Category Archives: Health Insurance

Private money saves successful Colorado IUD program

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By Katie Kerwin McCrimmon, Health News Colorado

A Colorado birth control program that has cut unintended pregnancies and abortions by nearly half since 2009 will stay alive for at least one more year thanks to $2 million in donations from private foundations.

Women and health advocates held a rally at the Capitol to urge approval of a program that provides IUDs and long-acting birth control devices to young women (Photo by Katie Kerwin McCrimmon/Health News Colorado).

Women and health advocates held a rally at the Capitol to urge approval of a program that provides IUDs and long-acting birth control devices to young women (Photo by Katie Kerwin McCrimmon/Health News Colorado).

The rescue of the highly-touted program comes after Republican lawmakers earlier this year killed a bill that would have provided $5 million in public funding for IUDs and other long-acting reversible contraceptives for low-income teens and young women.

Colorado health officials estimate that the IUDs and other devices have saved at least $79 million in Medicaid costs for unintended births, but some opponents claimed that IUDs are abortifacients and refused to approve funding in the Republican-controlled Senate.

From mid-2009 to mid-2015, the Susan Thompson Buffett Foundation funded a pilot effort in Colorado with a $25 million grant. The Colorado Family Planning Initiative provided teens and young women with more than 36,000 free or low-cost IUDs or other long-acting birth control devices.

The newest data from the Colorado Department of Public Health and Environment show a 48 percent drop statewide in unintended pregnancies and abortions. Births among teens ages 15 to 19 fell from 6,201 in 2009 to 3,361 in 2014, while abortions declined from 1,711 to 939 in the same period.

The 48 percent reduction is up from a 40 percent drop through 2013. Continue reading

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Few health savings accounts owners invest, study

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HSA piggy bank 300By Michelle Andrews
KHN

Only a tiny fraction of the growing number of people with health savings accounts invests the money in their accounts in the financial markets, according to a recent study.

The vast majority leave their contributions in savings accounts instead where the money may earn lower returns.

People who have had their health savings accounts for a longer period of time are more likely to invest their contributions, suggesting that there’s a learning curve in grasping how the accounts work and how to use them, says Paul Fronstin, director of the Health Research and Education Program at the Employee Benefit Research Institute and the study’s author.

Forty-seven percent of HSAs with investments were opened between 2005 and 2008; in 2014, just 5 percent of HSAs that were opened had investments. Continue reading

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State health exchange will offer more plans for 2016

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From the Washington Healthplanfinder

Washington Healthplanfinder to Offer Residents More Health Plan Options This Fall

Coverage is hereThe Washington Health Benefit Exchange Board today provided final certification of Qualified Health Plans to be offered through Washington Healthplanfinder during the third open enrollment period.

The open enrollment period, which runs from Nov. 1, 2015, to Jan. 31, 2016, provides coverage starting Jan. 1, 2016.

Exchange Board Certifies More than 180 Health Plans to be offered Starting Nov. 1

Following approval by the Office of the Insurance Commissioner yesterday, the Board certified 12 health insurance carriers at the monthly Board meeting to offer 136 Qualified Health Plans for individuals and families.

Additionally, six insurance carriers will offer eight pediatric Qualified Dental Plans. Last year, 10 health insurers were approved to sell 82 plans for individuals and families.

Every county in Washington State will again see an increased number of health plan options this fall. In the first open enrollment period, only two counties had more than six carriers offering coverage. This year, 14 counties will have more than six carriers offering coverage.

Approved insurance companies that are new to the market include Dentegra, Health Alliance Northwest, Regence BlueShield and UnitedHealthcare of Washington. Health plans still under review by the Office of the Insurance Commissioner include Coordinated Care. If Coordinated Care is approved, the Board may provide final certification at a later date.

Approval from the Office of the Insurance Commissioner and Board certification for these plans is required under the Affordable Care Act to ensure that each plan meets the requirements for Qualified Health Plans and the 10 essential health benefits, including regular doctor’s visits, maternity care and hospital stays.

