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New Resource for Health Care Information: Yelp? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 09 August 2015 00:00
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Doesn’t Yelp review restaurants and hotels? Is that where you would also look for information about hospitals and nursing homes?

Yes! Yelp, in partnership with New York’s ProPublica, a nonprofit news organization is now offering reviews updated quarterly for hospitals, nursing homes and dialysis centers. ProPublica compiles information from its own research and from the Center for Medicare and Medicaid Services. The data is for 4,600 hospitals, 15,000 nursing homes, and 6,300 dialysis clinics. ProPublica also chooses the metrics and the best way to explain the information on Yelp.

For hospitals, information compares the data to the state average. For example, the quality of a doctor’s communication, emergency room waiting time, and whether the rooms are quiet at night are compared to the state averages of these and other hospital components.

Nursing homes data includes the number of beds in addition to the fines assessed during the last three years.  Serious deficiencies identified will also be included.

Dialysis clinic information incorporates the number of dialysis stations and compares the hospital readmission rate and rate of patient survival to a standard number.Will people choose Yelp when comparing health care data? We’ll see. Open enrollment and Medicare enrollment are just around the corner for many people. Much of the hospital information is available on Medicare’s Hospital Compare web page. But information is often hard to find on Medicare.gov, so the addition of Yelp as a resource should enhance an individual’s ability to select the best option in these areas of the health care world.




For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 09 August 2015 16:44
Is Flexible Spending Really Flexible? PDF Print E-mail
Written by Ellen Breslow   
Monday, 20 July 2015 00:00
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Most likely it is more flexible than you think.  Health care flexible spending accounts (FSA) have been around for many years. Through pre-tax dollars, individuals are able to fund these accounts and use these funds to pay qualified medical expenses. Qualified medical expenses are most often used to reimburse deductibles, copayments, and coinsurance for an employee’s health plan. Over-the-counter medical devices such as bandages, crutches and eye glass repair kits are also allowable. Participation in a health care FSA does not prohibit an employee from participating in another type of FSA (i.e. dependent care), however, funds may not be transferred from one FSA to another FSA.

You may have been contributing to an FSA for years, and the concern with FSAs has been that you never know how much you will need to reimburse these out-of-pocket expenses. And in past years, with fewer expenses than you anticipated, you possibly forfeited money in your FSA. For that reason, many people have sworn off FSA participation.

With open enrollment just around the corner, if you haven’t been participating in your company’s
FSA, take another look this year. The ACA made changes to FSAs in 2014 which have been implemented by most employers, so it’s worth your while to revisit participation in the plan. Perhaps the most important change to the FSA is the carryover provision. Whereas in the past your contributions to the plan would be forfeited if not used for reimbursement of expenses accumulated during a calendar year, the ACA established a provision permitting individuals to carryover $500 from one year into the next year. Therefore, if you don’t deplete your FSA, up to $500 can be carried over to the next year.

While the maximum allowable contribution to a health care FSA has been reduced to $2550 in 2015 by the ACA, there will most likely be an adjustment for 2016. In any event, reimbursing out-of-pocket expenses with pre-tax dollars is certainly attractive.




For additional information, contact EAB HealthWorks.


Last Updated on Monday, 20 July 2015 12:33
Your Health Care Surprises: Out-of-Network? PDF Print E-mail
Written by Ellen Breslow   
Wednesday, 24 June 2015 00:00
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You were so careful during open enrollment. You checked your doctors, prescriptions and everything else you and your family needed. Yet, seemingly out of nowhere, an out-of-network charge appears. How can that happen?

Networks are narrow and getting narrower. If you or a family member see a primary care physician in the office which you have verified is in-network, you will have seen an in-network physician. But if any ancillary services are required during the visit, then the outcome of those services may be different. For example, say your physician’s office draws blood during the visit. Which lab does the practice use? Do they use more than one lab? The lab may be out-of-network. Should this be the case, you may want to have the physician write a prescription for blood work to be done at an in-network lab.

For the most part, colonoscopies are considered a preventative service, and are covered by health insurance. If you’ve selected an in-network provider, then you should be fine, right? You’ve verified that the facility where the procedure will take place is in-network and your doctor has indicated that this is a preventative screening. But what about the anethesiologist? Depending upon the facility, this doctor may not be in-network, and that is often the case with non-resident hospital facilities.


