Georgia Health Insurance 411

Archive for August, 2009

Over the last few months I have come to the conclusion that having health insurance in Atlanta, Georgia will make you sick. This came to me as an observation from talking to quite a few people over the last few months who are losing their employer health insurance plan or COBRA is expiring.

OK, this is not a scientific sampling by any stretch. But having spent the last few years talking to people who are looking to buy health insurance in Atlanta it is fairly obvious that people shopping for medical insurance today are generally sicker than those a year ago.

Most of those who contact me now have had employer group health insurance. There are a lot of nice things about employer health insurance. For one, your employer typically pays a portion of the premium. The first time you have a clue how much health insurance really costs is when you get your COBRA notice.

That is usually when I get the first call.

They really can’t believe the health insurance costs $1300 per month for their family when they were only paying $50 per week before. They think their employer is stiffing them.

That is not the case at all.

But the premium subsidy isn’t making you sick. What is making you sick is the level of benefits provided under an employer health insurance plan. The usual plan design has something like $15 – $25 unlimited doctor visit copay’s, $5 – $40 Rx copay’s (and no deductible) and a major medical deductible of $1000.

A lot of these plans also include dental insurance and maybe even a vision benefit.

When I start to gather information to pre-screen their application, I always ask for a list of any medications they are taking. Most people don’t know all of the names and they almost never know the strength. The reply usually is along the line of, “I take a white pill in the morning for blood pressure and another white pill for cholesterol. I take a blue pill so I don’t get depressed over my job and bank account and then another pill at night so I can sleep. You know, just the usual stuff. It’s not like I have anything wrong.”

In almost every case, if they can name the medication, it is almost always a high priced brand name drug.

I will ask them if they know how much their drugs would cost if they did not have health insurance.

They never have a clue.

A few weeks ago I talked to a man who owned a company. He had canceled his group medical plan a few months ago because the premium was increasing from $1100 to $1700 just for him and his wife. An agent had convinced him that finding coverage was “no problem”.

Wrong.

Seems the husband took 4 pills a day and was overweight while the wife took 3 pills a day. When I asked if he knew how much the medications ran he had no idea but speculated that it “couldn’t be more than $250 – $300″ since he only paid about $130 in copay’s.

I checked, and the discounted price to those who have health insurance was $930 per month.

He all but called me a liar.

He also said there were a couple of medications he didn’t really need to take but his doctor suggested them so he does.

I hear this quite often.

Last year I talked to a lady who was “healthy and did not take any medication.” Seems that was not exactly the case.

When her application was processed the health insurance company discovered she had filled 17 different prescriptions in the last two years.

So I asked about the discrepancy.

Whenever she had a symptom or pain, real or imagined, she went to her doc. Like a lot of patients she has already done her research and decided not only what her ailment is but which medication she needs to correct the problem.

One of her complaints was hay fever. Rather than trying an OTC medication she went to her doc. He wrote a script for a brand name drug which she filled, took for a few days, then quit because it made her mouth dry and eye’s hurt. (Her eyes were having a side effect to the medication which causes decreased tear production . . . resulting in dry eyes).

Back to the doctor who promptly writes a prescription for Restasis for dry eyes.

I am very familiar with this as a family member has a chronic case of dry eye (that has nothing to do with side effects) and she uses this daily. At $160 per month this is not something you use casually.

My client had filled the Restasis prescription but never used it. Once she stopped taking the hay fever medication she no longer had dry eyes or dry mouth.

If she had never had a plan with $20 copay’s I doubt she would have gone to the doctor as often and I can almost guarantee most, if not all of those medications would never be filled.

She was promptly turned down by every carrier. This was partly due to the number of medications but also due to the fact she failed to own up to any of them on the application.

If the man who canceled his group medical plan had known how much his medications really cost, and he had to pay for them without the benefit of a copay, I can bet he would have asked the doc for a lower cost alternative.

I can’t tell you how many times someone who is on medication for GERD (what we used to call indigestion) or taking an anti-depressant and sleeping pill will tell me they don’t really need the medication but they take it because their doc prescribed it.

Situational depression, caused by the death of a loved one, marriage or money issues can sometimes be better managed with medication. But if you are still taking anti-depressants 10 years after your dog died it is time to get off the pill and move on.

