Blog Bernardini & Donovan | Bernardini & Donovan Services

October 27, 2021October 14, 2021

Uninsured in California: Living in a state that requires health insurance

Uninsured in California Penalty fees, hindered medical care, and steep medical fees are no fun, but these are the realities to expect if you don’t have health insurance coverage in California or any other state where coverage is required.

While the number of uninsured Americans has dropped, many people still don’t have any type of healthcare insurance coverage.

As of 2019, Americans without health insurance are not taxed by the government (federal). However, as of 2019, you may be required to pay a fee when you file your state taxes if you do not have health insurance. This is because certain states and jurisdictions have enacted their own health insurance mandates.

The following five states* require health insurance and present a penalty if you don’t have it:

Massachusetts
New Jersey
Vermont
California
Rhode Island

*The District of Columbia (Washington D.C.) also falls into this category at the state level.

UPDATES TO HEALTH INSURANCE COVERAGE POLICIES

Prior to 2020, if you went without Affordable Care Act (ACA) compliant health insurance for more than two consecutive months, you would pay a penalty. This fine was called the Shared Responsibility Payment.

As we mentioned earlier, a small handful of states have since introduced state-level individual mandates to encourage residents to purchase health insurance and help moderate the cost of insurance purchased on the public exchange. The penalty for failure to obtain qualifying health coverage varies by state — but a penalty is involved if you remain uninsured.

The purpose of the penalty?

a. To encourage everyone to purchase health insurance if they weren’t covered through their employment or a government-sponsored program.

b. To protect people from skipping out on health insurance.

c. To discourage not being able to pay off medical expenses in the event of injury or illness.

CALIFORNIA INDIVIDUAL MANDATE

An individual mandate is a requirement by law for certain persons to purchase or otherwise obtain a good or service. For health insurance, this means:

Imposing a tax penalty on individuals who go without health insurance but can afford it

The prior tax penalty for not having health insurance in 2018 was $695 for adults and $347.50 for children or 2 percent of your yearly income, whichever amount is more.

Currently, the annual penalty for Californians who go without health insurance is 2.5 percent of household income or at least $750 per adult and $375 per dependent under 18, whichever is greater. The dollar figures will rise yearly with inflation.

The penalty is capped at the state average premium for a bronze level plan on the California exchange for the applicable household size and does not apply if that premium exceeds 8.3 percent of household income.

You may be eligible for an exemption in a few situations, such as:

Religious conscience exemption: if you or someone in your family is part of a recognized religion that is against private insurance or believes exclusively in spiritual healing, you may qualify for a religious conscience exemption.
Hardship exemption: you experienced certain hardships that prevented you from getting health coverage, such as homelessness, eviction, natural disaster, domestic violence, bankruptcy, etc.
Affordability exemption: the tax penalty doesn’t apply if the least expensive plan premium available to you would be greater than 8.27% of your household income in 2021.
Short coverage gap: you went without coverage for three consecutive months or less
Part of a federally recognized Native American tribe

AVOIDING THE INDIVIDUAL MANDATE TAX

To avoid this penalty and protect yourself from the potential financial burden of unexpected medical expenses, you can enroll in a health insurance plan during the open enrollment period.

If you lose your insurance in the middle of the year, you may qualify for a special enrollment period to purchase an ACA-compliant plan on the public exchange

Depending on which state you live in, you may also be able to enroll in short-term health insurance to help fill any coverage gaps you may experience throughout the year.

Catastrophic Plans: These plans will cover you in the event of an accident or illness. They have very low monthly premiums and provide a safety net should you need it. You can buy these plans through the Marketplace, directly from an insurer, or through an agent or broker.

October 19, 2021October 14, 2021

Is your health provider good? Pros/cons of a popular health care provider + reviews

health provider good

With over 12.5 million members, Kaiser Permanente is currently recognized by Americans as one of the leading health care providers and not-for-profit health plans.

The thing with Kaiser Permanente is that it’s not just a health insurance company. It’s a managed care organization. Consumers can purchase a health insurance policy and receive medical care from one of the Kaiser Foundation Hospitals and medical centers.

But does its popularity make Kaiser Permanente inherently better than other health care providers in the market? Let’s consider 3 pros and 3 cons of Kaiser Permanente, including some reviews of real KP member experiences:

Pro 1: Easy to View Plan Options
Pro 2: Variety of Health Insurance Plans
Pro 3: Unique Provider Network Approach

Con 1: Negative Customer Reviews
Con 2: Service Areas
Con 3: Limited to Kaiser Permanente Hospitals and Medical Centers

3 REASONS KAISER PERMANENTE IS GOOD

Easy To View Plan Options

The plan selection at Kaiser Permanente is quite admirable. Kaiser Permanente won’t require you to give out personal information like your DOB or parts of your medical history to get even the most basic information about its insurance policy options in your area. You’ll be able to see health insurance options in your area after providing the following information:

Whether you are turning 65 during the year
If you get insurance through an employer
If you’re looking for an individual plan or for a group
Your zip code

Getting the cost information for a plan will require further research because the monthly premium depends on several factors, like age. But the initial questionnaire will give you access to brief descriptions of the types of plans available and the overall coverage you can expect.

Variety Of Health Insurance Plans

Kaiser Permanente offers individual, family, and employer-provided health insurance plans. It also offers Medicaid, Medicare, and charitable health insurance to individuals who qualify along with catastrophic plans.

One Oregon KP member wrote:

Kaiser Permanente is the best supplemental insurance provider. I pay $5 copay to see my primary care doctor, $10 to see a specialist, and $25 for urgent care. I only paid a copayment of $125 for a $20,000 surgery. My prescriptions are only $5 for a month’s supply, and $10 for a three month supply.

Employers interested in adding vision and dental insurance to their employee health benefits can offer dental and vision insurance through Kaiser Permanente, too.

Unique Provider Network Approach

One KP member based in West Covina wrote: “Able to communicate with Dr through e-mails and texts. […] Kaiser is like Mini mart, everything you need is available at all facilities.”

As you consider Kaiser Permanente medical insurance plans, keep in mind that it does not offer typical network structures, like Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans.

Instead, Kaiser Permanente has its own facilities and providers for patient care. However, this could be a pro. As one member states: “It is very convenient to have a pharmacy, lab, and x-rays onsite.”

Care received elsewhere is not covered by the insurance provider. We’ll talk more about this in the following section, which focuses on some cons associated with the company that might make you consider other health insurance providers.

3 CONS OF KAISER PERMANENTE

Customer Service/Negative Customer Reviews

Though Kaiser Permanente has received a lot of praise for their customer service, they’ll also received a high percentage of negative reviews on various review platforms.

Most reviewers who left 1-star reviews shared difficulties with claims payments and dissatisfaction with care received from Kaiser Permanente providers. For example:

Long phone wait times, inability to access doctors’ offices to leave message, extraordinarily long wait times to talk to appointment schedulers, same thing for pharmacy inquiries. — Bellflower KP Member

Prepare to stay on the line for 45-minutes only to make a phone appointment 5-days later where they can then make an appointment for you. Seattle, WA KP member

A high proportion of negative reviews is not uncommon for health insurers. However, consider issues found in reviews as you decide whether or not to buy a health plan from Kaiser Permanente.

Service Areas

One major limitation of Kaiser Permanente is the span of states that Kaiser Permanente can work with — or should we say, the lack of span of states.

This company limits itself to just several states out of the 50 in the U.S., which means its health plans aren’t even an option for you if you live outside of these states.

If Kaiser Permanente’s plans are not available in your area, your only choice is to consider another insurance company that does service your area.

Limited to Kaiser Permanente Hospitals and Medical Centers

Unlike most health plans that allow enrollees to choose the provider network structure (PPO or HMO), Kaiser Permanente plans only offer coverage for its hospitals and medical centers.

Frequently asked questions about Medicare coverage for people with disabilities under 65

Learn about how people under 65 with disabilities can benefit from Medicare insurance, plans, and more

Medicare disability coverage

If you’re under 65 (age 18 to 64) and have a disability, Medicare could benefit you in many ways if you meet the requirements to receive for Medicare disability coverage.

Medicare was established in 1965 as the health insurance program for Americans age 65 and over; since 1973, it has also covered people under age 65 who receive Social Security Disability Insurance (SSDI) benefits.

Medicare is tied to your eligibility for Social Security Disability Income (SSDI) benefits. (One exception is for people with end-stage renal disease (ESRD), who are automatically eligible for Medicare solely on the basis of having ESRD.)

MEDICARE ELIGIBILITY & COVERAGE

Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. For those who are eligible, the full range of Medicare benefits are available.

Coverage includes certain hospital, nursing home, home health, physician, and community-based services. The health care services do not have to be related to the individual’s disability in order to be covered. There are also no illnesses or underlying conditions that disqualify people for Medicare coverage.

If you’re under 65 and meet the following criteria, you could be eligible for Medicare:

Must have received Social Security Disability benefits for 24 months

Have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease)

If you have Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease), you can get Medicare the first month you get SSDI monthly income benefits.

If you have end-stage renal disease (ESRD), you can get Medicare within 3 months of your first dialysis treatment, regardless of whether you apply and qualify for SSDI. You are eligible for Medicare solely on the basis of having ESRD.

Medicare eligibility for working people with disabilities falls into three distinct time frames:

Trial work period, which extends for 9 months after a disabled individual obtains a job

Seven-and-three-quarter years (93 months) after the end of the trial work period.

