Tuesday, November 13, 2012
Monday, November 12, 2012
Wednesday, October 24, 2012
Tuesday, October 23, 2012
Tuesday, July 31, 2012
Friday, July 27, 2012
Friday, June 22, 2012
Wednesday, June 20, 2012
Tuesday, May 15, 2012
Wednesday, May 9, 2012
Tuesday, May 8, 2012
Thursday, May 3, 2012
GAO Report Finds Many Adults Have Pre-Existing Conditions –
On Thursday, the Government Accountability Office (GAO) released a report that found as many 122 million adults in the U.S. suffer from a pre-existing health condition, which could result in a health insurer denying coverage, requiring higher-than-average premiums, or restricting coverage. The report compared several recent studies that tried to determine how many U.S. adults have pre-existing conditions, based on the prevalence of certain common conditions. Starting in 2014, the Health Care Reform Law prohibits insurers from denying coverage, increasing premiums or restricting benefits because of an existing or prior health problem.
In response to increased attention to pre-existing conditions and the individual market, America’s Health Insurance Plans (AHIP) posted information on their blog intended to provide a fact check on coverage for pre-existing conditions. Specifically, the blog post notes that the vast majority of people under the age of 65 get their health care coverage through their employer, are guaranteed coverage regardless of pre-existing conditions, and the premiums they pay are not based on their health status. Additionally, AHIP emphasizes that requiring plans to cover everyone is closely linked to the individual mandate, which the Supreme Court is currently reviewing.
U.S. House Ways & Means Committee Releases Report on PPACA’s Financial Incentives for Employers to Drop Health Coverage
On Tuesday, the U.S. House Ways and Means Committee released a report entitled “Broken Promise: Why ObamaCare Will Force Americans to Lose the Health Care Coverage They Have and Like.” The report follows Committee Chairman Dave Camp’s (R-MI) letters to the CEOs of the Fortune 100 companies – 71 of whom responded. Highlighting aggregate data the panel received from the companies, the report builds a narrative around the fiscal incentive that employers may have to drop employer-sponsored health insurance as a result of the Law. According to the report, these employers could save hundreds of millions of dollars a year under the new Health Care Reform Law by simply dropping their employer-sponsored health insurance and moving employees into the Law’s new health Exchanges.
Based on the report’s data, if all 71 respondents stopped offering health care and instead paid the employer mandate penalty they could save a total of $28.6 Billion in 2014 (an average savings of over $400 Million per company) and $422.4 Billion from 2014-2023 (an average savings of nearly $6 Billion per company). In a statement, Camp said, “The findings of the report, along with existing research, show that the Democrats’ health care law threatens the stability and sustainability of the employer-based health insurance system. Anyone who gets insurance through their job should be worried about what will happen next, because there is a distinct financial incentive for employers to terminate health care coverage under the Democrats’ health care law.”
Thursday, April 19, 2012
Friday, April 13, 2012
Tuesday, April 3, 2012
Monday, April 2, 2012
Friday, March 30, 2012
What a doctor knows about ObamaCare
By Dr. Marc Siegel
Published March 30, 2012 | FoxNews.com
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Insurance does not equal care. One patient’s needs can get in the way of another’s needs. My waiting room is like so many others in America, and when it is clogged with several patients with low-paying highly-regulated insurance, the waiting time goes up and the access to quality medical care goes down.
With all due respect to Supreme Court Justice Sonia Sotomayor, though it is true that everyone will get sick and need health care eventually, it is not true that health insurance automatically provides you with that care.
I can tell you as a practicing physician that the regulations and restrictions and red tape of health insurance (all increasing under ObamaCare) hamstring my office staff and interfere with my ability to take care of you.
What does provide an uninsured patient access to health care are laws that mandate that a hospital emergency room can’t turn you away when you are sick.
A false premise of ObamaCare is that mandating insurance for all somehow enables the ERs take care of all comers. In fact, studies show that Medicaid patients are much more likely to use the ER unnecessarily than are the uninsured. This clogs the ER and interferes with life-saving treatments for other patients.
Plus, the states, overburdened with administering the Medicaid expansion, will inevitably cut reimbursements to the hospitals, lowering the bottom line payments a hospital receives even as its volume increases.
Though politicians may even have the best of intentions when they compel you -- in defiance of the Constitution, in my opinion -- to purchase a product known as health insurance, in fact they are not even achieving their stated goal of providing for the public good, since this insurance doesn't equal care.
There wouldn’t even be a case before the Supreme Court if Congress and the president had stayed within their roles and expanded the National Health Services Corp and federal clinics expressly designed to care for the underserved. If there is a public health care need then let's get our government to provide for it directly.
In my office, and doctors’ offices across the country, the response to ObamaCare has changed.
Two years ago, when the law was passed, there was a pocket of patients who worked part time, had no health insurance, and looked forward to the day when they would be covered. But that early group of optimists has given way to a much larger group who worry that they will lose the employer-provided coverage they now have, and end up being forced to the state exchanges where they will be compelled to purchase (if the mandate survives) a policy they can’t afford with an inadequate federal subsidy.
Most of my patients are rooting for the Affordable Care Act to unravel especially if the individual mandate is declared unconstitutional. -- Transcripts and audiotape from the court this week make this possibility appear likely.
If ObamaCare somehow survives with or without the mandate, 16 million new Medicaid patients will quickly find out what current Medicaid patients already know; that it is very tough to find a doctor or network of doctors who will work with your insurance.
ObamaCare’s Independent Medicare Advisory Board and other regulatory committees and mandates will make it more and more difficult for doctors like me to practice and to order the tests and treatments we feel our patients need. We will require more staff hours to deal with all the red tape. As more of us drop out and no longer accept insurance, another unconstitutional mandate will become necessary to compel doctors to participate again.
Doctors everywhere are hoping and praying that dreaded day never comes. Even though the individual mandate and perhaps all of ObamaCare now appears to be in serious jeopardy thanks to the Supreme Court, doctors and their patients are not yet starting to breathe easier.
Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A team and author of several books. His latest book is "The Inner Pulse; Unlocking the Secret Code of Sickness and Health."
Friday, March 23, 2012
Thursday, March 22, 2012
Friday, March 16, 2012
Wednesday, March 14, 2012
Tuesday, March 6, 2012
Wednesday, February 22, 2012
Wednesday, February 15, 2012
Monday, January 30, 2012
Wednesday, January 25, 2012
Tuesday, January 24, 2012
Selecting the Right LTCI Policy For You:
- First and foremost, in order to qualify for a LTCI policy, the applicant must be reasonably healthy both physically and mentally at the time of application. The rate an agent quotes you may not be the rate you ultimately receive because the insurance company will medically underwrite your application and may find some adverse information in your medical records that cause the carrier to consider you a higher risk.
- Even though you may have been turned down by one LTC insurer, another company offering similar coverage may approve your application because it has more lenient underwriting guidelines that will make you an acceptable risk.
- Carefully study the policy’s criteria for determining when a policyholder becomes eligible for benefits (often referred to as benefit triggers) after satisfying the waiting (elimination) period. More liberal benefit triggers can be an advantage to the consumer.
- The better LTCI policies offer greater flexibility as to where and what kind of care is provided and therefore cover more options:
- Assisted Living Facilities
- Durable Medical Equipment
- Nursing Home Facility
- Home Modifications
- Adult Day CareHospice Services (not covered by Medicare)
- Respite Care while a caregiver (including a spouse or relative) takes a vacation.
- Home Health and Personal Care including meal preparation, chore services, light housekeeping, medicine monitoring, assistance with Activities of Daily Living.
- Have a clear understanding of how the insurance company credits days toward satisfying the policy's elimination period, the time between the qualifying event and when benefits actually commence. Under the Calendar Days Method, every day of the week counts toward the elimination period even though no services are provided on some days. With the Days of Service Method, only days you actually receive covered services are counted toward this waiting period.
- Even though the Compounded Inflation Rider (usually 5%) can significantly increase the premium, it is strongly recommended that this option be selected, especially for younger applicants (say under 65 or 70), as opposed to no adjustment for inflation or the less expensive Simple Inflation Rider. On average, long-term care services are escalating at a rate of 5% compounded per year.
- Consider a policy that has a longer Elimination Period to help lower premiums. One suggestion might be a waiting period of between 45 to100 days since there is a possibility that Medicare (for those age 65 and over) may cover some portion of this waiting period for medically-necessary services performed at home or in a rehabilitation or nursing facility.
- Consider a LTCI policy with a 3 to 5 year benefit period since the premiums are less than policies with 7 year or lifetime benefit periods. The average length of stay in a nursing home for persons 65 and older is about 3 years.
- Benefits are usually paid out under one of three different approaches:
- Expense-Incurred Method – the most common payment arrangement; benefits are paid to either the policyholder or the provider when a covered expense for an eligible service is incurred once the elimination period has been satisfied.
- Indemnity Method – Once the insurance company has determined you are eligible for benefits and the elimination period has been satisfied, benefits are paid to the policy-holder on a daily, weekly or monthly basis while receiving long-term care services regardless of the actual cost of those specific services rendered until the up lifetime limit has been met.
- Disability Method – The policyholder is only required to meet the benefit eligibility criteria; once satisfied, you receive the full daily benefit even if you are not receiving any services on a particular day.
- The better policies often include:
- Guaranteed Renewable provision so long as payments are made within the grace period.
- A Bed Reservation Benefit to set aside your bed in a nursing home or other facility while you are being treated in a hospital or rehabilitation unit.
- A generous (60 days +) Grace Period if premiums are late and written notification to alert your designated next-of-kin or friend of the delinquency.
- A Respite Period of up to 14 or 21 days (consecutive or non-consecutive) to enable your care-giver (even a family member) time off for a vacation.
- Payment for services to an Independent Care-Giver who is not associated with a private or public homecare agency.
- Care-Giver Training to instruct a family member or friend to provide long-term care assistance to the policyholder living at home or returning from a care facility.
- A substantial (up to 30% or even 40%) discount on each policy when two applicants living together (husband/wife, domestic partners, siblings) apply to the same insurer and are approved at the same time. Some companies give a lesser discount to the approved policyholder even though the spouse/partner who applied at the same time is turned down.
- International Coverage if residing or traveling in a foreign country, usually with limits on the amount or length of benefits to encourage return to the U.S.
- If financially feasible, the policyholder is well advised to pay the premium on an annual basis to realize greater premium savings. Insurance companies often charge a significant interest surcharge for monthly and quarterly modal payments.
- Marketed under different names, a Share(d) Care, Shared Benefit or Joint Benefit Coverage Rider for couples (spouses, two partners or related adults) may give a couple/partners piece of mind in knowing that if one partner uses up all of his/her benefits, that infirmed policyholder has access to the benefits of the healthy partner. Were the second set of benefits to also be exhausted, the policy usually allows the healthy partner to have his/her original benefits reinstated.
- The abilty to assign a younger relative or friend as a second person to be notified by the insurance company should the premium payment not be received within 30 to 45 days of the due date. The backup assignee is then able to contact the insured to make arrangements for paying the delinquent payment and to assess the reason for the delay in payment. If the the policy is canceled for lack of timely payment and the insured is determined to have a cognitive impairment, the contract should provide for the carrier to reinstate the policy without penalty or limitation.
Thursday, January 19, 2012
Wednesday, January 18, 2012
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