Individual/Family Archives - Page 5 of 6

Not-So-Special Enrollment Period

June 8, 2020/in Affordable Care Act, Individual/Family/by ARC Benefit Solutions

Many people have found themselves in a very trying and unfamiliar situation. After being laid off or experiencing a company-wide shut down, many are finding themselves without health insurance for the first time in their lives. As you embark on your new journey into the unfamiliar world of individual health insurance, there is a lot you will need to know. Here is the “who,” “what,” “when,” “where,” “why,” and “how” of the individual market to try and help ease the stress level.

Who will need coverage going forward?

Can members of the family go onto a spouse’s plan that is still employed? In cases of a split family, can the children go onto an ex-spouse’s plan? Does anyone have any conditions that may limit the plan types you may want to consider? Now that we know who is going to need the coverage we can move on to the next step.

What type of plan will make the most sense for my family and me?

One plan type will not fit everyone. Have you been laid off, but know you will be returning to the same job? Are you considering early retirement? Do you really not know and are unsure, but know you need coverage? With a change of income, will you be eligible for a tax credit? Will you be comfortable with pre-existing conditions clauses or plan limitations? What type of deductible and copays would you feel comfortable with? These are all things that will have a bearing on which type of plan you will want to consider.

A short-term plan, for example, may work for a healthy individual or family, especially if they know they may only be laid off for a short period of time. The short-term plans will have underwriting questions and pre-existing conditions clauses. Some may want the comfortability of copays and prescription coverage and others will be eligible for a tax credit to lower the monthly premium. Remember you want your plan to fit your needs.

When will you need your plan?

Did your coverage end immediately at the end of employment? Does your coverage run through the end of the month? This is a very important question. Affordable Care Act (ACA) plans can only start on the first of the month, while short-term plans can start next day if you get through underwriting. If you lose coverage on the tenth of the month, you may want to look at a short-term plan for the rest of the month then an ACA plan starting at the beginning of the next month. If you know ahead of time, try to be prepared. This is not always possible, but you want to try to avoid a gap in coverage if at all possible.

Where would you like to be seen?

Get a list of your doctors and preferred hospitals together. Unlike the employer benefit plans you may be used to, individual plans have narrow networks that may align with as little as one hospital group. If you have a doctor or doctors that you do not want to lose, you may want to prioritize your list to make sure you get the most important doctors covered on the plan you pick. If you have any non-generic medications, you will also want to check the plan’s drug formulary to make sure your prescription is covered.

Why do I need the health insurance?

You may plan on being back to work in a month or two. You may think, I only go to the doctor once a year so I can go without coverage for a while. The average cost for a single day in the hospital is $3,949. The average hospital stay is $15,743. It is a big risk and with the rising cost of services, going uncovered is not an option.

How do I get the new coverage?

Depending on the type of plan you choose, there are different avenues to getting coverage. A plan with a tax credit must be purchased through the Marketplace at Healthcare.gov. ACA plans are sold through the Marketplace, but a few carriers offer private plans that do not have a tax credit. The short-term plans are available directly through carriers, so you can visit their websites or call the sales department. However, the easiest way to ensure you are choosing a plan that suits your needs and budget is to work with an insurance agent. We help clients in your situation every day and we can help you find a plan that simplifies your life.

Remember, you need to feel comfortable with your plan and the premium. It’s really no benefit to you if you can’t afford the plan you pick or if you’re not getting the coverage you need. Try to purchase what you know you will use. If you go to the doctor once a year, for example, consider what you’re getting out of the plan versus what you’re paying. The goal should be balance and comfort. Remember, just because someone else says they found a great plan that doesn’t mean it is right for you. Do your homework and use the “who,” “what,” “when,” “where,” “why,” and “hows” to help narrow down your choices to get to the right plan.

ARC Benefit Solutions’ licensed sales agents are prepared with the expertise you need to make an informed decision about your health insurance during this uncertain time. Our experts have an average tenure of 17 years and work every day to help clients just like you find plans that work for their situation and their budget. Contact us today to get started.

