Why Privately Insured Seek Care in Emergency Departments

Patients' perception of the severity of their medical problem and who they first contact for help or advice are the factors most associated with whether they seek emergency care, according to a Center for Studying Health System Change (HSC) study based on the National Institute for Health Care Reform's (NIHCR) 2012 Autoworker Health Care Survey. Nearly a quarter of respondents (23%) reported having an urgent medical problem in the three months before the survey, and almost half (44%) of those with an urgent condition ultimately went to an emergency department for treatment. Of people with an urgent problem, nearly half first contacted their regular source of care-typically a primary care clinician-and those patients were less likely to go to emergency departments, the study found. Source: Center for Studying Health System Change (HSC)

Most Boomers Mistakenly Think Affordable Care Act Covers Long-Term Care Costs

Nationwide Financial Retirement Institute annual survey shows boomers’ estimates for long-term care costs drop by more than 50 percent in one year Nationwide January 21, 2014 10:30 AM COLUMBUS, Ohio--(BUSINESS WIRE)-- More than seven in 10 affluent baby boomers mistakenly think the Affordable Care Act will cover their long-term care (LTC) costs in retirement. The Nationwide Financial Retirement Institute’s annual survey, released today, also reveals that while boomers desperately want to receive LTC in their home, few are adequately planning for the costs – and many are not planning at all. According to the poll conducted by Harris Interactive of 801 Americans over 50 with at least $150,000 in household income, only 28 percent know that the Affordable Care Act does not cover LTC costs. Nearly half say they are worried about becoming a burden to their families, but 54 percent say they would rather die than live in a nursing home. “Neither the Affordable Care Act nor Medicare will help America’s workers pay their long-term care costs,” said John Carter, president and chief operating officer of Retirement Plans, Nationwide Financial. “Virtually no one wants to end up in a nursing home, but few are planning for long-term care costs. And if they have to rely on Medicaid, they may not have a choice.” According to the poll, affluent boomers expect their LTC costs to be on average $36,220 annually. That is less than half of what they estimated in 2012 ($78,920). The reality is by 2030 – the year the last of the baby boomers will reach retirement age – the cost of a nursing home (which is just one form of LTC) is expected to reach $265,000 per year. 1 “This drastic drop could be due to the media’s focus on the Affordable Care Act and people’s misconceptions about what it covers,” Carter said. “The reality is we can’t count on someone else to fix this problem. We will have to fund our own long-term care costs in retirement.” According to the survey, 71 percent of affluent pre-retirees want to receive LTC in their own home, but fewer than half think they will actually receive LTC in their home. Two in five think they will end up in an assisted living facility, and one in 10 think they will be in a nursing home. Opportunity for advisors Industry figures show many are in denial that they will ever need LTC, so they never plan for it. However, the U.S. Department of Health and Human Services estimates that 70 percent of Americans over age 65 will need LTC during their lifetime. 2 Nearly four in five (78 percent) say that when they hear the term “long-term care” they think of nursing home care. In actuality, nearly half of all LTC happens at home, with a little over a quarter (27 percent) taking place in a nursing home and 24 percent in adult day care. 3 “The most common mistake a financial advisor makes is his or her approach to the discussion. When an advisor says the words ‘long-term care,’ the client often hears ‘nursing home,’” said Kevin McGarry, director of the Nationwide Financial Retirement Institute. “This often causes the client to shut down. Instead, advisors should say: ‘Let’s talk about ways we can keep you in your home longer.’” “The next step is to get a fact-based estimate of what those long-term care costs may be and work to build a plan from there,” McGarry said. “Four in five advisors say they know if they can have these discussions, their clients will be more likely to stay with them.” Financial advisors can visit www.nationwidefinancial.com/healthcare to learn more. Methodology: The 2013 Health Care and Long-term Care Costs Study was conducted online within the U.S. by Harris Interactive on behalf of Nationwide Financial between Sept. 24 and Oct. 1, 2013. The respondents comprised a representative sample of 801 U.S. adults aged 50 or older with annual household incomes of $150,000 or higher. Results were weighted to the U.S. General Online Population of adults by sex, race/ethnicity, education and region. Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. Because the sample is based on those who were invited to participate in the Harris Interactive online research panel, no estimates of theoretical sampling error can be calculated. About Nationwide Nationwide Mutual Insurance Company, based in Columbus, Ohio, is one of the largest and strongest diversified insurance and financial services organizations in the U.S. and is rated A+ by both A.M. Best and Standard & Poor’s. The company provides customers a full range of insurance and financial services, including auto insurance, motorcycle, boat, homeowners, pet, life insurance, farm, commercial insurance, annuities, mortgages, mutual funds, pensions, long-term savings plans and specialty health services. For more information, visit http://www.nationwide.com/. Life insurance is issued by Nationwide Life Insurance Company or Nationwide Life and Annuity Insurance Company, Columbus, Ohio. Nationwide, Nationwide Financial, the Nationwide framemark, Nationwide YourLife and On Your Side are service marks of Nationwide Mutual Insurance Company. 1 Life and Health Advisor, “Don’t Let Your Clients Get Blindsided By Unexpected LTC Costs,” 2010 2 LTCI’s Revolutionary Evolution, Nov. 1, 2011, Life Insurance Selling 3 American Association for Long-term Care Insurance (AALTCI) 2011 Sourcebook Contact: Nationwide Charley Gillespie, 614-249-5701 gillesc1@nationwide.com http://finance.yahoo.com/news/most-boomers-mistakenly-think-affordable-153000372.html?goback=%2Egde_84467_member_5832128721061957635#%21

