Risk adjustment as a tool to improve solidarity and incentives for cost containment under consumer cost sharing

Size: px
Start display at page:

Download "Risk adjustment as a tool to improve solidarity and incentives for cost containment under consumer cost sharing"

Transcription

1 Risk adjustment as a tool to improve solidarity and incentives for cost containment under consumer cost sharing Richard van Kleef Second Health Policy Workshop November 9, 2011

2 Outline Background: cost sharing in health plans Limitations of traditional forms of cost sharing Risk adjustment as a solution Empirical illustration Discussion NB: arguments and illustrations are from two recent publications: Kleef, R.C. van, W.P.M.M. van de Ven, and R.C.J.A. van Vliet. (2011/2012). Riskadjusting the doughnut-hole to improve efficiency and equity, Inquiry, forthcoming. Kleef, R.C. van, W.P.M.M. van de Ven and R.C.J.A. van Vliet. (2009). Shifted deductibles for high risks: more effective in reducing moral hazard than traditional deductibles, Journal of Health Economics, 28:

3 Background The responsiveness of the demand for medical care to net price is beyond doubt (Zweifel and Manning, HHE 2000) Natural experiments, observational comparisons of individuals, and the RAND-experiment have shown that insurance leads to an increase in the demand for medical care (i.e. moral hazard). Many health insurance plans worldwide include some form of consumer cost sharing to counteract moral hazard. RAND-experiment: in health plans with cost sharing the total medical expenses per person were substantially lower (up to 31%) than in health plans with full insurance coverage. A shortcoming of traditional forms of cost sharing, however, is that they do not take into account individual variation in health.

4 The concept of a deductible Up to a certain amount (d) consumers pay their medical expenses themselves before the insurer starts reimbursement. Simplified graphical illustration:

5 Limitations of deductibles Limitation 1: Expected out-of-pocket expenses will be higher for the chronically ill than for the healthy. Limitation 2: Incentives for cost containment will be weak for the chronically ill.

6 Explanation of limitation 2 Newhouse (1993, page 81) argues: Consider someone with a deductible of $1,000 who has to decide whether to visit his doctor for a market price of $40 on the first day of the contract period. If he would know for sure that his total expenses in the contract period will not exceed $1,000, the perceived price of the visit equals the market price. However, if he would know for sure that his total expenses will exceed $1,000 (i.e., if he would anticipate free care later in the contract period), the perceived price of the visit equals $0.

7 Illustration: data Administrative data from a Dutch insurer on total medical expenses (for inpatient care, outpatient care and pharmaceuticals among others) in 1994 (year t) and drug prescriptions in 1993 (year t-1) for about individuals Individuals were classified as being chronically ill if they had had at least 4 drug prescriptions in 1993, related to one of the following diseases: psychosis, mood disorders, COPD, inflammatory disorders, heart disease, thyroid disorders, high cholesterol, gout, peripheral artery disease, glaucoma, epilepsy, high blood pressure, diabetes, gastric disorders, inflammatory bowel disease, chronic pain, rheumatism, Parkinson's disease, cancer, cystic fibrosis

8 Table 1. Mean and standard deviation (S.D.) of expenses, by health category Health category based on drug prescriptions in year t-1 Prevalence in year t (%) Mean of expenses in year t (euros) S.D. of expenses in year t (euros) None of health problems below ,109 3,869 Psychosis ,468* 5,556 Mood disorders ,743* 4,654 COPD ,113* 5,819 Inflammations ,405* 5,768 Heart disease ,720* 6,795 Thyroid disorders ,042* 7,537 High cholesterol ,024* 6,173 Gout ,084* 6,772 Peripheral artery disease ,488* 5,688 Glaucoma ,761* 6,668 Epilepsy ,083* 9,040 High blood pressure ,676* 9,981 Diabetes ,175* 8,388 Gastric disorders ,842* 10,208 Inflammatory bowel disease ,056* 9,338 Chronic pains ,167* 7,097 Rheumatism ,366* 12,995 Parkinson's disease ,910* 17,427 Cancer ,441* 17,681 Cystic fibrosis ,593* 18,750 Total ,674 5,450 * Statistically significant from the group of individuals with none of the 20 health problems (p.001)

9 Applying a deductible of 500 euro

10 Table 2. Applying a deductible of 500 euro Health category based on drug prescriptions in year t-1 Probability of exceeding deductible in year t Expected out-of-pocket expenses in year t (euros) None of health problems below Psychosis 0.53* 377* Mood disorders 0.65* 418* COPD 0.65* 432* Inflammations 0.61* 400* Heart disease 0.61* 416* Thyroid disorders 0.61* 406* High cholesterol 0.86* 478* Gout 0.85* 475* Peripheral artery disease 0.70* 433* Glaucoma 0.69* 441* Epilepsy 0.71* 443* High blood pressure 0.83* 470* Diabetes 0.85* 473* Gastric disorders 0.90* 481* Inflammatory bowel disease 0.75* 442* Chronic pains 0.81* 457* Rheumatism 0.91* 485* Parkinson's disease 0.96* 497* Cancer 0.96* 492* Cystic fibrosis 0.94* 486* Total * Statistically significant from the group of individuals with none of the 20 health problems (p.001)

11 Doughnut hole as a solution? After reaching a certain level of medical expenses (s), consumers face a gap (d) in coverage. Simplified graphical illustration:

12 Applying a doughnut hole of 500 euro Starting at the mean of annual expenses

13 Table 3. Applying a doughnut hole of 500 euro starting at 1,674 euro Health category based on drug prescriptions in year t-1 Starting point Prob. of reaching DH Prob. of exceeding DH Expected out-ofpocket expenses None of health problems below 1, Psychosis 1, * 0.27* 162* Mood disorders 1, * 0.34* 197* COPD 1, * 0.34* 194* Inflammations 1, * 0.36* 201* Heart disease 1, * 0.33* 184* Thyroid disorders 1, * 0.39* 206* High cholesterol 1, * 0.47* 262* Gout 1, * 0.49* 267* Peripheral artery disease 1, * 0.45* 254* Glaucoma 1, * 0.40* 228* Epilepsy 1, * 0.43* 235* High blood pressure 1, * 0.49* 278* Diabetes 1, * 0.64* 344* Gastric disorders 1, * 0.68* 369* Inflammatory bowel disease 1, * 0.53* 290* Chronic pains 1, * 0.70* 370* Rheumatism 1, * 0.74* 391* Parkinson's disease 1, * 0.90* 454* Cancer 1, * 0.82* 440* Cystic fibrosis 1, * 0.78* 411* Total 1, * Statistically significant from the group of individuals with none of the 20 health problems (p.001)

14 Proposal: Risk-adjusted doughnut hole Let the starting point of the doughnut hole increase with the individual expected expenses. For healthy individuals with low expected expenses the doughnut hole starts at a relatively low expenditure level For the chronically ill with high expected expenses the doughnut hole starts at a relatively high expenditure level

15 Where to locate the doughnut hole? Raising the starting point reduces the probability of exceeding the doughnut hole and, thereby, increases incentives for cost containment in area [0, s+d] (= effect 1) However, raising the starting point also reduces the probability of reaching the doughnut hole and, thereby, reduces incentives for containment in area [0, s] (= effect 2) The challenge is to find the starting point at which the first effect no longer dominates the second. Probably this point is to be found somewhere in the center of the individual s expenditure distribution where the uncertainty about reaching/exceeding the doughnut hole is highest. In our illustration we locate the doughnut hole such that for each health category the individual expected out-of-pocket expenses equal 250 euro.

16 Table 4. Applying a doughnut hole of 500 euro with a risk-adjusted starting point Health category based on drug prescriptions in year t-1 Starting point Prob. of reaching DH Prob. of exceeding DH Expected out-ofpocket expenses None of health problems below Psychosis Mood disorders 1, COPD 1, Inflammations 1, Heart disease 1, Thyroid disorders 1, High cholesterol 1, Gout 1, Peripheral artery disease 1, Glaucoma 1, Epilepsy 1, High blood pressure 1, Diabetes 2, Gastric disorders 3, Inflammatory bowel disease 2, Chronic pains 3, Rheumatism 4, Parkinson's disease 5, Cancer 4, Cystic fibrosis 11, Total

17 Compared to traditional deductibles and doughnut holes, risk-adjusted doughnut holes can improve both solidarity and incentives for cost containment Of course, there are some important issues for further research / consideration

18 Issue 1: data and risk adjusters Individual-level data on medical expenses and risk characteristics must be available. Several criteria need to be taken into account when selecting appropriate risk adjusters, e.g. measurability, validity and no possibilities for manipulation. NB: In the Netherlands data and appropriate risk adjusters are already used for the purpose of risk equalization.

19 Issue 2: criterion for locating the DH In our example we located the doughnut hole such that the expected outof-pocket expenses were equal across health categories. This criterion does not necessarily maximize the incentives for cost containment. Theoretically, a better criterion to maximize incentives for cost containment is the variance in expected out-of-pocket expenses A drawback of this alternative, however, is its complexity and the fact that it does not necessarily lead to equal expected out-of-pocket expenses This implies that the choice for a criterion requires a trade-off among incentives for cost containment, solidarity and simplicity.

20 Issue 3: level of differentiation The health categories in our empirical illustration are probably heterogeneous in terms of expected expenses. This implies that further differentiation i.e. taking into account more risk characteristics might further improve solidarity and incentives for cost containment. At the same time, however, further differentiation will reduce the transparency of the health plan. This implies that the level of differentiation requires a trade-off between solidarity and incentives for cost containment on one hand and transparency on the other.

21 Issue 4: will consumers understand? To achieve incentives for cost containment it is crucial that consumers understand how the cost-sharing concept works. Hsu et al. (2008) have shown that beneficiaries who were aware that their plan included a doughnut hole were more likely to report any cost response compared to the complementary group. Hsu et al. (2008) have also shown that consumer knowledge about cost sharing does not come naturally. This implies that some education might be desirable. It might also be wise to start off simple, e.g. to distinguish between just two risk groups.

22 Issue 5: risk-adjusted coinsurance rate Table 1 shows a positive relationship between the expected value and variance of expenses. This implies that even with a risk-adjusted doughnut hole the chronically ill have a lower probability that their expenses in the contract period end up somewhere in/around the doughnut hole than the healthy This implies that an interesting extension to a risk-adjusted starting point might be a risk-adjusted coinsurance rate.

