How to Find Student Health Insurance

Already burdened with the expense of college tuition and food and lodging, students also have to worry about medical care. Here are some important considerations when looking for student health insurance:

• If you are covered by your parent's health insurance, stay on it.  The recently enacted Affordable Care Act now allows parents to keep their children in their medical insurance plan until age 26.  This does not apply to employed children eligible to participate in their employer's health insurance plan. Since most students only work part time or temporary jobs, they are likely not eligible for employer medical insurance plans.
• Check out your college or university student health insurance plans.  Since most schools require students to have health insurance, many schools offer student health plans with their tuition payments.Be sure to check what is covered, deductibles, co-insurance and co-payments.  Some universities such as the University of Nebraska do offer a wide variety of benefits.  Some schools fully cover services offered within the university setting such as counseling in the student counseling center but have co-insurance for services obtained privately.
• If you have current health insurance, stay on it.  It is likely to have better coverage than the average student health insurance.
• Check with insurance brokers both in your locality and online.  They generally work with different medical insurance companies that offer student health insurance and can guide you on what is best for you.  be sure to exercise due diligence to be sure you are dealing with a reputable company.
• Before choosing a student health insurance plan, analyze your needs and resources.  If you are healthy and have enough savings to cover doctor visits, medicines and labs, you could opt for plans with high deductible and lower monthly premiums.In this case, you are simply insuring for catastrophic illness where you might require hospitalization.
• Be sure to analyze not only the benefits and services covered by your student health insurance plan but also the exclusions and limitations. The New Affordable Care Act has lifted the lifetime cap on medical benefits and by 2014, the annual cap on medical usage will also be phased out.  However, there are still coverage exclusions and limitations that companies impose.
• Colleges and universities usually require students from foreign countries to show proof of health insurance.  The considerations above can apply to them as well.
• Lastly, exercise due diligence in your choice of student health insurance plans.  There are outright fraudulent insurance companies out there who take your money and do not actually have you insured. You can always check with the state insurance regulator to be sure you are dealing with a reputable insurer.

Know Your Patient's Bill of Rights when Signing Up for Medical Insurance

http://edlabor.house.gov/blog/2010/09/a


On March 30, 2010 President Barack Obama signed the Affordable Care Act which came into effect on September 23, 2010.  This historic law affords insured patients important protections which put more control of  medical insurance coverage  in their hands.  This is known as the Patient's Bill of Rights.


Patient's Bill of Rights:

• Children can no longer be denied coverage because of pre-existing medical condition.  Previously, children born with or who develop costly medical illness could be denied coverage.The law now prohibits this and by 2014, all Americans will have this protection as well. The White House expects 72,000 uninsured children will benefit from this law.

• Insurance companies can no longer retroactively drop coverage for a sick insured member because he made an unintentional mistake in his application (unless fraud can be proven.) This has affected some 10,700 patients each year whose medical insurance coverage were dropped at a time when they most needed it.

• The lifetime cap of medical usage and benefits has been lifted.  Often patients max out on their lifetime benefit because of illness and are left to pay medical bills on their own.  The law affords this protection.The annual benefit limit will gradually be phased out and will be totally lifted by 2014..

• Patients may now choose their own physicians within their network. Women may choose their obstetrician and parents can choose the pediatrician for their child without first obtaining a referral from their primary care doctor.

• Parents may choose to keep their adult children in their health insurance plan until age 26, unless the child is employed and eligible to participate in his employer's medical insurance plan.

• In emergency conditions, patients may now use the closest emergency room even if it is out of network. Insurance plans are obligated to pay in network rates whereas in the past, the patient was penalized by having to pay higher cost sharing co-insurance for going to out of network emergency rooms.

• Patients now have the right to both an internal (within the insurance company) and an external (independent third party) appeal when the medical insurance plan denies a service.  In the past,patients could only go through the internal appeals process.

• Patients may now receive preventive services without having to pay deductibles, co-insurance and co-pay.  These services include mammograms, colonoscopies, prenatal care, immunizations and well baby care. Many Americans missed out on necessary preventive care due to the added expense.

 
Watch for more on the Affordable Care Act in this blog. 

CDC Reports Hispanics Live Longer

An October 2010 report published by the Centers for Disease Control finds that the life expectancy of Hispanics is longer than those of non-Hispanic whites and non-Hispanic blacks.  This is the first ever report on the life tables of Hispanic population and non-Hispanic black population.  This finding is a paradox in that  of the three groups, more Hispanics currently fall into the lower socioeconomic status. Nineteen percent of Hispanics live below the poverty line.

