Friday, June 22, 2018

Does Medicare Pay for Routine Physicals?

I get this question a lot. "Does Medicare pay for routine physical exams? I hear they are not covered".

I don't know who started this rumor but I wish they would stop.

Original Medicare includes a "Welcome to Medicare" physical exam. As long as you have the exam within the first 12 months of going on Medicare Part B there should be no charge.

Thereafter you are entitled to what Medicare calls the Annual Wellness Visit. At this time your doctor will update your records, check your blood pressure, height and weight. There may also be a cognitive impairment test and / or a balance and mobility test.

Rather than making you read all this, sit back and watch this 3 minute video.

Additional reading here.


You have questions. We have answers.

Never any charge.

#WelcomeToMedicareExam #MedicareRoutinePhysical #AnnualWellnessVisit

Thursday, June 21, 2018

Px: Revisited

Px as in pre-ex, as in Pre-existing conditions. We generally define these as health issues for which we are currently being treated, or have been in the recent past. As we know, ObamaCare requires health insurance plans to cover these immediately (subject to one's eligibility to buy a plan), and also forbids carriers from charging those with these conditions a different (ie higher) premium for the privilege.

Kind of like how auto insurers can't decline someone with 4 DUI's and 3 at-fault accidents, or charge them more than someone with a pristine driving record.

But what if the ObamaTax was itself a pre-existing condition?

That's the premise of this article in The Hill, tipped to us by a regular reader:

"As a physician whose career in medicine was dedicated to preserving and improving my patients’ health, I know firsthand how important it is for everyone to have access to care ... Before the ACA, having pre-existing conditions did raise the cost of health insurance — sometimes to unaffordable levels — for some Americans, and the key word here is “some.

As we've pointed out over the years, the actual number of folks that were adversely affected by the ability of insurers to actually assess and rate risk was negligible. Dr Hayworth quantifies this for us:

"Their numbers were very few relative to our population of over 300 million, and we can make a rough estimate of less than 120,000 — that is, well under 4 people per 10,000 nationwide."

Now, for those few, the results were daunting, and expensive. But there were already plans in place (PCIP comes to mind). And these could be quickly re-implemented if, as Dr Hayworth urges, we let the market provide the cure. She offers 3 very specific steps to get that rolling, starting with eliminating all the fluff that plans are required to include, but which really don't neet the definition of insurance. And she also endorses a tried-and-true strategy of assessing carriers to fund risk-pools for those who need that coverage.

There's more, and I especially like the way Doc H presents her case in a straightforward way, without relying on scare tactics or sob stories.


Wednesday, June 20, 2018

You, Your Money, and Nursing Homes

Allison Bell is one of my very favorite insurance journalists, and we've quoted her work quite often. Her articles are typically first-rate: understandable, accurate and complete.

You just knew there'd be a "but" here, didn't you?

Recently, she posted an article on the cost of nursing home care depending on whether one was self-pay (including long term care insurance), Medicare and Medicaid:

"If nursing home owners had a choice, they might prefer to see Medicare patients come through the door."

That;'s because (apparently) Medicare pays about 60% more for nursing home care than private payers (including the aforementioned LTCi policyowners) do.

Which makes sense, actually, since Medicare doesn't actually pay for long term care, which is where the nursing homes would then make up any shortfalls. And for short term, Medicare-eligible stays, it's unlikely that very many LTCi plans would pay a nickel, since most will have a 20 or 90 (or longer) day waiting period. It's also important to note that the criteria for Medicare reimbursement is quite different than what would trigger an LTCi claim, further reducing the number of those actually paid for such short term stays.

Now what would be interesting would be to include those newfangled short term care plans in this mix.

One wonders how they might fare.

Tuesday, June 19, 2018

MVNHS© in Three Acts

What's it all about, Alfie?

The Much Vaunted National Health System© is famous for its enthusiasm for infanticide, the most recent example of which would be the Baby Alfie Evans case. We noted at the time that, as usual, this wasn't really about health care dollars (pounds?) or delivery, it was about control, period:

"[I]n this case it's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense."

Ah, but how much more, you ask?

This much more:

Indeed they do.

O say can you see?

We've long been aware of the horrendous wait lists to which British victims "patients" are subject, and now we have a picture-perfect metric of just how tragic that can be:


Food Fight!

And now for something completely different: (alleged) insurance fraud and travel insurance. Seems that Brit's have found a veritable pot of gold across the channel:

"The number of bogus food-poisoning and gastric illness claims filed by Britons traveling abroad is reported to have reached epidemic proportions"

Turns out, it's been amazingly easy to file a claim on the travel insurance available with vacation packages, often just needing a copy of a receipt for a bottle of Imodium. The practice has swelled of late, to the tune of over 100 of these claims a day. Some of this has been due to the fact that it's often cheaper to settle than to fight .... up to a point.

