Outside of Your Coverage ?

outside of Your Coverage

Outside of Your Coverage?

coverage insuranceOne of the most significant selling points of any insurance is that it brings peace of mind. Knowing that your well being and costs are being taken care of should anything happen to you or your family helps provide a sense of comfortable peace. But it would be foolish to assume that your Insurance will Cover Everything that could go wrong. That’s why you want to know exactly what is included in your home insurance and what your deductible is with your car insurance. There is the same train of thought with your health insurance. There are basics of your health coverage that you can always expect. Most of that includes preventative care such as doctor’s visits and hospitalization. However, not all care is covered.


There may be times that your doctor recommends a Specialist for surgery or some other care-related need. If they recommend someone outside of your coverage, you can find yourself in a tricky situation. One of our first recommendations is to ask your doctor if they can recommend anyone that is within your coverage. If they do not know anyone, then you can ask your insurance company to do the leg work. Ask them for a specialist that is within your insurance coverage. You can even ask them to cast a broader net to surrounding areas if you feel like you are not finding the specialist that is right for you. If you find someone within your coverage, great! Meet with them and make sure that you feel entirely comfortable with them and ensure that they feel confident in your treatment.  It can also be in your best interest to at least see the first recommended specialist. They can serve as a second opinion.

If you do end up paying out of pocket, try to negotiate the best price possible before the surgery. Go over Outside of Your Coverageevery possible expense and work with the hospital to ensure that any discounts that are available are applied. Also, please do not ignore the hospital’s collection department. It may seem like they are just like every other collection agency out there. However, they are trying to help you! They can help set you up on a payment plan as well as lower the cost of the final amount that you owe the hospital. It is in your best interest to become one of their favorite clients.

We hope that these ideas help you if you should ever find yourself needing care outside of your coverage. If you ever need to readdress your health care insurance needs, please always feel free to call us.

What to consider prior to buying health insurance for you and your family

As the time comes for open enrollment or to renew your health insurance, here are some helpful hints to look at before your purchase a plan.

Look before you renew
As the landscape for health insurance continues to change it is important that you make sure that your fully check out your options before opting to renew. Not only do the options available in your plan change from year to year but your personal circumstances change. You may have moved, found a new job, or had a child and all of these can change what you need from your provider. Also, if your plan is being replaced make sure you fully look over what it is being replaced with so you are not surprised later down the road and find that what you need is not covered.

Doctors and prescriptions, oh my…
You will want to make sure that your preferred doctor accepts that coverage before you enroll. And going to a doctor outside of your coverage can cost you substantially more that going in your plan. Also, you will want to know what your prescription medication is going to cost you. Most companies will assign medications to a different level or tier so that between different companies the medication you need may be covered but it may be on a different tier and therefore would cost you much more.

Consult an insurance broker
When the Affordable Care Act come into effect its purpose was to let people comparison shop relatively easily for different health care options. However, the health care market is wide and varied and you can very easily not see a special savings or find out that what you need is not covered when it is too late. Health Insurance brokers are working hard to stay ahead of the changes in the law, know all the different nuances of plans being offered and want to help you find your best fit. Contact us at Bernardini & Donovan and let us help you look beyond the bare essentials to finding a package that fits you and your family perfectly.

Changes to Covered California are Coming

Change is inevitable. Each day when you wake you just can’t be sure what that day will bring. Granted, sometimes you get a heads up. Like when you see the storm clouds brewing off in the distance, it’s a good idea to bring your umbrella. Or when you hear of a huge traffic hold up on your normal commute, you avoid that route and take the side roads. So here is your heads up when it comes to Covered California rates. They are going up to the tune of 13.2%

For the past two years California has been able to negotiate to keep the rates in an affordable increase averaging around a 4% increase. However, the legislation that allowed for them to do that is now is now expiring. With these rate increases we will see California’s rates being more comparable to the rest of the nation whose rates have been rising steadily over the past few years.

