Tag Archives: healthcare insurance

Unaffordable Rx: 9 Ways to Save

In the U.S., prescription drug prices continue their meteoric rise. The truly outrageous increases hit the national news outlets and some result in congressional hearingsFor example, Mylan, the maker of the life-saving EpiPen allergy-reaction injector, increased the price of its two-pack from $100 in 2009 to $608 in 2016.Nitropress, a common blood pressure drug, rose more than 300%, soaring from $214 to $881 last year. On average, drug prices have doubled in the last decade, according to AARP.

Simultaneously, insurance company formularies of covered drugs have narrowed, while co-pays have increased. This double-whammy has hit older Americans the hardest, as they use more medications than any other age group. Many retirees with limited income are faced with deciding whether to spend their limited funds on needed medications or on food.

As this situation will continue to worsen in the future, it’s getting more important to find ways to obtain the medications you need at better prices. Continue reading Unaffordable Rx: 9 Ways to Save

Obamacare 2017 Open Enrollment

The Open Enrollment Period for obtaining healthcare coverage through the ACA Health Insurance Marketplace is November 1, 2016 through January 31, 2017. However, to begin coverage January 1, 2017, you need to complete your enrollment by December 15, 2016.

As in previous years, depending on your income, you may be eligible for subsidies for monthly premiums. About 85% of ACA enrollees do qualify for federal tax credit subsidies.

The Kaiser Family Foundation (KFF)  provides an easy-to-use, free tool   for calculating your monthly premiums and subsidies:

http://kff.org/interactive/subsidy-calculator/?utm_campaign=KFF-2016-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=36914797&_hsenc=p2ANqtz-9i9tCWA45-q0Zj72lKxH_CvDBI40JCd_m9ODVftpiDnBz3wsqGaMwgCrrhHqn1M9b5buVUplnt8e0FGnW4uSJAFP8NRw&_hsmi=36914797#state=ca&zip=90402&income-type=dollars&income=40%2C000&employer-coverage=0&people=1&alternate-plan-family=individual&adult-count=1&adults%5B0%5D%5Bage%5D=62&adults%5B0%5D%5Btobacco%5D=0&child-count=0&child-tobacco=0

More Difficult to Find Affordable, Comprehensive Plans

Unfortunately, there are several unfavorable factors impacting Obamacare coverage for 2017, including the withdrawal of some large insurers from offering plans in selected states.

In general, 2017 premium increases will be larger than they were in 2016. Rates will vary by geographical area and the type of plan selected. This trend is not limited to Obamacare plans, but is also impacting individuals who have coverage through their employers. Deductibles and copayments are continuing to rise.

The other trend that is continuing is the narrowing of networks. There are both fewer doctors available in general and contraction of choice in specialists. Again, this is the situation for both Obamacare and employer plans.

A newer trend for Obamacare is the limited availability of independent insurance brokers to assist with making plan choices. These agents work on a commission basis, and now insurers are either reducing or no longer paying commissions to agents for helping people obtain ACA coverage. For example, Cigna, Aetna and UnitedHealthcare have dropped commissions in many states. As a result, a growing number of brokers are declining to offer their services to new enrollees, although some will continue to assist established clients.

For 2017 coverage, it may take a bit more time to evaluate your options and find a plan that is best suited to your needs. Remember, there is still help available from healthcare.gov and from individual insurers.

 

 

Medicare Open Enrollment

It’s that time again—October 15 – December 7—when you can make changes in your Medicare health plan (Parts A & B or C) and prescription drug plan (Part D) for 2017. If you’re happy with your current plan, you don’t need to do anything. However, if you want to switch between Original Medicare and Medicare Advantage, pick a different Medicare Advantage plan or change your Part D plan, you can only do so during the Open Enrollment Period.

2017 Medicare Changes

Premiums and Deductibles

The  Medicare Part B premium for new enrollees who have income of $85,000 or less is $121.80. For current enrollees the premium remains the same because there was no cost of living increase for 2016. The Part B deductible is $166 for 2017.

Coverage

Find coverage information at medicare.gov or in Medicare &You 2017, the official U.S. government Medicare handbook.

Medicare Advantage Provider Networks

Medicare Advantage Plan HMO and PPO networks change each year and sometimes during the year. If you want to keep particular doctors, make sure to check that they are still in your plan. There is a continuing trend to narrow networks, which means there is less provider choice.

Part D Pharmacies and Formularies

Which pharmacies are included in a Part D plan and which are preferred can change each year. Formularies typically change each year and sometimes during the year. Part D plans usually send out their next year’s information a month or more before Open Enrollment. Take the time to review these materials carefully for changes that effect you.

