Friday, July 29, 2016

Does Medicare Cover Cancer Treatment?

Does Medicare cover cancer treatment? When this first came up I thought, what a silly question. Of course it does.

Then I discovered people who have cancer policies, many they have had for years, and continuing to pay for them after they turned 65 and enrolled in Medicare.

No doubt many cancer insurance policies are sold, and bought, based on fear. My personal feeling about cancer policies have changed over the years. At one time I felt they were a waste of money. That position is tempered a bit. I still don't think most people NEED a cancer plan but if you want one for ancillary coverage, go for it.

Surprisingly, the biggest health issue for retirees on Medicare is not cancer but Arthritis.  Cancer ranks number three behind arthritis and heart disease.

Does Medicare Cover My Cancer Treatment?

Does Medicare cover my cancer screening and treatment? How about chemotherapy? How much will I have to pay for my cancer treatment? Does Medicare cover the rest? 

From a purely financial perspective, most people with original Medicare and a supplement (Medigap) plan will not have to worry about how they will pay for the cost of cancer treatment. Most Medigap plans cover 100% of your hospital inpatient (Medicare Part A) expenses and the bulk of your outpatient care.

Original Medicare pays all of your hospital inpatient bills and 80% of your outpatient medical expenses. Your Medicare Part A hospital inpatient deductible is $1288 in 2016 and your Part B (outpatient) deductible is $166.

Most Medigap plans cover your Part A deductible. Medicare supplement plans F, G and N pay the remaining 20% of approved Part B claims.

Cancer fighting drugs may be covered under Medicare Part B or Part D.

I have clients that are currently being treated for cancer. Their out of pocket costs for chemotherapy is $0 in most cases thanks to original Medicare and a solid Medigap plan.

Georgia Cancer Resources

How can I get help paying my medical bills? How much does it cost to treat cancer?

Beyond the thought of dealing with your illness, financial concerns can cause as much stress as the disease. Fortunately there are resources and support groups.

This site has a list of cancer resources you may find helpful. You may also want to search additional information about cancer by following this cancer information link.

#DoesMedicareCoverCancer #CancerResources #CancerTreatment

Thursday, July 28, 2016

Doctors Who Refuse Medicare Patients

A doctor that doesn't take Medicare? Get out of here! No way. All doctors accept Medicare.

Don't they?

Most do, a few don't.

If you are turning 65 and enrolling in Medicare, there are things you need to know.

Medicare Assignment, No Assignment, Opt-out

Roughly 99% of doctors participate in Medicare and 96% of those accept Medicare assignment. That makes your job a lot easier.

If you have original Medicare.

Not so much if you have a Medicare Advantage plan.

With original Medicare you can use (almost) any doctor anywhere in the United States. No networks. No referrals. No paperwork.

Your job is a bit more complicated with an Advantage plan.

Advantage plans run on a calendar year basis. "Your" doc may participate this year but not next year. That can make it a challenge if you have a medical condition that needs the attention of someone who really knows your history.

And what about that 1% of doctors that opt-out of Medicare.
Opt-out doctors who accept no Medicare reimbursement and put the onus on the patient to foot the entire bill, except for medical emergencies. These physicians are required to tell patients the costs of services up front and have them sign what are known as private contracts, agreeing to the opt-out method. - Next Avenue
Doctors that opt-out of Medicare is generally limited to the psychiatric field. If you need counseling, are turning 65 and enrolling in Medicare you need to ask your therapist if they participate in Medicare

What if Your Doctor Says No?

Don't be too concerned. Remember, most doctors participate in Medicare but some are not taking on new patients.
In 2010 a Texas Medical Association survey found that 18 percent of the state's physicians were restricting the number of Medicare patients they treated, while 16 percent were no longer seeing new Medicare patients. 
Nationally, the number of physicians who still participate in Medicare is unclear. As of 2008 only 58 percent of physicians were willing to see all new Medicare patients, while fully 13.7 percent were no longer willing to see any new Medicare patients, a survey by the Center for Studying Health System Change survey found.4 Both a 2010 American Medical Association (AMA) survey and the 2011 National Ambulatory Medical Care Survey found that about 17 percent of physicians were restricting the number of Medicare patients they treat. - National Center
I am a baby boomer enrolled in Medicare. Moreover, I have over 400 clients in Georgia, all have original Medicare. 

Most had doctors before turning 65, and every one of them were able to keep their doctors. The few that did not have a doctor before 65 had no trouble finding someone to accept them as a new patient.

A few clients moved to Georgia from other states. A few had a serious ongoing medical condition.

