Questions For Americans About New Health Insurance Exchanges

[Ominous Gamer]

http://www.irs.gov/uac/Affordable-Ca...ines-and-Drugs

1. How are the rules changing for reimbursing the cost of over-the-counter medicines and drugs from health flexible spending arrangements (health FSAs) and health reimbursement arrangements (HRAs)?
A. Section 9003 of the Affordable Care Act established a new uniform standard for medical expenses. Effective Jan. 1, 2011, distributions from health FSAs and HRAs will be allowed to reimburse the cost of over-the-counter medicines or drugs only if they are purchased with a prescription. This new rule does not apply to reimbursements for the cost of insulin, which will continue to be permitted, even if purchased without a prescription.

4. How do I prove that I have purchased an over-the-counter medicine or drug with a prescription so that I can get reimbursed from my employer's health FSA or an HRA?
A. If your employer’s health FSA or HRA reimburses these expenses, you would provide the prescription (or a copy of the prescription or another item showing that a prescription for the item has been issued) and the customer receipt (or similar third-party documentation showing the date of the sale and the amount of the charge). For example, documentation could consist of a customer receipt issued by a pharmacy that reflects the date of sale and the amount of the charge, along with a copy of the prescription; or it could consist of a customer receipt that identifies the name of the purchaser (or the name of the person for whom the prescription applies), the date and amount of the purchase and an Rx number.


Steps in laymens speak:

visit doctor -> doctor writes prescription -> either take prescription to pharmacist and get it filled with regular meds (or) purchase otc meds with you HSA debit card and fax prescription to health care provider to avoid 20% penalty

[Lewkowski]

You can have a prescription for over the counter meds

Over the counter is a term for non prescription medication. Yes I'm aware doctors can prescribe the same medicine but the difference is that previously you could use HSAs to buy non prescription medication. That option is being taken away.

[GGT]

Also the whole 26 thing irritates me because the mentality is that kids should still be dependent on their parents EIGHT years after they have reached adulthood. EIGHT years? Really? Eight years of being out on their own and working and they are still dependent on their parents. That's the wrong message to send on a cultural level.

But it's a logical, pro-active, and responsible decision families make, considering our expensive and dysfunctional healthcare system. It's also a reflection of changes in our labor markets. We have more young entrepreneurs, self-employed, contract workers, and/or part-time employment --- without employer-subsidized group health insurance plans.

Buying individual plans used to mean a strict medical underwriting process, where a "family history" of heart disease could be used to exclude coverage for heart disease (or anything cardiac-related) -- even for the young, healthy Invincible demographic. A "pregnancy with complications" (and any C-esection) could be defined as a pre-existing condition to deny coverage for reproductive organs.

Obviously, premiums to add coverage for those things was too expensive for most people, but especially 18-26 year olds. They're predisposed to think they don't need health insurance at all, because they're young and healthy....but could be lured by insurance carriers to pay $50/month premiums that turned out to be worthless JUNK. You should know all this, since you work in the insurance industry.

Over the counter is a term for non prescription medication. Yes I'm aware doctors can prescribe the same medicine but the difference is that previously you could use HSAs to buy non prescription medication. That option is being taken away.

Wrong.

[GGT]

Double posting to add more about medications, prescriptions, and the gaps/loopholes in our fubar system: some folks have $1 to $5 co-pays for prescriptions, and since that's cheaper than buying OTC brand name equivalents, or generics, doctors oblige and write the script. A common expectorant (guaifenesin) can cost $15 when labeled as Mucinex, $12 as Robitussin, or $8 as a store brand generic. But you can ask the pharmacist for a no-name generic that costs $3 that's kept 'behind the counter' (ie, not stocked on shelves).

Pharmaceutical and insurance industries have created lots of distorted incentives, and influenced patients and physicians in some very negative ways. The US has only about 5% of the world's population, but uses more than half of global pain med prescriptions, without cost-savings or better health outcomes. That's not just unsustainable, it's stupid and shameful.

[Veldan Rath]

Care to readjust that world population % to reflect the part of the world that does not have steady access to cheap and abundant pain meds?

