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  1. Going to your dentist's office Getting your teeth worked on can be risky, according to California's warning system. Some chemicals on the state's list are used in common dental procedures. "These include sedation with nitrous oxide; some root canals, crown placements or removals, dental bridge placements; tooth restorations with fillings that contain mercury; and the use of some dental appliances," California's warning says. Having a bite to eat in a restaurant Going out to eat is not a cancer-risk-free activity either, according to California. Any place that serves fries, alcohol, or some balsamic vinegars that may contain lead must also serve up this warning to customers: "Certain foods and beverages sold or served here can expose you to chemicals including acrylamide in many fried or baked foods, and mercury in fish, which are known to the State of California to cause cancer and birth defects or other reproductive harm." Acrylamide, the chemical that California's worried about in coffee, is found in some foods cooked at high temperatures. But again, the Food and Drug Administration says the levels of the chemical in foods like fries or crackers are much lower than the levels linked to cancer in animal studies. The state suggests residents also limit their consumption of grilled foods, since those cooking processes can also contribute to an increased cancer risk. Enjoying a day at an amusement park Amusement parks aren't all fun and games, according to Prop 65 ( https://www.p65warnings.ca.gov/fact-sheets/amusement-parks ). California cautions that exhaust from rides, lead in railings, secondhand smoke from fellow parkgoers, and greasy food could all raise cancer risk. It's true that the chemicals in those things have been found to be linked with higher rates of cancer, but you'll find all of them outside amusement parks too. Drinking alcohol Though some of California's cancer warnings seem silly, others are very sound. Scientists have known for years that the more alcohol you drink, the higher your risk may be of developing cancer in the throat, liver, breast, or colon. Cancer doctors in the US say even as little as one glass a day of an alcoholic drink can contribute to your risk of developing cancer.
  2. Being on your phone Phones aren't chemicals, so they're not on the official Prop 65 list, but the California Department of Health still warns that the radio frequency energy they emit might cause cancer. Scientific studies haven't demonstrated that cellphone radiation levels are anything to worry about in humans, though researchers have noticed some worrisome tumor growth and heart-tissue damage in rats who were exposed to cellphone radio frequency radiation, Science Friday recently reported, though the scientists weren't able to replicate the effects in mice. California residents are told to not keep their phones in their pockets and to store them away from their bed at night. The health department also suggests people use wired headphones, wireless headsets, and speakerphone capabilities instead of holding their phone up to their ear, and send more texts to avoid keeping phones close to their heads. Staying at a hotel Even spending a little time as a tourist in California can increase your cancer risk, the state says. "When you check in at a hotel, look for a Proposition 65 warning sign at the hotel's check-in desk, or a warning printed on the registration form," the state says, adding, "If you have any questions about the warning, ask hotel representatives." Not all hotels have the cancer warnings — much of the danger California is worried about in hotels comes from toxins in substances like secondhand smoke or alcohol. Drinking and smoking are both activities known to increase your risk of developing cancer, so California suggests choosing smoke-free hotels or avoiding smoking areas.
  3. Parking your car in an indoor, enclosed parking deck A concrete parking lot is not the best place for a casual, cancer-risk-free hang. "Breathing the air in this parking garage can expose you to chemicals including carbon monoxide and gasoline or diesel engine exhaust," California says on its parking-lot warning. "Do not stay in this area longer than necessary." The state insists that phrase is printed on signs in indoor parking decks or just about anywhere that people park inside. The International Agency for Research on Cancer agrees with California on this one. Diesel oil has more than 30 known components that can cause cancer — though in a well-ventilated parking deck, there shouldn't be too many fumes. Drinking coffee California warns all residents that a cup of joe might cause cancer. A judge ruled earlier this year that the warnings were necessary as coffee contains a tiny dose of a chemical called acrylamide and therefore might be associated with an increased cancer risk. The compound can form when food is cooked at high temperatures through processes like frying, baking, and roasting. Acrylamide has been linked to cancer in mice and rats when it's put in their drinking water, but only in very high doses. "In animal studies, if you give animals a very high dose of acrylamide, it may cause cancer," Frank Hu, the chair of the nutrition department at the Harvard T.H. Chan School of Public Health, recently told The Seattle Times. "However, there is no evidence that acrylamide intake is related to cancer in humans." Researchers who've for years studied coffee drinkers think those people probably aren't at any higher risk of getting cancer. Instead, the International Agency for Research on Cancer and the American Cancer Society both point to scientific evidence suggesting that drinking coffee may lower a person's risk of developing some kinds of cancers, including oral, prostate, and liver cancers. Acrylamide is in all kinds of cooked food we regularly eat, like french fries, potato chips, cookies, and cereal. There's no evidence yet that the amount of acrylamide in a cup of coffee has any detrimental health effects — in fact, you'd have to drink thousands of times the amount of acrylamide in that cup to get to those levels. It's much more likely that acrylamide in cigarettes could be worrisome for people. The California Office of Environmental Health Hazard Assessment is challenging the coffee-warning ruling, arguing there's not enough evidence that coffee causes cancer. Still, places like Starbucks in California have started pinning up signs to comply with the regulation.
  4. In California, it seems you're never far from a reminder about cancer. You can't park a car indoors in the Golden State without seeing a warning about the ways your cancer risk might spike. Earlier this year, a California judge ordered that all coffee sellers in the state must post warnings about the potentially cancer-causing effects of a chemical in coffee called acrylamide. But the ruling is being challenged by the state's Office of Environmental Health Hazard Assessment because there's no solid scientific evidence that coffee can cause cancer. Acrylamide occurs naturally in small quantities when coffee beans — and many other plant-derived foods — are roasted. And research suggests the health benefits of drinking coffee vastly outweigh the risks. California's cancer-warning policy comes from a 1986 state law called Proposition 65, enacted to protect California's drinking-water supply from toxic and potentially cancer-causing chemicals. It also mandates the state keep a master list of all chemicals known to be toxins and requires manufacturers and businesses to warn people about these chemicals if they're present in products or buildings, even in extremely small doses. There are more than 1,000 chemicals on California's warnings list, which grows every year. Some chemicals on it have been proven to cause cancer, but not all. A chemical needs to have only a one-in-100,000 chance of upping your risk for cancer to merit a written warning to consumers. "We now have so many warnings unrelated to the actual health risk posed to consumers that most people just ignore them," Democratic Rep. Kurt Schrader of Oregon said in a release this month blasting the new coffee warnings, adding: "When we have mandatory cancer warnings on a cup of coffee, something has gone seriously wrong with the process." The way cancer develops in the body is extremely complex, so a person's cancer risk isn't just about what they put in their mouth, car, and lungs — it has a lot to do with our genes and family history too. For that and other reasons, many Californians and cancer experts lament that the warnings aren't all that helpful as written. The American Cancer Society says on its website: "The Prop 65 labels only tell you that a product has something in it that might cause cancer or affect reproduction. They don't say what the substance is, where it is in the product, how you might be exposed to it, what the level of risk is, or how to reduce your exposure."
