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

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! 

Hospital & Doctor Plans

Hospital & Doctor plans are also often called fixed-benefit insurance or fee for service insurance. That’s because this type of insurance pays you a set—that is, fixed—amount of money for specific services covered by the plan.

Unexpected medical bills can disrupt even the healthiest home budgets. Health ProtectorGuard, underwritten by Golden Rule Insurance Company, is a fixed-benefit hospital doctor insurance plan that can help you deal with the unexpected by paying you or your provider a preset benefit amount for some of the most common medical costs you and your loved ones might face.

Call (484) 509-1784 to learn more today

With a Health ProtectorGuard indemnity plan:

  • You are paid regardless of other insurance coverage.
  • You don’t have to meet a deductible before you receive benefits.
  • Your fixed benefits are paid straight to your provider or to you after a covered expense is submitted.
  • You choose the doctor or health facility you need.
  • You can apply year round, not just during an enrollment period or because of special circumstances.

What is indemnity insurance?

A fixed indemnity plan like Health ProtectorGuard is much different than a major medical insurance plan. READ HERE FOR MORE DETAILS.

A regular major medical health insurance plan pays for all or a percentage of covered expenses after you meet a deductible, pay a copay or reach a certain amount of out-of-pocket costs. Put simply, for qualified expenses, in most cases, you pay first, and then your insurance company covers the rest.

A hospital doctor insurance plan offers limited benefits and is meant to supplement a more traditional health insurance plan. Indemnity insurance essentially flips how you are paid when compared to major medical insurance. You or your provider are paid a predetermined fixed benefit for certain health care expenses you have incurred, and then you are responsible for the rest.

Call (484) 509-1784 to learn more today

What are the features of a hospital doctor insurance plan?

In addition to the set amount of money paid for receiving specific medical services, Health ProtectorGuard is designed with enhanced features to make the plan helpful just when you may need it most – afterall, it’s hospital doctor insurance.

Features for doctor/urgent care visits

  • Some Health ProtectorGuard hospital doctor insurance plans allow you to rollover unused doctor office/urgent care visits (up to a maximum of five visits) in those years you don’t need them.
  • Health ProtectorGuard features preventive care benefits for visiting the doctor to stay healthy, like to get a physical or a mammogram, not just when you feel ill.
  • The Health ProtectorGuard second surgical opinion feature can help you seek out additional medical advice about potential surgery.

Features for hospitalization

  • Health ProtectorGuard features unlimited inpatient hospital confinement and surgical benefits, which means no matter how long you stay in the hospital or how many surgeries you have, you may receive benefits.
  • Set payment for injury-related hospitalization increases 25% for every year up to the fifth year you keep your Health ProtectorGuard fixed indemnity plan.
  • Health ProtectorGuard fixed indemnity insurance recognizes some surgeries are more complex and expensive. It pays more for certain surgeries and may include additional payment when an assistant surgeon is involved.
  • If a hospital stay involves the intensive care or critical care unit, payment for that stay is made in addition to the daily inpatient hospital confinement benefit. That’s more cash to deal with more serious hospitalization costs.

Saving now and later

  • Take advantage of network discounts — You have no network restrictions with Health ProtectorGuard. You can go to any doctor or health care facility you want and still get your eligible benefits. However, you also have access to discounted rates for services if you use doctors or providers in the MultiPlan Limited Benefit Plan network. (Note: There’s a $3.25 MultiPlan network access fee included in addition to your premium each month.)
  • There are no deductibles, no application or association fees to pay.
  • Use your prescription drug discount card — Every plan comes with a card that helps you get drug discounts of up to 50-75% off.5
  • In most cases, Health ProtectorGuard fixed indemnity insurance is renewable up to age 65.

Call (484) 509-1784 to learn more today

How do I use my Health ProtectorGuard insurance?

It’s simple. You or your provider just submit a covered expense. The fixed benefit for that eligible service is then paid, regardless of other insurance coverage.

Health insurance isn’t cheap, but going without it can cost you even more.

