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Understanding CHIP

The Children’s Health Insurance Program (CHIP) provides low-cost insurance converge to children in families who earn too much money to qualify for state Medicaid. If your child(ren) are eligible for CHIP, you do not have to purchase an insurance plan to cover them. Each state has its own rules and guidelines, but the CHIP program works closely with the state’s Medicaid program.

The funding for the program expired on September 30 and in recent actions by Congress, short-term funding for CHIP will again expire at the end of January. A new budget was proposed last week.

“The Congressional Budget Office says a Senate bill adding five years of financing to the program would cost $800 million. Previously, the analysts estimated it would cost $8.2 billion.” –Associated Press

What CHIP covers.

CHIP benefits are different in each state. But all states provide comprehensive coverage, including:

  • Routine check-ups
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Dental and vision care
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services
  • Emergency services

There is no cost for routine ‘well-child’ doctor and dental visits under CHIP. However, there may be co-payments for other services. In addition, some states charge a monthly premium for CHIP coverage but you will never pay more than 5% of your families’ yearly income.

 

Five Insurance Tips for Millennials

 

 

Millennials find themselves in the stage of life that may require them to purchase their own insurance. After having aged out of their parent’s insurance coverage and buying or renting a place to live, coverage needs may not be as black and white as one might think.

Knowing these five tips will help navigate through the sometimes-complicated policies out there.

  1. Shop smart for adequate coverage- Although cost is an important factor, having the coverage you need is equally important. You may be tempted to choose the least expensive plan but when it comes time to make a claim, you will see less of a financial benefit. In fact, a high deductible could cause a unexpected financial burden.
  2. Look for discounts- Often insurance carriers will offer discounts for bundling services, such as your home or rental insurance and your car insurance. In addition, there are discounts for being in school and getting good grades. Be sure to ask your agent about these and other possibilities.
  3. Fill in the gaps- An average policy will provide basic coverage but that may not be enough for all your coverage needs. For instance, a rental or homeowner’s policy may not cover personal items such as jewelry over a certain dollar amount.  Be sure to ask if you have collectables or higher value items. 
  4. Purchase life insurance- Life insurance is important, no matter how old you are. For a millennial, it may also save you money on a policy in the long run. It is especially important if you have children. Life insurance can help your family cover unexpected costs in your absence. If you have children, a life insurance policy can support their education or child care expenses.
  5. Consult an independent broker or agent- Talking with an independent insurance agent is the first step in finding the coverage you need and can afford. An independent broker works with multiple providers and can help you navigate the different policies and coverage. They can also help explain some of the terms and conditions that may be difficult to understand.

 

Common Health Insurance Terms

Common Health Insurance Terms

Common Health Insurance Terms

We understand that navigating the insurance maze can be daunting. Insurance companies use terms like, “Copay” and “Out of Pocket” and sometimes their terms can seem like a foreign language. Here are some of the most common terms you may hear and what they mean.

 

Insurance Premium– This is the cost of your plan, the monthly bill you, or your employer, pays for insurance coverage.

 

Deductible-This is the amount you pay BEFORE your insurance plan kicks and pays for certain services.

 

Copay– This is the upfront fee you pay to your doctor for services and office visits. This also applies to some medications.

 

Coinsurance– This is the amount you pay for services after your deductible has been met.

 

Total Member Responsibility-The amount that you owe for services AFTER your insurance plan has paid their portion. This can include deductibles, copays and coinsurance.

 

Out of Pocket Maximum– This the MOST you will be required to pay towards your deductible, copays and coinsurance. When you meet the Out of Pocket Maximum, all eligible charges for medical services are covered at 100% for the rest of the year.

 

Have questions? Give us a call!

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

 

 

Open Enrollment Begins November 1–Five Factors to Consider.

Did you know there are five factors that can affect how much your health plan’s monthly premium under the health care law? However, individual states can limit how much these factors come into play.

These five factors are:

  • Age: Premiums can be up to 3 times higher for older people than for younger people.
  • Location: Where you live has a big effect on your premiums. Differences in competition, state and local rules, and cost of living are the reasons why.
  • Tobacco use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.
  • Individual vs. family enrollment: Insurers can charge more for a plan that also covers a spouse and/or dependents.
  • Plan category: Bronze, Silver, Gold, Platinum, and Catastrophic. The categories are based on how you and the plan share costs. Bronze plans usually have lower monthly premiums and higher out-of-pocket costs when you get care. Platinum plans usually have the highest premiums and lowest out-of-pocket costs.

In addition, insurance companies may offer more benefits, which could also affect costs. Furthermore, insurance companies can not charge women and men different prices for the same plan, nor can they take your current medical history or health into account when, otherwise known as pre-existing conditions.

Understanding Mini-Medical Plans

Many industries or small sized employer groups utilize a mini-medical plan, such as restaurants, hotels, maid services, catering services, etc. These limited benefit plans pay for covered services at an affordable premium for both the employees and the employers. But keep in mind, they cost less, so they cover less, and most likely will not protect you from a bankruptcy situation for any catastrophic medical care.

Mini-medical plans provide a basic level of coverage for people who do not have access to a major medical plan or traditional coverage.

Some large employers have a class of employees who are ineligible for their companies traditional health insurance plan for a variety of reasons. For instance, they may be only seasonal or part-time employees. Being able to offer them a mini-medical plan helps to boast employee moral and increases retention.

Mini-medical plans are not meant to replace major medical plans, but to fill a specific niche and provide some medical coverage for those who may not qualify otherwise.