I visit a doctor once a year at the most, and I hardly require prescription medicine. The cost of my health insurance premium is about $800 this year for my HMO plan. My employer pays a larger percentage of the total premium, but the prices increase each year by a percentage much higher than inflation. A similar HMO plan, if I were to quit my job and buy individual health insurance in New Jersey, I would pay more than $800 a month, though there are less expensive options.

I’m lucky I don’t have any dependents.

The more individuals in the world with access to good and affordable heath care, the healthier the world will be in general, so I am in favor in reform that brings better care to more people. While reduced costs for me would be nice, that would be just an ancillary — and selfish — benefit. Will any of the various sets of proposed legislation succeed? I don’t know anyone who can answer that question with any sort of definitive answer. Health care is a monster, a complicated system with many moving parts that won’t be fixed right away.

The Congressional Budget Office released their cost estimates for the version of the legislation that is up for a vote within the Senate Finance Committee, and the numbers look better than expected: The bill would could $829 billion over ten years and actually reduce the budget deficit by $81 billion over the same time period. This bill doesn’t include a government-run plan, but it also leaves more people uninsured than some would like.

This legislation has a long way to go. The version of health care reform offered by the Senate Finance Committee needs to be combined with the version being considered by the Senate Health Committee. The Senate then needs to vote on and pass a bill. The House of Representatives also needs to vote on and pass its version of the health reform bill (H.R. 3200). Eventually the bills that pass both the House and the Senate need to be combined, voted on, passed and presented to the President.

None of this will happen without more changes and compromises, and even then it may not gain the votes needed to succeed.

Please share your thoughts and join the discussion. What issues should health reform address? What are your experiences with health care?

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Friday Discussion: The Need for and Cost of Health Care Reform

It’s been a while since I’ve taken the pulse of our readers on a hot topic, so I figured it was time. I’ve been paying closer attention than usual to the various proposals in Congress dealing with healthcare and health insurance reform, and I’ve made a list of the different things they’re trying to tackle. (You’ll notice there’s nothing in the list about assisted suicide or bureaucrats deciding who lives and who dies… that’s because nobody is proposing anything of the sort.)

So, press “Yay” on the things you want to see change in America, and “Boo” for those that aren’t important to you. If you think the state of healthcare in America is just fine the way it is, and you’re happy with healthcare costs rising three times as fast as wages, then by all means press “Boo” for everything on the list.

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What’s Important to You in Healthcare Reform?

When I write about advocating for the consumer when he or she is in debt, I usually receive a good amount of feedback blaming the consumer for his or her situation. Yes, in many cases, households fall into debt because they buy more things they cannot afford, whether knowingly or unknowingly. In many cases, they ignore their own financial condition without worry for their future or while knowing that a declaration of bankruptcy can save them when life gets rough.

Not everyone falls into these categories, I remind the critics. Medical emergencies are expensive and cannot always be adequately planned for in advance. Credit card debt maybe the only option, or sometimes just a slightly better option that financing your bills directly from the hospital. Here is one example from the New York Times:

Mr. Kupka has multiple sclerosis. The Kupkas, who live in Lindstrom, Minn., have an annual income of $45,000 — a combination of her salary as an office manager and his disability payments. More than 20 percent of that income goes toward health care. Their annual insurance premiums total $5,400, and then there’s the $4,000 Mr. Kupka spends on drugs, doctor’s visits and lab fees before he fulfills his policy’s deductible.

In the three years since Mr. Kupka’s disability forced him to stop working as a mental health therapist, he has accumulated $12,000 in debt. “It’s frustrating,” he says. “We earn too much to qualify for state and county assistance, but not enough to stay ahead of the bills. I’ve thought maybe my wife and I should get divorced. But not only is it against our faith, it turns out it wouldn’t help…” [A]s Mr. Kupka’s situation illustrates, it’s not just uninsured patients who rack up large bills. Nearly two-thirds of those with debt problems… had health insurance.

The article offers tips for dealing with insurmountable medical expenses:

• Confront, don’t ignore, your situation. If you don’t pay your bills and the hospital decides to use a collection agency, your hardship will increase. Your credit report and credit score will be adversely affected.
• Review your bills. Health providers make mistakes on bills all the time, but many errors are not caught. Some procedures or services may have several names, identical is everything except price, so it helps to work with a medical expert if you have any questions. You can also resubmit your bills to your insurance company if coverage is denied. If you are still not satisfied, your bills may qualify for a third-party review.
• Hire an expert. The article suggests working with the Medical Billing Advocates of America to find a qualified mediator to negotiate between yourself and the health care provider.
• Don’t use a credit card. If you can help it, avoid paying your bill on a credit card if you can’t pay off the balance quickly. Interest charged for your use of someone else’s money will increase your debt. Watch out for credit cards offered by a hospital with immediate approval. These are like store credit cards; they might offer a 0% interest rate up front, but you might fall into a trap and owe much more interest than they’ll tell you when they’re busy saying, “You’re approved!”
• Don’t let debt collectors take advantage of you. Know your rights for dealing with debt collectors in your state. They may only call you during certain hours, they may not harass you, and they may not threaten you. If they break the rules, you can file a complaint with the Federal Trade Commission.

