Individual/Family Plans | Lee Health Insurance Services

How to reduce Medicare Prescription Drug Costs Using Mail Order

January 19, 2011 By Phil Lee

We assisted a client in reducing her out of pocket costs for Medicare prescription drugs simply by switching from buying 30 day supplies from her her local pharmacy to using Express Scripts, the mail order service used by Anthem Blue Cross. Her projected annual expense for copay, co-insurance, deductible and premium for the next 12 months will drop from $1,971 to $1,099.
After you switch to mail order, the reduction may even allow you to downgrade to a less expensive prescription drug plan, increasing your savings.

Use the Medicare Rx calculator to compare drug plans:

http://www.medicare.gov

Compare health plan rates at:

https://health-insurance.com

Filed Under: Individual/Family Plans, Medicare Plans Tagged With: MAPD, Medicare Advantage., Medicare Plans, Medicare Prescription Drug, Prescription Drug, Rx plan, Senior Drug plan

2011 Health Savings Account (HSA) Contribution Limits

January 18, 2011 By Phil Lee

The 2011 HSA Health Savings Account contribution limits are the same as 2010’s limits:

Single HSA: $3,050
Family HSA: $6,150
Over 55 years old (but under 65): add $1,000 each person, maximum of 2 per family.

Filed Under: Group Plans, Health Savings Accounts, Individual/Family Plans Tagged With: Group Health Insurance, Group Health Plans, Health Savings Account, Health Savings Accounts, HSA Contribution, HSA Contribution Limits, Individual Health Plans

Important changes to your Health Savings Account (HSA) for 2011

January 18, 2011 By Phil Lee

If you use your HSA funds to buy over-the-counter items such as allergy and pain-relief medication, fish oil supplements and vitamins. As of January 1st, 2011, you can no longer use your HSA funds to buy over-the-counter medication without a doctor’s prescription.
In addition, you are no longer able to use your HSA money to reimburse yourself for these purchases. You may, however, reimburse yourself for over-the-counter drugs purchased in 2010.

Also, the tax penalty has doubled to 20% of the total withdrawal if you use your HSA funds for non-medical purposes.

These reductions in HSA benefits were brought about by the Health Care Reform Act of 2010, also known as PPACA, Patient Protection and Affordable Care Act or Obamacare.

To read more about over-the-counter purchases and how these changes affect your HSA, visit the IRS website at www.irs.gov and look for IRS Notice, 2010-59.

Filed Under: Group Plans, Health Care Reform, Health Savings Accounts, Individual/Family Plans Tagged With: Health Care Reform Act, Health Savings Account, Health Savings Accounts, IRS HSA., IRS Notice 2010-59, Obamacare, over-the-counter medication, Patient Protection and Affordability Act

Guarantee Issue Health Insurance Coverage for Children in California

January 7, 2011 By Phil Lee

The California Department of Insurance has issued guidance on this one provision of the Health Care Reform legislation.
Insurers in California must now offer coverage to children on every non-grandfathered individual policy that it sells. The Open Enrollment Period goes from Jan. 1st 2011 to March 1st 2011.
Children, including those with pre-existing conditions who have previously been denied coverage, may now be guaranteed issue.
Click link below for full text of regulatory guidance from the California Department of Insurance:

http://www.insurance.ca.gov/0250-insurers/0500-legal-info/0200-regulations/HealthGuidance/Guide22441F.cfm

Click link below to obtain market rates:

https://health-insurance.com

Filed Under: Health Care Reform, Individual/Family Plans Tagged With: California Department of Insurance, children health insurance, guarantee issue coverage for children, guarantee issue health plans for children, Health Care Reform, health insurance, pre-existing conditions

Is Guarantee Issue Health Insurance for Children going into effect on Sept. 23rd ?

August 11, 2010 By Phil Lee

Some of you have been asking us about this feature of the HCR (Health Care Reform) bill. I’m going to share with you a clarification that I received from Anthem Blue Cross. This one aspect of the massive HCR law, which will take effect on Sept. 23 applies only to the following:
1) If an overage dependent has been dropped from a health plan in the past due to having attained age 23, this dependent will be allowed to enroll, guarantee-issue, back onto the parent’s plan after Sept. 23rd, as long as they are not yet age 26.
2) The no pre-existing condition rule for children means that children (under age 18) will no longer have to be subject to the 6 month pre-existing condition waiting period (which currently applies to all PPO plans for individuals who did not have continuous coverage, or did not have prior creditable coverage making them eligible for the 6 month pre-existing condition waiting period waiver.)
3) Rule #2 above does not bar insurers from still denying coverage or ‘rating up premiums’ for dependents (with pre-existing conditions) who do not satisfy Rule #1 above.
4) Rule #4 above has since been revised by the regulators after further discussions and negotiations with insurance companies. The rules now mandate Guarantee Issue as well as the elimination of Pre-Existing Condition waiting periods for children.