  5. There is no universal healthcare. The U.S. government does not provide health benefits to citizens or visitors. Any time you get medical care, someone has to pay for it. Healthcare is very expensive. According to a U.S. government website, if you break your leg, you could end up with a bill for $7,500. If you need to stay in the hospital for three days, it would probably cost about $30,000. Most people in the U.S. have health insurance. Health insurance protects you from owing a lot of money to doctors or hospitals if you get sick or hurt. To get health insurance, you need to make regular payments (called “premiums”) to a health insurance company. In exchange, the company agrees to pay some, or all, of your medical bills. You will get most of your care from your “primary care provider” (PCP). After you buy health insurance, you can choose a PCP who is part of your insurance company’s network. If you buy an MIT health insurance plan, you will choose a PCP at MIT Medical. Your new PCP could be a nurse practitioner or a physician. You will see your PCP when you need a physical exam or lab test, when you are sick, or if you need care for an ongoing condition, like diabetes or high blood pressure. You will usually need an appointment to get medical care. If you want to see your PCP, you will need to call your PCP’s office to make an appointment. When you call, you need to explain why you need the appointment. If you are sick or hurt, you will get an appointment very soon. If you just need a routine physical exam, you might have to wait several weeks or even a month.
  6. You can’t put a price on a beautiful smile. But you do want a comprehensive dental insurance plan at a reasonable rate. You can find a dental insurance plan individually or perhaps through your employer’s insurance coverage plan (some employers pay for all or part of their employees' dental coverage as part of their benefits package). When making your choice, it's important to consider your specific needs. Maybe you have kids that need coverage, or you’re trying to maximize the number of discounts you can get. Perhaps you’re a frequent traveler that would benefit from a large network of dentists. Regardless of whether you are buying dental insurance through an employer or purchasing an individual plan, you need a reputable insurer. Here are some of the best options for dental insurance on the market 01 Best for Family Plans: UnitedHealthOne Dental Insurance Courtesy of United Healthcare Dental coverage through UnitedHealthOne is available in both individual and employer plans, in 40 states and the District of Columbia. The company has an “A (Excellent)" rating from A.M. Best. Individual deductibles start at $50 and you will never pay a family deductible if you have more than three family members. However, plans do not include coverage for orthodontic care. Six dental plans are available: Dental Primary: $50 per person deductible. 50% for basic care after deductible. Annual maximum is $1,000 per person. Dental Primary Preferred: $50 per person deductible for basic and major services when using an in-network provider. The plan pays 35% for basic services after deductible and 15% for major services after deductible. The annual maximum benefit is $1,000. Dental Essential: $50 per person deductible for basic services with an in-network provider with no co-pay for preventive services, 50% on basic services after deductible. Annual maximum $1,000 per person. Dental Essential Preferred: $50 per person deductible for basic and major services when using an in-network provider after deductible, the plan will pay 50% on basic and 15% on major services. Annual maximum is $1,000 per person. Dental Premier Choice: $50 combined per person deductible on basic/major services with a network provider. No co-pay is required for preventive services. Basic services are 50% after deductible and 10% after deductible on major services. Maximum benefit is $1,500 per calendar year. Dental Premier Elite: $50 combined deductible for basic/major services with an allowance to use an out-of-network provider. Maximum per person is $2000 per calendar year. All other benefits are the same as the Dental Premier Choice plan. 02 Best for Families on a Budget: Delta Dental Insurance Courtesy of Delta Dental Insurance Delta Dental is the largest provider of dental benefits in the U.S., providing coverage in 15 U.S. states plus the District of Columbia. The company has an A.M. Best “A (Excellent)" rating and includes a large network with over 140,000 participating dental offices. Individual and group plans are available as well as plans through the Marketplace/Exchange. Delta Dental offers plans designed to help families on a budget with a scheduled services chart that lists fees for preventive, basic and major services upfront. Here is an overview of two individual Delta Dental Insurance Plans: DeltaCare USA: This is an HMO-type plan where you can choose a primary care dentist from the preferred provider network and see your costs upfront. There is no waiting period, and no annual maximum or deductible. There is a list of co-pay amounts for every covered procedure so you can plan for costs. Delta Dental PPO: Use any licensed dentist of your choice with added discounts if you pick a provider within the preferred dental network. Covered services are paid on a percentage basis of the rental fee. Depending on the services and your state of residence, you may be responsible for a deductible in addition to your percentage payment. 03 Best for Discounts: Humana Dental Insurance Courtesy of Humana As one of the largest dental insurers in the United States, Humana offers dental insurance plans for individuals, groups, and employers. It gives some special discounts for combining dental/vision coverage, up to $35. You can also save on prescriptions through in-network pharmacies, get discounts on glasses when you combine a vision and dental plan and receive other discounts on services including hearing exams and alternative medical treatments. Here are some of the dental plans available through Humana: Humana Preventive Plus Package for Veterans: Your choice of dentist, in-network or out-of-network. Deductible of $50 per person and $150 per family. The annual maximum benefit is $1,000. Routine cleanings and x-rays are 100% covered. Dental Loyalty Plus: Your choice of in-network or out-of-network provider, with a one-time per-person deductible of $150 or $450 per family. Benefit maximums increase yearly up to $1,500 for three years or more with the same plan. Dental Preventive Plus: In- or out-of-network dentists with a $50 per person and $150 per family deductible. X-rays and cleanings are 100% covered and there is no co-pay for office visits. Dental Savings Plus: Discounted services through in-network providers. This is a discount plan rather than insurance. There is a one-time $15 enrollment fee. 04 Best for Global Coverage: Cigna Dental Insurance Courtesy of Cigna Cigna has excellent financial strength ratings and offers three different dental plan options through its network of more than 70,000 dentists. If you often travel abroad, Cigna’s coverage is global so you won’t have to go without dental care while you are away from home. Another great thing about Cigna Dental is its preventive care coverage option, which covers 100% of preventive care. Costs are discounted when using an in-network provider. Three dental plans are available in all states with the exception of New York and Washington. Some benefits are limited or exclusions to coverage may apply based on your specific state. myCigna Dental Preventive: 100% coverage for preventive/diagnostic services with discounts available for restorative/orthodontic services. myCigna Dental 1000: Provides an annual maximum benefit of $1,000 with a $50 individual and $150 family deductible. The plan covers preventive, diagnostic and restorative services with discounts available for orthodontic work through an in-network provider. myCigna Dental 1500: This plan provides a calendar year maximum benefit of $1,500 per person with preventive, diagnostic and restorative services. Orthodontic benefits are available to all family members on the policy. 05 Best for Rewards Programs: Ameritas Dental Insurance Courtesy of Ameritas Ameritas is well known in the insurance industry as a top provider of dental insurance. The company has an “A (Excellent)" rating with A.M. Best and an “A+” rating with the Better Business Bureau. Dental plans are available to residents of all 50 states. One great thing about Ameritas Dental Insurance is its rewards program, available to policyholders who submit at least one dental claim each year with total benefits paid out below the maximum allowable. If you qualify for rewards and see an in-network provider, you also qualify for an additional PPO Bonus. The maximum rewards and network bonus accumulation is $2,000 in year one and increases to $2,900 in year five. And using a preferred provider qualifies policyholders to receive a 30% discount on out-of-pocket costs. Here are some features that come standard with all Ameritas Dental Plans: Preventive services are 100% covered including an annual dental exam and cleaning, as well as fluoride treatments for patients under 14. All plans include the “dental rewards” program. You can visit any dentist, in-network or out-of-network (additional savings are available when visiting an in-network dentist). Save on prescriptions at over 60,000 participating network pharmacies.
