Epilepsy Talk
How The New Health Coverage Bill Will Affect You… | March 26, 2010
One of the main goals of the new Health Care Bill is to make sure most Americans have insurance coverage, no matter what their health status is, their age or their disability. Thirty-two million more Americans would obtain coverage beginning in 2014. That’s about 94% of citizens and legal residents.
For example: Medicaid would be turned into a true program for the poor, rather than just covering about half the poor, mostly because of the way the eligibility rules differ from state to state.
The good news is: Everybody who is above Medicaid eligibility level becomes able to buy insurance through exchanges. Every state is authorized to set up an exchange. The states will get money from the federal government to set them up. But states don’t have to do it. And they can defer to the federal government, which will also set up a multistate exchange.
Subsidies will be available to people on a sliding scale. For example, those with the lowest incomes will only have to pay 2% of their income for a premium. The rest will be picked up by the subsidy.
Timeline: When will the new health care reform affect you? (As explained by CNN)
Within the first year
Insurers will be barred from imposing exclusions on children with pre-existing conditions. Pools will cover those with pre-existing health conditions until health care coverage exchanges are operational.
Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill.
Lifetime limits on benefits and restrictive annual limits will be prohibited.
New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018.
Plans will be required to implement an appeals process for coverage determinations and claims.
Young adults will be able stay on their parents’ insurance until their 27th birthday.
Seniors will get a $250 rebate to help fill the “doughnut hole” in Medicare prescription drug coverage, which falls between the $2,700 initial limit and when catastrophic coverage kicks in at $6,154.
2011
States can offer home-and community-based services to the disabled through Medicaid rather than institutional care beginning October 1.
Medicare will provide free annual wellness visits and personalized prevention plans. New plans will be required to cover preventive services with no co-pay.
A 50% discount will be provided on brand-name drugs for Prescription Drug Plan or Medicare Advantage enrollees. Additional discounts on brand-name and generic drugs will be phased in to completely close the “doughnut hole” by 2020.
2013
Health plans must implement uniform standards for electronic exchange of health information to reduce paperwork and administrative costs.
The hospital insurance tax will increase 0.9% points for those earning more than $200,000 ($250,000 for married filing jointly), and it includes net investment income.
A 2.9% excise tax on the first sale of medical devices will be established. Excepted are eyeglasses, contact lenses, hearing aids or other items for individual use.
2014
Insurers can no longer refuse to sell or renew policies because of an individual’s health status. Health plans can no longer exclude coverage for pre-existing conditions. Insurers can’t charge higher rates because of heath status, gender or other factors.
Health plans will be prohibited from imposing annual limits on coverage.
Health insurance exchanges will open in each state to individuals and small employers to comparison shop for standardized health packages.
Credits will be available through exchanges for those whose income is above Medicaid eligibility and below 400% of poverty level who are not eligible for or offered other acceptable coverage.
Medicaid eligibility will increase to 133% of poverty for all nonelderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.
Citizens will be required to have acceptable coverage or pay a penalty of $95 in 2014, $325 in 2015, $695 (or up to 2.5% of income) in 2016. Families will pay half the amount for children, up to a cap of $2,250 per family. After 2016, penalties are indexed to Consumer Price Index.
Workers who are exempt from individual responsibility for coverage but don’t qualify for tax credits can take their employer contribution and join an exchange plan.
Yes, it’s not perfect, but it is a step forward…
Resources:
http://www.cnn.com/2010/POLITICS/03/23/health.care.timeline/index.html
http://www.pbs.org/newshour/indepth_coverage/health/healthreform/
http://www.pbs.org/newshour/bb/health/jan-june10/health2_03-23.html
http://www.cbsnews.com/8301-503544_162-20000846-503544.html
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Hi Phylis, I am glad you brought this subject up. I have a couple of questions.
What about the homeless? They do not have an address and I believe to get insurance you have to have one. The hospitals do not have to take in anyone, in the ER, who does not have insurance, now.
Insurance companies do not have to keep children on their policies after the age of 26-27. I am confused on the age. I have heard that it is on the 26th birthday.
We have a son who is on our policy who is 30. That will hurt us greatly if he is dropped and has to get his own insurance. We depend on his SSI to get by. That will mean a lot less money for our food and bills.
Do you know what the new law is on those 2 things?
Ruth
Comment by Ruth Brown — March 26, 2010 @ 9:15 AMMar -04:00Mar
I’m afraid the homeless are out of luck unless they can get help at shelters.
After the age of 27, a child has to get his/her own insurance. If they are unemployed, I think they can apply for Medicaid.
However, it is not until 2014 that Medicaid eligibility will increase to 133% of poverty for all nonelderly individuals to ensure that people obtain affordable health care.
My guess is that both of you will have to apply of re-apply for new SSI. I’m not sure of the answer.
But that change is going to happen THIS year,so I suggest you contact an SSI caseworker and find out what the provisions are.
Comment by Phylis Feiner Johnson — March 26, 2010 @ 9:15 AMMar -04:00Mar
Hi Phylis,
I will wait and see, first. I do not want to give them any ideas.
If their are any changes, I will get a letter.
Ruth
Comment by Ruth Brown — March 26, 2010 @ 9:15 AMMar -04:00Mar
Some more info: Advancements to Medicaid:
The new healthcare Bill will expand Medicaid to include 133 per cent of federal poverty level, which is a yearly income of $29,327 for a family of four.
It requires that states expand their respective Medicaid to include childless adults, starting in 2014.