Did You Recently Lose Your Job? You Have Health Insurance Options!

May 11, 2020/in Employee Benefits, Individual/Family/by ARC Benefit Solutions

Recently, many workers have lost their jobs from massive layoffs due to the coronavirus. According to a report from the Labor Department, the U.S. lost a staggering 20.5 million jobs just in April. Job loss means more than just a loss of a paycheck. Many workers who are recently unemployed are now also faced with the question: What about my health insurance?

It’s scary to lose something as important as health insurance in the midst of a pandemic, but don’t worry, we’ve got you covered. There are a number of health insurance options available to you on the market, including…

Consolidated Omnibus Budget Reconciliation Act (COBRA)

If an employee loses their job or experiences a reduction in their work hours, COBRA could be a viable health insurance option for both the employee and their dependents. An individual who has lost their coverage and is eligible for COBRA coverage will be offered the same coverage as an active employee. You will be given a 60-day election period to choose whether or not to continue coverage. If you decide waive COBRA, you can change your mind as long as it is within the 60-day election period.

An individual that selects COBRA will be able to continue with their same physicians, health plans, and medical network providers. Beneficiaries can also continue with coverage for pre-existing conditions and prescription.

However, the downside of COBRA is the high cost. Because the employer will no longer pay a portion of the premium, the entire cost is totally on the insured. COBRA coverage is also usually limited to between 18 and 36 months. If the employer decides to discontinue COBRA, then the employee and their beneficiaries will no longer have coverage.

The Affordable Care Act (ACA)

ACA plans are designed to make guaranteed issue health insurance plans available to everyone. These plans cover pre-existing conditions, along with essential health benefits that will not change from plan to plan. When applying for an ACA plan, you cannot be denied coverage even if you have pre-existing conditions.

The ACA has established an open enrollment period for individual health insurance. If you miss the open enrollment period, which runs from November 1 through December 15, and you have a qualifying event you will be able to enroll with a special enrollment period. Life-changing events like marriage, divorce, moving, having children, and losing a job are all considered qualifying events that will allow you to enroll during a special enrollment period.

Many who apply for ACA coverage also qualify for a tax credit, which is based on the annual income and the number of people in the household. This tax credit can reduce the monthly premium of the ACA plan that they want to enroll in.

Short-Term Health Insurance

Short-term medical plans are different from the ACA plans in that you will have to go through underwriting and it will not cover anyone with pre-existing conditions. If you meet the criteria for short-term plans, you may have coverage very quickly and the premiums are often much lower. To learn more about the differences between short-term and ACA coverage, click here.

Short-term medical plans are designed to cover you for an unexpected illness or injury. You should know that a short-term plan will only cover you for 30 days to 12 months. This would give you time to enroll in an ACA compliant plan at open enrollment. Be aware that having a short-term medical plan does not meet the health insurance requirements of the ACA Plans.

Losing a job can be scary, but you don’t have to make these decisions on your own. ARC’s licensed health insurance agents are readied with the information you need to make an informed choice about your health care coverage in between jobs. Contact us today for a free consultation.

Resources

FAQs on COBRA Continuation Health Coverage for Workers (Department of Labor)

What is Health Insurance? (Investopedia)

Unemployment Numbers ‘Will Get Worse Before They Get Better,’ Mnuchin Says (NPR)

Why We Need Health Insurance, Especially Now

April 14, 2020/in Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

COVID-19 has taught us the importance of securing proper health insurance. Financial planners and other experts have emphasized the need for health insurance for years and many Americans have taken heed, yet some still do not prioritize purchasing adequate coverage for themselves or their families, citing expensive premiums and deductibles, a lack of access to preferred doctors, or the notion that they “never get sick.” Yet, financial hardship related to medical expenses affected almost 137.1 million Americans in 2018, according to the Journal of General and Intermedicine.

This hardship may be even greater for those without insurance who have been hospitalized over the last several weeks due to COVID-19. Budgeting for health insurance should be given as much consideration (if not more) as purchasing a vehicle, starting a mortgage on a house, or even planning a wedding.

