But were too afraid to ask!

According to Lesson 16 from CNN’s Money 101, there are a few things to know about health insurance:

A lot of people who think they are healthy may believe that having no insurance saves them a lot more money than having insurance. But what if there’s a catastrophe? You may get into a car accident and get hurt or get hurt on your yearly skiing trip. You may be a healthy person but no one can avoid accidents or unexpected illnesses. A major illness can even push you to bankruptcy.

Make sure you compare plans. Benefits vary from plan to plan and comparing plans can help you find the plan that fits your specific needs.  Also know that a low premium doesn’t always mean cheaper health coverage. A low premium usually means a higher deductible. This means that you must reach this deductible before the insurance starts paying.

In the event you lose your job, COBRA can protect you from losing your health coverage. COBRA usually has higher premium costs but expensive health insurance is better than none at all. COBRA fills the gap while you are looking for an individual plan, getting on your spouse’s insurance, or finding another job.

Indemnity plans v. Managed Care plans

Indemnity plans allow you to go to any primary care doctor, specialist or hospital. You or your employer pays the premium and there is a deductible that needs to be met before insurance kicks in. After your deductible is met, your health plan pays for a percentage of your health care expenses, usually 80%.  Indemnity plans offer the best choice of a provider but usually have more expensive premiums, deductibles, and coinsurance.

Managed Care plans consist of Health Maintenance Organizations (HMO), Preferred Provider Organization (PPO), and Point of Service plans (POS). HMOs have the least expensive monthly premiums but offer the least choice of a provider.  HMOs manage both the financing and delivery of a broad range of healthcare services. HMOs focus on prevention and primary care. You usually pay a small copayment for each doctor’s visit instead of a deductible and coinsurance.

PPOs allow you to go to out of network providers but you receive better benefits if you stay in network. You usually have direct access to specialists but some PPO plans require you to obtain a referral from your primary care physician (PCP) before seeing a specialist.

POS plans are a combination between HMOs and PPOs. You can choose how to access the plan each time you need treatment. You can stay in network or go out of network but will have to pay deductible and coinsurance charges if you choose to go outside the HMO network.

To make an informed decision, compare many plans before diving into a health plan that looks good. Check out providers; compare deductibles and premiums, and the benefits associated with the health plan.  A good health insurance policy covers hospital expenses, surgical expenses, and physician’s expenses. Some additional benefits are prescription drugs, preventive care, vision care, and maternity care. The best health insurance plan gives you flexibility at a low cost. Make sure you know the health services that you need because you want your plan to cover the health services you need.

U.S. News & World Report has released the rankings of the best health plans of 2008. The highest possible score is 100 points. Scores are based on performance relative to other plans in consumer satisfaction, prevention, and treatment, as well as accreditation by the National Committee of Quality Assurance (NCQA). Listed below are the top 5 health plans for each region of the United States: North, South, Midwest, and West. Also listed is the America’s Best Health Plans Honor Roll which recognizes the very best of the hundreds of commercial plans reviewed. The plans below list the state they have members, the type of plans they have (Health Maintenance Org., Point of Service), their star ranking (1-5) in Consumer Assessment, Prevention, and Treatment, and their overall score.

Best Commercial Health Plans: North

1.       Harvard Pilgrim Health Care:  Offers HMO and POS plans to members in Maine and Massachusetts. Earned 5 stars for Consumer assessment, prevention, and treatment and an overall score of 91.2

2.       Tufts Associated HMO: Offers HMO and POS plans to members in Massachusetts, New Hampshire, and Rhode Island. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and overall score of 91.2

3. Harvard Pilgrim Health Care of New England: Offers HMO and POS plans to members in New Hampshire. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 90.6

4. Geisinger Health Plan: Offers HMO and POS plans to members in Pennsylvania. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 88.2

5. Health New England: Offers HMO and POS plans to members in Connecticut and Massachusetts. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 88.1

Best Commercial Plans: South

1. Capital Health Plan: Offers HMO plans to members in Florida. Earned 4 stars in Consumer Assessment, 5 in Prevention, and 4 in Treatment and an overall score of 86.8

