MONEY Health Care

What You Need to Know About This Year’s Obamacare Kick-Off

Obamacare Take 2 film clapper
Sarina Finkelstein (photo illustration)—Getty Images (clapper)

It's Year Two for health reform, as the online insurance exchanges open on Saturday. Here’s what to pay attention to if you're in the market for a plan.

Starting Saturday, consumers who buy their own health insurance can finally sign up for a 2015 plan. Healthcare.gov, the troubled online insurance market created by the Affordable Care Act—a.k.a. Obamacare—will begin accepting enrollees, as will the 14 state-run insurance exchanges.

This year the government opened the federal site for window shopping in advance, so you’ve been able to get a sneak peek at what’s available in your area before the formal sign-up process kicks off this weekend. Although experts can’t promise that open enrollment will run smoothly this go-around, they do think the process will face fewer problems.

If you bought insurance last year, you may figure that you don’t need to do anything in year two. Or if you went without last year, perhaps you plan to do the same. Not so fast. Read this before you make any health-care shopping decisions.

Skipping Insurance Will Cost You More

If you decided to go without health insurance in 2014, you’ll likely get hit with a penalty when you file your income taxes this April. It’ll be the greater of $95 for an adult ($285 per family) or 1% of family income.

But going without insurance in 2015 will cost you even more. For the 2015 plan year you’ll owe the greater of $325 for an adult ($975 per family) or 2% of family income, which you’ll pay with your taxes in spring 2016.

You may qualify for an exemption if the lowest-cost plan in your area would cost you more than 8% of your income, or if you went without insurance for fewer than three months.

Even If You Enrolled Last Year, You Should Shop Around Again

By now you should have received a notice from your current health plan explaining that your coverage will end December 31. You’ll also be told whether the insurer will offer that same plan in 2015 and, if so, what it will cost and how it will change, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

If you signed up for coverage last year, or even just a month or two ago, you may think you’re all set. Why go through what was likely a taxing experience, given the technical problems the exchanges had last year? Here’s why.

First, there’s a good chance you’ll have different plans to choose from this year. Some insurers will exit the marketplaces, but many others have joined. In 35 states, the number of insurance companies offering coverage on a state exchange is increasing, according to the Kaiser Family Foundation; only two states, California and Oregon, will see a slight decline. New Hampshire, which had one insurer participate in its exchange in 2014, is adding four new insurers for 2015. In Ohio, you’ll find five new insurers, and four in Pennsylvania.

Premiums are also changing. An early analysis of monthly plan costs across 15 cities found that the premium for the second-lowest-cost silver plan, before taking any income-based tax credits into account, is decreasing by an average of 0.8%, according to the Kaiser Family Foundation. However, that’s not true everywhere. The premium for that silver plan will jump 8.7% in Nashville, for example, 6.6% in Burlington, Vt., and 6.0% in Portland, Ore. The cost will drop 15.6% in Denver and 11.4% in Providence.

You’ll want to get to know your new choices and reassess your options. “It’s a good idea for consumers to check in, see what is being offered and its cost, and make an active decision to keep their plan or make a change,” says Pollitz.

Your Subsidy Could Change (Even If Your Income Didn’t)

What’s more, if you qualified for a tax credit last year, which about 85% of exchange enrollees did, update your income information and financial assistance application and see how much of a subsidy you’ll qualify for in 2015. Even if your income hasn’t changed, the subsidy you’re eligible for may go up or down. That’s because it is based off the price of the second-lowest silver plan in your area, which could have changed.

You can use this newly updated calculator from the Kaiser Family Foundation to estimate your subsidy.

You’re Not Stuck With Healthcare.gov

While the federally run site garners most of the attention, it isn’t the only place you can sign up for a plan.

If you expect to qualify for a premium subsidy (available if your income falls between 100 and 400% of the federal poverty level), your options are somewhat limited. You’ll either have to shop on the exchange or a health comparison site that’s authorized in your state to sign you up even if you qualify for a subsidy, such as ehealthinsurance.com and gohealth.com.

If you aren’t going to qualify for a subsidy, you can buy insurance anywhere, including directly from a private insurer. Just keep in mind that if you look at only a single insurer’s plans, you may miss less expensive or more appropriate options from competitors.

For the first time this year many Walmart stores have kiosks manned with insurance agents to answer questions about your plan options. They won’t be able to sign you up in the store, however. You’ll need to call or go online to directhealth.com to enroll.

Given the complexity of your options and the sign-up process, it’s understandable if you’d like telephone or in-person help. You can find local navigators or other resources in your area, such as nonprofits and consumer advocacy groups, at localhelp.healthcare.gov.

Drag Your Feet and You Could Be Auto-Enrolled

Don’t wait until the last minute to shop, warns Pollitz. In most states consumers who have not actively chosen a new plan by December 15 will be automatically re-enrolled in their current plan, or switched to a similar one if that plan is no longer available. While you can still swap coverage even after you’ve been re-enrolled, try to avoid that headache.

In a few states, such as Massachusetts and Oregon, there won’t be any auto-renewal, says Pollitz, so if you want coverage next year you must actively renew. You also won’t be auto renewed if your insurer is exiting the market in your area.

You Could Be Locked Out if You Delay

Pre-Obamacare, you could buy an individual health insurance plan at any time (assuming you were in good enough health to be approved, of course). Now the annual open enrollment window, which runs from November 15 through February 15 this year, is the only time you can sign up for individual coverage for 2015 (and you can’t be turned down based on your health).

Unless you have what’s called a qualifying event during the year, such as losing job-based health coverage or moving to a different state, you will not be able to buy a plan, putting you at risk of paying a penalty.

