3 Open Enrollment Tips

WITH ALL THAT'S going on in the market, it would be nice to think you could leave your health care on autopilot — but you'd be wrong. This October, as usual, 158 million American workers will have to make seemingly small but ultimately crucial decisions, as corporate America shifts more of its $537 billion health care burden onto workers. "People need to be more thoughtful about their choice than in the past several years," says Jay Savan, a principal with the professional-services firm Towers Perrin — especially if they don't want to get stuck with hefty bills. Some tips on being choosy:

Watch for hidden costs
Read the fine print: One trend Savan expects to see grow is surcharges — sometimes as high as $150 each month — for employees who opt to cover a spouse or child who could get benefits elsewhere. And the consultancy Mercer Health & Benefits estimates that 25 percent of large employers will offer prescription-drug plans that make employees pay a portion of drug costs instead of a simple copay. That'll sting if you're on, say, a $14,000 cancer drug.

Snag incentives
Being healthy can be good for a lot more than your waistline. In 2007 almost one in four large companies offered workers incentives for healthy behavior, a trend experts say will mushroom in 2009. Alexander Domaszewicz, a principal at Mercer, says he's seen perks such as lower deductibles and even a month of benefits for healthy decisions like losing weight. Don't lie, though: "That's like stealing from the company," Domaszewicz says, and can be a fireable offense.

Don't fear health-savings accounts
With caps on out-of-pocket costs and coverage for most preventive screenings, these plans can be a good deal, especially for the very sick or for very healthy consumers looking to sock away pretax funds. Balance the huge amount you'll save in premium costs against your exposure, Savan says. Many insurers' Web sites can help evaluate various plans.

Health care costs taking growing bite out of farm incomes

Too many farmers don't have enough -- if any -- health insurance simply because it costs too much. And, for those without adequate insurance, health care costs are taking a growing bite out of their wallets.

As a result, one group says it's Congress' job to "develop alternatives to a private market that is unwilling or unable to provide affordable protection to the self-employed and small business owners."

The Boston-based health care watchdog group The Access Project on Wednesday released a report entitled Who is Uninsured? that shows a growing number of farmers and ranchers are having trouble making ends meet while keeping adequate health insurance coverage. It's causing either excessive debt or delays in seeking care, which can exacerbate medical conditions.

Ten percent of farmers don't have health insurance, and on average, the uninsured are spending 10% of their income on health care costs. While the prior number is slightly lower than the percentage of those uninsured in the U.S. population in general, growing expenses are making it tougher for farmers to get by without insurance.

"Those most reliant on income derived from the family farm or ranch are least likely to be able to afford private health insurance" says Carol Pryor, lead author of the report and Policy Director at The Access Project. "This threatens both their health and their livelihoods."

The report that's based on a survey of farmers and ranchers in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota and South Dakota, also found:

Farmers and ranchers delayed care more than twice as frequently as those with insurance;
40% of uninsured use savings or take out loans to pay for health care costs;
34% of the uninsured spend 10% or more of their income on health care;
32% say health care costs "contributed to financial problems;
32% accrued medical debt.

Because of the trend these numbers show, Center for Rural Affairs director of rural research and analysis at the Center for Rural Affairs in Lyons, Nebraska Jon Bailey says plans to reform the health care system nationally must take into account the needs of rural businesses and communities.

"Health reform that continues to rely solely on the private insurance market and attempts to strengthen employer-provided insurance, no matter how regulated or reformed, will be irrelevant to a large number of rural people," Bailey says in an Access Project report. "If you want farmers to continue growing the food for our families, and if you want rural communities to thrive, then availability of affordable and quality health insurance must be effectively addressed."

Partisan Ire Surfaces as Senators Start Work on Health Bill

WASHINGTON — Partisan anger flared Wednesday as senators began the public drafting of legislation to remake the health care system. By day’s end, lawmakers had settled in for a long, hard slog that may not fit with President Obama’s goal of signing a bill within four months.

“This is about as historic as it gets for all of us,” Senator Christopher J. Dodd, Democrat of Connecticut, said as he opened a day-long session of the Committee on Health, Education, Labor and Pensions.