According to the report, the Hispanic population of any age from birth has a higher life expectancy than the non-Hispanic white and non-Hispanic black population until age 95 when life expectancy of Hispanic males equal that of non-Hispanic black at 3.5 years. Of those born in 2006, Hispanics can expect to live an average of 80 years, non-Hispanic whites to 78 and non-Hispanic blacks to 73.

The report speculates the reasons could be due to data artifacts, migration effects and cultural effects.  The last two are still conjecture and will require further study.

• ·         Data artifacts could include incongruence between ethnic classifications of the numerators  (data from vital registration) and denominators (data from census population estimates)  of death rates, misstatement of age thus affecting the age report at time of death, and problems with data linkages which could under report the death numbers.

• ·         Migration effects are thought to be due to migration of healthy individuals called the healthy migrant effect and the return of ill immigrants to their home country called the salmon bias effect.

• ·         Cultural effects of family structure, lifestyle behaviors and social network found in the Hispanic community could confer some degree of protection from the negative effects of minority and low socioeconomic status.

Declining Rate of Vaccination of Children Covered by Private Health Insurance

The National Committee for Quality Assurance in its State of Health Care 2010 report notes that there is a decline in the vaccination rate of children covered by private health insurance by almost four per cent while vaccination of children enrolled in Medicaid programs actually increased.  NCQA report shows that multiple childern vaccinations prevent some 10.5 million diseases per birth cohort in the US and saves in direct and indirect health care costs.

www.commons.wikimedia.org

NCQA speculates that parents of children with private insurance delay or decline vaccination of their children in the unproven notion that vaccinations cause autism spectrum disease.  The report notes that this thinking is fostered especially through internet articles and celebrity endorsement. Parents in private health insurance plans who are generally well educated tend to overvalue this misinformation regarding the relationship between vaccination and autism and predicts that if the trend continues, in the long run, these children of the middle class may be less healthy than children in Medicaid health insurance plans.

NCQA Report on Health Insurance Plans

The National Committee for Quality Assurance, a private non profit organization, the most recognized agency that monitors health care in the US just released its State of Health Care Quality report on October 13, 2010.  This is the annual report on the quality of health care in America. The interesting finding is that "health plans that spend the most on care don’t always deliver the best quality." 

The analysis used the interphase between relative resource use (RRU), an indicator of health services utilization (e.g. doctor visits and hospitalizations) with the outcomes for five common costly chronic diseases  and comparison between different health insurance plans within the same region and within similar members. It found that the outcome was not necessarily better with health insurance plans that utilized more services and spent more.


A relevant follow-up might be to study the factors that produce better outcomes in these chronic diseases given that more dollars spent does not insure better results.  I would wager that lifestyle changes and individual responsibility for ones health will prove to be significant factors.

October Is Open Enrollment Season for Your Health Insurance

Image from change.gov

Each year in October, employers provide open enrollment for the health insurance plans they provide.  It is important to review the offerings, find out the changes and what it will cost you in the long run.  Failure to do this will place you on the company default health insurance plan which may or may not be what you want.

Some helpful information:

• Co-pay is a fixed amount that you pay when you receive health care services.  You are expected to pay this with each visit.
• Co-insurance is percentage difference between what the health insurance plan pays and the health care provider charges.  For example, Medicare pays 80 percent of the negotiated health care charge and you are responsible for the remaining 20 per cent.
• The new health care law now extends health insurance coverage of dependent children to age 26.  It now includes insurance coverage for annual physical examinations and some preventive services.  It also lifts lifetime coverage caps.
• Check out any changes in premium structure for family plans.  Instead of a single premium for a family plan, some health insurance plans may charge individual premiums for the employee, the spouse and dependent children.  
• Review your health service utilization in the last year to see how much to add to your flexible spending account (tax free savings plan for eligible health care expenses such as co-pays, deductibles and other health services not covered by your health insurance plan.)
• Weigh your health services utilization against the value of signing up for a higher deductible and putting away the money saved.  For instance, healthy young persons may opt for a higher deductible premium, saving the difference and using their flexible spending account for deductibles.
• Maintain a healthy lifestyle.  Most health  insurance companies offer incentives for weight reduction, smoke cessation and other preventive practices.

