Two Major Benefits Enabling Success of Health Insurance Exchange

The U.S. health insurance market is at its peak of major transformation essentially from an employer-based model to something that directly involves more and more consumers and employees. In this scenario, the private health insurance marketplaces carrying a defined approach helps acting as a significant catalyst to the process. There are at least 10 factors that enables a private health insurance exchange to be successful in providing seamless healthcare facilities to its consumers, two of them have been discussed here:

1. Abundant coverage capitalizing

The present health care system provides two ways to fund how to buy health insurance plans.

One- funding health insurance on the basis of after-tax expenditure. Here, enrollees pay the coverage out-of-pocket, without having any tax preference while buying the plan. This kind of coverage is commonly practised in the individual market of health care plans. In this kind of plan, Government or employer does not provide subsidies to the coverage.

Two- This is an employer-based buying of healthcare coverage. In this plan, the employer will typically pay either the entire or a part of the employee’s medical coverage. This plan typically reduces the employee’s cost incurred towards the plan. Moreover, even though a portion of the employer’s contribution comes from employee’s compensation, this portion paid by the employer will not be taxable to employee’s income tax. If the employee is paying a portion of the subsidy, employers usually provide tax exemption plans so that employee pays that amount before his tax gets calculated on his salary. The tax exemption feature is the best benefit provided by employer-based health insurance plan.

Any successful health insurance exchange will enable a smooth process for a health insurance enrollee to buy the coverage. This help will be irrespective of whether the enrollee is paying it entirely from his pocket or his employer is buying the coverage for him.

It will be the task of private health insurance exchange to provide a defined system of payment in a situation where the employer is just contributing in funding of the medical coverage buying. The exchange may either outsource the functions of payroll reduction to another business that is specially involved in giving payroll services or provide the service in-house. In both situations the task of the exchange is to enable smooth and error-free transfer of funds to the insurer company that is providing the coverage.

2. Stock of most of the important health plans

Yet another factor that makes private health insurance exchange successful is providing the consumer a plethora of health insurance plans to choose from. There can be more that 15 to 20 health plans that an exchange has in stock- all ranging from high-cost to even the minimum low-cost sharing health insurance plans. These variety of healthcare designs provides both the individual consumer and the employer to choose that funding system that suits him best. This actually helps in huge cost saving for both the individual and employer.

An important point of observation for private healthcare marketplaces is the wide array of major health insurance plans that are offered by many carriers. As most of the plans today get underwritten on individual basis, the carriers are usually managing their consumer’s risks that they have covered under the insurance plan.

There is ample likelihood of private exchanges to flourish. It is highly possible that there will be many undifferentiated offerings that will get implemented soon. However, to win in this marketplace, the exchange will require to differentiate all by itself through creation and sharpening a significant value proposition. 

Student Health Insurance Plans and Their Benefits

For those who are below 26 years of age, thanks to Obamacare, you are under the coverage of your parents still. However, not every individual is able to finish his studies before the age of 26 years. Most students doing higher studies, or studying multiple faculties have crossed the threshold of 26 years and are no longer covered under their parent’s health insurance plans. If purchasing health insurance plan can be a nightmare for those who are earning, for those who are students, it must be really scary.

So, should these students discontinue their studies and get into some jobs, just to be able to pay for expensive medical care? Thanks to Students Health Insurance Plan (SHIP), this category of the U.S. citizen are not dying being unable to pay for their health care. There are two coverage cycles under SHIP- fall (August 15^th to December 31^st) and Spring (January 1^st to July 31^st). Those who wish to register for Fall 2017, your coverage will be effective from August 1^st 2017.

