Category Archives: Benefits

Hey Medicaid – Why So Skimpy on Dental Care?

I finally went to see a local dentist group yesterday and when they handed me the proposed treatment plan, I was shocked to see that Medicaid was only going to pay $154 of the $884 the dentist was going to charge. The rest, $730, was to be my responsibility. So much for having insurance.

My current plan is one of three plans accepted here in Florida by the state. The young lady in the dentist’s office who check me out said that they were not their favorite plan, and that perhaps I could still change to another plan.

I then called the Florida Department of Children and Families (DCF), but they were closed due to the holiday yesterday. This morning, I called the plan, and was told that they only received the treatment plan today, and that it was being reviewed and that I would hear back in seven to ten days.

In the meantime, I contacted one of my LinkedIn contacts who does medical travel for dental care to Costa Rica, and she will be getting in touch with a dentist down there to compare costs between what they charge in CR, and what the dentist here is proposing.

But the real reason for writing this post today is because Medicaid in Florida limits what services they will cover, and focuses more on the dental care of children, rather than giving adults the same or equal care, relative to their age and medical condition.

For example, Medicaid covers such services for children as: Ambulatory Surgical Center of Hospital-based Dental Services, Dental Exams, Dental Screenings, Dental X-rays, Dentures or Partials, Extractions, Fillings and Crowns, Fluoride, Oral Health Instructions, Orthodontics (Braces), Periodontics, Root Canals, Sealants, Sedation, Space Maintainers, and Teeth Cleanings.

For patients over 21, this is what the all the plans cover: Dental Exams (limited), Dental X-rays (limited), Dentures, Extractions, Pain Management, Problem Focused Exam, Sedation.

There are Extended benefits for patients over 21, and include the following with prior approval from the plan: Additional dental exams, Additional dental x-rays, Additional extractions, Dental screenings, Fillings (silver and white), Fluoride, Oral Health Instructions, Sealants, and Teeth cleanings (basic and deep).

We all know that adult dental care is more comprehensive and more expensive than that of children, yet, there are services missing from the adult plans that should be covered, such as Crowns, Root Canals, Bridges, and yes, even implants. Dentures are so last century.

Fortunately for me, the two teeth that will be extracted are next to each other and are in the back of my mouth, so you can’t see them. But what if they were two front teeth, as the song goes during Christmas? Does Medicaid tell the patient, “Sorry, now you can whistle through the space in your teeth?”

When are we going to catch up with the rest of the Western world and provide all of our citizens with a complete range of services for dental, vision, and medical care that does not cost an arm and a leg? When will we take the profiteering out of health care like other countries do? We need to stop nickle and diming the American people when it comes to our health. We need Medicare for All, not Medicaid  that does not provide enough services.

Benefits Industry Leaders Warned About Medicare for All

It is amazing, but not surprising that we are seeing more and more business leaders coming out to prevent Americans from getting single payer health care under an improved and expanded Medicare for All.

The following article from BenefitsPro.com is aimed at warning the benefits industry not to underestimate single payer, and advises them on how to deal with this.

Naturally, it is all about selling a product to make a profit from not covering all Americans, and only those who get their health insurance from their employers, since that is what the article discusses.

They don’t care about the millions who are uninsured, under-insured, or who can’t afford insurance, let alone the cost of prescription drugs and medically necessary treatments. What matters to them is how many benefit packages they can sell to employers.

One thing to note from the article, Nelson Griswold said the following at the NextGen Growth & Leadership Summit:

“Once a country has moved to government-controlled health care, it has never gone back. My prediction is that we’ll have single payer in five years.”

I hope he’s right, as far as his prediction is concerned. However, he is also right about one other thing, No country has or will give up their current system for the one we have here in the US. They would be crazy to do so, and we are crazy for not doing what they have been doing for many years, and they are doing ok with theirs.

