Georgia Health Insurance 411

Posts Tagged ‘Georgia health insurance’

you can keep it . . . unless of course it goes away. Obamacare has already started to create casualties and the latest, at least for Georgia health insurance plans is another health insurance company that will no longer offer maternity benefits.

Right now there are only two choices for maternity coverage in Georgia . . . Blue Cross and Kaiser. If you pick Blue Cross you have to wait 12 months before conception if you want any benefits.

Kaiser does not have a waiting period.

By October if you want a plan with maternity your only choice will be Blue Cross unless of course they decide to pull out of that market as well.

Thank you Obamacare.

We still have affordable health insurance plans in Georgia but I can’t say how much longer that will be true.

Buying a health insurance plan in Georgia that does not cover prescription drugs is like playing Russian Roulette with your life. The following appeal was posted on a forum where health insurance agents congregate.

My aunt was just diagnosed with lung cancer called EGFR mutation and has been prescribed 150mg of Tarceva, which should treat this to some degree. The really bad news is that she didn’t choose any type of Rx coverage on her individual plan. The condition is terminal but she could live for several years. However, the cost of the Rx is $5,000+ per month out of pocket which would wipe her out financially.

She lives in DC and has a Personal Comp Plan through Care First Blue Cross Blue Shield.

Annual deductible of $500

Annual family aggregate deductible of $1,000 and

Out of pocket cost limit of $2,000

All policy benefits are paid at 80%

No Rx coverage

They will reimburse for Rx for $500 after deductible on an annual basis. She has an ARGUS prescription discount program that is associated with this policy, but I am not familiar with this and guess it is worthless.

She also has a Catastrophic Individual Policy with Care First Blue Shield.

Is there is anything that she can do to get this Rx covered or is she going to have to pay for it all?

The short answer is, no, she cannot go back after the fact and buy Rx coverage. She may be able to get financial assistance through places like NeedyMeds or RxHope. Beyond that she is pretty much on her own.

If you have a plan that does not cover prescription medication you need to make a change now before it is too late. Some of the popular health insurance plans sold in Georgia that do not cover Rx (or impose severe limits on what they will cover)  include the Aetna Value plans, Blue Cross Blue Shield SmartSense and Golden Rule Saver plans. Also plans sold by Assurant as Save Right or Right Start have low annual caps for Rx that can be breached in a matter of weeks.

At Georgia Insurance Shop we never recommend plans that limit or exclude coverage for brand name medication. If you think you have a Georgia health insurance plan that does not fully cover prescription drugs, contact us immediately.

If you have a Georgia health insurance policy through Blue Cross (BCBSGA), you may be in for an unwelcome surprise. Some of their plans may not cover your brand name drug.

I discovered this quite by accident while helping a friend navigate her new BCBSGA health insurance policy purchased through Blue Cross direct (no agent involved). She is a bit overweight and takes medication to control high blood pressure and cholesterol. In applying for coverage she did ask if her medications would be covered.

The rep indicated that two of the three medications were not on their formulary, but that is as far as they went.

Her husband contacted me for advice and we went looking for a plan that would cover all of her medications. I found two plans that included all three med’s and after further review, we picked one that was a better fit.

She applied for coverage through Georgia Insurance Shop and everything went fine until the underwriting phone interview. During the recorded interview she revealed that she had lost weight over the last 12 months. The weight listed on her application was right on the border for a potential decline so the health insurance company did the responsible thing and requested medical records.

As it turns out her last recorded weight was higher than listed, and her weight from a year ago even higher. The combination of these factors, plus the medications resulted in her application being denied.

So why did Blue Cross accept her and this carrier did not?

Blue failed to conduct a thorough investigation on the front end. And yes, this can come back to haunt her in more ways than one.

Her husband asked for suggestions to save money on the cost of medication, so I linked him to some mailorder Rx sites. I told him to have his wife call Blue Cross (I can’t do it since I am not her agent) and ask how much these non-formulary drugs will cost under her Blue Cross plan.

The response . . . full retail and she cannot use their mailorder facility. Not only that, but since they are not covered there is no deductible credit either.

That was a shock.

