Tag Archives: Health insurance

How to Find Health Insurance


Do you have health insurance? Even if you do, do you still feel like you pay a lot for your medical expenses? Here’s the point: do you know what the #1 cost of personal bankruptcy is in the U.S.? Medical bills. Want to know a very easy way to rack up huge bills? That would be using the emergency room as your source of care. The average cost of a visit to the ER for over 8,000 patients across the U.S. was $2,168, according to a recent study funded by the National Institute of Health. Look at these average costs (the interquartile range (IQR) represents the difference between the 25th and 75th percentile of charges, looking at the wide discrepancy in charges).

Can you afford this without insurance (or even with insurance, given your co-pays and deductibles)? This Straight, No Chaser post is the first of your empowerment series. Remember, health empowerment starts with knowledge. Remember it’s the above types of charges that you’re trying to avoid.

Did you know that according to the Census Bureau, there are still about 27.5 Americans without health insurance as of 2018 (that number was estimated to be as high as 50 million prior to the implementation of the Affordable Care Act, aka Obamacare)? 2018 was also the first year since 2008-09 for which there was an increase in this number. Draw your own inferences about why this is the case (or just look at the below picture!).

Insurance Options

Where do you start if you don’t have insurance? What should you do if you have insurance? What if it’s an emergency? Let’s go through a series of options you have available to you that you may not know how to enlist.

How do you choose affordable insurance coverage if you don’t have a job, your job doesn’t provide health benefits, or if you just don’t have enough money to afford it? Work through the following steps.

  1. Look For Coverage Through Your Spouse or Domestic Partner. If you have a spouse or partner, there’s money to be saved by piggybacking off the other’s coverage. Explore this option before accepting a new plan that requires you to pay more.
  2. Explore the Health Care Marketplace as Your First Stop. This is especially the case if you’re otherwise uncovered or are an entrepreneur or small business owner. It’s also especially applicable if you have a pre-existing medical condition. Go to healthcaregov.org for details.
  3. Medicaid: In more than half the US, state Medicaid expansion accompanied the Affordable Care Act. This has resulted in the number of people qualified to receive Medicaid increasing dramatically. It’s also included many above the poverty line who previously hadn’t been eligible. Google your state insurance commissioner for your specific set of qualifications.
  4. Medicare: You can qualify for Medicare if you receive Social Security disability benefits or if you’re age 65 or older. Check with the Social Security Administration for your eligibility.
  5. Consolidated Omnibus Budget Reconciliation Act (COBRA): COBRA is another short-term coverage option. It might be for you if you’ve been laid off or aren’t working. It’s especially appropriate if you had insurance through your former job or otherwise participated in a group health insurance plan. This is great for access but is a more expensive option than the health care marketplace.
  6. Workers Compensation: If you are being treated for a workplace injury, your state’s workers’ compensation program might have health care solutions for you.

Less Obvious Insurance Options

  1. Short-Term Health Insurance Coverage: Short-term coverage is available! Think about this if you need to avoid gaps while searching for other options. A simple Google search will point you in the right direction in your state.
  2. High Deductible Health Plans: A high deductible “emergency” policy is another way to maintain a low-cost health insurance plan. However, it’s akin to making a bet that you won’t get ill. Maintaining a Health Savings Account (HSA) for smaller health issues will probably save you money in the long run. 
  3. Group Insurance from Organization Memberships: If you belong to any kind of membership organization (e.g. an alumni association, professional organization, business bureau, independent worker associations), it’s worth asking if they have a health insurance plan. These also provide reduced health insurance premiums for their members. You don’t have to go the route of employer-provided insurance.
  4. Group Health Expenses Sharing Plan: These health expenses sharing plan involves a group of people pooling money together to pay each other’s health care costs. They operate a bit like their own insurance company. Members’ pooled contributions are invested and are usually reserved to pay major medical expenses. These plans aren’t typically used for basic day-to-day health costs like checkups or small procedures. Group health expense sharing plans aren’t insurance plans, so they’re not regulated in the same way as insurance. Look into the history of any of these plans before you join one.
  5. Health Care Sharing Ministries (HCSMs): A health care sharing ministry (HCSM) is another example of a group of people with shared beliefs creating a health expenses sharing plan. An HCSM is a non-profit entity, so again, it’s not health insurance and it’s not regulated in the same way. This alternative to insurance often include provisions that accommodate the beliefs of the group. As a result, procedures (e.g. abortion) that are deemed objectionable would not be covered. 
  6. Health Insurance Discount Cards: These aren’t insurance options but a way of obtaining discounts on medical services. They provide low-cost health services in exchange for a membership fee. They also don’t offer any medical reimbursement but lower your costs when you use the services of members participating in the plan. 

