Did you know… about the 80/20 rule?
We realize that many people may have health care but don’t know how the systems work or what their premiums are going to each month. We understand that life is busy and that you may not have all the time in the world to research and learn an argumentatively complex system of health care insurance and providers. So we thought that we would start a new series of posts focused on “Did you know…” With this blog, we will be looking at the 80/20 rule.
Did you know… that health insurance companies are required to spend a mandated amount on your healthcare? Insurance Companies are mandated to $.85 of every dollar on your Health Care.
This 80/20 rule is also referred to as Medical Loss Provision Ratio in the Affordable Care Act. The rule states for 80% of premiums collected must be spent on health care or on improving actions for the person. The other 20% can go to administrative needs of the medical insurance company such as marketing or other financial needs. These numbers specifically apply to individual and small group markets. If you are part of a large group market, then the numbers change to 85% and 15% of healthcare and administrative needs respectively. The thought process with this rule is to ensure greater transparency within insurance companies so we can truly see where the money is going. If an insurance company does not spend the 80 to 85% of premiums toward healthcare, then they are required to provide a rebate for the portion that was not spent. This rebate looks at the entire corporation and their spending and not just on one individual’s health care expenditures. Are you someone who has received this kind of rebate in the past? If so you know that the rebates usually come in the form of a check to the individual, are applied as a credit to their account or are reflected in the rates of the following year of insurance. Or if you are part of a small or large group then the rebate is given to your employer who passes it along to their employees. We hope that this “Did you know” blog was helpful. If you have any more questions about the Medical Loss Provision Ratio, please feel free to call and ask us.
Healthcare In the News – August Edition
In the past month, we have seen some seriously dramatic news stories about our nation’s health care laws. Usually, dramas of that sort are kept to cable television, but maybe art does imitate life, especially as we watched the news coverage of the US Senate. If you have been living under a rock or just don’t enjoy listening to the news, let us give you a quick fly over.
In May, the House voted to pass the ACHA which had a series of changes to our current Affordable Care Act. The Senate then decided to write their bill however they delayed the voting until they could work out their details within the Republican party. It failed to pass. Then a series of votes continued to try and repeal and possibly replace Obamacare. None of those passed either. The Republican party needed every representative to vote yes, and with some dramatic conversations between party members, the numbers didn’t rally.
When Senate Majority Leader Mitch McConnell was asked about the future of healthcare reform, he stated that they had suffered a setback and that the future was “murky.” This murkiness has started talks with Democrats about single payer healthcare. If you are unclear about what single payer healthcare is, you can read about it on our previous blogs: www.bdhealthinsurance.com/single-payer-healthcare and how it doesn’t work here: www.bdhealthinsurance.com/single-payer-healthcare-cons-part-one and here: www.bdhealthinsurance.com/single-payer-healthcare-cons. Representative John Conyer (D- Mich) has already introduced his single payer bill called Medicare for All. He already has the support of about half of the House Democrats behind his bill. Senator Bernie Sanders says he will propose his bill shortly. It will probably look very similar to the plan he posted on his website last year, and we heard him speak about on the campaign trail. We will have to wait and see how this unfolds in the next few months.
Value of Health Insurance
Having health insurance provides real tangible benefits. It also provides more abstract benefits. With any insurance that you are purchasing you are essentially investing in your peace of mind. There are always What-if’s that run through our minds. But insurance promises to be something that will help you if any of those scary what if’s come to pass. You get in a car accident – you have insurance for that. Your loved one passes away – you have insurance for that. You get sick – you have insurance for that.
Health insurance comes with mandated benefits as well. Every insurance plan that you can purchase will include:
Some plans that you purchase can have more services. But under the Affordable Care Act, which is still the law, though that may change soon, these benefits are all mandatory.
Without health insurance, there is a higher possibility of suffering from debilitating debt due to high medical costs. No one plans on breaking a bone or needing to stay in the hospital. If it were up to us, we would all be healthy at all times. But these things do happen, and the cost of fixing a broken leg can be up to $7,500. A three-day stay in the hospital can be upwards of $30,000. These are astronomical numbers in comparison to what you pay in premiums and co-pays.