2. Kaiser Foundation Health Plan of Georgia: Offers HMO plans to members in Georgia. Earned 2 stars in Consumer Assessment, 5 in Prevention and Treatment and an overall score of 86.7

3. CIGNA HealthCare Mid-Atlantic: Offers HMO and POS plans to members in DC, Maryland, and Virginia. Earned 3 stars in Consumer Assessment, 4 stars in Prevention and Treatment and an overall score of 84.9

4. Optima Health Plan: Offers HMO and POS plans to members in Virginia. Earned 4 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 84.9

5. Health First Health Plans: Offers HMO plans to members in Florida. Earned 4 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 84.5

Best Commercial Plans: Midwest

1. Grand Valley Health Plan: Offers HMO plans to members in Michigan. Earned 4 stars in Consumer Assessment and Prevention, 5 in Treatment and an overall score of 89.1

2. Group Health Cooperative of South Central Wisconsin: Offers HMO plans to members in Wisconsin. Earned 3 stars in Consumer Assessment, 5 in Prevention and Treatment and an overall score of 87.8

3. Priority Health: Offers HMO plans to members in Michigan. Earned 5 stars in Consumer Assessment, 4 in Prevention and Treatment and an overall score of 87.2

4. Security Health Plan of Wisconsin: Offers HMO plans to members in Wisconsin. Earned 4 stars in Consumer Assessment and Prevention, 5 in Treatment and an overall score of 86.9

5. Unity Health Plans Insurance: Offers HMO and POS plans to members in Wisconsin. Earned 4 stars in Consumer Assessment and Prevention, 5 in Treatment and an overall score of 86.8

Best Health Plans: West

1. Kaiser Foundation Health Plan of Colorado: Offers HMO plans to members in Colorado. Earned 2 stars in Consumer Assessment, 4 in Prevention, 5 in Treatment and an overall score of 85.7

2. Kaiser Foundation Health Plan of Northern California: Offers HMO plans to members in California. Earned 2 stars in Consumer Assessment, 4 in Prevention, 5 in Treatment and an overall score of 85.3

3. Kaiser Foundation Health Plan of the Northwest: Offers HMO plans to members in Oregon and Washington. Earned 2 stars in Consumer Assessment, 3 in Prevention, 5 in Treatment and an overall score of 85.3

4. CIGNA HealthCare of Colorado: Offers HMO and POS plans to members in Colorado. Earned 3 stars in Consumer Assessment, 4 in Prevention and Treatment and an overall score of 83.9

5. Group Health Cooperative: Offers HMO plans to members in Idaho and Washington. Earned 3 stars in Consumer Assessment and Prevention, 4 in Treatment and an overall score of 83.1

America’s Best Commercial Health Plans Honor Roll

1.       Harvard Pilgrim Health Care: 91.2

2.       Tufts Associated HMO: 91.2

3.       Harvard Pilgrim Health Care of NE: 90.6

4.       Grand Valley Health Plan: 89.1

5.       Geisinger Health Plan: 88.2

6.       Health New England: 88.1

7.       Anthem BC/BS of CT: 87.8

8.       Group Health Cooperative of South Central WI: 87.8

9.       BC/BS of MA: 87.8

10.   CIGNA HealthCare of NH: 87.6

For the complete list, refer to the U.S. News & World Report website. The site also ranks best Medicare health plans as well as best Medicaid plans.

HealthAmerica and HealthAmerica Advantra’s HMO, POS, and Medicare Advantage plans rank among America’s top 20 health plans. This ranking was made by U.S. News & World Report in conjunction with the National Committee for Quality Assurance (NCQA). HealthAmerica was ranked 12^th among 287 commercial plans and HealthAmerica’s Medicare Advantage plan, Advantra, was ranked 18^th among 216 plans nationally.

