Reuters Money
Patient Protection reform could mean higher healthcare costs
Of the endlessly debated provisions in the Patient Protection and Affordable Care Act (PPACA), the requirements for Medical Loss Ratios (MLRs) stand out for insurance companies because the requirements are designed to dictate how those companies pay their bills.
Until now, it’s been mostly unclear how those requirements will affect consumers. But a new study from the U.S. Government Accountability Office released last week sheds some light. And experts are weighing in.
First, some background: For every dollar taken in by insurance companies for health plans, those companies will now be required this year under the PPACA to spend either 80 or 85 cents – depending on the size of the plan; smaller group plans are held to the lower number – on costs related to healthcare.
In the past, insurance companies have traditionally spent less than that on healthcare costs and as much as 30 or 40 percent on administrative costs. The ratio of healthcare costs to administrative costs is called – you guessed it – the Medical Loss Ratio.
If companies do not meet the new MLR requirements under the PPACA, they are required to send their customers a refund to make up for the difference. This year is the first year that insurers will be held to the MLR requirements; the first set of insurer data is due in June 2012.
The goal of the MLR requirements is to make health insurance companies more efficient, says Dr. Timothy S. Jost, a law professor at Washington and Lee University who is a co-author of a textbook on healthcare law and a consumer representatives to the National Association of Insurance Commissioners, which helped to develop the MLR requirements.
The MLR requirements will “eliminate administrative costs, control profits and hopefully force these companies to provide better care to people,” he says.
Is gadget insurance worth it?
When Abby Speed was in Puerto Vallarta, Mexico two years ago, she left her $300 camera in her purse on a table at a cafe. Both disappeared.
Luckily she had invested in gadget insurance, so her camera (along with her laptop, cellphone and other electronics) was covered for theft with a $50 deductible. Speed says she is glad for the peace of mind that comes with paying Worth Ave Group Insurance a couple of hundred dollars a year to cover all of her electronics.
“I travel a lot,” the 29-year-old activities director from Dallas says. “Things get broken or stolen.”
With as many gadgets as many people now carry, the game has changed for consumers when it comes to warranties and specialized insurance. There’s no longer a simple answer.
Part of the problem comes with the portability of the devices. Some people go everywhere with a pricey gadget like an iPad. One big drop or an errant cup of coffee can be disastrous.
Aaron Cooper, marketing director for Worth Ave, says the top three claims categories for gadgets are: cracked screens, theft and water damage. The differences between gadget insurance and buying a special warranty can be subtle, but theft is one category covered by insurance but not in a warranty. Warranties are connected to mechanical failure while insurance is more built around human error. And insurance can be purchased at any point, while extended warranties usually have a time limit, often within 30 days of purchase.
Cooper says one thing that consumers often overlook is the real cost of their gadgets. You might have paid $200 for your iPhone, he says, but that’s because it was subsidized by the phone company. If you drop it in the toilet, the replacement cost could be closed to $700.
Sure, get one, and you can take your mind off the rest of the insurance industry http://www.cheapinsurance123.com/blog/20 11/09/16/unemployment-in-u-s-deepens-hea lth-insurance-crisis/
Shopping for health insurance? 5 tips on how to get it right
When Ronna Wisbrod, a real estate broker and personal organizer, returned to the Chicago area last year, she needed to figure out new health insurance. Now 57, she knew she had to have insurance, but as she set up her own business, Organization by Ronna, she also wanted to keep costs down.
“I’m at a rebuilding stage and in the process of rebuilding my budget, [which] is very tight,” Wisbrod says.
So, she looked around for insurance and spoke with an insurance broker and decided to go with a high-deductible plan that she figures will cover her in case of a medical emergency. That plan, from Assurant Health, has a $5,000 deductible, but costs a very reasonable $380 a month. “I had a $2,800 deductible before, and I didn’t satisfy it because I don’t go to the doctor that often,” she says. “So what does it matter if the deductible is $5,000? It lowers my premium.”
Shopping for insurance is all about figuring out those trade-offs of coverage and cost and finding the plan that works best for you. The variations in insurance plans are mindboggling and few people bother to read the fine print till they run into trouble. Making matters more complex, there are vast differences between states, some of which permit medical underwriting (which means the insurer can reject you from a policy or raise your premium based on your medical history) and those that do not (which means the premiums will typically be higher overall to cover the risk).
