Insurer unveils advance peek at doctors' bills

Ever wonder how much your insurer pays your doctor for the services you receive? If your insurer is Aetna Inc., now you can find out.

South Florida is one of a dozen markets in the United States where Aetna began this week allowing members to have access to pricing information before they go to a doctor's office. Previously, they learned what the insurer paid only when they received an explanation of benefits report weeks after treatment.

The information helps consumers doctor shop because rates can vary. For example, Aetna pays West Palm Beach orthopedic surgeon Pierre Girars $1,713 for a hip replacement. But it pays another West Palm Beach orthopedic surgeon, Milan DiGiulio, $1,456 for the same procedure. Doctors get paid differently because they negotiate with insurers separately.

Although most large U.S. health insurers disclose some cost and quality data on hospitals and doctors, Aetna is the first to provide the doctor-specific pricing information to its members via the company's password-protected Web site (Aetnanavigator.com). Insurers have closely guarded payment data in the past, citing competitive pressures. Aetna is the nation's second-largest health insurer with more than 15 million members.

Aetna expects the pricing information to be most useful to the small but growing number of customers who have health savings accounts tied to a high-deductible insurance plan that require consumers to pay for most of their routine care out-of-pocket. The decision to release the data is part of Aetna's larger effort to make consumers better health-care shoppers.
But the company said even those customers in its traditional HMOs or PPOs will benefit because it will help them appreciate the true cost of their health care.

"Some people still think the cost of their health care is their $10 or $15 co-payment," Dr. Charles Cutler, Aetna's national medical director, said Tuesday. "This will help raise the level of awareness about the difference in costs and support the whole consumerism approach where people make decisions about health care the same way they act in other domains."
Aetna's member Web site also discloses whether the doctors met certain Aetna quality and efficiency standards, but it provides no specifics.

During the past decade, the federal government, most states and private health insurers have been giving consumers a growing amount of cost and quality data to compare doctors and hospitals. But some health analysts and doctors question whether consumers even look at it.
"I think its totally meaningless," Dr. Steven Rosenberg said of the Aetna data. He said patients will continue to select doctors based on proximity to where they live and recommendations from family and friends.

Aetna pays Rosenberg, a West Palm Beach dermatologist, $80.79 for a skin biopsy and $29.37 for each additional biopsy. Prices may vary because some doctors use nurse practitioners and physician assistants, which can keep their costs lower because they allow their practices to see more patients, Rosenberg said.

Doctors across the region will be interested in looking at the pricing data so they can see whether they are getting a fair deal. "We all want to know who is getting paid for what to make sure we are not being underpaid compared to other doctors," Rosenberg said.

Dianne Howard, risk management director for the Palm Beach County School District, applauds Aetna's effort to give consumers more data to make decisions. "This is part of the whole transparency movement in health care," she said.

Most school district employees get their health benefits through United Healthcare. Nonetheless, the data showing what doctors get paid would be enlightening to employees used to paying a small co-payment for their care, she said.

Aetna tested its new doctor-pricing data in Cincinnati last year. In that market, about 1,000 consumers each month looked at the database, Aetna officials said. In addition to South Florida, the program is being rolled out in other markets, including Ohio, Connecticut and the Washington, D.C., area.

Some health analysts predict that, in a few years, most consumers will be getting their health insurance through health savings account/high deductible plans and they'll want to shop for health care the same way they do for a new car. "Employers will demand to have this type of information for their workers," said a Palm Beach-based insurance broker. He predicts other insurers will release similar data. "You can't negotiate if you don't know what the price is."

Learn About Fake, Counterfeit Drugs

More than six million consumers have logged on to BuySafeDrugs.info over the last year to learn about the risks associated with fake and counterfeit medicines. The Web site, sponsored by the Pharmaceutical Research Manufacturers of America (PhRMA), was launched June 21, 2005, and is the first online clearinghouse of information on the potential dangers of buying medicines outside of the secure U.S. drug delivery system.

"When we launched the site, our goal was to educate and inform patients about the growing problem of fake, substandard and counterfeit drugs imported into the United States. Since then, BuySafeDrugs.info and the number of people visiting it have grown tremendously. This demonstrates the need to provide patients with reliable information on how to identify potential problems so they are armed to make smart decisions about where to get their medicines," said Ken Johnson, senior vice president of PhRMA.

In the year since the Web site's launch, numerous federal and international authorities have weighed in on the dangers of illegal importation and counterfeiting, including the Food and Drug Administration (FDA), Drug Enforcement Agency (DEA) and the World Health Organization (WHO). In December, an FDA operation found that nearly half of the imported drugs they intercepted from four selected countries were shipped to fill orders that consumers believed they were placing with "Canadian" pharmacies. A number of these products were found to be counterfeit. On June 4, NBC News's "Dateline," aired a stunning expose into the growing international problem of counterfeit prescription drugs.

The Center for Medicines in the Public Interest predicts that counterfeit drug sales will reach $75 billion globally in 2010, an increase of more than 90 percent from last year. According to WHO, the consequences of accidentally taking counterfeit medicines can be serious, leading to therapeutic failure or drug resistance, and in some cases, even death.

"When people can't afford their prescriptions, they should not be directed to foreign countries where unsafe and counterfeit drugs have been found," said Johnson. "This site not only educates consumers about the potential dangers associated with imported medicines, but also puts them in touch with resources that can help them safely save on their prescription drugs."

More than 475 assistance programs are available now to help through the Partnership for Prescription Assistance (http://www.pparx.org or 1-888-4PPA- NOW). To date, the PPA has matched nearly 2.5 million patients to programs that can provide free or nearly free medications.

The new Medicare prescription drug program is also offering a safe, legal alternative to beneficiaries looking to save on their medicines. A recent AARP study found many seniors will save more through Medicare's new drug program than through illegal importation schemes. The typical senior who previously lacked drug coverage will save $1,100 annually on their prescription drugs through the new Medicare plan, according to this study.

The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country's leading pharmaceutical research and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. PhRMA companies are leading the way in the search for new cures. PhRMA members alone invested an estimated $39.4 billion in 2005 in discovering and developing new medicines. Industry- wide research and investment reached a record $51.3 billion in 2005.

For information on the danger of imported drugs, visit: http://www.buysafedrugs.info

PhRMA Internet Address: http://www.phrma.org

For information on how innovative medicines save lives, visit: http://www.innovation.org

For information on the Partnership for Prescription Assistance, visit: http://www.pparx.org

Ten tips: If disability strikes, be ready

Most working adults in the United States would not be capable of paying their bills for very long if they became disabled and lost their ability to earn a living. It's important to know what kinds of financial assistance might - repeat, might - kick in if something bad were to happen during your working years.

1. KNOW YOUR COMPANY'S SICK LEAVE POLICY. How much sick leave do you have at full pay? Can you accumulate sick leave over time? Do so if possible, and also find out whether your employer provides short-term disability insurance, which usually lasts 26 weeks.

2. UNDERSTAND HOW WORKERS' COMPENSATION WORKS. The only way you can be eligible is if your disability is caused by an accident on the job. Workers' comp provides medical benefits and cash, typically two-thirds of your average weekly wage.

3. INVESTIGATE SOCIAL SECURITY DISABILITY INSURANCE. To get this coverage, you have to prove that your disability is so serious that you won't be able to work for at least a year, and also show that you've worked long enough and paid enough Social Security taxes. Two-thirds of first-time applicants get denied. (You can appeal the decision.)

4. ASK ABOUT LONG-TERM GROUP DISABILITY COVERAGE. Your employer may or may not provide this coverage. About 40 percent of workers at medium-sized and large firms have group disability coverage, meaning many employees do not.

