11.1.2011 - A New Definition of “Affordable”

Under the Patient Protection and Affordable Care Act’s (PPACA) the law requires that an employer must make health insurance coverage “affordable.” A newly released set of rules defines “affordable” as premium costs not to exceed 9.5% of an employee’s family income. However, this definition only applies to single coverage, not family coverage.

What does this mean for employers? As long as an organization offers insurance and the employee rate for single coverage meets the above guideline, then all other rates (employee + spouse or employee + family) are deemed ok. No news yet how an employer is supposed to know if the rate is affordable to their employees. This also means that families cannot go to the government subsidized exchange for help in paying for family coverage.

Congress has asked for clarification on this definition since many of them supported the PPACA because it would make it easier for employees AND their dependents to get coverage. If the Administration decides to leave the definition as-is, then families will only have employer sponsored coverage. If the definition changes, then thousands more could end up on the government subsidized plan and tax payers would be footing the bill. Either way, it appears that employers will now need to keep track of their employee’s family’s income.

10.28.2011 - And POOF, The CLASS Act Disappears

By now you've probably heard that the Department of Health and Human Services (HHS) has said they can't possibly fund the CLASS Act and that it should be repealed. Thankfully someone in Washington DC knows when to throw in the towel. The major issue seems to have been funding. With long term care costs on the rise, there was no way for the US Government to run the program without being in the red. For at least a decade if not more.

 

So now what? Currently our legislators are holding hearings regarding the decsision by HHS not to implement the healthcare law's CLASS program.  While it looks like this bit of legislation is at an end, the issue of Long Term Care certainly isn't over. But what are the issues?

 

If you are caring for a parent you know how difficult your day to day routine can be. Do you want the same for your children? Could our children even afford to? Lots of young men and women can't find a job let alone afford to live apart from their families. Young families are moving in with parents at an increasing rate because of financial hardships. We all want to think we will be there for our parents but can we afford to take time off for their care? Can we afford to pay someone else to do the caregiving?

 

Long Term Care insurance isn't expensive when you look at all of these considerations. A healthy couple in their 50's might be looking at a $2000-$5000 a year policy. Most companies now offer monthly and quarterly payment plans so there's no need to come up with a lump sum like in the past.

 

Healthcare reform was right to start to tackle the huge issue of long term care, though maybe not in the way they initially set forth. Last year's census shows that there are almost 80 million people in the US born between 1946-1964, during the so-called "Baby Boom". The first born turned 65 this year and someone is going to have to care for this portion of our population. 

10.6.2011 - The CLASS Act . . . huh?

If you have a parent over the age of 70, it's likely you devote a good portion of your time and earnings to their care. In fact, 70% of people over the age of 65 need some type of long term care services and 40% need to be in a nursing home. The CLASS Act is part of Health Care Reform and is supposed to provide a minimal amount of financial help to those who need Long Term Care but have no way to pay for it. Before you breathe a sigh of relief and think that what the government provides will be good enough for you, let me illustrate a few points.

1. The CLASS Act provides $50 a day (but up to $75/day for severe disability) for those who chose to participate in the plan and qualify for care. Great! But know that home health aides cost $25 an hour or more.
   
2. Health insurance (like Medicare) will not pay for long term care. Medicaid will, but you must first exhaust all financial resources. And "resources" are sometimes hard to convert to cash. If you had to sell your home today so you could receive care, could you? How long would that take? Would you get enough money or even a fair price?
   
3. There's a 5 year vesting period once you sign up to participate in CLASS. Benefits are not paid until you satisfy this waiting period. What if you need help before then?
4.  
5. At $50 a day, CLASS pays $18,250 a year.
   At $75 a day, it pays $27, 375.
6.  
7. Home care (5 hrs per day, 7 days per week) is $35,000 a year.
   Assisted care is $41,000 a year.
   A semi-private nursing home (you share a room) is $72,000 a year.
   A private nursing home is $81,000 a year.
   