 

The following insurance carriers were approved to sell health and pediatric dental plans through Washington Healthplanfinder:

  • BridgeSpan Health Company
  • Columbia United Providers
  • Community Health Plan of Washington
  • Delta Dental of Washington – pediatric dental only
  • Dental Health Services – pediatric dental only
  • Dentegra – pediatric dental only
  • Group Health Cooperative
  • Health Alliance Northwest
  • Kaiser Permanente – health and pediatric dental plans
  • LifeWise – health and pediatric dental plans
  • Moda Health
  • Molina Healthcare of Washington
  • Premera Blue Cross – health and pediatric dental plans
  • Regence BlueShield
  • UnitedHealthcare of Washington

Washington Healthplanfinder Business, the state’s business marketplace, will expand its statewide coverage this year with two insurance carriers, Moda Health and UnitedHealthCare, and 47 plans available. Kaiser Permanente will continue to offer health plans to small businesses in Clark and Cowlitz counties.

Starting this November under the Affordable Care Act, Washington Healthplanfinder Business will expand its coverage from businesses of up to 50 employees to larger businesses of up to 100 employees. Washington Healthplanfinder Business allows businesses to compare plans, decide their contribution level and manage payment in one place. Eligible small business owners may also access tax credits when they enroll through Washington Healthplanfinder Business.

Five additional multi-state plans must be certified by the U.S. Office of Personnel Management (OPM) before they can be offered through Washington Healthplanfinder. Multi-state plans are provided by OPM and private insurance carriers to drive additional competition in health insurance marketplaces across the country.

More information about the health plans that will be offered on Washington Healthplanfinder is available by clicking here.

For more information about Washington Healthplanfinder, please visit www.wahealthplanfinder.org.

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Are you missing out on co-pay, deductible assistance?

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Study: 2 Million Exchange Enrollees Miss Out On Cost-Sharing Assistance

By Michelle Andrews
KHN

Twenty-dollar bill in a pill bottleMore than 2 million people with coverage on the health insurance exchanges may be missing out on subsidies that could lower their deductibles, copayments and maximum out-of-pocket spending limits, according to a new analysis by Avalere Health.

Those who may be missing out are people with incomes between 100 and 250 percent of the federal poverty level ($11,770 to $29,425).

Under the health law, people at those income levels are eligible for cost-sharing reductions that can substantially reduce their out-of-pocket costs. But there’s a catch: the reductions are only available to people who buy a silver-level plan. Continue reading

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Providence and Walgreens to open new retail clinics

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29897_Logo3_310x137Walgreens and Providence Health & Services increase the number of their retail clinics Oregon and Washington to 25.

“Providence and Swedish Express Care at Walgreens will offer a fast, easy and affordable option for treating common illnesses and injuries.

The clinics will operate extended hours seven days a week, allow for walk-ins and same-day scheduling and provide an after-hours option for care on evenings and weekends,” Providence said in a statement.

The clinics will be owned and operated by Providence and its affiliates, and become the first to open at Walgreens stores under a new collaborative services model.

Providence Express Care at Walgreens, or Swedish Express Care at Walgreens in the Seattle area, will open three clinics in both the Portland and Seattle areas in early 2016, with plans for further expansion within the next two years.

In the first six clinics, Swedish providers will staff Issaquah, Kirkland and Renton, Wash. locations and Providence providers will staff Beaverton and Milwaukie, OR. and Vancouver, WA locations.

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Americans favor government action on drug prices – poll

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KHN

Most Americans value the prescription products the drug industry produces, but they sure don’t like the prices and want the federal government to take action, according to a new survey.

Kaiser Health Tracking Poll: August 2015

Just over half of Americans (54 percent) are currently taking a prescription drug. While most say their drugs are easy to afford, consumers in general (72 percent) believe drug costs are unreasonable, according to the poll by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent part of the foundation.)

More people (51 percent) think competition would do a better job of controlling prices than federal regulation (40 percent).

