HHS Lists Final Preventative Care Rules

The Departments of Health and Human Services, Labor and Treasury published in the Federal Register today the interim final rules on preventive services coverage under the Patient Protection and Affordable Care Act.  Under the regulations, any health plan policy year beginning on or after 9-23-10 must cover specific prevenative care services WITHOUT a cost to the patient if care is provided by a network provider.  These rules ONLY apply to non grandfathered plans (plans that were in effect prior to 3-10 with no significant plan changes) or plans that lose grandfathered status.

The Preventative Services include: 

Evidence-based preventive services,  such as breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling. 

Routine vaccines: those recommended by the Advisory Committee on Immunization Practices ranging from routine childhood immunizations to periodic tetanus shots for adults.

Prevention for children: including regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight as recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics.

Prevention for women: Health plans will cover preventive care provided to women, with final guidelines for services covered to be issued by August 1, 2011.

Why Buy Long-Term Care Insurance?

My parents retired to Florida 10 years ago, escaping the harsh midwestern winters.  I left 24 years ago, moving to the West Coast for the same reason.  At the time they moved, they were independent.  None of us gave a thought to what their future medical concerns might become.   By the time my father passed away 3 years ago, he was living in a Medicaid funded nursing home.  My mother was unable to care for him and this was all any of us could afford. 

I wish we all had thought about what might have happened to him well in advance of his final years.  I regret that none of us considered getting long-term care insurance before he could longer complete ordinary, daily living activities such as bathing, using the bathroom, preparing meals, and following medical directives — including taking prescription drugs.   We found out that paying for help with these activities can be very expensive. I know that my dad felt horrible that he, and by extension our family, was in this situation.  None of us think about aging and illness.  The fact is that we all get older, and most of us wind up with health issues as we age.  I strongly believe that everybody needs to have a plan  to address the possiblity of long-term care expenses.

Why would anybody possibly need long term care?   

When my parents moved to Florida they were in their sixties, and reasonably healthy.  My father’s health worsened as he entered his seventies.  My mother did the best she could to help him, and I came from California as often as I could to give her respite.  But I had my own children to care for and a job, so I was unable to help as much as I would have liked.  There were no other close relatives nearby to help.  After a few years of this, my father’s numerous medical conditions became too difficult for my mother, and we were faced with the difficult decision of how to best care for my dad.

A report last year by the National Alliance for Caregiving in collaboration with AARP found that just one in five caregivers had their care recipient living with them. So unfortunately, formal long-term care may be the only solution for people whose health has deteriorated and who have no family nearby.

Medicare will pay limited benefits for a nursing facilty following a hospital stay.  They do not pay for care facilities that help with common activities like dressing, bathing or using the bathroom.for long-term care expenses.   Since my parents didn’t have Long Term Care insurance, they had no choice but to apply for Medicaid to cover his expenses.    There are financial requirements and benefits can be hard to obtain. Moreover, Medicaid laws vary from state to state

Insurance company statistics advise that two-thirds of people aged 65 and over will need long-term care in their lifetime.  When my parents moved to Florida they certainly didn’t think my dad would be one of them.  Most of us don’t think about that real possibility – until they are actually in need of care.

Why buy Long Term Care insurance??

Because we all age.  Because most of us become less healthy as we age.  Because we all want to have control over the quality of our medical care.  Because none of us want to leave our children with  the regret and guilt of not being able to care for our parents.

Is Health Risk Reduction important in reducing Health Care costs?

Is Health Risk Reduction important in reducing Health Care costs?

Healthways Center for Health Research recently released a May 2010 report that analyzes potential savings in the commercially insured population.  We all know that people can be categorized as low, medium or high health risks.  Unfortunately, as we age most of the United States tend to move from a Low Health Risk toward a High Health Risk.  The report found that if risks could be “reduced” 10% or 25% we would conservatively save estimates between $363 billion and $945 billion over a 10 year period.

Our new health reform bill focused on providing coverage to the uninsured, who account for $56 billion annually in  uncompensated care.  Three quarters of that care is financed by the government.  The remainder is paid by charity and cost-shifting to private health plans.  Hospitals demonstrate “cost-shifting” as well as anyone, they lose money on medicare and medicaid patients so they over charge private health plans to make up the loss.  If you are covered by a private health plan like me,  we are paying more that we should, and we may even pay more as the government further reduces what medicare and medicaid will pay doctors and hospitals.

To download the full report click here.

Health Reform – What are Grandfathered Plan and Why Are They Beneficial?

Under the recently enacted Health Reform Legislation, Individual and Group plans that are in existence from March 23, 2010 to January 10, 2014 may be “Grandfathered”, and will not have to meet the premium and benefit requirements that will be implemented in 2014 by the Federal Government. To retain the grandfather status the benefits of the existing plan must not be substantially changed.  The following changes are allowed without impacting the grandfather status:

  • Premiums
  • Benefits to comply with changes in state or federal law or PPACA
  • Changes to provider network or prescription formulary
  • Changes to third party plan administrator
  • Changes to plan structure, i.e. switching from insured to self funded

 Increases in co-insurance percentage, changing insurers, employee contributions by more than 5% or elimination of benefits to treat a particular condition are among the changes that would cancel a plans grandfather status. 

 For a full list please refer to: www.healthcare.gov/news/factsheets/keeping_the_health_plan_you_have_grandfathered.html – 47k – 2010-03-23

Tips to Reduce Medical Expenses

Until health care reform is finalized in 2014, the 46 million currently uninsured Americans will have to find ways to pay for medical care.  If you don’t have coverage and cannot afford insurance, below are some tips to find lower cost medical care:


Maintaining a  relationship with a primary care doctor going for routine visits is the best way to stay healthy and avoiding the need for emergency care.  There are low cost or free clinics, check with your community or city health care system for more information, or look online at http://findahealthcenter.hrsa.gov/.  If you lost insurance coverage, tell your physician about the change in your status and perhaps discounts can be negotiated for cash payment.


Please use the ER only for true life threatening emergencies.  For routine medical care, please go to a physician’s office or urgent care center.  Emergency rooms are higher in cost for routine care.  If you must visit the ER, please contact the billing department of the hospital as soon as possible after the visit to ask them to renegotiate the billing for cash payment, or to set up a payment plan.


The federal government and some states, including California, offer coverage for children when their parents cannot afford private coverage.    There are income qualifications that have to be met.  For more information go to: http://www.insurekidsnow.gov/.


Your physician may be able to provide you with samples of prescribed medications.  Community medical clinics may also have low cost medicines. Pharmaceutical Research and Manufacturers of America, the drugmakers’ trade group, provides free and low-cost drugs through its Partnership for Prescription Assistance http://www.pparx.org/. Individual drugmakers often have their own programs that offer free or reduced-cost drugs as well.