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Prescription Drugs

In this post I will that we do spend time to check prescriptions are covered and some tools we use. We help clients with individual, group and Medicare Prescription Drugs needs to ensure that they are on the formulary list.  

Spending time reviewing to ensure that your prescriptions are covered is an import part of the process of selecting coverage.  Using tools to aid in ensuring you are getting the best costs on your medications.  The GoodRX.com application is a handy tool to look up a drug your doctor is prescribing.

The tool allows you to see retail pricing at pharmacies around your area.  GoodRX application for your prescription shares with you coupons available. GoodRX displays pricing at local pharmacies. Government sponsored plans (Medicare or Medicaid) they typically will not let you use the coupons. Some pharmacies will sometimes allow government sponsored plan members use the coupons.  Worth asking about at your pharmacy to see if they will let you.

Manufacturer copay cards can aid in lowering prescription pricing. The tool will as well share Patient Assistance Programs (PAP) that can help you get lower costs for expensive medications.  Some of the programs review your income and some do not.  We do spend time to try and assist you to find the best options to investigate.

Prescriptions are complex part of selecting health a plan – individual or group health insurance or Medicare prescription drug plans.  We work with you to understand your needs and guide you to the best options for your situation. There is no reason not to work with an agent to assist you.  We can make finding a solution easier for your leveraging our experience.

Individual Health Insurance Open Enrollment Period this year is only 45-days – November 1st through December 15th.  This is your only time to purchase or make changes to your coverage.  To purchase it any other time in the year, you need to have a SEP -Special Enrollment Period.   Make it a priority to review your coverage and check your current plan’s network and ensure your doctors are still in the network.  As a result of the network changes,  do not assume because last year the provider was in network, they will be in their network the next policy year.

Carriers to Consider

Oscar

The insurance carrier Oscar is a new company serving the Austin health insurance market.  They are an EPO-Exclusive Provider Organization.  An Exclusive Provider Organization (EPO) health insurance plan requires you to use the doctors and hospitals within its own network. As an EPO member, you cannot go outside your plan’s network for care. Also, note that there are no out-of-network benefits under an EPO health insurance plan.  Oscar plan does allow for self-referral within the network.  They as well have a Telemedicine included at no cost to allow you consult with an online doctor and they can prescribe for routine needs. You can check out Oscars product offerings and sign up with them using this link: Oscar 2018 Plans and Enrollment.  They have Scott and White and Austin Regional Clinic (ARC) in the network.

Vista 360 Health

Vista 360 Health is another carrier worth checking out in the Austin market.  headquartered in Austin, Vista has been growing their network of doctors.  They have just added Austin Diagnostic Clinic (ADC) to their list of in-network doctors.  Being a local carrier Vista 360  was familiar with and focused on their network of doctors starting with the two big groups ARC (Austin Regional Clinic) and ADC (Austin Diagnostic Clinic).  All of Vista 360 plans have Telemedicine included at no extra cost, it can really save you a trip to the urgent care or the primary care office.  They leverage the ARC Telemedicine, so the doctors are Austin doctors who support the service for Vista 360 Health.  You can check out their 2018 plan using this link: Vista 360 Health Plans and Enrollment.

Now is a time to enroll in health coverage, or make changes to your plan selection.  Take advantage to review all your options before the Individual Health Insurance Open Enrollment Period ends on December 15th, 2018.  If you are confused, frustrated or need assistance in finding a plan, please work with a broker or agent.  There is no charge to working with an agent to help you find the best options.  We may even have suggestions you may not have thought about.

RF Insurance Masters, Ray Freer was included this month in the Advisors Magazine September 2017  issue page 38 with our view on the current situation of health insurance choices.  As an insurance agent, it has been a difficult time trying to help our clients find the best coverage for their needs with the limited number of choices of carriers and plan designs.  The largest challenges are the finding their doctors participating in the carriers Health Maintenance Organization (HMO) networks.  In Texas we are limited to the HMO plans only not allow members to choose doctors outside of the network and have their visit covered.  The other large challenge is how to keep the premiums affordable with the benefits the client is hoping to have.  Sometimes it will force a client to give up some of their current doctors to make the premiums lower by choosing another carrier that does not have their doctor in network.  For an agent, it has been a hard couple of years assisting clients and finding that the best choice for them falls far below their expectations.  We hope that we will see more choices in health insurance and better networks as this affordable care act continues to evolve.

