California Individual And Group Health Insurance Plans

Bangalore, June 26. (PTI) : The National Insurance Company is on the way to come out with a new health policy especially for the elderly above the age of 60.

"We are awaiting IRDA's approval. Official clearance has to come," company Chairman and Managing Director V Ramasaamy said here the Insurance Regulatory Development Authority said to reporters here today.

"We want to launch it on October one -- the World Elders' Day", he said, declining to reveal the features of the policy.

He said the company will launch health insurance product for "younger generation" below the age of 25, as even a family floater policy in July.

Company officials said the policy is accessible for the sum insured from Rs 50,000 to Rs three lakh with annual premiums ranging from 878 to Rs 4,461, and the benefits are obtainable for families up to four members.

Nearly 46 million people in America lack health insurance, according to the U.S. Census Bureau, and the cost to the country also adds up to tens of billions of dollars.

Directly or indirectly, the states choose up much of this tab. Uninsured individuals flood state-subsidized clinics and even emergency rooms. States also bear the treatment costs for constant illness among the uninsured. And a population that is not well cannot utility to full capacity, hampering a state's productivity.

The issue is so urgent that in the last two legislative sessions; more than a dozen states have stirred to repair coverage for those without health insurance. In the absence of federal policy or Washington leadership set to take on the issue, more states are building the uninsured a priority.

The new program would be administered by private insurance companies yet to be named. The plan would cost an average of $150 per month per participant, Drescher said a spokesman for the state's Department of Finance and Administration, Democratic Gov. That fee would be divided equally among the state, the employer and the individual. If a business owner balks, the employee could pay two-thirds of the fee, or about $100 per month, Drescher said

Approximately 41.3 million U.S. residents, or 14.2%, of the U.S. inhabitants, had no health insurance in 2005 at a precise point in time, representing a small development over 2004, according to a study published on Wednesday by the National Center for Health Statistics, Reuters reports (Reuters, 6/21). Study results were base on responses from 98,300 U.S. residents. According to the study:

29.2 million individuals, or 10% of the population, had been uninsured for additional than a year at the time of the survey;

51.3 million people had been uninsured for at least part of the prior year (Mufson/Eilperin, Washington Post, 6/22);

About 6.5 million children, or 8.9% of individual's youngsters than age 18, lacked health insurance in 2005; about one-third fewer than eight years earlier, Bloomberg News/Los Angeles Times reports (Bloomberg News/Los Angeles Times, 6/22). In 1997, 15.4% of U.S. adults and 13.9% of U.S. children were uninsured;

Coverage diverse by state, with Massachusetts having the lowest uninsured rate at 6% and Texas having the highest at 24%:

More than 70% of adults and 62% of children had personal insurance coverage; and

Almost 30% of children and 11.5% of adults had some kind of public insurance such as SCHIP, Medicare or Medicaid (Reuters, 6/21).

WASHINGTON - More than 13 percent of Americans lack health insurance last year, a somewhat lower share than 2004, according to federal statistics published on Wednesday.

The survey, by the National Center for Health Statistics, also stated that 8.9 percent of U.S. children were not covered by health care.

The issue of health-insurance coverage is at the center of an extensive debate over health care in the United States that relies typically on employers to cover workers.

On Wednesday officials in San Francisco said they were pressing in front with plans for funding health care for 81,000 residents who do not have health insurance, at a cost of $200 million a year.

The center's report says that in 2005, 41.3 million Americans, or 14.3 percent of the population, were uninsured when its review was conducted. It said 51.3 million had been uninsured for at least part of the prior year and 29.3 million, or 10 percent, had been uninsured for more than a year.

