Medicare Plan N will include copayments for doctor appointments as well as emergency room care. Therefore, the monthly premium will be 28% lower than Plan F, according to the Tuscon Citizen Online. Plan N is recommended for healthy individuals because of the $20 copay for doctors visits; Plan F may be the better choice for those who expect frequent doctor visits.

Those who choose Medicare supplement Plan M can split the Medicare Part A deductible with the insurance company 50/50 to lower monthly premiums. This should be around 15% lower than supplement Plan F, according to EzineArticles.

Medicare supplement Plans N and M do not cover Medicare Part B.

Carriers have been given until this date to change their plans. AARP, or UnitedHealthcare is now the first carrier to release their rates. Plan N’s premium is announced at $86.27.

In addition, Medicare plans will now offer a hospice benefit while at-home-recovery and preventive care will be removed.

From: Hispanic Business News

To view Molina Healthcare plans, visit our Molina Healthcare page.

Before you buy health insurance, it is important to make sure the company is licensed. Health Plan One assures its customers that every single company we represent is licensed to sell health insurance. When you apply through a plan through our website, please know that all your options are through legitimate health insurance companies.

The hospital tax, according to Tennnesean.com, expired in 1994, when TennCare was created. Though these cuts would save the state approximately $380 million, they would really be costing Tennessee as much as three times more in federal aid. Hospitals have estimated around $526 million in state and federal funding this year and according to Craig Becker, the president of the Tennessee Hospital Association, some state services and hospitals will disappear, which is why the new tax is being proposed.

Tennessee is not the only state facing Medicaid costs. According to the Virginian-Pilot, rising health care costs and a growth in the number of Medicaid patients have increased the government’s obligation to pay over $750 million within the past two years. New Hampshire and Wisconsin as well may see state-level Medicaid cuts, according to a post in KaiserHealthnews.org.

On Monday night I had the pleasure of attending the health care debate between congressman Jim Himes, Ned Lamont, and State Senator Dan Debicella. The participants offered up a comprehensive review of Democratic and Republican talking points that are worth a quick analysis. We’ll start with the Democratic talking points:

1. We have a moral obligation to cover all those without insurance.

I think many Americans agree with that statement. And we actually do cover all Americans today because no one can get turned away in an emergency room. A related question to ask is: why don’t these Americans have insurance? In many states, like Connecticut – and in Massachusetts prior to healthcare reform – almost half of the uninsured individuals are, in fact, eligible for Medicaid. They may not sign up because the state makes it difficult to enroll or the individual does not take the time to enroll. It seems like one prescription for our health care problem is: let’s get people enrolled in a program we have today.

The next big batch of uninsured Americans is illegal aliens. This is one of the toughest issues in healthcare reform – what do we do with the 10-15 million illegal aliens in the United States that do not have health insurance. I wish I had a prescription but unfortunately there is no easy answer on this one. The next batch of the uninsured are “risk takers.” Unfortunately, the risk takers are risking the taxpayers’ money and the money of those who are insured, not their own. If they get really sick we treat them anyway! A prescription for this problem is, in fact, a mandate. Finally, the rest of the uninsured population is people who are too sick to qualify for health insurance. Those people need financial assistance.

2. We need more competition (more insurance companies). Therefore, we need a public option.

Interesting point but completely irrelevant in Connecticut. In Connecticut’s individual insurance market we have Cigna, Aetna, Connecticare, Anthem Blue Cross, Time Assurant, Celtic, Golden Rule, and a few other no-names. Clearly, lack of competition is not a problem. So I’m not sure why Himes raised this talking point.

3. Insurance companies are bad.

Congressman Himes skewered the insurance companies; referring to their “pernicious” practices of rescinding policies after issuing them. In reality, this practice of “rescission” is rare. At Health Plan One, we have sold thousands and thousands of policies and have never had one client’s policy rescinded. Rescission occurs in the event of fraud perpetrated on the insurance company and its policyholders. For example, if an insurance applicant has cancer and intentionally misrepresents his/her condition, an insurance company may face hundreds of thousands of dollars of liability and has one of two choices: rescind the policy, due to fraud or take those losses and charge all their honest customers. Pretty easy choice for the policyholders and insurance company. Not sure who Mr. Himes thinks should pay for insurance fraud?

