The costs of good health

| February 03, 2008

Dr. Ronald Rush examines driver Heath Hudlow of Jasper, Ga., at Highway Health Care in Texarkana, Texas.

When it comes to health insurance, the dream of self-employment – owner-operator aspiration among truckers – isn’t always what it’s cracked up to be.

Truckers News’ Fit for the Road program participant John Shook, as an owner-operator leased to Landstar, had what he calls “just-in-case insurance.” Shook’s wife, Jennifer, was self-employed as a mental health therapist at the time and in the same boat he was – having to shop on the individual policy market. Getting covered under her plan wasn’t an option for Shook. The couple’s high-deductible plan, he says, only helped with major expenses, though they paid $526 a month for the coverage. When they purchased the plan, long before John’s participation in the Fit for the Road program, his blood pressure was high and he was 50 pounds heavier. They’d both already been turned down for a family policy by Blue Cross Blue Shield due to pre-existing conditions. They were taking what they could get.

Such is the case for legions of Americans – in past years, as health-care costs have risen dramatically and employers, looking to cut their own costs, have increasingly made group plans optional with at least partly employee-paid premiums, costs for insurance have risen accordingly. The fewer members in any group plan, the higher the individual risk and thus the higher the cost. Optional coverage, furthermore, tends to be selected by only the most needy – read: unhealthy – individuals, and in a sort of self-fulfilling prophecy, rates rise. A profusion of large claims, combined risk spread ever thinner, drives up plan costs over time.

Today, an average company driver family plan takes $65 from every weekly check, or $260 monthly, according to National Transportation Institute data, up 3 percent from the preceding year. For individuals the numbers are better, but the rate at which they’re rising is higher.

The burden on the self-employed is perhaps the greatest. Trucking companies that both employ drivers and utilize owner-operators as independent contractors can allow contractors to buy into company-administered group plans, but the companies can’t contribute to the contractor’s membership. Rates can be as high as $1,000 a month for a comprehensive family medical plan under this arrangement, which sends many owner-operators into the individual policy market for a cheaper, limited benefit plan. There, as evidenced by the Shooks’ difficulties, often only those in good health are even eligible for something other than catastrophe insurance.

When Pennsylvania-based Joe Cummings transitioned out of an operations position at TMH Associates to go out on his own with truck and trailer in regional hauling, he elected to pay for COBRA continuation. The government program allows employees to remain covered under their old employer’s plan after employment status changes – at their own expense. Cummings paid a $340 monthly premium for the privilege.

But COBRA eligibility is temporary (18 months; 36 months for dependents in certain situations). With his wife working as a full-time waitress without company benefits, Cummings found himself calling insurance companies this past October. “I know I’m not thin,” says the 46-year-old. “At 6’3″, 260 pounds, I’m a big guy.” Not just big, according to the number crunchers at one provider – a body mass index of 32.5 qualifies Cummings in the eyes of the medical establishment as obese. The insurance company denied him coverage.

The potential for saving on insurance by reducing his own health risk was part of what motivated Shook to succeed in losing weight in the Fit for the Road program. But he managed only to slow the bleeding, so to speak. Well into the yearlong program, with his blood pressure back to normal levels and his weight greatly reduced, his insurance company informed him that “the cost of insurance had gone up,” he says. His rates, therefore, would remain the same.

Shook’s now a company driver covered under East St. Louis, Ill.-based Beelman Transportation’s group health plan at a weekly cost to him of $50. His son is covered on his plan. His wife is now the manager of a team of mental-health professionals and is covered on a company plan as well.

Cummings explored a variety of solutions to his problem, chief among them a “HIPAA Conversion” from COBRA, made possible by requirements of the Health Insurance Portability and Accountability Act. It’s meant to ensure that former recipients of group coverage can buy an insurance plan roughly comparable to their COBRA plan after it runs out, despite pre-existing conditions.