To make sense of what works for you, you’ll need to understand how your own medical spending patterns interact with the details of the different plans for which you qualify. Whatever you choose, if you’ve been covered by an employer group plan before, prepare for sticker shock. Here’s how to get through the process:
1. Understand your options If you’ve recently left your job or been laid off, COBRA is the simplest option. It allows you to stay on your employer’s plan. But because it requires you to pay the full cost, it may not be the least expensive. That’s because many employers subsidize the premiums for employees who never see the full bill. If you’re healthy and see the doctor rarely, you may be able to find a high-deductible plan with less coverage at a lower cost.
On the other hand, if you have medical issues, COBRA may be a better deal overall. “The central issue of COBRA, which is critical for people to examine if they or their family have a pre-existing condition, is that you don’t have to worry about qualifying for it,” says Martin Rosen, co-founder of Health Advocate and co-author of The Healthcare Survival Guide.
I don’t agree that COBRA is the simplest option. COBRA has been amended 12 times over 25 years it’s been around. There is widespread confusion about who qualifies, notices, and deadlines. Also COBRA premiums are not usually tax deductible. And the COBRA subsidy that was paid out for 15 months ends next week.
Earthquakes, hurricanes and smart insurance moves
What a week: An earthquake gave the East Coast a jolt and now a hurricane is bearing down.
No one’s immune. Virgin Atlantic mogul Richard Branson’s compound on Necker Island in the British Virgin Islands was destroyed by fire this week after being struck by a Hurricane Irene-connected lightning bolt.
And, according to The Chubb Group of Insurance Companies, lightning can strike twice. So there’s no such thing as being too prepared.
Given that the weather is in motion, it’s time to deal with most folks’ biggest investment — their homes. So, whether you’re going to hunker down or be evacuated, batten down the hatches.
The questions you should be asking, according to Scott Spencer, senior vice president and worldwide appraisal and loss prevention manager for Chubb Personal Insurance, are: “Where are you going to go? What are going to take with you? And how you are going to secure your property?
If you have the time, check your policy to see what coverage you have for evacuation. Spencer said some policies (Chubb’s do) cover hotel costs when you have to flee for your own safety.
He suggests leaving behind fragile items — things more likely to damaged in transit — and move them to an interior location with some degree of protection from potential wind and water entering the home. “You shouldn’t take with you your fine arts. I wouldn’t recommend you take your priciest art work with you as you go down I-95.”
I think having good insurance coverage for all the expensive items in the house, especially insurance for every member of the family is important. What else is important is that these documents are protected from the elements and possibly waterproofed. I would definitely keep a copy of important family documents with a trusted family member somewhere else too. I have seen people lose everything in major disasters, and that has taught me to be extra cautious when it comes to valuables.
David – http://www.savoydoors.co.uk
Hedging can end your retirement panic now
Even with the most recent market agita, there’s no reason for you to worry long-term about your retirement funds.
Is my head in the clouds? As darkly volatile as this moment in personal investing may seem, it’s actually a golden age for portfolio insurance. Retirement worries as we know it can come to an end — if you know how to hedge properly. There are plenty of retail tools available to that end.
Part of my optimism is based on the availability of off-the-shelf portfolio insurance for everyone. If you hedge your holdings the way the big institutions do, big dips will do no harm and you can even make money when the market’s down.
The three most powerful hedging devices come in the form of exchange-traded funds (ETF), which are pooled portfolios based on securities and indexes traded on stock exchanges. You can buy them from any deep-discount broker and leave them in place.
Hedge inflation A rising cost of living generally hurts bond prices. Unlike most bonds, when inflation climbs, Treasury Inflation-Protected Securities gain value. One suggestion is the iShares Barclays TIPS bond fund.
Hedge your stocks Inverse ETFs such as the ProShares Short S&P 500 ETF, move in the opposite direction of the popular stock index.
Hedge your bond position You can short a broad-market bond index through the Direxion Daily Total Bond Market Bear 1X Share or similar ETFs. This is a good hedge if your portfolio is heavy in bonds and interest rates are rising.
I agree that hedging opportunistically can make sense for investors, but when it comes to hedging stocks, I think buying optimal puts on individual stocks (to hedge stock-specific risk) or on index ETFs (to hedge market risk) makes more sense than buying inverse ETFs.
One reason is that optimal puts offer more precision. Another is that they give you the ability to cap your cost at the outset. A third reason is that they can be less of a drag on your portfolio during periods when the market goes up. I elaborated on this in a post a while back: http://seekingalpha.com/article/271046-o ptimal-puts-versus-inverse-etfs-for-hedg ing
Self-employed? How to find disability insurance
If you’re self-employed and work out of your home, it’s probably occurred to you that you ought to have long-term disability insurance. If you’ve mentioned this to your insurance agent, they’ve probably told you it’s a good idea and not a problem.
