Tag Archives: Health Insurance

Analysis: Why Dental Care Costs So Much In The U.S.

Americans have a tendency to avoid the dentist. More than 40% of Americans said they don’t see a dentist as often as they would like, according to a 2018 survey by the American Dental Association.

Their number one reason for skipping visits is cost, even among those with dental insurance. Dental insurance policies can be confusing and difficult to use, making some Americans wonder whether dental insurance is worth investing in at all. Watch the video to find out to learn what it actually costs to go to the dentist, whether dental insurance is worth investing in and what patients and policymakers can do about it.

Chapters 0:00 – Introduction 1:42 – How dental insurance works 4:15 – Dental care costs 6:17 – Is dental insurance worth it? 9:49 – Solutions Americans have a tendency to avoid the dentist. More than 40% of Americans said they don’t see a dentist as often as they would like, according to a 2018 survey by the American Dental Association. People have lots of reasons for not going, including fear, inconvenience and trouble finding a dentist who take their insurance. But the top reason Americans cite for avoiding the dentist is cost, with nearly 60% of Americans saying cost was the main reason they haven’t visited the dentist in the past 12 months. Cost remained the number one reason regardless of age, income level or type of insurance. Dental insurance can be confusing since it’s considered a separate service from medical insurance, which means it has different policies and procedures that many patients are not familiar with. From a lack of transparency about benefits to rules like annual maximums — which means plans stop paying for treatment after hitting a certain amount for the year — some patients question whether dental insurance is worth investing in at all. “There’s this misnomer that you need dental insurance to go to the dentist, you really don’t,” said Dr. Mark Vitale, a general dentist and owner of Edison Dental Arts in Edison, New Jersey. “Dental insurance is not the panacea that most people think it is.” But the industry landscape is shifting as more traditional health insurance companies are supplementing their medical plans with dental benefits. “Dental insurance is extremely profitable to the insurance companies, which is why many of the insured many of the major carriers offer dental insurance,” Vitale said.

Views: Is U.S. Healthcare System Broken? (Harvard)

Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.

Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.

The cost is enormous

  • High cost, not highest quality. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is relatively low in the US.
  • Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.

Access is uneven

  • Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
  • Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
  • Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.

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Retirement: Medicare, Medigap & Part D – Seniors Find Choices “Dizzying”

If you’re enrolled only in original Medicare with a Medigap supplemental plan, and don’t use a drug plan, there’s no need to re-evaluate your coverage, experts say. But Part D drug plans should be reviewed annually. The same applies to Advantage plans, which often wrap in prescription coverage and can make changes to their rosters of in-network health care providers.

“The amount of information that consumers need to grasp is dizzying, and it turns them off from doing a search,” Mr. Riccardi said. “They feel paralyzed about making a choice, and some just don’t think there is a more affordable plan out there for them.”

November 13, 2020

When creation of the prescription drug benefit was being debated, progressive Medicare advocates fought to expand the existing program to include drug coverage, funded by a standard premium, similar to the structure of Part B. The standard Part B premium this year is $144.60; the only exceptions to that are high-income enrollees, who pay special income-related surcharges, and very low-income enrollees, who are eligible for special subsidies to help them meet Medicare costs.

“Given the enormous Medicare population that could be negotiated for, I think most drugs could be offered through a standard Medicare plan,” said Judith A. Stein, executive director of the Center for Medicare Advocacy.

“Instead, we have this very fragmented system that assumes very savvy, active consumers will somehow shop among dozens of plan options to see what drugs are available and at what cost with all the myriad co-pays and cost-sharing options,” she added.

Advocates like Ms. Stein also urged controlling program costs by allowing Medicare to negotiate drug prices with pharmaceutical companies — something the legislation that created Part D forbids.

Read full article in NY Times

Medical Economics: Virus Exposes America’s “Broken Healthcare System” (2020)

From The Guardian (April 16, 2020):

The Guardian Healthcare“As this epidemic makes clear, at any moment, any of us could become sick, could become hospitalized, could be on a mechanical ventilator,” said Adam Gaffney, an ICU doctor in Boston. “And that, in the United States, could mean potentially ruinous healthcare costs.”

With over 21,000 people dead and more than a 547,000 infected with the coronavirus in the US the last question on a person’s mind should be how they will pay for life-saving treatment.

There were 27.9 million people without health insurance in 2018, and record-high unemployment will increase that figure by millions

But as the death toll mounted, a patient who was about to be put on a ventilator in one of New York City’s stretched to capacity intensive care units had a final question for his nurse: “Who’s going to pay for it?”

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Politics: Bernie Sanders “Medicare For All” (NPR)

NPR PodcastsAs we head into South Carolina’s primary and gear up for Super Tuesday, the 2020 candidates are looking to stand out to voters. But perhaps no policy proposal has marked this election more than Sen. Bernie Sanders’s push for Medicare for All.

While the Democratic candidates agree on expanding health coverage, they’re divided on how to insure everyone, whether to insure everyone, and, of course, how to pay for it all.

Bernie Sanders Website

So how are they similar? How are they different? And how does that compare to President Trump?

Rachana Pradhan, correspondent for Kaiser Health NewsNoam Levey, national healthcare reporter for The LA Times; and Dan Diamond, health reporter for Politico and host of the “Pulse Check” podcast helped us break down where each candidate stood on health care.

Healthcare Interviews: Centers For Medicare And Medicaid Services Director Seema Verma

Seema Verma, administrator for the Centers for Medicare and Medicaid Services, sits down for a rare one-on-one interview with special correspondent Sarah Varney of Kaiser Health News. They discuss President Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future, and the latest Medicare for all proposals.

Healthcare For Seniors: Best Buy To Increase “Digital Health” Service And Insurers Will Pay

From a Becker’s Hospital Review online release:

Best Buy Assured Living“Today, most of the seniors we serve are utilizing easy-to-use mobile phone products and connected devices that are tailored for seniors and come with a range of relevant services,” Best Buy CEO Corie Barry said during an earnings call Nov. 26, according to a transcript from Seeking Alpha

“We also expect to advance our commercial business where the services we provide for seniors are paid for by insurance providers. This includes services such as remote monitoring based solutions that provide meaningful insights to improve timely care and reduce the cost to serve frail seniors,” she said.

Best Buy is known as the largest specialty electronics retailer in the U.S., and a key part of its growth strategy is centered on digital health initiatives.

In the past year, Best Buy has spent roughly $1 billion on acquisitions to expand its healthcare services, according to Forbes. The company’s expansion into healthcare has helped it overcome broader declines in consumer electronic sales, according to Bloomberg.

To read more: https://www.beckershospitalreview.com/strategy/best-buy-s-healthcare-strategy-get-insurers-to-pay.html?oly_enc_id=9129H5611090H0N

Seniors Health Care: AMA Launches New Medicare Insurer “Zing Health” To Focus On Patient-Physician Relationship

From a Fast Company online article:

Zing Health news releaseZing’s plan will give seniors access to a network of clinics in Cook County, Illinois, starting in January. The company hopes to expand to three states by 2022. It’s a managed care plan, which means the Centers for Medicare and Medicaid Services (CMS) will pay a single monthly fee per member in exchange for a more holistic approach to nurturing patient health. Zing is working with a network of community health centers, including Oak Street Health, which recently raised $65 million for its senior-focused facilities. Continue reading Seniors Health Care: AMA Launches New Medicare Insurer “Zing Health” To Focus On Patient-Physician Relationship