Let’s take a moment to re-examine some pertinent reasons for buying health insurance:

Insurance companies are waiving COVID testing and even treatment in some cases.

Most, if not all, health insurance companies have decided to waive the cost for COVID-19 testing. In these cases, a member will not be charged their deductible or a copay to find out if they have the virus. Some carriers went further and stated that they will even cover treatments a member needs, like an office visit to their doctor (in person or virtually) or a trip to the emergency room. Not having coverage during this pandemic could lead to catastrophic financial losses if one is uninsured.

Avoiding general financial hardship and bankruptcy.

The 2018 statistic above estimating that nearly one-third of the country faced medical financial hardship is astounding. Further, a study from 2001 in five states found that just above 45 percent of all bankruptcies were related to a medical problem. Dylan Roby, associate professor of Health Services Administration at the University Of Maryland School Of Public Health, says “A cancer diagnosis, car accident, or even a broken leg can cost thousands of dollars out-of-pocket.”

Many Americans do not have several thousands of dollars saved up to face the challenge of even one major health incident. Even with health insurance, they would still face some high costs, but not be subject to the devastation of having no coverage at all.

Early detection of illness.

Many employer-based insurances or individual plans through the Affordable Care Act cover quite a few preventative services (often covered at 100 percent) to help members become proactive about their health. The hope here is to eliminate the fear of high costs from doctor visits and possible diagnosis of a medical issue. Pre-emptive measures taken to discover potential diseases early on can lead to better chances of successful treatment with lower costs compared to the expenses for treatment methods for advanced illnesses .

The landscape of health insurance may look drastically different after the upcoming 2020 presidential election, but right now our society may need to have a mentality shift towards health insurance, with more of us giving it a higher priority in our budgets than we once did. College students, though mostly young and healthy, will want to make sure they have health coverage through their school or individually, as this expense should be taken into account as much as tuition, books, rent, and other costs. Those looking for employment will need to give strong consideration to companies that offer group health insurances versus ones that do not. Those considering self-employment will need to evaluate the risks of purchasing individual coverage, as this market may create more out-of-pocket exposure compared to working for an employer and having group coverage.

All in all, if most of us decide to buy health insurance, collectively, we may be able to reduce some health care costs for everyone and give more access to care for those who need it, especially in these uncertain times.

Resources:

https://www.investopedia.com/articles/personal-finance/120815/dont-have-health-insurance-whats-worst-could-happen.asp

https://www.amjmed.com/article/S0002-9343%2809%2900404-5/pdf

What is Telemedicine and How Can I Use It?

March 31, 2020/in Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

Telemedicine is a cost-effective and accessible option that involves electronic communication and software to provide clinical services to patients without an in-person visit. Many people opt for telemedicine because it can be done from the comfort of your own home or anywhere else like work, vacation, the park, etc. You do not have to bring yourself or your children in contact with illnesses that you may encounter at the doctor’s office.

Moreover, every physician you see using telemedicine communications will be considered in network no matter where you are. Physicians can prescribe certain medications through telemedicine, including medications for allergies, arthritic pain, asthma, bronchitis, colds and flu, diarrhea, infections, and insect bites. Regardless of location, your telemedicine doctor will be able to find the closest in-network pharmacy for you to pick up your medications.

Depending on the carrier, how telemedicine operates can vary. In most cases, you log into your carrier’s website, enter your member identification number, and answer any questions that your doctor may need to provide a diagnosis. Using your insurance carrier’s telemedicine services, you are able to speak with a physician in real time from one computer screen to another through a HIPAA compliant video conferencing tool. Most telemedicine options also allow you to take pictures so the doctors can review your case.

It is important to note that telemedicine is not an appropriate communication channel for all cases and conditions. Your physician will make a judgement call on the communication that will be most effective for you and your situation. The cost of using telemedicine services will, depending on your carrier, often match what you would pay as copay for a normal doctor’s visit on your plan. If you have a Health Savings Account (HSA), the cost will be a lot less in most cases because there is set copay (which goes toward your deductible) for the visit.

