Obamacare’s Floating Deadlines Cause More Confusion

The deadline has passed for uninsured Americans to enroll in qualified healthcare plans and avoid a government penalty.

Well, sort of.

The deadline for the Affordable Care Act, better known as Obamacare, is a moving target that really doesn’t mean anything until March 31. That’s the last day that you can enroll in a government-approved program and not have to pay the late fees: $95 per adult and $47.50 per child in each household or 1 percent of your annual income, whichever is greater.

Confused? So is nearly all of America.

Sign-Up Still Available

The Obamacare rollout has been indecisive, ineffective and inconsequential. It appears the current administration is simply winging it by implementing their landmark healthcare program.

The original sign-up deadline of Dec. 15 was postponed to Dec. 23, and then quietly rolled over to Dec. 24. But don’t worry if millions of other last-minute shoppers trying to sign up interrupted your application on Christmas Eve. The deadline will flex further, according to Julie Bataille, a spokesperson for the Centers for Medicare & Medicaid Services, which runs the site where you sign up.

“If you have trouble due to high demand, we will make sure we help you get signed up,” Bataille said in a statement.

It is the latest in a series of missteps by an administration still trying to figure out what exactly it’s going to require from Americans for insurance purposes and when exactly it will start charging you a fee if you don’t have it.

Pay Your Premiums

If you have signed up, here are a few things you should check to ensure you are indeed covered if you have to fill a prescription or visit a doctor starting Jan. 1.

  • Signing up doesn’t mean anything until you pay your first premium. Depending on where you live, and the company you signed up with, the deadline to make payments could be Jan. 6, 7, 10 or 15. If you haven’t made a payment, you aren’t covered.
  • If you did sign up and did pay a premium, call the company you’re with and make sure the paperwork has arrived and is verified. If not, you won’t be covered.
  • Getting a bill for your premiums is actually a good thing. It means the paperwork went through the right channels. Pay the bill and you should be good to go.

Fee: 1 Percent of Income or $95

If you haven’t signed up yet, here are some highlights from the many things that could change between now and when you do.

  • If you don’t sign up for a health plan, you will have to pay all your own medical bills, even catastrophic ones that could lead to bankruptcy.
  • If you don’t sign up, you will incur a government fee that acts suspiciously like a tax or fine. The fee for 2014 is either 1 percent of your income or $95 per adult and $47.50 per child in your household — whichever is higher. The maximum penalty is $285 per family.
  • In 2015, the fee will rise to 2 percent of income or $325 per person, and rise again in 2016 to 2.5 percent of income or $695 per adult. The fee for children always half of what it costs for adults.
  • If you are uninsured for part of the year, 1/12th of the penalty applies for every month you’re uninsured, but if you’re uninsured for less than three months, you don’t have to make a payment.

Of course, if you enroll by Mar. 31 all fees and missed deadlines are forgiven — assuming the administration or Congress doesn’t change anything else between now and then.

Cost of funeral flowers

Avoiding Medical Debt after Unexpected Death of a Parent

My mother passed away six months ago.

It amazes me how fast time goes by. It feels like just yesterday when I was standing in line at Universal Orlando’s Halloween Horror Nights, braiding my little sister’s hair as my mom braided mine.

If there’s something I miss most about her, besides her sometimes-inappropriate humor, and her laugh, it’s her touch. There’s really nothing more warming than holding hands with mom or a big hug just because.

Sometimes I forget that she’s not here. Everything happened so fast, so unexpected. It was one of those things that you sympathize with others about, but never imagine it could happen to you.

She was in ICU for three days. It felt like weeks.

At one point, it was just a waiting game for all of us. So, I left the hospital because there was nothing else I could do. Sometimes, I wish I never did. The drive back to the hospital on that third day was the worst drive I’ve ever made.

Just like that, she was gone. And just like that, we had $600,000 in medical bills to pay. The bills didn’t stop there, either.