Another Senate committee, dogged by questions about the cost and complexity of the legislation, postponed its session, scheduled for next Tuesday, until after July 4. Democrats said they needed the delay by the Finance Committee to work on reducing the cost of the bill, intended to provide insurance to millions of people with no coverage.

Mr. Dodd presided over the health committee in the absence of its chairman, Senator Edward M. Kennedy, Democrat of Massachusetts, who is battling brain cancer.

Senator Dodd said he hoped the committee would finish its work and approve a bill by June 26. But he told his colleagues, “My intent is not to jam anything, force anything on people.”

Within 15 minutes after the session started Wednesday, Republicans began to protest. Senator John McCain, Republican of Arizona, said it was ridiculous to take up such a large bill without a complete cost estimate.

He and other Republicans demanded more details of the legislation and more time to digest it.

Senator Orrin G. Hatch, Republican of Utah, said Democrats had made some grave errors.

“You advance legislation by focusing on areas of compromise, not strife,” Mr. Hatch said. “Now unfortunately we are beginning a partisan exercise on perhaps the most important legislation of our lives. I am personally somewhat, well, actually, very disappointed, because I wanted a thoughtful bipartisan compromise that could have become a lasting legacy for my dear friend, Ted Kennedy.”

President Obama is pressing Congress to speed work on the measures, which embody his top legislative priorities, reining in health costs and covering the uninsured. Mr. Obama wants to sign a bill by October, but senators of both parties said it was more important to get the policy right.

The bill before the health committee, drafted by Mr. Kennedy and Mr. Dodd, would require people to carry insurance, with federal subsidies for those who could not afford it, and would require most employers to help pay for coverage of their employees.

The bill would impose stringent new federal regulations on insurers and make far-reaching changes in the health care industry, which accounts for one-sixth of the economy.

Senator Michael B. Enzi of Wyoming, the senior Republican on the health committee, said the panel was moving “too fast to do an adequate job.”

Mr. Dodd said, “I appreciate the frustrations being expressed,” but plowed ahead. “We have a moral imperative to act,” he said.

Mr. Enzi said the bill had been drafted “with no input from Republicans,” and he asserted, “The bill costs too much, covers too few and will cause 10 million Americans to lose the insurance they currently enjoy.”

A preliminary estimate by the Congressional Budget Office said the bill would cost $1 trillion over 10 years but leave many uninsured. The office said an early version of the Finance Committee bill would cost $1.6 trillion.

Senate Democrats conceded that the unexpectedly high estimates had forced them to regroup, and acknowledged that they were still divided over how to pay for the legislation.

But Robert Gibbs, the White House press secretary, said he did not see any setback. “The president, I think, has laid out a timeline to get this done this year, and thinks that we’re on course to do it,” he said.

Senator Judd Gregg, Republican of New Hampshire, said he was on the committee when it considered President Bill Clinton’s plan for universal coverage in 1993-4. “It’s sort of déjà vu all over again for me,” he said.

Mr. Gregg said the Kennedy bill looked as if it had been written by Rube Goldberg, Karl Marx and Ira C. Magaziner, Mr. Clinton’s health care coordinator. Mr. Gregg criticized a provision that would establish a Medical Advisory Council to recommend minimum benefits for insurance policies.

“This is the elite of the elite deciding how everybody else will get health care,” Mr. Gregg said.

Senator Barbara A. Mikulski, Democrat of Maryland, fired back. “Our current system is a combination of Adam Smith, Darth Vader and the ‘Invasion of the Body Snatchers,’ ” she said. “So I like our plan the better.”

Ms. Mikulski said the Republicans’ complaints reminded her of objections to the creation of Medicare in 1965.

“The arguments against Medicare are the same arguments we are hearing now — government control, centralized bureaucracy,” she said. But, she noted, Medicare is hugely popular.

Senator Bernard Sanders, independent of Vermont, said, “The fight for comprehensive, universal health care is the civil rights struggle of the moment.”

And he issued this warning: “To all the lobbyists, all the big-money interests who give us campaign contributions and lobby so successfully with those 30-second ads on TV, I say your time has come and gone.”

