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Do High Deductible Plans Cover Chronic Care Up Front? PDF Print E-mail
Written by Ellen Breslow   
Thursday, 29 September 2016 00:00
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Good question. That depends on your high deductible plan and its relationship to a health savings account.  As more people are covered by high deductible plans, some employer sponsored plans are covering benefits like doctor visits or generic prescription drugs to help ease the costs to the individual before meeting the deductible. Here’s the catch: if your plan is linked to a health savings account, it can only cover preventative services like vaccines and mammograms until you meet the deductible.

Twenty-nine percent of workers with employer sponsored coverage are enrolled in high deductible plans with some kind of a savings account, according to Kaiser Family Foundation’s annual survey of employer sponsored benefits, up from 17 percent in 2011.  These people generally pay more out of pocket for care that those individuals in traditional plans. In a recent study by the Health Care Cost Institute that examined claims data from three major insurers for 40 million Americans, people in high deductible plans were responsible for 24 percent of their medical costs between 2010 and 2014, compared with 14 percent for people in traditional plans.

A bipartisan bill was introduced in July that would allow high deductible plans that can link to health savings accounts to cover chronic conditions like diabetes and heart disease before individuals have met their deductibles. The legislation, which has been endorsed by consumer groups and policymakers who are supporters of “value based insurance design”, encourages health plan features that urge participants to get clinically effective care by reducing or even eliminating out-of-pocket costs for these services.

Although such legislation would be attractive to plan participants, it remains to be seen if insurers buy into it. Allowing plan design that provides pre-deductible coverage for chronic conditions could certainly increase premiums. Determining which doctor visits should be eligible, for example, would be a difficult task.


With open enrollment upon us, if you have a choice of plans at work, take a look at all of them with an eye towards the best affordable coverage for you and your family.


For additional information, contact EAB HealthWorks.


Last Updated on Thursday, 29 September 2016 07:55
Will Your Prescription Drugs Be Covered Next Year? Better Check! PDF Print E-mail
Written by Ellen Breslow   
Monday, 12 September 2016 00:00
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Open enrollment is upon us. If your employer offers more than one plan and you are like a majority of others, you’ll just reenroll in the same plan. It may not be perfect, but it’s working pretty well. Not so fast. On the surface, it may look identical to what you have this year, but maybe not. And it’s worth the time to look closely at it.

CVS Caremark and Express Scripts, the biggest prescription insurers, released their 2017 lists of approved drugs last month and each has a long list of excluded medications. Some of the drugs newly excluded are prescribed to treat diabetes and hepatitis. The CVS list also excludes Proventil and Ventolin, commonly prescribed brands of asthma inhalers, while Express Scripts had dropped Orencia, a drug used to treat rheumatoid arthritis.

There are any numbers of reasons that prescription insurers are dropping drugs from their tier programs. In many cases, the cost of the drugs to the insurer is too high, and by eliminating it from the formulary, they hope to negotiate discounts from the manufacturers. In some cases, such as CVS dropping two biologic drugs—Lantus and Neupogen-- they will offer an alternative known as a biosimilar which is not the same as the brand name drug. Finally, if there is no generic alternative, the individual will have to go back to the doctor for a new prescription.

Although you may think that it is unlikely that anything on your list of medications is excluded, don’t assume. Take the time to research all prescriptions that anyone in your family takes on a regular basis. You’ll want to choose the plan that best addresses your family’s current prescription needs.



For additional information, contact EAB HealthWorks.


Last Updated on Monday, 12 September 2016 10:46
Retiree Health Insurance: I Have That, Don't I? PDF Print E-mail
Written by Ellen Breslow   
Monday, 09 May 2016 00:00
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You’ve been covered by private health insurance through your employer for years. It’s taken care of all of your medical expenses. Sure, the premiums and the deductibles have gone up, but given the state of health care in the United States you feel lucky. With retirement on the horizon, you’ll be enrolling in Medicare, which, as we know, doesn’t cover everything. No worries: there is retiree health insurance. It helps fill the gaps in Medicare and helps limit the costs you would otherwise incur for medical care.

Stop right there. The Kaiser Family Foundation has been tracking trends in employer-sponsored health coverage and has documented a significant drop in the share of large employers (200 employees) offering retiree health insurance coverage, from 66% in 1988 to 23% in 2015. Many firms that still offer retiree benefits have adopted changes in these programs. Many retiree health insurance plans are now defined contribution health plans accessible through a private health insurance exchange. Also, employers have increased premiums and cost-sharing requirements paid by retirees and their spouses. You may not have retiree health coverage at all, and if you do, it is likely different than what you have now.

This drop in employer-sponsored retiree health coverage is an important factor for retiring baby boomers who are approaching their Medicare years. Insurance needs change over time, and an increasing number of boomers are enrolling in Medicare without the additional financial security of an employer-subsidized retiree health plan. This decline in coverage will ultimately lead to a fundamental change in the way individuals fund their health care in retirement.


