Archive for the ‘Insuring Your Health’ Category

Tax Break Can Help With Health Coverage, But There’s A Catch

There are two kinds of financial help for people planning to enroll in the online health insurance marketplaces that will open this fall. One could put people at risk of having to pay some of the money back, while the other won’t.

That’s one big difference between tax credits and subsidies, both of which are intended to help people with lower incomes pay for health insurance through the new health care law.

People with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for individuals in 2013) may be eligible for tax credits to reduce the cost of their monthly health insurance premiums.

In addition, people with incomes between 100 and 250 percent of the poverty level ($11,490 to $28,725) may qualify for cost-sharing subsidies that will bring down their deductibles, copayments and coinsurance. The subsidies also reduce the maximum amount they can be required to pay out of pocket annually for medical care.

Instead of waiting until tax time to claim the credit for the premiums on their return, people can apply to get it in advance, based on their estimated income for 2014. In that case, the state health exchange, or marketplace, will estimate the tax credit and send it directly to the insurer.

But there’s a catch. When April 15 rolls around, the Internal Revenue Service will reconcile the amount of the advance payments sent to the insurer with the taxpayer’s actual income. If a person’s income is higher than the estimate, the taxpayer will have to repay the difference.

But there’s some good news, too. If a person’s income is lower than estimated, the taxpayer will get a credit.

People who quality for the cost-sharing subsidies won’t face the same financial risk. The federal subsidies, which reduce consumers’ out-of-pocket costs, will be paid directly to insurers. They could cover thousands of dollars of costs, depending on a person’s health care usage.

But with the subsidies, if a person’s income changes during the year, he or she won’t be responsible for any extra costs.

“It’s not a reconcilable tax credit, so consumers aren’t on the hook if their income changes,” says Christine Monahan, a senior health policy analyst at Georgetown Health Policy Institute’s Center on Health Insurance Reforms.

So check out both options for cheaper premiums, but be well aware of the differences.

Wednesday, July 10th, 2013

Federal Rule Extends Subsidies For College Students

Beginning in 2014, most people, including students, will have to have health insurance, whether or not they are claimed as a dependent on their parents’ tax returns.

The federal health law says if they don’t, they or their parents will face penalties.

While expansion of coverage under the health law has helped about 3 million young people get insurance through their parents’ plans, many remain uninsured or have coverage through student health plans.

But that’s not an option for some students, who might look to student health plans or the online health insurance marketplaces for coverage next year.

The question has been: are those students eligible for subsidies to buy insurance on the state online insurance marketplaces next year instead of signing up for a student plan?

Although they may not have realized it, students enrolled at some of the country’s top colleges lucked out last week when federal guidelines cleared up a situation that would have made them ineligible for subsidized health coverage.

(more…)

Tuesday, July 2nd, 2013

Why You May Want To Reconsider That Plan With A Health Savings Account

Health plan deductibles keep getting higher — the proportion of workers with a deductible that topped $1,000 for single coverage nearly tripled in the past five years, to 34 percent.

Since high-deductible plans often mean you pay more out of pocket for medical care, it might seem like a no-brainer to sign up for a plan that links to a health savings account so you can sock away money tax free to cover your medical expenses. But there are good reasons to think twice before making that choice.

In order to get the tax advantages of a health savings account, the health plan it’s linked to has to meet certain criteria. In 2013, for instance, an HSA-qualified plan has to have a deductible of at least $1,250 for single coverage and $2,500 for family coverage, and the maximum out-of-pocket limits can be no higher than $6,250 and $12,500, respectively, for single and family coverage.

But HSA-qualified plans have other limitations that consumers often aren’t aware of. For one thing, even though the Affordable Care Act allows parents to keep their adult children on their policies until they reach age 26, they can’t use funds from their HSA to pay for the child’s care after age 24. That’s because “dependent” is defined differently for HSA purposes than it is under the ACA provisions that extend dependent coverage to adult children.

In addition, except for preventive care, which is generally covered at 100 percent and is not subject to the deductible, consumers in an HSA-qualified plan may be on the hook for the entire cost of medical care — including doctor visits, medications, tests and treatments — until they reach their deductible. (They will be charged the negotiated rate their insurer has agreed to pay providers for services, however, not the “rack” rate paid by the uninsured.)

Regular high-deductible plans, on the other hand, offer many more options. In addition to covering preventive care at 100 percent, some function like traditional plans, requiring only a copayment for doctor visits and medicines even before the deductible is met. Or they may offer a limited number of doctor visits with a copayment before people meet their deductible, says Carrie McLean, senior manager of customer care at eHealthInsurance.com, an online vendor.

