Open Enrollment: A Critical Time for You and Your Family

Whether you’re one of the lucky folks who still have health insurance from your employer or you purchase insurance on your own, open enrollment is right around the corner. It’s a critical time in terms of choosing or renewing benefits, so approach with care and caution.

Here’s what it is:
An annual event, open enrollment gives you an opportunity to change your current health plan or benefit options, such as dental or vision care. Once open enrollment is over, you can’t make any changes to your plan design for an entire year, unless there’s an IRS qualifying event, such as marriage, divorce birth, adoption, or death.

During Open Enrollment, examine your plan choices for the following:

The Network: Compare your doctors and specialists (along with your preferred hospital) with the plan’s list of network providers. Who’s in? Who’s not? Can you live with that? Are you allowed to use out-of-network providers and hospitals? If so, what are the costs and prerequisites?

Cost Per Visit: Look at monthly charges, deductibles, and co-pay requirements for doctor and specialist visits. Do the math. If you see doctors often, you may want a higher monthly payment with lower co-pay; if you go occasionally, consider a lower payment and higher co-pay.
Prescription Coverage: Basically, you want to compare plans in relation to the annual cost of all your prescriptions. Which plans have a separate prescription deductible? What about co-pays? How much will you save with generics or ordering by mail?
Plan Features & Overall Coverage: Think about the services and supplies you normally use; now imagine the coming year and what you might need. Will you be traveling? Having surgery? Will you need short term rehabilitation and physical therapy? Does your plan require precertification? Are you covered anywhere in the U.S. or if you travel abroad? Are preventative care and immunizations covered? Of the plans you’re considering, which offers discounts for services like gym memberships? Is that important to you?

Choose your plan according to your needs — the ones you have now and the ones you envision for the coming year. You only get one chance each year to get it right. If you need help comparing plans and benefits, give Health Champion a call. We’re here to make Open Enrollment easy on you.

So you have two health plans…what should you know?

Double the Benefits

You’re married. You have jobs. And both employers provide health benefits. Double the insurance, double the benefits, right? Not so fast. And, while all the folks with little to no health insurance are likely reading this, saying, “I should have such a problem,” there really is a bit of Double Trouble when you have two sets of benefits under one roof.

The key to managing your coverage is understanding the rules, knowing which policy is your primary one and which is secondary (you don’t get to choose no matter how much you may like one plan over the other). However, you have to follow the rules of both, so pay attention to the details.

Some tips and reminders:

When there are dependent children on both policies, most plans follow the birthday rule: the parent whose birthday month falls earlier in the calendar year holds the primary plan. The actual birth year is ignored.

Make your doctor aware of all your health insurance coverage; always give copies of both cards.

Ask if your doctor’s office will send the secondary carrier a copy of the bill along with an explanation of payment. If not, you’ll need to do that. This is critical to having the claim processed correctly.

Using network/out of network providers: If your primary plan allows you to see both types of providers, but your secondary plan requires that you use only participating providers, the limitations of the secondary plan take precedence. In this case, the provider must be participating with the secondary plan. Otherwise, benefits won’t be paid.

Ditto for preauthorization or precertification: the rules of the secondary health plan have to be met in order to process the claim.

Dual coverage is definitely a benefit, but it takes vigilance to ensure you don’t fall between the cracks of your coverage. When in doubt, call your plan administrators to learn what’s covered, what’s not and how to receive maximum benefits.

Next week, we’ll look at the Medicare Factor and see its impact on coverage.

It Kills. And it’s Silent: High Blood Pressure

When the heart stops ticking, so do we. That’s the plain and simple truth. So let’s work at keeping it healthy for as long as possible. No lectures here. Just a couple of reminders and a new way of looking at things. For instance, contrary to popular assumption, heart disease is not the result of isolated, unconnected diseases; rather it runs along a continuum. And it starts with high blood pressure.

Known as the Silent Killer, high blood pressure can start in teens or early adulthood, generally has no symptoms, and can go undetected for years. Left untreated, it only gets worse. And so does your risk of stroke, heart attack and death.

Quick Review:

Your heart beats rhythmically, transporting blood through arteries and veins, stopping by the lungs to pick up oxygen and then moving on, delivering oxygen-ripe blood throughout your body, returning to the lungs and beginning the journey once again. All day. All night. This elegant system of pressure and movement keeps us alive and healthy.

