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Maximizing Your Mental Health Insurance Benefits — A Guide for Gen Z in 2023

This past year, members of Generation Z began to turn 26, which, for many, meant leaving their families’ health insurance plans and picking their own for the very first time. As the generation reporting the highest rates of mental health issues, choosing an insurance plan and understanding the benefits associated is essential for maximizing your health, including your mental well-being.

READ: 7 Tips for Choosing Your Health Insurance in 2023

So, first things first, Gen Z: get familiar with health insurance lingo. Understanding common terms allow you to accurately evaluate your needs, understand and compare benefits and manage costs (check out this guide for a quick refresher on common insurance terms). 

Now that you have the lingo down, it’s time to grasp the benefits associated with your plan. Remember, mental health affects everyone differently, and treatment isn’t one-size-fits-all. To make sure you are maximizing your benefits, here are a few tips to consider when choosing a plan:

Check your mental health insurance benefits

Caring for your mental health is crucial in achieving overall wellness. Coverage for your mental health care services depends on the benefits of your plan. You can determine the services you are eligible for by signing into your health plan or calling the number on your ID card. Some health insurers give members access to phone and mobile app services with certain health plans to help people cope with stress, anxiety and depression as a complement to their health care coverage.

READ: The Top 5 Ways You Can Support Mental Health in the Workplace

Understand your prescription benefits

Understanding your plan’s prescription benefits may help you manage costs. You can view a list of medications and see how they’re covered through your plan’s Prescription Drug List (PDL). PDLs may change, so if you have a medication you take regularly, you should keep a close eye on your plan’s PDL to stay ahead of any potential changes in costs. You may also be able to fill your prescriptions at a participating network pharmacy or with home delivery via mail if it’s included in your benefits, which can also lower costs and save you money.

Review wellness and rewards programs

Remember, our physical health and mental health are intertwined. Many health plans offer incentives and rewards for everyday healthy living, such as completing a health survey, exercising or avoiding nicotine.  Plans may also offer gym memberships or wellness programs at no additional cost. 

Consider a plan with virtual visits

If you are someone who juggles work, school, kids, travel, or just prefers to connect with a doctor from the comfort of your own home, check if your plan includes 24/7 virtual care. Virtual care, sometimes called “telehealth,” may include in-network virtual visits for medical, mental health, physical therapy, occupational therapy, speech therapy, chiropractic, home health, vision, hearing and dental services. These visits are typically lower in cost and allow you to connect with doctors about any mental or physical health issues from the convenience of your own home using a smartphone, tablet, or computer.

READ: Telehealth to Play Key Role as Geriatric Population Soars

If you need help understanding what benefits are right for you or want to explore speaking with a professional, some health insurers, like UnitedHealthcare, offer advocacy services and employee assistance programs to help you find the right type of care.

 

Dr. Donald TavakoliDr. Donald Tavakoli is the national medical director for behavioral health at UnitedHealthcare.

Guest Column: Denver Physician Details 5 Common Medicare Mistakes

For those already on Medicare or anyone who is about to be eligible, one of the best times to reevaluate your plan or sign up for one is during the Medicare Annual Enrollment (AEP) Period, October 15 – December 7. It is during this time that Medicare plan beneficiaries can sign up for benefits, reevaluate coverage, make changes to existing coverage, or adjust policies for Original Medicare, supplemental drug coverage, or Medicare Advantage.

Medicare beneficiaries include persons ages 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). Those who have participated in open enrollment previously know there are a lot of choices when it comes to Medicare. While the most important might be choosing to take charge of your Medicare decisions in the first place, it’s also a good idea to make sure the choices you make aren’t costing you unnecessarily.

READ — 7 Tips for Choosing Your Health Insurance in 2023

Here are five common mistakes that you don’t want to make during this time – and the reasons why.

