Discussion in 'US Health Care Reform' started by Darryl, Mar 23, 2010.
My main question is what about pre-ext for adults? Kaleb will be 19 in December, no longer a kid.
I did hear you can put Kaleb on your own insurance from the age of 19 to 26 and I THINK that is one of the provisions that start either immediately or within the next six months. If your insurance company denies you, immediately call your Representative to see if they can. Do not drop him from your insurance.
Is this whats in the bill now? or is this what they are adding in?
i'd like to know more about pre-existing exclusion for adults...my son will be 22 and graduate from college this spring.
my husband's fortune 500 employer has already indicated that the extension to age 26 will be an option for the company and they, of course, have told us they won't participate....
so, newly graduated with an engineering degree...never missed a day of school since 7th grade when he got his pump....not insurable due to his 'pre existing' condition and my husband's employer has slammed the door on us too cuz they don't want to 'play'.
Matt will turn 19 next month. He's still a full time student and we can cover him on my DH's plan until 25 as long as he's still our dependent. I've heard that this bill will allow children to be covered on their parents' insurance until age 26 despite student status and marital status. Is this true?
Wow that's reality for you. I wonder when we'll hear about this type of thing in the news? Will they be fined if so how much?
I'm sorry Susan. You know we're in the same boat. We're looking at Cobra if ds is still looking for a job.
The new law says:
"A group health plan and a health insurance issuer offering group or individual health insurance
coverage that provides dependent coverage of children shall continue to make such coverage
available for an adult child (who is not married) until the child turns 26 years of age."
I don't think your husband's fortune 500 employer has any option but to follow this law.
You should contact their HR department and ask them to clarify under what section of the law
they have the "option" to not comply. Would be interesting to know their answer if you can post it here.
thanks for posting this. i will read it later today.
the timing on this is really difficult for us. his commencement is 5/15. the HR department has put us on notice that we have to make it 'official' with them 30 days prior to his graduation so they can 'remove' him from the group policy.
so we 'remove' him and then he's got a pre-existing condition and even if they do extend to age 26, i fear he won't get back in due to the D....also, the reenrollment into this plan happens at year-end only, no exceptions.
they are more or less forcing our hand before the law becomes clear.
it feels so unfair to me but i know i am jaded. i mean, it's been 19 years.
Yes that is true, in Maryland he can stay on your coverage till the age of 26 regardless of student status marital status. However if your husband is on a group insurance plan through his work the group can not state what age they are covered to. In Maryland they changed the age from 19 to 23 then last year it went to 23 to age 25 and now this year to 26.
Does Kaleb have coverage now under your group plan or individual plan? If so when he goes to take other coverage lets just say as an individual the Pre-Ex wouldn't apply since there would be no gap in coverage. If you go 31 days without insurance coverage there is a gap, therefore the pre-ex would apply. (check your state on the days)
example. Lets say I lost my job and my health coverage. I am offered COBRA but its way to expensive. If I find other individual insurance coverage within the 30 days of being laid off, my pre-ex is waived. However if I wait longer the Pre-Ex would apply to me since there is a gap in coverage. That is why whenever you are laid off GET HEALTH COVERAGE just so you don't have the pre-ex when you find another job that offers health care.
I'm posting this without comment in case it has more up-to-date info. It's from a House Ways and Means document.
The final health insurance reform legislation (the Senate bill as improved by the Reconciliation Bill) that the House passed on March 21st will ensure that all Americans have access to quality, affordable health care and significantly reduce long‐term health care costs. The non‐partisan Congressional Budget Office (CBO) has determined that it will provide coverage to 32 million more people, or more than 94% percent of Americans, while lowering health care costs over the long term. This historic legislation will reduce the deficit by $143 billion over the next ten years, with $1.2 trillion in additional deficit reduction in the following 10 years.
QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Bars insurance companies from discriminating based on pre‐existing conditions, health status, and gender.
Provides Americans with better coverage and the information they need to make informed decisions about their health insurance.