The study is based on a normal survey of more than 98,300 people

MarketWatch - June 14: San Francisco - It's not just higher co-payments and monthly premiums that can crimp your health-care budget. Along with a trend of sharply rising cost-sharing and higher deductibles that put consumers on the hook for more money up front in the last few years, many large employers and private insurers also have been raising the total amount the insured has to pay out of pocket every year before full coverage kicks in, experts say.Out-of-pocket maximums aren't always easy to decipher or compare because some plans count the deductible in the tally while others don't. Excluding deductibles, the median out-of-pocket maximum rose 10% to $1,650 in 2005 from $1,500 in 2003 among 975 employer clients surveyed by benefits consultant Hewitt Associates, said Johan DeKeyzer, principal in Hewitt's health-management practice in Newport Beach, Calif."The philosophy there is it's still an affordable number," he said. "People will pay that in car insurance, basically." Increases would have been much worse had employers not shared in the burden of rapidly rising health costs, said Chris Renz, principal with Mercer Health & Benefits in San Francisco."During this 10 year period, total plan costs have doubled, yet out-of-pocket maximums have only gone up 50%," he said. At Watson Wyatt, a benefits consultant in Stamford, Conn., the average for plans with an out-of-pocket maximum was $1,735 in 2005-06, though the research doesn't specify if the deductible is included in that figure, senior consultant Tom Billet said.Nearly 88% of 498 companies surveyed last year had employee-only, in-network, out-of-pocket maximums, while 12% had no maximums, he said.Higher out-of-pocket maximums mean the relatively small portion of people who need extensive health care will end up paying more for it before getting full coverage, said Paul Fronstin, director of the health research and education program for the Employee Benefit Research Institute in Washington."Most people still have very good protection because they won't need a lot of health-care services," he said. "But if you do need a lot, it's going to cost you more than it did in the past...More is going to come out of your pocket before insurance kicks in 100%."Such trends may be worrisome for those hit hard by health problems. Last year, some health-policy experts found a strong correlation between crushing medical bills and bankruptcy for low and middle-income consumers, many of whom had insurance at the time the illness began. See related story.As easy as it is to focus on deductibles and co-pays, insured workers are wise to look at all their plan's maximums, including internal plan limits such as fixed-dollar caps on prescription drugs, mental-health visits and physical therapy, health experts say. "What I see happening in the next few years is continued upward movement on the out-of-pocket limits, and particularly as more employers move toward consumer-directed plans," Renz said. "I do see some pain for employees in this area, particularly for those who have poor health status or high medical costs."His advice: Don't compare plans on monthly premiums alone. Examine options carefully and in their entirety. "Not just premium, not just deductible, but what the out-of-pocket protection is.While some people may save money by choosing the lowest possible up-front costs, doing so can be a big gamble for others, he said. "Sometimes we see an employer, they might get a lot of lower-paid people electing that because it's the cheapest. But if they end up with a serious condition it could really be devastating from a financial perspective."What percentage of plan participants are likely to spend to the max? "About 5% would be expected to hit the out-of-pocket maximum in a year," Renz said.States have different approaches to determining thresholds for health plans' out-of-pocket maximums, ranging from permissive to authoritarian. New Jersey, for example, sets a cut-off, said Marshall McKnight, spokesman for the Department of Banking and Insurance's Office of Managed Care in Trenton."Once a person has spent $5,000 on co-insurance, co-payments or deductibles in a year, network services must be covered with no more cost sharing," he said. In California, high-deductible HMO products on the individual market have annual out-of-pocket maximums as high as $4,000 for individual coverage and $8,000 for a family, said Lynne Randolph of the California Department of Managed Health Care in Sacramento. But those maximums don't include deductibles ranging from $1,000 to $2,500 for an individual and $2,000 to $5,000 for a family, bringing the true out-of-pocket costs to as much as $6,500 and $13,000 respectively, she said.Out-of-pocket costs are nearly double in some cases what they were two years ago, Randolph said. "Two years ago, we were given products with a range of $2,000 to $2,500 per individual out-of-pocket max and $5,000 per family, so they have [risen] over the past two years." This upper range "seems to be the highest threshold we will be considering in the near future," she added. Individual health policies traditionally have higher out-of-pocket maximums than group insurance, said Bob Hurley, vice president of ehealthinsurance.com, an online insurance broker in Sacramento.

