Who says we don’t have Richard Nixon to kick around anymore? This President let HMO’s creep in on his watch. Kaiser Permanente reinvented the health care insurance model and did so with Nixon’s blessing.

When you first look at HMO’s the concept doesn’t sound too poor. Catch and cure problems before they become big and expensive medical catastrophes. If you join and use in plan Doctors, testing facilities and Hospitals, you pay a minimal amount, if anything out of pocket beyond your periodic insurance fee. You bag check-ups to produce sure you don’t have any major problems that can be caught and treated early. Medications are cheaper because the HMO plan administrators can bargain with Pharmaceutical Companies to get medications at a remarkable cheaper rate than any individual.

So far, so good except the HMOs found out they could make a lot more money by not paying for Doctors, Testing Facilities and Hospitals than by just paying less. They therefore, invented the phrases “reasonable and customary”, “elective procedures”, and the plan’s “pharmaceutical list”.

To the HMO reasonable and customary fees means the fees charged decades ago by the least expensive Physicians or Hospitals. My wife recently underwent surgery which resulted in a Hospital bill of $60,000. The HMO paid less than $5,000. So far so reliable since we didn’t have to pay the difference out of pocket. However, we had to exhaust the Doctors assigned by the Hospital instead of the Doctors we wanted to spend. My wife was in the Hospital for 14 days and only saw the Doctor in charge of her case on only 3 occasions. The result was that she put on 30+ pounds of water weight, while eating virtually nothing. If we had a Doctor who showed up they might have noticed this problem developing and given her diuretics to shed the water. Instead they released her and a day later she was readmitted through the ER for Congestive Heart Failure. She could not breath because the water filled her chest cavity causing heart failure and the inability to use her lungs which were compressed by the vast amount of liquids surrounding and compressing them.

The Hospital floor seemed to be divided into two sections. One for indigents and HMO patients who got minimal Doctor and Nursing care and the other side by people with Major Medical, PPO and self pay patients who received intensive Doctor and Nursing care.

My wife after a total of 18 days in the Hospital was told she would need standard Physical Therapy for patients with congestive heart failure. The HMO conception rejected this as an elective contrivance even though the Doctors said it was necessary. I was forced to give her IV medications at home even though I never did this before. If I made one mistake it could have been fatal.

Personally, I was taken off of prescribed medications that worked well and forced to consume over the counter medications which of could I had to pay for 100% out of pocket and which did not work as well as the prescription they didn’t want to pay for. I got a letter from them with this switch and a coupon for $5 off the price of the first box of the over the counter medication. They have tried to switch other medications I capture and I had to appeal their decision and get letters from my primary care Doctor to say that I would not do well with the medication switch.

I also noticed that HMO patients had to wait up to two months for a Specialists appointment. I asked the appointment desk if I was paying cash could I see the Doctor sooner. They said yes.

HMOs seem to reward Primary Care Doctors who give fewer referrals, cheaper medications, and who just dumb refuse treatment. My Doctor admitted this to me. Then he switched me to the office Physician’s Assistant rather than use his precious time with me.

There are some major problems with our current medical system. HMO’s are leading the way to poor quality health care in this Country. By the way, for this insurance my wife and I have to pay a fee of over $500 each month and my Employer has to kick in even more than that.

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On November 17, 2007 during Light Up Night you will be able to seek the Unity Tree Lighting. It is sponsored by Highmark Blue Cross Blue Shield. It will be very special to see this tree light so make distinct that you produce it to the corner of Stanwix Street and Penn Avenue at between 6:30 pm and 7 pm so that you can view the official lighting of the Unity Tree. It will be something to see. Have your camera along because you will surely want to get some great pictures of the fabulous decorations that will be all around you.

When you are in the city of Pittsburgh for Light Up Night you are in for some very nice experiences. You will also want to quit in the city until 9 pm at least for the tall fireworks residence to holiday music. It is a great display so plan on being there for that also. There are also plenty of other great festivities that you will want to see while you are there. Don’t worry if you can’t get there are on Light Up Night because you will be able to see many of the decorations throughout the holiday season. Station Square has many different displays and all over the city there are various ones. You will want to look at my articles that give you all the different ones so that you can pick and choose which ones you would like to see during this holiday season. Be sure that you get to see as many of them as you can.

