How Are You Affected by Health Care Reform? – Part 1

Health Care reform… “What does it do for me?” “Is it going to be free?” “Will there be waiting lines at doctor offices?” “What about rationing?” These are all legitimate questions and will be addressed over the next few weeks.Efforts to change the delivery system of health care in the U. S. goes back over 100 years. However, the most well known attempt at reform was as recent as 1994 during the Clinton administration. The overriding goal of reform debate has been to get all Americans insured and relieve the system of treating patients who had no insurance.Providers then would shift the cost (I.e. cost shifting) to those who could afford to pay out of pocket or who had insurance. Consequently, the well to do and insured Americans saw their costs of health care rise disproportionately over time along with the premiums for health insurance.Since the failure of the 1994 attempt at reform, the health care system introduced “Managed Care” plans. These plans offered discounts in premiums to steer insureds into certain blocks of providers. These plans had a number of different looks, but the most common in the West Texas area was PPO plans.Managed Care plans helped alleviate the cost shifting stress for a while, but failed to bring more uninsured folks into the system. Eventually, as the number of uninsureds rose, premiums were forced higher and higher until today where it is not unusual for a family premium to be more than a house payment.Most estimates say 47 million Americans are without health insurance today. The original goal of reform debate when it was seriously renewed in 2008, was to force that 47 million people into the cost sharing arena.By March 23, 2010, the result of reform provided only modest incentives for those 47 million to participate in cost sharing system. Rather, the result ended up as insurance reform.On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). On March 30, 2010, the President signed into the law the Health Care and Education Reconciliation Act of 2010 (HCERA), adding certain amendments to PPACA. Combined the two laws comprise health care reform.The end result of reform will not reduce costs. The primary focus intended to get those 47 million Americans in the system as participating financial contributors by forcing them to purchase health insurance or open the health insurance markets up to insure those with pre-existing health conditions.The incentives to get more people into the system include:-tax credits for businesses who offer and help pay for insurance
-penalties to individuals and families who do not buy insurance
-elimination of pre-existing health condition exclusions by health insurance carriers
-premium subsidy payments to individuals and families who could not afford insurance
-expansion of MedicaidThese mandates along with a host of other mandates will be phased in over the next seven years, with the majority required by January 1, 2014. It is on this date that subsidies, penalties, and adult pre-existing condition limitations begin. Other prominent provisions begin on that date as well:-State run “Health Insurance Exchanges” must be operating
-Policies may no longer include limitations on annual benefits
-Wellness programs begin
-Group plans will not be able to extend waiting periods for insurance eligibility beyond 90 days
-Employers must begin to “certify” coverage.Other mandates require insurance companies to install important provisions by September 23, 2010:-Dependent children, whether married or unmarried, student or non-student may remain as dependents until age 26
-Group health plans may not set lifetime maximum benefit amounts on “Essential Health Benefits”. The Dept of Health and Human Services will be determining what “Essential Health Benefits” are by September 23
-Children under age 19 who have a pre-existing condition must be “guaranteed issue”
-Insurance companies may not rescind health insurance policies except in limited cases of fraud or misrepresentation by an applicant
-A $250 payment will be made to Medicare Part D (prescription drug plan) beneficiaries as the first installment toward closing the “donut hole” by 2020.Health plans in effect on March 23, 2010, or collectively bargained plans will be exempt from certain requirements and will retain the “grandfathered” status until, as yet undefined, policy changes are made. The grandfathered plans must still abide by dependent children to age 26 and benefit limitation rules. However they will be exempt from other more significant requirements that will be addressed in later columns.Grandfathered health plan premiums will likely be less adversely affected than post-grandfathered plans which will have to conform to many mandates. Most experts believe health insurance on January 1, 2014, could be well over 75% higher than a similar policy today.Very small group plans may give way to individual plans of insurance because the structure of health care reform blurs the line of distinctions between the two.In the meantime prior to September 23, 2010, insurance companies will distribute updates to small group plan sponsors the following items:-Children can remain on parents’ coverage until age 26
-elimination of lifetime benefit caps
-35% tax credit for offering and paying all or a portion of group health planThe next article will focus on group insurance reforms with more detail about the effects on small
businesses.

