New Mexico’s Health Insurance Safety Net

With so many changes to health insurance and the laws behind regulating who gets what, it is important to continue our coverage of these changes to keep you well-informed.  

Among these changes are some alterations to the pre-existing health insurance safety net. 

The first thing we will be covering in this blog post what a health insurance safety net actually is and the purpose it serves.

The Safety Net

The health insurance safety net was created to help insure the small group of people who were ineligible for health insurance. The reasons for this can vary from an employer not providing it to lack of funding to afford it on their own.

Sometimes, it can even be the insurance company’s refusal to take them on as a client because of a pricey preexisting condition. 

These ‘high risk’ individuals as they are called could essentially lose money for the insurance company and though it may not be fair that is how it has worked for quite awhile. Luckily, the safety net has been able to help some of the people in the high risk pool.

Typically, each state has one of these safety nets in place. Here, in New Mexico, that safety net comes in the form of The Alliance. 

They are a unique, non-profit organization here in New Mexico whose sole purpose is to help people and small businesses that do not normally qualify for health insurance get insured. They offer a choice of insurance types -- from HMOs to PPOs -- among other great features including:

•  Your choice in medical plans. They don’t throw you in what is cheapest. Instead, they give you options and that allows you to pick what best fits you and your lifestyle.
• No health screening. This means that you don’t need to be worried about being rejected from a company because of a pre-existing condition. This is a good thing being that some companies have the gall to call pregnancy a pre-existing condition.
• A very good benefits plan that will cover all of your bases. This means you get a physician, reoccurring visits to the doctor’s office, and even access to prescription drugs if you are sick.
• You aren’t stuck with one plan. You have to option to change annually.
• Probably one of the best features for small business employers is groups as small as 1 or 2 employees have been covered, and these only require 50% of eligible employees to be on the plan.

Getting health care can be tough in today’s day and age, but with The Alliance here to help you may not be as far away from a good health plan than you first thought.  

Getting Health Insurance with a Preexisting Condition

Health problems are a pretty big deal and it is no wonder why they can be absolutely terrifying even with health insurance coverage. What happens if you have health problems with no insurance though? 

It happens all over the country and while the health care reform is hoping to lessen the numbers of those that go without the option for health care, it can still be quite a challenge to attain the care you need for your conditions.

There are many factors as to why a company can deny your health insurance coverage, but typically it will come down to one simple factor. Just how much are you going to cost them? 

An insurance company wants you to pay in without them having to ever payout much. It is how they make their money and why many companies will deny coverage to those with preexisting health conditions.

Know Your Options

They key to getting health care when you already have some kind of health condition is to know your options and not give in easily. Obviously, your first step is to talk to your employer, find out if they have health care options, and determine what you need to do to get on the plan. 

Ask if your employer is considering adding a company health care plan in the future and respectfully make your case and explain your situation. A decent employer may be more understanding than you might think.

The reason why getting insurance through your job is your best option is because an insurance company by law cannot exclude you on a group policy because of your health condition. 

Of course, we aren’t all in the same position and many of you may not have the option to turn to your employer, so what now? 

Now you work because if you don’t work hard and push for yourself, you will not see any results and be stuck without health insurance.

You will have to contact a lot of insurance companies and be prepared to pay the fees and costly payments of having your very own policy. 

At Linton and Associates, we have prepared a list of health care providers in New Mexico that may very well be able to assist you with your dilemma. 

Be sure to check it out here. Remember that if you have any questions or concerns, feel free to contact us and we would be more than happy to assist you in any way we can. 

Group Insurance vs. Individual Insurance – It’s Not a Competition

With the Health Care Reform passed, most everyone has had a few questions on how and why things are changing and how it will affect them. 

At Linton and Associates, we have tried to answer these questions for you, but in the end there are always more to be answered.

For instance, which is better -- group insurance plans or individual insurance plans?

 Honestly, it is not about which is better but about which is better for you. In this blog post, we are going to break down what group insurance plans are and what individual insurance plans are as well as help you to identify which best suits you because, come 2014, everyone will have to be insured.

Group Insurance Plans

Group insurance isn’t something that you, as an individual, just goes out and buys; it is the most popular of insurance plans and most commonly seen in practice at the office. Group insurance is the type of health insurance that is offered to you through a company.

You pay a small portion of the premium and you get what is called employee benefits. Since your boss is dealing with the insurance company, you don’t have to worry about them, excluding some type of healthcare from the plan because of a defect in your family history.  

So, why do insurance companies offer group insurance? Well, simply put, it’s because though there is a chance of loss to be factored in. 

For the most part, health care with employees promotes good health and makes them less likely to grow severely ill with regular doctor’s checkups and such.

Not to mention that all the employees paying a monthly premium makes for good money in the insurance world. In short, group insurance is a win-win – that’s a win for both the insurance company and the people.

Individual Insurance Plans

These plans are designed for individuals. Most often, the people who opt to purchase them are either self-employed or unemployed. These plans are expensive due to being high risk for most insurance companies, and these factors have actually led to many companies not offering this service any longer. 

However, if you are self-employed and cannot access a group insurance plan, there is not always a choice, which is why many Americans go without health insurance every year.

When it comes to choosing health insurance, it always comes down to what you need and have available. 

Many people would prefer employee benefits, but they do not always have the option and so they then can choose to try and qualify for the individual plan or just not have it at all.

Linton and Associates is a firm supporter of the health care reform because everyone should have access to insurance, so we are here to help with specific group insurance solutions and individual insurance solutions that will hopefully fit your budget and needs. 

