Thursday, April 30, 2009
Friday, April 24, 2009
10 Ways to Keep Health Coverage if You Lose Your Job
Top 4 that I found interesting from National Center for Health Policy Analysis: (read all 10 here)
6. Shop for Individual Coverage. There may be cheaper alternatives to COBRA, especially if you have no severe health problems. For example, a Dallas family of four with both parents in their 20s could buy a preferred provider organization (PPO) plan with a $2,000 deductible for a $4,680 annual premium. That same family's annual COBRA premium would be closer to $13,000, on average. If the family chose a $5,000 deductible, the annual premium would be less than $3,500. Some of these plans also qualify for an HSA, allowing the policy holder to set money aside tax-free to pay medical expenses. You can contact independent insurance agencies to compare policies or shop online at sites that compare prices, such as http://www.ehealthinsurance.com. Some insurers even offer short term medical "gap" coverage for people between jobs, retiring prior to Medicare eligibility, or not yet eligible for company benefits and for students about to graduate.
7. Even if You Are Uninsurable, You May Be Able to Get Insurance. Under federal law, people who have been continuously insured with no significant gaps in coverage (that is, no more than 62 days), cannot be denied individually purchased coverage because of health status. Different states enforce this federal requirement in different ways. Some states require insurers to accept all applicants, regardless of pre-existing conditions. However, in states with so-called guaranteed issue regulations, premiums are often two to three times as high as those in states that allow insurers to charge premiums based on health status. More commonly, 35 states have high-risk pools to insure those who are turned down by commercial insurers. Twenty-nine states requires insurers to make at least one "guaranteed issue" plan available to those who have been continuously covered, regardless of health status.
9. Consider a Limited Benefit Plan. Limited benefit plans - sometimes called mini-meds - have a maximum annual benefit. They may pay for a set number of office visits per year and may only cover generic drugs. These policies usually also cover some hospitalization. However, benefits may be capped at a maximum of, say, $10,000, $25,000 or possibly $50,000 in a given year. When Tennessee moved many families on its Medicaid program (TennCare) to limited benefit plans, about 98 percent of enrollees never exceeded their $25,000 annual maximum.
10. Join a Concierge Physician Practice. Some innovative physician practices provide primary care in return for monthly (or annual) fees. Dallas-area physician Nelson Simmons offers a package of services for less than $500 a year. About 70 small business owners pay $40 per employee per month for Simmons' plan. In return, employees get same-day primary care services and steep discounts. Enrollees must pay out-of-pocket for specialist care, surgeries and diagnostic tests, but Simmons negotiates the rates with providers. The total out-of-pocket cost is typically much lower than what you would pay as an uninsured individual. For example, a tonsillectomy for a child costs less than half of the normal fee ($2,100 versus $4,800) and an MRI scan can be less than one-fourth the standard rate ($350 versus $1,600).
An Arizona-based firm, the No Insurance Club, has a package that allows individuals to see a primary care physician up to 12 times per year in return for an annual fee of $480. A family can share 16 visits per year for $680. Generic drugs are discounted and most routine lab tests are low cost or included in the annual fee. This type of arrangement may even be combined with a catastrophic health plan to ensure a major illness doesn't turn into a financial catastrophe. Physicians are joining the practice in selected cities nationwide.
6. Shop for Individual Coverage. There may be cheaper alternatives to COBRA, especially if you have no severe health problems. For example, a Dallas family of four with both parents in their 20s could buy a preferred provider organization (PPO) plan with a $2,000 deductible for a $4,680 annual premium. That same family's annual COBRA premium would be closer to $13,000, on average. If the family chose a $5,000 deductible, the annual premium would be less than $3,500. Some of these plans also qualify for an HSA, allowing the policy holder to set money aside tax-free to pay medical expenses. You can contact independent insurance agencies to compare policies or shop online at sites that compare prices, such as http://www.ehealthinsurance.com. Some insurers even offer short term medical "gap" coverage for people between jobs, retiring prior to Medicare eligibility, or not yet eligible for company benefits and for students about to graduate.
7. Even if You Are Uninsurable, You May Be Able to Get Insurance. Under federal law, people who have been continuously insured with no significant gaps in coverage (that is, no more than 62 days), cannot be denied individually purchased coverage because of health status. Different states enforce this federal requirement in different ways. Some states require insurers to accept all applicants, regardless of pre-existing conditions. However, in states with so-called guaranteed issue regulations, premiums are often two to three times as high as those in states that allow insurers to charge premiums based on health status. More commonly, 35 states have high-risk pools to insure those who are turned down by commercial insurers. Twenty-nine states requires insurers to make at least one "guaranteed issue" plan available to those who have been continuously covered, regardless of health status.