Telemedicine might be a good option for you as we navigate the COVID-19 orders for social distancing. Contact your ARC representative today to learn more about your telemedicine options and how you can use it to your advantage.

How to Update Your Income for ACA Plans to Qualify for Subsidies

March 17, 2020/in Individual/Family/by ARC Benefit Solutions

If your income has changed as a result of the coronavirus (COVID-19) pandemic, and you are covered by an ACA on-exchange health insurance plan, you may qualify for additional subsidies. Please update your application in accordance with any income or household changes as soon as possible to find out if you are eligible for savings.

You can update your income information by logging in to your Healthcare.gov account and clicking on “Report a Life Change”.

If your income estimate increases or you lost a household member, you may qualify for less savings than you are receiving now. If you don’t report the change, you may have to pay money back when you file your federal tax return.

On the other hand, if your income estimate goes down, you may qualify for more savings, which could lower what you pay in monthly premiums. You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Contact your ARC representative with any questions.

Exploring Cost-Effective Health Insurance Options: What is Medicaid?

March 17, 2020/in Individual/Family/by ARC Benefit Solutions

As costs continue to rise in the individual health insurance world, consumers are continually looking for alternative cost-effective options. This is especially true for people who do not qualify for a monthly tax credit because their income is too high and those who are ineligible for underwriting with a short-term plan. But what about those who are on the other end of the spectrum and have income that is too low to qualify for a tax credit? Medicaid is an option worth exploring for those who are eligible for low-cost (and sometimes free) health care.

Medicaid is a joint state and federal program that is administered by each state to provide health coverage to particular groups of people. Medicaid enrollment in 2018 was just under 75 million and is the largest single source of health care in the United States. Eligibility for Medicaid varies from state to state and could depend on whether or not that state expanded Medicaid after 2010 when the Affordable Care Act (ACA) created the opportunity. This eligibility is based largely on your Modified Adjusted Gross Income (MAGI) and tax household size. One of the misconceptions around Medicaid is that only those with a low income are eligible for the program. However, certain conditions or situations may make someone eligible, including those who are disabled, pregnant, blind, or in foster care.

Children make up the largest group enrolled into Medicaid. Due to a high number of eligible children, it is important for each state to provide comprehensive benefits. If a state has chosen to provide a separate Children’s Health Insurance Program (CHIP), then they must provide one of three coverage types: benchmark, benchmark-equivalent, or secretary-approved coverage. Benchmark coverage is a plan that is equal to a Federal Employee Plan, State Employee Plan, or HMO plan in that state. Benchmark-equivalent coverage has an aggregate actuarial value that is equal to or greater than the benchmark coverage types listed above. Secretary-approved coverage is approved by the Health and Human Services (HHS) secretary to be appropriate for the targeted low-income children that are under the plan. Just like the ACA, the CHIP plans are required to cover certain benefits including well-baby and well-child care, dental coverage, behavioral care, and vaccinations for free or at very low cost.

CHIP can be especially helpful to families that make too much for everyone to be put on Medicaid, but not enough to purchase private coverage. Let’s take the example of a family of three (married with one child) that makes around $42,000/year gross. They are very close to the threshold amount of being eligible. If this family applies for Medicaid, the state can place the child on a CHIP plan (denying the parents), but allow the parents to enroll in private coverage with a monthly tax credit/discount. This situation is common and is something that some people tend to shy away from. In reality, it is a win-win situation because it allows everyone in the family to receive coverage and take advantage of all possible savings. Now, this example can vary state to state as each have different requirements, but even if a family is in a situation similar to the above, it doesn’t hurt to apply and let the state make a determination. Income limits also change year to year, so just because a family/individual is found not eligible one year does not automatically count them out for the next year.

