What Does “Out-of-Pocket Maximum” Mean?

Out-of-pocket maximum (OOPM) is the most you have to pay for covered services in a single year, aside from premiums. Once you reach your out-of-pocket max, your plan pays 100 percent of the allowed amount for covered services. For instance, if you rack up $25,000 in medical bills and your OOPM is $7,000, that’s the […]

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In California, Your Health Plan is Likely Required to Cover Abortions

California law is clear: Abortions are legal, and almost all health plans are required to cover them. That includes all private insurance plans offered by insurers such as Anthem Blue Cross, Kaiser and UHC. Our colleagues at Warner Pacific put together a table with detailed info about each carrier. The only plans that aren’t required […]

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Biden and Democrats Save ACA Subsidy Improvements From Expiring

Great news for Californians and anyone in high-cost urban areas that are on individual and family (IFP) health insurance plans! The Inflation Reduction Act that is on it’s way to Biden’s desk for signature includes a three-year extension of the massive improvements in federal subsidies for IFP health insurance coverage. The increased subsidies make people […]

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Mexico Steps Up to Provide Americans Access to Abortion

Last year, the Mexican Supreme Court decriminalized abortion. Now, as our regressive Supreme Court and cruel Republican politicians work feverishly to restrict abortion in the U.S., Mexico is stepping up to fill the void. Mexican activists are planning to help shuttle Texans and other Americans seeking abortions into Mexico and to build networks to ferry […]

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California Modernizes Medical Malpractice Law

Starting January 1, 2023, Californians who believe they have been harmed by medical malpractice will be able to sue for up to $350,000 for “pain and suffering” (aka non-economic damages), an increase from $250,000, which had been the law since 1975. The cap will increase gradually to $750,000 over the next 10 years, with a […]

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How to Use COBRA to Get Free Catastrophic Health Insurance

You leave your job and your employer offers you continuous coverage through COBRA. Unless you are about to start a new job offering no lapse in coverage when you switch from your old employer’s plan to your new plan, you’re going to need coverage the day COBRA ends. But there’s actually a very cool way […]

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Highly Targeted Cancer Treatment Proves “Stunningly Successful”

Chemotherapy has become increasingly effective in slowing and stopping many cancers, but it is still mainly a broad-brush approach, filling the patient’s body with harmful chemicals to kill only a few cancerous cells. Researchers have been working for decades to develop the next generation of cancer drugs that are much more highly targeted at only […]

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Cannabis Use in the Workplace: Is it Legal?

Alcoholic beverages have long been associated with the workplace, from beer busts for staff to mixed drinks in the boss’ office. But what about cannabis? Now that it’s legal either as a “recreational” or “medical” drug in 39 of the 50 US states, is it ok to be stoned at work? In California, where it […]

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Small Business Deadline for CalSavers is Fast Approaching

The program mandates that almost all California businesses offer a retirement savings payroll deduction option no later than June 30, 2022 Do you have retirement savings? If you don’t, you are hardly alone. 49% of adults ages 55 to 66 had no personal retirement savings in 2017, according to the U.S. Census Bureau’s Survey of Income […]

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Saving Money on Dental Implants by Going to Mexico

What if I told you that you could get a dental implant for $1,500 instead of the going rate in California of $3,500 or more? Would that perk up your ears? The catch: You have to travel to Mexico to get the great rates. Going to Mexico for dental work isn’t new. The cost of […]

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California is Gearing Up to Protect the Right to an Abortion

While it’s horrifying that the Supreme Court seems likely to either completely overturn Roe v. Wade or severely limit its scope, such a decision doesn’t make abortion illegal overnight. Roe made it illegal to write laws banning abortions. Overturning it means states can again make abortion illegal, but it doesn’t stop other states from continuing […]

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A plant-based diet is the best way to avoid heart disease

A report published in the Cardiovascular Research medical journal makes a convincing case that the best way to avoid heart disease is to avoid excess sodium, sugar, trans fat and ultra-processed foods, while eating a diet consisting of vegetables, fruit, whole grains, beans, nuts, fish, eggs, poultry and dairy in their simplest forms, i.e. “whole […]

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Doctors and Hospitals Are Radically Over-Charging for Drugs