Creates health insurance exchanges - competitive marketplaces where individuals and small business can buy affordable health care coverage in a manner similar to that of big businesses today.
Offers premium tax credits and cost‐sharing assistance to low and middle income Americans, providing families and small businesses with the largest tax cut for health care in history.
Insures access to immediate relief for uninsured Americans with pre‐existing conditions on the brink of medical bankruptcy.
Creates a reinsurance program in support of employers who offer retirees age 55‐64 health coverage.
Invests substantially in Community Health Centers to expand access to health care in communities where it is needed most.
Empowers the Department of Health and Human Services and state insurance commissioners to conduct annual reviews of new plans demanding unjustified, egregious premium increases.
KEY INVESTMENTS IN MEDICAID AND CHILDREN?S HEALTH
Expands eligibility for Medicaid to include all non‐elderly Americans with income below 133 percent of the Federal Poverty Level (FPL).
Replaces the so‐called "Cornhusker" deal with fair assistance for all states to help cover the costs of these new Medicaid populations.
Maintains current funding levels for the Children?s Health Insurance Program (CHIP) for an additional two years, through fiscal year 2015.
Increases payments to primary care doctors in Medicaid.
Adds at least nine years to the solvency of the Medicare Hospital Insurance trust fund.
Fills the Medicare prescription drug donut hole. In 2010, Medicare beneficiaries who go into the donut hole will receive a $250 rebate. After that they will receive a pharmaceutical manufacturers? 50% discount on brand‐name drugs, increasing to a 75% discount on brand‐name and generic drugs to close the donut hole by 2020.
Provides new, free annual wellness visits, and eliminates out‐of‐pocket copayments for preventive benefits under Medicare, such as cancer and diabetes screenings.
Provides better chronic care, with doctors collaborating to provide patient‐centered care for the 80% of older Americans who have at least one chronic medical condition like high blood pressure or diabetes.
Improves Medicare payments for primary care which will protect access to these vital services.
Reduces overpayments to private Medicare Advantage plans. Medicare currently overpays private plans by an average of 14 percent. This legislation reins in those overpayments to ensure a fair payment system that rewards quality.
Encourages reimbursing health care providers on the basis of value, not volume. The bill includes a number of proposals to move away from the ?a la carte? Medicare fee‐for‐service system toward paying for quality and value while reducing costs for America?s seniors.
PREVENTING CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
Promotes preventive health care at all ages and improves public health activities that help Americans live healthy lives and restrain the growth of health care costs over time. The legislation eliminates cost‐sharing for recommended preventive care, provides individuals with the information they need to make healthy decisions, improves education on disease prevention and public health, and invests in a national prevention and public health strategy.
HEALTH CARE WORKFORCE
Makes key investments in training doctors and nurses and other health care providers. Currently, 65 million Americans live in communities where they cannot easily access a primary care provide. An additional 16,500 practitioners are required to meet their needs. The legislation addresses shortages in primary care and other areas of practice by making necessary investments in our nation's health care workforce. Specifically, it will invest in scholarship and loan repayment programs through the National Health Service Corps to expand the health care workforce. The bill also includes incentives for primary care practitioners and for providers to practice in underserved areas.
TRANSPARENCY AND PROGRAM INTEGRITY
Provides consumers with information about physician ownership of hospitals and medical equipment companies, as well as nursing home ownership and other characteristics. The bill also includes provisions that will crack down on fraud, waste, and abuse in Medicare, Medicaid, SCHIP and private insurance. It establishes a private, non‐profit entity to identify priorities in patient‐centered outcomes research that will provide doctors with information on how to best treat patients and end wasteful overspending.
IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES
Establishes a regulatory pathway for FDA approval of biosimilar versions of previously licensed biological products.
COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORT (CLASS)
Makes long‐term support and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities. CLASS is a voluntary, self‐funded, insurance program provided through the workplace. For those whose employers participate, affordable premiums will be paid through payroll deductions. Participation by workers is entirely voluntary. The Congressional Budget Office confirms that the program, which has been revised from earlier versions, is actuarially sound.