Another important aspect to look at with health care is the preventative care. Most of these services have no cost to you. Receiving shots or getting specific screening tests allows you to catch anything early or prevent illness from ever getting a foothold. Our health is one of our most valuable assets. And keeping our health as a priority through proper preventative care will save you in the long run. Speak to us today about which health insurance will be the best for you, your family or your business.
Health Insurance for Children
With the recent twists and turns of the Affordable Care Act, there have been many changes to health insurance. While most people talk about how this will affect the health insurance needs of adults, not many people think about how it can help children. The Affordable Care Act has made it easier than ever for children to be covered with the right health insurance policy.
In order to sign up for health insurance, adults have to wait for an open enrollment period or have a qualifying life event. However, children are able to get covered with the right health insurance plan at any point in the year through Medicaid and the Children’s Health Insurance Program, also known as CHIP. Both federal and state programs offer low cost or free health care to children, which help to bring the number of uninsured children to record lows.
Many private health insurance providers are now offering the same services that CHIP and Medicaid are offering, including various preventive care services that come at no cost. These preventive services include immunizations, autism screenings, depressions screening, obesity screenings, and more to help ensure the health of children across the country.
All health insurance plans are now required to offer 10 services, including vision and dental care for children, as well as maternity and newborn care. It is important to keep in mind that insurance companies do not have to offer dental and vision care to children who are over the age of 19, so look carefully when deciding on the right policy to fit your needs.
Contact the insurance experts at Bernardini & Donovan Insurance Services in Redlands, California for all of your child health insurance needs. We will work with you to ensure that you have the right amount of coverage for everyone in your family, all at the right price.
Free Preventive Care
Under the Affordable Care Act, all health insurance policies that are purchased through the Marketplace allow people to have access to free preventive care. These preventive care options are meant to keep people healthy to help them avoid trips to their doctor and pricey medications.
While they are known as free preventive care services, they are not really free. They are paid for by your insurance company with the money that you pay each month for your premiums. However, there is no out of pocket costs for you when you need these services, meaning you can never be charged a copay, deductible, or coinsurance.
There are many different services that are part of free preventive care, including immunizations, cholesterol and blood pressure screenings, depression screening, and oral health and vision screenings for children. There are also preventive services that are available to women, including prenatal care and contraceptives.
When going in for these free preventive services, it is important to tell your doctor when you make the appointment so that you are not charged for the visit. Keep in mind that while these services are free, there may be some associated costs, such as if you need a follow up visit or a separate treatment.
Keep in mind that most health insurance providers will only pay for preventive care if you go to an in network doctor. If you choose to go to a physician that is out of the network of your health insurance provider, you may be left paying for the services out of your own pocket.
For all of your health insurance needs and to ensure that you are able to take advantage of the free preventive care that is available, contact the insurance professionals at Bernardini & Donovan Insurance Services in Redlands, California.
Health Insurance Special Enrollment Period
If you missed out on signing up for health insurance during open enrollment, do not worry! The Federal government has recently announced that they are opening a special enrollment period for those who were not able to sign up for health insurance during open enrollment. This special enrollment period runs from March 15th to April 30th and is the last time that you will be able to sign up for health insurance coverage for 2015. While this special enrollment period only applies to the 37 states that are covered through the federal marketplace, state-run exchanges are expected to follow.
In order to qualify for the special enrollment period, people will have to prove that they only became aware of the tax penalty for not having health insurance when they were filing their taxes. While the special enrollment period will not reverse the fine for not having health care, it will give people a chance to get the right health care plan for their needs.
Under the Affordable Care Act, everyone is required to have a health insurance plan, or face a financial penalty. However, many people were not aware of the penalty for not having health insurance until they started filling out their tax return for 2014.
The government also recently accounted that the wrong information to help calculate whether they received too much or too little of a subsidy for last year was sent out to 800,000 people. People who have been affected should have already been notified by phone or email, and need to wait to file their taxes until they receive a new 1095-A form, which was sent out in early March.
For all of your health insurance needs and to ensure that you have the right amount of health care under Covered California, contact Bernardini & Donovan Insurance Services in Redlands, California.