The licensed sales representatives at ARC are available to help you sort through your health insurance options. Your family may be eligible for Medicaid! Contact us today for more information.

https://www.medicaid.gov/medicaid/eligibility/index.html

https://www.medicaid.gov/chip/benefits/index.html

Short-Term Health Insurance: Advantages and Disadvantages

February 10, 2020/in Individual/Family/by ARC Benefit Solutions

In December of 2017, Congress eliminated the individual mandate that made it obligatory for everyone to purchase the Affordable Care Act (ACA), also known as Obamacare, health insurance or pay a tax penalty. The mandate repeal became effective January 1, 2019. Because short-term medical plans were viewed as potential competition to the ACA prior to the repeal of the mandate, legislation was introduced to limit short-term plan terms to a maximum of six months.

Since the repeal, the Department of Insurance in many states has revised the regulations to making short-term plans available for longer terms, though each state has different regulations. Some states now permit those plans to provide coverage for up to three years of coverage with one single application, which other states still regulate the coverage to a maximum of six months. Short-term medical plans are available from different private insurance companies and are similar to major medical coverage. Like the ACA plans, short-term plans provide the option for a low, medium, or high deductible, enabling the balance of premium cost and risk exposure. However, compared to the ACA, short-term plans usually have a much lower monthly premium cost.

Health insurance premium cost is partially age sensitive. Clients between the ages of 60 and 65 who are considering early retirement may want to look at the cost difference between COBRA, and/or ACA compared to the short-term medical option. In some cases where employer group coverage provides a very low cost for the employee but the rates soar for spouse or family coverage, short-term can help keep the cost more affordable. In other cases where someone is transitioning between jobs, short-term can be a solution and can be set up for a specific number of months and canceled if other coverage becomes available. Unlike ACA HMO plans, most short-term plans have national provider network so the option for health care is not isolated to a local or regional network. This makes short-term health insurance a particularly attractive alternative for a student living away at college.

One fundamental difference between ACA plans and short-term plans has to do with “guaranteed issue”. ACA is considered guaranteed issue, which means coverage is offered to eligible applicants regardless of health status, making it an ideal choice for individuals with pre-existing medical conditions. Short-term plans, on the other hand, are medically underwritten and favor those in good health who do not have pre-existing medical conditions. There are some limitations and exclusions with this type of policy, including the maximum coverage limit, which can range from $600,000 up to $5,000,000 per policy term, depending on the plan offerings of the issuing insurance company. Furthermore, short-term medical plans are limited to the original policy term and are not renewable. If a covered individual’s policy comes to term, they can reapply for coverage. Another consideration to keep in mind is that short-term medical does not have a “preventative care” component that is included with ACA plans. Generally, the preventative care in ACA plans provides zero-cost annual wellness visits with a primary care doctor, as well as other age- and gender-related tests and screenings that are not included with short-term coverage.

Short-term plans also exclude prescription drug coverage. However, most short-term plans will include or offer a small prescription discount card to offset the cost of listed medications. In summary, when you compare the cost of ACA plan to the cost short-term medical plans, you can save a significant amount in premium cost. If you use the health system infrequently throughout the year you will save enough in premium dollars to pay out-of-pocket for a few doctor visits and a few low cost medications and still save on your annual cost of health care.

Insurance doesn’t have to be complicated. The licensed sales agents at ARC Benefit Solutions are equipped with the knowledge and expertise you need to make an informed decision about your health insurance at no cost to you. We will walk you through all the options that make sense for you and your family. Contact us today to get started. [/av_textblock]

What You Should Know About Your Health Insurance in the New Year

January 13, 2020/in Individual/Family, Medicare/by ARC Benefit Solutions

It’s a new year! That means it’s a good time to review the intricacies of your health plan for 2020 so you can maximize your savings. Here are some of the details of your health plan that you should keep in mind as you get organized for the year:

New ID Cards

Your health insurance ID card is your proof of insurance that may include personal information, your insurer’s name and contact information, your plan type, what benefits are covered, and your costs for services. You show this card when visiting a doctor, hospital, or any other provider so they can calculate how much you owe for services. If you receive a new ID card, be sure to check that your personal information is correct and update your records with copies of the new card with any pharmacies or providers that you use.

