Are you one of the millions of Americans who finally have health insurance? Although you're probably feeling relieved to have the financial protection your new health plan provides, don't assume that your health plan will pay for all of your health care. You'll probably still end up paying out-of-pocket for at least some of your health care. Learn why in ""I Have Health Insurance. Why Do I still Have to Pay for Health Care?"
Whether health insurance is new to you or you've been insured for years, managing your health insurance can be confusing. Get your ducks in a row to make sure nothing falls through the cracks. Here's what needs to be done.
- If your health plan uses a claim system, make sure a claim is filed each time you get health care. If you use an in-network provider, your provider will usually file any necessary claims. However, if you go out-of-network, you may have to file the claim yourself.
- Follow up on each and every claim. Make a note to yourself to check on the status of the claim in 4-6 weeks if you haven't received an EOB. Usually claims are processed without a glitch. However, sometimes your health plan may request more information. While the health plan usually requests this information from the service provider, if you're aware, you can intervene to make sure any necessary information gets to your insurer in a timely manner.
- Follow your explanation of benefits. When your health plan has completed processing a claim, it will send you an EOB. Read those EOBs to make sure the claim was paid correctly and your share-of-cost like deductible, copay and coinsurance was listed correctly. Get in the habit of reading each EOB and cross-referencing it with each claim. This isn't just so you can catch billing errors; it's to alert you to medical identity theft and health care fraud.
- Pay your health insurance premium on time every month. If it isn't taken from your paycheck automatically, consider setting up an automatic payment system through your bank or credit card.
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If you're one of the newly-insured millions, you may have a steep learning curve ahead. If you haven't had health insurance before or haven't been covered for years, you may be surprised by how much you have to pay out of your own pocket for health care even though you have health insurance.
If you don't understand your health plan's rules and accidentally violate one, you may end up getting health care services your health plan won't pay for. You could be stuck paying the bill yourself even though you have health insurance.
How do you make sure this doesn't happen to you? You have to understand how your health plan works and what your responsibilities are. Start by reading "Understand Your Health Insurance: 7 Key Concepts."
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If you're going to itemize your tax deductions this year, don't forget about the tax deduction for medical expenses. Learn which expenses count and whether or not it will be worth your while in "How To Write Off Medical Expenses as a Tax Deduction."
Tax season is upon us. If you're like me, you're scrambling to find every possible tax deduction so you can keep more of your hard-earned income. Have you considered writing off your health insurance premiums?
In many situations, health insurance premiums are tax deductible. The rules can be complicated, but taking five minutes to review them will pay off in spades--and cold, hard cash--if you find your health insurance premiums are tax deductible.
Learn more in "Is Health Insurance Tax Deductible?"
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If your spouse's job provides your health insurance, your coverage may end when he or she has to go on Medicare. Although losing your health insurance when you're in your sixties can be disheartening, it doesn't have to be nearly as scary as it was before the Affordable Care Act, so don't lose hope. The Affordable Care Act prohibits charging more for health insurance because of preexisting conditions, so your high blood pressure and that bout with depression you had several years ago won't be held against you as you search for replacement coverage.
This doesn't mean your only option for coverage is an Affordable Care Act health insurance exchange, though. You have several options for health insurance when your spousal coverage ends. Since turning 65 is a predictable event, you'll also have plenty of time to weigh those options. Start a few months before your spouse's birthday and you'll have your new coverage lined up before your spousal coverage ends.
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Most people assume that, if they lose their job or get a divorce, they'll be able to get their health insurance through COBRA. That's a dangerous assumption.
You have to qualify for COBRA continuation coverage, and the rules for who qualifies are quite specific. Even if you're eligible, some health plans don't have to offer COBRA continuation coverage.
You're most likely to need COBRA coverage when you're laid off or quit your job, when you get divorced, or when you move. These events rank pretty high on the scale of stressful life events. Don't make it even more stressful by assuming you'll be eligible for COBRA coverage and then having to scramble to come up with plan B when you discover you're not. Learn more about who can and who can't get COBRA continuation coverage in "Am I Eligible for COBRA Health Insurance?"
My friend Dana has an all too common horror story about trying to enroll in health insurance on an Affordable Care Act health insurance exchange. Her story will help you understand why we have to do better if we want people to sign up for health insurance.
First some background. Dana is a tech-savvy, assertive, educated, self-employed woman who negotiates complex financial deals for a living. She's also had more than her fair share of bad luck when it comes to her health, so she has a lot of experience with the health care system and with cutting through health insurance red tape. She's highly motivated to get and keep good health insurance, and she's willing to pay for it.