It is not unusual to find that your medication may not be on a formulary, but very unusual to discover the drug is not covered under any circumstances.

So this lady is in a bit of a pickle . . . and so is everyone else who bought this plan.

The med’s she takes that are not covered are relatively inexpensive . . . less than $200 at retail. So what happens if she develops a new condition that requires her to take an expensive medication that falls outside their formulary?

Not covered.

No copays, no discounts, no deductible credit.

That’s a real bummer.

So how do you find out if a medication is covered under a formulary?

Well you have to ask. But if you fail to ask the right question you may not get the answer you need.

How do you find out what is covered on the BCBSGA formulary?

Buy a policy, then go to their website or call customer service. Even if you are dealing with an agent, that agent will not be able to tell you unless he/she is also a Blue Cross policyholder.

If you have bought a Blue Cross of Georgia individual major medical policy in the last two years, you need to ask them if non-formulary drugs are covered under your plan. If not, you need to make a change right now if you can.

I have been in this business for more than 35 years and have never run across a provision like this that is so well hidden you will never find out until it is too late. This has prompted me to pose a direct question to other health insurance companies I represent and ask how their plan treats non-formulary drugs.

If you are looking for affordable health insurance in Georgia, be very careful and don’t be afraid to ask questions.

If you have a Georgia health insurance policy from Aetna, there are changes in the wind that you may not like. As a result of the Patient Protection and Unaffordable Health Care Act (Obamacare), the change you hoped for may not be the change you get.

The ink is hardly dry on the law and already Washington is trying to figure out what the law means, and how it will impact health insurance policyholders. In fact, they are making up rules as they go along.

Since Washington has no clue, neither do the health insurance companies. Most of the carriers are taking a wait and see approach before making drastic changes but some have decided to completely abandon the individual major medical market.

So far, Aetna isn’t one of them but they are introducing some surprises that will make life difficult.

If you have an Aetna health insurance policy in Georgia, you have have already received a letter telling you of changes that will come about in July. Since Aetna did not bother to tell their agents about the letter, or the changes, we are finding out after the fact.

Here is what you can expect.

If your health insurance policy is more than 12 months old you will be getting a rate increase in July. Even if you just had a policy anniversary or age change increase you are getting another increase in July.

If your policy is less than 12 months old there will not be any changes until the 1st policy anniversary.

If you have an Aetna health insurance policy with doctor and Rx copays, your plan of benefits will change in July as will your rates. In most cases you will be looking at lesser benefits and possibly higher rates.

If you have a high deductible HSA plan there are no changes in benefits but rates may change in July.

The biggest changes will occur for those who have a Value plan or the $0 deductible plan.

We encourage anyone who currently has an Aetna plan to contact a knowledgeable agent that is familiar with plans from Aetna as well as other health insurance companies. In most cases, you will not need to change carriers or plans, but some will benefit from moving to a different plan with a different health insurance company.

Changing to a richer benefit plan within Aetna will require going through the underwriting process once more. Changing to a new health insurance company will require you to submit your medical information to a new carrier for review.

Frankly, some people who bought a plan they liked with Aetna will be stuck and will not have any options. If you chose a Value plan before you may be trapped in a new plan that has a higher deductible than before, fewer allowed doctor visits and no brand name prescription drug coverage.

And you may pay a higher premium as well.

You have every right to blame Aetna but you must also recognize the rules governing health insurance plans have been changed and not for the good. The folks in Washington who make the rules have no idea what they have done to have a negative impact on policyholders. Over the next few months as the new law phases in you can expect even more surprises.

Most will still be able to find affordable health insurance in Georgia, but they may have to look a little harder. That’s where we come in. We represent all major health insurance companies in Georgia and know how to find the best value.

If you have questions about health insurance, hopefully we have answers. If we don’t have an immediate answer we know where to go to get a response. Let Georgia Insurance Shop be your resource for information on health insurance in Georgia.

When it comes to buying health insurance in Georgia, it seems some folks just want to do it themselves. I have been in this industry for more than 30 years and can’t imagine why anyone would want to go to the trouble of looking at hundreds of health insurance plans, going to numerous websites, entering your information over and over only to have your phone ring off the hook and then give up in frustration and just apply direct with insurance companies.

