The Current Healthcare Reform Issue

If health insurance premiums continue to rise at the current rate, it will cost a family of four $24,000.00 per year to be insured by 2016. This is an 84% increase from today's rates. At this pace, half of American households would spend about 45% of their income on their health insurance premiums.

Obama's cabinet has stated that healthcare reform is a core economic issue in 2009. The health insurance industry is becoming increasingly anxious by the future administration's determination to bring healthcare cost under control. Some Americans are seeing their healthcare premiums rising at four times the rate of inflation. Health insurance premiums are climbing at such an incredible rate that most Americans are deciding to elect cheaper plans with less coverage or drop their health insurnace all together. These individuals are creating a bigger problem for the future, but trying to save money now.

Time will tell if the Obama team will be able to tackle the healthcare reform issue in the coming year.

Hypertension: How to Monitor It

There are digitial blood pressure monitor (sphygmomanometer) that allows you to monitor your blood pressure without a doctor's assistance. There are several factors that can contribute to temporarily rise your high blood pressure levels.

1. Stress
2. Smoking
3. Cold Temperatures
4. Exercise
5. Caffeine
6. Certain Medicines

To manual read your blood pressure:

First, you need to locate your pulse by lightly pressing your index and middle fingers on the inside bend of your elbow.

Secure an arm cuff around your bicep with the stethoscope head over the brachial artery. Use the fabric strap to make sure the arm cuff is snug, but not too tight. Place the stethoscope in your ears. Tilt the ear pieces slightly forward to get the best sound.

Finally, Close the airflow valve on the bulb by turning the screw clockwise. Inflate the arm cuff by squeezing the bulb and listen for your pulse through the stethoscope. Watch the gauge. Keep inflating the arm cuff until the gauge reads about 30 points above your expected systolic pressure. At this point, you should not hear your pulse in the stetoscope. Keeping your eyes on the gauge, slowly release the pressure in the arm cuff by opening the airflow valve.

The gauge should fall only 2 or 3 points with each heartbeat. Listen for the first pulse beat. As soon as you hear it, note the reading on the gauge. This reading is your systolic pressure (the force of the blood against the artery walls as your heart beats.) Continue slowly deflateing the arm cuff. Listen until the sound disappears. As soon as you can no longer hear your pulse, note the reading on the gauge. This reading is your diastolic pressure (the blood pressure between heartbeats).

With these two reading, you should be able to determine your resting blood rate. The systolic pressure over the diastolic pressure. Some friendly advise from www.Gizmohealth.com .

Aetna's New Weight Management Discount Program

Aetna individual members can receive a discount on Jenny Craig products and services. Aetna members can save money with thier new weight management program. Details below:

1. Free 30 day trail membership
2. 6 and 12 month programs available, featuring 30% off OnTrack (Gold/Platinum) membership and 15% off Jenny Rewards membership
3. One on one weekly consultations
4. Personalized menus
5. Tailored activity planning
6. Visit a Jenny Craig centre or choose the Jenny Direst at home program

Get fit in 2009 with Jenny Craig and Aetna's help!

Top 10 Things You Need to Know About Health Insurance

1. Insurance costs a lot but having nothing costs even more.

There are many different ways to save money when dealing with health insurance, but waving coverage is not the way. Medical bills are expensive and can added up quickly. Even a minor car accident can put a large dent in your savings - If you are not careful a major illness can push you into bankruptcy.

2. If your employer offers insurance, take it.

Group coverage, particularly when it's employer-subsidized, is almost always a better deal than anything you can get on your own, even if you're young and healthy. If you're NOT young and healthy, it's definitely a better deal.

3. Comparing different plans and carriers when shopping for health insurance is a must.

Benefits and rates vary from plan to plan and carrier to carrier. Exam each one of your options very carefully.

4. The plan with the lowest premium isn't always the best option.

What the plan covers is more important than what the premium is, because if your plan doesn't cover your condition/ treatment than in the end you are going to be pay for more out of pocket.

5. Even good comprehensive plans can have coverage issues.

You can count on your health insurance to cover you for a hospital stay. Some plans cover doctor visits, but benefits for mental health, prescription drugs and dental care are strictly optional.

