Health Insurance News and Blog Feeds

We mentioned yesterday that the feds are proposing their annual tweaks to the way Medicare pays doctors. But we were so busy geeking out on a proposed accounting change that we neglected to mention a few other details likely to be of interest: Namely, the feds want to increase Medicare payments to primary-care docs, and decrease payments to some specialists.

This is something that’s been bandied about for awhile, and there have been some small shifts in this direction. Still, specialists argue that they often have to train years longer than primary care doctors, and deserve higher pay. (They will still be paid more if the new Medicare payments take effect, but the gap between specialists and primary care docs might shrink a bit.)

CMS, the agency that runs medicare, is proposing a set of tweaks that would raise the fees Medicare pays for primary care by 6% to 8%, according to this statement. (The physicians included in this bucket are internists, family docs and geriatrics specialists.)

Medicare payments to cardiologists would be cut by 11% overall, with certain procedures (echocardiograms, cardiac catheterizations) facing steeper cuts, the WSJ says. Radiologists would see a cut of about 20% for doing high-tech scans such as CTs and MRIs, an official at the American College of Radiology told the WSJ.

Update: CMS estimates that radiologists would see an 11% cut overall; here’s the complete list of estimated payment changes by specialty, on pp. 716-717 of the proposed rule changes published in the Federal Register.

Photo: iStockphoto

Multaq, Sanofi-Aventis’s treatment for heart-rhythm disorders, has made a comeback. Rejected by the FDA in 2006 because of safety concerns, the agency has approved Multaq, the company announced today.

The drug approval is the French drug maker’s first major U.S. approval in seven years, according to Bloomberg. Late last year, Sanofi decided to discontinue development of obesity drug Acomplia, which was once thought to have much promise. Lately, the company has faced questions lately about whether its diabetes drug, Lantus, is linked to cancer.

Sanofi has predicted that Multaq, which treats atrial fibrillation and atrial flutter, eventually will bring in annual sales of more than $1 billion, notes Dow Jones Newswires.

The FDA rejected Sanofi’s initial attempt for approval because a study showed that patients on Multaq were more likely to die than those who received a placebo. The company has since conducted more research looking at patients at a less-advanced stage of heart disease.

Sanofi will also implement a risk evaluation and mitigation strategy to help “ensure the safe use of Multaq” and help health-care workers identify patients appropriate for the treatment, according to the company.

“The drug is now approved, ending Sanofi’s streak of pipeline futility,” UBS analyst Gbola Amusa told Dow Jones.

Image courtesy of Columbia University Medical Center

Health-care giant J&J is making a $1 billion bet for a stake in Irish drug maker Elan and will invest an additional $500 million in Elan’s closely watched experimental bapineuzumab that is in late-stage studies to treat Alzheimer’s, the companies announced this morning.

With the deal, Elan essentially turns over to J&J the development rights of bapineuzumab, which Elan has been developing in partnership with Wyeth (soon to be bought by Pfizer). But the compound isn’t as promising as it initially appeared to be, which resulted in severe punishment of Elan’s stock price last year. Elan has also been sharply criticized by shareholders for its botched marketing of multiple sclerosis drug Tysabri and executive perks.

In January, Elan announced that it would conduct a strategic review process to examine options for the future of the company. More than 30 companies expressed interest in talking with the company since then, Elan CEO Kelly Martin told analysts on a call today.

Under the deal, J&J will become Elan’s largest shareholder with a 18.4% stake in Elan. J&J will also form a new subsidiary company with assets from Elan’s Alzheimer’s drug-development program, in which Elan will hold a 49.9% stake. Elan will share in the profits of bapineuzumab.

The proceeds will allow cash-strapped Elan to reduce its debt to $400 million from about $1.8 billion, said Elan’s chief financial offier, Shane Cooke, on the call. The company will continue to develop other compounds in its pipeline for treatment of multiple sclerosis and Parkinson’s disease. See the WSJ story for more on the deal.

Martin called the deal an “exciting new chapter in our history” and with J&J as a partner, hopes to build the “leading neuroscience immunology company in the world.”

Photo: Associated Press

In this blog, I have frequently discussed the merits of Canadian and American health care systems (see Health Care Grudge Match).  One thing most people can agree with is that mental health care is subpar in both countries.  