Change is hard, but once change happens, people generally feel that the change was worth it, and that all the worrying and apprehension over that change was misplaced, misguided, and silly.

So it will be with Medicare for All. They said the same thing about Medicare, and they recruited a has-been actor who would later turn politician to scare the living daylights out of seniors with the phrase, “socialized medicine.” Now, many Americans like Medicare. And the term, “socialized medicine” has another meaning. It means that capitalist medicine is better than socialized medicine, but that too has been proven wrong.

Anyway, here’s the link to this warning shot across the bow of single payer from an unexpected sector of the medical-industrial complex and consulting industry.

https://www.benefitspro.com/2019/02/08/why-single-payer-may-be-closer-than-you-think-and-what-to-do-about-it/?kw=Why%20single-payer%20may%20be%20closer%20than%20you%20think%20%28and%20what%20to%20do%20about%20it%29&slreturn=20190113103133

 

Tax Benefits of Medical Travel

An online newspaper, Medical Tourism Daily posted an article today from The CPA Journal examining the tax benefits medical travelers could receive if they sought medical care outside of the US.

This article is a further elaboration of an earlier article written by an ERISA lawyer and that I wrote about four years ago, Beware the IRS: What to Know Before Using Medical Tourism for Group Health Plans.

Today’s article was authored by three CPA’s and PhD’s from the University of North Florida, in Jacksonville.

The authors discussed the additional savings for taxpayers who seek medical care abroad, above the savings from the medical care itself.

The main takeaways from the article are as follows:

  1. Deductibility of Medical Expenses – generally, the deductibility of medical expenses is determined without regard to where the expenses are incurred. Taxpayers seeking medical care abroad are subject to the same rules and regulations as those who seek medical treatment in the US. There may be some differences in the types of expenses incurred. Example: medical travelers generally incur travel and lodging expenses not associated with domestic medical care. The type and quality of medical care vary from country to country; some treatments, therapies, or drugs administered in other countries may be seen as experimental in the US. Medical facilities may also be different, with services performed on both an in and outpatient basis. Lastly, some overseas providers may require a significant, upfront, lump-sum payment, which would make determining deductibility of expenses.
  2. Allowable Medical Expenses – in order to deduct the cost of medical travel, the expenses incurred must qualify as medical expenses rather than as personal or vacation expenses. To qualify as a medical expense, costs must be incurred for the diagnosis, treatment, cure, or prevention of a mental or physical illness or injury. The cost of equipment, supplies, medicines, and materials needed for the diagnosis, treatment, prevention, or cure of illnesses and abnormal conditions may include, but are not limited to some of the traditional medical expenses. Medical insurance premiums are also allowed to be deducted, as well as long-term care services and transportation costs related to treatment are also deductible. For medical travelers, transportation expenses and meals and lodging expenses are also deductible, under certain conditions (meals and lodging only).
  3. Potential Tax Benefit – in order for a medical traveler to derive any benefit from medical expenses, the taxpayer must have allowable medical expenses that exceed 10% of adjusted gross income (AGI) and must itemize. Choosing to itemize actual expenses implies that the taxpayer has expenses that exceed the standard deduction. They cannot deduct both the standard deduction and itemized expenses in the same tax year.
  4. Paying for Medical Care Abroad – paying for medical expenses while living or traveling abroad is different from paying for medical expenses domestically. Many providers out of the US do not bill insurance companies directly. US citizens living and working abroad may want to fund medical care through high-deductible medical plans in conjunction with health savings accounts (HSA’s). US citizens are taxed on all income worldwide; therefore establishing an HSA can provide significant tax benefits in addition to effectively fund out-o-pocket costs. They can also be used by US citizens traveling abroad for the sole purpose of medical care, as long as the services qualify for the treatment of medical expenses in the US.

The authors conclude their article by advising medical travelers planning to travel for the purpose of medical treatment to carefully consider all factors involved with the tax treatment of their expenses. Lastly, they should keep detailed records and documentation.

