by LAS
Please read about this shocking story on Associated Content at http://www.associatedcontent.com/article/5632476/the_real_reason_your_hospital_bills.html?cat=3
Please read the original article at Washington Monthly and then raise some hell with Congress: http://www.washingtonmonthly.com/features/2010/1007.blake.html
Showing posts with label cutting medical expenses. Show all posts
Showing posts with label cutting medical expenses. Show all posts
Tuesday, July 6, 2010
Sunday, September 6, 2009
How Much Will You Spend on Healthcare In Retirement?
By L.A.S.
Will Medicare really cover all or most of your health care expenses while you are retired? I witnessed the bills and stress that my parents went through after my father retired, and I am pretty sure that the answer is no.
The most recent surveys of annual out-of-pocket expenses for seniors show that seniors pay anywhere from $3800 to $8300. Again, this is OUT OF POCKET expenses. This does include your premiums for Medicare, which seem to increase every year.
The truth is that seniors spend MORE on out-of-pocket health care expenses than any other age group. Seniors 65 and over spent an average of $4888 per year on out-of-pocket, according to a 2004 study; that included deductibles, copays, insurance premiums, and miscellaneous expenses not covered by insurance.
I might as well take the opportunity to remind you that Medicare does not cover hearing aids, dental care, or vision needs. My mother was actually rather lucky that she had gotten dentures rather early in life and so did not have the rude awakening as to how expensive dental care has become.
Breaking down the senior demographic into smaller divisions shows that the older you are, the worse it gets. Those 65 to 74 spent $3850 a year; those 75 to 85 spent $5060 a year; and those 85 and older spent $8300 a year.
Try to stay out of the hospital. The deductible for a hospital stay under Medicare was $1068 in 2009. If you are unlucky enough to stay in the hospital for more than 60, you will then incur daily charges of $267 a day. After 90 days as an inpatient, those daily charges increase to $534. As a practical matter, the hospital and your doctor will do all they can to get you transferred to an intermediate care facility or released to your home. By an intermediate facility is meant a rehabilitation hospital, a day-care facility, or perhaps an assisted living home.
Medicaid was never intended to pay for long-term care in a nursing home. However, seniors have hit on ways of spending themselves down to poverty-level in a way that allows them to stay in a nursing home they already live in. These strategies include but are not limited to: divorce, transfer assets to children, or setting up irrevocable trusts.
Transferring assets to children is becoming less and less successful with increasing “look-back” periods for determining if you are trying to hide assets. You are subject to a five-year “look-back” period by the state in which you live, and any tangible assets that have been transferred during that time (especially cash, stock, real estate) Medicaid will add to your list of assets.
Seniors eligible for long-term care under Medicaid can keep a house and car, but the house's value is limited to $500,000. The cash assets cannot exceed $2000 for singles and $3000 for couples.
Will Medicare really cover all or most of your health care expenses while you are retired? I witnessed the bills and stress that my parents went through after my father retired, and I am pretty sure that the answer is no.
The most recent surveys of annual out-of-pocket expenses for seniors show that seniors pay anywhere from $3800 to $8300. Again, this is OUT OF POCKET expenses. This does include your premiums for Medicare, which seem to increase every year.
The truth is that seniors spend MORE on out-of-pocket health care expenses than any other age group. Seniors 65 and over spent an average of $4888 per year on out-of-pocket, according to a 2004 study; that included deductibles, copays, insurance premiums, and miscellaneous expenses not covered by insurance.
I might as well take the opportunity to remind you that Medicare does not cover hearing aids, dental care, or vision needs. My mother was actually rather lucky that she had gotten dentures rather early in life and so did not have the rude awakening as to how expensive dental care has become.
Breaking down the senior demographic into smaller divisions shows that the older you are, the worse it gets. Those 65 to 74 spent $3850 a year; those 75 to 85 spent $5060 a year; and those 85 and older spent $8300 a year.
Try to stay out of the hospital. The deductible for a hospital stay under Medicare was $1068 in 2009. If you are unlucky enough to stay in the hospital for more than 60, you will then incur daily charges of $267 a day. After 90 days as an inpatient, those daily charges increase to $534. As a practical matter, the hospital and your doctor will do all they can to get you transferred to an intermediate care facility or released to your home. By an intermediate facility is meant a rehabilitation hospital, a day-care facility, or perhaps an assisted living home.
