MONEY Health Care

Why Your New Health Plan Might Not Cover Hospital Stays

Person in hospital bed
Companies that haven't offered health coverage before are the most likely candidates to roll out hospital-free plans now. Blend Images—Alamy

A debate is growing over whether an Obamacare calculator really lets some employers offer health insurance without hospital coverage. Is this a software glitch, or a giant loophole in the law?

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.

“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”

Timothy Jost is pretty sure the whole thing was a mistake.

“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.

At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits.

The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a calculator-certified plan shields employers from penalties of up to $3,120 per worker next year.

Many insurance professionals were surprised to learn from a recent Kaiser Health News story that the calculator approves plans lacking hospital benefits and that numerous large, low-wage employers are considering them.

Although insurance sold to individuals and small businesses through the health law’s marketplaces is required to include expensive hospital benefits, plans from large, self-insured employers are not.

Many policy experts, however, believed it would be impossible for coverage without hospitalization to pass the minimum-value standard, which requires insurance to pay for at least 60% of the expected costs of a typical plan.

And because calculator-approved coverage at work bars people from buying subsidized policies in the marketplaces that do offer hospital benefits, consumer advocates see such plans as doubly flawed.

Kaiser Health News asked the Obama administration multiple times to respond to criticism that the calculator is inaccurate, but no one would comment.

Calculator-tested plans lacking hospital benefits can cost half the price of similar coverage that includes them.

While they don’t include inpatient care, the plans offer rich coverage of doctor visits, drugs and even emergency-room treatment with low out-of-pocket costs.

Who will offer such insurance? Large, well-paying employers that have traditionally covered hospitalization are likely to keep doing so, said industry representatives.

“My members all had high-quality plans before the ACA came into existence, and they have these plans for a reason, which is recruitment and retention,” said Gretchen Young, a senior vice president at the ERISA Industry Committee, which represents very large employers such as those in the Fortune 200. “And you’re not going to get very far with employees if you don’t cover hospitalization.”

But companies that haven’t offered substantial medical coverage in the past — and that will be penalized next year for the first time if they don’t meet health-law standards — are very interested, benefits advisors say.

They include retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay. Temporary staffing agencies are especially keen on calculator-tested plans with no hospital coverage.

“We’ve got many dozens of staffing-firm clients,” said Alden Bianchi, a benefits lawyer with Mintz Levin in Boston. “All of them are using these things.”

Advisors and brokers declined to identify employers sponsoring the plans, citing client confidentiality.

Benefits administrators offering the insurance say it makes sense not only for employers trying to comply with the law at low cost but for workers who typically have had little if any job-based health insurance.

“This is a stepping-stone to bring in employers who have never [offered] coverage and now they’re willing to come forward and do something,” said Bruce Flunker, president of Wisconsin-based EBSO, a benefits firm.

The plans are an upgrade for many workers at retailers, staffing agencies and similar companies, he said.

“OK, if I go to the hospital I don’t have coverage,” he said. “But I don’t have [hospital] coverage now. And what I get is a doctor. I can go to a specialist. I get a script filled at the pharmacy. I get real-life coverage.”

Companies considering such plans include a restaurant chain with 1,000 workers, a trucking firm with 500 employees and dependents, a delicatessen, a fur farm and firms working the oil boom in upper Midwest, Flunker said.

Employer interest in the plans “is definitely picking up pretty quickly,” said Kevin Schlotman, director of benefits at Benovation, an Ohio firm that designs and administers health coverage. “These are organizations that are facing a significant increase in expenses. They’re trying to do their best.”

Because hospital admissions are rare, plans paying for routine care are more valuable to low-wage workers than coverage of expensive surgery and other inpatient costs, say consultants offering them.

Such plans come with deductibles as low as zero for doctor visits and prescriptions and co-pays of only a few dollars, they say. Emergency-room visits cost members in the $250 or $400 range, depending on the plan.

By contrast, health-law-approved insurance with inpatient benefits often includes deductibles — what members pay for all kinds of care before the insurance kicks in — of $6,000 or more.

Generous coverage of routine care is “what these people want,” said Shnider. “They want to be able to go to the doctor. Take care of their kids, go to the emergency room.”

In some cases, employers sponsoring calculator-approved plans without hospital coverage also offer “fixed indemnity” coverage that does pay some hospital reimbursement, advisors say. But the benefits are typically a small fraction of hospital costs, leaving members with the likelihood of large bills if they are admitted.

