How the bill relates to someone with a pre-ex medical condition

Effective 7/1/2010:

• Children under the age of 19 can not be declined coverage for a pre-existing medical condition when applying for private health insurance such as BCBSIL, Humana and Aetna

• When between 19-26 years of age a "dependent" will be allowed to join their parent's plan of health insurance
• If the parents can not afford the premium for the addition of their dependent, than coverage can be denied based on pre-ex in the private market

• If you are above 26 years of age and have a pre-ex, coverage can still be denied or offered with an exclusion rider on the specific medical condition and treatment
• Illinois has had the Illinois Comprehensive Health Insurance Plan (ICHIP) in place for a long time.  This is the high-risk pool for the un-insurable in Illinois
• What the bill is providing, is more state high-risk pools such as ICHIP

Hope this helps with the confusion out there!

-The Shoppe

FPL percentage calculator

Please click on the below link to determine your FPL percentage:

http://www.safetyweb.org/resources/misc/fplcalc.asp


-The Shoppe

Are you a small business owner with less than 25 employees?

Are you a small business owner with less than 25 employees?

Well...here is what you can begin to see if you currently offer health insurance coverage or are thinking on offering coverage in the near term:

Beginning in 2010-2013

• Employers with 25 or less employees with an average annual income of $50K amongst their employees will begin to receive a 35% tax credit on their 50% minimum contribution to their current premium

• Employers with 10 or less employees with an average employee income of $25K will receive a full tax credit on their 50% contribution in premium sharing

• ***Tax exempt small business's meeting the above requirements will be eligible for tax credits of up to 25% of the employers contribution toward the employees health insurance premium.

Starting on January 1st, 2014

• Employers with 25 or fewer employees who purchase coverage through the "exchange" will receive a tax credit of 50% on their 50% contribution of the employees premium

Hope this helps clarify some questions...

-The Shoppe

What the bill means for someone who can't afford coverage currently

If you are currently want health insurance coverage and are unable to afford health insurance right now, you may be able to qualify for Medicaid.

In 2014, Medicaid will be expanded on a larger income index scale.

For now, the qualifying limits for Medicaid are:
-Income not exceeding 133% or more of FPL
-$14,404 or lower for individuals
-$29,326 or lower for a family of four

In 2014 you can see the Medicaid expansion to the following income levels:
-Incomes between 133-400% above the FPL
-$14,404-$43,320 for individuals
-$29,326-$88,200 for a family of four

When this comes into play you will receive subsidy from the government to afford a private health insurance plan or a better plan than what your current employer might offer.

Hope this helps!

-The Shoppe

Mandate in having to have health insurance coverage

In 2014, it will be mandated that every American be required to carry health insurance coverage.  When 2014 comes around and you are not currently covered by insurance...this is what will one will incur if they choose not to be covered:

Under the legislation, most Americans would have to have insurance by 2014 or pay a penalty. The penalty would start at $95, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. This is an individual limit; families have a limit of $2,085. Some people would be exempted from the insurance requirement, called an individual mandate, because of financial hardship or religious beliefs or if they are American Indians, for example.

Blue Cross and Blue Shield of Illinois eligibility on common medical conditions

Please click on the below link to view how Blue Cross and Blue Shield of Illinois will treat common medical conditions at time of application.

http://docs.google.com/fileview?id=0B4K7vlwJ6AOqOTI0ZWQ4OWMtY2YwOS00NzBiLWI5MDYtMDEyN2Y0NjgyMzll&hl=en

Please call the shoppe with any questions!


-The Shoppe

What last night means for local readers...

Well the Democrat's could not be any more excited about what happened last night.  Not one Republican voted for the House Bill.  Still...the bill must go through the Senate where changes can be made.

As of now, what you will notice in the near future of 2010 after the Bill is enacted is:

• A dependent child can be covered up until the age of 26, no matter what their current education status is. (this was enacted in Illinois in July of 2009)
• Private insurance companies can not decline coverage for children (17 and under) based on a pre-existing medical condition.
• Individuals with income below $14,400 annually (133% of FPL) or $29,327 for a family of four can begin to receive subsidy to buy private health insurance.

For those who are 18 years of age an older and are being declined coverage for a pre-existing condition or having an exclusion rider on that specific condition will not see change until 2014.

What is going to happen until 2014, is that states are going to create high risk pools of insurance for those who are uninsurable.  Right now, the State of Illinois, already has one in place called the Illinois Comprehensive Health Insurance Coverage (ICHIP) plan.

Feel free to call or stop by the shoppe to learn more.

