Friday, December 14, 2018

How's Healthcare.gov Doing?

Through six weeks OE6 is at 4,132,432 plan selections. This includes the period from November 1st through December 8th.

So how does it compare to years past?

2015  4,171,714
2016  4,015,709
2017  4,678,432

Not bad, considering the better economy has created more opportunity for people to gain employer sponsored insurance, Virginia expanded Medicaid, Trump rolled back the Obama rule to allow short term plans to last up to a year, and he saved taxpayers by slashing "marketing and outreach" funding to special interest groups.

No comment

R'unh ro!

[click to enbiggen]

#CMSNotWoke

Thursday, December 13, 2018

Medicare4All in a nutshell

Hello, and Welcome to McDoctor's!

You might have seem this in the news recently:

"New technology revolutionizing area McDonald’s with self-order kiosks"


Well, turns out MickyD's isn't the only place in town implementing this new technology. Recently, FoIB Holly R was at her new (to her) doctor's office, where she was checked in via a similar kiosk:




[click to embiggen]

(And note the hand sanitizer next to it. Heh)

"There's a bank of them with one human helper."

Imagine the airport, or the self-checkout line at the grocery store.

It makes a lot of sense in the medical setting, as well: easier HIPAA compliance, and the machines don't get a paycheck or insurance, or vacay or sick days. And this doc's figured out how to have a bunch of them: imagine how much that would cost as human office staff.

Welcome to the future.

Merry Health Wonk Review!

Our good friend Peggy Salvatore hosts this month's joyous compendium of wonky posts, do stop by to unwrap one for yourself. From Massachusetts to Colorado to Russia, there's something to celebrate.

Thanks, Peggy!

Wednesday, December 12, 2018

Interesting CMS Trick

So as Open Enrollment v6.0 winds down (with Saturday being the deadline for most of us), those of us certified to sell on the Federal Marketplace (aka "Exchange" or "HIX") received this email from the Centers for Medicare & Medicaid Services (CMS) this morning:

"As with previous years, some consumers who call the Marketplace Call Center during high-volume periods may be asked to leave their contact information to complete their enrollment after the December 15 deadline. This process will reduce hold times and allow those consumers to come back and complete their enrollment for January 1 coverage." [emphasis in original]

Hunh.

So how does that work?

Well:

"As we get closer to the deadline, the Marketplace Call Center may start prompting some callers to leave their contact information. This is an automated process enabled when volume is high. When someone calls, they will either be asked to leave their information or they will wait to speak to a representative. If a consumer is able to speak with a representative, they will be offered assistance with enrollment. There is no option for a caller to ask a representative to leave their information for a later enrollment."

Well that makes sense, sorta:

If the deadline is December 15, and we've known about the dates and the cutoff for many months, why are we coddling late-comers who've had plenty of time to make this happen before the last minute? I think we all know the answer to that:

"Has anyone noticed there's only abt 10m enrolled in exchanges & the (2013) baseline estimate is about triple that?"

Proving that the rocket surgeons in DC will do pretty much anything to goose those numbers.


Outstanding Customer Service Trick

We recently purchased a new refrigerator to replace our previous 27 year old one (don't judge). Obviously, this entailed removing the old fridge, revealing ancient secrets which would have delighted Dr Jones.

Among them were several long-lost gift cards to various places, including one from Carrabba's Italian Grill. Since there was no indication of how much was left on it, I got online and clicked over to their company website, where there was a handy feature where one could check gift card balances. Alas, the widget required not only the card number (which I obviously had), but a 4 digit "pin number," as well (which this card lacked).

Not to be discouraged, I used the handy online contact form to explain my plight and ask for help.

I got an email reply almost immediately, asking for the card number, which I provided. What came next was purely delightful:
"Henry,

Can you please provide your mailing address so we can send a replacement card out in the mail? Since this card was produced back in 2007 it was not printed with a pin, which is now required at the time of redemption.

Thank you,
Gift card team"
Waitaminute! That little guy had been trapped under (or behind) our refrigerator for 11 years? Yikes! And these folks are offering to replace it?

WOW!

It just doesn't get any better than that.

Thanks, Carrabba's, and kudos!

