The first question we hear quite a bit is, “Do people like Medicare Advatage?”  More people are familiar with Medicare Supplement Insurance plans, so when one of our agents describes Medicare Advantage (or Medicare Part C), this is the next logical question we hear.

My answer would be as follows: As with anything, some people like Medicare Advantage and others do not. And, the reason one person likes it can be the same reason another person does not.

Without giving an opinion, here is a list of the things that make Medicare Advantage different from original Medicare and, in some cases, from Medicare Supplement Insurance plans:

1. Prescription Drug coverage: Most Medicare Advantage plans include prescription drug coverage, which means you may not have to write two premium checks or sign up for two different plans like you do with a Medicare Supplement plan – one for the drug coverage and one for the medical coverage.

2. Monthly premiums: In some cases Medicare Advantage plans cost $0 per month in premium beyond what you’re already paying for Medicare Part B. In other words, you could sign up for the plan and pay nothing extra each month to maintain your coverage.

PlanPrescriber did a high-level review of all Medicare Advantage plans available nationally using the Center For Medicare and Medicaid Services (CMS) Landscape Data files, which are available publically online at: https://www.cms.gov/PrescriptionDrugCovGenIn/.

That review showed that, among the 43,329 plans available nationwide for 2012, 14,297 plans (33% of all plans available) have a monthly premium of $0 above what a person would already pay for Medicare Part B. And, the data showed that there were $0 premium plans available in 49 states, the District of Columbia and Puerto Rico.

However, plans with $0 monthly premiums may not be available in every county. Among all plans available, the average monthly premium was $57.56, per month.

 3. Out-of-pocket limits: “Original Medicare,” Parts A and B, do not place a cap or limit on what you might have to pay out of your own pocket for medical expenses. But, the Patient Protection and Affordable Care Act (health reform) did place a mandatory maximum limit of $6,700 on all out of pocket medical costs for Medicare Advantage plans. This limit is referred to as the “Maximum Out of Pocket” or MOOP.

The MOOP does not include prescription drugs and monthly premiums. The Mandatory Maximum Out of Pocket (MOOP) is $6,700 but Medicare allows for a “Voluntary MOOP” of $3,400 or less. And, when we looked at the 2012 data we found that, of the 43,329 plans available nationwide, the average maximum out of pocket, or MOOP, was $4,516.

4. Dental, Vision, etc. Benefits: Some Medicare Advantage plans will cover things like routine vision and routine dental care, as well as benefits like audiology services and fitness classes. The majority of Medicare Advantage plans include the Medicare Part D prescription drug benefit.

 5. Flexibility: Unlike Medicare Supplement plans, in every state a person can change their Medicare Advantage plan once a year without undergoing medical underwriting. In most states, a person with a Medicare Supplement plan has only a seven month window to enroll in a Supplement plan. After that “initial enrollment period,” a person’s application for a Medicare Supplement plan can be declined.

In any state, a person with a Medicare Advantage plan can change their coverage during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 in 2012. People are encouraged to at least check their drug coverage and benefits once a year while on Medicare, as the prescription drug  and other benefits tend to change from year to year.

There may be additional opportunities to change coverage throughout the year based on individual circumstances. For example, in 2012, anyone with access to a Medicare Advantage or Prescription Drug Plan with a “5 Star” rating will be able to enroll in that plan at any time throughout the year.

6. Variable Plan Types: In the past, Medicare Advantage plans were often available primarily as HMO plans where services were provided through a specific network of doctors and hospitals that often required referrals to see specialist. Medicare Advantage plans are becoming increasingly  available as; Preferred Provider Organizations (PPOs), which offer a wider choice of providers; Private Fee-for-Service (PFFS) plans that don’t typically have networks, however, providers must accept plan payment and rules; and Special Needs Plans (SNPs) specifically designed for people with lower incomes and/or specific diseases or conditions.

 Check Medicare Advantage Costs

 Medicare has not reviewed or endorsed this information

In case you missed it, the report found that 42% of the US population would be obese by 2030 – currently 36% are obese today. The report also pegged the cost to treat rising obesity at an additional $550 billion over the next 20 years.