Concerned for their reputations, larger administrators are wary of managing benefits without hospitalization, even if they do pass the calculator.

“Our self-funded customers hand out insurance cards to their employees with Blue Cross all over it,” said Michael Bertaut, health care economist at BlueCross BlueShield of Louisiana, which has no plans to handle such coverage. “Do we really want someone to present that card at a hospital and get turned away?”

There are two health-law coverage standards that large employers must meet to avoid paying a penalty.

One, for “minimum essential coverage,” merely requires some kind of employer medical plan, no matter how thin, with a potential penalty next year of up to $2,080 per worker. Many low-wage employers are meeting that target with “skinny” plans that cover preventive care and not much else, say brokers and consultants.

The calculator tests the health law’s second, more exacting standard — to offer a “minimum value” plan at affordable cost to workers. Failure to do so triggers the second penalty, of up to $3,120 per worker.

The argument over the calculator is whether plans carving out such a large chunk of benefits — hospitalization — can mathematically cover 60% of expected costs of a standard plan.

They probably can’t, Jost said. The fact that the calculator gives similar, passing scores to plans with hospital benefits and plans costing half as much without hospital benefits suggests that it’s flawed, he said. Plans with similar scores should have similar costs, he said.

On the other hand, others ask, why did the administration make a calculator that allows designers to leave out inpatient coverage? Why didn’t the law and regulations require hospital coverage for self-insured employers — as they do for commercial plans sold through online marketplaces?

“The law and calculator were purposely designed as they are!” Fred Hunt, past president of the Society of Professional Benefit Administrators, said in an email widely circulated among insurance pros. “No ‘glitch’ or unintended loophole.”

“That’s baloney,” said Robert Laszewski, a consultant to large insurers and a critic of the health law. “Nobody said we’re going to have health plans out there that don’t cover hospitalization. That was never the intention… I think they just screwed up.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

Why Your Drug Store Is Teaming Up With Your Doctor

CVS Pharmacy Minute Clinic, Mount Laural, New Jersey.
CVS Health is beefing up its ties with doctors and hospitals. John Greim—LightRocket via Getty Images

As pharmacy chains look to play a bigger role in health care—not to mention get more customers in the door—they are cutting deals to share electronic medical records with hospitals and MDs. What's in it for you?

Neglected to pick up your prescription? Now, there’s a good chance your doctor will know and do something about it, thanks to a slew of new partnerships between CVS Health and various health systems.

One of the most recent, which is slated to begin by early next year, will integrate the electronic medical records from MedStar Health’s 10 hospitals and 4,000 doctors—located in Washington, D.C. and Maryland—with CVS pharmacies as well as the chain’s 900 Minute Clinics located across the country.

It makes coordination easier, said Bob Gilbert, MedStar’s president of ambulatory services. When someone gets care at a pharmacy or retail clinic, it will be entered in the patient’s MedStar records for the doctor to see. If a MedStar patient receives CVS service in another state, practitioners there will still be able to see the patient’s records.

Counting the MedStar partnership, CVS now has 41 such health-system agreements in place, with the last nine encompassing the retailers’ pharmacies. CVS hopes the other existing arrangements—which linked the systems with the Minute Clinics—will follow this course.

The move underscores a larger push by retail pharmacies to expand their role in the health care market. CVS has the most physician partnerships, but competitor Walgreens is also associated with 20 health systems and has joined accountable care organizations—the care-giving coalitions created by the health law to control costs. Even stores like Wal-Mart and grocery companies such as Safeway, which features some in-store pharmacies, are looking to bolster ties with clinics and hospitals.

“There aren’t enough primary care physicians to treat enough chronic and routine care that patients need. Ergo, the market is responding,” said Christopher Kerns, managing director for research and insights at the Advisory Board Company, a health care consulting firm.

CVS—which itself operates more than 7,600 pharmacies with more than 800 clinics—now has relationships with between 300 and 350 hospitals in addition to clinics and physician groups, according to spokeswoman Christine Cramer, adding that the exact number is hard to quantify. These collaborations extend over 24 states plus the District of Columbia.

The agreements do not have any explicit financial element. “It’s purely a clinical collaboration,” said MedStar spokeswoman Ann Nichols.

