Equal rights for vision!

For the last 15 years, my family has purchased an individual health insurance policy. Individual plans, as opposed to employer-based insurance, usually don’t cover vision. We could buy a separate vision policy, but in an average year the premiums would cost more than our annual eye exams, glasses and contacts combined.

Even Medicare doesn’t pay for routine eye exams and corrective lenses, except one pair after cataract surgery.

Of course, eye diseases and injuries (your mother always told you not to run with pointy objects, didn’t she?) are covered as medical care.

But I’ve always wondered why screening exams for … Continue reading

Medicare: No longer the light at the end of the health care tunnel

During the presidential campaign last year, Paul Ryan, the vice-presidential candidate, presented his plan for what we all know is much-needed Medicare reform (too many baby boomers; too little money). Under his plan, seniors would choose a  “Medicare certified” private health insurance plan and, depending on the senior’s income, a percentage of the premium would be subsidized.

His plan sounds a lot like the new health insurance exchanges that are set to begin in 2014, doesn’t it?

Yesterday, an article on the National Review Online caught my attention because the author presented a compelling scenario by which the government could … Continue reading

A possible silver lining to Obamacare

Last fall I blogged about an inherent unfairness in our health insurance system. (I know, there’s more than one.) In short, those with employer-sponsored insurance (ESI) generally have lower premiums, lower out-of-pocket costs, and better coverage than those of us that buy health insurance through the individual market.

With the new insurance exchanges, the Affordable Care Act (ACA) is supposed to decrease costs and improve coverage. Because of the law’s mandates for preventive services and essential benefits, coverage will be more equitable with the large, ESI plans. Whether premiums will be more affordable continues to be a topic of much … Continue reading

Got (breast)milk?

I was surprised recently when I read the following article on Kaiser Health News: Nursing moms get free breast pumps from health law.

Really?

So I went to Healthcare.gov, the official website of the Affordable Care Act (ACA) and found the expanded list of essential benefits/preventive services for women that went into effect on August 1, 2012. Breast pumps, listed under “Breastfeeding Support, Supplies and Counseling,” are indeed considered “preventive” and must be covered without cost sharing (co-pays or deductibles).

According to the factsheet: “Breastfeeding is one of the most effective preventive measures mothers can take to protect Continue reading

Will coverage for pre-existing conditions really be affordable?

The Pre-Existing Condition Insurance Plan (PCIP) was created by the health reform law and enacted in 2010 to provide coverage for low and moderate-income people who could not buy health insurance because of a pre-existing condition—the “uninsurables”.

The plan was to be funded through 2013 until the law’s signature provision—that insurers could no longer exclude those with pre-existing conditions—kicked in on January 1, 2014.

Sadly, the plan has already run out of money and enrollment was suspended February 16th, leaving many thousands without access to health coverage until at least 2014.

Related story from Kaiser Health News: Feds increase Continue reading

Premiums, mandates and penalties

I posted a couple weeks ago that health insurance companies wanted to increase the penalty I mean tax on people who ignored the individual coverage mandate. The companies fear the penalty tax, only $95 the first year, is not stiff enough.

Well, according to recently released information from the IRS and the Department of Health and Human Services (overseers of the health law), the insurance companies have cause for worry. Not because so many people will ignore the mandate, but because so many people will be exempt.

Related reading from National Review Online: Obamacare’s pressure points

Who will be exempt? … Continue reading

Taxes, income and subsidies

Yesterday, the IRS finally began processing 2012 tax returns.

In 2014, if and when you apply for individual health insurance through one of the state-run exchanges, it will be important to know your 2012 income. Why? Because that figure will determine whether or not you will be eligible for a federal tax credit to help cover the cost of premiums.

In a previous post, I explained how the federal subsidies will work. In short, individuals and families earning up to 400% of federal poverty level (FPL) will be eligible, and the savings could be substantial—over $10,000 a year in some … Continue reading

Obamacare’s Y2K: Coverage for pre-existing conditions

Starting in 2014, one of the signature features of the Affordable Care Act (ACA) will be implemented: No adult with a pre-existing condition can be denied health insurance.

But it seems from recent news reports that both the administration and the nation’s health insurance carriers are getting a little nervous about exactly how much that will cost and whether sufficient funds will be available.

In theory, the individual mandate ensures that enough healthy young people buy insurance to keep premiums affordable and provide enough money to cover the care of the already sick. But no one knows with any certainty … Continue reading

The demise of competition

I read with concern yesterday that one of the victims of the recent fiscal cliff deal was the program funding the creation of new non-profit health insurance carriers. Consumer Operated and Oriented Plans, CO-OPs for short, were meant to provide some much-needed competition to the private carriers on the health insurance exchanges and keep premiums more affordable.

At least, that was the theory.

But now Congress has sliced the program’s budget from $6 billion to $2.4 billion. And the money is in the form of loans, not grants. Besides the many other challenges facing these start-ups, they have a very … Continue reading

Beware that bonus!

Two days ago I wrote a post about the proposed health insurance exchanges and the federal premium subsidies.

Beginning in 2014, if you buy health insurance from a state-run exchange, your estimated 2014 income will determine if you qualify for a subsidy.

You will need to supply that information to the insurance exchange when you sign up for health insurance. If you qualify for a subsidy, the exchange will then apply to the federal government for the extra funds to cover your premiums.

When you prepare your 2014 tax return (in 2015), you will discover how accurately you guestimated.

The … Continue reading

Sticker shock

My family does not have an employer-provided health plan, and we live in a state that will set up a state-run health insurance exchange, so I wanted to learn more about the exchanges and proposed subsidies.

Several recent articles have warned of “sticker shock.” Beginning in 2014, state exchanges must offer plans that cover all “essential health benefits” as defined by the government. In other words, there will be no more “catastrophic” plans with low monthly premiums and high deductibles. (Except perhaps for young adults under 30, but information on this point remains unclear.)

To make such comprehensive … Continue reading

Nightmare

Last night I dreamt that my husband was diagnosed with metastatic melanoma.

He was lying on an exam table for some reason when the nurse spied a large, red spot on his head (he’s not bald, but in my dream he was!) and said “Oh my, that doesn’t look too good.” The doctor then looked and said “It’s a melanoma. I’ll take it off.”

Immediately the doctor excised the melanoma as well as some cervical (neck) lymph nodes, which were also cancerous. The melanoma had spread.

As I watched the operation, I thought Oh, please let this be a dream. Continue reading

A picture worth a thousand words

Last week, the publication of three short health care reports caught my eye. Separately, each is a “bad-news-as-usual” snapshot of health concerns; spliced together, however, they create a bigger, grimmer picture of the health and financial future of our country.

First, the Centers for Disease Control and Prevention (CDC) reported that between 1995 and 2010, the incidence of adults diagnosed with diabetes has almost doubled.

Part of the rate increase is explained by improved diagnosis and diabetics living longer, but the report’s authors concluded that the “major driver” is that “the increase in diabetes prevalence coincides with the increase in … Continue reading

How much does an MRI cost?

Sorry, wrong code

I read a story on Kaiser Health News this morning about the author’s struggle to be a responsible and informed health care consumer: How much for an MRI?

I can completely relate!

I had a similar experience with a heart ultrasound two years ago. It’s a cycle of frustration: You can’t get a price without a procedure code, but you can’t get the correct code until after the procedure is done. Classic.

Health care costs have long been kept hidden from the public—until after you get the bill.

And here’s a funny video put out by the … Continue reading

Will the Affordable Care Act really be affordable?

Last night, Barack Obama was re-elected president of the United States.

So, the Affordable Care Act (ACA or Obamacare, as it’s commonly known), having survived its precipitous birth and a few close-calls with death, is poised to enter a prolonged and awkward adolescence.

I haven’t spent a lot of time educating myself about Obamacare because of the possibility that it would be overturned after the election. Now, however, I want to know more, but it’s not easy to get clear answers because so much has yet to be decided and defined.

Kaiser Health News has prepared a brief summary, After Continue reading