Personal Injury/Accident Protection

If you are self-employed or work for an employer who does not carry Workers Compensation Insurance, you can purchase your own “Personal Injury/Accident” plan. You could receive cash benefits for your injuries, whether you are hurt on or off the job!  Your receipt for treatment of an accidental injury by a doctor, emergency room, or urgent care facility will trigger payment of funds based on your plan’s payment schedule.  You use the money however you wish, regardless of health insurance coverage.

Most accident plans have a fixed benefit that they will pay a client for items like: emergency room treatment, dislocated or broken limbs, severe lacerations or burns, eye injuries, hospital stay, ambulance transportation, and other common injuries.  Many even provide an accidental death benefit, which is payable to one’s designated beneficiary.  It doesn’t matter whether your medical treatment was covered by a health insurance policy or if you paid for it yourself. Proof of the injury is what justifies payment of your claim.

These accident policies are available for individuals or families. This protection could greatly reduce parents’ financial expenses if their children were injured while participating in sports.  If a family member is involved in an accident on vacation far from home, it does not affect your eligibility for benefit payment…there are no “Network” restrictions on who provides the emergency treatment.  Just be sure to get an itemized written receipt for treatment of those injuries from a medical professional.

Many policies have multiple levels of coverage, and their premium cost is relative to the amount of compensation paid to the insured for each specific injury category. Therefore, if your risk/danger of injury is high due to your occupation, lifestyle, sports participation, or hobbies, it is wise to consider a higher level of protection.  Those are all factors which affect your odds of experiencing an accidental injury!

Remember, your plan must already be in effect, in order to pay benefits for any accidental injury.  A licensed independent insurance agent from AustinHealthPlans.com can provide you with details and no-obligation quotes.  This coverage could save you hundreds of dollars if you sustain a serious injury!   Contact us at: Ph  (512) 535-3556 or e-mail:  tom@austinhealthplans.com

Wishing you a Happier New Year in 2016!

Happy New Year to all my neighbors in Dripping Springs, Austin, and other nearby communities! I want to thank those of you who have followed my articles over the years, and especially those who have given me the opportunity to serve as their local insurance agent.  These are difficult times that present many challenges in the area of healthcare.  As a self-employed individual, my family and I are also affected by the higher rates, smaller networks, reduced benefits, and fewer companies from which to choose.

If you are unhappy with these unprecedented negative changes, why not write to your congressmen in Washington, D.C. and voice your opinion? We have experienced significant rate increases for three years in a row, from all of the major health insurance companies in our area.  Two major companies in Central Texas have decided not to renew many of their individual PPO plans for 2016.  Also in the last few years, three additional major health insurers chose not to sell ACA-Compliant insurance plans in our area.

The Open Enrollment will be over on January 31^st.  If you don’t take care of business by that date, the only way to get a new health insurance plan later will be if you experience a “qualifying life event”.  Those special enrollment periods include: birth or adoption, death, marriage, divorce, loss of qualified health insurance, moving outside your plan’s coverage area, etc.  However, Short-Term Major Medical insurance plans, can be sold throughout the year, although these are NOT ACA-Compliant.

Supplemental insurance plans like dental, vision, personal injury/accident plans, disability plans, hospital indemnity plans, cancer plans, long term care, and life insurance can be purchased throughout the year. Except for dental, vision, and accident plans, most of these other types of insurance require underwriting evaluations, based on medical history and pre-existing conditions.  Apply while you are in good health!

A licensed independent insurance agent can help you with free quotes for any of these supplemental insurance plans. When you request an agent to enroll you in an insurance plan, that agent represents your interests if there are ever problems with your insurance company, with no fee charged for their services!  Call AustinHealthPlans.com at: 512-535-3556 or send an e-mail to: Tom@austinhealthplans.com and request details about securing great coverage for your insurance needs today!

Getting ready for Medicare Insurance soon?

If you are about to turn 65 in the near future, information in this article may be very beneficial to you.  As a taxpaying U.S. citizen, you will finally be able to enroll in Medicare health insurance!  For most people, the expense for this new health care coverage will mean a significant reduction in premiums, especially if their current individual insurance is through a private off-market plan.

