Texas Health Insurance

TEN EASY REFORMS TO COVER PREEXISTING CONDITIONS

2010-02-23T13:47:00.000-08:00

TEN EASY REFORMS TO COVER PREEXISTING CONDITIONS

Why choose individual insurance over an employer's group plan?

2009-11-06T12:46:00.000-08:00

There are many benefits to an employer's group insurance plan, especially large employers, but there are some cases where it makes sense to look at your options in the individual market.

Premiums - Employer subsidy

Employers are required by law to subsidize a minimum of 50% of the health insurance premiums for employees, however that requirement does not apply to spouses and dependents.

Often times it makes financial sense for the employee to accept the group plan, but if responsible for all of the dependent premiums the question becomes: "What is the best balance of benefits and budget for a particular family?"

Many employers do contribute towards spouse and dependent coverage, however in the midst of this difficult economy, some have had to reduce those contributions significantly or drop coverage entirely.

Premiums - Healthy Discounts

Group insurance cannot single out high-risk individuals, but those costs are factored into the total cost of the group plan and spread across all participants. At the same time, group insurance cannot single out healthy individuals either, which means they could be paying more for a group plan than they would in the private market.

In the private market, healthy individuals may qualify for healthy discounts or preferred ratings that otherwise wouldn't be available under a group plan.

Portability - Policy Ownership

Individual policies go with you regardless of employment status. Group plans are held at the employer level so if you leave the employer you leave your coverage behind.

Plan Design - Freedom to Choose

There are many individual carriers and plan types to choose from, however employers make broad-brush selections for the whole employee population. Individual plans are easier to customize and tweak, allowing people to tailor a plan for their specific needs and budget.

Qualification - Underwriting

Not everyone can qualify for individual plans. Each company underwrites slightly different, but there are certain "big ticket" conditions that are not well catered for, such as heart problems, cancer, diabetes and current pregnancy. Group plans absorb the risk with these conditions by spreading the cost across the entire group.

Advocacy

Individual plans are often purchased through licensed agents whose job it is to guide people to the right plan for them and support them throughout the life of their policy.

Group plans are normally presented once a year at Open Enrollment and then it's between the customer and the company to handle questions. HR departments, where they exist, don't always have the time or expertise to guide their employees through the intricacies of health insurance plans.

Ask yourself these questions:

Does anyone in my family have a significant health problem?
Am I completely satisfied with the insurance plan options and costs offered by my employer?

If you answer "No" to either question, then consult your plan options and determine how much it costs to cover your spouse and/or dependent. Then contact myself or another licensed health insurance agent who can help you navigate through the hundreds of options available to you in the private market.

You can also research individual plan options and get a quote on my website www.tailormadehealthplans.com

UniCare Individual Medical Insurance is exiting Texas

2009-10-29T09:50:00.000-07:00

UniCare is exiting the individual medical insurance market in Texas effective June 1, 2010. They have collaborated with Blue Cross and Blue Shield of Texas to allow customers to continue health insurance without the need to qualify medically for coverage with another carrier.

UniCare clients must accept the offer with Blue Cross and Blue Shield of Texas by December 1, 2009. Clients who miss the deadline or apply later will be required to qualify medically.

If you are a current UniCare client and have questions about what is best for you, please contact Tailor Made Insurance at 214-437-1410 or email amandawray@me.com

What you don't know about public health care reform!

2009-07-09T18:34:00.000-07:00

I am a licensed health insurance agent in the state of Texas. I want to express my objections to a government run insurance program ("public plan") under consideration as part of health reform legislation. I am also very concerned for the buying public that losing the value of a personal advisor via the health insurance agent/broker will significantly hamper the customers' abilities to identify the right products, to manage their own costs, and to personally assist them on claims and related issues.

The "Exchange" proposed is no substitute for a live person who is a state-licensed expert in health insurance. In the rural areas, we still go to the customers' homes when needed. For small employers, we ARE their "Benefits Department." My clients don't want to see me replaced with a toll-free number or a website link. Please vote against a health insurance exchange -- we are already doing the job much better!

I also urge you to oppose the government-run health plan and instead encourage our representatives to focus on reducing costs by eliminating unnecessary medical procedures, medical malpractice reform, simplifying and standardizing administrative processes, focusing on wellness, along with a variety of other valid options -- all of which I have seen discussed in the media. Though I have heard the rhetoric, there is no way that the insurance companies can "compete" with the government: since most of every dollar is spent on medical services -- and private companies are not allowed to dictate pricing to providers like the government does -- there is automatically a significant disadvantage for the companies.