Situations deteriorate faster if you do not have health insurance. Find a way to get covered if you are not a member of plan yet.

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Medical Bills, Even if You Have Insurance, Can Cause Frustration and Debt

A former high-powered, strongly motivated boss of mine did not believe in sleep. In order to be the best in the world at what we do — and this was the goal, no doubt — sleep is an obstacle to be overcome. I disagreed, as it seemed to me at some point, bodies and minds will find what they need whether or not you try to control them.

While he was in his office until four in the morning many nights, trying to work, I was getting the sleep I needed to be effective during waking hours. Our disagreements about this as well as some other philosophies of life eventually led to my departure from the organization.

Scientific studies have long proven the importance of a good night’s sleep, but there’s some new research that links sleep deprivation and serious illness.

A 2008 research project at the University of Chicago’s medical school kept young, healthy volunteers awake for all but four hours a night for six nights running. The result: The levels of subjects’ hormones shifted – in particular a hormone called leptin that affects appetite. They became ravenously hungry, scarfing down pizza and ice cream long after they would have felt full normally, and their blood sugar shot up to pre-diabetic levels – an ominous result after less than one week of inadequate sleep.

…[T]he World Health Organization (WHO) has gathered data from around the globe showing that sleep deprivation depresses the immune system, to the point where WHO is considering labeling chronic sleep deprivation a carcinogen, comparable to tobacco and asbestos.

Sleep deprivation also results in an overestimation of health; people deprived think they have more control than they do.

One experiment at U. Penn’s medical school kept subjects up until 4 A.M., woke them at 8 A.M., and then gave them a series of tests designed to measure memory, alertness, and the ability to react quickly to new information. The researchers were startled to find that subjects’ mental acuity declined markedly after just one night and kept dropping with each successive night of four hours’ sleep. Even more worrying: The study’s volunteers were unaware of their impairment. One woman, so fatigued that she could barely say her name, was nonetheless certain she was able to drive home.

In addition to these studies, entrepreneurs surveyed about their sleep habits have claimed to come up with many of their ideas while asleep. So it seems that sleeping is good for business.

Here are five free ways to improve sleep and five more free ways to improve sleep. Get Rich Slowly also has a brief guide to better sleep.

Make Sleep Work For You, Anne Fisher, Fortune Small Business, August 25, 2008.

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Sleep Makes You Healthier and Smarter

Rather than firing up the central air conditioning, you can keep it off or lower its power in the heat of the summer by exploring some of these low-cost alternatives.

1. Use fans. While fans don’t change the temperature of the air, they increase air movement, which will make you feel cooler by a few degrees. Look for fans with large blades. In general, the large blades will move more air with less power and less noise.

2. Cool the air naturally. If you hang damp sheets in front of your window, air coming into your house or apartment will lower the temperature of the air as it enters.

3. Wear light colors. Black fabric absorbs heat while light-colored fabric reflects. Light-weight fabric allows your skin to breathe. Fashion aside, proper summer clothing can help keep you cool.

4. Install shades and blinds. By keeping your rooms shielded from the sun, you can avoid direct light and heat. Keep the blinds closed during the day and open the windows during the night. There are window coatings available that let in light while keeping out heat. Try searching Home Depot for heat and glare control window films.

5. Wear a cooling bandana. Here’s a stylish way to keep yourself cool. Cooling bandanas can be soaked in water and are worn around the neck. As the water evaporates your body remains cool. You can find cooling bandanas on Amazon.com.

6. Avoid chores. Forget about using the clothes dryer or the oven; these appliances emit heat, so your cooling system must work harder whenever you’re cooking or drying. While the weather is hot, eliminating strenuous chores will help protect your body from dehydration. Alcohol and caffeine should be avoided as well for the same reason.

7. Spray yourself with water. Never was a wet tee-shirt contest a better idea. Keep yourself wet with sprinklers outdoors or spritzers (water bottles with a spraying handle) indoors.

8. Leave the house. Take advantage of large businesses that must keep their air conditioners running to keep customers comfortable; take a trip to the mall. If you do stay in and run the air conditioner, however, keep the thermostat high and supplement the house cooling with fans.

Where I live, the temperature has been above 90 degrees lately, with the heat index over 100 this past weekend. I don’t have it quite as bad as those in Texas, for example, but heat makes everyone uncomfortable. As someone I knew used to say, you can only remove so many layers of clothing.

Beat the Heat Without Busting the Budget, Rodika Tollefson, LifeWire

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Stay Cool This Summer: Air Conditioner Alternatives

If you’re moving into a new neighborhood, it’s usually easy to drive around (or walk around if the new neighborhood is a city) to find amenities and stores within walking distance. If you agree that walking is a necessary exercise, the ability to walk to destinations should be a large factor when deciding where to live.

Now you can find similar information with a handy web site called Walk Score. Type an address when prompted and Walk Score will provide a map containing local grocery stores, restaurants, schools, fitness centers, and more, including walking distance from the address. The web site uses an algorithm to develop a score, the “Walk Score,” for the neighborhood.

For example, here are the results for Princeton, NJ, not my neighborhood, but nearby.

