California Health Insurance Options has moved!

For all the readers of this blog you can find my new blog at my personal website at http://www.jclis.com/blog

Thank You for reading! :)

50% of personal bankruptcies in the U.S. are due to people being unable to afford medical bills

Two recent studies published by Harvard Medical School and the Health Affairs Journal revealed that approximately 50% of personal bankruptcies in the U.S. were a result of people being unable to pay medical bills. It was found that the typical person who filed bankruptcy due to medical bills was about 40 years old and a middle-class homeowner. Amazingly, 68% of these people actually had health insurance! However, injury and illness often lead to loss of job and on top of that, loss of health care benefits. It should be stated (although it was not included in the study) that some these people probably had inadequate health insurance benefits which did not offer strong catastrophic coverage. Surprisingly, the out-of-pocket medical debt of $12,000 was the average among these Americans that filed bankruptcy.

6.7 million Uninsured in California!

Recent studies show that California contains the highest amount of uninsured people out of any other state at 6.7 million! The video below is from Lets Shield California.com, a website run by Blue Shield of California that is helping to spread awareness. Within the website there is a section where Americans can email Nancy Pelosi, Speaker of the US House of Representatives. Blue Shield of California has chosen Nancy Pelosi to receive the opinions of any Californian or American who has something to say about the situation. Here is your chance to voice your opinion on the Healthcare!

Benefits of a Health Savings Account (HSA)

In today’s post I am going to use myself as an example to show you the benefits of a Health Saving Account (HSA).

On March 24, 2009 I decided to go to a sleep lab and get tested for obstructive sleep apnea. For those of you who are unfamiliar with this condition, obstructive sleep apnea or OSA for short, is a common sleep disorder that involves the partial or complete collapse of the airway during sleep. After researching the condition I found out that people can stop breathing in their sleep and actually die as a result of OSA! Having been a chronic snorer for many years (snoring is a major symptom) I decided it would be a good idea to get tested.

Anyone who feels they may have OSA should the read through the following symptoms.

-Excessively loud snoring

-A type of snoring that includes a pause in breathing and a sudden gasp for air (due to airway being closed).

-Excessive sleepiness, morning head aches, trouble concentrating, irritability, anxiousness, or depression.

-Frequent trips to the bathroom at night and loss of interest in sex.

For those interested in knowing more about OSA please visit the American Academy of Sleep Medicine.

So how was the sleep study covered by my insurance plan?

Well, the total cost for the sleep study (polysomnogram) was $2128.15; this whole figure was applied to my $3000 deductible. My current insurance policy is with Blue Shield of California and is HSA compatible. I have funded the maximum HSA contribution amount of $2900 in 2008 and $3000 in 2009 (maximum contributions for a family were $5800 in 2008 and are $5950 in 2009) which comes out to be $5900 of tax deferred money that I have saved. Not only did I benefit from saving on a tax deferred basis but now I only have $871.85 of my deductible left to satisfy before Blue Shield is going to pay 100% of my medical claims (hospitalization, surgery, catastrophic emergency, ect..) To top off the situation there was no element of surprise, I could afford the sleep study because I had planned ahead and funded my HSA.

For those of you who would like more detailed information on HSAs please visit our website at J.C. Lewis Insurance Services and click "tell me about HSAs". There is a very valuable tool that you can access (at the above link) that will calculate your tax deferred savings for the life of your policy, it will also help you stay up to date with the maximum annual contributions.

The Bottom Line

If you have the money to fund an HSA you are making a great investment in your health! You are preparing for future medical expenses and the funds will roll over every month tax free!

How to buy California Health Insurance

There are a couple things you should ask yourself before you buy health insurance. What do you want and what do you actually need?

Everyone wants a low deductible, office visit co-pays and good prescription coverage but what a person may need can be far different. Health insurance can get extremely expensive depending if you choose to elect a low deductible health plan with first dollar benefits. Such a plan would serve very well the individual who visits a doctor frequently, although the plan would most certainly come with a hefty price tag. On the other hand, if you are completely healthy and see a doctor but once year, then having a lot of first dollar benefits and a low deductible will leave you paying high premiums for coverage that you never use.

Before you buy a health insurance policy you should take these areas into account.

Are you in good health? (This will determine what is available to you and have a bearing on your monthly premium if approved for a health plan)

How many times do you go to a doctor in a given year?

How much money are you comfortable with in paying a monthly premium?

Do you want strong catastrophic protection for a serious emergency? (a low out-of-pocket maximum)

How important are your first dollar co-pays for doctor’s office visits? (offered before you have to satisfy the deductible)

Is strong prescription drug coverage important to you? (low co-pays for generic, brand and formulary drugs)

When choosing individual or family health insurance, being in good health is critical. Health Insurance carriers are still for-profit businesses (until president Obama says otherwise) and will decline your application if they feel you are a potential risk. This fact alone is why you should consider buying health insurance why you are healthy. Health insurance carriers can not terminate your plan if you come down with a serious illness or have an accident. They also have the right to rate your monthly premium higher than the original rate if you have pre existing conditions.

How many times you see a doctor in a given year will help you (or your insurance agent) determine what type of a plan you need. If you see a doctor but once a year you may benefit from a high deductible health plan (catastrophic plan) that has the availability of one physical exam. In this case you will pay a lower monthly premium your health plan will better fit your lifestyle (until you need better coverage someday). If you see a doctor several times a year then a plan with office visit co-pays before deductible will better suit you.