But, chances are when you looked into it, it has, indeed, been a problem.
Policies seem expensive and unlikely to replace the income you actually need — if you can get coverage at all.
Here is what you need to know to get the coverage you need at the best price possible.
How much insurance do you need? The point of long-term disability insurance is to replace your income if you’re disabled and unable to work for an extended period of time — maybe a few years or maybe until you qualify for retirement benefits at age 65.
The tricky part is that policies for self-employed workers rarely replace gross revenue, the total amount you bring in. More likely, it will replace the portion of your income left after you take out your business costs, which is the amount the insurance company believes you live on, says Neil Palache, a financial coach in Westlake Village, California, who worked as an insurance broker for many years. To get an idea of what this would be, look at the portion of your income you pay income taxes on.
If there are expenses related to your business that you’ll want to continue covering while you’re disabled — say a license you want to keep current if you hope to get back to your profession eventually— Palache suggests adding a Business Operating Expenses policy to your LTD policy.
Yes. And the most serious question you ought to ask yourself is why they would ever pay you anything. And if they possibly could pay a claim. Insurance companies are no more reliable than banks and they themselves are not insured. What is more, insurance companies can be hijacked by crooks just as banks and investment funds can.
You are paying to get taken care of when you are weak and unlikely to be a threat to anyone. Look around you. What is happening to the weak and the needy? Would you voluntarily pay to be treated that way?
What you need to know about consumer-driven health plans
A mid-career engineer, Michael Eckman, 37, bounced back from a year of unemployment by recently landing a new job about 15 miles northwest of Philadelphia. It happened quickly. He sent the initial application on a Wednesday, heard back that Thursday, interviewed Friday and received an offer a week later.
Once employed, his benefit choices emerged quickly, too.
For health insurance, he had two options: He could access a traditional preferred provider organization, which would organize every aspect of his healthcare.
Or he could enter a “consumer-driven health plan.”
The latter option, he said, would give him an annual cash allotment earmarked for heath expenses.
It was intriguing. But one element of the plan made him nervous: The annual cash allotment wouldn’t roll over yearly. He’d have to spend it or lose it each year.
“I felt like it was asking, ‘Do you plan on being sick or healthy this year?’ ” he says. “What kind of a question is that?”
How to avoid hospital bills from doctors that don’t take insurance
Marissa Dennis had a relatively uneventful labor and recovery when her son was born at a New York City hospital in 2008. So she and her husband were taken aback when they received a bill for more than $800 for the handful of routine check-ins they received from the on-call pediatrician.
“It was 10 times what the entire rest of the bill came to,” she said. It turned out that while the hospital took the family’s insurance, the pediatrician didn’t. Dennis and her husband managed to pay the unexpected bill, she said, “but it really ticked us off.”
Such stressful surprises aren’t unusual in medical care today, billing experts say. Doctors who have privileges at hospitals typically aren’t employees and aren’t obligated to accept the same insurance the hospitals do. Often, functions like anesthesia, radiology, pathology or emergency room services are provided via contracts with a single large group that accepts little or no insurance because they prefer not to settle for the discounted payments that insurance companies routinely negotiate.
The best way to protect yourself is to learn to ask questions and even shop around, said Martin Rosen, co-founder of Health Advocate, a healthcare advocacy and assistance organization based in Plymouth Meeting, Pennsylvania. “We do this in other areas of our consumer life, but it’s awkward to do it when it comes to our health because we aren’t used to asking these questions and doctors aren’t used to answering them.”
Some tips on how to avoid these unexpected bills and to manage them if you can’t:
Ask ahead As part of a pre-procedure consultation, patients often receive a bundle of paperwork from the hospital or the doctor detailing the procedure and verifying insurance information, said Simone Rattiga, who worked as a medical billing analyst for more than 10 years in New York City, including several years at a large anesthesiology practice. This packet should also include services that will be ancillary to the procedure, like anesthesiology or pathology, and name the doctors who will provide them. “If you don’t get this, ask for it and look it over carefully,” she said.
If the doctors’ names aren’t there, speak to your doctor’s office manager, or call the hospital and ask for patient accounts, she said. These people will know which doctors will be involved. Then you can call them directly and ask about insurance. If the medical group doesn’t take your plan, the office manager or the patient accounts representative at the hospital should be able to help you estimate how much you might be billed. “Don’t be afraid to ask in advance if they can lower the cost for you,” said Rosen. “You’d be surprised how often they will.”
How a traffic ticket or five extra pounds can raise your insurance rates
The following is a guest post by Jennifer Merritt. The opinions expressed are her own.