Suggested forms of “Federal intervention” in the report included:

• Banning sugary drinks and junk food at schools
• Monitoring how much weight pregnant women gain
• Requiring child-care facilities to make sure young wards stay active
• Restricting the types of foods that can be marketed to children
• Putting employers or managers in charge of watching an employee’s weight
• Adding sidewalks for walking, running and biking to communities to emphasize physical activity

Health care advocates LOVED the report, applauded its call to arms, and repeated its loud and clear message that our nation needs to take the issue of obesity seriously.

Perhaps somewhat unexpected was a backlash from many critics who blasted the report, claiming this was “nanny state totalitarianism” leading us down a path toward marshal law.

Outrage and Backlash

Even controversial, high-profile conservative pundit Rush Limbaugh weighed in on the issue, arguing that the cost to enact and monitor these changes be more than it saves (do we search kids’ backpacks for Twinkies when they show up at school?). The crux of the opposition to what was in this report was the idea that putting the Federal government in charge of a person’s weight eliminates that person’s accountability for their own health.

A Fair Point?

While it’s hard to oppose efforts to make people healthier, it’s also fair to say that some anti-obesity measures could be difficult and costly to implement or enforce. It might be easy to find obese people when they go to the doctor, but what about the people who don’t go to the doctor? Taken to extremes one could envision random obesity check points where police randomly stop people on the street and screen their BMI. And, these are the extremes that opponents like Limbaugh seemed to be most fearful of.

Calmer Heads Prevail  

But, what’s not in question is that the goal of the research, which is to decrease the rate at which Americans are becoming obese, has been well served by the controversy around the recommendations. The fact that the report has been so widely covered in the media has raised awareness of an important issue. And, while one can argue all day about the proper role of government, one can’t ignore that government’s job is – at least in part – to make us aware of danger and try to help us avoid it, in some way.

Eric Finkelstein, the leader of the study from Duke University in Durham, N.C. said, “Whatever the reasons, further small successes in anti-obesity efforts — more effective weight-loss drugs, public health campaigns to encourage exercise and more-healthful eating, or workplace health promotion policies — could flatten the curve even more, Finkelstein said.”

What Can You Do?

So far the report is just a report, and there has been no move by the Federal government to create a new Anti-Obesity Police Force (unless it’s a secret police force…) But, there are a number of things individuals and employers can do to help their employees lose weight and stay healthy.

A survey we ran earlier this year found that only 23% of small employers had even considered offering wellness programs incentives to employees in order to reduce their health care costs.

Also worth pointing out is a report we published in 2011, which showed that people considered to be overweight paid 22% more – on average –for health insurance than people who maintained a healthy weight. And, there is no controversy over these numbers. So, if you’re in a position to help yourself or someone else lose weight or maintain a healthy weight, there has never been a better time to do so. It can help your bottom line and our country’s as well.

If you need help getting started our guest fitness bloggers Ben Greenfield and Cyndi Kramer

Cyndi Teague Kramer

can help you get headed in the right direction.

You can also check out the Los Angeles Times article on this report here to learn more.

Ben Greenfield

Bike to Work Day schwag bag!

I try to ride my bike to eHealth’s San Francisco office a couple of times a week. It saves money (parking & gas), saves the environment and hopefully shaves some inches off my waistline. And yes, it is a great way to get out of the car or the train and enjoy your surrounding, whether it be the taquerías in the city or the green open spaces in the suburbs. And there are a fair number of folks in eHealth’s different offices across the country that ride their bike to work. We are fortunate that the company supports this commuting option by offering bike lockers or other bike storage, showers and Clif Bars in the kitchen. We even hosted an energizer station in front of our Mountain View office this morning for the South Bay cyclo-commuters.

When riding in the city, the one thing that I observe quite often is the number of cyclists that ride without a helmet. I pretty much shake my head every time – not in judgement but in pure wonder as to why anyone would hit the streets and ride 15-20 mph alongside 2-ton pieces of metal that are moving at twice the speed and not protect themselves. According to the National Highway Traffic Safety Administration, “despite the fact that nearly 70 percent of all fatal bicycle crashes involve head injuries, only about 20 to 25 percent of all bicyclists wear bicycle helmets.” Wearing a helmet is kind of a no-brainer, pun intended.