But I will agree we are an over medicated society...but we may have spill for that soon to!

[GGT]

Care to readjust that world population % to reflect the part of the world that does not have steady access to cheap and abundant pain meds?

That'd have to be done by WHO or other data collection/analytical agencies, but we know 'those parts of the world' wouldn't be 95%.

But I will agree we are an over medicated society...but we may have spill for that soon to!

huh?



edit: I'm stuck on figuring out how/why Insulin will be dispensed without a Rx.

[Veldan Rath]

Pill, not spill...darn phone

[GGT]

I'm among the 5% of Americans that buys private health insurance. I live in PA, one of the states that decided not to create its own MarketPlace Exchange. That meant I had to use the federal web site, by default. It wasn't so great on its Oct. 1 launch, but it did link to FAQs, and insurance carriers in my state who were underwriting individual policies.

I'm waiting for the ability to "shop" and compare policies, without needing to "enroll" or create an "account" first. IMO that was a major flaw in the original .gov web site structure. I can understand why they wouldn't want to equate buying health insurance with buying refrigerators or dishwashers....but the "shopping experience" could still be similar, for the consumer/buyer.

There is nothing preventing Insurance carriers from using models that helped manufacturers and distributors sell household appliances. Or using Consumer Reports metrics for car purchases. Or using the Amazon model of comparisons and consumer ratings. FFS, even Sears gives me the ability to compare brand reliability with performance and cost-savings....for fridges or snow tires.

[Dreadnaught]

There is nothing preventing Insurance carriers from using models that helped manufacturers and distributors sell household appliances. Or using Consumer Reports metrics for car purchases. Or using the Amazon model of comparisons and consumer ratings. FFS, even Sears gives me the ability to compare brand reliability with performance and cost-savings....for fridges or snow tires.

Of course there are regulations preventing that. Insurance carriers can't compete across state lines. The features of their policies are dictated by the government with increasing ferocity.

If you don't want a car with a CD changer because it's 2013 and you don't own CDs, you don't have to get one. If you don't want to pay an added health insurance premium to cover a potential sex change, you're out of luck.

Totalitarianism is the politicization of everything. Your health care choices are now subject to even more politics than they were before. Congrats.

[Flixy]

That has got to be one of the poorest comparisons you could think of.

Also, correct me if I'm wrong, but gender issues, you're born with that or not right? Not much point making that optional if no-one will take it except people with gender issues who want a sex change. That's like

[Loki]

How about ugliness? Or personality (which is at least partially genetically determined)? Or even intelligence (see previous point)?

[GGT]

Of course there are regulations preventing that. Insurance carriers can't compete across state lines.

We keep hearing that bandied about, without further explanation or citations. Of course Insurance carriers can 'compete' across state lines -- they choose which states to conduct business, sell their policies, and compete against other carriers in that state, with regulations from the State's Insurance Commissioner and legislature.

The features of their policies are dictated by the government with increasing ferocity.

New Regulatory oversight with valid reasons: the Insurance Industry has been ripping people off for decades, particularly in the individual markets but also in group-rate, employer-subsidized plans. Like

[GGT]

huh, my reply was truncated for some reason

....like Walmart or McDonald's offering $50/month "healthcare policies" that turned out to be junk, with $2,000 annual reimbursement caps.

And noting that Dread was quoting his favorite "faux" news source the NYT, with a crap op-ed short on facts but high on emotion and anecdotes. Plus, romanticizing our healthcare system, and thinking it ever had apolitical "choices".

[Ominous Gamer]

How about ugliness? Or personality (which is at least partially genetically determined)? Or even intelligence (see previous point)?

are you suggesting that debilitating disfigurements and mental health issues are things that the government shouldn't have a hand in protecting their citizenry from?

[GGT]

I'd like to get back to the myth that Insurance Carriers can't compete across state lines. Blue Cross subsidiaries are a good example. They're present in almost every state, 'competing' against other insurance carriers for market share. Dread's op-ed link came from an Anthem Blue Cross California policy-holder...complaining about Obamacare as Kafkacare. She didn't seem to understand her own policy, or the new law. If she had, she'd have written an op-ed criticizing the Insurance Industry broadly, and Blue Cross specifically, for not having "grandfathered" her previous policy.

