Anthem Revised Rules Regarding Lipitor

 Anthem Blue Cross of California has recently announced that all members with prescriptions for Lipitor will need to have their prescriptions pre-authorized effective April 1, 2012 

This change is due to the addition of atorvastatin, a new generic for the brand name Lipitor, on their covered drug list.

This change impacts all of the commercial and individual business in California and New York. Medicare Part D and state-sponsored business are not impacted.

Part B 2012 Medicare Premiums Announced

The Department of Health and Human Services (HHS) has announced that Part B premiums for Medicare beneficiaries will rise to $99.90 in 2012, an increase of $3.50 over the 2011 cost. This was far lower than the anticipated increase of $106.00 per month.

Part B pays for physician visits, hospital outpatient costs and certain other services.

Officials attributed the lower than expected premium increase to several factors, including lower-than-expected use of medical care and slower cost growth.

For more information please visit www.medicare.gov.

 

Dental Procedures Demystified!

Fear of the dentist is not uncommon, in fact, about 50% of Americans admit some fear of dental procedures and about 10% are so frightened they actually avoid dental care.  It is far worse to avoid dental care, as dental pain and issues only get worse over time.  If you are afraid of dental treatments, you can talk to your dentist about sedatives designed to ease your anxiety and get you through dental procedures.

Once thing that can also help you is knowing more about the following common dental procedures:

Extractions

Teeth may need to be pulled in the event of dental pain or infection.  A certain amount of blood and pain is to be expected, so anesthesia can be used to reduce pain.  You can also use an MP3 player to deaden any sound.  Remember that any blood you se is mixed with your saliva, so it actually looks like you are bleeding more than you actually are!

Fillings

Cavities are small holes in teeth caused by germ-containing plaque, is treated by removing the surrounding area and filling the hole with materials to rebuild the tooth.  If cavities are not treated early, the bacteria will continue to eat away at the tooth, possibly resulting in a need for a root canal.  One way to lessen fear of the drilling and filling is to bring an MP3 player or similar device to listen to music while your dentist is working.

Root Canal

During a root canal, damaged tissue is cleaned out from inside a tooth. It’s a long procedure (sometimes lasting about two hours), but it can save your tooth. You can also bring along an MP3 player or you can break the treatment down into more manageable time periods.

X-Rays

X rays are designed to help your dentist find little problems before they become worse.  It can become a problem is you have a strong gag reflex or fear of radiation exposure.   Your dentist can use a little topical anesthesia to help control your gag reflex during this short dental procedure. It also may help to remember that the actual radiation exposure from dental X-rays is relatively minimal compared with the radiation exposure you get naturally each day.

Crowns

Crowns are used to protect a worn-out or weakened tooth.  The worst part of the procedure is the gag-inducing mold made of your tooth to shape the crown.  One way to alleviate this problem is to sit upright and use a faster-setting mold.

Dental Implants

Implants are used to replace missing teeth. They look natural and are stable as they are molded to your bone below your gums.  If you are afraid you can consider anesthesia.

Seven Common Health Insurance Mistakes

When selecting a health insurance policy, evaluate what you need as well as how much risk you can afford to take. Keep your eyes open for potentially nasty surprises.  Poring over the fine print of health insurance plans to choose a policy is at best, tedious, but you’re better off researching  before you buy than risk being under or over insured later. The right fit will depend on your needs and how much financial risk you can bear. 

 Whether you’re choosing among group health plans offered by your employer or shopping for individual health insurance coverage, there are seven mistakes to avoid.

 1. Your doctor isn’t in the network. You’ll pay more to use health care providers who aren’t in your health plan’s network, so check to see if the doctors and other professionals you want are included. A plan that tightly restricts you to a local network might be sufficient if you need care only in your area, but it won’t benefit a kid away at college or meet all your needs if you spend a lot of time on the road.  Make sure any specialists you need are also covered by the plan.  Don’t assume a specialist is in the network just because your primary care doctor gave you the name.

 2. You pay huge insurance premiums to save a few bucks on the co-pay.  Don’t focus so much on getting a low co-pay and fail to look at how much extra premium you will pay for it.  Evalute the need for the extra premium cost.  If you go to the doctor only a couple of times a year, is it worth hundreds of dollars extra on the premium just to get a lower co-pay?

3. The drugs you take aren’t covered.  If the plan provides prescription-drug coverage, check to see if your medications are included on its formulary, which lists the preferred drugs that are either included or covered at a better copay.  Check to see if  the plan provides discounts if you mail-order prescription drugs in bulk.

4. You are overinsured.  In addition to comprehensive health plans, many employers offer supplemental insurance policies, such as cancer or critical illness insurance, that pay a lump sum of cash after diagnosis. Such policies can provide valuable protection, but they might not be unnecessary if you already have excellent under your medical insurance and short-term and long-term disability insurance plans. 