“You wouldn’t believe how many phone calls I’ve made,” Cummings says of the bureaucratic nightmare of obtaining all the necessary information. “It’s taken me about a week to figure it out.” He could retain coverage for a monthly $331 with $15 copays for office visits, though the deductible offered was high.

Cummings also looked at the potential of leasing on with a carrier to take advantage of their group plan, but as of press time hadn’t made a final decision.

According to estimates from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey, average yearly health-insurance-premium cost per family buying directly in 2002 was $4,442. For employer-provided insurance in the transport sector, the average premium cost (split between employer and employee in most cases these days) rose from $3,223 in 2002 to $4,015 in 2005. If the same 25 percent rate of increase applies to the individual policy market through 2008, average family buyers will be looking at $463 a month in premiums this year. Whether you’re an owner-operator or company driver whose carrier doesn’t offer insurance, reducing that number raises your personal bottom line. Getting healthy’s your best bet toward that goal, but quality, affordable insurance can help.

Knowing your options
The Shooks’ and the Cummings’ health-insurance solutions only begin to scratch the surface of the many routes to coverage. Some may be right under your nose, as many carriers are diversifying their health-plan options in an attempt to reduce costs while tailoring plans to drivers’ individual needs. In a cafeteria plan like Schneider National’s TrueChoices, drivers and owner-operators can pick and choose coverages – for instance, a single male driver in his 20s may choose to opt out of cancer coverage to save on the premium. Companies like Dart and Greatwide, in turn, offer multiple plan selections, and levels of coverage and investment can be considered before signing up.

If your fleet doesn’t offer insurance or if it’s just too costly, options abound. In addition to Medicare for the over-65s and Medicaid for low-income families, some states subsidize part of the cost of private insurance for citizens with pre-existing conditions or in other circumstances that make finding affordable insurance impossible.

MinnesotaCare is one such state insurance program. Brainerd, Minn.-based driver Glenn Wolf changed carriers a little over a year ago, losing group coverage for himself and his wife, both of whom had chronic medical conditions in need of regular treatment. “We just kept our fingers crossed against something major,” Wolf says, “and paid for small things out of pocket.”

But after the six-month waiting period at his new carrier was up and Wolf made moves to enroll in it, he found out the carrier’s self-funded plan would come at a $575 monthly cost. That’s when Wolf checked out MinnesotaCare, where he could get the equivalent of a quality group plan for $475 a month, he says. Contact your state’s health department to see if it has a similar program.

And if you have young children, your state’s Children’s Health Insurance Program may be an option for their coverage, depending on your income. SCHIP plans, as they’ve been called in the news media of late in coverage of the legislative and executive wrangling over budget appropriations, are meant to help families who make too much to qualify for Medicaid but who have no access to quality health insurance through their employers.

Ultimately Glenn Wolf went the route of many an owner-operator and joined his working spouse’s group plan at a monthly premium less than what he’d have paid into his own company’s plan.

One way toward quality comprehensive group coverage for owner-operators, and drivers in certain cases, is to join an association that offers participation in a health plan to its members. Local chambers of commerce often have small-business benefit programs, and some national outfits, like the National Association for the Self-Employed, offer health plans to their members.

One such trucking outfit to do so is the Owner-Operator Independent Drivers Association, whose Advantage plan is available to new members with no pre-existing limitations as long as they sign up within the first 60 days of membership. It pays specified amounts for certain services regardless of provider. Visit ooida.com, click “Benefits,” for information.

Many state and regional trucking associations partner with insurance carriers to offer group rates to members as well. The Mid-West Truckers Association (midwesttruckers.com) partners with the Associated General Contractors of America in the AGC Health Plan
(agchealthplan.com), which among other benefits offers the service of Health Reimbursement Arrangement administration. HRAs are a novel utilization of spousal insurance for the self-employed. Section 105 of the IRS code allows for a sole proprietor owner-operator who can establish an employer-employee relationship with his or her spouse, whether as team-drivers or not, to provide a medical plan to the spouse and set up an HRA spending account from which to pay medical bills for both people. All health costs can then be noted on Schedule C as a business deduction rather than as line items on your 1040, saving on self-employment, federal and state taxes. HRA administration involves a great deal of paperwork, but in addition to AGC there are a plethora of service providers out there to help. Total Administrative Services Corporation’s BizPlan service (tasconline.com) is available for $195 a year, and HSA for America (HSAforAmerica.com) offers a similar service.