In-Network Providers and Pharmacies

One simple way to maximize savings with your health insurance plan is to find doctors and pharmacies that are in network. In-network providers charge lower rates in exchange for being part of the provider network of a given insurance company. Many insurers have convenient online tools that you can use to make sure your preferred providers are in network. If you need help determining who is in network and who is not, contact your ARC representative.

Deductible Resets

A deductible is the amount you pay for covered services before your health insurance plan begin to pay. Most health plans (not Medicare plans) have yearly deductibles that restart on the first of the year. Be sure to review your plan online to determine when your deductible will restart.

Recurring Payments for Premiums

To ensure that your making consistent premium payments month after month, set up recurring payments from your checking or savings account. This means the payment will be taken our of your account at the same time each month and you won’t ever miss a payment.

Our goal is to simplify your life. If you have any questions about your health plan throughout the year, feel free to contact us! We are here to provide the guidance you need to properly manage your health care.

How to Take Advantage of Your Health Insurance Plan

December 4, 2019/in Individual/Family, Medicare/by ARC Benefit Solutions

Health insurance can save you money.

Stay with me.

While health insurance can be expensive, it’s important to run through the finer points of your plan to find out what benefits are available to you and how you can be rewarded. Below are some of the details you should be aware of when reviewing your health insurance plan.

Walk through your plan

How much is your deductible? What is your maximum out of pocket? What penalties should you be aware of if you don’t make your premium payments each month? Take some time to read through your summary of benefits to learn more about what you’re covered for and any stipulations on your plan that you may need to know about.

Preventive services

Taking control of your health doesn’t have to mean breaking the bank. Most health insurance plans offer preventive services at little to no cost to you. This means yearly wellness visits, dental screenings, vision screenings, immunizations, and more, which can help prevent illnesses, diseases, and other health problems, or detect illness at an early stage, are covered benefits.

Discounts

Your health insurance plan may provide benefits that go beyond the doctor’s office. Many plans offer discounts for gym memberships, massage sessions, and more!

Rewards for healthy living

You should be rewarded for your healthy lifestyle. That’s why many health insurance plans offer benefits that help you stay the course and incorporate healthier decisions on a day-to-day basis. From access to a health coach to programs that may reward you for exercising and eating right, many plans want to reward their members for being healthy and fit. Many plans also offer classes and seminars on fitness, nutrition, or other health topics.

Your ARC representative is available to walk you through the details of your health insurance plan so you can fully understand where your money is going. Call today to find out what is available to you or find out how you can get set up with a plan that benefits your health.

Things to Consider About Your Health Insurance Before the End of the Year

November 15, 2019/in Individual/Family, Medicare/by ARC Benefit Solutions

2020 is upon us and many of you may be considering moving to a new health insurance plan. There are a couple things to consider before your plan goes into effect in 2020…

Prescription Drugs

If your plan is changing in 2020, be sure to get your prescriptions refilled before the end of 2019. Depending on your medication, there may be some requirements with your new plan that may take a little longer than normal to get medications refilled.

Deductibles

Most plans restart on January 1, which means your deductible will also reset. If you are close to hitting your deductible, or if you have already met it, you might want to consider having any tests or procedures completed before the end of 2019 so it will count towards the 2019 deductible amount. If not, you will be starting over from zero on January 1, 2020.

Premiums

If you change your plan, you might have different due dates for your monthly premium. If you have had your former plan premiums deducted from your banking account, you will want to make sure that those automatic premium deductions cease effective December 31. You will also need to contact your new insurance company to set up automatic bank draft before January 1. Most plan premiums are due before the first of the month and are paying for the upcoming month, not a month in arrears.

Enrollment Deadlines

Have you scheduled your annual review? Don’t leave it until the last minute! The Annual Enrollment Period for Medicare ends December 7, 2019, and the Marketplace Open Enrollment Period ends December 15, 2019. Contact your Client Care Advisor to get started!