Posts Tagged - ‘health insurance’

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Healthcare Reform Lawsuit Arguments Continue

Tuesday, August 31st, 2010
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Image: steakpinball under CC 3.0

When it comes to healthcare reform, controversy is never far behind. The federal government has continued to argue that the law is constitutional. In a district court, their lawyers claim that the burden of proof should be on the coalition of states suing.

Specifically, the states claim harm from the provision that mandates the purchase of health insurance plans. If a person or business does not comply, they are subject to annual fines of $695. However, the plaintiffs have allegedly failed to demonstrate imminent or actual financial injury, since that aspect of the legislation does not take effect until 2014.

Moreover, the federal government claims that even if the penalty (which would be collected by the IRS) is technically considered a tax, the Anti-Injunction Act prevents states from challenging it, since the individual mandate is considered integral to the structure of the bill.

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Most Health Insurance Plans Don’t Cover Fertility Treatments

Monday, August 30th, 2010
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Image: Daquella manera under CC 3.0

Treatments for infertility can be very expensive. The average cost of one round of in-vitro fertilization is $12,400; it often takes several cycles in order for it to be successful. Meanwhile, many women choose to implant multiple embryos for greater chances of success.

Not only are the actual treatments expensive, but they can lead to high-risk pregnancies and the complications that often result from multiple births. Due to the high cost, most health insurance plans don’t cover fertility treatments. The number of plans that include infertility coverage has decreased over the past decade.

Those that do are typically larger employers. In those cases, oral medications that promote fertility are more likely to be covered except for a nominal co-payment.

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Health Insurance Plan Agents May Suffer Under Reform

Friday, August 27th, 2010
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Image: Jennifer Feuchter under CC 3.0

Although healthcare reform tries to help many, it will end up hurting at least some. For example, the business model of many health insurance brokerages and agencies is in danger.

Provisions involving medical loss ratios, which include agent commissions in the “administrative” category that will be regulated and limited, will have a negative effect. In addition, brokerages may be made redundant by the state insurance exchanges and accompanying websites that must be launched by 2014. On the bright side for them, the National Association of Insurance Commissioners passed a resolution that affirmed the importance of licensed insurance professionals.

With the possibility of a double-dip recession looming, more job losses is obviously a downside. However, industry experts predict that these companies have several options for adaptation. Hopefully, their experience in navigating the complexity of the market and helping people decide on a health insurance plan will still be in demand. Their compensation model may also be adjusted in favor of flat fees instead of commissions.

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Inflation of Health Insurance Plans Continued in 2009

Thursday, August 26th, 2010
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Image: Paolo Camera under CC 3.0

2009 had the American economy in the throes of recession. Inflation was very low, while the Federal Reserve cut the interest rate to almost zero. So why did the cost of health insurance plans continue to rise?

To be exact, United Benefit Advisors found that health insurance rates increased by an average of 7.3% for employers. That’s almost three times the inflation in general consumer prices.

Insurers tend to blame an increase in medical expenses. Meanwhile, companies are using consumer-directed health plans to pass more of the cost of group health insurance coverage onto their employees.

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No Fee on Health Insurance Plans to Pay For Okla. Medicaid

Wednesday, August 25th, 2010
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Image: KB35 under CC 3.0

Recently, the Oklahoma state legislature attempted to implement a one percent fee on the sale of health insurance plans. The proceeds were supposed to help pay for the state’s Medicare program.

However, the state’s Supreme Court just ruled that such a fee is unconstitutional, agreeing with Insurance Commissioner Kim Holland’s objections. Six out of nine justices decided that since the law was passed during the final week of the legislative session with less than three quarters of the legislature in favor, it could not stand.

The fee was to be charged to employers that offer health insurance coverage to their employees. It was supposed to raise $78 million for the fiscal year beginning July 1st.

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Health Insurance Scammers Prey on Healthcare Reform Confusion

Wednesday, August 11th, 2010
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Image: B Rosen under CC 3.0

Over the past several months, the American public has been wrestling with the advent of healthcare reform and what it will mean for them. For many, it will require them to purchase a health insurance plan.

