There remains confusion about what the Affordable Care Act did, is doing and will do. This 9 minute cartoon does a very good job of explaining things. Use at will:
Showing posts with label Health Insurance. Show all posts
Showing posts with label Health Insurance. Show all posts
Wednesday, May 4, 2011
Monday, September 27, 2010
Health Care Reform - Changes in Law
This past week was the six month anniversary of the signing of the Affordable Care Act by President Obama. Several important pieces of the health care reform bill went into effect on September 23, 2010. This post highlights the most important changes in federal health care law. In addition, it provides more information on www.healthcare.gov, a national website that has valuable information for everyone wanting more information.
In effect as of September 23, 2010:
Rescission is Outlawed
Insurance companies aren’t allowed to drop people’s coverage when they get sick (this is known as “rescission”).
New Coverage Options for Children
Insurance companies aren’t allowed to deny coverage to children under 19 because of pre-existing conditions.
Children can stay on (or be added to) their parents’ insurance policies until they turn 26, if they can’t get insurance through a job. This applies to all insurance plans that provide dependent coverage. A new open enrollment period for children starts on September 23, 2010 and is required by law to continue for at least 30 days.
Ban on Lifetime Coverage Limits
For new individual insurance and all group plans, insurance companies aren’t allowed to put caps on the amount they will spend on lifetime coverage costs on “essential benefits”. Essential benefits include hospital stays, doctor visits, and prescription drugs.
Annual limits are restricted in all group plans and in new individual plans. Starting in 2014, annual limits will be banned completely.
More Preventive Services Covered by Private Health Coverage
All new group and individual plans will have to cover certain recommended preventive services, like cancer and diabetes screenings. Insurance companies will be required to offer these services free to the patient - without deductible, coinsurance, or copayment charges.
In effect in 2011:
Prescription Drug Discounts for People who Fall in Medicare’s Donut Hole
Starting January 1, 2011, people on Medicare who fall within the prescription drug coverage gap (the “donut hole”) will get a 50% discount on brand name prescription drugs and a 7% discount on generics.
These discounts are in addition to the annual rebates for people who fall in Medicare’s “donut hole”.
The website www.HealthCare.gov can provide you with invaluable information on changes under the health reform bill, the Affordable Care Act of 2010 (ACA).
For beneficiaries, there is an easy-to-use tool on this website called “Find Insurance Options”. Beneficiaries can use this tool by themselves to learn about the health care options that are available to them, given their circumstances (age, health condition, etc.). For example, it will provide information on specific Medicaid categories that they may be qualified for. It can ba found at: http://finder.healthcare.gov/ .
To read about changes to the High Risk Pool program in you state, go to http://www.healthcare.gov/law/provisions/preexisting/index.html and enter in your state. You will learn about how your state has chosen to implement its Pre-Existing Condition Insurance Plan program, which can either supplement or replace the existing state High Risk Pool. There is also a timeline on the website showing major changes that occur each year, with links to more information on each change.
Thursday, April 15, 2010
COBRA FAQ's
In 2009, the American Recovery and Reinvestment Act (ARRA, also called the Stimulus Act) provided a 65% reduction in monthly COBRA premiums for individuals who met the qualifications.
Below you'll find some helpful facts on this Health Insurance coverage option.
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Question:
I was recently laid off of my job. I was told that I may be able to get a reduction in my COBRA premiums? Is this true?
Answer:
The answer to this question depends on when you were laid off and under what circumstances. The American Recovery and Reinvestment Act of 2009 (ARRA) provides for a 65% reduction of COBRA premiums in some cases. You can pay only 35% of the full COBRA premium for up to 15 months if you are eligible for the premium assistance. To qualify, you must have involuntarily lost your job between September 1, 2008 and February 28, 2010. If your job ended on or after March 1, 2010 you will not be eligible for the premium assistance. You will also not be eligible for premium assistance if you quit your job – but you can still use COBRA to continue your employer-sponsored group health coverage.
Here are two examples. In the first case, my job ended on February 7, 2010. I did not quit but was laid off. My health coverage from my job will end at the end of February. Under COBRA, I can choose to continue the group health coverage for myself and for any dependents after February. I will have to pay a monthly premium to keep this coverage. Because my job ended before March 1, 2010 I am eligible to pay a reduced monthly premium (only 35% of the full premium) for up to 15 months. After 15 months, if I still need the coverage, I will have to pay the full premium amount each month.
In a second example, I am laid off on March 4, 2010. I am not eligible for premium assistance under ARRA because my job ended after February 28, 2010. I can still use COBRA however to continue the health coverage for myself and any dependents. I can continue my health coverage for up to 18 months (or 29 months if I have been determined disabled by Social Security).
What Is COBRA Continuation Coverage?
