Debbie Perlman Blog

A health insurance network is a group of doctors, hospitals and clinics that have agreed to provide plan members with health care services. When you enroll in an insurance plan with a network, in order to get the best value from your plan you must use those doctors and hospitals for your health care needs. If you receive care outside of your network (other than in an emergency) you could end up paying out of pocket for most of those costs. The size of the network depends on the insurance plan you choose. Usually, the larger the network, the higher your monthly premium will be. Many private Medicare plans, like Medicare Advantage plans, have limited networks, and this can mean lower premiums for you. But it’s not all about the costs. Limited networks make a lot of sense for meeting most people’s health care needs. Can a limited health insurance network actually be good for you? The short answer is yes. And here’s why. 1. Networks include high quality doctors and ho...

Portland, Ore. (September 26, 2019) —The National Psoriasis Foundation, NPF, applauds Senator Lisa Murkowski (R-AK), Senator Doug Jones (D-AL), Senator Bill Cassidy (R-LA), Senator Margaret Hassan (D-NH), Senator Cindy Hyde-Smith (R-MS), and Senator Jacky Rosen (D-NV) for introducing the Safe Step Act. This legislation amends the Employee Retirement Income Security Act (ERISA) to require a group health plan (or health insurance coverage offered in connection with such a plan) to provide a robust exception process for step therapy protocols. Step therapy is a tool used by health insurance providers to control spending on patient’s medications. While step therapy can be effective in containing the costs of prescription drugs, in some circumstances, it can have a negative impact on patients including delayed access to the most effective treatment, severe side effects, and potentially irreversible disease progression. Currently, when a health care provider prescribes a t...

It’s no coincidence that one of the most special times in a person’s life also happens to be among the most expensive. Having a baby in a hospital setting costs a family an average of $3,035 — and that’s just for a delivery that’s “natural” in nearly every sense of the word (read: no epidural). The dollar signs tick up from there, amounting to medical bills that can keep coming long after mom returns from maternity leave. But chances are none of this is a shock to you or your employees. The thing about babies, at least biological ones, is that nature gives most new parents roughly nine months to prepare. And many new moms or dads know to expect medical expenses ahead of time. Still, there are some costs that even the most astute planners may not anticipate. Life can throw wrenches in every part of a person’s birth plan, and your employees may get hit for more than they bargained for when welcoming that new bundle of joy — which can seriously affect their engagem...

Here's how to increase your Social Security payout. Boost your benefit. Your Social Security payment amount is determined by how much you earn while working and when you elect to start receiving payments. Married individuals are additionally eligible for spousal and survivor's payments. But there are many strategies you can use to increase how much you will receive in retirement. Here's how to get the highest Social Security payment you qualify for. Work 35 or more years. Your Social Security payments are calculated using your 35 highest-earning years in the workforce. If you don't work for at least 35 years, zeros are factored into the calculation and reduce your payments. Even a low-earning year is better than having a zero averaged in. Earn a higher salary. The more you earn and pay into Social Security up to the taxable maximum of $132,900 in 2019, the higher your retirement payments will be. Earnings above the taxable maximum are not subj...

Every fall, the 60 million Americans who use the health plan can compare options and save money. Here’s what to consider. If you’re enrolled in Medicare but worry about the cost of health care, your chance to do something about it is right around the corner. Most people enroll in Medicare when they become eligible at age 65. But every fall, they have the opportunity to change their coverage during an enrollment season that runs from Oct. 15 through Dec. 7. This is the time of year when you can switch between original fee-for-service Medicare and Medicare Advantage, the all-in-one managed care alternative to the traditional program. You also can re-evaluate your prescription drug coverage — whether that is a stand-alone Part D plan, or wrapped into an Advantage plan. It’s a good idea to do a checkup on your coverage, even if you are happy with your current choices. Prescription drug plans often revise their lists of covered drugs, the rules under which they ...

