Health Insurance

Health Insurance Coverage in the United States

In September 2019, the U.S. Census Bureau published a report on health insurance coverage in the United States.  The report is based on information collected in The Current Population Survey Annual Social and Economic Supplement and the American Community Survey.

Here are some of the highlights from the report:

  • In 2018, 8.5 percent of Americans, or 27.5 million people, did not have health insurance at any point during the year.
  • The percentage of people with health insurance coverage for all or part of 2018 was 91.5 percent, lower than the rate in 2017 (92.1 percent).
  • In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3 percent of the population and 34.4 percent of the population, respectively.
  • Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9 percent.
  • The percentage of uninsured children under the age of 19 increased by 0.6 percentage points between 2017 and 2018, to 5.5 percent.

For more information, click here.

Teaching Suggestions

  • Ask students if they have health insurance of their own or through their parents. What are the premiums for their coverage?
  • Ask students to make a list of available sources for private and public health insurance coverage in their states.

Discussion Questions

  1. What might be some reasons why 8.5% of people, or 27.5 million, did not have health insurance in 2018?
  2. While most people have a single type of health insurance, some people may have more than one type of coverage during a calendar year. Why?
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SPREAD THE WORD, NOT THE VIRUS

The infectious disease experts are urging all Americans to do their part to slow the spread of the Coronavirus.  Even if you are young, or otherwise healthy, you are at risk and your activities can increase the risk for others.  It is critical that you do your part to slow the spread of the Coronavirus.

Work or engage in schooling from home whenever possible.  Avoid social gatherings in groups of more than 10 people.  Avoid eating or drinking at bars, restaurants, and food courts—use drive-through, pick-up, or delivery options.  Avoid discretionary travel, shopping trips, and social visits.  Do not visit nursing homes or retirement or long-term care facilities unless to provide critical assistance.  Practice good hygiene.  Wash your hands, especially after touching any frequently used item or surface.  Avoid touching your face.  Sneeze or cough into a tissue, or the inside of your elbow.  Finally, disinfect frequently used items and surfaces as much as possible.  Furthermore:

  1. Listen to and follow the directions of your federal, state and local authorities.
  2. If you feel sick, stay home. Do not go to work. Contact your medical provider.
  3. If your children are sick, keep them at home. Contact your medical provider.
  4. If someone in your household has tested positive for the Coronavirus, keep the entire household at home.
  5. If you are an older American, stay home and away from other people.
  6. If you are a person with a serious underlying health condition—such as a significant heart or lung problem—stay home and away from other people.

For more information, click here.

Teaching Suggestions

  • Ask students if they are practicing social distancing. If not, what are the reasons?
  • Ask students how difficult has it been since the world has almost come to a standstill. What has changed in their life?

Discussion Questions

  1. Are the President’s Coronavirus Guidelines for America fair to the citizens? Explain why or why not?
  2. Since older people are particularly at risk from the Coronavirus, why are younger people being quarantined?
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Paying for Long-Term Care

Paying for long-term care (sometimes called “long-term services and supports”) includes non-medical care for people who have a chronic illness or disability. This includes non-skilled personal care assistance, such as like help with everyday activities, including dressing, bathing, using the bathroom, home-delivered meals, adult day health care, and other services. Medicare and most health insurance plans, including Medicare Supplement Insurance (Medigap) policies, don’t pay for this type of care, sometimes called “custodial care.” You may be eligible for this type of care through Medicaid, or you can choose to buy private long-term care insurance.

Long-term care can be provided at home, in the community, in an assisted living facility, or in a nursing home. It’s important to start planning for long-term care now to maintain your independence and to make sure you get the care you may need, in the setting you want, now and in the future.

For more information, click here.

Teaching Suggestions

  • Ask the students if they have Long Term Care insurance since 40 percent of the 13 million people receiving long term care services are between the ages of 18 and 24.
  • Ask students to prepare a list of services that long term care insurance policy may provide.

Discussion Questions

  1. If majority of Americans will be cared for at home by family members and friends, why should anyone purchase a long-term care insurance policy?
  2. Do younger people need long-term care insurance? If so, why?  If not, why?
  3. Why long- term care insurance is very expensive? Should everyone purchase long term care insurance?
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Deceptive Stem Cell Therapy

People spend billions of dollars each year on health-related products and treatments that don’t deliver. People who buy them are cheated out of their money, their time, and even their health.