PR Newswire - June 14: Washington - HHS Secretary Mike Leavitt today announced that 38.2 million people with Medicare are now receiving comprehensive prescription drug coverage, in many cases even better coverage than they ever had before. A surge in enrollment took place in the closing weeks of the enrollment period, with more than 2 million beneficiaries signing up between May 1 and the May 15th deadline."Introduction of the Medicare prescription drug benefit created an unprecedented opportunity and a breathtaking challenge," Secretary Leavitt said. "The challenge has been met, and today, for over 38 million Americans - 90 percent of people with Medicare the promise is being fulfilled, day in and day out, prescription by prescription. In fact, more than 3.5 million Part D prescriptions are being filled each day and the cost of monthly plan premiums is nearly 40 percent lower than original estimates."The average premium in 2006 for beneficiaries, not counting retiree coverage, is less than $24. In addition, 87 percent of beneficiaries chose plans other than the standard benefit, according to the Centers for Medicare & Medicaid Services (CMS)."With help from thousands of partners across the country, and personalized assistance from 1-800-MEDICARE people with Medicare and their family members were able to get the drug coverage they prefer at a far lower cost than expected," said CMS Administrator Mark B. McClellan, M.D., Ph.D. "Thanks to Medicare beneficiaries making informed choices to meet their needs, the costs of Medicare drug coverage are way down and we will continue to support effective competition to provide high- quality, low-cost coverage."Total enrollment in Medicare Advantage plans increased by over 26 percent (1,249,041 self enrollees) during the six month enrollment period, bringing the total number of beneficiaries enrolled in Medicare Advantage plans to 7.4 million. Included in that total are about 4.8 million who chose to enroll in these plans before January, 2006.About 87 percent of all beneficiaries who enrolled in a prescription drug plan chose a plan that offers coverage other than the standard benefit, such as no deductibles or coverage in the "donut hole." Most beneficiaries enrolled in Medicare Advantage plans are also getting more comprehensive drug coverage than in the standard plan. In addition, almost 10 million low-income beneficiaries are getting comprehensive drug coverage for little or no cost.Among the 38.2 million beneficiaries who are now receiving prescription drug coverage, approximately 32.8 million have coverage from Medicare and 5.4 million have coverage from other sources, including the Department of Veterans Affairs (VA), primary coverage from an employer (from beneficiaries who are working after age 65), and state prescription drug programs that are not yet combined with Medicare Part D. Based on the latest information on the choices of veterans with VA benefits and Medicare coverage, almost 40 percent are enrolled in Medicare Part D, a much larger number of VA beneficiaries than previously expected.Enrollment for the new Medicare prescription drug coverage began on November 15, 2005 and ended on May 15, 2006.

Business Wire - June 13: Lincolnshire, Ill. - Preliminary information from Hewitt Associates, a global human resources services company, shows that 2007 HMO rates will increase approximately 11.7 percent representing the fourth consecutive year of declining rate increases.As U.S. companies begin to negotiate HMO plan rates for 2007, data from Hewitt Health Resource - a Web site that captures HMO rate information for nearly 160 large companies representing more than 1 million employees and annual premiums of nearly $4 billion shows that initial 2007 HMO rate increases are averaging 11.7 percent compared with 12.4 percent in 2006 and 13.7 percent for 2005. After plan changes, negotiations and terminations, the final average HMO rate increased by 10 percent in 2006. "Although there has been a steady decline in the level of HMO rate increases over the past several years, double-digit increases are still very difficult for employers to absorb," said Paul Harris, senior health care strategist, Hewitt Associates. "The good news is that there do not appear to be market pressures that might cause rates to begin increasing again. We are continuing to work closely with employers in developing benefit programs that make the most of their current resources, while still providing their employees with high-quality health care coverage."Regional While the U.S. is showing a lower rate of increase overall, some areas of the country, namely the Southeast and West, are experiencing slightly higher rate increases. Preliminary analysis shows 11 percent increases for the Southeast in 2007 compared with 9.4 percent at this time last year, and 13.7 percent for the West compared with 10.9 percent last year. Managing Costs Although increases are moderating, companies are still facing double-digit increases and, as a result, continue to make plan design changes and share more of the cost with employees. For example, the number of companies offering $20 office copays continues to increase from 16 percent in 2004 and 25 percent in 2005 to 29 percent in 2006, while the number of employers offering $10 copays dropped to 17 percent in 2006 compared with 22 percent in 2005 and 29 percent in 2004.Employees are also being asked to share more of the cost of prescription drugs. Employers are also trying to control costs by increasing copays for specialty care and emergency room visits. For example, the number of employers who require more than a $50 copay for emergency room visits has increased to 52 percent in 2006, a significant increase from 33 percent in 2005, 16 percent in 2003 and 7 percent in 2001, while the number requiring only a $50 copay for emergency room visits has decreased to 32 percent in 2006, compared with 55 percent in 2005.

Mayor Gavin Newsom make public a proposal today that would make San Francisco the first city in the country to provide health care for all of its uninsured residents through a plan that covers all from patient doctor visits and surgeries to prescription drugs.

San Francisco's predictable 82,000 uninsured residents, who classically go to public clinics and hospitals for treatment, will be covered under the plan, named the San Francisco Health Access Program.

It will offer people the primary and preventative health care they at present lack and allow them to entrée hundreds of doctors in public and private hospitals and clinics.

"This is not a pipe dream," Newsom said. "This city is going to be the first city in America to achieve universal health care access"

The plan varies from other proposals because it is not health insurance. Those who sign up will have admission to care only in San Francisco and, despite paying monthly premiums, will not be covered by the plan if they required treatment outside the city limits.

The National Health Insurance Company - Daman established licensing to insure both the Government and Private Sector by the Ministry of Economy and through the General Authority for Health Services (GAHS).