1. Don’t allow automatic plan renewal to make your choice for you.

Your Medicare Part D or Medicare Advantage plan renews every year on January 1, unless you decide to change it. Automatic renewal may make your life easy, but it might not be the best way to make your Medicare decisions. This is especially true if your health care needs have changed in the last year, if you are taking more medications, if you have wished you’d had more benefits, (such as dental or hearing), or if your finances have changed – to name a few considerations. Plans also may change what they cover from year to year, including what you will pay in deductible, premium, copay or coinsurance amounts. This information will be contained in the Annual Notice of Change, which is discussed next.

 2. Don’t ignore your plan’s Annual Notice of Change (ANOC).

Typically delivered to mailboxes by September 30, ANOC letters ensure that plan members have up-to-date plan information before AEP begins. This document explains any changes in your plan benefits and costs for the upcoming year. The changes may affect your health care and your budget, so it’s important to know what to look for in the ANOC, as it can help you decide early whether to keep your current plan or alert you that you may want to look for a new one during the AEP.

3. Don’t base your plan choice on the premium alone.

It is easy to focus only on premiums when looking at Medicare costs, but it’s a good idea to look at the big picture, too.

A plan could have a low monthly premium, then charge a medical or prescription drug deductible or have higher copayments. You might prefer this if you rarely go to the doctor and don’t take many medications, but a plan like this could be expensive if you use health care services often, even with the low premium.

It’s important to think, too, about all the out-of-pocket costs as well as your healthcare needs when choosing a plan. For example, many Medicare Advantage plans offer routine vision, hearing, and dental coverage, and certain plans also provide fitness membership benefits at no additional cost.

4. Don’t pick a plan because your spouse, relative or friend has it.

You might count on a friend’s word when deciding what new restaurant to try, but a Medicare plan is a personal choice. What works for one person may not fit with the needs of another. You will probably have several plans to choose from, so it’s a good idea to look at all your options, keeping your healthcare needs and budget at the forefront of your mind. The Medicare.gov website suggests considering seven things when choosing a plan that’s just right for you: cost, coverage and benefits, any other coverage you hold, prescription drugs, doctor and hospital choice, quality of care and travel coverage.

5. Don’t assume that you don’t qualify for help with Medicare costs.

Several programs offer financial assistance with Medicare premiums and other costs. In some cases, Medicare Savings Programs may pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions.

There are four kinds of Medicare Savings Programs: Qualified Medicare Beneficiary (QMB); Specified Low-Income Medicare Beneficiary (SLMB); Qualifying Individual (QI); and Qualified Disabled & Working Individuals (QDWI). If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get extra help paying for Medicare drug coverage. You may want to look into them, even if you think you might not be eligible.

For full information on enrolling in Medicare plans, you can review the CMS website at www.medicare.gov or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, seven days a week. You can also contact your State Health Insurance Assistance Program office (https://www.shiphelp.org) to discuss your situation.

 

Lewis2018Dr. Matthew Lewis is the Senior Medical Director of Primary Care with New West Physicians, part of Optum.

7 Tips for Choosing Your Health Insurance in 2023

Amid higher inflation, you may be looking at ways to adjust your lifestyle and spending habits. But when it comes to health care, it’s important to keep your well-being and budget in mind.

Annual and open enrollment season is here — a time when more than 5.7 million people in Colorado and across the country will have the opportunity to select, or switch, their health insurance plan for the coming year.

Open enrollment is a good chance to review how often you’re using health services and decide whether you’ll stick with the plan you’ve got or switch to another being offered. It’s also an opportunity to assess your overall care costs to ensure you’re choosing a plan that will work best for next year’s budget.

READ — A New twist on health insurance

Enrollment timing — For people with coverage from their employer, open enrollment typically happens for two weeks sometime between September and December. Medicare members can enroll or make changes to coverage from Oct. 15-Dec. 7. Most selections made will take effect on Jan. 1, 2023.

Here are seven things to consider when evaluating the next move in your health insurance journey:

1. Understand all your options

Take time to understand and compare the benefits, services and costs of each plan, so you can figure out which will work best for you. A good first step may be to watch a quick refresher video on health insurance lingo, including premiums, deductibles, copays, coinsurance and out-of-pocket maximums.

