Author Archives

    Sherri Martin

    Posted on

    What is Open Enrollment?

    You may be hearing the term “open enrollment.” Toward the end of the calendar year, this term becomes especially relevant. So, what does it mean?

    Open enrollment is the period of time during which you can enroll in a health insurance plan. Depending on where you get your health insurance, this time period may or may not fall at the end of the year. Generally, it is the only time of year you can enroll in new coverage or change your existing coverage. Exceptions may be made in the case of life changes like marriage, divorce, or childbirth.

    If you get your insurance through the Affordable Care Act, you are buying insurance through the health exchange. When you hear the term Obamacare, it refers to this type of insurance. Open enrollment has just begun for Obamacare. To enroll in this health insurance for the 2018 calendar year, you must sign up between November 1, 2017 and December 15, 2017. You can do this through healthcare.gov or through your state marketplace.

    If you get your insurance through your employer, ask your employer when open enrollment is. You likely will have enrolled in the insurance plan when you started working for the company. After that, there is usually one month out of the year during which you can re-enroll for another year or make changes to your policy. Ask your employer, typically the human resources department, when the enrollment period is and what forms you will need to complete.

    Other health insurance options may not have specific open enrollment periods. For example, Medicaid and the Children’s Health Insurance Program, or CHIP, allow you to apply at any time.

    Enrollment for Medicare is based on age. You can enroll for Medicare at age 65 years. The enrollment period begins 3 months before your 65th birthday and ends 3 months after your 65th birthday.

    Although the fate of Obamacare is currently in question, as of this writing, open enrollment is open. If you plan to use this health insurance, be sure to sign up during open enrollment. The deadline is December 15.

    Do you want more guidance as you choose which health insurance plan is best for you and your family? Get my book Easy Healthcare: Choose Your Health Insurance. In it, I walk through everything you need to know, including what kinds of health plans may be available to you, what information you should gather before choosing a plan, and some of the terms you will want to know.

    Posted on

    How to Find Out if Your Doctor is “In Network”

    Are you switching health insurance plans? If so, one of the first things you will want to check is which physicians are “in network.” This is especially important if you have a particular physician or specialist that you see would prefer to continue with him or her rather than switching to a new doctor.

    Insurance plans often have preferred doctors and may refer to that list of physicians as in network. There may be a separate list of physicians that are out of network. Some health plans may refer to these levels with different terminology like Tier 1 and Tier 2. Whatever language is used, it’s important to pay attention to these lists, because the difference could impact your wallet.

    In network or preferred doctors are those that have accepted arrangements with your particular health insurance to be reimbursed for payment. These doctors generally have low, or sometimes no, copay and usually all or most of the work by that physician will be covered by your insurance.

    Out-of-network doctors do not have these same benefits. Be sure to carefully read what is covered for visits with out-of-network physicians. These visits may have higher copays, higher deductibles, and you may receive a bill for some or all of the costs. For example, a visit to an in-network primary care physician may have a $15 copay and the rest of the visit cost may be fully covered by insurance, meaning you don’t have to pay anything further. The same visit to an out-of-network primary care physician may have a $30 copay, and the insurance plan may only cover 80% of the cost of the visit, meaning you will get a bill for the other 20%. Out-of-network costs can really add up over time.

    So, how do you know if your favored doctor is in network? There are several ways you can find out. A good place to start is the health plan’s website. Most health plans have a “find a doctor” search tool. Search for your doctor there and see if they show up as in network (or preferred or Tier 1) or out of network.

    You can also call your doctor’s office directly and ask if your doctor participates in the health plan. They will be able to tell you if the doctor and facility are fully or partially covered.

    Once you have your answer, you’ll be able to make a decision about which insurance plan is right for you.

     

    Looking for tips on wellness? Pick up the Women’s Mind Body Wellness Summit. The summit contains 6 interviews from top female health professionals plus three videos from MyHealthSpin Founder Lori-Ann Rickard, as well as two bonus workout videos. Use promo code “BEWELL” to recieve 50% off!

    Posted on

    How is Hurricane Harvey Impacting Healthcare?

    Hurricane Harvey has caused extreme flooding in Houston, Texas – the nation’s fourth largest city – and it is wreaking havoc on healthcare and patients alike.

    What is it like for people trying to get healthcare there now? It’s tough all around. Here are some of the conditions Houston and other flood-damaged areas are dealing with.

    Physicians have waded miles to get to their clinics and to hospitals.

    Patients in need of regular treatments, such as kidney-dialysis, have had trouble getting treatment because roads are not drive-able and ambulances are often unable to reach patients.

    Hospitals and clinics have been worried about their patients, physicians and staff.

    CHI St. Luke’s Health – The Vintage Hospital had to evacuate patients by boat last week, and other hospital evacuations were expected.

    Patients who were discharged from hospitals often had trouble getting home or had nowhere to go because many homes were flooded.

    Most outpatient procedures and elective surgeries were canceled, and hospitals had to deal with the issue of replenishing supplies.

    2,500 hospital workers at Texas Children’s Hospital stayed at the hospital, sleeping on cots, to be able to provide patient care. Texas Children’s also had to deal with leaks and burst pipes.

    The flooding continues to cause issues, and the damage will take a long time to repair, just as it did in New Orleans and other areas affected by Hurricane Katrina in 2005.

    Katrina left many citizens without access to health care, and changed the health system dramatically.

    One year after Katrina, the New Orleans metropolitan area had fewer than half of the hospital beds it had before the storm, and only about one-quarter of the physicians had returned. In addition, there were significantly fewer nursing homes one year after the storm.

    Other effects included patients losing health insurance because of lost jobs and hospitals losing federal funding. The loss of funding affected poorer residents who rely on it for health care, as well as hospital staff members who were laid off.

    Things had improved by 2015 – 10 years after the storm – according to research findings.

    But it is evident that these things take time. Health systems affected by Harvey may have a long road ahead of them to return to full services for their communities.