Health Insurance Blog and Resources

Guest Post by Jan Dubauskas Many of us are experiencing major life adjustments as we social distance and shelter in place while we wait for the coronavirus to pass. Grocery stores are no longer stocked with our favorite foods, and restaurants are closed for all but take-out. We’re working from home while homeschooling our kids, and these changes can be overwhelming, especially if someone in the family needs medical treatment. Fortunately, telemedicine makes it easy and affordable to receive medical treatment while social distancing. In recent days, the Trump administration has promoted telemedicine as an excellent way to receive regular healthcare while maintaining a safe distance. Also, the FDA has just provided guidance to expand the availability and capabilities of remote healthcare devices. Before telemedicine, when we were sick and needed treatment right away, we had to either go to the emergency room or call the doctor’s office and hope for an opening the next day. Now, thanks to continued advancements in connectivity, we have access to a telemedicine provider at all times. And many doctor’s offices have ventured into the world of telehealth so their patients can work directly with their regular physicians. What is telemedicine? First, let’s define telemedicine. Telemedicine is the telephonic delivery of healthcare services where a healthcare provider is connected over the telephone or video with a patient who needs treatment. The appointment, diagnosis and treatment plan are all discussed during the telephone appointment.   Just like an in-office appointment, the doctor and patient discuss the symptoms, and any treatment already received. Once the physician has made the diagnosis, she communicates her decision and, if a prescription is required, can submit the order directly to the pharmacy of the patient’s choice.     What conditions does telemedicine treat? Patients are often surprised to learn the number of conditions that can be treated by telemedicine. It can be a quick and effective way to handle routine illnesses like a cold or flu, sinus or bacterial infections, conjunctivitis (pink eye), yeast infections, bladder infections and more. Telehealth professionals can treat patients for allergies, skin infections, rashes, moles, acid reflux, arthritis and more. In addition, mental health conditions such as depression, grief, anxiety, and stress are more frequently being treated through telehealth providers. Telemedicine doesn’t cover emergency situations like heart attack, stroke, accidents or injuries. For emergency situations, patients should review their health insurance network options and consider whether to visit an urgent care facility or the emergency room. How much does telemedicine cost? Although each telemedicine provider program is a little bit different, typically there is a monthly fee that starts around $19.99 per month for an individual and more for a family. There is usually a cost for each telephone appointment of $20 or $40. Telemedicine is not insurance, so any costs from the telemedicine would not apply toward a deductible or be discounted by a health insurance network.   If the patient’s telemedicine appointment is with his regular doctor, the visit typically costs the same or less than a regular office visit. Can I submit my telemedicine bill to my insurance company? Yes, appointments that are given by a patient’s regular doctor can be submitted to insurance. Recently, the Trump administration relaxed the rules for Medicare allowing doctor visits by telephone that can be submitted to Medicare for payment. Unfortunately, standalone telemedicine and telehealth provider services are not typically covered by insurance. Look closely at your insurance policy to decide if it covers telemedicine or telehealth and feel free to call their customer service number to find out more. Can online doctors use FaceTime?   While most telemedicine is conducted telephonically, video visits are becoming more popular, too. Some telehealth providers are video-capable, and can conduct the appointment from Skype, FaceTime and other online video applications.   Certain uses for video appointments may be particularly helpful. For example, physical therapists are providing appointments via telemedicine, and their live-action video can demonstrate real-time physical therapy techniques. Does my doctor use telemedicine? The best way to know if a doctor uses telemedicine is to call their office and ask. Another way to find out which doctors are in the telemedicine network is to contact the telemedicine provider and either look up the doctors online or call in and ask.   If a doctor does not offer telemedicine services through her practice, a telehealth product can be purchased online. Also, many employer health insurance plans provide a telemedicine solution, so it is important to check your plan to determine if telemedicine is already included. If not, there are many affordable options available. Extraordinary challenges call for extraordinary solutions. Unexpectedly, coronavirus is teaching us to embrace newer technology, products, and ideas, like having a doctor’s visit over the phone, instead of in-person.  Jan Dubauskas is a healthcare expert, enthusiastic insurance pro and mom serving as Vice President and Senior Counsel of HealthInsurance.com.

Read our customer review report for 2020: "What Health Insurers Are Doing Right: 2020's Customer Reviews" Your health matters. It directly affects your quality of life, ability to work, and longevity. Health insurance is key to many people’s ability to access the health care they need, but accessing health care isn’t always easy even with insurance.  Because health is so central to our lives, it isn’t surprising that government policy around health care will be one of many important issues on voters’ minds in November. Whether you’re a health insurance shopper, U.S. voter, or part of the health insurance industry, paying attention to what customers are saying will help you understand the state of the health insurance industry in the United States and identify ways it can be improved. Want to skip to the review data? Jump to the Reviews Analysis Why health insurance matters A recent Freedom Debt Relief study found that affordable health care was the top concern when people ranked current issues in order of importance. Health insurance and health care costs are at the forefront of many Americans’ minds. There is a strong correlation between having health insurance and accessing health care. According to a Kaiser Family Foundation brief on uninsured Americans found that “(43 percent) of uninsured people said they had problems paying household medical bills in the past year and are more likely to have medical debt than people with insurance.”  No one should have to make sacrifices in their health to maintain their financial security and avoid debt. But, medical care is expensive, and people are making health sacrifices because of it. Freedom Debt Relief’s study found that only 28 percent of people hadn't skipped doctor or dentist appointment, delayed receiving a procedure, or rationed, found alternatives to, or didn't buy prescriptions. While having health insurance usually increases access to health care, health insurance itself isn’t cheap. The uninsured rate in the United States rose slightly in 2018. Recent changes to health care policy may have had an effect according to a New York Times article. There was less advertising and education due to budget cuts. Subsidies available under the Affordable Care Act were also eliminated.  Medicaid enrollment has also been affected by other changes. Moves to request proof of eligibility more frequently and limiting access for those applying for green cards or citizenship likely caused the lower enrollment rates. While the uninsured rate is still low compared to pre-Affordable Care Act levels, limited access to health insurance affects millions of people in the United States. The Kaiser Family Foundation brief found that cost was the main reason adults had for being uninsured. Forty-five percent of uninsured adults reported that cost was a barrier according to the brief. Other barriers to access included no employer-coverage, no Medicaid expansion, and ineligibility for subsidies or lack of knowledge of subsidies.  While some of these studies focus on access for U.S. citizens and documented immigrants, undocumented immigrants are not eligible for these programs, so they experience even more barriers when trying to access medical care. Some of these barriers are related to government policy. However, the largest barrier was cost, which begs the question: What are the costs of health insurance that could be lowered to increase access? The Freedom Debt Relief study sheds some light on this question and on what consumers would like to see in their health plans: Lower deductible (54%) Lower monthly payment (44%) Expanded coverage (31%) Coverage for whole family (27%) These consumer insights combined with other studies offer valuable insight into current issues in health care and health insurance. Customer reviews add another dimension to these conversations because they document the challenges people face when dealing with insurance companies. Why customer reviews matter Unfortunately, as valuable as health insurance is, the pasture isn’t necessarily green once you have it. We looked at health insurance customer reviews left on Best Company during 2019 to learn more about the biggest issues people have with health insurance companies. Reviews offer excellent insight into the customer experience because you find stories of how the company treated a customer and the value the customer gives the service rendered. Reviews can help shoppers avoid bad companies and choose good ones.  Given that "82 percent of buyers consider user-generated reviews to be extremely valuable," you probably looked at reviews the last time you made a purchase. Reviews can also help companies understand what they’re doing well and how to improve to attract more clients in the future. From an industry-level, reviews also show us the problems within the industry. Identifying the problems is the first step to finding innovative solutions. Health care is a major issue in the United States, and health insurance plays an important role in health care access. Customer reviews are becoming more and more important for consumers and businesses. More customers are reading reviews before making purchases, which helps them understand the quality, value, and what to expect from their purchase.  Bad reviews are bad news for businesses, so it’s tempting to pay for good reviews or repress bad ones. Companies sometimes pay for fake reviews. Companies also incentivize customers to leave reviews. While these reviews may not be fake, incentives increase motivation for fake reviews and even the real reviews may not genuinely reflect the customer experience.  In some cases, companies may be able to work with a review website to stop publishing bad reviews. Even if it’s tempting to pay for good reviews or to repress bad reviews, businesses can use better methods like responding to them.  Because review guidelines are not standardized across the industry and there are unethical practices in use, consumers need to understand a review site’s policies and practices regarding review publication. While this review analysis is limited to Best Company reviews, it contributes valuable information to the broader discussion of health care access and health insurance. Best Company vets each review submission before publication to ensure that the review is genuine, not fake. It also publishes all genuine reviews — good and bad.  