MONEY Health Care

6 Questions to Ask Before You Sign Up for a Health Plan This Year

tweezers and pill
Geir Pettersen—Getty Images

Employers are changing your health insurance options more than ever. Rushing through your open enrollment paperwork could cost you.

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans—where most working-age folks get coverage—are changing too.

Rising costs, a looming tax on rich benefit packages, and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015.

“If there’s any year employees should pay attention to their annual enrollment material, this is probably the year,” says Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don’t blow off the human resources seminars. Ask these questions.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”

Insurers publish directories, but the surest way to see if docs or hospitals take your plan is to call and ask.

“People tend to find out the hard way how their health plan works,” says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “Don’t take for granted that everything will be the same as last year.” (Kaiser Health News is an editorially independent program of the foundation.)

2. Is my employer changing where I get labs and medications?

For expensive treatments—for diseases such as cancer or multiple sclerosis—some companies are hiring preferred vendors. Getting infusions or prescriptions outside this network could cost thousands extra, just as with doctors and hospitals.

3. How will my out-of-pocket costs go up?

It’s probably not a question of if. Shifting medical expense to workers benefits employers because it means they absorb less of a plan’s overall cost increases. By lowering the value of the insurance, it also shields companies from the “Cadillac tax” on high-end coverage that begins in 2018.

Having consumers pay more is also supposed to nudge them to buy thoughtfully—to consider whether procedures are necessary and to find good prices.

“It gets them more engaged in making decisions,” says Dave Osterndorf, a benefits consultant with Towers Watson.

How well this will control total costs is very unclear.

Your company is probably raising deductibles—the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation. One large employer in three surveyed by Marcotte’s group planned to offer only high-deductible plans (at least $2,600 for families) in 2015.

Employers are also scrapping co-payments—fixed charges collected during an office or pharmacy visit.

Once you might have made a $20 copay for a $100 prescription, with the insurance company picking up the other $80. Now you might pay the full $100, with the cost applied against your deductible, Marcotte says.

4. How do I compare medical prices and quality?

Companies concede they can’t push workers to shop around without giving information on prices and quality.

Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5. Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren’t that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time.

Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

Don’t necessarily think of HSAs as money down the drain, says Osterndorf. Think of them as a different kind of retirement savings plan.

6. How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharma benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary’s bottom tiers–usually cheap generics—and highest for specialty drugs and biologics.

If you’re on a long-term prescription, check how it’s covered so you know how much to put in the savings account to pay for it. Also see if a less-expensive drug will deliver the same benefit.

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

You Won’t Believe Your Employer Can Ask You These Personal Health Questions

Office lamps pointed at pill bottle interrogation-style
Sarina Finkelstein (photo illustration); OsakaWayne Studios (pill bottle); David Malan/Getty Images (office lamps)

When you sign up for health coverage this year, your employer might ask you for a lot of details about your health and your habits. The goal: Cut the cost of your care.

This year, one third of employers will ask workers who enroll in the company health plan to complete a questionnaire about their health, according to the Kaiser Family Foundation. That’s up from 24% of firms last year. The questionnaires, often called a “health risk assessment,” are even more common at big companies; more than half of employers with 200-plus employees offer them.

And as more companies look to control health-care costs with programs aimed at making workers healthier, the stakes for sharing personal details about your health are getting higher.

Last year, Penn State faced a backlash for a questionnaire that, among other things, asked female employees about their pregnancy plans. Workers who refused to fill it out had to pay an extra $100 a month. Penn State later suspended the program.

If you’ve never seen one of these assessments before, here’s what to expect, what happens to the information you provide, and what your rights are.

What kinds of questions can my employer ask?

The questionnaires are crafted to identify current behaviors that may cause costly health problems in the future, says Jillian Fagan of Wellsource, a technology company that creates health risk assessments. Wellsource’s questionnaires cover a long list of topics, including weight and height, chronic illnesses, treatments you’re getting, your willingness to make lifestyle changes, tobacco use, physical activity, diet, alcohol consumption, cancer screenings, hearing and vision impairment, flu vaccinations, stress levels, and depressive symptoms.

