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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.
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Friday Health Plans: Who Are They?
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Recent Posts
How Much Auto Insurance Coverage Do You Need?
While auto insurance can be pricey, Nevada Insurance Enrollment can help you find the right balance between great insurance coverage and an affordable auto insurance premium. Understanding the options available to you, what coverage you’re required to carry, and evaluating your exposure to risk are good first steps.
Auto Insurance Coverage When Driving in a Different State
Auto insurance coverage can be confusing, largely because insurance laws and requirements vary greatly from one state to another. As a Nevada driver, you’re required to carry liability insurance in the amounts of 25/50/20 (learn more about state minimum coverage here). However, in states like Arizona where coverage runs cheaper, state minimum coverage is a little skimpier.
Health Insurance Plans for Year 2019 and Beyond
According to a recent study, health insurance premiums could increase for individual plans on the ACA marketplace between 35 and 94 percent by 2021. Concern over health care is nothing new; in fact, this is the fifth consecutive year that Americans have ranked health care as a top concern.
Health Insurance Could Become The Wild Wild West Once Again
At least for now, many aspects of ACA are still in place. Currently, an insurer can’t turn you away for a pre-existing condition, and long-term health insurance plans still have to provide coverage for ACA’s 10 essential health care benefits. Prior to 2010, private health insurance usually did not cover maternity, or preventative like it does now, and mental health was generally non-existent.