Employees choosing workplace health benefits for next year will probably not see a major change in their premiums. But they are likely to encounter more options for “virtual” doctor visits.

As the annual open enrollment season for health benefits gets underway, more large employers are offering services that let patients consult doctors who are in a separate location, using technology like secure video chats or remote monitoring. About three-quarters of large firms that offer health insurance now cover such “telemedicine,” a recent survey from the Kaiser Family Foundation found. That is up from 27 percent three years ago.

And half the large employers that were surveyed by the National Business Group on Health said adopting virtual solutions was their “top initiative” in 2019. The nearly 160 companies in the survey collectively employ about 13 million people.

Employers are moving to virtual care partly to make health care more convenient for workers, who can get advice for non emergency ailments without visiting a doctor’s office.

Despite employer adoption of virtual visits, they have been slow to catch on with patients. Fewer than 1 percent of enrollees in large employer health insurance plans used telemedicine services in 2016, according to a separate Kaiser analysis of medical claims data.

Mercer, a large employee benefits consulting firm, also found that worker use of telemedicine remained “frustratingly low.”

“It has not quite hit the mainstream yet,” said Mei Wa Kwong, executive director of the Center for Connected Health Policy, a nonprofit group that promotes the use of virtual technologies in health care.

Employers are also seeking ways to rein in health care costs by reducing unnecessary office and emergency room visits.

The average total annual premium paid for family health coverage is about $20,000, up 5 percent since 2017 and 20 percent over the past five years, the Kaiser foundation found. Employers pay most of that amount, while employees, on average, contribute about $5,550, Kaiser said. (The share of the family premium paid by workers has remained about 29 or 30 percent since 2010, Kaiser found.) The Kaiser survey, of about 2,200 employers, was conducted in the first seven months of 2018.

It’s hard for some people to break out of the tradition of going to a doctor’s office, Ms. Kwong said. Some people simply may not know the services are available or how they work. She said offering demonstrations of the technology might be helpful.

“Seeing is believing, for a lot of folks,” Ms. Kwong said.

Tracy Watts, a senior partner at Mercer and a specialist in health care cost management, gave an example of how “super easy” an online visit can be for a patient with, say, a rash. The patient chooses an appointment time and can upload a picture of the rash. The doctor and the patient then talk online at the appointed time, and the doctor can call in a prescription to the patient’s pharmacy — all in about 10 or 15 minutes.

For now, employer adoption of virtual medicine is on the upswing. But that may change. Some studies suggest virtual visits may increase costs by spurring patients to seek treatment for minor ailments that wouldn’t otherwise have prompted them to see a doctor.

Here are some questions and answers about virtual health care:

Is there a fee for consulting a doctor online?

Fees or co-payments depend on the details of your insurance plan.

Some employers offer virtual visits through a health plan, while others contract with separate companies to offer the service. While some providers charge people without health coverage about $70 per virtual visit, the cost can be $40 or less — or even free — for people with workplace health insurance. Some health plans may offer virtual visits with no or lower fees to encourage workers to use them, the Kaiser study found.

Mercer has found that lower fees are linked to higher use of virtual visits. Among employers who reported relatively high rates of telemedicine use, the typical co-payment was $15. Employers with below-average use had a typical fee of $30.

Whether a virtual visit costs a patient more than an in-person visit depends, again, on your insurance. The average co-payment for a primary care office visit is $25, according to the Kaiser foundation. But the cost for someone with certain health plans — like high deductible plans, which have a different payment structure — may be much higher.

How can I help a virtual visit go smoothly?

Online visits are best for routine ailments, like cold or flu symptoms, allergies, pinkeye, bronchitis or skin problems, or for follow-up visits, providers say. More severe symptoms — say, a lump that raises a cancer concern — call for an in-person visit.

Virtual visits are also particularly useful for psychological counseling and other behavioral treatments, since they tend to involve talk therapy rather than a physical exam, Ms. Kwong noted.

If you decide to try a virtual visit, it helps to familiarize yourself with the service’s rules and sign up ahead of time, so you won’t have to worry about filling out online forms when you aren’t feeling your best.

“Set up the account before you get sick,” Ms. Watts advised.

