Best Insurance Blog and Articles » health reform

How Can Unisured Diabetics Afford Health Care?

admin — Tue, 17 May 2011 13:49:32 +0000

Medical Help For Uninsured Diabetics

Options For Uninsured Diabetics

Even though it has been over a year since the Affordable Health Care Plan passed, many Americans still wonder how to afford health care, especially for uninsured people with pee-existing conditions.
Diabetics have always struggled. Group policies, through employers, should cover most medical services and prescriptions. However, many Americans lack group coverage. Few major medical policies will accept diabetics on an individual or family health insurance plan. Since proper care is crucial to maintain health, how can families get help?

What About Health Reform?

Health reform has already brought some changes. Insurers are not allowed to decline children, up to age 19, for pee-existing health conditions. Furthermore, parents can keep kids on their plan up to age 26. This has helped many people make sure that young people, whose parents have group coverage, get help affording health care.
But what about adult diabetics without medical plans? What about young people who do not have the luxury of parents with health insurance? How can these people find help?
State And National High Risk Health Plans: Every state in the US has a high risk health plan or pool for people with health conditions. Now, there is also a new federal health pool that is being implemented all over the nation. You can look for the website for your own state’s high risk health plan in order to find more information for your state, and for how and when the federal plan will be implemented in your area.
The federal program promises some relief. But even though each state has a plan, some of these plans are quite expensive. They may also have waiting periods, and also, not everybody qualifies for coverage. There is also a limit to the amount of people who will be accepted by the national program.
CHIPS: The children of families with low to moderate incomes may also qualify for the Childrens Health Insurance Plan (CHIPS). This is a federal and state effort to cover millions of kids in the US who do not have any other access to health insurance.
So while the state or national high risk pools will help some people, they are not a perfect solution for everybody. And families must meet income qualifications in order to get their children enrolled in CHIPS.

Private Foundations For Uninsured Or UnderInsured Diabetics

There is a private foundation that brings together a lot of resources, including health resources for diabetics. This is the Partnership for Prescription Assistance. You can visit their website at PPARX.org. This resource has helped a lot of people, with diabetes and other health issues, find help.
As the name implies, you can find a central resource for help affording prescription medication and supplies. There is also a simple zip code search if you need to search for low cost clinics and doctors. In addition, you can find contact information for foundations with money to help people who have problems because of specific diseases.
It is tough for people to manage their health issues without a good medical plan. However, this is the situation that millions of Americans find themselves in. There are resources out there to help these people, and it may take some work, but you can find help.

Concierge Medicine: Health Crisis Symptom or Problem?

FinanceGuy — Tue, 05 Apr 2011 14:03:32 +0000

What is concierge medicine?

Does Concierge Medicine Make Doctors and Patients Happier?

A concierge medical practice charge patients a yearly fee in order for patients to belong to a medical practice. Sometimes these are also known as retainer based medical practice, similar to having a lawyer on retainer.

Typical fees may range from $1,500 to $1,800 a year. Fees and care levels do vary though. Some practices may only charge a $500 fee while others may charge $5,000. Sometimes this type of practice is also known by other names like boutique or retainer-based medicine.

Right now, only a few thousand doctors belong to membership based practices, but the number is increasing. All sorts of medical practices, from dentists to pediatricians, may adopt this business model. However, in response to lower Medicare payments and tighter restrictions, there have been more Medicare doctors who have begun to impose a yearly membership fee on their patients.

Advantages of Retainer-Based Medicine

Doctors defend this practice by saying they can see fewer patients and deliver higher quality medical care. Lower payments, by health programs like Medicare and private insurance companies, have encouraged more practices to adopt this business model. Instead of rushing through appointments in order to generate revenue, the membership fees allow medical service providers to reduce the number of patients they see. This allows them to spend more time with each patient.

Most of the medical practices also argue that their membership fees are modest. Middle class people can afford the fees if they see their health care as a priority.

Controversy over Membership Medical Practices

Critics claims this promotes a 2 tiered medical system, and that it aggravates problems for doctors who do not charge a membership fee. People can afford the fee may get faster service and more time with a medical professional. Those who cannot afford the fee may find they are waiting longer for less service.

