MONEY Health Care

5 Things to Know About Vaccines

It's not too late to get your flu shot -- peak flu season has yet to arrive. Illustration: Gillian Blease

With reports that the flu season has started early this year—and that it could be worse than last year—it pays to get vaccinated.

Here are five reasons why you should consider getting the flu shot and other vaccines.

1. You may need more than you think

About 40% of us are inoculated against the flu each year. But you may not realize you also need periodic boosters for whooping cough and tetanus, among others.

According to the Centers for Disease Control, just 8% of adults were inoculated against whooping cough between 2005 and 2010.

Meanwhile, the U.S. is in the midst of the worst whooping cough epidemic in 50 years, sickening nearly 30,000 so far.

Not sure what you need? See the guidelines from the Centers for Disease Control and Prevention.

2. Missing shots can impose a high cost

Contracting a major illness like pneumonia or whooping cough puts you at risk for an expensive hospital stay. Yet even a bout of the flu can be costly in terms of co-payments for doctor visits, prescription medications, and lost workdays.

A recent study by the National Business Group on Health found that healthy immunized adults had up to 44% fewer doctor visits and missed 18% to 45% fewer workdays during flu season vs. those who skipped the shots.

3. For most, vaccines are cheap

Thanks to health reform, you probably won’t be charged for a vaccine at your doctor’s office. (Some insurance plans are excepted from this rule, and you may still have to pay for the office visit.)

For seniors, Medicare covers vaccines for the flu, pneumonia, and hepatitis B for free, but other vaccines can still be pricey. The shingles vaccine, for example, runs an average of $57 in copayments, though some seniors pay well over $100.

4. A doctor’s visit isn’t necessary

Many who get their vaccines cite convenience as a reason, says Carolyn Bridges, associate director for adult immunization at the CDC.

You probably don’t need to go out of your way. Many large companies offer free onsite flu shots (ask your HR department).

You can also get most common vaccines at major pharmacies and retailers such as Wal-Mart. Your in surer may reimburse you for the cost (about $30 for the flu and $50 to $100 for other vaccines).

5. There’s no excuse for skipping the flu shot

If shots make you faint, you may better tolerate the new intradermal, which uses a needle that’s 90% smaller than a regular one (if you have to pay for the shot, it’s pricier). Many adults can also get a flu vaccine via nasal spray.

Related: Check out of the Hospital and Stay out

Moreover, even if you’ve dragged your feet, you’re definitely not too late: “January to March is usually peak flu season,” says Gregory Poland, director of the Mayo Clinic Vaccine Research Group.

MONEY Health Care

Employees: 5 Things to Know About Open Enrollment

This year many employers are offering more options for family health insurance coverage. Illustration: Gillian Blease

Open enrollment season is upon us. This year, employees can expect clearer coverage choices and more health plan options. But some things will get smaller, like your flexible spending account. Here are five things you need to know.

1. Comparing health plans just got easier

This year’s info packet will include simple, consistent summaries of coverage and costs, as required under the 2010 health reform law. They will allow you to do an apples-to-apples evaluation of any plan your company offers, as well as a spouse’s plan or an individual policy, to see which one is best for your family, says Michael Thompson, a principal at PwC. You’ll also see examples of typical costs for two common scenarios: having a baby and managing Type 2 diabetes.

2. Expect more options for family coverage

Besides the basic choice between individual or full family coverage, many employers will be offering gradations in between, such as “employee plus spouse” and “employee plus children,” says Tracy Watts of Mercer. You’ll pay more to cover dependents — companies might pick up 32% of an individual premium but only 25% if you add family members — so make sure your spouse and kids don’t have cheaper options before you put them on your plan.

3. Networks are shrinking. Your costs could too.

Expect to see smaller provider networks, sometimes designated “preferred” based on cost and quality measures. If your doctors participate, it may be a good deal, cutting co-pays by $5 to $15 or your co-insurance share from, perhaps, 20% to 10% of the total bill, Thompson says. But go out of network and you may be charged up to a third more than the network rate.

4. FSA allowances are getting smaller …

The maximum you can set aside in a flexible spending account to cover health care costs with pretax dollars shrinks to $2,500 for 2013, down from the common limit of $5,000 now. The change won’t affect the typical FSA account holder, who deposits $1,700 a year, says Watts. But if you were counting on a bigger FSA to help with hefty bills you’re likely to incur — maybe you want Lasik surgery or the kids need braces — time to rethink that plan.

5. … But coverage for women is better

The health law spelled out several preventive health benefits for women that most plans must provide free next year. Among them: contraceptive services, annual well-woman visits, and screening for gestational diabetes as well as HIV. When you schedule an appointment, make it clear that the services are for preventive, not diagnostic, care, says Julie Stone of Towers Watson, to ensure that benefits are paid at 100%.

MONEY Health Care

Who Is Your Biggest Health Care Advocate?

To find the right kind of health-care provider, you have to think outside of the medicine bag. Photo: Joshua Scott

Got a tricky or specialized health care situation? To find the right kind of provider, you have to think outside the bag and seek out a new kind of pro.

Your primary-care doctor can be a gatekeeper for all sorts of specialized care, but there are some things he can’t do. Maybe you’re dealing with a non-medical issue such as billing, for example, or making a care plan for a loved one.

“In our fragmented health care system, doctors don’t speak to each other,” says Byron Cordes, president of the National Association of Professional Geriatric Care Managers.

Here are four times to try a different kind of provider:

For billing or treatment problems

Who: Health care advocate

Why use one: Up to 80% of medical bills contain costly errors; an advocate can help you sort out the mess. Struggling to make a decision about care for an ongoing issue? An advocate can also help you get a second opinion and figure out the best treatment plan.

Where to find one: You can find local advocates via companies like Best Doctors or HealthCare Advocates, which contract with large companies that offer this service as a perk.

Besides several years’ experience, you want to have an advocate who works as part of a team, to fill in any gaps in his knowledge, says Joanna Smith, founder of the National Association of Healthcare Advocacy Consultants. The advocate should also be willing to sign a service agreement detailing the nature of the work he’ll perform and what he’ll be paid.

Typical cost: Depends on the work involved; $125 to $500 is typical.

Insurance coverage? No

For end-of-life care and serious conditions

Who: Palliative-care workers

Why use them: People commonly use these specially trained hospital-based teams (often a doctor, nurse, social worker, and chaplain) to help manage loved ones’ end-of-life care. But palliative-care workers can also assist patients and their families outside the hospital in coping with severe, chronic illnesses.

They might help a cancer patient weigh the pluses and minuses of undergoing another round of chemo, for example, or work with an HIV patient to reduce nausea and pain.

Studies show that patients who receive early palliative care sometimes live longer and have a better quality of life than those who don’t, and their health care costs are often lower.

Where to find one: Most large hospitals and some nursing homes offer palliative-care services; Go to www.getpalliativecare.org/providers to find one in your area.

Typical cost: Depends on insurance.

Insurance coverage? Yes

For elder-care issues

Who: Geriatric-care manager

Why use one: These pros, usually nurses or social workers, do anything from researching assisted-living facilities to getting meds delivered to providing referrals to elder-law attorneys.

“We find the chinks in seniors’ armor and make recommendations to fix them,” says Cordes. Getting the right medical care and other support upfront means Mom is less likely to undergo a scary, expensive hospital stay.

Where to find one: Find local help via the National Association of Professional Geriatric Care Managers. You want someone who is knowledgeable in the area you need — a nurse is best for medication management, for example — and has a minimum of two years’ experience.

Typical cost: $100 to $150 an hour.

Insurance coverage? Some long-term-care policies will cover the cost.

When fighting mild ailments

Who: Your company doctor

Why use one: Boss not happy about your taking half a day off work to get a prescription for pinkeye?

Nearly half of large firms offer on-site health clinics staffed by MDs and registered nurses. While they usually handle mild issues like fever or flu, they also increasingly are providing primary-care and wellness services, from physicals to diabetes management.

Some clinics even welcome employees’ children and spouses, as well as retirees, says Bruce Hochstadt, a health and benefits consultant at Mercer.

Where to find one: In your building. Some small firms may have clinics at central locations. Check with your HR department to see what’s available.

Typical cost: Free or reduced co-pay.

Insurance coverage? Sometimes.

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