Sunday, 21 December 2014

Data breach trends for 2015: Credit cards, healthcare records will be vulnerable



The data breaches of 2014 have yet to fade into memory, and we already have 2015 looming. Experian's 2015 Data Breach Industry Forecast gives us much to anticipate, and I've asked security experts to weigh in with their thoughts for the coming year as well.

Experian highlights a number of key factors that will drive or contribute to data breaches in 2015. A few of them aren't surprising: Organizations are focusing too much on external attacks when insiders are a significantly bigger threat, and attackers are likely to go after cloud-based services and data. A few new factors, however, merit your attention.

First, there is a looming deadline of October, 2015 for retailers to upgrade to point-of-sale systems capable of processing chip-and-PIN credit cards. As banks and credit card issuers adopt more secure chip-and-PIN cards, and more consumers have them in hand, it will be significantly more difficult to clone cards or perpetrate credit card fraud. That’s why Experian expects cybercriminals to increase the volume of attacks early in 2015, to compromise as much as possible while they still can.

The third thing that stands out in the Experian report is an increased focus on healthcare breaches. Electronic medical records and the explosion of health or fitness-related wearable devices make sensitive personal health information more vulnerable than ever to being compromised or exposed.

The risk of health related data being breached is also a concern voiced by Ken Westin, security analyst with Tripwire. He pointed out that part of the reason that retail breaches have escalated is because cybercriminals have developed the technologies and market for monetizing that data. “The bad news is that other industries can easily become targets once a market develops for the type of data they have. I am particularly concerned about health insurance fraud—its driving increasing demand for health care records and most healthcare organizations are not prepared for the level of sophistication and persistence we have seen from attackers in the retail segment.”

“There will absolutely be more breaches in 2015—possibly even more than we saw in 2014 due to the booming underground market for hackers and cybercriminals around both credit card data and identity theft,” warned Kevin Routhier, founder and CEO of Core Telligent. “This growing market, coupled with readily available and productized rootkits, malware and other tools will continue to drive more data breaches in the coming years as this is a lucrative practice for enterprising criminals.”

The rise in data breach headlines, however, may not necessarily suggest an increase in actual data breaches. It’s possible that organizations are just getting better at discovering that they’ve been breached, so it gets more attention than it would have in previous years.

Tim Erlin, director of IT risk and security strategy for Tripwire, echoed that sentiment. “The plethora of announced breaches in the news this year is, by definition, a trailing indicator of actual breach activity. You can only discover breaches that have happened, and there’s no indication that we’re at the end of the road with existing breach activity. Because we expect organizations to improve their ability to detect the breaches, we’ll see the pattern of announcements continue through 2015.”

The combination of a rise in actual data breach attacks and an increase in the ability to discover them will make 2015 a busy year for data breaches. Whether we’re defending against new attacks, or just detecting existing breaches that have already compromised organizations, there will be no shortage of data breach headlines in 2015.



For more info: Westhill Insurance Consulting Data breach trends for 2015: Credit cards, healthcare records will be vulnerable.

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Sunday, 14 December 2014

Medicare Overbilling Probes Run Into Political Pressure

When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened.

Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official who oversees Medicare, Marilyn Tavenner, asking her to back down, according to documents reviewed by The Wall Street Journal. In a June 2012 letter to Ms. Tavenner, Rep. Jackson Lee said blocking payments had put the hospital at financial risk and “jeopardized” patients needing Medicare.

Weeks later, Ms. Tavenner, administrator of the Centers for Medicare and Medicaid Services, instructed deputies to restore most payments to the hospital even as the agency was cooperating in a criminal investigation of the facility, according to former investigators and documents. “These changes are at the direction of the Administrator and have the highest priority,” a Medicare official wrote to investigators.

About two months after that order, Riverside’s top executive was indicted in a $158 million fraud scheme. The hospital was barred from Medicare this May, and the CEO was convicted in October.

What happened at Riverside General Hospital shows how political pressure from medical providers and elected officials can collide with efforts to rein in waste and abuse in the nearly $600 billion, taxpayer-funded Medicare system. More than a dozen former investigators and CMS officials said in interviews that they faced questions from members of Congress about policy changes or punitive action affecting providers or individual doctors.

Ricky Sluder, a former senior investigator for a Medicare contractor who oversaw part of the Riverside investigation, said “it was extremely frustrating to stall an investigation to give some explanation to a lawmaker. It’s providers’ way of using political power.”

In an emailed statement, Medicare administrator Ms. Tavenner said the Riverside episode “reflected the tension between fraud prevention and access to care.” She said she wasn’t aware of the pending indictments and that her job required her to “balance two important policy goals” — saving taxpayer money and protecting Medicare’s beneficiaries.

A spokesman for Rep. Jackson Lee declined to comment.

Medicare has reported that during the 2013 fiscal year, waste, fraud and abuse accounted for an estimated $34.6 billion in improper payments to medical providers. CMS says it clawed back about $9 billion that year through audits and investigations.

Medicare hires contractors to enforce antifraud rules and fight improper billing. The contractors can suspend payments to doctors and hospitals and revoke billing privileges. They also can block some payments to review claims — called “prepayment review.”

Such actions can squeeze medical providers and even threaten to put them out of business. Medical providers sometimes seek help from elected officials. Politicians have a stake in such disputes: Health providers often provide jobs and valued services in their districts, and can be campaign contributors.

Houston’s Riverside hospital, for example, had treated patients in that district for nearly 100 years and employed about 200 in 2011.

Ted Doolittle, a former deputy director of the Center for Program Integrity, CMS’s antifraud unit, said most legislators support Medicare’s efforts to fight fraud. But “the member who just lost 150 jobs in her district at the hands of faceless Washington bureaucrats, she is flipping livid,” he said.

Mr. Doolittle, who left the agency in May and joined law firm LeClairRyan, said the antifraud office should be sheltered from political pressure, which he said can interfere with investigations. CMS’s top fraud investigator reports to Ms. Tavenner, who was appointed by President Barack Obama in 2011 and whose agency is overseen by Congress.

In her statement, Ms. Tavenner said: “I must be available and responsive to each of the constituencies that CMS serves, including our beneficiaries, professional associations and elected officials.”

Over the past five full years, medical providers and health-care interests spent $2.5 billion lobbying federal officials and lawmakers, according to the Center for Responsive Politics, fueled in part by a surge before passage of the 2010 health law. That constitutes 15% of all federal lobbying over that period.

