Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts

Monday, May 9, 2016

Health Insurance Glossary: 10 Terms to Know


Since the Affordable Care Act (ACA or ObamaCare) went into effect, the uninsured rate in the United States has reached record lows. But, there is still great confusion when it comes to health insurance information. Many Americans can’t even define basic health insurance terminology if prompted. A recent study in the state of Texas found:
  • 25% of respondents, regardless of insurance status, lack confidence in understanding basic health insurance terms like “deductible,” “premium,” and “copayment”
  • 40% of respondents with an individual plan expressed lack of confidence in understanding “co-insurance” and “maximum out-of-pocket expenses”
  • More than 33% of respondents with an individual plan said they were confused by what counts toward a deductible and what health services were covered under their plan

We get it – health insurance terminology is tricky, but understanding the language will bring you one step closer to better managing your health and maximizing your insurance plan. To help, FamilyWize has compiled a list of the top 10 terms you need to know when it comes to health insurance. Bookmark this post for future use, and be sure to share it with family and friends!

People and Organizations Involved in Your Plan

  • Dependent: Any individual, either spouse or child, that is covered by the primary insured member’s plan.
  • Network: The group of doctors, hospitals, and other healthcare providers that insurance companies contract with to provide services at discounted rates. You will generally pay less for services received from providers in your network. You can usually check which providers are in your network on your insurance company’s website or by calling. You can also call your provider and ask!

Fees and Costs Associated with Your Plan

  • Co-pay: The flat fee you pay for certain medical expenses. Example: You pay a fee of $10 for every doctor visit, but then the insurance company pays the rest.
  • Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance in addition to any deductibles you owe. (For example, if your plan’s allowed amount for an office visit is $100, and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.)
  • Deductible: The dollar amount (example: $1,000) you pay each year, after which insurance protection begins. You pay expenses up to the deductible amount and then the insurance company pays the remainder, up to the policy limit (Example: $50,000). Some plans pay for certain healthcare services before you’ve met your deductible.
  • Premium: The payment you provide to the insurance company in exchange for insurance coverage. In some cases, your employer may cover this expense (or part of it).
  • Maximum Out-of-Pocket Expenses: The most money you will pay during a year for coverage. This includes deductibles, co-pays, and coinsurance, but is in addition to your regular premiums. Beyond this amount, the insurance company will pay all expenses for the remainder of the year.
  • Cost for Choosing Out-of-Network Services: A doctor, hospital or pharmacy that is not part of your health plan's network of preferred providers. You will generally pay more for services received from out-of-network providers.

Affordable Care Act 

  • Affordable Care Act (ACA; ObamaCare): Signed into law by President Barack Obama on March 23, 2010, the ACA was enacted to increase the quality and affordability of health insurance, lower the amount of uninsured individuals by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and for the government.
  • Preventive Care Services: Services like vaccinations and other key screenings that are required by the Affordable Care Act (ACA) and are offered at no cost to you through private insurance plans. 
For a complete list of insurance-related terms, refer to the Centers for Medicare and Medicaid’s full glossary.

FamilyWize is here to help you better navigate the complicated and ever-changing healthcare marketplace. Our free prescription discount card is available for everyone to use – whether you are insured, underinsured or uninsured. Remember to always carry the card with you (or download our free app), and present it to the pharmacist each time, to ensure you receive the lowest price possible on your medications.

Tuesday, October 6, 2015

Drugs & Diabetes: Six Cost-Saving Strategies


According to the CDC, diabetes is the seventh leading cause of death in the United States, with more than 600,000 deaths annually. It also creates high health costs for many families, with sources estimating the national cost of diabetes at over $132 billion a year. If you suffer from diabetes, these six tips can help you ease those costs and stay healthy.
Tip #1: Use mail-order services for prescription discounts
Under Obamacare, Medicare now has a National Mail-Order Program, which can save you quite a bit on lancets, test strips, batteries, and other common diabetes supplies. Plus, it’s all delivered straight to your door, which can save you time and gas.
Tip #2: Use Obamacare’s free preventative care options
Most of the plans under the Affordable Care Act (ACA) are required to provide free preventive care services, which would include screening for diabetes if you’re an adult with high blood pressure or if you’re pregnant. Though the coverage rules vary by state, ACA’s free preventive care also includes medical nutrition therapy for those with diabetes.
Tip #3: Use your FSA
If your employer offers benefit plans with a Flexible Spending Account (FSA), you can save substantially – up to 30% – on your out-of-pocket medical expenses.

