Many Children with Special Needs Underinsured
Nearly a third of children with special healthcare needs lack adequate health insurance according to a recent study published in Pediatrics, the official medical journal of the American Academy of Pediatrics. The study, published online March 8, also noted that the rates of underinsurance varied by state. Where special needs children live makes a significant difference in whether they will have sufficient health coverage. The authors of the study defined special needs in the pediatric population as "children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or an amount beyond that required by children generally." Costs and Risk Factors
The authors noted that while 14% of children in the U.S. have health issues related to special needs, they account for more than 40% of all medical spending for children. The risk for special needs children being underinsured is due to a number of factors, including: - race and ethnicity
- child's age
- family poverty level
- degree to which the child's activities are affected by the condition
- number of families who have no or inadequate health insurance
Survey of Parents Helps Define "Underinsured"
The researchers analyzed data from a National Survey of Children with Special Health Care Needs, representing more than 40,000 children. The parents of special-needs children who answered the survey responded as follows: - 12.7% reported that insurance did not offer benefits or cover services that met the child's needs
- 28.0% reported that the costs that were not covered by insurance were not reasonable
- 9.3% reported that the insurance did not allow the child to see the healthcare providers that he or she needed
State Variations
After adjusting the survey results for factors such as a child's age, race, and poverty level, the authors documented that the proportion of children without adequate healthcare coverage ranged from 23% in Hawaii to 38% in New Jersey. Noting the disparity among the states, the authors of the study wrote that, "If policymakers are interested in ensuring equitable treatment in the healthcare system for children with special healthcare needs, then policy initiatives aimed at reducing underinsurance and increasing uniformity of coverage across states are also needed." Read the complete article: State in Underinsurance Among Children With Special Health Care Needs in the United States What do you think? Please leave a comment below or in the Health Insurance Forum. To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter. ..............................................
Photo © stockbyte/Getty Images Many Children with Special Needs Underinsuredoriginally appeared on About.com Health Insuranceon Tuesday, March 16th, 2010 at 15:14:10. Permalink| Comment| Email this
Cholesterol and Diabetes Drugs Top Medicare Drug Spending
Medications used to treat high cholesteroland diabetesaccount for the greatest Medicare prescription drug expenses, according to researchers at the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services. These medications, with a cost of $18.6 billion in 2007 (the latest year for which figures were available), represent 23% of the almost $82 billion spent by Medicare on drugs for the elderly. The most commonly prescribed medications for the elderly are for the treatment of high blood pressure and heart disease. AHRQ noted that more than 77% of Medicare recipients purchased a drug to treat these cardiovascular conditions. Although fewer prescriptions are filled for cholesterol and diabetes drugs, they cost more. On average, the heart drugs cost about $40 per prescription while the cholesterol and diabetes drugs cost $94 per prescription. Medicare Part D
In addition to the $82 billion spent by Medicare, seniors with Part D drug coverage also paid out-of-pocket expenses, such as annual deductibles and copayments. In addition, many seniors who take expensive brand name drugs hit the Medicare Part D donut hole. Cholesterol and Diabetes Drugs Top Medicare Drug Spendingoriginally appeared on About.com Health Insuranceon Friday, March 12th, 2010 at 14:54:24. Permalink| Comment| Email this
Decisions, Decisions! How Much of the Premium Should Be Shared with Employees?
Many, if not most, health insurance premiumincreases for businesses happen towards the end of the calendar year. However, many companies operate on a fiscal year and will see insurance premiums rise at the beginning of July. To give employees sufficient time to consider health plan enrollment options, some companies are facing an April 1st deadline deciding about ongoing health insurance coverage for employees. Although I am not an employer, I am president of the board of our local non-profit community health center. In that position, I have to help make decisions about important financial matters concerning the health center. Current Health Coverage
Currently, the health center provides a PPOhealth plan that has a low annual deductiblethat does not include doctors' visits and prescription medications. And, the health center pays 85% of the premium, which is considered to be generous. For example, the local town pays 60% of the premium for its employees. Additionally, nearly all physicians participate in the PPO network, an advantage that decreases the potential for increased out-of-pocket expenses. The Problem
The health center is facing a 10% premium increase, amounting to an additional cost of more than $50,000 - a very significant increase for a non-profit organization that is the last alternative for people with limited access to healthcare. The Solution
Although not a final decision, the health center management will most likely recommend a solution that is workable for the organization and employees. The current PPO will continue to be offered and employees who choose this option will pay 18% of the premium instead of 15%. In addition, the health center will offer a second health plan option, an HMOwith an annual deductible of $500 and lower premiums. Because of the significant increase in out-of-pocket expenses, the premiums are much lower than the PPO plan and employees who choose this option will actually see their monthly premiums drop. Every year, virtually every employer that offers health insurance is facing this issue and will need to make a decision about how much of the cost to pass on to employees. If you are an employer or an employee, you may be feeling the pain! What do you think? Please leave a comment below or in the Health Insurance Forum. To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter. ..............................................