Funeral Costs

Cost of funeral flowers

My mom wasn’t married when she passed. As her oldest child, I had to assume full financial responsibility – and quickly. I had about five minutes of bereavement before it was all paperwork and business.

I needed to call work, friends and family, make funeral arrangements, sign release forms, gather all her information and sort through her files at home.

My mom didn’t have life or health insurance and I wasn’t quite sure about anything else. I knew there was going to be a wrongful death claim from the car accident, but even if we won the case, the money wouldn’t come in time to help pay for the funeral happening in four days.

Funerals aren’t cheap; especially for a Thai and Laotian family with hundreds of family members everywhere. Everyone knew her and everyone loved her. The chapel hall didn’t have enough seats to hold friends, family and others who came to pay their respects.

The average cost of an adult funeral is $6,560. The total cost for my mom’s funeral was about $25,000. It was all paid out of pocket by family members and donations from friends.

In our culture, funeral ceremonies are generally spread out over a one-week span. The preparations include booking the funeral home, organizing the reception, and purchasing a casket, urn and floral arrangements.

We also invite Buddhist monks into our home and provide offerings for them for the duration of the ceremonies.

Providing a week’s worth of food for more than 100 people is costly. Thank goodness we had really supportive friends and family who helped out.

Medicaid Saved Us

This was all new to me. I figured someone would take care of the hospital bills, but I didn’t know who.

I just assumed that’s what happens when someone passes. I thought it’d be enough for a family to grieve over a loss without asking them to worry about medical costs.

My aunt is the one who took the leadership role when it came to the medical expenses. She didn’t want me to worry about the $600,000 bill on top of everything else.

She applied for Medicaid for my mother’s hospital bills about two months after she passed. The letter of approval we received a month later was the best news that we had heard in a while.

The Florida Medicaid plan was now going to cover my mom’s 20-plus medical bills.

It’s such a relief when money is one less thing that you need to worry about. It would have helped if my mother had health and life insurance, but my family and I still managed to work with each other and the providers to get everything worked out.

While unexpected events happen more often than we like, it’s important to expect the unexpected. However, not everyone has that opportunity or foresight. My advice: Take a breath, embrace what you have, and should something sudden come your way, don’t panic. There are people out there who are willing to help with your medical debt if you ask.

10 Ways to Save on the Cost of Prescription Drugs

People talk about the high price of an emergency room visit or surprise surgery, yet most people shell out money every month for prescription drugs without a second thought.

The price of drugs can be high and, for some, the need for medication is long term or permanent. With few options, some people go into credit card debt to pay necessary, life-preserving expenses.

While your doctor tells you this is the only way to maintain your health, it makes it increasingly difficult to maintain your budget. So, on top of the physical and mental needs that require treatment, you have stress.

To help alleviate this stress, here are 10 tips to get you prescription drug savings:

  1. Think preventative care. By taking advantage of yearly health screenings and check-ups offered by your health care provider, you can tackle conditions before they require multiple prescriptions.
  2. Stick to necessities. Keep yourself from being in the position of paying for a medication you do not need by going over all of your medications with your doctor. There may be newer medications that do the job of two older medications or health problems that are resolved and no longer require treatment.
  3. Go generic. On average, generic prescription drugs cost 80 to 85 percent less than brand-name drugs, according to the Food and Drug Administration. You can take advantage of this by asking your doctor about getting the generic brand.
  4. Be honest with your doctor about finding a cheap alternative. Some drugs do not have generic versions available, however there may be a similar type of drug (with a different active ingredient) that performs the same function and has a generic alternative. Although it can be an awkward conversation, it’s worth taking a few extra moments to discuss options with your doctor, before panicking when your pharmacist gives you the total.
  5. Ask for samples. Doctors receive dozens of samples from manufacturers which they can give you at no cost. Sometimes you can leave with a bag full, saving you the cost of the first few weeks of your prescription.
  6. Find manufacturer coupons online. Look up your medication before you go to the store and print out coupons. Read the fine print, too, because you may be able use the same coupon more than once if you will be refilling the prescription.
  7. Ask about larger pills or larger quantities. Double doses of pills do not always cost twice as much. You may be able to save money by ordering the bigger doses and then cutting pills in half. You can also ask your doctor about prescribing a three-month supply, which often costs less than three individual co-pays.
  8. Utilize Patient Assistance Programs. Sponsored by pharmaceutical companies, these programs offer discounts for people with low to moderate incomes.
  9. If you don’t have insurance, head to the superstore. You can use the pharmacies at stores like Sam’s Club or Costco without being a member and find significantly lower prices than many grocers and convenient stores.
  10. If you do have insurance, go online to see your insurer’s list of medications that are covered. Sometimes there will be multiple drugs with the same function—like two drugs that treat cholesterol—and the co-payment on one will be less, even though the drug is not any less effective.

