Tuesday, October 29, 2013

The future of health care depends on good information and good decisions

As I organized my thoughts in preparation for 2013 “Future of Healthcare on Long Island Symposium,” I thought long and hard about one of the questions I was given as a panelist: ”What part of your job responsibilities keeps you up at night?”

Panel moderator Dr. Jeffrey Reynolds asked many tough questions of the panelists who joined me at Long Island University.  I served on the panel with Arthur Gianelli, chief executive officer of NuHealth; Gwen O’Shea, chief executive officer of the Health and Welfare Council of Long Island; and Dr. Kenneth Kaushansky, senior vice president of Health Sciences and dean of Stony Brook School of Medicine.

And I’m certain I wasn’t the only panel member who spent many sleepless nights thinking about how to improve our health care system.

While there are many issues about the future of health care that are on my mind, the most important one is how we at UnitedHealthcare can respond to an ever-changing environment to help the people on Long Island and across the country, make good decisions about their health.  But to make those good decisions, people need good information.

As I shared in another recent blog, the Journal of Health Economics recently reported that only 14 percent of Americans understand basic health insurance concepts such as deductibles, copays, co-insurance and out-of-pocket maximums.  Furthermore, many people and companies are not clear about what’s happening with health reform and how the law affects them.

One of the things we have done to make information accessible and easy to understand  is create UHC-TV. Found here, UHC-TV breaks down industry jargon into simple, everyday language, sometimes with a touch of humor.

We have also designed online tools that help people understand their costs and payment responsibilities.  Some examples are the myClaims Manager, which helps people manage their health care expenses, and the myHealthCare Cost estimator, which helps people comparison shop for health care services based on quality and cost.

When it comes to health care reform, we have created a number of resources to break down the provisions of the Affordable Care Act (ACA) into simple bite sized chucks.  For example, UnitedHealthcare worked with health literacy experts to create our new health care educational booklet called the “10-Minute Guide to Health Reform,” which helps explain the ACA, government health exchanges and how reform affects people in different situations.

As we say at UnitedHealthcare, better information helps people make better decisions about their health. As the trend continues toward consumer-driven health care, it’s more critical than ever that people understand their options.  And I will admit that our continuous search to find new ways to simplify the health care experience and give people more information, more data and more education about their health– well, it keeps me up at night.

Thursday, October 17, 2013

Signs of fall and…Open enrollment

Crisp cool days, colorful leaves, bright orange pumpkins…all clear signs of the autumn season. But fall also brings signs of another season: email reminders from your employer, non-stop ads from AARP and this year, the launch of state and federal health care Exchanges or Marketplaces.

That's right, its open enrollment, the time of year, usually between September and December, when millions of Americans have the opportunity to select or switch their health insurance plan for the following year. This fall, the Congressional Budget Office estimates an additional 7 million people may participate in open enrollment as a result of the government’s newly created state health insurance exchanges, otherwise known as “marketplaces.” The exchanges are designed to give individuals who are currently without health insurance and small business owners a resource to purchase health insurance.

Most people who purchase health insurance through their employer and those who have Medicare or Medicaid health insurance will see little or no change in the open-enrollment process this year.  The vast majority of Americans – about 157 million with employer-provided coverage, and more than 51 million Medicare beneficiaries – will continue to select a health insurance plan in the same way they have done in the past.

Regardless of how you access health insurance, it’s important to pay attention to the following open-enrollment dates and tips:
  •  Employer-Provided Coverage – Fall; specific dates depend on the employer
    Most Americans receive employer-provided health benefits, so their open-enrollment process will most likely stay the same. Large employers and some small employers typically schedule a two- to three-week period during the fall when their employees can select health benefits for the following year.
    • Tip: Ask about wellness programs. Some health insurers, including UnitedHealthcare, offer incentive-based wellness programs that provide financial rewards for completing health assessments, lowering your cholesterol, losing weight or signing up for a health coaching program.

  • Medicare – Oct. 15 through Dec. 7
    For most Medicare beneficiaries, the open enrollment period is the only opportunity all year to make changes to their Medicare coverage.
    • Tip: Think about what’s changed regarding your health and your options. A lot can change in a year. Consider if your current plan is still meeting your health and budget needs. Medicare plans can change each year, too, so spend time reviewing the options available. Some Medicare Advantage plans offer additional benefits that can help enhance your health and well-being and save you money, such as vision coverage and hearing aids. You can compare your options using the plan finder tool on www.Medicare.gov.

  • A public health insurance exchange may be a good option for people who don’t have health insurance since they may be eligible to receive a government subsidy that lowers monthly premiums.
    • Tip: Find out if you qualify for a subsidy. In general, subsidies are available to individuals who meet household income requirements and who are not eligible for certain government insurance programs (such as Medicaid) or do not have access to affordable coverage through their employer.  Use an online calculator to see if you qualify.

Unfortunately, just 14 percent of Americans understand basic health insurance concepts such as deductible, copay, co-insurance and out-of-pocket maximum, according to a recent study published in the Journal of Health Economics.  Before you dive into the selection process, make certain that you understand the basic definitions, for example “what’s a copay?”


For helpful information that’s simple and easy to understand visit UHC.tv.com  or MedicareMadeClear.com. To learn more about health insurance exchanges, visit www.healthyny.com or www.healthcare.gov. 

Tuesday, October 15, 2013

Demystifying health reform: Adult children on parents’ health plans

As many people know, the Affordable Care Act allows adult children to stay on their parents’ health insurance plans up to age 26.

But many people still have questions about whether there are restrictions that can affect an adult child’s eligibility.