  7. Understanding Government Health Programs: Medicare and Medicaid In 1965, an amendment to the Social Security Act established Medicare and Medicaid. Medicare and Medicaid are both government-run programs. Medicare and Medicaid have similar names, so people often get confused about what each program covers. In some cases, people may be eligible to be covered by both programs. You also have options in coverage, which makes understanding these two programs even more confusing, but understanding the differences and how these two programs work can save you money on your health care costs. Here is a review of who qualifies for Medicare and Medicaid, what's covered with some of the key differences. Key Differences Between Medicare and Medicaid A key difference between Medicare and Medicaid is that one is primarily age-based, and the other is income based benefiting people with limited financial resources, regardless of age. Medicare is a federal government health program available to people aged 65 and older, or under 65 with certain medical disabilities or diseases. vs. Medicaid is a jointly run state and federal government health program whose eligibility is based on income rather than age or disability. Medicaid was developed to help people and families with limited financial resources get health care. Medicare applies to the qualified individual, not the entire family. Medicaid applies to the family situation, so if one member is covered, all members of the family would qualify for Medicaid. You can apply for Medicaid at any time your situation warrants it, you do not have to wait for an open enrollment period. In most cases, people who qualify for Medicaid may be exempt from the individual penalty. See the eligibility criteria below. Whereas, when you apply for Medicare outside the open enrollment period you may be penalized. Medicaid coverage and eligibility varies from state to state due to the fact that it is both federally and state managed. Medicare basics are standard. Differences in Dental and Vision Care in Medicare vs. Medicaid Medicare plans A and B do not include dental care like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices, whereas Medicaid may cover preventative dental care for adults in some states, as well as treatment in others. This varies by state but can be a definite advantage over Medicare alone. Under certain special circumstances, Medicare Part A may cover dental care if received in a hospital. This would not normally include your standard dental care. Medicaid covers dental care for children. Vision Care like eye exams, optometry care or glasses may be covered by Medicaid in most states, whereas Medicare may include a basic vision test as part of Medicare Part B coverage in the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit. Sources of Help to Understand Medicare and Medicaid Options Trying to understand all the information about Medicare or Medicaid can be very confusing. There are many programs available and making the right choice is often hard. There are thankfully many places to get free information to help you make good decisions. There are also additional programs that may be available depending on what needs you have. State Health Insurance Assistance Programs (SHIP) State Health Insurance Assistance Programs (SHIP) provide free, in-depth, non-biased, information to help people understand their coverage and government program options which can help save money. You can find out if there is a local SHIP office near you, or get contact information from the SHIP website. Understanding Medicaid Coverage Medicaid may provide free or low-cost health care to low-income individuals and families, pregnant women, seniors and people with disabilities. According to The Kaiser Family Foundation, 20 percent of people in the United States were covered by Medicaid/CHIP in 2015: Medicaid and the Children’s Health Insurance Program (CHIP) provide health and long-term care coverage to more than 74 million people in the United States Medicaid federal rules specify certain mandatory benefits and each state may choose to offer optional benefits in addition to the basics. Because Medicaid is ultimately managed by each state, the state may determine the scope of the optional benefits as well as eligibility criteria. How to Qualify for Medicaid Medicaid coverage is different than Medicare because it is based on financial eligibility and not age. The following criteria are taken into consideration when looking at qualifying for Medicaid: Income Household size Disability Family status People who may be eligible for Medicaid may include Pregnant women, teenagers living alone, parents of sick children, people with high medical costs, blind or disabled people, or low-income level families or individuals. The way the financial eligibility is determined varies by state. Some states that have "Expanded Medicaid" include higher income levels in their eligibility criteria than states who have not expanded Medicaid. This link will help you find out if your state is expanding Medicaid, and see if you qualify for Medicaid based on income or if you qualify for additional savings on health care. Examples of the Basic or "Mandatory" Medicaid Benefits Here are some examples of basic essential services that may be included in Medicaid: Hospitalization and clinic treatment Laboratory and x-ray services Doctor services, nursing services, medical and surgical dental services Family planning and midwife services Nursing facility services for people aged 21 or older Home healthcare for people eligible for nursing facility services Pediatric and family nurse practitioner services Screening, diagnosis and treatment services for persons under age 21 "Dual Eligible" Can You Have Medicare and Medicaid? People who have Medicare may also qualify for Medicaid and use Medicaid to help pay the monthly premiums and out-of-pocket expenses like deductibles of their Medicare program. If you qualify for both you are "Dual Eligible" Medigap is another form of supplemental health plan for Medicare that may help cover co-pays and deductibles if you do not qualify for Medicaid. Understanding Medicare Coverage Options Medicare provides coverage in several "parts", with different plan options. You can have Original Medicare or an Advantage Plan. You can get Medicare from the government, or through private insurance. Taking Medicare through a private insurance, such as in the case of the Advantage Plan, may allow you greater options in your care, for example, learn more about different health insurance types here. Medicare Part A covers hospital services and is usually free. However, you may pay for Medicare part A in some circumstances, for example, if you did not work long enough. Medicare Part B covers medical services, there is a cost associated with Part B coverage. Medicare Parts A and B do not cover dental care, this may be covered by an additional supplemental health insurance plan. Medicare Part C, could be a little confusing because it covers parts A and B, and may even include prescription drug costs. Medicare part C is what is known as an Advantage Plan. You may be able to get an Advantage Plan that could also offer vision and dental care. Be sure and check all your options when researching an advantage plan. Medicare Part D covers prescription drugs If you want to access a list of what Medicare may cover, you can check this list of Medicare test, service or item coverages for detailed info. How to Qualify for Medicare: Eligibility for Parts A, B, and C Medicare Part A Eligibility: You must be 65 years or older. You may qualify for Medicare if you are under 65 with certain disabilities or conditions, end-stage renal disease or Lou Gehrig's disease. If you are disabled and receiving social security benefits for more than 24 months, you may be enrolled in Medicare Part A automatically. Medicare Part B Eligibility: If you qualify for Part A, then you usually have met the same criteria to Qualify for Part B. TIP: Medicare Part B is optional so make sure and sign up for it in time or you may pay a penalty for singing up after enrollment. Medicare Part C (Medicare Advantage Plans) Eligibility: In order to be eligible for Part C, you must meet the criteria of A and B, however, you may not have: end-stage renal disease or require hospice care. You can switch from a Plan A and B to a Plan C during the enrollment period. If you wish to change out of the enrollment period, you may be penalized. Additional Resources: Read more about Medicare in An Introductory Guide to Medicare Parts A, B, C, and D or details about The Federal Poverty Level - Guidelines and charts here. Medicare Savings Programs and the Medicare Extra Help Program There are several kinds of Medicare Savings Programs that may help if you are not eligible for Medicaid. It is worth looking into these to see if you qualify. You may also be interested in looking into the Medicare Part D Low Income Subsidy for Prescription Drugs: The Medicare Extra Help program. Medicaid Facts and Information Kaiser Family Foundation's Medicaid Pocket Primer offers extensive information and a strong overview of the importance of the Medicaid program in the United States and data about the various people who benefit from coverage.
  8. If you are a senior on Medicare, you probably already know that it does not provide all the health insurance coverage you need — this is where a Medicare supplement plan, also sometimes referred to as Medicare gap coverage, comes in. There are many different plans of gap coverage you can purchase to help supplement the medical expenses Medicare will not cover. What Medicare Does Not Cover What you may not know about Medicare is that prescription benefits are suspended after you reach a certain dollar amount. This is referred to as the “Medicare donut hole.” After you reach your deductible for prescription expenses, Medicare pays for a certain percentage of your prescription drug costs — that is, until you reach the donut hole portion. This is the time frame between when Medicare stops paying for prescription care until your prescription costs reach “catastrophic” levels. Once you reach the catastrophic level, Medicare will pay 95 percent of prescription drug costs. Many seniors stop taking their medications once they reach this gap in coverage. This makes them more susceptible to illness and even death. Seniors should never be put in the position of having to choose between medicine and other necessities. You do not have to worry about being without life-sustaining prescription medications if you have proper Medicare gap coverage. Another flaw of Medicare is that is leaves seniors without important coverage for other essential services such as vision and hearing. A large percentage of all seniors who are on Medicare have vision or hearing problems. Again, here is another way where Medicare gap coverage can make the difference for seniors to be able to afford the health care services they really need. Considerations for Buying a Medicare Supplement Plan When choosing a Medigap Plan, you have 10 standardized plans to choose from (A,B,C,D,F,G,K,L,M and N) and most are guaranteed renewable for life, meaning that if you pay your premium on time, you won’t be cancelled because of any health conditions or because of age. To find the medical supplemental policy that will work best to meet your medical needs, you will have to compare and carefully weigh the benefits and options provided by each plan. Here are some of the top considerations for comparing Medicare supplemental plans: Type of Provider Plans that are Available: You will want to find out what types of provider plans are available. This is important as it will determine the healthcare professionals you are approved to see. You need to know whether you can choose your own healthcare provider or whether you must use a doctor or health care facility that is part of a HMO or PPO. Find out whether or not a referral is necessary if you have to see a specialist and if the cost is paid for by the supplemental insurance plan. Prescription Drug Coverage: Prescription costs make up a large percentage of healthcare expenses. Find out if the plan has a co-pay amount, how much it is, and if there is a deductible you can satisfy so that all your prescription costs are covered. Additional Benefits: There may be additional benefits you want that are not covered by regular Medicare. Depending on your situation, these could be very important. Some of the additional coverage options you need to find out about include coverage for hearing and vision services. Overall Cost of the Plan: A plan that provides more options to you will generally be more expensive. You will have to determine what is more important to you — freedom to choose your own services and providers or keeping health care costs at a minimum. If you compare plans carefully, you might be able to achieve a “happy medium” where you can keep costs down while still being able to have some of the provider and service options you want. Medicare gap coverage may help ease any worries you have about paying for medical care that is not covered by your current Medicare plan. You become eligible to purchase a Medigap policy as soon as you reach age 65 and are eligible to enroll in regular Medicare Benefits (Parts A & B). If you are retiring, see if your employer offers an extension of your current health care benefits to supplement your Medicare benefits. If you are still unsure of the amount of supplemental Medicare insurance you may need, talk to your insurance agent who may be able to help you find an affordable plan with the right coverage options.
  9. Trying to find the best health insurance can be a confusing process. There are several criteria to keep in mind when you make your decision including financial strength, customer service ratings, claims service, plan prices, policy offerings, coverage benefits, and provider choices. There is no one “best” health insurance company, but the best one for you will depend on the type of health insurance you need, your budget, and what is available in your area. Many health insurers offer the option of a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) Plan. An HMO has its own network of doctors who have an agreed-upon price for the health care services they provide, while a PPO is made up of pre-approved physicians that participate in the network and offer lower costs to members. Most PPO plans will also allow you to access an out-of-network provider for a higher fee. The region you live in will determine which health insurers you have access to, and coverage options vary from state to state. It can be a daunting process trying to find a health insurer that matches all your needs, but we’ve done the research to come up with a list of insurers that have a good reputation and perform well in the areas of policy offerings and plan choices. These 8 health insurers are some of the best options for health care coverage for 2019. Best for Health Savings Plan (HSA) Options: Kaiser Permanente Courtesy of Kaiser Permanente Kaiser Permanente is a trusted name in health insurance. It offers medical care through its managed care organization and a network of Kaiser Foundation hospitals and medical centers. It has won numerous customer service awards from J.D. Power & Associates and has excellent financial strength ratings. Kaiser Permanente offers health insurance to residents of Colorado, Georgia, Hawaii, Washington, and both Northern and Southern California, as well as those living in the Mid-Atlantic and Northwest regions. Its network includes more than 22,000 participating physicians. If you live in Kaiser Permanente’s coverage area, you have access to several plan options including classic plans, essential plans, and advantage plans. All plan types offer the option to add a health savings Plan (HSA) option. HSA options have an individual deductible of $5,000 and a family deductible of $10,000. Depending on the plan you choose, you have access to services like unlimited doctor’s visits, no co-pay plans, after-hours care, generic prescription drugs, and online wellness tools. 02 Best Large Provider Network: BlueCross/BlueShield Courtesy of BlueCross/BlueShield The Blue Cross Association offers health insurance coverage not only in the United States but worldwide in over 170 countries. Almost 100 million Americans have their health insurance through a BlueCross/BlueShield organization. There are 39 Blue Cross health insurance organizations in the U.S. and most have A.M. Best financial strength ratings of “A+ (Excellent)" or above. Blue Cross member s have access to plans through HMOs and PPOs. The HMO plans offer the most comprehensive plans at the greatest savings but limit doctor choices to those inside the HMO. The PPO plans, on the other hand, offer more flexibility with a great number of participating doctors. In fact, Blue Cross PPO providers are so numerous that you are likely to be close to one no matter what part of the country you live in. Blue Cross plans also give you access to HSA and FSA health savings accounts. With an FSA plan, you can save money tax-free for health insurance deductibles and other health-related expenses. The HSA plan is similar but must be used only for medically-qualifying expenses. Many people apply the funds in these plans to insurance deductibles and enjoy the benefits of lower insurance premiums with a high-deductible plan. 03 Best for Online Care: UnitedHealthCare Courtesy of UnitedHealthCare UnitedHealthCare has an “A (Excellent)" financial strength rating from A.M. Best and is the largest single health insurer in the U.S. It offers individual insurance that meets the Affordable Care Act (ACA) requirements for essential care. A real standout feature for UnitedHealthCare members is the access to online care, including the ability to order prescriptions online, speak with a nurse help hotline, and participate in online wellness programs. Members can also go online 24/7 to set up doctor's appointments, file claims, and find doctors. They even have a mobile app so you can use these resources on the go. UHC is a great choice for people who want the option to manage their health care electronically. HMO and PPO plans are available with access to healthcare savings accounts (HSA) and Flexible Spending Accounts (FSA). Member discounts are available for hearing aids, vision services (including Lasik), and smoking cessation programs. UnitedHealthCare has a very large preferred provider network of over 790,000 participating physicians. 04 Best for Employer-Based Plans: Aetna Courtesy of Aetna Aetna has an excellent reputation and is one of the largest health insurers in the U.S. It has an “A (Excellent)" A.M. Best rating and provides employer health plans to residents of all 50 U.S. states. Aetna offers affordable health insurance options that include preventive care, hospitalization, office visits, immunizations and other types of essential health care services. Members also have access to tax-free health savings account (HSA) plans. There is a large provider network, so members will be able to find an Aetna-approved provider no matter the part of the country they reside in. Network plan options allow members to see an in-network doctor or any licensed doctor, although seeing a network doctor will provide the greatest savings. There are numerous wellness programs available to Aetna members including gym memberships, weight-loss programs, chiropractic services, and more. 05 Best for Telehealth Care: Cigna Courtesy of Cigna Cigna is a global health insurance provider and offers health insurance in 12 U.S. States: Arizona, California, Colorado, Connecticut, Florida, Georgia, Maryland, Missouri, North Carolina, South Carolina, Tennessee, and Texas. It has an “A (Excellent)" financial strength rating from A.M. Best. Its preferred provider network includes more than 500,000 participating physicians. No referrals are necessary to see an out-of-network provider although greater savings are realized by using an in-network provider. Plan options, deductibles and co-pay options will vary by state. High-deductible plans are available along with health care savings plan options. Policyholders have access online to search plan network doctors, estimate costs, check claims status, and get insurance ID cards. There are several attractive member benefits including access to a home delivery pharmacy, health information helpline, rewards programs, flu shot information, and the Cigna telehealth connection program, which allows you access to board-certified telehealth providers including American Well and MDLIVE. 06 Best for HMO Plans: HCSC Courtesy of HCSC Health Care Service Corporation (HCSC) is the largest customer-owned health insurer in the U.S. It was founded in 1936 and services more than 15 million members in its operating states of Illinois, Montana, New Mexico, Oklahoma, and Texas. (Plans and coverage options vary by state.) Wellness programs are available including an online health assessment tool, smoking cessation support, weight-loss programs, maternity programs, fitness programs, and a 24/7 nurse hotline. You can choose coverage from several plan types including HMO and PPO plans. Health savings plans are available, and you can also choose a high deductible plan to help reduce insurance premium costs. 07 Best for Wellness Care: Molina Healthcare Courtesy of Molina Molina Healthcare offers health insurance to residents of California, Florida, Idaho, Illinois, Michigan, Mississippi, New Mexico, New York, Ohio, Puerto Rico, South Carolina, Texas, Utah, Washington, and Wisconsin. It insurers more than 3.5 million members across the United States. Coverage options, plan choices, and benefits vary by state. Many of its health plans come with no copays and cover these types of essential medical care: prenatal, emergency services, hospital care, vaccinations, lab tests/x-rays, prescription drugs, doctor’s visits, and vision insurance. Molina has some excellent perks, wellness care, and preventive health care services for its health insurance members including unlimited doctor’s visits, a pregnancy program for high-risk mothers, a 24-hour nurse advice helpline, vouchers for 10 weeks in the Weightwatchers program, and access to over-the-counter smoking cessation products. 08 Best for Eastern States Residents: Highmark Courtesy of Highmark Highmark is a regional health insurer offering coverage to several eastern U.S. states. Coverage plans and options will vary based on where you live. Tiered plans are available with gold, silver. and bronze options. Highmark has an Exclusive Provider Organization (EPO) plan which means you can only use the providers within the network. There are no health benefits for out-of-network providers. Preferred Plan Provider (PPO) options are also available. There is a wide range of deductible and co-pay options, so you are likely to be able to find a plan to meet your budgetary needs. Highmark offers member benefits including a wellness profile, personal health digital assistant, health trackers, a symptom checker, and other health education and information. Discounts are available to members for nutrition, fitness, vision, and hearing services, as well as travel savings. Lifestyle program services are available to members who need assistance with weight loss, nutrition, exercise, stress management, behavioral health, and smoking cessation.
  10. With individual health insurance premiums averaging about $393 per month in the United States in 2017, many people may be left wondering if affordable health insurance plans exist. Currently, the cheapest health insurance you can get is Medicaid, because it provides free or low-cost coverage to those who qualify. If you need coverage but don’t meet the qualifications for Medicaid, don’t panic. You may have other options for cheap health insurance. However, take caution before you sign up for any plan, warns health care expert Shelby George, senior vice president of Advisor Services at Manning & Napier. “The unfortunate reality today is that there’s so much jargon, complexity, and misunderstanding in the health insurance world,” she says. “It’s become just like shopping for a car. Spend the hours necessary to understand what you’re getting for what you’re paying.” Here are some questions to ask while looking for affordable health insurance plans. Can You Get Health Insurance for Free? Before you shake your head at the prospect of an unaffordable policy, figure out what you’ll actually pay. For many people, the answer may be nothing if you qualify for the Affordable Care Act’s premium tax credit health insurance subsidy—a tax credit taken in advance to lower the amount you pay for your monthly health insurance premium. To get the subsidy, you must apply for it and purchase a plan through your state’s health insurance exchange, also known as the Health Insurance Marketplace. The amount you receive will depend on the estimated household income that you put on your Marketplace application. Usually, you must make between 100 and 400 percent of the federal poverty level to qualify. If you qualify for a subsidy, the Marketplace can send it directly to your insurance company, which will apply to your monthly plan premium. In some cases, you may not have to pay out of pocket at all for health care costs. Every state has different rules and different costs, but this bears looking into before you evaluate any other alternatives. Is a Short-Term Policy for Me? On February 20, 2018, the Trump administration proposed a plan that would loosen regulations on short-term health insurance. The Obama administration had capped short-term health insurance policies at 90 days, but the new plan would allow short-term policies of up to a year. That hasn’t happened yet, but you can essentially get the same thing by purchasing a three-month policy that will renew for the next nine months. These policies do not cover you for pre-existing conditions that transpired before you purchased the policy, but if you develop a condition during the term, you’ll have coverage for it for the rest of the year, explains Nate Purpura, vice president of marketing for individual and family products at health insurance company eHealth. Short-term policies offer limited benefits compared with policies on the Affordable Care Act health insurance marketplaces offered by each state. They don’t include maternity care, substance abuse, and mental health, and can charge more at the outset for people with pre-existing conditions. But, on the whole, they cost less than comprehensive policies without a subsidy. A 35-year-old could purchase a short-term policy with a $5,000 deductible and $500,000 in total available benefits for about $100 a month. Can I Combine Health Insurance Policies? Another possibly cost-effective way to insure yourself is with a combo platter of sorts—but it could also become more complicated. You can try mixing traditional indemnity insurance, designed to pay a set daily benefit if you’re hospitalized or in an accident, with a short-term medical plan that can enable you to get to the doctor a few times a year for your more minor ailments. George from Manning & Napier noticed consumers jury-rigging these sorts of arrangements on their own, with sometimes troublesome results. In some cases, people had to file every claim with all insurers on the menu so that every possible dollar could be recouped. That became complicated, so recently, the company rolled out combo plans with single insurers to make the claims process easier. Still, Purpura notes that you have to pay particular attention to two things when choosing health insurance plans: “Is the plan medically underwritten [based on your health], or guaranteed issue?” And second, “What will it cover on a daily basis if you’re hospitalized?” Always make sure you understand what you’re getting for what you’re paying before choosing a health insurance plan.
