In 2010, proposed rules were issued and approved by the National Association of Insurance Commissioners (NAIC) for measuring the Medical Loss Ratio (MLR). The MLR is part of the Affordable Care Act (ACA), a law that puts into place comprehensive health insurance reforms that is intended to hold insurance companies more accountable, will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans. The MLR is the amount of every insurance premium dollar that insurance companies have to spend on medical costs or improvements to quality of care. This amount, which has been established at 80 cents (small groups and individual policies) to 85 cents (large group policy holders) of each premium dollar, has been an integral factor in the ACA’s efforts to control health insurance premiums.

The remaining 15 to 20 cents can be used for expenses such as payroll, advertising, overhead and profits that do not directly benefit customers. Companies that fail to meet this test must rebate funds to subscribers. For example, if an insurer collects $100 million in premiums for large-group coverage but spends only $75 million on legitimate medical care, the insurer would have to return $10 million to the policyholders. In 2010, Cigna Healthcare’s medical-loss ratio to date was 82.3% whereas BlueCross BlueShield of Tennessee’s most recently calculated medical-loss ratio from December for both group and individual under-65 plans was 85.3% percent.

The hotly debated topic is what counts as “health care.” The criteria can vary widely from company to company. Individual plans allocate much more of their premium dollars to administrative costs compared to large group plans, according to a study published in April by the Senate Commerce Committee. Proponents of the MLR believe that this will be an ideal way to regulate premium increases and keep insurance premiums lower, while opponents believe that such regulations will discourage insurance companies from investing in administrative services such as information technology and other medical management systems, which could save consumers money in the long run.  According to Bob Laszewski, president of consultancy firm Health Policy and Strategy Associates, “This will absolutely have unintended consequences and the consumer will suffer.”

At the last minute the NAIC, backed by the Department of Health and Human Services (HHS), amended the proposal to allow the insurance industry to count marketing campaigns performed in conjunction with state and local public health departments as medical expenses. As a result, insurance companies would be allowed to count their collaborations with public health departments as quality improvements. This means that partnerships between private, for-profit health insurance companies and cash-strapped public health departments for such things as public health campaigns would be included in the expenditures of your premium dollars to improve your health.

Currently, there are few legitimate public-private partnerships. The ones that do exist most often take the form of marketing campaigns which focus on public health issues such as smoking cessation. If this rule stands, industry experts believe the private sector will slowly start to infiltrate public health territory and the following will occur:

1. Premium dollars will be spent on marketing campaigns re-classified as “health awareness”
2. The legitimate existence and funding for real public health department initiatives will be weakened as the energies of scarce public health staff are used to determine whether particular insurance company campaigns are genuine or not
3. Public health campaigns such as cessation of smoking can help insurance companies identify and then “cherry-pick” customers, either excluding smokers from coverage, or charging them more (excess charges remain legal even after new rules take effect in 2014)

The insurance industry is also lobbying to avoid counting investment income, or the taxes they pay on investment income for purposes of calculating the MLR.  According to industry experts, these are the taxes that they should be paying to support state and local health departments.

One thing is for certain, Health and Human Services has to certify the NAIC’s recommendations before they take effect. This could entail a long, drawn out struggle. As Americans face a mandate to buy health insurance starting in 2014, consumers want assurance that health care companies will spend their money on medical care.

On June 1st of 2010, the decision was made to end the COBRA subsidy, which effectively increased the health insurance payments of all unemployed individuals by 65%.  This news, while unfortunate, was just another article I had written.   However, a recent development has shown me first hand, just how unaffordable COBRA health insurance is for unemployed persons.

Earlier in 2010, my girlfriend was let go from her job and now her health insurance runs out at the end of the month.  Should she want to continue her coverage, the cost is a few pennies shy of $450 a month.  Had the subsidy still been in place, the cost would have been south of $200.  While at her job, she didn’t have to pay a dime for health insurance so up until last week, this was an absolute blessing.  But now, as she begins unemployment filings and the new job search, that number is just ridiculously high to try and pay.

When you consider just how much of a person’s salary that is, realize that with unemployment, the average take home amount is just over $1,000.  With rent (or a mortgage) and COBRA insurance, most people would already be out of money and we haven’t even talked about the other necessities in life like food and utilities.