Medicaid was never intended to pay for long-term care in a nursing home. However, seniors have hit on ways of spending themselves down to poverty-level in a way that allows them to stay in a nursing home they already live in. These strategies include but are not limited to: divorce, transfer assets to children, or setting up irrevocable trusts.
Transferring assets to children is becoming less and less successful with increasing “look-back” periods for determining if you are trying to hide assets. You are subject to a five-year “look-back” period by the state in which you live, and any tangible assets that have been transferred during that time (especially cash, stock, real estate) Medicaid will add to your list of assets.
Seniors eligible for long-term care under Medicaid can keep a house and car, but the house's value is limited to $500,000. The cash assets cannot exceed $2000 for singles and $3000 for couples.
Canadian Drug Prices Up Too -- by Almost 16 Per Cent
by L.A.S.
If you've been idealizing the Canadian health care system because it appears to work while keeping costs under control -- that may be. But the fact remains that overall medical care costs (that is, everything except medications) rose 13 percent in 2008 and just over 14 percent in 2009. And prescription prices rose 15.9 percent so far in 2009.
Canadians are feeling squeezed by the recession just as much as we are. Nervous Canadians are taking advantage of their healthcare benefits, and paying more attention to wellness issues. Among employers, wellness programs are gaining support as a way to control costs while reducing absenteeism and increasing productivity.
If you've been idealizing the Canadian health care system because it appears to work while keeping costs under control -- that may be. But the fact remains that overall medical care costs (that is, everything except medications) rose 13 percent in 2008 and just over 14 percent in 2009. And prescription prices rose 15.9 percent so far in 2009.
Canadians are feeling squeezed by the recession just as much as we are. Nervous Canadians are taking advantage of their healthcare benefits, and paying more attention to wellness issues. Among employers, wellness programs are gaining support as a way to control costs while reducing absenteeism and increasing productivity.
Thursday, June 11, 2009
Your Pharmacist Does NOT Have a Right to Change the Rx to a Generic!
Stories have been coming out from consumers regarding how their pharmacist changed their prescription to a generic -- and this was done without telling them, and without asking their permission!
This has led to some horror stories of inadequate medication in the bloodstream for an epileptic. Her pharmacist, she learned, had exchanged her Tegretol for a generic that worked a little differently. "Just imagine what could have happened had I been behind the wheel of a car," she says. Luckily she was on a bicycle and while she sustained serious injuries, at least there was no fatality.
Pharmacists are so afraid of running afoul of insurers' pressure to use generics that they mistakenly tell patients that it is the law that they do so. Under a practice called "therapeutic substitution", pharmacists may substitute a generic for a brand-name drug even if your doctor specifies the brand name.
According to an article on MSNBC:
This has led to some horror stories of inadequate medication in the bloodstream for an epileptic. Her pharmacist, she learned, had exchanged her Tegretol for a generic that worked a little differently. "Just imagine what could have happened had I been behind the wheel of a car," she says. Luckily she was on a bicycle and while she sustained serious injuries, at least there was no fatality.
Pharmacists are so afraid of running afoul of insurers' pressure to use generics that they mistakenly tell patients that it is the law that they do so. Under a practice called "therapeutic substitution", pharmacists may substitute a generic for a brand-name drug even if your doctor specifies the brand name.
According to an article on MSNBC:
A pharmacist legally switched a drug prescribed by her doc — but without telling her or her physician. Usually, pharmacists replace a brand-name drug with a generic formulation of the exact same medication. Therapeutic substitution is similar but with one crucial distinction: The new drug is in the same class as the old and treats the same condition, but it's not precisely the same medication.
To understand the nuance, think of statins. They constitute a single class of medication because they all lower cholesterol by reducing its production in the liver. But not every statin lowers cholesterol by the same amount or with the same balance of LDL to HDL. So if your doctor orders a brand-name drug but your pharmacist switches it for the cheaper version of a different medication (but still a statin), you may not get the precise benefit your doctor had in mind — and may, in fact, suffer unexpected side effects.
This is horrendous -- we are all in favor of lower drug costs and in favor of using generics where appropriate, but no pharmacist should ever spring a surprise on any customer.