There are certain things that you cannot change –like the inevitability of bills or chronic illnesses—but, you may be able to pay less for the medications that enable you to stay on top of your health.

The Duque-Loaiza works to cover the medical expenses of Lucas, who has autism.

Financial Concerns of Caring for a Child with Autism | Real People, Real Life

In light of World Autism Awareness Day, I wanted to get a closer look into one family’s story — their difficulties in caring for their child, their financial adversity, their moments that make all the pain, the worry, the struggle disappear.

I want you to meet Lucas.  He’s 5 years old, and he was diagnosed with autism when he was 2.

Although I haven’t had the pleasure of meeting him in person yet, I’ve only heard wonderful things about this beautiful boy. “He’s got one of those smiles and laughs you fall in love with,” one of his cousins told me.

His intelligence is remarkable, and his ability to learn so quickly is astonishing. Even with the communication barrier and his inability to express how he’s feeling all the time, he’s able to continuously stun the people around him.

He is constantly progressing and exceeding expectations in his development. However, it’s not always easy.The Duque-Loaiza works to cover the medical expenses of Lucas, who has autism.

I spoke with Lucas’ mother, Marta, and asked her to share a little bit of their story with me:

“When I had Lucas, I wanted to stay home with him for the first year. We started noticing that he wasn’t interacting with us or making eye contact in times we felt he should. That’s when we found out he had autism. We expected what his condition was, but hearing it from the doctor was very shocking and upsetting. Things that we thought were important weren’t so important anymore.

I took the next year off from working, so my husband needed to work extra hard to pay the bills. Then, the debts started getting bigger as the doctor visits increased and our insurance covered less.

We needed to make a decision: Do I stay home with my son or go back to work?

I stayed home with Lucas for 5 years. I would take on hobbies, like selling cakes. I couldn’t call it a job because it costs money to have your own business. If you aren’t doing well financially, it’s even harder. You don’t want to leave him alone, but you need money to help him.”

Caring for a child with autism is not only emotionally tiring, but financially as well.

Treatment for Autism isn’t Cheap

There is no one cause of autism, just as there is no one type of autism. Every diagnosis is different, and that makes it more challenging for families to find information and provide the proper treatment for their loved ones.

Successful treatments are hard to come by; some work, and some don’t. Regardless of the effect, they’re all very costly.

ABA, or Applied Behavior Analysis, is currently the most accessible treatment for autistic children. It is mostly funded by education systems and is readily available in most schools. But what if the child doesn’t like the treatment? Like Lucas. He wasn’t comfortable with it, and his mother wasn’t going to force him to do something he didn’t want to do. However, other treatments weren’t covered by the government or their insurance.

Marta and her family decided to teach themselves how to effectively support Lucas and help improve his development. They follow The Son-Rise Program, giving him love, attention and respect 24/7.

It isn’t just the treatment and the doctor visits that are expensive. Lucas has to be on a special diet, as well. He needs supplements and organic foods, which can be up to three times more expensive than nonorganic food products.

“I’m lucky to have a great family that will help me, too, when they can.”

Accepting Autism

Every 1 in 55 boys is diagnosed with autism, yet the awareness and sense of urgency to provide lost parents with answers are low.

