Anthem Blue Cross and Blue Shield Health Insurance Options

Anthem Blue Cross and Blue Shield offers several comprehensive health insurance plans in the individual, family and group marketplaces. We work direct with Anthem to provide those quotes to our clients – both on and off of the federal exchange.

While Anthem may be more well known for their employer sponsored plans, medical coverage for individuals and families is also prominent in Ohio.  Recently, Anthem has introduced a new portfolio of plans for individuals and families offering a wide array of coverage choices.

Blue Cross & Blue Shield Health Insurance Plan Choices

OH Anthem BCBS Quotes »

• Short Term Insurance
• Popular Maternity Plans
• Great Preventive Care
• HSA and Dental Insurance
• Copay and Coinsurance Options

Offerings from Anthem are extensive in all markets. They offer comprehensive coverage through their Bronze, Silver & Gold plans as well as their HSA plans.

By law, preventive care is included in all plans and is not subject to the deductible.  Insureds can visit their regular physician and/or OBGYN yearly without significant out of pocket.

Ohio Anthem Maternity Insurance Coverage

By law, all plans include maternity coverage with no waiting periods.  Plans must be purchased during open enrollment or if you are experiencing a qualifying life event.  There are no special deductible for maternity coverage any longer.

All coverages offer an unlimited lifetime maximum of benefits as mandated by law.  Prescription drug coverage is available as a first dollar benefit as well as a benefit that would begin after the deductible has been reached – such as with an HSA plan.  Additionally, dental and life insurance riders can be added to any plan.  Groups can add life insurance, vision, and accidental death and dismemberment riders.

Anthem’s Competitive Niche

Anthem is competitive across the board – especially for those who desire comprehensive coverage.  Small groups will also find premiums to be competitive.  The network is vast and nationwide.  Frequent out of state travelers can benefit from such a large network.  The preventive care benefit follows the recommendations of the American Medical Association and is thus quite good.

Unlike some insurers, underwriting is offered on either an accept or decline basis.  There are several premium bands for consumers depending on their health status, but coverage for preexisting conditions will not be excluded from the policy for any longer than twelve months.

In summary, Anthem is a well known insurer offering medical insurance in all markets.  They are competitively priced with a large nationwide network of doctors and hospitals.  Preventive care benefits are robust and maternity coverage is very reasonably priced when added to an HSA qualified policy.

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Category: Health Insurance

Aetna Health Insurance Quotes & Coverage

Category: Health Insurance

Health Care Reform in 2008

The final presidential debate of 2008 highlighted the stark differences between the two candidates health care plans. In a nutshell, Senator McCain favors tax cuts, choice and portability while Senator Obama is looking for an increase in corporate and government responsibility. Either way, it may be years before any significant legislation is passed to reform health care in the United States.  Our government is running enormous yearly deficits and will continue to do so – especially considering the most recent $700 billion bailout for Wall Street.

Obama’s plan will have significant costs if a centralized federal pool is created and McCain’s plan for government tax credits will essentially mean less tax revenue for the treasury. It is difficult to determine where these additional funds might materialize during such difficult economic times.

Are you Waiting to Buy Coverage?

The point of the story is if you are waiting to purchase a health insurance plan for you, your family, or your small business, then it could be a long wait.  Health care reform is more than a couple of years away and at that time, it is nearly impossible to guess what shape it may take. Consider that the current President Bush could not pass Medicare reform until his second term. These are “hot button” issues and our elected officials are reluctant to pass legislation that may affect their time in office.

It is cliche, but there is no time like the present to enroll in a health insurance plan.  You may need care before Congress and the President have done anything to increase access to affordable health coverage.

There is no doubt that health insurance provides significant peace of mind to individuals, families, and groups who elect coverage.  Premiums can be tailored to fit almost any budget. After all, insurance is for the unknown. Consumers who wait may severely limit their options.  Purchase a health insurance plan today and rest easy.  Reform is most likely years away.

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Category: Health Insurance

Health Insurance with Prescription Drug Coverage

Finding a suitable health insurance plan can be difficult for many consumers. However, obtaining reliable medical insurance with adequate prescription coverage requires even more due diligence. The problem lies in the fact that consumers taking several prescriptions are likely to have preexisting conditions or poor health. Poor health and/or several preexisting conditions may cause the insurance company to decline the application.

Editor’s Note: No longer can applicants be denied health insurance due to preexisting conditions.

Assuming the potential insured is in moderately good health, he or she will have several health plans with rx coverage to choose from. Those under age 65 and in the individual and family market can choose from traditional plans and health savings accounts. And those above age 65 or on disability can choose from several prescription Part D insurance plans.

Prescriptions Coverage Tiers

Many plans cover generic drugs ($15 co-pay is most common) without the insured first reaching a predetermined deductible. Preferred name brand drugs and non-preferred name brand drugs usually have close to $25 and $50 co-pays respectively. However, in order to be eligible for the co-pay amount with name brand drugs, a predetermined deductible (not the policy deductible) will need to be met first. This amount is usually between $100 and $250 depending on the insurance carrier.