  11. Best Health Insurance Companies When shopping on eHealth, you have the advantage of variety. Instead of searching health insurance companies one by one, and then comparing plans available from the company you choose, you get to compare and see free quotes from different health insurance companies and plans all in one place. In addition to having access to the largest private online Marketplace for health insurance, you can rest assured that you’re seeing plans from the best health insurance companies out there. Health care needs are incredibly specific to individuals, families, and small businesses, so it’s up to you what the “best” health insurance company is. Keep reading to learn about some of the top health insurance companies offered at eHealth, and visit our website where you can easily compare quotes on plans from some of the best health insurance companies in the health care industry. Top Health Insurance Companies United Healthcare: United HealthCare (UHC) was founded in 1977, and currently serves all 50 U.S. States According to the National Association of Insurance Commissioners (NAIC)’s most recent annual report UHC’s market share of healthcare is 12.75%, making UHC the top health insurance company in terms of market share. “Highest overall experience” in Arizona according to J.D. Power ranking, and ranked “among the best” health insurance companies in Texas Aetna: Named on Fortune’s “World’s Most Admired Companies” list, Aetna provides covered to about 22.1 million people If age and experience is what you’re looking for, then consider Aetna the best health insurance company in that sense—they’ve been around since 1853 Aetna’s market share according to NAIC’s report: 5.54% Ranked as “better than most” for J.D. Power Member Satisfaction Index Ratings in Florida Kaiser Permanente: Founded in 1945 in Oakland California, Kaiser Permanente has grown to become the largest managed care organization in the U.S. Kaiser’s market share according to NAIC’s report: 7.37% According to J.D. Power rankings, Kaiser ranks the highest in six regions: Maryland, South Atlantic, California, Virginia, Northwest and Colorado Anthem: With 40 million health plan members, Anthem is the largest for-profit managed health care company within the Blue Cross Blue Shield Association, placing it among what some might consider the best health insurance companies Anthem’s market share according to NAIC’s report: 6.07% Anthem BlueCross BlueShield (Blue Card) in Massachusetts was ranked “among the best” for J.D. Power Member Satisfaction Index Rankings Humana: In the 1960’s Humana was a small nursing home company, but twenty years later, broke into the health insurance business. Humana has been ranked #1 in Fortune’s “Social Responsibility” category. Humana’s market share according to NAIC’s report: 5.46% Ranked “better than most” in Florida for J.D. Power’s Member Satisfaction Index Rankings Cigna: Cigna was founded officially in 1982, but traces their roots back 200 years with the Insurance Company of North America (INA) Cigna’s market share according to NAIC’s report: 2.49% Ranked “among the best” in Florida for J.D. Power’s Member Satisfaction Index Rankings Blue Cross Blue Shield: Setting it apart from the other top health insurance companies on this list, Blue Cross Blue Shield (BCBS) is actually comprised of 36 independent and locally operated health insurance companies If you put your trust in volume, then you may consider BCBS to be among the best health insurance companies, with 106 million plan members insured under this umbrella company BCBS’s market share according to NAIC’s report: 1.69% (This share is representative of BCBS in California only, which holds the most significant share compared to BCBS in all other states) The sum of Blue Cross Blue Shield and all of it’s subsidiaries actually holds a much larger amount of the market share Ranked “among the best” for J.D. Power Member Satisfaction Index Rankings in Massachusetts. Wellcare: Wellcare was founded in 1985 and specializes in government-sponsored health care products like Medicaid, Medicare Advantage, and Medicare Prescription Drug Plans If you’re in the market for government-sponsored health care, then you’ll have a good chance finding a plan with quality care from one of Wellcare’s 571 thousand contracted healthcare providers Wellcare’s market share according to NAIC’s report: 1.28% Highmark: Highmark’s offers Blue Cross Blue Shield-branded health plans in Pennsylvania, Delaware, and West Virginia If dental insurance plays a big role for you in deciding what the best health insurance company is, then you’ll be happy to know that Highmark health insurance offers dental coverage through Concordia Dental in all 50 U.S. States Highmark’s market share according to NAIC’s report: 1.54% Highmark Blue Cross BlueShield of Delaware was ranked highest according to J.D. Power ranking HCSC: Health Care Service Corporation (HCSC) is an independent licensee of the Blue Cross and Blue Shield Association, and provides coverage to over 15 million customers HCSC’s market share according to NAIC’s report: 3.28% “Highest overall experience” J.D. Power rating for Illinois and “highest customer service” rating in Florida. Now that you know a few things about some of the “best” health insurance companies, you can start comparing products and getting free quotes for plans in your area. You’ll be able to search plans from these top health insurance companies plus others, and get free quotes from eHealth. You can always count on eHealth to offer plans from the top health insurance companies, and provide all the information and options that you’ll need to pick a health insurance plan that works for you, your family, or your small business. Visit eHealth today to start looking at plans from some of the best health insurance companies in the industry.
  12. International Vision and Dental Coverage Vision Included in the Platinum plan; Optional on other plans Included at 100% for the Platinum plan with Vision and Dental module, limits on other plans Rider Available for select plan options Dental Included in the Platinum plan; Emergency included on all other plans, non-emergency optional on all other options Accidental included; Comprehensive dental plans available, ranging from $1,250-$5,500 in preventive, basic and major services annually. Some services subject to waiting periods Accidental dental, $1,000 per year, $200 per tooth, Dental Rider available for select plan options
  13. Preventive and Office Visits Doctor Visits Included; subject to deductible, no waiting periods Included; subject to deductible if elected, no waiting periods Included; deductible waived, no waiting periods Prescription Medication Inpatient: Included Outpatient: coverage varies by plan level Inpatient: Included Outpatient: $500, $2,000, or Paid in Full Inpatient: Included Outpatient: $1000, upgrade available up to $25,000 (including contraceptives and maintenance meds, subject to qualifying period or prior credible coverage) Wellness Checkups Included in Silver plan and above after 6-12 month waiting period; Child wellness only on Silver Included with International Outpatient module (routine health checks, vaccinations, etc.), not subject to deductible, no waiting periods Included (routine health checks, vaccinations, etc.), deductible waived, no waiting periods Mental Health Silver plan and above included after 12 mo. waiting period 100% paid for Platinum, $10,000-Gold, $5,000-Silver Included
  14. Hospitalization and Maternity Benefits Hospitalization Semi-private or private rooms, depending on plan Semi-private or private rooms, depending on plan Included Intensive Care Included Included Included Maternity Included in Platinum plan after 10 month waiting period ($2500 additional deductible and $50,000 maximum lifetime benefits) 12 month wait for Gold and Platinum plans (up to $7,000 for Gold and up to $14,000 for Platinum) Immediate with Select plan, 364 day wait for maternity upgrade. Covered as any other condition to the unlimited policy maximum PPO Network Inside the U.S.: FirstHealth or UnitedHealthCare Network Outside the U.S.: Expansive network Inside the U.S.: Cigna Open Access Network Outside the U.S.: Over 1 million providers worldwide with direct billing options available, no out of network penalty Inside the U.S.: Blue Cross Blue Shield PPO (92% of doctors, 96% of hospitals participate with BCBS PPO) Outside the U.S.: GeoBlue elite contracted & profiled providers or you choose medical providers, direct billing is available for inpatient and outpatient, no pentaly out of network