So if it weren’t for rich benefit plans, especially those provided through your job, I suspect quite a few people would not spend as much needless time in the doctor’s office and would learn to “suck it up” rather than buying a medication that is going to sit in the medicine cabinet and never see the light of day.

All too often, people coming off employer group health plans are taking so many expensive medications it becomes almost impossible to find a health insurance company willing to issue coverage. If they do issue coverage the rate is jacked up to cover the cost of the medication.

Most people only need a bare bones health insurance plan, but they think they need one with all the bells and whistles.

A question I always ask is this. Does your car insurance have a copay for tires, brakes and oil changes?

The answer is always, “of course not”.

If you don’t need a copay for tires brakes and oil changes why do you need a copay to see the doctor or fill a prescription?

They don’t, but they think they need a copay because . . . they have absolutely no idea how much it costs to see a doctor or purchase medication. There is no need for them to know because they have a copay.

Eliminate the copay and they suddenly become better shoppers for health care and, a big plus, they save a lot of money in reduced premiums and out of pocket expenses.

If you think your Atlanta health insurance policy is making you sick, we need to talk.

If you are looking to buy Cigna health insurance in Georgia you can now view their plans and rates along side other carriers.

Compare Cigna plans to Aetna, Blue Cross, Humana, United and more with one click at Georgia Insurance Shop.

Does your Atlanta health insurance policy cover prescription drugs? Believe it or not, many plans sold in Atlanta, Macon, Savannah, Columbus, Dalton and more do not cover prescription medication.

This is not just no-name carriers. Big name health insurance companies like Blue Cross, Aetna, Humana, United and Assurant may leave you paying all, or substantially all the cost of prescription drugs.

Why should you care?

The New York Times found some folks whose health insurance plan left them with empty pockets when it comes to prescription drugs.

Mr. Stauffer, a 62-year-old Oregon farmer, had to pay $5,500 for the first 42-day supply of the drug, Temodar, and $1,700 a month after that.

“Because it was a pill,” he said, “I had to pay — not the insurance.”

If you are not taking medication, or your medication isn’t exotic or expensive, you may not be aware of the price of some medications. I work with this every day and can tell you how much some med’s cost. Temodar for example, is $2380 per month for 60 pills. That is your price at health insurance carrier discounts.

Pills and capsules are the new wave in cancer treatment, expected to account for 25 percent of all cancer medicines in a few years, up from less than 10 percent now.

That number is expected to grow over the next few years which only makes having a good Rx benefit all the more important.

Although drug makers are developing oral versions of some infused cancer medications, most of the new pills and capsules have no intravenous equivalent.

The oral exemplar is Gleevec from Novartis, which since its approval in 2001 has helped turn chronic myeloid leukemia as well as gastrointestinal stromal tumors into manageable diseases for many patients.

You probably never heard of Gleevec either,  but that runs $2100 for a 30 day supply.

Douglas Jenson, 75, of Canby, Ore., has taken Gleevec for 10 years for leukemia. He goes for a blood test once every three months and sees his oncologist every six months, but is healthy enough to go whitewater rafting.

Making it even easier, Mr. Jenson gets his Gleevec free because he participated in an early clinical trial of the drug. Otherwise it would cost more than $40,000 a year.

While Mr. Jenson has been diligent about taking his five capsules every day at lunchtime, research indicates that many patients on the oral drugs do not consistently take the proper dose. One study, for example, found that Gleevec patients, on average, were taking only 75 percent of their prescribed doses.

Failure to take a full dose is a problem. For many it is an affordability issue. For others it may be the side effects or just forgetting to take their med.

Even Medicare will not cover outpatient Rx unless you have the relatively new Part D coverage.

Under Medicare, most oral cancer drugs are covered by the Part D prescription drug program, which has a 25 percent co-payment. It also has the annual “doughnut hole” — reached when a patient’s total drug costs hit $2,700, after which the patient must shoulder the next $3,000 or so before coverage resumes.

Part D has only been around a few years. While I appreciate this observation, four years ago there would have been no coverage at all for these medications.

