States with Republican governors kept up the pressure last week on Washington to give the states greater control over health care under the Patient Protection and Affordable Care Act (PPACA). Twenty-one Republican governors sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius asking for greater authority over some provisions of health reform, including the ability to define “essential” health benefits and set minimum criteria for participating in insurance exchanges. They threatened not to run their own state-based exchanges if HHS does not act on their requests. Sebelius quickly responded with her own letter in which she reviewed the various options states have to reduce costs in their Medicaid programs, and she indicated she is continuing to review what authority she may have to “waive the maintenance of effort under current law.” Senate bills have already been introduced to address the role of the states in health care reform, which is sure to keep the issue on the front burner. Visit Easy To Insure ME for more info
Federal
The House Committee on Ways & Means held a hearing last week on “The Health Care Law’s Impact on Medicare and Its Beneficiaries,” featuring testimony from CMS Administrator Donald Berwick, M.D., and CMS Chief Actuary Richard Foster. Berwick testified that the PPACA has had a positive impact on Medicare beneficiaries, noting that beneficiaries now have first-dollar coverage of key preventive benefits, additional assistance with prescription drug costs, and an annual wellness visit with the physician of their choice. In response to concerns noted by several committee members about the impact of funding cuts on Medicare Advantage, Berwick indicated that Medicare Advantage enrollment increased by 6 percent from 2010 to 2011. He suggested that the program is healthy and offers robust choices. Foster’s testimony reiterated his prior projection that the PPACA will cause Medicare Advantage enrollment to decline by about 50 percent by 2017 — from a projected 14.5 million under the pre-PPACA law to 7.3 million under the new law. His testimony further explained that Medicare Advantage enrollees will experience “a large increase in out-of-pocket costs” and “less generous benefit packages” because PPACA will reduce rebates to Medicare Advantage plans, with the reduction in rebates reaching $1,500 per beneficiary by 2019.
The Administration last week issued favorable guidance with respect to student health coverage that will result in little disruption, if any, to this business until at least the 2012-2013 academic year. This guidance was announced in a Notice of Proposed Rule Making (rather than as an interim final regulation), which fortunately means that the rule is not effective immediately as has been the case with most regulations relating to PPACA reforms. The proposed student health rule would create a special class of individual coverage for student health pursuant to a set of factors, e.g., written contract between school and insurer, coverage only for students and dependents, health status may not be used as a condition of eligibility. As Aetna has advocated, the impact would be delayed, as the rule (whenever finalized) would not be effective until policy years beginning on or after January 2012. Until then, student health is not subject to PPACA reforms. And, when effective, student health would be excepted from the current guaranteed issue and renewability provisions of PPACA. While it will be unclear for a while whether and how student health will be subject to the medical loss ratio (MLR) provisions of PPACA, we are encouraged by the fact that the proposed rule invites comments on whether student health should receive some sort of special accommodation (akin to the special rule for limited benefit plans) with respect to MLR, owing to the unique characteristics of the student health market.
States
ARIZONA: The industry-supported exchange bill was introduced last week under the sponsorship of the House Health Committee Chairman and the respective chairmen of the House and Senate Banking and Insurance Committees. The bill provides for a market-based mechanism; governance by a board with insurer representation; no dual regulation; and a conditional repeal provision. The first hearing will be held this week. In other news, Governor Jan Brewer appointed Don Hughes, former AHIP retained counsel, as Special Advisor for Health Care Innovation. Hughes will help direct state efforts to improve the cost-effectiveness and accessibility of health care. He will engage in strategic planning with a focus encompassing both public health care and Arizona’s large private health insurance industry.
CONNECTICUT: A jointly held public hearing of the Public Health and Insurance and Real Estate Committees was scheduled for this week on two new health care bills. The first bill would establish the SustiNet Plan Authority, a quasi-public agency empowered to implement a public health care option. The SustiNet Plan is a health insurance program that consists of coordinated individual health insurance plans that provide health insurance products to state employees, Medicaid enrollees, HUSKY Plan, Part A and Part B enrollees, HUSKY Plus enrollees, municipalities, municipal-related employers, nonprofit employers, small employers, other employers, and individuals in Connecticut. The Authority is authorized, but not required, to begin offering SustiNet coverage to employees and retirees of non-state public employers, municipal-related employers, small employers, and nonprofit employers after January 1, 2012. Beginning on January 1, 2014, SustiNet will offer coverage to individuals and employers. Among other things, the bill directs the Authority to implement primary care case management and patient-centered medical homes for all SustiNet Plan members, establish a pay-for-performance system, and establish procedures to prevent adverse selection.
