The Affordable Care Act, also known as Obamacare, is still making headlines and causing confusion. But after two years of carriers exiting markets and fairly steep rate increases, we’re seeing an influx of carriers joining the exchanges for 2019 — or rejoining, after a previous exit — and average rate increases that are substantially smaller than they were for 2017 and 2018.
State-run marketplaces / exchanges have more flexibility in terms of when they make new plans available for browsing. For example, Your Health Idaho, the state-run exchange in Idaho, debuted window-shopping for 2018 plans on October 2, 2018, nearly a month before the start of open enrollment, just as they did the year before. And Covered California is starting their open enrollment period (not just window shopping) two weeks early, on October 15. This will be the schedule they use in future years as well.
Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician.[10]
Thanks for the post. My wife and I have achieved FI and are exploring when we can retire (she is only working part time now). My biggest challenge is that I have a chronic leukemia that requires medication for life (fortunately I am in remission but still need to take medicine daily). What surprised me the most when searching for health plans on the exchanges, was the lack of hospitals and doctors in the plans. I live in Houston and none of the major hospitals in the medical center are in the market place plans. So if I quit my job I would loose access to the specialist that I have seen for almost 7 years now. I’ve thought of moving to a different state where the plans have access to specific local specialists (of course who knows if the plans in other states will eventually drop those doctors). But for now I feel a bit stuck in my job if I want to visit the doctor and have access to the medical facility that I am so familiar and comfortable with.
State-run marketplaces / exchanges have more flexibility in terms of when they make new plans available for browsing. For example, Your Health Idaho, the state-run exchange in Idaho, debuted window-shopping for 2018 plans on October 2, 2018, nearly a month before the start of open enrollment, just as they did the year before. And Covered California is starting their open enrollment period (not just window shopping) two weeks early, on October 15. This will be the schedule they use in future years as well.
Objective: This study investigates the feasibility of using the Exemplary Care Scale (ECS) among Chinese dementia familial caregivers, and reports its psychometric properties. Method: Back translation was used to develop the Chinese version of ECS (C-ECS). Three hundred and ninety-seven dyads of caregivers and their relatives with dementia responded to an assessment battery which included questions on care recipients’ cognition, behavioral and psychological symptoms, daily activities assistance, social support, and caregiver well-being. Results: Results of an exploratory principal component analysis revealed two subscales in the 11-item C-ECS: considerate caregiving and preserving esteem. C-ECS and its subscales demonstrated sufficient reliability, as well as criteria-related validity through its association with care recipient’s cognition and health, and caregivers’ well-being and social support. Discussion: Our findings provide preliminary support to C-ECS as a reliable and valid measure of exemplary caregiving among Hong Kong Chinese familial dementia caregivers. In the light of the increasing importance of familial care in dementia care planning, we recommend the use of this brief scale in regular caregiver assessment in research and service delivery. Full article
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There's no single answer that applies to everyone. And sometimes changes that seem uniformly good can actually result in higher premiums for some enrollees. Tennessee is a good example of this: Two new insurers are joining the exchange for 2019, two existing insurers are expanding their coverage area, and two insurers are lowering their prices by double-digit percentages.
That's the market that was most in need of reform before the Affordable Care Act, and it's the market segment that was most heavily affected by the ACA (the small group health insurance market also saw some significant reforms, but not as much as the individual market). Not surprisingly, it's also been the market that has seen the most change over the last several years and has been in the spotlight each year when rate changes are announced.

Here's what might trigger a special enrollment period: divorce, marriage, birth or adoption of a child, death of a spouse or partner that leaves you without health insurance, your spouse or partner who has you covered loses his/her job and health insurance, you lose your job and with it your health insurance, your hours are cut making you ineligible for your employer's health insurance plan, or you are in an HMO and move outside its coverage area.


Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.
For calendar year 2019, Vanderbilt will have two health plan offerings: the Select PPO (Preferred Provider Organization) and the Choice CDHP (Consumer-Driven Health Plan). While the two plans are quite different, they share several important common features. Both plans will continue to use the existing “Tier 1” VHAN (Vanderbilt Health Affiliated Network) and “Tier 2” Aetna network of health care providers, and both provide preventive care at 100 percent coverage. The monthly premium for both plans will continue to be based on a three-tier salary band approach established in 2018 – premiums are adjusted for salary level, and higher-paid employees have higher premiums.
Group health insurance in the United States has evolved during the 20th century. The idea of collective coverage first entered into public discussion during World War I and the Great Depression. Soldiers fighting in the First World War received coverage through the War Risk Insurance Act, which Congress later extended to cover servicemen’s dependents. In the 1920s, healthcare costs increased to the point that they exceeded most consumers’ ability to pay. The Great Depression exacerbated this problem dramatically, but resistance from the American Medical Association and the life insurance industry defeated several efforts to establish any form of a national health insurance system. This opposition would remain strong into the 21st century.
Out-of-pocket maxima: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maxima can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.

Background: Studies evaluating the end-of-life care for longer periods of illness trajectories and in several care places are currently lacking. This study explored bereaved family members’ satisfaction with care during the last three months of life for people with advanced illness, and associations between satisfaction with care and characteristics of the deceased individuals and their family members. Methods: A cross-sectional survey design was used. The sample was 485 family members of individuals who died at four different hospitals in Sweden. Results: Of the participants, 78.7% rated the overall care as high. For hospice care, 87.1% reported being satisfied, 87% with the hospital care, 72.3% with district/county nurses, 65.4% with nursing homes, 62.1% with specialized home care, and 59.6% with general practitioners (GPs). Family members of deceased persons with cancer were more likely to have a higher satisfaction with the care. A lower satisfaction was more likely if the deceased person had a higher educational attainment and a length of illness before death of one year or longer. Conclusion: The type of care, diagnoses, length of illness, educational attainment, and the relationship between the deceased person and the family member influences the satisfaction with care. Full article

The Swiss healthcare system is a combination of public, subsidised private and totally private systems. Insurance premiums vary from insurance company to company, the excess level individually chosen (franchise), the place of residence of the insured person and the degree of supplementary benefit coverage chosen (complementary medicine, routine dental care, semi-private or private ward hospitalisation, etc.).
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

My family currently has a HDHP, which is nearly identical to the catastrophic coverage I had in college. It allows us to invest in an HSA, and actually ends up being less expensive than having “comprehensive” coverage. As far as what will happen in the future, that’s anyone’s guess. I wouldn’t be surprised if some of us can’t collect social security, till our 80’s, and barring a change to a single-payer system, Medicare could conceivably push eligibility out further.


Consumers who are unable to afford ACA-compliant coverage can now purchase short-term coverage with a much longer duration. Federal regulation changes finalized this summer and announced this month will make it possible for many buyers to purchase a short-term plan with an initial duration of nearly a year – with renewal options that allow the plan to remain in force for three years.
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