Interesting CA Healthcare Law From 2006

Wow ... have you been one of many who might be thinking low income people are going to be sorry that they just can't go the hospital anymore once the ACA goes into place?  You just might be right! 

The attached link is to an article talking about a CA law implemented in 2006 that had "no-cost" services for those below poverty income levels, guarantees of rates no higher than those on medicaid for other low income levels and so on!  Read all about it.  

Also, unlike the ACA, it applies to all hospitals!  Thinking there might be some sorry people!! Your thoughts? 

Here's the link: http://www.californiahealthline.org/articles/2013/6/4/california-law-reduces-medical-bills-for-uninsured-study-finds.aspx

From Kathy
http://www.healthbroker.com

Medicare Advantage Might Get Expensive In 2014

Excerpts taken from CNN article written by Jen Christensen
x
The Medicare Advantage coverage plan could soon cost more, according to an announcement expected Monday. The Centers for Medicare and Medicaid Services (CMS) will announce on Monday the final Medicare Advantage rates for 2014, which are expected to be cut, saving the government money -- but potentially costing the public more.
x
CMS had first proposed a 2.3% reduction in what the government pays the insurance companies that provide Medicare Advantage plans. Upset, the insurance companies have spent the public comment period time lobbying legislators and running ads against the cut.
Ads from the America's Health Insurance Plans' Coalition for Medicare Choices called the proposal "drastic" and "too much" and featured seniors saying they can't afford to pay more for health care.
x About 25% of the 47 million Americans on Medicare pay more to have Medicare Advantage. The plans are run by private insurance companies that are reimbursed by the government for doing so. The plans vary, but they offer the elderly more than they would get with regular Medicare. Most plans offer prescription drug coverage; some also offer dental and vision. All the plans cap a person's out-of-pocket expenses, while regular Medicare does not.
x
The rate reduction, which is a part of the Obama administration's ongoing effort to save money on the program, comes on top of other reductions that all go into effect at about the same time. The result is an unusually large reduction ... about 8% less.
x Seniors won't know what the out-of-pocket costs these cuts will bring until the fall. That's when the insurance companies put in their bids for the government work. By law, those out-of-pocket expenses can't go up by more than $30 more per month. That doesn't sound like a lot, but it can add up for seniors on a fixed income.

Source CNN.  Jen Christensen 

Could The ACA Be Repealed?

Rep. Ryan's FY 2014 Budget Proposal Aims To Repeal, Replace ACA

During an interview on "Fox News Sunday," House Budget Committee Chair Paul Ryan (R-Wis.) said his fiscal year 2014 budget proposal -- which he is expected to unveil this week -- would renew the GOP's efforts to repeal and replace the Affordable Care Act, the Washington Post's "The Fix" reports (Sullivan, "The Fix," Washington Post, 3/10).

Although many GOP lawmakers -- including House Speaker John Boehner (R-Ohio) -- have said that the ACA is here to stay, Ryan said Republicans remain opposed to the law and would continue to push for its repeal because they believe the law "will not work" (Bolton, "Blog Briefing Room," The Hill, 3/10).

Ryan dismissed criticism that House Republicans have little hope of dismantling the law, saying Republicans "believe it should" be repealed (Nelson, "Washington Wire," Wall Street Journal, 3/10). He noted, "This is what budgeting is all about. It’s about making tough choices to fix our country's problems," adding, "We believe Obamacare will actually lead to hospitals and doctors and health care providers turning people away" ("Blog Briefing Room," The Hill, 3/10).

However, Ryan's call to repeal the ACA could put him at odds with GOP lawmakers who want to find common ground with President Obama to reduce the federal deficit, particularly after the Supreme Court upheld the law, according to the Los Angeles Times.

Ryan's FY 2014 budget proposal also includes a provision from his FY 2013 budget proposal to turn Medicare into a premium-support system, the Times reports. Under Ryan's plan, beneficiaries would receive a federal subsidy to purchase either private coverage or a traditional Medicare plan. Just like the 2013 plan, the 2014 blueprint also would rely on more than $700 billion in Medicare savings from the ACA to "make Medicare more solvent" (Mascaro, Los Angeles Times, 3/10).

Ryan said changing Medicare to a premium-support model "is the best way to save Medicare for future generations." He added, "This guarantees that Medicare does not change for people in or near retirement, and it also guarantees for those of us who are under the age of 55, that we actually have a Medicare program when we retire" (Zigmond, Modern Healthcare, 3/10).

In addition, Ryan said his budget blueprint would undo the ACA's Medicaid expansion and give states more control over their programs by turning Medicaid into a block-grant system, the Times reports (Los Angeles Times, 3/10). According to Ryan's budget, this would generate $770 billion in Medicaid savings over the next decade.

When asked if Obama would accept his proposed changes to Medicare and Medicaid, Ryan said, "My guess is he won't." However, he added, "I think there are things that we can do that don't offend either party's philosophy, that doesn't require someone to surrender their principles" (Brown/Sullivan, Washington Post, 3/10).

