Good Neighbor Insurance (dev.gninsurance.com and www.gninsurance.com) is continuing to update our clients on the new health insurance laws. There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. Many critical details of this new insurance law will be clarified in the months and years to come.
These six major coverage options are:
(1) Individual or family coverage (private health care plans)
(2) Employee/employer group option for small businesses (typically under 50 employees)
(3) Employee/employer group option for large businesses (typically larger than 50 employees)
(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)
(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards
(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service
As of 1 January 2011, some of the provisions of the 2010 Health Care Reform legislation become effective. What follows is a summary of these provisions.
Allocation of health care premiums
To ensure that premium dollars are spent primarily on health care, the Health Care Reform legislation generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.
FSA & HSA drug eligibility
Over-the-counter (OTC) drugs are not eligible for reimbursement under health flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), health savings accounts (HSAs) or medical savings accounts (MSAs). Insulin remains reimbursable.
Also, starting 1 January 2011, the excise tax for non-medical HSA or MSA distributions increase from 10% to 20%.
Pharmaceutical manufacturers are required to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap. Concurrently, federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap begin to phase in.
A 10% Medicare bonus payment is introduced for primary care services and for surgery services provided by general surgeons practicing in health professional shortage areas.
Cost-sharing for Medicare-covered preventive services rated A or B that are recommended by the U.S. Preventive Services Task Force is eliminated. In addition, the Medicare deductible for colorectal cancer screening tests is waived and Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment, is authorized.
The income threshold for income-related Medicare Part B premiums for 2011 through 2019 are frozen at 2010 levels, and the Medicare Part D premium subsidy is reduced for those with incomes above USD 85,000 (individual) and USD 170,000 (couple). Payments for private Medicare Advantage plans are frozen at 2010 levels.
A new Medicaid state option is created to allow certain Medicaid enrollees to designate a provider as a “health home.” States receive a 90% federal matching payment for two years for health home-related services. Federal 3-year grants are available to states that develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs to meet certain health behavior targets.
Wellness program grants
Employers with less than 100 employees working at least 25 hours a week, that establish wellness programs on or after 23 March 2010, may apply for federal grants of up to 5 years starting in fiscal year 2011.
Other measures becoming effective in 2011
- 23 March 2011: Federal funding becomes available to states to begin planning the establishment of American Health Benefit Exchanges and Small Business Options Program Exchanges. States are required to create and maintain health care exchanges through which health insurance providers compete on equal terms. All employees whose employers do not offer health coverage and would like to purchase a plan may participate of these exchanges. Enrollment in Exchanges begins 1 January 2014.
- 1 October 2011: Funding becomes available for the establishment of a 15-member Independent Advisory Board to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending whenever spending exceeds targeted growth rates. First Board recommendations are expected for 15 January 2014.
- 1 October 2011: The Medicaid State Balancing Incentive Program is created. The Program is to provide enhanced federal matching payments to increase non-institutionally based long-term care services, and to establish the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities.
Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, http://onlineglobalhealthinsurance.com/my-travel-guard.asp , information with him at all times when he travels Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the US health care system.