Sunday, December 16, 2012

Are Many States Creating Health Exchanges? Study Finds Interesting Input ...

Interesting article found in California Healthline, Daily Digest of News, Policy and Opinion - Friday, Dec. 14th...

"Federal Government To Operate Most Health Exchanges, Study Finds ...

The federal government will operate health insurance exchanges under the Affordable Care Act in a majority of states, according to an analysis by Avalere Health, The Hill's "Healthwatch" reports.
As of Thursday -- one day before the federal deadline for states to declare whether they intend to run their own exchange -- 14 states and the District of Columbia had submitted plans, while three more states publicly have committed to operate their own exchange (Viebeck, "Healthwatch," The Hill, 12/13).

Under the ACA, states can operate their own exchange, partner with the federal government or let the government run an exchange for them (Lengell, Washington Times, 12/13).
In a letter sent to governors in November, HHS Secretary Kathleen Sebelius said the administration was extending the deadline for states to submit detailed applications -- or blueprints -- required by federal officials to Dec. 14, but the Nov. 16 deadline to notify HHS of their decisions would stand.
Meanwhile, states that intend to partner with the government will have until Feb. 15 to submit their declaration letter and blueprint. Sebelius noted that the extended deadlines would not affect the anticipated launch of the exchanges in January 2014.
Details of Analysis
Because a large number of states are defaulting to federally run exchanges, Avalere estimated that two-thirds of U.S. residents who obtain coverage through an exchange under the ACA will do so in either a federally run exchange or a partnership exchange ("Healthwatch," The Hill, 12/13). Some experts predict that the federal government ultimately could be responsible for running exchanges in more than 30 states.
GOP Lawmakers Point to Compliance Costs, Lack of Guidelines as Reasons for States' Choices
At a House Energy and Commerce Subcommittee on Health hearing on Thursday, Republican lawmakers pointed to compliance costs and a lack of federal guidelines on the exchanges for many states' reluctance to run their own insurance marketplace, Reuters reports. Rep. Michael Burgess (R-Texas) said, "The uncertain regulatory environment and the overall lack of response from HHS are not encouraging the states or the health plans to move forward."
However, Rep. Frank Pallone (D-N.J.) countered that Republicans who oppose the law for political reasons are simply trying "to delay implementation under the guise of lack of information" (Morgan, Reuters, 12/13). Rep. Henry Waxman (D-Calif.) added, "For some states, no amount of information will ever be enough. And that's the tragedy of politicizing the law" (Sanger-Katz, National Journal, 12/13).
Experts Doubt Federal Government's Ability To Operate Exchanges
Meanwhile, some experts raised questions about the federal government's ability to successfully operate exchanges for so many states. Experts say the largest challenges for HHS will be the creation of a health IT system that can exchange data with multiple states, as well as providing adequate customer service to handle enrollment (Reuters, 12/13).
CMS Refuses To Delay Insurance Exchange Rules
In related news, Gary Cohen -- director of CMS' Center for Consumer Information and Insurance Oversight -- denied Republican senators' request to extend the comment period and delay the finalization of rules governing the health insurance exchanges, Modern Healthcare reports.
"There's not a lot of time between now and October, and people are saying that we need to get these rules; the [insurance] industry in particular is saying 'We need to get these rules finalized in order to know how to develop plans and get them into states,'" Cohen said (Daly, Modern Healthcare, 12/13)."

Tuesday, December 4, 2012

Affordable Care Act "Must Knows!"

Taken from and written by Bruce Jugan ...