Mr. Obama and many other Democrats have called for a new public health insurance plan, to compete with private insurers.

Senator Sherrod Brown, Democrat of Ohio, said such competition would “hold down premiums, discipline the market and keep the private insurances industry on its toes.”

But Mr. Hatch said, “Medicare and Medicaid are already on a path to fiscal insolvency; creating a brand-new government program makes no sense.”

Health insurance for men: what are the best options?

Should men be taking a closer look at health insurance, following news this week that they are more likely than women to get many common types of cancer?

More worrying still, this research showed that men are far more likely to die of certain cancers, compared to women with the same condition.

Although the report, from the National Cancer Intelligence Network, found "no biological reason" why this should be so, it is thought men's unhealthier lifestyles and their reluctance to get symptoms checked by a doctor at an early stage are largely to blame.

Of course, spending hundreds of pounds a year on health insurance won't stop you getting cancer – or any other disease for that matter. But it will ensure that you are in a better position to deal with the financial consequences of serious illness; and taking a more active interest in your health may mean that early signs are detected sooner.

The question remains though, what type of health insurance is best?

There are a number of different types of policy. The best known is probably private medical insurance (PMI), which basically pays for private consultations and treatments, allowing policyholders to bypass NHS queues. Some employers will offer this insurance to staff, and it can also be bought individually. The main drawback is that it can prove expensive for comprehensive cover – particularly as you get older.

Cheaper, and far more widely bought, is critical illness insurance, which is often sold to those taking out a mortgage along with basic life insurance. Rather than pay directly for private treatment, this insurance is designed to pay out a tax-free cash sum on the diagnosis of certain life-threatening diseases. The idea is that this money will enable policyholders to pay off the mortgage, reduce their working hours or take extended leave while they recuperate.

Most critical illness policies cover about 30 conditions, and all should cover cancer, heart disease and stroke. But within these broad definitions there are numerous exclusions. Certain types of breast, prostate and skin cancers, for example, which are not considered "life-threatening" are routinely excluded on most policies.

Another option is an income-protection policy. Rather than cover specific ailments, this pays out a regular income to those who are unable to work through ill health. Provided a doctor has signed you off sick, these policies should pay up, regardless of the nature or severity of the illness. As well as covering cancer and heart disease, these policies help those with back problems, stress or depression.

The final option is a "cash plan". These schemes are relatively cheap, but the benefits are more limited. However, those who contribute to one of these plans can claim a contribution to regular medical bills, such as dental charges, opticians fees, physiotherapy and so forth.

So what should you buy, given most of us don't have the inclination or the financial wherewithal to pay for them all?

Alan Lakey, a financial adviser specialising in protection policies, says: "Both men and women should ask themselves what would happen to their income if they had a long-term health problem or illness. Those who work for an employer like the police or the NHS may have more generous staff benefits that would pay long-term sick pay at a reasonable rate. But most people won't have this luxury to fall back on. If this is the case, then income protection should be your first port of call."

He said critical illness could be useful, but it does not offer the same flexibility. He added that some customers may want to opt for private medical treatment, but this in most cases is unlikely to be their main priority – particularly given the cost.

Matt Morris of Lifesearch, a firm of advisers, agrees: "Anyone with dependants or debts who relies on their salary to live should ensure that they have adequate income protection in place as a first priority. Ideally, everyone would have an income protection, critical illness and a basic life insurance policy – usually in that order of importance."

Further information on each of these main products is given in the linked stories below, so men and women can decide what policy would give them the protection they need.

Critical illness
Income protection
Private medical insurance

The great uninsured--decreasing the surplus population

Strange times we live in. We are now evaluating if we really need to do something about health care--the very sustenance of existence. We are not talking about who should get a tax break but who should be cared for so they may survive their time on our planet. The stakes don't get much higher than that for the millions of the great uninsured.


I spoke with a woman who told me she had just lost her home in Florida. She is a realtor and has a nice home in the Chicago land area. Maybe in her fifties. We chatted about real estate and selling my two flat and somehow we started talking about doctors. That's when she dropped the bomb and said she was uninsured and that she couldn't afford to get sick.

