Saturday, November 30, 2013


a Definition: Some health insurance requires that you pay a percentage of the cost of covered health-related services after you have met your annual deductible. This is known as coinsurance and most often is about 20% to 30% of what your health plan approves. Your health plan will pay the remaining 70% to 80%.Mr. Jones has a family health plan with a $500 annual deductible and 20% coinsurance. In February, his wife and two children got checkups from their family physician. Mr. Jones paid the physician for these services, which cost $510. In March, one of the children got sick and the cost of the office visit was $50. Since the annual deductible was met, the health plan paid the doctor $40 (80%) and Mr. Jones paid the doctor $10 (20%)

Concierge Medical Practice

a Concierge Medical Practice - Is your doctor switching to a practice with a retainer fee?Tom Gill/Getty Images Are you joining a concierge medical practice? The Affordable Care Act, which President Obama signed into law in March 2010, includes mandatory health coverage for people without health insurance. Adding more than 30 million newly insured people into our health system will make the shortage of primary care physicians (PCPs) worse. There will be many more patients and a lot fewer primary care physicians!Faced with the burdens of an aging population and low reimbursement for their services, many PCPs are leaving primary care or changing the way they practice. Some PCPs are switching to concierge practices, a growing trend, also known as retainer, boutique, or direct medical practices. They are controversial and many in the healthcare system think they will make the shortage of PCPs worse, especially in 2014 when many more Americans will have access to affordable health insurance.The concierge practice model, allowing PCPs to offer more personalized care by decreasing the number of patients they care for from about 2000 to less than 1000, first appeared in the 1990’s. In return for these enhanced services, PCPs charge patients a retainer fee, which can range from about $1500 a year to as much as $15,000 per year depending on location and the type and extent of new services.If you are in a retainer practice, your doctor may continue to bill your health plan for covered services, with the retainer (or supplement) you pay being used to pay for the extra services your doctor provides that are not covered by health insurance. Some doctors will not except any health insurance and will use the retained fee to pay for all services; this type of arrangement is known as a “cash-only“ or a “direct primary care” practice.The ability to spend more time with patients, decrease the amount of paperwork and office administration, and make more money, improves physician satisfaction. And, patients who can afford the increased cost are likely to be more satisfied with the attention they get from their doctor.If you are in a retainer practice you will continue to receive basic healthcare services that are traditionally provided by your doctor. Depending on how your doctor has set up the retainer practice (and perhaps how much extra you pay each month), you may receive some of the following additional services:more time with physician during each visitsame day appointments or within 24 hours of callingextended evening and weekend office hoursaround-the-clock access to your physician, including 24-hour availability by pager, cell phone, or home phonepersonalized coordination of hospital carehouse callsaccompanied visits to specialistsprocedures and services that may not be covered by traditional health insurance, such as annual physicals, preventive care, weight loss programs, and wellness advicenicer and less crowded reception and waiting areas and spa-like amenitiesThe main selling points for most patients who decide to join a retainer practice are better and more immediate access to, and more undivided attention from, their physician.Healthcare experts and others opposed to the concept of concierge practices are concerned that these practices promote a two-tiered health system that favors wealthier patients and reduce the number of physicians who are available to care for patients who cannot afford an additional fee.While running a retainer practice may be more lucrative for some physicians and makes healthcare more convenient for their patients, it may make care less available for other patients who cannot afford (or choose not) to pay the required practice membership fees. Since Americans are already coping with a shortage of primary care physicians, the increasing numbers of concierge practices along with health reform changes (millions more with health insurance) may further place a burden on the people trying to find a PCP.People who support retainer practices argue that the practices meet consumer demand, allow physicians to provide the treatment they deem necessary, improve both patient and doctor satisfaction, and improve quality of care by increasing the amount of time that can be spent on prevention and wellness services.Among physicians there is an ongoing debate about the ethics of retainer practices that has become more heated since the passage of the Affordable Care Act and the concern about the worsening shortage of PCPs.In an editorial – Concierge Medicine: A “Regular” Physician's Perspective – published in the Annals of Internal Medicine (a journal of the American College of Physicians) in March 2010, Dr. Michael Stillman, a primary care physician from the Boston University School of Medicine, raised concerns about the ethics and quality of care delivered in retainer practices, and urged the physician community to abandon “the neutrality with which the medical community has addressed” this issue thus far.However, there is a growing interest among internal medicine physicians and family physicians to change their traditional practices to a retainer practice. Seminars are being offered around the country, including at annual meetings of various medical organizations.For example, an affiliate of the American Academy of Family Physicians offers a seminar for physicians (for a fee of $800) “to learn the nuts and bolts of building a concierge practice.” An excerpt from the course description provides an interesting overview of the type of message physicians are getting about retainer practices:Concierge medicine is emerging as the only solution for physicians to escape the failing health care system. Over 1,000,000 patients across the country are in a direct practice and 17,000 primary care doctors intend to transition to a direct practice in the next 5 years. Direct practice is a way to get back to practicing medicine without all of the interference of insurance companies. Physicians simply can no longer increase volume and push patients through an assembly line to survive, and yet practice quality care, while enjoying being a physician healer.

Friday, November 29, 2013

Using Health Information Technology to Manage...

aUsing health information technology to manage your personal health information is an important part of our changing health care system. You and your doctor can better manage your health care by improving how you communicate with each other and how you maintain your health information.Using computers and other electronic devices makes it easy for you, your doctor, and other health care providers (such as hospitals, labs, and X-ray facilities) to store, share and access your health information. Using computers in this way is known as Health Information Technology (HIT) or Health IT.Health information technology may be useful for:reducing paperwork by eliminating the need for handwritten medical recordsreducing medical errors by transmitting accurate information electronically and eliminating mistakes due to misreading of your doctor’s handwritingreducing health care costs by decreasing the need for repeat medical tests by different doctors and eliminating storage space and staff time to maintain medical recordsimproving your quality of care by decreasing medical errors and assuring that all your health care providers have accurate and timely informationAlthough HIT has many uses throughout our healthcare system, three important types of health IT may affect you in the near future as more consumers use personal health records (PHRs) and more physicians use electronic health records (EHRs) and electronic prescribing (e-Rx).Your personal health record (PHR) is an online document with information about your health (and the health of family members) that you keep up to date for easy reference. Using your PHR, you can keep track of your family’s health information, such as the date of your children’s immunizations, last physical exam, major illnesses and operations, allergies, or a list of family medicines.Many PHRs are easy to use and may be provided free from your health plan, the government, your doctor’s office, and private companies. Some PHR companies charge a monthly or annual fee. Since your PHR is online, you can get into and manage your health information from anywhere that you have access to the internet.Since you can collect, view, manage, and share your health information electronically, having a PHR will allow you to take a more active role in managing your own health care.An electronic health record (EHR) is computer-based document that is used by your doctor, your doctor’s staff, or a hospital. An EHR (similar to your old paper medical chart) contains health information from your doctor and other health care providers. A typical EHR has information about your health conditions, allergies, treatments, tests, and medications.Many EHRs can connect with health care providers outside your doctor’s office such as specialists, labs, imaging facilities (X-rays, CT Scans, MRIs), and the local hospital. This allows your doctor to share up-to-date information with your other providers as well as getting quick and easy access to your tests and hospital information.Since everyone involved in your health care can share accurate information, your EHR can help lower the chances of medical errors and may help improve the quality of your health care. Some EHRs have warning systems built in to let your doctor know about drug allergies or potential problems with drug interactions.Also, some EHRs have medical alerts to remind your doctor to perform certain tests or procedures. For example, if you have diabetes, your doctor’s EHR may remind your doctor to check your feet at every visit or order a blood sugar test.Depending on the EHR used by your doctor, you may be able to link your personal health record with your doctor’s electronic health record and share information back and forth.Electronic prescribing or e-prescribing (eRx) is a way for your doctor and other health care providers to send your prescriptions to your pharmacy electronically. Instead of writing out a prescription and having you take it to your drugstore, your doctor orders your medication through her office computer, which then sends a secure electronic prescription to your pharmacist.Electronic prescribing helps to:avoid mistakes due to your doctor’s handwriting or your pharmacist’s misreading of your doctor’s prescription abbreviationsavoid harmful drug interactions by letting your doctor know that the drugs being ordered may interact with a medication you are already takingallows your doctor to see what medications are on your health plan’s drug formulary to make sure the drug being ordered is coveredOver time, all of your health information will be available electronically, not only to you and your doctor but also to other health care providers and your health plan.Because many organizations and people may have access to health information there is concern about the privacy and security of health information technology tools. Over the past several years there have been security breaches in hospitals and doctors’ offices resulting in medical identify theft. Access to your personal information may allow thieves to bill for medical services in your name.Through the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the federal government has established strict rules to protect the privacy and security of your electronic information. HIPAA gives you rights over your health information and sets rules and limits on who can look at and receive your health information.Your doctor, other health care providers and your health plan are required to keep your information private by teaching their staff how your information may and may not be used and shared and take appropriate and reasonable steps to keep your health information secure.

Thursday, November 28, 2013

Assurance-santé conjoint - changer à...

