Posts Tagged ‘pre existing condition’

Health Insurance Reform Schedule

Wednesday, July 21st, 2010

2010
New programs:

  • Temporary retiree reinsurance program.
  • National risk pool, small business tax credit.
  • $250 rebate for Medicare members who reach the “doughnut hole”.

Health Insurance Reforms:

  • No lifetime benefit limits based on dollar amounts.
  • Allowed restricted yearly limits on the dollar value of certain benefits.
  • No coverage rescissions/cancellations (except for fraud or internal misrepresentation).
  • No cost-sharing obligations for preventive services.
  • Must have dependent coverage up to age 26.
  • New internal and external appeal process.
  • No pre-existing condition exclusions for dependent children (under 19 years of age).
  • New health plan disclosure and transparency requirements.

2011
Insurance Reforms:

  • New uniform coverage documents and standard definitions are developed.
  • Must have minimum medical loss ratios.

Medicare Reforms:

  • Start of Medicare Advantage cost-sharing limits.
  • Medicare beneficiaries who reach the doughnut hole to get a 50% discount on brand name drugs.
  • Primary care doctors and general surgeons practicing in underserved areas, such as inner city and rural communities to get a 10% bonus.
  • Medicare Advantage plans begin having payments frozen.

Other:

  • Yearly fee for brand-name drug manufacturers.
  • Start of voluntary long-term care insurance program giving a cash benefit to help those with disabilities stay in their homes or pay nursing home cost: benefit starts 5 years after paying coverage fee.
  • Increased funding for community health centers to provide care for many low-income and uninsured people.

2012

  • Hospitals, doctors and payers encouraged to join forces in “accountable care organizations”.
  • Hospitals with high rates of preventable readmissions facing reduced Medicare payments.

2013

  • Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35% on earned income – up from the current 1.45%. A new 3.8% tax on unearned income, such as dividends and interest, also added.
  • Contributions to flexible spending accounts (FSAs) limited to $2,500 a year – indexed for inflation. And the threshold for deducting medical expenses on taxes goes from 7.5% to 10% income.
  • Medical device manufacturers have a 2.9% sales tax on medical devices; with exemptions for some, like eyeglasses, contact lens, and hearing aids.
  • No more deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D-eligible retirees.

2014
Coverage Mandates & Subsidies:

  • New Individual and employer coverage responsibilities.
  • New Individual affordability tax credit and expanded small business tax credits.

Health Insurance Exchange & Insurance Reforms:

  • State individual and small group health insurance exchanges operational.
  • Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) effective.
  • No more lifetime and yearly dollar limits for essential benefits.
  • New taxes on health insurers.

2018

  • New tax (“Cadillac tax”) on employer-sponsored health plans that offer policies with generous coverage levels.

2020

  • Doughnut hole coverage gap in Medicare prescription benefits is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

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Posted in health care overhaul, health care reform, health insurance exchange, health insurance reform, obama care, pre existing condition, prescription | No Comments »

Truth of Health Insurance Reform by the New York Times

Monday, April 19th, 2010

In Sunday’s edition of the NY Times, buried in the Regional section, comes an analysis of the current health insurance reforms in the state of New York that were implemented over fifteen years ago.  Similar to Obama Care, the state of New York required all health insurance carriers to issue guaranteed acceptance policies to people with pre existing conditions as a means of making the health industry fair and imposes community pricing rather than risk based insurance premiums.  So how did this work for New Yorkers?  About the same way Obama Care critics predict.

According to the New York Times Sunday Edition
“New York’s insurance system has been a working laboratory for the core provision of the new federal health care law — insurance even for those who are already sick and facing huge medical bills — and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients’ advocates say that New York’s extensive insurance safety net for people like Ms. Welles is falling apart.

The problem stems in part from the state’s high medical costs and in part from its stringent requirements for insurance companies in the individual and small group market. In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.
New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.

Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans. The pool of insured people shrank to the point where many of them had high health care needs. Without healthier people to spread the risk, their premiums skyrocketed, a phenomenon known in the trade as the “adverse selection death spiral.”

That death spiral has nearly wiped out the individual health insurance market in the state.  New York has the highest annual premiums for individual policies in the country, at over $6600 for an individual and double for families.

