Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

Medical Price Transparency

Transparency and the need for it in different industries is a word and requirement we hear a lot about. It should not surprise anyone that some insurers and hospital groups are working to block the implementation of federal rules that make hospital pricing transparent. They argue these will confuse consumers and potentially lead to higher costs. But there is good news. According to the New York Times, a federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.

Most of us have our health insurance provided by our employers and we do not pay as much attention to the price of medical care as we do the cost of other consumer items. But maybe we should pay more attention? The fact that the charges for our visits to the doctor, hospital and pharmacist are mostly paid for by our insurance does not make us any less likely to get both overcharged and underserved. In fact, it is a lack of transparency that makes medical costs so high.

The issue is that patients do not know the actual price of services. The list price is the price charged to patients without insurance. Each Insurance company negotiates a discounted price. Thus there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. Medicare sets the price standard based on costs. Thus, hospitals are cost plus operations with little incentive to reduce costs.

Learn more by listening to the podcast.

Job Losses Equal Employer Funded Health Insurance Loss

Closed for Coronavirus

Here Are Some Resources

Even with fewer jobs lost in May than anticipated Americans now experience an unemployment rate of 13.3% or 21 million people out of work due to the coronavirus/covid-19 pandemic. On top of lost income, loss of employer provided health insurance makes the cost even higher for those who through no fault of their own find themselves in a very challenging situation. On his podcast this week, Dr. Steven Goldstein describes how job losses equal employer funded health insurance loss and some available and often free resources for those who need health insurance. To listen to the podcast go to: Soundcloud, iHeart, Spotify, or iTunes. Or click here to listen:

 

Double Loss; Job and Health Insurance

Most Americans rely on their employers to provide health insurance for them and their families and when those jobs disappear so does the coverage. “It is extremely important that people get some type of coverage when they have lost their health insurance,” Dr. Goldstein told his listeners. “The available things to look into are COBRA, spouse insurance, faith-based cooperatives, enrollment on the insurance exchange (Obama Care), Medicaid and CHIP.”

COBRA Coverage

COBRA allows employees (and their families) who would otherwise lose their group health coverage due to certain life events to continue their same group health coverage. The former employee generally pays the full monthly rate and not the discounted one for their health insurance. Under COBRA, group health plans must also provide covered employees and their families with certain notices explaining their COBRA rights. The revised model notices provide additional information to address COBRA’s interaction with Medicare. The model notices explain that there may be advantages to enrolling in Medicare before, or instead of, electing COBRA.

State Insurance Exchange

While typically only available during certain months of the year, the state insurance exchange can open for those who experience a ‘life changing’ event. One such event is the loss of a job and employer sponsored health insurance. “You can shop for health plans through your state’s insurance marketplace,” Dr. Goldstein said. “But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period.”

Spouse Insurance

In households where a spouse’ employer offers health insurance; those benefits may be available. “It is easy enough to find out if a spouse’s job offers health insurance and sign on for that,” Dr. Goldstein said.

Faith Based Health Cooperatives

Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. “As such, the premiums are lower in comparison to those of traditional health care,” Dr. Goldstein said. “These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care.”

Medicare

Eligibility for Medicare is based on income and the size of family. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. “But do not assume that you do or do not qualify,” said Dr. Goldstein. “There are online resources available from the U.S. Department of Health and Human Services along with state references to help guide you.”

CHIP

CHIP stands for ‘Children’s Health Insurance Program.’ CHIP offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage. This coverage comes through the Medicaid program, which is why they are frequently seen together.

Income Qualification for Medicare

A family of four with an income of $25,750.00 at the poverty level and eligible for Medicaid or CHIP coverage. For an individual the amount was $12,490.00. The amount goes up by $4,420.00 for each additional family member. “The guidelines change every year,” Goldstein said.

The Good News

There are plenty of alternatives available to individuals and families that can be used short or for the longer term that are not all based on a job with insurance. People under age 26, may even be able to join their parents’ employer-based plan. “There are places to go and affordable resources available,” Dr. Goldstein concluded. “Any type of healthcare insurance or coverage will help protect your finances later.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

 

Managing Prescription Medicine Costs

Prescription medicine is expensive, and in some cases unaffordable. The reasons for the high costs of some medicine are talked about by patients, physicians and politicians. But the reasons for high costs matter less than the reality that there are people who could get their medicine for a lot less money if they knew just a few things about how drugs are sourced and priced.  Here today to help us crack this code and hack drug prices is respected Houston based neurologist and founder of the Houston Healthcare Initiative Co-Op Dr. Steven Goldstein.

