Here are all the articles I've written about Health Insurance. Enjoy!

July 17th, 2017

Pack your bags – we’re goin’ on a trip around the world!

The Insurance Mom mentioned in last week’s post that there seems to be a huge misunderstanding of how America’s health care delivery system compares to those of other countries.   The divine Michael Lujan, shares his expertise:

The UK Model – In this mostly single-payer model, healthcare is provided and financed by the government through taxes. Except for small co-pays for prescriptions, there are no co-pays or deductibles as health care is delivered as a public service, like fire and police. With Britain’s National Health Service, most doctors and hospitals are owned by the government and patient wait times can vary by region or treatment type. As the sole payer, the government controls what doctors can do, and what they can charge. Our Veterans (VA) system is a close example. They also have private insurance options.

The Canadian Model – With this “National Health Insurance model”, the providers are private but the payer is a government-run insurance plan everyone pays into. Our Medicare system is a close example of this model. The private insurance plans are non-profit and manage their costs by limiting or delaying care.  Canada’s decentralized health system (coincidentally called “Medicare”) is technically a multi-payer system with slight differences for each of their ten provinces and three territories; some provinces/territories have co-pays at the point of care and others don’t.

The German Model – In this multi-payer system, providers and payers are private and largely funded through employer-based payroll deductions. Patients have co-pays at the point of care. The world’s first national health system (established around 1883) offers citizens 135+ private insurance plans called “sickness funds”. These private insurers negotiate prices with private hospitals and providers. Patient wait times are shorter than U.S. patients typically experience. This is the system most familiar to most Americans and might be …

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July 7th, 2017

Is Health Care A Right or a Privilege? (more brilliant comments from the amazing Michael Lujan)

Inspired by the great Michael Lujan and his post on LinkedIn.

At the center of the debate is this simple but loaded question. Every other developed nation has answered the question and enacted some form of universal health coverage (UHC). Proponents of the bill often make comparisons to the Canadian or the UK health systems. These comparisons are inaccurate, deliberately misleading, or possibly uninformed. The term “single-payer” refers to the financial arrangement; meaning one entity (the government) collects the funds (usually in the form of taxes) and this “single payer” also pays the providers. In a single-payer model, the providers can be private or government-owned. The government replaces the insurance company role and instead of paying premiums, Californians would pay for health care through higher taxes.

“When you look at all the different health care systems around the world… They are not all single-payer… and most are less socialized than America’s.” – T.R. Reid

Visit us next week when The Insurance Mom shares a comparison of four health care models around the world.…

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June 30th, 2017

What a difference a week makes! SB 562 Update

Thanks for tuning in for our series on single payer!  What a difference a week makes; big update on SB 562.

On Friday, 6/23/17, CA Assembly Speaker Anthony Rendon (D-Lakewood) shelved the proposal saying it is “woefully incomplete” and has postponed any further legislative action until January 2018.

“If you think health care is expensive now, wait until you use what it costs when it’s free.”  – P.J. O’Rourke

The Insurance Mom’s colleague, Michael Lujan (one of CA’s best-known expert insurance legislative analysts) offers this in his amazing post on LinkedIn:

Single Payer (SP) would:

  • Replace all forms of private and public health insurance in California with a state government-run health system.
  • Would eliminate an estimated half million insurance, health care administration and related jobs, tripling our current unemployment rate. And without payroll contributions going into the system, there will be no money to pay unemployment benefits.
  • Could make California a health care destination for anyone seeking “free healthcare” as neither citizenship, nor permanent residency is required to use the SP system.
  • Requires massive tax increases. The additional 15% payroll tax would make California the highest taxed state in the country.

If enacted, The Healthy California Act (SB 562) would be the largest tax increase in California’s history. The entire state general fund is $183 billion. As proposed, the bill would cost an estimated $400 billion for the initial year and unknown costs for subsequent years. While that may seem like a deal-killer, the bill moved forward to the State Assembly and should not be ignored (when it resurfaces in 2018).

While this bill may be dead in the water, single payer / universal healthcare / socialized medicine / Medicare-for-all have been floating around the brains of the public.  The Insurance Mom wants her kiddies well-informed about …

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June 23rd, 2017

What’s going on with healthcare today!?

Are YOU confused?  We all are!  There are some VERY big things being discussed right now regarding health insurance.   But we read all the articles and boil it down into an easily digestible stew.  Here’s the inside scoop from The Insurance Mom!

While a lot is happening in Washington, there’s even more urgent things happening here at home in CA.

SB 562 — The Healthy California Act — is working its way through Sacramento right now.   You probably won’t get to vote on it.

State Senators Ricardo Lara (D-Bell Gardens) and Sen. Toni Atkins ((D-San Diego) say they know what’s best for their constituents.   They say… “all Californians will have one plan, more choice.”  Huh?  What does that mean??

Welcome to Our Blog Series

The Insurance Mom wants her insurance family to be informed, insured, and inspired to engage in the future of health care.  That’s why I’ve written a blog series about Single Payer Health Care.  Tune in next week for some truly EYE-OPENING info on our insights of these concepts.…

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May 11th, 2017

Are AHCA concerns making you sick? Pre-existing conditions and MacArthur and more….

Holy cow, folks!  What a crazy time for health insurance!

Politics aside, The Insurance Mom wants you to be really, totally clear about what’s happening in the wacky world of health insurance.

The first thing most clients ask me these days is about pre-existing conditions.  What if I have an illness before I buy health insurance?  What if my sick child loses coverage?  “What-ifs” all over the place!

All we can do right now is breathe.  We don’t know what’s going to happen with this bill (it’s not a law yet!).  But I did want to shed some light on the latest MacArthur Amendment.

The LA Times did an EXCELLENT article on just this issue here:  http://www.latimes.com/business/lazarus/la-fi-lazarus-gop-healthcare-macarthur-amendment-20170504-story.html

Here are a couple of excellent quotes… but the whole article is awesome.

“And it protects people with pre-existing conditions much as starving people may be welcome at a restaurant, but only if they order the most expensive dishes on the menu.”

“This much is clear: Republican lawmakers have provided a textbook example of how not to enact major legislation.  They’re aiming to radically overhaul the $3-trillion U.S. healthcare system yet have shunned the input of major stakeholders such as medical organizations, hospitals and patient-advocacy groups, which are uniformly against the measure.”

What do YOU think, my lovely peeps?  Do you believe everyone should help pay for the sick?  Did you like the old way of doing things before the ACA?  Do you benefit from Obamacare?  Do you hate Obamacare (aka ACA)?  Tell The Insurance Mom your every little thing!…

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April 18th, 2017

Have You Heard? BIG changes coming to health insurance in 2018! BEWARE – BE AWARE!!

In 2018, if you’re buying individual health insurance for you and the fam (not through an employer),  PAY ATTENTION!
Open enrollment is scheduled to start NOVEMBER 1, 2017 (for new coverage starting January 1, 2018)
NEW RULE:  
Open enrollment will ONLY be for FORTY-FIVE days, ending December 15th.  That’s half of what it’s been in prior years.  YES!!!  No kidding.  PAY ATTENTION!!  
Health insurance will be harder to buy – or change —  in 2018. So The Insurance Mom wants you to really PAY ATTENTION!!  Outside of Open Enrollment (after 12/15/17) you’ll have to seriously PROVE that you’re eligible to buy health insurance or make changes to your plan.  It’s called a Qualifying Life Event.
 
MORE CHANGES:
  • The new rule could reduce the amount of federal subsidies that currently make premiums more affordable for low- and middle-income people
  • The new rule could allow insurance companies to offer even skinnier networks
  • The new rule could make coverage skinnier, too
PAY ATTENTION!   New regulations do NOT require Congressional approval… just the signature of a President.  If you’re not happy with the way things are going and are worried that you could lose the coverage you have, The Insurance Mom encourages you to contact your Members of Congress.
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March 13th, 2017

Is TrumpCare my Care??

The Insurance Mom is back to blogging after a very busy Open Enrollment!  Thank you to all our followers and lovely clients who sent along referrals.  We are very grateful for you!

 

It’s been an interesting end of 2016 and beginning of 2017.  With that, we are seeing a TON of proposed changes that could affect your health insurance.    But, we probably won’t know for quite some time.   Remember, it takes a while to un-law a federal law!

 

But what’s it all mean, Mom!?  My brain hurts with all the HSA, tax credits, tax penalties, cross-border, stuff!
Well, that’s why I’m here, sweetie!  To take your hand, and tell you to take a deep breath because it’s going to be a long time before we see any changes take places.  And so far, no one can seem to get close to agreeing what those changes will be.  Now that we’re all feeling a little better, let’s get back to our health insurance education.

 

Here’s a great article from the fabulous team at Vox which does great work at explaining things in a simple way.  But the gist is this… Trump proposes these things:

 

  1. Pre-existing conditions will not affected.
  2. The tax credit thing is going to change, likely based on age not income.
  3. Trump and the GOP really like Health Savings Accounts (HSAs).
  4. He wants to remove the plan restrictions.  So that whole metallic thing will likely go away and companies can design their own plans again.
  5. Trump is a little unclear about the Medicaid situation, but the GOP seems to want to decrease Medicaid enrollment.
  6. Trump would like to reduce costs of insurance and drugs.

 

Here’s the Insurance Mom’s takes on these things, by the numbers:

 

  1. Goodie.
  2. The GOP’s current proposal called the American
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October 3rd, 2016

Open Enrollment is almost here– Are YOU Ready!?

