Health insurance Articles
Medicare Prescription Drug Coverage
- ... can enroll in a Medicare Advantage plan that offers drug coverage. The stand-alone plans are sold by many private insurers. [The CMS web site [ww...
Financing Social Security and Medicare
- ... both employers and employees. Selfemployed individuals pay double these rates and, of course, it is worth noting that employees effectively pay ...
Latest "Health insurance" Articles
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Tips for choosing the best medical health insurance in Virginia
(...) If it's a managed health care insurance option, all your needs should be met inside the network of providers and hospitals.
Though purchasing of any medical health insurance policy depends straight to the medical care coverage needs of the consumer and also the budget he/she really wants to spare, yet, there are specific tips or tricks that should help the customer to make your decision. Medical health insurance isn't a sundry product that you should purchase with no attention. (...)
Should experimental or unproven medical care be covered by insurance
Then, when they have drawn their own clearly finance-based personal line in the sand, they sometimes publicly say that the payer who doesn't choose to write the check to them, for "experimental" care is actually the party in the situation who is "making an economic decision" about the life of a patient.
Interesting thought process. In many cases, of course, the recommended procedure involves teams of people and the whole funding stream is a lot more complicated than that. (...)
New drugs and technology increase health care costs
(...) These new developments and new approaches create both new care results and new care costs. Those "new care" costs are being introduced every year in addition to - and on top of - the normal inflation rates for current and existing patterns of treatment and approaches to care.
When new treatments, devices, or pharmaceuticals replace old drugs or devices, the new version typically both does more and costs a lot more. (...)
Statutes against discrimination in health insurance and Medigap coverage
(...) Inpatient care for medical observation, evaluation, or other care that could be provided on an outpatient basis will not be considered medically necessary.
Other phrases commonly used in the insuring agreements of health insurance policies to express the same concepts are reasonable and necessary expenses and usual and customary expenses. Regardless of the phraseology used, because these terms appear in insuring agreements, they are subject to the general rule that an interpretation that results in coverage is to be favored over one that does not. (...)
Medicare provides same benefits to all Social Security contributors
(...) One explanation involves the altruistic desire to help the elderly. There were (and still are) many poor elderly whose needs for medical care exceed those of the rest of the population.
Viewing Medicare as a charitable redistribution program does not satisfactorily answer certain questions, however. (...)
Health insurance for the elderly and the working middle class
(...) Low-income aged must rely on Medicaid for their long-term-care needs. Middle- and high-income aged do not want to spend down their assets to qualify for Medicaid if they incur large long-term-care expenses. Rather than purchase asset protection (long-term-care insurance) through the private market, middle- and high-income aged would prefer government long-term-care insurance so that their cost can be shifted to others. (...)
What are the prospects for national health insurance or universal coverage
(...) Health insurance companies and HMOs are simply required to provide them. The public is pleased by seemingly receiving something for nothing. Although the costs of these regulations are apparently borne by the insurers and HMOs, in reality those (diffuse) costs are shifted toward purchasers in the form of higher health insurance premiums. (...)
Looking at alternative ways to pay for health care
(...) Health insurance is particularly subject to the problem of "moral hazard": once a person is insured, that person is more likely to define a problem as an illness and is more likely to seek care.
These factors make it difficult to predict health care expenditures for a population group. As a result, many traditional insurance companies shied away from insuring for health care. (...)
Medicare services providers and physician capitation
(...) In most cases, the payments were higher than HMOs' actual costs, leading them to provide many optional (that is, nonstatutory) benefits for little or no out-of-pocket premium. Because HMOs were not permitted to give the overpayments to enrollees in the form of premium rebates, some of the additional benefits were inefficient, in the sense that beneficiaries would not have been willing to pay as much as the benefits actually cost.
A second problem was that the FFS system, with its open-ended expenditures, was protected from competition with the capitated plans. (...)
Indemnity payments and marginal costs for Medicare patients
(...) The difference between USD 10,000 and USD 2,000 represents avoidable expenses. Unfortunately, neither the measures of central tendency nor the measure of risk in reported medical expenditure data distinguish between avoidable and unavoidable expenses. Therefore, reported medical expenditure data will overestimate the actual risk to which patients are exposed, but the size of that overestimate is unknown. (...)
Medical Savings Accounts and Flexible Spending Accounts
(...) There is no requirement that a high-deductible health plan be offered; indeed, an employer need not offer any health insurance plan to still offer an FSA. However, FSAs are only available through an employer. An FSA is a tax-sheltered account held by an employer. (...)
Reforms in the Small Group Health Insurance Market
(...) In 1989, only one state had enacted a barebones exemption; by 1995, 43 states had done so [Jensen and Morrisey 1999b]. The argument was that this provision would make health insurance more affordable for small businesses and encourage them to begin or continue to offer coverage.
The second category of small-group reforms premium regulations either established rating bands or limited the use of certain underwriting provisions. (...)
The Medicare health insurance program
This article has a twofold purpose. The first is to simply describe Medicare a large and important program. Approximately 93% of Medicare's elderly beneficiaries have some form of health insurance coverage in addition to traditional Medicare. (...)
Medicare Hospital Insurance Coverage plan A
(...) Some under-age-65 individuals can be eligible for Medicare hospital health insurance coverage due to disability or inclusion in the end-stage renal dialysis program. At the close of 2005, there were 42 million Part A Medicare beneficiaries [Boards of Trustees 2006].
Medicare Part A covers hospital, skilled nursing home, home health, and a handful of other largely inpatient benefits. (...)
Medicare Coverage under Supplemental Part B
(...) In addition, those with incomes below 135 % of the federal poverty line and with limited assets are eligible for further subsidies that cover some or all of the premium.
As a result of the Medicare Modernization Act, beginning in 2007, higher-income beneficiaries were charged higher premiums. At the end of a three-year transition period, those with higher incomes will pay 35, 50, 65, or 80% of the full cost of Part B, depending on their income. (...)
Medicare Prescription Drug Coverage
The total cost of Part D coverage and the beneficiary's premium depends on the plan chosen. In 2006, the national average premium was expected to be about $32.20 per month [Boards of Trustees 2006]. (...)
Financing Social Security and Medicare
(...) However, the remaining increases and the increases in the tax rates are the result of expansions in the generosity of the programs, the growth of the elderly population, the decline in the working-age population and, for the HI trust fund, increases in the costs of medical care. Second, note that in 1991 the tax base for the Medicare HI trust fund was de-coupled from the tax base for the Social Security trust funds and became unlimited in 1994.
In contrast, the Medicare SMI trust fund is financed with both beneficiary-paid premiums and general tax revenues. (...)
Competition between Medigap and Medicare Advantage
(...) 8% of those with PPO coverage chose PPO coverage on retirement, and 47.5% of those with traditional coverage chose to continue with traditional coverage. These transitions suggest that future retirees with even greater experience with managed care plans may be amenable to Medicare Advantage type plans, just as those with employer-sponsored retiree coverage are disproportionately likely to remain in managed care plans. (...)
Health Insurance firm Medicaid Managed Care
(...) The plans also maintain relatively broad service offerings.
Second, while commercial plans have moved away from utilization management, Medicaid managed care plans have not. Part of this reflects an inability to use anything other than nominal copays to limit moral hazard [see Box 23-2]. (...)
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