Photo © iStockphoto.com Decisions, Decisions! How Much of the Premium Should Be Shared with Employees?originally appeared on About.com Health Insuranceon Monday, March 8th, 2010 at 10:58:00. Permalink| Comment| Email this
White House Shares Letter from Woman Struggling with Health Insurance
Amid continued political bickering and reports of significant increases in the cost of health insurance in many states, President Obama is pushing on to get a final resolution on health reform. In yesterday's daily press briefing at the White House, Press Secretary Robert Gibbs read a letter from an Ohio woman who has been struggling with her constantly increasing costs for health coverage. Her letter is a poignant reminder of why we need health reform! Dear President Obama, I am 50 years old. I was diagnosed with carcinoma 16 years ago and following my divorce 12 years ago I became self employed. After my COBRA benefits ran out I was able to find costly yet affordable health insurance. As a responsible individual I have struggled to maintain my individual coverage and have increased my deductible and out of pocket limits in an attempt to control my costs and keep my health insurance. Last year. 2009, my insurance premium was increased 25 % even though I increased my deductible and out of pocket to the highest limits available. I paid out over $6075.24 in premiums $20415.26 for medical care $225 in co-pays and $1500 for prescriptions. I never reached my deductible of $2500 so the insurance company only paid out a total of $935.32 to my providers. I must repeat, in 2009 my insurance company received $6075.24 in premiums and paid out only 935.32. IncrediblyI have been notified that my premium for next year, 2010, has been increased over 40% to $8496.24. This is the same insurance company I've been with for over 11 cancer-free years. I need your health reform bill to help me. I simply can no longer afford to pay for my health care costs. Thanks to this incredible premium increase demanded by my insurance company, January will be my last month of insurance. I live in the house my mother and father built in 1958 and I am so afraid of the possibility I might lose this family heirloom as a result of being forced to drop my health care insurance. What do you think? Please leave a comment below or in the Health Insurance Forum. To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter. ..............................................
Photo © allkindza/iStockphoto.com White House Shares Letter from Woman Struggling with Health Insurance originally appeared on About.com Health Insuranceon Friday, March 5th, 2010 at 08:37:43. Permalink| Comment| Email this
Why We Need Health Insurance Reform – Stories from America (#2)
As members of Congress and the White House continue to disagree about health reform, many Americans, especially people impacted by the economic downturn, continue to have significant problems either getting or affording health insurance. Every week I get emails from people asking for help with their coverage. I will publish one of their stories each week. Question
Dr. Mike: I volunteer at a local food bank that also helps people with budgeting. More and more people are coming in for food and services and one of the biggest complaints I heard was about the cost of prescription drugs. Some of the people I spoke with had to make decisions everyday about paying for food or for medications because they could not afford both. Do you have any information that will help? Thanks, Nancy R - Chicago Answer
Nancy: Because of the economy and the increasing costs of prescription drugs, this is a growing problem. Here are some tips to help your clients: Generic medicationscan save you up to 80% on the cost of a prescription compared to the brand name drug. Ask your doctor if there is a generic drug available to treat your condition. Shop around at pharmacies in your area.Many large drugstore chains such as Walgreens and CVS may have lower prices. If you are taking a generic drug, you may be able to buy these for $4.00 for a 30-day supply or $10.00 for a 90-day supply at large national stores such as Wal-Mart and Target. Check onlineto see if you can find a lower price. You can order your medication and have it delivered to your home. Make sure to only shop at a reputable online company. Learn about discount drug programsand companies that provide prescription assistance. A good place to start is NeedyMeds.com. Learn about pill splittingto see if you can do that safely with your medications. Talk to your pharmacistand find out if she is aware of any other programs that might help you. Your pharmacist knows the comparative process of medication and may be able to suggest to your doctor a less expensive alternative for you. Nancy, the following articles provide more information: What do you think?Please leave a comment below or in the Health Insurance Forum. To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter. ..............................................
