The healthcare reform bill that was narrowly passed by the House of Representatives on Saturday night includes provisions that would take effect in as early as 2010.

- Private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage, or abandon people when they become ill.

-Children, up to age 27, would be allowed to remain on their parents’ family policy.

-Seniors who fall into the donut hole would get a 50% discount on their drug costs.

These would be wonderful changes that would benefit many people I know. They are relatively easy to implement and could take effect quickly.  Other parts of the bill would take three or four years to put in place – like the public option.

On Sunday we were close to getting dramatic change for 2010. On Monday we were told the bill is D.O.A. in the Senate. They say creating legislation in the US Congress is like making sausage – you don’t want to watch how it’s done. I can’t watch anymore because I get excited one day and disappointed the next.  We are so close – and yet so far away from changing our shameful health insurance system. (This is my opinion – and I’m an insurance broker.)

How much does cataract surgery cost?  It depends on your insurance coverage and whether or not you go to a doctor “in-network”.

The information below is from a recent survey of America’s Health Insurance Plan members.  The “billed amount” is what doctors try to get from insurance companies when the patient is out-of-network.  It is also the amount you might have to pay if you don’t have insurance.

The “Medicare fee” column shows how much Medicare pays for the service.  Private insurance companies usually pay an amount that is somewhat higher than what Medicare pays, but much less than the charges for “out-of-network” services.

 VARIOUS OUT-OF-NETWORK PHYSICIAN CLAIMS
FILED IN THE STATE OF ARIZONA IN 2008

Shingles, according to the Centers for Disease Control, is “an extremely painful and debilitating rash that can lead to more serious complications.” The signs of Shingles are usually a rash on one side of the body, and you’re vulnerable if you’ve had chickenpox because the virus remains dormant in your body for life and can reappear as Shingles at any time.

Zostavax is the vaccine for Shingles and it is highly recommended for people over age 60. But there seems to be a lot of confusion over how seniors can get the vaccine and what it will cost. I’ve heard that seniors on Medicare, or enrolled in Medicare Advantage plans, have gotten different answers from the same insurance company.

In one case, a husband and wife are both enrolled with the same Medicare Advantage plan. The wife got her vaccine from her primary doctor and paid nothing. When her husband went to his doctor to get the vaccine, he was told he would have to pay $150. The last I heard, the husband was still not satisfied with the answers he was getting from the insurance company.

In most cases Zostavax will come under Part D, but you need to check with your plan to see what the co-payment will be. In many plans Zostavax is a “specialty drug” with a co-pay of 25% or even 33%, depending on the plan. The actual cost of Zostavax should be $150, meaning a Part D co-pay should be between $30 and $50.

However, in most cases you must also pay co-pay to have your doctor administer the shot. And I wouldn’t be surprised if your friends who seek out the Shingles vaccine will have a different payment experience than you.  That’s just the way the crazy system works.