“We have to find our own answers. It gets really hard sometimes, but that doesn’t matter. I know I have to keep trying because no one else is going to do it for me. I have a choice to make: I can keep crying all the time, or I can do my best to help him.

The most difficult part about having a child with autism is helping people understand him the way my family and I do. Not many people know what autism is. It’s easy to get frustrated and stressed, but when you realize that it’s not about what other people say or think, and you realize it’s about your child, you feel happiness.

I am blessed in the moments that I embrace autism rather than fight it, in the moments I learn from autism. I am blessed in the moments I accept and connect with my son.”

In honor of World Autism Awareness Day and Lucas and the Duque-Loaiza family.

Medical Credit Cards: Proceed with Caution

For someone who is slapped with a large out-of-pocket medical bill, a medical credit card may seem like a good idea. But it may not be the best financial option.

Medical credit cards, which are offered by companies like Wells Fargo, JP Morgan Chase, Citigroup and GE Capital, provide a credit line to cover medical treatments and procedures for the entire family, including pets.

With rising health care costs, credit cards that are designed to meet health care needs are becoming more popular, but state attorneys general and consumer advocates are speaking out about the cards and warning that they can increase a cardholder’s debt rather than reduce it.

“Ironically, these cards may be best suited to people who already have financial resources,” said Mark Rukavina, executive director of the Access Project, a consumer advocacy group in Boston, and co-author of a study on medical debt. “But it’s usually people with limited resources who sign up,” he told The New York Times.

How Medical Credit Cards Work

Medical credit cards work similar to other credit cards. The cardholder takes out a loan to pay for medical treatment, and then pays it back over time. Medical credit cards can be used for most medical care, vision care, dental visits, cosmetic treatments and surgeries, hearing care and veterinary care.

Patients typically sign up for the cards at their health care provider’s office. The cards may come with zero interest as long as each new charge is paid within a certain time period, typically 6 to 24 months. Some cards offer extended payment plans up to 60 months with a fixed interest rate.

Beware of the Fine Print

When someone faces a $1,000 emergency dental bill, medical credit cards that promise no interest may seem like a great solution. But most cards require a minimum monthly payment, and if even one monthly payment is late, the interest rate can dramatically increase. And if the full balance is not paid by the end of the promotional period, the interest rate could jump up to 30 percent.

To avoid interest, cardholders must make monthly payments on time and pay off each charge within the allowed time period. If the balance reaches beyond the promotional period, the cardholder will be subject to high interest rates that can range from 24 percent to 30 percent of the original purchase amount, retroactive to the date of purchase.

There is some concern that patients sitting in a doctor’s office may not have time to read the fine print and may not have enough information to make an informed decision.

“You’re dealing with people in the most vulnerable state,” Mark Rukavina, principal at consulting firm Community Health Advisors, in Chestnut Hill, Mass., told Kiplinger. “Most people go into a health care provider with pain and concern, and they’re not there to make a financial-services decision.”

Patients may also assume that their health care provider is simply offering a payment plan, rather than a credit card. In fact, many health care providers do offer no-interest payment plans, as well as discounts for paying with cash. Consumers need to be fully aware of their options before signing up for a medical credit card.

Five Tips to Reduce Your Health Care Costs

We all know the saying, “An apple a day keeps the doctor away.” While it may take more than just an apple, a new study found that the general principle is true: Patients who take an active role in their daily health have lower health care costs, suggesting they require less medical attention.

In the study, Dr. Judith Hibbard of the University of Oregon examined data from 33,000 patients. She found that patients who are confident and knowledgeable when it comes to self-care had significantly lower medical costs.

Even among patients with similar medical backgrounds, those who were more involved in home care – judged by their self-reported levels of knowledge, skills, motivation and confidence – had costs up to 21 percent lower. Unexpected medical bills are one of the most commonly cited causes of bankruptcy, but such a reduction in costs may be enough to save some people’s financial situations.

