The Morning Call

New guide lays out health care advice for all

- Elliot Raphaelson Elliot Raphaelson welcomes questions and comments at raphelliot@gmail.com.

As we all know, the U.S. health care system is very complex. No matter what stage of life you are in, it is crucial to understand your options to obtain the best care in the most cost-effective way. Philip Moeller, author of the popular “Get What’s Yours” series, has a new book that will prove invaluable.

“Get What’s Yours for Health Care: How to Get the Best Care at the Right Price” (Simon & Schuster), available in early January, will help you find the best health insurance, top-quality physicians and hospitals in the most cost-effective way. You will get a better understand­ing of the health care you need and what it really costs. You will learn how to reduce the cost of prescripti­on drugs and how to handle your medical debt.

The book covers many aspects of private health insurance coverage and useful details about deductible­s, copays and co-insurance. High deductible plans are covered, and the many tax advantages of health savings accounts, including after you retire.

The book outlines the 10 essential benefits all plans must cover under the Affordable Care Act, as well as the six health conditions they must cover. The difference­s among the four types of ACA plans are discussed, and the tax benefits of ACA are identified.

The Veterans Health Administra­tion covers about 9 million veteran enrollees, providing services at 170 medical centers and 1,100 outpatient clinics. Studies find VA care is regularly comparable or even superior to private care, and often less expensive. VA eligibilit­y categories depend on service records. Eight priority groups are identified specifying eligible benefits.

The book covers all components of Medicare, including whether you need it. No one is required to get Medicare. If you continue working after

65, your options are discussed. Medicare Advantage (MA) plans, offered by private companies — also known as Part C, which must include all the features of Original Medicare (including Parts A and B) — are discussed. Advantage plans, which include some benefits not offered by Original Medicare, now account for more than 35% of Medicare coverage.

Although traditiona­l Medicare does not provide health coverage outside the U.S., some Medicare Advantage and Medigap supplement­al plans do provide emergency coverage up to $50,000.

Prescripti­on drug coverage can be a complicate­d topic. The book will give you a good understand­ing of the rigid rules associated with the timing of enrollment.

Medicaid has surpassed Medicare as the government’s largest health care program. This has happened because of the ACA expansion incorporat­ed by a majority of the states. Eligibilit­y and coverage rules vary by state. Medicare does not cover nonmedical care that disabled and older people need, such custodial care, referred to commonly as long-term care. The eligibilit­y requiremen­ts associated with Medicaid regarding income and assets are complex. You should consider the guidance of an elder care attorney or an attorney with expertise regarding Medicaid regulation­s.

You will learn how to build a personal health team to support you and execute documents on your behalf. You will learn how to use a long-term profession­al care team made up of specialist­s, clinics and physicians. The book has great advice on finding reliable rating services to identify the best-quality providers, accurate pricing informatio­n so you can shop for cost-effective doctors, procedures and prescripti­ons, and which tests and procedures are actually necessary.

“Get What’s Yours for Health Care” contains valuable appendices, such as centers of excellence, by category of treatment; top-rated preventive care measures; and most reliable rating sites for doctors, hospitals and nursing homes.

You will find this book essential for making intelligen­t health care decisions for all your family members.

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DILOK KLAISATAPO­RN/DREAMSTIME

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