Considering Dental Insurance?

As of  late many of the insurance carriers that I represent now offer a stand-alone dental plan, not only available with your current health insurance plan.

Before selecting this optional benefit, it is important to understand how dental insurance works.

1. Does your dentist accept the plans terms of service and is he considered to be a "In-Network" or "Out-of-Network" provider.  If your dentist is "In-Network" than the dental plan will provide greater benefits.
2. Preventative Services such as cleanings and X-Rays are covered 100%
3. All plans have a 6 month waiting period for Basic Services (cavities, fillings, extractions) and a 12 month waiting period for Major Services(root canal, crowns, dentures, restorative).  After waiting periods, member pays either 20% or 50% of allowable charges.
4. All costs that are paid out by the insurance carrier are applied towards the plans $1,000 or $1,500 annual benefit maximum

The only way around the waiting periods is acquiring a dental plan from Blue Cross and Blue Shield of Illinois (BCBSIL) that must be taken when applying for a plan of health insurance coverage.  BCBSIL only has a 12 month waiting period for crowns, dentures and restorative.

If your teeth are in great shape and you seek semi annual cleanings, you may want to weigh the cost of coverage to the actual cost you are to pay retail.

If you do not have a dentist, then it might be wise to acquire a plan to cover the cost of your initial "new patient" consultation and cleaning, especially if you plan on going twice a year.

If you just found out that extensive work is needed, your best bet would be BCBSIL since there are not any waiting periods for Basic Services and a few Major Services.  If not BCBSIL, none of the plans will be a benefit.

Fore more information please contact the shoppe.

-The Shoppe

Maternity Coverage in Illinois

Happy Holidays and Merry Christmas!

I hope that the readers of my postings, which are few, had a great holiday weekend :)

As of the past month there have been quite a few inquiries on obtaining maternity coverage in the private market.  Unfortunately, there is only one private health insurance carrier that offers an optional Maternity benefit, Blue Cross and Blue Shield of Illinois (BCBSIL).  This optional benefit must be elected at time of application or on the anniversary date of a current BCBSIL plan.

The benefit is payable after a 12 month waiting period with continual monthly premium payments.  All pre-natal care will be covered after the waiting period to then include delivery and post-natal care.  After the waiting period all covered care will be subject to your plans coverage.  Once post-natal care is completed you will then request to remove the Maternity benefit.

If a plan member with the maternity benefit delivers by Cesarean C- Section and removes the benefit, and is to add the benefit again at plan anniversary, there will be complications.

When applying for the benefit at anniversary, all members of the plan must go through medical underwriting, and until January 1st, 2014 (health care reform), BCBSIL can place condition specific exclusion riders.  For example, BCBSIL would offer the optional Maternity benefit but will place an exclusion on future C- Sections, not covering it at all.

Now...the final thing to mention is the Maternity Benefit that is available with the Illinois Comprehensive Health Insurance Plan (ICHIP).  ICHIP is the state high risk pool and the benefit is available with their Traditional coverage option.  To qualify for this coverage you must not be insurable in the private market or have a private policy that is more costly than the ICHIP.  The optional Maternity benefit has a 9 month waiting period.

For additional information on Maternity coverage please contact the shoppe.

Best,

The Shoppe

BCBSIL has updated their effective date guidelines

Effective 12/1/2010, Blue Cross and Blue Shield of Illinois (BCBSIL) has new effective date guidelines.

You can now request an effective date 2 weeks out from the date you submit your application.  If a decision has not been made within the 2 weeks, your effective date will be on approval, but can not be the 29th, 30th or 31st of the month.

Please contact the shoppe with any questions.

-The Shoppe

Recent Visit to the Emergency Room

Well...not so recent as I am late in keeping up with updating our BLOG.

Back in August I had cut my finger with a knife when I was packing up my apartment.  There was no to much pain but a whole lot of bleeding.  After 20 min of continuous bleeding I decide to visit the Emergency Room (ER) as it was during the middle of the night.

Living in the Gold Coast I chose to visit St. Joseph's which is Resurrection HealthCare.  I was treated right away and during my 45 minute stay I received gel foam to help coagulate the blood on the cut, which was wrapped up with a band-aid.  I was then visited by a physician who went over the gel foam and told me to keep it on for 24 hours and then let it heal naturally.

Two weeks following my visit I received a bill from Resurrection HealthCare for $1072.50 which was for Facility Emergency Services.  The next day I received another bill, this time for Physician Services which was for $196.  This brought my total bill to $1,268.50.

$1,268.50 is the retail cost and is the cost one would be responsible to pay if not covered by health insurance.

Being self-employed I have private health insurance coverage with Blue Cross and Blue Shield of Illinois (BCBSIL), in which I presented my insurance card at time of service.  The plan I have is HSA compatible with an annual $2,600 deductible then 100% coverage after. My plan design leaves me to pay up to the my deductible before BCBSIL is to pay a percentage or all.

Back to the bills....

Once I received all billing from Resurrection I then received two Explanation of Benefits (EOBs) from BCBSIL that went over my recent visit, costs and then showed the allowable amount I was to be billed for these services.  The "allowable amount" also known as the "negotiated/contracted rate" is the amount the provider (Resurrection) is allowed to bill me since they accept BCBSIL and are considered an "in-network" provider.

Another week went by and I then received updated billing from Resurrection requesting the reflected amount on my EOBs.  This final amount is what I owe to the provider and is applied towards my deductible.

The final costs were $521 for Facility Services and $56 for Physician Services, $577 total. This is how health insurance works! 

No matter what my plan benefits are compared to anyone else with BCBSIL this would be the plan members responsibility prior to their plan benefits.