With all this on the horizon you should be thinking of getting an early start on your holiday decorating and shopping. The sooner you begin the better because that way you will not be under a lot of stress and pressure to get it done. This way it will be done and you will be able to enjoy yourself and take in as many of the holiday activities that you can while you are there. Light Up Night is a fantastic time of the year in Pittsburgh and so is the rest of the time all the way until the Unique Year. Celebrate it all as much as you can. That is the fun about the holiday is that there are so many pretty things to contemplate and great things to do and people are in such festive moods. Take part in all that you can to create your holiday the best one ever.

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By shopping around it is possible to find cheap health insurance that will meet your requirements.

The insurance companies try to provide for different budgets and in doing so they offer cheap health insurance for folks who cannot afford comprehensive insurance coverage.

Think about talking to your fresh insurance company first if you have other items already insured, as this is a good plot to derive cheap health insurance coverage by including it in your current insurance policy.

Make sure that you read all the terms of the insurance because quite often cheap health insurance doesn’t cover all the areas of health that you might require to satisfy your needs.

With the competitive rates that are offered by many of the insurance companies online these days it has become a lot easier to find cheap health insurance that will cover the essentials that are necessary for most people.

Family health insurance allows you to get reduced rates by insuring all members of the family in one group policy.

It is well worth considering getting family health insurance if you have young members in the family as the everyday cost of living will generally have most family budgets stretched to the limit and the additional expense of medical fees can push your expenditure beyond levels where you are able to cope comfortably.

If the only alternative is that your family’s health will suffer due to a lack of funds then you will understand the vital importance of having family health insurance to acquire optimal health screen for all members of the family while growing up.

If you can combine your family health insurance with your other household and contents insurance you can quite often pick up reduced rates however it is also well worth considering looking into companies that specifically offer family health insurance simply because they have packages that are often cheaper than those you would be able to gather elsewhere.

Most insurance companies will offer a group health insurance plan that can be tailored to the requirements of the particular group.

A group health insurance conception can achieve a much amount of money for the individuals of the group and insurance companies are generally happy to offer discounts for group health insurance plans because they can often get additional sources of income for other types of insurance for the individuals of that group.

A Group health insurance idea can benefit both parties in the transaction by introducing new people to the insurance company who would not otherwise give them their insurance business if it weren’t for the fact that they were participating in a group health insurance plan.

Many of the smaller insurance companies have built their business hastily by focusing on group health insurance plans as a way to acquire up their customer wicked.

For any type of insurance discuss with your insurance representative whether they can prepare a group health insurance plan that will suit your needs and the needs of those people who you can introduce to their business and see what discounts they can offer.

Before you get a health and medical insurance quote reflect checking out some of the available options on the Internet first before you go to your insurance company as this will give you something to compare with the rates that your own insurance Company is offering with their health and medical insurance quotes.

Once you have this information in hand it will give you a lot better bargaining power and you will be quite surprised to know that most insurance companies will reduce their health and medical insurance quotes if they are forced to do so when you reveal a more competitive price elsewhere.

There is lot of profit being made in the insurance sector and there is room to move for most insurance companies when they give you a health and medical insurance quote but they won’t do so unless they are forced to by people like you presenting them with better options that you have found available elsewhere.

So keep that in mind this fact next time you are planning to get a health and medical insurance quote.

As a licensed insurance agent who sells Medicare Part D prescription plans I’ve seen a huge amount of people who are unable to afford a prescription plan. Medicare with assess a 1% penalty per for month for each month you are not covered by a Part D plan or creditable coverage (as good as or better than the Medicare plan). People are getting stuck between a rock and a hard place because of these guidelines. There are multiple extra help programs designed to help people who are unable to afford their prescription plans or are in the infamous Medicare Coverage Gap.

Low Income Subsidy (LIS)

The low income subsidy, or LIS, program is run by the Social Security Administration. This extra befriend is designed unbiased for the Medicare Fragment D plans that are available. If you qualify for LIS then SSA will pay a percentage or even all of your Part D premiums and will lower the out of pocket cost of your medications. There are a few levels of LIS that are available and it all depends on your income level as to which kind of benefit you may qualify for. When SSA shows that they are going to pay the premium they will detestable it on percentages but they will only pay up to a certain amount for each state. If you find that you are eligible for LIS and have 100% subsidy on the premium then it doesn’t necessarily mean your entire premium will be paid in full. The benchmark is the average of all of the Portion D premiums in your spot. They have level 1 which is the most common level to have. If you are a level 1 LIS then SSA will pay 100% of the premium, up to the benchmark for your station, and your generic medications will cost $2.25 and any other kind of medication will cost $5.60. Level 2 subsidy is usually for people who are Medicaid or for people who have a very low income. Level 2 beneficiaries will also have 100% of the premium up to the state benchmark and the generic drugs have a copay of $1.05 and anything not generic will have a copay of $3.10. Level 3 subsidy is for people who are on Medicaid and in a nursing home. These people will not be charged a copay for their medications and the premium is paid 100% up to the station benchmark. Level 4 subsidy means that your premium may be paid 25%, 50%, 75% or 100% depending on your income and your co-pays will be 15% of the medication cost or the base copay of your plan for that type of drug, whichever is cheaper. LIS levels 1, 2, and 3 beneficiaries will have $0 deductible on their plans and the coverage gap is eliminated. Level 4 beneficiaries will have a $56 deductible and will pay 15% of what their drug cost is in the coverage gap.