What should you do? First, keep up with your health insurance benefits. A large percentage of employees automatically elect the same coverage year after year. If you spend the time reviewing your employer’s health insurance benefit, you will be able to ascertain whether there is a retiree health plan, in addition to what’s currently best for you and your family. Then, review your financial plan with an eye towards health care expenses in retirement. Without an employer-sponsored health care plan, you should incorporate what may be higher health care expenses.


For additional information, contact EAB HealthWorks.


Last Updated on Monday, 09 May 2016 11:39
Note to Candidates: Health Care is More Than Obamacare PDF Print E-mail
Written by Ellen Breslow   
Wednesday, 25 May 2016 00:00
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You’ve been watching the presidential campaign, so you can’t miss the references to Obamacare. It’s a significant component of the rhetoric for all the candidates. Hillary wants to add to it, Bernie wants a “Medicare for All” program, and Trump wants to repeal it altogether. We haven’t heard much else about healthcare from the candidates.

But there’s a lot more confronting us than Obamacare. Americans are facing some critical health care issues that will impact their lives.

Consider out-of-pocket spending. Although millions more people have health insurance thanks to the Affordable Care Act, most individuals are paying more of their medical bills than ever before. Employers are also feeling the pinch of rising health care costs and are passing some of them on to employees in the form of increased premiums, deductibles and out-of-pocket costs. Often these costs are rising faster than wages. Those who are buying coverage through the ACA’s health insurance exchanges are finding that their costs associated with even the richest plans render them unaffordable.

We’ve heard the candidates talk about the price of prescription drugs. Rising drug prices are an increasingly bigger problem for patients. Drug companies tell us that the cost of drug development impacts the expense to the consumer. What happens when insurance doesn’t cover prescriptions and the out-of-pocket is too much for the individual?

And then there’s long term care. Every day, 10,000 baby boomers turn 65 and qualify for Medicare. An estimated 70 percent of those who reach age 65 will need some sort of long term care. And those of us who have had experience with long term care know it’s not cheap. Although Medicare does have some nursing home and home care benefits, they are temporary and limited to specific medical needs. Most people who need long term care need simple care with what is considered “activities of daily living”. In addition, long term care insurance is very expensive and has become more difficult to find as there are fewer insurers who underwrite it.

Lack of dental care continues to be a problem. According to the Centers for Disease Control and Prevention, one in every three adults has untreated tooth decay. The same reports says that more than 100 million Americans don’t have dental insurance. Also 38 percent of adults aged 18-64 reported no dental visits in 2014.


There is a lot on the horizon in the world of health care. It goes way beyond Obamacare.


For additional information, contact EAB HealthWorks.


Last Updated on Wednesday, 25 May 2016 09:35
A High Deductible Plan Was My Only Choice: Now What? PDF Print E-mail
Written by Ellen Breslow   
Monday, 08 February 2016 00:00
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More than three quarters of large employers are offering high deductible plans, and in increasing numbers it is the only plan. Although the premiums are often lower, the deductible can be as high as $6550 for an individual or $13,100 for a family. In order to keep out-of-pocket expenses manageable, consider the following:


Preventative services. Under the Affordable Care Act, even high-deductible plans must offer free preventative care with no copays or deductibles. Preventative care can include vaccinations, cancer and other health screenings and wellness visits. Taking advantage of these services can help you avoid paying for others that aren’t covered.

Use in-network providers. Although insurance won’t pay until the deductible is met, plans have negotiated discounts with providers and hospitals. Participants are entitled to those discounts as long as they use the providers within the network. Some health insurance plans have preferred provider networks. Discounts in preferred provider networks can be even more significant than those offered through standard in-network providers.

Be an educated consumer. High deductible plans are frequently called consumer-driven health plans. Participants who need medical services should shop not only for the best provider, but also for the best price. A variety of online comparison tools are available to help participants evaluate hospitals, providers and other services.

Pay close attention to your bills. Before playing a bill, compare it to the Explanation of Benefits (EOB) that your receive from your provider. If you find an error, call your provider and ask for the bill to be resubmitted with the appropriate codes. It will take the insurance company some time, but follow up to be sure it is processed correctly.


Contribute as much as possible to a health savings account. High deductible health plans can be tied to health savings accounts which allow contributions to be made on a tax deductible basis to help pay for unreimbursed medical expenses. Unlike traditional flexible spending accounts, there is no requirement that the funds be depleted annually so that funds can be accumulated over time. For 2016, an individual can contribute $3,350 and a family can contribute $6,750 to a health savings account. Individuals who are age 55 or older can make additional catchup contributions annually.



For additional information, contact EAB HealthWorks.


Last Updated on Monday, 08 February 2016 11:12
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