• Do not unzip the file if it gets downloaded as a .pptx.zip file (unless it is supposed to be a .zip file).
• Rename the file to remove the .zip extension and keep the .pptx extension.

.pptx files are viewable with:

• Microsoft Powerpoint in Microsoft Office 2008 for Mac Home and Student Edition. You can download a free 30 day trial version.
• Impress in OpenOffice which is free.  OpenOffice doesn’t display the .pptx files perfectly but it is good enough if you just want to be able to read the file.
• Keynote in Apple iWork.  You can download a free 30 day trial version.

Anthem Blue Cross revised the PPO Share (HIPAA) 2009 rates earlier this year, so I am redoing my previous financial analysis of the low deductible vs. high deductible PPO Share (HIPAA) plans with the new prices here.

In the new pricing scheme, the difference in premium between the low deductible and high deductible plans is smaller and also decreases with the person’s age, reaching no difference at ages 60-64. Previously, the difference in premium increased with the person’s age. Both of these changes make it more likely than before that the low deductible plan would be the better choice. However, as before, the pricing scheme is entirely subject to change every year.

The plans have 30% co-insurance for the majority of in-network services. This graph and analysis only takes into account in-network services.

On the x-axis is the cumulative in-network medical bill per year. On the y-axis is the total patient cost per year including monthly premiums and out-of-pocket costs for covered health care. The two lower plots are for a younger person aged 30-34 and the two higher plots are for an older person aged 60-64.

Premium

The y-intersect value at x = 0 is the cost of the health insurance premium for one year (12 months). This is what it costs per year if you have zero medical bills and your only cost is the health insurance premium. In this example, for a person aged 30-34, the yearly premium for the low deductible plan is $411/mo. * 12 mo. = $4932, and the yearly premium for the high deductible plan is $360/mo. * 12 mo. = $4320. For a person aged 60-64, the yearly premium for both the low deductible plan and high deductible plan is $756/mo. * 12 mo. = $9072.

The relatively high prices of the monthly premiums used in my example are for the HIPAA plans in “Area 3″ (Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara counties) in California. As described in my previous article, HIPAA plans are one of the guaranteed-issue health insurance plans for individuals and families who would otherwise be uninsurable after losing employer-sponsored group health insurance coverage and exhausting COBRA.

Deductible

The first section of the plots where the slope = 1 corresponds to the deductible. Until the deductible limit is reached, the patient pays the full cost (at the network rate) of any medical bills. In this example, we are comparing a plan with a $1500 deductible and a plan with a $5000 deductible.

Co-insurance

The second section of the plots where the slope = 0.3 corresponds to the 30% co-insurance for in-network medical services. Mathematically-speaking, the plot of the low deductible plan changes slope from 1 to 0.3 at $1500 in medical bills for covered services, and the plot of the high deductible plan changes slope from 1 to 0.3 at $5000 in medical bills for covered services.

Out-of-pocket maximum

The last section of the plots where the slope = 0 corresponds to the out-of-pocket maximum. After the out-of-pocket maximum has been reached for the year, the patient no longer has to pay any more for covered medical services. In this example, the low deductible plan has an out-of-pocket maximum of $6000 and the high deductible plan has an out-of-pocket maximum of $7500.

Although the out-of-pocket maximum is $1500 less for the low deductible plan than for the high deductible plan, in this example, for a person aged 30-34, since the premium for the low deductible plan costs $602 more per year than the high deductible plan, the remaining difference after the out-of-pocket maximums have been reached is only $898 per year. The difference becomes larger as a person ages since the difference in price between the low deductible and high deductible plans decreases with age. For a person aged 60-64, the premium for the low deductible plan costs the same as for the high deductible plan so the difference after the out-of-pocket maximums have been reached is $1500 per year.

Low deductible vs. high deductible

We can see from this graph that an individual aged 30-34 on the low deductible plan starts with a higher premium than the high deductible plan, and pays the full cost of medical services for a shorter amount of time before paying the reduced 30% co-insurance.