9. Consider a Limited Benefit Plan. Limited benefit plans - sometimes called mini-meds - have a maximum annual benefit. They may pay for a set number of office visits per year and may only cover generic drugs. These policies usually also cover some hospitalization. However, benefits may be capped at a maximum of, say, $10,000, $25,000 or possibly $50,000 in a given year. When Tennessee moved many families on its Medicaid program (TennCare) to limited benefit plans, about 98 percent of enrollees never exceeded their $25,000 annual maximum.
10. Join a Concierge Physician Practice. Some innovative physician practices provide primary care in return for monthly (or annual) fees. Dallas-area physician Nelson Simmons offers a package of services for less than $500 a year. About 70 small business owners pay $40 per employee per month for Simmons' plan. In return, employees get same-day primary care services and steep discounts. Enrollees must pay out-of-pocket for specialist care, surgeries and diagnostic tests, but Simmons negotiates the rates with providers. The total out-of-pocket cost is typically much lower than what you would pay as an uninsured individual. For example, a tonsillectomy for a child costs less than half of the normal fee ($2,100 versus $4,800) and an MRI scan can be less than one-fourth the standard rate ($350 versus $1,600).
An Arizona-based firm, the No Insurance Club, has a package that allows individuals to see a primary care physician up to 12 times per year in return for an annual fee of $480. A family can share 16 visits per year for $680. Generic drugs are discounted and most routine lab tests are low cost or included in the annual fee. This type of arrangement may even be combined with a catastrophic health plan to ensure a major illness doesn't turn into a financial catastrophe. Physicians are joining the practice in selected cities nationwide.
Tuesday, April 7, 2009
Massachusetts Healthcare Update
Boston Globe -
Apr. 7: On the third anniversary of Massachusetts' landmark health insurance overhaul, a new report shows that employers, consumers, and state government paid the same, proportionately, for health coverage after 2006 as they did the year before the initiative started.
The study, released yesterday from the Center for Health Law and Economics at the University of Massachusetts Medical School, found that employers contributed about half (48 percent) of the overall spending on coverage in Massachusetts in 2007. Individuals accounted for about a quarter of the total, and government - divided between the state and federal level - contributed about 27 percent.
"With all the criticism from the left and the right before health reform started - that individuals will have to pay more or that government will have to pay too much - this says both of the concerns are unfounded," said Michael Widmer, president of the Massachusetts Taxpayers Foundation, a business-funded public policy group. The foundation played a key role in creating the 2006 law.
The report, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, found that overall spending on healthcare coverage increased $4.7 billion, or 23 percent. Nearly $21 billion was spent on coverage in 2005, while $25.5 billion was spent in 2007. But the majority of the increase, the report found, was not from the new law.
Sixty percent of the rise was due to healthcare inflation unrelated to the law. Another 31 percent was linked to new enrollment in already-existing programs, such as employer-paid healthcare or Medicaid, according to the report.
And the debate continues...
Also today from the Sac Bee:
Apr. 7: Gov. Arnold Schwarzenegger briefly returned his attention Monday to universal health care, a subject he hoped to make part of his legacy before the state had to focus on the more basic task of paying its bills amid a multibillion-dollar deficit.
The Republican governor, along with Washington Gov. Chris Gregoire, hosted the fifth and final regional White House health care forum in Los Angeles. The town-hall style meeting came as Congress is constructing a health care overhaul plan.
President Barack Obama and congressional leaders have taken the lead on health care this year after states and cities pursued their own universal coverage efforts in recent years. "The action is now," Schwarzenegger said. "Not acting would be irresponsible. We've got to act and we've got to create the action, and this is the year we have got to do it."
In California, lawmakers last year rejected a plan that would have cost nearly $15 billion. Proponents, including Schwarzenegger, said the plan would have been self-funded. But opponents feared that it would have worsened the state's budget deficit.
Congressional Democrats have built a framework that would require all people to have health insurance while demanding that insurers cover all patients regardless of pre-existing conditions, similar to California's plan. But the proposal has big questions, such as who will foot the bill and to what extent a public alternative to private health insurance should exist.
Apr. 7: On the third anniversary of Massachusetts' landmark health insurance overhaul, a new report shows that employers, consumers, and state government paid the same, proportionately, for health coverage after 2006 as they did the year before the initiative started.
