Tag: Deductible

Two tips to help you choose a health plan
During open enrollment season, many of us struggle to figure out which health plan to choose. People typically remain in their current health plans because that’s generally the easiest choice to make (it may also be our only choice). But, it may not be the wisest. Your plan costs and benefits may be changing. And, there may be a better, less expensive plan, available to you.

How do you choose a health plan? If you have Medicare, most people choose traditional Medicare, the public health plan administered by the federal government, because it covers your care from virtually any doctor or hospital in the U.S. And, so long as you have supplemental coverage, almost all of your costs are covered. Here are four tips to consider before choosing between traditional Medicare and a Medicare Advantage or private Medicare plan. If you are choosing among different private health plans–employer plans, exchange plans or Medicare Advantage plans–because you generally will not know your future health care needs or what services the health plan will cover and what you will need to pay out of pocket, it’s really not possible to choose a health plan that you can be sure will meet your needs.

Here are two factors to consider:
1. Your doctors and hospital: If you have doctors you know and trust, you likely want to call them to find out which health plans they are enrolled in and narrow down your options to those health plans. Keep in mind that doctors may switch from one health plan to another at any time during the year, so don’t assume that your doctor will remain in your health plan. Also, if you travel a lot or live in different places at different times of the year, you probably want a health plan that will cover your care wherever you are. Traditional Medicare covers your care anywhere in the United States. Commercial (private) health insurance often limits your coverage to a particular geographic network and does not usually cover out-of-network care, except in emergencies. If you have Medicare, here are two questions to answer during the open enrollment period.
2. The premium, deductible and copays: When you compare health plans based on costs, be sure to look at the deductible—the amount you pay out of pocket before coverage begins—as well as the premium and copays. Often health plans with low premiums have high deductibles and, if you do end up needing health care services, your costs can be far higher in one of those plans than in a health plan with a higher premium and a lower deductible. For example, a health plan with a $200 monthly premium and a $2500 deductible is effectively charging you $4900 for the year ($2400 plus $2500) if you need a bunch of health care services. A health plan with a $250 monthly premium and a $1000 deductible will cost you $4,000 for the year ($3000 plus $1000). Copays, the amount you pay out of pocket for a doctor’s visit can also add significantly to your costs if they are high and you have a complex condition that needs a lot of care. Keep in mind that your annual out-of-pocket cap can be quite high–it’s as much as $6,850 in a Medicare Advantage plan in 2016. For a crash course on five important health insurance terms, click here.
Note: If you are enrolled in a Medicare Advantage Plan and would like to switch to traditional Medicare, you can until February 14. To learn more and get free advice, call your State Health Insurance Assistance Program.

Here’s more from Just Care:
- If you are just turning 65, here are seven questions you should answer to plan for your care.
- Beware of out-of-network costs for ER care
October 15, 2015
The Affordable Care Act: What happens between now and the November 2016 elections?

The Supreme Court’s decision last month affirming, yet again, the legality and structure of Obamacare (the Affordable Care Act) could signal an end to the 5-year slog of bitter political divisiveness over the law. Or not.

As I see it, one of two divergent scenarios could play out between now and November, 2016:

(1) The number of people benefiting from the law grows briskly, premium increases remain modest, and Americans finally accept the law as permanent and worth it; that leads Republicans (and their presidential candidates) who have vigorously opposed the law to back off, realizing they’re fighting a losing battle that could cost them control of Congress and their bid for the White House in 2016.

(2) The number of people benefiting from the law plateaus, premiums in the state-based exchanges increase 15% a year in 2015 and 2016, deductibles and co-pays increase, concern about restricted provider networks grows, and the public remains deeply divided over the wisdom and impact of the law. Skating off that and sensing blood in the water, Republicans double-down on their opposition to the law and make the election a referendum on it.

These scenarios are oversimplified, of course.   Other events and factors could come into play, such as a foreign crisis that diverts attention from health care.

But there’s little doubt we are now (sorry for the tired metaphor) at a crossroads.   The Supreme Court’s ruling pretty much means that the only route to dismembering the law is political.

As a reminder, the Republican-controlled House of Representatives has voted along party lines over 50 times to repeal parts or all of the law.   In the Senate, also controlled by Republicans since the 2014 elections, efforts by members of that party to repeal the law have been bogged down by rules that require 60 votes to get major legislation to a full Senate vote. The Republicans hold 54 seats in the Senate, to the Democrats’ 44, plus 2 independents. Obama has also pledged to veto any bill that undermines the law.

So the 2016 elections could well decide Obamacare’s fate. If Republicans win the White House and maintain their majorities in Congress, the only way Democrats could block repeal of the law—assuming Republicans pursue that—is through the 60-vote rule in the Senate to break a legislative filibuster.   That assumes Republicans don’t top 60 seats in the Senate in the 2016 elections, a pretty safe bet.

