Health Insurance Blog

California-based insurance behemoth Blue Shield raised eyebrows today with the announcement that it would be raising its fees--in some cases as high as 59% for individuals, the LA Times reports. The increases will take effect on March 1st, and will likely affect tens of thousands of people. While Blue Shield rates have gone up an average of 30 or 35%, it appears that one in four Blue Shield customers will experience an increase of 50% or more.

We'll see what pans out before March 1st--and how effective new Insurance Commissioner Dave Jones will be at blocking the changes. Right now he doesn't have the authority to do so, but he says that the situation is "under review."

"Blue Shield's increases pose the same problem posed by Anthem Blue Cross last year and other health insurers as well," Jones told the LA Times. "My hope would be that Blue Shield would reexamine these rate hikes, particularly in the face of the impact they are having on individual policyholders."

You may be running low on time to spend the rest of your flexible spending account (FSA) before the end of the year.

Depending on your insurance and your health care needs, here are some possible ways to drain your FSA:

• Get some glasses.
• Stock up on medications.
• Birth control can be an approved expense.
• Check your teeth.
• See an acupuncturist - some alternative medical treatments may be covered.

And, give yourself the best holiday gift. Stop smoking - clinical smoking-cessation treatment is an OK expense.

More Information from Dr. Mike:

• Top 10 Ways To Use Your FSA Dollars

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

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Photo © iStockphoto.com

One of the contributors to my forum recently posted the following comment. I thought it was worth sharing as an example of how the Affordable Care Act can make a difference to someone with a pre-existing health condition.

I have not been able to find full time work. And I have been denied personal coverage for years due to pre-existing conditions (with thyroid cancer added to the list). I was at wits end two months ago because I need one more treatment for my cancer. Then, I found out that part of Obama's bill includes the Pre-Existing Conditions Insurance Plan. It is basically a large US GOV group plan that covers the gap for people who (a) do not qualify for subsidized care like Medicaid, (b) can pay competitive group premium rates, (c) have a pre-existing condition for which one has been denied coverage, (d) have not had insurance for at least 6 months, (e) have been denied coverage in the last 12 months.

PCIP Updates for 2011
22 states and the District of Columbia are offering pre-existing condition insurance plans run by the U.S. Department of Health and Human services. The rest of the states are managing state-run plans.

In 2011, the program administered by the federal government will include three health plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays.

For information about the program - including how much it may cost you each month and which states are "doing their own thing" - visit the PCIP website.

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

Dr. Mike's Monthly Health Tips for December 2010.

With health insurance premiums climbing along with annual deductibles, you can save money by staying healthy and helping to keep your family healthy.

This month's health topic: Don't let the flu spoil your holidays!

• Tip #1:  Wash your hands, thoroughly and often.
• Tip #2:  Get the flu vaccine, especially if you are at high risk.
• Tip #3:  Sneeze and cough into the crook of your elbow.

To learn more about the flu, visit the Cold & Flu website of Kristina Duda, RN, my About.com colleague.

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

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Photo © Buena Vista Images

In a fascinating interview published in Kaiser Health News last week, Uwe E. Reinhardt, a well-respected Princeton economist and health policy expert, suggested that President Obama should tell Republicans in Congress to go ahead and repeal health reform. "That way the GOP would have to come up with its own solutions to the health care cost crisis, many of which, he wagers, would look much like parts of the current law."

Read the Interview!
In this provocative interview, Reinhardt does not mince words as he critiques the Affordable Care Act, recent proposals from the President's deficit-cutting panel, and the U.S. healthcare system in general.

• Reinhardt: Repeal Health Care, Make GOP Cut Costs

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

Given the serious shortage of primary care physicians in the U.S. (which most likely will get worse as the Accountable Care Act is fully implemented), I read with great interest the executive summary of The Future of Nursing: Leading Change, Advancing Health, an examination of the nursing workforce.

The report, recently published by the Institute of Medicine (IOM), offers recommendations that "are intended to support efforts to improve the health of the U.S. population through the contributions nurses can make to the delivery of care."

IOM Recommendations
The IOM report makes the following recommendations:

• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
• Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
• Effective workforce planning and policy making require better data collection and information infrastructure.

According to the IOM, "skilled nurses--who are quicker and easier to educate than doctors--should be allowed to take on more primary-care roles to meet the future demand under healthcare reform and the aging of the baby boomer population."

Robert Wood Johnson Foundation Campaign
Building on the recommendations of the IOM, earlier this week the Robert Wood Johnson Foundation (RWJF) announced the Future of Nursing: Campaign for Action, "which will work to address the increased demand for care by using all the skills, talents, knowledge and experience of nurses."

The Campaign will work with five states to implement measures that can be successfully replicated by additional states later. The states are: California, New Jersey, New York, Michigan, and Mississippi.

Importantly, "This Campaign will transform our nation's health care system so that all Americans have access to high-quality, patient-centered care where they live, work, learn and play and across the lifespan," according to Risa Lavizzo-Mourey, President and CEO of RWJF. "This Initiative is vital to the strength of our nation's health, and will remain so for generations to come."

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

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Photo © Yellow Dog Productions

That scary message sent by AARP arrived in my mailbox causing me to almost choke on my leftover turkey sandwich!  The hard-to-miss postcard went on to say: You've earned your Medicare and the doctors you count on. Unfortunately, unless Congress acts by January 1, 2011, doctors who treat Medicare patients will see their pay cut by 25 percent.