The Social Security Administration can be contacted at 1-800-772-1213 between 7am and 7pm, Monday through Friday if you want to see if you qualify or have questions about the program. You can also visit Socialsecurity.gov for an online application and more information. There is an income limit on the LIS program with SSA and the income limits depend on if you are married or single. There is also asset limits that you must be under in order to qualify. The best place to get these limits is SSA because it can vary in different states.

Medicaid:

Medicaid is the spot health insurance program for low income persons or families and also for people with certain disabilities. If you qualify for the site Medicaid you automatically qualify for extra help on the Part D plans. Medicaid will pay the premium up to the benchmark for your state and will lower your co-pays. Most people who qualify for Medicaid will pay $1.05 for generics and $3.10 for all other drugs, unless you are on Medicaid and in a nursing home. Some people who have a very shameful income will not have to pay co-pays on their medicine if they have Medicaid. That will be something that Medicaid will have to determine. If you want to check to see if you qualify for Medicaid you can contact your local Department Of Social Services, Department Of Aging or you can contact the Medicaid offices for your location. All of these numbers will be listed in your local phone book or online.

State Pharmaceutical Assistance Programs (SPAP):

These programs are dwelling specific. The states that have an SPAP program are: Connecticut, Delaware, Illinois, Indiana, Massachusetts, Maryland, Maine, Missouri, Montana, New Jersey, New York, Nevada, Pennsylvania, Rhoad Island, South Carolina, Virgin Islands, Vermont, Wisconsin and Washington. Some of these programs require a yearly enrollment fee but it isn’t very large. Other states like Virginia have an SPAP program for people who have HIV/AIDS or have end stage renal disease. These programs require that you not be eligible for the state Medicaid. These programs succor out with out of pocket costs associated with the Medicare Part D prescription plans. If you are alive to in getting the contact information on the SPAP programs in your area you can visit Medicare.gov.

Help from Pharmaceutical Manufacturers:

Some drug manufacturers will help Medicare beneficiaries pay for their drugs during the coverage gap in the Part D plans. The best device to get in touch with these manufacturers is to contact your doctor and ask for the contact information of the manufacturers who make your drugs. Some doctors even keep forms on hand that you will need to fill out to request help from the drug manufacturers but you will probably need to ask for them upfront and not wait for the doctor to offer these to you. I discover this frequently with manufacturers of expensive drugs such as cancer treatment medications. If you are unable to get the information from your doctor then do a search on the Internet for the manufacturers that make your drugs and they will show contact information on their websites.

State Health Insurance Assistance Programs (SHIP)

The SHIP departments are in connection with Medicare. They are local offices that can help gather ways to get extra help on the Portion D plans. SHIP is offered in every state. SHIP can encourage fetch extra help programs for people who cannot afford their drugs. They can find discount cards, free medication cards and manufacturer programs for people in need of help with their prescription needs. To get the number to your local SHIP office visit Medicare.gov or call 1-800-Medicare (633-4227).

If you do not qualify for any of these extra support programs the best way to cut your costs down in the Medicare Part D programs is to take as many generics as possible. If your medications come in tablet form you can ask your doctor to double the dose and have you lop them in half, this does aid with the total cost of the drug that counts towards your $2510 limit. If you are unable to assume a generic or are allergic to the generic of your drug then there are still ways to cut your costs down. You can look for lower cost alternative medications with your doctor or some drug plans even have a tier change request. If you’ve tried a generic of your brand medication and it didn’t work or you’ve had a awful reaction your doctor can contact your drug concept and examine the ticket drug be put on a lower cost tier so that your copay is less. If you are taking a lot of generics then you can look for a drug plan that covers generics during the coverage gap. Also if you have a Medicare Supplement plan you might be eligible for a discount card that you can use during the coverage gap. Unfortunately there is no plan that covers the coverage gap completely lawful now and for people who fall between the cracks are suffering financially. There is hope but you need to do your homework and search for the help.

