About Health Insurance

Lemon Laws Provide Remedy for Defective Cars

2011-11-29T15:05:00.002-06:00

Have you ever bought a new car hoping to be repair worry free for sometime and found that you have frequented the dealer repair shop for the same problem more times than you care to have? You may have a "lemon" and yes, there is recourse.

A "lemon" is American slang for a car which turns out to be defective after it is purchased. In 1970 Nobel prize economist, George Akerloff published a paper: The Market for Lemons: Quality Uncertainty and the Market Mechanism. It discussed lemon cars in the used car business and asymmetry of information meaning that the seller may have had information that the buyer did not have at the time of purchase, making the quality of the product uncertain. Five years later, the US Congress enacted the Lemon Law also known as the Magnuson-Moss Waranty Act to protect new car buyers in all states. Different states may have different additions to the law. State laws provide the new car owner, remedy when the car repeatedly fails to meet average standards of quality. Although enacted for new car buyers, there are also some provisions for used car purchases in most states. When faced with a lemon complaint, it may be helpful to consult a lawyer such as Lemon Law attorneys in California or other states.

The premise of "Lemon Law" is a breach of warranty by the manufacturer. Some requisites for a car to be considered a lemon (such as in the California Consumer Warranty Law) include:

The manufacturer or its agents have made four or more attempts to repair the same problem and/or the car has been out of service for 30 or more days, not necessarily consecutive.
The car problem is covered by the warranty, has caused decrease in use or value and is not due to owner abuse or negligence.
The four repair attempts occurred within 18 months of purchase or 18,000 miles whichever comes first.
The owner has directly notified the manufacturer of the problem as required by law or by the warranty.

In California, consult California Lemon Law attorneys for other provisions of the law. Consult your state lemon law attorneys for provisions in your particular state.

Essentially you have the responsibility to:

Notify the manufacturer of the defect within the warranty period. Be sure to read your warranty declarations and be aware of the time or mileage limits.
You must give the manufacturer or its agents the opportunity to repair the defect. It is customary to allow the manufacturer four attempts. Be sure to keep a record of the problem, repairs done and the results and the time period that the car was not able to be in service due to the defect. Keep receipts.
Be sure to service your car at recommended intervals, keep records of the service and repairs performed regardless of who performs it, and again, keep receipts.
In states like California, you may be required to submit to arbitration.

Warranty Laws may also apply in certain instances to used cars which still fall under warranty. It pays to be a responsible and aware consumer. For more information, contact the Federal Trade Commission at http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt192.shtm.

Watch this video on how to file a consumer complaint with the FTC.

Europe

2011-11-17T00:10:00.001-06:00

Guest written by our friend Donnie Donovan

I logged onto http://www.directstartv.com/ and upgraded our television package when I learned that we were going to be able to go on our dream vacation. My husband and I have been wanted to go to Europe for years, but have never been able to afford it. Now, we have saved money in a special account for a couple of years that we got back from our tax returns for the last five years and have decided that now is the time. I wanted to upgrade our television package to make sure that we were going to be able to get all of the travel channels. I have loved watching all of the shows and getting ideas about where to visit and where to eat. My favorite travel show is the one that feature Samatha Brown. I just love her personality and like how she takes affordable trips, what we are hoping to achieve on this long overdue vacation! I think that this is going to be the only time that we get to go to Europe for a long time, so I really want to make sure that we do it right and see everything that we want to see.

Medical Identity Theft Protection

2011-10-29T15:16:00.000-05:00

While most of us have become increasingly aware of identity theft and follow reasonable precautions to safeguard our credit cards and bank accounts, we must now pay closer attention to health information and medical identity theft protection. The next year will see implementation of electronic medical records in full force which places medical records breach an ever increasing possibility. Identity theft protection companies such as Identity Hawk will become crucial participants in monitoring information breach.

