Bärnighausen, Till; Sauerborn, Rainer (May 2002). "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low income countries?" (PDF). Social Science & Medicine. 54 (10): 1559–87. doi:10.1016/S0277-9536(01)00137-X. PMID 12061488. Retrieved 10 March 2013. As Germany has the world's oldest SHI [social health insurance] system, it naturally lends itself to historical analyses.
When you purchase coverage during open enrollment, the effective date will be January 1, 2019. If you already have an individual market plan and you’re picking a different one during open enrollment, your current plan will end on December 31 (assuming you continue to pay all of your premiums when they’re due) and the new plan will take effect seamlessly the following day.

Then you may want to consider alternatives to ACA coverage like the HSA 5000, Premier Plans, Fixed-Benefit or AlieraCare. All of these alternatives give you nationwide coverage. There are very few ACA plans that will give you this nationwide coverage for anything other than a medical emergency. There are NONE in Arizona, South Dakota, or Texas (popular RVer domicile states). Florida Blue* remains a good ACA option for Florida residents that still allows members to use the national Blue Cross Blue Shield network when traveling outside of Florida.


Probably not a surprise since we’re talking health insurance, but there really isn’t a great one-stop-shop. Insurance is regulated at the State level so insurers and plans will vary. I’d start with checking the major health insurers directly (Aetna, UnitedHealthcare, Anthem and Cigna) as they operate in many states. But there could be small insurers that offer CAT plans in your state as well so Google searching might be a good resort to find specific plans in your State (and buying them direct from the insurer). Wish I could be more helpful here.
Probably not a surprise since we’re talking health insurance, but there really isn’t a great one-stop-shop. Insurance is regulated at the State level so insurers and plans will vary. I’d start with checking the major health insurers directly (Aetna, UnitedHealthcare, Anthem and Cigna) as they operate in many states. But there could be small insurers that offer CAT plans in your state as well so Google searching might be a good resort to find specific plans in your State (and buying them direct from the insurer). Wish I could be more helpful here.
So we can expect a slight decline in the value of premium subsidies in 2019, on the heels of two consecutive years when average premium subsidy amounts increased significantly. But the cost of your specific health insurance policy could go up or it could go down, depending on whether you receive a premium subsidy (most exchange enrollees do, but everyone who enrolls outside the exchange pays full price), and how much your plan's price is changing.
Bärnighausen, Till; Sauerborn, Rainer (May 2002). "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low income countries?" (PDF). Social Science & Medicine. 54 (10): 1559–87. doi:10.1016/S0277-9536(01)00137-X. PMID 12061488. Retrieved 10 March 2013. As Germany has the world's oldest SHI [social health insurance] system, it naturally lends itself to historical analyses.
As it turns out, both sets of the headlines are true—in some areas, premiums are going down for a variety of reasons. But in most areas, premiums are also going to be higher than they might otherwise have been without various government decisions. Let's sort through all the noise and figure out what's really happening to your health insurance premiums.
Nice discussion, Green Swan. One concern I have for young early retirees is that medical conditions accumulate as you and your family age. So, in the case of our host, PoF, in his early 40’s, he might be currently well served by a catastrophic plan. Ten years, fifteen years, from now, he and his wife might have some medical baggage that needs medication or maintenance, and the cat plan may not serve him well.
The Medical Loss Ratio (MLR) was put in place under the Affordable Care Act, with the purpose of ensuring health providers offer value to their members. The Medical Loss Ratio is scored from 0% to 100%, and measures the amount of money from member premiums spent by health insurers on members’ claims rather than overhead costs. For example, if a health insurance company allocates $0.90 of every dollar to cover medical claims, and the remaining $0.10 to cover overhead costs, the MLR score for that insurer would be 90%.
The UK's National Health Service (NHS) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8)[39] are met directly from general taxation. The NHS provides the majority of health care in the UK, including primary care, in-patient care, long-term health care, ophthalmology, and dentistry.

