bloginsurance

Continued from yesterday... Dr Greenberg does, however, make one somewhat valid point (making him 1 for 5, not exactly Hall of Fame material): if all plans were individually owned, there�d be increased competition, and more efficient benefit usage. For more on this, see the posts on � Catastrophic vs Insular .� Of course, he then goes on to break his one-point winning streak with this gem: �Individuals might belong to a health care plan for many years or decades.� Why? Oh, because plans would have an incentive to �invest in a person�s health.� He�s kidding, right? Carriers are impersonal, corporate entities which are designed to generate a profit for their shareholders. They do this by offering reasonable plans, at reasonable prices, for a reasonable time. Eventually, though, rates begin to climb (regardless of whether employer-based or individually owned), and adverse selection takes over. There�s also attrition due to age, family status, heck, where one lives. I would have expected t

So opines my better half. Her point is that everything happens for a reason, although that reason may not be immediately (or ever) apparent. I bring this up because Bob Vineyard recently posted this comment: � My personal opinion is that employers should provide as many health benefits as possible . . . in lieu of higher wages. The tax breaks to the employer (and employee) are considerable. � The �coincidence" is that Dr Ford over at CA Medicine Man has posted his response to an article on this very subject in Internal Medicine News. Let me take a moment to mention that Dr Ford�s blog is an extremely readable, informative, and interesting place. As a physician, he brings specific medical knowledge, but it�s never too technical, and never dry. The article, by Dr. Warren Greenberg, posits that we should do away with the corporate tax-break for health insurance, which would lead to increased competition based on quality of care. Dr G is a Professor of Health Economics at George Was

Some thirty states are considering bills that would require employers to pay for at least part of the health coverage for the uninsured . There is, of course, more here than meets the eye. First, there is a tendency in the media (and among those in the professions) to conflate �health care� and �health insurance.� This is demonstrably inaccurate: those without health insurance rarely go without health care , unless they deliberately choose to forego it. Second, we constantly hear about �tax breaks for business,� and �employer paid health insurance.� Neither of these things actually exist: Businesses do not pay taxes, they collect them. And businesses do not pay for health insurance, they simply re-route dollars from employees� wages to health insurance carriers. The regulations under discussion here tend to fall into three broad categories: 1) Mandating employers to provide health care to workers or pay into a state fund to help the uninsured 2) Requiring that employers doing busine

Tonight marks the beginning of the Jewish festival of Passover. We celebrate the time, thousands of years ago, when we were freed from slavery. For the next 8 days, we'll eat nothing made with yeast (in fact, there's a whole raft of foods which we'll miss). Our major staple is a cracker-like product called Matzah, made simply of flour and water. There is a whole litany of terrific Passover humor, as well. Here's one of my favorites: A Jewish man took his Passover lunch to eat outside in the park. He sat down on a bench and began eating. A little while later a blind man came by and sat down next to him. Feeling neighborly, the Jewish man passed a sheet of matzoh to the blind man. The blind man ran his fingers over the matzoh for a few minutes, looked puzzled, and finally exclaimed, 'Who wrote this nonsense?' Have a great Passover!

It�s been said that the life insurance industry moves at the speed of, well, snails. And there�s some truth to this. But every once in a while a new product, or a substantive enhancement to an existing product, comes along. Such is the case with Return of Premium term life insurance. A relatively recent development in the life insurance universe, RoP seeks to address one of the major disadvantages of term insurance: what happens at the end of the �term?� To understand why this is important, let�s examine what term insurance does, and what it doesn�t do. Term life insurance is �pure protection;� that is, it pays a death benefit if/when you die during a specific time frame, or �term.� It�s analogous to renting or leasing your insurance. I�m not going to get into the whole term vs permanent debate here, let�s just leave it that term insurance can provide reasonably-priced coverage for a set amount of time. One further note: term insurance premiums are generally �locked in� for that period

My good friend, insurance guru Bob Vineyard and I have been engaged in a lengthy, interesting, and frustrating email correspondence. It all started innocently enough: Bob wrote to tell me that he got his hand slapped (which is in itself not really all that surprising) because � apparently � HIPAA doesn�t consider pregnancy a pre-existing condition. Usually. And that�s where it gets interesting. According to the DOL (Department of Labor): �If you find a new job that offers health coverage, or if you are eligible for coverage under a family member's employment-based plan, HIPAA includes protections for coverage under group health plans that:Limit exclusions for preexisting conditions Moreover, under HIPAA, preexisting condition exclusions cannot be applied to pregnancy, regardless of whether the woman had previous health coverage." This seems counter-intuitive, given that other provisions in HIPAA limit coverage for pre-existing conditions. So, I identified 4 scenario�s where t

Dr John�s conclusion is that � (t)o bring down utilization (and therefore costs) from both the patient and the doctor side, one can require more direct patient out-of-pocket contributions .� While I don�t disagree, I think that this ignores other factors which contribute to the overall cost of coverage. For example, in any given policy (group or individual), up to 17% of the price is due to government mandated benefits. Such benefits are an integral part of the plan, and cannot be reduced or eliminated. This means that, even if you don�t want or need that benefit, you can�t request its removal in order to reduce premiums. As to Econblog�s dismay that folks choose plans which are contrary to their best interest: folks still eat Big Macs, smoke, watch way too much TV, and don�t exercise enough, either. All of these are antithetical to one�s good health, yet many (most?) of us are guilty of at least one or two of these �sins.� So it should come as no surprise that health insurance consum

