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"Is this doctor in my network?" Maybe. PDF Print E-mail
Written by Ellen Breslow   
Saturday, 21 February 2015 00:00
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It seems like the answer to this question should be a simple yes or no. It is undoubtedly one of the most frequently asked questions by individuals when reviewing their health insurance options. In truth, however, the answer is often more complicated.

Many participants take great pains to research which doctors and hospitals are considered in network providers, most often when facing a surgery or other complex procedure. Yet they still end up with huge bills. How can this happen?

Let’s say that a physician has multiple offices. Not all of the offices may be part of the network. Should a participant choose the wrong office, the procedure can be considered out-of-network. The same can be said for a doctor that is part of more than one practice.  Although the doctor may be in network in one practice, the same is not necessarily true for the same services provided in a different practice.

Even doctors within a group practice may not be part of the same network. So if a particular medical group practice is listed as in network, some physicians may have agreed to accept rates negotiated with an insurer, while others have not. Those physicians would be deemed out-of-network. When investigating physicians, network participation isn’t always transparent and requires a careful look.

A critical component of a hospital network are physician and service providers at that hospital. An in network hospital may rely on out-of-network physicians such as emergency room doctors, radiologists and anesthesiologists. Individuals cannot assume that because a hospital is in network, all of its providers are included in the same network. Sadly, many individuals don’t discover this until they receive an explanation of benefits outlining hospital costs.

Before you select a physician, dig deep. Be sure that you research every aspect of your care, especially if this includes a hospital stay. There can be less in your network than meets the untrained eye.







For additional information, contact EAB HealthWorks.


Last Updated on Saturday, 21 February 2015 10:59
Do Targeted Therapies and Personalized Medicine Work For Everyone? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 15 February 2015 00:00
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Isn’t all medicine personal? Doctor and patient, hopefully yes, but what about drug development? Does all of the prescription drug development generally benefit everyone?  Or is it specialized to meet the specific needs of segments of the population that are not being currently addressed?

A little known and small component of President Obama’s 2016 budget proposal is the $215 million Precision Medical Initiative, an ambitious plan for biomedical research for treatments tailored to the genetic makeup of individuals.

Many of the current breakthroughs stem from successful mapping of the human genome, completed in 2003. This trend has benefited from significant declines in the cost of genome sequencing. What used to cost many millions of dollars—decoding one person’s genome—can now be done for around $1000. Using the human genetic code, more scientific research is focused on specific segments of the population, whether for rare diseases or components of more common diseases. As the world become increasingly connected by mobile technologies and electronic records, storing mass amounts of data is easier and cheaper than it once was.

This in turn enables the pharmaceutical industry to develop and concentrate on new medications to focus on our most important needs.

As is the case with most prescription drug development, these specialty medications come with a high price tag. At this point, because these drugs are usually considered part of targeted therapy, they are generally covered by private insurers and Medicare as they account for a very small share of overall health care spending. Over time, however, as these targeted drugs become more prevalent in the treatment of diseases, will they still be covered by insurers?

Relative to the size of a $4 trillion budget, the Precision Medical Initiative is tiny. It does have bipartisan support. Advocates say the payoffs could be very big both for improving basic scientific knowledge and finding ways to personalize medical treatments.





For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 15 February 2015 17:34
Shopping with Your Flexible Spending Account? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 21 December 2014 00:00
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When you think of a flexible spending account, or FSA, you think of deductibles, uncovered prescription drugs and nonreimbursed medical expenses. And this being the end of the year, you probably are realizing that you may have extra funds parked in your flexible spending account. But wait! There are other expenses eligible for flexible spending that you may not have considered.

Taking a warm weather vacation soon and need sunscreen? These products are eligible for flexible spending reimbursement. With dollars parked in an FSA, you can stock up on these sun care products now.

Are you a runner or a cyclist? Even if you have a daily exercise routine, you may find that you suffer from muscle and joint pain. Managing this pain can qualify as a flexible spending expense. Knee and ankle braces, hot and cold packs and heating pads can help you reduce pain and manage your FSA dollars.

We often associate allergies with springtime, but many individuals experience allergies year-round. Over the counter allergy remedies and prescription nasal solutions are FSA eligible. Keep this in mind if you or any member of your family needs allergy remedies regularly.

Time for new glasses? Historically, participants with balances remaining in flexible spending accounts have treated themselves to new glasses. Late December is a great time to purchase new or prescription sunglasses for your next vacation.

If you’re finished with your shopping, check to see if your plan has a grace period. If so, you may have the first two and a half months of next year to use your FSA from this year. Also, your plan may have the option to rollover some of your funds from your FSA to next year. But your plan won’t have both, and maybe neither of them, so check the features carefully.

