American Medical system - some thoughts.

[prasad1]

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This thread was started on request of Mr. RaySunder.

Millions of Americans have been hit with high drug costs within the last year. In fact, a recent Consumer Reports National Research Center poll of 1,037 adults showed that a third of those who currently take a drug said they experienced a spike in their prescription drug prices in the past 12 months—anywhere from just a few dollars to more than $100 per prescription.

According to the American Society of Health-System Pharmacists, big price jumps can be due to anything from a product shortage to a change in your insurance coverage. And in rare instances, manufacturers may raise prices simply because they have no competitors also selling the medication. (Because this landscape can be so confusing, Consumer Reports Best Buy Drugs evaluates medications for price as well as safety and efficacy; go to CRBestBuyDrugs.org to learn more.)
Frustrating as sudden price hikes can be, our poll shows that most people just fork over the money. Only 17 percent comparison-shopped to see whether they could get a better deal. If you have a standard insurance co-pay, it might not occur to you to shop around. But sometimes the price you’d pay out of pocket (what those without insurance are charged) might be less than your co-pay —a fact pharmacists may neglect to mention. Case in point: Metformin—used to treat type 2 diabetes—sells for just $4 for a month’s supply, or $10 for a three-month supply, at stores such as Target and Walmart, while a co-pay for a month’s worth averages about $11.


And if you do decide to pay out of pocket, the prices retailers charge can vary a lot. To find out what various retailers were charging, we had secret shoppers check prices for five common generic drugs at stores around the country, including chain drugstores, big-box retailers, supermarkets, and independent pharmacies.


What We Uncovered

In our national price scan, secret shoppers made more than 300 phone calls in all, to more than 200 pharmacies in six cities and their surrounding areas across the U.S. They requested prices for five common generic drugs: Actos (pioglitazone), for type 2 diabetes; Cymbalta (duloxetine), an antidepressant also used to treat muscle and bone pain; Lipitor (atorvastatin), for high cholesterol; Plavix (clopidogrel), a blood thinner; and Singulair (montelukast), for asthma. What we found was startling. In short, prescription drug prices can vary widely from retailer to retailer, even within the same ZIP code.


Drugs could cost as much as 10 times more at one retailer vs. another. We’re not talking about regional differences; we found big variations at retailers in the same area. For example, where Debbie Diljak lives in Raleigh, N.C., the cost for a month’s worth of the generic Cymbalta she takes ranged from $249 at a Walgreens to $43 at Costco. (At Walgreens, the pharmacist did suggest using the store’s discount program to lower the price to $220, but it comes with a $20 annual fee.) See more examples in the map below.
Similar patterns emerged across the U.S. In Dallas, a shopper was quoted a price of $150 for generic Plavix at a centrally located CVS. But Preston Village Pharmacy, an independent just a 20-minute drive away, said it would sell the drug for just $23. In Denver, the grocery store Albertson’s Save-On said its price for generic Actos was $330, but nearby Cherry Creek Pharmacy said it would sell it for just $15. For the variety of prices we found, see the chart below.

Who Sells It for Less: Our Pricing Analysis

Earlier this year, we had secret shoppers make calls to the pharmacies of more than 200 stores across the country to price a market basket of five common generic prescription drugs. We followed up with half of them recently, and also checked one online pharmacy, to get the most up-to-date prices. The numbers in the chart below are averages of the price retailers quoted for a one-month supply. Retailers are listed from least to most expensive for the total price of our market basket.

Try mail order Pharmacy, Sams Club, Costco. My local Kroger matches all prices and generally is lower than others.
http://www.consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices/

 

[raysundar]

Thanks Prasad,
That's pretty good amount of information about drugs. My bigger issue is with doctors who seem to charge at their own rates and there seems to be one standard if you are insured and another if you go without or some kind of discount program. Have you done similar comparison for insurance carriers say for an average 60 yr old. That is when most retirees like me start facing financial problems. As long as company pays for health care it appears that insurance carriers thrive on that. Our company could afford about $1500 per month per employee with co-pays of $20 for office visits and prescription drugs starting at $5. Prior to Obamacare my monthly contribution was about $60 per month, and copays were $15 but after Obamacare both doubled since the company wished to share some of their burden with employees.
I have analyzed this scenario's some what and found that network clinics are forced to take whatever the insurance pays them and they can be different for different carriers. From what I see the clinics can clearly post good chunk as losses in business by billing the insurance higher and getting paid less and take business tax deductions. Whereas I have the 7.5% AGI before I can any tax deductions on medical expenses. The only way out was Flexible Spending Account(FSA) or HSA. Again HSA meant that your first $3500 to $5000 comes out of your HSA and you have to pay whatever the doctor bills you. That bill is slightly lower than their bloated retial but higher than what insurance companies pay the doctor.
So Obamacare is a good start for the millions who got coverage but at the cost of middle class people like me. The rich are never affected by any of this and they continue to fight any Govt. health care program.
This year I will be once again shopping around for healthcare for my family to save "a few bucks".
For me BC&BS for medicare worked out the best. I only pay for my Part B to the Govt Medicare and I get $0 copay for both doctor and prescription drugs. I don't have Dental or Vision. I have signed up with a yearly membership with my Dentist that gives me and my family discounted prices for all his services. That worked out cheaper. God forbid I break my teeth or have problems when I am on travel.
If any one you know has any better program for family then kindly send me the appropriate links or send me private message on that.
I am basically looking for large expenses coverage in the case of emergency or hospitalization.

 

[prasad1]

Thanks Prasad,

You are welcome sir.

In USA Medicare for retirees start at 65. At 60 you will be out of luck.
Anybody under 65, and without employer paid insurance will be in a difficult situation.