The way a Flexible Spending Account works is by letting you set aside pre-tax money from your salary to put towards expected medical expenses. By doing this, you effectively reduce your taxable income. You can then use the money you set aside to cover many medical expenses not covered by your health plan, such as copays and over-the-counter medications.
Tip #4: Use a free discount prescription card
You can save an average of 42% on your prescriptions by using the free FamilyWize Prescription Savings Card or the FamilyWize smartphone app.  To download the app, follow these links to the Apple App StoreGoogle Play, or the Windows Store. Last year, the FamilyWize card saved over $175 million on prescriptions!
Tip #5: Take advantage of other discounts via coupons and rebates
There are many things you can do as part of your regular shopping routine to save money. For example:
  • Watch the weekly ad flyers or coupon books coming to you in the mail from your drug store.
  • Keep an eye on your area drugstores’ websites for digital coupons you can print or save on your phone.
  • Ask if your pharmacy has a loyalty program. A higher volume customer, such as a person with diabetes, can often get frequent discounts on general merchandise or even prescription medications.
Tip #6: Go generic
Buying generic (unbranded) versions of drugs can reduce your cost of diabetes care, sometimes significantly.  Read more on the cost advantages of buying generic drugs at WebMD.

The most important thing: Do not let limited funds keep you from your necessary diabetes drugs.  According to a 2004 University of Michigan study, 11 percent of diabetes patients skip diabetes medication doses because of the high cost. Inevitably (as confirmed by other studies), this worsens blood sugar control. By using the tips provided here, you can help ensure you're leading a savings-smart, healthy life.

Ric Moxley
Contributing Writer

Thursday, September 10, 2015

The Donut Hole is Real

If you're covered under Medicare Part D, the “donut hole” is real, and can dramatically affect the cost of your prescriptions. Here’s how and why.

What is the Medicare donut hole?

The "donut hole" is a coverage gap in certain Medicare prescription drug plans. This gap is a temporary limit on what the plan will cover.

As part of the Affordable Care Act, the health insurance program Medicare gives qualified recipients (people 65 or older, people under 65 with certain disabilities, and a few others) the option of paying a monthly premium for outpatient prescription drug coverage. This section is called Medicare Part D.

With Medicare Part D, you pay a monthly premium, plus the full price of your medication until you reach the $310 deductible amount. After meeting this deductible, you pay 25 percent of your prescription drug costs, until the total spending between you and your plan reaches a certain limit ($2,960 in 2015, or $3,310 in 2016).

After you hit this limit, the coverage gap, or “donut hole,” begins. You are now responsible for 45 percent of the cost of covered brand-name prescription drugs until you reach the yearly out-of-pocket spending limit (which differs from year to year), after which coverage kicks back in.

Reducing the wallet impact of the donut hole

If you're looking to save during the coverage gap, switching over to generics could be a good option. Medicare pays 35 percent of the price for generic drugs during the coverage gap, as opposed to 45 percent for brand-name. More good news: the percentage you pay for generics during the coverage gap will decrease each year until it reaches 25 percent in 2020.

However, even with these discounts on generics, the Medicare “donut hole” can make it hard for senior citizens without any supplemental plan to pay for their prescriptions. This is a good reason to look into the FamilyWize Prescription Savings Card. It’s free to obtain and use, and gives you discounts on prescriptions, whether you're insured or uninsured. There’s no registration required, and using the card when buying prescription drugs can save you up to 75 percent.

Just show the FamilyWize card to your pharmacist the next time you pick up a prescription, and ask them to compare the discount offered by the card to the discount offered by your insurance. In many cases, the FamilyWize price is often the better deal. You can also check the price and compare before picking up by using our Drug Price Lookup tool, available on our website or through the smartphone app (just search "FamilyWize" on your smartphone's app store).

You can also check to see if you qualify for Medicare’s Extra Help options for paying Part D, which prevents you from entering the coverage gap. Also, check out the Medicare website’s Part D section for further information on the donut hole gap, with scenarios to help explain it.

Ric Moxley
Contributing Writer