5 Things Everyone Needs To Know Abouto The Affordable Care Act:

The Affordable Care Act (ACA), health care reform known as "ObamaCare," kicks into high gear in 2014. If you buy your own medical insurance, read on for 5 things you need to know.
1. You MUST BUY health insurance - or pay a tax penalty.
  • You’ll have to buy your own plan if you don’t get coverage through your employer. This is called the "individual mandate." In the summer of 2012, the U.S. Supreme Court found it constitutional for the government to require everyone to buy health insurance. The high court determined that the individual mandate is a tax, so be prepared to either pay for health insurance or pay a tax penalty.
  • You’ll be exempt from paying the tax if the cost of your health insurance coverage would be greater than 8 percent of your household income or you meet a few other criteria.
  • Estimates are that 40 percent of Americans will be exempt from the penalty.
  • In 2014, the penalty is only $95 per adult and $47.50 per child (up to $285 for a family) or 1 percent of family income, whichever is greater.
  • Watch out: If you don’t buy coverage during the "open enrollment period" you may have a difficult time buying coverage when you need it.
2. You CAN BUY any health insurance plan you want. Insurance companies can’t decline you because of a pre-existing medical condition.
  • This is called "guaranteed issue" and it is a HUGE deal. No matter what your medical condition you can get the same plan as everyone else and at the same price.
  • The only things that can influence the price of your health plan in California are your age and where you live.
  • California will have an "open enrollment period" every year when everyone must buy coverage. This prevents people from waiting until they get really sick or injured and buying coverage at the hospital or doctor’s office when they need medical treatment.
3. Your new policy will have much BETTER BENEFITS than the one you currently have.
  • ACA requires every health insurance plan to have "essential benefits." These essential benefits include coverage of both brand and generic prescription medicine, maternity care, low deductibles and comprehensive coverage in and out of the hospital.
  • Gone will be the low-cost, low-benefit plans that are intended for catastrophic coverage and that are popular with people who buy their own medical insurance.
  • Gone will be the adage that "some coverage is better than no coverage." Under the ACA, the minimum available coverage is "comprehensive coverage."
4. The monthly PRICE of an individual health insurance plan will likely SKYROCKET.
  • Hold onto your wallet because 3 forces will cause the monthly price of an individual plan to increase significantly:
    1. No medical underwriting (see No. 2 above).
    2. Much better benefits (see No. 3 above).
    3. "Modified community rating," which changes the way the cost of coverage is spread among the young and the old.
  • While it is terrible for an insurance company to decline to cover people with pre-existing medical conditions, the reality is that "medical underwriting" allows those who are able to qualify for coverage to pay less. Eliminating underwriting will increase the cost for healthy people.
  • The price of medical insurance in California today is lower than just about every other state because of medical underwriting. In 2014, the entire country will look like New York or Massachusetts, which outlawed underwriting years ago; health insurance plans there cost more than twice as much as in California.
5. You may receive a SUBSIDY to lower the cost of your plan.
  • Single people who earn roughly between $15,400 and $46,000 per year will be eligible for a subsidy to lower the cost of their health insurance. Check out this health insurance subsidy calculator.
  • The subsidy amount is higher the less you earn and lower the more you earn. A single person who earns more than $46,000 per year in 2014 is not eligible for a subsidy and must pay the entire cost of her medical insurance.
  • How the subsidy will work: Assume a health insurance plan costs $344 per month for a 30-year-old living in California. If that person earns $31,200 per year ($15.00 per hour) she must pay the insurance company $225.25 each month. The government will pay the insurance company $118.75 per month.
  • People who earn less than $15,400 per year in 2014 will get their health insurance through Medi-Cal, California’s Medicaid program for low income people. This is a big change. Before 2014, a low wage worker with no children did not qualify for Medi-Cal yet he could not afford a health insurance plan. Now he will get Medi-Cal.
If the rules and regulations behind Obama Care sound complicated, that's because they are. And that's why we're here. We’ve been advising clients for more than four decades. can help guide you through the process of finding a health insurance plan that makes sense for your needs and budget. Just give us a call at (800) 746-0045.

Monday, November 19, 2012

Medicare Part B To Increase In Cost In 2013

Taken from California Healthline, under Medicare, 
as reported via AP/New York Times, 11/16

Monthly Premiums for Medicare Part B Set To Increase Slightly in 2013

Medicare Part B premiums will increase by $5 per month next year, CMS announced Friday, the AP/New York Times reports (AP/New York Times, 11/16).

According to a notice published in the Federal Register, the monthly premium for Medicare Part B -- which covers physician visits, outpatient care and medical supplies -- will be $104.90, up by 5% from $99.90 in 2012. Annual deductibles for Part B also will rise, from $140 to $147.

Meanwhile, premiums for Medicare Part A -- which pays for inpatient hospitals, skilled-nursing facilities and some home health care services -- will decline by $10 to $441 in 2013. Part A deductibles will increase by $28, from $1,156 last year to $1,184 in 2013 (Zigmond, Modern Healthcare, 11/16).

Medicare actuaries had estimated that Part B monthly premiums would increase by $9, based on early estimated cost growth for the program (Radnofsky, Wall Street Journal, 11/16).

CMS Acting Administrator Marilyn Tavenner noted that while the premium increase is less than anticipated, it is still enough to account for about one-quarter of a typical retiree's cost-of-living raise in Social Security payments next year (AP/New York Times, 11/16).

Please let anyone you know who is paying for medicare.

Saturday, November 17, 2012

Medicare & Medigap Plan A Basics!

Plan A is basic to all medicare coverage.  It is an individual option as well as a part of all enhanced optional coverage. Here is an outline that includes what Medicare Plan A covers and how a Medigap Plan A may be utilized with it.  As always . your questions are welcomed!  Call me, Kathy Hope, at 800-792-9114.

Plan A Coverage 
Is Included In All 10 Plans
Medicare Part A pays for hospitalizations for the 1st 60 days but only pays a portion of the daily costs from the 61st day through the 150th day.  You must pay the coinsurance amounts for those days.  
Medigap Plan A pays the coinsurance amount for those days and provides an additional 365 lifetime days.  
Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year.
Medigap Plan A pays for the first three pints of blood not paid for by Medicare. 
Medical Expenses:
Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. 
Medigap Plan A pays the coinsurance (generally 20% of the "Medicare approved" amount) under Medicare Part B.
Note the definitions of deductible & co-insurance
Deductible - must be paid before medicare activates.
Co-insurance - After deductible and paid in addition to medicare covera

Wednesday, November 7, 2012

How Healthy "IS" Living In California?

How healthy is living in California?  A little bit more healthy than in 2010! 
Here is a recent study as published at 

California climbed two spots from its #26 ranking in 2010, and is now ranked as the 24th healthiest state to live in, according to the 2011 America's Health Rankings® by the United Health Foundation.

The good news:
Smoking has been on the decline in California, falling by 20 percent over the past decade (though nearly 3.4 million adults still smoke).

The bad news:

  • The number of obese Californians has risen by 2 million over the past decade. More than 6.9 million California adults are now obese.
  • Diabetes among adults has also risen over the past decade, from 6.8 percent to 8.6 percent of adults.
  • The percentage of children in poverty has increased from 18.5 percent to 23 percent over the past five years.
California's best and worst category rankings:

Smoking – 2nd
Early Prenatal Care – 3rd
Occupational Fatalities – 4th
Infant Mortality – 5th
Lack of Health Insurance – 45th
Air Pollution – 50th


Thursday, November 1, 2012

"Covered Califonia" - New Name For CA Health Ins. Coverage

We finally have a new name for our California Health Insurance ... are you ready?
It is ......  Covered California 

Here are all the details as written today by David Gorn in the Capital Desk Column of California Healthline.  Here you go:

"Exchange Picks New Name: Covered Californiaby David Gorn
The California Health Benefit Exchange board voted Tuesday to adopt a new name for the health insurance coverage it will offer starting January 2014 -- Covered California.

The decision comes after months of work. In August, the long list of potential names was winnowed to about a dozen possible names -- including CaliHealth, CalAccess, Wellquest, PACcess and Covered California. The list alos included unusual trademark names such as Ursa, Healthifornia, Eureka, Beneficia, Cal-Vida and Condor, as well as the crowd favorite, Avocado.

After designing logos, holding focus group meetings and running trademark searches, that list was cut down to four finalists in September: Ursa, Eureka, CaliHealth and Covered California. Trademark concerns emerged around Ursa and CaliHealth, and those names were dropped, said Chris Kelly, who made the final name presentation to the exchange board.

Kelly presented final logo designs to the board for Covered California (tagline: "Your destination for affordable healthcare"), a related-but-separate design for Covered, CA and Eureka ("Where California discovers affordable healthcare"). After gauging the final set of focus group opinions, Kelly said the recommendation to the board was to go with Covered California.

Eureka was seen by focus groups as more of a private insurance program, Kelly said. Covered California was particularly well-liked by the Latino population in the focus groups, and by almost two-thirds of respondents overall.

"We're looking for a brand consumers can relate to, and inspire them to enroll in health care in the exchange," said Oscar Hidalgo, director of communication and public affairs at the exchange. "This is a real pivot point for us, using that brand and tagline and logo for future campaigns to help consumers relate to our mission. We're still working on a few other things to complement that, and that should be done by the next exchange board meeting."
The next steps, Kelly said, are to secure the final trademark and finalize the logo and tagline, which should be done by Nov. 12. Those final designs should be ready for the next exchange board meeting, he said, on Nov. 14."

California Health Insurance

Wednesday, October 24, 2012

California Scores High In Quality Of Hospitals!

It's always a good thing to know that our hospitals are good ones! And ... it looks like California is doing well in that category!  Given the costs of healthcare, it's especially good to know that we have the best care in our local access.   
Get the details in this article just reported in the California Healthline as written by  Lloyd in USA Today:

Report Finds California Among States With Best Hospitals
California is among the states that scored highest for hospital care related to conditions and treatments commonly linked to mortality, according to a report released by Healthgrades, USA Today reports.
Details of the Report

The report ranked states and individual hospitals based on data released by CMS between 2005 and 2011.
Researchers examined data on 4,500 hospitals nationwide, focusing on four key conditions and procedures commonly linked to mortality:

  • Coronary artery bypass graft;
  • Heart attack;
  • Pneumonia; and
  • Sepsis.

The four conditions and procedures account for 54% of all hospital-related deaths in the U.S.
Main Findings

According to the report, states with hospitals that provided the best care for those conditions and procedures were:
Illinois; and
States and areas with hospitals that provided the worst care related to those conditions and procedures were:

Washington, D.C.; and
West Virginia.

According to the report, patients had a 55% lower risk of dying and a 42% lower risk of having complications when treated in the best hospitals.
Evan Marks -- a lead author of the study -- said that the differences in hospital quality in various states are "substantial."

Researchers also found that the quality of care can vary widely among hospitals within a single state.Nancy Foster -- vice president of quality and patient safety policy for the American Hospital Association -- said that individuals also need to know how factors not accounted for in the study affect health outcomes.She said, "People come to [hospitals] ... far sicker if they're from a low income area," adding, "They might have multiple complications" and "might struggle to find healthy food" or "a safe place to exercise." She said, "All are important components of good health outcomes" (Lloyd, USA Today, 10/23).

Wednesday, October 17, 2012

It's Medicare Open Enrollment!

It's Open Enrollment from now until December 7, 2012! 

So what? It's a pretty big what as this is the time you can increase, decrease, change, delete, adjust your medicare coverage! Beyond this window of time you are stuck!  It's that simple. 

If you still have questions and/or concerns you should contact your insurance agent. I also found this posting written by Marilyn Tavenner, Acting Administrator at The Medicare Blog.  Think she says it pretty well in very readable language. Hope you enjoy. 

Per the words of Marilyn Tavenner:  

"It’s picking season – pumpkins, apples, Halloween candy…and a Medicare health or drug plan." 
"In my work with Medicare, one of the questions people ask me often is which plan is the best one. That’s not something I can answer, because picking a plan is an important and personal decision. Each person has a unique set of priorities. How do you weigh your options? Now’s the time to think about what matters to you, and pick the Medicare plan that meets your needs.