And why does the government think it can run a large health insurance program, and be successful at it, when Medicare has $44 trillion in unfunded liabilities? And yet, the government pays much less than private companies already. If it had to operate like a private company it would be further in debt. Medicare was supposed to be self-sustaining too. There are simply too many negatives when it comes to increasing the government's role in health insurance.

I would hope that you would pause for a moment, reflect, and remember that there is a whole lot of needed, and non-controversial, reform to be implemented without either a public plan or an exchange. Later, IF we see those are needed, then we can have round 2 of reform. From my experience in this field, I do not believe we will ever need a round 2.

I have been disappointed and insulted to hear policy makers refer to agents as merely an unnecessary administrative expense. We fill a critical role for your constituents as stated above: providing personal service, timely objective information, guidance and accountability that is impossible to replicate through any other mechanism.

So please, let's allow the private insurers "make good" on all the concessions they have offered, keep the agents in charge of expediting suitable and affordable coverage for Americans, and pass responsible health care reform this year!

The National Health Care Debate

2009-03-24T20:38:00.000-07:00

Here's a red hot and wickedly controversial topic to stimulate water cooler conversations, if there ever was one! Not to be overly simplistic, but as an attempt to hit the high level issues, read on...

As always, with the advent of a new Democratic President, comes the conversation surrounding 'national health care/socialized medicine' plans. The GOP still favors a free market system of choice and tax benefits for responsible insurance policy owners.

Like with anything there are 2 sides to every tale. Here's a quick and dirty look at the issues.

Pros

1. Access - everyone can get medical attention and not see/fear that bill hitting the mailbox
2. No more wrestling with insurance companies - pre-authorizations, PPOs, HMOs, POSs, premium payments, annual enrollment etc.
3. You can show off that cool scar that you get from an emergency appendectomy after you pass out while waiting hours to see a physician (my fiance' is from Britain and he has the scars to prove it)
4. Honestly, I've run out of pros, please leave your comments and I'll be happy to add to this post!

Cons

1. Government runs USPS - imagine that kind of enthusiasm in your doctors and nurses!
2. Government runs Medicare and Medicaid programs - both have costs spiralling out of control, not to mention the fraud.
3. Taxation - this is not a no cost proposition - do you want to pay through taxes for a generic system or have freedom to choose how you're covered?
4. Other national systems - take Britain, Canada - it's FREE (or at least invisible through taxes) so it must be good, right? Riddle me this, why do those who can afford to opt to seek treatment abroad and/or opt into the ever-increasingly popular private systems growing in popularity in these countries.
5. Research & Development - with a public-run system there'll be no more money to continue to push the envelope in new and less invasive treatments. America leads the world in this regard - are we willing to give it up?
6. Control - the government would now dictate what medical attention and services you will receive. And you thought it was bad when the HMOs had that kind of power.
7. Look at the states in the Northeast that have adopted quasi-universal health care plans - look at budget projections! Now multiply across the nation!
8. Imagine a brain drain in the M.D./PhD community - these smart people will likely do something else - who does that leave us with?

Whichever camp you are in, there is no question that the system as it stands is broken. So, do you want to nationalize our health system, banks, railways, buses etc. and have your life dictated to you and a system wherein you are heavily taxed? Or, are you in favor of a free market system which offers freedom of choice, increased access, continued renown as the world's leader in medical advancement and government regulation that creates a standardized template for minimum requirements in policies?

At this time, it is unclear exactly where we're headed, be sure to make your voice heard with your representatives as to what you need to happen!

Short-Term Medical Insurance

2009-03-12T11:23:00.000-07:00

Short-Term Medical insurance - What is it? How does it work?

Short-Term Medical insurance was born to 'bridge a gap' in health insurance coverage that can typically be caused by or fall into one of these categories;

Loss of employment
Graduation from college
Awaiting activation of employer coverage
Early retirement

Basically, look at Short-Term Medical insurance as a mechanism designed to give you catastrophic insurance protection in the absence of other coverage. What it is not designed to do is handle your everyday health care needs. It is very common for a Short-Term policy to contain very strict provisions around 'pre-existing' medical conditions.

So, look for this coverage to fulfil two basic purposes;

Offer you protection from an unseen illness or injury
Assist you in maintaining 'creditable coverage' so that you can enter your next permanent policy without having a break in coverage that would result in your being subject to a 'pre-existing' clause.

Short-Term Medical insurance is very simple from an application standpoint with very limited medical questions for qualification. It is also very much an affordable option when compared to typical COBRA premiums. However, there can be times, when 'pre-existing' is a big issue that it makes sense to retain and pay for COBRA continuation.

Our Addiction to Co-Pays

2009-03-09T16:02:00.000-07:00

It may sound funny, but it's true, especially for those who are accustomed to employer sponsored group coverage. I too was addicted to co-pays before I took the time to really understand and take ownership of my health insurance.