While analyzing reviews from Best Company yields a more accurate representation of the customer experience, there are a few limitations when analyzing 1-star reviews in aggregate. Best Company has 62 health insurance companies listed. Reviews (including 1-star reviews) are not evenly distributed between the companies. Some companies even have no reviews. Companies also have different splits among 5-star, 4-star, 3-star, 2-star, and 1-star reviews. Companies with a higher proportion of 1-star reviews may skew the broader analysis. However, even though some companies may have fewer 1-star reviews, understanding the difficulties people experience with health insurance regardless of the company is valuable information for anyone trying to make health insurance better and anyone shopping for health insurance. While there are some limitations related to sample size and scope, because Best Company verifies the reviews that come in and publishes all genuine reviews this analysis gives a good picture of how customers experienced the health insurance industry in 2019. Health insurance reviews analysis Overall, the review breakdown of the total 1066 reviews was 28 percent 5-star reviews, 18 percent 4-star reviews, 8 percent 3-star reviews, 5 percent 2-star reviews, and 41 percent 1-star reviews.  The combined total of 5-star and 4-star reviews helps paint a more hopeful picture of the industry. However, using these ratios to calculate a weighted score gives health insurance companies a 2.9 user star-rating on Best Company.  In other words, there’s room for improvement. 1-star review analysis When we analyzed the 1-star reviews, complaints fell into the following categories: 42 percent of reviewers mentioned poor customer service 32 percent of reviewers mentioned coverage approval difficulty or denial 23 percent of reviewers mentioned claims process and payment difficulty 22 percent mentioned provider network satisfaction 21 percent talked about the cost vs value of the insurance plan 13 percent of reviewers mentioned company errors 7 percent referenced coverage misrepresentation 5 percent said they would have given a lower rating 4 percent sought additional help by filing formal complaints, getting an attorney, etc. Reviewers mentioned as many as four of the above issues. Some mentioned fewer. The average length of a 1-star review was 117 words, while the average word count for a 5-star review was 42 words. When people had bad experiences, they had on average more than twice as much to say and typically mentioned more than one problem. Poor customer service If you’ve ever had an unfruitful or difficult interaction with a customer service representative, it’s no surprise that this complaint tops the list. Reviewers that complained about customer service mentioned poorly trained representatives, getting the runaround, not getting the help they needed for finding a provider or enrolling, and getting conflicting information. While you can find similar customer service complaints in almost any industry, poor customer service in health insurance can affect people’s finances and health in important ways. Coverage approval difficulty or denial Reviewers who had difficulty getting prescribed medicine and treatment approved talked about how the delays with the process and denials affected their health. These reviews were the hardest to read. Unfortunately, these difficulties aren’t surprising. Health insurance adjusters will look for cheaper treatment alternatives and may not always consider the unique circumstances, like allergies or negative side-effects associated with some drugs. Some treatments, procedures, and surgeries are considered experimental, and insurance companies don’t always cover those because they have not yet become a widely accepted treatment. It’s also important for insurance shoppers to realize that health plans have different rules regarding coverage and cost-sharing. You’ll want to carefully evaluate health plans with a trusted insurance agent to be sure that you understand the caveats and what the plan may not cover. Claims process and payment difficulty Some reviewers had difficulty using making premium payments either online, via phone, or with a check. While these payment difficulties are troublesome and can lead to loss of coverage, they are easier to fix and were mentioned less frequently in comparison to difficulties with the claims process. Reviewers who had difficulty with the claims process were frustrated as they had to go back and forth between their provider and the insurance company. In some cases, claims weren’t paid or were denied because of a company error or an error in coding the health service received. Resolving these issues was not easy for most people. No one enjoys dealing with a difficult claims process, especially when they’re recovering from treatment or caring for a recovering family member. An insurance company’s failure to pay claims also resulted in doctors stopping acceptance of the company’s insurance plans. Provider network satisfaction Health plans typically come with specific provider networks. Seeing in-network care providers tends to be cheaper for you and the insurer. Some plans offer coverage for out-of-network care. Although typically more expensive for you, having flexibility when choosing providers is nice. Complaints about the provider network included a doctor’s bedside manner and interactions with patients and the difficulty of finding a network doctor nearby. Some complaints mentioned the insurance company’s failure to update its provider lists, which made it harder for plan members to find network doctors to get the treatment they needed while getting the most value from their plan. Cost vs. value While many factors affect the value of a health plan and a customer’s experience of value, not all reviewers explicitly referenced a disproportionate relationship between the cost of a plan and its value. Cost usually referenced the monthly premiums. Value represents the coverage and cost-sharing customers received. Reviewers felt that the premiums were higher than the coverage and cost-sharing offered. Company errors Company errors fell into several categories: there were coverage errors, inaccurate billing, policy cancelations that took reviewers by surprise, poor record keeping by the company, incorrect network provider lists, and incorrect information given by company representatives. One reviewer even had difficulty with the prescription delivery service. Some of these errors had an effect on the reviewer’s health. Others mostly affected the reviewer’s finances.   What’s most concerning about these complaints is that reviewers noted difficulty working with the company to resolve the errors. It took a lot of effort and consistent communication over time to get errors fixed. In some cases, the errors were not fixed. Coverage misrepresentation Coverage misrepresentation usually resulted from working with a third party or receiving bad information from a company representative. Most of this seems like it could have been unintentional, a result of poor training, or even miscommunication. While the reasons for the disparity between expectations and reality may be relatively benign, the effects on customers were serious because they affected their finances and access to health care in unexpected ways. Lower rating Some reviewers noted that they would have given a lower rating than 1-star if they could have. This came up frequently enough to track it. These comments reflect the deep dissatisfaction that consumers feel compared to what was expressed by other reviewers. Sought additional help A few reviewers felt they had been treated so unfairly that they were considering filing a formal complaint with a government agency or meeting with a lawyer. Several already had taken one of those steps. Where we go from here There are two ways to approach these results: from a company level and from a consumer level. We’ll go over action items for both. Health insurers 1. Provide better training for customer service representatives You can do a better job training their representatives. Training should involve professionalism on the phone and providing reliable information to customers. Well-trained representatives go a long way in improving the customer experience when asking questions and resolving issues. 2. Create a smoother prior authorization process You can evaluate your prior authorization processes to help members achieve better health outcomes. Finding ways to be more efficient with this process will make it easier for members and doctors to work with companies while delivering or receiving the care they need. 3. Revisit your claims process You can review the claims process. First, you need to be reliable in making payments to health care providers. When insurance companies are not consistently reliable, doctors stop accepting plans. Second, find ways to make the claims process easier. What are your protocols for when claims issues arise? Are there processes you can change to make processing claims and dealing with disputes easier? 4. Make it easier to resolve issues and fix errors You can make it easier to catch and correct errors in general. Most importantly, you need to evaluate your processes for resolving errors when they happen. If errors are faster and easier to resolve, they will not be as big of an issue for members who deal with them. 5. Offer robust provider networks You can increase the value their plans offer by maintaining robust provider networks. Plans that make it easier to find in-network providers will help keep members with the company. Part of maintaining a good network includes making timely payments to doctors and hospitals when they make a claim. Consumers 1. Be wary of companies with too many 1-star reviews You should avoid companies with high percentages of 1-star reviews, especially if the reviews are recent and come from people in your area. Reading customer reviews from your area will give you a good sense of how a company treats its clients. If your options are limited to a poorly rated company, you’ll be prepared because you’ll know what difficulties to expect. 2. Check provider networks When shopping for insurance, you should ask your provider if they accept any of the plans you’re considering. If you don’t already have providers, you should look at the network of doctors listed by the health insurer and in-network. Call a few to see if they still plan on participating in the plan’s network. This is extra work on your part, but it will help you know how accurate the provider lists are and give you an idea of how easy it would be to find an in-network doctor. 3. Keep your own records You can also keep your own records of conversations with representatives and enrollment. This documentation can help you resolve errors if they arise, even if the resolution process may be difficult.  And, if your challenges need to be escalated to legal action or filing a formal complaint, you’ll already have the documentation to support your case ready. Methodology These results are based on a total of 1,066 health insurance reviews left on Best Company in 2019. Of those reviews, 439 had 1-star ratings. A random sample of 202 1-star reviews is the basis for the complaint analysis. Results of the 1-star review analysis have a 95 percent confidence level with a 5 percent margin of error.

