Consumers ultimately pay for drug cost increases.

When it comes to claims of price gouging, drug companies rarely flinch. But EpiPen makers (Mylan) have gotten an ear full and then some. This week, Mylan announced the release of a generic version of the EpiPen at half the cost ($300).  See Reuters Report.  But these spikes in drug costs are intended for insurance companies…not the consumer, right? Ultimately, one way or another, it is the consumer who will pay.

Another significant (double-digit) premium rate increase is anticipated in 2017 for some individual and family plans in California.  Insurance carriers have stated that drug costs are one of the main reasons for the increase.

Lower cost plans in our new healthcare reform marketplace (Bronze) tend to have smaller premium increases, but medication costs are subject to a large plan deductible like any of the other covered services. This is one of the factors that make the Bronze plan premiums less expensive.  This also means rising drug costs will have a significant impact on a Bronze plan subscriber’s out-of-pocket costs.

In our new healthcare system, individuals can change plans from year-to-year during open enrollment.  So, wouldn’t the increase in out-of-pocket costs be temporary if a Bronze plan member moved to a Silver or other plan level? Moving to a Silver level plan, for instance, would mean having a separate drug benefit with copays kicking in after a $250 drug deductible is met.  Having a lower deductible and copays for expensive medicine can often make up the difference for higher premium plans.  Problem solved, right? Not exactly. Carriers typically increase premiums of these richer benefit plans (Silver, Gold, and Platinum) to compensate for the increased cost in medical and drug services.

How long can these double-digit rate increases continue? Some insurance companies don’t see a future in remaining in the public healthcare exchange.  A number of carriers have already left state exchanges stating financial losses.

While pharmaceutical companies are counting on insurance companies to cover the increased drug cost gouge, in the end, the consumer pays both in cost and choice.

Phil Dougherty

To COBRA or not to COBRA, this is a frequent question.

First, COBRA is not health insurance. COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that governs how and when a qualified beneficiary can continue terminated group health insurance coverage for a specified period of time by self-paying the premium.  In short and in general, it’s a law that allows an ex-employee and /or their dependents to remain on the employer-sponsored group health plan for a period of time. When you leave employment you are mailed a COBRA Election Notice that includes all of the dates, deadlines, and rules for making an election. To learn more about COBRA, visit: Continue reading

Travel Insurance provides peace of mind.

Many travelers are under the wrong impression their domestic health insurance plan or the US government will provide assistance in the event of a medical emergency while traveling abroad. With international travel at an all-time high, more travelers are realizing the benefit of knowing they are covered by travel medical insurance should they become ill or injured while traveling out of the country.

Take some of the stress out of traveling by following these recommendations.

Before you leave:

  • Review your domestic health insurance plan to know what it does or does not cover while traveling abroad.
  • Purchase travel insurance and become familiar with your plan’s benefits and limitations. If coverage for a pre-existing condition is important, be sure it’s included in the policy you purchase.
  • If you’re planning high-risk activities (such as surfing, skiing, or climbing), be sure and add the appropriate riders.

While traveling abroad:

  • Bring along a record of your medical health history, including your primary doctors’ names and phone numbers, health conditions, as well as your prescription names and dosages.
  • Keep a copy of your travel insurance identification card with you, which will include the insurance company’s 24-hour hotline phone number.
  • Keep all receipts should you need to file a claim when you return.

For information and quotes on travel insurance, please visit OnlyHealthInsurance.

Phil Dougherty

Special Enrollment Period

The ACA reform has brought with it restrictions on when individual health insurance plans can be purchased. Every year there is an open enrollment period during which time those who are uninsured can enroll in a plan or those with a plan can make a plan change. The open enrollment period this year is November 1, 2016 through January 31, 2017. Outside of this open enrollment period, you’d need to experience a “qualifying life event” to enroll in coverage.

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Keeping your health plan current.

A belated Happy New Year!

Now that your health insurance is in place for another year, I hope it provides you the peace of mind you were looking for and that you’ll have little need of it.

What’s important now is to keep your plan active. A plan termination due to an unintended non-payment can be costly, and not just for the potential exposure to high health care costs. If your plan is canceled, you could be unable to restart coverage until next January. In addition to lack of insurance, you could be fined for not having ACA-compliant coverage. Continue reading

Best ways to check if your providers participate in the network for “off-exchange”, non-CoveredCA plans.

Ensuring your “must have” providers are in your health plan’s network is not as easy as it should be. Some PPO carriers have gone to narrower networks (namely Anthem Blue Cross, Blue Shield and CIGNA) so it’s important to check provider participation. Although carriers each have a provider search tool on their website, search tools are not always easy to use or up-to-date.

Before finalizing your health insurance carrier and plan decision, you’ll want to take several steps to make sure your providers take your plan. Although the following suggestions are not fail proof, they can provide some peace of mind that your providers are likely “ in-network”. Continue reading

Open Enrollment starts November 1!

The annual health insurance open enrollment period is fast approaching! This is the time when individuals and families already enrolled in ACA-compliant coverage can review their health insurance and make a plan change, and when those without coverage can enroll as well.  This year, more than ever, it is important to be informed of the changes coming to your specific plan and California’s health insurance marketplace in general.  Read your carrier renewal packets thoroughly!

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Dental Insurance – Is it worth it?

If you are like the millions of Americans who don’t have dental insurance provided by an employer, you may wonder why there aren’t more “reasonable” insurance products available in the individual market.  There is no shortage of individual dental plans; all medical insurance companies offer them.  But after looking more closely many people conclude correctly that it just doesn’t add up.  So how come? The devil is in the details. Continue reading