In fact, premiums have risen slightly every year for the past six years, according to a 2017 Employer Health Benefits Survey by Kaiser Family Foundation/Health Research & Educational Trust. If you’re in good health and don’t have anyone depending on you like a spouse or children, you may be tempted to forgo the cost of buying health insurance.

But not having health insurance can cost you far more in the long run than the cost of paying premiums. Without health insurance, you likely would be responsible for paying all costs if you get sick or injured.

What health insurance typically covers

Whether you’re relatively healthy or chronically ill, health insurance can provide the financial protection you need for both routine and unexpected healthcare needs. Here are just a few benefits to consider:

  • Health insurance typically covers preventive health services to keep you healthy and screen for potential health issues that could cause problems later on.
  • Health insurance typically covers other essential health benefits like emergency services, prescription drugs and diagnostic testing.

What are your health insurance options

  • Major Medical Insurance – The Affordable Care Act established the Healthcare Marketplace, where all plans cover the 10 essential health benefits. The cost of these plans depends principally on your income. And, these plans come with deductibles and fixed copays.
  • Short Term Medical Plans – Outside of open enrollment, Major Medical Insurance is only available to people with a qualifying life event. For everyone else outside of open enrollment, insurance companies offer Short Term Medical (STM) plans. STM plans may not cover pre-existing conditions or pregnancy, but they are more affordable than Major Medical, and satisfy many non-government requirements for insurance. Read here for a longer comparison between STM and Major Medical Plans.
  • Fixed Indemnity Insurance – Fixed indemnity plans provide fixed cash benefits for covered medical care. They are labeled as Supplemental Health Insurance because they help cover out-of-pocket costs for medical expenses they expect to incur during the year while you are paying the deductible on your Major Medical Plan. When used alone, they can cover the cost of doctor visits, routine care, and prescriptions, and they are less expensive than Major Medical and STM plans.
  • Critical Illness Insurance – Critical Illness plans provide large lump-sum cash benefits for individuals if they become diagnosed with a heart attack, stroke, or cancer. The benefits can offset the expensive medical care for those covered illnesses.
  • Accident Insurance – For healthy individuals, the primary threat of sudden high medical bills comes from a massive injury or accident. Accident insurance protects specifically against that, with lump-sum cash benefits for qualifying injuries, including loss of a limb or physical mobility.

Your Options for Affordable Health Insurance in Reading PA

We Can Help with All Off-Marketplace Options

We offer affordable health insurance in Reading, and elsewhere, on America’s largest PPO network – the Multiplan PPO Network, a network that has led the way in:

  • Extending network access for its highly mobile membership
  • Containing out-of-network medical cost
  • Preserving its relationships and reputation with the local provider community

Multiplan has strengthened its bill review and network services by:

  • Using analytics tuned to find wasteful or abusive medical billing practices not identifiable by more automated bill review programs
  • Implementing resolution strategies appropriate for the severity of issues and nature of the provider relationships

Our Agents Can Help Simplify Health Insurance

If you need affordable health insurance in Reading PA, or elsewhere, you can obtain a free health insurance quote by filling out the form on this page or by calling our local phone number. Our local manager, Dan Rhoads, is a health insurance specialist who will work with you to develop a plan that provides the coverage your family needs at a price you can afford.[/vc_column_text][/vc_column]

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Anyone who’s had a high deductible healthcare plan knows – they don’t work.

High deductible healthcare plans were designed to reduce the overall cost of coverage while maintaining high maximum benefits. In essence then, they only offer coverage if your health really takes a dive. For that type of coverage, you might as well have critical illness insurance.

Health wonk Joe Paduda even says:

Instead, patients avoid care they should get, go bankrupt trying to pay sky-high deductibles, and even worse, don’t do a damn thing to get high utilizers to modify their lifestyle or care decisions.

Lazy benefits managers and employers looking for a quick fix to rising premiums continue to tout HDHPs despite the warning signs. Now, over a decade after these plans first became widely popular, some employers are finally getting the message.

I’d go so far as to argue that HDHPs help drive health care costs up; sick folks get sicker because they can’t afford preventive and routine care, while the 20% of members who incur 80% of the healthcare costs blow thru their deductible in March and then have no financial inhibitions.

