Recent Event Highlights: Tax on high cost insurance plans , Increased Medicaid Reimbursement for Primary Care Physicians , Free Preventative Services for Medicare and Medicaid Patients , Regulating How Your Premium Dollars are Spent , Free Preventative Care , Federal Health Care Reform Signed into Law, and 8 more...
Created by VPIRG on Dec 28, 2010
Last updated: 03/02/11 at 12:02 AM
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Starting in 2018, high value insurance plans will be subject to an excise tax, meaning the tax is placed on the insurers offering the plan. A high value plan is defined as one that costs over $10,200 for an individual and $27,500 for a family plan. The cost of vision and dental coverage will not be included in this calculation. The 40% tax will only be applied to the amount of premiums over the single and family plan thresholds defined above.
If you have trouble affording the cost of insurance in the new exchange program, the federal government may help you pay for it. Only households below 400% of the federal poverty level will be eligible for help. In 2011, this is $88,000/year for a family of four
http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html
Requires most Americans to have health insurance. The federal government will help you pay your premium if you can't afford it. If you don't have an insurance plan, you may have to pay a tax penalty.
Starting in 2014, Medicare Advantage plans must spent 85% of every premium dollar you pay on direct care.
The PPACA requires state's to set up an online benefits exchange by Januayr 1, 2014. The exchange will provide Vermonters with a one-stop shopping experience for insurance. Plans sold in the exchange must meet minimum benefits standards and described in easy to understand language that allows you to easily compare the plans on cost and services provided. Minimum benefits include emergency services, hospitalizations, maternity care, mental health, prescription drug and preventative services, among others. If you buy insurance in the exchange and make less than 400% of the FPL, the government will help you pay your premium.
Companies with over 50 employees will have to pay a penalty if they don't offer health insurance to their employees. Smaller businesses are exempt from this and will not have to pay any penalties. If your company employees over 200 people, they must automatically enroll you in their health insurance plan, unless you tell them you don't want it.
The new law encourages employer health plans to give a premium discount of up to 30% to employees who make a commitment to health behaviors, such as eating well and exercising regularly.
http://www.healthvermont.gov/family/fit/worksitewellness.aspx
Increases Medicaid reimbursement levels for primary care physicians to match those given by Medicare. This should help increase the number of primary care physicians accepting Medicaid patients, improving access for non-elderly, low-income Vermonters.
Currently, you can deduct up to 7.5% of your gross adjusted income in itemized medical expenses on your federal tax return. The new law raises this threshold to 10%
http://www.irs.gov/taxtopics/tc502.html
Increases Medicaid reimbursement levels for primary care physicians to match those given by Medicare. This should help increase the number of primary care physicians accepting Medicaid patients, improving access for non-elderly, low-income Vermonters.
Once this provision takes effect, if you are employed, you will have the option to enroll in an insurance plan that will pay for long term care if you need it later in life. There will be premiums associated with this and these plans will be regulated by the state of Vermont. THis will cover care at home, in a community or institution of your choice. The premium can be paid via a payroll deduction and will result in at least $50/day for care when you need it. This minimum will ba adjusted annually for inflation. Enrollment will be automatic for workers, but you can opt out.
http://www.cahealthadvocates.org/advocacy/2010/class.html
The PPACA pushes nonprofit hospitals to play a more active role in their community. Starting in 2012, they each have to complete a community needs assessment every 3 yrs to make sure it's meeting the need for care. Each hospital has to report the progress it makes each year and spell-out the details of its financial assistance program for patients who can't pay their bill.
Requires restaurants with 20 or more locations to print nutrition facts, including fat and calories on all menus, include in the drive through.
All new health insurance plans must cover preventative services and health screenings for you, with no out of pocket costs or co-pays. This includes recommended immunizations and breast cancer screenings.
