The effect of owning private long-term care insurance policies on out-of-pocket costs.
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This article examines the effect of owning long-term care insurance policies on the amount of out-of-pocket costs incurred by the elderly during their nursing home stays, and the importance of different policy features and restrictions. Data were drawn from the 1985 National Nursing Home Survey, and from copies of long-term care insurance policies collected from 11 leading companies during the spring and summer of 1988. The study results show a great deal of uncertainty concerning amounts the policies are likely to pay toward nursing home stays. This implies that the policies collected did not adequately fulfill one of the primary purposes of insurance: a reduction in risk and uncertainty. To examine whether rapid policy changes in recent years have made a difference, we assessed each of seven policy features and found that the two most important restrictions in long-term care insurance policies are prior hospitalization and level-of-care requirements. Recently, the National Association of Insurance Commissioners (NAIC) recommended that states prohibit the sale of policies containing these restrictions. Our findings confirm the wisdom of this recommendation. We did find, however, that two other policy restrictions--policy maximums and lack of inflation adjustment--are problematic. We recommend that the NAIC expand its model regulations to require that policy maximums be a minimum of four years, and that some form of inflation protection be incorporated into policy benefit structures. (+info)
Elimination of co-payment for weight management counseling.
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The Department of Veterans Affairs (VA) published a direct final rule amending our medical regulations to designate weight management counseling (individual and group sessions) as a service that is not subject to VA's co-payment requirements. VA received no significant adverse comments concerning this rule or its companion substantially identical proposed rule published on the same date. This document confirms that the direct final rule became effective on June 16, 2008. In a companion document in this issue of the Federal Register, we are withdrawing as unnecessary that proposed rule. (+info)
The effects of the coverage gap on drug spending: a closer look at Medicare Part D.
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Consumer-directed health care for persons under 65 years of age with private health insurance: United States, 2007.
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Data from the National Health Interview Survey. In 2007, 17.3% of persons under 65 years of age with private health insurance were enrolled in a high deductible health plan (HDHP), 4.5% were enrolled in a consumer-directed health plan (CDHP), and 14.8% were in a family with a flexible spending account for medical expenses (FSA); Persons with directly purchased private health insurance were more likely to be enrolled in a high deductible plan than those who obtained their private health insurance through an employer or union; Higher incomes and higher educational attainment were associated with greater uptake and enrollment in HDHPs, CDHPs, and FSAs. National attention to consumer-directed health care has increased following the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (P.L. 108-173), which established tax-advantaged health savings accounts (1). Consumer-directed health care enables individuals to have more control over when and how they access care, what types of care they use, and how much they spend on health care services. This report includes estimates of three measures of consumer-directed private health care. Estimates for 2007 are provided for enrollment in high deductible health plans (HDHPs), plans with high deductibles coupled with health savings accounts also known as consumer-directed health plans (CDHPs), and the percentage of individuals with private coverage whose family has a flexible spending account (FSA) for medical expenses, by selected sociodemographic characteristics. (+info)
Medicaid program; premiums and cost sharing. Final rule; delay of effective date and reopening of comment period.
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This action temporarily delays the effective date of the November 25, 2008 final rule entitled, Medicaid Program; Premiums and Cost Sharing" (73 FR 71828) until December 31, 2009. In addition, this action reopens the comment period on the policies set out in the November 25, 2008 final rule, and specifically solicits comments on the effect of certain provisions of the American Recovery and Reinvestment Act of 2009. (+info)
Paradoxical effects of cost reduction measures in managed care systems for treatment of severe psoriasis.
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BACKGROUND: Insurance companies vary widely in their coverage policies for severe psoriasis therapies. Unfortunately, coverage policies for psoriasis therapies do not necessarily follow current treatment paradigms, such that more expensive second or third line treatments may be more easily obtained than first line treatments. METHODS: We reviewed insurance policy bulletins, statements of coverage/medical necessity, and prior authorization forms for three large insurance carriers regarding psoriasis treatment with biologic agents and phototherapy. A cost comparison was performed to estimate total costs to patients and insurer under the current system as well as a hypothetical system in which co-pays and deductibles are eliminated. Additionally, we reviewed the total cost to an insurer for placing a patient on a trial of home phototherapy before approving use of expensive biologics. RESULTS: Requirements for coverage for phototherapy treatments are often the same, if not more stringent, than those for biologics. On an annual per patient basis, insurance companies pay an estimated $5, $76, and $23,408 for home phototherapy, office phototherapy, and biologics, respectively. The first year cost to patients, however, is estimated to be $2,590, $3,040, and $920 for home phototherapy, office phototherapy, and biologics, respectively. An initial 3-month trial of home phototherapy yields a graded annual cost savings to insurers of $21,610 to $2,110 per patient. DISCUSSION: The evolution of psoriasis treatment has resulted in a paradoxical situation in which the use of lower-cost psoriasis treatments, with longer safety track records, is discouraged relative to newer options. If co-pays, deductibles, and prior authorization requirements that discourage phototherapy were reduced or eliminated, more patients and physicians would likely choose phototherapy over biologics. This has the potential to reduce overall healthcare costs for psoriasis management. (+info)