What do I need to participate in a virtual doctor visit?

You’ll need reliable internet access and an appropriate digital device. Patients can use a computer or a laptop, but most services also work with apps that can be downloaded onto a tablet or a mobile phone.

Informational Source

Choosing a health savings account can be daunting, especially for people funding one for the first time. But some comparison shopping can help minimize fees and maximize savings, researchers say.

Providers of health savings accounts are generally doing a better job of disclosing details like fees and investment options, said Leo Acheson, associate director of multiasset and alternative strategies at the financial research firm Morningstar. But, he added, “there’s still some room for improvement.”

While updating an analysis of 10 big providers of the accounts, he said, Morningstar found that just four made all details — like fees charged — available on their websites.

A health savings account, or H.S.A. — available when paired with a specific type of high-deductible health insurance plan — offers triple tax benefits. You can contribute to an H.S.A. through paycheck deductions, reducing your taxable income; interest or investment gains are tax free; and withdrawals aren’t taxed, either, as long as you spend the money on eligible items or treatment. (If you don’t have health coverage through your employer, you can make tax-deductible contributions on your own to an H.S.A., as long you have a compatible health plan.)

Money in the accounts can be used for current health and medical expenses, or invested for care in the future. According to Fidelity Investments, a couple who are 65 years old and retiring in 2018 may need about $280,000 to cover health costs in retirement, and funding an H.S.A. can help with that burden.

But most H.S.A. holders don’t appear to be saving for the long term, according to findings from the Employee Benefit Research Institute, which analyzed a database of about six million accounts. Most account holders, the institute reported in October, appear to be using H.S.A.s as “specialized checking accounts,” not investment accounts.

People generally use the money to cover current costs, like deductibles and co-payments, rather than contributing as much as possible and investing for the future. Over all, two-thirds of account holders withdrew funds — an average of $1,725 — in 2017. Just 5 percent of account holders had investments other than cash.

That may be because most people simply can’t afford to pay for health care out of pocket and need the cash in the accounts for medical bills, said Paul Fronstin, director of the institute’s health research and education program. Or, he said, it could be that people still think of H.S.A.s as flexible health spending accounts, a different sort of workplace account with fewer perks. Unlike those accounts, H.S.A.s are portable, so you can take yours with you if you change jobs.

Over time, however, H.S.A. holders appear to become more comfortable with investing. In 2017, for instance, 10 percent of accounts that had been opened a decade earlier had investments other than cash, compared with just 2 percent of those opened in 2017, the institute found.

“It takes time to learn how these things work,” Mr. Fronstin said.

Whether you are using your H.S.A. for saving or for investing, it’s wise to compare fees and other features offered by different accounts, Mr. Acheson said.

If you have health insurance through your employer, your H.S.A. account is usually chosen for you, and your employer probably pays any monthly maintenance fee. But if you’re buying insurance on your own — or if you don’t like the investment options available in the account your employer offers — you can choose another account provider. Mr. Acheson suggests keeping your company’s H.S.A. to receive any employer contributions, then transferring the money periodically to the second H.S.A.

Morningstar recently rated 10 large account providers available to individuals, based on whether the account is mainly for spending, or for investing.

Spenders should look for H.S.A.s that offer checking accounts with no monthly maintenance fees, reasonable interest on deposits and Federal Deposit Insurance Corporation insurance, Mr. Acheson said.

Investors should also look for low fees, whether on “passive” index fund investments or actively managed funds, and no threshold on investments or a low one. (Some accounts require a minimum balance — often $1,000 to $2,000 — to be maintained in the checking account before money can be invested.)

Morningstar ranked the H.S.A. Authority, offering accounts through Old National Bank in Indiana, as the best for both spenders and investors.

Fifth Third Bank’s H.S.A. is “compelling” for spenders, the report found, if they are able to keep an average of at least $4,000 in their checking account. The bank paid a somewhat higher interest rate on deposits, and if that $4,000 balance was maintained, the bank waived its monthly fee.

Accounts from Further, an account administrator formerly known as SelectAccount, and Bank of America were deemed “solid” choices for investors.