Daman has by now begun to meet with many organizations in Abu Dhabi as they arrange for the new Health Insurance Law Requirements. The lately accepted Health Insurance by Laws for Law No. 23 - 2005 issued by President H. H. Sheikh Khalifa Bin Zayed Al Nahyan creation it obligatory for employers and business owners in Abu Dhabi to give health insurance coverage for their émigré employees and their families was accepted and announced early June by the Executive Council of Abu Dhabi.

Phase I of the law would need all Abu Dhabi Government, Semi Government and large organizations with more than 1000 employees to give health insurance coverage for the employee, the employee's spouse and up to 3 dependents under the age of 18 years by July 1st, 2006. This would crash just about 250 organizations in Abu Dhabi during the Phase I. Daman has begun to meet with these organizations to bring in the a variety of insurance products that have been urbanized and providing them with the necessary requirements to start the process. The second phase, which would be in effect during January, 2007 would need all expatriates to be insured.

UF would offer free health insurance to some of its graduate students near January, university President Bernie Machen announced Friday.

Other graduate students would be eligible for health care at an abridged rate, including those with spouses, children or domestic partners.

At Friday's Board of Trustees meeting, Machen expose the GatorGradCare insurance plan that he expects would lure more talented students to the university.

"It's a huge effort, and I think the University of Florida will be in a great spot next year as we go out and recruit new graduate students using this plan," Machen said trustees.

Though not all of UF's graduate students would qualify for the package, about 4,500 are qualified, as well as the universities research and graduate assistants.

"We anticipate virtually all to enroll," said Kyle Cavanaugh, UF's vice president for human relations and one of the plan's key organizers.

The total package is predictable to cost between $6 million and $7 million per year, he added.

SACRAMENTO, Calif. -- Gov. Arnold Schwarzenegger reserves himself from his fellow Republicans Thursday on one of the major issues holding up the state budget: whether the state must provide health care for all children, counting those who are undocumented refugees.

Republicans in the Legislature say they will not vote for an expenditure plan if it includes about $22 million the manager is proposing for county health-insurance agendas that would cover all children, including those who are undocumented. Republicans also resist another $1.8 million Democrats added as a first step toward permitting all children to qualify for state health care programs that serve low- and moderate-income families.

At a press conference Thursday, Schwarzenegger agreed with Democrats that the state must provide coverage to children in spite of their immigration status.

"For me, we should not politicize the children and drag them into this," Schwarzenegger said. "Children need to get all the attention if they are here legally or illegally. Every child should have the right to some health care and the schooling and so on."

But the governor also said he resists Democrats' plans to expand the number of children who are entitled for health programs because the state cannot pay for it right now.

No one is maintaining that Cover Tennessee would solve all of the health-care problems that the state's un-insured workers are facing.

But the plan that Gov. Phil Bredesen planned early in the legislative session and signed into law this week must provide some relief.

The plan is optional and would give low-income workers a chance to purchase essential subsidized health insurance. Their employers, if the business has 25 or fewer workers, also would have the option of paying part of the premium. As things have stood, some employers at small businesses have not been able to pay for to offer any health care benefits at all.

At the signing ritual for the $358 million program, Bredesen said the key to its achievement will be whether enough of those small businesses will sign up. If enrollment is low, the program would fail, the governor said, and then the state would only "have an extremely expensive, very narrow program that won't work."

Under Cover Tennessee, premiums will average about $150 per month. The state will pay $50, employers would have the option to add another $50 and employees pay the rest.

The benefits that enrollees will receive have yet to be determined. That would depend upon what benefits participating insurance companies say they could offer for $150 per month.

CHICAGO - The nation's major doctors group said Tuesday that Americans who could afford health insurance must be necessary to buy it, a recommendation aimed chiefly at young adults who tend to delay coverage.

The American Medical Association accepted the recommendation at its annual meeting; promising to lobby for federal legislation that will mandate health insurance first for people whose income is better than 500 percent of the federal poverty level.

That means the law will apply to individuals who make money at least $49,000 annually and families of four with an income of at least $100,000. Those individuals and families account for about 11 percent of the nation's 46 million uninsured, or even about 5 million Americans, the AMA said.

The policy suggests that those who don't purchase a minimum of catastrophic health insurance and coverage for defensive health services be held accountable, possibly through tax penalties that would make revenue to help lower-income people buy insurance.

SPRINGFIELD - Barry Maram and his employees have done just about all they could to be ready for All Kids.

They've took a trip the state, recruiting enrollees and training thousands of workers for the nation's first program guaranteeing health insurance for each child.

Now the Department of Health Care and Family Services faces the key question -- Would people start signing up when the agenda opens July First?