Indefinite period following those 93 months.(See the statute at 42 U.S.C. § 422(c), and regulation at 20 C.F.R. § 404.1592).

Related reading(s): Medicare Coverage for People with Disabilities

Keep in mind that Medicare eligibility during each of these periods applies only while the individual continues to meet the medical standard for being considered disabled under Social Security rules.

It should also be noted that — after a beneficiary is determined to be disabled — there is a five month waiting period before a beneficiary can begin to collect Social Security Disability benefits.

People with ESRD and ALS, in contrast to persons with other causes of disability, do not have to collect benefits for 24 months in order to be eligible for Medicare.

FAQS ABOUT MEDICARE DISABILITY COVERAGE

Do I need to sign up?

People who meet all the criteria for Social Security Disability are generally automatically enrolled in Parts A and B.

People who meet the standards, but do not qualify for Social Security benefits, can purchase Medicare by paying a monthly Part A premium, in addition to the monthly Part B premium.

If you select the latter option, you automatically get Part A and Part B after you get one of these:

Disability benefits from Social Security for 24 months
Certain disability benefits from the RRB for 24 months

People who qualify for Social Security Disability benefits should receive their red, white, and blue Medicare card in the mail when the required time period has passed (3 months before your 25th month of disability).

If this does not happen or other questions arise, contact the local Social Security office.

I’ve earned income. Can I still receive Medicare health insurance?

Individuals who still have the disabling impairment but have earned income that meets or exceeds the “Substantial Gainful Activity” level can continue to receive Medicare health insurance after successfully completing a trial work period. Substantial Gainful Activity Levels can be found at http://www.socialsecurity.gov/oact/cola/sga.html.

Can I lose my SSDI benefits? How/Why?

The Social Security Administration periodically reviews eligibility for SSDI. If your condition improves or you have a successful kidney transplant, you can lose your SSDI benefits and Medicare (unless you also have another disability or chronic health condition that qualifies you for SSDI).

However, if you no longer qualify for SSDI because your condition improves or you successfully complete a trial work period, you may still be able to keep your Medicare benefits.

Federal legislation known as the Ticket Act allows a person with a disability who is eligible for Medicare and returns to work to keep his/her Medicare benefits (including free Part A coverage) for at least 8 1/2 years.

Are there any circumstances where a disabled individual isn’t eligible for Medicare?

Yes. An article published on the official California Health Advocates website states that many people with disabilities, including children, are not eligible for Medicare benefits because they do not have the work credits to qualify for SSDI benefits.

Children with disabilities and adults who are not eligible for SSDI are often eligible for Supplemental Security Income (SSI) benefits. People with SSI benefits are covered by Medi-Cal (California’s Medicaid Program), not Medicare.

For more information on SSI, check out this article.

September 9, 2021September 8, 2021

What you need to know about Medicare & home health care

Medicare home health care costs, payments, and how to make the right decision

According to Johnson, Fred Johnson, president and CEO of Team Select Home Care, a national home health agency, there are two primary types of home health care:

Skilled home health care is prescribed by a physician and includes physical therapy, occupational therapy and speech therapy, as well as care provided by a registered nurse.

Non-skilled home health care includes services such as bathing, cleaning and errands. This type of care is typically provided by a certified nurse assistant or home health aide.

Related reading(s): Forbes: How Much Does Home Health Care Cost?

In general, home health care includes a wide range of health and social services delivered that are given by a variety of skilled health care professionals in your home to treat illness or injury.

These services include skilled nursing care as well as physical and occupational therapy, speech-language therapy, and medical social services.

The home health staff provides and helps coordinate the care and/or therapy your doctor orders.

Along with the doctor, home health staff create a plan of care, which is a written plan for your care. This plan tells what services you will get to reach and keep your best physical, mental, and social well-being. Where possible, home health care helps you get better, regain your independence, and become as self-sufficient as possible.

Related reading(s): Medicare and Home Health Care

Medicare pays for you to get health care services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.

Services covered by Medicare’s home health benefit include intermittent skilled nursing care, therapy, and care provided by a home health aide. Depending on the circumstances, home health care will be covered by either Part A or Part B.

HOME HEALTH CARE NEEDS & BENEFITS

The need for home health care has grown for many reasons. Consider three following benefits of home health care:

Medical science and technology have improved. Many treatments that could once be done only in a hospital can now be done at home.

Home health care is usually less expensive and can often be just as effective as care in a hospital or skilled nursing facility.

Most patients and their families prefer to stay at home rather than be in a hospital or a nursing home.

WHO QUALIFIES FOR MEDICARE HOME HEALTH & DOES HOW MEDICARE PAY FOR THE SERVICES

Medicare covers your home health care if:

You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.

You need skilled nursing services and/or skilled therapy care on an intermittent basis.

1. Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite.
2. Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.
3. Skilled therapy services refer to physical, speech, and occupational therapy.