The left column shows the closest location in each category, but is expandable to show all locations within walking distance. You can compare Walk Scores between neighborhoods to help determine an optimal place to live for your exercise needs.

As you can see above, Princeton, New Jersey has a Walk Score of 85. But what does that mean? The web site provides this guide to help you interpret the numbers:

90 – 100: Walkers’ Paradise. Most errands can be accomplished on foot and many people get by without owning a car.
70 – 90: Very Walkable. It’s possible to get by without owning a car.
50 – 70: Some Walkable Locations. Some stores and amenities are within walking distance, but many everyday trips still require a bike, public transportation, or car.
25 – 50: Not Walkable. Only a few destinations are within easy walking range. For most errands, driving or public transportation is a must.
0 – 25: Driving Only. Virtually no neighborhood destinations within walking range. You can walk from your house to your car!

My neighborhood’s Walk Score is 60, an accurate evaluation of my opportunities for ambulatory errand completion.

Walking should be a strong factor in your decision. According to the Walk Score website, walking increases your health, reduces greenhouse gas, increases your social capital, strengthens local businesses, and allows for more public transportation options.

I certainly don’t walk enough as I should. I have a grocery store practically across the street from where I live. Rather than making smaller shopping trips more often in order to walk, I usually wait and make large trips less often, requiring the use of my car to transport the bags of groceries required.

This is one habit I should change for my own benefit.

What is your neighborhood’s Walk Score?

Thanks to Julia_JJ for the tip.

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What’s Your Neighborhood’s Walk Score?

In two short weeks, 2007 will come to a close. If you have money in your Flexible Spending Account when the new year comes around, and your company doesn’t offer a grace period, you will lose those funds.

A Flexible Spending Account is a savings plan offered by many employers that lets you put aside some money from your paycheck each week. The money is saved in an account held by your employer. With a Health or Medical FSA, the most common type of FSA, you can use the account for medical expenses. Either you can receive a debit card linked directly to the account for use when paying medical expenses or you can apply for reimbursement of expenses paid otherwise.

The primary benefit of these accounts is the money used for reimbursement will not be subject to income tax. However, you have to use the funds put aside by either the end of the year or by a date such as March 31, depending on your employer’s rules. Since you enroll in the FSA in the prior year, you have to predict your future medical expenses. If you have a pretty good idea of what your expenses will be, you can determine how much you’ll save through the use of an FSA account. It’s just a question of subtracting your used medical expenses from your gross income (upon which tax will be deducted) rather than your net income. This is a particularly good option if you don’t itemize your tax deductions or if your health expenses won’t reach the threshold of 7.5% of your Adjusted Gross Income to qualify.

A poor prediction means you’ll be leaving money on the table at the end of the year. If your prediction was not far off, there are still some options that will prevent you from losing the money you put away. Here is what I would suggest. Go to the pharmacist and pick up over-the-counter medication. I probably spend about $25-$35 a year on regular strength pain relief medication (naproxen). If I had a Flex account, I would stock up at the end of the year. Cold and allergy medicine qualifies as well, and the weather makes the end of the year a good time to stock up. First aid supplies qualify as well.

In many cases, the FSA can be used to cover expenses for your family members, as well. Make sure you have been reimbursed for every medical expense throughout the year by going through your receipts if you’ve kept them. Speaking of receipts, it’s important to keep documentation for all medical expenses you’ve paid, whether directly from your Flex account via a debit card or for reimbursement later. In many cases, you will be required to substantiate the qualification of your expenses.

By the way, if you end up leaving unused money in your FSA at the end of the year, that money goes back to your employer, not to you. Also, you will owe income tax on the remainder even though you won’t “receive” that income.

Note: This article is a contribution to the Money Blog Network Monthly Group Writing Project. This month, the focus is on year-end financial strategies. Here are the other articles included in the project, all with great ideas for things to think about as 2007 comes to an end.

* Time to Rebalance Your Portfolio
* Dumb Year End Money Moves
* Clearing Out Your House For Fun and Profit
* Jump Start Your Debt Reduction Using Christmas Gifts and Year End Bonuses
* Make Your Charitable Deductions Before Year End
* Grab Some Year End Bargains
* Paycheck and Witholding Calculators for Year End Money Moves

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Use Your Flexible Spending Account (FSA) Funds Before It’s Too Late

My company was offering vaccinations today for any employees wanting to gain protection from the flu this season. By the early afternoon, they ran out of vaccine and added another date a week from now to the schedule for those who did not get a chance.

I’ve never opted for the flu vaccine. It has always been my method of operation to take my chances and deal with the flu (without prescription medication) if the virus finds its way into my system. Last year, however, I had a tough time, and was out of commission more often than I would have liked. I suppose this comes with the territory of having a girlfriend whose job is to spend 8 hours a day with twenty-five ten-year-old germ balls.

I’ve always held the opinion that I shouldn’t need to introduce any more medication into my body than absolutely necessary. Not only that, but the vaccine works only against specific strains of influenza but is not very effective overall. As a relatively healthy individual, I do not have a high risk of complications from the flu, so other than missing a few days of work feeling sick, I don’t think it will hurt to skip the vaccine. Doing so might even mean that there is one more shot available for a young child or elderly individual with high risk for complications.

