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Patient Advocacy and Navigating the Changing Healthcare Maze

As the various components of Obamacare become available, healthcare options will be changing fairly dramatically, particularly for disabled and chronically ill patients. We recently shared some detailed information about Special Needs Trusts and coming changes related to the Affordable Care Act (Obamacare)Regardless of your personal feelings about the Affordable Care Act, the reality is that our healthcare landscape is changing and there will be different options for people. Clients who have had difficulties due to issues like pre-existing conditions or lifetime limits will now be offered some additional choices.

patient advocacy navigating ObamacareWe have seen the health and long-term care landscape change drastically over the years already. Consider today’s abundance of rehabilitation, assisted living and home care options. These choices did not exist when many of our grandmothers were caring for their own parents. Having the options is definitely positive, but navigating them proves a challenge for many families. We try to keep you updated with educational resources and specific information that we see affecting our clients. If you are dealing with these issues and trying to navigate how the provisions will affect you, it is worthwhile to contact a professional patient advocate such as one of our Aging Wisely care managers. 

The Affordable Care Act provides a number of mechanisms, such as mandates, subsidies and insurance exchanges designed with the goal of increasing affordability and access. Here is an overview of some of the major mechanisms of Obamacare:

  • Mandate: requires all individuals not covered by an employer plan, Medicaid, Medicare or other public insurance to purchase an approved private insurance policy or pay a penalty (waived if part of a religious group approved by IRS or for financial hardship cases)
  • Health Insurance Exchange: a set of government standardized healthcare plans from which individuals may purchase health insurance, eligible for government subsidies
  • Subsidies: tax breaks and other subsidies to assist with transition and access
  • As of January 2014, Floridians will be able to purchase private plans on the insurance exchange which must meet these minimum requirements
    • No pre-existing medical condition issues

    • No annual or lifetime limits

    • No difference in premium due to health conditions

    • The insurance is guaranteed renewable until the age of 65

    • Premium support available to purchase insurance (based on the modified adjusted gross income income)

    • The insurance must include these essential health benefits:

      1. Ambulatory patient services
      2. Emergency services
      3. Hospitalization
      4. Maternity and new born care
      5. Mental health and substance use disorder services, including behavioral health treatment
      6. Prescription drugs
      7. Rehabilitative and habilitative services and devices
      8. Laboratory services
      9. Preventative and wellness services
      10. Chronic disease management
      11. Pediatric services including oral and vision care

What will all of this mean for patients? It will certainly mean that those with chronic illness or serious disability have new alternatives. As mentioned in our previous article on Special Needs Trusts, this means the pros and cons of each choice must be carefully weighed. Professionals advising clients must make sure to have a comprehensive understanding of: the patient’s diagnosis, prognosis and medical/care needs; current and projected expenses; care and benefits options (what types of benefits is the person eligible for and how does that affect planning?); and the client’s and family’s priorities, concerns, etc.

Many of our clients are eligible for Medicare due to either age or disability. The Medicare program has already seen a number of changes related to the Affordable Care Act and its precursors. We assist our clients to stay ahead of these changes. Medicare open enrollment is coming up October 15th-December 7th and our care managers are available to help clients reexamine their plan choices. We also assist new retirees with navigating their healthcare choices and understanding the deadlines and decisions they need to make.

Our patient advocates are experts at bringing you through the healthcare maze with relative ease. We can save you costs and get you the best options, as well as assist in times of crisis or resolving problems or claims issues. Contact us at 727-447-5845 to discuss how we can help.

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