Consequences of Medical Identity Theft:

Life threatening errors: Erroneous medical information, laboratory and other test results may not only result in the wrong diagnosis and treatment but in life threatening drug interactions, wrong procedures and medications.
Financial consequences to the individual as well as to the public in general: The Ponemon Institute, a watch dog agency which conducts research on security breach estimates that in 2010, there were 1.5 million victims of medical identity theft at a total cost of $26 billion or $20,000 per victim. In 2011, the Department of Health and Human Services allocated $1.7 billion for fraud detection.
Individuals have been billed for services they have never received. Identity theft has resulted in erroneous caps in medical insurance and the victim becoming liable for large co-payments when insurance benefits are maxed out. Victims have suffered denial of medical insurance due to false medical information. (Medical Identity Theft:The Information Crime that Can Kill You)
Limited victim recourse: While bank and credit card companies offer some degree of fraud protection to the victim, there is very little recourse available to the medical identity theft victim.
Increased cost of medical care: Protection measures essential to the security of protected health information will certainly add to the administrative cost of medical care which gets passed on to the consumer.
Loss of reputation: Damming false medical information once entered into the medical record may follow a victim

Consumer should utilize the same precautions with their medical insurance and social security information as they do with their credit card and bank information.The Department of Health and Human Services has proposed certain safeguards to the implementation of the HITECH Act of 2009 (Health Information and Clinical Health Act) to include the right and ability of the consumer to request a record of who has accessed his protected health information.

Baking Novice

2011-09-14T01:40:00.000-05:00

This guest post from Rafael Hodge

I didn’t know a thing about baking when I started at the shop but Jenny was so sweet and was really patient with me while I learned. I’ve been here about two years now and while I’m still no Wolfgang Puck I’m getting better every day and I’m even starting to like waking up at like 3 in the morning! The people I work with are just great and Jenny allows me to play to my strengths which really lie in organization. She has me doing all the payroll stuff and the bank card processing and that makes me feel better about what I’m contributing to the bake shop as a whole. I wish I could be as proficient as she is at icing cupcakes or getting cakes to stand straight but I’m just not and I guess I never will be. Baking isn’t in my blood like it is in hers but I tell you one thing, there’s something new in my blood since starting here and I think it’s high cholesterol!

The Simpsons' Is Still The Best Cartoon

2011-07-11T13:52:00.000-05:00

Thanks for the post from Noe Castro

When it comes to cartoons, 'The Simpsons' has been one of the best for years. The show has been on for over twenty years. Fortunately, it has remained fresh during its entire run. I watch 'The Simpsons' on directstartv.com whenever I get a chance. It is one of the most engaging shows of any kind.
'The Simpsons' features tons of characters. Outside of the main family, we see different residents of Springfield pop up in different situations. My favorite character on the show is Montgomery Burns. Burns is the old, wealthy owner of the nuclear power plant. Often times, Burns seems to think he lives in the 1920's. He references out of date technology all the time. Another great character on the show is Ned Flanders. Flanders is the religious neighbor of the Simpson family. No matter how much Homer mistreats him, Flanders remains as happy as can be.
'The Simpsons' has been on for so long that you would think they've covered every storyline possible. However, they keep finding more. Unlike most shows, episodes of the 'The Simpsons' rarely relate to one another. Each one stands alone. While the Simpson family appears in every episode, the rest of the town appears sporadically. This enables 'The Simpsons' to offer a lot of different storylines. Given that the show isn't ending any time soon, that is good news for the fans.

Senior Citizens Are in Jeopardy of Losing Health Care

2011-05-14T10:12:00.000-05:00

Rising health care costs, a decreasing income tax base, and the increasing number of retirees contribute to possible earlier depletion of the Medicare hospital insurance trust fund which is now expected to happen in 2024, 5 years earlier than previously estimated. This is frightening news to the 46 million people currently enrolled in Medicare many of whom rely solely on social security income averaging $1077 per month. Social Security retirement benefits are as well in jeopardy of being cut as the funding source dwindles.

Congress has been slow to enact substantive reforms that do not rely on obsolete premises such as cutting physician and hospital payments by 30 per cent. As in other similar situations like approving the federal budget, legislators have been painstakingly slow in acting, waiting until the very last minute to find a stop gap measure. If Congress acts true to form in its procrastination, senior citizens, health consumers, and health care providers are in for a tragic health care crisis.

The trustees of the Medicare and Social Security programs are sounding the alarm call. Led by Treasury Secretary Timothy Geithner, the trustees warn of the impending perfect storm in health care which could lead to drastic cuts in health care benefits and services.

