medical

5 Common Medicare Myths, Debunked

Dan Rafter — Thu, 05 Oct 2017 08:00:06 +0000

There is no larger health insurance program in the United States than Medicare. According to the Centers for Medicare & Medicaid Services, more than 57 million people were receiving health benefits through the program as of March 2017.

But just because millions are on Medicare doesn't mean that most people, especially those who have yet to hit 65, understand how this government program works. Most people instead believe several easily debunked myths about what Medicare does, how financially healthy it is, and what it doesn't do.

1. Medicare won’t be around for me

You might worry that Medicare won't be around to cover your health care needs by the time you retire. Here's some good news: Medicare is not broke ... yet.

The Medicare program had about $200 billion in reserves at the end of 2015. So the program does have money.

There is some concern, though. Medicare is projected to run a surplus every year through 2020, when a growing number of Baby Boomers will start retiring. This means that Medicare will then run at an annual deficit beginning in 2021. If nothing is done to prevent this, the program will exhaust its reserves by the year 2028.

That will be a big problem if it is allowed to happen. There are possible solutions, though, even though they will require some financial pain. The most obvious one would be to raise Medicare taxes. That won't make anyone happy, but it is the simplest way to ensure that Medicare does have enough dollars to cover all of its beneficiaries.

2. There's only one type of Medicare

Medicare is a complicated system. In fact, there are actually four types of Medicare coverage.

Medicare Part A and Part B are part of what is known as original Medicare. Medicare Part A, known as hospital insurance, covers inpatient care received at hospitals and nursing facilities. Part B covers services and supplies that you need to treat health conditions. This part of Medicare covers outpatient care, preventive services, ambulance rides, and medical equipment.

Medicare Part C is a bit more complicated: It's the part of the program that makes it possible for private health insurance companies to provide Medicare private health plans — in the form of HMOs and PPOs — known as Medicare Advantage Plans. You can elect to receive your medical benefits through a combination of Medicare Part A and Medicare Part B or from one of these private Advantage Plans. (See also: 8 Tips for Getting the Most Out of Your Medicare Plan)

Medicare Part D subsidizes the cost of your prescription drugs. This part of the program is often referred to as the Medicare prescription drug benefit.

3. You'll never have to pay for health insurance once you're on Medicare

Medicare will cover much of your health insurance needs. But there are some costs that you'll still need to cover on your own.

For instance, Medicare does come with deductibles that you must pay before the insurance kicks in. These deductibles can change each year. For 2017, Medicare Part A comes with a $1,316 deductible per benefit period for your hospital stays. This means that if you do end up in the hospital, you'll have to pay this amount out of your own savings before Medicare will cover the rest of your expenses.

Medicare Part B has a deductible of $183 for 2017. Again, you'll have to pay this amount before your Medicare coverage kicks in. And even after Part B coverage begins, you'll still have a copay. Medicare Part B generally covers 80 percent of your medical services. You'll have to cover the remaining 20 percent of these costs on your own.

There are also coinsurance payments. If you must stay in a hospital for more than 60 days, you'll have to make a coinsurance payment for your Medicare Part A benefits.

4. Medicare covers all my medical needs

There are some medical services that Medicare does not provide any coverage for. Unfortunately, these services aren't exactly frivolous ones.

Medicare does not provide dental coverage. It also doesn't pay for vision examinations for glasses. You can't rely on Medicare to cover the costs of dentures or hearing aids. And if you need long-term care, Medicare again won't provide coverage.

You can purchase specialized insurance programs to cover these medical expenses. But you'll have to pay for the plans on your own. (See also: Is Long Term Care Insurance Worth It?)

5. I won't have to pay any premiums for Medicare

Most people won't pay any monthly premiums for their Medicare Part A coverage. That's the good news. The bad news? You will pay a monthly premium for Medicare Part B.

As of 2017, the Part B premium stood at $134 a month. Medicare, though, says that most people who get Social Security benefits pay less than that, for an average monthly premium of $109. This premium is usually deducted directly from your Social Security benefits. You won't be writing a check each month, but you'll still be paying for that Part B coverage.

You'll also have to pay a premium each month if you elect to sign up for a Medicare Part C plan. These premiums will vary depending on your plan. Medicare Part D comes with a monthly premium, too, though this will vary according to your specific plan.

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This article is from Dan Rafter of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Women Pay More for Health Care — Here's How to Pay Less

Mikey Rox — Thu, 12 Jan 2017 10:00:11 +0000

It's no secret that a variety of factors can affect your health care costs. For example, people who smoke usually pay more for health insurance, and an unhealthy lifestyle can increase the risk of chronic illnesses and lead to more trips to see the doctor. But among the many factors triggering higher health care costs, it's being a woman that's perhaps the most obnoxious.

Before the Affordable Care Act, women buying health insurance on the individual market paid premiums as much as 50% higher than men due to gender rating, a practice where health insurance providers charged women more because they were considered a higher risk. Gender rating is now illegal, but this doesn't mean women are saving big bucks on health care costs.

According to data provided by the health care company Vitals, women spend on average 69% more out-of-pocket than their male counterparts for health care. That's a huge difference — even from the now-abolished gender rating system. Considering how women statistically earn less than men in just about every occupation, many women feel the pinch. But the question remains, why do women pay more, and what can they do about it?

Women Use More health Care Services

Compared to men, women typically use more health care services, which could explain higher health care costs. Go figure. They're more likely to ask questions about their health, get routine screenings, and schedule appointments when sick. Being proactive helps women maintain their health, but it comes at a cost.

Additionally, some women experience higher health care costs because of certain procedures, including gynecologic surgeries. Women are also six times more likely to have knee replacement surgery — a cost that can soar up to $65,000 — and women are two times more likely to develop cataracts, which can cost up to $5,000 per eye to correct.

And let's not forget the cost of labor and delivery for women. That's big business with the average national cost for a routine delivery at $8,775, and the average for a C-section at $11,525. (Worse, this number doesn't include prenatal care or post-delivery care.) And even if women have health insurance, high deductibles typically mean paying a large percentage of services out-of-pocket.

