Tag Archive for: health insurance

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Understanding Preventive Health Services

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Preventive Health Service

 

 

Did you know that many preventive health services are covered by most health insurance policies at no cost to you? Waiting until you need to go to the doctor due to illness should be a thing of the past, practicing a healthy lifestyle and visiting the doctor for routine, preventive services is the key to a longer, healthier life.

When you become ill, you have no choice but to pay attention to your health. But, with free preventive services, like immunizations and yearly exams, you can get ahead of something that may have become catastrophic otherwise. Insurance companies want you to stay healthy, and in doing so, it keeps the cost of healthcare down.

Insurance carriers do have some age restrictions on some services, but overall, these preventive services are covered:

*Adult services:

• Laboratory tests

• Contraception

• Procedures; i.e., Pap Test, Lung Cancer Screening (between ages 55 and 80), Screening Mammogram

• Immunizations

• Examinations and Counseling; i.e., Physical Exam

*Obstetrical services:

• Laboratory tests; i.e., Iron Deficiency Anemia Screening, Diabetes Screening

• Breast feeding supplies and support; i.e., Breast Pump

*Pediatric services:

• Examinations and Counseling; i.e., Well-child Visit

• Immunizations

• Laboratory tests; i.e., Newborn Metabolic Screening (younger than age 1),

It may be beneficial to think of utilizing preventive services as a personal investment in your health future. In additional to practicing healthy living habits, like exercising and eating a well balanced diet, getting to the doctor on a regular basis will pay large dividends in your overall health as you age.

 

 

Source: Select Health 

Common Health Insurance Terms

Common Health Insurance Terms

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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

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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

 

 

Report shows ACA marketplaces experienced most profitable first quarter yet

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According to a new analysis by the Kaiser Family Foundation, health insurers who participated in the Affordable Care Act marketplace earned an average of $300 per member in the first part of 2017.

This figure is more than double than this time period for the previous three years.

The figures presented to do not account for administrative costs, however, the increases still show that the marketplaces are becoming more profitable for private companies selling plans on the exchanges.

According to Cynthia Cox, a researcher at the Kaiser Family Foundation who worked on the analysis, the current profitability seems to come from increased premiums and steady cost which also suggests the markets are becoming more stable.

These increases were partially due to insurance companies underestimating the cost to cover people in the marketplace, many were sicker than expected and seeking insurance. Additionally, costs have been stable over the past few years, indicating that healthy people were not driven out of the marketplace. Insurers have set premiums high enough for them to profit but not so high that healthier customers left the market, allowing the market to achieve stability.

Source: Kaiser Family Foundation

Small business owners are voicing their opinions on the President’s ideas to repeal and replace the Affordable Care Act.

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When 1,000 small business owners were recently survived, 53.1 percent are against the health care bill passed by the House, while only 13 percent support it.

An impartial position of 34 percent was reported while a large majority of 60.4 percent do not think the bill would have a negative effect on their small business. Almost all agreed at 92.5 percent that insurance companies should provide coverage to people with pre-existing conditions.

At 72 percent, most small business owners agreed that expanding access to health care is most important over reducing taxes and decreasing the federal debt.

 

Sources: BenefitsPro.com, Fit Small Business