COBRA law was enacted in 1985 under the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows an employee to choose to continue employer-sponsored group health coverage after the employee stops working. The employee can choose to pay a monthly premium and continue the health coverage for themselves and any dependents who were covered by the plan. To qualify for continuation coverage under COBRA, an employee must have lost group health coverage because of: 1) voluntary or involuntary termination of employment, for reasons other than gross misconduct, or 2) a reduction in the hours they work. There are other events (such as the death of a covered employee, divorce, or a child's loss of dependent status) that can provide someone with an opportunity to continue health coverage under COBRA. The employee can continue health coverage for up to 18 months, or up to 29 months if they are found disabled according to Social Security rules.
When a beneficiary is considering using to use COBRA, it is important that they consider all other possible health coverage options, such as Medicaid. COBRA premiums can be very expensive for many of the beneficiaries we work with. The ARRA premium assistance program has made COBRA premiums more affordable, but this program will not be available to workers whose jobs end after February 28, 2010. Often individuals will use up all of their savings paying COBRA premiums, when there are other less expensive alternatives that can provide them with health coverage.
Employers with 20 or more employees are subject to federal COBRA rules. In your state, additional employers may be required to offer continuation coverage. 40 states have laws that expand the federal COBRA laws. You can find information on your state COBRA laws at:
http://www.statehealthfacts.org/comparetable.jsp?cat=7&ind=357&typ=5&gsa=1
Full information on COBRA, including how to enroll in COBRA continuation coverage, can be found at the U.S. Department of Labor website:
http://www.dol.gov/ebsa/cobra.html
This website provides a Fact Sheet on COBRA Premium Reduction under the ARRA:
http://www.dol.gov/ebsa/newsroom/fsCOBRApremiumreduction.html
There is also “An Employee's Guide to Health Benefits Under COBRA” will at:
http://www.dol.gov/ebsa/publications/cobraemployee.html
I was recently laid off of my job. I was told that I may be able to get a reduction in my COBRA premiums? Is this true?
Answer:
The answer to this question depends on when you were laid off and under what circumstances. The American Recovery and Reinvestment Act of 2009 (ARRA) provides for a 65% reduction of COBRA premiums in some cases. You can pay only 35% of the full COBRA premium for up to 15 months if you are eligible for the premium assistance. To qualify, you must have involuntarily lost your job between September 1, 2008 and February 28, 2010. If your job ended on or after March 1, 2010 you will not be eligible for the premium assistance. You will also not be eligible for premium assistance if you quit your job – but you can still use COBRA to continue your employer-sponsored group health coverage.
Here are two examples. In the first case, my job ended on February 7, 2010. I did not quit but was laid off. My health coverage from my job will end at the end of February. Under COBRA, I can choose to continue the group health coverage for myself and for any dependents after February. I will have to pay a monthly premium to keep this coverage. Because my job ended before March 1, 2010 I am eligible to pay a reduced monthly premium (only 35% of the full premium) for up to 15 months. After 15 months, if I still need the coverage, I will have to pay the full premium amount each month.
In a second example, I am laid off on March 4, 2010. I am not eligible for premium assistance under ARRA because my job ended after February 28, 2010. I can still use COBRA however to continue the health coverage for myself and any dependents. I can continue my health coverage for up to 18 months (or 29 months if I have been determined disabled by Social Security).
What Is COBRA Continuation Coverage?
COBRA law was enacted in 1985 under the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows an employee to choose to continue employer-sponsored group health coverage after the employee stops working. The employee can choose to pay a monthly premium and continue the health coverage for themselves and any dependents who were covered by the plan. To qualify for continuation coverage under COBRA, an employee must have lost group health coverage because of: 1) voluntary or involuntary termination of employment, for reasons other than gross misconduct, or 2) a reduction in the hours they work. There are other events (such as the death of a covered employee, divorce, or a child's loss of dependent status) that can provide someone with an opportunity to continue health coverage under COBRA. The employee can continue health coverage for up to 18 months, or up to 29 months if they are found disabled according to Social Security rules.
When a beneficiary is considering using to use COBRA, it is important that they consider all other possible health coverage options, such as Medicaid. COBRA premiums can be very expensive for many of the beneficiaries we work with. The ARRA premium assistance program has made COBRA premiums more affordable, but this program will not be available to workers whose jobs end after February 28, 2010. Often individuals will use up all of their savings paying COBRA premiums, when there are other less expensive alternatives that can provide them with health coverage.
