Goodbye to Lifetime Limits
Starting next month, insurance companies are no longer allowed to impose lifetime dollar limits on essential benefits. What this means is that there is no longer a cap on how much an insurance company will pay for a person’s entire lifetime. Note though that under the Affordable Care Act this only applies to health plans that begin on or after September 23,2010. So if its time for you to renew your plan soon check to make sure the lifetime limits on insurance coverage is no longer there.
Just to ensure there is not confusion, note that the lifetime limit on insurance coverage is different from the annual limit. Insurance companies can still impose an annual limit, although the Affordable Care Act also seeks to regulate those limits. However, this is still good news, especially for people who get sick quite often and are nearing their lifetime limit. It just feels good not to have to compute how many more times you can afford to get sick in your lifetime, doesn’t it?
Negativity definitely doesn’t help but the latest news doesn’t really help in painting a more positive picture. According to a study conducted by UCLA, an additional 8 million California residents are have lost their health care coverage due to the economic turmoil. Of those 8 million, 85,000 come from Sacramento.
These numbers does pose a very grim picture for these people and their families since with all the other things on their plate (i.e. joblessness and foreclosures) there is no certainty when they will able to afford insurance again. Even worse, their financial state and the emotional and psychological toll of all these problems often leads to increased health problems, if not vulnerability.
In the end, one can only hope that the economy will recover at a faster rate and in the meantime depend on sheer will and resourcefulness. After all, despite the Affordable Care Act, it will take sometime before people will be able to not worry about money to buy groceries, much less their health insurance premiums.
It’s final. President Barrack Obama has signed the Affordable Care Act yesterday. So what does this really mean to people and how will it impact everyone in the near future?
First of all it is important to note that the Affordable Care Act will not be implemented overnight. In fact it is estimated that the comprehensive health care insurance reforms will take more than four years before they are rolled out, with most of the changes having been completed by 2014.
Some of the more immediate changes that will be seen though include:
- Health insurance tax credits for small business (up to 35% of employers contributions to employee’s health insurance) – Effective the start of this year
- A $250 Medicare drug rebate for senior citizens – to be implemented this year
- Federal matching funds to states for covering low-income families under Medicaid – to be implemented this year
That is only the start. However, we can expect to see more changes as the year progresses and the years to come.
The Case for Going Generic
It is not uncommon for people to shy away from generic drugs, thinking that they are either less potent that branded ones. However, this misconception is generally unfounded. In fact, according to the FDA, generic drugs “have the same active ingredient, strength, dosage form, and route of administration as the brand name (or reference) product.” As for the other ingredients on the label, it is actually not important that they may be different because the other ingredients are inactive and play no role in the effectiveness of the drug.
Generic drugs really are a safe, effective and affordable option. As long as the generic drug is FDA approved you can be sure that the drug is of the same quality is the reference drug and that any difference in absorption of the drugs by the human body is minimal (average difference is 3.5%).
Considering the amount of money that a person can save by going generic (Generic drugs are cheaper by 80-85% on average), it is hands down generic drugs for me, especially these days when every cent counts.
US Senate Passes Health Care Bill
After almost a month of debating the fate of the health care bill, the US Senate has finally decided on passing the historic $871 billion health care reform on Thursday. Must be a great Christmas present for President Obama, who said that the country is now close to making “health insurance reform a reality”.
The bill was passed with a 60-39 vote, which was a big victory for the Democrats but a clear bitter pill for Republicans, who ALL opposed the measure. Almost all senators were present for the vote except for Sen. Jim Bunning of Kentucky (R), who was a very outspokenly against the bill.
The next stop is to merge the health care bill with a $1 trillion plan that was already approved by the House of Representatives last November. The bill aims to provide insurance coverage to 31 million Americans who are currently without one.
A guaranteed renewable policy is defined as an insurance policy feature that obligates the insurer to continue coverage as long as premiums are paid on the policy. What this means is that an insurance company has no choice but to renew the policy.