Over at California Medicine Man , Dr John is hosting a debate (of sorts) regarding Consumer Driven Health Care (CDHC). His post (linked in the title above) quotes from an Econlog item written by two economists. Confused yet? It gets better� Briefly, Econlog posits that � most consumers would prefer��insular� coverage in favor of so-called �catastrophic� insurance. � �Insular coverage� being defined as what most folks own today: office visit and rx co-pays, low deductibles and some modest co-insurance. In other words, generic coverage. �Catastrophic coverage� would be some form of High Deductible Health Plan (HDHP), presumably one that would be HSA-compliant. Econlog�s puzzlement with this mimics my own take on the generic vs HDHP debate, namely: most people, in most years, spend far more in premiums than they receive in benefits , which seems bass-ackwards. As economists, Econlog expresses dismay at this seemingly irrational choice. As a physician, Dr John believes this is because the

Recently, I had occasion to work with a nice lady whose COBRA benefits were about to expire. Unfortunately, she has a number of health conditions that render her uninsurable in the individually-underwritten market. What to do� There were three choices, really: transition from COBRA to HIPAA, purchase a limited benefit but guaranteed issue plan, or go naked uninsured. She came to me with about two weeks left before COBRA ran out. BTW, you may be thinking that a Short Term Medical plan would have bought her some time. Unfortunately, before she came to me, she had applied, and been declined, for an individual medical plan. STM plans, as a rule, are not available to those who have been declined for coverage for health reasons. In any case, the premiums for a HIPAA plan for her run between $1,000 and $1,300 a month, depending on benefits. The guaranteed issue plan runs about $180. No brainer, right? Not quite. True, the guaranteed issue plan would save her $10,000 to $13,000 per year. But,

Just to let y'all know that we made it back safe and sound. New Mexico may be the friendliest place we've ever been (outside Ohio, of course). A special Thank You to Bob Vineyard ( HealthInsurance411 ) for keeping the homefires burning here at InsureBlog.

Health Savings Accounts are helping individuals save thousands of dollars on their income taxes. These tax-favored accounts, which have only been available since January of 2004, can be opened by anyone with a qualifying HDHP (high-deductible health insurance plan). Once you open an account, you can place tax-deductible contributions into it, which can then be used later to pay medical expenses. Any money not used grows tax-deferred, like an IRA. HSAs offer many tax advantages over traditional health insurance arrangements. 1) Reduce your federal income taxes. Regardless of your income level or how your income was earned, any money you deposit into your Health Savings Account is considered an �above-the-line� deduction, giving you a 100% write-off against adjusted gross income. 2) In addition the deducting the loss fund contribution, premiums paid for the HDHP are also deductible. 3) Reduce your state income taxes. 4) Tax-deferred growth. Like funds in an IRA, the money in your account

Many consumers are making decisions on health care coverage that are potentially deadly. Rising premiums force many employers to cut back or even eliminate group health insurance coverage. COBRA premiums can create �sticker shock� for those who have always enjoyed the shelter of an employer plan. Medical discount plans, illegal in some states, still prevail and consumers choose these plans as an alternative to INSURED health coverage. All of these factors, and more, force consumers into the market place in search of affordable health care. In an attempt to make coverage more affordable, some carriers are introducing limited benefit plans with premium savings of 40% or more. Sadly, many agents are pushing these plans in an attempt to gain new clients and compete in a market place where low price is a deciding factor. But how much will these limited benefit plans really cost you? Those who purchase these plans will not know the TRUE cost of coverage until they have a major claim . . . by

Your perspective on the availability and pricing of health insurance depends mostly on whose ox is being gored. If you are in good health, you pretty much have your pick of plans, carriers and pricing. If you are not your choices become much more limited. I can empathize with those who are having difficulty finding health insurance due to existing health conditions. But I do find it interesting that some are almost militant in their demand for ready access to health insurance without restriction. Let�s say you are using anti-depressants, are on a low, maintenance dosage, and have had good success in your treatment. You have not been hospitalized, taken time off from work, have not attempted suicide or other bodily harm. In general, you function within �normal� limits but the meds help to stabilize your moods. No problem, right? Not necessarily. If you are looking for individual coverage the best you can hope for among PPO plans is standard issue but no coverage for meds or provider ses

Throw out the highs and the lows, then work with the ones in the middle. This was advice given to me a long time ago by a lady I admired. She was a consultant with one of the alphabet houses in Nashville and handled some big regional, and national accounts. One day I was calling on her as she was sorting through various bids for coverage on one of her accounts. Despite what most casual insurance buyers think, this is a tedious process. Most insured �shop� their coverage maybe every 2 � 3 years while a few will more often than that. To the untrained eye all plans with the same deductible and �roughly� the same coverage should offer the same coverage. They don�t. To the casual buyer, once policies with the same deductible and copay are grouped together, you look for the lowest price. This is a fatal flaw and one of the reasons I encounter so many people who are dissatisfied with their health insurance plan. In truth, there are often subtle differences from plan to plan. On the surface th

In the old Bugs Bunny cartoons, the wascally wabbit could often be heard to exclaim: " I knew I should have taken that left turn at Albequerque " Well, that�s where my family�s headed next week. We�ve never been out that way before, and decided that Spring Break would be a fine time to head out west. While I�m gone (or, as my new friend Kat would say, �on hiatus�), my good friend, health insurance guru Bob Vineyard , will be filling in. Please don�t be too hard on him. Have a great weekend!