Thursday, January 2, 2014

How To Find Obamacare In Pennsylvania

You can get Obamacare coverage in Pennsylvania. Although properly comparing and purchasing health insurance plans requires professional guidance, you can find affordable policies, whether you need single, family or business owner coverage. The price you pay will not be based on your health. The Pa Marketplace offers amny low-cost plans.

Where?

There are many reputable and trustworthy websites you can visit for free quotes, advice and plan comparisons.Of course, you should not ever provide your social security number or billing information to view prices. But it is acceptable to give out your name, address, phone number and dates of birth.

Pahealthinsurancecoverage.com is our preference, since we know and are very familiar with their track record and how they operate. The content and advice offered is also very current and insightful. The 33 years of experience of helping consumers is, of course, a big plus, along with their modern software, which coupled with human interaction, yields the lowest available prices. Of course, there are no fees or charges.

Most importantly is the enrollment help you will receive. Whether you need a Jan 1 effective date or a later date, enrolling can be a tedious process that involves calculation of the subsidy, selection of plan, review of cost-sharing options, and matching benefits with needs. Obviously, you want expert help when you are ready to apply for an Obamacare policy. Even after Open Enrollment expires, specific plans can be purchased.

Get The Least Expensive Medical Coverage In Pa.
Pa Healthcare Reform Is Here To Stay


The .gov website has been a popular site for enrollment. But with a steady flow of glitches, delays, security concerns and patches, consumers still are frustrated with the lack of functionality. Perhaps that is why broker websites have become more popular with consumers, since they pay no fees, enroll easier, and receive unbiased assistance. Pa Marketplace information is easy to find. But the quality of that information must be considered.

What?

It's difficult to say "what" the best plans are, since everyone's needs and budget are different. But here are a few thoughts:

The cheapest form of coverage is a "temporary" contract. It's very affordable (Typically $25-$75 per month) and the carrier often approves benefits either instantaneously or within a day. For unemployed or laid-off workers, it's a very attractive low-cost option. However, since a temporary policy does not meet many of the necessary  required mandates of Obamcare, they can only be purchased  as an "off-Exchange" plan.

"Golden Rule," who is part of the UnitedHealthOne family, often offers the lowest-priced options. Pre-existing conditions are not covered and this type of plan is designed to be kept in stop-gap situations that are shorter than 12 months.

The most comprehensive contract is perhaps an HMO (Health Maintenance Organization) with no deductible and low out of pocket expenses. Virtually everything is covered and there is rarely a limit on the number of physician or specialist visits. HealthAmerica (Coventry) and Independence Blue Cross (IBX) offer excellent HMOs through the Marketplace. However, there are many PPO plans that feature lower deductibles and copays.

Highmark is one of the largest healthcare providers in the US. Throughout Western Pa and other parts of the state, they typically offer rates that are among the lowest available in that area. In Western Pennsylvania, Highmark BCBS, along with UPMC, provide the largest selection of low-cost plans. Their network availability of physicians and hospitals is among the largest that is offered through the Marketplace.

A "Primary Care Physician" coordinates all of your needs with an HMO, including determining most of your medical treatment. So you better get along with them! Of course, you can always change PCPs, although the best time would be at the beginning of the calender year. A PPO plan will allow you more flexibility regarding what providers you use and in which areas you can receive treatment.

When?

Actually, it does matter when you apply for coverage. You can apply today, tomorrow, next week or next year. Of course, if you wait too long, you might have to pay for a large claim and that won't be an enviable experience. And Open Enrollment runs only for specific times of the year. For 2014, the last date to enroll is March 31st. If you miss the deadline, you may be subject to a $95 (per adult) tax, or 1% of your income...whichever is higher.

Open Enrollment takes place at the end of every year. There are also special Enrollment periods for persons that left an employer, got divorced or turned age 26 and had to leave a parent's plan. If you qualify for one of these situations (and there are more), you can receive the federal subsidy to help lower premiums.

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But will you get approved? Yes, unless you don't meet citizenship requirements. As previously mentioned, when Pennsylvania Open Enrollment began in October (2013), it did not matter what medical conditions you were currently being treated for, or what conditions you were treated for in the past. Quite simply, the only factors that will impact your premium are your age, where you live, whether you smoke, and of course, the type of coverage you are purchasing.