Photo © photosoup/iStockphoto.com Why We Need Health Insurance Reform – Stories from America (#2)originally appeared on About.com Health Insuranceon Wednesday, March 3rd, 2010 at 13:29:26. Permalink| Comment| Email this
Dental Visits Down in Chicago as Unemployment Rises
Dental patients are asking, "Does it really need to be done?" According to a recent survey, dentists in the Chicago area are seeing fewer patients as unemployment continues to increase. Ninety percent of the 300 dentists who participated in the online survey said they were impacted by the current recession. Of the dentists surveyed: - More than 50 percent said their patients are putting off necessary dental work
- 60 percent noticed a drop in elective procedures, such as cosmetic dental procedures
- 40 percent reported fewer preventative visits
More Dental Patients Stressed The dentists also weighed in on their patients' dental health, claiming that they were seeing a 65 percent increase in bruxism(grinding teeth) and clenching of teeth. Both of these may be associated with an increased level of stress. Tooth Fairy Should Fight Inflation As part of the online survey, dentists also were asked their thoughts about how much the tooth fairy should be paying for a child's tooth. Although most selected $1.00, 16 percent of the dentists said the fairy should leave $2.00 per tooth while 17 percent opted for $5.00 per tooth. Currently, four "Real Human Wisdom Teeth" are being auctioned on eBay with a recent bid $24.99, or about $6.25 per tooth! Read more about dental coverage: Dental Insurance - Beyond Medical Coverage Please leave a comment below or in the Health Insurance Forum. ..............................................
Photo © bobbieo/iStockphoto Dental Visits Down in Chicago as Unemployment Risesoriginally appeared on About.com Health Insuranceon Monday, March 1st, 2010 at 09:40:28. Permalink| Comment| Email this
It’s Tax Time! Check Out IRS Publication 502 – Medical and Dental Expenses
I'm in the middle of doing my 2009 taxes and, as in years past, I'm pulling my hair out trying to decide what I can and cannot deduct. I have the business deductions figured out, but I'm always fascinated by what the IRS deems is acceptable (or not) when it comes to medical expenses. Medical and Dental Expenses Since I'm "pulling my hair out"I decided to look at IRS Publication 502, which defines medical expenses as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes." But, not "expenses that are merely beneficial to general health, such as vitamins or a vacation." What About My Hair? The IRS allows a deduction for a wig "upon the advice of a physician for the mental health of a patient who has lost all of his or her hair from disease. "Very appropriate, but looks like I don't qualify. Perhaps a hair transplant? Although I could use one, the IRS considers it a cosmetic procedure. Oh well, maybe I'll take some aspirin - whoops that's also not deductible. What About My Health Insurance Premiums? Self-Employed: If you are self-employed, the answer often is yes -- the premiums you pay to cover yourself and your dependents probably are tax-deductible. They are not, however, if you, your spouse, or your dependents are covered by another employer's group health insurance plan. Health Savings Accounts: If you work for a company that offers health insurance as part of what's known as a cafeteria plan, you may have a health savings account (HSA). The contribution you make to your HSA is 100% tax deductible up to a limit of $5950 for family coverage and $3,000 for individual coverage -- for 2009. If you are not self-employed, and you don't work for a company that provides health insurance with a cafeteria plan, the Internal Revenue Service (IRS) allows you to count health and dental insurance premiums as part of the 7.5% of your adjusted gross income that has to be spent on health care before any out-of-pocket medical expenses can be deducted. That's good news for me. My wife and I paid more than $15,000 in health insurance and long-term care premiums in 2009, a big deduction that will help lower my taxes. Please leave a comment below or in the Health Insurance Forum. ..............................................
Photo © peanut8481/istockphoto.com It’s Tax Time! Check Out IRS Publication 502 – Medical and Dental Expensesoriginally appeared on About.com Health Insuranceon Saturday, February 27th, 2010 at 12:30:58. Permalink| Comment| Email this
Why We Need Health Insurance Reform – Stories from America (#1)
As members of Congress and the White House continue to disagree about health reform, many Americans, especially people impacted by the economic downturn, continue to have significant problems either getting or affording health insurance. Every week I get emails from people asking for help with their coverage. I will publish one of their stories each week. Question
Dr. Mike, I was laid off about four months ago and continued my coverage via COBRA. I am now about to start a new job and while filling out the insurance forms I was asked about previous conditions and medications. I am now taking Lexaprofor depression and anxiety and was treated several times for knee problems. Otherwise, I'm in good health. I'm afraid that when the insurance company sees my answers, I will get a coverage denial. I am so worried about this, I'm having trouble sleeping. Molly - Hingham, MA Answer
Molly, I'm sorry to hear that you are concerned about your health coverage. One of the biggest problems with our insurance system is that many people are denied coverage because of a pre-existing conditionor get an insurance policy in which their pre-existing condition is not covered for six to 12 months (pre-existing condition exclusion period). When people switch from COBRAto a new health insurance plan they are protected by a HIPAA, a federal law that limits the ability of a new employer health plan to exclude coverage for pre-existing conditions. Specifically, under HIPAA, a plan is allowed to look back only six months for a condition that was present before the start of coverage in a new employer health plan. In many parts of the country, your pre-existing depression could prevent you from getting full coverage for some period of time. However, you are fortunate to live in Massachusetts, a state that has been a leader in health reform. Your home state (and mine as well) requires your new health plan to cover pre-existing conditions. Molly, hand in your insurance forms and get some sleep! Please leave a comment below or in the Health Insurance Forum. ..............................................