Reading the plights of others online soon made me realize that the $450 price tag is actually quite low compared with what others are paying.  In some cases, workers are asked for payments of more than $750 a month on their health insurance and that’s with a $3,000 deductible.  So with 21 days left and counting, we’re doing our best to get her checked out for anything and everything.  We’ve got appointments lined up day in and day out and God-willing, we can close the month knowing there’s nothing wrong and hold out for a bit until a new job (and a new three-month waiting period) is acquired.

But that may not be an option for everyone.  Even though we’re working off of a bad situation, we’ve had a few lucky breaks.  The lay-off at the beginning of the month has given us time to take care of a few things that others cannot.   And having this health-care has already allowed for a few check-ups and tests so with her being in her 20′s and in good health, the risk of not having health insurance is low.  Certainly not a risk I prefer taking but considering the situation, a necessary one.

The primary alternative we now have is to find a health care plan for her on our own, and even though we’ve already decided on the no health care option, I still visited eHealthInsurance.com to see what kind of plans were available.  We’ve reviewed their site in the past and actually found a fair amount of plans that were priced at 60% of what the COBRA payments would be.  Different providers offered different coverage amounts, copays and deductibles and if we were in dyer need of a health plan, that is certainly the place we would pick it up.

Considering the high price that needs to be paid for COBRA insurance after losing a job, I just can’t see the value in paying it, rather than finding a discount health plan in it’s place.  I’m sure there are unique circumstances and previous health conditions that make finding a new policy just as, if not more difficult and costly but for us, the only option is not to pay.

On June 1st, COBRA subsidies expired, meaning newly unemployed individuals can no longer be eligible to receive a 65% deduction on their current health care plan if they chose to keep it after becoming unemployed.  For example, let’s say John Q was laid off on January 1st, 2010.  COBRA allows John to continue his health-care plan for up-to 18 months following his termination, so long as he pays 100% of the plan costs.  Now, most unemployed individuals cannot afford to pay 100% of their health-care insurance making COBRA a somewhat unaffordable solution however the government passed a subsidy in 2009, which paid for 65% of  health care premiums for unemployed individuals for up-to 15 months.  So if John Q had a $1,000 a month premium, he would only have to pay $350 to remain insured.  Sweet Deal.

Unfortunately, after a few extensions, it is no longer a reality.  Any newly unemployed individual as of June 1st 2010 still insured through their old place of employment will be require to foot 100% of the bill.  Obama and members of Congress were hoping to extend this subsidy well beyond June, possibly to December, however the bill never made it to vote.  It would appear that discounted medical insurance for newly unemployed workers has become a dead issue.

Now, Obama is asking Congress to pass an “emergency” $50 billion aid package, to be distributed to local and state governments, for the continued employment of teachers, police officers and firefighters.  The current unemployment rate is 9.7%, which is just about where it was a year ago and without this aid, it most certainly will begin to climb.  The possibility of our economy being worse-off than it was a year ago seems odd considering how much money has been thrown into this problem but it’s looking more and more like a feared reality.

Should another $50 billion be given to retain jobs that could be lost?  Seems like there is a bigger problem at hand here in that every time there’s a problem, the only solution is to fix it with money.  The United States ran out of money a long time ago, so what now?  Feel free to express your feelings on the issue in the comments section below.

Now let’s take a look at the best money articles from this past week.

Handling a Major Oil Spill in Your Own Life @ US News: With BP struggling to find ways to end this oil spill once and for all, there are lessons that can be learned.  Apply what you’ve seen to your own life,  preventing major financial spills in the future.

Paper Currency Certainly Isn’t What It Used To Be @ Personal Finance By the Book: There’s going to come a time very soon when cash is no longer a way of life.  Read up on how cash has evolved in the last 250 years and where it could be headed next.

Life is Like a Budget? @ Enemy of Debt: If you sat down every morning and budgeted your time for the entire week, how accurate do you think you could make it?  The more hectic the life, the more difficult the budget and so is true with your financial life.