Obama Care supporters argue that the federal individual health insurance mandate will solve this problem. However, the mandate in Massachusetts hasn’t kept costs in line. The New York Times is also skeptical.

“The new federal health care law tries to avoid the death spiral by requiring everyone to have insurance and penalizing those who do not, as well as offering subsidies to low-income customers. But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.

Under the federal law, those who refuse coverage will have to pay an annual penalty of $695 per person, up to $2,085 per family, or 2.5 percent of their household income, whichever is greater. The penalty will be phased in from 2014 to 2016.”

The math is very simple. If an individual has to pay $6600 per year for a policy they feel they don’t really need or pay $2500 on a salary of $100,000, which one will healthy young earners take? Of course this is based on the assumption that the government will actually enforce the mandate, which Democrats insisted the Obama Care bill couldn’t do.

Arguments to this will be that most young  people earn much less and will get federal subsidies, but that still depends on them deciding whether to pay anything for a policy that clearly doesn’t suit them.  The argument has neglected the fact that the actual costs will absolutely skyrocket and that taxpayers will be on the hook for the subsidies, which will have to increase to match the premium hikes to remain effective.  Instead of having premiums based on a rational risk assessment, we have the young and healthy subsidizing premiums for the older and the much less healthy in comparison, who then subsidize the younger and healthier through federal handouts. A crazy way to run health care in the U.S.

The individual health insurance mandate is nothing more than a way to get young people to create a proxy welfare state by forcing them into a extorting health insurance model.  It does nothing to reduce actual costs at all, and in fact makes cost increases both more frequently and more rapidly.

Easy To Insure ME .com would also like to note that this story was buried in the regional section and not the front page.  This reflects on the arrogance of the whole Obama administration and their gag orders on speaking out about health insurance reform.

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Posted in health care overhaul, health care reform, health insurance reform, individual health insurance, individual health insurance mandate, obama care, pre existing condition | No Comments »

Health Insurance Reform Guide In 2010

Friday, April 16th, 2010

Changes occurring in 2010 include:

Young Adults on Parents’ Health Insurance Plans. Young adults may stay on their parents’ health insurance until age 26, effective six months after enactment.

Prohibition on Pre existing Condition Exclusions for Children. Insurers are prohibited from excluding coverage of any  pre existing condition for children in the individual health insurance market, effective six months after enactment of the bill.

Prohibition Against Plan Rescissions. Carriers providing group or individual coverage are prohibited from rescinding coverage once an enrollee is covered under the plan, except in the case of an individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of the material facts. Effective six months after enactment of the law.

Prohibitions Against Lifetime Maximum Benefit Caps. Carriers providing group or individual coverage are prohibited from setting lifetime maximum limits on the dollar value of benefits and from setting unreasonable annual limits on the dollar value of benefits, effective six months after enactment.

National High Risk Pool. People with pre existing conditions who are uninsurable will be eligible for subsidized coverage through a national high risk pool, beginning 90 days after enactment.

Limits on Share of Private Premiums Insurers Spend on Non Medical Costs. New limits will be set for the percent of premiums that insurers can spend on non medical claim costs.

Annual Review of Health Premium Increases. Effective immediately, the HHS secretary and states will establish a new process for annual review of unreasonable insurance premium increases.

Elimination of Cost Sharing for Preventive Care in Medicare and Private Plans. In 2010, cost sharing for proven preventive care services is eliminated in both Medicare and private plans.

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Posted in children, health care overhaul, health care reform, health insurance shopping, individual health insurance, obama care, pre existing condition | No Comments »

This Week In Health Care Reform

Friday, April 2nd, 2010

President Obama finalized his health care reform package this week, signing into law the package of fixes approved by the House late last week. While some of the new provisions won’t take effect until 2014, some will be phased in beginning this year.

Health Care Reform
President Obama Signs Final Health Care Bill into Law:  On Tuesday, President Obama signed into law the package of changes to the newly enacted Patient Protection and Affordable Care Act. Approved over unanimous Republican opposition in both chambers of Congress, this reconciliation bill increases the overall cost of the health care reform legislation by $65 billion, bringing the new total to $940 billion over the next 10 years.