The old saying “you get what you pay for” rings true when it pertains to health insurance. I am a healthy 27 year old male and what I make a year would not be enough to cover the high premiums I would pay for a low deductible health plan. Let me show you…

The following quotes are with Blue Shield California and are based on a healthy 27 year old male in Sonoma county California.

Shield Spectrum 500 $310
Shield Spectrum 750 $219
Shield Spectrum 1500 $193
Shield Spectrum 2000 $113
Shield Spectrum 5000 $63

The winner in this case would be the PPO Savings Plan 4000 at $54. I would have a physical offered once a year for a $35 co-pay and my out-of-pocket maximum is only $4000 a year. This means after I satisfy the deductible that everything is covered at 100%. Considering I would only need to use it in an emergency, this would be the perfect plan for me.

In the event that you require strong prescription drug coverage you want to be aware that many plans out there will strip the Rx benefits in order to make the premiums more affordable. Many companies will offer generic only prescriptions while some will put “caps” on the yearly maximum pay out. In the event that you have a catastrophic emergency and require expensive brand name drugs you want to make sure your plan offers both brand and generic Rx with no cap on the maximums.

As always, if you have any questions please contact me or J.C. Lewis Insurance Services ; our services are at no cost to you!

Blue Cross of California Lumenos Plans

Blue Cross of California hit the nail right on the head with their release of the Lumenos plans. These plans speak directly to the healthy individual who seeks an affordable monthly premium with great catastrophic protection.

Preventative care is covered at no charge (provided you see an in-network-provider) making this an ideal option for the individual who rarely sees a doctor but 1-2 times a year. This means you incur no cost for procedures such as annual physical exams (for women this includes pap and mammogram). You can also purchase the Lumenos plans with or without maternity making it flexible for either gender’s needs.

These plans are HSA compatible. With an HSA (Health Savings Account) you can make tax deductible contributions to your account, and withdraw the money tax-free to pay for qualified medical expenses, including prescription drugs. An HSA will help you budget for medical expenses and not be taxed on your savings if you choose to fund them. Please take a look at my post on HSAs to get the full scoop on how they can benefit you.

Lumenos deductible options

• 1500 (3000 family)
• 3000 (6000 family)
• 5000 (10,000 family)

If you would like more detailed information on the Blue Cross Lumenos Plans (including rates) please feel free to contact me!

California Dental Insurance

California dental insurance plans typically offer $500-$1500 in maximum benefit per year. When it pertains to major oral surgeries this does not offer a whole lot of coverage. This is mainly due to the fact that dental insurance in California focuses more on preventative care to “prevent” large dental claims. While it is still better to have a California dental insurance plan than not, it is always wise to evaluate your options before you buy. If you do not understand your options it is best to have a California insurance agent help guide you.

In this blog post I am going to analyze a couple of the larger California dental insurance companies to help you make an informed decision when it comes time to purchase one of their plans. Many people have chosen poorly when it comes to their dental benefits; if you take the time to understand what is covered before you buy then you won’t have any surprises when you receive the first bill from the insurance company.

Today I will be covering California dental plans offered through Blue Cross of California and Delta Dental of California. In my opinion these are the 2 best stand alone carriers that will offer you dental insurance without having to already be enrolled on one of their health insurance plans.

The Dental Blue 100 Basic with Blue Cross of California

With the monthly premium at $20 per individual and $65 per family this California dental insurance plan has some serious value. It is perfect plan for the individual that only sees a dentist twice a year for 2 semi annual routine cleaning visits. With this plan you may seek care with any dentist that is a member of the Dental Blue 100, 200 or 300 Network but the savings will be the best within the 100 Network (contact me for details). You will have a $25 deductible (waived for preventative and diagnostic care if in network) and a $500 annual benefit max per year.

Preventative and Diagnostic Services (covered at 100%)

• Cleanings
• Exams
• X-rays
• Sealants
• Space Maintainers

Basic Services

• Fillings
• Stainless steel crowns for primary (baby teeth) and pulpotomies

Unfortunately there is no coverage for major services and Orthodontics under the Dental Blue 100 Basic plan but you will still receive a negotiated fee discount if you undergo major services with a Dental Blue provider (for more information on this please contact me).

Major Services Include

• Oral Surgery
• Endodontics
• Crowns (for adult teeth)
• Prosthodontics

If you require more care than the Dental Blue 100 Basic can offer you will most certainly want to take a look at the 3 other Dental Blue plans available. The Dental Blue 100 Plus, Dental Blue 200 Plus and the Dental Blue 200 essential will all cover major services but the waiting periods (the time you must be active on the plan before you can receive coverage benefits) range from 6 months to a year (please contact me for full details).

DeltaCare USA program with Delta Dental of California

The DeltaCare USA plan is an HMO program that provides comprehensive dental care (both preventative care and major services). It is a great match for someone that does not have a current dentist because it does not work like a PPO network. The HMO network is of course much more limited than the PPO but the coverage is much richer. There are no waiting periods and no coverage limit! Most PPO dental plans have a $1000 maximum benefit making the DeltaCare HMO plan a very wise choice provided you can find a close provider in your area of residence (for help locating your closest dental care facility please contact me).

What do the premiums look like?

• For a single individual you will pay an annual fee of $97 plus a one time enrollment fee.

• Enrollee plus dependent $155 ($15 one time fee)

• Enrollee plus 2 or more dependents $225 ($15 on time fee)

Like the Dental Blue 100 Basic, preventative and diagnostic care are covered at no charge. There are many different major services which of course you will pay a specific co-pay amount. For more information on this please contact me and I will email (or mail) you a free brochure that describes the DeltaCare HMO in full detail.