Despite all of the media attention and outreach last year, many consumers who didn’t buy during the 2014 open enrollment period were surprised to find out later that they were locked out, says Carrie McLean, director of customer care at ehealthinsurance.com.

Others found themselves locked out until next year because they had lost insurance due to a life change (new job, divorce) and didn’t realize the window to buy coverage closed in 60 days. If they finally got around to trying to sign up months later, it was too late.

Since the new rules have kicked in, ehealthinsurance.com has recorded a spike in interest in short-term health plans. These plans, however, offer limited benefits and do not fulfill the requirement that you buy a qualified plan or pay a fine. All the more reason you need to shop now.

MONEY Health Care

Take the Sting Out of Alternative Medicine Costs

Acupuncture needles stuck in $100 bill
Claire Benoist—Prop Styling by Brian Byrne for Set in Ice

Spotty insurance coverage means you'll often be stuck with the bill. Here's what you need to know about the costs and benefits of four common natural-healing strategies.

A visit to a chiropractor, acupuncturist, or other nontraditional healer has become increasingly commonplace; more than a third of Americans use some form of complementary or alternative medicine, according to the National Institutes of Health. But even though a growing number of studies suggest that these treatments can be beneficial for many patients, insurers are still reluctant to cover all types of alternative medicine, often leaving you on the hook for the costs.

You may consider that money well spent, especially if you suffer from chronic pain. “Combined with traditional medicine, alternative therapies are important treatment tools,” says Dr. Marc Brodsky, medical director of the Center for Integrative Medicine and Wellness at Stamford Hospital in Stamford, Conn.  These common approaches have research to back up their effectiveness. Still, they don’t work in every case. The key is figuring out when shouldering the cost pays and when it doesn’t.

Here are some considerations to factor into your decision.

Chiropractic

What it’s best for: These adjustments to the spine and elsewhere are most helpful for low-back pain, research indicates. “A lot of chronic pain is musculoskeletal, and chiropractic increases movement in joints and relaxes muscles,” says Dr. Melissa Young, an integrative medicine specialist at the Cleveland Clinic Center for Integrative Medicine.

The pro to see: One with a state license, which requires four years of postgraduate training at an accredited chiropractic college.

The cost: $40 to $125 per session. Fifteen to 25 visits are typically covered by insurance. You can also pay with tax-free dollars from your health savings or flexible spending account.

Acupuncture

What it’s best for: Inserting thin needles into the skin has been shown to help with headaches and low-back, neck, and knee pain. “Acupuncture increases endorphins, or feel-good hormones,” says Dr. Houman Danesh, director of integrative pain management at the Icahn School of Medicine at Mount Sinai in New York City.

Still, if you haven’t seen any results after four to six visits, you may want to move on, says Simsbury, Conn., acupuncturist Steve Paine.

The pro to see: Look for a state license and National Certification Commission for Acupuncture and Oriental Medicine certification.

The cost: $50 to $150 per session. For insurance coverage, you may need a diagnosis of a specific condition, such as migraines. The typical cap is 12 to 20 visits a year. As an alternative, your insurer may offer discounted rates at certain providers, says Susan Connolly, health and benefit consultant for Mercer.

Bar graph of insurance coverage
MONEY

Biofeedback

What it’s best for: You’re hooked up to sensors that display your heart and breathing rates and other vitals. With exercises such as guided imagery, a therapist teaches you to, say, lower your heart rate. “Since it’s a relaxation technique,” says Young, “it makes sense that it helps with issues that are exacerbated by stress.” Those include hypertension and chronic pain.

Some patients see their symptoms gradually improve, says Dr. Michael Sitar, president of the Mid-Atlantic Society for Biofeedback and Behavioral Medicine. Others report more erratic results.

The pro to see: A therapist certified by the Biofeedback Certification International Alliance (bcia.org).

The cost: $75 to $200 per visit. Insurance typically doesn’t cover it; some plans do for a diagnosis such as headaches or fibromyalgia.

Naturopathy

What it’s best for: Based on the theory that the body can heal itself through diet, lifestyle, herbs, acupuncture, and chiropractic, it’s especially good for chronic pain, including low-back pain. “Rather than providing a Band-Aid solution for symptoms, practitioners try to get to the root cause of the disease,” says Dr. Melinda Ring, medical director of Northwestern’s Integrative Medicine center.

The pro to see: A licensed naturopathic physician who has finished a four-year program at an accredited school, not a so-called traditional naturopath. Find one at naturopathic.org.

The cost: $250 to $400 for an initial 90-minute visit; $100 to $200 per follow-up. Insurance doesn’t typically pay for naturopathy, but that’s starting to change. In five states, including Washington, Connecticut, and Vermont, it’s typically covered.

MONEY home financing

It Could Soon Be Easier to Get a Mortgage

Fannie Mae headquarters in Washington, DC
Kevin Lamarque—Reuters

The nation's largest mortgage firms plan to once again buy loans where the borrowers put as little as 3% down.

Perhaps you thought the days of putting little money down for a home were gone. Well, not so fast. On Monday the CEO of Fannie Mae, Timothy Mayopoulos, announced that the housing giant planned to once again buy loans for which the borrowers put as little as 3% down. Mayopoulos told the crowd gathered at the Mortgage Bankers Association conference in Las Vegas that Fannie, which along with Freddie Mac supports the bulk of the mortgage market today, is working to finalize the details of the offering and gain regulatory approval to proceed. “We want this business,” he said.

So far no details have been announced about what income or credit score requirements borrowers making such small down payments will need to meet the group’s standards. Mayopoulos said more information would be released in the coming weeks. Both Fannie and Freddie previously purchased loans with 3% down but had stopped in recent years. Today the firms usually require at least a 5% down payment on most loans.