Health insurance companies are not set up to do anything other than take your order. That may be fine, but most of the time you may not like what you bought.

It’s like going into a fancy restaurant where the menu is in French which can be a problem unless you are fluent in French. You think you are buying a plan that covers prescription drugs and will be accepted everywhere only to discover later that your medication and your doctor are not on the plan.

If everyone was in perfect health your job would be much easier. Unfortunately, most folks have some kind of ailment they are willing to dismiss as “nothing” only to find out the health insurance company feels it is a big deal.

Like the fellow I have been trying to help for the last 4 months. His medical bills and health insurance premiums combined ran almost $20,000 last year. Some of those expenses are extraordinary and won’t repeat, but he needs help.

Instead of taking my advice he calls to let me know he is going with Kaiser and wants to see prices on coverage for his wife and son.

I got news for him.

Kaiser won’t take him.

Neither will Aetna, Blue Cross, or Cigna.

I don’t even have to run numbers or make application. I just know how each of these health insurance companies will view his application.

Finding affordable Georgia health insurance can be challenging, but it is not difficult when you know where to look and how the game it played.

Anthem/Wellpoint, parent of Blue Cross of Georgia, has been in the news over rescinding policies of women with breast cancer. The Reuters article made it appear as if Anthem/Wellpoint had a top secret computer program that was designed to target women who were diagnosed with breast cancer and capriciously cancel these policies.

The logic was as flawed as the reporting which led Reuters to issue a correction. The corrected article was in response to this notice issued by Anthem/Wellpoint explaining the facts.

Rescission (the cancelling of health insurance policies) is not widespread with Blue Cross or any health insurance company. All policies, not just health insurance, have provisions that allow them to deny a claim or cancel a policy if there is proof positive the applicant has lied on the application or misrepresented the facts with regard to their health.

As someone with more than 35 years in the health insurance industry, I can tell you that most people give honest responses to health questions on the application. But I also talk to those who are looking for ways to hide medical conditions in an attempt to obtain coverage. They will say things like, “If I don’t tell the insurance company (about my condition) how will they know?”.

Or sometimes it comes in the form of “I have not been diagnosed with anything so it isn’t a pre-existing condition”.

Both of these approaches will create problems down the road for the applicant and any agent that assists them in filing a fraudulent application.

In all my years I have only had one policy rescinded. The individual who applied for coverage lied about a medical condition and hid the fact they had been treated before applying for coverage. They lied to me, they lied to the health insurance company.

If you are looking for affordable Georgia health insurance we are here to help you find a plan that fits your needs and budget.

If you need health insurance in Georgia but think you can’t afford it, chances are you are not looking at the right coverage. You are not alone. Many people have never bought health insurance before and don’t know how to look for the right plan. If they had health insurance from an employer they think they need to replace it with a plan that is similar.

Truth is, your group health insurance plan through an employer was subsidized. You paid a portion of the premium and your employer paid the rest. In some cases, employees pay less than 20% of the premium while their employer pays the other 80%.

Group health insurance plans have a lot of bells and whistles that most people never or rarely use but they boost the premium by a lot. I tell clients to look at their car insurance policies. Auto insurance doesn’t have copays for tires, brakes and oil changes so why does a health insurance policy have copays for routine things?

Because someone convinced employers they need to have these things in a “good” plan.

Copays add 15 – 20% to the premium and deliver almost no benefit. Similarly, most people think they need a low deductible even though they rarely (if ever) hit their $1000 – $1500 deductible on the group health plan.

You can easily cut your premium by 40% or more by choosing wisely when shopping for health insurance policies.

Georgia Insurance Shop has many affordable health insurance plans for individuals and families in Atlanta and the rest of the state.

If you want to know what the future for health insurance in Georgia holds, you need look no further than Maine. Health care reform has been passed in Washington and those seeking affordable health insurance in Georgia will be disappointed at the new Obamacare plans.

We don’t need a test tube to predict the future. All we need do is look at states that already have a form of Obamacare. States like New York, Vermont, Massachusetts and Maine . . .

