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May 7th, 2021
May 7th, 2021
Imagine this: You go to the doctor for help with depression. She prescribes you an antidepressant. Weeks pass and you can't tell if it is making a difference. You get a four-week follow-up appointment and your medication dose gets adjusted or your prescriber gives you a different medicine, and you get to wait several more weeks to see if it's working. In the meantime, you have to put up with side effects like headaches, blurred vision, nausea, bad breath, bathroom troubles, and trouble sleeping — all for a medication that you don't know is even going to help you. If this sounds familiar, you are not alone. Millions of Americans are living with depression. We don't yet fully understand what causes depression. Due to that, treating depression isn't easy and it's certainly not quick. Over 12 percent of Americans take antidepressants — for 30 percent of them, meds don't work. When a person is prescribed a medication to treat depression, it is a process of trial and error. About half of patients with moderate to severe depression do not respond to their first medicine. You don't always get it right on the first try. For people looking for relief, this can be a huge problem. They are left feeling hopeless and alone. Life would be so much easier if your clinician could get it right on the first try. What if you could just take a simple test to figure out what medications would work best? Fortunately, there an up-and-coming medical answer on the horizon — the field of pharmacogenomic testing. If you haven't used this type of test yet, it's likely that you will in the near future. In this article, we will be explaining pharmacogenomic (PGx) testing, its potential benefits and limitations, as well as different routes for accessing it. What is pharmacogenomic testing? Pharmacogenomic (PGx) testing combines two fields of study: pharmacology and genomics, to provide people with the medications and medication doses that they are best suited for, based on their genome found using DNA testing. This emerging field of genetic testing offers many benefits to patients with more than just depression. PGx testing can provide helpful insights for all types of medications, whether treatment has already been started or not: If you are already taking medication, a PGx test can help you better understand why you are having side effects. If you haven't started taking medication yet, a PGx test can help inform your doctor which medications would be most beneficial to you, with the lowest risk for negative side effects. Before we dive further into the topic, let's clear up a few key terms that are often used in connection with this topic. Pharmacogenomics, pharmacogenetics, and more key terms Many different related terms are often used to refer to PGx. Some are synonymous, others are adjacent, and still others occupy a confusing in-between space where they sometimes mean the same thing, but not always. To better understand the topic, we are going to define a few useful key terms. These definitions come from the National Institute of General Medical Sciences Glossary: Genetic code — "The instructions in a gene that tell the cell how to make a specific protein." Pharmacodynamics (PD) — "The study of how drugs act at target sites, called receptors, on organs and tissues in the body." Pharmacogenetics (PG or PGt)— "The study of how people's genes affect their bodies’ responses to medicines, often one gene at a time." Pharmacogenomics (PGx) — "The study of how people's genes affect their bodies’ responses to medicines, often encompassing the entire genome." Pharmacokinetics (PK) — "The study of the level of a drug and its breakdown products in the blood over time." Precision medicine — "An emerging approach for disease prevention and treatment that takes into account individual differences in lifestyle, environment, and biology." Side effect — "The effect of a drug, other than the desired effect, sometimes in an organ other than the target organ." Note: The term pharmacogenetics is often used interchangeably with PGx; however, Pharmacogenomics Knowledgebase (PharmGKB) explains, "In general, pharmacogenetics usually refers to how variation in one single gene influences the response to a single drug. Pharmacogenomics is a broader term, which studies how all of the genes (the genome) can influence responses to drugs." In this article, we will be using them synonymously. Why is PGx testing important? As we mentioned, PGx DNA testing has the potential to help more than just people with depression. It can help people who take all sorts of prescription drugs because drugs don't work the same for everyone who takes them. A UK drug executive made waves in the early 2000s by estimating that 90 percent of prescription medications work for less than half of people. This is where the study of pharmacogenomics has the potential to changes lives — by reducing trial and error treatment and helping to develop more specialized medicines. Benefit #1: Moving away from trial-and-error The main goal of pharmacogenomic testing is to contribute to the field of tailored, personalized treatment. Known as precision medicine, this field aims to "target the right treatments to the right patients at the right time, "according to the FDA. Issam Zineh, Director of the Office of Clinical Pharmacology (OCP), explains, "Personalized medicine aims to streamline clinical decision making by using biological information available through a genetic test or biomarker, and then saying, 'based on this profile, I think you're more likely to respond to Drug A or Drug B, or less likely to have an adverse reaction with Drug C.' The idea is to get patients on the right medication and to get them on it sooner." PGx information can help make sure that people are prescribed a medication that will help treat their symptoms as soon as possible. Genetic information can also help to avoid many adverse drug reactions (which bring more than 1 million people a year to the ER), and provide better dosing guidelines, to help patients avoid side effects. Starting a proper treatment plan earlier and steering clear of negative side effects and severe drug reactions will help to improve patient health. It will also help to save time and money, let alone stress and pain. Benefit #2: Developing better drugs Studying the relationship between genetic variations and medication can help to revolutionize the pharmaceutical industry. Where before, the goal was to make drugs that worked for the largest about of people, with the fewest negative side effects, this data can help to identify subsets of people that will do better or worse on a prospective medication. This means that new drugs can be developed that work better for individual groups. So, in addition to bettering our understanding of existing medications, PGx study can aid the creation and marketing of more effective, tailored drugs. How do genes affect medication responses? It's easier to understand how each person's DNA can make our medication experiences different if we need to have a basic knowledge of a drug's journey through our bodies, and the factors that affect this journey, both internal and external. In this section, we are going to explain how your genes can change drug responses from two perspectives: pharmacokinetics ( a drug's movement/pathway through the body) and pharmacodynamics (how drugs interact with their target sites in the body). A drug's journey through your body Once a medicine enters your body, its life is broken up into four steps: 1. Absorption — This stage starts when a drug enters your body and lasts until it's in your bloodstream. Drugs enter the body in several different ways, but to explain this stage, we are going to explain using the most common example: orally. Once you swallow a pill, it gets absorbed in the tissues of your GI tract. From there, it travels through a special blood vessel to your liver. 2. Distribution — From your liver, the drug disperses into tissues and intercellular fluids, where it can bind to receptors. Drug molecules can disconnect from receptors and enter the bloodstream. In this stage, you can feel the side effects of your meds when, during its flow through your bloodstream, organs other than the intended destination are affected by it. 3. Metabolism — Once the medication has been distributed throughout the body and reached its target, its time to go. The drug molecules traveling through the bloodstream can undergo changes in a process called metabolism. This happens in your liver and other tissues. 4. Excretion — Once your liver enzymes break down the medication, it is inactive. It gets excreted from your body in the normal course of waste elimination. Your genes can interfere with the way that a drug is supposed to interact at each stage of the process. For example, if your genes block a drug from being absorbed, it can't move on to distribution, and you may need to try another medication or a different administration method. Most issues related to drug processing happen during step 3 — metabolism. If your genes make you code more enzymes than the average person, you will metabolize certain medications much more quickly. In this circumstance, you may do better on a different dosage or a different drug that is metabolized by different liver enzymes. Helpful resources: Pharmacogenomics of Drug Metabolizing Enzymes and Transporters: Relevance to Precision Medicine Check out this helpful youtube video from Ted-Ed: How does your body process medicine? How does PGx testing work? A PGx test looks for genetic variations that would cause you to process a medication than the average person. DNA testing focuses either on a panel of medications related to diseases, targeted medication panel, or known variants and their influence. It's really just down to how the genetic testing company organizes the information. PGx testing angles: targeting genes, drugs, and diseases More than 400 FDA-approved medications include pharmacogenomic drug labelling information. In general, this information includes different actions to take based on biomarkers. It's a newer practice, but doctors have begun to use PGx testing in a few circumstances. To get a better idea of the role that your genes play in your body's reaction to medications, let's examine some examples. Here are three different examples of drug-gene relationships, with three different angles: Gene function — starting from what we know about gene function, applying it to different medications that treat multiple diseases Medication function — starting from a disease-specific medication and finding out what genes and genetic variants that affect its ability to function optimally Disease-targeted needs — starting from a disease for which you need to be treated, and testing for genes known to affect disease-targeted meds, to find which meds will work best Cytochrome P450 and known variants: Targeting insightful genes Variations in the Cytochrome P450 (CYP450) family of genes are a great example of how genes affect medication response. The CYP450 family contains genes responsible for coding enzymes that affect drug metabolism — how quickly your body processes drugs. In fact, 70 to 80 percent of the enzymes that affect drug metabolism rates are cytochrome P450 enzymes. Included in the cytochrome P450 enzyme family is CYP2D6, a gene related to the processing of many antipsychotic and antidepressant meds, among others. This gene is known to affect up to 25 percent of commonly prescribed medicines, including the following: Antidepressants — Amitriptyline (Elavil), Clomipramine (Anafranil), Desipramine (Norpramin, Pertofrane), Doxepin (Sinequan), Fluoxetine (Prozac, Sarafem), Fluvoxamine (Luvox), Imipramine (Tofranil), Maprotiline (Ludiomil), Nortriptyline (Pamelor), Paroxetine (Paxil, Pexeva), Trimipramine (Surmontil), Venlafaxine (Effexor) Antipsychotics — Aripiprazole (Abilify), Haloperidol (Haldol), Olanzapine (Zyprexa), Perphenazine (Trilafon), Risperidone (Risperdal), Thioridazine (Mellaril) Pain meds — Codeine, hydrocodone, oxycodone, tramadol Depending on your genetic variants, you can be classified as one of the following: Poor metabolizer — You break down related medications slowly. Doctors can use this information to give you different doses. Intermediate metabolizer — Your enzymes are working, but not as well as normal metabolizers. Normal metabolizer — Your CYP2D6 enzymes are coded as normal. Standard prescribing and dosing recommendations should work best for you. Ultra-rapid metabolizer — Based on your genetic variants, your CYP2D6 enzymes are very active, which causes you to break down related medications really quickly. You may need increased dosages or drugs unrelated to this gene for best results. Indeterminate — The test wasn't able to predict your enzyme activity, so standard drug selection and dosing are recommended. Read more: Mayo Clinic — Cytochrome P450 (CYP450) tests Abacavir (Ziagen): Targeting genes based on a specific drug Abacavir, brand name Ziagen, is an antiretroviral medication for HIV patients. In clinical trials, some patients developed a hypersensitivity reaction, with symptoms like headache, fever, rash, nausea, and more. When people stop taking the drug, symptoms go away. However, if they start taking it again, a "rapid, severe, and even life-threatening recurrence" can occur. Now, before people are prescribed this medication, the FDA's drug label recommends they be screened for a genetic variation called HLA-B*5701. If tested positive, genetic screening helps you avoid the toxic and possibly life-threatening reaction. Heart disease: Testing for multiple variants that affect the treatment of one disease Cardiovascular disease (CVD) is the leading cause of death in the United States. The term actually refers to several heart conditions that affect your heart's ability to function properly. One example, coronary artery disease, happens when blockages decrease blood flow to your heart muscle, so it doesn't get the oxygen it needs. When you have heart problems, in addition to lifestyle recommendations, your doctor will likely prescribe medications to help treat your symptoms. Examples include the following: Angiotensin-converting enzyme (ACE) inhibitors, like benazepril (Lotensin), ramipril (Altace), and captopril, are prescribed to help help with high blood pressure by widening your blood vessels Anticoagulants, like enoxaparin (Lovenox), heparin, and warfarin (Coumadin), are prescribed to help prevent heart attack, stroke, and other issues. They prevent blood clots from forming, so that a blockage doesn't shut off blood flow to your heart. Beta-blockers, like metoprolol (Lopressor), labetalol (Trandate), and propranolol (Inderal), are often prescribed to help prevent heart attacks. They work by blocking chemicals that stimulate your heart, so it can beat more slowly. These are just a few of the different categories of drugs that are used to manage heart disease and its symptoms. Because they target different things, it's common for doctors to prescribe multiple medications for people that have CVD. Pharmacogenomic testing has the potential to help improve the way that your cardiovascular disease is treated. People react in different ways to CVD treatments. Your genes can give us clues to the way that your drugs are absorbed, distributed in your body