What Does This Health Care Reform Legislation Mean: The biggest changes to the nation’s health insurance system will not take effect until 2014. Some of the changes include: the creation of insurance marketplaces called “exchanges” where people can shop for insurance; rules requiring insurers to accept all applicants, including those with pre-existing conditions; and an expansion of state Medicaid programs. Some additional provisions will become effective immediately while others will kick in later this year.

These are some of the features of the new health care overhaul bill passed through the reconciliation process and slated to begin to take effect in 2010:

  • For new sales and subscribers who change policies after March 23, 2010, insurance companies will be required to make additional changes beginning in approximately 6 months, such as removing any member cost sharing for “preventive” benefits (as defined by the legislation). The renewal product requirements beginning for plan years 6 months after enactment include:
  • Coverage for dependents up to age 26;
  • Removal of limits on lifetime maximum benefits;
  • Temporary federal high-risk pools; and
  • Tax credits for small group employers.

Health Care Reform Impacts on Premiums: There are concerns that the new taxes on health insurance will likely increase premiums. Members of the news media report that under the health care overhaul , young adults who buy their own individual health insurance will carry a heavier burden of the medical costs of older Americans. This is expected to raise insurance premiums for young people when the plan takes full effect in 2014.

Additional Activities
Several Companies Push to Repeal Provision of Health Care Law: The American Benefits Council, an association representing hundreds of large corporations, urged President Obama and Congressional Democrats to repeal a provision in the health care bill that reduces the tax deductions allowed to companies that provide drug coverage for their retired employees. As a result of this impending provision, companies like AT&T, Caterpillar, Prudential, Deere Co. and 3M have all announced substantial charges against their first-quarter earnings in order to comply with federal accounting rules.

Insurers Will Comply With Law Regarding Children’s Coverage: This past week, despite vague language in the new health care law regarding coverage of children with pre-existing conditions, insurance companies assured HHS Secretary Kathleen Sebelius that they await clarification and will comply with the law, effective later this year.

Indiana health insurance Joins States’ Lawsuit Against Health Care Bill: In response to the new health care reform legislation, the Attorneys General of several states across the country filed lawsuits arguing against the constitutionality of requiring Americans to purchase health insurance. This week, the state of Indiana joined 13 others in a lawsuit filed last week in a Florida federal court. The 14 states – Indiana, Florida, Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington – will become joint plaintiffs in the suit and split the costs of the legal challenge.

Doctors Group Files Lawsuit to Repeal Health Care Legislation: The Association of American Physicians and Surgeons filed a lawsuit in the U.S. District Court for the District of Columbia against HHS Secretary Kathleen Sebelius and Social Security Administration Commissioner Michael Astrue. Attorneys for the group argue that the insurance mandate is unconstitutional. They also argued against the constitutionality of other provisions saying, “If the bill goes unchallenged, then it spells the end of freedom in medicine as we know it.”

Public Opinion
More Americans Disapprove of President’s Handling of Health Care: In a recent CNN poll, 54 percent of Americans said they disapprove of the way President Obama is handling health care reform, while 45 percent approve. In addition, 56 percent of respondents feel the Democrats’ health care legislation creates too much government involvement in the nation’s health care system.

Americans Unhappy over Health Care Reform Passage: In a recent USA Today/Gallup poll, 50 percent of Americans said the recent passage of health care reform legislation is a bad thing. Further, 55 percent say health care costs in the U.S. will rise as a result of the bill.

Two Polls Offer Different Results:  In a newly released Rasmussen report, 54 percent of Americans favor repealing the recently enacted health care legislation. Further, 49 percent believe the new law will reduce the quality of care, while 60 percent think it will increase the federal budget deficit. In contrast, supporters of reform are touting the recent CNN poll that shows 50 percent of Americans are either fine with the new legislation or would favor seeing more government involvement in health care. In this poll, only 47 percent of Americans favor repealing the bill.

Looking Ahead
Late this week , President Obama traveled to the swing states of Maine and North Carolina to discuss details of the new health care reform law and its effects on unemployment and small business. At the same time, Republicans continue to debate how best to leverage growing discontent over the bill and its implications in the months leading up to the November elections. In the meantime, it’s within federal agencies such as HHS that much of the detail, timing and how-to questions will be worked out going forward.

