Category Archives: Health Insurance

Just Some Friendly Advice…

September 28, 2015Group Health Insurance, Health Care Reform, Health Insurance, Healthcare updatesDebbie Sears

The affordable care act (PPACA) went into effect in 2009. Most people didn’t feel any change for the first few years.

However, on January 1, 2014, the individual mandate was enacted. This was meant to incentivize the uninsured to acquire either individual insurance, coverage through their employer or coverage through the “market place”. For those that chose not to insure, a penalty was imposed. This did not amount to a great deal of consequence as it was a low fixed dollar or low percentage of annual “household” income.

The end result was that there were more expenses incurred than there were premium and penalty dollars brought in. So, each year, if you want to look at the ACA timeline – you will see each year the provisions that are being enacted.

There are employer reporting requirements for 2015 (effective 2016, IRC Sections 6055 and 6056); upcoming in 2018, there’s the “Cadillac” tax, discrimination guidelines and new carriers in the marketplace.

At this point, I encourage anybody and everybody to reach out to an independent agent that can sit down and review all of your options and help you make choices based on the benefits appropriate for your health and the premiums that are comfortable for your budget. I also encourage you to work hand in hand with your CPA if you are a business owner.

To Everybody Who Has Parents Over Age 65, Please Listen Up!

September 21, 2015Health Insurance, Medicare, Part D, RX drugDebbie Sears

If you are 65 or older, please take note. We have limited timelines set by the Federal Government for our Part D prescription drug plans and changes for January 2016.

The annual enrollment period (you will see the acronym AEP) is October 15 – December 7, 2015 for coverage effective date of January 1, 2016. What that means is we can check your drug list and ensure that you have the right plan fit for the prescriptions you’re currently taking. This could save you a lot of money in deductibles and co-pays throughout the year.

Follow this link to MedicareBlue Solutions and if you click on “Learn”, you will see a countdown to Medicare which is going to explain to you how this Medicare enrollment process works, how you get Part A (hospital coverage) and Part B (medical coverage) of your Medicare and if you scroll down, it will address Part D of your Medicare which is your prescription drug plan.

This, I assure you, will be as clear as mud. If you feel overwhelmed or confused, please raise your hand, because if you’re honest with yourself, everybody is confused. I am here to help you and am a mere phone call away. This is one of the most concise and easy to read references that I am aware of. After you read this and get a general idea of where you’re at, call me, because everybody’s situation is different and I will be happy to guide you through the process. Don’t forget these dates: October 15 – December 7, 2015 for coverage effective dates of January 1, 2016.

Educational Resources from Wellmark!

September 14, 2015Health InsuranceDebbie Sears

Your Wellmark Plan comes with some amazing educational tips that you may not be aware of such as finding a doctor. You will save money by selecting network providers, so this would be worth the look. This can also be accessed on the goMobile App on your smart phone.

The second thing I’d like you to know is how and where to find a dentist. If your plan includes dental coverage, you can log on to find your dentist, track your claims, check your benefits and more…

And the last thing is if we are not well, there’s a strong chance that we may need a prescription, so check out a flier that Wellmark provides called 6 Tips for Saving Time and Money So You Can Get the Most Value from Your Health Plan. With the Wellmark Wellness Center, which is powered by WebMD, you will have the help you need to reach your health goals and live a healthier life. Again, you can register for myWellmark online or with the Wellmark Mobile App.

Once you’re signed in, click the “visit the wellness center” link on your home page so you can take an assessment to determine your health goals and how you can reach them. If there’s a new baby about to be a part of your life, there is a Wellmark Pregnancy Support Program that is your reassuring resource for a healthy and stress-free pregnancy. This is not intended to be a substitute or to contradict your doctor, but, we all know that a healthy beginning for your baby starts with you and we are here to help.

Health Care Rate Increases and What They Mean to You

September 8, 2015Health Insurance, Healthcare updatesDebbie Sears

If you refer to any of my previous and most recent posts, you will notice that I’m trying to educate and prepare you for rate increase letters that may be coming your way. This is not intended to create a panic; this is intended to create an awareness. Some will get this, some will not and nothing has to be done until January 2016.