An owner-operator whose business is a C Corporation can provide his or her own medical benefit and reimburse expenses from an HRA.

Otherwise, drivers on the individual policy market have decisions to make. The ideal health plan might have low copays for doctor visits, a low deductible, and low or no coinsurance (the percentage of your medical expenses you’ll pay out of pocket after the deductible is met). But premiums for a plan of this type can exceed $1,000 a month easily for a family. On the other hand, if you’re young and in relatively good health, a high-deductible plan can have a premium as low as $70. Even 25-year-olds have accidents, after all, and high-deductible insurance can save you from being saddled with a massive surgery bill.

Increasingly, though, high-deductible plans make sense for families and older individuals as well, as Health Savings Accounts enable tax-deductible health-expense budgeting of up to $5,800 yearly for a family to be deducted from taxes, representing $1,450 federal tax savings in the 25 percent tax bracket. The accounts allow for funds to roll over to the next year if unused.

The key is in budgeting for both premium and out-of-pocket expenses and having enough in the HSA to cover them. If the health plan paired with them has no copays or coinsurance, an HSA might even make sense for individuals with higher expenses. Frequent doctor visits and prescriptions will meet deductibles quickly, and the rest of the year’s eligible procedures will be covered in full.


Roadside Doctoring
Trucker-friendly clinics help ease suffering of drivers in need of health care
By Randy Grider

OK, so you have insurance or cash in your pocket for health care services – what are your choices while on the road?

Most truckers will tell you, they are few and far between.

In most places across the country, truckers’ health care opportunities are limited to urgent care-type facilities, hospital emergency rooms and local physicians – if you’re lucky enough to talk one into seeing you.

“It hasn’t been easy getting health care on the road,” says 53-year-old Wayne Helton of Memphis, Tenn., a former owner-operator who now drives for SMS Trucking of Cabot, Ark. “I’ve had to reach into my own head and pull my own teeth.”

Helton, who can recall numerous personal health emergencies during his 27 years of driving a truck, says his experiences are not uncommon.

“There are many drivers out there driving up and down the road sick,” Helton says.

There are myriad reasons drivers cannot, or will not, stop to seek health care while on the job, among them a lack of insurance, the high costs of walk-in services and fear of losing their jobs if they shut down their rigs while under a load. “Some companies out there brainwash their drivers into believing they can’t put themselves out of service for health reasons,” Helton says. “These type companies use the drivers and run their health into the ground.”

But an equally influential deterrent to health care on the road is a lack of available facilities that fit the trucking lifestyle. The majority are located in areas not easily accessed by commercial vehicles.

Joyce Nolte, a 64-year-old Texarkana, Ark., resident who retired from trucking four months ago after 13 years of over-the-road driving, says having a medical problem on the road is a helpless feeling. She once suffered gall bladder problems that confined her to her truck in California until the condition forced her to call for an ambulance in Tennessee to rush her to the hospital.

“A lot of times, truckers have to wait until they get home,” Nolte says. “When you’re driving a big truck, there’s no place to go with them.”

Finally, some relief.

Dr. Ronald Rush, who is Nolte’s hometown physician, was moved to act by another trucker patient, who came to his office with a broken ankle.

“I asked him when he had injured his foot,” Rush says. “He told me he had done it two weeks earlier when he was jumping down from his truck. He said he was on the East Coast and couldn’t find a doctor, so he waited until he got home to see me.”

Rush, who was building a bigger clinic on the Texas side of Texarkana just off Interstate 30 (U.S. Highway 71 North), decided something needed to be done to help truckers in similar situations.