5. FIND OUT WHAT YOUR GROUP COVERAGE COVERS. If you have it, this insurance typically provides 60 percent of your former income, maxing out at $5,000 a month; some plans limit the benefit to $3,000 a month. You may have to work at the company for several years before qualifying.

6. GET A CLEAR DEFINITION OF "INCOME.' If you'll be getting 60 percent of your former income, clarify whether that income includes overtime, bonuses, commissions or pretax contributions to a 401(k) plan. (Warning: It might not.) Also, brace yourself for a big tax wallop. You'll owe income taxes on any disability coverage bought by your employer.

7. SUPPLEMENT GROUP COVERAGE WITH INDIVIDUAL COVERAGE. If you buy additional coverage on your own, you can take it with you when you change jobs, and it will be tax-free. Comprehensive coverage can be costly, although you can find accident-only disability policies for $25 a month.

8. OR YOU CAN BUY EXTRA GROUP COVERAGE. Group coverage always costs less than individual coverage, so you could buy additional insurance through your employer to save money. The amount you buy would be tax-free, but you wouldn't be able to keep the coverage if you switch jobs.

9. REDUCE YOUR PREMIUMS. If you're paying for individual or extra group coverage and your insurer knows you have a condition such as diabetes or heart disease, you may be able to lower your premiums by documenting any health improvements. Be sure to let your insurer know if you lose weight, quit smoking or commit to a regular exercise routine.

10. BE PREPARED FOR STAGGERED HELP. Even if you qualify for all of the above-mentioned benefits, you can't tap them at the same time to increase the amount of money you have coming in each month. Workers' comp usually activates first, followed by Social Security disability, then group disability.

Sources: Kiplinger's Personal Finance magazine (www.kiplinger.com) Life and Health Insurance Foundation for Education (www.life-line.org) Florida Division of Workers' Compensation (www.fldfs.com/WC/) Social Security Administration (www.ssa.gov/disability/)

Insurers Expanding Public Access to Medical Cost Information

Shopping for information about the cost and quality of medical care is becoming easier for patients as health insurers compete to become more consumer-friendly.

Insurers are coming up with new ways to provide price and service information to customers who are being called on to take more responsibility for their health insurance.

Aetna Inc. announced last week that as of Aug. 18, it will provide online access to physician costs, clinical quality and efficiency information in Connecticut, six other states and Washington, D.C. Price information will be available in four other states.

The information will be available to all Aetna members. But the new information will be particularly useful to consumers with high-deductible health plans tied to health savings accounts or health reimbursement arrangements.

"While purchasing health care is a much different decision than buying a house or a car, we firmly believe that consumers should ultimately have access to exactly what they're demanding _ the same kind of objective cost and quality information that is readily available when making other significant purchases,'' Ronald Williams, chief executive and president of Aetna, said in a statement.

Aetna launched a price transparency program in August 2005, allowing consumers to research physician pricing before treatment. Between 600 and 1,000 consumers a month have since accessed the information for about 5,000 physicians and physician groups in the Cincinnati area.

With the expansion in August of this year, information on clinical quality and efficiency will be available for nearly 15,000 specialist physicians. Specific pricing will be available for more than 70,000 physicians.

Doctors' pricing would cover 30 procedures by each physician, with a total of 800 procedures when accounting for various physician specialties.

Grace-Marie Turner, president of the Galen Institute, a research organization focusing on health and tax policy in Washington, endorsed the Aetna plan.

"Consumerism is something taking hold not just in this country, but in Europe,'' she said. "They're seeing that more information is out there to help them make decisions. You can't have one-sixth of our economy operate on a different level than the rest of our economy.''

Humana Inc., based in Louisville, Ky., offers Web-based consumer pricing. Minneapolis-based UnitedHealth Group provides information on quality and costs for doctors, hospitals, dental care and pharmacies.

Quality is gauged in consultation with expert groups, said Daryl Richard, a spokesman for UnitedHealth Group.

Philadelphia-based Cigna announced in April that it will provide online health care cost and quality information, including cost data about outpatient surgery procedures and radiology services. The information will be provided initially in New Hampshire and Wichita, Kan.

And Medicare earlier this month published what it pays for 30 common procedures and reported how frequently hospitals perform the procedures.

The release of the information fits with the Bush administration's strategy of moving more people into health savings accounts and high-deductible insurance policies. Such insurance policies require people to bear more of the initial medical expenses.

Bush administration officials say that as more people buy such policies, cost increases would slow because consumers would do more to seek the best deal or decide against a medical service.

Merrill Matthews, director of the Council for Affordable Health Insurance, a research and advocacy group in Alexandria, Va., welcomed Aetna's move.

"The problem we've had in the past is if you had managed care with a $20 copay or traditional HMO, there's really very little incentive to care what the price is,'' he said.

In addition, because the price is negotiated between the insurance company and provider, consumers traditionally have difficulty finding the price for various services, he said.

Aetna adds Jackson Memorial Hospital

Aetna has announced that Jackson Memorial Hospital has joined the Aetna Dade/Broward Florida network effective 07/01/2006. This hospital will be available to employees and their dependents enrolled in the following products:

• HMO
• Aetna Open Access^® (an HMO plan)
• Quality Point-of-Service^® (QPOS^®)
• Aetna Choice^® POS
• Aetna Choice^® POS II
• USAccess^®
• National Advantage™ Program
• Managed Choice^® POS
• Aetna Open Access^® Managed Choice POS
• Elect Choice^® EPO
• Aetna Open Access Elect Choice EPO
• Aetna Select^SM
• Open Access Aetna Select^SM
• Open Choice^® PPO
• Aetna HealthFund^®

Vermont signs ambitious health-insurance law

MONTPELIER, Vermont (Reuters) - Vermont's governor signed a bill on Thursday that would make the state the second in the nation with near-universal health-care insurance by extending coverage to as much as 96 percent of its residents by 2010.

The law comes a month after neighboring Massachusetts passed the nation's first near-universal health-care reform plan, which aims to provide insurance to about 95 percent of the state's half-million uninsured residents by 2009.

Both plans reflect state efforts to tackle growing concerns over health care with 46 million Americans uninsured, traditional employer-based coverage shrinking and the cost of insurance premiums steadily rising.

Vermont's legislation, signed by Gov. James Douglas at a ceremony at the state's second-largest hospital, aims to reduce the ranks of uninsured -- about 10 percent of the state's 620,000 residents -- while also streamlining care given to those with coverage.

A new subsidized health-care plan called Catamount Health will be offered by insurance companies and paid for in part with a hike in the state's cigarette tax and a fee on employers who do not offer health insurance to their workers.

It will provide coverage similar to that offered to state employees, taking nearly 25,000 people off the rolls of the uninsured, backers of the legislation say.

"This is potentially a national model," said Kenneth Thorpe, an Emory University professor and health-care consultant who helped create Vermont's reforms.

Massachusetts' plan has also been touted as a possible national model by requiring all residents to obtain health insurance by July 1, 2007, or face possible tax penalties

The Massachusetts plan will provide insurance to the lowest-earning residents by offering low- or no-cost plans, with premiums and co-payments paid entirely by the state.

In Vermont, insurers can begin offering the new plan from July 1, 2007, but some benefits will be phased-in sooner.

Douglas, a Republican, had up to a month ago threatened the Democrat-controlled Legislature with a veto if they rejected his demand that the plan be run by private insurers.

"This law preserves the private sector role in providing insurance, it preserves economic security of our state and it makes a strong commitment toward wellness and the management of chronic diseases," he said.

The reforms follow a two-year debate in the state Legislature and call for streamlined record keeping, free immunizations, and greater access to preventive care.

Should Your Business Switch to an HSA?

IT'S RARE WHEN a small-business owner is enthusiastic on the topic of health care. Each year, rising costs force more firms to drop coverage for employees. But Andrew Field, owner of a web-based commercial printer in Livingston, Mont., tells a different tale: His company's medical plan has gone from bare-bones to better, with a cost savings to boot.