Melvin Watt, director of the Federal Housing Finance Authority, which regulates the two government enterprises, said his group was working with them to develop “sensible and responsible guidelines” for the 3% loans, in an effort “to increase access for creditworthy but lower-wealth borrowers.” He cited “compensating factors” in evaluating such borrowers, though he didn’t say what those factors would be.

A 3% down payment is not exactly nonexistent today. The Federal Housing Administration has been offering mortgages with as little as 3.5% down for years. Traditionally, most borrowers were lower income, and the amount they could borrow was capped, but today even higher income folks use FHA loans to buy homes in expensive areas (loan limits vary by state but typically top out at $625,500). In recent years, these mortgages—which come with higher fees than traditional loans, as well as pricey mortgage insurance—have accounted for a larger than normal share of the market.

Now Fannie seems intent to grab some of that business. The low-down-payment loan, Mayopoulos promised, “will also be competitively priced, including against FHA execution.”

In a related move, FHFA’s Watt also announced that the agency is working to provide more details on when the housing giants can force a lender to buy back a loan that goes bad, which he hopes will encourage banks to loosen their lending standards. Over the past few years Fannie and Freddie have required lenders to buy back millions of dollars of bad loans, “sometimes for seemingly minor issues, such as missing a piece of paperwork,” said Keith Gumbinger, vice president at mortgage information publisher HSH.com.

“This clarification might allow lenders to look at riskier borrowers with less fear of having to buy these loans back in the future,” he said. He noted, though, that any changes are likely to be incremental: “It might let a few more borrowers in at the margin, but it won’t be like flipping a light switch where FICO scores down to 640 are now in.”

It’s important to note that Fannie and Freddie can’t force banks to lower their lending standards. In fact, most banks today require tougher standards than the government agencies impose, partially because they are fearful of having to buy back loans that go bad. For example, Fannie and Freddie will buy loans with FICO scores as low as 620, but most banks require at least a 660 or 680, Gumbinger said.

Similarly, lenders could always decide not to offer 3% down loans, even though Fannie and Freddie have agreed to eventually start buying them again. So it remains to be seen whether and how much the rule changes, when they are formally announced in the next few weeks, will ease the way for borrowers.

Read More About Getting a Mortgage in Money101:
How Much House Can I Afford?
What Mortgage Is Right for Me?
How Do I Get the Best Rate on a Mortgage?

MONEY Rentals

The Money Mistake That 48% of Renters Make

List of bills to pay, with "paid" written in red on top
David Gould—Getty Images

They assume their on-time payments will help boost their credit score, according to a new TransUnion survey.

Most Americans know that a good credit score can open the door to lower cost loans for big adult milestones, such as buying a home or car.

Yet it turns out that many renters are misinformed about what goes into that somewhat mysterious three-digit number: Nearly half of renters ages 18 to 64 think rental payments to their landlords are automatically reported to the credit bureaus, according to survey results released last week by TransUnion, one of the nation’s three major credit reporting agencies. The survey also revealed that more than half of renters believe payments for cable and internet, utility and cellphone bills are regularly reported to the bureaus.

Credit agency firms TransUnion and Experian did recently start allowing rental payments to be collected and factored into credit reports. But in practice, most landlords do not yet share with the data collectors that you’re paying on time each month, says Ken Chaplin, senior vice president of TransUnion’s consumer division. Cable, internet, utility and cell providers also typically do not, he says.

Even if your landlord or service firm is one of the few that does report, the payments may not be included in the most common credit score lenders use, called the FICO score. So if you were counting on your on-time monthly rent checks to help you build your credit score, you’re out of luck.

Keep in mind that although being conscientious on paying your rent and utilities won’t help you, your failure to make a payment can hurt you. Some landlords and utility companies do report delinquent customers—not to mention the fact that your accounts could end up in collections. So this isn’t an excuse to stop paying these bills.

Instead it should serve as a wake up call that you may need to work in other ways to improve your credit score, such as paying car loans, student loans and credit card bills on time each month.

Related:

What is a credit report and when is it used?

How is my credit score calculated and how can I improve it?

MONEY Health Care

How to Save Lots of Money on the Health Tests You Need

Legs on scale at doctor's office
Scott M. Lacey

Catching medical problems early is good for your health—and your wallet. But don't go overboard. Learn to weigh the pros and cons of what the doctor orders.

The latest big push in health care is keeping you from getting sick in the first place. Insurers are sending you reminders to schedule regular exams. Employers are rewarding workers who quit smoking or lose weight. And a key provision in the Affordable Care Act, a.k.a. Obamacare, is full coverage for certain preventive care—with no out-of-pocket costs for you.

Getting a handful of basic tests ­every year can reap rich rewards. “So many diseases, such as hypertension and diabetes, are symptomless in the early stages, when they can be easily caught and controlled,” says Dr. Nieca Goldberg, director of the NYU Women’s Heart Center. So see your primary-care doctor annually once you reach your forties (until then, every two or three years is usually sufficient).

Even though fully covered tests are getting more common, for many ­others you will face co-pays or co-­insurance—and shoulder the full cost until you reach your deductible. To keep those costs to a minimum, we recommend two strategies.

First, look for ways to save on every test you take. Prices can vary widely for the same service, even when you stick with in-network doctors and facilities.

Start by checking your health insurer’s website—many list doctors that insurers believe offer quality care at fair prices. Keep in mind that MRIs, CT scans, and other imaging tests often cost much less at free­standing radiology centers. ­(Just be sure the facility is accredited by the American College of Radiology and that your doc will accept the results.) And when your doctor orders a blood test, ask about all your options, including outside the office. “Labs are so standardized, a $10 lipid panel will get the same results and same quality as a $200 lipid panel,” says Scott Matthews of Castlight Health, which helps big businesses manage their health care costs.

Second, learn which screenings are worth your health care dollars and which you can skip. Here’s what you need to know:

6 Essential Tests for Everyone

1) Skin exam

With skin cancer on the rise, it’s smart to have a dermatologist examine the skin over your entire body, looking for suspicious growths, moles, and lesions.

When to get it: At least once a year. “If you have risk factors, such as being fair, having a lot of moles, or having a family history of skin cancer, you may need to be seen as often as every three to six months,” says Dr. David Leffell, chief of dermatologic surgery at the Yale School of Medicine. You could go to your ­primary-care doctor, but dermatologists are better at diagnosing potentially cancerous lesions, studies show.

Cost: $50 to $150. Insurance covers the visit after you meet your deductible; your usual co-pay or co-insurance will apply.

2) Cholesterol check

This blood test, a.k.a. a lipid panel or profile, reports your total cholesterol, your LDL (“bad”) cholesterol, your HDL (“good”) cholesterol, and a type of fat in the blood called triglycerides. High levels of all but the good stuff raise your risk of heart disease and stroke.

When to get it: Men over 45 and women over 50 should be checked every one to three years, says Goldberg. (Until menopause, women have the protective benefits of estrogen.) At younger ages, test every four to six years. Among the reasons for more frequent screenings: Your results aren’t normal, there’s a family history of heart disease, or you have risk factors like being overweight, you smoke, or you have high blood pressure.

Cost: $110 to $305 for test alone. Cholesterol testing is often included in an annual physical, which insurance covers in full.

3) Blood-pressure check

High blood pressure raises your risk of heart disease, stroke, kidney failure, and other serious conditions.

When to get it: Every two years as part of a routine physical; once a year or more if your pressure is above 120/80.

Cost: $70 to $200 for a doctor’s visit, but insurance pays the full tab for your annual preventive checkups

4) Eye exam

Even if you think your vision is 20/20, have your eyes examined regularly—­especially after 40. As you age, you’re at risk for conditions such as glaucoma, which is symptomless. “An exam can also find signs of another disease that may be affecting your eyes, such as diabetes or high blood pressure,” says Dr. Rebecca Taylor, an ophthalmologist in Nashville and a spokesperson for the American Academy of Ophthalmology.

When to get it: Before age 40, Taylor suggests getting a full exam with an optometrist or ophthalmologist every five to 10 years (yearly if you wear glasses or contacts). After that, make it every two years. Reasons to get more frequent exams include a family history of eye disease, previous eye injuries or surgery, diabetes or high blood pressure, or you are over 65.

Cost: $75 to $200 with an ophthalmologist; $50 to $150 with an optometrist. Insurance coverage varies.

5) A1C blood test

This has become the screening test of choice for diabetes, as it measures your average blood glucose over roughly three months; the fasting blood glucose test tells doctors just what your level is at that moment.

When to get it: The standard recommendation is every three years starting at 45. The American Diabetes Association advises beginning earlier if you’re overweight and have certain risk factors, including high blood pressure.

Cost: $40 to $260 for test. If you have high blood pressure, insurance covers in full.

6) Colonoscopy

This exam is your best defense against colon cancer. While there are other screening tools, a colonoscopy is considered the gold standard: “It doesn’t just diagnose; if the doctor sees adenomas [potentially precancerous polyps], he can remove them then and there,” says Dr. Seth Gross, director of endoscopy at Tisch Hospital at NYU Langone Medical Center.

When to get it: Start at age 50, earlier if you’ve got other risk factors, such as a family history or if you have suspicious symptoms. If the test is negative, get one every 10 years.

Cost: $1,100 to $2,800. Insurance pays every 10 years for adults ages 50 to 75.

4 Essential Tests for Women

Insurance will cover the basic pelvic and breast exams that are part of your annual visit to a gynecologist. Other tests aren’t needed as often—and your insurance coverage will probably reflect that.

1) Pap smear

A Pap smear, also called a Pap test, is when your gynecologist collects cells from your cervix to screen for precancerous changes. Thanks to this test, the cervical cancer death rate declined by almost 70% between 1955 and 1992, according to the American Cancer Society (ACS).

When to get it: Every three years, provided your last test was normal; most women can stop at age 65.

Cost: $75 to $350. Insurance pays in full every three years from ages 21 to 65.

2) Mammogram

There’s been controversy in recent years about when to begin breast cancer screening and how often to do it, but the American Cancer Society and American College of Obstetricians and Gynecologists still recommend getting your first mammogram, an X-ray of your breasts, at 40— earlier if you have risk factors like a family history. Ask your doctor about 3-D mammography, now available at some major medical centers: It reduces false positives and slightly bumps up detection rates, according to a recent JAMA study.

When to get it: Once a year starting at age 40.

Cost: $150 to $375. Screening is covered every one to two years at age 40-plus. Most plans don’t cover more precise 3-D mammograms, so you may owe $40 to $60.

3) DEXA scan for bone density

An X-ray test to measure bone density, this screening is recommended for all women at age 65. But you may want to get one around menopause, when declining estrogen levels increase your risk of osteoporosis.

When to get it: Start at age 65, then consult doctor. With risk factors like smoking and osteoporosis in family, begin at menopause.

Cost: $60 to $385. Insurance pays in full when 65-plus; with preapproval, it often pays for younger postmenopausal women too.

4) HPV (Human – papilloma- virus) test

Typically done at the same time as a Pap, this checks for strains of HPV that are most likely to cause cervical cancer. Before age 30, nearly all sexually active people contract HPV at some point, according to the Centers for Disease Control. Most of the time, HPV is harmless and clears up on its own. But since HPV infection is less common in women over 30, a positive test result is more apt to signal a potential problem.

When to get it: Women ages 30 to 65 should get an HPV test paired with a Pap smear every five years.

Cost: $30 to $125. Insurance pays in full every five years from 30 to 65.

6 Tests You May Need

1) Vitamin D test

Vitamin D helps you absorb calcium and maintain strong bones. Since up to 75% of Americans have low levels (a 2009 study suggests), ask your doctor about adding this to your physical, advises Dr. Marianne Legato, professor emeritus of clinical medicine at Columbia University Medical Center.

Cost: $25 to $150; some, but not all, insurers cover

2) Thyroid-stimulating hormone test

Experts disagree about whether routine thyroid screening is necessary, but make sure to get your blood level of TSH checked if you have fatigue and unexplained weight gain.

Cost: $15 to $115; often covered. Deductible and co-pay or co-insurance apply.

3) Cholesterol particle tests

People whose particles of LDL cholesterol are mostly small and dense have a threefold greater risk of coronary heart disease. Ask your doctor about this test if your cholesterol is borderline, especially if you’re debating whether to go on cholesterol-lowering medications, Goldberg says.

Cost: $15 to $265; not usually covered for routine screening but may be covered in part if you have risk factors.

4) Coronary calcium scan

A CT scan of your heart is used to look for specks of calcium in your arteries that may indicate early signs of coronary artery disease. While this scan is not recommended for everyone, it can be useful if you’ve got a family history or other risk factors. “A score greater than 300 tells us that you’re at increased risk of cardiovascular events in the next five to 10 years,” Goldberg says.

Another heart exam—an exercise stress test—isn’t a useful screening tool if you’re low risk, she adds, due to a high rate of false positives. As a rule, it’s best reserved for people who have risk factors or symptoms such as chest pain or an irregular heartbeat.

Cost: $10 to $300; not usually covered for routine screening, but may be covered in part if you have risk factors.

5) CRP (C-reactive protein) test

This measures blood levels of CRP, an inflammatory protein associated with heart disease. It’s most predictive in men over 50 and women over 60, Goldberg says. In a 2010 study, people in these age groups who were at intermediate risk of heart disease and who had normal cholesterol but high CRP levels benefited from going on cholesterol-lowering medications.

Cost: $10 to $115; not usually covered for healthy patients but often covered in part if you have risk factors.

6) Prostate exam

Screening for prostate cancer used to be a must. Now it’s a maybe. “Intuitively, it makes sense to treat prostate cancers early,” says Dr. Richard Wender, chief cancer control officer at the American Cancer Society. “But some grow so slowly that they’d probably never be life-threatening, and the treatment would be worse for quality of life than the disease itself.” That said, a study published in The New England Journal of Medicine this past March found that men under age 65 who underwent surgery for early-stage prostate cancer (instead of watchful waiting) had better survival rates.

Bottom line: At 50, talk to your doctor about your risks (like a family history). If you decide to undergo a PSA (prostate-specific antigen) blood test and it’s under 2.5 ng/mL, you can wait at least another two years to retest. If it’s over that, test annually.

Cost: $25 to $125 and may be covered by insurance for men older than 50, or starting at age 40 if you face certain risk factors.

 

 

 

MONEY home financing

If You Still Haven’t Refinanced, Now’s a Good Time (Again)

hand turning over house picture on cards
Mark Hooper—Getty Images

Homeowners who missed the last refinancing boom are being given another chance, albeit not quite as sweet as the last one.

Growing fears over the health of the global economy are sending ripples far and wide. Along with Wednesday’s cratering stock market and worrisome bond yields comes another consequence, albeit one that may carry a silver lining for some: Mortgage rates are at their lowest levels since June 2013.

According to mortgage website HSH.com, the rate on a conforming 30-year-fixed loan has dropped to about 4%, after hovering around 4.25% for most of the summer. That’s still well above the 3.5% some fortunate homeowners snagged back in late 2012, but certainly lower than where many economists expected rates would be today.

What’s behind the drop? “Growing concerns about weak economic growth in Europe caused a flight to quality into U.S. assets last week, leading to sharp drops in interest rates,” Mortgage Bankers Association chief economist Mike Fratantoni noted in a statement. The 30-year fixed rate tends to move in the same direction as 10-year Treasury yields, which fell below 2% on Wednesday morning for the first time in 16 months.

If you are among the homeowners who never took advantage of the historically low rates during the last refinancing boom, now could be your opportunity. Maybe you simply never got around to it (the so-called “failure to refinance” that strikes approximately 20% of homeowners who stand to benefit)—or, more likely, you didn’t qualify then. The good news is, now you might get approved.

“Some people over the last six months may have had things align so they can qualify,” says Keith Gumbinger, vice president of HSH.com. For example, previously you may have had a credit score below 740, the minimum threshold often required for the best rates. Or you didn’t have enough equity in your home; most lenders require a stake of at least 10% to 20%. The median home price nationwide, though, has shot up an average of 42% since its January 2012 bottom, according to the National Association of Realtors. That spike lifted millions of homeowners—nearly one million in the second quarter alone, according to Corelogic—out from underwater loans, meaning they no longer owe more on their mortgage than the place is worth.

Or maybe, like former Fed chairman Ben Bernanke, you’d just changed jobs last time and now have the two-year employment history lenders like to see.

“Is the drop in rates enough to drive a substantial amount of people into the marketplace? No,” says Gumbinger. “But it could open the window to a few stragglers.”