What Is This All About?
In 1997 Congress created a system (known as the Sustainable Growth Rate formula, or SGR) to try to control Medicare spending. Under SGR, if actual Medicare spending (what Medicare pays for all types of health-related services) exceeds a target based the country's Gross Domestic Product, then Medicare must reduce physician payments in the next year.

The problem is that the cost of managing a medical practice keeps going up while payments to physicians keep going down. This is especially a problem for the lowest paid physicians - the primary care doctors (internists and family physicians) who provide the basic health care for seniors.

As seniors age, they tend to have more health care needs and more time-consuming and complex medical issues. You can do the math, less money for each patient visit + needing to spend more time with each patient = less hourly income to pay staff and bills. In fact, in some areas of the U.S., payments are so low that a physician practice with more than half of its patients on Medicare may actually lose money.

Can This Be Fixed?
YES! Congress needs to change the system for paying physicians who manage the health care needs of seniors. However, Congress has not acted to change the law. Periodically, Congress will pass a short-term "patch" to stall cuts in payments.

Congress needs to do two things:

1. Pass a one-year patch to continue current physician reimbursement - an expensive but necessary move.
2. Come up with a more permanent solution to the Medicare spending issue.

My Own Experience
I live in an area that is heavily populated by retirees. When I moved to the community, I was fortunate to find an outstanding internist, who not only had excellent technical skills but also spent the time needed to make sure my healthcare needs were being met.

Several years later, frustrated by his inability to spend time with the growing number of seniors in his practice and his falling revenues, he closed his practice to be a stay-at-home dad. I had to scramble to find another physician!

A Final Word from AARP
The last paragraph on the card I received from AARP said: "Congress Needs to Act: Protecting your relationship with your doctor shouldn't be a partisan issue. It's time for politicians to stop pointing fingers and work together to stop these cuts.  You should have peace of mind about keeping your doctor."

I agree - how about you?

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

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Photo © Vicky Kasala/Getty Images

Now that the Thanksgiving leftovers are gone and you've recovered from the "Black Friday" shopping frenzy, it's time to refocus on your Medicare choices for 2011.

If you are enrolled in Medicare, you have until the end of December to switch from regular Medicare to a Medicare Advantage plan, change your Medicare Advantage plan, or choose a new Medicare Part D prescription plan.

It's especially important to take look at the Part D plans in your area since many plans are changing in 2011. Most plans have increased premiums, and fewer plans are waiving the $310 deductable or providing some drug coverage in the donut hole.

And, don't forget to check your Part D drug plan formulary to make sure that your medications are still covered. If you are content with your current Medicare Options, you do not need to take any action.

So make a decision and enjoy that leftover slice of pumpkin pie!

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

To all my friends and website users, have a peaceful and healthy Thanksgiving.

Although the economy is slowly improving, there are still many people who are out of work and in need of food, clothing, shelter, and basic health care services. The food bank in my small New England town (population 31,000) is giving out the fixings for 900+ turkey dinners and we are expecting to serve an additional 1,000+ free holiday meals on Thanksgiving Day.

Earlier this week, I worked with dozens of volunteers to collect all the fixings for the holiday meal. If you have the means, please reach out to your friends and neighbors who may be having a difficult time this year.

FactCheck, one of my "go-to" websites for checking on political myths and misleading information, recently published an article about the increase in health care premiums.

The Republican leadership in Congress is blaming the Affordable Care Act for double-digit rate increases being sought by a number of health insurance companies. However state insurance regulators, well-respected health care experts and health plans themselves mostly blame rising medical costs.

New required and improved benefits mandated by the health reform law are responsible for only a small portion of the premium increases, which for the most part apply to consumers buying individual health coverage.

"Whopping" Premium Increase Blamed on Health Law
According to FactCheck, "Some Republicans have claimed the law is responsible for "whopping" premium increases, but they have misrepresented the facts in the process." FactCheck notes the following examples:

• House Speaker-in-waiting John Boehner said premiums will "skyrocket" because of the law, citing a report on rising premiums by the Kaiser Family Foundation. But the Kaiser report covered increases that took effect before the law was signed.
• Senate Minority Leader Mitch McConnell points to a news story about a Washington insurance provider that blamed premium increases on the health care law. But the state insurance commissioner says the increase had "absolutely nothing to do with health care reform," and the insurance company later admitted the law is only partly at fault.
• Both politicians refer to premiums for new plans on the individual market, where only about 6 percent of those with insurance now get their coverage.

FactCheck further reports that according to a health policy analyst with the National Association of Insurance Commissioners "as a general trend across all carriers in a state ... there's about a 1 to 2 to 3 percent increase in premiums in the individual market due to the health care law. If the legislation hadn't been enacted, the bulk of the reported premium increases still would have occurred. The real driver of the premiums is the costs, and you have to get the costs under control."

I urge all of you to read the full article - it is an eye-opener!

• The Truth About Health Insurance Premiums

FactCheck.org, a project of the Annenberg Public Policy Center of the University of Pennsylvania, is a nonpartisan, nonprofit "consumer advocate" for voters that aims to reduce the level of deception and confusion in U.S. politics.

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.