Unfortunately, scammers in 24 states are taking advantage of this uncertainty. They are advertising medical discount plans as full-fledged health insurance, which they are not. Unlike standard insurance, these limited plans aren’t accepted by doctors and hospitals to cover most or all of a person’s medical bills.

The Federal Trade Commission has joined in the fight to crack down on these misleading marketing tactics. They hope to eliminate them before the mandate provision of the law goes into effect in 2014.

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Health Coverage and HIV/AIDS

Tuesday, July 13th, 2010

Image: Sully Pixel under CC 3.0

With its affordable health insurance legislation under its belt, the Obama administration has begun tackling a new health issue: the HIV/AIDS crisis. Although new infections have slowed since their peak in the ’80s, many people are still affected.

It is a two-pronged effort, aimed at reducing new infections while increasing access to health care for those who already have it. Instead of allocating significant amounts of new funding, existing funding will be redirected to high-risk populations like African-Americans and gay/bisexual men.

Some fear that the new comprehensive strategy won’t be enough, however. The economy has resulted in many people losing their jobs, which for many also means losing health coverage. Although there are medications that allow HIV patients to live longer and healthier lives, they are still very expensive. The out-of-pocket cost is almost out of reach for the uninsured. In addition, a person with HIV or AIDS would find it almost impossible to buy health insurance on the open market for the next several years.

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Federal Grant To Review Illinois Health Insurance Premiums?

Tuesday, July 13th, 2010

Image: woody1778a under CC 3.0

Over the past several years, Illinois health insurance rates have risen significantly. Like many other states, their insurance department has been overburdened and unable to investigate premium increases.

States have been criticized for rubber-stamping health insurers’ requests in the past. Illinois is looking for a $1 million federal grant from the healthcare reform law to analyze and collect information about health insurance premiums in the state. Their intention is to better determine which would be considered reasonable, and which should be deemed unconscionable–higher than both the medical inflation rate and national averages.

If the state’s application is approved, they’ll receive the funding next month.

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Is There Precedent To Uphold Healthcare Reform?

Monday, July 12th, 2010

Image: BAR Photography under CC 3.0

One of the main arguments against the legality of healthcare reform is the contention that it is unconstitutional. Many opponents believe that the individual health insurance mandate, in particular, violates the 10th Amendment. That amendment says that all rights not specifically given to the federal government in the Constitution or its amendments are left to each state.

However, a competing interpretation–accepted by some conservative justices, no less–states that at times, the national government can exercise powers not expressly mentioned in the document. A recent Supreme Court decision (approved by seven out of the nine members) upheld the federal government’s right to indefinitely detain sex offenders after serving their sentences. Surely, the specifics of ankle monitoring or house arrest for child molesters and others were not on the founding fathers’ minds.

Granted, U.S. vs. Comstock is relatively less controversial an issue than affordable health insurance reform. Still, it’s a sign that the highest court is willing to consider the application of the “elastic clause”, which states that the federal government is allowed to pass laws to help it execute the powers it was expressly given.

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Co-Payments Vs. Co-Insurance

Monday, July 12th, 2010

Image: db*Photography under CC 3.0

When trying to find affordable health insurance, it can be difficult to find the right policy. One of the most confusing aspects is the out-of-pocket cost you are expected to pay, above and beyond the monthly premium.

Most health coverage options include co-payments, co-insurance, or both. What’s the difference?

  • Co-insurance is a percentage of the fee charged for an item or service. For example, if you have a 30% co-insurance percentage under your policy and a doctor normally charges $100 per visit, you will be responsible for paying $30 upfront. In many cases, this is the more expensive option. However, it is becoming more common among group health insurance plans, due to employers trying to reduce their cost burden.
  • On the other hand, co-payments are a fixed amount. If your insurance company specifies a $15 co-payment for prescription medications, that is the amount you’ll pay the pharmacy each time you fill the prescription–regardless of how much the medicine actually costs. Sometimes, insurers have multiple tiers of co-payments: depending on the type of medication, doctor visit, or hospitalization, the copayment will be higher or lower.
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