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5 Tips To Get The Most Out Of Obamacare

Mon, 11/10/2014 - 12:13pm
5 Tips To Get The Most Out Of Obamacare November 10, 201412:13 PM ET

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Mary Agnes Carey

Look no farther for the top things to watch out for when shopping for health insurance on the online marketplaces.

Giorgio Magini/iStockphoto

The second open enrollment season for health insurance offered through marketplaces created by the Affordable Care Act is just around the corner. Are you ready?

Here's a quick checklist for people who don't get their health insurance at work and plan to shop for coverage on the health law's online exchanges. Enrollment starts Nov. 15, but you can start kicking the tires now.

Compare plans and prices at HealthCare.gov or, if your state has its own exchange, shop there to find out which coverage is best for you. And you may be eligible for subsidies to help pay your premium.

Keep these five things in mind as the three-month open enrollment period begins.

Shop Around: Just because you're enrolled in a policy now doesn't mean it's the best deal for you next year. If you're currently in the federal marketplace and don't take any action, you'll be re-enrolled in the same plan. Federal officials, as well as many analysts, are urging consumers to go back to the exchanges to compare plans and prices. You might discover that you have more — or different — choices than you had a year ago.

Don't Get Billed Twice: Insurers have expressed concerns that if a consumer changes plans, problems with the federal website might keep insurers from learning of the change and consumers could get billed for both plans. "It's an issue we're aware of, and we're working with exchange officials to make sure there's a solution for consumers," said Clare Krusing, a spokeswoman for America's Health Insurance Plans, an industry trade group. Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said insurers will get lists of individuals who have been automatically enrolled into their current plan as well as those who chose to re-enroll. He also said the agency is "examining options" on how to provide insurers the names of people who picked another plan during open enrollment.

Just in case, keep proof of payment to answer any billing questions, and once you've cancelled the old policy, watch your credit card statements, or, if the payment was deducted directly from a bank account, watch those charges to make sure you aren't paying for two policies. And don't cancel your current insurance until you have confirmation from your new carrier that you're covered.

Find Out If You Qualify For Financial Help: Enter your most up-to-date income information on HealthCare.gov or with your state exchange to see if you are entitled to receive a tax credit toward the cost of your health insurance. Even if you are like the majority of those enrolling in marketplace plans who receive a subsidy, update your income to make sure you get the correct amount next year. This is important because if you get too much of a subsidy, you'll have to repay it when you file your taxes the following year.

Know All Costs: It's not just the monthly premium that will cost you. Understand a policy's out-of-pocket costs, things like copays, co-insurance and deductibles, before you enroll. The health law allows out-of-pocket maximum caps of $6,600 for an individual policy and $13,200 for a family policy in 2015, but some of your health care expenses — including out-of-network care — might not be included in that cap.

Confused? Get Help If You Need It: There are several ways to get help. Work with a local insurance agent or broker. Find one of the law's trained navigators or assistors. Or call the federal consumer assistance center at 800-318-2596 for a hand or to find out if you are eligible for a subsidy. Folks there can also help you enroll in a health plan or, if you qualify, Medicaid, the federal-state program for low-income people.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Combining The DNA Of Three People Raises Ethical Questions

Mon, 11/10/2014 - 3:03am
Combining The DNA Of Three People Raises Ethical Questions November 10, 2014 3:03 AM ET Listen to the Story 8 min 28 sec   Daniel Horowitz for NPR

In a darkened lab in the north of England, a research associate is intensely focused on the microscope in front of her. She carefully maneuvers a long glass tube that she uses to manipulate early human embryos.

"It's like microsurgery," says Laura Irving of Newcastle University.

Irving is part of a team of scientists trying to replace defective DNA with healthy DNA. They hope this procedure could one day help women who are carrying genetic disorders have healthy children.

"We are talking about conditions for which there is currently no cure," says Dr. Doug Turnbull, a professor of neurology at Newcastle University who is leading the research. These mitochondrial diseases are caused by hereditary defects in human cells.

"Mitochondria are like little power stations present in all our cells," Turnbull says. These power stations provide the energy that cells need. If the mitochondrial DNA is defective, the cells don't work right. The cells in effect run out of energy.

"I see the anguish of the families in every clinic that I do," says Turnbull. The severity of the disease can vary, with some families seeing their babies die in the first few hours of life. For others it can be a slow, progressive illness often leading to an early death.

