Archive for the ‘State Health Insurance’ Category.

From state to American state, rules and rates for health insurance will vary, and these changes may affect the amount that you pay for your health insurance (as well as the coverage that is provided to you). If you want to know about health insurance in Texas or health insurance in New York, you need a resource that offers you a wealth of free health insurance information. Luckily, we are here to provide you with a detailed archive that is chock full of practical and factual information about health care insurance rules and prices.

For example, the way health insurance is sold in the American states will be changing in a big way. Over the next two years, it will be possible to use state insurance exchanges to get a better price on your health insurance premiums. If you’re unaware of upcoming state exchanges and other initiatives related to the Patient Protection and Affordable Care Act, our web page will prove to be an excellent resource that will help you to plan for tomorrow while you investigate health insurance today.

Browse Our State Pages for Detailed, Clear Information

Everyone wants cheap health insurance that doesn’t break the bank; however, the cost of health insurance may vary depending on where you live. To be sure that you’re getting the best deal on health insurance in Texas or in any other American state, scroll down this page and peruse our concise, informative and factual articles. Our writers work hard to bring you the latest information related to buying affordable health insurance in any American state. The best way to enjoy our web page and its various benefits is to bookmark it and check in frequently. If you’re shopping for health insurance, you’ll likely do a little bit of research before you make a final decision. Whenever you have a free moment, visit our bookmarked page and read a couple of articles about health insurance rules and guidelines for every American state.

Once you’ve built up a good foundation of knowledge, you’ll be ready to explore some other elements of our website, such as our other archives. Each web page on our website features a special category filled with articles on that subject. For example, if you’re looking for health insurance for a child or children, you should check out our family health insurance archive. If you need health insurance for your employees, be sure to drop by our group health insurance archive.

In a nutshell, we offer everything that you need, and all you need to do is browse our different web pages. Once you feel secure in your knowledge of health insurance rules and types, you will be ready to fill out our form, where we host a one hundred percent free service that puts health insurance quotes at your fingertips. You may call our representatives to get your free quotes, or you may use our convenient email form. The choice is yours, thanks to our versatile and user-friendly interface.

Arm Yourself with Knowledge

People who don’t understand what they’re buying tend to get ripped off or to get a worse deal than they could. If you don’t really understand health insurance, you’re not in a good bargaining position when it comes to working out a deal with a small or large health insurance provider. However, our web archives make it possible to arm yourself with knowledge that you can “take to the table” when it comes time to do a deal with a health insurance company.

For example, once you read about health insurance deductibles and the ways that they can be used to lower monthly premiums, you’ll know how to reduce your monthly payments for the cheapest health insurance possible. Without the tips and tricks found at this website, you’ll have a tough time finding the affordable health insurance that you need. If you’re buying health insurance for a family, you may have to spend a grand or more a month just for basic family health insurance. However, there are ways to lower these big costs, and we outline them in our archives.

Make the most of your next health insurance expenditure – get educated at our website, and then comparison shop with the best free quote service on the Internet. Our representatives are standing by to help you connect with reputable insurance agents that live right in your own area. Call or email today to get the best deal on affordable health insurance that still gives you your desired level of coverage.

State Guidelines are Important

State guidelines for health insurance are important, and they do change dramatically now and then. New political administrations adjust rules, and ripples of change begin to appear in state regulations and stipulations. If you need concrete, current information about health insurance in Texas or in any other American state, be sure to spend some time at our archive today.

Over the next two years, until full implementation of the provisions of the Patient Protection and Affordable Care Act in 2014, the greatest change in health insurance on a state-by-state basis will involve the establishment of insurance exchanges. A primary aspect of the Obama health care reform measure, the exchanges are intended to create a public marketplace where consumers who are not covered by job-related health benefits can purchase coverage at competitive rates.

The process of establishing these exchanges, however, is being hampered by uncertainties about the state-federal relationship that underpins the effort. The law allows for single states to design their own exchanges, to develop them in partnership with neighboring states, or to allow the federal government to take the lead in administering the exchange within the state’s borders.

The relationship between state and federal rights has long been fundamental to the American political debate. At the same time that many state budgets have been strained beyond the breaking point by the recession that began in 2009, the state governments are still loathe to relinquish their prerogatives to the national government, even in exchange for federal funds. This is a greater problem in the states of the south and west, where adherence to the concept of states rights is more dearly held.

For consumers in the coming two years, this likely presages a mishmash of confusing insurance regulations that will not only affect the quality of their health care, but the condition of their wallets. With the transition to the new health care legislation in full swing, it is now more important than ever to know what insurance laws apply in your state and never to make assumptions about insurance when moving from one state to another. A further kink will be thrown into this already tangled mess if the Supreme Court rules against the provisions of the Affordable Care Act that would require all Americans to carry health coverage by 2014. The only given is that in coming months everything you thought you understood about insurance in your state is likely to change.  

The 2010 Patient Protection and Affordable Care Act

The 2010 Patient Protection and Affordable Care Act is an extensive document that will, over the next two years, affect the manner in which individual health insurance is handled and priced in the U.S. and how key state programs are administered.  

Health Care Exchanges

A key provision is the establishment of American Health Benefit Exchanges in each state, a process currently underway, but proceeding slowly. The Exchanges, which are to be fully implemented by 2014, will make premium and cost-sharing credits available to consumers who make 133-144% of the federal poverty level. Currently, for a family of three, that would be approximately $25,390.   Separate exchanges will be established to benefit small businesses who want to purchase insurance and make coverage available as a job benefit to employees.  

Federal Poverty Level

The Federal Poverty Level was established as a measurement standard to aid government agencies in setting eligibility levels for assistance programs including Medicaid.

Household Size100%133%150%200%300%400%
1$11,170$14,856$16,755$22,340$33,510$44,680
2$15,130$20,123$22,695$30,260$45,390$60,530
3$19,090$25,390$28,635$38,180$52,270$76,360

For a more complete breakdown of the federal poverty level, and specific levels for Alaska and Hawaii, see FamiliesUSA.org

Types of Insurance Exchanges to be Created

Under the provisions of the Affordable Care Act, each state has flexibility in contracting with health plans, but all plans must meet a set of minimum federal requirements for eligibility.   Exchanges that include all qualified health plans will be termed as “clearinghouse” exchanges, while those that include only selected plans or that give consumers an option to negotiate premium prices will be “active purchaser” exchanges.  

Temporary High-Risk Pools

In 2010, as a temporary measure until health insurance exchanges are functioning in each state, the federal government, in conjunction with the states, created temporary high-risk insurance pools specifically for adults with pre-existing conditions who have been excluded from other forms of coverage either by direct denial of coverage or by virtue of coverage limits.   (It should be noted that under the provisions of the Affordable Care Act, no child, in any state, can be excluded from health care coverage due to a pre-existing condition, with the same protection to be extended to adults in 2014.)   Known as the “State Pre-Existing Condition Insurance Plan,” this temporary coverage is currently available in 34 states. Citizens and legal residents of the U.S. with a pre-existing condition who have not had health insurance for the previous six months may apply for coverage through these high-risk pools.   The Affordable Care Act allotted $5 billion for the administration of the temporary pools to be used for claims and administrative costs over and above premiums collected from participants. The temporary high risk pools will be in place until January 1, 2014 when the exchanges become fully operational.  

National Health Insurance Requirement

A hotly debated aspect of the Affordable Care Act is the national requirement, set to take affect in 2014, for all citizens to carry health insurance. The U.S. Supreme Court will debate the constitutionality of that provision after hearing arguments in March 2012.

Federal Assistance Programs: Medicare and Medicaid

The primary social insurance program administered by the federal government in the U.S. is the Medicare program, which provides health insurance to citizens age 65 and over, those under 65 with permanent disabilities, or those who meet special criteria for specific conditions.

Medicare

Medicare is a complex system involving four parts:

  • Part A – hospital insurance
  • Part B – medical insurance
  • Part C – Medicare Advantage
  • Pard D – Prescription Drug Plans

The coverage is most often only a portion of an older person’s health insurance coverage, with supplemental or sanctioned Advantage plans addressing gaps in coverage.   Due to the aging of the American population, in particular the Baby Boomers, Medicare coverage is expected to encompass 79 million people over the next two decades.  

Medicaid

Under 1965 amendments to the Social Security Act, medical assistance to qualifying low-income became available via the Medicaid program. (This is the same law that created Medicare.) Before the establishment of Medicaid, low-income health services were provided through a confusing welter of state and local initiatives, private charities, and public hospitals.   There are three basic types of health protection provided through Medicaid:

  • Aid to families with children and to the disabled.
  • Long-term care for the elderly and the disabled.
  • Supplemental coverage for low-income Medicare beneficiaries for services not covered by that program.

Currently, Medicaid is the third largest provider of health insurance in the nation after employment-based medical coverage and Medicare. Medicaid is considered the largest of all the federal “safety net” programs, servicing some of the most vulnerable segments of our society.  

Medicaid Eligibility

Eligibility for Medicaid assistance relies on a combination of factors, but is basically tied to income as a percentage of the current federal poverty level.

  • Beneficiaries must qualify as low income.
  • Income thresholds are determined by the states.
  • Beneficiaries are divided into categories, for instance pregnant women, or the disabled.
  • The availability of other assistance programs in the state is also considered.

Broad federal guidelines exist to guide states in determining which services will be covered by the program, as well as the amount of care (in terms of scope and duration), which can  be extended to specific categories of qualified recipients.   For more information, see the website Centers for Medicare & Medicaid Services at www.cms.gov.  

Children’s Health Insurance Program (CHIP)

The State Children’s Health Insurance Program was implemented in 1997  to protect children who fall into the gap between private and public health insurance coverage. Federal funds were given to the states, who then devised their own means of implementing the assistance.  

COBRA

Under the terms of the Consolidated Omnibus Budget Reconciliation Act of 1985 or COBRA, and similar laws at the state level (known as mini-COBRAs), when an employee loses his or her job, the employer must offer that employee and any qualified family members the chance to buy the insurance coverage that was a benefit of their job status. The law, in general, affects employer with group health plans who, in the past year paid 20 or more employees. Depending on the event leading to the COBRA qualification, the continuation may last for 18 to 36 months.

For more information see: http://www.dol.gov/dol/topic/health-plans/cobra.htm  

Health Insurance Portability and Accountability Act of 1996

In 1996, Congress passed the Health Insurance Portability and Accountability ACT (HIPAA) establishing a national standard for the transfer of health-related data and it security. Privacy right are addressed in the same legislation.   For more information on HIPAA see: http://www.privacyrights.org/fs/fs8a-hipaa.htm  

Directory of State Department of Insurance Sites


Wyoming Health Insurance (WY)

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All of the states are currently reviewing their existing insurance laws to come into compliance with the 2010 Patient Protection and Affordable Care Act, which is enacting health care reform on a progressive schedule toward full implementation in 2014. Currently, children may no longer be excluded from coverage based on pre-existing conditions, and they may remain on their parents’ health insurance up to age 26, regardless of their educational or marital status. Adults with pre-existing conditions may now draw on temporary high risk pools for insurance protection until the federally required health insurance exchanges become operational on January 1, 2014.

General Insurance Regulations

Insurers in the state of Wyoming must include a guarantee of renewability in their health policies. Currently, exclusions for pre-existing conditions may be in place for up to 12 months, with a six-month look-back period. Babies and adopted children are covered for a minimum of 31 days if dependents are already included in the policy. Health status can be used to set rate levels and to deny coverage, however a policy cannot be canceled due to illness.

Health Care Exchange

Currently Wyoming is studying its options for the creation of the federally required health care exchange, but no substantive action is expected in 2012. If action is not taken by January 1, 2013, the U.S. Department of Health and Human Services will take over responsibility for the exchange.