When you sit down to review your Medicare health and drug plan choices this year, keep track of the things you may want in a plan, and pick one that’s right for you. Here are some things to keep in mind while you consider your choices:

You should look at your current health care costs to find coverage that works with your financial situation. How much are your premiums and deductibles? How much do you pay for hospital stays and doctor visits? Just like with everything else, the lowest-premium health plan option might not be the best choice for you.

Are the services you need covered? We know future health care needs can be hard to predict, but changes happen. Maybe your doctor changed your prescriptions this year or you have different health concerns. Make sure you understand what services and benefits you’re likely to use in the coming year and find coverage that meets your needs.

Your time is valuable. When comparing plans, make sure you check which doctors and hospitals you’ll be able to use. Where are they located and what are their hours? Check which pharmacies you can use. Can you get prescriptions by mail? Remember that even if you’re happy with your current plan, these answers might change from year to year.

Quality of care
Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes."

Marilyn also invites you to call 1 800-medicare.  I also invite you to call me here at if you have questions or need to discuss alternatives to your existing coverage.   You can find me at 800-792-9114    714-840-0047 

Thursday, October 11, 2012

Who Is A Full Time Employee Under The New Healthcare Act

If  you've been listening to the news the last couple of days, you've probably heard that the owners of Lobster House and the Olive Garden are changing some employees to part time workers vs. full time to save costs on the reformed healthcare laws.  Think we will see more of this as the days go forward and businesses need to see how adaptations can affect their bottom lines both positively and negatively.     

If you are in a position of reviewing who is full time and/or part time you may benefit from this article written and posted by Tina Bull on October 9th, 2012 in the PSA Perspective, by  PSA  Insurance and Financial Services.  
"The Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer affordable, valuable minimal essential coverage to all full-time employees or pay a penalty. This requirement is referred to as the employer shared responsibility requirement and is effective January 1, 2014.

ACA defines a full-time employee as one who has an average of at least 30 hours of service per week. Proposed regulations are expected to provide that 130 hours of service in a calendar month will be treated as the monthly equivalent of 30 hours of service per week.

The IRS has issued Notice 2012-58 to describe safe harbor methods an employer may use to determine if current employees and new “variable hour” employees must be treated as full-time employees for purposes of the shared responsibility requirement. An employee may be considered a “variable hour” employee if, based on facts and circumstances, it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

Ongoing Employees

For an ongoing employee (i.e. an employee who has been employed at least one standard measurement period as described below), full-time status may be determined under the safe harbor by calculating the employee’s actual average weekly hours of service during a specified look back period. This specified period is referred to as the standard measurement period and is a defined length of time between three and 12 consecutive calendar months.

If the employee averaged 30 or more hours of service per week during the standard measurement period, then health coverage must be offered to that employee during a subsequent stability period (of at least six months and no shorter than the standard measurement period). This coverage is provided to the employee for the entire stability period without regard to the number of hours of service the employee has during the stability period. However, another measurement period will commence for purposes of determining whether health coverage must be offered during the next stability period.

Between the measurement period and the stability period, an employer may use an administrative period of up to 90 days to notify and enroll eligible employees.

Employers will likely establish a standard measurement period immediately preceding annual open enrollment, an administrative period that coincides with open enrollment, and a stability period that matches the plan year. This means that the first standard measurement period may start as early as October 2012.

New Employees

For new variable hour and seasonal employees, the safe harbor method is similar. However, the initial measurement period and the administrative period combined cannot extend beyond the last day of the thirteenth full calendar month of employment. The initial stability period must be the same length as the stability period for ongoing employees.

In addition, certain hours of service during the initial measurement period will also be counted toward the next standard measurement period that begins after the new employee’s date of hire. A variable hour employee who is determined to be full-time during the initial measurement period must be offered coverage during the full initial stability period, regardless of the average number of hours of service during the first standard measurement period.

If a new employee is reasonably expected to work full-time at the date of hire, then the safe harbor method for variable hour and seasonal employees does not apply. The employee must be initially classified as full-time and coverage must be offered to the employee at or before the conclusion of the employee’s initial three calendar months of employment.

Reliance and Comments

Employers may rely on the safe harbors for measurement periods that begin through 2014 and related stability periods that may extend into 2016. The IRS has asked for comments on the following: other safe harbors for categories of employees that present special issues, other guidance that may be needed to determine full-time status, measurement/stability period issues during a merger or acquisition and how seasonal worker should be defined.

While the safe harbor methods are optional and may be administratively challenging for employers, use of them will provide certainty that an employer will not be subject to the ACA penalty for failing to offer coverage to all or substantially all full-time employees."

Monday, October 8, 2012

New CA Laws Preparing State for New Healthcare Insurance

It is all rolling along at a fast clip!!  CA is getting ready for Obama Care!  Gov Brown just signed into CA law the following items ... probably just the first of many??  

Here is the list as published in the LA Times and written by Scott J. Wilson
October 7, 2012

"Gov. Jerry Brown signed into law last week a set of measures aimed at preparing California for coming changes in how consumers get healthcare insurance. Some of the laws:

• To head off deceptive marketing attempts, AB 1761 bans unauthorized individuals and businesses from claiming to represent the California Health Benefit Exchange, the new central marketplace for buying insurance that goes into effect in 2014.

• Beginning in 2014, under AB 792, Californians who lose their health insurance because of job loss, divorce or legal separation will receive information about reduced-cost plans available through the health exchange and no-cost coverage from Medi-Cal.