The Vancouver Sun reports of a man committing suicide by jumping off the Granville Street Bridge.  
[In British Columbia]…family members of persons with severe mental health problems complain about the difficulty of getting loved ones committed. They cite restrictive confidentiality rules that isolate the family member in need, or the difficulty of getting doctors to agree to a commital or the system’s unwillingness to commit a patient until it is too late.

“In the 20-month period from December, 2006 through to Mr. Kwapiszewski’s suicide in 2008, Ms. Haboosheh — either directly or through her husband, Mr. Kwapiszewski’s GP, a lawyer, and a North Shore mental health worker — contacted Vancouver mental health services 16 times, desperately trying to get them to intervene as her brother showed more and more troubling behavioural symptoms. Three letters were also filed as part of, or in conjunction with, those contacts, and some meetings were also involved. Ms. Haboosheh also called the Vancouver Police Department on three different occasions to report him missing. Of the 16 calls and other contacts, 10 were with Mental Health Emergency Services and six with the Midtown Mental Health Team. They consistently, however, declined to commit Mr. Kwapiszewski for treatment, insisting he was non-committable. There was no mistaking his deterioration, however.�

There are fewer quantitative tests associated with mental health evaluations.  Also, there is also more of a stigma associated with mental compared to physician illness.  For both of these reasons, mental health problems too frequently take a back seat to physical health illnesses.

I sure had a good chuckle reading the Wall Street Journal’s lead story today (Wal-Mart Backs Drive to Make Companies Pay for Health Coverage). As reported, Wal-Mart wrote a letter to President Obama –co-signed by the Service Employees International Union (SEIU) and the Center for American Progress (CAP)– calling for an employer mandate to offer health insurance coverage.

The parts that made me chuckle were the reactions from those who thought Wal-Mart was on their side:

The National Retail Federation, the industry’s main lobby, said it was “flabbergasted” by Wal-Mart’s move. “We have been one of the foremost opponents to employer mandate,” said Neil Trautwein, vice president with the Washington-based trade group. “We are surprised and disappointed by Wal-Mart’s choice to embrace an employer mandate in exchange for a promise of cost savings.”

Mr. Trautwein said an employer mandate is “the single most destructive thing you could do to the health-care system shy of a single-payer system,” under which the government handles health-care administration. The mandate “would quite possibly cut off the economic recovery we all desperately need,” he said.

And this:

The U.S. Chamber of Commerce said most of its members oppose an employer mandate, and it doesn’t think Wal-Mart’s stance will change that. “The kind that the groups in this letter support is the worst incarnation, the most dangerous policy,” said James Gelfand, senior manager of health policy for the group, which represents three million businesses.

Those quotes are pretty lively –much more so than what you typically see from sober minded groups like the Chamber of Commerce!

There’s not much analysis of the reasons behind Wal-Mart’s new approach in the Journal article, and not much in the Journal’s Health Blog either. Comments on the blog post and article are fairly inane as well.

Here are a few reasons that could explain Wal-Mart’s stance, from most to least obvious:

• Wal-Mart figures it will be pressured into offering health insurance anyway, so wants to make sure that it’s on a level playing field with smaller competitors that might otherwise escape without offering insurance
• Wal-Mart’s customers are hard hit by health care costs. Even those without health problems are worried about health care costs, which limits their propensity to spend money at Wal-Mart. If customers have health insurance from their employees they can spend more freely on other goods
• Wal-Mart sees a big growth opportunity in the provision of health care services and/or health insurance and the company wants to make sure there is a big market for its offering

I really hope the last point is true.

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I just read an article at Science and Sensibility, written by Amy Romano, about how Canada’s Society of Obstetricians and Gynecologists (SOGC) has changed its position on breech delivery protocol.  I believe strongly that minimal intervention is best when it comes to childbirth, and I was heartened by Amy’s article.  She discusses the Term Breech Trial, and how it had set the standard for routine c-sections of breech babies.  Turns out that there were plenty of flaws in the TBT, and SOGC has determined that c-sections should no longer be routinely performed when babies are breech.  This will give women more control over their own bodies and births, and will likely help to lower the total number of c-sections performed.

Now we just have to get ACOG on board too.  C-section rates in the US are far higher than the World Health Organization recommends, and women here who have a breech baby are routinely herded into the OR, with little choice in the matter.  Jay was born breech, and so was his sister.  Neither was a c-section, and both turned out great (you can pay me later, Jay).  Obviously those are just two incidents (and we all know that anecdotes are not data) but had Jay and his sister been born 30 years later than they were, Jay’s mother would have been subjected to two major abdominal surgeries - which also involve risk - that she didn’t really need.

