Wiser Fitness and Health Blog

A 2010-2011 WISER Health Insurance Consumer Guide - Part 19

Wed, 23 Mar 2011 19:40:44 GMT

15. What is PCIP and how could it affect you?

With the passage of Obamacare in March, 2010, the Federal government is now offering a high risk program for insureds with preexisting conditions. It is called the Pre-existing Condition Insurance Plan, or PCIP. PCIP is a four year program that will cover qualified uninsurable patients until the full implementation of healthcare reform in 2014.

PCIP is a federally-funded program that calls for states to administer the fund in a manner similar to Medicaid. States are required to agree to partner with the federal government to implement the program. However, there are two major problems with the PCIP program. First, the plan was under-funded in the federal legislation. Second, any funding deficit in the plan must be borne by the partner states.

The funding issue was not accidental. It was done purposely to reduce the official cost of Obamacare in order to get it passed. The result of passing costs along to state taxpayers has kept some twenty-two states from signing on to PCIP. As far as an individual patient is concerned, this does not matter. Residents of states that did not participate can apply through federal officials rather than state offices.

To qualify for the PCIP program, you must be a US citizen or lawfully present in the US. You must have been uninsured for at least six months. This requirement could possibly work against you if you secured coverage through your state of residence high risk pool, if PCIP subsidized premiums are lower than the state pool rates. And finally, you must have evidence that you were denied insurance due to a pre-existing condition.

If you have been denied private insurance due to a preexisting condition, PCIP may be your answer. To learn more and to apply, go to http://www.healthcare.gov/ and click on Pre-Existing Condition Insurance Plan.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 18

Wed, 15 Dec 2010 19:54:46 GMT

14. What is SCHIP and how could it affect you?

State Children's Health Insurance Program, or SCHIP, is a Federally-funded program that is administered by and through the states. The objective of children's health insurance is to cover uninsured kids in families with incomes that are modest but that exceed Medicaid limits of one times the federal poverty level. Those eligible for Medicaid are not eligible for SCHIP.

Every state has a SCHIP program. Within Federal guidelines, each state has the authority to establish program design and qualifications.

SCHIP covers kids from birth up to the age of 18 who live in families with incomes up to 300 percent or more of the Federal poverty guideline. With a 100 percent poverty level factor for a family of four being about $21,200, the indicated income range for SCHIP could be three times that amount or more. New regulations also broaden the pool of those qualified for coverage.

Qualifying for SCHIP requires periodic renewal and re-qualification. Depending on applicable regulations, Children's Health Insurance may provide healthcare services at minimal cost or no cost. For those who qualify, SCHIP offers relief from the concerns for childrens healthcare and for the high cost of health insurance. As currently constituted, eligibility for SCHIP expires as children age or if family income exceeds the permitted limit.

To inquire about the application of the State Childrens Health Insurance Program to your family in your state, go to your state of residence public health or insurance webpage. Then, click on the SCHIP page link. Each state may have children's health insurance listed under their unique program name.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 17

Tue, 30 Nov 2010 14:32:00 GMT

13. What is Medicaid and how could it affect you?

Medicaid is a federal and state funded and state administered health insurance assistance program that helps families with low incomes. Medicaid can help children or qualified adults and seniors.

To qualify for Medicaid Health Insurance assistance to children, families must meet Aid To Families With Dependent Children (AFDC) eligibility requirements for their state of residence. Kids under six years of age can qualify if their family income is at or below 133 percent of the Federal poverty level. This amounts to about $28,000 annual income. Children ages six to 19 with family income up to 100 percent of the poverty level ($21,200) may also qualify. The poverty level figures are adjusted annually.

Medicaid can also work in conjunction with Medicare to assist Medicare-covered seniors who meet Medicaid income requirements to pay for Medicare premiums.

The fastest growing Medicaid program is the Medicaid nursing home coverage for seniors, as the "greatest generation" of the depression and World War II era reach elder status. The dark cloud overhanging future federal and state budgets are the prospects for a Medicaid explosion of costs when the 78 million Baby Boomers begin to reach the age of needing nursing home care after about 2025. The Medicaid cost could be beyond taxpayer ability to pay.

Medicaid program requirements are determined and administered by each state, in accordance with Federal guidelines. To determine eligibility and to apply, you must contact the Medicaid office in your state of residence.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 16

Fri, 26 Nov 2010 17:17:46 GMT

12. What can you do if you have retired early or been laid off but do not yet qualify for Medicare?

If you qualify for COBRA from your employment, you can always consider that option. However, if you look into other alternatives, you will probably find that COBRA is not your best choice.

If you have more than a year until reaching age 65 to qualify for Medicare, you should look into getting a personal or family comprehensive major medical insurance plan. See Guide Sections 2, 3, 4, 5, and 9 for tips on what to do and why.

If you have less than a year to age 65, you may need to consider a short term plan because you may not qualify for the conventional comprehensive plan that has a minimum term of one year. You can get the details on short term plans on our Fitness Culture Health Insurance information website at http://www.fitness-culture-health-insurance.com/short-term-health-insurance-plans.html .

If you have a preexisting condition that creates a problem in qualifying for private insurance coverage, go to Section 6 of this Guide for help.

If you can qualify for coverage but have an affordability challenge with most health insurance plans, check Section 7 of this Guide to see the options available to you.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 15

Mon, 22 Nov 2010 22:13:30 GMT

11. What are Long Term Care Insurance Plans and why should you consider them?

Long Term Care (LTC) Plans are supplemental plans that are designed to cover some part of or all of the cost of long term care, usually in a nursing facility. LTC plans may cover skilled nursing care, but also typically cover assisted living care and services which may include activities such as dressing, bathing, eating, toileting and getting into and out of bed. Most patients who use LTC benefits are Medicare patients, but Medicare does not cover LTC services.

About sixty percent of patients over age 65 will require nursing home care at some point during their lifetime. The average age of entry into a nursing home is about 84 or 85 years old. The average stay of a patient in a nursing or assisted living facility is about four and one half years. The cost of a nursing or assisted living facility can vary widely depending on the location and on the menu of services. In 2000, the average daily cost was about $100. In 2010, that average daily cost is up to about $168.

Long Term Care plans can be set up to cover all or a portion of daily charges. Plans typically have a maximum aggregate benefit, whereupon it will discontinue payments. For example, if you buy a $50,000 maximum coverage plan, you could have the option of getting reimbursed at the rate of $100 per day for 500 days, or a greater or lesser daily amount for the appropriate time period. You would be responsible for paying unreimbursed charges.

Many people wrongly assume that Medicare will cover nursing home costs. Beyond an initial 100 day skilled nursing benefit after a covered Medicare event, Medicare does not cover long term assisted living care. Medicaid provides assistance for about seventy percent of nursing home residents, but Medicaid recipients are required to deplete their assets in order to qualify.

So, why should you consider buying LTC insurance? You might think of LTC coverage in the same manner as liability coverage. Why do you get liability insurance? You hope you never have to use it, but you need it to protect your assets. It's the same with LTC. You hope you never have to use it, but if you need it, it will help you protect your assets. If you have to use long term care, LTC insurance will help defray the cost and protect your estate assets for a longer period of time.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 14

Tue, 16 Nov 2010 16:43:51 GMT

10. What if claims are denied or delayed? What can you do?

The preface of this Guide states the premise that no one will manage your healthcare affairs better than you will if you know how. The objectives of this Guide and of our informational website at http://www.fitness-cuture-health-insurance.com are to show you how.