Passage à votre conjoint ou une partenaire santé régime santé d'assurance peuvent économiser de l'argent vous. Si vous et votre époux ou conjoint de fait est admissible à des prestations de santé, examen chaque options d'assurance de la compagnie au cours de l'inscription ouverte pour voir qu'ils peuvent vous coûter moins. Employeurs diffèrent considérablement d'un montant de cotisations et vous pourrez faire des économies en changeant d'assurance familiale pour votre conjoint.Lors de l'inscription ouverte de votre entreprise, relatives à ce plan d'options de vos offres de l'employeur. Vous pourrez faire des économies en choisissant un plan différent, comme un HMO ou PPO qui vous oblige à choisir un médecin de soins primaires pour coordonner vos soins. Dans de nombreuses régions du pays, les médecins locaux peuvent être dans l'ensemble ou la plupart des réseaux du plan de la santé et vous n'avez pas à se préoccuper de changer de médecins.Beaucoup de grandes entreprises offre une variété de plans de santé. Au cours de la période d'inscription ouverte de votre entreprise, vous pouvez être en mesure de modifier votre couverture santé à un régime différent quel que soit leur état de santé. Vous pouvez être en mesure de choisir d'autres options, comme augmenter ou diminuer le montant de votre franchise annuelle. Vous pouvez également démarrer l'assurance-santé si vous n'avez pas ou déposer la couverture si elle permet à votre entreprise.La plupart des entreprises maintiennent leurs périodes d'ouverture (généralement un mois) enregistrement à l'automne de chaque année afin de permettre des changements en bienfaits pour la santé le 1er janvier de l'année prochaine. Certaines entreprises ont leur enregistrement ouvert à d'autres moments et vous pouvez vous attendre d'être assez avisé à l'avance.Une fois que votre entreprise est inscription ouverte fin de la période et a fait ses choix pour la prochaine année, votre couverture santé est verrouillé jusqu'à la prochaine période d'inscription annuelle. Si vous avez n'importe quel type d'événement de qualification, vous ne serez pas en mesure de modifier votre couverture santé pour toute l'année.Une épreuve de qualification vous permet de changer votre couverture d'assurance de santé basée sur le travail à tout moment au cours de l'année. Ce qui se qualifie comme un « événement » est déterminé par le service des revenus internes (IRS) et comprend :MarriageBirth ou l'adoption d'un childDivorce ou une separationDeath juridique de votre conjoint ou une de ses filialesEn outre, si vous avez un plan de gestion des soins (HMO ou PPO) et utilisez un réseau de fournisseurs, vous pourrez changer les plans de santé si vous déménagez dans une autre communauté.Bien que vous pouvez prendre un certain temps, exécuter les numéros pour voir si il est logique pour tous les membres de sa famille à suivre le même plan de la santé. Vous pouvez être en mesure d'économiser de l'argent en ayant une couverture médicale, séparée par quelques membres de la famille. Par exemple :Don et BarbaraDon S., âgé de 46 ans et sa femme Barbara S., 44 ans, tous deux ont le choix de l'assurance maladie par le biais de leurs employeurs. Ils ont une protection familiale par le biais de cadeau, qui comprend une couverture pour ses deux fils, de 10 à 14 ans. Don a surpoids et diabète de type 2, hypercholestérolémie et hypertension artérielle ; Il utilise beaucoup de services de santé. Barbara et les enfants sont en excellente santé et ont seulement besoin de contrôles réguliers ces dernières années.En raison de problèmes de santé de Don, ils ont un plan faible franchise santé de la famille qui a des primes très élevées. La famille peut être en mesure d'économiser de l'argent en faisant Don de changer à un faible régime individuel déductible par l'intermédiaire de votre employeur et que Barbara pour choisir un régime familial de haute-franchise pour elle et les enfants par le biais de leur employeur.Maria et JorgeMaria G., 32 ans et son mari Jorge G., age 33, tous deux travaillent à temps plein et ont une assurance des employeurs individuels. Les deux sociétés disposent d'un délai d'enregistrement ouvert de mi-octobre à mi-novembre.En septembre, Maria a donné naissance à un enfant, une épreuve de qualification qui permettait ajouter Jorge, Jr., un de leurs plans d'assurance santé. Toutefois, ajouter une personne à charge ou des changements de plan d'assurance de couverture individuelle aux personnes à charge, augmentant considérablement les primes mensuelles.Une augmentation de plus de 250 $ chaque mois de tout employeur, le couple a regardé leurs options. Une solution consiste à attendre les inscriptions ouvertes et mettre tous les membres de la famille dans un un plan de santé employeur - économisez de l'argent en abaissant le plan individuel d'un autre employeur.Une autre option est d'acheter une police privée d'assurance pour le bébé. Le couple, qui vivent dans la région de Phoenix, a été capable d'aller en ligne et trouver les plans plus d'une douzaine de compagnies d'assurance bien connus, leur offrant une couverture adéquate pour Jorge, Jr. pour moins d'argent que plus de la prime au travail.

How the Subsidy for Your Out-Of-Pocket Maximum...

aBuying health insurance is expensive, and paying the monthly premium isn’t the only cost involved with health insurance. You also have to pay deductibles, copayments, and coinsurance when you use your health insurance. These additional out-of-pocket costs, known as cost sharing, can add up to thousands of dollars per year.The Affordable Care Act created health insurance subsidies to make buying and using health insurance more affordable for people with low and modest incomes. There are two types:Subsidies that pay monthly health insurance premiums so buying health insurance is more affordable. Learn more about this in, “How Does the Health Insurance Subsidy Work—Understanding the Premium Tax Credit.” Subsidies that help pay out-of-pocket costs like deductibles, copayments and coinsurance. These are known as reduced cost-sharing subsidies and come in two parts: Part one reduces the amount you pay for your deductible, copayments, and coinsurance each time you use your health insurance. Learn more about this subsidy in, “How the Cost-Sharing Health Insurance Subsidy Works.” Part two reduces your out-of-pocket maximum so you pay less when your health care expenses are high.The out-of-pocket maximum, or the out-of-pocket limit, is the worst-case-scenario maximum amount you’ll have to pay toward cost-sharing expenses like your deductible, copayments, and coinsurance each year. Once you’ve paid enough in deductible, copayments and coinsurance to have reached the out-of-pocket maximum, your health insurance pays all your covered healthcare expenses for the rest of the year.If you don’t use your health insurance much, your cost-sharing expenses aren’t likely to reach the out-of-pocket limit. However, if you have an expensive chronic health problem or even a single catastrophic illness or injury, you could easily pay enough in coinsurance and deductible costs to reach the out-of-pocket maximum.For example, if you fall off of a ladder and break your hip while trimming a tree, your share of the emergency room, surgery and hospitalization costs could exceed $10,000 if your health insurance policy doesn’t have an out-of-pocket limit.However, if your health insurance policy has an out-of-pocket limit of $6,000, you stop paying once you’ve paid $6,000 toward your health care bills. After that, your health insurance company pays 100 percent of your health care bills for the rest of the year. You would pay $6000 rather than $10,000. If you needed more care later in the year, your health plan would pay the entire cost.The out-of-pocket maximum doesn’t include your monthly health insurance premiums. It doesn’t include expenses for things that aren’t covered by health insurance or aren't essential health benefits. For example, if your health insurance doesn’t cover acupuncture services, your acupuncture expenses won’t count toward your out-of-pocket maximum. It doesn’t include the balance-billed portion of care you got from an out-of-network health care provider.All individual and family health insurance policies bought through the Affordable Care Act’s health insurance exchanges must have an out-of-pocket limit. The federal government regulates how high that limit can be, and the allowed amount changes each year.For 2014, the out-of-pocket maximum can’t be more than about $6,400 for an individual or $12,800 for a family. A health insurance policy can, however, have an out-of-pocket limit lower than that.How much the subsidy reduces your out-of-pocket limit depends on your income. The closer your income is to the federal poverty level, the more your out-of-pocket maximum will be reduced. FPL changes each year and varies depending on family size and where you live.The FPL used to determine your 2014 subsidy is $11,490 for an individual, $15,510 for a couple, and $19,530 for a family of three. You can find the FPL for other years and family sizes here.Since both FPL and the federal limit on out-of-pocket maximum amounts change each year, the dollar amount of your reduction will change each year.For 2014, if your income is: 100-200 percent of FPL, your out-of-pocket limit won’t be more than $2,250 for an individual. your out-of-pocket limit won’t be more than $4,500 for a family.200-250 percent of FPL, your out-of-pocket limit won’t be more than $5,200 for an individual. your out-of-pocket limit won’t be more than $10,400 for a family.A special reduction is available for Native American Indians with incomes below 300 percent of FPL. In their case, the health insurer will eliminate all cost sharing for any of the essential health benefits.The out-of-pocket maximum subsidy doesn't actually give you money. Instead, it potentially saves you money since you pay less before reaching your out-of-pocket maximum.If you reach that reduced out-of-pocket maximum and continue to use health care services, your health insurance company will end up paying more for your care than if you hadn’t received the subsidy. In that case, the federal government will reimburse your health insurance company for the extra money it spent because of your subsidy.To be eligible for this subsidy: Your income must be 100-250 percent of FPL. (This could vary from year to year but won't exceed 400 percent of FPL.) You must get your health insurance through your state’s health insurance exchange. You must choose a silver-tier health plan. If you’re married, your tax filing status must be married filing jointly. A status of married filing separately will disqualify you. You must reside in the United States legally. You can’t be incarcerated.Apply for the reduced out-of-pocket limit subsidy at your state’s health insurance exchange when you shop for health insurance. You can apply for the other health insurance subsidies at the same time. Be prepared to give the health insurance exchange information about your income, family size, and employer if you have a job. Find your state’s health insurance exchange.Except for special circumstances, you can only buy health insurance through the health insurance exchange during the yearly open enrollment period. The first-ever open enrollment period is October 1, 2013-March 31, 2014. Thereafter, open enrollment will be from October 15-December 7 every year.If you get the reduced out-of-pocket maximum subsidy, make sure to notify your health insurance exchange if your income changes during the year. If your income decreases, you may be eligible to have your subsidy adjusted to further reduce your out-of-pocket maximum.The Affordable Care Act stipulates the out-of-pocket limit be reduced by 2/3 for people with incomes from 100-200 percent of FPL. 1/2 for people with incomes from 200-300 percent of FPL. 1/3 for people with incomes from 300-400 percent of FPL.However, that’s not how it ended up working. The Department of Health and Human Services determined it would be impossible to discount the out-of-pocket maximum that much for people making more than 250 percent of FPL without violating other parts of the law or causing an increase in the deductible for some subsidy recipients. So, in the final rule fleshing out how the subsidy will work, HHS changed those figures to reduce the out-of-pocket maximum by about: 2/3 for people with incomes from 100-200 percent of FPL 1/5 for people with incomes from 200-250 percent of FPL No reduction for people with incomes above 250 percent of FPL.HHS can make adjustments to these amounts each year when it publishes its “Notice of Benefit and Payment Parameters” for the coming year.Sources:The Notice of Benefit and Payment Parameters for 2014, Department of Health and Human Services, Accessed September 10, 2013.Actuarial Value and Cost-Sharing Reductions Bulletin, Department of Health and Human Services, Patient Protection & Affordable Care Act, section 1402 (c). Accessed September 9, 2013.Jost, Timothy, “Implementing Health Reform: The Benefit and Payment Parameters Final Rule” accessed on, September 9, 2013.