In the current quest to reform health care, everyone is talking about controlling costs.  Lowering the rate of c-sections would have a significant impact on the cost of maternity care, since vaginal births are much less expensive than surgical births.  Maternity care is something that most women eventually use, and lowered costs would translate to lowered health insurance premiums for all of us.  I have friends here in Colorado who have been subjected to routine c-sections because their babies were breech, and in one case the parents ended up paying several thousand dollars out of pocket for the birth, since the surgery was done at an out-of-network hospital.  A change in protocol for breech births seems like it would benefit mothers, babies, and health insurance companies (and all of us who pay premiums for insurance).  Let’s hope that ACOG follows in SOGC’s footsteps.

I found Amy’s article in Grand Rounds last week, hosted at Florence dot com.

Jaan Sidorov, at Disease Management Care Blog considers devoting this week’s Cavalcade of Risk to Michael Jackson, Bernie Madhoff, Farrah Fawcett, or Mark Sanford before settling on risk explicator Peter Bernstein.

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The Disease Management Care Blog hosts this week’s edition of the Cavalcade of Risk.

CNN Money has an interesting piece (How to get help in a hurry in the ER) on tactics to reduce one’s wait in the emergency room. The author describes the experience of a house guest who had an allergic reaction, then asks four ER physicians what they would do to get a loved one seen faster.

The suggestions include:

• Telling the triage nurse the patient’s condition is worsening or that the patient has “an emergency medical condition that should be evaluated right away”
• Drop the name of a hospital big shot (that’s what the house guest does and what one of the ER docs recommends)
• Page the patient advocate or hospital administrator

I’m not that comfortable with these suggestions. In particular, if everyone acted this way it would make things much, much worse than they already are. The first suggestion is especially troublesome if it means exaggerating the patient’s condition. On the other hand, I know the helpless feeling of being in an emergency room and not feeling like your making any progress moving toward the front of the line. Some of the comments on the CNN article are from triage nurses who basically say, “trust us,” but I’m not really buying that either.

In my experience, the best option is to try to avoid going to the emergency room unless it can’t be avoided. If possible, that means going to see one’s own doctor or meeting him or her at the hospital. Not every doctor can or will do it, and it won’t always work, but it’s worth a try. Although I’m not a big fan of concierge medicine, this is the type of situation where it could be worth it for the patient.

In some communities –though not where I live– urgent care clinics or MinuteClinics are a realistic alternative and a better experience. Finally, some hospitals’ emergency rooms are less busy than others. Sometimes those are found in community hospitals rather than big academic medical centers. If it’s going to be a 3 or 4 hour wait, driving an extra 15 or 20 minutes for a better experience can easily be worth it.

When I visited Singapore, some hospitals were putting video cameras in their emergency room waiting areas so people could see for themselves what the crowding was like before coming in.

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This week I’ll be in Vancouver for the Western Economic Association International Conference.  

I’ll be presenting my paper on “Why Does Getting Married Make You Fat? Incentives and Appearance Maintenance.”

Most people are aware that they need health insurance.  Some might not be able to afford it, and others might not be able to qualify for a policy, but just about everyone considers it a necessity.  This is in sharp contrast to general perceptions about long term care insurance.  Mike, writing at InsureBlog, has an article about the discussions going on in the UK regarding how to go about insuring the population for long term care.

Based on my own very un-scientific surveys over the years (mainly talking with my own friends and acquaintances), I don’t think that most people are aware that Medicare does not cover long term care.  I think that people with lots of money (who tend to have financial advisors) know that they need long term care insurance.  At the other end of the spectrum, people who have very little money might qualify for Medicaid without much “spending down” in their later years.  But it’s the people in the middle who are probably most likely to be thrown for a loop by the costs of long term care.

Long term care insurance is a bit like disability insurance, in that both are likely to be needed at some point, and yet they aren’t high on most people’s lists of must-have insurance products.  Is it because we don’t like to picture ourselves needing long term care, or being disabled?  Is it because the products are expensive? Life insurance isn’t something that most of us particularly want to think about needing to use either, but term life insurance policies are very inexpensive.  Long term care is a more expensive product, and thus requires more of a sacrifice on the part of the policy holder.

I think that there’s a general perception that once a person becomes eligible for Medicare, medical expenses will no longer be a worry.  While Medicare does provide a good safety net for older Americans, it’s far from complete on its own.  Medicare Part D, Medigap policies, and long term care insurance are all pieces of the puzzle too, but might not be widely understood by people who haven’t yet experienced the Medicare system.

