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Applying for health insurance doesn’t have to be confusing. Here’s a handy glossary

General Information

Applying for health insurance doesn’t have to be confusing. Here’s a handy glossary

The first piece of advice is this: Don’t do an online search for “I need health insurance” and expect the internet to help you out. That’s an easy way to end up on sketchy websites or bombarded with ads and phone calls. Instead, figure out where to go — based on your age, job, income — and go straight there to find a plan.

Medicare: If you’re 65 or older, you’re eligible for Medicare. It’s a federally run program — the government pays for your health care. You might also be eligible even if you’re not yet 65 if you have certain disabilities or conditions like kidney failure.

Medicaid: Medicaid is a health insurance program for people with low incomes, and others with certain disabilities. It covers around 80 million people — nearly one in four Americans. It’s funded by both the federal and state governments but run by the state, so whether you’re eligible depends on which state you live in. You can apply for Medicaid coverage at any time, all year round, and Healthcare.gov will help you figure out if you qualify and where to apply in your state.

CHIP: CHIP stands for Children’s Health Insurance Program and provides affordable coverage for kids in low-income families. In some states, it’s part of the state’s Medicaid program, and in some states, it’s a standalone program. Children might be eligible for CHIP even if their parents don’t qualify for Medicaid. Routine doctor and dental checkups are free under CHIP. Like Medicaid, you can apply for coverage any time, all year round. Look here to find out what CHIP and Medicaid are called in your state, and find how to apply at Healthcare.gov.

Employer: Almost half of all Americans get their health insurance as a benefit through their job. These are private group health insurance plans, and your employer usually pays most of your monthly premium.

Affordable Care Act Marketplaces: For practically everyone else, the place to go is Healthcare.gov, where you can shop for insurance in the marketplaces created by the Affordable Care Act. If you hear “health insurance marketplace” or “insurance exchange” or “Obamacare insurance” — they’re all the same thing. They refer to the online shopping tools you can use at the federal marketplace website, Healthcare.gov, or through one set up and operated by state. Some states run their marketplaces, like Your Health Idaho or DC Health Link. (If you live in one of these states, not to fear, starting at Healthcare.gov will still get you the right place.) The number of plans you have to choose from and how expensive they are will vary a lot, depending on your income and where you live.

Other options: If you’re a veteran, you can get health coverage through the Veterans Health Administration. If you are a tribal member, you may have options through the Indian Health Service. If you’re in college, you can choose from student health plans (though be careful — health plans based at the college are usually quite limited) or you can stay on your parents’ plan as long as you’re not 26 or older.

And if you’ve lost a job that offered you health insurance, you may be able to keep your old plan through COBRA, although you’ll be paying a much higher premium since your company won’t be chipping in (if you’re eligible, you should get information from your insurer or employer on how to sign up).

Not all plans are created equal. Some plans are more flexible than others, and some plans look like great deals but are actually skimpy.

HMO or Health Maintenance Organization: An HMO tends to have a strict network of doctors and other health care providers — if you see a provider in the network, you’re good, but if you go outside of the network, the costs are all on you, except in certain emergency situations.

PPO or Preferred Provider Organization: A PPO still has a network of providers, but if you see out-of-network providers, your insurance will still cover some of the costs.

Short-term or “Limited Duration” plans: You have to be super careful about this. Some of the health insurance plans people might try to sell you are “short term” or “skinny” plans. They might seem very appealing because they’re cheap, but they also might not cover some basic things like prescription drugs and annual checkups. That’s why a lot of experts warn that — beyond use for a few weeks or months between school and a job, for instance — they’re not a very good deal.

To compare plans and figure out which one might work best for you, you need to learn your health insurance vocab. Otherwise, it’s just a smorgasbord of (nerve-wracking-ly high) dollar figures.

