Yup, me too! I had no idea what an ACO was, or why I should care. After doing a little research I thought I would share with you why they may become very important in a Macro kind of way. Firstly A.C.O stands for ” Accountable Care Organizations” , which usually ends up the antithesis of it’s name. Years from now they may call them W.S.O. or “Wallet Siphon Organizations”. Essentially the purpose of these A.C.O.’s is to coordinate care for people undergoing certain treatments. Want a typical government text book definition, click here for Definition of Accountable Healthcare Organizations provided by Healthcare.gov. 

Essentially the idea is that by coordinating care for Medicare , if we can reduce costs below a certain benchmark the savings that result will be shared by Medicare to the A.C.O. ( in theory). The reality may be that hospitals and  doctors are setting up these new ” Accountable Healthcare Organization entities with the intent to create ideal situations for more efficient health care, but may in fact ultimately drive costs higher by reducing supply. The fear critics have is that Hospitals will merge, and create ever larger pools of hospital doctor coalitions which would in turn leverage their size to garnish higher fees and wages. Funny how we see this time and time again, remember Enron, and electricity deregulation that was supposed to create private market competition and drive prices lower? Yeah we know how that story ended. 

This new quirk in the healthcare law bares watching for a myriad of reasons, higher health care cost with diminutive services for starters. Know what A.C.O.’s are, and watch their impact in your local market. For all our sake I hope  the geniuses who drafted this are correct; that this will lower our already burdensome Medicare costs, which is a signifiant burden both at the federal and state level especially. We shall see…….

The two seasons a year I hate the most are Tax Season, and Open Enrollment for our Health Insurance Plan. The later is interesting as it gives me a fabulous lens from which to see and feel a clients frustration as they wade into the perceived toxic waters
of buying insurance. Even with my background, I become exasperated, confused, frustrated and ultimately passively resigned to the realities of the health insurance marketplace. When I am done reviewing the Health Insurance for the company, and my family I
always come away with, "this must be how my clients feel", which ultimately led me to form Metropolitan Risk; the founding basis
MAKING INSURANCE PAINFREE TO PURCHASE THRU PROTOCOL.  Simply translated it’s an ongoing process to teach employees , and senior management how to manage their companies risk, understand how insurance fits into the whole process,
thereby making it much easier to manage and buy because we understand it, and are comfortable because we can manage the end result ( the price we pay) which can be very cathartic.

I am off my soap box and onto the meat of why you clicked here in the first place. First the bad news; Health Insurance premiums are set to rise 8.8 % according to benefit consulting firms. If you are an employee, the effective increase will be higher 12.5%
once you take into account , deductible increases, premium increases , higher co pays, and co-insurance. It’s that special! 

What Can We Do Insurance Mic? Glad you asked , let’s break it down on the telestrater.

OUT OF POCKET EXPENSES:

I love spreadsheets! They are my Magic 8 Ball, lets see what they say. To do a fair comparison we need to see what you spent last year. Create a Column on you spreadsheet that’s labeled "LAST YEAR" , in the row description put in items such as "insurance
premium" "deductibles" "prescriptions", "co-pays" or "co-insurance" which ever was applicable. Label the second column "Current Year" . Input into this column the answers the descriptions I stated above to see what the cost difference will be to your family
in this current year contingent on which Health Insurance Quote or Option you choose. Try and keep you inputs consistent with the previous year so your data, and answer has integrity. For example if your family paid a $50 co-pay last year per visit, and they
visited the doctors office 10 times. The answer for that Row is $500 . If the current year the Co-Pay goes up to $75 per visit , use 10 visits as your benchmark for the current year and input the cost for this line items as $750. See where Waldo is going here. 

Do this for each row description to compare the new proposed plan, versus what you had last year to figure out what proposal has the least cost associated with it, not necessarily the lowest cost premium. It’s all about the out of pocket expense, NOT the
premium Jimmy Neutron! 