6. You'll pay more for better networks.

Plans with the most comprehensive coverage at the lowest out-of-pocket cost require you to use a specified network of hospitals, doctors, labs, and other providers. The more flexibility you demand, the more you'll pay, in either premiums or co-payments.

7. You have a free-look period after you sign up.

You have a 10 day window after you sign up for coverage to review your policy and make sure the premium amount is correct.

8. You can keep your insurance through your previous employer with COBRA.

State and federal regulations protect you from losing your health coverage in the event you lose your job. It will be the same coverage although you are responible for 100% of the premium plus a 2% administative fee.

9. Couples that work together have a little more to think about.

If you and your spouse both get health insurance at work, you must sort out whether it makes more sense to have two policies or for one of you to cover the other. If you have kids, you need to decide who's going to cover them.

10. Tax breaks can help.

Ordinarily medical expenses, including insurance premiums, are not tax deductible until they exceed 7.5 percent of your income. However, if you're self-employed or your employer offers a flexible spending account, you can get a tax break without meeting the threshold.

How to Get Group Health Insurance in Place!

This post is for people who are trying to get group health insurance for their small business. There is a list of things that need to be completed before your broker can get rates for the group. First, you need to fill out a census with the employees' information including name, date of birth, number of dependents, and the zip code of the business. This will give the broker a chance to research plans and get standard rates for coverage.

The employees who wish to elect the group coverage need to fill out applications. The empolyees who don't wish to elect the coverage need to fill out the wavier section of the applications. The insurance carrier will review the applications and employee's medical history allowing them to offer a premium amount for the plan/ plans for the small bussiness. As long as 70% of the group takes the coverage the plan can be put into place.

The insurance carrier will require a binder check for the first month's premium. At this point, the policy will be active and in force. The open enrollment period will be one year after of the effective date of the policy. To begin the process of getting group health insurance in place, click on the Gizmo Health group census link below:

http://www.gizmohealth.com/Gizmoweb/GroupQuoteRequest.aspx

Dental Insurance: Is it worth it?

Brushing your teeth is an important factor when it comes to maintaining your overall health.  A substance produced in the body called high-sensitivity C-reactive-protein (hs-CRP) is suspected to play a role in the link between gum disease and heart disease. Acute gum disease increases the amount of hs-CRP in the bloodstream, which is a natural response to inflammation caused by injury or infection. The American Heart Association says hs-CRP may signal an increased risk for heart attacks. 

Heart disease is the nation's top killer, claiming a staggering 450,000 lives in 2004, according to the American Heart Association. Although it's unknown how many of those deaths are linked to gum disease, oral pathologist Dr. Dwight Weathers of Emory University suspects that the number would be high, "given that 85 percent of people over age 65 and probably half of people younger than that have some form of periodontal disease. Wow. That would be a big number."

So when it comes to dental insurance, it is worth it in the long run.  Most insurance carriers offer stand alone dental coverage for cheap. For about 30 to 40 dollars a month, you can take care of any preventative care services, i.e. oral exams, cleanings, x-ray, and gap maintances once you are approved.  After 6 continuous months, you can deal with any basic dental services, i.e. fillings and cavities.  After 12 continuous months, you can deal with any major dental services, i.e. removal of any teeth and root canals.

Most insurance carriers limit the maxmium coverage to a $1,000.00 per calendar year with a $50 deductible per individual. Based on whether your denist has a contract with the insurance carrier, each procedure will have a contracted or discounted rate. So for a few bucks a month, you can improve your oral hygene and reduce the risk for cardiovascular disease. It's worth it!

Aetna, Unicare, United Healthcare, and Humana- all have stand alone dental plans.

President Obama Impact on the Health Insurance Industry in the United States

Healthcare reform is one of the key issues of the new Obama administration. With Democrats now in control of both the White House and Congress, they have a chance to pass reform legislation to provide healthcare coverage for the more than 46 million uninsured Americans (about 15% of the total population).

The new coverage will be funded to a large extent by the federal government (which most experts estimate will cost between $120 billion and $150 billion, depending upon the scope of the package). This package would likely expand access to affordable healthcare coverage for individuals and increase revenue for the providers of the medical products and services, especially pharmaceutical companies.