2018 Individual Health Insurance OEP – Open Enrollment Period

This year for the first time they will not have an extended enrollment period for the 2018 Individual Health Insurance OEP.  To make changes or to enroll in a health plan

 for 2018, you will have a 45-day window to make plan changes – November 1st, 2017 through December 15th, 2017.  If you miss Open Enrollment Period (OEP) you can only enroll in a plan is you have a Special Enrollment Period (SEP).  Make sure you take advantage of this time to evaluation the many new options you may have in your area.  You do not want to let the opportunity to change plans be missed, otherwise you will be stuck with your current plan for another year.

Special Enrollment Period (SEP)

You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan.  If you do not have one of these SEPs, you will not be able to enroll in a individual health plan.   As long as you are healthy, you can enroll in a short term health plan, that will cover you for 90-days.  When you apply for these short term plans they do look at your medical history or if you have any pending medical needs.  They can deny offering you coverage because of those conditions.

Association Health Plans

There are Association Health Plans that allow you to enroll any time during the year, but they do underwriting as well and will only let healthy people join the group.  These Association Plans are true group insurance run by an Association.  They allow you to join the group, you will get a full Affordable Care Act (ACA) Compliant Group coverage.   These plans can really help clients that have missed the Open Enrollment and do not have a Special Enrollment Period.

Health Share Plans

Health Share Plans – these are not health insurance, but they can provide an Affordable Care Act exception from penalty.  You can join these plans year round, they do have waiting periods on plans before they cover pre-existing conditions.  These plans are as well a lower cost approach to protection and we have seen many people gravitate to this type of coverage.  These are not health insurance though, so do you research on the various plans and make sure you know what you are purchasing.

Agents Assist You to Find the Best Coverage during 2018 Individual Health Insurance OEP

Finally, if you are having trouble trying to figure out which options would be best for you, work with an independent agent.  Agents are familiar with the many health plan options that are on the market.  The agent-broker can help you answer any questions or concerns you may have before selecting a plan.   Independent agents can as well help you verify if your doctor is part of the plans network.  With all the HMO plans we have in Texas, this has become the biggest challenge for our clients to find out if they can continue to go to their doctor.  The agent can help you navigate the best options for you and your specific situation.  You do not need to go it alone, contact an agent to assist you during 2018 Individual Health Insurance OEP.

 

Recheck your doctors are in network/accepting your 2016 Individual Health Policy, before enrollment period ends on 1/31/2016.  Some directory errors can leave you without your doctor accepting

your insurance.

Shopping for individual insurance for 2016 has been quite different than in the past year. During the initial enrollment period starting in November 2015 there was mostly HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans on the market. These are closed network plans that does not allow members to go out of the provider’s network for any medical services.   All the major insurance companies Aetna, BCBS, Humana and United Health Care removed their PPO (Preferred Provider Network) plans from the market removing the flexibility to go to any doctor (in or out of network) while allowing self-referring to any specialist and smaller networks of providers that require referrals to specialists from the Primary Care Doctor. HMOs and EPOs do not allow out of network coverage.

The biggest challenge for people shopping for insurance is finding plans that will allow members to keep their doctors in 2016 on the available plans. This has been a challenge for many of our customers to find the plan that works. We have had a client that had seven doctors and they were forced to change all of them because no plan offered any of their doctors in network. The end result for this client was she had to accept changing all of her doctors. They as well needed to change from the flexibility of a PPO plan to a HMO or EPO.

We have as well found that the systems on the carrier’s website we used to check if your doctor was participating in a company’s network to select a plan may have been outdated or incorrect. This makes it very important to take the time to confirm that your doctors accept the plan you selected for 2016. We have had numerous clients contact us that they found out that their doctor does not take their insurance.

We have also discovered that some doctors will not accept any individual insurance, so that leaves loyal patients in a situation to decide if they should pay cash outside of their insurance to keep their doctor. Some of our clients do not have the means to do that so they will be forced to change to a new doctor.

If you are not satisfied with your health insurance choices and you own an LLC or small business a group insurance plan may be the answer to be able to get a PPO/POS plan that you were used to before this year. Ask an insurance agent broker about details to see if you can put a group together with your company.

For others take a few minutes to confirm with your doctor they really do accept the insurance plan you signed up for. You want to do this before the annual enrollment window closes. Once you miss the January 31 2016 date to select a plan, you will be stuck with this insurance for the entire year.

If you are not happy about the state of individual health insurance and the offerings, this is a good time to let your elected officials know what you are going through with your health insurance. I really do not think they know what the American people are having to deal with.