If you suffer an injury or illness, individual health insurance can help pay for the cost of health care. Health insurance can also help pay for a wide range of medical services including medical emergencies, routine doctor's appointments, preventative care, prescription drugs, and inpatient/outpatient treatment. You'll typically pay a monthly premium, plus a deductible or copayment.
Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in human beings. Healthcare is delivered by health professionals (providers or practitioners) in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of healthcare. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.
Do your wife’s retiree health benefits provide for the option to buy insurance through the employer or actually help cover some of the cost as well? Either or, that’s an awesome option you folks have that very few folks are offered. My employer would offer retiree health insurance in a similar situation as your wife, but I’d have to pay the cost full-freight so I don’t think it would be a great option for us (plus 55 is still a long ways off for me).
The new CMS rules, titled in true Trump fashion, “Final 2019 Payment Notice Rule To Increase Access To Affordable Health Plans For Americans Suffering From High Obamacare Premiums,” could potentially save you from paying a tax penalty this year. The new rule provides exemptions to residents living in counties where no health insurance companies offer coverage, or only one insurer offers coverage. The rule also states that those living in counties where the only available health insurance plans cover abortion can also be exempt from a tax penalty for 2018 if it goes against their religious beliefs.

The new CMS rules, titled in true Trump fashion, “Final 2019 Payment Notice Rule To Increase Access To Affordable Health Plans For Americans Suffering From High Obamacare Premiums,” could potentially save you from paying a tax penalty this year. The new rule provides exemptions to residents living in counties where no health insurance companies offer coverage, or only one insurer offers coverage. The rule also states that those living in counties where the only available health insurance plans cover abortion can also be exempt from a tax penalty for 2018 if it goes against their religious beliefs.
Hi reader in the U.S., it seems you use Wikipedia a lot; that's great! It's a little awkward to ask, but this Thursday we need your help. If you have already donated, we sincerely thank you. We’re not salespeople, but we depend on donations averaging $16.36 and fewer than 1% of readers give. If you donate just $2.75, the price of your coffee this Thursday, Wikipedia could keep thriving. Thank you.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (800-633-4227). TTY or TDD users should call 877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY or TDD users should call, 800-325-0778; or Your State Medical Assistance (Medicaid) Office.
The UK's National Health Service (NHS) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8)[39] are met directly from general taxation. The NHS provides the majority of health care in the UK, including primary care, in-patient care, long-term health care, ophthalmology, and dentistry.
The Medical Loss Ratio (MLR) was put in place under the Affordable Care Act, with the purpose of ensuring health providers offer value to their members. The Medical Loss Ratio is scored from 0% to 100%, and measures the amount of money from member premiums spent by health insurers on members’ claims rather than overhead costs. For example, if a health insurance company allocates $0.90 of every dollar to cover medical claims, and the remaining $0.10 to cover overhead costs, the MLR score for that insurer would be 90%.
Nurse leaders in middle management positions in Norway and other Western countries perform additional new tasks due to high demands for quality and efficacy in healthcare services. These nurses are increasingly becoming responsible for service development and innovation in addition to their traditional leadership and management roles. This article analyses two Norwegian nurse leaders efforts in developing an emergency service in rural municipal healthcare. The analysis applies an ethnographic approach to the data collection by combining interviews with the nurse leaders with observations and interviews with six nurses in the emergency service. The primary theoretical concepts used to support the analysis include “organizing work” and “articulation work”. The results show that in the development of an existing emergency room service, the nurse leaders drew upon their experience as clinical nurses and leaders in various middle management positions in rural community healthcare. Due to their local knowledge and experience, the nurses were able to mobilize and facilitate cooperation among relevant actors in the community and negotiate for resources required for emergency medical equipment, professional development, and staffing to perform emergency care within the rural healthcare context. Due to their distinctive professional and organizational competency and experience, the nurse leaders were well equipped to play a key role in developing services. While mobilizing actors and negotiating for resources, the nurses creatively balanced these two aspects of nursing work to develop the service in accordance to their expectation of providing the highest quality of nursing care to their patients. The nurse leaders balanced their professional ambitions for the service with legal directives, economic incentives, and budgets. Throughout the development process, the nurses carefully combined value-based and goal-based management concerns. In contrast, other studies investigating nursing management and leadership have described that these orientations are in opposition to each other. This study shows that nurses leading the processes of change in rural communities manage the change process by combining the professional and organizational domains of the services. Full article
Colombians report little to no confidence in judges, the formal legal system and their rights. And yet they continue to file tutela claims. I conducted research in Colombia between July 2016 and May 2017 to investigate this, interviewing 90 lawyers, judges, government officials and service providers, as well as 93 everyday citizens from various class backgrounds. I also surveyed 310 Colombians who were in the process of filing tutela claims. I concluded that citizens view the tutela as the only mechanism through which they can make claims to things they care about, such as health care. Colombians turn to the courts because they see no other alternative, not because of their robust belief in the courts.
The UK's National Health Service (NHS) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8)[39] are met directly from general taxation. The NHS provides the majority of health care in the UK, including primary care, in-patient care, long-term health care, ophthalmology, and dentistry.
Australian health funds can be either 'for profit' including Bupa and nib; 'mutual' including Australian Unity; or 'non-profit' including GMHBA, HCF and the HBF Health Fund (HBF). Some, such as Police Health, have membership restricted to particular groups, but the majority have open membership. Membership to most health funds is now also available through comparison websites like moneytime, Compare the Market, iSelect Ltd., Choosi, ComparingExpert and YouCompare. These comparison sites operate on a commission-basis by agreement with their participating health funds. The Private Health Insurance Ombudsman also operates a free website which allows consumers to search for and compare private health insurers' products, which includes information on price and level of cover.[9]
ageing, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control, conception, sexual problems and sex changes; chronic conditions; complications from excluded or restricted conditions/ treatment; convalescence, rehabilitation and general nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc); dialysis; drugs and dressings for out-patient or take-home use† ; experimental drugs and treatment; eyesight; HRT and bone densitometry; learning difficulties, behavioural and developmental problems; overseas treatment and repatriation; physical aids and devices; pre-existing or special conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems and disorders; speech disorders; temporary relief of symptoms.[40] († = except in exceptional circumstances)
Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK. Full article
Sure enough, in the spring and early summer of 2018, when insurers began filing their proposed rates for 2019, the elimination of the individual mandate was almost universally listed as a factor driving up premiums. Even in cases where the insurer had proposed an overall rate decrease, they generally noted that rates would be decreasing even more if the mandate penalty wasn't being eliminated.
Employer-sponsored group health insurance plans first emerged in the 1940s as a way for employers to attract employees when wartime legislation mandated flattened wages. This was a popular tax-free benefit which employers continued to offer after the war’s end, but it failed to address the needs of retirees and other non-working adults. Federal efforts to provide coverage to those groups led to the Social Security Amendments of 1965, which laid the foundation for Medicare and Medicaid. These government-sponsored health plans continue to provide care to those left out of employer-sponsored group health insurance plans. As national health expenditures have climbed past 15 percent of gross domestic product (GDP), the Affordable Care Act of 2010 substituted a nationwide mandate that each taxpayer join a group plan for the sort of single-payer solution that has faced stiff opposition since the 1930s.

