mental health care

Your Money: A Guide to the New Exchanges for Health Insurance

September 27, 2013 by NewsMaker

But after much anticipation, the curtain will finally rise on the exchanges next week, providing millions of consumers with an online marketplace to compare health insurance plans and then buy the coverage on the spot.

The exchanges are likely to be most attractive to people who qualify for subsidized coverage. Individuals with low and moderate incomes may be eligible for a tax credit, which can be used right away, like a gift card, to reduce their monthly premiums. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). And all of the plans on the exchanges will be required to cover a list of essential services, from maternity care to mental health care.

“In today’s individual market, it’s like Swiss cheese coverage,” said Sarah Dash, a research fellow at the Health Policy Institute at Georgetown University. “Consumers should have an easier time figuring out what they are getting for their money.”

But it’s still going to take some time to analyze the plans and their costs, which are expected to vary widely across the states. And the coverage may still pinch many families’ budgets. Fortunately, there’s a six-month window, from now to March 31, for people to figure it all out.

Here’s some information to get you started:

Q. Where can I apply or get more information on the exchanges?

A. To avoid fraud artists, enter through the front door: Healthcare.gov. From there, you can find links to the exchange offered in your state. There may be technical glitches as the program gets started, so alternatively, you can call 1-800-318-2596.

Q
. When does coverage go into effect?

A. You can apply as early as Oct. 1, but coverage won’t begin until Jan. 1. The enrollment period for coverage in 2014 closes on March 31, 2014. After that, you can enroll only if you have a major life event like a job loss, birth, marriage or divorce.

Q. What sort of coverage will be offered?

A. All plans will have to provide the same set of essential benefits, including prescriptions, preventive care, doctor visits, emergency services and hospitalization (this also applies to most individual and small-employer group plans sold outside of the exchanges). But plans can offer additional benefits, or different numbers of services like physical therapy, so you’ll need to do a side-by-side comparison to see what fits your needs — or at least the needs you can anticipate.

Q. Are the plans sold on the exchange more comprehensive than plans outside?

A. There are four plan levels, each named for a precious metal. They all generally offer the same essential benefits, but their cost structures vary. The lower the premium, the higher the out-of-pocket costs.

The bronze level plan, for instance, has the lowest premiums, but will require consumers to shoulder more costs out of pocket. They generally cover 60 percent of a typical population’s out-of-pocket costs, and include deductibles, co-payments and coinsurance. The silver plans cover 70 percent; gold, 80 percent; while platinum covers 90 percent (and therefore carries the highest premiums).

If you buy a plan on an exchange, your annual out-of-pocket costs cannot exceed $6,350 for individuals and $12,700 for a family of two or more in 2014. Catastrophic plans are also available to people under age 30 or those suffering a financial hardship. These carry high deductibles (equivalent to the out-of-pocket maximum, or $6,350 for a single person, in 2014). You cannot apply tax credits to these plans, either.

Premiums will vary across the states because of a variety of factors, like market competition, the underlying cost of care and the negotiating power of the exchanges, according to Kaiser research.

Q. If the costs with plan levels are similar, how will plans differ within the metal levels?

A. Networks of doctors and hospitals will differ, and cost-sharing structures may also vary. One plan might have lower deductibles and higher co-pays, whereas another plan might have a separate deductible for prescriptions. Various medications may also be covered differently. “If you are someone who is taking medicines, make sure you know what your drugs will cost in the various plans being offered,” said Cheryl Fish-Parcham, deputy director of health policy at Families USA, a Washington consumer advocacy group.

Q. Will I be eligible for a premium tax credit (subsidized coverage)?

A. People with income between 100 percent of the poverty line (or about $23,550 for a family of four) and 400 percent of poverty ($94,200 for a family of four) are eligible for a tax credit to defray premium costs. (All income eligibility is based on your modified adjusted gross income; the online version of this column links to a guide explaining how that is calculated).

The tax credits are set up so that consumers will not have to pay more than a certain percentage of their income, ranging from 2 percent for those with incomes of up to 133 percent of the poverty level ($15,282 for a single and $31,322 for a family of four) to 9.5 percent for those with income of 300 to 400 percent of the poverty level, according to the Center on Budget and Policy Priorities. The dollar amounts of the credits are calculated based on the costs of the second-to-lowest-cost silver plan available to you.