It is incumbent on the patient, and not the facilitator to thoroughly educate themselves about the benefits and liabilities they may face if they fail to properly account for all of there medical travel expenses. It would be a wise and customer-focused facilitator, well-versed in tax issues to advise all medical travelers so that they can realize even greater savings from the medical care they receive.

CMS Proposes to Allow States to Define Health Benefits

A connection of mine today posted a link to a CMS Fact Sheet in which they propose to allow states to define essential health benefits beginning January 1, 2019.

According to the fact sheet, this rule is intended to increase flexibility in the individual market, improve program integrity, and reduce regulatory burdens associated with the PPACA in the individual and small group markets. (See my post, “Regulation Strangulation“)

The rule also includes proposals that would provide states with more options in how the essential health benefits (EHBs) are defined for their state, it would also enhance the role of states related to qualified health plan (QHP) certification, and to provide states with additional flexibility in the operation and establishment of Exchanges, particularly the Small Business Health Options Program (SHOP) Exchanges.

Finally, they propose to permit states to reduce the magnitude of risk adjustment transfers in the small group market to minimize unnecessary burden, and proposes other changes that would streamline the Exchange consumer experience and the individual and small group markets.

What does this really mean?

Anytime the federal government attempts to allow the individual states to determine or define certain social benefits, we end up with a hodgepodge of rules, regulations, costs of impairment, etc.

We know that in certain states, the loss of a body part in one state has an impairment value different from the same body part in another state, according to the ProPublica report .

So when I see that CMS wants to allow states to define what essential health benefits are,  we have to ask ourselves, what do they mean by essential, and is one state’s essential health benefits, another state’s burden?

I understand that certain states, particularly so-called “Red” states with conservative governors and legislatures, will be free to decide that certain treatments and procedures are just too expensive for them to cover, or that they violate the ethical or moral sentiments of the community in the state, i.e., abortion, birth control, sexual reassignment surgery, etc.

Allowing states to define and decide what is essential and what is not, may be harmful to the health of many of their citizens, even if it saves the state money.

And I am rather leery of CMS’s desire to “strengthen” the individual or small group markets, because who decides what constitutes strengthening, and who makes those decisions and under what circumstances.

Rather than allowing legislators and governors to decide what medical care their citizens can receive in their state, rather than trying to shore up a market, whether it is the individual market or the group market, we should move to provide all Americans with the same health care and the same medical benefits, coast to coast, under a Medicare for All plan.

Anything less would be worse than what we have now, and would be more costly and more complex and confusing. This rule should be scraped.

Infographic on Mobile Health

Here’s an infographic courtesy of URAC. What will this mean for workers’ comp, health care and medical travel?

Millennials and Mobile.png

ARAWC Strikes Again: Opt-out Rolls On

“Just when I thought I was out… they pull me back in.”

Michael Corleone, Godfather, Part III

Source: https://www.pinterest.com/Mamzeltt/famous-movie-quotes/

When Michael confronts Connie and Neri in the kitchen of his townhouse, he warns them to never give an order to kill someone again (in this case, it was Joey Zaza), and goes on to state that when he thought he had left the mob lifestyle, they pull him back.

Thus, is the case with opt-out, as I discussed in my last post on the subject.

Kristen Beckman, in today’s Business Insurance, reminds us that opt-out, like the Mob, is pulling us back into the conversation.

As I reported last time, a bill in Arkansas, Senate Bill 653, pending in that state’s legislature’s Insurance & Commerce Committee since the beginning of March, proposes an alternative to the state system.

Ms. Beckman quotes Fred C. Bosse (not Fred C. Dobbs), the southwest region vice president of the American Insurance Association (AIA), who said that the bill is an attempt to keep the workers comp opt-out conversation going.

Mr. Bosse said that the AIA takes these bills seriously (good for them) and engages legislators to dissuade progress of such legislation the AIA believes could create an unequal benefit system for employees. (They haven’t drunk the Kool-Aid either)

Arkansas’ bill is the only legislation currently under consideration, but a state Rep in Florida, Cord Byrd (there’s a name for you), a Republican (it figures) from Jacksonville Beach, promoted legislation last year, but never filed it.

South Carolina and Tennessee, where bills were previously introduced within the past two years has gone nowhere.

And once again ARAWC rears its ugly head. For those of you unfamiliar with ARAWC, or the Association for Responsible Alternatives to Workers’ Compensation, it is a right-wing lobbying and legislation writing group based in Reston, Virginia. (see several other posts on ARAWC on this blog)

A statement ARAWC sent to BI said that these bills are beginning to pop up organically to model benefits that companies have seen from Texas’ non-subscription model. (Organically? That’s like saying mushroom clouds organically popped up over Hiroshima and Nagasaki)

Here’s a laugh for you, straight from the ARAWC statement:

Outcomes and benefits for injured workers have improved, employers are more competitive when costs are contained and taxpayers are well served by market-driven solutions,” They further said, “We recognize that each state is different and that the discussions at the state level will involve varied opinions.”

Of course, we cannot really know if injured workers are benefitting, or just being denied their rights, and it seems that opt-out is only to help employers and taxpayers get out of their responsibility to those who sustain serious injuries while employed.

In another post, the notion that Texas’ system could serve as a model for other states was outlined in a report by the Texas Public Policy Foundation (don’t you just love the names of these reactionary groups?)

Bill Minick, president of PartnerSource, praised the report, according to Ms. Beckman, and said that competition has driven down insurance premium rates and improved benefits for Texas workers. (That’s what he says, but is any of it true, I wonder? I doubt it.)

ARAWC has listed a laundry list of benefits they say responsible alternative comp laws could provide:

  • Better wage replacement
  • Reduced overall employer costs
  • Faster return to work
  • Fewer claims disputes (yeah, because they would be denied)
  • Faster claim payouts
  • Faster closure (well, when you deny claims, they can be closed faster, duh!)

It is good to know that the AIA is critical of the report, and that in their opinion, it is unworkable to allow employers to adopt a separate, but unequal system of employee benefits.

And as we have seen with the defeat of the AHCA, leaving a government-sponsored program up to market-driven forces is a recipe for disaster that should not be repeated in workers’ comp, no matter what flavor the Kool-Aid comes in.

Deaf, Dumb and Blind, part Deux

Back in June, I wrote a post with the above mentioned title. Then, I was on a rant, now I am just reporting what my fellow blogger, Joe Paduda has written about today regarding a report from the U.S. Department of Labor (DOL) on the various state workers’ compensation systems.

This report harks back to one conducted in 1972 on the state of workers’ compensation then, but as Joe points out today, seeking a return to that Commission report and to that decades-old recommendations is absurd.

Rather than give you my take on this meeting from yesterday, here is Joe’s article. I always give credit where it is due, and he is due a lot of credit for his reporting.

It would seem that not only is the workers’ comp industry deaf, dumb and blind, but so is the federal government, if we are to take Joe at his word.

And in the meantime, who gets hurt while these eggheads, bureaucrats, nincompoops and sticks-in-the-muds do more study, research, look back forty years and pine for an economy and workforce that no longer exists? The injured workers.

And who, in the meantime, while the insurers, employers, and various stakeholders gouge and game the system, gets hurt, disabled or even dies? The injured workers.

It seems to me that the only thing that matters to the eggheads, bureaucrats, nincompoops, sticks-in-the-muds, insurers, employers, and various stakeholders is, how to screw the worker, save money by not paying adequate wages and benefits, make more profits off of someone’s disability, and not the care and treatment of the one who is disabled and forced into poverty.

Here is the perfect example of the state of affairs in workers’ comp, both inside and outside the industry:

hear-no-evil-see-no-evil-speak-no-evil