The health-care industry long has contributed to lawmakers who oversee government health spending. In the current election cycle, for example, hospitals and nursing homes gave $218,800 to Rep. Kevin Brady, the Texas Republican who became chairman of the House Ways and Means health subcommittee last year, through his personal campaign fund and two political-action committees, according the Center for Responsive Politics. Those contributors gave $39,500 to him in 2012 when he didn’t hold the key position, and when his overall contributions also were less. Prior chairmen of health committees also saw jumps in such donations.

The Ways and Means Committee crafted a March bill that barred Medicare recovery auditors from scrutinizing short hospital stays — historically, an area of concern for incorrect payments — until April 2015. Last month, Rep. Brady put forward a discussion draft for a bill to overhaul audits of those short stays and provide a “comprehensive solution” to hospital payments for those visits, according to a statement from his office.

Hospital lobbyists credited the Ways and Means Committee and Rep. Brady for helping on the audit issue.

A spokeswoman for Rep. Brady said he supports the Medicare audit program “and wants to ensure it is accomplishing its mission — deterring fraud, waste and abuse.” But the current rules for short hospital stays, she said, are “arbitrary” and lack “clinical basis.” She said the March decision was made by Republican leaders in the House.

Medicare providers under investigation sometimes contact lobbying organizations for help.

Medicare investigators began looking into Florida skilled-nursing facilities in 2011 and found what they considered suspicious billing patterns at 33 homes. CMS contractor SafeGuard Services LLC was concerned about how often Florida nursing facilities were charging for the costliest physical and occupational-therapy services, according to documents. About a quarter of the 33 facilities were paid at least 20% more a day than their local rivals, a Journal analysis of Medicare data found.

Three of the 33 are owned by Plaza Health Network. Plaza Chief Executive William Zubkoff previously ran a hospital that was barred in 2006 from billing Medicare and other federal health-care programs following fraud allegations. The U.S. attorney’s office for the Southern District of Florida also is investigating whistleblower allegations that Plaza paid kickbacks for patient referrals between 2008 and 2011.

Lawyers for Plaza and Dr. Zubkoff said neither has done anything wrong and both are cooperating with the investigation. They said Dr. Zubkoff wasn’t personally accused of wrongdoing in the 2006 matter.

By 2012, the Medicare investigators had partially blocked payments to the 33 nursing homes.

Some of the nursing homes contacted the Florida Health Care Association, a trade group. It asked lawmakers and Florida Governor Rick Scott, a Republican, for assistance, according to the group’s director and emails.

Gov. Scott contacted Ms. Tavenner, according to a person familiar with the investigation. The two had once worked together at hospital operator HCA Holdings Inc., where both had been executives. The governor’s office connected CMS to the Florida Health Care Association. The trade group put an owner of two of the nursing homes, William Kelsey, on the phone with Ms. Tavenner.

Mr. Kelsey told her the prepayment reviews were “creating a real hardship on the business, staff and residents,” he recalled recently.

On Aug. 22, 2012, Ms. Tavenner ordered the agency’s antifraud officials to release payments for the 33 homes, including the two operated by Mr. Kelsey, according to emails.

A CMS spokesman said Ms. Tavenner got involved to ensure the agency was “preserving access and quality of care.” The spokesman said Ms. Tavenner “often discusses issues and concerns with elected officials . . . including Gov. Scott.”

In an email ordering SafeGuard to restore payments, John Spiegel, a Medicare antifraud official, said one reason for the action was that the nursing homes were “established providers with long-standing history.”

“Thanks to you and Governor Scott, some sanity has prevailed,” Florida Health Care Association Executive Director J. Emmett Reed wrote to a Scott staffer that Aug. 22.

The spokesman for Gov. Scott said he couldn’t confirm or deny that the governor called Ms. Tavenner about the nursing homes.

Medicare later told its antifraud contractors to avoid using “prepayment review” on skilled-nursing facilities without first receiving approval from CMS, according to documents. The CMS spokesman said the agency instructed contractors to use other approaches to recoup money before resorting to prepayment review.

Former investigators for SafeGuard, a unit of Hewlett-Packard Co., said that decision stripped them of an important tool for fighting fraud and chilled their nursing-home probe. SafeGuard referred questions to CMS.

The CMS spokesman said there is “no single viewpoint” about the value of various antifraud tools, and the agency must also consider patients’ access to care.

As of January 2014, none of the Florida nursing homes caught in SafeGuard’s probe faced any new prepayment action, a former investigator said.

The CMS spokesman said the agency advised law enforcement of its concerns about seven of the nursing homes and that its antifraud investigators referred 30 of them to another contractor to attempt to recoup excess payments.

Houston’s Riverside General Hospital already had been tangling with law enforcement before Rep. Jackson Lee contacted CMS.

In February 2012, in a separate case, the hospital’s assistant administrator, Mohammad Khan, pleaded guilty to defrauding Medicare, admitting that many services weren’t medically necessary and in some cases never provided.

By that time, Medicare antifraud contractor Health Integrity LLC had concluded that 88% of a sampling of Riverside’s partial-hospitalization claims — Medicare’s term for certain outpatient mental-health services — were incorrect, according to government records.

That June 8, Medicare suspended all payments to the facility and put its claims on prepayment review.

Then Rep. Jackson Lee jumped in. In a June 18 letter to Ms. Tavenner, she said the action could harm the “most vulnerable patients.”

Mr. Doolittle, a senior Medicare antifraud official at the time, responded in writing that “the balance favors protecting [Medicare] and the taxpayers,” and the agency would continue to block funds.

At a follow-up meeting that July with Medicare antifraud officials, Rep. Jackson Lee argued that Riverside was the area’s only provider of certain mental-health services, according to CMS investigation records.

Medicare antifraud officials determined that six other providers within 10 miles of Riverside offered the same services, records show, and they again declined to restore payments.

Rep. Jackson Lee spoke with Ms. Tavenner, according to people familiar with the investigation. Ms. Tavenner “listened to her concerns” about how the payment suspension could limit patients’ access to care, the Medicare spokesman said.

Afterward, Ms. Tavenner instructed her antifraud team to restore 70% of Medicare payments to Riverside, effective immediately, according to an email to contractors from a Medicare antifraud official.

At that time, a criminal investigation into Riverside executives, including CEO Earnest Gibson III, was already under way. Ms. Tavenner’s spokesman told the Journal she was unaware of details of the criminal investigation when she ordered the resumption of payments. However, Ms. Tavenner and senior Medicare officials had discussed the possibility of pending law-enforcement action in a conference call earlier the same day, according to one person who was on the call.

