The Health Shopper

In the past, employers have offered various weight loss, diet and nutrition, and smoking cessation classes, but the programs have done little to ameliorate poor health practices – and they’ve failed to pull in a crowd. Now, along with the free programs, many employers are tacking on much higher premiums for unhealthy employees.

While the programs will remain voluntary, employees will likely find that utilizing them will be beneficial in the long run. From lowered premiums to employer bonuses to HSAs, the financial rewards for taking advantage of the programs are likely to be a big push for employees. For example, Union Pacific employees can currently receive up to $300 in employer contributions to their HSAs if they complete a provided health assessment, don’t use tobacco, and go in for an annual physical.

According to Reuters almost 40 percent of employers will begin hiking premiums for unhealthy employees in 2012, more than doubling the 19 percent of employers using the penalty strategy this year.

Earlier this week we reported on open enrollment 2011-2012. Wall Street Journal just came out with a helpful article examining significant aspects of this season’s open enrollment. Here are the highlights:

• Many employees will face increased out-of-pocket expenses, which are the charges they pay for health-care services. Notably, there will be a jump in the use of high deductibles—the upfront sums employees pay before coverage kicks in. To help workers defray those costs, some employers are offering financial incentives to those who make efforts to track and improve their health.

• Employees also will likely see at least small upticks in their monthly premiums for coverage, while some employers are trimming costs by offering a smaller array of doctors and hospitals.
• Even if employees opt for the same plan they had last year, they should watch for changes that might not be obvious, such as having to pay more to use medical providers that are outside the insurer’s network.
• You should delve into the details of plans’ charges before you choose one. Keep an eye out for where you will owe co-insurance, which is a percentage of the cost of care and tends to be more expensive than a flat co-pay, and for fees that may not count toward your out-of-pocket maximum.
• For consumers, a health savings account—which can be set up by people whose health plans meet certain requirements, such as high deductibles—has some advantages over other types of accounts. Unlike a flexible spending account, which is another type of tax-free account linked to health expenses, an HSA’s contents can be held over from year to year. Moreover, an HSA stays with you if you move to a different employer, and it can be used to save for medical expenses in retirement.

Folks, open enrollment season has rolled around once more! The exact dates vary, but enrollment typically begins around mid-to-late October and ends early in November. Here’s a rundown of the changes this enrollment season:

Health care costs have been risins across the board, both for providers as well as consumers. As a result, employers are likely to increase health insurance premiums by almost 12 percent according to consultancy Towers Watson, as well as switch from co-pays to coinsurance for doctor’s visits. Employers also plan to offer more high-deductible plans, which have lower premiums and up-front costs but can cost much more down the line.

Opening an HSA could be a great way to save should out-of-pocket expenses shoot up, and some companies contribute to employee HSAs each month. Many employers also offer wellness incentives, which could add up over the year. On the whole providers and employers are pushing wellness and preventive care to encourage healthy practices.
Be sure to get insured this enrollment season!

It’s that time of the year again, folks! The Surpreme Court’s 2011-2012 term began yesterday on Oct. 1, and a number of cases have reached the Court’s desk, two of the which have important implications for health care.
According to Andrew Cohen at The Atlantic, “in Caraco Pharmaceutical v. Novo Nordisk, the justices will broker a dispute between generic drug manufacturers and their brand-name counterparts. And in Mayo Collaborative Services v. Prometheus Laboratories, the justices will return again to the issue of whether a doctor’s diagnostic methods may be patented”.
The former, Caraco Pharmaceutical v. Novo Nordisk could massively impact prices of pharmaceuticals and the consumer’s access to generic drugs. The Mayo Collaborative Services v. Prometheus Laboratories case examines whether labs can patent certain diagnostic tests.
The star of the health care cases, however, is the Affordable Care Act. The constitutionality of reform has long been a subject of debate, and CNN predicts that we may have a verdict on the case by next June.
So keep your eyes peeled: there are big cases coming up in the high courts!

On the whole prescription drug prices have been steady for some time and are projected to remain so through 2012. According to HHS, approximately 900,000 beneficiaries are currently receiving discounts of up to 50 percent on brand-name drugs through Medicare and have seen greater accessibility in generics.

But a recent study from NERA Economic Consulting reveals that seniors, particularly those on specialty tiers in their health plan, are currently “largely unaware” of the often-exorbitant costs of prescription drugs. “Specialty tiers”, as defined by NERA, are separate prescription categories that include “higher-cost, brand name medications… used to treat conditions like cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS and lupus”.

