Cincinnati Pioneers “Health Coaching” Program in Partnership with Kroger

by LAS

The City of Cincinnati partnered with Kroger and Anthem Blue Cross Blue Shield of Ohio to run a pilot program for 600 employees and retirees. The programs offer “health coaches” in Heart Healthy Coaching and Diabetes Coaching for some amazing results.

The enrollees were compared to a control group and saw statistically significant results. Enrollees were better at adhering to medications, and blood pressure dropped 4 percent. Kroger's clinical development manager stated that just a 2 percent drop in BP can mean a 10 percent drop in stroke deaths.

Emergency room visits dropped 40 percent with the group in the Heart Health program, compared to the general population. Participants in the Diabetes Coaching program saw an astonishing 90 percent drop in cardiovascular-related ER visits.

Those who did not participate in the program saw total cardiovascular medical costs triple, compared to a drop of 11 percent for the enrollees.

A carrot was held out to participants in the form of deep discounts on their medications as long as they were active in the coaching program. Co-pays were waived.

The first visit with a coach typically lasted an hour, when the patient declared what their goals were, and the coach started to guide them through the kinds of decisions they were making.

Many times, an enrollee would meet with a dietician who would walk the participant through the grocery aisle and help her decode food labels so she could make smarter choices. Sometimes the pharmacist is the coach for someone who has several medications or has questions or concerns.

As of 2012, Kroger was exploring whether it could expand the program to other chronic conditions such as asthma or chronic obstructive pulmonary disease. Kroger rolled out the program to all 17 of its Cincinnati-area stores. Meantime, the City of Cincinnati is looking for other claims and pharmacy data that could show whether the program is succeeding or not, and by how much. 

Telemedicine Cutting Costs of Health-care While Improving Outcomes

by LAS

The innovation of offering telemedicine – where patients contact their doctors by phone, email or online – is not only helping shave the cost of health-care but is also helping patients manage ongoing health problems more successfully.

Employers and insurers are both hopeful that telemedicine will potentially keep more patients out of the emergency rooms who do not need that level of care.

Often patients go the ER because they have no other options, either they have no insurance or no local urgent care clinic or the clinic is closed at that hour that they need it. So telemedicine is really offering a medical advice service that is on-call 24/7.

It may shock you to learn that in 2009, there were 136 MILLION emergency room visits, and that at least 20 percent (and by some measures as much as three-quarters of them) could have been properly treated either in a clinic by their primary-care provider or in an urgent care facility. Given that the average ER visit costs at least $1,400, channeling those visits into other options has a high priority.

The good news is that telemedicine is getting rave reviews from users, never mind the insurers. Upwards of 90 percent of patients who used telemedicine gave it a positive approval rating.

One such telemedicine provider is STAT Doctors in the Scottsdale, Arizona area. Scottsdale began offering the telemedicine option and began seeing benefits: lower costs of course, but also decreased absenteeism.

Many employers offer call-a-nurse services as part of their healthcare plan. If more employees took advantage of that service, maybe a true form of telemedicine with access to physician consultations would be deployed.

Looking ahead, applications designed for wireless home-based health care services and advice is expected to grow from a $304 million-dollar market to $4.4 BILLION by the end of this year. 

Four Medical Tests for Women Over 50; Four Medical Tests for Men Over 50

by LAS

Dr. Oz has been promoting the value of four basic medical tests for men and women age 50 and over to catch the most serious health problems early.

FOR MEN--

1- A PSA test. Recommended on an annual basis for men age 50 and over. You might get the test at age 50 just for a baseline reading, but Dr. Oz still feels that annual testing provides essential information for your healthcare provider.

2- Colonoscopy. Colon cancer is the third most common cancer in men.

3- Hearing test. Going to the audiologist is recommended especially for men, who more often work with power tools, jackhammers, or in noisy environments. Hearing loss affects about a third of adults over age 65, and almost half of all men over 75. Tinnitus (ringing in the ears) is also a reason to see your doctor.

4- Not a single medical test, but a head-to-toe skin check to catch changes in moles or other abnormalities that can signal skin cancer.