Depending on the health insurance company, Arizona individual and family health insurance rates for couples can be based on the age of the youngest person on the policy. Some couples with an age difference of several years may find they save money by applying for the same plan rather than individually. Couples that are only a few years apart might be able to reduce their total costs by applying for separate health insurance plans. If you decide to apply for a health insurance plan as a couple, make sure the plan you choose covers the benefits both of you need.
https://www.ehealthinsurance.com/arizona-health-insurance/health-plans/individual-medical

https://www.ehealthinsurance.com/arizona-health-insurance/health-plans/dental

www.vmshh.com

https://www.healthcare.gov/shop-health-plan-information/

https://www.ghc.org/individual-family

http://health.usnews.com/health-insurance/arizona

I do not know a whole lot about ARIZONA Health Plans.

 

[prasad1]

How to Ease the Pain of Rising Health Insurance Rates
http://www.usnews.com/dims4/USNEWS/...3f5/resizes/1500/150730-moneyhealth-stock.jpg

As a consumer, it can be frustrating to watch rates continue to rise. The good news? By making smart decisions before next year's even begins, it's possible to ease the impact on your wallet.

The numbers for 2016 are eye-popping: In some states, insurers are seeking 20 to 40 percent increases in premium rates on public exchanges. Meanwhile, people with insurance from their employers are paying a greater share of their own costs. A typical family of four will spend more than $24,600 on health care this year, including premiums and copays, according to the 2015 Milliman Medical Index.

But even with rates rising, there are ways to manage the pain. Here's what you need to know to minimize your costs.

Start by Learning the Basics

One of the smartest steps you can take is to learn the ins and outs of your health insurance plan.

"Now more than ever, you really have to understand your plan's out-of-pocket costs – the deductible, copayments and formulary constraints," says Gerry McCarthy, president of TransUnion Healthcare.

More than 60 percent of consumers in a recent TransUnion survey said they are at least sometimes confused by their out-of-pocket costs.

Your work isn't done once you select a plan. Choosing doctors and hospitals wisely is important, too.


"You don't have to go to the hospital down the street or the surgery center nearest to you," McCarthy says. "It's about quality and financial outcomes."

McCarthy advises calling providers ahead of time to get a custom estimate on any upcoming health services you need. Insist on a detailed upfront estimate based on your health plan, including your share and the insurer's.

When shopping around, you might find provider options to be limited, or the service you need might be very expensive by nature. When that happens, McCarthy suggests discussing payment options with your provider.

"Most providers today will negotiate with you; they'll offer discounts for faster payment, offer payment plans and they can also help you search for charity care," McCarthy says.

Whether it's your premiums or your share of a bill, arming yourself with information is the best way to combat high health costs – before and after care, and all year round.






http://health.usnews.com/health-new...n-of-rising-health-insurance-rates?int=aad309

 

[prasad1]

If you have health insurance, there's a good chance you'll pay more for it in 2016.

Health care and health insurance costs increase year to year, like most expenses. Since the implementation of the Affordable Care Act, growth in premiums has mostly slowed (as has the rise in health care costs overall), while your share of expenses – like deductibles – has increased. For several reasons, increases in both premiums and other out-of-pocket costs are expected in the coming year.

You can cope with these cost increases by understanding how they'll happen and what you can do to mitigate their effects. How they affect you depends largely on where you get your insurance.During the second open enrollment period of the ACA, an estimated 11.7 million people had selected or were automatically re-enrolled in health insurance plans on the federal and state marketplaces, according to the Department of Health and Human Services.

Recent media coverage of planned 2016 premium hikes refers to plans purchased by individuals on these health care exchanges. But these reports don't tell the whole story.

"The data that's out there about 2016 premiums is a little deceiving," Corlette says. "And that's because, in most states, the only rates that have to be posted right now are those that are proposed to be over 10 percent increases." Insurance companies projecting more modest increases, therefore, don't have to share that publicly, creating a skewed sample.

But, Corlette says, that doesn't mean there won't be premium increases. They're driven largely by rising prescription drug costs, insurers having a clearer picture of their policyholders' health care needs and the end of temporary "risk mitigation" programs that gave cash incentives to insurers for approving everyone.

In 2016, if you buy your insurance on state or federal health insurance marketplaces, you're likely to see both increased premiums and cost-sharing. But unlike employer-based coverage, increased premiums on these plans are often offset by subsidies.

The solution, as with employer coverage, lies in shopping carefully.

● Reapply for the premium tax credit or health care subsidies. The Department of Health and Human Services estimates 87 percent of people purchasing marketplace plans receive this financial assistance to help lower premium costs. Updating your income information each year will ensure you're getting the maximum allowable benefit.

● Be flexible and willing to part with your current plan. As costs change, the government may label another marketplace plan the "benchmark," or the plan to which subsidy amounts are tied. If the price of your current plan goes up and another goes down, that lower-priced option may be deemed the benchmark. By switching plans, you'll likely avoid cost increases altogether.

"The subsidy is almost like a gift card," Corlette says. "So if you take it and stay in your same plan, even though that plan has gone up, yes, you'll be paying more. But if you take it and go shop for a lower-priced plan, you should be fine."

● Apply for Medicaid or CHIP coverage if you have children. If you make too much to qualify for Medicaid, your children could still be eligible for it or for The Children's Health Insurance Program. Both are designed to provide health insurance to children at no or low cost. Eligibility varies by state, income and family size. In some states, children in a family of four could be eligible even if the household adjusted gross monthly income is as much as $6,000 or $7,000.
http://health.usnews.com/health-new...her-health-insurance-costs-in-2016?int=adaf09

 

[prasad1]

Buying health insurance during open enrollment?

http://www.consumerreports.org/cro/...th-insurance-during-open-enrollment/index.htm