health reform: what it means to our community. health reform: key provisions o provides coverage to...
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Health Reform:What It Means to Our
Community
Health Reform: Key Provisions
o Provides coverage to 32 million uninsured people by 2019.
o Changes insurance rules to protect consumers.
o Builds on existing employer- and government-sponsoredinsurance programs.
o Tests ways to tie payment of hospitals and physiciansto quality improvement.
10 Things to Know Health Reform:
10 Things to Know
1. No lifetime benefit limits and no annual limits on coverage.
2. Coverage cannot be denied coverage based on health status.
3. Dependent adult children can stay on parents’ health policy until age 26.
4. No insurance coverage exclusions for pre-existing conditions beginning in 2014.
5. Mandates coverage of preventive care.
Health Reform: The Top 10
6. Coverage cannot be cancelled when someone becomes sick.
7. Limits insurers’ ability to set premiums based on health
status and other factors.
8. Creates a new marketplace called an insurance exchange to help people find insurance.
9. Provides subsidies to help people buy insurance through the exchanges.
10. Requires all Americans to have health insurance.
Health Reform: The Top 10
Health Reform: A Deeper Look
Health Reform:A Deeper Look
What does reform mean for me?
What Does Reform Mean for Me?
Employer-sponsoredor
Buying coverage on your own
Most individuals with coverage through their employers should not see substantial changes.
The bill includes incentives for your employerto offer insurance.
Employer Coverage
Individuals who purchase their own insurance coverage may:
o Be eligible for coverage through the exchanges.
o Qualify for tax credits to help purchase coverage.
Buying Coverage on Your Own
What Does Reform Mean for Me?
Medicare Beneficiaries
Individuals with traditional Medicare coverage should not see substantial changes, but will receive some additional benefits.
Additional benefits will include:
o Free preventive screenings such as colonoscopies and mammograms.o A free annual physical or “wellness” visit.o Discounts for brand-name prescription drugs.o A 50% discount on brand-name drugs while in the “doughnut-hole” coverage gap.
However, individuals with Medicare Advantage plans may see changes in their benefits depending on how their insurance company responds to reduced funding for this type of plan.
Medicare
What does reform mean for me?
What Does Reform Mean for Me?
Individuals without Insurance
Beginning in 2014, all U.S. citizens and legal residents must have coverage or pay a penalty.
o Uninsured individuals will have access to coverage through insurance exchanges.
o Subsidies will be available to help low-income individuals buy private health insurance.
Uninsured
o Eligibility for Medicaid is expanded to low-income individuals.
o Starting in 2010, a high-risk insurance pool will be available to individuals with pre-existing conditions and early retirees -- those 55 or older but not yet eligible for Medicare.
◦ Every state must set up an exchange by 2014.◦ The high-risk pool expires in 2014 when exchanges and rules to prevent insurers from excluding individuals with pre-existing conditions are in place.
Uninsured
“Small companies and individuals who don’t have insurance through work will
be able to purchase insurance through newly
created marketplaces, known as insurance exchanges, created and regulated by
states.
… Think of it as an Orbitz or Travelocity for health
care plans.”
- USA Today
Insurance Exchanges
What does reform mean for me?
What Does ReformMean for Me?
Large Employers or
Small Businesses
Note: Employers are not required to provide coverage.
Large Employers
Large employers – businesses with 50 or more employees – will be fined if their employees purchase health care coverage through the new exchanges and receive federal help to pay their premiums.
Small Employers
Small businesses are eligible for subsidies to offer insurance and have access to the exchanges.
o Employers with 10 or fewer employees who earn, on average, less than $25,000 a year can get a 50% tax credit for providing health insurance.
o Employers with 25 or fewer employees who earn, on average, less than $50,000 can receive a partial tax credit.
Health Reform:What Happens Next?
In 2010Insurance reforms:
o No lifetime benefit limits on coverage for all new plans.
o Appeals process and patient protections for all new plans.
o Dependent children up to age 26 can remain covered under their parents’ plans.
o Children with pre-existing conditions cannot be denied coverage.
Health Reform:What Happens Next?
In 2010Insurance reforms (cont.):
o New plans cannot cancel coverage for individuals if they get sick.
o No discrimination based on salary for all group health plans.
o Insurers will be required to spend at least 80% of all premiums payments on medical services.
Health Reform:What Happens Next?
In 2010Coverage:
o Establishes a temporary national high-risk insurance pool for individuals with pre-existing conditions and early retirees – those 55 or older but not yet eligible for Medicare. Once the exchanges are in place, this provision will expire.
Quality:
o Establishes a national strategy to improve the delivery of health services and patient health outcomes. Reduction of health disparities is a major focus.
Health Reform:What Happens Next?
In 2010
Medicare:
o Provides a $250 rebate to Medicare beneficiaries who reach the prescription drug “doughnut-hole” coverage gap in 2010.
Note: The gap is scheduled to be eliminated by 2020.
Health Reform:What Happens Next?
In 2010
Employers:
o Small businesses can receive tax credits to purchase insurance for employees.
Health Reform:What Happens Next?
In 2011
Medicare:
o Beneficiaries receive a 50% discount on brand-name drugs while in the “doughnut-hole” coverage gap.
o Offers a comprehensive health risk assessment.
Health Reform:What Happens Next?
In 2013
Families with an annual income above $250,000 will be required to:
◦ Pay an additional 3.8% tax on investment income.
◦ Contribute more to the Medicare program in payroll taxes.
Health Reform:What Happens Next?
In 2014
Most Americans will be required to have insurance coverage or face a federal penalty:
o Fine would start at $95 per person, up to $285
per family, or 1% of taxable household income, whichever is greater.
Insurance reforms:Insurers will be prohibited from refusing to sell policies and there are new limits on their ability to set prices based on health status.
Health Reform:What Happens Next?
In 2014
Employers:
o Businesses with 50 or more employees must provide coverage or pay a penalty.
Health Reform:What Happens Next?
In 2016
Penalties would grow to $695 for each family member, up to $2,085, or 2.5% of taxable income.
Resources
Kaiser Family Foundation: www.kff.org
Federal government: www.healthreform.gov
AARP: www.aarp.org
Robert Wood Johnson Foundation: www.rwjf.org
Resources