Short-term health plans can be a good option if you need coverage before your health plan kicks in or if you missed the enrollment period. These plans usually have cheap premiums, but their coverage is also more limited compared to more traditional health plans.  Short-term health insurance offers the most basic health coverage. It helps with doctor visits, diagnostic tests, and emergency services. These plans are not compliant with the Affordable Care Act. Pre-existing conditions are not covered with these plans.  For more information and expert insight on short-term insurance plans, read part one of this series: Short-Term Health Insurance: What You Need to Know. Not all health insurers offer short-term health plans. Only two of Best Company’s top 10 health insurers offer short-term plans. However, there are a few other companies worth considering. We'll review what the following companies offer: BlueCross BlueShield UnitedHealthcare National General The IHC Group Note: Screenshot headings are from April 28, 2020. BlueCross BlueShield BlueCross BlueShield is ranked number two on Best Company. It has earned an overall score of 7.8/10 and a user star rating of 3.6/5. BlueCross BlueShield’s offers short-term health plans through some of its subsidiaries. You’ll need to check with your local subsidiary to see what’s available in your area. For example, BlueCross BlueShield of South Carolina offers short-term plans called Blue TermSM. These plans do not cover pre-existing conditions. They also only offer coverage for visiting in-network providers. You can customize your Blue TermSM plan by choosing the length of time you want covered. You’ll find several plan options for each specified length of time with varying premiums, deductibles, and out-of-pocket maximums. The cost-sharing rules (e.g. coinsurance) also varies by plan. BlueCross BlueShield Customer Reviews Learn more about BlueCross BlueShield by reading customer reviews. Read Reviews Back to Menu UnitedHealthcare UnitedHealthcare is ranked number six on Best Company. It has an overall score of 7.2/10 and a user star rating of 3.1/5. UnitedHealthcare offers two kinds of short-term health insurance plans: Short Term and Enhanced Short Term. These plans can last 30 days to close to a year. Plans are not guaranteed issue plans, so you'll need to go through underwriting for approval. These plans offer coverage for doctor visits, ER care, hospitalizations, labs, and may offer some coverage for prescriptions The Short Term plan is available in 27 states, including Florida, Illinois, and Texas. While there is variability by state, UnitedHealthcare offers three different lifetime maximum benefits that each have a few plan options in a majority of these states. The per-person lifetime maximum benefit amounts are $250,000, $600,000, and $2,000,000. Each option offers choices for the deductible amount. Some also offer coinsurance choices. The level of customization and flexibility is a nice feature of these plans. The Enhanced Short Term plan is available in 19 states, also including Florida, Illinois, and Texas. These plans also vary by state. However, offerings in a majority of states are the Plus Elite, Copay/Direct, Plus/Direct, and Value/Direct plans. Each plan’s cost-sharing rules differ, which allows you to choose what matters most to them in cost sharing. If you prefer lower premiums, you can choose a plan with higher out-of-pocket costs. You can also choose a plan based on how you want to control your out-of-pocket expenses. Some of these plan structures are only available for specific lifetime maximum benefit amounts.  Plus Elite, Copay/Direct, and Value/Direct plans are available with the $500,000 per-person lifetime maximum benefit plans. These plans allow you to choose your deductible amount. Plus Elite, Copay, Plus, and Value plans are available with a $2,000,000 per-person lifetime maximum benefit. These plans also allow policyholders to choose their deductible. UnitedHealthcare Customer Reviews Learn more about UnitedHealthcare by reading customer reviews. Read Reviews Back to Menu National General National General has yet to earn a rank on Best Company because there aren't enough reviews to give a score. National General offers short-term plans with Aetna and Cigna PPO networks. Aetna network plans are available in 32 states and Washington, D.C. Cigna PPO network plans are available in 17 states. Plan features vary by state and network chosen. However, I’ll briefly review the options available in the majority of states for both networks. Both Cigna PPO and Aetna PPO network plans include LIFE Associate Membership, which gives you access to telemedicine, pharmacy discount card, negotiators for hospital bills, and wellness perks. Both also offer options to buy renewable plans or consecutive plans. These options may not be available in every state. With the renewable option, you can have some costs covered for pre-existing conditions after the first 12 months. Your deductible and coinsurance reset with each new coverage period, but the maximum benefit does not. If you'd like to lock in your premium rates, you can, but it's not a standard part of the renewable option. With this option you can buy three years of coverage.  Buying consecutive plans is similar to the renewable option. The differences are that there is no guaranteed rate option, the maximum benefit resets each period, and you can buy two years of coverage. Plans with Cigna PPO network National General offers two plan options with the Cigna PPO network: Enhanced PPO and Copay PPO. Each option offers different deductible amounts and cost-sharing structures. The maximum benefit, referred to as the coverage period maximum, is $1,000,000 for the Enhanced PPO plans and $5,000,000 for the Copay Enhanced PPO plans. Plans with Aetna PPO network Plans and plan availability varies by state. In a majority of states, National General offers four plans: Essentials PPO Enhanced PPO Copay Enhanced PPO Guaranteed Issue PPO Each of these plans have different coverage period maximums: $250,000, $1,000,000, $5,000,000, and $100,000 respectively. Once you've chosen the kind of plan that best suits your needs, you can choose from available deductible and cost-sharing structure options. Back to Menu The IHC Group The IHC Group has yet to be reviewed by customers, so it does not currently have a score on Best Company. When you visit IHC Group’s website and decide to shop for short-term health plans, you can click on a link that directs you to healthedeals.com. There you can get quotes on short-term health plans. You can filter your quotes by how frequently you want to pay the premium (all at once or monthly) and how long you’d like to have coverage. Plans vary by area, so it’s best to research options on your own. Think Short-Term Health Insurance Is a Good Fit? Learn more about short-term health plans by looking at the top-rated companies and their customer reviews. Learn More

Maybe you just lost your job. Maybe you missed open enrollment. Maybe you just need a health plan to cover a short lapse of coverage. Whatever your situation, a short-term health plan can be a good option if you don't qualify for a Special Enrollment Period or don't want to pay a higher premium. Before you buy a short-term health plan, you need to understand the following: What is short-term health insurance? What does underwriting mean for short-term plans? What laws and regulations govern short-term health insurance? What are the pros and cons of short-term health insurance? How do I get short-term health insurance? What is short-term health insurance? "Short-term health insurance was designed for people who had a gap in coverage. For example, say you accepted a new job but had to wait 60 or 90 days for benefits to kick in. That's when it was a great fit," says Chris Castanes, insurance agent, speaker, and author. These plans typically cover: Doctor’s office visits Some emergency services Some surgery Short-term health plans have many exclusions, which makes them a riskier type of health insurance. “These policies don't cover usually much in the way of preventive care — like wellness visits and annual checkups with your primary care doctor or OBGYN. They also only might provide discounts for some prescriptions, but they won't cover more expensive Tier 3–5 type pharmaceuticals,” says Adam Hyers, Hyers and Associates, Inc. insurance agent. Exclusions also include pre-existing conditions. For example, if you need emergency services for a pre-existing condition, the plan usually won’t cover your care.  John Barnes of My Family Life Insurance identifies an even bigger problem: "Generally speaking, if you are diagnosed with a health condition during your coverage, the plan will pay. However, when your benefit term is up and you need re-enroll, chances are the carrier will not cover you or your condition going forward. What will you do then? You have to wait for the ACA open enrollment, which could be months away. You'll potentially be exposed to significant health care costs." Short-term insurance plans usually have cheaper premiums because there are so many exclusions. However, with all the exclusions, short-term health insurance isn't a good fit for everyone. "I usually don't recommend these plans to consumers because of these omissions. However, short-term health plans may be valuable to a pocket of consumers including, but not limited, to: 1. students at colleges/universities2. people on early retirement and waiting for enrollment to Medicare3. immigrants here in the United States who are legally in the process of obtaining green card/permanent residency While it is true that consumers can save money on premiums compared to a similar ACA health insurance plan, consumers need to read the fine print on these plans and be aware of limitations," says Barnes. Even though the coverage is very limited, having some health insurance is usually better than having none at all. “With the coronavirus having a foothold in the United States, these policies might be a good way for the uninsured to find affordable coverage for unknown issues that could result from something like that,” says Hyers. Keep in mind that short-term health plans do not have to offer coronavirus coverage like comprehensive plans. As awareness and concern develops, coronavirus care may be excluded from these policies. Be sure to read your policy carefully to understand the terms before buying coverage. Some states have opened special enrollment periods to allow people to buy comprehensive coverage that will offer coverage for coronavirus treatment. Back to Menu What does underwriting mean for short-term plans? Underwriting is how insurers determine whether or not they’ll insure someone and at what cost. Plans that follow the Affordable Care Act guidelines have rules that make insurers ignore pre-existing conditions when determining premium costs and require that care is covered even if there are pre-existing conditions. Short-term health plans are not considered acceptable health coverage under the ACA because they do not meet these guidelines. short-term plans are underwritten, which affects your plan in two big ways: You may not be accepted. “There are some drawbacks to these plans. First and foremost — not everyone will qualify. short-term health plans are medically underwritten — so some will not be accepted," says Hyers. Pre-existing conditions are excluded. “Unfortunately, most people don't realize that it's underwritten, so pre-existing health conditions can be excluded,” says Castanes. Back to Menu What laws and regulations govern short-term health insurance? Federal rules allow you to have a short-term health plan for up to 364 days with the ability to renew three times. While these federal guidelines are fairly lax, some states have stricter rules around short-term health plans. Most states allow you to have short-term health insurance for more than two months. Some states cap at almost three months. Others allow people to have these plans longer. Eleven states, however, have more restrictions on these kinds of plans — either not allowing them or having such strict rules that insurers do not want to bother with these plans.  According to HealthInsurance.org, short-term health insurance is not available in California, Colorado, Connecticut, Hawaii, Maine, New York, New Jersey, New Mexico, Massachusetts, Rhode Island, and Vermont. If you’re in one of these states, a short-term health plan is not an option for you. Back to Menu What are the pros and cons of short-term health insurance? Short-term health plans have several pros and cons. How these trade-offs affect your purchase decision depends on your health and financial situation and what your health coverage options currently are. Pros Cheaper premiums No enrollment period Quick approval and start date Customizable plans Cons Limitations and exclusions Coverage for a short period Potential coverage denial Maximum benefit from insurance Cheaper premiums vs. limitations and exclusions One of the biggest draws of short-term health insurance is that the premiums are much lower than health plans that offer comprehensive coverage.  “Lower premiums are one of the biggest advantages to short-term health insurance plans. They can cost half as less than ACA plans if you don't qualify for a tax credit, says Hyers. Short-term health plans also have more limitations and exclusions when it comes to coverage, which is what makes these plans so inexpensive. No enrollment period vs. potential coverage denial Another great advantage of a short-term health plan is that you can buy one at any point in the year, there are no enrollment periods to limit when you can enroll. However, this flexibility doesn’t help you if you are denied coverage through the underwriting process. Quick start date vs. coverage for a set period Short-term health plans can have a fast effective date. Sometimes, you can be covered the day following your enrollment. This quick turnaround is a nice feature of these plans.  You can also buy multiple plans at once to have longer coverage. “Plans can be purchased in some states for up to three years at a time with no need for additional medical underwriting. Other states, the limit is six months, however. So, you need to be thinking about what you'll do when the term is up,” advises Hyers. Like Hyers notes, the downside is that these plans only cover care for a limited amount of time. Understand what your state’s rules are about short-term health plans when you enroll so that you can prepare for your next step. You also need to realize that these plans are temporary. When you buy a new one, you're resetting the whole process. Not only does this affect coverage for pre-existing conditions, it also affects your out-of-pocket costs. Barnes gives a good example: "One confusing part I see consumers have is with the benefit period. If you choose a six-month benefit period. That is your term. Deductibles start over again if you reapply at the end of the term. Let's say you have a six-month short-term health insurance plan with a $1,000 deductible. You have surgery. The provider makes the claim with the carrier, and you pay the $1,000 deductible. Your term ends, and you reapply for a new term without problems. Three months later, you are in a new benefit term, and you need another surgery. You will have to pay that deductible all over again." Customizable plans vs. maximum benefit from insurance Most short-term health plans are customizable. You can choose the coverage length, deductible, and in some cases the coinsurance. Choices on the deductible and coinsurance will affect premium rates. Short-term plans usually also have a maximum benefit amount. The maximum benefit is a cap on what the insurance company will pay towards eligible bills. Any additional costs fall on you. These maximum benefits are usually fairly high, like $250,000 or $2,000,000. In addition to how much the maximum benefit is, you should also pay attention to what kind of maximum benefit it is. Is it a lifetime benefit or is it for each plan’s term? If the benefit renews with each plan’s term, that’s ideal. If the plan has a lifetime benefit, once it’s used up the insurer may not pay more even if you renew the plan. Think Short-Term Health Insurance Is a Good Fit? Learn more about short-term health plans by looking at the top-rated companies and their customer reviews. Learn More Back to Menu How do I get short-term health insurance? If short-term health insurance is a good fit for you, you just need to find companies that offer short-term plans. Compare your options from several companies and thoroughly investigate the exclusions. Then, work with the insurance company to enroll in the plan. You can also work with an independent insurance agent to help you through the research and comparison process. If you work with an agent, they can help you enroll in a plan. However you choose to enroll in a short-term plan, be sure to do your research and thoroughly understand the terms, limitations, and exclusions. To learn more about what top companies offer, read part two of this series “Short-term health insurance: What top companies offer.”

We're in the midst of tax filing season. You may be looking forward to a nice tax return or worried about how much you'll owe. If you used a Health Savings Account (HSA) last year, you'll need to have a few more documents on hand as you prepare your taxes. HSAs are paired with High Deductible Health Plans (HDHPs). With these plans you can set aside pre-tax dollars that'll remain tax-free as long as they are used for medical expenses. The funds in your HSA rollover year to year and can be invested for more growth. Here's what you need to know about HSAs when you file taxes this year: Contributions Withdrawals Tax forms Federal vs. state taxes Contributions The IRS sets annual limits on how much you can contribute to your HSA. The limits for 2020 are $3,550 for an individual and $7,100 for a family. Knowing the contribution limits will help you maximize the tax benefits and avoid penalties for over-contributing. Expert tips Contribute up to the annual limit Andrew Latham, certified personal finance counselor and SuperMoney.com managing editor“If you didn't hit your limit and you can afford it, contribute the maximum amount before April 15 and designate them as 2020 payments before you contribute to other tax-advantaged accounts. On the other hand, you don't want to exceed your HSA contributions limit. If you do, you will have to pay a 6 percent excise tax on excess contributions. You can use Form 5329 to work out how much you need to pay in excise tax. However, the good news is if you do mess up, you can withdraw any excess contributions from your HSA and avoid the excise tax as long as you do it by April 15 (or later if you were granted an extension). Just make sure you report the excess contributions and any interest you earned from them as income.” Take advantage of catch-up contributions Robert Lindstrom, CFP ®, Enrolled Agent, Provision Financial Planning“There are two neat tricks people can use with their HSA. First, they can still contribute for 2020 directly reducing their taxable income. Second, a spouse 55 or over can contribute $1,000 as a catch-up contribution to their own HSA separate from the employee’s account as long as they are covered under the plan.” Alistair Bambridge, Bambridge Accountants“Contributions to HSA are before you pay any tax, for 2020 the limit is $3,550 for individual HSAs and $7,100 for families. When you are 50 or older you can contribute another $1,000 per year. Exception is if you are enrolled in Medicare, then no contributions are allowable.  Earnings from an HSA are tax exempt which is a big plus. Withdrawals from an HSA are tax free if you use them for qualified medical expenses. If you live in New Jersey or California, you don't get to deduct the contributions on the state return, just the federal.” Plan HSA contributions and enrollment in Medicare John Norce, Medicare Portal president“People with HSA accounts need to know that if they enroll in Medicare Parts A and/or B, they can no longer make contributions to their HSA. If you work at least six months past 65 and apply for Medicare, note that your Part A will start six months prior to your date of submission.  Under IRS rules, that leaves you liable to pay six months’ of tax penalties on your HSA. So it is important that you coordinate your funding of an HSA with your enrollment into Medicare A and/or B.” Withdrawals If you used your HSA account last year, you’ll need to document how you used those funds when you file taxes. Since these funds are tax-free because they are for medical expenses, you have to show the IRS you used the funds appropriately. Expert tips Use your HSA wisely David Bakke, DollarSanity tax expert“Health savings accounts come with tax benefits, just be careful so you don't end up paying what could be a variety of penalties and unnecessary taxes. That said, to begin with, money deposited into an HSA is free from taxation, as is any interest you may earn on the account. Just make sure that any withdrawals you make are for qualified medical expenses, because if you don't the money is considered income which is taxable, and there might be an additional 20 percent tax (assuming you are younger than age 65).  And finally, there is one other important distinction regarding HSAs and taxes. Any qualified medical expenses which are paid for using funds from your HSA cannot also be claimed under the realm of medical deductions when filing your taxes. You can't double-dip.” John Norce, Medicare Portal president“For those on Medicare, you can use your existing HSA funds to pay for Medicare premiums for Parts B, C, and D as well as copayments and deductibles related to medical and prescription costs.  Also, you can use it for vision and dental expenses.” Keep the receipts Andrew Chen, Hack Your Wealth Founder“You should save your receipts for qualifying healthcare purchases, but no one other than the IRS will ask to see them. Your HSA bank will reimburse you for health expenses and will not ask to see your receipts. The IRS may ask for your receipts if you get audited, but otherwise you aren’t required to submit them anywhere.” Tax forms There are several tax forms that you may need when you file taxes. You’ll most likely start with Form 1040 and your W-2. If you’ve been contributing to your HSA before you get your paycheck, those contributions will appear on your W-2. You’ll also need to complete and submit Form 8889. This form summarizes all of your HSA information for the IRS. “When filling out your tax return, you will need to report contributions to your HSA on your 2020 tax return on an IRS Form 8889 –Health Savings Account (HSA), which will be included with your regular tax return. You will report what type of high deductible health plan you participate in (self-only or family coverage), the amount of contributions that you have made to the HSA, any catch-up contributions made if you are age 55 or older, any contributions your employer made on your behalf, and any other HSA contributions made. From this, you will determine the amount of your HSA deduction and include that on your tax return. You will also use IRS Form 8889 to report any distributions from your HSA in 2020. You will list the total amount of HSA distributions for 2020 and the amount of qualified medical expenses that the HSA distributions paid for,” says William Sweetnam, ECFC legislative and technical director. You need to understand that if you used your HSA for medical expenses, you cannot claim those expenses as a tax deduction. The money you used to pay for them was already tax-free. “When it comes to itemizing your medical expenses, your deductible expenses must be more than 10 percent of your adjusted gross income. If you used your HSA to pay for medical expenses, then you can’t itemize for the same expenses.  When it comes to filing your tax returns — especially as it relates to your medical deductions — you’ll want to speak with a tax professional who can help make sense of all of the nuances, exceptions, and rules,” says Alexa Serrano, Finder.com banking and investments editor. According to Lively, you’ll receive Form 5498-SA (HSA contributions) and Form 1099-SA (HSA distributions) from your HSA custodian by the end of May.  You may want to request an extension for filing your taxes because of this delay. Keep in mind that extensions are only for filing, not paying your taxes. If you’ve exceeded the HSA contribution limits for the year, you’ll also need to complete Form 5329.  Federal vs. state taxes HSAs have nice tax benefits. However, these tax benefits may be different for state and federal taxes depending on where you live. Your taxable income is adjusted for federal taxes based on the contributions you make to your HSA throughout the year. Many states that have an income tax also offer an adjustment for HSA contributions. “While you can always get a tax deduction for HSA contributions at the federal level, you can only sometimes get a tax deduction at the FICA and state level. You’ll only get the 7.65 percent FICA tax deduction (a unique feature of HSA contributions) if you contribute through employer payroll deductions,” says Chen. California and New Jersey tax HSA contributions. New Hampshire and Tennessee tax HSA earnings, not contributions.