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans Tagged With: Dependent Age 26, Group Health Insurance, Group Health Plans, guarantee issue coverage for children, guarantee issue health plans for children, Health Care Plans, Health Care Reform, health insurance, Individual Health Plans, Overage Dependent, Patient Protection and Affordable Care Act, pre-existing conditions

Retail Health Clinics: Good way to save money, especially if you’re using Health Savings Accounts

June 4, 2010 By Phil Lee

I just learned that Anthem Blue Cross expanded their network of providers to include Retail Health Clinics: small, walk-in clinics located inside retail outlets, like pharmacies and supermarkets. For those of you on HSA-compatible health plans, this is another way to reduce your medical expenses, leaving more in your tax-free account for retirement. For more details …

(Below article from Anthem Blue Cross News Flash, 6/3/2010)
[Read more…]

Filed Under: Group Plans, Health Savings Accounts, Individual/Family Plans Tagged With: Anthem Blue Cross, Group Health Plans, HSA's, Individual Health Plans, Preventive Health, Retail Health Clinics

Differences Between Individual and Group Health Insurance

June 22, 2009 By Phil Lee

For those individuals or family members who are not covered by an employer group health insurance plan, the individual health insurance market is the most popular first place to shop due to the attractive and affordable premiums. The monthly premiums for these plans are generally lower than what employers pay for group health plans, and therefore also lower than Cobra premiums. In addition there is a wide selection of plans with lower benefit levels (i.e. higher deductibles and fewer bells and whistles) and thus lower premiums for those with smaller budgets. The most important thing to know about the individual health insurance plan market is that you have to have good health to qualify. There is an application and underwriting process that determines your eligibility for these plans. There is generally no risk and no obligation in applying. Depending on your individual circumstances, the application process may take anywhere from a few minutes to several weeks. The application process and medical approval may involve the insurance underwriter having to obtain medical records from your physicians. The end result is that you may be either accepted, accepted at a higher rate level, postponed or declined for coverage.

Find Rates and Quotes for Affordable Health Insurance Plans at www.health-insurance.com.

Filed Under: Group Plans, Individual/Family Plans Tagged With: Family Health Insurance, Family Health Plans, Group Health Insurance, Group Health Plans, Health Care Plans, health insurance, Individual Health Insurance, Individual Health Plans

Applying to the right California Health Insurance Plan

June 11, 2009 By Phil Lee

Depending on your health condition, you may not be accepted into some plans like individual and family health plans.
Since health plans and rates are vastly different between the individual/family health insurance market, the Small Group market, the Cobra and HIPAA markets. You need to determine which is the most advantageous plans to apply to first. Usually this would depend on which plans have the lowest rates. If in the event you do not qualify for your top plan choice, you need to determine which alternatives to explore and in what order.
Frequently this is dependent on certain deadlines. For example you may be given 45 days after your termination from an employer to decide if you want to accept the Cobra that you are offered. Or you may have a 63 day window to decide if you want to apply for a guarantee-issue HIPAA plan after your Cobra expires.
In addition, the cost of each of these alternatives will have to figure into your decision. If you are unable to figure out the best course of action on your own, you may need the assistance of an experienced health insurance agent to help you select the most appropriate plans to apply to in different markets and in different orders or priority, based on your personal health and medical care needs, your pre-existing conditions, your guarantee-issue options, your risk tolerance and your budget.

Filed Under: Individual/Family Plans Tagged With: California Health Insurance, children health insurance, Family Health Insurance, Family Health Plans, guarantee issue coverage for children, guarantee issue health plans for children, Health Care Reform, health insurance, Health Insurance California, Individual Health Insurance, Individual Health Plans

How to Shop for Health Insurance in California

June 11, 2009 By Phil Lee

Start by determining what type of health insurance plan you currently have. Are you on:

• Your employer’s group health insurance plan?
• Your parents’ employer group health insurance plan?
• Your former or soon to be ex-spouse’s health plan?
• An individual health insurance plan?
• A Cobra or Cal-Cobra plan?
• A guarantee-issue HIPAA plan?
• A guarantee-issue high risk plan like California’s MRMIP (Major Risk Medical Insurance Program) or AIM (Access for Infoants and Mothers)?
• An employer group plan?
• A college-sponsored campus health insurance plan, with or without off campus coverage?
• A government-sponsored health insurance plan like Medicare, Medicaid, MediCal?
• A military health insurance plan like Tricare or medical coverage through the Veterans Administration?

If you don’t know the answer, you should start by asking your health insurance agent, your current health insurance carrier, your current or former employer, or your employer’s health insurance administrator, also known as a TPA (third party administrator).

In addition, if you don’t know already, find out what the premiums, costs and benefits of your current health plan are, i.e. the:

• Monthly Premium
• Office Visit Copay
• Annual Deductible
• Copays and deductibles for Brand Name and Generic drugs.
• Annual Maximum Out of Pocket Costs
• Maximum lifetime benefits
• Co-insurance percentage
• Hospital Copays or Coinsurance amounts
• Maximum daily or annual benefits if any.
• Maternity coverage if any
• Coverage for Preventive care such as annual Physical Exams, pap smear, mammogram, PSA antigen prostate test.
• Benefit limits not covered above

Once you know the details of your current plan, then you need to determine what your individual circumstances are:

• Are you terminating your employment from your employer?
• Is your former employer going out of business?
• Are you going to be offered Cobra?
• Are you in the election period of federal Cobra or Cal-Cobra?
• Are you being offered Cobra as a dependent spouse?
• Are you past the required Cobra Election period?
• Are you already on Cobra?
• Do you qualify for a guarantee-issue HIPAA plans?
• Do you have any pre-existing health conditions that would preclude you from being accepted into an individual or family health plan?
• Would your pre-existing condition be mild enough to allow you to still be accepted, but at a higher rate level?
• Do you own a small business with 2 or more full time employees including yourself?
• Does your profession have an association that offers guarantee-issue health plans?
• Are you in a low enough income bracket to allow you to qualify for coverage from certain government-sponsored health plans?
• Are you well covered by an employer, but are required to pay a substantial contribution from your paycheck in order to cover your spouse and your children?
• Are you turning 65 within the next 6 months?
• Are you between ages 18 and 23 and on your parents health insurance plan?
• Are you on your parents health insurance plan and about to leave college?

Next, you need to determine which health insurance “universe” or “market” you should be shopping in. The available markets are:

• Individual and family health insurance plan market
• Medicare senior health plans market
• Small business group health care plan market for companies with 2-50 employees.
• Mid market employer group health care plan market for companies with 51 to 200 employees
• Large employer group health care plan market for companies with over 200 employees.
• Association plans market for Individuals or small businesses in certain industries.
• Guarantee issue HIPAA plans market for those coming off of Cobra plans whose plans are ending.
• Government subsidized plans like Medical, Medicaid, Healthy Families, AIM, MRMIP (Major Risk Medical Insurance Plan)

Once you have gone through this exercise and know what type of health insurance plan you have now and what your options will be. Then it should be clear what steps to take next.

If it is still unclear to you what steps to take, then you should consult an experienced health insurance agent. Try to figure out with his/her assistance whether you should start applying to an individual health insurance plan first, or because of health conditions, not waste your time and go directly to a guarantee-issue plan, or try to set up a small group plan, etc., etc.
You may contact an agent at 800-286-7445. By email at [email protected], or go to www.health-insurance.com.

Filed Under: Individual/Family Plans Tagged With: children health insurance, Family Health Insurance, Family Health Plans, Health Insurance California, Health Plans California, Individual Health Insurance, Individual Health Plans

Who should buy Individual and Family Health Insurance Plans

June 11, 2009 By Phil Lee

Health insurance plans are not always provided by employers. In the 60 or so years since World War II it has become customary for employers to provide workers with their health insurance plans. But this was not always the case. During the wage freeze of WWII, Employers were not allowed to raise wages to entice women to join the workforce. Their solution was to provide benefits, starting with health insurance coverage. This has since become an entitlement.

If you are:
1. 0 through 64 years old.
2. Currently uninsured.
3. If you are paying too much for your current health plan.
4. If you change jobs frequently and prefer to have an individual plan as a backup in case you are disabled.
5. If you are self-employed.
6. If you own a small business.
7. If your employer does not offer group health insurance.
8. If your employer offers to pay for an individual health plan on your behalf.
9. If you don’t like the choice of plan offered by your employer.
10. If you are on COBRA.
11. If you are on an expensive guarantee-issue HIPAA mandated health plan.
12. If you are on an expensive out of state health plan.
13. If you are on a health discount program that are frequently disguised as affordable health insurance. These plans are dangerous and are not true health insurance.
14. If you have been laid off or are in between jobs.
15. If you are forced to seek individual coverage due to a divorce.
16. If your employer’s plan does not offer you the providers you need.
17. If you missed your employer’s open enrollment period for coverage.
18. If you got dropped from your parents plan due to age (19 to 24) or lack of full time student status.
19. If you retired before age 65 and need to bridge coverage to age 65.
20. If it costs too much to cover your spouse and children under your employer’s plan.
21. If you just started your own business.
22. If you just immigrated to the U.S.
23. If you plan to travel to other states or countries for a part of the year.
24. If you are uninsured and don’t want to rely on government run county or state hospitals and clinics.
25. If you are a physician with your own medical practice.
26. If you are on a work visa in the U.S.
27. If you are visiting the U.S. for an extended period of time.
28. If you are a Foreign Student.
29. If your College or University does not offer any medical care outside of an on-campus clinic.

Filed Under: Individual/Family Plans Tagged With: California Health Insurance, California Health Plans, children health insurance, Family Health Insurance, Family Health Plans, guarantee issue coverage for children, guarantee issue health plans for children, Health Care Plans, Health Insurance California, Health Plans California, Individual Health Insurance, Individual Health Plans

How to reduce Medicare Prescription Drug Costs Using Mail Order

Important changes to your Health Savings Account (HSA) for 2011

Guarantee Issue Health Insurance Coverage for Children in California

Applying to the right California Health Insurance Plan

How to Shop for Health Insurance in California

Who should buy Individual and Family Health Insurance Plans

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