May I ask you a few questions to determine your best health care options?

Melissa Shaw

Do you want to consider a change to your individual health insurance coverage? Guarantee Issue goes along with Open Enrollment:

 

OPEN ENROLLMENT for individual health coverage is November to February. Certain Qualifying Events can open the door for coverage off cycle, or special enrollment.

Hello, I’m Melissa Shaw, CFP® owner of Accent Insurance Brokerage. I can help you figure out the U.S. health insurance maze. There are a lot of changes happening right now, as we implement the Patient Protection and Affordable Care Act, also known as PPACA, ACA and Obamacare.

Starting in January 2014, the ACA required that most U.S. citizens and legal residents be enrolled in health coverage that meets minimum essential standards. Those who do not have coverage may have to pay a penalty. This is to ensure that people can take advantage of the health and financial benefits of insurance, but also to make it possible to implement many of the insurance market reforms included in the Affordable Care Act.

The initial ACA open enrollment ran from October 1, 2013 to March 31, 2014, whereby guarantee issue individual insurance was offered by insurance companies and California Exchange, the Covered CA. If you're not in Open Enrollment, you will not be able to get coverage unless you experience a Qualifying Event. Dental applications may continue to be submitted after Open Enrollment ends. Open Enrollment for 2016 plans opens November 1, 2015 and runs to February 1, 2016.

With the Affordable Care Act, guarantee-issue coverage is available in the individual marketplace with effective dates of 1/1/2015 and later. If you are not going to take advantage of the tax credits, or you are not eligible for the tax credits, then you can buy your coverage outside the EXCHANGE. if you need Medi-Cal or tax credits to help pay for coverage, then Covered CA can help you.

Let me first say that health care is expensive. One way to make it more affordable is to keep everyone well so they don’t get sick! We try to do more with preventive measures now, so that you are inspired to take better care of yourself and maybe need less care in the long run.

It is scary to think that a typical health insurance premium for a family of 4 is $1300 a month. With the new mandated benefits for “free preventive services” as well as other essential coverage, it is safe to say that healthcare is more expensive, not more affordable, but hopefully we all care more and are healthier.

The government attempt to make it more affordable comes in the form of expanded services for those in low income and poverty through our Medi-Cal program, or the Federal Medicaid in many states. Everyone who should be in those programs needs to be in them. How much income does your household have?

If you have affordable group insurance offered through your employer, you should take advantage of it. If the employer requires you to pay more than 9.5% of your household income toward insurance premiums, then you may be eligible for financial assistance through Covered California.

To evaluate your needs for health insurance, we need to address these issues.

  1. How old are you and where do you live?  We look at your Date of Birth and zip code as part of the pricing structure.

  2. Do you have a family?  Who else needs insurance? How many people are in your household?

  3. What do you have now for coverage and how much does it cost?

  4. How do you like to get your health care services?

  5. Tell me a little about your health history and any diagnosis or ongoing conditions…

  6. Are you current with your Income Taxes, and without tax liens or back child support obligations?

  7. Pull out your tax return so we can review your past income figures and current income.

With those answers we can determine which direction you might want to go for coverage.

If you are under age 65 we may have some years to plan for before you enter the Medicare healthcare system. If you’re getting close to 65, then we need to discuss Medicare Advantage and Medicare Supplement plans, and the whole Social Security process. Please give me a call.

If you are interested in shopping for INDIVIDUAL HEALTH INSURANCE coverage, then the search engine below can help you do just that.

You can shop based on either price or benefits. The search engine below can help you shop for a variety of companies writing insurance in California.

 


With the Affordable Care Act (ACA) the design of contracts begin to look similar as we refer to the actuarial value assigned to each plan in the metal tiers of Bronze, Silver, Gold or Platinum. The health insurance plans that cover the greatest percentage of health care expenses also have higher premium expenses. Do you want to pay higher premiums monthly and have fewer medical expenses, or is it better to pay lower premiums now and more out-of-pocket costs when you incur expenses?

Category Percentage of expenses paid by health plan Percentage of expenses paid by individual
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%

With insurance it is helpful to understand the vocabulary. There are new Essential Heath Benefits required in contracts starting in 2014. Insurance policies must cover certain benefits in order to be certified and offered in the marketplace. There are a broad array of services required that include preventive and wellness services. Pediatric dental is now required on medical plans to provide some dental coverage through age 18. We all share in the premiums of this mandate to help our kids be healthier. We hope that our population will take better care of themselves and require less medical care over time as a result of it.


 

How do you like to get your health benefits?

Do you like a co-pay at the office and a co-pay for your Rx? Premiums can be higher on a monthly basis, but it keeps your exposure to large medical bills somewhat smaller. I like to look at the Annual Out of Pocket Maximum (OOPM) of a policy to see where your losses stop. If that number is $6,350 could you cover it with savings or credit? That is why you always want to have an emergency fund.

Whether you are better off with a high premium and a low out-of-pocket expenses or vice-versa depends on your situation:

  • If you know you have an expensive medical condition consider a plan with a higher premium that covers more of your costs.
  • If you are generally healthy, you could consider paying a lower premium and a bigger share of costs for the services you use. But you must then be prepared to pay more out-of-pocket if you unexpectedly become sick or injured.

I like the Health Savings Account plans because it forces me to think of wellness as a way of life. It requires a special "high deductible" plan design to meet the guidelines Congress set for the Health Savings Account concept of insurance along with a special savings account. First you must get the insurance, then you can open the Health Savings Account. Although it has a higher deductible, the premium tends to be lower than the co-pay plans. We also have a “family deductible” so all of us work towards one aggregate deductible. That works well for us. We get all the discounts Blue Cross has negotiated into our office visits, and Blue Cross tracks our deductible and stop loss for us.

The health savings account is a tax deductible expense above the line of adjusted gross income. So it's before tax dollars that you spend on a qualified medical expense. You will want to review the rules in more detail, but generally you can purchase anything that is an unreimbursed medical expense with your Health Savings Account dollars, and that includes your office visit, deductibles, prescriptions, eye exams and glasses, dental visits and even some alternative health care services. It is a wonderful opportunity to take wellness into your own hands and start with your mouth and eyes, and then work on the rest of your body too! It may just inspire you to take better care of yourself.

Get the best INDIVIDUAL health insurance coverage quotes, instantly!

For years, Accent Insurance Brokerage has been helping people find the right health coverage — and get the most for their healthcare dollars. If you're ready to view popular plans online, get your free quotes now. If you'd like to talk about your options, please contact us. Our service is free, and it doesn't stop once you purchase a plan.

Start your quote right now or drop us a line at melissa@accentinsurancebrokerage.com.
Or call 800-729-6344 x 204 or 949-699-1662 x 204.

 

 


Accent Insurance Brokerage
Helping you find wellness with health insurance and risk management solutions that make sense.
26477 Rancho Parkway South
Lake Forest, CA 92630

800-729-6344
949-699-1662
Melissa ext. 204 • Email: Melissa@AccentInsuranceBrokerage.com
Sheryl ext. 207

Fax  949-699-1069

This web site is owned and maintained by Melissa Shaw, CFP® which is solely responsible for its content.  This site is not maintained by or affiliated with Covered California, and Covered California bears no responsibility for its content.  The email addresses and telephone numbers that appear throughout this site belong to Melissa Shaw, CFP® and cannot be used to contact Covered California.

 

Copyright 2005 Project Seven Development