Even though we have discussed the battle of rates in Massachusetts in the past, there is a similar war going on on Maine between the DOI and Anthem Blue Cross.

While many know Maine for their lobsters, that tiny state is also the home of high health insurance rates. It has nothing to do with the climate but rather the state legislature that decided years ago they wanted to make health insurance available to anyone, regardless of any pre-existing medical condition.

So they proceeded to place restrictive mandates on plans that could be offered to the populace.

The result was a mass exodus of carriers which essentially left the market pretty much to Anthem Blue Cross and a handful of HMO’s.

Premium rates shot up almost overnight and the number of plans available to consumers dropped dramatically to only a handful of plans.

Does any of this sound familiar?

To counter rising premiums the state created Dirigo which has since gone bust a couple of times due to lack of taxpayer funding. The idea of Dirigo was to provide a taxpayer subsidized plan to help pay for coverage for the states 130,000 without insurance.

Currently there are only 8300 on the plan and it is closed to new applicants.

Care to guess why these type of plans never seem to work?

But back to Anthem vs. the Maine DOI . . .

A few months back, Blue Cross ask for a rate increase which was denied. The justification was, even though Blue Cross had slim margins on their individual major medical business in Maine, the parent company (that would be Anthem) made money so the requested increase was denied.

This is like telling Ford they have to keep selling Pinto’s, even though they lose money on every one, because as a whole the company made money.

Just because the government doesn’t have to bring in enough revenue to cover their marker doesn’t mean businesses can do likewise.

Blue protested and went to court. Here is what the courts have said.

The Maine Superior Court has affirmed a decision by state regulators to cut the increase in Anthem Blue Cross and Blue Shield of Maine’s rates for individual health plans from 18.1 percent to 10.9 percent.

Superior Court Chief Justice Thomas Humphrey said in a ruling Wednesday that Maine law does not “expressly entitle insurers to a mandated profit margin.’’

That was a silly ruling.

Of course companies (of any flavor) are not GUARANTEED a profit. All they want is a CHANCE to make a profit.

The company has not decided whether it will appeal the ruling.

“That said, we stand by our position that filed rates need to both cover the medical costs for our members and allow for an adequate risk margin to cover unanticipated costs,’’ said spokesman Christopher Dugan

Regardless of what happens, the consumer will lose.

Blue will agree to write business at the lower rate and be forced to take other action such as restricting benefits on new applicants, or they could pass on the rate hike on renewals but leave new business rates in compliance.

The other thing Blue can do is decide to leave the state. In that same vein they can stop offering individual major med business and concentrate on other lines (such as group) that is potentially more profitable.

Regardless of what Blue does, the consumer will ultimately lose.

This scenario will play out on a national scale as well as Obamacare rolls out. Georgia health insurance rates will likewise see the same problem the citizens have in Maine.

When you have an application for health insurance denied by Blue Cross of Georgia (or any other health insurance company), what do you do?

It depends.

Yesterday someone looking for health insurance in Georgia found my site, ran a quote with BCBSGA and applied online in less than 15 minutes. This morning I was notified their application was rejected by Blue Cross.

After reviewing the application it is very obvious why Blue made such a quick decision. There are some options available for now, and could be others by summer.

Health insurance companies are rejecting 40 – 50% of all applications. Once you are denied coverage it does not mean you cannot be accepted by a different carrier but you do need to be careful. The worst thing you can do is submit multiple applications to multiple health insurance companies.

Many people that have their application for health insurance rejected can find coverage if they know the rules of engagement. I have a good record of finding coverage for those who have health issues. When you know what the health insurance companies are looking for, and how each one underwrites, you have a leg up.

Shopping for Georgia health insurance can be frustrating, and even more so if you have applied for health insurance and had your application rejected. The thing to know is, it is possible to find affordable health insurance in Georgia and have your policy issued without a hitch if you know how to work the system in your favor.

If you are looking for health insurance in Georgia for your child(ren), now is the time to lock in rates. Starting in July, premiums for children’s health insurance will double or triple.

Georgia Insurance Shop offers health insurance for children from all the major health insurance companies.

Shop and compare children’s affordable health insurance now.