How about you? Will you be receiving the vaccination?

For some interesting reading, take a look and compare the information presented in the Center for Disease Control and Prevention’s Seasonal Flu information page (strongly pro-vaccination), Wikipedia’s entry on the flu vaccine (somewhat neutral and scientific), and the British Medical Journal’s Influenza Vaccination: Policy Versus Evidence (strongly conclusive against vaccination).

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Do You Get Vaccinated Against Influenza?

I’m following the CNN Money series focusing on five couples earning about the U.S. median income, $46,000 a year (couple one, two, and three). The fourth couple in the series lives in Ruidoso, New Mexico, a noisy town.

Brent Wheat is a self-employed contractor and Shawna Wheat is an office coordinator. Together, they earn the “median household income range.” With three kids and a three-bedroom house, they are doing okay according to Shawna. They have three cars, including a truck used for Brent’s business. Like the other couples, health insurance is a problem. Medical costs were high last year due to a son’s car accident, and will be high this year thanks to the same son’s braces.

Do the Wheats want to do better? While Shawna says they’re okay, she does wish they could take a trip. Looking at their expenses pie chart, they seem to be in control of most of their expenses. The pie chart in their case is based on a total of $50,000 in expenses. It’s not clear if that is the same amount as ther annual income.

It’s also not clear if the 3% ($1,500) they pay to credit cards will eventually pay down their debt, or if they build up more debt at the same time. The 9% ($4,500) of their total expenses earmarked for retirement is better than a good portion of this country. I’m sure they’d like to do better in that respect, but they could be doing a lot worse.

I think that once they get their health care expenses in check — they might have to wait until the kids are on their own — they can take that trip they’d like.

The Consumerism Commentary Podcast is in full swing with new episodes every Sunday. Listen and subscribe now!

Five Couples Living on $46k, Number 4: The Wheats

I enjoyed Matthew’s guest post last week, Cutting Down on the Cost of Razor Blades. Several commenters, including MillionDollarJourney and Dimes, pointed out the cost advantage of opting to use a decent quality electric razor. Here’s what (a different?) Matthew had to say:

I’d agree with the above comments about electric razors. I’ve had two now, each cost about $80 and lasted about 8-10 years each. I’ve never had to replace the blades and I’ve learned that when the battery dies, I can just plug it in to use it. $10 a year for shaving? Not bad at all…

Back in high school and college, I was a die hard electric razor user. At some point in my life, someone — perhaps my father — mentioned that a standard razor would be better for my face. Most notably, no more random pimples.

I wouldn’t say that my face was breaking out often back then, but one was sure to rear its ugly head right before dates and job interviews. I made the switch to Gillette Mach 3, and I’ve been paying (for the blades) ever since.

I don’t particularly think the face is any smoother now; in fact, I believe the electric razor (Norelco) provided a closer shave. I’m also not sure that there’s been any difference in the pimple department, either. I don’t go on dates or job interviews anymore. At least, not recently.

I’m thinking of going back to electric. Do you have any tips for the best razor? Or do you think I’m crazy for going back? Please let us know.

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Men: Do You Like Electric Razors?

After writing about the effect CitiBank’s new balance transfer fee has on balance transfer arbitrage, I received an email from a reader, Andy, who has an idea to take advantage of healthcare savings account (HSA) reimbursements. This is a summary of his idea.

A good way to make some extra money is to take advantage of expected reimbursements. Medical expenses are good examples. If your HSA is efficient and sends your reimbursement quickly after your claim is received, you can deposit the funds, pay the bill by credit card as late as possible, and earn interest until the bill is due later. Here’s how the time line works out:

* 1st of month. I receive a medical bill for $1,000 and immediately submit the claim to HSA.
* Likely before the 15th of month. Receive reimbursement from HSA and deposit into savings account.
* 15th of month (or first day of the next credit card statement period). Charge bill to credit card.
* 15th of following month (or several days after the end of the statement period). Receive credit card bill with $1,000 charge.
* 15th of third month (or credit card statement’s due date). Pay credit card bill using $1,000 from savings.

If you assume that you’re receiving a 1% rebate on your credit card, and your savings account earns 5% annual interest, here are Andy’s calculations, outlining two months of interest plus a rebate on the bill. None of your payments will be late.

Obviously, this is a best-case scenario and the actual return would be lower. Missing the credit card payment will negate any benefit. It’s interesting to note that if your card offers a 2% rebate, the annualized return increases to 18.25%.

What you can earn from this technique is limited by the maximum reimbursement you can receive from your HSA, but if you qualify for other employer reimbursements, you can use them to your advantage as well.

The Consumerism Commentary Podcast is in full swing with new episodes every Sunday. Listen and subscribe now!

Another Form of Credit Card Arbitrage

Just when I’m considering becoming a member at a gym to help myself stay in shape, SmartMoney publishes 10 Things Your Gym Won’t Tell You. If you’re looking for a demotivator to keep you from spending money for a membership that many find a waste of money, this article has what you’re looking for. Here are ten things about gyms that will help keep you away.

