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Planning for Health Care

Health Insurance Definitions

Rosemary K. Heins, Extension Educator — Family Resource Management

It is not fun to have an illness and some people feel ill just trying to make sense of the words used by the insurance industry. Consumers need to understand insurance terms to be smarter about their health insurance dollars. Let’s review four of the terms: premium, co-payment, co-insurance and deductible.

Premium is the amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Co-payment is a fixed amount, for example $15, you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service and some services, based on the plan, may not have a co-payment.

Co-insurance is your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. For example, if your co-insurance rate is 30% and a procedure costs $1,000, the insurer will pay $700 and you will owe $300.

A final term, deductible, is the amount you owe for health care services before your health insurance plan starts to pay within a calendar year. Certain health care services are subject to a deductible and others may not be. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services. Each calendar year the deductible amount will need to be met before the insurance pays.

Insurance terms can be confusing. And I’ve only reviewed four of the many that would be in a good health insurance glossary. The message is if you don’t understand a term, ask questions, to be an informed consumer.

For answers to your health insurance questions, go to https://ask.extension.org/groups/1790

Considerations in Choosing a Health Insurance Plan

Rosemary K. Heins, Extension Educator — Family Resource Management

November 2013.

Comparison shopping can save you dollars; this is even more important in looking at the various health insurance plans to choose from. However, good comparison shopping for health insurance begins with truly taking a look at your households' health care needs.

Start by doing an inventory of how you use or may use health care services. Do you expect a lot of doctor visits? How many prescriptions do you need to fill regularly? Do you see any specialists? Is there a chronic disease you are managing? Do you anticipate in any health care changes in the coming year, like for having a child or a child turning 27?

You also need to determine costs that include the monthly premium and how much you have to pay out-of-pocket for services when you get care. Health care plans available through the health insurance marketplaces are put into categories based on the percentage of cost you are willing to take on. The lower the premium, the higher the out-of-pocket costs when you need care. The higher the premium, the lower the out-of-pocket costs when you need care.

Another factor to consider is the possibility that because your income is lower, you are eligible for tax credits. These are potentially available by selecting a health care plan made available through the health insurance marketplace. In Minnesota this is called MNsure. For more information you can go to the MNsure website or call 1-855-366-7873.

The bottom line is that you need to balance affordability with coverage. That begins by looking at the total picture of your households' health care needs.

Source

MNsure.org

HIPAA and Health Care Privacy

Rosemary K. Heins, Extension Educator — Family Resource Management

September 2013

HIPAA, commonly pronounced like the word for a large African animal — hippo — relates to medical information privacy. The acronym actually stands for Health Insurance Portability and Accountability Act of 1996. It guides health care providers in determining who they can share your information with.

A health care provider or health plan may share relevant information with family members or friends involved in your health care or payment for your health, if you tell the provider or plan that it can do so, or if you do not object to sharing of the information. An example would be, if you do not object, your doctor could talk with the friend who is with you at the hospital or the family member who pays your medical bill.

A provider or plan may also share relevant information with family or friends if, using professional judgment it believes you do not object. For example, if you send your friend to pick up a prescription for you, the pharmacist can assume you do not object to their being given the medication. Or when you are injured and cannot give your permission, a provider may share information with family or a friend with you since doing so would be in your best interest.

These are simple examples but recognize that HIPAA is a law that health care providers are required to follow. It is part of your privacy rights over health information, including getting a copy of your information, making sure it’s correct and knowing who has seen it.

Source

U.S. Department of Health and Human Services, A Patient’s Guide to the HIPAA Privacy Rule: When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved In Your Care, retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_ffg.pdf

Financial Caregiving Goals

Rosemary K. Heins, Extension Educator — Family Resource Management

September 2013.

Adult children often do not know much about their parents’ financial situation. This can be a big problem if there is a sudden change in their health and they are no longer able to handle their own monetary affairs.

Advance planning helps a family avoid crisis decision-making, increases the parents’ future options, saves money, reduces sibling disagreements and lessens the possibility of needing to take court action in order to manage a parents’ financial affairs. It can also provide parents and children with peace of mind. The parental peace of mind comes from knowing their wishes are understood and will be carried out.
There are two goals important to caregivers that advance planning achieves. Through planning, caregivers are prepared for an emergency by knowing where to find the parent’s important financial and legal documents. The second goal is that through advance planning parents are encouraged to prepare financial and legal tools, such as durable power of attorney for financial decisions and for medical decisions.
If your parents are healthy and independent, children don’t need to know the specifics of their financial situation. The top priority is to share where parents keep their financial records and what do they want done in an emergency situation. As you learn more about their financial situation, you may not like or agree with their choices. However, remember it is their money and they have a right to make their own financial and estate-planning decisions. Encourage your family elder to seek advice from a qualified professional such as an attorney, accountant, or financial planner.

If your family hasn’t already had this conversation with parents, now could be the best time to start.

Source:

Swanson, P.C., Schindler, N., Tran,T. (December 2009), Introduction to Financial Caregiving and Glossary, University of California Agriculture and Natural Resources, retrieved from http://anrcatalog.ucdavis.edu/pdf/8379.pdf.