The Unexpected Downside of Short Selling Your Home @ Debt Kid: With all of the expected downsides, it’s difficult to find one you may not be anticipating but if you read this article, you may be surprised learn of one you haven’t thought of.

Seven Habits of Financially Healthy Couples @ Money Smart Life: I was expecting all seven of them to be compromise but it seems that there are six other habits.  Huh.

Workplace Discrimination or Harrassment?  Fired For Being to Pretty @ The Digerati Life: A woman claims to have been fired from her job at Citibank because she was too pretty.  What will they think of next!

4 Skills That Employers Are Looking For In Any Job Market @ Money Crashers: The long you’re on the hunt for a job, the more stressful it can become so make sure your resume includes these four skills no matter what you’re applying for.

Good health is important to everyone and these days health insurance is a necessity that you can’t afford to be without. If you can’t afford to pay for health insurance right now, you might be eligible for Medicaid. Medicaid can make it possible for you to get the care you need to get healthy and stay healthy. Certain low income individuals and families may qualify for Medicaid if they fall into an eligible group that is recognized by the federal and state government.

Medicaid sends payments to your health care provider and depending on the rules in your state, you may be required to pay for a portion of the cost of some medical services. Medicaid is administered by each state and it is up to the state to set the eligibility guidelines. This article mainly focuses on some of the guidelines that have been established for the state of Ohio. The basic elements of Medicaid are the same throughout the country, but the eligibility guidelines and the services provided through Medicaid can differ from state to state.

Who Qualifies for Medicaid In Ohio

Ohio Medicaid provides coverage to the following groups of people:

• Children
• Pregnant women
• Families with children younger than age 19
• People with disabilities
• Older adults (age 65 and older)
• Certain women screened for breast and/or cervical cancer
• Other Types of Assistance: Medicare Premium, Disability Medical, Refugee Medical, Alien Emergency Medical

To qualify for Medicaid, a person must meet these basic requirements:

• be a U.S. citizen or meet Medicaid citizenship requirements
• be an Ohio resident
• have or get a social security number
• meet certain financial requirements

Programs for Children, Families and Pregnant Women

Ohio Medicaid offers two programs: Healthy Start and Healthy Families. Healthy Start is for children and Healthy Families is for families and pregnant women with limited income. Once eligible for Medicaid, each child (birth through age 20) will have access to an important group of services known as HealthChek.

HealthChek is Ohio’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. It provides a group of services to children and teens (birth through age 20) which include: prevention, diagnosis and treatment. The purpose of HealthChek is to discover and treat health problems early. These services are marketed as HealthChek to parents as a set of preventive health screenings with follow-up diagnosis and treatment. If a potential health problem is found, further diagnosis and treatment is covered.

Healthy Start

Healthy Start (also called SCHIP) is a Medicaid program available to:

• Children (younger than age 19) in families with income up to 200% of the federal poverty level.
• Pregnant women in families with income up to 200% of the federal poverty level.

Healthy Families

Healthy Families is a Medicaid program available to families with income up to 90% of the federal poverty level (families must include a child younger than age 19).

What Is The Federal Poverty Line?

There are two slightly different versions of the federal poverty measure: the poverty thresholds and the poverty guidelines.

The poverty thresholds are updated each year by the Census Bureau and are the original version of the federal poverty measure. They are used for the statistical purposes like knowing how many Americans are in poverty each year. To find out how the Census Bureau applies thresholds to a family’s income to determine its poverty status, see “How the Census Bureau Measures Poverty” on their website.

The poverty guidelines are the other measurement of federal poverty. The are released each year in the Federal Register by the Department of Health and Human Services (HHS). They are used to determine eligibility for certain federal programs. You can view the current guidelines at the Federal Register notice of the 2009 poverty guidelines.

The 2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia are as follows:

1 person in family – $10, 830
2 persons in family – $14,570
3 persons in family – $18,310
4 persons in family – $22,050
5 persons in family – $25,790
6 persons in family – $29,530
7 persons in family – $33,270
8 persons in family – $37,010

*For families with more than 8 persons, add $3,730 for each person.

This information was obtained from the United States Department of Health and Human Services website.

