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November 22, 2011
PLYMOUTH—Let's face it. Navigating the complexities of the health care insurance decision-making process can be bewildering and intimidating for most of us, especially for small business owners, retirees and the self-employed. Add to the picture the changes that are coming down as a result of the national health care reform process, and the task can be truly overwhelming.

Fortunately, many individuals and business owners in the local area found welcome and helpful information at a luncheon seminar held last Wednesday at the Pease Public Library, hosted by the Plymouth and Newfound Regional Chamber of Commerce, featuring guidance from insurance broker Patty Stewart, from Plymouth's Patty Stewart and Associates Insurance Agency, Inc.

Many people are unaware that an insurance broker is available to assist with the task of understanding health insurance changes and comparing and contrasting available plans and options, ordinarily at no charge to the client. This resource can be invaluable for individuals, small businesses and retirees looking to understand the way different options will affect their accessibility to medical care and impact their bottom line.

Several seminar attendees expressed confusion as to where to find simple, summary information to understand exactly what is covered by the plans that they currently hold.

"There should be a one page policy or benefit summary that tells you exactly what you have to pay for what services," said Stewart. "These usually are sent out when you first sign up with your insurance cards. Believe it or not, it is really worth reading these policies. There is a lot of useful information in these statements that you can use."

"There are ways to save money by choosing the policy that is right for your individual circumstances," said Stewart.

Many people are eligible for group insurance plans through their employer. In this cas,e the employee is automatically approved for the plan, and there is no medical underwriting involved, although group demographics generally determine the structure of benefits costs and coverage. But the employee cannot be denied.

Group health plans typically negotiate discounts with healthcare providers that save money for their members, and provide coinsurance (often 80 percent) to pay for a large portion of covered expenses after deductibles in exchange for monthly premiums, and in some cases, individual co-payments.

It is important to know that the self-employed can purchase group insurance (for a group of one) in October or April each year. Groups of more than one employee may purchase group plans at any time of the year.

Individuals who are not eligible for a group plan through their employer may obtain an individual plan that is medically underwritten. The insurance company will look at health history, factors like age, weight, smoking, etc., in deciding whether to provide a preferred or standard plan, or possibly to deny coverage entirely.

In New Hampshire, individuals who are denied coverage because of a pre-existing condition can obtain coverage by applying to be accepted into the established New Hampshire High Risk Pool, but this option is generally comparatively expensive, with a high deductible (of $5,000) and premiums running around $450 per month.

One popular option for people is to establish tax free Health Savings Accounts (HAS's) in which they can place up to $3,500 per year to pay for future medical expenses, premiums or deductibles. There is a penalty for withdrawing funds from the HAS for purposes that are not medically approved.

Stewart says that temporary insurance can be an inexpensive and appropriate option for some people, especially if they are in good health. Individuals can purchase temporary insurance in six-month contracts of up to three terms (or 18 months) at a low monthly premium ($100). This type of insurance will not cover pre-existing conditions, generally defined as any illness that has occurred in the last 12 months, and does not cover many routine expenses.

"The most important thing in New Hampshire is to be able to document continuity in coverage," said Stewart. "If you have been covered all along, you can often avoid the problem of pre-existing conditions. But you can't just hold out until you develop an illness or a condition to jump on a plan, or it will not be covered."

Stewart outlined the various options for Medicare recipients, including the Medicare Advantage Plan option, Medicare supplement plans, and Part D prescription coverage.

"I love working with clients over 65 because it is mostly good news. They are always very happy," said Stewart.

Finally, Stewart reviewed some of the major changes to insurance that have happened as a result of national health care reform. Some changes started in 201 include the Early Retiree reinsurance Program, small employer tax credits, and some efforts to close the Medicare Part D prescription drug "doughnut hole."

In 2011, dependent coverage on parental plans became required up until age 26 (something New Hampshire already had enacted). Dollar limits have been lifted on lifetime benefits. There is no longer exclusion for pre-existing conditions for children under the age of 18. There is 100 percent coverage for "preventative services" in network. Referrals are no longer required for OB/GYN, and several other changes have occurred.

2013 is the year when Health Exchanges are expected to go online, making it easier for consumers to shop the market…but the big year for changes is 2014. However, the U.S. Supreme Court has just accepted an appeal of a lower court ruling finding controversial provisions of health care reform, such as the insurance mandate, to be constitutional. It remains to be seen which of the anticipated changes will ultimately be implemented. Stay tuned.

Salmon Press
Martin Lord Osman
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