Maram, the agency's director, doesn't falter to say it would be a big success.

He told the Associated Press in a meeting last week that the state is still on aim to cover 50-thousand people in its first year and a new managed-care program would cover its 45 (m) million dollar cost.

He says the biggest challenge would be signing up participants but he expects that would be successful like other current expansions of programs such as Kid Care and Family Care.

DUBAI: The Emirate of Abu Dhabi would commence a health insurance policy next month, which would help low-income group.

"From July 1, all companies that fall under the Phase 1 category will be obliged to take part in the health insurance scheme which will make the lowest paid the first to benefit from the law," said Dr Ahmad Al Mazroui, Director General of the General Authority for Health Services (GAHS) in Abu Dhabi.

Implementation of the Abu Dhabi health insurance regulation would take place in two separate phases, with Phase 1 set to begin by July. All governmental and semi-governmental companies are necessary to stick to it, as well as private companies with over 1,000 employees.

Phase 2 of the health insurance scheme would begin in January 2007, and would apply to companies that employ less than 1,000 people.

More than half a million expatriates are predictable to benefit from the scheme.

WASHINGTON,-- Millions of Americans have found out the tough way that employer-provided health plans present far more limited mental health benefits than for physical illnesses.

"This lack of parity is leading to a national mental health crisis and is costing far more than providing proper coverage," says Pamela Greenberg, chair of the Coalition for Fairness in Mental Illness Coverage.

"Lack of true mental health parity, coupled with ignorance and social stigma about mental illness, means that our nation faces a mental health crisis that will continue to skyrocket with crippling effects for many Americans, their families, communities and their employers," Greenberg stresses.

"Our family was fortunate enough to have the financial resources to sustain my son's mental health crisis -- and it still required a titanic lift from everyone involved. But the sad reality is that there are millions of families whose insurance won't cover their children's psychiatric care," remarks Griffith, whose journal Will's Choice examines how she coped with her son's depression and confronted a health care system fraught with economic inequalities.

Today's health plans regularly provide coverage for mental health that is far more incomplete than coverage for physical illnesses. Some patients now face lifetime coverage limits of the number of action sessions they could receive -- regardless of their medical needs. But insurance sets no similar advantage limits on needed treatment for any other illness.

"A comprehensive parity law is more than a decade overdue. We need to end insurance discrimination against people with mental health problems," emphasizes Greenberg.

Deducting the cost of health insurance premiums might keep self-employed entrepreneurs in business, according to a survey released by the Office of Advocacy of the U.S. Small Business Administration. The study shows that the health insurance inference for the self-employed has reduced the likelihood of entrepreneurial exit by 10.7 percent for single filers and 64.8 percent for married filers.

"Access to healthcare continues to be the top issue for small business," said Thomas M. Sullivan, Chief Counsel for Advocacy. "This study would help Congress and the administration as they consider policies that help small business and strengthen the economy."

Dr. Tami Gurley-Calvez wrote the study, Health Insurance Deductibility and Entrepreneurial Survival, with backing from the Office of Advocacy. It inspects how the introduction of tax deductibility for self-employed health indemnity premiums affects the chances of entrepreneurial exit. Among the study's findings:

* The presence of the health insurance deduction decreases the chance that a self-employed entrepreneur would choose to exit the entrepreneurial sector by 10.7 percent for single filers.

* For married filers, the presence of the health insurance inference decreases the rate of way out from entrepreneurship by 64.8 percent.

* The total dollar amount of the health insurance premium deduction also influences the chance of exit from entrepreneurial activities. For single filers a 10 percent increase in the dollar amount of the deduction decreases the probability of exit by 10.7 percent. For married filers the probably of exit is only reduced by 1.1 percent.

For more information and a copy of the complete report, visit the Office of Advocacy website at www.sba.gov/advo

NEW YORK - Americans in their 20s is one of the largest segments of the inhabitants lacking health insurance, and new research suggests the problem is growing.

In 2004, nearly 14 million Americans among 19 and 29 years old were uninsured, an increase of 2.5 million since 2000, according to a report by the Commonwealth Fund, a private investigate foundation that focuses on health and social issues.

The result is that the health coverage problem is the majority acute among low-income young adults, who frequently do not attend college and often have jobs with no health benefits.

At any given time, 40 percent of 19- to 23-year-olds who do not be present at college or are part-time students have no health insurance, according to Collins and her colleagues. Commonwealth Fund reviews in 2005 found that among workers ages 19 to 29, 43 percent of those who make less than $10 an hour were uninsured.

