MEDICARE CORNER CAN WE TALK ABOUT HEALTH CARE? Quite frankly we can’t afford not to talk about health care insurance. It is important to keep in mind that Medicare is Federal Health Insurance Coverage. Most people paid into Medicare while working and pay a standard Part B Annual Premium. Medicaid is a Federal Program that helps to lower the out of pocket costs for prescription drugs and health coverage for low income beneficiaries. Each state determines the allocation of Medicaid. All other health insurance coverage and prescription drug coverage is provided through private insurance companies. Private Insurance companies increase premium costs and beneficiaries out of pocket costs for health and prescription drug coverage each year. First let’s start with what we know about current health care coverage through the Affordable Health Care Act (ACA) and the Patients Protection Rights Act, enacted by the 111th Congress March 23, 2010: PRE-EXISTING CONDITION Current Benefits: • Adults and children with pre-existing conditions cannot be denied coverage • Adults and children cannot be charged more, because they have a pre-existing condition • Benefits and coverage for treatments cannot be limited because of a pre-existing condition Exception to the rule are individual health insurance policies, which were purchased by individuals on or before March 23, 2010. These policies are referred to as “Grandfathered Plans.” They qualified for an exception because changes in the policies did not increase costs to the insured or diminish their benefits. Grandfathered Plans are exempt from the Annual and Lifetime Limits charges. YOUNG ADULT COVERAGE Current Benefits: Parents can continue to cover their adult children on their health insurance policy until they reach age 26 even if they are: • Married • Not living at home • Not attending school • Financially independent • Eligible to enroll in their employer’s health plan CANCELLATION OF POLICIES Current Benefits: Insurance companies can no longer cancel an insurer’s policy because of a chronic long term illness or because of an honest error in completing the application. LIFE TIME AND ANNUAL LIMITS Current Benefits: Insurance companies cannot set a dollar limit on the amount they will pay for your coverage for benefits, which are considered medically necessary. As a protection to the beneficiary, Medicare Advantage Plans (Part C) cannot charge a beneficiary for Medicare covered benefits beyond the “Maximum Out of Pocket Cost (MOOP).” PREVENTIVE CARE Current Benefits: Medicare Beneficiaries can have “A Welcome to Medicare” preventive screening when first enrolled in Medicare. During this screening, the doctor and/or provider will update your medical history. Also, each year a “Wellness Screening” is done at no cost to the beneficiary. During this annual visit, you and your provider or doctor will plan a course of action to prevent illness. Note: There may be some out of pocket cost for the following: • If the screening is not the primary reason for an office visit • Out-of-Network doctors or providers may charge a fee • Grandfathered Plans may not provide these benefits PERSCRIPTION DRUGS Current Benefits: Prescription drug savings for formulary drugs (covered drugs) will continue through 2020. In 2020, when you reach the coverage gap (donut hole), you will pay the following percentages until you reach the True Out of Pocket Limit (TROOP): • 25% for brand-named Drugs • 25% for generic drugs PROPOSED CONGRESSIONAL ALTERNATIVE PLANS Will the Affordable Health Care Law and Patient Protection Rights Act be repealed and replaced, repealed only, redesigned or…? Let’s review the “alternative facts,” meaning what may be the revealed truth about proposed plans to repeal and replace, redesign, 2017 Reform Act H.R. 3121 appropriation of $25 billion dollars April The following is a brief outline over ten years has been proposed to of H.R.3121 “The American subsidize high risk insurance pool. ¢Health Care Reform Act of What happens when the money COURIER 2013” drafted by the Republican runs out? Subcommittee and sponsored by • End protection of cancelation Republican Representative Phil Roe of Insurance Coverage due to (Tennessee), co-sponsored by 107 chronic long term illnesses TOWERS or only repeal the Affordable out of 204 Republicans: • Replace current employer-sponsored Health Care Act and the Patient • Proposed Repeal or Roll Back insurance and self-employed Protection Rights Act. • Roll back Expansion of tax exemption with a standard Each of the following bills proposed Medicaid eligibility, leaving private deduction SHORE various reforms without insurance unaffordable for low • Increase allowable contributions establishing cost or coverage for income individuals to Health Savings Account (HSAs) the uninsured: • Establish ‘High Risk Pools’ • Individuals would be able to NORTH • 2009 Patient’s Choice Act for individuals with pre-existing purchase insurance across state • 2009 Empowering Patients First conditions. Individuals would purchase lines. States issuing the insurance Act of 2009 and 2013 insurance coverage through would determine regulations of 20 • 2013 American Health Care these high-risk pools. Federal insurance. Resolutions of consumer and low income individuals. disputes would be based on state issuing the insurance coverage, not necessarily where the insured lives. • H.R. 3121 would prevent Federal Funding for abortions. Health Insurance Plans would not be required to cover abortions. Finally, The Affordable Health Care Act and Patient Protection Rights Act can, and perhaps should, be amended. This can be accomplished without ending the ACA and Patients Protection Rights Act. Amendments to the ACA and Patient Protection Rights Act should include protection for children, individuals with pre-existing conditions, disabled adults and children,
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