In February 2005, Field switched his 130 employees at PrintingForLess.com from a traditional Blue Cross plan to health savings accounts, or HSAs. The process, he admits, has not been without rough patches. And "we were a little worried that it might have some bad side effects — that it might not be as good as the advocates claim," he says. But the verdict, more than a year later? "It's better than we thought," he says.

HSAs, created by Medicare legislation in late 2003, were designed to help small businesses trim the soaring costs of employees' health benefits. In 2005, small firms (those with fewer than 200 employees) reported a 9.8% increase in health-insurance premiums, according to the nonprofit Kaiser Family Foundation in Menlo Park, Calif. On average, a small business pays $4,032 a year to cover an employee's individual coverage, and $10,587 if the worker needs family coverage. The hefty tag has forced many small businesses to drop health coverage entirely.

The alternative that Field and other business owners are trying is the HSA, a tax-free savings account where employees can store money for medical expenses. The money in the account can earn interest and "roll over" year-to-year, potentially creating a sizable nest egg for the employee. The HSA can only be opened in conjunction with a high-deductible health plan, which is typically cheaper than a comprehensive plan and covers major expenses such as hospitalization and surgery.

At PrintForLess.com, Field had heard employees complain that the Blue Cross plan cost a lot but didn't cover many common expenses, such as the price of contact lenses. The annual premium for a worker's family coverage was about $6,000; of that, the company picked up 60%, or about $3,600, and the employee paid the remaining 40%, or $2,400. "I was getting complaints from people saying, 'I've taken the kids to the doctor once this year...I'm not utilizing it,'" Field says.

With the price of health insurance rising each year, Field decided to ditch the traditional plan and switch to HSAs. The move has allowed him to hold costs steady — and, in his opinion, give his staff a better health plan. The company splits with employees, 60-40, the total cost of fully funding the HSA and paying the high-deductible insurance premium — roughly $6,000 a year. So employees' payroll deductions remain virtually the same.

Under the new plan, employees now have a slightly higher deductible — $2,400 a year for families, and $1,200 for individuals — than they had before. But now, employees can tap into their HSAs to pay for qualified medical expenses, which includes medical, dental and vision care, as well as eye glasses, flu shots, birth-control pills and over-the-counter drugs such as aspirin. (Under federal rules, the maximum contribution to an HSA in 2006 matches the amount of deductible, up to $5,450 for families and $2,700 for individuals.)

Field estimates that it took about six months to put the HSA plan in place — a tedious process made harder by the fact that, in 2004, the accounts were unfamiliar to banks, insurers and employees alike. He settled on an HSA plan using John Alden Insurance though a regional firm, Payne Financial Group in Helena, Mont.

To smooth the transition, the company explained HSAs in a slide show to employees, and Payne Financial representatives came on-site to answer questions. Employees reacted with "trepidation" but most like the new plan, Field says.

"We didn't know how well it would be accepted — with any change, people may think they're being screwed," he says. To make it more palatable, the company funded the first year upfront, so that employees had money in their HSAs at the get-go. (Through a paycheck deduction, the employees paid the company back over the course of the year). Most employees like HSAs over their old plans because they can choose their doctor and pay for services or products with relative ease, using their debit cards or checks, according to Field.

"I wholeheartedly recommend it," says Field. "It fits into our whole philosophy of letting people make their own decisions."

Blue Cross Launches New Plans for Small Business

As a growing number of small businesses in Florida are dropping health coverage because they can no longer afford it, the state's leading insurer announced today new health plans aimed at dramatically cutting the costs of insurance for small businesses.

Blue Cross Blue Shield of Florida has come up with several ideas intended to limit coverage but able to protect persons from huge losses.

''This is to protect yourself from bankruptcy -- the really catastrophic stuff,'' said BCBS spokeswoman Valerie Rubin.

The offerings could reduce employer costs by 30 to 70 percent, the company said. The exact amount depends on the age and sex of employees as well as previous medical conditions.

The issue is huge because small business coverage in the state has been plummeting. Studies by the Florida Office of Insurance Regulation and the Bureau of Labor Statistics show that the number of small employers in the state that offer health insurance dropped from 266,000 in 1996 to 123,000 in 2004 -- a decline of 53 percent.

Measuring health plans, enrollment in small groups dropped 42 percent -- from nearly 1.8 million to just over 1 million during that period, while Florida's population grew by three million.

These numbers ''provide a worrisome glimpse into how far the healthcare crisis has come in a single, large state,'' says Brian Klepper of the Center for Practical Health Reform. ``There is little reason to believe that the dynamics are not approximately the same throughout the rest of the U.S.''

Klepper says the figures show Florida's small group plan enrollment ``has eroded, on average, by about 5.3 percent (95,000 lives) per year. This number is significantly higher than the 3.0 percent year national drop in private sector jobs with health benefits during the same period reported by the US Bureau of Labor Statistics (BLS) in 2004.''

In BCBS's plans announced Monday, one will cover only the most costly events -- inpatient hospitalizations and outpatient surgeries.

Another would provide comprehensive coverage, with deductibles and co-pays for basic family physician visits and generic drugs. Everything else, including hospitalizations, would require the patient to pay a 50 percent co-insurance but the rates would be those negotiated by BCBS, which are about a third of the gross charges that the uninsured are usually hit with after hospital stays.

Another plan would be based on health savings accounts, similar to 401(k) plans, in which people can set aside money in tax-free savings accounts for future health expenses. This plan is combined with a high-deductible and co-pays. Many other companies are also offering HSA plans.

The plans are intended to help smaller businesses, many of which have been dropping health coverage in recent years as insurance premiums keep going up by more than 10 percent a year.

As part of its motivation, BCBS cited surveys by the Florida Chamber Federation, which showed that 91 percent of Florida businesses offered health benefits in 1999. This year the chamber says only 63 percent will over coverage.

Rubin said later the products will be introduced into the market for individual purchasers.

United HealthCare to give discount for splitting prescription drugs

Retirees often joke they will get in trouble if the HMO finds out they split their pills to save money, but now one of the nation's largest health insurers is pushing the idea.

United HealthCare, the nation's second largest insurer and among the largest in Florida, is the first major health plan to give discounts of up to $300 a year to members who split pills in half as a way to save on prescription drugs.

United executives said they have extended the offer of pill-splitting discounts to 13 million people who have company health policies at their workplaces, including about 1 million in Florida. That does not include Medicare recipients, but might in the future. So far, only 16 drugs are covered by the offer.

"You essentially get two pills for the price of one," said Tim Heady, chief executive of the company's UnitedHealth Pharmaceutical Solutions subsidiary. "The members can save money, the employers can save money and we can save money."

Of $8 billion in drug costs a year, United, based in Minnesota, said pill-splitting could save 1 percent, or $80 million. Of that, about one-third would go to consumers, Heady said.

Drug makers strongly oppose pill-splitting, but United is trying to cash in on a common pricing quirk of the drug business, in which manufacturers charge the same price for, say, a pill containing a 10 milligram dose as one containing 20 milligrams.

Manufacturers do that to dissuade customers from jumping to a competitor's pill if the doctor raises the dosage level, especially if the cost of making the drug is small compared with other costs.

For example, Walgreens charges $148 for 30 of Merck & Co.'s Zocor cholesterol-lowering tablets, regardless of whether the dosage is 20, 40 or 80 milligrams.

United's program lets members pay half the normal co-pay if they split their pills, Heady said. Paying $25 a month for a brand-name drug that normally has a $50 co-pay would save $300 a year. Consumers could save $60 or $150 a year for drugs with lower co-pays. They also get a pill splitter.

