Lyme disease, caused by the spirochetal bacterium, Borrelia burgdorferi sensu lato (Bbsl), is typically transmitted by hard-bodied ticks (Acari: Ixodidae). Whenever this tick-borne zoonosis is mentioned in medical clinics and emergency rooms, it sparks a firestorm of controversy. Denial often sets in, and healthcare practitioners dismiss the fact that this pathogenic spirochetosis is present in their area. For distribution of Bbsl across Canada, we conducted a 4-year, tick–host study (2013–2016), and collected ticks from avian and mammalian hosts from Atlantic Canada to the West Coast. Overall, 1265 ticks representing 27 tick species belonging to four genera were collected. Of the 18 tick species tested, 15 species (83%) were positive for Bbsl and, of these infected ticks, 6 species bite humans. Overall, 13 of 18 tick species tested are human-biting ticks. Our data suggest that a 6-tick, enzootic maintenance cycle of Bbsl is present in southwestern B.C., and five of these tick species bite humans. Biogeographically, the groundhog tick, Ixodes cookei, has extended its home range from central and eastern Canada to southwestern British Columbia (B.C.). We posit that the Fox Sparrow, Passerella iliaca, is a reservoir-competent host for Bbsl. The Bay-breasted Warbler, Setophaga castanea, and the Tennessee Warbler, Vermivora peregrina, are new host records for the blacklegged tick, Ixodes scapularis. We provide the first report of a Bbsl-positive Amblyomma longirostre larva parasitizing a bird; this bird parasitism suggests that a Willow Flycatcher is a competent reservoir of Bbsl. Our findings show that Bbsl is present in all provinces, and that multiple tick species are implicated in the enzootic maintenance cycle of this pathogen. Ultimately, Bbsl poses a serious public health contagion Canada-wide. Full article

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.
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.
Insurance companies are not allowed to have co-payments, caps, or deductibles, or to deny coverage to any person applying for a policy, or to charge anything other than their nationally set and published standard premiums. Therefore, every person buying insurance will pay the same price as everyone else buying the same policy, and every person will get at least the minimum level of coverage.
Health insurance costs vary in many ways. Deductibles, premiums, and copayments all play into what your health insurance costs will come out to. eHealth studies have shown that in 2018 the average individual premium was $393 without any subsidies. By comparing quotes, and speaking with a licensed agent, you might be able to find prices significantly lower than this, that still meet your needs. Taking the time to shop around and compare can make a huge difference in what you’re paying for your health insurance.
eHealth is a free service, with an A+ rating from the Better Business Bureau, providing easy-to-use-and-understand plan finders and comparison tools. Plans sold through eHealth won't cost more than if you buy directly from one of our providers. eHealth will recommend plans that are best suited to your needs and budget, whether it's during the annual open enrollment period or if you have a qualifying life event. In certain states, eHealth can even help you apply for the Affordable Care Act tax credit offered by the government. eHealth is proudly invested in helping you with all your medical insurance questions and concerns, including:
 An important note about Avera Health in South Dakota. Avera Health declined to renew our contract to offer their ACA plans in 2019. When we inquired as to why, we received this reply on 10/18/18: “RVers… I am sorry, but a narrow network product does not fit well for the members. We want to be able to take care of our members when they have an accident or illness. We do not have any providers or facilities outside of SD and NW Iowa, which makes us not the best fit for RVers.” While we agree that their plans are not a great fit for RVers, it seems it should be left to the members to decide if they are willing to risk traveling with their coverage. Nevertheless, it looks like RVers are not welcome to enroll with Avera Health for 2019.
The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.[5] This includes professionals in medicine, psychology, physiotherapy, nursing, dentistry, midwifery and allied health, along with many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive, curative and rehabilitative care services.
The term "secondary care" is sometimes used synonymously with "hospital care." However, many secondary care providers, such as psychiatrists, clinical psychologists, occupational therapists, most dental specialties or physiotherapists do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care.
(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.