To read the whole article you may go here: http://www.msnbc.msn.com/id/30627962/
In one way, at least, patients can benefit from substitution — smaller co-pays. But two-thirds of people who reported having meds switched in a National Consumers League survey said they weren't consulted. Of those, 40 percent said the new drug was not as effective, and a third said it had more side effects. "It's not okay for your insurance company or pharmacist to change your drugs without your knowledge," says NCL Executive Director Sally Greenberg.
Tuesday, August 19, 2008
IRS Rule Changes Sweeten HSA Pot for Employers, Employees
Health savings accounts (HSAs) will likely prove even more popular than ever due to a sweetening of favorable tax treatments and more funding options.
Readers may want to check with their financial advisor about the new IRS guidelines that allow a transfer of individual retirement account (IRA) funds to an HSA; this transfer is tax-free. Second, employees are no longer subject to the 10 percent additional tax if they use their IRA funds to pay for medical benefits -- referring to IRC Sec. 72(t). Thirdly, qualified employees may contribute IRA funds to their HSA without tax.
Q: If I already have an HSA for myself and want to put some money into a high-deductible health plan (HDHP) for my family, can I do that?
A: Yes. If you have an HSA for yourself and you buy a family HDHPan HSA owner has a self-only high deductible health plan (HDHP) and buys a family HDHP, you can make that second transfer during the same taxable year. The fund distribution will still be without tax. One big advantage to doing this is that you will reduce your tax liability AND lower your health insurance premium. That is potentially, at least -- it will all still depend on your total financial picture and for that, you ought to go in to see your own financial advisor.
Fourth, the IRS also raised the ceiling for individuals and families to their HSAs for the 2009 tax year. Individuals will now be able to contribute up to $3,000 per year; families can contribute a maximum of $5,800 per year. (NOTE: The current maximum limit is $2,900 for individuals and $5,650 for families. The catch-up contribution for people who are 55 years old and up is increasing to $1000, from the current $900.)
The IRS released other new guidelines expected to boost the HSA market by further increasing employers’ adoption of HSA-linked consumer-driven health-care plans (CDHP).
Employers received much-clamored-for clarifying guidelines such as these (and employees will probably have to get the full details from your Employee Benefits department):
-- ON-SITE CLINICS that provide free or low-cost services will NOT affect an employees’ eligibility for an HSA. ALLOWED SERVICES INCLUDE: treating on-the-job injuries, immunizations, annual exams.
-- HOWEVER, if the clinic provides more significant medical benefits, you, the employee, are not eligible for an HSA. Example: a hospital permits its employees to receive medical treatment at its facilities for all of their medical needs for either no cost or at a reduced rate. (I and probably millions of you would probably give our eyeteeth to have such a generous employer.)
-- If an employer mistakenly contributes to your HSA, the employer is allowed to retrieve the funds by asking the financial institution holding the account (ie the bank or other seller) to return them. Otherwise, the employer may treat this amount as part of your income. (ie that means this could raise your IRS obligation; you are probably better off returning the money to the employer!)
A special note to HSA holders age 65 and up: You may use money in your HSA to cover Medicare Part D prescription drug PREMIUMS. If your spouse is older than 65 but you yourself are younger than 65, the enrollee’s HSA funds can NOT be used to cover your spouse’s Medicare Part D premiums without being part of your taxable income.
Hybrid financing is new and is expected fuel further growth in HSA accounts. Under this strategy, your employer pays ALL of an HDHP for you and your fellow workers AND gives each employee a defined cash allowance. Employees can decide how to use that cash.
Example: an employer provides a $2,000 deductible HDHP. You (employee) pay all costs under $2,000 while the insurance company covers EVERYTHING above that -- ie, your maximum out-of-pocket amount is $2,000 if you need surgery or pay a hospital bill – an amount similar to many traditional PPO plans. (Actually a lot of PPOs or indemnity policies may have limits of $2500, $3000, or even $5000. That may seem like a lot, but often that is the only way to keep the premiums down.)
Your monthly cash allowance of $125 (or $1,500 a year) also from your employer? You may choose to put that into your HSA, OR use it to buy a better health plan.
An unnamed small company in the communications sector used this hybrid financing strategy to walk away from a traditional insurer that quoted monthly premiums of $1800 per employee. It is no wonder that the employer switched to a high-deductible plan and an HSA, is it? This company is very generous and provides a $10,000 deductible for their employees plus the HSA, which is owned by the company.