One issue that is going to be greatly effected by the new administration is the Medicare Part D prescription drug program.  Obama plans to eliminate the non-interference clause in the Medicare Part D prescription drug program, which helps fund drug coverage for some 44 million elderly Americans.  Under the present system, the government is prohibited from engaging in Medicare drug pricing negotiations with pharmaceutical manufacturers.  Negotiations are handled strictly by private-sector managed care and pharmacy benefit management firms.

President Obama and congressional Democrats favor changing the program to allow or possibly require direct government negotiations with drug manufacturers, which is expected to sharply lower the program's cost.  Another likely money-saving tactic will be greater use of inexpensive generics through new incentives.

2009 U.S. Treasury guidelines for HSAs

The following are updates to High-Deductible HSA-Compatible Health Plans issued by the U.S. Treasury Department for 2009.

Deductible Changes - The minimum deductible requirement for qualified high deductible health plans has increased to $1,150 for individuals, and $2,300 for families.

Annual Contribution Changes - The annual contribution maximum1 has increased to $3,000 for individuals and $5,950 for families.

I am a diabetic

What is the best insurance for diabetics.

There is no evidence that brand-name drugs given to treat heart and other cardiovascular conditions work any better than their generic

WASHINGTON (Reuters) - There is no evidence that brand-name drugs given to treat heart and other cardiovascular conditions work any better than their cheaper generic counterparts, U.S. researchers said on Tuesday.

The findings run counter to the perception by some doctors and patients that pricier brand-name drugs are clinically superior, said Dr. Aaron Kesselheim of Brigham and Women's Hospital and Harvard Medical School in Boston, who led the study.
Kesselheim and colleagues combined the results of 30 studies done since 1984 comparing nine sub-classes of cardiovascular drugs to generic counterparts.
The brand-name drugs did not offer any advantage for patients' clinical outcomes in those studies, they wrote in the Journal of the American Medical Association.
"Brand-name drugs for cardiovascular disease can be as much as a few dollars a pill, whereas generic drugs might be as little as a few cents a pill," Kesselheim said.
"If a patient is prescribed a generic drug because that's what's appropriate for their condition, then they should feel confident taking that drug. And physicians themselves should also feel confident prescribing generic drugs where appropriate," Kesselheim said in a telephone interview.

He said rising costs of brand-name prescription drugs strain the budgets of patients as well as public and private health insurers. Overall U.S. prescription drug sales hit $286.5 billion in 2007.

© 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

http://GizmoHealth.com

How to Save on Your Prescription Drugs

Americans shell out more than $200 billion this year for prescription drugs. This statistic is  up 50 percent since 2001, according to a Kaiser Family Foundation survey. These high costs are having a big effect on consumer’s choices. One survey found 40 percent of the patients said they have skipped taking some of their medications because they couldn’t afford them.

A few ways to save on prescription drugs:

Generic is The Way to Go: Whenever you can, opt for the generic drugs. Generics drugs are on average a 1/3 of the cost of their brand-name counterparts.

Research your Insurance Plan: Review your current prescription plan coverage and the list of drugs covered by your insurance. If you are taking drug X, see whether there is a comparable, cheaper drug available.

Order Prescription Drugs Through the Mail: Many health insurance plans will allow you to order your drugs via mail.  Buying in advance can sometimes be cheaper (one or three month supply).

Choose Static Co-pays: Choose a health insurance prescription drug coverage that offers a set co-pay of $10 or $15. Avoid plans that base their coverage on percentages, as they are often considerably more expensive.

Many doctors have free samples, and while that won’t hold you over for long, they can certainly spread out the cost and the trips to the pharmacy.

PPO vs. HMO

A Preferred Provider Organization (PPO) is a managed care organization of hospitals and doctors who have contracted with an insurer or a third-party administrator to provide health care at a reduced rates to its members.

The idea of a preferred provider organization is that the providers will provide the insured members a substantial discount below their regularly-charged rates. The insurer will be billed at a reduced rate when its insured utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all insureds in the organization will use only providers who are part of the PPO. Even the insured should benefit, as lower costs to the insurer should result in lower rates of increase in premiums. 

A preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions and, in some instances outpatient surgery as well, must have prior approval of the insurer and often undergo "utilization review" in advance. The aspects of utilization review and pre-certification are now widely used even in traditional "indemnity" plans, and are widely regarded as being essentially permanent features of the American health care system.

PPOs often require insurers to pay a claim within a certain timeframe in order to take the PPO discount, calculating the PPO discount and having the insurer pay the PPO's access fee is still one more step — and one more opportunity for mistakes and delays. Since PPOs have more power in their relationship with providers, they can still provide a benefit to insured patients. Uninsured patients may, however, be unable to obtain these discounts — even if they pay cash.

A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. The Health Maintainence Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options.  Unlike traditional indemnity insurance, an HMO covers only care rendered by those doctors and other professionals who have agreed to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers.

Most HMOs require members to select a primary care physican (PCP), a family doctor or general physican who acts as a 'gatekeeper" to direct access to medical services. Absent a medical emergency, patients need a referral from the PCP in order to see a specialist or other doctor, and the gatekeeper cannot authorize that referral unless the HMO guidelines deem it necessary.

"Open access" HMOs do not use gatekeepers - there is no requirement to obtain a referral before seeing a specialist. The beneficiary cost sharing (e.g., co-payment or coinsurance) may be higher for specialist care, however.

HMOs monitor doctors to see if they are performing more services for their patients than other doctors, or fewer. HMOs often provide preventative care for a lower co-payment or for free, in order to keep members from developing a preventable condition that would require a great deal of medical services. When HMOs were coming into existence, indemnity plans often did not cover preventive services, such as immunizations, well-baby checkups, mammograms, or physicals. It is this inclusion of services intended to maintain a member's health that gave the HMO its name. Some services, such as outpatient mental health care, are limited, and more costly forms of care, diagnosis, or treatment may not be covered. Experimental treatments and elective services that are not medically necessary (such as elective plastic surgery) are almost never covered.

Other choices for managing care are case management, in which patients with catastrophic cases are identified, or disease management, in which patients with certain chronic diseases like diabetes, asthma, or some forms of cancer are identified. In either case, the HMO takes a greater level of involvement in the patient's care, assigning a case manager to the patient or a group of patients to ensure that no two providers provide overlapping care, and to ensure that the patient is receiving appropriate treatment, so that the condition does not worsen beyond what can be helped.

Humana changes policy in Illinois regarding Breast Ultrasound and Mammogram Screening

The terms of HumanaOne policies have changed.

Humana has revised the age intervals and medical necessity for receiving routine mammogram services.

In accordance with Illinois law, Humana has added a benefit for comprehensive breast ultrasound screening following a mammogram demonstrating heterogeneous or dense tissue. And mow provides benefits for contraceptives and outpatient contraceptive services.

To review these changes in detail visit http://GizmoHealth.com run a quote and select the "details" link in any HumanaOne plan.

Why Use A Broker When Buying Health Insurance?

Most people misunderstand the purpose of using a broker when buying health insurance. They think it is just one more person to the equation (or middle man) cause the price of the insurance to increase (to cover the cost of his/her services).  This is not true!  

The price of health insurance is fixed and regulated by the Division of Insurance in each state.  This means that a particular plan sold by a carrier will cost exactly the same for everyone that falls into that catagory.  The price of health insurance is based on the individual's gender, age, and the location in which they resided.  Now, don't get me wrong, the price can be adjusted based on pre-existing conditions or prescription requirements, etc.

A health insurance broker is used to assist in the plan selection and application process. For example, if you were buying a house, you would use a realtor to help you find the best house for your circumstance.  A health insurance broker is just like a realtor.  They are more familiar with the insurance carriers, the products they sale, and any terms and conditions that the insurance carrier might have.

The broker is compensated by the insurance carrier based on the number of customers they sign up with that carrier.  The customer should not have to pay for any broker services or application fees in less otherwise specified.  A health insurance broker should be there to give you a third party perspective regardless of what carrier you decide to go with.