Most individuals will automatically be eligible for Medicare Part A (hospital coverage) when they turn 65, if they or their spouse paid Medicare taxes while they were working.  Medicare Part B helps with the cost of medical treatment from doctors, etc. outside of a hospital setting.  However, in order to be insured for medical treatment for Part B, you must actually apply for coverage through the Centers for Medicare and Medicaid Services (CMS) within a certain specific time period.  If you are eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes your birth month, and ends 3 months after the month you turn 65.  (It is usually a good idea to begin the application process as soon as possible.)

Once you have applied for your “Original” Medicare Parts A & B, you will then have some other options to consider.  You can add a prescription drug plan, known as Part D, if you like.  Many people want additional coverage to help with those expenses that are not included in Parts A, B, and D.  (Medicare has certain limits and does not cover all medical costs.)  There are two different ways to achieve this higher level of protection.

Most major insurance companies offer a Medicare Supplement, commonly referred to as a “Gap Plan” or “Medi-Gap”.  As the name implies, these supplemental plans help to fill the gap for those costs that Original Medicare does not cover.  The second choice is to consider applying for a “Medicare Advantage Plan”.  These plans can be purchased with or without a prescription drug plan (MAPD) or (MA), and are required to provide coverage for the same benefits as Original Medicare Parts A & B at a minimum.  They usually cover some added benefits as well.  If you choose a Medicare Advantage plan, you will receive your benefits from a private insurance company instead of the U.S. government.

There is a lot of information to review and evaluate.  It’s a good idea to take the time to consider which method will provide you with the best benefits and at the right cost.  Contact a “Medicare-Certified” agent for more in-depth details so you will be prepared when the time comes for you to enroll for your Medicare benefits.  There is no fee for requesting the assistance of a certified agent!  If you live anywhere within the borders of Texas, Austinhealthplans.com can help you get started.  Call 512-535-3556 or send an e-mail message to: Tom@austinhealthplans.com.

Is Health Insurance cheaper if I get it by myself?

In our modern high-tech society, is there really any reason to ask an insurance agent to assist you in finding the health insurance that best suits your needs?  Isn’t that what people used to do 25-30 years ago, before the Internet, computers, and e-insurance?  Everyone knows that they can find whatever they need to know about any subject via the help of their computer.  Using an agent is old-fashioned, right?

I’m sure there are some people who believe that to be true.  The majority of American households have at least one computer. Every second more data is added to the Internet’s ever-growing collection of facts.  There’s a whole universe of knowledge available for us to access.  Health insurance benefits and details can be reviewed and compared without having a college degree!  Why should I involve an agent/broker in purchasing my health insurance?

A significant percentage of my clients have expressed their disappointing experiences, after they initially purchased health insurance on their own!  For example, they mistakenly thought their doctor would be in their plan’s Network.  (“Out-of-Network” benefits are almost always greatly reduced from “In-Network” coverage!)

Another major consideration is if a client should ever encounter difficulty in getting satisfaction in a claim dispute, the computer will only be a limited resource in dealing with your insurance company.  When you have your own “independent insurance agent”, that person represents YOU.  Your agent/broker will work through a local or regional representative to help to resolve problems.  Agents develop a working relationship with these representatives over time.  The agent can request the assistance of their local rep to review restricted information that the client cannot access on their own, not even with their home computer.

Often by contacting his/her representative, your agent will be able to achieve a favorable outcome, when there is a misunderstanding or a mistake in the details.  If a client disagrees with the fees listed on their EOB (estimate of benefits) for example, they can bring this matter to their agent/broker to help determine if the charges are accurate and justified.  Your agent has experience in many areas of the health insurance field, and this is an asset when the client needs answers to billing questions, plan benefits and details, etc.

Since there is no fee to request the assistance of an experienced, licensed agent, why would anyone want to spend hours of their time in getting quotes, checking doctors’ network participation, comparing the benefits of dozens of health plans, etc?  Most independent brokers can furnish you with fast, free quotes from several different major insurance companies…not just one!  For best results, it is wise to take advantage of the knowledge and experience a professional can provide.

Lastly, consider this fact: Your health insurance premium will cost the same amount, with or without an agent!  It’s your choice.  You could save money, time, frustration, and possibly regret, if you contact an independent licensed agent to find an inexpensive health plan.  An agent represents YOU! 

HSA’s Can $ave You Money!

 

In previous articles I offered some suggestions on how to save money by being healthy.  Maintaining a healthy lifestyle plays a big role in keeping your medical costs down. Regular exercise can reduce body fat, lower blood pressure, and help you to release stress.  We all know the importance of eating a balanced diet, taking supplements, drinking purified water, breathing clean air, getting enough sleep, and teeth brushing.  If you smoke, consider quitting.

