High-deductible health plans are a great option for people with low health care costs, but beware that you must meet a high annual deductible before your health insurance company kicks in any money toward your care.

In fact, that deductible could be as much as $6,550 for an individual or $13,100 for a family, according to the Internal Revenue Service. This could cause quite a dent in your pocketbook, so you’ll need to take advantage of ways to keep out-of-pocket costs down.

Here are tips from health insurance experts for containing out-of-pocket costs with any health insurance plan, but especially when you have a high-deductible health insurance plan:

Take advantage of preventive care.

Under the Affordable Care Act, even high-deductible health plans must offer free preventive care with no copays and no deductibles, says Nicole Wruck, a senior director and health and welfare practice leader with Aon Hewitt in Chicago.

Preventive care could save more than 10,000 lives each year if Americans received that care, according to the Centers for Disease Control and Prevention (CDC).Preventive care can include vaccinations, cancer and other health screenings, and wellness visits. Combine preventive care with a healthy lifestyle, and it may keep you out of the doctor’s office and avoid having to pay for services that aren’t covered, says Abbie Leibowitz, chief medical officer and executive vice president of Health Advocate in Plymouth Meeting, Pennsylvania.

Shop for services.

“When you have a high-deductible health plan, it makes you a consumer in your health care,” Wruck says. That’s

why high-deductible health plans are often called consumer-driven health plans.

When you have an HDHP and need medical services, you should shop for not only the best provider but also the best price. “Just as you question things when you go to the supermarket or purchase a car, you have the responsibility to do it when it comes to your health care,” Wruck says.

Members of these plans are encouraged to use online price comparison tools for services.

Shop for the best prices on prescription drugs, too.

Ask your doctor if there’s a generic or if he has coupons or samples that you can have, and talk to your pharmacist, Wruck says. The pharmacist may be aware of other options that will cost less, she says.

Speak up.

Doctors don’t usually know what type of health insurance plan their patients have, Wruck says. Should your doctor recommend a test or treatment, it’s OK to say, “I have a high-deductible health insurance plan. This is going to cost me a good deal. Is it absolutely necessary? Is there a lower-cost option?”

Most people aren’t used to questioning their provider’s recommendations, says Wruck. But there’s no harm in at least asking and weighing options and costs.

Use in-network providers.

Even though your insurance won’t pay until you’ve completed payment of your high deductible, your plan has negotiated discounts with providers and hospitals, and you’re entitled to those discounts as long as you use those in-network providers, Leibowitz says.

Expert advice on high-deductible health plansBeth OrensteinInsure.com | December 17, 2015

Insure.com | December 17, 2015

Some health insurance plans even have preferred provider networks. Leibowitz says the discount they negotiate with preferred providers is greater than those who are simply “in network.”

Question every bill.

Before you pay that bill, compare it to the Explanation of Benefits (EOB) statement you receive from your provider, Leibowitz says. The bill could contain errors.

If you discover an error, ask your provider to resubmit the claim using the correct codes. Give it some time, and follow up with your insurance company to make sure the bill was reprocessed correctly.

Contribute as much as you can to a health savings account (HSA).

HDHP plans can be tied to a health savings account that allows you to put money away tax-free to help pay for medical expenses.

Unlike flexible spending accounts, HSAs are not “use it or lose it,” Wruck says. The money will stay in your account and grow tax-free. The IRS has set the maximum contribution to an HSA for 2016 at $3,350 for an individual and $6,750 for a family. If you are 55 or older, you can make additional catch-up contributions of up to $1,000 annually. Contribute as much as you comfortably can.

Being willing to put in the work to research and compare providers, services and prescriptions could end up saving you a lot of money that you otherwise might have paid in premiums with another plan.

Insure.com | December 17, 2015

People avoid going to the doctor for many reasons, but cost is a huge deterrent. According to a 2014 report from the Kaiser Family Foundation, 26% of women and 20% of men delayed or went without health care because of the cost.

Medical debt is no joke: For years, it has been the leading cause of personal bankruptcy in the U.S., and unpaid medical bills can trash your credit standing, though newer credit scoring models are starting to weigh medical debt differently.

Most people know health care can get expensive, but part of the problem is unpredictability. Even if you have health insurance, understand your deductible and memorize your co-pay amounts, it sometimes seems like there’s no way to know exactly what your bills will amount to.

Estimating your medical bills before you receive treatment isn’t easy, but it’s getting better. Marty Rosen, a vice president at Health Advocate, a health care advocacy and patient assistance company, said cost transparency has improved significantly in the past three to five years, allowing people to shop around for affordable treatment options.

“Is it perfect? No. Is it improving? Yes, and if you gauge it against a bigger time horizon, the changes are profound,” Rosen said. The hope is that improving transparency in health care pricing will not only help people save money but also make better decisions about their health care.