Now....the final thing to discuss is how the plan design of my HSA compatible plan works.  The plan requires that I meet the first $2,600 before BCBSIL is to pay 100% of all remaining calendar year expenses.  I take a monthly medication that costs $46 each time at Walgreens, totaling $552/year that is applied toward my deductible.  With the above ER expense I have applied a total of $1,129 toward the plan deductible.  This leaves me knowing that if anything major happened to me, I would only owe a remaining $1,471 before BCBSIL is to pay 100%.  For the price I pay in premium, I don't find a high deductible plan of coverage without copays to be too bad.

Hope this helps in making a decision towards purchasing a plan or understanding how a plan of coverage works.

Thanks,

-The Shoppe

sliw afternoon and vail kills time at the shoppe

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What does having a low deductible mean?

When referencing a low deductible it is in the line of $500 or $1,000.

These are most likely found when coverage is being provided through your employer.

Having a low deductible only means that you are paying a lower amount prior to your insurance carrier paying a percentage (coinsurance) in which you pay your percentage share towards the plans out-of-pocket expense limit in addition to your plans deductible.  Any copays do not apply to the plan deductible or out-of-pocket.

A lower deductible will come into play better than a high when looking at outpatient procedures that total from $500-$2,000

When faced with a large claim such as hospitalization than a low deductible plan will pay them same when comparing high deductible plans, $2,500 or above, especially with 100% coverage after the high deductible,  The main note is that the higher deductible plan can cost anywhere from 30-40% lower in monthly premium.

When choosing to pay the premium for a low deductible, the insured is making the choice in paying upfront to pay less at time of service.  When choosing a higher deductible, especially HSA compatible, the insured is saving in premium and self insuring themselves for small expenses such as office visits.

Please contact the shoppe with any questions.

-The Shoppe

Late night at the shoppe with vail

Awesome

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Check out The Shoppe on ABCs LiveWell HD

Please make sure to check out The Shoppe on ABCs LiveWell HD
http://bit.ly/livewellhd

Thanks for all your support!

vail

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how your health insurance works

Benefits aside, every plan of coverage no matter the insurance carrier has one common factor; a network of providers.

Providers are considered to be physicians, hospitals, facilities and labs.

Each health insurance carrier provides one or up two networks to choose to participate in, with the larger network costing more in monthly premium.

Providers that are within your plans network have a contract to charge you a negotiated rate in service. This rate can be from 30-70% lower than the retail cost of those services.

So in paying your monthly premiums you are gaining access to a provider network, that when utilized can save substantial amounts of savings by not having health insurance.

So, even by paying additional premium for benefits such as office visit copays the insured is paying that amount on a discounted service. Ir may be wise to learn what the true cost of your office visits are to your internist and adjusy a savings to see if a copay is worth the cost.

- the shoppe

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Applying to IPXP

It has come to out attention that many Illinois residents who are applying for the new state health insurance plan are submitting application without the required documents.

In order to qualify for coverage you must have been denied health insurance by a private health insurance carrier within the past 9 months, was offered private coverage (not accepted) that contained an exclusion rider on your medical condition or must have one of the presumptive medical conditions that must be accompanied by a Attending Physician Statement (APS).

Please call The Shoppe to inquire.

-The Shoppe

Mandatory Preventative Care Benefits

Effective for all major medical health insurance policies sold after 9/23/2010, preventative care services that fall under HHS guidelines are now covered at 100% by health insurance carriers.

Please follow this link to learn more on what services are now covered at no cost to the insured:
http://bit.ly/PrevCare_Benefits 

For more info please call The Shoppe!

Sincerely,

The Shoppe

Illinois guaranteed health insurance plan for pre-existing conditions

Effective Today!!
Illinois will start taking applications for health insurance coverage for individuals who meet the below eligibility requirements:

1. Must be a state resident
2. Must have been uninsured for at least 6 months; and
3. Have a pre-existing medical condition.

For more info on the plan please visit http://bit.ly/new_state_plan

A few simple facts on the plan:

• $2,000 annual deductible
• You then pay 20% until an additional, $2,350 is spent in additional out-of-pocket expenses
• Rx will be covered at 80% to a maximum out-of-pocket of $1,600 to the insured being paid at 20%

The Network of providers in Cook County is Health Link, http://www.healthlink.com/home_participant.asp

You can access a list of doctors and hospitals from this link.  you will want to click the network, "State of Illinois Plan"

Please contact The Shoppe with any questions.

-The Shoppe

Prescription Drug Coverage with Health Insurance

If you are looking to purchase health insurance coverage and are currently taking prescription medications (Rx), then this blog will explain how the most competitive carriers The Health Insurance Shoppe represents will cover your prescription medication.

If you are currently insured (privately) than this will help explain your current prescriptions benefits.

Before I go into explaining how each carrier provides benefits, it is important to note, that as long as there is not an exclusion rider on your plan than you will never pay the retail cost of the drug.  When you purchase prescriptions at a participating pharmacy within your plan you are to pay the negotiated (discounted) rate.  If your plan does not have a copay for prescription drugs then it is best to shop around with local pharmacies to see who has the lowest retail cost and accepts your health insurance.

The second thing to note is all carriers mentioned below, except Humana, will not cover prescription medications for the first year of the plan if they were being used within the 12 months prior to application.

Blue Cross and Blue Shield of Illinois (BCBSIL)


All plans other than the SelectBlue, SelectBlue Advantage and BlueChoice Select with a $500 or lower deductible will require you to pay the negotiated rate of your prescriptions towards your plan deductible.  Once you satisfy the plans deductible you will begin to pay 20% on the negotiated rate towards your plans out-of-pocket expense limit.   Once the plans out-of-pocket expense limit is met the insured will continue to pay 20% The only plan offered by BCBSIL that will begin to cover prescriptions at 100% after the deductible is satisfied, is the BlueEdge HSA with 100% coverage.


