We all take something for granted. Clean water, the love of a faithfull pet…even health insurance. For most of us, insurance has generally been available through our employers, so we don’t typically give it a second thought.

But with rising health care costs and a changing economy, some employers have had to drop insurance coverage, leaving employees to look for new or additional protection.

If you do end up looking for health insurance, the task can seem daunting. The phone book and Internet are flooded with insurance agents and companies that offer various types of policies–unless you know where to look and what to look for.

STEP ONE:

Evaluate Your Needs

The same principle applies when shopping for health coverage as when shopping for groceries–purchase the items you really need and save money by eliminating the ones you don’t. Compare plans based on your age, current health conditions and family medical history to help ensure you get the benefits you need without spending a lot.

Do you need coverage for hospital stays or doctor’s office visits? Today, many surgeries are done on an outpatient basis, so it may be wise to consider a plan that covers both outpatient and inpatient procedures.

It’s also important to think about your coverage for catastrophic events. Can you afford to pay the higher expenses a catastrophic illness or injury may bring or are you more worried about the day-to-day medical services?

STEP TWO:

Know the Total Cost of Coverage

Check to see if you can get discounts on your premiums, perhaps by paying them once a year, paying online or having the premiums deducted straight from your bank account.

Co-pays and deductibles can also be part of a health insurance plan, so make sure to figure those expenses into the total cost of your insurance. Or, find a plan that has no co-pays or deductibles (like a limited-benefit plan).

STEP THREE:

Research the Company

Consider the company itself. Are there local representatives or ones available by phone who can help if you have questions? Having a person in your area who can provide answers is always a bonus.

Additionally, research insurance companies based on financial strength and claim payment history. Independent rating agencies and your state’s insurance department can be good resources.

Good health insurance is a must-have in today’s world of high-priced medical procedures, so take the time to fina plan that can be tailored to meet YOUR needs.

Thirty years ago, cancer was a death sentence. Today, cancer remains a formidable foe, but survivors have battled back and are pushing the statistical trend toward the other direction. In fact, the five-year survival rate for all cancers diagnosed between 1996 and 2002 is 66 percent — that’s up 51 percent from 1977.¹ Thanks to improvements in technology and advances in medical science, leading a productive and healthy life after cancer has become probable for many Americans.

Even with cancer survival rates increasing, winning the physical battle is only the first step. Many times a financial fight sits waiting in the wings for individuals and their families. This is also true for employers who, through lost productivity and other indirect costs of cancer, suffer financially. The National Institutes of Health estimated that the total cost of cancer care in the United States in 2005 was $209.9 billion. Of that total, $17.5 billion was attributed to indirect morbidity costs (i.e., lost productivity), and indirect mortality costs (i.e., lost productivity due to premature death) accounted for $118.4 billion.²

Adding cancer insurance as part of an overall benefits package — whether employer-funded or employee-paid — can be a tremendous asset to employers who are doing all they can to retain talent in their organizations. Adding cancer coverage that incorporates a wealth of physical and emotional wellness features, as well as providing financial benefits, gives policyholders benefits that help reduce the overall impact of a diagnosis. It also helps employers demonstrate care and concern for their workforce — their most valuable asset.

Cancer insurance defined

When most people think of insurance, they think of it as a benefit to families of a loved one who has died. However, cancer insurance is a living benefit, a supplement to traditional medical insurance paid direct to the policyholder upon diagnosis to help them pay for the cost associated with their disease and hopeful recovery.

Nearly one-third of American families deplete all or most of their savings because of a serious illness. Specifically, studies show nearly 65 percent of cancer treatment costs are not covered by traditional medical insurance plans.³ These indirect costs typically include out-of-pocket expenses, deductibles, coinsurance, loss of wages and salary, travel expenses to and from treatment centers, lodging and meals, and child care.

Providing affordable cancer insurance for employees can help them handle the extra expenses accompanying cancer treatment. Providing them with a plan that also offers educational and emotional resources and support can help keep them healthy in the first place and, in the unfortunate event of a diagnosis, help them take control of their treatment.

Knowledge is power

In providing access to educational resources, employers not only help employees live a healthy lifestyle today, they also help employees reduce their risk of illness in the future. There are several ways of doing this, but the two main vehicles are maintenance of physical health and early detection.