Tuesday, December 11, 2018

From Zero, A Hero

So the other day, I ran into a (newish) outfit called The Zero Card, which appeared to promise that now ubiquitous "free" health care. And since this didn't appear to be a state-sanctioned (or run) program, I was intrigued, and so I reached out to FoIB Dutch Rojas for introductions.

Dutch hooked me up with TZC's Chuck Foster, who graciously spent almost an hour with me explaining how the plan works, its limitations and benefits:

The Zero Card is based out of Tulsa, Oklahoma, and its plans are currently available in almost a dozen markets (with expansion plans in the works). It's available to self-funded groups exclusively (why that must be will become evident shortly), and operates as a sort of "sub-network" to a company's primary insurance-provided primary network.

From the employee's perspective, it couldn't be simpler (or better):

By choosing a provider associated with The Zero Card, all deductibles, co-pays and co-insurance is waived, the procedure or service becomes free to that patient. This in contrast to using the primary network which would entail potentially large out-of-pocket expenses. Best of all, the employee (or covered dependent) incurs no charge or fee. And because of how it's designed, there are no pre-authorization or second opinion hassles. Sweet!

But of course, the actual service does come at a price, and entails a bit more framework. From the employer's end, there's a percentage of claims ("spend") cost, but the plan is designed to nullify that: everything is in a bundled transparent price agreement, no "percent of medicare," etc.

Here's how it works:

The employer enters into an agreement with The Zero Card folks to offer the benefit, at no upfront cost. What TZC does then is adds 15% to the cost of the service or procedure; the idea is that they've saved the employer more than enough to compensate for this added expense.

How do they do that? Well, they go out to local providers (doctors, hospitals, facilities) and negotiate service "bundles." This results in more business for those providers, and helps to drive down the service costs. Chuck explained it like this:

In a typical plan, a service that costs $10,000 means that the employer is on the hook for $8,000, the employee for $2,000 [ed: excludes deductibles and co-pays].

The Zero Card folks have negotiated rates to a point that, even though the employer is on the hook for 100% (plus the 15% The Zero Card fee) that they still save money and, of course, have very happy employees. In order for this to actually happen, they strive for at least 35% savings off the traditional insurers' networks.

Another thing that Chuck stressed to me is their data analysis prowess: they are able to pinpoint how and what claims are paid in a way that really helps employers understand what's happening with their employees' and their plans. One can see where that could be a major benefit for both the employer and the employees.

Of course, this model really only works with self-insured group plans (because there’s no way to incorporate it into traditional fully-funded insurance plans), so it's limited, but as more and more carriers roll out self-funded plans for smaller and smaller groups, that's bound to mean market growth for TZC, too.

One thing we didn't discuss, but which occurred to me afterwards was what, if any, role they might play in the Association Health Plan space. Maybe next time.

[IB Thanks to Dutch and Chuck!!]

Monday, December 10, 2018

The Flipside of HSA's

As regular readers know, we've long been advocates of Heath Saving Accounts (HSAs). Unfortunately,the individual medical market no longer allows the kind of true catastrophic plans that make the accounts financially viable, but hope springs eternal.

For those lucky enough to have group and/or older individual HSA plans, though, the tax benefits remain a major draw. But what happens when one hits retirement age and offboards to Medicare?

Well, at that point, you can no longer contribute to the account itself, but can continue using it for medical expenses. But you can also use it as a (supplemental?) retirement vehicle, and apparently that's quite the popular option. As FoIB Allison Bell reports:

"Steve Neeleman, HealthEquity’s founder and vice chair, said employers are now asking for a “marriage of health savings accounts and other retirement plans.

Having the accounts managed by the same folks that manage the company retirement plans can be a big bonus:

"Integrated retirement plan-HSA systems could make it easier for employee clients to pull the records they need to have comprehensive discussions of their finances with their advisors."

Among other advantages (follow the link for more).

A Holly Jolly Linkfest

Courtesy of FoIB Holly R.

Camp Fire kills carrier:

"The local Merced County Insurance Company — whose client base is overwhelmingly located in the wildfire-prone Sacramento Central Valley area — announced this week that it was closing shop because it can’t pay out the expected fire-related insurance claims."

Facing at least $64 million on claims, and with only $23 million of available assets, the company sought - and has received - bankruptcy protection. Fortunately for their clients, the California Insurance Guarantee Association (sort of like FDIC for insurance companies) will step in and cover their losses.