Employers with 20 or more employees are subject to federal COBRA rules. In your state, additional employers may be required to offer continuation coverage. 40 states have laws that expand the federal COBRA laws. You can find information on your state COBRA laws at:
http://www.statehealthfacts.org/comparetable.jsp?cat=7&ind=357&typ=5&gsa=1
Full information on COBRA, including how to enroll in COBRA continuation coverage, can be found at the U.S. Department of Labor website:
http://www.dol.gov/ebsa/cobra.html
This website provides a Fact Sheet on COBRA Premium Reduction under the ARRA:
http://www.dol.gov/ebsa/newsroom/fsCOBRApremiumreduction.html
There is also “An Employee's Guide to Health Benefits Under COBRA” will at:
http://www.dol.gov/ebsa/publications/cobraemployee.html
Monday, April 12, 2010
Health Care Reform - Changes Important to People With Disabilities
The recently passed Patient Protection and Affordable Care Act (Public Law 111-148) and Health Care and Education Reconciliation Act (Public Law 111-152) will result in significant reform of our nation's health care system, including extending coverage to many more millions of Americans. There's a lot to learn about the new laws, and many people have questions about how the changes will take effect. It's important to remember that some changes in the new laws will not happen immediately, but will happen over a period of years, through 2019.
The attached summary was created by the World Institute on Disability. It is intended to be a "plain language" overview for the general public, with a timeline showing major implementation dates, so that people can get a better understanding of the changes that will affect them in the short-term, to help people prioritize what to focus on first, and learn the details in stages.
The attached summary was created by the World Institute on Disability. It is intended to be a "plain language" overview for the general public, with a timeline showing major implementation dates, so that people can get a better understanding of the changes that will affect them in the short-term, to help people prioritize what to focus on first, and learn the details in stages.
Wednesday, August 27, 2008
2008 Democratic National Convention: Remarks as Prepared for Delivery by Pamela Cash-Roper, Unemployed Nurse and Lifelong Republican From North Caroli
Includes an interesting story about SSDI and Health Insurance.
Could work incentives helped their situation???????????
WWD and Private Health Insurance—Scenario
John is a gainfully-employed individual with a disability, and he has healthcare coverage under Worker with Disabilities (WWD), North Dakota’s Medicaid buy-in program. He pays a premium of $80 per month for the WWD coverage. John’s employer recently told John that John has worked for the business long enough, and is working enough hours, to qualify for coverage under the employer’s health insurance plan. John’s share of the premium for this coverage would be just $40.00 per month.
Should John have both WWD coverage and the private health insurance? The answer depends on a number of factors, including what items and services the private insurance plan covers, whether John will lose the private insurance if his work hours decrease, and whether John has to pay the premiums for both WWD and the private plan.
The private insurer would be required to be the primary, or first, payer of the medical expenses covered under the plan. After that, WWD, as a Medicaid-type program, would fill in the gaps as the secondary payer.
Medicaid might pay John’s share of the premium for the private health insurance if it is "cost effective" for Medicaid to do so. If this is cost effective, Medicaid could even require John to apply for and take the private insurance so that the private insurer would pay first. However, if Medicaid required John to enroll in the private plan, Medicaid would pay the premium for the private insurance in order to save money for the WWD program. Medicaid would not require John to enroll in the private plan if Medicaid would not pay the premium for it.
John should bring this matter to the attention of his eligibility worker at the county Medicaid office for a "cost effectiveness" determination.
Source: Medicaid Program Policy Manual sections 510-05-20-05 and 510-05-20-15.
Any questions may be directed to: rsi5@srt.com
Should John have both WWD coverage and the private health insurance? The answer depends on a number of factors, including what items and services the private insurance plan covers, whether John will lose the private insurance if his work hours decrease, and whether John has to pay the premiums for both WWD and the private plan.
The private insurer would be required to be the primary, or first, payer of the medical expenses covered under the plan. After that, WWD, as a Medicaid-type program, would fill in the gaps as the secondary payer.
Medicaid might pay John’s share of the premium for the private health insurance if it is "cost effective" for Medicaid to do so. If this is cost effective, Medicaid could even require John to apply for and take the private insurance so that the private insurer would pay first. However, if Medicaid required John to enroll in the private plan, Medicaid would pay the premium for the private insurance in order to save money for the WWD program. Medicaid would not require John to enroll in the private plan if Medicaid would not pay the premium for it.
John should bring this matter to the attention of his eligibility worker at the county Medicaid office for a "cost effectiveness" determination.
Source: Medicaid Program Policy Manual sections 510-05-20-05 and 510-05-20-15.
Any questions may be directed to: rsi5@srt.com
Tuesday, July 8, 2008
Schneider proposes plan to expand health insurance to uninsured N.D. children
Teri Finneman, The Forum
Published Tuesday, July 08, 2008
During a news conference, the Democratic-NPL candidate for insurance commissioner outlined his proposal to provide 3,300 more children access to health insurance.
Schneider wants to expand the state’s Healthy Steps income eligibility limits from 150-percent net income of the poverty line to 200 percent.
“It’s a top priority for me to make sure our youngest residents have access to health insurance,” Schneider said.
In addition to increasing eligibility limits, Schneider wants to form an advisory council to study how to expand access to health insurance to all
Approximately 15,000 children in the state don’t have health insurance now, he said.
For more on this story, read tomorrow’s Forum.
Readers can reach Forum reporter Teri Finneman at (701) 241-5560
Any questions may be directed to: rsi5@srt.com
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