The advantages and pitfalls of short-term health insurance

Whether you're a college student searching for health coverage to tide you over before you start a new job, or a recently laid-off breadwinner who no longer can afford the COBRA coverage from your old job, you may want to consider exploring a short-term health insurance policy.
Short-term plans offer temporary coverage for a designated period of time (often one month to several months) to pay for things like office visits, diagnostics, inpatient care, emergency services, immunizations and prescription medications.
Often, they are high-deductible plans that would provide coverage for major medical events or emergency care -- but not regular checkups until the deductible is met. After the term of the policy lapses, you must reapply for another term. Companies like Fairmont Specialty and Blue Cross Blue Shield offer various short-term health insurance packages that you can tailor for your needs and budget -- ideally with the help of a credible local agent.
Short-term health policies may present a viable option for:
o Individuals who can't afford COBRA coverage.
o Individuals in a holding period before coverage kicks in at a new employer.
o Seniors nearing retirement who are not yet eligible for Medicare.
o College grads or other young professionals who lack coverage but who plan to find employment soon.
One of the attractive aspects of short-term policies is that they provide stopgap protection at potentially lower rates than COBRA coverage.
A 30-year-old male who doesn't smoke could pay as little as $30 in monthly premiums for a short-term plan with a $5,000 deductible, according to a preliminary online quote from UnitedHealthOne. Fairmont Specialty's short-term medical insurance plan provides a lifetime maximum of $1 million in benefits per policy. This kind of coverage helps consumers hedge against catastrophic medical bills stemming from, for instance, a sudden illness or a motor vehicle accident.
According to Families USA, a nonprofit organization that advocates for health care consumers, family COBRA premiums consume, on average, 84 percent of unemployment benefits. The group says COBRA monthly premiums average $1,069, while monthly unemployment benefits average $1,278. In nine states, COBRA premiums actually exceed (or are equal to) the average benefits that unemployed workers get.
Ron Pollack, executive director of Families USA, summarizes the situation bluntly: "COBRA health coverage is great in theory and lousy in reality … for the vast majority of workers who are laid off, they and their families are likely to join the ranks of the uninsured."
The major downside is that short-term health insurance does not cover those who have pre-existing conditions when they apply -- and does not cover pregnancy-related expenses.
There's also the lack of continuity. If you develop a medical problem or suffer an injury during the term of your coverage, this problem will be treated as a pre-existing condition when you apply for a subsequent term or another kind of insurance.
In other words, say you find a short-term policy that gives you low rates. It seems like a reasonable alternative to COBRA coverage, so you sign up. But during the term of the policy, you develop diabetes. As a result, you must engage in a costly course of therapies and medications. When it comes time to re-up your coverage, your rates almost certainly will skyrocket. Plus, you may not be able to get coverage for this new pre-existing condition.
Furthermore, you may not reapply for short-term coverage indefinitely. For instance, with the Fairmont Specialty insurance plan, people who are 65 or older cannot reapply. Terms, conditions and exclusions for short-term insurance, as with all health insurance, will vary from plan to plan and from consumer to consumer.

Original article:
http://www.insureme.com/health-insurance/advantages-and-pitfalls-short-term-health-insurance

Health Care Reform - Key Features

Key Features of the Law
The health care law offers clear choices for consumers and provides new ways to hold insurance companies accountable. The most important parts of the law are broken into groups below. We’ll highlight new features of the law here as they roll out between now and 2014.

Rights & Protections

The Affordable Care Act puts you – not insurance companies – back in charge of your health care. The following rights and consumer protections are available through the health care law

Insurance Choices

The Affordable Care Act gives you a variety of alternatives to the individual private insurance market.  If you need health insurance, these programs may be available to you.

Insurance Costs

The Affordable Care Act provides you with new ways to hold insurance companies accountable and keep your costs down.  These changes can help you get the most out of your health insurance.

65 or Older

The Affordable Care Act strengthens Medicare, offers eligible seniors a range of preventive services with no cost-sharing, and provides discounts on drugs when in the coverage gap known as the “donut hole.” Learn how the health care law affects people age 65 or older.

Employers

Tax credits and new programs are now available to small businesses. Learn how the law helps make care more affordable for employers, employees, and early retirees

Full text of the Affordable Care Act (PDF)

Read more: http://www.healthcare.gov/law/features/index.html  Key Features of the Law

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5 Questions to Ask About Your 2012 Health Benefits

Many U.S. employers will drop a bunch of health-care options in their workers' laps in the next few weeks, if they haven't already.

