Consumer Driven Health Care


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Consumer Driven Health Care

  1. 1. CONSUMER DRIVEN HEALTH CAREAre You Up to Speed? Presented By: John V. Stewart, MSM, CDHC Stewart’s Insurance Depot S.E. Georgia 912.434.2090 N.E. Florida 904.729.4025 Metro Indianapolis, IN 317.570.1271 Metro Cincinnati, OH 513.868.0040 Nationwide 866.203.5097
  2. 2. Stewarts Insurance DepotCONSUMER AWARENESS 2
  3. 3. Stewarts Insurance Depot Consumer AwarenessSome myths and facts:Health insurance companies make lots of money on us! Fact: Health Insurance Companies make 3 cents on every dollar. Fact: The insurance industry is the only industry required by law to make a profit. So where does our insurance dollars go? 3
  4. 4. Stewarts Insurance DepotSo where does our insurance dollars go? If 87 cents of every major medical insurance dollar goes to covering us, what can I do to help control my costs and keep my insurance premiums as low as possible? 4
  5. 5. Stewarts Insurance Depot Your personal Survey on Major Medical Insurance Cost savings start with what kind of major medical plan I am looking to purchase.The plan will cover with ages of:I would like a ( local, regional or national ) insurance carrierWhat amount do I want to pay as a deductible?Do I want a coinsurance amount (what % 90/10, 80/20,70/30, 50/50)?How many times a year do I go to the doctor?Do I want a plan that has doctor copays?How many prescriptions do I purchase a year?Do I want a plan that has prescription drug coverage?Do I want a tax advantage plan with qualifying highdeductible insurance? Y or NHow much am I willing to put into an HSA account/year? 5
  6. 6. Stewarts Insurance DepotHow much do you want to spend on Major Medical Insurance? George Ready (Age 30) 32034 Single Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year Saver $2,500.00 $3,000.00 $5,500.00 N/A $70.80 Base of % Base No Copay 80% Plan $2,500.00 $3,000.00 $5,500.00 N/A $106.68 33.63% Copay Plan $2,500.00 $3,000.00 $5,500.00 $35.00 $110.57 35.97% $477.24 100% Plan $2,500.00 $0.00 $2,500.00 N/A $127.09 44.29% Single HSA * $2,500.00 $0.00 $2,500.00 N/A $128.02 44.70% Nancy Ready (Age 30) 32034 Single Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year Saver $2,500.00 $3,000.00 $5,500.00 N/A $91.94 Base of % Base No Copay 80% Plan $2,500.00 $3,000.00 $5,500.00 N/A $140.08 34.37% Copay Plan $2,500.00 $3,000.00 $5,500.00 $35.00 $166.98 44.94% $900.48 100% Plan $2,500.00 $0.00 $2,500.00 N/A $165.13 44.32% Single HSA * $2,500.00 $0.00 $2,500.00 N/A $167.91 45.24% George Ready & Family (Parents Age 30) 32034 Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year Saver (2) $5,000.00 $6,000.00 $11,000.00 N/A $268.83 Base of % Base No Copay 80% Plan (2) $5,000.00 $6,000.00 $11,000.00 N/A $270.68 0.68% Copay Plan (2) $5,000.00 $6,000.00 $11,000.00 $35.00 $506.15 46.89% $2,847.84 Plan 100 (2) $5,000.00 $0.00 $5,000.00 N/A $481.89 44.21% Family HSA (1)* $5,000.00 $0.00 $5,000.00 N/A $451.67 40.48% Gearge Ready & Wife (Age 60) 32034 Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year Saver (2) $10,000.00 $6,000.00 $26,000.00 N/A $285.72 Base of % Base No Copay 80% Plan (2) (2) $10,000.00 $6,000.00 $26,000.00 N/A $374.78 23.76% Copay Plan (2) $10,000.00 $6,000.00 $26,000.00 $35.00 $445.28 35.83% $1,914.72 Plan 100 (2) $10,000.00 $0.00 $20,000.00 N/A $443.43 35.57% Family HSA (1)* $10,000.00 $0.00 $10,000.00 N/A $521.38 45.20% () Indicates number of persons needed to meet deductible requirement * HSAs have benefit of a health savings account and tax deduction of income and 0 tax when used for IRS acceptable major medical procedures and Rxs Note: the plans outside the HSAs and 0 coinsurance plans have larger out-of-pockets Look what it costs to have an office visit copay and other bells and whistles. Note: rich benefit plan 6
  7. 7. Stewarts Insurance DepotWHY HSA QUALIFIED PLANS? 7