When you know what's likely to happen, you are better prepared. You will have fewer surprises and disappointments. We can't eliminate system challenges and adverse events, but we can help you minimize them and manage them. It is easier to be your own advocate when you know what to expect and why.

However, we also have to recognize that being your own advocate has limitations. You can be the expert on you, but most people do not have the time, inclination and resources to become an expert on all phases of the healthcare system. How can you know what you don't know?

One way is to enlist the aid and assistance of people who have expertise in one or more areas of medical care, health insurance and our healthcare system. You may have family or friends who are trained and experienced in medical care and who would be willing to advise and assist you. Your health insurance agent can advise you about insurance coverages.

An issue in our healthcare system can be the resolution of disputes over payment of claims. These often arise because insureds are misinformed or uninformed over what to expect. Sometimes the insurer is at fault by accident or by design. What can you do if you encounter such a problem?

A professional healthcare advocate can be the answer. Healthcare advocates understand the health insurance and healthcare systems and can represent a consumer in a dispute over insurance claims and other systemic issues. To learn more about healthcare advocacy, check out the Patient Care Plan on our Fitness Culture Health Insurance website.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 13

Fri, 12 Nov 2010 21:51:27 GMT

9. What are Supplemental Insurance Plans and why should you consider them?

Supplemental health insurance plans are limited benefit plans which are generally aimed at filling a specific gap in coverage or offering coverage for a specific risk or class of risks. A supplement plan that we commonly hear about is the Medicare Supplement, or Medigap plans, that most seniors buy to fill the gaps in basic Medicare coverage.

Another well-publicized supplemental plan is the AFLAC plan touted by that loud-mouthed white duck on TV. The Aflac duck plan will pay you a cash benefit to replace lost income due to illness or injury.

Many insurance companies offer a wide range of supplemental insurance plans to cover a whole spectrum of risks for which consumers have a need for coverage. Most plans are relatively low in cost because they are limited in benefits or terms. Benefit payments might be in lump sum cash, like Aflac, or over an extended time period, such as Long Term Care to cover nursing home expenses.

There is likely to be a supplemental health plan that can satisfy the needs of any healthcare consumer. For example, a consumer with a family history of cancer might want to secure a supplemental cancer policy which covers expenses related to cancer treatment. Other types of supplemental plans include disability, dental, vision, accidental injury, Accidental Death & Dismemberment, hospital confinement, heart and stroke or travel health plans for coverage outside the US.

As healthcare and comprehensive medical insurance plans become more expensive, supplemental health plans can play a significant role to fill specific coverage gaps on a cost-effective basis. A consumer who buys individual or family coverage can make very good use of one or more supplemental plans in conjunction with limited benefit or high deductible health plans to get health insurance on an affordable basis.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 12

Mon, 08 Nov 2010 14:26:28 GMT

8. What if you need care immediately while out of network area or uninsured? How can you minimize your cost?

If you are either uninsured or insured but out of your network area, and you are faced with a critical need for emergency or urgent care, go to the nearest emergency room. Get the care you need to stabilize your medical condition, then deal with the financial arrangements. If you are uninsured, you will need to make whatever arrangements are necessary with the medical care provider. When you are in a critical medical condition, you may not enjoy the benefit of being able to negotiate beforehand.

If you have insurance but are out of your network coverage area, you likely have an obligation under your plan to notify the insurer within a specific period. Be sure to comply. Non-compliance might result in a penalty. At a maximum, you may have to pay a higher deductible or copay for services received. Not a catastrophe.

If you are insured and plan to travel to areas for which your insurance plan does not provide coverage, such as outside the US, you should consider getting a supplemental policy (see Part 9 of this Guide) that will provide coverage for the areas of travel. Travel health plans are usually not expensive.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 11 (Continued)

Fri, 05 Nov 2010 14:39:05 GMT

7. What can you do if you can't afford health insurance?

The focus here is not eligibility or any preexisting condition. It is simply a question of cost and affordability.

Community Health Centers: They are often free or provide subsidized low-cost physician care. Check out any near you to know if you qualify;

Retail "Doc-In-A-Box" Outlets: These recently-developed doctor retail stores can be found in many suburban shopping centers. They are usually cash or credit card operations that are often less expensive than hospital emergency rooms. They see a lot of bumps and scrapes, bruises and brakes, and respiratory problems. A good option if you do not have a regular doctor. A better option than an ER if no major illness or injury;

Negotiated Cash Deals: If you have a doctor or need to go to a doctor or hospital, ask for the cash (no insurance red tape) price and try to negotiate a discounted cash deal before taking services. Once services are delivered, it's too late. Get it in writing if possible;

Prescription Drug Assistance: With prescription drugs, especially brand names, check online at www.rxassist.org or at www.needymeds.com or at Rxaminer or at DestinationRx or the Partnership For Prescription Assistance. If you have to get a brand name drug, look on the drug manufacturer's webpage to see if they have a drug assistance program. If so, apply. Always ask your doctor who writes the prescription for a generic substitute and for samples.

Medical Equipment and Devices: For any medical equipment or device needs, check with second-hand or charity stores such as Goodwill or Salvation Army to find perfectly good alternatives often at less than ten percent of their new price. A soap and water clean up makes for a great deal.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 11 (Continued)

Wed, 03 Nov 2010 15:12:23 GMT

7. What can you do if you can't afford health insurance?

The focus here is not eligibility or any preexisting condition. It is simply a question of cost and affordability.

If you do not have children or if neither of the federal-state subsidy programs of Medicaid or SCHIP apply to you, then you need to focus on two other areas - low-cost health insurance and becoming a savvy, effective value shopper for healthcare services and products.

Low Cost Health Insurance: Generally, you can secure lower cost health insurance plans in one of two ways. Either get a limited benefits plan which may have limited coverage, lower maximum limits, be for a shorter term, or have other restrictions that justify a lower premium. Limited benefit plans will not offer the catastrophic loss coverage that comprehensive major medical plans do. Limited benefit plans may also be used in conjunction with supplemental health plans (see Part 9 of this Guide) to fill specific gaps in coverage on a low-cost basis.

The other option is a high deductible health plan (HDHP) by which you will essentially self-insure for the affordable lower health expenses but secure coverage for the catastrophic expenses you could not afford to suffer. HDHP's are the most affordable form of health insurance because they adhere to the basic principles of insurance. Supplemental plans may also be used in conjunction with HDHP's.

Value Healthcare Shopping: You save money by buying lower cost health insurance that leaves gaps in your coverage. You then need to close those gaps by spending time to become a savvy, effective buyer of healthcare services. You need to have a plan.

You will need to do your homework, understand your options and be able to make sound decisions before you encounter the crunch of needing emergency or urgent care. Then, when that need arrives, work your plan. What alternatives are available? The following are some, but not all, of your options for lower-cost healthcare:

Supplemental Insurance Plans: Supplemental insurance plans (see the guide section on these plans) are niche plans that can offer low-cost gap coverages and that are often available in conjunction with other insurance plans such as health or auto;

A 2010-2011 WISER Health Insurance Consumer Guide - Part 11

Mon, 01 Nov 2010 14:20:19 GMT

7. What can you do if you can't afford health insurance?

The focus here is not eligibility or any preexisting condition. It is simply a question of cost and affordability.