The Federal Trade Commission (FTC) reports  that California-based Regenerative Medical Group, Telehealth Medical Group, and Dr. Bryn Jarald Henderson, the founder of both companies, sold false hope at high prices.

These companies and Dr. Henderson used social media and websites to promote stem cell therapy for all kinds of health issues affecting older adults and children. Supposedly, it could treat and cure diseases and health conditions such as Parkinson’s disease, autism, dementia, depression, multiple sclerosis, cerebral palsy, traumatic brain injury, heart disease, macular degeneration, chronic kidney disease, osteoarthritis, and stroke. Dr. Gunderson  charged up to $15,000 for their initial stem cell therapy and up to $8,000 for follow-up treatments.

But, according to the FTC, these claims were not backed up by any scientific studies and, in fact, no studies have established that stem cells cure, treat, or reduce the severity of diseases or health conditions in humans. With the exception of a few FDA-approved treatments, stem cell therapy is still largely experimental.

Are you — or someone you know — thinking about stem cell therapy?  If so,

  • Be skeptical about amazing health claims.
  • Don’t trust a website just because it looks professional, uses medical terms, or has success stories from “real people.”
  • Talk to your health care professional before you consider any medical treatment.

For more information, click here.

Teaching Suggestions

  •  Help students understand that health information, whether online or in print, should come from a trusted source.
  • Let students make a list of the richest and most reliable sources of health information and share it with the class.

Discussion Questions

  1. Why is it important to seek a second or even third opinion from a qualified health care provider before trying experimental medical procedures?
  2. What can the FTC and other federal/state governmental agencies do to prevent such businesses to make deceptive treatments.
Categories: Chapter 9, Frauds and Scams, Health Insurance | Tags: , , | Leave a comment

Fake healthcare plans

If you’re looking online for health insurance, there are lots of results that seem to offer good choices. But dishonest companies are literally counting on you being confused by all those choices. So, before you sign up and pay, take steps to know you’re getting exactly what the plan advertised. Otherwise, fake “coverage” can leave you exposed to substandard benefits and costly payments.

For example, according to the Federal Trade Commission, a Florida-based company, Simple Health Plans, LLC, allegedly tricked consumers into believing its plans offer comprehensive coverage and are compliant with Affordable Care Act (ACA) standards. The company allegedly lured people in through lead-generation sites, using logos of well-known health insurance providers to make itself look credible. Simple Health asked for personal information on the site, followed up with phone calls, and pitched what it said were affordable, comprehensive, ACA-qualified plans with low or no co-pays or deductibles.

But once consumers signed up — often at premiums as high as hundreds of dollars per month — the FTC says they did not get anywhere near the full coverage Simple Health promised, and the benefits were not ACA-qualified.

For more information, click here.

Teaching Suggestions

  • Ask students if they or any of their friends and relatives have received sham health insurance plans calls. If so, how did they handle such calls?
  • Help students understand that two best-known and legitimate sources of the government health insurance are Medicare and Medicaid.

Discussion Questions

  1. What are some ways to protect yourself against false health care plans?
  2. Why is it important to learn the difference between health insurance and medical insurance discount plans?
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New Medicare cards are on the way

Changes are coming to your Medicare card.  By April 2019, your card will be replaced with one that no longer shows your Social Security number.  Instead, your card will have a new Medicare Beneficiary Identifier (MBI) that will be used for billing and for checking your eligibility and claim status.

Having your Social Security number removed from your Medicare card helps fight medical identity theft and protects your medical and financial information.

Here are some common Medicare scams relating to the new cards:

  • Someone calling, claiming to be from Medicare, and asking for your Social Security number or bank information.
  • Someone asking you to pay for your new card.
  • Someone threatening to cancel your benefits if you don’t provide information or money?

For more on the new changes to your Medicare card, visit Centers for Medicare & Medicaid Services.  And report scams to the FTC.

For more information, click here.

Teaching Suggestions

  1. How do you think this change will affect patients? You?
  2. Replacing Social Security number with Health Insurance Claim Number will cost millions of taxpayers dollars. Do you think it is worth the expense?

Discussion Questions

  • What is the biggest reason the Social Security is taking the Social Security Number off of Medicare cards?
  • How will the new system affect people with Medicare?
  • Who will be the affected stakeholders?
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Fighting Against Medicare Fraud and Abuse

Don’t Stand by…..Speak Up!