Premium: The premium is the amount you pay every month. It’s just like your internet subscription or any other bill — pretty straightforward. If you’re buying insurance on Healthcare.gov, you might get discounts on your premium costs, depending on your income, where you live, and who’s in your household, so always shop for plans after you’ve entered that information. Millions of uninsured people qualify for zero-dollar premium plans — and even more people qualify for plans with premiums of $10 or less per month.

Cost-sharing: “Cost-sharing” is an umbrella term — it’s your share of the costs for health care services you receive. It comes in several forms: the deductible, co-payments, and coinsurance. While you pay your premium every month no matter what, these other payments only come into play when you pick up a prescription or see a doctor or other provider, or have some sort of exam or procedure done.”

Deductible: Your deductible is a threshold — it’s the amount of money that you have to spend on health services before your insurance starts paying. At the beginning of every year, your deductible resets to zero, so the first appointments and prescriptions you pick up in the year might seem extra expensive because you haven’t hit your deductible yet. Your insurance company is waiting, and when you hit that magic number, it’ll sit up and start kicking in.

Copayment and Coinsurance After you hit your deductible, you’ll likely still have some costs when you go to the doctor, in the form of a copayment (a fixed amount) or coinsurance (your percentage of the total cost).

Out-of-pocket maximum All this cost-sharing does have a limit. If you end up using a lot of health insurance in a single year, you might hit your out-of-pocket maximum, which is the most you’ll ever have to pay on covered health services in a given year. It’s the threshold above the deductible — if you hit it, you’ll have no copays or coinsurance — your insurance will pay 100% of the cost of all covered health services for the rest of that calendar year.

If you have a lot of options and need to narrow it down, think about what’s predictable about your health to guide you — for instance, the particular doctors or specialists you want to see, prescriptions you know you’ll be picking up, and ongoing conditions you need to manage. If you need dental or vision care, check to see if your plan includes those things or if you’ll have to buy that sort of insurance separately.

Also — rest assured that any health plan you pick through work or the federal or state marketplaces set up through the Affordable Care Act will cover the ACA’s 10 essential benefits — such as free preventive care and hospital coverage.

Basic or catastrophic: If you’re pretty healthy — no chronic medical conditions, or need to take pricey prescription drugs — a basic plan might be all you need. It’ll provide financial protection if you get a serious diagnosis or get into an accident, and you’ll otherwise only need to worry about — hopefully affordable — premiums. Under the “metal categories” on Healthcare.gov, these are the bronze plans.

Medium coverage: If you do have specialists you know you need to see or other ongoing health issues, you might want to look at the plans that may have higher premiums, but offer more coverage. On Healthcare.gov you can enter the names of your prescriptions or doctors you know you’ll need to see to filter out plans that don’t include those medicines or people. These are the silver plans on the marketplaces, and they sometimes come with extra discounts. If you’re getting a plan through work or elsewhere and you can’t easily filter plan options, you can always call the insurance company and ask: “Is my doctor (or preferred hospital or other health care provider) in-network for this plan?” “Is my medicine on the plan’s formulary (the list of medications an insurance plan will cover)?”

Comprehensive coverage: Say you have a bigger budget for monthly premiums and you want to pay more every month to have access to more flexibility and lower copays — a comprehensive plan might be your best bet. These are gold or platinum plans on Healthcare.gov. You can use the same tips to make sure the plans will cover what you need — filter for your regular doctors or prescriptions, or — when in doubt — call the insurance company and make sure the plan you’re considering will be there when you need it.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 

 
October 29, 2021
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Bridging Technology Gaps to Drive Healthcare Interoperability

General Information

 

Bridging Technology Gaps to Drive Healthcare Interoperability

The conversation about interoperability tends to focus on new and emerging standards and technologies as the future of health data exchange, but what becomes of healthcare organizations unable to implement the latest and greatest solutions?

For interoperability to move forward and have widespread impact on the healthcare industry, existing and emerging modes of information sharing must be able to connect and support an ecosystem that enables healthcare IT systems of many types to participate in robust health

data exchange.