Guest Post by Nicole T. Rochester, MD National Doctors' Day is celebrated annually on March 30th to honor and celebrate physicians and their contributions to patients, communities, and society at large. While the holiday was signed into law by President George Bush in 1990, the concept originated in the 1930s with Eudora Brown Almond, the wife of a prominent Georgia physician. The date commemorates the first time an anesthetic was used in surgery (March 30, 1842). As an experienced pediatrician who completed residency training 20 years ago, I have been the beneficiary of numerous Doctors' Day celebrations, and I am grateful. I appreciate the pastries, herbal tea (because I never developed a taste for coffee), chair massages, branded gifts (blankets, umbrellas, travel mugs, etc.), invited speakers, and extravagant lunches. But I hope you'll understand and will not be too offended when I say that these acts of kindness fall terribly short of what is truly needed to address the crisis facing today's physicians. In the latest Mayo Clinic survey, 43.9 percent of physician respondents reported burnout, characterized by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. What used to be medicine’s “dirty little secret” is now discussed widely in mainstream social and traditional media. These open discussions have led to some controversy over the use of the word “burnout,” as some feel the term is a form of victim-blaming. Many feel that the term moral injury, defined as the betrayal of what is right by someone who holds legitimate authority in a high stakes situation, is a better descriptor for what physicians currently experience while practicing medicine in an environment that threatens their autonomy and well-being. Semantics aside, suffice it to say that doctors are hurting. The statistics regarding physician suicide are also sobering. An estimated 300–400 physicians die by suicide every year, a rate that is higher than any other profession. As I write this article in mid-February, an Illinois pediatrician’s suicide has been in the national headlines for the last few days. Sadly, questions surrounding his vaccination practices seem to have overshadowed the tragedy of his death and the magnitude of this growing epidemic.  It’s not often that individuals get an opportunity to see their profession from the inside, Undercover Boss style. Unfortunately, the only way to do this in the healthcare field is to either become a patient or a family caregiver. For almost three years, I had the honor of being a caregiver to my late father and it was like watching sausage being made. I witnessed disjointed communication, medication errors, and near misses. I am convinced that my medical knowledge, professional influence, and ability to strongly advocate for my dad saved his life on more than one occasion. It would have been easy to blame the physicians and label them as careless or incompetent, but I knew better. What I knew in my heart was that they were just as broken as the systems in which they worked. In their desperate attempts to survive, they had become disconnected. It’s what happens when computer screens create physical barriers between doctors and patients, when administrators and insurance companies rob physicians of their decision-making authority, and when your love for medicine is no longer strong enough to mask the bitter taste of reality. The overwhelming majority of us became doctors because we wanted to help people. It sounds cliché, but it’s true. The problem is that patients have been reduced to checkboxes, physicians spend their days racing from one exam room to the next, and meaningful patient encounters are interrupted by misaligned administrative tasks. In this environment, it’s easy to forget why you chose this noble path. I believe that the disruption of human connection is the thread that continues to unravel the practice of medicine as we know it.  When an unknown homeless man slowly walks past your car window begging for change, the decision to stare blindly ahead while waiting for the traffic light to change is not a particularly difficult one. But if you engage in a conversation with that homeless gentleman while volunteering at a local shelter, and learn that he lost everything when his wife succumbed to cancer, you’ll roll down your window the next time your paths cross.  Similarly, when we refer to patients as room numbers or by the names of their chronic diseases, this anonymity separates us from their suffering. But if we take a few moments to learn something substantive about our patients, it creates a connection that facilitates healing on both sides of the stethoscope. I call this a 90 second encounter. I believe that if doctors use the first 1.5 minutes of every patient visit to engage in dialogue that creates genuine human connection, the results would be transformative.  To my amazing physician colleagues who are making a difference in clinical and non-clinical arenas, I salute you. Happy Doctors’ Day! To the hospital, health system, and practice administrators, I’d like to issue a friendly challenge. Cancel next year’s bulk order of customized reusable water bottles. Invest that money in system changes that foster opportunities for doctors to connect with their patients. We don’t need another luncheon. What we need is innovation, servant leadership, and compassion. March 30, 2021 will be here before you know it, and we’re counting on you. Photo by Jackie Hicks   Nicole T. Rochester, MD is a board-certified pediatrician, independent health advocate, TEDx and keynote speaker, and the CEO of Your GPS Doc, LLC, an innovative company that helps aging individuals, those with chronic illnesses, and their family caregivers navigate the healthcare system. Dr. Rochester was inspired to start her company after caring for her late father and witnessing the complicated healthcare system from the other side of the stethoscope. She is the author of Healthcare Navigation 101: A Guide for College-Bound Students (and Parents!). Dr. Rochester is committed to educating and empowering individuals and believes that patients and family caregivers belong at the center of every medical team. She has been featured on WJLA/ABC7 and in numerous digital publications, including KevinMD, Authority Magazine, Modern Healthcare, Reader’s Digest, and Best Company.