Happy Holidays!






For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 21 December 2014 16:34
Is Your Health Insurance a Luxury? PDF Print E-mail
Written by Ellen Breslow   
Monday, 12 January 2015 00:00
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How could that be? Health insurance is now mandatory. Why should health plans be subject to a luxury tax? Beginning in 2018, employers that provide high-cost benefits through an employer sponsored group health plan will be subject to an Affordable Care Act (ACA) created excise tax, also known as the “Cadillac” luxury tax on these plans.


The plan is to assess employers 40% of the cost of plans that exceed predetermined threshold amounts. For planning purposes, the threshold levels for high cost plans are $10,200 for individual coverage and $27,500 for family coverage. For pre-65 retirees and individuals in what are considered high-risk professions, the threshold levels are $11,850 for individuals and $30,950 for family coverage. Keep in mind, this tax doesn’t only apply to premiums paid by the employers, but also to tax-free employee contributions and reimbursements from flexible spending accounts for medical expenses. These amounts will most likely be adjusted in 2018, as the cost of coverage will have risen from current levels. Threshold levels are also expected to be indexed for inflation in future years.

Three years seems like a long time away to be concerned about a penalty tax. According to the Kaiser Family Foundation, last year average family premiums rose 3% to $16,834, while individuals’ remained steady at $6,025. Companies with a large percentage of high-wage workers paid more, with an average of $6,244. As a result of the inflationary increases the American Health Policy Institute estimates that in 2018, this tax will hit 17% of all American businesses and 38% of large employers. Anticipating this tax in 2018, employers are shifting more cost of these plans to employees.

Why the excise tax? The purpose of this tax is to generate new tax revenue to fund the expansion of health coverage. In fact, the Congressional Budget Office (CBO) estimates that the excise tax will result in approximately $5 billion in 2018, $10 billion in 2019, and $13 billion in 2020.  The CBO also predicts that higher taxable wages paid to employees to offset the rise in employee costs will generate an increase in income and payroll tax revenue.


The potential impact of this tax is driving employers to reassess their health care costs to see how they want to approach health care in the future. As the cost of benefits continue to rise, eventually used car benefit plans will be taxed as Cadillacs. We’ll see what 2018 brings…..





For additional information, contact EAB HealthWorks.


Last Updated on Monday, 12 January 2015 15:11
Health Savings Accounts: New Rules of the Road for You? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 14 December 2014 00:00
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More than three quarters of large employers now offer a high deductible health plan as an option for employee health insurance. For an increasing number of employers, it is the only choice.  If you are new to high deductible health plans, now is the time to familiarize yourself with a health savings account and its benefits for you.

A health savings account (HSA) allows you to pay qualified medical expenses (including the plan deductible) or save it for future expenses. HSAs offer triple savings: tax deductible contributions, tax free interest and investment earnings, and tax free distributions when used for qualified medical expenses. Unlike traditional flexible spending accounts (FSA), you are not required to use the funds each year; they can accumulate over time. You must be a participant in a high deductible plan for yourself or your family to contribute to an HSA.

In order to be considered a qualified high deductible health plan, the minimum deductibles must be at least $1300 for individual coverage and $2600 for family coverage in 2015. Maximum out-of-pocket limits for in network services are $6450 for individual coverage and $12,900 for family coverage. This coverage must be your only overall health insurance plan.

The IRS sets limits for HSAs each year. For 2015, and individual can contribute up to $3350 to an HSA; a family is eligible to make a $6650 contribution. If you are 55 or older, you can contribute an additional $1000 as a “catch-up” contribution to an HSA. There are no income limitations for contributions to HSAs. It is also possible to transfer one year’s contribution from an IRA to an HSA. HSAs are portable, and can be transferred at any time or rolled over annually. Keep in mind, however, that you cannot participate in both an HSA and a FSA. Many employers have begun making contributions to HSAs to encourage employee participation, so take a close look at your employer benefit plans to see if this is available.

HSAs operate on a calendar year. If you are a late enrollee or a new hire during the year, you can still make contributions to an HSA provided you are participating in a high deductible health plan on December 1st. You would have to remain in the plan for a “testing period”, which starts with that December and continues through thirteen months until the next December. Should you not stay in the high deductible health plan, your contributions would no longer be tax free and would also be subject to a 10% penalty tax. Other proration rules apply for plan participants who aren’t in the plan on December 1st.

HSAs are often referred to as health care IRAs. If you’re a participant in a high deductible health plan, take advantage of the opportunity to save for health care expenses both now and in retirement.








For additional information, contact EAB HealthWorks.


Last Updated on Sunday, 14 December 2014 11:00
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