Health Insurance Blog

The Dow Jones News Service reports in the Minneapolis Star-Tribune that the Center for Medicare and Medicaid Services is planning on limiting out-of-pocket charges and plans under private Medicare Advantage insurance. The Obama administration has announced plans to enact cost-sharing limits; patients will pay less for certain treatments, including:

• home nursing services/home health care
• renal dialysis
• selected prescription drugs

In addition, the number of Medicare Advantage plans on the market will be limited in order to reduce consumer confusion. CMS claims that a quarter of all Medicare Advantage programs have fewer than 10 people enrolled!

Insurers, such as UnitedHealth Secure Horizons, state that they have expected reductions in health insurance rates under Medicare Advantage and will adapt through benefit modifications and cost management.

The New Hampshire House of Representatives is considering enacting legislation what would increase coverage of their health insurance program for low-income New Hampshire residents.

The proposed legislation would enable adults aged 19 to 25, who earn less than $3600 per month, to be eligible for the New Hampshire Healthy Kids Program.  Currently the program is open to children under age 18.

In other New Hampshire Health Insurance news, the NH house went on record last week backing a single-payer nathional health care system.

Blue Cross Blue Shield, and AHIP, issued a joint statement opposing President Obama’s proposal to create a government run health plan.  They believe that the creation of a government run health plan would be detrimental to a overhaul of our ailing health system.

In their statement sent to key senators, AHIP and the Blue Cross Blue Shield Association (BCBSA) said that any such program “would thwart the ability of the healthcare sector to implement meaningful delivery system reforms, exacerbate the cost-shift from public programs to consumers and employers in the private market, and destabilize the employer-based system.” The two groups said that more than 100 million Americans would leave their existing private health insurance plan for the proposed federally subsidized health plan.

Both AHIP and BCBSA said they would guarantee health insurance coverage to all families and individuals, including those with pre-existing medical conditions, but only if there is a federal mandate that requires Americans to obtain and hold health insurance coverage. Even so, “rating flexibility based on age, geography, family size and benefit design would be needed to maintain affordability.”

This is a interesting development in the ongoing debate about how to fix the broken health care system in the United States.  This proposal seems like it would make sense for health insurance shoppers if the rates would indeed be affordable.  My gut feeling says that  if health insurance companies are required to cover unhealthy individuals at the same rates as healthy individuals, the healthy people will bear the financial brunt of this compromise.

Washington state Insurance Commissioner, Mike Kriedler, is advocating regulating the currently unregulated health discount plans, that have become much more common over the past few years.  Specifically, Mr. Kriedler would like to enact legislation that would make these plans financially responsible for paying the health care expenses that they advertise.  Commissioner Kriedler states that he has received hundreds of complaints from customers who purchased these plans and received no benefits.

If his proposed bill passes, all discount health plans (offered in Washington) must be licensed by the Washington state Insurance Commissioner. They must clearly disclose that they are a health discount health plan and not health insurance. They cannot mislead the consumer and must list the services and products that are discounted.

The health plan bill recently passed the Senate and is up for a vote in the House.

If the legislation passes, Washington will join 33 other states in regulating discount health plans.The bill would take effect July 1, 2009.

The Detroit Free Press’  Patricia Anstett recently exposed several forthcoming changes to new Blue Cross Blue Shield of Michigan individual policies. Among them is a reduction in maternity coverage.

After March 31st, all new individual health plans will include only a $7,500 reimbursement for the cost of a medically necessary Cesarean sections. There was previously no limit on the amount reimbursed; this modification could result in some women paying thousands out of pocket for their C-section.

Those with employer-sponsored health insurance provided by BCBS are not affected, nor are those with existing individual health plans. The insurance company claims that changes such as this are necessary to prevent further losses. Unfortunately, as the Michigan health insurance company of last resort, BCBSMI is the only option for many people with various pre-existing conditions.