Through a product-agnostic approach, once the ever-shifting interoperability challenge is solved, healthcare organizations can then move on to the task of structuring data irrespective of its point of entry and allowing for the application of powerful technologies that help deliver actionable information to the point of care. But to get this far, stakeholders must first bridge the gap between established and brand-new methods for transmitting protected health information and other data.

Backward compatibility is essential to advancing interoperability considering that numerous solutions and protocols enable health data exchange today. The push from federal officials to increasingly employ Fast Healthcare Interoperability Resources (FHIR) to view, transmit, and download health information is the right path, but much of the industry still relies on their existing technologies and protocols to ensure that pertinent health information is available to providers at the point of care. This cannot be ignored.

Cloud fax may lack the flashiness of FHIR and other recent standards, but it is just as effective and can be made even more so by creating a digital ecosystem that transforms data sent using fax protocols into structured information digestible by the receiver’s system of choice.

In a highly regulated industry such as healthcare where regulators are pushing healthcare organizations to improve information sharing while complying with HIPAA and HITECH, a proven and affordable transport mechanism checks all the boxes. And what distinguishes cloud fax from traditional fax technology is the former truly digital nature.

Its digital capabilities aside, cloud fax is especially adept at accommodating paper-based workflows, which are still a common occurrence in healthcare despite protests calling for the industry to axe the fax machine, but cloud fax can even take things a step further once paper becomes digitized.

By creating a digital ecosystem for interoperability and health data exchange, innovators are then able to apply powerful technologies such as artificial intelligence, machine learning and natural language processing to give structure to information no matter where it originates. The future of interoperability is now.

For the healthcare industry to enter the next phase of interoperability, it must first come to terms with how data becomes actionable information in the hands of providers, payers, and patients. Doing so begins by getting documents into a digital environment where artificial intelligence and automation can do the heavy lifting behind the scenes that not only securely delivers information from one system to another but also gives structure to data that is immediately available and usable by the receiver. In other words, the receiver can then extract the data required to quickly make decisions that can save money, time, and even improve health outcomes.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 28, 2021
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Why Your Clients’ College-Age Children Need Health Care Directives

General Information

 

Why Your Clients’ College-Age Children Need Health Care Directives

As we head into the Great Wealth Transfer of $68 trillion being transitioned from older generations to younger generations, financial advisors have an opportunity to bridge generational gaps and seamlessly work with their clients’ families.

One way to begin financial planning conversations with the younger generations is for financial advisors to connect with their existing client base and encourage parents of college students to put health care documents in place for their children.

Having college students put their core health care documents in place is an excellent way to help protect them in an emergency, as well as to begin the broader conversation of managing their personal finances and health as young adults.

With winter break on the way, now is a great time to begin this conversation with your clients and encourage them to talk to their children about providing them with a health care directive, HIPAA authorization form, copies of all health-related insurance cards and an emergency contact plan.

A health care directive is a core estate planning document that financial advisors should encourage their clients and their college-age students to put in place. This document makes a college student’s wishes known to family members and doctors in the event that they are incapacitated and unable to communicate their decisions. They also can nominate a health care agent to make heath care decisions for them if they are incapacitated.

The value-add to clients is that they can make sure their college student is protected during an unexpected medical emergency and that the student will have their loved ones make decisions for them.

As soon as your clients’ children reach 18 years of age, the only way your clients can be provided health information and make decisions for their children in the event of a health crisis without a court order is if they are the named agent in their child’s health care directive.

When talking with young adults about a health care directive, it is important to highlight for them that they are in control of their own health care decisions as long as they can communicate them. Their health care directive is only “active” if they are incapacitated and are not able to communicate their own health care decisions.

Since every individual has their own values and goals for their health, and state laws vary across the country, there is no one size fits all approach for health care directives. It is vital to connect your clients with a trusted estate planning attorney who can make sure that the health care directives for their children are tailored to comply with the laws of the state in which the student is studying.

October 27, 2021
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What’s the best booster to get? And other questions about Covid-19 boosters

News

 

What’s the best booster to get? And other questions about Covid-19 boosters

The US Centers for Disease Control and Prevention has weighed in with the latest word on booster vaccines and drugstores have already started advertising their supply.

Any of the three authorized vaccines in the US — Pfizer/BioNTech’s, Moderna’s or the Johnson & Johnson Janssen vaccine — may be used for a booster dose for eligible people.

There are not any booster police, but the CDC and the US Food and Drug Administration have set some eligibility requirements around who should be seeking booster shots.

People who got a Pfizer or Moderna series of two shots six months ago or longer may consider getting a booster if they are also:

  • 65 or older.

  • At risk of severe Covid-19 from a breakthrough infection because of a medical condition such as diabetes, kidney disease or pregnancy.

  • At risk because of living conditions or work, so people who work in healthcare, frontline healthcare workers, people living in shelters or incarcerated people.

Moderna’s vaccine is given as a half dose for boosters; Pfizer’s is given as a full dose.

Anyone who got a Johnson & Johnson shot two months ago or longer is eligible two months after getting the first shot. That’s because the vaccine doesn’t provide as much protection as the other two do, and studies show a booster brings protection up to levels of more than 90%.

Federal health officials made a point of urging pregnant women to get a booster.

There’s no reason to wait if you are eligible. The booster can be administered along with other shots, such as flu shots or shingles, pneumococcal or other vaccines.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 26, 2021
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CDC endorses booster doses of Moderna and Johnson & Johnson vaccines, says mix and match is fine

News

 

CDC endorses booster doses of Moderna and Johnson & Johnson vaccines, says mix and match is fine

US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky endorsed recommendations for booster doses for Moderna’s and Johnson & Johnson’s coronavirus vaccines Thursday, allowing millions more Americans to begin getting booster shots.

The CDC re-aligned its recommendation for the existing recommendation for Pfizer boosters, placing Moderna’s and Pfizer’s boosters in the same category.

The CDC’s Advisory Committee for Immunization Practices had just hours earlier voted to accept the US Food and Drug Administration emergency use authorizations for each vaccine — after considerable discussion about whether such broad authorization was needed for Moderna’s.

Members agreed that people who got Johnson & Johnson’s vaccine need a second vaccination, as that vaccine is less effective than Moderna’s and Pfizer’s in preventing infection.

The pace of Americans getting booster doses is higher than the rate of those being vaccinated for the first time. CDC officials and others have made it clear the best way to reduce the spread of the coronavirus is to get more people vaccinated in the first place.

CDC officials said they’d issue more guidance on boosters in an upcoming report.

They said that young women, who have a higher risk of rare blood clots from the J&J Janssen vaccine, might want to consider using one of the mRNA vaccines — Pfizer’s or Moderna’s — as a booster, while young men, who have a higher risk of an inflammatory heart condition known as myocarditis from an mRNA vaccine, might prefer Janssen’s vaccine for a booster if needed.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 22, 2021
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Booster shots could soon be recommended for people as young as 40

News

 

Booster shots could soon be recommended for people as young as 40

Booster protection could soon expand to a much broader population, as a source says the US government likely will soon recommend additional doses to people as young as 40 who received a Moderna or Pfizer Covid-19 vaccine.

 Americans who haven’t been vaccinated are 18 times more likely to end up hospitalized with Covid-19 than those who are vaccinated, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention.

Unvaccinated people are also 11 times more likely to die from Covid-19 compared to vaccinated people. They were also six times more likely to test positive for Covid-19.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 21, 2021
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Is It Cold, Flu, Allergies or COVID-19?

News

 Is It Cold, Flu, Allergies or COVID-19?

If you have sniffles, sneezes, coughing or sore throat, it can be hard to tell if your symptoms are from allergies, a cold or the flu. And now there’s another possibility: COVID-19.


Until you know for sure what’s causing your symptoms, it’s always good to err on the side of safety and stay home and away from others.