Trying to save money while seeking medical treatment can be as frustrating as having medical problems in the first place. Pricing on the same services varies

wildly among providers in the same area, and if you don’t ask ahead of time, you’re unlikely to have any idea how much a health care provider will charge you.

Unfortunately, along with cost, finding the time to go to the doctor is among the top reasons people avoid getting medical care, according to that Kaiser Family Foundation report. In order to get somewhat affordable health care, you need to spend some time comparing prices, and you probably feel like you don’t have that time.

Of course, if you need emergency treatment, you’re not going to have time to crunch numbers, leaving you few options beyond hoping your insurance covers a lot of it and negotiating the costs once you get the bills. Emergencies aside, the cost of health care can devastate your finances, which is why you should try to figure out your expenses in advance. You have much more leverage in negotiations before you receive treatment, so when you can, shop around for the best deals in health care. That starts with understanding your insurance.

Know the BasicsYou can’t expect to be able to estimate your medical bills if you don’t understand your insurance. Given the increasing number of insured Americans, there are a lot of online resources available to help explain things like deductibles and co-pays, which will help you determine your out-of-pocket costs on various treatments.

The first thing you do is shop around for an insurance plan you think will suit your needs. Once you have insurance and need medical care, you’ll want to know if your provider is in your insurance network.

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How to Predict the Size of Your Next Major Medical BillChristine DiGangi Credit.com | October 6, 2015

That’s often a more complicated question than it seems.

“Call the insurer to make sure you have all the precertifications in place, then call the provider and say, ‘I want your guarantee that everyone who touches my case is in my network,’” said Sarah O’Leary, CEO and founder of ExHale Healthcare Advocates, a consumer health care company.

O’Leary said it’s common for consumers to go to a hospital that’s in their network and a doctor that’s in their network, but then the radiologist who reviews their MRI (for example) isn’t in network, and the consumer gets a huge bill for dealing with an out-of-network provider. To protect yourself from something like that, you need to ask about every worker with whom you’ll interact.

Research Prices, Then NegotiateThere are dozens of online tools for estimating the cost of health care, and many insurers have cost estimators on their own websites. A few minutes of online research should help you get an idea of what your treatment should cost in your area, and then you can use those figures to negotiate pricing when you ask specific providers for their estimates.

You can negotiate on either end of the process, but you have more leverage before you receive the treatment — when a doctor gives you a quote that’s twice as much as the price you found in your research, you have the ability to say you’ll go somewhere else for your care. If you can pay upfront or have a relationship with the doctor, leverage that to get a better deal, Rosen said.

You also need to consider that certain providers cost more.

“If you broke your arm, you don’t have to go to a trauma center,” Rosen said. “If you go to a trauma center for a lower-level emergency, it’s going to cost you more money.” In essence, you’re paying for the sophisticated capabilities of that trauma center, which you may not benefit from in the case of a simple broken arm.

Ask a Lot of Questions (& Get the Answers in Writing)Part of what makes health care more confusing than other purchases we make is how many variables it involves. You’re not just getting a hip replacement, you’re paying for the specialists who perform the procedure, the anesthesiologist who keeps you under, the drugs that the medical team administers throughout the process and the socks they put on your feet to keep your toes warm in recovery, and so on. You need to know all the details that go into your procedure (and whether they’re covered by insurance) in order to know what you’re going to pay.

“I always tell people to ask the providers to respond, in writing, what the procedures and charges will be and what the patient will be responsible for,” said Adria Goldman Gross, owner of MedWise Insurance Advocacy. “As long as it is a planned procedure, the providers should be able to provide you with this information.”

Then, of course, there’s the possibility of errors. Request an itemized invoice of your treatment so you can review it for mistakes and contest them.

Various studies have found the error rate in medical bills to be between 30% and 90%, which is where having all those estimates in writing can come in handy. That also means the legwork doesn’t end after you’ve spent hours of your life researching medical procedures and talking to your insurer and health care providers. But if you really want to avoid overpaying for medical care (or worse, dealing with massive medical bills that put you into debt and trash your credit), it’s something you probably have to do.

“It’s certainly not fun for people to do, it’s not pleasant, but if your goal is to protect your fiscal health, you have to work at it,” O’Leary said.

Credit.com | October 6, 2015

A new study from Dartmouth College shows that even though the U.S. spends more money on cancer treatment than Western Europe, there are more cancer-related deaths in the U.S. than there are in Western Europe, and the decline in mortality rates has only modestly decreased since 1970.

This year alone, approximately 1,658,370 new cases of cancer are expected to be diagnosed in the U.S. according to the American Cancer Society. Each day, the American Cancer Society estimates that 1,620 American will die from cancer in 2015.

The study, written by Samir Soneji, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and a member of the Norris Cotton Cancer Center, and JaeWon Yang, a Dartmouth undergraduate, also suggests that cancer care treatments in the U.S. for certain types of cancers—including breast, colorectal, prostate, and lung—may provide less value than corresponding cancer care in Western Europe.