Health Market Finding In Los Angeles & San Diego

Taken from California Healthline, Hospitals, Monday, January 28, 2013.

New Reports Highlight Emerging Health Market Trends in L.A., San Diego
Two new studies highlight the differences between the Los Angeles and San Diego health care markets, Modern Physician reports.
The studies were conducted by the Center for Studying Health System Change and funded by the California HealthCare Foundation, which publishes California Healthline. CHCF previously funded similar market studies on San Francisco, Fresno, Sacramento and Riverside/San Bernardino.

The Los Angeles and San Diego market studies were based on interviews with health care leaders in the regions in March and April of last year.

Findings About the Los Angeles Market
The Los Angeles report found that mid-sized physician groups increasingly are affiliating with or joining large independent practice groups, which have more market clout to negotiate with health insurers (Robeznieks, Modern Physician, 1/25).The report noted that the increased affiliations are helping physician organizations attract patients, compete with Kaiser Permanente and prepare for the implementation of the Affordable Care Act.
The report on the Los Angeles market also found that:

• Physician organizations are leading efforts to develop accountable care organizations;
• Health care providers serving beneficiaries of Medi-Cal — California’s Medicaid program — are showing interest in participating in ACOs, unlike providers in other areas; and
• New county leadership is redesigning the county-run health care delivery system and increasing collaboration between public and private safety-net providers (HSC release, 1/23).

Findings About the San Diego Market
Meanwhile, the San Diego report found that the region is dominated by Sharp HealthCare, Scripps Health, Kaiser Permanente, UC-San Diego Health System and Palomar Health (Modern Physician, 1/25).

According to the report, San Diego health care providers fared well during the economic downturn.

The report also found that:

• Physician practices are seeking to expand lucrative services — such as cardiovascular care and children’s services — offered in well-insured areas;
• Hospital construction has increased substantially to meet state seismic building requirements;
• Many safety-net providers have expanded their capacity;
• There has been an increase in limited-network insurance policies being offered; and
• County government is playing a more active role in health care, approving a 10-year strategic plan that aims to improve care for low-income residents (HSC release, 1/23).

Source:  http://www.californiahealthline.org/articles/2013/1/28/new-reports-highlight-emerging-health-market-trends-in-la-san-diego.aspx

California's Health Exchange Receives Fed Grant Of $674 Million

Written Friday, January 18, 2013 by David Gorn, Capital Desk, California Healthline: 

Covered California Lands $674 Million Federal Grant

As written ..

Peter Lee could hardly contain himself yesterday.

"In 2010, California was the first state in the nation to say we want a state-based exchange. Then, earlier this month, the federal government approved our blueprint for the exchange," said Lee, the executive director of the state's health insurance exchange, Covered California.

"And now," Lee said, "the feds have given us the resources we need to launch Covered California. This is an historic moment."Yesterday federal officials awarded $674 million to the California exchange, a Level 2 establishment grant that funds the set-up of the exchange through the end of 2014.

It was slightly short of the $706 million originally requested for the grant, but Lee was not about to quibble.

"The feds reduced 2014 potential payment for outreach and enrollment by about $30 million," Lee said. "But we think we have enough resources on hand to do the biggest outreach that I've ever seen."

State HHS Secretary Diana Dooley pointed out that the extensive planning for the exchange was accomplished in a relatively brief time frame, as the exchange board was only formed in April 2011.

"I just have to say how proud I am of the work this group has done in such a short time," Dooley said. "The work that's been done is nothing short of extraordinary."

Yesterday's federal announcement came a few hours before the board's monthly meeting -- this time held in Los Angeles -- where the good financial news continued.Exchange board member Robert Ross, who also sits on the board of the California Endowment, had another funding announcement."We are committing a minimum of $225 million to implement health care reform in our state," Ross said of the California Endowment. "There will be four major areas of spending," Ross said. "Outreach and enrollment, health workforce, chronic disease prevention and cost control and the fourth one is thinking about the population that's left behind, the undocumented."

Lee said he hopes the work being done to make health coverage affordable for low- and middle-income Californians will have a ripple effect throughout the health care industry."Covered California is not only going to make health care coverage available for millions," Lee said, "Covered California is going to be integral to creating a health care marketplace that works for everybody."

Serious Errors In Ten California Hospitals

The following was written by Anna Gorman, Los Angeles Times. It is more than scary to read reports like this. Our hospitals are supposed to be where we are safe.  Read on .... 

Last December, ten California hospitals received fines  for errors that resulted in either serious injury or death to a patient.

The California Department of Public Health issued a total of $785,000 in penalties for errors that include removing the wrong kidney, leaving surgical objects behind and failing to call for assistance when a patient began bleeding excessively.

The civil fines, ranging from $10,000 to $100,000, were issued to hospitals throughout the state for errors that occurred in 2010 and 2011. Two facilities in Los Angeles County and two in Orange County were among those fined.

Hospitals are required to report certain errors to the state. The goal of issuing the penalties and making them public is to reduce surgical and medication mistakes, said Debby Rogers, deputy director of the department's Center for Healthcare Quality.