One lady was recovering from ovarian cancer but had a relapse shortly after moving here. She had no trouble getting accepted into an Emory Hospital practice that specializes in her type of cancer.

Not only was she able to get the care she needs, but all of her inpatient and outpatient bills have been paid by Medicare and her supplement plan. Her only out of pocket for medical care is the Medicare Part B deductible ($166 in 2016).

Another client had not seen a doctor in years but had been, in his words, "feeling puny" for several months. He was looking forward to turning 65 and getting on Medicare.

Almost immediately after enrolling in Medicare he made an appointment with a doctor for his Welcome to Medicare physical. He had been taking antacid medication for several months for heartburn.

After several tests he was diagnosed with esophageal cancer. Living in south Georgia, was a challenge since there were few doctors nearby that could effectively treat his condition. 

The good news is he was accepted into a specialized treatment program at Mayo Clinic in Jacksonville. His condition has improved considerably thanks to the aggressive treatment at Mayo.

Once again, his only out of pocket for medical treatment has been the Medicare Part B deductible. All of his hospital bills and all of his outpatient medical bills that exceed the Part B deductible are paid in full.

Tomorrow we will address the question, "Does Medicare Cover Cancer Treatment?".

#DoctorsNotTakingMedicare #Turning65

Wednesday, July 27, 2016

Thank You Sir, May I Have Another?

In the movie Animal House a young actor (Kevin Bacon) played the part of Delta House pledge Chip Diller. As part of the initiation ritual, pledges had to subject themselves to humiliation by assuming the position and being whacked in the butt with a paddle. 

Most of the main characters in Obamacare either decided not to pledge or have flunked out.

While most of the carriers have lost money by the buckets, a few have thrived in the Obamacare market and are coming back for more.

Centene has learned how to make money in the Medicaid market. A combination of lean plans and even leaner networks seems to be a winning combination when serving up health insurance on the dollar menu. That same approach works well in the Obamacare market.

At the same time, carriers like United Health Care, Assurant, Humana and others were losing money by offering prime rib to the bologna crowd.

You can count Health Net in the loser bunch.

Then along comes Centene who gobbles up the Arizona and California business written by Health Net. That move created financial indigestion for the otherwise profitable Centene.
Centene's ACA exchange profits remain “at the high end of our targeted range,” but acquiring Health Net dragged the company down 
Specifically, the losses were tied to “unfavorable performance” in Health Net's Arizona and California individual markets. That included a lack of risk-corridor funding and detrimental effects from the “grandmothering” of older, pre-ACA plans, which means they only had to comply with some of the ACA's standards. Health Net also has PPO plans with broader networks of hospitals and doctors, which often appeal to sicker people who are willing to pay higher premiums if it means their providers are in-network. Conversely, Centene offers more high-deductible, narrow-network plans with cheaper premiums, plans that attract price-sensitive consumers. - Modern Healthcare
But not to worry. Centene will correct the problems caused by the stupidity of Health Net when 2017 rolls around.

Come 2017, Health Net won't be playing in the Obamacare market while Centene will only offer plans in a few markets. Residents can say goodbye to rich plans with broad networks. They will be replaced by a much leaner fare.

So while Health Net bails, Centene says "Thank you sir, may I have another?".

How Important is Medical Underwriting?

Recently I moved a small employer from the fully insured Obamacare plan that was written in 2014 into the Anthem MEWA here in Ohio. As a start up in 2014 the company knew they had to provide insurance benefits to attract the quality employees to make the business successful.

Unfortunately as a new company entering the world of employee benefits, they were forced into the high priced community rated pool created under Obamacare. At the time the idea of using alternative funding arrangements was just beginning to enter the equation and for many insurers they were still a work in progress. Many products were still being developed and few were approved by the Department of Insurance. 

My client did what they had to do and bit the bullet paying a steep price. All the while knowing that I would be coming back this year with high expectations that we would have a few extra arrows in the quiver. Which is exactly what we brought.

I have to say, there was pain in the process. Employees had to complete an online data collection program. FormFire is an encrypted portal for employees that streamlines them through a questionnaire enabling their personal and health information to be integrated into almost any health insurer's application. While time consuming and tedious it's become the only way to effectively receive underwritten rates from insurance companies.

In the end it's the results that matter. A couple of month's worth of headache has resulted in this healthy small employer finding savings. And, they can confirm that there is a significant cost for Obamacare.

In case you want to know how much savings... 

$55,475 to be exact. More than enough to help this growing start up hire an additional employee.

Tuesday, July 26, 2016

Risk Adjustment: It's only money

Almost two months ago, we noted that the "risk adjustment program was designed to dissuade insurers from targeting only healthy people ... The problem is that measuring metrics often encourage companies to optimize their score"

The point being: even when it works (for certain values of "works") it's a giant time bomb ticking away.