For nearly 60 years, many have answered this question by getting a job, likely with a large employer, that offered health insurance benefits to its employees. Such employees often found themselves locked in to jobs they did not like because they could not leave the security of those employer-paid health insurance benefits. Lately, this has become less applicable because many employers are reducing or dropping their health benefits due to high costs, and because fewer employers are hiring in tough economic times.

So, let's focus on solutions other than employer programs.

In a worst case scenario, if your family income is at or below the federal poverty level, you may be eligible for Medicaid assistance through your state of residence. Check with your state Medicaid office for details and application.

If your family income is above the federal poverty level, but not more than three times that income level, the family children and perhaps the mother may qualify for assistance under the State Children's Health Insurance Program (SCHIP). This is another federally-funded, state-administered program. Check with your resident state children's health insurance program office for details and application.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 10

Fri, 29 Oct 2010 14:13:23 GMT

6. What can you do if you can't qualify for health insurance?

Who is eligible for an individual or family comprehensive major medical plan?

Adults are usually eligible until they qualify for Medicare at age 65. Dependents are eligible without regard to pre-existing conditions under a parents plan through age 26 under the 2010 federal healthcare reform act. Newborns may be covered at birth. Expectant parents will usually not be accepted for a new plan but can be covered after the birth.

Who is not eligible? Incarcerated individuals, non-US citizens, unless they have a visa and green card, and those age 65 or over. Seniors over age 65 can secure coverage through Medicare. Some insurers exclude applicants who have hazardous occupations or activities.

Most individuals who are not eligible for private insurance for reasons other than age or citizenship rights have been ineligible due to preexisting health conditions that private insurers would not cover because it would lead to guaranteed losses. Disabled individuals are often not eligible for comprehensive major medical coverage but may be approved for Limited Benefit coverage.

Under the 2010 federal healthcare reform bill, denial of health insurance coverage due to a preexisting health condition is being phased out. Preexisting condition exclusions for dependents covered under a parent's plan were prohibited effective October 1, 2010. Such exclusions for all applicants are prohibited effective January 1, 2014. Until 2014, consumers with preexisting conditions who are denied coverage by private insurers will have at least one and maybe two options.

The first option is state high-risk pools which are offered by 32 states. The premiums are usually higher, but coverage is available in most cases without regard to preexisting conditions. To get details, go to the webpage of the insurance commissioner for your state of residence.

The second option is the federal Preexisting Condition Insurance Plan, or PCIP, which was created by the 2010 federal healthcare reform bill. In 28 states, PCIP is administered by a state authority. In 22 states, which did not accept partnership in PCIP with the federal government, the program is administered directly by the federal government. To qualify for PCIP, an applicant must show evidence of having been rejected for insurance due to a preexisting condition and must have been without insurance coverage for at least six months.

Applicants for the PCIP program will likely pay higher premiums. The PCIP rates are subsidized by the federal government, so PCIP rates may be less than the state pools. Having coverage through a state pool plan will disqualify a person from PCIP unless that applicant has been without coverage for at least six months. To check out the PCIP, go to http://www.healthcare.gov/ and click on Pre-Existing Condition Insurance Plan.

The PCIP program will terminate the first of 2014 when the healthcare reform bill requires that all preexisting condition exclusions are prohibited.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 9 (Continued)

Wed, 27 Oct 2010 14:16:44 GMT

More of What's the best type plan? Why?

Health Savings Account (HSA) Plans: For the purposes of this guide, we will term this class of plans as HSA plans. However, you need to understand that we are also talking about high-deductible health plans, HDHP's, which we will define as any health insurance plan with an annual deductible of $1,000 per person or more. An HSA plan is actually an HDHP that meets HSA deductible requirements ($1,200 per person in 2010) and is combined with a health savings account that is similar to an IRA and that allows you to save money to pay for qualified medical expenses not covered by insurance on a tax-free basis.

The deductible and total out-of-pocket limits that comply with HSA requirements change each year, so you have to check on the current regulations. In addition, medical expenses that can be paid from the tax-free HSA account must be on the IRS approved qualified expenses list. You must contribute pre-tax monies to the HSA fund each year. Then, you can either pay appropriate medical expenses out of that HSA fund tax free or roll the fund balance over to apply to future medical expenses. Earnings from the HSA fund are also retained tax free.

HSA plans and benefits can be applied to Indemnity plans, to PPO plans or to POS plans provided those plans comply with and are coordinated with HSA high deductibles and other requirements.

Why would you want an HSA plan? Because it offers the best combination of reduced cost and optimal self control of your healthcare, while protecting against the catastrophic costs of a major illness or injury. Because the high-deductible plan design adheres to the basic premise of insurance, it is the most cost-effective approach for securing insurance coverage. Because you are essentially self-insuring to the extent of your deductible and MOOP limit, your exposure to higher but affordable costs in any year could be greater.

A survey indicates that in any given year, only eight percent of insureds exceed that limit, while 92 percent do not. To be sure that you are in a financial comfort zone, you need to "Work The Numbers", as described in part 4 above, to establish your annual limit for premiums + deductible + coinsurance to MOOP. You will be protected against the killer catastrophic loss, so you can have peace of mind.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 9 (Continued)

Mon, 25 Oct 2010 12:58:44 GMT

More of What's the best type plan? Why?

Health Maintenance Organizations (HMO) Plans: An HMO is the icon for managed care which has the objective of providing an acceptable quality of care while holding down cost by trying to promote wellness through preventive care and the delivery of medical services through controlled and tightly managed provider services.

With an HMO, you pay a specified premium for a menu of HMO benefits that are delivered though the HMO network of physicians, hospitals and support facilities. Some HMO's develop and operate their network of service providers through contractual arrangements with independent providers. Other HMO's own the service providers, so that the network is actually an internal or "company store" type of operation. Either way, the objective is to manage service delivery in a controlled manner so that it can deliver an acceptable quality of care at reduced cost.

In an HMO you choose a primary care physician, a PCP, from among the HMO staff or network choices. Your PCP coordinates and manages your care by referrals to HMO network services providers. To see a specialist, go to a hospital or get lab work done, you must have a referral from your PCP. The HMO network concept is similar to the networks used in PPO and POS plans, but the HMO program is usually more restrictive in an effort to control costs.

Like other plan forms, you pay a premium to the HMO. Most HMO's charge a copay for office visits, some have a copay for hospital visits. With a true HMO, you may not have to deal with insurance features such as coinsurance, MOOP's and maximum coverage limits. However, some insurers offer HMO-type plans that incorporate features that are a hybrid between POS and HMO formats.

Why would you want an HMO? Lower cost. HMO's are typically the lowest cost options for traditional-type health insurance plans. The price you pay for the low cost of an HMO is loss of control and flexibility in managing your own healthcare. The corollary to that loss of control can be lower quality of services and reduced access.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 9

Fri, 22 Oct 2010 13:55:01 GMT

More of What's the best type plan? Why?