  • Medicare members: As you weigh your options, ensure you’re familiar with the difference between Original Medicare and Medicare Advantage. If you need a review, visit MedicareEducation.com — an online resource with answers to questions about eligibility, plan choices, cost basics, prescription coverage and more.

2. Check your prescription benefits

Knowing how to get the most out of your prescription benefits may help you manage costs. For example, check into discounts and lower-cost alternatives, including generics, which may be available. You may also be able to fill your prescriptions at a participating network pharmacy or with home delivery by mail — two more money-saving options. 

  • Medicare members: You may be surprised to learn Original Medicare doesn’t generally cover prescription drugs. Consider adding Part D or a Medicare Advantage plan with prescription drug coverage to help keep your medication costs in check.

3. Check for mental health coverage

In addition to in-person mental health care, you may have access to a large virtual network of therapists and psychiatrists. Some health insurers also offer advocacy services to help you find the right type of behavioral health care.

  • Medicare members: Some plans offer virtual mental health care with a $0.00 copay, including UnitedHealthcare Medicare Advantage.

4. Don’t forget about specialty benefits

Additional benefits, such as dental, vision, hearing or critical illness insurance, are often available and may contribute to overall well-being.

  • Medicare members: You may be surprised that Original Medicare doesn’t cover most dental, vision and hearing services, but many Medicare Advantage plans do.

5. Look into wellness programs

Many health plans offer incentives that reward you for taking healthier actions, such as completing a health survey, exercising or avoiding nicotine.

  • Medicare members: Many Medicare Advantage plans also offer gym memberships and wellness programs for members at no additional cost.

6. Anticipate next year’s health expenses

If you’re expecting a significant health event in the next year, such as surgery or the birth of a child, compare the differences in plan designs for that specific situation, including any out-of-pocket costs.

7. Consider a plan with virtual care services

If you’re busy or just prefer connecting with a doctor from the convenience of your home, consider choosing a plan that includes 24/7 virtual care. You may have access to virtual wellness visits, urgent care and chronic condition management.

  • Medicare members: Most Medicare Advantage plans provide access to virtual care, which can be an easier, more affordable way to talk with doctors about common health issues on a smartphone, tablet or computer.

For more helpful articles and videos about open enrollment, visit uhcopenenrollment.com.

 

George Young 1George Young is the CEO at UnitedHealthcare Medicare & Retirement, AZ, CO, MT, NM, WY.

 

Aco Summitt

Marc Neely is the President and CEO at UnitedHealthcare Employer and Individual, CO & WY.

 

New twist on health insurance

Trying to understand health insurance can be like decoding a foreign language. But as of 2020, there’s a new vocabulary term you might want to learn: Individual Coverage Healthcare Reimbursement Arrangement, or ICHRA.  

An ICHRA (pronounced “ick-ruh”) refers to situations where an employer reimburses employees for health insurance expenses. With an ICHRA, employees go to the insurance exchange, buy their own plan, and receive a tax-free reimbursement from their employer. This is a departure from traditional group health insurance plans, where employees only have one option: the health insurance plan their employer buys for them.  

Colorado-born Snarf’s Sandwiches offers a case in point: “We previously had a large group plan,” says Cara Greene, Snarf’s human resources director. “And when we were going through a renewal for 2021, we got a 46% increase in premium, which is not sustainable.” Greene needed to find another option for the company’s nearly 100 employees. Her broker introduced her to the concept of an ICHRA. 

“We were a little hesitant at first,” Greene says, but trying it out in 2021 proved successful for employees. Now, Snarf’s Sandwiches employees aren’t locked into a single group plan, and the company can help employees pay their premiums by offering set reimbursement amounts depending on age. “They have the flexibility to be able to go out and shop for a health plan that works best for them and their health issues,” she says. “So if they’re willing to pay a little bit more out of pocket every month, to have a more robust plan, then they have the option to do that.” 

