Blue Cross Blue Shield of NC Can Help You Understand the Affordable Care Act

A couple of posts ago, I wrote about the Affordable Care Act of 2010. I didn’t expect we would have an answer so soon. As you probably know, the Supreme Court upheld the ruling that mandating health insurance coverage is constitutional.

So what does the Affordable Care Act mean for you?

  • All of us must have medical insurance starting in 2014 or face a penalty tax of $95 or 1% of your income, whichever is higher.
  • Parents can cover their kids under their BCBS health insurance plan in North Carolina until they are 26 years of age
  • If you have no coverage, you will have to get insurance quotes and buy health insurance from an independent agency by 2014
  • Low income earners can qualify for Medicaid if you earn 133% less than the federal poverty level (currently $14,856).
  • If you earn up to  400% of the poverty level ($44,680) and you don’t have health insurance from your job, you may be eligible for federal help to purchase a health insurance plan
  • Federal tax credits are available to businesses with up to 25 employees if they want to provide health insurance coverage
  • Businesses with 50 or more employees must offer health insurance to them
  • Over 200 employees? Health insurance enrollment in the company’s health care plan is mandatory
  • Finally, by 2014 no one can be denied health insurance coverage because of a pre-existing condition

This means a lot of different things to a lot of people, and there are three variables that will affect each person’s opinion and use of the health system: Job security, your health, and finances.

A mother or family with a chronically ill child requiring continual care will certainly feel different than a healthy 30 year old who doesn’t think he needs health insurance, and is made to pay the government tax.

What do I believe? Since I’m a cancer survivor, it is comforting to know that Blue Cross Blue Shield will not deny me coverage, and that my out of pocket costs for deductibles and co-payments are capped at 30% of the total cost of my insurance.

Politics aside, we will have a long way to go before the problems in health insurance quotes, coverage and implementation are resolved. No plan will ever be perfect. Do you think we’re closer now? Call me if you want to understand how your health insurance quote may change based on the Supreme Court’s ruling. I can help you compare plans and know your options for the best coverage and costs available. Blue Cross and Blue Shield of North Carolina has innovative programs, and wants to help decrease the costs of our health care system. I love helping people, and would love to help you find the best insurance match for your family.

Health Insurance for Starter Families

Starting out in life is tough and starting out with a family can be even tougher. You want to do everything you can for them and, just in case, you want them protected. One of the most important types of protection is Health Insurance.

 Why Health Insurance?

 Health insurance protects you and your family from the high cost of medical care. In the most basic form you pay a monthly premium and the provider offers certain coverage.  One common fear is the cost of health insurance but imagine what the consequences could be of not having coverage.  Medical bills from a small playground accident can delete any savings and a major illness could put you into bankruptcy.

 Comparing Plans

 There are basically two types of plans, Traditional or Indemnity and Managed care.

Indemnity also known as ”Fee for Service” generally covers illness and accidents. There are no provisions for preventive care (flu shots, birth control, yearly wellness checks). And they may not offer prescription coverage. A big advantage is that you will have more freedom as to choice of doctors but you will pay for it with higher premiums.

 Managed care is what most of us are more familiar with. These include HMOs (Health Maintenance Organization) and PPOs (Preferred Provider Organization). HMOs offer lower premiums by offering care through a network of doctors and hospitals.  Co-payments are generally lower and prescriptions, preventive care and mental health are covered.

 PPOs are like a combination of the “Fee for Service” and the HMO. You have the option to use doctors out of the network but you will pay a higher portion of the cost. Using doctors within the network will save you in out-of pocket-costs which could include co-payments, deductibles, or other fees that you are required to pay outside of your health benefits plan. Premiums for PPOs are generally higher.

 Choose a health Plan

 Health insurance can add to the family budget, but there sensible ways to save money by shopping wisely. If you look around you will find options.  If your employer offers insurance you should take advantage.  You will almost always get a better premium with group or employer-subsidized plans.