5. You can’t afford your share of the medical bills.  Low premiums are an attractive feature of high-deductible health plans, however, you need to make sure you’re prepared to pay your portion of the medical expenses.  Check the maximum out-of-pocket expenses you pay. After you pay the deductible, many plans pay only a portion, such as 70%, of covered medical expenses. Your 30% share is called co-insurance, which you must pay over until you reach the cap on out-of-pocket expenses.

6. Your policy doesn’t cover maternity care.  Most employer-sponsored plans cover maternity and prenatal care, thanks to federal and state laws in place.  Individual plans do not require maternity coverage.  Starting in 2014, individual and small-group plans sold through state health insurance exchanges must include pregnancy and newborn care, along with other essential benefits.

 7. You don’t check your health plan for changes.  During your annual open enrollment, check the details of your current health plan to be aware of any changes that may impact your health care needs. Don’t assume the plan is still the same. Coverage levels, costs and networks could change from one year to the next, even if the plan is offered by the same insurer.

A good Health Insurance Advisor or Broker will help you sort through the plans available and help you find the plan that best suits your needs.  Please call our office at (888) 474-6627 and we will be happy to help you find the right plan for you and your family.

Insurance Carriers Now Required To Justify Premium Increases

  U.S. health insurance carriers will have to justify big premium rate hikes effective September, 2011  under new rules issued by the U.S. Health and Human Service Department   Insurers will have to publicly post proposed rate increases for the small group and individual markets. Any increase of 10% or more will have to undergo review by independent experts at the state or federal level, the agency said.

These rules were signed into law last year under health care overhaul.  HHS Secretary Kathleen Sebelius said her department will provide greater scrutiny of health insurance premium rises at a time when insurers are demanding premium increases, even as they enjoy lower costs and huge profits.

“Even though insurers are seeing lower medical costs as people put off care and treatment in a recovering economy, insurance companies continue to raise their rates. Often these increases come without any explanation or justification,” she added.

Results of reviews will be posted on the HHS Website, and insurers will be required to post that information on their sites as well, she said.

While federal regulators cannot set health insurance rates, Sebelius said a growing number of states have this authority.  Sebelius said her agency was working closely with states to undertake the review process. HHS will take over in cases where a state does not take up the responsibility.

The 10% threshold will be replaced in September 2012 by a state-specific threshold that takes into account trends in a state’s health care market.

Steve Larsen, director of HHS’s Center for Consumer Information and Insurance Oversight, said the current rule applies only to the individual and small group market but that the agency was seeking comment on applying the rules to groups that purchase coverage through associations.

Part D Prescription Drug Plan Premiums to Increase for Wealthy Seniors

As reported yesterday,  Medicare Part B premiums are tied to a seniior’s income history.  The most affluent seniors have been paying higher income threshold Medicare Part B premiums (doctor visits and outpatient services) since 2007. The surcharge was put in place by the Medicare Modernization Act of 2003

 This premium increase also  extends the income threshold formulas to Part D prescription drug enrollees for the first time. This will affect just 5% of Medicare enrollees this year, although that figure will rise to 14% by 2019 according to the Kaiser Family Foundation.

High-income seniors who pay both Part B and Part D premiums could see their combined premiums rise anywhere from $300 to $700 per month by the end of the decade, according to Juliette Cubanski, associate director of Kaiser’s Medicare Policy Project.

The new income thresholds also affect people who choose a Medicare Advantage plan (Part C), which often covers prescription drugs. Advantage enrollees typically pay the monthly Part B premium plus a supplemental premium to the Medicare Advantage plan; now, these premiums are being adjusted to factor in the higher-income amounts for Part B and Part D coverage, where applicable.

The policy aims to help offset the cost of health-care reform by reducing taxpayer subsidies on Medicare services for seniors who don’t really need the help.  Kaiser estimates that the higher premiums will save taxpayers $25 billion for Part B from 2010 to 2019, and $10.7 billion for Part D.

These changes will provide important new benefits to retirees that should at least take the edge off the higher expenses over time.

The Medicare D prescription drug doughnut hole will be closed. That’s the coverage gap that starts when a beneficiary’s annual drug spending hits $2,830, and resumes at the catastrophic level ($4,550). This year, pharmaceutical companies are providing a discount of 50% on brand-name drugs to low- and middle-income beneficiaries who find themselves in the gap. Then, the doughnut hole itself will shrink a bit every year, ultimately disappearing entirely in 2020.

These will also be important improvements to traditional Medicare aimed at boosting preventive care. Medicare patients now receive an annual wellness visit–with no co-payment or deductible–that includes a comprehensive health risk assessment and a long-term personalized prevention plan. Deductibles and co-payments also were eliminated for most preventive care services.