In an interesting twist, Dutch medical authorities have discovered medical ethics. Readers may recall our recent post about a Dutch doc in the dock:

"Dutch doctor faces first euthanasia prosecution"

Well, it seems that another of the country's traditions is about to expire:

"Two major Dutch hospitals say they will stop importing human body parts from American firms, which they have been doing without any regulation for a decade."

Parts is parts, as the saying goes, but apparently this practice was a bridge too far for even the Dutch:

"The move comes amid investigations by U.S. law enforcement into some so-called body brokers - companies that obtain the dead, often through donation, dissect them and sell the parts for profit. "

More details at the link.

  The Much Vaunted National Health Service© is also in the news for coming clean on their own little shanda:

"The family of a former soldier who took his own life have won a six-figure payout after NHS chiefs admitted a catalogue of failings in his care."

The 29 year old paratrooper, Aidan Knight, had served in Iraq for half a decade. He finally bailed, having "seen too much death." He'd been trying to get professional counseling for two months, unsuccessfully. In a case of "too little, too late," the MVNHS© has apologized and cut a cheque.

Better than nothing, one supposes.

Friday, December 07, 2018

Pearl Harbor Day 2018

77 years ago today:

Thursday, December 06, 2018

DPC & HSA: A Contrarian's View

We're big fans of Health Savings Accounts and, more specifically, of true catastrophic major medical plans, which would be ideally suited for "wrapping around" Direct Primary Care subscriptions. Currently, DPC fees are not eligible for HSA reimbursement, and there are a lot of folks (myself included) who would like to see that corrected.

On the other hand, it turns out that what seems like a simple idea may not, in fact, be such a slam-dunk:

"A quick analysis of this bill by DPC docs was startling. This “simple fix” was suddenly no longer simple, and it wasn’t really a fix at all."

This was in response to new legislation, called the Primary Care Enhancement Act (PCEA), that has been bandied about the hallowed halls of Congress for a little while. Once it finally got through that meat-grinder, what came out was a stripped down, essentially useless bit of fluff without real-world application or benefit:

"DPC agreements could only include services represented by codes for “evaluation and management” office visits (CPT 99211-5). That means that Pap tests, wellness exams, simple in-office testing, strep tests, urinalysis, EKGs or any office-based procedures would need to be excluded."

Ooops. Again, the goal was to make more widely available a model that took obviously non-insurance services (pap smears, physicals, etc) out of the bloated (and unnecessarily expensive) ObamaPlans and put them back where they belonged: with the patient. By then allowing these fees to be run through one's HSA (just like contact lens solution and baby sunscreen) one's net cost is then reduced, making this an even more affordable option.

Alas and alack, it appears that this is not to be:

"The bill fixes the wrong Internal Revenue Code ... it makes DPC an exempted health plan ... [which] creates conflict in the 25 states that passed legislation declaring DPC is not a health."

/sigh

And that just scratches the surface of what's wrong with this ill-advised effort. Do click through for more gory details.

[Hat Tip: Dr Lee Gross]

Wednesday, December 05, 2018

Medicare4All: An Economics Lesson

From our friend Michael Bertau:

[click to embiggen]

This in response to a request for a comparison of Medicare reimbursement levels to commercial (private sector) carriers.

It's a very useful way to visualize what would happen under even the most rosy of M4A scenarios; that is, what physician in their right mind would agree to take that kind of financial haircut?

As Michael goes on to explain, "[i]t's more of a local question anyway. We've got quite a few safety net hospitals in our networks, for example, who are spending 70%+ of their bed/days on Medicaid/Medicare. That's quite a big hole in their finances to fill with private pay."

In layman's terms, it means that the current (imperfect at best) system is currently bailing out the gummint-run one. What happens when that "safety net" goes away?

And as long as we're piling on, there's this. According to the gentleman who actually did the study that's received the most attention:

"It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that health care providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.”

Oh.

[Hat Tip for Meratus link: Leo Perez]

Tuesday, December 04, 2018

Tuesday Linkfest

■ Just a thought in clarification of Justice Roberts' ObamaTax observation:

[click to embiggen]


I'd never seen it explained that way before, but that is, in fact, pitch perfect.

