The More Critical Questions...
How Big are the Hikes going to be?
How much will your premiums increase?
Will your carrier still be your provider?
- Will your coverage and benefits suffer from the losses the insurance carriers have incurred these past years as a results of the Marketplace?
- Meaning, will your premiums and deductibles (individual and family, in-network and out-of-network) increase?
- Will you have access to your current plan, will you have access to your favorite doctors, etc?
- What happens in an emergency...will it be out-of-network and then you'll have to cover everything out of pocket?
- Did you know that 20-30% of Emergency Department Physicians are Considered out-of-network?
- Will you even have a choice in your healthcare plans?
*These are all extremely critical questions that you should be completely aware of and know the answers to, because in an emergency you will not be worried about these questions or even have time to worry about them. Be prepared in advance and it could most importantly save your life. If you have an HMO you are limited to the network your insurance company has allotted you to receive your coverage. If you become sick you are not allowed to go outside that network to see specialists. This could be a matter of life and death, if you been critically ill. As well, this difference of plans, HMO versus PPO could not only be life saving by allowing you trauma coverage, second opinions, and choices- it may also save you thousands, if not hundreds of thousands of dollars.
Definition(s):
Health Maintenance Organization (HMO)- In most HMO insurance plans, you are allowed to only go to doctors, health care providers, facilities, or hospitals, on the plan's list except in the case of an emergency. Now even in the case of an emergency your costs may not be covered. In order to see specialists, you typically need to get a referral from your primary care doctor that is considered in network with your HMO plan.
Participating Provider Organization (PPO)-In health insurance in the United States, a PPO, sometimes referred to as a participating provider organization or preferred provider option is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.
2017 Health Insurance Rates Are Coming? At What Price?
The summary of this article is based on the 2017 healthcare rates. According to Geisinger, who runs The Geisinger Health Plan, based out of Danville, PA, of the nation’s top-rated
health care organizations. The Geisinger Health Plan executives foresee medical costs increasing next year
by 7.5 percent (at a minimum) for people buying insurance under the Affordable Care
Act. " Dr. David T. Feinberg, the president and chief executive of the Geisinger Health System, said its health plan was losing $30 million a year on coverage sold on the federal exchange in Pennsylvania. But leaving the market here would be unthinkable. Last October the Pennsylvania Insurance Department, headed by a former Obama administration official, approved a 20 percent increase in Geisinger’s rates, about half of what the company had requested."
For some reason consumer advocates seem shocked yet, they shouldn't be since all of the "big players', Blue Cross Blue Shield (Has Reported $2 Billion in losses), United HealthCare (Reported almost $500 Million in Losses), and even The Geisinger Health Plan. United HealthCare is pulling out of most States for the Marketplace and limiting its participation in many plans it used to be a part of. "The giant UnitedHealth Group, having lost money on individual policies under the federal health law, is pulling out of many insurance exchanges next year. A number of health insurance cooperatives created under the law have shut down." In accordance with the past few years of losses and his actuaries request, Kurt J. Wrobel, has requested a rate increase of 40% for the 2017 year. Blue Cross Blue Shield is asking for a 60% increase for 2017. Along with the dramatic premium rate increase, United Healthcare and Blue Cross Blue Shield will not be participating in the Marketplace for the 2017 calendar year due to the significant losses the companies have experienced.
“Historical experience is the lifeblood of what we do,” Mr. Wrobel said, in an interview at Geisinger’s headquarters here. “We take that experience, adjust it for the underlying growth of health costs and project it into the future so we can estimate the expected costs for a particular insurance policy.”
So
when Geisinger requested a rate increase of 40 percent for 2017,
consumer advocates were amazed. And Kurt J. Wrobel, Geisinger’s chief
actuary for, found himself, along with other members of his profession, in
the middle of the health care wars still raging in this political year.
Actuaries
normally toil far from the limelight, anonymous technicians stereotyped
as dull and boring. But as they crunch the numbers for their Affordable
Care Act business, their calculations are feeding a roaring national
debate over insurance premiums, widely used to gauge the success of President Obama’s health care law.
Health plans around the country have just filed proposed rates for
2017. State insurance commissioners are still reviewing them.
Presumptive Republican presidential nominee, Donald J. Trump, wrote in a Twitter post, "There is panic and anger as health care costs explode!" referring to the nearly 60% increases sough by Blue Cross Blue Shield of Texas for 2017's premium increases.
"But questions about the proposed increases are reverberating through the health care system and into the political campaign."