Here are some tips on how you can become more active in your health care and lower your bills long term:


1. Prepare for doctor visits.

Before any appointment, make a list of your prescriptions and other drugs, including dietary and herbal supplements. Also write down any questions you have for your doctor about existing or potential medical issues.


2. Communicate with your doctor.

During the appointment, be sure to ask questions, discuss your symptoms and conditions, and request additional information in the form of written instructions or online resources. If you need to undergo any procedures, be sure you understand the purpose and expected outcome. Always inform your doctor if you are pregnant, nursing or allergic to any medications.


3. Follow up.

Follow your doctor’s instructions at home and make follow-up appointments. Also, call your doctor if symptoms worsen or you have trouble carrying out instructions. Request any lab results, and ask for explanations of any abnormal findings.


4. Get or stay healthy.

Make an effort to follow tried-and-true rules like sleeping enough, drinking plenty of water, exercising and eating well. Also try to reduce your stress levels and cut bad habits like smoking and drinking.


5. Get preventive tests and care.

Preventing a potential medical condition is safer and cheaper than treating an existing one. Talk to your doctor about screening for high blood pressure, high cholesterol, cancer, sexually transmitted diseases and other medical conditions for which you may be at risk. Ask about ways to reduce your risk of health problems.


Taking better care of yourself has a multitude of physical and mental benefits, as well as financial ones. If you’re not sure where to start, you can get tips from the U.S. Department of Health and Human Services. Then, make an appointment with a general practitioner for a physical and ask about what else you can do on your own.


Improving Economy Means Fewer People Seeking Disability Benefits

Applications and approvals for Social Security Disability Insurance (SSDI) were both down in 2012, which could be another small sign that the labor market continues to improve.

There were 2.82 million applications for SSDI last year, a drop of just under 60,000 from 2011. The number of people approved for monthly benefits was 979,973, the fewest since 2008.  Beneficiaries receive payments that average $1,111 per month.

The slight drop mirrors the slight drop in unemployment levels for 2012. The unemployment rate fell about one-half of 1 percentage point – 8.3 percent to 7.8 percent – from January to December.

This is the second year in a row that applications for SSDI declined, which is somewhat of a surprise given the fact the baby boom population has been pushing through the system, increasing the number of people who are prone to disabilities.

“Social Security anticipated an increase in the number of disability applications as the baby boom generation aged,” Patti Patterson, regional communications director for the Social Security Administration, told Debt.org. “But the economy also is a factor, and we saw increases beyond the estimated demographic effects in the late 2000s. Recently, however, the numbers are lessening because of the continuing economic recovery.”

The number of applications and approvals peaked in 2010 when nearly 3 million people applied and just over 1 million were approved for benefits. This coincided with the height of the Great Recession when unemployment numbers reached 9.9 percent.

SSDI was created in 1956 as a safety net for people who could no longer work because of illness or injury. The program originally was restricted to people between the ages of 50 and 65, and was meant to help those with serious illnesses such as cancer or heart disease.

It was soon expanded to include anyone who had worked and paid Social Security taxes for at least five years. The number of people receiving benefits reached 1 million adults in 1966, then nearly tripled to 2.8 million by 1977 and tripled again to 8.8 million by the end of 2012.

Program on Brink of Insolvency

The surge in claims has pushed the program to the brink of insolvency. The Congressional Budget Office expects SSDI to be insolvent as soon as 2016. Since 2009, the program has been paying out more than it takes in. In 2011, $128 billion was paid out, but program revenues were only $94 billion.

Not everyone attributes the long-term surge in numbers to the slow economy.

Oklahoma Sen. Tom Coburn, the top-ranking Republican on the Senate Permanent Subcommittee on Investigations, conducted an investigation in 2012 that determined that benefits were being awarded improperly because the system was being overwhelmed by applications.

Coburn claimed that judges weren’t able to “properly address insufficient, contradictory or incomplete evidence.”

“The administrative law judges are not looking at the cases because the pressure from Social Security is to get the cases out,” Coburn told The Associated Press. “I think you could flip a coin for anybody that came before the Social Security commission for disability and get it right just as often as the (judges) do.”