■ Harv Randecker (of the National Association of Alternative Benefits Consultants) alerts us to some interesting HSA news:

"Disenrollment from HSA-Eligible Health Plans Increases Employer Health Benefit Costs"

That is, deleting these types of plans actually increases ESI (Employer Sponsored Insurance) costs:

"There is evidence that individuals who disenrolled from HSA-eligible health plans were more likely to have certain health conditions than those who remained enrolled in HSA-eligible health plans"

But is the cart pulling the horse?

"Individuals with multiple conditions were even more likely to disenroll"

It's certainly a possibility.

■ This is interesting: you know all those GoFundMe campaigns to help raise money for folks facing catastrophic medical bills? Well, FoIB Rob M warns the folks behind them to tread carefully:

"[M]any people on ACA exchange policies likely also utilize GoFundMe and other "Crowdsourcing" tools to raise money for their medical expenses even if they also receive ACA subsidies ...  some funds raised via GoFundMe accounts counted as taxable income*, that means they also may* count against your ACA subsidy eligibility." [emphasis in original]

That is, if you're worried about clawback (and you should be), then you need to be aware of this potential money trap.

And by the way, great catch there by our friend Charles Gaba.

Monday, December 03, 2018

Chag Chanukah Sameyach!

Case Study: DPC & ACA

So, working on an interesting, perhaps one-of-a-kind case:

Sally, 62 years young, has a very limited income, a few meds, and a need for health insurance. Fortunately, she qualifies for a substantial subsidy: so substantial, in fact, that one of the plans would cost her $0 in premiums [ed: Hi, Jeff!]. On the other hand, that plan has a substantial out-of-pocket liability of its own, to the tune of $7900, which represents a rather significant portion of her income were she to encounter a major, catastrophic expense.

And speaking of catastrophic expenses, one of the problems with the Direct Primary Care model has been the lack of plans to provide coverage for major claims (eg heart attacks and cancer treatment). On the other hand, it does offer affordable primary care (of course), and often includes deeply discounted prescription drug costs.

Well, it turns out that we may have our first legitimate "you got my DPC in my ACA" case:

We checked DPC Frontiers, and it turns out there are a couple of practices located near Sally, and with affordable rates (about $100/month). Coupled with that "free" ACA plan to act as the DPC "wrap," it looks like we have a winner:

Catastrophic coverage in case she gets hit by a bus, or cancer
Not defined by or limited to in-network doc's (other than, perhaps, specialists), and so not deterred by narrow networks
Perhaps my biggest DPC bugaboo is unnecessary (and costly) duplication of coverage, which this basically resolves
From what I have gathered, DPC doc's also have access to low(er) cost prescription meds, which obviates the need to ACA-plan rx coverage
Seems like a win-win to me.

Unfortunately, of course, this will continue to be the exception, rather than the rule, until we get true catastrophic plans back.


Friday, November 30, 2018

Autism & Death: Euthenasia in the spotlight

What with the measles news out of North Carolina (and Israel), vaccines and the folks on the anti-vaxx bandwagon are at one another (again). We tend to side with the folks who think protecting our children (and hence our communities) seems like a no-brainer, but the anti-vaxx folks contend that the medicine leads directly (and inexorably) to autism.

Okay, so what's your point, Henry?

Well, it seems that the folks who run nationalized health care schemes have their own vendetta out for the autistic among us:


But that was then, and this is, well:

As we've long noted, the challenge with state-run health "care" schemes is that it is, ultimately,the state that gets to make real life-and-death decisions. And, of course, the culture itself plays an important role: why else would this doc think helping a young woman kill herself was acceptable?

Thursday, November 29, 2018

Oy Canada: Make mine a double

Shot (courtesy Surgery Center of OK, about which we've posted):

"Family frustrated with lack of bed at Halifax hospital for mother with cancer"

One of the major problems with nationalized health care schemes is that the law of supply and demand is immutable. That is, there will always be a (growing) demand for health care, but there is also a limited (or at least finite) supply. We've seen what happens when you make health care a "right," and it's not pretty:

"Vowing to maintain public dental services in the province, Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system." The case at hand, though, is far more serious, since it involves a potentially life-threatening condition, and the patient suffering even more damage as a direct result of the system.

But then, these systems are also capable of turning out world class meds, which brings us to...

Chaser (via Ace of Spades):

"It is one of this country's great scientific achievements. The first drug ever approved that can fix a faulty gene ... But most Canadians have never heard of it."