After quitting smoking, the best way to cut cancer risk is to achieve and maintain a healthy weight, to be physically active on a regular basis and to make healthy food choices. Approximately 550,000 Americans die of cancer each year; one-third of these deaths are linked to poor diet, physical inactivity and carrying excess weight.⁴

While the equation “healthy lifestyle = less chance of cancer” might seem common knowledge, it’s not necessarily a top priority in today’s workforce. What’s more, employers don’t always have the internal resources to make this information easily accessible, let alone engage their employees in a discussion of overall wellness as part of cancer prevention.

In terms of early detection, the equation is even simpler: “early detection = improved chance of survival.” Recognizing symptoms, scheduling annual screenings and performing self exams play a crucial role in diminishing the chances of receiving a cancer diagnosis, particularly for those who fall into certain risk categories. Many of today’s cancer insurance policies include allowances for general health screenings and specific early detection screening.

Again, by introducing cancer insurance protection as part of an employee benefit package, the employer provides valuable information and screenings, aids in the recruitment and retention of high-quality staff members and positions the company as an employer of choice. The key is to have the information and support come from a credible source and the policy from a trusted carrier with a successful track record.

Support is out there

Speaking of credible sources and successful track records, six-time Tour de France champion Lance Armstrong knows what it takes to win. He also knows what it takes to beat cancer and wants to help others win the battle as well. To that end, he founded the LIVESTRONG(TM) Lance Armstrong Foundation (LAF). This effort seeks to empower those combating cancer and to help them focus on living. Other organizations such as the American Cancer Society and National Cancer Institute offer valuable information as well for people seeking support and direction regarding cancer and its effects.

LAF, in particular, connects people with a broad array of resources designed to help them stay healthy and, should a cancer diagnosis arise, take control of their treatment. Numerous benefits are available to assist people in treating their illness including simple steps such as making positive choices that contribute to a healthier future. For those embarking on cancer treatment, LAF can provide qualified referrals and connection to counseling services that provide emotional support, individual counseling, help addressing financial concerns, assistance with legal and insurance questions and matching to clinical trials.

Winning the battle is part of winning the war

Make no mistake; beating cancer is a major accomplishment. Unfortunately, most survivors enter remission with another battle looming. They find themselves saddled with financial burdens lasting much longer than the disease itself. In addition, fighting this disease exhausts a person and his or her family emotionally and physically. Owning a cancer insurance policy gives families some financial peace of mind during the struggle.

For employers, providing their employees with access to a supplemental plan that provides educational, emotional and physical support, as well as a financial benefit, guaranteed and payable directly to the insured to use as they see fit, not only protects their most valuable asset — their employees — it can protect them against lost productivity.

Remember: While eliminating cancer entirely remains a goal yet unrealized, a healthy lifestyle, educational and emotional support, and smart financial planning that includes cancer insurance can help win important small battles along the way to victory.

¹Cancer Facts & Figures, 2007, American Cancer Society
²Journal of Clinical Oncology, American Society of Clinical Oncology, January 2007
³“Health Insurance and Cancer,” Paula Burkes, Business Writer, The Oklahoman, March 30, 2008
⁴“Prevention & Early Detection,” American Cancer Society, 2008

*For further information, or to contact this author, please leave a comment and your e-mail address in the forum below.

The Medicare Modernization Act of 2003 (MMA), best know for creating the new entitlement Part D for prescription drug coverage, also created the Medicare Advantage program. This allows private plans to offer replacement Medicare coverage with additional benefits on a voluntary enrollment basis. MMA also created a new category of Medicare Advantage plans known as “special needs plans.” SNPs were designed for people who had particular circumstances that could be better addressed by a health plan designed for their special needs. There are three types of SNPs:

       Institutional SNPs designed for people in long-term custodial care in nursing homes

       Chronic condition SNPs for people with a particular diagnosis, such as congestive heart failure, chronic obstructive pulmonary disease, or Alzheimer’s disease

       Dual-eligible SNPs, meant for people who qualify for both Medicare and Medicaid

By January 2008, there were 775 SNPs available across the country. There are now about 70 institutional SNPs, about 265 chronic condition SNPs, and about 440 dual-eligible SNPs.