[Lewkowski]

I'd like to get back to the myth that Insurance Carriers can't compete across state lines. Blue Cross subsidiaries are a good example. They're present in almost every state, 'competing' against other insurance carriers for market share. Dread's op-ed link came from an Anthem Blue Cross California policy-holder...complaining about Obamacare as Kafkacare. She didn't seem to understand her own policy, or the new law. If she had, she'd have written an op-ed criticizing the Insurance Industry broadly, and Blue Cross specifically, for not having "grandfathered" her previous policy.

You don't get the concept of selling across state lines.

Say for example Texas has a law that states insurance companies must do X. In Louisiana no law exists that says that. Insurance company wants to sell a policy to an individual from Texas, the policy will be purchased on-line from a website hosted in Louisiana... but no can do because of the Texas law. Selling across state lines means that the state where the company resides have rules and individuals can freely choose to purchase a policy there or anywhere else. Not being able to sell across state lines means you are pigeon holed into following your states insurance laws.

[Loki]

are you suggesting that debilitating disfigurements and mental health issues are things that the government shouldn't have a hand in protecting their citizenry from?

Are you suggesting that the government should ban firms from firing/not hiring workers for any factor that has a strong genetic basis?

[Dreadnaught]

That has got to be one of the poorest comparisons you could think of.

Also, correct me if I'm wrong, but gender issues, you're born with that or not right? Not much point making that optional if no-one will take it except people with gender issues who want a sex change. That's like

Not sure why your post and GGTs post cut-off after the word "like".

But please clarify why insurance should cover sex change? I mean, I don't want to discount the value of sex changes to those who feel they need it. It's very valuable. But that doesn't mean it's an insurance issue.

[Loki]

Because it's a serious mental health issue. Do you think in-patient psychological care shouldn't be covered by insurance either?

[GGT]

You don't get the concept of selling across state lines.

Say for example Texas has a law that states insurance companies must do X. In Louisiana no law exists that says that. Insurance company wants to sell a policy to an individual from Texas, the policy will be purchased on-line from a website hosted in Louisiana... but no can do because of the Texas law. Selling across state lines means that the state where the company resides have rules and individuals can freely choose to purchase a policy there or anywhere else. Not being able to sell across state lines means you are pigeon holed into following your states insurance laws.

That's a misuse of the term and concept "selling across state lines". The fact is -- States want their own regulatory oversight and legislation, either as interstate commerce/legislation, or as state's rights issue. Following state laws is normal practice in every industry or business sector, whether there's federal regulation or not. Insurance companies can operate in any state, as long as they follow state insurance laws (with heavy influence from lobbyists) and State Insurance Commissioners. That can mean setting up branches or LLCs (or web site hosting) in that state. State Farm does that using independent agents/offices.

[GGT]

Are you suggesting that the government should ban firms from firing/not hiring workers for any factor that has a strong genetic basis?

Pretty sure there's already federal law protecting people from "genetic" discrimination. But it's more about personal DNA ownership, and limits on what genetic testing companies can do with the results (like not share it with employers). It has an acronym that sounds like ninja, maybe wiggin will come along with details.

[GGT]

If you don't want a car with a CD changer because it's 2013 and you don't own CDs, you don't have to get one. If you don't want to pay an added health insurance premium to cover a potential sex change, you're out of luck.

Again with the car comparisons? First, you don't have to buy a car, or even drive a car, to still get around. NO ONE goes through life without needing basic medical care, and occasional skilled care, to still be around. Insurance works best when the least common diseases/conditions, and most expensive treatments are included in the actuarial pools. Because only 1% of the population could afford OOP costs for things most people don't anticipate: premature babies, pediatric cancers, spinal cord/head injuries, dialysis, or organ transplants. And very few people had insurance plans that covered all those things, even with employer subsidies, without lifetime caps or denials for pre-existing conditions.

