So how do these new plans compare to Regence’s current offerings? From a cost standpoint it seems that in many cases we will see similar costs when comparing new plans to comparable current plans. If the preliminary rate structure they provided is adopted, pricing will not change significantly, rather it is the benefits that will decrease.

The biggest changes are in the areas of coverage and coverage limitations. Some of these new plans contain exclusions that could have a significant negative financial impact on their policyholders. For instance, none of the new plans allow you to see the doctor as many times you like for a simple copay. Instead, their richest benefit plans now only allow you to see a doctor 4 times a year with a copay, after that you’re going to start paying the entire cost of subsequent doctors visits until you have met your annual deductible. Also, in many of the plans the coinsurance (the amount you pay after reaching your annual deductible) has increased, causing a higher maximum out of pocket expense if you were to become seriously ill.

Regence will also join fellow Washington Health Insurance Company. Lifewise and now charge for each child in a family. Their old pricing structure only charged for up to two children in a family plan no matter how many children are on the plan (Group Health still only charges for a maximum of two children). This was a nice benefit to large families with more than two children that already experience greater expenses due to their size.

So to summarize, Regence is keeping prices for their Washington State Health Insurance Plans relatively stable, but cutting benefits when you do need to seek medical care. Ultimately this shifts the costs from the insurance company to consumers, especially those with more than two children.

Being that Regence is the largest provider of Washington health insurance how will the other providers react to these changes? Time will tell.

Naturally, the ideal time to plan for maternity expenses is before you become pregnant. The whole concept of health insurance is to plan ahead, to have medical coverage for potential future events. Not that it is impossible to obtain health insurance for maternity expenses after you become pregnant, but it is much more difficult to get maternity health coverage once baby is on the way. Health insurance companies look at pregnancy as a “pre-existing condition.” If a woman applies for health insurance that covers maternity after she becomes pregnant she will be using healthcare dollars, without having paid her share of premiums to cover the expense. That of course defeats the reason insurance works.

So, what do you do? There are several ways to obtain affordable health issuance coverage for delivery and maternity expenses:

First, check to see if you can obtain health insurance through your employer. Keep in mind that if you are working, not all companies provide health insurance, and even if they do, not all employee based group health insurance covers maternity expenses. The first step is to check with your benefits advisor at work if applicable, and see what your health insurance covers. If your plan doesn’t cover maternity or you don’t work for an employer with health insurance available, see what may be offered under your spouse’s health insurance plan if available. Even if the specific pregnancy is not covered under your plan, illness or other complications resulting from the pregnancy or childbirth will normally be covered under your regular health insurance.

Second, if you are low income you may qualify for the Pregnancy Related Medical program in Washington State through Medicaid. This is a great program that covers the mother’s prenatal care, labor and delivery expenses, as well as the new baby’s expenses for a period after the birth. There is currently no waiting list for Pregnancy Related Medical as there is for the Washington State Basic Health Insurance program.

Finally, if insurance through your employer or your spouse is not an option and you do not qualify for Pregnancy Related Medical through Medicaid, your remaining option is to purchase a private health insurance policy through My Health Insurance of Washington. Of course, if you are buying a policy after you are already pregnant, that pregnancy may still not be covered (there are many ways to get around the preexisting condition however) but at least complications resulting from your pregnancy may be. Since average delivery expenses for a routine birth are around $10,000 (without complications!) it does make sense to pay for individual health insurance, even if the premiums may be several hundred dollars a month. While shopping for a private health insurance policy, keep in mind that most low-cost health insurance plans do not include maternity coverage so be very careful about what you buy. Sometimes buying a “cheap” policy to save a few dollars each month will cost you thousands if the pregnancy is not covered.

How do you figure all this out? Call me, I’d love to help! www.myhealthinsurancewa.com 1-877-877-9545

My Health Insurance of Washington specializes in helping individuals, families, the self-employed, and small business find quality health insurance plans to meet their health and financial needs. Based in Washington State, their sole focus in on Washington State Health insurance www.myhealthinsurancewa.com 1-877-877-9545

New plans are introduced all the time and if you’re healthy you may be able to reduce your monthly premiums. If you consider a higher deductible plan, be sure you can afford the deductible in case of an accident or illness.