Kaiser has a calculator that can give you an idea of your eligibility.

Q. Can I get help with my out-of-pocket expenses, like deductibles?

A. People with incomes between 100 percent of the federal poverty line ($23,550 for a family of four) and 250 percent ($58,875 for a family of four) are also eligible for cost-sharing reductions, which means you’ll pay less for items including deductibles and co-payments, and you’ll have lower out-of-pocket maximums.

Article source: http://www.nytimes.com/2013/09/28/your-money/health-insurance/a-guide-to-the-new-health-insurance-exchanges.html?partner=rss&emc=rss

Filed Under: Your Money Tagged With: mental health care, moderate incomes, tax credit

Economix Blog: Most U.S. Health Spending Is Exploding — but Not for Mental Health

July 2, 2013 by NewsMaker Leave a Comment

CATHERINE RAMPELL

Dollars to doughnuts.

As I write in a magazine column this week, mental illness costs the country a lot of money, primarily in indirect costs like lost worker productivity and increased use of the social safety net. That is one argument for why it might be cost-effective to increase national spending on the direct costs of treatment (like therapy, drugs, etc.).

And there does seem to be some room for increasing spending on mental health care; so far, anyway, the United States has not had the same problem with out-of-control mental health treatment costs that has been seen with other kinds of medical spending.

Mental health spending, both public and private, was about $150 billion in 2009, more than double its level in inflation-adjusted terms in 1986, according to a recent article in Health Affairs. But the overall economy also about doubled during that time. As a result, direct mental health spending has remained roughly 1 percent of the economy since 1986, while total health spending climbed from about 10 percent of gross domestic product in 1986 to nearly 17 percent in 2009.

Source: Katharine R. Levit, Tami L. Mark, Rosanna M. Coffey, Sasha Frankel, Patricia Santora, Rita Vandivort-Warren and Kevin Malone, “Federal Spending on Behavioral Health Accelerated During Recession as Individuals Lost Employer Insurance,” Health Affairs, 32, No. 5 (2013).

These numbers might seem particularly surprising given greater awareness of mental health care and higher take-up rates for it. Here is a chart, from the National Institute of Mental Health, showing the number of Americans who had any expenses associated with any of the five most costly medical conditions in 1996 versus 2006:

National Institute of Mental Health. AHRQ stands for Agency for Healthcare Research and Quality.

As you can see, the fastest growth has been for those with mental disorders, and in 2006, more Americans had expenses for care related to mental disorders than for any other medical condition except for asthma.

Now here is a chart from the same source showing the average expenditures per person associated with each of those five most costly medical conditions, in inflation-adjusted terms:

National Institute of Mental Health. AHRQ stands for Agency for Healthcare Research and Quality.

For most medical conditions, costs per person have gone up, but for mental disorders and heart conditions, they have fallen slightly.

So what is holding costs down? One explanation has to do with the patent system. A number of blockbuster psychiatric drugs like Prozac lost their patent protection in the early 2000s, which has helped slow growth in the costs of treatment per patient for many mental illnesses. The Health Affairs article also mentions that shortages of inpatient hospital beds in some areas may have helped slow spending growth for inpatient services as well.

In any case, while costs have been relatively controlled, a larger share is being borne by the public sector rather than the private sector, according to the Health Affairs article. In 1986, 43 percent of all mental health spending came from private sources (like patients or private insurance companies); as of 2009, that share had fallen to 40 percent. The cost shift primarily occurred from 2007 to 2009, the years of the recession, as people lost their private insurance and went onto federal programs like Medicaid.

The cost shift from private to public payers has been even greater for overall health spending, of which 59 percent was paid by private sources in 1986 versus 51 percent in 2009.

Article source: http://economix.blogs.nytimes.com/2013/07/02/most-u-s-health-spending-is-exploding-but-not-for-mental-health/?partner=rss&emc=rss

Filed Under: Economy News Tagged With: behavioral health, levit, mental health care