Tuesday, December 2, 2014

Help a First Responder Help You -- Set Up an Emergency Medical ID on Your Phone

A group of us spent yesterday afternoon running through disaster recovery scenarios at ASHA. This lead us to talking about emergency contact information and the new emergency Medical ID in iOS8's new health app. I'd never actually tapped "emergency" in the lower left corner of the passcode screen. (I was afraid it would dial 911.) It actually leads you to a screen with your Medical ID. 

Open the health app and tap Medical ID in the lower right corner to set it up. This apple insider article explains how to set it up if you need help. You can include medical conditions, allergies and reactions, blood type, organ donor status, and who you would like to have contacted in the event of an emergency. A first responder can see this information without unlocking your phone. 

If you don't have an iPhone or the current operating system, download an app called ICE and use it. I'm also a big fan of the low tech, Road ID


Monday, December 1, 2014

Can I Have a Health Savings Account if I'm Eligible for Medicare?

During our open enrollment period a lot of questions came up about Medicare. I reached out to our attorneys to confirm my understanding of some key issues. I'll share that information here, but first let's make sure we're on the same page in discussing the parts of Medicare. In the simplest terms: 
Image from www.scottinsurance.com

  • Medicare Part A covers hospitalization. It's free to those who enroll.
  • Medicare Part B covers physician care. Participants pay for it. 
  • Medicare Part D covers prescription drugs. Participants pay for it. 
Obviously, there are a lot more nuances to Medicare, but the above should suffice for this discussion. (You can read more about the different parts of Medicare on the Medicare.gov site.) 

It's a common misunderstanding that you have to apply for Medicare Part A when you turn 65. If you are an active employee and enrolled in health coverage, it's not necessary for you to enroll in Medicare Part A or Part B. It's enrollment in Medicare that precludes you from contributing to an Health Savings Account (HSA), not your age. So, you can contribute to an HSA if you have a high deductible health plan and you're Medicare eligible as long as you do not enroll in Medicare. If you start receiving social security benefits, you will be automatically enrolled in Medicare Part A. If you work for an employer with 20 or fewer employees, you may be required to enroll in Medicare when you become eligible. Check with your plan administrator.

Once you are no longer working, you must enroll in Medicare Part A and Medicare becomes primary. Most retiree health plans also require you to enroll in Part B by reducing the benefits as if Part B was elected. If you didn't enroll in Part B, you'd be left responsible for the part of the bills it would have paid. This is how ASHA's plan works. If you retire from ASHA and keep our retiree coverage, you should enroll in Part A and Part B. You should also not wait to enroll in Part B, once you are no longer working. If you wait to enroll in Part B, you may have to pay a penalty for late enrollment, which will last for as long as you are enrolled in Part B. 

Medicare Part D is different. It's completely voluntary and if you already have broad based prescription drug coverage (like what ASHA provides) you should not enroll in Part D. Many retiree plans state that if a person does enroll in Part D that the retiree coverage will terminate because the coordination of benefits provisions between Part D and a retiree plan are too cumbersome. ASHA provides a creditable coverage notice to our retirees each year. Because our coverage is creditable, our retirees can use ASHA's coverage and not pay a higher premium (a penalty) if they later decide to join a Medicare drug plan. 

Pretty straight forward so far, but now it gets tricky. I stumbled upon this warning at the end of this AARP Article
Warning for when you retire: You cannot contribute to an HSA in any month that you are enrolled in Medicare.  And there’s a pitfall inherent in that rule that you need to be aware of.  When you finally sign up for Social Security retirement benefits—probably when you’re on the point of retirement—and if you’re already at least six months beyond your full retirement age (currently 66)—Social Security will give you six months of “back pay” in retirement benefits.  It’s a generous gesture, but it means that your enrollment in Part A will also be backdated by six months.  Under IRS rules, that leaves you liable to pay six months’ of tax penalties on your HSA.  To avoid the penalties, you need to stop contributing to your account six months before you apply for Social Security retirement benefits.

When applying for social security, a person may be entitled to monthly benefits retroactively for up to six months for full retirement age claims. When social security benefits are paid retroactively, typically the Medicare Part A enrollment is also made retroactively to the same effective date. There is little information available about this. It may be possible to inform the social security administration that you had other coverage and you do not want to start Part A retroactively. If you were able to do this, there would be no problems contributing to an HSA while you're employed. Here's what we recommend: 
  1. Stop your HSA contributions six months prior to applying for social security benefits. When you do apply, ask the social security administration not to backdate your Part A enrollment. If they honor your request, you can make an additional contribution equal to what you would have contributed in the six months prior to applying for social security benefits. You'd make this contribution directly to the HSA trustee before December 31 or before you file your tax return for the relevant year. Then, you'd deduct the "missed" contribution from your income taxes. 
  2. If you do not stop your HSA contributions six months before applying for social security benefits and you are enrolled in Part A retroactively, contact the HSA trustee and request that your contributions during that time period be removed from your account and refunded to you. You should do this before December 31 of the year you became ineligible. (You may be able to do it up to the point when you file your tax return for that year, but that's more complicated.) If you do not have the ineligible contributions refunded, a special penalty tax applies to that contribution for the year and for each future year that the contribution is not withdrawn. 
So, the answer to the question posed in the title of this post is "Yes", but it can get complicated. We're hoping to have a Medicare expert come in and talk with ASHA staff next year. 