This type of insurance policy is very attractive when it comes to health insurance because insurance companies tend to refuse to renew coverage when people become classified as high risk (i.e. those that get sick regularly or get dreaded conditions). With a guaranteed renewable policy, insurance coverage will continue even if you grow older and eventually have lots of health problems.
The downside to guaranteed renewable policies is that the premiums can rise from year to year. They can rise simply because of the length of time you have been insured or because of the use of many services. Insurance companies do this to discourage people from renewing coverage. In the end though, even with a rising premium a guaranteed renewable policy may be worth it for certain individuals.
Waiting for Health Care Reform? DON’T!
While the big debate on health care reform is still raging it is important that you don’t lose focus on what you need right NOW. Sometime in the near future either the Democrats or the Republicans will be able to push their own health care agendas but right now it is best to look at the options in front of you. Health insurance is very important and something that you shouldn’t put off, waiting to see what happens just in case new laws passed will eventually affect your policy. After all you never know if you’ll end up needing your health insurance before the debates, and the the reforms, are passed.
In the meantime what you can and should do is to…
- Start taking control of your health – Live a healthier lifestyle and PREVENT health problems!
- Look at you current insurance policy and see if your coverage is enough for your needs.
- Find out about your options – Whether you do not have coverage or need a better one, looking at your options is a must.
- Get health insurance – If you really can’t afford it now start saving up for it.
A dilemma people often face due to health insurance restrictions is in the choice of doctor. Most HMOs and EPOs do not pay for the cost of service or at least just pay a partial amount if the doctor consulted does not belong to the list of accredited doctors. What this means is that it limits the patient’s choice. However, this does not mean that the patient has no choice at all.
One of the best strategies for ensuring that you get the best health care possible while still managing to lower the costs through your health insurance policy is simply by researching the list of the HMO accredited doctors. Who knows your current primary doctor may even be accredited!
Another way is to go to the HMO accredited doctor/clinic for routine lab tests and checkups and to go to your own doctor for cases you think need special attention.
You can also visit your own doctor for a checkup and find out his initial diagnosis, then go to the HMO doctor for a second opinion (getting a second opinion is good practice!) then having all the other tests done care of the HMO. This way you only need to pay a consultation fee and still be at peace that you’re getting quality yet affordable care.
CHIPRA Big Help to Children’s Health
Earlier this month, President Obama signed the Children’s Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA is meant to provide additional funding in order to renew the Children’s Health Insurance Program (CHIP), which provides low-cost insurance to children coming from families that do not qualify for Medicaid but cannot afford private health insurance. According to Health and Human Services Secretary Kathleen Sebelius, thanks to the signing of CHIPRA, 10 states will be able to share in the $100 million grant to “help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives.”
While rules and benefits vary for each state, basically those that qualify are all children up to age 19 whose families have incomes lower than $45,000 (even higher in some states). What many people do not realize though is that CHIP also cover pregnant women. This means that pregnant women can have the cost of lab tests, labor and delivery covered thru CHIP.
Tom Daschle announced as new nominee for Secretary of Health and Human Services.
We now know who the face behind the shaping of reforms to the health-care system will be – Tom Daschle.
President-elect Obama revealed in a new conference in Chicago on Thursday that former Senate majority leader Tom Daschle will be the new Health and Human Services Secretary and spearhead the health reform.
Tom Daschle is a good choice in terms of being well-versed in health policy and, of course, Senate procedure. However, some of his ideas regarding health care can prove to be very controversial, especially his idea of establishing a Federal Health Board, which will act like the Federal Reserve but in the field of health care. We’ll just have to see though if he will try to insert that in the future health care bill.
As for his commitment and zeal to provide health insurance to those who don’t have any coverage we can be sure that he cares very much. As he said, “Our growing costs are unsustainable and the plight of the uninsured is unconscionable.”