If you have been uninsured for at least six months because of a pre-existing condition, a new law may provide you with new coverage options. As part of the recent Affordable Care Act, the Pre-Existing Condition Insurance Plan was designed to provide alternatives to uninsured Americans with pre-existing condition. Each state can choose to run this program or, if not, to be part of the plan established by the Department of Health and Human Services. The plans cost are expected to be higher than comparable traditional health insurance and benefits may be limited. If you are not sure if you can be approved for traditional health insurance due to a pre-existing condition, please contact a Medicoverage associate to assist you.
Wellpoint CEO Angela F. Braly responded to Obama’s weekly address with a formal letter saying among other things “I was disappointed to hear you repeat false information regarding WellPoint’s coverage of breast cancer.” She also says that, “If we are going to make this law work on behalf of all Americans the attacks on the health insurance industry—an industry that provides valued coverage for more than 200 million Americans—must end.” We were able to track down the most recent one on may 8th. And we have included it below.
You will see it does mention Wellpoint / Anthem by name regarding price increases but we don’t see any reference to breast cancer recissions as featured in her letter. Here is the letter Braly sent to Obama regarding Wellpoint and Anthem health insurance. Check it out and let us know what you think:
Dear Mr. President:
I was disappointed to hear you repeat false information regarding WellPoint’s coverage of breast cancer in your weekly Presidential radio address as a demonstration of your Administration’s commitment to strong patient protection. Mr. President, I will tell you the same thing I told HHS Secretary Sebelius in a recent letter, your statement grossly misrepresents WellPoint’s efforts to help prevent, detect and treat breast cancer among our 34 million members.
To be absolutely clear: despite your claims, WellPoint does not single out women with breast cancer for rescission. Period.
The actual facts could not be clearer. In 2009, WellPoint covered the treatment of approximately 200,000 women with breast cancer at a cost of nearly $2 billion. During that same period, there were four cases nationwide where the issue of breast cancer or the possibility of breast cancer was identified in a rescission, but they were not singled out because of their breast cancer. Clearly, covering the treatment of close to 200,000 while rescinding four policies should make our intent in this regard quite clear. Our policy on rescissions has always been that it is based on fraud or misrepresentation - a policy consistent with that contained in the new legislation. In fact, we adopted the precise policy of the new legislation before any other insurer.
We should also note that we cover screening for women 40 and older, 10 years earlier than the guidelines published by your own US Preventive Services Task Force. We made this decision because we know that early detection is the key to survival, with a 5 year survival rate of nearly 100% when diagnosed at stages 0-1. This also reduces costs for the entire system by avoiding the nearly ten-fold increase in costs associated with treatment beginning after stage 3.
Mr. President, this country has a long history of coming together after tough debates. The implementation of the new health care reform law should be no different. If we are going to make this law work on behalf of all Americans the attacks on the health insurance industry—an industry that provides valued coverage for more than 200 million Americans—must end. We believe that our recent action to adopt many of the insurance reforms earlier than required by law is an indication of our willingness to work with your Administration to achieve this objective.
We agree that healthcare costs are rising at an unsustainable rate. While we continue to strive to make healthcare coverage more affordable for our members, we know that there are many causes for rising costs. Some of the most concerning cost drivers include inflation in the cost for medical services provided, increases in utilization, or the frequency with which these services are provided, and the increased cost borne by the insured population when healthy individuals choose not to carry health care coverage. These issues are of critical importance to all Americans and will require solutions that include all stakeholders in healthcare, business and government. In fact, we have repeatedly asked to meet with Secretary Sebelius, but have not yet received a response. This is simply not productive and not in the best interests of Americans.
We share your vision for a better America and look forward to working with you and your Administration.
Health Savings Accounts (HSAs) are featured in the health insurance reform bill but I haven’t heard anyone mention yet. The new change will affect over 8 million plus people with HSAs so why isn’t it news? Effective January 1, 2011, taxpayers with HSAs no longer will be allow to use them to purchase over-the-counter medicines. This is according to Sec. 9003 of the Health Reform Act. Previously if you had an HSA and needed aspirin you could pay for it with your HSA account…meaning you got the aspirin tax free! But not anymore after the new year. This new restriction will also apply to individuals with Flexible Spending Account or Health Reimbursement Accounts.
Unfortunately you cannot include all the details of the health care reform in 4 minutes. We have watched this white house video over and over and there is no mention of changing HSA tax benefits.
Additionally 2011 will mark the first time HSA 20% penalties will be assessed for non-qualified withdrawals from your Health Savings Account. You can learn more about these penalties by checking out Sec. 9004 of the health care reform act.
