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

If you have recently applied for health insurance...beware

If you have applied for health insurance coverage with an effective date after 3/23/2010 and before 9/23/2010 than this blog may be important to how your plan is effected with the new health care bill.

Right now, as everyone knows from media, a child less than 19 years of age can not be declined coverage or have any exclusions on pre-existing medical conditions.

This law is to take effect on 9/23/2010.

If you have applied as a family between the dates mentioned and have had a child declined coverage, you will not be able to add your child back onto your policy until 1/1/2011.

The reason is that any health insurance plans issued with an effective date between 3/23-9/23/2010 are grandfathered into the plans previous provisions after the law was passed on 3/23 and prior to the enactment on 9/23.

Please call the shoppe with any questions on the new health care bill.

Thanks,

-The Shoppe