Medical Services That Are Covered by Medicaid

Ohio’s Medicaid program limits some services by dollar amount, number of visits per year, or setting in which they can be provided. The program also includes preventative care. By Federal Law, the Ohio Medicaid program must offer the following services: Ambulatory Surgery Centers, Certified family nurse practitioner services, Certified pediatric nurse practitioner services, Family planning services & supplies, Healthchek (EPSDT) program services (screening & treatment services to children 21 and younger), Home health services, Inpatient hospital, Lab & X-ray, Medical & surgical dental services, Medical & surgical vision services, Medicare Premium Assistance, Non-Emergency Transportation (NET) to Medicaid services, Nursing facility care, Outpatient services, including those provided by Rural Health Clinics & Federally Qualified Health Centers, and Physician services.

Ohio also offers other Medicaid services which can be found on the Ohio Job and Family Services website.

How To Apply

To apply for Medicaid, you must fill out an application and either fax, mail it, or take it to your local county Job and Family Services location. The eligibility guidelines are attached to the application which will help you determine if you meet the criteria. The Ohio Job and Family Services Department suggests that you should apply even if you are unsure if you are eligible. In the event you don’t meet the guidelines, they might be able to find another program you are eligible for. Once your application is received, along with any required documentation, you will be scheduled for a face to face interview.

Once eligible, coverage may be retroactive up to 3 months prior to the application. Most States have additional “State-only” programs to provide medical assistance for specified poor persons who do not qualify for the Medicaid program. No Federal funds are provided for State-only programs.

Individual health insurance plans can be costly, complex and downright confusing. Navigating the world of co-insurance, co-pays and deductibles becomes a difficult task when it comes to choosing insurance plans that are not prepackaged and backed by an employer. Many self-employed individuals and those who work for employers that do not provide health insurance spend hours trying to decipher the language of the industry and find the best coverage for the lowest premiums.

All health insurance plans are not created equally. There are a variety of different approaches that health insurance companies take when developing products and services for individual buyers. Low premiums might not necessarily mean that individuals are getting the type of coverage they need. The first step in exploring the many different types of individual health insurance plans is to learn all about the basic terminology and common features associated with individual health care plans.

What is Co-Insurance?

Co-insurance is a method that health insurance providers use to split the cost of your health care needs. The insurance company pays for part of the cost and the individual pays the remaining balance due out of pocket. Insurance companies determine a percentage of the cost they will cover in advance, and then the individual is also responsible for a predetermined percentage. This is often times referred to as “percentage participation” rate.

Some standard percentage participation rates for co-insurance include 70/30, 80/20 and 90/10 plans. On a 70/30 plan, the insurance company pays for 70% of costs incurred, while the individual is responsible for the remaining 30%. We learned about the cost of co-insurance the hard way when my wife spent 9 days in a hospital in 2008.

As an added measure of protection, most major health insurance companies will limit the amount of money that an individual is responsible for paying out of pocket on a yearly basis. This is called a “co-insurance cap,” and it protects those on the plan in the event of a catastrophic medical problem, such as a debilitating car accident or terminal illness. A typical co-insurance cap is limited to $2,000 – $3,000. Once the co-insurance cap is reached, the insurance company will assume responsibility for 100% of any charges incurred thereafter.

Typically, a health insurance plan with a high percentage participation rate – such as 70/30 – has a much lower monthly premium, while plans with lower percentages will feature higher monthly premiums.

What is a Co-Pay?

A co-pay is commonly confused with co-insurance. The two are similar, but there is one key difference. With a co-pay, the dollar amount that an individual will pay for health care services is fixed. There are absolutely no percentage participation rates with a co-pay. Different services are assigned a dollar amount that will be paid by the individual receiving services. For example, a standard co-pay for a visit to a family doctor might be $25. This means that each time the insured individual walks into the family doctor’s office, they can expect to remit a payment of $25 at the time of service.

When it comes to health care, a “service” might be a doctor’s office visit, a trip to the emergency room, or prescription medications. Co-payments may vary for different services, but the dollar amount will always be fixed. The services that insurance companies cover also vary; for instance, certain providers might not offer coverage for dental procedures or eye exams as part of their health insurance plan. Typically, a health insurance plan with higher co-pay rates for various health care services has a much lower monthly premium, while plans with lower co-pay rates will feature higher monthly premiums.