“It’s a fundamentally new way for employers to provide benefits to employees,” says Jack Hooper, CEO of Take Command, an ICHRA administrator based in Dallas. An ICHRA offers a way for employers to help reduce their monthly premiums by giving employees monetary reimbursements, tax-free, to help offset the cost of health insurance. 

Like HRAs, but with more choice 

HRAs, or Health Reimbursement Arrangements, have been around for decades. “They were typically established for large employers who were self-insured — didn’t buy insurance — and they were to cover things that were not covered by the health plan,” says Bill Lindsay, Principal and CEO of employee benefit consulting firm Lindsay 3. Another form of coverage, the Qualified Small Employer HRA, or QSEHRA, offered a provision for employers with 50 employees or fewer that wanted to offer health insurance options. QSEHRAs didn’t really take off, he says, because they proved to be very restrictive.  

An ICHRA, then, represents a tool for employers to reimburse employees for health insurance premiums with fewer restrictions and no upward cap; an employer of any size can use it, and the employer decides how much to reimburse per employee per month.  

Then, Lindsay says, the employee can decide what coverage they want or need simply by choosing a plan through Colorado’s health insurance marketplace and submitting proof to their employer.  

Claire Brockbank, CEO of Peak Health Alliance — a health insurance purchasing alliance founded in Summit County — says the ICHRA “gives the employee maximum choice.” Brockbank adds that many Peak Health Alliance members are covering more employees for less money — a big deal in a tough labor market. 

According to Take Command, Colorado employers reimbursed, on average, $371.59 per month per employee. This more than covers the average bronze plan and silver plans — $280 and $313 respectively — on Colorado’s official health insurance marketplace, Connect for Health Colorado. 

Colorado has a whopping 527 individual plans available across the state, which creates more choice and competition on the market. Additionally, Colorado’s reinsurance program — essentially insurance for insurance companies — lowers insurance companies’ risk, which in turn lowers costs.

Senior,patient,having,consultation,with,doctor,in,office

Why are ICHRAs trending in Colorado? 

The Centennial state has many seasonal industries and small businesses, but many of those companies have never offered insurance before — and if they employ fewer than 50 people, they aren’t required to. Group insurance can be expensive, and many plans require 70% employee participation. For companies that have a mix of hourly or full-time and seasonal workers, it’s hard to meet that threshold. And due to the pandemic, employees may be more dispersed than ever before. Traditional group plans might not have coverage outside of the employer’s city headquarters. 

Colorado has a whopping 527 individual plans available across the state, which creates more choice and competition on the market. Additionally, Colorado’s reinsurance program — essentially insurance for insurance
companies — lowers insurance companies’ risk, which in turn lowers costs.  

What’s more, in October 2021 Gov. Jared Polis and Lt. Governor Dianne Primavera announced that Coloradans will save on average 24.1% on individual premiums in 2022. Those Colorado consumers buying individual plans can expect only a modest average increase of 1.1% over 2021 premiums. Compare that to the 46% premium increase Snarf’s Sandwiches was facing with their previous group plan, and you can see the appeal. 

ICHRAs offer employees more choice, too. Say their employer offers a $400 per month reimbursement. They can still choose a plan that costs $500/month, but in that situation only $100 comes out of their paycheck. If the employee chooses a plan that costs less than the monthly ICHRA amount from the employer, they can put that difference toward a copay or prescriptions. 

New concept, new challenges 

ICHRAs aren’t without potential setbacks. Moving from the traditional fully insured small-group market to the ICHRA market requires time, energy and know-how.  

“There are fewer and fewer agents who sell individual health insurance,” Lindsay says. “Many of them have moved out of that market, because the insurance companies have cut the commissions that they pay substantially, or maybe don’t even offer commissions.”  

The employer needs to have a plan description and timely employee communications or it could face penalties. If a company already has a general insurance agent for its workers’ comp or liability insurance, it might be able to call on the agent for that expertise — or, hire a third-party administrator like Take Command. “Otherwise, that employer would have to figure all this out on their own” Lindsay says. 

