Health Care Summit and Medicare Advantage

For those who are watching or listening to todays health care summit, Medicare Advantage has taken up a good amount of time of the summit.

What is Medicare Advantage, and should the public be against it?

First, you need to know how Medicare works.  Medicare is a plan of insurance that we have paid into since we ever began receiving wages.  Medicare is a 2 part system (Part A and Part B).  Once you turn 65 years in age, you are entitled to Medicare Part A, which covers the hospital.  You are also entitled to Medicare Part B, but at a premium based on income.  The starting rate is $98/month for Part B which is to cover physician services and medical services, including outpatient procedures.

Part A:

• Leaves you to pay a $1,100 deductible for days 1-60 at the hospital
• Leaves you to pay $275/day for days 61-90
• Leaves you to pay $550/day for the 91st and after

Part B:

• Leaves you to pay a $155 deductible
• after deductible you begin to pay 20% on all Medicare Approved amounts.
• Does not cover excess amounts charged above Medicare

Now, seniors, entitled to these benefits have the option of picking up a "gap" policy, know as a Medicare Supplement.  By paying an additional monthly premium you can purchase a supplement policy from Blue Cross for around $129-$250/month depending on age, that will come in and cover what Medicare leaves you to pay along with the excess charges.

Now with Medicare Advantage, offered by Private Insurers, can start at $0/month for a plan that provides:

• $10-$30 copays for physician office visits
• $100-$200 copays for days 1-7 in the hospital
• FREE prescription drug card!!!!!!!!!!
• Offered in either a PPO or HMO ($/monthly)

So....for low income individuals who can not afford a Medicare Supplement plan, than a Medicare Advantage at $0 in monthly premium is the best possible health insurance plan available to them, and it provides annual physicals and dental coverage, which original Medicare or Medicare Supplements do not cover.

Hope this helps!

-THIS

Dental Insurance...is it a benefit??

Yes and No!

When looking for dental insurance in the individual or family market (not group health insurance) there are limited  options.  Other than Aetna, all carriers require that dental insurance be purchased with your health insurance policy or added on as an additional benefit to current policies without.  The Health Insurance Shoppe only represents one stand-alone dental product and that is with Aetna.

Now...for myself, I have never had dental insurance.  I have always had a dentist in the family who took care of my cleanings or any cavities I may have had.  Any work such as wisdom teeth removal were covered by my parents, when I was young.

In the past three years I have gone without getting my teeth cleaned.  Unfortunately, this was not a good idea, since I love candy!  Long story short, I began noticing some sensitivity and then went to a local dentist who was referred through the family.  Since this was a new dentist, I had to pay an initial consultation fee which was around $150, which included x-rays, teeth inspection and photographs.  From this I was recommended for an extensive deep cleaning to be completed.  This cleaning happened over a two visit duration and ended up costing  $900.  After the cleaning, the sensitivity and any pain that was there prior, had gone away.

The above example cost me a total of $1,150.  Since I did  not have insurance, and was able to take care of this in 90 days, the dentist had lowered the cost to $900.

Three months later, I noticed a pain in my lower front incisor and ended up needing an emergency root canal for interior resportion, which is caused from braces or trauma to the head.  My dentist referred me to a top Endodontist, who performed the root canal.  After two visits, the total for the root canal was $1,200.  Once again, since I did not have insurance, the price was discounted to $950, over a 90 day payment plan.

For these visits I paid a total of $1,850 over 6 months, $308/month.  To me, that was affordable.  Now if I did have dental insurance, I most likely will be paying a premium of around $26-$45/month in premium for a dental plan with a $1,000 or $1,500 calendar year maximum in payouts.

I would be paying roughly $420 over the course of the year in premium.  With all the insurance carriers out there, neither my dentist or Endodontist accepted dental insurance.  Depending on the dental plan, I might have coverage at 50% or none for a dentist who does not accept insurance, and is considered "out-of-network".

With an exception of the plans, I would have to wait 6 months after being insured before I could receive a benefit for the extensive deep cleaning that was $900.  If it had been 6 months after being covered, I would have owed $450.

As for the root canal, I would have to been covered under the dental plan at least 12 months before there would be coverage for Major Services.  Depending on the plan, I could expect to see the dental insurance pay out $135-$400 (depending on plan) towards the root canal.

If I had dental insurance I could have expected to pay ($420+$450+$400) $1,270 compared to the $1,850 without having dental insurance.  This cost figure can only be true if I had exhausted the initial 6-12 month waiting periods.  