The prices that hospitals charge patients and their insurance companies for cancer drugs are often at least double what the hospital paid to acquire the drugs, according to a new study in the prestigious medical journal JAMA: Internal Medicine. In some cases, the hospitals marked the drugs up as much as 7X what it cost […]

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Some Doctors Say Prostate Cancer Is Over-Diagnosed

Some doctors are urging the medical community to stop using the word “cancer” to describe the lowest-grade form of the disease, which is common in men as they age and usually doesn’t lead to a more serious cancer diagnosis. A Gleason 6 score on a prostate cancer biopsy is the lowest score you can get, […]

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Telehealth Gaining Popularity Among Californians

More Californians are receiving care via telehealth than last year, according to an annual survey of healthcare trends by the California Health Care Foundation.  More than half (55%) of survey participants reported receiving care by phone in the last 12 months, an increase from 45% in last year’s poll, and more than 4 in 10 […]

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Finally, A Fix for Covered California’s “Family Glitch”

The Biden Administration is finally going to fix the “family glitch” in the Obamacare subsidy system. Biden doesn’t need Congressional approval – it’s a regulatory process only. Thank goodness – finally, a permanent improvement to the ACA that Congressional Republicans can’t sabotage. The family glitch is this: If an employee and their family are offered […]

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Californians may lose millions of dollars in healthcare subsidies if Congress doesn’t act

The generous healthcare subsidies Californians have been receiving will expire in 2023 unless our elected representative take swift action.  Californians benefited greatly from the improved subsidy system put in place by the federal government as part of the American Rescue Plan Act (ARPA), which passed in early 2021. The new method of calculating eligibility finally […]

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If You Received an Obamacare Subsidy, the 2021 Covid Relief Bill Changed How You File Your Taxes – And May Cost You Some Money

Obamacare Subsidy

If you received a subsidy to purchase health insurance through Covered California in 2021, you have to report that on your federal and state taxes due on April 18, 2022.  But take note – the subsidy system completely changed in May 2021 when the American Rescue Plan Act (ARPA) went into effect in the middle […]

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How Much Caffeine is Good For You?

Caffeine is the most widely consumed psychoactive drug in the world. People love it, and count on it, for its stimulative properties, especially first thing in the morning, when the body is waking up and caffeine blocks the neurotransmitter adenosine that promotes sleep. But after you wake up, do you really need it during the […]

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Scientists are infecting “organoids” with COVID to see what happens

Scientists are able to create tiny mini-organs no bigger than a lentil from artificially created stem cells and they are injecting them with Covid-19 to study the effects. The news was reported by Science Reporter Lisa Krieger.  “By creating disease in a dish,” Krieger wrote, “the scientists hope to better understand the mysteries of COVID. […]

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Surprise Bill? You probably used an out-of-network provider

Don’t be surprised if you choose an out-of-network medical provider to treat a health problem and get a huge bill as a result. Unfortunately, too many people do this and then blame everyone but themselves for the mistake. This article is about a woman who took her problem all the way to the Colorado Supreme […]

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Financial Love Letter to Heirs Will Give Them Peace of Mind

Having everything set up so your family or other beneficiaries know what to do when you die or become too ill to care for yourself is a true act of love. The author’s 76-year-old father gave her a file labeled “financial love letter,” containing a copy of his will and further instructions on what to […]

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Studies Find That Doctors Are More Likely to Describe Black Patients as Uncooperative

It’s not news that African-Americans have been discriminated against in access to medical care. Now, studies are showing that healthcare professionals aren’t color-blind when making notes about their patients. One study found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term – […]

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How the Tax Bill Affects Your Healthcare

The Tax Cuts and Jobs Act is a Presidential signature away from becoming law. What’s in it that impacts your healthcare? Here is a rundown…

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Does My Doctor Take My Insurance?