The study, released yesterday from the Center for Health Law and Economics at the University of Massachusetts Medical School, found that employers contributed about half (48 percent) of the overall spending on coverage in Massachusetts in 2007. Individuals accounted for about a quarter of the total, and government - divided between the state and federal level - contributed about 27 percent.
"With all the criticism from the left and the right before health reform started - that individuals will have to pay more or that government will have to pay too much - this says both of the concerns are unfounded," said Michael Widmer, president of the Massachusetts Taxpayers Foundation, a business-funded public policy group. The foundation played a key role in creating the 2006 law.
The report, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, found that overall spending on healthcare coverage increased $4.7 billion, or 23 percent. Nearly $21 billion was spent on coverage in 2005, while $25.5 billion was spent in 2007. But the majority of the increase, the report found, was not from the new law.
Sixty percent of the rise was due to healthcare inflation unrelated to the law. Another 31 percent was linked to new enrollment in already-existing programs, such as employer-paid healthcare or Medicaid, according to the report.
And the debate continues...
Also today from the Sac Bee:
Apr. 7: Gov. Arnold Schwarzenegger briefly returned his attention Monday to universal health care, a subject he hoped to make part of his legacy before the state had to focus on the more basic task of paying its bills amid a multibillion-dollar deficit.
The Republican governor, along with Washington Gov. Chris Gregoire, hosted the fifth and final regional White House health care forum in Los Angeles. The town-hall style meeting came as Congress is constructing a health care overhaul plan.
President Barack Obama and congressional leaders have taken the lead on health care this year after states and cities pursued their own universal coverage efforts in recent years. "The action is now," Schwarzenegger said. "Not acting would be irresponsible. We've got to act and we've got to create the action, and this is the year we have got to do it."
In California, lawmakers last year rejected a plan that would have cost nearly $15 billion. Proponents, including Schwarzenegger, said the plan would have been self-funded. But opponents feared that it would have worsened the state's budget deficit.
Congressional Democrats have built a framework that would require all people to have health insurance while demanding that insurers cover all patients regardless of pre-existing conditions, similar to California's plan. But the proposal has big questions, such as who will foot the bill and to what extent a public alternative to private health insurance should exist.
Monday, April 6, 2009
Health 2.0 Conference
If you are planning on being in Boston later this month and interested in healthcare and emerging technology, then you may want to visit the Health 2.0 conference. If you cannot make Boston then check out the website as well as video from last year's (and the 1st) here in San Francisco.
Below is an outline from their website on what "health 2.0" means:
So what’s the definition of Health2.0?
Actually there are several. Defining Health2.0 is also a user-generated phenomenon. You can choose your own definition. Scott Shreeve has one here. Jos Bakker from Philips disagrees and uses another more limited one—his is largely based on the O’Reilly definition of Web2.0. Ingenix CEO Andy Slavitt has a third. David Kibbe from AAFP has recently been talking about it too, and Cleveland Clinic’s John Sharp gave a good talk on it in 2007. Most recently Ted Eytan has been creating a definition including discussion of “participatory medicine”.
Our definition is currently focusing on user-generated aspects of Web2.0 within health care but not directly interacting with the mainstream health care system. That means, a) search, b) communities, c) tools for individual and group consumer use. But clearly there are blurring boundaries between all these, and the question of connecting Health2.0 user-generated content to the wider health care system—which hasn’t exactly adopted Web1.0 with a flourish yet—is coming into closer focus as more clinicians and organizations start to use these technologies to communicate with consumers.
There is huge room for debate about whether we’re talking about limited use of tools and technologies or a wider movement to change the whole healthcare system—or perhaps if it’s just all buzzwords with no substance.
If you aren't going to Boston come by and visit us and we'll talk about it.
Below is an outline from their website on what "health 2.0" means:
So what’s the definition of Health2.0?
Actually there are several. Defining Health2.0 is also a user-generated phenomenon. You can choose your own definition. Scott Shreeve has one here. Jos Bakker from Philips disagrees and uses another more limited one—his is largely based on the O’Reilly definition of Web2.0. Ingenix CEO Andy Slavitt has a third. David Kibbe from AAFP has recently been talking about it too, and Cleveland Clinic’s John Sharp gave a good talk on it in 2007. Most recently Ted Eytan has been creating a definition including discussion of “participatory medicine”.