Two months after Ms. Tavenner ordered the payment release, federal agents arrested Mr. Gibson at the hospital and charged him with crimes related to health-care fraud.

Medicare officials resumed blocking payments to Riverside, according to investigation records. This May, Riverside’s Medicare billing privileges were revoked for two years, Medicare emails show. A lawyer for the hospital, Clement Aldridge Jr., said the facility now is “on its last breath,” with most of it closed.

Garnet Coleman, the state representative for Riverside’s district, said that after the payments stopped, “there were no patients, so there was no money.” He said low-income people now have fewer choices for psychiatric care.

“We need that kind of care in the community,” he said. But in the end, he said, it became clear to him that the person handling the disputed program “broke the rules.”

Mr. Gibson, the CEO, was convicted in October. His lawyer, Dick DeGuerin, said his client is innocent and is seeking a new trial.

In a recent interview, Mr. Gibson said he was unaware of fraudulent billing at the time, and that he later learned that an employee and some contractors submitted fraudulent bills for their own gain. He said executives sought to retract incorrect bills.

Mr. Gibson said he sought help from Rep. Jackson Lee to “make sure we got a fair shot.”

This June 12, Rep. Jackson Lee requested a phone meeting with Ms. Tavenner to discuss Riverside, an email shows.

CMS employees prepared talking points for Ms. Tavenner, advising her to inform the congresswoman that a revocation of hospital billing privileges is “appealable,” an email shows.

Asked about the June meeting, the Medicare spokesman said Ms. Tavenner “tries to listen to as many of the concerns that are raised as possible and ask many questions of our CMS staff to make sure we are preserving access and quality of care while aggressively preventing and punishing fraud.”

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Sunday, 7 December 2014

There Is a Reason We Never Crack Down on Medicare Fraud

Did you know there’s a government program that gives more than $60 billion a year to felons and voracious, unscrupulous hospitals and doctors?

There is: improper health-care payments. In FY 2012, Medicare fee-for-service, Medicare Advantage, and Medicaid produced $61.9 billion in improper spending. $30 billion of that is Medicare alone. It should anger us, obviously, but also worry us, because the federal government is expanding its reach into the health-care market as we speak. 

Congress is doing very little to address all that fraud and waste and the little it does is very ineffective. Nobody in the health care system has a real incentive to crack down on fraudulent or mistaken payments, so nothing gets done about it. In an eye-opening piece last year, Citizens Against Government Waste’s Leslie Paige laid out the efforts by health-care providers and some lawmakers from both parties to slow down the rate of improper payments through recovery audit contractors (RACs).

This means that wasteful and fraudulent spending will continue to cost taxpayers billions — when it doesn’t have to, or certainly doesn’t need to in the same proportion.

It has other tragic effects too. Case in point (via Michael Cannon): 

U.S. Attorney Barbara McQuade will seek life in prison for what she called “the most egregious” health care fraud case she has ever seen. McQuade said that in addition to insurance fraud, which involved a $35-million Medicare fraud scheme from 2009 until the present, Fata also harmed, and in some cased subsequently killed, his patients with dangerous chemotherapy drugs they did not need. According to government records, Fata’s medical practice included 1,200 patients. The formerly prominent cancer doctor will be sentenced in February before U.S. District Judge Paul Borman. The doctor’s bond was set at $9 million.

First and foremost, this fraudulent doctor caused suffering and event death. But the added tragedy is Medicare’s inability or unwillingness to prevent fraud. If he hadn’t been caught and stopped because of the vigilance of a nurse concerned for the welfare of her patients and a few others, the fraud would likely still be going on.

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Monday, 27 October 2014

BBB Tip of the Week

Open enrollment for many 2015 health insurance plans is around the corner.

Those searching for plans online may think they have found a great deal when they’ve found a scam.

Recently, a bogus trade association encouraged people and small businesses to pay for membership in order to qualify for health insurance. Once members, they would pay their monthly health insurance “premium,” anywhere from $40 to $1,000, thinking they had purchased a comprehensive health insurance plan. Instead they were paying premium prices for a medical discount plan with very limited discounts for just a few doctors and hospitals.

The FTC has reached settlements stopping two businesses perpetrating such schemes: Independent Association of Businesses and Health Service Providers Inc.

Similar online schemes may still be operating. In addition, online phishing scams are eager to collect your personal information by pretending to offer health insurance.

The Better Business Bureau offers the following tips to keep your information safe and find legitimate health insurance:

• Don’t share your personal information online unless you are completely certain that the website is legitimate.

• To be certain that you are dealing with a legitimate health insurance exchange, start your search at www.healthcare.gov.

• If you would rather deal directly with an insurance company or broker, research the company first.  Also check the company’s business review at www.bbb.org or by calling (455)-4200.

• To verify that the health insurance plan and company are legitimate, check with the Washington state Office of the Insurance Commissioner at www.insurance.wa.gov.

• Insurance plans have policy details available for you to review before you enroll. If an insurance broker, company or association refuses to give you up-front details about a policy, then it is probably a scam.

If you’ve been the victim of or suspect a health insurance scam, file complaints with the Washington state Office of the Insurance Commissioner at www.insurance.wa.gov, the FTC at www.ftccomplaintassistant.gov, and the BBB at www.bbb.org. 

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Thursday, 23 October 2014

PROTECT YOURSELF FROM HEALTH INSURANCE SCAMS

The U.S. health care system has changed significantly since the passage of the Affordable Care Act. The federal law introduced many changes to the insurance space and health care market and helped change the way that people shop for health insurance coverage. With the launch of insurance exchanges, new marketplaces were opened up to consumers, but these exchanges also represented a promising opportunity for scammers that are looking to exploit a person’s private information.

The U.S. Federal Trade Commission recently issued a warning about the growing prevalence of insurance scams, and there are some things that people can do to protect themselves and their information when shopping for insurance coverage.

Be Careful About What You Share Online
Many insurance scams seek to collect personal information through fraudulent websites. These sites can be designed to look official, but are merely fronts for criminal activity. Many fraudulent sites attempt to show that they represent an insurance or government agency, offering policies at discounted rates, but the policies that these sites offer are not real and exist only to collect information, such as medical records.

Beware of Unsolicited Calls
Sometimes, scammers prefer to take a more direct approach and will disguise themselves as insurance agents representing a reputable company or exchange. These people often attempt to call consumers and offer inexpensive insurance policies based on the information that they provide. Insurance exchanges do not randomly contact consumers and organizations promoting coverage through exchanges will never ask for personal information to be shared over the phone.