She said she couldn't afford health insurance and worse no one would insure her because she has pre existing conditions. This is not a poor person. This is not someone who doesn't pay taxes and has a mortgage. She simply cannot get insurance. Depending on where you come down in this debate you may say it is this woman's own fault. She should have been working for a company instead of a straight commission job. She should make more so she can afford health care.
The truth is everyone could become this woman.


The argument against Universal Health Care is that it will knock down the quality of our health care. But to the millions of uninsured in this country, some health care is better than no health care. I suppose it comes down to your view of America. If we are a country that takes care of it's people then you believe that health care is a right. But if your view is that it is every man and woman for himself and take the more Darwinian approach of survival of the fittest--then we should stop all the pretense and just say good luck to people like this woman.
There are a lot of people finding themselves in the unemployment line now. Some will never be rehired and will lose their benefits. Some will get old outside the corporate safety net without health insurance. So if we decide to tell all these people they are own, then like Scrooge, we should also tell that if they are going to die, then they should do it, and decrease the surplus population.

Laid off, what about health insurance

Laid off? What about health insurance. Typically, you have three options – COBRA, purchasing on own, and going without. Going without is a really bad idea, and if it can be avoided then do so. COBRA is another option, and with the American Recovery and Reinvestment Act (ARRA) of 2009 the government may pay for 65% of your premiums. The final option is purchasing directly.

How you choose between the three options depends upon age, health, family size, available assets, eligibility under ARRA, and state you live in. The younger you are the more tempting it may be to go without coverage. The problem is that health issues are often a “surprise”. More importantly, if you experience a health issue when you are not covered it will most likely be difficult to get coverage later.

For example, a person in their 20’s opts not to get insurance. (Health insurance for a 20 something is comparatively cheap, so I can’t imagine why anyone would do this.) While they are not covered this person finds out that they have diabetes. It will be difficult to then go out and look for health insurance because you now have a pre-existing condition. Usually, this ends up being an issue always. If you were covered before the diagnosis, then it would not inhibit you from changing plans. However, once diagnosed it is advisable to never be without coverage.

COBRA is mandated by federal law. Basically, it allows the employee to purchase similar (or the same) coverage they had during employment. Often it is very expensive. However, under the ARRA you may qualify to have 65% of the premiums paid. Therefore, you would only be responsible for 35% out of pocket. As an example I will use a COBRA premium of $1,000. If you are a family that is pretty close to what your cost could be. You would only have to pay $350 per month for continuation of coverage. That is a pretty good deal, and worth every penny.

Government subsidized COBRA does not apply to everyone. (I have included a link on the bottom for more information.) There are restrictions on who will receive assistance and it lasts for 9 months. So if you are unemployed longer than 9 months you may have to consider other options. Usually, it is the choice of purchasing on own or continuing COBRA. (COBRA is usually available for 18 months, government subsidy only for 9 of those.)

As I have said, COBRA may be $1,000 per month for a family. It could also be higher. Typically these plans have low, if any, deductibles. So it may be worth looking at purchasing insurance individually. You could purchase a higher deductible policy and deposit the difference until you have the deductible set aside. (I give a $ example on my blog.)

Here are some bullet points to consider when choosing between COBRA and individual purchase:

Are you eligible under ARRA
Is the 65% co-pay taxable in your state
Not taxable for Federal Income
Varies by state – Oregon likely to be taxable; Washington & California not taxable
What is the cost of purchasing directly?
This may be tax deductible
Given the money that you have, what is going to work best for you?

Kennedy health plan includes long-term care

WASHINGTON (AP) — Americans would be able to buy long-term care insurance from the government for $65 a month under a provision tucked into sweeping health care legislation that senators will begin considering next week.

The 651-page bill, released Tuesday by Sen. Edward M. Kennedy, D-Mass., would revamp the way health insurance works. Insurance companies would face a slew of new government rules, dealing with everything from guaranteed coverage for people with health problems to possible limitations on profits. Taxpayers, employers and individuals would share in the cost of expanding coverage to nearly 50 million uninsured Americans.