And now we learn, thanks to FoIB Allison Bell, that it's about to go off:

"For Congress, putting a health insurance risk-adjustment program in the legislation that created the Patient Protection and Affordable Care Act of 2010 was a no-brainer."

Which is quite apt, don't you think?

The result of mindless tinkering is that "[w]hen insurers are dealing with the ACA risk-adjustment program, the amount of cash they get may ultimately depend on whether competitors make good on risk-adjustment obligations."

That is, they're trusting ion the old adage about honor among thieves, and relying on not just the willingness, but the ability of other carriers to pony up their share. Which, given the current state of the market, is, well, problematic. For example, Meritus Health Partners, Arizona's Co-OP, owes almost $50 million.

The problem?

"Reminder: Meritus has been placed under supervision by the Arizona Department of Insurance."

And that's just the 10th place finisher. Top billing [ed: ISWYDT] goes to Molina Healthcare of Florida, with an estimated tab of almost $219 million. That's a substantial hit, no matter how big you are.

All told, those Top 10 account for some $5.6 billion in risk adjustment fees.

"Bending the cost curve down," indeed.

How About a Refund?

Jonathon Gruber, the MIT smart-ass that designed Obamacare, the bill that became law due to "the stupidity of the American voter", has decided to dine on crow.

Kind of.

Gruber claims Obamacare hit its' mark of 20 million people as of 2015 but also admits that maybe they, the architect brain trust, might have missed it by this much . . . .
The rise in the Medicaid rolls has been much higher than expected. In May, 2013, CBO projected that Medicaid would grow by 12 million by 2015 and stay more or less at that level in 2016. In fact, Medicaid had grown by about 15 million by the beginning of 2016 - Poltico
For those with short attention span, all the hoopla and borrowed money spent to throw the health insurance baby out with the bath water resulted in only 15 million people on Medicaid who (presumably) could not access health care that way before.

How much has Obamacare cost?

According to the UK Daily Mail, about $50,000 for every American that gets coverage through Obamacare.

Put another way,
It will take $1.993 trillion, a number that looks like $1,993,000,000,000, to provide insurance subsidies to poor and middle-class Americans, and to pay for a massive expansion of Medicaid and CHIP (Children's Health Insurance Program) costs.
The $50,000 per person figure is a bargain compared to the figure presidential candidate Jeb Bush spent on his failed bid to be known as President Bush III. The Washington Post claims Bush the Lesser spent $53 MILLION per delegate in his run for the rose garden

Meanwhile, back in D.C. the current president has or will spend close to $2 TRILLION dollars on his failed health care plan but will only collect $643 billion in new taxes and fees creating a $1.4 TRILLION dollar loss.

This was the plan that would not add one dime to the deficit.

Not only should we demand that Gruber return his $2.5 million in architect fees but the American voter should demand a recount on all those Obama votes cast in 2008 and 2012.


Monday, July 25, 2016

Are the LTC shoes starting to drop?

The Office of Personnel Management announced last week that premium rates for the Federal Long Term Care Insurance Program will increase by an average 83% effective November 1.   John Hancock is the present insurer, and was the only bidder for the new contract beginning November 1.   

Officials representing Federal Employees expressed shock and anger at the news.  The anger is understandable - the shock is much less understandable.  There has been plenty of information about national, rapid increases to LTC costs. And specific to the federal LTC program, last August OPM made a sudden, unprecedented decision to levy substantial premium increases for new enrollees.  It was then unmistakable – or should have been unmistakable – that the federal LTC house was on fire.  However, the officials who are shocked today, seem not to have thought it important enough last August to prepare their constituents.   As this most recent news confirms – the LTC house is still on fire.

Where the Federal program goes from here is anyone’s guess. In fact, where LTC Insurance in general goes from here is anyone’s guess.  The principle remains that the reason to buy LTC insurance is to insure one's assets. The point at which that is a break-even or better risk-management decision appears to be going up. 

Health Tip of the Day


Friday, July 22, 2016

ICYMI: MergerMania under the scope [UPDATED]

[Scroll down for update]

FoIB Holly R has the latest on the proposed mergers of Cigna with Anthem and Humana with Aetna:

"The Department of Justice announced Thursday that it would file lawsuits against the proposed merger[s] ... there are [currently] five major health insurers in the United States — and if these mergers went through, that would drop to three."

And the numbers are staggering: if both deals go through those three mega-carriers would account for something like half the under-65 population.