The status of the individual mandate was very much in question. Even if the ACA repeal bills weren't successful, insurers didn't know if the IRS would continue to enforce the mandate. And even if they did, there was uncertainty over whether the public would perceive that the mandate wasn't being enforced, which could lead to fewer healthy people purchasing coverage.
Many countries, especially in the west are dealing with aging populations, so one of the priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home such as transportation to and from doctor's appointments along with many other activities that are essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents a challenge for the design of ICT (information and communication technology) for home care.[16]

It’s true that there will be more loosely-regulated coverage options available in 2019, thanks to the expansion of short-term plans, association health plans, and state-based alternatives to ACA-compliant plans. And there will no longer be a direct penalty for relying on those types of coverage. But they all have drawbacks, so read the fine print carefully if you’re considering them.
Few factors bear as heavily on the well-being of any state’s citizens as their overall quality of health. In evaluating the Best States for health care, access to preventative medical and dental treatment for children and adults alike is a key consideration. Since adoption of the Affordable Care Act of 2010, also known as “Obamacare,” the percentage of Americans without health insurance has reached a record low, falling below 10 percent. The measure has been politically controversial since its inception, and the Republican-run Congress and President Donald Trump have vowed to repeal Obamacare. A rollback of the law's mandate that everyone have coverage – either through employers or public health care programs – or pay a tax penalty passed in late 2017, posing challenges to millions who have found insurance under the law.
There are fewer than 16 million people enrolled in individual market health insurance in the United States. That amounts to less than 5 percent of the U.S. population. So, although the vast majority of Americans get their health insurance either from an employer or from a government-run program (Medicare, Medicaid, CHIP, the VA, etc.), the headlines that you're seeing don't tend to have anything to do with those plans. Instead, the headlines tend to refer to the individual market.

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%.
Can anyone address the elephant in the room: as medical therapeutics change and biologics are available and more appropriate for various conditions it is noteworthy to realize that these costs are often not covered by many government insurers and not eligible for foundations grants (as are sometimes offered in the form of copay cards, or copay assistance). I’m talking 20% out of pocket cost for a biologic can run 1500-2000 out of pocket after insurance. If you happen to get one of these rheumatologic or immunologic diseases, Medicare is NOT going to cut it. Are people folding in these possibilities into their projected costs in retirement. How does the FIRE community think about these things (I mean the medical FIRE community…I don’t think the non-medical FIRE community is even aware of these nuances unless they’re already dealing with a chronic or rare disease under treatment).
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To clarify a small point, some high deductible (as high as $10,000 for family) plans that would be considered by many as “catastrophic plans” have been available AND Obamacare compliant. The compliance rules relate to the out of pocket maximum and other benefits rather than the deductible per se. furthermore, these plans are not necessarily cheap at all as many will tell you. I would not count on a huge break/savings once the Obamacare rules for Heath plans are no longer in play.
In the United States, primary care physicians have begun to deliver primary care outside of the managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine. Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington.
That will continue to be the case in 2019, and the disproportionately large subsidies will be available in more places (for example, Vermont and North Dakota didn’t allow insurers to add the cost of CSR to premiums for 2018, but are allowing them to add the cost to silver plan rates for 2019, resulting in much larger premium subsidies. Colorado and Delaware required insurers to spread the cost of CSR across premiums for all plans in 2018, but are allowing the cost to be added only to silver plans for 2019, resulting in larger premium subsidies). So don’t pass up the opportunity to get a subsidy! Even if you’ve checked your eligibility before, make sure you do so again for 2019. As the poverty level rises each year, the income cap on subsidy eligibility also rises; it will be above $100,000 for a family of four in 2019.
There are also some states where insurers that are expanding their existing coverage areas, including Kentucky and Colorado. But that’s not the case everywhere. Some insurers in Washington, for example, are reducing their coverage areas. And in Georgia, Anthem is simultaneously reducing the number of counties where they’ll offer plans, but increasing the number of people who will be eligible for their plans (by exiting numerous rural counties and rejoining almost as many populous counties)
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