You can make yourself dizzy looking up all the time tables for when your new health insurance benefits will enhance your plan. Insurance companies are varied in their approaches to providing benefits outlined in the Obama-care legislation. The edges to the mandates are fuzzy. Whenever an insurance company ponders the rule, they will enact the lowest cost approach. Why shouldn’t they? They can’t print money when they lose money. When they lose money they increase our insurance premiums.

Just a few things will cost the premiums to increase by 30 to 40% in the next 12 months.  I will bet anyone a glass of water on this. Here are a few benefits that are pretty expensive to offer: No co-pays on well person colonoscopy, unlimited dollar amounts on  physical therapy, unlimited prosthetic allowance, unlimited durable medical equipment, dependant coverage to age 26. You might want to think about cost for a minute.

Colonoscopy at your local outpatient pavilion: $1,600,  Physical Therapy Apt. $ 200 heat pack: $150 , State of the art prosthetic leg: $48,000, Therapy equipment for shoulder surgery: $300 day, Dependant daughter has normal delivery childbirth: $35,000. .. 100% coverage: PRICELESS…almost.

Theoretically compare your car insurance plan to health insurance. If you purchased a plan that paid for your oil changes, new tires and engine maintenance, would it be more expensive? Of course it would. Use that logic with health insurance.

 We all need to make a lot more money to pay for our new and enhanced health insurance.  Perhaps we should invest in a company that makes durable medical equipment. Do be careful about making too much money….more on that later.

What do we do?? Vote in November and please listen to your legislator. If they brag about Obama-care you should consider their flawed logic.

Most people are too busy with their lives to pay attention to what is happening with the health-care legislation. The baby boomers are just starting to enroll in Medicare and are experiencing savings in their coverage. HOLD ON. This will change. I promise you that.

President Obama promised changes in Medicare spending. This would help fund the uninsured. That savings comes in the form of cuts to capitation. Now what is that? There are two different ways to cover gaps in the Medicare program. Most seniors do know that Medicare alone will leave you with some unpaid medical bills. Two plan designs help fill those gaps. The original was called Medigap insurance and the second is now called Advantage plans. The Medigap is often called alphabet soup because it is named by letters. My personal favorite is plan F. Medigap plans follow MediCare. Right now I want to focus on the Advantage plans.

Advantage plans are like HMO plans. Under a HMO agreeement, physicians and physician groups are paid a “head fee” per person who picks that physician group. A portion of the premium goes to the physician group each month.  The physician group pays for much of the services that person needs.  When the HMOs first came to the market, doctors loved them because of the guaranteed money per month.  The members do not see any bills. The members have lower office visit co-pays. The physicians soon realized they may not be making enough to offset bills for expensive illnesses such as diabetes. Some physician groups would negotiate to increase this “head fee” aka capitation. Some groups would just say we won’t take those contracts anymore. This is where members would lose their doctors. Doctors would blame the insurance companies.

Fast forward. The Medicare HMOs now called Advantage programs have many names. Secure Horizon, Scan, Kaiser, Pearl and so on. The most popular has been Secure Horizon from United/PacifiCare. This also is the chosen plan of AARP.  The Social Security department pays the advantage plan a set capitation fee per person. That fee is about $800 per month per person. In return the Advantage plan covers most of the services the senior requires. The advantage plan insurance company shares that capitation with the physician group. Some plans charge more to accommodate and include certain physician groups.  CUTTING CAPITATION is the easiest way to save money without evaluating medical cost.  Common sense dictates that when an insurance company receives less money, they will trim benefits. This will happen. By 2011 Federal Government will be trim $195 per month per person on the Advantage plans. By 2012 this will increase to $585. These cuts are predicted by the National Center for Policy Analysis and the Congressional Budget Office.

I have tried to hit the high points of the information. The old saying; “Follow the Money” should be easier for you if you have read this. Please email me if you want to know more! You may also go to www.ncpa.org for more information on these upcoming CUTS.

President Obama is speaking to concerned gay activists this Saturday October 10, 2009. Why didn’t he take the time when thousands of concerned citizens showed up to protest the health insurance take over? These folks were not just Republicans, they were concerned people from across the nation. Recently another group of people showed up to protest. They were doctors.  Keep in mind that the AMA endorsement for Obama healthcare only represents 17% of doctors.  Doctors who are concerned about the cost shifting and reduced services took their concerns to the White House Lawn. President Obama did not address them.

 The main stream media purposely overlooks these groups. This is a dangerous time when you think about it.  Studies have shown that 80% of the US citizens are happy with their healthcare. Insurance experts have not been consulted. If they were, the statements made would not be so outlandish. But who in the White House cares? What can anyone do? Perhaps we could set up a country on the moon.

Recently a client was telling me that her friend was totally dragging herself to work every day after her chemo therapy. She has stage 4 colon cancer. She works because she needs her health insurance. She is so weak, her husband drives her to work. Mind you the husband is working and makes good money.

Please let me educate anyone out there who has this situation.

 First. There is Cobra or CalCobra. This means that if you quit or are fired you get an extension of your health benefits for 18 months and another 18 months if you are working for a California employer.

Second. If you are laid off (or fired for not showing up because you are sick like this lady) you should be eligible for the Stimulus Act subsidy. This subsidy will pay for 65% of your Cobra premium for 9 months. After that you will need to pay for the entire premium on your own. I am willing to bet that subsidy act will be extended.

Third. When your Cobra runs out you will be eligible for a HIPAA Guaranteed Issue plan from one of the main insurance companies. Personally my favorite is Anthem’s plan. It is a only little more expensive than a standard PPO. The key is to purchase this HIPAA GI plan at the end of your Cobra plan and before 63 days has passed.

Finally: After I updated my client’s education she said “oh.” She did tell me her friend actually liked going to work and it was only for 2 to 3 hours a day.  I think she was doing an emotional stress test on me!

Moral to the Story: Beware the emotional sound bites!

Apology: I am very sad for this woman. If she were my client I would be coaching her on the best access and use of her health insurance. This would be the very least I could do and that wouldn’t be enough.  My comments on this issue are meant to inform.