The executive order directs the Secretary of HHS to consider establishing a special enrollment period through HealthCare.gov that will run from February 15 to May 15, 2021. It cites provisions of the ACA governing the marketplaces and federal regulations that allow a special enrollment for “exceptional circumstances”—here, these circumstances are the ongoing COVID-19 pandemic.
The Health and Human Services Announcement
HHS immediately announced the HealthCare.gov special enrollment period in a press release and fact sheet. The special enrollment period will be available to all qualifying consumers who submit a new application or want to update an existing application (i.e., for current enrollees). State-based marketplaces can, but do not have to, allow for a similar special enrollment period, although some stateshave already announced that they will do so. Coverage is prospective, meaning it will begin on the first day of the month after a consumer enrolls through HealthCare.gov. Current enrollees will need to revise their current application to claim the special enrollment period and receive an updated eligibility determination. HHS’s fact sheet makes clear that applicants should face no heightened application questions or verification requirements (such as documentation to show they qualify for a special enrollment period).
$50 Million Committed To Outreach and Education
At the same time, HHS announced that it would commit $50 million to outreach and education to raise awareness of the special enrollment period. This is incredibly important since awareness of the marketplaces remains low, and the HealthCare.gov advertising and marketing budget was cut by 90 percent under the Trump administration. HHS can easily pull these funds from the user fees that insurers pay for the use of HealthCare.gov. A recent analysis from the Kaiser Family Foundation found that HHS currently has more than $1 billion in unused federal user fee revenue. These funds could be tapped to invest in HealthCare.gov marketing and advertising and the navigator program, as well as make other consumer-friendly improvements to HealthCare.gov and the call center. (Under the partial final payment rule for 2022, HHS would further cut the user fee for HealthCare.gov.)
A special enrollment period, paired with an aggressive advertising and marketing campaign, could have a significant impact. An analysis by the Kaiser Family Foundation suggests that nearly 9 million currently uninsured people could enroll in free or subsidized coverage through HealthCare.gov. Of these, 4 million would qualify for a no-premium bronze plan. An additional 6 million uninsured people could qualify to purchase unsubsidized ACA coverage if they can afford it. The executive order notes that people of color—Black, Latino, and Native American people, in particular—are more likely to be uninsured even while being disproportionately affected by the COVID-19 pandemic.
This broad special enrollment period is likely to be good for the marketplace risk pools rather than lead to adverse selection. State-based marketplaces have indicated that their COVID-19 special enrollment periods helped bring in younger enrollees. And the same Kaiser Family Foundation analysis notes that the remaining uninsured who could qualify for free or low-premium coverage are more likely to be young adults. For instance, 39 percent of the 4 million uninsured people who qualify for a no-premium bronze plans are between the ages of 19 and 34.
Health Sharing programs are 501(c) 3 non-profit organizations that help their members share their money to pay for each other’s medical bills. These programs are not insurance programs in the traditional sense, but offer an affordable alternative to cover your medical expenses. Plans on the Healthcare.gov marketplaceoften come with high premiums and deductibles, making a HealthShare plan a great option for people without pre-existing conditions.
The Best, Most Affordable HealthShare Companies Reviewed
HealthSharing companies became very popular after the Affordable Care Act was passed because they offered an affordable alternative to marketplace plans. However, picking the right organization is important. You want to make sure that the company is reputable, long standing and, most importantly, regularly pay the claims of their members.
Offers three programs, Samaritan Given, Samaritan Classic and Samaritan Basic. Given is an app-based program that allows you to manage your plan through your phone. Classic is a less tech savvy way to still get medical coverage traditionally
Samaritan Given plans include Annual Household Portions (deductibles) at $1,000, $2,000 and $5,000
Does not cover pre-existing conditions
Requires a strict faith commitment and regular church attendance
Charges a $200 on-time startup fee
Requires you to negotiate with medical providers directly
Monthly Share (monthly bill)
Samaritan Basic: $227 Samaritan Classic: $555
Initial Unshareable (amount you pay before coverage kicks in)
If you’re someone who doesn’t get health insurance through their employer, you’ve probably signed up for an Affordable Care Act (ACA) plan through healthcare.gov. But did you know that there are other, Healthcare.gov certified, partner sites that allow you to enroll as well?
Why Use An ACA Certified Partner Site?
These sites were started after the Healthcare.gov marketplace was launched to address the slow, clunky and confusing experience. A certified partner site offers the exact same plans and the exact same prices as Healthcare.gov, but help you make a more informed decision. They’re faster too—enrolling in health insurance through HealthSherpa takes only 15 minutes on average.
These sites also offer free features like dedicated expert call and chat support, so you can get help if you get stuck or have questions about your options.
Between November and December, every year, is when people are allowed to sign up for a health insurance plan for the first time or make changes to their existing plan. We’ve collected the key dates, deadlines and answered the most common questions to make this year’s open enrollment as seamless as possible.
Key Dates And Deadlines For Healthcare Marketplaces During Open Enrollment 2021
When does open enrollment start?
When is the deadline to enroll?
Dec 22, 2020
Jan, 15 2021
Jan, 15 2021
Jan, 15 2021
Jan, 15 2021
Jan, 23 2021
For Rhode Island
Jan, 23 2021
Jan 31, 2021
For District of Columbia
Jan 31, 2021
For New Jersey
Jan 31, 2021
For New York
Jan 31, 2021
For all other states
December 15, 2020
When does coverage begin?
January 1, 2020 (or after you enroll if you live in a state that’s extended open enrollment)
Important: You Have To Enroll Before Your State’s Deadline
If you don’t act by December 15 (or your state’s extended deadline), you can’t get 2021 coverage unless you qualify for a Special Enrollment Period. If you haven’t already, find a plan today with Health Sherpa.
Reminder: The 10 Essential Benefits That Are The Same For All Marketplace Plans Found On Health Sherpa
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Answers To The Most Common Open Enrollment Questions
Where Is The Best Place To Shop For Plans?
You canshop available plans to find the best coverage using Health Sherpa. Enrolling on HealthSherpa only takes an average of 15 minutes. If you’re stumped on which plan to choose, you can talk to an expert who will walk you through the process. Call (844) 215-9595 to for help enrolling or to get answers to any questions you may have.
HealthSherpa is a certified enrollment partner of the government and their enrollment process is straightforward and simple. They offer all of the same plans at the exact same prices as HealthCare.gov, the government’s enrollment site. The difference is they offer a smarter enrollment process, a website that’s easier to use, and help you to maximize your subsidies and savings.
Who is eligible to shop during Open Enrollment?
Not sure if you’re eligible to shop the Marketplace for an Obamacare plan? Good news: you probably are!
If you are a U.S. citizen, national or legal resident of the United States who currently resides in the U.S., you’re qualified to shop the Marketplace. This includes green card holders, refugees, asylees, and individuals with non-immigrant status who have a valid worker visa.
The only exceptions? If you’re currently enrolled in Medicare or currently incarcerated.
Will I Have To Pay A Fine If I Don’t Have Health Insurance In 2021?
Congress repealed the penalty for having health insurance in 2018. That means in most states, you won’t have to pay a fine if you go without coverage in 2021.
However, the following states passed their own individual mandates, you may have to pay a penalty.
Which States Have A Penalty If I Don’t Have Health Insurance?
What do I need when I’m ready to enroll?
You’ll need some basic information on-hand to get started with the Open Enrollment process.
First, you’ll need to provide information about your household, including household size (including anyone you claim on your tax return). For each of these people, you’ll need some basic information like birth dates, home addresses, and social security numbers.
Additionally, you’ll need information about your best estimate for your 2021 income, information on how you file your taxes if you have a spouse, information about your sources of income, and policy numbers from any current health insurance plans.