Mitochondria have their own DNA, separate from the DNA that helps control the color of our eyes and hair, the shape of our noses, and how tall or smart we are. The mitochondrial DNA is passed down from mothers to their children.

Replacing defective mitochondrial DNA with healthy DNA might prevent these diseases from occurring. And that's exactly what Turnbull and his team want to do: DNA transplants.

The Delicate Art Of DNA Transfer

Newcastle University scientists perform DNA transplants on very early embryos. The scientists hold the embryo very still with the tip of a pipette, left. They pull out the nuclear DNA of a mother and father hoping to have a healthy baby. It's then inserted into the embryo of a donor with healthy mitochondrial DNA. That embryo has had the rest of its DNA removed.

Newcastle University scientists perform DNA transplants on very early embryos. The scientists hold the embryo very still with the tip of a pipette, left. They pull out the nuclear DNA of a mother and father hoping to have a healthy baby. It’s then inserted into the embryo of a donor with healthy mitochondrial DNA. That embryo has had the rest of its DNA removed.

Credit: Newcastle University

But the idea of scientists manipulating a human being's DNA in this way is very controversial. It would be the first time genetic changes have been made in human DNA that would be passed on, down the generations, through the germline. Any baby born this way would have genes from three different people.

One of Turnbull's patients is Victoria Collins. She comes from a family that has had trouble having healthy babies for generations.

"My grandma had twin sisters who both died as babies," says Collins, 37, who lives in County Durham. "One died at 13 days old and one at 6 months old." Their little bodies just wasted away. "No matter how much food the babies were getting, the nutrients just weren't getting through to the body," Collins says.

Collins would like to have children, but like other women in her family, she has defective mitochondrial DNA. "It's always in the back of my mind that I could pass on mitochondrial disease to a child of mine," she says.

To solve that problem, scientists recruit women with healthy mitochondrial DNA to donate eggs. Next, the researchers fertilize the egg, creating a very early embryo. Then they carefully remove all of the DNA in the nucleus, leaving behind only the healthy mitochondrial DNA.

The scientists then add in nuclear DNA from an affected couple's very early embryo. The result is an embryo with the healthy mitochondrial DNA of the donor and the nuclear DNA of the mother and father.

The British scientists are waiting for government approval for the next step — transferring an embryo made this way into the womb of a woman trying to have a healthy baby.

Shots - Health News Proposed Treatment To Fix Genetic Diseases Raises Ethical Issues

"A lot of people find that very troubling," says David King, a molecular biologist who runs Human Genetics Alert, a British genetics research watchdog group. "It speaks to something very deep and emotional in the human psyche about how human reproduction is supposed to work."

King worries that scientists could make some kind of mistake as they are doing the transplant.

"You're making changes which we may not know the actual consequences until that person is born, which could include damaging effects on that person's health," King says. "And then those problems would be passed down the generations to that person's descendants. And obviously that's something that you don't want to do."

Allowing scientists to tinker with human DNA for a medical reason, King says, could open the door for doing this kind of thing for other reasons.

"That's something that can potentially lead to this future of designer babies and consumer eugenics — whereby people will be able to purchase for their children sort of genetic enhancements of certain characteristics like athletic ability or intelligence," King says. "It will be absolutely socially disastrous for our society."

Despite these concerns, the British government is moving toward letting mitochondrial DNA transfers go ahead. Dr. Sally Davies, England's chief medical officer, dismisses the worries about designer babies and children with three genetic parents. She likes to compare the procedure to changing the battery in a car.

"It is all about changing the battery so it works, so you're healthy," Davies says. "The child will have the characteristics any other child would have in that family: intelligence, looks, behaviors, whatever. The only thing different would be those 37 genes in each mitochondria."

For her part, Victoria Collins isn't worried about having a baby with a few dozen genes from another woman.

"You've got this desire to be a mother. And you ultimately want your child to be healthy," Collins says. "So it would give us peace of mind, really."

Science A Potential But Controversial Fix For Genetic Disease

The British Parliament may vote on this by the end of the year. If so, the Newcastle scientists hope to do their first DNA transplant sometime next year.

In the United States, scientists are working on a similar technique using eggs before they are fertilized. They have used the technique in monkeys, but they are a long way from getting approval to use the procedure in humans.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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