“Our study looked at a broad range of cancers, like breast, prostate, colon, and lung, and what we found is that both the U.S. and Western Europe—for many cancers—have achieved about the same levels of reductions in cancer mortality,” says Soneji. “But that progress has come at a much higher cost for the U.S. than for Europe. So, what’s the value of U.S. cancer care? We’ve had these achievements, but they’ve come at much higher costs.”

The Role the ACA Plays in Cancer Prevention

The value, Soneji suggests, lies not just in cancer treatment but also in prevention. “The more the U.S.

healthcare system can prevent cancer from occurring in the first place, the more value we get as a nation from getting the healthcare,” he says. “And if you can’t prevent it, screening for cancer can provide value as long as it detects cancer early and extends life.”

When it comes to preventative care, cancer screen-ings, and treatment, the Affordable Care Act (ACA) can be a huge help.

“Preventive care is important for everyone, and under the Affordable Care Act, most healthcare insurance plans cover preventive services at no cost to patients,” says Martin B. Rosen, Executive Vice President, Health Advocate, Inc. “This includes selected cancer screenings, immunizations, and tobacco cessation resources for people who smoke, among other services.”

“Previously, it was up to insurers to determine if preventative screenings were covered,” says Soneji. “When the ACA was enacted, many of the cancer screenings that have proven to be the most effective—such as colonoscopies and mammograms—no longer require co-pays or deductibles, which is really important.”

And if you have already been diagnosed with cancer, preventative care is “even more critical” says Rosen.“Cancer treatment can weaken a cancer patient’s immune system. For example, getting vaccinated for the flu can help prevent serious, and potentially life-threatening, problems for people with cancer.”

Not only that, but the ACA stipulates that insurers can no longer deny coverage to people with pre-existing conditions, including cancer. “Insurers can’t refuse to

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The Role the ACA Plays in Cancer PreventionDeanna Ting HealthPlans.com | July 13, 2015

pay for otherwise-covered medical care and services due to a pre-existing condition or charge you more because of a pre-existing condition,” Rosen adds.

“Similarly, insurers cannot drop coverage for anyone because they have been diagnosed with cancer,” he notes. “It’s also important to know that health plans can no longer set annual or lifetime dollar limits on essential benefits, including most cancer treatments and follow-up care, so people with cancer do not need to worry that their coverage will run out.”

While the ACA has expanded access to preventative care and screenings, as well as provided a safety net for those who have been diagnosed with cancer, there are still a few potential obstacles that patients should be aware of, too, warns Rosen.

“While the Affordable Care Act has implemented many changes to most healthcare plans, some plans have been grandfathered, which means they are not required to include all features outlined by the ACA,” Rosen explains. “It’s important to check if your plan is considered grandfathered, as it may not offer some important features or benefits that are important for people undergoing cancer treatment.”

In other words, it pays to pay close attention to your healthcare plan, regardless of your current medical condition—but especially so if you are diagnosed with cancer.

Finding the Right Health Care Plan

Rosen says that if you are currently undergoing cancer treatment and shopping for a new health plan, it pays to check if your specialist, as well as other providers or facilities, including Centers of Excellence, are included in your network. You may also want to check if your specific treatment is included in your coverage. It’s also important to take note of how costs, including pharmacy benefits, are shared in a plan.

“For example, for someone with cancer or any long-term or chronic condition, it may be best to consider a plan with a higher premium that offers lower cost-sharing, Rosen explains. “A high-deductible plan has a lower monthly premium, but will often require higher co-pays, coinsurance and deductible payments, which can add up much more quickly for someone who requires ongoing treatment and care.”

Soneji adds that there can still be some barriers to getting the care that people need, too. “Whether or not these preventative services or screenings or treatments are being utilized is an open question,” he says. “You’ve got to get time off of work to get that screening or make that appointment. Getting ready for a colonoscopy can be a two-day process. Even if this care is being provided, we still don’t know if it’s being used by the people who are most at risk or could really benefit from these services.”

For help and resources, Rosen suggests people with cancer reach out to advocacy groups such as the American Cancer Society, National Cancer Institute, Health Advocate to help better understand all the available healthcare and insurance-related options. He also says that many hospitals offer access to social workers or oncology department case managers who can help patients with their coverage and other cancer-related issues.

Whether or not you have been diagnosed with cancer, however, when it comes to your healthcare coverage, prevention and knowledge are absolutely essential, and the ACA can be a huge benefit.

“The most important thing is that the benefits of preventative services are vast,” says Soneji. They can improve your quality of life and length of life. As citizens, we all contribute the cost of the healthcare system. Accessing and utilizing preventative services that are now more and more available to us is being responsible—it’s about taking care of ourselves and reducing the cost of healthcare for the country.”

