Archive for the ‘Laws’ Category

Many Important Health Care Reform Changes for Young Adults

Thursday, June 17th, 2010

While many young adults faced losing coverage as they aged off their parent’s plan, had no coverage in the case of an unexpected pregnancy, or merely had the bare necessities covered by their school plans, all can breathe a sigh of relief as health care reform promises to end their fears.

As mentioned in earlier posts, the most immediate change is coverage will be extended to overage dependents, as long as they are not offered other employer sponsored coverage, up through their 26th birthday. This helps ease the burden of uninsured claims, as many of these adult children would wait over two years before attempting to obtain their own coverage.

Another helpful option for these previously uninsured individuals is the fact that more than half of them will be eligible for either Medicaid in 2014, as their income is expected to be less than 133% or qualify for government subsidies if they decide to purchase private insurance through an exchange if they are earning 400% of the poverty level.

More relief serves in the fact that maternity coverage will be a mandatory inclusion on the plans, something that is either excluded completely or greatly restricted, depending on what state you reside in. This is most important during young adulthood, as is the need for access to contraceptives, which will also be covered.

The fact that lifetime maximums will be eliminated also sheds light on the current state of most university based plans. Many tend to cover only the most basic of health needs, and offer only limited protection for conditions that are considered eligible medical expenses. With the implementation of comprehensive coverage for all adult children, in spite of of any pre-existing conditions, we can breathe easy that coverage is in place should they need it. Regardless of how you feel about health care reform, we can all agree that all youths of our nation deserve health care coverage!

Insurers to Offer Overage Dependents Coverage Earlier Than Anticipated

Tuesday, May 4th, 2010

As planned during six months following the signing of the health care reform bill, coverage will be extended for dependents up to the age of 26. This will allow parents to continue to offer health insurance coverage to their dependent children, even if those children do not live in the same household. This also holds true for young adults under 26 living out of state, and those that are married. Basically, unless they are offered employer sponsored health insurance, they can continue to remain on their parent’s coverage.  

The deadline to implement this extension of coverage is September 23rd, 2010. However, numerous insurance carriers have decided to offer the coverage much sooner than that. CIGNA, Humana, United Healthcare, and Kaiser are a few that are increasing the dependent age limit as soon as June 1st. You can check with your carrier, or with us, to determine how your eligible dependents maintain coverage on your current plan. Regardless of whether a plan decides to implement this change ahead of schedule, health care reform will ultimately bring changes to all plans.

The First Year for Health Care Reform – Step One

Thursday, March 25th, 2010

Though some fine tuning will be taking place, the plan for implementing the Health Care Reform Bill during the first year will (most likely) look something like this:

  • Dependent children will be eligible to stay covered under their parent’s plan until their 26th birthday. The House is still pushing to make this coverage last through their 26th birthday.
  • Insurers can no longer impose exclusions on pre-existing conditions in children. Children are considered exempt from this until their 19th birthday 
  • Lifetime maximums on benefits and annual limits on coverage will be discontinued 
  • A “high risk pool” will be created for people who cannot otherwise obtain individual coverage due to pre-existing conditions 
  • Seniors will receive a $250 rebate for help them cover the costs of their medication while in the “doughnut hole” (between $2700.00 and $6154.00) 
  • The implementation of covered preventative care services requiring no co pays

Though the final outcome is still yet to be known, these are some of the highlights of the plan of action for health care reform in 2010. Though changes will be made, and battles will be fought, we can expect some of these changes to take shape in less than 6 months from now. From then on? No one knows for sure. We do know, however, that every American will be watching and waiting to see what happens next.

Health Care Reform is here! What does this mean for you?

Monday, March 22nd, 2010

No one really knows! It seems that revisions are made by the hour, and nothing is quite set in stone as of yet. Also (as of this hour) 11 states have filed lawsuits stating that the bill is unconstitutional, in that it forces people to pay for coverage or face financial penalties. Does it promise to cover all Americans? Supposedly, by 2014, after spending the next few years inching towards this goal by means of guaranteed issue policies, no lifetime maximum amounts, the cessation of policy rescission’s, etc. Once this is in place, individual policies would be purchased via an exchange:

 Health Benefit Exchanges. Effective in 2014, state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges are established, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. States are permitted to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017. States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. (Funding available to states to establish Exchanges within one year of enactment and until January 1, 2015)

 We will see some changes right away, such as offering coverage to all children regardless of pre-existing conditions, and the creation of high risk health pools. Others will take more time, such as the adult pre-existing conditions being a non-issue when it comes to obtaining medical coverage.

 Proponents of the bill claim this will save us trillions over the years, while opponents can’t see how that is possible. Guaranteeing and requiring that all obtain health insurance coverage cannot be without a hefty price tag, can it?

 Stay tuned………

California’s Timely Access to Medical Care

Sunday, February 14th, 2010

 Recently, the California Department of Managed Care has released some new guidelines for HMO patients, in order to create a more efficient and comprehensive level of care for these patients. Among the new rules:   

• A physician appointment within 10 business days of a request 

• A specialist appointment within 15 business days of a request 

• An urgent care visit within 48 hours of a request 

• Telephone access to a health care professional at all times.  

The state is giving health plans one year to comply with these new regulations. After the one year grace period, non-compliant carriers will face heavy fines. With the implementation of these new rules, it is hoped to reduce emergency room traffic, as more patients are able to obtain urgent care visits instead, as well as the overall reduction of appointment wait times (which benefit all patients – HMO and PPO alike).  

Opponents to these new regulations feel that this adds to an already strained system of primary care physicans, who are already in shortage. Fears also lie in the fact that the doctor would now be forced to spend less time with each patient. However, with the average waiting time to see a general practitioner at 20 days, it does seem that the pros outweigh the cons with these timely-access rules.