The initial health care, except for urgent care and emergency care, has to begin at University Health Services. These services have to be authorized by the office of Student health insurance to enable payment of the cares provided. Every state and its University provides certain benefits to the students under SHIP. These benefits are somewhat same across all Universities, leaving certain small differences (for HMO plan):

1. All preventative care are fully covered (100% coverage) and you need not pay a single cent for it.
2. In case of primary care, you as student will require to pay $15 in copayment.
3. In case you need seeing a specialist, if this specialist is from in-network and referred by your primary care provider (PCP), you need to pay only $15.
4. For urgent care required under UHS, you will pay $30 and for outside UHS, it is $50.
5. Students requiring counseling for certain mental or behavioral disparities will receive first five counseling at UHS for free. However, for the same service outside UHS, the student requires to copay $15.
6. In case you require an emergency room, you pay $100 upfront as copay. Moreover, 90% of rest of the services will be paid by your SHIP, other than lab tests and x-rays.
7. For hospitalization, you need to pay only 10% of the coinsurance after calculating the deductibles, rest 90% your SHIP will take care.
8. For your lab tests and x-rays, you pay 10% coinsurance again, while your insurer will cover the rest 90% after checking your deductibles.
9. For all your prescription drugs, you need to pay $5 for generic, $40 for official list of describable medicines, and $25 for brand name prescription medicines.

In case you are not covered under your parent’s health insurance coverage and you are still a student, you may not worry going untreated due to lack of funds. The Student Health Insurance Plan (SHIP) takes care of majority of your health care costs, leaving you tension free to concentrate on your work. Of course, you will need to make some research on which plans under your university will provide the best facilities for your medical care services. 

Health Insurance Companies and 5 Healthcare Options for Small Enterprises

The recent news of health insurance companies like Aetna, Humana, Athema, etc. getting merged is leaving a lot of speculations in the health insurance marketplace. While the practicing doctors and hospital authorities feel it will leave many of them in out-of-network facilities, there are many financiers who see this merger as a good possibility to reduce the cost of expensive health insurance in the USA.

But, what do the health insurance companies do? Or, how do they function. Mentioned below are a few ways health insurance companies or brokers help small scale employers with ideal sort of small group health coverage.

If you are an insurance agent or a small entrepreneur, you will feel like issuing the ACA to your employees/clients. However, if you are a company with less than 50 employees, you may not provide any health insurance to your staff. There are absolutely clear options provided for small group health coverage.

In 2016, you have 5 options mainly for providing health insurance to your employees:

1. Private Exchange
2. The SHOP marketplace
3. Co-operative
4. Small group plan (private)
5. Individual health coverage (you may or may not take defined allowance contribution)

1. Private exchange

Private exchange is the most sort about healthcare marketplaces today. When small employers go for private exchanges, they provide the employees with a set of pre-defined contribution towards different plans available. You can divide the options into either individual- or even group- health insurance plans. The biggest advantage in private exchange is the defined contribution planning.

Insurance agents either work with a private health insurance company or defined contribution and provide such options to smaller groups. There are innumerable small start ups and also new divisions of big names in insurance companies that offer these small group- or individual-health insurance.

2. The SHOP marketplace

These are marketplaces run by state- or Federal- exchanges that also sell group health insurance for small enterprises. SHOP can be a good healthcare exchange for all those employers who have 50 or less employees, provided they meet some essential criteria. For instance, Massachusetts requires employers contributing 50 percent of the total health insurance cost in SHOP. Those employers with staff strength between 1-5 must have cent percent employee enrollment, while with 6-50 employees, 75% of the employees need to be enrolled.

Small business groups that are eligible, SHOP provides access to tax credits exclusively available through its platform.

3. Co-operative

The co-op is a more like a traditional health insurance approach for all small groups. The main idea is- the co-operative will increase the purchasing power, the risk of which will be spread across a larger group. There is a different structure for every co-operative, and depending on the state’s underwriting laws plus the co-op, it can decide about providing better insurance rates than the SHOP or small group, to get into the open market.

4. Small group plan

Small groups also have an option of buying private plans from small groups. They may find further carriers and options to choose from within the private market just like SHOP. There are only some states that have such one to two small group plans to choose.