"The value of the fines is bringing awareness both to the healthcare industry and healthcare providers but also to consumers," she said in a call to reporters.

Four of the hospitals fined were Kaiser facilities. At Kaiser's South Bay Medical Center, a patient died after mistakenly being given a blood thinner instead of medication to stop bleeding in the digestive tract. The state fined the facility $50,000.

At Kaiser's Oakland Medical Center, a 29-year-old woman died during a laser surgery to remove a congenital birth defect from her upper lip. The state fined the hospital $100,000.

An official with Kaiser Foundation Hospitals and Health Plan in Northern California said in a statement that she deeply regretted what occurred at its Oakland facility. "This should never have happened and we have taken steps to prevent it from happening again," said Barbara Crawford, vice president of quality and regulatory services.

Kaiser's Southern California office also submitted a statement saying that patient safety is "paramount" and that the facility took the errors very seriously and put in additional safeguards to prevent future problems.

A few of the penalties were due to surgical items being left behind in patients during operations. At Methodist Hospital of Southern California in Arcadia, surgeons left in a sponge when doing a gallbladder surgery and had to do another operation to remove it. The fine was $50,000.

Hospital spokesman Rick Miller said it was a "one-time" incident. "Since that time, we revamped our policies and procedures," he said. "There have been no other cases like this."

One facility, UC San Francisco Medical Center, received its sixth fine since 2007. In 2010, a nurse practitioner prescribed a cancer patient a medication that she was allergic to, resulting in her spending time in the intensive care unit and a skilled nursing facility.

The fact that the hospital has had so many fines is "obviously concerning to us," Rogers said.

After the error, the medical center re-trained staff on procedures regarding allergies and evaluated the nurse practitioner workload. The hospital also now has a comprehensive electronic health records system that makes it easier to access patient information, said Josh Adler, chief medical officer of UCSF Medical Center.

Rogers said the state recently proposed regulations that would raise the amount of penalties, making the initial fine $75,000, the second $100,000 and the third $125,000. The regulations also would allow the state to issue fines for errors that do not rise to the level of "immediate jeopardy" to patient health and safety.

The two Orange County hospitals that were fined were Mission Hospital Regional Medical Center in Mission Viejo and Orange Coast Memorial Medical Center in Fountain Valley.

Since 2007, the state has fined 141 hospitals a total of $9.6 million in penalties. The state has collected $7.5 million of that amount.

Health & Human Services Secretary To Remain In Obama's Cabinet

From Healthwatch, The Hills Healthcare Blog ...
Written By Sam Baker - 01/09/13 04:52 PM ET

       

Health and Human Services Secretary Kathleen Sebelius will stay in her post, a White House official said Wednesday. 

Several of President Obama's top Cabinet officials have either stepped down or announced their plans to do so relatively soon, as is common at the beginning of a president's second term. But the White House official said Sebelius — along with Attorney General Eric Holder and Veterans Affairs Secretary Eric Shinseki — will be sticking around.

Sebelius's decision isn't surprising. She was expected to stay on at least through next year, when the biggest components of the Affordable Care Act are set to take effect.

It could be difficult for a new secretary to win Senate confirmation, given the rough road Senate Republicans have laid out for healthcare nominees since President Obama's signature reform was signed into law.

California's Status On Healthcare Reform

Hi .. 

Here is a great article written by Michael J. Mishak, of the Los Angeles TImes last December: 

Facing a federal deadline, the CA Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.

Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.

But healthcare remains one of the largest and most immediate challenges.

The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.

Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.

"It's a very, very big undertaking to make the promise of the Affordable Care Act a reality," said state Health and Human Services Secretary Diana Dooley. "We are working as hard and as fast as we can in a very complex area with a lot of conflicting information."

As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.

It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.

One of the most significant proposals will be an expansion of Medi-Cal, the state's health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.

According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.

California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.

Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California's working poor. "I don't think they should be choosing between putting food on the table and buying health insurance," he said.

Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.

"We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs," said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.

Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.

"It should be a goal of the state to have millions of people enrolled on Day 1," said Anthony Wright, executive director of the consumer group Health Access California, "to bring in those federal dollars and make healthcare cheaper for everybody."

Are Many States Creating Health Exchanges? Study Finds Interesting Input ...

Interesting article found in California Healthline, Daily Digest of News, Policy and Opinion - Friday, Dec. 14th...

"Federal Government To Operate Most Health Exchanges, Study Finds ...

The federal government will operate health insurance exchanges under the Affordable Care Act in a majority of states, according to an analysis by Avalere Health, The Hill's "Healthwatch" reports.

As of Thursday -- one day before the federal deadline for states to declare whether they intend to run their own exchange -- 14 states and the District of Columbia had submitted plans, while three more states publicly have committed to operate their own exchange (Viebeck, "Healthwatch," The Hill, 12/13).

Background

Under the ACA, states can operate their own exchange, partner with the federal government or let the government run an exchange for them (Lengell, Washington Times, 12/13).