Document Everything
Keeping records of all salespeople you may come in contact with, as well as the names of their representative companies, could be valuable if your information is ever compromised. Information can be used for or against you, and collecting information from the agents or organizations trying to sell you insurance could be a powerful tool in keeping yourself safe. Reputable organizations have little concern with sharing their own information.

Research

Research can help uncover a scam relatively quickly. Searching for a company’s name and the complaints lodged against them online can provide some insight into whether or not that company can be trusted. An organization with a poor, or non-existent, reputation may be something to avoid.

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Monday, 20 October 2014

Westhill Healthcare Consulting Jakarta fraud prevention review - FTC Warns about fake health insurance sites trying to trick you out of personal information

Tulsa – October marks the start of when many health insurance plans open enrollment. Medicare and Obamacare will also soon begin enrolling for next year’s coverage.

2NEWSProblem Solver Jamil Donith has a word of caution before you shop for health insurance online.

According to the Federal Trade Commission, health insurance scams are preying on consumers shopping for or comparing health plans online. Scammers use websites or phony non-profit sites that seem to offer discount medical plans. In reality, the sites are set up to get your personal information. Things like your age, occupation, contact information, marital status and whether you have pre-existing medical conditions.

The FTC advises:
Be stingy with your personal information when you’re on the web. When a site asks for your personal information know that data could end up in the wrong hands. A health insurance website might look like the real deal, but many are fronts for criminals wanting to steal your money and personal information.
Research a company before giving it your business. Enter the company’s name and the “complaints” into an online search engine to see what comes up. And, before giving any personal information ask the company for the details in writing about what you want to buy. If it can’t provide the fine prince, that’s a big red flag.
Finally, check to find out if the plan you want to buy is really insurance. The State Insurance Department can tell you whether the plan is legitimate and whether an insurance provider is licensed to do business in Oklahoma. The Oklahoma Insurance Department website link is www.oid.ok.gov

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Thursday, 16 October 2014

Westhill Healthcare Consulting Jakarta fraud prevention review Wonkbook: Why the Obama administration won’t oversell Obamacare in year two



Wonkbook’s Number of the Day: 70 percent. That's the latest estimate of the mortality rate in the Ebola outbreak in West Africa, the World Health Organization announced.

Wonkbook’s Chart of the Day: Oil prices are falling, and fast.

Wonkbook's Top 5 Stories: (1) Obamacare October surprises and a lower sales bar; (2) Ebola treatments for U.S. patients; (3) attorney general nomination update; (4) security threats of climate change; and (5) new help for long-term jobless.

1. Top story: With a month to go, why the Obama administration won't oversell Obamacare in year two

Team Obama's year-two strategy: Underselling Obamacare. "The Obama administration vastly oversold how well Obamacare was going to work last year. It’s not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.Sobered — and burned — by last fall’s meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible. Officials say the site won’t be perfect but will be improved." Jennifer Haberkorn in Politico.

Explainer: 5 things we need to know about Obamacare before enrollment begins. Jason Millman in The Washington Post.

If you like your plan, can you keep it this time? "Health insurance companies, at least so far, seem to think HealthCare.gov is on the right track to function more smoothly for new customers. But insurers still see gaps in the system for people who want to renew their coverage, including pitfalls that threaten consumers with duplicate enrollments, unexpected cancellations, or surprising tax bills. Insurers aren't necessarily worried about problems as dramatic as last year's HealthCare.gov failure, but rather what one industry official called 'a soup of kind of icky things' that could make life difficult for returning enrollees. Some of the technical problems stem from the difficult balance between keeping people enrolled and encouraging them to shop for a better deal." Sam Baker in National Journal.

The potential perils of auto-renewing. "If you auto-renew, you’ll most likely be assigned the same tax credit as you had for 2014. But if your income has increased, your credit may be too large — and you could end up owing the government money, when the numbers are reconciled at tax time. Consumers are supposed to report changes in income during the course of the year, he said, but it’s likely that many have not. So by re-enrolling and updating details about income, you’ll help make sure the credit is properly adjusted. Also, because of a quirk in the way the A.C.A. calculates the tax credits, some consumers who stick with their same plan actually could end up paying more — even if their original plan doesn’t raise its rates." Ann Carrns in The New York Times.

Explainer: How the new HealthCare.gov stacks up with the old Ricardo Alonso-Zaldivar and Calvin Woodward in the Associated Press.

An Obamacare October surprise? "Obamacare premiums aren’t rising everywhere. They just have a way of finding the states with the biggest Senate races. And that could be very bad timing for Democrats in two of the party’s key contests. Double-digit rate hikes for individual health insurance plans have become an issue in the Louisiana and Iowa Senate races over the past week, where the Republican candidates are hammering their Democratic opponents for the steep premium increases on the way next year for some customers under the Affordable Care Act....The attacks could easily give the impression that the health care law is causing premiums to go through the roof around the country. They’re not." David Nather in Politico.

For employer-based plans, expect modest premium hikes and higher consumer costs likely. "Premium increases for 2015 plans are expected to be modest on average, but the shift toward higher out-of-pocket costs overall for consumers will continue as employers try to keep a lid on their costs and incorporate health law changes. Experts anticipate that premiums will rise a modest 4 percent in 2015, on average, slightly higher than last year but lower than typical recent Increases. Even so, more employers say they’re making changes to their health plans in 2015 to rein in cost growth....They are motivated in part by upcoming changes mandated by the health law." Michelle Andrews in Kaiser Health News.


Cities are eliminating health benefits once promised to retirees. Can Obamacare fill the gap? "Indeed, public employers across the country may soon begin following Detroit’s lead and withdrawing coverage for retirees, instead sending them to the health-care exchanges set up by the Affordable Care Act. 'Since the passage of the Affordable Care Act, I think it is fair to say that every public-sector employer is looking at the exchanges as a potential way to get out of the unfunded liabilities that the public sector is bearing,' said Olivia Mitchell, executive director of the Pension Research Council and a Wharton professor. 'People are becoming more expensive to take care of.'" Alana Semuels in The Atlantic.