When 49-year-old Femi Obikunle began shopping for life insurance three months ago, the price seemed right. For under $900 per year, the generally healthy father of four was told he could likely get a $500,000 term policy. Then came the physical and blood tests. The new rate he was quoted: more than $4,000 per year.
You’d think that the routine screenings had found something seriously wrong with Obikunle, say abnormally high blood pressure or cholesterol, or a life-shortening disease.
But there wasn’t anything terribly wrong with Obikunle — at least not a condition any doctor would treat him for. Instead, the rate he was quoted more than quadrupled because his blood sugar levels indicated he could be pre-diabetic. His doctor disagreed and Obikunle says he probably just drank a few too many sugary drinks in the days leading up to the tests.
“It’s outrageous,” the Columbus, Ohio resident says. “Even though the doctor will say your range is alright, the requirements insurers want are much too stringent.”
Most people know smoking, obesity and high blood pressure can mean paying more for life insurance, but increasingly, other factors have been keeping even those in good health from scoring the best-available rates. On paper these days, a 40-year-old man in very good health and no real risk factors could buy a $500,000, 20-year term policy for as little as $360. But few people actually pay that little.
Life insurers generally tier their rates and the price goes up exponentially, between 25 percent and 50 percent each time you fall from a high tier to a lower one. Preferred plus, the lowest rate available, is reserved for those who are in excellent health and who have no risk factors, says Byron Udell, CEO and Founder of life insurance comparison and quote website AccuQuote.com. Add a risk factor — or two or three — and you’ll be bumped to a lower tier and pay more. And some insurers add surcharges for undesirable behaviors, illnesses or hobbies.
Nowadays, everybody has at least an insurance, whether it’s a life insurance, or you just have your car insured. I knew that your rates can go up if you receive a traffic ticket, but the other reasons you’ve mentioned here, that can generate increase in rates are very new to me. Still, it’s good to know this kind of information, to be informed.
Life insurance: Will your heirs get what you’ve paid for?
Gotta love those life insurance companies.
According to a Wall Street Journal report, some of them will scour state mortality lists to make sure they aren’t paying out any lifetime benefits (such as from annuities) to people who have died. But they won’t bother to check those lists for life insurance policyholders whose beneficiaries may have some money coming to them.
“That’s not their job,” said fee-only insurance consultant Peter Katt. “It’s in their business interest to avoid paying death claims.”
New York Attorney General Eric Schneiderman is reportedly investigating this, and has subpoenaed the records of nine leading life insurers — including some “very good companies,” according to the Consumer Federation of America’s point man on insurance James Hunt.
Problems can arise with old policies when the insured person forgets they have a policy, said Hunt. Sometimes, people buy life insurance policies and don’t even know which insurance company holds it; they only know the name of the agent who sold it to them. Other times, an older policy can become paid in full, so the policyholder no longer gets annual bills. Or the premium on a policy can be paid automatically from the policy’s cash value, so that the insured person loses track of it. Older people who have held policies for a very long time can forget about them, and that’s not a practice limited to the senile, says Katt.
“People need to have an inventory of their assets and they need to make that inventory available to the family,” he said.
No duh, suggests Hunt: “Of course everyone should do that, just like everyone should have a will and keep their Individual Retirement Account beneficiaries up to date and so on and so forth. Responsible people should do that, but of course, everyone does not do that.”
There are great investments out there in Healthcare IT, you just have to find them,, here is one….
After following MMRGlobal for the last 3 years our research has concluded that OTC: MMRF is one of the most undervalued health care IT plays we’ve seen in recent years. The definitive agreement announced by the company on September 19th adds the credibility we were looking for to the earlier September 7th announcement of the non-binding term sheet with the same company. From sources in the industry, if MMRGlobal acquires over $150 million in revenue this stock currently trading at $.03 could realistically trade at a valuation of $3.50- $4.00 stock with a market cap in the $800mm to 1.2b range. We base this on comparable valuations in the health care IT sector such as Accretive Health and Merge Healthcare Inc. It is important to note that MMR is the only pure play personal health record company with connectivity to any health care professional, EMR, patented technologies, with an emerging global footprint and very credible strategic partners including AIG/Chartis, Kodak, Unis and others. Considering the most recent industry valuations, health care IT firms are being valued at 4 to 6 times revenue. With the MMR announcement of a definitive agreement with the firm who invested almost half a million dollars in MMRPro, the combined companies will offer health IT proprietary software and revenue cycle management solutions to its own surgery center clients in addition to the PHR solution it offers to the surgery center patients and the mass market. Additionally MMRF has a biotech portfolio that could have a value of at least the 140 million dollars the company invested in it