I agree with Mike that we need to be having a discussion here in the US about how to better fund long term care.  Private insurance policies work well, for the relatively few people who purchase them.  But I think more intensive public education is needed in terms of what is and isn’t covered by Medicare.

I found Mike’s article in the Cavalcade of Risk, hosted last week at Supporting Safer Healthcare.

For many of us, the most unbearable part of going to the doctor is when the series of “post-visitâ€� EOBs, bills, statements and paperwork start to arrive in the mail.  Wouldn’t it be nice to know your out-of-pocket costs BEFORE you visit a health care provider? 

In order for consumers to make informed choices, we need tools that provide accurate price and quality information.  Unfortunately, our current health care system lacks transparency and waiting around for health insurers or health care providers to solve this problem could take a long time.  In the meantime, we are starting to see some new tools that consumers can use to look-up price estimates for health care services and get an idea of a fair price for service.  The tools are not perfect, but it’s better than not knowing at all how much things cost.  In fact, whether you are insured or uninsured, it would be helpful to know up front what your out-of-pocket expenses will be --- before you visit the doctor!

 

So the next time you need to have an MRI, x-ray, mammogram, CT scan, colonoscopy, dental exam, eye exam, lab test or office visit, ---be sure to take a few minutes to visit some of these free websites so you have a better idea of fair prices for specific services.  You might even be able to use this information to negotiate a discount with your health care provider.

 

Tools to look-up prices for health care services

 

Healthcare Blue Book

Leslie’s List

MainStreetMedica

NewChoice Health

OutofPocket

Spectrum Health

USA HealthCare Costs

Vimo

 

An article in CNNMoney, Biggest Medical Mystery: The Bill, discusses obstacles and price transparency.

 

I was both saddened and intrigued when I read this article.  Executives from Wellpoint, UnitedHealth, and Assurant met with lawmakers earlier this week to discuss policy rescissions.  When pressed as to whether their companies would be willing to limit rescission to only cases of intentional fraud, all three executives said no.

I’ve been thinking about this for the last couple days.  First of all, health insurance companies have some work to do in the public opinion department.  So it is a bit of a mystery to my as to why the executives who met with congress were so adamant that rescission not be limited to cases of intentional fraud.

But the flip side of the issue is that it’s tough to really differentiate between intentional fraud and accidental omission.  The only person who really knows what an applicant’s intentions are is the applicant.  Do we use the “reasonable and prudent person” idea here?  Would a reasonable and prudent person forget that she had been hospitalized or taken to the ER?  Probably not.  Might she forget that she had been treated for a sinus infection six years ago?  Perhaps.

When I was new to the health insurance business, I remember hearing a story about a lady who “forgot” to mention on an application that she had emphysema.  She was later diagnosed with cancer and her policy was rescinded.  There is no part of me that believes that a person with emphysema could answer “no” to the question about lung/respiratory conditions and chalk it up to an accidental omission.  Health insurance applications are designed to eliminate accidental omission as much as possible.  There are health questions relating to pretty much every body part and organ system.  And then there’s a catch-all question at the end, asking for details about any conditions not specifically mentioned.  Any illness that required more than a passing glance from a doctor would be tough to forget when answering such specific questions.

Some people do lie intentionally when completing health insurance applications.  These people might not realize that rescission is a possibility, and might not understand what a dicey situation they’re putting themselves in.  In Colorado we have a high risk pool health insurance policy that is available for people who don’t qualify for individual health insurance.  Cover Colorado is far superior to getting an individual policy based on a fraudulent application.

Another problem is bad agents.   Over the years we’ve spoken with numerous clients who tell us that they have condition XYZ, but mention that their last agent told them that they didn’t have to list it on their application.  I have no idea what these agents are thinking.  All of us know about the possibility of rescission - it’s a basic part of health insurance license training and continuing education.  I don’t know if these agents are just trying to secure their own commissions, or if they honestly think that the condition is minor enough that it doesn’t need to be listed, or if they think that not listing it will make the process easier for their clients.  But no agent should ever tell a client to leave anything off of an application.  If a condition is minor enough to not be an issue, the underwriters will dismiss it.  But that is a decision for underwriters, not agents or applicants.  Any other course of action is way too risky.