Reduces the deficit in the next ten years and beyond. The bill is fully paid for with revenue provisions that focus on paying for reform within the health care system.
Tightens current health tax incentives, collects industry fees, institutes modest excise taxes, and slightly increases the Medicare Hospital Insurance (HI) tax for individuals who earn more than $200,000 and couples who earn more than $250,000. The taxable base of the HI tax is also broadened by including net investment income. The HI tax increases will not only help fund health care reform, but, when combined with other provisions in the bill, will also extend the solvency of the Medicare Trust Fund by at least nine years to 2026.
Includes a fee on insurance companies that sell high cost health insurance plans. The fee is designed to generate smarter, more cost‐effective health coverage choices. The reconciliation bill delays this new fee until 2018 so that plans have time to implement reform and begin to save from its efficiencies.
Changes health care tax incentives by increasing penalties on nonqualified distributions from HSAs, capping FSA contributions, and standardizing the definition of qualified medical expenses. The industry fees and excise taxes reflect responsible contributions from health care stakeholders who will benefit from the expanded coverage of millions of additional Americans under health care reform. The bill also assesses a small excise tax on indoor tanning services.
In total, the revenue provisions in the bill represent a balanced, responsible package of proposals that bend the health care cost curve by putting downward pressure
This is false. The bill intentionally omitted $371 billion in payments to doctors. It also includes money the government claims it will save by taking over student lending. The CBO also estimated that by now Medicare would only cost $12 billion per year.
If by "choice" they mean being forced to buy government-approved plans, then this is correct.
Any business that has more than 50 employees must provide coverage or pay a fine; that along with a 2.3% sales tax on virtually all OTC medicine, prescriptions, and medical procedures that were previously not taxed. You also are now capped at putting $2500 in your FSA, which is a tax increase.
Does this bill pay any of my current medical bills?
I think the retirees from AT&T, Verizon, Caterpillar, and John Deere would disagree.
Still think this bill won't be a government-only plan?
Instead of "expands eligibility," this should say requires everyone below 133% to enroll in Medicaid, even if they have insurance that they like.
Once the stimulus money runs out, the cost of these new Medicaid customers will be carried by the states; and the costs of setting up the bureaucracy needed to execute this bill are not covered.
I think we all like this.
I'm not sure how this is possible when part of the "deficit reduction" was produced by cutting payments to physicians. Unless it was never really meant to be part of the plan to begin with.
By cutting $500 billion from Medicare that won't really ever be cut.
I agree with this. It's nonsensical to cover physician visits and procedures, and then not to cover prescription drugs.
A little note about Medicare here. Medicare pays physicians very little per visit, and does not generally allow a visit to cover multiple treatment plans. In other words, if you have Medicare and see your physician for the flu, and the physician also sees that you have a foot injury, the patient has to book a second appointment for the physician to prescribe orthopedic supports that will be covered.
This is a reference to Medicare's expansion of their "telehealth" program, which is a FANTASTIC idea that's time is long overdue.
By penalizing physicians that refer more than 10 patients per year to specialists.
It does this by eliminating Medicare Advantage Plans. Those plans control costs for Medicare, but Medicare sees them as a cost center. I have no idea why.
I'm not familiar with what the plan is here.
This scares me. A LOT. http://www.healthreform.gov/reports/diabetes/index.html
Notice how type 1 is not mentioned at all, and how much focus is put on "prevention" of diabetes in people over 40. Don't get me wrong, that's a good plan for type 2, but that there's no mention of type 1 worries me. A vial of insulin "might cost as much as $70?" Yikes. What else do they not know about type 1?
This is done by paying for medical school. Other incentives require, in part, that the provider make technology upgrades. I read the rules for earning this incentive yesterday. It was 40 pages long and in about 6 point font with no spaces.
Umm. I've heard that before.