The new health care reform bill has promised that children as old as 26 can stay on their parents health plans. Due to the bill’s fine print, however, many parents may have to wait until 2011 before this benefit becomes available.
Adult children health care coverage explained
Prior to health care reform, may children who were over 18 and not full-time students could not remain under their parent’s health insurance. Under the new health care act, children less than 26 year can stay under their parent’s coverage, as long as the adult child is not offered insurance through an employer. Although the act will be in place by September 23rd, it will not become effective until the next plan year. This is the fine print that some people didn’t read. This will mean that most people trying to take advantage of this provision will have to wait until January 1, 2011.
What should Adult children do for health insurance
Whether your adult child qualifies for this benefit or not, you should probably compare your options with an individual health insurance plan. When kids are young and healthy, insurance companies always charge less than their older counterparts for individual health insurance. We are not aware of any provision that makes sure that children covered under their parent’s plan will be guaranteed a competitive rate. On the contrary, we believe that the health insurance companies will, in the short-term, consider Adult children on their parents plan as “risky” since they chose not to move to less expensive plans that require medical underwriting. The assumption is they pre-existing conditions that will proclude them from being approved on an individual plan. This, of course, will change in 2014 when all new health care plans will be mandated to approve everyone.
SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.
Basically this section says the insurance companies cannot “impose any cost sharing requirements” for certain preventive treatment. Meaning that insurance companies will have to foot-the-entire-bill for preventive treatment in the future if this bill stands. This is a huge provision and it is rarely, if ever, mentioned by the mainstream media.
Currently many health insurance plans require patients to pay for physicals, OBGYN visits and their related diagnostic tests until the member first satisfies their calender year deductible. That means that today most people pay for most preventive work with money out-of-pocket. Some insurance plans on the market today will request a doctor visit co-pay of say $40 but will not cover the related preventive lab work. It is rare to find a plan that has no doctor visit co-pay and covers all related diagnostic testing. The only examples I can think of are very expensive comprehensive HMOs and some of the high deductible HSA plans.
When will Coverage of Preventive Health Services take place?
It is unclear when health insurance companies will have to offer full reimbursement of these preventive services.. The document says the minimum shall not be less than 1 year. Ok, so we know it won’t happen for at least a year. But what is the maximum time before this will be implemented on all health insurance plans. I haven’t figured that one out yet. If I do come across it I’ll post it up here.
Fun fact of the day: There is no such word as preventative. It’s preventive. Now you to can feel smug and correct others who mispronounce the word.
My next post: How this confusing to read bill will force health insurance companies to explain their benefits is a simple and standard way. Sounds like fun!
So if you have been following this blog, you know the good folks at Medicoveage allow me to speak my mind on anything regarding health insurance and reform. I think they know that I don’t have a heavy political agenda and they have a good bit of tolerance for my unorthodox grammar and spelling. My latest goal is to read through the new health care reform bill page-by-page and squeeze out all the juicy stuff and they are ok with that.
Just in case you were misled by the title, I will not do it in one sitting but I am going to read it every day until I finish it. I’m going to try to have daily short entries about what is in there and how it may affect you. I’m going to share things with you that may not see on CNN or FoxNews twenty-second-news-bite.
First of all, I must tell you that it’s a rather thick document. Put it this way, the BMI (body-mass-index) on this book would not meet most health insurance underwriting requirements for approval. Even the title is long. Get this: they call it the “Patient Protection and Affordable Care Act - Title I: Quality, Affordable Health Care for All Americans - Subtitle A: Immediate Improvements in Health Care Coverage for All Americans.” Regardless of the name, at slightly under 2000 pages there is a lot of information to digest. It will no doubt provide me with a plethora of Health Insurance related material. I might even find something humorous in there. Who knows because I’m guessing no one has actually ever read it.
The U.S. House of Representatives passed the Senate-approved health insurance bill with some provisions to take place immediately and others to take place in 2014. If the reconciliation conditions included in the House bill are approved and it becomes law, the following would provisions would take place.
WITHIN A FEW MONTHS, THE NEW HEALTH CARE BILL PROPOSES:
Lifetime maximums would be removed from health insurance plans.
Typically, health care plans have a listed maximum amount that insurance companies will pay for medical expenses throughout the lifetime of the policy. It varies by plan and state but in California the industry average is $5 million dollars. This currently means if a client has a plan with a $5 million lifetime maximum and has over $5 million in medical cost, he or she is require to pay for any additional fees. Moving forward there would be no lifetime maximum and in the last example the insurance company would be obligated to continue paying beyond the lifetime maximum. To our knowledge, none of our current clients has ever reached their lifetime maximum in reimbursed medical fees.