How Much?

Ah yes...How much does it cost? If you're young and healthy, you can afford to take more risk with a catastrophic plan with high out-of-pocket expenses. However, if you're a bit older with ongoing treatment, you will have to pay a higher premium because of your age and also since you may need a plan that pays a higher percentage of your anticipated expenses.

"Bronze" plans are the least expensive since they pay about 60% of the anticipated medical expenses you might incur. Conversely, a "Platinum" plan will pay about 90% of the anticipated expenses, and will be the most costly. Additionally, a "Gold" and "Silver" option is also available.

Silver plans provide a special cost-savings feature that lowers deductibles and copays. Because of this feature, often, it's best to select this option if you meet the subsidy guidelines. It's actually possible to cut the deductible in half (or more) and slash the premiums by as much as 50%-100%. Copays and coinsurance can also drastically reduce.

In many situations, it is more advantageous to pay slightly more for a Silver plan than a fairly similar Bronze plan. The reason is that if your household income is under 250% of the Federal Poverty Level, the reduction in deductibles and copays will easily offset the few extra dollars you may have to pay.

To help pay premiums, a new federal government subsidy is paid to anybody that has household income under 400% of the Federal Poverty Level. For example, for a family of two adults and two children, income up to about $94,000 will result in some form of financial aid. Naturally, the lower the income, the bigger the tax credit. Also, the more children you have, the bigger the subsidy.

Can you get free healthcare? Actually, yes you can! If your income is high enough to be ineligible for Medicaid, but still receive the ACA subsidy, it is possible that a few Bronze plans will not cost you anything. Of course, they will likely have higher deductibles.

Obamacare in Pennsylvania. We'll help you compare, enroll and save money! Many of the new legislative changes will help consumers pay less, and enjoy benefits they never had before.

Update January 28 2013 - Poor children in Pa do not have to move to Medicaid for the rest of 2014. The ruling came from the federal government and gives Governor Corbett some extra time to work on a solution for 2015 and beyond. Many of the children are currently enrolled in CHIP.

Many physicians prefer CHIP over Medicaid because of reimbursement and the avoidance of bureaucracy when submitting claims for payment. Medicaid offers more comprehensive coverage and households between 100% and 133% of the Federal Poverty Level were required to change to Medicaid (under the ACA).

Sunday, April 28, 2013

Compare Health Exchange And Marketplace Options In Pennsylvania

In October the Pennsylvania Health Insurance Exchange became operational. No...wait. The federal government is now calling them "Marketplaces," and not "Exchanges." Is there a difference? Does it really matter? The answer is no! Coverage is guaranteed and you don't have to answer medical questions regardless what you call it.

For years, we have been watching the Exchange idea start from an idea, to proposed legislation, to a passed bill (that wasn't studied by very many people), to a working project, to what it is now. And that is...a near-finished project that offers insurance to individuals, families, the self-employed and business owners. Notice, that I did NOT include the word "affordable" in that description, since without the subsidy, prices can be quite high.

But a funny thing happened last year. Unexpectedly and without warning, healthcare.gov started to eliminate references to Exchanges and began to insert the term  Marketplace in instead. Of course, this is not a devious act and probably wasn't spotted by folks that aren't in this field. But clearly, there was a shift.

Find cheap Pa Insurance Through Marketplace
Here Come The Exchanges (Marketplaces?)


Why did this occur? Probably because the second term gives the impression that you are buying Pennsylvania health insurance plans (or any state) in a competitive environment where you shop for bargains, find quite a few and then pick your favorite. The first term just didn't seem to resonate with consumers. It almost sounded like you were exchanging  one product you were not happy with, for another product you were unsure about.

OK...So now they are called Marketplaces. What exactly are they and how does the process of buying health insurance change? You still should use experienced brokers and preferably reputable websites that update content and explain current topics such as different "Medal" plans and the federal tax subsidy. But whether you call it an "Exchange" or "Marketplace," one thing doesn't change. And that is you no longer have to answer medical questions when applying for coverage.