On the other hand, FoIB Brian D wonders:

"How can you pass restrictions and rules that push health insurers to the brink of bankruptcy then block insurers to merge to save costs? Could it be you look forward to government take over?"

I replied that this has been the plan all along.

And by the way, Aetna and Humana have announced their plan to fight this decision tooth-and-nail.

Fighting city hall? Hunh.

UPDATE [Related]: Co-blogger Bob also chimes in with this tip:

"[Humana] says it will sell individual health coverage in no more than 156 counties in 11 states in 2017, down from 1,351 counties in 19 states this year. That will reduce the number of counties in which it sells individual exchange plans by at least about 88 percent."

And, taking a nod from United Healthcare, it's not selling any off-Exchange plans next year.

But hey, if you like your plan...

Thursday, July 21, 2016

Obamacare's New High Risk Pool

Anticipation of huge premium increases in the small employer market has been building since 2013. New rules were to take effect on January 1, 2014 that would eliminate medical underwriting and reduce the number of criteria insurers could use in developing premiums. Insurance professionals, insurers, and organizations such as the U.S. Chamber of Commerce were preparing businesses with less than 50 employees for significant increases to their medical insurance premiums and the potential of losing their plans.

Realizing the potential catastrophe of fully implementing this rule, President Obama had his leaders at HHS issue a letter to state insurance commissioners offering to extend plans that existed prior to October 1, 2013 through 2014. Less than four months later HHS followed up their prior letter with an additional extension lasting through 2017.

The delay has benefited employers and bought insurers time. This has resulted in a series of new plan designs featuring alternative funding arrangements that will help small employers avoid the costly rules associated with ACA compliant plans.

These products include self-funding with lower stop loss deductibles, level funded plans, and Multiple Employer Welfare Arrangements (MEWA). Most of these arrangements aren't new. They have simply been modified or adjusted to meet the needs and budgets that small employers need to retain a solid benefits offering at an affordable cost.

The biggest difference between ACA compliant fully insured plans and all of these options is medical underwriting. Under Obamacare, all fully insured plans for small employers must use adjusted community rating on their policies. The rules of adjusted community rating only allow for insurers to offer different rates for age, location, and tobacco use. Essentially taking the greatest risk factor - medical history - out of the process. The result is ACA regulated plans will increase the cost to employers with healthy employees while limiting the costs to employers with unhealthy employees.

On the other hand, alternative funding arrangements can continue to use medical underwriting to develop rates for employers allowing those with healthy employees to reap the benefits of a lower premium.

With Obamacare's rules on guaranteed issue and no pre-existing conditions, small employers will be able to shift from one arrangement to another based on their employees health risk. This will result in a separation of good and bad. Alternative funding arrangements will be filled with healthy risk and ACA fully insured plans will become a dumping ground full of bad health risk creating a costly high risk pool.

From an employer perspective this gives them the best of both worlds. At least until insurers pull out of the high risk market.

Cleveland-sized Health Wonk Review

Steve Anderson presents this month's round-up of fantastic health policy related posts, with almost Trumpian flair.

Not to be missed.

Wednesday, July 20, 2016

Midweek Spindle Clearing

As we noted last month, it looks like the Feds are getting serious about cutting Short Term Medical plans off at the knees. Thanks to a tip from Insurance Services of America, we have some new details:
The U.S. Department of Health and Human Services (HHS) has proposed major changes to short-term, limited duration insurance plans:
• Short-term health policies could be written for no longer than three months, instead of up to a year as is now allowed.
• Consumers would not be able to rewrite the policies.
Just more proof that the ACA was never about insuring people, just controlling them.

Consumers (and of course, agents) can comment on the new regs until early August.

Co-blogger Bob tips us that Palmetto State officials "warn the Obamacare health insurance marketplace is on the verge of collapse." Currently, most South Carolina counties have exactly one choice of insurers: Blue Cross. And it looks like they may be the only one left standing statewide for 2017.

Direct Primary Care continues to make inroads. In Cleveland, a local hospital network is offering their own take. Via co-blogger Patrick:

"On Wednesday, [MetroHealth] rolled out a program aimed in part at catering to people unhappy with the cost and complexities of their Obamacare plans. The program, called Select Direct, will allow patients to get primary care services by paying a fixed monthly fee ... You pay the amount and we'll take care of all of your preventive and health maintenance needs"

Which sounds great, since plans are available for as little as $40 a month. It's intended to supplement high deductible plans, or even as an ObamaPlan substitute. It's not clear from the article, but one presumes that it qualifies as an excepted benefit, and thus able to dodge the tax penalty fine.

As with all of these plans, of course, how one pays the oncologist and cardiac unit remains the big question.

