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

The Danger Lurking in Your Medical Bills

Claire Benoist

Medical billing errors are more common—and more costly—than you might think. Here's how to give your bills a checkup.

Odds are, there’s a mistake in the medical bill that’s in your mailbox. A recent NerdWallet analysis of 2013 hospital audits by Medicare found that an average 49% of bills contained errors, and that some medical centers messed up on more than 80% of claims to Medicare.

Such errors now matter more than ever to consumers: Greater health insurance cost sharing means that a mistake can take serious money out of your pocket. “If you’re responsible for the first $5,000 or $10,000 of your care, you’re going to want to be more attentive,” says Stephen Parente, a professor at the University of Minnesota’s Carlson School of Management who studies health finance.

But billing errors can be tough to spot, and tougher to remedy. Disputes can go on for months, and if you don’t take the right steps, your account could be put into collections in the meantime—a recent report by the Consumer Financial Protection Bureau found that a whopping 52% of all debt on credit reports is due to medical bills. Follow these steps to ensure a clean bill of health:

Understand your bill

Step one is knowing exactly what you’re being charged for. Can’t tell from the bill? Ask the provider for an itemized statement, says Pat Palmer, CEO of Medical Billing Advocates of America, a professional organization that assists individuals and companies with medical costs and disputes. Doctors use standardized numerical “CPT” codes to categorize treatments, and you can Google the numbers to find out what they stand for.

Question discrepancies

If the price strikes you as high for the services rendered, “follow your gut and investigate,” says Mark Rukavina, principal at Community Health Advisors, a hospital consultancy. Your insurer may offer an online price transparency tool. If not, try Guroo.com, a website that shows the average cost by area for 70 non-emergency diagnoses and procedures. A big discrepancy suggests that you should start asking questions.

Next, compare the bill to the explanation of benefits you get from your insurer. If these differ on the amount you owe, that can be another red flag, says Erin Singleton, chief of mission delivery at the nonprofit Patient Advocate Foundation.

Source: Consumer Financial Protection Bureau

Diagnose errors

Even if you don’t have sticker shock, give your invoice a close read. Some common mistakes can be easy to spot. They include services that weren’t performed, tests that were canceled, and duplicate charges, says Kevin Flynn, president of HealthCare Advocates.

Palmer says one of the more frequent errors she sees is providers charging patients separately for things that are supposed to be under one umbrella, such as a tonsillectomy and adenoid removal. Ask your provider about this if you are billed item by item for something that might be one procedure.

Remedy the problem

When you spot an error, ask the billing department to start a formal dispute. Put your concerns in writing. Include any documentation you have and request that the provider support its claim as well, says Palmer. Also, notify your insurer, which can be a good ally if the company will be on the hook for part of the charge.

Typically you don’t have to pay disputed charges until the investigation is complete, but do pay the rest of the bill. And always respond promptly to billing communications so that charges aren’t sent to collections. That’s a very real risk; one in five credit reports is married by medical debt, with an average of $579 in collections. Fortunately, relief is on the way—the three major credit agencies recently agreed to institute within the next few years a 180-day grace period before adding medical debt to credit reports (now there is no official grace period) and to remove debt from a report if the insurer pays the bill.

Rukavina says that, with persistence, you should be able to resolve most disputes on your own. But if you’ve been fighting to no avail for more than a month or so, consider hiring a medical billing advocate to work on your behalf. Find one via billadvocates.com or claims.org. You’ll likely pay an hourly rate starting at around $50 or a fee of about 30% of what you’ll save. But that could be pocket change compared with what you’d owe otherwise, not to mention what a ding to your credit score could cost you.

Read Next: The Debt You Don’t Know You Have

MONEY Health Care

You May Still Have Time To Avoid the Health Law’s Tax Penalties

The tax-filing deadline may have passed, but it's not necessarily too late to get around the penalty for going without health insurance last year.

Even though the April 15 tax filing deadline has passed, you might be eligible for some health law-related changes that may save you money down the road.

•If you owed a penalty for not having health insurance last year and didn’t buy a plan for 2015, you may still be able to sign up for a marketplace plan, even though the open enrollment period ended Feb. 15. Many people who didn’t have insurance and didn’t realize that coverage is required under the law are eligible for a special enrollment period to buy a plan by April 30. If you sign up now, you’ll have coverage and avoid the 2015 penalty, which will be the greater of $325 or 2% of your household income.

