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How to Find Health Ratings

Get in touch with the National Committee on Quality Assurance (NCQA). The NCQA accredits and issues “report cards” on various plans. To find out whether a specific plan is accredited, see its report card, or to find out what criteria are used for evaluation, contact the NCQA at (202) 955-3500 or visit the Web site at www.ncqa.org.

The Joint Committee on Accreditation issues reports about preferred provider organizations and managed behavioral health care. For more information, visit www.jcaho.org.

Keep in mind both these organizations are funded and governed in part by the health care industry.

Another resource is a Consumer Reports article from August 1996 entitled “How Good is Your Health Plan?” This article ranks many of the large plans based on a satisfaction survey. You can order a copy from Consumers Union of U.S. Inc., Yonkers, NY 10703-1057. Specify report number RO155 and send a check or money order for $5.

Get in touch with your state’s department of insurance for reports on plans, or information on complaint ratios.

Some community groups, state agencies, and employers have developed their own report cards. The National Association of Insurance Commissioners is at 120 W. 12th Street, Suite 1100, Kansas City, MO 64105-1925. Its phone number is (816) 842-3600, and the Web site is www.naic.org.

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Medicare
Medicare is a federally administered program that provides hospital and medical insurance protection to people aged 65 and older, disabled people under age 65 who receive cash benefits under Social Security or Railroad Retirement programs, and people of all ages with chronic kidney disease. Since 1973, aliens and some federal civil service employees and annuitants have been eligible to enroll by paying a monthly premium.

Benefits
Medicare consists of two parts: Part A and Part B. Part A is compulsory hospital insurance (HI), financed by contributions from employees, employers, and participants. HI pays for hospital, nursing home, home health and hospice service. Part B is voluntary supplemental medical insurance (SMI), financed by payments from those who enroll in it. SMI covers physicians’ services and a variety of other goods and services.

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DENVER - The prospect of having to move to a nursing home at some point is not an appealing thought for many older Americans. Yet independent living is not always possible. One increasingly popular alternative is the continuing-care retirement community. Michael Snowdon, CFP, CMFC, and the CFP Program Manager at the College for Financial Planning, provides answers to some commonly asked questions about this relatively new housing plan for older Americans.

What’s the difference between a continuing-care facility and a nursing home?

Continuing-care retirement communities provide a continuum of care, generally guaranteed for a lifetime. You may start out living independently at the community in your own unit, with only light housekeeping services. Later you may require some medical or living assistance, such as with taking medication or dressing. And later still you may need to move into the facility’s nursing home for full-time care, either temporarily or permanently. A good continuing-care community can make these transitions seamless.

Not all of the continuing-care retirement communities (CCRCs), sometimes called life-care communities, provide the same level of services. Some facilities offer a full spectrum of services, from transportation and laundry service to extensive recreational facilities such as for golf and swimming. Others are more modest, though most offer some recreational and social activities, meals, and transportation to local events and shopping.

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DENVER - Would a long stay in a nursing home wipe out your life savings? People living longer, tougher qualification rules for Medicaid, smaller families, and rising health care costs have increased the need for long-term care (LTC) insurance to help pay for extended nursing home or home health care. But who really needs such a policy and what benefit features are best to choose?

“A year of nursing home care can cost individuals from $30,000 - $65,000 a year, or more, in this country,” says Michael Snowdon, CFP, CMFC, and the CFP Program Manager at the College for Financial Planning. The wealthy generally can afford to meet that expense out of pocket. People at the other end of the economic scale generally can’t afford the LTC insurance premiums and probably would qualify for Medicaid, anyway. People who have more modest assets, modest retirement income, especially those who have little or no family to provide care at home, and who don’t want to rely on government programs are the ones who should consider purchasing long-term care insurance.

People should begin considering LTC insurance in their 50s, even if they don’t buy it until they’re in their 60s (premiums rise dramatically after that). The first step is to determine need. To do this, an individual might find out the average cost of local nursing home care and then, with the help of a financial professional, determine what portion he or she could afford to pay annually out of assets and income and what portion would have to be covered by LTC insurance. If nursing home care runs $150 a day and the person can pay $50 of that, the policy might need to carry a daily benefit of $100.

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All health plans are not created equal. And there’s no rule of thumb for which ones are good and which ones aren’t. The best plan for one person may not work at all for another. The best plan for you will depend on just what kind of health care you need, whether you have family members and what their needs are, and a few other personal factors.

Features and options vary widely among types of plans more so than among companies providing the plans. Where things vary among companies is usually cost - depending on your personal circumstances, some companies’ rates may be less than others.