Point-of-Service (POS) Plans: Along the management spectrum line from self management to managed care, the POS is another step from the self-managed PPO and toward the managed care HMO. The POS combines components of the PPO and the HMO, but there can be many shades of gray. Some plans allow you to self select your service providers, others require coordination through a primary care physician. Plans that simulate a PPO plan will have PPO network guidelines, copay and coinsurance features. Those that mimic an HMO format will have HMO guidelines with only a copay. You will be able to obtain services outside the respective PPO or HMO network at higher cost factors.

With POS plans you will typically pay a copay. You may pay a low deductible, and maybe a low coinsurance expense. These cost factors will be higher for out of network providers.

Why would you select a POS plan? If you have some concern in selecting service providers, but greater concern in reducing cost and saving money. If you are comfortable with the premise that medical care standards are good and sufficient no matter the provider, then cost becomes a more prominent factor.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 8

Tue, 19 Oct 2010 14:47:58 GMT

5. What's the best type plan? Why?

Insurance plans are classified by types which draw distinctions in the way services are delivered, managed and paid. Traditional Indemnity Plans are at the self-management end of the spectrum and health maintenance organizations (HMO's) are at the managed care end. In between are point of service (POS) plans and preferred provider (PPO) plans which have many variations that blur the distinctions among them. It is often difficult to measure where a plan fits on the spectrum.

The fifth plan, called the high deductible health plan (HDHP) or the health savings account plan (HSA) is a departure from the others in regards to management and payment but not in delivery of services.

Traditional Indemnity Plans: With this plan, you can go to any doctor on a fee for service basis. Either the service provider submits a claim to your insurance company or you pay the provider and submit the claim for reimbursement. Typically, indemnity plans pay about eighty percent of the "usual and customary" medical charges and you pay the balance under the coinsurance terms.

You will be insured only for covered procedures, but indemnity plans usually offer a broader definition of coverage. If a service provider charges more than usual, you are responsible for the excess. So, you need to negotiate fees before services. Most indemnity plans have a deductible as well as typical insurance plan features that are described in other sections of this guide. If the plan qualifies, it could be coordinated with an HSA to maximize tax benefits.

Why would you favor an indemnity plan? Because it offers the most control in selecting service providers without network limitations. It offers you the opportunity to be proactive in managing your care. Can you save money? Probably, if you are willing to spend the time to do it.

Preferred Provider Organization (PPO) Plans: Closest to the indemnity plan in regard to control but a step toward managed care, the PPO negotiates discounts with service providers to form a "network" of discount fee providers. You can see any network service provider at any time without referral. You can also see a service provider outside of the network, but that will cost you more because the insurer does not have a discount agreement with that provider.

With the PPO plan, you will typically pay a copay, a deductible, a coinsurance factor and a MOOP in the network, but such expense factors will be higher out of network.

Why would you prefer a PPO plan? Second to the indemnity plan, the PPO offers more control in selecting physicians and other service providers, but you have to deal with network limitations. If the network includes the physicians that you favor, network limitation may not be a factor. Because the insurer pays less with the discount network, premiums will be lower than an indemnity plan, so you might achieve both better control and reduced cost.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 7

Fri, 15 Oct 2010 16:24:32 GMT

More on choosing a health insurance plan. What's important?

Maternity: Maternity benefits are available in many group plans, but are not offered in most individual policies. Some plans have optional maternity riders, but the premiums may be high and the deductible is usually high. It is often cost-effective to pay out-of-pocket for delivery rather than paying the premium for a very high deductible plan. Most policies will cover any complications for the mother.

Dependent Children Coverage: Under the 2010 Healthcare Reform Bill, effective October, 2010 for existing plans, insurers must cover dependents up to age 26 and can not exclude dependents for any preexisting conditions. You should consider covering your dependent children under your group or personal family plan if that is affordable.

You have two government-related alternatives to consider. The first is Medicaid, which is a federally-sponsored, state-administered program for families under the federal poverty income level. The second is a similar federal / state program called the State Children's Health Insurance Plan, or SCHIP. SCHIP offers subsidized health insurance assistance to children of families with incomes up to or about three times the federal poverty income level. Check with your state of residence for details.

Pre-Existing Conditions: If you or a family member has a pre-existing health condition, that can be your overriding concern in seeking health insurance. If the condition is serious in nature, group coverage provided by a large employer might be the best, if not the only private option. Many small-group plans will either deny coverage, limit coverage or offer coverage at increased premiums. Most individual and family plans will not cover serious conditions and will limit or delay coverage of less serious conditions, usually at increased rates. Always be candid about your situation in inquiring about coverage to avoid spinning wheels that will end in denial. Make your inquiry through an insurance broker. Different insurers have different underwriting guidelines. What is a denial to one may not be to another. A knowledgable broker will know where to go and can be your best advocate.

All but eighteen states have high-risk pools that can provide coverage to resident insureds who have been denied private coverage because of a pre-existing condition. These state pools usually carry high premiums. In addition, the state pools conflict with the federal pre-existing condition coverage program, because they disqualify insureds from participation in the federal plan unless the consumer is without coverage for at least six months.

The Healthcare Reform Bill of 2010 legislates changes to handling pre-existing conditions in several steps until 2014. It prohibits pre-existing condition exclusions for dependents beginning in October of 2010. It also offers a federally-subsidized, state-administered program, called Pre-existing Condition Insurance Plan, or PCIP, for consumers who have been denied coverage due to a pre-existing condition and who have been without coverage for at least six months. You can check out PCIP at www.healthcare.gov/ . All pre-existing condition exclusions will be prohibited effective January 1, 2014.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 6

Mon, 11 Oct 2010 13:26:44 GMT

4. How should you choose a health insurance plan? What's important?

You should approach the purchase of health insurance with the intent to be an informed, savvy buyer the same way you make any other important financial commitment or major purchase. Do your homework. Review information, so that you know the basics, can comprehend your options, can ask good questions and understand when you get good answers. Then, you can make informed decisions.

Study The Details: Review the plan summary to understand what is covered and what is not. What about health issues that are important to you? Issues for which you or your family members have a history or exposure? What about an unexpected serious illness or injury? How would that be handled according to the plan summary? Familiarize yourself with the rules that would apply. Do you foresee a problem?

Check Out The Network: Most policies are allied with a "Network" of physicians and hospitals which are contracted with the insurer to provide services at lower fee rates, thus permitting the insurer to hold down premium costs. Services from providers outside the network cost the insurer more, so usually involve penalties on you in the forms of higher copays or deductibles and lower coinsurance factors. Determine if physicians and hospitals you prefer are in the network.

Work The Numbers: What do you typically spend annually on healthcare issues? Check your previous few year's records to get an estimate. Then, add the total cost of annual premiums for the proposed health insurance plan plus the annual out-of-pocket limit. If that total is too high, work the numbers. You could trade a higher premium for a lower out-of-pocket limit. You could opt for a higher deductible to reduce premium. Remember that up-front benefits typically cost more than their benefit value. Your primary objective should be to protect against catastrophic loss you can not afford. Figure the maximum annual cost you can comfortably afford, then seek the most coverage that will buy. That usually will be a high-deductible, no copay HSA plan.