SF Bicycle Coalition volunteers hand out coffee and breakfast in SF

I choose a sleek, racer-style helmet – likening myself to Levi Leipheimer climbing the Alps, but others might prefer the more fashionable, urban helmets. Helmet manufacturer Nutcase has a very cool collection of helmets, including one with a Union Jack design. So, if you don’t have a helmet and like to bike a lot – get one today. Getting your work done at the office is hard enough with a brain – it’s pretty much impossible without a good head on your shoulders.

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Jean got one question from a self-employed viewer about health insurance. And, as it turns out, many self-employed people don’t know the difference between “individual and family” health insurance (also called non-group insurance) and small group health insurance.

Here are a few tips to remember when considering one or the other:

Eligibility: Family plans are designed for one or two adults and dependent children under the age of 26.A small group plan usually requires you to have at least two people working for the business (not in all states, but most ).

The second person can be a spouse, as long as you can prove they work for the business and get paid as an employee. Insurers will typically require proof of employment.

Underwriting: Underwriting means your health status is reviewed by the insurance company.

If you have a small group plan the underwriting has an impact on the rate you pay for your insurance each month. But, you’re application cannot be declined due to a pre-existing condition.

Family or “non-group” medical insurance is also medically underwritten, but the insurer can deny your application for coverage in most states.

Typically, the benefit of buying individual or family medical insurance is that those plans are, on average, approximately sixty-percent less expensive than group plans in most states. But, that 60% is an average, and may not be applicable in some states. Everyone wants “cheap” health insurance, even though affordability is relative. Talk to a licensed agent to find out what “cheap” means for you.

Tax Breaks: This is where small group health insurance has a benefit over health insurance for individuals and families. Small group plans typically allow you to deduct the money you spend on premiums for yourself, employees and dependants, from your income taxes. Premiums spent on family plans are usually not tax deductible.

We’re not qualified tax advisors, so you should consult a tax expert. But, if the cost of a family plan is hurting your small family business, you may want to investigate switching to a small group health insurance plan.

HSAs: Health Savings Accounts (HSA) are tax-advantaged accounts you can use in along with a qualified high-deductible health insurance plan in the individual, family and small group health insurance markets.

HSAs let you deposit portions of your pre-tax income in a tax-advantaged savings account. The money grows tax-free and you can withdraw it tax-free to pay for qualified medical expenses. There is some good information about HSAs at www.ehealthinsurance.com/hsa.

Small business owners may even have a few additional options for employees if they go with a small group HSA, including the ability to contribute money directly to their employee’s HSA tax-free basis. Again, it’s a good idea to consult a tax licensed professional when reviewing specific tax implications of an HSA account.

The important thing to remember is that there are people out there who may be able to help you find “affordable health insurance” you can actually afford.

Check Health Insurance Costs

We also like to encourage people to visit TheSelfEmployed.com if you have questions about anything related to being self-employed or a small business owner.

First, let’s revisit why National Women’s Health Week is so important.   If you chat with a mom you may hear her talk about all the people she cares for and how busy she is doing so, but you probably won’t hear her talk about taking care of herself.   However, taking care of physical and mental health is something women need to do so they can continue taking care of everyone else and continue with other parts of their life, such as a career or other pursuit.

According to the Centers for Disease Control and Prevention, in 2007 the leading cause of death for females was heart disease, cancer, and stroke.  For many women, these diseases can be prevented by taking good care of their health.  And recently in the news, USA Today reported by 2030 obesity could affect 42% of Americans.

At womenshealth.gov it is advised women take action this year with their new 2012 campaign, “It’s your time.”

