Health Insurance Insights

Here are 5 topics we see occurring again and again.

December 1, 2019

If you have ever purchased health insurance, you know how confusing it can be to pick a plan. Recent regulatory and legal changes further complicate the situation.

At Better Health Advisors, we work to simplify the process and ensure you have the best plan for your specific health and wellness needs. However, unlike a traditional insurance broker, Better Health Advisors works on behalf of individuals, like you, to make sure your needs are met.

Here are 5 topics we see occurring again and again.

  1. Your plan can be cancelled due to nonpayment. If you don't make your monthly premium payments on time, you are at risk for losing your coverage for the entire year.Unfortunately, many people learn this the hard way. While you may be able to appeal this cancellation, many companies will still deny you coverage. We recommend setting up electronic auto payments to avoid missing a month, and to always confirm payment receipt with your insurer if you are paying by check.
  1. Dates matter. Some insurance companies have hard cut off dates for enrollment. For example, individual or family plans purchased through the New York Health Insurance Marketplace (Obamacare plans) only provide coverage starting the 1st of the month if you have enrolled by the 15th of the prior month. When possible, complete your health insurance application online or fax it to the company, as sending it in the mail can cause delays.
  1. If you lose your job, you may be eligible for COBRA. The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides extended health insurance coverage if you lose your job or are no longer eligible for employer-based health insurance due to other reasons. COBRA allows you to keep your employer-based plan for up to 18 months – but, at a cost. Instead of splitting premium costs with your employer, you will have to bear the entire cost of the insurance plan plus administrative fees.
  1. COBRA coverage applies retroactively. You have 60 days after you lose your benefits to decide whether or not to elect for COBRA coverage. Assuming you enroll during this window, your coverage can also be applied retroactively if you pay the previous months’ premiums. For example, if you first become eligible for COBRA on March 1st but don’t enroll until April 1st, COBRA will cover any medical bills incurred in March as long as you pay for the March premium.
  1. Your insurance company may reimburse you for less than expected. If your insurance company pays for 80% of out of network services for example, and you get a $400 bill from your doctor, you would expect the insurer to pay for $320. Unfortunately, this is rarely the case. Instead, insurance companies pay 80% of the “allowable amount,” which is the maximum amount that the insurer will pay for the service. This is determined based on the type of care received, the type of medical provider and the location.

If you have questions about health insurance or want to better understand your plan, contact Better Health Advisors.  

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