  15. When living abroad for an extended period (1 year or more), make sure you have the best health coverage possible to insure you and your family should you need medical care. Below you can review and compare global health insurance plans. The companies compared below offer comprehensive worldwide annually renewable health insurance tailored to the needs of expatriates, global nomads or international citizens. We have selected highly rated insurers with excellent customer service, 24/7 emergency assistance and the most extensive network of doctors and healthcare facilities. We offer three plans; each provides essential as well as more comprehensive options with additional benefits and coverage options. Compare for yourself and then give us a call - our experienced staff of insurance experts can then answer any questions that remain and walk you through the process of applying. Plan Name IMG Global Medical Insurance Cigna Global Health Options GeoBlue Xplorer Health Plans Review / Best For Affordable coverage. Good option for budget-conscious individuals or local nationals looking for private medical insurance. High-quality coverage. Best for expats, families or individuals living abroad for one or more years. Flexible plan design to lower costs. Premium level coverage. Great for U.S. citizens living abroad or internationals residing in the USA. Reduced costs if you maintain a U.S. health plan. Plan Options Bronze, Silver, Gold, and Platinum Silver, Gold, and Platinum with optional modules Xplorer Essential, Select and Premier Policy Maximum $1,000,000 – $8,000,000 lifetime per individual $1,000,000, $2,000,000 (per year) or Unlimited Unlimited Deductible Multiple options from $100 – $25,000 Multiple Options from $0 – $10,000; outpatient visits subject to a separate deductible if elected, no deductible for preventative services Multiple Options from $0 – $5,000; deductible waived for preventative care, office visits, evacuation, and prescriptions Eligibility All nationalities up to age 74 All nationalities, all ages U.S. citizens up to age 74 Renewable Annually renewable to age 75 (eligible to apply up to age 64) Lifetime renewable Annually renewable to age 84 (eligible to apply up to age 74) Coverage Area Worldwide or Worldwide excluding USA, Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan Worldwide or Worldwide excluding the U.S. Worldwide or Worldwide excluding the U.S. Home Country Coverage U.S. citizens up to 6 months; all others 12 months per 12-month policy period Up to 6 months per 12-month policy period U.S. citizens up to 9 months per 12-month policy period Pre-Existing Conditions Pending results of underwriting; Platinum immediately, other plans (excluding Bronze) after 24 months Pending results of underwriting; No waiting period if approved without exclusion, specific exclusions may be added to your plan Pending results of underwriting; 6-month waiting period (waived if there is prior creditable health coverage) Administrator International Medical Group Cigna GeoBlue Underwriter Sirius International Cigna 4 Ever Life International Rating A (A.M. Best) A (A.M. Best) A- (A.M. Best)
  16. Prevention includes a wide range of activities — known as “interventions” — aimed at reducing risks or threats to health. You may have heard researchers and health experts talk about three categories of prevention: primary, secondary and tertiary. What do they mean by these terms? Primary prevention Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples include: legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) immunization against infectious diseases. Secondary prevention Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. Examples include: regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer) daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes suitably modified work so injured or ill workers can return safely to their jobs. Tertiary prevention Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) support groups that allow members to share strategies for living well vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible. Going “upstream” To help explain the difference, take this example. Let’s say you are the mayor of a town near a swimming hole used by kids and adults alike. One summer, you learn that citizens are developing serious and persistent rashes after swimming as a result of a chemical irritant in the river. You decide to take action. If you approach the company upstream that is discharging the chemical into the river and make it stop, you are engaging in primary prevention. You are removing the hazardous exposure and preventing rashes in the first place. If you ask lifeguards to check swimmers as they get out of the river to look for signs of a rash that can then be treated right away, you are engaging in secondary prevention. You are not preventing rashes, but you are reducing their impact by treating them early on so swimmers can regain their health and go about their everyday lives as soon as possible. If you set up programs and support groups that teach people how to live with their persistent rashes, you are engaging in tertiary prevention. You are not preventing rashes or dealing with them right away, but you are softening their impact by helping people live with their rashes as best as possible. For many health problems, a combination of primary, secondary and tertiary interventions are needed to achieve a meaningful degree of prevention and protection. However, as this example shows, prevention experts say that the further “upstream” one is from a negative health outcome, the likelier it is that any intervention will be effective.
  17. Programs for individuals with Severe and Persistent Mental Illnesses (SPMI) requiring tertiary care should be informed by principles of psychosocial rehabilitation (PSR) with sophisticated medication management and behavioural interventions. In summary, PSR is a therapeutic approach to the care of mentally ill individuals that encourages each person to develop his or her fullest capacity through learning procedures and environmental supports. PSR approaches have been implemented in various tertiary care settings. One application, developed by Lieberman and others, consists of a series of psychoeducational modulesto teach social and instrumental skills (6). Wallace and others report that in a variety ofsettings, including a state hospital, the modules fulfilled their objectives, with demonstrated improvements in patients' knowledge and performance ofskills targeted by the training (7). Other applications of PSR approaches in tertiary care settings have been shown to be effective by the Boston University Centre for Psychiatric Rehabilitation (8). Links and others describe the role ofthe psychiatrist in PSR programs (9). They recommend thatpsychiatrists work with interprofessional teams in applying PSR approaches and that several key elements be established inrelation to the psychiatrist's role. These include providing expertise in psychiatric assessment and medication management; establishing, developing, and maintainingthe therapeutic alliance with SPMI individuals; and attending to the various interfaces between assessment and medication management, development oftherapeutic alliances, andrehabilitation interventions
  18. Consumer Profile Most individuals with Severe and Persistent Mental Illnesses (SPMI) can function effectively in community-based service systems with access to general hospital psychiatric units. However, several authors have identified patient characteristics that interfere with placement in community settings and may indicate a need for tertiary care (1-3). The most common behaviours are aggressiveness, noncompliance with medication, danger to selfand/or others, or inappropriate sexual behaviour. Other problems include incontinence, fire risk, suicidal risk, substance abuse, stealing, urinating or defecating in public, begging, bulimia or polydipsia, and poor orientation or absconding. Aviram and others identified characteristics of patients not ready for discharge from New Jersey state psychiatric hospitals (4). These patients were severely disabled in comparison to a discharge-ready group and required special precautions with regard to danger to others. The proportion of those completely or frequently dependent on others for personal care was substantially higher in the not-ready group. A seminal article on deinstitutionalization was published by Gudeman and Shore in 1984 (3). These authors identified 5 subgroups whose needs cannot be met by the primary and secondary mental health care system. These groups include: 1) elderly patients suffering from dementia, psychosis, and medical illness; 2) developmentally handicapped patients with psychiatric disorders, often with assaultive behaviour; 3) brain-damaged patients with loss ofimpulse control; 4) patients with schizophrenia who are chronically psychotic, assaultive, or suicidal; and 5) chronic schizophrenia patients with severely regressed behaviour. There are other subgroups (for example individuals with eating disorders, first-episode schizophrenia, or personality disorders) with specialized needs generally treated by secondary care services. Because they present significant treatment challenges, academic health science centres have an important role to play. While these subgroups may be treated appropriately in tertiary-level programs, they most often are served at the secondary-level and so are not discussed further in this review.