If you live in a cold and snowy climate, you know that nothing feels better than warming weather and spending time comfortably outdoors. Take advantage of good weather to be outside. Hiking, swimming, running, or even just taking a walk outside supports your physical and mental health. Physical health Taking advantage of nicer weather by exercising outdoors is a great way to boost your physical fitness levels. “During spring you should take advantage of the longer days and improving weather. You could consider joining a running group in the evening. Even a short afternoon stroll during a lunch break could be enough to improve your overall health. It's recommended that as little as 30 minutes of walking a day can improve your cardiovascular health, strengthen bones, and reduce body fat,” says Guiseppe Aragona, MD, Prescription Doctor family medicine doctor. However, it’s important to take some precautions for your health as you move outdoors. Use sunscreen Tsippora Shainhouse, MD, FAAD, dermatologist in private practice at SkinSafe Dermatology and Skin Care“If you have been negligent about wearing it all winter, now is the time to get back into the habit of applying it every morning. Sunscreen is not just for beach days and even 10–20 minutes of unprotected sun every day on your way to work adds up. UV rays can reflect off of water and sand, as well as ice, snow, and concrete, and it can pass through both clouds and window glass. UV rays can directly damage DNA in epidermal cells, trigger unwanted pigment production, and damage structural collagen, which can lead to the development of skin cancers and premature aging, respectively. Look for a light-weight product with broad-spectrum UV protection and an SPF of at least 30. Layer it under your make-up.” Wear sunglasses Rahil Chaudhary, MD Managing Director and Ophthalmologist at Eye7 Chaudhary Eye Center“It may not be summer yet but as we enter spring, the weather will improve and you may want to spend more time outdoors and in the sun. Sunglasses aren’t just fashion accessories. They protect your eyes from UV radiation. The UV radiation from the sun’s rays can damage your eyes in a number of ways. This could include causing blindness or cancer, and you can even get sunburnt on your eyes.” Bring a jacket Jennifer Fidder, M.A. CPPC, Jennifer Alice Training and Coaching LLC mindset coach and personal trainer“Even though it's getting warmer outside, it can be pretty windy and rainy. Everybody who decides to take their workouts outside should make sure to have a jacket they can throw on after exercising. Being sweaty and cold is the perfect basis for the sniffles.” Mental health As you take care of your physical health and stay safe outdoors, remember to take time for your mental health, too. Spend time in the sun Myles Spar, MD, MPH, Vault Health chief medical officer and integrative men’s health specialist“Start getting back outside and soaking up Vitamin D. Vitamin D deficiencies are seen very commonly during the winter months, as we are not exposed to sunlight as much. Vitamin D deficiencies are known to cause a weakened immune system; heavy fatigue and sluggishness; depression; muscle, bone and back pain; and can prevent the body from repairing itself.” Exercise Judy Gaman, Executive Medicine of Texas CEO and Stay Young America! podcast host“When it comes to boosting mental health, we now know that exercise is just as effective, and often more effective than antidepressants. This may be why the change in season can help improve overall mood. We've found that simply tracking movement will cause people to move more. Measuring and monitoring is a great source of self-motivation. That's why we recommend that patients wear a step counter and strive for no less than 10,000 steps per day.” Meditate Haley Neidich, LCSW“In order to improve health and well being this spring, I encourage people to begin a meditation practice. Even just two to three minutes of sitting in stillness daily can have an impact on our health and mental health. People should avoid stress in order to avoid getting sick and to boost their mental health. Meditation helps to combat stress by creating a more peaceful mind. When we meditate, we're able to observe our experiences rather than react to them.”

With the warming of the weather, many people carry on the tradition of spring cleaning to help them refresh their home from the winter. As you're refreshing your home, here's some expert advice to help you spring clean your health in these three areas: Allergies Immune system Nutrition Allergies Avoid bringing allergens indoors Tsippora Shainhouse, MD, FAAD, dermatologist in private practice at SkinSafe Dermatology and Skin Care“Prone to seasonal allergies? Spring is the season for pollen from growing trees, flowers and grasses. It gets on your hair, skin and outerwear from the air, park benches and brushing up against flora. Reduce the risk of bringing the pollen indoors with you by removing exposed items at the door.  Did you go for a run outdoors in the finally warm enough weather? Toss your clothes in the washer and take a shower to remove pollen. Other tricks to reduce exposure is keeping bedroom windows closed and replacing the filter screens in your vents.”  Eat local honey Lisa Richards, nutritionist and The Candida Diet author"Honey is a natural sweetener which can help reduce the amount of added sugar you have in your diet, but can also improve your seasonal and environmental allergies. Integrating local honey into your diet may help reduce allergies because bees make their honey from the pollen you live and work around. Giving yourself a small dose of this on a regular basis can help to build immunity to these typical allergens.” Keep your indoor air circulation clean Mark Dawson, One Hour Heating & Air Conditioning COO“Clean your HVAC registers and vents: All of the air handled by your HVAC system blows through them, so these vents will inevitably get dusty. A flexible duster or the wand attachment on your vacuum should make this an easy job, and it can cut down on the amount of dust blowing through your home. Clean your ceiling fan blades: Just as with your vents, dusty ceiling fans can circulate even more dust around your home. And while you’re at it, reverse your ceiling fan direction so that the blades turn clockwise, creating an updraft. This helps circulate warm air throughout the room and may allow you to set the thermostat a couple degrees lower without sacrificing comfort. Switch your fan to 'on' mode: This strategy is a trade-off: when your fan runs constantly, your indoor air is always being filtered, boosting air quality. But you may see the difference in your monthly utility bills, and it will also increase the wear and tear on your HVAC system’s fan. The secret to healthy home air is striking the right balance when it comes to moisture control. Too much humidity is an invitation for mold – but too little can result in dry air that triggers allergy symptoms.” Immune system Take your vitamins Dr. Nikola Djordjevic, MD, health advisor at healthcareers.co“Vitamin C is an excellent supplement for boosting your immune system. Zinc is a fantastic supplement to take along with vitamin C, that will help you fight viruses faster. A healthy diet with fruits rich in vitamin C — i.e., citruses — will be an excellent way to take vitamins. Still, I suggest taking additional supplements during the seasonal change, to support your organism with little extra nutrients.” And, take your supplements Myles Spar, MD, MPH, Vault Health chief medical officer and integrative men’s health specialist“Set your immune system up for success by staying hydrated. Rethink your beverage choices, lower your alcohol intake, and switch to water and water with lemon to keep your organs healthy and flush out toxins.  Take immune-boosting supplements that help act as anti-virals like Elderberry, Echinacea and NAC (N-acetyl cysteine). Zinc also helps, since it is an antiviral. I like the product by Source Naturals called Wellness Formula.” Watch out for colds and the flu Jocelyn Nadua, registered practical nurse and C-Care Health Services care coordinator“Even though winter might be the worst for cold and flu season, spring would be the next one up. The change of temperature can often fluctuate during the spring, catching many of us off guard in the process. For instance, too often do people catch colds in March because they've been underdressed for the past few days, believing it's warmer outside than it actually is. Since we've been used to freezing temperatures for the last few months, a few degrees above zero can feel as though it's summer. With that being said, once spring arrives, don't dress by gauging the weather by how it feels, dress by the actual temperature.”  Take care of your gut Judy Gaman, Executive Medicine of Texas CEO and Stay Young America! podcast host“Research shows that 70 percent of the immune system is in the gut. Don't wait until you're sick to boost your gut microbiome. Take a high quality probiotic supplement, as well as consume foods that are high in probiotics and prebiotics. For example, sauerkraut, cheese, and other fermented foods are high in probiotics, and fibrous vegetables like asparagus are the food the microbiome feeds off of, also known as prebiotics.” Drink water Dr. Nikola Djordjevic, MD“Don't forget to drink a little more than usual. When seasons change, we tend to dress by inertia, keeping too many warm layers far longer than the temperatures demand. Due to excess of clothes, we sweat more and lose fluids. Increasing your water intake will ensure you don't dehydrate. It will provide optimal conditions for metabolic processes, and support the immune response to viruses that can thrive in the changing, warm weather.” Nutrition Plan ahead Jess Dang, Cook Smarts founder and chief kitchen cheerleader“One of the best things you can do to take control of your health is to get in the habit of meal planning. So many of us have good intentions about eating healthier, but when we're rushed and without a plan in the moment, we make choices we regret. My advice? Take some time on the weekend to think through what you have going on in the week ahead. Know when you'll have time to cook, when you'll need to be able to throw together something quick, and when you want to go out to eat or grab takeout. When you have a plan for each night's dinner that takes into account your actual life, you're much more likely to stick to it!” Choose nutrient-rich food Elliott Upton, NASM-certified personal trainer at Ultimate Performance“While there are no such things as ‘weight loss foods’ or foods that are somehow inherently ‘fattening,' there are certain types of foods over others that are more conducive to weight loss and will make it easier sticking to your diet. These are invariably meals that are high in protein, with nutrient-dense vegetables and good quality fats and carbohydrate sources that support general health and well-being, above calorie-dense, nutrient-poor processed foods.  There are plenty of foods that fit this mold for spring — grilled lean meats, fresh fish, low fat dairy for good sources of protein, green vegetables, crisp salads and general non-starchy vegetables to fill you up for less calories, healthy fats from things like olive oil drizzled on salads, nuts for added crunch or avocados for texture, along with small portions of carbs with a lower glycemic load, like brown rice or sweet potato, to keep you full and your blood sugar levels more stable.” Eat green things Pam Sherman, personal trainer and The Perfect Balance CEO“Have you been surviving on soups and comfort food this winter? Try swapping these out for lighter dishes that better reflect the new season, like salads or fish. The greenery that is starting to emerge around you may inspire you to add green foods into your diet more often.” Eat fruits and veggies Myles Spar, MD, MPH“Switch up your diet. A recent study shows prominent results indicating that a high intake of fruits and vegetables promotes higher levels of optimism and self efficacy, reduces psychological distress, reduces cancer fatalism, and protects against depressive symptoms in adults.” Visit the farmer’s market Jennifer Fidder, M.A. CPPC, Jennifer Alice Training and Coaching LLC mindset coach and personal trainer“Spring is also a great time to check out your local farmer's market. In the United States, all sorts of lettuce, leafy greens, as well as asparagus are in season this time of year.”