If I did not exhaust the waiting periods, than the above would have cost an additional $420 (premium) more than not having dental insurance.




Now, if I had not gone 3 years without a teeth cleaning and went at least once a year, then the above would not be an issue, other than the root canal.  If you have good teeth without decay, than you can expect to pay anywhere from $89-$129 for a teeth cleaning.  If you had dental insurance, than your teeth cleanings would be covered at 100% by insurance, only if the dentist is in network.

You would most likely be paying more in annual premium than what it would have cost if you did not have the dental insurance for regular teeth cleanings.

Please feel free to contact the shoppe with any questions!

-THIS

Looking for affordable individual health insurance??

Beginning today for the young (19-35), Celtic is going to be the most affordable option without a reduction in benefits when comparing to Blue Cross and Blue Shield of Illinois, Aetna, Humana, UHC and Assurant.

It's simple...The plan is called the Celtic Saver HSA and has the following deductibles with 100% coverage after:

• $1,500
• $2,600
• $5,000

Below are the prices for single males living in Chicago applying for a $2,600 deductible:

Age                 Monthly Premium

25                        $86.67

30                        $97.22

35                        $124.02

40                        $155.83

Below are the prices for single females living in Chicago applying for a $2,600 deductible:

Age                 Monthly Premium

25                        $95.05

30                        $117.60

35                        $152.44

40                        $187.26

What these premiums provide is superior financial protection on any exposure to large claims from an accident or illness.

These plans can provide for an additional $8/month a preventative care benefit (annual physical or annual mamm and pap) to be covered at 100% after a 90 day waiting period.  With out the added benefit, the cost would be applied towards the $2600 deductbile.

All prescription drug costs will be applied towards the deductible then covered at 100%

All physician visits will be subject to the $2600 deductible then covered at 100%

This is insurance for accidents and illness or also known as major medical.  If you are looking for insurance to cover your office visits, than this is not it, nor is there any affordable coverage that does such.  office visit copayments only cover the cost of the visit....not any lab work, diagnostic tests or x-rays.  These are all considered deductible expenses.  You would end up paying anywhere from $30+/month to add a copay.

Call your current doctor and ask how much an office visit costs for someone without insurance.  What ever that # is, reduce it by 20-40% which is your network discount when you see a provider with-in the network, which in this case, is PHCS. www.phcs.com  The second largest network nationwide.  The final cost is what would be applied towards the deductible where as a copay would not.

but why such a high deductible???

$2,600 is not a high deductible...If you were hospitalized for a 2 days or more, the most you would pay is $2,600 on an average bill of $14k-$25k.  Is that a deal?  Does that sound like a high amount?  Also, any additional physician follow ups would be paid for at 100%.

I also forgot to mention that this plan is compatible with a HSA (Health Savings Account), which means that you would be allowed to pay for your deductible tax-free, lowering your true exposure and putting more money in your pocket.

It is a guarantee that you would owe more on this example with a plan that you currently have, with a much higher premium and probably a lower deductible.

STOP BY THE SHOPPE TO LEARN MORE!

THE SHOPPE IS OPEN

-THIS

Why HSA compatible health insurance plans make sense!

Lets put the actual Health Savings Account (HSA) aside and talk about the basics of the actual health insurance plan.  One word : SIMPLICITY


The health plan consists of one deductible, that all your medical expenditures (even prescription drugs) apply towards.  Once the deductible is met, the insurance carrier will begin paying 100% for the remainder of the year.

For 2010 the lowest compatible deductible is $1,200 for an individual and $2,400 for a family.

Other than select insurance carriers, plans that include copays, do not offer a deductible lower than $1,000.


Lets put some #'s to the test, shall we...

Male, 30yrs old, living in Chicago and is a non-smoker:

$200.13/month for a plan that includes:

• $1,000 deductible
• You begin to pay 20% on the next $5,000 after the deductible for a total additional out-of-pocket of $1,000
• $20 unlimited office visit copay
• 100% ER coverage
• Rx is applied towards deductible than you pay only 20%, even after your out-of-pocket is met

$143.51/month for an HSA compatible plan that includes:

• $1,750 deductible
• 100% coverage after deductible is met
• $20 office visit copay for annual physical / mammogram and pap smear
• Rx is applied towards deductible than covered at 100%
• Added benefit of opening an HSA and being able to pay for your deductible or any qualified medical expense tax-free

Plan 2 is $56.62/month lower in premium for an annual savings of $679.44.

Now..lets put these two plans to the test...