For example, a medical practice with a lot of Medicare patients may impose a concierge fee. This office will still accept this government health insurance, but only for patients who pay the yearly fee. While these patients can still get their medical services covered by Medicare, they cannot get the membership fee covered.

Note that I used Medicare as an example. You could make a similar comparison with other health insurance plans too. I do not know of any medical plans that will cover the membership fee.

What happens? Patients who can afford, and see the value of, the yearly fee will remain. They may be very pleased because they will not have to wait as long for appointments and can actually talk to the doctor on the phone between visits. When they do visit the doctor, they may find that the doctor can spend more time with them.

Doctors can concentrate on delivering better quality medical care too. They get to spend more time with each patient, and they find that this type of practice is less exhausting and more rewarding.

Here’s the problem. Many people do not have the extra income to pay for a membership, and they will need to seek another doctor. Senior citizens are making do on fixed incomes. Almost 50 million Americans do not even have health insurance!

The membership practice gets to increase revenue with fewer patients. Other doctors that still accept patients without an extra fee, could see their practices becoming a lot busier. These doctors may not want to abandon patients who cannot afford the fee, but find that they are struggling to keep their practices afloat because of lower insurance payments and higher expenses.

Will Concierge Medicine Hurt Health Reform Efforts?

Right now, membership medical practices are still a small minority, though the concept is becoming more popular with doctors and some patients who do not mind paying more for extra care.

Actually, the increase in these practices is more of a symptom of a problem than the actual problem. Some hybrid or very efficient membership practices provide very good benefits with a very modest fee (like $25.00 a month). The practices make use of nurse practitioners and physician’s assistants to see patients with routine complaints and reserve doctors for more complex issues. Others have a membership program with a higher service level, but still accept non-membership patients.

Health reform needs to address the issues that are making concierge services more popular.

Health Reform: Health Insurance Exchanges Explained

admin — Thu, 31 Mar 2011 14:34:29 +0000

Health Insurance Exchanges Explained

As I detail one of the biggest parts of the new US health reform act, bear with me. The exchanges are part of President Obama’s US health reform act. This was signed in March of 2010. However, health insurance exchanges are only implemented in a few places right now. They are scheduled to be implemented, by each state, by 2014. So things are still fluid, and this means that things could change.

The fact that things are fluid, and that the actual program has not yet been implemented, probably explains why a lot of the information is a bit confusing and vague. I am doing my best to reduce the information to something simple.

These new exchanges will be, like most insurance, regulated at the state level with federal assistance. The exchange will decide which insurers to admit, but insurance companies can still sell major medical outside of the exchange. You can find US state insurance departments here.
They should NOT affect people who work for larger companies and get their medical benefits from a group health plan. They are mostly intended to benefit people who do not get group health and who are not qualified for Medicare.
Some examples of people who may use the exchange would be self employed people and small business owners, people with jobs in smaller companies that do not provide group health plans, unemployed people, or those who have retired but are not old enough for Medicare. The big change will be to the individual health insurance market. One website discussed how health insurance exchanges may benefit older insurance shoppers.
Insurance plans will be standardized. There will be different levels like “bronze”, “silver”, “gold”, and “platinum” plans. This should make purchasing decisions less confusing because it will be more possible to compare “apples to apples”. Even though these plans are not for Medicare beneficiaries, it is helpful to compare these levels to Medicare Supplement standardized plans.
Health insurance companies may not decline people with health conditions. They also cannot charge more. This means that the risk has to be spread, and this is the reason that the insurance companies want the purchase of health insurance to be mandatory (or the non-purchase to be penalized).
Insurers may charge different rates by age, location, and plan level.

Again, more than half of people in the US (under 65) get group medical benefits. This is for the “other half’ who relies on private of government programs. Apparently there will be a subsidy for those with low to moderate incomes so they can afford the premiums. I do not have any information about how those premiums will compare to current insurance rates.