HealthPlans.com | July 13, 2015

Nearly 80 percent of employers offer programs to promote the physical wellbeing of their employees. They may want to expand wellness programs to address depression and other mental health issues, based on a disturbing trend documented in a recent study by the American Journal of Preventive Medicine.

“Every 20 minutes, someone commits suicide in the United States,” said Bert Alicea, licensed psychologist and vice president of EAP and Work/Life Services for Health Advocate Inc. in Plymouth Meeting, Pennsylvania. “Given that rate, there is a possibility of a suicide at your workplace.”

The study found that slightly more than 1,700 employees committed suicide in the workplace between 2003 and 2010, for an overall rate of 1.5 per one million workers. Suicides declined between 2003 and 2007 but then spiked during the remaining years of the study. Non-workplace suicides totaled 270,500 during this period, for a rate of 144 per one million people.

Among the significant findings about workplace suicides:• Rates were higher for men (2.7 per one million).• Workers aged 65 to 74 (2.4 per one million) were

more likely to end their lives.• The profession with the highest suicide rate is

protective services such as police and firefighters, followed by farming, fishing and forestry.

The human toll is devastating, but there also is a high economic cost. A 2010 analysis estimated the price of depression at $210.5 billion, with 45 percent to 47 percent attributable to direct costs; 5 percent to suicide-related costs; and 48 percent to 50 percent to workplace costs.

Why?

There often are more questions than answers on this sensitive topic. Why would a person kill him or herself, and why in the workplace? The journal article suggests:

Occupation can largely define a person’s identity and psychological risk factors for suicide, such as depression and stress, can be affected by the workplace. Also, as the lines between home and work continue to blur, personal issues creep into the workplace, and work problems often find their way into employees’ personal lives.

Clare Miller agrees with this assessment. She is director of the Partnership for Workplace Mental Health, which is part of the American Psychiatric Foundation in Alexandria, Virginia.

“The line between work and home more and more is nonexistent,” she says. “More of us work at home part time or bring work home to do in the evenings, so there is no line of demarcation.”

In other words, home is no longer a safe haven from work-related stress, and personal issues also enter the workplace. “Employees may be dealing with other things in their lives, such as divorce or separation; financial hardship; or the death of a family member,” Alicea says.

The increase coincides with the recent recession, and workplace bullying also can play a role.

“We did a study not long ago that found that asking people to do more with less can increase stress,” Miller says. “We also have found more incidences of bullying, which can be an outgrowth of poor organizational practices.”

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Workplace suicide new disturbing trendAlan Goforth benefitspro | April 23, 2015

Education is essential

Regardless of the cause, employers have an opportunity to educate and encourage employees, and intervene if necessary. As the Journal article states:

Suicide is a multifactorial outcome and therefore, multiple opportunities to intervene in an individual’s life — including the workplace — should be considered. A method that may reduce the burden of suicide suggested by the National Action Alliance for Suicide Prevention Research Prioritization Task Force was increasing the number of people trained for suicide assessment and risk management. Implementing effective and evidence-based programs for the training of these individuals is pivotal. The workplace should be considered a potential site to implement such programs and train managers in the detection of suicidal behavior….

A successful strategy has two key components — education and observation. Although society has come a long way, many people still attach a stigma to mental health issues. “The objective is to create awareness and change mental health from a taboo subject to something that can be openly discussed,” Alicea says. Health Advocate Inc. offers a number of printed resources to its clients. Partnership for Workplace Mental Health offers a number of free resources to all employers.

“We have program called the Right Direction Initiative for employers to use to raise awareness of depression, which tends to be a leading cause of suicide,” Miller says. “Not every person who has depression is suicidal, but it can be a key indicator. We have a portal through which employers can get communications materials, posters and information for company newsletters. We encourage them to use it as a tool to get employees started talking about mental health.” This information is available at rightdirectionforme.com.

Employee participation

Programs like this will succeed only if employees are educated, know where to turn for help and are encouraged to not be afraid to seek assistance. That information often is lacking For example, many employees are not even aware that their company has an EAP, she said. Although top-down commitment is important, the best prevention tool may be peer-to-peer accountability.

“Colleagues really need to reach out to each other, because they often can see tangible signs of depression,” Miller says. One practical tool is a Workplace Mental Health website called ICU, which is free to access at workplacementalhealth.org/Spotlights/ICU.aspx

The worst outcome is to play “Monday morning quarterback” and connect the dots only after a tragedy has happened, Alicea says. “Don’t be afraid to ask questions,” he says. “Employees may have a change in appearance, or say things such as ̀ life is not worth living’ or talk about hurting themselves. One sign by itself may not be an indicator, so look for different factors. Have a responsible plan to provide education before a situation occurs.” An EAP, if properly implemented, can be a valuable resource.

“Your EAP can help you see those red flags and assess risk factors,” Alicea says. “But don’t implement an EAP simply for the sake of saying you have one. Show that you care about your employees, and make it visible. Present it not as a medical model but as an educational model. If you do it right, it will have a big return on investment.”