United tested the program in Wisconsin early in 2005 and found that 30 percent of people taking the 16 drugs participated, Heady said. During the first few months after extending the offer nationwide late last year, 11 percent participated, but Heady expects the number to approach 30 percent.

The pill-splitting discounts apply to the 16 drugs because United included only those that come in easy-to-split tablets, that have the manufacturer pricing and that physicians deemed would be effective even if the pills were not split perfectly, Heady said. That still includes blockbusters like the cholesterol drug Lipitor and the heart pill Cozaar.

Consumers can get the discounts only if the doctor writes a prescription for half-pills, preventing consumers from trying to go it on their own, Heady said.

"You don't want people to unilaterally split medicines when they might not know what they are doing," he said.

Several other health plans have encouraged pill-splitting as a way to cut costs for insurers and consumers, said Dr. Randall Stafford of Stanford University's Prevention Research Center in California.

"It can be a reasonable strategy for cost savings when drug costs are out of control," said Stafford, an associate professor of medicine.

Drug manufacturers oppose the widespread use of drug-splitting, saying there's not enough clinical evidence that the practice produces doses that are safe and effective.

Some manufacturers argue the main reason they put the same price on several different dosages is so patients will not switch to a too-low dosage solely to save money.

"Splitting pills can be dangerous for certain types of patients and for certain medications," said Jeffrey Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers of America, an industry trade group.

Pill-splitting should be attempted only if the patient has enough hand strength to handle the pill cutter and has no memory impairment such as Alzheimer's disease, said Dr. Karl Dhana, medical director at the Joseph L. Morse Geriatric Center in West Palm Beach.

But Dhana said he has advised patients in some cases to halve their pills to cut costs.

"The bottom line is it's been done for years," Dhana said. "Doctors say, `Take a half of tablet.'"

Splitting is gaining a foothold among other health insurers. WellCare Health Plans, in Tampa, has no program or plans to offer one, but is "willing to support people doing this, assuming they have spoken to their doctor and pharmacist," said Heath Schiesser, the company's president of prescription drug plans. WellCare has 1.5 million members nationwide, most of whom are not elders.

Bloomberg News Service contributed to this report.

Limited Medical Plans -- What You Should Know

You've probably seen the signs for low-cost prescription drug cards, discount dental/vision programs, subsidized doctor's office visit, or $500 hospital benefits. These same flyers and ads also tell you your acceptance is guaranteed. They promise great savings on all kinds of medical services.

The signs and flyers and marketers are everywhere - on telephone poles, in your company mail, on your desk when you get back from lunch, under your windshield wiper blade, or stuck in your front door when you get home.

Are these plans for real? Are they a good idea?

First of all, keep in mind most of these plans are not insurance. You need to read the fine print to see what services are excluded from coverage, and whether your service provider is included in the benefit plan. Once you are comfortable with any limitations, here's the next thing to check out.

Contact your local Better Business Bureau (BBB) and the national BBB (at www.bbb.org) to see if there have been complaints about or issues with the company. Then find out what state the company is “domiciled” in and make sure it is in good standing. Ask around to see if others know about the company. Check the plan out with your state Division of Insurance to make sure there are no outstanding issues or complaints. Finally, do an Internet search on the company name to see if there's any news headlines or information out there you should know.

What do these plans cover? Who offers them? Are the coverage types and limits going to meet your needs and address your concerns?

Most of these plans are the result of negotiated discounts with groups of service providers, and may even be offered by the service providers themselves.

An example of a provider-offered plan is a dental plan with a chain of offices where you pay an annual fee to cover one or two complete check-ups and exams and x-rays, and then also get significant discounts on other services such as fillings and crowns.

Other plans offer you a set amount of coverage for a number of services each year, up to a fairly low maximum amount. For example, you may get 2-4 office visits per person, with a participating doctor, included for your monthly fee. In addition, you may also get $500 per day for a few days toward hospital stays. The maximum coverage amount is chosen by you, but is usually between $2,500 and $5,000 per year, and may only apply to accidents, not illness or maternity, for example.

If your employer does not offer health insurance and you cannot obtain it (or afford it) on your own, these discount or pre-pay programs may be worth looking at, but tread carefully. Many are legitimate, but some aren't. Always check the plan out before sending money, and never give your social security number or checking/banking/credit card information out to get the plan in place.

Let Your Uncle Sam Help with Medical Costs

Your health insurance, no matter how good the plan, will not cover all of your medical costs. Travel, meals, and lodging may play a part in the costs associated with a serious acute or chronic illness. Or, a doctor may recommend a pain management program, massage or other 'quality of life' procedures not typically covered by insurance.

That doesn't necessarily mean you'll have to shoulder the entire burden. You may be able to deduct some of those costs from your IRS bill. For this purpose it is essential to maintain correct and substantial records to back up the claim for all deductions the IRS allows.

Keep the following in mind when creating your medical records, so you can take all the deductions available to you. Before assuming any deduction is allowable, however, be sure to consult the appropriate IRS tax publications or your tax advisor. Most medical related expenses must exceed 7.5 percent of your annual adjusted gross income in order to be deductible. Still, that may well happen in the case of chronic conditions or very serious acute medical problems.

Always retain these documents:

• All medical bills, paid or unpaid, by you or your insurance company
• All claims you have filed
• All vouchers for reimbursements
• A log of all conversations with insurers and medical personnel, including names, dates and brief descriptions
• Receipts for meals, lodging and gasoline or other travel costs - airplane or railway tickets (one of the most overlooked expenses)
• Long-distance telephone calls for medical discussions
• All prescriptions and also over-the-counter drugs recommended by a medical professional

Making sure you have all the documents you might need requires some thought and attention, too. So:

• Decide who will be responsible for collecting and filing documents, and at what intervals. (If you are a single head-of-household, you may want to ask a friend, relative or neighbor to help, especially during acute illnesses or conditions.)
• Create a file system in a filing cabinet or document file box available at office supply stores.
• Create a system for incoming documents for your review or action before they are filed.
• Keep a calendar on which you designate days for filing to be completed, bills paid or letters written/phone calls made.

If you use your own car, you can claim actual costs of gas and oil for the trips, or use the current standard mileage rate. In either case, you can also deduct parking fees and bridge or highway tolls. The standard mileage deduction for medical treatment car use is not the same as for business car use; it is far less, almost two-thirds less, at 15 cents a mile for 2005. Still, it's something.

The mileage deduction can apply to a wide range of medical needs, including:

• Driving a wheelchair-bound patient to school.
• Driving to Alcoholics Anonymous or Narcotics Anonymous meetings.
• Trips to visit a child at an institution if the visits are deemed essential to the child's treatment.
• Trips to visit family members in the hospital when a weakened condition makes your presence indispensable to care/recovery.
• A trip to bring back a family member who becomes ill abroad and cannot travel home without help.
• Trips to accompany ill or injured family members who cannot speak due to permanent or temporary medical conditions.

Other deductions you can use

There are other deductions for which you might also qualify, so keep those receipts, as well. Some are:

• Installing ramps.
• Widening doorways to accommodate wheelchairs.
• Bathroom railings and support bars.
• Modifying height of cabinets or equipment.
• Altering electrical outlets.
• Installing porch or stairway lifts, but not elevators (which could be used by anyone, not just the person in need of assistance ascending or descending).
• Modifications to stairways.
• Hardware alterations on doors.
• Installation of other grab bars and handrails.
• New landscape grading to accommodate specialized vehicles.

If you're in doubt about whether a purchase or trip is deductible, keep the receipt anyway, and mark it with a question mark. Then bring it up with your tax advisor, or research the expense with the IRS through its website at www.irs.gov.

New Health Insurance company in Florida

The first new fully-insured health plan available to employers and individuals statewide in more than five years has been approved by the State of Florida Office of Insurance Regulation (OIR) and is now available, announced the Company's co-founder and Chief Executive Officer Charles O'Neill. Florida based Avalon Healthcare, Inc. (Avalon) offers consumer driven health plans (CDHP) on a preferred provider organization (PPO) platform with the option to add Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).

"There is a dynamic change taking place in the health insurance industry with the movement of healthcare plan designs away from first dollar coverage options like HMOs to consumer directed PPO plans with health savings options like HSAs attached," O'Neill said. "These plans will have a tremendous impact on how Florida employers and consumers purchase, use and manage healthcare for years to come."

Avalon Healthcare was founded by O'Neill and Drew Cassidy in August 2004 in anticipation of changes expected in health insurance products and as an answer to the diminishing competitive healthcare landscape in Florida. Within the past 10 years, a large number of health insurers have left Florida leaving only a few carrier options in the small group and individual healthcare markets.

Company facts

New college grads enter insurance maze

In the next month or so, college graduates will step on stage to pick up their degree--and frequently step off as another member of the uninsured.

The reason: Most health plans drop coverage for dependents once they are out of school. If you lack a job with benefits, you'll have to buy your own insurance.

"Young adults probably have the weakest connection to employer-based coverage," said Sara Collins of the Commonwealth Fund, a non-partisan foundation that focuses on health-care issues. "They're more likely to get jobs that are low wage, part time or with small businesses that can't offer insurance."

Individual insurance has its bonuses, mainly that it stays with you no matter what job you have.

But it can get confusing and expensive.

In Columbus, Ohio, for instance, a 25-year-old woman who opts for a $5,000 deductible would pay $40 a month, according to eHealthInsurance, an online marketplace for individual and family plans. For a $1,050 deductible, she'd pay $23 more.

But in other cities, the difference is far greater. The same woman would pay $35 a month for a $4,000 deductible in Los Angeles. For a $1,100 deductible, the premium catapults to $524 a month, in part because of less competition for certain types of plans in California.

"This shows that carriers will price insurance quite differently," said Emily Fox, a representative for eHealthInsurance.com. "You really need to do some homework and consider what you need and can afford."

One thing is clear: You shouldn't skip on health insurance altogether. Several studies have found that medical expenses are the leading cause of personal bankruptcy.

So to minimize the cost, especially with such other expenses as housing and student loan payments competing for your paycheck, consider these options.

-- Get a temporary policy

If you'll be without health insurance for only a few months, opt for high-deductible, short-term coverage. You often can become insured within one day and stay covered for up to 12 months.

And since it's a temporary policy, you don't need to pay for all-inclusive coverage.

Doctor shopping? How to find the best match

Changing doctors is an increasingly common fact of American life. Sometimes, you force the change—if you switch jobs, or insurance plans, for instance. Other times, the change is forced upon you—your doctor moves or retires.

Whatever the source, there is a lot you can do to smooth the transition and boost the chances of finding a doctor with whom you can forge a beneficial relationship, experts advise.

Finding a good doctor is good for your health. It increases the chances you'll get quality care and decreases the likelihood that you'll be hospitalized, research shows.

If you're like most people, you'll find a new doctor by first asking around.

"Most people find a doctor by getting a referral from a friend or relative," said Dr. Caroline Rudnick, an assistant clinical professor of family medicine at St. Louis University, and a family physician who often counts as her patients all members of a family. "Usually, they don't know anything about our background when they come to see us."

Get basic info
When doctor-shopping, experts suggest you start by checking your potential doctor's credentials. This is no time to be shy, Rudnick said. She encourages prospective patients to inquire about the doctor's medical training—where he or she went to medical school, did his or her residency.

You should also ask about the scope of their practice. Does the doctor care for patients of all ages? And if you have a chronic condition like diabetes, you should ask if the doctor has a lot of experience dealing with patients with the disease, Rudnick suggested.

At Blue Cross and Blue Shield of Florida, prospective members can find this information and much more right on our website by searching our online provider directory. We also offer members Physician Selection Advisor^®, an online tool for helping you search for the doctor that’s right for you. The tool links to Hospital Advisor, another tool that provides vital information about the hospital(s) at which the doctor has admitting privileges.

"You should also feel free to ask about the mechanics of the practice," said Dr. Mary Frank, president of the American Academy of Family Physicians, and a family physician in Rohnert Park, Calif. For instance, you'll want to know what would happen if you get sick on a weekend, or who would cover the practice if your doctor is out of town.

Also, try to determine if your new doctor's philosophy about preventive health meshes with your own, experts advise. Ask about views on complementary and alternative medicine, for example, if that's important to you.

If you rely on acupuncture, for instance, and your new doctor doesn't see a role for it, you should probably keep looking for a new physician, Frank said.

Give basic info
Once you feel like you've found a good match, you should provide accurate, thorough information about yourself so your new doctor can care for you in the best way possible, Frank and Rudnick said.

Start by covering four topics during your first visit:

• your medical history
• your family history
• your lifestyle
• medications you take

Knowing which health problems you've had in the past can help your new doctor assess your current health status and be on the lookout for potential problems, Rudnick said.

And learning about your family's medical history can also help your new doctor help you, Rudnick and Frank said. Certain diseases and conditions—cancer, diabetes, heart disease, mental illness, high blood pressure and high cholesterol, for instance—often run in families, Rudnick said.

Lifestyle factors can also have an enormous impact on your health and are another great source of information. Tell your new doctor if you exercise, smoke or drink alcohol, and whether you have a pet. Owning a pet, for instance, can mean the difference for some people between being sedentary and getting some exercise.

And instead of telling your new doctor which medications you're on, Rudnick advises that you bring prescription bottles so the physician can examine them. If you can't bring them to an appointment, make a list of the drugs, including dosages, she said.

Staying with a doctor is good for your health
Staying with the same doctor can also pay health benefits, Frank said. "A trust builds up," she said. "The patient feels comfortable talking to the physician."

And the physician feels comfortable doing a bit of gentle nagging, Frank added. For instance, she said, if she had a patient who smoked, she would encourage him to quit. "And every time I see him, I am going to say, 'What's going on with the smoking?'"

Research suggests that keeping the same physician is good for your health. In a study published last year in the Journal of Family Practice, researchers reviewed the results of 18 studies examining "continuity of care" and patients' outcomes.

They found that those patients who stayed with one doctor had better care, were less likely to be hospitalized or go to the emergency room, and were more satisfied with their care.

More information
To learn more about choosing a doctor, visit the American Academy of Family Physicians.

Publix to open health clinics

Publix Super Markets and The Little Clinic LLC have signed an exclusive agreement to open medical clinics within Publix stores. The first clinics will be located in the Atlanta, Miami, Orlando and Tampa markets in the first half of 2006.

"We are pleased to select The Little Clinic, a leading provider of convenient, walk-in clinics, to offer our Publix customers quality care," said Maria Brous director of media and community relations. "We admire The Little Clinic's focus on customer service and commitment to wellness programs."

The Little Clinic health care centers will be staffed by nurse practitioners who can write prescriptions, provide diagnosis and treatment of common ailments and minor injuries and offer wellness care like physicals, screenings and vaccinations. They will be open seven days a week and most services are expected to cost less than $50.

"We're delighted to work with Publix as we execute our strategy to significantly expand our presence inside well-recognized retail stores," said Bruce Peacock, CEO of The Little Clinic. "This agreement marks an important step in The Little Clinic's expansion plans throughout the United States. We share Publix's commitment to superior customer service and look forward to helping Publix further serve its customers as we install The Little Clinic health care centers in select Publix stores."

"The commitment by quality retailers is a very strong endorsement of this form of health care delivery for consumers who are demanding greater convenience and affordability," said Molly Ashby, founder and CEO of Solera Capital LLC, the majority owner of The Little Clinic. "We are especially pleased that Publix, a company recognized for innovation and superior customer experience, has selected The Little Clinic as its exclusive provider."