The first 3 plans mentioned with a $500 or lower deductible will provide an upfront $10 copay for Generics and will require the member to pay 35% on the negotiated rate for Preferred Brand name drugs and 50% on Brand Name drugs.  The total paid would not apply to the plans deductible.


Aetna


Other than HSA qualified plans, Aetna will provide members with an upfront $15 or $20 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $30 copay on Preferred  Brand drugs and a $60 copay for Brand Name drugs.  The copay paid will not apply to the plan


Depending on the cost of the prescription medication, Aetna may increase your premium to take on the cost against risk.


Humana


Other than HSA qualified plans, Humana will provide members with an upfront $15 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $65 copay for Brand Name drugs.  The copay paid will not apply to the plan


Depending on the cost of the prescription medication, Humana may increase your premium to take on the cost against risk.


United Health Care (UHC)


Depending on the health insurance plan, UHC will provide members with an upfront $15 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $250-$1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $65 copay for Brand Name drugs.  The copay paid will not apply to the plan


Celtic


Other than HSA qualified plans, Celtic will provide members with an upfront $15 or $20 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $70 copay for Brand Name drugs.  The copay paid will not apply to the plan


Hope this information helps in making a decision towards purchasing a plan of coverage.

Please call with any questions.

-The Shoppe

Dental Insurance

The Shoppe has been receiving a lot of inquiries in the past couple of months on stand-alone dental insurance.  Stand-alone is coverage that does not need to be purchased at time of acquiring a health insurance plan.

Plan can range from $14-$38/month (for single coverage) and range from HMO to PPO plans of coverage.

What does Dental Insurance cover?
Dental insurance will cover your preventative care which is two annual cleaning and X-Rays that come with.  As long as your dentist accepts your dental insurance you would not owe anything for these services.

Preventative will be the only immediate benefit and you will be subject to a 6 month waiting period for Basic Services and a 12 month waiting period for Major Services.

After the waiting periods you would only be able to receive anywhere from $1,000 - $1,500 at the most in annual benefits, payable by the insurance carrier.

Basic Services
All Basic Services will be subject to a 6 month waiting period other than dental coverage with BCBSIL that must be acquired with a plan of health insurance and begins at $26.55/month for single coverage.  Basic Services include:

• Fillings, resin or amalagram
• simple extractions (not wisdom teeth)

After the waiting period these services are typically covered at 50% or 80% by the insurance carrier with benefits payable to the plans maximum at the negotiated rate of service if in-network or up to the maximum allowable amount if services are rendered at a non-participating dentist.

Major Services

All Major Services will be subject to a 12 month waiting period other than dental coverage with BCBSIL as mentioned prior.  Major Services include:

• Endodontics (root canal / therapy)
• Periodontics (gum surgery / oral surgery)
• Crowns
• Bridges
• Dentures

After the waiting period these services are covered at 50% by the insurance carrier with benefits payable to the plans maximum.

The thought process to getting coverage is that you are paying a premium to receive services after a 6 - 12 month waiting period, but at the same time will receive cleanings at no cost.  If your teeth are in good condition and you maintain cleanings annually or semi-annually than your cost for the cleanings will be lower than the cost of the dental insurance premium.

If you are planning on having basic or major services done in the next 6 months, than dental insurance will not be a benefit unless you acquire a health insurance plan with BCBSIL and elect their dental coverage which does not have waiting periods.

The final thing to note is whether or not your dentist, endodontist or periodontist accept dental insurance.  If they do not, than  it will not be a benefit to obtain dental insurance for the payouts will not be worth the premium paid.

For questions on stand-alone dental coverage please call The Shoppe.

Thanks,

The Shoppe

How to use your HSA

Well...I have to admit that it has been a slow month in posts from The Shoppe.  Sorry about that.  The Shoppe has been extremely business placing customers in appropriate health insurance plans.

For the final post of the month I would like to discuss how to use your Health Savings Account (HSA) once you have opened one up.

The First Method
The main concept of electing an HSA qualifying plan of health insurance is that the premiums were substantially lower than a traditional plan that included unlimited office visit copays and a generic drug card.  Instead of paying the additional $40-$100 more in monthly premium for a plan with pre-paid benefits, copays, you would take the difference in premium and deposit into your HSA account in which you would be provided a debit card and check book to pay for qualifying medical expenses.  So...when it was time for an office visit and a bill was received you would simply pay out of the HSA, and the total amount spent would go against your health insurance plan deductible, where copays do not.

This method will end up with the bank sending you a 1099 at the beginning of each calendar year declaring how much money was deposited into the account for the prior year.  This reflected amount is what you would take as a 100% above-the-line tax deduction, meaning your taxable income is reduced by the total amount that was deposited into the HSA.  Any remaining funds in the account will roll-over to the next year for additional contribution.

Bottom line is that your medical expenses are paid for tax-free.

The Second Method
You are allowed to contribute up to $3,050 for an individual and $6,150 for a family for the year 2010 into the HSA.  If you are above age 55 than the IRS allows for an additional $1,000 to be contributed.  The total allowable or any amount can be deposited at any time throughout the year.

If you have available funds to set aside and deposit into the HSA, then remember, that once deposited you can only withdraw the money tax-free to pay for or reimburse on qualified medical expenses.  If you take the money out for non-qualified expenses you will be subject to a 10% penalty and must pay taxes on that amount.

So...if you are not looking to have much money in your HSA that you can not access, well only for qualified expenses, it might be smart to make small deposits into the account and see how far those funds can take you.

The Third Method
The final method is the one that I use and promote.  Depending on your bank in where you open your HSA your account may be free or cost anywhere from $2-$5/month to maintain in fees.  My account is free and I keep a minimum balance of $25.  If there were monthly admin fees then I would keep a minimum to cover the monthly fees.

