Tagged Insuring Your Health

Over-The-Counter Devices Hold Their Own Against Costly Hearing Aids

Hearing aids that can cost more than $2,000 apiece are only slightly more effective than some over-the-counter sound-amplification devices that sell for just a few hundred dollars, according to a recent study.

The study bolsters legislation pending in Congress, which would have the Food and Drug Administration set regulations for cheaper over-the-counter products and is designed to make the devices more widely accessible and safer. Consumers with mild to moderate hearing loss would be able to purchase the devices without a prescription and without a medical exam, knowing they meet federal safety standards.

For the study, researchers compared how well 42 older adults with mild to moderate hearing loss repeated sentences spoken in the presence of background noise. The researchers first tested their ability to understand the speaker without any devices. Then they tested the subjects successively with a hearing aid and with five “personal sound amplification products” sold over the counter.

Michelle AndrewsInsuring Your Health

The hearing aid used in the study was a brand commonly dispensed in audiology clinics. The personal sound amplification products (PSAPs) that were selected either had the best electroacoustic properties or were commonly available in retail pharmacies. PSAPs perform like hearing aids but can’t be marketed as hearing aids because they don’t meet standards set by the FDA.

The results, published this month in JAMA, found very little difference between the hearing aid, which costs about $1,900 per ear, and some of the PSAPs, which mostly cost between $300 and $350 each.

On average, study participants were able to accurately repeat about three-quarters of the words spoken to them without using any device. Using the hearing aid boosted their understanding to an average 88.4 percent. And four out of the five PSAPs were nearly as effective as the hearing aid, with average word understanding ranging from 81.4 percent to 87.4 percent. The fifth PSAP performed poorly: People could hear better with their naked ears.

Age-related hearing loss is a common problem, but only about a quarter of the roughly 30 million people who have it use hearing aids, said Nicholas Reed, an audiology instructor at Johns Hopkins School of Medicine who was the study’s lead author.

“That’s a lot of people who aren’t getting in through the door,” he said.

Cost is a deciding factor for many consumers. Medicare doesn’t cover hearing aids, nor do most private health insurance plans.

Identical versions of the bipartisan Over-the-Counter Hearing Act of 2017 were introduced in the House and Senate this year. The text of those bills has been added as an amendment to the FDA Reauthorization Act of 2017, a bill that is key to FDA operations because it sets the government’s system for collecting fees during the drug approval process.

Not surprisingly, hearing aid manufacturers and distributors are against the bill. So are gun owners, who claim that regulating hearing amplifiers, which some hunters use to detect game, is in effect a way to regulate hunting and undermine their Second Amendment rights.

Reed said that by requiring the FDA to issue regulations on over-the-counter hearing aids, the proposed amendment would improve the products sold. Many of them, he said, are not effective and some are dangerous because there’s no control over amplification levels.

“When it gets to a certain amplification, it will just blow your hearing out,” he said. “Over-the-counter hearing measures would regulate these devices and force them to meet standards.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Health Industry, Insuring Your Health, Public Health

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Trump Plan Might Cut Expenses For Some Insured Patients With Chronic Needs

Erin Corbelli takes three medications to treat high blood pressure, depression and an anxiety disorder. Her health plan covers her drugs and specialist visits, but Corbelli and her family must pay a $3,000 annual deductible before the plan starts picking up any of that tab.

Corbelli’s insurance is linked to a health savings account so that she and her husband can put aside money tax-free to help cover their family’s drug and medical expenses. But there’s a hitch: Plans like theirs can’t cover any care for chronic conditions until the deductible is satisfied.

Those out-of-pocket expenses could shrink under a Trump administration draft executive order that would change Internal Revenue Service rules about what care can be covered before the deductible is met in plans linked to health savings accounts, or HSAs.

“It would save us a lot of money,” said Corbelli, 41, who lives in Orlando with her husband and their two children, ages 3 and 5.

Michelle AndrewsInsuring Your Health

Health plans with deductibles of thousands of dollars have become increasingly commonplace. Plans often cover services like generic drugs or doctor visits before consumers have satisfied their deductibles, typically requiring a copayment or coinsurance rather than demanding that consumers pony up the entire amount.

But plans that link to health savings accounts have more restrictions than other high-deductible plans. In addition to minimum deductibles and maximum HSA contribution limits, the plans can’t pay for anything but preventive care before consumers meet a deductible. Under current IRS rules, such preventive care is limited to services such as cancer screenings and immunizations that prevent a disease or condition, called “primary prevention.” With HSA-eligible plans, medical services or medications that prevent an existing chronic condition from getting worse or prevent complications from occurring — called “secondary prevention” — can’t be covered before the deductible is paid.

The Trump administration’s draft executive order, which was first obtained last month by The New York Times and has yet to be issued, would allow such secondary preventive services to be covered.