Where the plots intersect corresponds to the break-even point between the low deductible and high deductible plans. In this example, for a person aged 30-34, the break-even point occurs at $2360 in in-network medical bills per year. For a person aged 60-64, the low deductible plan is always less than or equal to the cost of the high deductible plan.

People who expect to have lower medical bills on average per year than the break-even point should expect to save money with the high deductible plan, and people who expect to have higher medical bills on average per year than the break-even point should expect to save money with the low deductible plan.

Imagining a vertical line at each x-value, the difference in y-value between the point on the plot for the low deductible plan and the point on the plot for the high deductible plan is the difference in total cost for x amount of cumulative in-network medical bills per year.

One thing to note is that a $1500 deductible plan does not ever save you $3500 over a $5000 deductible plan when there is co-insurance. In this graph, the maximum amount saved corresponds to the maximum difference between the plots of the low deductible plan and the high deductible plan, which occurs during the parallel section of the middle (co-insurance) section of the plots where the slope = 0.3. For a person aged 30-34, the most the low deductible plan would ever save over the high deductible plan in any year is $1838. For a person aged 60-64, the most the low deductible plan would ever save in over the high deductible plan in any year is $2450.

To help me decide whether to purchase the low deductible ($1500) or high deductible ($5000) version of the Anthem Blue Cross PPO Share (HIPAA) health insurance plan, I graphed the comparison.

The following graphical comparison of a low deductible plan versus a high deductible plan is based on the Anthem Blue Cross PPO Share HIPAA plans before they revised their pricing scheme in the first quarter of 2009. The plans have 30% co-insurance for the majority of in-network services. This graph and analysis only takes into account in-network services.

On the x-axis is the cumulative in-network medical bill per year. On the y-axis is the total patient cost per year including monthly premiums and out-of-pocket costs for covered health care. The two lower plots are for a younger person aged 30-34 and the two higher plots are for an older person aged 60-64.

Premium

The y-intersect value at x = 0 is the cost of the health insurance premium for one year (12 months). This is what it costs per year if you have zero medical bills and your only cost is the health insurance premium. In this example, for a person aged 30-34, the yearly premium for the low deductible plan is $437/mo. * 12 mo. = $5244, and the yearly premium for the high deductible plan is $360/mo. * 12 mo. = $4320. For a person aged 60-64, the yearly premium for the low deductible plan is $919/mo. * 12 mo. = $11,028, and the yearly premium for the high deductible plan is $807/mo. * 12 mo. = $9684.

The relatively high prices of the monthly premiums used in my example are for the HIPAA plans in “Area 3″ (Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara counties) in California. As described in my previous article, HIPAA plans are one of the guaranteed-issue health insurance plans for individuals and families who would otherwise be uninsurable after losing employer-sponsored group health insurance coverage and exhausting COBRA.

Deductible

The first section of the plots where the slope = 1 corresponds to the deductible. Until the deductible limit is reached, the patient pays the full cost (at the network rate) of any medical bills. In this example, we are comparing a plan with a $1500 deductible and a plan with a $5000 deductible.

Co-insurance

The second section of the plots where the slope = 0.3 corresponds to the 30% co-insurance for in-network medical services. Mathematically-speaking, the plot of the low deductible plan changes slope from 1 to 0.3 at $1500 in medical bills for covered services, and the plot of the high deductible plan changes slope from 1 to 0.3 at $5000 in medical bills for covered services.

Out-of-pocket maximum

The last section of the plots where the slope = 0 corresponds to the out-of-pocket maximum. After the out-of-pocket maximum has been reached for the year, the patient no longer has to pay any more for covered medical services. In this example, the low deductible plan has an out-of-pocket maximum of $6000 and the high deductible plan has an out-of-pocket maximum of $7500.