23 Table 4. Applying a doughnut hole of 500 euro with a risk-adjusted starting point Health category based on drug prescriptions in year t-1 Starting point Prob. of reaching DH Prob. of exceeding DH Expected out-ofpocket expenses None of health problems below Psychosis Mood disorders 1, COPD 1, Inflammations 1, Heart disease 1, Thyroid disorders 1, High cholesterol 1, Gout 1, Peripheral artery disease 1, Glaucoma 1, Epilepsy 1, High blood pressure 1, Diabetes 2, Gastric disorders 3, Inflammatory bowel disease 2, Chronic pains 3, Rheumatism 4, Parkinson's disease 5, Cancer 4, Cystic fibrosis 11, Total

24 Issue 6: potential cost savings? How large will be the extra cost savings when replacing traditional deductibles/doughnut holes with risk-adjusted doughnut holes? Van de Ven and Schut (TPE 2010) simulate that replacing a traditional deductible of 165 euro by a risk-adjusted doughnut hole of 165 euro in the Netherlands would substantially increase the reduction in moral hazard. Further research is needed to examine the relationship between price sensitivity and ex-ante probabilities of reaching/exceeding coverage gaps.

25 Conclusion Cost sharing can benefit from risk adjustment in terms of solidarity and incentives for cost containment. It might be desirable to start off simple, e.g. by distinguishing just two groups. When technical requirements have been met and consumers are familiar with the concept solidarity and incentives for cost containment can be further improved by more detailed risk adjustment.

How Can We Bend the Cost Curve? Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity

How Can We Bend the Cost Curve? Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity How Can We Bend the Cost Curve? Richard C. van Kleef Wynand P. M. M. van de Ven René C. J. A. van Vliet Risk-Adjusting the Doughnut Hole to Improve Efficiency and Equity An important goal of consumer cost-sharing

More information

Medical Matters Action Checklists

Medical Matters Action Checklists Medical Matters Action Checklists The following Action Checklists are included in Chapter 5: Medical History Personal Medication Record Health Care Power of Attorney Medical Orders (Do Not Resuscitate/POLST)

More information

Risk selection in a regulated health insurance market: a review of the concept, possibilities and effects

Risk selection in a regulated health insurance market: a review of the concept, possibilities and effects Risk selection in a regulated health insurance market: a review of the concept, possibilities and effects Expert Rev. Pharmacoecon. Outcomes Res. 13(6), 743 752 (2013) Richard C van Kleef*, Wynand PMM

More information

Agenda. Medicare Basics Parts of Medicare What is a Medicare Advantage Plan? How do Medicare Advantage Plans work?

Agenda. Medicare Basics Parts of Medicare What is a Medicare Advantage Plan? How do Medicare Advantage Plans work? Agenda Medicare Basics Parts of Medicare What is a Medicare Advantage Plan? How do Medicare Advantage Plans work? Cost sharing, networks and eligibility MCHCP and Medicare Advantage Advantage? What is

More information

NATIONAL HEALTH FUND PRESENTATION

NATIONAL HEALTH FUND PRESENTATION NATIONAL HEALTH FUND PRESENTATION WYNDHAM KINGSTON HOTEL KINGSTON JULY 28, 2012 TOPICS FOR PRESENTATION NHF - HISTORY - BENEFITS - APPLICATION - ENROLMENT JADEP - CONDITIONS COVERED NHFCARD - CONDITIONS

More information

Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?

Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid? Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid? Each month through our Helpline, PHLP talks to individuals (or to their family members, advocates or providers)

More information

Understanding Your Health

Understanding Your Health Understanding Your Health 2015 Objectives of Understanding Your Health After today s presentation, you will: Have a basic understanding of what is driving healthcare costs and how wellness and preventive

More information

Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population

Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America

More information

10 Years of the NHF - Performance Challenges and Lessons of Experience

10 Years of the NHF - Performance Challenges and Lessons of Experience 10 Years of the NHF - Performance Challenges and Lessons of Experience 8 th Caribbean Conference on Health Financing Initiatives - Jamaica, Nov. 12-14, 2013 Presentation Topics.. Background.. Program Design..

More information

2014 Summary of benefits plan comparison

2014 Summary of benefits plan comparison 2014 Summary of benefits plan comparison The tables below summarize the 2014 Benefits for the Samaritan Choice Medical Plan options (Basic, Wellness and High-Deductible Plans). Pease refer to your plan

More information

Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act

Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Spring 2009 A b r i e f o v e r v i e w o f

More information

Chapter 8: Just in Case Additional Material

Chapter 8: Just in Case Additional Material Chapter 8: Just in Case Additional Material Here I go into detail about Medicare, Medicare Advantage (MA) plans, and Medigap plans. What about Medicare? Medicare is a federal health insurance program for

More information

Income and the demand for complementary health insurance in France. Bidénam Kambia-Chopin, Michel Grignon (McMaster University, Hamilton, Ontario)

Income and the demand for complementary health insurance in France. Bidénam Kambia-Chopin, Michel Grignon (McMaster University, Hamilton, Ontario) Income and the demand for complementary health insurance in France Bidénam Kambia-Chopin, Michel Grignon (McMaster University, Hamilton, Ontario) Presentation Workshop IRDES, June 24-25 2010 The 2010 IRDES

More information

City of Richmond Open Enrollment Effective August 1, 2015 Medical and Dental Plans Effective August 1, 2015 1 Good News! NO changes to the benefits and rates again for August 1, 2015. Mandatory mail order

More information

The introduction of deductibles for prescription drugs in a national health insurance: compulsory or voluntary?