You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).

Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.

1. Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.

And, you receive care from a Medicare-certified home health agency (HHA).

Note: You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy.

When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 30-day period of care. You can have more than one 30-day period of care. Payment for each 30-day period is based on your condition and care needs.

HOW TO FIND AND COMPARE HOME HEALTH AGENCIES

Ask yourself a few questions.

Is the home care agency licensed by the state? Most states require a license and reviews. Request a review through your state health department.

Is the home care agency certified by Medicare to meet federal requirements for health and safety? Most home care agencies are not, but some are Medicare certified. If they are not certified by Medicare, ask why not?

What type of screenings are performed before hiring staff?

Ask for references. Ask for a list of doctors, hospital discharge planners, or other professionals with experience working with the home care provider.

Ask for a list of current and former clients.

Ask doctors, family and friends for home care recommendations.

Related reading(s): Selecting a Home Care Agency

August 23, 2021August 11, 2021

What free-market healthcare looks like in the U.S. (pros and cons)

Overview: Evaluating the disputable pros and cons of a free-market healthcare system.

free-market healthcare

Americans have been debating health care for decades, and establishing a free market in healthcare in the U.S. has been part of the debate for decades. Characterized by opaque pricing, varying levels of quality, and inefficiencies that make getting care confusing for patients and providers alike, the U.S. health care system today isn’t really a free market, but there are some pockets that operate more like one than others.

As health insurance providers, we understand firsthand the complexity of any insurance decision-making process. And whether you’re a consumer or an employer, keeping up with all the changes (federal and state laws, insurance company plans change, and ongoing conversations about what will, what was, and what currently is) could be confusing.

What is free market health care and why the debate

Free market health care is a system where there is minimal or no government regulation. With this minimal regulation, health care providers are free to provide services without needing to satisfy strict regulatory standards and requirements. As a result, health care providers do not need to comply with restrictive government licensing.

The debate usually boils down to: Which path would improve access to care and lower costs — a more centrally-planned health care system or a more free-market approach? Today we’ll be focusing on the pros and cons of the latter: a free-market approach to the healthcare system.

Related reading(s): Free Market Health Care; Does the U.S. have ‘free market’ health care?

Some pros and cons of free-market healthcare

ARGUMENTS THAT SUPPORT FREE MARKET IN HEALTHCARE

Improved cost and quality of healthcare resulting from little to no government involvement
Flexibility to develop policies that accommodate numerous consumer preferences for healthcare financing and delivery

Improved Cost and Quality of Healthcare Resulting From Little to No Government Involvement

Some argue that to improve the cost and quality of healthcare, the government should get out of the way and let the free market reign. Thus, the biggest advantage of “free market health care” is the fact that it requires little or no government involvement.

Healthcare regulations at all levels of government can increase price, limit

choice, and stifle competition — which, in combination, lead U.S. healthcare to fail to provide its full value.

Flexibility to Develop Policies That Accommodate Numerous Consumer Preferences for Healthcare Financing and Delivery

A key goal for the healthcare marketplace is to provide effective, high-value care to all Americans. Recent health policy changes at the Federal and State levels have sought to give consumers more control over their medical expenditures so they can seek greater value for their health investment.

In Chapter 5 of the Economic Report of the President (2021), it’s argued that free-market healthcare aims to foster healthcare markets that create value for consumers through the financing and delivery of high-quality and affordable care. Government mandates can reduce competitive insurance choices and raise premiums.

By focusing on choice and competition, States are encouraged to provide flexibility to develop policies that accommodate numerous consumer preferences for healthcare financing and delivery.

ARGUMENTS THAT OPPOSE FREE MARKET IN HEALTHCARE

Free-market healthcare is a concept, not a system; insurance is based upon risk pools, not competition
There is no evidence that giving consumers “skin in the game” prompts them to become more astute healthcare consumers

Free-market Healthcare as a Concept, Not a System; Insurance is Based Upon Risk Pools, Not Competition

According to one Family Law attorney, ““free market health care” is a concept, not a system.” In theory, by increasing competition and making the environment “friendlier” to health insurers, the cost of health insurance will decrease. The main problem with the theory of free market health insurance is the fact the insurance is based upon risk pools, not competition.

For health insurers, premiums are determined by the probability of the members in the risk pool needing health care. For health insurance companies, cost savings come from managing or manipulating the risk pool. For example, by removing people with “pre-existing conditions,” an insurer can create a healthier risk pool with fewer payouts and thereby lowering the premiums. Therefore, free market health care cannot even attempt to insure everyone.

The advantage of increasing the number of insurers in a given market is questioned by many as there are no practical examples of any significant decreases in premiums.

By comparison, it has been shown that when the health insurance industry is deregulated, the cost of insurance decreases. However, that decrease in cost comes at a price: more “loopholes” for insurers not to pay claims. It costs less because it is worth less.