Yup, that's right: Canadian researchers at the prestigious University of British Columbia "spent decades developing the treatment for people born with a genetic mutation that causes lipoprotein lipase disorder."

Decades, and tonnes of dollars loonies.

The condition, more commonly known as LPLD, is the result of a genetic mutation, and causes ones blood to thicken with potentially deadly results. It also renders females who suffer from it barren (due to the high risk of miscarriage).

The med, called Glybera, promises to fix all that. The problem is that it was just too expensive, and thus was allowed to whither away on the vine.

To be fair, this isn't the fault of Canada's health care system, but one of simple economics:

"Van Deventer says the company never considered lowering the price ... Why would we? Pricing shouldn't be a political decision. It should be a rational decision based on merits and values.'

Which is contra what a lot of folks here say about "Big Pharma."

Interesting dilemma, no?


Bonus:

Wednesday, November 28, 2018

Vets & DPC

No, not that kind of vet, this kind.

Our youngest is the proud mother of two cute cats and, as a graduate student, has a limited budget for feline-related medical expenses. She uses the services of a national chain called Banfield Pet Hospitals, which offers a unique (AFAIK) and interesting option that looks a lot like the Direct Primary Care model (for people) about which we've written so often:

"We focus on preventive veterinary care to promote and improve overall pet health. Routine check-ups allow us to diagnose, treat and protect your pet from contracting serious, costly and sometimes fatal diseases."

These services include vaccinations and dental care, complete exams, even nutritional counseling. That last, by the way, may be something that our own DPC providers may not routinely offer (but which might be a great idea).

The basic Banfield plan looks to be about $30 a month or so (depending on services, breed and age), which seems pretty reasonable. There's a modest one-time sign-up fee, as well; I've also seen these with DPC practices.

Of course, the "Hospital" in the name also means that they also offer more robust services, but I like the preventive care idea, and wonder if we'll start seeing similar collaborations with the DPC community/model.

Meow!

Tuesday, November 27, 2018

That was then...

Regular readers may recall our piece on Direct Primary Care "wrap" policies from a few years back:

"Pan-American VP Carlo Mulvenna was kind enough to walk me through the basic idea behind the plan's design, as well as share product details."

Recently, a reader emailed asking about the status of this plan:

"Have you seen any new major medical/catastrophic wraps for DPC since the article was written in 2015?"

So, I reached back out to Carlo Mulvenna (subject of the interview) who, as it turns out, is still with Pan American Life, and who graciously responded with an update:

"Henry,

Good to hear from you.

The MedLion relationship remains though they are focused on a new segment of Virtual Primary Care. For our traditional relationships of employers with large populations of hourly workers we have added a new relationship with HealthCare2U. I've attached a copy of our promotional/info piece."

Regards,

Carlo
"

Very nice.

The brochure explains that the program is designed to offer "Affordable, Convenient Access To Healthcare" by packaging online tools and "unlimited same-day/next-day doctor appointments for acute issues at $10 a visit and around-the-clock telemedicine for no out-of-pocket cost."

There are also tools and services available to help manage chronic diseases, which could be very handy.

The "bad" news, of course, is that we still don't have a workable DPC "wrap" plan for catastrophic situations. Oh, well.

Thanks Carlo and Jeremy!

Monday, November 26, 2018

Medical Tourism: An Ugly Turn

Back in October, a realtor from Dallas took a trip south of the border for some body work (rhinoplasty and a breast enhancement tune-up). What seems like fairly routine procedures led to some pretty serious complications, and ultimately took her life.

But there's a larger lesson in this, one having to do with getting what one pays for, at least according to her attorney:

"So that her death is not in vain, people should think of Laura before they look for cross border discount surgery ... Always LOOK before you leap!"

Always sage advice, and it appears that Ms Avila had done her homework:

"Laura's fiance Enrique Cruz said he had researched the clinic and found positive reviews online."

Which may or may not be worth the pixels they're printed with.

I don't really think that one can generalize from this that medical tourism is inherently more dangerous than care we receive here, but it's worth noting that it's not necessarily worth the savings, either.

Caveat emptor, indeed.

