young african american man needing health coverage outside of open enrollment

What Are My Options if I Lose Healthcare Coverage?

Maintaining health insurance coverage is a vital step in your plan to remain financially secure. However, there are times in life when your health coverage may be interrupted. When this happens, it’s imperative that you find affordable health insurance coverage quickly in order to protect yourself and your family.

Why Would My Coverage Be Cancelled?

There are a few factors that could contribute to the loss or interruption of health insurance coverage. If an individual does not pay their premium, their policy may be canceled. This is not always a result of poor money management; if there has been a significant change in income or other pressing financial obligations, it is easy to redefine financial priorities and let those monthly insurance premiums slide. It is also possible that individuals can lose their coverage when a grandfathered plan is canceled. However, the loss of a job that provided insurance coverage is the more likely reason someone may lose their benefits.

These factors are very hard to foresee, and therefore can be very stressful when you learn that your health insurance coverage is going to be affected. However, as soon as you find out your coverage is being canceled, there are steps you can take quickly to make sure you maintain health insurance coverage for you and your family and protect your financial stability.

Option #1: Continue Existing Coverage through COBRA

COBRA is a Federal law that makes it possible for individuals who were covered under company health insurance plans to maintain those existing plans following a job loss. In order to take advantage of COBRA benefits, the individual must pay the full monthly health insurance premium amount. These amounts are usually substantially higher than what you were previously paying because in most cases the employer was paying a portion of your monthly premium. The COBRA plan, however, does ensure that your existing policy will stay intact for up to eighteen months following a job loss. This is crucial for many individuals who have severe health problems and would be in financial jeopardy if they lost their coverage for even a short amount of time.

Option #2: Purchase a New Plan on the Insurance Exchange

If an individual loses health insurance coverage due to the loss of a job, purchasing a new health insurance plan on the insurance exchange could be better, and more affordable, answer to your problem. The Insurance Exchange is a multi-carrier private exchange offering a wide range of health insurance choices for individuals and their families.

These types of benefits are time-sensitive, so it is best to begin the process before losing your insurance coverage. Although insurance exchanges usually have set open enrollment periods (running from November to February), those who suffer from a job loss are offered a Special Enrollment Period to allow them to obtain coverage within a specific time frame after the job loss occurs.

Which Do I Choose?

The most cost-effective solution for most people is to seek a new plan entirely. Insurance plans on the exchange offer generally lower monthly premiums than what you’d pay for your existing plan under COBRA. However, it is crucial that you do not waste time, as the special enrollment period for these plans is 60 days from the qualifying event or last date of coverage. It is important to act quickly to get the best selection of plans and ensure you are able to obtain coverage within the required time frame.

healthy elderly couple over the age of 50

9 Health & Fitness Tips For Those Over 50

Today’s mid-life looks quite different than generations past — 50 really can be the new 30. Medically, we know more about the body and how to maintain optimal health at every age. While there are a vast number of changes and improvements for people to live a healthier lifestyle, here are nine important health tips for those in their 50s and beyond.

  1. Perform Mental Gymnastics. Your mental state is imperative to good health. Choose activities that keep your analytical skills sharp and always seek to learn new things. Not only does this make your day-to-day life more interesting, but it may help to decrease the chances of dementia later in life.
  2. Maintain Good Oral Hygiene. This is something that many don’t associate with good health, but gum disease is linked to serious health conditions, including various forms of cancer and heart disease. Did you know that 3 out of 4 Americans have some form of gum disease?
  3. Increase Exercise. Regular exercise helps overall health in a number of ways, including regulating blood sugar and combating high blood pressure. If you’re not exercising regularly, find a low-impact regimen or activity you are comfortable with and start from there. It’s also important to keep increasing your exercise activity as you get more comfortable. If you’ve been doing ten laps at the pool for months and it’s easy for you, it might be time to add ten more to make your body work harder. (Note: Be sure to check with your doctor before starting any exercise regimen.)
  4. Make Dietary Changes as Needed. As we age, we’re at a higher risk for heart- and pulmonary-related diseases. There are a number of things we can do to reduce risks, chief among these being a change in diet. As we age, we should reduce salt intake, cut down on unnecessary sugars, and add more natural fruits and vegetables to our daily intake.
  5. Get Regular Checkups. As you pass 50, it’s more important than ever to see your physician regularly. Many health risks can be diminished by early detection. Ask your doctor what tests you should expand upon if your family history indicates a high risk for any specific illness.
  6. Get Your Specialty Health Screenings. Outside of the regular yearly check-up, men should make certain to get checked for prostate cancer and women should be screened for breast and ovarian cancers. Early detection is key to success in treatment.
  7. Get Enough Sleep. Getting the proper amount of sleep is imperative to overall health. Inadequate sleep puts you at a greater risk for cognitive decline, makes it harder to maintain a healthy weight and to avoid type 2 diabetes. Lack of sleep also puts you at greater risk for depression and increases your chances of having a heart attack.
  8. Participate in Regular Social Activities. Regular activity is important to overall health, both physically and emotionally. As people age, they sometimes take themselves out of social settings and this can lead to depression. It’s important to stay active, whether that means running around with grandkids or volunteering in your local church.
  9. Take Your Vitamins. A great diet is a start, but most people will not get all of the nutrients they need from simply eating well. As you age, make sure your dietary supplements contain all of the vitamins you need, like calcium for bone mass and omega-3 fatty acids to maintain healthy brain function.