You should also ask yourself these questions:
What type of plan is it?
Health Maintenance Organization (HMO) – does not have out of network benefits
Preferred Provider Organization (PPO) – has in and out of network benefits
Health Saving Account Plans (HSA) – lets you save for medical expenses on a tax deferred basis
Are my current doctors and specialists and hospitals covered (in-network)?
Are my current medications covered (in-network)?
What will I be paying including premiums and out of pocket costs?
Are any of my medical needs excluded?
What if I already have a plan from last year?
If you had Marketplace health insurance in 2020, you will be automatically re-enrolled in that plan for next year if that plan is still being offered. If that plan is no longer available, you’ll be enrolled in an “equivalent” plan. Although that might sound like the easiest way to approach OEP, it isn’t necessarily your best option. In fact, people who who shop and switch plans save an average of 38%on their monthly premiums.
Most insurers are expanding their coverage areas this year, which means there will be more plans available to you. Without shopping to compare what plans, and savings, are available to you this year, your premium payments may increase substantially. Plan details can change from year to year, too, meaning that prescription coverage, provider networks, and coverage benefits could change even if you keep the same plan. By shopping the Marketplace, you’ll find out what kinds of available plans might best suit your needs for the coming year, and what cost savings you will be eligible for with those plans. It only takes a few minutes to shop and compare your options, and this can keep you from paying more later.
Am I Eligible For Subsidies, Cost-sharing Reductions, And Tax Credits?
Many Americans are eligible to save on their health insurance costs as a result of the Affordable Care Act. No matter where you live, if you earn between 100 – 400% of the Federal Poverty Level (determined by the federal government) and aren’t eligible forMedicaid, you will qualify for a premium tax credit that will help lower your premium costs. By 2020’s FPL numbers, this meant that a family of four whose combined household income was between $26,200 and $104,800 would qualify for a premium tax credit.
Depending on your income, you may also qualify for Cost Sharing Reductions(CSR), which are special savings built-in to Silver-level Marketplace plans for people who earn between 100 and 250% of the federal poverty limit. These CSRs limit and reduce out-of-pocket costs like copays and deductibles.
Remember that if you are married and do not file taxes jointly with your spouse, you will not be eligible for any subsidies or CSRs in the Marketplace.
Open Enrollment Is Your Biggest Chance To Reset Your Coverage
If you’re someone who has a chronic condition and has to pay for bills and prescriptions related to treating your condition, open enrollment is your biggest chance this year to get the coverage that’s right for you. By right coverage, we don’t mean the cheapest plan option. We mean finding the insider tips and tricks to cover your expenses while still saving money.
In this guide, we’re going to walk through an Uncovered member’s story, Carol’s story, and show you how she saved $8,000 a year on her health coverage by making smart choices during open enrollment and the steps you should be taking to save like she did.
To protect her privacy, Carol’s name has been changed, but the details of her story are true.
How Carol Saved $8k a Year. The 4 Things She Did Differently:
For comparison sake, this example is based on 2020 numbers.
For starters, Carol has multiple chronic conditions that she needs health insurance to help her pay for. She is self-employed, which means she was using the Affordable Care Act healthcare exchange to buy her own insurance to cover medical expenses.
The problem is, her insurance was breaking the bank and barely covering her needs. So she started by sitting down to do a little homework to see what her situation was.
Carol’s Health Situation
Carol is female, 46, single, with multiple comorbidities
She has rheumatoid arthritis and high blood pressure
Her BMI is 29
1. Where She Started: Getting An Accurate View Of Her Financial Situation
She started by putting together a rough picture of how much she expected her medical costs to be without any insurance coverage.
Her total income
$63,000 per year
Her after tax income
Her monthly medication cost for Humira
$5,500 per month
Her monthly medication cost for Amlodipine
$20 per month
She anticipated 1 primary care visit per year
$120 per visit
She anticipated 2 visits with a specialist per year
$480 ($240 per visit)
Her total estimated medical cost without insurance for the year
2. What She Did Next: Shopped the market for her options
What were Carols’ insurance options? Due to her preexisting conditions, the only programs that cover pre-existing conditions are ACA compliant plans. Therefore, she will need to go through her state’s healthcare insurance exchange, ideally through Health Sherpa to maximize her subsidies.
Health Sherpa will automatically calculate the availability of any subsidies based on Carols’ income and dependent status. Unfortunately, Carol did not qualify for any subsidies.
Health Sherpa will allow you to see all plans available and allows you to quickly sort to find the lowest premium plan or the lowest total out of pocket plan.
[insert image from Health Sherpa]
Here’s a tip: if you don’t anticipate using your insurance, take the lowest premium plan. But if you’re in a health situation like Carol, you’ll need to spend more time to find the right plan.
This is the best deal on health insurance Carol could find:
Lowest Monthly Premium Plan Cost
$13,142 per year
The big problem with her options:
That’s extremely expensive compared to Carols household budget
The significant contributor to the annual cost was Carol’s Humira
3. She Didn’t Give Up, And Found A Solution For Her Biggest Problem
But Carol didn’t give up. She realized that her biggest expense was her Humira prescription—so she turned to prescription patient assistance programs (PAP programs) and used RXHope.com to search for any PAP programs for Humira. She found two that would turn out to be game changers.
She found a PAP program she could apply to through her physician that might reduce her costs.
It was based on her income and on high insurance out of pocket costs.
The direct manufacturer program was called Humira Complete.
It reduced her costs to as low as $5/mo.
It required her to have insurance that was not federally or state funded, she must have insurance that covers Humira (both options she considered did).
Humira would reimburse the insurance company and pay her portion of the deductible associated with the Humira costs.
Note: you must make sure the insurance coverage you are considering does not exclude such programs. You will need to contact the insurance company directly and inquire. The enrollment firms will not be able to help at his detail level.
4. How Her Hard Work Saved Her Thousands
Carol revisited her health plan options and confirmed directly with her chosen insurance company that they would accept the Humira complete card.
Lowest Monthly Premium Plan Cost
Original cost per year
Cost after PAP program
Total Carol Saved
Carol’s health profile and understanding her costs allowed her to pick the most appropriate plan for her budget. Her additional effort in reducing her drug cost significantly reduced her total expenses to a manageable level. It was worth the extra work!
Can You Do The Same Thing?
Step 1: Start By Completing Your Health Profile
Do what Carol did to start. Fill out what you think your medical expenses will be in the coming year. Here’s how to do that:
Do you expect to have the same, less or a greater number of services for this coming year?
Based on the costs for those services last year and the number you predict for next year, add up what you anticipate spending in the coming year.
If you anticipate needing additional care, get an idea for what that might cost using Fair Health
Now you are prepared to shop for health insurance coverage.
Step 2: Find your biggest recurring expense.
The next step is to see if you have a major recurring expense each year. If you have a chronic condition you take medication for, it’s probably that prescription. If you can identify where you’re spending the most before hitting your deductible, you can find tactics to reduce it.
Step 3: Find an insider way to save on it
You’ll want to look for cost assistance prescription programs. Search for PAP programs on RXHope.com, they can help you find significant discounts or no cost branded drugs that do not have an alternative generic. By doing so you may reduce a significant portion of your out of pocket insurance expenses which may influence what plan you pick.
Then you should always want to look into drug discount cards to see if you can reduce costs on other drugs you are using. Try using our drug discount search engine.
Step 4: Re-evaluate your health plan options
Now that you have an idea of the real coverage you need, go back and look at those plans again. Maybe you don’t need the most expensive option that looks like it offers the best care. Maybe you don’t need to find the cheapest monthly premium option. Either way, comparing your homework to the plans will help you find the best deal.
Step 5: Make an informed decision
Always ask the potential insurance company you’re considering these questions to uncover if you in the right place:
Are preexisting conditions covered
Are the benefits unlimited?