and how quickly they are metabolized. Currently, CVD drugs with clinically actionable genomics-based FDA label recommendations are Warfarin and Clopidogrel. Warfarin dose adjustments are based on variants of CYP2C9 and VKORC1 and Clopidogrel recommendations are based on CYP2C19. Read more: Opportunities and Challenges in Cardiovascular Pharmacogenomics Where can you get PGx testing?: Access routes, examples, and recommendations You can access PGx testing from your doctor or by ordering online. Tests that study relationships between genes and drugs have lots of names, including the following: Pharmacogenomic (PGx) test Pharmacogenetic (PG or PGt) test Genetic pharmacology test Medication response test Drug response test Personalized medication test Either way, PGx test results are meant to be shared with your doctor, to help get the best medication or dosage for you. Clinical PGx testing If you are interested in learning about medications that work best for your or your dependents, and you have a current clinical reason, your first step should be your doctor. Your doctor can order clinical PGx testing at an accredited lab, if indeed it is recommended for your circumstance. In general, blood samples are used for these in-lab tests, although cheek swab samples are also used. When you take a clinically prescribed test, a big benefit is that insurance might cover the cost, depending on your coverage. One example of clinical PGx testing is provided by Cincinnati Children's Hospital's Genetic Pharmacology Service. The hospital offers tests panels focused a couple different things: The Psychiatry Pharmacogenetics Expanded Panel looks for genetic variations that are related to over 20 common psychiatric medications. The Opioid CYP2D6 Pharmacogenetics Panel looks for genetic clues to how your body processes common opioids (codeine, tramadol, hydrocodone, and oxycodone). In addition to these panels, there is another that looks for warfarin predisposition in CYP2C9 and VKORC1, as well as targeted genotyping for specific genes, including CYP2C19, CYP2C9, CYP2D6, CYP2D6 / CYP2C19, TPMT. Physician-prescribed or referred PGx testing On the other hand, many genetic testing companies work with physicians to provide low-cost (lower-than-clinical cost) DNA testing services for health purposes, including genetic health risks, carrier screening, and pharmacogenomics. In these cases, your doctor can prescribe a test, which you order online, based on your doctor's referral. Sometimes, a doctor will partner with a DNA testing company to offer in-office purchases for a DNA kit that a patient does on their own at home. Availability depends on your doctor. At-home and direct-to-consumer (DTC) PGx testing If you want to take charge and proactively learn about your predisposition for certain medication responses, it's becoming more and more common to be able to order these tests online, provide a sample at home, mail it back to the lab, and receive your results online, which can be shared with your doctor. However, there are four different general groups of at-home tests and analysis that you should be aware of. Each has its own hoops to jump through, as well as test limitations, based on regulatory approval, lab location and accreditation, physician-involvement, and more. Though the individual platforms and sellers of at-home DNA kits for PGx testing vary, at-home tests do not produce clinical results. They also often take longer than in-lab bloodwork or saliva sample tests, because of shipping and wait times typical for consumer DNA testing. Additionally, even when shared with your doctor, you may be required to take follow-up clinical testing to verify the test results. That's why it's best to ask your doctor first. PGx testing via DTC online ordering While the FDA has approved one company, 23andMe to provide DTC PGx testing, this service is not currently available, unless prescribed by a physician. Despite this, on Hong Kong-based genetics company offers an easy-to-order DTC test: #1 CircleDNA The Circle Premium DNA Test ($629) includes lots of health information and lifetime access to the platform. It also includes drug response information about 103 FDA-approved medications. The test includes two 30-minute phone consultations with Circle's trained staff to help you understand and benefit from the results, but doesn't require a physician to sign off on your order before it is approved. PGx testing via online ordering (with independent or on-staff physician order approval) #1 Color Genomics Color offers medication response analysis with the Color Standard service (only available through employer programs or from healthcare providers, as well as in the Color Extended test ($249). Color tests can be ordered by your own physician or, when you place an online order, it is reviewed by an independent physician. Included in the cost of testing is a one-on-one genetic counseling session to help understand your options. The test includes 14 genes associated with common meds: CYP2C19, CYP2D6, CYP1A2, CYP2C9, CYP3A4, CYP3A5, CYP4F2, DPYD, F5, IFNL3, NUDTI15, SLCO1B1, TPMT, and VKORC1. #2 ONEOME ONEOME offers a RightMed ($349), co-developed with Mayo Clinic. Itests for specific variants in 27 genes. This test isn't a DTC test because physician ordering is included. A 30-minute genetic consultation is included to help understand your results. Pay with a credit card, HSA card, or PayPal This test offers gene-based results. It doesn't include information regarding specific drugs. This means that you do need to rely on follow-up to better understand your results and what they mean. #3 Helix Helix offers the Mayo Clinic GeneGuide test ($149), which among much other health information, including carrier status and disease risk, also includes four medication response reports, with information about Ibuprofen and Omeprazole. Includes physician ordering and genetic counseling. Not available for people in New York. PGx testing via online ordering (requires physician approval to activate) #1 GnomeDX Rather than physician review at the time of order, with this DNA testing company, anyone can go to the website to order a DNA kit. From there, you need to go to the doctor who prescribes your test: CardiacDX, PsychDX, PainDX, or Complete DX. CardiacDX ($250) covers inherited heart disease risk assessment as well as genes that relate to 40+ medications PsychDX ($250) is recommended for people that have already been diagnosed with depression, anxiety, ADHD, bipolar disorder, epilepsy, and similar conditions. It covers 12 genes related to 92 mental health drugs PainDX ($250) tests for genetic variations in seven genes that affect your reaction to more than 34 medications CompleteDX ($250) doesn't include any disease risk assessment (CardiacDX), but it does cover genes related to 150 medications of various types — heart, pscyh, diabetes, pain, GI, and more PGx information from analysis platforms Some testing companies focus on providing an online platform focused on providing health information (including drug response details) first, and genetic testing second. Here are a couple of examples: #1 Pharmazam The Pharmazam PGx test ($499), which provides information on all prescription drugs (more than 130,000) and most over the counter meds. This isn't a DTC test. You can request the test online, but a Pharmazam doctor places your order. Additionally, your results are reviewed by medical staff before you get them. For this test, you need to download the app and update your personal health information. In addition to genetic information, the app also reports interactions with other drugs, illnesses, allergies, foods, and lifestyle. #2 SelfDecode Whether you order a SelfDecode DNA test or you upload your raw DNA from another source, you can get access to more than 70 categories of health reporting, including pharmacogenomics. This DNA analysis platform requires an annual subscription ($59) or lifetime membership ($199). 6 Key PGx Takeaways Now that we have covered the PGx basics and explained how to get a test, if you are interested, there are a few key points to share with you before you take a DNA test. Here are four key points that you should know before you take a PGx test. 1. PGx is relatively new and interpretation of test results are evolving Professor Peter Gregersen, MD, from the Institute of Molecular Medicine at the Feinstein Institutes for Medical Research shares this advice, "The data on pharmacogenetics is still in a relatively early stage of interpretation, although some can be useful." The issue for most consumers is understanding what actually constitutes useful information. Research is ongoing and, just as we don't yet understand all of the genetic components that relate to disease, we don't yet understand all the ways that your genes (and the proteins they encode) will affect or derail a medication's prescribed course through your body. If you are looking for a current reason why your medications aren't effective, your first stop should always be your physician or prescriber. They can let you know whether a PGx test would be helpful in your circumstances. 2. PGx is just one part of the puzzle It is important to know that your genetic variants are just one of many things that affect how your body responds to drugs. The Merck Manual on drug response shares the following factors: Genetic makeup Age Body size Use of other drugs and dietary supplements (such as medicinal herbs) Consumption of food (including beverages) Presence of diseases (such as kidney or liver disease) Storage of the drug (whether the drug was stored too long or in the wrong environment) Development of tolerance and resistance It's important to understand that PGx test results can provide helpful information, but there is much more at play than your genes. Those results aren't actionable until all of the other factors are taken into account. One company, PHARMAZAM, is trying to help people partially overcome this hurdle. Its platform lets you input your personal health and lifestyle information, including diseases and all of the drugs you are taking. From there, you can take a DNA test to add the genetic drug-response factors (that we know of) to the equation. 3. PGx testing isn't yet routine In 2015, President Obama gave precision medicine a shout out in the State of the Union address, announcing the new Precision Medicine Initiative. The group's mission statement is as follows: "To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care." Drug response DNA testing isn't currently a standardized clinically accepted practice, but it's expected to be a normal practice by 2023. While PGx tests are not yet a part of routine medical care, "Nevertheless, they are likely to be quite useful in certain cases," advises Gregersen, "so it is not a bad idea to have this information available to you." The future goal is to have DNA info on file so that when you need a medicine, your doctor can guide your treatment, without needing to order additional testing and wait for results. However, we are nowhere near this point. Unfortunately, you may run into issues when requesting this type of test from your doctor. Survey results show that only 28 percent of genetic counselors feel comfortable ordering PGx tests. Worse than that, the survey also shows that only 13 percent of physicians report feeling comfortable doing it. If doctors and genetic counselors aren't comfortable ordering a PGx test, how will they be with helping to interpret and provide actionable advice? "There is no harm in getting this info and having it available for your physician or pharmacist to interpret," says Gregersen. "But beware, not all physicians and pharmacists are knowledgeable about this, and there is still lack of agreement on interpretations and their utility, which is why these tests are not routinely part of medical care yet." 4. PGx test limitations, both general and test-specific There are many limitations to the field and practice of PGx testing, including big and small issues. According to the Mayo Clinic, current PGx testing limitations include the following: "One single pharmacogenomic test cannot be used to determine how you will respond to all medications. You may need more than one pharmacogenomic test if you are taking more than one medication. Pharmacogenomic tests are not available for all medications. Because pharmacogenomic tests are available only for certain medications, your health care provider determines if you need to have a pharmacogenomic test prior to beginning a specific treatment. There are currently no pharmacogenomic tests for aspirin and many over-the-counter pain relievers." In addition to these industry-wide limitations, each PGx test itself has its own limitations. For example, the ONEOME test includes this disclaimer: "The test does not detect all known and unknown variations in the gene(s) tested, nor does absence of a detectable variant (designated as *1 for genes encoding drug metabolizing enzymes) rule out the presence of other, non-detected variants." — and that's not even the whole disclaimer. It goes on and on. When you join an online health decoding platform or buy a DNA test, even those that include physician approval as part of the ordering process, are sure to state that test results are for educational purposes only, are subject to interpretation, and are not a substitute for medical advice. Additionally, each test is different. You need to make sure that genes relevant to your current situation are being studied. The extensiveness of a test depends on the number of known variants it is looking for, as well as the type of technology that is being utilized to look for them. For example, a simple microarray test will hunt for and record known variants, while a test that uses sequencing will record the whole gene in question, to show not only the most common variants, but even uncommon ones. Finally, with at-home DNA testing, Dr. Gregeresen advises, "Again, anything that you act on should be confirmed in a clinical approval lab." 5. PGx test results don't tell you which medication(s) are best for you When you take a PGx test, you won't just get a result that says 'Drug A is always the drug one for you.' It's actually kind of the opposite. Results will explain how your genes affect your body's processing of drugs related to that gene. With interpretation, you can see drugs that may not be effective for you, drugs that you may need higher or lower doses of, or even those that you try to avoid for your own safety. It doesn't work the other way around. 6. PGx test results don't make you a doctor Pharmacology is complex. Taking a PGx test will provide you with detailed information, but it doesn't make you all-knowing. Don't change your medications or doses, or stop taking current medications without talking to a doctor. This is one of the biggest concerns when it comes to DTC-marketed PGx tests. While drug-gene relationships can be helpful, you need to understand that your prescriber takes into account environmental interactions, your size and weight, and other possible drug interactions that affect a medication's efficacy and its side effects. Theirs is an educated, objective, integrative approach. If you stop taking your medication or change your dosage on your own, without a green light from your prescriber, you put your own health at risk, in more ways than you may understand.
