Category Archives: Health Insurance

Plan F Plan G

Medicare Supplement Plan F or Plan G

“That is the real question, which Medicare Supplement Plan do I go with?” Bob said. “Plan F or Plan G? They both look the same.” “Good question.” I told him. Then I began to explain as I do to all the folks I talk to who ask this same question. It’s funny how in the end, they always seem to agree and make the same decision because it just makes $ense.

Here is the deal. Plan F has been the most popular plan in the Medicare Supplement Market for years. Mainly because it is simple to understand; most people have almost no out of pocket costs other than what they pay each month for the plan. If Medicare pays, then the Medicare Supplement pays. Some people even say the “F” stands for “Full coverage”. However, “Full coverage” as we all know, comes at a price, and sometimes it isn’t the best “bang for your buck”.

Plan F and Plan G are identical, the ONLY difference is, on Plan G you have to pay for the Medicare Part B deductible. Therefore, Plan G is becoming more and more popular, mainly because of the cost. If you look at the graph below, the Part B deductible has not changed in the past 3 years.

PART B DEDUCTIBLE HISTORY

In 2010 Part B deductible was $155
In 2011 Part B deductible was $162
In 2012 Part B deductible was $140
In 2013 Part B deductible was $147
In 2014 Part B deductible was $147
In 2015 Part B deductible was $147

Even though the Part B deductible hasn’t changed much in the past 5 years (in fact it’s lower than it was in 2011), Plan F prices have steadily been increasing every year. Basically, for 4 years people with Plan F have been paying more for a benefit that hasn’t changed.

When you look at the actual numbers, the Medicare Part B deductible breaks down to around $12 per month ($147 / 12 months). So if a Plan F costs $12 more than a Plan G per month for you, then you are paying too much!!! Make $ense??

In some areas, we see a Plan F for a customer and a Plan G be as much as $40 difference! So tell me, if Progressive or Geico told you that you could save $480 per year in premium and only add $147 in your deductible, would you be willing to make that change? Of course you would, because it makes $ense.

So after quoting Bob Plan F @ $187.39 per month and Plan G @ $157.35 per month … I said to Bob … “I always give folks the choice by showing them the price difference and let them make the decision … which plan do YOU think you should go with?” Without hesitation Bob blurted “Well I would be dumb to not go with Plan G!” Bob is a smart man. Over 90% of our customers go with Plan G, however if you are willing to give an insurance company $200-$400 in trade for $147, then we won’t mind helping you do that.

special enrollment

Life events can change insurance

Some of our biggest life events that trigger special enrollments and change our healthcare coverage too.

Under the Affordable Care Act, many life events, such as losing a job, having a baby, moving, divorcing and getting married, allow people to sign up for health insurance throughout the year, outside of the annual open enrollment period.

Obamacare enrollment runs from Nov. 1 through Jan. 31 for 2016 coverage.

Young adults are more likely than any other age group to experience a life event that qualifies them for special enrollment

Once people understand that getting married, having a kid or moving can be an opportunity to enroll in affordable care, people are interested in hearing about their options. Especially if they picked a plan they are not so happy with.

One thing to remember though, there is only a limited period of time to get a new health policy when these life events happen.

As a general rule, you have to enroll within 60 days of a qualifying event. It’s not an open window.

Not all big life events can alter your insurance coverage — at least not immediately.

Pregnancy

Having a baby, triggers an opportunity to switch health plans, but most people are suprised to find out that pregnancy does not trigger an opportunity. Pregnancy doesn’t allow you to switch plans, it only allows you to add the child to the plan.

Here are some common reasons people qualify for a special enrollment period under Obamacare:

Losing insurance

The reasons for losing insurance are varied – The loss of a job-based plan, aging out of a parent’s coverage at the age of 26, losing coverage through divorce, or losing eligibility for Medicaid or the state’s insurance program for people with low incomes, trigger a special enrollment period.

Most people feel COBRA is their only option. They aren’t aware that after leaving or losing their job they can sign up for a plan and even apply for a tax credit to lower their insurance costs.

Once you elect COBRA, you can’t just drop it. If you continue your current job-based health plan through COBRA, you’ll have to keep it until it ends or the next annual open enrollment comes around when you can sign up for a new plan. Canceling COBRA before it expires does not count as a qualifying event triggering a special enrollment period.

In fact, losing insurance because of something you do yourself — say, stopping payment because you believe that your plan is too pricey — won’t qualify you for a special enrollment period.

Moving

Most health plans operate within a specific geographic area. If you permanently move to a new city or ZIP Code, you may qualify for a special enrollment period and have the chance to pick a new plan.