[Hat Tpi: FoIB Holly R]

Thursday, November 22, 2018

A Blessed Thanksgiving

There's a theory that the original Thanksgiving celebration, and the holiday itself, is modeled on the Jewish Festival of Sukkoth (Tabernacles). The idea is that they're both harvest festivals that take place in the Fall, and that the Pilgrims, as religious folks, would have looked to the Bible for inspiration.

The reality is that it's highly unlikely to be true, but it's always fun to speculate on these kinds of connections.

A joyous and blessed Thanksgiving to all of our readers!

Wednesday, November 21, 2018

Pre-65 Medicare Health Insurance

It's currently Open Enrollment season for both ObamaPlans and Medicare Supplements. The former has been a bit frustrating (the only non-Medicaid carrier available in this market has a *very* narrow network) and I've been referring the latter out for many years.

But it got me to thinking that perhaps it's time to reprise another of my former Answers.com gig's posts:

For millions of younger Americans with health problems, Medicare may be available to cover medical expenses. This would include those with long-term disabilities or who have been diagnosed with specific diseases or health conditions, such as amyotrophic lateral sclerosis (ALS) or end-stage renal disease. As with those who qualify due to their age, though, Medicare itself doesn't cover everything, and some form of supplemental coverage may be desirable.

What's the problem?

During surgery, a client's adult daughter was deprived of oxygen for many minutes, resulting in brain damage that left he unable to support herself. She was eligible for Social Security Disability, and thus for pre-65 Medicare health coverage. The challenge is that there are deductibles and co-payments that add to her out-of-pocket costs. A Medicare Supplement policy might be able to pay for most of them. Unfortunately, many people don't know that these plans exist.

What's available?

In some states, one can purchase a standardized Medicare Supplement policy from a licensed carrier. These plans, which are usually available only to those 65 and older, are made available to those who qualify for pre-65 Medicare. They can be expensive, but in many cases the coverage they provide far exceeds the monthly premium.

Medicare Advantage Plans may also be an option, depending on one's residence.

How does Medicare Advantage work for pre-65 beneficiaries?

There are several benefits to an Advantage Plan. First, it caps one's maximum out-of-pocket in case there are a lot of claims (or one very big one). Second, many plans are available at little or no cost to the consumer. This can save thousands of dollars a year in premiums over a standardized Medicare Supplement policy.

The downside to Advantage plans is that one is limited to certain providers for health care, and not all of one's medications may be covered.

What about Open Enrollment?

One challenge with switching to a Medicare Advantage plan is that this can generally only be done during Open Enrollment. Fortunately, my client's daughter was also participating in Social Security's "Extra Help" program. Extra Help enables qualifying Medicare beneficiaries to purchase their meds at greatly reduced prices, with the government picking up the cost. According to the Social Security Administration (which oversees the program), Extra Help "[is estimated to be worth about $4,000 per year]( ttp://www.ssa.gov/prescriptionhelp/)." 

What about an Exchange Plan?

One of the alternatives we explored was whether or not an ACA-compliant Exchange plan would be appropriate. This was quickly discarded because, according to the Centers for Medicare and Medicaid, "it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan".

And people who do choose to reject Medicare and end up buying a plan from the Exchange are ineligible to receive any subsidy.

And so?

Americans who are on Medicare due to serious health conditions have limited health insurance choices. For many, a Medicare Advantage plan may be the most efficient means to supplement their Medicare coverage.

Monday, November 19, 2018

MVNHS© hates women, too

We've long known that the Much Vaunted National Health Service© really doesn't like kids:

"[I]t's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense."

Turns out, the health "care" scheme doesn't much like their mom's, either:

"Error means 48,000 women have not received cervical cancer screening information"

To be fair, this mistake was made by an MVNHS© vendor, not the service itself. Still, the buck pound sterling has to stop somewhere.

And hey: Free!

[Hat Tip: FoIB Dutch R]

CanuckCare© Gone ... Wrong?

Earlier this month, we reported on a service available to our Neighbors to the North© that helps them obtain health care while they can still use it:

"Check out Timely Medical Alternatives in Canada, which specializes in helping Canadians find affordable care (for cash payment) instead of waiting in the queue."

Well apparently that isn't sitting too well with the rocket surgeons who run the country's free health "care" system:

Ooops.

Friday, November 16, 2018

Medicare - New rates for 2019, some history too.