If you're one of those workers, unless you change jobs or lose your job, the choices you make will stick with you and possibly your family for all of 2012, so it's important to scrutinize and compare health-plan options.

You may be tempted to automatically re-enroll in the same plan you have now, but that could cost you. Many plans are shifting costs and benefits around and some employers have introduced new ways for workers to save money, experts say.

"If an employee blows off open-enrollment communications, the employee could pay more because they're missing incentives to pay less that are tied to participation in wellness activities," said Eric Parmenter, vice president of consulting for High Roads, a benefit consulting firm in Nashville, Tenn.

For next year, employers generally aren't as interested as they've been in recent years in raising workers' premium contributions, but they're finding other ways to pass on higher health-care costs, said Michael Thompson, principle in human-resource services at PricewaterhouseCoopers in New York.

"There's not as much focus on increasing premiums for workers as much as there is on increasing the amount of cost-sharing workers have at the point of service," he said.

People who use their health plan might feel more of a squeeze than those who don't, said John Asencio, senior vice president of Sibson Consulting, a human-resource consulting firm in New York.

"If you had a $15 copay, you'll probably see those go up to $20, $25 for physician office visits," he said.

The good news is underlying benefit-cost increases are expected to be moderate, compared with earlier in the 2000s when double-digit premium spikes whipsawed employers and employees alike.

Though they still far outpace general inflation and workers' wage gains, health-benefit costs are on track to rise 5.4% on average next year, the lowest rate of increase in 15 years, according to preliminary survey data from Mercer, a consulting firm in New York. If employers did nothing to manage the cost increase through plan-design changes, the increase would be 7.1%. The overall trend of the past five years has been about 9%, according to Mercer's findings.

Use of health-care services declined last year as people were left with less disposable income in a struggling economy and more workers faced higher out-of-pocket medical costs, said Beth Umland, director of research for health and benefits for Mercer in New York.

"If money is tight and you've got a $1,000 deductible, you might think twice about going to the doctor if you also think you could put it off," she said, noting the average deductible has doubled in the past five years.

Here are five bottom-line questions to consider as you compare your 2012 options:

1. What's new this year? As part of the health-reform law that kicks in more comprehensively in 2014, most employers already extend coverage to workers' adult children up to age 26 even if they're married or in school. And they have to offer free preventive care for a number of services such as colonoscopies and mammograms. For 2012, many employers are offering what are called consumer-driven health plans, which have high deductibles and often attached savings accounts. They're trying to control costs before 2014, when they have to extend coverage to part-time workers putting in at least 30 hours a week, among other anticipated costs, Umland said.

For 2012, the minimum annual deductible required for high-deductible health plans to be coupled with health savings accounts (HSAs) is unchanged at $1,200 for self-only coverage and $2,400 for family coverage. But the annual maximum for workers' out-of-pocket expenses is going up $100 to $6,050 for single coverage and rising $200 to $12,100 for family coverage next year, according to the Internal Revenue Service. Out-of-pocket expenses include deductibles and copays but exclude premiums.

Workers with HSAs for themselves only can contribute up to $3,100 to their accounts in 2012 compared with up to $6,250 for workers with family coverage in a high-deductible health plan. Those limits are slightly higher than for 2011.

2. What would the plan cost me? If your plan is shifting to coinsurance, where you pay a percentage of the total instead of a flat fee, you may have to think differently. "If you had a $10 or $20 copay, it was easy to understand what it was going to cost you when you went to the doctor," Thompson said. "If the plan now has coinsurance and a deductible, that visit may cost over $100 if you haven't met your deductible."

In making a total estimate of what a plan might cost you, first take stock of the premiums, the amount you contribute each month out of your paycheck, which will likely be higher for more a comprehensive benefit plan than for a bare-bones one. The second part relates to your out of pocket costs. For this, consider your recent history of health services. If you see a doctor or need blood work drawn frequently, for example, your copay or coinsurance amounts could make a big difference in your overall spending projections.

Next, if you're considering a health plan with a savings account such as an HSA, factor in what, if anything, your employer contributes to that account that may offset your costs. Your monthly premiums will likely be lower, but don't forget unpredictable and intangible costs. "How much am I saving for sure vs. how much might I lose if I actually use the plan?," Umland suggested asking. Plus, are you OK with managing another financial account? Try to find out how many extra administrative tasks you may need to do to use the HSA funds. Some offer debit cards you can swipe, but others may force you to submit and track claims for reimbursement.