Consumers need to evaluate the full spectrum of costs and benefits for HSA plans, but the advantages may have nothing to do with medical expenses, she advises. “The true benefit you get from these accounts is because you’re putting money away and you get that tax [savings],” says McLean.

Tuesday, April 2nd, 2013

Today Few Public Family Planning Centers Accept Insurance

Most women can expect to get contraceptives without paying out of pocket for them thanks to the federal Affordable Care Act.

Women who are young or those who are poor and rely on publicly funded family planning centers for reproductive health services are covered, too.

But there’s a catch. Many of the state and local health departments, community health centers, Planned Parenthood clinics and other family planning centers that serve these women don’t accept insurance, not even publicly funded insurance such as Medicaid. Not yet, anyway.

To take advantage of required insurance coverage of these benefits under the law, the centers will have to learn the ins and outs of contracting with insurers and beef up their computer systems pronto, according to a study by the Guttmacher Institute, a reproductive health organization.

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Tuesday, February 19th, 2013

Long-Term Care Protection May Be Toothless

There aren’t many investments people make to protect themselves against something that may happen 20 or 30 years down the road. Yet that’s exactly what long-term care insurance purchasers do.  But a provision in those policies that people rely on to help ensure their coverage will meet their needs decades hence may do nothing of the kind.

The clauses are called “alternative plan of care” benefits. They’re intended to provide coverage for services that aren’t spelled out in the policy but may emerge in the future, says Bonnie Burns, a policy specialist at California Health Advocates, a Medicare advocacy and education organization.

Long-term care policies that were sold 30 years ago, for example, didn’t cover care in an assisted living facility, she says, even though such coverage is common now.

Long-term care insurance offers financial protection if a person needs help with daily tasks such as eating and bathing. Policies typically cover care provided in different settings, whether it’s a nursing home, a private home or an assisted living facility. People usually buy a policy that provides up to a specified daily dollar amount—say $150—for between three and five years.

Burns says that although alternative plan of care clauses can be beneficial, they are honored at the insurance company’s discretion.

“It’s completely up to the company,” she says. “I’ve had situations where companies have refused to pay under that benefit.”

Alternative plan of care clauses may be increasingly important. In the past decade, the average age at which people buy a long-term care insurance policy has decreased from 68 to 59, according to a survey by America’s Health Insurance Plans, a trade group.

When considering a policy, people have to ask themselves: “What’s the long-term care landscape going to look like in 20 years?” says Burns. An alternative plan of care clause may help provide some sense of security, but it’s no panacea.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Tuesday, February 5th, 2013

Health Insurance Prices For Women Set To Drop

Any woman who has bought health insurance on her own probably didn’t find herself humming the old show tune, “I Enjoy Being a Girl.” That’s because more than 90 percent of individual plans charge women higher premiums than men for the same coverage, a practice known as gender rating.

Women spend $1 billion more annually on their health insurance premiums than they would if they were men because of gender rating, according to a recent report by the National Women’s Law Center.

Under the health care overhaul, the practice is banned starting in 2014. But according to the Kaiser Family Foundation’s April health tracking poll, only 35 percent of people are aware of this fact. (Kaiser Health News is an editorially independent program of the foundation.)

Like or loathe the recent Supreme Court decision that the law is constitutional, most people support leveling the premium playing field for women and men. Overall, 6 in 10 people have a favorable view of that provision, according to the poll, including 74 percent of Democrats, 59 percent of independents and 51 percent of Republicans.

Insurers charge women more because they tend to be bigger consumers of health care than men, in part because they’re the ones who get pregnant and give birth.

The health law permits insurers to vary premiums based on four factors: individual vs. family enrollment, age, where the insured people live and tobacco use. That formula will be a substantial change over current practice under which, for example, the NWLC report found that more than half of individual plans charged a 40-year-old woman who doesn’t smoke more than a 40-year-old man who does.

Tuesday, July 17th, 2012

Psychiatric Manual May Soon Include ‘Gambling Disorder’

Can someone actually be hooked on a behavior, like gambling?

Problem gambling isn’t considered a true addiction in medical circles. But that may change as psychiatrists revise the diagnostic manual that spells out criteria for more than a dozen varieties of mental disorders.

Photo by Doug Wheller via Flickr

The proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, would add “gambling disorder” to alcohol and drug problems as a “substance use and addictive disorder” that insurers and others would use to make decisions about treatment and coverage.

“Research and clinical work [indicate that] the underlying pathology and genetics of addiction involve not only substances but may also involve behavior,” says David J. Kupfer, chair of the DSM-5 task force overseeing revisions to the manual, which is produced by the American Psychiatric Association.

The proposed revisions, which are open for public comment, will be finalized and published in May 2013.

The proposed guidelines would add only problem gambling as an addictive disorder, but the designation would clear a path to add other behavioral problems — such as sex or Internet addiction — in the future.

“We’re being very conservative about this,” Kupfer says.

So what sort of behavior makes for a gambling addict? In the past year, people with this diagnosis would have manifested four or more of nine specific behaviors, including a need to gamble with more money to maintain excitement and lying about how much they gamble. Also, to qualify, the gambling excesses couldn’t be explained by an episode of manic behavior.

Tuesday, May 29th, 2012

Smart Shopping Can Relieve Pain From Dentists’ Charges

If you need dental work, chances are you’ll pay a big chunk of the bill out of your own pocket, even if you have dental insurance.

Photo by Michael Rosenstein via Flickr

Dental coverage often maxes out at just a few thousand dollars a year or less and typically covers only half of the cost of major procedures like crowns and root canals.

Getting a reliable estimate of prices in your area can be critical if you want to keep a lid on costs. A free consumer website may provide the information you need.

It’s the work of Fair Health, a nonprofit corporation that was created as part of a 2009 settlement between then-New York Attorney General Andrew Cuomo and insurers.

An investigation revealed that an insurer-owned claims database used to determine out-of-network reimbursements presented a conflict of interest. In addition to the consumer website, Fair Health provides independent-claims data that insurers can use to determine out-of-network rates.

The Fair Health database is regularly updated and contains medical and dental claims from insurers and third-party administrators covering 126 million people. With the database, people can look up out-of-network reimbursement amounts for procedures in their area.

According to Robin Gelburd, president of Fair Health, 40 percent of dental care is provided out-of-network compared with just 10 percent of medical care. That makes the dental cost calculator a potentially useful tool for many consumers.

During a recent search on a zip code in Manhattan, for example, I learned that the estimated cost for a porcelain crown is $2,100 here, making the $1,750 that my dentist charges seem, if not exactly a bargain, at least not highway robbery.

Tuesday, April 17th, 2012

Timing Of Birth Control Coverage May Differ For Students, Profs

Could Georgetown University students like Sandra Fluke have to wait an extra year for free birth control?

There’s a reason to ask the question.

Fluke, in case you missed it somehow, is the law student who testified before the House Democratic Steering and Policy Committee last month about the importance of providing free contraceptive services to students and others at religiously affiliated institutions.

Her comments drew a caustic and mocking response from conservative radio talk show host Rush Limbaugh, who called her a “slut” and a “prostitute.” He later apologized, but many advertisers on his show have reportedly pulled their ads.

Under the health care overhaul, new health plans (or those that change their benefits enough to lose grandfathered status) have to begin providing free contraceptive services to women in August.

(more…)

Tuesday, March 13th, 2012

Convenient Methods For Birth Control Aren’t Always Easy To Pay For

Free contraception has sure been a hot topic lately. But there’s still one facet that hasn’t received much attention.

Photo by Nicole Lee via Flickr

Religious leaders and politicians have debated whether requiring employers to cover prescription birth control for employees gratis — as required under the health care overhaul — tramples on religious freedom.

But what about over-the-counter methods like condoms, spermicides and contraceptive sponges?

Those methods aren’t generally as effective as oral contraceptives, IUDs or hormonal implants. But they have the advantage of convenience, they’re easier than other methods to employ on the spur of the moment.

The largest proportion of women — about 28 percent — use oral contraceptives. Only about 5.5 percent use highly effective alternatives like the IUD and hormonal implants. These methods have high up-front costs, though they’re cost-effective in the long run.

And women’s health advocates expect more women will choose them once price isn’t a factor. Still, some 10 percent of women use over-the-counter birth control.

But insurers often don’t cover these methods unless people get a prescription for them. And that requires thinking ahead. “It loses the convenience factor,” says Adam Sonfield, a senior policy associate at the Guttmacher Institute, a nonprofit research center on reproductive policy.

Of course, making something inconvenient means people may be less likely to take advantage of a benefit, like free contraceptives. “Insurers are betting that a lot of their clients are going to use contraception anyway,” says Sonfield.

Tuesday, February 21st, 2012

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