(example)

Two old time friends Mike and Sam are both 30 and live in Chicago.  Mike had bought health insurance plan #1 and Sam, #2.  Both were living healthy life styles and active in sports.  Now both have a demanding mother who reminds them every year to go and get their annual physical.  Being friends they both see the same internist.

• Both Mike and Sam paid a $20 copay

With Mike and Same being active, they both play in a separate outdoor football league and on the same summer day, both had broken their leg while falling to the ground as they were tackled.  After a visit to the ER that day, both had a bill of about $3,000 which icluded fees, tests and x-rays.

• Mike will nothing for the ER visit, since it is covered at 100%
• After the ER bill was ajudicated by their insurance carrier (hospital was in network) Sam owes $1,300 which is applied towards the $1750 deductible, leaving Sam to only have to pay an additional $450 before the plan begins to pay 100%

The next day both go to the same specialist for an opinion if surgery is needed.  The cost of the office visit is $300

• Mike will owe a $20 copay
• Sam will not owe anything, and will have to wait for the claim to be submitted.  Once submitted, the bill was $150 which was applied towards the deductible, leaving same only $300 to pay before the insurance company begins paying 100%

From this visit, it is recommended that they both need surgery.  Both go ahead with the surgery and the final bill after ajudication is $12,000.

• Mike will have to pay $1,000 (deductible), leaving $9,000, to which he must pay 20% of until an additional $1,000 is spent.  total of $2,000 spent
• Sam will owe $300, then the bill is picked up 100%

Both require 6 additional follow up visits

• Mike will pay a $20 copay for each visit.  $120
• Sam will owe nothing since coverage is at 100%

It is now the end of the year, and going into the new year, their deductibles have reset.  So...for the year mentioned above, below is payout both Mike and Sam had for premium and plan responsibility:

Mike:

• $2,401.56 in annual premium
• $2,000 (deductible and out-of-pocket)
• $140 copays (initial visit and follow up visits)
• 4,541.56 = total of above

Sam:

• $1,722.12 in annual premium ($679.44 in savings)
• $1,750 deductible
• $3,472 = total of above

Sam saved $1,069.56 compared to the plan Mike has which had cost an additional $56/month.

*****Now, even better, if Sam had opened the HSA and was able to contribute $1,750 into the account over the year, or at one time.  If Sam made the contribution, he is able to take an above the line tax-deduction on his medical expenses that are paid or reimbursed out of the HSA.  If Sam is in the 30% tax bracket, than their is an additional $525 in savings.

Which plan makes more sense?

You decide!

-The Health Insurance Shoppe

Office Visit Copays - What does the copay cover?

Office visit copays cover the cost of your visit to either a specialist or non-specialist physician.  Usually, a plan will have a copay from $20-$50.

When paid, your copayment does not apply to your plans deductible or out-of-pocket expense limit.

Your copay will only covers the cost of what the physician charges for that particular office visit.  If you receive any immunizations or vaccines at the time of visit, they will be covered under the copay.  If the doctor requests any additional lab work or diagnostic tests, these will not be covered under the copay, and be an expense subject to your plans deductible and/or out-of-pocket expense.

This week in Health Care reform

Peek at the Week: Health Care Edition


February 8-12, 2010

White House/Democratic Leadership:

President Obama met with House Speaker Nancy Pelosi (D-CA) and Majority Leader Steny Hoyer (D-MD) yesterday to discuss health care reform and the jobs bill. Senate Democrats, led by Finance Chairman Max Baucus (D-MT), continue their work on jobs legislation that would include a short-term fix for the physician sustainable growth rate (SGR) as well as several Medicare extenders. Chairman Baucus is working with his Republican counterpart, Finance Committee Ranking Member Chuck Grassley (R-IA), on the package in the hopes of garnering some Republican votes. At this point, it appears that the main sticking point is the length of time included for the SGR fix and Medicare extenders. Democrats are determined to keep the SGR fix to 3 months and the Medicare extenders to no longer than a year. Democrats feel that anything longer will weaken the urgency for passage of larger scale health care reform. Majority Leader Harry Reid (D-NV) hopes to have the jobs bill on the floor next week.

Despite the apparent Democratic shift to jobs as the top domestic priority, the President reaffirmed his commitment to health care reform last night when he addressed officials from the Democratic National Committee (DNC). The President stated that he would like to meet with Democrats, Republicans, and health experts one more time to review the bill and see if any bipartisan agreement could be reached. If the meeting does not produce an accord, the President would push for a vote. The House and Senate leadership are still working to reach a deal that would involve the House passing the Senate bill and the Senate passing some House priorities through budget reconciliation; however, an agreement is unlikely to occur in the short term.