3. What happens if I get really sick or injured? Try to run a worst-case health scenario under each of the plan options to see how financially exposed you would be among them should you or one of your covered dependents have a grave accident or illness. Know what expenses are counted in the out of pocket maximums. "How much would I be out of pocket in this option vs. this option if I suddenly need $50,000 worth of care?" Asencio said.

4. Are my meds covered? If you're on maintenance medication for a chronic illness, check to see if any plans will waive your copay or coinsurance on certain prescription drugs, making them effectively free to encourage you to keep taking them, Thompson said. You may have to talk to a health coach or participate in a disease-management program to get the free meds, but more employers are trying this option to get a handle on their long-term health costs. Some plans also offer a separate out of pocket maximum for prescription drugs, he said.

5. Am I leaving money on the table by failing to participate in wellness programs aimed at making or keeping me healthy? Whether it's a game-oriented workplace exercise competition, private dietary counseling, talking to a health coach or taking classes to help you quit smoking, you may not be able to afford to ignore your employer's 2012 wellness offerings. "While these programs have been around for a while, employers are really taking them seriously now as a way to manage costs," Umland said.

You may not have to do much work to score a break on your health-care costs. In fact, some employees may end up paying $25 to $50 more in premiums per month or hundreds of dollars more in deductibles if they don't complete a health risk assessment or other activities meant to gauge their general health status, Asencio said. "Companies are getting more aggressive around these issues."

[Credited] - Original source: http://finance.yahoo.com/news/5-questions-ask-2012-health-070000424.html

Kristen Gerencher is a reporter for MarketWatch in San Francisco.

Health insurance: Two other numbers to look at

Most people, of course, have almost no control over their health insurance:  They get what their employer provides (if they have a good job) or else they get nothing.  Whether they pick their own policy or not, the first two numbers everyone looks at are thepremium and the deductible.  Well, here are two other numbers that are at least as important.

The premium and the deductible, of course, are very important–those are the numbers that determine whether you can afford thepolicy and when it starts paying something if you get sick.

If you think of your insurance as being a sort-of prepaid medical package–you pay a monthly premium and they provide whatever care you need–then the deductible (and the co-pays) are what matter.  If you think of it as insurance though, there are two other numbers to pay close attention to:  the out-of-pocket maximum and the policy limit.

The out-of-pocket maximum

Even after you pay your deductible, your insurance only pays a percentage of your bill.  (It used to be universally 80%.  Now you often see 90% for in-network coverage and 50% for out-of-network coverage, but in policies that you buy yourself, just about any numbers can show up.)

This is all well and good as long as you don’t get seriously ill or have a bad accident.  If you do, though, even 10% of your medical care can add up fast.  An extended stay in the hospital–even a short stay in intensive care–can reach hundreds of thousands of dollars.  If that happens, your 10% plus co-pays would be in the tens of thousands of dollars–enough to ruin the finances of many households.

That’s what the out-of-pocket maximum is all about.  Once your share of the charges hits the maximum, the insurance should pay the rest.

The out-of-pocket maximum is the single most important number in determining if your insuranceis really insurance.  If your finances are such that you could pay the maximum without going bankrupt, then your insurance policy is about the size you need.  If they aren’t, then you don’t really have insurance at all–you’ve got one of those increasingly common pre-paid medical packages.  (And you’ve got a bad one–one that leaves you vulnerable to ordinary bad luck ruining your finances along with your health.)

One other thing to be aware of regarding the out-of-pocket maximum is that it often doesn’t apply to out-of-network coverage:  you not only have to pay 50% instead of 10%, but the amount you pay may not count toward the limit, leaving you on the hook for virtually unlimited expenses.

The policy limit

Just like any insurance, medical insurance has a policy limit–the most they’ll pay.  When I got my first job, $1 million was common.  Nowadays I see a lot of policies with $3 million or $5 million limits (although I’ve also seen policies with limits of just $300,000).

A policy limit is necessary for the insurance company in order to be able to calculate how much they’re on the hook for–without that information, they have no idea what premium to charge.

The policy limit doesn’t come into play very often.  Usually, insurance companies will aggressively deny coverage for expensive stuff right from the start–long before they even approach the policy limit.  But it’s always possible to argue about coverage for procedures that the insurance company doesn’t want to pay for–you have access to appeals, arbitration, lawsuits.  In the extreme, it’s even possible to get the legislature involved, passing laws that require insurance companies to pay for certain things.  That’s not true about the policy limit.  Just like with other kinds of insurance, once you hit the policy limit, the insurance company has no obligation to pay any more money.