Wednesday, November 27, 2013

Medical Necessity

aDefinition: Health insurance companies provide coverage only for health-related serves that they define or determine to be medically necessary. Medicare, for example, defines medically necessary as: “Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.”Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem.Most health plans will not pay for healthcare services that they deem to be not medically necessary. The most common example is a cosmetic procedure, such as the injection of medications (such as Botox) to decrease facial wrinkles or tummy-tuck surgery. Many health insurance companies also will not cover procedures that they determine to be experimental, or not proven to work.It’s important to remember that what you or your doctor defines as medically necessary may not be consistent with your health plan’s coverage rules. Before you have any procedure, especially one that is potentially expensive, review your benefit handbook to make sure it is covered. If you are not sure, call your health plan’s customer service representative.

Tuesday, November 26, 2013

Assurance-soins dentaires : au-delà d'une couverture médicale

Assurance-soins dentaires, car il est fourni par votre employeur ou une politique que vous achetez directement d'une assurance dentaire, est destiné à aider à couvrir certains des coûts associés à vos soins dentaires.Routine dentaire, y compris les contrôles réguliers et des services de prévention, comme le nettoyage, les soins sont relativement peu coûteux, cependant, les procédures de restauration dentaires comme les implants dentaires et couronnes peuvent être assez chers.Bien que de nombreux employeurs offrent l'assurance ordinaire comme un avantage, cependant également fournir une assurance dentaire. Comme le coût des soins de santé a augmenté, beaucoup d'employeurs ont abandonné les soins dentaires ou changé plus du coût mensuel de la prime à ses employés. Par exemple, si vous travaillez pour le gouvernement fédéral, vous avez une assurance dentaire à un coût relativement faible, mais il devra payer 100 % de la prime.Il existe que plusieurs façons dans lequel peut fournir l'assurance-soins dentaires, régime de soins dentaires motif typique utilise un réseau de dentistes participants et possède les caractéristiques suivantes (selon l'endroit où vous habitez et le nombre de personnes de votre famille assurés) :Un avantage maximum de $1000 à 1350 $ yearDiagnostic et de soins (régime de soins dentaires paie 100 %) Nettoyages parodontales et la maintenance préventive (plan dentaire paie base réparation de prothèses dentaires (régime de soins dentaires paie 80 %) (80 %): chirurgie orale obturations (régime de soins dentaires verse 50 %) - tirant d'une racine de la dent ((plan dentaire paga 50 %) (régime de soins dentaires verse 50 %)))Après 12 mois, le régime de soins dentaires peut verser jusqu'à 50 % des coûts de traitement de la gingivite chronique, couronnes, prothèses dentaires et le dysfonctionnement commun traitement temporo-mandibulaire (ATM). Procédures dentaires cosmétiques (comme les placages ou une cure de jouvence sourire) ne sont pas généralement couverts par une assurance-soins dentaires.La prestation maximale autorisée chaque année et paye le pourcentage que le plan de paie votre dentiste pour des procédures spécifiques varieront selon le montant de la prime, vous ou votre employeur. La prime typique est d'environ 50 $ par mois.Il y a plusieurs régimes de soins dentaires disponibles dans la majeure partie du pays qui peuvent être achetés par un particulier. La plupart de ces plans sont une variation d'un FCPP dentaire qui peut accéder à des services dentaires des dentistes qui font partie du réseau de l'assurance dentaire ou qu'il envisage à rabais à payer un pourcentage de votre facture de soins dentaire à un dentiste de votre choix.Une source en ligne pour plus d'informations est la section des assurances dentaires de Après avoir répondu à quelques questions simples et fournir votre code postal, le site vous fournira une liste d'options dans votre région, y compris les participants les noms de dentistes, les coûts et les avantages du plan.Si vous appartenez à une organisation comme un groupe d'entreprises locales, l'Association des anciens étudiants de l'Université, organisation fraternelle ou groupe religieux, vérifier pour voir si elles peuvent fournir un accès au régime d'assurance dentaire de groupe. Et, si vous êtes un membre de l'AARP, vous pouvez acheter un des deux plans dentaires du Delta Dental, un de la plus grande assurance dentaire aux États-UnisSi vous estimez que votre traitement dentaire coûtera plus de 500 $ par année, il serait judicieux d'envisager une politique d'achats ou de prendre part à un régime de soins dentaires à le œuvre. Si vous et votre famille avez des dents saines et il s'est engagé à la santé bucco-dentaire, vous n'aurez pas d'assurance dentaire. N'oubliez pas, cependant, qu'une fois que vous avez besoin des obturations, les dents qui ont besoin d'être tiré ou un traitement de canal, factures peuvent s'additionner rapidement.Sauf pour les dommages accidentels à une dent, la plupart des maladies dentaires sont évitables. La meilleure façon d'éviter la nécessité de soins dentaires (et factures dentaires) est de brosser les dents après chaque repas, la soie dentaire régulièrement et consultez votre dentiste tous les six mois pour un examen de routine et de nettoyage.

Why am I being forced into Medicare at age 65?

a Answer: Every American aged 65 or older is eligible for Medicare. Those who receive Social Security benefits are automatically enrolled in Medicare. There is no way to opt out. Either you enroll in Medicare Part A, or you forfeit your Social Security benefits. There is a great deal of speculation as to why this is, but unfortunately, there is no clear answer. Perhaps this policy was instituted to make it easier for seniors to enroll in Medicare, and was never discontinued when private coverage became more commonplace. Regardless of why, this is the rule, and it is not likely to change in the near future.Many companies which offer retiree health benefits will terminate your coverage when you turn 65 because they know you have access to Medicare. In this case, even if the government weren't forcing you to choose between Social Security and keeping your private health coverage, your company would be making the decision for you!But other companies will continue to offer supplemental retiree benefits, which can be used in conjunction with Medicare. These benefits may include prescription drug coverage, doctor visits, and other outpatient health care. Medicare must still be your primary coverage, but you can have private supplemental coverage.

CHIP - The Children’s Health Insurance...

aThe Children’s Health Insurance Program (CHIP), created by Congress in 1997, is a partnership between the federal government and the states to extend health coverage to uninsured children and pregnant women in families who cannot afford to purchase private health insurance but have incomes too high to qualify for Medicaid.Your state has the option to either expand its Medicaid program to include people who are eligible for CHIP or create a separate state program.A Dr. Mike CHIP fact: In 2008 more than 7.3 million children received services from the Children’s Health Insurance program.On February 4, 2009, President Obama signed into law the Children's Health Insurance Program Reauthorization Act (CHIPRA), which renews and expands CHIP from 7 million children to 11 million children. The new law also pays for CHIP through 2013.If you cannot afford to buy private health insurance and your family earns too much to qualify for Medicaid, you may be eligible for CHIP.Each of the states and the District of Columbia has different eligibility rules. However, in most states, uninsured children who are 18 and younger whose families earn up to $44,100 a year (for a family of four) may be eligible.The annual income figure varies depending on the size of your family. For example, for a family of two the income limit is $29,140 a year and for a family of six the income limit is $59,060 a year.If your children are currently enrolled in the CHIP program in your state, it is unlikely that you will notice any changes in your children’s benefits or where they receive care due to the passage of the Patient Protection and Affordable Care Act (health reform) in March 2010.The health reform law requires your state to maintain the current eligibility in CHIP until 2019. The bill also extends funding for CHIP through 2015.Depending on your income and the state you live in, you may have to pay a small monthly premium to receive coverage. Some states also have an enrollment fee or copayments for healthcare services. For example, the state of Colorado charges $35 to enroll two or more children and has a copayment of $2 to $5 for a doctor’s visit and to fill a prescription.The fees required by the states are often very low and may be related to your income. For example, in New York State, you may be eligible to enroll your children in CHIP with a higher income and pay a monthly premium of $9. And, in Illinois, a family of four with an annual income between $44,000 and $66,156 would have to pay a monthly premium of $40 for each child.Although your state can create its own set of benefits for CHIP, each state is required to cover the following services:routine check-upsimmunizationsdental careinpatient and outpatient hospital careEmergency room visitslaboratory and x-ray servicesAs previously mentioned, your state can require that you share in the cost of CHIP through monthly premiums and copayments for services. However, preventive care must be provided at no cost to you.One of the best resources for information about CHIP is the government-sponsored website InsureKidsNow.This site provides information about CHIP and Medicaid and, using an interactive map, gives you access to CHIP in all 50 states and the District of Columbia. The site also has a hotline and you can watch a video that features families who have benefited from CHIP.In his remarks when he signed the Children’s Health Insurance Program Reauthorization Act, President Obama said the following:“No child in America should be receiving her primary care in the emergency room in the middle of the night. No child should be falling behind at school because he can’t hear the teacher or see the blackboard. I refuse to accept that millions of our kids fail to reach their full potential because we fail to meet their basic needs. In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation – health care for our children is one of those obligations.”And, “Since it was created more than ten years ago, the Children’s Health Insurance Program has been a lifeline for millions of kids whose parents work full time, and don’t qualify for Medicaid, but through no fault of their own don’t have – and can’t afford – private insurance. For millions of kids who fall into that gap, CHIP has provided care when they’re sick and preventative services to help them stay well."