• Self-employed people will be covered, under AB 1083, by California's law governing small business health insurance. Previously, businesses had to have at least two employees to qualify. Backers argued that the change, effective in 2014, will expand the availability of affordable coverage to entrepreneurs.

• Insurers hoping to sell policies through the state exchange will have to meet minimum coverage standards as established by AB 1453 and SB 951. The new laws, supported by Consumers Union and other groups, designate two Kaiser HMO plans as the state's "benchmarks" for benefits and services.

• The state's Managed Risk Medical Insurance Board, which oversees plans that help those who cannot get health insurance elsewhere, will get increased subsidies under AB 1526 to lower rates consumers pay. Legislative analysts estimated the bill will cost the state $16 million in 2013."

Wednesday, October 3, 2012

Privacy Rights .... When On Parent's Health Insurance Policy!

Thought this article written by Michelle Andrews and provided by Kaiser Health News was especially interesting.  Generally the ability for young adults up to the age of 26 to remain on their parents health insurance has been received as an excellent enhancement. BUT ... what about the privacy rights of the young adults??  Hmm... read on!  Here is some input from Michellel Andrews.
Elizabeth Nash was 21 and just finishing her junior year at the College of William & Mary when she had a miscarriage. She planned to tell her parents about it in person, but her insurer beat her to it when, as a matter of routine, it mailed them a form that described the medical treatment she'd received.
Nash says the experience "caused a rift that took a while to repair."
Nash, now 38, recently co-authored an analysis of state laws on health-care confidentiality for insured dependents for the Guttmacher Institute, a reproductive health organization, and was surprised to find that state laws in this area are "so lacking and vague and mushy."
Under the Affordable Care Act, which allows adult children to stay on their parents' plans until they reach age 26, breaches of privacy such as the one Nash experienced may become a growing problem. Since the law passed, more than 3 million young adults have gained coverage, according to the Department of Health and Human Services.
Although parents must give consent for most care provided to children younger than 18, many states allow minors to consent on their own to such potentially sensitive services as testing and treatment for sexually transmitted infections, prenatal care and delivery, contraception and outpatient treatment for mental health and substance abuse.
The privacy rule of the federal Health Insurance Portability and Accountability Act (HIPAA), which took effect a decade ago, generally prohibits the unauthorized disclosure of individuals' medical records and other health information. But there's a catch. Health-care providers and insurers can generally use such information when trying to secure payment for treatment or other services.
And that can be problematic. Providers submit bills to insurers, which process them and generate a document, often an Explanation of Benefits (EOB) form, that tells the insured or the policyholder how much the insurer paid and what, if anything, is owed on the bill.
These communiques are important to combat fraud and identity theft, and many states require that they be sent, according to Nash.
But the documents do not always go to the person who was treated. "The notice could go to your parents or to you, depending on state law, insurance contracts and insurance policy," says Abigail English, director of the Center for Adolescent Health and the Law, and lead author of the analysis published by the Guttmacher Institute.
English says it's "extremely common" for insurers to send EOBs to the policyholder rather than the patient.
Under federal privacy regulations, patients can request that insurers not disclose confidential information or ask that they send it to an address of their choosing. Insurers are required to comply if not doing so would endanger the patient, says English, for example, if it posed a threat of domestic violence.
"Plans typically do have procedures in place to deal with the disclosure of sensitive information," says Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade group.
Some insurers have made strides in addressing confidentiality issues related to billing and other communications. Cigna, for example, redesigned its EOB forms to strip out specifics about the treatment or services provided, says Joe Mondy, a spokesman for the company. The form, which typically goes to the policyholder, does name the facility and the provider, however.
In addition, unless the law requires it, the insurer sends an EOB only if there's a balance due.
Policy experts say strategies such as Cigna's make sense. That's especially true given the expansion in free preventive services under the Affordable Care Act. Starting in January, for example, many women in new health plans or in those that have changed their benefits enough to lose grandfathered status will be eligible for such services, including contraceptives, counseling and screening for sexually transmitted infections, and screening and counseling for domestic violence.
"With more insurance coverage of contraception, there will be more issues of whether insurers are protecting confidentiality," says Tina Raine-Bennett, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Oakland, Calif., who is chair of the Committee on Adolescent Health for the American College of Obstetricians and Gynecologists.
Although protecting young women's privacy poses a challenge for insurers, "I do believe there will be a net gain in having those services," she says."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Tuesday, September 25, 2012

To Buy Health Insurance Or Pay The Penalty??

Which are you planning on doing?  The time will soon be here where there will be a tax penalty to pay if you do not have health insurance.   You may purchase health insurance directly from a provider, through a state created insurance exchange ( with or without qualifying for credits, i.e.discounts), or through a company group plan!  

It looks like, from the following article that the penalty is going up!  So do do your homework.

Here is info written by Ricardo Alonso-Zaldivar on September 24, 2012 in the Insurance Journal: 

"Nearly 6 million Americans — significantly more than first estimated— will face a tax penalty under President Barack Obama’s health overhaul for not getting insurance, congressional analysts said. Most would be in the middle class.

The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises.

The numbers from the nonpartisan Congressional Budget Office are 50 percent higher than a previous projection by the same office in 2010, shortly after the law passed. The earlier estimate found 4 million people would be affected in 2016, when the penalty is fully in effect.

That’s still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000.