Now more than ever, it is important for the young and old alike to make the necessary lifestyle changes to remain healthy as long as possible. Many illnesses are attributable to over indulgence, overeating, sedentary lifestyle and tobacco abuse. These are preventable and doable by the individual. It is clear that we are no longer able to simply expect someone else to fix us. We, like our government, need to be proactive with our own health care and remain healthy for as long as possible.

Walking the Dog as a Recreational Activity

2011-05-03T22:46:00.000-05:00

Contribution by Stevie Kirby

Every afternoon, my dog and I go outdoors and walk around our neighborhood. My dog, who is close to two years old, is a black and white shih-tzu whose pedigreed name is Picasso, but whom my family and I call Speckles. He has black spots on his hind legs, thus his nickname.

He's the most energetic dog who greatly enjoys our afternoon excursions. He immediately grins and runs in circles when he sees me grab his leash and tell him it is time to go on a walk. Because he is a house dog, one that is small in stature, he generally does not need a great deal of exercise. However, his veterinarian recommends a daily walk to help keep him trim and to keep him curious and in a happy mood. We prefer to walk in the afternoons instead of in the mornings because the afternoon sun helps warm his coat. He also enjoys smelling the flowers and watching the birds while walking around our neighborhood.

On our way out the door, I pause to set my home security alarm from ALLHOMESECURITY and then close and lock the door. I allow him to smell around our front yard first to orient his senses to the outdoors. Then we head off on our walk. I try to keep a brisk pace to give Speckles a good workout.

Virginia Wins Challenge to Affordable Care Act

2010-12-15T03:13:00.000-06:00

U.S. District Court Judge Henry Hudson in Richmond, Virginia delivered the first blow to the Affordable Health Care Act when he ruled on December 13, 2010 that the foundation provision mandating individual Americans to obtain minimum health insurance to be unconstitutional. He cites that in this provision, Congress overreaches its power to regulate interstate commerce. He also cites the dispute to also be about “the individual’s right to choose to participate.” Judge Hudson did not address other parts of the law allowing for implementation of other provisions.

Virginia is one of over 20 states to challenge the Health Care Reform Act which hopes to bring affordable health care to all Americans. It is expected that the ruling will eventually be kicked up to the Supreme Court. The Virginia challenge was based on the Virginia Health Care Freedom Act which bars compulsory purchase of health care insurance by its citizens. Many other states do not have similar laws thus the ruling may not generalize nationwide.

Insurance companies express concern that without the mandate for Americans to obtain minimum health insurance coverage, many individuals will not buy medical insurance until they get sick. The Affordable Care Act mandates that by 2014, insurance companies can no longer deny coverage for pre-existing illness. Without the pool of healthy subscribers diluting the pool of sick members, insurance premiums are expected to sky rocket.

Important Medicare Update on Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS)

2010-12-03T23:17:00.002-06:00

If you are an original Medicare subscriber using durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) such as diabetic testing kits, there is an important change that may affect you financially. Effective January 1,2011, Medicare will launch a new program where suppliers of durable medical equipment and supplies in select cities in 9 states must enter into a competitive bid arrangement in order for Medicare to pay for the product. In time the program will be effective nationwide.

What is this all about?

The Balanced Budget Act of 1997 mandated Medicare to find a system of competitive bidding for durable medical equipment prosthetics orthotics and supplies in an effort to provide quality goods at lesser cost. In 2002 Medicare completed demonstration studies to test the cost effectiveness and quality of competitive bidding with overwhelmingly positive results. The study showed that with competition, Medicare subscribers received quality equipment and supplies at reasonable and fair prices. Beneficiaries saved 20 per cent and remained highly satisfied. About 77 percent of winning bidders were small business suppliers.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 mandated a gradual phasing in of the competitive bidding process. The first phase showed 26 per cent projected Medicare savings. Implementation started in 2008 with notices going to interested bidders and in 2011, the plan will be in full swing in selected cities.

Who are affected?

This only involves original Medicare subscribers. Medicare subscribers who belong to HMO's are not affected. Initially the program will take effect only in the following states:

California- Riverside, San Bernardino, Ontario
Florida- Miami, Ft. Lauderdale, Pompano Beach, Orlando, Kissimmee
Missouri and Kansas- Kansas City
North and South Carolina- Charlotte, Gastonia, Concord
Ohio- Cleveland, Elyria, Mentor
Ohio, Kentucky, and Indiana- Cincinnati, Middletown
Pennsylvania- Pittsburgh
Texas- Dallas, Fort Worth, Arlington

How does this affect you?