One of the best things an EAP can provide is a nonthreatening atmosphere to talk things over. “Confidentiality is really important,” he says. “Employees need to know they can call us anonymously or even do a depression assessment on our website.” Perhaps the most important thing an employer can do is to counter the stigma surrounding mental health. “Don’t ignore it,” Alicea says. “It’s OK to talk about mental health. If employees are not comfortable, make sure they know it is confidential.”

Human resource professionals can play a critical role in helping prevent workplace suicide, Miller says. “HR professionals are in a position to really make a difference,” she says. “I would point to two things. The first is in their role as a purchaser of health care. You need to really ask questions of your health vendor partners. Ask about mental health, because that issue often is not raised.

“Second, take action to promote awareness of services to employees. Don’t wait for the perfect mental health awareness plan, because it will never happen.”

benefitspro | April 23, 2015

A medical emergency leaves you with tens of thousands of dollars in unpaid hospital bills. Your health insurance company rejects coverage for an important medical test. An unexpected diagnosis requires you to find three new medical specialists.

In today’s health care system, consumers are increasingly on their own when these complex -- and often costly -- medical problems arise. Primary care doctors once helped patients manage such situations, but many physicians now have 15 minutes or less for each appointment. It’s in this high-pressure environment that a new industry of patient advocates -- sometimes called patient navigators -- has emerged, offering to help guide patients through knotty health situations.

Driven by an increasing number of baby boomers dealing with chronic medical problems, the field has mainly taken shape in the last 5 to 10 years, according to Professor Theresa Cronan of San Diego State University.

“People with chronic conditions use the health care system more. But the health care system has become so complex that it’s really hard for people to navigate,” said Cronan, who has studied the health advocacy industry.

Here are some questions and answers about these businesses and the services they offer:

1. What do patient advocates do?

Patient advocates are hired to help solve health care problems or help patients get the best care possible. Advocates can work for companies with hundreds of employees or operate as stand-alone consultants for a handful of clients. Some of the most common tasks health advocates work on include:

• Negotiating discounts and payment plans for large medical bills;

• Managing and filing insurance paperwork, especially appeals where companies deny coverage for expensive procedures or equipment;

• Helping patients find and schedule appointments with medical experts who specialize in rare or hard-to-treat diseases.

2. How can these businesses potentially save me money?

Many patient advocates highlight their ability to help reduce medical bills or cut through insurance red tape.

Health advocates can review patient records to spot billing errors that drive up costs. They can also coordinate care between a number of physicians, usually for patients with complex conditions, avoiding repeat billings and insurance payments.

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Medical Expenses: Finding Your Way With a Patient NavigatorMatthew Perrone AP Health Writer | April 2, 2015

AP Health Writer | April 2, 2015

In other cases, advocates will help patients find the best price for an expensive test or procedures. Prices for common tests, such as medical scans, can vary by hundreds or thousands of dollars, even among hospitals that are only a few miles apart, as demonstrated by payment records released by the government’s Medicare program. With many patients in high-deductible insurance plans that require them to pay substantial out of pocket costs before coverage kicks in, the difference between a $300 MRI scan or a $1,300 MRI scan can be significant.

3. How much do these services cost?

Patient advocates typically aren’t covered by insurance, so customers should expect to pay out of pocket.

Many charge an hourly rate, ranging from $50 to $250 depending on the nature of the work, their location and background. Advocates charging the highest fees usually have a medical degree. Other services may use alternative fee structures. For instance, the medical bill saver service offered by Health Advocate of Plymouth Meeting, Pennsylvania negotiates uncovered medical or dental bills of $400 or more at no upfront cost to the customer. Instead, the company takes a 25 percent cut of the recouped savings. So if the company negotiated a $10,000 medical bill down to $5,000 the company would earn a $1,250 fee. Health Advocate sells access to its bill saver service and other offerings through an annual membership fee of $29.95. About 10,000 companies also offer Health Advocate’s services as a benefit to their employees.

4. What qualifications do patient advocates need to have?

Currently there are no professional credentials required to be a patient advocate, so be careful about choosing a service. Several universities offer specialized courses and degrees in patient advocacy, including Sarah Lawrence College, the University of Miami and the University of Wisconsin. Such programs often combine training in medicine, health policy, economics and law. Other health advocates have backgrounds in nursing, social work, medicine and the insurance industry.

Before hiring a health advocate be sure to ask for references and information on training and experience. Customers should also receive a written contract specifying the services to be delivered and the fees.

“If you’re going to get a health care advocate you’re probably feeling vulnerable already, so you want to make sure you look very carefully at the organization that is going to provide these services,” Cronan said.