Enrollment in SNPs is permitted on a year-round basis. Any Medicare beneficiary can enroll in a SNP if they meet the qualification criteria. Enrollees can also opt out at any time and return to fee-for-service Medicare. The institutional and chronic condition SNPs are determined by the client’s health status, whether they are in a long term care facility, or if they have received a qualifying diagnosis.

The dual-eligible SNP criteria are based on the client’s income level. If they have Medicare and their income falls below the level required of their state’s Medicaid program, they have the option of joining a dual-eligible SNP.

Under normal circumstances, a person who qualifies for both Medicare and Medicaid has comprehensive coverage. Medicare coverage for such a “dual” is no different than any other Medicare beneficiary. There are the usual deductibles, copayments and lifetime limits. However, because the beneficiary also qualifies for Medicaid, they have additional coverage at no cost to them that covers all the deductibles and Medicare copayments and adds important additional home care and long term care benefits. A dual will get full coverage for custodial care in a nursing home if they meet the admission criteria.

A dual prior to 2006 would have also received drug benefits through Medicaid. Beginning Jan. 1, 2006, all duals were auto-assigned to a Part D prescription drug plan. Because the duals’ income qualifies them for Medicaid, they also receive low-income subsidy coverage under Part D that eliminates deductibles, most copays, and the “doughnut hole.” In most cases, they are subject to only a nominal $1 to $3 copay for generics or brand-name drugs.

With this triple hit of Medicare, Medicaid, and Part D, duals have comprehensive coverage and would not seem likely candidates for a Medicare Advantage plan or other supplemental products. However, the coverage is provided through three different plans, each administered by a different entity. Medicare, a federal program, is administered by a Medicare intermediary. Medicaid is a state program administered by each state through its own bureaucracy. And Part D is a federal program administered by private companies under contract to Medicare.

Duals are challenged to contend with three ID cards, three description of benefits, three sets of claim forms, and three different customer service numbers.

The introduction of a SNP can integrate all of these into one plan, so the member — or the member’s caregiver — deals with a single card, telephone number, and set of claim forms.

SNPs often assign each member a nurse care manager who works closely with the family in planning and overseeing all medical decisions for the member. Having a nurse care manager streamlines the care process and also offers a personal touch to the member or for adult children acting as caregivers. Since a major goal of a SNP plan is to keep the member healthy, out of the hospital, and at home among the family, these options are likely to have great appeal to duals worried about being admitted to a nursing home or to their adult children caregivers seeking solutions for their parents.

SNPs should not be overlooked as an option for any Medicare beneficiary. They are called special needs plan for a reason; they cater to smaller cohorts of people whose special needs may not be addressed by fee for service Medicare or traditional Medicare wraparound, supplemental or Advantage products. It requires a bit of research, but the benefits of a SNP can be worth the additional effort

Presidential candidates’ plans for health care reform

Now that the presidential race has narrowed to two candidates, it’s a good time to review where each of them stands on the issue of health care reform and what they intend to do about it. While Senator Barack Obama and Senator John McCain agree on many of the problems with the current health care system, they offer very different solutions.

One issue that McCain and Obama agree on is controlling health care costs. This reflects a growing consensus among health care experts that something must be done to bring the growth of health care spending under control.¹

Most Americans share this concern. According to an October 2007 Kaiser Family Foundation poll, more Americans were “very worried” about being unable to afford health insurance than about losing their job or house, or even experiencing a terrorist attack.²

McCain and Obama do differ on the issue of universal coverage. McCain wants to give everyone access to health insurance, but is against any mandates requiring that everyone have coverage. Obama intends to mandate that all children are covered, but stops short of requiring every American to purchase health insurance.

Historically, the primary difference between the Republican and Democratic approaches to health care reform involves the role of government and this is very evident in their two plans.

Barack Obama’s plan

“My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

Barack Obama —Iowa City, May 29, 2007³

According to his website, Obama’s plan promises:

• Quality, affordable and portable coverage for all – he will make a new national health plan available to all Americans, including the self-employed and small businesses, offering affordable health coverage similar to the plan available to members of Congress, including:
• Guaranteed eligibility.
  -­ Comprehensive benefits.
  -­ Affordable premiums, copays and deductibles.
  -­  Subsidies.
  -­  Portability and choice.
• Lower costs by modernizing the U.S. health care system – his plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee to use those savings to reduce the cost of workers’ premiums. He also supports:
  -­ Helping patients with disease management programs, coordination and
     integration of care, and requiring full transparency about quality and costs.
  -­  Ensuring health care professionals deliver quality care. 
  -­  Lowering costs through investment in electronic health information technology
     systems and increasing competition in the insurance and drug markets. 
  -­  Lowering prescription drug costs by allowing Americans to buy their medicines
      from other developed countries increasing the use of generic drugs.
• Fight for new initiatives, such as:
  -­  Advancing the biomedical research field.
  -­  Fighting AIDS worldwide. 
  -­  Supporting Americans with disabilities. 
  -­  Improving mental health care.

