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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Harvoni, Solvadi and hepatitis C screening

harvoni hepatitis c treatmentNew treatments for hepatitis C

I read an article online the other day in which the author practically shouted at her readers to “Run as fast as you can to your doctor’s office and get screened for hepatitis C!”

OK, what she actually wrote was:

Overall, the outlook for patients with hepatitis C is much better than it was just a couple of years ago. So if you’re a baby boomer who hasn’t been screened for hepatitis C yet, don’t wait. 

Still, let’s step back and look at the big picture.

Hepatitis C screening has been in the news a … Continue reading

The Open Payments database

Lots of data, but not user friendly

Have you ever wondered if your physician receives a substantial amount of money from a pharmaceutical or medical device company?

Is your physician’s decision to write you a prescription for the newest brand-name drug, or replace your knee with a state-of-the-art joint, based on corporate influences? Conflicts of interest run rampant in health care, and it would be nice to know, wouldn’t it?

Earlier this fall, the Centers for Medicare and Medicaid Services (CMS) launched a new website called Open Payments. It’s part of the Sunshine Act, which in turn … Continue reading

Be informed: Read Elisabeth Rosenthal

Investigating the high costs of health care

Over the last year, Elisabeth Rosenthal, a journalist and science editor for The New York Times, has written a brilliant series of articles titled Paying Till it Hurts:

In her series on the costs of health care, Elisabeth Rosenthal of The New York Times examines the price of medical care in the United States, interviewing patients, physicians, economists, and hospital and industry officials. In each installment, readers were invited to share their perspectives on managing costs and treatment.

I’ve been reading the series, and the truly shocking charging and billing practices she … Continue reading

Researching health care costs

It’s not that simple

Last night on the local news I watched a story about health care costs. The reporter, a consumer affairs specialist, talked about the expanding trend in health care of high-deductible medical insurance plans. Under the ACA, family annual deductibles can reach up to $12,700 (increasing to $12,900 for 2015); whatever your deductible, you pay your medical bills out of pocket until that deductible is met.

The uninsured, of course, just pay out of pocket.

Related post: Health insurance basics, part 1

The reporter encouraged us to

…take some time to research, and see what the

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How “lump-sum” cancer insurance policies work

lump sum cancer insurance policiesThis is a guest post by Kristen Reineke of CancerInsurance.com. I’ve posted previously about Alternatives to Obamacare, and critical illness plans are a relatively simple supplement to standard comprehensive health insurance plans. Cancer, specifically, is an expensive diagnosis, and my new ACA-compliant health plan not only has costly premiums, but a huge deductible (over $10,000). Most of the leading cancer hospitals in Seattle (University Medical Center, Fred Hutch Cancer Research Center, and Seattle Cancer Care Alliance) are not in my network, which could also lead to higher out-of-pocket costs. Kristen explains how these critical illness or “lump-sum” policies Continue reading

Do you need an annual pelvic exam?

annual pelvic exams unnecessaryYet another screening exam found unhelpful

Earlier this month, the American College of Physicians (ACP) published its recommendation in the Annals of Internal Medicine that routine annual pelvic exams are unnecessary for healthy, non-pregnant women with no gynecologic symptoms (bleeding, discharge, pain, etc.).

The ACP looked at evidence on pelvic examinations dating back almost 70 years and concluded:

… no data support the use of routine pelvic examination (excluding cervical cytologic [Pap] examination) for reducing the morbidity [disease] or mortality [death] of any condition. Furthermore, limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety,

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Do you need an annual exam?

The yearly reminder

The other day I received in the mail a form letter from my physician’s office reminding me that I am due for my annual “well woman” visit. The letter also pointed out that if I have an ACA-compliant health insurance plan, the cost for the exam would be 100% covered as a preventive benefit.

I have three problems with this letter.

  1. Although my current physician is part of my new insurance plan’s network, the hospital she works out of is not. What if I needed to have surgery or be hospitalized? My care would then be given
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Obamacare – Good, bad or indifferent?

It’s complicated

Five years ago, I didn’t think our health care system could get any more complicated. Well, I was wrong.

I have watched it become increasingly tortuous as Obamacare’s rules, regulations and mandates have brought about a seemingly endless stream of unintended consequences.

The major benefit, I think, of Obamacare was to take away the pre-existing coverage clause in insurance policies. The idea was to provide health coverage for everybody, regardless of current health, and to make medical expenses more equitable; that is, some will pay more (the young and healthy) and some will pay less (the older, sicker … Continue reading

The high cost of Non-24

hetlioz non24Another drug we can’t afford

A few weeks ago I posted about the recent slew of commercials to “increase public awareness” of the chronic sleep disorder Non-24.

As Non-24 (formerly known as circadian rhythm disorder) affects totally blind people and is rare otherwise, it wasn’t clear to me why we needed increased awareness until I realized a new drug was coming to market.

When I wrote that post, this new drug, Hetlioz (tasimelteon), was not yet available in pharmacies. I speculated that it would be costly, perhaps as much as $10 per tablet. If only!

A few days ago … Continue reading

Save money by Choosing Wisely

save money choosing wiselyUnnecessary care = unnecessary expense

Every day I see a new article about the high costs of health care.

A new study suggests that in a single year, up to 42 percent of Medicare patients got at least one medical procedure they didn’t need — overtreatment that cost as much as $8 billion.

Use of [Mohs] surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its

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Obamacare premium increases for 2015

We knew they were coming

Yesterday I looked on the website of my state’s (Washington) Office of the Insurance Commissioner (OIC). Health insurance companies are required to submit requests for 2015 premium increases in May. The OIC then posts these requests and the public is allowed to comment.

Insurers also have to file any benefit changes to existing plans, and details of any new plans they will offer in 2015. Actuarial data (what the company paid out in medical claims, administrative costs, enrollee risk profiles, profits, etc.) must be included to support the need for the rate hikes.

Rates are … Continue reading

Unbelievable security flaw

Mark my words—Washington state’s health exchange is going to be the next big news story about an internet security breach resulting in the theft of consumers’ personal information.

As I mentioned in Monday’s post about internet security and your health care records, I recently changed the password to my family’s account on our state’s health benefits (Obamacare) exchange, wahealthplanfinder.org.

In that post I cautioned against using your personal (insecure) email to communicate sensitive health information.

So imagine my surprise and dismay when I received an email from Washington Healthplanfinder not only acknowledging my change of password, but also … Continue reading

Health-sharing ministries rise in popularity

A few months ago I posted about health-sharing ministries as an affordable alternative to Obamacare’s marketplace.

And recently I read that these groups are enjoying a surge in enrollment.

Since the launch of HealthCare.gov on Oct. 1, membership at each of the ministries has exploded, with nearly 30,000 new enrollees — more than the number of people who selected a plan through ObamaCare in 24 states.

Anyone participating in a health-sharing ministry is exempt from the mandate to buy ACA-compliant health insurance.

For more information about these ministries, read one of my posts on the topic:

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The French health care system

french health care systemC’est bien!

A friend emailed me a link to a recent article about a patient’s experience with the health care system in France.

The writer’s father, a French citizen living in New York, was diagnosed with pancreatic cancer and chose to forego treatment at one of America’s top-notch hospitals and return to his native country for chemotherapy.

The writer was understandably worried for her father: How could a public hospital in Paris possibly improve on Sloan Kettering’s cancer treatment?

Indeed. But what she discovered over the course of her father’s treatment is that the French have a pretty awesome … Continue reading