(The analysis didn’t include H.S.A.s from Fidelity because the company didn’t begin offering the accounts to individuals outside employer plans until Nov. 15, after the report was completed.)

Eric Remjeske, president of the H.S.A. research firm Devenir, said that it made sense to evaluate the costs of a plan, but that consumers should also consider what they were getting for the extra fees. Some higher-fee accounts, for instance, may offer more services, like the availability of “robo” advisers to help with investment selections.

Devenir offers HSAsearch.com, a tool that includes more than 500 accounts, to help consumers compare H.S.A.s.

Here are some questions and answers about health savings accounts:

How do I know if my health plan is compatible with an H.S.A.?

Most plans that qualify to have a health savings account will be labeled “H.S.A. eligible.” If you’re not sure, ask the insurance company or your employer. For 2018, criteria include a deductible of at least $1,350 for an individual and $2,700 for a family. (Minimum deductibles won’t change in 2019, the Internal Revenue Service has said.)

What can I buy with my H.S.A.?

You can spend the money on a wide variety of “qualified” expenses, including doctor visits, eyeglasses, fertility treatment and drug addiction treatment. For a complete list, see I.R.S. Publication 502. Be sure to keep receipts, or benefit statements from your insurer, in case you have to document your spending, Mr. Fronstin said. If you spend the money on noneligible items, the withdrawal is taxed as income, plus a 20 percent penalty. (After you turn 65, the penalty goes away, and you’ll pay just income taxes on nonqualified withdrawals.)

Do you want to more information about the virtual doctor and Health Saving Account management then please contact us in the comment section.

Informational Source

Poor hearing is not just an annoying inconvenience.

The earsplitting sound of ambulance sirens in New York City is surely hastening the day when I and many others repeatedly subjected to such noise will be forced to get hearing aids. I just hope this doesn’t happen before 2021 or so when these devices become available over-the-counter and are far less expensive and perhaps more effective than they are now.

Currently, hearing aids and accompanying services are typically not covered by medical insurance, Medicare included. Such coverage was specifically excluded when the Medicare law was passed in 1965, a time when hearing loss was not generally recognized as a medical issue and hearing aids were not very effective, said Dr. Frank R. Lin, who heads the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health.

Now a growing body of research by his colleagues and others is linking untreated hearing loss to several costly ills, and the time has come for hearing protection and treatment of hearing loss to be taken much more seriously.

Not only is poor hearing annoying and inconvenient for millions of people, especially the elderly. It is also an unmistakable health hazard, threatening mind, life and limb, that could cost Medicare much more than it would to provide hearing aids and services for every older American with hearing loss.

Currently, 38.2 million Americans aged 12 or older have hearing loss, a problem that becomes increasingly common and more severe with age. More than half of people in their 70s and more than 80 percent in their 80s have mild to moderate hearing loss or worse, according to tests done by the National Health and Nutrition Examination Survey between 2001 and 2010.

Two huge new studies have demonstrated a clear association between untreated hearing loss and an increased risk of dementia, depression, falls and even cardiovascular diseases. In a significant number of people, the studies indicate, uncorrected hearing loss itself appears to be the cause of the associated health problem.

In one of the studies that covered 154,414 adults 50 and older who had health insurance claims, researchers at Johns Hopkins found that untreated hearing loss increased the risk of developing dementia by 50 percent and depression by 40 percent in just five years when compared to those without hearing loss.

An analysis of the voluminous data by Nicholas S. Reed and colleagues linked untreated hearing loss to more and longer hospitalizations and readmissions and more visits to an emergency room.

Within 10 years, untreated hearing loss accounted for 3.2 percent of all cases of dementia, 3.57 percent of people significantly injured in a fall, and 6.88 percent of those seeking treatment for depression. The percentages may seem small, but given how common these conditions are, they affect a very large number of individuals, resulting in great personal, financial and societal costs.

About 85 percent of those with hearing loss are untreated, Dr. Lin said. For older adults alone, this increased health care costs by 46 percent over a period of 10 years, compared with costs incurred by those without hearing loss, the authors reported in November in JAMA Otolaryngology Head and Neck Surgery.

One of the authors, Jennifer A. Deal, an epidemiologist and gerontologist at the Johns Hopkins Bloomberg School of Public Health, said that while “hearing loss itself is not very expensive, the effect of hearing loss on everything else is expensive.”

