Your Agent can Help Decode Health Insurance Issues

Don’t Forget These Simple But Important ACA Changes

On January 1, all the provisions of the Patient Protection & Affordable Care Act (ACA) went into force. While many of us have been bombarded with the more complex ACA issues, not a lot of ink is being given to many simple, yet important, changes.

Here is a reminder of some key changes to help you get the most from your policy.

  • Emergency Services: Policies have to cover ER care. Previously pre-authorization from insurers was often needed for illnesses requiring an ER visit.
  • Preventive Care: Most policies now include free preventive care, like regular annual physicals. You’re now guaranteed at least one free annual wellness visit.
  • Prescription Drug Coverage: Your policy will now cover at least one drug in each category and medication class, or alternatively, must cover the same number per class as the benchmark plan. A benchmark plan is comparable to the average plan in your state. You’ll still be responsible for co-payments, but whatever you pay goes towards your annual out-of-pocket maximum.

Remember that, under the ACA, you are required to have a health care insurance plan or a penalty will be levied on your income tax return. In 2014, the fines are: $95 per adult and $47.50 per child.

If you are still confused, your insurance agent can help decipher the ACA for you, and if you haven’t already got a policy, you can obtain it through him or her.

NOTE: Changes to the ACA may have occurred after this newsletter was written. Call us for updated information.

Aha! Moments From Science Class

“Exciting” or “cool” isn’t how most kids would describe their last math or science class. But when lessons are less about listening and more about doing, that changes.

That’s what the New York Times discovered in a contest in 2013 when they asked for the best answers to the question: “What Memorable Experiences Have You Had in Learning Science or Math?”

The contest was open to students between the ages of 13 and 19. They were asked to submit a memorable moment from any time in their STEM (science, technology, engineering and math) education, and what they learned from it. Responses were colorful, passionate, and pretty cool.

Here’s a sampling of best entries:

Glowing pickles

Destiney’s science teacher had a penchant for weird experiments. Destiney had a penchant for pickles, so she found this experiment memorable. Her teacher plugged pins into either side of the pickle and charged it with electricity until it began to glow. The best part? She got to eat the pickle afterwards.

Fun physics

Shaun recalled his high school physics teacher spilling coffee on the floor, throwing balls in the air and pretending to get shocked with electricity to make lessons come to life. “Sure, some moments in Physics didn’t seem educational, but they could always be tied back to what we were learning,” Shaun wrote. He learned “how to calculate how far an object will go when thrown…that time isn’t the same in any one place (and) that the speed of light can never be reached.”

Fields of green

“ColterLA235” said their third-grade teacher changed their perspective on numbers by asking them figure out how many blades of grass were in the area that the class was sitting in. Using area dimensions and estimates, they came up with a plausible answer.

The lesson – for all of us: Learning can (and should be) fun.

What’s With the Great Disappearing App?

Choose anything you want to do and look for the top 500 (or 400 or 250) applicable applications (apps). Then visit some of their websites or try to find them on iTunes.

Regardless of the industry, topic, or function you searched for, you’ll likely discover that many of these apps are no longer downloadable. In fact, it seems as though some of them never even existed – as though they, their websites, and their social media accounts simply vanished into thin air.

So what’s with The Great Disappearing App? After all, apps are where it’s at: Mobile app downloads are expected to hit 108 billion in 2017, and app revenue growth is projected at $46 billion in 2016.

Initially, the high turnover of apps seemed isolated to the most popular category: games. Now, that category is just an extreme example of disappearing apps. The website, SomeGeekinTN, found that 69 percent of the top 400 games in 2013 were new. The old ones? Going…or gone?

Why? Perhaps in the rush to pump out new apps, creators produce poor ones. Rushing development, cutting corners, and not updating consistently means failure. And fail they do.

According to IdeatoAppster (ITA), it costs $30,000 to $150,000 to create a great app with staying power. That’s not chump change for a failed app. And what about that perfect app that does just what we need it to do. Blink and it’s gone; we can’t even find out why. Probably just another Great Disappearing App.

Your Agent Can Help Decode Health Insurance Issues

As if anything to do with insurance isn’t hard enough to understand, things like healthcare billing certainly make it so. Policyholders commonly experience “balanced billing,” and getting one from a hospital ER, for example, might not be anything like you’d expect.

Common health insurance policy types – HMO and PPO plans – work within specific networks of healthcare providers to provide lower premiums. Unfortunately, even when visiting an in-network hospital, the doctor or surgeon who treated you may not be part of the same network.

After visiting a hospital, clinic, or any medical facility operating outside of your health insurance network, you may receive a bill for the difference owed after your health insurance has paid its share of the medical provider’s invoice.

For example, if you have a visit to a hospital emergency room (ER), you might receive a bill that looks a bit like this:

The hospital charges your insurance carrier $500 for an ER visit. The insurance pays $250. You don’t pay anything additional because the hospital is in a network contract with your insurance provider. You’re only responsible for co-insurance and co-pay amounts less your deductible.

A treating doctor also charges $500 for your ER visit. Insurance pays $250. Because the treating doctor hasn’t a contract with your insurance provider, you’re responsible for the additional $250.

To avoid “balanced billing”, ask your insurance agent which healthcare providers are in your policy’s provider network, so you can go to network providers wherever possible.

If you need health insurance, don’t feel as though you can buy coverage only through the government’s website or any of the third parties soliciting consumers. The insurance agent you have always worked with (and who is familiar with your individual situation) can answer your questions about healthcare reform and help you compare coverage. You also can purchase a plan through him or her.