Concern about catching the COVID-19 virus has made everyone more tuned in to the people around them, especially if they’re showing any signs of sickness. They may be more worried than usual about a cough or sneeze, even if you think it may just be sinus troubles.

So how can you tell what you have?

Stay Alert

Take a close look at your symptoms. A cough alone may not be cause for concern, but if you get a fever or have trouble breathing, call your doctor right away.

The signs of COVID-19 include fever, dry cough and shortness of breath. You may also have other symptoms that you get when you have a cold or the flu, such as congestion, feeling tired and an upset stomach.

If your symptoms are mild, you may get better on your own. In that case, you may not need to be tested for COVID-19. But it is still important that you not go around others until you are well.

Not getting near someone who has the virus or the things they’ve touched are the best steps. But people are contagious before they have symptoms. So it’s hard to know if you are around someone who has it. That’s why you are asked to stay away from public places and groups of people when possible. 

Colds and Allergies

When you don’t feel well, you might wonder whether it’s a cold or allergies. They share some similar symptoms like coughing, sneezing, and runny or stuffy nose. So how can you tell the difference?

How long your problems last is one of the big clues. Colds don’t often stick around more than two weeks. Allergy symptoms can linger much longer.

Colds are caused when a virus gets into your body and makes you sick. Your immune system launches a defense against germs. Your body fighting off the cold is what causes symptoms like a stuffy nose or cough. Unlike allergies, colds can also make your body ache.

Allergies are caused by an overactive immune system. Your body overreacts to harmless things like pollen or dust, and works to protect you from them. That can cause coughing, sneezing and stuffy nose, like colds. Unlike colds, allergies often cause watery, itchy eyes.

Also keep in mind that colds are contagious, while allergies are not.

Flu

While flu shares some symptoms with colds or allergies, it is more severe and also causes more serious symptoms. It also tends to come on much quicker and more severely. The American Lung Association says to watch for these signs of flu:

  • Sudden, high fever

  • Headache, muscle and joint aches and pain

  • Dry cough

  • Sore throat

  • Chills

  • Nasal congestion

  • Runny nose

  • Fatigue

  • Stomach symptoms like nausea, vomiting or diarrhea (more common in children)

Get Your Flu Shot

Like colds, flu is contagious and is caused by a virus. Unlike colds, you can get a vaccination to help protect yourself and others from the flu. 

The CDC says most people who are six months or older should get a yearly flu shot. It takes about two weeks after vaccination for the shot to protect against flu virus infection. So don’t wait until peak flu season to get your shot. Get it as soon as it is available. Your health plan may cover a flu shot at no cost to you when you go to your primary care doctor or use an in-network provider.

Avoid Germs

To stay healthy, protect yourself from germs of all kinds:

  • Wash your hands often with soap and water for at least 20 seconds.

  • Use hand sanitizer often throughout the day.

  • Try not to touch surfaces used by a lot of people, like door handles, light switches, phones, keyboards and flat surfaces. Disinfect those surfaces around your home or office often.

  • Keep your hands away from your eyes, nose and mouth, especially when you’re away from home.

  • When you’re out in public, try to stay 6 to 10 feet away from other people.

Nose Relief

How can you help your poor nose when you’re sick? 

  • Drink lots of fluids, especially water.

  • Use an OTC saline nasal spray. Only use decongestant nasal sprays for a few days (read the label).

  • Try a cool-mist humidifier in your bedroom.

  • Drink hot tea.

  • Try facial steam or a hot shower.

  • Use a Neti pot (with distilled water).

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 19, 2021
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The Power of Preventive Care For Mental Health

General Information

 

The Power of Preventive Care For Mental Health

Observances such as the World Health Organization’s World Mental Health Day today help elevate this much needed dialogue. However, while these days are important, they also remind us to treat every day as a mental health day. People constantly face stressors, events and diagnoses that impact our overall well-being, a reality that the COVID-19 pandemic has further revealed, making it critical that our approach to preventing and caring for these mental health issues meets these needs. 