These are options. However, the question many of you have remains unaddressed: what if you believe you can’t afford any of these? Well actually you can; some of the above have eligibility based on financial status, such as Medicaid and Medicare. It’s up to you to do the work and discover where you’re eligible.

Furthermore, this is why health prevention is so important. This is why the rest of the health empowerment series focuses on what you can do to swing the pendulum away from waiting to need sick care toward being proactive with preventive and self-care. Stay tuned.

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Straight, No Chaser: Sign Up For the Affordable Care Act – Today's the Deadline


Over 6 million of the previously 50 million American medically uninsured have already signed up for the Affordable Care Act (ACA aka Obamacare). Have you? Let’s consider this an open forum. Today is the deadline for signing up without penalty. It’s important that you realize what that means. I’m willing to answer any questions you have on signing up, penalties for not signing up and what it means to be enrolled.  In the meantime, refer to these past Straight, No Chaser blogs and refer to the governmental site at www.healthcare.gov.

I welcome any questions or comments. To get you started, here’s five quick points you should know.

  • In order to sign up, go to www.healthcare/gov or call 1-800-318-2596.
  • You can also buy policies directly from insurers. However, you won’t be eligible for premium tax credits that can reduce your costs. Those who purchase on the exchange and have an income between 100% and 400% of the poverty level may get tax credits to reduce their costs.
  • If you fail to sign up, the fine is $95 or 1% of your income after $10,150 — whichever is higher — for a single person this year. However, that penalty increases over time and with the size of your family.
  • To be eligible for health coverage through the ACA Marketplaces, you must live in the U.S. and be a U.S. citizen or national. You also can’t be in prison.
  • The cost of insurance vary dramatically, based on your income and family size. Check www.healthcare.gov for details.

Good luck, and good healthy!
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Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight, No Chaser: A Solution to the Upcoming Healthcare Crisis and the Affordable Care Act

Many of you have heard or seen me discuss various aspects of the Patient Protection and Affordable Care Act.  This ambitious effort seeks to maintain the current level of quality that exists (via maintaining the same insurance coverage for those individuals that already have it), while adding approximately 30 million individuals to the insurance rolls while not increasing overall system costs.
Have you noticed that one part of the conversation that doesn’t seem to occur is “Who’s going to take care of these 30 million new individuals? Also, what about the other 20 million that still won’t have insurance?” The twin deterrents of co-pays and deductibles will eventually be stiffened to curtail over- and inappropriate utilization of the emergency room for both the newly insured and the uninsured voucher recipients (Besides, who wants to deal with the long wait times both in your physician’s office and the ER, soon to be even worse with all the newly insured?). Similarly, you would presume that armies of new physicians are being trained to meet this growth in the newly insured, but that simply isn’t the case. Additional options to address this influx will be necessary. Prominent among these options will be those providing better education and greater empowerment of patients to direct their own care.
Sterling Medical Advice (SMA) is a national public health initiative that provides a solution to these issues by the introduction of 24/7 online personal healthcare consulting, featuring physicians and other care professionals covering the entire spectrum of medicine and healthcare. Consultations will be personalized and immediately available to those in need around the clock.
“What’s that, and when might you use it?” Here are a few examples.

