MONEY Health Care

Americans with Obamacare Are Still Afraid of Big Medical Bills

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Walker and Walker—Getty Images

A new survey finds most Americans are satisfied with their Obamacare plans, but they're still worried about one thing.

Americans gave Obamacare plans high marks in a survey out today from the Kaiser Family Foundation. Three-quarters of those enrolled in health plans through the marketplace say they’re satisfied with the choice of primary care doctors, 73% express satisfaction with their doctor’s visit copays, and 65% say they’re satisfied with their premiums. Overall, 40% say they’ve mostly benefitted from the Affordable Care Act, while only a third say they’ve mostly been negatively affected.

But there’s one nagging problem. Even though Americans are generally happy with Obamacare plans, a large minority—38% of marketplace enrollees—say they still “feel vulnerable to high medical bills.” (A similar proportion of people in non-Obamacare plans agree.)

Most alarmingly, Americans enrolled in plans that meet ACA requirements are more likely to struggle with medical bills than Americans enrolled in plans that do not meet ACA requirements. Americans in ACA-compliant plans are also more likely to report skipping care because of cost. Even though the Affordable Care Act outlawed annual and lifetime coverage maximums—the health insurance provisions that saddled the insured with hundreds of thousands of dollars in medical debt and doomed the sick to bankruptcy—more than half of Americans enrolled in ACA-compliant plans say they’re worried they won’t be able to afford the health care services they’ll need in the future.

One culprit may be high deductibles. In a previous survey, the Kaiser Family Foundation found that Obamacare silver plan enrollees have an average $3,453 deductible, meaning they need to pay more than $3,000 out-of-pocket before insurance would cover part of the cost. On average, Americans enrolled in bronze plans need to pay more than $5,372 out-of-pocket before insurance kicks in.

Unsurprisingly, people with high-deductible plans, whether ACA-compliant or not, feel more financially vulnerable. Only 7% of Americans on high-deductible plans say their health insurance is an “excellent” value for the cost, compared with 19% of Americans on lower deductible plans. And fewer than a third of Americans on high-deductible plans say they could pay a $1,500 medical bill without borrowing money—which is a problem, because a $1,500 bill is a real possibility with a $3,000-plus deductible.

How to save on medical care:

MONEY Health Care

How to Survive This Awful Allergy Season

pollen written on windshield covered in pollen
Joseph De Sciose—Getty Images/Aurora Creative

Lingering winter cold means pollen levels could rise quickly—and so could your medical costs.

Grab your tissue box. We’re in for a terrible spring allergy season. Experts say that the long winter may cause early-blooming trees to pollinate late this year, which means more trees pollinating at the same time.

About one in five Americans suffer from some kind of allergy, with seasonal allergies the most common, according to the Asthma and Allergy Foundation of America. While not as severe as food and insect allergies, hay fever can put a real damper on your life—seasonal allergies are responsible for some 4 million missed or lost workdays every year, the National Academy on an Aging Society estimates.

The upside is that if you take your allergies seriously this year, you might feel better and save money. True story: My entire childhood, I had “seasonal” allergies that lasted almost year-round. (For some reason, no one thought this was weird.) As an adult, I finally got tested. I was allergic to my cat. Part of me wishes I didn’t know that, but I don’t have to buy as much Claritin now.

Here’s what allergies could cost you—and how you can save.

Over-the-counter antihistamines: 10¢ to 67¢ a pill

With hay fever, you can burn money on boxes upon boxes of over-the-counter allergy relief like Claritin, Allegra, and Zyrtec. But you can save a ton if you just compare prices online, says Elizabeth Davis, editor-in-chief of GoodRx blog, a prescription savings blog.

“One thing that tends to be worthwhile is going for the non-name brand version,” Davis says. “It looks like you can get [generic Claritin] for as low as $10 for 100 tablets, but I’m generally seeing about $20 or so for a regular box of brand-name Claritin, which has 30 tablets.”

So shop online, save 85%.

Another medication to consider: nasal spray. Nasacort and Flonase were both recently approved for over-the-counter sale, where they cost between $17 and $25 a bottle, Davis says.