Does the plan cover the ten essential coverages? (see attached)
Am I guaranteed renewal?
Note: The exchange provides a summary of benefits and plan details on every plan offered. Make sure you read them.
If you’re willing to put in the hard work, you have a choice. That choice could mean savings of thousands of dollars—which is worth the extra effort!
If you’re enrolling in a health insurance plan for 2021, marketplaces likehealthcare.gov or HealthSherpa are ideal for people who don’t get their insurance through their employer and who have pre-existing conditions or higher health needs.
But what if you’re healthy? What if you don’t have high expenses related to chronic conditions? What if you still want health coverage without having to pay hundreds every month for a plan that has a $2,000, $3,000, or $4,000 deductible?
If you do not have pre-existing medical conditions, you should consider and compare Health sharing programs, otherwise known as Christian care plans.
The Alternative To ACA Plans That Can Save You Up To 50% Per Month On Healthcare
What Are Health Sharing Plans?
Health Sharing programs are 501(c) 3 non-profit organizations that help their members share their money to pay for each other’s medical bills. These programs are not insurance programs in the traditional sense, but they do cover your medical expenses and can save you hundreds of dollars on premiums and deductibles compared to ACA plans. Read Nat’s story to see Medishare in action.
Coverage for unexpected medical bills – A health sharing plan covers you for unplanned, costly medical expenses like a broken bone or getting diagnosed with a disease like cancer
A PPO Network – Most Health Sharing plans offer a Preferred Provider Organization (PPO) where members can choose in-network doctors to receive discounted medical care
Coverage for prescriptions – Prescriptions can be covered but are limited to six (6) months of treatment for each medical condition over the lifetime of the Member.
What’s Different Compared To An ACA Plan
Since health sharing programs are not health insurance, they aren’t mandated to cover the 10 essential benefits that all ACA plans are required to cover. Because of this, health sharing plans mostly focus on providing assistance for unexpected, larger medical expenses. These are the key differences between a health sharing plan and typical health insurance.
They require a commitment to certain Christian Tenets – Because most health sharing organizations are Christian faith organizations, they do not cover health needs that fall outside the tenets of the religion. Things like alcohol abuse, illegal drug use and birth control related costs are not covered.
They can exclude pre-existing conditions – If you have preexisting conditions, they can choose not to accept your member applications since they are not governed by the affordable care act.
Share in the financial health burdens of other members – Your monthly share payments go directly to helping other members pay for their medical bills.
Ask for your medical history – As a part of the application process, most health shares ask you to complete a medical history questionnaire before your application is approved.
They may limit medical coverage levels – health share plans usually do not offer unlimited medical coverage. They will cover you up until a point, usually $1 million, after which you have to start paying the medical bills.
Do You Have To Be Christian To Have Christian Care?
In order to qualify to become a member, you have to abide by the tenets of the health share. This usually includes making a statement of faith when you sign up. Beyond that, members are asked to agree to live by biblical standards and to support one another’s burdens. However, there aren’t explicit requirements that applicants have to belong to a church to become members.
When considering this type of plan always ask the following:
What type of plan is it HMO (do not have out of network benefits), PPO ( has in and out of network benefits), and Health Saving Account Plans (HSA) ( let you save for medical expenses on a tax deferred basis).
Are my current providers covered?
Are my current medications covered?
Are any of my treatments or services excluded?
To shortcut reading the whole summary plan description document, go to the exclusion section first. Then you service is not specifically excluded read the entire document.
Comparing ACA Plans To A Health Share
So how do Health Share plans stack up to a comparable ACA plan? Below is an example of the comparison for someone who’s 29 years old and doesn’t have health issues.
What insurance pays before deductible is met
Visit to a Primary Care Provider
Visit to a specialist
Deductible must be met first
Deductible must be met first, then 100%
6 months covered after deductible has been met
Deductible must be met first, then 100%
$200 per visit
Inpatient Hospital Visit
Deductible must be met first, then 100%
Deductible must be met first, then 100%
Deductible must be met first, then 100%
6 months psychotherapy covered
Deductible must be met first, then 100%
Coverage limited to tenet guidelines
In Network Coverage
Varies by plan
990,000 nationwide providers
Out Of Network Coverage
Varies by plan
Plan pays 70%, you pay 30%
Reviewed: Which Health Share Company Is Right For You
Trust is important when it comes to finding a health share organization that fits your needs. When the affordable care act was passed, so-called “health share” companies started to pop up as a way to skirt ACA requirements and offer sub-standard coverage. These newer organizations were also notorious for being slow to pay for benefits or even not paying at all.
Has it been a year already? Healthcare open enrollment is approaching faster this year, than any other year, and choosing a health plan is very important. A lot has changed since last year because of COVID-19 and it’s critical that you have some form of health insurance for the coming year.
Biggest 2021 Open Enrollment Updates
Insurance Rate Increases Are Going To Be Lower Than Previous Years
Good news! From an insurance standpoint, the average rate increases appear to be lower than previous years.
There Are More Insurance Providers in The Marketplace
Another upside is the number of health insurance carriers offering plans is increasing. On average, marketplaces are offering 4.5 health insurance carrier options per state up from 3.5 in 2018 and 4.0 in 2019. That means more options for you to choose from!
You May Qualify for Subsidies If You Recently Lost Your Job or Took a Pay Cut
Remember that ACA plans are the best options for people with pre-existing conditions or if you qualify for subsidies. If that’s not you, check out our post on alternative health plans.
Qualifying For Subsidies
ACA endorsed enrollment systems will calculate whether or not you qualify for subsidies. Uncovered’s partnership with Health Sherpa will help calculate your potential subsides when you enter your estimated income for 2021 (Bonus! Through Health Sherpa, you’ll be able to calculate your subsidies in just minutes vs the typical 25+ minutes through healthcare.gov.) The calculator will determine if you qualify for a health insurance subsidy and how much that subsidy will be or if you qualify for Medicaid, which in many states requires little or no monthly premiums*
To illustrate how powerful these subsidies can be, we calculated a Michigan family of four making $63,000 a year. They lost a third of their income during the pandemic, reducing their family income to $41,500. When reapplying for a health plan, they became eligible for subsidies which reduced their monthly premiums from $1,100 to $108 per month!
*Note: if your estimated 2021 income ends up higher by year end the government has the right to recoup apportion or all of the granted subsidies difference. The 2021 results will vary due to new 2021 premium and plan offerings.
Depending on Where you Live, The Process of Signing Up for ACA Will Vary.
For most states, you can begin the ACA sign up process directly through Health Sherpa to find the plan that’s right for you. However, if you live in one of the states in the list below, you must sign up for ACA through a state-specific process, since these states are “State-based Marketplaces” or SBM’s.
Find your state below and click the link to start the process of signing up for ACA:
For information about the difference between State-Based Marketplaces, State-based Marketplace-Federal Platform and Federally-facilitated Marketplace, see below:
State-based Marketplace (SBM): States running a State-based Marketplace are responsible for performing all marketplace functions for the individual market. Consumers in these states apply for and enroll in coverage through marketplace websites established and maintained by the states.
State-based Marketplace-Federal Platform (SBM-FP): These states are considered to have a State-based Marketplace, and are responsible for performing all marketplace functions for the individual market, except that the state will rely on the federal Healthcare.gov website for eligibility and enrollment functions. Consumers in these states apply for and enroll in coverage through Healthcare.gov.
Federally-facilitated Marketplace (FFM): In a Federally-facilitated Marketplace, HHS performs all Marketplace functions. Consumers in FFM states apply for and enroll in coverage through Healthcare.gov.