Monday, November 25, 2013

Bronze, Silver, Gold & Platinum–Understan...

aIf you’re trying to choose a health plan or compare health insurance plans in the United States, you need to understand the metal-tier system. The Affordable Care Act standardizes how health plans are valued. Starting January 1, 2014, health plans fall into one of four categories: bronze, silver, gold or platinum.The metal tier tells you the actuarial value of the health plan. It's a simple way of comparing the value of one health plan to another. All health plans on the same metal tier have the same actuarial value.What Does Actuarial Value Mean?The actuarial value of a plan tells you what percentage of health care costs that health insurance plan is expected to pay for its beneficiaries. A plan with an actuarial value of 60 percent is expected to pay approximately 60 percent of the health care costs of its beneficiaries. The plan’s beneficiaries will pay the other 40 percent of their health care costs in the form of deductibles, coinsurance, and copayments.Actuarial value is calculated for the health plan as a whole, not for individual members. So, on average across all of a health plan’s subscribers, the actuarial value describes the percentage of health care expenses that will be paid by the plan. However, the percentage of your health care expenses the plan will pay will vary depending on how you use your health insurance.For example, let’s say your health plan has an actuarial value of 80 percent. If you only use your health insurance once all year long, perhaps to visit an urgent care clinic for a case of the flu, you may find that your health plan doesn’t pay anything at all toward your health care expenses that year. If you hadn’t met your deductible that year, you’d likely end up paying the urgent care bill yourself. The money you paid would be credited toward your deductible. In this case, your health plan certainly didn’t pay for 80 percent of your health care expenses. You paid for 100 percent of your health care expenses.However, across the entire plan membership, individual cases like the example above would be balanced by cases in which the health plan paid 100 percent of the bill for preventive care services like yearly physical exams and birth control. Those people didn’t pay anything toward their own health care expenses that year. When the expenses of all of the plan’s subscribers are totaled at the end of the year, a plan with an actuarial value of 80 percent should have paid 80 percent of the health care expenses of all of its beneficiaries together.Actuarial value calculations don’t include health insurance premiums or things the health plan doesn’t cover. For example, if your health insurance doesn’t cover weight loss surgery, the cost of weight loss surgery wouldn’t be included when coming up with the value of the health plan.How Do Metal Tiers Relate to Value?Bronze-tier health plans have a value of 60 percentSilver-tier health plans have a value of 70 percentGold-tier health plans have a value of 80 percentPlatinum-tier health plans have a value of 90 percentBy using the metal-tier system, people who don’t understand exactly how actuarial value works still understand intuitively that a gold-tier plan is worth more than a bronze-tier plan.Should I Choose Bronze, Silver, Gold or Platinum?Base your choice of metal tier on a balance of how much you’re willing to pay in premiums with how much coverage you need. Higher value plans have higher premiums, but they pay a higher percentage of your health care expenses than lower-cost, lower value plans.Each of the articles below includes sections on who should consider and who should avoid that particular metal tier. If you’re choosing a health plan, once you’ve determined the plan’s metal tier, make sure you’re not on the list of people who should avoid that tier.Your eligibility for government subsidies may influence your choice of metal tiers. If you’re eligible for a government cost-sharing subsidy to help you pay for your deductibles, copays, and coinsurance, you won’t get the subsidy if you don’t buy a silver-tier health plan using your state’s health insurance exchange. To learn more about subsidies, read, “Can I Get Help Paying for Health Insurance?”If All Plans on a Given Tier Are the Same Value, Why Not Just Pick the Cheapest?Although all plans on a given tier will have the same actuarial value, they'll differ in other ways. Take those differences into account when choosing a plan; pick a plan that works well for your situation.For example, one gold plan might have a deductible of $1,500 and coinsurance of 15 percent. Another gold plan might have a low deductible paired with higher coinsurance and prescription copays. If you can’t afford to pay the larger deductible before your health insurance kicks in, you might choose the plan with the lower deductible even if it has slightly higher premiums. You know the actuarial value of all gold plans is the same, so your choice is being made based on how you’d like to use the insurance rather than on how much it's worth.Other comparison points include the health plan’s network. Is your doctor in-network with the all of the health plans you’re comparing? Is each plan’s network of providers large enough to give you a choice of providers if you decide you don’t like a particular physician or hospital and want to switch to another?Does one plan offer you more freedom of choice than another? HMOs generally won’t pay for care you get out-of-network. However, PPOs will pay for out-of-network care, but at a lower rate than if you had stayed in-network. Are you willing to pay higher premiums for a plan that allows you to get care out-of-network if you wish? Or would you rather give up that freedom of choice, but pay lower premiums?Are the quality scores for one plan much better than for a competing plan? Are the premiums for one plan significantly lower than for competing plans with similar quality scores?If you plan to use your health insurance a lot, compare the out-of-pocket maximums of the plans. If one plan has a significantly lower out-of-pocket maximum than the other plans on the same tier, you might save money choosing the plan with the lower out-of-pocket maximum. You’ll find more information about how this technique works in, “How To Save on Health Insurance if You Reach the Out-Of-Pocket Maximum.”

Sunday, November 24, 2013

Silver Plan–What Is It?

a Definición:Un plan de salud de plata es un tipo estandarizado de seguro médico que paga, en promedio, 70 por ciento de sus gastos de cuidado de la salud. Usted paga el otro 30 por ciento de sus gastos de cuidado de la salud en la forma de los copagos, coseguros y deducibles.FondoPara que sea fácil para usted para comparar el valor que te por el dinero que gastas en primas de seguro de salud, el Affordable Care Act normalizados los niveles de valor para los planes de salud. Estos niveles, o niveles, son de bronce, plata, oro y platino. Todos los planes de salud dentro de un determinado nivel se esperan que ofrezcan el mismo valor total. Para los planes de nivel de plata, el valor es del 70 por ciento. Planes de bronce ofrecen un valor de 60 por ciento; planes de oro son valorados en 80 por ciento; platino planes ofrecen un valor de 90 por ciento.¿Qué significa valor cuando se habla de seguro de salud?El valor actuarial te dice qué porcentaje de los gastos médicos cubiertos se prevé un plan para pagar su membresía en su totalidad. Esto no quiere decir que, personalmente, tendrá exactamente el 70 por ciento de sus costos de atención médica pagados por su plan de plata. Es un valor promedio repartidos en todos los miembros de un plan de. Dependiendo de cómo usar su seguro de salud, tendrás más o menos de 70 por ciento de sus gastos.Gastos médicos no cubiertos no cuentan para determinar el valor de un plan de salud. Por ejemplo, si su plan de salud de nivel plata no provee cobertura para medicamentos de venta libre, el costo de ellos no incluyeron al calcular el valor de su plan.¿Tendré que pagar con un Plan de plata?Tendrás que pagar primas mensuales para obtener la cobertura del plan de salud. Las primas del plan plata son más caras que nivel bronce planes porque planes de nivel Plata esperan pagar más dinero hacia sus cuentas de atención médica que hacer planes de bronce. Asimismo, las primas del plan plata tienden a ser menos costoso que planes de oro o platino nivel puesto cuentan con planes de plata pagar menos hacia sus cuentas de atención médica.Además de sus primas mensuales, cada vez que usas tu seguro médico, tendrás que pagar gastos como los copagos, deducibles y coseguro. Cómo te hace pagar su cuota de 30 por ciento cada plan plata variará. Por ejemplo, un plan de plata podría tener un deducible alto $2000, acompañado de un coseguro del 20 por ciento bajo. Un plan plateado competencia podría tener un deducible de $1000 inferior apareado con un coseguro superior y un copago de $40 para las prescripciones.¿Por qué debo elegir un Plan de plata?Elija un plan de salud plata si usted está buscando para equilibrar el costo de sus primas mensuales con el costo de sus gastos como deducibles y el coseguro. Si quieres evitar los costos de alta calidad de oro y platino planes, pero también quiere protegerse de la posibilidad de tener que pagar un entero 40 por ciento de sus gastos de cuidado de la salud como lo haría con un plan de bronce, un plan de plata podría funcionar para ti.Si usted es elegible para los subsidios de gastos porque su ingreso está por debajo de 250 por ciento del nivel federal de pobreza, se debe elegir un plan de nivel plata para conseguir las subvenciones. No te las subvenciones gastos si usted elige un plan de salud de cualquier otro nivel.Subsidios de gastos bajen sus deducibles, copagos y coaseguro de modo que usted paga menos cuando utilizas tu seguro médico. En efecto, un subsidio de costo compartido aumenta el valor de su plan de salud sin tener que elevar la prima. Es como recibir una actualización gratuita en valor. No te la actualización gratuita a menos que usted elige un plan de salud de plata.¿Por qué debo evitar una bandeja de plata?Usted no debería elegir un plan de salud plata si usted no puede permitirse pagar aproximadamente el 30 por ciento de los gastos de su atención médica. Si usted está tratando de limitar sus gastos cada vez que usas tu seguro de salud, harás mejor con un plan de oro o platino.Si utilizas tu seguro médico mucho, quizás porque usted tiene una condición crónica cara, tomar una mirada cuidadosa en el desembolso máximo del plan plata. Si sabes de antemano que sus gastos superará este desembolso máximo, usted podría ahorrar dinero al elegir un plan de nivel bronce con una similar primas máximo pero menor desembolso. Sus gastos de desembolso anuales totales será el mismo, pero usted tendrá que pagar menos por las primas. Puedes leer más acerca de cómo funciona esta técnica, "Cómo a ahorrar en seguro de salud si alcanzas el desembolso máximo."

Le crédit d'impôt pour Premium - Qué pasa ?

Définition :Crédit d'impôt pour cotisations est une subvention gouvernementale afin que les primes de l'assurance maladie plus abordable pour les personnes à revenu faible et intermédiaire.La subvention est réservé aux personnes ayant mis à jour le revenu brut ajusté de 100 à 400 pour cent de la pauvreté fédérale niveau. En outre, la subvention n'est disponible pour ceux qui achètent d'assurance maladie à travers les échanges d'assurance maladie d'État.Si vous êtes admissible à la subvention de prime fiscale crédit, peuvent recevoir à l'avance directement à votre compagnie d'assurance mensuelle. Cela permettra de réduire le montant que vous aurez à payer les primes chaque mois. Ou, vous pouvez choisir de le faire comme une somme incluse avec votre remboursement d'impôt fédéral.Vous souhaitez en savoir plus sur le crédit d'impôt de prime ? Découvrez si vous êtes admissible, comment appliquer, quel est le crédit, et vous devrez retourner la partie du crédit pour la lecture, "comme le crédit d'impôt de subvention prime d'assurance le fait?"« Je peux obtenir de l'aide payer pour l'assurance? » donne plus d'informations sur les programmes gouvernementaux, y compris le crédit d'impôt de prime, pour aider les gens à faibles revenus et à obtenir une assurance de santé sans faire faillite.Également connu sous le nom :Certains se réfèrent au crédit d'impôt pour la prime ou subvention de subvention de prime d'assurance-maladie.