FOR WOMEN--

1- Bone Scan-- Osteoporosis can lead to bone fractures particularly in women past menopause. If you are identified as having a bone-thinning disease, you may elect to take bisphosphonates to curb further bone loss. Other approaches such as weight-bearing exercises or dietary changes can also fend off further bone loss.

2- Colonoscopy-- Colon Cancer kills more women than ovarian, uterine and cervical cancer combined. Testing can start at age 50, though you only need to take it once every decade.

3- Mammogram-- A baseline test is suggested at age 40, then annual tests after age 50. Your doctor may want annual tests earlier than that if you have had any family history of breast cancer.

4- Pap Smear Test-- Annual testing is suggested for most women of any age. You could elect to drop this test after age 65, though, since one's risk drops off greatly after that if you have had mostly clean screenings.

Smokers Cost Employers $12K More Per Year (each) than Non-smokers

by LAS

Studies show that each smoker costs a company an average of $12,000 a year more than non-smokers. Inspired by a California study that showed every dollar spent by the state on smoking-cessation programs saved $18 in health care costs – more employers are moving to start smoke-free policies or tobacco-cessation programs in the workplace.

Employers do have to skirt some smokers' rights laws in a few states to avoid discrimination lawsuits if they become too invasive.

In just 29 states, the employers are limited to prohibiting smoking in the workplace, and states may prohibit smoking in public places. They have what is called “lifestyle laws” that protect workers. Employers may not take smoking into account regarding promotions, hiring or firing.

These laws, one must admit, are pretty toothless. It is difficult to prove that an employer violated the law because they know enough to provide some other, innocuous reason for not hiring or promoting someone.

Some of the state laws are even weaker. The Virginia law apply only to state employees. Three states – Minnesota, Illinois, and Montana – protect smokers rights but allow employers to charge higher premiums for the smokers. Three states – Tennessee, Louisiana, and Colorado – apply their protection of smokers to future hires, not current employees (when the law was passed).

Smokers who try to quit generally have to make many attempts before it sticks. Statistically, it takes seven attempts for a smoker to quit smoking. So keeping trying, you never know what approach will finally help you reach your goal.

More Than Two-thirds of ER Visits Avoidable, Says Study

by LAS

A recent study by Truven Health Analytics found that 72 percent of emergency room visits were avoidable, and could have been safely treated by a primary care provider. Truven drew upon a database of 24 million patients.

Healthcare situations were broken down into four categories of urgency. Category One is Non-emergent; medical care was not required within 12 hours.

Category Two is Emergent – Primary-Care Treatable; medical care was required within 12 hours but could have safely been delivered in a primary care setting (that is, in a clinic office).

Category Three is Emergent, (preventable or avoidable); this means that the patient needed medical care within 12 hours, for could have been prevented with effective office visits. An example of the latter would be someone who had diabetes or high-blood pressure who was not taking their medication as advised, and suddenly had a sudden event such as a stroke.

Category Four is Emergent (not preventable or avoidable); these are the kinds of events that people normally associate with an ER visit – a child falls out of a tree, someone is a victim of a car accident or shooting, someone is hit by a softball in a game, a homeowner falls off the roof, etc.

Some events were split between two categories, such as “abdominal pain, unspecified site” since there is a 33 percent chance of it being a serious problem requiring emergency treatment and a 67 percent chance of being something that could be looked at in your doctor's office.

The good news that only 6 percent of patients had an event that could have been prevented with proper primary care. That suggests that people are taking existing conditions seriously, taking their medicine, and making sensible lifestyle decisions.

Almost half (42 percent) could have been acceptably treated by their primary care provider. No reason was floated for why patients did not go to their physicians. Possibly they felt they could not get into a treatment room in a timely fashion.

One quarter had serious conditions but did not require treatment within 12 hours. Presumably they could have gotten into their primary care provider within that time, or gone to an urgent care center.

When broken down by age, it was shocking to see that three-quarters of the visits by children age four and under were of a nature that should have been seen in a primary care setting. Whether the parents had health-care coverage for minors was not addressed in this report. But still, these health events should have been seen in a primary care setting by a pediatrician who was familiar with the child's background.