These tips can help to maintain a healthy lifestyle in your 50s and beyond.

mother and daughter practicing good oral hygiene

The Link Between Gum Disease and Health Conditions

Most people want a straight, white smile because it looks better, or makes them look younger. What many people don’t realize is that good oral health is an indication that your body is healthier as well. There is a correlation between periodontal disease and a number of illnesses. According to one recent study, those with serious gum disease were up to 40% more likely to have a chronic health condition.

Doctors and dentists today are aware of these cross-overs in conditions and will often recommend that patients get checked for other illnesses that correlate, which is one good reason to be proactive with scheduling regular dental checkups.

Three Conditions Affected By Your Oral health

There are known links between many different conditions, but those with gum disease are at a higher probability of also having these three common and serious illnesses.

  • Diabetes. Diabetes and periodontal disease go hand in hand. Inflammation of the gums is known to negatively impact the body’s ability to process and use insulin. In this particular case, the conditions will exacerbate each other — diabetes causes the body to lack the ability to fight infection, including gum infections, while inflammation inhibits the ability to regulate sugar.
  • Heart Disease. Up to 91% of patients with heart disease suffer from periodontal disease — a high enough correlation to take precautionary measures. Get a regular, thorough exam if you suffer from any form of gum disease. While the cause still isn’t clear, there is some speculation that having periodontitis raises the risk of developing heart disease.
  • Osteoporosis. It’s a natural warning sign that both osteoporosis and periodontal diseases are forms of bone loss. Osteoporosis tends to impact more women, while men have a higher incidence of gum disease. However, some researchers today are testing out the theory that gum disease inflammation may trigger bone loss in other areas of the body, besides the jaw.

Outside of these known conditions, there are also common medications that can impact oral health. More specifically, some side effects can be detrimental to teeth and gums over time. Side effects to be aware of and mention to your dentist include dry mouth, abnormal bleeding, altered taste, oral sores or inflammation, enlarged gums and cavities, and any medication that is known to contribute to bone loss.

Schedule Your Check-Up

Information is power. The important thing is to realize that scheduling regular dental and medical check-ups can help you to maintain optimal health and stay on top of any potential problems before they become life-changing. 

female cancer patient hugging daughter

What Breast Cancer Awareness Month Means for Your Health

Regardless of whether breast cancer runs in your family history or not, there are some preventative measures you should be taking and some things you should know about the second most common type of cancer in women.

The Importance of Early Detection

Breast cancer occurs in progressing stages, becoming increasingly difficult to treat with each stage. This is why detecting breast cancer as early as possible is so important. At the age of 40, most women should begin having annual mammograms done as a means of detecting potentially cancerous growths in breast tissue. For women with a family history of breast cancer, however, annual mammograms may be recommended to begin even sooner.

For women under 40, regular self-breast exams are also recommended. Giving yourself a monthly exam, in addition to being on the lookout for sudden pain or changes in the breasts, can help with early detection before an annual clinical breast exam is done.

Common Myths About Breast Cancer

Unfortunately, there are many myths floating around about breast cancer that put many people (not just women) at greater risk. For example, it’s a commonly perpetuated myth that only women can get breast cancer. Unfortunately, men can have breast cancer, too — and due to lack of information on male breast cancer, their mortality rates are extremely high.

