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Healthcare Reform, Medicare Changes & Pre-Existing Conditions

In addition to assisting clients with analysis of their best health insurance and Medicare options, we try to keep our readers informed of Medicare changes and important news in the healthcare field, including insurance and coverage options.

We do not sell insurance, but offer our clients an analysis of options based on our expertise and experience day in and day out in the healthcare system. We provide analysis, troubleshooting and advocacy.

As you are probably aware, a large number of changes to our healthcare system were passed in 2010. Do you know about the provisions of this law? Do you know about those that are already in effect and how they might impact you? While there are uncertainties about future changes and challenges to these laws, there is some important information for you to know about today.

We will use the term Affordable Care Act (ACA) to refer to The Patient Protection and Affordable Care Act, H.R. 3590, P.L.111-148 and the Health Care and Education Reconciliation Act, H.R. 4872, P.L. 111-152, signed by President Obama on March 30, 2010 (which amended #1). These acts made many changes, ranging from the eventual abolishing of pre-existing condition clauses in insurance to requiring individual coverage for those not covered under various programs.

Some of the first changes that have taken effect are in the Medicare program. Starting in 2011, the “doughnut hole” in the Medicare D prescription drug program will be phased out. This year, individuals who reach the doughnut hole will receive a 50% discount on covered brand name drugs while in the gap. Additionally, sections 4103 & 4104 updated the preventative care benefits under Medicare, so that now an annual wellness visit is covered at 100% along with screenings for colon, breast and prostate cancer.

As part of the requirement for all individuals to have coverage by 2014, certain programs have been implemented to phase in coverage for different groups traditionally at a disadvantage in securing coverage. One such program, which began last year, is the Pre-Existing Condition Insurance Program (PCIP). Sec. 1101. Immediate access to insurance for people with a preexisting condition: Provides up to $5 billion for this program, which terminates when the American Health Benefit Exchanges are operational in 2014. Also establishes a transition to the Exchanges for eligible individuals.

To be eligible for this program the individual must: 1. Be a citizen or lawful resident. 2. Have been uninsured for at least the last 6 months. 3. Show proof of the pre-existing condition (such as letter from doctor, insurance denial because of it, or insurance coverage turned down with rider excluding the condition. There is an online application and there are no financial qualifications. There are no waiting periods (if you sign up by the 15th of the month, coverage will begin at the beginning of the coming month). Recipients have three plan options: a standard plan, an extended plan and a Health Savings Account plan. The rates are very competitive and were actually reduced in July of 2011. For more information, please visit www.pcip.gov.

Come back to visit us for more information and continued updates on healthcare reform, Medicare changes and information on Florida Medicaid and eldercare resources. You can sign up for our newsletter for monthly updates delivered right to your inbox!

CONTACT US TODAY for a Medicare Analysis appointment or consultation on your healthcare and eldercare options.

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