Beginning January 1, 2011, large group insurance plans must spent 85% of each premium dollar on director. For small group plans, the threshold is 80%. This is known as a medical loss ratio.
http://www.healthcare.gov/news/blog/medical_loss_ratio.html
Beginning in 2011, insurance companies who want to raise premium rates by more than 10% will have their rates reviewed by both the State of Vermont and the federal government. All of this information will be public and posted on the Health and Human Service Department website. Both the state and the federal department can deny the rate increase if it is found to be unreasonable. It that case, the insurance company must revise their calculation and propose a smaller increase.
http://www.familiesusa.org/assets/pdfs/health-reform/rate-review.pdf
Imposes new annual fees on pharmaceutical and insurance companies to help pay for the costs associated with implementing the new federal health care law. Between 2010 and 2019, this will generate
Starting in 2011, if you have between $2840 and $6,6448 in drug costs per year, you will only have to pay 50% of breand-name prescription drug costs and 93% of generic drugs. After you reach the upper threshold, you will only have to pay 5% of drug costs for the rest of the year. The percentage that medicare covers wil gradually increase each year untl the gap is completely closed in 2020.
If your business has less than 25 works and their average pay is under $50,000/year, the federal government will help you buy insurance for your employees. Between 2010 and 2013, businesses can get a tax credit of up to 35% of the cost of premiums, although it varies depending on the size of the business and the wages of its employees. In 2014, the tax credit goes up to 50%, as long as you are purchasing insurance within the insurance exchanges.
Prevents insurance companies from denying coverage to children with pre-existing conditions. This will be extended to all adults in 2014
All new health insurance plans must cover preventative services and health screenings for you, with no out of pocket costs or co-pays. This includes recommended immunizations and breast cancer screenings. This will be extended to Medicare and Medicaid patients in March of 2011.
http://www.healthcare.gov/law/provisions/preventive/moreinfo.html
You now have the right to appeal any eligibility or coverage decision that your insurance company makes. If the insurance company denies your appeal, you have a right to have the claim reviewed by a third party. The insurance company is required to cover the costs of the a third party review and if you win, the insurance company must pay for the claim that they denied.
http://www.bishca.state.vt.us/health-care/consumer-information/consumer-information
Prohibits insurance companies from putting lifetime benefits on insurance plans. In 2014, annual limits will be forbidden as well.
Requires that new insurance plans allow parents to keep their children on their family plan through age 26. As a consumer, you must pay the extra premium costs associated with this.
http://www.studentpirgs.org/healthcareguide
Strengthening prevention and encouraging wellness are key to helping Vermont families stay healthy. The PPACA
sets aside $500 million to fund public health programs in 2010. The funding increases each year, until it maxes out at $2 billion in 2015. The money will be given out to states to support projects like health screenings, walking paths, and immunization programs,etc. It also provides $50 million in grant funding through 2013 to build school-based health centers.
http://www.healthvermont.gov/
Understanding your options and finding insurance coverage can feel overwhelming. In May of 2010, the White House launched www.healthcare.gov, a website to help you figure out how the new law can help stay up to date and take advantage of new benefits and protections. It answers many common questions and links to state-specific resources, including Vermont's.
www.healthcare.gov
Currently, there are no standards for comparing the effectiveness and cost of the methods we use to treat particular illnesses or conditions. The new law creates The Patient Centered Outcomes Research Institute and provides it with funding through 2019 to conduct this much needed research. All of the results will be published and it is hoped that they will help doctors and patients weigh treatment options more effectively. We must keep a close eye on this however, to make sure that pharmaceutical companies do not haev too much influence over the treatment recommendations that are made by the Intitute's Advisory Board.
Thousands of Vermont's seniors on Medicare Part D find themselves struggling to cover their prescriptions drug costs. Those who had over $2,840 in prescription drug costs began to see some relief in June of 2010, when they received a $250 check in the mail. Starting in 2011, these same seniors will get a 50% discount on brand-name prescription drugs and 93% of generic drugs. When your costs get too high, your out-of-pocket share will drop to 5%. The amount that Medicare will increase gradually each year, until the gap is completely closed in 2020.
http://www.greenmountaincare.org
The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama on March 23, 2010. This historic law will bring coverage to 32 million Americans and save families from some of the worst insurance company abuses. For Vermont, this also means millions of federal dollars to help us build an affordable and universal health care system.
www.healthcare.gov
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