"Guarantee Issue" is now the name of the game (started in 2014). No long applications...Oh...wait. They still are long since your federal tax subsidy has to be calculated. Rates? If you qualify for the subsidy, you're in pretty good shape. If you are unfortunate enough to make more than $95,000 (Total household income for four persons) or close to that amount, you may not be very pleased with the "Affordable" Care Act, since it doesn't seem to make new plans very affordable.

Although "navigators" may become available to help consumers, they will be mostly inexperienced compared to licensed brokers that have been writing business for decades. Since there are tax subsidy and suitability issues, along with determining if in or out of the Exchange is appropriate, utilizing respected websites and broker/agents will be critical.
Find Broker In Pa To Help With Health Insurance
Brokers Save Consumers Money


"Navigators" will play a role in reaching consumers that do not have access to the internet or simply choose to attempt to work through an intricate process without the best available help. And yes, there will be plenty of consumers that take that route.

So...Exchanges. Marketplaces. Does it really make a difference what we call it? Not really. But it does make a difference who helps you and which website you visit to learn about your options.


Thursday, April 11, 2013

Small Business Owners Choosing To Drop Employee Healthcare

Many small business owners are choosing to drop their healthcare plans. It's not that they are being mean or hateful. They are simply trying to survive, and ironically, protect the jobs of their employees. The Affordable Care Act legislation has not been kind to most employers, and survival is, as you might expect, the top priority.

In 2014 when much of the new healthcare began, a business that had 50 or more full-time employees, was forced to purchase health insurance for workers that average 30 hours (weekly) in a specific month. And that is expensive. However, the alternative is rather attractive. A mere $2,000 tax for any full-time employee in the company (exceeding 30).

Since many business owners spend twice or three times that amount on healthcare benefits, it is tempting to drop the group medical plan and pay the fine. With the extra money (and there could be quite a bit), more funds are spent on research, development and upgrading equipment, which potentially would make the price of their products more competitive.



Also, since these changes would result in increased sales, the security of the employee's job position would be enhanced, and perhaps wages would also increase. Of course, the worker would not have to purchase their health insurance through their state Exchange or Marketplace, which would require the help of an experienced broker.

A company that employs 250 people is likely to save between $350,000 and $750,000 in insurance premiums each year by allowing workers to purchase their policies on an Exchange. It costs (on average) about $15,000 per family to cover medical benefits. That saved money may provide more employment possibilities for the company, and ultimately helps the local community. A bit like a vicious circle, but just the opposite!

And if the family that is losing benefits qualifies for the federal subsidy, it is likely their cost will be very affordable, and the coverage will include maternity and most (or all) benefits that were enjoyed on the group plan. Since Open Enrollment occurs every year, a worker that is not provided group benefits can apply for a new plan, or keep their existing benefits on an annual basis.

Many of these mandatory requirements for business owners have been put off...for now. First extended to 2015 (and now extended to 2016), the Administration seems to comprehend that the new legislation forcing businesses to buy expensive healthcare must be tweaked or changed. And so far, that's exactly what is happening.

The Department Of Health And Human Services predicts that most employers will not drop their healthcare plans and pay the fine. By the beginning of 2016, we'll find out. I suspect more employers will indeed terminate group plans simply to stay competitive with other US, European and Asian competition. However, if problems begin to surface with hiring the best workers (because of lack of healthcare), the percentage of businesses that retain benefits will be higher.


Wednesday, August 8, 2012

Pittsburgh Vs. Philadelphia - Compare Health Care Options

Pittsburgh and Philadelphia are of course the two largest cities in Pennsylvania. More people buy health insurance plans in these two cities than any other area of the state. There are multiple options, both private and through an employer. So what are the differences and does one side of Pa offer better health care than the other? Let's find out.

But before discussing some of the best options, it's important to recognize the changes from the Affordable Care Act. In addition to instant approval underwriting and mandated "essential health benefits," the federal Obamacare subsidy has provided thousands of dollars of financial relief for many consumers.

Depending on your income (as it relates to the Federal Poverty Level),  your new rates could be considerably less than expected. It's not unusual to see premiums reduced by up to $500-$800 per month, resulting in $1000 monthly rates reducing to less than $300. The federal subsidy is based on your projected household income for that year. If you receive a raise, or lose your job, the amount of the subsidy will change.