Obama doesn’t support a mandated plan because he says that people don’t have health care because it’s too expensive, not because they don’t want it. He would create a national health insurance program for those without employer-provided health care and who don’t qualify for existing federal programs. Although it doesn’t mandate individual coverage for all Americans, it does require coverage for all children.⁴

According to Obama, his plan will save the typical family up to $2,500 every year through:

• Investing in health information technology.
• Improving prevention and management of chronic conditions.
• Reducing insurance overhead by increasing insurance industry competition and reducing underwriting costs and profits.
• Reducing insurance premiums by providing reinsurance for catastrophic coverage.
• Making health insurance universal, reducing spending on uncompensated care.⁵

Obama’s central proposition is that the government can intervene to improve the quality of health care provided in the U.S.⁶ He estimates that his plan would cost $50 billion to $65 billion a year, which he would pay for in part by rolling back tax cuts for those who make more than $250,000 enacted by President Bush.⁷

John McCain’s plan

“The biggest problem with the American health care system is that it costs too much… Businesses and families pay more and more every year to get what they often consider to be inadequate attention or poor care.”

John McCain — Des Moines, Oct. 11, 2007 ⁸

According to John McCain’s website,⁹ McCain believes the key to health care reform is to reduce costs and restore control to the patients themselves by:

• Reforming health care to make it easier for individuals and families to obtain insurance – his plan will use competition to improve the quality and variety of health insurance to meet individual’s needs, lower prices and encourage portability by allowing the purchase of health insurance nationwide, across state lines.
• Reforming the tax code to offer more choices beyond employer-based health insurance coverage by offering the option to receive a direct refundable tax credit of $2,500 for individuals and $5,000 for families to offset the cost of insurance.
• Increasing the benefits of health savings accounts (HSAs) for families.
• Working with states to establish a guaranteed access plan to take care of the traditionally uninsurable.
• Promoting disease and individual case management, as well as health and wellness programs.
• Proposing initiatives that can lower health care costs, such as:
  -­ Lowering drug prices with through safe reimportation of drugs and faster
     introduction of generic drugs. 
  -­  Providing quality, cheaper care for chronic disease. 
  -­  Promoting coordinated care. 
  -­  Expanding access to health care through walk-in clinics in retail outlets.
  -­  Greater use of information technology. 
  -­  Reforming the Medicaid and Medicare payment systems. 
  -­  Bringing transparency to health care costs.

McCain contends soaring health care costs are the result of treatment for chronic diseases, such as cancer, diabetes, lung problems and heart disease. He wants to improve preventive care and develop a national medical records network to enhance the care of people with chronic diseases.¹⁰

McCain’s staff said his proposal would cost about $10 billion a year in reduced federal tax revenues and subsidized coverage for the poor.¹¹

Analyzing the candidates’ health care reform plans

Obama’s plan encourages the sharing of risk between the healthy and the sick, while McCain’s plan maximizes individual choice in obtaining coverage, at the cost of reducing risk-sharing.¹²

One analyst feels that McCain may be pushing for greater changes than Obama. Today, employers can write off the cost of health insurance premiums as a business expense, just like salaries. But employees don’t pay taxes on the value of that benefit, making employer-provided coverage tax-free for the 60 percent of workers who receive health benefits through their employers. In addition to being administratively efficient, this system promotes the pooling of risk.¹²

According to a Kaiser Family Foundation survey released last year, the average annual premium of an employer-based insurance policy is $12,000, of which employees pay about one-third.¹¹ By ending the employer tax exemption, employees would pay taxes on those benefits.