Medicaid backlogs could worsen once Obamacare signup season arrives. "The delays stem from various technical problems and the sheer volume of Medicaid applications states must process. Some applications that come through the federal enrollment site, HealthCare.gov, and are transferred to the states still have problems with data accuracy, said Matt Salo, executive director of the National Association of Medicaid Directors. While consumers can apply for Medicaid anytime, an influx is expected when exchanges reopen for enrollment on Nov. 15 and eligible applicants go into the Medicaid system." Stephanie Armour in The Wall Street Journal.

Other health care reads:

Your guide to Medicare open enrollment. Jonnelle Marte in The Washington Post.

U.S. finds many failures in Medicare plans. Robert Pear in The New York Times.

KLEIN: Obfuscating on Obamacare in Kentucky. "In attempting to navigate this environment, McConnell has staked out a position that’s incoherent — arguing that he wants to wipe out the awful entity 'Obamacare,' while trying to create the impression that it wouldn’t affect anybody’s benefits....But Grimes wasn’t being forthright either. It’s popular to criticize Republicans for attacking Obamacare without offering an alternative. On the flip side, Grimes vowed to streamline and fix Obamacare, without offering a single workable suggestion for how she’d go about it." Philip Klein in the Washington Examiner.
Top opinion

THOMA: What's the best way to overcome rising economic inequality? "So my approach to fighting inequality in the short-run is to use taxation and corrective redistribution to ensure that workers receive the income they deserve, to fix the distributional problems that have allowed those at the top to capture more than their fair share of income, and enact supply-side incentives that have been shown to work as soon as possible. The hope is that the supply-side policies and corrections to the distribution of income will produce the types of jobs and equitable compensation that are needed to solve the inequality problem in the longer run. But there’s a chance that no matter what we do, the inequality problem will persist." Mark Thoma in The Fiscal Times.

FEYMAN: Are private exchanges the future of health insurance? "In 2014, about 2.5 million people across companies of all sizes will be enrolled in health insurance through so-called private exchanges. These are analogous in some ways to Obamacare’s state and federal-based health insurance exchanges but instead are run by private consultancies like Aon Hewitt or Mercer. While these platforms generally offer a similar 'e-commerce' approach to purchasing health insurance — either with a single carrier or multiple carriers offering plans — as the public exchanges do, there remain key differences." Yevgeniy Feyman in Forbes.

PORTER: The risks of cheap water. "As climate change and population growth further stress the water supply from the drought-plagued West to the seemingly bottomless Great Lakes, states and municipalities are likely to impose increasingly draconian restrictions on water use. Such efforts may be more effective than simply exhorting people to conserve. In August, for example, cities and towns in California consumed much less water — 27 billion gallons less —than in August last year. But the proliferation of limits on water use will not solve the problem because regulations do nothing to address the main driver of the nation’s wanton consumption of water: its price." Eduardo Porter in The New York Times.

McARDLE: Don't care about the deficit? Now you should. "As the Fed tightens up on monetary policy, our borrowing costs are going to rise, not just for the new debt we take on, but also for the debt we already have. As old debt matures, we’ve been borrowing at record-low interest rates, which has helped hold down the deficit. But as the Fed tightens, that party will end, and the numbers will start moving in the other direction. This will take time — the Obama administration has been actively working to lengthen its debt maturities in order to take advantage of the low rates. But in future years, this will place constant upward pressure on our deficit." Megan McArdle in Bloomberg View.

CRAWFORD: A Nobel-winning message for the FCC. "Jean Tirole's Nobel Prize in Economic Sciences is being celebrated on both sides of the Atlantic by academics and economists. But there is no joy in the power circles of U.S. telecommunications policy. More than a decade ago, federal policy makers turned their backs on Tirole's sensible assessments of private communications utilities — and with disastrous results. Tirole's insight was that any company controlling physical lines into homes and businesses, left to its own devices, would act as a natural monopoly, extracting tribute from every other business and customer that depends on communications capacity. To constrain that power, regulators might need to separate wholesale and retail communications-access services, and require interconnection with other networks." Susan Crawford in Bloomberg View.

FRIEDMAN: A pump war? "Bottom line: The trend line for petro-dictators is not so good. America today has a growing advantage in what the former Assistant Energy Secretary Andy Karsner calls 'the three big C’s: code, crude and capital.' If only we could do tax reform, and replace payroll and corporate taxes with a carbon tax, we’d have a formula for resiliency and success far better than any of our adversaries." Thomas L. Friedman in The New York Times.

Science interlude: Schrödinger's cat — the thought experiment, explained.

2. How America is treating its Ebola patients

Breaking: 2nd worker who cared for Ebola patient tests positive. "The worker reported a fever Tuesday and was immediately isolated at Presbyterian hospital. Preliminary tests were performed late Tuesday by the laboratory for the Texas Department of State Health Services in Austin, and the positive results were received at about midnight. Additional tests to confirm the positive reading were underway by the federal Centers for Disease Control and Prevention in Atlanta. Officials interviewed the worker to identify anyone else who might have been exposed, the Texas Department of State Health Services said in a statement, but it was unclear whether any others were being monitored." Manny Fernandez in The New York Times.

As nurses balk at protocols, hospital, CDC to ramp up its response measures. "A nurses’ union released a scathing statement that it said was composed by nurses at the Dallas hospital where the nurse, Nina Pham, 26, contracted Ebola. The statement told of 'confusion and frequently changing policies and protocols,' inadequate protection against contamination and spotty training....Officials at the hospital, Texas Health Presbyterian Hospital, defended their efforts to 'provide a safe working environment,' but said they would review any concerns raised by nurses. C.D.C. officials...pledged to dispatch within hours a newly created response team to any hospital that had a confirmed case of Ebola, and they increased the amount of expertise, oversight and training at the hospital." Manny Fernandez and Jack Healy in The New York Times.

Nurse with Ebola was given serum from surviving American doctor. "In late July, when it looked like Dr. Kent Brantly wasn’t going to make it, a small news item escaped Liberia. It spoke of Brantly’s treatment — not of the Ebola vaccine, Zmapp, which Brantly later got. But of a blood transfusion. He had 'received a unit of blood from a 14-year-old boy who had survived Ebola because of Dr. Brantly’s care,' the missive said. Now months later, Brantly, who has since recovered from his battle with the virus, has passed on the favor. A 26-year-old Dallas nurse named Nina Pham, who contracted the illness while treating the United States’ first Ebola patient, has received Brantly’s blood." Terrence McCoy in The Washington Post.