While ancestry DNA testing is more and more of a household topic, the genetics field with the most potential to impact our daily lives in the near future is much murkier. Before you spend any money on an at-home, or direct-to-consumer (DTC) health-related DNA test, there are lots of things you should consider. In this article, we are going to cover key things you should understand before you fork over your saliva for another round of digital-only results that at first glance — and probably second, third, and fourth glance — can cause confusion and undue stress. Here are 12 things to consider before taking an at-home health DNA test: 1. How are at-home DNA tests meant to be used? "Most DTC DNA tests are intended for entertainment, not for medical management," advises Ellen Matloff, President and CEO of My Gene Counsel. "But if you stumble across information that places you at higher risk for a genetic condition, it is worth discussing with a genetic counselor and your doctor to evaluate the best next steps." 2. Do you have a family history of disease? As an expert, Matloff advises consumers, "If you have a personal and/or family history of a disease and you are trying to figure out your risk of developing that disease, I would not recommend a consumer DNA test. Speak to a certified genetic counselor, by phone or in person, and figure out the best and most accurate test for your situation." This applies to both carrier screening and genetic health predisposition testing. With a known family history, if you want to look into inherited health risks for cancers and other conditions, you can still order a test from home; however, you will likely need to look into a different tier of DNA testing, with pre-test genetic counseling. Most tests that you can order online require people with a family history to have pre-test counseling either from a physician or genetic counselor that okays your order and makes sure that it is the right test for you, so that you know the risks, what to do about them, and you don't waste stress and money on a test that doesn't benefit you. If you have a family history, here's what you should know: Physician approval tests may reject you, so you would just be refunded and referred to a medical specialist. Pre-test counseling is recommended. Targeted screening is likely more informative (instead of just looking for a few things related to lots of diseases, you can get all of the info (as suggested by a doctor) about one health risk or genetic disorder. You can use DTC as a tool, but if you aren't a doctor, you might be lost. 3. Do you want a medical diagnosis or just a low-priced first opinion? However, Dr. Charlie Murphy reinforces, if you want to take a test for medical reasons, "it is always advisable to do so through your doctor." At-home testing can help indicate things, but it is often not considered diagnostic due to test limitations. For example, DTC testing company 23andMe is FDA approved, but if you want to know your BRCA status, you should go to the doctor. Why? Consider how extensive the test is. Matloff advises, "If you want to take a consumer DNA test for fun, be sure you understand the risks (privacy, unintended family results, potentially incomplete or inaccurate health information) before you spit and send." There are more than 1,000 known variants between BRCA1 and BRCA2 that are known to increase cancer risk. Out of 1,000 variants, 23andMe only tests for three, which are prevalent only for people with Ashkenazi Jewish descent. According to 23andMe, only about one in 40 people with Ashkenazi heritage has one of the three variants its report tests for. In contrast, when the general population is considered, one in 400 people have a known BRCA variant, when a full panel is considered. Additionally, when it comes to carrier screening, test panels and technologies have a huge effect on what you can learn from a DNA test. 4. What is your ethnicity? Ethnicity and genetic health analysis have a complicated relationship. Your ethnic background makes some tests more or less relevant. Here are a few examples: Certain genetic diseases are often more prevalent in people of certain ethnicities. Most genome studies have been focused on people with European ancestry. DNA tests often focus on the most common SNPs, or genetic variants that indicate either genetic carrier status or health risk. These aren't always relevant for every test-taker. Creating targeted health test panels for specific ethnicities doesn't always solve the problem because our self-reported ethnicity is reductive, especially when we have diverse backgrounds. 5. What state do you live in? Depending on where you live, you may not be legally allowed to participate in consumer-access DNA health screening. This is true in varying degrees, for people that live in New York, Maryland, or Rhode Island. However, there are exceptions on a test-by-test basis. 6. Can you handle the stress? Learning about your health risks, or your risk of passing on a disease to any children can be stressful. Do you really want to learn about it from a computer screen that you can't ask questions to? Carrier screening is a great example of this. Dr. Barnish explains, "Finding out if an individual is a carrier of a genetic disease can lead to serious anxiety, required testing of partners, testing of other family members and concerns when conceiving. Many parents, that both screened positive for the faulty gene, would have to opt to go down the route of genetic screening of embryos and IVF route when conceiving, costing them time, anxiety and lots of money. For people that cannot invest in this way, then they may choose to never conceive given the risk. Given, not all genetic diseases would leave people in this situation. Given this, a DTC test should always have some medical professional support or advice prior to taking the analysis and afterwards to support with the results and subsequent advice." 7. Would you want to learn about risk for a disease that isn't curable? Just like the stress that may come learning you are a genetic disease carrier, and have the possibility of passing it on to your children, testing for genetic health risks might be stressful, even when you properly understand the results. A national survey found that 74 percent of people would be interested in learning about genetic health risks for diseases with no known cure. In fact, 78 percent said they were most interested in learning their risks for developing Alzheimer's disease. Would you feel the same? While genetic health risk does NOT mean that you will get the condition, many people may feel worried to know the risk exists. In fact, 23andMe offers a privacy setting for health customers, where results for certain disease risks can be excluded from your results. 8. Is aftercare included in the price of your test? Follow-up is key to personally benefiting from the burgeoning DNA health information market. Before you order a test, you need to know whether you will be provided with a genetic consultation by your testing service, whether the cost is included in the price of the test, or whether you need to seek out advice on your own. 9. Can your doctor help interpret your results? The vast amount of health data that you can learn from a DNA test is crazy, but what happens when you bring your results to your physician for help? Physician reactions may vary, but it seems like there is room for improvement. Only about 30 percent of people who take a health-related DNA test share the results with their healthcare provider. One of the issues is that doctors might not be well-trained in providing actionable advice or help with understanding a DNA test's results. In fact, 85 percent of physicians say that they don't feel comfortable answering genetics questions. However, as the idea of a health-based DNA test becomes more and more common, this attitude won't be around for long. For example, a 23andMe study "found that doctors’ understanding and perceptions of DTC genetic testing changed significantly after testing,” says one of the paper's co-authors, Esther Kim, PharmD. Before testing, 25 percent said they were comfortable discussing genetics and genetic health risks. After testing, 60 percent of respondents felt more confident. As genetic health testing becomes more commonplace over the next few years, this should improve vastly. However, at this point, not all medical professionals are on the same page yet about providing genetic advice. 11. How will your data be protected? Most Americans feel positive about the importance of genetic research. In fact, a survey from the American Society of Human Genetics (ASHG) shows that 43 percent strongly agree that it's important to improving the health of their family. In addition to that, another 34 percent somewhat agree. Most DTC DNA testing companies offer consumers the opportunity to participate in genetic research. While most people agree that genetic research is important, data privacy is also a high priority. The ASHG survey also strongly indicates that people want to know exactly how their data is used. When deciding whether or not to participate, 66 percent of respondents said that research participation consent and data privacy would factor into their choice. You likely feel the same. Be sure to read through any and all privacy information provided by a DTC DNA service before you submit your sample. You need to know exactly how your DNA will be stored and shared, and what options you have in the way of research participation, account deletion, and what actually happens to your DNA sample. 12. If my test results are negative, am I in the clear? Scientists only finished mapping the human genome in 2003. We know what the encoded proteins are supposed to do. We know what things are supposed to look like normally, but we don't understand most of the possible mutations mean, whether they are benign or pathogenic, and the extent of their influence. Due to this, no genetic health test is completely conclusive. It's important that we don't let negative test results foster a false sense of security. Each DNA test has its own limitations. This is true for both genetic health risks and carrier screening. Researchers go to work every day to advance what we know about genetics and health. There is much we do not know. In addition to the unknown, there are still further limitations to this type of test and its results. Genetic health testing limitations are due to the technology and analysis used to turn your genetic code into answers. This is especially true when it comes to non-clinical testing. Each company has its own testing panel, but what they have in common is that they aren't complete. Here are two examples: Genetic Health Risks Carrier Screening If you take a DNA test from AncestryDNA and you get information back that you do not have any BRCA variants, you might feel great. What you should know is that there are a million variants and this test only says that you are negative for the ones it covers. If you take a DNA test from 23andMe and you get results saying that you are negative as a cystic fibrosis carrier, this means that you don't have any of the pathogenic carrier status variants, or mutations, included in the test. However, the test doesn't cover all known pathogenic variants. While expanded screening for less-common variants related to both health risks and carrier screening are available clinically, they still can't rule out all possibilities because we don't know the significance of all possible variants. It's important to keep these limitations in mind both when deciding whether to take a test, and when going over your test results. Read More: What Are the Benefits and Risks of Direct-to-Consumer Genetic Testing? (NIH/U.S. National Library of Medicine) Results of At-Home Genetic Tests for Health Can Be Hard to Interpret (NPR) The Limitations of At-Home Genetic Tests (Cancer Treatment Centers of America) Should You Get a Home Genetic Test? (Harvard Men's Health Watch) Should You Get At-Home Genetic Testing? Know the Facts First (University of Michigan Health Management) At-Home Genetic Tests Miss Many Mutations Linked to Cancer, Especially in Ethnic Minorities (breastcancer.org)
We are constantly bombarded by social media posts, billboards, and advertisements of images of the perfect body. Because of this, when we think of the gym or dieting we think of an impossible body image. We think of a girl who weighs less than a first grader, a guy with a hundred pounds of muscle and only 2percent body fat, or a woman who can lift well more than most guys. Although these people exist, they aren’t the norm. But this is the way we are now viewing diet and exercise; it is a serious issue and part of the reason we are trending in the wrong direction in terms of health. The way we view diet and nutrition is hard on our mental health. It will cause some people to go to extremes to match this “perfect body image” or it will discourage others from caring about their nutrition because it is “impossible.” Rachel Fiske, a nutritionist and personal trainer for Family Living Today says, “Mentally and emotionally, it takes a major toll, disconnecting you from the foods you eat and nourishment that food also provides spiritually and socially, and creates a mindset of deprivation and seeing food as a privilege or punishment, for example.” Most of us don’t need to lose 100 pounds or be able to lift 400 pounds, but we may need to lose a few pounds or get into a little better shape. So instead of telling you what to do, let’s talk about dieting at its core in simple terms. How can I lose weight? Losing weight is difficult for most people. And hundreds of companies make a huge profit on the newest dieting trend or weight loss pill, although they are usually just a short term fix. Calvin Mcduffie, a Health and Wellness Coach and Founder of Guide Your Health, recommends “. . . avoiding appetite suppressants and caffeine supplements for weight loss as they don't address the cause of weight gain, a slower metabolism. Weight loss supplements such as black seed oil, CLA, prebiotics, and probiotics not only have additional benefits to overall wellness but they boost metabolism.” Unless you understand nutrition deeply, are a doctor, or understand the molecular structure of food, which 99 percent of us don’t, this is the most basic explanation for why your body is gaining or losing weight: If you want to lose weight, you need to eat below your BMR(Basal Metabolic Rate) calories and if you want to gain weight, you need to eat above your BMR calories. (NoobGains.com)This may seem redundant, but this principle is so simple, yet so underappreciated. Your body will either take fats, carbs, or proteins your body has in reserves and turn it into energy, or it will store fats, carbs, or proteins that are left over each day. If you eat less than your body needs it will burn your reserves of fats, carbs, and proteins and you will lose weight. If it has extra fats, carbs, or proteins at the end of the day, you will gain weight. You hear of diets that require you to eat very little or restrict a particular food or nutrient. Although some of these diets are good and add needed nutrients to help with heart health and metabolism strength, be careful because some of these restrictive diets can be very dangerous. Our diets consist of eating a certain amount of carbs, proteins, and fats. These all are forms of energy that we call calories. You need a certain amount of energy to survive and keep your body functioning properly.You’ve probably heard that a basic diet consists of 2,000 calories a day. Although this is true for a specific few, odds are your body is different than the person sitting next to you, and your metabolism is probably different too.The number of calories your metabolism will burn in a day is found through the Basal Metabolic Rate or BMR. Your body will burn the food you supply it with daily, and if it needs more, it will grab from your carbohydrate reserves, fat reserves, or protein reserves. As your body turns these reserves to energy, you will lose weight. Rachel Fiske, a certified Personal Trainer and certified Nutritionist for Family Living Today, explains “BMR refers to basal metabolic rate, and is essentially how well your metabolism is functioning. It specifically means how much energy your body burns while at rest, just carrying out vital activities like digestion, circulation, etc…. If things are slow or not functioning well, weight gain, weight loss resistance, and even chronic diseases can follow.”You can find your BMR in a couple different ways. Olyvia DuSold, owner of AlignMii explains how to get an exact measurement: “For your BMR to actually be tested you would go into a lab like setting, have your body composition measured (so how much of your weight is fat, how much is bones, and how much is muscle), make sure that your body is done digesting (because that takes up a surprising amount of energy, on average 10% of your total daily expenditure), placed in a warm room (so your body doesn’t have to fight so hard to keep warm), all while being in a physically and psychologically rested state(aka no movement and no thought processes that bring on stress or excited emotions). These are the strict criteria that people need to experience to honestly test their BMR.” For those wanting to truly know their exact metabolic rate, going to a lab is the best way to find your BMR. The majority of us, however, will use the Harris-Benedict equation.To calculate your BMR using this equation:Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) - ( 4.7 x age in years )Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in years )This final number is about the number of calories your body turns into energy daily without exercise for the average person. If you are more active your body will need more sustenance. You can track the number of calories you burn in exercise through apps, smartwatches, or exercise machines. If you want to stay the same weight, eat that amount of calories. Eating a lot less than your BMR can be dangerous, but is how some unhealthy diets companies have made their fortune.Eating significantly more than your BMR can also cause strain on a body, creating heart problems, type 2 diabetes, or other health-related issues.To lose a pound a week requires someone to cut 500 calories from their diet daily or 3,500 calories a week. This can come from eating less, exercising more, or a combination of the two. To gain a pound a week, your body will need to eat 500 calories more than your daily diet or 3,500 calories a week. This can come from eating foods high in calories.BMR is a rough estimate but is pretty accurate. Beverly Friedmann, a manager for a ReviewingThis, who focuses on the health and beauty departments says, “A person with a naturally higher metabolism and thyroid function will naturally burn off more calories per day than a person of the same BMI metrics and activity levels. Younger people who are still growing tend to burn calories at a faster rate... and all of these factors connect with faster levels of weight loss (all other factors equal).”BMR is the best way we have found to quickly find how fast or slow your metabolism works, but of course, it is not a perfect algorithm. As you test the numbers this equation gives you, and as you continually update your BMR each time you lose or gain a few pounds, you will continue to trend in the desired direction. Can’t I just eat less? Just like any diet, even just eating less has some concerns that should be addressed to ensure that people are losing weight in a healthy way. Eating less will help you lose weight, but it may also cause serious issues if you are not being smart and paying attention to your body. To make healthy adjustments to your diet, pay attention to these three factors: Metabolic rate Food choices Fat/muscle ratio Metabolic rate Realize your metabolism changes with weight, height, and age. Remember your BMR is a combination of those three things and so updating your BMR often is really important. Calvin McDuffie, from Guide Your Health, adds some insight into why it seems we have to eat less to stay the same weight as we age:“A calorie is a measurement of heat and energy, the same heat we use to "burn fat" or have a "hotter" metabolism. When our metabolism is hotter, we absorb the nutrients from our foods and excrete the waste at a faster pace. Every year we are past our pubescent years, our metabolism begins to "cool off" or "slow down.”Make sure to continually update your BMR whenever you lose weight, have a birthday, or grow in height. Food choices Eating foods that help our metabolism work faster is a great way to lose weight. If your metabolism is slow, eating less won’t help it start moving faster, it will just slow down more. Having a combination of both eating less and eating healthy is important in weight loss. Ben Tzeel, a weight loss and diabetes management specialist, asked this simple question, “Why [would your metabolism] burn at a rate of 1800 calories per day when you're only taking in 1200 calories? Eventually [your metabolism, will] get down to 1200 calories burned per day, hence weight