Quicken Medical Expense Manager

You’ve got a brand new hip. Or maybe a brand new baby.

Then comes the paperwork. As medical invoices and statements from doctors and insurance companies come rolling in, you struggle to keep up. Have I met my deductibles? Didn't I already pay this bill? What can I apply to my Flexible Spending Account? Do I have any tax write-offs?

When your mailbox starts bulging with medical bills, you really want to know one thing: How much do I owe?

Quicken Medical Expense Manager software is designed to help you organize even the heaviest loads of health care paperwork. If you're budgeting for yourself, a parent or a whole family, if you have a chronic condition or a child with allergies, Quicken Medical Expense Manager gives you the peace of mind that comes from paying only what you owe and getting the benefits you deserve.

Check it out at Quicken Medical

President Bush speaks about HSA accounts

On January 31, President Bush presented the 2006 State of the Union address. In this speech, he reinforced several themes related to expanding access to affordable health care. He also asked that all policymakers renew their attention to advance enhancement solutions to our current health care system. Among President Bush’s specific proposals, and subsequent statements, was the expansion of Health Savings Accounts, electronic health records, extending affordable access for individuals and small businesses, portability of coverage, transparency in health care, assistance to vulnerable populations, and medical liability reform

Read the transcript here

16 Ways to slash your insurance rates

If you're buying life, disability, long-term care or health insurance, your insurance company wants to know more about you. Depending on the type of policy, it could inquire about your habits, medical records and family history. Based on the answers, it will slot you in one of several categories that will help determine just how much you pay for coverage.

What you say and how you say it can make a difference in how your insurance company sees you and what it charges.

"It's not enough to say you got a good rate," says Randy Herz, senior vice president of Herz Financial, an insurance advisory firm in Farmington, Conn. "You have to look at what their classifications are. Then you have to understand your own health. Health is one of the biggest factors in determining the cost of your insurance."
$100? $200?
$300?
You can't save
if you don't shop around.

• Auto • Health
• Home • Life MSN Money Insurance


Here are some tips from insurance insiders to help you get the best health ranking -- and the lowest rates:

Communication counts
Tell the truth, the whole truth and nothing but the truth. Think that leaving something shady out of your health history might help? Wrong, for two reasons. First, the insurance company will likely find out (it is reading your records, after all), and it will assume the problem is severe because you didn't mention it. Even worse, if you withhold information that the company regards as material, it could cancel your life policy within the first two years, says Bob Hunter, director of insurance for the Consumer Federation of America.

Give your complete health story, but do it on your own terms and give the complete picture. Don't just say you have high blood pressure. Say you were diagnosed with high blood pressure five (or however many) years ago and have successfully controlled it with medication.

"The consumer should think about it from the side of the insurance company," says Robert Hoyt, head of the risk management and insurance program at the University of Georgia and president of the American Risk & Insurance Association. "To the extent you give them good, complete information and reduce the uncertainty, then ultimately you're going to get a fairer price."

If your agent or broker knows what wrinkles might give you a problem, he can shop you to the companies most likely to take you on at a good rate.

Watch your language. Sometimes incomplete answers can paint a bad picture. And insurance underwriters are trained to assume the worst. So be clear and complete in your answers. If you had a nonaggressive cancer removed from your face one time several years ago, don't simply say you had cancer removed, says David Johnson, an insurance agent and board member with the Georgia Association of Health Underwriters. List the specific type -- basal cell, for instance -- and that it was done once with no recurrence.

Sometimes an application will ask the ever popular question, "Which of the following conditions have you been treated for?" Instead of just checking "chest pains," include the fact that it turned out to be indigestion and no follow up was needed.

Know the rules of the game. "You need to ask what the (health) ranking is based on," says Hunter. "There should be objective criteria. And you really should shop a little. The criteria vary."

Find out what your ranking is with a specific company and why, says Hunter. It could be that something they don't know will improve your ranking and decrease your premium.

Shop around. It's common consumer advice, but it can be even more important with insurance. Two different companies can view a person's health and the risk he or she poses very differently.

"Most companies try to put you in the right slot," says Hunter. "But if they make a mistake, you don't want that to be the only one you talked to."

Even the lingo varies from company to company. A ranking of "preferred" or "standard" might mean two very different things, with different rates, at two different companies.

Smart shopping is very important for smokers, especially people who only occasionally smoke a cigar or pipe. While some companies will automatically put you in a less-desirable category with a higher premium, others won't penalize you for that once-a-year stogie.

Your physician can help
Alert your doctor. Insurance companies want to talk with your doctor's office and look at your most recent records. Failing that, they might have to use only the records from the Medical Insurance Bureau (a repository for medical records used by insurance companies), which might not be to your advantage. Sometimes a doctor can give some perspective to a condition that might look worse in black and white (for example, a high cholesterol condition that's being treated successfully).

But a busy doctor's office can sometimes drop the ball, says Dave Evans, vice president and publisher for the Independent Insurance Agents & Brokers of America. And the insurance company will only try so many times before it gives up.

So let your doc know you're applying for insurance. A little advance notice can ensure the call isn't overlooked and give you the best chance at a good rating.

Make sure the company gets all of your records, not just some. To get the most complete, up-to-date picture of your health, the company needs all of your records.

"If you've moved or migrated doctors, the fact of the matter is you probably have to be more proactive," says Evans.

Shop quietly. Similar to a lot of inquiries on your credit, a lot of inquiries on your insurability can throw up a red flag, says Herz. Instead, choose an agent or broker who can quietly do some informal shopping to narrow your options before you do anything official. "It avoids you getting declined or rated," says Herz.

In addition, if you use several different agents or brokers, let them know you're shopping around. That way, "everyone knows what they're working with and it might make them more competitive," says Herz.

Pick your insurance professional carefully. Not every agent is up to the task, especially if you've had some health problems in the past.

"If you're dealing with someone who does this a lot, they can help coordinate and shepherd you along because they are comfortable with the process," says Evans.

If you anticipate problems, it's especially important to have someone who knows the system. This can be an agent or broker who knows which companies are likely to give you the best rates and someone who knows how to talk to underwriters to convey the true risk -- or lack of risk -- you would pose.

"The worse your health is, the more this matters," says Herz.

About your vices: Cut them out
Develop good habits. The insurance company probably won't ask how many times a week you work out, how many grams of fat you consume or how many glasses of water you drink. But all of those things impact the criteria they will examine. So hit the gym, lose those extra pounds and keep yourself healthy.

"These things can make a difference for people, not just in getting coverage but in the price you'll get," says Evans.

Want to drop 30% from your life insurance premium? Kick the cigarettes.

"Smoking can add up to 30% to the cost of your life, disability and health insurance premiums," says Johnson.

Avoid drugs and alcohol. If you take illegal drugs, you're not going to find an insurance company that wants to take you, says Johnson.

"If (a person) has a recent history of drug use, they're not going to be able to get insurance," he says.

If you're a recovering alcoholic, "You're probably going to be able to get coverage, but it could be a higher premium," says Johnson. Emphasize, with medical records to back you, how long you've been sober. The insurance company could see a relapse as a risk to them, so the more you can show how unlikely that is, the better for your rates.

Prepare for your exams. In some cases, the insurance company will require either a physical or a short exam by a paraprofessional, which can include taking your vital signs and drawing some blood.

To get the most accurate reading, schedule it first thing in the morning on an empty stomach. (Obviously, if you have a condition that makes that tricky, talk to your doctor first.) Give up vigorous exercise like that three-mile run 24 hours in advance. Get a good night's sleep. And some experts recommend forgoing your morning coffee, or even water.