But health system partnerships can still benefit a pharmacy company like CVS.

“When it comes to chronically ill patients, there’s now incentive [for physicians] to refer them to CVS” for day-to-day disease management, Kerns said. That can give a company a new stream of customers and drive up pharmacy sales and in-store foot traffic.

How Hospitals Win

Entering such partnerships can make sense for a hospital system, too. For instance, if different providers communicate well, they help reduce how often the chronically ill need to go to the hospital.

“It’s a way of being able to provide more care to more people, more conveniently and ideally at a lower cost,” Kearns added.

By reducing admissions and readmissions, for instance, hospitals can address one of their major budget challenges. In addition to paying for patient care itself – which can be costly if those patients have lower incomes and are uninsured – hospitals with high readmission rates can face financial penalties from the government through reductions in Medicare payments—as much as 3% of each Medicare payment per patient for an entire year starting in October. Across all penalized hospitals in the country, those reductions are expected to total around $330 million annually.

Retail clinics say they offer routine health services in a cheaper and more convenient setting than doctors’ offices, urgent care or emergency facilities. In ads, CVS boasts that the clinics are open seven days a week, with nurse practitioners giving physicals, vaccines, strep tests and other basic services. Most services cost less than $100. Clinics are often separated from pharmacies by a privacy screen.

“It really goes back to today’s health care consumers looking for care when they want it,” Gilbert said.

Much of the arrangement might remain invisible for a MedStar patient, said Patrick Gilligan, CVS’ senior vice president for system alliances.

But even if patients don’t see it directly, a stronger network between physicians, pharmacists and retail clinics is valuable, said Christine Alexander, 66, a MedStar patient who frequently gets basic health services and medication from her local Minute Clinic and CVS in Washington, D.C.

About 10 years ago, she said, health problems meant she had to take multiple kinds of medication, but “there wasn’t good communication, and I ended up taking way too many drugs that were interacting with each other.”

For patients with chronic conditions, “long term adherence is a big issue,” Gilligan.

But with this type of arrangement, pharmacists and nurse practitioners can more easily share information with doctors, providers can work in concert to encourage patients to stay on medication, Gilligan added. “You tend to have a lot higher compliance rate,” Gilbert said.

In addition, because pharmacists see a patient’s entire drug regimen, they often notice the potential for drug interactions and other risks. When records are integrated, that information can more easily be transmitted to doctors, too.

“A lack of adherence and a problem of mixing the wrong medications is one of the leading causes of adverse events—it’s one of the leading causes of readmissions,” Kerns said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME politics

Lawmakers Push Increased Access to Emergency Contraception

Bipartisan U.S. Budget Deal Said to Ease Automatic Spending Cuts
Sen. Patty Murray (D-Wash.), who introduced a bill to increase access to emergency contraception. Bloomberg—Bloomberg via Getty Images

Bill comes ahead of a midterm elections in which women are expected to be a key voting bloc

Updated: September 23, 4:40 p.m. ET

Five Democratic senators introduced legislation Tuesday that would require any federally-funded hospital to provide emergency contraception to rape survivors.

The Emergency Contraception Access and Education Act of 2014 was introduced by Sen. Patty Murray (D-Wash.), with Sens. Elizabeth Warren (D-Mass.), Barbara Boxer (D-Calif.), Richard Blumenthal (D-Conn.) and Cory Booker (D-N.J.) signing on as co-sponsors. The bill would ensure that any hospital receiving Medicare or Medicaid funds provides accurate information and timely access to emergency contraception for survivors of sexual assault, regardless of whether or not they can pay for it. It would also require the Secretary of Health and Human Services to disseminate information on emergency contraception to pharmacists and health care providers.

“As we saw in the aftermath of the Hobby Lobby decision, and as we’ve seen in state legislatures across the country, Republicans are intent on standing in the way of women and their ability to make their own decisions about their own bodies and their own health care,” Senator Murray told TIME. “This means, now more than ever, it is our job to protect these kinds of decisions for women, their families, and particularly for survivors of sexual assault. Emergency contraception is a critical part of these family planning choices and it’s time Republicans join us in supporting this safe and responsible means of preventing unintended pregnancies.”

“It is unacceptable that a survivor of rape or incest can be denied access to emergency contraception in the emergency room, and therefore forced to carry a pregnancy caused by her attacker,” Planned Parenthood president Cecile Richards said in a statement. “Decisions about emergency contraception, like all forms of birth control, should be between a woman and her doctor, not her pharmacist, her boss, or her Congressman.”

The bill may face opposition from congressional Republicans, and comes just two months before the midterm elections, in which many expect women to be a decisive voting bloc.

TIME Health Care

Obamacare Enrollment Tops 7 Million

Obamacare Expedited Bid Process Limited Who Could Build Website
Andrew Harrer—Bloomberg/Getty Images

Latest data from an enrollment period that exceeded expectations despite a hobbled start

About 7.3 million Americans have completed enrollment in health insurance plans through the health care reform law’s insurance exchanges, a top Obama Administration health official said Thursday.

Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services, provided the latest Obamacare enrollment figures to Congress. Tavenner said the figure includes those who had paid their premiums by Aug. 15 and that the number is subject to change slightly as consumers move in and out of coverage.

“We are encouraged by the numbers of consumers who have paid their premiums and continue to enroll in the marketplace coverage every day through special enrollment periods,” Tavenner said.

The Obama Administration said in March that the insurance exchanges had signed up a little more than eight million people, but the federal government did not release data at the time on the percentage of enrollees who completed enrollment by paying premiums. Despite the downtick in the final number, it still reflects an enrollment process that exceeded expectations following the disastrous launch of the website last year.

The latest figures also don’t include millions who have gained health insurance from the Affordable Care Act’s expansion of Medicaid.

TIME Health Care

Survey: Number of Americans Without Health Insurance Falls

Health Insurance Doctor Patient
Getty Images

Federal survey found an 8% decline in uninsured Americans over the year to April 2014

The number of uninsured Americans dropped in the wake of the Affordable Care Act, according to the first government survey conducted since the law’s major insurance expansion programs went into effect.

In the National Health Interview Survey, a widely respected measure of the rate of insurance nationwide, researchers from the Centers for Disease Control and Prevention interviewed 27,000 people in the first quarter of 2014, and found that the number of Americans without health coverage had fallen by 8% since the same period in 2013. That was a decline of 3.8 million, resulting in a new total of 41 million uninsured.

Before the health law was implemented, many predicted it would bring new health coverage to millions more than that, but the CDC survey did not capture the surge of insurance sign ups in the final days of the first ACA open enrollment period, experts said.

Larry Levitt, a director at the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, told the New York Times, “Regardless of what you think of the [Affordable Care Act], there should be no doubt at this point that the law is increasing the number of people insured.” He added that this survey’s findings “dramatically understate the effect” of the law.


TIME Health Care

The Global Problem With Overdiagnosis and Overtreatment

Equipment in a doctors office
Getty Images

Two new studies make a case against too much medicine

It’s a public health conundrum: Current screening guidelines lead to an overdiagnosis of diseases like cancer, which results in overtreatment for ailments that might never seriously impact a person’s health.

We’ve heard the overdiagnosis argument in the U.S. before, especially surrounding breast cancer; in 2009, the United States Preventive Services Task Force recommended against annual breast cancer screening starting at age 40 and instead advised women get mammograms starting at age 50.

Now, two new studies published Monday in the medical journal The BMJ highlight the global problem with overtreatment in both breast cancer and heart disease.

In a new analysis report, a team of researchers conclude that hypertension is being overtreated in people with mild cases of the disease. The researchers write that about 40% of adults worldwide have hypertension, and more than half of those people have mild cases of the disease (meaning they’re low risk and don’t have existing cardiovascular disease). But more than half of people with mild hypertension are being treated with blood pressure-lowering drugs–even though the research on whether this reduces cardiovascular-related disease and death is not established. The researchers argue that the practice is unnecessary and costs $32 billion each year in the U.S. alone.

Instead of recommending lifestyle modifications proven to work, like cutting back on alcohol and exercising more, many doctors opt for drugs because they want to do something right away without having to rely on the often-unhealthy environment beyond their office walls, says study author Vikas Saini, president of the Lown Institute. “[Doctors] need the confidence that we have systems in place that encourage a healthy lifestyle,” he says.

“Most doctors feel a little under siege; they see blood pressure rising and weight going up and they want to do something, but they know they have huge headwinds,” says Saini. “Prescribing a pill is the path of least resistance, but it’s a lot of money.” According to the researchers, the clinical treatment for mild hypertension needs to shift away from a heavy emphasis on drugs.

The second study adds to a growing body of research that supports later initiation into breast cancer screenings. The study authors argue that screening older women over age 70 for breast cancer doesn’t offer enough benefit to be worth it.

In 1998, the upper age limit for breast cancer screening in the Netherlands was extended from age 69 to age 75. The researchers wanted to see if the change actually resulted in fewer late-stage cancers among 70 to 75 year olds, so they looked at about 25,500 new breast cancer patients in a Dutch cancer registry between 1995 to 2011. What they found was that early-stage breast cancer in women 70 to 75 rose sharply after the screening recommendations changed, and while the number of new cases of advanced-stage breast cancer fell significantly, the absolute decrease of those cases was small. For every advanced-stage cancer detected by screening among women over age 70, about 20 “extra” cases were also diagnosed, the researchers concluded.

“Those numbers need to be told to women,” says study author Gerrit Jan Liefers, a surgical oncologist at Leiden University Medical Centre. “We are not voting against screening, but you should individualize your screening to women. To use it as a population-wide tool is wrong. You end up screening women who would never be affected by the cancer.”

The message both studies send to doctors is that physicians need to consider each patient individually and inform men and women of their options.

The two studies are part of the 2014 Preventing Overdiagnosis Conference in Oxford. The BMJ has also launched a “Too Much Medicine” campaign you can follow here.

MONEY Health Care

4 Ways to Cope With the High Cost of Caregiving

Kirby Hamilton—2012

It's not just time and hard work. Nearly half of unpaid caregivers spend more than $5,000 a year on medical expenses and more, a new study finds. Here's how to make sure you're prepared to help.

Providing care for a loved one is a job that many Americans will one day take on. But the steep cost of this help may take you by surprise. And the unexpected time and money you’re devoting can potentially put a dent in your retirement plans and even damage your career.

According to a new report from, 46% of family caregivers—defined as someone who takes care of a family member or friend for no pay—spend more than $5,000 a year on medications, medical bills, in-home care, nursing homes, and other health expenses. More than one in ten spend between $10,000 and $20,000 annually, while 7% go through $50,000 or more each year.

Spending that kind of money can have a huge effect on your finances, especially your retirement funds when you are suddenly tasked with taking care of elderly parents. The extra work can also set back your career. A third of family caregivers spend more than 30 hours a week looking after a loved one, and 60% of all caregivers say their duties have a negative effect on their job.

What can you do to keep caregiving obligations from shattering your own financial future? Andy Cohen, CEO of, has a few suggestion on how to plan ahead.

1. Spend your parents’ money first

It might seem counterintuitive, but when you’re providing care it’s smarter to use your parents’ funds before your own. “Most adult children want to help their parents, but it’s a better financial decision to spend their parents’ assets first,” says Cohen.

By doing so, you can trim the size of your parents’ eventual estate, reducing the chance of facing estate taxes. If your parents have a modest net worth, spending down that money can qualify them for Medicaid benefits, including help with long-term care.

2. Don’t overlook benefits

Make sure your family member is getting all the financial help he or she is entitled to. As a veteran, for example, your parent may be in line for help with health care.

Use the U.S. Administration on Aging’s Eldercare Locator to find local programs that could help ease your burden. BenefitsCheckUp, run by the National Council on Aging, can help you identify services your parents may qualify for.

3. Look at your own benefits as well

It’s bad enough that unexpected caregiving can put a dent in your retirement plans, but it can also hurt your career by forcing you out of the office. “One of the problems of caring for an aging parent is that it impacts your own work,” says Cohen. “Make sure you check with your company before you make a rash decision to take time off unpaid or go part-time.”

If you need to take time off, know your rights. Under the Family and Medical Leave Act, if your company has 50 or more workers and you’ve been on the job for a least a year, you’re entitled to 12 weeks of unpaid leave to take care of a family member.

Luckily, says Cohen, an increasing number of companies are including caregiving under their paid family leave policies, making it possible for you to take time off and still collect a salary.

4. Talk to your loved ones—sooner rather than later

A conversation about aging is difficult, but it will be easier to have when your family members are in good shape. Planning how you’ll handle care, including the costs, is one essential topic to bring up, but it’s not the only one. You should also make sure your parents and other relatives have proper estate planning documents in place, including a power of attorney, health care proxy, and living will.

Should your loved one’s health start to fade, says Cohen, “the adult child has to step in and make decisions, and if they don’t have financial or medical power of attorney they won’t be able to do that.” Making arrangements that will enable you to care for your elders both medically and financially, if that becomes necessary, should give peace of mind to everyone.

More on caring for your aging parents:


MONEY health

How the Flu Shot Became the New Doorbuster Deal

Flu Shots
Yagi Studio—Getty Images

Pharmacies are using coupons and early season promotions in an aggressive competition to give flu shots to more Americans. The hope is that these efforts give their overall sales a shot in the arm.

Take a look at any chain pharmacy in your neck of the woods, and odds are it’ll be advertising special deals on flu shots. The trade publication Supermarket News recently rounded up a list of promotions showing that retailers are getting “creative” to encourage more customers to get flu shots. CVS promises shoppers that they’ll get a free flu shot (with most insurance plans), as well as a “shopping pass” valid for 20% off non-sale merchandise on the day you’re vaccinated. Safeway knocks a flat 10% off your grocery bill when you come in to get a flu shot. Target is waving a deal of 5% off your total purchase on the day you get a flu shot, which can range in (retail) price from $24.99 to $49.99. Get vaccinated at a Giant Food store and you’ll be rewarded with a coupon book good for savings of more than $30.

What’s more, just as retailers are constantly expanding the Christmas season with promotions and ads that start earlier and earlier every year, pharmacies are trying to beat the competition to the punch by pushing flu shots long before flu season is on the radar of consumers. Walgreens, which is utilizing a “Get a Shot. Give a Shot.” marketing campaign to win over consumers’ flu shot business—money raised helps poor children around the world get vaccinated—announced back on August 19 that all of its stores, health care clinics, and Duane Reade locations (which it also owns) were armed and ready to administer flu shots. Rite Aid actually beat Walgreens by a week, informing customers that flu shots were available at all of its stores starting on August 12, more than two weeks before Labor Day weekend.

There’s certainly nothing wrong with stores encouraging Americans to protect their health by getting flu shots. The CDC recommends annual flu vaccinations for almost everyone ages 6 months and up.

Yet it still seems fair to question the motivation of the flu shot peddlars. You don’t have to be a cynic to see that retailers promote flu vaccinations and other health-minded initiatives at least partly out of self-interest. When CVS stopped selling tobacco products, it was regarded first and foremost as a win for the health of all Americans, but it has also come to be seen as a savvy business move that’s helped the drugstore chain stand out from competitors in the marketplace and boosted the company’s stock price significantly.

With that in mind, it’s worth noting that flu vaccinations are very profitable for drug makers and drugstores alike. Sales are increasing rapidly in the age of Obamacare and increased coverage too. Forbes reported in 2013 that the number of flu shots administered by CVS had more than doubled the previous year. For the first quarter of 2014, immunizations at Walgreens were up 34% compared to the previous year. In early September, Meijer Pharmacy announced that it expects to administer 30% more flu shots this season compared to a year ago.

An increase in flu shots means an increase in shoppers, who are especially likely to browse the aisles and buy stuff when they’re given a coupon for discounted merchandise that day. So in a way, flu shots are not unlike loss leaders or Black Friday doorbuster deals: They’re handy for helping retailers to draw loads of customers inside stores. Only with flu shots, pharmacies aren’t losing money each time one is sold, which is often the case with deeply discounted “doorbusters.” Drugstores must also like establishing the idea in the minds of consumers that a store that’s good for vaccinations is also probably a solid go-to resource for nearly all of the customer’s health needs, preventive care in particular.

Varying advice on when flu shots should be administered may raise some eyebrows as well. No one gets more than one flu shot (at least not on purpose), so there’s a natural incentive for pharmacies to try to get their needles into the shoulders of shoppers before the competition does. But is getting a flu shot while it’s still summer a good idea?

Rite Aid certainly thinks so. “Getting a flu shot as soon as it is available is the single best way to protect yourself and others against the flu,” Robert I. Thompson, Rite Aid executive vice president of pharmacy, said in a press release.

“The best time to get a flu shot is not October, but actually before or soon after school starts,” Meijer Drug Store Vice President Nat Love said in a statement. “Once classes begin, kids can literally bring viruses into your home every day, and it becomes difficult to keep influenza from spreading throughout the whole family. There is no expiration date to receiving a flu shot, so the sooner you get your flu shot, the better chance you have of staying healthy.”

As for the CDC, its recommendations for timing are as follows: “Vaccination optimally should occur before onset of influenza activity in the community. Health care providers should offer vaccination soon after vaccine becomes available (by October, if possible). Vaccination should be offered as long as influenza viruses are circulating.”

That would seem to settle that. Only it doesn’t because not everyone is on the same page. Dr. Mark Dowell, an infectious disease doctor at Rocky Mountain Infectious Diseases, recently told the Casper Journal (Wyoming) that because a flu shot’s efficacy starts wearing off as early as four months after being injected (perhaps sooner if you’re over 65), you could be asking for trouble by electing to being vaccinated before October 1. “If you get your flu shot too early,” Dr. Dowell said, “you may run out of protection before the peak flu season hits in Wyoming.”

It also seems worth pointing out that, at times, marketers seem guilty of stretching the truth in order to give customers the hard sell on flu vaccinations. “Following a second straight severe flu season in the U.S., and one which impacted younger adults in particular with increased hospitalizations, health officials are encouraging early vaccination to help protect against influenza this season,” a Walgreens statement released in August explained. Indeed, the CDC verifies that the flu hit young people particularly badly in 2014. But overall, it was not a “severe flu season” like Walgreens suggests. In fact, despite the brutally cold winter, cough and flu medicine sales from giants like Procter & Gamble were weak, indicating fewer people were sick.

And, ostensibly, a big reason fewer people were sick is … because they’d gotten flu shots!

So go on and get your flu shot. But go in with your eyes wide open, understanding how the game is played.

MONEY Health Care

The Easy Way to Beat the High Cost of Health Care in Retirement

Senior couple riding bicycles
Ariel Skelley—Getty Images

Out-of-pocket healthcare costs may total $318,000 in your retirement, new research shows. This expense is most peoples' biggest worry. But it needn't be.

Americans’ top financial concern in retirement is paying for healthcare, which has been rising at twice the rate of inflation and will reach more than $318,000 in out-of-pocket expenses per retiree over a 30-year stretch, new research shows. And those out-pocket costs do not include potential further expenses associated with long-term care.

Strikingly, the fear factor is most acute among the affluent. Perhaps because they have more to lose (or fewer things to worry about), 60% of folks with investable assets greater than $5 million name healthcare costs as their top retirement concern, compared with 35% of those with less than $250,000 in investable assets.

The findings come from a health and retirement report out today from Bank of America Merrill Lynch and aging consultants Age Wave. Overall, 41% of those age 50-plus name healthcare costs as their top financial concern; 29% say it’s outliving their money; and just 11% cite Social Security cuts.

Three major health-related forces are conspiring to change the face of retirement planning, according to the report:

  • Boomers, now all 50-plus, have high expectations for wellness and will demand care that may be costly but keeps them vital and feeling young.
  • Longer life spans will give rise to greater numbers of retirees suffering from chronic diseases including hypertension, heart disease, diabetes, cancer, Alzheimer’s and arthritis.
  • Long-term care costs are unpredictable and can run into many tens of thousands of dollars in a short time, potentially putting a lifetime of saving and planning at risk.

These forces present a huge challenge to government, which must try to keep costs from rising too fast, and to the scientific community, which could make longer lives a joy by discovering treatments for chronic diseases. The report notes:

“If we could find an effective treatment or cure for Alzheimer’s the future health and financial landscape for almost every family would be dramatically improved. The goal is to match our health spans (how long we can expect to be healthy) with our increasing life spans.”

A more readily solved problem may be the dearth of medical professionals focused on healthy aging. Today, there is only one certified geriatrician for every 13 pediatricians, even though the 65-plus population is growing four times faster than any other cohort and is most likely to suffer from some kind of ailment, according to the report. Put another way: We have one pediatrician for every 1,200 children, but just one geriatrician for every 9,400 older adults.

Institutional change will not come fast. So it is important that, as part of taking charge of your financial future, you also take charge of your health. This includes:

  • Exercise People who begin exercising in their 60s or 70s are three times more likely than those who don’t exercise to age in good health.
  • Diet A healthy diet improves heart health, fortifies bones, and reduces the risk of stroke, type 2 diabetes and cancer.
  • Weight People 45 to 64 who eat well, maintain a healthy weight, and exercise a few hours a week can reduce risk of cardiovascular disease by 35%.
  • Connections A low level of social interaction is just as unhealthy as smoking and can be unhealthier than lack of exercise or obesity.
  • Lifestyle It’s never too late to quit smoking, and the benefits are almost immediate. People who consume more than two drinks a day have a 62% greater risk of stroke.

Your money and your health are all part of the same equation in retirement. The good news is that anyone can choose to live healthier—and doing so can make a big difference as to how well you live your last 20 or 30 years.

Do you want help getting your retirement planning off the ground? Email for a chance at a makeover from a financial pro and to appear in the pages of MONEY magazine.

Live a Little, Your Kids Will Make Their Own Money
Our Retirement Savings Crisis—and the Easy Solution
Why Gen X Feels Lousiest About the Recession and Retirement

TIME Health Care

What Missouri’s New Abortion Law Means for Women

Missouri Abortion
Elizabeth War looks over a gathering of her fellow abortion opponents in the Missouri Capitol rotunda in Jefferson City, Mo. on Sept. 10, 2014. Jeff Roberson—AP

A 72-hour waiting period could have big consequences

A new Missouri law imposing a 72-hour waiting period on women seeking abortions could decrease the abortion rate in the state, increase the abortion rate elsewhere and drive up expenses for women terminating pregnancies.

The Missouri legislature voted late on Sep. 10 to override Democratic Governor Jay Nixon’s veto of the law, which requires women seeking abortions to have an in-person appointment at Missouri’s only abortion clinic, wait three days and return for the procedure itself. Abortion rights advocates say the 72-hour waiting period, which is similar to policies in Utah and South Dakota, makes accessing abortion far too arduous and intrudes into women’s personal health care decisions. Anti-abortion advocates say it gives women time to fully consider their decisions and could reduce the number of terminated pregnancies.

Reliable data on how Missouri’s new law will affect either the abortion rate or when in their pregnancies women choose to have them does not exist, but researchers have found that 24-hour waiting periods, which are law in more than 20 other states, cause women to undergo abortions later in pregnancies and travel to other states instead. This is according to an analysis of existing research compiled by the Guttmacher Institute, a research organization that supports abortion rights. In a 2009 paper, Guttmcher researchers explained that after Mississippi imposed a 24-hour waiting period in 1992, the number of abortions in the state fell 22 percent and the proportion of women who underwent abortions after 12 weeks gestation increased 17 percent. After accounting for women who traveled to other states to access abortion services, the researchers said 11 to 13 percent of women who would have had abortions did not get them due to the 24-hour waiting period law.

In addition to affecting the timing, location and rate of abortions, waiting periods also increase costs for some women who are forced to travel to clinics at least twice. In a state like Missouri, which has a single abortion clinic, some women will have to travel long distances twice or spend three or four days away from home to make time for an initial appointment, the waiting period and abortion itself. In addition to the basic travel expenses, such trips can include additional costs in the form of childcare and time off from work.

One recent study, which has not been published, examined the impact of Utah’s 72-hour waiting period. In a 2013-2014 survey of 500 women who showed up for their initial counseling visits, researchers found that when contacted three weeks later, 85 percent of women had had abortions. Of those who had not, some had miscarried, others were still seeking abortions and some decided to continue their pregnancies. The rate of women who decided against having abortions was similar to the rates in other studies of locations without waiting periods, according to the study’s lead author, Sarah Roberts, an assistant professor at the University of California, San Francisco School of Medicine.

In addition, Roberts says the study found that the average period of time between the first visit for women in Utah and the abortions was eight days, not three, due to the need to arrange logistics like lodging, transportation and childcare. She says the average additional cost imposed by Utah’s mandatory 72-hour waiting period was $40 to $50, equal to about 2.5 percent of monthly household income for women in the survey. “The costs are not insignificant,” she says, particularly for low-income women. Roberts says the Utah study also found that the three-day waiting period forced women to tell more people about their abortions, in the course of making arrangements.

As for Missouri, Roberts says it’s impossible to accurately predict what the new waiting period will mean for women in the state. But, she says,“based on our data, I would continue to expect that women would face additional financial costs. Making arrangements to go back would probably force women to tell more people about their abortions.” And, she says, “we would expect additional delay.”

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