But not all telemedicine companies are created equal. While most offer board certified doctors, the quality of the service and app can be huge, plus the pricing can change dramatically. If you’re looking for an appointment with an online doctor, there tons of choices, making it difficult to find the right answer for you.
We’ve reviewed the best telemedicine services to make it easier for you to find the right online doctor.
Best For Immediate Access To Virtual Doctors For Urgent Needs
As coronavirus and the encouragement for social isolation continue, stress is taking its toll with job-loss, loneliness and worry are surging. As reported in in a post in the Wall Street Journal on May 25, 2020, Andrea Peterson reports that more are turning to medications; like anti-anxiety anti-depressant medications and sleep aids which have risen during the pandemic.
Tina Fey’s wisdom on the impact from stress was highlighted in her book Bossypants,
“I was a little excited but mostly blorft. "Blorft" is an adjective I just made up that means 'Completely overwhelmed but proceeding as if everything is fine and reacting to the stress with the torpor of a possum.' I have been blorft every day for the past seven years.”
Peterson, continues, prescriptions for anti-anxiety medications, like Klonopin and Ativan, rose 10.2% in March 2020 and prescriptions for antidepressants, like Prozac and Lexapro, rose 9.2% in the same period.
Circumstances including health concerns, social isolation, childcare, at home schooling and job losses are eroding the sense of calm and taking a toll on people’s well-being. In fact, the American Psychological Association shared that was parents with children under 18, 46% rated their average stress level related to the pandemic as 8, 9 or 10 on a 10-point scale, according to a survey the released May 21.
As reported in the Washington Post on May 26, 2020, the Census bureau recently released a study suggesting 1/3 of all Americans now show signs of anxiety depression or both. Most would think the most of those experiencing these symptoms of fear would be the most at risk, those over the age of 80. Not true, this study found that younger people, specifically younger Americans under the age of 30, are more upset and challenged by the Coronavirus Anxiety and Depression.
What can we do, you and me, to address the anxiety and depression and the fears that seem to be our new normal.
Here’s some thoughts
ONE - pay attention to what you are listening to ... turn off the news and turn on your favorite Pandora playlist. If you need an example, I listen to a soft jazz and a reggae playlist. Both help me to exhale and that feels much better than the churn of my stomach after a daily dose of the news.
TWO - smile ... yes smile. My kundalini teacher Jae Dev Sing suggests when our body is engaged our mind will follow. So, take some time each day to smile ... especially with those you love and care for, be it on a phone call or in person, even if you are socially distanced.
Until then, I am Doc Frank your friendly psychologist.
Frank Wood, PHD
Dr. Frank Wood is a Licensed Psychologist and the creator of Thriving with Stress, an innovative training program designed to leverage stress – in the workplace, in relationships and with life.
As a speaker, author and trainer on stress, Dr. Frank has applied all of his expertise and experience in developing The Thriving with Stress program; a program that clients refer to as a "game changer" and a “program that is turning the tables on stress.”
Uncovered, in partnership with HealthSherpa, is committed to keeping you up-to -date on what your health insurance covers for COVD19, and what to do if you lose your health insurance. We wanted you to see what HealthSherpa has published on questions you may have – as well as a question direct from our community.
Right now, many Americans are practicing
social distancing to help “flatten the curve” of the transmission of
coronavirus. But at the same time, they are also seeking information on what to
do should they contract COVID-19.
If you are concerned you may have COVID-19,
here’s what to know about how your insurance works when it comes to testing in
light of the expanded Centers for Disease Control (CDC) testing
If you don’t have health insurance, enter your
zip code below to search for plans and prices below. If you lost your insurance
recently, you may qualify for a Special Enrollment Period (SEP), and several
states have announced SEPs for all residents due to COVID-19.
Per the CDC, testing for coronavirus—the novel
virus that causes COVID-19—is now available in all 50 states. There are
currently a total of 75,000 lab kits “cumulatively” available for public labs
and more are hoped to be available soon. Private companies like Lab Corp and
Quest Diagnostics will be providing the majority of testing, though. And many
Americans may be wondering what this means in terms of what their insurance may
The Trump administration has announced that
testing for COVID-19 has been designated as an Essential Health Benefit (EHB),
meaning that testing must be covered by all ACA- compliant plans. This means if
you are enrolled in a Marketplace plan, your insurance company will cover
COVID-19 testing is also covered by Medicare
and in most cases by Medicaid.
If you have coverage through an employer,
whether COVID-19 testing is covered depends on the size of your employer. If
you are employed by a company with fewer than 50 full time employees, COVID-19
testing will in most cases be covered. If you are employed by a larger company,
whether COVID-19 testing is covered is determined by your employer; you should
contact your benefits department for more information.
In addition, many health insurance companies
have announced that the test will come with a $0 co-pay, at no cost to the
Many insurance plans will also be covering
telemedicine services should Americans wish to speak with a doctor at home
through web-based conferencing, thus allowing them to continue to socially
distance. Contact your health plan to learn about their telemedicine
Any treatment you need for COVID-19 will
be covered by your insurance in the same way as any other similar treatment or
hospitalization, although some insurance companies are waiving certain copays
you may have to pay for COVID-19 treatment. Once again, you can consult this list from America’s Health Insurance Plans
(AHIP) to learn more about the details of coverage.
Depending on the type of plan you have, the
kind of coverage it provides, and your specific insurance carrier, the
specifics of cost-sharing and benefits can vary when it comes to costs you
may need to incur as a result of testing and treatment. Important to keep in
mind is that while co-pays may be waived or COVID-19 testing, this may not
apply for all other tests, treatments, or doctor’s visits associated with the
virus, including hospitalization. Which means depending on the kind of health
insurance plan you have, you may need to meet your deductible before full
coverage kicks in for your treatment, including whatever benefits you may have
for in-patient hospital care.
What are the risks of
being uninsured during the coronavirus outbreak?
If you are uninsured, then you will need to
pay for the cost of coronavirus testing and any treatment associated with
COVID-19 yourself. The out-of-pocket costs for testing without insurance can range from approximately
$500 at a doctor’s office to approximately $1000+ in a hospital setting.
In 2018, 27.9 million nonelderly Americans were uninsured in
the United States. Most uninsured people are in low-income families, with
families of color disproportionately represented among uninsured
Outside of Open Enrollment, you can typically
only enroll in health coverage if you have a qualifying life event—for example,
losing your health coverage within the last 60 days.
From our Uncovered community: What if I lose my employer-based coverage? What if my income changes and I can’t afford coverage? What if I don’t currently have coverage?
If you’re concerned about losing your health insurance due to job status change (full time to part-time or job loss), consider these options:If your employer has over 20 employees ask your employer about your COBRA option. You can continue under your current plan for up to 18 months but will be required to pay the full monthly premium. Currently your employer contributes between 75-80% of the monthly cost. Loss of health insurance due to a job status change within the last 60 days is deemed a qualifying life event which entitles you to enroll in any ACA health plan. If this is you (you have lost your insurance and you want to enroll in an ACA plan) – and you live in California, Colorado, Connecticut, DC, Massachusetts, Maryland, Minnesota, Nevada, New York, Rhode Island, Vermont or Washington – click on your state link listed below and you can see how to enroll now.If this is you (you have lost your insurance and you want to enroll in an ACA plan) – and you live in a state other than those listed in the point above, CLICK HERE and we will connect you to enrollment options. The resulting reduction in earnings from a job loss may qualify you for government health insurance subsidies on qualified ACA plans or for Medicaid coverage which varies by state but requires minimal premium contributions.If you don’t currently have health insurance and haven’t experienced a job status change, many states—currently California, Colorado, Connecticut, DC, Massachusetts, Maryland, Nevada, New York, and Rhode Island—have opened up Special Enrollment Periods to help people without health coverage get insured during the coronavirus pandemic. The federal government has not yet BUT is considering opening a Special Enrollment Period as well. So if you live in one of the states not listed in the point above, stay tuned – you may have a chance to enroll at a future date before the October, 2020 open enrollment period. We will keep you apprised of if and when that happens.