ObamaCare Highlights Truth: Insurance Companies Prosper

Whatever one thinks about the nature of ObamaCare, officially called the Affordable Patient Protection and Care Act (ACA), it’s certainly not the foul-smelling, socialistic takeover of the medical establishment as claimed by many right-wing pundits and politicians.

How can one be sure? Easy. If the nation’s health insurance companies supported it, which they did, it’s only because their capitalistic olfactory sensors picked up the scent of massive future profits just down the road, when tens of millions of Americans will be compelled to buy their own health care policies under the law’s individual mandate.

Holding Their Breath — and Noses

Of course health insurers haven’t seen those dollars yet, as that particular provision of the ACA doesn’t go into effect until 2014; right now, they’re simply holding their collective breath. They’re also, very likely, holding their noses because of one particularly malodorous ACA regulation, the so-called “80/20 rule” that has been on the books since January 2011.

What is the 80/20 rule? It’s the provision of the law that is also known as the “medical loss ratio” or MLR. It requires health insurance companies selling plans to individual consumers to spend at least 80 percent of collected premiums on genuine medical claims as opposed to overhead, administration, marketing and profit taking.

And according to a just-published study by the Commonwealth Fund, a nonprofit health care advocacy group, in 2011, the first full year the MLR was in effect, insurance companies were forced to rebate an estimated $1.1 billion to American consumers and further saved them an additional $350 million in premium costs, because they exceeded the law’s required limits.

Rebate Checks and Whining

So, since this past summer, some 13 million U.S. policyholders got a letter from their health insurance companies with an unfamiliar enclosure inside: a rebate check ranging anywhere from $1 to $517. And the insurers can’t get away with cooking the books to make an end run around the MLR, even if they wanted to. The law requires them to publicly disclose to their policyholders precisely what share of total premiums actually goes to medical care.

Naturally, the companies whined about the new requirements. In a statement issued by America’s Health Insurance Plans, an industry lobbying group, they contend that mandates on how much they should spend on medical care belies a basic misunderstanding about the real cause of rising health insurance premiums: It’s the medical costs themselves that are going up drastically, they opine, not the administrative ones.

They also maintain that pressure to lower premium rates might cause some insurers to leave certain market sectors altogether – especially the individual market, where, last year, profit margins declined. It’s an old dodge: If you make us play by any rules we don’t like, we’ll pick up our ball and go home.

Working Out the Details

Funny, isn’t it, how the companies are all for the individual consumer mandate — one that portends to be a windfall for them a few short years away — but bristle at the thought that they too should be required to have some skin in the game?

2013 will be an interesting year as the insurance companies, the states and the federal government work out the details of the insurance exchanges through which individuals and employers will be purchasing policies come 2014, including the prices of those policies.

So don’t be too surprised if a good chunk of the lost $1.45 billion, or even more, is clawed back by the insurers by the end of the individual mandate’s first year. And after that, who knows? Profits smell sweet, and their aroma is hard to rebuff.

After all, the game is still capitalism. And the object is making money, not giving it away.

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Health Insurance Tips for Open Enrollment Period

With 2012 coming to a close in a matter of weeks, now’s the time to start planning for a healthy and prosperous new year.

October and November mark the period most companies unveil their group health insurance benefit packages to employees and give them the opportunity to select new options. Any changes needed, from medical insurance coverage to the amount of money withheld for a flexible spending account, must to be made now in order to go into effect in January.

What is Open Enrollment?

While each company may have individual deadlines, open enrollment traditionally is held 30 to 60 days prior to the benefits’ renewal or effective date of coverage.

According to the National Association of Insurance Commissioners (NAIC), insurance carriers are obliged to accept all group applicants during this enrollment time without underwriting or providing evidence of insurability.

If your employer-sponsored health insurance program deadline is missed, you may not be able to enroll in your company insurance program until the following year. Exceptions are made for new employees or those with a qualifying life-changing event, such as a marriage, divorce, birth or death.