Women Live Longer Than Men

Women also pay more for health care because they live on average two years longer than men. That's an extra two years of paying health insurance premiums and out-of-pocket costs for health care services. Even if a woman is healthy during her younger years, she may develop at least one ailment later in life that requires regular doctor visits, especially as she moves closer to retirement age. Studies suggest that a 55-year-old healthy woman retiring today would spend about $79,000 more than a similar man on health care costs during her final years.

How Can Women Protect Themselves From Higher Costs?

When it comes to the cost of health care, it is what it is — but there are plenty of ways for women to prepare and possibly reduce their expense.

Don't Ignore Health Screenings

Preventive care reduces risk factors that trigger many chronic illnesses and can thus lower overall health care costs. Under the Affordable Care Act, you don't have to pay for many preventive care services delivered by a doctor or medical facility within your insurance company's network. These include immunizations, annual physical examinations, colonoscopies, mammograms, and other screenings.

Make Healthy Choices

A healthy lifestyle can also reduce your number of trips to the doctor. Eat a healthy diet of fruits, vegetables, low-fat foods, and lean meats. Exercise for at least 30 minutes three times a week. Apply sunscreen when outdoors to reduce your risk of skin cancer and stay physically fit during your retirement years.

Compare the Cost of Services

To lower your health care costs, compare the cost of services at different facilities. You'll find that some facilities within your insurer's network charge significantly different prices for the same services. For example, an in-network hospital may charge $1,500 for an overnight sleep study whereas an in-network sleep clinic may only charge $600 for the same study.

Don't Underestimate Health Care Costs

Prepare for health care costs now and in the future. This includes having adequate health care coverage to reduce your out-of-pocket expenses — as much coverage as you can afford based on your present health care needs. And while you're saving for retirement, don't forget to plan for future health care costs. Women who live longer than their spouses are left to manage health care costs on their own. Therefore, look into purchasing long-term care insurance. Don't wait until you are ready to retire to buy a policy; it's more expensive once you're at that stage of your life. If you lock in a price while you're young and relatively healthy, however, you'll pay lower premiums over the long-term.

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This article is from Mikey Rox of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Health Insurance: How to Fight Back Against 4 Common Claim Denials

Anum Yoon — Tue, 20 Dec 2016 11:00:15 +0000

Denials of medical claims are all too frequent. Roughly 14% of all claims are denied every year, according to Department of Labor records. Not only that, but almost 10% of claims processed by insurance companies contain errors. Your claim could have been denied because it was coded as a different procedure than what you received from the doctor!

There is a silver lining in the clouds of denial or error, however. You can always appeal a health care claim denial. Patients who appeal win about 50% of the time. Not only that, but the more familiar with health care claims you become, the more you will learn about what's covered — and what is not.

The passage of the Affordable Care Act (ACA) increased rights to appeal, whether you are covered under ACA or not. Think of it this way: You or your employer, or both, are already paying a hefty price for health care. Appealing your denial and knowing how to determine errors is part of getting what you and your company have already paid for.

Before You Appeal: Know the Codes and How to Appeal

Any appeal to a health insurance company has to contain some basic knowledge of the information they provide you, as well as your rights.

After a visit to a physician's office or a procedure, you will receive a form called an Explanation of Benefits (EOB) from the insurance company. An EOB arrives for all claims, approved or denied. It details what was charged, what the insurance company paid, and sometimes a remainder of what the patient is responsible for.

If a claim was denied, it will receive a code. Most insurance companies provide a key to the code. (Check the back of the form.) If it does not, call and ask the insurance company what the code means.

The Four Most Commonly Denied Claims

At times, knowing the code will immediately help you appeal a denial. Sometimes the denial is the result of sheer error. Here are the four most commonly denied claims.

1. Your Plan Does Not Cover the Procedure

If the code indicates that the denial occurred because the plan did not cover the procedure, check your plan to see if it is, in fact, covered. If you received a vaccination, for example, double check what kinds of services your plan covers. Many plans cover preventive care (care received to prevent disease before it begins, rather than to treat a condition that exists). Vaccinations and flu shots are both examples of preventive care. This type of denial is surprisingly common.

A similar situation can occur with vision claims. You may receive a denial stating that vision care is not covered. However, many policies cover eye care if it is needed medically. People with diabetes, for example, are covered for annual exams because the condition can affect vision, while regular eye exams are not. Plans can cover surgery for cataracts, but not eyeglasses.

Errors of this kind can be appealed fairly easily. If you were denied because of lack of coverage and the procedure was in fact covered, call the health insurance company. Be sure to make note of the name of the person you spoke to, their title, and the date.

2. Errors in Coding

Knowing the code can also help you discover a coding error. You may find that the code for the service doesn't actually match what you visited the doctor for. The procedure or diagnosis code could have been entered incorrectly. You should also check every piece of information, including your name, date of service, place of service, and provider number. If any of these are erroneous, it can result in a denial.

If you find a coding error, call the billing office of the doctor or hospital involved and ask them to resubmit the bill with the correct code. Again, it's vital to get the name of the person, their title, and the date.

3. Payment for a Procedure Was Included in the Allowance for a Related Procedure Performed the Same Day

Patients are not responsible for a charge like this. Call your provider's office and ask for an adjustment to the bill.

4. You've Reached the Maximum Amount of Times a Service Is Covered

Again, the best action is to double check your policy. Is it true that it is only covered a maximum amount of times? If there is a dollar limit, check it against what you received. Contact your insurance company in the case of any errors.

For a denial of this type, check what the provider's discount is as well. Many doctor's offices and suppliers contact an insurance company to set a price for goods and services that is less than the market rate. You could be charged the market rate unless you specifically follow up about the discount. Even if you are denied legitimately for the maximum number of times a service is covered, you are still eligible for the discount the provider offers.

Given the frequency of denials and related errors, it's wise to be on your guard every time a denial is issued. Don't assume the denial is correct! Appeal and follow up on your appeals as needed.

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This article is from Anum Yoon of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Everything You Need to Know About Buying Travel Insurance

Nick Wharton — Thu, 14 Jul 2016 09:00:12 +0000

Choosing the right travel insurance can be a difficult task. With so many policies out there and all with differing service and ease of claims, your head might start to spin. Do you like to scuba dive, sky dive, or high dive? You better make sure you're covered for that. Are you carrying expensive electronics? They should be insured if they're lost or stolen.

There's a lot more to choosing the right travel insurance than just finding out how high your hospital bills might be. Let's break down the basics so that you can make an informed decision about which travel insurance is right for you. (See also: The Dirt on Travel Insurance)

Travel Insurance Isn't Just Medical Coverage

Before I get started with the five things you should consider before buying travel insurance, I should clarify that travel insurance can cover you for a lot more than just medical emergencies. Most people who are thinking of buying travel insurance are doing so because they're worried about a hospital visit.

But you can make claims for stolen goods, broken cameras, canceled flights, family emergencies, lost luggage, and so much more. A good travel insurance policy is basically a universal protection plan to ensure that you're covered for whatever the road throws at you.

What Is the Coverage Limit?

When looking at a travel insurance policy, one of the first things you should look for is the maximum coverage limit on the plan. If you're only covered for $5,000, there's not much point. Medical emergencies can cost tens of thousands of dollars, or even hundreds of thousands depending where you are and what happens to you.

A solid plan will cover you for at least $100,000. This limit can go all the way up to $1 million. A high coverage limit is extremely important when choosing travel insurance because if you are injured, fall ill, or need serious medical attention while on the road, you want to make sure that no matter how high the hospital bills are, you won't end up paying out of pocket.

The worst thing that can happen to you in a medical emergency is being stuck in a hospital because of a serious injury or illness and then coming out of it and realizing that you owe thousands of dollars. Make sure your plan has coverage of $100,000 or more.

What Activities Are Covered?

What kind of traveler are you? Will you be doing adventure activities like rock climbing, desert safaris, scuba diving, horseback riding, and mountaineering? You should always check your policy to ensure that you're covered for any activities you plan on partaking in.

You may expect that travel insurance will always cover you for whatever endeavors you get up to while on vacation, but that simply isn't true. Different plans cover different things and the more adventurous you are, the higher your insurance rates will likely be.

World Nomads has some of the best travel insurance for backpackers and long-term travelers. They allow you to start your policy while you're already on the road, they make it easy to make claims, and you can keep your policy going year after year.

The best part is that they cover you for a huge variety of wacky travel activities. Just look at their list of coverage:

What Gear Is Covered?

One of the best parts of a good travel insurance policy is peace of mind, knowing that your electronics and travel gear are covered if lost or stolen. A good travel insurance policy will reimburse you if anything happens to your valuables.

The issue with extra coverage on electronics is that most companies have a pretty tight limit on what they will reimburse you for. Generally $500 is the maximum payout for any lost or stolen electronics. Given that the average laptop costs $1,000 these days, and a camera can be even more than that, $500 doesn't go very far.

If you're traveling with a lot of gear, you may want to consider buying extra insurance through a specified electronics insurance plan. Clements Insurance offers special coverage for your electronics. They'll allow you to make claims on unscheduled receipts up to $10,000, meaning that you don't have to pre-submit your receipts and the cost of your laptop and camera will probably be covered.

Does the Policy Include Emergency Evacuation?

Emergency evacuation and care is an extremely important part of any travel insurance policy. You want to make 100% sure that if you're in a life-threatening situation, you will be covered for medevac, ambulance, and emergency air lift.

The cheapest emergency air ambulance is probably going to cost you $10,000 or more, with international medevacs costing upward of $40,000. That's a purchase you don't want to add to your travel budget.

If you're canyoneering in Utah and you fall and break your leg, your policy should cover your evacuation to the hospital. If you're in Thailand when a tsunami hits and you need to be evacuated to a safe place, your plan should cover that as well. Any good plan should cover a medical evacuation expense of up to $300,000 USD.

There are also times when an evacuation means that you need to be flown from a hospital to your home country. Standard emergency evacuation usually includes this provision, but you should always check with your insurance provider to make sure. Believe me, you don't want to pay for a medevac from Indonesia to the U.S.

How Easy Is It to Make a Claim?

Just because you have travel insurance, doesn't mean that you can easily call them up at a moment's notice, tell them what happened, and they'll send you a check.

The quality of service varies greatly from provider to provider and some make it very difficult and frustrating to make claims. The best companies will allow you to make a claim online and they may have a list of hospitals and clinics that they work with directly so they can pay the bills without you having to pay out of pocket.

Keep in mind that travel insurance companies are just that — companies. They're in the game to make money, so they're not waiting next to the phone, ready to hand out checks to every person who calls in. Even the best travel insurance companies can take a long time to reimburse you.

To try to speed up the inevitably slow process, make sure you have all your receipts, necessary forms, and proper documentation when making the claim, and keep it organized until you have been fully reimbursed.

A Few Other Things to Consider

Multiple Countries: Some policies only cover you for pre-specified destinations, while others won't cover you at all for countries with government travel advisories.
24-Hour Emergency Service: If you're having a medical emergency, you want to make sure that your insurance provider will be there to help you, no matter what time of day or night you call in.
Family Emergencies: If you're on a long trip and something happens to a loved one back home, your travel insurance policy should cover your flight home to be with that person.
Flight Cancellation Costs: If you have to pay for a hotel, another flight or some other kind of transportation booking because your airline canceled your flight last minute, your travel insurance should cover the costs.

Do You Need Travel Insurance?

Ask anyone who has been in a medical emergency overseas without coverage. They'll say yes. Ask any traveler who had medical insurance and thanked their lucky stars that they were covered. They'll say yes. A good travel insurance policy will likely only cost you a few dollars a day, but it could potentially save you tens of thousands of dollars if something does end up happening to you or your possessions.

Insurance is the one thing that every traveler should buy before going on a trip, but it's something that you hope you never have to use. Do your research. Find a travel insurance provider that is right for you and make sure your policy covers everything you need.

Have you ever purchased travel insurance? Did you need it?

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This article is from Nick Wharton of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

4 High-Paying Medical Jobs You Don't Need an MD For

Samantha Stauf — Fri, 17 Jun 2016 09:00:05 +0000

Doctors are the rock stars of the medical world. They complete life-saving procedures, diagnose complicated illnesses, and in their free time, enjoy a lavish lifestyle from their six-figure salary. Doctors make a lot of money, so it's not surprising that "doctor" is commonly listed as one of the top dream jobs of children in the United States.

By the time children reach adulthood, most realize that the high salary often correlates with a huge time commitment. Doctors typically spend eight years as a medical students and then can spend another three to eight years completing a residency before they become a fully independent doctor. For those who want to work in the medical field, but cannot commit more than eight years to receive highly intensive medical training, there are other medical career options to pursue. Here are some other lucrative job options.

Nurse Practitioner

Nurse practitioners are RNs that have completed a Master of Science in Nursing. According to Ohio University, NPs typically make an annual salary around $100,000.

The salary might be around significantly less than a doctor's salary, but it only takes anywhere from 15 months to 24 months to complete an MSN degree (depending on education level). If a nursing student took four years to complete a BSN, it will only take around another year or so to become a certified NP.

What's so special about NPs? Right now in 16 states and Washington D.C., nurse practitioners can work without the oversight of a doctor. This means that NPs can open their own health clinics in some states.

Health Informatics Specialists

Health informatics specialists are responsible for monitoring and helping health establishments as they utilize various pieces of technology. Job duties often include training staff how to use technology, creating written and visual guidelines on how to properly utilize technology, and helping hospital staff as they have problems with the technology in the hospital.

Health informatics specialists typically make on average around $61,050 per year. Lower end health informatics jobs don't always require a college degree. These have an annual salary in the $35,000 range. Not bad if you consider that you won't be paying off student loans.

For slightly higher paying jobs, individuals can either pursue a four-year bachelor of computer science or a bachelor of science in nursing. The RN trajectory tends to be slightly more competitive and offers a slightly broader range of potential jobs (including informatics nurse and clinical informatics specialist).

Biomedical Engineer

Biomedical engineers are responsible for creating, designing, installing and maintaining the equipment, computer systems, and software utilized in different health care settings. They're not working directly with patients, but the tools they create and maintain are vital to an efficient and safe medical setting.

The amount that biomedical engineers are paid is dependent on where they work. Hospital biomedical engineers make an average annual salary of $72,060 per year. Biomedical engineers that work for companies designing equipment can make around $91,000 per year.

There are a few paths individuals can take to become a biomedical engineer. They can complete a bachelor's program in biomedical engineering or bioengineering. Or they can complete a bachelor's degree in engineering and either take biological science electives or complete a biomedical master's program.

Health Care Entrepreneur

If you have dreams of starting your own business, you might want to consider becoming a small business owner of a health care franchise. The franchise business model (most commonly known for the fast food business model) has become a fairly lucrative business model for senior care and home care.

According to Forbes, start-up costs for health care franchises are lower ($150,000 or less) than they typically are to open a fast food franchise ($500,000 or more). Revenue for home health care businesses are currently high and as more baby boomers begin to need the services, those numbers will continue to skyrocket.

Becoming a franchise owner doesn't have any educational requirements. The only requirements tend to be the ability to meet a certain cash investment without the help of small business loans. Franchise owners must also commit to uphold set franchise rules and standards.

Like all business ventures, opening a health care franchise is a risky venture. There is a chance that you will fail to create a lucrative business, so have a solid game plan before you commit.

Have you explored a career in the medical field? Share with us!

This article is from Samantha Stauf of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

5 Things You Must Know About Health Care Open Enrollment

Shannah Game — Wed, 18 Nov 2015 14:15:40 +0000

It used to be easy. You got a benefits package at work, selected your health care plan, and your company footed most, if not all, of the monthly premium. But health care reform has brought some changes, and that includes the open enrollment period during which individuals select health plans.

Open enrollment for health insurance is November 1 through January 31, 2016, and vanishes just like Cinderella's glass slipper until this time next year. (Some exceptions to the open enrollment period exist, such as marriage, childbirth, or loss of employer-provided insurance.) That means that you've got no time to be lazy when reviewing your health care plan options for 2016 — and no excuse for not knowing the essentials of picking coverage.

Here are the five health insurance basics you must know before selecting a plan during open enrollment season.

1. Name That Plan

Plans change names, and it's common for the plan you had last year to completely disappear and suddenly be replaced by one that you don't recognize. Still, your insurance provider should notify you of any name changes to your existing plan, and provide annual renewal options that'll make the new name (and any other plan changes) clear. Also, keep in mind that a plan's name is less important than its premium, deductible, and benefits; if you can't find the plan you want by name, try searching by benefit levels and price, or contacting the insurer directly to inquire about new options.

2. Three Powerful Letters: HSA

Many employers are now offering what is called a high-deductible health plan. And if you have such a plan, you may be able to take advantage of a powerful addition called the Health Savings Account. HSAs allow you to sock away money to pay for your out-of-pocket health care costs — things like contact lens exams, prescriptions, doctor visits, etc. The beauty of the HSA account is that it's tax deductible — any money you place into this account can be deducted from your taxes the following year. In order to use this benefit, you've got to make sure that your health policy says it's an HSA compliant plan. Check with your HR department for guidance on HSAs.

3. Understand Deductibles

If your deductible is $5,000, then it means that any health care costs you incur during that year up to $5,000 will be your responsibility to pay. Once you hit that $5,000 mark, then your health plan will start covering some or all of your expenses (the percentage also varies by plan).

It doesn't matter if you have an HMO or a PPO — you will most likely have a deductible. Some plans will have a $0 deductible, and others a deductible of many thousands, but nevertheless, it's critical that you know what your deductible is. That is the amount that you'll be responsible for before your insurance kicks in.

If you don't have a large emergency fund saved and finances are tight, you might want to consider a lower deductible plan, even if it costs you a bit more per month. It may sound counterintuitive, but paying an extra $50–$100 a month for a lower deductible plan is probably a lot easier than suddenly coming up with $5,000 to pay the deductible on a hospital bill. In the end, there are no right or wrong choices when it comes to deductibles, but you must know what yours is — and be comfortable with that amount.

4. You Pay This, They Pay That (AKA Copay)

Your copay and deductible are like peanut butter and jelly — it's hard to have one without the other. Once you've hit your deductible amount, then your insurance enters the copay zone. This is when your health plan will start to pay a larger percentage of benefits towards your medical expenses.

For example, let's say your deductible is $2,000 and you've had a surgery this year, blowing past that deductible amount. You are now in the copay zone, and according to your plan, your copay amount is 20%. That means that you will owe 20% of all future medical costs for the rest of the year, and your health care plan will pick up the remaining 80%.

The higher the copay, usually the lower the monthly premium on your health plan, because you'll be picking up more of the bill. The key is picking a plan with a deductible and a copay amount that you and your budget can be happy with.

5. Out-of-Pocket Max

There's one last piece to talk about, and it may be the most important. Your out-of-pocket max is the maximum amount of money that you will have to pay toward your health care in a year. These numbers are usually larger than your deductible amounts. According to the Affordable Care Act, the max out of pocket for 2016 will be $6,850 for an individual and $13,700 for a family plan. These numbers are especially critical to know if you're planning on major surgery or have a serious medical condition requiring ongoing treatment. Purchase coverage and plan your finances accordingly.

Are you ready for open enrollment?

This article is from Shannah Game of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

7 Places to Get Vaccinated for Cheap or Free

Damian Davila — Thu, 27 Aug 2015 11:00:15 +0000

Less than half of Americans were vaccinated against the flu during the 2013–2014 season.

The statistics for other types of immunizations are even more discouraging:

21% of adults with high-risk conditions have received a pneumococcal vaccination;
24% of adults over age 60 have received a shingles vaccination; and
17% of adults have received a Tdap (tetanus, diphtheria, and pertussis) vaccine in the last 8 years.

While there may be many reasons why people aren't getting vaccinated, cost shouldn't be one of them. Here are seven places to get immunized for cheap or free.

1. "Stop Flu at School" Programs

During the fall, most state Departments of Health in the country offer free flu vaccine programs at participating public, private, and parochial schools. For example, the Hawaii State Department of Health provides flu shots to over 65,000 students statewide every year through its Stop Flu at School program.

Participation in school vaccinations is voluntary and requires permission of a child's parent or legal guardian. Check with your school whether or not it's participating in a flu vaccination program and inquire about more details, such as necessary consent forms and available methods of vaccine delivery.

2. Your Workplace

Every year, nearly 111 million U.S. workers get sick with the flu, costing about $7 billion per year in sick days and lost productivity. Even more troubling is that adults ages 18 to 64 account for about 35% to 40% of flu hospitalizations. If you're the main breadwinner at your home, you need to take action to protect yourself and your loved ones against preventable diseases and potential financial strains.

This is why many businesses are offering free flu shots and other types of immunizations to their employees. The larger the organization that you work for, the higher the chances that your workplace offers at least one type of immunization for free. Check with your HR department for more details.

3. County Health Department Programs

Many county health departments offer immunization services that have lower prices than private pharmacy service providers.

For example, the cost of a hepatitis A/B (Twinrix) vaccine at the Washoe County Health District is $63, while the cost of the same vaccine at Costco is $109.97. Another example is the State of Hawaii, Department of Health, which offers free or low cost vaccinations for persons without health insurance.

Keep in mind that most county health departments require an appointment and walk-ins often result in long waiting times. Check with your local county health department for more details.

4. Participating Locations Through the Health Insurance Marketplace

Thanks, Obama.

Per the Affordable Care Act, all health care plans sold through the health insurance marketplaces must cover certain preventative services, such as immunizations, without charging you a copayment or coinsurance.

Here is a list of the covered immunization vaccines for children and adults:

Hepatitis A
Hepatitis B
Herpes zoster
Human papillomavirus
Influenza (flu shot)
Measles, mumps, rubella
Meningococcal
Pneumococcal
Tetanus, diphtheria, pertussis
Varicella

Check with your insurance provider for details about where you can receive immunizations for free. To get a list of locations near your zip code that may accept your insurance plan, you can also use the vaccine finder offered by Vaccines.gov.

5. Costco

Assuming that you have no health insurance, you need a flu shot right this minute, and are ready to pay out-of-pocket, your best bet is to visit a Costco Pharmacy. At $14.99, Costco offers the most affordable flu shot (influenza) to anybody that doesn't have insurance and is ready to pay out-of-pocket. Costco also offers types of vaccines, such as pneumonia and shingles.

No Costco membership? No problem. Immunization services are one of the seven things non-members can get at Costco.

6. Target

If a Target offering flu shots happens to be more convenient for you than the nearest Costco warehouse, then you can take advantage of Target's price match guarantee to lower the cost of your immunization.

Bring proof of the listed price for a flu shot at a nearby Costco and Target will lower the price of its original flu shot from $23.99 to $14.99. Call your nearby Target location for more details and a list of available immunizations for children and adults. (Note: Target stores in Hawaii and Alaska are excluded from the price match program.)

7. Sam's Club

Neither a Costco or Target nearby? Head to the nearest Sam's Club that offers pharmacy services. Non-members don't need a Sam's Club membership to buy pharmaceuticals and Sam's Club doesn't charge extra for those purchases.

If you do have an insurance plan, it may entitle you to a free flu shot at qualifying Sam's Club locations. The cost of a flu shot is at Sam's Club is $15. The big box retailer also offers other types of immunizations.

Where do you get immunized for cheap or free?

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This article is from Damian Davila of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Follow These 5 Steps to Full Health Care Coverage in Retirement

Carrie Kirby — Thu, 14 May 2015 15:00:09 +0000

Are you sure you'll be able to afford healthcare in retirement? Positive?

Consider this: A recent report analyzing the rising out-of-pocket Medicare costs estimated that people retiring 10 years from now will spend $9 of every $10 they receive from Social Security on health care, in the form of copays, supplemental insurance premiums, prescription drugs, and things not covered by Medicare such as visits to the dentist.

This means that the cost of medical care is something everyone should factor into their retirement saving plan. But this is no ordinary expense — there are specific strategies for saving for health care that can put you in a much better position in your golden years.

1. Maximize Your Social Security Benefits

"The number one thing people should do — most people aren't aware of this — is optimize Social Security," says Ron Mastrogiovanni, founder of HealthView Services, which issued the alarming report.

The main way to maximize benefits is to wait as long as possible to start receiving Social Security. A couple retiring 10 years from now at age 65 will receive $142,000 less in lifetime benefits than they would if they worked until age 67, he said.

"If you're capable of working, why would you throw away $142,000?" Mastrogiovanni says.

2. Start a Roth IRA

"Under Medicare, they have something called means testing; the more you earn, the more you pay," Mastrogiovanni says. "Here's the kicker: Those income brackets are not indexed to inflation." That means that if the government doesn't adjust the income at which retirees are considered affluent, many middle earners of today will end up paying more once they retire.

But not all retirement income is counted in this calculation. Money drawn from a traditional 401(k) counts, but money drawn from a Roth IRA or a Roth 401(k) doesn't. So if your regular 401(k) is building up towards a high income in retirement, you might want to divert some of your contributions to a Roth, or convert the account to a Roth, to keep your income below the level where you'll be considered an affluent retiree.

3. Consider a Health Savings Account

Health savings accounts are not generally considered a retirement savings vehicle — they are meant to help people pay high medical care deductibles with certain insurance plans. But Medicare expert Katy Votava advocates saving excess contributions to HSAs for retirement health care needs.

"You can put in significant money and it grows tax free. Most people don't need to spend their full health savings account every year to meet their full health insurance needs," Votava says.

4. Consider Long-Term Care Insurance

The high out-of-pocket costs outlined in the HealthView report do not include the cost of nursing homes or other long-term care, but those are obviously a major concern when looking at lifetime health care costs. Some advisors recommend purchasing insurance that would protect your savings if you go to a nursing home, while others warn against it. This Wall Street Journal report explores both sides of the long-term care insurance issue.

5. Purchase the Right Supplemental Plan

Your parents or grandparents may not have had to pay anything out of pocket once they qualified for Medicare, but people retiring now and in the future need supplemental insurance to cover the copayments, coinsurance, and deductibles that Medicare doesn't cover. You'll also have to pay for a prescription drug plan. Choosing the right plan can be so complicated that many people turn to consultants like Votava to help them figure out which to pick. Before signing up for a plan, make sure it covers your doctors and your medications, because not all plans cover everything, Votava warns.

What are you doing to ensure sufficient health care coverage in retirement?

This article is from Carrie Kirby of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Best Money Tips: Save on Medical Costs and Improve Your Family’s Health

Ashley Jacobs — Wed, 30 Jul 2014 19:00:06 +0000

Welcome to Wise Bread's Best Money Tips Roundup! Today we found some amazing articles on saving on medical costs and improving your family's health, things you need to throw away, and remaining frugal while traveling.

How About a Price List at the Hospital or Doctor’s Office?

Paul Michael — Fri, 21 May 2010 13:00:04 +0000

In the past, I’ve been lucky enough to have very good health insurance. And before health insurance, I had the National Health Service in Britain. So it’s fair to say I haven’t really been fully invested in the healthcare debates that have steadily increased in the U.S. over the last few years. However, after recent events in both my life and the lives of friends and family around me, I am becoming more and more frustrated (and outraged) at the current state of healthcare in this country.

In my days in England, a trip to the Emergency Room was just something that happened. Costs were not considered as it was all paid for through taxes. If you got sick, you went to the E.R. The same applied to any other kind of care, including routine operations, dental work, mental health and more.

But fast forward a decade and I find myself looking at medical bills that just leave me scratching my head. And I know I’m not the only one.

Recently, my wife was having very intense pains her arm, enough for her to call me crying in agony. I obviously told her to go straight to the doctor, but he couldn’t see her. There were no appointments for days. That left the E.R. So, she managed to get herself there, with two kids in tow, and received treatment. She was in the E.R. for an hour or so, had some X-Rays, a shot of muscle relaxer, and was given a prescription for the pain.

The co-pay for that little excursion was $150, which we happily paid. $150 for treatment and peace of mind that my wife was OK seemed a small price to pay.

That was just the start of the bills. A few months later, we received a bill from the doctor on call that day, for around $600. And then, a week later, another bill from the hospital, and this one was close to $3,000! I couldn’t believe it. Less than 90 minutes in the E.R. a couple of X-Rays and a shot of muscle relaxant came to the same price as a very nice 1 carat engagement ring!

I looked through the bills and got nothing from them. They were muddled, confusing (purposely I believe) and used terminology that was impossible to decipher.

Our insurance company negotiated a big chunk of it for us, but we’re still out of pocket for much more than we can afford this month, and next month, and the month after. We will have to pay it, of course.

Then I started asking around and heard very similar stories. E.R. visits are costing people a fortune. A real fortune. And people have neither the knowledge nor the abilities to fight the bills and decipher the confusing medical terminology. Overbilling is rife in the medical system, and if you are not an insurance company with a staff of experts on call, you’re out of luck, and out of pocket.

A friend of mine recently went to the E.R. suffering from chest pains. They ran a few tests, kept him in overnight, and discovered he had a pulled muscle in his chest. The prescription for ibuprofen helped. The bill a few months later for over $12,000 almost put his heart under serious pressure.

If he had known of the costs before he agreed to the treatment, he could have made the decision to check himself out of the E.R. and spend the night at home. That alone would have cut the bill in half. He could the have came back the next day if the pains continued.

If my wife had been given a quote before her treatment, before she was admitted, of the $3800 bill that was about to be given to us, she may have asked for just the muscle relaxant and pain meds. No X-Rays, no 90-minute stay.

In fact, in most other professions, including the practice of law, you are given price quotes before you agree to anything. “My retainer is $1,200” a lawyer will say “and $300 an hour after that.” If you go to a mechanic, you are told the financial damage before anyone puts a wrench in the engine. At a restaurant, the prices are on display. Come to think of it, I can think of very few professions, if any, that have the billing free reign of the hospitals and doctors. It almost seems arbitrary what they can charge.

On a recent bill a doctor friend of mine received, he noticed a tetanus shot was priced at over $300. The actual price of the shot is under $30, and he should know…that’s what he pays. How can something be priced up by a factor of 10?!

Some will say that we shouldn’t know the costs, as it will stop the doctors from doing their jobs. Maybe. Maybe not. But I do know that as the price of healthcare continues to skyrocket with no oversight, and more and more families going bankrupt or falling deeply into debt because of medical bills, something must be done. And a price list at the entrance to the hospital or doctor’s surgery is start. A quote for the services about to be performed, even better. At least you don’t get a nasty surprise months after the event.

Do you agree? Do you have a better solution? Have you experienced nightmare medical bills. Let us know, and tell us how you handled them. In the meantime, I would strongly suggest everyone budget for unexpected medical costs, even if it's just $50 - $100 a month. Hopefully, you won't need to dip into it, but with healthcare costs becoming more and more outrageous, something tells me that won't be anywhere near enough.

This article is from Paul Michael of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Financial Peace in Hard Times

Catherine Shaffer — Tue, 30 Sep 2008 15:08:02 +0000

Six months ago, I had plans. Lots of them. Career plans. Vacation plans. Financial plans. Then everything fell apart. My mother became ill. She had already been ill, having been diagnosed with cancer in 2005. However, her general health deteriorated drastically in March, and there followed five weeks of hospitalization, followed by a major life change. She moved in with me, and I became her primary caregiver.

One crisis followed another. When we thought we had her other health problems resolved, we learned the cancer was back. For a long time it seemed everything was getting worse, and suddenly we were spending more time in the Emergency Room than some of the people who actually worked there (or so it seemed). I started to feel like I was friends with the security guard who printed out my badge each time. Unlike on television, you tend not to meet the same doctors and nurses on repeat visits—in fact, over the course of maybe a dozen emergency trips, we never saw the same medical staff twice. Only my friend the security guard. In the middle of all of Mom's health problems, my husband fell ill, and also made a couple of trips to the hospital.

I am pretty sure there was a whole month where we had a doctor's appointment or a hospital stay every single day. One day, after a long and stressful summer, I decided that, for once, I was going to take my son to the pool with friends and relax. And so I did. I sat there in a pool lounger, knotted up with tension from my scalp to the soles of my feet, and things seemed slightly better. I told my friend, “I think I am starting to relax.” Then I got home and my neighbor told me that an ambulance had arrived to take Mom away. That's how my summer went.

Where am I going with this? Well, all my plans were dashed to matchsticks. The career plans got put on hold. The vacation plans went down the toilet. Everything was postponed, canceled, or ruined. Except for those financial plans. See, last year, my husband and I got serious about paying off all of our consumer debt, and getting on a robust budget that included savings for many of life's little surprises. I began keeping track of every penny we spent, and aggressively paying off our creditors. I used much of Dave Ramsey's program, and established a $1000 emergency fund. At first, it was difficult. With the increased credit payments, we were barely breaking even every month. Twice within the first six months, I had to dip into the $1000 emergency fund and then repay the fund.

Sooner than I thought, we sent in our last credit card payment, and shortly after that, our last car payment. All of a sudden we were debt free except for the mortgage. That was in March.

And you know what happened in March. So here's the thing. All of that planning and work carried us straight through to today. We've had a couple of automobile breakdowns, a couple of budget overruns, some ups and downs in income, and one very strange pet accident. We've eaten far more restaurant meals than any budget-conscious family should. Gas prices have gone up. Groceries have gone up. But we're okay. I was able to pay in cash for every unforeseen emergency, and focus on what mattered most—my family and my health. All of the sacrifices we made to get on top of our consumer debt were absolutely worth it.

This article is from Catherine Shaffer of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Refactor Your Budget Categories

Philip Brewer — Sat, 17 May 2008 16:02:28 +0000

There are a lot of budget templates out there. Any will serve the purpose, and if you've got one that's working for you, that's a good enough reason to stick with it. If you don't have a budget, though, or if you're going to be changing your budget categories around for some other reason, I've got some thoughts on what makes a good category. (See also: 8 Tips for Improving or Starting a Budget)

My own thinking in this area dates back some 15 years, to when I was setting up spending categories in Quicken. The software came with some default categories, but I found they didn't suit me. I was reminded of this just recently, when (working on another post) I was looking through the Bureau of Labor Statistics document that lists the relative weights of various categories of spending. I was intrigued to find that their categories look a rather lot like mine.

My Categories

When I was designing the structure of my categories, the first change I had to make was to get rid of a top-level category for insurance. Instead, I put insurance expenses where they belong: auto insurance under transportation, health insurance under medical, and homeowner/renter insurance under housing.

I also eliminated a top-level category for utilities. I put the power bill under housing. (I'd put heat, water, garbage, sewer, etc. there too, but those items are included in the rent where I live right now.) I put the cell phone and internet charges in a new top-level category for communications, and put postage there as well.

In addition to putting car insurance under transportation, I made sure to put all my smaller transportation expenses there as well — not only fuel and car maintenance, but also bus tokens and bicycle maintenance. Having them all right together makes sure that I know just how much owning a car really costs compared to the alternatives. (See also: How to Cut Car Ownership Costs)

Categories Matter

Budget categories are important — they can either illuminate or obscure our spending choices. For example, does the fitness center membership go under entertainment, or under medical? You can make a case for either. Your choice is driven by your values, and by your view of how the world works. But be aware that it will influence your future behavior. (For example, suppose you decide to cut your spending and start by looking for something to trim from the entertainment budget. Is the fitness center membership there, or safely tucked away under medical?) (See also: How to Trick Yourself Into Better Credit Card Behavior)

As I said, the Bureau of Labor Statistics categories turn out to look a lot like the categories that I used. In particular, they put both insurance and utilities in almost exactly the same categories where I put them, except that they had a merged top-level category for "education and communication" which does include phone, internet, and postage — but also has tuition, text books, child care, and nursery school.

Because our categories match up so well, it was easy for me to see how my spending compared to the average consumer. That's not an important comparison — my spending is influence by my own values, so there's no particular reason that it would look especially like that of the average consumer — but for me it was an interesting comparison. For example, because we live in a cheap apartment, our housing budget is a much smaller fraction of our total budget than the average consumer's. Our spending on food, clothes, and entertainment, though, is roughly in line with the average consumer. My budget line-item for medical is hugely higher than average, because I'm about to go out and (try to) buy my own medical insurance, instead of getting it as an employee benefit.

Looking at the BLS categories would be especially useful if you're creating your first budget, in that it's going to have lots of categories that you probably wouldn't think of. Many of those categories will come in at zero and should just be left out. (We don't have a line item for "renting and repairing medical equipment" or for "moving, storage, and freight.") But it's a useful memory-jogger to see the long list of categories and think, "Oh, yeah, we do need to budget a little something for new sheets and towels." The average urban consumer, for example, allocates 0.555% of the budget to "Club dues and fees for participant sports and group exercises." If you do yoga or aerobics or tai chi or belong to a softball league, you'll want to have the expense as an item on your budget.

As I say, if your budget is working for you, there's probably no good reason to change it. But if you're changing your categories anyway for reasons of your own (or making a new budget), you could do much worse than basing your categories on those used by the BLS.

This article is from Philip Brewer of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

I'm Fleeing The Country For Healthcare!

Amy B. Scher — Fri, 07 Dec 2007 00:08:53 +0000

It’s all the buzz lately as healthcare costs rise, and especially after Michael Moore’s SICKO caught the attention of the masses. Those of us not living in places where everyone seems to get a free ride on the healthcare wagon are up in arms. Yet, we don’t seem to hear enough from those who take the leap and leave their home country in search of less expensive (and often higher quality) care. So, how can we know if it’s worth the trip? I’m going to India to find out. There are a million questions spinning around about this subject and I want to hear from WB readers. Maybe together we can bring light to this important issue. Please post questions on this thread and let me see if I can dig up some answers for all of us.

The term “medical tourism” equals big business. It was originally connected to boob jobs and face lifts in faraway lands. Now, it’s not so. People are leaving the country for major medical procedures such as cardiac surgery and organ transplants, which are depending on the country, often 5 to 10 times lower than the cost in the states. A bone marrow transplant that could cost approximately $250,000 in the U.S. is about $26,000 in India. Some countries are offended by the coined term of “medical tourism” because of its negative connotation. It’s regularly associated with people setting off to vacation-type destinations for cosmetic surgery at upscale spa-like facilities. These countries want credit for being just as technologically advanced in medicine as we are – and in many cases, even more so.

After navigating the medical maze all across the United States for years, I’m getting on a plane and going to New Delhi, India Dec. 9th for treatment that’s not legal here – embryonic stem cell therapy. After developing severe neuropathy (nerve damage in my limbs) at the age of 25, I began a journey that I could have never imagined would lead me nearly 8,000 miles from home. Earlier this year, I discovered that the neuropathy, along with a host of other serious health problems, was due to an undiagnosed case of Lyme Disease and other infections transferred from the tick that bit me. I do believe long-term antibiotic therapy is helping to control the Lyme bacteria. Unfortunately, my immune system, nerves and tissue have all been compromised over this time period. This is an ongoing battle for me - one that has amazing financial consequences as my health insurance denies claims and prescriptions left and right. I believe embryonic stem cells will help to restore my body. To me, it’s priceless to be able to receive this type of treatment because it’s a chance at a healthy life I don’t have the opportunity for here. In addition, maybe it will put an end to or at least curb future medical costs by helping my body heal instead of masking its problems. Even if the treatment was available in the U.S., I’m confident the cost would be astronomical and not covered by insurance.

Some are adamant there is high risk associated with leaving the country for medical care, but I’m not worried. I’ve suffered long enough, researched and utilized western medicine (which I’m thankful to have) - but now it’s time to step outside of the box. The average cost for procedures and care in India are about 1/5 what they are in the west; it’s one of the biggest pharmaceutical distributors to over 180 countries; and clinical outcomes for surgeries and treatment are par with the world’s best centers. To me, not following this road would pose the biggest risk of all – possibly at the cost of my future health.

If you want to follow my India trip, you can do so at www.HealthcareHacks.com over the next two months. But, I'll be back on WB to report what the quality, cost and attitude of healthcare is in a country that’s third-world by most standards, but ironically can offer more than available in many flourishing countries.

This article is from Amy B. Scher of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

medical

5 Common Medicare Myths, Debunked

1. Medicare won’t be around for me

2. There's only one type of Medicare

3. You'll never have to pay for health insurance once you're on Medicare

4. Medicare covers all my medical needs

5. I won't have to pay any premiums for Medicare

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Women Pay More for Health Care — Here's How to Pay Less

Women Use More health Care Services

Women Live Longer Than Men

How Can Women Protect Themselves From Higher Costs?

Don't Ignore Health Screenings

Make Healthy Choices

Compare the Cost of Services

Don't Underestimate Health Care Costs

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Health Insurance: How to Fight Back Against 4 Common Claim Denials

Before You Appeal: Know the Codes and How to Appeal

The Four Most Commonly Denied Claims

1. Your Plan Does Not Cover the Procedure

2. Errors in Coding

3. Payment for a Procedure Was Included in the Allowance for a Related Procedure Performed the Same Day

4. You've Reached the Maximum Amount of Times a Service Is Covered

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Everything You Need to Know About Buying Travel Insurance

Travel Insurance Isn't Just Medical Coverage

What Is the Coverage Limit?

What Activities Are Covered?

What Gear Is Covered?

Does the Policy Include Emergency Evacuation?

How Easy Is It to Make a Claim?

A Few Other Things to Consider

Do You Need Travel Insurance?

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4 High-Paying Medical Jobs You Don't Need an MD For

Nurse Practitioner

Health Informatics Specialists

Biomedical Engineer

Health Care Entrepreneur

5 Things You Must Know About Health Care Open Enrollment

1. Name That Plan

2. Three Powerful Letters: HSA

3. Understand Deductibles

4. You Pay This, They Pay That (AKA Copay)

5. Out-of-Pocket Max

7 Places to Get Vaccinated for Cheap or Free

1. "Stop Flu at School" Programs

2. Your Workplace

3. County Health Department Programs

4. Participating Locations Through the Health Insurance Marketplace

5. Costco

6. Target

7. Sam's Club

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Follow These 5 Steps to Full Health Care Coverage in Retirement

1. Maximize Your Social Security Benefits

2. Start a Roth IRA

3. Consider a Health Savings Account

4. Consider Long-Term Care Insurance

5. Purchase the Right Supplemental Plan

Best Money Tips: Save on Medical Costs and Improve Your Family’s Health

Top 5 Articles

Other Essential Reading

How About a Price List at the Hospital or Doctor’s Office?

Financial Peace in Hard Times

Refactor Your Budget Categories

My Categories

Categories Matter

I'm Fleeing The Country For Healthcare!