Steering patients to the proper non-ER setting would by itself create huge cost savings for not only insurers but the patients, who presumably would have come up with much larger copays for an ER visit. 

Gee, Does Medical Tourism Mean I Can Go To Appleton???

by LAS

I ran across a mention that a hip replacement costs only about $27,000 in Appleton, Wisconsin, while it can cost as much as $126,000 in a major metro area such as Houston, Texas. Why the disparity?

Obviously wide variations in income levels between major metro areas and smaller towns are a big factor. But also the fact that the hospital has to pay much higher property taxes and other expenses in a big city is another major factor. It may also have to buy another lot to build a parking structure on for patients and visitors, while the small town has free street parking.

The small town hospital might also sacrifice some frills, too. 

Joe Schmo and Mrs Schmo and the Inherited IRA

by LAS

Joe Schmo can leave his IRA to your surviving spouse (Mrs Schmo) or child (Johnny Schmo), no problem. But doing it right can avoid a big tax bite. This is according to Jane Bryant Quinn, so if your local finance advisor is at all confused over how to handle this, tell him that.

Mr Joe Schmo has a very fine IRA, but one day he kicked the bucket. Fortunately he designated Mrs Schmo as his beneficiary.

Mrs Schmo has to put this IRA in her name. This is called retitling. With a traditional IRA, she has to leave the money alone until she reaches age 70 and a half, when the law requires her to start making withdrawals. (NOTE: With a Roth IRA, you can keep money you do not need in the IRA for the next generation.)

Mrs Schmo is under 59 and a half, so this is how she should re-title this IRA: “Joe Schmo IRA (deceased MO-DAY-YR) for the benefit of Jane Schmo, beneficiary.”

When Mrs Schmo reaches 59 and a half, she ought to re-title it once more, this time in her own name. This has the advantage of allowing her to let the money accrue value until she need it, or rather when she is required to make withdrawals at age 70 and a half.

Now, let's say that a parent leaves the balance of an IRA to an adult child. The child also has to re-title the IRA. Joe Schmo leaves his IRA to his only child, Johnny Schmo, so Johnny has to re-title it like this: “Joe Schmo IRA (deceased MO-DAY-YR) for the benefit of Johnny Schmo, beneficiary.” (if there are several children, each one should re-title his or her share of the IRA)

Note that inherited 401(k)s can also be similarly retitled as an inherited IRA.

There is a book out there on this specific topic, “Retire Secure! Pay Taxes Later” by James Lange. 

“Payable-on-Death” or Power of Attorney to Avoid Inheritance Taxes?

by LAS

Bereaved parents who added an adult child to their bank accounts have found that the state can tax their own money as an inheritance, if the child dies an untimely death.

Laws in Pennsylvania, Indiana, and Nebraska tax inheritances. Also, Iowa, Kentucky, Maryland and New Jersey tax inheritances but exempt parents from being assessed this tax. (NOTE: When I lived in Wisconsin I had to pay inheritance tax to the state as well as the federal government; I have no idea why Wisconsin is not on this list.)

So keep this in mind if you live in those states and you wish to have an adult child handle bills for your funeral and other debts without waiting for probate to be settled. We have found that most banks will allow you to put the name of an adult child on your account under the terms of “payable on death” – which would have avoided the cases of parents paying taxes on their own money because of an untimely death of the designated child. 

One Nagging Question About Qualifying for PPACA Exchanges

by LAS

One of the nagging questions that keeps bothering me about the states insurance exchanges is whether the people who need it will be be able to get coverage.

The PPACA law was intended to expand Medicaid coverage to all low-income adults under age 65 beginning in 2014. This would have brought 16 million uninsured under the Medicaid umbrella – assuming income of up to $15,415 for an individual and $26,344 for a family of three.

However, the Supreme Court ruled that the states can decline (opt out) of the expansion of Medicaid. About a dozen governors have said they will not expand Medicaid in their states, or are leaning in that direction. Now, since the Supreme Court ruled on this matter, I hear that the federals are trying the ol' carrot-and-stick approach with the recalcitrant states in question.