For all medical expenses I use my personal credit card to pay out.  I gain miles and get a few months to pay off, depending on APR percentages.  Towards the end of the year I will add up my medical expenses and then take enough paychecks to equal the total amount and deposit them into my HSA. Once the deposits clear I will withdraw the total deposited amount as a reimbursement to the credit card bill I have paid off that was used to pay for qualifying expenses.

This allows for my HSA account to stay at $25, however the bank will send me a 1099 reflecting the total amount that was deposited in which I would take a 100% above-the-line tax deduction on that amount.

Catch the drift?

Please call The Shoppe with any question on your HSA.

Thanks,

The Shoppe

The Shoppe will be closed on 7/24

Sorry for any inconvenience, but The Shoppe will be closed this Saturday.  We will return on 7/26.

Enjoy your weekend!

Blue Cross announces new child only policy

On Friday, July 16, 2010, Blue Cross ad Blue Shield of Illinois filed a new policy called Blue Pathway to provide coverage for children age 1 through 18 when the child is the primary insured (commonly called “child-only” policy) with the Illinois Department of Insurance (DOI).


This new coverage option responds to an Interim Final Rule that was issued by the Department of Health and Human Services (HHS) to implement several provisions of the Patient Protection and Affordability Act of 2010 (PPACA). In this Rule, HHS has determined that provisions limiting the application of pre-existing condition exclusions for children under 19 means that all children under 19 who apply for insurance for which they are eligible on or after Sept. 23, 2010, cannot be denied coverage—this is commonly known as “guaranteed issue.”


During the interim period while waiting for authorization to sell this new product, BCBSIL will temporarily suspend issuing new policies to children under 19 when the child is the primary insured. BCBSIL will stop quoting its current child-only policies on July 30, and the last assigned effective dates for those policies will be Sept. 15, 2010. Any application that has not been approved by Sept. 1, 2010, will be withdrawn from consideration. Once the DOI approves this new policy, BCBSIL will provide information on how to apply for the coverage. 


From what is gathered this product will not be marketed through a retail store front such as The Health Insurance Shoppe.  You will need to contact Blue Cross direct to inquire more on this information.


Feel free to call The Shoppe with questions.


-The Shoppe

WE WILL BE CLOSED ON SATURDAY 7/10 FOR BURGERFEST

ATTENTION:

We will be closed this Saturday and will have a tent at the Roscoe Village Burgerfest, starting one block west of The Shoppe.

Please make sure to stop by and visit!

Sorry for any inconvenience:-(

-The Shoppe

New Government Health Care website

Today, the U.S. Government has launched a new website, www.healthcare.gov

From this portal you will be able to find the following:

• Health Insurance Carriers in your location
• How health insurance carriers treat medical conditions
• Information on hospital care and quality
• Information on how the new health care bill impacts you
• Information on small business tax-credits

Please feel free to contact the shoppe with any questions!

-The Shoppe

Illinois State Health Insurance Plan not starting till late summer

With the new health care reform, states were to have set up high-risk health insurance pools for individuals with pre-existing conditions that could not get coverage in the private market.

This pool was to be in effect on 6/1/2010, but Illinois has yet to establish.

Individual's eligible for coverage must have gone without health insurance for the past 6 months in order to apply.

Currently, Illinois has always had The Illinois Comprehensive Health Insurance Plan (ICHIP) for high-risk insured's.  There were 4 types of coverage available, and depending on coverage there is  a 6 month waiting period for coverage on pre-existing conditions.  There is no current requirement to how long you have been without health insurance for.

For more information please feel free to contact The Shoppe.

-The Shoppe

Make sure you know what Hospitals are covered with your health insurance

Be careful when applying for new health insurance coverage in the private market.

The #1 mistake people can make is going to a hospital or doctor that is not in their health insurance plans network of providers.

Click to see a list of hospitals covered by major health insurance companies in Chicago...http://bit.ly/NetComp

Even though your plan may be a Preferred Provider Organization (PPO), many insurance carriers offer smaller networks of providers for a discounted cost in monthly premium.

Depending on the insurance carrier, plans have separate deductibles and out-of-pocket expense limits for non-participating providers.

When selecting a smaller network of providers, make sure that your hospital of choice is in the network as well as your current doctor if you have been seeking care with him/her for a while.

If you live in the City of Chicago you will not find Northwestern Memorial, Rush, and possibly Advocate.

For any questions, please contact The Shoppe.  Hope this was useful information.

Thanks!

-The Shoppe

How to cut your costs with HSAs

Are you looking to cut your health insurance premium cost's.  Look no further than moving to an HSA compatible plan.

The below link will take you to a comparison of 3 plans of health insurance coverage from Blue Cross and Blue Shield of Illinois for a 35 year old male living in Chicago.


http://bit.ly/bWHWFo

The comparison will show 2 traditional plans of coverage that have office visit copays with 1 HSA compatible plan that does not provide office visit copays, but will cover annual physicals under a $20 copay.


The comparison will show the costs for someone who has been having issues with their stomach and acid indigestion.  The insured first seeks care at their internist who then must refer to a Gastroentologist, a specialist.

In the comparison all 3 plans have the same cost exposure other than for office visits.  The HSA compatible plan is the most beneficial in this scenario, since it has the lower deductible and provides 100% coverage after the deductible is met...and did I mention it is the lower cost in premium..??

As for the Rx illustration, none of the plans have a copay.  With BCBSIL you must select a $500 or lower deductible in order to receive a $10 copay for generics and cost share for preferred and brand name drugs.  The presented plans will all discount the cost when purchased in-network and the final paid will be applied to the plans deductible.