And the budget office analysis found that nearly 80 percent of those who’ll face the penalty would be making up to or less than five times the federal poverty level. Currently that would work out to $55,850 or less for an individual and $115,250 or less for a family of four.

Average penalty: about $1,200 in 2016."

You may read the entire article here:

Saturday, September 15, 2012

CA Consumer Complaint Study

Did you know that there is a Consumer Complaint Study (CCS) published by the California Department of Insurance (CDI) to assist insurance consumers as they shop for insurance. In addition to using this study, consumers should also consider coverages, premiums, agent service, and insurer financial strength before buying a policy.
The Consumer Complaint Study is a combination of two studies which provide informational data. The primary study is the Justified Complaint Study (Composite Ratio) which ranks the insurance companies according to their justified complaint ratio. The secondary study is the Company Performance and Comparison Data Study.
Click on the following link to view Consumer Complaint Study.  Hope this information is useful to you!

The above is taken from the CA website:

Wednesday, September 12, 2012

10 Services Of CA Dept Of Public Health

How much do you know about the California Department of Public Health.  Here are 10 of their primary services:
  1. Monitoring health status to identify community health problems including health disparities.
  2. Detecting and investigating health problems and health hazards in the community.
  3. Informing, educating, and empowering people and organizations to adopt healthy behaviors to enhance health status.
  4. Partnering with communities and organizations to identify and solve health problems and to respond to public health emergencies.
  5. Developing and implementing public health interventions and best practices that support individual and community health efforts and increase healthy outcomes. 
  6. Enforcing laws and regulations that protect health and ensure safety.
  7. Linking people to needed personal health services and ensuring the provision of population-based health services.
  8. Assuring a competent public health workforce and effective public health leadership.
  9. Evaluating effectiveness, accessibility, and quality of public health services, strategies, and programs.
  10. Researching for insights and innovative solutions to public health problems. 

Sunday, September 9, 2012

Got A Healthcare Question? Live In California?

As written by David Gorn
The Department of Managed Health Care recently received a $4.6 million federal grant to fund its consumer assistance program to help answer questions from California consumers about health coverage.

"This will enable us to reach and assist more Californians who are struggling with health coverage questions," said Marta Green, deputy director for communications and planning at DMHC. "The focus of the grant is on consumer assistance for Californians," Green said, "and in particular to help seniors and people with disabilities, who have more specific needs."

The California Department of Insurance and the Office of the Patient Advocate stand to benefit from the grant money, as well, according to Green. "It is a single-applicant grant, but DMHC will distribute some funding, such as to OPA for data collection, and to CDI for enhancement for the health center." DMHC is working with nonprofit, community-based service organizations to work in a proactive way to reach anyone with concerns about coverage, rather than waiting for questions to appear. "The community services groups are sort of our boots on the ground," Green said. That includes data collection across different programs, she said, "which allows us to spot problems and any trends emerging. And that's a very good thing."
So, heads up to all who are connected to community organizations that could benefit from the above.  Get yourselves known and use this new service here in CA.   Trust me, you will have questions!!! 

Friday, September 7, 2012

Great Tips For Doctor Visits & Taking Care Of Yourself

Thank you AHRQ for these tips ... some great tips for your next visit to a new doctor or even one you've been using!

Before Your Appointment

  • Bring all the medicines you take to your appointment. This includes:
  • Prescription medicines.
  • Non-prescription medicines, such as aspirin or antacids.
  • Vitamins
  • Dietary or herbal supplements.
  • Write down the questions you have for the visit..
  • Know your current medical conditions, past surgeries, and illnesses.

During Your Appointment

  • Explain your symptoms, health history, and any problems with medicines you have taken in the past.
  • Ask questions to make sure you understand what your doctor is telling you.
  • Let your doctor know if you are worried about being able to follow his or her instructions.
  • If your doctor recommends a treatment, ask about options.
  • If you need a test, ask:
    How the test is done.
    How it will feel
    What you need to do to get ready for it.
    How you will get the results.
  • If you need a prescription, tell your doctor if you are pregnant, are nursing, have reactions to medicines, or take vitamins or herbal supplements.
  • Find out what to do next. Ask for:
    Written instructions.
    Web sites.
After Your Appointment

  • Always follow your doctor's instructions.
  • If you do not understand your instructions after you get home, call your doctor
  • Talk with your doctor or pharmacist before you stop taking any medicines that your doctor prescribed.
  • Call your doctor if your symptoms get worse or if you have problems following the instructions.
  • Make appointments to have tests done or see a specialist if you need to.
  • Call your doctor's office to find out test results. Ask what you should do about the results.

Free Tools
The Agency for Healthcare Research and Quality (AHRQ), an agency within the U.S. Department of Health and Human Services, supports research that helps people make informed decisions and improves the quality of health care.

AHRQ offers these free resources to help you make decisions about your health care:

  • Questions are the Answer: 
    This Web site lets you make a list of questions that you can bring to your medical appointments and gives you tips on talking with your doctor.
  • Consumers & Patients:
    This page links to consumer information on staying healthy, getting high-quality health care, and more.
  • Your Medicine: Be Smart. Be Safe:
    This booklet answers common questions about getting and taking medicines and has a wallet card to help you keep track of your medicines. Order a free copy by calling 1-800-358-9295.

Friday, August 31, 2012

Should Doctors Be More Sensitive To Costs?

Interesting article written by  Alicia Caramenico on the value of training interns on being aware of the cost of their decisions for medical care. It's a fine line but an interesting idea. See what you think!  Here is the article as it appears in Fierce Healthcare. 

The Hippocratic oath requires physicians to abstain from doing harm--but does that include financial harm?

With medical bills as the number once source of personal bankruptcy, teaching hospitals are encouraging students to consider health costs, the Chicago Tribune reported.

Some, including the University of Chicago's Pritzker School of Medicine, want to take it a step further and add "do no financial harm" to the Hippocratic oath.Vineet Arora, an assistant dean and associate professor of medicine, is developing training videos to make medical students more aware of how the costs of their decisions will affect patients.

"We are totally insulated from price, what medical care actually costs the patient," Andrew Levy, a recent med school graduate who is working with Arora, told the Tribune. "I can't tell when a test I order becomes a bill or if and when my patient gets charged by it, and that's absurd."

Medicals schools already have started incorporating cost control into future doctors' curriculum, according to first-year Harvard Medical School student Ilana Yurkiewicz. But in her Scientific American blog post, she acknowledged that it may be more difficult to include cost in decision-making when face-to-face with patients than during hypothetical scenarios in a classroom.

Moreover, cost considerations can become a slippery slope between reducing unnecessary medical costs and rationing care. So healthcare educators emphasize teaching medical students to look for alternatives that their patients can afford, the Tribune noted.

However, it's not only prospective doctors that can benefit from cost awareness. Reminding practicing physicians how much money blood tests cost could cut unnecessary medical spending, according to a study published last year the journal Archives of Surgery.

Saturday, August 25, 2012

California Health Insurance Rate Regulation News!

This is important for all to know regarding California health insurance.  The article is written by Sandy Kleffman of the Bay Area News Group. Here you go ..... 

An initiative that would bring health insurance rate regulation to California has qualified for the November 2014 ballot, setting the stage for a vigorous and costly battle between insurers and consumer groups. 
The measure, sponsored by Consumer Watchdog, would give the state insurance commissioner the power to deny certain premium increases if they are deemed excessive. The insurance commissioner has little control over such rate hikes now.
The initiative would apply to the individual and small group health insurance markets, but large employer group plans would be exempt."We're thrilled that voters will get the chance to decide whether or not it's time to rein in outrageous rate hikes," said Carmen Balber, a spokeswoman for the Consumer Watchdog campaign."We expect a battle royale," she added. "We have no doubt that the health insurance industry will throw down tens of millions of dollars to oppose this."

Opponents have already begun to organize their campaign.
"This flawed, costly measure is not real health reform," said Patrick Johnston, president and CEO of the California Association of Health Plans, in a statement. "This measure would give one politician too much power over health coverage, do nothing to address the underlying costs driving health care premiums and create an expensive and duplicative state bureaucracy that will be paid for with higher health insurance premiums."

Consumer Watchdog had hoped to qualify the initiative for this year's ballot. But after a random sample of petitions failed to produce enough valid signatures, counties did a full signature check, pushing the count past the deadline for this November's election. On Thursday, the Secretary of State's office announced that Consumer Watchdog had gathered the required 504,760 signatures.
Balber said having the election in 2014 may be good timing because it will occur as the national health reform law takes full effect, including a mandate that most Americans have coverage."The price and affordability of health insurance will be at the top of Californians' minds," she said."

Friday, August 24, 2012

Employer Wellness Programs - A Good Thing!!

Saw this post written by the editorial staff at EBN, Employee Benefit News and wanted to share it with you, especially if you are an employer offering group health insurance for employees.  Even small businesses can provide some sort of "wellness" program for their employees and it appears to be a "good thing!"  Read on ....

"The Principal Financial Group, in its annual ranking of the 10 best American companies for employee financial security, has seen a marked increase in wellness initiatives. An independent panel of judges selected firms they saw as leaders in worker long-term fiscal stability, and the winners ranged from a Maryland nonprofit to a pair of Arizona credit unions. What all 10 had in common was employee wellness programs.

“When the program began 11 years ago, we saw some companies attempting wellness,” says David Wray, president of the Plan Sponsor Council of America and one of the seven judges, “but today all winners offer wellness programs in some meaningful way.”

Apart from any direct medical benefits, companies reaped rewards for their efforts in a variety of ways. For example, with comprehensive engagement and communications that include wellness programs, Principal’s top 10 saw an average voluntary turnover rate of 9.8%, compared to a national average of 24%. And those of sound body also had sound portfolios.

“Healthier employees spend less on medical care, leaving to more to save,” says Luke Vandermillen, Principal vice president. “Beyond physical health, these companies offer a number of ways to impact the long-term financial health of their employees through income protection and retirement programs with generous employer matches and contributions.”

The Principal program honors growing companies, or those with between five and 1,000 employees. This year’s winners were:

  • American National Bank of Texas, Terrell, Texas
  • Arizona State Credit Union, Phoenix, Ariz.
  • Cypress Creek Emergency Medical Services,  Spring, Texas
  • Dunmore Corporation, Bristol, Pa. (manufacturing)
  • Flow Science, Inc., Santa Fe, N.M.; (software development)
  • M3 Insurance, Madison, Wis.
  • nLogic, LLC, Huntsville, Ala. (information technology/software)
  • The United States Pharmacopeial Convention, Rockville, Md. (nonprofit )
  • Vantage West Credit Union, Tucson, Ariz.
  • WHR Architects, Inc.,  Houston, Texas

Tuesday, August 21, 2012

How Well Do Your Employees Understand Their Healthcare Benefits?