Totalitarianism is the politicization of everything. Your health care choices are now subject to even more politics than they were before. Congrats.

Wake up. Your healthcare "choices" have been dictated by the Insurance Industry, and their political power, long before you were born. What are your ideas for reforming our health system? Does it come without any regulations of the Insurance Industry?

Not sure why your post and GGTs post cut-off after the word "like".

Maybe the auto-save feature got glommed up, or timed out.

[Loki]

Pretty sure there's already federal law protecting people from "genetic" discrimination. But it's more about personal DNA ownership, and limits on what genetic testing companies can do with the results (like not share it with employers). It has an acronym that sounds like ninja, maybe wiggin will come along with details.

If you read the previous post, you'd see that I wasn't talking about genetics in terms of DNA, but rather in terms of traits that are strongly influenced by genetics (i.e. intelligence, personality, looks, etc.).

[Ominous Gamer]

which is at least partially genetically determined

any factor that has a strong genetic basis?

I think this calls for a patented Loki Weasel Word Citation™

[Flixy]

Not sure why your post and GGTs post cut-off after the word "like".

But please clarify why insurance should cover sex change? I mean, I don't want to discount the value of sex changes to those who feel they need it. It's very valuable. But that doesn't mean it's an insurance issue.

Because, as Loki said, it's a serious mental health issue. I honestly don't see the problem with that Unless your point is that since you don't personally need it, you shouldn't be insured against it - so why not exclude any condition you are born with? Because if you're not born with it, you don't need it. Unless, of course, you also see healthcare insurance as everyone paying a share of what's essentially determined in a big part by luck, and everyone having health insurance makes that more fair (and definitely a lot more fair than some people having insurance, some not, and anyone who isn't and gets bankrupt is essentially bailed out.

Unless your point was that it's just something some people 'want' and not a mental health issue.

Also, not a clue, I'm pretty sure I wrote more after 'like'.

[Dreadnaught]

Because it's a serious mental health issue. Do you think in-patient psychological care shouldn't be covered by insurance either?

Because, as Loki said, it's a serious mental health issue. I honestly don't see the problem with that Unless your point is that since you don't personally need it, you shouldn't be insured against it - so why not exclude any condition you are born with? Because if you're not born with it, you don't need it. Unless, of course, you also see healthcare insurance as everyone paying a share of what's essentially determined in a big part by luck, and everyone having health insurance makes that more fair (and definitely a lot more fair than some people having insurance, some not, and anyone who isn't and gets bankrupt is essentially bailed out.

Unless your point was that it's just something some people 'want' and not a mental health issue.

Also, not a clue, I'm pretty sure I wrote more after 'like'.

I believe people should be able to choose plans based on cost and coverage, and that it's immoral to force people to be in pools they don't want to be in. Even if it's stupid for them to not insure against certain things, forced participation is little more than forcible redistribution.

We can all think of instances where it would be sad/bad to not have coverage for something that ultimately impacts you. But forcing everyone to have coverage for everything** is not a solution.


**"Everything" as defined by a bureaucrat, who has the power to make or break entire medical professions. Just imagine if the Affordable Care Act came about in a culture where transexuality was not an accepted diagnosis and sex changes were not an accepted treatment. It would be horrible.

Wake up. Your healthcare "choices" have been dictated by the Insurance Industry, and their political power, long before you were born.

So the solution is...more and worse regulations, with a politically-appointed board deciding what should/shouldn't be covered? No one said the US healthcare system isn't deeply flawed and shouldn't be reformed.

[GGT]

If you read the previous post, you'd see that I wasn't talking about genetics in terms of DNA, but rather in terms of traits that are strongly influenced by genetics (i.e. intelligence, personality, looks, etc.).

Ah, I see what you meant. Employers do use IQ and personality tests as a predictor for job performance, with a heavy dose of subjective 'analysis'. Those tests include an amount of 'nurture' and environmental influences in the results (unlike DNA/genetic tests).

I believe people should be able to choose plans based on cost and coverage, and that it's immoral to force people to be in pools they don't want to be in. Even if it's stupid for them to not insure against certain things, forced participation is little more than forcible redistribution.

But that's not how actuarial science and risk pooling works. People don't "choose" their own pools -- the insurers do. They underwrite group policies by pooling large, disparate groups together, and negotiate with providers for rates and reimbursements, and with employers for premiums.

Do you consider it "forced participation" if your <employer-subsidized group plan> covers organ transplants, but you're morally opposed to them? What about mammography/breast cancer/reconstruction coverage for the women in your pool? How about peers who have a premature baby and needs heart surgery and NICU for 100 days? Not sure what kind of pool you'd "choose" if you could --- only healthy, young, unmarried male professionals, with no children?

We can all think of instances where it would be sad/bad to not have coverage for something that ultimately impacts you. But forcing everyone to have coverage for everything** is not a solution.

**"Everything" as defined by a bureaucrat, who has the power to make or break entire medical professions. Just imagine if the Affordable Care Act came about in a culture where transexuality was not an accepted diagnosis and sex changes were not an accepted treatment. It would be horrible.

I wonder what you'll think as medical science advances, even faster than now. There was a time when Insurers didn't cover bone marrow transplants, not even for pediatric cancer patients, even after they were no longer considered "experimental". Those kids' families had to run benefit fund-raisers or appeal to charity if they didn't have funds to pay OOP -- and Medicaid didn't cover them either.

*Everything* is also defined by physicians, academics, researchers, providers and caregivers in the medical community....who are incentivized toward Longevity, often at all/any cost. They can't be held-harmless in this mess, or whine in their soup about their profession being hijacked by Insurance Industry middlemen "dictating how they practice medicine". Wanna talk about Death Panels now?

So the solution is...more and worse regulations, with a politically-appointed board deciding what should/shouldn't be covered? No one said the US healthcare system isn't deeply flawed and shouldn't be reformed.

You deleted the important part of my post: What are your ideas for reforming our health system? Does it come without any regulations of the Insurance Industry?

[Dreadnaught]

People do choose pools when they are given a choice of pools. That's not the system we have or are moving to.

I've outlined my views time and time again, and those views favor new/better regulations for the insurance industry to help competition and prevent insurance companies from dropping policies.

[Veldan Rath]

I'm sorry but isn't the reason we were forced to have certain coverages was due to State regulartoes to begin with?

Maine forces broader coverage on insurers than NH, which leads to higher premiums in Maine. (But I can't buy a NH policy, which is what we've been saying about selling across state lines GGT)

[GGT]

People do choose pools when they are given a choice of pools. That's not the system we have or are moving to.

The system was previously segregated by risk pools, and income groups, as designed by the Insurance Industry -- with help from legislators. Millions of people (85% of the population) have false impressions of "choice", as presented by HR depts. and employer sponsored subsidized group policies, Network restrictions, and premium support...negotiated with insurance carriers. The remaining 15% was either 'forced' to use Medicaid/Medicare programs, buy policies in the Individual market scam, or go un-insured. So don't wax romantically about "choice" -- that's something only the very wealthy 1-10% can afford.

I've outlined my views time and time again, and those views favor new/better regulations for the insurance industry to help competition and prevent insurance companies from dropping policies.

Dude, that is the PPACA! Especially the Patient Protection parts of the law that are Regulatory in nature. What you're missing is that individuals haven't been able to "compete" with big employers....and Insurers weren't incentivized to reform the Individual markets, because they could make more money by scamming folks into Junk policies. So don't wax poetically about "competition", either.

I'm sorry but isn't the reason we were forced to have certain coverages was due to State regulartoes to begin with?

Maine forces broader coverage on insurers than NH, which leads to higher premiums in Maine. (But I can't buy a NH policy, which is what we've been saying about selling across state lines GGT)

Yes, State legislators and Insurance Commissioners control standards for coverage, and regulate premiums. There's a coordinated dance between states, public programs (Medicaid) and taxes. Think about it -- why would Maine providers accept an insurance policy underwritten in states using much lower UCR reimbursement rates? And why would NH people, who pay more in state taxes, accept policies underwritten in states with broader coverage than their own?