October Is Breast Cancer Awareness Month

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October is Breast Cancer Awareness Month, an opportunity to raise awareness about breast cancer, the importance of early detection, and steps you can take to better understand your risk.

Breast cancer is one of the most common cancers among women in the United States. According to the American Cancer Society, approximately 1 in 8 women will develop invasive breast cancer during their lifetime.

Regular screening helps detect breast cancer early. Mammograms can identify breast cancer before symptoms develop, when treatment is often more successful. The American Cancer Society recommends that women at average risk begin regular mammograms by age 45, with the option to start at age 40. Talk with your healthcare provider about when to begin screening and how often, based on your age and personal risk factors.

Understanding your personal risk is also important. Age, family history, certain inherited genetic changes, and personal medical history can influence your risk of developing breast cancer. If breast or ovarian cancer runs in your family, share that information with your healthcare provider. Some individuals may benefit from earlier screening or additional testing.

In addition to regular screenings, pay attention to changes in your breast health. If you notice a new lump or other unusual changes, talk with your healthcare provider. These changes don’t necessarily mean cancer, but you shouldn’t ignore them.

While not all risk factors are within your control, maintaining a healthy weight, staying physically active, and limiting alcohol consumption may help reduce your risk.

Breast Cancer Awareness Month is a good reminder to review your screening history, talk with your healthcare provider about your personal risk, and schedule any recommended screenings you may be due for.

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How to Compare Health Plans During Open Enrollment

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When comparing health plans during open enrollment, people often look at the monthly premium first. While it’s an important part of the decision, it doesn’t tell you what your healthcare may actually cost over the year.

For example, imagine you’re comparing two health plans. One has a lower monthly premium but a higher deductible. The other plan costs more each month but has a lower deductible and different copays or coinsurance.

If you rarely need medical care, the lower-premium plan may be appealing. But if you regularly visit specialists, take prescription medications, or expect ongoing treatment, the higher-premium plan could potentially cost less overall.

Start by calculating the annual premium for each plan. Then consider what you might pay for regular appointments, prescriptions, and other services. Remember, meeting your deductible doesn’t necessarily mean you’re done paying. Copays and coinsurance may continue until you reach your out-of-pocket maximum.

One thing worth double-checking is the provider network. Even when the same insurance company offers two plans, their networks may differ. If keeping a particular doctor, specialist, hospital, or medical group is important to you, verify that the plan you’re considering includes them.

Prescription coverage can also make a difference. A medication covered under one plan may have different costs or coverage requirements under another. Checking your prescriptions before enrolling can help you avoid surprises.

The goal isn’t necessarily to find the plan with the lowest premium or deductible. Choose coverage that fits your healthcare needs and budget. Before making your final decision, review each plan’s Summary of Benefits and Coverage (SBC). It provides a standardized overview of covered services and cost-sharing, making plans easier to compare.

 

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CalCPA Health Announces CEO Transition

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CalCPA Health Members, Business Partners, and Friends:

The Board of Trustees of CalCPA Health is pleased to announce an important leadership transition.

Ron Lang will be retiring from CalCPA Health after serving 14 years as CEO. During his tenure, Ron has helped guide and strengthen the organization while maintaining its focus on serving California’s CPA community. The Board thanks Ron for his leadership, dedication, and many years of service and wishes him all the best in retirement.

The Board is also pleased to announce the appointment of Randy Lee as CalCPA Health’s next Chief Executive Officer.

Randy joins CalCPA Health from Kaiser Permanente, where he most recently served as Vice President leading its Federal Employee and Postal Service Health Benefits Program. He previously served as Senior Director of Business Planning and Analysis and has more than 20 years of experience in healthcare, strategy, business operations, and health benefits administration.

We are confident that Randy’s experience and leadership will serve CalCPA Health well as we continue our commitment to providing quality health and employee benefit programs to California’s CPA community.

Please join us in thanking Ron for his many contributions and welcoming Randy to CalCPA Health.

Sincerely,
Board of Trustees
CalCPA Health

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September is National Preparedness Month

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September is National Preparedness Month, a good reminder to think about how prepared you and your family would be if an emergency disrupted your normal routine.

Most of us know the basics: have food, water, flashlights, batteries, and other emergency supplies on hand. But your healthcare needs should be part of your emergency planning too.