loss plateaus.”To ensure that your body is continually losing weight, eat healthy foods that boost your metabolism.Caleb Backe, Elliott Upton, Rachel Fiske, and Tracee Gluhaich, all health professionals in the field, share vitamins or nutrients that have been shown to help in weight loss: Omega 3 fish oil — reduce inflammation, improve insulin sensitivity and minimize fat storage, while improving cell health to optimize the utilization of stored fatty acids. Vitamin D — helps your body better absorb other key nutrients, reduce inflammation, and increase insulin sensitivity. Vitamin B6 — improves how your body uses energy from protein and carbohydrates and optimizes the absorption of amino acids which are key to muscle building and recovery. Other Vitamin B supplement — helps your body metabolize all your macronutrients and use stored energy. Glucomannan — a type of fiber taken in supplement form that has been shown to support satiety and perhaps weight loss. Probiotics — helps reduce fat mass. Magnesium — improves sleep quality which leads to less inflammation, lower stress hormones, better insulin sensitivity, and improved recovery, performance, and appetite regulation. Zinc — necessary for improving thyroid health and neurotransmitter production and function. It also supports testosterone production which in turn creates the conditions for better muscle building, fat burning, rest and recovery, and performance output in the gym. Black seed oil — Also known as Nigella sativa oil, black cumin seed oil, or kalonji oil this oil can be used in cooking and helps in many ways but especially in boosting your metabolism. CLA — naturally occurring nutrients found in fatty acids in meat and dairy products can improve metabolism. Fat/muscle ratio For those who only care about the number on the scale, this section will not pertain to you. But another key aspect to consider as you are dieting is this: although you are losing weight, what type of weight are you losing? Fat or muscle? Elliott Upton, a personal trainer at Ultimate Performance, proposes, “If you eat less than [your BMR], you will start to lose tissue of some kind, preferably fat, but it's most likely muscle if there is no demand put on the body to retain muscle mass.” A key issue with those trying to lose weight by eating less is that they are losing the wrong type of weight. But if you eat less as you work out, your body will keep the muscle and burn the fat. The sad truth behind restrictive diets Doing any diet that is meant to help you lose more than two pounds a week falls under the restrictive category.Restrictive diets work because they require you to eat less than your BMR, often to an unhealthy amount. Although these diets work fast, they might not be the best for your sustained growth or nutrition goals.Kim Melton, a registered dietitian and owner of www.nutritionprocensulting.com, explains the major issue with trying to lose more than two pounds a week: “Losing weight at a rate of more than two pounds per week has been shown to cause an increase in weight gain over time.”Eating too little, which is often the case with restrictive diets, can cause your body to go into starvation mode. Starvation mode is the most significant issue with restrictive diets. Often these diets require you to eat thousands of calories less than your BMR causing you to lose weight fast, but it is also a sure way to gain it all back the second you finish your diet.Jennifer Smith, owner of Joy Energy Nutrition and a registered dietitian, cautions, “There are physical and psychological negative effects that can occur from restrictive dieting. Physically, your body thinks that you are starving. If you are being too restrictive on calories or certain food groups your body could start breaking down protein and actually storing more fat when you start eating again making it more difficult to lose weight. People who are involved in yo-yo dieting or weight cycling have a larger risk of premature death and heart disease. Restrictive dieting causes you to ignore your natural body signals of hunger and satiety. It can increase your risk of developing an eating disorder as well as erode your self-confidence.” Libby Parker, MS, RD who specializes in eating disorders linked restrictive diets to malnutrition, organ failure, social isolation, and sudden cardiac death.When your body is in starvation mode, it grabs everything that it is given and hurries to store it. Your body does this to survive, but your body can’t break the reserves down fast enough to power the functions of the body in order to run properly. In essence, doing these types of diets will not allow you to think, act, or be yourself. This is why many people starting big diets are grumpy, reactive, or slow. The second you stop these extreme diets, your body will stay in starvation mode. It will continue to store the fats, proteins, and carbs instead of using them. Restrictive diets cause you to gain your weight back extremely fast. Because of this, companies who promote these diets will often keep their clientele for years. Their customers will often make statements like, "This diet is the only one that works for me. I lost 30 pounds in a month!” Then they become forever customers, crawling back every six months after they have gained back all of their weight.Although other safer diets take more time, they also aren't hurting your body the way these restrictive diets do. Other diets are designed to keep weight off indefinitely.Taking 500 calories out of your daily calorie intake may seem like a lot, but 500 calories is only a large fry at McDonald's. Just take out a side dish at two of your meals, or eat a few bites less at each meal and you will easily hit your goal of eating less. This is the real truth behind dieting. Eating less is perhaps the easiest way to start losing weight. You don’t have to be a health expert, a gym rat, or a nutritionist to start losing weight and keep it off.Listening to your body is also important. Dieting should be about your overall wellness. It is not supposed to be about the numbers on the scale. Rather than paying attention to the number on the scale, concentrate on how your body feels day in and day out. These restrictive diets are unhealthy and hurt your body in the long run. If you're looking to lose weight, make sure that the diet you choose is about eating healthy, eating less, and is not restricting you in a dangerous way.Disclaimer: Always consult a doctor before making serious changes to your diet or lifestyle.
Last week, a special enrollment period for health insurance was announced for states that use HealthCare.gov as their health insurance marketplace. Some states that do not use HealthCare.gov have decided to open their own marketplaces, too. HealthCare.gov will be open for enrollment February 15, 2021 through August 15, 2021. (The enrollment period was recently extended.) Plans purchased during this period will likely be effective starting the month after you make a selection. During this enrollment period, you can enroll in a Marketplace health plan or change to a different Marketplace health plan. (States opening their own enrollment periods may have different dates and possible actions.) You can enroll or make changes three ways: Online through HealthCare.gov Over the phone with the Marketplace call center Through direct enrollment channels (e.g. working with a licensed insurance agent certified by the Marketplace) Louise Norris Health Insurance Expert Expert Tip People should seek out help if they feel unsure of the process. It's important to find a navigator, enrollment counselor, or broker who is certified by the exchange. In HealthCare.gov states, people can use this tool to find local help; the state-run exchanges have similar tools. Typically, you can only enroll in health insurance during the annual open enrollment period (November 1 through December 15). To enroll at any other time, you have to qualify for a Special Enrollment Period by experiencing a Qualifying Life Event. This recently announced special enrollment period offers a valuable opportunity to ensure that you have the health coverage you need. Tips for navigating the special enrollment period If you missed open enrollment, here's your chance to enroll in the coverage you need. Having health insurance can bring peace of mind at any time. However, the peace of mind a health plan offers is only heightened during a pandemic. As you evaluate health plans, pay attention to cost and coverage. Cost Health plan costs include the monthly premiums and out-of-pocket expenses. First, let's talk about premiums. These expenses need to fit your monthly budget so you can maintain your coverage. Subsidies on premiums are available with Marketplace plans. These subsidies are based on your income. When you apply for coverage through the Marketplace, you'll be able to check your eligibility for subsidies. Using these subsidies can make buying a health plan more affordable. With the economic uncertainty and significant changes people are experiencing, anticipated income can be harder to estimate as you determine whether or not you'll qualify for a subsidy. Norris notes how job loss and stimulus checks have posed some difficulty when estimating income: "It's important to understand that unemployment benefits, including the extra federal benefits that were provided last year and again in the bill that was enacted in December, are counted as income when subsidy eligibility is determined." In addition to ensuring that the monthly premium fits your regular budget, consider the plan's out-of-pocket costs. Health plans have an annual deductible that must be met before the insurer begins taking more responsibility for costs. Health plans also have an annual out-of-pocket maximum. This maximum is usually higher than the annual deductible. If you reach your out-of-pocket maximum, the health insurer will take responsibility for covered health care services. As you consider the deductible and out-of-pocket limits, look at the amounts for copays and percentages for coinsurance. These costs are usually paid at the time of service, so they're important to keep in mind. Depending on your health needs, it can make sense to pay a higher premium for better cost-sharing and lower out-of-pocket costs. Coverage Most health plans available offer coverage per Affordable Care Act requirements. Coverage includes mental health services, hospitalizations, preventive care, maternal care, newborn care, prescriptions, and more. However, short-term and indemnity health insurance plans do not offer the same level of coverage. These plans often cover significantly fewer health services and don't cover pre-existing conditions. As you navigate this enrollment period, make sure you're looking at health plans offering full coverage. "It's also important to avoid scammy websites and sales entities that might try to piggyback on this special enrollment period in order to sell short-term plans, fixed indemnity plans, etc. People should start at HealthCare.gov, on the "get coverage" page. When they select their state, it will either keep them on HealthCare.gov or direct them to their state's marketplace, whichever is applicable. That way they'll know for sure that they're shopping in the official marketplace for their state," recommends Norris. As you consider health plans, understand the coverage offered and pay attention to costs to help you find a plan that meets your needs. Implications of the special enrollment period The special enrollment period will affect health insurers and uninsured or underinsured Americans. Health insurance industry Lesa Votovich, GBA Health and Benefits Vice President for Cowden Associates, Inc. observes that health insurers have responded positively to the special enrollment period: "I would say it is welcomed mostly due to the fact that leaving individuals uncovered in general is not good for our society as a whole. It is important for individuals to have access to coverage and to obtain the care that they need. The delay in care often leads to more adverse, higher cost medical events for individuals." Better health insurance coverage within a population can result in better health outcomes, reduce the necessity for expensive care, and protect people financially. During this special enrollment period, many Americans will be able to enroll in a health plan, which also helps insurers manage risk. "From a business perspective in insurance the law of large numbers applies, i.e., the more people you have insured, the more revenue you have to offset the expense and to level premiums against thus keeping insurance premiums in check," continues Votovich. In other words, more people enrolling in health insurance helps to keep premium rates reasonable. Of course, the number of people insured isn't the only thing that affects premium rates, but it does play a role. How much this special enrollment period will affect health insurers depends on how people respond: "Overall, I think the true impact on the health insurance industry will be determined based on how the numbers increase and the actual level of risk that exists within those that do enroll," says Votovich. Uninsured and underinsured Americans According to Kaiser Family Foundation research, having health insurance plays a key role in health care access in the United States. This special enrollment period can help many Americans overcome a major health care access barrier by getting needed coverage. Yet, simply having health insurance may not always translate to health care access for everyone. While acknowledging the importance of having health insurance, Nicole Rochester, MD and founder of Your GPS Doc, LLC also underscores how problems with the health care system affect health care access: "There are many structural barriers that prevent marginalized communities (even those with insurance) from accessing appropriate health care and those barriers will also need to be addressed. Getting health insurance is a first and necessary step, and I’m hopeful that we will see additional improvements moving forward." Taking advantage of this special enrollment period? Here are helpful resources to help you assess health plans and health insurance carriers: 4 Things to Look For in a Health Plan [Video] Aetna vs. Cigna vs. Kaiser Permanente 2021 Review 66% of BlueCross BlueShield Reviews Are 4 or 5 Stars Best Health Insurance Companies: What 2020's Customer Reviews Reveal [Video] Top Health Insurers According to Customer Reviews
2020 brought the importance of health insurance and health care access into sharp relief as we followed implications of the COVID-19 pandemic. It also heightened the importance of the customer experience in client retention as companies adjusted operations along COVID-19 guidelines. Regardless of industry, customer reviews play an important role in understanding what clients want. We analyzed health insurance customer reviews received in 2020 to understand more about what matters to health insurance plan members. Key Takeaway: Health insurers can improve the customer experience in 2021 by focusing on the areas listed below. Customer service Coverage options Provider networks Claims processing Affordability 2020 Customer Review Breakdown Best Company received 905 total reviews for the health insurance industry in 2020, slightly below 2019's 1066 total reviews. (Read the full 2019 report.) Here's how 2020's review star ratings came out: 44 percent 5-star (compared to 28 percent in 2019) 21 percent 4-star (compared to 18 percent in 2019) 6 percent 3-star (compared to 8 percent in 2019) 5 percent 2-star (compared to 5 percent in 2019) 24 percent 1-star (compared to 41 percent in 2019) The biggest difference between 2019 and 2020 reviews is the increase in 5-star reviews and the decrease in 1-star reviews. This change in review data makes the health insurance industry more hopeful than last year: 65 percent 4-star and 5-star reviews in 2020 versus 46 percent 4-star and 5-star reviews in 2019. These differences in review percentages may indicate that health insurers are doing a better job when providing services. However, we only have two years of similar analyses. Until we have more data, whether health insurers responded to 2019's complaints is uncertain. It's also unlikely considering the more pressing issues of responding to COVID-19. 5-star review analysis Since the largest proportion of 2020's reviews are 5 stars, we dug deeper to understand what plan members value about their experience: 47 percent mentioned good customer service 28 percent discussed coverage satisfaction 20 percent talked about provider networks positively 15 percent mentioned positive user experience with the insurer's platforms 14 percent of reviewers were happy with claims 14 percent of reviewers discussed cost satisfaction 7 percent of reviewers mentioned affordable out-of-pocket costs (counted separately from general cost satisfaction) Interestingly, 9 percent of 5-star reviewers mentioned being on a health plan through an employer. Customer service When you have a question or need to resolve something with a company, good customer service makes a big difference. Our data analysis found that praise for customer service included short wait times, quick response times, and knowledgeable representatives. Health insurers can continue to deliver high quality customer service by focusing on these aspects. Coverage You buy health insurance for the coverage, so good coverage is important. With health insurance, it's key to balance cost and coverage. Health insurers can make it easier to find good coverage that fits your price point by offering a variety of health plans. In customer reviews, reviewers liked having a variety of coverage options. Adjectives describing coverage also included "excellent" and "great." Customer Review: Nathan from Broomfield, Colorado "I have always been impressed with the quality and quantity of coverage I have gotten from Blue Cross Blue Shield. They have helped me get through some very trying times and pay for my medication!" Provider network The third most frequent praise was about provider networks. Reviewers mentioned either their plan's wide acceptance or praised the quality of their care providers and facilities. Finding a doctor you trust that provides good care matters. Large provider networks make it easier to find a good in-network, which helps you keep your out-of-pocket costs down. Platforms Reviewers also appreciated how easy their insurer's platforms were to use. These included the company's website, online member portal for tracking claims, tools for finding providers, and the mobile app. Customer Review: Rahim Sabadia from Yorba Linda, California "Excellent overall care. Very responsive and their online platform and tools make it very easy to keep track of appointments, lab results and communications with health care providers." Telemedicine is also included in this category because it can be accessed through platforms connected with an insurer. Platform interfaces and ease-of-use mattered even more in 2020 as we did more things remotely. Cost The cost satisfaction category included general statements about cost and affordability. In some reviews, it seems like these references were about monthly premiums. However, some reviewers may combine premiums and out-of-pocket costs when commenting on cost generally. Seven percent of reviewers specifically mentioned satisfaction with out-of-pocket costs. These were counted separately. Claims Claims satisfaction was just as common as cost satisfaction in 2020 5-star reviews. Reviewers mention never experiencing a denial or timely processing and payouts. Customer Review: Patti Miller "I had BC&BS for 27 years through my work place. Never had a claim denied. Not alot of time past before payments were made. Customer service was always available to answer questions." 2019's complaints and 2020's praises It's not hard to imagine that 1-star reviewers and 5-star reviewers have very different experiences with a company and an industry. Considering 2019's high number of complaints alongside 2020's high number of praises reveals a helpful parallel. 2019 Complaints Poor customer service (42 percent) Coverage difficulty or denial (32 percent) Claims process or payment difficulty (23 percent) Provider network concerns (22 percent) Cost vs value of plan (21 percent) 2020 Praises Good customer service (47 percent) Satisfaction with coverage levels and options (28 percent) Happy with provider networks (20 percent) Smooth claims processing (14 percent) Affordable cost (14 percent) Top complaints in 2019 strike similar notes as 2020's top praises. This congruity highlights the importance of each of these factors to the overall customer experience. Health insurers should pay attention to these areas as they train employees and serve plan members. Methodology These results are based on a total of 905 health insurance reviews left on Best Company in 2020. Of those reviews, 401 had 5-star ratings. A random sample of 163 5-star reviews is the basis for the praise analysis. Results of the 5-star review analysis have a 90 percent confidence level with a 5 percent margin of error.