He was already doing drug screenings and DOT physicals, but with the addition of eight tractor-trailer parking spots (and plans for more) at his new medical clinic, he created Highway Health Care.

When walk-in truckers arrive at the Rush Family Health Care clinic, they receive priority treatment.

“I understand truckers don’t have a lot of time sitting around to see a doctor,” Rush says. “We put them at the front of the line so they can get back on the road.”

The clinic regularly treats chronic diseases such as diabetes, high blood pressure, high cholesterol, thyroid problems, obesity and attention deficit disorder, as well as acute problems like colds, flu, cuts, abrasions, infections, asthma attacks and minor injuries.

The facility also operates four rooms for sleep testing, doing both overnight and daytime sleep studies for sleep apnea, daytime somnolence, narcolepsy and other sleep disorders.

Rush also implemented pay options to fit truckers. He accepts credit card, debit card, e-screen, cash, insurance and Comdata checks. For cash-paying truckers, DOT physicals are $89 for in-and-out service. All other office visits are a flat fee of $79.

“I love the way Dr. Rush has set up this clinic for truckers and other travelers, including RVers,” Nolte says. “He understands and cares about truckers.”

To let truckers know about Highway Health Care, Rush has erected billboards along U.S. 59 and I-30.

Heath Hudlow of Jasper, Ga., a driver for Auto Truck Transport of Springfield, Okla., was quite pleased to find a trucker-friendly clinic when he visited the facility in mid-November. The 32-year-old was feeling under the weather when he stopped in Texarkana en route to Michigan.

“I found the clinic in the phone book, and I was surprised when they told me they had truck parking,” Hudlow says. “I’m very picky about physicians I see, but we hit it off. The staff seems very informed and very friendly.”

On a more national scale, a new chain of truckstop clinics began popping up across the country last year. The Professional Drivers Medical Depots (PDMD) has opened three clinics so far, at Petro Stopping Centers in Knoxville, Tenn., and West Memphis, Ark., and a Sapp Bros. Truck Stop in Peru, Ill.

PDMD offers DOT physicals, drug screening, minor medical, first-aid for injuries, prescription refills, flu shots, free lab screening, fast-track emergency evaluations and diagnostics, access to a national hospital network, multiple payment options and other services.

PDMD completed a survey of 2,000 truckers last summer that highlighted the need for better health care for over-the-road drivers.

According to the survey, nearly 65 percent of truck drivers rate their health as fair or poor – with 85 percent citing their top concerns as heart disease or diabetes. Ninety percent of drivers already take blood pressure, diabetes, cholesterol or heart medications.

Additionally, 70 percent of drivers are at high risk for sleep apnea. Preliminary results from PDMD’s survey indicate that the average weight of a driver is 240 pounds. The study also shows that a driver’s Body Mass Index is a good predictor for this ailment.

“Heart disease and diabetes are often interrelated, and as you can imagine, given some of their occupational risks, the numbers are even higher for professional drivers than among the average population,” says Dr. John McElligott, chairman and CEO of PDMD. “And without regular medical care, these conditions, which could be diagnosed, monitored and treated, are often left until it is too late.”

PDMD locations under construction include those at three Petros (Atlanta, Shreveport, La., and Mebane, N.C.) and two TravelCenters of America (Lafayette, La., and Ontario, Calif.). PDMD plans to open as many as 60 to 80 clinics by 2010.

For more information on Highway Health Care, visit www.highwayhealthcare.com.

For PDMD, log onto www.pd-md.com.
Kristie Busam contributed to this report.


Info on Government Health Programs
Medicare, Medicaid and state Children’s Health Insurance Programs fall under the purview of the federal Department of Health and Human Services (www.hhs.gov) and applicable state agencies. The website for the Centers for Medicare and Medicaid Services (www.cms.hhs.gov) contains a wealth of information on qualifications, benefits and links to specific state information.

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