-The Shoppe

Your taxes must be filed by the 15th of April. Were you able to take a $3,050 or $6,150 deduction for your 2009 Medical Expenses?

For those of you with your own private individual or family major medical health insurance, this blog is for you!

• Do you currently take prescription medications for daily or monthly treatment?
• Do you currently take a brand name birth control prescription medication (YAZ)?
• Do you currently have anxiety or depression and take maintenance medications?
• Do you currently have Asthma that requires prescription medication (inhaler)

Well...if so...how do you pay for these prescriptions?

a) copay

b) separate Rx deductible of $500 or $1,000 before you receive a copay for a Brand Name drug

c) final discounted cost of prescription is applied towards deductible

If you answered "a" or "b", than the money you pay in a copay does not apply towards your plan, nor does the separate Rx deductible.  This applies only for Rx, not medical.

If you answered "c" then you must ask yourself, is your current plan compatible with a Health Savings Account? If not, than you need one!

No matter your employment status, in order to take a deduction on your medical expenses, the total # must exceed 7.5% of your Adjusted Gross Income (AGI)....unless your health insurance plan is compatible with an HSA.

If your insurance plan is compatible, than as an individual you can contribute up to $3,050 or $6,150 for family coverage into the HSA.  The money contributed into the HSA can be used to pay for or reimburse qualified medical expenses, such as your deductible, prescription drugs, dental, vision...you name it!

Any funds remaining in the account at the end of the year, roll-over to the next for additional contributions.

And if you answered "yes" to the initial questions, than that cost of medication would be applied towards your plans deductible then covered 100% for the remainder of the year (copays will always remain even if the deductible and out-of-pocket) have been met.  Having the cost of the prescription medications applied towards the deductible will only lower your responsibility at time of an accident or illness.

Not to mention, at the end of the year, you will be taxed on less money.

Please call or stop by the shoppe to learn more about the savings with an HSA.

-The Shoppe

Comparison of benefits on a small business consisting of 12 employees

Are you paying a high amount for health insurance coverage for your employees?

If you have 12 or less full time employees please read below about the benefits of an HSA or HRA.

When quoting a new business of 12 employees with Humana in the city of Chicago, below are the rates for two types of coverage:

                                     Humana Traditional                Humana HSA

Monthly Premium                     $7,641                                   $5,949


Employee Only cost                    $365.62                                  $283.29


Employee + Spouse                    $800.77                                   $623.33


Employee + Child                       $690.98                                  $538.24


Family                                           $1,112.13                               $878.19




Plan deductible                           $1,000                                      $2,500


Plan Out-of-pocket                     $2,000                                      NONE


Total Risk Exposure                   $3,000                                      $2,500


Preventative Care                    covered 100%                    covered 100%


Office visit copay                       $20/$40                        applied towards ded.






With employer provided coverage the employer is responsible for at least 50% of the employee only rate.  IF you were to take the rates provided at 50% paid by the employer, the HSA would be saving an annual amount of $5,928, or $494 per employee.  The HSA plan provides a lower exposure on a large claim, making it a better benefit for the employee.


If the employer were to retain the money and pay out only as claims came in, chance are he could see a 30-40% savings, reimbursing employees for claims then paying the money directly to the insured.  Also, the employee would see the same amount of savings.


If you pay more than 50%, than the savings will only be greater.


Please stop by or call the shoppe for more questions.


-The Shoppe

How to solve the high cost of small group health insurance!

Are your health insurance premiums for your small business getting to costly?  Are you waiting for the government to reform health care and lower your cost?  Why wait...you can begin saving substantially now with HSA qualified high deductible health plans.

How much can you save?  15-60% off your current costs


Is there a reduction in benefits?  No, but you can see an increase in benefits


If you currently have a health insurance plan that includes office visit copay's, emergency room visit copays and prescription drug copays...we will want to remove them.  This is the main factor in the high cost you currently have.

Most likely you have a $1,000, $1,500 or $2,500 deductible at either 90% or 80% coverage after the deductible for an additional $2,000-$6,000 per insured in out-of-pocket expenses before the plan will begin to pay 100%  Just with the lowest of the options, you would be looking at $3,000 ($1,000 ded + $2,000 OOP) in exposure before the plan would begin paying 100%.  And...if there is more than one member on the plan, than the above applies for each additional member.  Adding even more exposure when there is more than one insured (husband and wife or family).

When you implement an HSA plan you will have deductibles beginning as low as $1,500 then $2,500 and $3,500 with 100% coverage after the deductible.  When there is more than one insured, the deductible is doubled, but is aggregate between more than one member.  This means that if one insured were to satisfy the deductible on their own, than coverage will be paid at 100% for all remaining members.