And Lee Newcomer, senior vice president for oncology at UnitedHealthcare, the big insurer, said many commercial policies capped total annual out-of-pocket expenditures, so patients should not have huge co-payments month after month.

Most, but not all HSA plans cover Rx and will cover them at 100% after you have satisfied your annual deductible. There are still way too many people who have bought copay plans and HSA plans that have little or no coverage for prescription medication.

When clients ask about buying health insurance in Atlanta we always suggest plans that cover Rx at 100%.

The newly christened Kennedycare is trying to gain new life. Not to speak ill of the dead, but if Obamacare wasn’t such a great idea then why should the same plan with a new name be any better?

But this isn’t about Kennedycare, or Obamacare. This is about a plan that has been around since 1965. Medicare was part of sweeping legislation signed into law by LBJ to provide health insurance for seniors.

For the last 40+ years Medicare has limped along with only a few changes.

So how well is the government doing at managing the financial side of Medicare?

Not to well according to US Government Spending.

In fiscal year 2008 the federal government spent $391 billion on health care for seniors. That’s about $10,000 per senior covered under Medicare.

That same fiscal year the federal government took in $194 billion in Hospital Insurance taxes.

That’s a paid loss ratio of  200%.

Expressed another way, Medicare paid out $2 in benefits for every $1 they took in by way of taxes earmarked for Medicare.

How about the Social Security side?

It did much better but nothing to write home about.

In FY 2008 the federal government collected $658 in Social Security taxes and paid out $669 in benefits. At least it came close to breaking even.

So they have a retirement plan that has been in place for 70+ years and it is around a break even point (not including unfunded liabilities) and a health care plan that is slightly more than 40 years old and spending money two  years worth of budget in a year.

And they want to take over health insurance for everyone.

How long has Medicare been losing money like this?

In 1998 they spent $193 billion on Medicare and took in $120 billion in HI taxes.

In 1990 the collected $69 billion in HI taxes and spent $98 billion on Medicare.

I could go back further, but why bother?

OK, just for chuckles and grins, let’s look at 1970. Medicare is 5 years old at the time. They collected $5 billion in HI taxes (dang that number seems small) and paid out $6 billion in Medicare benefits.

So it would seem that Medicare has never paid for itself and continues to run up a deficit, year after year.

I challenge you to find a single health insurance company in business during that time period that continually paid out more than it took in.

Of course some would say this is proof we need to let the government run a health insurance scheme for everyone. They can do it for less money than a profit driven insurance company.

But here is one difference.

If the insurance company continually loses money they eventually get out of that line of coverage, and many have. When they do, another carrier steps in to take their place.

Those losses do not become an undue burden on the taxpayers for generations to come.

I can’t say the same for Medicare.

Folks looking to buy health insurance in Atlanta right now seem mostly like that line about “the King”.

Elvis is dead and you don’t look so good either.

Sure, things are tight. People are scrimping to get by and jobs are scarce.

So how is that extra $13 per week tax cut working for you?

In general, business is good. People are still shopping for affordable health insurance in Atlanta, and for most folks, they can find what they need.

But some folks aren’t so lucky.

If I didn’t know better, I would think everyone who had a job with benefits must have been sick for years. They lose their job and many times their health insurance as well.

Oh sure, there is COBRA. And there is even a subsidy . . . unless the employer goes belly up and/or terminates the group insurance plan.

Then what do you do?

You go looking for a health insurance plan that will meet your needs and budget.

Many will use the internet and come across Georgia Insurance Shop. Our site is more than just a place to get health insurance quotes. You can also research information on taxpayer funded and charitable groups that offer assistance for those having trouble paying their medical bills. Search our FAQ page by topic. If you don’t find an answer to your question, email us.

With the sputtering economy the biggest challenge to my business is helping clients find coverage for their pre-existing medical conditions. I consider it a personal challenge to find the best value for my clients. Many times people call who have been turned down by health insurance companies due to existing medical conditions.

In the last 8 months or so I would have to say the majority of people who call are those who have lost their health insurance, or COBRA is expiring, and they are having trouble finding health insurance at any price.

With over a dozen health insurance companies and more than 4,000 different plans, we can usually find something that works for everyone. The key is to gather good data on the front end, review underwriting guidelines and then follow up by pre-screening all applications before submitting them to underwriting.