Anticipated Changes for 2013

Although most changes reflecting the Obama administration’s Affordable Care Act won’t be taking effect until 2014, review your 2013 options carefully as your company may have made some adjustments because of new rules and inflation.

According to the National Group on Health annual survey of health benefits, employers anticipate costs to rise 7 percent in 2013, and 60 percent say they plan to pass on some of that added cost (approximately 5 percent of it) to employees through higher premiums. Forty percent of companies plan to raise in-network deductibles, while 33 percent plan to increase out-of-network deductibles. The survey also revealed 32 percent of companies plan to boost their out-of-pocket maximums, with 13 percent of companies raising the co-payment for using a retail pharmacy for prescriptions. About 8 percent intend to increase the cost of coinsurance for primary and specialist care.

According to a study completed by the nonprofit Kaiser Family Foundation, a family with employer-provided health insurance pays almost $16,000 in annual premiums — about 4 percent more than one year ago. An individual policy saw an increase of 3 percent from last year, totaling an average $5,615. These costs are likely to be passed on to you through the premium and/or coverage.

Changes in Women’s Health

One provision that has been somewhat controversial this year is the mandate that companies and insurers must offer free preventative care for women. This includes well-women visits, screening for gestational diabetes, breastfeeding support, domestic violence screening, counseling and prescription birth control.

The health care reform law will also reduce the amount of money you can contribute to a health savings account or flexible spending account using tax-free dollars. The new provision also adds stricter rules regarding how the money can be used.

According to the national survey, 94 percent of companies indicated they will have to lower the medical flexible spending account ceiling to adhere to the $2,500 maximum for 2013, down from an average $3,000 to $4,000. Many companies will be offering a grace period until mid-March 2013 to use the flexible spending account money from 2012.

Research Your Options Carefully

Your company should offer you access to materials regarding physicians, hospitals, labs and pharmacies within the coverage network and how much coverage the insurance carrier will pay for each plan offered. Be aware there may be changes in these benefits.

Before enrolling in a health care program, the NAIC recommends the following:

  • Many insurance carriers, such as HMOs and PPOs, contract with medical providers to negotiate lower patient care costs. While this saves money, be sure your preferred doctors and hospitals are included in the plan. If it’s really important to you to keep your physician, talk to the doctor’s office to verify they will accept your new coverage in the new year.
  • If you need coverage for a spouse or dependent, make sure the plan offers you the opportunity to enroll family members
  • Be aware of your rights and responsibilities are under each plan.
  • Examine the pre-existing condition exclusions and pre-authorization requirements.
  • Not all prescription medications are on the list of approved drugs under some plans, so ensure the medicine you take is covered to avoid out-of-pocket costs.
  • If you are unsure of coverage or have questions, it’s best to contact the human resources department at your company or the insurance carrier.

Plan for Life’s Challenges

Medical debt can add up very quickly — that’s why it is essential you review the extent of your medical coverage carefully. Even a brief stay in the hospital can leave you with overwhelming bills, so be sure you review the summary of benefits. This is where you will find information regarding your deductible and maximum out-of-pocket cost.

Be sure you investigate the following when choosing a benefits package:


Most doctor visits will require a co-payment, a fixed cost per visit. This cost may be higher if you see a specialist or a doctor outside your network, so make sure you are aware of the possibility of additional expenses. Some visits may also be subject to a deductible.


This is the amount you will pay each year out-of-pocket for medical services before you receive coverage from the insurance company. Opting for a high deductible in an effort to lower your monthly rate may not be a good trade-off if you don’t have the savings necessary to pay that high deductible in the event of an emergency.

Maximum Out-of-Pocket Limit

Once you have paid a certain amount of medical expenses from your own wallet, your insurance company should pick up the bill for most medically necessary expenses. Be sure to find out what the maximum limit will be in the event you have an emergency situation.