Managing Prescription Medicine Costs

Most people have read or heard about how high the price of prescription medicine is here in the U.S. and how relatively inexpensive it is in other countries, especially Canada. What do the Canadians know? According to Dr. Goldstein, prices for drugs in Canada are set by a special review board that compares prices of medicine in Europeto then decide what to charge.  “Here in the U.S. Medicaid does not negotiate prices with the pharmaceutical companies and consequently the prices are higher,” Dr. Goldstein told his listeners.


 

 

Time To Renew Your Health Insurance

It is the time of year for all of us to renew our existing health insurance or pick a provider. Open enrollment for the individual health insurance market starts November 1 and lasts through December 15, 2018. The sign-up time and role of the government in our health care begs the question; is access to healthcare a right or is it a privilege or something else? Should we also have the right to not purchase insurance? To help us sort through this we need someone well versed in medicine and health coverage and we find both in the founder of the Houston Healthcare Initiative (HHI) Dr. Steven Goldstein.

 

Unintended Consequences of Not Purchasing Insurance

Remember President Obama’s promise to lower health care rates? Experts now say health insurance will be crazy expensive again in 2019. The Heritage Foundation’s Doug Badger says Obamacare was supposed to get lots of young subscribers to sign up and help subsidize the older among us, but that didn’t happen. Young people found that in many cases paying the penalty was still less expensive than insurance. Consider too that millennials tend to marry and start families later in life than those who came before them, so the perceived need for insurance is not as obvious to them as it is for people who have more responsibility. Here to help us make sense of it all is Dr. Steven Goldstein, a much-respected neurologist and founder of the Houston Healthcare Initiative.

Fines for not purchasing insurance under ‘Obamacare’ were supposed to cause more people buy insurance and lower the cost, but neither happened. Dr. Steven Goldstein, respected Houston neurologist and founder of the Houston Healthcare Initiative (www.houstonhealthcareinitiative.org) discussed the ramifications of the cancellation of financial penalties associated with ‘Obamacare’ among other things, on his weekly podcast. To hear the podcast go to https://houstonhealthcareinitiative.org/the-houston-healthcare-initiative-podcast/.

As the Trump administration has cancelled the fines assessed for not purchasing health insurance that were mandated by President Obama, the impact of the removal of these government-imposed purchases did nothing to lower the price of insurance or make the American public healthier. The positive effect of Obamacare on the price of insurance was what was promised, though little happened to make charges for insurance more affordable.

 

Changing Insurance Providers & Managing Change

Medical and health coverage is often a complex proposition for people whether they are thinking of changing providers or getting one for the first time. HHI has a free brochure and lots of other free information about the coverage available from the web site at: houstonhealthcareinitiative.org. Or call them at 346-400-2789 and talk with them in real time.

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Complexities of Health Coverage

Healthcare and what causes rates for services and insurance to go up at a startling rate are complicated. What is not that complex is the need for an affordable way to pay for most medical and doctor related expenses. That is what the Houston Healthcare Initiative (HHI) is offering in the form of a member owned co-op. The HHI initiative can replace traditional health insurance for qualified individuals and families. HHI will provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. The medical co-op promises to save qualifying individuals and families money on health insurance. At the same time, HHI will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health.

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What If I Do Not Have Health Insurance?

What happens if someone does not have health insurance? The ramifications will affect the tax filings of people this year but be different next year. Beyond the financial implications, there are others for patients and their loved ones. Here to help us learn what to do and why is Houston based neurologist and the founder of the Houston Health Initiative Dr. Steven Goldstein. You can learn more about The Houston Healthcare Initiative Co-Op at their web site, www.houstonhealthcareinitiative.org.

 

Did the Recent Court Ruling on the Affordable Care Act Really Change Anything?

The Affordable Care Act or Obama Care has been in the news a lot lately because of a court ruling that declared it unconstitutional. This happening the day right before the deadline for signing up for next year’s coverage. Of course, we are not lawyers here and cannot comment on the “legal-eze” but one thing that Dr. Steven Goldstein can comment on is the cost to businesses and people that this and other government regulation generates for all of us. He is a respected Houston Neurologist and the founder of the Houston Healthcare Initiative Co-Op.

What Is Prior Authorization & What To Do About It

Prior approval is a way that insurance companies decide on how or whether a prescribed medical service, medication, test or procedure meets their coverage criteria. What can people do? Listen to find out.

 

Achieve Your 2019 Health & Money Saving Goals Now

It’s the start of a new year and everyone gets a new start resolving to do things better or differently than they did before. The most popular of these resolutions every year involve health in some way and saving money. People determine to lose weight, stop smoking, exercise more often and fritter away less money every January and most get off to a good start. Just try getting into your local health club during the month of January this or any year. But as the weeks go by, eagerness for those health and fitness resolutions is replaced by apathy. Of course, healthcare is an everyday concern for Dr. Steven Goldstein who is a respected Houston based Neurologist and the founder of the Houston Healthcare Initiative Co-op. Click here to listen.