But large majorities said they would favor allowing Medicare to negotiate with companies on prices and allowing people to buy medicines imported from Canada. Continue reading

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Washington exchange customers must pay premiums to insurers directly beginning September 24th

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WA_Healthplanfinder_RGB

 Healthplanfinder Announces Premium Payment Change for Customers

Health, dental plan customers must pay insurance companies beginning Sept.

Washington Healthplanfinder today announced that current Qualified Health Plan and Qualified Dental Plan customers must pay their monthly premium payment directly to their insurance company beginning Sept. 24.

Washington Healthplanfinder will no longer accept premium payments after Sept. 23. Continue reading

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The hospital is in network, but not the doctor – New York tries a fix

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The Hospital Is In Network, But Not The Doctor: N.Y. Tries New Balance Billing Law

By Elana Gordon, WHYY

He thought it was pneumonia. Michael Trost, 52 and seemingly healthy, just wasn’t feeling right. During a chance break at work as a wood finisher, Trost’s wife brought him to an emergency room near where they live at the edge of the Poconos in Dingmans Ferry, Pa.

“They’ll give me a chest x-ray and antibiotics and I’ll be on my way,” Trost thought.

Michael Trost of Dingmans Ferry, Pa. (seen here with his wife, Susan Rosalsky) was billed $32,325 for a surgery with an out-of-network doctor in an in-network hospital. (Elana Gordon/WHYY)

Michael Trost of Dingmans Ferry, Pa. (seen here with his wife, Susan Rosalsky) was billed $32,325 for a surgery with an out-of-network doctor in an in-network hospital. (Elana Gordon/WHYY)

Trost left in April with much more than that: six weeks at home, recovering from open-heart surgery.

Even though they made a point of going to hospitals covered by their insurance, the doctor who performed the surgery was out-of-network.

Doctors had learned that Trost’s heart was “pumping really hard, and it’s not working,” he recalls, so they transferred him to a bigger hospital for a mitral valve repair. He was discharged a few days later.

But a few weeks after the unanticipated surgery, the bills started rolling in, including one for $32,325.

Turns out, even though the two had made a point of going to hospitals that were covered by their insurance, the doctor who performed the heart surgery was out-of-network. Continue reading

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Cost of diabetes drugs often overlooked, but shouldn’t be

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GlucometerBy Michelle Andrews
KHN

When it comes to treating chronic conditions, diabetes drugs aren’t nearly as sexy as say, Sovaldi, last year’s breakthrough hepatitis C drug that offers a cure for the chronic liver infection at a price approaching six figures.

Yet an estimated 29 million people have diabetes — about 10 times the number of people with hepatitis C — and many of them will take diabetes drugs for the rest of their lives. Cost increases for both old and new drugs alike are forcing many consumers to scramble to pay for them.

“Every week I see patients who can’t afford their drugs.”

“Every week I see patients who can’t afford their drugs,” says Dr. Joel Zonszein, an endocrinologist who’s director of the clinical diabetes center at Montefiore Medical Center in New York City.

Many people with diabetes take multiple drugs that work in different ways to control their blood sugar. Although some of the top-selling diabetes drugs like metformin are modestly priced generics, new brand-name drugs continue to be introduced that act in different ways.

They may be more effective and have fewer side effects, but it often comes at a price. For the fourth year in a row, spending on diabetes drugs in 2014 was higher on a per member per year basis than it was for any other class of traditional drug, according to the Express Scripts 2014 Drug Trend Report. Less than half of the prescriptions filled for diabetes treatments were generic. Continue reading

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When rehab might help an addict, but insurance won’t cover it – WITF-Fm

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Federal law requires insurance firms to cover treatment for addiction as they do treatment for other diseases. But some families say many drug users aren’t getting the inpatient care they need.

Cris and Valerie Fiore hold one of their favorite pictures of their sons Anthony (with the dark hair) and Nick. Anthony died from a heroin overdose in May 2014 at the age of 24. Cris Fiore’s eulogy described his son’s death as a shock, but “not a surprise.” Anthony had been addicted to heroin for years.

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Achieving mental health parity: Slow going even in ‘pace car’ state

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Flag_of_CaliforniaBy Jenny Gold
KHN

After the state of California fined her employer $4 million in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job — and her patients’ lives — to get better.