So why were they ranked among America’s top 20 health plans? For 13 consecutive years, HealthAmerica’s HMO product and HealthAssurance’s POS product were both awarded “Excellent” accreditation from the NCQA. They’re HMO and POS are number 1 in 8 of 15 key measures. They have received the highest scores in:

• Well-child visits for members 3 to 6 years old
• Well-child visits for members over 6 years old
• Beta blocker after a heart attack
• Prenatal care in the 1^st trimester
• Cervical cancer screening
• Screening and testing of adults with diabetes
• Controlling hypertension (high blood pressure)
• Cholesterol screening for patients with cardiovascular conditions

HealthAmerica provides its members with a greater combination of health benefits and services for their money suitable to their needs and wants. They offer more health benefits, like coverage for most preventive health services, including periodic checkups, coverage for hospital and surgical care, emergency care worldwide, and chiropractic services. They offer access to over 35,000 providers in Pennsylvania and Ohio and more than 350 hospitals.  As a member, you are also entitled to the WellBeing program. This program offers free wellness programs and discounts on a wide range of products and services such as:

• QualSight LASIK Discount Program
• Weight Watchers
• GlobalFit fitness network
• Healthy Living and Wellness
• Health Education Reimbursement
• Wellbeing fitness clubs, acupuncture, and massage discounts
• Personalized Health Improvement
• EyeMed Vision Care Vision One EyeCare Discount Program and LASIK Vision Correction

With your health plan you also get 24 hour assistance. You can call and talk to a Member Service Representative and get answers about any question you may have with convenient hours during the week and on the weekends. The website is always available for health information. My Online Services is a feature that allows you to manage your personal health care transactions anytime it’s convenient for you.

They have a wide variety of other products, employee health benefit plans, and value-added services. With the ability to customize benefit programs that meet your needs, you can choose from HealthAssurance Coordinated Care PPO (POS), HealthPass/HealthAssurance PPO, HealthAssurance FlexChoice, and HealthAmericaOne Individual plans.

HealthAmerica’s health insurance plans can help you get the coverage you need. They are known nationwide for their service and quality and in result they have achieved the recognition of top rank in health plans. HealthAmerica’s commercial plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction. The plans were also ranked higher than the Pennsylvania state average in 12 of the 15 key measures.

According to a New York Times article, women are paying more for health insurance than men even though the coverage is identical. And we’re not talking about a small difference. The size and prevalence of these disparities are very surprising, because women are paying hundreds of dollars a year more than men. The reason this is an issue is because of a practice known as “gender rating.” This allows insurers to set different health insurance rates for men and women. Gender rating can happen because there are no federal guidelines governing specific amounts health insurance companies can charge in the individual market. Among states that gender rate, some insurers charge a 40-year-old woman up to 48% more than a man the same age for the same coverage.

Though the sector of women who are buying individual coverage is low because most women receive health insurance coverage from their employers, it is becoming more and more popular. Because of the declining economy, many people are losing their jobs and are being forced to buy individual health insurance on their own. Also, many employers are now ridding their companies of health coverage and instead giving employees a fixed sum to buy insurance in the individual market.

But why charge women more for health insurance than men? The one main reason is that women are more likely than men to access healthcare services, thus providing women under the age of 55 healthcare costs substantially more than men of the same age. Women are more likely to visit doctors, get regular checkups and take prescription medications. Some other factors that force health insurance companies to charge women more than men is maternity care and increased incidence of chronic conditions among women. Some women are even holding off on having children because their insurance policies do not cover maternity care.

Marcia D. Greenberger, co-president of the National Women’s Law Center, has it right: “The wide variation in premiums could not possibly be justified by actuarial principles. We should not tolerate women having to pay more for health insurance, just as we do not tolerate the practice of using race as a factor in setting rates.”

These disparities aren’t only evident in major insurance companies. Disparities have also been evident in state high risk pools, which offer coverage to people who cannot obtain private individual coverage. Most state insurance pools, for high-risk individuals, also use sex as a factor in setting rates. Some facts from the article state that “in Dallas or Houston, women ages 25 to 29 pay 39 percent more than men of the same age when they buy coverage from the Texas Health Insurance Risk Pool. In Nebraska, a 35-year-old woman pays 32 percent more than a man of the same age for coverage from the state insurance pool.”