Thought the following post written by Christine Dugas of USA Today was very interesting and wanted to share with you.  If you are an employer offering health insurance to your employees make a special effort to read this.  It is about how little employees know about what they choose for their health insurance benefits.  Employers would be smart to offer some education on the benefits as well as the benefits themselves. 
Here we go  ... from the written hand of Christine: 
As the open-enrollment season for health benefits approaches, many workers will be making some bad choices, according to a new survey.
"Far too many people don't really understand their benefits," says Audrey Tillman, executive vice president of Corporate Services at Aflac. "In fact, most employees are on autopilot." The majority of American workers — 56% — estimate that they waste up to $750 each year because of costly mistakes they have made with their health insurance benefits, according to the Aflac WorkForces Report, a July survey of more than 2,000 consumers released today.  That could represent four months of the grocery budget for a single person.
"Health insurance is complicated with all of the different terminology that goes along with it," says Carrie McLean, a consumer specialist at "And people have gone through open enrollment with their eyes closed."   This is the second year Aflac has conducted a health care survey, and the situation is getting worse, Tillman says. In 2011, 24% of workers were confident about their decisions, vs. 16% this year.
Among common errors that Aflac found:
Many employees, 89%, say that they simply elect the same benefits options every year.
Nearly half of workers (47%) say that they rarely or never exceed their deductible costs.
Only 16% contribute the right amount to flexible spending accounts
Americans clearly understand that it's an important issue. Rising out-of-pocket medical expenses are one of the most costly financial burdens they face, say 43% of workers, Aflac found. As benefits change, workers need to pay closer attention to their selections during open enrollment, the experts say. This year, many plans have increased the in-network deductibles, emergency room co-payments and prescription drug co-payments, said the PwC Health Research Institute annual report published in May. And nearly six of 10 employers (57%) are considering increasing employee contributions to health plans, the PwC report says.
There also are some new plan benefits that could help workers as more companies offer financial incentives to promote wellness and health-improvement programs. Although workers need better health plan information so they can make smart choices, what employers tend to do is give them a packet of 20 to 50 pages, and say read through this and decide which option you want to pick, McLean says.
"It was shocking to me when I saw that 52% of employees in our survey said that their company does not communicate with them at all about the open-enrollment process," Tillman says. "But if the benefits are not appreciated, or understood, or utilized in a way that is meaningful to employees, it's a waste on the employers as well," Tillman says
End of Christine's article.  
What do "you" think?  How up to par are your employees in their understanding of their health care benefits?  Are you doing your part in helping them choose what's best for their individual needs?  Taking the time to do so can come back to you in the form of strong loyalty!   Sounds like a good employee quality to me!

Monday, August 20, 2012

Future Of Medigap

Came across a question recently pertaining to the future of medigap policies under the new healthcare law.  Something very interesting to be aware of.  Read on and pay attention to the "good" reasons for lessening the full coverage terms of some medigap plans. Think you'll be as amazed as I. Here is the question as found in Kaiser Health News: 

Q. How will the new health law affect Medigap policies? I’m on Medicare with a Medigap Plan F. Premiums are rising 20 percent a year. It’s a real strain for me.

A. The health care overhaul doesn’t make any immediate changes to Medigap policies, but it sets the stage for potential changes to Plans C and F in 2015.

One in five Medicare beneficiaries has a Medigap policy to supplement their coverage under the traditional Medicare program. The standardized policies, which are identified by letters, cover coinsurance, deductibles and services not covered by Medicare to varying degrees.

Plan F and Plan C are the most popular Medigap plans, chosen by nearly two-thirds of beneficiaries. Those are also the policies that provide significant "first dollar" coverage: they pay the deductibles for both the hospital and outpatient portions of the traditional Medicare program (Parts A and B) as well as the 20 percent coinsurance required for doctor visits, and cover other services as well. People with these supplemental plans may pay virtually nothing for medical services beyond their premiums.

And that has policymakers concerned. If people don’t have to pay anything out of pocket for doctor visits and other medical care, there’s no financial incentive to get only the care they really need. Studies have shown that people get less medical care when they have to make some sort of financial contribution, though they skimp on both necessary and unnecessary care.

A 2009 study conducted for the Medicare Payment Advisory Commission found that medical costs for people with Medigap policies were 33 percent higher than the costs of beneficiaries without supplemental insurance.

"So the thinking has been that if you prohibit first dollar coverage and require some cost sharing when beneficiaries see a physician, it might encourage them to see the physician only when they need to," says Gretchen Jacobson, a principal policy analyst with the Program on Medicare Policy at the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

There have been a number of proposals put forward in recent years that would reduce Medigap coverage in some policies and require beneficiaries to pay more. To date, nothing has changed.

But the health care overhaul opens the door to changes in the future. Under the law, the National Association of Insurance Commissioners is required TO evaluate the benefit packages of Plans C and F with an eye toward adding nominal cost sharing by 2015.

Even if that happens, however, it’s unclear whether it would affect you or other current policyholders, says Jacobson.  "The changes might only apply to new policyholders," she says.

By Michelle Andrews
Kaiser Health News