Health Care Reform
Obamacare arrives Thursday -- here's what to expect
Some copays will vanish, sick kids won't be denied coverage -- and insurance premiums will still rise.
BY JOHN DORSCHNER
Some copays will vanish, sick kids won't be denied coverage -- and insurance premiums will still rise.
BY JOHN DORSCHNER
Of the many healthcare changes starting Thursday as part of federal reforms, one is a potential life-changer for Tarina Garcia, a Miami mother who was unable to obtain commercial insurance coverage for her 11-year-old daughter's epilepsy because it's a ``pre-existing condition.''
Garcia says she lost her job because she spent so much time taking care of her daughter. That allowed the girl to qualify for Medicaid, the state-federal insurance for the poor. Now, because of the national healthcare reform act passed by Congress in March, Garcia could go back to work, losing Medicaid but still able to obtain private insurance through the individual market to cover her daughter.
Is the job available,how much will the insurance cost?
In massachussetts people lack insurance because they cannot afford it although it is available thue a very similar plan
And that, Garcia said, will be ``very good.''
Garcia is one of the tens of millions of Americans who are likely to see their health insurance change, starting with policies written after Thursday.
Because of the Patient Protection and Affordable Care Act, patients will no longer have co-payments for about 100 preventive measures.
But they need money to pay for the plan.
Adult children up to the age of 26 can be covered under their parents' employers policies.
Same.
Lifetime caps will be eliminated.
If you can pay for the insurance.Jobs??
Consumers will be able to appeal to a third party when they think their insurers have wronged them.
Who is the third party ??
And children will no longer be denied health insurance because they have a pre-existing condition.
Same
2,000 PAGES
The provisions kick in with the start of consumers' new insurance year, often Jan. 1 for those with employer-based coverage. But for those who have other renewal dates or are buying on the individual market, the changes could be much sooner.
Still, because the act runs more than 2,000 pages and the implementing regulations run hundreds of pages more, there are complexities and caveats.
Nokidding!!
The biggest is that employers' plans created before the reform act will be ``grandfathered in'' and won't have to abide by some of the reform requirements.
Again where is the $.The reason most people cannot buy insurance is because they do not have the $
A survey of 1,100 employers by Mercer, the national consulting firm, found that slightly more than half -- 53 percent -- plan to qualify for grandfather status.
If they keep the job.
``It's an interesting conundrum,'' says Pamela Rothstein, Ryder's senior director of employee benefits. For many employers, the question is whether it's cheaper to avoid reforms and keep their present system of co-pays, deductibles and such -- or to accept the reforms and make changes to lower costs by, for example, asking workers to pay more of the premiums.
Really.
Randy Kammer, vice president of regulatory affairs for Blue Cross Blue Shield for Florida, says she thinks most businesses in the state are likely to opt for revising their current policies to cut costs rather than trying to avoid reform costs.
Great for the Blues that provided penis implants to women.
Rothstein says Ryder is not planning to grandfather its plans, partly because the company is already complying with what many view as the most expensive provision of the reforms starting next week -- paying for preventive services.
First truth
``We're so convinced these screenings mitigate costs down the road, with a better quality of life,'' she said.
PREMIUMS RISE
The costs of reform are still being hotly debated. Some insurers nationally are blaming the new provisions for 10 percent increases in premiums next year. The Obama administration estimates reforms should raise costs no more than 2 percent.
Anyway you look at it it is more expensive
The Mercer survey found that employers nationwide estimate the changes will add about 2.3 percent to their costs. Blue Cross Blue Shield's Kammer says she doubts the provisions will increase rates in Florida, at least not at first.
Here's a rundown of healthcare changes coming up:
Preventive services -- Based on the theory that inexpensive preventive measures can reduce expensive hospital visits later, the reform act requires insurers to pay all costs for many immunization vaccines and screenings for colorectal cancer (for those over 50), depression, high blood pressure (for diabetics) and autism (for children 18 months to 24 months.)
Also covered at 100 percent are mammograms for women over 40 and smoking cessation programs.
The final blow to remaining bussiness
For a full list of preventive services covered go to www.healthcare.gov/law/
about/provisions/
services/lists.html.
Adult children -- All new private insurance that offers dependent coverage must allow parents to cover their children until age 26.
They can live elsewhere and still be covered, and they must be charged at the policy's prevailing child rates.
If adult children can get insurance through their own jobs, they can't switch to their parents' existing job-based coverage if it's grandfathered. But if they don't have work coverage, they can move to parents' plans, even if the employers are planning to continue using their current plans.