Another all-too-common myth about breast cancer is that if you find a lump, you must have cancer. This couldn’t be further from the truth. Abnormal growths in a breast are usually benign (not cancerous), so if you find one, you shouldn’t panic. Schedule an appointment with your doctor quickly if you do find anything abnormal in one or both of your breasts, and they can schedule a mammogram for you if needed.

Frequently Asked Questions

One of the most common questions women have in regards to breast cancer is, “what can I do to reduce my risk?” There are plenty of steps that can be taken to reduce one’s risk of breast cancer, such as:

  • quitting smoking
  • decreasing alcohol consumption
  • getting 30 minutes or more of daily exercise
  • reducing or managing stress in your life

Of course, there’s no surefire way to avoid getting breast cancer. Even women who have no family history of breast cancer can get it; in fact, most women who have breast cancer don’t have it in their family history. Taking steps to identify and treat cancer early is the single best thing a woman can do to protect herself. This means scheduling an annual exam with your doctor (and a mammogram, if you are of recommended age) as well as giving yourself monthly breast exams.

Sadly, breast cancer takes the lives of approximately 40,000 people each year. If your current health insurance policy doesn’t cover preventative care for breast cancer (or if you don’t have insurance), now is the time to find a policy that works for you.

picking a healthy fresh orange

Simple Tips for Making Healthier Eating Choices

In today’s world of readily available processed and fast foods, it’s more difficult than ever for busy people to make healthy eating choices. However, with more than two-thirds of Americans classified as overweight or obese, there has never been a greater need for a balanced, nutritious diet. If you struggle to make the right eating choices day after day, the good news is that there are a few simple tips you can follow to get on the right track.

Set Yourself Up for Success

Start by realizing you can’t make drastic diet changes overnight and expect them to be easy to stick with. Instead, set yourself up for long-term success by gradually transitioning into a healthier diet. Rather than giving up soda and sugary drinks cold-turkey, consider reducing your intake of them week by week until you’ve weaned yourself down to your desired amount.

Moderation is Key

When most people think of healthy diets, they think they’ll need to deprive themselves of the foods they know and love. However, this shouldn’t be the case. The key is to enjoy the foods you love in moderation. Allowing yourself a small snack every now and then (such as a slice of pizza or a scoop of your favorite ice cream) will allow you to fulfill cravings and avoid feeling like you’re depriving yourself.

Reduce Sugar and Salt

Added sugars and salts are a huge problem in the average American’s diet, with excess intake resulting in an increased risk of depression, obesity, heart disease, and diabetes. Make a conscious effort to read the labels on your food packaging and avoid excess sodium and sugar when possible. This may mean cutting back on your soda intake, avoiding processed foods (which tend to have lots of added salt), and choosing snacks that have no added sugar.

Eat Colorful Fruits and Veggies

Get the vitamins and nutrients you need while filling up on fewer calories by incorporating more colorful fruits and veggies into your diet. Consider replacing your typical starchy side of rice or potatoes at dinner with a large helping of roasted veggies or fresh fruit salad. Your body will thank you!

Eat More Healthy Carbs and Whole Grains

Many people trying to eat healthily think they need to avoid carbs altogether, but this isn’t the case. The key is to make sure you’re eating healthy carbs, such as those that come from legumes, whole grains, fruits, and veggies. On the flip side, try to reduce your intake of unhealthy carbs, such as:

  • white flour
  • white rice
  • refined sugars

Fiber Up

Last but certainly not least, load up on fiber; most Americans don’t get enough of it in their diet. Foods that are high in fiber will keep you full for longer and provide you with steady energy throughout the day. Getting enough fiber can also reduce your risk of heart disease and stroke.

These are just a few simple ways in which you can begin eating healthier and, as a result, feeling more energetic!

woman filling out health forms

Qualified Medical Expenses for Health Spending Accounts

Consumer-Directed Health Care

Health spending accounts are used to pay for medical expenses that your healthcare plan doesn’t cover, such as deductibles or copays. They’re part of what’s called consumer-directed health care. Consumer-directed means you manage more of the money you spend on health care costs.