2010 Tax Break For Self Employed Health Insurance

FinanceGuy — Mon, 07 Feb 2011 15:54:35 +0000

More Self Employment Tax Breaks For Small Business Health Insurance

Health Reform and Small Business

Just when it looked like all of the health reform changes were not doing much to help most small businesses owners, it seems like we may have missed something which can make a large impact on our total tax bills. Since 2003, self employed people could deduct health insurance premiums from their taxes. This only seems fair since employees with group plans did not have to pay taxes on company contributions and large employers certainly got a tax break. But was it fair enough?

USA Today reported that the average family health insurance policy costs about $14,000 a year. Keep in mind, this is the total cost. If you are employed by a company that offers group heath, your employer may pay part of this cost. However, if you are self employed, you probably foot the whole bill.

Since 2003, you could deduct that $14,000 (or whatever amount you paid) from your earnings as an income deduction. Of course, your own family premiums will vary because of the age, health, and number people in your family, plus the type of coverage you purchased and where you live.

Self Employment Taxes

The rules have changed so self employed people get another break for 2010 federal tax returns. Self-employed individuals pay 15.3% of their net earnings which is known as the self-employment tax. Employees usually share this burden with their employers. This tax covers social security and Medicare.

Deduct Health Insurance Premiums From Self Employment Taxes

For your 2010 taxes, you can also deduct health insurance payments from self employment tax too. This new deduction should lower your tax bill even more.

Are Your Tax Forms and Tax Software Updated With 2010 Tax Changes?

Make sure your tax forms are updated with these changes because it can provided a timely and much applauded benefit to self employed individuals such as real estate agents, insurance agents, consultants, etc. Some forms and online programs were not updated, and so taxpayers were urged to wait a while before filing.

You can find the IRS information about 2010 Self Employment Tax Health Insurance here.

Federal High Risk Pools : Health Reform Updates

David — Wed, 21 Jul 2010 16:01:24 +0000

Federal High Risk Health Pools Are Coming To Your State!

I noticed a note on the Texas High Risk Health Pool website when I was doing some research for a client.

Enrollees in the new federal pool program will pay standard market premium rates and their coverage will not be subject to any preexisting condition exclusion. Funds for the Federal Pool are limited, so eligible applicants should apply as soon as possible.

Federal High Risk Health Plans

What I took away from this is that, for now, the federal plan is being implemented, but will work in conjunction with the state risk pool. I get the idea that the premiums will be a bit lower, but that limited slots are open. I guess it will work on a first come/first served basis.

Now, as you may know if you are interested in health insurance risk pools, is that every state has their own way of handling individuals who have been declined for private major medical insurance. Apparently the federal plan is also being implemented on a state by state basis too. The point of this is that you need to check with your own state’s high risk plan, and the Texas website is just an example. This is the federal high risk health pool website.

What Are High Risk Health Pools?

Individual insurers can decline applicants if they do not meet the plan underwriting criteria. These declines may qualify for a state plan that covered “high risk” underwriting cases. Not everybody qualified, and the premium, in some states, was fairly high.

It is beyond the scope of this article to outline the requirements for every state, but it should be simple for you to find the website for your own state plan. However, let me list of of the federal plan requirements.

You must be lawfully present in the US. This is defined as a US citizen or national. The federal website has a list of documents that you must present in order to prove this.
You must have been uninsured for at least 6 months. I’m not sure why they have this requirement.
You must have had a problem getting private coverage because of a pre-existing condition. This plan is not for fairly healthy people who could qualify for individual health insurance! You can visit the link in the previous statement to find individual health insurance plans in your local area. It only takes a few moments to fill our the quote form, and it can put you in touch with competitive health insurance companies in your local area. They will have the information you need.

There is also a placce on the website to find your state high risk pool. There are some individual state rules too. I know this sounds complicated, but traditionally, most insurance is regulated by states, and not the federal government. That’s why I suggested looking for your own state website.

Advantages of The Federal Health Pool

I think the plan will come in cheaper than many state plans. I cannot really go into more details, because as it says on the federal website, the plans will vary by state! For my own state, it looks like the federal plan has less qualifications and lower premiums.

Good Luck!