Home Health Care: The Finest Package To Stay Healthy

Home health care is the answer to your long-time agony of restoring your most treasured health without living in a hospital. During this age and time, the number of people with chronic diseases, mentally challenged and physically incapacitated is growing. That’s why health care services that are delivered at home are of great significance to their lives. It includes the finest package to restore your health and eventually be in good physical shape.The idea of living in the hospital to meet your medical challenges is really dreadful. Aside from the costly medical procedures in a health care institution, you also find it uncomfortable to live each day of your life in the hospital. The development of health home care deletes this inconvenience. These services help you regain your optimal health. But this doesn’t sacrifice the idea of quality services when you are in an excellent medical institution undergoing sophisticated treatments. These home care services use state of the art facilities and are delivered by experienced and competent medical staff. Through that you will never have to put your own health at stake.But, what are really the services offered by this health home care providers? First, we have the language and speech therapy. Victims of a physically debilitating stroke can still recover their communication skills with the help of a competent speech therapist. Yes, it is a long process. But at the end, you’ll surely reap the fruits of your sacrifices. These services can also focus on educating the family. As we all know, prevention is always the best cure. These services also teach the significant knowledge needed by these individuals as they struggle in maintaining good health. They can also educate the family members of individuals who have chronic diseases of thing they should and shouldn’t do if emergency occurs. They can further educate the youth against the evil and danger brought about by sexually transmitted diseases. With this, you just can’t provide worthwhile knowledge but can straighten their paths as well. Lastly, these services also concentrate in feeding the emotional and spiritual well-being of dying patients or those who have chronic diseases. They could still assist these individuals to attain a dignified death when their time comes or could still let hope shine despite the overshadowing of darkness, as in the case of chronically ill patients. Whatever the purpose of health home care may be, its ultimate goal is to be a part of a patient’s life. Truly, these medical staff members want nothing but the best and quality life for their patients.Being a part of a health home care staff is really mentally taxing and physically demanding. But, do you know what makes this career path worth the sacrifices? It is the smile of the patients whenever you touch them with care and their satisfied hearts whenever you smile back at them. At the end of the day, you can truly say that these services don’t only provide purely medical treatment and health knowledge, but this career also touch lives as they become part of a patient’s heart.

Understanding Your Medicare Home Health Care Benefits

For many caregivers and families who are searching to find out more information on how they can care for their elders and loved ones, it can seem like a daunting task. One of the most important distinctions that have to be made on your information gathering quest is to know the difference between Medicare covered Home Care vs. all other forms of home care. In this article, we will explain what Medicare Home Care is and how to find out if you or your loved one qualifies.What is Medicare Home Health Care?Home Health Care is skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury.One of the services offered to senior citizens by Medicare is Home Health Services. Medicare recipients must qualify for services, and they must be recommended by the individual’s primary care physician or specialty care physician.Medicare beneficiaries who feel they may need Medicare home care should always look into whether they can actually qualify for Medicare home health services. It is not a general personal care or chore-worker service. Rather, Medicare home care covers limited, specifically defined at-home care related to diagnosed medical conditions, and sometimes includes personal care services.These Medicare home care services must be prescribed by a physician, and provided through a licensed home health agency. The beneficiary must have a medical condition, or combination of conditions, that require periodic services from a skilled nurse or therapist. A plan of care will be developed that describes the specific services covered. Eligibility and coverage are evaluated strictly so the beneficiary’s conditions and care needs must be aired fully.Medicare Home Care QualificationsIt is common for an elderly person to need assistance upon discharge from a hospital or in-patient rehabilitation stay. That individual’s physician, sometimes in concert with family members and the patient him/herself, would determine the in-home health care need and complete paperwork that refers the patient to home health care.Other common situations include the slow physical decline elderly people experience; when that decline includes inability to care for oneself on a daily basis-but nursing home care is not yet required-the physician may recommend home health care for just those tasks the senior is unable to perform.These four conditions must be met before homecare services can be prescribed and covered by Medicare:1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and2. You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech-language pathology services or continue to need occupational therapy; and3. You must be home bound or normally unable to leave home & leaving home takes a considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons; and4. The home health agency caring for you must be approved (“certified”) by the Medicare program.You can always find more information about your benefits and rights at Medicare’s website.