Highmark Blue Cross Rates In Western Pa
Highmark Offers Affordable Western Pa Healthcare Rates


Highmark Blue Cross Blue Shield is available to Western Pennsylvania residents only. So, of course, if you live on the other side of the state, you won't be able to purchase a Highmark plan. And that's a shame, since their rates are very competitive, especially for policies that cover one person. They offer various high-deductible plans which are very popular with small business owners.

Not only are Highmark rates competitive, but they also include maternity coverage on all plans, which is required by the Affordable Care Act. By purchasing a low deductible policy with maternity benefits, you will pay far less than you would for similar coverage in most of the state. Highmark's Network is impressive too, covering a vast number of doctors and hospitals.

When it comes to negotiating lower prices for their customers, they are very adept at it. Of course, they are $50,000 poorer now since they were recently fined $50,000 by the Department Of Insurance for denying claims (considered a minor violation). They are also in the process of merging with Northeastern Blue Cross, which will give them an additional 500,000 new customers.

UPMC is also only available in the Western portion of the state. Although their rates aren't as competitive (in most zip codes) as Highmark, they are indeed a new, but reputable and reliable carrier. Their HSA rates are very attractive to both single and family situations. There are multiple coinsurance and deductible options so there's no shortage of plans.



 UPMC also has comprehensive policies that are suitable for persons looking for "high end" types of options. These plans will offer richer coverage with additional benefits such as office visits (specialists included), prescriptions and  may other needed items. However, they also feature a few policies that are lower in cost and limit the number and type of covered office visit and RX benefits.

Lately UPMC and Highmark have been waging a war of supremacy for the area. UPMC may be making up some market share with some acquisitions, but we'll see how things shake up when Marketplaces are operational. Highmark's purchase of Northeastern Pa Blue Cross will expand their market share further.

Aetna and UnitedHealthcare are two large reputable insurers and both provide medical coverage for individuals and families in all parts of the state. UnitedHealthcare seems to have more competitive rates in the Western and Central parts of Pa. Aetna has very good rates in Reading and the Philadelphia areas, especially their HMO plans with maternity coverage. Both carriers have extensive network provider coverage in most of the state.

In the Eastern part of the state, Keystone (Independence Blue Cross) offers about 8-10 different affordable plans including, HSAs, comprehensive coverage and HMOs. Maternity coverage is available on the HMOs and some of the PPOs and prices are very affordable. Keystone also offers health care in other states. Most physicians and hospitals are very familiar with their policies.

You must live in the Philadelphia area (six counties), but the Network of doctors and hospitals is extensive. Most policies are underwritten although a "Personal Choice" plan can be applied for that is a "guaranteed issue"  contract. This specific plan is ideal if you have been denied by previous insurers or have multiple existing conditions. In 2014, all policies became "guarantee issue." Therefore no medical questions required and pre-existing conditions covered.

So...Which city is the best to buy health insurance? Actually, both Philadelphia and Pittsburgh have multiple insurers that can offer affordable premiums, generous benefits and large provider networks. You can't go wrong with either city! New plans are always being developed and network discounts continue to grow. Blue Cross has great options on both sides of the state.

Sunday, June 24, 2012

How Will I Buy My Health Care In 10 Years?

How will you buy your health care in 10 years? Or perhaps, will you not have to buy it? Will it be provided free to you by the federal or state government? These are questions that are hard to answer at this time, but we're very qualified to provide an educated guess. And with more than 30 years of experience in the business, our insight and predictions are usually accurate.

One of the big variables in the health care equation is who will you buy it from and what will be the cost. Will we have a single-payer system where health insurers are out of the picture? Or will there be many health insurers that effectively compete for your business with the government paying for some or all of your premiums? And what about Universal health care that is popular in Europe?

Pennsylvania Marketplace


No Medical Question Healthcare Pennsylvania
You Will Not Be Denied!


Another question mark is the current Pa Health Exchange. Will it be operational in 2016 or will election results in 2014 put the Exchange ideas to an end. That's a big variable and Pa consumers will have to keep a close watch on the developments. The election in 2016 plays a big role in the makeup of the Exchange. We do feel, however, regardless of the results, a repeal is not going to  occur. Perhaps some additional changes and tweaks though.

