’t really understand the requirement to have health insurance until they file their tax return and discover they owe a penalty have now been offered a second chance! If people file their 2014 tax return, discover the penalty, and realize that they wish they had health insurance in place for 2015, they are allowed to take advantage of a “Special Enrollment Period,” even though regular open enrollment ended February 15.

 

Officials  announced today that this group of taxpayers can take advantage of a special enrollment period through April 30.  Since the fee for not having insurance will be higher on the 2015 return, even those who owe only a small penalty on their 2014 return would be wise to explore their options.

Go to www.healthcare.gov or call 800-318-2596 to enroll.  Or to find someone who can help you through the enrollment process go to https://www.getcoveredamerica.org/connector/  

I hope many folks take advantage of this extended opportunity.

~Barb

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Proof of Health Insurance

tax-sign-sm-15457-53DG-1804x2712During this first tax-filing season since the requirement to carry health coverage has been in place, lots of taxpayers are worried about proving they have health insurance. This year there is no need to submit proof with your return, but it is wise to place some type of documentation with your tax return before you file it away at the end of the season.  Doing so will ease your worries if the IRS ever needs to follow up with you for more information.

If you purchase insurance individually, you may have the greatest need to maintain documentation that shows how many months of the year you were covered, the type of coverage, and premiums paid.  Those who are covered through an employer plan or a public program such as Medicare may have an easier task, but should also keep some type of documentation.  You should keep these – as you do other tax records – generally for three years after you file your tax return.

In future years, showing proof of health coverage may become more important, so we might as well start off on the right track with our 2014 tax files. To find other tax-related information about the health care law, visit irs.gov/aca.

~Barb

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Health Insurance: Shop Wisely

HClogoThe other day a friend asked me about health insurance.  She said “I’ve been getting all this different advice: ‘Go see Agent X – he’ll fix you up;’ or ‘Agent Y found a really good plan for me.’  I’ve seen a couple different agents and I’m confused.”

Until she talked with me, no one had suggested checking on www.healthcare.gov .

I don’t know what her income is, but I think she may be eligible for premium tax credits to help pay monthly premiums for health insurance.  But before our conversation, she didn’t realize that help was available.  The key point I explained to her was this:  Premium Tax Credits are only available if you buy your health insurance in the official “Marketplace” through www.healthcare.gov

Some insurance agents will help customers enroll in plans offered in the Marketplace.  They only receive a tiny commission for helping clients, but they do it anyway, because they want to serve their customers well.   If your income is below the income guidelines for premium tax credits (over $90,000 for a family of four), make sure your insurance agent shows you the plans available in the Marketplace and explains how the premium tax credits work.

To find a health care navigator or certified application counselor near you, go to www.getcoveredamerica.org/locator

Health Insurance is important.  Even if a cheaper plan is available somewhere else, you may come out ahead by purchasing a plan in the Marketplace, where Premium Tax Credits can help cover the cost of a plan that meets high quality standards.

Barb

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Direct-Pay Health Care

Between Mason City and Rudd, where I live, Mercy North Iowa has a billboard that reads, “Refer a Physician Earn $5000.” Demand for primary care services is projected to increase through 2020, largely because of the aging population and an increase in health insurance coverage following the implementation of the Affordable Care Act.

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With necessity being the mother of invention, some new models for delivering healthcare have come on the scene. One model gaining popularity, in which there is a direct financial relationship between the medical practice and the patient, is referred to by many terms including: concierge medicine, direct primary care (DPC), retainer-based, or membership medicine.[1] As the supply of doctors diminishes, this model strengthens the commitment between doctors and participating patients, ensuring patients’ access to services.

Concierge Medicine Iowa of Des Moines (first of its kind in Iowa) is part of a growing trend that has grown five-fold nationwide in the past five years. Concierge medicine is an approach to providing primary care in which the patient submits an annual or monthly fee or retainer to the physician directly. Fees range between $1200 to $10,000 per year depending on the practice and the patient’s age and marital status.