About one month ago (October 12) CMS announced the Medicare cost-sharing factors for 2019. The table below compares 2019 with 2018, together with a couple of historical years. 

                                                                                                                                  2019                     2018    
Part A Deductible per hospital admission                                             $1,364.00           $1,340.00
Part A full buy-in premium                                                                         $   437.00           $   422.00

Part B annual deductible                                                                            $    185.00             $   183.00
Part B standard monthly participant premium                                   $     135.50            $   134.00
Part B full buy-in premium                                                                        $     542.00            $    536.00


                                                                                                                                  2000   .
Part A Deductible per hospital admission                                              $   776.00
Part A full buy-in premium                                                                          $   301.00 

Part B annual deductible                                                                            $    100.00
Part B standard monthly participant premium                                   $       45.50
Part B full buy-in premium                                                                        $    182.00


                                                                                                                                  1980      .    
Part A Deductible per hospital admission                                            $    180.00
Part A full buy-in premium                                                                       $       78.00 

Part B annual deductible                                                                           $       60.00
Part B standard monthly participant premium                                  $         9.60
Part B full buy-in premium                                                                       $       38.40


Notes to the Table

1.  The good news is that the increase to participant cost for 2019 is very small.  This reflects continued moderation in the rate of increase of medical costs that began in roughly 2003.  Costs rose faster prior to 2003 and less so afterward.  Looking back over the 39 years 1980-2019, the Part B premiums rose by more than 14 Xs, the average annual increase was 7%. 

2.  About 92% of Part B participants pay the standard Part B premium. By CMS rules, about 3% pay less, and about 5% pay more.  

3. Deductibles have risen steadily over the years.  The Part A deductible rose about 5% per year on average, the Part B deductible 3%.  Premiums over the years would have risen much higher, if deductibles had not also increased.    

This table does not show one of the most significant facts about Medicare:  its budgeted income has not kept pace with expenditures. As a result, Medicare has run budget deficits for many years.  In fact, its actuaries calculate Medicare has accumulated future unfunded liabilities of well over $40 trillion.  That is 7-8 times total Federal spending anticipated for 2019. Any private insurance company having proportional unfunded liabilities, would be bankrupt. 

4.  The table does show Part A and Part B “full buy-in premiums” even though in the real world, no one pays those premiums.  Those are the premiums Medicare participants would pay – if they paid the full premium to cover Meidcare’s budgeted cost. For example, in 2019, the full buy-in premium for Part A plus Part B is $979, or $11,748 per year – per person.   Just keep in mind even those premiums, as high as they are, are not nearly high enough to cover Medicare expenditures.  

5.  For anyone who might be interested, when Medicare started, January 1, 1966, the Part A deductible was $40, the Part B deductible was $50, and the Part B monthly premium was $3.00.  Those numbers seem impossibly low today.  How times have changed.

Health Care Sharing Ministries in the crosshairs

This just in:

"Nebraska published a consumer alert about health care sharing ministries - consumers should be aware of the significant limitations (like no-legal-responsibility-to-pay-claims-level limitations)"

Why this is just now being treated as "breaking news" is beyond me: we've been pointing out these very real problems for years:

"My claim from October had still not been paid. Yesterday I received a notice dated April 19, 2017 that since I was no longer a paying member my medical claims are no longer eligible for payment!"

Of course, these plans have their good sides, as well: ACA-compliant, relatively inexpensive, often include decent benefits (and omit unnecessary ones that tend to drive up rates). But as I point out to my own clients, they aren't insurance, so there's really no recourse if they decline a claim or simply fold up shop. And, as the report points out, there are often significant limitations in what's covered (and for how much).

Still, they remain a viable ObamaPlan alternative, as long as one joins up with eyes wide open.

[Hat Tip: Rachel Schwab]

Thursday, November 15, 2018

Fall Health Wonk Review

Well, we got our first major ice-storm of the season last night (and continuing this morning), so it seems that Fall is, indeed, making itself known. And Lisa Lines is making her presence known, too, as she makes her Health Wonk Review hosting debut over at The Medical Care Blog.

And a right nice job she does of it: with posts ranging from Open Enrollment to Big Pharma Phunnelling Funds, you're sure to find *something* to pique your interest!