If you live in any of these cities and are an original Medicare subscriber, this may mean lower co-insurance when you buy or rent durable medical equipment from a participating provider because the cost of the equipment or supply will be lower.
However, if you choose to use a non-participating or non-contract Medicare provider,you will be asked to sign an Advanced Beneficiary Notice (ABN) indicating you understand that Medicare does not usually pay for this service with this provider and you agree to be liable for the entire amount.

What durable medical equipment and supplies are included?

Oxygen equipment, oxygen and supplies
Mail order diabetic supplies
Wheelchairs, standard power wheelchairs, scooters and accessories
Complex rehabilitative power wheelchairs and accessories (Group 2)
CPAP- continuous positive airway pressure devices, respiratory assist devices and supplies
Hospital beds and accessories
Walkers and accessories
Support surfaces (group 2 mattresses and overlays) in Miami, Fort Lauderdale, and Pompano Beach, FL only

What do you need to do?

Check your zip code to see if you are affected. (This includes purchases or rentals you make while visiting any of the locations above.)
Get a list of contract Medicare providers in your location to be sure that Medicare will help with these purchases. Use this link Contract Supplier Lists.
You may also locate a contract provider by zip code through the Medicare website, Medicare.gov
You may call Medicare at : 1-800-Medicare (1-800-633-4227); TTY users call 1-877-486-2048.

States to Establish Health Insurance Exchanges

2010-11-28T11:31:00.003-06:00

The Affordable Care Act of 2010 meant to provide universal health care for all Americans by January 1, 2014, has given to the states the task of establishing a health insurance exchange. A health insurance exchange is an organized marketplace which provides consumers with a central place to review, compare and purchase health insurance from a pool of insurance companies.

States may choose the model of health insurance exchange, set the minimum standards of services, and ensure transparency of offerings and premiums. They may act as facilitator by establishing guidelines for different offerings and designating who may participate. States may also choose to be active participants such as in accepting or rejecting plans, number of insurance participants or as active purchasers on behalf of consumers.

The oldest model of a health insurance exchange is the Massachusetts exchange called the Health Connector formed by the Massachusetts Health Care Reform Act of 2006. The Health Connector administers the Commonwealth Care program for persons with income of 300 per cent of the federal poverty limit or below who meet certain guidelines, sets premium subsidy levels for Commonwealth Care, provides a marketplace for persons not eligible for their employer sponsored plans, persons who are unemployed or those who work for businesses with no insurance plan (50 employees or less.) It also establishes a tax penalty on those who do not participate unless they have a waiver.

The Utah Health Exchange which became operational in 2009 is another model. It serves as an electronic portal by which consumers can research and compare health plan offerings and provide an electronic enrollment process. It is based on the principles of personal responsibility,private markets and competition. It provides the consumer with information on health care choices, costs, and health insurance plan services and premiums. It also relieves employers of the burden of having to administer their own employee health plan.

In October 2010, Governor Arnold Schwarzenegger signed the California Health Benefit Exchange into law which provides for the creation of an independent public health exchange entity governed by a five member board. Whatever model California implements will be important because the state is home to ten per cent of the US population.

The US Department of Health and Human Services recently announced that it will release to the states new funding grants and guidelines for implementation of health exchange models.

How to Find Student Health Insurance

2010-10-28T00:47:00.000-05:00

Already burdened with the expense of college tuition and food and lodging, students also have to worry about medical care. Here are some important considerations when looking for student health insurance:

If you are covered by your parent's health insurance, stay on it. The recently enacted Affordable Care Act now allows parents to keep their children in their medical insurance plan until age 26. This does not apply to employed children eligible to participate in their employer's health insurance plan. Since most students only work part time or temporary jobs, they are likely not eligible for employer medical insurance plans.
Check out your college or university student health insurance plans. Since most schools require students to have health insurance, many schools offer student health plans with their tuition payments.Be sure to check what is covered, deductibles, co-insurance and co-payments. Some universities such as the University of Nebraska do offer a wide variety of benefits. Some schools fully cover services offered within the university setting such as counseling in the student counseling center but have co-insurance for services obtained privately.
If you have current health insurance, stay on it. It is likely to have better coverage than the average student health insurance.
Check with insurance brokers both in your locality and online. They generally work with different medical insurance companies that offer student health insurance and can guide you on what is best for you. be sure to exercise due diligence to be sure you are dealing with a reputable company.
Before choosing a student health insurance plan, analyze your needs and resources. If you are healthy and have enough savings to cover doctor visits, medicines and labs, you could opt for plans with high deductible and lower monthly premiums.In this case, you are simply insuring for catastrophic illness where you might require hospitalization.
Be sure to analyze not only the benefits and services covered by your student health insurance plan but also the exclusions and limitations. The New Affordable Care Act has lifted the lifetime cap on medical benefits and by 2014, the annual cap on medical usage will also be phased out. However, there are still coverage exclusions and limitations that companies impose.
Colleges and universities usually require students from foreign countries to show proof of health insurance. The considerations above can apply to them as well.
Lastly, exercise due diligence in your choice of student health insurance plans. There are outright fraudulent insurance companies out there who take your money and do not actually have you insured. You can always check with the state insurance regulator to be sure you are dealing with a reputable insurer.

Know Your Patient's Bill of Rights when Signing Up for Medical Insurance

2010-10-25T01:24:00.004-05:00

http://edlabor.house.gov/blog/2010/09/a

On March 30, 2010 President Barack Obama signed the Affordable Care Act which came into effect on September 23, 2010. This historic law affords insured patients important protections which put more control of medical insurance coverage in their hands. This is known as the Patient's Bill of Rights.

Patient's Bill of Rights:

Children can no longer be denied coverage because of pre-existing medical condition. Previously, children born with or who develop costly medical illness could be denied coverage.The law now prohibits this and by 2014, all Americans will have this protection as well. The White House expects 72,000 uninsured children will benefit from this law.

Insurance companies can no longer retroactively drop coverage for a sick insured member because he made an unintentional mistake in his application (unless fraud can be proven.) This has affected some 10,700 patients each year whose medical insurance coverage were dropped at a time when they most needed it.

The lifetime cap of medical usage and benefits has been lifted. Often patients max out on their lifetime benefit because of illness and are left to pay medical bills on their own. The law affords this protection.The annual benefit limit will gradually be phased out and will be totally lifted by 2014..

Patients may now choose their own physicians within their network. Women may choose their obstetrician and parents can choose the pediatrician for their child without first obtaining a referral from their primary care doctor.

Parents may choose to keep their adult children in their health insurance plan until age 26, unless the child is employed and eligible to participate in his employer's medical insurance plan.

In emergency conditions, patients may now use the closest emergency room even if it is out of network. Insurance plans are obligated to pay in network rates whereas in the past, the patient was penalized by having to pay higher cost sharing co-insurance for going to out of network emergency rooms.

Patients now have the right to both an internal (within the insurance company) and an external (independent third party) appeal when the medical insurance plan denies a service. In the past,patients could only go through the internal appeals process.

Patients may now receive preventive services without having to pay deductibles, co-insurance and co-pay. These services include mammograms, colonoscopies, prenatal care, immunizations and well baby care. Many Americans missed out on necessary preventive care due to the added expense.

Watch for more on the Affordable Care Act in this blog.

CDC Reports Hispanics Live Longer

2010-10-21T00:49:00.001-05:00

An October 2010 report published by the Centers for Disease Control finds that the life expectancy of Hispanics is longer than those of non-Hispanic whites and non-Hispanic blacks. This is the first ever report on the life tables of Hispanic population and non-Hispanic black population. This finding is a paradox in that of the three groups, more Hispanics currently fall into the lower socioeconomic status. Nineteen percent of Hispanics live below the poverty line.

According to the report, the Hispanic population of any age from birth has a higher life expectancy than the non-Hispanic white and non-Hispanic black population until age 95 when life expectancy of Hispanic males equal that of non-Hispanic black at 3.5 years. Of those born in 2006, Hispanics can expect to live an average of 80 years, non-Hispanic whites to 78 and non-Hispanic blacks to 73.

The report speculates the reasons could be due to data artifacts, migration effects and cultural effects. The last two are still conjecture and will require further study.

· Data artifacts could include incongruence between ethnic classifications of the numerators (data from vital registration) and denominators (data from census population estimates) of death rates, misstatement of age thus affecting the age report at time of death, and problems with data linkages which could under report the death numbers.

