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Health Insurance Tips for 2016 from Michael J. McGuire

Did you get covered at a better rate? Do you just grin and bear the renewal? Have you decided to just take your chances?

by Michael J. McGuire

Open Enrollment for health insurance this year has been challenging to say the least. Non grandfathered poliies have had a renewal increase of 60 to 65 %. There are some opportunities out there to maintain or reduce your rate. It helps if you know where to look.

Last week I moved a restaurant server from $ 500 a month to $ 200 per month. At first, she was told that she didn’t qualify for a subsidy. She had no interest in shopping. Just for fun we ran the process to compare results. The first broker she worked with incorrectly filled the financial questions on the MNsure new account set up. From a search standpoint, there actually were other policies which were a better fit at a better rate.

The reality is that the MNsure site can be confusing even for a broker. You should seek the help of a certified MNsure broker who has ample experience, represents multiple health insurance carriers, and has advanced credentials (RHU, CBC, ACBC etc.). MNsure brokers have annual extensive training, exams, Navigators take a 4 hour class. They specialize in qualifying for subsides and public health programs. They have no training in health insurance.

Today I reduced a physical therapists insurance rate by 30 %. Surprisingly, I placed him with the same carrier with the same deductible. It is all about the math that works differently on newly launched policies. It’s worth the look because you often find surprises.

Do you just go for the lowest rate?
It is worth your time to do your homework on the carrier. The Affordable Care Act has not been kind to the carriers. They are all experiencing higher than expected losses. Two of the local carriers have lost their credit ratings. It may not mean much to you, but it does to clinic systems. When they take your coverage card, they are trusting the credit worthiness of the carrier. The clinics often drop out of a carrier’s network because they feel that the financial risk is too high. You can study health insurance carrier’s credit worthiness at www.ambest.com.

Do you qualify for MN care?
This public health safety program has been upgraded to a Gold Level Qualified Health Plan with no payout limit. The rate depends on your income and is usually less than
$ 100 dollars per month. As a single you could qualify if you earn more than $ 23,540 than and less than $49,960 . Do you have your 23 year old son or daughter on your policy ? You no longer get a rate break for dependents over 21 on your policy. Very often your dependent qualifies for MNcare.

Are you looking on your own?
If you go to MNsure, be aware that these policies costs less because they have more out of pocket exposure. A family deductible is normally two times the individual deductible. On MNsure it is three times the individual deductible. You just should know what you are buying.

The Devil Is in the Detail!
Just as this year’s rate increase is outrageous to you, they are cutting the compensation to your doctor. It is all about the new networks. Some doctors are saying “no” and dropping out of the network. So, it is imperative that you verify that your doctor is in your new network. You need to specifically find his/her name in the directory. Often a clinic stays in the network, but one doctor opts out.

Check the Approved Drug Lists.
This has affected several of my clients. Calling the carrier and asking the carrier over the phone is fraught with errors.  You should ask your carrier about drug coverage in writing. You can also find these lists on the carrier’s web site. You can also send your list to the carrier to be verified. Drugs do drop off the approved list. It happened to one of my clients who found that a particular drug was no longer covered. He suddenly had a $ 650 per month out of pocket expense. It is extremely important that you cheek the daily dosage for each drug on the list. A small variation can cost 1000 percent more. I get calls every week from people who get surprised that their new policy doesn’t cover what they thought because they didn’t check these details. Hopefully these tips can help you avoid problems.

Any SSPA member is welcome to call me for advice.


Michael J. McGuire currently serves on the Board of Directors the Minnesota Association of Health Underwriters and  is a former Legislative Director. He also was appointed to the MNsure Shareholder Broker Committee. He serves the members of SSPA. You can reach him at (651) 330-8035.

 

 

 

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