Womenshealth.gov advises women to take care of all aspects of their health including bone, breast, colorectal, diabetes, heart, reproductive, and sexual.  In fact, womenshealth.gov specifically advises women to:

• Visit a health care professional to receive regular checkups and preventive screenings
• Get active
• Eat healthy
• Pay attention to mental health, including getting enough sleep and managing stress
• Avoid unhealthy behaviors, such as smoking and not wearing a seatbelt or bicycle helmet

Now the gift part:  Here is a handful of healthful Mother’s Day gift ideas she’s sure to appreciate that will compliment her health:

• Gift certificate for a  massage (either at a spa or by a loving family member)
• Gift certificate for a pedicure, manicure, or both (also, either from a spa or by a loving family member)
• Gift certificate for her favorite healthy restaurant or a healthy recipe book
• New bike helmet, running shoes, yoga mat, or whatever  spruces up her favorite exercise related activity
• Healthful breakfast in bed, lunch, or dinner (check out these healthy recipe ideas from the Mayo Clinic)
• Gift certificate for her favorite bookshop

If you have other ideas, we’d love to hear them.  For more information on women’s health, please visit http://www.womenshealth.gov/whw/.

Image via Flickr user UF Digital Collections.

What if you had to choose between paying your student loans or having health insurance?

Student loans are getting a lot of mention in the news lately. Interest rates on many federally subsidized student loans are set to double from 3.4% to 6.8% as of July 1, 2012 – unless American lawmakers do something about it soon.

As many as 8 million current and former students could be affected by the hike in interest rates. And the average debt burden for people with student loans is over $25,000 at graduation. So, yeah, this is a big deal.

In our annual survey of college students and recent grads we asked some questions about student loans and confirmed that there’s a lot of anxiety around the issue. We also asked respondents how they would prioritize health insurance and student loans, if forced to make a choice.

Here’s what they said:

• First off, we found that among college student and recent grads with student loans, 58% of current students and 62% of recent grads are afraid they won’t be able to pay their student loans while in their twenties.

• Even more surprising, we found that nearly three-quarters of students (72%) and grads (75%) with loans would rather go without health insurance than default on their student loans.

Anecdotally, eHealthInsurance customers in this situation have told us that their primary concern is to maintain a healthy credit score. They’re more worried about defaulting on their student loans at this stage in life than getting sick and needing affordable medical care.

That’s understandable, perhaps. But what happens to your credit score and future financial prospects when you do get seriously sick or injured and end up with a $50,000 hospital bill that you can’t afford to pay?

Visit our Media Center to learn more about eHealthInsurance’s 2012 College Students and Grads Survey, conducted by Kelton Research.

Image via Flickr user stevendepolo

A Ewing Marion Kauffman Foundation report found that, “In every single year from 1996 to 2007, Americans between the ages of 55 and 64 had a higher rate of entrepreneurial activity than those aged 20-34.” And, a separate report from Small Business Administration that found over five million Americans age 55 or older run their own businesses or are otherwise self-employed.

A 2010 article in the New York Times highlighted one such person; Cinde Dolphin, a Sacramento resident and three-time cancer survivor who started her own business at the age 55. After decades of experience working for Coors, she started a marketing and public relations firm that helps California winemakers.

How Does One Become a “BoomerPreneur?”

Many would-be “boomerpreneurs” are looking for opportunities to start their own businesses, create jobs and help grow our economy. But, getting started is not easy or obvious.

Franchises are one popular option – See a recent article on TheSelfEmployed.com about starting a Franchise Business that tackles issues like; How To Limit Your Financial Risk, Starting Without Employees and Finding a Break Even Point – but the opportunities are limitless.

There is also a great article at TheSelfEmployed that outlines 10 Businesses You Can Start with No Money, and another that teaches you How to Price Your Services when You’re Self-Employed. The key to becoming an entrepreneur at any age is finding something you’re good at, that you enjoy doing, and that people will pay you to do. And, there are a number of resources available these days to help you.

Health Insurance is an Issue

Over a quarter (29%) of eHealthInsurance customers were self-employed, and over the age of 55, in an online survey we conducted with customers who contacted our customer care center over the past four years. And, nearly two-thirds (60%) were earning over $50,000 a year working for themselves.

But, many reported being concerned about qualifying for private insurance or dealing with premium increases, year-after-year. While it may be more difficult for older Americans to qualify for private health insurance, it’s not impossible.

Our licensed agents make the following recommendations for anyone attempting to buy private insurance on their own.