5. Individual health coverage (enrollees may or may not take defined contribution)

This is fairly a simple approach that has achieved results. It allows employees to buy individual health plans using a public exchange or even a broker. Employees have the option to select from any plan and carrier present in the marketplace. Individual employees can even get discounts on the paid premiums using the tax credits for individual health plans.

In an event where the small group employer wants to contribute towards his employee’s insurance premiums, can easily use the defined contribution allowances and assist his employees in paying the non-subsidized part of the insurance premium.

Health insurance companies generally involve to help in setting up those defined contributions and sell employees the individual plans. They thus act as consultants for these small entrepreneurs. This solution works best for small groups who are heavily priced out in any group health coverage. It also works well for those employers who are not eligible to provide group healthcare coverage, or those who wish to start for the first time. In case you do not have the administrative capability to use a group health insurance policy, you may go for individual health coverage.

For all the time, health insurance companies have been trying to help employers gather friendly group health insurance plans, so that they do not suffer maximum burden from this expensive industry. However, this was only possible as the number of companies were more, hence more competition. Now, with mergers happening and competitions going down, whether the health insurance companies keep their rates low is something everybody is curious about. However, companies like Aetna and Humana say they will be able to provide better rates in insurance premiums, as the hard work will be divided between two giants, not fighting each other but helping them instead.

6 Key Tips to Get Best Health Insurance Quotes

Okay! You have been overdosed with umpteen reasons as to why you should buy health insurance coverage for yourself and your family. Everywhere that you go- your friends house, a party thrown by your workplace guys, your parents, you are bombarded with questions on why you haven’t got yourself a health coverage. Flummoxed with your current insecure health care coverage status, you have decided to get yourself enrolled. What next!?

You will need to identify health insurers and brokers in your area to get quotes on health insurance. You will also need to know how you can qualify for cost assistance in the health insurance marketplace. The 6 tips mentioned below will help you gather the best health insurance quotes for you and your family:

1. The first primary requirement for you is to find quotes that tell you minimum coverage essential for you. You also need to find out about short term health insurance plans. This will be a smart way for you to understand what coverage you will receive. However, it won’t let you stay away from being insured or paying for your health coverage.


2. While open enrollment is on, you can get your quotes. You wish to get minimum essential health coverage quotes, you have to wait exclusively for open enrollment (for 2017, it begins from November 1, 2016 to January 31, 2017). You need to remember this every year so that you can change plans according to your requirements.


3. Every insurance option or cost sharing that you are looking for, primarily depends on Federal Poverty Level (FPL) and Modified Adjusted Gross Income (MAGI). You should be aware of these two conditions before you get down on comparing your quotes.


4. The best way of getting the best health insurance plan is to compare as many quotes as possible. The apt place to find all insurers conglomerated is your exchange (better known as health insurance marketplace). The exchange is one place that will get you cost sharing under you Patient Protection Affordable Care Act (PPACA).


5. There are certain criteria under which you may even apply from outside of the exchange. Insurance agents and brokers who actually operate out of the exchange can show you which plans can be opted outside the health insurance marketplace. However, it is really a smart move on your side to understand the exchange well. This will ensure you get local help over the phone either from an insurer directly or through a third party broker.


6. If you or someone in the family have access to affordable plan through the employer, you must remember that there will be no cost sharing in your case. However, you should know that an employer-based health insurance plan is always the cheapest of all plans, simply because your employer makes the maximum contribution.

So, with these tips in your hand, you can now confidently walk into any health insurance agency and look for the most affordable health care coverage for you. A little bit of homework can get you in running a long journey smoothly, especially when that journey concerns spending a lot of money just to ensure you are in good health.

Want Better Healthcare? Check How ‘Public Option to Obamacare’ Delivers

It was almost five decades back when there were certain actions taken to help the poor and the elderly population of America, received some relief in health care costs. With the federal government of USA introducing Medicaid and Medicare, citizen of the U.S. received certain relaxation in medical aids. In 2010, after almost half a century, President Barack Obama again took the initiative of coming out to help the needy and the constrained population of America. Patient Protection Affordable Care Act (PPACA), or Affordable Care Act (ACA), or Obamacare (more of a colloquial term) has come up with some sort of relief for every needy soul of America. Today, after 6 years of its successful implementation, President Obama has come up with an additional benefit ‘public option to Obamacare’ for the people of America.