Since many people buy health insurance through their employers, that adds another variable - some employers pick up more of your health care bill than others. (Since that can add up to a bundle, that makes asking about health benefits a good idea during job searches.)

But you don’t need to be an expert, or even spend a lot of time, to figure out which plan type is best for your needs. Understanding which type of plan offers the things you want should make a decision pretty easy. Here’s a rundown of the main differences among plan types:

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Today’s youth are far more likely to be found in front of the television or the computer screen, or at a fast food spot, than they are elevating their heart rates in sport or exercise.

According to the U.S. Center for Disease Control, poor fitness, inactivity and bad diet are contributing to increasing juvenile obesity. Since 1980, the percentage of children who are overweight has doubled. This brings on a host of health and social problems that get more serious as children become adults.

Studies have shown that children who are obese frequently struggle as adults with excess weight. And before they become adults, obesity puts them at a significantly increased risk of developing juvenile diabetes, heart disease and other chronic, life-threatening conditions.

The experts currently studying the problem tie the recent rise in overweight children to factors including fast food-centered diets, a reduction in physical education demands in schools, and increased “seat time” - more computer or television time and less active playing or sports.

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While the amount of American children with health insurance increased during the first half of 2002, the U.S. Department of Health and Human Services reports that nearly 10 percent of U.S. children (aged 17 and under) remain uninsured. This means that millions of children don’t get the health care they so badly need because they have no health insurance. Without insurance, common childhood illnesses often go untreated and can impair a child’s physical and mental growth and development. Obviously, untreated illnesses and injuries can cause physical problems for children, but missing school from these illnesses and/or lack of concentration due to suffering can also highly impact a child’s mental health. In addition, some studies show that one in 10 children suffer from an emotional or behavioral problem that would benefit from treatment, but only one in five of these children receive such treatment. Many health insurance plans have a mental health component that if utilized, could really help in these cases. But again, those that are uninsured cannot benefit from this treatment.

Childhood immunizations are the most effective method of preventing children from contracting devastating illnesses and diseases. Immunizations protect not only children, but also their communities from preventable illnesses. The increasing number of safe and effective vaccines for conditions such as measles, polio and tetanus protect children from acquiring these infirmities. While state laws require children to have such immunizations complete before entering the school system, this does not mean that 100 percent of children are immunized. Children who do not have health insurance often do not receive these important vaccines, and may suffer greatly as a consequence.

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Are you a slave to the computer screen? If so, you could be not only missing out on some important aspects of learning and living, but also harming your health. And that goes double for children.

E-mail, chat rooms, Web surfing, computerized games - your home PC contains something for everyone in the family to get sucked into. But adults and children already spend hours of daily computer time just on work and education. When those hours are compounded by several more spent on computer-related leisure and hobby activity, exercise, relaxation and face-to-face communication can suffer.

We need our computers for many of life’s daily tasks. And we want them for far more uses than we can list here. (Not to mention Game Boys and their like.) But all of this entertainment comes at a cost.

One seemingly obvious link is between screen time and obesity in both children and adults. Activities like Web surfing and video game playing don’t burn calories, but they sure lend themselves to snacking. Fitness and health patterns are established when children are young, and those patterns - whether good ones or bad - often continue into adulthood. Adults juggling job and relationship stress, tight schedules and financial burdens might not recognize how much time computer use is consuming, or feel simply too busy to think about healthy computer use.

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According the latest U.S. Census data, the number of Americans without health insurance increased by 1.4 million in 2003. 45 million Americans, or 15.6 percent of the population, lacked health insurance in 2003 (up from nearly 44 million and 15.2 percent in 2002). The U.S. Census Bureau also reported that the total number of people covered by employer-based health insurance declined by more than 1 million.

All of these figures point to a disturbing fact; the problem of the uninsured in this country is getting worse instead of better.

That’s why organizations like the Robert Wood Johnson Foundation formed Cover the Uninsured Week, a now annual week that brings this issue to the forefront through intense advertising campaigns. 2004’s Cover the Uninsured Week took place May 10-16.

“This advertising campaign has persuaded opinion leaders of the serious consequences faced by millions of Americans who go without health insurance,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of The Robert Wood Johnson Foundation, based in Princeton, N.J. “We are running ads in 2004 to keep the issue of health coverage high on the nation’s domestic agenda. By reaching more than 85 million Americans with messages that underscore the seriousness of this problem, we are bolstering the growing national will to finally secure coverage for all Americans.”

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