Some health insurance companies are rejecting half of the applications submitted. We have less than 5% of applications turned down because of our knowledge of the industry and strong relationships with the carriers.

If you think you are never going to find health insurance in Atlanta, give us a try.

This just in  . . . Aetna and Wellstar have inked a new 3 year contract. There will be no disruption in coverage for Aetna clients in Atlanta.

Do you need a blood test but don’t know how much it will cost? Maybe your doctor has ordered a test but you are wondering if you can afford it.

Perhaps you suspect a problem, but don’t have a doctor, or can’t afford to see a doctor and pay for testing.

How much is a PSA test or cholesterol test? Maybe you want to know if you have chlamydia, herpes or other STD.

Georgia Insurance Shop and Patient Charity have found a resource for low cost lab tests. You can use the power of the internet to find pricing and locate labs in your area.

Lab fee’s are discounted up to 80%. All work is performed by CLIA certified labs. You do not need a doctor’s order to have the lab work performed. Confidential results are usually available in 24 – 48 hours.

Perfect for those who do not have health insurance, or you have health insurance with a high deductible. Most Atlanta health insurance plans require you to pay for lab work separately from your office visit copay.

Direct access to lab testing for consumers interested in making smart decisions on health care and seeking the best pricing.

Affordable lab work at direct to consumer pricing.

What do people  think about Atlanta health insurance and health care reform?

The AJC recently did a story based on randomly interviewing people in Atlanta and as far south as Macon. Here are some of the things they heard.

William Mays moved the brush from one hand to the other, keeping it moving as he applied white paint to the black burglar bars on the front door of his brother’s southwest Atlanta home. He’s 45, self-employed, and favors a government plan for all.

“It’s got to be affordable,” said Mays, who is uninsured.

That’s nice, but nothing in HR 3200 even approaches affordable.

There is nothing magic about a government takeover of health care that will lower costs.

It hasn’t happened with Medicare. It hasn’t happened with Medicaid.

If it isn’t working for 80 million people why will it do any better for 330 million?

A veteran — he served in the Army from 1956 to 1959 – Scott has coverage through the Veterans Administration. He wondered out loud why lawmakers couldn’t expand Medicare and programs for needy children to cover people who cannot afford private health care.

“Couldn’t we improve on those programs to help the people who don’t have it?”

Yes we can.

But the way the government is going about it, making it another entitlement program, is not effective.

You can qualify for free health insurance (Medicaid) if you make less than 100% of the FPL (Federal Poverty Level), about $22,000 for a family of four. Rather than cutting people off at $22,100 let them buy in on a sliding scale.

This approach makes much more sense than simply cutting them off or even worse, giving it to them for free.

In a first-world country like this, I think it’s a right,” said Bower, 22, who is uninsured. “I think it is the responsibility, a little bit, of the government to protect families from financial ruin” brought by crushing health-care costs.

I always find it odd that most of the folks who want the taxpayer (government) to provide health insurance are those that don’t have it now. They don’t want health insurance but will sure take it if it is free.

Only children should be guaranteed health coverage; everyone else, said Dunlop, should work for a plan. He includes himself in that category: Dunlop said he isn’t covered

Guess it never occurred to the reporter to ask these folks why they didn’t have health insurance. At least that would give more credibility to the story.

Caldwell, 77, who has health insurance, thinks the government should establish a universal plan for those who cannot afford anything else. But people who can pay for their own coverage, she said, should be allowed to shop around.

Gee, that’s what we have now.

Medicaid for those who can’t afford health insurance, the ability to shop around for the rest.

Perhaps someone needs to tell her.

If you want to shop for affordable health insurance in Atlanta, we know just the place.

Folks looking for affordable health insurance in Atlanta need look no further than our site. We offer a dozen health insurance companies and over 4,000 different plans.

We also specialize in Bare Bones health insurance plans.

But the folks in Washington want you to have MORE health insurance, not less. And more health insurance is more expensive, not more affordable as they would have you believe. Witness this Alton Drew piece from the Washington Examiner.