Instead, she said, things got worse.

Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care.

Patients who were debilitated or dying from physical diseases for which they were receiving regular medical treatment had to wait months for psychological help, she said.

Some patients, she said, might not live long enough to make the next available appointment.

Psychologist Melinda Ginne, 65, at her house in Oakland, California on Tuesday, May 26, 2015 (Photo by Heidi de Marco/KHN).

Psychologist Melinda Ginne, 65, at her house in Oakland, California on Tuesday, May 26, 2015 (Photo by Heidi de Marco/KHN).

“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013. In February, two years after assessing the second largest fine in its history, the California Department of Managed Health Care stepped in again, finding that Kaiser Foundation Health Plan had improved somewhat but still was short-changing patients on mental health care. The state is considering another fine against the health maintenance organization, which is not affiliated with Kaiser Health News.

“Every time the DMHC has an edict, Kaiser Permanente has a way around it,” said Ginne, who retired in September 2014. Continue reading

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You may still be able to get coverage through special enrollment

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HCGOV SPECIAL ENROLLMENT PERIOD

Even though the open enrollment period is over, you may still be able to get 2015 coverage.

Certain life changes like losing your coverage, having a child, turning 26, moving, or getting married may qualify you for a Special Enrollment Period.

HCGOV SEE IF YOU QUALIFY

Important: If you qualify for a Special Enrollment Period, you’ll have 60 days from the time the life event occurs to enroll.

Take time today to see if you can still get Marketplace coverage.

The HealthCare.gov Team

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HHS’ change on out-of-pocket caps challenged

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Business leaders, GOP question HHS’ change on families’ out-of-pocket limits

Twenty-dollar bill in a pill bottleBy Michelle Andrews
KHN

One of the health law’s key protections was to cap how much consumers can be required to pay out of pocket for medical care each year.

Now some employers say the administration is unfairly changing the rules that determine how those limits are applied, and they’re worried it will cost them more.

Under the rule change, no one in the family can be on the hook for more than $6,850.

In addition, they, along with some Republicans on Capitol Hill, are questioning whether federal officials have the authority to make those changes.

Under the health law, the maximum that a consumer with individual coverage can be required to pay in deductibles, copayments and coinsurance for in-network care is $6,600. People with family plans max out at $13,200Continue reading

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Insurers must cover residential mental-health care – Kriedler

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Washington MapFrom the Office of the Insurance Commissioner

Washington State Insurance Commissioner Mike Kreidler has clarified to insurance companies in Washington that mental-health services must now be offered in parity with medical services.

The commissioner updated rules on mental-health parity in 2014 and asked insurers to review previous mental-health claims that had been denied under a blanket exclusion. He asked insurers to rectify those denials.

The need for clarification arose after a consumer filed a complaint with Office of the Insurance Commissioner after being denied for residential mental-health treatment. The individual said this violated federal laws regarding mental-health parity. Continue reading

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Employers look to tighten control costs of expensive drugs

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Twenty-dollar bill in a pill bottleBy Lisa Gillespie
KHN

More than half of large employers in 2016 will aim to more tightly manage employees’ use of high-priced specialty drugs, one of the fastest-growing expenses in their health plans.

Despite those efforts, companies still expect the cost of specialty drugs that are carefully administered to treat conditions such as cancer, HIV and hepatitis C to continue rising at a double-digit annual rate — well ahead of the pace for traditional pharmacy drugs or companies’ overall spending on health benefits, according to the National Business Group on Health.

55% of employers plan to direct employees to specialty pharmacies if they need high-cost drugs

.The group released a survey Wednesday that found 55 percent of employers next year plan to direct employees to specialty pharmacies if they need drugs that can cost thousands of dollars for a single treatment. That share was up from a third in the group’s survey a year ago on companies’ plans for 2015 health plans.

specialty-pharma-survey-081215-e1439389469737

More companies also say they will require employees to get prior authorization before buying specialty drugs under the employer’s health plan — 53 percent vs. 29 percent a year ago. Continue reading

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