But even many college graduates face a important period without health insurance, the study authors say. Of students who adapt between 1996 and 2000, they report, 38 percent were uninsured for at least part of the following year, with 21 percent leaving without coverage for six months or longer.

Collins and her colleagues offer three wide measures they say can address the problem. Regarding Medicaid and SCHIP, they propose Congress require states to extend coverage several years beyond age 18.

"Such a policy change," the researchers write, "could help the 2.9 million uninsured youthful adults ages 19 to 23 with incomes under 100 percent of poverty."

Forbes.com -May 31 - Orange, Calif. - CHOICE Administrators, the nation's largest administrator of employee-choice health benefit programs, today introduced Kaiser Permanente Choice Solution, available to California employers through licensed brokers, general agents, Kaiser Permanente and CHOICE Administrators. This new employee-choice product for employers with 2-50 employees offers seven Kaiser Permanente benefit plan designs all in one program, offering employees a broad selection of healthcare options and giving the employer the benefit of one simplified monthly bill and easy administration. "Kaiser Permanente Choice Solution is an innovative approach to purchasing small group health coverage with one of the strongest health plans in the state," said Ron Goldstein, president of CHOICE Administrators, a Word & Brown Company. "It's unique because it combines the security, flexibility and cost control of the nation's largest HMO network Kaiser Permanente with CHOICE Administrators' proven employee-choice model based on defined contribution. Employees can choose from a wide variety of the most popular Kaiser Permanente benefit plan designs; the employer decides how much he wants to contribute to the group's healthcare each month and it's all in one program." The program offers two HMO plans, a PPO plan and an HMO deductible plan. For employees who want even more flexibility, two POS plans are offered, which allow employees to choose their healthcare from a three-tier structure the Kaiser Permanente network, the Participating Provider network (one of the nation's largest networks) or any other licensed provider for healthcare. There is also a plan for employees who live outside of the Kaiser Permanente service areas the Kaiser Permanente Indemnity plan which gives employees the freedom to seek care for covered services at any licensed healthcare provider in or out of California. Kaiser Permanente Choice Solution also includes ancillary benefits including dental, life coverage and Section 125 plans.

Miami Herald - May 31: The Medicare prescription drug benefit has been cursed for its failures and celebrated for its triumphs. The program's flaws and shortcomings were exposed early and often in the first few months after its January launch.However, recent news of lower-than-expected drug costs, patient satisfaction and a seemingly successful enrollment drive have given the program a new bounce that could help Republicans fend off future Democratic attacks.The cost of the drug benefit has declined from a projected $737 billion over 10 years to $675 billion. Beneficiary premiums are averaging $25 a month, down from $37 in last July's budget estimates. And the projected net cost to taxpayers for 2006 will be $30.5 billion, 20 percent less than an earlier estimate of $38.1 billion. In addition to increased competition, Medicare officials credit lower-than-expected drug costs and dampened enrollment for the declines.A SPLIT DECISIONBut a split decision isn't exactly what Republicans were hoping for when the groundbreaking legislation became law in 2004. The largest expansion in Medicare's history was supposed to be a political knockout."There's no question the Republicans thought the passage of [the drug benefit] was their best opportunity in years to neutralize the advantage with senior voters that Democrats have traditionally had on health, and it hasn't worked out that way at all," said Drew Altman, president of the Kaiser Family Foundation. So how did a program with such strong initial public support turn into a possible election-year albatross? The answers are as complex the drug benefit itself. If the first five months are a sign of what's to come, special-interest groups, lawmakers and seniors will continue to seek changes that GOP lawmakers will likely oppose.The activity reflects the increasing view that the program is a work in progress, rather than a finished product. If Democrats regain control of the House of Representatives or Senate, expect a push for legislation that allows the government to negotiate drug prices for the program, Altman said.The AARP, whose backing of the program ensured its passage, now supports legislation by a bipartisan group of senators to remove, during the program's first year, the lifetime penalty for people who didn't enroll by the May 15 deadline. Currently, only Hurricane Katrina victims and people with low incomes can sign up now with no penalty.The bill, sponsored by Sens. Chuck Grassley, R-Iowa, Bill Nelson, D-Fla., and others, also would provide more funding to encourage enrollments. In the House, Rep. Nancy Johnson. R-Conn., is offering companion legislation.The Bush administration is urging Congress to delay action on the measure until Medicare analyzes final enrollment data to help determine if the changes are necessary. House Ways and Means Committee Chair Bill Thomas, R-Calif., said he'd conduct hearings on the matter. But Johnson and others are pushing for quick action.Another proposal with bipartisan support requires Medicare drug plans to reimburse pharmacists promptly for prescription claims filed electronically. A similar Senate proposal also requires paper claims be processed within 30 days.NUMEROUS COMPLAINTSPharmacists claim the plans sometimes take more than 45 days to fill claims. It's one of many complaints about the drug benefit. Another is that with more than 1,200 coverage plans offered nationwide and about 40 offerings per state, selecting a drug plan has been tough for many seniors.Computer glitches, inaccurate and incomplete data, and jammed phone lines caused hundreds of thousands of poor seniors to go without their medications when the new benefit began. About 30 states stepped in to pay for the drugs while the problems were worked out. Medicare agreed to reimburse states for their costs.