Our definition is currently focusing on user-generated aspects of Web2.0 within health care but not directly interacting with the mainstream health care system. That means, a) search, b) communities, c) tools for individual and group consumer use. But clearly there are blurring boundaries between all these, and the question of connecting Health2.0 user-generated content to the wider health care system—which hasn’t exactly adopted Web1.0 with a flourish yet—is coming into closer focus as more clinicians and organizations start to use these technologies to communicate with consumers.
There is huge room for debate about whether we’re talking about limited use of tools and technologies or a wider movement to change the whole healthcare system—or perhaps if it’s just all buzzwords with no substance.
If you aren't going to Boston come by and visit us and we'll talk about it.
Thursday, April 2, 2009
New Cobra Law
There is a fair amount of confusion over a recent piece of legislation passed. The American Recovery and Reinvestment Act of 2009 (ARRA) provides for premium reductions and additional election opportunities for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA.
Eligible individuals pay only 35 percent of their COBRA premiums and the remaining 65 percent is reimbursed to the coverage provider through a tax credit. The premium reduction applies to periods of health coverage beginning on or after February 17, 2009 and lasts for up to nine months.
The following link will take you to the COBRA Model Notices posted on the DOL site, including the Notice in Connection with Extended Election Periods.
http://www.dol.gov/ebsa/COBRAmodelnotice.html
Plans subject to the Federal COBRA provisions must send the Notice in Connection with Extended Election Periods to any assistance eligible individual (or any individual who would be an assistance eligible individual if a COBRA continuation election were in effect) who:
1. Had a qualifying event at any time from September 1, 2008 through February 16, 2009; and
2. Either did not elect COBRA continuation coverage, or who elected it but subsequently discontinued COBRA.
This notice includes information on ARRA’s additional election opportunity, as well as premium reduction information. This notice must be provided by April 18, 2009.
If you have additional questions or would like some guidance give us a call at 650-533-8387 and we would be happy to talk it through with you.
LEGAL CAVEAT:
As you know, our blog is for information purposes only and does not provide legal or health advice. This information should be reviewed with appropriate legal/health counsel.
Eligible individuals pay only 35 percent of their COBRA premiums and the remaining 65 percent is reimbursed to the coverage provider through a tax credit. The premium reduction applies to periods of health coverage beginning on or after February 17, 2009 and lasts for up to nine months.
The following link will take you to the COBRA Model Notices posted on the DOL site, including the Notice in Connection with Extended Election Periods.
http://www.dol.gov/ebsa/COBRAmodelnotice.html
Plans subject to the Federal COBRA provisions must send the Notice in Connection with Extended Election Periods to any assistance eligible individual (or any individual who would be an assistance eligible individual if a COBRA continuation election were in effect) who:
1. Had a qualifying event at any time from September 1, 2008 through February 16, 2009; and
2. Either did not elect COBRA continuation coverage, or who elected it but subsequently discontinued COBRA.
This notice includes information on ARRA’s additional election opportunity, as well as premium reduction information. This notice must be provided by April 18, 2009.
If you have additional questions or would like some guidance give us a call at 650-533-8387 and we would be happy to talk it through with you.
LEGAL CAVEAT:
As you know, our blog is for information purposes only and does not provide legal or health advice. This information should be reviewed with appropriate legal/health counsel.
National Coalition on Health Care April 14, 2009
There is quite a bit of discussion about National Healthcare. This came through my desk today. If you are interested on the variety of options on the table you may want to attend this event in Sacramento:
"The future of health care – in the United States and here in California – could be changed fundamentally by decisions made in the next few months. The stakes – for the health and well-being of all of us, for the growth and competitiveness of our economy, and for our living standards – are enormous.
Speakers will include (in alphabetical order):
·John Arensmeyer, Founder and CEO, Small Business Majority
·Barbara Blake, State Secretary, United Nurses Associations of California
·Denny Delk, Member of the National Board, American Federation of Television and Radio Artists
·Ted Epperly, M.D., President, American Academy of Family Physicians
For a more detailed list of speakers and more information or to register click here.
"The future of health care – in the United States and here in California – could be changed fundamentally by decisions made in the next few months. The stakes – for the health and well-being of all of us, for the growth and competitiveness of our economy, and for our living standards – are enormous.
Speakers will include (in alphabetical order):
·John Arensmeyer, Founder and CEO, Small Business Majority
·Barbara Blake, State Secretary, United Nurses Associations of California
·Denny Delk, Member of the National Board, American Federation of Television and Radio Artists
·Ted Epperly, M.D., President, American Academy of Family Physicians
For a more detailed list of speakers and more information or to register click here.
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