Also, if you are small business owner with 50-100 employees, the laws are changing for your health coverage. If you have 50 and up to 100 full time eligible employees then it is required that you provide health insurance for your employees.

So why are these changes happening? Peter Lee, the executive director of Covered California says that “Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance… We can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans.”
Of course as our country continues in our heated political race this discussion will continue to play a part as the presidential candidates weigh in on the effectiveness of the Affordable Care Act. With this change coming it will be interesting to see the full effects of these coming changes.

Covered California and Small Businesses

Looking into insurance for your employees at your small business? What does Covered California have to offer you as a small business employer? Well, we are glad you asked. Here is some basic information about what you could expect:

First, let’s define a small business. Covered California defines a small business as any business with under 100 full time equivalent employees which is a W-2 employee working 30 hours a week measured on a monthly basis. Covered California offers a variety of health insurance plans to puts you in charge of your health insurance budget while letting your employees get to choose from affordable, quality, and popular health insurance plans from private health insurance companies. The plans have levels of Bronze, Silver, Gold or Platinum. As an employer you can chose one or two plan levels of coverage to offer employees and define the amount they will contribute towards their employee premium. At that point the employee has the choice of which plan will meet their families needs. But regardless of the plan that they choose, all the plans offer these 10 basic benefits:

1. Doctor Visits
2. Prescription Drugs
3. Emergency Services
4. Pediatric Care with Dental and Vision
5. Lab Services
6. Maternity and Newborn Care
7. Hospitalization
8. Preventive and wellness care
9. Rehabilitation
10. Mental health and substance abuse services

You can enroll in Covered California at any time and the coverage will last for the 12 months following when you signed up. You can also add new employees to the program throughout the year as they get hired. You may even be eligible small business tax credit to offset the cost of providing insurance. To find out more about Covered California, more of what is offered, if this could be a good fit for your business and what is needed to qualify for the small business tax credit contact us at Bernardini & Donovan. We are experts in all the ins and outs Covered California and can help you make the best choice that fits your unique situation.

To offer health insurance or to not offer health insurance, that is the question…

When you run a small business there are a lot of different things on your plate and you wear a lot of different hats. Who is going to make sure the photo copier gets fixed? You are. Who is going to ensure that those invoices get paid? You are. Who is going to oversee the marketing and branding of your business? You are. And who is going to make sure that your employees are cared and happy? You are. When you are looking at the well being of your employees one of the first things that comes to mind is to offer health insurance. But in this new world of health insurance laws offering this benefit to your employees can bring with it additional costs and premiums for you, confusing jargon and still may not be exactly what your employees want.

When the Affordable Care Act was first brought on to the scene many small businesses opted to no longer provide health coverage for their employees. That was because they were given very little incentive at that time and little time to fully understand the programs they would be signing up for. Additionally, their employees could now pick their own insurance program.

However, some employers in the past few years have started to look at how they might be able to offer their employees either some form of coverage or help with paying for health insurance. The benefits for them were that they wanted to help their employees with their financial burdens. Only around 44% of Americans today say that they feel in control of their finances. This was also a great way for them to make themselves stand out when looking to hire new employees and retain the employees they already had.

If you are a small business owner and want to look into the different options available to you come speak to us at Bernardini & Donovan. We want to ensure your success and the happiness of your employees by offering the best health care solutions for your unique situation.

What To Do When You Miss the Insurance Enrollment Deadline

The healthcare marketplace officially closed on January 31. That can mean big trouble if you did not enroll in a healthcare plan and do not have one through an employer. However, there are ways you can enroll after the enrollment deadline. There are some catches though. There is a special enrollment period outside of the open enrollment period. To be able to sign up for health insurance through the marketplace after the open enrollment period, you must have a qualifying life event.


What is Classified as a Qualified Life Event?

There are some common life events that allow you to enroll after the deadline. Some of these include, but are not limited to, the following:


  • Getting married (or divorced)
  • Losing health insurance coverage from another party
  • Having a baby
  • Adopting a baby or placing one for adoption
  • Leaving prison
  • Losing coverage due to age (i.e. turning 26 and losing parental coverage)
  • Moving to another region (there are stipulations with this one)
  • Gaining U.S. citizenship or a lawful presence
  • Having a major income change
  • Having a “complex” situation that prevented you from enrolling before the deadline


What To Do Next

If you qualify for one of these special circumstances, you should enroll as soon as you qualify. There is still a window of time where you can enroll based off of the life event but if you miss it, you will either have to wait for another life event or open enrollment the following year.

If you do not qualify for any of these life events, you will either need to find employment where you can enroll in a plan or pay the fee during tax season. Also, be sure to mark your calendar for the next open enrollment period beginning November 15.


Tax Penalty

You should be as prepared as possible for the penalty for not enrolling in a plan. This year, the amount has increased per person. There are two ways to calculate it and you pay the penalty that is greater of the two options. The first way this is determined is through a calculation of the percentage of household income. For 2016, the percentage has increased to 2.5%. The maximum deduction through this method is equal to the total yearly premium of a Bronze plan through the marketplace (the national average). The other way this is calculated is per person. For 2016, the rate is $695 per adult and $347.50 per child that is under the age of 18. The maximum penalty for the household through this method is $2,085.
Health insurance is required by law. If you missed the deadline and have questions about enrolling, contact us to explore your options.

The Best Time of Year to Review Your Insurance Policies

Experts encourage people to review their insurance policies at least once per year. The same rings true for your healthcare insurance. The best time to really do this is during open enrollment when you can actually change to a better or more affordable plan.


Importance of Reviewing Your Options

When it comes time to re-enroll, it is very important to take a look at your current plan and the other options that are out there. There are several good reasons for this. First, you may find a better plan that will fit your needs more efficiently. Second, you may find a cheaper plan that you can better afford. Keep in mind that it is highly likely that the premium for your current plan has gone up and you will have to pay more throughout the year. Thirdly, you may find the best of both world’s and find a plan that is both less expensive and better for your needs. If you do not take a look at your options, you may be missing out on a better, less expensive plan.


Changes for 2016

No matter what you do, be sure that you are enrolled in a plan. This year, the penalty during tax season will be even higher than it was in 2016. If you miss the enrollment period, then you may still be able to qualify for a plan but you will have to meet certain requirements. These requirements are very specific. If you miss the deadline, be sure to contact an agent at B&D for assistance. For more information on this, please view one of our previous blog posts.


Getting Help Reviewing Your Policy Options

You do not have to review your policy on your own. You can use the help of professionals who have a better understanding of the terms and everything that is included in the plan. They will be better able to determine if your needs are met and how to meet them. It is always better to use a professional if you do not understand your policy or the other options that are available. If you need assistance, please contact us at B&D and we will be happy to help. We will review your policy and discuss all available options for you.

Is Medicare Advantage the Right Fit For You? Use This Helpful Guide to Find Out

One of the key components to making sure that you have the health insurance that you need is making sure that you understood all of the options that were available to you in the first place. Because many Medicare-related plans all have similar sounding names, it can be easy to confuse one from the next. By learning a little bit more about Medicare Advantage including what it does and who it is for, you can help find out if it is a right fit for your own personal situation.

What is Medicare Advantage?

At its core, Medicare Advantage plans are those that are offered by private health insurance companies that provide you all of the same benefits that you would receive under Original Medicare. Medicare Advantage health plans have HMO and PPO options. Another important thing to understand about the Annual Enrollment Period is that it isn’t just for new Medicare patients. If you’re already on Medicare and want to change either your health plan or the type of prescription drug coverage that you currently have, you can do that between October 15 and December 7 as well. Any changes that you make will go into effect at the stroke of midnight on January 1, 2016.


During this time you can make a host of different changes to your plan. If you do not already have prescription drug coverage, you can easily join a Medicare prescription drug plan. You can switch from one drug plan to another and can even disregard all prescription drug coverage if you determine that is the best path for you to take. If you’re already on Original Medicare and are completely happy with the way things are going, you also don’t have to make any changes if you don’t want to. More than anything else, the Medicare Annual Enrollment Period is about making sure that you have the options available to you to get the coverage that you need when you need it the most.

Who is Eligible for a Medicare Advantage Plan?

In order to join a Medicare Advantage Plan, there are a few important qualifications that you have to meet. For starters, it is required that you live in the service area of the type of Medicare Advantage Plan that you’re trying to join.


Another qualification is that you must already have Medicare Part A and Medicare Part B.  Finally, people who have ESRD or “end stage renal disease” are not qualified to sign up for a Medicare Advantage Plan and will need to pursue other options that are available to them.

At Bernardini & Donovan Insurance Services, our primary goal is to help simplify your insurance and healthcare needs whenever possible. If you’re trying to determine whether Medicare Advantage is right for you, or if you’d just like to sit down with someone and discuss your options further, please call us today.

The Medicare Annual Enrollment Period: What You Need to Know


The Medicare Annual Enrollment Period officially begins on October 15th, 2015 and ends on December 7th. Because healthcare is such an important part of our lives, it’s easy for people to feel overwhelmed when thrust into the middle of such a complicated topic. By understanding a little more about the enrollment period, you can do your part to make sure that you’re ready when October 15th comes around.

The Specifics of Medicare Enrollment

Exactly what you have to do on October 15th will vary depending on a number of factors. If you turn 65 before October 15 and are receiving Social Security, for example, you are automatically enrolled in Medicare Part A, but must elect part B, as there is a premium associated with Part B enrollment. If you have turned 65 but are still working, you might want to consider your coverage options.  You can remain on your employer plan, or, you can elect to enroll in a Medicare Advantage plan, but you need to understand the differences and see which option is best for you.

What If You Want to Change Your Plan?

At Bernardini & Donovan Insurance Services, our goal is simple: we want to clear the air surrounding confusing enrollment periods and other restrictions and help make your insurance options as clear and as concise as possible. If you have questions about the Medicare annual enrollment period or about any other subject, please contact us today.

What Affects Individual Insurance Prices

When picking individual insurance plans, one of the first things that you’ll notice is that the price will often vary wildly depending on exactly what type of plan you’re talking about. Many people also don’t realize that price fluctuations are common for the same plan when two very different people are involved. Person A might pay $100 a month, while Person B might get quoted $200 a month for the same plan. Understanding what affects individual insurance prices is one of the keys to making the right decision moving forward.


Risk Factors

One of the major things that can affect individual insurance prices involves certain risk factors with your body, your lifestyle or both. Individuals with a high Body Mass Index, for example, are much more likely to develop diseases like heart conditions, diabetes and more. Likewise, smokers are much more likely to develop cancer than someone who has never smoked tobacco in their life. If certain lifestyle decisions that you’ve made or are currently making identify you as a risk factor to an insurance provider, you can expect your monthly premium to go up as a result.


Your Age

Another common factor that affects insurance prices is actually your age. Generally speaking, a younger person in their 20s will pay much less on a monthly basis for health insurance than someone in their 50s. The reason is simple: older people are much more likely to develop certain age-related conditions and diseases, thus increasing their risk factor in the eyes of the insurance provider as a result.


Family History

Another very important factor that is weighed when determining health insurance premiums is the family history of the applicant. Certain diseases and conditions very much have a strong genetic link, meaning that even if you don’t have a disease like cancer now, you’re much more likely to get it in the future if it has a strong presence in your family throughout the years. An applicant who did not have a family history of any major or debilitating diseases, on the other hand, would likely have a much lower premium as a result.


Your Job

Similar to family history, your job plays an important role in determining how much you will pay for health insurance. People who have sedentary jobs for example are much more likely to be overweight or develop issues like cardiovascular diseases, causing their premiums to go up as a result.
If you’re in the market for a new individual insurance plan and want to make sure you’re picking the right one, please call Bernardini & Donovan Insurance Services today.