Government cracks down on waste and fraud by regulating providers out of business. When there are thousands of pages of rules that often contradict each other, it's not difficult to accuse someone of "fraud." I'll give you all an example. I have a customer that is in rehab because he falls a lot, but is otherwise in good condition mentally and physically. His physician and OT would like us to bring his power chair to the facility so he can practice with them and prevent more falls. Sounds like a common sense solution right? Nope. You have to be home for a full 24 hours first.
If that means generic insulin, then I am a happy camper.
I'm not sure how basically outlawing durable medical equipment Medicare is going to help people remain in their homes. The new rules will force what's left of the "mom and pop" DME providers out of business.
Nobody's buying this.
There's your tax on pumps. And see that little nugget about "net investment income?" That would be your 401(k) that you've been saving tax-free for so long. It's taxable now.
And by mandating coverage of everything and everyone, insurance companies will only be able to see "high cost" plans. Thus the president will get what he wanted all along: Universal, single-payer healthcare.
"Non-qualified distributions from HSAs" like aspirin, band-aids, glucose gel, tampons, etc. Then it throws in "The industry fees and excise taxes reflect responsible contributions from health care stakeholders who will benefit from the expanded coverage of millions of additional Americans under health care reform." That's bureau-sppeak for "We can stick it to whomever we want, because government will end up paying for it all anyway!"
I asked you about this in the other thread, but you either missed it or I missed your response. Wouldn't band-aids, tampons, etc. be part of the "exemptions" in that particular provision? And isn't there a difference between "medication" (i.e., aspirin or BCPs) and medical devices?
ETA: SEC. 4191. MEDICAL DEVICES.(a) IN GENERAL. There is hereby imposed on the sale of any taxable medical device by the manufacturer, producer, or importer a tax equal to 2.3 percent of the price for which so sold. (b) TAXABLE MEDICAL DEVICE. For purposes of this section (1) IN GENERAL.The term taxable medical device means any device (as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act) intended for humans. (2) EXEMPTIONS.Such term shall not include (A) eyeglasses, (B) contact lenses, (C) hearing aids, and (D) any other medical device determined by the Secretary to be of a type which is generally purchased by the general public at retail for individual use.
Wow, I wish there had been this much scrutiny over the decision to start the war in Iraq. Of course, the only cost of getting it wrong with regard ot a war is thousands of deaths, tens of thousands of injuries, over a trillion dollars in expense, deaths of countless innocent children and civilians, providing for 80 years of lifelong medical needs of 180,000 soldiers (which our soldiers absolutely do deserve if serving in any war, whether the war was justified or not), hundreds of thousands of children growing up in the US with a parent absent,...
Good thing the new health care rules are getting so much scrutiny, because you know, if we get this wrong we will face the ultimate sacrifice, the unthinkable end to civilization as we know it, the collapse of industry, the.... Oh wait, come to think of it, all we'd have to do is change the rules again in a few years. Whew!! that was a close call.
Yeah, me too. Having said that... does anyone get tired of the political games that are always played. You R's screwed up on the War! You D's are screwing up Healthcare Reform! Yawn....
Can we really say that there has been 'this much scrutiny' in regards to Healthcare? The problem that I have seen is that there has been next to no scrutiny BEFORE the bill was passed - which is a problem considering once it's passed... there's really no turning back. No one knows what's in the Bill or how it will affect you in the future - one way or the other... We are going into this blind.
ps. Why do you think that it would be so easy to just 'change the rules' in a few years? Is that just your wishful thinking kicking in? I gotta' get me some of that...
Man, no kidding!
Oh wait, it seems there was....
I've posted this before, but no one's cared to comment.
The problem is that the Secretary has not determined that anything other than glasses, contacts, and hearing aids would be specifically exempted yet. So based on the current language, the tax applies to anything and everything found within 201(h) of the Food, Drug, and Cosmetics Act.
When you look at 201(h), you'll see it encompasses many thousands of products.
As of now, they're all taxable. I do not know when or if there are plans in place to add more items to the list.
I'll comment... This just proves to me that both the R's and the D's are a mess.
Separate names with a comma.