Unfortunately, people tend to wait much too long to get their hearing tested and treated with hearing aids, and the longer they wait, the harder it is to treat hearing loss, Dr. Lin told me.

Age-related hearing loss comes on really slowly, making it harder for people to know when to take it seriously, he said. He cited two good clues to when to get your hearing tested: Family members or close friends say you should, or you notice that you often mishear or don’t know what others are saying.

But even when people are tested and spend thousands of dollars to purchase needed hearing aids, the devices often sit in a drawer. People may complain that the sound quality is poor, too static-y or otherwise annoying, and that the aids merely amplify all sound, making it still hard to hear in a noisy environment. All aids are not created equal, Dr. Lin said, and even expensive, properly fitted aids can require multiple adjustments. Some people give up too readily to get the best results.

“Unrealistic expectations are a big part of this problem,” Dr. Lin said. “It’s not like putting on a pair of glasses that immediately enables you to see clearly,” he said. “Hearing loss is not fixed as easily as eyesight. The brain needs time — a good month or two — to adjust to hearing aids. And the earlier hearing loss is treated, the easier it is for the brain to adapt.”

The new studies give ample cause for taking hearing loss seriously. Consider, for example, the link to dementia. People who can’t hear well often become socially isolated and deprived of stimuli that keep the brain cognitively engaged. As input lessens, so does brain function.

“Hearing loss is not a volume issue,” Dr. Deal said. “It’s a quality-of-sound issue. Certain parts of words drop out and speech sounds like mumbling. A garbled message is sent to the brain that it has to work harder to decode.”

In addition, when information is not heard clearly, it impedes memory. “A good clear auditory signal is more easily remembered,” Dr. Deal said. “The key to memory is paying attention. The brain can’t stay focused on the words when it is working overtime to decode the signal.”

With respect to falls, she said, hearing loss often goes hand-in-hand with balance issues. “Even when we don’t realize it, we’re using our ears to position ourselves in space,” she explained. Also, when people can’t hear well, they are less aware of sounds around them. They may fall when startled by someone or something that seems to come silently from behind.

Dr. Deal said she and her co-authors were surprised to find a link between poor hearing and cardiovascular disease. “It could be that vascular disease is common to both,” she said, but added that social isolation and stress resulting from hearing loss are also likely to play a role

There’s good news for New York City residents, among whom noise pollution is the leading municipal complaint. By 2011, all of the more than 10,000 police department vehicles were switched to lower-frequency “rumbler” sirens, which are 10 decibels quieter, and the fire department has begun using them too.

The next step is to get less shrill sirens for the more than 2.5 million ambulance calls in the city every year. The Mount Sinai Health System is testing the two-tone sirens that make an “ee-aw” sound commonly heard in Europe, and the Greater New York Hospital Association has begun testing rumbler sirens for its ambulances.

Informational Source

WHEN it looked like their 6-year-old son was developing a severe cold last month, an East Hampton couple knew that it would be a good idea to keep him home and visit a pediatrician. They did neither.

One parent would have to stay home with the youngster, which would mean a loss of pay. There was another reason why they avoided an office visit and the antibiotics the physician would likely prescribe: the family had no health insurance.

People on Long Island are increasingly gambling with illness. The relatively high rate of unemployment means that fewer people are covered by health insurance, and some employers, faced with rapidly rising insurance costs, are scaling down coverage or insisting that their workers pay a larger part of the premiums.

The couple with the sick son had relatives nearby who could presumably help them with money. But the parents chose not to ask, because they were reluctant to reveal that they were uninsured.

Although they felt badly about exposing their son’s classmates to a contagious cold, the parents continued to send him to school and hoped that he would improve. But he did not.

In a few days, the boy suffered from bronchitis and an ear infection, and his parents had to contend with medical bills amounting to three times as much as they would have originally spent. They had lost the gamble.

On the South Fork, the problem is particularly acute, and a forum on options for noncovered people, with the Amagansett P.T.A., the South Fork Community Health Initiative and the East Hampton Rotary Club, will be held on Wednesday at 7:15 P.M. in the Amagansett School on Montauk Highway.

