Health Insurance Blog

Effective January 1, Blue Shield of California will be removed from the Major Risk Medical Insurance Program (MRMIP) because their premiums were substantially higher than the rates offered by the other two insurers that make up the Program.

The MRMIP currently covers almost 7,000 California residents who are unable to purchase private health insurance due to pre-existing conditions.

Health insurance companies that participate in the MRMIP Program are allowed to charge 25% higher premium than the market rate for a given health insurance policy, and if the insurer loses money they will be reimbursed by the state.  Despite the state subsidization, Blue Shield’s health insurance rates were much higher than both Kaiser Permananete’s or Anthem Blue Cross of California.

Current enrollees in the MRMIP Program via Blue Shield will be able to keep their existing coverage until January 1, and then must enroll with one of the other health plans that participate in the Program.

More information about California health insurance.

Blue Cross Blue Shield of Florida (BCBSFL) offers a Medical Discount Card called FamilyBlue that provides discounts on health care.  FamilyBlue is not health insurance, but it does provide discounts on heath care services which is negotiated with providers.

As mentioned above, FamilyBlue is not health insurance, and should be viewed as a last resort only if health insurance cannot be obtained.  If you shop around and compare rates for individual health insurance plans in Florida you will find that there are many affordable health plans available.  A true health insurance plan will offer superior benefits and protect you more comprehensively should you have an accident or become ill.

There are two different FamilyBlue Plans.

• $14.95/mo.per family - discounts on doctor visits, medical services, and Rx drugs.
• $19.95/mo. per family - discounts on doctor visits, medical services, Rx drugs, as well as dental, vision, diabetic supplies, hearing, vitamins and more

More information about Florida health insurance.

Many people are confused by the difference between PPO health insurance and HMO health insurance.  A helpful article on insurance.com entitled “HMO vs PPO” in their FAQ section does a great job of explaining the differences.

With an HMO, which stands for health maintenance organization, members must choose a primary care doctor from a list of member doctors.  This doctor will foresee all of your general medical care and must refer you to specialists.  With PPO health insurance, which stands for preferred provider organization you can either choose a general practitioner or a specialist, without a referral which can save a lot of time.

HMO’s usually require you to see in-network doctors, whereas PPO’s do not.  But with PPO’s there often is incentive to stick with in-network doctors.  The main benefit of HMO’s compared to PPO’s is that there usually isn’t a deductible to meet and the co-payments are generally lower.  The best choice totally depends on your personal situation and your particular needs.  It’s important to take the time to evaluate each health insurance option before making a decision.

As unemployment rises so does the number of people who need help finding health insurance.  A lost job usually means a loss in employer based health insurance as well.  According to the article on WISN.com, millions of Americans are an illness away from financial ruin because they are not protected by health insurance. 

Finding health insurance does not have to be difficult.  Consumer Reports supports checking to see if you qualify for Medicaid.  If you do not, another option is checking to see if your kids qualify for the Children’s Health insurance program (CHIPS). 

By visiting govbenefits.org you can see if there are any other government insurance programs you may be eligible for.  It’s important to shop around and educate yourself on the different types of health insurance options out there.

The Texas Health Insurance Pool website gives some history and background to what the pool is and how it benefits Texas residents.

The Texas Legislature created the Texas Health Insurance Pool to provide Texas health insurance benefits to eligible Texans who are unable to get coverage from commercial insurance companies because of previous or current medical conditions. 

The Pool is also an alternative means for individual health insurance coverage which guarantees transferring coverage to qualified residents who lose their coverage under an employer based plan, a church plan, or a state plan.  This is mandated by the federal Health Insurance Portability and Accountability Act of 1996, also known as HIPPAA.

According to an article on news.prnewswire.com the US Census Bureau just published 2006 estimates of health insurance coverage for each county in the nation.  Small Area Health Insurance Estimates (SAHIE) use a variety of sources for their survey models. 

The Centers for Disease Control and Prevention uses SAHIE to support its National Breast and Cervical Cancer Early Detection Program.  Free cancer screenings are offered by the program to low income and uninsured women.

