The healthcare reform bills passed by committees in the House of Representatives and the Senate have significant differences. These variations will have to be hammered out before a final bill is presented to both chambers in Congress. In general, the House’s bill is more comprehensive and allows for greater public involvement in providing Americans with health insurance. Interest groups are vying for benefits in the bill, which will no doubt see budget cuts before it comes up for a general vote. Unfortunately, older Americans appear to suffer in both bills, due to proposed insurance regulations that will allow insurance companies to charge higher rates based on age. Many baby boomers are in this precarious age group: too young for Medicare, disproportionately suffering from layoffs in this terrible economy (therefore losing their employer’s insurance), and often having pre-existing conditions that may prevent them from buying individual health insurance at all. Still, which version of healthcare reform passes will be of great consequence to older individuals.Currently, insurance companies are not limited in how much they charge older people when underwriting policies. In that regard, either reform bill could be considered an improvement. Insurers would be allowed a 2-to-1 ratio in health insurance rates under the bill that passed the Education and Labor and Ways and Means committees in the House. This means that they can charge a middle-aged person up to twice as much as a younger person in similar health. The Senate Finance and Health Committees’ bill would allow insurance companies to charge up to four times as much to insure an older individual. Lobbyists for the insurance industry claim that even the Senate’s looser regulations will hurt their profit margins and raise premiums across the board. Trade group America’s Health Insurance Plans is promoting a 5-to-1 ratio, and some studies back that up. Those experts claim that insurers could justify charging older, higher-risk patients up to seven times as much as a younger, higher risk patient. On average, older individuals do tend to use more health care services, get sick more often, and are more likely suffer from chronic conditions.Even if they work for an employer that offers health insurance, middle-aged individuals will still pay higher health insurance rates. Estimates vary, but anywhere from 40% to 83% of Americans in private sector jobs work in small businesses. Companies employing a majority of older workers can pay 10-20% more to provide health insurance, passing the costs onto their employees. There is often a reason for this; insurers such as Blue Cross Blue Shield have found that medical claims increase by up to 2% for each year older a person gets. Since private insurers prefer to pay as few claims as possible, workforces with higher average ages (mid 40s or older) are less attractive markets. This problem compounds for small businesses, according to NPR. Unlike larger companies, businesses with under 1,000 employees don’t have enough historical claim data available for insurance companies to make a fairer judgment. Age (and gender) become the determinants of insurance premiums as a result. Neither the House nor the Senate bill address this issue.Why does there seem to be congressional agreement on allowing age discrimination in the health insurance market? One of the main priorities of this administration is to expand health care coverage to as many Americans as possible. Despite the above disadvantages in acquiring insurance, only 12.5% of 55-to-64 year olds lack health insurance. While that’s a significant figure, it pales in comparison to the 30% of 19-to-24 year olds who are uninsured. Putting too much of the cost burden on young adults could make them even less likely to buy student health insurance. On the other hand, more middle-aged individuals have a family and household to support; if premiums become too high, they may have to cut back on other necessities. Even though charging older people significantly more for health insurance is touted as an unfortunate side effect of insuring more Americans, the Congressional Budget Office found that the House measure (with stricter regulations on age discrimination in the market) has the potential to insure 97% of the country, versus the 94% that would be insured by the Senate’s plan.There are many changes ahead for healthcare reform; both houses of Congress need to combine their bills into one that will be presented to the entire House and Senate. No doubt that there will be tons of debate and amendments when that time comes. Democratic Senator John Kerry is one congressperson against these provisions; he was quoted in the Miami Herald saying that “allowing insurers to charge older Americans vastly higher premiums”â”ÂÂwhen they are equally healthyâ”ÂÂ”simply because of their age is discrimination, pure and simple”. As expected, senior citizens’ advocacy groups also oppose these measures and plans to lobby against them. No matter what happens, it is unwise for baby boomers to drop their health insurance. Premiums may or may not decrease for older Americans, but suffering a serious medical catastrophe while uninsured could cost even more.