Check The Insurer: With the passage of the Healthcare Reform Act, insurance companies are becoming more restricted. By 2014, coverage will be compulsory for all applicants, regardless of health conditions. While that sounds good for health insurance consumers, such universal coverage is very expensive. Insurance companies will have to pass on increased costs of higher claims. As a result, when buying a new health insurance policy, you should check out the insurance company. Are they reputable? Do they have a proven track record? Are they financially stable? You can check independently through the insurance rating firm, A.M. Best at www.ambest.com . Best's "Secure" class of insurance company ratings range from a high of A++ Superior down to B+ Good. You should probably avoid any insurer rated below B+.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 5

Tue, 05 Oct 2010 15:05:28 GMT

3. With health insurance, what should you expect to pay out of pocket?

In summary, for each calendar year you will pay for your insurance and normally pay the first sums spent in the forms of the copay and deductible. After that, you will pay a minor portion of covered claims amounts, the coinsurance, up to an annual limit called the maximum-out-of-pocket. If you reach the MOOP, the insurer will pay all covered costs for the remainder of that year. Of course, you would pay for any uncovered expenses, and you would pay into an HSA or any other tax advantaged fund from which uncovered but qualified expenditures might be paid. More detailed explanations follow:

Premium: This is the amount you pay for your insurance policy, usually paid monthly;

Deductible: The amount you must pay each year on covered medical expenses before your health insurance plan begins to pay. Lower deductibles are offset by increased premiums. 92 percent of insureds overpay in premium cost to reduce their deductible lower than they need;

Copay: The flat fee you pay to the medical service provider each time you receive medical care. For example, if your doctor's office charges $50 for a standard office visit and your copay is $20, you would pay $20 and the insurer would pay $30. Lower copays can be expensive and may be more than offset by higher premium;

Co-Insurance Factor: The co-insurance factor is the percentage of claims expenses paid by the insurance company after the deductible has been satisfied. The higher the co-insurance (for example 80 versus 70), the higher your premium. Any coinsurance amount paid by you would apply to the maximum-out-of-pocket amount, or MOOP. Once you reach your MOOP, the insurer will pay the balance of covered claims for the rest of that calendar year;<./p>

Maximum-Out-Of-Pocket: This is a provision that specifies the total amount you would pay out-of-pocket for covered claims, usually expressed as a calendar year limit. The lower the MOOP amount, the higher the premium;

Uncovered Claims: Expenses for any medical services for conditions that are normally not covered by insurance unless added by rider (such as maternity) or that are specifically excluded or limited by rider (such as a pre-existing condition that is not covered for some initial period);

Health Savings Account: For qualified high deductible health plans, an HSA matches with the deductible as an IRA-type, portable savings account that permits you to save and control funds on a tax-advantaged basis. Contributions to the HSA are pre-tax. HSA funds can pay qualified healthcare expenses without tax consequences. HSA balances not paid out for qualified medical expenses can rollover annually tax-free until you are age 65. After age 65, you can no longer contribute to the HSA, but you can withdraw funds from the HSA, although a non-medical application is a taxable event.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 4

Fri, 01 Oct 2010 19:01:40 GMT

What does health insurance cover? What's not covered?

Like all financial contracts, which is what an insurance plan is, the devil is in the details. What is covered depends on the type of plan, the plan design, the service provider network associated with the plan, the terms and conditions specified in the plan, and any exclusions or limitations that are made a part of the plan by addendum or rider.

All insurance plans must be filed by the insurance company and approved by the appropriate state and/or federal authorities. Except for Original Medicare, there is no such thing as a "standard insurance plan", so most plans differ somewhat among and within each insurer. Most insurers publish a summary of benefits of their plans for easy review. Always review the summary to check and understand the primary benefits and any particular benefits that are important to you. In addition, check any addendums or riders for additions, exclusions or limitations.

A typical plan summary will describe coverage options for office visit copays, for deductibles, for out-of-pocket maximums, for preventive care services, for physician services, for facility inpatient and outpatient services, and for mental health and alcohol or chemical dependency care services. It will also describe coverage for other medical services or products such as skilled nursing services, hospice, home health care, urgent care, spinal adjustments or care, durable medical equipment, ambulance services, maternity benefits and transplants. The summary will also specify the lifetime maximum benefit.

You should always assume that anything not specified as covered in the plan summary is not covered. Again, covered services may be limited or excluded by special stipulation in a rider or addendum attached to the policy. So, always read the summary and any attached riders.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 3

Wed, 29 Sep 2010 22:35:46 GMT

There is one other factor in this area of need for insurance that is becoming prominent. That involves the governmental mandate that insurers must offer health insurance coverage to all applicants without regard to pre-existing health conditions. In state-controlled health plans, such as Massachusetts, and in the March, 2010 Federal Healthcare Reform Plan, this required coverage provision only works if everyone is required to buy coverage.

Without such a purchase requirement, individuals who "game" the system will not buy insurance until and unless they are ill or injured. Insurers will then have to cover them under a guaranteed loss condition. In Massachusetts, where the requirement to buy insurance has not been enforced, insurance companies are now faced with the dilemma of either going bankrupt or getting out of the program. Either way, the state healthcare program will crash. Taxpayers will be left with the bill.

Until Obamacare is fully implemented in 2014, the federal government is offering an interim subsidized plan called "PCIP" to cover those who are uninsured due to a pre-existing health condition. Like Massachusetts, the federal government is requiring everyone to buy insurance and is charging the Internal Revenue Service with the responsibility for enforcement.

IRS is hiring more than 15,000 new agents to accomplish this and will likely tie enforcement to individual tax return requirements. However, several of the states are filing lawsuit against the federal government claiming that this requirement to buy insurance is unconstitutional and therefore unenforceable. So, this required insurance question is still a "ball in the air".

A ball that is no longer in the air is the requirement that insurers offering child-only plans must cover all pre-existing conditions, as described in our last blog entry. Many insurers have dropped such coverage.

Healthcare Reform Impact: Insurers Exit Child Only Market

Mon, 20 Sep 2010 20:40:09 GMT

Effective September 23rd, Federal mandates under the Patient Protection and Affordable Care Act, also known as Obamacare, require that insurance carriers that offer child-only plans must make such plans available to all children under age 19 without regard to pre-existing health conditions.

Obamacare provisions further provide that insurers must continue such coverage without maximum limits. However, Health and Human Services officials have not been able or willing to clarify questions raised by the insurers about continuing insurer obligations under child-only plans.

According to insurers, these federal mandates have created an unbalanced market for child-only plans as well as a future for which they can not accurately assess risk. Insurers claim they can not offer affordable rates with confidence.

As a consequence, September 23rd is the date that will signal a mass exodus of insurers from the child-only market for new individual policies.

Obamacare supporters have reacted that insurers are taking a step backwards. However, forcing private insurers out of the market is exactly what many Congressional members who voted for Obamacare said they wanted.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 2

Fri, 17 Sep 2010 15:48:44 GMT

People who have health insurance tend to be healthier because they are more conscious of their health and wellness affairs and because they are less reluctant to see a physician when they encounter a health issue. Another reason you need health insurance? To help stay healthy.