Women’s Wellness and West Side Family Medicine in Dubuque is one of 4,400 Direct Primary Care practices in the U.S[2], and is also the first of its kind in Iowa. There were only 756 DPCs in 2010 and even fewer in 2005 (146)[3]. In the last year, there has been a 30% increase the number of Direct Pay clinics. Instead of paying a deductible through health insurance, clients pay a monthly fee whether they visit the doctor or not. Similar to concierge medicine, the services covered by a physician vary, but patients can generally expect 24/7 access to doctors including same day appointments and the ability to reach doctors by email and/or phone. Additionally, office visits are longer (at least 30 minutes) and basic medical tests are no additional charge.

Neither DPCs nor concierge medicine have co-pays, deductibles, or co-insurance fees. The difference between a concierge medical practice and a DPC is that DPCs do not accept insurance; whereas retainer-based concierge might accept insurance.

The monthly fee paid to the medical practice essentially serves as a substitute for insurance coverage on the services provided.  However, in a medical emergency or if need arose for specialty services outside those provided by the practice, the patient would have no coverage.  Therefore, to meet the mandate for health insurance under the Affordable Care Act, individuals utilizing DPCs must also carry a catastrophic health insurance plan. The same would be true for participants in concierge medicine if they did not have other health coverage.  Catastrophic plans typically have significantly lower premiums than the standard Bronze, Silver, Gold or Platinum insurance plans.

Some of these new forms of health care may seem expensive, but may actually not be much different than the cost of health care premiums plus deductibles and co-payments.  Even if it does cost more, some consumers may decide it is worth the money if access to care is an issue. The cost is expected to drop as the availability of these models increases. ~Brenda

[1] Tetreault, M. (2014, February 20). Concierge medicine’s best kept secret, the price (revised). Concierge Medicine Today and Direct Primary Care Journal. Retrieved from http://conciergemedicinenews.wordpress.com/2014/02/20/concierge-medicines-best-kept-secret-the-price-revised/

[2]  http://www.marketwatch.com/story/why-concierge-medicine-will-get-bigger-2013-01-17

[3] Chris Silva, “Concierge Medicine a Mere Blip on Medicare Radar,” American Medical News, September 30, 2010, http://www.amednews.com/article/20100930/government/309309997/8/ (accessed June 16, 2014)

Brenda Schmitt

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Is Your Health Insurance Right for You?

SmartChoiceLogo1Last week it was announced that people who signed up for health insurance through the official Marketplace (www.healthcare.gov) will automatically be re-enrolled in the same plan for next year, unless they log in to make a change.

I see that as good news, because it guarantees that no one will just forget to sign up again next year.  Hopefully it will also reduce the “traffic” on the healthcare.gov website.

But is re-enrolling in the same plan the best choice for you? 

That will be the key question. Paying attention now will help you be ready when next fall’s enrollment period comes around.  Here are some questions to keep in mind throughout the year:

  1. Am I happy with the doctors and other health providers available in my plan’s network?
  2. How much am I using health care services? (it’s smart to keep track of visits and costs for each family member)
  3. Am I taking advantage of the preventive care which, under most health plans, is available with no co-payments or deductibles?
  4. Have I met my plan’s deductible?
  5. How much have I spent in co-payments or co-insurance?
  6. Have your health care needs changed during the year?

Knowing how much care you needed in 2014 will help you make a smart health insurance choice for 2015.  When choosing between platinum, gold, silver, and bronze plans, you need to balance the costs and benefits:  higher premiums in exchange for lower deductibles and co-pays?  Or will you be better off paying lower premiums, even if the deductible and other out-of-pocket costs are higher?

To help you understand how to use your health insurance, ten helpful new videos, each lasting just one or two minutes, are available at http://marketplace.cms.gov/help-us/c2c.html .  They’re available in both English and Spanish!

~Barb

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Bronze, Silver, Gold… Olympic Health Insurance?

olympicsAs the Winter Olympics launch this week, gold, silver and bronze medals will be awarded to the athletes who performed best – the highest honors in the world of sports.

In the new health insurance marketplace, consumers can choose from health insurance plans that are designated as bronze, silver, gold, or platinum plans.  Health insurance metals are not the same as Olympic medals. For one thing, in health insurance we have a fourth option: platinum.