Although President Obama was re-elected, details about the inner workings are still being worked out. The Marketplace is up and running, but there are many issues that are unanswered. Cost overrun is always a major concern. One of the variables is which carriers will continue to offer plans. Not all companies  participate, which ultimately hurts consumers. And the shrinking size of Networks is always a concern.

More than likely, in Pennsylvania and the rest of the US, we will see a blend of these two concepts. If you are at or near the poverty level, there should be some type of assistance that will help pay for some, most or all of your premiums. But where will the bar be set? $20,000 of household income? $40,000? This will be a very contentious topic. And perhaps it will be a rolling amount...slightly increasing every year.

Your Income And The Federal Poverty Level

Currently, if you make over $96,000 (family income), there will not be a tax subsidy. However, if you fall under that amount, you will be eligible for financial aid from the federal government. These subsidies will be badly needed since prices may be high without them. Purchasing coverage outside the Exchange may also be an attractive option to be considered.

The Federal Poverty Level guidelines greatly dictate how much financial aid you will receive from the government. That, along with the number of dependents you have, can mean the difference of receiving $10,000 in aid or none at all. This Subsidy Calculator will help you determine your financial aid.

Over Age-65 Market

But as people are able to be treated for more diseases and conditions, and thus live longer, the big burden may not be on health insurance for folks under 65. Medicare may bear the brunt of many current and future problems. Invariably, copays will have to rise and mismanagement, fraud and waste will have to be brought to a grinding halt. OK. I know. Maybe not to a grinding halt, but perhaps a bit better controlled. There's a lot of money that can be saved by simply managing our own house better.

The usage and availability of Medicare Supplement plans may change. Of course, currently, there are plenty of options available and the rates are reasonably priced since it just needs to cover "gaps" in coverage. But as these gaps get larger and seniors become older, rates may go up. And the makeup of policy coverages may change if Medicare changes its basic coverage. I can only say "stay tuned" and let's see what happens.

Another variable is if the Medicare-eligibility age changes. Currently it is age 65. For instance, if it were to change to 67, that could put some pressure on individual health insurance rates since the health of older persons is not as good (generally) as younger persons. Someone would have to pay for that and it may be us! We believe that the Medicare eligibility age will remain at 65.

Pa Medicare Provides Comprehensive Benefits For Consumers
Don't Miss Your Medicare Enrollment


But the Social Security retirement age could increase. In fact, it may have to so it can remain solvent. One possibility is an increase of three months every other year. This nominal jump should placate both Democrats and Republicans, and allow Social Security to continue to safely provide retirement income to millions of senior citizens.

Health insurance won't be free in 10 years or 50 years. So yes, you will still have to buy it. But the double digit increases in premiums will be long-gone with various subsidies keeping premiums to a somewhat reasonable level. Non-generic prescriptions will still be expensive, but hopefully the multitude of generic drugs will allow consumers to cheaply purchase the medications they need. And if major diseases such as cancer and heart disease become less costly to treat, it could have a major impact on long term health care costs.

Sunday, May 27, 2012

I'm Self-Employed In Pennsylvania. Now What?

You're self-employed and you live in Pennsylvania. You need health insurance for yourself and your family. You want an affordable plan, but also would like to have top-notch protection, especially if there is an expensive injury or illness. What are your options? Should you purchase coverage through an exchange or through one of the top healthcare websites such as www.Pahealthinsurancecoverage.com? So many questions and the answers aren't easy.

Actually, there are quite a few health care plans in Pa that will help without putting a huge dent in your budget. If you are currently uninsured, and are in reasonably good health, you should be able to qualify for an underwritten plan. Since preventive coverage is included in the vast majority of plans, a great "starter" policy would be a simple policy that covers the big expenses only. It provides rich benefits for big claims and keeps the cost within your budget.

Plans like this are typically the least expensive option and when you view plans on reputable websites (as mentioned above), you can usually view them at the top of the screen. You will notice deductibles between $3,000 and $10,000 and often limited office visit and RX benefits. But if you have no serious medical isuues, it may be a big budget-saver.

If you have existing medical conditions and previously have been turned down, the State Open Enrollment plan has very good prices (under $300 per month) and after 2014, your health history will not be a factor in the underwriting of a policy. And regardless of how large or small your business is, that factor alone may be a big money-saver. However, after March, this program will not be available.