Are you paying for benefits you don’t need?

Guys, you don’t need maternity coverage! Ladies, you don’t either if you are past your child bearing years! If you’re paying for benefits you don’t use (like maternity or chiropractic care), you might save money with a plan that excludes those benefits. On the other hand, if you’re paying too much out of pocket for recurring medical services (like prescriptions or checkups), consider a plan that adds these benefits.

Can you save by mixing and matching health plans?

If your whole family is covered under a single plan, you could be missing out on savings. When some family members are healthier than others, or see doctors less frequently, or don’t need certain benefits like Prescriptions or Maternity, you might save by tailoring the coverage to your individual needs.

Have you experienced any big life changes?

If you recently had a child, shift in income or change in marital status – or if you anticipate these events in the year to come — it may be time to change your health insurance coverage.

Have you talked to your broker or accountant about tax advantaged H.S.A. Plans?

If you are self employed, or otherwise have an individual policy, there are many great reasons to consider an H.S.A. if you are relatively healthy and don’t need prescription drug coverage.

My Health Insurance of Washington specializes in helping individuals, families, the self-employed, and small business find quality health insurance plans to meet their health and financial needs. Based in Washington State, their sole focus in on Washington State Health Insurance plans www.myhealthinsurancewa.com 1-877-877-9545

Everyone’s needs are different, and thus the best plan for a friend or coworker is likely not the right plan for you. Pick the wrong plan and you could pay a high financial price beyond just the monthly premiums. Here are some basics to think about when starting to search for the right plan. Naturally, before making a final determination, you will want to get expert advice from someone like My Health Insurance of Washington who will help guide you to the right plan to fit your needs.

Catastrophic vs. Comprehensive Plans:

Health Insurance plans fall into one of these two categories. While both may offer a maximum “cap” on the amount you would pay per year if you had a major medical event, there are important differences.

Catastrophic plans have higher deductibles (you pay more up front for medical care) and more limited coverage. They may limit the number of times you can visit a doctor and generally exclude maternity coverage and prescription medications. Generally if you purchase a Catastrophic policy it will cost less in monthly premium but you will usually end up paying more out of your pocket for medical expenses when you are sick or hospitalized.

Comprehensive plans have lower deductibles and a more complete benefit package that often includes maternity coverage and prescription medications, along with unlimited visits to the doctor. Naturally, these plans cost more on a monthly basis than Catastrophic plans, but if you get sick or need medications, you will pay less out of your own pocket.

For fairly healthy and younger people, Catastrophic plans can offer good value. However, if you have known health conditions, take medications, or expect something to crop up in the near future, it may be better to pay more per month with a Comprehensive plan. Thus, paying more for a Comprehensive plan may actually save you money in the long run!

PPO Plans vs. HMO Plans:

These are the two most common types of plans in Washington. Preferred Provider plans (PPO Plans) and Health Maintenance Organization (HMO) plans. An example of a PPO plan is Regence Blue Shield, while Group Health offers HMO plans (Group Health also offer plans that act like a combination of a PPO and HMO as well).

PPO Plans provide the maximum benefit if you stay within the plan’s provider network. The physicians, hospitals and other medical providers have agreed to the plan’s schedule of payments for services performed. This network is usually quite large and provides many choices of doctors and other medical providers to choose from. These plans usually do allow you to receive healthcare services outside their network of providers, but at an additional cost to you. Some may require the selection of a Primary Care Physician (PCP), a personal physician who directs all your care and who’s written referral you need prior to visiting a specialist. Naturally, with a large network of doctors, you can expect to pay more for a PPO type plan.

HMO Plans require you to use HMO doctors and their own facilities to obtain benefits. This type of plan provides relatively fewer doctors and other medical providers from which to choose. With this type of plan you may not have any coverage outside the HMO network so this is a consideration. If you are not that picky about seeing a particular doctor however, an HMO may be a good option that can save you money. HMO’s are not for everyone, as you need to stay within their network or face high extra costs when you see a non-network doctor, but can save you money over the long run.

Which Health Insurance Company should you choose?