2020 has affected our daily lives in profound ways. Job loss affected access to health insurance and health care in the middle of a pandemic. Health insurance changes may also be on the horizon because the Supreme Court starts hearing a case on the Affordable Care Act in November. A decision is anticipated in 2021. COVID-19 and potential changes to health insurance laws make this year's Open Enrollment period more important than ever. Employers are also feeling pressure from COVID-19's fallout, which may affect the health insurance options they offer employees. Whether you're buying health insurance on your own or through your employer, shopping for and enrolling in health insurance for 2021 has more significance than past years. A recent study from Unum found that 64 percent of workers plan to pay more attention and spend more time reviewing their benefits and 36 percent plan to enroll in different benefits. While there is no data on these questions to compare with previous years, these numbers do show that workers are making adjustments and planning to increase time understanding their workplace benefits. As we enter the Open Enrollment period, here's what you should know as you select health insurance plans. COVID-19 pandemic We're all too familiar with stories of COVID-19 patients needing care in the ICU, and that level of medical care can add up quickly. The U.S. legislative responses to COVID-19 provided resources to cover COVID-19 care for uninsured individuals. Although those resources make a difference, buying health insurance can offer valuable financial protection, peace of mind, and help you access medical care when you need it. Fortunately, there's good news if you're buying your own insurance. "Because the marketplaces are strong and healthy, we’ve seen an increase in the number of insurers participating and an increase in the number of options being offered. Regardless of the pandemic, high-quality, affordable and comprehensive coverage remains available," says Joshua Peck, cofounder of Get America Covered. The risks of going without health insurance are starker this year than they were last year. Insurance premiums aren't cheap, but it's worth making adjustments to your budget and exploring subsidies available to fit it in. Peck continues, "It’s always risky to be without coverage. No one knows when they’ll have an emergency or develop a serious health problem. Last Open Enrollment, no one deciding whether to get covered or not could’ve anticipated this pandemic. It’s abundantly clear that this pandemic is not temporary. It’s not going away any time soon, and no one understands the long-term health implications of even mild cases of COVID-19. Everyone deserves to enjoy the peace of mind offered by health coverage — especially amidst this potentially devastating illness." If you receive insurance through an employer group plan, you may see some changes. These will vary by employer, so it's difficult to make generalizations at this point. Peter Nieves, Chief Commercial Officer and benefits management expert with WINFertility, provides wise insight for employees who want to maximize their benefits: "Employers may shift costs to employees through higher deductibles and coinsurance or only offer a high deductible plan. Employees should consider optimal use of FSA, HSA or HRA accounts and, if not enrolled in an HDHP, consider the lower monthly cost of the offer. If an Employee will have a greater cost share burden in 2021 for care, then be sure to not delay treatment, surgery or testing and take thoughtful action in 2020." Although changes are possible, Lesa Votovich, Vice President of Health and Benefits at Cowden Associates, Inc., notes that employers are working to avoid making changes: "In the group marketplace, it has been my experience thus far that employers are trying to make as few changes as necessary, recognizing the impact that the pandemic has had on their employees this year. They definitely are not looking to add more insult to injury wherever possible." Supreme Court case The Supreme Court will start hearing arguments for California vs. Texas in November. This case calls the Affordable Care Act's (ACA) "individual mandate," requiring everyone to purchase health insurance, into question. The Court's ruling could upend the health insurance landscape we've become accustomed to if the ACA is overturned. The ACA protected people with pre-existing conditions from being denied coverage or charged higher premiums on policies. It allowed children to stay on their parents' health plan until age 26. It expanded Medicaid and instituted income-based subsidies on Marketplace monthly premiums that made buying a good health insurance plan more affordable. Insurers used to have annual and lifetime benefit maximums that shifted excess costs on policyholders and limited the benefits available to people with chronic conditions. "It’s difficult to predict how the Supreme Court will rule and thus hard to predict how it will impact people enrolled in health plans. But no decision is likely until June of 2021, so anyone who needs coverage now should check out their options, enroll, and know that their coverage is secure," advises Peck. Although there is uncertainty, it's important to consider the potential fallout if the ACA is overturned by the Supreme Court. Votovich paints a bleak picture of the effects that ruling could have: "Should the Supreme Court decide to strike down the ACA, more than 20 million people will lose their health care coverage. These are individuals who obtain their health care policy through a federal marketplace plan. Those covered by employer-sponsored health care coverage will likely still remain covered by that plan. Currently, as we are in the midst of the pandemic, continued racial disparities in coverage and the heightened likelihood of a potential financial crisis, the impact of individuals losing coverage would be devastating." Anticipate how the Supreme Court ruling to uphold or overturn the ACA would affect you. Make sure you get the coverage you need for 2021 during Open Enrollment. Votovich shares this advice: "Understand the coverage that you are purchasing. If you are uncertain and have questions about the options available to you, seek out an agent who can assist you in navigating the plans. Assess the typical services that you receive in a year and disclose them to the agent you may work with so that they can provide you with options that may best meet your needs. Most importantly, don’t let your coverage lapse. If the Supreme Court does strike down the ACA, you want to make sure that you have continuous health coverage so that you may avoid being limited by pre-existing condition policy limitations in the future. If history holds true, if one does have coverage for a continuous period without a 60-day lapse, then pre-existing conditions will not likely apply." We have time before the Supreme Court issues a ruling. If the Court overturns the ACA, some of the changes will be immediate. Others will take more time. "Once the ruling is made there will likely be a noted transition period. For example, if the Court rules next June there may be a period of six months to a year for insurers to decide how they will react to the ruling and formulate what their individual market will look like on a go forward basis," says Votovich. Managing through uncertainty One of the challenges of 2020 has been confronting uncertainty and dealing with the unexpected. We've confronted realities in new ways and adapted to new circumstances. Enrolling in a health plan during Open Enrollment can help you be prepared for uncertainty in 2021, whether it's unexpected medical expenses or transitioning to an unfamiliar health insurance landscape. Use the checklist below to help you navigate this year's Open Enrollment period.
Updated October 26, 2020 2020 Open Enrollment is just around the corner. With health care concerns from the pandemic and increased health care access concerns resulting from shutdown layoffs, health insurance's role in removing barriers to health care access is much clearer. Since health insurance companies can change their offerings and even your current plan, you should shop around each year to make sure that you have health insurance that fits your budget and meets your needs. For helpful information on choosing a health plan, read "4 Things to Look For in a Health Plan [Video]". In addition to finding a good health plan, it's important to choose a trusted and reliable insurer. To help you identify the best health insurance companies to work with, we'll review what this year's customer reviews say about nine companies. While Best Company lists more than nine health insurance companies, only these had a worthwhile number of reviews to analyze. These nine are listed from most 2020 reviews to fewest 2020 reviews. (In other words, we're the most confident about our findings for BlueCross BlueShield because there were more reviews. We're the least confident about our findings for Molina Healthcare because there were fewer reviews to analyze.) BlueCross BlueShield UnitedHealthcare Oscar Kaiser Permanente SelectHealth Ambetter Cigna Aetna Molina Healthcare 1. BlueCross BlueShield Best Company Rank: #12020 Best Company User Rating: 4.10/52020 Review Breakdown: 54% 5-Star 24% 4-Star 7% 3-Star 7% 2-Star 8% 1-Star 2020 Reviews by State: 12% from Utah 8% from Texas 7% from Mississippi 6% from California 6% from Florida 2020 Most Common Complaint: Cost (10%)2020 Most Common Praise: Customer Service (30%) Coverage dissatisfaction (8%) and concerns with red tape (6%) both followed cost dissatisfaction. Praise was much more common in BlueCross BlueSheild's 2020 reviews than complaints were. Other common praise included coverage satisfaction (22%), cost satisfaction (21%), general satisfaction (17%), network satisfaction (17%), and claims satisfaction (15%). Note: Qualitative analysis based on a random sample of 114 out of 194 reviews left on Best Company for BlueCross BlueShield as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 reviews by state, 2020 geography breakdown) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Vantresa Scott from Annapolis, Maryland "I've been with BCBS for most of my life. They have been great. I started when I was 26 years old and I am now 57. Their physician network is terrific and plans are great and I have never had a problem with them covering my expenses. NEVER EVER. I started my own company 5 years ago and we only offer BCBS plans because of the exceptional quality. Their national and international coverage is top notch." Our Advice With 78 percent of this year's reviews hitting 4 or 5 stars, BlueCross BlueShield is a great company to work with. Before enrolling in a plan, be sure you understand what's covered and what requires prior authorization. Having this understanding will help you be prepared for prior authorization and can prevent coverage concerns. While the most common concern was cost (10%), 21 percent of reviews were happy with the cost. As you look at plans consider whether the monthly premiums fit into your budget and do your best to estimate what your out-of-pocket costs may be next year. After evaluating BlueCross BlueShield plans, you can be confident in your insurance company choice since reviewers had more positive comments regarding customer service, provider network, coverage, and claims than negative ones. Keep in mind that BlueCross BlueShield is a national company and works through many subsidiaries. For more specific information on the BlueCross BlueShield subsidiary in your area, look for reviews for it by name. Subsidiaries include Regence, Anthem, Florida Blue, Independence BlueCross, and others. BlueCross BlueShield Health Insurance Learn more about BlueCross BlueShield by reading customer reviews and our expert analysis. Learn More Back to Company List 2. UnitedHealthcare Best Company Rank: #62020 Best Company User Rating: 3.61/52020 Review Breakdown: 51% 5-Star 16% 4-Star 2% 3-Star 7% 2-Star 25% 1-Star 2020 Reviews by State: 15% from Utah 10% from Florida 7% from California 7% from Texas 5% from Arizona 4% from New York 2020 Most Common Complaint: Customer Service (21%)2020 Most Common Praise: Customer Service (25%) The two other most common complaints were about claims (14%) and coverage (14%). Network satisfaction (14%) and general satisfaction (12%) followed praise for customer serivce. Note: Qualitative analysis based on a random sample of 85 out of 122 reviews left on Best Company for UnitedHealthcare as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Dorothy from Omaha, Nebraska "I have been a UnitedHealthcare customer for 2 years and highly recommend this reputable company. I was enrolled in their student health insurance plan and the plan's details were easy to understand, the plan was accepted at all of my providers, and customer service was always helpful!" Our Advice Based on this year's customer reviews, it's harder to give a clear recommendation of UnitedHealthcare. It's promising that a majority of its reviews (67%) are 4 or 5 stars. However, 25 percent of this year's reviews are 1 star. It's also concerning that reviewers offered more specific complaints than praise. As with most health insurance companies, your coverage, network, and cost vary depending on the plan you choose. Health plan offerings can also vary by location. Because of this variation, you need to review any health plan you consider carefully to ensure it covers the medical services you need. You also need to ensure that the monthly premiums fit your budget and that the health plan will help you control your out-of-pocket expenses. Since a majority of UnitedHealthcare members reported a good experience this year, UnitedHealthcare is worth considering. However, carefully review the coverage offered in each plan you consider before you enroll. You'll want to avoid issues with claims and coverage. Double-checking that the services you need are covered will increase the odds that you'll have a good experience with UnitedHealthcare. UnitedHealthcare Health Insurance Learn more about UnitedHealthcare by reading customer reviews and our expert analysis. Learn More Back to Company List 3. Oscar Best Company Rank: #32020 Best Company User Rating: 3.54/52020 Review Breakdown: 42% 5-Star 22% 4-Star 7% 3-Star 6% 2-Star 23% 1-Star 2020 Reviews by State: 33% from Texas 22% from California 12% from Florida 12% from New York 2020 Most Common Complaint: Provider Network (21%)2020 Most Common Praise: Customer Service (41%) Poor customer service was the next most common complaint at 16 percent. Praise was more common in Oscar reviews and included satisfaction with the app (20%), satisfaction with perks and incentives (18%), general satisfaction (14%), network satisfaction (14%), and cost satisfaction (14%). Note: Qualitative analysis based on a random sample of 56 out of 69 reviews left on Best Company for Oscar as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Brock Williams from Los Angeles, California "Oscar has been the best health insurance company I've ever had. I've been self-employed my entire adult life, so I've paid for my own health insurance and I've had a lot of different policies with different companies, in multiple states. Oscar has been the most affordable, easiest to navigate and best coverage I've ever had." Our Advice While 64 percent of Oscar's reviews are 4 or 5 stars, 23 percent are 1 star. As you consider Oscar health plans, pay attention to the provider network in your area. Make sure that the doctors you need are reasonably close. Fortunately, Oscar reviewers had more positive things to say than negative ones. If you're looking for a good app, nice perks and incentives, and good cost, Oscar is worth investigating further. Again, be sure to review each plan's network, coverage, and cost to ensure that you find an affordable health plan