In a letter sent to governors in November, HHS Secretary Kathleen Sebelius said the administration was extending the deadline for states to submit detailed applications -- or blueprints -- required by federal officials to Dec. 14, but the Nov. 16 deadline to notify HHS of their decisions would stand.

Meanwhile, states that intend to partner with the government will have until Feb. 15 to submit their declaration letter and blueprint. Sebelius noted that the extended deadlines would not affect the anticipated launch of the exchanges in January 2014.

Details of Analysis

Because a large number of states are defaulting to federally run exchanges, Avalere estimated that two-thirds of U.S. residents who obtain coverage through an exchange under the ACA will do so in either a federally run exchange or a partnership exchange ("Healthwatch," The Hill, 12/13). Some experts predict that the federal government ultimately could be responsible for running exchanges in more than 30 states.

GOP Lawmakers Point to Compliance Costs, Lack of Guidelines as Reasons for States' Choices

At a House Energy and Commerce Subcommittee on Health hearing on Thursday, Republican lawmakers pointed to compliance costs and a lack of federal guidelines on the exchanges for many states' reluctance to run their own insurance marketplace, Reuters reports. Rep. Michael Burgess (R-Texas) said, "The uncertain regulatory environment and the overall lack of response from HHS are not encouraging the states or the health plans to move forward."

However, Rep. Frank Pallone (D-N.J.) countered that Republicans who oppose the law for political reasons are simply trying "to delay implementation under the guise of lack of information" (Morgan, Reuters, 12/13). Rep. Henry Waxman (D-Calif.) added, "For some states, no amount of information will ever be enough. And that's the tragedy of politicizing the law" (Sanger-Katz, National Journal, 12/13).

Experts Doubt Federal Government's Ability To Operate Exchanges

Meanwhile, some experts raised questions about the federal government's ability to successfully operate exchanges for so many states. Experts say the largest challenges for HHS will be the creation of a health IT system that can exchange data with multiple states, as well as providing adequate customer service to handle enrollment (Reuters, 12/13).

CMS Refuses To Delay Insurance Exchange Rules

In related news, Gary Cohen -- director of CMS' Center for Consumer Information and Insurance Oversight -- denied Republican senators' request to extend the comment period and delay the finalization of rules governing the health insurance exchanges, Modern Healthcare reports.

"There's not a lot of time between now and October, and people are saying that we need to get these rules; the [insurance] industry in particular is saying 'We need to get these rules finalized in order to know how to develop plans and get them into states,'" Cohen said (Daly, Modern Healthcare, 12/13)."

Affordable Care Act "Must Knows!"

Taken from BenefitsCafe.com and written by Bruce Jugan ... 5 Things Everyone Needs To Know Abouto The Affordable Care Act:

The Affordable Care Act (ACA), health care reform known as "ObamaCare," kicks into high gear in 2014. If you buy your own medical insurance, read on for 5 things you need to know.
1. You MUST BUY health insurance - or pay a tax penalty.

• You’ll have to buy your own plan if you don’t get coverage through your employer. This is called the "individual mandate." In the summer of 2012, the U.S. Supreme Court found it constitutional for the government to require everyone to buy health insurance. The high court determined that the individual mandate is a tax, so be prepared to either pay for health insurance or pay a tax penalty.
• You’ll be exempt from paying the tax if the cost of your health insurance coverage would be greater than 8 percent of your household income or you meet a few other criteria.
• Estimates are that 40 percent of Americans will be exempt from the penalty.
• In 2014, the penalty is only $95 per adult and $47.50 per child (up to $285 for a family) or 1 percent of family income, whichever is greater.
• Watch out: If you don’t buy coverage during the "open enrollment period" you may have a difficult time buying coverage when you need it.

2. You CAN BUY any health insurance plan you want. Insurance companies can’t decline you because of a pre-existing medical condition.

• This is called "guaranteed issue" and it is a HUGE deal. No matter what your medical condition you can get the same plan as everyone else and at the same price.
• The only things that can influence the price of your health plan in California are your age and where you live.
• California will have an "open enrollment period" every year when everyone must buy coverage. This prevents people from waiting until they get really sick or injured and buying coverage at the hospital or doctor’s office when they need medical treatment.

3. Your new policy will have much BETTER BENEFITS than the one you currently have.

• ACA requires every health insurance plan to have "essential benefits." These essential benefits include coverage of both brand and generic prescription medicine, maternity care, low deductibles and comprehensive coverage in and out of the hospital.
• Gone will be the low-cost, low-benefit plans that are intended for catastrophic coverage and that are popular with people who buy their own medical insurance.
• Gone will be the adage that "some coverage is better than no coverage." Under the ACA, the minimum available coverage is "comprehensive coverage."

4. The monthly PRICE of an individual health insurance plan will likely SKYROCKET.

• Hold onto your wallet because 3 forces will cause the monthly price of an individual plan to increase significantly:
1. No medical underwriting (see No. 2 above).
2. Much better benefits (see No. 3 above).
3. "Modified community rating," which changes the way the cost of coverage is spread among the young and the old.