Those who are in good health and have created a healthy lifestyle spend less money on medically-related expenses.  Their primary interest in health insurance is protection against any expensive treatment for unexpected, undiagnosed major illness or serious injury.  They do not need to see their doctor very often since they don’t have serious health conditions. Therefore, since the risk of frequent medical treatment is low, they can choose a high-deductible health plan, saving money through lower monthly premiums.

Did you know you can also save money by lowering your taxes at the same time?  There are qualified HDHP’s (high-deductible health plans) that allow you to do both; offering you lower monthly premiums AND helping you to lower your taxable income!  If you choose this type of health plan, you can open a Health Savings Account or HSA, and deposit funds to pay for medically-related expenses. Some of those allowable expenses include out-of-pocket medical, prescription, chiropractic, dental, and vision costs. At retirement, you can spend any remaining funds on ANYTHING you like.

You can deduct your HSA contributions on your Federal Income Tax Return, even if you do not itemize!  Distributions are tax-free if you pay for qualified medically necessary expenses.  Many banks and credit unions can show you how easy it is to open one of their HSA’s, and provide you with more details.  To learn more about HSA guidelines, see IRS Publication 969 at www.irs.gov.

A licensed independent health insurance agent can help you select an HDHP from a variety of qualified health plans that are available through many different insurance companies. Contact AustinHealthPlans.com at (512)535-3556 or send an e-mail to: tom@austinhealthplans.com and request a free quote.

Bridging a Health Insurance Gap

If you are currently without health insurance, but anticipate the availability of new coverage in the future, there is a way to get short-term coverage for this temporary need. Several notable insurance companies offer “Short-Term” health plans, to protect you from the high cost of hospitalization and more.

Here are some situations in which a short-term health plan could be useful. Perhaps you have lost health insurance coverage due to a job change, or some life event change. Maybe you are a recent graduate who has found a job, but must complete a probationary period before being eligible for the employer’s insurance plan. Many part-time or seasonal employees are not eligible to participate in a group health plan.

Once a person reaches age 26, they can no longer continue coverage through a parent’s plan. Some retirees may need health insurance protection before they become eligible for Medicare. For others, the cost of regular ACA-compliant health plans may be considered too expensive, compared to the lower rates for short-term insurance.

Most short-term health plans will have a limit on their maximum benefit amount. For some it may be $250,000 or up to $1,500,000 in maximum lifetime coverage. (Note that as of Jan.1, 2014, a requirement for all ACA-compliant health plans is to have NO LIFETIME LIMITS.) Some companies will offer coverage on their short-term plans for up to 11 consecutive months.

Normally these plans require an applicant to answer a few health questions about current or previous health conditions. Serious pre-existing conditions like cancer, heart problems, stroke/brain problems, diabetes, HIV/AIDS, etc. will prevent the issuance of these plans.

Further, less serious pre-existing health conditions will not be covered, although they do not prevent an applicant from getting insurance. Certain plans provide doctor visit copays, but most do not. Most benefits are subject to the insured meeting their deductible first.

The time one is covered on a short-term plan will not count toward the required 9 months minimum coverage to avoid a penalty, since they are not ACA-compliant. A licensed health insurance agent can provide you with further details and discuss your options and rates.

AustinHealthPlans.com can answer any questions you have and provide you with fast, free quotes.  Contact us at: tom@austinhealthplans.com or call: (512) 535-3556.

Should One Health Plan Fit All?

As healthcare costs continue to rise, we have been using various ways to make our health insurance more affordable. Eliminating the doctor visit copays and/or the prescription drug copays from your major medical plan can definitely save money on your premium. So if you are normally healthy, not accident-prone, and seldom need to take prescription medications, eliminating copay benefits would probably suit you and your wallet.

Another means of cutting cost is with a high-deductible health plan; the rate is usually less expensive than health insurance with a low deductible. This option is based on the risk (hope) that you will not be in a medical situation which will require you to meet that deductible, and it is more practical for healthy individuals. You accept more of the financial responsibility with the high deductible, and therefore pay a reduced premium.

Yet another way to trim your health insurance expenses is to enroll in an HMO health plan, rather than the more traditional PPO type. HMO plans generally cost less in comparison to PPO plans which have the same benefits, deductible, and maximum out-of-pocket responsibility. The main trade-off is network restrictions.  HMO networks tend to be smaller than PPO networks.

