New Prescription Product

Prescription medications can be expensive. But until now, the Rhoads Insurance Agency has been unable to offer anything for individuals and families. Now we have a solution. We recently contracted with the IHC Group to be able to offer the RxPay Advance Drug Card.

 

Why Haven’t We Had Options Before?

Prescriptions are an uninsurable risk, except for older consumers who are much more likely to need prescriptions as a demographic. For the rest of us, we only want protection from high prescription costs when we’re sick. So most of us would choose not to have prescription coverage.

The insurance companies would lose too much money, unless everyone got it and not just the sick.

There are exceptions, such as when the government forces companies to include prescription benefits. This is the case for the ACA Marketplace. Another exception is for Group insurance, when everyone at a company is required to join the plan whether they need it or not.

 

Most Private Plans offer only Discounts

Discount plans usually don’t work. We’ve tried a lot out and have been underwhelmed. The best situation you’ll be able to find are plans that reimburse you a fixed amount, for up to 12 pharmacy visits per year. Those benefits help, but there are many cases where the reimbursement amount is miniscule compared to the cost of, say, a specialty brand name drug.

 

How does this RxPay Plan work?

No prescription plan has to cover all medications. Instead, each plan establishes a formulary – a list of medications that are covered under the plan. Formularies are established with input from doctors, pharmacists, and administrators.

The Advance Drug Card focuses on generic and other low cost brand name drugs. This program is designed to help you find drugs within the same therapeutic class as a drug you may currently be taking. Most of all, this program is designed to save you money on your prescription drug costs.

Tiers indicate retail pharmacy pricing and position. Drug quantities listed must be adhered to in order to receive tier pricing at participating retail network pharmacies.

 

Contact Us for More Details

Want to get a quote and enroll in the RxPay Advance Drug Card? Set an appointment with us here:

Request a Free Quote

Trends in Group Coverage

Many people I speak with still hold employer-provided Group plans as the best kind of health insurance. Trends in group coverage actually suggest otherwise. This point of view is expressed in an article on the Harvard Business Review recently:

As a result of these trends, employers have shifted costs to employees; one common example is the implementation of high-deductible insurance plans, which increase consumers’ out-of-pocket costs. High costs can hurt employees in other ways, too: there’s evidence that as employer-provided health costs rise, employers are constrained in their ability to increase wages.

Consumers will see with their employer-provided insurance plans, all things being equal, that deductibles will rise, and they will have to pay more out-of-pocket for healthcare. I’m not about to suggest you turn down your employee health insurance plan though. Your employer is paying for most of it. But it will cover less in the future.

What to do then, if you’re in this situation? I’d suggest you get a hospital and doctor plan to go with your employer coverage. That could help pay all or part for doctor and outpatient healthcare expenses, before your deductible is met. That would be the best way to manage your healthcare costs.

Talk to me today and I’ll explain how we could help.

Dan Rhoads

ACA premiums rising beyond reach of older, middle-class consumers

Sixty-year-olds with a $50,000 income must pay at least one-fifth of what they earn for the least expensive premiums for health plans in Affordable Care Act marketplaces across a broad swath of the Midwest, the analysis shows. In much of the country, those premiums require at least one-sixth of such people’s income.

And that’s just the beginning. I’ve seen plans as high as $4400/month! Obamacare is too expensive.

So what do you do? Well, let me give you my perspective.

Yes, there should be options that cover pre-existing conditions, and I’m concerned for uninsured people out there who will be caught in the trap should the ACA become unsustainable.

But, THERE ARE ALTERNATIVES. Talk to me. Get health insurance BEFORE your health takes a turn for the worst.

I have plans and options that are affordable and can stay with you until you turn 65 and get Medicare.

 

Multiplan PPO Plans

What is the Multiplan PPO Network?

Multiplan started in the 1980’s as a regional NY hospital network, and has grown to be the largest PPO in the US. There are over a million healthcare providers in network. They’ve grown so much because they provide a great value to both insurance companies and to consumers. Multiplan helps insurers reduce the cost of care, which those insurers pass along to consumers with more competitive rates vs benefits. It has a flexible network structure, and covers all specialties. This PPO really does make healthcare flexible.