• While it is terrible for an insurance company to decline to cover people with pre-existing medical conditions, the reality is that "medical underwriting" allows those who are able to qualify for coverage to pay less. Eliminating underwriting will increase the cost for healthy people.
• The price of medical insurance in California today is lower than just about every other state because of medical underwriting. In 2014, the entire country will look like New York or Massachusetts, which outlawed underwriting years ago; health insurance plans there cost more than twice as much as in California.

5. You may receive a SUBSIDY to lower the cost of your plan.

• Single people who earn roughly between $15,400 and $46,000 per year will be eligible for a subsidy to lower the cost of their health insurance. Check out this health insurance subsidy calculator.
• The subsidy amount is higher the less you earn and lower the more you earn. A single person who earns more than $46,000 per year in 2014 is not eligible for a subsidy and must pay the entire cost of her medical insurance.
• How the subsidy will work: Assume a health insurance plan costs $344 per month for a 30-year-old living in California. If that person earns $31,200 per year ($15.00 per hour) she must pay the insurance company $225.25 each month. The government will pay the insurance company $118.75 per month.
• People who earn less than $15,400 per year in 2014 will get their health insurance through Medi-Cal, California’s Medicaid program for low income people. This is a big change. Before 2014, a low wage worker with no children did not qualify for Medi-Cal yet he could not afford a health insurance plan. Now he will get Medi-Cal.

If the rules and regulations behind Obama Care sound complicated, that's because they are. And that's why we're here. We’ve been advising clients for more than four decades. BenefitsCafe.com can help guide you through the process of finding a health insurance plan that makes sense for your needs and budget. Just give us a call at (800) 746-0045.

Medicare Part B To Increase In Cost In 2013

Taken from California Healthline, under Medicare, 

as reported via AP/New York Times, 11/16

Monthly Premiums for Medicare Part B Set To Increase Slightly in 2013

Medicare Part B premiums will increase by $5 per month next year, CMS announced Friday, the AP/New York Times reports (AP/New York Times, 11/16).

According to a notice published in the Federal Register, the monthly premium for Medicare Part B -- which covers physician visits, outpatient care and medical supplies -- will be $104.90, up by 5% from $99.90 in 2012. Annual deductibles for Part B also will rise, from $140 to $147.

Meanwhile, premiums for Medicare Part A -- which pays for inpatient hospitals, skilled-nursing facilities and some home health care services -- will decline by $10 to $441 in 2013. Part A deductibles will increase by $28, from $1,156 last year to $1,184 in 2013 (Zigmond, Modern Healthcare, 11/16).

Medicare actuaries had estimated that Part B monthly premiums would increase by $9, based on early estimated cost growth for the program (Radnofsky, Wall Street Journal, 11/16).

CMS Acting Administrator Marilyn Tavenner noted that while the premium increase is less than anticipated, it is still enough to account for about one-quarter of a typical retiree's cost-of-living raise in Social Security payments next year (AP/New York Times, 11/16).

Please let anyone you know who is paying for medicare.

Medicare & Medigap Plan A Basics!

Plan A is basic to all medicare coverage.  It is an individual option as well as a part of all enhanced optional coverage. Here is an outline that includes what Medicare Plan A covers and how a Medigap Plan A may be utilized with it.  As always . your questions are welcomed!  Call me, Kathy Hope, at 800-792-9114.

Plan A Coverage 

Is Included In All 10 Plans

Hospitalization: 

Medicare Part A pays for hospitalizations for the 1st 60 days but only pays a portion of the daily costs from the 61st day through the 150th day.  You must pay the coinsurance amounts for those days.  

Medigap Plan A pays the coinsurance amount for those days and provides an additional 365 lifetime days.  

Blood:

Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year.

Medigap Plan A pays for the first three pints of blood not paid for by Medicare. 

Medical Expenses:

Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. 

Medigap Plan A pays the coinsurance (generally 20% of the "Medicare approved" amount) under Medicare Part B.

Note the definitions of deductible & co-insurance

Deductible - must be paid before medicare activates.

Co-insurance - After deductible and paid in addition to medicare covera

How Healthy "IS" Living In California?

How healthy is living in California?  A little bit more healthy than in 2010! 

Here is a recent study as published at healthinsurance.org/california 

California climbed two spots from its #26 ranking in 2010, and is now ranked as the 24th healthiest state to live in, according to the 2011 America's Health Rankings® by the United Health Foundation.

The good news:

Smoking has been on the decline in California, falling by 20 percent over the past decade (though nearly 3.4 million adults still smoke).

The bad news:

• The number of obese Californians has risen by 2 million over the past decade. More than 6.9 million California adults are now obese.
• Diabetes among adults has also risen over the past decade, from 6.8 percent to 8.6 percent of adults.
• The percentage of children in poverty has increased from 18.5 percent to 23 percent over the past five years.