If you don’t feel compelled to stay with a particular physician because of a long medical treatment history, you could select a primary care physician (PCP) from an HMO network, who would then refer you to specialists when necessary. However, there are NO out-of-network benefits, so be sure to choose from their network provider directory.

Most couples tend to share the same health insurance plan. They are not obligated to do this; it is merely their choice. If one spouse has excellent health and seldom needs medical treatment, but their partner has a health condition which requires frequent doctor visits, lab work, imaging/x-rays, therapy and prescription drugs, those folks obviously have different health insurance needs!

Why should they both pay a higher premium for a low-deductible copay plan, when only one person uses the full benefits of that insurance? The healthier person could save money by getting their own separate higher-deductible health plan, possibly with no copays as well. In health insurance, one plan does not fit all!

Does your plan suit you?  If not, contact AustinHealthPlans.com at (512) 535-3556 or send an e-mail to: tom@austinhealthplans.com.  We will discuss your situation and make recommendations for several options.  There is no obligation and no fees for our services.  Get a free quote today!

Can I still enroll for Health Insurance after Open Enrollment ends?

Normally health insurance companies will only allow you to apply for individual health insurance during the annual  “Open Enrollment”.  However, the Affordable Care Act still permits you to apply for new major medical coverage under certain special circumstances. Here is a list of the main “qualifying life events” which would allow someone to apply for health insurance after the open enrollment has ended: birth/adoption of a child, marriage, divorce, death of a dependent policyholder, loss of previous employer-sponsored health insurance coverage, exhaustion of COBRA insurance, or loss of eligibility for CHIP or Medicaid.

Additional reasons include: gaining status as a citizen, national or legally present individual, loss of coverage due to a permanent move outside of your plan’s coverage area, termination of a short-term (temporary) health plan, or change in income that affects eligibility for premium tax credits for Marketplace enrollment only.

Penalties for not having a “qualified” health plan for at least 9 months in a calendar year, will be assessed based on the number of months one is not insured with a qualified major medical plan. You can minimize or prevent this penalty depending on how many months you maintain at least the minimum essential coverage.

Based on adjusted gross household income, some low/middle-income applicants may be eligible for savings on their health insurance premiums, by applying through the Health Insurance Marketplace.   To be eligible for consideration, an individual’s gross adjusted household income must be between 100% – 400% of the Federal Poverty Level (FPL).  Even if they do not qualify for a premium tax credit, they could still apply for an “Off-Marketplace” regular ACA-Compliant health plan, without financial assistance.

Most insurance companies offer traditional qualified PPO plans, but rates are generally higher than last year. If having a more affordable health plan is a priority, many insurance companies also have HMO health plans available at lower rates. HMO plans are still qualified major medical insurance, but they have certain Network restrictions.

You can get answers about health insurance questions by contacting a licensed independent health insurance agent at AustinHealthPlans.com.  There are never any fees for quotes or other services.  An agent will assist you in choosing an appropriate, affordable health plan and help with the completion of your application.

Contact us at: tom@austinhealthplans.com or call (512)535-3556 and let us know how we can help you.  We are “Tejas” friendly and serve clients throughout the entire state!

Were you ever declined for Health Insurance?

Are you one of millions of frustrated Americans who were told they did not qualify for traditional major medical insurance because of a “high-risk” pre-existing health condition?  Well as of Jan. 1, 2014, you can no longer be declined if you had/have Diabetes, Cancer, Heart Disease, Rheumatoid Arthritis, Alzheimer’s Disease, or any other serious health problem.  Additionally, new individual health plans will also provide benefits for Maternity.  (Maternity is not currently covered on individual health plans!)

On October 1^st, you will be able to choose from a variety of affordable health plans, regardless of your health!  That’s right, “Open Enrollment” through the Health Insurance Exchange program will begin on that date, and coverage for those health plans will become effective Jan. 1, 2014.

The determination of rates for these new “Qualified Health Plans” (or QHP’s) will only consider the following criteria: age, geographic location, single/family status, and tobacco use.  No exclusion riders or additional rate-ups can be imposed due to a person’s build (height/weight ratio), gender, prescription drug use, or health issues!

The Affordable Car Act requires these new QHP’s to be offered with several different deductible levels and coinsurance choices.   These non-grandfathered plans are required to provide a minimum of 10 Essential Health Benefits (or EHB’s).  You can refer to this list of EHB’s by visiting this link on the cms.gov web site: http://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html .   No “lifetime dollar-limits” or “annual dollar-limits” of benefits will be permitted as of Jan. 1, 2014.

