What’s new in health care reform
More Young Adults Covered
Since last year, the fastest-growing group to gain health care coverage is those between the ages of 19 and 26. In fact, estimates from the Centers for Disease Control and Prevention are that in the first quarter of this year, there were 900,000 fewer uninsured adults in this age bracket than in 2010.
The U.S. Census Bureau reports that the share of young adults without health insurance declined by 2 percentage points. That drop indicated that more than a half-million fewer 18- to-24-year olds were uninsured. Most obtained coverage through private — not government — policies.
This trend occurred despite the continuing sour economy and accompanying bleak prospects for employment for young adults, who are without jobs at nearly twice the rate of older Americans. A provision of the Affordable Care Act permits parents to cover dependents until their 26th birthday.
New Appeal Process Announced
The Obama administration has announced new regulations that will allow consumers to appeal decisions made by their health plans. Under the new regulations, consumers in new health plans in every state will have the right to appeal decisions, including claims denials and rescissions, made by their health plans.
Both group and individual plans will be covered, but not those that have been “grandfathered” in under the health care law. As plans lose their grandfathered status in future years, more will have to comply with the new federal appeals process. The number of individuals covered by the new appeals rules is expected to rise to 88 million by 2013. The rules will also apply to self-insured companies.
For more information about the new appeals regulations, go to http://www.healthcare.gov/news/factsheets/protectconsumers_factsheet072210.pdf.
Information about Pre-Existing Condition Insurance Plan
Learn more about the temporary Pre-Existing Condition Insurance Plan, which gives access to health insurance to individuals with pre-existing conditions who have been uninsured for at least six months. Applications will be available in early August.
Help for Medicare Part D enrollees
Vice President Biden announced that checks for $250 are in the mail for seniors who have fallen into the Medicare “donut hole.” This refers to a gap in prescription drug coverage for these enrollees in Part D. The one-time, tax-free checks have been sent to seniors who have already fallen into the coverage hole. If a senior hits the donut hole in the future, a $250 check can be expected about a month later.
Other points that the vice president shared about what health care reform means for seniors:
Guaranteed Medicare benefits are protected, regardless of whether you are enrolled in Original Medicare or Medicare Advantage.
Free preventive care for services such as colorectal cancer screening and annual wellness checkups.
Patient-centered care provided by community health teams so seniors won’t need to see multiple doctors who do not coordinate care.
See http://www.whitehouse.gov/seniors-town-hall for more information.
HHS, Department of Justice announce new efforts to fight fraud and abuse
The Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder recently announced new efforts to prevent fraud using tools provided by the Affordable Care Act. The new law strengthens law enforcement capabilities and shifts the emphasis from the old model of “pay and chase” to a new model that emphasizes fraud prevention and program integrity.
From the Public Employees Benefit Board:
We are evaluating whether to apply for a portion of the $5 billion in federal funds available under the Early Retiree Reinsurance Program through 2013. This new health reform law helps to fund early retiree programs. However, there are costs to implement the program, so if PEBB estimates that it will receive more federal money than it costs to set up the program, then PEBB will likely apply. If the federal government accepts the application, funding will begin in 2011.
The program does not allow PEBB to send rebate checks to or directly compensate early retirees. The money can be used to limit increases in premiums and copays next year.
This part of the Patient Protection and Affordable Care Act is designed to encourage employers to establish or re-establish retiree coverage. At a time when many employers are scaling back or eliminating their retiree health coverage, PEBB has continued to provide comprehensive coverage options for retirees.
PEBB will provide updates about this and other health reform topics at www.pebb.hca.wa.gov.
Temporary high-risk cost pools
The U.S. Department of Health and Human Services reported that as of May 3, 29 states and the District of Columbia will participate in a new program to offer insurance to people with pre-existing conditions, with 17 states opting out. The health reform law creates a temporary, high-risk health insurance pool program to provide health insurance coverage to uninsured individuals with pre-existing conditions, and provides $5 billion in federal funds to support it.
Web portal requirements
HHS recently made public an interim final rule on the health insurance Web portal required by the Affordable Care Act. The law establishes authority for a Web portal through which individuals and small businesses can obtain information about the insurance coverage options that may be available to them in their state. The rule adopts the categories of information that will be collected and displayed as Web portal content, and the data that will be required from issuers and requested from states, associations and high-risk pools to create content. Regulations are effective May 10.
Because of the short time frame between passage of the Affordable Care Act and the requirement that the portal be available on July 1, the portal will launch in phases. The first phase will be introduced by July 1, as required in the law. It will provide summary level information on coverage options by state and zip code in the private market and information about public programs with links to more detailed information. It will be followed by a second phase in October that will have more detailed pricing and benefit information.