Questionnaire writers have leeway about how to pose the questions. For example, Fagan says employers usually don’t want to explicitly ask if you’re depressed. Instead, you might be asked questions like, do you have a social group? Are you married? Do you feel like you’re getting the support you need? How many alcoholic drinks do you consume every week?

You may also be asked about your outlook for the future, how much time you have to relax, your energy level, and whether you’re satisfied with your work-life balance, Fagan says. Wellsource develops its questions based on scientific research and includes links its the underlying medical literature.

Is there anything my employer can’t ask?

Inquiring about your parents’ health would probably violate the Genetic Information Nondiscrimination Act, which prohibits employers from collecting genetic information, says Maureen Maly, employee benefits and executive compensation attorney at Faegre Baker Daniels. A family history of breast cancer, say, could indicate a genetic predisposition.

“Once upon a time, it would get into some questions about family medical history,” says Maly. “Most of these questionnaires will not ask that—and they will usually have a warning saying, ‘Don’t volunteer any information.’”

Can my boss see my answers?

Generally, no. Under HIPAA, the Americans with Disabilities Act, and state privacy laws, employers are prohibited from using health risk assessments for any reason other than for wellness programs, says employee benefits attorney Todd Martin.

Keep in mind that often your employer already has information on your health. If your health plan is self-funded and self-administered—meaning your employer pays the claims directly rather than contracting with an insurer or third party—someone in your office gets your health claims. Your employer is legally bound to maintain a firewall, secure your private information, segregate it from other employment files, and limit staff access, Martin says. Health risk assessments aren’t much different.

And besides, seeing that information could expose the company to a lawsuit if you’re fired or disciplined. “Most employers don’t want to see that information as much as employees don’t want to give it to them,” says Fagan of Wellsource.

So employers usually hire a third party to administer the questionnaires. If that’s a medical provider, that firm is subject to additional privacy rules, says Martin.

That’s really personal! Why is my employer asking me all that?

The goal is to give you a picture of your health and suggest how to do better, Fagan says. “Health risk assessments show you where you’re going to be in five years,” Fagan says. “If we notice that you don’t work out, you’re eating lots of sugar, and your diet is not so great, if you continue down this road, you’re going to have tons of health problems in the years to come.”

Of course, there’s something in it for your employer too—potential cost savings if you stay healthy.

How can knowing more about my health save my boss money?

More than half of large firms surveyed say that they see wellness initiatives as one of the most effective tactics for controlling health-care costs, according to the National Business Group on Health. Such programs can include weight-loss and smoking cessation classes, nutritional counseling, gym discounts, and lifestyle coaching.

With a summary of the answers employees gave on the questionnaires in hand, a company can see, for example, that a lot of workers are struggling to quit smoking (but not who those employees are), which can help it decide whether or not to offer a smoking cessation class (a common perk). To date, however, the research on the effectiveness of wellness programs is mixed.

What’s more, Jennifer Bard, professor at the Texas Tech University School of Law, says she has serious concerns about the privacy risks associated with wellness initiatives.

“It’s not clear how those risks translate into future health,” Bard says. “There isn’t enough information to say that somebody with a particular blood pressure or cholesterol reading or weight is going to have a specific problem. It’s one thing to diagnose someone who is sick, but the science of risk is not as well-developed.”

What else can come of sharing health information?

Your employer can set health-related goals for you. For example, if you’re overweight, your employer can offer a financial incentive for you to lower your BMI. As part of the Affordable Care Act, those financial incentives can be worth 30% of the total cost of plan costs, up from 20% before health reform.

That kind of outcomes-based wellness program is subject to a strict set of rules, Martin says. If your doctor says that you are unable to achieve the goal, your employer has to offer another way for you to earn the incentive.

Outcomes-based wellness programs are growing but not yet widespread. And only 7% of employers say that employees with health risks must complete some kind of wellness program or face a penalty, according to Kaiser.

“The restrictions have made a number of employers want to stay away from outcomes-based programs and focus on the participation-based programs like the health risk assessment,” says Martin.

Can my employer force me to fill out a questionnaire?

Probably not. Only 3% of large firms that offer questionnaires require employees to fill them out, according to Kaiser.