Your job and my job in the interim is to reassess your needs. Has you’re health changed, has a child aged out, do you have a child leaving home for college. Let’s get current and up to date on what’s going on in your world and then I can show you all of your options and we can measure your needs and your budget for a comfortable transition and fit for 2016. Please read this article and give me a call at your convenience.

With this being midyear, it is a good time to review all of your insurance(s). This is the time of year that we review the rate increases on health care plans for 2016. Open Enrollment for 2016 begins November 1, 2015 and runs through January 31, 2016. It is a time to understand the increases and what options each of us have. By doing so, we are not trying to make decisions at the last minute in frustration. The rate increases do not affect people over 65 or persons insured on the employer groups. Within the individual market there are two groups.

So, Who Is Impacted By the Rate Increase?

Wellmark Individual grandfathered and grandmothered (Pre-ACA) members make up about 6% of Wellmark’s total business. These plans have an effective date prior to January 1, 2014. This represents approximately 110,000 members (of the total 1.7 million Iowa Wellmark members). Some members will see no base rate increase and others may see an average base rate increase ranging from about $36 to $60 per month depending on their plans.

Premium Change: What’s Driving Costs? Members used more services than anticipated.

1) There was a 300% increase in prescription drug cost and use.
2) 15% higher costs for specialty drugs, treating serious conditions like multiple sclerosis, cancer and hepatitis.
3) 9% increase in high-cost inpatient services.

Understanding Iowa Individual ACA 2016 Proposed Rates: Many factors impact ACA Individual Rates:

1) Higher Cost Claims – members in ACA plans used 30% more services – that is ALMOST DOUBLE what was anticipated. This equates to 18% more members with claims greater than $50,000.
2) More Prescriptions – members in ACA plans used 33% more prescriptions and 5 times more insulin. Higher-cost prescriptions were up by 47% on prescriptions ranging between $2,500 and $20,000 per prescription.
3) Cost of Services – for every $1 in premiums paid by members, Wellmark is spending $1.28 to pay for the cost of services.
4) Members Cancelling Coverage – 135 members cancelled their coverage after receiving several million dollars in services. There were 10% collected in premiums as compared to several million dollars paid for services.

Health Care 101

Protecting Our Members

The Medical Loss Ratio (MLR) requirement of the ACA requires insurers to spend 80% of Health Care Premiums on medical costs and quality improvement and no more than 20% on administrative costs for individual policies.

Community Approach

The basic concept behind health insurance is a community approach to sharing cost. Purchasers of insurance combine their premium dollars with other purchasers. This allows the insurance
company to pool funds together to pay for the costs of medical services for all members in the pool.

So, why does Sears Insurance prefer Wellmark Blue Cross and Blue Shield?

They are focused on improving the health and well-being of the communities they serve. They have been trusted since 1939, they have the largest network of doctors, they are owned by their policy holders, 1 in 3 (or 105 million Americans) carry Blue Cross and Blue Shield cards, helping their members live healthier lives by providing smart planning tools – that is why they are 1.7 million members strong!

I want to visit with each and every client to learn about any changes that may have taken place in your lives, such as children aging past 26 years old, new babies, travel plans for students,
vacation or work, marriage, divorce, job changes, etc. This allows me to determine what is suitable for your needs. We will review your current plan and premiums, as well as take a look at all of
your options. In doing so, we will find a plan that meets your needs and your budget.

Please give me a call today for a FREE consultation! Please visit www.searsinsurance.info for up-to-date information on my newsletter and blogs.

Thank you for your business and the professional confidence that you continue to place in me and Sears Insurance.

myWellmark Mobile App

August 31, 2015Health Insurance, UncategorizedDebbie Sears

School’s on! And I’m going to play teacher for a minute!

You will be putting the final touches on school enrollment, supplies, contact information, health insurance, etc. As we approach the first day of school.

In that laundry list, there may be the need for an athletic physical (hopefully). If you haven’t had your son or daughter in this year for their FREE physical and wellness exam offered by your health insurance, you might be able to double dip. I am attaching a couple of items that I feel are very important. One of them I’ve shared before and it’s the immunization schedules and the second one is myWellmark mobile app.