Uncontrolled high blood pressure makes the heart work harder. The harder it works, the larger and less efficient it becomes, resulting in irregular heat beats (arrhythmias), blood clots — which can block veins and arteries or break off and travel to your lungs or brain — and even heart failure.

Think of high blood pressure as the beginning of heart disease — the beginning of a story where you can help write the ending with healthy behavior. Have regular check ups. Take medication if required, even if you have no symptoms. Exercise. Lay off salt. Eat well. And pay attention to the other risk factors along the continuum. Next time we talk about hearts, we’ll examine cholesterol.

Meanwhile, remember that in 2006 high blood pressure killed 56,561 people across the U.S. It’s time to change those numbers. If you’re going to be a statistic, be a good one! Start by taking care of your blood pressure.

When do you know it’s time?

We’re called the Sandwich Generation: adults caring for maturing children — who require financial, physical and emotional support — AND aging parents who may be ill, forgetful, running out of money, and unable to perform simple tasks.

One of our biggest fears is having “that conversation” with our parents. The one that begins with, “I’m worried that home may no longer be the best place for you to live anymore.”

Maybe you’ve had an initial talk and were able to modify their environment — like placing grab bars by the toilet and in the shower, removing fall risks like throw rugs, or engaging an in-home caretaker. Maybe they’ve moved closer to you or a sibling. But, eventually, they may require a higher level of care. It’s time for that conversation when you notice . . .

old and/or spoiled food in the refrigerator and cabinets
infrequent bathing; poor personal hygiene
frequent bruises due to falls
lack of movement around the house; too much time in bed
inability to transfer from bed to chair and back again
old and new medicine bottles scattered around the house
infrequent eating and/or poor nutrition
decreased ability to control urinary and fecal discharge or manage toileting

As you find yourself filled with natural feelings of guilt and confusion, remember . . .

When they were taking care of you, they made difficult decisions to keep you safe and healthy regardless of whether you agreed with them. Now it’s your turn.
When you visit, you see them at their best. Unless you’re able to spend a few days, you may not see all of their struggles.
Make sure you’re advocating change because it’s in their best interest and not simply yours. Examine your deepest motives.
Quality of life still matters. Home is not always the best place to age; it can become isolating and depressing.

If you need help or support, use available resources.

A Geriatric Care Manager can provide a full home assessment and offer impartial recommendations. Our Health Champion@ Home is here to help when the time comes: www.healthchampion.net.

In addition, contact your state’s Department of Aging and The National Area on Aging: www.aoa.gov .

Being responsible for two generations of loved ones — our kids and our folks — is challenging and fulfilling as we engage fully in the cycles of life. We just have to remember to breath. And to know when it’s time for new and next steps. As always, you’re invited to post your comments and questions.

Being There During A Medical Emergency

One moment your mom or dad is doing fine. Or fine enough, given their age, health and limitations. The next minute one of them is rushed to the emergency room. You get the call. You start putting your life on hold, knowing you need to be there overseeing care and critical decisions. But it could take hours, even a day or two, depending upon geography, work, and other family responsibilities to get there.

Now what? Unless you have a plan in place, your loved one will likely be alone in the emergency room, even if they’ve been living in an assisted living facility or nursing home. No one goes with them. And, very often, neither does critical information.

According to an article in the Journal of the American Medical Directors Association (March, 2010), researchers found that when nursing home residents are bought to an Emergency Department, typically, 10% arrive without any medical information and the remaining 90% arrive missing some critical pieces!

These same patients, alone and frightened, are often unable to answer even simple questions. This inability could be due to shock and fear, an already reduced mental ability, or a sudden change in mental status due to the acute illness.

In order to make an accurate diagnosis and begin treatment, the medical team needs basic, critical information — from current medications and allergies to a full medical history and understanding of what is considered to be the patient’s normal mental status. Having this information helps avoid complications, misdiagnoses, redundant lab work and expensive tests, unnecessary hospitalizations, increased medical costs, and discharge to a rehab facility when they can often return home with added supports.

So, you’re on your way. Meanwhile, your parent is alone in the ER … What’s the solution?

Plan ahead for the possibility. Find someone you trust to accompany your parent when an emergency occurs. Give that person all vital information and permission to serve as your parent’s advocate until you arrive. Explore Health Champion’s new Health Champion @ the ER program to see how we can fill this essential role for your family. There’s more than one way to be there.