What is a Deductible?

Some insurance plans include a deductible. The deductible is a fixed dollar amount that an individual must pay out of pocket before the insurance company will begin to cover the costs of any health care services. For example, if a plan has a deductible of $500, then the insured party must spend $500 on services out of pocket. After that $500 mark has been reached, the insurance company will begin to assume responsibility for health care costs, usually either via co-insurance or a co-pay, depending on the type of plan.  Typically, a health insurance plan with a high deductible has a much lower monthly premium, while plans with lower deductibles will feature higher monthly premiums.

Unfortunately, there is no simple solution or one size fits all answer for choosing an individual health insurance plan. As evidenced by the terms, conditions and numbers above, a plan with a low premium will not necessarily be the very best choice. It is important to weigh the costs associated with co-insurance percentage participation rates, co-payment amounts and the services that are covered, as well as deductible rates.

For those who purchase health insurance through an employer, the process involves selecting medical coverage from a few options. If your employer does not offer health insurance, you’re unemployed or your self-employed, finding quality, affordable health insurance can be overwhelming. Fortunately, there are resources available to help find individual health insurance.

In this article, we’ll look at one of the best online resources that will enable you to quickly and conveniently compare online the cost of several individual health insurance options. Best of all, you can compare health insurance options with no obligation and without providing any personal information

Online Health Insurance Quotes

One of the top online resources for health insurance quotes is eHealthInsurance.com. The company was founded in 1997 and was the first to sell health insurance policies via the Internet. eHealthInsurance is headquartered in Mountain View, California and is licensed to market and sell health insurance in all 50 states and the District of Columbia. eHealthInsurance has developed partnerships with more than 180 health insurance companies, including Aetna, Blue Cross and Blue Shield, AARP, Coventry Health, Humana, and Kaiser Permanente.

Using eHealthInsurance to get free no obligation health insurance quotes is easy. From the main page of eHealthInsurance (which you can go to by clicking here), enter your zip code. From there you’ll enter just four pieces of information about yourself and any family members you want included in the policy: gender, date of birth, whether you or family members used tobacco products in the last 12 months, and whether you or family members are full-time college students.

With just this information, eHealthInsurance will present you with multiple health insurances plans for you to review. Based on my family’s information, including our two children, here is just a portion of what eHealthInsurance offered online in a matter of seconds:

Benefits of eHealthInsurance

There are several really important features offered by eHealthInsurance.

1. Many Options: While the image above lists just three options from my search for medical coverage, eHealthInsurance actually presents about 100 options to choose from, depending on where you live.
2. Easy to Search: The various options can easily be sorted based on a number of factors, such as eHealth’s top pics, by price, by deductible, by ratings, or by the health insurance company.
3. Easy to Compare: eHealthInsurance makes comparing policies a snap. Once you’ve sorted the options based on the factor that’s most important to you, eHealth allows you to compare side-by-side up to four plans at a time.
4. Tons of Information: Like it or not, health insurance is a complicated subject. From deductibles to co-pays, co-insurance to doctor networks, there is a lot to consider when purchasing medical coverage. eHealth lays out all of this information for each insurance offer in an a way that’s easy to follow and understand.
5. Search by Your Doctor: This is one of the most important features eHealth offers. If you already have a doctor, you can search for plans accepted by your doctor. After entering our family physician’s name, eHealth produced 38 medical plans accepted by him.

In addition to all of the above features, eHealth can further refine your search for health insurance by a number of factors, including:

• Premium Range: You can search for available plans based on a minimum or maximum premium.
• Plan Features: Whether the plans are HSA eligible or include prescription coverage.
• Plan Type: Whether the plan is a network or PPO.
• Office Visits: Whether the plan covers office visits at all, and if so, after the deductible is met or before.
• Deductible Range: You can search for available plans based on a minimum or maximum deductible.
• Coinsurance Range: You can search for available plans based on the amount of coinsurance, ranging from 0% to 40%.

If you’d like to review your medical coverage plan options, you can do so by visiting eHealthInsurance.com.