There are several good insurance company options available to Individuals and Self Employed people in Washington. These include Lifewise, Regence, Assurant, Asuris, KPS, and Group Health. Make sure you pick a reputable carrier with good customer service and which pays their claims, and not a carrier based somewhere far away like the Mid-West or Tennessee.

All these carriers offer various plans at different price points. While their coverage for many plans may be quite similar, the monthly cost may be much higher at one carrier vs. another, so it pays to shop around. Why pay more for a plan at one carrier, when the similar coverage plan at another costs less per month? Since rates and benefits change from year to year, it is always best to have someone like My Health Insurance of Washington shop your plan each year to make sure you are getting the best bang for your buck.

My Health Insurance of Washington specializes in helping individuals, families, the self-employed, and small business find quality health insurance plans to meet their health and financial needs. Based in Washington State, their sole focus in on Washington State Health insurance www.myhealthinsurancewa.com 1-877-877-9545

For the past two years Lifewise has not been that competitive in the eyes of many health insurance brokers with respect to their rates compared with other health insurance options for the self employed and individual consumers in Washington State. However, starting in 2010 they are offering one particular health insurance plan which will provide good preventative and catastrophic coverage combined with a first of its kind prescription drug benefit, and for a very reasonable cost.

This combination of catastrophic health insurance combined with prescription coverage is something new to Washington State. Whereas before, the self employed and individuals had to choose either a catastrophic plan without prescriptions, or a much more expensive comprehensive plan with prescriptions, now they are able to have both Catastrophic coverage combined with a prescription plan. Formerly, the only other option was to add a separate drug plan from Assurant Health (if one’s health qualified them for it) to whatever other plan was chosen. This was cumbersome and complicated, as consumers had two health insurance plans to manage as opposed to one.

This new offering from Lifewise, called WiseEssentials RX will be available on January 1st for 2010. It will be offered with three deductible choices, $1,850, $2,500, and $3,000. Especially attractive is the $1,850 deductible option, as on that plan the Diagnostic and Lab Work is not subject to the deductible, potentially saving the average consumer several hundred dollars or more a year. One caveat is that the drug coverage does not include all prescriptions however, as the plan is limited to strictly Generic Drugs. Keep in mind though that not all Generic Drugs are inexpensive, as many of the most common still cost several hundred dollars and aren’t available for the much advertised $4 Generic price many chain drugstores advertise. In addition, most (but not all) drugs do have generic counterparts today.

This new Lifewise WiseEssentials RX plan is well designed, fills a previous void in the market, and will provide yet another option to choose from in the wide variety of health insurance plans offered to self employed and individual consumers here in Washington State. Thanks Lifewise!

For more information about washington state health insurance for self employed, please visit myhealthinsurancewa.com.

“Group” Status: A widely misunderstood belief is that only traditional “Group” plans can be expensed as a company cost. That is no longer true in Washington State. Now, with the proper tax plan documents (a specific HRA plan document under section 125 of the IRS tax code) a small business can reimburse, and thus deduct as an employee benefit expense, premiums their individual employees pay towards their own individually owned health insurance plans.

Cost: There used to be a substantial price break for small business when they formed a group insurance plan. Not anymore. Here in Washington State, rates for both small group community pool plans as well as individual health insurance plans are based on the age of the person(s) joining the plan. Over the last several years, the price of the Small Group plans has gone up faster than the rates for the individually owned insurance plans, leaving the individual health insurance plans priced less than the fairly comparable Group Plan options. In addition, the small changes in the way individually owned insurance plans operate have also given them a considerable cost advantage.

Employees can “own” their plan: With individually owned health insurance, unlike “Group” plans, employees are able to choose and own their plans. When they leave the company, change jobs, or become unemployed they don’t lose their coverage like they do with a “Group” plan, but simply take their insurance with them. In the current economic climate one can certainly see how beneficial this can be!

Less Administration: With no “Group” Plan, the small business has no renewals each year to go through, no participation requirements for employees on the plan, no minimum financial percentage required from the business, etc, the list goes on and on! Plus, the business can still decide who is eligible for the new plan and when they are eligible with the same criteria they used before.