1. Most new memberships in January will cancel by April. That’s a lot of New Year’s Resolutions gone bad.
2. There is bacteria everywhere, including on the equipment and in the locker room towels.
3. Gyms aren’t equipped to handle health emergencies.
4. People don’t need any type of certification to become trainers, and they may not know much more than you.
5. They make it very difficult to quit membership. If you don’t pay, they may report you to credit reporting agencies even if you claim you canceled your membership.
6. There are catches in the fine print of the membership contract.
7. Gyms aren’t required to maintain their equipment, so there can be a danger in operating the equipment.
8. You can negotiate your membership rates by paying attention to specials offered throughout the year.
9. The lockers in which you leave your personal belongings can be robbed, and the gym is not held liable.
10. By joining or even entering a gym, you generally sign a waiver that relieves the company of any liability.

Still want to join a gym? I think I’ll work on exercising with my own equipment at home this year.

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10 Things Your Gym Won’t Tell You

Alcoholism. Depression. Heart disease due to stress. Delusions of failure.

If you’re on the path to become an investment banker on Wall Street, this is what you have to look forward to. Yes, you’ll make tons of money and your materialistic friends will silently envy you while despising you, but what use is money if you’re killing yourself slowly?

The article seems to exaggerate the situation, but I don’t know any investment bankers. So, you tell me. What’s it really like to work on Wall Street?

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Want to Be an Investment Banker? Read This.

Over the weekend, I received the annual benefits enrollment package from my employer. Last year, the health benefits offered by the company changed significantly to take advantage of Health Savings Accounts and to raise prices. Even after the multiple sessions with Human Resources, there were some of my coworkers who didn’t know the difference between HSAs, PPOs and HMOs.

The publisher of Fred Brock’s new book, Health Care on Less Than You Think: The New York Times Guide to Getting Affordable Coverage, sent me an excerpt from this book, and I’d like to share it. Presumably the book will help the reader make the most out of health insurance options at the lowest cost possible.

The excerpt is a concise glossary of some of the most relevant health insurance terms.

Before selecting a policy from an employer menu (or shopping for an individual policy), you should be certain you understand the terms used by the health insurance industry. The meanings can vary slightly among insurers, so if a number or explanation doesn’t match up with the following definitions, press the insurance provider for more details; there may be costs or exceptions hidden in the differences in jargon.

Coinsurance is the amount you must pay after your health plan’s deductible has been met. It’s usually expressed as a percentage. For instance, you might have to pay 20 percent of every bill until the total of your own payments hits your out-of-pocket maximum.

Copayment is a flat fee you pay for health-care services, regardless of how much the doctor or hospital receives from your insurance provider. Some plans, especially HMOs and some PPOs, require a copayment, usually $10 to $30 for each office visit to a doctor and often higher copayments for emergency care.

Credit for prior coverage may be something you need to prove — normally with a letter from your former insurer — if you are switching employers or insurance plans and need preexisting conditions to be covered right away. This is especially important if you are buying an individual policy, which can have a waiting period for preexisting conditions.

A deductible is the amount you must pay for your medical bills before your insurance kicks in. Usually the higher the deductible runs, the less expensive the policy is.

EOB (explanation of benefits) is a statement from your insurance company showing what it has paid and not paid for a claim. Some companies resist supplying duplicate EOBs, so maintaining an organized file of your EOBs is important if you need to challenge a bill.

An EPO (exclusive provider organization) plan allows you to use any doctor or hospital within the insurance provider’s current network, without a referral. You have no coverage, however, outside the current network even if your doctor used to be included in the plan. There can be copayments similar to those for HMO and PPO plans.

A fee-for-service (indemnity) plan is the traditional kind of healthcare policy that allows you to go to any doctor or hospital you choose. Deductibles can range from several hundred to several thousand dollars. After you have paid bills totaling your deductible, the plan usually pays 80 percent of all bills; you pay the other 20 percent up to an out-of-pocket maximum that generally runs between $1,500 and $3,000. After you have reached the out-of-pocket maximum, the policy pays 100 percent of your medical expenses. In most states, fee-for-service is the most expensive health insurance you can buy.

An HMO (health maintenance organization) is essentially a prepaid health plan. For a monthly premium, the HMO provides comprehensive care. You likely pay a copayment for office visits, but most HMO plans have no deductibles. (The exception to the no-deductible rule is an HMO that is eligible for a health savings account.) There are usually no forms to fill out or bills to keep track of. You are, however, quite limited in your choice of doctors, hospitals, and other health-care providers. You commonly must get a referral from your primary-care physician to see a specialist; if you don’t, your treatment with the specialist is not covered. Though HMOs were designed to control costs, they have been the source of many consumer complaints. These complaints were often because of coverage limitations or the fact that some doctors were compensated for denying treatment or referrals to patients or punished for providing what was considered by the HMO to be excessive treatment, although both problems have lessened in recent years. Because of their comprehensive, deductible-free coverage, HMOs often compete with the most affordable health insurance options.

An HSA (health savings account) is a less expensive, high-deductible policy linked to a tax-free savings account that can be used to pay medical bills before the policy’s deducible is met.

