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Special Enrollment Period (SEP)

Did you know that certain life changes may qualify you to enroll in health insurance coverage outside of the standard enrollment period?

Did you or anyone in your household lose qualifying health coverage in the last 60 days? If so, you would qualify for the special enrollment period.

Here are some examples of qualifying events:

  • Marriage
  • Birth of a child
  • Gained or became a dependent
  • Divorce or legal separation resulting in lose of health insurance
  • Death
  • Change in income
  • Change in zip code/primary place of living
  • Denied Medicaid or CHIP
  • Gained citizenship in the United States
  • Released from incarceration

 

If any of these apply to you or your family, please give us a call for a quote today!

 

 

Recent Study Looks At Health Care Pricing

According to a recently published healthcare economics paper, different insurers pay varied prices for the same services and procedures at the same hospital, indicating that bargaining leverage really does impact healthcare prices.

 

Authors took actual data from claims for three national insurers. Studies showed that dominate hospitals can dictate how much they are going to get paid for specific services and procedures. For hospitals that hold an monopoly in their area, that number was 12.5% higher than those who had nearby competitors. For more concentrated markets, providers can shift more risk to insurers, which affects the ability to keep prices at a set standard.

 

“The two main types of contracts use prospectively set prices that pay a fixed dollar amount based on the DRG classification code, or a model that sets payments as a percentage of hospital charges.
Hospitals are likely to prefer the latter because they get paid for every service they provide, and thus bear less risk. This drives prices up and also places less pressure on the hospital to reduce costs.”

 

In simply terms, it’s about negotiation. The hospital may charge $50,000 for a hip replacement, but the negotiated price may be more like $22,000, Medicare reimbursements would be even less.

 

“Researchers also found that prices increased by more than 6% when merging hospitals were less than 5 miles apart. They didn’t find significant price impact when the hospitals were separated by at least 25 miles.”

 

 

Sources: The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured Zack Cooper (Yale University) Stuart V. Craig (University of Pennsylvania) Martin Gaynor (Carnegie Mellon University and NBER) John Van Reenen (Massachusetts Institute of Technology, CEP, and NBER)

Modernhealthcare.com

Health Care Cost Institute

 

 

It’s Allergy Season | Be Prepared

With spring weather comes allergy season. Plants are starting to bloom and pollen is in the air to fertilize other plants. Pollen can also pollinate your nasal passages which can bring discomfort.

Be Prepared for Allergy Season

Common sources of allergies, sometimes referred as  ‘hay fever’ come from weeds, flowers, grasses, and trees. Symptoms include sneezing, itchy and watery eyes, and runny nose.

Your physcian can perform a skin prick test to help determine what you are allergic to so you can use the most appropriate treatment.

These simple tips can also help prevent reactions.

  1. Limit your time outdoors on high pollen days and keep your windows closed.  The local news is a great resource for sharing this information.
  2. Take over the counter medication after consulting with your physician.
  3. Change your bedding once a week to remove any pollen you may have brought indoors.
  4. Remove your shoes in the house to avoid dragging it in from outside.