More recently, health carriers have also introduced a 4th tier. This tier usually includes the more expensive drugs or newer drugs that have just been approved. The insured will be responsible for a percentage of the cost of Tier 4 medications, usually 25%.

It should also be noted that many health insurance companies have a calendar year maximum in prescription benefit payouts. It is not uncommon for drug benefits to cease if the insured reaches $5000 in prescription benefits in a given year. However, some plans will allow, at an additional cost, a buy-up provision that has no maximum in yearly RX benefits.

Health Savings Accounts and Prescription Drug Insurance

Typically, health insurance plans coupled with a health savings account will offer no prescription drug coverage until the policy deductible has been met. This is unlike the traditional plans described above in that traditional plans have prescription specific deductibles unrelated to the overall policy deductible. HSA plans will only provide drug coverage when the policy deductible has been met. Health savings account plans are advantageous for health consumers who are not worried about immediate drug coverage and who also want to keep their premiums low.

Group Health Insurance and RX Coverage

When selecting a group  health insurance plan for their employees, the administrator will usually have three or more prescription options to couple with their group policy. A simple way to describe plan offerings in the group market is high, medium, and low. Companies wanting to offer the best drug coverage will select a “high” coverage plan for their employees. Of course, the better the plan, the more expensive it will be for the group. Agents specializing in group health insurance will be able to provide information and descriptions of the options available from various insurance carriers.

Part D Drug Coverage

Part D plans are the result of recent legislation from the federal government separating prescription coverage from Medicare and Medicare supplement insurance. There are several insurance carriers offering plans to consumers on Medicare and/or Medicare disability. Most companies offer three plans to choose from and each plan will have a different deductible and/or co-pay for generic and brand name drugs. Usually, consumers can use online software to determine which plan is best for them based on their prescription needs. In fact, www.medicare.gov allows consumers to compare plans with almost all carriers offering Part D coverage.

In summary, when consumers are most concerned with prescription drug coverage, it is best to compare several plans with a knowledgeable agent. Health polices can differ greatly in the amount of benefits provided, when the benefits begin, and when the insured has reached the maximum in benefits. Learning limitations on benefits and purchasing an appropriate plan can eliminate potential problems in the future.

Contact us today for a health insurance quote including prescription drug coverage.

Category: Health Insurance

Health Insurance Terms Explained

When speaking with our prospective clients, oftentimes there is confusion as to the meaning of certain insurance terms.

Consumers want to understand health insurance terminology. They also want to learn how it affects not only the cost of their health insurance policy, but also their out of pocket exposure.

Listed below are explanations of common terms associated with most individual and family health insurance coverage.

Health Insurance Deductibles Explained

The deductible is the amount the insured must pay before the insurance company provides most benefits. Deductibles can range from a very small amount, such as $250, to much larger amounts, like $10,000 or $20,000. Insurance providers keep a running total of all claims in a calendar year until the deductible has been satisfied.

The insured is not responsible for paying the deductible until there is a claim. The insured only needs to pay the premiums. If there is not claim against the policy in a given year, the insured does not also have to pay the deductible amount.

It’s important to note that some benefits are not subject to the deductible like preventive care for instance. In other words, the insured has access to preventive care at a $0 cost and the deductible will not come into play.

Traditional Family Deductibles

Family plans will usually double the deductible amount from an individual plan. If the individual deductible is $2500, then the family deductible is $5000. A family must reach the increased amount before the insurance pays toward any claims.

For example, if a family selects a $5000 deductible, then the policy would not pay benefits until the family had collectively reached $10,000 in covered out of pocket expenses.

Family Embedded Deductibles

Family policies with an embedded deductible will require that at least two family members meet the deductible in a calendar year before the entire family has satisfied the policy requirements.

For example: If a family selects a $3000 deductible, the policy would pay benefits to the individual who reaches $3000 in out of pocket expenses. An additional family member would also have to reach the $3000 amount in the same year to obtain benefits from the policy. Once two family members have reached the deductible, the entire family would be eligible for immediate benefits from the policy.

It is difficult to say whether a traditional or embedded deductible is more advantageous to the insured. Depending on the situation, one plan might be better for one family and another plan will be more favorable to another. It really depends on what the family is most comfortable with in the long run.

Health Insurance Coinsurance Explained

Coinsurance is the percentage of the bill the insured is responsible for after the deductible has been reached. The most common percentage is 80/20 and it usually applies to the next $10,000 of the health related bill. The insurance provider would be responsible for 80% of the bill and the insured would be responsible for 20% of the medical bill up to $10,000. Then the coinsurance cost-sharing ends and the policy pays 100% of the covered bill.

For example: An insured with a $500 deductible and an 80/20 to $10,000 plan has medical bills totaling $7,000. The insured would be responsible for the first $500 (the deductible amount) and 20% of the next $6,500 of the medical bill or $1300. The insured would be responsible for a total of $1,800 and the health insurance provider would pay the remainder.

