Regence Blue Shield Announces Reduced Benefits

This month Regence Blue Shield of Washington unveiled significant changes to their Washington health insurance plans. Regence is replacing all their current individual and family plans with their new “Evolve” plans. Although Regence is not yet requiring customers with their existing Washington health insurance plans to move to these new plans, we think that will happen within the next year or so. That means that if you have a current Regence plan, you would be forced to change to one of their new plan designs at some point in the future.

So how do these new plans compare to Regence’s current offerings? From a cost standpoint it seems that in many cases we will see similar costs when comparing new plans to comparable current plans. If the preliminary rate structure they provided is adopted, pricing will not change significantly, rather it is the benefits that will decrease.

The biggest changes are in the areas of coverage and coverage limitations. Some of these new plans contain exclusions that could have a significant negative financial impact on their policyholders. For instance, none of the new plans allow you to see the doctor as many times you like for a simple copay. Instead, their richest benefit plans now only allow you to see a doctor 4 times a year with a copay, after that you’re going to start paying the entire cost of subsequent doctors visits until you have met your annual deductible. Also, in many of the plans the coinsurance (the amount you pay after reaching your annual deductible) has increased, causing a higher maximum out of pocket expense if you were to become seriously ill.

Regence will also join fellow Washington Health Insurance company Lifewise and now charge for each child in a family. Their old pricing structure only charged for up to two children in a family plan no matter how many children are on the plan (Group Health still only charges for a maximum of two children). This was a nice benefit to large families with more than two children that already experience greater expenses due to their size.

So to summarize, Regence is keeping prices for their Washington State Health Insurance Plans relatively stable, but cutting benefits when you do need to seek medical care. Ultimately this shifts the costs from the insurance company to consumers, especially those with more than two children.

Being that Regence is the largest provider of Washington health insurance how will the other providers react to these changes? Time will tell.

Health Insurance Checklist for the New Year

Have you compared rates in the past Year?
New plans are introduced all the time and if you’re healthy you may be able to reduce your monthly premiums. If you consider a higher deductible plan, be sure you can afford the deductible in case of an accident or illness.

Are you paying for benefits you don’t need?
Guys, you don’t need maternity coverage! Ladies, you don’t either if you are past your child bearing years! If you’re paying for benefits you don’t use (like maternity or chiropractic care), you might save money with a plan that excludes those benefits. On the other hand, if you’re paying too much out of pocket for recurring medical services (like prescriptions or checkups), consider a plan that adds these benefits.

Can you save by mixing and matching health plans?
If your whole family is covered under a single plan, you could be missing out on savings. When some family members are healthier than others, or see doctors less frequently, or don’t need certain benefits like Prescriptions or Maternity, you might save by tailoring the coverage to your individual needs.

Have you experienced any big life changes?
If you recently had a child, shift in income or change in marital status – or if you anticipate these events in the year to come — it may be time to change your health insurance coverage.

Have you talked to your broker or accountant about tax advantaged H.S.A. Plans?If you are self employed, or otherwise have an individual policy, there are many great reasons to consider an H.S.A. if you are relatively healthy and don’t need prescription drug coverage.

Pregnant and without Health Insurance?

Naturally, the ideal time to plan for maternity expenses is before you become pregnant. The whole concept of health insurance is to plan ahead, to have medical coverage for potential future events. Not that it is impossible to obtain health insurance for maternity expenses after you become pregnant, but it is much more difficult to get maternity health coverage once baby is on the way. Health insurance companies look at pregnancy as a "pre-existing condition." If a woman applies for health insurance that covers maternity after she becomes pregnant she will be using healthcare dollars, without having paid her share of premiums to cover the expense. That of course defeats the reason insurance works.

So, what do you do? There are several ways to obtain affordable health issuance coverage for delivery and maternity expenses:

First, check to see if you can obtain health insurance through your employer. Keep in mind that if you are working, not all companies provide health insurance, and even if they do, not all employee based group health insurance covers maternity expenses. The first step is to check with your benefits advisor at work if applicable, and see what your health insurance covers. If your plan doesn’t cover maternity or you don’t work for an employer with health insurance available, see what may be offered under your spouse's health insurance plan if available. Even if the specific pregnancy is not covered under your plan, illness or other complications resulting from the pregnancy or childbirth will normally be covered under your regular health insurance.