There is No Evidence That Giving Consumers “Skin in the Game” Prompts Them to Become More Astute Healthcare Consumers

Because of the structure of our healthcare system, consumers are, for the most part, unable to make informed decisions that in other markets can lead to increased competition for consumers’ spending. There are many reasons for this, including information asymmetry, healthcare not viewed as a commodity and the need for third-party payers.

You can read more about this argument in the article, “Rethinking Consumerism in Healthcare Benefit Design.”

August 16, 2021August 11, 2021

Free COBRA health insurance ends Sept. 30: 3 options for the unemployed

Overview: Unemployed? Here are 3 things you could do when your COBRA’s premium health insurance ends Sept. 30

Switch to an Affordable Care Act policy once your free coverage ends
Qualify for a special enrollment period (SEP)
Talk to your plan administrator and/or former employer

COBRA health insurance ends Sept. 30 When Sept. 30 rolls around, it’ll be goodbye to that premium health coverage from COBRA and hello to many, many questions (and a bit of financial panic for the unemployed). But we’ll start by saying you shouldn’t panic — there are options that unemployed individuals could and should begin to consider now.

Keep these things in mind: It’s true that after Sept. 30, the group health plan can charge the usual COBRA premium for the coverage. And the premium assistance lasts through Sept. 30 but may end sooner if you reach the end of your maximum COBRA continuation coverage period which is, generally, 18 months.

3 HEALTH INSURANCE OPTIONS FOR THE UNEMPLOYED AFTER SEPT. 30

Option 1: Switch to an Affordable Care Act policy once your free coverage ends.

The special enrollment period for Affordable Care Act coverage ends Aug. 15. Here’s why it’s a useful option: ACA policies — by contrast to COBRA coverage — are typically subsidized with tax credits that make the coverage more affordable.

In one particular case, a spouse lost their job and was on COBRA continuation coverage for health insurance. They didn’t have to pay the premiums (through Sept. 30) as a result of the American Rescue Plan (passed in March). The question was asked if there was anything available on Oct. 1 if the spouse was still unemployed by that time.

The American Rescue Plan requires employers to pay COBRA premiums for eligible former employees for April through September. The employers will be reimbursed through a tax credit. (The subsidy may last fewer than six months if someone’s COBRA eligibility ends before September, or if they become eligible for group coverage through their job or their spouse’s job.)

When the premium-free coverage ends, the spouse would qualify for a special enrollment period that allows them to switch to an Affordable Care Act policy. Not only that, but anyone who is unemployed at any point during 2021 will qualify for a premium-free comprehensive policy through the ACA for the rest of the year.

Option 2: Qualify for a special enrollment period (SEP) to enroll in individual market health insurance coverage, such as through a Health Insurance Marketplace®.

When your COBRA premium assistance ends, you may be eligible for a SEP to enroll in coverage through a Health Insurance Marketplace®, or to enroll in individual health insurance coverage outside of the Marketplace. You may also qualify for a SEP when you reach the end of your maximum COBRA coverage period. Below are links to additional information.

For more information about this SEP, see:
- https://www.healthcare.gov/unemployed/cobra-coverage/

For more information about enrolling in Marketplace coverage, see:
- HealthCare.gov
- Or you can call 1-800-318-2596 (TTY: 1-855-889-4325).

If your state has its own Marketplace platform, find contact information for your State Marketplace here:

https://www.healthcare.gov/marketplace-in-your-state/

You may apply for and, if eligible, enroll in Medicaid coverage at any time. For more information, go to:

https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

Option 3: Talk to your plan administrator and/or former employer

Karen Pollitz, a senior fellow with the Kaiser Family Foundation, said some employers and COBRA administrators were still working out the details. If you believe you are eligible for the subsidy that ends after Sept. 30 and haven’t received a notice with the required forms, you can notify your former employer. In more detail, Pollitz encourages individuals to:

Notify their former employer

Fill out and sign this form, published by the Department of Labor
1. Turn the form into your plan administrator if you’re already enrolled in COBRA
2. Send the form to your former employer if you’re trying to sign up

Pollitz said if you have a relationship with your provider, you could also ask if it’s possible to wait a little longer to bill your insurer until the COBRA coverage kicks in.

DO YOU HAVE A TRUSTED HEALTH INSURANCE AGENT TO GUIDE YOU WHEN YOUR PREMIUM HEALTH INSURANCE ENDS?

Remember: The Affordable Care Act is over 60,000 pages long. Medicare is written over tens of thousands of pages. And Insurance Laws and Regulations are profoundly extensive. So if you’re wondering what to do when COBRA’s premium health insurance ends, we can help.

We understand that there is not a single “best” plan when it comes to health insurance — and it’s even more complicated when unemployment is involved. And we understand that your needs are unique.