Pre-Existing Condition Insurance

The U.S. Department of Health and Human Services runs the Wyoming Pre-Existing Condition Insurance Plan to provide primary and specialty care, hospitalization, and prescription medication coverage. According to age and option, monthly premiums run from $126 to $542. Deductibles range from $1000 to $3000 with maximum annual out-of-pocket expenses capped at $7000.

Medicaid

Medicaid eligibility is based on income figured as a percentage of the Federal Poverty Level. In Wyoming, all children under age 5 are Medicaid qualified at 133% FPL. Those from 6-19 may draw benefits at 100%.

Pregnant women are eligible at 133% FPL, parents at 48%, and non-elderly disabled Social Security beneficiaries at 74%.

Medicare

Approximately 14 percent of the population of Wyoming draws Medicare coverage, with more than 75,000 accessing prescription drug coverage.

Wisconsin Health Insurance (WI)

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All the states are faced with bringing their insurance regulations in line with the requirements of the 2010 Patient Protection and Affordable Care Act, the legislation that is implementing progressive stages of health care reform in the United States. Children are now protected against coverage exclusions and refusals for pre-existing conditions and may remain on their parents’ health policies to age 26 regardless of educational or marital status. Adults with pre-existing conditions may seek temporary coverage through high-risk insurance pools that will be replaced on January 1, 2014 by health care exchanges.

General Insurance Regulations

Health policies in Wisconsin must carry a guarantee of renewability, but currently exclusions for pre-existing conditions can be permanent with an indefinite look-back period. Rates may be raised on the basis of health status, and applicants may be denied for the same reason. A policy may not, however, be canceled due to illness. Newborns and adopted children must be covered for a minimum of 60 days if the policy already covers dependents.

Health Care Exchanges

Wisconsin is continuing to study its options for the creation of a health care exchange, but progress has been limited to investigating the necessary information technology and taking feedback. Currently any further action is on hold pending the Supreme Court decision on the constitutionality of the individual insurance mandate contained in the 2010 Patient Protection and Affordable Care Act. If no further action is taken, the federal government will assume responsibility for the creation of the Wisconsin exchange.

Pre-Existing Condition Insurance

The Wisconsin Pre-Existing Condition Insurance Plan program is run by the Health Insurance Risk-Sharing Plan (HIRSP) Authority, and offers benefits for primary and specialty care, as well as hospital stays and prescription medication. Premiums fall in the range of $94 to $754 with deductibles of $500 to $3500. Out-of-pocket limits are set at $1000 for medical costs and $2000 for pharmacy expenses.

Medicaid

Recipients qualify for Medicaid based on income as a percentage of the Federal Poverty Level, the same formula applied for benefits through Children’s Medicaid and Children’s CHIP-funded Medicaid Expansions. Infants under the age of one year qualify for Medicaid at 300% FPL, and for CHIP at 133%. Those ages 1-5 receive Medicaid benefits at 185% FPL, while the 6-19 age group is at 100%.

Pregnant women qualify for Medicaid at 250% FPL, parents at 200%, and non-elderly disabled Social Security recipients at 93%.

Medicare

Approximately 15 percent of the residents of Wisconsin draw Medicare benefits, with more than 877,000 accessing prescription drug coverage.

West Virginia Health Insurance (WV)

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Health insurance companies have many requirements, provisions and regulations that they must comply with and that they impose upon insured people. The residents of West Virginia need to be aware of these provisions and regulations as well as what their rights are to best protect their needs and the needs of their families. Also, West Virginia has many options for residents regarding health insurance.

West Virginia Health Insurance Requirements

Health insurance companies in West Virginia must follow the guidelines required by HIPAA, the Health Insurance Portability and Accountability Act. The act was enforced in 1996 by US Congress in an effort to better protect patient privacy rights. HIPAA basically requires that any health information or medical records cannot be released without obtaining a signed authorization.
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Washington Health Insurance (WA)

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Many people are discussing the impending changes that are expected for health insurance, but consumers are in need of knowledge about their current health insurance needs too. There are many requirements, regulations and provisions that greatly affect the outcome of health insurance for people today. Individuals with a better understanding of these rules and their rights can make better decisions to protect themselves and their families.

