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What are “carve-outs” in health insurance?

Carve-out plans take specific diseases or categories of services and place them under control of a third party managed care organization. Usually, the carve-out involves higher priced services that will require additional payments from employees and beneficiaries. Some carve-outs involve specialized fields like mental health and drug abuse. The second type of carve-out creates employee […]

If an employer pays your health insurance is it taxable?

If your employer pays for your health insurance under a group insurance plan, you will often see the amount listed on your pay stub, but the payments are not taxable income. Other methods of employee health insurance coverage can be subject to income tax. The rules are complex, and the Internal Revenue Service offers extensive […]

What does “PD” stand for in health insurance?

Prescription drugs and the rising costs of them are central themes in health care in the US. As a background fact, drug prices are significantly higher in the US than in other similar advanced societies. There are many examples of designer brand drugs that cost three to four times more in the US than in […]

Medical Insurance for One Year

You may need insurance for one-year or one day. There is such a thing as short-term health insurance. Let us get that out there and in the open right out of the gate! We all have a variety of needs as consumers, and those needs give us power in one of the most competitive industries […]

What is a guaranteed issue health insurance plan?

Guaranteed-issue health insurance accepts all applicants. In its pure form, guaranteed issue treats a group of applicants as a group. Upon accepting every applicant, guaranteed issue needs an equal playing field. The insurers must use community rating and offer identical terms, prices, and coverage to each member to promote the ideal of maximum inclusion. Guaranteed […]

What is a grandfathered medical plan?

A Grandfathered health plan is one that existed before the Affordable Care Act, and that the rules excused from meeting all of the requirements of the law. Grandfathered plans may continue to serve the membership existing as of the time Obamacare went into effect. The Individual Mandate The Affordable Care Act required every eligible resident […]

What is “actuarial value” in health insurance?

The Affordable Care Act reformed the insurance industry by requiring better policy coverage for consumers. The law sought to ban flimsy policies that provided far less protection than was needed for prices that far outweighed their value. Congress weighed facts and evidence about cost sharing in major medical coverage among large groups and public employees. […]

What does a healthcare navigator do?

Healthcare navigators have become very common in recent years. The passage of the Affordable Care Act, also known as Obamacare, has made the healthcare process more accessible and cheaper for many people. However, it is also hard to navigate for some people. This is why the term “healthcare navigators” is used. Healthcare navigators help people […]

Is rhinoplasty covered by healthcare?

Many people think rhinoplasties are not covered by health insurance because they are often considered to be plastic surgery. Most rhinoplasties are plastic surgery procedures, but some are reconstructive surgery procedures. Many people get reconstructive rhinoplasties after significant trauma to their nose. Insurers generally will not cover plastic surgery procedures, but many will cover reconstructive […]

What happens if I don’t want health insurance?

If you choose not to purchase health insurance, you will most likely be responsible for paying the individual mandate penalty fine. This is a monthly fee, so you will only pay 1/12 of the annual fee for each individual month that you went without insurance. You have to pay it when you file your federal […]

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