“Representative Xavier Becerra, Democrat of California, said that “if men could have kids,” such disparities would probably not exist.” I do not think it matters whether men can bear children or not. We live in the 21^st century and it’s about time women are treated equally, especially when it comes to health insurance. Health care is a human right, every women in the country deserves it. And they deserve it at the same price as men.

Blue Cross Blue Shield member health insurance plans have been launching new individual health insurance products that are designed to be more affordable. Due to the weak economy and our country’s recession, many people are losing employer-based health coverage and are resorting to individual health coverage. Below are three BCBS plans that are launching or have already launched affordable individual health plans.

In September, Blue Cross Blue Shield of Arizona launched 5 new individual plans to provide more options to meet the needs and budgets of Arizona residents. Richard L. Boals, BCBSAZ president and CEO says “By matching our individual product line to fit the evolving health coverage needs of today’s customer, we are providing competitively priced products delivered with the quality and service customers have come to expect from Blue Cross Blue Shield of Arizona.”

Their new plans are:

• BlueOptimum is a preferred provider organization (PPO) with co-pays covering in-network services such as office visits and urgent care. Deductibles range from $250 to $10,000 for individuals in-network, and $500 to $20,000 for families in-network. Coinsurance is 80/20 meaning BCBSAZ pays for 80% of most covered services after you meet the deductible and you only pay 20%. BlueOptimum is ideal for people who want set co-pays and first dollar coverage for in-network preventive care visits.
• BlueValue is a PPO plan with a mix of co-pay and coinsurance cost sharing, and the flexibility of fixed generic prescription co-pays. Deductibles range from $250 to $10,000 for individuals and $750 to $30,000 for families in-network. Coinsurance is 70/30 after the deductible is met. BlueValue is ideal for people who want to pay for services with a blend of co-pays and coinsurance that result in a lower monthly premium and who also want no deductible for preventive care visits.
• BlueEssential is a low cost PPO plan with basic coverage, a $1,000 cap on preventive care to help make the policy more affordable, and co-pays for three primary care physician (PCP) office visits per year. Deductibles range from $250 to $10,000 for individuals and $750 to $30,000 for families in-network. BlueEssential is ideal for people who want a plan with low monthly payments designed for low utilization of services and $15 co-pays for generic prescriptions.
• BluePortfolio is a qualified high deductible PPO plan for use with a health savings account (HSA). HSAs are tax-exempt trust or custodial account to be used for paying qualified medical expenses. Deductibles range from $1,750 to $5,500 for individuals and $3,500 to $11,000 for families in-network. BluePortfolio plans are ideal for people who want co-pays for in-network services such as physician office visits, urgent care, and prescription medications.
• BlueSecure and BlueSecure Plus are two options for a Health Maintenance Organization (HMO). PCP referrals are not required to visit specialists and co-pays apply to many covered services. The deductible for BlueSecure is $1,000 for individuals and $2,000 for families in-network. There is no deductible for BlueSecure Plus. BlueSecure or BlueSecure Plus is ideal for people who want an HMO plan that covered routine maternity after a 12-month waiting period or who want co-pays that cover most services.

WellPoint’s SmartSense product line makes up more than 50% of individual health insurance sales in California and is also available to Georgia residents. Since November, their SmartSense line of individual health insurance plans has been in the process of being launched in Colorado. SmartSense is tailored to fit your needs and is priced very low with premiums ranging from $33 to $178 a month for a health 25 year old male. The plan offers a wide range of annual deductibles and monthly rate combinations. It also has lower rates on services from in-network providers. They offer simple co-pays for your first three in-network doctor visits without having to meet your plan’s deductible first. SmartSense also offers out-of-state coverage which protects you from the high cost of unexpected emergencies when you travel.

Horizon BCBS of New Jersey has been making adjustments to their individual health plan prices. A new law in New Jersey allows them to use an applicant’s age in their rate calculations which should make plans more affordable for younger individuals.

Blue Cross Blue Shield isn’t the only health insurance company trying to launch new plans for individuals. Health Insurance is vital and many health insurance carriers are trying to make health plans for individuals more affordable.