BestWire Services - Jun. 5: Prompted by rising health-care costs, enrollees in consumer-directed health plans nearly doubled in a year, increasing to between 5 million and 6 million in January, up from about 3 million in January 2005, the Government Accountability Office said in a report.GAO, Congress's nonpartisan investigatory body, was told to find out how widespread CDHPs are, how they are funded and used, and the factors that could strengthen or weaken their appeal. In the report, GAO found that such plans the most common of which are health savings accounts and health reimbursement arrangements, both of which allow for tax-free withdrawals for medical expenses grew from about 1.6% of all U.S. private health insurance enrollees to 2.8% to 3.4% in only a year. That, the GAO said, means those plans, while still relatively few in number, are becoming a fast-growing segment of the private health insurance market.Citing health insurance industry officials and experts, GAO said, "the primary factor responsible for the growth of CDHPs is the rising cost of health care coverage." Officials interviewed for the report said the growth in enrollment was prompted by a "desire to lower premiums" and to earn a tax advantage. Employers are more likely to offer CDHPs, the GAO found, if those plans show that they can rein in costs, and employees are more likely to enroll in them if employers offer "more comprehensive CDHP benefits" as well as more education about the plans. GAO also found the proportion of employers offering CDHPs to their workers quadrupled in about a year, rising from about 1% in 2004 to 4% in 2005. Large employers were more likely than small ones to offer such plans, with larger companies more likely to offer HRAs and smaller companies more likely to offer HSAs. Where employers offered multiple plans, employees were more likely to enroll in traditional health plans than in CDHPs, GAO said. The GAO also found specific data about usage and contributions in the plans; data from three multistate insurance carriers, which GAO didn't name, showed that the most common employer HRA contribution in 2004 ranged from about $500 to $750 for an individual and from $1,500 to $2,000 for two or more people.Employers are required to contributed to the accounts associated with HRA-based health plans. GAO also found that usage within the HRA plans was high: Nearly 75% of single HRA-based enrollees and more than 95% of family enrollees used some or all of their HRA funds in 2004. Among HSA plans, about two-thirds of employers contributed to their workers' accounts, with an average 2005 employer contribution of $553 for individuals and $1,185 for families, GAO said. GAO also said "employers would be more likely to offer a CDHP if the cost of health-care coverage continues rising significantly or if CDHPs demonstrate the ability to reduce these costs." According to the report, premiums in the group health insurance market since 2000 have increased nearly five times faster than the overall rate of inflation and the rate of increase in workers' wages. In collecting its data, GAO said it interviewed officials from America's Health Insurance Plans; the Blue Cross Blue Shield Association; HSA Insider, a service that helps individuals and businesses to find and purchase CDHPs; "a nationwide health insurance broker;" and "health insurance carriers" that GAO didn't name. GAO also interviewed officials at the Treasury Department and the Internal Revenue Service, as well as employers that offered CDHPs and financial institutions that administer HSAs.
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PR Newswire - Jun. 1: Chicago - While still reaching double- digit figures, healthcare costs are beginning to increase at a lower rate, according to Aon Consulting, the human capital consulting organization of Aon Corporation.Aon Consulting surveyed more than 70 leading healthcare insurers (representing more than 100 million insured individuals) and found healthcare costs are projected to increase in the next 12 months by 12.2 percent for HMOs, 12.4 percent for PPOs and 11.9 percent for POS plans. This compared to one year ago, when HMO cost increases were 13.2 percent, PPO increases were 13.0 percent and POS cost increases were also 13.0 percent. Meanwhile, consumer-driven health plans (CDH) are estimated to increase by 12.5 percent, similar to a year ago when these plans were forecasted to increase 12.7 percent. "This is the sixth year of double-digit increases in healthcare costs," said Bill Sharon, senior vice president with Aon Consulting and director of the study. "Employers have been responding to this by using a variety of strategies to control healthcare costs such as increasing deductibles and co- payments, expanding disease management programs, adding health promotion programs and introducing new consumer-driven health plans. While these initiatives are slowing the rate of increase, healthcare costs continue to grow at a pace that is three to four times the rate of general inflation."Insurance companies are forecasting consumer-driven health plan trend rates to be on par with PPO trend rates, but it's important to look at the first year of CDH savings, Sharon said. "Although consumer-driven health plans may increase at a similar rate as other plans this year, considerable savings still will be realized by making the switch. Our analysis shows that a company can achieve first year savings of 8 percent of their premium if they implement an effective consumer-driven healthcare strategy."Healthcare rate increases for retiree medical are projected to be lower than active employees, according to the Aon Consulting study. During the next 12 months, Medicare Supplement plans are predicted to increase by 11.5 percent and Medicare Advantage plans will likely increase by 10.2 percent."Retiree medical benefit cost trends are heavily influenced by government reimbursement rates for Medicare and prescription drug costs," said Jonathan Nemeth, senior vice president, and chief health and benefits actuary with Aon Consulting. "Some modest improvements in these two areas are leading to a slightly lower trend rate for these plans."As for prescription drugs, general pharmacy costs are expected to increase by 12.2 percent, compared to 13.1 percent a year ago. Specialty drug costs will increase by 17 percent, down from 22.5 percent last year. (Specialty drugs are biotechnology-derived injectable medications used primarily to treat high-cost disease states for which previous treatments were more invasive or unavailable.)