Health care expenditure can be a major cause bringing severe damages to health in the United States of America. Expensive treatments, prescriptions, drugs, hospital stays, laboratory tests, all can even make a person go bankrupt. However, the long-standing hindrances in providing adequate health care to the people of USA seem to be finding solutions with Obamacare ultimately. Ever since ACA was enacted into law, the following changes have been observed over a few years time, like:

• The rate of uninsured people in the US have reduced to 43%
• 2010- 16.1% US citizen were uninsured
• 2015- 9.1% people remain uninsured
• estimated reduction in middle aged unable to afford health insurance coverage to 5.5%
• Federal goverment could reduce its debt towards collecting $600-$1000 for each enrolee to health insurance plans
• Reduction to about 3.4% in middle aged people reporting poor health conditions
• The health care payment process too has transformed. Around 30% of the traditional payments of Medicare are flowing through the alternative models of payment.

All these and more such reforms have made serious contributions to sustained time period of spending on health sector for every insuree. Yet, there’s lot more that has to be achieved to achieve the target.

Changing how the health care system delivered

Earlier, when ACA wasn’t introduced, the health industry depended mostly on free service payment system by individual donors. The system would levy penalty on those organizations that who did efficient delivery while they were incapable of rewarding better quality care providers.

With modifications in health coverage law and further adding health option, those organizations can now provide those advantages that health insurance plans like Medicare and Medicaid were given better payments. The goal is to align them better with the actual costs that come in providing care. With changes in Medicare payment plans, the private sector too received decreased price in the health expenditure.

ACA helps detect health frauds

Many policies were included in Obamacare to identify and prevent frauds that happen in the health insurance sector. Higher scrutinization before someone gets enrolled into Medicare or Medicaid to prevent high rates of fraud prevalant in the domain. If any organization was found incurring more than $1 million loss, were charged stronger penalties to prevent such crimes. Implementing the “value based payment,” where Medicare related systems tie up with different health care enterprises and professionals for fee-for-service paying. There are efforts to foster a health insurance market

5 Vitalities to Remember While Buying Health Insurance Plans Arizona

So, you finally realized you require a health insurance? And, you have tried reading all kinds of material trying to figure out how to go about it. I am sure you have all sorts of questions looming in your head-

• Will I be able to afford a health insurance?  
• What will be provided for Arizona? 
• What will get covered when I fall sick? 
• Who do I go to for a good health insurance plan for Arizona?

If you have begun with your research, you may have already heard of the penalties you pay in case of being uninsured. And if you haven’t, it’s better are aware that you pay penalties while submitting your tax details in case you are uninsured. And there is nothing to get jittery about buying a health insurance plan. If you have right resources and facts, you can easily make smart decisions about which insurance you should buy.

There is detailed information available in the health insurance marketplace, making it easier for you to compare the various available plans. You can check and then easily pick a plan that perfectly fits your budget. This blog is to help you with the 5 vital factors you need to remember before buying your health coverage deals:

1. Where should you look: on or off the health insurance marketplace (exchange)?

This condition applies only for those who intend to buy their plans personally (not offered by employer)

To buy personal health insurance plans in Arizona, you have two choices- buying them through the state’s exchange, or not, i.e., off the state exchange.

There are insurance companies that provide plans both ‘on’ and ‘off’ the exchange. In case your income falls below 400% of the federal poverty level, you may get some premium discounts issued in your plan. However, these discounts work only and only when you buy the plan through the health insurance marketplace or exchange.

While, in ‘off’ the exchange, there are some plans, which may have wider network in terms of providers of health care.