The introduction of deductibles for prescription drugs in a national health insurance: compulsory or voluntary? k~h-i pdiiy ELSEVIER Health Policy 31 (1995) 53-65 The introduction of deductibles for prescription drugs in a national health insurance: compulsory or voluntary? F.M. Bakker, R.C.J.A. van Vliet*, Department

More information

Medicare Economics. Part A (Hospital Insurance) Funding

Medicare Economics. Part A (Hospital Insurance) Funding Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 7.1 August 1, 2013 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international

More information

GROUP MEDICARE SUPPLEMENT PLANS. S5753_081213_GB03_MN Internal Approval 08/13/2013

GROUP MEDICARE SUPPLEMENT PLANS. S5753_081213_GB03_MN Internal Approval 08/13/2013 2014 GROUP MEDICARE SUPPLEMENT PLANS S5753_081213_GB03_MN Internal Approval 08/13/2013 CREATE A HEALTHIER ORGANIZATION. Your employees are your organization s most valuable asset. As they retire, you want

More information

Medicare can be confusing. So let s make it simpler: When are you eligible? What do Parts A, B, C and D mean? When do you sign up?

Medicare can be confusing. So let s make it simpler: When are you eligible? What do Parts A, B, C and D mean? When do you sign up? Y0066_110719_142204 File & Use 08022011 Medicare can be confusing So let s make it simpler: When are you eligible? What do Parts A, B, C and D mean? When do you sign up? 2 When are you eligible? You re

More information

Health declaration for occupational disability insurance or life insurance that covers occupational disability

Health declaration for occupational disability insurance or life insurance that covers occupational disability The English translation has no legal force and is provided to the customer for convenience only. The Dutch health declaration should be filled in. Health declaration for occupational disability insurance

More information

THE A,B,C,D S OF MEDICARE

THE A,B,C,D S OF MEDICARE THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION

More information

GROUP MEDICARE PLANS AT A GLANCE FOR EMPLOYER GROUPS. Toll-free 1-800-851-3379 ext. 8024 TTY: 711 HealthAlliance.org

GROUP MEDICARE PLANS AT A GLANCE FOR EMPLOYER GROUPS. Toll-free 1-800-851-3379 ext. 8024 TTY: 711 HealthAlliance.org GROUP MEDICARE PLANS GROUP MEDICARE PLANS AT A GLANCE FOR EMPLOYER GROUPS 2016 Toll-free 1-800-851-3379 ext. 8024 TTY: 711 HealthAlliance.org Coverage You Know and Trust If you ve worked with Health Alliance

More information

If I have a psychiatric disability. Will Health Reform Help Me?

If I have a psychiatric disability. Will Health Reform Help Me? If I have a psychiatric disability Will Health Reform Help Me? For consumers of mental health services, a review of the bills passed by Congress in 2009 This paper was written by Chris Koyanagi, policy

More information

2015 Orange County HICAP Medicare Advantage Special Needs Plans Comparison Chart

2015 Orange County HICAP Medicare Advantage Special Needs Plans Comparison Chart Brand New Day Brand New Day Brand New Day Brand New Day Bridges Drug Savings Bridges Extra Care Harmony Healthy Heart Drug Savings dementia. dementia. chronic and disabling mental health conditions. chronic

More information

Medicare part d, which offers

Medicare part d, which offers Trends The Effects Of The Coverage Gap On Drug Spending: A Closer Look At Medicare Part D Beneficiaries who entered the doughnut hole decreased their monthly prescriptions by about percent per month. by

More information

MEDICARE: You ve earned It. Make the most of it.

MEDICARE: You ve earned It. Make the most of it. Cigna Medicare Services MEDICARE: You ve earned It. Make the most of it. A simple guide filled with useful information on Medicare, health and wellness and more. Section 1 MEDICARE. PLAIN AND SIMPLE. Section

More information

Hospitals and Health Systems:

Hospitals and Health Systems: Hospitals and Health Systems: An Inside Look at Employee Health Plan Strategies To Control Costs and Provide Access to Healthcare August 2010 Highlights Because of their dual role as benefit plan sponsor

More information

Medicare supplement plans. Peace of mind from a name you trust

Medicare supplement plans. Peace of mind from a name you trust Medicare supplement plans Peace of mind from a name you trust Flexible plans backed by over 70 years of experience We ll be there for you Medicare supplement plans are designed to fill in the gaps that

More information

Your Plan: Premier HMO 20/200A/100 OP Your Network: California Care HMO

Your Plan: Premier HMO 20/200A/100 OP Your Network: California Care HMO Your Plan: Premier HMO 20/200A/100 OP Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect

More information

A Roadmap to Better Care and a Healthier You

A Roadmap to Better Care and a Healthier You FROM COVERAGE TO CARE A Roadmap to Better Care and a Healthier You Step 2 Understand your health coverage Your ROADMAP to health 2 Understand your health coverage Check with your insurance plan or state

More information

WESTERN NEUROLOGY, PLLC Kan Yu, MD, PhD

WESTERN NEUROLOGY, PLLC Kan Yu, MD, PhD WESTERN NEUROLOGY, PLLC Kan Yu, MD, PhD New Patient Registration **Please complete entire form in blue or black ink** Name: Date of Birth: Last First MI SSN: - - Email: Address: Gender: M or F Age: Street

