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Smart Benefits: Make the Most of Your Health Plan in 2014

Monday, December 30, 2013

 

Every year it seems health insurance premiums and out-of-pocket expenses increase while plans cover less. So how can consumers get the most out of their coverage in 2014? Here are five ways to put your plan to good use next year – and reap some savings along the way.

1. Get your Annual Wellness Check. An annual dose of prevention can mean early detection for a myriad of illnesses. So be sure to see your primary care physician (PCP) annually for a wellness check this year. Healthcare reform requires your coverage to provide this service at no cost – meaning, you’ll pay no copay or deductible. Get age-appropriate screenings as part of your visit since those are also covered.

2. Switch to lower cost prescription drugs. Carriers charge up to three or even four different prescription copays depending on the coverage. And the differences can add up. Tier 1 medications are usually $7 or $10 while Tier 3 copays are often $50 or $60. Ask your physician if there is a lower cost equivalent of your Tier 1 medication to save $43 or more per month – with potential annual savings of greater than $500.

3. Move to mail order and save even more. Most insurance carriers offer mail order benefits for maintenance medications, which can typically save you the equivalent of 2-4 weeks of medication costs per quarter. Plus, you’ll save on gas by having the medications shipped right to your door. And you’ll avoid impulse buying at the pharmacy while waiting for your prescriptions to be filled.

4. Join a fitness club. Carriers offer discounts, and in some cases, reimbursements if you join a fitness club and use it. Tufts Health Plan just enhanced its fitness discount reimbursement program to include studio classes for programs like Pilates and dance classes.

5. Comparison shop. BCBSRI and UnitedHealthcare both offer cost estimators that allow consumers to shop and compare costs for care by type of service (e.g. MRI versus x-ray) or by setting (e.g. hospital, doctor’s office or stand-alone facility) and even check prescription copays by pharmacy. If you’re willing to do the research, you can save a tremendous amount of money. And if you have a plan with a deductible, any savings realized means less money from your pocket.

To save even more, remember to enroll in either a Health Savings Account (HSA) or Flexible Spending Account (FSA), both of which help to pay for out-of-pocket expenses on a pre-tax basis with money you are able to set aside through payroll deduction or savings deposits. Money saved is loaded onto a credit or debit card and can be used to pay for purchases through the year – so you don’t have to take from your spending money.

Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.

 

Related Slideshow: 13 Biggest Healthcare Stories in Central MA in 2013

The most import stories from one of the most historic years in memory for Central Massachusetts healthcare.

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13 Inspection Scores

INTERACTIVE: Worcester Restaurant Health Inspection Tracker

Before you go out to dinner, make sure you know about the cleanliness of the establishment. GoLocalWorcester spent weeks going through the files of every health inspection in Worcester for nearly 700 restaurants. Use our proprietary interactive map to check any restaurant before you go out to eat. Check out our interactive map and fully sortable and rankable tabular data set to explore how your favorite restaurants did on their latest health inspections.

GoLocal also reported on the 50 Restaurants with the Worst Health Code Scores in Worcester and talked with experts about inspections -- and foodborne illnesses.

Click here to explore the interactive map!

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12 MA's Top 25 Diseases

The 25 Biggest Diseases To Strike Massachusetts

What infectious diseases hit Massachusetts the hardest, and in the biggest numbers? In July, The Centers for Disease Control (CDC) released its latest data for "notifiable diseases," defined as those infectious diseases "for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control fo the disease," according to the CDC. The latest data reports the number of cases in MA from 2011.

Click here to see the most prevalent notifiable diseases in MA!

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11 Famous Twins Thriving

Worcester Twins Thriving 17 Years After Famous Hug

When the Jackson twins were born 12 weeks premature in October of 1995 in Worcester, doctors were not sure if the two newborn girls were going to make it.

When one started to fade at just three weeks old, a nurse thought to put her sister in the same incubator as her, resulting in an immediate improvement in her health and the famous photograph of the "rescuing hug."

Now the girls are thriving 17-year-olds, and their story was recently featured on CNN.

Check out the video of the segment here.

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10 High Stress in MA

Gallup Poll: MA 5th Most Stressed Out State

A new poll from Gallup revealed that Bay State residents are a bunch of worrywarts. According to their most recent ranking, Massachusetts is facing the fifth highest levels of stress in the country.

While the Commonwealth’s ranking in this Gallup poll didn’t change since last year (also fifth place), the figures did shift. 

Click here to find out by how much.

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9 Healthiest Counties

The Healthiest Counties in Massachusetts

Worcester County ranked 9 out of Massachusetts’ 14 counties in overall health according to 2013 rankings by the Robert Wood Johnson Foundation, a national foundation focused on improving public health. The 2013 County Health Rankings place Worcester County somewhere near the bottom of pack. Dukes and Middlesex counties are the healthiest, while Suffolk and Hampden counties are the least healthy.

To see how all of Massachusetts's counties were ranked for overall healthiness, click here.

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8 MA Sexual Health

New National Ranking: How Sexually Healthy Is MA?

Massachusetts came in 4th place for sexual health in New England, according to the brand-new Sexual Health Rankings, just released this week.

The first-ever assessment of state-by-state data on 26 comprehensive health and services measures that speak to sexual health put the Bay State at #5 overall in the US, and #4 among New England states. Vermont was the #1 state in the country for sexual health, while Mississipi was the worst at #51. Variance, LLC, has produced the rankings in collaboration with The Center for Sexual Pleasure and Health, an education and advocacy organization based in Pawtucket, RI.

Click here to see where each New England state fell in the rankings.