This is where we come in. Contact us to get your questions answered! We’ll offer our expertise in health insurance so you’re taken care of during these complicated times.

https://www.bdhealthinsurance.com/

July 20, 2021July 9, 2021

Starting in the health insurance industry: 6 Tips to be successful

Overview: In order to be successful in the health insurance industry, pay attention to these 6 pieces of advice.

health insurance industry

What makes a successful health insurance agent successful in the competitive zeitgeist of the 21st century? It’s more than what you’re saying or selling.

To be successful as a health insurance agent, you need to have strong sales, marketing, and customer service skills. You’ll be required to locate and attract potential customers. You don’t necessarily have to be born with these skills, but developing them is crucial to your success.

Essential tips for success as a health insurance agent:

Prioritize Good Customer Service

This is a three-part tip. You need to 1) put the needs of the client before your own interests 2) be attentive and available to answer client questions or concerns and 3) have emotional intelligence. All of these tie into prioritizing good customer service. Here’s why:

Putting a client into a product that pays a lower commission because it better fits their needs will likely help you retain customers.

Customers want to be able to get in contact with their agents. Timely responses to inquiries and phone calls is a must. You almost must be able to do what you say you will do, when you say you will do it, or at least have a good reason as to why you can’t.

Listen and empathize with clients on a deeper level in order to discern what they really want and need. A good agent is tactful and knows how to help a client see financial reality clearly, even when the client is dead set against it.

Bonus: Do not prioritize earning a commission! You likely won’t last long in the business. Agents who listen carefully to what their clients and prospects say will be able to earn their trust — which is the hardest part of their job.

Related article(s): 8 Qualities That Make a Good Insurance Agent

Focus On Good Salesmanship (Record/Listen To Yourself)

We all know that health insurance agents (like all types of insurance agents) are salespeople by nature. Sales is namely all about confidence first, knowledge second, and everything else after. One way to develop your sales skills is to record your voice on the phone while talking to some clients.

Do you sound smart?
Do you sound confident?
Do you sound like a little kid who picked up the phone?

You need to acquire strong sales skills and learn the process of acquiring, nurturing, and maintaining quality customers. This might require attending seminars or undergoing a professional training program in sales.

Develop a Strong Work Ethic

The insurance industry is competitive and you may be working independently for a good portion of the day. You need to develop a strong work ethic to be proactive when seeking out new customers, closing sales, and developing relationships with clients and industry professionals. Prioritizing your time and maintaining a strong work ethic will get you far throughout your career.

Study the Market

You need a plan to target the right prospects and seek out new customers in the right markets. Take the time to study the market and develop a strategy so you are making the best use of your time. Whether you are out on a sales call or conducting a presentation to potential customers, you need a deep understanding of what your customers want and who is the market to buy insurance — ideally, from you.

Learn From the Pros

Every successful agent needs a mentor, coach, or someone to guide them throughout their career. Make the time to connect with someone who is currently working your dream position or someone who is willing to mentor you as you grow in your career. This will provide you with valuable insights about the industry, tips for overcoming challenges you are dealing with, and an opportunity to learn from someone who has been in your position at some point in his or her career.

Stay on Top of Market Trends

Because life insurance policies changes, it’s essential that you stay on top of trends to achieve the success you want. As a result, you’ll not only have a better chance of selling what the client needs but also what they believe they want. With a vast knowledge of life insurance and by remaining enthusiastic yet professional, you can carefully guide an individual toward the best coverage, whether trendy or not.

July 13, 2021July 19, 2021

Debunking 3 common U.S. health insurance myths

Preview: Let’s take a look at 3 popular myths about US. health insurance that might take you by surprise.

Here are some topics of conversation (aka “myths”) we’ve heard people discuss about health insurance in America that need major clarification:

The relationship with age and health insurance
Is Canada better than the U.S. when it comes to health insurance?
Outrageous out-of-pocket costs on top of premiums

Health insurance myth 1: Young and healthy individuals do not need health insurance

After the 2020 pandemic, this myth has likely deceased; however, we’re aware that conversations about health insurance often included this notion.

Research shows that people between 18 and 34 tend to be at their healthiest. So we’re not surprised that those in their early or mid-20s usually do not require much medical attention However, since many in this age bracket feel that they tend to “not need” medical attention, that also means that many feel they do not need to buy health insurance. But this is not true.

Young and healthy individuals can become sick. As we mentioned earlier, after the COVID-19 outbreak, many young people fell sick due to the virus and had to be hospitalized. For those who didn’t feel that they “needed” health insurance, this often meant that they would have to pay out-of-pocket.

Even if one isn’t sick or does haven’t signs of preexisting illnesses, buying health insurance early — before one develops any illness — ensures that there isn’t a waiting period. In case of any pre-existing illnesses, there is a waiting period of two to three years in health insurance for such diseases. During that period, if the policyholder is admitted to the hospital due to any ailment related to that disease, it won’t be covered by the health insurance company.