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The Committees also will hear testimony on a bill to establish the Connecticut Health Insurance Exchange pursuant to PPACA. The exchange would be a quasi-public agency offering qualified health plans to individuals and qualified employers by January 1, 2014. The bill would establish a 13-member board of directors to manage the exchange. The exchange would have the authority to review the rate of premium growth within and outside the exchange in order to develop recommendations on whether to continue limiting qualified employer status to small employers. It also would have the authority to charge assessments or user fees to health carriers to generate funding necessary to support the operations of the exchange. The bill directs the exchange board to report to the legislature by January 1, 2012 on whether to establish two separate exchanges, one for the individual market and one for the small employer market, or to establish a single exchange; whether to merge the individual and small employer health insurance markets; whether to revise the definition of “small employer” from not more than 50 employees to not more than 100; and whether to allow large employers to participate in the exchange beginning in 2017.
Aetna will submit comments on both bills through the Connecticut Association of Health Plans.
IDAHO: Draft legislation is circulating that would prohibit insurance companies and managed care organizations from refusing to contract with qualified providers solely because the provider: is not a member of a group, network or any other organization of providers contracting with the insurance company; or does not offer all of the services obtained through the group, network or organization of providers contracting with the insurance company. However, the provider may be required to comply with the practice standards and quality requirements of the contract specific to the services contracted. The bill generally is intended to impact insurers and managed care organizations. It does not contain an exclusion or exception for HIPAA-excepted benefits. As yet, the bill has not found a sponsor and has not been “introduced.” While there remains a possibility that the bill could be introduced before the deadline for committee bill introductions, it is considered unlikely.
MINNESOTA: When the legislature convened the first half of its 2011-2012 biennium last month, Republicans controlled both legislative chambers for the first time since 1972. And, Republican lawmakers wasted little time introducing bills to repeal measures passed by the 2010 legislature to fund state medical assistance, general assistance medical care, and MinnesotaCare. In his first official act as Governor, Mark Dayton signed an executive order implementing early Medicaid expansion (to 133 percent of the federal poverty level) for Minnesota, which is expected to make 95,000 more state residents eligible. Minnesota’s $188 million investment is expected to bring about $1.2 billion in matching federal funds. Governor Dayton also signed an executive order removing the ban on applications for federal PPACA-related grants. Minnesota is expected to receive an exchange planning grant soon. While Governor Dayton cleared the way for the state to seek grants for implementing federal health reform, it is unlikely that state legislators will be passing bills to implement the federal health reform law unless absolutely necessary. Other pending bills of interest include anti-PPACA legislation, a bill requiring guaranteed issue in the individual market, creation of a defined contribution program for childless adults with incomes at or above 133 percent of FPL (reduction from current level of 250 percent), the prohibition of dental plan fee schedules for non-covered services, and an
If you are self employeed you should take a serious look into Health Savings Accounts, for several reasons, starting with there is a huge savings on your monthly premiums regardless if you are insuring yourself or you and your family. Things that are considered by the insruance companies are the area you live in, the type of work you do and any pre-existing conditions you might have. If you are in the state of California, and you have employees, you need a minimum of two employees and/or 75% of the payroll to participate in the plan (regardless of HSA or regular insurance) to get a guaranteed issuance of the insurance.
If you are not self employeed but do have a job, again the HSA is great way to go, because you can make pretax contirbutions to the plan, take it with you where ever you go, and keep the insurance with you when you retire… which as common sense tells us, you are going to need healthcare much more in your retirement years (ie when you are older) then you will now. Also any qualified medical expenses can be paid tax free from the account, and once you hit your deductable out your account, anything above that is paid for by the backing insurance company.