The waters get pretty murky when it comes to looking at an application and determining what an applicant’s intentions were.  Did the person set out to deceive the insurance company?  Were they completing the application at the end of a long day, with a crying baby and a kid who needed help with homework?  Did one person complete the application for an entire family, and forget to mention a treatment that a spouse had several years ago?  Did they ask their agent for advice and get told that they could just not mention the condition on the application?

Several years ago, I spoke with a representative from Anthem Blue Cross Blue Shield about the issue of policy rescission.  She told me that - at least here in Colorado - rescission is reserved for serious cases where significant conditions are left off of applications, and that had the conditions been revealed during the application process, coverage would have been declined.  To me, this seems fair.  If a pre-existing condition is revealed after the approval process is complete, it should be underwritten just as it would have been if it had been noted on the application.  Trying to determine whether an applicant intentionally lied or genuinely forgot would just be speculation anyway.

Electronic medical records that allow underwriters to see complete medical histories at the time of application would greatly reduce the number of policy rescissions.  Then again, there’s a lot of talk on the table right now about eliminating medical underwriting all together, which would solve the problem once and for all.

The auto insurance industry has a rating system that offers safe drivers premium discounts.  What if the health insurance industry implemented a rating system, similar to the auto insurance industry, where “healthy membersâ€� get premium discounts when the members demonstrate healthy behaviors?  Some employers have adopted these financial incentives and their results demonstrate reduced employee health care spending after these programs are implemented.   

  My current auto insurance policy offers me discounts on my premium for:  

-       Save driver (accident free)    

-       Multi-car policy                     

-       Good grades for teenage drivers in the household

-       Anti-theft device installed in vehicle(s)

-       Air bags installed in vehicle(s)

 

What if health insurance policies started offering premium discounts for behaviors like:

-       Taking a health risk assessment

-       Exercising on a daily basis

-       Eating healthy

-       Reducing weight

-       Stop smoking

-       Lowering blood pressure

-       Lowering cholesterol

-       Monitoring and follow-up on chronic diseases 

 

As more consumers take personal responsibility for their own health, these kinds of tactics will become more common. 

 

In the health care debate - as in most debates - it all depends on your perspective.  People with awesome group health insurance benefits that are paid for by their employer might think that everything is fine the way it is.  People who don’t have an option for employer sponsored coverage and can’t afford or qualify for individual health insurance probably see it a little differently.  People who are healthy and rarely use their health insurance are probably less likely to see the problems that exist in our system.  But people who battle chronic illnesses get up close and personal with the flaws in our health care system on a regular basis.

Duncan Cross is very familiar with the health care system in the US.  He’s been through more than his fair share of medical procedures.  And he’s not impressed with a recent WSJ editorial that calls for Americans to take on more of the cost of their health care.  I can absolutely see his point.  He’s had to self-ration health care because of money.  He struggles to afford COBRA.  He’s already paying a good chunk of his income for health insurance and health care.  And his chronic illness means he’ll have to keep doing so indefinitely.

But I think that the WSJ editorial might have been aimed at a different sector of the population.  Although there are plenty of people like Duncan Cross who pay all of their own health insurance premiums and then have to continually pay out additional amounts for treatment of chronic illnesses, there are others who pay little or nothing for their health insurance premiums (thanks to employee benefits) and have very low copays when they seek care.  I was talking recently with a friend who is pregnant.  She had a baby a few years ago, and spent a total of $200 for the pregnancy and delivery.   She mentioned that her new health insurance plan is “nickle and diming” her, because she had already spent $200 for prenatal care and ultrasounds, and was going to end up paying another few hundred dollars by the time the delivery (a scheduled c-section) is complete.  This is the sort of person that I think the WSJ editorial is aimed at.  I honestly don’t think that she knows or cares how much her prenatal care and surgical delivery cost.  Her portion is a tiny fraction of the total, and yet to her it seems like a lot of money.  It’s all relative.  I have a friend who paid $7000 for her c-section delivery - and yes, that was with health insurance.  Both women had employer sponsored health insurance, but with drastically different coverage.

Proponents of HSA qualified, high deductible health insurance plans say that they make people think twice before utilizing health care.  The jury is still out on whether this is the case.  I know that a lot of our clients in Colorado request HSA qualified plans, mainly because the premiums tend to be lower.  Jay and I have an HSA qualified plan, and it has worked well for us.  But we’re healthy, with no chronic medical issues, and we’re the sort of people who would think twice (or six times) before utilizing health care anyway.  Even when we had fancy group health insurance coverage with $15 copays, we never went to the doctor.   I have a feeling that a lot of our clients who request HSA qualified plans look at health care the same way.  We don’t mind shouldering a potentially hefty chunk of our health care costs, because we typically don’t have much in the way of health care costs.  I have a suspicion that the people who wrote the WSJ article are probably in a similar position.  But the perspective probably looks a whole lot different if you’re not only paying for your own high deductible health insurance, but also facing the prospect of meeting that deductible year after year.

I found Duncan’s article in this week’s Grand Rounds, hosted at ACP Internist.

Here is an article worth reading about the nature of health care expenses, how we make the decisions about what to spend and how much, and why having your own health insurance policy may mean that you are a better cost risk than someone on a government or employer’s plan:

http://www.cnn.com/2009/POLITICS/06/15/miron.health.costs/index.html

Jonathan Pletzke is a consumer expert on health insurance and author of the health insurance book Get a Good Deal on Your Health Insurance Without Getting Ripped-Off, available online and at bookstores nationally. Additional details can be found at the consumers health insurance book and resources website www.BestHealthInsuranceBook.com. Copyright 2007-2008 Aji Publishing.

When Jay and I got our Humana policy, Jay had a pre-existing lipoma on his back.  So his policy has a lipoma exclusion.  A couple years ago, he decided to get the lipoma removed, which was a relatively simple procedure, but a billing circus.  We paid for it ourselves, since it was excluded on our policy.  We would have paid for it ourselves anyway, since we have a high deductible HSA qualified plan and the charges would have been less than our deductible.  But since it was excluded, the money we paid didn’t count towards our deductible at all.

We spoke with an underwriter at Humana who said that we had to wait at least 12 months after having the lipoma removed, and then have a doctor write a letter stating that it was gone.  We finally got around to having that done last week.  Jay got a note from a doctor here in Broomfield that says that the lipoma is gone.  We also have a copy of the receipt from the original removal procedure.  Tomorrow we’ll submit the paperwork to Humana, and hopefully the lipoma exclusion will be deleted from our policy soon.

It’s a lot of hoops to jump through, but if you have an individual health insurance policy in a state like Colorado that allows pre-existing condition exclusion riders, you might want to double check to see if your rider can be re-evaluated.  Most carriers in Colorado require that the condition be resolved (treatment and symptom free) for at least a year before you can request a review of the rider.  Some exclusions will never be removed, like the internal fixation rider on Jay’s arm.  He has a titanium rod in his arm from a snowboarding accident years ago, and as long as the rod is in his arm, the exclusion will remain.  Since the rod is permanent, so is the exclusion.

But other exclusions can be subject to review once a condition is resolved.  The same applies to someone who quits smoking.  If you pay tobacco rates on your individual health insurance policy and then quit smoking, you can request that your rates be reduced.  Most carriers in Colorado require that you be smoke-free for 12 months before the rate can be lowered, but it can make a significant difference in the premium, and is definitely worth pursuing.

This health insurance question came to me recently and I thought it worth sharing:

We are meeting with our health insurance broker tomorrow to review and select options in providing our employees HMO/PPO health insurance benefits.  We have many options, and many rates in front of us between two insurers.  Would you be able to suggest a few key critical review questions we should be asking our broker both from the perspectives of 1) lowest cost options to the company and 2) acceptable employee options?  We have under 50 employees now, and are going to contribute 50% to the plan for the employees.  None of us are experts in benefits, so we want to be sure we are making the choices in both the best interest of the company and to our employees which range in age from 22 to 75, half of which are over 50. 

From a benefits perspective, you certainly know more about what it takes to attract and retain employees in your industry. My recommendation is to make sure you get all the numbers to make your health insurance spreadsheet for comparison and know how high a health insurance deductible your group will be able to tolerate (the higher the health insurance deductible, the lower the monthly health insurance rate). Depending on the group of employees and creative strategies allowed in your state, some companies are able to create reimbursement packages for employees such that they buy their own health insurance and/or receive HSA contributions from the employer.

Buying health insurance will be an annual exercise for your company, and of course there are other options such as employee leasing companies that can handle all of these details for you. Be sure to check out news stories (such as those from the LA Times and the Wall Street Journal) on these health insurers as well as to check them out via the free online databases in the health insurance resources center. You may also wish to make sure you are considering all of your options by looking at the insurers rated best at in the health insurance resource center and ensuring that you have health insurance quotes from them.

Best wishes on your search.

Jonathan Pletzke is a consumer expert on health insurance and author of the health insurance book Get a Good Deal on Your Health Insurance Without Getting Ripped-Off, available online and at bookstores nationally. Additional details can be found at the consumers health insurance book and resources website www.BestHealthInsuranceBook.com. Copyright 2007-2008 Aji Publishing.

I know it sounds crazy, but did you know that if you move to another state you may easily get health insurance, no questions asked? The reason is because some states do not allow medical underwriting when applying for health insurance, whereas the bulk of them do. So those states that don’t allow medical underwriting are much easier to get health insurance regardless of medical status - the application forms don’t involve disclosing your detailed medical history.

Sure there’s a waiting period for pre-existing conditions (perhaps six months), but then you’ll have your health insurance - and having health insurance is an essential component of many people’s financial picture. For whatever reason you no longer have health insurance, whether it due to an illness, a family situation, a layoff, or one of the many other reasons, getting it back can be essential. Relocating to a friendlier state may be your solution, along with considering the other options available without moving, including obtaining employment that offers health insurance or buying your own (and making sure that you know all of your options - that’s why I wrote a book on health insurance!)

Moving is not to be taken lightly - there are many consequences and expenses involved with moving. However, you can move to your new state in a very lightweight way, simply by establishing a residence consisting of no more than a studio apartment or a bedroom in a shared house. As you further transition to your new state, you may begin moving more items to the new state, and continue to make your transition. Some people never move everything they own to a new state, but have a second residence elsewhere (such as the scenario that many retirees desire - with a residence in Florida and a second home elsewhere). So long as you meet the defined requirements of residency in your new location, you’ll still continue to be able to travel and visit anywhere that you wish.

So which are the states that offer guaranteed issue health insurance without medical underwriting? Presently the short list of states includes:

• Maine Health Insurance
• Massachusetts Health Insurance
• New York Health Insurance
• New Jersey Health Insurance
• Vermont Health Insurance

A few more states that I’ve found have special programs that really help people in need of guaranteed issue health insurance (check with your state department of insurance as well as others before you make a move):

• Oregon Health Insurance
• Washington Health Insurance
• Michigan Health Insurance
• Rhode Island Health Insurance

If you don’t wish to move, then you may find that your state offers guaranteed issue health insurance, subsidized rates for certain income levels, and special programs and special times of year when health insurance is not medically underwritten. There may also be specific special programs for those that have lost employment due to jobs moving overseas, or certain other industry and natural events. The best place to start finding out about these programs is with your state department of insurance. You can find contact information for your state department of insurance at State Health Insurance Resources at http://www.besthealthinsurancebook.com/state-health-insurance-resources/

As always, consult your team of financial and medical professionals before making a move. With these ideas and their advice, you may be better off.

This post originally appeared at HealthCentral.com at http://www.healthcentral.com/caregiver/c/76590/31355/insurance-move

Jonathan Pletzke is a consumer expert on health insurance and author of the health insurance book Get a Good Deal on Your Health Insurance Without Getting Ripped-Off, available online and at bookstores nationally. Additional details can be found at the consumers health insurance book and resources website www.BestHealthInsuranceBook.com. Copyright 2007-2008 Aji Publishing.

Cato Institute’s Michael Cannon hosts this compendium of insurance/risk related posts

Jonathan Pletzke is a consumer expert on health insurance and author of the health insurance book Get a Good Deal on Your Health Insurance Without Getting Ripped-Off, available online and at bookstores nationally. Additional details can be found at the consumers health insurance book and resources website www.BestHealthInsuranceBook.com. Copyright 2007-2008 Aji Publishing.

Medicare - What's Covered and What's Not

Medicare can be confusing. There are a number of pieces to the Medicare puzzle, and understanding how they fit together and where the gaps are is important to knowing where Medicare coverage begins and ends. For the official U.S. Government perspective on Medicare, visit the Medicare Options Compare website. Remember that Medicare is a financial tool and should be used with your own common sense to determine things you may also want above and beyond Medicare.

Pieces of the Medicare Puzzle

Medicare comes in four parts, with variations, and can be supplemented with other health insurance options purchased privately or from an employer retirement plan. The four parts of Medicare have evolved over time, and names have changed, too. They are now known as Part A (Hospitalization), Part B (Medical), Part C (Medicare Advantage), and Part D (Prescription). The other popularly known piece of the puzzle is Medigap, which is private insurance that supplements the other parts.

