Tag: Health Plans

  • Don’t worry…we’re going to fix it now

    April 20, 2018

    Tags: , , , , , , , , , , , , , ,

    Well, now the concerns are over.  Jamie Dimon JP Morgan, Jeff Bezos from Amazon and Warren Buffet from Berkshire Hathaway have all teamed up to solve our nation’s health care problems.  There are no details at this point, of course, but they say they plan to hold down costs by bringing “their scale and complementary expertise to this long term effort”  They will create an independent company “free from profit making incentives and constraints” to focus on technology solutions”  This is great, except for the fact that technology is only one part of the problem (but definitely worth fixing) and that the scale these companies bring will really only benefit a narrow slice of consumers – their companies.  By the way, Steve Case of AOL tried this years ago and failed miserably, but who remembers Steve Case any more?

  • Price Shop Healthcare | CA Benefit Advisors

    April 3, 2018

    Tags: , , , , , , , , , , , ,


    As the costs of health care soar, many consumers are looking for ways to control their medical spending. Also, with the rise of enrollment in high deductible health plans, consumers are paying for more health care out-of-pocket. From medical savings accounts to discount plans for prescriptions, patients are growing increasingly conscious of prices for their healthcare needs. Price shopping procedures and providers allows you to compare prices so that you are getting the best value for your care.

    Why do you need to look beyond your nearby and familiar providers and locations for healthcare? Here’s a hypothetical example: Chris is a 45-year old male in good physical health. During his last check-up he mentions to his doctor that he’s had some recent shortness of breath and has been more tired as of late. His doctor orders an EKG to rule out any problems. If Chris went to his local hospital for this procedure, it would cost $1150. He instead looks online and shops around to find other providers in his area and finds he can get the same procedure for $450 at a nearby imaging center. His potential savings is $700 simply by researching locations.

    So where do you start when shopping around for your health care?  A good place to begin is by researching your health plan online. Insurance companies will post cost estimates based on facility, physician, and type of procedure. Keep in mind that these are just estimates and may vary based on what coverage you are enrolled in. Another way to shop is by checking out websites that have compiled thousands of claims information for various procedures and locations to give an estimate of costs. However, deciphering whether a site is reporting estimates based on the “medical sticker price” of charges or rates for private insurance plans or Medicare is difficult.  There are huge differences in prices at different providers for the exact same procedure. This is because contracts between insurance agencies and providers vary based on negotiated amounts. This makes it hard to get consistent pricing information.

    Check out these sites that do a great job comparing apples to apples for providers:

    • Healthcare Blue Book
      • What Kelly Blue Book is to cars, Healthcare Blue Book is to medical pricing
    • New Choice Health
      • Reports on pricing of medical procedures, providers, quality of facilities, and customer feedback for healthcare in all 50 states
    • The Leapfrog Group
      • Publishes data on hospitals so patients can compare facilities and costs for treatments and procedures

    After compiling all the information on prices and procedures, you can still call and negotiate costs with the location of your care. Fair Health Consumer has tips on how to negotiate with providers and plan for your healthcare needs.

    Knowledge is POWER and when you spend time researching and comparing healthcare costs, you are empowering yourself!  Exercising due diligence to plan for you and your family’s medical needs will save you money and give you confidence in your decisions for care.

     

     

  • It ain’t over til it’s over – the mandates may live on in states

    March 20, 2018

    Tags: , , , , , , , , , , ,

    Insurance carriers are dismayed  that the individual mandate is being repealed for the simple reason that the ability of individuals to opt out of coverage will cause a negative spiral in health care costs, as the pool of covered people devolve into those who are more in need of services.  Some states, however, including California, are fighting back and considering a state mandated mandate. We shall see.