Employees who had high medical expenses and depleted their HSAs, were reimbursed up to the deductible out of the HRA. This company pays a premium of only about $600 a month per employee (family coverage). The employees do pay toward the premium; the amount varies depending on whether it is a single or family plan.
It is hoped that the IRS changes will help both employers and employees contain the cost of healthcare. As an example, the above employer calculated that even if every employee got sick, the company would still save 18 percent compared to traditional healthcare insurance. And HSAs are much less likely to suffer annual hikes in premiums like those that plagued small businesses in the past decade.
Industry statistics show that HSAs grew by 73 percent from late 2006 to the beginning of 2008. The total dollar amounts in those HSAs also increased by 140 percent during the same time frame. It is a bit of a mystery why this popularity has not been evenly expressed across the country.
For example, a study showed that only 2.4 percent of residents enrolled in private health insurance in Missouri, 2.1 percent in Oklahoma, and 3.2 percent in Kansas have used HSAs.
Possible reasons that people are not switching to HSAs or other high-deductible plans: 1) they opt to stay with traditional, low-deductible healthcare plans, 2) the HSA is still pretty new, and perhaps they do not have anyone to familiarize them with it.
Readers may want to check with their financial advisor about the new IRS guidelines that allow a transfer of individual retirement account (IRA) funds to an HSA; this transfer is tax-free. Second, employees are no longer subject to the 10 percent additional tax if they use their IRA funds to pay for medical benefits -- referring to IRC Sec. 72(t). Thirdly, qualified employees may contribute IRA funds to their HSA without tax.
Q: If I already have an HSA for myself and want to put some money into a high-deductible health plan (HDHP) for my family, can I do that?
A: Yes. If you have an HSA for yourself and you buy a family HDHPan HSA owner has a self-only high deductible health plan (HDHP) and buys a family HDHP, you can make that second transfer during the same taxable year. The fund distribution will still be without tax. One big advantage to doing this is that you will reduce your tax liability AND lower your health insurance premium. That is potentially, at least -- it will all still depend on your total financial picture and for that, you ought to go in to see your own financial advisor.
Fourth, the IRS also raised the ceiling for individuals and families to their HSAs for the 2009 tax year. Individuals will now be able to contribute up to $3,000 per year; families can contribute a maximum of $5,800 per year. (NOTE: The current maximum limit is $2,900 for individuals and $5,650 for families. The catch-up contribution for people who are 55 years old and up is increasing to $1000, from the current $900.)
The IRS released other new guidelines expected to boost the HSA market by further increasing employers’ adoption of HSA-linked consumer-driven health-care plans (CDHP).
Employers received much-clamored-for clarifying guidelines such as these (and employees will probably have to get the full details from your Employee Benefits department):
-- ON-SITE CLINICS that provide free or low-cost services will NOT affect an employees’ eligibility for an HSA. ALLOWED SERVICES INCLUDE: treating on-the-job injuries, immunizations, annual exams.
-- HOWEVER, if the clinic provides more significant medical benefits, you, the employee, are not eligible for an HSA. Example: a hospital permits its employees to receive medical treatment at its facilities for all of their medical needs for either no cost or at a reduced rate. (I and probably millions of you would probably give our eyeteeth to have such a generous employer.)
-- If an employer mistakenly contributes to your HSA, the employer is allowed to retrieve the funds by asking the financial institution holding the account (ie the bank or other seller) to return them. Otherwise, the employer may treat this amount as part of your income. (ie that means this could raise your IRS obligation; you are probably better off returning the money to the employer!)
A special note to HSA holders age 65 and up: You may use money in your HSA to cover Medicare Part D prescription drug PREMIUMS. If your spouse is older than 65 but you yourself are younger than 65, the enrollee’s HSA funds can NOT be used to cover your spouse’s Medicare Part D premiums without being part of your taxable income.
Hybrid financing is new and is expected fuel further growth in HSA accounts. Under this strategy, your employer pays ALL of an HDHP for you and your fellow workers AND gives each employee a defined cash allowance. Employees can decide how to use that cash.