That point, apparently, is now:

"Between 2013 and 2016, the number of allegations skyrocketed 500 percent  ... spurring some hoteliers in Spain and Turkey to threaten that they would suspend vacation deals from the UK market entirely."

I have a suggestion.

Monday, June 18, 2018

Kid's a major liability

You've likely read by now about the young lad, attending a wedding reception replete with expensive (and apparently fragile) art work, who (apparently accidentally) knocked over a priceless glass statue.

Well, not "priceless," exactly, more like $132,000:

"A Kansas mother says an insurance company wants her family to pay $132,000 after her 5-year-old son accidentally knocked over a sculpture at a city community center."

Now, one may argue over whether or not it was "worth" $132 large (the artist himself apparently didn't think so, since he chose not to insure it). And, ultimately, the parents' homeowners insurance would likely cover the expense.

But as is often the case, the lede gets buried for the sake of clicks:

"All the city did was file an insurance claim," Overland Park communications manager Sean Reilly told CNET ... We are NOT seeking payment from the family"

Oh, so non-story, then.

But hey, there's clicks to be had and papers to move.

And they wonder why we don't trust the MSM.

Early Fraud Warning

Our very first substantive post (way back in January of Aught Five) was about folks who thought they could cheat their way to big time insurance bucks. As one can imagine, they were not exactly successful in these endeavors, although they may have earned an "A" for effort.

But that was then, and this is now, and it appears that bad actors get early starts:

[Hat Tip: Bits & Pieces via FoIB MisHum]

Friday, June 15, 2018

Critical Illness Plans: A refresher

It's been a while since we've looked at Critical Illness (CI) plans:

"For several years now, colleagues (and marketers) have been urging me to offer Critical Illness (CI) plans."

A few days ago, I learned of a real life example of one of these plans in action:

Tammy was recently diagnosed with breast cancer. Fortunately for her, she had purchased a CI plan a few years ago; she went ahead and filed a claim on it, has been approved, and soon she'll have a check for $50,000 to help pay off any medical insurance out-of-pocket expenses, clean up some debts, and keep groceries on the table while she recovers.

This is my first experience with someone I know who had one of these plans - now that I've seen it in action, I really think I need to be more proactive in marketing them.

For those who are interested, one of our vendors (Guarantee Trust Life) has provided this very helpful video explaining how these plans work:

GTL's New Cancer, Heart Attack and Stroke Insurance from Guarantee Trust Life Insurance on Vimeo.

Thursday, June 14, 2018

A Midsummer Night's Health Wonk Review

Bill Shakespeare's classic wedding comedy is about the nuptials of the Duke of Athens and the (former) Queen of the Amazons, and has absolutely nothing to do with this month’s 'Review (I just liked the wordplay for the title).

Fortunately for our readers, we do have some amazing posts to share with you, so consider this your Playbill:

Roy Poses looks at CVS's recent "own goal" regarding donations to "a Sketchy Non-Profit."

Including exec's who (allegedly) made some pretty nasty remarks.

HWR newcomer Vincent Grippi offers us this interesting podcast with HWR veteran David Williams, discussing (prescription) drug pricing issues and challenges here in the US.

Fellow insurance blogger - and another longtime HWR favorite - Louise Norris explores the brave (not so) new world of Association Health Plans (AHPs), and what role (if any) they may play in reining in health insurance costs. As usual, Louise makes otherwise dry material quite interesting.

And speaking of our friend David Williams, his own submission is this fascinating post on whether or not the proposed merger between Partners HealthCare and Harvard Pilgrim Health Care is actually ready for prime time.

Will they or won't they? Time will tell.

Workers' Comp Insider's Tom Lynch has this take on GOP efforts to (finally?) take out ObamaCare, and what it means if their current efforts are successful. But the best part is his touchstone question: What happens if they "win?"

'Review co-founder (and all-around nice guy) Joe Paduda offers a round-up of his own, including a report on Purdue Pharma's opioid issues and Medicaid's on-going problems with work requirements.

Friend Tinker Ready has news about the proposed CVS/Aetna merger, and the CVS plan to offer more than just urgent care services [ed: let's hope the plan is shorter than their typical receipt!]

Over at xpostfactoid, Andrew Sprung offers an "elastic idea" for Democrats looking to expand Medicare, from a buy-in option for near-seniors all the way to "Sanders' Big Rock Candy Mountain." Sweet.

And finally, our own entry, in which we offer a disturbing glimpse at the true, grisly human costs of nationalized health "care:" dismembered babies.

On a brighter note, please join us next month at Peggy's Place (on July 12th).