HSA plans will provide 100% coverage for annual preventative and wellness care.

Any additional office visit is subject to the plans deductible at the negotiated rate of service.  If there is a copay, then that amount does not apply to the plan.

In going this route, you and your employees will see savings in the portion of premium being paid, reducing the cost on the both sides.  Now, since you are saving a substantial amount of money now, and on future renewals, the concept is to take a portion of the savings and either give it back to the employees through an HSA contribution (employee owns the contribution) or you can set up a Health Reimbursement Arrangement (HRA).  With the HRA, you, the employer would retain the savings and then define a contribution that you are to give to your employees for re-imbursement of medical expenditures.  Going the route of an HRA, the employer will retain the savings until a claim comes in.

Now, with the plan not having any copays, your employees might be weary.  If you were to define a contribution of $500 in the HRA, then the employee would not be concerned if they do visit the doctor, since the first $500 in claims will be on the employer.

Going both the route of an HSA or HRA is retaining money that you would be paying an insurance carrier for pre-paid benefits that rarely get used.

If you have questions about HSAs or HRAs, please call or stop by the shoppe!

-The Shoppe

What is Preventative Care / Wellness Care?

Preventative Care and Wellness Care are the same.

For males: this will be your annual physical and any preventative lab work or diagnostic tests that are done on the same day in relation to your physical  For males of an older age, this would include a PSA or a colorectal exam.

For females: this will be your annual physical, annual OB/GYN visit that includes your mammogram and pap smear.

Getting these exams annually is going to lower the risk of illness or disease in the near or distant future.

These benefits are going to be included in every private individual or family health insurance plan.  Depending on the insurance carrier you might see the following benefits:

• covered under a $20 or $30 copay up to $500 in maximum benefits paid annually.
• covered at 100% after a 90 day waiting period, up to  $300 in maximum benefits paid annually.
• covered at 80% after a 90 day waiting period,up to  $300 in maximum benefits paid annually.
• NOT COVERED...their are local clinics that charge $0-$75 for this benefit.
• covered up to $500 or $1,000 in maximum benefits that is applied towards plan deductible.

For those with employer provided health insurance coverage, this benefit is covered at 100% and not subject to a copay.

Hope this helps..

-The Shoppe

Prescription Drug Coverage with Health Insurance

Do you currently take prescription medication and are without health insurance?

If so, here is how prescription drug coverage is offered through various Illinois health insurance carriers.

Blue Cross and Blue Shield of Illinois only offers a $10 copay for generics on 3 of their plans offered.  Brand and Preferred Brand name drugs will be paid at a percentage by the insured, usually 35-50%.  All other plans will require you to pay the discounted (when pharmacy is in carriers network) price that is applied towards your plans deductible or out-of-pocket expense.


Majority of Aetna's plan's offer an upfront $15-$20 copay for generics, then will subject the insured to a separate $500 or $1,000 deductible before Brand or Preferred Brand name drugs are subject to a copay of $30/$40 that are not applied to the plan.


Humana, Celtic, United Health Care and Assurant have similar Rx benefit schedules to Aetna's.


Some carriers will only offer a discount on Rx,  not applicable to the plans deductible or to the plan itself.  Going this route will save substantial money in premium.  Not recommend for someone who takes a Brand Name drug routinely.

Hope this helps!

-The Shoppe

Just laid off? Looking for a quick fix for your COBRA cost's?

Were you just laid off?

Currently looking for new employment with health insurance benefits?

Stop by The Health Insurance Shoppe to learn about Humana's new Short Term Medical health insurance plans that can be purchased for up to one year, one a month-month payment basis.

These plans are going to be the lowest cost available option for accident or illness coverage.

These plans are not meant to cover any pre-existing condition.

Call or come by to learn more.

-The Shoppe

The Purpose of The Health Insurance 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

The breakdown of a typical health insurance plan design

For those with health insurance currently....Let the shoppe ask you a question.

What is your deductible?  If it took you longer than 10 seconds to come up with a "maybe" response or no response at all...then read below.

Every plan of health insurance will have two key common components.  A deductible(1) and out-of-pocket(2), which when combined, equal your true exposure to risk in a calendar year.

The Deductible is the amount of money that you must spend before the insurance company will begin to pay a percentage of further claims.  Please note that the final costs you pay towards the deductible are on the negotiated rate of service between the insurance carrier and provider.

The Out-of-Pocket (OOP) is the remaining amount that you must pay after the deductible before the insurance company will begin to pay 100% on future claims for the remaining calendar year (Jan 1st - Dec 31st).  Your OOP is paid at a percentage cost share between you and the insurance company.  A common percentage is 80/20, with you, the insured paying 20% until you reach your maximum OOP.