If you have lost your health insurance and want to enroll in a new ACA healthcare plan, and you live in one of the states below, click on the state in which you live. Otherwise, CLICK HERE.
If you are currently uninsured, don’t forget
that you can apply to
see if you or anyone in your family may qualify for Medicaid or CHIP at any
time—you don’t need a qualifying event to apply.
How does ACA insurance
compare to short-term insurance during the coronavirus outbreak?
While coronavirus testing is now an Essential
Health Benefit (EHB) and thus qualified for no co-pay coverage, EHBs only apply
to ACA-regulated plans. Which means that EHBs do not apply to short-term health insurance.
Short-term plans typically do not cover
pre-existing conditions, preventive care, emergency services, mental health
care, prescription drugs and maternity care. If you have a short-term health
insurance plan, know that you may need to pay out-of-pocket for any coronavirus
testing or coronavirus-related hospitalization you may need for
Only plans that are regulated by the
Affordable Care Act, such as those available on the Health Insurance
Marketplace, contain no-cost Essential Health Benefits.
Enter your zipcode to search for marketplace plans and prices.
Medicaid is a program jointly funded by the
federal government and the states to provide health insurance to low-income
Americans. Medicaid eligibility is determined based on income level. Adults,
children, pregnant women, the elderly, and people with disabilities can all
become Medicaid recipients. Medicaid covers one in four children, 21 percent of
all low-income adults, and 60 percent of nursing home residents in the United
States at this time.
While details of Medicaid programs and
benefits vary by states, federal law does require that all Medicaid programs
cover a certain set of “mandatory benefits.” These include inpatient and outpatient
hospital services, nursing facility services, home health services, physician
services, and laboratory and x-ray services.
What is CHIP?
The Children’s Health Insurance Program (CHIP)
provides low-cost health insurance to children up to age 19 to children whose
families earn too much to qualify for Medicaid in their state, but do not earn
enough to be able to afford private insurance. In some states, CHIP also covers
pregnant women. Every state runs and offers their own CHIP insurance program
While you can apply for CHIP at any time, and
do not have to wait for the annual Open Enrollment Period (OEP), in 15 states,
children may have to be uninsured for up to 90 days before becoming eligible to
enroll in CHIP.
Each state has different guidelines in terms
of income eligibility and eligibility standards. 46 states plus the District of
Columbia make CHIP eligible for children whose families earn up to or above
200% of the Federal Poverty Level (FPL). That translates to $50,200 for a
family of four. 24 of these states offer CHIP eligibility to children in
families who earn 250% or more of the Federal Poverty Level, or $64,750 for a
family of four.
While details of CHIP benefits vary slightly
by state, federal law guarantees that CHIP programs everywhere must provide
comprehensive coverage, including:
Megan Weddle works for First Stop Health, a company that specializes in bringing telemedicine to consumers, so it’s no surprise she’s a fan of technology itself. Her reason, though, is beyond professional—it’s personal.
Telemedicine helped Megan discover her twelve-year-old-son Brady—whom she thought was dealing with a simple stomach flu—was actually facing appendicitis.
Not the Stomach Flu
It all started when Megan decided to take her eleven and twelve year old children on a flight to the west coast to visit relatives. It was the first long flight for the kids, and her son Brady complained a little about his stomach hurting on the flight. They thought it was just upset from the cookies on the plane.
“The number one thing the kids wanted to do when we got to California was go to In-N-Out Burger,” Megan says. “After visiting the Hollywood sign, my son looked at me and said, ‘I need to find a bathroom NOW.’”
The flight, the burger, the time difference . . . Megan knew it could have been anything.
They hopped in the car on the way to Santa Monica, and Megan wondered several times if she’d need to pull over for Brady, who was still struggling with stomach issues in the back seat.
An hour later, as she was handing her card over to the receptionist at the hotel, Brady ran straight for the bathroom. He came out a few minutes later, saying he’d gotten sick.
As the rest of the family went to the pool—with everyone agreeing it was best to stay away from what was surely the stomach flu—Megan considered her options.
Where Megan Turned Instead Of Racing To Urgent Care
“It was close to the time an urgent care would be closing. Then, I thought to myself, I am going to call First Stop Health. I work for a telemedicine company. This is what it’s for: avoiding unnecessary visits to the ER or the doctor.’”
Megan picked up the phone and dialed. Although she could have opted for a video visit, she chose the phone option that time. Even though Brady wasn’t registered with First Stop Health, she was able to use her info and give his age, medical history, and presenting symptoms. She told the nurse that she thought it was the stomach flu and likely needed some anti-vomiting medication.
The Doctor’s Time Saving Diagnosis
When the doctor got on the line, he indicated he wanted her son to do a balance test, just to rule out anything more serious than the stomach flu.
“He told me to have Brady jump on one foot. I thought it was ridiculous—he’d been jumping all day, running around, before he started to feel bad. Brady refused to jump, though. Then the doctor said he hated to be the bearer of bad news, but my son was presenting with appendicitis.”
The doctor gave her information for two hospitals near where they were staying. They went immediately to the ER, where the doctor gave the same balancing test—which Brady failed.
His appendix was about to burst, and he needed emergency surgery.
Brady made it through the surgery just fine, but if his appendix had burst, there could have been serious complications. Megan credits First Stop for being a big reason why she got Brady to the hospital in time.
“The best part of this service is having access to a doctor 24/7. As a parent, sometimes you think you know it all. But, to be fair, we don’t. If Brady’s appendix would have ruptured, we would have been in California longer. Because we caught it and did the surgery right away, we only had to spend one night in the hospital. He bounced back.”
What’s Different About First Stop
On top of being a quick way to talk to board certified doctors, First Stop has other benefits, too. The service costs just a couple of dollars every month for individuals, unlike other telemedicine services that charge up to $75 per call.
First Stop can also be used by up to seven other family members, meaning the whole family can have instant access to care.
A Good Call For Moms With Kids
In addition, using telemedicine can be uber-convenient and less risky to other members of the family who are not sick.
“Sometimes, you don’t want to drag your non-sick kids into a waiting room, which is a petri dish. There’s only so many times you can say, ‘don’t touch that.’ I know. I am a mom of four!”
In the end, telemedicine not only made the trip easier on Megan and her family, but it also could have saved Brady’s life. That’s a call that’s always worth it.
“It never occurred to me to shop around before then,” Kelly said. “It’s kind of a one-pony show up here. You go to the place that’s available.”
Kelly said she considered paying cash to get a lower rate, but because she knew she’d need surgery and thus meet her deductible for the year, it was more cost-effective to find the cheapest route through her health insurance.
How To Find The Best MRI Cost
Kelly followed a step by step approach to research and shop for the best, most affordable care. Here’s how to do what Kelly did:
Call the physician and ask for the procedure code. Note that there can be multiple codes for each type of procedure. For an MRI, for example, there are different codes for “with contrast” and “without contrast.” Be sure your doctor provides you with the code for the precise procedure you’re getting.
Call different facilities you’d like to price shop, ask for their facility code (or ICD10), and ask the medical billing department for their price based on the procedure code from your physician. See our list of healthcare transparency sitesfor resources to help you find and compare providers.
Call the insurance company and give them the information: the procedure code, the facility code, and the quoted price—and have your insurance company confirm what you’ll owe.
Make the decision that is most in line with what you want and need for your healthcare—and your bank account. You should also remember that most outpatient facilities offer payment programs, which can be a great fall back option.