The bottom line is that regardless of what you believe to be in-network, follow up must be done on an ongoing basis. Physician networks change regularly, and those physicians in multiple practices may not be in-network in all of the practices. It is also not unusual for a doctor to use an out-of-network lab for blood work. Assume nothing. Whether it be a procedure or a routine office visit, ask before anything is done to avoid surprises.




For additional information, contact EAB HealthWorks.


Last Updated on Wednesday, 24 June 2015 11:35
"Established by the State": The SCOTUS has spoken. PDF Print E-mail
Written by Ellen Breslow   
Thursday, 25 June 2015 00:00
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The King vs Burwell decision has been long awaited. In a 6-3 overwhelming victory for the Affordable Care Act and the Obama administration, the Supreme Court has found for the continued availability of subsidies through the federal government’s health insurance exchange.

David King and a group of plaintiffs from Virginia had hoped that the Supreme Court would review the phrase “established by the state” and determine that the subsidies only be available where an individual’s state had established a health insurance exchange. These subsidies, in most cases, reduce the cost of the insurance so that it is less than 8% of household income. The ACA’s individual mandate provision states that, if health insurance coverage is less than 8% of income, then it is qualified coverage for the mandate. The King vs Burwell case said that if these subsidies were illegal in healthcare.gov, individuals whose premiums were more than 8% of income could qualify for an exemption to the individual mandate.

Although Delaware, Pennsylvania and Arkansas have submitted plans for their own state exchanges, they won’t be required for individuals to go on receiving subsidies. Obamacare won its second SCOTUS victory.


Bottom line: the ACA is unchanged for now. The individual mandate remains intact; some will qualify for federal subsidies, some won’t, but their state of residence won’t be a factor.


For additional information, contact EAB HealthWorks.


Last Updated on Thursday, 25 June 2015 11:57
When I'm 64...... PDF Print E-mail
Written by Ellen Breslow   
Monday, 15 June 2015 00:00
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A favorite of so many baby boomers. Sargent Pepper’s Lonely Hearts Club Band and the song “When I’m 64”. As baby boomers reach age 64, “When I’m 64” has a new health care meaning: Applying for Medicare.

But if you’re not yet age 65, why do you have to think about applying for Medicare?  What’s the hurry? You’re feeling good, you’re 64, you have post- retirement health insurance.

Not exactly. Not applying for Medicare on a timely basis can impact your premiums for years to come. How does that work and what are the deadlines with which you need to be concerned? Suppose you’re still working and are covered by your employer’s plan? Should you get a notice from Medicare? Lots of questions…

First, and maybe foremost, you won’t get a notice that it’s time to enroll, unless you began receiving social security prior to age 65. So, it’s important to understand your Initial Enrollment Period (IEP) and what circumstances allow for a Special Enrollment Period (SEP). Part B is the trickiest and missing a deadline can have the most significant impact in the future.  Here’s a quick look at what you can do when you’re 64.

For most individuals, the IEP begins three months prior to your 65th birthday, includes the month of your 65th birthday and extends three months past your 65th birthday for a seven month total IEP. To avoid late penalties, sign up for Parts A and B if you are covered by an individual plan (nonemployer), post-retirement health benefit, COBRA, or if you are working and your employer has fewer than 20 employees. For most people, Part A is premium free; it is the Part B premiums (and perhaps Part D) that have late enrollment penalties.

What is also critical to note is that under the above circumstances, Medicare is considered the primary coverage. Other types of health insurance will only pay AFTER Medicare, so that missing your IEP can result in your becoming uninsured.

Can you qualify for a Special Enrollment Period? If you’re still working for an employer with more than 20 employees and are covered by an employer sponsored health plan, or you are covered by a spouse’s health insurance plan, you will be entitled to a SEP. The SEP allows you to enroll in Medicare eight months (including the month you retire) after your retirement. Coordinating effective dates is of utmost importance so you don’t find yourself without coverage.

This is just the beginning of Medicare. When you’re 64, you’ll be faced with these and other health insurance decisions. Don’t wait until you’re 65.






For additional information, contact EAB HealthWorks.


Last Updated on Monday, 15 June 2015 09:30
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