Brown’s Victory & What it Means for Health Care Reform

Tuesday, February 2nd, 2010

Health Care reform faced yet another setback as Massachusetts State Senator Scott Brown received 51.9% of the vote needed to fill late Senator Kennedy’s seat in the US Senate. This now makes the Republican head count 41, thereby bringing the 60-count Democrats were relying on to pass the health care reform legislation to an end. Brown’s strong statements regarding the negative portions of the bill, such as higher taxes and the destruction of jobs, played a major role in his political success. However, ironic that he fills the seat of a major proponent of universal health care, many are breathing a sigh of relief as the thought is while health care reform is much needed, it is something that needs to be dealt with carefully – not a “fix it later” attitude.  

While Brown’s win does not mean this legislation is dead in the water, it will mean that it goes back to the drawing board, where hopefully a system that works for all will come to light.

Is There a Answer for COBRA Subsidies?

Monday, January 18th, 2010
Worries grow as those Californians who have been receiving assistance with their COBRA premiums are faced with losing financial assistance. As federal stimulus money dwindles, the 65% of premium formerly covered by this subsidy will expire, leaving many to make a tough choice – pay the premiums or go without coverage. COBRA (the Consolidated Omnibus Budget Reconciliation Act) was passed in 1985, allowing involuntarily terminated employees to keep their current health plan, and take over the payments for their monthly premiums. However, after many years and skyrocketing health care inflation, many people are finding that their COBRA premiums are exceeding their unemployment benefits.
 
If reports are correct in showing that 40% of newly employed people applied for the COBRA subsidy, these numbers can mean that the number of uninsured people will rise along with the lack of federal support. There are some plans in the works, however, which may bring some much needed relief:
 
HR 3930 would extend the period of eligibility through June 2010, increase the maximum duration of the subsidy to 15 months and end all subsidies at the end of December 2010.
 
S 2730 by includes the same provisions as the House bill and would also increase the federal subsidy from 65% of the premium to 75%, as well as expand eligibility to include employed people who lose health coverage because of involuntary reduction of hours.
 
COBRA Subsidy Laws are changing all the time. We will try and bring you the most updated information as we can. In the meantime, there are many websites to help you keep up with the changes. We are also happy to answer any questions you have!

Expiration Date Nears for COBRA Federal Subsidy

Monday, November 2nd, 2009
The federal economic stimulus package which covers 65% of the cost of COBRA premiums is set to end as of December 2009. This reduction was designed to assist those who had an involuntary termination of employment and were eligible for COBRA during the period of September 1, 2008 through December 31, 2009. Though the subsidy is set to end after a period of 9 months, this does not mean you are going to lose your coverage. Instead, you will now be covering the entire cost for the remainder of your 18 months, or longer if your coverage is eligible for extension. The subsidy will end prior to the 9 months in the case of eligibility for coverage under a new group plan, eligibility for Medicare, or in the case of non-payment of the remainder of the COBRA premiums.
 

Let us help you find alternate coverage before your COBRA expires. There are many options for you and your family, and we are happy to help you determine whether a new plan is the best route, or to stay on COBRA for the remainder of your eligibility period.  It is our pleasure to help you determine the best choice for your health insurance coverage.

No Premium Increases for Medicare Part B in 2010

Monday, September 28th, 2009
For the 42 million seniors and people with disabilities who are currently enrolled in Medicare Part B, a recent vote has ensured that there will be no premium increase for Part B. The standard premium is currently $96.40; slightly higher for those with incomes over $85,000 for individuals or $170,000 for couples. This premium is calculated annually to cover around 25% of the Medicare program. For 2010, this would mean the premiums would be at about $103 (and up!) per month. However, there is a “hold harmless” policy which eliminates this rate hike, by utilizing $2.8 billion from a 2008 fund to improve Medicare.
 
Due to the economic recession, Social Security’s cost-of-living adjustment is expected to be zero, and therefore the checks will not increase. Therefore, if the Part B premium increase is projected to be more than the increase in Social Security, most current Medicare enrollees are ensured no premium hikes. As with any law, however, there are loopholes and if Congress did not step in, there would have been some enrollees who would have not fallen under the hold harmless policy (i.e. new Medicare enrollments, and those whose premiums are not deducted from the Social Security checks). With the implementation of this act, all Medicare enrollees will be spared any rate increases for their Part B premiums.

Healthy Families Program Spared Massive Cuts

Wednesday, September 23rd, 2009

  California children will not be losing their Healthy Families coverage thanks to the implementation of Assembly Bill 1422. Over 600,000 children were going to be disenrolled starting October 1st, due to a lack of funding. Currently, there are 71,000 children on the waiting list since enrollment was frozen in Mid-July. Parents and guardians can breathe a sigh of relief, however, as this affordable medical, dental, and vision coverage will remain in place.  

This bill works in numerous ways to utilize taxes, donations, and cost sharing to avoid dropping children from the program. First, the First 5 California Commission, which oversees children’s health and educational programs via tobacco tax revenues, has offered to contribute more than $81 million. An additional $17.6 million is expected to be raised by implementing higher premiums for those above the poverty level, and raising copaymentsfor ER room visits, doctor office co pays, and prescription co pays. Health plans that administrators Medi-Cal benefits would see a 2.35% tax. This levy will replace the current 5.5% fee, which is expected to expire in October.  

With all of the above and more, let’s hope this eases the financial burden on this program, and avoids having any child go without the coverage they need.


© 2009 Abrams California Health Insurance Agency. All rights reserved.
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