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Beth Cox Report: December 2013

Dear Loyal Readers, Authors, and Publishers,

As the end of 2013 closed in, I embarked on adventures in health care under America's new system.

It was a minor ordeal. Sometimes the website wouldn't work at all. Then it would not accept my identity. I had to try and fail repeatedly to assure the government that I was, in fact, me. After I made several attempts, the website directed me to a phone number for a third-party service that I could call to verify my identity, and I gained the ability to shop in the health care marketplace.

(If the phrase "verify your identity" rings alarm bells in your head, that's because it appears in countless spam, scam, and phishing emails. To be safe, NEVER click on links in any email, and always visit the website by typing the URL directly into your browser).

My effort paid off, because after a comparison of costs and benefits, I learned that my old health insurance charged a platinum level premium for bronze level coverage. I've switched plans; my premium remains about the same, but my deductible is now $0 instead of $3000.

I am emphatically not an expert on these matters, but I'll offer some basic definitions for anyone new to shopping for health insurance. This is only a smattering of terms; to learn more about the industry's jargon, and how to interpret it when selecting a health care plan, I recommend browsing the glossary at

Deductible: "In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses." (quoted from Wikipedia)

I learned about this the hard way under my old insurance policy with a $3000 deductible. When I had a brief hospital visit a couple years ago (don't worry, it was nothing serious), the total bill was over $7000. I had to empty my bank account for $3000 of that; the insurance company picked up the rest. The memory of that cringe-inducing expense is the biggest single reason when I'm switching health care insurance providers.

Copayments: these are small, fixed fees that the enrollee must pay for each doctor visit or prescription pickup. In my new plan, I agree to provide a co-pay of $4 every time I pick up my medication (assuming it's a generic drug), $20 every time I visit my primary doctor, and $70 every time I visit a specialist doctor.

Coinsurance: this is often confused with, or used synonymously with co-payments. In the marketplace, coinsurance is expressed as a percentage, from none at all to 50%. What it means is that, after the enrollee has paid their deductible, they must still pay this percentage of all health care costs, up to the out-of-pocket maximum.

Balance billing: most health care insurance companies have contracts with "preferred providers" - these are the doctors and hospitals that enrollees are expected to use. If an enrollee goes to a different health care provider instead, and the out-of-network provider charges more for a given service than the health insurance company permits (the "allowed amount"), then the enrollee will be typically expected to pay the difference, a practice called "balance billing."

Incidentially, this is why I opted not to get a health care plan with dental coverage. A plan with dental coverage would have required going to a new dentist, rather than the local dentist that I know and trust.

Out-of-pocket maximum: also known as "out-of-pocket limit", this is the maximum amount money that the enrollee can be compelled to pay in a given year; after this point, the insurance company must pay 100% of health care costs for that year. Certain things are excluded from this limit, including premiums, balance-billed charges, or health care not covered by one's plan. The site expressly warns, "Some health insurance or plans donít count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit."

Be particularly wary of whether or not your chosen health care plan counts coinsurance toward the out-of-pocket limit. Why? Because if you get sick with cancer or another expensive disease, the cost of treatment can potentially be in the millions. If you're responsible for 10% coinsurance of $1 million, and your coinsurance isn't bound by your out-of-pocket limit, then you're on the hook for $100,000. Staggering numbers like this are why medical bankruptcy is the single most common type of bankruptcy in the United States.

On a more cheerful note, here's the December Link of the Month! It's a site called Khan Acadamy:

Khan Academy is, in many ways, the ultimate educational website. It offers bite-sized instructional videos about math, biology, chemistry, physics, finance, history and more, as well as interactive challenges, assessments, and randomly generated math problems tailored to whatever one wants to practice.

Best of all, Khan Academy's resource are completely free to anyone and everyone - students, parents, coaches, tutors, and teachers. Anyone with access to the web can learn from these world-class teaching materials, or use them to instruct others!

I'll wrap up the year with the Review of the Month, which is about the drastically changing business of news in an era when digital transfers of information are fast eclipsing print:

Out of Print
George Brock
Kogan Page USA
1518 Walnut Street, Suite 1100
Philadelphia, PA 19102
9780749466510 $24.95

Out of Print: Newspapers, Journalism and the Business of News in the Digital Age examines the past, present, and future of the journalism and periodical industry. A brief survey of journalism's history and evolution leads toward modern transformations that are forcing people to rethink how journalism can be accomplished, both ethically and profitably. As newspaper and magazine subscriptions crumble and website hits rise, the growing ubiquity of digital technology demands a change in business models. "This does not mean that 'print' will die. It means that the business model for daily newspapers is in trouble and that trouble is most acute for general-interest newspapers. What applies to the time-sensitive, advertising-dependent economics of newspapers does not automatically apply to books, directories or magazines. All supply different demands in different ways." Out of Print also examines multiple recent scandals that have been undermining journalistic credibility, notably the phone-hacking scandal that blackened the reputation of Rupert Murdoch's media empire. The pros and cons of possible future revenue sources are also weighed, from digital "paywalls" (which tend to be effective only for online publications with specific data that people crave and that cannot be easily replicated, such as sports statistics), to advertising-dependent models, to philanthropic giving, to public funding or tacit governmental support. Out of Print is a "must-read" for anyone in today's journalism or periodical industries, and is worthy of the highest recommendation for public or college library Media Studies shelves.

Every month it seems as though more and more of the world is going digital. Books, music, movies, video games, social media - if it can be reduced to bytes of information on the World Wide Web, then it will be. Unlike my father, I believe that print media will never completely go away. However, it's clear that the publishing industry as a whole will have to adapt or die. Amazon has experimented with including a free ebook version of the print books it sells; this may be one step closer to the way of the future.

That's all for the December 2013 Beth Cox Report. I hope you have a happy new year!

Bethany Cox
Managing Editor
The Midwest Book Review

James A. Cox
Midwest Book Review
278 Orchard Drive
Oregon, WI 53575-1129
phone: 1-608-835-7937

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