Why not give this blood to everyone? "It’s sheer luck that Brantly has been a match for all three. Another Ebola survivor, missionary Nancy Writebol, offered blood to Thomas Eric Duncan, but it wasn’t a match. Duncan died last week. The use of what’s called convalescent serum — blood from survivors of Ebola — is also controversial. It’s not clear whether it helps patients recover, although Brantly also received serum, in his case from a boy he treated in Liberia....Is there a way to make a 'universal' donor? Is there some way to make blood that doesn’t react with anyone’s blood? That’s what the makers of the experimental drug ZMapp are trying to do." Maggie Fox in NBC News.


Company puts sole focus on experimental Ebola drug ZMapp. "As Ebola continues to ravage West Africa and spreads for the first time in the United States, a Kentucky company is putting all other work aside to concentrate solely on producing the experimental medicine ZMapp. The goal: to ramp up production of the drug and get it approved and to the people who need it more quickly. Kentucky BioProcessing, contracted by privately held drugmaker Mapp Biopharmaceutical of San Diego to produce ZMapp, makes the compound using tobacco plants. The plants act as 'photocopiers' to mass-produce proteins." Laura Ungar in USA Today.

Chart: Experimental drugs used for Ebola. The Washington Post.

Experts question ethics of placebo trials for Ebola drugs. "A group of influential health experts has argued the standard practice of using placebos in drug trials would be unethical in the case of experimental medicines for Ebola, given that the world is in the middle of a deadly epidemic....A different group of disease experts last month argued in a letter to the Journal of the American Medical Association that experimental Ebola drugs were best tested in normal RCTs. A similar debate is going on in the field of cancer drugs, where researchers increasingly question whether randomisation — where some patients are given a treatment and others get a 'control' substance for comparison — makes sense in patients with an incurable disease." Kate Kelland in Reuters.

Explainer: A summary of promising Ebola therapies. Liz Szabo in USA Today.


The long quest for a vaccine slowed by ethics, politics and science. "The insidious nature of the Ebola virus has been among the hurdles in the long, elusive quest to develop an effective vaccine and treatment for one of the most dangerous viruses the world has ever known. Progress also has been slowed by the hazards that come with researching it and — perhaps more than anything else — by the economic and moral questions of focusing on a pathogen that until the current outbreak had infected fewer than 2,400 people worldwide....In the coming months, as caregivers, politicians, and armies struggle to deal with the spiraling number of cases, a handful of vaccines and treatments will be tested on humans for the first time." Karen Weintraub in National Geographic.

Has virus mutated to become more dangerous? We don't know yet. "While scientists don’t fully understand what the changes mean, some are concerned that alterations in the virus that occur as that pathogen continues to evolve could pose new dangers. Researchers have identified more than 300 new viral mutations in the latest strain of Ebola, according to research published in the journal Science last month. They are rushing to investigate if this strain of the disease produces higher virus levels — which could increase its infectiousness. So far, there is no scientific data to indicate that." Robert Langreth, Michelle Fay Cortez and John Lauerman in Bloomberg.

KLEIN: Panic, but not because Ebola threatens the US. "if Ebola becomes endemic in West Africa, all this will get much worse. In addition to the ongoing breakdown in basic services, it will be harder for West Africans to travel because few countries will let them in, it will be harder for them to trade because fewer businessmen will want to travel to the region, it will be harder for them to invest because international bankers will be scared off by the disease. It could set the region's development back decades. That's worth panicking over, not because it might kill vast numbers of Americans, but because it might cause a vast amount of human suffering. So yes, panic about Ebola. But if you live in the United States, calm down, it's not going to kill you." Ezra Klein in Vox.

GOTTLIEB AND TROY: Countering the domestic Ebola threat. "Health care professionals at all levels are of course not perfect and will make mistakes. Hospital protocols and public health preparedness plans must leave room for human error — especially when it comes to very hot pathogens like Ebola. But the CDC must do a better job of establishing clear and accurate procedures, take appropriate measures to reduce risk, and properly calibrate its public statements, if we’re going to inspire the public confidence that will be needed to prevent disruptions in the likely event of a wider, future outbreak." Scott Gottlieb and Tevi Troy in Forbes.


TORREY: How the US made the Ebola crisis worse. "A 1974 report on the 'Brain Drain' for the House Foreign Affairs Committee noted that the current policy was widening the gap between rich and poor nations, and warned that the policy 'has a great potential for mischief in the Nation’s future relations with the LDC [less developed countries].' Despite such complaints, U.S. policy has continued to encourage the immigration of physicians and other health workers from poorer countries....The consequences of this policy may be more than 'mischief.' Ebola may be merely the first of many prices to be paid for our long-standing but shortsighted health manpower policy." E. Fuller Torrey in The Wall Street Journal.

Animals interlude: A wrinkly bulldog puppy attempts to howl.

3. More clues on Obama's Holder successor

Ruemmler said to be the favorite. "Former White House Counsel Kathryn Ruemmler has emerged as President Barack Obama’s preferred candidate as the next attorney general, though he hasn’t decided on a nominee and is still weighing other choices, people familiar with the deliberations said. Advisers have told Obama that Ruemmler would encounter tough questioning in confirmation hearings about advice she gave the president during episodes of his presidency that have drawn Republican scrutiny, including the handling of lapses by the Secret Service, they said....A White House official said earlier today that Obama will wait until after the Nov. 4 midterm congressional elections to announce his choice to succeed Eric Holder." Mike Dorning and Del Quentin Wilber in Bloomberg.

The delay carries some legislative risks. "The White House aide said the decision to wait was driven in part by Senate Democrats. Had a nominee been named before the elections, Democratic Senate candidates inevitably would have been hounded on the trail to weigh in on the choice — presenting an uncomfortable situation for people who have been trying to keep their political distance from Obama, but would eventually be called on to support the president’s pick....The delay could create a chaotic situation if the White House wants a lame duck confirmation, even if the nomination comes immediately after Election Day. The the majority of the Senate might not be known for days, given several tight races. It could even take weeks." Edward-Isaac Dovere in Politico.


As Holder packs his bags, the DOJ plans to change its counsel competence waiver practices. "The Justice Department said Tuesday that it will no longer ask criminal defendants who plead guilty to waive their right to claim that their attorney was ineffective and deprived them of their constitutional right to a competent counsel. Attorney General Eric H. Holder Jr. said the new policy, his latest effort to reform the criminal justice system, is an attempt to ensure that all individuals who face criminal charges are ably represented." Sari Horwitz in The Washington Post.

