Tuesday, December 4, 2012

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.

Monday, November 19, 2012

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.



Saturday, November 17, 2012

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


Wednesday, November 7, 2012

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

Thursday, November 1, 2012

"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

Wednesday, October 24, 2012

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).

Wednesday, October 17, 2012

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