Now Hear This!

Posted by Medicare Made Clear Tue, Dec 24, 2013 @ 09:00 AM This time of the year can be filled with festive gatherings. But some settings can get loud and make it hard for people who have trouble hearing. Some people with hearing loss start to avoid social situations. But isolation may lead to feelings of loneliness and depression. There can be many reasons for hearing loss. It’s possible for parents to pass it on to their children. Other causes may include: • Loud noises. • Head injuries. • Ear infections. • Certain medications. People with mild to moderate hearing loss are least likely to use hearing aids.1 Some of their reasons include concerns about looking old, and the cost. Many insurance plans, including Medicare Part B, do not cover the cost of hearing aids, fittings or screening tests. The exception is when your doctor thinks your hearing loss may be due to a recent injury or illness. Under those circumstances, your doctor’s order for hearing tests may be covered by Medicare. Your deductible and copay may apply. Some Medicare Advantage (Part C) plans offer coverage for hearing aids and screening tests. Insurance plan coverage for hearing aids varies. Review your Summary of Benefits and Coverage to find out if you are covered. If you are covered, you may have to follow certain rules, or buy from approved suppliers. In some cases, Medicaid, the U.S. Department of Veterans Affairs, or state programs may offer financial assistance or reduced cost hearing aids. If you or a loved one has trouble hearing, it’s a good idea to talk with your doctor. Hearing loss is not just inconvenient; it’s a serious health condition. Older adults with hearing loss are five times more likely to get dementia than people with normal hearing.2 Life is full of beautiful sounds like church bells and children’s laughter. Make sure you don’t miss a minute of it. Better hearing may lead to a better life! For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. 1. The American Speech-Language-Hearing Association, 2013 2. Archive of Neurology, Feb 2011 Resources: State Benefits Guide: Learn how to apply for your state’s financial assistance programs. Medicare.gov: Read about Medicare Part B coverage for hearing aids and diagnostic tests NIDCD: The National Institute on Deafness and Other Communication Disorders Y0066_131212_081905 Accepted

Today's Datapoint

8.7% … of Medicare Advantage premiums in 2012 were devoted to median administrative costs, according to Sherlock Co.’s annual survey of health plan administrative expenses.

Quote of the Day

“The biggest [compliance risk in the year ahead] is electronic health records. I saw one that was 500 pages for just six days. It was not articulated in a very good way and kept repeating lab values. There was a lot of stuff written that was not germane to what an auditor might look at, and auditors won’t infer.” — William Malm, senior data projects manager at Craneware in Atlanta, told AIS’s Report on Medicare Compliance.

Today's Datapoint

63% … of the 7 million uninsured non-elderly people in California are now eligible for either Medicaid or subsidized coverage through the state’s exchange, according to information posted recently by the Kaiser Family Foundation.

Quote of the Day

Narrow network products that often don’t include out-of-network coverage are “likely to result in increased member complaints and litigation regarding access to providers…and pressure on plans to expand the networks. The likely result will be some increase in the network sizes, more products with out-of-network coverage, but ultimately, consumers will likely adjust as they view the cost differences in those products.” With expanded choices, “the market can answer whether consumers value provider choice over lower cost.” — Jack Rovner, a founding attorney and member of The Health Law Consultancy in Chicago, told AIS’s Inside Health Insurance Exchanges.