Although the out-of-pocket maximum is $1500 less for the low deductible plan than for the high deductible plan, in this example, for a person aged 30-34, since the premium for the low deductible plan costs $924 more per year than the high deductible plan, the remaining difference after the out-of-pocket maximums have been reached is only $576 per year. The difference becomes even smaller as a person ages since the difference in price between the low deductible and high deductible plans increases with age. For a person aged 60-64, the premium for the low deductible plan costs $1344 more per year than for the high deductible plan so the remaining difference after the out-of-pocket maximums have been reached is only $156 per year.

Low deductible vs. high deductible

We can see from this graph that an individual on the low deductible plan starts with a higher premium than the high deductible plan, and pays the full cost of medical services for a shorter amount of time before paying the reduced 30% co-insurance.

Where the plots intersect corresponds to the break-even point between the low deductible and high deductible plans. In this example, for a person aged 30-34, the break-even point occurs at $2820 in in-network medical bills per year. For a person aged 60-64, the break-even point occurs at $3420 in in-network medical bills per year.

People who expect to have lower medical bills on average per year than the break-even point should expect to save money with the high deductible plan, and people who expect to have higher medical bills on average per year than the break-even point should expect to save money with the low deductible plan.

Imagining a vertical line at each x-value, the difference in y-value between the point on the plot for the low deductible plan and the point on the plot for the high deductible plan is the difference in total cost for x amount of cumulative in-network medical bills per year.

One thing to note is that a $1500 deductible plan does not ever save you $3500 over a $5000 deductible plan when there is co-insurance. In this graph, the maximum amount saved corresponds to the maximum difference between the plots of the low deductible plan and the high deductible plan, which occurs during the parallel section of the middle (co-insurance) section of the plots where the slope = 0.3. For a person aged 30-34, the most the low deductible plan would ever save over the high deductible plan in any year is $1628. For a person aged 60-64, the most the low deductible plan would ever save in over the high deductible plan in any year is $1206.

With this analysis, I decided for myself to purchase the high deductible plan, Anthem Blue Cross PPO Share 5000 (HIPAA). The reasons include the following. The low deductible plan would guarantee my paying at least $924 more per year every year, and this would increase with age. The amount potentially saved with the low deductible plan in years when medical bills are higher is fairly small.

One last thing to note is that Anthem used to charge the same premium for both the low deductible and high deductible HIPAA plan. In that case, the low deductible plan is obviously better. In 2009, the high deductible plan has a lower premium. In the event that they return to the same premium for low and high deductible plans, locking in to the high deductible plan now and then having to pay the same premium as the low deductible plan later would become relatively worse off.

How to start and stop the Apache HTTP Server

1. Go to: System Preferences -> Sharing
2. To start the server, select Web Sharing. To stop the server, unselect it.

Install MySQL

1. Download MySQL for Mac OS X. For my computer, I used the package format for Mac OS X 10.5 (x86).
   
2. Verify package integrity using MD5 checksums or GnuPG.
3. Follow the instructions for installing MySQL on Mac OS X. I recommend installing both the MySQL Startup Item and preference pane as well. These will make it possible to have MySQL start automatically during system startup and enable you to start and stop the MySQL server with a click of a button.
4. Post-installation setup and testing.

Enable PHP

Mac OS X comes with the Apache HTTP Server and PHP installed. The PHP module needs to be enabled.

Find the location of httpd.conf, the main configuration file for the Apache HTTP Server, using the command, httpd -V.

Note: The $ at the beginning of the lines in the following examples is the command prompt.

$ httpd -V | grep SERVER_CONFIG_FILE
-D SERVER_CONFIG_FILE="/private/etc/apache2/httpd.conf"

Beware. Proceed only if you know what you are doing. I expect that you have the technical ability of a software developer familiar with Unix.

Edit the httpd.conf file using root access with the sudo command and your favorite text editor. I use vi.

$ sudo vi /private/etc/apache2/httpd.conf

Uncomment the line:

# LoadModule php5_module

Save the file and exit.