A child may be covered by a parent’s health care plan per Affordable Care Act (ACA) regulations through age 25, regardless of whether the child is a dependent for tax purposes; however, under separate IRS regulations, a parent’s HSA funds cannot be used to reimburse for a child’s health expenses unless the child is claimed as a dependent on the parent’s tax return.
HealthCare.gov includes a Find Local Help tool that allows you to easily search for approved brokers and navigators in your area. You’ll be able to select from “assisters” (navigators and enrollment counselors) or agents/brokers. Navigators and enrollment counselors can help you with the logistics of the enrollment process, but they cannot make plan recommendations.
Humana individual dental plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Benefit Plan of Louisiana, Inc., or DentiCare, Inc. (DBA CompBenefits). Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. For Arizona residents: Insured by Humana Insurance Company. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits).
(US specific) Provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor (USDOL). The specific benefits or coverage details are found in the Summary Plan Description (SPD). An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the USDOL to review for ERISA compliance, and then file a lawsuit in federal court.

News Flash: The health insurance landscape has changed. Individuals who once could buy health insurance whenever they wanted are now forced to act like traditional company employees, and only enroll in a health insurance plan during an annual open enrollment period. However, life can throw curve balls, and leave an individual without health insurance outside…
Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
Co payments were introduced in the 1980s in an attempt to prevent over utilization. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the United States (5 to 6 days).[27][28] Part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days as opposed to procedures or diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).[29]
This year’s enrollment period offers good news to many Americans. After two years of carriers leaving markets and steep rate increases, states are seeing carriers re-enter exchanges for 2019 – and average rate increases are smaller than they were in 2017 and 2018.  And, although premium subsidies will be slightly decreased in 2019 (though not in all states), those eligible for cost-sharing reductions will continue to receive them.
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