In these tough times, most insurance carriers have outsourced their sales department to local brokers in the customer's area.  So, even when you contact the insurance carrier directly, they are probably just turn around and give your name and number to broker in the area (to contact you).  

A broker can also help even after the policy is in place.  If you have a billing or claims issue, a broker should be able to assist or at least point you in the right direction in terms of how to take care of it (a telephone number).  Dealing with the insurance carriers directly can sometimes be overwhelming. If you have a serious issue, you want to know that someone is on your side and fighting for your rights.  At Gizmo Health, www.GizmoHealth.com we are on your side!

Can I get insured, if I have a pre-existing condition?

The always nagging question:  Can I still get insured, if I have a pre-existing condition?  The answer is YES!  When applying to a major health insurnace carrier for an individual policy, the insurance carrier has the opportunity to review your medical history and deny you based on the results.  This is the main difference between group and individual insurance.  With group insurance, an insurance carrier can not deny an individual based on their medical information. 

With an individual policy, after reviewing your medical history an insurance carrier is either go to: 

1. Approve you as a stardard offer.  

2. Approve you with an exclusion, wavier, or rider.  

3. Approve you with an adjustment rate. 

4. Or deny you, all together.

If you are denied coverage from a privately held health insurance carrier, there are options to get insured. For example, in Illinois there is a state sponsor health insurance plan for people that can not get insured elsewhere.  ICHIP, The Illinois Comprehensive Health Insurance Plan is a guaranteed issued health insurance plan for people that are in a high risk pool.  The monthly premimum are substantial higher and there are specific enrollment requirements.  Please contact a Gizmo Health representive for ICHIP enrollment details.

What is Co-insurance?

Co-insurance is the portion of the plan where the member and the insurance carrier work together to pay for the cost of the medical claim/bills.  The co-insurance portion comes into play after the member have satified their deductible requirements and any office visits charges. Co-insurance is usually displayed as a percentage. The percentage represents the amount that the member is responsible for. Most plan have 80/ 20 coverage, which means that the insurance carrier pays 80% of the cost and the member pays the remaining 20%. Once the member has reached the plan's co-insurance maximum out of pocket limit, the percentages change.  The insurance carrier will cover the plan at a 100% up to the plan's lifetime maximum. At this period, the member just needs to continue to pay for their monthly premium.

Example: If the plan has 20% co-insurance and the claim is for $1,000.00. You will pay 20% of $200.00, while the insurance company is responsible for the remaining 80% or $800.00.  

New BCBCIL HSA Deductable starts 1/1/2009

Blue Cross and Blue Shield of Illinois introduced a new deductible option to the BlueEdge Individual HSA (health savings account) plan. Along with the existing deductible offerings of $1150, $1750, $2600 and $5000, a $3500 deductible option is being added beginning January 1, 2009.

The new $3500 deductible HSA will be available at both 80% and 100% coinsurance coverage levels, and with or without maternity. Marketing of the $3500 deductible began November 15, 2008 with January 1, 2009 or greater effective dates. Also, January 1, 2009, the deductible level for the $1,100 plan will increase to $1,150, in keeping with the IRS HSA minimum deductible guidelines.

To apply click:https://services.hscil.com/il/eapp/wxpm1653.pl?id=6123&source=WEB2009520

or visit http://www.gizmohealth.com/

How to select a Deductible Level with your Health Insurance Plan

When selecting a deductible level with your health insurance plan, you should take all things into considation.  Your overall health, age, and what you can afford.  If you are young and relativily health, but can't afford an expense plan. I would suggest a high deductible plan. You will be save money on your monthly premium in exchange for the risk of having to pay more out of pocket if something does happens.  

  If you are older and have some medical issues, you should probably go with a lower deductible plan.  You are probably going to need to go to the doctor's office more often or even visit a hospital.  These exspenses can added up quickly.  With lower deductible plans you are not going to have to pay as such, because you are going to reach your deductible level sooner (The insurance carriers are going start pay their portion of your medical exspenses with the co-insurance).  BUT, the your monthly premium is going to be significantly higher.