  • Benefits Easy: Intro to Self-Funding | Petaluma Benefit Advisors

    February 9, 2018

    Tags: , , , , , , , , , , , ,

    As the first month of 2018 wraps up, companies have already begun the arduous task of submitting budgets and finding ways to cut costs for the new year. One of the most effective ways to combat increasing health care costs for companies is to move to a Self-Funded insurance plan. By paying for claims out-of-pocket instead of paying a premium to an insurance carrier, companies can save around 20% in administration costs and state taxes. That’s quite a cost savings!

    The topic of Self-Funding is huge and so we want to break it down into smaller bites for you to digest. This month we want to tackle a basic introduction to Self-Funding and in the coming months, we will cover the benefits, risks, and the stop-loss associated with this type of plan.

    THE BASICS

    • When the employer assumes the financial risk for providing health care benefits to its employees, this is called Self-Funding.
    • Self-Funded plans allow the employer to tailor the benefits plan design to best suit their employees. Employers can look at the demographics of their workforce and decide which benefits would be most utilized as well as cut benefits that are forecasted to be underutilized.
    • While previously most used by large companies, small and mid-sized companies, even with as few as 25 employees, are seeing cost benefits to moving to Self-Funded insurance plans.
    • Companies pay no state premium taxes on self-funded expenditures. This savings is around 1.5% – 3.5% depending on in which state the company operates.
    • Since employers are paying for claims, they have access to claims data. While keeping within HIPAA privacy guidelines, the employer can identify and reach out to employees with certain at-risk conditions (diabetes, heart disease, stroke) and offer assistance with combating these health concerns. This also allows greater population-wide health intervention like weight loss programs and smoking cessation assistance.
    • Companies typically hire third-party administrators (TPA) to help design and administer the insurance plans. This allows greater control of the plan benefits and claims payments for the company.

    As you can see, Self-Funding has many facets. It’s important to gather as much information as you can and weigh the benefits and risks of moving from a Fully-Funded plan for your company to a Self-Funded one. Doing your research and making the move to a Self-Funded plan could help you gain greater control over your healthcare costs and allow you to design an original plan that best fits your employees.

     

     

  • Don’t worry…we’re going to fix it now

    April 20, 2018

    Tags: , , , , , , , , , , , , , ,

    Well, now the concerns are over.  Jamie Dimon JP Morgan, Jeff Bezos from Amazon and Warren Buffet from Berkshire Hathaway have all teamed up to solve our nation’s health care problems.  There are no details at this point, of course, but they say they plan to hold down costs by bringing “their scale and complementary expertise to this long term effort”  They will create an independent company “free from profit making incentives and constraints” to focus on technology solutions”  This is great, except for the fact that technology is only one part of the problem (but definitely worth fixing) and that the scale these companies bring will really only benefit a narrow slice of consumers – their companies.  By the way, Steve Case of AOL tried this years ago and failed miserably, but who remembers Steve Case any more?

  • Price Shop Healthcare | CA Benefit Advisors

    April 3, 2018

    Tags: , , , , , , , , , , , ,


    As the costs of health care soar, many consumers are looking for ways to control their medical spending. Also, with the rise of enrollment in high deductible health plans, consumers are paying for more health care out-of-pocket. From medical savings accounts to discount plans for prescriptions, patients are growing increasingly conscious of prices for their healthcare needs. Price shopping procedures and providers allows you to compare prices so that you are getting the best value for your care.

    Why do you need to look beyond your nearby and familiar providers and locations for healthcare? Here’s a hypothetical example: Chris is a 45-year old male in good physical health. During his last check-up he mentions to his doctor that he’s had some recent shortness of breath and has been more tired as of late. His doctor orders an EKG to rule out any problems. If Chris went to his local hospital for this procedure, it would cost $1150. He instead looks online and shops around to find other providers in his area and finds he can get the same procedure for $450 at a nearby imaging center. His potential savings is $700 simply by researching locations.