Under the Affordable Care Act, most health plans, including HSA-eligible plans, are required to cover services recommended by the U.S. Preventive Services Task Force without charging consumers anything for them. That requirement is generally limited to primary prevention.

“We know health savings accounts are here to stay and we’d like to make them better,” said Dr. A. Mark Fendrick, an internist who is director of the University of Michigan’s Center for Value-Based Insurance Design and who has advocated for the change.

If people have diabetes, for example, they need regular eye and foot exams to prevent complications such as blindness and amputations down the road. But HSA plans can’t pay anything toward that care until people satisfy their deductible. “The executive order gives plans the flexibility to do that,” he said.

Similarly, it’s critical to remove obstacles to treatment for people like Corbelli with high blood pressure or heart disease, said Sue Nelson, vice president for federal advocacy at the American Heart Association.

“For people with cardiovascular disease, affordability is their No. 1 concern,” Nelson said.

The draft executive order is short on details, and administration officials would have to determine which new preventive services should be covered pre-deductible. Guidelines from medical specialty boards and quality metrics that many physicians are already being measured against could be used, said Roy Ramthun, president and founder of HSA Consulting Services who led the Treasury Department’s implementation of the HSA program in the early 2000s.

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Back then, they took a conservative approach. “We said we can be more flexible later, but we can’t put the genie back in the bottle,” said Ramthun, who supports expanding preventive services coverage.

Many more employers would offer HSA-eligible plans if the list of services that could be covered pre-deductible were expanded, said Tracy Watts, a senior partner at human resources consultant Mercer. Fifty-three percent of employers with 500 or more workers offer HSA-eligible plans, according to Mercer survey data. Three-quarters of employers put money into their employees’ HSA accounts, she said.

Erin Corbelli’s husband’s employer contributes up to $1,500 every year to their health savings account, which can help cover their pre-deductible costs.

Not everyone is so fortunate. “You’re kind of at the mercy of what your employer can offer and what your disposable income is,” she said.

Republicans have long advocated for the expanded use of health savings accounts as a tax-advantaged way for consumers to get more financial “skin in the game.”

Consumer advocates have been much less enthusiastic, noting that the accounts typically benefit higher-income consumers who have cash to spare.

Still, given the reality of the growing prevalence of high-deductible plans, with or without health savings accounts, it’s a sensible proposal, many say.

“This is not a silver bullet or a solution to the problems that high-deductible plans can pose,” said Lydia Mitts, associate director of affordability initiatives at Families USA, an advocacy group. “But this is a good step in thinking about how we offer access to treatment people need in a timely and affordable way.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Cost and Quality, Insurance, Insuring Your Health

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Unpaid Premiums? Switching Plans? What Changes Are Coming For 2018 Coverage

People are anxious about what’s going to happen with marketplace coverage next year. Even if Republicans succeed in passing a bill to replace the Affordable Care Act, the marketplaces will offer plans this fall for 2018 coverage. Below I explain some of the important changes that are in the works that could affect consumers’ enrollment and coverage next year.

Q: I stopped paying for my marketplace plan at the end of June because I couldn’t afford the premiums. Will I have trouble this fall when I try to sign up for a new plan?

You could run into roadblocks. The Trump administration is giving insurers leeway next year to demand payment for unpaid premiums during the previous 12 months before allowing consumers to enroll (see page 18349) in one of the insurer’s plans again.

The Affordable Care Act gives consumers who are receiving premium tax credits a “grace period” of three months to catch up if they fall behind on premiums. Under current regulations, if they don’t make up the payments in three months, insurers can cut off consumers’ coverage after the first month and aren’t responsible for paying any claims that are pending after that.

Michelle AndrewsInsuring Your Health

But insurers complained that the rules encouraged consumers to game the system by halting their premium payments late in the year, hoping that they wouldn’t need care. Then they’d re-enroll the following year, thus saving up to two month’s worth of premiums without any penalty for the months that they didn’t pay.

There are many reasons why people might drop coverage during the year, including the one you describe – that they’re unable to afford it. According to a McKinsey & Company study, roughly 1 in 5 people who bought a marketplace plan in 2015 stopped paying it at some point during the year. Forty-nine percent of those people repurchased the same plan in 2016.

Insurers aren’t required to adopt the administration’s new approach and states can prohibit them from doing so if they wish.

The new rule for paying back premiums only applies if you want to buy a plan from the same insurer. If you switch insurers you can’t be denied a new plan because you owe premiums to another company.

Insurers have to notify consumers of their policy in enrollment applications and nonpayment notices. But, even so, consumer advocates expect changes to cause confusion among consumers. Further, there’s no mechanism in the new rule for consumers like you to contest a bill from an insurer for unpaid premiums that you don’t believe you owe.

“Insurers are certainly going to try to collect everything they can,” said Timothy Jost, an emeritus professor of law at Washington and Lee University who’s an expert on the health law.

To avoid problems next year, make sure to call your insurer and cancel your current coverage before your 90-day grace period ends at the end of September, consumer advocates say.