If your health insurance is to be real insurance–the kind that protects your finances from being ruined by bad luck–then you’ll want to pay special attention to the out-of-pocket maximum and the policy limit.  Appropriate amounts for those values will matter far more than the deductibles, co-pays, or even the premiums.

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Health-Insurance Changes for 2011

Here's what to expect when your employer gives you choices during open-enrollment season this fall.

What differences can I expect to see in my health insurance for 2011 during my employer's open-enrollment season this fall?

Employers will be making some changes to their health insurance plans for 2011 because of health-care reform — such as offering coverage to children up to age 26 — and as a way to help control rising health care costs. A recent survey of large companies by the National Business Group on Health found that employers estimate their health-care-benefit costs will increase by an average of 8.9% in 2011, compared with an average increase of 7% this year. These employers are continuing to boost premiums and co-payments, but they're also beefing up programs that encourage employees to lower their medical expenses.

Higher Premiums and Co-Pays

Sixty-three percent of the employers surveyed plan to increase the percentage that employees contribute to the premium (on average, employees contribute 17% of the premium for individual coverage and 27% for family coverage). And 46% plan to raise out-of-pocket maximums. About 40% of employers also intend to increase in-network or out-of-network deductibles.
These large employers have already been boosting employees' share of the premiums and co-payments over the past few years, and they realize that increasing employee costs cannot be their only solution — especially because many workers have had stagnant wages and may have a spouse who lost a job, says Helen Darling, president of the National Business Group on Health.
If employers increase co-pays too much, the employees may not seek care they need, which could lead to greater medical expenses in the future. And the claims costs have a direct impact on these employers, who are self-insured and pay claims from their own money, using an insurance company only for administration (a common practice for many large companies). These employers are targeting some of their increases at areas that will help encourage employees to be more careful about costs — such as increasing cost sharing for non-emergency care at an emergency room.

The Solution
If you have a choice of several plans, factor your potential out-of-pocket costs into the equation rather than looking just at premiums. Evaluate the new rules for co-payments carefully when deciding which type of care to use throughout the year.

 
More High-Deductible Health Plans and Health Savings Accounts

Sixty-one percent of the employers surveyed said they plan to offer a consumer-directed health plan in 2011 (usually a high-deductible health plan combined with a health savings account), which helps lower health-care costs because it encourages employees to become better health care shoppers. In fact, 20% of the employers plan to make the consumer-directed health plan the only choice. Those that are offering several options are steering employees toward the high-deductible plans by reducing premiums and often contributing money to the employees' health savings accounts.

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The Solution
These extra incentives may make a high-deductible plan worthwhile, even if you aren't in perfect health. Also, most high-deductible plans now cover preventive care without cost sharing before you reach the deductible. Look carefully at the high-deductible plan option this year and consider adding some of your own money to an HSA (if you're eligible). Contributing to an HSA lowers your taxable income, and your money grows tax-deferred for the future and can be used tax-free for medical expenses in any year — even after you switch to a new job.

Better Deals for Primary-Care and Wellness Programs

Many employers intend to reduce or eliminate the co-pays for primary care and preventive care, which can help catch problems early and lower medical expenses in the long run. Employers have been experimenting with various forms of wellness benefits over the past few years, and most now give people bonuses for participating in wellness programs rather than penalizing them if they do not. "They like carrots more than sticks," says Darling. Forty-one percent of the employers are offering discounts for participation in wellness programs, and the average incentive to employees is $380; 22% of employers offered discounts on premiums for participating in tobacco-cessation programs.

[What your doctor may not tell you]

The Solution
Employers realized that they needed to provide workers with better incentives to sign up for wellness programs. So if participating in one seemed like a hassle in the past, it may be worth a second look this year. Also, get a list of free preventive-care services and make the most of them throughout the year.

Extra Charges for Brand-Name Drugs

Over the past few years, more employers have been charging varying levels of co-pays for different types of drugs. Sixty-three percent now have a three-tiered design for their prescription-drug coverage, charging the lowest co-pay for generic drugs, the middle rate for preferred brand-name drugs and the highest co-pay for other brand-name drugs.
People also have to jump through more hoops to get their drugs. Seventy-three percent of employers now require prior authorization before they will let you use certain drugs, and many are using step therapy, which requires doctors to try a lower-cost drug first before certain higher-cost drugs will be covered. Employers are also changing co-pays to encourage you to get your drugs from a cheaper source. For example, some will fully cover the cost of maintenance medications only if you use mail-order pharmacies. If you choose to get the medication at a local pharmacy instead, you pay the difference between the cost of mail order and the retail price.