  8. 8. Stewarts Insurance Depot Why HSA Qualified Plans?• You are in control of how you use your health care dollars.• Become more involved in managing your cost of care.• Learn how to shop for the best prices for your care.• Your tax-advantage contributions to your HSA account grow over time.• It is your money to use tax-free for qualified medical expenses.• There is no “use it or lose it” philosophy. If you don’t use it, save it for next year. Or better yet, for retirement.• After age 65, HSA funds can be used for non-qualified expenses and only income tax is assessed. From HSABank website 8
  9. 9. Stewarts Insurance Depot An HSA Growth IllustrationIncome tax reduction anyone? The Happy family with George age 30 and Susan age 30 have changed from a conventional major medical Contribution 2011 Limits Single Family plan to a High deductible HSA qualified family plan.Minimum Deductible $1,200 $2,400 No kids yet, but who knows…. Remember HSA/HDHP family plans; all insured members haveMaximum Out-of-Pocket $5,950 $11,900 access to these funds for medical expenses asContribution Limit $3,050 $6,150 allowable by the IRS. When George and SusanCatch-up Contribution (55 or older) $1,000 $1,000 convert to Medicare at age 65, here is what they have. Estimates Below for this illustration: Enter your average contribution per year: $ 4,000.00 Enter your average medical expenses per year: $ 850.00 How many years will your account accumulate? 35 Enter your federal tax bracket: 28% Enter your state tax: Florida no state income tax Enter your bank interest rate: 3% Results of the Happy family having a HDHP/HSA: Future Value Calculator Net Contributions: $110,250.00 Net Contributions Per Year: $3,150.00 Tax Savings on Contributions: $30,870.00 Tax Savings on tax-deferred growth: $22,457.56 Future Value: $190,455.56 From HSABank website 9
  10. 10. Stewarts Insurance Depot Investigate Make Ask Cost of Informed Questions Care DecisionsALL RIGHT: I’M READY TO TAKE CONTROL! How do I do it? 10
  11. 11. Stewarts Insurance Depot Are we shopping for major medical care services like we shop for other things? Are we a savvy shopper for major medical care services? Do we just wave our major medical insurance card and say ….. “just fix me?” OR Check if you do: • Do we check out where we are going to buy• Do we ask what the costs will be? our medications?• Do we check to find the least • Do we investigate second opinions costs for the and services needed? alternate treatment regimens?• Do we use our network provider • Do we investigate the treatment we directory? need to be informed? 11
  12. 12. Stewarts Insurance DepotOUR VISITS TO OUR DOCTORS 12
  13. 13. Stewarts Insurance Depot What to do at the doctor visit:• Inform your doctor of any changes you are experiencing.• Be honest about how you are feeling.• If you are taking medication(s) prescribed by another doctor(s), inform your doctor of these and why you are taking them.• Give your doctor your family medical history regarding major illness issues and cause of death. Go back to at least your grandparents. Remember the 6th highest cause of death in the US is from taking Also be sure to: the wrong prescription! Take your notebook and pen…. Take notes on what to do. Ask questions…… Write down answers. 13
  14. 14. Stewarts Insurance Depot Some Helpful Resources:Your doctor says you need to have a Carpal Tunnel condition evaluatedand you need to have it verified by an MRA and then possible surgery. You are now a savvy health care shopper what do you do? Here are some suggested internet resources:The HSA Insider hsafinder.comCDHC Solutions CDHC Solutions “Ask the Experts”Consumer Driven Patient2Patient”Market ReportMCOL’s ConsumerDriven Care Or any other resource you choose. Here is what we found… 14
  15. 15. MRI- MusculoskeletalAlways check our yourprovider directory and the cost first Source: 15