At 19 I worked for a small business that did not provide health insurance and like most young adults, I didn't think I needed it either. Then I developed a nerve problem in my foot and had to see a podiatrist. That was my first experience with the full cost of a specialist's office visit. Gone were the days of my parents' health insurance with a $1.00 office visit co-pay!

My next job was for a very large company with great benefits and I can clearly remember reviewing the health insurance coverage and marveling at the $10 office visit co-pay. I just pay the monthly premium, subsidized by my employer of course, and I can see the doctor as many times as I want. A nasty paper cut? No problem! I was still young and had no idea how health insurance actually worked.

For many years I had what I thought was the luxury of co-pays. That peace of mind of knowing that I could see my doctor at any time was important, I thought. I never actually saw a doctor for that paper cut, or for much else in reality. But I could if I wanted to!

Years later, I spend an awful lot of time trying to help my clients break the habit and give up the addiction to co-pays. Not without conquering my own addiction, of course.

Several years ago I was introduced to High-Deductible plans. At first it was hard to wrap my head around, but I've always loved math, so I put the numbers to a test. I could save roughly $1,200 per year in premiums just by giving up my co-pay? That's a lot of office visits! At $100 per visit, I could see my doctor once per month before the other plans started to make sense. Why was I paying higher premiums all of these years? For the peace of mind of knowing that I could see the doctor at the first sign of sniffle for the price of a movie ticket?

Once I better understood how my health care costs were calculated, I decided to take ownership of my health insurance coverage and manage it like a business. When you look at it objectively, you can remove some of the emotion and feeling that play into what you think you need in health insurance coverage and focus on what you do need.

Do you really need the peace of mind of a co-pay if it costs you $1,200 more a year in premium? Or would you be better off setting that money aside each month in a savings account? Better yet, a Health Savings Account (HSA) that allows you to save money tax free!

The bottom line is that health insurance exists to minimize your risk if you develop a major illness or become seriously injured. Do the math! Or, ask a licensed agent how you can save money on your health insurance!

COBRA Subsidy

2009-03-04T17:05:00.000-08:00

On February 17, the American Economic Recover and Reinvestment Plan Act became law. In addition to other spending and stimulus measures, the law provides temporary subsidies to involuntarily terminated workers who enroll in COBRA or state continuation coverage (where required by state law).

While this program may be beneficial to some, there will be many others who will find better value in an individual medical or short-term major medical plan. This is an opportunity to help my clients compare costs and determine the most accurate and cost-effective solution for them. Some may be pleasantly surprised at how affordable an individual or short-term plan is, even when compared to the subsidized-COBRA options.

COBRA Subsidy Information

Subsidy details:

The subsidy provides qualified enrollees with a 65% premium discount for up to nine (9) months for coverage beginning on or after 3/1/09.
Individuals may be required to pay the full amount for the first 60 days of coverage. If an individual has paid full premium for a period during which the subsidy would apply, the excess premiums will be credited or refunded to them.
Reimbursement to employers or insurers who accept reduced premiums from subsidized indviduals will be made through an offset to employer federal payroll taxes.

Eligibility:

To qualify for the subsidy, an individual must have been involuntarily terminated from employment between 9/1/08 and 12/31/09.
If the employee had family members covered under the group health plan while employed, the dependents would also be eligible for the subsidy and special enrollement periods (see below).
Subsidy eligibility is reduced or eliminated based on the taxpayer's modified adjusted gross income (AGI). Individual filers whose AGI exceeds $145,000 and joint filers whose AGI exceeds $290,000 are not eligible. Reduced subsidies begin at $125,000 for individual filers and $250,000 for joint filers.
Employers and insurers must provide notice regarding the subsidy to individuals and others whose employment terminates between 3/1/09 and 12/31/09.

Special enrollment for previously terminated employees:

The law provides individuals who lost coverage on or after 9/1/08 another chance to enroll for continuation coverage. During a special enrollement period, qualified individuals who lost or did not elect continuation coverage may elect to enroll. The subsidy will not apply retroactively for coverage prior to 3/1/09.
Employers and insurers must notify previously terminated individuals of the special enrollment period.
Notices of the special enrollment opportunity must be mailed by 4/18/09. Qualified individuals must enroll within 60 days after the notice.

It's important that everyone understands the facts in order to evaluate their own personal situation. In a world of challenging, important decisions, health insurance ranks highly but also tends to be one of the more frustrating selections we make. My job is to try to simplify this decision for clients by explaining fully the programs available, their benefits, costs and relative value to their specific situation. All too often we get caught up in what we think we need, not what we actually do need.

Note: This information is provided as general guidance to the Act and is not intended to be legal advice.