Changes in your 2016 out-of-pocket maximum

It’s almost that time of year when insurance companies start sending out information about next year’s plans and what may or may not have changed in their policies, such as premiums and benefits.

A little-known new rule of the Affordable Care Act (ACA) will take effect on January 1, 2016, and might affect your health insurance plan and health care costs.

Specifically, this rule takes away what’s been called the “umbrella limit” on out-of-pocket maximums for families.

If you currently have a family policy with a family out-of-pocket maximum (up to $13,200 in 2015), even if only one family … Continue reading

Mega-insurance companies versus mega-health care systems

Two big health insurance mergers are in the works: Aetna plans to buy Humana for $33 billion, and Anthem will take over Cigna for a whopping $54.2 billion.

The number of major health insurers in the US will soon be three, down from five.

So much for more competition, huh?

What’s happening in the health care delivery system mirrors the insurance industry. The biggest health care corporations are furiously buying up smaller hospitals and physicians’ groups.

From their points of view, it makes sense: Each side believes being bigger will give them the upper hand in reimbursement negotiations (that is, … Continue reading

Know your health insurance

Two recent stories from Kaiser Health News caught my attention because they underscore the burden placed on patients to understand exactly what services their health insurance does or doesn’t cover.

Of course everyone should know their health plan’s benefits, but with so many different types of plans, and the hair-pulling-out frustrations of narrow networks, it can be really difficult. Unfortunately, the financial consequences of making a mistake are heavier than ever.

The first story tells of a … Continue reading

A routine urinalysis is unnecessary

This week the National Kidney Foundation (NKF) started a public health campaign called “Everybody Pees.”

The highlight is a short video featuring a catchy song and colorful South Park-esque kidneys peeing in all sorts of places—parks, swimming pools, on top of a car, etc.

OK, it’s cute, kind of. But here’s my problem with this video (other than the it’s a cartoon more appropriate for six-year-olds): a routine urinalysis is NOT recommended to screen for kidney disease.

But that’s what the song seems to tell us to do:

The smartest place to pee

Is at

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Surprise medical bills

One of the premises of Obamacare was that if patients were expected to pay more towards their health care—have more “skin in the game”—they would shop around for the best prices and spend less.

If only.

I posted about how difficult, if not impossible, it is for patients to shop for health care. Prices are not as transparent as some policy makers would like to think.

Related post: Researching health care costs

A recent article in Kaiser Health News confirms this:

Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them

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Obamacare premium increases for 2016

Here we go again!

Every May, health insurance companies file their requests for premium increases for next year’s plans.

I’ve been watching my state’s website for the Office of the Insurance Commissioner. Rate increases for all health plans—group, small business, and individual (both on and off the health exchange)—are posted for public review and comment.

The insurance commissioner has until late summer to either approve, disapprove or modify the increase. Insurance companies are required to give their subscribers a 90-day notice of any premium increases.

My insurance company is asking for a 9.6% rate hike. Our family’s premium will go … Continue reading

Elisabeth Rosenthal on the problems of Obamacare health insurance

Take time to read Elizabeth Rosenthal’s latest installment of her “Paying Till it Hurts” series in The New York Times: Insured, but not Covered.

If you are like many Americans struggling with high-deductible, narrow-network health plans, you might relate to the families she writes about.

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

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Deferred deductible plans – a new option?

I was driving through Seattle the other day when a billboard caught my eye. The large multi-specialty clinic where I worked for many years, and which I still use for my primary care, was advertising something called a “12-month deferred deductible plan”.

Huh, I thought, and as soon as I got home I jumped on their website to find out more.

Acknowledging the problematic trend of high-deductible health insurance plans, the clinic created a program by which patients can extend their deductible payments over a 12-month period, rather than pay the entire amount at once.

Related post: High-deductibles Continue reading

Forced into Medicaid

I read an article in the New York Post this week by a young man who was upset because he lost his student health plan and couldn’t find an affordable new health plan. His income was too low for a subsidy, so his only option under the Affordable Care Act was to sign up for Medicaid.

So there I was: A struggling grad student with no health insurance, and unable to afford unsubsidized ObamaCare plans I’d hardly, if ever, use.

But Uncle Sam was there on his white horse, ready to save my day with . . . Medicaid?

There’s

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Protecting your personal health data

Almost since it went online, experts have been pointing out multiple security flaws in the federal health insurance exchange website, HealthCare.gov.

And I’ve reported about security problems in my state-run exchange, as well.

But the latest information about a security issue affecting your personal data isn’t the result of poor design—it’s intentional—and that makes it even more egregious: HealthCare.gov Sends Personal Data to Dozens of Tracking Websites

The digital watchdog group, Electronic Freedom Foundation (EFF) reports:

EFF researchers have independently confirmed that healthcare.gov is sending personal health information to at least 14 third party domains, even if the

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Controlling health care costs

The fact is, when you need health care the most, you are least able to “shop around.”

That’s why one of health care reform’s goals of pushing consumers to “have more skin in the game” won’t always work.

Sure, when our health concerns are not urgent we can take time (lots of it) to make phone calls to providers and insurance companies. But when we are sick or injured, we can’t. And sky-high deductibles and narrow provider networks make controlling costs more difficult.

A pediatrician on his blog writes the following post:

In today’s enlightened times, health care isn’t

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Obamacare: “America’s Bitter Pill”?

obamacare america's bitter pillTwo days ago, author Steven Brill was interviewed on 60 Minutes about his recently published book, America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System.

Brill came to the nation’s attention two years ago when he wrote a lengthy article for Time magazine titled “Bitter Pill: Why Medical Bills are Killing Us.” He introduced us to the term “chargemaster”—the hospital pricing list that is kept hidden, perhaps because the prices are outrageous and irrational.

But his book reads like a season of House of Cards; Brill even says in the 60 MinutesContinue reading

High deductibles = delayed care

Last week USA Today published an excellent article about the problems with the new trend of really high-deductible health care plans:

It explains how the overarching goal of Obamacare to provide coverage for the sick and low income demographic has had a rather unfortunate (although not unforeseen) unintended consequence.

Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away.

“It’s flip-flopped,” says Arla, who helps his father run a

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More find health care unaffordable, are underinsured

Despite reforms, health care is less affordable for many

CBS News and The New York Times recently conducted a poll and I found the results both interesting and alarming (although not surprising).

Fifty-two percent of Americans say they find basic medical care affordable, but that’s down from 61 percent last December. Today, for 46 percent of Americans, paying for medical care is a hardship, up 10 points.

Most attribute the rise of out-of-pocket costs to more expensive medical treatment, rather than an increase in the amount of treatment they are receiving.

When Americans are asked about some specific ways they

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Obamacare, taxes and subsidies

An email from a friend this weekend made it clear that many people don’t understand how the much-lauded Obamacare subsidies work.

That’s understandable, if they are not directly affected. However, it seems even those who qualify for and receive subsidies don’t necessarily understand how they work.

The devil is in the details, as they say, and Obamacare is nothing if not full of fine print and unintended consequences.

Unfortunately, not knowing the details of how the subsidies work will result in nasty financial surprises for some families, especially when tax time rolls around next year.

Related posts:

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