There are several types of health spending accounts, including:

  • A health savings account (HSA) is a tax-favorable savings account for medical expenses and is typically used in conjunction with a high-deductible health insurance plan. Unlike a flexible spending account (FSA), unused money in your HSA isn’t forfeited at the end of the year; it can be rolled over and used for the following year’s qualified health expenses. You can only have an HSA if you enroll in an HSA-compatible health plan.
  • A flexible spending account (FSA) is set up by your employer. They own the account, but you get to decide which qualified medical expenses to pay for with your FSA. What makes it flexible? It works with most of PPO employer-sponsored health plans. Unused money in the FSA at the end of the year may have to be forfeited. In addition to medical expenses, FSAs can often be used to pay for childcare expenses, as well as other expenses.
  • A health reimbursement arrangement (HRA) is a benefit fund set up by your employer. Your employer contributes a certain amount of money each year for you to use for medical expenses not covered by your health plan. Only your employer can fund an HRA. In most cases, if all of the money is not used by the end of the year, the HRA can be rolled over to the following year – as long as the employee stays on the same plan.

Money is deposited in these accounts tax-free and is taken out tax-free or tax-deductible. You can use it to pay for qualified medical expenses. A debit card may also be available depending on your plan. Where they differ is the kind of health plan they work with, who owns the account, who controls it and who can put money into it. Here is a comparison chart showing some of the similarities and differences:

HSA HRA FSA differences

Examples of Qualified Medical Expenses

If you have one of these health savings accounts, it’s important to be aware of what is considered a qualified medical expense to be able to use these funds. A qualified medical expense is one that can be purchased with tax-free money through your health savings account.

Some examples of qualified expenses include:

  • insulin and diabetic supplies
  • eye surgery (including laser eye surgery)
  • doctor’s fees
  • fertility enhancement (including in-vitro fertilization)
  • first aid supplies and bandages
  • dental treatment (x-rays, fillings, extractions, dentures, braces, etc.)
  • braces and supports
  • wheelchairs and walkers
  • contact lenses and reading glasses
  • prescribed medications
  • sleep aids

Note that some qualified medical expenses require a prescription from your doctor. If you’re thinking about purchasing something with your health savings account, it’s recommended that you first check to ensure that the expense is qualified and what the procedure is for getting it covered (such as sending a copy of your prescription or receipt or filing a reimbursement request form).

Young biracial woman in business attire smiling on a cell phone on an overcast day

Need Health Insurance and Miss out on Open Enrollment?

Your Guide to Understanding Qualifying Life Events and Special Enrollment

Life happens, and when it does, it is very likely that your health insurance coverage may need to change. When you encounter a qualifying life event that impacts your insurance needs, it is important to know that you can take advantage of a special enrollment period – since most people are unaware that they may enroll outside of open enrollment.
This guide is created to help you understand everything you need to know about qualifying life events and the special enrollment period. You will learn whether or not you qualify and what documents you will need prior to enrolling and shopping for coverage.

#1 Loss Of Coverage

Due To:

  • Termination of group coverage
  • Reduction of hours to part-time status
  • Loss of employer contribution
  • COBRA ending
  • REQUIRED PROOF: Letter from employer, Certificate of credible coverage

#2 Marital Status Change

Due To:

  • Marriage
  • Divorce
  • Legal separation
  • REQUIRED PROOF: Marriage Certificate or divorce/separation court documents, Certificate of credible coverage.

#3 Dependent Status Change

Due To:

  • Birth of a child
  • Adoption
  • Aged out of dependent status
  • REQUIRED PROOF: Child’s DOB, Legal adoption paperwork, Certificate of credible coverage.

#4 Moving

Permanently move to another state and/or no longer live in the existing/prior plan’s service area.

REQUIRED PROOF: New Mortgage Bill/Renter’s Agreement and drivers license, utility, Postal Service change of address receipt.

#5 Death

Your primary policyholder passed away leaving you with no coverage.

REQUIRED PROOF: Death Certificate, Copy of termination letter from prior insurance company.

#6 Income Change

That makes you newly eligible or ineligible for a tax credit.

REQUIRED PROOF: Copy of certificate of creditable coverage OR a copy of the termination letter from prior Insurance Company and/or federal or state agency.

#7 Non-Calendar Year

Your current plan ends on a non-calendar year basis.

REQUIRED PROOF: Copy of termination letter from prior insurance company OR Certificate of Credible Coverage Anytime that you enroll in a plan you will be asked to provide the following information:

  1. What was your qualifying event?
  2. What was the date of this event?
  3. You’ll be asked to submit supporting documents.