One factor of health insurance with which Americans have lost perspective and control is that many people have come to expect health insurance to pay for all of their routine health expenses no matter how trivial. They no longer think of health insurance in terms of saving them from catastrophic expenses. This has contributed to the radical increase in the cost of healthcare and of health insurance premiums.

When health insurance claims payments are applied to first dollar costs to pay for routine and affordable healthcare expenses, there are several adverse effects. It promotes more claims because insureds have nothing at risk, no skin in the game. They consider they are spending only the insurance company's money, so they are not inhibited by cost. They are not value shoppers. People who would never buy another product or service without knowing the cost often have no idea what they are spending for healthcare.

In seeking first dollar coverage, health insurance consumers over pay in premiums to get low deductibles and low co-pays that they never use. Their approach to buying health insurance is exactly the opposite to what it should be. They create a lose / lose scenario that costs them more and drives up insurance rates.

A 2010-2011 WISER Health Insurance Consumer Guide - Part 1:

Tue, 14 Sep 2010 12:32:56 GMT

Preface:

It is our belief that no one will manage your health insurance and wellness affairs better than you will, if you know how. The objectives of this Consumer Guide and of our Fitness Culture Health Insurance informational website are to show you how.

Our goal is to help you achieve success as a savvy buyer of health insurance and healthcare services. A buyer who understands your options, can make informed decisions with realistic expectations and can better manage your outcomes.

When you know what's likely to happen, you are better prepared. You will have fewer surprises and disappointments. We can't eliminate system challenges and adverse events, but we can help you minimize them and manage them. That is easier when you know what to expect and why.

1. Why do you need health insurance?

The basis for answering this question must focus on "what is insurance?" and "what is the purpose of health insurance?" At its core, insurance is the pooling of financial assets by many to protect against a potential but yet unrealized catastrophic risk that may be experienced by a few.

Specifically, therefore, the purpose of health insurance is to protect against the catastrophic expense of treatment and rehabilitation that you might incur as the result of illness or injury of yourself or a family member. Health insurance will not restore your health from illness or injury, but it will help you pay for the cost of care and restoration.

So the basic and most important reason to get health insurance is that it is too risky financially to go without it.

Group Quote Guide

Thu, 09 Sep 2010 16:07:06 GMT

How To Get The Best Group Health Plan Quotes

Group Quote Request

Tue, 07 Sep 2010 22:34:47 GMT

Group health insurance plan quote request form.

Pseudo Group Health Plans

Tue, 07 Sep 2010 15:09:10 GMT

Pseudo Group Health Plans are low-cost substitutes

Group Health Insurance Cost Factors

Tue, 07 Sep 2010 14:34:19 GMT

How to control group health insurance cost factors

Affordable Group Health Insurance Plans

Tue, 07 Sep 2010 14:27:45 GMT

How to design an affordable group health insurance plan

Group Health Insurance Eligibility and Underwriting Factors

Tue, 07 Sep 2010 14:14:30 GMT

Manipulate group health insurance eligibility and underwriting factors to your advantage.

Medicare Dilemma . . . . Painted Into A Corner

Mon, 09 Aug 2010 22:12:30 GMT

Obama Administration officials in the Department of Health and Human Services have extended the projected financial viability of Medicare from 2017 to 2029. A miracle? Not quite. HHS officials just revised their cost projections based on the assumption that Medicare will cut payments to physicians.

Medicare payment rates for doctor services are scheduled to be reduced by 23 percent on the first of December, 2010. Existing law also requires a second cut of 6.5 percent on January 1, 2011. Despite the scheduled cuts in physician fees, HHS is blindly forecasting that healthcare service providers will increase their productivity so that Medicare will save billions more over the twelve year extension.

HHS projections ignore the dissenting opinion of the Medicare Actuary office that says the projected savings might not be realistic. The assumed increased productivity could be difficult to achieve and sustain in view of the lower fees and higher service requirements being forced on participating service providers.

Nowhere in the Medicare assumptions do the Obama officials account for the substantial resistance they are generating from medical professionals. Some surveys of physicians have indicated that more than half of doctors serving Medicare patients threaten to discontinue Medicare services if the scheduled fee cuts become effective.

The administration passed Obamacare by promising that Medicare recipients would be able to keep their physicians and by promising to reduce the costs of Medicare services to make the program feasible. These two conflicting positions are clearly pulling against each other.

HHS has painted itself into a corner. It can not deliver on both promises. In fact, it is unlikely to deliver on either promise. What is likely? Higher costs. Reduced and delayed service. And, Medicare patients scrambling for another doctor.

Deja Vu . . . What's The Point?

Fri, 06 Aug 2010 22:19:03 GMT

In my last blog contribution, I described the healthcare experience of an old friend and school mate. I knew his condition through a daily journal written by his children. His almost four month ordeal in the hospital was a testament to his faith and strength of character. He suffered due to mistakes in care. It did not end well because of a major misstep.

The experience of my friend brought back vivid memories my family experienced almost thirty years ago when we lost my father due in large part to errors in medical care.

So, what's my point?

I guess I have several. First, by no means do I indict the medical system. I believe America has the best medical system in the world. If you have a serious illness, this is the place to be. But, our healthcare system is not infallible. It makes mistakes. Too many mistakes.

US healthcare studies reveal that each year more than 100,000 patients die and more than one million patients have their hospital stays extended due to mistakes in medical care. Mistakes that should not happen, but do.

If you think that is a reason to advocate government controlled healthcare, you need to understand that the government systems - the VA, the Armed Services system, Medicare and Medicaid - are worse in mistakes, in poor care and in poor access to service.

What can a patient do? Two things. First, understand that when you go into the healthcare system, you are in harm's way and there are no guarantees. The practice of medicine is both science and art. The science side is more predictable, the art side is less. Maybe that's why they call it practicing.

Second, there is no substitute to minding your healthcare affairs. Pay attention. Do your homework. Have an advocate with you at all times to watch your back, especially when in the hospital. Ask questions, even uncomfortable questions, and demand good answers that make sense to you.

Of course, if you have spent much time on this website, you knew all of this already.

Healthcare Deja Vu All Over Again

Wed, 04 Aug 2010 20:05:09 GMT

Almost thirty years ago, my father entered the hospital for what the cardiac surgeons called "routine bypass surgery". It was at a prominent Atlanta hospital that had an excellent reputation for heart surgery. The surgical team was both qualified and experienced. The surgery went well.

However, the recovery kept running into small issues, nagging issues. Recovery lasted a week longer than expected, but finally the day of my father's release from the hospital arrived. I was scheduled to pick him up at 2:00 PM. About noon, the hospital called and said I better get there as soon as possible. That did not sound good.

I made the trip in record time, only to discover I was too late. I was too late before I started. While getting dressed to go home, Dad had suffered a blood clot going to his lungs. He died instantly. I was not prepared for that.

I remember it vividly because that was absolutely the toughest day of my life, so far. I have lost close family and friends, but no one closer than Dad.

A childhood friend and high school classmate recently had heart surgery. The surgery went ok, but the recovery was bothersome. Then came some infection issues and some additional surgery. To me, it just didn't feel right, but finally his condition improved and he was scheduled for release.