Long Term Care Health Insurance and Health Reform

FinanceGuy — Fri, 16 Jul 2010 18:10:12 +0000

Health Reform: Long Term Care Insurance

Long Term Care Health Insurance

One thing that really surprises me, with all of the talk and debate about heath reform, is that there has been little discussion about new long term care insurance plans. Planning for nursing care should be considered by anybody who is doing retirement planning these days, and I think that a lot of people do not consider it because they just do not know how much it costs or figure some government plan already exists to take care of that concern.

Find Out How Much Long Term Care Insurance Costs - Compare Local Quotes For Free

Since long term care health insurance is a type of heath insurance, it has been included in the new health reform bill. However, what has been included is NOT comprehensive, and it will not remove the need to plan.

The details are not totally firm yet, but you can search for the CLASS act. It proposes a voluntary long term care insurance program that workers can opt out of. It has been devised to be self supporting, so it will not rely on any federal tax money.

What We Know About The CLASS Act

If the enrolled people pay the premiums, which are scheduled to be adjusted for lower income people, and they are in the program for a waiting period (5 years), it will pay $50 a day for nursing care. This care could be from a nursing home, assisted living facility, or at home health care.

As this plan has not yet been implemented, and as it also will require a waiting period, it will not provide any immediate relief for people who need nursing care. Also note that the plan is not just for senior citizens who are of Medicare age. Disabled people of any age who meet the other qualifications could use the plan benefits.

Do We Need To Worry About Long Term Care Insurance?

This will not totally remove your concerns. Even today, nursing homes can cost over $100 a day or more. So the new plan may pay half to a third of the total price tag. It should help remove some concerns, but it is not a total solution.

Many people assume that some federal program is already in place to take care of the rest. Understand that Medicare, the federal health insurance for disabled people and seniors, only covers SHORT TERM CARE. Medicaid, the US health insurance for low income people, forces people to spend down most of their assets to qualify. So there are some governement programs, but they are hardly perfect either.

Nursing Care Solutions

One common solution is long term care insurance (LTCi). There are even tax qualified plans that can be used as a tax deduction today. There are also LTCi alternatives like savings or annuities and life insurance with nursing care riders. The important thing is to learn about your options, and try to choose one that will provide security for you in the future and work with your budget today!

For more information, you might find this interesting: Pros and Cons of Long Term Care Insurance

Otherwise, we welcome any discussion in the comments!

Health Insurance Scammers Exploiting Health Reform

David — Wed, 21 Apr 2010 13:17:47 +0000

Health Insurance Scams Are Back with Health Reform Confusion

Well, we might have hoped that, if health reform did one good thing, it would reduce the number of health insurace scams that keep popping up. And it may very well help to do that, but right now, there seem to be a spike of them. Scammers see an opportunity to exploit confusion over the health reform bill, and they are out preying on the vulnerable again.

Who are vulnerable. Well, it appears that lots of people are struggling with high medical insurance premiums and lower incomes right now. The opportunity to save a few hundred dollars a month is certainly attractive. Just keep in mind, that if something sounds way too good to be true, it probably is!

Here are some common health insurance scam markers for 2010:

If anybody is trying to get in your front door selling OBAMACARE policies, just keep your door shut.There is not such thing, and really that term is a cynical pejorative. President Obama’s health reform bill has not started creating special health insurance policies now, and anyway, they certainly would not have that name. We already have reports of agents (or possibly impostors) using this as a tactic to meet with clients for both private health insurance and Medicare health insurance plans.
Are the premiums too good to be true? A small business owner was tempted by saving $500 a month on his family health insurance premiums by a very smooth sales person. He reduced his premiums from about $700 a month to $297. In the end, when is son needed treatment, he found he had purchased a medical discount plan, and did not have any major medical coverage at all!
A salesperson claims to be a federal employee out signing people up. Honestly, the federal government does not go door to door, or senior community to senior community, to enroll people in Medicare Advantage or Medicare supplements. These are sold by private insurers or local insurance agents. And they certainly do not go out to enroll people in private major medical policies for people under Medicare age.