The Democratic party has made the issue of health care a component of its platform over the last few decades and President Obama promised during his campaign to address the problem of 47 million people in America having no health insurance. To address this problem, the administration and democratic members of Congress have proposed offering a government-sponsored health insurance plan that they hope will provide a competitive option to private health insurance companies eventually leading to slowing down increases in insurance premiums.

Yes, that is what they are saying. More competition from the government will mean lower health insurance premiums.

But the ideas don’t match up with the rhetoric

Alton Drew makes some salient points in his article.

Government, in its attempt to maintain inexpensive health insurance, will fail to promote health care by intentionally avoiding the monitoring necessary to ensure consumers practice preventative care. The slippery slope may not get steeper, but as we add more consumers to the hill of no accountability, there will be an eventual mudslide in terms of the human costs resulting from continued poor health care habits.

Mr. Drew correctly points out the difference in health care, and health insurance.

Obamacare seeks to not only cover more people under health insurance plans, but at the same time, significantly increase the cost of such coverage.

What the Obama administration should be focusing on is why, with our willingness to purchase food, cars, houses, and clothes without any subsidies or insurance, would Americans not give the purchase of health care services the same priority. In the 1950s, Americans paid for 50% of their health care out of pocket. Today we pay approximately 10% of our health care out of pocket. If our health is our wealth, why are we afraid to invest in it?

Say it, brother!

Smaller cars, bigger health insurance, Poppa Washington.

Health insurance in Atlanta is affordable when you know where to look.

Proponents of health care reform say one reason for a public option is that it will introduce competition in the market place which will result in lower premiums.

On the surface, the argument seems to have merit. More companies offering more plans means more choice and lower pricing.

The problem is, they picked Maine to make their point.

Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.

Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.

Wow! One carrier has 71% of the market.

Wonder how that happens?

“There is a serious problem with the lack of competition among insurers,” said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. “The impact on the consumer is significant.”

Could it be because the legislature in Maine decreed that health insurance companies would not be allowed to refuse coverage to anyone at any time due to pre-existing health conditions? In other words, if you apply for health insurance the company must issue a policy and cover your conditions, no matter how sick you are or how expensive it is to treat your condition.

Any health insurance company who wishes to write health insurance in Maine must “guarantee issue” all plans to all people at all times.

Maine is also a community rating state, which means there are upper limits on how much a health insurance company can charge for coverage.

Both guaranteed issue and community rating are key points of HR 3200, commonly known as Obamacare.

Both provisions drive up the cost of health insurance for everyone and drive away carriers who may want to compete in a free market.

Don’t you find it disturbing that Olympia Snowe has no clue why there are so few health insurance competitors in her home state of Maine? Not only does it have very few competitors, but also has some of the highest premiums in the country.

And the linked article mis-states the problem. Maine is not a high cost area for health care. There is nothing to indicate doctors and hospitals in Maine charge any more than in neighboring states.

But the repressive health insurance regulations result in some of the highest premiums in the country.

Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn’t have to turn a profit.

This is true.

A public plan, like Social Security, Medicare, Medicaid, Cars for Clunkers, etc. are never required to turn a profit. In fact, they can lose money month after month, year after year, and never worry about turning a profit or even breaking even. They can run a deficit year after year until the taxpayers run out of money to fund these plans.

“Right now, there’s no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums,” said economist Linda Blumberg, co-author of the report. “A public plan would have the leverage to set lower payment rates and get providers to participate at those rates.”

Where did Linda Blumberg study economics? It appears she did not earn a passing grade in her studies.

The incentive for carriers to negotiate lower provider fee structures is to lessen the amount they pay for health care. When you can get health care at a lower price than your competitors, you can pass those savings along in the form of lower premiums.

What part of that is lost on Ms. Blumberg?

A public plan, such as Medicaid, does have leverage. When you have 39,000,000 individuals on a health insurance plan paid for by taxpayers you have leverage. So much leverage that you can name your price and providers have to take it if they want your plan participants.

Of course medical providers lose so much money on Medicaid and Medicare patients that they cost shift those losses to private pay patients . . . those who have health insurance. But if the public plan eliminates the private health insurance market will health care providers abandon their profession? How much money do they have to lose before they say “enough”?

Smaller cars, bigger health insurance, Poppa Washington.