8. You probably aren't working while you receive your care. If your retirement was supposed to provide for you and a spouse, your spouse may have to return to work to supplement the income. Or, your spouse may have to quit a job to provide for your care, further jeopardizing your financial situation.
9.  

If this all sounds bleak you're right; it is . . . IF you don't plan. Talk with us about Long Term Care Insurance. No one wants their kids or spouse to have to provide the uncomfortable end-of-life duties or to cause financial distress but we also don't want to be crammed into a publicly-funded care facility where we receive subpar medical treatment. If you can, give yourself and your family peace of mind and help protect their finances with Long Term Care Insurance.  

9.27.2011 - Decision on health-care law means Supreme Court will likely determine constitutionality next summer

(Washington Post) - The constitutionality of the 2010 health-care law could be determined by the Supreme Court this term, with a decision coming next summer in the thick of the 2012 presidential campaign.

The Justice Department said Monday evening that it had decided not to ask the full U.S. Court of Appeals for the 11th Circuit in Atlanta to take up the case. A three-member panel of the court last month decided 2 to 1 that Congress overstepped its authority in passing the Affordable Care Act, which requires virtually all Americans to obtain health insurance.

 

Although the department declined further comment, the logical next step for the Obama administration is to ask the justices to make what would be the final determination on the law’s fate.

9.13.2011 - US Proposes Direct Patient Access to Lab Tests

(Reuters) - U.S. medical patients would be able to get their laboratory test results directly from the labs rather than wait for a copy from their doctors under a new rule proposed by federal health officials.

 

U.S. Department of Health and Human Services Secretary Kathleen Sebelius on Monday proposed new rules giving patients more rights to access their health information.

Speaking at a meeting on consumer health information technology, Sebelius recounted her own frustrations with a lack of communication between doctors that led to extra testing or having to refile the same forms over and over again.

 

The proposed rule would amend the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to require that labs covered by HIPAA provide test results to patients or their personal representatives in a secure manner.

 

U.S. health regulators have been promoting innovation in health IT, and especially health information access and exchange, in a broader effort by President Barack Obama's administration to update the U.S. medical records system.

 

In May, HHS proposed another rule allowing patients to see a list of everyone who has accessed their electronic medical records.

9.8.2011 - New Insurance Guidelines for Women

The Department of Health and Human services released new guidelines for women's care in August of 2011. In these guidelines are additional preventive services that health plans must cover in full without co-pay, co-insurance or deductible. Starting in 2014, health plans must cover the following:

• All contraceptive methods approved by the Food and Drug Administration, sterilization procedures and patient counseling. (Includes condoms, birth control pills, IUD's, etc)
•  
  A "well-woman" preventive care visit annually for adult women.
• Screening for gestational diabetes for women 24 to 28 weeks pregnant and those at high risk.
• Screening for the human papilloma virus, which causes cervical cancer, for women age 30 and older every three years.
• Annual HIV screening and counseling for HIV and other sexually transmitted infections.
• Breast-feeding support, supplies and counseling.
• Domestic violence screening and counseling.

HHS hopes these new additions to "preventive services" will reduce the stubbornly high U.S. rate of unplanned pregnancies -- nearly half of all pregnancies -- and thus, abortions. However, not everyone agrees that making contraceptive options readily available will lead to fewer abortions.

"We definitely think it's a bad step," said Marc Tuttle, president of Right to Life of Indianapolis.

 

Whether you support or object to these new mandates, the cost will undoubtedly be passed on the consumer in the form of higher premiums.

9.2.2011 - US requires health insurers to publicly justify big rate hikes

Health insurers will have to start publicly justifying big rate hikes, according to a new requirement of the federal healthcare law that is meant to put pressure on insurance companies to hold down skyrocketing premiums.

The new rule, which went into effect Thursday, will mandate that insurers post on their websites explanations of premium increases exceeding 10% and submit the hikes to state and federal regulators, who also will post them starting this year.

 

The rule does not give state and federal regulators new authority to block rate hikes**, however, even if government officials find the increases to beunjustified.

 

The administration plans to work with states to set individual state-by-state thresholds for rate hikes that will require public explanation from insurance companies.