Lifetime maximum is the maximum amount of covered expenses your insurance company will pay in your lifetime. Look for a policy with a lifetime maximum of at least $3 million.

Out-of-pocket maximum is the amount of coinsurance you must pay yourself before an insurance policy will pay 100 percent of your bills. It may or may not include the deductible. The term stop-loss is sometimes used to refer to the point at which you have met your deductible and paid your out-of-pocket maximum.

A POS (point-of-service) plan is like a PPO except that you need a referral from your primary-care physician to see an out-of-network doctor, for which you may have to pay extra. Without the referral, you will likely have to pay the entire bill for the out-of-network physician.

A PPO (preferred provider organization) plan is a cross between a fee-for-service plan and an HMO. You can see any doctor you choose without a referral, although if the physician is outside the insurance plan’s network you will probably be reimbursed at a lower rate. For network doctors, you usually have only a copayment for office visits. There can be varying copayments — as well as deductibles, coinsurance, and out-of-pocket maximums — depending on the policy. Most plans that are eligible for use with a health savings account are PPOs with a high deductible tacked on.

These terms, of course, aren’t exclusive to individual policies. Many employers offer a menu of plans for you to select from that usually includes HMOs, PPOs, and traditional indemnity plans. Increasingly, companies are offering HSAs and dropping indemnity plans because they are so expensive.

Reprinted from Health Care on Less Than You Think: The New York Times Guide to Getting Affordable Coverage by Fred Brock. Copyright © 2006 Fred Brock. Published by Times Books; October 2006;$15.00US/$20.00CAN; 0-8050-7980-7.

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Know What Your Insurance Protects

I had written a long post on this topic, but DreamHost went down before publishing it and I lost everything. Anyway, the Christian Science Monitor has an article describing how more people are traveling out of the country for healthcare, where service is less expensive. Some small companies are suggesting, requiring, or providing incentives for their employees to avoid the expensive United States healthcare system. Here’s an example:

Garrett’s medical care alone may save [his] company $50,000. And instead of winding up $20,000 in debt to have the operations in the U.S., he may now get up to $10,000 back as a share of the savings… His two operations could cost $100,000 in the U.S.; they’ll run about $20,000 in India.

Money leaving the United States can leave hospitals without money for medical research and for services for people who cannot afford insurance. Despite this, there’s a possibility outsourcing healthcare benefit the world in the long run. Organizations like the American Medical Association might disagree.

Have you ever traveled outside the United States for healthcare? Would you consider it now? If not, what would it take for you to consider it?

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Would You Travel Overseas for Cheap Surgery?

In January, I wrote about one of my goals for this year: getting in shape. Now that I’ve posted a recent photograph of myself, you can see that getting in shape is a worthwhile issue. My lifestyle is sedentary, involving a large amount of sitting at computers and driving (commuting). My girlfriend already expressed interest in a bicycle for her birthday, so before looking for apartments today, we shopped at Sports Authority and selected one for each of us.

I think solution has the best chance of being productive. I haven’t been able to motivate myself to work less at night and wake earlier to go running by myself. She would rather bike than jog or run, so I believe bicycling will be a way for us to motivate each other to get into shape. I’d still like to get in the habit of running before leaving for work in the morning, but I’m not convinced I can gain the time to do so until I finish my masters degree.

Two new bicycles, a trunk-mounted rack for my car, and a pair of locks: $500.

Could we have saved money buy buying bicycles from eBay or Craiglist? Probably. The store provided us with a wide selection. I have short legs so the chances are low that searching used listings would have yielded me something that fits me correctly.

We didn’t have time to finish shopping. We’ll still need helmets before we do serious riding; the protective gear looks to be about $20 to $30 for each of us.

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Buying My Way In Shape

One thing that is important to remember is that parial sleep loss is cumulative. That means that if you get 30 minutes less sleeping time than your body needs each day during the week, your body will want to make up two and a half hours of sleep during the weekend, or whenever you can afford to sleep in.

In my case, there are times when I miss out on more than an hour of necessary sleep each night, building up a large deficit. When I let my body and mind recouperate, I’m missing out on time that could be spent working on projects, earning money, or doing chores that will free more valuable afternoon time when I can work efficiently later in the day.

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The Finance of Sleep Loss

This is the second and last part of a short series on suggestions for improving sleep without spending a ton of cash. I published part 1 yesterday. We’re continuing with the second half of suggestions provided by Melinda Fulmer from MSN Money. Here are the remaining tips.

6. Set your thermostat between 60 to 68 degrees. A cool, but not cold, temperature helps most people to sleep better.

I always liked to sleep with the thermostat at 72 degrees. In college, my girlfriend liked it much cooler to snuggle under multiple layers of blankets. I preferred not much covering of any kind. I’ve grown to enjoy the layers but I still prefer “freedom.”

7. Use your bed only for sleep and sex. Don’t watch television, read or fill out paperwork in bed.

I moved the computer out of my bedroom a few years ago and I haven’t had a television in my bedroom since the time my only room was a dorm. I do read in bed occasionally, but that hasn’t caused much of a problem. I often just pick up the latest personal finance book I’m reviewing and in many cases a chapter or two gets me in the mood to doze off.