Release of the bill by Health, Education, Labor and Pensions Committee Democrats came as lawmakers at both ends of the Capitol accelerated their drive to enact health care legislation. House Democratic leaders also outlined a proposal, but offered only limited details.

Both plans omitted specifics on how to cover the costs, which could exceed $1 trillion over 10 years. Given the uncertainty as well as the political sensitivity over raising taxes or cutting Medicare, Senate Republicans prodded Democrats to fill in the blanks before the scheduled beginning of committee work next week.

A first-ever tax on employer-provided health benefits figures prominently among financing options under consideration in Congress, but President Barack Obama campaigned against that last year and its inclusion would require him to reverse course. Obama has proposed $634 billion in tax increases and spending cuts as a down payment on the plan and is soon expected to outline an additional $300 billion in Medicare and Medicaid cuts.

Kennedy's long-term care plan is designed to help disabled people pay for support services that would allow them to remain in their own homes and avoid moving into nursing homes. People would enroll in the program during their working years and begin paying premiums. To collect benefits, a person would have had to pay premiums for at least five years.

The benefit would be modest — not less than $50 a day — but it could be used to cover a wide range of services.

Prospects for the long-term care provision are uncertain, but Kennedy's advocacy may sway other lawmakers. For Kennedy, who is being treated for brain cancer, health care legislation would be the crowning achievement of a long and productive career.

At their core, the partial draft bill released by Senate Democrats and an outline circulated by senior House Democrats were largely identical.

Individuals would be able to purchase insurance through a new federally regulated national exchange, and private companies would be barred from denying coverage or charging higher premiums because of pre-existing conditions. Those who are satisfied with their current coverage could keep it.

Both bills would require individuals to purchase insurance if they could afford it. Waivers would be available in hardship cases. The Senate measure provides for an unspecified penalty for anyone refusing to obey the so-called mandate, and House Democrats are considering a similar approach.

In both the House and Senate, Democrats want to provide subsidies to families with incomes well into the middle class. One option under the Senate plan would phase out subsidies at about $110,000 for a family of four.

House Democrats also are said to be considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to providers. Medicaid is a joint state-federal program of health coverage for the poor.

The Senate plan would allow children to stay on the parents' insurance until age 26.

On a particularly contentious point, the emerging House plan would give people the option of buying insurance provided by the federal government.

Democrats on the Senate committee embraced a similar provision last week but omitted it from Tuesday's draft in what Sen. Chris Dodd, D-Conn., said was a gesture to Republicans who oppose it.

Sen. Mike Enzi, R-Wyo., the top Republican on the committee, responded derisively. He said Democrats did so "because they know we're not going to like what they've written and they don't want us to have any time to comment."

Senate Republicans on two committees most involved with health care urged Democrats not to move ahead without detailed cost information. "Paying for health reform in a responsible and sustainable way may be the most single difficult element of our efforts," they wrote.

But after months of preliminary effort, Democrats made clear they intend to move ahead on their own timetable, one that calls for passage of legislation in the House and Senate by early August. A final compromise would wait for September or later in the fall, according to a schedule the party's leadership established weeks ago.

"This is the year we have to do it," said Rep. Henry Waxman, the California Democrat who chairs the House Energy and Commerce Committee. Waxman was one of several senior Democrats who outlined proposed legislation to the party's rank and file during the day.

Numerous senior Democrats now aging and ailing have worked their entire careers on health care, but no one is more identified with the issue than Kennedy, first elected to the Senate in 1964. In a poignant announcement Tuesday, Dodd said Kennedy, diagnosed a year ago with a brain tumor, will be unable to attend the working sessions of the health committee he chairs beginning next week.

Health insured prepare for new costs

US Health insurance analysts are preparing to assess health care costs.

The American Health Insurance Plan group is about to kick off a three-day conference in San Diego, to discuss the turmoil which has been occurring in the health industry.

More than 2,000 commercial insurers, employers, medical groups and hospital officials will be attending the conference to discuss the consumption of different health plans.