“It is a kind of a new concept to try to get used to,” Greene says, for both Snarf’s Sandwiches and their employees. She’s had to get used to telling workers, “You need to go out and you need to pick a plan that works for you, and I can’t make that decision for you. You have to do that for yourself.” Even if employees leave the company, they can keep their plan as long as they keep paying the premiums. 

Still, companies are finding value in this new way of paying for employee insurance. Snarf’s Sandwiches will continue using an ICHRA in 2022, and even plans to increase its employee reimbursement benefit. 

6 strategies to reduce health care disparities among employees and tackle top cost drivers

A recent white paper by the Health Action Council (HAC) and UnitedHealthcare finds companies that implement deliberate strategies around their employees’ most common chronic health conditions may improve overall employee health and achieve cost-savings over the long-term.

The findings are based on a study of five chronic health conditions – hypertension, diabetes, back disorders, mental health and substance use, and asthma – across more than 280,000 HAC members insured with UnitedHealthcare.

Many of us will suffer at least one of these conditions during our lifetime, with a real impact on health care costs.

The study also revealed a number of important disparities in care, which can be improved through a combination of lifestyle modifications and targeted wellness programs.

Care Disparities Revealed

  • Among HAC members, African Americans are 63% more likely to have hypertension than other races or ethnicities. Also, the study found women are sub-optimally treated across all age groups versus men, who were typically administered more prescription drug treatments.
  • Men over 50 in lower income groups have the highest prevalence of diabetes, while those of Asian ethnicity have a 43% higher than average prevalence of the condition, largely driven by genetics and diet.
  • Typically, employees with back disorders skew older and are in lower income brackets, with factory work identified as one of the top jobs linked to back pain. Despite a strong case that physical therapy or chiropractic care helps reduce reliance on muscle relaxants and other drugs, our study found 6 out of 10 obese employees with a back disorder are foregoing or not being offered physical therapy or chiropractic care.
  • Those with mental health and substance use challenges tend to be female, younger and in lower-income Caucasian groups. Rural areas are often unable to meet mental health care needs due to inadequate services, leading to a higher than average number of emergency room visits and hospitalizations.
  • African Americans have a 20% higher prevalence of asthma than other races and are more likely to experience a flare-up that requires treatment, yet they are less likely to have been prescribed asthma steroids.

Tips for Tackling Health Care Disparities in Your Workforce

To address care disparities and ensure all employees have access to proper care, we recommend employers consider their population’s demographic and geographic profile and then create simple, targeted wellness programs to address the most prevalent common conditions.

Here are several suggestions:

  • Evaluate your current benefit plan design for opportunities to implement a care program that evolves with the patient over time – for example, making chiropractic care or physical therapy mandatory for back disorders before moving to more aggressive treatments.
  • Cover medications as preventive care for specific chronic conditions or promote the use of patient assistance programs for specific types of medications. The latter may require exclusion of some medicines from your benefit plan design.
  • Institute an exercise, stretch or meditation program at the beginning of work shifts to improve safety and decrease injuries. These types of practices are preventive and may decrease the severity of an injury if one occurs.
  • Create targeted communications for specific regions and demographics. Consider sharing success stories or appointing a program champion from the target audience. Understand and reflect on cultural differences when developing each communication.
  • Promote virtual care to improve access to treatment for specific conditions – for example, mental health support in rural areas.
  • Work with your third-party administrator or medical expert(s) to identify opportunities for provider outreach and education on best-in-class approaches.

You can reach and help those who may be at greatest risk of these common conditions and yet least likely to take action on their own.

To learn more, please read our white paper in full: Finding the uncommon: revealing disparities in care and prescribing for common conditions.  

Patty Starr is the President and CEO of Health Action Council and Craig Kurtzweil is the Vice President of UnitedHealthcare Center for Advanced Analytics. Health Action Council is a not-for-profit organization representing large employers to enhance human and economic health through thought-leadership, innovative services and collaboration. UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience.