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Essential Health Benefits: Get More for Your Money

Upgrading to the Meal

That glorious moment when the server at a restaurant clarifies that your meal comes with a drink … not for an extra cost, but with. Wow, what a moment. As of January 1, 2014, your health insurance plan comes with Essential Health Benefits.

If you’ve been a Health Alliance member before, we’ve covered many of these benefits for years, so you won’t see or feel much change. But if you’re new to us, welcome and enjoy!

Essential Health Benefits stretch across 10 categories. By law, no matter your age, gender, or medical history, you’re covered in these 10 areas.

Essential Health Benefits

Details

Ambulatory Patient Services Care you get at a doctor’s office, clinic, or outpatient surgery center, including home health services and hospice care.
Emergency Services Care provided in an emergency situation where you believe your health is in serious danger, like chest pain, a broken bone, or unconsciousness.
Hospitalization Care from doctors, nurses, and hospital staff, room and board, surgeries, and transplants you receive during your hospital stay, or care in a skilled nursing facility.
Laboratory Services Testing to help a doctor diagnose an injury, illness, or condition, or monitor how well a treatment is working.
Maternity and Newborn Care Prenatal care through newborn care.
Mental Health Services and Addiction Treatment Inpatient and outpatient care to treat a mental health condition or substance abuse.
Rehab Services and Devices Services and devices to help you regain mental and physical skills lost because of injury, disability, or a chronic condition.
Pediatric Services Wellness visits and recommended vaccines and immunizations for infants and children, as well as dental and vision care for children under 19 years old.
Prescription Drugs Antibiotics and medicines to treat an ongoing condition, like high cholesterol.
Preventive and Wellness Services and Chronic Disease Treatment Physicals, immunizations, preventive screenings, and care for chronic conditions, like asthma and diabetes.

*Some services do have limits.

Affordable Care

Crunching Numbers for You

The Affordable Care Act is here to make health care affordable! Let’s run through some facts about the kinds of help you can get paying for your Health Alliance individual insurance plan, called premium tax credits and cost-sharing subsidies.

What’s a premium tax credit?

A premium is what you pay monthly to have insurance. A premium tax credit lowers your cost to make a plan affordable for you.

What is a cost-sharing subsidy?

A cost-sharing subsidy makes other health insurance costs affordable, like your deductible, coinsurance, and out-of-pocket max.

Who qualifies for help?

There’s a little math involved here. First, you need to know your individual or family income. If your income falls between 100% and 400% of the federal poverty level, you can get help from the government.

You can get government help if you’re…
An individual with a gross income* of $12,000-$46,000 a year
A family of four with a gross income of $24,000-$94,000 a year

*Gross income is everything you make in a year, before any taxes or deductions.

What’s the federal poverty level?

The federal poverty level depends on your family’s size. In 2013, it was $11,490 for a single adult and $23,550 for a family of four. You can make up to 4 times that amount and still get help!

How much help will I get?

Again, there’s a little math involved. A few tools online will do the math for you, or a Health Alliance rep can help find your subsidy amount. Call or stop by our Champaign location at 206 W. Anthony Drive, near Alexander’s Steakhouse—we’ll crunch the numbers for you.

How do I apply this help to my bill?

The only thing you have to do is pick a plan from the Public Marketplace. Any public plan will let you apply for government help. The government deals directly with us after you enroll to apply its help to your bill.

What can I do if I don’t qualify for help, but I still don’t have a lot of money? 

  1. Think about your individual risk. Your individual risk is the plan’s medical deductible added to the out-of-pocket max. This is the most you’ll have to pay (besides the monthly premium,) before a plan will cover 100% of your costs. What are you OK with paying if the worst were to happen?
  2. Pay attention to a plan’s deductible and out-of-pocket max. The higher your deductible and out-of-pocket max, the lower your monthly premium. Keep in mind that if you get sick or hurt, you will have to pay for all your medical costs until you meet your plan’s deductible.
  3. Call or stop by. It’s not a sign of weakness. It’s smart. When you need medical advice, you call the doctor. When you need health insurance insight, you talk to our helpful reps.
Young Invincibles Growing Up

Young Invincibles Feel the Love for Health Insurance

Young Invincibles

Young invincibles are young, healthy, independent, and don’t have a lot of cash to throw around, but, like everyone else, they need help when it comes to:

  • Understanding their options under the new health care law
  • Choosing the plan that’s best for them
  • Listening to their mother

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Conventional Wisdom

All kidding aside, the conventional wisdom surrounding young invincibles in need of insurance isn’t so conventional, after all. Sure, they aren’t flocking to the exchanges in droves, but they aren’t avoiding them, either.

In fact, according to this article by Aaron Smith, co-founder and executive director of Young Invincibles, as well as this press release from his organization’s website, it seems these youngsters are signing up in numbers proportional to the overall population, and possibly even at a higher rate than their older and wiser counterparts.

So good job, Mom—it turns out you raised them right!

What’s the Deal?

This may be their first time around the health insurance block, but the appeal to reason, and their very limited budgets, is bringing youthful buyers to the table. One small car or bike accident, sports injury, or even a bad case of mono could add up to HUGE medical bills that a struggling student or first-rung employee could never afford.

While many feared the typical response to the pay premiums vs. pay a tax penalty debate would be to just pay the penalty, stats show many young invincibles can do the math:

Paying a penalty and all of their potential medical costs for a year is not a good deal.

Not so Invincible, After All

It’s important to note that young invincible isn’t a title these people gave themselves. Obviously, they’re well aware it’s a big, dangerous world out there, and the smart play is getting yourself covered.

In fact, not only are your super-smart kids signing up to protect their wallets, they’re actually signing up to protect their (gasp!) health. They’re taking advantage of subsidies to buy up from the high-deductible catastrophic plans many assumed they would purchase, and investing in more benefit-rich Silver, and even Gold and Platinum, plans.

And why wouldn’t they? With many plan premiums starting under $100 a month, it’s a small price to pay for peace of mind and financial security.

Take Good Care of My Baby

So Mom, while we know you always want to take care of your kids, maybe it’s OK to let them leave the nest. And here’s something else that might ease your mind:

We’re here to help.

Keeping your family healthy and safe is a priority for us, too. Maybe you already have our group or individual plans, or know someone else who does. After all, we’ve been helping people find plans that meet their needs and situations for over 30 years, since before most of the young invincibles were even a gleam in anyone’s eye!

We have great plans, a great network of doctors and hospitals, and great people ready to explain the options, answer questions, and find the right match for your babies, as if they were our own.

Get signed up. To learn more or shop for plans, call 1-888-382-9771, visit us online at HealthAlliance.org, or stop by our Anthony Drive location in Champaign today!

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Don't Miss Your Deadline!

The End is Near: March 31, 2014

NPHIt’s crunch time, and tomorrow may be too late. We know you understand the definition of a deadline, but what happens if you miss March 31? In short, nothing good!

Let’s run through a few questions you might have about what this deadline really means and why waiting might mean less money in your bank account.

What happens if I don’t enroll in a plan by March 31?

After the deadline, an individual can no longer enroll in a plan. You’d have to:

  • Wait until the next Open Enrollment Period (in Fall 2015)
  • Qualify for a Special Enrollment Period (for example, marriage or the birth of a child).

On top of that, you have to pay a tax penalty. And that doesn’t mean you’re covered, you’ll still have to pay 100% of your medical costs!

If I wait until the end of March to enroll, will I have to pay the tax penalty? I’ve heard if my gap in coverage is more than 3 months, I still have to pay.

As long as you’ve completed the application process by March 31, an exemption will keep you from having to pay a penalty on your 2015 tax returns.If you want to learn more about this exemption, visit the CMS’s Enrollment Period FAQ.

Does enrolling in a Short-Term plan save me from the tax penalty?

No. Individuals on short-term plans will pay the penalty on their 2015 tax return (unless they meet an exemption).

Can I change my plan after March 31?

No. You’ll have to wait until the 2015 Open Enrollment Period to make changes to your plan.

The only exception to this rule is adding a newborn. You have about a month to add your new little bundle of joy to your plan.

You can cancel your plan at any time, but depending how long you go without coverage, you may have to pay a penalty.

How will the government really know whether I have insurance?

Great question. When you submit your federal taxes in 2015, the forms will have a new question about health insurance coverage. Health insurance companies, like Health Alliance, will also have to send the IRS info about who has a coverage with us.

You still have time to enroll in a plan.  And we’re here to help you find one that fits your needs (yes, even if it’s in the last 10 minutes!)

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In Case of Emergency

ER Care vs. Urgent Care

Your 2-year-old has an earache. You slip and sprain your ankle. You’re feeling chest pain. Do you know where you should be getting care in each of these cases?

It can be hard to know, but it’s important because if you go to the emergency room when it’s not actually an emergency, your insurance may not pay for your care.

A trip to the ER is usually the most expensive kind of care. The average ER visit costs more than the average American’s monthly rent.

If you don’t need help right away, you can save time and money by setting up a same-day appointment with your doctor or going to an urgent care or convenient care clinic. These usually have extended hours, you don’t need an appointment, and many clinics have them.

But when something happens and you need care right away, you should know which things you should go to an urgent care location for, and when you should go to the ER.

Emergency Room or Convenient Care?

Earache

Visit convenient care. This needs care to keep it from getting worse, but it won’t pose a serious health risk if not treated immediately.

Sprained Ankle

Visit convenient care. This injury isn’t life threatening, but you may need medical attention to treat it.

Chest Pain

Go to the ER. This could because of a serious problem and is normally considered a medical emergency.

A trip to the ER is usually the most expensive kind of care. If you don’t need help right away, you can save time and money by setting up a same-day appointment with your doctor or going to an urgent care or convenient care clinic. These usually have extended hours, you don’t need an appointment, and many clinics have them. Carle, for example, has a few convenient care options.

Let these examples be your guide to where you should go:

Emergencies

Urgent Care Situations

  • Shortness of breath
  • Chest pain
  • Poisoning
  • Broken bones
  • Fainting, seizures, or unconsciousness
  • Sharp wounds
  • Serious bleeding
  • Constant high or rising fever
  • Migraine headaches that don’t improve
  • Uncontrolled vomiting or diarrhea
  • Bronchitis
  • Severe allergic reactions
  • Cuts, even minor ones, that need closed
  • Constant high or rising fever
  • Migraine headaches that don’t improve
  • Uncontrolled vomiting or diarrhea
  • Bronchitis
  • Allergies and asthma
  • Cold and flu
  • Minor infections, like bladder, sinus, or pink eye
  • Rash or sunburns
  • Sprains and strains
  • Back and neck pain
  • Muscle or body aches
  • Earache
  • Strep throat
  • Minor cuts
  • Minor work illness or injuries

 

It’s not always easy to know if you should go to the emergency room, especially when you need to act fast. The key is to trust your judgment. If you believe your health is in serious danger, it’s an emergency.

Understand Blood Pressure

Understanding Blood Pressure

Getting your blood pressure checked is nothing new. But do you understand it all?

What Exactly Is Blood Pressure?

Blood pressure’s the force of your blood pushing against the walls of your arteries. High blood pressure, or hypertension, is a common disease when that pressure of the blood flowing through the blood vessels is too high.

If your blood pressure gets too high, it can cause serious damage which can lead to blockage which can cause heart attacks, strokes, and heart failure.

There are 2 main types of high blood pressure:

  • Primary high blood pressure is the most common type and it tends to develop as you age.
  • Secondary high blood pressure is caused by another medical condition or use of certain medicines and it usually goes away when this issue is treated.

Risk Factors for High Blood Pressure

  • Age – Men usually develop it around age 45 and women after age 65.
  • Race – High blood pressure and serious complications are more common for African Americans.
  • Family history – It tends to run in families.
  • Certain chronic conditions – Kidney disease, diabetes, and sleep apnea can raise your blood pressure.
  • Stress
  • Pregnancy
  • Being overweight
  • Not being physically active
  • Tobacco use
  • Too much salt
  • Too much alcohol
  • Too little potassium
  • Too little vitamin D

If you have some of these other risk factors, your doctor may set your blood pressure target lower.

What Are the Numbers?

  • Systolic is the pressure in your arteries when your heart contracts, the top number.
  • Diastolic is when your heart rests, the bottom number.

 What Are They Doing?

When a nurse takes your blood pressure, you might wonder what they’re doing. These are the steps they’re following:

  • They wrap the blood pressure cuff around your arm.
  • They place a stethoscope under the cuff at the crease of your elbow (where the major blood vessel of the upper arm is.)
  • They inflate the cuff until it stops the flow of blood.
  • They slowly loosens the cuff’s valve to let the blood start to flow again and listen for sounds in the blood vessel.
  • Then, the first tapping noise they hear, they’ll note as the systolic number, the maximum pressure when the heart contracts.
  • The taps fade, and they note the pressure at the last tap as your diastolic number, the minimum pressure while your heart’s at rest.
  • Along with your numbers, they note which arm they took your blood pressure on and how you were positioned, like sitting with your feet flat.

 Where Should My Numbers Be?

Systolic Measure

Diastolic Measure

What to Do

Normal

Below 120

Below 80

Maintain a healthy lifestyle to avoid raising your levels.

High-normal

120 to 139

80 to 89

Make lifestyle changes.

High

140 to 159

90 to 99

Make lifestyle changes. Possibly start a low-level diuretic.

Extremely High

160 or higher

100 or
higher

Often 1 or 2 meds are required right away, plus lifestyle changes.

Source: Consumer Reports, “onHealth”, Volume 23 Number 2

It’s also normal for your blood pressure to change when you sleep, wake up, are active, and are excited or nervous.

If you’re worried about your blood pressure, keep an eye on your levels and take them with you to your next appointment. A broad look at your numbers can help your doctor put you on the right track for heart health.