(Photo credit: Emery Co. Photo under CC 2.0)

Walt Williams reports in the State Journal that West Virginia Senator Jay Rockefeller has introduced a bill that is intented to increase health insurance access to those with pre-existing conditions. The Pre-Existing Condition Prevention Act would prevent insurance companies from excluding a pre-existing condition from their coverage. Rockefeller claims that over 130 million Americans suffer from chronic conditions that could lead to individual health coverage being denied them. He also says that this bill is essential to pave the way for universal health care reform at a lower cost.

On the other hand, Walt quotes an industry spokesperson who says that the impact of such denials are heavily exaggerated (although they have far more impact when shopping for an individual health insurance policy on the open market, as opposed to an employer-sponsored health plan that puts a potential policyholder in a larger pool that reduces the risk of any one person with a chronic illness), and that the bill could result in a moral hazard: people will drive up the cost of health care by only buying insurance after they desperately need it.

A representative in the U.S. House of Representatives will reintroduce legislation to help small employers pay for their employees’ small business health insurance, reports Astrid Fiano in DOTMed Business News. The CHOICE Act, according to sponsor and chair of the House Small Business Committee Nydia Velasquez, will do the following:

• Offer a tax credit equal to 65% of the cost of health insurance offered to employees
• Allow multiple small companies to pool their employees in voluntary health collectives, which will result in lower health insurance rates because of the reduction in insurers’ risk
• Set the stage for a possible health insurance mandate for small employers, to be partly paid for by the aforementioned tax refund

The bill promises to lift some of the burden off the small companies that are known to be major drivers of the American economy and has bipartisan support.

(Photo credit: gcoldironjr2003 under CC 2.0)

After April 1, Medicare beneficiaries will be locked into their current plan through the remainder of 2009.  If you are enrolled in a Medicare health plan and unhappy with it, don’t procrastinate shopping for a new plan.

According to Paul Precht from the Medicare rights Center, below are the changes that can be made before April 1.

• A Senior who is enrolled in a Medicare private health plan with drug coverage (like an HMO or PPO) can switch to another Medicare plan that also offers drug coverage. They can also switch to “original Medicare” with a stand-alone drug plan.
• If someone has original Medicare with a stand-alone drug plan, they can switch to a Medicare private health plan with drug coverage. However, they cannot,  add or drop the Medicare drug benefit (Part D) and they cannot switch from one stand-alone prescription drug plan to another one. Most people with Medicare will not be able to change their health plan again until 2010.

More information about senior health insurance options

Since the Healthy Indiana government-subsidized health care program was opened to adults without children in January 2008, it has given thousands greater access to Indiana health insurance. According to the Courier-Journal’s Leslie Stedman Weidenbener, the plan has been so successful that many people are on a waiting list to enroll (due to limited program funds). State legislators negotiated an exception to Medicaid regulations that limit the program to families. 34,000 out of 49,000 enrollees are adults without children who are unable to afford individual health insurance.

People covered under the Healthy Indiana program must pay a sliding scale monthly premium based on their income (from $20 to $75).

What’s included under the Healthy Indiana plan?

1. $500 in free preventative care each year
2. An annual health savings account (HSA) of $1,100
3. After the HSA is spent, there is a traditional health insurance plan without co-payments or deductibles.

To qualify for the Healthy Indiana program, Leslie writes that a childless adult must meet the following requirements:

• They must work for a company that doesn’t offer health insurance (so employers can’t drop them from their coverage and shift the burden onto the state)
• A single adult can make no more than $21,660 per year, or 200% of the poverty level
• They must have been without health insurance for at least six months.

On St. Patrick’s Day, there will be a Tuscon health insurance fair to assist the local uninsured, reports the Arizona Daily Star. 30 insurers will be in attendance at the event, taking place in the El Rio Community Health Center.

People without Arizona health insurance (about 1 in 5 of the state’s population) will be able to take advantage of free health screenings, nutrition advice, and more. There will also be help in applying for affordable health insurance plans.