While I am on the subject of PPACA, here is what goes into effect in 2014:

by LAS

Several provisions of the PPACA law, aka Obama-Care, will go into effect in 2014. Let's review them now.

First, we should mention that the “employer mandate” has been pushed back to 2015. No word on what happens then.

Second, rules regarding waiting periods will go into effect. The most important provision is that waiting periods for health care coverage can no longer extend past 90 days. This may be a bit tricky for employees who work seasonal or variable hours. In that case, it may be that these employees might not be covered at all in 2014 if the employer requires its employees to work a minimum number of hours to be covered.

Third, pre-existing conditions cannot be used as a grounds for denying a policy nor for denying treatment for that condition. Plans cannot discriminate against persons for any of a range of health factors. Plans cannot impose restrictions on eligibility or charge more for coverage based on health history, etc. Women cannot be charged more than men. Also a part of this clause is that all employees must be given comparable healthcare plans; that is, high-income employees cannot get gold-plated plans and everyone else gets a tin version.

Fourth, starting in July 2013, employers start paying one dollar per employee into a fund for the Patient-Centered Outcomes Research Institute, which will collect and publish data relating to effectiveness of medical treatments. The assessment goes up to $2 per employee for years 2 thru seven, when it is designed to terminate.

Fifth, rewards for meeting requirements under wellness programs will increase from 20 percent of cost of coverage to 30 percent. Wellness incentives for quitting smoking will increase up to 50 percent.

Sixth, the so-called “donut hole” in Medicare Part D prescription coverage will shrink until it is eliminated in the year 2020.

Seventh, the individual mandate may (or may not) also be pushed back, but there was never any provision for sending people to jail for not buying insurance. People may lose all or part of a tax refund, or pay an annual tax for 2014 of one percent of income or $95, whichever is greater. 

The House tries yet again to delay or gut Obama-Care mandates; And who is behind all these attempts

by LAS

The GOP-dominated House has yet again passed a bill to delay or gut key provisions of the PPACA (aka Obama-Care) law. This week they passed bills to delay implementation of two key provisions, the individual mandate and the employer mandate (for businesses with 50 or more workers).

First of all, even though the House has made several attempts to delay or gut provisions of the reform law, it is very unlikely that the Senate will even discuss comparable bills on the floor. In fact, the House has voted 37 times already to “repeal or defund at least part of the health-care law, including three times to annul the entire measure” since 2010.

The Obama administration said in a statement that the measure to delay the employer mandate is “unnecessary,” and legislation postponing the individual requirement “would raise health insurance premiums and increase the number of uninsured Americans.”

However, House members of the GOP ran on promises to delay or defund PPACA in 2010 or 2012, and so they wish to make a little political hay during the summer months by keeping the issue on the House floor.

But my question is more about who is behind all these attempts to gut the bill. The key is the the employer mandate applies to companies with 50 or more employees. Specifically, companies that may have thousands of employees.

What many Americans may not know is that the PPACA law includes something called the non-discrimination clause. This has nothing to do with the color of a policy-holder's skin or what religion he or she believes in.

As it is now, companies can design deluxe healthcare plans for executive employees,as long as the plan was fully insured. But the non-discrimination clause in Obama-Care applies to ALL group healthcare plans, in terms of eligibility or benefits. The fact is that current healthcare plans treat different groups of employees differently. Most people are aware that the top brass gets the best perks package in the company. But most people may not be aware that even their healthcare plans are different, and that the PPACA specifically bars this and penalizes this practice.

First let us define the term “highly compensated” employees. This group includes the five highest-paid officers of the company, the shareholders who own 10 percent or more of the company, and all employees among the top 25 percent of all the company's employees.

Violators of the non-discrimination rules will be subject to stiff fines. This starts at $100 per day, per “failure penalty” – which will likely apply to each NON-highly-compensated employee who is left out of the cushy coverage plans. The company is also vulnerable to a civil lawsuit to compel it to provide the same upscale coverage plan to the non-covered employees.

Multiply that $100 per day per non-covered employee for a large multinational corporation, and you are talking about a significant hit to the corporate pocketbook. For a company with say, 500 employees, this easily adds up to a fine of $37,500 PER DAY. This is where I believe the pressure is coming from on House members to keep trying to negate provisions of the PPACA law.