Start the HTTP server and test that PHP is running by creating a file in your Web directory containing a call to the function phpinfo().

File: /Users/<username>/Sites/test.php

<?php phpinfo(); ?>

Navigate to the URL, http://localhost/~username/test.php .

Change MySQL socket

If you were to try to install WordPress now, you would probably run into this error:

Error establishing database connection

This error occurs because the PHP build that comes installed on Mac OS X (Leopard) is configured to look for the MySQL socket at /var/mysql/mysql.sock. In the current release of MySQL, the default socket is at /tmp/mysql.sock. Here is how to fix this.

Find the PHP configuration file path from the call to phpinfo() from earlier. It is probably /etc and this location is probably a symbolic link to /private/etc.

Create a php.ini file if it doesn’t already exist by copying the default configuration file, php.ini.default, using root access with the sudo command. Give the root user write permission on the file.

$ cd /private/etc
$ sudo cp php.ini.default php.ini
$ sudo chmod +w php.ini

In php.ini, edit the two lines for the parameters mysql.default_socket and mysqli.default_socket to be:

mysql.default_socket = /tmp/mysql.sock

mysqli.default_socket = /tmp/mysql.sock

Save the file and exit.

Enable .htaccess

If you want to use pretty permalinks in WordPress, you need to enable .htaccess. Otherwise you will see this error:

404 Not Found: The requested URL <URL> was not found on this server.

Edit the Apache configuration file to allow override. If you are using your Sites Web directory:

$ sudo vi /private/etc/apache2/users/<username>.conf

Find AllowOverride and change its value from None to All.

AllowOverride All

Save the file and exit.

Start Apache HTTP Server

Now that you have enabled PHP and .htaccess, restart the HTTP server.

Download and extract WordPress

Download and extract WordPress. To have WordPress automatically configure wp-config.php, before you proceed with Step #3 of the WordPress installation instructions, set the file permissions as follows.

Set file permissions

On Mac OS X (Leopard), the Apache HTTP Server runs under the user account, _www which belongs to the group _www. To allow WordPress to configure wp-config.php during installation, update files during upgrades, and update the .htaccess file for pretty permalinks, give the server write permission on the files.  I do not know if there are any security issues with this.  If you are more knowledgeable than I am on this matter, please chime in!

Updated February 17, 2010. My preferred way to do this is to change the group of the wordpress directory and its contents to _www and give write permissions to the group. Keep the owner as your <username>.

$ cd /Users/<username>/Sites
$ sudo chown -R <username>:_www wordpress
$ sudo chmod -R g+w wordpress

However, when I tried this, it did not work for automatic upgrades to newer versions of WordPress although it worked for automatically updating the .htaccess file for pretty permalinks.  End of update.

Another way to do this is to change the user of the wordpress directory and its contents to _www.  Keep the group as staff, a group to which your user account belongs and give write permissions to the group.

$ cd /Users/<username>/Sites
$ sudo chown -R _www wordpress
$ sudo chmod -R g+w wordpress

With both of these methods, the WordPress directories have a permission level of 775 and files have a permission level of 664. No file nor directory is world-writeable.

For reference, the Apache configuration file, httpd.conf, contains entries for the User and Group which the server will run as. The default setting is www for both.

For reference, on Mac OS X (Leopard), the user account information is located in the file:

/private/var/db/dslocal/nodes/Default/users/_www.plist

This file shows that the _www and www name map to the same user account.

Install WordPress

Now resume the steps for installing WordPress. If you did not change the file permissions, you will need to edit the wp-config.php file yourself instead of having WordPress create it automatically.

Follow Symbolic Links

In some Apache server configurations, mod_rewrite requires FollowSymLinks to be enabled. Otherwise you might see this error:

403 Forbidden: You don’t have permission to access <URL> on this server.

Add this line to the top of your .htaccess file:

Options +FollowSymlinks

All done!