Saturday, November 23, 2013

Comment trouver un médecin que vous aimez

Si vous êtes nouveau dans un domaine qui a besoin de trouver un médecin pour vous ou votre famille. Qui aussi peuvent chercher un nouveau médecin parce qu'ils ont signé pour un nouveau plan de santé et vous devez choisir un PCP (PCP).Il est très important de trouver le meilleur médecin pour vous aider avec vos besoins de santé. Les relations qui sont développent avec votre PCP grandement influe sur les décisions de santé et de bien-être.Certains médecins en leur disant ce qu'il faut faire, mais étant donné le choix, la plupart d'entre nous un PCP qui soutient notre désir de jouer un rôle actif dans notre santé. Lorsque vous choisissez un médecin, étudier ce qui suit :La médecine est une profession difficile qui exige un engagement à l'apprentissage continu. La plupart des médecins commencent leurs études en remplissant quatre années de collège et ensuite participer à l'une des plus de 125 écoles médicales américaines où ils apprennent la complexité du corps humain, ainsi que de la cause, traitement et prévention des maladies.Au cours de la faculté de médecine, les étudiants apprennent comment évaluer la santé d'un patient, diagnostiquer les maladies et autres problèmes de santé, planifier et appliquer le traitement et évaluer leur fonctionnement leurs interventions pour aider les patients. À la fin de l'école de médecine, étudiants obtiennent leur diplôme de docteur en médecine (MD).Après école médicale, presque tous les médecins entrant dans un programme de formation spécialisée - également connu sous le nom d'une résidence - d'acquérir une expérience supplémentaire dans l'un des 24 domaines de spécialisation. Au cours du programme de formation, qui peut durer de trois à sept ans, le résident travaille sous la supervision de médecins expérimentés dans cette spécialité. Exemples de spécialités reconnues : pédiatrie, médecine interne, médecine familiale, chirurgie et orthopédie.Suite à sa résidence, les médecins peuvent commencer sa propre pratique médicale, travaillant pour un hôpital ou un grand groupe de médecins, de rejoindre la faculté d'une école de médecine pour enseigner et faire de la recherche médicale ou poursuivre leur formation dans l'un des plus de 75 surspécialités - y compris la chirurgie cardiologie, neurologie pédiatrique et main.Tout au long de leur carrière, les médecins continueront à apprendre en participant à des activités de formation continue, qui peuvent être nécessaire pour maintenir son statut de licence médicale ou la participation à un réseau de PPO ou HMO. Formation continue assure également que les praticiens garder le jour avec l'information sur la prévention, de diagnostic et de traitement de la maladie qui sont en constante évolution.C'est le parcours éducatif plus courantes pour les médecins dans ce pays. Il y a beaucoup de médecins qualifiés qui ont obtenu un diplôme d'une école d'ostéopathie et de recevoir le diplôme de docteur en ostéopathie (DO). Autres médecins étudient la médecine en dehors des États-Unis et revenir pour l'amélioration de la spécialité. Beaucoup de ces médecins seront certifiés par le Conseil d'administration, tel que décrit ci-dessous.Après avoir terminé la formation en résidence, les médecins sont admissibles à la certification dans une spécialité médicale Conseil. Lorsque vous sélectionnez un médecin, recherchez celui qui est certifié. Cela signifie que le médecin a complété avec succès une spécialité de programme de formation approuvé et ayant subi une épreuve visant à évaluer les connaissances, compétences et expérience du médecin.Pas tous les médecins sont certifiés. Un médecin qui n'a pas la certification du Conseil ne pas ont repris l'examen de certification, ou peut avoir pris les tâtonnements.À Dr. Mike Astuce : Il est important de se rappeler que les choses comme les soins et l'empathie pas peuvent être mesurées par un examen et non certifiés de nombreux médecins d'excellents et compatissants.Avant de programmer une consultation avec une nouvelle PCP, demandez et soyez sûr d'obtenir des réponses satisfaisantes à - ces questions :Sont le Bureau du médecin et de l'emplacement commode heures? combien de temps il faut pour obtenir un rendez-vous pour un examen ou une routine soins médicaux? qui couvre le médecin après heures ou lorsque le médecin est en vacances? sont médicaux et personnel de bureau convivial et respectueux de la vie privée des soins infirmiers ?Le médecin est associé à un hôpital local. Si vous préférez un hôpital spécifique, est médecin associé? est la partie médicale du réseau des médecins dans votre plan de santé ?Si nécessaire, le médecin accepte Medicaid ou l'assurance-maladie ?La démographie est un terme sens "caractéristiques de la population" qui comprennent des choses comme l'âge, sexe, race et l'origine ethnique, la religion et la situation de famille. Certains d'entre eux peuvent être important pour vous lorsque vous choisissez un médecin.Par exemple, beaucoup de femmes seulement voit une femme pour les soins courants ou préférez quelqu'un de leur âge. En revanche, d'autres peuvent se rapporter à n'importe quel médecin qui regarde et écoute, âge et le sexe sont moins importants.Certaines personnes sont aussi plus à l'aise avec un médecin qui a le même ensemble de valeurs ou d'expérience de vie.Essayez de trouver un PCP qui écoutera et aider à trier leurs problèmes de santé et de leurs préoccupations. Votre médecin doit prendre le temps de répondre à vos questions et, si nécessaire, élaborer un plan de traitement que vous comprenez et que vous pouvez suivre.En tant que patient, vous avez le droit d'exprimer leurs opinions et préoccupations et de poser des questions. Mais il a également la responsabilité d'écouter, de fournir les informations nécessaires pour que le médecin de faire un diagnostic et traitement de planifier et de suivre les recommandations du médecin s'il estime qu'elles sont appropriées.Votre PCP devrait également inciter à en savoir plus sur votre santé et toute condition médicale qui a. Si votre médecin n'a pas le temps de fournir le niveau de détail dont vous avez besoin, il est important que les autres professionnels de la santé au bureau ont le temps de parler avec vous et fournir une liste des sites Web de la santé, informations de contact de livres, de vidéos et de groupe de soutien approprié.Enfin, vous voulez choisir un médecin de confiance et avec qui vous êtes à l'aise. Sa décision, dans le choix entre les médecins qui sont très bien formés, peut venir à la personnalité et le style.Après la rencontre avec le médecin, si vous vous sentez à l'aise, fiez-vous à votre instinct - il a trouvé la plus probable est que ce droit pour faire la fête.

What Is a Health Insurance Exchange?

a Definition: A health insurance exchange, otherwise known as a health insurance marketplace, is a shopping area for health insurance. Although private health insurance exchanges do exist, the phrase most commonly refers to public health insurance exchanges developed within each state as part of health care reform.Background:Mandated by the Affordable Care Act to be running in every state by October, 2013, the intent is to provide individuals and small businesses somewhere to shop for affordable health insurance that meets the requirements of the Affordable Care Act.How Health Insurance Exchanges Work:Insurance companies compete for your business using the marketplace. This competition is meant to keep the cost of health insurance premiums down.Another consumer-friendly aspect of health insurance marketplaces is the ease of comparing apples to apples. The exchanges allow direct comparison of competing health insurance policies in two ways. First, all health insurance policies offered through the exchanges must provide a minimum set of essential health benefits. Second, all health insurance policies offered must conform to one of four benefit tiers: bronze, silver, gold, and platinum.A policy’s benefit tier describes the percentage of covered healthcare expenses the plan will pay, otherwise known as the actuarial value of the plan. This helps policy holders estimate the amount of cost-sharing the policy requires. You can learn more about how these benefit tiers work in, "Bronze, Silver, Gold, and Platinum—Understanding the Metal-tier System."Health insurance exchanges are the access point for government subsidies that make health insurance more affordable for low income Americans. The only place you can apply for a government health insurance subsidy is your state's health insurance exchange. The subsidy is only good for health insurance bought on the health insurance exchange. You can learn more about these subsidies in, "Can I Get Help Paying for Health Insurance?"Even if you don't want to buy health insurance, you may end up having contact with your state's health insurance exchange since health insurance exemption certificates are only issued through health insurance exchanges. If you don't have health insurance, don't want to get health insurance, and want to avoid a tax penalty, you'll need an exemption certificate. find out if you're eligible in, "Can I Get a Health Insurance Exemption??"Health insurance marketplaces are state based, and their health plan offerings will vary from state to state. A state may run its own exchange, or choose to have the Federal Government run its exchange. Find out how to contact the health insurance exchange in your state, as well as whether it's run by your state or by the federal government.Health insurance marketplaces begin enrolling people in October 2013 for benefit coverage starting January 1, 2014. This coincides with the Affordable Care Act’s individual mandate, which also goes into effect January 1, 2014, requiring all citizens and legal residents of the United States to have health insurance.

How To Save on Health Insurance if You Reach...