It just doesn’t make sense that way. Save money by getting a solid fixed indemnity plan, and life insurance with living benefits (critical / chronic illness benefits). Your wallet will thank you.

 

I Wish You’d Had Life Insurance …

We all have stories of life insurance (or lack of it) effects us when a loved one dies. For a colleague of mine, it was about five years ago, living out West with her husband and teenage son. One day, they received a call that their son had died in a car accident – he’d fallen asleep at the wheel.

Her husband (the son’s step-father), had to work the day of the funeral in order to scrape together the money to pay for the funeral.

I can’t imagine that. They couldn’t afford to grieve.

Six months later, tragedy struck my friend’s family again. Her husband died unexpectedly, again with no life insurance. With no way to cover the funeral or the mortgage any longer, she lost the house.

That’s right, within a year, she lost her son, her husband, and her house. She had no way to survive, so she had to move across the country and move in with relatives in North Carolina. It took her 3 years to get back on her feet.


My personal story is about what could happen to my family if something happens to me.

My first career was a s a biomedical scientist, but from about 2010 to 2015, I was living in an area where there weren’t jobs in my field, and I was broke. I had a wife and two young children who depended on me, and I was broke. The strain ruined my marriage, and I had to move to earn money to support my children.

I saw what financial problems did to my family, and the people that I loved. It broke my heart. I’m doing better now, but not so much better that I don’t worry about what could happen to them if I wasn’t supporting them financially. It kept me up at night.

Life Insurance (and Health Insurance) helps me sleep better at night.

I spend close to 10% of my income on life and health insurance because I want to sleep better at night. I want to know that:

  1. if I die, the money will still be there to allow my daughters to attend college.
  2. if I have a heart attack or cancer, I’ll have my medical expenses covered and money to continue supporting my daughters.
  3. I can affordably go to the doctor to make sure that (1) and (2) don’t happen.
  4. and I gain cash value with these plans that allows me to retire one day. I don’t want to have to work until the day I die.

I have three plans to help me do that:

First, I have a fixed indemnity plan as health insurance on myself, as an affordable way to see the doctor if something happens to me.

Second, I have guaranteed universal life plan on myself, with critical and chronic illness benefits, so that if I die, get cancer or can’t work any longer due to illness, I’ll have money to replace my income and (if necessary) bury me with.

And third, I have an IUL that grows interest on the cash value of my life insurance, so I can retire one day.

I have all of this, because I want to sleep better knowing my loved ones will be okay.

Dan @ Rhoads Insurance Group

The Rhoads Insurance Group loves helping families save money, with health insurance as well. That’s why we work with the Multiplan PPO network plans.

 

What is the Reading Multiplan Network?

Reading Multiplan started in the 1980’s as a regional NY hospital network, and has grown to be the largest PPO in the US, with over a million healthcare providers in network. They’ve grown so much because of the value that they provide to both insurance companies and to consumers. With payment integrity, they help insurers reduce the cost of care, which those insurers pass along to consumers with more competitive rates vs benefits. And with a flexible network structure, covering all specialties in the entire United States, this PPO truly makes healthcare flexible.

 

A Better Reference for Pricing

There is a growing trend among health insurers to base reimbursement for claims on Medicare reimbursement rates, under the name of Reference-Based Pricing. The problem is, Medicare is not only a flawed valuation for many healthcare services, but it also can deliver unintended consequences. The better measure is one that more directly ties to a doctor’s or hospital’s own costs.

 

Extending the Power of Bill Review

Reading Multiplan uses analytics tuned to find wasteful or abusive medical billing practices not identifiable by more automated bill review programs, and implements resolution strategies. That means that when you go to a doctor who is in-network, you can trust that you’re not being over-billed; every in-network doctor has had their billing practices reviewed before joining the network. And it also means that for every medical bill, there is a negotiating team in place.

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

Reading Multiplan is a PPO network that many insurance plans can use for their healthcare payer services. That means that this great network fosters even more competition – there are many plans out there that work on this network, all getting cost-reducing benefits from the network, and all vying to earn your business by passing on those savings.

Contact me today to hear more about the options we can provide at the Rhoads Insurance Group.