California's best and worst category rankings:

Smoking – 2nd

Early Prenatal Care – 3rd

Occupational Fatalities – 4th

Infant Mortality – 5th

Lack of Health Insurance – 45th

Air Pollution – 50th

_______________________
http://www.healthbroker.com

"Covered Califonia" - New Name For CA Health Ins. Coverage

We finally have a new name for our California Health Insurance ... are you ready?
It is ......  Covered California  Reaction???

Here are all the details as written today by David Gorn in the Capital Desk Column of California Healthline.  Here you go:

"Exchange Picks New Name: Covered Californiaby David Gorn
The California Health Benefit Exchange board voted Tuesday to adopt a new name for the health insurance coverage it will offer starting January 2014 -- Covered California.

The decision comes after months of work. In August, the long list of potential names was winnowed to about a dozen possible names -- including CaliHealth, CalAccess, Wellquest, PACcess and Covered California. The list alos included unusual trademark names such as Ursa, Healthifornia, Eureka, Beneficia, Cal-Vida and Condor, as well as the crowd favorite, Avocado.

After designing logos, holding focus group meetings and running trademark searches, that list was cut down to four finalists in September: Ursa, Eureka, CaliHealth and Covered California. Trademark concerns emerged around Ursa and CaliHealth, and those names were dropped, said Chris Kelly, who made the final name presentation to the exchange board.

Kelly presented final logo designs to the board for Covered California (tagline: "Your destination for affordable healthcare"), a related-but-separate design for Covered, CA and Eureka ("Where California discovers affordable healthcare"). After gauging the final set of focus group opinions, Kelly said the recommendation to the board was to go with Covered California.

Eureka was seen by focus groups as more of a private insurance program, Kelly said. Covered California was particularly well-liked by the Latino population in the focus groups, and by almost two-thirds of respondents overall.

"We're looking for a brand consumers can relate to, and inspire them to enroll in health care in the exchange," said Oscar Hidalgo, director of communication and public affairs at the exchange. "This is a real pivot point for us, using that brand and tagline and logo for future campaigns to help consumers relate to our mission. We're still working on a few other things to complement that, and that should be done by the next exchange board meeting."
The next steps, Kelly said, are to secure the final trademark and finalize the logo and tagline, which should be done by Nov. 12. Those final designs should be ready for the next exchange board meeting, he said, on Nov. 14."

California Health Insurance
www.healthbroker.com

California Scores High In Quality Of Hospitals!

It's always a good thing to know that our hospitals are good ones! And ... it looks like California is doing well in that category!  Given the costs of healthcare, it's especially good to know that we have the best care in our local access.   
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Get the details in this article just reported in the California Healthline as written by  Lloyd in USA Today:
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Report Finds California Among States With Best Hospitals
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California is among the states that scored highest for hospital care related to conditions and treatments commonly linked to mortality, according to a report released by Healthgrades, USA Today reports.
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Details of the Report
The report ranked states and individual hospitals based on data released by CMS between 2005 and 2011.
Researchers examined data on 4,500 hospitals nationwide, focusing on four key conditions and procedures commonly linked to mortality:

• Coronary artery bypass graft;
• Heart attack;
• Pneumonia; and
• Sepsis.

The four conditions and procedures account for 54% of all hospital-related deaths in the U.S.
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Main Findings
According to the report, states with hospitals that provided the best care for those conditions and procedures were:
Arizona;
California;
Illinois; and
Ohio.
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States and areas with hospitals that provided the worst care related to those conditions and procedures were:
Alabama;
Arkansas;
Georgia;
Nevada;
Oklahoma;
Washington, D.C.; and
West Virginia.
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According to the report, patients had a 55% lower risk of dying and a 42% lower risk of having complications when treated in the best hospitals.
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Implications
Evan Marks -- a lead author of the study -- said that the differences in hospital quality in various states are "substantial."
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Researchers also found that the quality of care can vary widely among hospitals within a single state.Nancy Foster -- vice president of quality and patient safety policy for the American Hospital Association -- said that individuals also need to know how factors not accounted for in the study affect health outcomes.She said, "People come to [hospitals] ... far sicker if they're from a low income area," adding, "They might have multiple complications" and "might struggle to find healthy food" or "a safe place to exercise." She said, "All are important components of good health outcomes" (Lloyd, USA Today, 10/23).

It's Medicare Open Enrollment!

It's Open Enrollment from now until December 7, 2012! 

So what? It's a pretty big what as this is the time you can increase, decrease, change, delete, adjust your medicare coverage! Beyond this window of time you are stuck!  It's that simple. 

If you still have questions and/or concerns you should contact your insurance agent. I also found this posting written by Marilyn Tavenner, Acting Administrator at The Medicare Blog.  Think she says it pretty well in very readable language. Hope you enjoy. 

Per the words of Marilyn Tavenner:  

"It’s picking season – pumpkins, apples, Halloween candy…and a Medicare health or drug plan." 

"In my work with Medicare, one of the questions people ask me often is which plan is the best one. That’s not something I can answer, because picking a plan is an important and personal decision. Each person has a unique set of priorities. How do you weigh your options? Now’s the time to think about what matters to you, and pick the Medicare plan that meets your needs.