Part A: Hospitalization 

If you end up in the hospital, you're likely to have significant medical bills. Medicare Part A, hospitalization insurance, is intended to help you reduce your liability for those charges that occur when you are in a hospital, a skilled nursing facility, or hospice, along with some home health care expenses.

View an Instructive Diagram of Medicare Part A Coverage

• Premium: Varies based on your eligibility. Can range from nothing to several thousand dollars depending on whether you've worked the minimum 10 years to qualify.
• Out of pocket: You must pay an annual deductible that is close to $1000 for the first 60 days of hospitalization. For 61-90 days in the hospital, you must pay about $250 a day. For 91-150 days in the hospital, you're on the hook for about $500 a day. Go over 150 days and you pay it all.
• Providers: Anyone who takes Medicare Hospitalization.

Part B: Medical (Doctor) 

Unpredictable medical expenses can make your financial life a mess. Medicare Part B, Medical Insurance, is intended to balance out the financial ups and downs to help you stay financially sound in the face of medical needs, including outpatient services, doctor visits, and some home health care. It specifically does not include vision, dental, routine foot care, hearing aids, and routine doctor visits.

View an Instructive Diagram of Medicare Part B Coverage

• Premium: about $100 a month or more
• Out of pocket: You pay 20% of the total allowable charges, Medicare picks up 80%.
• Providers: Anyone who takes Medicare Medical.

Part A + B Supplement: Medigap 

The Medigap supplement reduces the difference between what is paid by Medicare and what is charged by the healthcare providers. This can really make a difference once you look at the out of pocket costs of Medicare Part A and Medicare Part B. Since it is purchased from private insurers, the quality of the insurance company should be foremost.

• Premium: Varies. For a 65+ in excellent health, insurers in my county are charging from $60 to $250 a month per person.
• Out of Pocket: Varies
• Providers: Anyone who takes Medicare Hospital & Medical

Part C: Medicare Advantage from a private insurer 

When managed care was introduced for Medicare recipients, many insurers entered the market only to withdraw after a few years, leaving their policyholders unable to get coverage at the same rates. While this market has settled down, there is still a slight risk that this might happen again. Medicare Advantage Policies cover parts of A (hospitalization), B (medical), and D (prescription) and may cover other things, such as vision or dental. These are purchased from a private insurer and feature a "network" of authorized medical providers, much like an HMO or PPO, that restrict which providers you may see in order to be covered.

• Premium: Varies, perhaps slightly more than A+B+D together
• Out of pocket: Varies
• Providers: Restricted to a network of providers. Utilization outside of network may result in higher costs or denial of coverage.

Part D: Prescription 

Anyone who is taking significant prescriptions or who may take significant prescriptions may want this coverage. While the premium may exceed the cost of prescriptions while healthy, you may find that it works well if you need medication due to an illness. This is a particularly tricky one to figure out the point at which you break-even on the premiums due to the complex nature of the way it pays for medication.

View an Instructive Diagram of Medicare Part D

• Premium: Varies, less than $100 a month
• Out of Pocket: Varies. An example, after a deductible near $250 a year, you pay 25% until you've paid over $500, and then you pay about another $1500 before you get benefits again: where you pay 5% of prescriptions. Confusing? Yes!
• Providers: Most pharmacies

Your Medicare Mileage will vary...

It may take some work to figure out the best Medicare options for you and your spouse. There are a few other things to keep in mind before jumping in:

• Get a good insurer - if you're selecting Medigap or Medicare Advantage, you'll be working with a private insurer - and there is variance in satisfaction.
• Make sure you play by the rules - ask first, don't assume, make sure it is necessary or covered when possible.
• Know when to appeal - to the insurer, to the government.
• Never miss a payment - if you do, you may not be able to get back into the plan, and if you can you may have to wait or pay a higher rate.

What is and is not payable under the plan is always changing - new items are added regularly, and things that you might have had last year may no longer be covered. You should check with your provider to determine what they believe is covered - and hold them to it. If in doubt about coverage of specific items, check with the Medicare Coverage website.

Jonathan Pletzke is a consumer expert on health insurance and author of the health insurance book Get a Good Deal on Your Health Insurance Without Getting Ripped-Off, available online and at bookstores nationally. Additional details can be found at the consumers health insurance book and resources website www.BestHealthInsuranceBook.com.

 This post originally appeared at HealthCentral.com at http://www.healthcentral.com/caregiver/c/76590/29443/medicare-covered