“But based on experience,” Mr. Wrobel said, “the 2016 premium rate is too low, so we want to correct it in 2017.”
"Kurt Wrobel, chief actuary at Geisinger
Health Plan, at a hospital in Danville, Pa., on Monday. Mr. Wrobel said
based on experience, “the 2016 premium rate is too low, so we want to
correct it in 2017.”
Mark Makela for The New York Times ".
Personal Stories
On a personal note, let me tell you a couple of true life short stories of small business owners and their families, I have helped in the past couple of weeks.1. Many families I know locally, in the Wisconsin, area that are small business owners. In recent weeks, they have just received letters from United HealthCare (UHC). These letters are not "thank you" letters for being loyal customers. Instead these letter are termination letters stating after the end of this year, December 31st 2016, their coverage will be ceased and UHC will no longer be covering these small business owners and their families. The coverage is not being terminated due to illnesses or excessive claims. The result of the termination is due to the fact that United HealthCare losing so much money in the past couple years in the Marketplace they are trying to limit the markets they are covering and they must end the losses and increase their profit margins. So the small business owners of America that were already paying high premiums with large deductibles and out-of-pocket expenses with UHC plans that felt they had a secure, steady plan are now in a bind and have to quickly find a new insurance provider.
I met with one of these families and was able to lower their premium by $400-$500/month, deductible from $10K to $2500/person (max of 3 people), co-insurance 100%, and built in accident/critical/disability benefit for $10K for both the husband and wife in case a major incident occurs. I also added dental for the entire family. They could not be happier. Again, they transitioned from the extremely expensive UHC plan that was a nightmare to deal with and thrilled to let them go even while receiving expensive premiums to a carrier that was glad to take them for a much better rate with better coverage.
2. I recently met with a couple that had a strong well known carrier that was a PPO. They felt it was a strong plan. They were paying close to $800/month for a family plan, just the two of them. It was decent, however the plan had a $7,000 individual "in-network" deductible and a $12,500 "in-network" family deductible. What was terrifying was they did not know they had an individual "out of network deductible of about $21,000 and a family "out of network deductible" of $52,000. Can you imagine? Say you're traveling and an emergency happens and you are life lighted to the nearest trauma center not in network. Fortunately your life is saved but you have to cover the minimum out-of-network deductible coverage of $52,000. This would be devastating and financially crushing to any family. Not to mention in a situation like this usually one or both of the family bread winners is unable to work. This is not okay. This is once again why it is critical to understand the details and complexity of your plan.
For this family I was able to set them up on an Major Medical PPO for under $500/month with a $2500 deductible per person (in-network or out-of network). The co-insurance is 100%. So once they meet their deductibles their coverage is 100%. As well in a plan like this accident/critical/disability benefit can be built in for only $5/month additional to the monthly.
The importance of these two stories is there is help and as a SOCIETY we must do something. You must make the investment to take the time to review & understand your insurance and change your plan to make sure you have great comprehensive insurance that fits your needs. You don't have to have high premiums to have great insurance coverage for you and, or your family. Contact someone today so you are properly insured and you can begin fully understanding your benefits.
Wouldn't you like to save money and have a sense of peace knowing you have a thorough, affordable, comprehensive plan?
Kick your feet up and celebrate your new insurance! Free yourself, your friends, and your family by reaching out to a Benefits Consultant to receive Expert Consultation regarding the healthcare world. It's a dynamic situation and always changing.
It does not take a lot of time. You can receive a quote, fill out an online application, and have a new, comprehensive, affordable plan in less than 30-minutes. It can all be done over the phone.
You can sign up for the following:
- Health
- Dental/Vision
- Critical/Accidental/Disability
- Life
- Medicare/Supplements
Please know that it's better to move now as rates on plans go up each week, and every month they go up significantly. Please know, you are not limited to open enrollment.
A Benefits Consultant can help you understand your coverage and how to fully research and understand your plan.
Take control of your life now!!
Please contact:
Stephanie Puryear
Benefits Consultant, Licensed Insurance Broker
Licensed: Wisconsin, Arizona, Colorado, Illinois, Iowa, Michigan, Texas, Virginia, Washington, and Florida (pending).Email: spuryear@myhst.com
Phone: (847) 530-8943
LinkedIn: https://www.linkedin.com/in/stephanie-puryear-a472824b
Twitter: https://twitter.com/SensoryStepsInc
Facebook:https://www.facebook.com/spuryearHST/
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