The impetus for the forum stems from a talk by Fran Donovan, a social worker affiliated with several schools, at December meeting of the P.T.A. According to Ms. Donovan, up to 50 percent of the Amagansett schoolchildren are from families without health insurance, a percentage she believes also applies to surrounding communities. Because of the sluggish economy, she said, the number of uninsured families is expected to increase.

‘Situation Has Gotten Worse’

A major reason for the problem, Ms. Donovan contends, is that, when compared with other regions, the South Fork has proportionately more people who are self-employed, work part-time or have service jobs.

“In the last couple of years, the situation has gotten worse,” Ms. Donovan said in an interview. “Jobs in the tourism industry rarely carry health insurance. As the farming and fishing industries have waned, those families have had to choose between paying for insurance or paying their mortgages.

“And as the economy has slumped, some companies have either tightened eligibility or have dropped coverage for their workers. It’s not an exaggeration that if you don’t work for the town or the schools, you don’t have coverage.”

Ms. Donovan said she based her estimate on the children, parents and teachers to whom she talked, “but I’m sure there are many others in the same situation we don’t know about.” Rise in Absenteeism

Ms. Donovan said the schools should address the problem because it affected children’s health and absenteeism. When a child is sick, she said, an uninsured family is less likely to seek early medical attention. That not only increases the risk of a child’s becoming seriously ill, she noted, but also infects classmates if the child continues to attend school.

“This winter in schools in this area we’re seeing a high incidence of pneumonia and tuberculosis,” Ms. Donovan said. “These children are sent to school in the early stages, when they’re the most contagious. Some parents are embarrassed.

“I had one woman tell me she hoped her parents didn’t find out she had no health insurance. It used to be you would never go without medical coverage, at least for your children. But now some people simply don’t have a choice. It’s pay premiums or buy food.”

The president of the P.T.A., Emily Nixon, and Ronnie Todaro of the Community Health Initiative have been working on the problem and sharing information with neighboring P.T.A.’s, church groups, Chambers of Commerce and community organizations in the Town of East Hampton. What If the Child Is Sick?

“Most definitely, there is a negative impact on the children,” Mrs. Nixon said. “Without insurance, it’s hard enough to keep up with the routine needs of a well child. But what if she gets sick?

“Even a simple cold can develop into a full-blown chest illness. That child misses valuable school time, feels miserable and passes it on to her friends and family. Once a chain reaction starts, you just hope it doesn’t get too bad.”

Although Mrs. Nixon stressed that a P.T.A. could not provide insurance, Amagansett’s has found plans that individual families or groups of families could use at little or no cost.

One is Child Health Plus, underwritten by the state. Depending on family income, the plan provides basic physicians’ care for children under 13 at no cost or $25 a year.

Another plan is Kid Care, through Empire Blue Cross and Blue Shield. It has no income restrictions and provides physicians’ care for children under 18 for $30 a month and hospitalization for an additional $33 a month.

“Health insurance is an awful dilemma right now for families everywhere, but it seems to be approaching a crisis point on the East End,” Ms. Todaro said. “Elsewhere people can get involved in programs like H.I.P. But for someone out here the nearest participating physician is 50 miles away. So if you can’t afford regular insurance premiums, which seem to jump almost every month, you’re stuck.”

Ms. Todaro said the forum would try to “get the ball rolling” to finding ways for families to buy insurance, at least for their children. Representatives of insurers, Planned Parenthood, business groups and the Suffolk Coalition for National Health Insurance are expected to offer information at the meeting.. Chamber of Commerce Program

Also to be discussed are how other regions have addressed the problem. In Hudson in Columbia County, the Chamber of Commerce provides medical coverage for self-employed residents. Another is Mutual of Omaha Medflex plan, which can provide relatively low-cost major-medical coverage to groups of 20 or more families.

“More and more people are without a safety net when it comes to medical problems, and it’s especially scary when you’re talking about children,” Ms. Donovan said. “A lot of parents are just praying there isn’t a playground accident, appendicitis or something else. Not only would the child suffer, but a family without insurance would get hit with medical bills that could wipe them out.”

Informational Source