ACA (Obamacare) and Contraceptives

We have a pretty crazy system whereby employers are in charge of selecting/paying your medical insurance.  My employer offers Aetna.  I had nothing to do with that choice, but I understand that they were able to bargain for a good rate, given their large number of employees.  Of course the money paid to the insurer is deducted from my paycheck.  So they are not really “paying”.  I am.

We also understand as individuals that, in general, when you cede control over any aspect of your life, the entity that has the control (employer in this case) may want to make decisions for you!  That is why the system is “crazy”!  And not replicated in any other western democracy that I know of.

So where is this leading?  Contraceptives: should they be covered or not.  There are 2 pending supreme court cases.  The first one deals with a Florida based private business called “Hobby Lobby”.  Here is an excellent discussion of the issue by Rick Lowery (a writer, a minister and a bible scholar), which I highly recommend as a ‘must read’.  It is actually highly relevant to all of us, regardless of whether we buy contraceptives or not!  For the guys out there, I would remind everyone that when you get prostate cancer, there are countless women that have paid insurance fees that help support coverage of your prostate problem (even though as far as I know they don’t have a prostate and don’t particularly need that kind of coverage for themselves).  That is just the way insurance works.

If you want to learn about “Hobby Lobby” click here.

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Weighing Health Plans: The Devilish Details (NYT)

A very useful article appeared on Dec 21st, 2013 in the NY Times and many may have missed it (as I did)!  It described in detail the choices of plans offered by the ACA.  A good read before you get started!

Weighing Health Plans: The Devilish Details, by Tara Siegel Bernard.

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Facebook Group ‘docs4bishop’

If you prefer Facebook, you can visit this site, ask to join the group, and leave comments!

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Obamacare Facts versus Myths

There is a proliferation of websites spawning myths and scare tactics on Obamacare.  Unfortunately they outnumber the serious sites that offer real facts and try to help those that are in need.

If you have questions this site may be useful for you:

http://obamacarefacts.com/

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Effects of Government Shutdown for Cancer Patients

Being an oncologist I have been meaning to write about this for some time.  It is difficult enough to have an cancer diagnosis. It is also a challenge for the patient (and the doctor) to navigate the multitude of new treatments being offered and specially those that are still investigational.  For the patient that means they need to participate in a “protocol” often run through Governement programs.  The NIH (National Institutes of Health) is the most important institution in this area.  So how did last years gov shutdown affect patients and patient care?  IT REALLY DID.  Read more on this here, and in particular read the end of the article subtitled “one patient’s experience” about a 30 year old woman with fibrosarcoma trying to get on to a NIH clinical trial of cabozantinib.  Fortunately for this patient (and many others) the shutdown was eventually lifted.   Lesson: a prolonged shutdown would most certainly cost lives.  Disease is not partisan!  It affects all of us.

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Another Testimonial: Take your time – don’t do it all in one session

(I posted this for my friend J)

My wife and I went through the NY State Health website https://nystateofhealth.ny.gov/

There are a few tricks you learn along the way….first register. You don’t have to do it all at once, you can come back.

You will be asked to estimate next years income and based on that you will be provided with a deduction that is taken off the published premium…..don’t freak out because that premium doesn’t show the applied premium deduction. It will show only after you complete the application.

You will be asked to submit some document numbers (for instance my wife is a naturalized citizen, so she needed to provide that info) plus SS#’s.

Each time you look at the plans, until you actually choose one, you have to restart. After a few revisits it becomes easy. We found the most frustrating part was determining a plan, so you really have to figure out what you want based on past history, such as prescription use or child care etc. Try to determine what you spend on the most and what you need medically. Balance that against deductible versus premium.

Looking for a plan that includes your current physician is also a little weird. Our Physician’s office was not all that up to speed as to what plans they accept because there have been so many changes…ask if they accept the insurance company first, if they do, they will most likely accept the specific plan you choose….some physician offices are not aware of some of the different company relationships (like United Health and OSCAR) because they are so new…..we had to educate them…..it took a few calls to straighten that out. The Physician look up function works, but make sure the address is correct and choose the right specialty: General Medicine, etc

The best advice I can give is to not try and do it all at once…..when it gets annoying, stop and come back. Keep a good password record.

The suggestion of finding a navigator is a good one.

We are still waiting for new cards and were told that some companies are behind but will honor the application if you get a confirmation letter which is sent to you in your application account mailbox. Call the insurance company you choose for information. We had to overcome our desire of getting it all done at once.  Now, we feel pretty good about our plan.   J

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Flyers with Useful Info (in English or Spanish)

You can print them and post them anywhere.  On the bulletin board at your job, community center, church, health store, workout center/club, any place you frequent…

ACA Flyer wNYinfo[2]

ACA Flyer wNYinfoSPAN[2]

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More Testimonials Regarding Signing up for ACA (Obamacare)

I spoke to Alice who told me of the existence of “navigators”, live people who are available throughout the country to talk or meet with subscribers.  I found one in my area (Suffolk county), who walked me through the various options and gave me some real advice and suggestions.  So I signed up for a multi-state PPO with only a $1,500 deductible for $70 a month after my credits!  The plan pays at least 50% of medications and doctors visits before the deductible is met.  Of course, without knowing about these navigators I would still be floundering – I was originally looking at a $6,000 deductible plan for $50 per month.  So for an additional $20, I got a much lower deductible and pretty much the same benefits and for a 26 year old that is perfect!

We need to get the word out about navigators.  They really can make all the difference to a successful sign-up or not.

Sam

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Health Reform by Gwen O’Shea

Here is a reminder of what Health Reform is all about!  It is a slide presentation by Gwen O’Shea:

SP2 presentation

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Health Reform Presentation by Gwen O’Shea

sp2-presentation

Health Reform
by Gwen O’Shea

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