Adult Children Covered under Parents policy
The new bill will force health insurance companies to allow children up to the age of 26 to stay on their parents plans. Previously,the age dependents would have to leave their parents plans varied by state and student status. It is unclear if this rule applies to existing plans or only new plans purchased by parents. Also there doesn’t seem to be a provision stopping insurance companies from charging a huge fee to keep older children on the policy.
New “risk pools” set up for those with pre-existing conditions.
Currently many individuals who apply for insurance plan can be turned down for coverage because of pre-existing medical conditions. The bill sets aside $5 billion dollars to help set up a risk pool for people who want coverage but have been turn down due to a medical condition. We are still looking into the details how this pool would work, but we know it will only last until 2014 when the Health Insurance Exchanges (described below) are set up.
Senior Drug Coverage
Although not addressed in most media coverage, the new bill offers some additional drug coverage for those who qualify for Medicare part D. The amount starts off at $250 dollars but goes down in price as drug companies agree to reduce their costs.
IN 2014, THE NEW BILL PROPOSES:
All insurance plans must approve everyone
Guaranteed issuance health insurance is probably the largest change to our existing health care system. It will mean that if you apply for health insurance in 2014 you cannot be turned down due to previous health conditions. It is unclear at this time if the health insurance companies will be able to charge more for people with pre-existing conditions than those who have no previous medical issues.
Health Insurance Exchanges
The proposed health insurance exchange would only be offered in 2014. The exchange would not offer a public option but would be a place where people could research and purchase private health insurance. If you want to see what a health insurance exchange looks like now, just visit www.medicoverage.com. Our site currently acts as a health insurance exchange offering quotes from multiple private insurance companies at the guaranteed lowest price. As you can see, we are unsure what benefit the proposed new health insurance exchanges will offer now that a public option is off the table.
Tax Breaks for Health Insurance Premiums
The recent bill approved by the House will also offer some tax breaks in 2014 if ratified.
Fines for People Without Health Insurance
If you don’t have health insurance in 2014 you will be required to pay a penalty of 1% of your income or $95 (whichever is higher). By 2016 this fee would raise to about $700 or 2.5 percent of your income. This is the health insurance mandate that people talk about. There will be subsidies for certain people who cannot afford health insurance.
Medicare Expansion
The proposed bill will expand medicare to cover more individuals in 2014. Certain people who are living below the poverty line will now quality for Medicare even if they are not 65 years of age.
The U.S. House of Representatives will vote today on health insurance reform intended to bring health care to roughly 30 million uninsured Americans. Members of the Democrat party only need a simple majority to pass the legislation and they claim they have it.
What will it mean if this health care bill passes?
Well that depends on who you speak to. Many Republican’s say the bill would mean higher taxes, higher insurance premiums and a bigger government to meddle in your health decisions. They claim the bill does little to address the run-away cost of health care.
Democrats, on the other hand, say that this bill is the best way to provide health care insurance to millions of Americans currently without coverage. Regardless of whose side you are on, the proposed legislation will force health insurance companies to accept all individuals with pre-existing medical conditions should it pass. It would also require that people purchase health insurance or face fines. We will explain all the ramification of the bill in this blog should it become law.
What health care legislation are the voting on today?
There will be two votes today in the House of Representatives. The first vote is on the health care bill previously passed Senate. Congress will then vote on a second bill (the so-called reconciliation bill) that is intended to resolve the major differences between previous versions of the bill. If the first one passes then that is law. If the first bill fails and the second one passes, the Senate would still have to vote on the reconciliation measure.
This should be interesting. Remember, that any health care reform that should pass today will take a long time before it is implemented. If you are currently uninsured, you should consider getting individual health insurance for the foreseeable future. We will keep you posted as soon on our health insurance blog as we see the results.
With no alternative other than to reach out to the Republican party, President Obama has scheduled the first bi-partisan televised health care summit of the current administration this Thursday, Feb. 25, 2010.
As you can see from the video below, Obama is asking that both sides find common ground in the health care debate. It will be interesting to see what happens. One typically Republican point of reform allows for health insurance companies to provide coverage across states. Despite previous claims that this initiative would allow insurance companies to “poach the healthiest in each state”, Obama now says it is a good idea. Are there any other examples of common ground? We will keep you posted on the results of the summit.