In the meantime, the House continues to work on individual bills that incorporate some of their health reform principles. Next week, they will vote on a bill that strips away the anti-trust exemption from health insurance companies. The bill is sponsored by two freshman House Democrats, Reps. Tom Perriello (D-VA) and Betsy Markey (D-CO).

Weekly Prescription:

The shock that consumed Congressional Democrats after the Massachusetts Senate race has given way to tension and mistrust. While House Speaker Nancy Pelosi (D-CA) has said that she has the votes to move the Senate bill, she will not schedule the vote before the Senate makes some of the changes that the House wants through budget reconciliation. Moreover, Members of both bodies are frustrated with the lack of direction from the White House. Senate Democrats gave an earful to White House Senior Adviser David Axelrod recently, complaining that the President has provided inadequate leadership resulting in health care being stalled. These feelings make it difficult to forge a path forward on health care reform. The leadership will likely try and figure out the next steps before adjourning for the President’s Day recess, but it would not be a surprise if an agreement is not reached by then. While there will be stories stating that health care reform is dead, it is more likely that it will continue toexist in an induced coma until a jobs bill is passed.

Lets talk HSAs

What is an HSA?

• An HSA (Health Savings Account) is a government regulated savings account where you can contribute money, tax-free, to pay for your medical expenditures, such as your deductible, prescriptions drugs, dental, vision and so on...  Any unused funds in the account for the year, roll over to the next year.  Your money in the account will earn interest that is tax-deferred.

• In order to have an HSA you must apply for a qualifying High Deductible Health Plan (HDHP)

What is a HDHP?

• An HDHP is a health insurance plan with a deductible greater than $1,200 that does not include any pre-paid benefits such as an office visit copayment or prescription drug card.

• In Illinois, there are only two carriers that offer deductibles below $1,000.  All other carriers begin at $1,000 or $1,500 for non HSA plans.

What will happen when there are no copayments for office visits or prescription drugs?

• First, when you become a member of an insurance carrier, you are given access to their network of providers, known as a PPO (Preferred Provider Organization).  By seeking services at providers within the network, you fully utilize the plans benefits.  This allows you to receive a negotiated rate on the services provided.
• An example would be a doctor charging $100 to the public for an office visit in relation to an accident or illness.  If the doctor is in your carriers network, you would not be subject to the $100, but a negotiated rate, which could be anywhere from 20-50% lower. 
• The final negotiated rate is what the insured would be responsible to pay the provider, which would be applied towards the plans deductible, whereas an office visit copay would not apply to the plan.  An insured may be responsible for around $65-$70.

• Second, 90% of insurance carriers cover your annual physcial for males and females along with a females annual OB/GYN visit at 100% or under a copay, even HSA plans.

• If a non-HSA plan has an office visit copay, the copay will only cover the cost of the initial visit, the negotiated rate.  Once lab work, diagnostic tests or X-rays are ordered...than they all become a deductible expense and do not fall under the copay.
• Now, keep in mind that doctors all charge different rates, especially a specialist which could run around $300/visit before the negotiated rate.
• You can always call your doctors billing department and ask how much they charge for visits.

• If you currently are in treatment and take prescription medication, carriers may offer a genric presciption drugs card on non-HSA plans than require you to meet a separate $500 or $1,000 deductible for Brand or Preffered Brand name drugs, before a copay would then apply.
• HSA plans will apply the cost of your prescription to your plans deductible, whereas if there was a copay for a Brand or Preferred Brand name drug, it would not be applied to your deductible
• If you were on a Brand Name drug and had a copay of $35-$75/month, the copay would not go towards your deductible.  This is an average of $500 in annual copays that would be an out-of-pocket expense.  If you had an HSA plan, than you would have lowered your deductible exposure by $500, meaning you would owe less on a larger claim, if there was one.

Update on Health Reform

 February 3, 2010


This Week in Health Reform

Federal Legislative Overview

House and Senate

House and Senate Democratic leaders remain at an impasse on merging their respective health care reform bills. Senate Majority Leader Harry Reid (D-NV) stated that they will not move forward on any health care reform measures before Republican Scott Brown is sworn in as Massachusetts’ junior senator.

Both party leaders decided to wait and hear what President Obama was going to say about health reform in his first State of the Union Address on Jan. 27. In it, he urged Congress to continue its work on health care reform, and outlined his agenda that focused heavily on reviving the economy to boost employment and reduce the budget deficit.

In an excerpt on health care reform from President Obama’s speech, he stated, “Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.”