4. Medicare represents a $40 trillion unfunded liability.

Wow! Kudos to Congressman Himes for bringing this up. He got off the talkpoint memo. The insolvency of Medicare and $40 trillion unfunded liability is our ultimate problem and everything else we’re doing is working on the margins. Unfortunately, after announcing this financial bomb, the Congressman had no solutions other than to cut Medicare Advantage which is a cut to seniors’ benefits, but sounds like cuts to the insurers which is more politically palatable. He offers no clear solutions for a big problem.

5. Eliminate preexisting conditions.

Good idea. Who’s going to pay for it? You can’t have a functioning insurance market with no preexisting conditions unless you mandate that everyone gets in the insurance pool. For proof, go to the New York insurance department where they implemented no pre-existing conditions. Every insurer in the state has moved out and prices are 10 times what they are in Connecticut or Pennsylvania. The weak $750 mandate will not be sufficient to obligate people to buy health insurance.

Republican talking points:

Senator Debicella started out strong with the salient point that escalating costs are the key problem. Then, on to Republican talk points:

1. Tort Reform

The cornerstone of any Republican plan is tort reform. Certainly a good idea and should be part of any plan. Reduce physician costs and mitigate wasteful defensive medicine.

2. Electronic medical records (also a Democratic talking point)

EMRs are a good idea and cost a lot of money, but they might save a lot of money in the future.

3. Buying insurance across state lines.

Great idea if you live in NY, RI, VT, and a whole bunch of states that have blown up their individual insurance market. You have to fire a lot of state regulators, though, so Dems hate this idea.

4. Introducing high deductible plans.

This is a great point. Higher deductible plans have lower premiums and introduce the concept of cost-sharing to the consumer. For example, at Health Plan One, we carry many high quality, high deductible plans that are great options, especially for younger consumers who are healthy. Reducing health care costs must include patient cost-sharing and innovation on health benefit designs. Current congressional bills prohibit this.

5. Wellness (also a Democratic talk point)

Who could argue with wellness? Wellness is a great idea but you’ve got to have a plan to implement it. Close McDonald’s?

Prospective governor talk points:

Mr. Lamont made it very clear he will run for governor. He pointed out that Connecticut has not created a lot of jobs over the last 20 years and believes that the high cost of health care is part of the problem. We’ve heard a lot about the problems which were largely accurate but the prescription is unclear.

A fun event but, unfortunately, Congressman Himes could not adequately defend the House or Senate health care bills that he wants to pass.

Score one for Debicella – start again!

In Utah, Republican leaders are looking to develop their own plan for health care reform – part of it urging Obama to allow with the right to create such a plan at the state level.

Medicaid is an out of control program that is bankrupting state and federal governments. The befits are similar to those of private insurance, but for free. The program will not allow copayments to change behavior, but without them, the systems are falling apart. Here in Connecticut, if you take a ride down to Bridgeport of Yale New Haven hospitals on a Friday afternoon and check out the ER you will see how jammed it is. Services for a majority of these people will be performed without so much as a copay. Even a copay of $5 could make a significant difference to the program. As head of Health Net Medicaid, I was sued regularly for trying to implement such ideas, but if something doesn’t change, these programs will continue to go bankrupt.

Connecticut’s strict Certificate of Need (CON) laws prevent new competition from entering the market. CON approval, regardless of cost, is required for anyone acquiring, purchasing, or accepting donation of a CT scanner, PET scanner, PET/CT scanner, or similar new technology equipment (see more about the Certificate of Need Process from the department of insurance). The CON board is controlled by the hospitals, making it even more impossible for new competition to enter the market.

This market power of the hospital oligopolies is one reason why the public option is so dangerous to private insurers. A public option would reduce unit costs below private insurers and quickly put them out of business, removing competition altogether.