1. Medical Underwriting: Small Group Versus Individual and Family Plans: If you apply for a small group health insurance plan the insurer will medically underwrite your policy, which means they’ll review the health status of everyone on the application order to determine what to charge you each month for your coverage.

Health insurance plans for families and individuals are also medically underwritten, but if the insurer determines that your medical risks are too high they can deny your application for coverage in most states.

The benefit of buying individual or family coverage is that those plans are, on average, approximately sixty-percent less expensive than group plans(2). The downside is that applications for coverage can be denied.

2. Enrollment: Small Group Plans Versus Individual and Family Plans: Family plans are typically designed for one or two adults and any children or “dependants” you may have. Once children turn 26 they’re usually no longer eligible for your family plan.

A small group plan requires at least two people in most states, and the second person can be a spouse, provided they’re an employee of the business. Insurance companies require proof of employment, which means you may have to provide some form of documentation.

There are a few states that are exceptions to this rule. Talk to a licensed agent for details.

3. Tax Implications: Small Group Plans versus Individual Family Plans: While we’re not qualified to provide tax advice, there are few basic things you should know. Individual and family health insurance products aren’t usually tax deductible, even for the self-employed.

But, the money you spend on premiums for yourself, employees and dependants on a small group health insurance plan is typically tax deductible. But, if you have detailed questions about tax policies regarding health insurance it’s also a good idea to consult a tax expert.

4. Business HSAs Versus HSAs: Individual or family Health Savings Accounts (HSA) are tax-advantaged accounts you can use in along with a qualified high-deductible health insurance plan. An HSAs will let you deposit some of your pre-tax income into a savings account. The savings grows tax-free and you can use them funds to pay for qualified medical expenses. There is some good information about HSAs at www.ehealthinsurance.com/hsa.

As a business owner, if you offer employees access to an HSA-eligible small business health insurance plan you’ll be able to offer them an employer-sponsored HSA and contribute money to their HAS to help them fund qualified medical expenses on a tax-free basis.

5. Medicare: If you’re an early boomer (you have already turned 65, or will be turning 65 soon), getting health insurance for a small business creates a new level of complexity. It’s a good idea to talk to a licensed small business agent about how your access to Medicare could impact your small group policy. If you’re on an individual policy, and planning to switch to Medicare when you turn 65, it’s also a good idea to get a basic understanding of how Medicare, Medicare Supplement Insurance, Medicare Advantage and Medicare Part D drug plans all work before you start shopping.

We have a series of videos available on YouTube that explain the basics of Medicare that can get you headed in the right direction.

But what if you already have health insurance? What if you’re already covered under a spouse’s employer-based plan? What if you already bought health insurance on your own and are quite happy with, thank-you-very-much?

Last week on Yahoo Answers we took a question from someone in that last scenario. She had a health insurance plan she’d bought on her own, and she wanted to keep it. Her employer told her that she MUST accept the company plan instead. Does that sound right to you?

The eHealthInsurance reply was voted Best Answer:

An employer can only force you to accept their health insurance plan when they pay for the full premium themselves and take nothing from your paycheck. If you’re working for a small employer, they may not be aware of the law. They can confirm it, however, by contacting your state department of insurance or the insurance company itself.

If you’re young and healthy, it may be that by adding you to the group policy the average monthly premium paid per person would be reduced for others. It’s possible that they are pressuring you to enroll in the plan for that reason. One healthy person on the policy can make a difference if there aren’t many people enrolled in the plan. However, they cannot legally require you to take the coverage unless they pay for your full monthly premium.

Image by Flickr user DorkyMum

How much are you willing to pay for health insurance?

eHealthInsurance recently sponsored a national survey of college students and recent grads. We’ll publish the results of that survey in the days to come, but here’s a little teaser.

One of our survey questions asked respondents to say what they considered a “fair” monthly cost for health insurance they bought on their own. Here’s what we found:

Current college students thought a fair monthly premium was $135. Recent grads (with a little more real-world exposure, presumably) thought $202 per month was fair.

So, how do these cost expectations match up to reality?

Pretty well, actually.