8. Eliminate as much as noise and light as you can from the room. Close the blinds, turn off the TV and tell that snoring spouse to roll over on his or her side. If you have a fan, turn it on to drown out street noise.

I don’t let my girlfriend snore, and hopefully I don’t snore too much, either. When my downstairs neighbors decide to party until 5:00 am, I get them to quiet down eventually.

9. When your head hits the pillow, imagine a relaxing setting or favorite memory, rather than thinking about sleep.

I have no idea what I’m thinking about when I fall asleep. My mind wanders, and it’s usually not relaxing.

10. If that doesn’t work, try a relaxation exercise, such as tensing and relaxing each section of your body from head to toe as you breathe deeply. Or try counting backward from 100.

The counting backward doesn’t work for me, but I have perfected a relaxation exercise. It’s similar to the suggested one above, but they have the technique reversed. You must start from your toes and go all the way to your head (including down your arms when you get to your shoulders). You must tense and relax each muscle twice and picture a relaxing scene. The scene I use for myself is a beach at night. By the time I get to the top of my head, I’ve lost my sensation of gravity. It can be a very relaxing and effective technique, and usually results in floating and sinking feelings. I’ve administered it to others with much success.

I really believe sleep is important to a full-functioning mind and body. In the past, I’ve had a boss who disagreed with me completely. He was happy sleeping 2 to 3 hours each day and believed that sleep was a waste of time when that time could be better spent working on great projects that help kids and save the world.

Since then, he’s discovered that balance is needed once in a while and humans are designed to require sleep.

What techniques do you use when you’re having problems sleeping, and how much would you spend to fix your sleeping habits?

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Ten Free Ways To Improve Sleep, Part 2

I’ve never been a good sleeper. Even as far back as high school, I remember lying in bed for hours before finally drifting off and having trouble getting out of bed in the morning. This continued for a long time. College wasn’t much better, and after college it was more of the same.

I’ve used a sound machine that generates relaxing noises, such as waves or running water, and I’ve tried a sweet-smelling pillow spray. Neither of those helped.

Friends recommended melatonin. I never tried that, but I did move everything out of my bedroom except the bed. The bedroom became a room for nothing but sleep. That helped for a little while but it still wasn’t perfect.

I purchased a bed last year, and that did wonders for my sleep habits, although they are still not perfect.

Although that required spending a good (but not outrageous) amount of money, I haven’t forgotten about trying to improve my sleep further without spending much money. This article from MSN Money, has suggestions for inexpensively achieving better sleep. Their suggestions beat buying various pillows, comforters, “supplements,” and therapy, but all of the above can be helpful.

Here are the first five tips.

1. Eliminate all caffeine, chocolate and other stimulating substances in the afternoon and evening. Check with a pharmacist to make sure none of your prescription drugs are keeping you awake. Don’t drink alcohol or smoke cigarettes before going to bed.

I have heard that drinking a glass of red wine before bed will help you sleep, but this piece of advice is contrary. I would imagine drinking anything will likely activate your bladder and lead to uncomfortable sleep or waking up in the middle of the night.

2. Exercise regularly, but not within two hours of bedtime.

Excerise gets the heart racing and the blood pumping. This is better suited as a morning activity. If I could get better sleep, I could wake up earlier and get exercise. That’s one of my personal goals for the year.

3. Don’t watch loud, suspenseful television shows or troubling news reports before bed. Read a book, take a warm bath or have a glass of warm milk.

Relax your mind. Don’t go to sleep right after watching Jack Bauer blow up lots of stuff or crash planes.

4. Maintain a consistent sleep schedule. Go to bed and wake up at the same time every day. Eliminate naps.

The Sunday nap leads to sleep problems on Monday morning and Tuesday night for me. There’s not enough time during the week to even consider napping. Sometimes, after an exhausting week, I try to name a nap when I arrive home from work on Friday, but that has always turned into more of a mess.

5. Go to bed only when sleepy. Get up if you can’t fall asleep within 15 to 20 minutes.

This is a tip I picked up many years ago. The idea is to get used to getting in bed only when you’re absolutely ready to fall asleep. This works. I try to make it into my bed only when I’m sure I’m going to fall asleep within 15 minutes.

Those were the first five suggestions. For the remainder, read part 2 of this two-part series.

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Ten Free Ways To Improve Sleep, Part 1

If you and your significant other retire right now, and if you represent the “average” couple, the two of you will need $200,000 to cover health care for 20 years. This is based on research by Fidelity, a company offering, among other things, investment products for those thinking about retirement.

This amount is up more than 5% over last year’s estimated cost. Assuming this health care metric continues to rise at 5.3% each year, someone who retires 30 years from now should expect to pay over $940,000 over the same 20-year retirement period. How much are you budgeting for health care in retirement?

There is good news for the economy as a whole, but not the good news you’re expecting. As mentioned in this CNN article, the new Health Savings Account (HSA) helps ease the pain of long-term health costs. There are some interesting findings — and here’s the good news: Those who have HSAs spend more money for the same care than those without, and they tend to avoid, skip or delay treatment. Over time, we may see the average lifespan decrease due to unaffordable health care. That may be good for the system as a whole, driving down the need for expensive elderly health care, but bad for those who would like to live longer and healthier.