Your role in all this?   Polls by the Kaiser Family Foundation, (“KFF”), since 2011 show Americans have been persistently sharply divided on the merits of the law, and that opinion is strongly party-affiliated. That is, a large majority of Republicans oppose the law while a large majority of Democrats support it.   This has always signaled to me and many other observers that the bulk of opinion on the law as a whole is driven by a combination of party and ideological loyalty, with a generous dollop of sentiment about the role of government in our lives.

Results from deeper-dive KFF surveys bear that out: a majority of Americans irrespective of political party affiliation support several major components of the ACA, such as requiring insurers to cover people with pre-existing medical conditions, without making them pay more.

I might be whistling into the wind, tilting at a big windmill or pushing the proverbial Sisyphian bolder up a steep hill, but I believe this crossroads is a time for opponents of the law (and those on the fence, about 10-15% of the population) to take a step back from the partisan political divide we all say we hate and reassess the ACA on the merits of what it has done to date, its actual provisions, and the concrete arguments pro and con. There’s no dearth of intelligent and easy-to-understand information on the internet, from both sides.

In short, make up your own mind and don’t be led by your political nose.   This is an issue that should transcend lock-step politics.

If premiums and costs rise, there’ll likely be more than a few registered Democrats who’ll need to shore up their support of Obamacare, too.

In very practical terms, take 2 to 3 hours some evening or weekend and learn how the law is actually constructed. Talk to trusted friends on the opposite side of the debate. Read behind the headlines and ignore the political rhetoric—from both sides. Be engaged.

Every so often, big social changes are needed. Health reform was such a moment (well, it actually took 20 years). Keep in mind that Republicans agree that the old system was broken and unsustainable. The ACA is not a perfect law.   Indeed, the tragedy of the 5-year senseless political fight over the ACA is that it’s made sensible fixes over the last few years impossible.

Be part of the solution to that, and refuse to perpetuate the problem.

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To understand how repeal of the ACA would drive the deficit up and leave 19 million uninsured, click here.

June 30, 2015
Out-of-pocket health care costs rising much faster than wages

Health care spending may not be growing as quickly as it has in the past, but most working Americans are not feeling the benefits. Increased health care costs are still eating into their wages. Wages are rising more slowly than people’s out of-pocket costs, including health care premiums and deductibles.

In fact, the latest data from the Kaiser Family Foundation shows a 23 percent increase in employee earnings in the eight years between 2006 and 2014. During the same period, there was a 72 percent increase in health insurance premiums and a more than doubling, 108 percent increase, in deductibles for individuals.

The chart below reveals the gap between worker wages and out-of-pocket health care costs, which continues to increase, despite a relatively slow rate of growth in overall health care spending. According to Drew Altman, “all signs suggest that out-of-pocket health costs will continue to rise faster than worker earnings.”

June 4, 2015
New federal law precludes people from buying coverage for Medicare Part B deductible

A new federal law, which Obama signed on April 16, precludes people with Medicare from buying supplemental insurance that offers first-dollar health care coverage. Requiring people with Medicare to pay the Medicare Part B deductible will impede access to needed care for many of them and is bad public policy.

If Medicare supplemental insurance does not cover the deductible, it forces those who need health care to pay more for their care or to forego it. The cost of the insurance policy should come down a little. But, Medicare becomes more expensive for people who need to see the doctor. The value of having supplemental insurance cover the deductible is that it pools risk; everyone shares in the cost of the deductible regardless of whether they need care, bringing down costs a little for those who need it.

For sure, requiring people with Medicare to pay the Part B deductible (currently $147) themselves will keep some of them from getting health care services they need because of the cost. It will be harder for them to budget for their care and to have predictable out-of-pocket costs. Based on the research, it will no more dissuade them from getting care they don’t need, the purported reason for this proposed change in the law, than it will keep them from getting care they do need.

The new law’s provision prohibiting Medicare supplemental insurers from offering policies with first dollar health care coverage would apply only to people newly eligible for Medicare beginning in 2020. The law discriminates against people buying supplemental coverage in the individual market since people with supplemental coverage from their former employers will still be able to have first-dollar coverage. The law also weakens Medicare by raising premiums for wealthier individuals with Medicare and positioning Medicare as a welfare program rather than a social insurance program.

The law does benefit many people with Medicare in two important ways. It pays for the Qualifying Individuals program that covers the Medicare Part B premium for about 500,000 people with incomes between 120 percent and 135 percent of the Federal Poverty Level ($14,100-$19,100 for individuals). And, it fixes payments to doctors, preventing a 21 percent cut in their fees. A cut that large would likely push many doctors to stop providing care to people with Medicare.

In short, the law–a fix in Medicare payments to doctors, an extension of the Qualifying Individuals program and the Children’s Health Insurance Program–seem to outweigh the risks–a weakening of Medicare through a premium increase to some individuals with high incomes and an end to first-dollar coverage through a Medicare supplemental insurance policy.

April 17, 2015