5. How can I find a patient advocate?

Academic programs like University of Wisconsin’s Center for Patient Partnerships can provide contact information for graduates in the field. There are also several professional groups that offer online search tools for finding patient advocates, including:

• National Association of Healthcare Advocacy, which requires members to sign a code of ethics: http://www.nahac.com

• Alliance of Professional Health Advocates, which requires participants to have professional liability insurance: http://www.advoconnection.com/

Are you a smoker? If so, you could be paying much more when it comes to your health insurance coverage.

Depending on which state you live in, you could be paying up to 50 percent more for your health insurance premiums if you are purchasing health insurance on the individual marketplace exchanges.

When the Affordable Care Act (ACA) went into effect last year, new federal guidelines were established for health insurance plans sold in the individual marketplace. According to the ACA, insurers are now allowed to charge tobacco users up to 50 percent more for premiums compared to non-smokers.

Each state can also establish more restrictive limits on health insurance for smokers, and insurers can set tobacco surcharges at any level up to those limits, as well as impose differential tobacco surcharges based on age.

Why is that? “This is because research shows that smokers tend to utilize healthcare services more than nonsmokers, leading to increased healthcare costs,” says Martin B. Rosen, executive vice president of Health Advocate, Inc. “According to the Centers for Disease Control (CDC), smoking costs employers approximately $193 billion annually in direct medical costs and lost productivity, with studies estimating costs at $5,816 per smoker per year for employers — hence why many plans have imposed surcharges for smokers.”

For example, in 2014, if you were a smoker who lived in Nevada, New Hampshire, and Ohio, you paid insurance premium rates of more than 25 percent higher than those paid by non-smokers. In total, 15 states allow maximum surcharges of up to 50 percent.

However, if you lived in California, New Jersey, or New York, you weren’t affected by any surcharge; those states, including the District of Columbia, Massachusetts, Rhode Island, and Vermont, do not allow any tobacco use surcharges for insurance plans. Other states such as Colorado, Kentucky, and Arkansas limit the maximum allowable surcharge below 50 percent.

How are these higher premiums determined? “I can’t really speak as to how they calculate those,” says Jennifer Singleterry, director of national health policy for the American Lung Association. “Smokers do have higher healthcare costs, especially in the long term, however.”

Rosen adds, “Many insurers consider the higher healthcare costs associated with smoking when adding a premium surcharge for tobacco users.” He notes, however, that the average surcharge on healthcare premiums for smokers is approximately 10 percent. “In order to help ensure smokers are able to afford healthcare insurance and stay covered, some insurers have kept the surcharges below the allowable maximum. This difference accounts for higher healthcare costs while helping to maintain coverage for everyone who needs it.”

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Smoking: How Much Does the Habit Really Cost You? Deanna Ting HealthPlans.com | April 1, 2015

HealthPlans.com | April 1, 2015

Regardless of the varying health insurance premiums associated with tobacco use, both the short- and long-term health costs of smoking do indeed add up. “Especially for people purchasing individual insurance plans through the exchanges, premium costs tend to increase with age,” says Rosen. “Combined with the smoker surcharge, smokers will continue to pay more for their healthcare coverage as they get older, leading to exponentially higher costs over time. Further, depending on the type of coverage a smoker has and their health, they will likely pay more in out-of-pocket costs since smokers are more likely to be hospitalized and stay longer when admitted than non-smokers.”

“Smokers are likely to have more healthcare costs later on in life, and we know that,” Singleterry says. “There are costs for treating lung cancer and heat disease that come along with tobacco use, and someone — whether it’s Medicare, insurance, or the smokers themselves — will be paying those higher costs.”

“All healthcare costs increase as you get older, and health insurance plans know that. For smokers, the effect is magnified,” says Dr. Ray Casciari, a pulmonologist at St. Joseph’s Hospital in Orange, CA, and a fellow in the College of Chest Physicians. Casciari has been a pulmonologist for the past 37 years and formerly served as the head of the lung cancer program at St. Joseph’s. “ Smokers have a higher incidence of heart disease and cancer. As you get older as a smoker, your risk goes up dramatically that you will have a more illness during the course of a year.”

The list of illnesses associated with smoking is long. “Smoking restricts your blood vessels, causing wrinkles, heart disease, and high blood pressure,” says Casciari. “It irritates your lungs and causes lungs to produce more mucous, infections, and damage to the lungs in the form of emphysema and bronchitis. We all get that as we age, but smokers get it faster and to a greater degree. Smoking also causes mutations in cells that lead to cancer. There’s no doubt that lung cancer is related to smoking, and we’ve known that since 1929.”

Singlettery also notes that the latest U.S. Surgeon General’s report on the health costs of smoking shows that blindness (macular degeneration), stroke, erectile dysfunction, and a host of other diseases can also be attributed to smoking. Rosen adds, “According to the CDC, smoking is a contributing factor in more than 480,000 deaths each year.”