Q: What happens if I sign up for a marketplace plan this fall and find out in January when I start using it that it’s not a good plan for me? Can I switch?

Probably not. Unless you get married, have a baby or experience some other event that qualifies you for a special enrollment period, you’ll have to stick with the same plan you chose during the open enrollment period, which will run for six weeks this fall from Nov. 1 – Dec. 15.

Last year, people had more wiggle room to switch plans in January and February, since the open enrollment period ran for three months, from Nov. 1 until Jan. 31.

Consumer advocates are concerned that consumers, many of whom wait to sign up for coverage until the end of the open enrollment period, might miss their window of opportunity this year.

In previous years when computer or other glitches slowed down the open enrollment process, the

Obama administration allowed people more time to sign up, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.

“The administration should be prepared to extend the open enrollment period” this year as well, Lueck said. But don’t count on it.

Q: With all the uncertainty in the marketplaces, why not just buy a short-term plan that covers me up to $1 million? I know they’re not as comprehensive as exchange plans but they’re a lot cheaper.

The low premium may be tempting, but be careful what you wish for, say experts. If you have a pre-existing medical condition like high blood pressure or diabetes, insurers may simply decline to sell you a policy at all, or sell you one that doesn’t cover any medical expenses related to that condition.

Once you have the plan, chances are you won’t be able to renew it if you actually get sick, because unlike regular coverage short-term plans aren’t guaranteed renewable.

Then there’s the fine print. “A lot of the plans have hidden exclusions or caps on specific services that may come back and bite you,” said Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms. “When you read it through, it may say it will cover an appendectomy up to $2,500, or it will cover each day in the hospital up to $300.”

Since short-term plans don’t count as “minimum essential coverage” under the Affordable Care Act, you could owe a penalty for not having health insurance. For all the talk of repeal, that’s still the law of the land.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, Repeal And Replace Watch, The Health Law

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GOP Seeks To Sweeten Health Savings Account Deals. Will Consumers Bite?

A growing number of employers are offering workers insurance that links to health savings accounts, and now congressional Republicans want to expand the contribution limits and uses for these tax-exempt funds. But do consumers want them?

A new study found that fewer than half of people with health savings accounts (HSAs) deposited any money in them in 2016. The average total account contribution, including both employer and employee deposits, was $2,922, significantly lower than the maximum allowable contribution for family coverage ($6,750) or individuals ($3,350), according to the study.

Republicans would like to expand the use of health savings accounts and promote them as a way to help consumers play a larger role in controlling their health spending. Plus, they say, the tax advantages of HSAs help consumers afford their care. But the latest study suggests that current legislative proposals may miss the mark.

“If your goal is to increase the number of people with HSA-eligible health coverage and thus HSAs, simply increasing the contribution limits isn’t going to get you there,” said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute and the author of the report.

Michelle AndrewsInsuring Your Health

Only 13 percent of account holders contributed the maximum amount, Fronstin said.

Money that employees contribute to a health savings account doesn’t count as taxable income, and interest and other earnings in the accounts grow tax-free. In addition, to remain nontaxable, the funds must be used to pay for medical expenses, such as doctor or hospital care, dental services and prescriptions. The accounts must be paired with a health plan that has a deductible of at least $1,300 for individual coverage and $2,600 for family coverage.

Both employers and employees can contribute to the accounts, and the money belongs to the employee if he leaves his job.

People with coverage on the individual market who buy a plan that meets federal HSA standards can also open and fund health savings accounts.

In 2016, 20 million people were enrolled in high-deductible health plans with a health savings account, according to America’s Health Insurance Plans, an industry group.

Republicans have proposed to increase the limit on health savings account contributions to equal the deductible and out-of-pocket spending limit starting next year, or at least $6,550 for individuals and $13,100 for families. Their bills would also allow spouses to make catch-up contributions to the same health savings account and let people use funds from their health savings accounts to pay for over-the-counter medications, among other things.The bill being advanced by Senate Majority Leader Mitch McConnell (R-Ky.) also would allow beneficiaries to use their account to pay premiums.

Critics charge that expanding health savings accounts will provide little benefit to lower-income people who have no spare cash to fund them.

The EBRI analysis is based on its database of 5.5 million health savings accounts with $11.4 billion in assets, representing 27 percent of all HSAs. The EBRI study found that roughly two-thirds of account holders withdrew funds that totaled an average annual $1,771 in 2016.

People’s account balances grew over time, the study found. Accounts opened in 2016 had an average balance of just over $1,000, while those opened in 2004 had an average balance of nearly $15,000. Since most people don’t have high health care expenses in any given year, they can build up balances over time, Fronstin said, and people also might contribute more as they learn how the accounts work.

“The longer you’ve had the account, the better you understand the tax benefits and understand the value of making a contribution,” he said.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, Repeal And Replace Watch, The Health Law

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