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Posted in alabama health insurance, children, colorado health insurance, florida health insurance, health care overhaul, health care reform, indiana health insurance, individual health insurance mandate, louisiana health insurance, michigan health insurance, nebraska health insurance, north carolina health insurance, obama care, pennsylvania health insurance, pre existing condition, south carolina health insurance, texas health insurance | No Comments »

Health Insurance Reform Immediate Actions

Thursday, April 1st, 2010

While the majority of health insurance reform provisions go into effect in 2014, there are a number of provisions that take effect in 2010. Here’s an overview of the provisions that become effective this year:

Immediately at enactment

  • Grandfathering – Plans and individuals that “renew” their coverage are exempt from any provisions of the law. These “grandfathered plans” must comply, however, with the following provisions of the law: extend dependent coverage through age 26, prohibit rescissions, eliminate waiting periods greater than 90 days, and eliminate pre-existing condition exclusions for children
  • Small employer tax credits – provides premium subsidies for small groups with 25 or fewer employees and average salaries of $40K or less

Less than six months

  • High-risk pool program – establish a temporary national high-risk pool for individuals with pre-existing medical conditions. (effective 90 days post enactment through January 1, 2014)
  • Temporary reinsurance for employer retirees – Creates a temporary reinsurance for employers providing health insurance coverage to retirees over 55 who are not eligible for Medicare (effective 90 days post enactment through January 1, 2014)

Six months plus

  • No lifetime limits – Eliminates all lifetime limits on the dollar value of coverage (effective six months post enactment)
  • Restrictions on rescissions – Prohibits insurers from rescinding coverage except in the cases of fraud (effective six months post enactment)
  • No pre-existing conditions for children – Eliminate pre-existing condition exclusions for children under 19 (effective six months post enactment)
  • Dependent age 26 – Extends dependent coverage to age 26 (effective six months post enactment)
  • Preventive care with no cost sharing – Eliminates cost-sharing for certain preventive services (effective January 1, 2011)
  • Appeals process – Individuals  have access to an  internal and external appeals process to appeal decisions by their health insurance plan.

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Health Insurance Overhaul Sued

Thursday, April 1st, 2010

On March 23,  thirteen states (Alabama, Colorado, Florida, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah, and Washington) filed one lawsuit in the U.S. Court system for the Northern District of Florida challenging the Patient Protection and Affordable Care Act. This came minutes after President Barack Obama signed the comprehensive health insurance reform legislation into law. The attorneys general’s argument is centered on two elements:

1) the Act’s individual health insurance mandate is an unconstitutional expansion of Congress’ ability to regulate interstate commerce;

2) the penalties for being non compliant within the individual health insurance mandate violates the taxation powers provided to Congress under the Constitution.

In addition, U.S. states are challenging provisions of the new law that will create dramatic Medicaid spending increases for the financial burden of the states.

Governor Jan Brewer also announced her support for a legal challenge to the federal reform law in an initiative to amend the constitution to prohibit mandatory coverage requirements. The attorney general will not contest the federal law. He also suggested to Brewer that she use any additional funds to reinstate the Arizona health insurance KidsCare program, which was cut due to the budget deficit and eliminated coverage for over 35,000 children.

Senator Tom George and Representative Marc Corriveau have introduced four bills that would completely change the individual Michigan health insurance market. The bills amend Blue Cross Blue Shield from being the insurer of last resort. Therefore, it would require all plans to be guarantee issue and will include a reinsurance pool to reimburse carriers for eligible claims.

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Posted in alabama health insurance, arizona health insurance, blue cross blue shield michigan, colorado health insurance, florida health insurance, health care overhaul, health care reform, health insurance reform, individual health insurance mandate, kids care, louisiana health insurance, michigan health insurance, nebraska health insurance, obama care, pennsylvania health insurance, pre existing condition, south carolina health insurance, texas health insurance | No Comments »

Individual Health Insurance Pre Existing Conditions

Thursday, March 11th, 2010

Creditable coverage must be counted towards any pre existing condition exclusion in an individual health insurance policy. This means that when submitting your application you must put your prior coverage on the application. If you do so you will not have any waiting periods towards coverage of your pre existing condition.

If you forget to put your pre existing condition on the application. You may have to wait up to year to receive benefits towards your conditions. A pre existing condition is any illness you may have had been treated for in the past six months or are currently taking prescriptions for.

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