When there is more than one member covered under a plan, each member will have their own separate deductible and OOP.  An example would  be a couple who are covered under one policy, and one member was exposed to a hospital claim that satisfied his deductible and OOP.  Under this, they would receive 100% coverage the remainder of the year, but their spouse would still be subject to their own deductible and OOP.

So...you would want to multiply the plan benefits by the amount of members in your family, to get the true exposure.



-The Shoppe

Taking a deduction on your medical expenses for 2010

Were you able to deduct your 2009 medical expenses:

• deductibles
• out-of-pocket
• prescription drug costs
• dental
• vision
• contacts, frames
• contact solution
• Physical Therapy
• Therapy

If you were not, learn how to for 2010 with a HSA qualified plan.

Stop by the shoppe or call to learn how!

-The Shoppe

If you are waiting for the government to solve your health insurance costs, Don't!

Why wait until 2018 for the government to help in the cost of your health insurance.  Start today with an HSA (Health Savings Account) qualified plan.

These plans can significantly lower your total premium costs, 30-40%, and also lower your exposure on large claims, without a reduction in benefits.

Stop by the shoppe today or call for more information!

-The Shoppe

Looking for dental insurance in Chicago...

The Health Insurance Shoppe has recently been receiving a lot of phone calls as of late on dental insurance.

Dental Insurance can be a little tricky in obtaining in the individual and family market.  Currently, only 1 insurance carrier out of the 6 we represent offers dental insurance by itself.  All other insurance carriers offer the benefit when you apply for their major medical health insurance plan.

If you currently have your own private insurance without a dental benefit, you will 99% of the time be able to request to add it on at the time of your health insurance policy renewal.

If you are currently uninsured or insured, Aetna, offers a stand alone dental plan.  In Chicago, for someone less than 50yrs of age, it would cost $37.99/month and for over the age of 50, it would run $50.61/month.

For this monthly premium your diagnostic and preventative (xrays and annual and semi-annual cleanings) will be covered 100% with no waiting period.

There will be a 6 month waiting period for:

• Periodontal cleanings------Plan pays 80%
• Denture Repair-------Plan pays 80%
• Fillings-------Plan Pays 50%
• Oral Surgery------Plan pays 50%
• Endodontics (root canal)------plans pays 50%

There will be a 18 month waiting period for:

• Periodontics-----Plans pays 50%
• Crown and cast restorations-----plan pays 50%
• Dentures------Plan pays 50%

The plan will only pay their percentage until it has reached a maximum benefit of $1,200.

Feel free to call or swing by the shoppe.  The Shoppe is OPEN!

NEW Humana Short Term Medical Plans

Humana has entered the Short Term insurance market within the past month month and is the only insurance  carrier that does not ask the question if you have been "declined" for prior coverage.  Until now, if you were, short term coverage could not have been offered.


So....this means that anyone who has been declined coverage and is currently left uninsured...there is an option!!


With Humana's new plans, there are only three medical questions asked, and coverage is only offered if you can answer "no" to all 4 medical questions:

1. Is any immediate family member or the proposed insured pregnant , an expectant parent, in the process of adopting a child or undergoing current fertility treatment?
2. Have you or spouse been residing in the U.S. for less than 6 months?
3. Are you or spouse over 300lbs if male, or over 250lbs if female?
4. For any of the following conditions, has any of the proposed insureds received, in the past 5 years, any:
• abnormal test results
• medical or surgical consultation
• treatment or advice
• consulted a health care professional
• or taken medication for..........
• DIABETES / EMPHYSEMA / CANCER OR TUMOR / STROKE / HEART DISORDER INCLUDING BUT NOT LIMITED TO HEART ATTACK OR CHEST PAIN / KIDNEY DISORDER / ALCHOLISM / DRUG ABUSE / AIDS

As long as you can answer "no" to all 4 questions then coverage can be issued as soon as the following day.  You have the option of purchasing coverage for:

• one month
• month-month up to 6 months
• month-month up to 12 months

These plans are not meant to cover pre-existing medical conditions (ADD,ASTHMA,HBP,ANXIETY...), but are there to protect against risk on a large claim due to accident or illness.

Plans are offered with 80% or 100% coverage after the deductible and begin at $80/month for a $2500 deductible with 100% coverage after.

G*d forbid, you were to be hit by a car, brake your leg, fall down the stairs or even have an emergency appendectomy, you would only owe $2500 on claims grossing more that $15,000.  That sounds like a bargain to the shoppe.

Click on the link to quote.

-The Shoppe