· Migration effects are thought to be due to migration of healthy individuals called the healthy migrant effect and the return of ill immigrants to their home country called the salmon bias effect.

· Cultural effects of family structure, lifestyle behaviors and social network found in the Hispanic community could confer some degree of protection from the negative effects of minority and low socioeconomic status.

Declining Rate of Vaccination of Children Covered by Private Health Insurance

2010-10-19T00:31:00.000-05:00

The National Committee for Quality Assurance in its State of Health Care 2010 report notes that there is a decline in the vaccination rate of children covered by private health insurance by almost four per cent while vaccination of children enrolled in Medicaid programs actually increased. NCQA report shows that multiple childern vaccinations prevent some 10.5 million diseases per birth cohort in the US and saves in direct and indirect health care costs.


www.commons.wikimedia.org

NCQA speculates that parents of children with private insurance delay or decline vaccination of their children in the unproven notion that vaccinations cause autism spectrum disease. The report notes that this thinking is fostered especially through internet articles and celebrity endorsement. Parents in private health insurance plans who are generally well educated tend to overvalue this misinformation regarding the relationship between vaccination and autism and predicts that if the trend continues, in the long run, these children of the middle class may be less healthy than children in Medicaid health insurance plans.

NCQA Report on Health Insurance Plans

2010-10-17T23:52:00.001-05:00

The National Committee for Quality Assurance, a private non profit organization, the most recognized agency that monitors health care in the US just released its State of Health Care Quality report on October 13, 2010. This is the annual report on the quality of health care in America. The interesting finding is that "health plans that spend the most on care don’t always deliver the best quality."

The analysis used the interphase between relative resource use (RRU), an indicator of health services utilization (e.g. doctor visits and hospitalizations) with the outcomes for five common costly chronic diseases and comparison between different health insurance plans within the same region and within similar members. It found that the outcome was not necessarily better with health insurance plans that utilized more services and spent more.

A relevant follow-up might be to study the factors that produce better outcomes in these chronic diseases given that more dollars spent does not insure better results. I would wager that lifestyle changes and individual responsibility for ones health will prove to be significant factors.

October Is Open Enrollment Season for Your Health Insurance

2010-10-16T18:46:00.000-05:00

Image from change.gov

Each year in October, employers provide open enrollment for the health insurance plans they provide. It is important to review the offerings, find out the changes and what it will cost you in the long run. Failure to do this will place you on the company default health insurance plan which may or may not be what you want.

Some helpful information:

Co-pay is a fixed amount that you pay when you receive health care services. You are expected to pay this with each visit.
Co-insurance is percentage difference between what the health insurance plan pays and the health care provider charges. For example, Medicare pays 80 percent of the negotiated health care charge and you are responsible for the remaining 20 per cent.
The new health care law now extends health insurance coverage of dependent children to age 26. It now includes insurance coverage for annual physical examinations and some preventive services. It also lifts lifetime coverage caps.
Check out any changes in premium structure for family plans. Instead of a single premium for a family plan, some health insurance plans may charge individual premiums for the employee, the spouse and dependent children.
Review your health service utilization in the last year to see how much to add to your flexible spending account (tax free savings plan for eligible health care expenses such as co-pays, deductibles and other health services not covered by your health insurance plan.)
Weigh your health services utilization against the value of signing up for a higher deductible and putting away the money saved. For instance, healthy young persons may opt for a higher deductible premium, saving the difference and using their flexible spending account for deductibles.
Maintain a healthy lifestyle. Most health insurance companies offer incentives for weight reduction, smoke cessation and other preventive practices.

Prescription Health Insurance: Five Ways to Save on Prescription Medications

2010-10-15T00:14:00.001-05:00

In a climate of decreasing income and high health insurance premiums buying prescription medications can eat up a good chunk of your income, even if you are lucky enough to have prescription insurance. Here are some ways to help obtain necessary medications for less.·

Generic medications:

Insurance plans usually charge lower co-pay for generic medications. Generic medications are lower cost preparations of brand name drugs whose patents have run out. Always ask you health care practitioner if a generic equivalent of your medicine would be just as effective. Your doctor can advise you if a generic equivalent is not advisable (such as medications in which it is important to have a consistent steady state blood level of the drug) or even available.