The federal government will compensate for 100 per cent of costs for covering newly eligible individuals through 2016.
http://www.healthwikisource.com/details
The new Health Care Bill creates immediate options for people who can’t get insurance today. 9% of people in California have diabetes2, and 25 percent have high blood pressure3 – two conditions that insurance companies could use as a reason to deny health insurance coverage. Reform will establish a high-risk pool to enable people who cannot get insurance today to find an affordable health plan.
The bottom line? I’m not sure THEY know yet!
Comment by Phylis Feiner Johnson — March 26, 2010 @ 9:15 AMMar -04:00Mar
Insurance Companies will not be able to uninsure people with pre-existing conditions.
They will read it carefully to see what donoght hole they can find.
The bill favors certain states to get more health benefits than others. Several states are trying to make the bill unconstitutional. We will have to wait and see.
Comment by Ruth Brown — March 26, 2010 @ 9:15 AMMar -04:00Mar
I don’t think they’ll be able to get away with the donut holes…because that’s a Federal mandate. As for states getting more health benefits than others, I guess it’s a demographic (rather than Democratic) decision. It’s all still very confusing even after reading about it for 5 hours yesterday and then another hour today!
I think there are a lot of wrinkles, which is why it’s going to take so long to iron out and implement…
Comment by Phylis Feiner Johnson — March 26, 2010 @ 9:15 PMMar -04:00Mar
My daughter is self employed dog groomer, she had little or no business since the last year. (because of the economy)she is unable to find or suitable work. My daughter sent he teenage children to live with their father. She is living on what I can send or, plus the odd dog grooming. Is there anyway she will be covered in the case of illness?, she is forty seven, living in California. There is no potential for work where I live.
Comment by Jean Bennett — April 1, 2010 @ 9:15 AMApr -04:00Apr
I honestly don’t know. (Someone on one of the forums said they doubted even President Obama knew!) But here’s a link to Free Medical Clinics and Free Dental Clinics in California http://www.freemedicalcamps.com/vcity.php?stateid=CA Also, check out the post on Deeply Discounted Drugs without Insurance http://epilepsytalk.com/2010/03/18/deeply-discounted-drugs-without-insurance/
You’d be amazed at what you can get at the “corner drug store.” Costco, CVS, Target, Walgreens, Walmart, and RXSavingsPlus all have plans for deeply discounted drugs. Some only cover generics, some cover both prescription and generics. But it pays to shop around (just click on the links) and see who has what’s best for you at the best price. (For example, CVS is slim on epilepsy drugs, but they have tons of diabetes stuff.)
There still are options…but they seem to be more at the retail level. And eventually, we’ll have wellness clinics like they have in Europe, where you can walk in with a minor illness (flu, broken arm, kidney infection, etc.) and be treated at a very nominal price. That would take a lot of the pressure off of the emergency rooms and the under-employed.
Comment by Phylis Feiner Johnson — April 1, 2010 @ 9:15 AMApr -04:00Apr
Today, my son was dropped from our family insurance plan. CVS pharmacy said that they could not help out. Their Health Card did not cover his medicine. They told us that he had to have some insurance of some kind.
It is good that he has Medi-Cal. He was able to get his medicine.
My husband called our insurance plan and they said that they would call back. They said that a lot of parents are calling up. I believe that.
I think we will have to go to Sacramento, where our insurance plan is from the government. We have been able to keep him on our plan because he is disabled. We are going to fight to keep him on it. Since he was 18, we have been able to keep him on our plan because of his disability.
Ruth
Comment by Ruth Brown — April 2, 2010 @ 9:15 PMApr -04:00Apr
I’m sorry to hear that. Did you try any of the other “drug stores” on the list? http://epilepsytalk.com/2010/03/18/deeply-discounted-drugs-without-insurance/ Costco, Target, Walgreens, Walmart, etc.
Comment by Phylis Feiner Johnson — April 2, 2010 @ 9:15 PMApr -04:00Apr
THANK YOU ,FOR YOUR INFORMATION, I SUPPOSE ONLY PATIENCE AND COMMON SENSE WILL PREVAIL, AS SOON AS THE PUBLIC REALIZE HOW FAR BEHIND WE ARE FROM THE REST OF THE WORLD WITH REGARD TO HEALTH PROTECTION PLANS FOR THE PUBLIC.
Comment by Jean Bennett — April 4, 2010 @ 9:15 AMApr -04:00Apr
Hi Jean, it is not the public that is ignornant. It is the government who has rushed through a bill that they do not understand.
I live in CA, too. Our govenor plans on cutting back on healthcare in our state.
One thing is certain, I am afraid that your daughter will have to get her own health coverage.
We will have to wait and see what the bill involves. We do not know, so let us wait.
Ruth
Comment by Ruth Brown — April 5, 2010 @ 9:15 PMApr -04:00Apr
One of the problems is that California is broke…
Comment by Phylis Feiner Johnson — April 5, 2010 @ 9:15 PMApr -04:00Apr
This encouraging news today from NPR: “The new health bill signed by President Obama includes an incentive for doctors to serve the poorest patients by increasing their federal Medicaid payments. This could be quite a significant inducement, as an additional 16 million people are expected to join the Medicaid rolls in the next 10 years.”
http://www.npr.org/templates/story/story.php?storyId=125570044&ft=1&f=1001
Comment by Phylis Feiner Johnson — April 5, 2010 @ 9:15 PMApr -04:00Apr
We got a phone call, finally, from Sacramento. They are going to send us a form to fill out to put our son back on our policy.
In the meantime, our son. who is on Medi-Cal, is going to get a doctor. He does not have a doctor until he is back on our plan.
Comment by Ruth Brown — April 7, 2010 @ 9:15 AMApr -04:00Apr
YAY!!!!!
Comment by Phylis Feiner Johnson — April 7, 2010 @ 9:15 AMApr -04:00Apr