HSH.com offers calculators to help homeowners decide if the savings will be significant enough to make a refi worthwhile. A general rule is that you should aim to shave at least one percentage point off your current rate to benefit, Gumbinger says, although the sweet spot will vary depending on your goals, such as whether you’re aiming for a lower monthly payment or to pay less in total interest over the life of the loan.

Another potential opportunity for savings: refinancing into a shorter loan, such as a 15-year fixed mortgage, which runs about 3.35% today. If you’ve been in your home for a few years, you may find that a 15-year product offers a slightly lower monthly payment, as well as shaves thousands of dollars off the total interest.

Of course, you may be wondering if you should wait in case rates drop further yet. Gumbinger suggests that if you see a deal that works for you today, grab it. “American mortgage borrowers are benefiting from the trouble in the world,” he says. But there’s no telling how long that benefit will continue.

Related:
Money 101: What Mortgage Is Right for Me?
Money 101: How Do I Get the Best Rate on a Mortgage?
Money 101: How Much Will My Closing Costs Be?

MONEY Health Care

The Simple Way to Get a Flu Shot for Free

Flu Shot sign in pharmacy
Terry Vine—Getty Images

Under Obamacare, most Americans will pay nothing for an influenza vaccine. And skipping the shot can be costly.

When you think of the flu, the cost of getting sick probably isn’t the first thing that jumps to mind. But coming down with the virus can prove pricey.

A visit to the doctor’s office can run $80 to $100—or more. If you need to head to the ER on a night or weekend for care, the tab can easily total $500. With the average health plan deductible rising, you could owe the whole bill, or at least a decent share. In extreme cases, if you land in the hospital the cost (before insurance) can be $2,000 a day. And the average stay for the flu is about four days.

As a parent, you also need to think about time away from work if your child gets sick. A 2012 study found that when children under the age of 5 came down with the flu parents missed an average of seven work hours if the child was treated in an outpatient setting, 19 hours if the child went to the ER, and 73 hours if the child was hospitalized.

The good news is that you probably don’t have to pay a penny for the best defense against the flu. Under Obamacare, a flu shot is free as long as you have health insurance (though plans that were in place before the law passed in 2010, known as grandfathered policies, are exempt). It’s one of the preventive services that insurers must fully cover without charging you a co-pay or co-insurance—even if you haven’t met your annual deductible yet. Under Medicare, you also pay nothing.

Still, even though the U.S. Centers for Disease Control recommends that everyone older than six months get the vaccine annually, many skip it. Vaccination rates top 70% for children ages six months to four years and are almost as high for those 65 and older, according to the National Foundation for Infectious Diseases. But 18-to-64-year-olds lag, with fewer than 40% rolling up their sleeves last year.

Where to go for the vaccine

Your vaccine should be free as long as you choose a provider that’s in your plan’s network. That could mean making an appointment with your doctor, or walking into your neighborhood drug store, urgent care clinic, or big-box retailer. Walgreens, CVS, Target, Walmart, and Kroger all dole out the vaccine, though make sure the branch near you offers the service (not all do). You can use this vaccine finder tool to look up providers near you.

Without insurance or outside your insurance network, you’ll probably pay the list price. At Walgreens, that’s $30 to $55, depending on the form of vaccine. Although a shot in the arm is the most common, you have options, including a nasal spray.

This week Sam’s Club announced it will match any competitor’s price at its in-store pharmacies. Other stores are running flu shot promotions to get you in the door, offering discounts on whatever else you buy on your visit. One caveat: Not every state allows stores to vaccinate children, so call ahead.

Your employer may also offer flu shots in its medical center or conference room, letting you get in and out in five minutes. Some schools provide free shots for students. (In a few states, including New Jersey and Connecticut, it is mandatory that children in licensed day care centers and preschools be vaccinated.) Many community health centers also offer the vaccine.

No matter where you go, don’t worry about missing out: The National Foundation for Infectious Diseases reports a “plentiful” supply this year. But don’t wait until the last minute. It takes about two weeks for the protection to kick in.

MONEY health insurance

You Can Now Buy Health Insurance at Walmart. Should You?

America's largest retailer is expanding more aggressively into the insurance market, hoping to become the go-to place for all your health care needs. But the store is far from the only place to get your coverage questions answered.

UPDATED: 5PM ET

Want help choosing a health insurance plan? Superstore Walmart is betting that many consumers do—and that they will visit a big-box store for guidance.

The company announced this morning that it is teaming up with the health comparison website DirectHealth.com to house insurance agents in 2,700 of its 4,300 U.S. stores. The agents will help shoppers understand and compare individual insurance plans as well as private Medicare plans, including drug, supplemental, and Advantage policies.

The agents will be in stores from this Friday, October 10, through December 7, a time frame that captures the kick-off of the annual enrollment periods for both individual health plans and private Medicare policies. Medicare open enrollment starts October 15; you can begin shopping for an individual policy for 2015 on November 15.

“For years, our customers have told us that there is too much complexity when it comes to understanding their health insurance options,” said Labeed Diab, president of Walmart’s U.S. health and wellness group, in a press release announcing the program. Since 2005, Walmart has hosted insurance agents from individual insurers in some stores to answer questions and enroll customers in health plans. This new program expands on that.

A bid for more health care business

This move isn’t the first time Walmart has dabbled in health care. The company has been slowly adding retail clinics to many of its locations, letting shoppers get primary care such as strep tests and treatment for ear infections at the store. Walmart’s total number of clinics, though, falls far short of what pharmacy chains CVS or Walgreens offer.

By adding insurance agents to its stores, the retailer appears to be aiming to get consumers to think of Walmart as a one-stop resource for health care. Walmart will not receive commissions on the sale of health plans, the Associated Press reports, but hopes the agents will attract consumers who will then rely on the stores for other health care needs, such as prescriptions. The agents will receive a commission from the insurers whenever a patient enrolls in a plan in the store, The Washington Post reports.

Where else to get help

In announcing the program, Walmart noted that many consumers have difficulty understanding their health plans. While that’s true, Walmart will be just one of many places where you can find guidance. Other comparison websites, such as ehealthinsurance.com and gohealthinsurance.com, already offer online and call-in assistance, though neither have retail locations around the country.

So should you head to Walmart face-to-face help with an individual or Medicare plan? The store will offer individual plans from 300 carriers, and Medicare plans from 13 firms. So you should be able to find options in your area. But keep in mind what other help is out there.

•For individual health insurance plans: Unless you qualify for a special enrollment period because you, say, lost your employer-based coverage or got divorced, you are generally locked out from buying a new individual health insurance plan or switching policies until the annual open enrollment period, which this year begins November 15 and runs through February 15. You’ll be able to buy a policy either through your state insurance exchange (find yours at healthcare.gov), an insurer, a comparison website, or an insurance agent.

Once open enrollment begins, many community centers and non-profits around the country will be staffed with counselors, navigators, or other assisters who can offer explain a plan’s details (though many aren’t supposed to tell you which plan is best for you). Find a group offering assistance in your area at localhelp.healthcare.gov. For questions about a plan sold on the public exchange, Healthcare.gov lists the 1-800 number for your state.

Unless you qualify for a subsidized policy under Obamacare (in which case you may be required to buy through an exchange), you should compare policies on the exchanges with those sold directly by insurers. You can find a local insurance agent who can sell you an on- or off-exchange individual policy at nahu.org. Comparison websites also list details for both types of plans, though there’s no guarantee every off-exchange plan available from an insurer will be listed on each site.

One caveat: the in-store agents will be able to explain plan details and help with comparison shopping, but they won’t be able to actually enroll you in an individual plan in the store, according to a Walmart spokesperson. To sign up you’ll need to call Direct Health, Walmart’s partner, or go to the website. (The agents will be able to enroll you in a Medicare plan while you’re in the store.)

Keep in mind that while DirectHealth.com is required by law to list every plan available through the exchange, it won’t necessarily include the full details for each plan. Instead, the site attempts to determine which plans may best suit you, says Michael Mahoney, senior vice president of marketing at GoHealth, which powers the DirectHealth.com comparison site. “We want to make sure people have the right amount of choice without overwhelming them,” he says. You decide if you’d rather see all your options, or only a limited choice.

•For private Medicare plans: You can make changes to your Medicare drug or Medicare Advantage plan starting on October 15. It is a good idea to analyze your current plan and new options every year instead of sticking with what you’ve got, since plans and premiums change and new options appear.

The Medicare Rights Center offers a national help line (800-333-4114) to help seniors understand the program and determine if their income qualifies them for other resources, such as a prescription drug subsidy. Your local State Health Insurance Assistance Program offers one-on-one assistance to Medicare beneficiaries and their families. Find your state’s at shiptalk.org.

The medicare.gov tool run by the Centers for Medicare and Medicaid Services lets you compare plans in your local area. This tool also lists every possible plan available to you, which is not the case with Walmart’s program. For example, a 67-year-old woman who lives in one Northern California zip code and takes no drugs has 11 Part D prescription drug plans options listed on DirectHealth.com. On medicare.gov, that same woman would find more than 30 choices.

 

MONEY Home furnishings

Why Ikea Items Look So Good… In the Catalog

The firm has embraced a cutting-edge technology to create images of scenes that don't actually exist.

Ever wonder why your Ikea chair or sofa doesn’t look quite the same as the one in the catalog? Turns out that many of the glossy images you’ve been drooling over aren’t actually photos of a physical chair, sofa, or any other object placed in front of a camera. Instead, the Swedish furniture firm uses 3D rendering technology to create digital models of their products, which can then be dropped into any room or scene the artists and photographers create. That way, they can easily tweak anything from the angle of the chair to the sunlight reflecting through the window to the placement of the fruit bowl on the table.

According to a post from the CG Society, an organization for digital artists, Ikea now uses the technology to create 75% of the product images in its catalog. The firm told CG Society that using 3D rendering is less expensive and logistically easier than trying to ship items from all over the world to be photographed. It also allows for more flexibility. For example, if an item is changed, it can simply be digitally tweaked rather than reshot.

Of course, this technology also allows the company to get the absolute “perfect” shot. “With a lot of those images from Ikea I could tell immediately they were done with 3D,” says Shamus Clisset, a New York City artist who generates his creations using similar technology, and has a show opening next week at Postmasters Gallery in Manhattan’s Tribeca neighborhood. “It is just a little too perfect about everything. The hard thing to get right in 3D is the imperfection.”

For instance, when you build an Ikea chair yourself, it may have a little nick or scratch—imperfections you’re unlikely to see in a digitally-rendered image, unless they’re added. Similarly, if you screw together a table, one of the legs may not stand completely straight, causing the table to tilt ever so slightly. The computer, on the other hand, can generate a perfectly geometric table.

To be fair, companies have always used tricks to create the best possible images of their products. “It isn’t that different from how product shoots were done in the past,” Clisset says. “When you see a bowl of cereal on the front of a box, it isn’t milk in the photo. You use glue instead because you have more control over it. Now it’s just done digitally.”

Clisset explains that the technology has come a long way in the last ten years, to the point where 3D artists can create images that are indistinguishable from an actual photo. “I have been doing the 3D stuff for almost ten years, and when I first started out people couldn’t even grasp the concept,” he says. “But today people are getting more familiar with it.”

Now an artist—or furniture company—can choose between, say, many different types and colors of wood, and simply digitally render them onto a model product, such as a floor or table.

You’re also likely to see this technology in auto ads, says Clisset. Want the car in the mountains? Sure. Desert? No problem. City? Just decide where to place the people.

Here is a thread that includes before and after shots from television and movies produced with the help of these techniques.

The challenge now for consumers will be to be able to discern what is real, and what is digitally created. That is, if they even care.

Click here for the original CGSociety post, which includes photos.

MONEY home prices

Backlash Against Foreign Home Buyers Takes Off

Foreigners are paying cash for U.S. real estate. Turns out some of that money is laundered. Fuse—Getty Images

It’s no secret that outsiders are collecting homes in cities around the country. Often the mystery is who they actually are, and where their money comes from.

Updated: August 1, 2014 11:00am

Foreign interest in U.S. real estate continues to grow, according to a report released this month from the National Association of Realtors. International sales rose from $68.2 billion to $92.2 billion over the past year, thanks to favorable exchange rates, affordable home prices, and rising affluence abroad.

In the wake of the housing bust, foreigners helped revive many U.S housing markets by scooping up properties when Americans were running scared. Despite the rise in prices since then, the attraction doesn’t seem to have soured. Experts estimate at least one-third of newly developed apartments in Manhattan go to international buyers. Other metropolitan areas including Los Angeles and Miami are also seeing demand, as well as even second-tier cities in places like Arizona and Texas.

Investors have been flocking from all over the map: China, Russia, The UAE, Switzerland. The industry catering to these faraway landlords—in charge of everything from managing payments to choosing lighting fixtures—has ballooned, since many of the apartments are rented out or sit empty.

Sales of ultra-high-end pads have received much of the media attention. Publications ranging from CBS News to Vanity Fair paid attention when two years ago a family member of Russian fertilizer oligarch Dmitry Rybolovlev purchased the most expensive condo in Manhattan, for $88 million. But you’d be wrong to think it’s only billionaires that want a place on American soil. Buyers regularly hunt for homes and apartments at more mainstream prices (although, to be fair, the median price of a condo in Manhattan runs nearly $1.4 million). The National Association of Realtors reports that more than one-quarter of agents have worked with international clients. Chinese buyers spend $425,000 on average on U.S. homes, with about two-thirds of the deals being all-cash.

The Backlash

No surprise, the out-of-towners have earned a bad rap from many locals, who are losing bidding wars to the cash offers and feeling squeezed by the inflated prices. The outrage had grown strong enough in New York that in February writer Diane Francis, a Canadian who owns a place on Manhattan’s 57th Street, penned an opinion piece in the New York Post proclaiming that foreign real estate buyers in New York are not the enemy. She pointed out that she and her husband pay at least $25,000 a year in property and sales taxes but don’t cost the state’s schools, hospitals, or jails a dime.

Last month New York magazine fueled the rage with its cover story, “New York Real Estate Is the New Swiss Bank Account,” suggesting that wealthy foreigners are using property to hide—and sometimes launder—their rubles and yuan. Another story a few days later from the Nation, both part of a joint project that included the International Consortium of Investigative Journalists and the Organized Crime and Corruption Reporting Project, piled on. A few tidbits from New York magazine:

As New York magazine noted, it’s often anonymous LLCs and bank accounts behind the purchases:

“There is nothing illegal—at least from the destination nation’s perspective—about sending money from an anonymous offshore bank account to purchase property in America. On the contrary, it’s an everyday occurrence.”

Sometimes not even building managers or the best neighborhood snoops know who the mysterious owners are, or where the money came from.

“With a little creative corporate structuring, the ownership of a New York property can be made as untraceable as a numbered bank account…. Those on the New York end of the transaction often don’t know—or don’t care to find out—the exact derivation of foreign money involved in these transactions.”

While not all of the foreign money coming in is laundered, some of it is, and public officials so far haven’t taken up the issue. From the Nation:

“U.S. authorities don’t put up many roadblocks for foreigners who want to launder money through American real estate. Escrow and real estate agents aren’t required to find out the true identities of property buyers—the real people behind the front men or corporate shells.”

Will enough outrage boil up that politicians feel obliged to make buying less attractive for foreigners? The capital-gains tax rules were recently modified in London, dimming future returns for foreign investors (and likely sending more buyers to this side of the Atlantic). Yet Adam Davidson, writing in the New York Times Magazine, points out one upside:

“I initially felt anger and disgust at the idea of absentee billionaires hoarding Manhattan real estate, making the city even more unaffordable while they live like princes in Moscow or Hong Kong or wherever. But then I did the math. Assuming that their money has to go somewhere, it’s not so bad that these billionaires choose to put a chunk of it here. Any city official in Dayton or, for that matter, Philadelphia would do anything to have such problems.”

The trend may slow on its own, particularly at the ultra high end. Developers looking to cash in on the world’s wealthy may oversaturate the market. There is, after all, a fixed number of people worldwide who want—and can afford—to plunk down upwards of $20 million for a pied-a-terre. The New York Daily News recently pointed out that sales in at least one building on Manhattan’s West 57th Street, so-called Billionaires’ Row, have slowed.

Then last week, the conversation about luxury real estate shifted from shady foreign buyers to an issue much closer to home for most of us: the question of whether non-ultra-rich residents of a new luxury development on Manhattan’s Upper West Side will have to enter through a separate door.

 

Correction: A representative of Dmitry Rybolovlev stated in an e-mail to MONEY that the Manhattan apartment was purchased by Rybolovlev’s daughter, not by Rybolovlev, as the article originally indicated.

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