Anthem Blue Cross Life and Health Insurance Company is responding to the national health care crisis by offering two new affordable health insurance plans for California residents. The two new plans will be rolled out in early 2010, providing low-cost health insurance alternatives for the many Californians who either don’t have health insurance or who have health insurance plans that they are struggling to afford.The first of Anthem’s new health plans – CoreGuard – will become available on January 1, 2010. CoreGuard is a PPO plan that provides tax deductible options and prescription drug coverage. Most importantly for many California residents: the monthly premiums for CoreGuard will start at “prices to meet just about every budget,” noted one California insurance agent.As an example of the low-cost rates for the CoreGuard plan, the monthly premium for a male under the age of 40 is expected to be about $75 per month. However, as with most healthcare plans, participants will need to meet a deductible in order to receive coverage. Participants can select from a wide range of annual deductible amount and rate combinations to select the one that best for their budgets and healthcare needs.The second of Anthem’s new affordable California health plans is ClearProtection. ClearProtection will launch on February 1, 2010 and is designed to provide a wide range of benefits, but still offer first-dollar coverage. A male under the age of 40 will have a monthly deductible of about $69. ClearProtection is being touted as the PPO health plan with the lowest rates of all of the Anthem PPO health plans.Blue Cross of California has one of the largest networks of healthcare providers throughout the state of California, which includes more than 50,000 doctors and almost 400 hospitals accepting PPO insurance. Anthem’s health insurance plans also travel with participants across the country, helping to ensure that even if California plan holders leave the state, they will still be covered.In addition to the basic healthcare coverage provided by these two new Anthem PPO plans, participants can also select from optional coverage for healthcare needs such as dental and term life.Anthem’s NextRX delivers prescription medications to California residents through the mailThe two new health insurance programs from Anthem may be the newest additions to Anthem’s health care program line-up, but they fall into line with a whole host of helpful healthcare services offered to California residents by Anthem.The NextRX program is Anthem’s preferred mail service pharmacy, which is available to Anthem members who taken maintenance medications on a regular basis. Many of the medications that qualify as maintenance medications include drugs that are used to treat heart disease, diabetes, depression, allergies, and even oral contraceptives.When California residents enroll in the NextRX program by December 31, 2009, Anthem will waive the first co-pay for each generic prescription that participants transfer to NextRX.Anthem also offers state health programsIn addition to the two new affordable health insurance plans offered by Anthem for California residents, Anthem also offers California state health programs, including Medi-Cal, Healthy Families, MRMIP, AIM, CMSP, and Telemedicine. Here’s an overview of each of these different California healthcare programs:Medi-Cal is California’s Medicaid Program, which is available at no cost for individuals and families who meet certain low-income or other qualifications.The Healthy Families Program is a low-cost managed care coverage program for children who live in households with financial situations that make them ineligible for the Medi-Cal Program.The MRMIP program (California Major Risk Medical Insurance Program) is a health insurance plan that is available for Californians who cannot obtain health coverage in the individual health insurance market.AIM is the low-cost manage care coverage available for infants and their mothers who have family incomes too high for Medi-Cal coverage.CMSP is a program that provides medical, dental, and vision services for eligible low-income adults who live primarily in one of 34 rural communities who are also not eligible for the Medi-Cal program.Finally, the Anthem Blue Cross Telemedicine Program provides access to specialized healthcare for rural Californians.For more information about Anthem’s CoreGuard and ClearProtection PPO health insurance plans, consumers should speak with a health insurance specialist who can explain the specific details of each different coverage option and type of plan. Also, in addition to Anthem’s health plans, California residents can select their insurance plans from a wide variety of other insurance carriers that service the state. A California insurance specialist can help California residents to sift through all of the available insurance options to find the right plan for their specific healthcare needs.
Congress is scrutinizing Health Insurance for California by challenging the reasons that prevent many people from obtaining health care coverage. When the largest health insurance company in the U.S. (WellPoint, Inc.) proposed raising monthly premiums by up to 39 percent in California, Congress summoned WellPoint chief executives. WellPoint postponed its premium increases until May 1st 2010, and California’s insurance commissioner will decide whether to allow the increases.In short order, Congress expanded investigation of Health Insurance in California to look at coverage being refused and medical claims being denied as “preexisting conditions.” Chief executives from three more of the country’s largest for-profit health insurers (Aetna, Humana, and UnitedHealth Group) were summoned to appear before the House Committee on Energy and Commerce and its investigations subcommittee on March 23rd.Congress asked the companies to provide internal documents and e-mails about guidelines, practices, and underwriting policies for the last five years. These companies have been asked to show average premiums and increases, as well as maternity coverage for individuals by March 12th. These four companies sell health insurance policies for individuals to approximately 17 million Americans without health coverage from work.Need for Maternity Coverage in California Health Insurance PlansLooking at maternity coverage is important because woman ages 18 to 29 are the most likely group in the U.S. to lack health insurance. With just 59 percent of these women having health insurance through an employer, these young women comprise the group that is least likely to have health insurance from work. One-fourth of these women have no health insurance at all, yet 3.5 million pregnancies occur among the 21 million women who are ages 19 to 29 each year.As in third-world countries, lack of health care hits babies the hardest. Uninsured pregnant women are 60 percent more apt to delay prenatal care, three times more likely to suffer adverse outcomes, and their babies are 30 percent more likely to die.Lower California Health Insurance Rates Found by Independent AgentsPremiums and benefits vary greatly between insurance companies. Even insurance companies that are raising premiums, may have alternative plans with higher deductibles and lower premiums.Look for Websites that compare plans and offer quotes from a range of companies to get a feel for benefits and prices. Independent agents (those who work with many different insurance companies) may know which insurers have more lenient underwriting for people with back problems, for instance. Independent agents can also appeal if you are denied coverage, or are assessed a higher rate because you have pre-existing conditions.Compare California Health Insurance Plans to Get the Most for Your MoneyWhen comparing policies look at the annual deductible, the percentage you pay for a medical service after a deductible is met (coinsurance), and the annual out-of-pocket maximum. That maximum is how much you have to spend on co-pays, coinsurance, and other costs before the insurance company covers any expenses for the year.Check whether doctor visits are covered, and whether hospital stays have limited coverage. Look at which doctors and hospitals are in-network, too. Some individual plans exclude maternity coverage, but separate policies deal specifically with maternity and prenatal care.If you aren’t taking prescription drugs, you can save by eliminating that coverage. If you are using prescription medications, research the cost of buying through discount drug programs at King Soopers, Wal-Mart, or other large chains.Be careful about letting coverage lapse while you’re looking for a better policy. Events during a coverage lapse might make you ineligible for coverage. For example, insurance companies may not cover birth or prenatal care if there has been a gap in coverage.More Help for Maternal and Child ServicesMaternal and child services are also available for women with low incomes who are pregnant, and have children under the age of 22. A program called Women, Infants and Children (WIC) provides education about nutrition and child care for woman with low incomes, woman who are breastfeeding, and postpartum women. WIC also provides health coverage for children under five.Even if you do not qualify for the above programs, you may still have access to care through free clinics, prescription drug assistance plans, or temporary state insurance. Your best bet may be to educate yourself about how health care insurance works, and find an independent agent that will take the time to listen to your needs and help you navigate the insurance jungle.