2. You must get your “SBC” for comparison

Always collect the summary of benefits and coverage (SBC) to make proper comparisons. The health reform legislations mandate every insurer to provide information about their plans. This is a ruling from the federal government that the plans should be explained in a standard, plain- language in terms of SBC. You can also ask for a glossary on the terms used in health insurance coverage and healthcare.

3. What will be the actual cost?

For every health insurance seeker in Arizona or anywhere else in USA, price is usually the prime criteria before picking any coverage plan. While, people mostly concentrate on the premiums they need to shell out, it is also necessary to go beyond what you are billed for in EMIs. You must check what you are paying out-of-pockets and what deductibles have been associated to your plan.

It is usually better to pay a little higher premium and have a less cost- sharing plan. 

To understand the cost-sharing, you have to read various health insurance plans.

4. Networks of your provider: are your doctors in the coverage? Do you require taking benefits outside-your-network?

For any plan you buy, you need to check if the doctors you wish to visit or other healthcare providers are in the same network as is in the plan. In certain cases, networks are different according to the plans, even so within same insurance companies. Also, it is better you ask your agency about it rather than depending on the insurer directory.

5. Do you have your medicines under the plan, what is their cost if they do?

There are separate lists of medicines for every health insurance plan. These are called formularies. You must check what medications your plans cover and which not. There are usually specified tiers for assigning covered drugs. The cost-sharing of the drugs for patients will depend upon the plan chosen. Even if the medicines are covered within the plan, there are different tiers allowed for each plan, which you need to check carefully.

Even when you have checked all the above vitalities to buy your health insurance in Arizona, it is always better to take assistance from a healthcare broker. The nature of healthcare and the design of different health insurance plans are a little complicated. Even if you think you understand everything, it is better to get clear understanding from an expert. Also, you may not receive all the information of your health plans from different resources online. A proper health insurance agent in Arizona will be able to provide you clearer picture of the marketplace. 

Impact ObamaCare Has Made on New Mexico

Are you planning to shift to New Mexico, or have you been living in the state for some time now? The first thing that you will have to consider, of course after you have found yourself a decent accommodation, is- what different issues will impact your health. You may even wish to find out how the state covers its residents with affordable health care and coverage. Well, it is true that NM remains infamous when counting on its people insured however, things are changing ever since the new Obamacare has been implemented.

Of course, before you jumped into conclusions about health insurance in New Mexico being pitiable, you need to look at the challenges it faces:

• It has the highest percentage of children and uninsured living in complete poverty
• Rate of drug deaths are really high
• Rate of school graduation quite low
• State funding on public health lowered by 10 percent
• High rate of violent crime and preventive hospitalizations

However, not everything about this state is bad. This state is possibly one with very low amount of air pollution. You will rarely find obese people and binge drinking is not a practice here. Moreover, affordable medical insurance New Mexico plan was initiated in 2014, to increase the access and affordability of health insurance to its residents. 

The implementation of Affordable Care Act (ACA) or Obamacare, amidst major differences between the republicans and democrats (remember the Ryan-Biden debate), actually changed the marketplace of health insurance across the USA:

In 2012- 2013, around 24% New Mexicans within 25 and 60 were uninsured- 4th highest in USA.	In 2014, the rate fell to 19.6% non-elder NM residents remaining uninsured.
In 2012- 2013, about 20.2% of the New Mexicans of all ages were uninsured.	Come 2014 end, the rate dropped to 15.3% remaining uninsured.

Under the ACA, there are five different health plans that have been designed. These are:

• Bronze Plans- Comes with lowest monthly premiums, where 60% of the medical cost gets borne by the insurance company.

• Silver Plans- The actuarial value is 70%, which means the company bears 70% of the medical expenses.
• Gold Plans - Premiums go higher with higher metal value. Gold has 80% actuarial value. Hence, your insurance company will pay 80% of the medical bills.
• Platinum Plans-You pay more monthly premium, you get more coverage on your medical bills. This health insurance plan in New Mexico gives 90% actuarial value, which means 90% of your health coverage is covered by the insurance company.