McCain’s plan would steer millions of additional Americans toward individual insurance, but many experts feel that the individual market can’t handle the load. Higher administrative costs for individual policies mean that a worker switching from a group policy to an individual one receives less coverage for the same price. And the cost of individual policies varies greatly, depending on the individual’s health.¹³

Plus, almost all analysts think that some employers would drop coverage if the tax exclusion is eliminated. Another concern is that younger workers would take the tax credit and buy inexpensive policies outside work, leaving employers to cover only the oldest and sickest. Obama says he would avoid this by reinforcing group coverage by maintaining the employer tax exclusion and adding new subsidies for companies to insure their workers.¹²

McCain would address these concerns by deregulating the insurance industry, allowing families to purchase health insurance across state lines, creating a bigger pool and better balancing risk. Currently, insurers need to follow the laws of the states where they sell their plans. He would also establish government-subsidized “high-risk” pools for those who still can’t buy private insurance due to pre-existing health issues.¹³

Obama’s plan would restructure the health insurance industry by imposing new national standards. He would also establish government-organized purchasing exchanges for individuals and small businesses, requiring insurers that participate in them to sell the policies to everyone at comparable prices, regardless of their health.¹³

Both McCain and Obama agree that a stronger role for primary care physicians and much bigger emphasis on preventive medicine would cut costs and improve care. They both also want to expand health information technology.¹⁴ This is a good idea, but these efforts are already underway in the U.S. health care system and is harder to accomplish than it first sounds.¹⁵

What does the insurance industry say? According to one article, America’s Health Insurance Plans (AHIP), the industry’s trade association, has endorsed a tax credit for the uninsured similar to the one McCain proposes, but opposes eliminating the tax break for employer-based coverage. AHIP has also not endorsed nationwide insurance sales.¹³

Aetna has long recognized the need for health care reform and has been involved in several efforts to make it happen. We were one of the first health benefits companies to embrace the concept of consumerism – giving members greater control over their health care decisions and spending. We also place a strong emphasis on all aspects of wellness – from encouraging a healthy lifestyle to providing benefits for preventive care and disease management. Aetna is also the first to endorse an individual mandate to obtain coverage. Ron Williams testified to this before the U.S. Senate Finance Committee on June 11.

Click here to read Aetna’s Proposal for Health Care System Transformation.

Click here to read about Ron Williams interview in FORTUNE magazine

Click here for the news release on Ron Williams’ testimony before the U.S. Senate Finance Committee.

Additional links

Comparison of Barack Obama’s and John McCain’s health care reform plans

Barack Obama’s website

John McCain’s website

NY Times Election Guide to the Issues: Health Care

Uninsured adults are more likely to be diagnosed with a disease, such as cancer, at an advanced stage, which greatly reduces their chance of survival. The Institute of Medicine found that uninsured adults are 25 percent more likely to die prematurely than adults with private health insurance.

The first wave of baby boomers turn 62 this year and will begin claiming Social Security benefits. And, according to new research from the National Association of Insurance Commissioners (NAIC), many are confused about their post-retirement health insurance options, including their Medicare eligibility.The NAIC’s national survey of 377 baby boomers — Americans born between 1946 and 1964 — found that only 36 percent correctly knew that Medicare eligibility begins at age 65.

Twenty-one percent thought Medicare coverage began at age 62; 9 percent said age 67; 6 percent said age 59½; and 28 percent said they were unsure of the age.

The NAIC survey also found: A large majority of baby boomers — 84 percent — said that access to health insurance was important when choosing a retirement date.

However, only 43 percent said that Medicare eligibility was an important factor in determining when they would retire. However, 48 percent said they expected to use Medicare to cover their health care needs during retirement. This number increased to 57 percent among older baby boomers, those 55 to 62 years of age.

In addition to these findings, the NAIC survey revealed a considerable lack of familiarity with Medicare’s coverage options. Sixty-six percent of respondents said they were “not very familiar” or “not at all familiar” with options such as Medicare Part B, Medicare Advantage plans, Medicare prescription drug coverage, and Medicare supplement (Medigap) insurance.

This number jumped to 72 percent among younger baby boomers, those 44 to 54 years of age.

A high level of concern about Medicare’s viability also added to the confusion. Eighty-two percent of those surveyed said they were concerned that future funding for Medicare might not be sufficient to provide the health care services they anticipate needing throughout their retirement.

Check back often for updates on improvements and offers in the realm of personal health insurance. This is a place for information and education concerning personal health insurance for the business owner and individual. Hi there.