that meets your needs. Oscar Health Insurance Learn more about Oscar by reading customer reviews and our expert analysis. Learn More Back to Company List 4. Kaiser Permanente Best Company Rank: #42020 Best Company User Rating: 3.97/52020 Review Breakdown: 57% 5-Star 15% 4-Star 10% 3-Star 3% 2-Star 15% 1-Star 2020 Reviews by State: 41% from California 15% from Utah 7% from Colorado 7% from Georgia 5% from Oregon 2020 Most Common Complaint: Doctors and Staff (17%)2020 Most Common Praise: Doctors and Staff (42%) Other complaints included issues with member services or red tape (13%) and concerns that Kaiser Permanente was expensive (10%). Other common praise included general satisfaction (17%) and convenience (12%). Note: Qualitative analysis based on a random sample of 52 out of 61 reviews left on Best Company for Kaiser Permanente as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Luna from Rockville, Maryland "The doctors and nurses there are very nice. They have clean and high technology equipment. I think it worth the money." Our Advice A majority of Kaiser Permanete's reviews this year were 4 or 5 stars (72%), it still received a fair number of 1-star reviews (15%). Considering other years, Kthe proportion of 5-star and 1-star reviews are similar. It's tricky to make a clear recommendation. Kaiser Permanente stands out from other health insures because it employes doctors and runs hospitals instead of negotiating and contracting with doctors and hospitals to build a provider network. When you enroll in a Kaiser Permanente plan, you'll be limited to its doctors, clinics, and hospitals. Since both the most common complaint and most common praise this year were about Kaiser Permanete's doctors, you'll want to know how many Kaiser Permanente facilities and doctors are in your area and how good they are to gauge how well a Kaiser Permanente plan might work for you. You'll also want to pay attention to how your plan's coverage works and whether any services require prior authorization. Doing so will help you use your health plan better and be prepared for the prior authorization process. Kaiser Permanente Health Insurance Learn more about Kaiser Permanente by reading customer reviews and our expert analysis. Learn More Back to Company List 5. SelectHealth Best Company Rank: #22020 Best Company User Rating: 4.41/52020 Review Breakdown: 57% 5-Star 33% 4-Star 6% 3-Star 2% 2-Star 2% 1-Star 2020 Reviews by State: 78% from Utah 8% from Minnesota 4% from California 2020 Most Common Complaint: Cost (8%)2020 Most Common Praise: Customer Service and General Satisfaction (tied at 35%) Praise was far more frequent in SelectHealth reviews than complaints. Other common praise included provider network satisfaction (29%), coverage satisfaction (27%), and clarity regarding coverage (12%). Note: Qualitative and quantitative analysis based on 51 reviews left on Bes tCompany for SelectHealth as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Aidan Keogh from Ogden, Utah "We have like Select Health Insurance. The coverage is great and the number of available facilities and providers is large. They are quick to pay out benefits and to inform us what they plan on paying." Our Advice SelectHealth offers health plans in Utah and Idaho. With 90 percent of this year's reviews earning 4 or 5 stars, SelectHealth is a recommended health insurer. Even though SelectHealth received only 51 customer reviews on Best Company this year, it has consistently received a high proportion of 4 and 5 star reviews. Based on this year's reviews, you're likely to find good customer service, good provider networks, coverage, and be generally satisfied. While 2020 SelectHealth's reviews were full of general satisfaction and praise, cost was the most common complaint. You'll want to review your health plan's costs before enrolling. Your costs include monthly premiums and out-of-pocket expenses. Review the copays or coinsurance for the health services you think you'll need next year. Since most of this year's reviews come from Utah, it's difficult to say whether SelectHealth is as good in Idaho as it is in Utah. If you're in Idaho, review SelectHealth plans for the provider network, coverage, and cost. Compare these three aspects to plans offered by other insurers in your area to see which best meet your coverage and financial needs. SelectHealth Health Insurance Learn more about SelectHealth by reading customer reviews and our expert analysis. Learn More Back to Company List 6. Ambetter Best Company Rank: #72020 Best Company User Rating: 1.98/52020 Review Breakdown: 18% 5-Star 7% 4-Star 2% 3-Star 2% 2-Star 71% 1-Star 2020 Reviews by State: 31% from Texas 14% from Georgia 11% from Arizona 11% from Florida 2020 Most Common Complaint: Coverage (36%)2020 Most Common Praise: Customer Service (13%) Complaints were quite common in Ambetter's reviews. Other common complaints included network dissatisfaction (27%), claims issues (24%), and poor customer service (24%). Note: Qualitative and quantitative analysis based on 45 reviews left on Best Company for Ambetter as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Even though Ambetter received only 45 reviews this year, 71 percent of them are 1 star. Ambetter has also consistently earned a high proportion of 1-star reviews on Best Company, which means that Ambetter is not a recommended insurance company. If you don't have another option in your area, ask questions about the provider network, the claims process, and be sure to throughoughly understand what coverage your plan offers. Learn more about Ambetter by reading customer reviews and our expert analysis. Back to Company List 7. Cigna Best Company Rank: #52020 Best Company User Rating: 3.33/52020 Review Breakdown: 36% 5-Star 15% 4-Star 18% 3-Star 8% 2-Star 23% 1-Star 2020 Reviews by State: 27% from Utah 13% from Texas 2020 Most Common Complaint: Coverage (18%)2020 Most Common Praise: Customer Service (21%) Other complaints included network dissatisfaction (15%), cost dissatisfaction (10%), and claims dissatisfaction (10%). Praise also included coverage satisfaction (15%) and claims satisfaction (13%). Note: Qualitative and quantitative analysis based on 39 reviews left on Best Company for Cigna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Kevin Liu from Sandy, Utah "Cigna has good coverage options for my primary care doctors. Their web ports is very transparent and easy to use to find physicians and see what I’ve paid towards my deductible." Our Advice A clear recommendation is also difficult to make for Cigna. The insurer only received 39 reviews this year. While 51 percent of these reviews are 4-stars or 5-stars, a good chunk (23%) were 1 star. Considering all of the reviews left on Best Company regardless of year, Cigna has received a majority of 1-star reviews (40%). 4-star and 5-star reviews account for 43 percent of Cigna's overall reviews, 20 percent and 23 percent respectively. While it's promising that Cigna received a lower proportion of negative reviews in 2020, be careful as you look at plans from this company. Pay attention to the coverage offered, provider network, and cost to be sure you find a plan that meets your needs. Learn more about Cigna by reading customer reviews and our expert analysis. Back to Company List 8. Aetna Best Company Rank: #82020 Best Company User Rating: 3.53/52020 Review Breakdown: 41% 5-Star 22% 4-Star 6% 3-Star 6% 2-Star 24% 1-Star 2020 Reviews by State: 15% from Florida 15% from Utah 12% from California 2020 Most Common Complaint: Claims and Customer Service (tied at 18%)2020 Most Common Praise: Coverage (35%) Complaints were less common. Other complaints included network dissatisfaction (6%) and general dissatisfaction (6%). Praise also included good customer service (21%), cost satisfaction (18%), network satisfaction (18%), and plan choice (18%). Note: Qualitative and quantitative analysis based on 34 reviews left on Best Company for Aetna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Phil Carriere from Cambridge, Iowa "Looked at several other plans from various other companies , but felt like the Aetna plan was best for my wife and I. Low cost,covered everything we needed covered, and includes a dental rebate program. When i needed an answer to a question they have always been there for me and are always concerned about improving my well being." Our Advice Although Aetna received 63 percent 4-star and 5-star reviews this year, it also received a good chunck of 1-star reviews (24%). If you opt for Aetna, be prepared for potential issues with claims and customer service. Keep in mind that Aetna doesn't offer individual and family plans. It offers Medicare and Medicaid. If you qualify for those plans and find one that meets your needs, Aetna can be a good option. Learn more about Aetna by reading customer reviews and our expert analysis. For specific information about Medicare, read Aetna's Medicare profile. Back to Company List 9. Molina Healthcare Best Company Rank: #152020 Best Company User Rating: 3.56/52020 Review Breakdown: 4% 5-star 13% 4-star 8% 3 star 0% 2-star 75% 1-star 2020 Reviews by State: 17% from Utah 17% from Washington 13% from South Carolina 13% from Texas 8% from Wisconsin 2020 Most Common Complaint: Coverage (38%)2020 Most Common Praise: General Satisfaction (8%) Other common complaints included poor customer service (33%), dissatisfaction with network (33%), issues with red tape (25%), and premium or billing difficulties (21%). Note: Qualitative and quantitative analysis based on 24 reviews left on Best Company for Molina Healthcare as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Since the number of reviews is so small and this year's reviews are almost half of the reviews on Best Company for Molina Healthcare, it's hard to make a certain recommendation. It's concerning that 75 percent of this year's Molina Healthcare's reviews were 1 star while only 17 percent were 4 or 5 stars. If you're considering Molina Healthcare, call your current doctors — and even doctors you may need to visit — to ask if they accept Molina Healthcare insurance plans. You'll also want to carefully review the coverage Molina's plans offer so that you know how to use your plan and how to approach prior authorization when needed. You should also review your plan's costs, including the premium, deductible, copays, coinsurance, and out-of-pocket maximum. Keep an eye out for billing issues as well. Learn more about Molina Healthcare by reading customer reviews and our expert analysis. Back to Company List
BlueCross BlueShield has earned the top spot in health insurance on Best Company. It has earned a 3.6 user star rating, and 66 percent of its reviews are 4 or 5 stars. If these numbers seem just average or a little low, consider that 41 percent of health insurance reviews were 1-star in 2019. Since complaints are common for the health insurance industry, what look like average ratings are actually quite good. BlueCross BlueShield has also earned a 5.35 out of 10 net promoter score. This score indicates how likely reviewers are to recommend the company to a friend. A score of 5.35 may seem low, but the average for the health insurance industry is 4.14 out of 10. BlueCross BlueShield's net promoter score is above average. So, what is BlueCross BlueShield doing right? I looked at 4- and 5- star reviews to find out. The most significant areas of success were customer service, coverage, and reliability and quality. Customer service The most commonly mentioned positive experience with BlueCross BlueShield was customer service. Roughly 44 percent of reviews had praise for BlueCross BlueShield's customer service. Customer Review: Linda Hill "The best part of Blue Cross is their customer service. They are very patient and willing to take the time to explain your benefits." Customers appreciate BlueCross BlueShield's commitment to clarity and making sure they understand their benefits and claims. Customer Review: Thomas Hullinger from Pleasant Grove, Utah "BlueCross BlueShield has made it easy for me to take care of my health and the health of my family. They give you the information up front to make an informed decision and help you every step of the way. Top notch care from top notch doctors and nurses." Clarity isn't the only thing that BlueCross BlueShield customer service gets right. Members also appreciate how responsive BlueCross BlueShield is when they have questions or concerns. Customer Review: AJ and Maria Ferguson from Riverton, Utah "We have had BlueCross Blue Shield for many years. They have always been great in paying claims quickly. Their customer service has always been quick to respond and find the answers to my questions or help empower me with knowledge that I have needed when there has been a discrepancy with a provider." Another satisfied BlueCross BlueShield member was impressed by the care shown by company representatives. Customer Review: Brandy Rudy from West Jordan, Utah "I have had BlueCross BlueShield insurance coverage off and on since I was in college. The coverage and customer service remain impeccable and I highly recommend them. They send monthly updates on my coverage along with my usage and any concerns. They are truly concerned with me and my family receiving the best medical available." If you purchase a health plan from BlueCross BlueShield, these reviews show that you can expect clarity, caring, and quick responses from customer service. These traits of BlueCross BlueShield customer service are especially important because health insurance is where your health and finances meet. Coverage Positive reviews also frequently mentioned satisfaction with coverage offered by the plans. You're buying health insurance for coverage, so knowing that BlueCross BlueShield members are happy with coverage is reassuring. Roughly 36 percent of 4- and 5-star reviews mentioned satisfaction with coverage. Coverage and provider network satisfaction were often mentioned together. Roughly 19 percent of reviewers were satisfied with the network coverage. Customer Review: Jake from American Fork, Utah "Our favorite insurance we have had is Blue Cross Blue Shield. Their coverage of different things was very good. We also really liked their network of doctors and hospitals and urgent care facilities. It was very nice to know that they had such a wide range of coverage that was covered in network." Covered services and network size are both important because you don't want to buy a health plan from an insurer that doesn't have a good selection of providers in your area. If your area has many providers that accept your plan, it's easier to save money on care. Reliability and quality BlueCross BlueShield's general reliability and quality were mentioned by about 33 percent of reviews. Customer Review: Jerry and Janette Jack "Overall, they are excellent. I have had them on/off since the 1980's and they have improved vastly in that time." Improvement over the years shows that BlueCross BlueShield is committed to offering its plan members top notch services and plans. General reliability Health challenges are stressful enough without the added stress of an unreliable health plan or difficulties with insurance. Customer Review: Teagan Hickman from Salt Lake City, Utah "We have always had reliable insurance with bcbs they process their claims quickly" Knowing that reliability is one of BlueCross BlueShield's strengths offers peace of mind. General quality Quality is challenging to pin down because it encompasses many aspects of a health insurance company. Quality shows up in coverage, customer service, and more, but it can be articulated in vague terms. While these statements of how much people like having BlueCross BlueShield don't offer much in terms of specifics, they are indicators of general satisfaction. Other positive traits Customer service, coverage, and reliability and quality aren't the only things BlueCross