Here is an example of how it can work. ACME Company drops their Group Plan which costs $400 per month per employee and now pays a set $300 per month towards an employee’s similar individually owned health insurance plan. Right away they save $1,200 per employee per year. In addition, the company can “give” part of their premium savings back to employees to cover the first dollar costs (such as copays, part of a deductible, etc.) and still save money! The employee now has greater choice to choose which plan they want (they are no longer tied to just one company plan), and now can receive first dollar coverage towards their health expenses! The company benefits from having a specific dollar amount they will provide to each employee, thus their cost is fixed and doesn’t go up each year unless they decide to increase it! It’s a win-win for the business and the employees.

This is a basic description of how not having a Small Business Group Health Insurance Plan can be beneficial, but there are many pitfalls and caveats to be aware of. Small business owners should always consult My Health Insurance of Washington when putting any type of “Group” or non-Group plan together.

For more information about Washington State Health Insurance plans, please visit myhealthinsurancewa.com.

Let’s start by mentioning that I never thought the basic “Pay Less, Get MORE” principle would apply to this company. After all, the company I am referring to is usually thought of as an HMO, where you historically had to see their doctors at their facilities. Yuck. In many ways this resembles the ugly kid in class growing up to be a supermodel, it can happen, but it is rare. In fact, several years ago if you had told me that this company would have a huge network of providers and hospitals rivaling or exceeding Premera or Regence, I’d have thought you were kidding.

This company is Group Health. Remember when they were not so fondly referred to as “Group Death”? A lot has changed.
I was skeptical myself, and didn’t place a lot of clients with this new and improved version of Group Health until I saw that their new model was working. Well, it is working and is providing great health insurance benefits for very low rates. Even President Obama has recently lauded them as one of the best examples of care in the country.

They changed because they had to in order to survive. Their membership was stagnant, while Regence and Premera were growing. They were having a hard time attracting top talent, when Regence, Premera and others could afford the best management money could buy. So, Group Health rolled up their sleeves and changed. And, they didn’t receive any bailout money or tax assistance to do so.

The health insurance agent community is happy because now there are more competitive health insurance products that more people can afford. Health Insurance consumers ranging from individuals, families, self employed and small business are happy because the newly changed company fosters rate competition in Washington, a market historically dominated by Regence Blue Shield. Group Health is happy because their growth has increased revenues which allow them to attract better and more qualified employees than ever before.

So, the moral of the story is this. Anytime a health insurance company is allowed to offer more and expanded health insurance options at reasonable rates, we all benefit. Let’s just hope our elected leadership crafting new policy in Washington understands this basic economic principle.

For more information about Washington State Halth Insurance, please visit myhealthinsurancewa.com.

1. Which bill(s) are we referring to? There are over 6 bills circulating right now and the two front runners are likely to be merged soon.

2. What is the effect of the over 1,200 amendments to these bills? Will the amendments done at the request of the special interests neutralize any positive aspects intended? (Health Insurance Agents like myself just had a successful amendment added, can you guess what is was?)

3. What is the main problem we are trying to solve? Health Care spending or covering as many uninsured as possible? They are inversely related and none of the current bills adequately address both.

4. Do we want competition, regulation, de-regulation across state lines, etc.?

5. Will reform make us healthier, or just provide more customers to the health care and prescription drug industry?

6. Will the reform efforts help/make us change our lifestyles, the only way we will ever get healthier as a nation?

7. Should we bring back Richard Simmons and “Sweating to the Oldies”?

8. Would mandated insurance coverage for all be of enough benefit to outweigh the loss of personal choice?

I appreciate hearing so much feedback from all of you, so let me know what questions you think we should be asking!

For more information about Washington State Halth Insurance, please visit myhealthinsurancewa.com.

Most health insurance plans operate on a calendar year, from January 1st to December 31st. Your yearly deductible is usually also based on this time-frame. So, let’s say you have a $1,000 deductible plan with, 20/80 Coinsurance (This means after reaching your deductible you pay the remaining 20% and the insurance pays 80% of all bills until you reach a certain maximum, at which point you get covered at 100%.). Now assume that you have spent $800 of your deductible though October, and the doctor says you will need more medical treatment in the near future. In this case, if you wait to get your expected medical treatment until after January 1st, you may start paying towards your entire $1000 deductible again! However, if you complete the needed work or procedures BEFORE December 31st, you may only pay another $200 towards your deductible, and then just 20% of the remaining charges! You’ll “save” $800 of your own money from having to be used towards you deductible again.

Think of a deductible as “use it or lose it”. Once you start getting close to using your entire deductible for the year you might as well get as much other medical work done as you can, as it will cost you only incrementally more! People who get really burned by paying two deductibles in a close time period are those women who go into labor on December 31st, and end up having their baby on January 1! Having a baby is expensive and a pretty sure way to reach well beyond the yearly deductible. Thus, having the expensive childbirth cost split over two “years” requires one to potentially spend the entire deducible TWICE!

Now, it isn’t being advocated to have unnecessary medical procedures done just because you “can”, but if you know you must have more medical procedures done in the near future, getting as much done in one year as possible is a sure way to save money. Most though not all plans operate this way, so be sure to ask your broker if this situation applies to you.
My Health Insurance of Washington specializes in helping individuals, families, the self-employed, and small business find quality health insurance plans to meet their financial needs. Based in Washington State, their sole focus in on Washington State Health Insurance plans.

For more information about Washington State Halth Insurance, please visit myhealthinsurancewa.com.

The plans quoted are top of the line comprehensive coverage with Prescription, Maternity, and Naturopathy, and have a $1,000 per person deductible per year. Rates are based on an average non-smoking family of three, with a 45 year old husband and wife and one child using in-network providers. Other higher deductible plans will have similar rate differences from carrier to carrier. There may be small differences from plan to plan but we note the major differences or advantages of each that we feel are important. Information below is not a full summary of benefits, but the highlights.

Lifewise (Premera) Insurance:

Plan Name: Wise Choices-20% Coinsurance

Copay: $30

Prescriptions: Generic $10, Formulary $45, Non-Formulary 50%

X-Ray and Lab: Deductible required, then 20% Coinsurance

Preventative Check Up: Covered at 100% with $30 copay if in Network

(Note: Especially good immunization coverage for kids will save family about $100/year on average.

COST: $1086 NOTE: Rates increase January 1st for all Lifewise Plans

Group Health Insurance:

Plan Name: Balance 1000 20%-Coinsurance (This is their ANY doctor plan)

Copay: $30

Prescriptions: Generic $10, Formulary 30%, Non-Formulary 50%

X-Ray and Lab: 100% coverage (AMAZING BENEFIT HERE)

Preventative Check Up: Covered at 100% with $30 copay if in Network

(Note: This plan allows you to see the largest network(s) of doctors in Washington. Rich Lab and X-Ray benefit may save family about $300-$600 year in out of pocket costs. A few less visits for Chiropractic, Massage, Naturopathy than other plans.)

COST: $696

Regence Blue Shield:

Plan Name: Breakthru 70-30% Coinsurance

Copay: $30

Prescriptions: Generic $10, Formulary 30%, Non-Formulary 50%

X-Ray and Lab: Deductible required, then 30% Coinsurance

Preventative Check Up: Covered at 100% with $30 copay (limited to $200/year)

(Note: Regence is by far the most dominant insurance company in Washington.)

COST: $954

KPS Health Plans:

Plan Name: Sound Harbor Elite 1000-30% Coinsurance

Copay: No copays, must pay ENTIRE cost of doctor visits until deductible reached.

Prescriptions: Generic $10, Formulary 50%, Non-Formulary 50%

X-Ray and Lab: 30% coinsurance

Preventative Check Up: Covered at 100% with $30 copay (limited to $250/year)

(Note: Lifetime Maximum benefit is very low at only $1,000,000. No doctor visits included with Copay, instead you pay the entire doctors visit cost until reaching deductible! Minimum charge of $40 for Formulary and Non-Formulary Prescriptions.)

(We DO NOT recommend this plan as it is not as good as the others!)

COST: $659 (Watch out for plan limitations!)

Summary:

My opinion is that right now the hottest plans in terms of rates and benefits are the Group Health “Any Doctor” plans. Will that be the case in a few years? Perhaps not and at that point you may want to compare and change plans again. My Health Insurance of Washington is here to assist you in finding (or changing!) plans to fit your needs and budget. Give us a call to see if we can help prevent you from paying too much!