Corporate America really believes that the executive class has to be lured to work for a given company with the most extraordinary gold-plated perks of every kind. Not being able to offer a healthcare plan that has no deductibles and no copays seems like a small loss when they are offering a company car, country club and health club and golf club memberships, the proverbial key to the executive washroom, stock options, and much more.

The employer mandate is being delayed for one year with White House permission. And the government has stated that there will be a phasing-in period where employers will be given time to make adjustments before the government begins sanctioning those that do not comply. But still I would not be surprised if corporate America tries to get all current healthcare plans to be grandfathered under the law, thereby escaping all sanctions and fines entirely. 

Why health insurance premiums are tumbling in New York under Obama-Care

By LAS

The Washington Post of July 17 reports that health insurance premiums in New York state will plummet under PPACA (aka ObamaCare) provisions – some at least by half and some to as little as a third of the cost before controls take effect.

According to the Post, “Individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly,” Roni Caryn Rabin and Reed Abelson report. “With federal subsidies, the cost will be even lower.”

New York has had a law since 1993 that insurers have to accept anyone who applies for a health care insurance policy, no matter what kind of pre-existing condition they might have. That explains the highest premiums in the country. In fact, the Post explains it in scintillating simplicity thus: “New York has, for 20 years now, been a long-running experiment in what happens to universal coverage without an individual mandate. It’s the type of law the country would have if House Republicans succeeded in delaying the individual mandate, as they will vote to do this afternoon. The result: a small insurance market with very high insurance premiums.” (my bold)

However, now that some of the provisions of the PPACA law are taking effect, healthy individuals who had believed that they would always be healthy and never have to have medical care, will now be contributing to the pooled coverage, and bringing the average cost of healthcare (AND insurance premiums) down. Yes, DOWN.

That is why the House attempts to gut the individual mandate are very disturbing and will only serve to undermine the promised savings of the program. So far, the Senate has not caved in to Republicans or to the corporate pressure to delay or delete sensitive provisions of the PPACA program. Let's hope it stays that way!

[For original story in the Washington Post, you may go to http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/17/heres-why-health-insurance-premiums-are-tumbling-in-new-york/ ]

A Few Examples of Unusual, Humane Senior Care

by LAS

Here are a couple examples of humane senior care programs around the country. These are not the only ones out there, but we just wanted to let you know that you have choices when it comes to placing an aging parent in some kind of facility.

DAY CARE – at NIGHT

The Elder-Serve at Night program offered by The Hebrew Home in the Bronx, New York.

Similar to senior day care where adult children drop off a parent while they go to work, this one allows adult children to sleep when the senior is prone to wandering at night.

Patients can just socialize with the other patients, paint, do yoga, listen to live music. Therapies are offered – physical therapy, light therapy, and even aromatherapy.

Staffers are present at all times to provide services, and dispense medications if needed.

NO RULES for DEMENTIA PATIENTS

The Beatitudes Campus in Phoenix is flexible enough to accommodate patients who want a late dinner and a bath at 3 am. There are nurses who can play the piano, so that patients who remember little else can sing the lyrics to old songs. If a patient does better without medications, then he or she may be taken off the drugs.

The Campus provides a calming atmosphere that helps everyone to remain calm and engaged in things that they enjoy.

RURAL RETREAT for SENIORS

The Life Care Cneter of Nashoba Valley is a rural facility in the Littleton, MA area. A resident llama named Travis allows residents to pet him.

Staffers work at figuring out what triggers upsets and what kind of prop or activity will soothe them. For one person, music is soothing. For another, who was a former librarian, just holding a book is comforting.

Best wishes in finding the right place for a beloved but brain-damaged or senile parent.

Hospital “Merger Mania” Leading to Higher Bills for Patients

by LAS

Nationwide, we are seeing more and more concentration of medical care via mergers, acquisitions, joint operating agreements, and partnerships with doctors and other providers. However, these mergers rarely result in a cost savings for either the consumer or the hospitals themselves.