Aetna Health Insurance has teamed up with the AARP to present the AARP Essential Premier Health Insurance. This product is custom-designed with employer-like benefits for AARP members that are aged 50-64 to bridge the gap between employer coverage and Medicare. What makes this plan unique is the dependent coverage it offers. This is available to children, grandchildren, and dependent relatives.

The reason for the foundation of this type of insurance was to ensure that retirees, sole proprietors, and individuals not eligible for Medicare are insured. Since fewer employees are offering benefits to retirees there is the need for this option of health insurance.

A study done by Aetna, received from a U.S. Census report, shows that 14% of people ages 45-64 are uninsured. These unique products help target the many people who have difficulty getting health insurance. The biggest problem has been found in Georgia, where 17% of the population is uninsured.

You can select from a variety of plans including their quality Premier plans or Preventive and Hospital care plans. High deductible plans are compatible with tax advantaged HSAs (Health Savings Accounts). There are a total of 7 plan options to choose from within the three above plans. The Premier plans combine affordable medical coverage with prescription drug and hospitalization coverage. Members may choose in or out of network doctors and can choose from annual deductibles of $1,500, $2,500, and $5,000. The Preventive and Hospital plans include a physical exam, an annual ob-gyn exam and well child care. The plans also provide inpatient hospital coverage. Coverage for the above plans is nationwide so consumers do not have to worry when they are travelling.

AARP Essential Premier Health Insurance plans have special programs in addition to the standard health insurance coverage offered. Members can receive the Aetna Rx Home Delivery which allows them to order their medications through a mail order pharmacy. Other features include weight management programs, an informed health line with 24/7 access to health care answers, and the Aetna Natural products and services programs which allows eligible members to access complementary health care products at reduced rates. These products and services include massage therapy, dietetic counseling, acupuncture and chiropractic care. Some of the insurance plans also provide AARP Vision Discounts at no additional cost as well as pharmacy savings.

The AARP Essential Premier Health Insurance products are currently available in 31 states and Washington, D.C. They are sold in Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Maryland, Michigan, Mississippi, Missouri, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming and Washington, D.C

This is a great insurance option for AARP members. In this state of the economy, many “baby boomers” are being laid off because of the younger, college graduates who aren’t requesting as much money. It is getting harder and harder for retirees to maintain the health coverage they received when they were working so I’m sure the AARP Essential Premier Health Insurance is going to be a huge hit with the baby boomers.

Mercer conducted a survey, the National Survey of Employer-Sponsored Health Plans, which showed that the median deductible required by employers for individual coverage in PPO health plans jumped to $1,000 in 2008. Last year’s median deductible was $500. Since PPOs are the most popular type of health plan coverage with 69% enrollees of all covered employees, it is hard to believe that in just 8 years deductibles have risen from $250 to $1,000. The survey includes private and public employers with 10 or more employees. PPO deductibles remain lower for larger employers, with a median deductible at about $300.

Some findings from the survey include:

§  Employers held health benefit cost increases to about 6 percent in 2008 for a fourth straight year – but that has meant shifting more cost to employees

§  Consumer-directed health plans are offered by 20 percent of large employers, up sharply from 14 percent last year

§  More large employers add incentives to encourage health-conscious behavior
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§  Employers shed retiree medical plans in 2008, but with health reform looming there was no further erosion of active employee plans

 But not only are health insurance deductibles rising, but so are premiums. For coverage that is getting meager, premiums have rose 5% in the last year. Premiums for family coverage have increased to $12,680 and premiums for single coverage have increased to $4,704. Though the 5% increase is fairly low, experts say it is not going to last and it can be considered high when deductibles are increasing as well. Health insurance premiums have shot up 5x faster than workers’ wages since 2000. Since 2000, there has been a 78% rise in premiums from $6,672 in 2000 and $12,680 in 2008.

The rise in health care costs has put a strain on family budgets. These higher health care costs and the decline in the economy have forced families to go without needed prescriptions, preventive care, and tests and doctors’ visits.