[See How Behind Are Your Retirement Savings?]

The Solution
If you take medications regularly, look carefully at how the drugs are covered and your potential out-of-pocket cost. Switching to generics, when possible, will always save you money, and the cost savings becomes even more pronounced if your employer charges a lower co-pay for the lowest-cost drug. Also reconsider where you buy your medications if your employer provides a higher level of coverage for mail-order pharmacies. And find out about any prior authorization or step-therapy requirements before using a new medication so you don't get hit with surprise charges if you don't follow the rules.

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Open enrollment cutoff for Medicare plans moves up

A new deadline for privately run versions of the government's Medicare program may trip up customers who typically wait until the holidays to settle on their health insurance coverage for the coming year.

This fall's open enrollment deadline for Medicare Advantage plans and Part D prescription drug coverage has been moved up nearly a month to Dec. 7. The new deadline aims to help prevent coverage problems arising from late-December enrollment decisions, but it also could pose a quandary for many beneficiaries.

Medicare Advantage plans cover more than 11 million people. They offer basic Medicare coverage topped with extras, such as vision or dental coverage or premiums lower than standard Medicare rates.

Most beneficiaries enroll after they turn 65. Then they have an open enrollment window every fall in which they can drop their coverage and switch to another plan. Here are some questions to consider this fall.

— What deadlines will change?

Beneficiaries will receive their annual notice telling them about any changes in their coverage for next year by Sept. 30, which is a month earlier than last year. Insurers then will start marketing their 2012 plans on Oct. 1.

This year's open enrollment runs from Oct. 15 to Dec. 7. That's a longer stretch than last year's window of Nov. 15 to Dec. 31.

But the health care overhaul calls for the earlier deadline to ensure that new coverage begins as planned on Jan. 1, according to a Senate Finance Committee aide. The new date provides more time for applications to be processed by the end of the year.

— Will the deadline changes affect many beneficiaries?

Medicare Advantage customers will have enough time to consider their options and enroll in another plan if they avoid waiting until the last minute, said Judith Stein, executive director of the Center for Medicare Advocacy, a Connecticut-based consumer group.

But last-minute stragglers are common. Plans can receive as much as a quarter of the applications for coverage they normally get during open enrollment in those last three weeks of December, according to Matt Burns spokesman of UnitedHealth Group Inc., the largest Medicare Advantage coverage provider with more than 2 million customers.

Many people take time to make their coverage decisions. Beneficiaries start seeing Medicare Advantage ads in the fall. Then they might talk to their families, stew on the decision, and wait for the holidays to pass, said Dr. Jan Berger, chief medical officer at Silverlink Communications Inc., which works with Medicare Advantage providers.

— What happens if you miss the deadline and make no changes?

This can get complicated.

If the plan is still offered for 2012, then a customer who doesn't make any changes remains enrolled. But details of that plan may change.

If the plan is discontinued, customers may be switched to another Medicare Advantage plan offered by the same insurer. They also could be dropped into regular Medicare, which does not provide prescription drug coverage.

Options do not completely dry up if a beneficiary misses the Dec. 7 deadline. From January 1 to February 14, Medicare Advantage customers can drop their plans and enroll in regular Medicare. During this time, they also can pick a Part D prescription drug plan to go along with that coverage, but they cannot jump to another Medicare Advantage plan.

Here's another wrinkle: Beneficiaries can enroll any time during the year in a Medicare Advantage plan that has prescription drug coverage if they receive a low-income subsidy or if they have access to a plan with a five-star quality rating. The catch: Only a few plans attained that rating for this year, said David Lipschutz, an attorney with the Center for Medicare Advocacy.

The government will announce a new list of five-star rated plans next month.

— Should Medicare Advantage customers review their coverage even if they don't plan to make changes?

Absolutely.

Plans can change how they cover expenses from year to year. Customers may find that prescription drugs that were covered last year aren't covered in the new year, or they may suddenly face a big bill for a costly treatment like chemotherapy. Any changes will be laid out in the annual notices consumers receive from their insurers.

"People really, really need to look carefully and not assume that because something worked last year it will work this year," Stein said.

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