Health Insurance

Can Millionaires Cure Health Care Crisis

February 11, 2018 By Twila Van Leer

Does a record for amassing money and running successful businesses automatically qualify a trio of multi-millionaires to come up with successful solutions to the medical mess America has fallen into?

Jeff Bezos, Warren Buffet and Jamie Dimon think they can. They have announced that they are creating a new company to address health care costs for their U.S. employees. They think their solutions might work for other companies as well.

Their announcement recently sent shivers through people who are heavily invested in established health insurers and triggered a sell-off in their stocks.

Their particulars haven’t been published, but there are clues to what they might suggest based on their handling of their own businesses.

Buffett has Buffett’s Berkshire Hathaway; Bezos runs one of the country’s biggest retailers in Amazon; and Dimon heads JP Morgan Chase. Together, the three have a market worth of $1.62 trillion. They have used unique and daring methods to put themselves at the top of the earnings heap and are noted for inventive ways to meet challenges.

Buffet may have the most experience in the insurance world. Berkshire Hathaway owns several insurers, including GEICO. While that may not translate immediately into health insurance, Buffet at least knows how the market works. He is as long-time critic of America’s health care costs, calling them a “tapeworm” that harms the growth of the economy.

Dimon, as head of the largest U.S. bank in terms of both assets and deposits, also has an understanding of how money works. JP Morgan Chase got a big tax cut under the new national tax plan.

Bezos has cut a wide swath with his innovative approaches to online marketing. Now the richest man in the world, he has used some imaginative approaches to marketing, being willing to cut prices a little to attract customers. Amazon has built itself on that sort of thinking,

The trio said their project will focus on technology to provide simple, transparent care, avoiding the morass that complicates current health care and multiplies costs.

Though only time will tell if they are onto something good, some analysts who are familiar with their past performances say there is a good chance they can pull it off. Jeffries & Co. analyst Brian Tanquilut predicts that the new company will do such things as negotiating directly with health care providers such as hospitals and health care providers, bypassing the companies that act as middleman between patient and provider. That would reduce costs in medical and pharmaceutical chains, he said.

If nothing else the millionaire consortium on health care will shake up the industry and possibly induce new approaches in the market.

Small Businesses Look At Health Care Costs

October 26, 2016 By Twila Van Leer

Rising Healthcare Costs & High-Deductible Insurance Coverage Increasingly Lead Consumers to Negotiate Medical Costs

Autumn. That wonderful time of year for colorful trees, an abatement of unbearably hot weather and the return of children to their schools. For small business owners, the season also means a return to the anxious wait to see if their health insurance rates for employees will go up. And if so, by how much?

Their 2017 premiums could see just minor adjustments upward, or could jump by double-digit figures and for many of the companies that operate on a small margin, it could be the breaking point. Finding workers to man positions in the small companies often depends on being able to provide health insurance.

Prescription Drug Costs

Factors that enter into the health care issue include in which state the business is located and how much its carrier paid in claims in the previous year. But pin the greatest cause of rising health care costs on increasing prescription prices. It’s an issue that has risen to the level of national concern among lawmakers.

Companies with 50 or more employees are required by law to provide employee health insurance. Many smaller businesses do it because they think it is the right thing to do and because it’s a perk that draws better qualified employees.

Health Care Managers

When carriers up their charges, the small business operators sometimes have to decide if they must scale back coverage or find other alternatives. Many companies hire a manager to deal with health care issues. The managers prefer companies that have self-funded plans. Such plans sidestep the 6.5 percent federal tax on premiums.

12% Rise In Cost

Self-funding has inbred risks, but with the costs of commercial coverage rising at the rate of some 12 percent per year, it is an option more employers are considering. Unexpected fluctuations keep the pot boiling. An unexpected drop of 11 percent in premiums had a small businessman in Las Vegas scratching his head, since nothing in his figures had drastically changed. He didn’t ask questions, but took the windfall and added vision coverage to the plan for his employees. Other business owners have simply had to dig deeper to provide the coverage for their workers.

Health Care Spending Per Person Hits New High

October 10, 2016 By Twila Van Leer

Rising healthcare costs are a big concern.

Health Care Problem For New President

Whoever wins the current presidential election will inherit a scary health care reality when he/she takes office. For the first time in history, health care spending in America has topped, on average, $10K per person. That means the new president will be stuck with an unprecedented problem in how to provide the health care that was initiated during the Obama years.

Increase In Total Cost

The bean counters in the Department of Health and Human Services announced the new high last month and predicted that the total cost will increase by 5.8 percent annually from 2015 to 2025. That’s less than the increases from 2007-09, just before the Great Recession, but faster than in the post-recession years, when health care spending kept pace with modest economic growth.

Average Per Person

The per-person average of $10,345 is part of the $3.35 trillion total in health care expenditures expected this year. The annual increase for 2016 is expected to be lower than the forecasts for the rest of the decade.

Attributing Factors

DHHS experts attribute the rise to a stronger economy, faster growth in medical prices and an aging population. The Medicare and Medicaid programs that provide for the elderly and needy are both expected to see new demands as the baby-boomers shift into these categories. By 2025, the experts say, government spending at all levels will account for nearly half of all health care expenditures, an estimated 47 percent.

Obamacare

If Obama’s health care reforms survive attacks from the Republicans, the experts project that more than 90 percent of Americans will have some form of medical insurance.

Republican and Democratic Plans

The figures are causing major angst for both major political parties. Republican nominee Donald Trump has declared he will do away with Obama’s plan while preserving Medicare and seeing that Americans are not “dying in the streets.” Democratic choice Hillary Clinton promises to expand government health care benefits.