More information

Medicare Choice and Impact Study. September 2014

Medicare Choice and Impact Study. September 2014 Medicare Choice and Impact Study September 2014 ehealth Medicare Choice and Impact Study - Introduction and Summary This report presents an analysis of over 22,000 consumers who used the online Medicare

More information

The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including

The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including charts, tables, and graphics may be difficult to read using

More information

Improving risk adjustment in the Medicare program

Improving risk adjustment in the Medicare program C h a p t e r2 Improving risk adjustment in the Medicare program C H A P T E R 2 Improving risk adjustment in the Medicare program Chapter summary In this chapter Health plans that participate in the

More information

Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff

Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff Ibrahim Shehata April 27, 2006 Background Health expenditure is dominated by household direct out-ofpocket payments

More information

Medicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15

Medicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15 Medicare What you need to know Choose the plan that s right for you GNHH2ZTHH_15 Choosing a Medicare plan is a lot like buying a car. There are lots of options to consider. And what s right for you may

More information

Actuarial Equivalence of Medicare Prescription Drug Plans

Actuarial Equivalence of Medicare Prescription Drug Plans Copyright 2003 by the American Academy of Actuaries Actuarial Equivalence 1 Actuarial Equivalence of Medicare Prescription Drug Plans A Luncheon Briefing Sponsored By The American Academy of Actuaries

More information

Your Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO

Your Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO Your Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary

More information

We decided to start with the New Basics!

We decided to start with the New Basics! What employees think of healthcare Confusing Uhh, What?... Frustrating I give up! We decided to start with the New Basics! Agenda City of Dallas Challenges (what caused our approach to benefits to change)

More information

Beneficiaries: those who receive benefits through government programs like Medicare

Beneficiaries: those who receive benefits through government programs like Medicare Terminology: Beneficiaries: those who receive benefits through government programs like Medicare Deductible: a fixed monetary amount set by Medicare or a private insurer. You are responsible for all medical

More information

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation

More information

MEDCO BY MAIL ORDER FORM

MEDCO BY MAIL ORDER FORM OLD HERE OLD HERE 1 EDCO BY AIL ORDER OR ember information Please verify or provide member information below. ember ID: Group: Name: City, ST, ZIP: Daytime phone: Please send me e-mail notices about the

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 6.0 September 25, 2012 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and

More information

TRENDS&ANALYSIS. What s the Best Value? Comparing Medicare HMOs and Supplemental Policies. March 2003

TRENDS&ANALYSIS. What s the Best Value? Comparing Medicare HMOs and Supplemental Policies. March 2003 What s the Best Value? Comparing Medicare HMOs and Supplemental Policies Introduction Many California consumers seeking coverage beyond that provided by traditional Medicare have more than one option.

More information

Moral Hazard. Question for this section. Quick review of demand curves. ECON 40447 Fall 2009

Moral Hazard. Question for this section. Quick review of demand curves. ECON 40447 Fall 2009 Moral Hazard ECON 40447 Fall 2009 First day of class, listed five unique characteristics of the health care sector Uncertainty Large role for federal govt Agency problem Non-profit sector Medical care

More information

OCAN Comments Suggested Amendments to SFC Chronic Care Working Group Policy Options Paper

OCAN Comments Suggested Amendments to SFC Chronic Care Working Group Policy Options Paper OCAN Comments Suggested Amendments to SFC Chronic Care Working Group Policy Options Paper The Obesity Care Advocacy Network (OCAN) is pleased to provide the following comments in response to the Senate

More information

HNE Premier 1 (HMO) and HNE Premier 2 (HMO)

HNE Premier 1 (HMO) and HNE Premier 2 (HMO) 2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I

More information

MEDCO BY MAIL ORDER FORM

MEDCO BY MAIL ORDER FORM MEDCO BY MAIL ORDER FORM 1 Member Information Please verify or provide member information below. Member ID: Group: Name: City,ST,ZIP: Daytime phone: Please send me e-mail notices about the status of the

More information

Mail Order Prescriptions from Pharmacy Services at Good Samaritan Medical Center

Mail Order Prescriptions from Pharmacy Services at Good Samaritan Medical Center Mail Order Prescriptions from Pharmacy Services at Good Samaritan Medical Center Now you can have your prescriptions delivered right to your door. The Pharmacy Services at Good Samaritan Medical Center

More information

Advocare Essence (HMO-POS)

Advocare Essence (HMO-POS) Advocare Essence (HMO-POS) offered by Security Health Plan of Wisconsin, Inc. You are currently enrolled as a member of Advocare Essence (HMO-POS). Next year there will be some changes to the plan s costs

More information

Voluntary Health Insurance Scheme (VHIS) 08.02.2015

Voluntary Health Insurance Scheme (VHIS) 08.02.2015 Voluntary Health Insurance Scheme (VHIS) 08.02.2015 1 Nothing has changed except the NAME HPS VHIS 2 Voluntary Health Insurance Scheme (VHIS) standard plan structure Minimum Requirements Remarks 1 Guaranteed

More information

N Basic, including 100% Part B coinsurance. Basic including 100% Part B coinsurance* Basic including 100% Part B coinsurance