References

• httpd.conf location « splintor’s blog
• Mac, WordPress: “Error establishing a database connection” « A Fool’s Wisdom
• PHP & MySQL on Leopard: mysql.sock Location « beyondmac.com
• Enabling .htaccess in OS X « ClagNut
• Soup-to-nuts WordPress, PHP5 and MySQL on Mac OS X Leopard « The Book of Ryan
• Directory and File permissions. WordPress Support forum.
• When do I need Options +FollowSymLinks? Webmaster World forum.

Respond

Please let me know if you find any errors or have anything to add.

Here is an example shell script:

ftp -in <ftp-server> << EOF > ~/log.txt 2>&1
user <username> <password>
cd <directory>
get <file>
bye

Another way to send the username and password is:

ftp -in <ftp-server> << EOF > ~/log.txt 2>&1
quote USER <username>
quote PASS <password>
cd <directory>
get <file>
bye

The ftp -i option turns off interactive file prompting during multiple file transfers. The -n option prevents “auto-login” upon initial connection, which could involve prompting for a username and password.

<< EOF is a syntax called a here-document. It uses I/O redirection to feed a list of commands to an interactive program such as ftp until reaching the specified delimiter, end-of-file in this example. For more information, visit the Wikipedia article and the Advanced Bash Scripting Guide chapter at The Linux Documentation Project.

> redirects stdout to the specified file. The output of the program gets written to the specified file.

2>&1 redirects stderr to stdout. In this case, both the error messages and the output of the program get written to the specified file.

The rest are ftp commands. Please check the man pages for the ftp utility. Here is information about the ftp requests for USER and PASS sent via the quote command.

If you lose employer-sponsored group health insurance and have a medical history that makes you uninsurable in the individual health insurance market, there are several options available that may guarantee access to individual health insurance. To be eligible for these guaranteed access plans, first you have to use all of the COBRA continuation health coverage for which you are eligible.

COBRA

COBRA continuation health coverage from an employer is normally available for 18 months after termination of employment. The price of COBRA is the full cost of the insurance plan which was formerly subsidized by the employer plus up to an additional 2% allowed for administrative costs.

For example, while I paid only about $50 per month for a premium coverage health insurance plan for myself while I was working for a large corporation, I paid about $550 per month for the same plan while on COBRA. The full price of the medium coverage plan at my company, still a very good plan, for a single person was about $275 per month.

Cal-COBRA

In California, Cal-COBRA extends similar protections to employees of smaller businesses with 2 to 19 employees to which federal COBRA law does not apply. It also extends the length of eligibility for continuation health coverage to 36 months.

Note that Cal-COBRA does not apply to employers with self-insured plans. Many large corporations are self-insured. In this case, you would have 18 months of continuation health coverage instead of 36 months.

Conversion Coverage

Some group health insurance plans may have conversion coverage where your plan is converted from a group plan to an individual plan without being underwritten.

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) provides some protections for people after they lose employer-sponsored group insurance coverage. In California, all health insurance carriers that sell individual plans must offer their two most popular individual plans to people who qualify under HIPAA.

The rates are expensive, for example, ranging from about $300 per month for an individual in his 20s to about $1000 per month for an individual in his 60s for a plan from Anthem Blue Cross, depending on the plan and region. Information about the plans and rates is available at the Web sites linked above and below.

Dave Fluker is an insurance agent in California who specializes in guaranteed-issue health insurance plans which are not underwritten.

The application process is quick and simple. I faxed my application to the agent, received an e-mail confirmation of receipt from Anthem Blue Cross three days later, and received an e-mail notification of approval from Anthem two days after that.

MRMIP

If one is not eligible for HIPAA, California has a high-risk insurance pool, the Major Risk Medical Insurance Program (MRMIP). There is often a wait list and the benefits are limited.

For more information, visit:

• California Department of Managed Health Care
• Foundation for Health Coverage Education