Have you ever witnessed something that you knew was wrong and wondered if you should report it?  Did you want to say something, but didn’t because you were afraid of negative consequences?  Don’t be afraid, because there are federal laws to protect you.   Indeed, as a bystander, you can play an essential role in preventing violence, wrongdoings, and fraud.

Reporting information or activity that you suspect is illegal, dishonest, or false is your right.  Reportable violations could be abuse of authority, gross waste of funds, a specific danger to public health or safety, or gross mismanagement.

Social Security’s programs were originally created to serve the American public, and 80 years later they still provide critical support to people of all ages.  As good stewards of the tax dollars, Social Security Administration designs its systems to protect against fraud, waste, and abuse.  However, its systems can’t catch everything.  And that’s where you can help.  Report wrongful acts and protect lives as well as taxpayers’ dollars.

For more information, click here.

Teaching Suggestions

  • Ask students to comment on the statement: “Nearly 70 percent of consumers believe the Medicare program would not go broke if fraud and abuse were eliminated.”
  • What would YOU do if you suspected fraud or other wrongdoings, including wasting taxpayers’ dollars?

Discussion Questions

  1. Social Security Administration (SSA) will pay about $887 billion in Social Security benefits to almost 60 million individuals in 2015. What specific tools the SSA uses to fight fraud and protect taxpayers’ dollars.
  2. How does the SSA investigate people who provide false, incomplete, or inaccurate information to defraud the government?
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I’m Young and Healthy–Is an HDHP Right for Me?

“I’ve been told a high deductible health plan (HDHP) is a good choice for my situation and that it might save me some money.  Can you explain this to me.”

This Forbes article provides answers to the questions that many people–especially younger people–have about high deductible health insurance policies.  At the beginning, the author, Christina LeMontagne, points out that high deductible policies are a great option for healthy people, but may not be right for everyone.  She also describes what a high deductible health plan is, who can benefit  from HDHPs, and how they can save you money.

For more information, click here.

Teaching Suggestions

You may want to use the information in this blog post and the original article to

  • Reinforce what a high deductible health plan (HDHP) is.
  • Stress the fact that while an HDHP may save you money, there are risk involved if you choose this type of policy.

Discussion Questions

  1. What are the advantages of an HDHP plan?
  2. What are the disadvantages of an HDHP plan?
  3. Under what circumstances would you choose an HDHP plan?
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The Supreme Court, Health Care, and You

On June 26, 2015, the Supreme Court made an important decision about the Health Insurance Marketplace keeping           quality, affordable coverage for millions of Americans.  The Supreme Court’s decision confirmed that if you qualify, you can receive financial assistance, including premium tax benefit to make coverage more affordable no matter where you live.

On average, consumers enrolled in the Marketplace are receiving $3,260 per year in tax credit, or $272 each month.

About 8 in 10 consumers could find coverage for $100 or less with tax credit through the Marketplace.

If you don’t have health insurance, see if you can get health coverage for 2015.  You may qualify for a Special Enrollment Period due to life change, such as marriage, having a baby, or losing other coverage.  Open enrollment for 2016 starts on November 1, 2015.

For more information, click here.

Teaching Suggestions

  • Ask students if anyone in their family is affected by the Supreme Court ruling, and if so, how?
  • Ask students to prepare a summary of the major provisions of the Affordable Care Act.

Discussion Questions

  1. Why is it important to inform the Marketplace about any changes to your household, income, and insurance status?
  2. If you have health insurance through your employer or purchased it on the individual market, does the Supreme Court ruling impact you?
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CMS Proposes Rule to Strengthen Managed Care for Medicaid and CHIP enrollees

On May 26, 2015, the Centers for Medicare and Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries.  This proposed rule is the major update to Medicaid and CHIP managed care regulations in more than a decade.  It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage.  Overall, this proposed rule supports the agency’s mission of better care, smarter spending, and healthier people.

For more information, click here.

Teaching Suggestions

  • Ask students to visit the CMS.gov website to learn how the healthcare delivery landscape has changed and grown substantially since 2002.
  • Ask students how CMS might strengthen the quality of care provided to beneficiaries.

Discussion Questions

  1. Why is the CMS proposing new rules to strengthen managed care for Medicaid and CHIP enrollees?
  2. How does the CMS plan to modernize Medicaid and CHIP regulations?
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