N Basic, including 100% Part B coinsurance. Basic including 100% Part B coinsurance* Basic including 100% Part B coinsurance HEARTLAND NATIONAL LIFE INSURANCE COMPANY Outline of Medicare Supplement Coverage Benefit Plans A, D, F, G, M and N Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After Jun 1,

More information

Blue Cross and Blue Shield of Illinois. Information Guide for 2016 Annual Enrollment

Blue Cross and Blue Shield of Illinois. Information Guide for 2016 Annual Enrollment Blue Cross and Blue Shield of Illinois Information Guide for 2016 Annual Enrollment Welcome At Blue Cross and Blue Shield of Illinois (BCBSIL) we want to help you get the most from your benefit plan. Please

More information

Let s Learn Medicare. Employee to Retiree: What You Need to Know about Medicare. Transitions to Medicare

Let s Learn Medicare. Employee to Retiree: What You Need to Know about Medicare. Transitions to Medicare Let s Learn Medicare Employee to Retiree: What You Need to Know about Medicare Transitions to Medicare Medicare Rights Center The Medicare Rights Center is a national, notfor-profit consumer service organization

More information

Blue Cross and Blue Shield of Illinois. Information Guide for 2016 Annual Enrollment

Blue Cross and Blue Shield of Illinois. Information Guide for 2016 Annual Enrollment Blue Cross and Blue Shield of Illinois Information Guide for 2016 Annual Enrollment Welcome At Blue Cross and Blue Shield of Illinois (BCBSIL) we want to help you get the most from your benefit plan. Please

More information

Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam

Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam WOMEN with MEDICARE Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam This booklet will help you understand: What is covered in the Original Medicare Plan. What Medicare pays.

More information

You can usually only shop for insurance during a specific timeframe that occurs once a year called open enrollment.

You can usually only shop for insurance during a specific timeframe that occurs once a year called open enrollment. Getting Started So many of us forget about health insurance until we need to use it. Even when we have insurance, sometimes we forget about the routine and preventive services that help us to get and stay

More information

Cigna Open Access Plans for Tennessee

Cigna Open Access Plans for Tennessee Individual & Family Plans Insured by Connecticut General Life Insurance Company Cigna Open Access Plans for Tennessee medical & PHARMACY INSURANCE with the ONE-AND-ONLY YOU IN MIND. 858436 a 12/12 Services

More information

A comparison of the Risk Equalization systems and the policy context of 5 European countries

A comparison of the Risk Equalization systems and the policy context of 5 European countries IAAHS-Conference 5May07, Cape Town A comparison of the Risk Equalization systems and the policy context of 5 European countries Wynand P.M.M. van de Ven Professor of Health Insurance Department of Health

More information

ORANGE COUNTY EYE INSTITUTE

ORANGE COUNTY EYE INSTITUTE ORANGE COUNTY EYE INSTITUTE *Note: It is the patient s responsibility to file insurance claims if we are not contracted with your insurance company. *Note: Be aware that most medical insurance plans do

More information

Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2016 and beyond

Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2016 and beyond Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2016 and beyond The Fallon difference Direct Care is a Limited Provider Network. With Direct Care Deductible 2000 Hybrid,

More information

EFFICIENCY IN MANAGING CHRONIC DISEASES: COMPARISON OF FOUR PRESCRIPTION DRUG ASSISTANCE PLANS (PDAPs) IN THE CARIBBEAN

EFFICIENCY IN MANAGING CHRONIC DISEASES: COMPARISON OF FOUR PRESCRIPTION DRUG ASSISTANCE PLANS (PDAPs) IN THE CARIBBEAN EFFICIENCY IN MANAGING CHRONIC DISEASES: COMPARISON OF FOUR PRESCRIPTION DRUG ASSISTANCE PLANS (PDAPs) IN THE CARIBBEAN Stanley Lalta and Leena Ramrattan HEU, Centre for Health Economics Presented at COTE

More information

Member s responsibility (deductibles, copays, coinsurance and dollar maximums)

Member s responsibility (deductibles, copays, coinsurance and dollar maximums) MICHIGAN CATHOLIC CONFERENCE January 2015 Benefit Summary This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations

More information

YOUR HIGHMARK BLUE CROSS BLUE SHIELD TRANSITION GUIDE CHANGES EFFECTIVE UPON YOUR GROUP S 2016 RENEWAL

YOUR HIGHMARK BLUE CROSS BLUE SHIELD TRANSITION GUIDE CHANGES EFFECTIVE UPON YOUR GROUP S 2016 RENEWAL YOUR HIGHMARK BLUE CROSS BLUE SHIELD TRANSITION GUIDE CHANGES EFFECTIVE UPON YOUR GROUP S 2016 RENEWAL Highmark Inc. and Blue Cross of Northeastern Pennsylvania have worked together for decades to bring

More information

6. IMPLICATIONS FOR MEDICARE. Implications of Cholesterol Screening in the Elderly for Total Health Care Expenditures

6. IMPLICATIONS FOR MEDICARE. Implications of Cholesterol Screening in the Elderly for Total Health Care Expenditures . 6. IMPLICATIONS FOR MEDICARE Implications of Cholesterol Screening in the Elderly for Total Health Care Expenditures The literature reviewed in the preceding chapters suggests that the health benefits,

More information

MVA Accident Questionnaire

MVA Accident Questionnaire MVA Accident Questionnaire Name Date Date of Accident Time of Accident Road conditions at time of accident Were you the driver? Were you the passenger? Where were you seated in the vehicle? FRONT BACK

More information

ElderCare Medicare Health Plan Analyzer

ElderCare Medicare Health Plan Analyzer ElderCare Medicare Health nalyzer 1999 Prism Innovations, Inc. All Rights Reserved ElderCare Medicare Health nalyzer Table of Contents Introduction 2 Explanations of New Health Plan Options 3 Analysis

More information

What is prevention and how can we use guidelines for the most important issues?

