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Tag: healthcare premiums
Tips For Navigating Medicare Open Enrollment

Tips For Navigating Medicare Open Enrollment

By Janet Kidd Stewart, Chicago Tribune (TNS)

Frustrated with your Medicare coverage? You have until Dec. 7 to look for new options.

That’s the last day of open enrollment for current beneficiaries. Changes made to your plan go into effect Jan. 1.

With speculation still swirling about possible changes to the program’s “hold harmless” provision — a rule that will stick people who are delaying Social Security and higher income beneficiaries with big premium hikes for 2016 — managing costs and benefits is more important than ever, experts said.

“It really takes an individualized assessment to find the right plan,” said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. “The one that’s right for your neighbor or even your spouse might not be the one for you.”

That’s certainly true for couples with different health profiles, where one very healthy spouse might choose a plan that’s low on premiums and higher on out-of-pocket costs, while the sicker spouse chooses a higher premium and lower out-of-pocket costs.

But it could also be true for couples in more comparable health situations, she said.

“I was speaking with someone the other day who uses a brand-name medication, and his wife takes a different one. There wasn’t a single plan in the lowest cost tier that had them both, so they chose separate plans,” she said.

Managing two plans in one household could be a hassle but potentially worth it if it means savings of hundreds or thousands of dollars a year.

Here are some other tips to keep in mind as you choose.

Look to the stars. Check out Medicare.gov for access to the health plans available to you. Plans carry a star rating of 1 to 5, with 5 being the best. The plans earn stars based on measures such as customer service, how many of their participants have well-managed blood sugar levels, how many got their flu shot, and the like. Schwarz said these measures are best used to help distinguish between two or more finalists you’ve already narrowed down according to coverage and cost.

Study up. Make sure you understand fully the final plans you are considering. One reader of this column shared some frustrating experiences as he transitioned from COBRA to Medicare this year. While the move ultimately meant his total costs were cut in about half, he spent many hours on the phone with his insurance provider, haggling over getting access to the right dosage of a prescribed medication.

“We always look for plans with the fewest quantity limits,” said Maura Carley, president of Healthcare Navigation LLC, a consulting service. In theory, doctors can write prescriptions for whatever amount of medication they feel is suitable for a patient, but insurers increasingly are scrutinizing those orders, requiring an additional administrative step to verify the prescription amount is medically necessary.

Watch your step. Some drug plans offer cost incentives for step therapy, the practice of starting a patient on the lowest-cost drug and moving to higher-cost alternatives if the first one doesn’t work. In practice, Carley said, patients view these rules as very heavy handed.

Wanderlust? If you spend part of the year in another state, make sure your plan can travel with you, experts said. Some plans, for example, only cover you in your home base.

The bottom line, experts said: Don’t leap for a low-premium plan just to save a few dollars of monthly cost. Look for a plan’s total out of pocket costs and deductibles, and find out about restrictions on drug dosing.

©2015 Chicago Tribune. Distributed by Tribune Content Agency, LLC.

Photo: Don Ariosto via Flickr

Report: ‘Claims That Premiums Will Skyrocket Are Unwarranted’

Report: ‘Claims That Premiums Will Skyrocket Are Unwarranted’

Although Republicans and even some insurers anticipate rising health care premiums in the coming year, an Urban Institute and Robert Wood Johnson Foundation joint report released Tuesday could ease those fears.

The report analyzed 2014 premiums for policies on the Affordable Care Act exchanges in Washington, D.C. and seven states: New York, Maryland, Alabama, Michigan, Minnesota, Colorado, and Oregon. The study’s most notable finding is a correlation, arguably a direct one, between a state’s local health care market and insurance premium rates for the people of that state. A more diverse local health care market often times involves “nongroup” market insurers: Blue Cross plans and startup insurers, among others. The significance of these nongroup markets is found in their influence on the entire health care marketplace. As the report notes, “subsidies in the individual nongroup market are tied to the second lowest cost silver plan,” which then means that “individuals buying a more expensive silver plan or a gold or platinum plan would have to pay additional amounts.” This provides insurers — particularly those outside the nongroup market — greater incentive to “price aggressively to gain market share.” As a result, competing premium rates assigned to an assortment of health plans comprise the marketplace.

If “2014 premiums were moderate and below original expectations” as a result of diverse health care exchanges — established through the ACA — then 2015 rates should be similar, considering that most of the current insurers included in the exchanges plan on staying, and other new insurers will join in the coming year.

“How these scenarios will play out is hard to know, but claims that premiums will skyrocket are unwarranted based on 2014 experience and the evolving conditions for 2015 suggest otherwise as well,” the study says.

Another factor that supports the study’s findings is the inevitable increase in enrollments in the year to come. Competition among insurers participating in the market will be further fueled by greater numbers of Americans obtaining coverage through the exchanges. This also explains why “urban areas” as defined in the report, which boast higher numbers of enrolled Americans, tend to have a more diverse exchange, resulting in lower premiums.

Premiums in urban areas also tend to remain lower than those found in “rural areas,” which often face “difficulty in negotiating with the limited supply of physicians and hospitals” nearby.

Ultimately, diversity plays at least some sort of a role in determining whether or not rates will increase or decrease over time. Even the report concedes that “there may be real reasons to believe that premiums will increase substantially” — but only before adding that such an event would occur “particularly in less competitive states.” As Obamacare experiences increased participation from new and old health insurers and increased enrollments, “there are even stronger reasons to believe that premium increases will be moderate.”

For now, the rates of premiums for insurance plans nationwide make it almost impossible to deny that President Barack Obama’s health care reform has had a substantially positive effect on the cost of health insurance. The news reflects a similarly positive report from the nonpartisan Congressional Budget Committee that had originally projected Obamacare would cost $41 billion in 2014 alone; the report says that Obamacare coverage provisions are expected to cost $5 billion less in 2014 and $164 billion less in the next 10 years, in no small part due to reduced premium rates.

In spite of new data, hysteria over impending increased premium rates will certainly continue. But those who point to the Affordable Care Act as the source of the problem ignore the law’s capacity to shape the health insurance marketplace and foster competition beneficial to Americans.

AFP Photo/Joe Raedle