Photo © photosoup/iStockphoto.com Why We Need Health Insurance Reform – Stories from America (#1)originally appeared on About.com Health Insuranceon Wednesday, February 24th, 2010 at 11:00:32. Permalink| Comment| Email this
Olympic Curling or Health Reform “Summit” – Which One Will You Watch?
With the US ahead in the medal race at the Winter Olympics, many Americans have been "glued"to their TV screens watching our athletes score numerous victories. On Thursday, the President is holding a health reform summit at the White House during which he will push to find some compromise between Democrats and Republicans. The summit, an effort to revive the President's health reform agenda, is scheduled to be televised live on C-Span. On Monday, President Obama put forth a healthcare reform proposal that incorporates the legislative work done by the House and the Senate and adds additional ideas from Republican members of Congress. The President's proposal, Putting Americans In Control of Their Health Care, is available on the White House website. What Can We Agree On?
Most members of Congress seem to agree that our health system needs to be improved and that any reform needs to assure that all Americans have access to healthcare through appropriate health insurance coverage. Additionally, any health reform initiative needs to assure that Americans will be able to maintain a relationship with their doctor and not be overly burdened with health-related costs. I think on Thursday I'll skip the Olympics and tune into the summit. It should make for an interesting, and hopefully productive day, of television. Please leave a comment below or in the Health Insurance Forum. ...........................................................
Photo © wfnc_educ/iStockphoto.com Olympic Curling or Health Reform “Summit” – Which One Will You Watch?originally appeared on About.com Health Insuranceon Tuesday, February 23rd, 2010 at 10:04:20. Permalink| Comment| Email this
“Report Card” on the Health of Americans Shows Mixed Results
Americans may be exercising more and smoking less, but more of us are overweight, have diabetes, drink more alcohol, have no health insurance, and have no regular place to go for health care. These sobering statistics were released early last month by the National Center for Health Statistics, part of the federal Centers for Disease Control and Prevention (CDC). The numbers come from the National Health Interview Survey, which has been used to monitor the health of the nation since 1957. The information published by the CDC is for the first six months of 2009. The Good
Americans are exercising more - for the period January through June 2009, 35% of U.S. adults aged 18 years and over engaged in regular leisure-time physical activity, which was higher than the January through June 2008 estimate of 31%. And, we are smoking less - the percent of current smoking among U.S. adults generally declined from almost 25% in 1997 to about 20% for the period January through June 2009. The Bad
Although we are exercising a bit more, the numbers of Americans not exercising is still quite high - 65% in the latest survey. The lack of exercise and the fat and sugar-laden American diet may be contributing to the reported increase in obesity. The amount of obesity among U.S. adults aged 20 years and over has generally increased over time from more than 19% in 1997 to almost 28% for the period January through June 2009. And, the combination of obesity and lack of exercise is generally assumed to be related to the increase in diabetes. The number of diagnosed cases of diabetes among adults aged 18 years and over increased from slightly more than 5% in 1997 to more than 9% for the period January through June 2009. This almost doubling of the number of people with diabetes will have long-term implications for our healthcare system. And, The Ugly
In spite of increased need, many Americans do not have health insurance or a regular place to go for health care. The survey documented that during the first half of 2009: - More than 15% (or 45.4 million people) of the American population had no health insurance.
- Slightly less than 15% of Americans did not have a regular place to go for health care.
- More than 7% (almost 23 million people) of Americans failed to obtain medical care due to cost.
I encourage you to take a look at the full report. Please leave a comment below or in the Health Insurance Forum. “Report Card” on the Health of Americans Shows Mixed Resultsoriginally appeared on About.com Health Insuranceon Thursday, February 18th, 2010 at 14:44:24. Permalink| Comment| Email this
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