 

The COVID-19 pandemic has put a new lens on how we think about mental well-being, as people have faced increased levels of loneliness, routine disruption and anxiety. In fact, 65% of Americans ages 18-34 have had concerns about their own mental health or that of household members, family or friends since the pandemic outbreak began. Yet, the study also found that nearly one in four of the same respondents are not confident in finding help to address these concerns.  

Addressing loneliness is one way we can lower feelings of depression and anxiety before they even start. Bringing together communities that have faced similar experiences allows people to feel that they are not alone in the struggles they face. 

One in eight emergency department visits are related to mental health or substance abuse, demonstrating missed opportunities to identify early signs of mental health concerns before they rise to an emergency. By proactively surrounding individuals with mental health resources, in their everyday lives and when interacting with the health care system, we can effectively spot early signs of mental health needs and direct people on the right path to well-being. 

Preventive care is powerful, and we must not forget the influence it has on all aspects of our health, including our mental well-being. As the focus on the mental health of ourselves, loved ones and communities continues to rise, Aetna and CVS Health remain committed to ensuring that no one is alone on this journey and supporting our partner providers and companies across the country to do the same. Through this work, we can make progress toward improving mental health for our communities, workplaces and families.  

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 18, 2021
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Your Health Q&A: Can I get medical care from the comfort of home?

General Information, Health Resources

 

Your Health Q&A: Can I get medical care from the comfort of home?

Q: I try not to leave my house these days due to COVID-19 in my community. Is there any service that will give me basic medical care from the comfort of my own home?

A: Yes. Lee Health recently announced a new mobile healthcare service to community members in Lee County. The service is provided through a partnership with DispatchHealth, a national provider of in-home medical care.

Community members can be treated at home for injuries and illnesses like the flu, cuts and lacerations that require stitches, sinus infections, strep throat, minor fractures, sprains and strains, and many other conditions that are commonly treated in urgent care settings.

Once you request an appointment, the DispatchHealth onboarding team will confirm it’s not an emergency and it’s safe to treat your urgent but non-life-threatening medical condition at home. Then, a visit is scheduled and the DispatchHealth medical team arrives within a few hours, ready to treat your illness or injury in the privacy and comfort of your home.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 15, 2021
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Stigmas and Barriers To Mental Health Care In Hispanic Latino Communities

General Information

 

Stigmas and Barriers To Mental Health Care In Hispanic Latino Communities

The Hispanic Latino population has grown tremendously in Northwest Arkansas. However, resources to treat mental health care has not grown enough to keep up with their needs.

Living Better Lives Counseling LLC licensed professional counselor Massiel Bradberry says not only is there a lack of Hispanic Latino counselors in the area but there is a limited number of counselors who speak Spanish.

Bradberry tells us that the pandemic has been hard on folks with more people dealing with intense grief, job loss, burnout and evictions, etc.

She says language is a big barrier and it is important for people to be able to freely express themselves and have a counselor they can relate to. There are also some stigmas surrounding mental health and cultural barriers that also keep Latinx people from reaching out to mental health professionals.

Immigration status creates a barrier and it’s important for people to know that your status does not put them in any risk when seeking help. Cost of services and health insurance coverage also plays a role. It’s important for people not to wait until they are having a crisis to ask for help. Instead reach out to a counselor when you see a problem continue to come up in your life.

Within the year, Bradberry has seen an increase in Latinx people calling to schedule sessions, including teens calling for their parents. Mental health services are on high demand right now so scheduling a session is tough  but there are options.

She adds to look for local community support groups or workshops in your area. There are also a lot of services available online. Some counselors have podcasts or post videos on social media that can also help you.

Although it does not replace a one- on-one with a counselor at least you are getting some support or relief until you can get in for a session. It is also important for institutions, jobs, schools to continue to educate people about prioritizing mental health care and provide access to the resources they need to get the care they need, especially in these tough times.

Don’t forget that it’s never too late to enroll with Healthedly Insurance Services for your life insurance. 


October 14, 2021
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