In this scenario, if the insured has an HSA compatible, they are allowed to take up to a $3,050 above-the-line tax deduction for 2010.  The insured would have to open a Health Savings Account (HSA) at a local bank for free or for a $2-$3 monthly fee.

In this example, the insured could pay for these expenses out-of their own pocket or via credit card (get miles) and can definitely work out a payment plan with the provider.  The insured would then have to make deposits into their HSA for any amount up to the total amount of expenses prior to 4/15 of the following year.  A deduction can only be taken for the total amount on the HSA ledger.

Now...when the insured is to contribute monies into the account, he/she can then immediately withdraw the money as a reimbursement to what they had paid out-of-pocket or on credit card.  This then allows them to use the HSA strictly as a tax-vehicle for medical expenses, rather than a savings account.

Hope this is all making sense.  There is no need to pay the insurance company more in premium to have office visit copays or to have a lower deductible.

Please call the shoppe with any questions!

-The Shoppe

Let's talk about Health Savings Accounts (HSA)

What is an HSA?

• An HSA (Health Savings Account) is a government regulated savings account where you can contribute money, tax-free, to pay for your medical expenditures, such as your deductible, prescriptions drugs, dental, vision and so on...  Any unused funds in the account for the year, roll over to the next year.  Your money in the account will earn interest that is tax-deferred.

• In order to have an HSA you must apply for a qualifying High Deductible Health Plan (HDHP)

What is a HDHP?

• An HDHP is a health insurance plan with a deductible greater than $1,200 that does not include any pre-paid benefits such as an office visit copayment or prescription drug card.

• In Illinois, there are only two carriers that offer deductibles below $1,000.  All other carriers begin at $1,000 or $1,500 for non HSA plans.

What will happen when there are no copayments for office visits or prescription drugs?

• First, when you become a member of an insurance carrier, you are given access to their network of providers, known as a PPO (Preferred Provider Organization).  By seeking services at providers within the network, you fully utilize the plans benefits.  This allows you to receive a negotiated rate on the services provided.
• An example would be a doctor charging $100 to the public for an office visit in relation to an accident or illness.  If the doctor is in your carriers network, you would not be subject to the $100, but a negotiated rate, which could be anywhere from 20-50% lower. 
• The final negotiated rate is what the insured would be responsible to pay the provider, which would be applied towards the plans deductible, whereas an office visit copay would not apply to the plan.  An insured may be responsible for around $65-$70.

• Second, 90% of insurance carriers cover your annual physcial for males and females along with a females annual OB/GYN visit at 100% or under a copay, even HSA plans.

• If a non-HSA plan has an office visit copay, the copay will only cover the cost of the initial visit, the negotiated rate.  Once lab work, diagnostic tests or X-rays are ordered...than they all become a deductible expense and do not fall under the copay.
• Now, keep in mind that doctors all charge different rates, especially a specialist which could run around $300/visit before the negotiated rate.
• You can always call your doctors billing department and ask how much they charge for visits.

• If you currently are in treatment and take prescription medication, carriers may offer a genric presciption drugs card on non-HSA plans than require you to meet a separate $500 or $1,000 deductible for Brand or Preffered Brand name drugs, before a copay would then apply.
• HSA plans will apply the cost of your prescription to your plans deductible, whereas if there was a copay for a Brand or Preferred Brand name drug, it would not be applied to your deductible
• If you were on a Brand Name drug and had a copay of $35-$75/month, the copay would not go towards your deductible.  This is an average of $500 in annual copays that would be an out-of-pocket expense.  If you had an HSA plan, than you would have lowered your deductible exposure by $500, meaning you would owe less on a larger claim, if there was one.

What does a copay cover?

Office visit copays cover the cost of your visit to either a specialist or non-specialist physician.  Usually, a plan will have a copay from $20-$50.

When paid, your copayment does not apply to your plans deductible or out-of-pocket expense limit.

Your copay will only covers the cost of what the physician charges for that particular office visit.  If you receive any immunizations or vaccines at the time of visit, they will be covered under the copay.  If the doctor requests any additional lab work or diagnostic tests, these will not be covered under the copay, and be an expense subject to your plans deductible and/or out-of-pocket expense.


-The Shoppe

Faced with COBRA??

You may not know...but for someone who has been terminated from employment after 6/1/2010 they are not eligible for COBRA subsidy and will be responsible for the whole cost.

If you are now faced with the high cost of COBRA, here are some options:

1.  If you have medical conditions that make you ineligible for health insurance in the private market you can pursue ICHIP.  The Illinois Comprehensive Health Insurance Plan (ICHIP) is our states high-risk insurance pool.  If you have medical conditions that make you ineligible for health insurance in the private market you can pursue ICHIP.  The Illinois Comprehensive Health Insurance Plan (ICHIP) is our states high-risk insurance pool.  

• Depending on your age and smoking status, COBRA may be lower in cost
• Would need a declination letter from a private carrier to be eligible for coverage if COBRA has not exhausted

2.  Depending on medical condition coverage you can pursue coverage in the private market and possibly be offered  coverage w/o any exclusions, but with an increase of premium to take on health risk

3.  If you are not receiving treatment and have a clean health bill then seeking coverage in the private market is your best alternative to COBRA.

Please call or stop by the shoppe with any questions.

Thanks,

The Shoppe

Reviews from the shoppes clients..

The Health Insurance Shoppe allows current and past clients to write a review about their experience on YELP.

We currently have a total of 6 reviews but only 3 are being shown on YELP, while the other 3 are being filtered since the reviewers are not active on YELP.

Below are our 6 reviews from our clients...enjoy :-)


Jason B.
Chicago, IL
11/3/2009

The Health Insurance Shoppe was a pleasure to work with.  Mr. Wishner is extremely knowledgeable on the subject.  I quickly understood the underlying aspects of the different policies and made a decision with their guidance and expertise.  I plan on referring all of my friends to The Health Insurance Shoppe.  It was refreshing to actually sit down and discuss my options with someone in person versus today's automated world.