In fact, there are almost no restrictions on an adult child’s eligibility for health coverage under a parent’s plan.  Adult children up the age of 26 are eligible to stay on their parents’ health plan regardless of:
  • Whether the child is a student.
  • Whether the child is financially dependent on parents.
  • Whether the child lives at home.
  • Whether the child qualifies for benefits through his or her employer.
  • Whether the child is married.

While a married adult child under age 26 is still eligible for benefits under a parent’s health plan, the spouse and/or children are not eligible for coverage under the same plan according to the Affordable Care Act.  Some states, however, may require that the child’s spouse and children are covered.

The only exception to these rules applies to “grandfathered plans,” which are plans that were in effect before March 23, 2010 and have not changed much since then.  The plan materials must disclose if a plan falls under “grandfathered status.”  If so, then the plan is not required to provide coverage for children up to age 26 only if the child is eligible for his or her own coverage through an employer.  After 2014, the “grandfather” exemption will no longer apply and those plans will have to cover adult children even if his or her employer offers coverage.

Here’s an informative (and entertaining) video that breaks it all down:

Wednesday, October 9, 2013

Steps to Improve Children's Health

A new report by UnitedHealth Group's Center for Health Reform & Modernization proposes practical steps to address the unmet health needs of children. The findings in 100 Percent of Our Future: Improving the Health of America's Children identify initiatives that can be taken to combat health costs for children that now are increasing far faster than for adults.

The Center recommends the following:
  1. Expanding proven group prenatal support for pregnant women to cut preterm births and reduce health disparities;
  2. Scaling-up new lifestyle and behavioral interventions to successfully fight childhood obesity;
  3. Broadening care coordination in Medicaid to improve the health outcomes of underserved children;
  4. Supporting specialized networks to advance research and treatment of complex conditions that affect children.
Chronic health conditions are rising among children in America today. Childhood asthma affects almost one in ten children today.  Unprecedented increases in children's type 2 diabetes, hypertension and cardiovascular disease are being driven by the fact that one in three children in the United States are obese or overweight.

Last night I was proud to be a part of a program created by the YMCA that aims to address the Center’s second recommendation…to successfully fight childhood obesity.  The program is a combination of the YMCA’s 7th Grade Initiative and the UnitedHealthcare Health Bee.  Together these programs help children learn about nutrition, physical fitness and overall health in a fun and engaging way.

Students already making healthy choices at the
7th Grade Initiative Kickoff event held at the Westfield Area Y.
 The 7th Grade Initiative gives students free access to the YMCA exercise facilities as well as free programs that educate students about health, fitness and nutrition and encourages the involvement of parents, teacher advisors, school health professionals, and local government officials.

The UnitedHealthcare Health Bee, a quiz-show style competition that tests students’ knowledge about health and fitness topics, is the signature event of the 7th grade initiative.

A standing room only crowd of students, parents and siblings showed up last night at the Westfield, NJ area YMCA to sign up for the 2013-2014 program.  On average, more than 300 students enroll in the program. 

Last night’s turn-out is proof that while not all things run-in-the-family, healthy habits can and do in Westfield, NJ.

Me with John Verga from UnitedHealthcare and Mark Elsasser, CEO of Westfield Area Y.
Big thank you to both for supporting the 7th Grade Initiative. 

Wednesday, October 2, 2013

Deciding on health coverage: New approaches under health reform

Yesterday was the big day!  The launch of the most visible aspect of the affordable care act…the Exchange.  And while there have been lots of stories about system overload, it’s clear that the Exchanges offer different things to different people depending on their current situation.  For example, people who currently get health insurance from their small business employer but may still need coverage for a spouse, young people who are transitioning from their parent’s health plan to an individual plan of their own or people, like the neighbor my colleague spoke to, who said she went “shopping” for health care on the NYStateofHealth marketplace site because she was recently divorced.  All of these people must make decisions about their health care.

In my next few blog posts, I’m going to discuss some approaches people may want to consider when making decisions about their health care.  Here are a few examples of transition situations and how people may want to handle their health care:
  • I’m going to be too old for my parents’ health insurance soon.  How can I get a health plan that I can afford?  First, make sure you're too old. Under health reform, you can stay on your parent's plan until age 26, even if you have graduated from college.   If you are getting close to age 26, and you don't have a job that offers health insurance, you can buy a plan through the Individual Marketplace in your state.

  • I have a health condition that’s kept me from getting health insurance.  Can I get it now?  If you don't have health insurance because you couldn't get coverage or were charged extra because of a health condition, there's good news. Health reform means you can get the same plan as someone else without a health condition. Your application can't be denied because of your condition, and you can't be charged more because of it. And if you develop a serious condition while you have a plan, your coverage can't be cancelled because of the condition.
    This applies whether you get your health insurance through your employer (within or outside of the Small Business Health Options Program marketplace), through the Individual Marketplace, or directly from a health insurance company.

  • I’m going to be 65 soon.  What are my Medicare options?  As you retire, you'll probably transition to Medicare coverage to pay basic health care costs, just as you would have done before health reform. You'll be enrolled in Medicare Part A automatically. But you must enroll in Part B during the open enrollment period, which starts three months before you turn 65 and lasts for seven months. Consider adding coverage to help with the costs Medicare doesn't pay. For example, a Medicare Supplement (Medigap) plan, a Medicare Advantage plan, or your employer's retiree health insurance plan. If your plan doesn't cover drugs, you may also want Part D prescription coverage.
    If you're working past age 65, the rules are different. If your company has 20 employees or more, you can generally stay on your employer's plan. But be sure to enroll in Part B within eight months after you retire, or you may have to pay a penalty. If you work for a company with fewer than 20 employees, your employer's plan will provide only supplemental coverage after you're eligible for Medicare, so it's important to enroll in Part B as you near age 65. 

If you’d like more information about health insurance options for people who are in a transition phase, click here.