On the My Wellmark mobile app, your son or daughter (who may be a college student, living elsewhere), can find providers wherever they are for any illnesses or injuries that may come up outside of your home network of providers. Don’t forget Wellmark has you covered nationwide. I also encourage you to know where you’re at with health insurance. If anybody is taking a study abroad trip, etc. Along those same lines are immunizations. Here is a preventive care link for you. You will find adult health maintenance guides as well as pediatric and pre-natal.

It’s Only a Test

July 27, 2015Health InsuranceDebbie Sears

My Blue Community is great place to ask questions you’re not normally comfortable asking. You can ask anonymously and get feedback from other members with similar questions or interests. You can join discussions, find experts, connect with other members, get help or be of help. This is another tool provided to you compliments of Wellmark.

How Much Will It Cost?

July 20, 2015Group Health Insurance, Health Care Reform, Health Insurance, Healthcare updatesDebbie Sears

We are mid-term of 2015 and we’re all insured either individually or in a group. If there is a special qualifying event you can elect to insure and with whatever plan that suits your needs.

In the meantime, I would like to use this time to review the premium increases that we are all going to experience, look at our present coverage, see what our options look like in comparison and position ourselves for 2016.

And please call me after you receive your premium increase notification and we will discuss a date and time that works best for you.

When we make a purchase, we know what our costs will be up front; however, when it comes to our health care, which is a major expense, most of us have no idea of the cost before we schedule the procedure. There is a health care cost estimator available to you on the at myWellmark.com. Whether you’re having a baby or a knee replaced, you would be able to know by using this tool what your expected out of pocket costs should be.

If any of you are still on vacation or you have students preparing to move away for college, please note that if you go to wellmark.com/gomobile, you can download Wellmark’s free mobile App. This is good for any of us, particularly if you have students on the move. You can check the status of your claims and locate providers in your area. Please visit to see for yourself. And, don’t forget, you can also go to wellmark.com/memberdeals and use your wellmark id card to access Blue365 deals.

Health Insurance for Children

June 15, 2015Health InsuranceDebbie Sears

Did you know children can remain on their parents’ health insurance until age 26? If you have a recent graduate preparing to attend college in the fall, they can remain on your coverage in most cases. If your child is going to school in another state, it’s a good idea to call the number on the back of your BCBS member ID card for details about out-of-state coverage.

Call me so you can be sure about your students coverage. If your student is younger than 26 let’s make sure they are covered anywhere they may go!

Important Information Regarding Rate Increases

May 25, 2015Health InsuranceDebbie Sears

Sears Insurance appreciates the opportunity to serve your health insurance needs. Any time there are changes that we feel you would want to know more about, rest assured that we will keep you informed.

You may have heard the news that Wellmark has requested a rate increase for 2016. You will receive two letters from Wellmark. The first one will explain the rate increase request that is pending and the second one will provide a detailed explanation and information on public hearing schedules.

It’s important to remember that these proposed changes do not take place until the beginning of 2016, so no immediate decisions need to be made until open enrollment. Open enrollment opens Nov. 1, 2015 and runs through Jan. 31, 2016.

I am attaching a couple of easy and quick views for your reference. If you have any questions or concerns, please feel free to contact me. If you want to visit with me about plan options during Open Enrollment dates, we will show you all of your options.

Again, thank you for your business.

National Mental Health Awareness Month

May 4, 2015Health InsuranceDebbie Sears

May is Mental Health Awareness Month. As part of the ACA guidelines, mental health is a mandated covered item. We have a serious responsibility as family members, neighbors, work associates, to make a verbal awareness if somebody that we feel is “at risk”. Very seldom does a day go by that we don’t hear something that has to do with mental health, whether it be our veterans with PTSD or our children with ADHD. If you broke your arm and ignored it, you would be wrong. If you had chest pains, and I did not get you help, I would be wrong. My question is, if we know somebody that we feel is not “chemically balanced”, then let’s be compassionate and get them the care they need.