• Catastrophic Plans- Exclusive plans for those aged below 30 and they come with low premium, essential benefits and high deductibles.

Now that you are aware of the different health insurance coverage under Obamacare, the next thing you will want to know is the plan that will fit you. It is not at all a difficult process to find an affordable health insurance in New Mexico. Just fill in your essential details like your birth date, vital statistics (Height/weight), gender, basic health data, and your contact details. There will be available plans shown to you based on your location and the kind of health profile you possess. From there you can either choose to take a health insurance agent who lives nearby or connect to the resource center online. Certain basic questions will be asked to you in the resource center, like:

•    Do you wish to take an individual plan?
•   Do you have a small business here?
•    Do you fall under pre-existing conditions?
•    Do you come uninsured in New Mexico?
•    Do you already possess a New Mexico health insurance?
•   Do you wish to get an Obamacare exchange?
•   Do you wish to get an exclusive Obamacare quote?
•   Do you need the guide to New Mexico Obamacare?

Depending upon which section you fall under or, what specific information you wish to gather, you can collect all the materials you require. Once you have decided with your plan and need to execute the process of getting your medical insurance, you can visit the official healthcare site for filling in your details. 

How impactful has ACA been in New Mexico?

With all the above values shown and execution path described, an extremely relevant question will arise on how much impact has Obamacare or affordable medical insurance New Mexico been able to make. You must ensure your safety and protection before you get into any kind of long term investments, especially when it concerns your health plus, a sumptuous amount of your hard earned money.

More affordable, accessible and high quality

According to the reports available, ACA has managed to create more affordability to the US citizen in healthcare. The plans are of high quality, highly accessible, and designed after carefully observing the demographics of the people of New Mexico.

High numbers re-enrolling into health coverage

There were 52,358 customers of NM who got re-enrolled automatically into the new scheme. Throughout entire USA, about 11.7 million people were enrolled automatically in this marketplace.

 New Mexico gets $123,281,600 grants under Obamacare

The state has total grants of $123, 281, 600 to implement in the researching, planning, development of IT, followed by its implementation in the health insurance marketplace. While all open enrollments had been time-capped, enrollment for CHIP (children Health Insurance Program) and Medicaid is open all year round. The aim behind ACA was to reduce the total number of uninsured people in USA. New Mexico alone saw some 4.9% increase in its health insurance number in just one year’s time.

Retain children insurance till 26 years age

Moreover, there are new options of coverage made available to the young adults. Children are allowed to keep their insurance under mostly all conditions till they reach 26 years of age. This has reduced tremendous pressure on students who are graduating from colleges and universities and have an added burden of paying their education loans.  

Medicaid coverage expanded

With new ACA, states now can expand their coverage through Medicaid. Those with family income under 133% of the poverty level, or earning less than $32,253 per annum (four people in the family) will get extra coverage from Medicaid. The plan includes even non-elderly adults who don’t have dependent children. This category was earlier not covered under Medicaid.

To add more to the platter:

• 74% consumers of NM who signed up were given a tax credit of $196/month using the marketplace.
• Of those who enrolled in the NM marketplace, 49% got coverage paying $100 or less, if they had applicable tax credits. 84% of the total consumers were given the option to use.
• Earlier in 2014, consumers could choose from only 4 plans. In 2015, another issue got added and consumers can now choose from 5.
• There were a total of 36 health plans in 2014, which has been increased to 43 health insurance plans- more options for the consumers of NM.
• 29% or 15,143 consumers under 35 years are signed for medical insurance in New Mexico, and 21% or 10,965 consumers within the age of 18 and 34 years signed up.

With the new presidential elections coming round, which party and who comes to live in the White House will probably decide if Obamacare stays or has to exit. However, the changes it has made into an average American’s healthcare situation are phenomenal. For states like New Mexico and others who have been rather not adequately catered to by the federal government, Affordable Care Act or Obamacare sure looks like a healthier lifestyle choice.