Prescription antihistamines: 50¢ to $1.60 a pill

Sometimes, over-the-counter medications won’t be enough to alleviate your symptoms. If you’re still suffering, or if you find yourself relying on Benadryl on a daily basis, it’s time to see an allergist.

While prescription allergy meds are usually more expensive—as low as $15 but as much as $40 or $50 for 30 tablets, Davis estimates—what you pay will depend on your health plan. Doctor visits, tests, and prescriptions are typically covered by health insurance, with a co-payment or co-insurance, after you meet your deductible.

The higher dosages in prescription meds might be what you need to kick your symptoms. A doctor might double, triple, or even quadruple your dose, or advise you to take a combination of antihistamines and decongestants, says Neil Kao, an allergist in Greenville-Spartanburg, S.C.

“When you go the doctor, you might say, ‘Well, I took Claritin, and it didn’t work,'” Kao says. “The doctor might say you need two—one in the morning, one at night. You might say, ‘The box says one.’ Well, that’s why I went to medical school!”

Also, while prescription generic Nasacort nasal spray costs more—typically $50 to $75 a bottle—and prescription generic Flonase costs less—usually $12 to $17—the prescription versions could be a better deal than over-the-counter versions if you have a low co-pay, Davis says. Talk to your doctor and check your plan.

Allergy testing: $30 to $275

Once you’ve spent serious money on allergy medicine, you may want to know if you’re on the right track, Kao says. Are you sneezing because there’s pollen in the air, or because you have a cold, or because your cat is shedding his winter coat? With a simple skin test, an allergist can determine what, if anything, you are allergic to.

According to HealthSparq, a health costs transparency firm, an office visit with an allergist typically runs $200 to $300 before insurance. Those estimates are based on insurer-negotiated prices on claims filed in Oregon, Washington, Utah, and Idaho.

From there, the cost of the allergy tests can vary from $30 to $275, and even as high as $4,000, depending on the type and number of tests given, according to HealthSparq. Pro tip: 77% of large employers offer a price transparency tool, according to Mercer, so you can get your own individualized price estimate.

Immunotherapy: $15 to $20 a session

After you know what you’re allergic to, allergy shots are another treatment option. Here’s how it works: Your allergist uses a skin test to decide which allergens to put in your shots, which slowly expose you to your allergens to get your immune tolerance back up to normal, Kao explains.

Kao recommends shots for sufferers with moderate to severe allergies who either do not get enough relief from medications or who do not want to take medications any longer. “Statistically, [shots] help about 90% of well-selected people,” Kao says.

HealthSparq estimates that it typically costs $15 to $20 a visit before insurance kicks in, but could be as high as $170 a visit, depending on your course of treatment.

However, Kao says that in the long term, allergy shots pay for themselves. Think of the money you won’t be spending on over-the-counter medications, prescriptions, antibiotics for sinus infections, and doctor’s visits. “That’s all money saved,” Kao says.

EpiPens: $450 to $500 for a two-pack

Pollen means something else for people with bee sting allergies: It’s time to carry an EpiPen again. EpiPens—or epipnephrine auto-injectors—provide immediate relief to anyone suffering from anaphylaxis, a potentially fatal allergic reaction. The pen is inserted into the middle of the thigh while a patient awaits professional medical attention.

Unfortunately, the price of EpiPens have increased significantly in the past several years. Davis of GoodRX Blog estimates a two-pack could run about $450 to $500 before insurance.

Coupons can help. At EpiPen.com you can apply for discounted epinephrine pens. Many patients with private health insurance can get the EpiPen two-pack for free, and everyone else can get $100 off, says Davis.

Alternately, you can get a generic epinephrine pen for $250 to $300, but you’ll need to ask your doctor to write a prescription specifically for the generic, Davis says.

Update: This article was updated to indicate the correct use of an EpiPen.

MONEY Health Care

Why Young Millennials Are Turning Down Health Coverage at Work

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Getty Images—Getty Images I don't need health insurance, boss. I've got my mom's plan.

Thanks to Obamacare, they can probably get cheaper health insurance from mom and dad.

New college grads want a job, but they can take or leave the health insurance benefits that come with it. Less than half of all eligible employees under age 26 enrolled in an employer-provided health plan in 2015, according to a new report out today from the ADP Research Institute.

But don’t worry about the rest. Under the Affordable Care Act, young adults are allowed to stay on their parents’ health insurance plan until they turn 26. And that’s probably what many are doing, says Chris Ryan, vice president of strategic advisory services at ADP. “There are lot of people who do value health coverage very much, but they want to stay on their parents’ plan as long as possible,” Ryan says.

Why Young Workers Have More Options

The provision that lets young adults keep their parents’ health insurance until age 26 has been one of the most popular parts of Obamacare. It was also one of the first provisions to go into effect. Between September 2010 and December 2011, more than 3 million adults aged 19 to 25 got private health insurance largely thanks to the ACA, according to the Department of Health and Human Services.

A lot has changed since 2011. More millennials have entered the workforce, and a greater number have become eligible for health benefits. Today, 83% of employees under 26 are eligible for health insurance at work, up 8.5% from five years ago. Still, fewer millennials have actually enrolled in their employers’ plans. In 2011, almost 57% of young millennials who were eligible for employer-subsidized health coverage took it; this year, only 44% did.

One sign that many of these young adults are ditching their employer’s plans for their family’s plan: Once employees are too old to stay their parents’ plans, they’re much more likely to sign up for employer coverage. Three-quarters of eligible employees aged 26 to 39 enrolled in an employer health plan, the survey found.

Happily, after widespread concerns that young people would not sign up for health insurance, the vast majority are now covered one way or another. Nationally, 83.2% of Americans aged 18 to 25 now have health insurance, up from 76.5% in the last quarter of 2014, according to a recent Gallup poll. Today, there are 4.5 million more insured young adults who would not otherwise had coverage, according to the White House.

When Mom and Dad’s Plan Has the Edge

For millennials just starting out, however, health insurance premiums can still eat up a large part of their meager incomes. ADP found that employees earning $15,000 to $20,000 spent 9.5% of their annual income on premiums. Employees earning $45,000 to $50,000 devoted 5.8% of their income to premiums, while employees earning more than $120,000 spent just 2.3% of their income on premiums.

So even if young millennials have jobs with health benefits, the family plan is often the better deal. “Most millennials in their early 20s have entry-level salaries, so it’s attractive for our generation to get on a parent’s comprehensive plan for health and financial security,” writes Erin Hemlin, health care campaign director of Young Invincibles, a millennial research and advocacy group.

ADP found that individual premiums cost $486 a month, on average. But add two or more dependents to the plan, and premiums cost an average of $1,377 a month—which, split three or four ways, is less than an individual plan.

“There’s no question—it is usually cheaper for someone to be an additional dependent rather than pay for single coverage,” Ryan says. And then there are the tax benefits. “Because the premiums are on a pre-tax basis and parents are usually in a higher income bracket than their children, the parents are getting a better tax break, and the insurance overall is cheaper,” Ryan says.

Still, there are downsides to staying on a parent’s plan. If you don’t live near your parents, make sure you can find local doctors that are in your parents’ insurance network before you turn down health benefits at work. And consider if you want your bills and explanation of benefit statements mailed to your parents. Not sure what to do? Here’s more on how to decide— or shop for an individual plan on your own if you’re not getting coverage at work.

MONEY Taxes

These Are the People Who Are Most Likely to Get Audited

woman on balcony of modern house
Getty Images The uber-rich have the most to fear when it comes to tax audits.

As tax season draws to a close, you may be wondering if you're at risk. (Hint: Probably not.)

If Tax Day has you worrying about an IRS audit, you probably have little reason to be nervous. Last year, the IRS audited less than 1% of all taxpayers—and the federal agency is on track to audit even fewer people this year.

“The math is pretty simple. There are fewer audits because we have fewer auditors,” IRS commissioner John A. Koskinen told the New York State Bar Association in February. “The IRS lost more than 2,200 revenue agents since 2010. Last year alone, there were 600 fewer auditors, with the total falling to 11,600—the lowest level in more than a decade.”

Still, some Americans are subject to more scrutiny than others. The IRS doesn’t spell out why auditors single out some returns for special treatment, but a look at the agency’s track record provides some clues. Here are the groups that are more likely to get the government’s attention:

1. People who report more than $10 million in income—or none at all

It’s like the old saying about why the bank robber robbed the bank: “Because that’s where the money is.” With limited resources, the IRS takes a harder look at people with the most money (and the most to hide). In 2010, then-commissioner Doug Shulman told the New York State Bar Association targeting the rich was part of a new strategy to “work smarter.”

“This is a game-changing strategy for the IRS,” Shulman said. “Initially, we will be focusing on individuals with tens of millions of dollars of assets or income. Going forward, we will take a unified look at the entire complex web of business entities controlled by a high wealth individual, which will enable us to better assess the risk such arrangements pose to tax compliance.”

In 2014, the IRS audited more than 16% of returns reporting more than $10 million in income. But, as you can see in the table below, single-digit millionaires should take care with their tax returns as well.

Another group with a high-than-average chance of getting audited? People who report no income. If you’re reporting an operating loss on your business, the IRS might double check that you’re being honest. In 2014, the IRS audited 5.3% of the taxpayers who reported no income.

Otherwise, if you—like the majority of American taxpayers—earn between $25,000 and $200,000, you have a better-than-average shot of dodging an IRS audit. Here’s the breakdown:

Returns by Income

Percent of total returns

Percent audited in 2014

All returns 100% 0.86%
No adjusted gross income 1.83% 5.26%
$1 – $24,999 39.08% 0.93%
$25,000 – $49,999 23.32% 0.54%
$50,000 – $74,999 13.12% 0.53%
$75,000 – $99,999 8.33% 0.52%
$100,000 – $199,999 10.70% 0.65%
$200,000 – $499,999 2.87% 1.75%
$500,000 – $1 million 0.48% 3.62%
$1 million – $5 million 0.24% 6.21%
$5 million – $10 million 0.02% 10.53%
Over $10 million 0.01% 16.22%

Source: Internal Revenue Service Data Book, 2014

2. People who file estate tax returns for assets worth more than $5 million

Likewise, a huge estate tax return could raise some eyebrows at the IRS. Overall, 8.5% of estate tax returns were singled out for special scrutiny in 2014, way more than the 0.9% of individual tax returns.

And the bigger the estate, the more likely the IRS flagged the return for an audit. More than 21% of estate tax returns with assets between $5 million and $10 million were audited in 2014, and 27% of returns with assets worth over $10 million were audited.

However, estate tax returns are pretty rare: The IRS received 33,719 in 2013, and only 3,359 of those were for estates worth $10 million or more.

3. People who file international returns

If you’re mailing your return from the Cayman Islands, you can bet that the IRS is onto you. Over the past several years, the IRS has increased scrutiny of international returns.

“On the individual front, we have made putting a big dent in offshore tax evasion a major priority,” Shulman told the American Institute of Certified Public Accountants in 2012. “We view offshore tax evasion as an issue of fundamental fairness. Wealthy people who unlawfully hide their money offshore aren’t paying the taxes they owe, while schoolteachers, firefighters and other ordinary citizens who play by the rules are forced to pick up the slack and foot the bill.”

In 2014, the IRS audited 4.8% of international returns.

But there’s a cost to fewer audits

Law-abiding citizens have little reason to celebrate the limited number of tax audits. Koskinen expects that, thanks to federal budget cuts, the IRS will lose out on at least $2 billion in revenue that auditors would otherwise be able to collect. Plus, sometimes when the government takes a second look at your return, you get more money back: In 2014, the IRS decided 38,029 individual filers had paid too much in taxes and sent them additional refunds.

Related:

MONEY College

The 25 Best Colleges for Earning a Degree in Business

University of California Berkeley
Melanie Stetson Freeman—AP University of California Berkeley

The surprising public colleges that beat out many pricey private schools.

Anyone with a mind for business has the same question about college: What’s the return on my investment? If I’m going to take on some $28,400 in student debt, will that stake pay off in a lifetime of higher earnings?

Economists generally agree that a college degree pays off, but new research from PayScale has even better news for students planning on majoring in business: You don’t have to go to a pricey private school to reap the biggest return. In fact, you’re often better off at a state school.

PayScale calculates the expected “return”for colleges all around the country—how much more graduates earn over 20 years compared to high school grads, minus the total cost of school (everything from tuition to books) and the four years of income you give up while you’re studying.

The best return on investment for business majors? An education at the University of California-Berkeley (which overall ranks as the 13th best college value in MONEY’s Best Colleges list). Apparently the road to business success is lined with Birkenstocks.

The total in-state tuition and expenses is over $34,000, and the average borrower leaves Berkeley with $23,360 in loans. But that pays off with a median $1,133,100 return on investment over 20 years.

Precocious young investors might see those numbers a different way: That’s a 12.2% annualized ROI. Good luck finding that kind of return in the stock market.

And nine more public schools make the top 25 list: University of Virginia, University of North Carolina, Rutgers, University of Washington, UCLA, SUNY at Binghamton, Georgia Institute of Technology, University of California-San Diego, and Cal Poly.

Why do public institutions fare so well? “It’s likely a combo of lower tuition costs and location,” Lydia Frank of PayScale writes in an email. “You’ll notice that many of the public schools that rank well on that list are located in places like California where salaries tend to be higher. If alumni are sticking around after graduation, they’re going to fare better than students who went to public school somewhere in the Midwest and ended up working there.”

School 20-year net return on investment Total 2014-2015 tuition and expenses (on campus; in-state rates)
1. University of California-Berkeley $1,133,100 $34,356
2. University of Pennsylvania $1,039,000 $64,200
3. Babson College $762,800 $62,440
4. Santa Clara University $756,200 $61,638
5. University of Virginia $745,100 $27,010
6. Cornell University $730,000 $63,606
7. New York University $693,700 $66,022
8. University of North Carolina at Chapel Hill $664,300 $25,650
9. Rutgers University-New Brunswick $655,400 $29,933
10. Lehigh University $653,800 $58,835
11. Villanova University $650,100 $60,694
12. University of Washington-Main Campus $643,800 $26,698
13. University of California-Los Angeles $637,500 $32,978
14. SUNY at Binghamton $636,900 $23,648
15. Georgia Institute of Technology $636,300 $24,748
16. University of California-San Diego $635,000 $31,254
17. Loyola University Maryland $620,200 $59,925
18. California Polytechnic State University-San Luis Obispo $619,800 $24,683
19. Saint Mary’s College of California $611,000 $59,327
20. George Washington University $609,800 $63,210
21. Brigham Young University $605,700 $12,150
22. Washington University in St. Louis $605,000 $66,376
23. University of Notre Dame $596,600 $62,461
24. American University $595,100 $59,120
25. Hofstra University $589,200 $56,046

Of course, part of the reason those nine public schools offer such a high return on investment is because your upfront cost is much smaller when you pay in-state tuition. But even when you consider the cost for out-of-staters, public institutions top the list. Case in point: You’re still best off going to Berkeley, even if you have to pay more than $57,000 a year in out-of-state tuition.

School 20-year net return on investment Total 2014-2015 tuition and expenses (on campus; out-of-state rates)
1. University of California-Berkeley $1,041,600 $57,234
2. University of Pennsylvania $1,039,000 $64,200
3. Babson College $762,800 $62,440
4. Santa Clara University $756,200 $61,638
5. Cornell University $730,000 $63,606
6. New York University $693,700 $66,022
7. Lehigh University $653,800 $58,835
8. Villanova University $650,100 $60,694
9. University of Virginia $643,700 $56,196
10. Loyola University Maryland $620,200 $59,925
11. Saint Mary’s College of California $611,000 $59,327
12. George Washington University $609,800 $63,210
13. Brigham Young University $605,700 $12,150
14. Washington University in St. Louis $605,000 $66,376
15. Rutgers University-New Brunswick $603,900 $44,711
16. SUNY at Binghamton $600,900 $35,288
17. University of Notre Dame $596,600 $62,461
18. American University $595,100 $59,120
19. Hofstra University $589,200 $56,046
20. Boston College $588,900 $63,022
21. Wentworth Institute of Technology $583,600 $49,855
22. University of North Carolina at Chapel Hill $583,300 $50,732
23. California Polytechnic State University-San Luis Obispo $574,600 $35,843
24. Wittenberg University $573,800 $50,562
25. University of Washington-Main Campus $572,600 $47,817

Notes: Cost of tuition, fees, room and board, books, and supplies; does not include the salaries of college graduates who went on to get more advanced degrees; schools excluded if PayScale does not have statistically significant samples of earnings data.

MONEY identity theft

8 Ways You Didn’t Know Hackers Could Steal Your Identity

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Getty Images

Who knew?

There are a surprising number of ways that criminals can use your personal information to commit fraud. Here are some of the weirdest:

1) They can steal your frequent flyer miles.

Whenever your credentials are valuable, thieves want them—even your frequent flyer credentials. In December, some 10,000 American Airlines and United accounts were hacked, and in at least two cases, cybercriminals actually booked free flights and upgrades using stolen perks, the Associated Press reported. The hackers had somehow gotten access to victims’ login credentials. Happily, folks got their miles back, but this is just one good reason to change your passwords regularly and monitor your accounts.

2) They can steal your health insurance.

In a world of astronomical medical costs, insurance is very valuable. So it’s no surprise that medical identity theft is on the rise. How it works: Identity thieves obtain medical services using your benefits, saddling you with their health records. It can take a lot of time and money to set things straight. You might not notice a problem until you get an Explanation of Benefits statement for services you didn’t receive, so it’s a good idea to actually read your insurance paperwork.

3) They can commit crimes in your name.

Here’s a worst-case scenario: You get pulled over as part of a routine traffic stop, and you learn that there’s a warrant out for your arrest for a crime you didn’t commit. It can happen, if someone commits a crime and gives your name to the cops. Of course it’s rare—but here’s what the Privacy Rights Clearinghouse says you should do if it happens to you.

4) They can hack your company’s chat system.

Has your boss told you to download HipChat or Slack for interoffice correspondence? Both have been hacked in the past two months. In February, HipChat reported that hackers made off with “names, usernames, email addresses, and encrypted passwords for a very small percentage (<2%) of our users.” Similarly, Slack recently discovered that hackers broke into a database that stores usernames, email addresses, phone numbers, and Skype IDs for Slack users, and the messaging service notified a small group of people of other “suspicious activity.” All you can do? Change your passwords frequently and set up two-factor authentication if available.

5) They can take over your social media accounts and impersonate you.

You’ve probably received a message from a friend that goes something like this: “I’m on vacation abroad, I lost my wallet, and now I can’t get home. Will you wire me some money right away?” That’s a scam called “social engineering.” Identity thieves will hack your account, send messages to your friends, and try to ride on your reputation to trick people into sending you money. These scammers commonly use email and sometimes Facebook. To protect yourself, hone your BS radar—would your second cousin really ask you to wire money to Amsterdam without calling first?

6) They can steal your tax refund.

You need to file your taxes by April 15, but the IRS won’t check your return against your employer’s until July. That gives fraudsters a critical time window. With your Social Security number and name, an identity thief can file a fake tax return and collect the refund. You won’t notice until your real return is rejected. Prevent this theft by filing early and trying these other tricks.

7) They can hold all of your computer files for ransom.

In perhaps the scariest online scam of our age, cybercriminals will use a “ransomware” virus to encrypt all of your computer files, then refuse to decrypt the files until you wire them thousands of dollars. (Yes, this happened on “The Good Wife.”) The worst part? Right now, there’s little you can do except pay, writes Alina Simone in the New York Times. Instead, prevention is key: Keep your security up to date, back up your files, and beware of suspicious links and attachments in emails.

8) They can open credit card accounts in your name.

When most people talk about identity theft, this is what they’re really afraid of—not that someone will steal their credit card number, or their banking login, or the password to their email—but that someone will steal their Social Security number and start opening new accounts all over the place. If that happens, criminals can run up debt in your name, and you might not notice until your credit score tanks. So guard your Social Security number and check your free credit report three times a year for accounts you don’t recognize.

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