What Does My Premium Payment Pay For?
Before you blame the health insurance companies for being “greedy”, it’s important to note, there is a clause in the Affordable Care Act that is called the Medical Loss Ratio (MLR).
This Medical Loss Ratio states that insurance companies must pay a minimum of 80-85% of all the dollars they collect in premiums towards medical bills they receive (claims). In other words, if an insurance company collects $100 in a premium, $80 to $85 MUST pay a medical claim.
If at the end of the year they have collected too much from their members, they must send their members back a “rebate” check or give the members a credit for a future premium. So that leaves the insurance company the remaining 20% to pay all of their expenses (employees, buildings, marketing, broker costs etc). Within the 80-85% ratio’s, the insurance company can also spend money on things that improve healthcare quality. This medical loss ratio requires all insurance companies to send detailed reports to the Government about money being spent. The reports are a big responsibility and are very time consuming for the insurance companies to comply with.
When you hear someone talk about their premiums going up, have them read this definition and explanation.
Getting a Refund
We read an article a while back stating that the residents in Florida, almost 1 million customers, received a $65 refund because of this rule. The insurance company collected too much money in premiums and had to refund their customers the overage collected. Here in Nevada, we’ve had many customers receive a medical loss ratio refund too.
Your Health Insurance Benefits
Health insurance is very expensive these days. Your ACA qualified health insurance plan must cover these 10 “essential health care benefits”.
- Outpatient Treatment “Ambulatory Services”
- Emergency Care
- Hospitalization
- Maternity and Newborn Care
- Mental Health and Substance Abuse
- Prescriptions
- Rehab services and devices
- Laboratory
- Preventive / Wellness
- Pediatric Services – dental and vision
All of these services alone are very expensive, but ACA Qualified health plans must cover all of them. Prescription coverage alone accounts for a huge percentage of your premium.
Seeking Guidance With Nevada Insurance Enrollment
Navigating through the many options of insurance can be confusing and chaotic, but speaking with a locally licensed insurance agent will help you obtain the right coverage. You’ll have the peace of mind knowing that you are adequately insured when life complications arise. We work hard to find the most competitive quotes for your needs. Contact us today to begin the process of finding the best insurance plan for your family.
Recent Posts
What is Co-Insurance?
Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.
Health Insurance Coverage Effective Dates
Once you have picked a health insurance policy and paid your first month’s premium, you probably expect your coverage to begin immediately. However, depending on when you enrolled and under what circumstances, you may have several weeks before your health insurance coverage takes effect.
Health Insurance ‘Metal’ Plans Explained
Health insurance companies that sell plans on the Health Insurance Marketplace can offer four types of qualified health insurance plans, including Bronze, Silver, Gold, and Platinum. The plan you choose determines not only the premium you pay but also what portion of your health costs you pay.
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Recent Posts
Are Fertility Services Covered by Health Insurance?
Even if you live in a state that requires health insurance coverage for fertility treatments, there may be certain requirements that you have to meet to have services covered. For example, if you have unexplained infertility, you might only qualify for in vitro fertilization after a period of time or a specified number of in-vitro cycles.
Affordable Care Act Pros and Cons: Will It Last?
While a lot of good has come from the law, there have been serious downsides as well, leaving many to wonder whether the ACA will stand the test of time or be repealed and replaced.
What is Covered By Obamacare?
Preventive services are covered under the Affordable Care Act at no cost to the insured. This means there is no co-payment or deductible. There are specific services provided for all adults and specific benefits provided to women and children.
What Happens If You Forget To Pay Your Premium By The Due Date?
Life happens, and while you should make every effort to pay your health insurance premium on time, health insurance plans generally will have grace periods. You may have a grace period of 30 days, or if your insurance plan is through Nevada Health Link (on-exchange), it may be up to 90 days.