If you move to a ZIP Code where another plan is now offered or a plan that was offered is no longer available, that’s a qualifying life event.

Marriage – Divorce – Adoption

You can add someone to your health plan if you get married, or if you have or adopt a child. Losing insurance coverage because of divorce also qualifies you to buy a new policy during a special enrollment period.

There are a few other special events that may trigger a special enrollment opportunity. To learn if you qualify for special enrollment email us directly or call 877-740-8683 and we will be happy to assist.

BCBS PPO ACA

BCBS of TX PPO Members

Urgent ALL BCBS of TX PPO Members must read the following notification just released by BCBS of Texas.  This Notice affects all members who have an ACA (Affordable Care Act) PPO plan with Blue Cross Blue Shield of Texas.

As of December 31, 2015, BCBS of TX will no longer be offering their PPO insurance plans for the individual under 65 block of business going forward.  This means if you currently have one of the new ACA plans purchased after Jan 1, 2014, and it is a PPO, it will no longer be offered for 2016.   This means you must change plans for 2016!

According to BCBSTX, they have filed a new product that should give members a flexible choice.  Bottom line, their PPO network for new ACA plans is going away.  The 2016 plans are currently not available, but as soon as they are released, we will be contacting you.  You can count on us to make sure you see all options available to you, from All Insurers and that we will make this transition as smooth as possible for you.

According to BCBSTX, the reason for this is because for the past 2 years, they have been the only insurer offering individual PPO plans in all TX markets and due to anti-selection, they find the PPO product is unsustainable at an affordable price.  The will continue to offer other plan options in all 254 counties, on and off the Marketplace.

There are about 367,000 members who will have their PPO plan discontinued in 2016.  If this is you, click here.

There are about 148,000 members who are in a Grandfathered PPO plan who WILL NOT have their plan discontinued and will be able to continue to use the Blue Choice PPO network.

This does not affect Employer Group customers or Medicare members.

The Blue Advantage HMO Network will remain and BCBSTX is working to expand the number of providers in that Network.

According to BCBSTX, they paid out $400 million more in claims than it collected in premiums in 2014. Losses that high are unsustainable, and they must adjust offerings, as most of the other insurers have done also, in order to be sustainable in the new market reality.

As a Broker, who represents all the major Health Insurers, we are seeing many changes taking place in this entire market, which can have major effects on many consumers!  According to different Insurance News publications, it appears that Aetna is in the process of acquiring Humana and Anthem in the process of acquiring Cigna.  Acquisitions like this, mean less Insurers in the market, less competition, thereby creating less choices for our customers.  We realize this is not good for anyone, but we will help you find the best products that are available in the market.

Remember…A Broker works for YOU….not the Insurance Company!  It is ultimately our ONLY goal to make sure you have the plan that fits your needs best.  There are more things to take into consideration when choosing a plan, other than just the cost.  Many people found this out this year!

You will never pay more for your premium by working with a Broker, than you do by going direct with the Insurance company or by going direct to the Marketplace.

To shop for 2016 plans now, click here.

 

Important Deadlines

2016 Health Insurance Open Enrollment

Here are some important dates for the 2016 health insurance open enrollment dates:

  • November 1, 2015: Open Enrollment begins — This is the 1st day you can enroll in a 2016 health insurance plan
  • January 1, 2016: This is when the coverage will start if you enroll by December 15th.
  • January 31, 2016: Last day to enroll for 2016 coverage.

January 31, 2016 – FINAL DAY TO ENROLL

If you don’t enroll in a health insurance plan for 2016 by January 31, 2016, you CAN’T enroll in a plan for 2016 unless you qualify for a Special Enrollment Period.

Penalty for not having coverage in 2016

If you don’t get coverage, or choose to go without coverage in 2016, you may have to pay a fee. The fee is higher than it was in previous years. The fee for not having health coverage in 2016 ….

Shop for a 2016 health insurance plan now

Need a plan now, shop for a 2015 plan

No health insurance fee

2016 Penalty fee for not having health insurance

Each year you go without coverage, the fees get higher.  The 2016 penalty fee for no health insurance is more than 2015 and 2014 was.  If you don’t have coverage in 2016, you’ll pay the higher of these two amounts:

  • 2.5% of your yearly household income

OR

  • $695 per person ($347.50 per child under 18)
  • In future years, the fee is adjusted for inflation.

How you pay the fee

You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. Most people will file their 2015 returns in early 2016.

The fees for 2014 and 2015