You may think these claims are crazy, but this is already being reported. It is, of course, simple for an educated consumer to protect himself or herself against fake health insurance scams.

Every state has an insurance department. You can find your state insurance department here, and this is where you can research any insurance company or agent! You will also find a toll free phone number where you can call to ask questions about insurance topics.
Do Not Succumb to Pressure. There are plenty of legitimate insurance agents and companies out there. If a salesman uses high pressure tactics, that should be a red flag that you need to just say no so you can have time to check the plan out.
Do not hand out your social security card, bank account, etc. over the phoneunless you are very certain you know who you are dealing with. It is true that legitimate insurance is sold on the phone, or even through fax machines or the Internet these days. But if you are called by somebody you have never requested information from, it is a very good idea to confirm who you are speaking with before you hand out personal information.

These scammers hurt everybody. They hurt consumers, especially vulnerable people who are struggling with high insurance premiums. They also hurt legitimate insurers because they make it harder for them to do business.

If you have any more information about the latest scams, lets help stop this. You can register for free here, or you can join the discussion – Health Reform Insurance Scams.

Health Care Reform Bill : Where Are We Now?

admin — Thu, 18 Mar 2010 03:14:59 +0000

Health Care Reform Bill

So where are we, and President Obama, and the US Congress, on the health reform bill? I guess it is true that in order to understand the present, we have to take a look at the past. Right now, the whole health care reform thing seems pretty hard to understand no matter what we know, but let’s take a step back anyway.

Health Reform Ideas Are Not New

The idea of health reform is not new. In fact, FDR hoped to include some sort of national health care in social security legislation way back in 1935. The next president, Harry Truman, had hoped to create a national fund that we would all pay into that would provide the money for his program. That did not work out, but since that time, every Democratic president, and quite a few Republican presidents, have tried to provide affordable health coverage to more Americans.

A Quick History of US Health Reform

Progress has been made. We do have a national health care program for senior citizens and retired people. This is, of course, Medicare. Even though it seems like it is an American institution, and has been the model for other nations, Medicare has only been around since the early 1960′s. And you may be surprised to know that it passed after a lot of heated debate and the predicted ruin of American medicine. We also have Medicaid and CHIPS, which are state and federal efforts to cover people and families with lower incomes.

Since then, President Bill Clinton tried and failed to pass a comprehensive health reform bill. This bill was used by Republicans to attack the Democrats, and many credit it with a lot of conservative wins in congress at that time.

Health Reform in the USA Today

However, times have changed. Right now, employers and business groups are really concerned about the rising costs of health care coverage. They are actualy advocating for change. In addition, health insurance companies have said they will accept reform, but just want to be included in the discussion. Once the public option was brought up, the health insurance companies have not been as cooperative as we might hope. But, at least, they said they would try.

The House and Senate came up with their own versions of a health care reform bill, but never seemed to be able to cooperate enough to turn one into law. Meawhile, pundits on both sides of the issue are getting a lot of press time on TV.

March, 2010 Health Reform Update

On March 3rd, 2010, President Obama announced that he expected Democratic congress people to get in line behind him, no matter how concerned they were about their chances for being elected again.

Here is the latest update from the New York Times:

In a letter to Congressional leaders sent March 2, Mr. Obama said he was open to pursuing four specific ideas raised by Republicans during the Blair House forum, including establishing “health courts” to resolve medical malpractice claims and encouraging the use by individuals of tax-advantaged medical savings accounts.

But even as Mr. Obama sent the letter, his chief of staff, Rahm Emanuel, and top health policy adviser, Nancy Ann DeParle, went to Capitol Hill to meet with House Speaker Nancy Pelosi and Senate Democratic leader Harry Reid and prepare a final legislative package that they would be able to pass with simple majorities in each house, using a parliamentary tactic known as reconciliation to avoid a Republican filibuster.

So what do you think the solution is? Almost everybody agrees we need US health reform, but nobody seems to be able to agree on how we should accomplish this. Feel free to register for free and comment!