Over 100 hospital mergers took place in 2012, and the pace shows little sign of slackening. What advantage does this have for the hospitals? One effect is that by banding together, hospitals have greater bargaining power – but not, as you might hope, to negotiate lower prices with suppliers. Nope. The hospitals band together to bargain with the insurers for HIGHER payments.

This is partly due to less competition in a given city or county. With fewer providers or networks, the consumer cannot just go across the street for a knee replacement.

Less competition translates as higher costs to the consumer – a study published in 2011 showed that private insurers paid 13 to 25 percent more for procedures done in areas with less competition.

The increased cost is often paid by hapless consumers in the form of higher copays, higher insurance premiums, higher deductibles, and miscellaneous fees.

The real insult is that the quality of care has little relationship to the cost of care. Studies have not found any improvement in quality to match the increase in costs. 

A similar hospital merger boom in the 1990s resulted in increased patient costs of anywhere from 5 to 40 percent.

Another End-Run Around ObamaCare that Employers May Try: Cutting Hours Down to Part-Time

By LAS

It is well for workers to be aware that if ObamaCare does in fact become the law of the land for group plans as currently scheduled, employers may try yet another end-run to get out of having to comply – a risky end-run, but nevertheless, they could be tempted to try it.

That end-run is to cut affected employees' hours to less than the mandated 30 hours-per-week work schedule which triggers qualification for benefits.

I am told that “countless” employers and advisors are seriously considering this game-playing, this strategy to undercut the unpopular (among corporations) costs of ObamaCare.

However, employees who face loss of eligibility for any benefit should know that this may trigger legal ramifications that could prove costly to the employer if he should try this strategy. 

Employees are covered by provisions of the ERISA law – specifically, Section 510 (which in turn refers back to Section 502).

The pertinent paragraph of ERISA Section 510 states:

“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan – or for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.”

Aha! We gotcha now, you think. Well, maybe – depending on how much of a junkyard dog your attorney is.

Now, this is not affected by a short-term cut in hours due to a slow period. Many industries have slow periods in the spring or summer, and then ramp up sharply for the fall or winter. This is true of retail, for example, or of the tire business.

BUT if the SINGLE MOTIVE for cutting hours is to deprive employees of qualifying for any employment benefit – which includes ObamaCare – then the company faces legal shaky ground and fines for doing so.

The company stands to be assessed penalties for violating ERISA law. The Department of Labor can assess these fines if the company is found guilty of violating ERISA law, and these penalties are assessed FOR EACH INSTANCE of such violation of the law. Put into other words, the company will have to pay for each employee affected by their shenanigans.

How do you go about exercising your rights under the ERISA law? First you have to start a civil action against the company complaining of the loss of your ERISA rights, or complaining of their retaliation for exercising your rights under ERISA.

Keep a little diary or journal for each day from the moment that the company announces that some employees will have a cut in hours. Keep copies of any newsletters or memos related to this action. Note how many hours a day you worked. Keep this and other pertinent papers together in a little file or large envelope.

And good luck!

We Will Have to Watch Congress like Hawks to Keep Them from Repealing ObamaCare

by LAS

While the current political situation (i.e. – factional infighting) keeps any one party from being able to repeal the Affordable Care Act outright – that will not stop them from attempting the “death by a thousand cuts.” In other words, according to the National Association of Underwriters (an arm of the insurance industry), lobbyists will attempt to get individual provisions of the act repealed by inserting lines into other bills.

The insurance industry will be working with friendly members of Congress to insert language repealing just one given provision of the Affordable Care Act into bills that may about entirely unrelated matters. And they will do this for each provision of ObamaCare until it looks like Swiss cheese and totally useless for providing healthcare to those who need it. 

Supreme Court decisions on DOMA rules will affect gays' insurance, pensions, and more

by LAS

The recent Supreme Court decisions on the Defense of Marriage Act (DOMA) solidifies gays' rights in the 12 states that recognize same-sex marriage, but still leaves unclear areas in the other states. However, in those 12 states, gay couples will see personal benefits in healthcare coverage, pensions, annuities, 401(k)'s, and might possibly extend to COBRA and the Family Medical Leave Act.