    So where do you start when shopping around for your health care?  A good place to begin is by researching your health plan online. Insurance companies will post cost estimates based on facility, physician, and type of procedure. Keep in mind that these are just estimates and may vary based on what coverage you are enrolled in. Another way to shop is by checking out websites that have compiled thousands of claims information for various procedures and locations to give an estimate of costs. However, deciphering whether a site is reporting estimates based on the “medical sticker price” of charges or rates for private insurance plans or Medicare is difficult.  There are huge differences in prices at different providers for the exact same procedure. This is because contracts between insurance agencies and providers vary based on negotiated amounts. This makes it hard to get consistent pricing information.

    Check out these sites that do a great job comparing apples to apples for providers:

    • Healthcare Blue Book
      • What Kelly Blue Book is to cars, Healthcare Blue Book is to medical pricing
    • New Choice Health
      • Reports on pricing of medical procedures, providers, quality of facilities, and customer feedback for healthcare in all 50 states
    • The Leapfrog Group
      • Publishes data on hospitals so patients can compare facilities and costs for treatments and procedures

    After compiling all the information on prices and procedures, you can still call and negotiate costs with the location of your care. Fair Health Consumer has tips on how to negotiate with providers and plan for your healthcare needs.

    Knowledge is POWER and when you spend time researching and comparing healthcare costs, you are empowering yourself!  Exercising due diligence to plan for you and your family’s medical needs will save you money and give you confidence in your decisions for care.

     

     

  • It ain’t over til it’s over – the mandates may live on in states

    March 20, 2018

    Tags: , , , , , , , , , , ,

    Insurance carriers are dismayed  that the individual mandate is being repealed for the simple reason that the ability of individuals to opt out of coverage will cause a negative spiral in health care costs, as the pool of covered people devolve into those who are more in need of services.  Some states, however, including California, are fighting back and considering a state mandated mandate. We shall see.

  • Benefits Easy: Intro to Self-Funding | Petaluma Benefit Advisors

    February 9, 2018

    Tags: , , , , , , , , , , , ,

    As the first month of 2018 wraps up, companies have already begun the arduous task of submitting budgets and finding ways to cut costs for the new year. One of the most effective ways to combat increasing health care costs for companies is to move to a Self-Funded insurance plan. By paying for claims out-of-pocket instead of paying a premium to an insurance carrier, companies can save around 20% in administration costs and state taxes. That’s quite a cost savings!

    The topic of Self-Funding is huge and so we want to break it down into smaller bites for you to digest. This month we want to tackle a basic introduction to Self-Funding and in the coming months, we will cover the benefits, risks, and the stop-loss associated with this type of plan.

    THE BASICS

    • When the employer assumes the financial risk for providing health care benefits to its employees, this is called Self-Funding.
    • Self-Funded plans allow the employer to tailor the benefits plan design to best suit their employees. Employers can look at the demographics of their workforce and decide which benefits would be most utilized as well as cut benefits that are forecasted to be underutilized.
    • While previously most used by large companies, small and mid-sized companies, even with as few as 25 employees, are seeing cost benefits to moving to Self-Funded insurance plans.
    • Companies pay no state premium taxes on self-funded expenditures. This savings is around 1.5% – 3.5% depending on in which state the company operates.
    • Since employers are paying for claims, they have access to claims data. While keeping within HIPAA privacy guidelines, the employer can identify and reach out to employees with certain at-risk conditions (diabetes, heart disease, stroke) and offer assistance with combating these health concerns. This also allows greater population-wide health intervention like weight loss programs and smoking cessation assistance.
    • Companies typically hire third-party administrators (TPA) to help design and administer the insurance plans. This allows greater control of the plan benefits and claims payments for the company.

    As you can see, Self-Funding has many facets. It’s important to gather as much information as you can and weigh the benefits and risks of moving from a Fully-Funded plan for your company to a Self-Funded one. Doing your research and making the move to a Self-Funded plan could help you gain greater control over your healthcare costs and allow you to design an original plan that best fits your employees.

     

     

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