Prescription Drug Cost

Be sure to review whether your 2013 prescription coverage will require a co-pay or you will be expected to pay a percentage of the drug’s total cost. It’s also important to investigate coverage rules for generic drugs and brand-name drugs before you enroll. Some insurance programs may require you use their mail-order company for monthly prescriptions.

Disability Insurance

The National Safety Council reports a disabling injury occurs every two seconds that interferes with an employee’s ability to earn a living, making disability insurance important. Ensure your monthly expenses could be paid by this insurance when making your choice.

Life Insurance

Review your coverage amount, and make sure you have adequate coverage to protect your family in the event of death.

New Medicare Mandate Aims to Cut Costs But Could Affect Treatment

Admission procedures may run a little differently at your local hospital beginning this week. October 1 marked the launch of a key provision of the ObamaCare law that could create changes in the way hospitals treat elderly and poor Americans in the coming year.

In an attempt to save taxpayers money as well as enhance the quality of American healthcare, this new law will result in the fining of hospitals by Medicare that readmit patients within 30 days of discharge due to complications. These provisions, passed by the Democrat-controlled Congress of 2009, are part of the planned and measured implementation of healthcare changes under ObamaCare.

According to a study published by the New England Journal of Medicine, nearly 1 in 5 Medicare patients are readmitted within one month of being discharged. As of 2004, these return visits have been costing the federal government more than $17 billion per year.

New Law to Penalize Hospitals

Medicare will begin penalizing those hospitals whose patients have to return to the hospital within 30 days of discharge because of complications, the Associated Press reported.  Government officials estimate that at least 2,200 facilities – two-thirds of all hospitals treating Medicare patients – will be penalized an average of $125,000 per facility throughout the next year.

During the first year under the new law, hospital care will only be measured regarding three major medical conditions: pneumonia, heart attack and heart failure. In the beginning, the fine will be capped at 1 percent of the hospital’s Medicare payments, although it is anticipated a large majority of fined facilities will actually pay less.

According to the new law, the fines will steadily increase until 3 percent of Medicare payments to facilities are at risk. Eventually, Medicare may hold additional medical treatments accountable: stenting, heart bypass, stroke treatment and joint replacements.

High Readmission Rates

Readmission rates, which are estimated to be as high as 20 percent, contribute to the elevated costs associated with American healthcare. According to the congressional advisory group Medicare Payment Advisory Commission (MedPAC), an estimated 12 percent of hospitalized Medicare recipients are readmitted with potentially preventable issues.

The government anticipates the risk of fines will force hospitals to pay more attention to improving the way Medicare patients are treated while in the hospital. The government hopes hospitals will more strongly urge patients to seek follow-up care from an outside physician.

Nancy Foster, vice president for quality and safety at the American Hospital Association, said medication mix-ups account for a substantial amount of patient troubles. It’s common for Medicare patients to deal with several chronic conditions, and a patient’s medication typically needs to be altered during a hospital stay. Medication modifications are not always shared with patients’ doctors outside the hospital and too often the patient doesn’t understand the change, which can lead to continued medical problems and possibly a trip back to the hospital. Ensuring that Medicare patients schedule follow-up care upon discharge is another serious challenge hospitals will face.

Flaws of the Mandate

Critics of the newly implemented provision are concerned with how the threat of penalties may actually work against Medicare patients and lead to a weakened quality of care for those who need it most. MedPAC research has affirmed that facilities serving the poor, especially teaching hospitals, are most likely to face these fines.

Hospital officials are also concerned about the possibility of being held liable for situations beyond their control, such as when a patient does not complete recommended treatment once discharged and needs to be readmitted as a result.

Some opponents fear the new provision will affect the level of care a Medicare patient will receive if a readmission is medically necessary within the 30 day timeframe. With hospitals already facing financial cutbacks, critics are wary about how America’s elderly and poor, especially those with chronic illnesses, will be treated.

Republican presidential candidate Mitt Romney and his running mate, U.S. Rep. Paul Ryan, have declared that, if elected, they plan to repeal the ObamaCare law. They intend to replace it with tort and insurance reform.