Tuesday, June 28, 2011
Friday, January 7, 2011
Out-of-pocket maximum is the combination of deductible plus coinsurance. If a plan had a $2000 deductible and coinsurance maximum of $2000, the out-of-pocket maximum would be $4000. Most carriers do not add these two together, instead they describe the deductible and coinsurance as separate totals.
Coinsurance is the limit on the amount an individual is required to pay for health care services covered by his or her benefits plan after the deductibles and any copays are paid. Refers to care received from the network of participating physicians, hospitals and health care professionals. It is often described as a percentage 90/10, 80/20, 70/30, followed by a dollar number. In the case of 80/20 it may say coinsurance maximum or out-of-pocket maximum $2000. This means that you pay 20% of medical costs until you've paid $2000 (20% of $10,000 is $2000).
Monday, November 29, 2010
Diabetes is a serious disease. And one article projects that half of all Americans could be diabetics by 2020! Increased medical costs - a diabetic spends roughly 3 times what a similar healthy person does on medical expenses. More than half of diagnosed diabetics today are on Medicare or Medicaid. The culprit - obesity. The solution weight management and exercise. The reality, an already burdened Medicare system will swamped.
Here's the problem. To control Medicare costs, the government reduces the reimbursement to physicians. How many small businesses would continue to sell a product that wasn't profitable? Few if any. What a choice. Suppose you could deliver the same service to two different people, one pays $100 and the other pays $23. It's a no brainer. Check out one physicians frustration.
Friday, November 19, 2010
An announcement this week of long available prescription drug that has been pulled off the market - Darvon/Darvocet got me thinking about the cost of prescription drugs. A little research and I found that 90% of elderly Americans and 58% of adults rely on prescription drugs for some sort of malady. I don't know about you but that's astonishing to me from a health perspective and even more astonishing from a cost perspective. I can tell you that the number one factor in health insurance costs are the costs of prescription drugs. Most companies offering individual health insurance will increase rates on an applicant for any prescription drug currently being taken on a regular basis. Taking three or more prescription drugs and it may be difficult to obtain coverage. I had a client that was a Cancer survivor for over 5 years. When applying for health insurance coverage the insurance carriers ignored the Cancer when considering premium increase yet almost doubled the premium for the combination of high blood pressure (HBP), high cholesterol and anti-depressant meds.