Part two of a two-part series. Read part one here. If you're having a hard time fitting physical activity into your daily life, you're not alone. Overall, the Centers for Disease Control and Prevention (CDC)'s report on physical activity levels in U.S. states and territories shows that activity levels could be improved in most areas. The first article in this two-part series took a deeper look at the report and reviewed possible reasons for the striking differences the report found across regions and ethnicity. The CDC's initiative Active People, Healthy NationSM has great resources for organizations and community leaders working to encourage physical activity in their communities. These are helpful for addressing these physical activity trends from a larger scale. While broader trends and barriers to fitness are usually better addressed at a societal and community levels, it's possible to incorporate more physical activity into your life even with existing barriers. Active People, Healthy NationSM also has helpful advice and resources for individuals and families. Joining the initiative can also connect you with other people becoming more active and keep you up-to-date on the movement. We reached out to experts for tips on overcoming barriers to fitness. Whatever barriers you face when it comes to regular physical activity, working to overcome them will benefit you. Where to start As you plan to increase your physical activity, you’ll need to determine your end goal, identify potential barriers, and plan ways to be successful. As you think about your end goal, keep in mind that visualization won’t be enough to help you achieve. “Surprisingly, it has been found that visualizing isn’t enough and maybe even harms the process! That’s because visualizing can give us a feeling of reward right on the spot within our brain. Imagine saying “Ah, imagine if I’ve written that book . . .”  It feels great and then that was enough!” says Alexandra Miller, Psy.D, Host of Psychology America with Dr. Alexandra Podcast and Director of Live Well Psychology. Making a clear, doable plan can help. “The first thing is to not try and change too much too soon. What I mean by this is often someone is aware they should be more active and believes they need to start going to the gym every day and change their diet all at the same time. What happens more often than not is one will start off by going to the gym five or more times a week. This is too much to start off with,” recommends Anthony Treas, MPH, CHES, Men's Life Coach for STRONG Men Coaching, LLC. Pacing yourself and gradually increasing your physical activity levels will help you be more successful with your goals over time. “When I coach someone who would like to add physical activity in their life, we start by just adding just a few days a week. If they can do more, that is fine, but the goal for the first few weeks is to participate in physical activity for a few times a week. Then gradually work to adding more days to eventually be doing some sort of physical activity everyday. Once they have a good routine, then it is time to start changing the diet,” continues Treas. Another key to achieving your fitness goals? Finding something you like to do. “The second thing is to find a physical activity that is enjoyable. Doing something enjoyable will help someone to stay consistent and consistency is the key to receive the health benefits of physical activity. Although, it is important to add in strength training, flexibility, and functioning exercises, doing something you enjoy is the most important for longevity,” advises Treas. Even if you have a clear plan and an activity you look forward to, you can always change your mind in the moment. Miller has advice to counteract this:  “What we need to do according to recent research is consciously think of our biggest internal barrier to making our goal (i.e. increased activity) happen. This often comes in the form of one sentence we tell ourselves and will be unique to each person. For my patients it’s often 'I’ll do it tomorrow,' or 'I don’t have the energy' or 'I don’t have the time right now.' Once we come up with this sentence, we then make a plan of how to overcome this barrier. The play may be in the form of a sentence paired with an action, such as 'It’s now or never . . . and then I put on my running outfit.'  This method has a fancy title: ‘Mental Contrasting with Implementation Intentions,’” she says. How to overcome barriers Anticipating and planning to work around barriers will help you achieve your goals. “Make a list of how incorporating physical activity may be difficult for you. Identify these areas and then find a way to make it easier to incorporate physical activity. It will require some changes, but the health benefits are worth it,” suggests Treas. Specific barriers you face will vary in their type and intensity, so your plans to overcome your difficulties will likely be different from someone else’s. Below are some tips for overcoming common barriers. Weather Kristen Burris, LAc, MSTOM, Acupuncturist and Master Herbalist for Eagle Acupuncture“If weather is a challenge: either too hot or too cold, finding activities indoors will be your saving grace. In the dead of winter, going to a gentle warm heated yoga class sounds abundantly more appealing than walking in the windy city with snow all around.” Amber Nash, fitness expert and founder of Fit Healthy Best“Try 20-second exercise snacks to improve fitness and boost motivation in cold months. Researchers found that just 20-seconds of stair climbing a few times per day improved the subjects' cardiovascular fitness. This can be done easily indoors all winter or when someone does not have access to physical activity.” Michael Groesch, PT, DPT Clinical Manager of Menorah Park Center for Senior Living“Ice skating, skiing, and winter hiking can be a great way to beat the winter blues and avoid gaining the extra weight we may experience in colder months.” While these tips focus on colder weather, you may need to find indoor activities if the summers in your area are too hot.  Money Jennifer Ellis, ACE Certified Group Fitness Instructor and Life Enlightenment CEO“Just move. Many people I find feel like they have to join a gym, sign up for a class, walk a certain number of steps per day, etc in order to be active. I tell my students — just move! I don’t care what you do or for how long; any amount of movement will be beneficial — do a set of squats while brushing your teeth, park farther from wherever you are going and walk, if you are a parent with time constraints turn on some music and dance around the house with your kids. Those are a few of many easy examples I share with my students.” Michael Groesch“Even while watching TV, one can stand, do squats, lift light weights, (if you don’t have dumbbells try using books, filled bags, or canned goods for weight) do leg extensions, toe touches, and jumping jacks. Workout videos are entertaining, high energy, and can be done any time, and anywhere that you have access to a computer, TV, or phone with YouTube. Most are found free on the internet. Before bed, gentle stretching can be part of your nightly routine. Try sitting toe to toe with your partner and stretching back and forth.” Kristen Burris“Many community centers offer classes for free or for only a few dollars. Write down on a calendar each week a new activity you'd like to try from tai chi to yoga to square dancing to Pilates to weight training to snowshoeing to pickleball to flying a kite or riding a bike. Figure out what you like. The things you dread, avoid. If taking on activities feels too daunting, walk more, drive less, park further, carry more, take the stairs not the elevator, and start slow. The other option is to YouTube exercise for beginners or a 10-minute workout. All you need is a phone, Wi-Fi, and 10 minutes.” Time Sandra Crawley, RN, BSN and Mom Loves Best medical consultant“If someone puts in long hours working and comes home to take care of the family, then has to travel to a different location to be able to be physically active, chances are the first thing to go is physical activity. When time and money are limited, take small steps to become more active. Dance while doing chores — don’t just sit and watch the kids, get up and join them. Take a walk after dinner and explore your neighborhood. Find your support person. No matter what the perceived barriers are, there is always a way around them.” Gaye Groover Christmus, MPH of CalmHealthySexy“One of the easiest ways to get more physical activity is to work it into your daily life. Every day, think about your schedule and ask yourself, 'How can I move more today?' Wear an activity monitor, set a step goal, and add short periods of walking throughout the day. Walk at your children’s sports practices and lessons. Walk and talk with a colleague, rather than sitting and talking. Take 20 minutes of your lunch hour to walk.” Michael Groesch“If you can’t join a gym or health maintenance program, you can get your activity in at a local mall; it’s a great place to walk! Also, multi-level office and apartment buildings have steps to each floor, which provides great cardio. A 10-minute walk during your lunch break can do wonders for your energy level, cardio health, lowering blood pressure, and de-stressing.” Ways to stay on track Keeping yourself accountable will help you stay on track. You can hold yourself accountable to yourself or find a friend to work with are great options. If personal accountability works for you, you can use fitness technology, like Fitbits, to keep yourself going towards your goals. “Invest in some tech. Wearable devices that track your activity have been shown to be very effective. Setting an active goal and using technology to track your progress throughout the day is a great way to remind yourself to keep moving,” suggests Samantha Clayton, vice president of sports performance and fitness for Herbalife Nutrition. If tech is beyond your budget, you can use a calendar, journal, or make your own tracker. You can also keep track on your phone. Social support can also help you succeed. “To help increase activity levels, people should find some support, either from family, friends, or a group. People are more apt to be physically active if they have another person be active with them and the extra support will keep you motivated,” suggests Crawley. Finding a friend or family member to work-out with or even just to go on walks with can help you stay on track for your activity goals. You may even be able to find support groups by joining the CDC's Active People, Healthy NationSM. If you have a health plan, your insurer may offer rewards or programs that make it easier to be active. For example, Cigna offers a Healthy Rewards® program that provides discounted fitness club rates to plan members among other discounts.  With a workable plan and the right support, you can be successful and increase your activity. Explore Health Insurers Learn more about member benefits and fitness incentives offered by top health insurance companies with their plans. View Top Health Insurers