Monday, July 18, 2016

Ted Cruz Lies

The lie:

The truth:


[Hat Tip: FoIB Holly R]

Interesting Industry Trend

Our friend Joe L at Issue Insurance tells us that (at least) 3 life insurers have introduced accelerated underwriting programs that promise to cut both the time it takes to get a policy issues and save wear-and-tear on clients' veins.

For example, Banner Life offers AppAssist, which is available for face amounts up to half a million dollars. It does away with medical exams, labs and doctor's notes. The carrier promises that qualifying applicants "can be approved by the next business day, or even faster."

I must admit, this feature has me scratching my head:

"One inch automatically added to client’s height to potentially boost the rate class"

I mean, I get where that could be helpful in assigning a rate, I just don't get how they accomplish the feat: elevator shoes?

So, what makes one a "qualifying applicant?" Well, that will vary from carrier to carrier, but generally speaking: ages 18 to 50, and the carrier will do a 'script check' (for various medications) and run an MVR (for major traffic violations, such as DUI). Assuming the client is on few (or no) meds and has a clean driving record, he or she should be good to go - quickly.

SBLI and Lincoln Financial offer similar programs, all with the goal of streamlining the underwriting process.

I think this is a good trend: for one thing, faster (but careful!) underwriting means less hassle for the client. Be interesting to see how far this spreads.

Friday, July 15, 2016

Major Food Pyramid Update

Well, it's been well over two years since our last Food Pyramid update. At that time, chocolate and red wine were the stars of the show, but that was then and this is now:

■ First up, great news for those of us who enjoy "a slice" now and again:

"Hallelujah! Eating pizza can actually help you stay healthy, awesome new study finds"

Turns out, it's more about the amount of sugar in a given food that drives its weight-gain potential. According to the study, "researchers concluded that a high-calorie diet with lower sugar actually improved the children’s cholesterol, insulin levels, liver function, blood pressure, and blood sugar."

Now about those anchovies...

■ In related news, Co-blogger Bob tips us that:

"Pasta may not be fattening after all ... By analyzing anthropometric data of the participants and their eating habits, we have seen that consumption of pasta, contrary to what many think, is not associated with an increase in body weight; rather the opposite"

Now loading it up with extra cheese, bacon and other treats is probably ill-advised, but at least we can enjoy a nice pasta salad (and maybe some of that yummy, healthy red wine).

Thursday, July 14, 2016

Misguided LTCi "Reform"

Over at LifeHealthPro, FoIB Allison Bell has the story of a woman who doesn't understand the purpose of the product, who's never designed, priced, marketed or sold a plan, who may not even own one, yet is called upon to offer suggestions on how to "reform" Long Term Care insurance.

What could possibly go wrong?

Let's start with some basic facts:

First, the primary purpose of Long Term Care insurance (LTCi) is asset protection. That is, as homeowner's insurance protects one's home, LTCi protects one's retirement and other financial assets.

By definition, folks on Medicaid have no such assets to protect, hence no need for a plan. If one has no car or driver's license, why would one want (let alone need) to buy auto insurance?

Second, the primary reason that rates have continued to increase is that the industry made some (very) bad assumptions about retention. That is, they designed and priced the plans similar to disability insurance (close cousin), assuming a similar lapse rate. In hindsight, this turns out to have been a mistake, because insureds have been keeping their plans - even with rate increases - in droves. This drives up claims, and here we are.

Ms Burns offers 7 suggestions about how to "reform" Long Term Care insurance. There's a lot of bad advice (and assumptions) but we'll just look at three particularly egregious examples.

First, "(l)et Medicaid help low-income long-term care insurance policyholders hang on to their policies."

Why? If they're already on Medicaid, then they have no use for an LTCi plan (remember, it's primarily designed to protect assets). Now I could see where that might help Medicaid: after all, premiums are a lot less than benefits, and so the gummint would reap some major savings. But that's not the same thing as actually helping policyholders, who might have other uses for those dollars.

Second, "(l)et the government try to recover any long-term care insurance premium subsidies provided after the insured dies, from the insured's estate." There's a lot of stupid packed in here, but I'll try to help her out. To begin with, this is already the law as regards benefits. How's that turning out?  And comparing LTCi with reverse mortgages? Where's Fred Thompson when you need him?


Finally (at least for this post), "(b)uild in transportation and meal support benefits." Right, because adding even more benefits always drives down cost. If there was a market for such cover, rest assured that it would be offered as an option for those who wanted to spend the extra cash. It's called "the free market" and it works.

Next week, we interview an electrician about the best way to install a new toilet.