Julia Eisman at Families USA‘s Stand Up for Health Care blog writes:

“The economic downturn coupled with ever-rising health care costs has had serious consequences for many of us, but unlike the financial sector, working Americans can’t expect a government bailout. Instead, more individuals are incurring oppressive medical debt (more than half of bankruptcies are now due, at least in part, to problems with medical costs) and many Americans have joined the ranks of the underinsured and uninsured.”

So with Obama’s win, what does that mean for healthcare in the upcoming years?

Experts say that because of the financial crisis we are facing today, health care changes are more likely to be phased in over time. But over time we are likely to see an expansion on existing private and public program with help of federal subsidies and mandates. Obama has also repeadly states that the reforms he will impose will lower a family’s health insurance premiums by about $2,500 a year.

These reforms include:

• Requiring employers, except small businesses, to provide health insurance to their employees or contribute to the cost.
• Requiring that all children have health insurance.
• Expanding Medicaid and the State Children’s Health Insurance Program (SCHIP).
• Creating a National Health Insurance Exchange to pool risk and give people the choice of competing private or public health plans.

Karen Davis, President of the Health Policy and Research Group Commonwealth Fund, states that “We can’t afford to stay on the path we are on with regard to total health spending,” she says. “Employers can’t afford it, the government can’t afford it, and individuals can’t afford it. It is just not sustainable.”

Unprecedented economic and credit market turmoil dramatically impacts auto industry and GM results. GM has really taken a hit from the economic crisis our country is in. In April 2006, General Motors‘  plan to require hourly retirees to pay more of their health care costs was approved by a federal judge. Since then, retirees having been losing more and more benefits.

In an effort to reduce costs by $1 billion per year, GM and the United Auto Workers (UAW) agreed that retired hourly workers would start paying monthly contributions, deductibles and copayments for medical services up to $370 per year for individuals and $752 for families. In a March 2006 hearing, some GM retirees requested that the judge reject the settlement with the UAW. At least 1,250 retirees filed objections out of the 476,676 retirees and dependents affected by the agreement.

In October of this year, GM announced that it will no longer provide health insurance coverage for more than 100,000 retirees and their dependents as of January 1, 2009. This will cease medical coverage for its salaried retires ages 65 and older. Even former employees who are already in retirement will lose their benefits. This plan will save General Motors $3.3 billion per year. In order to replace its longstanding health coverage benefit, they will give their retirees an extra $300 in their pension checks so they can buy their own insurance.

GM has little choice but to make cuts this year, including benefits. This move is a part of a package of broad cutbacks to increase company liquidity, including a 20% reduction in payroll for salaried workers and suspension of GM’ annual stock dividend of $1 a share. The company is also temporarily suspending company matching of its 401(k) program as of November 1. GM is suspending tuition reimbursement and adoption assistance programs at the end of year as well. This, though, isn’ even enough to stabilize the company’ finances.

They aren’t the only ones cutting health coverage for hourly and salaried retirees. Ford and Chrysler have already cut health coverage for their retirees. Back in 2006 Ford Motor Co. stated that they will end health benefits for its salaried retirees beginning in 2008; and the time has come. In 2007 began yearly payments of $1,805 to its salaried retirees to cover health care costs after it cut retiree health benefits in a cost-savings move to slash expenses.

GM is the last of Detroit’s Big 3 to cut back on health care coverage benefits. But GM’s plan to increase retiree pension payments by $300 a month is a lot more generous than Ford and Chrysler. This would equal $3,600 a year, whereas Ford gave its retirees $1,800 a year and Chrysler gave its retirees $1,805 a year. As of January 1^, GM’s retirees will have to buy their own insurance, including Medicare Part B, which covers doctor’s visits.

GM has hired Extend Health to aid its retirees in choosing a health plan when their coverage ends January 1. Plans range from Medicare Advantage plans with very low premiums but high copayments to Medigap plans with high premiums but rich benefits and low out of pocket costs.

Now is the time for GM’s retirees to look for alternate coverage with the January 1 deadline approaching rapidly.