A Deadly Conundrum

Here's the (gruesome) headline:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

Now, we've discussed before the fact that one may not profit from a crime:

"In this story ... we learn about Joaquin Shadow Rams, who seems to have a habit of buying, and then collecting on, life insurance policies for his intended victims, including (allegedly) his mother and his girlfriend."

And of course there have been others. In all of the related posts I can find, though, all save one have been about straightforward and underwritten (term, whole or universal life) plans. But this one's different, and I'd like to talk about that difference.

"Regular" (aka "ordinary") life plans like term and whole life are generally underwritten (although there are guaranteed issue versions which impose waiting periods). But "accidental death" plans pay out only if the death is due to an non-purposeful injury (well, almost always). And the key to these plans is that they are generally not underwritten.

[ed: As an aside, one wonders if there was a cultural motive involved here in addition to the financial one]

In the case at hand, the facts seem pretty straightforward as to what happened. What's interesting to me is why the father chose an Accident Only plan instead of a term or even "Jumping Juvenile" one. And it seems to me that the answer is fairly obvious: the lack of underwriting makes it an easier "buy," and the fact that it's Accident only makes it a lot cheaper.

It's also worth noting this little tidbit:

"[T]wo years and 12 days earlier, Elmezayen bought the last of his insurance policies, which were purchased to cover his family in the event any of them accidentally died."

One presumes that this was to avoid triggering the "Contestability Clause," but I'm not seeing where that would apply to an Accident Only plan. After all, that clause is to protect the carrier from misstatements of health, age or sex; I'm not aware of any app that asks "Are you planning to murder your spouse/children any time soon?"

This is obviously a very sad case, but also a very strange one.

Wednesday, November 14, 2018

Cost transparency: I'll drink to that!

Shot:

"Health care is a service like any other. We ought to expect price transparency for medical goods and services to make informed choices that maximize value."

I, too, have been chasing this wild goose for many, many years. And I still believe that it's a noble goal.

But as long as government and insurance - in other words, 3rd party payers - are in the mix, it's not a viable one.

Chaser:

And why would any physician agree to this? And perhaps more critically, how would they?

Which brings me back to my first point (above): so long as the government (through Medicare and Medicaid reimbursement levels) and insurance (trough multiple provider contracts) distort the price (that is, that which the consumer/patient/insured pays), then there's no practical way for this to occur.

Which of course brings to mind Direct Care (whether Primary or other): when one pays the piper oneself, then it's reasonable (and viable) to pre-determine the cost of various services beforehand [ed: up to a point - what if the knee surgery uncovers something more serious?]. Of course, there's still an affordability challenge (and, often, an accessibility one), which means we still have a long way go.

Which is still another reason I'd love to see true cat plans re-legalized.

Tuesday, November 13, 2018

Tuesday Potpourri

So this past August we posted on the most recent "shiny new thing," Association Health Plans, which allows otherwise disparate groups of folks (employers and individuals) to band together to create larger insurance "pools." Our friends at HAFA (Health Agents for America), tip us that some carriers are beginning to roll out actual plans:

"Land O'Lakes, several Nevada chambers of commerce, and the National Restaurant Association have formed association plans this year ... the Land O'Lakes association plan “will offer another really good choice for individuals who either don't receive a subsidy and cannot afford coverage on the exchange or for some reason prefer not to purchase that coverage.”

Interesting. And we're seeing a lot of activity lately in the group self-funded space. So perhaps the market itself is killing ObamaCare with 1,000 cuts?

We'll see.

Thanks to FoIB Dabz, we're treated to this very interesting piece on creative (and viable) ways to deal with the (over-hyped) pre-existing conditions issue. For example:

"... the option of buying coverage at some point in the future—insurance against developing a health condition that makes one uninsurable."

This is not new; a decade ago we noted that (now-defunct) American Community Mutual rolled out "Community Flex," it starts out as an accident policy (major claims are only paid for injury, not illness), with some coverage for doc visits, preventive care, and a drug discount card ...  if you want more coverage, such is available through a "Gold Plan" buy-up."

And of course, "Dave's Plan" takes a similar approach:

"The capper, though, is that the plan has a rider that allows the insured, at their discretion (and with with no additional underwriting) to convert it to a major medical plan."

Which is to say, Chris Jacobs at The Federalist is spot on.

As we've long noted (most recently here), The VA is a hot mess. And if you still harbor any doubts, well:

Wonderful Veteran's Day.