The results of the study showed that Medicare consumers were not aware of Medicare Part D plans’ differences in prices of medicines for more serious recurring issues. They also misjudged the out-of-pocket costs for specialty-tier medications and thought they would be paying a co-pay (as opposed to coinsurance) for a prescription drug on the specialty tier. Overall, Medicare beneficiaries underestimated the prices of prescription drugs but, even worse, were not certain how much they were paying for each drug.

Medicare beneficiaries should consult with doctors and speak with Medicare or the provider directly before opting to use (and pay for) any prescription drugs.

As of Jan. 1, a variety of preventive screenings and services have been fully covered under Medicare. However, beneficiaries may not be fully aware of the new preventive services offered. The Centers for Medicare and Medicaid Services (CMS) has acknowledged that public awareness of the benefits needs to be increased, and that more needs to be done despite continuing efforts.
According to CMS, over 50 percent of Medicare beneficiaries utilized the new preventive screenings, but very few of the Medicare recipients have taken advantage of the Annual Wellness Visit, which includes consultations with health care providers to go over medical history, genetic inclinations, prescriptions, risk factors, choices for treatment, and to create screening schedules and take basic measurements.
Some of the free screenings include:

• Annual mammogram
• Annual prostate cancer screening
• Annual diabetes screening, twice a year for prediabetic patients
• Colonoscopy every 10 years, every 2 years for high risk patients
• Bone mass measurement every 2 years

You can have great, affordable health insurance, and fully utilize your benefits, but at the end of the day a good plan alone can’t ensure your good health the way you can. Maximizing the limited time with your physician is a key aspect of getting good health care.

Be clear, be thorough: In quantifiable terms if possible, give your doctor a clear idea of any symptoms you may have as well as any changes or issues in body functions from fatigue and bowel movements to sleep habits. Make sure your doctor has a good idea of any major lifestyle habits you may have.

Don’t be afraid to get a second opinion: Because different doctors prefer different diagnostic tests and treatment methods, and some interpret test results differently than others, it’s never a bad idea to ask around. This is especially true for any major diagnoses or treatments; before you shell out for the procedure, it’s best to double-check.

Be prepared: Make a mental list of your symptoms and know your history in context, along with any medications you use. If you have multiple issues to discuss, prioritize them ahead of time to ensure that all of your needs are addressed.

Don’t be afraid to ask: … or tell. Questions on dosage, expenses, even basic bodily functions? Ask. And tell! What seems minor to the patient could be of great significance to the practitioner. Keep in mind that during your appointment, you should have the physician’s undivided attention – so claim it! When it comes to matters of your health, you’re always better off knowing with certainty than having to guess and make assumptions.

Tis’ the season for sneezes. Allergies are always a pain, but here are some easy ways to keep the sniffles and itchy eyes to a minimum!

1. Shield your eyes. When you go outdoors be sure to wear sunglasses. This way, you protect your eyes from the sun as well as allergens!
   
2. Check the weather. Pollen counts tend to be higher on dry, windy days, so keep that in mind when you head outside.
   
3. OTC medication. Antihistamines, topical nasal sprays and eye drops can help soothe seasonal allergic reactions.
   
4. Keep the outside out. Make sure to wash up and change when you get inside, as you could carry allergens on you or track them into your home.
   
5. DIY! Sometimes home remedies, such as nasal irrigation with salt water, can be just as effective as some OTC goods.

As Americans shop around and the end of open enrollment hastens closer, it is good to keep in mind some of the additional advantages and reform-provided tweaks to all new health care policies.

1. Children under the age of 26 can be signed up under their parents’ plan – but don’t forget to enroll them, because this provision does not take effect automatically!
2. Flexible spending accounts can no longer be used to buy OTC medicines without a prescription, but you’ll still be able to use the money for everything else (including deductibles, treatments, etc.).
3. Children under the age of 19 cannot be excluded from any plan due to pre-existing conditions.
4. If your plan is no longer “grandfathered” you will be provided preventive services without co-pays, coinsurance or deductibles. Plans are required by the reform law to tell you whether or not they are grandfathered – so if you’re not sure, ask!

Happy open enrollment season!

Including costs, both medical and nonmedical, researchers at the George Washington University have put an alarming price tag on being obese: an individual’s cost of obesity stands at
$4,879 annually for women and $2,646 for men.

And according to ABC News, almost 10 percent of the country’s medical costs are linked to obesity treatment. The study provides even more incentive for our nation to rein in the obesity epidemic, both as health-conscious people and as consumers of health care.

Some of the reform bill’s provisions do lightly tackle the obesity problem. For example, chains and vending machines that have 20 or more locations will be required to provide nutrition data and caloric information for their products. Insurance providers are also required now to offer free preventive care services for consumers as part of their health insurance benefits package, which includes obesity screening.