Ashley W.
Chicago, IL
1/22/2010

For the many of us out there attempting to find the right health insurance plan, I strongly recommend that you consider the Health Insurance Shoppe. Working with the owner Jordan was quite pleasurable. It's refreshing to have an actual individual  to talk to about the matter and find a plan that meets each applicants unique needs.  Not only can you drop into his office on the fly (big plus!) but he is great about emailing and following up with phone calls. 

Overall,  if you are over your head trying to sort out health insurance,  it is definitely worth your time to stop in.  I am a 24 year old female and I did not feel pressured or taken advantage of  during the process. Jordan is highly personable and it shows that he has the desire to help individuals become insured. 

Like I said earlier, its worth the trip to Roscoe Village if you are contemplating heath insurance issues.

Carine M.

Chicago, IL

2/18/2010

We were approved in no time at all (for real, today is 2/18 at 9:47am, we finished our application at 6:15pm on 2/15) .  Fast service, too!  Thanks Jordan!

We had a great experience shopping for health insurance at the health insurance shoppe.  First of all, there is a super cute and friendly dog named Vail there that entertained our dog while we took care of business. 

Jordan was great and answered all of our questions.  We got on a great plan (once we're approved; cross your fingers everyone), and we are super excited to save $800/month!!

Wylee J.

Chicago, IL

3/1/2010

The Health Insurance Shoppe made it easy to select the right health insurance plan for me. As a freelancer, it's hard to find an affordable plan that still provides the coverage that I need. Jordan was able to help me select the best plan for me as well as go over it with me in person. He was extremely helpful throughout the entire process. I highly recommend stopping by or calling if you need health insurance!

Kay B

Chicago, IL

4/30/2010

If you are looking for Health Insurance, your search is over.  Jordan at the Heath Insurance Shoppe is wonderful.  He is very good at explaining all of your options so you can make an educated choice in Heath Care.  I would highly recommend him.  He is very professional and very knowledgeable.

Burt I.

Oak Park, IL

5/22/2010

I found myself with somewhat difficult problem of trying to get short term health coverage for my son who was bumped off my family plan when he turned 19.  I was told by several other insurance agents that the best I could do was pay a very high Cobra premium due to several preexisting conditions.  I had resigned myself to writing a big check (basically throwing money away) but as a last resort I called some more agents. I was lucky enough to find Jordan Wishner at the Health Insurance Shoppe. 

He was the first insurance broker I talked to that had the breadth of knowledge about the ins and outs of getting coverage with preexisting conditions in this complicated market.  Within a week we had approval for coverage for my son at about one third the price of Cobra. 

Jordan literally saved me thousands of dollars of Cobra payments.  I highly recommend you consult Jordan for your health insurance needs.  He's extremely competent and patient and knows the market very well. He went out of his way to help solve what seemed like an unsolvable problem before I talked to him.

Health Insurance 101

If you are in the search for a health insurance plan, Health Insurance 101 can be a great tool to help understand  the following:

• Difference between insurance carriers
• HSAs
• Glossary of commonly used terms

The link below will direct you to Health Insurance 101

http://bit.ly/9WblP1

Thanks,

-The Shoppe

#1 benefit to why HSA compatible plans are the plan to choose

Whether you are looking for health insurance coverage or are currently insured, the below link will take you to an illustration that will show how much one is to pay for a $10,000 hospital bill from 5 plans provided by BCBSIL.

HSA Plan Exposure Comparison

All 6 plans presented cover an annual physical and annual OB/GYN visit (mammogram and pap smear) under a $20 or $30 copay, even the HSA plan.

The first 5 plans will provide the same copay for additional office visits as well.  The HSA plan will not provide a copay and require you to pay the discounted amount of the visit towards the plan deductible.

Now onto the illustration....


The highlighted plan, being HSA compatible, is the lowest cost of the plans presented.  Not only is it the lowest in premium, but it also provides the least risk to the insured for a hospital expense as illustrated.

Now, if I compare the cost of the HSA plan to the first plan presented with the lowest deductible, the annual savings in premium is $793.  Since the HSA plan does not have copays, that amount in savings is more than enough to cover the cost of additional visits other than preventative.  Make sense?

Why should I pay an insurance company more premium for a plan that will cost me more at time of a large claim?????


As for the actual Health Savings Account (HSA)...This is a no-brainer.  HSAs can be opened at a local bank branch for free or for a $2-$3 monthly fee.  With the account, the IRS allows for an individual to deposit up to $3,050 for 2010.  The total amount deposited into the account, is taken as a above-the-line tax deduction, reducing your taxable income by up to $3,050.

Remember the account is optional.  In the presented illustration, the insured can pay for these expenses on a credit card or another payment other than the HSA.  Anytime before 4/15 of the following year, the insured can make deposits into the HSA for the amount spent, and then immediately withdraw as reimbursement.  This way, funds hit the ledger in order to take a deduction.

So...to sum it up, the one with the HSA plan will be able to take a 100% tax deduction on the total amount spent for the hospital bill, where as anyone on the other 5 plans would only be able to deduct if the expenses were greater than 7.5% of their total adjusted gross income.

Make Sense?

Please call the shoppe to learn more on HSAs.

Thanks!