Minnesota Health Care Directive

Rosemary K. Heins, Extension Educator — Family Resource Management

Reviewed June 2013 by the author.

None of us can predict our future. One step for planning ahead though is to complete a health care directive, sometimes labeled a living will or durable power of attorney for health care.

Adults have the right to control their own medical care by consenting to or refusing medical treatment. Patients have the right to understand health problems, care options, and the effects of accepting or rejecting treatments.

Sometimes decisions must be made when a person isn’t able to decide or communicate preferences. Putting your wishes in writing helps make sure they’ll be known if family, friends, or health care providers need to make a care decision.

How do you put together a health care directive? First, obtain a copy of the Minnesota Health Care Directive form. This can be accessed from a medical clinic office or online.

On Part I, you can appoint someone, called an agent, to make health decisions for you if you become unable to make or communicate health care decisions.

On Part II, you can leave written instructions that can include your health care goals, fears and concerns. You include what you want as well as what you don’t want. You can also state limits of the powers you want your agent to have.

To make it legal, sign and date it. Then have the document witnessed by a notary public or two people, neither of whom is the person you are appointing to make your health care decisions.

Finally share a copy of the directive with the person you’re appointing and your health care providers. For more information and forms to complete, contact your health care provider or print them off the internet. A link to the form is available from the University of Minnesota Extension website at www.extension.umn.edu.

Source

Stum, M. S. (2011, January). The Minnesota health care directive. St. Paul, MN: University of Minnesota Extension.

No one really plans to get sick or experience a health-related family crisis. Long term planning can help ensure that you and your family have the resources needed to cover costs and other needs related to health-related care. If you plan for financing long term care, you will also have more options about the type of care you and your loved ones receive. A good first step is to write down your wishes for your health-related care in a health care directive.

If you suddenly find yourself in a caretaker role for someone you love, you most likely will be faced with lots of questions and tasks that need to be accomplished. It helps to have access to additional resources, tools, and insight from other families going through the same situation.

Graduate with Coverage

Lori Hendrickson, Extension Educator — Family Resource Management

June 2014

College graduates may seem like “young invincibles,” but they are the age group most likely to visit emergency rooms. And without health insurance, the expense of a trip to the ER can create a heavy burden. MNsure has launched the “Graduate with Health Coverage” campaign to remind young women and men that they may be eligible for affordable health insurance through the state’s health insurance marketplace.

MNsure reminds young adults across Minnesota that after college graduation, many will lose the health insurance they had through school and the peace of mind that comes with that coverage. MNsure may be an option if certain criteria are met, so college graduates should explore their options on the MNsure site to get covered.

Though the regular Open Enrollment period for 2014 has ended, people with qualifying life events can still enroll, and college graduates may be among those eligible to enroll. While graduation itself is not a qualifying life event, college graduates who experience a qualifying life event — such as the loss of university- or employer-sponsored health insurance that meets minimum essential coverage standards — may be eligible to enroll through MNsure.

Graduates whose income makes them eligible for MinnesotaCare or Medical Assistance, and who do not have access to employer-sponsored health insurance, can also enroll through MNsure for coverage through one of those programs.

Visit the MNsure website to see if you qualify. That website is www.mnsure.org.

Featured Resource

Graduate with Health Coverage

Hear how young women and men may be eligible for affordable health insurance through the state's health insurance marketplace. More

The following resources will help you better manage medical debt through long term planning, create a health care directive, and more.

Health Insurance Definitions — Consumers need to understand insurance terms to be smarter about their health insurance dollars. Transcript and audio (2:06)

Considerations in Choosing a Health Insurance Plan — Comparison shopping can save you dollars; this is even more important in looking at the various health insurance plans to choose from. Transcript and audio (1:58)

Minnesota Health Care Directive — One step for planning ahead though is to complete a health care directive, sometimes labeled a living will or durable power of attorney for health care. Transcript and audio (1:57)

Health Care Directives Workshop — Arrange for us to come and teach on this important topic. Excellent resource for employee groups, community organizations, and more.

HIPAA and Health Care Privacy — The Health Insurance Portability and Accountability Act of 1996 guides health care providers in determining who they can share your information with. Transcript and audio (1:46)

Dealing with Medical Debt — Helpful advice about dealing with medical debt. Transcript and audio (1:36)

Other Recommended Resources

Across Generations: Dealing with Life Transitions — Advice on how to evaluate, set goals, and share your plans with others.

Are Consumers Vulnerable to Low-Knowledge of Long Term Care? — Journal article that reviews consumers' knowledge of long-term care. Written by Amanda E. Matzek and UMN Extension Specialist, Marlene S. Stum; featured in Family & Consumer Sciences Research Journal.

Caregiving — Are you in a caretaker role? Get resources, tools, and insight here.

Healthy Futures — You never know exactly what's going to happen down the road, but you can take steps to protect your health.

Use Your Home to Stay at HomeNational Council on Aging — This is the official reverse mortgage consumer booklet approved by the U.S. Department of Housing & Urban Development.

Financing Long Term Care: Insurance & Its AlternativesUtah State University Cooperative Extension — Reviews long term care options, costs, insurance, and other resources.

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