Why You Should Work With Bernardini & Donovan
At Bernardini & Donovan Insurance Services, we understand that finding the right health insurance policy can be confusing and difficult, which is why we are here to help. We strive to simplify all of the health care needs of each of our clients to ensure that you and your loved ones are able to get the perfect health care coverage to fit your specific needs.
Health care has been brought to the forefront of the insurance world thanks to the passing of the Affordable Care Act. All of our licensed agents and brokers have years of experience in the health care world, and are here to help you find the right policy to ensure that you have the right amount of coverage. No matter if you are looking for a policy to just cover you, or are looking for coverage for all of your employees, we are here to help.
At Bernardini & Donovan Insurance Services, we do more than just find you the right insurance policy. We work to build strong and long lasting relationships with each of our clients to ensure that they are comfortable talking about their policy and asking any questions that come up about the coverage that their policy provides.
With expertise in Group Health Insurance, California Health Insurance, California Life Insurance, and Long Term Care, we can help you find the policy that best meets your needs.
Contact Bernardini & Donovan Insurance Services in Redlands, California for all of your health insurance needs and to ensure that you invest in the right amount of coverage.
Understanding Eligibility Of The Special Enrollment Period
With the deadline for the second Obamacare open enrollment period now in the rear view mirror, many individuals who failed to obtain health insurance before the deadline will soon be receiving penalties in the mail. Due to the enactment of the Affordable Care Act, each and every one of us is now required to obtain health coverage or receive a penalty.
If you want to avoid penalties, you must obtain health insurance. However, there is one way out of this requirement: the special enrollment period. The special enrollment period provides an individual with varying circumstances a second chance at enrolling for health care. However, you must experience one of the many qualifying life events in order to be eligible for the special enrollment period.
Life events that may make you eligible to take advantage of the special enrollment period and avoid penalties include:
- Getting married changes your tax situation and health care needs, so you can take advantage of the special enrollment period.
- Likewise, having a baby, adopting a baby, and placing a child in adoption or foster care all make you eligible for the special enrollment period.
- Do not fret if your existing health coverage drops or changes, as you will be able to obtain new health insurance during the special enrollment period.
- Permanent moves that change your coverage area or coverage requirements allow you to obtain health insurance during the special enrollment period.
- If your citizenship status changes you can obtain health insurance during the special enrollment period.
Rather than leaving yourself unprotected, seek the care you deserve today! Contact Bernardini & Donovan Insurance Services in Redlands for all of your California health insurance needs. As Covered California experts, you can rest assured that we will be your guiding hand in the realm of health insurance and health care.
Understanding The SHOP Marketplace
Small business owners across the country have been experiencing change as they are now legally required to comply with new regulations and requirements under the Affordable Care Act. Since the world of health insurance and health care has transformed completely, choosing the right small business health insurance plans to best protect your team is more challenging.
If you missed the open enrollment deadline on February 15th and are beginning to panic since you have not properly set up your small business plans, do not fret! We can still write you a policy for your small business.
A unique entity known as the Small Business Health Options Program (SHOP) Marketplace allows small business owners to obtain the coverage they are required to offer their team, despite missed deadlines. When utilizing plans offered in SHOP, you have the luxury of avoiding restricted enrollment periods and offer deadlines.
There are many benefits of utilizing the SHOP Marketplace in addition to full luxury to pick and alter coverage as you please. If you are currently satisfied with your insurance agent, feel free to enroll with them! The SHOP Marketplace does not require that you change agents; therefore, you can go through this process with the agency you trust most.
The SHOP Marketplace is the perfect way to obtain health insurance and comply with all requirements set forth by the Affordable Care Act if you have 50 or fewer full time employees. The same goes for nonprofit organizations, however, if you are self-employed you cannot utilize the SHOP Marketplace.
Please do not hesitate to give us a call if you are in need of enrolling for a SHOP plan for your small business. Contact Bernardini & Donovan Insurance Services in Redlands for all of your California health insurance needs. As Covered California experts, you can rest assured that we will be your guiding hand in the realm of health insurance and health care.