Cheap Healthcare In Pa For Business Owners
Save Money With A Pa HSA


Often referred to as a "catastrophic" policy, your premium will be low and you'll be protecting the most important thing- the big unexpected claim. You never know when an illness or injury can occur or the amount of money that will be needed for treatment. And since your yearly annual physical is covered, you'll be encouraged to utilize it to stay in good health. You can choose many different plan options that will provide low premiums with higher risk or vice verse.

The Blue Cross (Blue Shield) plans in your area are always a good place to start. For example, if you live in Lebanon or Lancaster, Capital Blue Cross offers some very attractive plan options. There are many PPO plans that feature low premiums. A prescription rider can be added to many of the plans. A higher deductible such as $5,000 will help the premium reduce, although many other lower choices are offered as well. In the middle of the state, Geisinger should also be considered. The Network is not very large outside of the area, but if you rarely travel, it's a nice plan.

Other Blue Cross plans can be purchased in other areas. Independence Blue Cross is available in the Philadelphia area and Highmark plans are great plans to consider in the Western part of the state. Northeastern Blue Cross also offers coverage in that part of the state. For many self-employed individuals and small business owners, BC and BCBS plans are great places to start when searching for new coverage. They have big networks that tend to discount treatment very heavily.

A Health Savings Account should also be considered if cutting costs and reducing premiums is a priority. In addition to tax deductions, a savings element is included to go along with lower premiums. While an HSA should be researched before purchasing, they still remain on of the most popular plans today. You have a much broader control over the way your expenses are paid and what type of treatment you receive. And of course, most importantly, how much you are spending for your healthcare.

Wednesday, May 23, 2012

Ten Silly Ideas That Would Lower Healthcare Costs

Healthcare costs are too high.  The cost of a specialist or Emergency-Room visit has skyrocketed. What can we do? A lot. I have plenty of ideas and here are 10 of the best ones. I fully endorse all of them and hope to see them implemented soon.

1. Mandatory 10-mile runs for any man caught sitting on a couch longer than four days. This could help speed up metabolism and improve his relationship with other family members...if they're still around. After about four of these runs, he won't be a couch potato any longer!

2. No pasta Tuesdays. Instead, rice cakes, blueberries and pomegranate extract will be served at all college dining halls and hospital cafeterias. And no pizza deliveries at night on Tuesdays.

Lower healthcare expenses easily with these ideas.



3. Doogie Howser will become the new caretaker of national health care reform. Medical schools would provide special funding for applicants under the age of 12. Eligibility ages for driving will reduce from 16 to 11. And  Sesame Street and Big Comfy Couch will replace all evening programming.

4.  Routine annual physicals will become "routine weekly physicals." Just as garbage pickup is once per week (and that works pretty well!) routine physicals will occur every Monday or Tuesday, with recycling included.

5. Hospital semi-private rooms will be replaced by a maximum room occupancy of 14.Yes, crowded conditions will make treatment a bit impersonal, but large non see-through curtains would be utilized. Dependents on your policy can stay in the room along with three family pets. No goats or sheep please.

6. Everyone's appendix will be removed by age 24. At the same time, a small computer chip would be installed in its place. This chip would monitor the central nervous system and make subliminal suggestions. Eventually, psychiatrists would not be needed, except during March Madness.

7. Hockey and football players would wear protective watermelons over their helmet to help reduce the number of concussions. This could also help in keeping the players hydrated during games, although I don't know what would happen with the seeds.

Healthcare rates will increase if we all indulge in french fries
They Taste So Good!


8. Fast food restaurants will only sell french fries to customers that agree to eat them in the restaurant while walking on a treadmill. While it won't offset all of the calories, it will help a little. Large fries would require an extra hour of running.

9. Movie theaters will replace long-time favorites popcorn and nachos with bean curd and skim milk smoothies. To offset anticipated lost revenue, the average price of a movie ticket will rise from $9 to $65.

10. The last digit of your license plate will represent the number of prescriptions you take. Therefore, the healthiest drivers will have very low numbers as their last digit. If you are driving behind someone with a number higher than five...Look out!

You wanted lower healthcare prices? Now you have 10 recommendations that will save millions of dollars. And it might make your next visit to the doctor a lot more entertaining.