The conference has been called in response to the Obama administration's push to overhaul the health care system.

Most Americans who are covered by employer-provided health insurance, are now seeing increases in their share of health care costs.

At the same time, the cost of health plans is also rising, which some employers are refusing to pick up.

Health Insurance Plans Comparison

When it comes to finding affordable health coverage, it pays to do a health insurance plans comparison. After all, you want to make the most informed decision possible; one that will leave you feeling certain that you have made the right coverage choice for you and your dependents. Comparing and contrasting plans allows you to take a closer look at the details, pros and cons of each medical plan, so that you will know what to expect from the coverage once you make your decision.

Look at it this way; you are unlikely to purchase a new car without first comparing it to other makes and models to determine if it has exactly what you need or if another vehicle better suits your needs and preferences. So why would medical coverage be any different? It is an important decision that is worthy of your research, time and consideration.

How to compare and contrast medical health insurance plans

While it may not be incredibly exciting, conducting a health insurance plans comparison is easier than you may think. First, you will want to line up the different types of plans available to you. In most cases, you are going to be choosing between the following types of insurance plans:

* Preferred Provider Organizations or PPOs-designed to provide comprehensive medical coverage through a variety of different doctors and specialists as well as hospitals and clinics without the need for referrals. You can even go outside of the PPO network for care, but your out-of-pocket costs will be higher.

* Health Maintenance Organizations or HMOs-are quite commonly considered the most affordable health care coverage. They also provide comprehensive coverage, but it is important to stay within the network and with a particular primary care physician who refers the patient if any other specialist services are needed.

* Health Savings Accounts or HSA accounts-offer high-deductible coverage, so you may have to pay more up-front for medical care and premiums are lower. However, the HAS accounts also include a tax-free medical savings account to help cover your out-of-pocket costs.

* Fee for Service or FFS plans-provide an even more affordable option, but typically do not provide comprehensive coverage and things like preventative care. You pay for all medical appointments and services and then the FFS plan will reimburse you a certain, pre-determined percentage of your cost.

Lining up these types of accounts side by side, you will then want to make a list of the medical services you have received in the past two years as well as predict the services you may be utilizing in the coming year. Also, take into consideration your budget. Are you able to pay higher premiums in an effort to save on out-of-pocket medical costs, or does it make more sense to go with lower premiums and risk the possibility of having to pay more out-of-pocket if an unexpected illness or injury occurs? Would you have the funds to cover these kinds of unexpected costs?

Really looking closely at your unique medical needs as you conduct your health insurance plans comparison is the best way to choose the plan that is right for you. As you arm yourself with the information you need to make an informed choice, you can know that you have taken responsibility for the medical and financial health both of yourself and your family members.

Brits opt for private insurance deals

Worried Britons are seeking out private health insurance.The number of Britons taking out private insurance deals has risen over the past 12 months, despite the continued economic downturn.

New research from the Association of British Insurers (ABI) has found that over 6.2 million people were covered by private medical insurance (PMI) in 2008.

An additional 1.1 million consumers had arrangements in place with the Healthcare Trust, taking the total number of people covered by private insurance deals to over 7.3 million.

This marks a 2.7% increase on 2007's figures, with the ABI welcoming the results.

Director general Nick Starling explained that corporate PMI makes sense for both employees and companies.

He said: "PMI is good for companies and the economy because it enables employees to get back to work after illness or injury as quickly as possible."

Research from BUPA released in response to the ABI figures revealed that the top reason for taking out PMI is to gain access to clean hospitals.

Insured Cover Health Costs of Uninsured

A "hidden health tax" has families paying $1,017 more in health insurance premiums in 2009; according to Families USA, a healthcare advocacy group. Individuals pay an additional $368, the group says.

According to Reuters, a report released Thursday by Families USA said that healthcare providers charge those with private insurance more to cover the cost of care for those without it, and insurers, in turn, raise premiums to pass along the cost. In 2008, people without insurance got about $116 billion worth of healthcare and paid for about 37 percent of the cost.

While government programs and charities paid 26 percent, $42.7 billion was left on the shoulders of the privately insured, the report found.