Medicare at 55 – The Latest Health Reform Rewind

admin — Thu, 10 Dec 2009 20:15:05 +0000

Is a Lower Medicare Age Limit a Good Idea for Health Reform

I feel like a cartoon character today. You know, the type who sputter expetives like $#&! and stomps around. Why? Well, I am really disappointed that we are close to losing the health reform public option even though a majority of Americans say they favor it.

People, this is not about free health isurance. This is about having any access to health care at all for many people. Lots of Americans would be happy to pay a premium if they could get accepted. But they cannot get accepted because they have a health condition which cause insurers to decline them.

And yes, there are lots of Americans who cannot afford premiums which can average about $1,000 a month for an average family. Many people get help from their jobs so they do not pay that whole price tag. But millions do not have this luxury, and this is a real problem.

Drop The Medicare Age to 55?

But I have written before about how hard it is for middle aged people to get accepted by private health isurance companies. Learn more – health insurance over 50. So lawmakers thought they could reduce the problem of uninsured and uninsurable Americans by simply lowering the standard age limit for Medicare from 65 to 55.

Let’s think about this. The plan would allow uninsured Americans who are aged 55 to 64 to buy into Medicare. These would be people who do not have a group medical plan through their job or other private options. However, estimates put premiums at well over $600 a month, and that will still price out many of the 4 million people who might be eligible. Government subsidies are considered, but probably won’t be put in place right away.

Beyond that, many health providers are concerned because they already claim they lose money when accepting Medicare patients. They are not sure if they can continue in business if even more of their patients are using a Medicare card. On the other hand, many other medical providers rely on Medicare for most of their patient load, and these claim they will be happy to accept more patients.

The New Public Option?

We probably won’t be seeing Medicare for All any time soon. But instead of an actual public option, a private, non-profit insurance plan is being considered. This would be administered by the US Office of Personnel Magagement which already runs the federal employee’s health care system. This does not mean that lower wage earners would get the same level of benefits that your congressman does though.

So What is Health Reform Today?

I guess you should not to be ashamed to admit that you are confused by the current state of US health reform. It seems to have gone through so many changes in the last few months. And even if it was the same, it is complex, and as time passes it is hard to remember what was being proposed in the first place.

My hope is that our government can provide a way for every American to purchase affordable health insurance. Is that so complicated? I guess it is. I am not exactly how this new version of the health plan does that. Would somebody care to explain it to me?

Uninsurable Americans – Current Health Reform Update

admin — Fri, 06 Nov 2009 16:58:23 +0000

What About Uninsurables Under Health Reform?

One of my biggest concerns with health insurance today is the problem of uninsurables. That’s why Obama’s (and the Democrats) support of health reform was always attractive to me. I always believed that the biggest problem, and one that should be addressed first, were people who could not obtain medical coverage because they were already sick. I have seen this impact people, and I have seen how destructive it can be.

But I just read an article that says that the current bill will not allow these people access to the public high risk plan unless they have been without coverage for 12 months. This is just awful, and should start setting off alarm bills.

Here are problems that people have with current state high risk insurance programs:

People with a serious illness have maxed out their benefits, even though they are technically covered. Yes, this can (and does) happen all of the time with serious illnesses like cancer. You may have coverage through a private or group medical plan, but you can exhaust your plan max for all treatment, or for particular types of treatment. This happens a lot with expensive outpatient treatments like chemotherapy. Do you know what your own plan’s outpatient coverage limit is? Lots of people do not know until it becomes a problem!
What about a seriously ill person who has only lost coverage in the last 3 months (an arbitray number), but need like saving treatment today? For seriously ill people, waiting 3 months is a death sentance. What are they thinking?

This article in Yahoo outlines the problem, and addresses a specific individual with cancer.

“If you are a cancer patient and have cancer now, you can’t wait six months to go into a plan because your condition can go from bad to death,” said Stephen Finan, a policy expert with the American Cancer Society Cancer Action Network. He called the waiting period in the Senate bill “unacceptable.”

Please Question the Uninsurable Coverage Waiting Period!

Please let your representative hear your voice. Let them know that this waiting period makes this plan just about useless as a safety net, and then hear what they have to say!

As for myself, I am struck dumb with outrage.