In the short-term, too, the costs of smoking are clear. According to the American Cancer Society, each pack of cigarettes totals $35 in health-related costs per smoker. “With regards to workers’ compensation rates, smokers average $2,189 per year compared to $176 for non-smokers,” adds Rosen. “For individuals, in addition to paying higher health insurance premiums, smokers also pay higher costs for life and disability and have twice as many workplace accidents, according to the American Lung Association.”

What are your options? If you’re a smoker and shopping for a health insurance plan on the exchanges, it pays to look closely at your options by speaking to a local health insurance agent who knows the ins and outs of plans available in your state.

And if you’re looking to save on overall costs, you may want to consider quitting. Not only does quitting smoking have immediate health benefits, but it may also reduce your insurance premiums. “Additionally, as part of the ACA, all new health insurance plans are required to cover tobacco cessation treatments, helping people quit smoking and reduce their premiums,” adds Rosen.

“You have to decide whether or not you want to quit smoking,” says Dr. Casciari. “You have to be self-motivated to want to quit, and if you do want to do it, there are things that can help.”

Say you are five months pregnant and, uh-oh, your employer is changing health insurance plans. Your obstetrician is no longer part of your health plan’s network. A reason to panic? Not necessarily, health insurance experts say.

If you take the proper steps, chances are you will be able to continue seeing your doctor until you deliver, and for any post-pregnancy follow-up you need. Your new health plan should treat these remaining medical bills as if you received in-network care.

Not all health insurance plans are the same and you should check your policy and with your health insurer, says Anjanette Coplin, a spokesperson for Aetna. Here’s what would happen in this scenario if, for example, you had Aetna:

• If your plan changes and you want to stay with your doctor, you will need to apply for transition of care. “The member must submit a transition of care request, typically signed by her doctor, before the change in plans is made,” Coplin says.

There are some caveats to be eligible to apply for transition of care for pregnancy:

• You need to be at least 20 weeks pregnant unless your state or plan requirements are different.

• Or, you are less than 20 weeks but are considered and documented to be high risk by your providers.

Pregnancy isn’t the only reason you might apply for a transition of care from your health insurer. Transition of care applies to treatments for a diagnosed

condition that has a defined number of services or periods of treatment and includes a qualifying situation, Coplin says.

Here are examples of situations that are likely to qualify for transition of care and allow you to remain with your original doctors or other providers even when they are no longer in your health plan:

• Chemotherapy or radiation therapy.• Out-patient intravenous therapy for a

resolving condition.• Surgeries that are performed in stages.• Treatment for a mental illness or for

substance abuse.• Post-surgical care.• An organ or bone marrow transplant.

If your transition of care request is granted, you will be able to continue to see the health care providers who started your treatment. You will receive the treatments without penalty at your preferred plan benefit level. For example, if your request is approved and you have an HMO, you would be covered at the in-network benefit level regardless of whether your doctor is still part of your HMO network.

Transition of care requests

You’ll likely start the process by filling out your insurer’s transition of care request form. Here’s an example of one for Aetna.

Each request is reviewed on a case-by-case basis, Coplin says. Requests are reviewed by the insurer’s staff in consultation with the medical director. After

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How to Continue Treatment When Your Health Plan Changes Beth Orenstein Insure.com | February 17, 2015

Insure.com | February 17, 2015

the review is complete, you will receive a letter confirming whether your request for coverage under transition of care has been approved.

You can continue to see your doctors for a transitional period only. You won’t be granted an exemption forever, Coplin says.

As with pregnancy, you must be undergoing an “active course of treatment” that started prior to the enrollment date of your new plan. Coplin explains that an active course of treatment is a program of planned services provided by a specialty provider. The date the treatment starts is the day you receive a service or treatment for your diagnosed condition.

Get approval before you continue treatments

Your health insurance company is likely to ask your doctor to sign your transition of care request. It is important that you follow these steps before you continue your treatment. “In order for claims to be paid at the in-network level during the transition of care process, Aetna must approve any treatment prior to the treatment being rendered,” Coplin says.

It may take some time to get the approval (in some cases 15 days for non-urgent care, depending on your health plan and your state), so be sure to allow for that. Apply for transition of care as soon as you can.

Get your doctor to help

Martin Rosen, executive vice president of Health Advocate in Plymouth Meeting, Pennsylvania, a health care advocacy and assistance company, suggests you ask your doctors to go to bat for you if you want to continue receiving care from them.

“The reality is that expertise really matters,” Rosen says. That’s why having your doctor explain to your insurance company why you need to stay under his or her care is better than trying to do it yourself, he says. “Most physicians are more than aware and understand this challenge. They have lots of experience with it.”

Also, you are more likely to win the battle if your case is well documented and you have determined that you are seeking benefits to which you would be entitled had your plan not changed, says Rosen.

Rosen says most insurance companies do as Aetna does and allow women, if they are in their third trimester, to continue to see the provider with whom they started. “If your obstetrician is not in your new network, the insurance company will likely make arrangements for you in large part because of the general view that it would be deleterious to the health of the mother if you didn’t continue with the same care.”

Have things been moving a bit slower at the office since the end of the holiday break? Is it a little harder to get employees motivated in the early days of the new year? Don’t worry; you’re not the only one tackling the post-holiday blues.

The letdown in energy following the holiday season has many names: post holiday blues, Boxing Day blues (in England), or post holiday tension — whatever the name, it’s common for workers to feel a letdown after the energy and excitement that naturally come with the holidays. Getting back to the 8-5 grind with no big events on the near horizon can be daunting for anyone.

“It’s normal for people to fall into somewhat of a funk following the holidays,” says Bert Alicea, vice president of EAP and Work/Life Services at Health Advocate, an employee assistance program based in Plymouth Meeting, Pennsylvania. “They anticipated the holidays for weeks, so returning to work is difficult, especially if they don’t have another break for months.” Alicea estimated it takes two weeks or so for people to start returning to their normal routines.

Returning to reality

The added stress of the holiday season can naturally lead to a letdown once it’s over, says Brett Kennedy, a clinical psychologist based in Boulder, Colorado.

“You’ve just come off a period where there’s so much pressure at work to meet deadlines and wrap up your work, as well as the increased expectations and pressure from families, the social obligations

— you do see people reflecting on the stress of the holiday season. Most everyone in my practice express some degree of stress from the holidays, and they’re not particularly thrilled to go back into the grind.”

Alicea says that the busy holiday season leads some to put off priorities such as finances or health care appointments, leading to more stress once the new year begins. “People have a tendency to put their life on hold over the holidays,” he says. “But then reality begins to set in, in a wide variety of different ways, after the new year.” Tips for getting back on track

With the post holiday letdown such a universal — and usually temporary — conditions, experts say little things can go a long way to easing the transition. Kennedy says employees should make the most of what time off they do have.

“Take advantage of your lunch hour to go to yoga class or reconnect with your co-workers,” he says. “Don’t sit at your desk. Walk around; go have lunch with somebody.”

He adds that simply putting one’s nose to the grindstone can be counterproductive.

“Sometimes people feel behind at this time of year; they kind of jump back in a full speed,” he says. “You are dealing with the added pressure of returning to [work]. Take a week or two back to ease into your routine.”

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Workers Battling the Post-Holiday Blues (And How Employers Can Help)Scott Wooldridge benefitspro | January 13, 2015

benefitspro | January 13, 2015

Alicea says that group activities for workers, or some sort of recognition for a job well done, can be beneficial and help lift employees’ mood. Reminding them that they don’t have to try to do it all can help, as well, he says.

“Encourage employees to focus more on smaller tasks to reduce stress,” he says. “With this being the flu season, a lot of people come in to work when they’re sick. I would encourage employees to stay home when they’re sick, to avoid spreading the illness among other team workers.”

Kennedy adds that it’s important to recognize that the holidays often lead to excess.

“In general, a lot of us get off track in terms of eating, or exercise, or sleep,” he says.

“We get off our diets. I think one of the first things to do is focus on basic self care and get back to the things you know will make you feel better. Get back to sleeping your regular hours. Give yourself a little detox time from alcohol.”

Resolve to skip resolutions?

The traditional new year’s resolutions can add pressure for some, but Kennedy says they work for others.

“It’s a mixed bag — for some people it helps to reset and have some measurable goals to stick to, but for others it’s overwhelming and just adds more to their to-do list.”He says a more realistic approach is setting some short-term goals, such as ramping back into more-healthy eating and exercise habits.

“You resolve to get back on track, as opposed to making huge changes,” he says.

A group approach to new year’s resolutions can also be a positive step, when there is built-in support for the effort, Kennedy says. Company wellness programs often offer these types of goals.

According to Betsy Klein, vice president of New Directions Behavioral Health, employers can help workers with new year’s resolutions by having support programs such as financial seminars, wellness programs, or employee assistance programs to help with work/life issues.

“Whether they seek improved health, a stronger financial position or a renewed marital relationship, employers can help their employees thrive, resulting in a more satisfied and productive workplace,” she says.

When the blues outlast the holidays

Both Kennedy and Alicea say it’s important to watch for cases where employees do not get back to normal after the first few weeks. Alicea says that when workers are uncharacteristically moody, or lethargic, after the first two weeks back on the job, there might be a more serious issue — or one that requires additional support.

“EAPs can help employee tackle some of these issues,” he says. “Sometimes they might just need a coach to establish a plan to get back on track.”

Kennedy says he tells his clients to watch for different levels of post-holiday blues. A little grumpiness or lack of motivation is normal, he says.

“But if you find yourself in something that feels more severe and it’s impacting your ability to get to work on time, or to meet deadlines, and it goes on for more than two weeks, then you might want to consult with your EAP, or talk to somebody,” he says. “Because you might be experiencing something more serious.”