 

A Better Reference for Pricing

Often, health insurers base the amount they pay doctors and hospitals on Medicare reimbursement rates, under the name of Reference-Based Pricing. Sadly, Medicare is not only a flawed pricing strategy for many healthcare services, but it also can cause unintended consequences. For instance, doctors frequently raise their rates for Medicare patients, which ends up raising everyone’s rates. And you, the consumer, end up paying more for health insurance as a result.

The better way to set billing rates ties the expense to a doctor’s or hospital’s own operating costs.

 

Extending the Power of Bill Review

Multiplan uses analytics to find wasteful or abusive medical billing practices, then works to fix those problems. That means that when you go to a doctor who is in-network, you have a netogiating team there to prevent over-billing. And, every in-network doctor had their billing practices reviewed before joining the network.

Let’s see an example:

A spinal fusion procedure billed at $42,452 was reduced by bill review to $24,956. Payment integrity analysis determined that a spinal fusion and lumbar laminectomy were separately billed. Citing CPT Assistant, American Association of Neurosurgeons and the NCCI manual, the lumbar laminectomy is included in the spinal fusion if performed at the same spinal level, and is only as extensive as necessary to prepare the site for the fusion.

After discussion with the provider, the bill was reduced, with provider signoff, by an additional $5,852.

 

How this affects you

Multiplan is a PPO network that many insurance plans can use for their healthcare payer services. So the Multiplan network encourages even more competition. There are many plans out there that work on this network, all getting cost-reducing benefits, and all fighting to earn your business. It gives you more options and more competitive insurance rates.

 

Being good agents is simple. It’s the difference between doing anything to get the big sale, and doing anything to help the client get the big value. And let us tell you – Not all agents are good.

We’ve seen it ourselves. Dan, our managing agent, got started in health insurance by working for an agency that shall go unnamed. There, he saw that some agents (not all) were willing to knowingly say that some things were covered by plans, even when they weren’t. And they were good at doing that convincingly. It flew in the face of Dan’s morals, and he left there before long.

Dan was and remains motivated by a desire to do good. He’s trying to play the long-game: build a loyal client base slowly, rather than sell a lot of clients who cancel quickly.

But most consumers are bewildered by trying to understand their options, and don’t recognize a confident but fraudulent sales pitch when they hear it. So we wanted to share some of our tips on how to separate the wheat from the chaf.

 

5 Essential Tips for Finding Good Agents

  1. Obviously, make sure your health insurance agent is licensed. Simply ask them if they have a license. It is illegal for someone to pose as an insurance sales agent without being licensed and appointed in the state that you reside in. This one is simple – Good agents are licensed agents.
  2. Second, beware of agents using Power Statements and too many Tie-Downs. The quick sales strategies we’ve seen all center around starting off by making a lot of powerful statements that are difficult for you to fact-check. And once they get going, they’ll complete every other sentence with a loaded question that’s hard to say “no” to, to keep you nodding your head. That’s a Tie-Down. The premise is they’re trying to short-circuit your critical thinking and get you to say “yes” a lot. It’s a proven psychological trick that makes you more agreeable, and good agents don’t need to use psychological tricks on you..
  3. Third, ask to see a brochure that’s been approved by an insurance company’s regulatory compliance department. PDF is fine. Such marketing materials need to be approved by the state department of insurance, and good agents will have them available to email to you.
  4. Fourth, watch out for agents trying to get you to make an instant decision when you’re not ready to. Some agents will try to tell you that, “rates are going up on Monday so let’s get these rates locked in for you.” While rates are sometimes increased, the changes are almost never rapid and drastic. And small rate changes should not rush your decision-making. (That said, going uninsured is a bad thing, so don’t put it off too long!) Good agents will not use desperate please like that.
  5. And finally, trust your gut. Do you like and trust the agent? Good agents will be real with you, and display candor about what the plan(s) do and do not cover. Does the plan(s) sound too good to be true for the rates? Then they probably are. Remember, off-marketplace plans will cost more but won’t cover pre-existing conditions, pregnancy, substance abuse, or prescriptions.