The higher deductible plans aren't going to cover prescription drugs/ doctors office visits with a co-pay.  If you are looking for more of an old fashion traditional health insurance plan with a low deductible and twenty percent co-insurance, and a co-pay on your office visits and presciption drugs.  The high deductible health plan (HDHP) is not for you!

People who go with a higher deductible plan can sometimes offset the cost of your medical exspenses with a HSA account.  Some high deductible health plans will have a HSA account attached to them. HSA is a health saving account which allows you to put money aside pre-tax to pay for their medical exspenses.  In 2008, you could contribute up to $2,950.00 for a individual plan and $5,850.00 for a family plan.  HSA's are kind of structured like an IRA's, in that they accrued interest and the balance rolls over for year to year.  The adventures of these plans are that you have more control over your medical spenting.  

When you open a HSA, you are issued a debit card or checkbook to pay for doctor visits, precription drugs, and even your monthly premium.  One thing who should be aware is that there are penialties for withdrawing funds for stuff that are not medically related.  If you have any questions, Gizmo Health agents will anwser any questions that you might have.  You can reach them at 1-312-884-5150.

Payment Information for the insurance carriers

When apply for individual health insurance coverage, most insurance carriers require an inital payment (usually the first month's premium).  BlueCross BlueShield of Illinois, Aetna, Humana, United Healthcare, and Celtic all require a payment to process the application.  Unicare is the only insurance carrier that doesn't require a inital payment.  

If you are approved, the insurance carrier will accept your payment and start the policy as of your effective date.  If you are denied, the insurance carrier will accept the payment and will issue your a check for the exact same amount. The issue that some people have run into is that the insurance carrier cash ALL checks (so make sure that your bank account has sufficant funds to cover the cost and avoid overdraft fees).  People were thinking that the insurance carriers just hold on the check until they get a response of the underwriting department.  Which is untrue! 

When you use www.gizmohealth.com, there is no application and service fees.  Their webpage and brokers services are completely free to you, because they are compensated by the insurance carriers based on the number of clients that have with that carrier. Gizmo Health is a third party brokerage firm, that focuses on a solid relationships with the insurance carriers and excellent customer service.  Gizmo Health will give you an honest opinion based on your individual health insurance needs. 

Uninsured in Illinois

1.8 million Illinois residents lack health coverage. 1.3 million of those uninsured live in the Chicagoland area. Latinos currently represent more than 30% of Illinois uninsured.

HPV vaccine free for Aetna clients

Human Papillomavrius vaccine (HPV) Covered at 100% - Aetna’s Individual plans cover the vaccine (Gardisil) for girls ages 9 to 18 at 100%. No copay or coinsurance.

According to Center for Disease Control website (link below) the retail value is $375.

To apply directly to Aetna click: https://ips.aetna.com/Retail/Home_Login_Consumer.aspx?bid=2TzPPz%2fIcZA%3d


Gardisil: http://www.gardasil.com/

Center for disease control: http://www.cdc.gov/std/hpv/default.htm

To contact us at: http://www.gizmohealth.com/ call 312-884-5150

Customer Feedback 2/11/2008

I spent many agonizing months battling the insurance company over unpaid and denied claims. Without his personal help, sincerity, dedication and relentless pursuit on my behalf I would not have received the care and coverage in which I was entitled to. I want to thank everyone at Gizmo Health for all they have done. - Teresa

Illinios Group vs. Individual Insurance facts

All group insurance in Illinois includes maternity coverage, by law.

Individual insurance is medically underwritten, meaning your medical history is reviewed, giving the carrier the opportunity to deny coverage based on your medical condition. Group insurance with less than 50 members is guaranteed issue, meaning the carrier must cover the group, however the rates can be increased 67% based on medical underwriting.

Medical underwriting and an optional materity benefit allows insurance carriers to offer similar products to healthy individuals at a fracton of the group rate.

If you quailfy for individual coverage from BlueCross BlueShield, Humana, Aetna, United healthcare, Unicare or Celtic on our web site, it is the best coverage for the money available in Illinios.

GizmoHealth.com

Go GizmoHealth.com The Place to Buy Health Insurance. Call us 312-884-5150