Linton and Associates Guide to Health Care Terms

If you have been to a health insurance office, talked to a representative on the phone, or ever made a claim on your policy in order to have your insurance company cover something, then you have probably heard a few different health insurance terms at some point or another. 

But, did you understand them or did they perhaps leave you feeling baffled?

At Linton and Associates, we want our customers to be as informed about what their health care involves and what all the technical ‘stuff’ means. This is why we have prepared the is guide to some of the more commonly used health insurance terms and have even explained them for you in plain English.

Key Health Care Terms and What They Mean

There are many health insurance terms and, while we can’t cover them all, we are sharing the ones we find most common and relevant below:

• Alternative Care is the action of visiting a chiropractor or homeopathic doctor for medical treatment. Not all health insurance will cover alternative care treatments.
• The Carry-Over Deductible allows the last three months of the current years deductible to be brought over into next year provided you haven’t used it all up.
• Co-pays are the fees you must pay when visiting your physician; it is typically a small amount anywhere between $10 and $40 per visit.
•  A Deductible is typically the amount you pay per calendar year to be provided health insurance.
• The Gate-Keeper is your primary doctor i.e., the expert you visit for all your medical needs and who decides if you get the prescription or referral that you are requesting.
•  Indemnity is a term used to describe a plan that covers loss, injury, and damages incurred. The amounts that are covered will vary depending on the plan.
• Insurance Broker is a company or individual that sells insurance policies. Linton and Associates is a great example of an Insurance Broker.
•  Limitations are the coverage limits that each plan has and these vary from plan to plan.
• The Waiting Period is the time that you must wait while employed with a company to fall under the company’s health insurance benefits. It is essentially a probationary period that can be compared to the type of waiting period that some companies call ‘training period.’

When it comes to medical insurance terms, the list is extensive. 

At Linton and Associates, we don’t like to keep our customers in the dark, which is why we hope that this glossary has some light on a few things. 

Remember, if you have any questions, always feel free to contact us and we would be happy to help you.

Six Million May be Taxed through Affordable Health Care Act

Over the summer, the Affordable Health Care Act was found to be constitutional and was passed. While this Act ensures affordable healthcare to the vast majority of Americans, there is a small group that could be adversely affected by it and forced to purchase healthcare or pay a tax. 

This bill left a number of people disgruntled, believing that their rights were being imposed on; overall, however, the bill will help a many number of people.

Some people have been against the bill because of the fact that it mandates health insurance upon the American citizen. Originally, it was estimated that a mere four million people would be affected by this. 

However, recent speculation has that number at or above six million by the time the bill is fully in play in 2016 with many of these people being in the middle class.

The Bill Still Helps Millions of Citizens

Six million is a lot of people, but it is actually only a mere 2% of the country’s population. The other 98% of Americans are expected to not even notice a ripple effect from the Affordable Health Care Act. 

So, this begs the question:  Does the outcry of 2% of the American population matter when in the big picture so many will be helped?

In the military, there are acceptable casualties, so should this be treated the same? Is it not our civic duty to support this country? We all have different answers to these questions and it’s our own opinions so that is okay.

Remember though, in the end, the bill is constitutional and will help millions. After all, many Americans are already covered under employer health insurance programs, which have been made out to be more enticing to said employers through tax benefits.

Our children will be included on our insurance until the age of 26 to help them along until they can find employment that will help them cover their health costs. 

Medicaid and Medicare are also being revamped in order to make things better for the people of America. Many changes are coming to health care, and these are changes with regular people in mind.

What We Do

At Linton and Associates, we specialize in insurance and we strive to help families and employers. We do this by providing affordable insurance and standing by our word and promise to treat the customer like family. 

Here you will never be just a number; instead, you are a person with specific needs and unique requirements, and we understand and respect that. 

A Summary of the Affordable Care Act

Since its earliest beginnings and before the very first draft was drawn up, there had been controversy over the Affordable Care Act. It was a bill that, if passed, would make health care readily available to the masses, but, of course, to some this wasn’t viewed as a good thing.

There had been speculation over the tax increases this would cause -- after all, someone’s got to pay for the free healthcare, right?

Nothing is Free 
We will go on ahead and start with that. The bill isn’t called the ‘Free Health Care Act’ so where people are getting the idea that certain individuals will just be getting free health care thanks to a tax increase is just crazy and unwarranted.

Sure, Medicare will still exist and there have been alterations made towards it, but Medicare is there for everyone; after all, that is why we pay into social security. Then, of course, we have Medicaid for our elderly, which, thanks to the health care bill, have been heavily altered, making things better for everyone.

Nothing is free -- the health care bill doesn’t just give everyone free healthcare. In fact, it just makes healthcare more readily available to the general public. It does this mainly by creating insurance exchanges all over the country and then enforcing the companies involved in them so as to prevent underhanded and shady tactics that some insurance companies practice.

For example, denying a diabetic health care because they know it will cost them is not going to happen anymore if the bill is properly enforced.

What the Bill Does Well
Since we just covered what it doesn’t do (hand out freebies), we can now talk about what it does do. In every way, this bill makes getting health care easier for the average Joe, who may be working at a fast food joint while in college.

 It does this through the previously mentioned exchanges which basically allow Joe to buy insurance coverage at a rather modest price.

Next, the bill greatly helps to promote businesses (small businesses, in particular) to offer health insurance to their employees. The bill does this by offering the discounted insurance prices and the more lucrative tax benefits, thus encouraging employers to do the right thing.

Not to mention the fact that health insurance does help to promote good health among employees and basically anyone who has insurance.

Simply put, the health care bill has brought a more affordable insurance option to the American public and, in doing so, has greatly helped to promote public well-being. For more information on the health care act, you can read the law here.