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7 Health Code Experts

Experts Weigh in on Restaurant Inspections and Foodborne Illness

While restaurant inspections are required throughout the country, how they are conducted, recorded, and utilized varies greatly among towns and cities. While our custom interactive let you explore the inspections, its improtant to temper and contextualize your discoveries (some of them surprising!) with input from chefs, doctors, and national experts.

We reached out to a wide array of each when we conducted our look into the worst health inspection offenders in Worcester.

Click here to read their take on the story.

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6 Rampant Opioid Abuse

Massachusetts Drug Overdose Deaths Up 47% Since 1999

Last year we reported that Worcester's heroin use was twice the national average - Massachusetts is the top state in the country for opioid overdoses, and lifetime heroin use in Worcester is almost 5%, twice the state and national average.

This year a report recently released by the Trust for America’s Health (TFAH) showed that overall drug overdose deaths in Massachusetts have climbed 47% since 1999. The Bay State is now ranked 32nd out of 50 states in annual drug overdose deaths, with nearly 11 of every 100,000 deaths resulting from an overdose. The majority of these deaths were the result of prescription drug abuse- opioids.

Click here to read more.

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5 Curbing Candy Craze

11 Ways To Help Kids Curb Their Halloween Candy Craze

This Halloween, while Central Massachusetts kids were gearing up for a candy extravaganza, their parents were dreading the sugar assault on their children's health.

Statistics that show that Americans buy nearly 600 million pounds of candy during the Halloween season. That boils down to about 1.9 pounds of candy per person.

Kate Roberts, a consulting psychologist to school districts throughout Rhode Island and Massachusetts, says that with obesity and diabetes on the rise, not to mention the scare you’ll get at the dentist’s office parents may want to limit some of this devilish behavior. 

Check out her tips for curbing the crave here.

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4 Sale of St. Vincent's

Controversy Surrounds Buyer of St. Vincent + MetroWest Hospitals

On June 24th, Major US hospital operator Tenet Healthcare Corporaton announced its intention today to buy Vanguard Health Systems Inc for $1.73 billion, a purchase that would include Worcester's St. Vincent Hospital. The purchased marked the re-entry of Tenet Healthcare, a familiar and legally challenged for-profit hospital chain, back to Central Massachusetts.

Tenet owned the Central Mass. hospital once before, selling it to Vanguard in 2004. At the time, Tenet faced federal charges of Medicaid fraud. It wasn’t the first time that would happen, and it wouldn’t be the last. In the past decade, Tenet has shelled out more than $1 billion to settle a laundry list of legal charges. Read on to learn about the charges and for expert commentary on what their re-entry means for St. Vincent's and its patients.

Read the full report here.

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3 Nursing Home Rankings

Massachusetts Ranked #19 on National Nursing Homes Report Card

Massachusetts received a "B" ranking for nursing home quality of care from "Families for Better Care," a national nursing home resident advocacy group -- and earned the #19 top spot in the country overall.

The group published the nation’s "first-ever state-by-state nursing home report card" by analyzing eight federal measures to rank nursing home quality.

But local experts warned that MA's ranking did not directly mirror the more local picture in Worcester. While roughly 2/3 of nursing home residents in Massachusetts are there under Medicaid programs, the number is closer to 3/4 in Worcester County, according to Ernie Corrigan with the Massachusetts Senior Care Association. So do some more local research- check out our complete ranking and ensure the nursing homes you choose are not among the 1/3 of Worcester nursing homes graded "below average".

Click here for the full report.

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2 Nurses Fight at UMass

UMass Memorial Nurses Vote to Strike

Staff members at UMass Memorial hospital were embroiledinvolved in heated talks with the hospital’s administration, with the Massachusetts Nurses Association (MNA) union at their side. 2,000 of the hospital’s nurses were ready to take it to the next level. The nurses alleged that they were under staffed and putting patients at risk. The standoff dated back to mid-2012 and culminated around midnight on May 23rd, the night before the one-day strike was set to begin when a deal was reached to avert the strike.

The timeline:

November 15, 2012: UMass Memorial and Nurses Union Clash Over “Dangerous Mismangement”

December 13, 2012: Nurses Picket UMass Memorial Over Staffing + Pension Cuts

February 23, 2013: Local Nurses Say Hospitals “Skirting the Law”

April 11, 2013: UMass Memorial Nurses Prepared to Strike

April 12, 2013: UMass Memorial Nurses Vote to Strike

May 10, 2013: UMass Memorial Nurses to Hold One-Day Strike

May 18, 2013: UMASS Memorial/Hahneman Nurses Settle, University Nurses Pending

May 20, 2013: UMass Memorial Univ. Campus Nurses Strike Still Looming

May 23, 2013: No Strike—UMass Memorial and Nurses Reach Agreement

Prev Next

1 Patients Rank Hospitals

New England’s Best Hospitals Rated By Patients

Traditionally, hospitals are rated and ranked on a combination of sound technical care, adequate resources, and impressive statistics. But an increasing emphasis is being placed on perhaps one of the more important measures: the patient’s perspective. With that in mind, GoLocal has sifted through and analyzed the results from a government-sponsored survey of more than 50,000 patients in 176 hospitals in New England (full chart here), and emerged with the first-ever patient-based ranking of the region’s top hospitals.

GoLocal consulted with patients, experts, and hospital administrators for their take to contextualize the rankings- click here to read the story.

Click here for the ranking of New England's Top 20 Hospitals

 
 

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Comments:

Kent Fager

One think most don't realize is many time insurance companies make money on your generic drugs through copays. Many time the copays are higher than the cost of buying the drugs by mail order. I got my doctor to write a script for 360 days. I buy all my meds for $180.00 for the entire year. The copays were $440 per year. Buying 360 days also allows me to have all the meds on the same schedule. The drugs are the same brand for the whole year. I go to healthwarehouse.com




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