Medicare to the Rescue

Quick Test:

Are you — or someone you’re caring for — on Medicare and suffering from a variety of chronic health conditions?
Do you worry about taking all those meds: are they more than you need; are they even necessary?
Are you concerned about side effects or drug interactions?

If you’ve answered “yes” to any of the above questions, it’s time for answers. And you won’t have to search high and low to find them. Help is available through a federal program called Medical Therapy Management (MTM), offered by your Medicare Part D or Advantage prescription plan.

With MTM, a clinical pharmacist will:

evaluate your conditions and medications to ensure safe, appropriate, and cost-effective use.
contact your doctor(s) about any problems and work to help resolve them.
meet with you several times a year to help you keep track of all of your medicines and conditions and monitor your progress.
be available for questions and problems as they arise.

The best part? If you qualify, this service is free!

Why is this important?

The more medicines you take, the greater the risk for dangerous interactions, adverse side effects and mismanagement (not taking them as directed), leading to serious consequences. In fact, this is a growing public problem across the United States. Experts estimate that 1.5 million preventable adverse events occur each year, resulting in $177 billion in injury and death.

Find out if you qualify.

Contact your Medicare Part D prescription plan or your Medicare Advantage Plan; ask about their MTM services and how to qualify. Also ask for the names of clinical pharmacists in your area. It’s that simple.

Do this for yourself. Be Informed. And stay healthy!

A Money-Saving Prescription

When it comes to medications, are you getting the most value for your dollars? Here’s our prescription for saving time and money.

Think Generic: Save up to 80% on your meds. People sometimes resist generics because they worry about a drug’s effectiveness: how can an inexpensive version be as good as a brand name? They’re “generics” — not because they’re inferior — but because the branded medicine has lost its patent protection and other companies are allowed to manufacture and sell it. All have the identical chemical to the original. Because some generics — like coumadin and levothyroxine — may not work for you, ask your doctor before switching. Also, fillers may be different; check for allergies or intolerances. If all systems are “go” give generics a try and save lots of money.
Shop Around: Different pharmacies, different prices. Especially for generics. Call around, compare pricing, Check “big box” and club stores. Before switching pharmacies, ask if yours will match the lower price. Whatever you do, use the same pharmacy for all of your prescriptions to avoid drug interactions and other potential problems.
Pay Privately: You’re not required to use your insurance when paying for a prescription. You may want to keep a matter confidential; sometimes, it’s cheaper to pay on your own versus going through your insurance company with its limitations and co-pays. Evaluate your concerns. Do the math. When in doubt, ask your pharmacist for advice.
Use Mail Order Many insurers invite you to purchase three months of medicine for two months of co-pay. That means you save four times your monthly co-pay each year. This is ideal for people who are organized and can order meds well in advance of running out.
Talk to your pharmacist: Don’t be shy. Ask the money questions. Find out about generics or less expensive brand names. Protect your interests. The more informed you are, the healthier you will be. And if you’re still in doubt, seek the help of objective health care experts.

Do you have a tip we didn’t include? Post it in the comments section. We’d love to hear from you.

Choosing the Right Health Plan- Benefits by Design -

Continuing last week’s discussion, Choosing the Right Health Plan, let’s look at how the actual Benefit Design can — and should — shape your purchasing decision.

When we say benefit design, we’re simply acknowledging that medical insurance plans come in various shapes and sizes; you need to pick one that fits you and your family.

What’s in a Name?

Everything. The name itself often represents the type of product, reflects plan rules or highlights a unique element. Example: HDHP stands for “high deductible health plan!”

HMO, PCP, Gatekeeper — these names are associated with benefit designs from health plans versus insurance companies. They generally require a referral from a primary care physician before you see a specialist. Does that work for you? Are you willing to engage with a primary care physician as part of your health care team? Open Access, on the other hand, typically means you don’t need a referral from a primary care physician to see a specialist.

Points of Service

Before purchasing a health plan, make sure you understand how it’s designed in terms of service. For instance, will you be covered — to some degree, at least — if you see a non-participating doctor?

Warning: if you call a doctor’s office to see if they participate with your insurance and you get this response, “We accept all insurance” DO NOT think it means they participate with your plan. It simply means they’re willing to accept a check from anyone. Ask more questions.

Need physical therapy? Want to see a chiropractor? Make sure these services are covered and if there are limits on visits. It’s not unusual to see benefit designs with limited coverage for these services.