Prescription Drug Costs

Both candidates say they will tackle the high costs of prescription drugs and the resultant drain on health care dollars. But the extension of benefits to millions of Americans through Obama’s plan will inevitably add to the overall total unless changes are made.

Out-Of-Pocket

The DHHS report, published in the journal Health Affairs, also predicts that Americans will pay more out-of-pocket for care as the number of people covered by high-deductible plans continues to grow.

Medicare Benefits That May Help

June 28, 2016 By Twila Van Leer

Medicare Benefits

Learning about the benefits of medicare can be a daunting process. In the words of Jaryn Laengrich, chief service officer at Cariloop, a Medicare service to help people caring for elderly persons, it is a “sprawling, complicated piece of law” that can be baffling. She notes these little known medicare services that the eligible may find useful.

Medicare Annual Wellness Screening

Medicare benefits allow you an annul wellness screening by a primary care physician. The objective is to prevent illness where possible. It includes an extensive appointment with a thorough review of the patient’s medical history. An Alzheimer’s screening is part of the exam if the physicians thinks it necessary. The wellness screening is offered through Part B.

Alcoholism Screening

Screening and counseling for alcohol misuse. Widowers over the age of 75 have the biggest problem with alcoholism, according to the National Council on Alcoholism and Drug Dependence. More of those in this demographic are hospitalized with alcohol-related problems than for heart attacks. Annual screening is allowed by Medicare, if performed by a primary care physician. Four counseling sessions will be compensated, as well.

Balance Screening

Falls are a serious problem among the elderly. Medicare B will pay for 80 percent of a thorough screening to determine if balance is a problem and what might be the cause.

Obesity Counseling

Those enrolled in Medicare Part B. who have a body mass index score of 30 or higher may receive counseling in a primary care setting. The program also will pickup a major part of the cost of bariatric surgery aimed at reducing obesity. The amount depends on a patient’s Medigap supplement plan.

Shingles Vaccination

Shingles is a painful and distressing disease that can strike anyone who had chicken pox as a child. The coverage is included in Medicare Part D, which provides for medications.

Diabetes Self-Management Training

Medicare pays 80 percent of the cost of 10 training sessions, including one one-on-one visit with a specialist. The remainder are small-group sessions. The intent is to improve diabetes management. The disease can be debilitating and cause severe effects.

Hearing Tests

Although Medicare won’t pay for hearing aids, it will cover examinations to determine hearing loss. Efforts to get hearing aid coverage have failed to pass muster in Congress because of the scope of the problem. An estimated 37 million Americans suffer some hearing loss, but only 30 percent need hearing aids.

Hospice Care

Many Medicare recipients are not aware that they are eligible for end-of-life care. It is focused on palliative treatment, and is available only to those who are believed to be within six months of death. The patient must agree to forego treatment aimed at curing. Care usually is provided in the patient’s home and involves a team that includes a physician, nurse, social worker, chaplain and volunteer. The objective is to provide as much comfort care as necessary for the patient in his or her final days.

Be Aware Of Health Insurance Glitches

May 2, 2016 By Twila Van Leer

A large percentage of insured Americans receive unexpected bills. — Check to see if your medical appointments are covered by your insurance company. Don’t let your bill be a big surprise.

If you thoroughly understand every twist and turn of your health insurance, you’re one of a rare minority in America. Insurance plans have become so complex it’s hard to tell when you might be stepping outside your network’s coverage.

Unexpected fees

When you are recovering from a medical procedure is not a good time to learn. Unexpected fees might add to the misery. The problem is huge. Nearly a third of insured Americans who have financial difficulties can blame part of the problem on medical bills they were not anticipating, according to a survey conducted by the Kaiser Family Foundation.

Unexpected bills

Some 70 percent of those who received unexpected bills didn’t understand that they were receiving services outside their insurance parameters. Problems often occur when there is a hospitalization in which a number of health professionals are involved. Payment guaranteed to your primary care physician often does not extend to emergency care doctors, anesthesiologists, radiologists and others who provide services.

Out-of-network services

A New York study in 2011 showed that the average cost of out-of-network services was $7,000. Often, medical costs are accrued in an emergency, so it is not likely the patient will be able to ask if those who take over his/her care are on their covered network. They are at the mercy of the system.

How to protect yourself

If you know you are being hospitalized in advance, call the hospital and try to determine who will be involved in your care and if they are part of your network. It isn’t foolproof, since the hospital may not know in advance which individual in a group of experts will take care of you. Also, ask that necessary tests done outside the hospital be sent to network providers.

Call your insurance carrier

If you’ve made those efforts and they don’t fully protect you from unexpected bills, the first thing you should do is call your insurance carrier and tell them the circumstances. Some employer-sponsored plans have policies that consider charges that were made without the patient’s understanding, particularly if they occur during an emergency. Your insurance company may be willing to negotiate with the providers for a lower charge.

Consumer protection agency

See if your state has a consumer protection agency that deals with medical payment issues. At least 10 states do have a program that will help consumers who are hit with unexpected medical charges.

Changing the laws

Experts who have made in-depth studies of the problem say that it will take changes to several laws, usually at the state level, to address the issue. New York has taken steps to protect patients in such instances. Its’ law does not eliminate the fees, but requires the insurance carrier and providers to negotiate.

As the scope of the problem grows, it is likely that resolutions will be sought. In the meanwhile, the majority of patients who are billed for out-of-network services have little recourse except to pay the bills.