For value-based care to provide truly holistic, coordinated care to patients, it must incorporate behavioral health treatment. This can result in improving the quality of health care for your employees, especially those with chronic medical conditions. Despite the benefits of integrating behavioral health treatment into value-based care, physical and behavioral medicine too often remain siloed in our health care systems — even under value-based care arrangements. The Need for Inclusive Treatment Comprehensive primary care has begun to seek ways to integrate behavioral health treatment to improve outcomes and cost-effectiveness. Behavioral health conditions frequently co-occur with chronic diseases, but these symptoms may be overlooked. Depression symptoms, for example, may be masked by other medical conditions. Patients with diabetes often receive mental health education along with diabetes education, since anxiety and depression are frequently associated with this...

When President Lyndon Johnson signed Medicare into law on July 30, 1965, he declared, “No longer will older Americans be denied the healing miracle of modern medicine” (Johnson, 1965). On that promise, and much more, Medicare has delivered (Oberlander and Marmor, 2015). Over the past fifty years, Medicare has provided tens of millions of older Americans with a crucial measure of financial security and access to medical care. Moreover, since 1972, Medicare has provided coverage to persons with permanent disabilities and end-stage renal disease. Medicare is a program that almost all American families come to rely on. At the same time, so too has the medical industry come to rely on Medicare. As the single largest purchaser of medical services in the United States, Medicare is an important source of income for hospitals, physicians, home health agencies, and other medical care providers. Changes made in Medicare policy reverberate through American medical care. Medicare spending cu...

In July 2018, Better Medicare Alliance, a Washington, D.C.-based nonprofit, published research compiled by Avalere Health studying the treatment outcomes of chronic condition sufferers who have Original Medicare and compared them with a similar population of people who are enrolled in Medicare Advantage. The results could potentially affect how Medicare beneficiaries decide to receive their health coverage. Original Medicare Vs. Medicare Advantage Plans This particular study compared the two primary coverage options Medicare beneficiaries can typically consider. One option is to enroll in Medicare Part A and/or Part B (often called Original Medicare), which is the federally funded health insurance program founded in 1965. The other option is to enroll in a Medicare Advantage plan (full disclosure: one of my companies offers Medicare Advantage plans), which is sold by private insurance companies and offers the same benefits offered by Medicare Part A and Part B under one ...

Term life insurance is among the devices that people should consider when they want to provide an immediate estate for loved onces after their death. Although term insurance is not always the most effective type of life insurance for all of a client’s death benefit needs, it can be useful in many circumstances. Since term insurance is not just one product, but rather many variations on a general theme, different types of term insurance are indicated for different client needs. Keep in mind, term insurance, more than any other type of insurance, is pure death protection with little or no ancillary or lifetime benefits. Therefore, the two overriding considerations in the use of term insurance, regardless of the specific application, are Will death protection alone meet the need? Will the coverage last as long as the need? In short, with term life insurance — as with any other decision about appropriate coverage — the product must match the problem. Term Life Insurance Ad...

Most Americans have private health insurance. This is a big monthly expense and one that many would prefer to do without. But what are the advantages and disadvantages of a country using this type of health care system? Read below to find out. Advantages: 1. You Choose Your Doctor In the private healthcare system, you often have more flexibility in choosing a doctor as well as a medical facility. For patients that want the same doctor all the time, this can be a very important advantage of this type of system. 2. Shorter Wait Times If you are having surgery that is necessary but not life-threatening, there are often long wait times. In a private health insurance system, the patient will often have shorter wait times because the medical facility is less busy. And even if there are a lot of people waiting, you can often bypass the line by paying a little bit extra for faster medical attention. 3. Improved Facilities Unfortunately, because the public sy...

The cost of your Medicare Part D-covered drugs may change throughout the year. If you notice that prices have changed, it may be because you are in a different phase of Part D coverage. There are four different phases—or periods—of Part D coverage: Deductible period: Until you meet your Part D deductible, you will pay the full negotiated price for your covered prescription drugs. Once you have met the deductible, the plan will begin to cover the cost of your drugs. While deductibles can vary from plan to plan, no plan’s deductible can be higher than $415 in 2019, and some plans have no deductible. Initial coverage period: After you meet your deductible, your plan will help pay for your covered prescription drugs. Your plan will pay some of the cost, and you will pay a copayment or coinsurance. How long you stay in the initial coverage period depends on your drug costs and your plan’s benefit structure. For most plans in 2019, the initial coverage period ends after you have ...