Prescriptions are one of the most expensive parts of your health insurance. Usually, you need to take your medicine daily, or at least on a schedule. And they can be expensive – so regardless of whether your prescriptions are expensive, choosing a health insurance plan that covers prescriptions at all will make that insurance plan a lot more expensive.

There’s a solution for that. Be aware of what your prescriptions cost with and without insurance, and compare the prices for those medicines at various pharmacies near you.

Ok, we get it. That’s a lot of work and you’re a busy person. You don’t have time to drive around to 10 pharmacies and ask each pharmacist how much your medicine will cost with and without insurance. Not to mention, the pharmacist might think you’re crazy.

 

Work with an Agent

You might not be used to shopping for the best health deal, but a licensed health insurance agent is. A good agent will know how to use tools like GoodRx.com. He or she will be able to run a detailed analysis. See how much your prescriptions would cost you if you switch coverages. Together, you could get a picture of what your monthly out-of-pocket costs could be and get a realistic comparision of insurance plans.

 

Make a Prescription List

You can help an agent shop for you. Start by creating a list of names, formulations, dosages, and quantity needed per month for all of your medications. We have clients who keep theirs on the fridge at home. Make it easy to get to this list if you collapse and first-responders need such information.

Share that list with your agent – before you purchase health insurance.

If there are changes – and there will be as you age – let your agent know, at least when you speak for your annual review, if not before.

 

Save on Out-of-Pocket Expenses

Don’t assume that all plans include pharmacy benefits. We see it from time to time with new clients who assumed that – they end up being shocked at the difference in prices and how much more they have to pay. Be aware that your medications are a cost and that they will not always be low.

The Problem with a Deductible

Except for employer plans, high deductible health insurance feels like a scam to many healthy Americans. They see only 2 options:

  1. Their plan costs a few hundred dollars a month, and has a deductible that’s so high that it won’t pay for their healthcare until they’re bankrupt, or
  2. Their plan costs close to a thousand dollars a month (or more), and has a deductible that is low.

Either way, you probably feel about the same. That you’re paying double, once to the doctors and once to the insurance company, when you should only be paying once. It’s a painful cycle that angers many Americans. And in a way, it is a scam that the insurance industry has pulled on consumers – a way that they can get out of paying and turn your insurance premiums into pure profit. This has led many consumers to want to self-insure – to settle for paying for medical bills entirely out-of-pocket.

Let’s just get this out there: Self-insuring, or just avoiding medical care, is NOT a solution. If you get seriously ill or injured while under-insured, then you’ll be willing to pay just about any amount for healthcare, and the insurance companies will want nothing to do with you.

 

“How High a Deductible is OK for me?”

As a rule of thumb, you should look at your average bank balance. Most people know about how much cash they like to keep on hand for emergencies. Have a look at yours. And then, don’t ever choose a deductible that’s higher than the money that they would have available if they’d have a sudden serious illness or injury. Because, what’s the point in doing that? Simply trying to pay the deductible would put you in financial debt.

If all the only health insurance that you can afford comes with a deductible that’s too high, then you need to explore other options.

 

There are ways to get around your Deductible

For those who want to get real value out of their health insurance and get around their deductible, there are other options. They’ve heard of Health Savings Accounts (HSA’s), and similar employer contribution plans. Those who have such plans love them.

There are also fixed indemnity Hospital and Doctor plans. There are good and bad indemnity plans out there, so look out. But good ones will greatly reduce your out-of-pocket spending for doctors visits, lab tests, imaging, and hospitalization.

Indemnity plans don’t coordinate with your high deductible plans – which means you can have both types of plans if you want, and neither limits the benefits of the other.

You don’t have to combine an indemnity plan with a high deductible plan however. Not if it’s a good plan. Look for how much the plan would pay for hospitalization or surgery.

And, in place of a high deductible health insurance plan, consider a critical illness plan that will pay a large lump-sum if you have a heart attack, stroke, cancer, or something similar. There are many such plans available for critical illness, and those vary widely by state. Ask your insurance agent for advice.

 

How to Tell a Good Indmenity Plan from a Bad

  1. Have a look at the per-day hospital confinement benefit. $3,000 to $4,000 is good. $200-$1,000 is bad. And look to see how many days per year this benefit may be paid.
  2. Make sure that benefits are provided for wellness, out-patient diagnostics, advanced imaging, and ambulance.
  3. Stay away from plans that have an enrollment fee above $35.

 

Have questions? Call us at the RhoadsLife Insurance Agency today – (484) 509-1784.

HSA Alternatives

Health Savings Accounts offer a way to save for – and pay for – healthcare expenses. They are usually offered by employers, as they are a way to give benefits that are not subject to income taxes. For the employee, HSA’s work great with High Deductible Health Plans, since HSA’s have no deductible and can be used for all sorts of outpatient health services.

What if you don’t have an HSA though? Do you want something that helps you pay for healthcare expenses and has no deductible? Private healthcare companies offer great HSA alternatives called Fixed Indemnity Plans.

Indemnity plans are great HSA alternatives for individuals with private health insurers. BUT, you have to look closely at how much the plan pays for hospital and outpatient care. There are a lot of plans out there that offer a choice between affordable indemnity plans with little benefits, and expensive indemnity plans with reasonable benefits. United Healthcare is the only insurer that I’ve seen in my years of experience that provides good benefits at prices that accurately reflect your odds of using the coverage. That is, if you’re young, a good indemnity plan is very inexpensive, but if you’re in your 50’s or 60’s, expect the pricetag to be a bit more.

The bottom line: have a look at our simple chart, below, to compare your options.

Healthcare Options

 

Our best advice is to understand buying health insurance in the United States is extraordinarily complicated. Our agents can quickly learn about your situation and show you viable options to obtain coverage.

To check on individual or family health insurance request a free quote!

Combo 360 Plans

Major Medical plans are increasingly coming with higher and higher deductibles, and less and less benefits for routine checkups and outpatient services.

Indemnity plans on the other hand, cover routine checkups and outpatient services, but have no guarantee of a cap on how much you might have to pay for medical bills in a year.

United Healthcare has the solution. Combine a high deductible 12-month Short Term Medical plan (Part 1) with a Hospital and Doctor plan (Part 2) to get the best of both worlds. One plan guarantees security if your medical expenses explode, and the other promises affordable medical care until then.

 

Part 1: $2 Million High Deductible UHC Value Select A 

  • United HealthCare’s National Network
  • Short Term Medical for 360 days
  • $75 Copay for Urgent Care
  • $10,000 Hospital Deductible
  • After Deductible you pay 40% of covered charges until you have paid another $5000.
  • Max Exposure is $15,000
  • Keep in mind Part 2 will cover PART or possibly ALL your maximum $15,000 exposure

 

PART 2: Select a Health ProtectorGuard Select Value, No Deductible –First Dollar Coverage

  • Choose your own Doctor
  • Plan pays $100 per Office or Urgent Care visit 5 times per Year per a family Member
  • Preventive Coverage (after 6 months)
  • Hospital benefit is $3,000 per a day
  • You chose your own Hospital
  • ER Coverage
  • Lab and Imaging Benefits
  • Surgical Benefit Schedule

 

Customize your plan with a few other options I recommend:

Teledoc: For $20 per month your entire family has access to a physician by phone any time, saves you the time and expense of running to a doctor.

Dental:  United Healthcare National PPO – The #1 Selling Dental Insurance in the country.

Vision: Yearly coverage for Eye Exam, contact lenses, and/or glasses.

 

This new One Year PPO is significantly less expensive than an Affordable Care Act insurance plan. You do need to be relatively healthy to qualify. Pre-existing conditions are NOT covered and there are some exclusions. Please see the attached plan description for more information. 

Please call me directly and we can review all this again. Or I can assist you in submitting an application. We do have other options available, so please keep me posted on your thoughts! 

When we hear the word insurance, most of us tend to think of things like car or health insurance. Critical illness insurance most likely isn’t one of the types of insurance that comes to mind, even when talking about cancer or heart attack.

It makes sense—we often don’t want to think about the scarier health-related risks in life—especially not critical illness. Unfortunately this inclination to turn away also often leaves us vulnerable and unprotected should we be diagnosed with a critical illness.

The reality is by the time we reach retirement age, one out of every four of us will be out of work due to illness or injury for longer than our accrued paid time off allows.

What Counts as a Critical Illness? Not just Cancer or Heart Attack
Illnesses can happen to any of us, at any time. They might be simple like a cold, or one of the several critical illnesses that affect Americans. The three major critical illnesses are:

  • Cancer
  • Heart attack
  • Stroke

Other critical illnesses can include:

  • Blindness
  • Multiple sclerosis
  • Organ transplants
  • Kidney failure
  • Paralysis
  • Heart valve replacement

According to The AACII, statistics show annually:

  • Some 1.4 million Americans are diagnosed with cancer.
  • Every 40 seconds someone in the U.S. has a stroke; 600,000 people will experience their first stroke.
  • Every 34 seconds, an American will suffer a heart attack; 785,000 will have a new coronary attack.
  • 1.5 million Americans will declare bankruptcy this year; 60% are due to medical bills (up 50% over six years).

These numbers are alarming and that’s why protecting your income with disability and/or critical illness insurance is so important. Naturally, when we’re unfamiliar with certain types of insurance, many questions come to mind:

• Why do I need critical insurance?
• If I already have disability insurance should I get critical illness insurance as well?
• Which one is the best option?

Differences Between Critical Illness Insurance and Disability Insurance
Critical illness insurance pays you a lump-sum cash amount if you are diagnosed with any one of the critical illnesses covered by your policy, even if you make a full recovery. Disability insurance on the other hand pays you a regular payout when you’re ill or hurt and can’t work. It protects your income from the very real possibility you’ll become disabled for a period of time during your career, whether due to injury or illness.

There are several differences between critical illness and disability insurance.
Income protection: Critical illness insurance is meant to provide you a source of income to pay for your health costs if you are diagnosed with a critical illness, while disability insurance is meant to pay a portion of your income in the event that you cannot work.

Frequency of payment: Critical illness insurance generally provides you a lump sum payment as specified in the policy while disability insurance pays you a monthly benefit, usually a percentage of what you earned before becoming disabled.

Qualification of benefits: Critical illness benefits depend on the diagnosis of one of the policy-listed illnesses, while disability insurance benefits rely on your inability to work.

Tax implications: Critical illness gives you a lump sum tax-free cash payout, while disability coverage is calculated as a percentage of your after-tax income and is paid for a certain amount of time.

Requirement of proof of loss: Critical illness insurance generally doesn’t require any ongoing proof of loss of income, and is not affected by any other income you make, while disability insurance requires ongoing proof of loss of income. Disability insurance payments can stop when you go back to work and start earning income.

Which Critical Illness Policy Is Right For You?
Each critical illness policy has specific terms and conditions, which must be reviewed very carefully. Make sure you understand which types of illnesses are considered critical and will qualify for payment.

If your diagnosed illness is not included on the policy list, your claim may be denied by the insurance company. Also, be aware of the survival period of your policy. Critical illness policies typically have a survival period or waiting period, This is a period of time which specifies how long you must wait after you’ve received your medical diagnosis to collect the lump sum benefit from the insurance company. This period can vary from one policy to another.

Be sure to ask all your questions before buying a critical illness policy. This is where an insurance agent can be a valuable resource. They can help you understand the language in your policy, explain the specific terms and conditions, and guide your decision around which critical insurance policy is right for you.