Read President Obama’s full speech at:

http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address

The Republican response was given by newly-elected Governor Bob McDonnell at the Virginia State House. In an excerpt from his speech, McDonnell stated, “All Americans agree – we need a health care system that is affordable, accessible and high quality. But most Americans do not want to turn over the best medical care system in the world to the federal government. Republicans in Congress have offered legislation to reform health care, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes.”

Read Governor McDonnell’s full speech at:

http://www.cbsnews.com/stories/2010/01/27/politics/stateofunion/main6148483.shtml?tag=cbsContentWrap;cbsContent

Health Care Reform Next Steps

Congressional leaders continue to consider options for moving forward on health reform legislation following President Obama’s State of the Union address. Serious consideration is being given to taking action – possibly as early as next week – on a number of narrowly focused bills, some of which may be structured with the goal of attracting bipartisan support. Consideration of these bills is not intended to preclude action on comprehensive health reform at a later date.

One of the first bills likely to move to the House floor could be an antitrust bill that would repeal portions of the McCarran-Ferguson Act pertaining to health insurance issuers and medical malpractice issuers. This legislation, known as the Health Insurance Industry Antitrust Enforcement Act of 2009, was proposed last year in the Senate by Senator Patrick Leahy (D-VT) and in the House by Representative John Conyers (D-MI). It was ultimately included in the House health care reform bill, but not in the Senate reform bill.

As reported last week, one of the potential options for Democrats to pass health care reform legislation was to use the budget reconciliation process. Democratic leaders are purportedly continuing to weigh a two-track process in which the House would clear the Senate health bill, and then the Senate would use the filibuster-proof reconciliation process to incorporate a series of compromises with the House. Senate Majority Leader Reid said last week, “[Budget reconciliation is] something that we’re looking at, very closely. That’s where a lot of the procedural problems come in. It’s real tough to do it the right way, and we don’t know how to do that yet.”

In the meantime, the House will continue to focus on smaller health care bills. Speaker of the House Nancy Pelosi (D-CA) stated that her party will successfully complete their work on health care reform that they began last year. Pelosi said, “We’ll go through the gate. If the gate is closed, we’ll go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.”

HEALTH SAVINGS ACCOUNTS (HSA)

HSAs have been around since 2004, and were initially called Medical Savings Accounts (MSA) that were available in 1997, for the self-employed.

HSAs are a government regulated savings account that is mean to pay to qualified medical expenses, such as:

• Plan Deductible
• Prescription Drugs
• Dental services
• Vision services
• Eye wear and contact lenses along with solution
• Advil

and so on...

The best thing about the HSA account is that the money contributed into the account is either tax-free or can be an above-the-line tax deduction depending on your employment status.  This is the only available account where you can use tax-free money to pay for your medical expenses.  Also HSA plans are the lowest in premium and provide the most protection.

Now as for the actual health insurance plan, by far the best available plan in todays market.  With an HSA plan or also called a High Deductible Health Plan (HDHP), you are only required to meet a deductible with 100% coverage following.  All your medical expenses, including prescription drugs would be applied towards the deductible.  The plan deductible will be your total out-of-pocket exposure in a calendar year.

With the HDHP, there will not be any form of pre-paid benefits such as office visit copayments or an Rx card.  Other than your annual physical for males or annual OBGYN visit for females, which are covered at 100% by the insurance carrier, you would be responsible to pay the bill towards your deductible.

Now for non-HSA plans that include an office visit copayment and Rx card, there are negatives:

1. An office visit copayment only covers the cost of the initial doctor visit, NOT lab work, diagnostic tests or X-rays.  These are all deductible expenses.  A typical physician visit for accident or illness is usually around $70 for someone with insurance, which would be applied towards your deductible on a HSA plan, wheras a copay would not apply to the plans deductible or out-of-pocket.
2. Plans with prescription drugs cards usually provide an immediate benefit for generic drugs, but will require you to pay into a separate $500 or $1,000 Rx deductible before a copay begins on Brand or Preferred Brand name drugs.  Once you finally start paying a copay, it will not be applied to the plans deductible or out-of-pocket.
3. After you meet the plans deductible which usually begins at $1,000, you would then begin to pay a percentage (mostly 20% ) towards an additional out-of-pocket limit.  Majority of plans require that an additional $2,000-$3,000 be spent in addition to the deductible

As for Emergency Room benefits, all plans other than BCBSIL will require you to pay a copay and the whole bill at the ER. 


Please stop by the shoppe to learn more on HSAs