During the year, your plan may substitute one generic for another for treating the same condition. Be aware that all generics are not created equal. If a substitution occurs with a drug you take, contact the doctor who prescribed it as the new one may have different side effects than the original.

If you need an expensive drug that’s not in your formulary, visit pharmacychecker.com. This organization has a rigorous verification and certification process for finding and comparing prices of reputable, online licensed pharmacies. These foreign pharmacies, many in Canada, can legally provide a 3-month supply of branded drugs with your doctor’s prescription. The savings can be substantial. All large pharmaceutical companies have manufacturing plants in foreign locales that must meet the same FDA standards as U.S. plants. As overhead costs are much lower, the prices are also significantly lower. However, generic drugs are cheaper in the U.S. due to increased competition.

 

 

Employers Continue Their Cost-Shifting to Workers

With the news focused on Affordable Care Act (ACA) health insurance plans, it is often forgotten that nearly half (49%)  of  people under 65 receive their health insurance coverage from their employers or are covered by their spouse’s plan.

Patients, even those with employer-sponsored health plans, may face another condition after they are discharged from a hospital stay: acute sticker shock.

Out-of-pocket hospitalization costs rose 37% from 2009 to 2013, with the average patient paying more than $1,000 per hospital visit, according to a study conducted by the University of Michigan and published in JAMA Internal Medicine.

The survey, which was conducted before many of the Obamacare provisions were in place, including the 2014 health insurance marketplaces, examined 7.3 million hospital stays from 2009 to 2013, using data from three of the largest insurers: Aetna, United Healthcare and Humana.

Driven by an 86% rise in deductibles and a 33% increase in coinsurance — the part of the hospital bill that patients are expected to pay —out-of-pocket (OOP) costs rose faster than health insurance premiums. Annually, OOP spending increased 6.5%. In contrast, health insurance premiums increased 5.1%.

The data demonstrate that employers were shifting more costs to patients, according to Emily Adrion, lead author of the study. About 85% of health insurance benefit packages required coinsurance for inpatient hospitalizations, in addition to meeting an annual deductible. Patients with individual plans paid more than $1,800 on average, the researchers found. In contrast, those with consumer-directed plans — high deductible policies paired with health savings accounts (HSA) —OOP hospital costs topped $1,200.

Obamacare 6 Years Later

With all the political tirades focused on Obamacare and ongoing Supreme Court filings designed to dismantle one or more provisions,  the actual achievements of the Affordable Care Act (ACA) have been overshadowed.

Enrollment of 20 Million Previously Uninsured
As of early 2016, 20 million uninsured adults are now covered by health insurance, according to the Department of Health and Human Services. This breaks down to 17.7 million adults enrolled by the insurance exchanges and Medicaid and another 2.3 million young adults, aged 19 to 25 years, able to remain on a parent’s plan until age 26.

The overall uninsured rate has been reduced by nearly half in the last 4 years, from 20.3% in 2012 to the current 11.5%.  All ethnic groups have benefited. Hispanic uninsureds have decreased from 41.8% to 30.5%, Blacks from 22.4% to 10.6% and Whites from 14.3% to 7%.

Majority of Americans Deny They Benefit From ACA
What many don’t realize, says Drew Altman, CEO of the noted health research organization, the Kaiser Family Foundation, is  that those with insurance exchange coverage are just a small portion of the total U.S. population that has health insurance coverage. In contrast Continue reading Obamacare 6 Years Later

Beware of Out-of-Network PPO Providers

Insurers continue to look for ways to control costs. While using the term “consumer-driven,” many of the changes are not in the best interests of consumers. One technique that continues to grow is the creation of smaller networks of doctors and hospitals. Employers enjoy lower premiums from insurers, but workers are challenged with reduced access to providers.

To make matters worse, many in-network facilities contract Continue reading Beware of Out-of-Network PPO Providers

2016 Medicare and ACA Enrollment Deadlines

It’s that time of year again. If you obtain your healthcare insurance from your employer, you will be presented with open enrollment choices. As in previous years, the trend continues, with the employee portion of the premium typically increasing. People with coverage by Medicare and the Affordable Care Act (ACA/Obamacare) are also in the fall/winter enrollment period. Continue reading 2016 Medicare and ACA Enrollment Deadlines

Provider Landscape Changing

As the nation gets ready to provide healthcare insurance in 2014 for millions of uninsured Americans, concerns are being raised about having adequate numbers of doctors to treat these new patients—many of whom are sick with multiple chronic diseases.

Across the nation, “scope of practice” fights are becoming commonplace. Each state’s medical licensing board defines what services different healthcare practitioners are legally authorized to provide. For example, Continue reading Provider Landscape Changing