There’s a lot to consider when choosing a heath plan. And the wrong decision can be costly. Check with your state’s Department of Insurance website for a list of all licensed insurance companies and health plans doing business in your state. See what’s available. And when in doubt, consult an expert for advice.

-end-

Choosing the Right Health Plan

With the recently passed health care reform legislation, millions of Americans will find themselves having to “purchase” health care coverage. Whether you’re getting coverage for the first time, evaluating Medicare options, shopping for individual insurance, or choosing a plan from options offered by your employer, the process can be complicated and confusing. Start by evaluating the following:

Your Budget

Even if you qualify for a subsidy, determine how much you can pay for health care on an annual basis. Questions to ask yourself:

Who will be on the plan? Just you? You and a spouse? What about children? The new bill allows for adult children up to age 26 to stay on a parent’s plan. This decision affects premium rates.
Which works better for you: a lower monthly premium with an upfront deductible or a higher premium with no upfront deductible?
What about co-pays? If you go to the doctor frequently, you might want a plan with lower co-pays, a higher monthly premium and little, to no, upfront deductible.
Think in terms of surgery and preventative care (physicals, colonoscopy, etc). Check the plan for out-of-pocket (meaning your dollars) costs for these services. Many benefit plans include preventative services. Explore this carefully as it could have significant impact when you need care.

The Network
Once you’ve determined budget issues, consider the network. Make a list of all the doctors and health care providers you and your covered family members have seen in the last 12 months. If you currently have coverage, register for and use the plan’s website to review your claims history. Using this information, assess your needs by answering these questions:

Do see certain primary care or specialty doctors on a regular basis?
Do you prefer a particular hospital?
Do you want to be able to obtain second opinions outside of your local area? If so, you might want a health plan that includes some level of coverage for non participating doctors.

When evaluating your needs, be sure to include health care professionals such as physical therapists, chiropractors or optometrists.

Next week Health Champion will explain how to evaluate benefit designs. If you have any questions — or issues you’d like covered — please leave a comment and we’ll address your concerns in an upcoming blog.

This is March: Where’s your Colonoscopy?

If you’re 50 or older, this message is for you: Have you had your colonoscopy yet?

If so, congratulations. If not, what are you waiting for?

We know. The very word produces a Yuck response: not a topic for polite conversation. Except if you or a loved one has been affected by colon cancer. And then you can’t talk about it enough.

March is Colorectal Cancer Month, a time to remind people about preventative health screenings. So, that’s what we’re doing. Urging. And reminding. And 50 is the target time, because the majority of cancers occur after that age.

Colon cancer — a cancer in the cells of the colon or large intestines — is the third most common cancer in the U.S. — affecting about 110,000 men and women each year. Add in rectal cancer (located at the end of the colon), there are approximately 150,000 new cases annually. It often starts as a small benign (noncancerous) clump of cells called polyps, common in adults and usually harmless. However, since most colorectal cancer begins as a polyp, removing them early is critical to preventing cancer.

People prone to developing colon cancer are those who:

eat a high fat diet

have a family history of colorectal cancer and polyps

have polyps detected during a colonoscopy

have a history of chronic ulcerative colitis.

Planning for Your Colonoscopy:

Check your insurance benefits-if you are over 50 most insurance plans will cover a screening colonoscopy

Be sure to check whether your insurance benefits also cover the procedure if you have a polyp or any other tissue removed for biopsy

Check with your doctor which of your medicines you can take the morning of your procedure

Plan on being home the day before with easy access to a bathroom

Line someone up to drive you home, as you will not be allowed to have the procedure otherwise

Plan to wear loose, comfortable clothing

Prepping for Your Colonoscopy:

The day before: Known as “the bowel prep,” this is the most challenging part of the procedure. You’ll clean out your bowels by drinking clear liquids and taking laxatives according to detailed instructions…

The day of the colonoscopy: Arrive for the procedure a little early to allow for paperwork. You’re given a light anesthesia. The doctor inserts a long, flexible, lighted tube called a colonoscope into the anus, guiding it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits images to a computer screen. If the doctor sees a polyp or unusual-looking tissue, it can be removed and later examined for signs of diseases. The procedure takes 30 to 60 minutes. When you wake up, you’ll feel groggy and hungry. And that’s it.

Caught early, colorectal cancer can be successfully treated.

So, what are you waiting for?

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