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Prices for Healthcare in Retirement Up

A while ago, I used to hear those “exposé” news stories present reports on the health hazards of cellular phones, usually with hints that extensive use of the devices leads to exposure to radiation (in the form of radiofrequency absorbed by the body) and possibly cancer. I was happy to see a CNET report on the issue with some details.

While research abounds and some tests have shown that cell phone radiofrequency (RF) could accelerate cancer in laboratory animals, the studies have not been replicated. Cell phones can affect internal pacemakers, but there is not conclusive or demonstrated evidence that they cause adverse health affects in humans. So in short, the jury is still out, research is ongoing, and we will continue to monitor its results.

CNET provides radiation data for around 200 phones, starting with the ten phones with the highest radiation absorption levels (Motorola is a winner here) and the ten phones with the lowest levels.

Where is your phone? My Motorola V710 is a little on the high side, with a rating of 1.4.

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Cell Phones and Radiation

On the radio this morning listen to the report), the news anchor mentioned Bush would be proposing portable health care insurance in which workers can take your benefits with you from job to job. My gut says it sounds like a way to make insurance less costly for business and more costly for individuals.

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Portable Health Insurance

One of my personal goals this year — the year I’ll be reaching the big Three-Oh — is to get into better physical shape. It’s been a goal of mine for a while, but working, driving, working more, sleeping, and seeing my girlfriend always seem to take precedence and leave me with precious little time. Since I don’t get myself out of the apartment most of the time, I’ve been considering purchasing a treadmill in order to save time by exercising while cooking.

The main problem with treadmills and other exercise equipment is that they’re big and expensive. I’ve been told that a “good” treadmill can cost more than one thousand — even more than two thousand — dollars. I was looking at a couple in the $400 – $600 range. Even at that price, I’m not sure I can justify the expenditure.

I could join the gym at work for $25 per month, but then I’d have to arrive earlier in the morning or leave later in the evening, and I already spend so much of my time there when commuting and working overtime are taken into account.

My best option might just be to concentrate on crunches and push ups — exercises not requiring equipment — and walking or jogging when the weather is nice. I’m not convinved that when I do crunches and push-ups, I’m doing them correctly.

If anyone happens to know of any great resources for starting a fitness program on a budget (money and time), I’d be happy to hear all about them.

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Getting In (Physical) Shape

Many people take advantage of employer’s flexible spending accounts. These accounts allow you to defer income which can be drawn upon to reimburse you for medical expenses. The benefit is the funds in these accounts are not considered income for tax purposes.

In order to make the best use of these accounts, you have to decide at the beginning of the year how much you will spend for medical expenses even though it’s difficult to predict unexpected problems. You don’t want to overestimate, because any funds not used at the end of the year disappear. It’s similar to throwing money away or burning hundred dollar bills without the expenditure of a match or oxygen.

The good news this year is the government is giving you extra time to apply for medical reimbursement from a flexible spending account. In most cases, your employer will also offer the extended deadline, but you may have to check with your company.

If you have money left over, there are some things you can do to spend the remainder quickly but not thoughtlessly:

* Stock up on certain non-prescription drugs (not vitamins).
* Get a new pair of eyeglasses, contact lenses, or prescription sunglasses.
* Browse a list of all covered expenses to see if anything you missed this year is eligible.

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No Need To Panic About Flex Spending Accounts

I had a frustrating morning with one of my bosses today. It was the kind of encounter where you have to get up and walk away for a few minutes to refocus. I stool in an empty conference room for some time, talking myself down from my crazy thoughts such as quitting before I had a solid offer somewhere else.

I came back to my desk after cooling down and was blessed with two things.

First was an email from the company’s automated job board with a new posting for a position I might like. I quickly fired off my resume. (There are many problems with the automated system; for instance, the listed contact person does not exist and I’ll have to find an alternative recipient for my resume. That’s just a minor snag.)

The second thing I came across was an article on Yahoo Finance called Is Your Boss Killing You? (Fast Company provided the story to Yahoo.) It’s about health, not about Executives With Knives. I can identify with some items from the article:

A study of 6,000 British male office workers over a four-year period, published recently in the Archives of Internal Medicine, found that employees who felt their supervisors treated them fairly had a 30 percent lower risk of heart disease, which is the leading cause of death in the industrialized world. Put another way, caustic, abrasive, and overbearing bosses just might be taking years off their employees’ lives.

The article suggests taking periodic short breaks to refocus, just like I had to do a little bit earlier. Generally I’m known around the office for my laid-back attitude. Stress rolls off of my like water off a duck, but only to a point. There are some things — certain attitudes towards me — that I will not tolerate. That is what made me walk it off earlier today.

Note: I don’t normally talk much about my work life. No one in my office can access this website without a browser cookie enabled, but they wouldn’t be able to find Consumerism Commentary armed with only by real name. If that were not the case, I wouldn’t be writing so frankly about the issue.

The Consumerism Commentary Podcast is in full swing with new episodes every Sunday. Listen and subscribe now!

Working Environments With High Health Risk