Prescription Health Insurance: Five Ways to Save on Prescription Medications

In a climate of decreasing income and high health insurance premiums buying prescription medications can eat up a good chunk of your income, even if you are lucky enough to have prescription insurance. Here are some ways to help obtain necessary medications for less.·         

•  Generic medications: 

Insurance plans usually charge lower co-pay for generic medications. Generic medications are lower cost preparations of brand name drugs whose patents have run out.  Always ask you health care practitioner if a generic equivalent of your medicine would be just as effective.  Your doctor can advise you if a generic equivalent is not advisable (such as medications in which it is important to have a consistent steady state blood level of the drug) or even available.

A drug equivalent is not the same as a generic drug. They usually belong to the same class, may cost less but can just be as effective.  Ask your health care provider about this as well.

Pharmacy chains such as Wal-Mart and Sam’s Club have a list of over 100 generic medications for which they charge $4.00 for a month’s supply.  Many local pharmacies also have price matched this Wal-Mart offering so ask you pharmacist if they will match the $4.00 price.Check out Wal-Mart's $4.00 formulary here. Costco Pharmacy is another resource for less expensive generic medications. Anyone can avail of this pricing structure. If your health insurance co-pay is higher than $4.00, just buy the medicine outright.

• Understanding the tier structure of your prescription health insurance plan:

Note that your prescription health insurance may have different co-pay structures for different medications.  This is because there is a list of medications called a formulary.  The insurance health and pharmacy panel reviews the literature for the evidence base of the effectiveness of medicines for different conditions and they then assign these drugs to different tiers, usually first, second and third tier.

 Tier one include generic drugs which the FDA has determined to have the same bio-assayed ingredients and are as effective as the brand named drug. They have the lowest co-pay.

Tier two include brand named medications which are found to be effective for the conditions they are indicated and have middle range co-pay. Sometimes, the insurance company requires that a trial of a tier one medicine be tried before using the higher tier drugs.

Third and sometime fourth tier drugs are usually newer drugs for which effectiveness is still being evaluated. They have the highest co-pay which can reach over $100.00. Tier two to four drugs usually require a prior authorization from the insurance health plan.

• ·         Pharmaceutical company assistance:

Drug companies have indigent care subsidies for persons falling below a certain income level.  You will have to complete a form which details your income or lack thereof.  Your physician completes his part of the form and provides a prescription for a 3-4 month supply.  The medicine is either mailed to you or to the physician’s office.  You can avail of this service indefinitely as long as you fall within the guidelines.  Different companies have different requirements. Find a list of patient assistance programs here.

• ·         Prescription discount coupons:

Check with your pharmacy for discount coupons such as trial of new medication.  Your pharmacist can also find you the best deals on discount coupons for which you may qualify.

• ·         Take care of your health:

Living a health conscious lifestyle is the best way to save on health care cost.  Smoke cessation, mindful nutrition, exercise and learning stress management techniques can go a long way towards improving health.

Global to Local Health Care: A Seattle-King County Initiative to Improve the Health of Its Neediest Citizens

Swedish Medical Center, Seattle’s largest hospital chain is celebrating its 100th year. Today, they introduced an innovative template for improving health care delivery to the uninsured and underinsured. They call it Global to Local Health Care, a partnership with various health care and community leaders in the Seattle area designed to use proven effective techniques of health care delivery systems in developing countries to improve health care in local communities. To this end, the hospital has committed 1M dollars over a 4 year period to fund initial projects. It is a daring and exciting concept.

Two years in the making, leaders of various agencies in the Seattle area met to brainstorm how to improve the health of citizens in the underserved areas of Seattle-King County area. Spearheaded by Swedish Medical Center CEO, Dr. Rod Hochman, committed participants of the initiative include Healthpoint, a community health center serving low income, uninsured minority, immigrant, refugee and homeless families, Washington Global Health Alliance whose members include the Bill and Melinda Gates Foundation, a center for global health innovations, and the Public Health Department of Seattle-King County, one of the largest public health departments in the nation serving some 1.9 million residents. They have found that some King County communities live in conditions as impoverished as neighborhoods in the poorest developing country. The Seattle area is home to the wealthiest and the poorest in the country.

While Americans have one of the world’s best medical technologies and spend the most in health care in the world, sadly, its people are not the healthiest. While overall health care in the country is good, it does not speak to the wide range of best to poor health outcomes. Health care delivery does not necessarily have to be tied to health insurance. People with good health insurance are able to access the best medical technologies while the unemployed and uninsured postpone needed medical visits. David Fleming of the Public Health Department of Seattle-King County stresses that there are unacceptable disparities in health care right in the county’s backyard as is true elsewhere in the nation.