aIf you’re reaching your health insurance out-of-pocket maximum every year, you may have opportunities to save money. When you have a chronic medical condition or high healthcare expenses, it can be hard to save money on healthcare. Coinsurance expenses can be prohibitive if you’re on an expensive medication, require frequent infusions, or need recurring costly treatments. But, your high healthcare expenses are the key to two savings opportunities.First, you may be able to save on your out-of-pocket expenses like copays, coinsurance, and deductibles. Second, you may be able to save on health insurance premiums. These savings techniques only work for people who expect to reach their plan’s out-of-pocket maximum each year.Choose a health plan with a lower out-of-pocket limitOnce you’ve paid enough out-of-pocket healthcare expenses to meet your yearly out-of-pocket maximum, most health insurance companies will pay 100% of your covered expenses for the rest of the year. The only thing you continue to pay is your monthly health insurance premium.Therefore, if you choose a health plan with a lower out-of-pocket maximum than you’re currently paying, you save money. When you’re calculating the potential savings, make sure that the savings you’ve won haven't been eaten up by higher premiums.Your best bet to find a plan with a lower out-of-pocket maximum but premiums similar to your current plan is to look at plans with higher than average deductible and coinsurance. Since most people never reach the out-of-pocket maximum, the higher the deductible and coinsurance, the less the health insurance company has to pay for healthcare services. This allows the health insurance company to charge a lower premium.Since you know you’ll be paying the full amount of the out-of-pocket limit each year, the higher deductible and coinsurance don't increase your yearly costs. In fact, since you're choosing a plan with a lower out-of-pocket maximum, your yearly costs will go down. However, the higher deductible and coinsurance will impact when you'll pay your out-of-pocket expenses, shifting those expenses toward the beginning of the plan-year. You’ll reach the out-of-pocket maximum earlier in the year because it's lower so it's easier to reach, and because your deductible and coinsurance are higher causing you to pay more upfront to reap the yearly savings.Choose a health plan with the same out-of-pocket maximum but a lower premiumAnother way to save is to shop for a health insurance plan that offers the same out-of-pocket limit as your current plan, but a lower monthly premium. While you’ll still have the same yearly out-of-pocket healthcare expenses, you’ll save money each month on the cost of the premium.Once again, you’ll have the best luck finding a plan that meets these criteria if you look at plans with higher deductible and coinsurance than your current plan. Although you’ll need to have money available in the first few months of the year to meet your new deductible and coinsurance expenses, you’ll have wiggle room in your budget since you’ll be paying less each month in premiums.Caveat EmptorMake sure you fully understand the benefits of the plan you’re considering switching to. While most health plans cover 100% of your healthcare costs after you’ve met your out-of-pocket limit, some still require you pay copays to see the doctor, or coinsurance for drugs. You need to nail down these specifics before you switch plans. For example, it will cost you dearly if you switch to a plan with a lower out-of-pocket maximum, only to discover the plan requires you to pay 20% coinsurance on your expensive prescription even after you’ve met your out-of-pocket maximum. Worse yet would be to discover that your new plan doesn’t include your expensive prescription drug in its formulary, or doesn’t cover your costly treatment. You would have to switch drugs or treatments, or pay the entire cost out-of-pocket. Because your healthcare costs are so high, it’s crucial that you thoroughly investigate a new health plan’s benefit coverage before you switch.The Affordable Care Act requires all health plans sold through health insurance exchanges to cover 100% of eligible out-of-pocket expenses after you’ve met your yearly out-of-pocket maximum. But, most plans aren’t required to comply with that before January 1, 2014, some large plans don’t have to comply until January 1, 2015, and grandfathered plans may not have to comply at all.The Affordable Care Act also created a health insurance subsidy to help decrease the out-of-pocket maximum for eligible people with low incomes. Learn more about this in, "How the Subsidy to Reduce Your Out-Of-Pocket Maximum Works." Before you switch plansRead “Out-Of-Pocket Maximum—How It Works and Why to Beware” to ensure you understand the caveats before you make any changes to your health plan.Make sure you’ll have enough money available early in the plan-year to pay the potentially higher initial costs like deductible and coinsurance, before you meet the new out-of-pocket limit and start reaping the savings. Consider a Flexible Spending Account.Make sure the health plan you’re considering will accept your prior insurance as creditable coverage so you don’t run into a preexisting condition exclusion if you change plans before those exclusions are eliminated in January 2014.If sticking with your current physician is important to you, make sure he or she is in-network with the health plan you’re considering.

Friday, November 22, 2013

Beyond Medical Coverage: Vision Care Insurance

aIf you have an eye disease or eye injury your regular health insurance will pay for diagnosis and treatment. However, most regular health insurance policies do not pay for the costs of routine eye exams, corrective lenses, eyeglass frames, or contact lenses. Insurance coverage for such services is known as vision care insurance.Some large employers do provide vision care insurance as a benefit but most do not. According to the U.S. Department of Labor, less than 30% of employees receive vision care coverage.Vision care insurance usually pays for the following basic services:A yearly eye examination, including refraction to check your visionEyeglass lensesEyeglass framesContact lensesLASIK and PRK vision correction procedures at a discounted rateYour specific vision care plan may have a limit (such as every two years) on how often it will pay for lenses and frames.Usually, vision care plans (including those you buy or are provided by your employer) contract with eye care professionals to provide you with vision care services. In some plans you can use any eye care provider and receive a discount on the services offered. However, most plans purchased from a vision care insurance company are PPOs (preferred provider organizations) in which your eye care is managed by a network of eye providers. In a PPO, you also can use out-of-network eye providers, but you will pay a greater share of the cost.Eye care network professionals typically include optometrists and general ophthalmologists. Some networks also may include ophthalmologists who perform refractive surgery and provide LASIK and other vision correction procedures.An optometrist, also known as a doctor of optometry, is licensed to examine your eyes to diagnose vision problems, such as nearsightedness and farsightedness, and prescribe eyeglasses or contact lenses. Your optometrist also can test you for glaucoma and other eye diseases and diagnose eye problems related to diseases such as diabetes and high blood pressure. Optometrists can also diagnose and treat certain types of eye diseases, such as conjunctivitis (pink eye). Ophthalmologists are medical doctors who perform eye surgery, diagnose and treat diseases and injuries of the eye. Ophthalmologists, like optometrists, can also examine your eyes for vision problems and prescribe eyeglasses and contact lenses.Similar to dental insurance, you may be able to purchase vision care coverage through a local business group, college alumni association, fraternal organization, or religious group. If you are over 65, you may have a vision care (including eyeglasses) benefit if you are part of a Medicare Advantage Plan.You also can purchase your own vision benefit plan. For example, two of the larger eye insurance companies in the country that offer individual vision care policies are Vision Service Plan and Humana One. Both companies’ web sites provide access to information about the vision plans available in your state.If you wear corrective lenses and need periodic eye exams and changes in your eye lens prescription, it may be worthwhile to purchase vision care insurance. If you do not currently wear or need glasses, you may be able to get a periodic eye exam through your regular health insurance plan.An individual plan may cost you from $150 to $180 per year depending on where you live. You may also have a copayment for the initial eye examination and for the corrective lens prescription. The typical benefit usually includes:Eye Exam - Covered in fullPrescription Lenses - Covered in fullFrames - Covered up to $120Contact Lenses - $120 allowance for the cost of your contacts and the contact lens examAnother option is to enroll in a discount plan, which provides a specific discount for vision-related services. Although not an insurance policy, these plans can save you up to 30% to 40% off the retail price for exams and corrective lenses. For example, if you are a member of AARP, you can save 30% on eyeglasses and 20% on contact lenses by just presenting your AARP card to a participating vision care provider.

Thursday, November 21, 2013

What's the Difference Between Copay and...

a Answer: Copay and coinsurance help health insurance companies save money by making you responsible for part of your healthcare bills. Both are forms of cost sharing, meaning that you pay part of the cost of your care and the health insurance company pays part of the cost of your care. They differ in how the share of cost is divvied up between you and your health insurance company, and the amount of financial risk each exposes you to.How a copay worksA copay is a fixed amount you pay whenever you use a particular type of healthcare service. For example, you might have a $40 copay to see a primary care doctor and a $20 copay to fill a prescription. You pay the copay amount; your health insurance company pays the rest of the bill. Your copay for that particular service doesn’t change no matter how much the doctor charges, or how much the prescription costs.Unlike a deductible that’s only paid once per year, you pay the copay each time you use that type of healthcare service. So, if you have a copay of $40 for doctor’s office visits and you see the doctor three times for your sprained ankle, you’ll have to pay $40 each visit, a total of $120.How coinsurance worksUnlike the fixed amount of a copay, with coinsurance you pay a percentage of the cost of a healthcare service. Your health insurance company pays the rest of the cost. For example, if you have a 20% coinsurance for hospitalization, this means that you pay 20% of the cost of the hospitalization, and your health insurer pays the other 80%.Since most health insurance companies negotiate for discounted rates, you pay the coinsurance on the discounted rate. For example, if your sprained ankle isn’t healing well so you need an ankle MRI, the MRI facility might have a standard rate of $600. But, since your health insurance company has a discounted rate of $300, your coinsurance cost would be 20% of the $300 discount rate, or $60.Charging coinsurance on the full rate rather than the discounted rate is a common billing error that will cost you more than you should pay. You can see an example and learn how to catch this common error here.Pros and Cons of Copay vs. CoinsuranceThe advantage of a copay is that there’s no surprise about how much a service will cost you. If your copay is $40 to see the doctor, you know exactly how much you’ll owe before you even make the appointment. On the other hand, if the service actually costs less than the copay, you still have to pay the full copay. If you’re seeing the doctor frequently or filling lots of prescriptions, copayments can add up quickly.Coinsurance is riskier for you since you won’t know exactly how much you’ll owe until the service is performed. For example, you might get an estimate of $6000 for your upcoming surgery. Since you have a coinsurance of 20%, your share of cost should be $1200. But, what if the surgeon encounters an unexpected problem during the surgery and has to fix that, too? Your surgery bill could come out to $10,000 rather than the original $6000 estimate. Since your coinsurance is 20% of the cost, you now owe $2000 rather than the $1200 you had planned for.Insurance companies like coinsurance arrangements because they know you’ll have to shoulder a larger share of the cost for expensive things under a coinsurance arrangement than you would if you were paying a simple copay. They hope it motivates you to make sure you really need that expensive test or procedure since your portion of the cost can be a lot of money, even if it’s only 20% of the bill.Most health insurance companies count coinsurance toward your out-of-pocket maximum, but some don’t count copays toward your out-of-pocket maximum. A health plan’s benefit summary should tell you if it does or doesn’t credit your copays towards your out-of-pocket maximum.How a copay and coinsurance are used togetherYou don’t usually have to pay both a copay and coinsurance on the same healthcare service. For example, it would be unusual to pay a $40 copay for a doctor’s office visit, and then also have to pay a coinsurance of 20% of the cost on that same visit. However, it’s not illegal for health insurers to require this. Read the benefit summary carefully when you’re choosing a health plan so you’ll be aware if a health plan requires this unusual double form of cost sharing. You might end up simultaneously paying a copay and coinsurance for different parts of a complex healthcare service. Here’s how this might work. Let’s say you have a $50 copay for doctor visits while you’re in the hospital, and a 30% coinsurance for hospitalization. If the doctor visits you four times in the hospital, you would end up owing a $50 copay for each of those visits, a total of $200 in copay charges. You’ll also owe the hospital a 30% coinsurance payment for your share of the hospital bill. It might seem like you’re being asked to pay both a copay and coinsurance for the same hospital stay. But, you’re really paying a copay for the doctor’s services, and coinsurance for the hospital’s services.The difference between copay and coinsurance can be especially confusing with prescription drug coverage. Most health insurers have a drug formulary that tells you which drugs the health plan covers, and what type of cost sharing is required. The formulary puts drugs into different price categories, or tiers, and requires a different cost sharing arrangement for each tier.For example, the lowest tier might be generic drugs and common cheap drugs. That tier might require a copay of $5 for a 90-day supply of a drug. The second tier might be more expensive brand-name drugs and require a copay of $35 for a 90-day supply. The top tier might be really expensive biologic injectable drugs and oral chemotherapies that cost thousands of dollars per dose.For this tier, the health plan may abandon the copay cost sharing it used on the lower tiers and switch to a coinsurance of 30%. The coinsurance on the most expensive-tier drugs allows the insurer to limit its financial risk by shifting a larger share of the cost of the drug back onto you. This can be confusing since most of your prescriptions will require a fixed copay, but the most expensive prescriptions, top tier drugs, will require a coinsurance percentage rather than a copay.Coinsurance vs copay can be confusing, but understanding the difference between copay and coinsurance means you're better equipped to choose a health plan that meets your expectations, budget for medical expenses, and catch errors in your medical bills.

Frequently Asked Medicare Questions

aI will be happy to answer questions about Medicare. If I don’t have the answer, I will research it for you or provide you with resources that are credible and up to date. If the answer to your question is of interest to other readers, I may post it as a FAQ or in my Blog or newsletter.Although I may not always be able to advise you about your specific health insurance situation, I can let you know some of your options and how to find the information you need.You also can get some of your Medicare questions answered directly from the “horse’s mouth” at the Medicare Support Center.Resources:Do you have questions about Medicare? Are you having a problem with Medicare coverage or a Medicare claim? Not sure where to turn?Medicare Questions and Problems: Where to Get Help will show you the six best resources for answering your Medicare questions and resolving your Medicare problems.

Wednesday, November 20, 2013


a Definition: A deductible is the amount you must pay out-of-pocket each year for health-related expenses before your insurance policy begins to pay.Deductibles are common in PPOs for health care services received outside the PPO network.If you have Medicare, you will most likely have to pay a deductible for medical services and a separate deductible for medications under Medicare Part D.There is a wide range of deductibles – anywhere from none to $10,000 a year or more. And, if you have a large annual deductible, your monthly premium is likely to be lower.

I Missed My Job-Based Benefits Open Enrollment...

aQuestion: I Missed My Job-Based Benefits Open Enrollment Period. What Can I Do?Answer: If you get your health benefits through your job, you'll typically have an annual open enrollment period. This period typically occurs sometime in the fall, but not always - your company should notify you about your open enrollment period. Contact your Human Resources department if you are unsure. If you miss your company's open enrollment period for health insurance benefits, you may be out of luck unless you have recently experienced a significant, life-changing event that would trigger a special enrollment period. A special enrollment period could be triggered if you are covered on someone else's plan and lose that coverage. For example, if you are covered on your spouse's plan, but your spouse loses her job or you become divorced, this would trigger a special enrollment period that would allow you to enroll in your company's health plan right away. Additionally, if you marry, have a child, or adopt a child, you could enroll your dependents right away in a special enrollment period. If nothing has happened to trigger a special enrollment period, you will most likely have to wait until the next open enrollment period to sign up for health benefits. While you still cannot be denied coverage due to your health status, as a late enrollee, you could be subject to a longer pre-existing condition exclusion period.

Tuesday, November 19, 2013

How Does the Health Insurance Subsidy Work?

aHealth insurance is expensive, and not everyone can afford it. However, the Affordable Care Act requires that you have health insurance from January 1, 2014 onward.When they wrote the Affordable Care Act, lawmakers knew many people wouldn’t be able to afford the cost of health insurance premiums, so they included subsidies to help. One of those subsidies is the premium tax credit.The premium tax credit is designed to help people pay their monthly health insurance premiums. But, in order to get that financial help and use it correctly, you have to understand how it works.How Do I Apply for the Premium Tax Credit Health Insurance Subsidy?Apply for the premium tax credit through your state’s health insurance exchange. If you get your health insurance somewhere else, you can’t get the premium tax credit.Find out how to contact your state’s health insurance exchange.Will I Qualify for the Subsidy?People making between 100 and 400 percent of federal poverty level can qualify for the premium tax credit health insurance subsidy. Federal poverty level changes every year, and is based on your income and family size. You can look up this year’s FPL here.Using 2013 FPL levels, you'll qualify as an individual with an income range of $11,490-$45,960, a couple with an income of $15,510-$62,040, and a family of three earning $19,530-$78,120.If you meet the income qualifications, make sure something else doesn't disqualify you from receiving the subsidy. Learn more in, “Can I Get Help Paying for Health Insurance”; look for the section “What Things Disqualify Me From Getting a Health Insurance Subsidy?”How Much Money Will I Get?In order to figure out how much your premium tax credit will be, you have to know two things: Your expected contribution toward the cost of your health insuranceTip: You can look this up in the table at the bottom of the page. The cost of your benchmark health planTip: Your health insurance exchange can tell you which plan this is and how much it costs. Your benchmark plan is the silver-tiered health plan with the second lowest monthly premiums in your area. The Affordable Care Act classifies health plans based on how much of your health care costs they’re expected to cover. A bronze health plan will cover about 60 percent of the average person’s health care costs. A silver health plan will cover about 70 percent.Your subsidy amount is the difference between your expected contribution and the cost of the benchmark plan.See an example of how to calculate your monthly costs and your subsidy amount at the bottom of the page.Can I Buy a Cheaper Plan To Save Money, or Must I Buy the Benchmark Plan?Just because the benchmark plan is used to calculate your subsidy doesn’t mean you have to buy the benchmark plan. You may buy any plan listed on your health insurance exchange, but your subsidy amount stays the same.If you choose a more expensive plan, you’ll pay the difference plus your expected contribution. If you choose a plan that’s cheaper than the benchmark plan, you’ll pay less since the subsidy money will cover a larger portion of the monthly premium. If you choose a plan so cheap that costs less than your subsidy, you won’t have to pay anything for health insurance. However, you won’t get the excess subsidy back.If you’re trying to save money so you choose a plan with a lower value, (like a bronze plan instead of a silver plan), you’ll likely have higher coinsurance and copays when you use your health insurance.There’s another reason to choose a silver-tier plan. There’s a different subsidy that lowers copays, coinsurance, and deductibles for some low-income people. Eligible people can use it in addition to the premium tax credit subsidy. However, it’s only available to people who choose a silver-tier plan.Do I Have to Wait Until I File My Taxes to Get the Subsidy?You don’t have to wait until you file your taxes. You can get the premium tax credit in advance. If your income is so low that you don’t have to file taxes, you can still get the subsidy. However, if you’d rather, you may choose to get your premium tax credit as a tax refund when you file your taxes instead of having it paid in advance.How Do I Get the Money?If you choose to get the premium tax credit in advance, the government sends the money directly to your health insurance company on your behalf. You'll never actually lay your hands on the money. Your health insurer credits that money toward your cost of health insurance premiums, decreasing how much you'll pay each month.If you choose to get the premium tax credit as a tax refund, the money will be included in your refund when you file your taxes. This could mean a big tax refund. But, you'll pay more each month since you’ll be paying both your share of the premium and the share that would be have been covered by the subsidy if you'd chosen the advanced payment option.Why Wait Until I File My Taxes To Get the Subsidy?Most people won’t want to wait; they’ll choose the advance payment option. However, consider opting to get the subsidy along with your tax refund if: Your income is very close to 400 percent of FPL.Your income varies from year to year so you’re not sure how much you’ll make.When the subsidy is paid in advance, the amount of the subsidy is based on an estimate of your income for the coming year. If the estimate is wrong, the subsidy amount will be incorrect.If you earn less than estimated, the advanced subsidy will be lower than it should have been. You’ll get the rest as a tax refund.If you earn more than estimated, the government will send too much subsidy money to your health insurance company. You’ll have to pay back part or all of the excess subsidy money when you file your taxes. Even worse, if your actual income ended up more than 400 percent of FPL, you’ll have to pay back every penny of the subsidy. This could be thousands of dollars.If you get your subsidy when you file your income taxes rather than in advance, you’ll get the correct subsidy amount because you’ll know exactly how much you earned that year. You won’t have to pay any of it back.What Else Do I Need To Know When Applying for a Subsidy?If your subsidy is paid in advance, notify your health insurance exchange if your income or family size changes during the year. The exchange can re-calculate your subsidy for the rest of the year based on your new information. Example of How To Calculate the Subsidy:Figure out how your income compares to FPL.Find your expected contribution rate in the table below.Calculate the dollar amount you’re expected to contribute.Find your subsidy amount by subtracting your expected contribution from the cost of the benchmark plan.Tom is single with an income of $22,800 per year. FPL for 2013 is $11,490 for single people.To figure out how Tom’s income compares to FPL, use: income ÷ FPL x 100.$22,800 ÷ $11,490 x 100 = 198.4.Tom’s income is 198 percent of FPL. Using the table below, Tom is expected to contribute 4-6.3 percent of his income. Since he’s almost at the top of his category in the table, he uses the 6.3 percent figure. To calculate how much Tom is expected to contribute, use this equation: 6.3 ÷ 100 x income.6.3 ÷ 100 x $22,800 = $1,436.Tom is expected to contribute $1,436 per year, or about $120 per month, toward the cost of his health insurance. The premium tax credit subsidy pays the rest of the cost of the benchmark health plan. The benchmark health plan at Tom’s health insurance exchange costs $3,900 per year or $325 per month. Use this equation to figure out the subsidy amount: cost of the benchmark plan – expected contribution = amount of the subsidy.$3,900 - $1,436 = $2,464.Tom’s premium tax credit subsidy will be $2,464 per year or about $205 per month.If Tom chooses the benchmark plan, or another $325 per month plan, he’ll pay $120 per month for his health insurance. If he chooses a plan costing $425 per month, he’ll pay $220 monthly for his health insurance. If he chooses a plan costing $225 per month, he’ll only pay $20 per month for his health insurance.Your expected contribution will be

Monday, November 18, 2013

Generic Drugs - Are They as Safe and Effective...

aThis article about generic drugs is based on information from the U.S. Food and Drug Administration.Whether you have prescription drug coverage or not, if you use generic drugs when appropriate for your health condition you can save money – often more than 50% less than the brand name drug. But, are generic drugs safe? According to the U.S. Food and Drug Administration (FDA), generic medications are as safe and effective as the brand name equivalent.A brand name medication can only be produced and sold by the company that holds the patent for the drug. Brand name drugs may be available by prescription or over-the-counter. For example:Valsartan, a medication used to treat high blood pressure, is sold by prescription only by Novartis Pharmaceuticals under the brand name Diovan.Loratadine, a medication used to treat allergies, is sold over the counter by Schering-Plough HealthCare Products under the brand name Claritin.When the patent of a brand name medication expires, a generic version of the drug can be produced and sold. A generic version of a drug must use the same active ingredient(s) as the brand name drug and it must meet the same quality and safety standards. Additionally, the FDA requires that a generic drug be the same as a brand name drug in:dosagesafetystrengththe way it worksthe way it is takenthe way it should be usedthe health conditions that it treatsAll generic drugs must be reviewed and approved by the U.S. Food and Drug Administration (FDA) before they can be prescribed or sold over-the-counter.According to the FDA, all drugs, including brand name drugs and generic drugs, must work well and be safe. Generic drugs use the same active ingredients as their brand name counterparts and, therefore, have the same risks and benefits.Many people are concerned about the quality of generic drugs. To assure quality, safety, and effectiveness, the FDA puts all generic drugs through a thorough review process including a review of scientific information about the generic drug's ingredients and performance. Moreover, the FDA requires that a generic drug manufacturing plants meets the same high standards as a plant for a brand name drug. To ensure compliance with this rule, the FDA conducts approximately 3,500 on-site inspections each year.About half of all generic drugs are made by brand name companies. They may make copies of their own medications or another other company’s brand name drugs and then sell them without the brand name.Generic drugs are not allowed to look exactly like any other drugs being sold due to U.S. trademark laws. Although the generic drug must have the same active ingredient as the brand name drug, the color, flavor, additional inactive ingredients, and shape of the medication may be different.Brand name medications typically are given patent protection for approximately 17 years. This provides protection for the pharmaceutical company that paid for the research, development, and marketing expenses of the new drug. The patent does not allow any other company to make and sell the drug. However, when the patent expires, other pharmaceutical companies, once approved by the FDA, can start making and selling the generic version of the drug.Because of the patent process, medications that have been on the market for less than 17 years do not have a generic equivalent being sold. However, your doctor may prescribe a similar medication to treat your condition that does have an available generic equivalent. For example, if you are taking Lipitor (Atorvastatin), which is still on patent protection, for high cholesterol, your doctor can switch you to simvastatin, the generic version of Zocor.According to the Pharmaceutical Research and Manufacturers of America, it takes more than seven years to bring a new drug to market and costs more than $800 million. Since generic drug companies do not have to develop a medication from scratch, it costs significantly less to bring the drug to the market.Once a generic medication is approved, several companies may produce and sell the drug. This competition helps lower prices. In addition, many generic drugs are well-established, frequently used medications that do not need to bear the costs of advertising. Generic drugs often cost 30% to 50% less than brand name drugs.Despite the fact that the active ingredient in a generic medication is the same as in the brand name counterpart, small differences could effect how the generic medication works in your body. This may be due to how the generic medication is produced or the type and amount of inactive materials present in the medication. For some people, these slight differences may cause the drug to be less effective or lead to side effects.An example of the controversy about generic versus brand name medication is the drug levothyroxine, used to treat people with a low thyroid condition (hypothyroidism). Since many people with low thyroid are sensitive to very small changes in the dose of their medication, switching between brand name and generic versions of levothyroxine can cause symptoms of too little thyroid medication or side effects from too much medication.Before switching to a generic drug, speak with your doctor and make sure that you are both comfortable with the change.

Top 10 Ways To Use Your FSA Dollars

a (LifeWire) - Running low on time to spend the rest of your flexible spending account before the end of the year? Most people know they will lose the pre-tax dollars they have salted away in their healthcare FSA, also known as a cafeteria account, if they fail to spend it by the end of a calendar year. But you may not be aware of the many things you can spend it on, pre-approved by the Internal Revenue Service, in addition to the typical trip to the doctor's office.Here's our take on the top 10 ways to drain your FSA:1. Get some glasses. If you or anyone in your family needs corrective lenses, including contact lenses and prescription sunglasses, now is the time to order them. Because many health insurance plans don't cover such things, you will probably use a sizable chunk of your cafeteria funds to cover the bills. Don't forget to include in your claim the money spent on non-prescription supplies such as contact lens solution.2. Stock up on drugs. Fill any prescriptions that allow you to buy in bulk. And don't forget non-prescription drugs, such as headache medication and cold remedies. Even sunscreen and sunburn treatment creams are OK.3. Birth control. Condoms, birth control pills and other medically legitimate birth control devices are approved expenses.4. Sports equipment. Things you wear specifically to avoid athletic injuries, such as mouth guards, may be covered, depending on your company's plan.5. Medical scans. Ask your doctor to order a precautionary scan of your arteries and/or your heart. These tests may be able to flag problems early.6. Check your choppers. Any co-pays you shell out for dental exams or dental work are covered expenses. You might be able to claim the cost of a special toothbrush or toothpaste, too, if you buy them from your dentist, but you can't claim such routine things if you buy them over the counter.7. See an acupuncturist. Alternative medical treatments such as acupuncture, chiropractic care or a Christian Science treatment are covered. Naturopathic or herbal remedies, on the other hand, may not be covered unless they are prescribed by a licensed medical practitioner. Scientology audits are out, too.8. Stop smoking, drinking or abusing drugs. Any clinical smoking-cessation treatment is an OK expense, along with any prescribed medications. The same holds true for treatments to end a drug or alcohol dependency, along with meals and lodging expenses at a treatment center.9. Examine your life. Expenses for psychiatric care or psychotherapy are covered, as a rule, as are many forms of family counseling, prenatal counseling and adoption counseling.10. Clean your vents. Yes, you can claim the expense of having your home's heating and cooling vents cleaned, as long as you explain a medical need for it.And finally, a bonus idea: Travel, meals and lodging can be approved expenses if you incurred them while getting medical treatment for yourself or for a family member.LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. David Fisher is a freelance writer based in Bend, Ore. He has worked as a financial adviser with insurance licenses in several states.

Sunday, November 17, 2013

POS - Point-of-Service Plan

aDefinition: A point-of-service (POS) plan is a combination of a health maintenance organization (HMO) and a preferred provider organization (PPO). Typically, POS plans have a network that functions like a HMO – you pick a primary care doctor, who manages and coordinates your care within the network. POS plans also allow you to use a provider who is not in the network. However, if you choose to go out-of-network for your care, you will pay more.These plans are known as point-of-service, because each time you need health care (the time or “point” of service), you can decide to stay in the network and allow your PCP to manage your care or go outside the network on your own without a referral from your PCP. if(zSbL

Saturday, November 16, 2013

Affordable Care Act – What You Should...

a Affordable Care Act - You can expect significant health insurance changes in the coming years.alexsl/iStockphoto On March 23, 2010 President Obama signed into law the federal health reform legislation known as the Affordable Care Act. The purpose of the legislation is to assure that all Americans have access to affordable health insurance.The key reforms in the Affordable Care Act should significantly decrease barriers for obtaining health coverage as well as accessing needed health care services.After the legislation is fully implemented in 2014, all Americans will be required to have health insurance through their employer, through a public program such as Medicaid or Medicare, or by purchasing coverage from a state-based health insurance exchange.Bars health plans from:Denying coverage because of pre-existing medical conditions.Dropping the coverage of people who become sick.Charging higher premiums because of health issues.Requires large employers to:Provide health insurance, or be subject to potential penalties.Encourages small employers to:Provide coverage in exchange for tax credits.Requires individuals to:Obtain health insurance or pay a penalty, unless they qualify for certain exemptions.Allows parents to:Extend their health insurance to children up to the age of 26.Depending on your income, family size, and state of residence, you may have several coverage options, including financial help (subsidies) if you cannot afford to purchase health insurance. The following are examples of coverage options - the income levels are approximate and may be different in your state. Typically, the income levels are based on a percentage of the Federal Poverty Level.Example 1: Eligible for MedicaidAnnual income:up to $14,400 for an individualup to $29,300 for a family of fourComments:Low-income Americans who are U.S. citizens, as well as many legal immigrants, can enroll in their state's Medicaid program.Your state may impose some minimal level of out-of-pocket expenses, such as a copayment of $1 to $5 for a doctor's visit or for selected services.Example 2: Eligible to buy a subsidized health plan through a state-based health insurance exchange (starting in 2014)Annual income:up to $43,320 for an individualup to $88,200 for a family of fourComments:Health plans that participate in an exchange must offer a package of "essential" benefits that covers at least 60% of health care expenses.If you buy your health insurance in an exchange, your share of the premium may not exceed a certain percent of your income, ranging from 2% to 9.5% depending on how much you make each year.Example 3: Required to buy private coverageAnnual income:$43,321 and above for an individual$88,201 and above for a family of fourComments:You are not eligible for a subsidy, or financial assistance at this salary level.If you remain without health insurance, you may have to pay a penalty of up 2.5% of your income unless you qualify for certain exemptions.Depending on the type of health insurance you currently have, you will have multiple coverage options with the implementation of the Affordable Care Act. The following briefly describes what you can expect if you have a health plan from your employer, buy your own individual policy, or are currently or will become eligible for Medicare in the next several years.If your source of health coverage is an employer plan, these are some of your options:Stay in your employer plan: If your employer continues to offer health insurance, you can keep it.Shop for a health plan through the health insurance exchange in your state: If you own a small business, or your employer offers only minimal benefits, or you must pay more than 9.5% of your income in premiums, you can look for better options in the exchange.If your source of health insurance is an individual policy that you have purchased for yourself and/or your family, these are your options:Keep your current plan: If your health plan continues to offer the same coverage, you can renew it. However, new health insurance policies must comply with federal minimum coverage standards; older health plans that don't meet these standards cannot enroll new customers.Shop for coverage through the insurance exchange in your state: If your income is below $43,320, you may qualify for federal tax credits to help offset the cost of your premium.If you are on Medicare, your options may not change significantly, but your drug-related costs may decrease, and your access to services may improve:Your basic (or guaranteed) benefits and eligibility will not change: All Americans who qualify under today's rules will continue to do so.Medicare Advantage: Federal subsidies for Medicare Advantage plans will be eliminated, which may cause the private insurers who sell these plans to cut benefits, reduce enrollment, or raise premiums.Access to services: Physicians who treat Medicare patients in rural areas, inner cities, and other underserved areas will be paid a 10% bonus, which may make it easier for you to obtain care. However, there will be more people able to obtain health care, which might limit access to care because of a shortage of primary care physicians.Prescription drug coverage: The coverage gap (Medicare Part D doughnut hole) will be phased out, beginning with a $250 rebate in 2010.More Information: For details about the Affordable Care Act, including access to the entire law and regulations, take a look at