Showing posts with label benefit reductions. Show all posts
Showing posts with label benefit reductions. Show all posts

Friday, December 3, 2010

The 3 Times You Should Re-examine Your Health Care Benefits | Education & Careers

While our three (ring circus) branches of government try to figure what to do with health care, life for us down here in the trenches continues to march on. This means accidents happen, people get sick, and at some point every one of us ends up (at one time or another) in a doctor’s examination room wrapped in a paper gown. For this reason, you need to consider all your health insurance options whether you’re employed or not. Unfortunately, when your job status changes, so does your coverage. Here are the three most important times you need to re-examine your health care benefits.

When You Start a New Job

The sad truth is most employers can’t afford to cover their employees with 100% health care. In most cases, an employer pays for part or most of an employee’s plan, but then the employee has to also kick in to make up the difference. When you hire on with a new company, be sure to read the company’s health insurance policy from cover to cover. If you don’t understand something, ask your employer to spell it out for you. Typically, an employer health care plan DOES cover general doctor visits and catastrophic care, but usually DOESN’T include extras like dental, vision, chiropractic care, etc. If these things are important to you then often you can include them as extras on your policy, but you’ll have to pay for them.

Also if you or someone in your family has a pre-existing condition, you need to make sure that condition will be covered under your new plan. In fact, check on this BEFORE you quit your old job. And if you like the doctors you’ve been seeing make sure those doctors are covered under your new plan. If not, you may be paying for your doctor visits 100% out of your own pocket.

If You Quit or Are Fired From Your Existing Job

Regardless of the reason you leave a job the COBRA Act of 1985 ensures that you can take your company’s health insurance benefits with you for up to 18 months. Unfortunately, you’ll have to pay 100% of those monthly premiums yourself, but at least you’re covered. This is especially important if you’re going through specific treatment at the time you leave a job, or you want to retain your same health insurance while you look for a new job.

Whatever you do, DO NOT roll the dice and go without health insurance. That’s never a gamble worth taking.

If You’re In Between Jobs

If your employer’s health plan is too expensive for you to continue with on your own, then you need to get some sort of health insurance while you look for work. If you’re married, check to see if your spouse’s plan will cover you, at least for catastrophic care. You may have to pay a little extra, but it probably won’t add up to what you’d pay for your own policy.

If you have to purchase your own health insurance you basically have two options; A PPO (expensive, but covers a lot) or catastrophic care (cheaper, but with less coverage). The one you choose depends upon A) How much money you have to spend on health care, and B) How long you anticipate being unemployed.

A PPO is the closest thing your employer provided you with in terms of health care. Typically, a PPO has a family deductible of anywhere from $1,000 to $5,000 annually and also offers co-pays for doctor office visits and prescription drugs. This means you pay your doctor office co-pay of, for example, $25 per visit, every time you go to your doctor. But after you’ve paid enough medical bills (in a calendar year) to meet your deductible, then the insurance company pays anywhere from 80% to 100% of your remaining medical bills, but only for the rest of the calendar year. After January 1 the slate is wiped clean and you start paying toward your deductible all over again.

A PPO plan is pretty expensive because it covers everything from a cold to cancer. If you know you’re going to be out of work only for a short time, then a PPO may be overkill. Instead, you can go with a catastrophic care plan, which has a very high deductible (usually $5,000 to $10,000), and only covers you for major medical expenses, such as accidents or long term severe illness (like cancer). If you’re healthy, and left without health benefits for a month or less, then a catastrophic care plan may make more sense. It’s way cheaper than a PPO, but still guarantees you won’t lose everything if you happen to have an accident that requires expensive treatment while you’re without employer benefits.

Regardless of your employment status you should NEVER go without health insurance. It only takes something as simple as a hernia surgery or a broken leg to wipe out everything you’ve ever worked for. True, you don’t know if you’ll ever need to go to the doctor while in between jobs, but that’s why they call it insurance – because then you won’t have to worry if you do.

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Thursday, December 2, 2010

Arizona Cuts Financing for Transplant Patients

Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.

“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”

Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.

Francisco Felix, 32, a father of four who has hepatitis C and is in need of a liver, received news a few weeks ago that a family friend was dying and wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant.

He was prepared anyway at Banner Good Samaritan Medical Center as his relatives scrambled to raise the needed $200,000. When the money did not come through, the liver went to someone else on the transplant list.

“I know times are tight and cuts are needed, but you can’t cut human lives,” said Mr. Felix’s wife, Flor. “You just can’t do that.”

Such high drama is unfolding regularly here as more and more of the roughly 100 people affected by the cuts are becoming known: the father of six who died before receiving a bone marrow transplant, the plumber in need of a new heart and the high school basketball coach who struggles to breathe during games at high altitudes as she awaits a lung transplant.

“I appreciate the need for budget restraints,” said Dr. Andrew M. Yeager, a University of Arizona professor who is director of the Blood and Marrow Transplantation Program at the Arizona Cancer Center. “But when one looks at a potentially lifesaving treatment, admittedly expensive, and we have data to support efficacy, cuts like this are shortsighted and sad.”

State Medicare officials said they recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.

“As an agency, we understand there have been difficult cuts and there will have to be more difficult cuts looking forward,” said Jennifer Carusetta, chief legislative liaison at the state Medicare agency.

The issue has led to a fierce political battle, with Democrats condemning the reductions as “Brewercare,” after Gov. Jan Brewer.

“We made it very clear at the time of the vote that this was a death sentence,” said State Senator Leah Landrum Taylor, a Democrat. “This is not a luxury item. We’re not talking about cosmetic surgery.”

The Republican governor has in turn blamed “Obamacare,” meaning the federal health care overhaul, for the transplant cuts even though the Arizona vote came in March, before President Obama signed that bill into law.

But a top Republican, State Representative John Kavanagh, has already pledged to reconsider at least some of the state’s cuts for transplants when the Legislature reconvenes in January. Mr. Kavanagh, chairman of the Appropriations Committee, said he does not believe lawmakers had the full picture of the effect of the cuts on patients when they voted.

“It’s difficult to be linked to a situation where people’s lives are jeopardized and turned upside down,” he said in an interview. “Thankfully no one has died as a result of this, and I believe we have time to rectify this.”

Across the country, states have restricted benefits to their Medicaid programs, according to a 50-state survey published in September by the Kaiser Commission on Medicaid and the Uninsured. But none have gone as far as Arizona in eliminating some transplants, which are considered optional services under federal law.

Before the Legislature acted, Arizona’s Medicaid agency had provided an analysis to lawmakers of the transplants that were cut, which many health experts now say was seriously flawed. For instance, the state said that 13 of 14 patients under the state’s health system who received bone marrow transplants from nonrelatives over a two-year period died within six months.

But outside specialists said the success rates were considerably higher, particularly for leukemia patients in their first remission.

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******************************************************

Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

http://www.4nursing.com
http://www.howtostartanursingagency.com
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