When you sit down to review your Medicare health and drug plan choices this year, keep track of the things you may want in a plan, and pick one that’s right for you. Here are some things to keep in mind while you consider your choices:

Costs

You should look at your current health care costs to find coverage that works with your financial situation. How much are your premiums and deductibles? How much do you pay for hospital stays and doctor visits? Just like with everything else, the lowest-premium health plan option might not be the best choice for you.

Coverage

Are the services you need covered? We know future health care needs can be hard to predict, but changes happen. Maybe your doctor changed your prescriptions this year or you have different health concerns. Make sure you understand what services and benefits you’re likely to use in the coming year and find coverage that meets your needs.

Convenience

Your time is valuable. When comparing plans, make sure you check which doctors and hospitals you’ll be able to use. Where are they located and what are their hours? Check which pharmacies you can use. Can you get prescriptions by mail? Remember that even if you’re happy with your current plan, these answers might change from year to year.

Quality of care

Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes."

Marilyn also invites you to call 1 800-medicare.  I also invite you to call me here at healthbroker.com if you have questions or need to discuss alternatives to your existing coverage.   You can find me at 800-792-9114    714-840-0047 

Who Is A Full Time Employee Under The New Healthcare Act

If  you've been listening to the news the last couple of days, you've probably heard that the owners of Lobster House and the Olive Garden are changing some employees to part time workers vs. full time to save costs on the reformed healthcare laws.  Think we will see more of this as the days go forward and businesses need to see how adaptations can affect their bottom lines both positively and negatively.     

If you are in a position of reviewing who is full time and/or part time you may benefit from this article written and posted by Tina Bull on October 9th, 2012 in the PSA Perspective, by  PSA  Insurance and Financial Services.  

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"The Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer affordable, valuable minimal essential coverage to all full-time employees or pay a penalty. This requirement is referred to as the employer shared responsibility requirement and is effective January 1, 2014.

ACA defines a full-time employee as one who has an average of at least 30 hours of service per week. Proposed regulations are expected to provide that 130 hours of service in a calendar month will be treated as the monthly equivalent of 30 hours of service per week.

The IRS has issued Notice 2012-58 to describe safe harbor methods an employer may use to determine if current employees and new “variable hour” employees must be treated as full-time employees for purposes of the shared responsibility requirement. An employee may be considered a “variable hour” employee if, based on facts and circumstances, it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

Ongoing Employees

For an ongoing employee (i.e. an employee who has been employed at least one standard measurement period as described below), full-time status may be determined under the safe harbor by calculating the employee’s actual average weekly hours of service during a specified look back period. This specified period is referred to as the standard measurement period and is a defined length of time between three and 12 consecutive calendar months.

If the employee averaged 30 or more hours of service per week during the standard measurement period, then health coverage must be offered to that employee during a subsequent stability period (of at least six months and no shorter than the standard measurement period). This coverage is provided to the employee for the entire stability period without regard to the number of hours of service the employee has during the stability period. However, another measurement period will commence for purposes of determining whether health coverage must be offered during the next stability period.

Between the measurement period and the stability period, an employer may use an administrative period of up to 90 days to notify and enroll eligible employees.

Employers will likely establish a standard measurement period immediately preceding annual open enrollment, an administrative period that coincides with open enrollment, and a stability period that matches the plan year. This means that the first standard measurement period may start as early as October 2012.

New Employees

For new variable hour and seasonal employees, the safe harbor method is similar. However, the initial measurement period and the administrative period combined cannot extend beyond the last day of the thirteenth full calendar month of employment. The initial stability period must be the same length as the stability period for ongoing employees.

In addition, certain hours of service during the initial measurement period will also be counted toward the next standard measurement period that begins after the new employee’s date of hire. A variable hour employee who is determined to be full-time during the initial measurement period must be offered coverage during the full initial stability period, regardless of the average number of hours of service during the first standard measurement period.

If a new employee is reasonably expected to work full-time at the date of hire, then the safe harbor method for variable hour and seasonal employees does not apply. The employee must be initially classified as full-time and coverage must be offered to the employee at or before the conclusion of the employee’s initial three calendar months of employment.

Reliance and Comments

Employers may rely on the safe harbors for measurement periods that begin through 2014 and related stability periods that may extend into 2016. The IRS has asked for comments on the following: other safe harbors for categories of employees that present special issues, other guidance that may be needed to determine full-time status, measurement/stability period issues during a merger or acquisition and how seasonal worker should be defined.

While the safe harbor methods are optional and may be administratively challenging for employers, use of them will provide certainty that an employer will not be subject to the ACA penalty for failing to offer coverage to all or substantially all full-time employees."
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New CA Laws Preparing State for New Healthcare Insurance

It is all rolling along at a fast clip!!  CA is getting ready for Obama Care!  Gov Brown just signed into CA law the following items ... probably just the first of many??  