  16. 16. Carpal Tunnel SurgeryHow much do you want to spend?Source: 16
  17. 17. Stewarts Insurance Depot Are you receiving the best value for your dollar?Have you ever thought about paying cash instead of using your insurance? If youhave a health savings account/ high deductible major medical plan, you have thebest of both worlds. or ?Next time you visit your doctor and have to have an out-patient surgery and you have anHSA Account ask what it would cost if you paid using your plan or cash for it all? Using my insurance plan. $ Not using a hospital. $ Using a stand alone facility. $ From the above ask the Big Question…What if I pay cash for the whole procedure using this facility? $ 17
  18. 18. Stewarts Insurance DepotWHAT IS IN YOUR EYE? 18
  19. 19. Stewarts Insurance Depot What is in your eye?Your eyes can tell you many things about the condition of your body.Examination of your eyes can forewarn you of subtle changes taking place invarious parts of your body such as: Glaucoma Cataracts Diabetes High Blood Pressure Night Blindness Detached Retina Macro Degeneration Depth PerceptionWear good quality sunglass, avoid glares and use eye protection whenworking. Never ever look directly at the sun or other high intense light!!!!! 19
  20. 20. Stewarts Insurance DepotANYONE FOR HEARING? 20
  21. 21. Stewarts Insurance Depot Anyone for Hearing?Hearing is very important and subtle changes in hearingcan cause long-term results: • Get your hearing checked by competent professionals • Early detection results in less chances of major loss. • Never listen to very loud music or expose yourself to loud noises. • Wear ear protection. 21
  22. 22. Stewarts Insurance DepotSOME FINAL THOUGHTS ON OTHER CARE 22
  23. 23. Stewarts Insurance Depot Get Your Dental Check-Up & Cleaning WHY? • Prevents tooth decay • Check for oral cancers • Detection of Periodontal Diseases • Helps keep you healthy from other diseases.Periodontitis ( occurs when inflammation or infection of the gums gingivitis isuntreated or treatment is delayed. Infection and inflammation spreads from thegums (gingiva) to the ligaments and bone that support the teeth. Loss of supportcauses the teeth to become loose and eventually fall out. Periodontitis is theprimary cause of tooth loss in adults. This disorder is uncommon in childhood butincreases during adolescence.CausesPeriodontitis occurs when inflammation or infection of the gums gingivitis isuntreated or treatment is delayed. Infection and inflammation spreads plaque andtartar accumulate at the base of the teeth. Inflammation causes a pocket todevelop between the gums and the teeth, which fills with plaque and tartar. Softtissue swelling traps the plaque in the pocket. Continued inflammation eventuallycauses destruction of the tissues and bone surrounding the tooth. Because plaquecontains bacteria, infection is likely and a tooth abscesses may also develop,which increases the rate of bone destruction.Updated by: Jack D. Rosenberg, DDS, Advanced Dental Care, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network.Also reviewed by David Zieve, M.D., MHA, Medical Director, A.D.A.M., Inc. 23
  24. 24. Stewarts Insurance Depot Where do you keep a copy of your Health Care Power of Attorney? Bank File Drawer Shoe Box Attached to Oh, it is somewhere something aroundOne of the most important places to keep a copy of your POA Health Care is in: The glove box Mary Stewart I never thought of that….. 912.434.2090 And carry a card like this in your wallet. You never know what may happen. 24
  25. 25. Stewarts Insurance DepotIt’s all about how we take care of ourselves. Remember, take time out of your life for you 25
  26. 26. QUESTIONS? COMMENTS?Contact Us:Stewart’s Insurance Depot, John StewartS.E. Georgia 912.434.2090N.E. Florida 904.729.4025Metro Indianapolis, IN 317.570.1271Metro Cincinnati, OH 513.868.0040Nationwide 866.203.5097Email: stewartsinsure@yahoo.comWebsite: