March 2016

Three Changes Consumers Can Expect In Next Year’s Obamacare Coverage

Health insurance isn’t simple. Neither are government regulations. Put the two together and things can get confusing fast.

So it’s not surprising that federal regulators took a stab at making things a bit more straightforward for consumers in new rules unveiled in late February and published Tuesday in the Federal Register. Because those rules are part of a 530-page, dizzying array of changes set for next year and beyond, here are three specific changes finalized by the Department of Health and Human Services that affect consumers who buy their own health insurance in one of the 38 states using the online federal insurance exchange.

1) Consumers could have access to more information about the size of the insurers’ network of doctors and hospitals.

Most consumers care about two things: the cost of the plan and whether their doctor or hospital is in the plan’s network. The new rules would require insurers to give consumers 30-days’ notice when a provider is being removed from the network. They must also continue to provide coverage for that provider for up to 90 days for patients in active treatment, such as those getting chemotherapy or for women in the later stages of pregnancy — unless the provider is being dropped for cause. Consumers will also see another change: The relative breadth of each plan’s network will be noted with three size designations, which are roughly equal to basic, standard and broad.

2) Consumers could be given slightly more warning about “surprise” medical bills from out-of-network providers.

One of the most common complaints from consumers — even before the federal health law passed — concerns bills they get from out-of-network providers. Such bills can hit consumers even when they go to facilities that are in an insurer’s network because not all of the doctors and other medical staff in those facilities are part of the network. The new rules make a small change, requiring that amounts paid by consumers for ancillary care — such as anesthesiology or radiology — count toward their annual out-of-pocket maximum. That’s important because once a patient hits that out-of-pocket maximum, the insurer is responsible for all in-network medical costs for the rest of the year. But the new rule only applies in cases where the insurer hasn’t warned patients — generally at least 48 hours before the hospitalization or procedure — that they might receive care and bills from such out-of-network providers. Consumer advocates say insurers will simply issue form letters to as many patients as they can to avoid the rule, while insurers complain the rule doesn’t get at the heart of the matter: the high charges they say are set by out-of-network providers.

3) Consumers’ out-of-pocket costs could be more standardized.

This provision could be the rule’s most substantive change. Regulators are requesting that next year insurers voluntarily offer plans with a standard set of coverage costs — from deductibles to copayments for drugs or doctor visits.

The new rules aim to make comparison shopping easier. The change also gives a nod to a cost hurdle that may keep some consumers from enrolling: having to pay hundreds if not thousands of dollars in deductibles before some common services are covered. To entice those consumers, federal regulators created six standard plans that include specific flat-dollar copayments for urgent care visits, most prescription drugs, primary care, mental health and substance abuse treatment — without the consumer first having to spend money to meet an annual deductible. “Insurers will have to compete head-to-head providing the same benefit package, one that most consumers will find fairly attractive,” said Tim Jost, a consumer representative to the National Association of Insurance Commissioners and former law professor who writes widely on the health law.

Still, the standard copayments in plans will likely seem high for some consumers. For example, the bronze plan standard design sets a $45 copayment for a primary care visit and $35 for a generic drug prescription. Copayments are smaller in the standardized silver plans, which set a $30 flat rate for a primary care visit, $65 for a specialist, $15 for generic drugs, $50 for brand name products and 40 percent of the total cost for the most expensive type of drugs, deemed “specialty drugs.” Those amounts are slightly higher than the average costs in silver-level plans sold this year, according to an analysis by consulting firm Avalere.

Insurers opposed the idea of standardized plans, saying they could stifle innovation, lead to higher premiums and make it less likely they will be able to create plans that appeal to a broad variety of consumers. Still, a handful of states, including California, Connecticut, Massachusetts, New York, Oregon, Vermont and the District of Columbia, have designed standardized plans that all insurers in the state marketplace are required to sell. But, because this part of the regulation is voluntary — meaning the federal government is requesting rather than compelling insurers to make these changes — it is unclear how much impact it will have on consumers and the marketplace.

So, in the next open enrollment period, consumers could see such standardized plans available in addition to the varied policies currently sold, which can have widely different payment packages. For example, one plan may have a lower deductible but higher out-of-pocket costs for doctor visits, while another might exclude certain office visits from the annual deductible, while a different option does not. Such variations have provided choice for consumers but also made comparing and contrasting plans difficult.

Meanwhile, HHS also finalized its annual increase in the cap on how much consumers can be charged out of pocket annually for such things as deductibles and copayments. The rule applies to those who buy their own coverage and many employers plans. Next year the cap will be $7,150 for an individual or $14,300 for family coverage.

DST linked to increased stroke risk

Shifting the clocks by an hour increases the occurrence of stroke.

Stroke kills around 130,000 Americans per year; that equates to 1 in 20 total deaths.

The most common type of stroke is ischemic, accounting for 85% of all strokes.

Ischemic strokes occur when the artery that supplies oxygen-carrying blood to the brain becomes blocked, often by a blood clot.

Although a number of risk factors for stroke are known, including alcohol, smoking, obesity and lack of exercise, the current study adds another, rather different, factor to the list.

The research, authored by Dr. Jori Ruuskanen, utilized a decade of Finnish health care information, including thousands of patient records.

The team used the data from 3,033 individuals hospitalized during the week after a daylight saving time transition and compared it with the rate of stroke in a group of 11,801 people who were hospitalized 2 weeks before or 2 weeks after the clock change.


Clocks and strokes

The results are to be presented at the American Academy of Neurology’s 68th Annual Meeting in Vancouver, Canada, in April.

The researchers found that for the first 2 days after the daylight saving switch, the overall rate of ischemic stroke was 8% higher. After 2 days, the levels were back to normal.

For certain groups, the risks were higher; people with cancer were 25% more likely to have a stroke just after the transition than any other period. Also, individuals over the age of 65 were 20% more likely to have a stroke immediately after the shift.

Although the results do sound quite surprising, there are some existing theories that might help explain why a simple shift of 1 hour in time might bring about such a disruptive medical outcome.


Why daylight saving can be lethal

Researchers have previously spotted some circadian influence on stroke levels. A meta-analysis of stroke research, including data from 11,816 strokes, found that the chance of an ischemic stroke between midnight and 6 am was 55% higher than at any other time of the day.

It does seem that timing is somehow important in the etiology of strokes. However, this is the first time that daylight saving has been specifically investigated as a risk factor.

Medical News Today asked Dr. Ruuskanen what he thought was behind the observed effect. He said:

“We know from previous studies that stroke risk is highest in the morning hours and daylight saving time slightly shifts the timing pattern of stroke onset.

Previous studies have also shown that the disruption of the circadian clock due to other reasons (e.g. due to rotating shift work) and sleep fragmentation are associated with an increased risk of stroke.”

The findings will need to be corroborated with more investigation, but the team believes the results are strong. MNT asked Dr. Ruuskanen what further research would need to be done to prove the connection.

He advised that to make the findings unequivocal “would require abandoning the daylight saving time changes.” Debates do, occasionally, come up about whether daylight saving is necessary, so in the future this could become a reality.

Dr. Ruuskanen said that, should the time switch eventually be removed, and “a follow-up of several years saw that the small increase in stroke incidence […] disappears, it would make a strong argument that it actually is the clock change that raises the stroke risk.”

Even before follow-up research is completed, the results remain convincing, firstly due to the large data size, and, secondly, because the weeks after the clock change were compared with similar weeks over the course of a decade.

Dr. Ruuskanen told MNT that “it is hard to see any specific factors other than the shift that could be identified to differ between these weeks and affect stroke incidence.”

It truly does seem that a change of just 1 hour could raise the risk of stroke; MNT recently covered research in a similar vein demonstrating that broken sleep raises the risk of stroke.

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