What is prevention and how can we use guidelines for the most important issues? What is prevention and how can we use guidelines for the most important issues? Carel Hulshof Jos Verbeek Relation Work Health Work Health + income, contact, learning, self-worth, social functioning +

More information

[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered

[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered Incorporated Document (6) [COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered These charts show the benefits included in each

More information

Maryland Health Connection

Maryland Health Connection Maryland Health Connection What You Need To Know About Getting Health Coverage MarylandHealthConnection.gov Goals Today The importance of coverage What is Maryland Health Connection? Coverage options Qualified

More information

GHI-COMPREHENSIVE BENEFITS PLAN/EMPIRE BLUECROSS BLUESHIELD HOSPITAL PLAN (GHI-CBP)

GHI-COMPREHENSIVE BENEFITS PLAN/EMPIRE BLUECROSS BLUESHIELD HOSPITAL PLAN (GHI-CBP) GHI-COMPREHENSIVE BENEFITS PLAN/EMPIRE BLUECROSS BLUESHIELD HOSPITAL PLAN (GHI-CBP) GHI-CBP option consists of two components: GHI, an EmblemHealth company, offering benefits for medical/physician services,

More information

Can You Purchase Life Insurance If You

Can You Purchase Life Insurance If You Can You Purchase Life Insurance If You Are Diabetic Have Heart Disease Are Fighting MS Abused Drugs or Alcohol Have a History of Cancer Or Other Serious Illness InsuranceNebraska.org (800) 882-5009 The

More information

Healthcare Liberalisation in The Netherlands: The role of the Dutch Healthcare Authority (NZa) Ms Cathy van Beek, Msc MCM Acting chair of NZa

Healthcare Liberalisation in The Netherlands: The role of the Dutch Healthcare Authority (NZa) Ms Cathy van Beek, Msc MCM Acting chair of NZa Healthcare Liberalisation in The Netherlands: The role of the Dutch Healthcare Authority (NZa) Ms Cathy van Beek, Msc MCM Acting chair of NZa Commonwealth Fund and Alliance for Health Reform Briefing November

More information

Private Fee-For-Service ----- Beneficiary Questions and Answers

Private Fee-For-Service ----- Beneficiary Questions and Answers Private Fee-For-Service ----- Beneficiary Questions and Answers 1. What Is a Private Fee-For-Service Plan? A Private Fee-For-Service plan is a Medicare Advantage health plan offered by a private insurance

More information

Please list anyone that you give permission for us to discuss your personal health information with:

Please list anyone that you give permission for us to discuss your personal health information with: STATE EMPLOYEES INSURANCE BOARD HEALTHCARE CENTER New Patient Intake Form Last Name: First Name: Middle Initial: Date of Birth: Primary Insurance Contract Number: Primary Insurance Group Number: Secondary

More information

PATIENT INFORMATION INSURANCE INFORMATION

PATIENT INFORMATION INSURANCE INFORMATION (mm/dd/yyyy): Have you been to Physicians Urgent Care before? Yes No Arrival Time: If yes, when? Is this a follow-up to a previous visit: Yes No PATIENT INFORMATION Patient s First Name: Middle Name: Last

More information

Public / private mix in health care financing

Public / private mix in health care financing Public / private mix in health care financing Dominique Polton Director of strategy, research and statistics National Health Insurance, France Couverture Public / private mix in health care financing 1.

More information

The Elasticity of Demand for Health Care

The Elasticity of Demand for Health Care The Elasticity of Demand for Health Care A Review of the Literature and Its Application to the Military Health System Jeanne S. Ringel Susan D. Hosek Ben A. Vollaard Sergej Mahnovski Prepared for the Office

More information

Frequently Asked Questions: Medicare Supplement & Medicare Advantage

Frequently Asked Questions: Medicare Supplement & Medicare Advantage Frequently Asked Questions: Medicare Supplement & Medicare Advantage Who is eligible for CBIA s Medicare program? A CBIA Health Connections participant is eligible for either plan if they are qualified

More information

THE EFFECT OF THE TAX LAWS ON HEALTH INSURANCE AND MEDICAL COSTS. Statement by. Alice M. Rivlin Director Congressional Budget Office.