Monday, November 17, 2014

In the News: a new heart health calculator and a study on the value of cooking at home

Just a quick post to share two newsworthy items. First, the Harvard School for Public Health released a new online calculator to estimate your risk of cardiovascular disease. I like that it focuses on lifestyle choices and modifiable risks. It's easy to complete and you don't need to know your blood pressure or cholesterol to get your results. 

Despite being one of the leading causes of mortality and morbidity in the U.S. and worldwide, people seem to be less fearful of cardiovascular disease than cancer or Ebola. And, unlike some diseases almost all cardiovascular disease is preventable. The recommendations you receive after completing the survey include practical tips for improving your health. It's been so popular that the site sometimes gets overwhelmed (an encouraging sign), but keep trying. It's worth doing! 

Second, a new study from Johns Hopkins University Bloomberg School of Public Health revealed that:

"People who frequently cook meals at home eat healthier and consume fewer calories than those who cook less, according to new research. The findings also suggest that those who frequently cooked at home -- six-to-seven nights a week -- also consumed fewer calories on the occasions when they ate out."
Certainly, not surprising, but it does confirm again that we're on the right track in planning a series of cooking classes for ASHA staff.

Friday, November 14, 2014

Mediterranean Diet and Workplace Health -- The Evidence Behind the Recommendations

One final post about the the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. The conference organizers prepared the review paper below. It clearly indicates the health benefits of following a Mediterranean diet and the evidence that supports the recommendation. I particularly like this chart at the top of page three that provides clear instruction for following a Mediterranean diet. Please take a few minutes to peruse the paper. 

Thursday, November 13, 2014

Health Plan Changes for 2015

When I announced that ASHA will be self-insuring the medical coverage for staff next year, I mentioned that one of the advantages is that we have more flexibility in the plan design. This has allowed us to enhance benefits in a number of areas. Below is a summary of the changes our plan participants should expect for 2015.

1. You’ll receive a new card. Our administrator will be listed as UMR, but we’ll be using the same Choice networks through UnitedHealthcare that we have now. Your id number, the mailing addresses, phone numbers, and the website will all be new. We’re doing everything we can to assure you will have your new cards in hand before January 1, 2015. And, we will make sure you have all the up-to-date contact information for the 2015 calendar year.

2. To get a 90 day supply of a prescription medication, you will have to use mail order. Through mail order, you will receive 90 days of medication for two copays. (The cost of procuring the medication through mail order is less, so we’re passing along some of that cost savings to you if you chose this option.) If you chose to have your prescriptions filled at your local pharmacy, you will get a 30 day supply for one copay. Our copays will continue to be $10 for a generic (Level 1), $35 for a preferred brand name (Level 2) and $60 for a non-preferred brand name (Level 3.) If you are in the Choice Plus with HSA plan, you will continue to pay the cost of the medication until you hit your deductible. Then, the copays will apply.

All mail order prescriptions will be transferred from 2014. You will have to call OptumRX the first time you need a refill in 2015. After a prescription has been filled once, you’ll be able to order refills online at the UMR site. Your prescription number will stay the same. At a local pharmacy, you’ll just need to present your new insurance card. If you have a specialty medication, call and talk with your advocate. You’ll just need to provide your new id number and your prescription will be transferred.

Some of the tiers that drugs are in may change. The 2015 prescription drug list has been posted on the Healthcare Savvy ASHAnet site for you. Diabetic supplies will now be covered at the generic copay level of $10.

Learn more about prescription drug pricing and safety by reading the summary of the session we hosted here in July.

3. Out-of-network services will be reimbursed at 90% of UCR (usual customary and reasonable) in 2015 instead of 80% as they are now. This enhances the benefit for staff that seek services outside the network.

4. The in and out-of-network deductibles in the Choice Plus with HSA will now cross accumulate. This means that whatever you spend out-of-pocket for in-network services will also count towards your deductible for out-of-network services. This softens the hit of the out-of-network deductible.

5. Your pre-colonoscopy doctor’s visit and the “prep” kit will now be covered as preventive services if they’re billed as preventive. (They are currently subject to the deductible and copays, so this is an enhancement.)

6. Chiropractic services will no longer be limited to 30 visits per calendar year. They will be reviewed for medical necessity after 25 visits and an unlimited number of visits may be approved if they’re medically necessary.

7. Replacement batteries on durable medical equipment will be covered in 2015 enhancing your coverage.

8. A number of exclusions for mental health disorders have been eliminated for 2015 enhancing your coverage.

We will talk about these changes during our open enrollment meetings. The HR team will also be happy to answer your questions.