If you take prescription medications, include them in your emergency supplies. The American Red Cross recommends keeping a seven-day supply of medications and necessary medical items in your emergency kit. The FDA also recommends keeping an up-to-date medication list and copies of your prescriptions. If you are concerned an emergency could make it hard to get to a pharmacy, talk with your pharmacist or healthcare provider about planning ahead. Read more

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Understanding Your Deductible and Out-of-Pocket Maximum

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Your deductible and out-of-pocket maximum are two important numbers to understand when using your health plan, but it’s easy to confuse what each means.

Your deductible is the amount you generally pay for covered healthcare services before your health plan begins sharing the cost. Depending on your plan, some services may be covered before you meet the deductible, while others may require you to meet all or part of it first.

Your out-of-pocket maximum works differently. It is the most you may have to pay during the plan year for covered, in-network healthcare services that count toward the limit. Once you reach that amount, your health plan generally pays 100% of covered, in-network services for the remainder of the plan year.

Remember, reaching your deductible does not mean you are finished paying for healthcare. After meeting the deductible, you may still have copays or coinsurance until you reach your out-of-pocket maximum.

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What to Know Before Open Enrollment Begins

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Open enrollment is approaching, and for many people the process will look familiar: review the available plans, look at the monthly premiums, and decide whether to keep the same coverage for another year.

But the plan with the lowest premium isn’t necessarily the plan that will cost you the least, and the plan you have today may not be the best fit for you next year.

Before open enrollment begins, take some time to look at how you actually used your healthcare this year. Your claims, prescriptions, provider visits, and out-of-pocket expenses can tell you a lot about what to focus on when comparing plans.

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July is UV Safety Awareness Month

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Summer is a great time to enjoy longer days and spend more time outdoors. It is also a good time to think about protecting your skin from ultraviolet (UV) rays.

UV rays cause sunburns, premature aging, and an increased risk of skin cancer. While a sunburn may fade after a few days, repeated exposure to UV rays can have lasting effects on your skin.

The good news is that a few simple habits can make a difference:

  • Choose a broad-spectrum sunscreen with an SPF of 30 or higher and reapply every two hours, or more often if swimming or sweating.
  • Wide-brimmed hats, sunglasses with UV protection, and lightweight long sleeves can help reduce sun exposure.
  • The sun’s rays are typically strongest between 10:00 a.m. and 4:00 p.m., so try to limit sun exposure during these hours.
  • UV rays can pass through clouds, so sun protection is important even when it is overcast outside.
  • Become familiar with your skin and talk with your healthcare provider if you notice a new or changing mole, spot, or lesion.

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Why Prior Authorization Matters

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Your healthcare provider recommends a medical test or procedure, but before you can schedule it, your health plan may require one more step: prior authorization.

Prior authorization is a process some health insurance plans use to determine whether certain medications, imaging tests, procedures, or medical services meet the plan’s coverage requirements before they are provided. While not every service requires prior authorization, many plans use it for higher-cost services or treatments.

The purpose of prior authorization is to help ensure that care is medically appropriate and consistent with a health plan’s guidelines. Requirements vary by insurance carrier and health plan, which means a service that requires prior authorization under one plan may not require it under another.

One common misconception is that if a healthcare provider recommends a service, it is automatically covered by insurance. Provider recommendations and insurance coverage decisions are separate. Even experienced healthcare providers may not know the specific requirements of every health plan.

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Why Healthcare Costs Can Vary So Much for the Same Service

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Many people are surprised to learn that the cost of healthcare services can vary significantly, even when the service itself appears to be exactly the same.

For example, two individuals may receive the same imaging test, lab work, or office visit and receive very different bills depending on where the service was performed, whether the provider was in-network, and how their health plan is structured.

One of the biggest factors affecting cost is provider networks. In-network providers have negotiated contracted rates with insurance carriers, which are generally lower than out-of-network pricing. Out-of-network care may result in higher deductibles, coinsurance percentages, or additional balance billing depending on the plan.

Health plan design also plays a major role in what someone pays out of pocket. Traditional PPO plans often include fixed copays for services such as office visits or prescriptions, which can make costs feel more predictable. HSA-compatible high-deductible health plans typically operate differently. In many cases, individuals enrolled in HSA plans may pay the full contracted cost of services until the deductible is met, after which coinsurance may apply.

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