The rundown: Age shouldn’t and doesn’t determine whether a person should buy health insurance.

Related article(s): 6 Health Insurance Myths Busted

Health insurance myth 2: Canada has a better health care system than the U.S.

And so the debate rages on, and with good reason. Many people in the U.S. believe Canada’s healthcare system is superior to the U.S. for various reasons (lower costs, more services, universal access to health care without financial barriers, and superior health status). So, we completely understand this debate.

However, there’s a limit on what you can get with the Canadian healthcare system. Matt Tassey, a spokesman for LIFE, says, “Universal health care isn’t better; it’s just different.” Tassey many Canadians have come to the U.S. for care because they can actually get it. There is no rationing (in America) of any sort, so they can just write a check.

Americans may complain about the high cost of health care in the U.S., but there are two sides to every situation. In this case, Canadian healthcare isn’t necessarily “better.” Especially if Canadians have come here to the U.S. to receive various treatments.

Related article(s): 7 Health Insurance Myths Debunked

Health insurance myth 3: I will have to pay huge amounts out of pocket

We can’t deny that when it comes to health insurance, many people have to pay more than just their premiums. Some of these additional costs include the following:

A deductible. This is the amount that you must pay out-of-pocket before your health insurance pays for services. This amount resets each year.

A copayment. This is a flat fee that you pay each time you go to the doctor or fill a prescription and is usually printed right on your insurance card.

Co-insurance. Coinsurance is your share of costs for healthcare services and is generally figured as a percentage. Coinsurance usually kicks in once you’ve met your deductible.

For the 2021 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $8,550 for an individual and $17,100 for a family. The good thing is that there is a cap that’s placed on out-of-pocket costs for marketplace plans.

Once your out-of-pocket maximum is reached, your insurer has to pay the rest. For most people, $8.550 or $17,100 is a huge amount. However, if you think of what your costs would be without healthcare coverage, those amounts are pretty tame.

For example, the average cost for each death in a motor vehicle accident is $1,130,000. Meanwhile, the average cost for each nonfatal disabling injury is $61,600. Of course, this is a generalized statement (costs vary from state-to-state and with other factors included).

Nonetheless, there’s no denying that the cost of an accident is a lot. As such, most folks would choose the out-of-pocket maximum amounts over accident figures any day!

Related article(s): Top 5 Health Insurance Myths

June 22, 2021June 17, 2021

Shopping the marketplace: The #1 benefit to researching health coverage

Overview: This main benefit to researching health coverage options will help you choose the ideal plan.

Choosing the right health coverage plan requires conducting personal and professional research if you want to experience the full benefits. We don’t recommend that you choose the first health coverage plan that comes your way — as rushing and picking the wrong health insurance plan could be costly in more than one way.

It’s important that you prioritize your needs — whether that involves others (families) or not. As such, the main reason you should do research on health coverage plans is because you’ll be able to compare plans across the marketplace and essentially curate what you need based on the different options in the marketplace that you’ve come across. Granted, there aren’t too many options, but there are enough variations for you to pick-and-choose certain factors.

Do research to specialize your health coverage plan to your needs

Let’s say your employer offers health coverage plans but you’d rather shop the marketplace, this is when research and time come in. Conducting your own health coverage research is beneficial even if your employer does offer plans because you get to compare the different types of health insurance plans.

You might come across one plan that offers one thing that you like and another plan that offers another thing that you like. You’ll ultimately be able to curate an “ideal” list of factors you would like to have in a health coverage plan and start to tailor your research to that.

This isn’t to say that you’ll get exactly what you want, but the more specific you could get when doing research, the easier it’ll be to sift out what you don’t want. The reality is that there might be some aspects of certain plans that you don’t need and aspects of other plans that you consider to be a must-have. Factors such as cost, in-network options, referrals, and provider choice all play a role in what health coverage plan you ultimately decide on.

The main benefit of going through your employer for health insurance plans

If your employer offers health insurance, this already cuts the research aspect in half. While you can always search for alternative plans available in the marketplace, receiving health coverage through your employer means that you’re likely to have lower premiums since your employer pays a portion.

For the best decision, be aware of past treatment trends

Regardless of whether you choose to go through your employer or not, doing the right research should also take into consideration (1) the amount of treatment you’ve received in the past and (2) the type of treatment you’ve received in the past.

To help you narrow down choices, think about the following factors:

You see a primary physician or a specialist frequently.
You frequently need emergency care.
You take expensive or brand-name medications on a regular basis.
You are expecting a baby, plan to have a baby or have small children.
You have a planned surgery coming up.
You’ve been diagnosed with a chronic condition such as diabetes or cancer. Or, on the contrary:
You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.
You are in good health and rarely see a doctor.