Second, if you are low income you may qualify for the Pregnancy Related Medical program in Washington State through Medicaid. This is a great program that covers the mother’s prenatal care, labor and delivery expenses, as well as the new baby’s expenses for a period after the birth. There is currently no waiting list for Pregnancy Related Medical as there is for the Washington State Basic Health program.

Finally, if insurance through your employer or your spouse is not an option and you do not qualify for Pregnancy Related Medical through Medicaid, your remaining option is to purchase a private health insurance policy through My Health Insurance of Washington. Of course, if you are buying a policy after you are already pregnant, that pregnancy may still not be covered (there are many ways to get around the preexisting condition however) but at least complications resulting from your pregnancy may be. Since average delivery expenses for a routine birth are around $10,000 (without complications!) it does make sense to pay for individual health insurance, even if the premiums may be several hundred dollars a month. While shopping for a private health insurance policy, keep in mind that most low-cost health insurance plans do not include maternity coverage so be very careful about what you buy. Sometimes buying a “cheap” policy to save a few dollars each month will cost you thousands if the pregnancy is not covered.

How do you figure all this out? Call me, I'd love to help!

www.myhealthinsurancewa.com 1-877-877-9545

Use your health insurance to save money on taxes

Proper planning with respect to how you structure and use your health insurance can really pay off when the tax man comes. I’m not a registered tax planner, CPA, etc., but the next few items should be discussed with your tax preparer.

H.S.A Plans: A prior blog post from August 19^th described what they are and how they work. Amounts (up to certain limits) contributed to your H.S.A account can be deducted dollar for dollar from your top line income on form 1040. In 2008 it came out on the first page on line 25. That’s right, the money is yours to keep (it’s not use it or lose it) and spend on any qualifying health expenses you or your family incur now or in the future, and it is tax free. If you know you are going to have health expenses, you might as well pay for them with your tax free dollars. Keep in mind that you must contribute to your H.S.A account BEFORE you incur a qualifying health related expense however.

Self-employed deduction: This is a no brainer for self-employed people or people with a small business. Health insurance premiums for you and your family can be taken as a business expense. In 2008 on form 1040 it came out on line 29. In addition, if you have an H.S.A plan, not only can you take the top line deduction from your income for amounts contributed to your H.S.A account, but your monthly H.S.A health insurance premiums can also be taken as a business expense.

Health Expenses greater than 7.5% of your AGI: If your total health insurance expenses for you and your family are greater than 7.5% of your Adjusted Gross Income, amounts spent OVER that 7.5% can be taken as a deduction. What qualifies? Much more than you think! Please refer to the IRS site http://www.irs.gov/publications/p502/ar02.html for the full list. Many people just don’t keep receipts, and don’t know that money spent on a whole host of qualifying health expenses could have been taken as a legitimate deduction. If you had a major health event, had a new baby, or other combined health expenses which could put you over the 7.5% threshold, make sure you look into this.

What my two year old daughter Sonja tells me to do about health care "Reform"

1. Stop eating when you are full.
2. Fruits and veggies taste better than fast food once you start eating.
3. Go outside and run around if you start to get cranky.
4. Get more sleep. And take a nap now and then.
5. Hug people. It makes everyone feel good. Isn’t that the point?
6. Find some friends and laugh with them.
7. Have someone put sunscreen and a hat on you when you go outside.
8. Kentucky Fried Chicken doesn’t taste like chicken, and makes your tummy hurt.
9. Candy is only for when you’ve been REALLY good.
10. You find more food in your mouth when you floss! Ewwww!

Bonus! The doctor is more fun to see before you get sick!

Claim your Free Flu Shot!

FREE flu shots! Your current insurance most likely already covers it.

Did you know that most health insurance plans, even catastrophic, high deductible, and H.S.A. plans usually include getting your yearly flu shot? Flu shots are likely considered part of their “immunization” benefit for no additional cost.

Don’t expect to just waltz into a clinic, roll up your sleeve and get one though. Here’s how it usually works: If you haven’t already had your annual check up (and you get one every year right?) go ahead and schedule it. I always schedule mine in the fall so I can take advantage of the free flu shot. Let the receptionist know you would like to catch up on your immunizations as part of this preventative check up. When you go in, you’ll pay your copay in most cases, get your physical check up and get your flu shot (in addition to any other needed immunizations) all in one visit. Keep in mind you almost always need to ASK your doctor to give you the flu shot however!