Kelly’s Shopping Success Story
Ultimately, by using a simple online search to find facilities and then calling around to get the lowest price, Kelly found a facility that would do the MRI through her existing insurance for a price of $341—a savings of over $1,600. She scheduled the test for the exact day her six-week waiting period was up.
“Through this experience, I learned to shop around because the medical care that’s available to you isn’t always the cheapest. It pays to look for some competition,” Kelly said.
It’s important to note that the MRI Kelly received—the one that was $1,600 cheaper at another location—was a 2D MRI, not a 3D MRI. Both of these types of MRIs can generally be used to diagnose a meniscal tear with similar accuracy.
IMPORTANT NOTE: It’s critical to check with your doctor to see what kind of MRI you need in your situation, rather than go with the one that’s most convenient or cheapest.
“Here [at the local facility] I would’ve been paying for a fancier machine that I didn’t really need. My doctor didn’t care if the MRI was 2D or 3D. It definitely makes sense to do your research .”
Ultimately, the MRI confirmed what Kelly and her doctor had suspected, and she got the care she needed for her injured knee. She reports she is very glad to be back up and running!
If you have a planned hospital need, you aren’t at the mercy of the billing department: if it makes sense for you, you can pay cash and save—sometimes up to 75 percent! In this article, we’ll look at how.
Here at Uncovered, we get it. All those tests, procedures, and surgeries are stressful enough in premise alone. Then, you factor in the cost, the fear of medical debt (and the fact that it can feel impossible to know how much you’ll owe ahead of time), and your stress level goes through the roof, right?
It doesn’t have to be like that. With a few calls and by asking the right questions, you can learn your all-in price. What was Eric’s big trick?
Paying upfront, in cash.
When it doesn’t make sense to pay in cash
Look at what kind of plan you have. If you have a full plan that covers preventative care, you’re safe. Or, if it’s early in the year and you have a low deductible that you know you will hit—and need to hit to account for more upcoming expenses during that calendar year—you’re also safe. Nothing to do. (Just make sure you stay in network!)
When it does make sense to pay in cash
If you have short-term insurance, it almost never covers preventative care, so it makes sense to find out the cash price. If you have a deductible you know you will not meet during the calendar year and are having a non-preventative procedure, it also makes sense to find out the cash price. You’ll be paying it in cash anyway, so why not pay less?
Here’s how to find out the cash price:
Step One: Call the surgery center or physician and say you’d like to negotiate.
Step Two: Ask who is involved in the procedure, what services you will receive, and get a breakdown of those costs. For example, for Eric’s colonoscopy, they broke it down for him all the way to the cost per polyp removal.
Step Three: Tell them you’d like to negotiate an all-in price to pay on the day of service.
Step Four: Save big money!
These Tips in Action
Eric Neuville is the perfect example of what to do when it comes to negotiating hospital bills. When his doctor referred him for a colonoscopy, he knew it wouldn’t be covered under his short-term medical insurance because his plan didn’t pay for preventative care at all. He also knew his deductible was high–$8,000—and that he wasn’t going to meet it.
Eric’s doctor told him he wasn’t sure how much the colonoscopy would cost. What he refers to as his “sort-of” insurance carrier also told him they didn’t know (and wouldn’t until the surgery center billed them). The common refrain was that the procedure had to be done for them to know—which, according to Eric, was ridiculous. And he would know, as a twenty-five year veteran of the insurance industry who ran product development for Anthem Blue Cross and Blue Shield.
Eric’s wife called the surgery center and asked for the all-in cash price on a colonoscopy. They broke it down for her: if they paid in full on the day of service, it would be $1000 cash, a savings of almost 70 percent.
The day of the surgery, Eric walked in and told the receptionist he was quoted a cash price of $1,000. He gave them two cards: his insurance card and his payment.
When the couple later got a bill with a “discounted” price of over $3,000 for the surgery, Eric had to remind them that he’d already paid—and that he hasn’t paid nearly that much.
It wasn’t the couple’s first time using the cash method to save. When Eric’s wife had a hip and knee replacement due to arthritis, they got another 75 percent discount by paying a quoted all-in price up front.
What Eric Has To Say About Negotiating
Eric is an advocate for healthcare consumerism not just when it involves his bank account.
“We need to be as active in our healthcare choices as we are when we make a choice about what television to buy next,” he says. “We have to challenge ourselves. I have zero patience for the ‘I have insurance, so I don’t have to worry about it’ mindset. That drives up costs for us all.”
I spoke with M.C. Laubscher on his podcast, Cash Flow Ninja, recently about the things everyone should be thinking about when they’re making decisions about their healthcare. His listeners come to him all the time with questions about healthcare…”What should I do? How much should I be paying? How do I find better information to make smarter decisions?”
M.C.’s audience is filled with entrepreneurs and investors and the advice I have for them is perfect for anyone who is looking for individual insurance during open enrollment this fall. We talk through:
The difference between healthcare and insurance
What everyone should be doing during open enrollment to find the best insurance plan
Picking your health insurance plan for 2020 is an important decision you’ll be stuck with for the entire year. Which means it’s worth taking the time to do a little homework and make the pick that’s right for you.
Follow these seven steps to make sure your insurance plan fits your health needs and your budget.
1. Start With Your Health History
Make a list of how much you used your health insurance last year. The list needs to include physician office visits, prescriptions, diagnostic and lab work, and medical procedures.
2. Find Out What Plans Are Available To You
Identify the plans available to you, the amount of cov- erage they offer, and the amount of upfront dollars you will need to pay.
Use a chart like this to help you organize:
Premium (cost per month)
Deductible (amount you pay before insurance kicks in)
Out of pocket charges
3. See How Each Plan Stacks Up Compared To Your Expected Medical Costs
Compare the costs of every health plan available to you. Don’t automatically exclude any, even those with a high deductible. Which plan costs you the least in total?
4. Find Out What Can You Afford Monthly
Can you handle your healthcare costs in one payment or, if not, how much you can afford monthly. For example, can your pocketbook sustain $694 in monthly costs, or $8,365 annually? Be realistic.
5. See If Your Current Doctors And Hospitals Are In Network
If you go to an out-of-network provider, your copay, deductible, coinsurance, and out-of-pocket maximums will generally double. You’ll have to decide if that doctor/provider is worth it or be forced to find another doctor.
6. See What’s Covered
7. List the tax deferred mechanisms of each plan
Ask for and study all tax deferring or saving mechanisms available like premium-only plans, flexible spending accounts, health reimbursement accounts, and health savings accounts. These plans all allow you to save and use your dollars before income tax is applied, kind of like a 401K. These options are no brainers when they’re available to you since they increase the amount of money you have to pay for your health expenses.
Remember, don’t overinsure by selecting the plan with the lowest out-of-pocket fea- tures, because it will have the highest premiums, which are non refundable. This checklist will give you a clear idea of the most cost-effective plan that meets your specific needs.
You only have one chance a year to make the best choice, so do your homework!
Healthcare transparency sites give you access to information that could help you make smarter decisions and save you thousands of dollars. But not all healthcare transparency sites are created equal. Below is our list of the top healthcare transparency websites for 2019.
Be Careful Who You Trust
Healthcare transparency sites are usually built on access to real, anonymized healthcare records that allow them to analyze cost, effectiveness and provide reviews. The only problem is, sometimes this data isn’t accurate, or the site just isn’t pulling from a large enough population to provide accurate information.
The Sites That Made Our List
We’ve reviewed each an every one of these sites to make sure they’re helpful and user friendly—but most importantly, that you can trust them. They’ve earned our stamp of approval as insiders and we think you should use them.
Healthcare price transparency is a growing trend—more and more people want to know what they’re going to pay when they visit the doctor or hospital. Everyday new sites are started to help people better understand the cost of healthcare.
Bookmark this page. We’ll continue to update this guide as new sites become available. But most importantly, use these sites! The information they give you could save you hundreds or thousands of dollars.
“It’s not technically insurance—even though it is. And I can’t speak for everyone, but from my experience, there are no downsides.”
That is the way Nat Comisar describes the HealthShare program he and his wife switched to after finding the traditional route—searching on the Healthcare Marketplace (Obamacare)—to be far too pricey.
Nat was no stranger to the world of insurance, either. In the past, he was the employer who provided healthcare to his employees. When he became self-employed, he figured he’d have no problem securing insurance. After all, he was a healthy 55-year old man with no preexisting conditions and on no medications.
To the best of his memory, the best deal he could find was going to cost him $680 a month with a $7200 deductible. Because he rarely had any reason to go to the doctor in the first place, that could have amounted to almost $16,000 annually for something he didn’t even use.
So, what was next for Nat? He made the same decision a lot of people in that situation do: he went without insurance for five years, finding it far cheaper to simply pay the fine when tax time came around.
When Nat’s wife went to search in the Healthcare Marketplace, her premium was more reasonable—at first. It started at around $270 per month. Then, it started steadily increasing, all for the exact same coverage. When it approached $500 per month, Nat’s wife made the same decision as her husband: she went without insurance for about a 18 months.
While out to lunch with a friend—a friend who had just happened to be writing a book at the time about how to take control of your healthcare and save money along the way—Nat learned of an option he had no idea was out there: HealthShare.
“The way I understand it, the HealthShare Market is the way insurance is supposed to be,” Nat says. “It’s a pool of individuals who are funding a contingency for one another for health concerns.”
HealthShare programs are religion-based. Many don’t require you to be a member of that particular religion, just that you are a person of faith. Remember—each program is different, so do your research wisely.
Nat did just that, focusing on three major HealthShare companies. He ultimately chose the one that seemed easiest to join and most organized—Solidarity HealthShare, a Catholic Organization.
Practically, Nat now pays $300 a month to cover both him and his wife. Collectively, they have a $1000 deductible.
“We still don’t use any of our insurance dollars,” Nat says. “In this last year that we’ve been a part of this, I bet we’ve only spent about $400 towards our deductible. Still, it’s so worth it. A plus is that with this company, if I do get to a place where I need assistance, I can see who it comes from. I can also see where my contribution is being sent and send a message to them, if I want.”
To be eligible for this program, Nat had to pledge a few things: that he was a nonsmoker, did not use illicit drugs, and was a moderate drinker, if he drank at all. If he had any preexisting conditions (he didn’t), he’d have to declare them up front—but that would not make him ineligible for coverage. Instead, it would mean he could not be reimbursed in the first year of being in the pool, and only up to $25,000 annually the second and third years. For everyone—preexisting condition or not—there is a $1 million lifetime cap.*
Nat’s plan sends him and his wife to annual checkups, both of which are covered. There is no pharmaceutical component to his plan, but that’s okay—there are discount cards to help with that.
Sometimes, when Nat does need to use his HealthShare—which, by the way, satisfies the legal requirement for having health coverage, saving him that annual tax penalty—receptionists give him a funny look. He says he’s used to explaining from there.
“I tell them, ‘It’s HealthShare, not insurance. You should be able to file it. If you can’t, just consider us a self-pay, and we’ll file it.’”
The Bigger Picture
Nat says in the beginning, he was curious about the extent of the religious component.
“In the end, I’ve found it to be a Christian organization that is a big group of people supporting one another,” he says. “There’s not a profit motive.”
In retrospect, Nat says he wishes he would have known about HealthShare sooner.
“Before, I had 350 employees in the restaurant business. Had something like this existed—or had I known it existed—I could’ve covered everyone at 100 percent, purchased supplemental insurance, and still not have to ask for their financial participation.”
If someone who was in the business of providing health insurance didn’t know about this option, odds are that this is your first time learning about HealthShare, too. We want to be clear: this option is not for everyone, but if it turns out to be for you, you could be on the receiving end of some big savings.
*Remember that not all HealthShare programs are the same. For more information the company Nat and his wife decided to use, visit Solidaryhealthshare.org. To find the right option for you, visit HealthSharingPlans.com.
Prescriptions are expensive, but you have more resources available to help you cut those costs down than you think. Here, we’ll look at how one man saved $422 a month on his medication by leveraging a Patient Assistance Program (PAP)–and how you can get similar results.
(Yes, you did read that correctly: $422 a month!)
No one is immune to the high prices and feeling of bureaucracy that can sometimes shroud the world of healthcare and big pharma—not even Scott Heiser, who literally wrote the book on the subject.
The difference is that Scott knew what to do—and, by being here, that means you can, too.
In the past, Scott was hospitalized with deep vein thrombosis (DVT) and subsequent pulmonary embolism—i.e., a blood clot in the lungs. Scott recalls that the whole thing was a shock, kind of a “freak incident.” He talked with the physicians, who said he needed to be on a blood thinner for a year.
Together, they discussed options: there was Warfarin, an older and relatively inexpensive prescription, or Eliquis, a newer-generation drug that was more costly. Each drug—as is true for them all*—had pros and cons: Scott learned it was easier to control bleeding and coagulate more quickly with Warfarin, but he’d also to test his blood often. With Eliquis, he wouldn’t have to test his blood, and he’d have the convenience of only taking one pill a day. Although an uncontrolled bleed was not likely in his case, if he faced one, it would take him longer to coagulate.
Because Scott’s risk factors were low for needing quick coagulation—and taking into account he only needed to be on the precautionary medication for a year—he and his doctor decided Eliquis was the best choice.
The problem? It was $432 a month. Because Scott knew about PAPs to reduce consumer costs, though, he was able to get that cost down to $10 a month.
That’s that mega monthly savings we’re talking about! Hardly chump-change.
Let’s take a closer look at PAPs.
PAPs: What You Need to Know
PAPs are offered by pharmacy manufacturers to provide financial assistance to those taking a particular drug and who meet certain requirements. While each PAP is different, they generally provide assistance to those who meet one or a combination of the following criteria:
Have a high deductible health plan
Have an income of at or below a certain point
Do not have health coverage
Just as qualifications for each PAP are different, so are their means of providing assistance and reducing consumer costs. Some will cover your copay. When this happens, the pharmaceutical company still bills your employer (if they provide your insurance) the full amount—that’s just business.
“Our whole philosophy is that you, as a consumer, should understand the cost being borne by the system and be aware so you can try to minimize that cost. Why? Easy: it will pay dividends to you in the long run by keeping your premiums low,” Scott says. “If your employer’s premiums don’t go up, they don’t raise them for you, either.”
How Scott Saved Over $5,000
In the short game, though, Scott knows that money talks. And $10 is a whole lot more digestible than the alternative—which is an example of what makes PAPs so attractive.
Here’s how Scott secured the reduced rate:
He searched for the phone number of the manufacturer and called to ask if they offered any type of assistance program. (Spoiler alert: they did.)
He talked with the representative to see if he met the program requirements due to his high-deductible health plan. (Spoiler again: he did.)
The representative said he’d notify Scott’s pharmacy of his discount, which was good for 24-months. (That’s all, folks. Discount received.)
It took all of twenty minutes—for the online search and the phone call combined—for Scott to save more than $5,000 for the year he was on the drug (that, due to the timing of his hospitalization, he would’ve paid 100 percent out-of-pocket).
Today, it’s not even necessary to do your own online investigation. Instead, you can simply visit RXHope.com. This free, reference-based website lists over 330 drugs for which PAPs are available; it’s all right there for you.
Note that your drug may or may not be on the list—and if it is, you may or may not qualify for the PAP—but isn’t taking a few minutes to check worth the effort?
Discount Cards: Save $5, $50, or More!
Sometimes, a PAP may not be available for a drug you’ve been prescribed. In that case—and, really, in any case—Scott says he recommends utilizing a prescription drug coupon card.
He recalls having a prescription for Fluorouracil, a mild chemotherapy topical. He brought his coupon card (SingleCare, in this case) to the pharmacy, knowing what discount he was eligible for. The pharmacist (from a big chain store) said the cream would be $200, but—good news!—the store offered a $50 coupon.
Scott knew that with his coupon—one the pharmacist said he may not be able to accept because he couldn’t file it electronically through the store’s system—could save him $100. Ultimately, Scott requested the paperwork to file on his own, saving himself the extra $50.
The pharmacist wasn’t trying to pull a fast one; he was simply dispensing drugs and offering discounts in the manner in which he was trained. In fact, Scott even had a brief chat with him—to the benefit of others within earshot who were obviously listening—about the way the card worked as well as other ways to save on prescriptions (like visiting RXHope).
Had Scott not had the discount card and the pharmacy not offered its coupon, he would have had to pay the full $200 for the cream—in essence, meaning there was $100 that nobody would have known about that the insurance company was keeping. This shows that insurance companies aren’t passing down all the rebates to pharmacists—all the more reason to be an engaged consumer of healthcare.
Scott had a similar situation in which his wife went in to pick up a prescription for Estradiol, a hormone replacement patch. The brand name was $140, and the generic was $80. With the drug discount card, they were able to drop that price to $45—a substantial savings on any long-term medication.
At the end of the day, you want to save money on prescriptions, right? Rebates go on in the pharma world to employers and insurance carriers all the time. How do you get your own rebate? The true examples above are here to show you that it is possible to get in on that game.
As we’ve illustrated, with certain specialty or single-sourced drugs, manufactures will deal directly with you in the form of PAPs (if you meet their requirements). With other, more generic drugs, a discount card might be the way to go.
The bottom line? There is no downside to looking at your savings options—a little time could go a long way to the bank.
How much could you be saving? Once you get your prescription costs down, tell a friend. Help them. The more we speak up as consumers of healthcare, the more premiums will come down, and the more we can be a part of changing this industry.
Are you happy paying thousands of dollars in healthcare costs you don’t use? Are you angry at the medical bills you incur for services that should cost a fraction of that amount? Are you looking for answers?
This week we interview a healthcare industry insider, Scott Heiser. He spills the secrets on what is actually causing the problems in our system. He also gives us some simple tips and tricks to save yourself thousands of dollars with only a few minutes of your time...
Listen to the entire episode to learn insider negotiation techniques on The Money Tree Podcast!
Now, more than ever, prescription drug prices are expensive—especially if you have high out of pocket costs.
Specialty drugs, single source branded drugs, and repack- aged generic drugs are all escalating in cost (7 percent per year, two times the Consumer Price Index). Remember the EpiPen story? A low-cost generic solution was repurchased and repackaged by Mylan. Then, the drug manufacturer increased it from $70 to $600 without offering any product enhancements—just price increases!
If you aren’t aware of how to mitigate those costs, you might be needlessly throwing away thousands of dollars a year. Even if your insurance plan offers drug coverage, you can still use these tips to save even more money. The first step is to understand how drug manufacturers price their drugs and why they’re being prescribed.
The Questions To Ask Your Doctor To Save Money
If you’ve been to the doctor recently, you know that most visits end with you getting a prescription.
Why is that?
If you stop and think about it for a second, it makes sense. You go into the doctor expecting to be cured, and you want to walk away with something tangible that tells you you’ll get better. There are other things you could be doing to feel better, but that’s a topic for another post.
So when it comes to prescriptions, what can you do to save money?
Where To Start: Ask Your Doctor These Questions
How much does it cost?
Can the pharmacist substitute a cheaper, generic form of the medicine?
Are there cost-effective alternatives to this medication?
Does the drug company offer any discount or rebate programs?
Does the drug company provide a prescription drug assistance program?
Can you prescribe a half-year or year supply so I can buy in bulk?
Insider Tricks To Save Money On Prescriptions
So, how can you get the best price on your prescriptions? Think about it like anything else you would buy and SHOP! Here are some insider tips and tricks to save money:
Turn to big box stores.
Wal-Mart,Kroger,Costco,and even Amazon are getting into the drug business. Their goal is to get you in the door (or on the website) by any means necessary. For example, about a decade ago, Wal-Mart accomplished this by selling generic amoxicillin for just $4. Consumers came for the dirt-cheap drugs and, while they were there, bought orange juice, milk, and chicken noodle soup. It’s a straightforward model, and it still works today; you can find good deals on basic drugs at big box stores.
Use Price comparison tools
Check with your insurance plan for comparison tools. If you don’t have one with your plan or are uninsured, check with the following: GoodRx, One RX, or use our partner SingleCare’s tool on our How to Save page. They all will provide pricing for prescriptions at their negotiated prices. Compare them all. You’ll be surprised to find they are different. Also, compare one pharmacy location with one in another area of town. Sometimes there is different pricing, so it pays to look.
Note: When using one of the discount cards with your health plan, make sure the drug is on your formulary (approved drug list). Research the discount programs for the exact drug. Ask you pharmacist what the cost of the drug is through your health plan. If the discount card is lower, use it instead of your health plan. Then file that drug as a claim. You can access claims through your health insurance carriers’ web portal. It’s worth the extra effort. Check it out.
Use Over-the-Counter (OTC) First, Then Generic, Then Compare Brand vs. Brand
Generics are generally cheaper than brands. Unfortunately, you need to be aware of the industry’s trend to “patent stack” generics, significantly increasing their price (EpiPen). Therefore, check the over-the-counter alternative. Many times, the prescription for a generic scripted drug is about convenience (for instance, take one pill a day instead of two or four). Remember, you pay for that!
Also, check multi-source brand drugs (where there are multiple branded drugs, no generics, treat- ing the same symptom) and determine which has the highest efficacy: best price, similar medical outcome.
Get Your Prescriptions Through Mail Order
If you’re on a maintenance drug and your plan offers a mail order program, you may be able to save some money. If your plan has copays for a thirty- day supply, check what the copay is for the mail order at ninety days. It could be less, so it’s worth trying.
Also, the mail-order pricing may be more attractive than the retail.
Buy In Bulk. Get Your Doctor To Prescribe For Longer Periods
Did you know your doctor can prescribe a years’ worth of maintenance medication versus a thirty- or ninety-day supply? They can, and it can save you a lot. Use the highlighted shopping tools for a twelve-month supply. Currently, you can buy a year’s supply of atorvastatin, a generic statin heart medicine, for 20 percent less than buying a thirty-day supply each month for a year.
Buy In Higher Dosage And Split The Pills
Getting a higher dosage and splitting the pill may be less expensive. Ask your doctor, pharmacist, or insurance company if higher dosage and pill splitting would work in your situation.
Use Patient Assistance Programs (PAP)
RX HOPE is a website that lists over two hundred single source drugs that offer patient assistance programs based on income or for those participating in a high-deductible plan—i.e., 50 percent of the country in 2017.
These plans will offer coupons with sometimes dramatic price reductions for a set period of time. I previously highlighted the Eliquis savings, which was through a PAP ($4,440 savings/year). You can also contact the manufacturer of the drug directly and ask for avail- able coupon plans.
These are real techniques that can save you hundreds, even thousands of dollars on your prescription drugs. If you’re worried about talking about costs with your doctor—don’t be. It’s a conversation that is non threatening to them, it’s not like you’re challenging their diagnosis or treatment. Plus, they want to provide you with the best service possible, and if that means facilitating you saving on prescriptions they absolutely want to do it!
Navigating the health care system isn’t always easy, but this checklist gives you the tools you need to start saving.