Comparing common plans to start

Though it’s impossible to predict every medical expense, being aware of trends can help you make an informed decision. Let’s compare two common health coverage plans and see how they may or may not benefit you based on your needs.

HMO: HEALTH MAINTENANCE ORGANIZATION

If cost is your biggest determining factor, HMOs might be your best option. Choosing this plan means that you typically must see a primary care physician before scheduling a procedure or visiting a specialist. Due to this restriction, HMOs tend to be the cheapest type of health plan, overall.

You have to stay in network to get coverage except for an emergency
Procedures and specialists typically require a referral
There are lower out-of-pocket costs
You get a primary doctor who coordinates your care for you
Less freedom to choose providers

At the same time, another benefit with choosing HMO is that there is technically less work on your end, since your doctor’s staff coordinates visits and handles medical records.

PPO: PREFERRED PROVIDER ORGANIZATION

If being able to choose your specialist is your main interest when doing health coverage research, a PPO might prove ideal.

You do not have to stay in network to get coverage
In-network care is less expensive
Procedures and specialists do not require a referral
You have more provider options and no required referrals
There are higher out-of-pocket costs

This might be better for individuals who live in a remote or rural area and have limited access to doctors and care since you may be forced to go out of the network.

June 18, 2021June 16, 2021

The evolution of American health insurance services over the last few decades

Overview: How health insurance has evolved for Americans in recent years.

evolution of American health insurance services

From illness trends to the implementation of technology, changes in America health insurance services remain slow, complex, and constant much like the overall healthcare system.

Various healthcare proposals have been introduced over the years, but it’s the complexity of the healthcare industry in its entirety — environmental and technological factors — that remain the primary causes to changes in health insurance services in America.

Increase in technology & cost of medical services
Managed care & ability to select a doctor
Extending Medicare coverage for prescription drugs
How health care will change in the future (technology & more)

1. New technology; increased cost for health insurance

One primary change in American health insurance services is the increased cost for health insurance as a result of new technological treatments. Maybe back in the day, you could get away with surgery and a hospital stay without health insurance but now… not so much. (That goes without saying.)

This goes in tandem with the tremendous medical technology now available. If patients want to reap the benefits of these technologies, they must be willing to accept the ever-increasing medical costs that come with it.

2. Managed health care; limited doctor selection

As the cost for health insurance has risen there’s been a move toward managed health care. This move, in turn, has changed the health American insurance industry and services by creating limited flexibility for someone to choose a doctor.

Managed health care is a term that refers to health plans that involve selective contracting between insurers, health care providers, and employers to direct employees to a specified group of cost-effective health care providers.

This rapidly-changing revolution has affected everyone from physicians and hospitals to patients and insurance carriers.

Says Marc Maraccini, Vice President of Sales and Marketing at North Texas Healthcare Network: “Fifteen years ago, it used to be that a person had an insurance provider that covered almost anything with no questions asked. But this process made it difficult for employers to estimate how much they would pay for their employees’ health care. This is because a physician or hospital could charge almost any amount for a procedure or prescription.

A managed care plan has caused most people to receive coverage through their employer over the last decade. This practice saves money because unlike traditional plans, managed care plans contract directly with the health care providers to set payment for services.

Related article(s): The Evolution of Health Insurance

3. Medicare updated to include prescription drug coverage

In the early 2000s, one major change health insurance services saw was the update to Medicare to include prescription drug coverage. This idea that was initially proposed by George W. Bush eventually turned into the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (sometimes called Medicare Part D). Enrollment was (and still is) voluntary, although millions of Americans use the program.

For a detailed timeline of the evolution of the American health care industry from Colonial Times (1700s) to now (21st Century), take a look at the related article below.

4. Changes to expect for the future of health care services for Americans

As the baby boomer generation approaches retirement, thus qualifying for Medicare, healthcare spending by federal, state, and local governments is projected to increase.

Along with policy and technological changes, the people who provide healthcare are also changing. Providers are an important part of the healthcare system and any changes to their education, satisfaction, or demographics are likely to affect how patients receive care.

In the future, healthcare providers are more likely to focus their education on business than ever before. A large-scale analysis of Harvard Business School’s physician graduates indicates substantial growth in the number of physicians pursuing M.B.A. degrees in the last decade. This growth may result in more private practices and healthcare administrators.

Healthcare technology trends that focus heavily on patient empowerment will be on the rise (artificial intelligence, VR/AR, 3D-printing, robotics or nanotechnology). For example, the introduction of wearable biometric devices provide patients with information about their own health. Telemedicine apps allow patients to easily access care no matter where they live. These types of new technologies are focused on monitoring, research, and healthcare availability so patients will be able to take a more active role in their care.

With advances in digital healthcare technologies, healthcare workers have to embrace emerging healthcare technologies with an open mind in order to stay relevant in the coming years.