Meanwhile, SCOTUS messes with Texas: Justices block state's controversial abortion law. "The court’s decision is not a judgment on the Texas law, but whether the law’s new restrictions should be delayed while the legal battle continued. Texas has been a leader among a number of states that have enacted new requirements for abortion clinics....At issue is the Supreme Court’s decision more than 20 years ago that, although states may regulate access to abortion, they may not pose an 'undue burden' on women who seek an abortion early in pregnancy. But the new laws test the extent of that 'undue burden' with new requirements that abortion providers say are hard for them to meet." Robert Barnes in The Washington Post.

Chart: Number of states imposing new regulations on abortion providers is growing. The Washington Post.

But Texas can enforce its voter ID law, appeals court says. "Texas won emergency permission to keep the law in effect while it appeals the trial judge’s ruling, which included a finding that 600,000 registered voters would be kept away from the polls. The decision will slow the momentum of Democratic efforts to increase voter turnout and may fuel a push by some Republican-controlled statehouses to make people prove their eligibility to vote. Republicans say the measures are needed to prevent fraud, while Democrats contend they’re designed to suppress turnout of poor, minority and elderly voters, who are less likely to have photo IDs and more likely to vote Democratic." Laurel Calkins and Mark Niquette in Bloomberg.

For SCOTUS, dental case is like pulling teeth. "The Supreme Court seemed to have little problem Tuesday concluding that a state board dominated by dentists should not get to decide who can perform teeth-whitening services. But when it comes to brain surgery, many of the same justices said they would rather empower neurologists than bureaucrats. As a result, they had a conundrum.The case before the court dealt with a North Carolina dental board's exclusion of non-dentists from the business of teeth whitening — a procedure that had been offered in shopping malls, spas and stores. Although most justices recognized the risk of letting dentists push others out of the market, they might not want to place the same restriction on neurologists." Richard Wolf in USA Today.

Other legal reads:

Where the fight for gay rights is headed now. Kaveh Waddell in National Journal.

Trick shots interlude: Dude Perfect, Dallas Stars edition.

4. How climate change could threaten national security

A 'threat multiplier.' "U.S. military officials have long warned that changes in climate patterns, resulting in increased severe weather events and coastal flooding, will have a broad and costly impact on the Defense Department's ability to protect the nation and respond to natural and humanitarian disasters in the United States and around the globe. The new report — described as a Pentagon roadmap — identifies four things that it says will affect the U.S. military: rising global temperatures, changing precipitation patterns, more extreme weather and rising sea levels. It calls on the department and the military services to identify more specific concerns, including possible effects on the more than 7,000 bases and facilities, and to start putting plans in place to deal with them." Lolita C. Baldor in the Associated Press.


Explainer: 5 ways that climate change threatens national security. Brianna Ehley in The Fiscal Times.

What should a Paris emissions deal look like? A U.S. envoy explains. "His remarks about this emerging hybrid system — a pact with some kind of binding element but that doesn't impose emissions mandates on nations — underscore the intricate task that negotiators face. The talks are aimed at crafting a plan that can win buy-in from big developing nations that did not face obligations under the 1997 Kyoto Protocol....The U.S. never joined the Kyoto treaty. In addition, a new formal treaty would be dead on arrival in the U.S. Senate for the foreseeable future, so many observers expect the talks, if they succeed, to yield some kind of pact that would not need formal U.S. ratification. Stern's remarks, however, did not address that topic." Ben Geman in National Journal.

Advocates: EPA underestimating electricity's ability to be green. "The report says the U.S. Environmental Protection Agency set each state’s renewable energy production targets far too low in the proposed Clean Power Plan, the Obama Administration’s effort to reduce carbon dioxide emissions from existing coal-fired power plants. The plan’s goal is to reduce CO2 emissions 30 percent below 2005 levels by 2030. The Union of Concerned Scientists (UCS), a science advocacy organization, says states can reduce emissions even more, by an average of 40 percent by 2030, mainly through the expansion of renewable power production far beyond what the Obama administration may expect from each state." Bobby Magill in Climate Central.

As the U.S. chills, the world burns. "While the United States is on pace for its coolest year in almost two decades, global temperatures could set a new record high for the year. The world experienced its warmest September since records began in 1880, according to data from the National Aeronautic and Space Administration. Similar record-breaking months to close out the year would make 2014 the hottest recorded. U.S. residents, though, aren't feeling the heat, given the unusually mild summer that followed a frigid winter." Zack Colman in the Washington Examiner.


Other environmental/energy reads:

U.S. shale oil output seen growing even as prices drop. Dan Murtaugh and Jing Cao in Bloomberg.

Oil prices plunge as production rises, fueling concern in OPEC. Steven Mufson in The Washington Post.

The incredible shrinking Keystone XL. Elana Schor in Politico.

Life's ponderables interlude: Is it unhealthy to be standing in front of a microwave while it's cooking?

5. The administration's new push for the long-term jobless

Long-term jobless grants get $170M from Obama administration. "The Obama administration is announcing $170 million in grants divided among 23 work projects across the country that aim to reduce the number of long-term unemployed Americans....Labor Secretary Tom Perez and National Economic Council director Jeff Zients announced the grant awards late Tuesday. The two officials and Vice President Joe Biden will hold a round-table meeting with top corporate CEOS on Wednesday at the White House to discuss their efforts to meet commitments earlier this year to hire more long-term unemployed workers." Jim Kuhnhenn in the Associated Press.

Audition programs are helping the long-term jobless. "More than five years into the U.S. expansion, 2.9 million Americans are long-term unemployed....Vives is among the 2 million who have been off the payrolls for more than a year. The slow progress in bringing that share down is a sign of lingering weakness in the labor market and a potential limit on the consumer spending that makes up the biggest part of the economy. It’s one reason for Federal Reserve policy makers to be patient in raising interest rates, and has prompted the White House to funnel money into programs aiding that segment of the jobless. Vives has landed at one of those programs: Platform 2 Employment, or P2E." Michelle Jamrisko in Bloomberg.

Job market for new graduates is looking up. "Campuses’ career counselors have been seeing encouraging signs, and now a major survey of employers backs them up: The coming year looks to be a much better one for new college graduates seeking jobs. Job openings for those graduates are projected to grow by double digits in 2014-15, following several years of smaller increases, according to key findings from the survey, which was released on Tuesday. Hiring of new bachelor’s-degree recipients will increase by 16 percent, the survey projects; hiring among all degree levels will grow at the same rate." Beckie Supiano in The Chronicle of Higher Education.