A drug equivalent is not the same as a generic drug. They usually belong to the same class, may cost less but can just be as effective. Ask your health care provider about this as well.

Pharmacy chains such as Wal-Mart and Sam’s Club have a list of over 100 generic medications for which they charge $4.00 for a month’s supply. Many local pharmacies also have price matched this Wal-Mart offering so ask you pharmacist if they will match the $4.00 price.Check out Wal-Mart's $4.00 formulary here. Costco Pharmacy is another resource for less expensive generic medications. Anyone can avail of this pricing structure. If your health insurance co-pay is higher than $4.00, just buy the medicine outright.

Understanding the tier structure of your prescription health insurance plan:

Note that your prescription health insurance may have different co-pay structures for different medications. This is because there is a list of medications called a formulary. The insurance health and pharmacy panel reviews the literature for the evidence base of the effectiveness of medicines for different conditions and they then assign these drugs to different tiers, usually first, second and third tier.

Tier one include generic drugs which the FDA has determined to have the same bio-assayed ingredients and are as effective as the brand named drug. They have the lowest co-pay.

Tier two include brand named medications which are found to be effective for the conditions they are indicated and have middle range co-pay. Sometimes, the insurance company requires that a trial of a tier one medicine be tried before using the higher tier drugs.

Third and sometime fourth tier drugs are usually newer drugs for which effectiveness is still being evaluated. They have the highest co-pay which can reach over $100.00. Tier two to four drugs usually require a prior authorization from the insurance health plan.

· Pharmaceutical company assistance:

Drug companies have indigent care subsidies for persons falling below a certain income level. You will have to complete a form which details your income or lack thereof. Your physician completes his part of the form and provides a prescription for a 3-4 month supply. The medicine is either mailed to you or to the physician’s office. You can avail of this service indefinitely as long as you fall within the guidelines. Different companies have different requirements. Find a list of patient assistance programs here.

· Prescription discount coupons:

Check with your pharmacy for discount coupons such as trial of new medication. Your pharmacist can also find you the best deals on discount coupons for which you may qualify.

· Take care of your health:

Living a health conscious lifestyle is the best way to save on health care cost. Smoke cessation, mindful nutrition, exercise and learning stress management techniques can go a long way towards improving health.

Global to Local Health Care: A Seattle-King County Initiative to Improve the Health of Its Neediest Citizens

2010-10-13T00:03:00.000-05:00

Swedish Medical Center, Seattle’s largest hospital chain is celebrating its 100th year. Today, they introduced an innovative template for improving health care delivery to the uninsured and underinsured. They call it Global to Local Health Care, a partnership with various health care and community leaders in the Seattle area designed to use proven effective techniques of health care delivery systems in developing countries to improve health care in local communities. To this end, the hospital has committed 1M dollars over a 4 year period to fund initial projects. It is a daring and exciting concept.

Two years in the making, leaders of various agencies in the Seattle area met to brainstorm how to improve the health of citizens in the underserved areas of Seattle-King County area. Spearheaded by Swedish Medical Center CEO, Dr. Rod Hochman, committed participants of the initiative include Healthpoint, a community health center serving low income, uninsured minority, immigrant, refugee and homeless families, Washington Global Health Alliance whose members include the Bill and Melinda Gates Foundation, a center for global health innovations, and the Public Health Department of Seattle-King County, one of the largest public health departments in the nation serving some 1.9 million residents. They have found that some King County communities live in conditions as impoverished as neighborhoods in the poorest developing country. The Seattle area is home to the wealthiest and the poorest in the country.

While Americans have one of the world’s best medical technologies and spend the most in health care in the world, sadly, its people are not the healthiest. While overall health care in the country is good, it does not speak to the wide range of best to poor health outcomes. Health care delivery does not necessarily have to be tied to health insurance. People with good health insurance are able to access the best medical technologies while the unemployed and uninsured postpone needed medical visits. David Fleming of the Public Health Department of Seattle-King County stresses that there are unacceptable disparities in health care right in the county’s backyard as is true elsewhere in the nation.