BlueShield is getting right. These other aspects were not as commonly mentioned in reviews, but are still worth highlighting. Reviewers on Best Company were happy with the cost (17 percent), claims and paperwork (15 percent), value (9 percent), plan options (3 percent), and plan perks, meaning health incentive programs like Blue365®, (1 percent). Cost and value Generally, 4- and 5-star reviewers thought the rates were fair and were happy with the service and coverage they received in exchange. It's challenging to find an affordable health plan that offers the coverage you need. When customers mention reasonable rates and are happy with out-of-pocket costs, that's good news. Steven Davis also recognized the value offered by BlueCross BlueShield, even if the rates were a little higher. Customer Review: Steven Davis from Maineville, Ohio "Retired federal employee this is the best I have ever delt with and have delt with many. You get what you pay for, excemptional customer service and year-end tax info returns. Hospitals and Doctors love this insurance because of the service they provide (just ask, I did), no questions. Have never had a collections issue or billing. Customer oriented company. I will pay more for better service and thatâ€™s what I get." If you can afford to pay a little higher costs, the value and service offered by BlueCross BlueShield is worth it. Claims and paperwork Claims processing and getting the paperwork right are important for you and your doctors. Doctors need to be paid for their work, and you need to understand how your plan covered those costs and what you owe your provider. Plan options and perks If you're looking for an insurer, it's essential that it offers a health plan that meets your coverage and financial needs. You're more likely to find a plan that works for you when your health insurance provider offers a wide selection of options. Many health insurance companies are offering perks and incentives programs to encourage wellness among their members. While these certainly aren't a dealbreaker when choosing an insurance company, these programs are a nice feature and add value. Customer Review: Kristie Pierocich from Long Beach, Mississippi "Weâ€™ve had BCBS federal for many many years and the coverage and incentives are the best around." If you're looking for a health plan with a robust provider network and good value from an insurer that manages its claims and paperwork well and offers clarity, BlueCross BlueShield is an excellent insurance company to work with. Negative experiences Unfortunately, roughly a quarter of customers (26 percent) rating BlueCross BlueShield so highly also mentioned negative aspects and experiences. The most common concerns related to cost, coverage, claims, customer service, and network difficulties. It's important to understand that despite these concerns, these reviewers still gave BlueCross BlueShield high ratings and had good things to say about the company. In other words, even with the occasional difficulty, reviewers were still largely satisfied with their insurance. Cost The most common concern (32 percent) expressed by these customers had to do with cost. Some expressed regret for needing to switch companies because plans became too expensive to keep. Another reviewer felt that it was worth paying higher costs: Customer Review: Richard "Blue Cross has been the best provider I have had for 30+ years. We had switched providers many times, but have always returned Blue Cross. The extra monthly payments have been worth the coverage and services." It's hard to find a good health plan that fits your budget. However, if a BlueCross BlueShield plan does fit into your budget, you can know that you're buying a quality plan. Coverage The second most common concern was coverage (18 percent). Customer Review: Karen Nelson from Alpine, Utah "They occasionally are a hassle for us and don't cover things that we think they should. We have had to write a few letter to them to try to get them to cover different medicines and treatment, but other than that they have been pretty good at taking care of us." Be sure to understand how a plan works and check the Summary of Benefits before enrolling, so you have a better idea what to expect and know what's covered. Claims and customer service Issues with claims and customer service tied for third (16 percent of reviews with negative experiences). No one wants to deal with claims difficulties, but they do happen from time to time. Customers who rated BlueCross BlueShield highly were no exception. Be aware that issues with claims can arise, and be prepared to handle them whether you choose BlueCross BlueShield or another company. Customer service complaints tended to focus on trouble getting ahold of representatives. Provider network Concerns with provider networks were mentioned by 13 percent of reviewers who mentioned negative experiences. If doctors in your area don't accept your plan, it offers limited value, especially if it only covers in-network care. Some reviewers had trouble finding network doctors in their area. Before enrolling in a health plan, check the provider network online to see how big it is and if your current doctor accepts your plan. The most hopeful part of these reviews is that they mention positive responses from the company and the comparative ease of resolving issues and concerns. Methodology Data based on a random sample of 149 out of 241 BlueCross BlueShield's 4- and 5-star reviews from October 2017 to April 2020 on BlueCross BlueShield's profile. Roughly 37 percent of these reviews were from Utah, 11 percent from Arizona, and 22 percent did not have a location. Reviews from other states were between 0 and 5 percent. The confidence level is 95 percent with a 5 percent margin of error. The net promoter score data is based on review data from November 2017 to May 2020. BlueCross BlueShield has many subsidiaries that operate in specific states and regions. Many of these subsidiaries have their own profile on Best Company, like Anthem and Regence. Subsidiary profiles were not part of this analysis. BlueCross BlueShield Frequently Asked Questions How much is BlueCross BlueShield per month? It is difficult to give a good, blanket estimate on health insurance premiums because several factors affect the cost. Premiums for Affordable Care Act (ACA) plans are based on your age, location, and tobacco use. The kind of plan you choose and the number of people enrolled on the plan with you (e.g., spouse, children) also affect your rate. If you want to learn more about BlueCross BlueShield's monthly costs, you'll want to work directly with BlueCross BlueShield to compare coverage, out-of-pocket costs, and monthly premiums on different plans. What does BlueCross BlueSheild cover for dental? BlueCross BlueShield dental insurance coverage varies by dental plan. Some of BlueCross BlueShield's subsidiaries may not offer dental insurance. You'll need to work with the insurer directly to get more information. Learn more by reading BlueCross BlueShield dental insurance reviews. What vaccines are covered by BlueCross BlueShield? You'll need to check specific plans for vaccine coverage information. Many vaccines are considered preventive care, so plans that meet the Affordable Care Act guidelines should cover them. Call a BlueCross BlueShield representative or review your plan's Summary of Benefits and Coverage or the more detailed coverage agreement to understand vaccine coverage specifics. What does BlueCross BlueShield cover? Again, you'll need to check your plan documents or talk to a company representative to learn about what your plan covers. If you're buying an Affordable Care Act (ACA) plan, it will cover the Essential Health Benefits. These include outpatient and emergency care, prescriptions, preventive care, mental health services, and pediatrics. What type of insurance is BlueCross BlueShield? BlueCross BlueShield offers several types of insurance. It offers health insurance (including Medicare Advantage, Medigap, and Prescription Drug Plans), dental insurance, and vision insurance. Availability of specific kinds of insurance, plans, and network structures vary by BlueCross BlueShield subsidiary. How to read a BlueCross BlueShield insurance card? Your insurance card will have information on the kind of plan you have, its network structure, identifying numbers, and helpful phone numbers. The types of phone numbers may vary by plan and region, but possible phone numbers include customer service, pharmacy, and precertification. Your card will have all the information you and your providers need to access information on your health plan including the plan holder's name, member identity number, and its effective date. All the information is clearly labeled, but if you have trouble understanding the information on your card, you can reach out to customer service or check out this guide from BlueCross BlueShield Texas. How do I submit my insurance reimbursement to BlueCross BlueShield? In most cases, your health care provider or pharmacy will submit a claim on your behalf. However, you may need to file a claim yourself. Each BlueCross BlueShield subsidiary may have some variation in their processes. However, you'll have to complete a claims form and submit it within the deadlines. For more information on the process, reach out to customer service or do a quick Google search. How can you manage your Blue Cross coverage online? You can use your BlueCross BlueShield subsidiary's member portal to file a claim, estimate costs, request a member ID card, view Explanations of Benefits for care received, and check your deductible's balance.
Guest Post by Shobin Uralil No employee or employer could have predicted the wide-reaching impact of the COVID-19 pandemic when preparing for open enrollment last fall. Now, to help alleviate benefits costs in 2020, the IRS has taken an unprecedented step with IRS Notice 2020-29 to allow qualifying employees to make mid-year health plan election changes. This opportunity creates much-needed flexibility in a time of uncertainty. But health care needs are unfortunately even more unpredictable than a normal plan year. We will walk you through what your options are and how to think about health plan selection for the rest of this year. What happened? Specifically, the mid-year changes apply to employer-sponsored health coverage and spending accounts (Health Savings Accounts and Flexible Spending Accounts). This applies to all plans that are regulated by a 125 cafeteria plan. Section 125 is part of the IRS Code that allows employees to convert a taxable cash benefit (i.e., salary) into non-taxable benefits. Under a Section 125 Cafeteria Plan, you can elect to pay for qualified benefit premiums before any taxes are deducted from your paychecks for health care premiums, FSAs, and HSAs. Under the new IRS regulations, in 2020, employees are allowed to: Make a new health plan election. Cancel or change an existing health plan election. Continue using previously allocated FSA funds for qualified expenses until December 31, 2020, even if changes are made. This is only relevant if your employer selected the grace period option as part of their FSA plan design. Check with your HR or benefits administrator to confirm. What can you expect? Many of you get a chance to re-evaluate your health care needs and, most importantly, your out-of-pocket costs for the rest of this year. If you or a family member have had a change in your employment type, income, health expenses, or want to review your health care benefits, keep reading. Mid-year plan changes don’t mean that you can expect new health plan offerings at your current company. Instead, it’s an opportunity to change to another plan or pre-tax saving options that you previously did not select during open enrollment. There is one important caveat: employers are allowed to ‘determine the extent to which such election changes are permitted and applied, provided that any permitted election changes are applied on a prospective basis only, and the changes to the plan’s election requirements do not result in failure to comply with the nondiscrimination rules applicable to § 125 cafeteria plans.’ Essentially, these changes are not mandatory. This means that your employer can decide the extent to which plan changes are available. Check with your HR or benefits administrator to determine what changes are eligible at your company and when this special period takes place at your company. What should you do now? Even though this is a ‘mid-year’ open enrollment, it still follows the same key open enrollment parameters. You should select the most cost-effective and personalized health plan option that meets your and your family’s needs. Review your current health plan offering and your ongoing monthly costs. This includes the following: Monthly premiums Out-of-network care Out-of-pocket maximums Deductible amounts (before insurance kicks in) Co-pays and co-insurance Note: All of these costs (or cost scenarios) have one thing in common, they are paid directly by you, not your insurance provider. What is that monthly amount? Did COVID-19 impact your expected monthly costs or your ability to pay for those costs? Compare your current health plan elections to the full offering of your employer’s health care options. Here is a Health Plan Comparison Calculator to help you get started. Take a hard look at the costs outlined above, review receipts if you have any, and do your best to forecast your health care expenses and financial situation for the rest of the year. Change or keep your current health plan elections based on your findings. Select the best health, at the best cost, based on the coverage you need. Don’t overpay for coverage you don’t need! It might be time to consider what your health costs are going toward. If you haven’t considered adding a tax-advantaged savings account, like an FSA or HSA, you are overpaying for health care costs. Use this new review period to reconsider your health care and savings strategy. Take some time to think about what you missed. Health insurance is a direct intersection of your well-being and your personal finance. Many employees unintentionally overpay for bells and whistle coverage they don’t end up using. The right plan is the one that provides the most personalized and affordable health care coverage for you and your family. You get a do-over this year; make the most of it. The catch As with all good things, there is always a catch. In this case, it's related to the 2020 FSA and HSA contribution limits. Normally this would not be a concern unless you change jobs or had a qualifying life event. But with this mid-year change, there are some nuances to consider. If you previously contributed to an FSA in 2020 but decide to now switch to an HSA-eligible health plan, like a High Deductible Health Plan (HDHP), you would expect to be eligible to also contribute to an HSA. However, since you already contributed to an FSA, this disqualifies you from contributing to an HSA in 2020. It will be tough to find guidance around this and other nuanced rules, so check with a financial or tax professional to ensure you remain IRS-compliant. Looking ahead Without knowing what ‘next’ looks like, it is hard to prepare for the future. But with health care, what we do now know is that saving for the long-term, and the unexpected, is more critical than ever. Health care plans expire every year, but marrying an eligible high-deductible health care plan with a pre-tax savings account creates the only long-term health savings and planning option available today. Whether you are looking for short-term savings with an FSA or planning for a long-term safety net with an HSA, you can have savings ready for every ‘just in case’ scenario, at least for health care costs. Shobin Uralil is the co-founder and COO of Lively, a top-rated health savings account provider.