It should be easy to figure out whether your doctor takes your insurance. But as everyone knows, it rarely is. Your doctor is either in-network (meaning they take your insurance based on in-network pricing), or they don’t (meaning they will charge you full price, which counts against your out-of-network deductible, which you are unlikely to […]

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Several Good Analyses of the Failure of Republican Reform Efforts

Here are several links to good stories about the failure of the Republicans to pass healthcare reform: My write-up on LinkedIn: The ACA Will Not Fail On Its Own. It Will Take Active Efforts by the Administration and Congress. Kaiser Health News: GOP Failure To Replace The Health Law Was Years In The Making WashPost: ‘It’s […]

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Insurance Companies Come Out Strongly Against Loosening ACA Minimum Essential Benefits Requirements

The insurance industry was largely against the ACA’s requirement that all non-grandfathered individual and small-group health insurance policies provide minimum essential benefits such as maternity coverage, mental health and substance abuse disorders, emergency care and preventative services. They were opposed because these requirements reduced the number and types of policies that could be sold and […]

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Obamacare Exchanges Are Strengthening, Not in a “Death Spiral”

This is reality – the individual health insurance markets are generally in good shape, though in smaller states and counties, there is a serious problem of choice. Some markets are no longer served, and others have only one option. This is not good, but it could be solved in Washington was working on it, and […]

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Reactions to the Senate’s Trumpcare Bill: Jonathan Greer Quoted as Industry Expert

The Senate revealed its draconian version of Congress’ effort to weaken the Affordable Care Act yesterday. In his role as Media Chair and Spokesperson for the Golden Gate Association of Health Underwriters, Jonathan Greer was quoted in the San Jose Mercury News and its affiliated newspapers around the Bay Area. Here are his quotes: Jonathan Greer, […]

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Jonathan Greer Wins GGAHU’s “Out of the Box” Award for 2017

Jonathan Greer serves on the board of the Golden Gate Association of Health Underwriters GGAHU), the Bay Area’s health insurance broker trade association. Last week, his fellow board members honored him with the 2016-17 “Out of the Box” award for bringing new energy and a fresh perspective to the association’s important work representing employers, employees, consumers and our health […]

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Saving Lots of Money With an HSA-Wrap Benefit Plan

An excellent way for employers to save on health benefits is to essentially “self-fund” the deductible and out-of-pocket costs for employees while providing a high-deductible plan that acts like pure insurance for very expensive health care. We call this an HRA-Wrap, and I’d love to explain it to you in more detail because it can […]

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Teaching Hospitals Are Expensive Places to Get Healthcare Services

From the New York Times: Perhaps not evident to many patients, there are two kinds of hospitals — teaching and nonteaching — and a raging debate about which is better. Teaching hospitals, affiliated with medical schools, are the training grounds for the next generation of physicians. They cost more. The debate is over whether their […]

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Anthem to leave Ohio’s Obamacare insurance market in 2018

From Reuters: Anthem Inc, which has urged Republican lawmakers to commit to paying government subsidies for the Obamacare individual health insurance system, on Tuesday announced it would exit most of the Ohio market next year. The high-profile health insurer, which sells Blue Cross Blue Shield plans in 14 states including New York and California, for […]

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Over-Use of Specialists Is One Of The Biggest Drivers Of High Healthcare Costs

From the NY Times: The Affordable Care Act was misnamed; it should have been called the Access to Unaffordable Care Act. In 2015 health care spending reached $3.2 trillion — $10,000 for every man, woman and child in America. While our health care system is the most expensive in the world by far, on many […]

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Senate Republicans Pulling Away From ACA Repeal Legislation

From Politico: Senate Republicans remain publicly pessimistic about their prospects of repealing and replacing Obamacare this year with several raising concerns this week about the party’s central campaign promise even as one of their leaders vowed to pass such a bill this summer. Sen. Richard Burr (R-N.C.) made the most direct prediction on Thursday, telling […]

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Senate Republicans mull tax on employer-based health insurance

Senate Republicans set on reworking the Affordable Care Act are considering taxing employer-sponsored health insurance plans, a move that would meet stiff resistance from companies and potentially raise taxes on millions of people who get coverage on the job. Under longstanding tax law, compensation in the form of health insurance isn’t treated as income for […]

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California’s New Single-Payer Proposal Embraces Some Costly Old Ways

From the respected Kaiser Health Foundation: Three of the dirtiest words in health care are “fee for service.” For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers […]

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The Ugly Truth About Canadian Health Care

Perspective from a Canadian healthcare expert: “Overflowing emergency rooms and yearlong waits for treatment.” https://www.city-journal.org/html/ugly-truth-about-canadian-health-care-13032.html

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