If the mandate doesn’t pass, there is no way the pricing structure of the bill will work. If age-rated pricing is removed, it will become more and more necessary to include healthy, young people in the risk pool-exactly the people who do not “need” insurance. The only way to ensure the inclusion of this population is to mandate the purchase of health insurance. The two ideas are in direct conflict.  The bill cannot be passed with its current foundation.

What happened? People seeking health insurance want a competitively priced product that fairly reflects the cost of insuring against a future medical illness or injury. When you ask a ten year old healthy boy to pay into a pool that reflects the cost of much older (and more expensive) people, that might also be smokers with illnesses, the boy will conclude that the price is too high, and he may forego insurance. When a young healthy person opts out of the pool, prices go up for everyone and it begins a cycle of “adverse selection” where only the people that are in fact ill will purchase the insurance.

Congress has proposed a $750 penalty for people not purchasing health insurance. The likely effect is for people to self insure for routine services, and pay the annual penalty. If in fact they have a major illness, they can then go buy health “insurance” which will no longer exclude pre-exiting conditions.

Interestingly, these pricing rules do work in the employer, or group marketplace. This is due to the employer subsidy which is typically 50-80% of the cost of an individual health policy. The employee cost is then usually viewed as fair by the employee, regardless of age or health status.

Congress has, in fact, created a catastrophic plan. It costs $750 dollars a year and all preexisting conditions will be waved.

We have run this experiment before. 20 years ago, New York State had an enormous individual marketplace and in 1993, “reform” of the individual marketplace, in an effort to bring “fairness” to pricing, completely tanked the individual market. New York State prohibited pricing based on age, gender, health status, and smoking, and only allowed for pricing based on geography. Almost every insurer exited the marketplace and the price for individual policies increased astronomically. An individual policy in New York City for a 10 year old boy is over $1,000 a month. In Connecticut, a similar policy would cost less than $100 a month. We’ve tried to standardize pricing across various ages and health statuses before. We should avoid rolling out a failed experiment to the entire country.

We have seen situations where age-banding works. Take group or employer health plans. These plans are age-rated, but those covered under an employer plan are typically happier with their premiums than those covered under an individual policy. Why is this? Since these plans are subsidized 50-80% by the company, the policy holder ends up paying only 20-50% of the actual premium.

The original premise of health care reform was to reduce the spiraling costs of health care and reduce the number of uninsured. Unfortunately the senate bill does nothing to address cost increases, but instead accelerates the insolvency of Medicare and Medicaid, while creating a massive regulatory and tax behemoth that no senator fully understands nor can explain to his constituency.

If Senator Dodd loses his upcoming reelection it will not be because he was the Senate Banking Chairman during the catastrophic Wall Street and banking failure. Or for his sweetheart mortgages obtained from Countrywide mortgage. Or for his stonewalling on his ten acre Ireland “cottage.” Dodd will lose because he cannot coherently explain the $871 billion health care bill that he called the “most important” of his senate career.

The change will extend the nine month, 65 percent premium subsidy by six months, therefore applying to those involuntarily terminated up until February 28, 2010. The legislation also provides another six months of coverage at the subsidized premium rate for those whose nine month subsidy has already run out, for a total of 15 months of premium subsidy.

Those whose subsidy expired in the past and did not pay the full COBRA premium would not be able to receive retroactive coverage. Employers are required to notify current and future COBRA eligible employees of the new premium subsidy extension.

Health insurance companies are in the business of, in fact, issuing “insurance” policies. Insurance means that a company will assess a person’s risk and then set a price of insurance, commensurate with that risk. To the extent that insurance companies do a poor job at assessing risk, they will not be in business very long, as claims will quickly outrun premiums. In fact, the average insurance company posts 3% of premiums in after tax profits and therefore does not leave a large margin for error.

Insurance companies typically do not want to insure chronic diseases such as diabetes. They also do not want to insure undiagnosed conditions or imminent surgeries. So, for example, if someone has hurt their knee and needs a $5,000 operation, an insurance company will not offer a $200 policy so that person can pay for his or her $5,000 operation. What they will do is say they will not insure that knee but will insure the rest of that person’s health needs, or they will say get if that person gets his or her knee fixed, then 6 months later he or she will be eligible for health insurance. Health insurance companies do not want open ended risks that they cannot assess.

So, how should someone seeking health insurance with a medical condition proceed to purchase health insurance? First question is do you qualify today for individual insurance? At Health Plan One, we can quickly review your health status and tell you what company would potentially offer you health insurance. Or we may tell you that you should review alternatives. Depending on your state and situation, alternatives may include a COBRA plan, a sole proprietor plan, or a HIPAA plan. Certain states like MI, NY, NJ, MA, and others have guaranteed issue plans: they may be a bit more expense but anyone can qualify for these plans. In other states, like CT and NH there are high risk pools, or plans that although expensive but anyone can qualify for.

Again, the ability for health insurance companies to accept all comers regardless of health status requires that everyone participates in the pool. It also requires that health insurance companies are allowed to allocate costs commensurate with risk. For example, age is a big determinant of your health risk: a 5 year old child typically requires much less care than a 60 year old male. Insurance companies will charge that older male 4 to 5 times the premium of the younger male. This may seem unfair to the 60 year old, but it seems awfully fair to the child. Unfortunately, the insurance market needs to allocate prices according to risk profile or it won’t work. Take NY, for example where age rating is not allowed and regardless of age you pay the same price. A PPO policy costs $1,500 dollars per month. This happens because everyone pays the same rate regardless of age. The younger people will ultimately opt out of the insurance pool, viewing it as unfair and too expensive. If the 18 year old opts out because it’s too expensive, then it gets a little bit higher for everyone, and ultimately, the price will reflect a 64 year old male and almost everybody will opt out of the insurance pool.

So how do we deal best with an insurance market that demands we allocate risk appropriately? High risk pools are an excellent way. People buy insurance to guard against future risk not current risk, so you can take the really high risk people and put them in a high risk pool and protect healthy people in an insurance market that reflects the actual cost of insuring against a future event you will have a highly functioning insurance market. Taxes or some other mechanism must be issued to subsidized to the high risk pool, although if everyone has insurance, over time the need for that high risk pool will diminish.

H.R. 3326 states that the 65% premium subsidy would be extended six extra months and apply to anyone facing involuntary employment termination through February 28, 2010. There is also language regarding retroactive premium payments: an additional six months of subsidized coverage would be provided for anyone whose nine month subsidy has run out.

It is expected that the House will take up another bill that would extend the subsidy to those who lose their jobs through June 30, 2010. We will keep you updated.

The United States Department of Labor has just announced changes for the COBRA subsidy. In order for an individual to be eligible for the subsidy, two events must have occurred on or before December 31, 2009: 1) Involuntary job termination and 2) becoming eligible for COBRA.

An involuntarily terminated employee will not be eligible for the COBRA subsidy, if his or her coverage runs through December 31, 2009. Even if an employee loses his or her job before December 31, if his or her coverage lasts until the end of the month, he or she will not be eligible for COBRA coverage until January 1, 2010.

The Department of Labor has put out Question and Answers on their website which you can find at http://www.dol.gov.ebsa/COBRA.html.

For more information about the original components of the subsidy visit Health Plan One’s COBRA page.

What to do if your COBRA subsidy is ending:

As the subsidy lasts only nine months, it is now ending for many beneficiaries.  If you are a COBRA subsidy recipient, you may not receive notification that your subsidy is ending-you will simply see a huge difference in your next COBRA bill. Refusal to pay this will immediately end coverage. It is important that you do not have a lapse in coverage because health insurance carriers may use this as a reason to deny future coverage for preexisting conditions.

As recommended in the New York Times your best bet is to check for all your options. You can view pricing information from carriers in your area by entering your zip code in our zip code box which will take you to view available individual plans. As always, you can discuss your options with our licensed health insurance specialists, who can recommend what the best plan would be for you.