You have done your homework and determined that with some careful budgeting and a little luck you can afford to retire. Not only have you read books on financially preparing for retirement but you’ve also attended numerous free seminars on the topic which also had the fringe benefit of some free meals included. If you’re not yet 65 you have scoped out the health care issues and with the attend of COBRA or perhaps a company plan. If you’re officially a Senior Citizen welcome to the world of Part A, Fragment B, Part D, perhaps Medicaid and, of course, the numerous Medicare supplement plans. You’re ready to kick back and appreciate the good life with that Senior discount on your morning cup of coffee at the nearest posthaste food establishment. Sound like a belief? It’s a great start but there is a little more to it then meets the peer.

It is not surprising that a majority of the books on retirement focus on both being prepared financially as well as providing for health care. While these are usually the valuable first issues to research there are other facets to retirement that you should consider. These hidden factors may not apply to everyone but nonetheless, if they do, you should keep them in mind as you enter this recent phase in life.

Paychecks and Feedback: Since you’re ready to retire you’ve covered the paycheck, or lack thereof, piece of it. Financially you’re respectable to go. But besides the certain, which is money that isn’t coming in from your paycheck, consider some other aspects. First you have to become comfortable with the feeling that some have that they are leaving ‘money on the table’. This can occur whether you’re retiring early or even leaving a job at the age of 70 or older. In so many words you have to convince yourself that enough is enough. If you want to construct some money part time once you retire, go for it, but don’t do it just to partially replace the money you are leaving leisurely. Do it because it’s some activity you enjoy and win rewarding in some way such as giving back to the community. Once you retire you will quickly find that your paycheck served as a means of feedback from your employer that you were doing something worthwhile and of value to someone else. While in some jobs you have regular reviews, hopefully with warm fuzzy feedback, the bottom line is that the paycheck and the amount provides a very strong input your judgement of your self-worth. In preparing for retirement think about this and consider ways that you will replace this feedback with similar feedback. Spending part of your free time volunteering is an excellent plot of getting this feedback and reinforcing your self worth and feeling superb about it. Don’t underestimate this role that the paycheck plays in many or our lives. It’s not something you normally think about but when the paycheck isn’t there on a regular basis it can have a strong psychological effect.

A Spouse in the House? In planning your retirement you should also mediate if you have a spouse whether it is wise for both of you to retire at the same time if you both presently work. It may be tempting for both to retire together and enjoy your newfound freedom as a couple. Depending on the couple this may work fine but be aware that with some couples this can produce a great deal of anxiety and dissimilarity. Certainly not a good way to open a long awaited retirement! In most cases you have spent 40 or more hours apart from your spouse each week during the many years you have been working. When you suddenly have that time together, while the concept seems nice, it may in practice lead to some disagreements. When one person retires first they can adapt to the time off, find their own interests and decide in to this new design of life with a comfortable routine. At that point the spouse can retire and have their own time to adjust rather then both trying to do it simultaneously. Having gone through the adjustment the person retiring first should be sensitive to the adjustment their spouse is going through.

For Better or Worse: In the case where only one of the couple has worked outside the home there may be some additional challenges to believe. For example if the husband works and the wife is at home and typically eats lunch out with friends several times a week the husband might not understand when the wife isn’t there to prepare a noontime meal if he happens to expect that once he retires. Similarly if the wife works and the husband has been at home and typically goes off and plays golf the wife, now that she is home, may resent being left alone. These are typically not major issues but are among the things to consider prior to retirement rather then waiting for resentment to develop.

Imagine This: Many people will tell you that once you retire you can now pursue your main interest with a passion. While it is nice when you have that hobby or activity to immerse yourself into you should recognize that not everyone has such an interest and that it is OK not to have this and you shouldn’t consider yourself abnormal. This does not mean you should become a couch potato but rather use your time to search for many areas and recognize that there are numerous ways to use this time to learn about things, places and people. Many activities won’t float your boat however in the process of learning and exploring you may just find something you want to pursue in depth.Retirement isn’t a one-size-fits-all endeavor. It means different things to different people, which is the way it should be. Obviously you need to understanding the financial aspects of retirement with great care but don’t think the job is done then. Considering the more intangible parts of retirement ahead of time, such as those discussed here, will make retirement a distinguished more pleasant and meaningful experience.