by Chris Huckins Google+ Email 

 

Health Insurance 101

28 December 2012

The Los Angeles Smog Blog

Posted in Health Insurance 101

The Los Angeles Smog Blog

    The San Fernando Valley is hardly recognizable when viewed from the 405 after a day’s worth of rain, mainly because one can actually see the valley. It’s not news that smog is everywhere around us in Los Angeles, except downtown’s Oxygen District, literally a dome protecting an entire block from the effects of air pollution. But seriously, this smog is costing us money. And if there’s one thing universally agreed upon, it’s everyone hates to lose hard-earned cash.

    Everyone who’s paid taxes has already funded the public education of smog, greenhouse gases, and the ozone layer. In school we’re taught that the ozone layer is an atmospheric shield of trioxygen (O³) that protects us from the sun’s ultraviolet rays. Since the ozone layer is high in our atmosphere, we don’t realize that O³ can be toxic. However, with the Industrial Revolution came cars and factories that emit high levels of carbon dioxide (C0²). C0² eats away at the ozone layer, arguably increasing our environment’s temperature, like a sunlit greenhouse; hence the Greenhouse Effect. Today, 0³ is in higher concentrations within the troposphere, the lowest layer of our atmosphere, and affects plants and animals, including humans, adversely. This is known as tropospheric ozone.

    Tropospheric ozone carries particle pollutants that cause damage in our airways, including: increased mortality, decreased tolerance for exercise, lung inflammation, and increased asthmatic development. Smog, on the other hand is a mixture of tropospheric ozone and chemical reactions caused when celebrities start up their SUVs, becoming an even more powerful toxin. It’s evident that cities with higher concentrations of automobiles have increased levels of pollutants, but why do its citizens pay more to live in smog?

    A study by the non-profit think tank, RAND Corporation showed that hospitalization of smog-related illnesses in California cost the state, federal, and private health insurers over $193 million between 2005 and 2007. Not only that, but children, whose developing lungs are more vulnerable to smog, are absent from school and hospitalized; a double whammy for taxpayers who are billed for hospital visits by uninsured children and classrooms that aren’t filled.  Additionally, RAND studied over 3,000 children living in high-smog areas, concluding that those who were more active outdoors were more likely to develop asthma than those playing inside. This isn’t suggesting that we keep our kids on Xbox to withstand smog, unless they’re playing Kinect: Star Wars or other motion-detection games that restrict couch potato behavior.

    Smog isn’t necessarily a larger-than-life issue. To curb this perfect storm of smog, health problems, and bills in Los Angeles one can take the initiative by signing up for health insurance as suggested by Obamacare (PPACA, Patient Protection and Affordable Care Act). This will dramatically decrease the costs of everyone inevitably affected by poor air quality in our city. With the implementation of Obamacare in the near future, numbers that show the relationship between increased health insurance enrollment and lower hospital bills are expected and may be available for Californians this time next year.

    Happy Breathing!

07 December 2012

Mortal Combat: PPOs vs HMOs

Posted in Health Insurance 101

Mortal Combat: PPOs vs HMOs

    Taking a break from last week’s lesson of Healthcare Exchange 101, I’ve decided to take a good hard look at the foundation of Healthcare in America, HMOs versus PPOs. Exciting isn’t it?! Once you understand the two, you’ll no longer say IDK (I Don’t Know) about HMO (which stands for… you’re about to find out!).

    If you’re enrolled in an HMO (Health Maintenance Organization), you’re part of a network provider, meaning you’ve selected a PCP (Primary Care Physician) whose responsibility is to manage and coordinate your entire healthcare. Basically your doctor is the Alfred to your Batman, doing all the behind the scenes paperwork while you’re fighting crime, or you know, working a 9 to 5; whichever.

    HMOs operate in service areas, meaning they only provide health care within specific geographic areas. An HMO’s service area may include all or part of a particular county. If you’d like to have an HMO, you must live or work in its service area.

    With HMOs, you pay the following:

     Premium:

  • The fee an HMO charges each month to maintain your coverage.
  • The total premium is what you pay PLUS what your employer pays.

    Co-Payment:

  • The flat fee that you pay each time you see a doctor or get services.
  • Doctor visits, prescription drugs, emergency room visits, and hospital stays have different co-pays.

    Co-Insurance:

  • Some HMOs charge you a co-insurance instead of a co-pay. The co-insurance is a percent of the cost of a service.

    Annual Deductible:

  • Some HMOs have an annual deductible. This is the amount you must pay each year to providers before your HMO pays anything.
  • The annual deductible does not apply to preventive services. From the beginning of the year, you only pay the co-pay for preventive checkups, family planning services, maternity/prenatal care, and some other services.
  • You may pay a separate yearly deductible for prescription drugs.

    Out-Of-Pocket Maximum:

  • This is the total you have to pay each year for most of your services.

    However, you still pay co-pays for some services, including prescription drugs and most medical equipment, even after you meet your yearly maximum.

    We’ve broken down HMOs and learned a few new concepts along the way, such as coinsurance and annual deductibles. Below are some examples to help understand the two:
Consider co-insurance a payment on the procedure after making the annual deductible. Most percentage participation rates for co-insurance include 70/30, 80/20 and 90/10 plans. On a 70/30 plan, the insurance company pays for 70% of costs incurred, while the individual is responsible for the remaining 30%.

    The annual deductible is a fixed dollar amount you pay for covered services each calendar year or plan year before the healthcare provider covers the rest.  In layman terms, or in the theme of this week’s blog, Batman terms please enjoy the following:

    Mr. Wayne already paid the annual deductible of $500 with 20% coinsurance. In February he and his sons, Timothy and Damien, got an annual checkup from Dr. Thompkins. In March, Damien got poisoned and visited the hospital again, costing $50. Since Mr. Wayne already paid the annual deductible and the HMO paid Dr. Thompkins $40 (80%), Mr. Wayne only had to cover to $10 (20%). That’s a lot more money saved to protect his kids in the future!

    Be sure to ask your employer or plan for a summary of your costs if you choose an HMO. Use this worksheet on California’s Office of Patient Advocate’s website to list them.

    For all your insurance needs, contact Haronian Insurance at 818.784.7047 or click here for a free instant quote!