There are many kinds of health insurance plans and each one may operate slightly differently. Please feel free to call My Health Insurance of Washington to get a complimentary look at your plan and how to take advantage of this great benefit.
www.myhealthinsurancewa.com 1-877-877-9545

Two days in the hospital is how much!!? I thought I had insurance!

Today I have been battling the great faceless Corporate Insurance Giant.

Here is the story. My Client, let’s call him Billy Bob, starts developing pain, real pain, the bend you over until a grown man cries pain. Now, a regular guy would have taken several hundred Advil chased with a beer. Not this guy, he’s intelligent, and decides to go to the Hospital Emergency Room. However, despite the searing pain, Billy Bob has the foresight to actually make sure the Hospital he goes to is in his Health Insurance Plan’s Network. Luckily, the insurance company website lists the Hospital as being In-Network! He goes to emergency, gets admitted immediately, and after two days of quality medical care, is discharged.

Billy Bob isn’t worried though, because the Hospital was in his network and therefore most bills should be covered or discounted, right? Then the bills start showing up, big bills, multiple bills, bills the size of small SUVs. Billy Bob is stunned, how could it have been so much? Remember when I said Billy Bob was pretty smart? Looking the bills over he discovers something no one usually would; the Hospital was indeed in his network, but many of the doctors (who belong to their own separate doctor networks) working at the Hospital were not! Thus he gets billed super high rates for out of network doctors at an in network hospital! Not just a few out of network doctors mind you, he was in for two whole days and thus he gets billed from multitudes of specialists all billing from their separate networks!

This is why there is so much anger focused on insurance companies. It’s not the level of care he received, it was excellent and he made a full recovery, but rather the coordination of benefits and billing issues that are dumbfounding.

Needless to say we are arguing that all his services should be covered at the less expensive in network coverage level. How will this turn out? My guess is the great Corporate Insurance Giant will throw us a bone on some charges. That would be nice, but it doesn’t solve the problem.

Fire! Aim! Ready!..........Here comes Obama's Plan!

It looks as if our House of Representatives is doing exactly the opposite of what I discussed in my last Blog. That is, they are marching full steam ahead to tackle Health Care Reform, without first defining what problem they are trying to solve.

It appears it's not IF we are going to have a Government Run Health Insurance Option, but WHAT that option will be. Said Nancy Pelosi , Speaker of the House on July 13th:

"We are in the process of bringing our health care proposal to the floor, It will happen."
"It will have, coming out of the House, a public option," "The only debate on that is what it will be called -- a patient option, a public option, write in your suggestions."

This is just plain frightening. We ALREADY have Government Run Health Insurance, called Medicare. Medicare not only requires you to spend money for it its premiums, but also supplement that coverage (because it's so bad!) with purchased plans (to cover the gaps in its coverage) from private insurance companies!

Hey Nancy, would you fix the broken system we already have before throwing a $ Trillion $ or more at a brand new "Solution"!!?

There is no Health Care Crisis

How can I possibly say there is no Health Care Crisis? President Obama says it, the Media says it, so it must be true, right? What we have is a Health Care EXPENSE crisis, not a QUALITY crisis.

The quality of American Medical Care is among the best in the world, even though our health isn't. Who is to blame? We are. As a nation we are overweight, out of shape, and just plain don't take care of ourselves. Imagine if we treated car insurance coverage like health insurance. We'd all "drive it like we stole it". If the car broke, we'd take it to a mechanic, give them our insurance card, and demand it get fixed "fast". When it got out of the shop (for only a small copay of course!) do you think we'd dive it any differently? In this model, how high do you think our car insurance premiums would be? But this is exactly how we currently view Health Insurance!

If there were cost incentives (like good driver discounts) we would take better care of ourselves, use less medical care, health insurance and related medical costs would be much lower, thus providing more people greater access to high quality health insurance and medical care. Then and only then could we even come close to being able to afford health insurance coverage for every American. For a fun video of this topic go to http://www.myhealthinsurancewa.com/videos.html

So, let's tell those in Congress who are currently drafting massive overhaul to make sure they define what problem they are trying to solve. Solve the cost problem FIRST, and the rest
will be easy.