Richard Kaufman, in the Miami office of Aon, a consulting firm for benefits and other matters, says Florida law already allows children up to 30 to remain on parents' plans, but with various restrictions that aren't in the federal law.
Right to appeal -- Consumers covered under new, non-grandfathered insurance plans will have a right to appeal to an external party if, for example, their insurer denies coverage of treatments recommended by their doctors. Consumers will first have to file an internal appeal with the insurers. If not satisfied, they then can appeal to an impartial reviewer. Details of who will handle reviews and what regulations will apply are being worked out.
IN the meantime they can remain dead while they wait !!
No exclusions for children -- In the past, insurers can -- and regularly did -- deny children with pre-existing conditions. As of Sept. 23, Thursday, they will be required to accept all kids, regardless of health status.
This provision has led to spirited debate. Insurers' fear is that parents would wait until their kids got sick to buy coverage. ``What would stop anyone from signing up for a plan on the way to the hospital?'' asks Kammer of Blue Cross Blue Shield.
The blues always very concerned.About their money!!
Insurers depend on providing coverage for a broad pool of people -- with the healthy majority paying premiums that fund the sick minority. Their fear with reform is that if only sick people sign up, insurers will lose huge amounts of money or need to raise premiums to horrendously high rates. Starting in 2014, that fear vanishes, because virtually everyone will be required then to have insurance.
Regardless of money or jobs!!
Health and Human Services recently responded to the insurers' fears about kid coverage, allowing insurers in the individual market to have an open enrollment period of, say, one month a year in which families could sign up children under 19 with pre-existing conditions. That means families will be encouraged to enroll healthy kids because they won't be able to automatically sign them up when they get sick.
Lifetime caps removed -- Many policies have limitations of $1 million, $2 million or even more. Most people never even have to think about them. But for those with severe chronic illness, their removal could mean a lot, possibly even preventing bankruptcy. Even so, the insurers' cost for this ``is not that great,'' says Kammer.
High risk pools -- For the truly desperate, the new high-risk pools can be a lifesaver -- but not a cheap one. They're intended for uninsured patients who have pre-existing conditions and can't get coverage elsewhere. They will serve as a bridge until 2014, when there are new government-regulated insurance exchanges accepting virtually everyone who can't get coverage elsewhere.
Is this then for the very sick to wait??
Florida has had a high-risk pool for years, but because of the expense, it has been closed to new patients since 1991 and has only 250 members left, says director Jerome Ashford. The Legislature opted not to re-open it in response to the reform act, meaning that the state's residents can sign up for a federally sponsored pool, known as the Pre-Existing Condition Insurance Plan.
Under the plan, Florida residents will pay monthly rates ranging from $363 for those up to 34 and as much as $773 for those 55 and older, according to healthcare.gov . That's with a $2,500 deductible and maximum out-of-pocket of $5,950 a year.
WOW we really need those jobs
Those payments cover only part of their insurance costs. The feds have allocated $351 million to Florida to pick up the rest of the expenses till 2014.
You can add that up to the 6K million defict
Critics fear that's not enough.
The program is only for those who are legally in the United States, have been uninsured for at least six months and have been denied coverage because of a pre-existing condition. Applications are available at healthcare.gov or by calling (866) 717-5826.
Limiting insurers' profits -- Starting Jan. 1, insurers of large groups will be required to spend 85 percent of premiums on healthcare.
A lot of foxes needed to watch the hens house
For insurers of small groups and individual policies, it's 80 percent. In 2012, if insurers fail to meet these requirements, they must offer rebates to customers.
The idea is to make sure insurers don't spend too much on executive salaries, marketing and profits. This sounded simple to lawmakers, but it's ``proving to be challenging and a bit controversial,'' says Jennifer Tolbert of the Kaiser Family Foundation, a healthcare policy group.
Does that mean they are making how much?
Should money spent on converting to electronic records be counted as a medical expense or an administrative one? What about monitoring infectious disease rates in hospitals or money spent managing chronic conditions?
The National Association of Insurance Commissioners has been working on draft guidelines. The U.S. Department of Health and Human Services says it has not yet received them.
Other changes
• About one million seniors have already received $250 rebate checks because of high prescription drug costs that were not covered by Medicare Part D.
• About 70 South Florida organizations -- including the Miami-Dade and Broward school systems -- will get funds to help pay for healthcare for retirees aged 55 to 64 who are not eligible for Medicare.
WE will for sure see this in our property tax bill
• Starting this year, businesses with no more than 25 workers with average annual wages under $50,000 can get tax credits of up to 35 percent of the costs of premiums.