Washington Health Insurance Requirements

The state of Washington is responsible for complying with HIPAA. The Health Insurance Portability and Accountability Act, also known commonly as HIPAA, protect private information for patients. Per HIPAA, no medical records or health information can be released to anyone without signed authorization. Furthermore, HIPAA mandates how medical records and information can be transferred electronically.
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Virginia Health Insurance (VA)

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Each of the individual states must review its existing insurance regulations to bring them in line with the requirements of the 2010 Patient Protection and Affordable Care Act. Children may no longer be excluded from coverage for pre-existing conditions, and must be allowed to remain on their parents’ health coverage to age 26, regardless of marital or educational status. Adults with pre-existing conditions may currently draw on coverage from high-risk insurance pools, a temporary solution to be replaced on January 1, 2014 by the federally mandated health insurance exchanges.

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Vermont Health Insurance (VT)

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With the passage of the 2010 Patient Protection and Affordable Care Act, each of the states is faced with reviewing its insurance regulations for compliance with federal law. Major changes are already in place nationally regarding the handling of pre-existing conditions. Children may no longer be excluded from insurance coverage based on such conditions, and they are allowed to remain on their parents’ health policies up to age 26. (This is true regardless of educational or marital status.)

Adults who suffer from pre-existing conditions may seek insurance via high-risk pools, a temporary arrangement until January 1, 2014 when health care exchanges will begin to operate in each state.

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Utah Health Insurance (UT)

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All states are currently in the process of revising their health care regulations to come into full compliance with the provisions of the 2010 Patient Protection and Affordable Care Act, which has already made significant changes to how insurance is handled for given groups. Children, for instance, may no longer be denied coverage on the basis of a pre-existing condition.

Current Insurance Regulations

In Utah, all health insurance plans have guaranteed renewability, and cannot be denied renewal or be canceled on the basis of health status. Currently, pre-existing condition exclusions can be imposed for as long as 12 months, with a six-month look-back period.

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Texas Health Insurance (TX)

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With the 2010 passage of the Patient Protection and Affordable Care Act, all states are in the process of examining their insurance regulations with an eye toward federal compliance. A major change already in effect is the prohibition against excluding children from coverage on the basis of a pre-existing condition. Also, children may now remain on their parents’ health insurance up to age 26, regardless of educational or marital status.

Currently, adults with pre-existing conditions can access coverage via temporary high risk pools, an arrangement that will be replaced on January 1, 2014 by the federally mandated health insurance exchanges.

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Tennessee Health Insurance (TN)

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With the passage of the 2010 Patient Protection and Affordable Care Act, state insurance regulatory agencies were tasked with reviewing existing policies to come into compliance with federal law. A significant change already in effect is the prohibition against excluding children from coverage due to the presence of a pre-existing condition. Additionally, children may continue to be listed on their parents’ health policies up to age 26, regardless of their status as students or even if they have married.

Adults who have a pre-existing condition may currently seek coverage through temporary high-risk insurance pools. This arrangement will be replaced by the federally mandated health insurance exchanges on January 1, 2014.

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South Dakota Health Insurance (SD)

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The passage of the 2010 Patient Protection and Affordable Care Act has necessitated a re-evaluation of existing health insurance regulations by the individual states. Major changes wrought by the law already extend to the handling of pre-existing conditions, which can no longer serve as the basis to deny children health insurance coverage. Additionally, children are now allowed to be carried on their parents’ insurance up to age 26 regardless of either educational or marital status. Adults with pre-existing conditions may currently access coverage through high risk pools, a temporary system that will be replaced on January 1, 2014 when the health insurance exchanges mandated by the Affordable Care Act become fully operational.

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