It has been proven that global initiatives in the poorest countries are successful but that no one agency can do it alone, that the community itself must identify its needs and that grassroots efforts involving residents have the best outcome. Global health initiatives also found that the health of citizens is tied closely to its economic health and that in order to improve the health of a community, there must be a corresponding effort to elevate the economic status of its people. Thus Global to Local Health Care aims to take lessons learned from best practices all over the world into the poorest local community. For instance, it hopes to find collaborators who can help local grocers buy refrigeration systems so they can stock more produce, fund local one stop resource centers where citizens can access information, health care, legal, vocational and others, provide transportation, utilize existing agencies such as the local food banks and health care providers to a collaborative holistic provision of services. Global to Local Health Care is confident that this template can easily be reproduced in other communities as well.

Global to Local Health Care is hope inspiring in a time of unemployment, lost health insurance, and drastic cuts in government subsidy. When one’s choice is between buying medicine or putting food on the table, it is a no brainer what the choice will be. Having lost access to their health care provider, many frequent high cost emergency rooms for non-emergent conditions. Health care delivery need not involve traditional physicians and nurses alone. Developing countries have successfully utilized health educators, tribal councils, and community workers to educate citizens on healthy living, identify and refer those who require medical intervention and facilitate improvement of living conditions. Like her project collaborators, Lisa Cohen of Washington Global Health Alliance wants to see “the rising tide lift all boats.”

Nora Quiason is a physician and an online book seller. She also writes articles on senior living, book reviews and health care.

Contributor's Note Having worked in public psychiatry and painfully aware of the needs of what a former surgeon general calls the uninsured, uneducated and uninspired patient, I am always looking for initiatives that address this population.

External Links

http://www.swedish.org/About/Swedish-News/New-Global-to-Local-Healthcare-Initiative-Launched | http://www.pacifichealthsummit.org/downloads/global%20to%20local_Summit%20website.pdf

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Basics About Medicare, the Nation’s Largest Health Insurance Plan

2010-10-12T13:40:00.000-05:00

Medicare, the nation’s largest affordable health insurance plan, is a government health plan that insures citizens age 65 and over, qualifying disabled persons and persons with end stage kidney disease.

Centers for Medicare and Medicaid Services

Medicare pays 80 per cent of the allowable health care charge. Medicare has agreement with participating providers for a lower allowable charge for each medically necessary medical procedure reducing the charges for Medicare allowed reimbursement. You are responsible for the remaining 20 per cent. For this reason, many purchase another health insurance plan known as the tie-in plan to pay for the 20 per cent remaining bill. Important note: If your provider is not a participating Medicare provider, he is not obligated to accept reduced Medicare fees and you can be liable for a higher amount.

Types of Medicare coverage:

· Part A-The part of the insurance health plan that pays for hospital charges. All Medicare eligible persons are automatically enrolled in this.

· Part B- The part of the insurance health plan that pays physicians and other outpatient providers including medically necessary ancillary procedures such as physical therapy, home health care and some preventive services. You pay a monthly premium for this service which is a set amount each year plus additional amount depending upon your last two year income tax return. Those whose income fall below a certain amount are eligible for government subsidy of all or part of their Part B premium.

· Part C- Also called Medicare Advantage, are private health insurance plans which provide Medicare mandated services and usually other services such as preventive and health education programs. They are required by law to provide at least all services provided by the Original Medicare plan. Some also offer dental, vision and prescription insurance. You may choose to participate in either the Original Medicare or in a Medicare Advantage plan.

· Part D- The part of Medicare which pays for prescription drugs. You may participate in this through 1. Medicare Prescription Drug Plans (PDP) or 2. Medicare advantage mentioned above. Again, you pay a monthly premium for this and the government subsidizes the premium for those who fall below a certain income bracket.

Beware of the Donut Hole

Beware of the Donut Hole: Medicare prescription drug plans pay for prescriptions up to $2830 in 2010 and $2840 in 2011. Once you hit this spending mark, you are in the coverage gap or “donut hole.” You become liable for your medicine purchase until you have spent $ 4,550 for the year at which point catastrophic coverage kicks in and the health insurance picks it up again.

Medicare remains the largest affordable personal health insurance plan. For more detailed information request the free Medicare and You 2010 handbook through www.medicare.gov or call the 24 hour interactive phone line at 1-800 Medicare (1-800-633-4227) and TDD users at 1-877-486-2048. Download the pdf version at http://www.medicare.gov/publications/pubs/pdf/10050.pdf