Here is the list as published in the LA Times and written by Scott J. Wilson

October 7, 2012

"Gov. Jerry Brown signed into law last week a set of measures aimed at preparing California for coming changes in how consumers get healthcare insurance. Some of the laws:

• To head off deceptive marketing attempts, AB 1761 bans unauthorized individuals and businesses from claiming to represent the California Health Benefit Exchange, the new central marketplace for buying insurance that goes into effect in 2014.

• Beginning in 2014, under AB 792, Californians who lose their health insurance because of job loss, divorce or legal separation will receive information about reduced-cost plans available through the health exchange and no-cost coverage from Medi-Cal.

• Self-employed people will be covered, under AB 1083, by California's law governing small business health insurance. Previously, businesses had to have at least two employees to qualify. Backers argued that the change, effective in 2014, will expand the availability of affordable coverage to entrepreneurs.

• Insurers hoping to sell policies through the state exchange will have to meet minimum coverage standards as established by AB 1453 and SB 951. The new laws, supported by Consumers Union and other groups, designate two Kaiser HMO plans as the state's "benchmarks" for benefits and services.

• The state's Managed Risk Medical Insurance Board, which oversees plans that help those who cannot get health insurance elsewhere, will get increased subsidies under AB 1526 to lower rates consumers pay. Legislative analysts estimated the bill will cost the state $16 million in 2013."

Privacy Rights .... When On Parent's Health Insurance Policy!

Thought this article written by Michelle Andrews and provided by Kaiser Health News was especially interesting.  Generally the ability for young adults up to the age of 26 to remain on their parents health insurance has been received as an excellent enhancement. BUT ... what about the privacy rights of the young adults??  Hmm... read on!  Here is some input from Michellel Andrews.

Elizabeth Nash was 21 and just finishing her junior year at the College of William & Mary when she had a miscarriage. She planned to tell her parents about it in person, but her insurer beat her to it when, as a matter of routine, it mailed them a form that described the medical treatment she'd received.

Nash says the experience "caused a rift that took a while to repair."

Nash, now 38, recently co-authored an analysis of state laws on health-care confidentiality for insured dependents for the Guttmacher Institute, a reproductive health organization, and was surprised to find that state laws in this area are "so lacking and vague and mushy."

Under the Affordable Care Act, which allows adult children to stay on their parents' plans until they reach age 26, breaches of privacy such as the one Nash experienced may become a growing problem. Since the law passed, more than 3 million young adults have gained coverage, according to the Department of Health and Human Services.

Although parents must give consent for most care provided to children younger than 18, many states allow minors to consent on their own to such potentially sensitive services as testing and treatment for sexually transmitted infections, prenatal care and delivery, contraception and outpatient treatment for mental health and substance abuse.

The privacy rule of the federal Health Insurance Portability and Accountability Act (HIPAA), which took effect a decade ago, generally prohibits the unauthorized disclosure of individuals' medical records and other health information. But there's a catch. Health-care providers and insurers can generally use such information when trying to secure payment for treatment or other services.

And that can be problematic. Providers submit bills to insurers, which process them and generate a document, often an Explanation of Benefits (EOB) form, that tells the insured or the policyholder how much the insurer paid and what, if anything, is owed on the bill.

These communiques are important to combat fraud and identity theft, and many states require that they be sent, according to Nash.

But the documents do not always go to the person who was treated. "The notice could go to your parents or to you, depending on state law, insurance contracts and insurance policy," says Abigail English, director of the Center for Adolescent Health and the Law, and lead author of the analysis published by the Guttmacher Institute.

English says it's "extremely common" for insurers to send EOBs to the policyholder rather than the patient.

Under federal privacy regulations, patients can request that insurers not disclose confidential information or ask that they send it to an address of their choosing. Insurers are required to comply if not doing so would endanger the patient, says English, for example, if it posed a threat of domestic violence.

"Plans typically do have procedures in place to deal with the disclosure of sensitive information," says Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade group.

Some insurers have made strides in addressing confidentiality issues related to billing and other communications. Cigna, for example, redesigned its EOB forms to strip out specifics about the treatment or services provided, says Joe Mondy, a spokesman for the company. The form, which typically goes to the policyholder, does name the facility and the provider, however.

In addition, unless the law requires it, the insurer sends an EOB only if there's a balance due.

Policy experts say strategies such as Cigna's make sense. That's especially true given the expansion in free preventive services under the Affordable Care Act. Starting in January, for example, many women in new health plans or in those that have changed their benefits enough to lose grandfathered status will be eligible for such services, including contraceptives, counseling and screening for sexually transmitted infections, and screening and counseling for domestic violence.

"With more insurance coverage of contraception, there will be more issues of whether insurers are protecting confidentiality," says Tina Raine-Bennett, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Oakland, Calif., who is chair of the Committee on Adolescent Health for the American College of Obstetricians and Gynecologists.

Although protecting young women's privacy poses a challenge for insurers, "I do believe there will be a net gain in having those services," she says."

So now, what do you think??  See the actual article here, http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2012/under-26-insurance-privacy-michelle-andrews-100212.aspx

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.