Example: an employer provides a $2,000 deductible HDHP. You (employee) pay all costs under $2,000 while the insurance company covers EVERYTHING above that -- ie, your maximum out-of-pocket amount is $2,000 if you need surgery or pay a hospital bill – an amount similar to many traditional PPO plans. (Actually a lot of PPOs or indemnity policies may have limits of $2500, $3000, or even $5000. That may seem like a lot, but often that is the only way to keep the premiums down.)
Your monthly cash allowance of $125 (or $1,500 a year) also from your employer? You may choose to put that into your HSA, OR use it to buy a better health plan.
An unnamed small company in the communications sector used this hybrid financing strategy to walk away from a traditional insurer that quoted monthly premiums of $1800 per employee. It is no wonder that the employer switched to a high-deductible plan and an HSA, is it? This company is very generous and provides a $10,000 deductible for their employees plus the HSA, which is owned by the company.
Employees who had high medical expenses and depleted their HSAs, were reimbursed up to the deductible out of the HRA. This company pays a premium of only about $600 a month per employee (family coverage). The employees do pay toward the premium; the amount varies depending on whether it is a single or family plan.
It is hoped that the IRS changes will help both employers and employees contain the cost of healthcare. As an example, the above employer calculated that even if every employee got sick, the company would still save 18 percent compared to traditional healthcare insurance. And HSAs are much less likely to suffer annual hikes in premiums like those that plagued small businesses in the past decade.
Industry statistics show that HSAs grew by 73 percent from late 2006 to the beginning of 2008. The total dollar amounts in those HSAs also increased by 140 percent during the same time frame. It is a bit of a mystery why this popularity has not been evenly expressed across the country.
For example, a study showed that only 2.4 percent of residents enrolled in private health insurance in Missouri, 2.1 percent in Oklahoma, and 3.2 percent in Kansas have used HSAs.
Possible reasons that people are not switching to HSAs or other high-deductible plans: 1) they opt to stay with traditional, low-deductible healthcare plans, 2) the HSA is still pretty new, and perhaps they do not have anyone to familiarize them with it.
Should We Change How Much Medicare Pays for Treatment vs. Prevention? --i.e. should smoking cessation cost more than cancer treatment?
The writer of the HealthBeat blog, Maggie Mahar, writes a very good and sometime provocative journal on healthcare in America. However, while I do see the merits of her recent column on pricing of healthcare services, questions have to be asked regarding how changing the pricing schedule would affect insurers’ behavior.
I can well imagine insurers’ reluctance to fund open-ended smoking cessation treatment even tho it may ultimately cost them less than treating the complications of smoking. The fact is, they are much more nervous about UNKNOWN total costs than they are about KNOWN costs for cancer treatment. For example, they can calculate to the dollar what a given course of treatment for a lung cancer is; they know how many radiation treatments will be requested, they know if chemo will also be part of the treatment protocol and how many chemo treatments, they know how many days of hospitalization will be involved. What makes them really nervous, again, is an unknown dollar amount for something like smoking cessation -- which does not end till the patient can actually give up cigs for good, and who knows how long that will take?
Look, Maggie Mahar, I agree with you completely on the relative worth of preventive or wellness interventions vs. treating the disease. But I think you have a real selling job to get the insurers behind any such pricing system.
It’s worth having a full and public discussion on these issues, tho, so I hope that this is not the last we hear of this idea.
Please see her full article on this valuable issue at http://www.healthbeatblog.org/2008/08/today-we-pay-fo.html#more
I can well imagine insurers’ reluctance to fund open-ended smoking cessation treatment even tho it may ultimately cost them less than treating the complications of smoking. The fact is, they are much more nervous about UNKNOWN total costs than they are about KNOWN costs for cancer treatment. For example, they can calculate to the dollar what a given course of treatment for a lung cancer is; they know how many radiation treatments will be requested, they know if chemo will also be part of the treatment protocol and how many chemo treatments, they know how many days of hospitalization will be involved. What makes them really nervous, again, is an unknown dollar amount for something like smoking cessation -- which does not end till the patient can actually give up cigs for good, and who knows how long that will take?
Look, Maggie Mahar, I agree with you completely on the relative worth of preventive or wellness interventions vs. treating the disease. But I think you have a real selling job to get the insurers behind any such pricing system.
It’s worth having a full and public discussion on these issues, tho, so I hope that this is not the last we hear of this idea.
When Medicare first created a fee schedule, critics suggested that it was a Marxist invention. Nevertheless, the schedule, which lists what Medicare is willing to pay for some 7,000 procedures, has become the master list for physician reimbursement in our health care system: most private insurers peg their payments to the Medicare schedule.
The notion of deciding the precise worth of some 7,000 diagnostic and therapeutic procedures is mind-boggling. How exactly does Medicare do it?
The process began in the late 1980s when officials at the Department of Health and Human Services decided that the way Medicare paid doctors should be overhauled. At the time, Medicare was reimbursing physicians based on what was considered “customary, prevailing and reasonable” in a particular market —in other words the “market value” of the service in that region.
Instead, reformers urged Congress to begin paying doctors in a way that reflected the real cost, to the doctor, of providing the service.
Please see her full article on this valuable issue at http://www.healthbeatblog.org/2008/08/today-we-pay-fo.html#more
Tuesday, July 29, 2008
Are You One of the Thousands Going Overseas for Affordable HealthCare?
This is not exactly a new phenom -- this has been growing for at least ten years. But flying overseas to countries like South Africa, Thailand, India, or even Canada to get some amazingly affordable (and high-quality) surgery or other healthcare is a real option for thousands of Americans. They find that even with the travel expenses, their trip is a real money-saver plus the care is top-notch, often featuring private rooms and attentive nurses.
But do your homework first. I will have to stop back in again and post a summary of all the sources and groups that will help you get set up for your own medical travel. Also I might mention that Mexico is also very popular for DENTAL care -- the right clinics have up to date equipment and low pricees.
One of the more recent articles in the press is this story from Business Week called:
[Outsourcing the Patients
More U.S. health insurers are slashing costs by sending policyholders
overseas for pricey procedures.
For years, Americans have been traveling abroad to save money on elective procedures or dental work. David Boucher, 49, doesn't fit the usual profile for such medical tourists. An assistant vice-president of health-care services at Blue Cross & Blue Shield of South Carolina, he has ample health benefits. But Boucher recently chose to have a colonoscopy at Bumrungrad International Hospital in Bangkok, mainly to make a point about the expanding options available to Blue Cross customers. And his company happily picked up the $640 tab—a bargain by U.S. standards.
Blue Cross and other insurers would like to see more policyholders traveling abroad for medical care. Since the start of the year, Boucher has signed alliances with seven overseas hospitals and hopes to add five more by yearend, including them all in coverage for his company's 1.5 million members. As health-care costs continue to rise in the U.S., "medical travel is going to be part of the solution," he says.]
http://www.businessweek.com/magazine/content/08_12/b4076036777780.htm?chan=search
"Outsourcing the patients" it said. Yikes, I never would have thought it was possible. But with many elective (non-emergency) surgeries, it is so cost effective that even some insurers are paying for such trips. Best wishes to you and bon voyage.
But do your homework first. I will have to stop back in again and post a summary of all the sources and groups that will help you get set up for your own medical travel. Also I might mention that Mexico is also very popular for DENTAL care -- the right clinics have up to date equipment and low pricees.
One of the more recent articles in the press is this story from Business Week called:
[Outsourcing the Patients
More U.S. health insurers are slashing costs by sending policyholders
overseas for pricey procedures.
For years, Americans have been traveling abroad to save money on elective procedures or dental work. David Boucher, 49, doesn't fit the usual profile for such medical tourists. An assistant vice-president of health-care services at Blue Cross & Blue Shield of South Carolina, he has ample health benefits. But Boucher recently chose to have a colonoscopy at Bumrungrad International Hospital in Bangkok, mainly to make a point about the expanding options available to Blue Cross customers. And his company happily picked up the $640 tab—a bargain by U.S. standards.
Blue Cross and other insurers would like to see more policyholders traveling abroad for medical care. Since the start of the year, Boucher has signed alliances with seven overseas hospitals and hopes to add five more by yearend, including them all in coverage for his company's 1.5 million members. As health-care costs continue to rise in the U.S., "medical travel is going to be part of the solution," he says.]
http://www.businessweek.com/magazine/content/08_12/b4076036777780.htm?chan=search
"Outsourcing the patients" it said. Yikes, I never would have thought it was possible. But with many elective (non-emergency) surgeries, it is so cost effective that even some insurers are paying for such trips. Best wishes to you and bon voyage.
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