-The Shoppe

For Clients and prospects on Medicare

CMS mailing to Medicare Beneficiaries: "Medicare and the New Health Law - What it Means for You"

Beginning Thursday, May 27, Medicare beneficiaries across the country should begin receiving a copy of the brochure “Medicare and the New Health Law – What it Means for You."
The mailing from the Centers of Medicare and Medicaid Services (CMS) outlines key provisions of the Affordable Care Act for people with Medicare as well as members of their families.
Some of the improvements that beneficiaries will see during open enrollment this fall and in the future, include:

• More affordable prescription drugs
• Important new benefits to help beneficiaries stay healthy. Starting next year, free preventive care services like colorectal cancer screening and mammograms, in addition to a free annual wellness visit.
• Better access to care
• Better chronic care
• New tools to help fight fraud and protect Medicare rights

For complete details, please review the brochure, available in English or Spanish.
If you receive a call from a member, advise them to contact member services. Please do not refer members to contact 1-800-Medicare for assistance. 
FYI - CMS sanctions for Aetna Medicare MAPD/PDP plans
As previously communicated, CMS imposed intermediate sanctions on Aetna suspending the enrollment of and marketing to new members of all Aetna Medicare Advantage and Standalone Prescription Drug Plan Contracts effective April 21, 2010.

Aetna starting to add dependents before new Health Bill begins on 9/23/2010

If you currently are insured with Aetna or know someone insured with Aetna...please share :-

If you have a dependent child between 19-26 years of age, that is not a full-time college student, Aetna is beginning to add children back on to your coverage prior to the mandate that takes effect on September 23rd, 2010.

Please call the shoppe to learn more about this immediate benefit.

Thanks,
-The Shoppe

NEW Cash for Cancer plan from Humana

The Health Insurance Shoppe has a new product to offer to accompany the purchase of a health insurance plan.

Humana has introduced there Cash for Cancer plan for a limited time in Chicago.  You can click the title of the this blog for a benefit highlight of the plan.

The Cash for Cancer is a plan that will give the insured a cash payout from $10,000 - $50,000 in increments of ten when the insured is diagnosed with a form of cancer.

The cash payout will help the insured to cover the cost of their health insurance plans deductible and out-of-pocket costs, along with expenses that are not covered by your health insurance, such as wigs that can cost on average $7,000.

The insured has the option of paying monthly premiums for 20 years or for life with a Return of Premium (ROP) option available for both methods.

If there is more than one insured, than the benefit becomes available to all members of the insureds family.

Below are a sample of rates for a 20 year premium period:

Male and Female, 30-39 years of age
$18/month for $20,000 lump-sum pay
$45/month for $50,000 lump-sum pay
Male and Female, 40-44 years of age
$24/month for $20,000 lump-sum pay
$60/month for $50,000 lump-sum pay

Family, 30-39 years of age (premium based on youngest spouse)
$32/month for $20,000 lump-sum pay
$79/month for $50,000 lump-sum pay
Family, 40-44 years of age (premium based on youngest spouse)

$42/month for $20,000 lump-sum pay

$105/month for $50,000 lump-sum pay

Please feel free to share this information with anyone you know, who might see this plan as a benefit to their current insurance portfolio.

The Health Insurance Shoppe has had family members effected  by cancer and understands the cost that can come with this awful disease, any form.  We see plan strictly as insurance against high costs that can accompany the diagnosis of cancer.

Please feel free to call or stop by the shoppe with any questions.

Thanks!

-The Shoppe

Are you a small business owner

Please share this to any small business owners that you know!

1. Effective 1/1/2010 small businesses with 25 or less employees with an average salary of $50,000 or less can receive a dollar-for-dollar 35% tax credit on the employers 50% share of premium currently being paid.
2. Effective 1/1/2010 small businesses with 10or less employees with an average salary of $25,000 or less can receive a dollar-for-dollar 35% tax credit on the employers 50% share of premium currently being paid.

This amounts to a large sum of money an employer can receive in a tax credit.

Please call the shoppe for more information.

Thanks,

The Shoppe

Our Purpose at The Shoppe

At The Health Insurance Shoppe our goal is to educate the consumer on their current or future health insurance benefits to make sure they are receiving the best possible benefit at the lowest possible price.

What do we mean?

We want to address consumers that currently do not have a HSA (Health Savings Account) qualifying plan.The Health Insurance Shoppe is a large advocate of HSA compatible health insurance plans and believes that these are the best available plans to Americans and cost the least in monthly premium.  Before we are to et into HSAs lets go over a traditional plan of health insurance.

Right now in the current private health insurance market it is very difficult to find a low deductible health plan such as a $500 deductible.  There are two carriers that offer one, Blue Cross and Assurant.  All remaining carriers begin at $1,000 and up.  The deductible is the amount of money that you must pay first before your insurance company is to begin paying a percentage of future bills.

The percentage the insurance carrier will pay is referred to as Co-insurance.  This is usually presented as 100%, 80%, 70% and 50%.  This # represents how much the insurance carrier will begin to pay after your deductible.  Your share is the remaining amount out of 100%.  The percent that you pay goes towards what is  referred to as your out-of-pocket (OOP) expense limit.  Once your OOP is met, the insurance carrier will then begin to pay 100% of further calendar year expenditures.

When you add the plan deductible and OOP together, you will get your true exposure in risk on  a large claim.  If there is more than one person on the plan, than you must multiply the plans deductible and OOP x 2.  Each member will have their own separate deductible and OOP to meet before the plan will begin to pay 100%.

Some plans might include pre-paid benefits such as office visit copay's and prescription drug copay's and a possible ER benefit.  Blue Cross and Blue Shield of Illinois is the only carrier that offers an ER benefit that will either cover 100% of the charges or waive the deductible and require you to pay your co-insurance of the bill towards your OOP.  All other carriers are going to slap a copay of $100 and require you to pay the whole bill as a deductible than OOP expense.