Today California Insurance Commissioner Steve Poizner’s office shot a press-release-type email to all licensed California health insurance agents commenting on the recent Anthem Blue Cross rate increases scheduled for 3/1/2010. He wrote:
“I’m alarmed by the Anthem Blue Cross health insurance rate hikes, especially in a time when the recession has forced so many people into the individual health insurance market. State law requires that insurers spend at least 70 cents of every dollar of premium on medical care. I have instructed my department to hire an outside actuary to examine their rates line by line to ensure they are complying with this state law. If we find that their rates are excessive, I will use the full power of my office to bring these rates down.”
While I commend Mr. Poizner’s commitment to keeping prices low, I need one thing clarified. Since health insurance companies have to get all rate actions reviewed by the state before they can increase rates, wasn’t he aware of these new rates before today? When was he exactly “alarmed?” Was it when he learned of the new rate or when it became a news issue? We knew about these proposed rate hikes weeks ago.
Our California Insurance Commissioner should make sure that all increases to health insurance are justified and we are anxious to learn who or what is behind the rapidly increasing rates at Anthem. I hope, however, that in the future that cost issues are his active goal, not just a reactionary response that looks good in the papers.
Lawmakers in 34 states are attempting to make amendments to their constitutions to stop government health insurance mandates. Is it a good idea?
The proposed ban would make it illegal to penalize those who choose not to carry health insurance. This generally is a response to the current democratic initiatives in the Congress and Senate. I guess you could focus on whether this technique would even work. If there was a sweeping federal health bill that included mandatory purchasing of health insurance, it would most likely over-ride these state initiatives. The bigger issue concern we have is that this is just another illustration of how dysfunctional the health care reform process is. Rather then looking for real solutions, one group is trying to cram down reform while the other group is trying to block it.
Let’s get back to the core issue. COST. As everyone knows, health care costs in the United States are out of hand. According the the Kaiser Foundation, the average cost of a family policy offered by employers increased 5% in 2009 to a whopping $13,375. For the same amount of money, a small business owner could purchase a 2010 Nissan Versa 4-door car for each employee each year! Talk about benefits!
One way to address costs is to get more people into the insurance pool. There would be more healthy people paying premiums and this could offset the claims of those that get sick and could bring down the price of insurance. This is why some people support the mandate that everyone should purchase insurance. And while this may make sense in the abstract is would be very difficult to enforce. Yes, many make the comparison to the mandate to purchase car insurance. But there is a big difference. You can choose not to drive car but to choose not to live isn’t really an option. So a health insurance mandate doesn’t give individuals the chance to opt out like those who do not want to pay for car insurance. Also car insurance mandate is easy and cheep to enforce. No car insurance = no drivers license. We don’t think there is the equivalent in health care.
By the way, there is currently a mandate (of some sort) in small business health insurance. Most companies must require that 70% or more of their employees participate in the plan. This is to avoid what we call “adverse selection” where only the people with health issues join the plan. So this mandate aims at getting more healthy people into the plan yet prices are still very high. So a mandate cannot be seen as a fix all solution.
So what is the solution? Well, while we do think it is challenging to implement, we are not yet comfortable ruling out some sort of incentive to get more people into the insurance pool whether you call it a mandate or not. We do believe, however, that there are a few more politically viable alternatives that lawmakers should focus on right now.
1) Electronic Record Keeping
2) Transparency of Costs
3) Standard Negotiated Rates.
4) Addressing our National Obesity Crisis.
If we address the above we will be taking a big step to curb runaway health insurance costs. Each of these issues will be explored in more detail in future blogs and we look forward to your thoughts.
While many think last night’s victory by Republican Scott Brown was a major blow to health care reform, we think that this is a perfect opportunity to allow Washington make changes to the bill that will have a lasting positive impact. And it looks as if the White House may agree with us on this issue. According to the AP, President Obama urged lawmakers today not to try to force the current bill through but to scale the proposal down to what he called “those elements of the package that people agree on.”
In there lies the rub….what do people agree on when it comes to health care reform? Most people would say NOTHING. We, however, see a common ground. We think most everyone agrees that the growth rate of the cost of health treatment and insurance premiums in the United States is out of hand. We think health care reform should focus on controlling those costs. Rather than passing an enormous bill, we suggest small changes to our health care system that would make immediate impact to the cost of health care. The first bill should be called the Transparency of Cost Act. The bill that required health providers such as Doctors and Hospitals to alert patients of the estimated cost of health related procedure. This would directly address cost issues as many patients would be motivated to seek out better priced procedures. For example, if one facility charges $3000 for an MRI and another $1000, those patients with larger deductibles or coinsurance would select the less expensive option. This would save the patient and the health insurance company’s money and force the more expensive facility to reconsider their high price. This is a common sense that everyone can get behind.