Most low-income residents would have to spend between $30 and $140 a month to obtain health coverage under the state's new obligatory insurance law, according to a study by the Romney administration.

These estimates, the first sign of how much it can cost the state's poorest adults to comply with the law, suggest that insurance premiums will be affordable for many low-income residents but not for all, customer advocates said

Health and Human Services Secretary Timothy Murphy said the state developed the variety based on what seem reasonable for residents given their other likely expenses. Some residents would receive discounts off of their share of the premium while employers allow them to buy healthcare on a pre-tax basis.

For people who earn less than the central poverty level -- $9,800 yearly for a single person -- the state will pick up the entire cost of the premium, which officials estimate would be about $300 a month for an entity and $600 a month for a couple. For individuals who make money between $10,000 and $20,000 a year, the state will pick up 80 to 90 percent of the cost of the premium, a kinder share than that borne by many private employers.

But the subsidies slowly fall as income rises. Individuals who earn $20,000 to $29,400 would pay a far higher share of the premium, as much as 47 percent, or $1,680 a year. Advocates caution that this group in particular can run into problem paying for health insurance, particularly those residents who have devastating housing and child-care expenses or debt.

An authority shaped to implement the law, called the Commonwealth Health Insurance Connector, would make the final decisions about the quantity of the subsidies. The group plans to gather on Wednesday and must make its decisions soon, because the insurance plans for lower-income residents must be prepared by Oct. 1.

COUNTY -- Shelby County's health insurance premiums are up 9.4 percent next year, but officials are happy that the rate hike isn't higher considering the county's loss ratio

The Shelby County Board of Supervisors accepted last week a health insurance renewal for the 2006-07 fiscal years with Principal Financial. Randy Arnold, the county's insurance representative, called the 9.4 percent rate increase that amounts to a $70,388 increase in premiums next year, a good rate. Monthly premiums for the county's health insurance plan would increase from $55,000 to $60,949 next year.

In total, the county would pay $731,388 in health insurance premiums in 2006-07.

Arnold called the rate augment the best scenario for the county, as last year health insurance claims paid out exceed premiums paid. The loss ratio was at 104 percent of premium, not considering administration fees.

A check of comparable plans with a variety of companies yielded no cheaper rates. In fact, United Health Care, Mutual of Omaha and American Community declined to present bids. A bid from Well mark Blue Cross/Blue Shield was higher than the Principal renewal by nearly $5,000 per month.

"Companies were not spirited because of the loss ratios," said Arnold.

SPRINGFIELD -- Thirty days are left prior to Gov. Rod Blagojevich's All Kids insurance program goes online, but skeptics remain.

For six months, the state has been pre-registering children for the agenda by visiting schools and operational with healthcare providers in preparation for July 1.

"Enrollment is going well, its very steady," said Christine Glunz, a spokeswoman for the Illinois Department of Healthcare and Family Services. "We've taken every opportunity we could to make sure families are aware that their uninsured children can get health benefits."

The state wants to expand the benefits to 50,000 uninsured children in the program's first year. At present, Illinois provides health insurance care for 1.1 million children.

All Kids is aimed at children, whose parents create too much money admission state and federal aid but still can't afford coverage.

However, the program will allow parents that make as much as $160,000 annually to sign up for health insurance.