  19. There are some individuals with severe andpersistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospitalbased services. Increasingly, organized systems have been developed to ensure that individuals meet criteriafor tertiary care andreceive the most appropriate level ofcare. Most importantly, the delivery oftertiary care must not be tied toparticularsettings or timeframes, andlevel ofcare must be delinkedfrom model or location ofcare in order to create flexible, efficient, effective mental health services. The principal objective of efforts to reform mental health services is to improve care for individuals with severe and persistent mental illnesses (SPMI). Approaches involve increased resources for community supports and services and reduced reliance on hospital-based services, particularly services in provincial psychiatric hospitals. Organized systems ofcare characterized by accountability, a heavy reliance on case management, appropriate housing, and medication compliance are able to meet the needs of most people with SPMI, with occasional admission to a general hospital psychiatric unit to provide secondary care. However, there are subgroups who cannot be managed by primary and secondary services and require higher levels ofsupport. The goal oftertiary care services is to treat persons with problems that are complex and refractory to routine community and brief acute inpatient care. Tertiary care can be delivered by a range of specialized interventions designed to achieve change in severe, dysfunctional behaviours. Definition Tertiary care is defined as specialized interventions delivered by highly trained staff to individuals with problems that are complex and refractory to primary and secondary care. This type ofcare should require referral from secondary care. Criteria for access include the need for higher levels ofmanagement and security, staff expertise, and staff and program resources, as well as more detailed and specialized assessment and treatment. Given these criteria, there is no need to tie tertiary care to particular settings or time frames. In contrast to past reliance on inpatient settings for tertiary care, it is now possible to employ flexible strategies to maximize time in the least restrictive settings. For example, a portable tertiary care model such as assertive community treatment delinks location from level of care. Portable approaches help individuals maintain community tenure, expand the capacity ofthe secondary care system, and efficiently use tertiary care expertise. Portable tertiary care can be delivered to individuals not only in community settings but also in institutional settings such as nursing homes or general hospitals where it can assist staff to serve individuals who require complex care. Long-term care is not synonymous with tertiary care. Many long-term patients who reside in provincial psychiatric hospitals do not need tertiary care services. Provincial hospital patients who have complex but stable conditions can be supported in community settings with access to tertiary services. Level ofstaff expertise is a critical element of tertiary care. While many providers serve individuals with complex conditions, tertiary care providers have advanced training and a commitment to serve the population. Because of these requirements, tertiary care programs often are affiliated with academic health science centres.
  20. There are some individuals with severe and persistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospital-based services. Increasingly, organized systems have been developed to ensure that individuals meet criteria for tertiary care and receive the most appropriate level of care. Most importantly, the delivery of tertiary care must not be tied to particular settings or time frames, and level of care must be delinked from model or location of care in order to create flexible, efficient, effective mental health services.
  21. Secondary care Secondary care includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury, or other health condition. This care is often found in a hospital emergency department. Secondary care also includes skilled attendance during childbirth, intensive care, and medical imaging services. The term "secondary care" is sometimes used synonymously with "hospital care." However, many secondary care providers, such as psychiatrists, clinical psychologists, occupational therapists, most dental specialties or physiotherapists do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. In countries which operate under a mixed market health care system, some physicians limit their practice to secondary care by requiring patients to see a primary care provider first. This restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred. In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance. Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral. Tertiary care Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital. Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions. Quaternary care The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers. Quaternary care is more prevalent in the United Kingdom.
  22. Medical professionals frequently talk about levels of care. They're divided into the categories of primary care, secondary care, tertiary care, and quaternary care. Each level is related to the complexity of the medical cases being treated as well as the skills and specialties of the providers. Since you sometimes hear these words as a patient, their definitions can help you better understand exactly what doctors, nurses, and other medical staff are referring to. It can help you navigate the medical system and recognize the level of care you're receiving Secondary Care Specialists When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise in what is ailing you. Specialists focus either on a specific system of the body or a specific disease or condition. For example, cardiologists focus on the heart and its pumping system. Endocrinologists focus on hormone systems and some specialize in diseases like diabetes or thyroid disease. Oncologists have a specialty in treating cancers and many focus on a specific type of cancer. Secondary care is where most people end up when they have a medical condition to deal with that can't be handled at the primary care level. Your insurance company may require that you receive a referral from your PCP (Primary care providers) rather than going directly to a specialist. There are times when problems with specialty care develop. One reason may be that you have been referred to the wrong kind of specialist. For example, your initial symptoms may indicate one thing when in reality it is another condition that requires a different specialist. You may also experience problems while seeing more than one specialist if each is treating a different condition. In these cases, your care may not be fully coordinated. The specialists should work with your primary care health team to ensure everyone knows what the other is recommending. Tertiary Care and Hospitalization Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise. At this level, you will find procedures such as coronary artery bypass surgery, renal or hemodialysis, and some plastic surgeries or neurosurgeries. It also includes severe burn treatments and any other very complex treatments or procedures. A small, local hospital may not be able to provide these services, so you may need to be transferred to a medical center that provides highly specialized tertiary level services. Quaternary Care Quaternary care is considered to be an extension of tertiary care. It is even more specialized and highly unusual. Because it is so specific, not every hospital or medical center offers quaternary care. Some may only offer quaternary care for particular medical conditions or systems of the body.
  23. Tertiary care is healthcare provided in specialist centres. Consultants in tertiary care centres may have access to more specialised equipment and expertise for your condition. Referrals to tertiary services are usually made by your GP or the care professionals at your local hospital. You may find you have to travel some distance to reach a tertiary care centre. The National Hospital for Neurology and Neurosurgery in London is an example of a tertiary care centre.
  24. Secondary Care If you have a condition that a primary care professional cannot resolve for you, they will refer you to a secondary care service. Secondary care refers to services provided by health professionals who generally do not have the first contact with a patient. So for MS, you may be referred to a neurologist or MS team at your local hospital. Secondary care services are usually based in a hospital or clinic, though some services may be community based. They may include planned operations, specialist clinics such as cardiology or renal clinics, or rehabilitation services such as physiotherapy.
  25. What is secondary care? National Health Service (NHS) care is provided in two main ways: primary care (GPs (local doctor) and community services) and secondary care (hospitals and specialists). • Primary care is the first place people go to when they have a health problem and includes a wide range of professionals, e.g., GPs (local doctor), dentists, pharmacists and opticians. • Secondary care simply means being taken care of by someone who has particular expertise in whatever problem a patient is having. It’s where most people go when they have a health problem that can’t be dealt with in primary care because it needs more specialised knowledge, skill or equipment than the GP has. It’s often provided in a hospital. The GP will decide what kind of specialist the patient needs to see and contact them on the patient’s behalf to get them an appointment – this is called a ‘referral’. What do secondary care doctors do?Specialists in secondary care focus either on a specific part of the body or body system, disease or condition. For example, cardiologists focus on the heart and its pumping system. Endocrinologists focus on hormone systems and some specialise in diseases like diabetes or thyroid disease. Oncologists work on cancers.Where are secondary care doctors based?Secondary care services are usually based in a hospital or clinic rather than the community. Sometimes ‘secondary care’ is used to mean ‘hospital care’ but not all secondary care professionals work in hospitals, such as psychiatrists and some clinical psychologists and occupational therapists.What does secondary care include?Secondary care includes treatment for illness, injury or other health problem in hospital or in an outpatients’ clinic. It also includes tests and care for serious conditions. No one needs a GP referral if they need to use Accident and Emergency (A&E) for a serious, urgent problem – but many problems can be dealt with by GPs even when the surgery is closed. A small number of hospitals provide what is called ‘tertiary care’, which means the third level of care. This is where hospitals, such as Great Ormond Street for children, look after patients sent to them by other hospitals for highly specialised care.
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