Marcus Plescia, the director of the CDC’s Division of Cancer Prevention and Control in Atlanta says that the health insurance estimates are helpful in determining the level of need for cancer screenings in counties nationwide.  The data permits them to plan various programs and figure out how to allocate resources.

This SAHIE program includes data from various different ages, gender, income, race and low income children.  SAHIE offers a snapshot of those without health insurance that can be extremely valuable to officials as they plan to assist the uninsured.

According to the article “NC high-risk pool an option for many seeking health insurance” by Vicky Eckenrode on starnewsonline.com, there is a new state program to cover high risk applicants to ensure North Carolina health insurance is made available to them.

In 2007, state legislators started the Inclusive Health program.  It’s also known as the North Carolina Health Insurance Risk-Pool and it’s intended to assist people who are struggling to get covered because the industry considers them high risk.  Michael Keough, the program’s executive director says that this is an alternative mechanism to provide affordable health insurance to those high risk applicants.  Enrollment began in January and is up to about 1,600 covered now. 

State risk pools have been in existence for decades.  North Carolina is the 35th state to start this type of program.  The health insurance premiums for Inclusive Health are capped at 175% of the standard risk rate.  In other words, it tops out at 75% more than what a healthy person would pay for a similar policy.  The average age for this program is 50 years old.  This is a great option for many as Congress continues to figure out the health care reform debate.

According to an article on Yahoo sports today, two popular MMA fighters were injured recent MMA sanctioned fights this past week and both were uninsured!  The fighters were Jessica Bednark and Zach Kirk.

Because MMA is such a dangerous sport, and injuries are common, health insurance companies are not anxious to cover participants.  While the promoters of UFC, Strikeforce and Sengoku will apy for the medical expenses that result from injuries in the ring, they are unable to get health coverage for the fighters.

Even if these fighters apply for private health insurance on their own, and indicate their profession as mixed martial arts, the premiums are so high that a fighter can’t afford them, or the health insurance companies won’t cover them at all.

Blue Cross Blue Shield, and AHIP, issued a joint statement opposing President Obama’s proposal to create a government run health plan.  They believe that the creation of a government run health plan would be detrimental to a overhaul of our ailing health system.

In their statement sent to key senators, AHIP and the Blue Cross Blue Shield Association (BCBSA) said that any such program “would thwart the ability of the healthcare sector to implement meaningful delivery system reforms, exacerbate the cost-shift from public programs to consumers and employers in the private market, and destabilize the employer-based system.” The two groups said that more than 100 million Americans would leave their existing private health insurance plan for the proposed federally subsidized health plan.

Both AHIP and BCBSA said they would guarantee health insurance coverage to all families and individuals, including those with pre-existing medical conditions, but only if there is a federal mandate that requires Americans to obtain and hold health insurance coverage. Even so, “rating flexibility based on age, geography, family size and benefit design would be needed to maintain affordability.”

This is a interesting development in the ongoing debate about how to fix the broken health care system in the United States.  This proposal seems like it would make sense for health insurance shoppers if the rates would indeed be affordable.  My gut feeling says that  if health insurance companies are required to cover unhealthy individuals at the same rates as healthy individuals, the healthy people will bear the financial brunt of this compromise.

Walt Williams reports in the State Journal that West Virginia Senator Jay Rockefeller has introduced a bill that is intented to increase health insurance access to those with pre-existing conditions. The Pre-Existing Condition Prevention Act would prevent insurance companies from excluding a pre-existing condition from their coverage. Rockefeller claims that over 130 million Americans suffer from chronic conditions that could lead to individual health coverage being denied them. He also says that this bill is essential to pave the way for universal health care reform at a lower cost.

On the other hand, Walt quotes an industry spokesperson who says that the impact of such denials are heavily exaggerated (although they have far more impact when shopping for an individual health insurance policy on the open market, as opposed to an employer-sponsored health plan that puts a potential policyholder in a larger pool that reduces the risk of any one person with a chronic illness), and that the bill could result in a moral hazard: people will drive up the cost of health care by only buying insurance after they desperately need it.