Health Insurance Blog

According to a recent eHealthinsurance study, comprehensive maternity coverage was only available in 12% of the 3,500 individual health insurance plans surveyed.  Non-comprehensive maternity coverage was offered by an additional 9% of health plans surveyed.

The 3,500 health insurance plans were geograghically diverse, and represented 47 US states.

Women who are shopping for an individual health insurance plan should ask the insurer or agent the following questions to make sure they will be covered properly

• Is there an out-of-pocket maximum for maternity coverage?
• Are there waiting periods before maternity coverage kicks in?
• Am I covered out-of-network ?
• Is my obstetrician or hospital in-network?
• Is there a deductible or co-pay for prenatal, delivery and postpartum services?
• Does the policy pay for a home birth or birth center delivery?

In today’s economy many individuals and families are losing their health insurance coverage for a variety of reasons, including job loss.  There are many viable options for the uninsured, and if you have been unfortunate enough to be in that situation you should explore these options and obtain coverage.

Individual Health Insurance - The best option for individuals without access to employer sponsored coverage.  some states off this coverage to people regardless of health status.

High-Risk Pools - For people who can’t qualify for health insurance coverage due to medical conditions.  High risk pools exist in morethan 30 states.

COBRA - Allows individuals and families to continue their job based health coverage for up to 18-36 months should they be become unemployed.  Previous employer must have 20 employees or more, in order to be eligible. 

State Continuation Plans - are available in some states which provide similar coverage to people who were employed by small companies (<20 employees) but lost their jobs.

Other options that may be available in various states under certain circumstances to uninsured individuals include: HIPAA-Eligible, Conversion Plans, TAA Tax Credits, and Prescription Assistance Plans.

According to the Associated Press’ Melinda DeSlatte, the 2010 state budget may include tax breaks on Louisiana health insurance. Representative Gary Smith has proposed giving tax credits to small businesses that provide their employees with employer-sponsored health insurance. He also wants to offer tax credits to people who pay for individual health insurance policies, which is predicted to cost over $130 in lost tax revenue in its first year. These proposals would expand access to health insurance.

While the state currently has a billion-dollar budget deficit and plans to make cuts to health care programs, Smith believes that the health insurance tax credits will save the state government money in the long term, since fewer people would be uninsured and have to use state-funded health care services. Melinda says that Louisiana Governor Bobby Jindal has not yet expressed his opinion about this proposal but plans to make recommendations later this week.

Blue Cross Blue Shield of Rhode Island (BCBSRI) is the only game in town when it comes to the individual health insurance in Rhode Island.  For the second straight year, BCBSRI has applied to the Department of Insurance to raise their health insurance rates and for the second year in a row that request has been denied.

The rate increase that BCBSRI was seeking averaged 5.9% across all of their individual health insurance products, but half of that increase was meant for increasing the companies surplus fund.

Blue Cross and Blue Shield of Rhode Island has no plans to appeal the ruling.

America’s Health Insurance Plans (AHIP), the health insurance industry trade group, has expressed support for the idea of reforming the health care system. However, in the L.A. Times, Michael Hiltzik warns that insurers may not be as gung-ho about the possibility of universal health care as they present themselves to be.

AHIP recently released a brochure outlining its stands on health care. Some of their proposals include:

• being allowed to offer limited benefit plans among their individual health insurance policies without limits on the premiums insurers are allowed to charge
• a government-run health care option that takes only the “high-risk” patients (with several chronic conditions) private insurers don’t want, which would be very expensive since it prevents the government from spreading risk among a wide population
• a decrease in the fees paid to hospitals and doctors

These proposals are actually quite similar to what the insurance industry has asked for in the past. Michael speculates that insurers seem cooperative now because there is no specific plan for health care reform, but are prepared to fight against specific policies.

According to a recent article in the Orlando Sentinal, consumer advocate groups in Florida have warned that health insurance companies are misleading customers into believing that they are better off purchasing generic prescription drugs as opposed to their more expensive brand counterparts.

In many cases, brand name prescription drugs have an equivalent generic drug, which is perfectly safe and cost effective.  However in some cases, the Brand name drug that was prescribed by a patients doctor does not have an equivalent generic drug.  In those cases, the health insurer is recommending generics of different drugs that are in the same class.  This practice might not be a good plan for everyone, especially those prescribed anti-depressants, and blood pressure pills for example.   In any event, if the generic drug recommended is not an exact match of the brand name drug persribed, the doctor will have to approve the change anyway.

More information about Florida health insurance.

Sarah Komuniecki of WABI News reported that Anthem Blue Cross Blue Shield of Maine has filed a request to increase its rates by an average of 14.5%. Over 12,000 Maine health insurance customers with the following plans will be affected if the plan is approved:

• Health Choice
• Basic
• Health Choice Standard
• Lumenos Consumer Directed

The state’s Department of Insurance is currently asking residents to voice their opinions about Anthem BCBS of ME’s proposal in town hall meetings throughout the state or on their website.

Yesterday, the Associated Press reported that Governor John Lynch is planning to allow adults from ages 19 to 25 to buy New Hampshire health insurance through the state-subsidized Healthy Kids insurance program. Healthy Kids was previously open to children under 18 only.

After a three-month waiting period, young adults earning individual incomes below 400% of the poverty level ($3,610 per month) and without access to parent- or employer-sponsored health insurance will be allowed to participate in the buy-in program. The economy’s current troubles make it less likely that this age group will quickly find jobs with medical benefits, making this measure even more urgent. Currently, around 22,000 young adults in New Hampshire are uninsured.

The exact cost of the health insurance premiums is being finalized, but the president of Healthy Kids expects it to be less than $200 per month, significantly more affordable than most individual health plans.

The Republican Newsroom reports that there will be a slight decrease in premiums for certain Massachusetts health insurance customers. Commonwealth Care, the state-subsidized health care program for low-income individuals and families without employer-sponsored health insurance, is planning to lower rates for policyholders that choose to buy a plan other than the cheapest in their area. The Commonwealth Care plans are:

• Boston Medical Center HealthNet
• Network Health
• Neighborhood Health
• Fallon Community Health

John Dorchner reports in the Miami Herald that the state might consider a bill that would require gender equity in Florida health insurance premiums. Florida’s insurance consumer advocate Sean Shaw is looking to team up with a congressperson that would sponsor legislation that would ban the practice of gender rating. Women pay higher premiums than men, even when you exclude maternity coverage.

For example, a Blue Cross Blue Shield of Florida policy for a 30-year-old in Miami costs $246 for a man and $291 for a woman. Insurers claim that women use more health care services and are more likely to keep up with regular screenings; some believe that’s a perverse incentive to forgo preventative care.

However, due to that higher level of utilization, older women are in better health and have lower health insurance premiums than their male counterparts. Using the BCBSFL example above, a 60-year-old Miami woman pays a monthly premium of $593, while a man of the same age pays $644.