  • You need advice regarding an immediate medical concern
  • You need general information about your medical condition
  • You need immediate information about your prescription
  • You are experiencing symptoms and want to know why
  • You want to learn more information about a medical condition that is part of your family history
  • You want additional details on your upcoming medical procedure
  • You need advice regarding the best care option for addressing a medical concern (e.g., emergency room vs. urgent care vs. scheduling an appointment with your primary care physician)
  • You want a second opinion on your new diagnosis
  • You want a second opinion on your new treatment plan
  • You need additional information about what to expect from a newly diagnosed condition

Sterling Medical Advice will improve public health outcomes while reducing healthcare costs for individuals, families and businesses and the healthcare system at large. Personal healthcare consulting will create a better-educated and empowered population and will become an additional component to the American health care system without compromising quality.
To find out more about Sterling Medical Advice, visit www.sterlingmedicaladvice.com, and thanks for following Straight, No Chaser.

Straight, No Chaser: Revisiting the Affordable Care Act – How You or Your Employer Can Save Up to 50% of HealthCare Costs


Politics aside, I’m not so sure why business owners are focusing on the angst of implementation of the Affordable Care Act instead of the opportunities to save.
Consider the following from the Small Business Association website: “The Affordable Care Act (ACA) creates new incentives for employers to promote wellness among employees by creating supportive, healthier work environments and encouraging employees to take advantage of workplace wellness programs. Health-contingent wellness programs generally require employees to meet a specific standard related to their health, e.g., decreased tobacco use or lowered cholesterol levels. Under the ACA rules that take effect on January 1, 2014, employer rewards will increase from a 20–30% refund of their healthcare coverage costs for employing health-contingent programs, up to 50% for programs designed to prevent or reduce tobacco use.”
Subscribing to www.sterlingmedicaladvice.com as an employee benefit will save companies up to half of the insurance costs they are already paying for their employees.  These savings can occur at a cost of less than 10% of current costs of insurance! For more information about the final rules’ flexibility in eligible wellness programs, visit www.dol.gov/ebsa.  Have your employee assistance program administrator contact us at 1-866-ADVICE3 (238-4233) or email us at sales@sterlingmedicaladvice.com.

Looking to cut your ACA tax in half? Sign up with SMA, reduce absenteeism, win the appreciation of your employees, and save a bundle.
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Straight, No Chaser: It's October 1st – Do You Know Where Your Affordable Care Act Health Insurance Exchanges Are? Your Top Ten Questions


No politics here folks, just facts. The bottom line is the Affordable Care Act (ACA) isn’t going anywhere prior to implementation, so let’s look at where things are. You can go here for previous comments on the ACA.
1. What changes today? The exchanges as scheduled to open for administrative business and to begin signing up customers. This is expected to affect approximately 30 million Americans who previously had not been covered by insurance plans. However, online enrollment has been delayed until November. It is still thought this won’t delay the onset of benefits.
2. Do I qualify for an exchange? You do if you are an employee of a business with less than 50 employees and have to buy your own insurance, and if you currently can’t get insurance because of a preexisting medical condition, or you can’t afford the cost.
3. So do I have insurance today if I enroll? No. Benefits begin on January 1st.
4. What about the individual mandate? It’s still in effect. Starting January 1st, most Americans must either be insured or face a fine.
5. What about the employer mandate? It’s actually been delayed until 2015. This mandate requires any company with over 50 employees to offer benefits to anyone working more than 30 hours a week.
6. Is any of this affected by the governmental shutdown? No. In short, funding for the ACA is not under the control of Congress.
7. How do I know what’s happening in my state? 16 states plus the District of Columbia are setting up their own exchanges. The other 34 states  are being run either totally or partially by the federal government. Refer to the lead picture to see what your state is doing, then go to www.healthcare.gov for details.
8. How does the insurance provided by the exchanges compare with that of traditional insurance? Different exchange plans will have different levels of coverage (eg.bronze, silver, gold and platinum). You’ll get to select a plan based on your needs.
9. What about the costs? This is tricky. Obviously, the plans differ based on the one selected. Additionally, if you’re below 400% of the poverty level (which equals $45,960 for an individual and $92,200 for a family of four), you’ll be eligible for tax credits to bring down the costs of the respective plans. In general, the costs of individual insurance within the exchanges will be dramatically lower than private insurance for those who qualify.
10. Where do I sign up and/or get more information? Try www.healthcare.gov.