Follow up on the details of your medical records. Do your records contain a recommendation for a test that you never got? The insurance company could see that as a bad sign, says Herz. "Have the doctor note in your records that you didn't need it after all -- or get it done," he says. Otherwise the company is likely to think that you could have some undiagnosed problem.

Think about your future. If you're healthy now and considering buying term life insurance, make sure that it's renewable and convertible, says Evans. "What that means is that you can convert to permanent coverage without a physical. That would be worth paying extra for," he says.

Keep trying and keep asking questions
Try to get coverage even if you've had health problems. Work with a professional you trust and have him quietly look into what kind of ratings you would get, says Herz. Bear in mind that a number of conditions aren't the black marks they used to be.

"A person who had open-heart surgery used to be declined," says Herz. "Now they can get regular rates."

Ditto for folks who are using medications to control conditions such as high blood pressure and high cholesterol.

"I've seen people who have cancer, heart (problems), all sorts of things, get insurance because they were able to get a favorable prognosis," says Evans.

Ask why. If you are declined or end up with rates higher than you were expecting, find out why. Talk with your agent and ask how to get a copy of your records from the Medical Information Bureau, says Evans.

Don't give up. "Don't consider a (lower health ranking) or decline in the past as indicative of future events," says Herz. It could be that last time around your agent didn't work hard enough for you, or it could be that today, with new drugs and treatments, your condition wouldn't pose as much of a risk, he says.

And time does heal -- even in the insurance business. "Sometimes, the further you get from (an event)," says Herz, "the better off you are."

Become a health care shopper

Unfortunately, medical care doesn't come in packages with clear price tags. Often, finding out exactly how much you'll pay to get the care you need requires perseverance and -- no pun intended -- patience.

The California HealthCare Foundation recently had a small army of "mystery shoppers" -- people posing as uninsured patients -- call or visit hospitals in the state asking for specific medical procedures. The mystery shoppers found that pricing information often resides with off-site billing personnel whom few hospital staffers could identify.

In more than 600 calls and visits, fewer than one-third of the mystery shoppers could get a firm price or estimate with a single inquiry. In an extreme example, one mystery shopper was routed to 17 different people before getting any pricing information.

The problem is not limited to California, nor is it something only the uninsured face. A survey by the Kaiser Family Foundation and USA Today found that 52 percent of people polled nationwide said their doctors never or rarely discuss the costs associated with the procedures they recommend.

What's more, employee benefit plans are raising deductibles and co-pays, forcing individuals to bear more of the burden of medical care. As this trend deepens, individuals will need to be able to compare prices before committing to medical procedures.

"People need to be better shoppers for health care because more of their health care costs will be paid directly from their pockets or will come from health savings accounts," says Maribeth Shannon of the California HealthCare Foundation.

Among other things, Shannon recommends that people get plenty of information from doctors before visiting hospitals. "It's important to have as much information as possible to help the hospitals identify what you need," said Shannon. "This way they can price procedures accurately." A key piece of information is the diagnostic code that doctors assign to ailments.

Shannon also recommends phoning the hospital before visiting. Mystery shoppers who called were able to get pricing information faster than those who visited.

Finally, Shannon recommends asking for discounts and payment plans to reduce costs and space out bills. "If you don't ask for a discount," she says, "it almost certainly won't be offered."

Resources

Visit these sites for more information on health-related issues:

Health & Wellness Information, Physician Locator from WebMD
Read about today’s most current information and news on healthy living and medical issues by visiting WebMD. Find a quality physician near you by using the Physician Locator.

FirstGov’s Comprehensive Site for General Health Information
Stay informed about health issues with this comprehensive site targeted especially for consumers.

Reliable Health Information from Healthfinder
Search this government-backed, one-stop information source for health issues, using the health library, news, lists of organizations, online check-up and more.

Visit these sites for more information on choosing quality health care:

Hospital Quality & Safety Survey Results from the Leapfrog Group
Find out how your hospital ranks in the most recent quality and safety measures recommended by the Leapfrog Group.

California Healthcare Quality Rankings from HealthScope
Searching for quality health care in California? Visit HealthScope, one of the top independent resources for information on doctors, health plans and medical groups.

Physician, Hospital & Nursing Home Ratings from HealthGrades
What grade did your hospital receive? Find out with HealthGrades, the leading independent health care ratings company. More than 125 of the nation’s largest employers and health plans rely on HealthGrades’ ratings and advisory services.

Top 100 Hospitals from Solucient
Did your hospital make the Top 100? Find out by visiting Solucient’s list of Top Hospitals with information on benchmarks for success.

Guide to Choosing Quality Health Care from AHRQ
Find the information you’re looking for using the Agency for Healthcare Research & Quality (AHRQ). Search this comprehensive guide for information on choosing health plans, doctors, treatments, hospitals and long-term care providers.

U.S. News & World Report: Best Health Rankings
Find out which hospitals ranked the best nationally for treatments in cancer, geriatrics, psychiatry and many more areas.

Visit these sites for more information on choosing the right health plan:

Q-Biz
Using the latest technology, Q-Biz is a leading provider of retirement programs and employment benefit programs to small- to mid-size corporations and public organizations. Find out how Q-Biz can help your company today!

Family 1st Network

Designed for families & individuals without access to employer benefits, Family 1st Network is a resource for individual insurance coverages. Access plan info, get quotes, and apply online for a variety of coverages. Great service is always available online, over the phone, or in person!

Health Plan Report Cards from NCQA HealthChoices
How does your health plan stack up? Find out by viewing report cards issued by the National Committee for Quality Assurance (NCQA).

Health Plan Comparison Checklist from CMA
Need help when comparing health plans? Use the California Medical Association’s Health Plan Checklist to compare plans or summarize your current plan.

Family Health Budget Generator
Keep health care costs under control by budgeting ahead. Use Humana’s step-by-step guide to create a family health budget.

New survey shows low level of satisfaction with consumer-directed health plans

Americans enrolled in a relatively new type of health coverage designed to make them more cost-conscious are less satisfied with their health plan than those with comprehensive health insurance and are less likely to recommend the new plans to a friend or colleague, according to a new survey released by the nonpartisan Employee Benefit Research Institute and The Commonwealth Fund.

High-deductible health plans of $1,000 or more for individuals and $2,000 or more for families can be combined with tax-preferred savings accounts, such as Health Savings Accounts or health reimbursement arrangements. Employers can contribute money to HRAs and both employers and individuals can contribute to HSAs, which can then be used to pay for health care expenses not covered by the health plans. These consumer-directed health plans frequently have been called the latest big idea in health insurance in the United States. By giving more responsibility for costs to the consumer and theoretically providing cost and quality information about providers, the plans are designed to encourage participants to make informed, cost-conscious decisions about their health care.

The survey also found that those covered by these new plans, both with and without savings accounts, are more likely than those with comprehensive insurance to avoid or delay needed care. When they do get care, those in consumer-directed plans encounter larger financial burdens, compared with those with comprehensive insurance.

But individuals in the new plans do exhibit more cost-conscious behavior in their health care decisions – as the new plans intended – compared with those having comprehensive insurance, the survey found.

A full report on the study can be found at www.ebri.org and www.cmwf.org.

Top Ten Healthcare Trends of 2006, Forecasted by HealthLeaders-InterStudy

NASHVILLE, Tenn., Jan. 10 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, announced its list of the ten most important managed health trends to watch in the coming year.