It is pretty clear now that gay couples who live in those 12 states, who have for example, a pension plan in effect, will be able to draw survivors annuities rights. If the plan provides for a maximum benefit of $1500 per month, then the survivor could apply for a benefit check of at least $750 per month. Also, if a surviving spouse had already been receiving such survivor benefit checks, and those were taxed by the federal government, the survivor can now apply for a refund of that tax now that the benefit is not taxable.

Persons affected by these changes will still have to wait while employers prepare updated materials and forms related to these medical and pensions plans. So please, be patient, because this is not going to happen overnight – and typically employers have until the end of the year after such a ruling to get things in order. Again, be patient, because the employers have to make sure all the i's are dotted and t's crossed, and there are a lot of legal and tax implications to be thought through.

Still unclear are all the implications and applications when the couple was married in a state that recognizes gay marriage but no longer reside in a state that recognizes gay marriage. That could easily happen if a couple worked in New York, which does, and retires to Florida, which does not. Companies are still unclear on how a change in residence would affect coverage. Another area that needs clarification is in the case of companies that operate in several states – are they only bound by the laws in states where they have offices, or only the state where they are incorporated? In any case, it will be a tangled mess to prepare paperwork for employees in the several states where they have employees.

It is always a tangled mess that the courts weave, and employers and insurance companies will need some time to untangle it. 

set this one for 9 pm Sat., July 6

by LAS

California recently crowed that premiums for the new insurance exchange plans would be lower than current plans offered. However, that is because some of the most expensive doctors and hospitals were cut out of the provider networks covered by the exchange plans. Also, copays and other out-of-pocket charges will cost more for the patients.

With less than 90 days now remaining until the Oct. 1 target date for getting the states' exchanges up and running, it seems likely that even if they do get activated, consumers will likely find glitchy websites and application processes, and rather high premiums.

Still, coverage will be a relief for people who previously could not get a healthcare plan at any price, or at a prohibitive price. 

Buying All Your Health Insurances From Same Company May Not Be Best Strategy

by LAS

Unlike with casualty insurance, where the consumer is usually entice with some very nice discounts for buying both Home (or Renter's) insurance from the same company as your Auto insurance, bundling all your health insurances usually does not offer the same savings.

Buying both Health and Dental, or Physician and Hospital, insurances through the same carrier may be more convenient for you to pay the premiums every month, but they offer no savings otherwise.

In fact, because you automatically assumed that there was a discount offered and given, you may have failed to even shop around for a better deal or better coverage.

I recommend the following strategy---

IF you are carrying a High-Deductible, High-Copay policy, then by all means get yourself a voluntary policy that will cover Hospitalization. By this I mean a policy through a company other than one that serves your employer -- a fully portable plan that will go with you wherever you work.

My reasoning is this. Your current plan is leaving you vulnerable to mounting bills for high copays on hospitalization, the most expensive type of medical bill there is. To help close that gap, a voluntary policy will cover whatever costs are not paid by your primary carrier.

The second benefit to having this type of voluntary policy, is that the Hospitalization plan will cover you no matter what the reason for your inpatient stay. You may face cancer treatment, wind up in the hospital as a result of a non-workplace accident, or even go in for elective surgery. (Some policies will even cover elective medical care, so check around.)

No matter what the reason is for your stay, that policy will help cover the costs of your medical treatment. And isn't that nice to know?  

And where will all those doctors come from when ObamaCare kicks in, to treat all the new patients?

 By LAS

By now you know that I have been a supporter of the so-called Obama-Care plan, formally known as PAACA, for a long time now. I like the closing of the donut hole, the coverage of all children even those with pre-existing conditions, clamping down on Medicare fraud, and a lot more.

But there are the practical considerations of implementing this broad expansion of coverage to people who have rarely seen a doctor. Where will all the doctors come from to fill the increased demand for healthcare, for face time with a doc?

This is the silent, un-discussed question. It is NOT only Medicare patients who have problems finding a doc who will accept assignment. I refer to finding ANY physician who can fit you into his crowded schedule, once formerly uncovered people become potential or actual patients who need medical attention.

Are we just sending a whole new batch of people to the emergency rooms?