After spending hours on Cover Oregon's Website, she'd gotten nowhere. "I'd fill out all of the forms on their Website and nothing would happen. It goes into a black hole."
Since her privately purchased coverage was going to run out soon, she got a bit more aggressive and started making phone calls. To date, she's spent more than 80 hours on the phone with Cover Oregon. She's engaged the assistance of a health insurance agent to help with enrollment, and she still has no coverage. The 80 hours of phone time doesn't include the hours her insurance agent has spent on the phone with Cover Oregon.
Dana isn't a particularly complicated case. She's not applying for a subsidy. She doesn't need help choosing a health plan or learning how health insurance works. She's been buying individual policies privately for years.
She has her plan picked out. She wants a gold-plan offered by Providence and only available through Cover Oregon. She's spoken directly with Providence. Providence told her it would like to insure her. Providence was ready; Dana was ready; where was Cover Oregon? Radio silence from Cover Oregon even though Dana had provided it with every iota of information requested.
Meanwhile, Dana's existing health insurance policy expired. Now, she's uninsured.
Dana made more phone calls. She started speaking with supervisors at Cover Oregon. She refused to take promises that a supervisor would call her back and refused to hang up. "Don't ever believe they'll call you back. They say they will, but I've never gotten a call-back from them."
At long last, Providence got word from Cover Oregon.
The information Cover Oregon sent Providence was totally screwed up. Even simple things were screwed up. Her name was spelled incorrectly. Her coverage start date was a month later than it should have been. Now she's facing another month without coverage while she tries to get the information corrected.
If she buys a temporary off-exchange policy with worse coverage while she's waiting for Cover Oregon to get its act together, she'll have to pay two deductibles this year: one on the temporary policy and one on the exchange-based policy. The money she pays toward the deductible on the temporary policy won't count toward the deductible or the out-of-pocket maximum on the exchange-based policy. These deductibles are measured in thousands of dollars, and there's no recourse for getting that money back even though she wouldn't have had to pay it if the exchange was functioning properly.
So, Dana and her husband made a tough decision. They could afford one extra deductible, but not two. They bought him a temporary policy and are taking the financial hit of the duplicate deductible for that policy, but Dana is going without health insurance while she waits.
Dana has been very careful to maintain health insurance coverage for years. Even during the days of preexisting condition exclusions and strict underwriting, self-employed Dana managed to get and keep comprehensive individual health insurance coverage.
I find it ironic and pathetic that the first time she's without health insurance coverage in years, it's because she's using the very system that's supposed to bring near-universal coverage to America.
We must do better.
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The Department of Health and Human Services says 3 million people have enrolled in health insurance sold on Affordable Care Act exchanges so far. Another 6.3 million have been found eligible for Medicaid. Together, that's 9.3 million people with health coverage. But, those numbers don't tell the whole story.
The goal for ACA exchange enrollments, not including Medicaid, was 7 million. We're less than half way there, but more than half way through the open enrollment period. Of the 3 million new enrollees, how many have actually paid their first health insurance premium? We don't know. We do know that, if they don't pay their premiums, they won't be covered.
What about the 6.3 million Medicaid eligible folks? Eligible doesn't mean covered, it just means there's a decent chance of getting Medicaid coverage if you can cut through the red tape and complete your enrollment. I doubt all 6.3 million eligible people are going to be able to cut through the red tape and cross the finish line to actually get Medicaid coverage. Additionally, some of the 6.3 million aren't new; they're renewing their existing Medicaid coverage.
Seen in this light, the numbers aren't all that great. They're better than if none of these people were enrolled, but we have to do better. We must do better.
The Department of Health and Human Services has released 2014 federal poverty guidelines.
Here's a sampling of 2014 federal poverty levels and how they compare to last year:
- For an individual, FPL is $11,670. That's an increase of $180 from 2013's FPL.
- For a couple, it's $15,730, up $220 from last year.
- For a family of four, it's $23,850, up $300 from last year.
Federal poverty guidelines are the basis for the Affordable Care Act's health insurance subsidies, as well as factoring into Medicaid eligibility. However, these 2014 levels won't be used to calculate 2014's health insurance subsidies. Health insurance subsidies are calculated using the prior year's federal poverty guidelines, but your current year's income. These newly released guidelines will set the bar for next year's health insurance subsidies and Medicaid eligibility.
To find 2014 FPL figures for other family sizes, or the higher FPL figures for the states of Alaska and Hawaii, visit the Office of the Assistant Secretary for Planning and Evaluation.