It has been proven that global initiatives in the poorest countries are successful but that no one agency can do it alone, that the community itself must identify its needs and that grassroots efforts involving residents have the best outcome. Global health initiatives also found that the health of citizens is tied closely to its economic health and that in order to improve the health of a community, there must be a corresponding effort to elevate the economic status of its people. Thus Global to Local Health Care aims to take lessons learned from best practices all over the world into the poorest local community. For instance, it hopes to find collaborators who can help local grocers buy refrigeration systems so they can stock more produce, fund local one stop resource centers where citizens can access information, health care, legal, vocational and others, provide transportation, utilize existing agencies such as the local food banks and health care providers to a collaborative holistic provision of services. Global to Local Health Care is confident that this template can easily be reproduced in other communities as well.

Global to Local Health Care is hope inspiring in a time of unemployment, lost health insurance, and drastic cuts in government subsidy. When one’s choice is between buying medicine or putting food on the table, it is a no brainer what the choice will be. Having lost access to their health care provider, many frequent high cost emergency rooms for non-emergent conditions. Health care delivery need not involve traditional physicians and nurses alone. Developing countries have successfully utilized health educators, tribal councils, and community workers to educate citizens on healthy living, identify and refer those who require medical intervention and facilitate improvement of living conditions. Like her project collaborators, Lisa Cohen of Washington Global Health Alliance wants to see “the rising tide lift all boats.”

Nora Quiason is a physician and an online book seller. She also writes articles on senior living, book reviews and health care.

Contributor's Note Having worked in public psychiatry and painfully aware of the needs of what a former surgeon general calls the uninsured, uneducated and uninspired patient, I am always looking for initiatives that address this population.

External Links

http://www.swedish.org/About/Swedish-News/New-Global-to-Local-Healthcare-Initiative-Launched | http://www.pacifichealthsummit.org/downloads/global%20to%20local_Summit%20website.pdf

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Basics About Medicare, the Nation’s Largest Health Insurance Plan

Medicare, the nation’s largest affordable health insurance plan, is a government health plan that insures citizens age 65 and over, qualifying disabled persons and persons with end stage kidney disease.

Centers for Medicare and Medicaid Services

Medicare pays 80 per cent of the allowable health care charge.  Medicare has agreement with participating providers for a lower allowable charge for each medically necessary medical procedure reducing the charges for Medicare allowed reimbursement.  You are responsible for the remaining 20 per cent.  For this reason, many purchase another health insurance plan known as the tie-in plan to pay for the 20 per cent remaining bill. Important note:  If your provider is not a participating Medicare provider, he is not obligated to accept reduced Medicare fees and you can be liable for a higher amount.

Types of Medicare coverage:

·         Part A-The part of the insurance health plan that pays for hospital charges.  All Medicare eligible persons are automatically enrolled in this.

·         Part B- The part of the insurance health plan that pays physicians and other outpatient providers including medically necessary ancillary procedures such as physical therapy, home health care and some preventive services.  You pay a monthly premium for this service which is a set amount each year plus additional amount depending upon your last two year income tax return.  Those whose income fall below a certain amount are eligible for government subsidy of all or part of their Part B premium.

·         Part C- Also called Medicare Advantage,  are private health insurance plans which provide Medicare mandated services and usually other services such as preventive and health education programs.  They are required by law to provide at least all services provided by the Original Medicare plan.  Some also offer dental, vision and prescription insurance. You may choose to participate in either the Original Medicare or in a Medicare Advantage plan.

·         Part D- The part of Medicare which pays for prescription drugs.  You may participate in this through 1. Medicare Prescription Drug Plans (PDP)  or 2. Medicare advantage mentioned above.  Again, you pay a monthly premium for this and the government subsidizes the premium for those who fall below a certain income bracket. 

Beware of the Donut Hole

Beware of the Donut Hole: Medicare prescription drug plans pay for prescriptions up to $2830 in 2010 and $2840 in 2011.  Once you hit this spending mark, you are in the coverage gap or “donut hole.”  You become liable for your medicine purchase until you have spent $ 4,550 for the year at which point catastrophic coverage kicks in and the health insurance picks it up again.

Medicare remains the largest affordable personal health insurance plan.  For more detailed information request the free Medicare and You 2010 handbook through www.medicare.gov or call the 24 hour interactive phone line at 1-800 Medicare (1-800-633-4227) and TDD users at 1-877-486-2048. Download the pdf version at http://www.medicare.gov/publications/pubs/pdf/10050.pdf