What Medications Will Your Insurance Be Dropping?

In the world of prescription drug insurance, there are medications that are covered by a health plan and some medications that are not covered. The list of drugs that are covered is known as the Prescription Drug Formulary (or “Formulary” for short).

What is a Prescription Drug Formulary?

If you’ve ever visited a pharmacy with a prescription in one hand and your insurance card in the other, only to be told that your medication is not covered by your insurance… but if your doctor is willing to change the prescription to a similar drug used to treat the same condition… you have first-hand experience of a Prescription Drug Formulary.

The formulary is a list of approved medications for which an insurer has agreed to help cover the cost. However, there might be multiple manufacturers of numerous drugs designed to treat the same condition. This is an opportunity for the insurance company to trim costs by only agreeing to cover one drug for each health condition.

For pharmaceutical manufacturers, this can be a very big deal to be included or excluded from an insurer’s formulary list. Accordingly, each health plan generally reviews its coverage list on an annual basis. This helps ensure they continue to get the best possible price-points for the competing medications that are available to treat high-cost health conditions.

For patients, this can mean that, each year, they may discover the drug they had been taking is no longer covered. This may require them to switch to an alternative medication to continue receiving help paying for the medication from their insurance provider.

What If My Drugs Are Excluded?

It may also be worth double-checking the cash-price (i.e., the price without insurance) for your current medication. You can also contact your insurance company for a copy of their current formulary to review with your physician to see if an alternate medication is acceptable, which can lead to additional savings.

Since 1984 we’ve been working with individuals, families and small companies throughout California to provide complete and unbiased information, so you can make an educated decision for your health insurance needs. If you have questions about your coverage, or would like to explore other health plans, I hope you’ll feel free to contact us anytime.

Nick Whitney

CA Lic #0M47855

ABenefitStore.com

Open Enrollment Deadline

certified_agent_logo_color1772340034452824557.jpgThe deadline to apply for health benefits under Covered California is quickly approaching. The open enrollment period closes on January 15, but to have coverage starting at the beginning of the new year you must enroll before December 15.

According to Covered California, as of November 30 more than 90,500 new consumers signed up for benefits. That is ahead of the pace set in 2016, when Covered California delayed its marketing until after Election Day.

Covered California says they estimate 1.1 million uninsured residents are eligible to enroll for coverage and they may even be eligible for financial assistance.

“While we know that the financial help offered through Covered California is the big motivator for many people to enroll, with the penalty removed we do expect some consumers to roll the dice and go without health coverage, “said Covered California Executive Director Peter V. Lee. “We also know that life can change in an instant, and it’s important to have health coverage when it does.”

According to Lee, the average Covered California enrollee pays about $5 per day for coverage, but many consumers pay far less. One out of every three Covered California consumers who receives financial help can purchase a Silver plan – which provides the best overall value – for $50 or less per month. Nearly three out of five of these consumers can get a Silver plan for $100 or less per month.

If you or someone you know are planning to enroll in a new plan, or change your current plan, I hope you’ll feel free to contact us.

Since 1984 we’ve been working with individuals, families and small companies throughout California to provide complete and unbiased information, so you can make an educated decision for your health insurance needs. I hope you’ll feel free to contact us anytime.

Nick Whitney

CA Lic #0M47855

ABenefitStore.com

Obamacare Individual Penalty is Zero in 2019

Starting next year, the penalty for not having health insurance drops to zero. The change is due to last year’s Republican tax bill. The Congressional Budget Office estimated that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.
Some people who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement. For others, it’s simply an issue of affordability. Almost 90% of Covered California’s enrollees receive financial help in the form of tax credits to pay for their health coverage, but those whose incomes are too high to qualify for tax credits are having to pay 100% of the escalating monthly premiums.
According to a new study, up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsured rate for residents under 65 to 12.9%. The individual market would suffer the biggest losses.
Covered California, the state health insurance exchange, predicts that enrollment in the individual market — both on and off the exchange — could drop by 12% next year. Exchange officials also blame the end of the penalty for 3.5% out of a total 8.7% average increase in premiums, because the departure of some healthy people from the market will lead to a sicker and costlier insurance pool.
If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium.
Since 1984 we’ve been working with individuals, families and small companies throughout California to provide complete and unbiased information, so you can make an educated decision for your health insurance needs. I hope you’ll feel free to contact us anytime.
Nick Whitney
CA Lic #0M47855
ABenefitStore.com

Access to Care Matters

A recent report found that 13% of Americans live in a county with a shortage of primary care physicians and the problem is more common in rural areas. It’s expected to get worse in the coming decades, especially since only one in six medical school graduates picked a primary care residency program last year.
Nurse practitioners and physician assistants have recently taken on a larger role in primary care. Health experts say those roles will help fill primary care gaps in the coming years with physician shortages expected.
The report also found 51% of the office visits for employer-sponsored insurance were for primary care physicians in 2012. Four years later, that percentage dropped to 43%. Overall, office visits to nurse practitioners and physician assistants skyrocketed 129% between 2012 and 2016. Office visits to specialists and other non-physician providers remained similar between 2012 and 2016.
“Many factors likely influenced the trends described in this brief, including state policies, variation in insurance benefit design and changes in access to different types of providers,” according to the report.
The report didn’t explore how age or demographics may influence the trend. Patients, especially younger ones, often want convenience and don’t feel as connected to a specific primary physician. Those patients are more likely to get care beyond a usual doctor’s office visit.
Care through nurse practitioners and physician assistants might be thought of as a lower-cost solution to primary care physicians, but the report found similar costs for office visits. PCP office visit costs were $106 in 2016 and $103 for nurse practitioners and physician assistants. So, while those visits may offer greater access to care and more convenience, they might not provide lower-cost care.
Shopping for health insurance has become more complicated over the years, with narrow networks and access to care being a high priority.
Since 1984 we’ve been working with individuals, families and small companies throughout California to provide complete and unbiased information, so you can make an educated decision for your health insurance needs. I hope you’ll feel free to contact us anytime.

Nick Whitney
CA Lic #0M47855
ABenefitStore.com