Are this the middle class business that have closed and are closing?
For further information, healthcare.gov is the government site for the reform act. The Kaiser Family Foundation (kff.org), the Commonwealth Fund (commonwealthfund.org ) and Families USA (familiesusa.org) are three Washington nonprofits that provide details and analysis of the reform act.
Garcia says she lost her job because she spent so much time taking care of her daughter. That allowed the girl to qualify for Medicaid, the state-federal insurance for the poor. Now, because of the national healthcare reform act passed by Congress in March, Garcia could go back to work, losing Medicaid but still able to obtain private insurance through the individual market to cover her daughter.
Is the job available,how much will the insurance cost?
In massachussetts people lack insurance because they cannot afford it although it is available thue a very similar plan
And that, Garcia said, will be ``very good.''
Garcia is one of the tens of millions of Americans who are likely to see their health insurance change, starting with policies written after Thursday.
Because of the Patient Protection and Affordable Care Act, patients will no longer have co-payments for about 100 preventive measures.
But they need money to pay for the plan.
Adult children up to the age of 26 can be covered under their parents' employers policies.
Same.
Lifetime caps will be eliminated.
If you can pay for the insurance.Jobs??
Consumers will be able to appeal to a third party when they think their insurers have wronged them.
Who is the third party ??
And children will no longer be denied health insurance because they have a pre-existing condition.
Same
2,000 PAGES
The provisions kick in with the start of consumers' new insurance year, often Jan. 1 for those with employer-based coverage. But for those who have other renewal dates or are buying on the individual market, the changes could be much sooner.
Still, because the act runs more than 2,000 pages and the implementing regulations run hundreds of pages more, there are complexities and caveats.
Nokidding!!
The biggest is that employers' plans created before the reform act will be ``grandfathered in'' and won't have to abide by some of the reform requirements.
Again where is the $.The reason most people cannot buy insurance is because they do not have the $
A survey of 1,100 employers by Mercer, the national consulting firm, found that slightly more than half -- 53 percent -- plan to qualify for grandfather status.
If they keep the job.
``It's an interesting conundrum,'' says Pamela Rothstein, Ryder's senior director of employee benefits. For many employers, the question is whether it's cheaper to avoid reforms and keep their present system of co-pays, deductibles and such -- or to accept the reforms and make changes to lower costs by, for example, asking workers to pay more of the premiums.
Really.
Randy Kammer, vice president of regulatory affairs for Blue Cross Blue Shield for Florida, says she thinks most businesses in the state are likely to opt for revising their current policies to cut costs rather than trying to avoid reform costs.
Great for the Blues that provided penis implants to women.
Rothstein says Ryder is not planning to grandfather its plans, partly because the company is already complying with what many view as the most expensive provision of the reforms starting next week -- paying for preventive services.
First truth
``We're so convinced these screenings mitigate costs down the road, with a better quality of life,'' she said.
PREMIUMS RISE
The costs of reform are still being hotly debated. Some insurers nationally are blaming the new provisions for 10 percent increases in premiums next year. The Obama administration estimates reforms should raise costs no more than 2 percent.
Anyway you look at it it is more expensive
The Mercer survey found that employers nationwide estimate the changes will add about 2.3 percent to their costs. Blue Cross Blue Shield's Kammer says she doubts the provisions will increase rates in Florida, at least not at first.
Here's a rundown of healthcare changes coming up:
Preventive services -- Based on the theory that inexpensive preventive measures can reduce expensive hospital visits later, the reform act requires insurers to pay all costs for many immunization vaccines and screenings for colorectal cancer (for those over 50), depression, high blood pressure (for diabetics) and autism (for children 18 months to 24 months.)
Also covered at 100 percent are mammograms for women over 40 and smoking cessation programs.
The final blow to remaining bussiness
For a full list of preventive services covered go to www.healthcare.gov/law/
about/provisions/
services/lists.html.
Adult children -- All new private insurance that offers dependent coverage must allow parents to cover their children until age 26.
They can live elsewhere and still be covered, and they must be charged at the policy's prevailing child rates.
If adult children can get insurance through their own jobs, they can't switch to their parents' existing job-based coverage if it's grandfathered. But if they don't have work coverage, they can move to parents' plans, even if the employers are planning to continue using their current plans.
Richard Kaufman, in the Miami office of Aon, a consulting firm for benefits and other matters, says Florida law already allows children up to 30 to remain on parents' plans, but with various restrictions that aren't in the federal law.