As far as office visit copay's, these will cover the cost if the initial office visit, not any additional lab work, x-rays or diagnostic tests that may be requested at time of visit. Please note that copay's do not apply to the plans deductible or OOP.  When you select a copay, you are automatically asking the insurance company to begin paying on claims.  The typical cost of an office visit for an Internist is usually $75-$125.  This cost is established for patients w/o health insurance.  If the provider accepts your insurance than you will receive a discount on the base cost.  Typically 30-40%.  So...if we discounted $125 x 40%, we would be looking at a true cost of $75.  With a copay, you would be paying anywhere from $20-$35 for this cost, and at the same time, you are paying 30-40% more in premium for this benefit.


Now, with prescription drugs, majority of carriers other than Blue Cross and Blue Shield of Illinois (must select $500 or lower deductible) will provide an upfront generic Rx copay than require you to meet a separate $500 or $1,000 deductible for Brand Name or Preferred Brand Name drugs, before you would begin to pay a copay.  Please note that Rx copay's do not apply towards the plans deductible or OOP.
If there is not a copay for prescription drugs on your plan, but with a benefit, the end cost (discounted rate) will be applied towards your plans deductible then OOP.

That pretty much sums up traditional plans of health insurance.

Now...when we talk about HSA qualifying plans, they are referred to as High Deductible Health Plans (HDHP) .  These are the only plans are regulated by the U.S. Government, and for 2010, the lowest qualifying deductible is $1,200 for an individual and $2,400 for a family.  The government also regulates how much risk you can be exposed to in a calendar year.  For 2010 an individual can not be responsible for more than $5,800 in exposure and $11,600 for a family.

HSA plans are usually presented with 100% coverage or 80% coverage.  At 80%, it might be more beneficial to look at a plan with copay's that will provide less risk than the deductible and OOP combined when looking at 80% coverage.

When their is more than one member on the plan, the deductible is a family deductible, and all expenditures are applied towards the one deductible, not separate, like traditional plans.

When looking at 100% coverage after the deductible, the premium rates are significantly lower than non-HSA
plans with the same deductible, and are providing 100% coverage after the deductible, rather than 80%.

HSA plans do not include copays for office visits or prescription drugs.  You will be responsible to pay for these expenses at the negotiated (discounted) rate towards your plans deductible.

However, HSA plans will cover your Preventative Care at either a copay or 100%.  So...their might not be a copay if you are sick and need to see the doctor, but there is one for your annual physical and OB/GYN for females.

Even while saving you money in premium rates and risk exposure, having an HSA qualifying plan, allows you to open up an actual Health Savings Account (HSA) at your local bank (some offer free-checking).  With this account, the money that you contribute into it can be used to pay for your deductible expenses and any IRS qualifying expense tax-free.  This method will only put more of your hard earned money back into your pocket.  The total amount of money that enters the account for the year, becomes an above-the-line tax deduction.

An individual has the opportunity to contribute up to $3,050 into the account, and a family can contribute $6,150 for 2010.  Any unused funds, roll over to the next year for additional contributions.

Please call the shoppe today to learn how you can benefit from HSA plans, and begin to start saving $ today!

You can learn more information by visiting my website, www.thehealthinsuranceshoppe.com

thanks,

-The Shoppe

Why HSAs plans are the way to go...w/o the actual HSA

What is an HSA compatible plan and why do I need one?


First, when The Health Insurance Shoppe recommends an HSA compatible plan, we are recommending the actual health plan design more so than the actual Health Savings Account (HSA) that you have an option of opening.


Traditional plan designs have 5 common elements:

• Plan Deductible
• The amount of money the insured must spend before the insurance carrier is to begin paying any portion of future medical expenses covered under the plan.

• Out-of-Pocket (OOP) Expense Limit
• This is the amount the insured must meet after their deductible before the insurance carrier is to begin paying 100% of remaining calendar year medical expenses covered under the plan.
• The OOP is paid by a percentage, your plan's coinsurance.  You either will pay 20%,30% or 50% after the deductible has been met, which is applied towards the plan's OOP.

• Office Visit Copay's
• Fixed dollar amount the insured must pay the provider at time of visit.
• Copay does not apply to the plan and will always be applied even if the plan is satisfied.
• Copay will only cover consultation and any vaccine or flu-shot that is given.  The copay will not cover any additional lab work, diagnostic tests or X-rays.  These are all deductible expenditures.

• Preventative Care
• This is a male and females annual physical (includes all diagnostic tests and lab)
• Females annual OB/GYN that includes an annual mammogram and papsmear
• Covered under a copay

• Prescription Drugs
• Depending on insurance carrier, plans may have copay's for prescriptions drugs
• If the plan has a copay, it will usually be for generic drugs and the plan will then subject the insured to a separate $500 or $1,000 Rx deductible for Brand Name and Preferred Brand Name drugs before a copay will begin to apply
• The copay will not be applied to the plan
• If the plan does not have a copay, the discounted cost of the prescription will be applied towards the plans deductible

HSA plan designs have only 3 of the above elements, Deductible, Prescription Drugs and Preventative Care.  There is no OOP because these plans are offered with 100% coverage after the deductible is satisfied.  Your preventative care will be covered at either 100% by the insurance carrier or under a copay, just like the traditional plans.

As for physician services (office visits) these will be applied towards your deductible at the discounted rate.

Prescription Drugs will be applied towards the plans deductible and then covered at 100% after.

Second, HSA plans are 30-40% lower in cost than traditional plans.  You can take the savings in premium and place 50% in your sock drawer, and you would have more than enough money to cover to office visits, when not having a copay.

Not to mention that if you decide to open the HSA you can pay for your medical expenses tax-free!!!

Please take a look at the attached link to view a comparison of an HSA plan and a traditional plan in an hospitalization scenario.

Hope this info helps in making a decision on what plan to choose when applying for health insurance coverage.

-The Shoppe