One note about the non bias oppinon of "brokers," they get paid on a commission as well by the companies they represent, and some companies pay more than others. Just because you are working with an "independant" does not mean you are getting the best price, or service. You want to work with someone who knows the products that they work with inside and out, or have access to the people who do so that all your questions can be answered to your satisfaction. Some times a huge selection does not mean a huge savings in time and money.
1) Most employer provided health insurance is deducted "pre-tax" so there is no deduction on the tax return.
2) Your parents must be your dependents (or would have been your dependents except for the gross income test) for you to take a deduction anyway. So, unless you are supporting them: No.
What a god awful version of the song,
MATT SMITH SPEAKING!!!
Well, if she's 40 and perfectly healthy, it's going to cost her about $500 a month to have a low/no deductible plan that covers checkups.
You BUY it on a month to month basis. If you want low monthly payments, you have to cut the coverage – like take a $10,000 deductible. Or higher. That would cut payments down to maybe $200 a month or less.
The older she is, the less healthy she is, the more it costs.
Your best bet, is to find a local, independent agent, who can help you balance cost with coverage.
most insurance will cover the costs you mention if the doctor thinks it is medically necessary.
i htought the main reason of living in a society was to help each other out, am i wrong?
No.
The insurance through your husband's employer does not meet the test of having been established through the S-corp.
Since the health reform act, insurance companies have pretty much stopped selling maternity coverage. When you CAN buy it, it's about $300 a month extra, and most of the time you have to purchase it a full year becoming pregnant, for it to cover. So yes, it's normal for maternity to NOT be covered, under an individual policy.
You're not going to get the same kind of coverage that you would through an employer. On an individual policy, they can exclude coverage for stuff already wrong. If you ARE currently pregnant, you're uninsurable on an individual plan until after the baby is born (just sayin', because 95% of the women who mention interest in maternity coverage here, are ALREADY pregnant).
For good advice that's valid in YOUR area, you should talk to a local agent near you. They'll know what state you are in, and which deals are best – and they can help you balance coverage and cost to find what you can afford, and they'll EXPLAIN how it all works. You won't get that from an online website.
@amyarkle10 LOL taw Amz..
i love watchin this coz of matt smith -3
lol if the BUPA people went on youtube and were like “YAY LOOK AT THE VIEWS” when really half the people all watch it to hear the god-like matt smith’s voice xD
The only reason I love this advert because of Matt Smith’s voice! <3<3
0:50 LOL the way Matt Smith says ‘bupa’ :’) Got to love him! <3<3
Haha my m8 is in this
(The guy in the wig shop)
interesting videos. thanks for sharing information
The purpose of any type of insurance is to protect against catastrophic loss. Using health insurance as an example, most everyday medical expenses are not very expensive (a physical exam averages $150.00+/-), but if you are admitted to the hospital for an emergency your medical bills would be in the tens of thousands of dollars at a minimum. If you do not have insurance you "self-insure" againts that potential catastrophic loss. Without insurance, the average person would face financial ruin if faced with a major loss.
You've asked a very broad question. There is no simple answer.
In truth, health insurance works a little differently in each state.
To answer your specific questions:
1) No, health insurance is not compulsory for everyone. If you're lucky, you are able to join a group policy at work. (If you're really lucky, it's a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that's such a recent change that there's no clear cut answer yet for how that's going to work.
2) What happens if someone can't afford it is… they don't get it, usually. Except if your income puts you below the "poverty level", in which case you qualify for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)
3) Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you're really, REALLY lucky, you don't have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you're in Congress.)
4) Yes, the patient has some say over procedures. However, if the patient opts for an "experimental" procedure, or one that isn't deemed "medically necessary", then health insurance may refuse to cover any charges at all.
In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)
** Edited to add:
It's not ALL about the money when a procedure is involved. If it is, the state keeps track of complaints filed on behalf of consumers with "managed care" (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations — also known as PPO, HMO, and POS) and may very well revoke a company's charter to do business in the state should the company be turning down too many legitimate claims.
However, insurance companies are sticklers for following the "standard" for medical care. This is what makes it difficult to answer your question. Because they should not deny anything that's considered standard for care in the given circumstances (should not and will not being two completely different things, of course.) And there may be several options that would be considered "standard." If the patient wants treatment that isn't yet considered "standard", they would balk. Period.
is it just me or does the guy at 00:46 have a boner? :/