So how long is this special enrollment period? Typically, you only have 60 days from the QLE to enroll in a new plan due to ACA law, carriers are very strict on enrollment timelines.

stressed young man at work

Crucial Health Insurance Terms You Need To Know

Navigating the tricky waters of health insurance terminology can be difficult. This is why we’ve put together this handy guide featuring some of the most popular insurance language terms and explaining just what they mean as it relates to you and your family.

Coinsurance:

Coinsurance is your share of the costs of a covered healthcare service calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you still owe for a covered health service.

Premium:

A premium is the amount of money charged by an insurance company for coverage. The cost of premiums may be determined by several factors, including age, geographic area, tobacco use, and number of dependents.

Copayment:

A copayment, or co-pay, is a fixed amount you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

Deductible:

A deductible is an amount you owe for health care services each year before the insurance company begins to pay. For example, if your annual deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services that are subject to the deductible. The deductible may not apply to all services, such as when a co-pay only applies or preventive care services. Deductibles are useful for keeping the cost of insurance low. The amount varies by plan, with lower deductibles generally associated with higher premiums. They are fairly standard on most types of health coverage.

Out-of-pocket Maximum (OOPM):

An out-of-pocket maximum is the most you should have to pay for your health care during a year, excluding the monthly premium. It protects you from very high medical expenses. After you reach the annual out-of-pocket maximum, your health insurance or plan begins to pay 100 percent of the allowed amount for covered health care services for the rest of the year. The deductible, coinsurance, co-pays and prescription drug co-pays are included in the out-of-pocket maximum.

Annual Limit and Lifetime Limit:

In the past, health insurance carriers imposed Annual and Lifetime limits on the benefits you receive. You are no longer subject to these limitations and there is no maximum to the benefits you may receive.

Preventive Care:

Rather than waiting for a patient to become sick, preventive care aims to keep people healthy, or at least catch illnesses at their earliest and most treatable stages. Preventive care includes preventive services performed by providers, such as annual physicals or mammograms. Under the provisions of the Affordable Care Act (ACA), policies must cover various preventive services for men, women, and children without sharing the cost for these services through coinsurance, deductibles or copayments. Certain Preventive care services are subject to frequency limitations.

PPO Plan:

This plan allows you to receive care from any doctor you choose, no referral for specialty care (except United HealthCare FL), may use out-of-network doctors – but may have to pay additional fees. PPO plans typically have higher monthly premiums.

POS Plan:

Very similar to a PPO. The biggest difference between the two is the contract between the insurance carrier and healthcare providers.

HMO Plan:

Must pre-select an approved Primary Care Physician, referrals are needed and for most plans, there are no out of network benefits except for qualifying emergencies. HMO plans typically have lower monthly premiums.

EPO Plan:

This is a hybrid network that has limitations that vary based on the carrier. In some instances, you would need to get referrals and may not have coverage for out-of-network. These plans typically have a lower monthly premium.

woman with curly hair in coffee shop holing her phone and smiling over good news

Short-Term Health Insurance Soon Available For Up To 36 Months

New Rule Loosens Current Restrictions

Effective October 2, 2018, a new rule will allow individuals to purchase short-term, limited-duration health insurance coverage for a period of less than 12 months, and renew such coverage for up to 36 months. Under current law, the maximum coverage period for short-term, limited-duration health insurance is less than 3 months, and these policies cannot be renewed.

Notably, short-term, limited-duration health insurance is:

  • Not required to comply with the Affordable Care Act’s ban on pre-existing condition exclusions and lifetime and annual dollar limits.
  • Not required to comply with the Affordable Care Act’s essential health benefits requirement, which requires individual health insurance policies to cover, among other things, hospitalizations, emergency services, and maternity care.
  • Not “minimum essential coverage,” meaning that policyholders may remain liable for an individual mandate penalty for any month in 2018.

Click here to read the new rule. A fact sheet is also available.

person inputting numbers into calculator for tax season

Reminder: Individual Mandate Remains in Effect for 2018

Requirement is Effectively Repealed Beginning in 2019

Individuals are reminded that the section of the Tax Cuts and Jobs Act which effectively repealed the individual shared responsibility provision (“individual mandate”) of the Affordable Care Act does not become effective until 2019. As a result, individuals are required to have minimum essential health coverage, qualify for an exemption from the requirement, or pay a penalty tax for 2018.

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