DPC vs HSA: Interesting Twist

DPC, of course, being Direct Primary Care, about which we've written extensively over the years (here, for example). My primary criticism of the model (and really the only substantive one from my perspective), is this:

"As long as ObamaCare remains the law of the land, there is never going to be a good *economic* rationale for DPC." [emphasis in original]

But that may be changing, if only a little.

There's a movement gaining steam proposing that DPC fees be made eligible for reimbursement from one's HSA (Health Savings Account):

Dear @RepMarkMeadows and Freedom Caucus: Use your leverage over CR vote to let patients to use HSAs for #DPC. cc @RepDaveBrat @RepAndyHarrisMD @DesJarlaisTN04 @RepGosar @RandPaul #HR365 pic.twitter.com/WqP1y2JAlL

— AssocAmerPhys&Surg (@AAPSonline) January 17, 2018

I think this is a great idea, and I would suggest only that it doesn't really encompass the full value of such a change.

And what's that, Henry?

Well, in the Alternative Benefits field, we talk a lot about HSAs, but also HRAs (Health Reimbursement Arrangements) and FSAs (Flexible Spending Accounts). Seems to me that whatever magic necessary to make DPC fees HSA-eligible would, by definition, render them kosher for HRAs and FSAs, as well.

I suspect that there are a lot more FSAs (and, perhaps, HRAs) out there than HSAs, specifically in the group market (where employers' financial liability is much favorable to the former two).

In any case, a hopeful sign, and perhaps a welcome change

[Special IB Thanks to Jennifer C at FlexBank]

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From the Mailbag: Muddy P&C

Last week, FoIB Jeff M and I were chatting and the subject of the (horrific and now deadly) California mudslides came up. We wondered if (and/or how) one would be covered if one's house (literally) went downhill.

Eventually, we turned to Co-blogger Bob, who's a regular participant in an agents' forum, and asked him to research there for this on our behalf.

We were not disappointed.

The two most helpful replies:

"Most HO policies exclude flood and earth movement. The NFIP forms define what "mudflow" is. DIC policies may cover mudslides and earth movement, but if it's in an area blighted by wildfire, availability and affordability could be an issue for a DIC policy."

And:

"Hello! Here's what I heard back from our underwriter @ Safeco... I am based at CA.

'No coverage for mudslide, only possibly covered under Flood coverage depending on the % of water in it (a mudflow). There is no coverage for hotel/food etc. under the home policy either if evacuated due to the mudslide. Mudslide is covered under EQ if a result of an earthquake.'"

Thanks, Bob (and IF folks)!

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WooHoo - New Wonk Review!

Health Wonk Review co-founder (and all-around mensch) Joe Paduda gets the first 'Review of 2018 and hits it out of the park.

From  rx cost sharing in Germany to expanded association plans to industry corruption, and lots more. Enjoy!

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Breaking: Goodbye Good Sam

It's been just a couple of weeks since we learned that Premier Health and United Healthcare had buried the proverbial hatchet; now we learn that the former is cutting loose what seems to have become quite the financial albatross:

"Good Samaritan Hospital, the fourth-largest hospital in the Dayton region, will close."

Premier Health appears to be streamlining its facility offerings, in line with its self-proclaimed "2020 strategic plan." The company says that Good Sam's services will still be available, just moved over to Miami Valley Hospital (about 5 miles, or 14 minutes, away). How that will work out is, of course, anyone's guess.

Stay tuned...

[Hat Tip: FoIB Debbie C]

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Can’t say I’m surprised. You?

According to Gallup, “After four years of Affordable Care Act implementation, the percentage of adults with no health care insurance has hit 12.2 percent”

So is that an increase or a reduction? The linked article continues:

“In the last quarter of 2016, the percentage of uninsured hit a record low of 10.9 percent. A year later, in the last quarter of 2017, the percentage of uninsured increased by 1.3 points—the largest single-year increase Gallup has seen since it began tracking the measure in 2008.”

Based on US population of approximately 320 million, each 1-percentage point increase to the uninsured rate is about 3.2 million people. Do the math.  The number of uninsured Americans increased by more than 4 million just in one year - 2017!  (For any progressives who may struggle with math, 3.2 x 1.3  = 4.1). And this happened B.T. - Before Trump.  

Also note that after 4 years of Obamacare, and despite the “mandate”, Americans age 26-34 have the highest  uninsured rate = 20.1%.   Can’t say that’s a surprise either.  

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Data, Data, Who owns the data? Part #3,624

So here's an interesting (if tragic) scenario:

"An Afghan refugee named Hussein Khavari is being accused of raping and murdering 19-year-old medical student Maria Ladenburger, disposing of her body in a river."

He has since confessed to the crime, but is disputing some of the details that were obtained once the police were able to access his iPhone's health/activity data for the date of the crime. It seemed to confirm his guilt, but has raised some interesting questions (some of which we've seen echoed here: the Sam Bernadino tragedy comes to mind):

"Sean O’Brien, a researcher at Yale Privacy Lab [believes that it] would be much better... not to collect such surveillance data at all. Such data is best kept locally on devices whenever possible. If it is collected, those who handle it have a deep responsibility to defend the privacy of their users.”

It seems to me that there are (at least) two issues in play here:

First, as we've asked more than a few times before, who actually owns your data? It's not as clear-cut as one might think:

"Hugo Campos has [an ICD] buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart."

The information the device accumulates is stored in a proprietary format, inaccessible to Hugo (or anyone else, for that matter). The iPhone data is also, after a fashion: the owner must either give up the password or the authorities must (try to) use brute force to unlock it themselves. And of course here there are significant 4th Amendment issues at play here (not so much in Germany).

On the other hand, the data can be prove useful in other ways, (alleged) crime-wise:

"Further investigating – including a review of a Fitbit activity tracker – showed the scene was staged and 43-year-old Jeannine Risley knowingly filed a false report."

Two steps forward....

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Throw Momma From the Plan

Have you ever bought something that sounded sooooo good at the time but later regretted it? Perhaps that salesperson made it seem absolutely wonderful but neglected to tell you a few things. You know, stuff that, had you known at the time, might have led you to a different decision. But the salesperson kept talking and talking and talking.

Some people without brains do an awful lot of talking, don't they? - Wizard of Oz

One of InsureBlogs favorite curmudgeon's, Wendell Potter, penned an article for Medicare Resources that caught my eye. Recent discussions with fellow agents regarding how Medicare treats SNF care led me to an article titled "Why Mom Went Back to Traditional Medicare".

This is allegedly a true story and the names have not been changed to protect the innocent.

As it seems Wendell's real mom had a real Medicare Advantage plan. At age 91 Mrs. Potter is in relatively good health for someone her age. But according to her son she might not have been so lucky had she stayed on a Medicare Advantage plan. Like a good son, Wendell switched his mom from the Advantage plan to original Medicare when she was "critically ill".

Many Medicare Advantage enrollees do exactly what Mom did after a serious illness or injury, and the MA plans they “disenroll” from couldn’t be happier to see them go. When they go back to traditional Medicare, the MA plans are off the hook for covering expensive care.

(The Medicare Advantage disenrollment deadline is Valentines Day every year, so mark your calendar for 2/14/2018).

According to Wendell, his reason for throwing Momma from the plan was this.

the head nurse took me aside and told me that another nurse – not at the facility but at Mom’s Medicare Advantage plan – had come to the conclusion that the skilled nursing was no longer “medically necessary.” This other nurse – a so-called “utilization management” nurse – had never laid eyes on my mother, much less treated her. But she was able to insert herself between my mother and her treating physician and, for all practical purposes, determine whether or not she would get the care her doctor said she needed.

Beyond being a dutiful son, Mr. Potter had RESEARCH to back up his decision.

Kaiser Health News quoted J. Michael McWilliams, the Harvard professor who led the research team, as surmising that “beneficiaries who developed serious ailments might leave the (MA) plans to get unfettered access to physicians and treatments through traditional Medicare.”

Unfettered access as opposed to managed care that is baked in to Advantage plans.

Claims submitted to original Medicare are still required to meet medical necessity standards, but there are no utilization monitors overseeing the ongoing claim. Claims are adjudicated AFTER THE FACT rather than ongoing when you have an Advantage plan.

That's not as bad as it sounds.

If the attending physician cannot prove medical necessity for the treatment under original Medicare the beneficiary is not responsible for the claim. An exception occurs if the patient signed an Advance Beneficiary Notification form PRIOR TO the procedure or treatment.

ABN applies to claims with original Medicare, but not Advantage plans.

So Wendell was able to use the system to get Momma off the managed care plan and into an un-managed plan with original Medicare.

But he neglected to mention one thing.

Disenrolling from the Advantage plan the way she apparently did negated any guaranteed right to purchase a Medicare supplement plan. The way his article is worded it appears this was a VOLUNTARY disenrollment, not one triggered by moving out of the service area or because her current plan was discontinued.

Perhaps his mother was healthy enough to qualify for a Medigap plan, or perhaps not. He does not elaborate on this point.

Disenrolling from an Advantage plan does allow you to go to original Medicare without answering health questions. But without the protection of a supplement plan the beneficiaries exposure on Part B is unlimited.

Or as I like to explain it, your 20% share of Part B expenses continues until you get well, run out of money or die.

Only one of those results is optimum.

While the saga of Mrs. Potter and the nursing home makes for an interesting read it can be a bit misleading to those who think disenrolling means you can automatically enroll in a Medigap plan.

But now you know.

#MedicareAdvantageDisenrollment  #ManagedCare  #NursingHomeCoverage

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