A special enrollment period is running from February 15, 2021 to August 15, 2021 in many states. If you don't have coverage, you can enroll in a health plan. Learn more about this special enrollment period. 54 percent. That's the percentage of Americans who don't know their health insurance options if they were to lose their coverage according to a recent study by HealthInsurance.com. If you're in that 54 percent, read on to learn more about your options for getting the coverage you need to defray health care costs. If you didn't have health insurance through your job and want to have coverage just in case, you'll also learn about health insurance options that may be available to you. In addition to reviewing your health insurance options if you lost employer-sponsored coverage or didn't have any health coverage, I'll also summarize how legislation in response to COVID-19 has affected health care coverage: I had insurance through my former employer. I did not have insurance through my employer. I want to learn about legislation responding to COVID-19 and its effect on medical expenses. I had insurance through my former employer. Normally, you can only enroll in a health coverage during open enrollment. However, a qualifying life event triggers a special enrollment period. Because you lost your health coverage when you lost your job, you qualify for a special enrollment period. This allows you to enroll in a health insurance plan even though it may not be open enrollment. Special enrollment periods end 60 days after the qualifying event. If your spouse has health insurance through their employer, you can work with their human resources department to be added to be added to your spouse's insurance plan during your special enrollment period. You can also choose to extend your former employer's coverage through COBRA, buy private health insurance, or buy an Affordable Care Act plan through the health insurance marketplace. If these plans aren't a good fit, you can explore alternatives. These options include short term health insurance, health care sharing ministries, and government-funded plans. To learn more about these, jump ahead to "I did not have health insurance through my former employer." For more on Special Enrollment Periods, read "[Infographic] 5 Questions to Ask About Special Enrollment Periods". COBRA COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It allows you to continue your employer coverage for 18–36 months. To be eligible for COBRA the following must apply: Your former employer must have had at least 20 employees for more than half of its business days last year. You were terminated, but not for gross misconduct. Or, your hours were reduced. If you're a dependent of someone who lost their job or now has reduced hours, you also qualify for COBRA coverage. Dependents are also eligible for COBRA if the employee becomes eligible for Medicare, in situations of divorce or legal separation, and if the employee passes away. If you choose to enroll in COBRA continuation coverage, you'll take full financial responsibility for participating in the health plan. The employer contributions will become your responsibility. "If someone loses their job because of COVID-19, they should first figure out when their health insurance will run out and what COBRA will cost them. COBRA is typically prohibitively expensive, but may be worthwhile if you have special or extensive health care needs or existing health care relationships you need flexibility to maintain," Deborah Gordon, The Health Care Consumer’s Manifesto author. Your former employer is legally obligated to provide you information on COBRA and enrollment. You typically have 60 days from when you receive the election notice or lose coverage, whichever is later to decide whether to enroll in COBRA. COBRA can also be retroactive, so if you do not enroll and need medical care within the 60-day election period, you can enroll, pay past premiums, and have coverage. You can enroll yourself or your dependents separately in COBRA. Each eligible person must make an election to be covered through COBRA. For more information on COBRA, read the Department of Labor's helpful FAQ. Private insurance Insurers can offer plans that do not meet the Affordable Care Act guidelines. Because these plans don't have to cover everything Affordable Care Act plans do, you may be able to find a plan that offers the insurance coverage you need at a lower price. These plans can have a lot of variability, so you need to carefully review what's covered and what isn't along with the premiums and out-of-pocket costs. Private insurers also offer off-exchange plans that do meet Affordable Care Act guidelines. These plans are not listed on your state's health insurance marketplace and are not eligible for premium-subsidies. However, they still offer comprehensive coverage. Working with an independent insurance agent can help ensure that you find a plan that meets your needs. Affordable Care Act plans If you visit HealthCare.gov, you can view the Affordable Care Act plans (also called Marketplace plans) available in your area. Depending on your financial circumstances, you may be able to qualify for a subsidy on monthly premiums. Marketplace subsidies make the monthly premium more affordable by giving you an advance tax credit. If you took too much or too low of a subsidy, the balance is adjusted when you file your tax return. Affordable Care Act plans do not have exclusions for pre-existing conditions and provide comprehensive coverage for health care services. If you're in good health and are under 30, you may be able to opt for a catastrophic insurance plan. These plans have low premiums and high deductibles. These plans are designed for people who don't have medical concerns and mainly need coverage for emergency situations. Compare Health Insurance Companies Learn more about health insurers and their offerings by looking at the top-rated companies and their customer reviews. Learn More Back to Contents I did not have insurance through my former employer. If you did not have health insurance through your former employer, you'll have to wait for the next open enrollment period to enroll in a typical health plan. However, some states have opened statewide special enrollment periods because of COVID-19 concerns. Do a quick Google search or check this helpful HealthInsurance.org article to see what your state has done. If your state has opened a special enrollment period, review the options in the "I had insurance through my former employer." If not, the options below are still available to you. Short-term health insurance Short-term plans can be bought year-round. These plans offer coverage for doctor visits and emergency room services. In some cases, they may even offer some coverage for prescriptions. These plans are very limited because they do not cover pre-existing conditions. Once your current short-term plan ends, any medical issue that occurred within that time frame is a pre-existing condition when you renew or buy another plan. Some states do not allow short-term plans If you just need some coverage to get you through, a short-term plan can be a great health insurance option. Just be sure to pick the longest term length you need in case any medical issues arise. For expert advice on short-term health insurance, read Short-term Health Insurance: 5 Questions You Should Ask Before You Buy Short-term Health Insurance: What Top Companies Offer Indemnity health plans You can also buy indemnity health plans without needing an enrollment period. These plans offer set benefits for specified health care services. You'll be responsible for paying your health care provider and making claims with the insurance company. "An indemnity plan may pay a maximum of $3,000 per day for a day in the hospital or maybe $5,000 a day, some only pay $300–$400 per day. So you have to really understand how they work. It can be a great value, but education is crucial," says Eric Wilson, Principal of Wilson & Associates. Understand what the fixed payments are for claims and check what services are covered. You'll also want to pay attention to coverage exclusions. Like short term health insurance, indemnity plans typically do not cover pre-existing conditions. Health care sharing ministries Another alternative to health insurance are health insurance ministries. Health care sharing ministries are usually connected to religious groups and expect members to live religious, low-risk lifestyles and be healthy. These are attractive, especially to people in good health, because the monthly premiums are usually lower than health insurance. Laura Handrick, Choosing Therapy contributing HR professional, shares her experience with a health care sharing ministry: "After extensive research, we chose a health share instead of insurance. The costs of these programs run 50–75 percent less than traditional healthcare. For just over $400 per month, we have access to low-cost medications, free telehealth, and affordable medical visits. Catastrophic health issues are covered, often at higher rates than traditional insurance." While these ministries can offer valuable coverage, realize that health care sharing ministries aren't technically insurance. They do not have the same legal obligations as insurers. Do thorough research because covered services vary. For more information on health care sharing ministries, read HealthInsurance.org's health care sharing ministry overview. Government-funded plans The government funds several programs to help specific demographics access health care. Most people become eligible for Medicare when they turn 65. However, there are other eligibility criteria that allow people to qualify sooner with certain diagnoses like End-Stage Renal Disease. Medicaid eligibility is primarily determined by income. In some cases, you may qualify because of disability or significant medical needs. Check your state's Medicaid policies even if you think you won't qualify. Some states have expanded Medicaid to increase access. "Some people may qualify for Medicaid, the public insurance program for lower-income people. In some areas, not as many doctors or health care providers accept Medicaid, but, to cover you in a gap, it may be worth signing up. It is usually free or very low cost if you qualify, and the benefits are mandated and comprehensive," says Gordon. The Children's Health Insurance Plan (CHIP) provides health insurance for children who do not qualify for Medicaid, Medicare, or have other insurance options. If you don't qualify for Medicaid coverage, you may be able to get coverage for your children through this program. Telemedicine subscription services Telemedicine services are not health insurance. However, if an insurance plan isn't an option for you, buying a telemedicine subscription can make it easier and more affordable to receive non-emergency medical diagnoses and medical advice. Telemedicine apps work differently. Some are subscription-based and allow a certain number of virtual visits per month. Others are fee-based and charge a set fee for each virtual visit. As you compare telemedicine services and costs, be sure to check that the application's security is HIPPA-compliant. Telemedicine is especially helpful right now as clinics and hospitals have instituted protocols and restrictions to prevent the spread of COVID-19. Having access to medical professionals through telemedicine can help offer you peace of mind. For more on telemedicine, review: Telemedicine: What You Need to Know What to Expect from Telemedicine Yes, You Can Get Health Care While Social Distancing Compare Health Insurance Companies Learn more about health insurers and their offerings by looking at the top-rated companies and their customer reviews. Learn More Back to Contents I want to learn about legislation responding to COVID-19 and its effect on medical expenses. Several pieces of legislation have been passed in response to COVID-19 including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act. "A key focus of the CARES Act is the adoption of a variety of measures designed to expedite the approval and availability of drugs and devices needed to fight the pandemic, to shore up the financial positions of hospitals and other healthcare providers facing unprecedented demands, and to temporarily relax restrictions that may make it more difficult for patients to obtain access to needed testing and care," says Roger Milliner, MetroPlus Health Plan Chief Growth Officer. Federal legislation has responded to the many different types of needs created by the current crisis throughout the United States. States have also taken independent action to respond. We'll focus on federal changes specifically related to health care and health insurance. These governmental changes have made accessing telemedicine easier. "The CARES Act expands telemedicine so that healthcare providers and consumers can speak over the telephone, Skype, or Facetime to conduct a medical appointment. Telemedicine allows for diagnosis and a treatment plan to be developed over the phone, and the doctor can order labs or prescriptions as needed. This ease and efficient use of technology is typically a much more cost-effective solution that can help people who are uninsured receive reasonably priced treatment.” says Jan Dubauskas, healthinsurance.com Vice President. The CARES Act also expanded how Health Savings Accounts (HSAs) can be used to include telemedicine, over the counter drugs, and menstrual products. Some insurers also made adjustments to cover telemedicine visits the same way they cover in-person visits on plans that did not include coverage for telemedicine. As far as handling COVID-19 health expenses, the Families First Coronavirus Response Act and the CARES Act have made managing those costs easier for people with and without health insurance. If you do not have health coverage, the Provider Relief Fund will be used to pay eligible hospitals at Medicare rates for treating uninsured COVID-19 patients if they do not do balance billing for all COVID-19 treatment. If you have health insurance, your insurer is required to cover your cost-sharing payment for COVID-19 testing. The Trump administration has also negotiated with well-known health insurers like Cigna and United Health Group to have cost-sharing payments waived for all COVID-19 treatment costs. The CARES Act also incentivizes providers to bill all COVID-19 treatments at in-network rates with payments. "The CARES Act will make payments to certain providers if they agree to treat all COVID-19 patients with a preferred payment schedule as in-network patients, keeping costs down for patients whose coverage is out of network," says Dubauskas. Even with these legislative measures in place, your hospital may not qualify for or seek these incentives. If you get an unexpected bill, ask questions about the CARES Act and what payment options exist. In some cases, it may be helpful to seek a lawyer's advice. "In the worst case, if you don’t qualify for lower-cost insurance and you can’t afford to buy private coverage, you can wind up with a hefty medical bill if you get sick with COVID-19 or otherwise. In that case, negotiate! Ask for a payment plan. Seek forgiveness for the medical debt. No matter what, though, get care if you need it, and sort out the finances when you can," recommends Gordon.