•If you paid the penalty for not having insurance for some or all of last year and didn’t carefully check to see if you might have qualified for an exemption, it’s not too late. You can still apply for an exemption from the requirement by amending your 2014 tax return. It’s worth looking into since the list of exemptions is a long one. For example, if your 2014 income is below the filing threshold of $10,150—or $20,300 for a married couple—you don’t owe a penalty for not having coverage. Likewise if insurance would cost more than 8% of your income or if you’ve suffered financial hardships like eviction or bankruptcy.

•In February, the Centers for Medicare & Medicaid Services announced that 800,000 tax filers who received a federal subsidy to help pay their insurance premium and used the federal health insurance marketplace received incorrect 1095-A tax forms. These forms reported details about the advance premium tax credit amounts that were paid to insurers based on the consumers’ estimates of income. They were then used to reconcile those payments against how much consumers should have received.

If you filed your taxes based on information that was incorrectly reported by the government on the form, you generally don’t have to file an amended tax return even IF you would owe more tax. But you may want to at least recalculate your return, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities.

“You have the option to amend if it helps you,” she says. Unfortunately, the only way to figure that out may be to do the math on the tax form 8962 that you use to reconcile your income.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Health Care

You Can Now Use a Yelp-Like Star System to Check Out a Hospital

hotel sign with stars
Agencja Fotograficzna Caro—Alamy

The federal government's new ratings show you how satisfied patients have been with their care.

In an effort to make comparing hospitals more like shopping for refrigerators and restaurants, the federal government has awarded its first star ratings to hospitals based on patients’ appraisals.

Many of the nation’s leading hospitals received middling ratings, while comparatively obscure local hospitals and others that specialized in lucrative surgeries frequently received the most stars.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers, and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare website, many are hard to decipher, and there is little evidence consumers use the site very much.

Many in the hospital industry fear Medicare’s five-star scale won’t accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many died or got infections during their stay, but those are not yet assigned stars.

“There’s a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons,” the American Hospital Association said in a statement.

Medicare’s new summary star rating, posted Thursday on its Hospital Compare website, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others. Hospitals collect the reviews by randomly surveying adult patients–not just those on Medicare—after they leave the facility.

In assigning stars, Medicare compared hospital against each other, essentially grading on a curve. It noted on its Hospital Compare website that “a 1-star rating does not mean that you will receive poor care from a hospital” and that “we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital.”

Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7% of all the hospitals Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.

A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic’s hospitals in Phoenix, Jacksonville, Fla., and New Prague, Minn. Mayo’s flagship hospital in Rochester, Minn., received four stars.

Medicare awarded three stars to some of the nation’s most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3%.

On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin, and Minnesota, KHN found. Thirty-four states had zero one-star hospitals.

Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California, and the District of Columbia scored lowest on average. Thirteen states and the District of Columbia did not have a single five-star hospital.

In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014. Medicare gave out four stars to 1,205 hospitals, or 34% of those it evaluated. Another 1,414 hospitals—40%— received three stars, and 582 hospitals, or 16%, received two stars. Medicare did not assign stars to 1,102 hospitals, primarily because not enough patients completed surveys during that period.

While the stars are new, the results of the patient satisfaction surveys are not. They are presented on Hospital Compare as percentages, such as the percentage of patients who said their room was always quiet at night. Often, hospitals can differ by just a percentage point or two, and until now Medicare did not indicate what differences it considered significant. The Centers for Medicare & Medicaid Services (CMS) also uses patient reviews in doling out bonuses or penalties to hospitals based on their quality each year.

Some groups that do their own efforts to evaluate hospital quality questioned whether the new star ratings would help consumers. Evan Marks, an executive at Healthgrades, which publishes lists of top hospitals, said it was unlikely consumers would flock to the government’s rating without an aggressive effort to make them aware of it.

“It’s nice they’re going to trying to be more consumer friendly,” he said. “I don’t see that the new star rating itself is going to drive consumer adoption. Ultimately, you can put the best content up on the Web, but consumers aren’t going to just wake up one day and go to it.”

Jean Chenoweth, an executive at Truven Health Analytics, which also publishes its own list of top hospitals, said she feared hospital marketing departments would oversell the meaning of the stars. “It would be very unfortunate and misleading if a hospital marketing department could claim to be a CMS five-star hospital and fail to mention it only reflected a patients’ perception of care,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Aging

A Sad Lesson From My Mother’s Decline

senior woman staring out window
Getty Images

A diagnosis of dementia spotlights the importance of protecting against devastating outcomes.

Lessons of financial awareness and self-sufficiency began early for me. I was just 13 and my sister was 11 when our father left us. My mother was 35 at the time and had no work experience and only a high school diploma. She had dedicated her married life to our family and supporting my father’s career.

She never had access to our household finances, ever. In the blink of an eye she was faced with having to learn how to provide for the three of us. She found a retail position, making little more than minimum wage. My sister and I did what we could to help, both working full-time in addition to going to school.

When my mother was 53, I was 31 and married with two young children. My sister and I started to notice Mom’s increasingly odd behavior. She got lost while driving familiar places, acted like a child, and forgot to bathe and wash her clothes, among other worrisome behavior. We thought perhaps she was dealing with depression and we sought professional help. She was prescribed antidepressants and went to counseling. Over the next year she continued to decline, and lost her job as a customer service representative.

Shortly thereafter, she was a target of a financial scam. She initiated three outgoing wire transfers totaling nearly $30,000, her life’s savings. To her, in her increasing confusion, it was great news! She had won the Mexican lottery! We only learned of it from a bank teller who was suspicious of the wire instructions. (If a loved one is exhibiting early signs of dementia, it’s very helpful to get to know the local bank branch staff and title accounts so they can alert family if they notice odd or uncharacteristic behavior by a longtime customer).

She soon could not pay her mortgage and we were forced to sell her home. She moved in with us. I was able to find an adult daycare to care for her while my husband and I were at work. So on we went day by day. I’d drop my kids off at school and mom off at daycare, at my expense.

Several years later, when she needed around-the-clock care, we looked for a facility that approved Medicaid, since she had no resources to pay for long-term care. This was a painful, difficult lesson – and one that I share with my clients: The time to purchase long-term care is when you don’t need it. My mother would hate knowing that my sister and I are paying out of pocket for preventative care and day-to-day expenses.

Dementia may have a long life cycle. Today my mother is 68. She has not recognized my sister or me for over six years. We have seen firsthand how 13 years in long-term care facilities can devastate a family both financially and emotionally.

There was a time when we had resources to purchase protection again these risks, and we didn’t. Dementia or other disabilities can happen at any age, and the lessons have been painful on many levels. A proud woman, my mother never expected to be financially dependent on anyone. It is a painful lesson for all of us. But if there is a silver lining, it’s this: As a financial adviser, I have been able to help others avoid making a similar mistake.

As the Baby Boomer generation ages, some estimate that as many as one in three individuals will suffer some form of cognitive dysfunction, from mild impairment to full-blown dementia. Our family wasn’t ready for this. Is yours?

———

Margaret Paddock, who oversees U.S. Bank’s wealth managers and financial advisers in the Minneapolis/St. Paul market, is quick to advise her clients to make preparations for catastrophic care and provisions for situations that are hard to envision, but which can come to pass.

MONEY Medicare

Congress Just Passed a Medicare ‘Doc Fix.’ Here’s What That Means to You

doctor with money in his lab coat pocket
Peter Dazeley—Getty Images

Both houses have approved an overhaul to how Medicare reimburses doctors. Will that mean higher costs for seniors?

Medicare’s troubled physician payment formula will soon be history.

As expected, the Senate Tuesday night easily passed legislation to scrap the formula, accepting a bipartisan plan muscled through the House last month by Speaker John Boehner and Democratic leader Nancy Pelosi. The Senate vote came just hours before doctors faced a 21% Medicare pay cut.

Under the bill, the current reimbursement schedule would be replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.” Existing payment incentive programs would be combined into a new “Merit-Based Incentive Payment System” while other alternative payment models would also be created.

“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” said Dr. James L. Madara, chief executive officer of the American Medical Association. “Patients will be able to get the care they need and deserve.”

The Senate voted 92 to 8 to approve the legislation, which the House passed 392-37.

It now moves to President Barack Obama, who—shortly after the Senate vote—said he would sign the bill, calling it “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs.”

There’s enough in the wide-ranging measure for both sides to love or hate. “Like any large bill it’s a mixed bag in some respects, but I think on the whole it’s a bill well worth supporting,” Senate Majority Leader Mitch McConnell, R-Ky., said Tuesday.

The bill includes two years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $210 billion package. The Congressional Budget Office has said the bill would add $141 billion to the federal deficit.

Consumer and aging organizations also have expressed concerns that beneficiaries will face greater out-of-pocket expenses on top of higher Part B premiums to help finance the way Medicare pays physicians.

But lawmakers said they had struck a good balance in their quest to get rid of the old system. “I think tonight is a milestone for the Medicare program, a lifeline for millions of older people,” said Sen. Ron Wyden, D-Ore. “That’s because tonight the Senate is voting to retire the outdated, inefficiency rewarding, common sense-defying Medicare reimbursement system.”

For doctors, the passage is an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agreed was broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times.

Here are some answers to frequently asked questions about the legislation and the congressional ritual known as the doc fix.

Q: How would the bill change the way Medicare pays doctors?

The House package would scrap the old Medicare physician payment rates, which were set through a formula based on economic growth, known as the “sustainable growth rate” (SGR). Instead, it would give doctors an 0.5% bump in each of the next five years as Medicare transitions to a payment system designed to reward physicians based on the quality of care provided, rather than the quantity of procedures performed, as the current payment formula does. That transition follows similar efforts in the federal health law to link Medicare reimbursements to quality metrics.

The measure, which builds upon last year’s legislation from the House Energy and Commerce and Ways and Means committees and the Senate Finance Committee, would encourage better care coordination and chronic care management, ideas that experts have said are needed in the Medicare program. It would reward providers who receive a “significant portion” of their revenue from an “alternative payment model” or patient-centered medical home with a 5% payment bonus. It would also allow broader use of Medicare data for “transparency and quality improvement” purposes.

House Energy and Commerce Committee Chairman Fred Upton, R-Mich., one of the bill’s drafters, has called it a “historic opportunity to finally move to a system that promotes quality over quantity and begins the important work of addressing Medicare’s structural issues.”

A “technical advisory committee” will review and recommend how to develop alternative payment models. Measures will be developed to judge the quality of care provided and how physicians will be rewarded or penalized based on their performance. While the law lays out a structure on how to move to these new payment models, much of their development will be left to future administrations and federal regulators. Expect heavy lobbying from the physician community on every element of implementation.

Q. Will seniors have to help pay for the plan?

Starting in 2018, wealthier Medicare beneficiaries (individuals with incomes above $133,500, with thresholds higher for couples), would pay more for their Medicare coverage, a provision expected to impact 2% of beneficiaries.

In addition, starting in 2020, “first-dollar” supplemental Medicare insurance known as “Medigap” policies would not be able to cover the Part B deductible for new beneficiaries, which is currently $147 per year but has increased in past years. If the policy had been implemented in 2010, it would have affected Medigap coverage for roughly 10% of all 65-year-olds on Medicare, according to an analysis from the Kaiser Family Foundation. Based on declining Medigap enrollment trends among 65-year-olds, expect this policy to impact a smaller share of new Medicare beneficiaries in the future, according to the study. (KHN is an editorially independent program of the foundation.)

Experts contend that the “first-dollar” plans, which cover nearly all deductibles and co-payments, keep beneficiaries from being judicious when making medical decisions because they are not paying anything out-of-pocket and those decisions can help drive up costs for Medicare.

The bill also includes other health measures — known as extenders — that Congress has renewed each year during the SGR debate. The list includes funding for therapy services, ambulance services and rural hospitals, as well as continuing a program that allows low-income people to keep their Medicaid coverage as they transition into employment and earn more money. The deal also would permanently extend the Qualifying Individual, or QI program, which helps low-income seniors pay their Medicare premiums.

AARP, a seniors’ lobby group, sought to repeal a cap on the amount of therapy services Medicare beneficiaries could receive, telling senators that it would be a “key vote” for the organization.

“Similar to the SGR debate, an extension of the therapy cap — rather than full repeal — is short-sighted and puts beneficiaries in a dire situation when the extension expires,” AARP Executive Vice President Nancy LeaMond wrote in a letter to senators. “This amendment is important to the overall success of the Medicare program and the health and well-being of Medicare’s beneficiaries.” The amendment failed.

Q. What about other facilities that provide care to Medicare beneficiaries?

Post-acute providers, such as long-term care and inpatient rehabilitation hospitals, skilled nursing facilities and home health and hospice organizations, would help finance the repeal, receiving base pay increases of 1% in 2018, about half of what was previously expected.

Other changes include phasing in a one-time 3.2 percentage-point boost in the base payment rate for hospitals currently scheduled to take effect in fiscal 2018.

Scheduled reductions in Medicaid “disproportionate share” payments to hospitals that care for large numbers of people who are uninsured or covered by Medicaid would be delayed by one year to fiscal 2018, but extended for an additional year to fiscal 2025.

Q. What is the plan for CHIP?

The bill adds two years of funding for CHIP, a federal-state program that provides insurance for low-income children whose families earned too much money to qualify for Medicaid. While the health law continues CHIP authorization through 2019, funding for the program had not been extended beyond the end of September.

The length of the proposed extension was problematic for Democrats, especially in the Senate. In February, the Senate Democratic caucus signed on to legislation from Sen. Sherrod Brown, D-Ohio, calling for a four-year extension of the current CHIP program. A Senate amendment to extend CHIP funding for four years failed.

Q. What else is in the SGR deal?

The package, which Boehner, R-Ohio, and Pelosi, D-Calif., began negotiating in March, also includes an additional $7.2 billion for community health centers over the next two years. NARAL Pro-Choice America and Planned Parenthood have criticized the provision because the health center funding would be subject to the Hyde Amendment, a common legislative provision that says federal money can be used for abortions only when a pregnancy is the result of rape, incest or to save the life of the mother.

In a letter to Democratic colleagues before the House vote, Pelosi has said that the funding would occur “under the same terms that Members have previously supported and voted on almost every year since 1979.” In a statement, the National Association of Community Health Centers said the proposal “represents no change in current policy for Health Centers, and would not change anything about how Health Centers operate today.”

Q. How did the doctor payment formula become an issue?

Today’s problem is a result of efforts years ago to control federal spending — a 1997 deficit reduction law that set the SGR formula. For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors were furious when their payments were reduced by 4.8%. Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size of the fix needed the next time.

The Medicare Payment Advisory Commission (MedPAC), which advises Congress, says the SGR is “fundamentally flawed” and has called for its repeal. The SGR provides “no incentive for providers to restrain volume,” the agency said.

Q. Why haven’t lawmakers simply eliminated the formula before?

Money was the biggest problem. An earlier bipartisan, bicameral SGR overhaul plan produced jointly by three key congressional committees would cost $175 billion over the next decade, according to the Congressional Budget Office, and lawmakers could not agree on how to pay for the plan.

This time Congress took a different path. The measure both chambers approved is not fully paid for. That is a major departure from the GOP’s mantra that all legislation must be financed. Tired of the yearly SGR battle, veteran members in both chambers appeared willing to repeal the SGR on the basis that it’s a budget gimmick – the cuts are never made – and therefore financing is unnecessary.

But some senators objected. In remarks on the Senate floor, Sen. Jeff Sessions, R-Ala., said any repeal of the SGR “should be done in a way that should be financially sound.”

Most lawmakers felt full financing for the Medicare extenders, the CHIP extension and any increase in physician payments over the current pay schedule was needed. Those items account for about $70 billion of financing in the approximately $210 billion package.

Conservative groups urged Republicans to fully finance any SGR repeal and said they would be watching senators’ actions closely. For example, the group Heritage Action for America promised to “key vote” an amendment that the measure be fully financed. That amendment failed.

Some members of Congress seemed pleased to have this recurring debate behind them. “Stick a fork in it,” said Rep. Upton. “It’s finally done.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Health Care

Why Young Millennials Are Turning Down Health Coverage at Work

150414_FF_MILLHEALTHCOVERAGE
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.

TIME Chris Christie

How Obamacare Makes Chris Christie’s Medicare Plan Possible

Chris Christie
Mel Evans—AP In this April 8, 2015 file photo, New Jersey Gov. Chris Christie addresses a gathering as he announces a $202 million flood control project for Union Beach, N.J.

New Jersey Gov. Chris Christie would like to raise the age to qualify for Medicare, part of a bold plan to reform entitlements that he released Tuesday morning.

The proposal was greeted with cheers from many conservatives, but there’s a twist. The main reason that slowly raising the retirement age from 65 to 69 is politically feasible is a law that many conservatives hate: Obamacare.

That’s because working-class Americans who lose health insurance at work when they retire at, say, age 65, would instead be eligible to receive modest subsidies on insurance exchanges set up by the Affordable Care Act. (Very low-income seniors could also sign up for Medicaid in some states or receive larger subsidies for coverage on the exchanges.)

“Obamacare soaks up the people who would otherwise be displaced by raising the eligibility age for Medicare,” said Avik Roy, a prominent Republican expert in health care policy who has argued that conservatives should use Obamacare to promote their own policies rather than repeal the law. “In the old days, if you raised the eligibility age for Medicare, then someone who is low-income at 65, but not eligible for Medicaid, are stuck in this gap, so what do you do?”

“But with [Obamacare], that safety net is there, so it’s much easier to raise the Medicare age,” added Roy.

But if retirees who, at 65, would have qualified for Medicare, which is relatively cheap, shift en masse to private insurance, which is relatively expensive, does Christie’s plan of raising the eligibility age actually save any money?

That answer has been hotly debated for years, since the cost of providing health care to 65-69 year-olds wouldn’t just disappear, it would shift to another part of the federal budget.

Some argue that it would save money, since the subsidies under the Affordable Care Act get smaller as seniors’ income rises, while Medicare serves seniors of all incomes the same.

“In general, raising the eligibility age for Medicare will save money for the federal government because seniors with relatively higher incomes wouldn’t be eligible for any other federal subsidies,” said Michael E. Chernew, a professor of health care policy at Harvard Medical School. “That’s the simple analysis.”

A 2011 Kaiser Family Foundation study estimated that raising the eligibility age for Medicare from 65 to 67 would save the federal government as much as $5.7 billion in the short term. But it could also cost 65- and 66-year-olds $3.7 billion in out-of-pocket expenses, and employers $4.5 billion in retiree health-care costs. (And that’s to say nothing of how the policy could negatively affect the cost of Medicaid and Medicare Part B premiums, according to the Kaiser study.)

Chernew added that raising the Medicare age comes with other, more complex ramifications, including the type and quality of care available, and whether such a policy would encourage more older Americans to remain in the workforce for longer. Another part of Christie’s plan directly incentivizes Americans to keep working past the age of 65 by eliminating the payroll tax for workers 62 and older.

But the broader question is whether conservatives want to make use of the Affordable Care Act to make their own changes to the health care system or whether they want to repeal the law and start from scratch.

Roy, who has advocated for “transcending Obamacare,” argues that that Christie’s policy proposal is a smart political play. “He’s staking out ground as a credible, bipartisan entitlement reformer,” he said.

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TIME Chris Christie

Chris Christie to Propose Changes to Social Security, Medicare

Chris Christie
Mel Evans—AP In this April 8, 2015 file photo, New Jersey Gov. Chris Christie addresses a gathering as he announces a $202 million flood control project for Union Beach, N.J.

He'd raise the retirement age and means-test benefits

New Jersey Gov. Chris Christie will unveil a proposal to change Social Security and Medicare Tuesday in a speech in New Hampshire, as he seeks to inject new life into his presidential ambitions.

The outspoken Republican’s political fortunes soured after last year’s controversy over the political closure of approach lanes to the George Washington Bridge and a tough fiscal picture at home. But Christie is hoping that by embracing the third rail of American politics with two hands he can bolster his credentials as a truth-teller.

“Washington is afraid to have an honest conversation about Social Security, Medicare and Medicaid with the people of our country,” Christie will say in a speech at New Hampshire’s St. Anselm College Institute of Politics. “I am not.”

Christie will propose raising the retirement age for Medicare to 67 and for Social Security to 69, arguing that entitlement programs must be fair for all Americans, including the next generation that is paying into the programs while questioning whether they will ever see benefits.

In a controversial move, Christie would means-test Social Security, reducing or cutting payments entirely for those who continue to earn income in retirement. He will argue that he wants to return the program being a social insurance program, where only those who need the outlays will receive them.

“Do we really believe that the wealthiest Americans need to take from younger, hard-working Americans to receive what, for most of them, is a modest monthly Social Security check,” Christie will say. “I propose a modest means test that only affects those with non-Social Security income of over $80,000 per year, and phases out Social Security payments entirely for those that have $200,000 a year of other income.”

To incentivize work as more Americans continue to hold jobs later into life, Christie would eliminate the payroll tax at 62.

Christie’s political identity stems from his willingness to take on powerful interests, such as his home state’s teachers unions, altering the calculus in favor of what for most other politicians would be an undeniably risky move. But Christie’s proposals stop short of radically altering either Medicaid or Social Security as some conservatives have proposed, staying away from the 2000s-era privatization debates.

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