The more important difference, though, is that with health insurance metals, there is not an absolute BEST.  For some people Bronze may be best; others will decide that Silver, Gold, or Platinum is the best choice for them.  The best choice for you depends on your situation.

Here’s how it works:

All the health insurance plans in the marketplace cover the same essential health benefits – hospitalization, prescriptions,  mental health care, and more .  All plans in the marketplace also offer free preventive care, with no co-payments or deductibles.

What’s different from one plan to another is how the cost is split between the consumer and the health insurance company.  The insurance companies set up plans that have different cost-sharing elements – these are the deductibles, co-payments, and out-of-pocket maximum limits which consumers pay when they use health care.  And then they set appropriate premiums for each plan, based on all their statistics about costs and typical consumer use.

  • With a bronze plan, the consumer’s share of the cost of care is higher (i.e. deductibles, co-pays and out-of-pocket maximum amounts are higher).  But the premiums the consumer pays are lower.
    In order to be called a bronze plan, the insurance company must pay, on average, 60% of health care costs for the average consumer.  This is the minimum value allowed for a qualified plan under the new law.
  • Silver plans must pay an average of 70% of consumers’ health care costs; therefore, the consumer’s share of cost (deductibles, etc) will be lower than bronze plans.  And the premiums will be higher.
  • Gold insurance plans pay an average of 80% of health care costs, so the consumer’s share averages 20%; consumers pay higher premiums for gold plans, compared to silver and bronze.
  • And – you guessed it – platinum plans pay an average of 90% of health care cost, leaving the consumer paying only 10% of costs through deductibles and co-payments.  Platinum plans will generally have the highest premiums.

You might be tempted to say that platinum plans are the best, because they cover more, and cost more.  We’re accustomed to thinking that the BEST always costs the most.

But I suggest that the best choice for you is the plan that makes the most of your dollars.  Why pay a high price for something you are unlikely to need?  If you use a lot of health care, a gold or platinum plan may be the logical choice; sure, your premiums will be higher, but then your out-of-pocket costs throughout the year will be lower.  On the other hand, if you don’t expect to need much health care, why spend the extra money on a higher-premium gold or platinum plan, if you’ll barely use any of the benefits?

The best plan for you depends on your expectation for health care needs in the coming year.

Here’s another piece of good news: you can change plans next year.  The plan you choose now does not lock you into that plan for future years – each year you can choose based on your current health care needs and finances.

If you don’t have health insurance now, be sure to check out the health insurance marketplace (www.healthcare.gov) soon – open enrollment continues until March 31!

~Barb

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Obligation or Opportunity?

health costsThe idea of not having health insurance scares me.  I remember a time when I ended one job on a Friday (October 20), and my new job started on Monday (October 23). I was worried – asked questions: “what if something happened over that weekend?”  I don’t remember which insurance plan covered those two days, but I do remember that I received assurance that I was covered.

Beginning in 2014, everyone is required to be insured (with a just few exemptions from the penalty).  While that is an obligation, it is also an opportunity!

As I see it, health insurance is a safety net – one that has always been really important to me.  Even healthy young people can find themselves needing serious (and expensive) medical care.  Accidents happen, and so do illnesses that can cause hospitalization and tremendous costs.  Even a healthy pregnancy involves significant medical costs.  Currently the average cost for a 3-day  hospital stay is $30,000; the cost of a broken leg: $75,000.    Most people, regardless of age, are not prepared to take on the cost of a serious medical problem  – whether it’s $20,000 or $200,000 or $2 million.

The main reason young adults have been without health insurance has been cost.  Beginning in 2014, cost will be less of a problem, since assistance with paying health insurance premiums will be available to people with incomes up to about $45,000 (single adult) or more (based on family size).  A single adult with income under $20,000 will pay little or nothing for health insurance – as income rises, people pay more on a sliding scale.

To me, getting health insurance is a no-brainer.  No matter what my situation, I will always want health insurance if I can possibly get it.  I hope that young adults are not turned off by the fact that it’s now an obligation – I hope they instead focus on the opportunity to protect themselves from disastrous health costs. 

For more information on health insurance changes, here are some reputable resources:  www.healthcare.gov;  http://www.extension.org/pages/68659/health-insurance-faqs;  http://kff.org/health-reform/

Barb

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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