Right to appeal -- Consumers covered under new, non-grandfathered insurance plans will have a right to appeal to an external party if, for example, their insurer denies coverage of treatments recommended by their doctors. Consumers will first have to file an internal appeal with the insurers. If not satisfied, they then can appeal to an impartial reviewer. Details of who will handle reviews and what regulations will apply are being worked out.
IN the meantime they can remain dead while they wait !!
No exclusions for children -- In the past, insurers can -- and regularly did -- deny children with pre-existing conditions. As of Sept. 23, Thursday, they will be required to accept all kids, regardless of health status.
This provision has led to spirited debate. Insurers' fear is that parents would wait until their kids got sick to buy coverage. ``What would stop anyone from signing up for a plan on the way to the hospital?'' asks Kammer of Blue Cross Blue Shield.
The blues always very concerned.About their money!!
Insurers depend on providing coverage for a broad pool of people -- with the healthy majority paying premiums that fund the sick minority. Their fear with reform is that if only sick people sign up, insurers will lose huge amounts of money or need to raise premiums to horrendously high rates. Starting in 2014, that fear vanishes, because virtually everyone will be required then to have insurance.
Regardless of money or jobs!!
Health and Human Services recently responded to the insurers' fears about kid coverage, allowing insurers in the individual market to have an open enrollment period of, say, one month a year in which families could sign up children under 19 with pre-existing conditions. That means families will be encouraged to enroll healthy kids because they won't be able to automatically sign them up when they get sick.
Lifetime caps removed -- Many policies have limitations of $1 million, $2 million or even more. Most people never even have to think about them. But for those with severe chronic illness, their removal could mean a lot, possibly even preventing bankruptcy. Even so, the insurers' cost for this ``is not that great,'' says Kammer.
High risk pools -- For the truly desperate, the new high-risk pools can be a lifesaver -- but not a cheap one. They're intended for uninsured patients who have pre-existing conditions and can't get coverage elsewhere. They will serve as a bridge until 2014, when there are new government-regulated insurance exchanges accepting virtually everyone who can't get coverage elsewhere.
Is this then for the very sick to wait??
Florida has had a high-risk pool for years, but because of the expense, it has been closed to new patients since 1991 and has only 250 members left, says director Jerome Ashford. The Legislature opted not to re-open it in response to the reform act, meaning that the state's residents can sign up for a federally sponsored pool, known as the Pre-Existing Condition Insurance Plan.
Under the plan, Florida residents will pay monthly rates ranging from $363 for those up to 34 and as much as $773 for those 55 and older, according to healthcare.gov . That's with a $2,500 deductible and maximum out-of-pocket of $5,950 a year.
WOW we really need those jobs
Those payments cover only part of their insurance costs. The feds have allocated $351 million to Florida to pick up the rest of the expenses till 2014.
You can add that up to the 6K million defict
Critics fear that's not enough.
The program is only for those who are legally in the United States, have been uninsured for at least six months and have been denied coverage because of a pre-existing condition. Applications are available at healthcare.gov or by calling (866) 717-5826.
Limiting insurers' profits -- Starting Jan. 1, insurers of large groups will be required to spend 85 percent of premiums on healthcare.
A lot of foxes needed to watch the hens house
For insurers of small groups and individual policies, it's 80 percent. In 2012, if insurers fail to meet these requirements, they must offer rebates to customers.
The idea is to make sure insurers don't spend too much on executive salaries, marketing and profits. This sounded simple to lawmakers, but it's ``proving to be challenging and a bit controversial,'' says Jennifer Tolbert of the Kaiser Family Foundation, a healthcare policy group.
Does that mean they are making how much?
Should money spent on converting to electronic records be counted as a medical expense or an administrative one? What about monitoring infectious disease rates in hospitals or money spent managing chronic conditions?
The National Association of Insurance Commissioners has been working on draft guidelines. The U.S. Department of Health and Human Services says it has not yet received them.
Other changes
• About one million seniors have already received $250 rebate checks because of high prescription drug costs that were not covered by Medicare Part D.
• About 70 South Florida organizations -- including the Miami-Dade and Broward school systems -- will get funds to help pay for healthcare for retirees aged 55 to 64 who are not eligible for Medicare.
WE will for sure see this in our property tax bill
• Starting this year, businesses with no more than 25 workers with average annual wages under $50,000 can get tax credits of up to 35 percent of the costs of premiums.
Are this the middle class business that have closed and are closing?
For further information, healthcare.gov is the government site for the reform act. The Kaiser Family Foundation (kff.org), the Commonwealth Fund (commonwealthfund.org ) and Families USA (familiesusa.org) are three Washington nonprofits that provide details and analysis of the reform act.