Applicants for these certified QHP’s through The Exchange may qualify for a premium tax credit.  Subsidies will also be available through a cost-sharing provision.  Individual/family household income will be considered for eligibility for these two types of assistance.  Eligibility for these premium-savings options will automatically be determined during the application process.

There will continue to be individual/family major medical insurance offered “Off-Exchange”, for those who do not choose an “On-Exchange” QHP, or employer-sponsored group insurance.  The new “Off-Exchange” plans must also provide the required minimum EHB’s, and accept ALL applicants regardless of health conditions, Rx use, gender, or build.

We can help you compare your benefits on your current health plan, and offer our insight and suggestions for your 2014 coverage options.  For additional details or for answers to your questions, contact a certified Exchange agent at AustinHealthPlans.com by calling: (512) 535-3556 or e-mail at: tom@austinhealthplans.com.

Information About the New Health Insurance Exchange Program

Americans can enroll for health insurance through their State or Federal Insurance “Exchange” beginning on Nov. 15, 2014 through Feb. 15, 2015.  However, regular “qualified” individual and group plans will still be available “off-exchange”, and will satisfy the mandate for being insured.   The Affordable Care Act requires that everyone (with a few exceptions) must have qualified health insurance  After Jan. 1, 2014, or pay a fee/tax.  Each year the penalty, which is based on a certain percentage of one’s income, is scheduled to increase.  IRS will oversee the taxation.

Millions of lower-income Americans will benefit from participation with Qualified Health Plans (or QHP’s) offered through the Federal or States Exchanges.  Subsidies and premium tax credits will be available for those whose incomes are low enough to qualify.  Persons whose incomes exceeds the maximum qualifying amount, will still be able to find individual insurance “off-exchange”.  After Dec. 31, 2013, pre-existing health conditions will no longer cause any applicants to be denied health insurance, a major component of Healthcare Reform for Americans!

The health plans from the Exchanges will be Major Medical insurance, with a variety of deductibles and coinsurance percentages from which to choose.  Doctor visit “copays” will be included on many plans, and all plans will have a “maximum out-of-pocket” responsibility limit per year.  With HMO plans, there will be no benefit coverage for services which are performed at “Out-of-Network” facilities or by “Out-of-Network” providers (physicians, etc.).  These Networks will likely be smaller than most traditional PPO networks!  Be sure that you know whether you are choosing an HMO or a PPO health plan.  It will be indicated as either one or the other.  Not all major insurance companies will participate in the Exchange program in every area.  Ask a certified agent which companies will be available where you live.

Review your current insurance policy’s benefits summary and plan details!  It may be advisable that you consider enrolling in a new health insurance plan if your existing one was issued before Sept. 23, 2010.  Plans prior to that date will be “grandfathered in” and will not have to include those “10 essential health benefits” that will be required on plans issued Jan.1, 2014 and later.  For details about these newly mandated essential benefits, go to:   https://www.healthcare.gov/glossary/essential-health-benefits/ .

Also, plans issued after Sept. 23, 2010 allow children up to age 26 to be included on a parent’s plan, and they cannot be denied coverage if they are under age 19, due to pre-existing health conditions.  (However, they can be assessed a higher rate due to increased risk factors.)  All plans issued after this date must provide coverage for one free annual preventive exam per person.

If you do not enroll in a major medical health insurance plan by the end of “open enrollment” (Feb. 15, 2015) you will not be able to get insurance through the Exchanges again until the “annual enrollment”.  You must, however, have health insurance coverage for at least nine months in 2015 to avoid the tax.  If you experience a “qualifying life event” (QLE), that exception will allow you to apply for health insurance within a certain short period of time.  Some QLE’s are: marriage, divorce, birth, adoption, death, loss of health insurance or a move outside of your current plan’s area.

“Certified agents” and “navigators” will be permitted to enroll you in a plan from the Exchanges.  After reviewing your current insurance policy, why not ask a helpful agent at AustinHealthPlans.com to explain your options?  New individual/family “Off-Exchange” major medical plans will still be available for those who do not choose plans through the Insurance Exchange program.  There is no charge for our services and we can often generate quotes within 24  hrs.  Contact us at: (512) 535-3556 or through e-mail at: tom@austinhealthplans.com for further details.