[$500 (deductible amount) + $1300 (coinsurance) = $1800]

After the coinsurance has reached its maximum, the insurance company is responsible for the remainder of the bill at 100%. It is important to note, that coinsurance amounts will cover wide ranges with different carriers. If the insured opts to be responsible for a larger coinsurance percentage, generally the policy will cost less. Additionally, some policies will offer a zero percent coinsurance option such as plans coupled with health savings accounts.

Maximum Out of Pocket Expenses

This is the maximum amount the insured is responsible for in a calendar year. Insurance companies arrive at this number by adding the deductible to the insured’s coinsurance percentage.

For example: An individual who purchases a health plans with $500 deductible and 80/20 coinsurance to $10,000 will have a maximum out of pocket expense of $2500.
[$500 (deductible amount) + $2000 (or 20% of $10,000 coinsurance) = $2500]

Another example: A family who selected a $1000 traditional deductible and 80/20 coinsurance to $15,000 will have a maximum out of pocket of $5000.
[$1000 x 2 plus ($2000 family deductible amount) + $3000 (or 20% of $15,000) = $5000]

Lifetime Policy Maximum

The maximum amount the health insurance company will payout in the insured’s lifetime is referred to as the lifetime maximum. The amount varies based on the type of policy you choose, but insurance providers will cover a wide expanse here as well.

Typically, coverage mounts will range from one to two million with most short term health insurance plans. Should the insured reach their lifetime maximum, then the remainder of the expenses will not be covered by the insurance company.

Editor’s Note: All Affordable Care Act policies sold today do not have a lifetime maximum. They can theoretically pay-out tens of millions of dollars to the insured.

Doctor’s Office Copay Amounts

This amount is the insured’s responsibility for a routine visit to the doctor. Co-pays usually range from $25-$50 for a visit depending on the policy provisions. It is an optional feature on most health insurance plans and will increase the overall cost of the coverage.

Most clients request this feature as they do not want to pay the entire amount for an office visit. An office co-pay falls under a broad category of policy provisions referred to as first dollar benefits. In many cases, the copay amount for your primary doctor is less than for a specialist.

First Dollar Benefits

These are the benefits that are usually not subject to the deductible and/or coinsurance amounts. Preventive care, doctor’s office visits, child wellness visits, immunizations, OBGYN appointments, prescriptions and other policy specific provisions fall into this category. Certainly, the more first dollar benefits a policy contains, the better off the insured will be as he/she will have less in out of pocket expenses.

In summary, consumers in search of health insurance quotes and coverage have several options available to them. Deductibles, coinsurance, and first dollar benefits are three of the most important factors that determine the cost of the insurance as well as the strength of the benefits provided by the carrier.

Category: Health Insurance

Health Insurance Options and COBRA

Employer based health insurance provides coverage for tens of millions of Americans. Unfortunately, many employees will be without coverage if they lose their job, quit, retire or if their company goes out of business. In most cases, an employee can elect COBRA upon losing employment. The Consolidated Omnibus Budget Reconciliation Act will provide 18 months of additional coverage so long as the group consisted of 20 or more employees.

Size of the Employer Group Dictates Cobra Options

In Ohio, if the group is under 20 employees COBRA allows for up to six months of coverage. This law is sometimes referred to as”Baby COBRA.” There are certain rules regarding who is eligible to elect COBRA and what the cost will be, but in all cases COBRA is temporary insurance for the insured. In addition, the expense to the former employee can be significant. Ultimately, the cost will be determined by the premiums for the former plan plus a 2% administrative fee. Former employees are often surprised to discover how much it will cost to elect their company insurance through COBRA.

Once their COBRA benefits have run out, individuals and families will need to search the individual health market. If you are in good health, usually there are few problems obtaining an individual or family policy. However, if the former insured is in poor health – finding a comprehensive policy can be very difficult. (Editor’s note: Due to healthcare reform, those in poor health cannot be turned down for health insurance during a qualifying event.)

Buying Health Insurance Both On and Off The Federal Exchange

There are providers who will insure high risk individuals, but typically the benefits to the insured are far less than their employer sponsored plan. When possible, an individual in poor health may only be able to find adequate coverage in another employer sponsored plan. The state of Ohio does offer an HMO plan providing open enrollment with select companies. The coverage offered will vary by county and the enrollment window will differ from company to company. However, you can expect these plans to be very expensive.

Thus, it is advisable to explore your options as soon as you lose your employer sponsored coverage. COBRA can be helpful, but because it is not permanent, new coverage will usually be needed at some point. One potentially difficult scenario can be easily avoided by shopping for insurance early.

Electing COBRA while in good health and waiting to apply for permanent coverage until the allotted 18 months expires is a risky proposition. What if your health changed for the worse during that period of time? You may have difficulty finding coverage in the individual market. However, you would have been insurable had you applied for a plan immediately after becoming unemployed. In many cases, the permanent individual coverage would be less expensive as well.

Contact Us for Group and Individual Health Insurance Quotes

In summary it is always advisable to obtain permanent health insurance coverage while you are in good health. Once accepted, you can keep this coverage for as long as you need it. If you rejoin a group plan later, you may elect to drop the coverage or maintain it if you feel that you have a superior plan.

Contact us for health insurance quotes both on and off the exchange today!

Category: Health Insurance