 

Calling all insured and soon-to-be-insured!  Open Enrollment is JUST AROUND THE CORNER…. November 1 through January 31st.  Have you made an appointment to talk to your Insurance Mom?

We posted this back in August in preparation and wanted to remind you what’s new for 2017.  Please review!

——————————————————————————————————————————————

Are you ready for health insurance news for NEXT year??   Sit, get cawfee, or a cocktail and let’s tawk!

This interesting article from the NY Times and this one from the Free Beacon each have loads of important info, but here’s the gist.

The SAME news: the NEXT open enrollment period will be 11/1/16 through 1/31/17.

The HAPPY news: Obamacare will be rating health insurance plans based on how many doctors and hospitals are in their networks.  BUT (as I am your interpreter of bulls*#$) this doesn’t necessarily mean that doctor networks are going to improve for individual plans.  It just means there might be more transparency for you to be able to make informed choices.

The PHEW! news: there’s a new requirement next year called “continuity of care.”   What do you do if your doc leaves your network?  Often they leave or get dropped from the network without any heads up to YOU.  BUT in 2017, if you’re in an “active course of treatment,” you’ll (hopefully!) be able to continue seeing the doctor if they leave the network.

The BAD news: out-of-pocket maximums are going up.  WAY UP!  In some states, they’ll increase from $6500 to $7150 for individuals, and from $13,000 to $14,300 for families.

The YUCKY news: The Beacon article anticipates that deductibles in most states will see increases , too.   No, we don’t know what the increases will be… yet.

The WORST news: hold on to something…  premium increases are on the horizon for 2017.   No, we …

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August 17th, 2016

“What’s Up, Doc?” Blog Series Part 11: All Better… But OUCH, This BILL!!

Oodles of gratitude for taking this virtual trip to the doctor with us!  Here’s even more in the series “What’s Up, Doc?”  Catch up with parts one, two, three, four, five, six, seven, eightnine, and ten.

And now, our last in the series… “All Better… But Ouch, THIS BILL!!”

  1. Your doctor is IN-network right?    The doctor’s office MUST submit the bill (aka “the claim”) directly to your insurance company.
  2. The IN-network doctor CAN ask you for the office visit co-pay at the time of the visit.    But, for medical services done during the visit…
  3. The IN-network doctor canNOT charge you until after the insurance company applies the IN-network discounts (the negotiated rate).
  4. When you get a bill from the doctor’s office, be sure that the IN-network discounts have been applied.   How do you know?
  5. … because you got an Explanation of Benefits (EOB) from the insurance company!   Check the EOB against the provider’s bill, and THAT’s how you know you’re getting the right discounts.
  6. If the doctor is OUT-of-network you’ll be submitting your own claims to your insurance company – and the doctor can charge you whatever she likes, there are no discounts.
  7. If you have an HMO, you must ONLY see a doc in your HMO group.  There are NO benefits in an HMO if you go to an out-of-network doctor.

Talk to me!  Was this helpful?  What was your fave piece of info?  Suggestions and thoughts are welcome.  And as always, reach out to us for any of your insurance needs.…

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August 10th, 2016

“What’s Up, Doc?” Blog Series Part 10: Fanks, Doc, I Pheel Bmuch Mbetter

Hi again, my friends!  Thank you so much for taking the virtual blog version of a doctor’s office visit with us.  Here is our tenth part in the series, How to make the most of your office visit- a multi-part series.”  Check out parts one, two, three, four, five, six, seven, eight, and nine.

 

And now, a segment we call “Fanks, Doc, I Pheeell Bmuch Mbetter.”  Your clothes are on and you’re out the door.  On your walk to the car, evaluate.  How did you do?  Did you get all your questions answered?  Did you already forget the answers?

 

  1. If you have follow-ups, don’t be shy!  Call the office and schedule a time to chat with the doctor OR email her OR have the nurse practitioner clarify.
  2. What’s next?  Do you need to schedule lab tests?  Do you need to see a specialist?  Make sure they’re IN-network and cross-reference with Yelp and https://www.ratemds.com/ for the best of the best.
  3. About those medications your doctor wants you to try… check out our blog, “Better Living Through (Cheaper) Chemistry!”
  4. Try finding the cheapest price at GoodRx.  Did you know … prices are different from pharmacy to pharmacy
  5. If the drug isn’t in your plan’s formulary, ask your doctor to call the insurance company for Prior Authorization.  If that doesn’t work, you can file an appeal but that takes a long time and doesn’t always work.
  6. If the drugs your doc prescribed are too pricey, go to Canada!  Not really, but check out Pharmacy Checker for discounted Rx costs.  Or you can find discount pharmacy cards online.  OR you can Google the name of the drug + coupons and try that on for size.  Often these options can be cheaper than the cost
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