 Whether you are getting insurance coverage through your employer or you have to buy it yourself it is important to do your homework and pick the plan that is right for you. Another good idea is to investigate insurance brokers. A broker has access to multiple providers and can help you make the right choice. Some questions you should ask your broker or while shopping around:

 – Does the plan cover the services I may use? Are there any pre-existing conditions, do you plan on having children. Does their network cover favorite doctors or hospitals?

– Prescription cost, how much they cover, what they cover. Do you have any special prescription needs?

– What are the co-payments?

– What are the deductibles? A common mistake is to choose a high deductible to keep the premium low. This could actually prevent you from getting care if you can’t cover it so keep the deductible realistic.

– What expenses have t be paid before reimbursement

 Before you make a final decision with a company take a few minute and get online and check them out. Look for things like complaints or high dropout rates. Look for accreditations and memberships. Purchasing health insurance is one of the most important decisions you will make for your family and it is a choice that needs to be made wisely.

Medicare Annual Enrollment

You probably have noticed an increase in TV ads regarding early enrollment for this year, October 15 through December 7. Due to the changes in policies, this earlier open enrollment allows time to receive updated policies and insurance cards for the beginning of the year to avoid delays and uninterrupted coverage for 2012. The insurance options seem so daunting and so complicated, most people find it easier just to let the policies they have in place, simply renew on their own rather than delve into the options available that could potentially save money.

The recent passage of the “Affordable Care Act”, will reduce premiums for the majority of beneficiaries while receiving more benefits and lower prescription costs. The new plan allows for an Annual Wellness visit with your primary doctor without a co-pay or deductible. This also includes mammograms and gynecologic visits. This new legislation also gives those in the “donut hole”, greater discounts for brand name drugs and expanded coverage for generic prescriptions. An easy way to compare plans, and you don’t have to be computer savvy, is go to and check out the Medicare Plan Finder. This page allows you to compare last years plans with the available options in the plans for 2012. They also have a 5 star quality rating system which lets you view the higher quality ratings for the past three years and the projected rating for 2012. Every individual is different and each have very different needs, but if you will take the time to sift through the many options, you will get a better understanding of what you need and what is available while navigating the insurance maze.

BCBSNC is the largest provider of Medicare supplement insurance in NC. The Medicare Advantage organization has a Medicare contract which, in simplistic terms, means more physicians accept BCBSNC than any other plan. There are substantial savings for you in terms of clarifying if your physician is an in-network carrier or out-of-network carrier, he either accepts BCBSNC or he doesn’t. This doesn’t mean you can’t go to an out-of-network physician, it just means you will pay more for the services. It is always advisable to check with your physician before hand to verify your coverage as this can change from year to year.

Here is a simple check list to get started:

  1. Define what your needs are in health insurance,

a. lower cost office visits

b. lower prescription costs

c. higher deductible with lower premiums

  1. Go to and read up on available options and changes in your policy
  2. Contact your physicians insurance specialist to verify your insurance is accepted with their firm
  3. Do a little homework so you get a basic understanding of the insurance lingo. Another website for overall information is

If you still find this too complicated, find an authorized licensed BCBSNC health agent and they will be more than happy to help assess your needs and provide you with a recommended plan that will compliment your Medicare.

Blue Medicare Advantage Open Enrolment

There are changes coming for Medicare Advantage and Part D plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013. For Medicare supplement plans, the changes occur on June 1 of each year.

 For over 77 years, Blue Cross and Blue Shield of North Carolina (BCBSNC) has provided quality health care coverage for North Carolinians. And we’re committed to providing you with affordable Medicare coverage.

For more information or answers to you questions contact me at 800-438-5834 or my website: or find me on Facebook;

 For Medicare Advantage and Part D plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013. For Medicare supplement plans, the changes occur on June 1 of each year. Please contact BCBSNC for details.

For over 77 years, Blue Cross and Blue Shield of North Carolina (BCBSNC) has provided quality health care coverage for North Carolinians. And we’re committed to providing you with affordable Medicare coverage.