But health assessments, medical screenings, and wellness programs are still a legal gray area.

The Department of Labor says employers can require workers complete a health risk assessment before enrolling in a company health plan, so long as the employer doesn’t deny benefits or change premiums based on the information.

But the Equal Employment Opportunity Commission recently sued three employers on the grounds that their mandatory wellness programs violated anti-discrimination statutes. The EEOC has sued Honeywell over its wellness program, even though the company says it’s voluntary. But employees and spouses who refuse to participate in health screenings face up to $4,000 in financial penalties, which, the EEOC contends, effectively makes the program mandatory.

“It’s helpful for people to know that this is unresolved,” says Bard, the Texas Tech University law professor. “These kinds of wellness programs with a bite, with a financial consequence, are relatively new. Everyone is watching the EEOC lawsuits very carefully.”

That said, if the wellness program is mandatory, you might have little choice. “In my opinion, anyone who chooses not to comply puts themselves at risk for being a test case,” Bard says.

My employer says it’s voluntary. Why should I fill it out?

Health risk assessments are a benefit, says Fiona Gathright, president of Wellness Corporate Solutions, a third-party vendor that administers wellness programs for employers. “We’re trying to help people manage their health, and we’re trying to help people live longer,” Gathright says. “Answer the questions as honestly as you can. If we uncover that you have a risk, we’re going to you help you a manage that risk.”

Still not convinced? More than half of large firms sweeten the deal with some kind of financial incentive, according to Kaiser; 36% of those firms offer a financial incentive worth more than $500.

I’m still uncomfortable with this. What should I do?

Carefully read the disclosures, which usually contain information about who will see your answers and in what form, says Fagan. And ask your own questions

First, who is doing the assessment? An outside vendor, especially one that’s also a medical provider, is best. How is sensitive personal information protected from data breaches?

Second, what information gets back to the employer? Only you should see your individual results. If your employer will see aggregated responses, how big is the sample size? Is there any way you could be identified—say, if you’re the only obese employee at a small firm? There may be rules against reporting results from small groups.

Finally, ask how your employer intends to use the questionnaire. Know ahead of time if you’re just getting information about your health risks—or if you’re laying the groundwork for an outcomes-based wellness program that will ask you to make big changes.

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MONEY Health Care

The Hidden Financial Benefits of Keeping Yourself Fit

running shoes hovering over a scale
Geir Pettersen—Getty Images

Investing in fitness can generate financial rewards as well as health benefits.

You know exercise is good for you. What you may not know is that working out can have financial benefits too.

Plenty of research suggests that overweight people spend more on health care, but it’s not just the thin who stand to save. Fact is, regardless of your weight, if you’re a couch potato you’re likely missing out on earning and saving opportunities.

The Payoff in Your Paycheck

Health care costs aren’t the only way physical activity is a benefit. People who work out regularly, as in at least three times per week, are more productive at work than those who don’t, according to research published in the Journal of Occupational and Environmental Medicine. Those who get sufficient exercise also miss fewer workdays, according to the same study. Those absences can translate to lost income and lost opportunities for advancement.

Another study published in the Journal of Labor Research found that men who work out regularly can expect to make 6% more than their sedentary counterparts, on average. For women, the pay boost is higher: Fitness-savvy females make 10% more, on average.

A Nudge From the Boss

If you’re not already working out, it doesn’t have to cost an arm and a leg to start.

For starters, some employers just flat-out pay their employees to work out as part of workplace wellness initiatives. For example, IBM offers cash to employees who meet certain fitness goals. Employees at Google and Zappos can use on-site fitness classes and facilities, enabling them to skip membership fees at traditional gyms. Even if your company doesn’t currently offer wellness benefits, it might soon: Under the Affordable Care Act, employers can receive grants to get one started.

Your employer may have a deal worked out with a local gym where employees can get discounted rates. Even if your company doesn’t offer such an incentive, chances are that your health insurance provider does. UnitedHealthcare offers reimbursements of $20 per month to members who use one of many participating gyms, while Blue Cross Blue Shield has worked out a $25 membership fee for their members at over 8,000 gyms nationwide. These insurance giants aren’t the only ones in on the game—most health care insurers offer some type of fitness benefit for members.

Just Do It

On the other hand, skipping the gym altogether may be your biggest money saver. If a participating fitness center isn’t available near you, or you’re just not the gym-going type, there are plenty of ways to get in shape for free. You can use the myriad online videos in the comfort and privacy of your own home, such as those offered on Bodyrock.TV or YouTube’s workout channel. If you like mobile apps, try Daily Workouts free app, or iPump. If you’re close with your co-workers you can start a lunchtime walking group. Your boss may just end up rewarding you for it.

Read more from NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and lower their medical bills.

MONEY Health Care

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

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

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

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

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

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

Skipping Insurance Will Cost You More

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

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

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

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

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

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

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

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

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

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

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

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

You’re Not Stuck With Healthcare.gov

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

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

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

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

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

Drag Your Feet and You Could Be Auto-Enrolled

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

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

You Could Be Locked Out if You Delay

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

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

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

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

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

MONEY Health Care

Why You May Need to Act Fast to Keep Your Health Coverage

140603_FF_QA_Obamacare_illo_1
Robert A. Di Ieso, Jr.

Obamacare open enrollment begins this Saturday and runs through February. But waiting too long to sign up for insurance could put you at risk of owing a penalty—and leave you stuck with big medical bills.

Mind the gap. When the 2015 open enrollment period begins on Nov. 15 for plans sold on the individual market, consumers should act promptly to avoid a gap in coverage.

Failing to do so could not only leave you exposed to unexpected medical bills—hello, appendicitis!—but you could also be hit with the penalty for not having health insurance that kicks in if you’re without coverage for three months or more during the year. The coverage requirement applies to most people in group and individual plans unless they qualify for a hardship or other type of exemption.

In 2015, the penalty will be the greater of $325 or 2% of household income.

The open enrollment period runs through Feb. 15, 2015. But if you bought a plan last year and need to renew your coverage, you must do so by Dec. 15 if you want it to start Jan. 1.

In general, you must buy a plan by the 15th of the month in order to have coverage that starts the first of the next month. So if you buy a plan on Dec. 16, for example, your coverage won’t start until Feb. 1.

If you don’t have insurance and you buy a plan by Feb. 15, your coverage will begin by March 1 and you’ll avoid owing the penalty since your coverage gap will be less than three months.

Last year, the marketplaces got off to a bumpy start and many people weren’t able to sign up for coverage before open enrollment ended on March 15. The federal government allowed anyone who got their application started before the deadline to avoid the penalty.

This year, President Barack Obama has vowed that the marketplace will function on time. “We’re really making sure the website works super well before the next open enrollment period. We’re double- and triple-checking it,” he told reporters last week.

There is also another way that people can be affected by the coverage gap. For people who are receiving premium tax credits but lose or drop their coverage, health plans are required to allow them a 90-day grace period to catch up with their premiums if they fall behind, as long as they’ve already paid at least one month’s premium that year. But they don’t have 90 days before the coverage gap countdown starts. If after three months someone still hasn’t paid what he owes, his coverage would be terminated retroactive to the beginning of the second month of the grace period. In that case, the penalty clock for not having coverage would start ticking after the first month of nonpayment, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

People who aren’t receiving premium tax credits on the exchange would be subject to state laws regarding grace periods for nonpayment. Typically they’d have 30 days to pay up, Solomon says.

If you lose your job-based health insurance, you’ll have 60 days after your coverage ends to sign up for new coverage. This “special enrollment opportunity,” as it’s called, would count toward a gap in coverage.

Although people are limited to a single coverage gap of less than three months annually, some may be able to sidestep the issue.

“If you have coverage on any day during a month you’re considered covered for the month,” says Solomon.

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 Health Care

Millions Fewer Americans Will Enroll in Obamacare Plans Than Predicted

The home page for the HealthCare.gov on March 31, 2014 in Washington, D.C.
The home page for the HealthCare.gov on March 31, 2014 in Washington, D.C. Karen Bleier—AFP/Getty Images

Through the law’s new marketplaces in 2015

Expectations for how effectively the Affordable Care Act would impact the U.S. uninsured rate were high—too high in fact. That’s according to an analysis released Monday by the Department of Health and Human Services that says millions fewer Americans will get private health insurance through the law’s new marketplaces in 2015 than was previously estimated.

The department now says it expects between 9 and 9.9 million Americans to enroll in private health plans through state and federal exchanges by next year, down from 13 million, which the nonpartisan Congressional Budget Office had predicted. The revised projection is due to deeper analysis on how long it takes for new federal programs to “ramp up,” according to HHS, which said the new estimate includes about 6 million Americans who will re-enroll in plans through the exchanges, as well as new customers who buy coverage there. Some 7 million Americans are enrolled in exchange plans today.

“The next group of people will be harder to reach,” HHS Secretary Sylvia Mathews Burwell said at a Center for American Progress event on Monday. Open enrollment through the ACA’s insurance exchanges is set to begin Nov. 15 and last until Feb. 15, 2015. Last year’s enrollment period was plagued by major technology snags, with the federal insurance marketplace HealthCare.gov and some run by states largely inoperable at the outset. The snafus embarrassed President Obama’s Administration and cast doubt on HHS’s ability to manage a large, complicated new program.

To avoid similar issues this year, Burwell said HHS and the contractors who are building and operating HealthCare.gov have been testing the system for five weeks. Burwell said tech experts are testing how many users the systems can handle at once and whether various parts of the computer programs work seamlessly together. Security testing is also part of the process, Burwell said, in addition to a simpler application for coverage that reduces the screens a new consumer must navigate from 76 screens to 16. “Things are simpler, faster and more intuitive,” she said.

Still, the secretary warned that performance perfection in the exchanges is unlikely. “We will have outages. We will have downtime,” she said.

MONEY Health Care

5 Things You Need to Know About Obamacare This Year

empty shopping baskets
If you buy your own health insurance, get ready to shop. Larry Washburn—Getty Images

You can start shopping for an individual health insurance plan for 2015 this Saturday. Keep these tips in mind.

The health law’s open enrollment season is just around the corner. Are you ready?

Here’s a quick checklist for people who don’t get their health insurance at work and plan to shop for coverage on the health law’s online exchanges, or marketplaces, starting Nov. 15. You can compare plans and prices at healthcare.gov or, if your state has its own exchange, shop there to find out which coverage is best for you. And you may be eligible for subsidies to help pay your premium.

Keep these five things in mind as the three-month open enrollment period begins.

1. Shop Around. Just because you’re enrolled in a policy now doesn’t means it’s the best deal for you next year. If you’re currently in the federal marketplace and don’t take any action, you’ll be re-enrolled in the same plan you’re in now. Federal officials, as well as many analysts, are urging consumers to go back to the exchanges to compare plans and prices. You might discover that you have more—or different—choices than you had a year ago.

2. Don’t Get Billed Twice. Insurers have expressed concerns that if a consumer changes plans, problems with the federal website might keep insurers from learning of the change and consumers could get billed for both plans. “It’s an issue we’re aware of and we’re working with exchange officials to make sure there’s a solution for consumers,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an industry trade group. Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services, said insurers will get lists of individuals who have been automatically enrolled into their current plan as well as those who chose to re-enroll. He also said that the agency is “examining options” on how to provide insurers the names of people who picked another plan during open enrollment.

Just in case, keep proof of payment to answer any billing questions and once you’ve cancelled the old policy watch your credit card statements or, if the payment was deducted directly from a bank account, watch those charges to make sure you aren’t paying for two policies. And don’t cancel your current insurance until you have confirmation from your new carrier that you’re covered.

3. Find Out If You Qualify For Financial Help. Enter your most up-to-date income information on healthcare.gov or with your state exchange to see if you are entitled to receive a tax credit toward the cost of your health insurance. Even if you are like the majority of those enrolling in marketplace plans who receive a subsidy, update your income to make sure you get the correct amount next year. This is important because if you get too much of a subsidy, you’ll have to repay it when you file your taxes the following year.

4. Know All Costs. It’s not just the monthly premium that will cost you. Understand a policy’s out-of-pocket costs, things like co-pays, co-insurance and deductibles, before you enroll. The health law allows out-of-pocket maximum caps of $6,600 for an individual policy and $13,200 for a family policy in 2015 but some of your health care expenses—including out-of-network care—might not be included in that cap.

5. Get Help If You Need It. Confused? There are several ways to get help. Work with a local insurance agent or broker. Find one of the law’s trained navigators or assistors. Or call the federal consumer assistance center at 800-318-2596 for extra help or to find out if you eligible for a subsidy. Folks there can also help you enroll in a health plan or if you qualify, Medicaid, the federal-state program for low-income people.

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 health insurance

How a Repulican Majority Could Change Obamacare

With Republicans soon to be in charge of the House and Senate, talk of repealing the Affordable Care Act (ACA) is heating up again. Here’s what you need to know about Republicans’ plans for the law and whether the GOP has a chance at changing—or repealing—it in the next two years.

 

Full Repeal

House Republicans have voted more than 50 times to repeal Obamacare. Even with its new Senate majority, the GOP lacks the 60 votes necessary to overcome a filibuster, meaning repeal legislation is unlikely ever to reach President Obama’s desk. Even if it did, he has said he would veto such a bill.

Incoming Senate Majority Leader Mitch McConnell has indicated he may try to alter the ACA through the budget reconciliation process that requires just a 51-vote majority, but full repeal isn’t possible under the special budget rules.

Odds: Not going to happen

 

Repealing the individual mandate

Obamacare’s requirement that nearly all Americans have health insurance is unpopular, but as a centerpiece of the law, the individual mandate is critical to its function. Voiding the mandate would likely cause insurance premiums to rise steeply and would increase the uninsured rate, which the ACA has steadily brought down since its enactment. The mandate’s unpopularity means some Senate Democrats might feel pressure to vote for repeal, but President Obama has indicated he would veto such an action, saying Nov. 5, “The individual mandate is a line I can’t cross.”

Odds: Not going to happen

 

Repealing the medical device tax

Getting rid of one of the ACA’s revenue generators, a 2.3 percent tax on medical devices, had bipartisan support even before the recent midterm elections and is likely to come up for a vote soon. The medical device lobby is powerful and has made the case that the tax, which started in 2013, is being passed to consumers in the form of higher health care and insurance costs. The provision is expected to generate about $30 billion over ten years. The medical device tax, part of a package of new fees meant to offset costs of the ACA, is not critical to the law’s function and President Obama may agree to roll it back if he can get something in return.

Odds: Possible

 

Repealing, altering or delaying the employer mandate

The ACA requires that mid-sized and large employers provide health insurance to full-time workers. Most already did even before the law, but there’s evidence that the employer mandate is causing some companies to eliminate insurance for part-time workers or convert some full-time positions into part-time ones. The employer mandate has already been delayed multiple times, most recently earlier this year when the White House announced that medium-sized businesses would not have to comply with the provision until 2016. The requirement for large businesses is scheduled to begin in 2015, but given that the provision is not in effect for any companies yet and the White House has delayed it before means it’s a target for repeal or revision.

Odds: Possible

 

Eliminating the Independent Payment Advisory Board

The IPAB is an independent panel created by the ACA to lower Medicare payments to health care providers if Congress doesn’t act to keep the program’s spending under control. IPAB is somewhat unpopular—Republicans have erroneously dubbed it a “death panel”—but since the board seats aren’t even filled and it hasn’t taken any action, garnering enough support to get rid of it might be challenging.

Odds: Possible

 

Lower the minimum threshold for what insurance must cover

Health plans for sale through the ACA’s insurance marketplaces, or exchanges, all have minimum requirements for what they cover and limits on how much consumers must pay out of pocket. Aside from those under 30 or those who’ve been given special exemptions, who can comply with the individual mandate by purchasing high-deductible catastrophic insurance, everyone must have standard comprehensive health plans to meet the individual mandate. But Republicans have said cheaper plans that provide less coverage should be offered to more people and should meet the requirement to have insurance.

Odds: Unlikely

MONEY Health Care

How to Protect Your Heart Health—and Save Big on Medical Costs

Heart Monitor
The costs of treating heart disease in America has hit $444 billion a year. Justin Lambert—Getty Images

A single heart attack could leave you on the hook for thousands. That’s just one reason prevention pays off.

You may have heard that heart disease is America’s biggest killer, but it’s also one of America’s costliest health problems. More than a third of adults in the U.S. have heart disease, and treatment costs totaled $444 billion in 2010, according to the Centers for Disease Control and Prevention. Yet heart disease is largely preventable, and most of us can do our part to avoid it — and the associated high medical bills.

“The patient who has a heart attack and comes to the emergency room within 90 minutes and is seen immediately…can be discharged the next day and return to work in a week or two,” says cardiologist Lawrence Santora, medical director of the Orange County Heart Institute and Research Center. “The cost is about $1,000 or so for the cardiologist and $15,000 to $20,000 for the hospital.”

In fact, the average cost of treating a patient admitted to a hospital with a heart attack is $18,200 according to Medicare data. Unfortunately, you don’t get to opt for the average charge, and if an ambulance brings you to one of the higher-cost emergency rooms for cardiology, the total tab for a single heart attack could be $100,000 or more.

That’s the cost without insurance. But even with health coverage, you’ll still have to pay out-of-pocket costs, which normally include your deductible and co-insurance. The cap on deductibles this year is $6,350 for an individual and $12,700 for a family, and rises to $6,500 and $13,000 in 2015. However, that includes only what you spend on covered items. Anything that your insurance doesn’t cover is billed at full price and does not count toward your deductible.

It’s hard to know what a heart attack will cost you because every hospital sets charges for individual services. The total cost of a heart attack varies widely across the country, and even within some metro areas. To get an idea of average costs in your area, check out this comparison tool by NerdWallet.

A single heart attack with no complications isn’t common, though. “The patient who delays coming to the hospital usually has more extensive heart muscle damage,” says Santora. “This is when costs skyrocket. A severely damaged heart muscle can lead to congestive heart failure and a lifetime of future hospital admissions.”

The Best Prevention

Fortunately, it’s far cheaper to prevent and detect heart disease early. While many people are genetically predisposed to heart problems, there are two ways you can protect yourself: a healthy lifestyle and early detection. When compared to the high cost of heart disease, and especially ailments such as heart attack and stroke, these are well worth the investment.

So what does that healthy lifestyle entail? It’s not as strict or as difficult as you might think, according to the American Heart Association. Just an average of 30 minutes of exercise each day, five days per week, and a few dietary changes will do.

“Do any exercise you enjoy,” Santora says. “A reasonable target is 150 minutes of aerobic exercise per week and light weight training for 20 minutes, three times per week. Buying a pedometer and walking 10,000 steps per day is another simple method to lower heart risk.”

As for diet, that’s also pretty simple, according to Santora. Stick to a Mediterranean diet and avoid processed meats whenever possible—although steak and other lean, unprocessed red meats are fine a few times a week—to keep your heart healthiest, he says.

“Don’t focus on cholesterol,” Santora says. “The cholesterol you ingest doesn’t raise the levels in your blood—it’s animal saturated fats that do that.” In other words, eggs and plant-based cholesterol are fine.

The Tests You Need

Lifestyle changes aren’t the only preventive measures you can take. Under the Affordable Care Act, many preventive services are free, including those that help improve heart health. Obesity and diet counseling, aspirin, blood pressure screenings, and cholesterol screenings are all provided free of charge as long as you have an ACA-compliant health plans.

Early detection means visiting your doctor regularly, sometimes getting diagnostic scans like echocardiograms or CT scans, and seeking immediate medical treatment whenever you suspect heart problems. Under the ACA a visit to your primary care doctor is also free once per year. Preventive and diagnostic measures are also likely to be covered in part by your health plan, because prevention saves insurance companies money down the road as well, according to the American Heart Association.

That monthly $60 gym membership fee is looking more and more like a bargain.

Read more from NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and lower their medical bills.

MONEY Health Care

Take the Sting Out of Alternative Medicine Costs

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

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

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

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

Here are some considerations to factor into your decision.

Chiropractic

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

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

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

Acupuncture

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

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

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

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

Bar graph of insurance coverage
MONEY

Biofeedback

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

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

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

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

Naturopathy

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

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

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

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