Part one of a two-part series. Read part two here. Did you make an exercise goal for a New Year's resolution? Are you having difficutly meeting it? If you are, it might not just be you. There may be some external factors at play. In January, the Centers for Disease Control and Prevention (CDC) released data on adult physical inactivity in the United States and several U.S. territories using data collected from 2015 to 2018. Overall, the report shows that over 15 percent of adults in U.S. states and territories did not participate in any physical activity outside of their job. Most states and territories had 20 percent or more adults reporting no leisure time physical activity in the past month. Keep in mind that even doing one leisure time physical activity during the last month would have changed the results. Being physically active once a month is a pretty low bar when it comes to evaluating fitness levels. By and large, the report indicates that adults in the United States need to be more physically active. Since the report measures leisure time physical activity, here's our first question: Does discounting job-related physical activity make this an unfair representation of fitness levels and overall health in the United States? The CDC also created maps that show hot zones of inactivity by state or territory. There are several maps that show differences in activity levels by region and ethnicity. These differences are striking. “When you go through the CDC report, there are two main points that stand out. The first is that Southern states and the Northeast states have one of the highest inactivity levels. The second fact is that non-white Hispanics and non-Hispanic black adults got the least amount of exercise,” observes Dr. Dheena Sadik, Consultant Nutritionist and Dietician for Tea Leafed.  So, the second question: What barriers exist preventing leisure time physical activity? And, to wrap up this two-part series: What can people do to increase their activity levels regardless of the barriers they may face? We reached out to health and fitness experts and looked at research studies to learn more about these questions. Read on to get their insight. Does discounting job-related physical activity make the results an unfair representation of fitness levels and overall health in the United States? While some experts noted that job-related physical activity contributes to overall health and fitness, others had compelling reasons for it not being an unfair statistic.  Here’s why: 1. Active day jobs may not affect everyone’s fitness levels the same way. Kristen Burris, LAc, MSTOM, Acupuncturist and Master Herbalist Eagle Acupuncture“Oddly, in 20 years of practice, I have not noticed a correlation with active day jobs equating fitness. You would think every housekeeper in America would be underweight and muscular from the demands their job ask of them; however, it is not true. Leisure activity is key.” 2. Job-related activity is different from fitness. Dr. Dheena Sadik“A study conducted by Netherland researchers found that individuals who worked in construction and similar jobs were actually at risk for dying earlier. It appears that physically demanding jobs require a different type of physical activity. This, coupled with the fact that these workers don’t get as much rest could be doing their cardiovascular system more harm than good. So, in that way, even people with such jobs may need to work out during their leisure time as well.”  Jasmine Marcus, PT, DPT, CSCS of McCune and Murphy Physical Therapy“I'm a physical therapist and strength and conditioning specialist. I do think it's important to overlook the physical aspects of work, because your body becomes used to this level of activity, and to truly benefit from exercise, you usually have to overload the body and do more than what it is used to.  Additionally, while a job may require heavy lifting, it probably isn't adequately lifting all the muscle groups that need strengthening. Additionally, everyone needs both cardiovascular activity and strength training, and even an active job may not hit both of these goals.” 3. The purpose of physical activity matters. Samantha Clayton, Vice President of sports performance and fitness for Herbalife Nutrition“All activity counts in terms of assessing people’s sedentary lifestyle behaviors. However, there is a big difference between doing purposeful exercise with the aim of improving your fitness level with dedicated time, versus simply moving your body doing activities of daily living or work.  All activity is important, but intentional activities done for the purpose of decompressing or health improvement has a greater impact on our mental health and this, in my opinion, makes the report truly accurate. It’s for this reason that more people are prioritizing self-care wherever possible. Stress relief is needed in our busy lives and physical activity has so many positive health benefits.” All of this is to say: having a physically active day job doesn’t mean your body is getting what it needs.  As you evaluate your physical activity level, keep in mind that your activity levels also need to hit recommended levels to get the health benefits. "An important thing to remember is the recommendation of 150 minutes of moderate-intensity aerobic exercise per week, so although your activity during the day is beneficial you want to make sure it is enough to raise your heart rate to get the benefits of exercise,” says Michael Groesch, PT, DPT Clinical Manager of Menorah Park Center for Senior Living. What barriers exist preventing leisure time physical activity? While the study also shows exercise rates across states and ethnic or racial groups, regions and ethnicity may not be the best way to interpret the findings. There are other factors that may have more of an effect. Sadik remarks: “The one thing that the CDC study didn’t take into account was socioeconomic factors. However, if you were to take a closer look, this could be the missing piece to show why non-whites were getting less activity outside of their jobs.” Socioeconomic factors likely have more of an impact on physical activity levels than anything else.  In fact, the states with the highest poverty levels almost exactly match up with the states with the lowest activity levels when you look at the Overall Physical Activity Map from the CDC’s report and compare it to The Percentage of People in Poverty for the United States and Puerto Rico: 2018 map (Figure 2 in Poverty: 2017 and 2018 of the American Community Survey Briefs, issued November 2019). When you consider that disparity in socioeconomic outcomes and poverty rates in the United States are different across racial and ethnic groups, it’s not surprising to see that these outcomes affect health. For example, the Kaiser Family Foundation has data from 2018 that shows poverty rate differences across racial groups. The overall U.S. poverty rate for Whites is 9 percent. In contrast, the poverty rates for Blacks (22 percent) and Hispanics (19 percent) are both double the poverty rate for Whites. If you look at the states with the highest poverty rates for each group, they generally match the states that have 25 percent and higher reported inactivity levels in the CDC's report. While there are a few exceptions, these trends are telling. “Across our nation, we see that the lower economic areas have the highest rate of a sedentary lifestyle. Many of the rural areas lack the simple amenities already mentioned, but have the added barriers of the lack of funds to join a gym, take classes, or buy the perceived necessary equipment. Inner-city areas have plenty of sidewalks but may be unsafe and lack outdoor green space,” says Sandra Crawley, RN, BSN and Mom Loves Best medical consultant. These differences indicate a relationship between socioeconomic factors and physical health. While there is evidence suggesting a strong correlation between poverty rates and leisure time physical activity, regardless of race, ethnicity, and region, there are other regional factors to consider. These include geography, weather, and climate. For example, areas with hiking trails and nicer weather may make it easier for people to get outdoors and be active. Colder weather and storms can make it harder to get outside or even drive to a recreation center. Experts we talked to also identified other potential barriers. Some of the barriers mentioned below are socioeconomic factors. Each potential barrier listed below may be experienced differently based on identity and location. Weather Amber Nash, fitness expert and group exercise instructor of Fit Healthy Best“I live in Kansas City and getting outside from December through February is very difficult, which is common across the entire Midwest.   Even on the days when there is no precipitation, you have to really bundle up to get out and be active. This can be harder for people with limited resources to buy warm layers or for parents with very young children.  On top of that, if you have limited financial resources and don't live close to a public rec center, your options for physical activity during these three months are severely limited.   According to my fitness tracker, even though I aim to be active all winter, my activity levels do plummet during these months.  It's simply so much easier to just walk outside during the spring, summer, and fall in the Midwest and get in some movement than it is during the harsh winter months here.” Fatigue and expectations around exercise Alysa Boan, NASM Certified Personal Trainer at MyTennisLessons and RealFitnessMaven“Physical activity can be daunting. Oftentimes we are not confident in the gym so we avoid it. Or we are so exhausted from our day, exercise gets pushed to the bottom of the priority list. What we must recognize is that exercise and a healthy diet are proven to increase energy levels, decrease stress, and improve sleep. All of which help to battle exhaustion and lack of motivation. Increasing exercise can be a strong indicator for improving overall health and wellness.” Work-life balance Michael Groesch“Other barriers include time constraints and access to exercise equipment.  A lot of people have difficulty with finding a balance between work, responsibilities at home, and physical fitness.” Samantha Clayton“The main barrier that I see while traveling is that many people struggle to find a work/life balance. Technology as well as the expectation to be constantly connected to work is preventing people from making their health and activity a priority. In most major cities around the world, time stuck in traffic or commuting each day also interferes with recreation, family time, and food prep time. People are then reduced to having to pick up takeout or skip the gym. A way to manage this is to try to beat the traffic, get to work early and squeeze in some exercise, use your lunch time to move or workout close to work, or use your time wisely after work to allow the traffic to die down. This way you can reduce your stress while also getting in your fitness activity for the day.” Pain Michael Groesch“A large barrier we see in my profession to physical activity is pain. If pain is limiting your ability to be physically active this can impact your health substantially.  Consulting with a physical therapist is a great way to help you overcome this barrier and get back on track with your exercise.” Read the second article in the two-part series: "More Than Willpower: Overcoming Barriers to Fitness"