THE EFFECT OF THE TAX LAWS ON HEALTH INSURANCE AND MEDICAL COSTS. Statement by. Alice M. Rivlin Director Congressional Budget Office. THE EFFECT OF THE TAX LAWS ON HEALTH INSURANCE AND MEDICAL COSTS Statement by Alice M. Rivlin Director Congressional Budget Office Before the Subcommittee on Oversight, Committee on Ways and Means and

More information

STAR CROSSED: WHY DOCS TRUMP HEALTH PLANS IN CMS STAR SCORES

STAR CROSSED: WHY DOCS TRUMP HEALTH PLANS IN CMS STAR SCORES Health and Life Sciences POINT OF VIEW STAR CROSSED: WHY DOCS TRUMP HEALTH PLANS IN CMS STAR SCORES AUTHORS Andrea Jensen, Senior Consultant Martin Graf, Partner An analysis of Medicare Advantage data

More information

Your Medicare Options Guide Book

Your Medicare Options Guide Book Your Medicare Options Guide Book H4152_ageinoptionsbook123 Accepted Turning 65? Time to get informed. Maybe you re not thinking about retirement yet. These days people are working and enjoying life longer

More information

Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care

Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care Affordable Care Act Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care SPECIAL REPORT / MAY 2015 WWW.FAMILIESUSA.ORG Executive Summary Since its passage

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 9.0 June 22, 2015 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international

More information

North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS

North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS Often times in the early care and education field we

More information

Let s talk about Critical Illness insurance

Let s talk about Critical Illness insurance Let s talk about Critical Illness insurance ivari can help you and your family keep the quality in quality of life should you be diagnosed with a critical illness. Critical illness insurance from ivari

More information

Medicare Supplement (Medigap) Coverage for Medicare Beneficiaries

Medicare Supplement (Medigap) Coverage for Medicare Beneficiaries Medicare Supplement (Medigap) Coverage for Medicare Beneficiaries Brian Webb Manager, Health and Life Policy Nat l Assoc. of Insurance Commissioners February 6, 2009 Original Medicare Created in 1965,

More information

How Medical Consumerism Can Lower Healthcare Costs. Presented by: Bill Byron Assistant Wellness Manager

How Medical Consumerism Can Lower Healthcare Costs. Presented by: Bill Byron Assistant Wellness Manager How Medical Consumerism Can Lower Healthcare Costs Presented by: Bill Byron Assistant Wellness Manager Session Objectives Review the health care problems and challenges we face nationally and here in New

More information

BlueHealth Solutions. Your guide to integrated health management

BlueHealth Solutions. Your guide to integrated health management BlueHealth Solutions Your guide to integrated health management We re committed to the health of Vermonters, outstanding member experiences and responsible cost management for all of the people whose lives

More information

Medigap Insurance 54110-0306

Medigap Insurance 54110-0306 Medigap Insurance Overview A summary of the insurance policies to supplement and fill gaps in Medicare coverage. How to be a smart shopper for Medigap insurance Medigap policies Medigap and Medicare prescription

More information

Closing the Coverage Gap

Closing the Coverage Gap MEDICARE PRESCRIPTION DRUG COVERAGE REVISED MAY 2013 Information Partners Can Use on: Closing the Coverage Gap The Affordable Care Act includes provisions to close the Medicare Part D prescription drug

More information

Using routine prescribing data to identify comorbidities in cancer patients

Using routine prescribing data to identify comorbidities in cancer patients Using routine prescribing data to identify comorbidities in cancer patients Chris Brown, Linda Sharp, Kathleen Bennett, Ian Barron National Cancer Registry Ireland @CStatsAU @IrishCancerReg 1 Comorbidities

More information

Massachusetts Health Connector logo. What Does National Health Care Reform Mean for You?

Massachusetts Health Connector logo. What Does National Health Care Reform Mean for You? Massachusetts Health Connector logo What Does National Health Care Reform Mean for You? 1 National health care reform offers more opportunities for individuals, families, and small businesses to save on

More information

801501-MSP-WI. Medicare Supplement

801501-MSP-WI. Medicare Supplement 801501-MSP-WI Medicare Supplement 1 Medicare supplement Not so surprisingly, seniors have questions about health care - especially Medicare. Even with all of the information out there you may still be

More information

Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 (RX $15/$40/$60/30%) Your Network: Prudent Buyer PPO

Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 (RX $15/$40/$60/30%) Your Network: Prudent Buyer PPO Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 (RX $15/$40/$60/30%) Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed

More information

Frequently Asked Questions about the Anthem Lumenos Health Reimbursement Account (HRA) Plan 2016

Frequently Asked Questions about the Anthem Lumenos Health Reimbursement Account (HRA) Plan 2016 Frequently Asked Questions about the Anthem Lumenos Health Reimbursement Account (HRA) Plan 2016 You can learn more about the Anthem Lumenos HRA Plan enhancements for 2016 by logging in to our online educational

More information

Your Guide to Medicare Special Needs Plans (SNPs)

Your Guide to Medicare Special Needs Plans (SNPs) CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Special Needs Plans (SNPs) This official government booklet has important information about Medicare Special Needs Plans, including the following:

More information

Medicare-Medicaid Dual Eligibles Characteristics, Care Needs, and Costs

Medicare-Medicaid Dual Eligibles Characteristics, Care Needs, and Costs Medicare-Medicaid Dual Eligibles Characteristics, Care Needs, and Costs Prepared by James M. Verdier Mathematica Policy Research for the National Health Policy Forum Washington, DC October 21, 2011 Introduction

More information

Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA

Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual &

More information

For Retirees of City of Memphis. Features that Add Value. Freedom of Choice. Quality Service Is Part of Quality Care

For Retirees of City of Memphis. Features that Add Value. Freedom of Choice. Quality Service Is Part of Quality Care For Retirees of City of Memphis Features that Add Value The Cigna Medicare Surround indemnity medical plan helps pay some of the health care costs that your Medicare Part A or Part B do not cover such

More information