Our 2011 report on the costs of individual and family health insurance found that the average monthly premium paid for individual coverage for someone age 18-24 was $110. For policyholders age 25-34 it was $132.

In other words, despite that real-world experience, current students were more realistic than recent grads when it came to average health insurance costs in the individual market.

It’s not an apples-to-apples comparison, but according to the Kaiser Family Foundation, employer-sponsored health insurance in 2011 cost an average of $446 per month for single-person coverage. Of that, employees paid $78 on average and employers picked up the rest.

Check Health Insurance Costs

…Want to know more about what students and grads think about health insurance, student loans, and the 2010 health care reform law? Watch this space for more data from our forthcoming survey.

The Medicare Part D Donut Hole is a coverage gap in which, after the initial coverage amount is reached, Medicare beneficiaries must pay for all their prescription costs in full out-of-pocket until they reach the catastrophic coverage limit.

Seniors may not be taking their heart medications due to being in the Medicare Donut Hole, new research suggests

Seniors with Heart Problems in the Medicare Donut Hole

The study featured more than 120,000 Medicare beneficiaries dealing with cardiovascular conditions receiving Medicare drug benefits in 2006 and 2007. High blood pressure was prominent in the majority of the seniors studied and a third of the participants had congestive heart failure in the study, headed by Jennifer Polanski, a Harvard instructor.

4,000 seniors in the Medicare Donut Hole with heart complications and no additional drug coverage were compared against 4,000 Medicare beneficiaries who were in a similar situation, but had additional financial assistance for drug costs. Although neither group was likely to switch their heart medications due to being in the Medicare Donut Hole, researchers did find that that the lack of financial assistance for drug costs in the Medicare Donut Hole made seniors 57% more likely stop taking their heart medications.

No particular change in death rates or health incomes was noted in the four months of follow-up; however, the authors do note that there may be long-term health implications for stopping heart, cholesterol, or blood pressure medications.

U.S. News and HealthDay also covered this story. You can read their report here.

Future of the Medicare Donut Hole

It is important to note that since this study has been conducted, there have been changes to Medicare drug coverage and the cost of prescription drugs in the Medicare Donut Hole.

The Affordable Care Act, signed into effect in 2010, introduced a one-time $250 rebate for Medicare beneficiaries in the 2010 Medicare Donut Hole as well as drug cost discounts, adjusted yearly, for generic and brand-name drugs. The purpose of these discounts is to phase out the Medicare Donut Hole over time.  Just this Monday, the Center for Medicare and Medicaid Services (CMS) announced that the Affordable Care Act has already saved Medicare beneficiaries more than $3.4 billion on prescription drugs, thus helping to reduce the Medicare drug coverage gap.

What to do if you are in the Medicare Part D Donut Hole

A Medicare beneficiary will hit the 2012 Medicare Donut Hole after their initial coverage period, which ends after their plan has paid $2,930 in medication costs, up until they hit catastrophic coverage, which begins when their expenses for drugs on the plan’s formulary reaches $4,700.

There are a few key points to keep in mind when you evaluate drug costs in the Medicare Donut Hole:

• Discounts on Generic and Brand-Name Drugs: In 2012, individuals who hit the Medicare Donut Hole will receive a 50% discount on brand-name drugs and a 14% discount on generic drugs.
• Extra Help Program: Some Medicare beneficiaries, with limited resources and income, may be eligible for the Medicare Extra Help, also known as Low-Income Subsidy, for assistance on their prescription drug costs.
• Medicare Part D Plan: Signing up for a Medicare Part D plan is important because enrollment in Medicare Part D will not only help you avoid a late enrollment fee, but it can also offer coverage for your prescription drugs. Every Medicare Part D plan has a different drug formulary and regulations around drug coverage. Given that each individual takes different amounts and combination of prescription drugs, it is important to select a Medicare Part D plan with the most drug coverage and lowest out-of-pocket costs for you and the unique combination of prescription drugs you take. You can compare Medicare Part D plans based on your individual medication needs by visiting the PlanPrescriber Medicare Part D plan comparison tool.

 * This information has not been reviewed or approved by Medicare