Cities hiring most since 2008 thanks to the economy. "More U.S. cities are hiring than at any time since the Great Recession as the reviving economy and rising property taxes allow higher spending for a second straight year, according to a report released today. One-third of cities and towns expanded their workforces this year, compared with reductions in 18 percent, according to an annual survey by the National League of Cities. This is the first year since 2008 that job additions outpaced cuts. The gains come as 80 percent of cities said their financial position is stronger than a year ago, the most in at least 29 years." William Selway in Bloomberg.

Other economic/financial reads:

The $11 trillion advantage that shields the U.S. from turmoil. Shobhana Chandra in Bloomberg.

AIG bailout architects leave questions for executives. Andrew Zajac and Christie Smythe in Bloomberg.


Fed is silent on "doomsday" book, a blueprint for fighting crises. Binyamin Appelbaum in The New York Times.

Proposal interlude: A lip-dub marriage proposal at a cafe.
Wonkblog roundup

The Supreme Court deals a fresh setback to efforts to restrict access to abortions. Wonkblog Staff.

The Ebola outbreak is not just a human tragedy. It’s also an economic one. Ylan Q. Mui.

Paul Ryan has a trick up his sleeve when it comes to taxes. It won’t work. Matt O'Brien.

It’s not just Ebola. Health care is pretty dangerous work. Jason Millman.

Colorado marijuana revenues hit a new high. Christopher Ingraham.

Whites are more supportive of voter ID laws when shown photos of black people voting. Christopher Ingraham.

The many reasons millennials are shunning cars. Emily Badger.
Et Cetera

How churches are slowly becoming less segregated. Laura Meckler in The Wall Street Journal.

Government snooping proves weak campaign issue. Erin Kelly in USA Today.

Key Obama decisions on hold until after midterms. Josh Lederman in the Associated Press.

Senior House Financial Services members propose bipartisan Ex-Im Bank bill. Kristina Peterson in The Wall Street Journal.

Got tips, additions, or comments? E-mail us.

Wonkbook is produced with help from Michelle Williams and Ryan McCarthy.


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Monday, 13 October 2014

Everyday Low Benefits Wal-Mart dumps 30,000 part-timers onto the ObamaCare

Walmart-Logo
Wal-Mart endorsed ObamaCare in 2009 and helped drag the bill through U.S. Congress, and so far it hasn’t recanted. By holding back economic growth and incomes, perhaps the law is expanding the retailer’s customer base. Another plus—at least for management—is that Wal-Mart can jettison its employees into the ObamaCare insurance exchanges.

The Associated Press reported Tuesday that the largest U.S. private employer is dropping health benefits for some 30,000 workers, or about 5% of its part-time workforce. Earlier health-plan eligibility triage in 2011 had removed tens of thousands of Wal-Mart workers from the balance sheet, so this latest purge was probably inevitable.

Wal-Mart cites its inability to manage higher-than-anticipated health expenses. Perhaps— wasn’t ObamaCare supposed to bring those costs down? Obviously the company is also responding rationally to ObamaCare’s incentives. With a subsidized government alternative now open for business, and since corporations aren’t liable for a penalty for not covering people who work fewer than 30 hours a week on average, cost-control logic says to send such coverage ballast over the side. Other retail and grocery chains including Target, Home Depot and Trader Joe’s have already done the same.

ObamaCare’s critics predicted that such insurance dumping was inevitable, and the only question now is how many and how fast other companies partake of the new all-you-caneat entitlement buffet. Get whatever you like, the bill’s on taxpayers. The disruptions will be concentrated in industries with large numbers of low-skilled and low-income workers, like restaurants, hospitality and, yes, retail.

The irony is that even as Wal-Mart drops insurance because it is too costly, President Barack Obama is claiming credit for lowering health costs. He boasted the other day that the law gave every U.S. family “a $1,800 tax cut” by supposedly reducing the rate of employer-premium growth. ObamaCare had nothing to do with that, and it surely won’t be any consolation to Wal-Mart’s latest health-plan diaspora.


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Thursday, 9 October 2014

4 Tips for Navigating Open Enrollment for Insurance

When shopping for a plan, start with the basics of what you’re looking for and what you’re willing to pay for, says Michael McMillan,Executive Director of Market and Network Services at Cleveland Clinic. Then make your selection carefully so you get what you’re paying for, he adds.
To help you navigate enrollment — either on health insurance exchanges or elsewhere — McMillan offers the following helpful tips:

1. Know what services are covered under a selected plan
Start by reviewing what each particular plan offers. For example, what does the network of care providers look like? What services are most important to you based on your particular health needs or conditions, and are they available within a plan’s coverage?
“This will be a period of great change, and consumers will have a lot of options they haven’t had before on the exchanges,” McMillan says. “It’s important to be clear on what’s available and what isn’t.”

2. Make sure your providers are part of the network
When choosing plans, this is a major factor. Look at any given plan to see if your doctors and hospitals you use regularly are listed as network providers.
One evolving trend has been for health plans to create narrow networks — smaller versions of their standard network that help them achieve a lower price. The bottom line: Not all providers are included in these limited networks, so it’s worth your effort to check first and make sure your new plan includes the doctors and other practitioners you see regularly, McMillan says.

3. Know your out-of-pocket costs
These are costs associated with the care received. They include things such as deductibles — the amount you pay before coverage kicks in — as well as copays and coinsurance on services. Out-of-pocket costs vary by the “metal” level of plan you choose on a health insurance exchange. So, for example, you would pay 40 percent of costs of coinsurance in a bronze plan, and 30 percent for silver.

In some high-deductible health plans, the first several thousand dollars will be your responsibility, too. For your personal budgeting and planning, it’s critical to know how much money you’ll have to pull out of your pocket when you go to the doctor, to the hospital, to the medical lab or for any other health service, McMillan notes.

4. Understand how your monthly premium works
Premiums are the monthly payments you make for your insurance coverage. Because the benefits for most plans, both on and off the exchanges, have become standardized, it should be fairly easy to make apples-to-apples comparisons among plans.
“You should be able to compare premium amounts, how much you pay every month for the service,” McMillan advises. However, your personal premiums may vary depending on your own circumstances — including whether you’re single or married, a smoker or a nonsmoker, and other factors.

2015 open enrollment for health insurance exchanges starts Nov. 15, 2014 and lasts until Feb. 15, 2015. Open enrollment periods for insurance plans outside of exchanges vary. No matter which path you pursue, learn as much as possible about your plan options before you buy, and you’ll end up with coverage that suits your needs as a result.

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