COVERAGE FOR DEPENDENTS:

Insurance carriers have been chisiling coverage away little by little for years, 2011 will be no exception and may even be worse. Experts suggest that premiu charges for dependents should increase for dependents on your health plan. Employers may also re-structure
the way you pay for dependent coverage. Instead of charging one price for Family coverage , they are starting to charge per dependent. As an example last year a carrier may have charged $3,000 for a family plan, now they will charge $2,000 per dependent which
is an enormous increase for families! Another trend we are seeing is Employers cutting back on how much they will pay for dependent benefit packages. 

IF you and your spouse work for different companies and both have access to dependent health benefits compare and contrast the coverage and premiums offered by both employers as the coverage offerings and pricing may differ substantially between the two
leaving your family an obvious choice. 

CO-PAYS V.S. CO-INSURANCE :

Another sneaky trick employed by the carriers is the old Co-Insurance Trick. Simply put Co-Insurance substantially increases your out of pocket expense. Consider the following claim. You have an MRI on your knee done that costs $2,500. Your old plan has
a $50 co-pay assuming you remain in Network, your new plan has a 10% Co-Insurance
provision which means your $2,500 MRI costs you $250 out of pocket now, versus the $50 you would have spent on the
Co-Pay of your old plan. You don’t need to work for Google to figure out the math here, and who it favors. 

These are just the obvious items that I thought folks should look out for. Naturally there are a slew of others contingent on you families or companies unique circumstances. We always advocate having a strong benefits consultant t help both your company,
and your employees make value decisions . One of the top reasons families file for personal bankruptcy is for Medical Costs. Please make thoughtful decisions.

As part of the new health reform, Private Insurance carriers who offer Children Only policies must accept every child , and cannot alter their rates based upon the child’s health going into the plan. Searching for a child only health insurance policy just
got much easier. Simply go to the governments new health insurance website  Healthcare.gov and enter your child’s data. The site will show you a basket of options from which you may choose from. The
site is also particularly helpful if find coverage for families and individual adults as well.

Just thought you should know!

Children in families whose income levels do not exceed, $ 88,200 in New York, $77,175 in New Jersey may be eligible for for
CHIP,
Children’s Health Insurance Program.

The CHIP program is for children of parents who make too much money to qualify for Medicaid, but not enough money to afford to purchase a health insurance plan to cover their children. To qualify for the plan you must meet your state’s designated income
level, and your child must be presently uninsured.

Each state is different in terms of eligibility, coverage guidelines, administrative procedures and benefits. To find your state CHIP plan Click this CHIP MAP now for detailed state
information. To Apply for CHIP you may call their HOT LINE directly @ 1-877-543-7669  to be placed in touch with your state specific administrator.  

It can take up to 45 days for approval, however 11 states, New York being one of them may grant immediate, temporary coverage for children in both Medicaid and CHIP if they appear to be eligible.  

This can be a very affordable option for families who are struggling to provide critical health care coverage for their children. Finally it appears Congress got something right.

If you found this helpful leave a comment. I put alot of information out there and I am not sure what resonates and what doesn’t. Good luck, and god speed.

At the beginning of summer two things happen. School let’s out , and the Department of Labor releases it’s average weekly wage rate for New York State. I know, there are some geeks out there screaming , NO that data is released in March. Yeah, yeah, however
it becomes meaningful to employers, and injured workers typically July 1st, when the New York Workers Compensation Board releases the actual MAXIMUM weekly benefit rate, which for July 2010 thru July
2011 is $ 739.83. The monks at the Comp Board arrive at this number by taking the New York Department of Labor average weekly wage rate for the state which was  $1109.75 released in March 2010 , and
applying a factor of 2/3’s , which is how we end up at the MAXIMUM NY WORKERS COMPENSATION BENEFIT RATE of $ 739.83 for July 2010 thru July 2011.

Hopefully you are reading this a a mere satistical curiosity, and not as a number you will depend on to feed your family. The good news for injured workers is the benefit rate has gone up dramatically over the last several years, and is actually pegged to
a real number that should increase every year, rather than having the benefit rate remain static over a period of many years eroding the benefit to working families thru the disease better known as inflation.

Just thought you should know!