    1. The year 2006 will mark the biggest change -- and biggest free-for-all
      -- to hit the Medicare program since its inception -- Between 11 and 20
      organizations are offering Medicare Prescription Drug Plans (PDPs) in
      each Medicare-defined region. Nine organizations are offering PDP
      coverage nationwide. In addition to PDPs, seniors face a huge range of
      coverage choices, from Medicare Advantage PPOs and HMOs to private fee-
      for-service plans. The Centers for Medicare & Medicaid is heavily
      promoting regional PPOs as a way to extend access to rural areas, but
      local health plans are still drawing the most interest.
   2. Health plan mergers and acquisitions will continue -- In 2005, the
      largest plans, UnitedHealth Group and WellPoint Inc., increased market
      share through purchases of other health plans. Expect to see further
      activity in 2006: CIGNA and Aetna have spare cash, and Coventry Corp.
      seems ready for another acquisition.
   3. Consumer-directed plans generate more media coverage than healthcare
      coverage -- A lot of health plans and financial institutions like the
      new Health Savings Accounts (HSAs) and their associated high-deductible
      health plans. However, traditional first-dollar-coverage health plans
      have loosened their restrictions in recent years and remain the first
      choice among consumers. Despite a lot of discussion, this is unlikely
      to change in 2006.
   4. The uninsured remain uninsured -- Employers and government tried a
      variety of innovative ways of getting healthcare coverage to the
      uninsured in 2005. Attempts included "three-share" style plans in which
      government, employers, and employees each kicked in a third of premium,
      and Maine's launch of its Dirigo Health, but both saw poor uptake.
      Small-scale attempts to deal with a large-scale problem are no more
      likely to succeed in 2006.
   5. Medicaid moves back toward managed care -- Texas, Ohio, and Georgia all
      extended their managed care Medicaid programs in 2005, moving large
      numbers of beneficiaries out of fee-for-service. This won't sweep the
      country in 2006, but expect to see several companies, including Aetna,
      extending their management of Medicaid.
   6. Health plans continue their progress on encouraging electronic medical
      records (EMRs), and 2006 could be a break-out year -- Health plans love
      EMRs, which make tracking and quality checking of healthcare easier and
      cheaper, and want providers to love them too. So the upgrading of
      systems will continue, with dramatic initiatives by Kaiser, Blue Cross
      and Blue Shield of Massachusetts, and others.
   7. HMOs decline -- HMOs have been losing market share. A few bastion
      states, like Michigan and Massachusetts, will have high HMO
      participation, but, as employers move more and more to self-insurance,
      HMO market share nationally will continue its decline.
   8. Disease management expands -- Health plans will rely on disease-
      management programs to attempt to control costs, and are beginning to
      see results. The newest programs are in managing complex chronic
      conditions such as hemophilia, scleroderma, and multiple sclerosis.
      Such conditions are relatively rare, but greater oversight of each
      expensive case can show good financial return.
   9. Individual insurance plans with basic benefits increase market share --
      As the cost of health insurance rises for employers of all sizes,
      insurance is becoming more of an individual game. Health plans are
      tapping into this market with basic-benefits plans for recent college
      graduates, early retirees, and people between jobs.
   10. Pay-for-performance shows its hand -- Health plans have been pushing
       pay-for-performance measures on physicians for several years. 2006
       will be a critical year for measuring return on investment now that
       some P4P programs have several years' worth of data to evaluate. Does
       P4P improve physician performance or pay already high-performing
       physicians more for work they would do anyway? Results in 2006 will
       help answer these questions.

ABC's of Healthcare

If you're still mulling over the alphabet soup of health coverage options, here's a quick primer.

HMO (health maintenance organization): A prepaid health plan in which you pay a monthly premium and the HMO covers your cost of care to see doctors within its network at negotiated rates. Co-pays usually apply. You must choose a primary care physician who coordinates all of your care and makes referrals to specialists. If you don't use the doctors, hospitals and clinics in your plan's network, you usually will bear the cost.

PPO (preferred provider organization): A network of health care providers that provide medical services to a health plan's members at discounted costs. PPO members typically make their own decisions about their health care rather than going through a primary care physician.

POS (point-of-service): A type of managed care plan combining features of an HMO and PPO. You can go to a network provider and pay a flat dollar amount or go to an out-of-network provider and pay a deductible and/or a co-insurance charge.

HSA (health savings account): Lets you set aside pretax dollars for future medical, retirement or long-term care expenses. The funds roll over from year to year, and you can take them with you when you change jobs. You must be enrolled in a qualified health plan with high deductibles, which you pay out of your savings

U.S. healthcare tab growing faster than the economy

America's healthcare bill rose to nearly $2 trillion in 2004, or about $6,280 for every man, woman and child, a team of government economists reported today.

Healthcare spending grew faster than the output of the economy, siphoning off a disproportionate share of increasing incomes.

But the 7.9% rate of increase was a little lower than in 2003, the experts said, because some efforts to control prescription-drug costs were succeeding.

"Medical spending continues to rise faster than wages and faster than economic growth, and workers are paying much more in healthcare premiums than just a few years ago," said the report by economists from the Centers for Medicare and Medicaid Services, published in the journal Health Affairs.

Although polls show that increasing medical costs and diminishing insurance coverage are leading concerns for voters, it's unlikely that a Congress bitterly divided along partisan lines will succeed in any comprehensive effort to control costs or expand coverage for an estimated 46 million uninsured people.

"What you see is ongoing pressure," said economist Deborah Chollet of Mathematica Policy Research, which conducts technical studies for government and business. "There is an agreement by most observers that the private health system is crumbling."

The report warned: "Continued spending growth will require difficult trade-offs for businesses, households and governments as other spending also rises. These trade-offs are more stringent for those with fewer resources."

As the government's annual accounting of healthcare costs, the report found that spending is growing not only in dollar terms, but as a share of the economy. Healthcare represented 16% of the economic pie in 2004, compared with 13.8% in 1993 and 9.1% in 1980.

For those concerned about costs, prescription spending was a bright spot.

Americans paid $188.5 billion for prescription medications in 2004, about $14 billion more than the year before. But the 8.2% increase was the first time in a decade that drug costs have risen by less than a double-digit percentage.

The drug industry hailed the statistic as evidence that companies were not overcharging. But the report attributed the slower cost increase to a rapid rise in the use of generic drugs and mail-order pharmacies, as well as conversion of allergy and indigestion medications to over-the-counter status and safety fears that have reduced consumption of some painkillers.

Relief from increasing rates of healthcare spending may be only temporary, said John L. Palmer, one of the trustees appointed to oversee Medicare and Social Security finances.

"It's encouraging in the sense that it is a little bit of a slowdown, but we seem to be stuck at a pretty high level of continued increases," said Palmer, who also holds the post of university professor at Syracuse University's Maxwell School of Citizenship and Public Affairs.

Hospital care accounted for 30% of all healthcare spending, the report found, and physician services 21%. Because hospitals and doctors represent such a big share of the healthcare marketplace, price increases for their services drive most of the overall rise in costs.

Insurance premiums increased by 8.6%, with the cost of family coverage approaching $11,000 a year. Consumers' out-of-pocket spending grew by 5.5%, slower than the overall trend.

Two giant government programs together paid a little less than 40% of the nation's healthcare bill. Medicare, which covers the elderly and disabled, and Medicaid, which covers a broad cross-section of low-income individuals, both grew in 2004, but Medicare spending increased more rapidly.

The report did not take into account the impact of the Medicare prescription-drug benefit, which began this month.

In a separate technical analysis, the government economists concluded that households pay about 32% of all healthcare costs, a bigger share than either employers or federal and state governments. But that calculation involved counting individuals' Medicare taxes as healthcare costs -- something most consumers probably would not think of doing.

Economists say there is no clear limit beyond which continued growth in healthcare spending could endanger the overall economy. But it may become politically untenable to keep putting healthcare ahead of other priorities, such as education, housing and transportation.

"I don't think there's any magic tipping point," Palmer said. "Whether this is sustainable politically is a different question. In all probability, there is going to have to be some political action to address these broader issues. I don't think the political climate is such that we are ready."