My high school class, which has always been very close-knit, kept informed about our ailing member through a daily email diary written by his daughter and son. Throughout their ordeal, the kids remained optimistic and upbeat. Last week, our class member was set to get out of the hospital on Tuesday. Finally, the end was in sight.

But, an emotional bomb dropped on Monday. The hospital staff discovered that some medication our patient had been given had destroyed his bone marrow, rendering his immunity system helpless. The medical staff offered no hope.

After a day, he was gone. Joy had turned to deepest despair. The family was not prepared for that. For the kids, I'll bet it was the toughest day of their lives. I remember that feeling.

What If . . . You Are Self-Insured Or Have A High Deductible And Need Affordable Care Options?

Mon, 02 Aug 2010 21:51:25 GMT

The premise of this webpage is that no one will mind your healthcare business better than you will . . . if you know how. A key element of the pursuit of such consumer-driven healthcare is the high-deductible health insurance plan with which the insured essentially self-insures the basic but affordable risk in return for reduced premium for covering the catastrophic, unaffordable risk.

This is a reflection of the underlying principle of insurance and is the most cost-effective approach to buying health insurance.

Studies have shown that consumers who direct their own healthcare effectively manage their affairs with lower costs and without reducing quality once they learn to be informed and savvy shoppers. This should come as no surprise, because Americans have been astute shoppers in every other retail venue. We just got out of the habit with healthcare.

If you have insurance, even though you have not satisfied deductible requirements, you may qualify for reduced fees and rates negotiated between your insurer and the service provider. In any event, negotiate for cash discounts. Healthcare providers that do not have to file for insurance and deal with the bureaucratic hassle are often very receptive to a quick but lesser cash payment.

If time and need are not critical factors, shop around for lower prices and better terms. You would do that to buy a car. Why not do it to get medical services or products. Even if you need a treatment or procedure that only a handful of physicians can provide, become an informed and savvy shopper before you leap.

The premise of minding your own business is most important in the hospital and healthcare facility sector. Expect hospital overcharges and phantom charges. Have the mindset that bills are confusing on purpose. Demand itemized bills that are clear and understandable. Keep you own records and compare them meticulously with invoices. Check our Medical Self Care Management section.

What If . . . You Are Between Jobs And Need Health Insurance Now?

Sat, 31 Jul 2010 12:02:44 GMT

If you have lost a job with which you had health insurance through your employer, you may be entitled to extended coverage for up to 18 months under the federal Consolidated Omnibus Budget Reconciliation Act, or COBRA. However, you have to pay the entire premium for such extended coverage. The cost is far more than most people have experienced as employees and is often beyond reach.

Because COBRA is usually so expensive, it can be a fickle remedy. Unless you, or a covered family member, have a preexisting health condition for which COBRA offers the only coverage, there are often better alternatives.

If you have are no pre-existing condition issues, a high-deductible medical benefits plan may be a more affordable permanent option. An even less expensive choice would a short term health plan. Short term plans can cover terms of 30 days up to one year.

Most short term plans are limited benefit plans, which means they are not as benefit rich as comprehensive major medical plans. That is a primary reason they are not nearly as expensive as comprehensive plans. In addition, a medical condition that develops during the short term plan period would be covered during that term but might be excluded or conditionally covered under a succeeding short term plan.

A combination of a short term plan and a supplemental plan that covers accidental injury and / or critical illness benefits can make for a very effect lower cost alternative while you search for a more permanent solution to your employment and health insurance dilemma.

Check out our information page on short term health plan considerations to see if a short term plan is a good option for you. One thing you will usually discover is that it will be better than COBRA.

What If . . . You Are Uninsurable Due To A Pre-Existing Condition?

Wed, 28 Jul 2010 20:20:40 GMT

People who have a pre-existing health condition may be rated up with a premium surcharge for some period, or may have the specific pre-existing condition excluded for a defined period, or may be declined outright for coverage. The coverage determination can vary with different companies, so it is best to apply to more than one insurer.

Impaired risk applicants who are denied private insurance coverage due to a serious medical condition have been forced to self insure or to seek relief through Medicaid, if they qualify, or through state-guaranteed high risk pools if that is available in their state of residence. All but eighteen states have such high risk pools.

With the passage of Obamacare in March, 2010, the Federal government is now offering another alternative called the Pre-existing Condition Insurance Plan, or PCIP. We have mentioned the PCIP in earlier blog articles before it even had a name. The PCIP is a four year program that will cover qualified uninsurable patients until the full implementation of Obamacare in 2014.

The funding issue was not accidental. It was done purposely to reduce the official cost of Obamacare in order to get it passed. The result of passing costs along to state taxpayers has kept some states from signing on to PCIP. As far as an individual patient is concerned, this does not matter. Residents of states that did not participate can apply through federal officials rather than state offices.

To qualify for the PCIP program, you must be a US citizen or lawfully present in the US. You must have been uninsured for at least six months. And, you must have been denied insurance due to a pre-existing condition. To learn more about PCIP and to apply, go to http://www.healthcare.gov/ and click on Pre-Existing Condition Insurance Plan.

Healthcare consumers who pursue the PCIP coverage should keep in mind that this is a government controlled program. As such, expect it to have all of the characteristics of a government program. Heavy on rules and regulations, but light on friendly service and responsiveness.

We have mentioned that the Obamacare plan was patterned after state insurance programs, such as Massachusetts and Tennessee. The state programs have encountered problems of funding and service shortfalls. PCIP already admits to a shortage of funding. And, anyone who expects the government to deliver good or prompt service simply lives a fantasy. Be prepared to wait.

Minding Your Healthcare Affairs - Longevity Guide: Summary

Mon, 26 Jul 2010 21:47:01 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

You cant change who you are, the fixed factors of your life. But, you can change the variable, fitness, dietary and life quality factors of how you live your life.

The Longevity Guide advisories can show you how to embrace good habits and healthy conduct that might extend your lifespan up to an additional thirteen to fifteen years. More importantly, these advisories can help you avoid or minimize harmful conduct and bad health habits that could penalize you by thirty years . That could be a potential swing of more than forty years. A lifetime of enjoyment.

Take charge of your health and your life. Nobody has more invested in it than you, and no one will do it better.

Minding Your Healthcare Affairs - Longevity Guide: Harmony

Fri, 23 Jul 2010 16:18:37 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

Harmony in your daily life is vitally important to the quality and length of your life. A happy and harmonious relationship can add years to a woman's life, even more years to a man's. Compatibility and friendship are important, but so is an active and healthy sexual relationship.

For guidelines and tips that do not involve some little blue pill, check out our Life Quality Factors section.

Minding Your Healthcare Affairs - Longevity Guide: Life Quality

Mon, 19 Jul 2010 14:35:23 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

For most, life quality issues become more important to us after we pass the mid-life level. Some experience a dramatic mid-life crisis. But, for most, we undergo a subtle, gradual physical deterioration. We probably notice it most in changes of clothing sizes and hair lines or color.

Eventually, we discover that we have new and more frequent aches and pains. And, at some point, we realize that we have don't recover from exertion as quickly. That's the stage at which most of us start to deal with the symptoms of aging and then the health causes that detract from life quality.

A few of our previous longevity topics have dealt with the two primary causes of reduced midlife quality - obesity and smoking. Related conditions can include diabetes and high blood pressure, which start to demand attention in our forties or fifties.

