On October 31st, Medicare announced that it is considering paying doctors for having conversations about end-of-life options with their patients.

This statement followed a New York Times article in August reporting that the American Medical Association (AMA) has created billing codes for end-of-life conversations and submitted them to Medicare for consideration. That in and of itself is significant, although not a guarantee that Medicare will reimburse physicians for this activity. Many private insurers and some states, including Colorado and Oregon, already reimburse doctors for these “advance care planning” conversations.

While many doctors have informal conversations with their Medicare patients about their end-of-life wishes, and encourage them to complete advance directives (also known as health care powers of attorney), this proposed change to Medicare would formalize the process and reimburse doctors for the time they spend.

If the codes for reimbursement submitted to the AMA in August are accepted, Medicare might begin covering end-of-life discussions as early as 2016.

“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the AMA committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

As people are living longer, many want to play a more active role in these decisions about the kind and amount of care they receive at the end of their lives.

Most of us probably don’t think of window shopping for health insurance, but starting November 10th, that’s exactly what people can do on HealthCare.gov. Even though the federally managed public health insurance exchange doesn’t open for business until November 15th, it’s available now for visitors to browse.

In addition to being able to sort plans by price and plan category or “tier,” visitors also can filter plans based on the level of coverage for common conditions such as asthma, heart disease, depression, diabetes and more. Providing the ability to quickly sort through plans in these ways will likely aid people in picking plans that best suit their needs.

Visitors to HealthCare.gov are initially prompted to enter their ZIP code. People who live in states that do not run their own exchanges can proceed through prompts asking about the number of people in their household and household income to determine their eligibility for subsidies or Medicaid. Once that has been determined, they are free to browse the federal site. Those who live in states with their own exchanges, such as Covered California or Minnesota’s MNSure, are redirected to those sites.

These should streamline the process of evaluating and selecting plans on the site this year.

The open enrollment period runs from November 15, 2014 – February 15, 2015.

Health Insurance Literacy

November 4, 2014

A recent national survey by the American Institute for Research (AIR) tackled the challenge of measuring Americans’ “health insurance literacy.” AIR defines health insurance literacy as:

“The degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own—or their families’—financial and health circumstances, and use the plan once enrolled.”

This is a mouthful, but simply put, health insurance literacy means having the knowledge and technical know-how to select and use the best and most affordable health plan that meets your needs.

The Affordable Care Act empowers individuals to be their own health care advocates, their own price checkers, their own quality control measurers. This makes being health insurance literate an essential skill, but it’s not one that can be acquired overnight.

A startling statistic from AIR reveals just how unprepared many people are to manage their own health care coverage choices. Three out of four Americans surveyed said they believe they know how to use health insurance, but just one in five could correctly calculate how much they would owe for a routine doctor’s visit.

The 2013 AIR survey was completed by 828 people aged 22 to 64 who were uninsured, privately insured or had Medicaid.

AIR breaks health insurance literacy into four main areas: knowledge, information seeking, document literacy, and cognitive skills.

Knowledge means knowing insurance terms and concepts, such as the definition of a premium (paying for insurance that protects against an unforeseen medical event). It also includes understanding types of healthcare services and enrollee rights.

Information Seeking is the ability to find unknown information and distinguish between credible and not credible sources of information. Examples include locating eligibility requirements and navigating health care or insurer websites.

Document Literacy is the ability to understand and follow directions, fill out forms, and follow schedules, such as provider or drug tier schedules. These are the basic mechanics of applying for insurance.

Cognitive Skills are required to accurately assess one’s own preventative care needs (called “wellness”) and personal risk factors. Key skills include being able to calculate out-of-pocket costs, assess value, and formulate questions.

All of these four areas come together, according to AIR, to comprise “self-efficacy,” which is the ability to perform the tasks, such as correctly filling out forms, asking the right questions, and assessing one’s own health needs, “with confidence.”

Some of these skills come with age, as evidenced by the following chart (Exhibit 3), taken from the AIR survey report:

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Those who are young and or have never had health insurance before face a steeper learning curve, but the report also showed that knowledge and skills increase with use (Exhibit 4).

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For more on health insurance literacy, including a checklist to help consumers pick the right plan, click here for the full AIR report.