Helping make the health care system work for you

Ask Impatient: Which kind of insurance is best for an out-of-hospital birth?

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Vanessa Villegas, 31, of Los Angeles, and her husband would like to start a family soon. She says she's interested in having the baby at a birthing center or at home with the help of a midwife. She asks Impatient: What type of health insurance plan would provide the best coverage for an out-of-hospital birth?

Villegas currently has a high-deductible health plan. Now that Covered California has begun its new open enrollment period, she wonders whether it would be wiser to keep this type of plan and use her Health Savings Account to pay for any birthing expenses not covered by insurance, or whether she should switch to a plan with a higher premium and lower deductible.

Before I answer her question, let's review a few facts:

  • Under the Affordable Care Act, a lot of women's prenatal care should be fully covered by insurance. Preventive tests – like those for Hepatitis C or gestational diabetes – should be covered at no additional cost, but services for diagnosis or treatment may not be.
  • Labor and delivery should also be covered by insurance. But as I reported during our #PriceCheck investigation into the cost of childbirth in Southern California, deductibles, co-pays and coinsurance could apply.

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It's open enrollment season! Are we freaking out yet?

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It's open enrollment season!

For folks who buy private health insurance or have employer-sponsored coverage, this is the time of year that they decide whether to stick with their current health plan or select a new one.

As KPCC Health Correspondent Stephanie O'Neill reported last year, there’s a lot to consider during this period, like:

  • Do you want an HMO or a PPO?
  • Do you want a Health Savings Account or Flexible Savings Account?
  • Do you want a plan with a higher premium or a higher deductible?

If your blood pressure rises just thinking about all of these options and wonky terms, then take a deep breath and read on: O'Neill has written this updated guide to surviving open enrollment. And I'm here to help answer your personal questions about choosing a health insurance plan.

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#PriceCheck: How to avoid paying for your flu shot

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Want to protect yourself and loved ones against the flu?

The best thing you can do is get your annual flu shot, the Centers for Disease Control and Prevention says. The Affordable Care Act tries to make it easy for people to follow that advice: Under the federal health law, the seasonal flu shot is considered preventive care, so it's covered at no extra cost to you.

But as with most things in health care, the devil's in the details.

When is your flu shot free?

Generally, if you have an HMO plan, you'll need to visit a doctor or facility in your insurance network to get your free shot.

Kaiser Permanente members, for example, can get the vaccine at no extra cost at Kaiser facilities.

"We believe this is important to enable us to maintain records of when our members received this preventive care, especially for our must vulnerable populations - small children, the aged, and those with respiratory issues," Kaiser spokeswoman Amy Thoma says in an e-mail.

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FAQ: The American Cancer Society's new mammogram guidelines

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The debate over when women should start getting mammograms and how often they should get them took another turn Tuesday when the American Cancer Society updated its guidelines in an article in the Journal of the American Medical Association.

The organization pushed back its suggested age that women be screened for breast cancer and made changes to how often it recommends they be tested. 

So what are the new recommendations?

The American Cancer Society now recommends:

  • Women at average-risk for breast cancer start getting annual mammograms between ages 45 and 54. That's a change from the Cancer Society's previous (2003) guidelines, which advised women to start getting screened at age 40.
  • Women get mammograms every two years after age 55, continuing that regimen as long as they are healthy and have a life expectancy of at least 10 years. The old guidelines said women should get screened annually as long as they are in good health.
  • Average-risk women of all ages should not get a clinical breast examination. This is a change from the previous guidelines, which called for periodic exams for women in their 20s and 30s, and annual exams for women 40 and older.

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A new tool to help doctors, patients weigh cancer drugs' value

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How can someone diagnosed with cancer decide which treatment is right for him? An initiative from 26 leading cancer centers aims to provide doctors and patients with a new way to evaluate the efficacy of different treatments - including an assessment of cost. 

The National Comprehensive Cancer Network – which includes facilities like the City of Hope Comprehensive Care Center in Los Angeles and the Stanford Cancer Institute in Stanford, Calif., - unveiled the tool Friday. Its new Evidence Blocks are a graphic measurement of five factors that providers and patients can consider when weighing different treatment options.

The Evidence Blocks score different treatments on their effectiveness and safety, as well as the quality and quantity of evidence supporting them. The final factor they evaluate, affordability, is not typically considered when doctors and patients discuss treatment. This measurement is an estimate of the overall total cost of a therapy, including acquisition, administration, toxicity monitoring and hospitalization.

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