Another condition which takes on greater importance after mid life is sleep and rest. Sufficient quality rest benefits alertness, memory, problem-solving and overall health. Rest requirements that can be pushed beyond limits when you are young become much more necessary after midlife.

Our longevity guidelines on these life quality factors can offer some hints.

Minding Your Healthcare Affairs - Longevity Guide: Nutritional Factors

Fri, 16 Jul 2010 16:42:19 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

Diet management primarily deals with eating the proper amounts of the right kind of foods for weight control. Nutritional management applies to eating and drinking the best food and drink for optimum health and wellness of your body, as well as avoiding intake of food, drink or diet substances that could be harmful.

Nutritional management can step on the toes of some of the popular and most abundant food products of our modern culture. That makes nutritional management even more difficult, because it's often less convenient and/or more expensive.

Check out our longevity nutritional guidelines.

Minding Your Healthcare Affairs - Longevity Guide: Diet and Weight

Tue, 13 Jul 2010 19:41:20 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

Eating is one of lifes joys, if we control it. Everyone does it, so everyone has an opinion. In fact, there are so many opinions out there, it's confusing and hard to keep up with.

A fact that is not confusing, however, is the high cost of obesity. Obesity has a major negative impact on health quality, on life quality and on longevity.

Abstinence is the best course for avoiding smoking hazards, but it's not practical for avoiding obesity. To apply some common sense to the weight control issue, check out our diet management guidelines.

Minding Your Healthcare Affairs - Longevity Guide: Anti-Aging Fitness

Mon, 12 Jul 2010 21:53:08 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Fitness Culture Health Insurance.com website is, at its core, an information resource intended to help you know about, understand and be able to better utilize the healthcare system and health insurance options that are available to you.

As we age, the three primary issues of physical decline are reduced lung capacity, increased body fat and reduced flexibility. The short duration, alternating high intensity exertion with low intensity recovery that benefit body enhancement for younger bodies will offer similar results for older bodies.

It helps maintain higher lung capacity. It stimulates burning fat calories to maintain better body mass index. And, the recommended stretching routines before and after workouts help with the flexibility issues.

What about the longevity benefits? A Harvard study indicated that three or more workouts a week can have significant lifespan benefits.

Healthcare Reform Impact - The Coming Trainwreck

Fri, 09 Jul 2010 15:07:26 GMT

In a few previous blog comments, we referenced the Massachusetts state healthcare program which was the template used to write Obama's healthcare reform bill.

To summarize, Massachusetts healthcare officials made it mandatory for health insurers to unconditionally accept all applicants regardless of preexisting condition. Then, to control medical costs and health insurance premiums, Massachusetts political officials invoked insurance premium price controls that have no relationship to real costs.

We predicted that insurers underwriting the Massachusetts healthcare plan would be faced with the dilemma of withdrawal from the program or bankruptcy at the hands of the politicos. In the end, healthcare consumers will be left with limited access and reduced medical services, while taxpayers will face much higher taxes to pay for healthcare cost shortfalls.

On July 7, 2010, The Wall Street Journal reported on the condition of the Massachusetts healthcare plan, describing it as a "trainwreck" that foretells the future of Obamacare.

You can see the Wall Street Journal article by clicking on the following link . . .

Go to Healthcare Trainwreck.

Minding Your Healthcare Affairs - Longevity Guide: Body Enhancement Exercise

Wed, 07 Jul 2010 18:53:37 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Recent research has revealed that long-term duration workouts in an endurance pattern often lead to overuse injuries that interrupt program participation. Exercises that alternate high-intensity exertion with short duration lower intensity rest or recovery routines offer greater benefits in burning fat, in building muscle and in developing better cardiopulmonary health.

Such alternating high-intensity, low-intensity routines also offer greater benefits with shorter workout periods as seldom as three times weekly.

Check it out.

Minding Your Healthcare Affairs - Longevity Guide: Stress Management

Tue, 06 Jul 2010 18:04:24 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Some of the information here focuses on fitness and health as continual reminders of how to better manage those aspects of your life. The Longevity Guide is an advisory to make you aware of the of the small things that you can do or avoid to improve your life experience and your lifespan.

The Longevity Guide recognizes certain "Variable Factors" that you can embrace, or change or avoid to enhance your life experience. Variable factors can make up for many genetic, gender or age deficiencies and can constitute seventy percent or more of the weighted factor importance in the longevity and life quality equation.

Stress and anxiety are hard taskmasters that each of us face. Stress can erode our health. A variable factor is stress management, which determines how well we handle stress.

On the longevity scale, those who have a plan to manage stress and who do it well live longer. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Retiring

Mon, 28 Jun 2010 14:12:58 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Another variable factor is retiring. Retirement is a goal long anticipated by many people. Recent economic circumstances have forced many to change their retirement plans. Some, once retired, find that they don't like the reduced pace. They want to be more active, so they un-retire.

On the longevity scale, there is no penalty for retiring, but there is a benefit not to retire. Those who stay active, live longer. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Smoking

Fri, 25 Jun 2010 22:15:08 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

Another prominent variable factor is smoking. Should you smoke or not? Smoking is one of the most harmful habits we inflict on ourselves. It's damage to heart and lung health are well established. In the US, smoking causes over 400,000 deaths per year. If you don't smoke, don't start. If you do smoke, abstention would be the healthiest step you could take. The benefits will begin almost immediately.

On the longevity scale, the penalty for smoking is severe. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Alcohol

Wed, 23 Jun 2010 12:11:54 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

A prominent variable factor is alcohol. Should you drink or not? This is a moral question for some and a physical question for others. If there is history of alcoholism in your family, you should probably avoid drinking. Women with a family history of breast cancer should have reservations about partaking. If it is a moral issue, avoid temptation.

For others however, a good case can be made for the health benefits of moderate alcohol consumption. To discover more, check it out on our Variable Factors page.

Minding Your Healthcare Affairs - Longevity Guide: Family History

Tue, 22 Jun 2010 17:56:03 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed to know what you don't know.

The Longevity Guide recognizes certain "fixed factors", such as your age, gender and family health history, that are facts you cannot change. They're genetic. You are born with them or have already experienced them. But, you can learn from these factors to improve your life quality and longevity by altering your actions to avoid habits or conduct that were detrimental to the health or well-being of your parents.

Taking charge of your healthcare affairs means being proactive. Check it out on our Longevity Fixed Factors.

Minding Your Healthcare Affairs - Get Help

Tue, 22 Jun 2010 17:49:46 GMT

No one will manage your healthcare affairs as well as you will - if you know how. So, get informed.

Some of the information focuses on fitness and health. Some focuses on medical service providers and options. Some focuses on the healthcare and governmental systems. And, some focuses on information that you don't know you don't know.

When you're thrown into the healthcare system whirlpool, how can you know who to see, what to say or what questions to ask? How can you know what to do when your claim has been denied or your credit tarnished by unpaid medical bills you thought were covered? How can you find someone to be on your side in our complex healthcare system?

You could enlist an experienced and trained family member or friend. Or, you could use professional healthcare advocacy and concierge services. You can learn more about it in our Patent Care Plan section.