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What’s In Store For Obamacare?

As we quickly approach the end to Trump’s 100 days in office (April 29, 2017), many are curious as to where we stand when it comes to Obamacare AKA The Affordable Care Act.  At the beginning of his campaign, Trump made a lot of promises and proclamations about repealing Obamacare.  Since the election, the republicans has toned down their stance.

What Plans Does the New Administration Have for Obamacare?

The Republicans recently revealed what their big plan is when it comes to The Affordable Care Act.  One of the most glaring changes in their proposal is the name given to Obamacare.  Their proposal changes the name from The Affordable Care Act to The American Care Act.  Some of the other changes we may see under the new Administration include:

  • Removing the requirement of having insurance or risk the consequence of suffering a fine
  • Ending Obamacare taxes on the wealthy
  • Changing how people get financial aide needed in order to purchase health insurance coverage on an individual level

Keeping in mind that this is still in the proposal stages, other items on the table for approval are:

  • Changing the way the Medicaid system is funded
  • Eliminate the rule that requires companies with 50 or more full time employees provide health coverage or pay a fine
  • Ending subsidies for out of pocket costs for low income Americans
  • Creating a new system of financial aid and penalties for those who allow coverage to lapse
  • Tax credits based on age – starting at $2,000 for those in their 20’s with a gradual increase to $4,000 for those aged 60 and over available to individuals who earn up to $75,000 and households up to $150,000
  • Insurers allowed to charger older citizens premiums up to 5 times the rate of younger people which is different from Obamacare’s 3 to 1 rate
  • Not giving states the authority to expand their Medicaid programs to all adults by 2020 after which date no newly eligible adults could sign up

The bill will still include:

  • Pre-existing conditions where insurers cannot deny coverage or charge higher rates to people with pre-existing conditions
  • The ability for adults under the age of 26 to get coverage from their parents plan
  • The 10 essential health benefits set up by The Affordable Care Act
  • The fact that insurers will be barred from setting maximum limits on benefits paid out

While there are many changes on the table, there are many items that will not change.  The republicans look to make changes to drive down costs while providing quality health insurance at more affordable prices. Some may challenge this by saying the plan will remove coverage from many Americans who couldn’t afford it previously.

Stay tuned as we continue to learn more about what actually ends up being approved.

If you have questions about your coverage or getting covered, contact me today!

I can be reached at: (813) 391-3448 or email me at Dave@YourObamacareGuy.com

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The Future of Obamacare…Could it be here to stay?

img_3667As the new Administration is settling in, it seems the language of “repealing and replacing” Obamacare is becoming gentler and softer.  A “rescue” and “repair effort may more accurately describe how the system will be handled, especially since the deadline of January 27, 2017 for repeal legislation has quickly come and gone.  Additionally, it seems as though a replacement system may be more difficult to find. Many senators have claimed they will not vote to repeal the program unless they are able to see a clear picture of what will replace the Affordable Care Act.

Repeal or Rescue…What do these semantics mean to you and me? 

We probably will not experience much of a change during 2017.  While the republicans continue to draft healthcare system proposals, we can more than likely expect for the healthcare system to remain “business as usual”.  How can we be so sure?  Recently Trump and Republicans indicated they wanted to keep key provisions such as:

  • Guaranteed coverage for pre-existing conditions
  • Allowing children to stay on parent health plans until the age of 26
  • Subsidies or possibly a tax reduction to help pay for it
  • An incentive instead of a penalty or fine to make you want to get health insurance.

While I’m sure there will be changes, its a long way off yet and I can’t help but think of the old saying….

If it looks like a duck and it quacks like a duck……..its a duck!

It is important to note, there are no official plans on the table to replace Obamacare.  Also, keep in mind, it will be extremely difficult to take a system away from the 20 million people who received health insurance due to the Affordable Care Act. 

For more details and commentary, please explore these articles:

G.O.P. Campaign to Repeal Obamacare Stalls on the Details

GOP mulls ‘repairing’ Obamacare law it vowed to repeal

Trump remarks latest evidence of health law repeal slowdown

 


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Here’s to a Happy New Year and a Healthy You!

Now that you have gone through the open enrollment process for health insurance coverage, it is time to take advantage of what is available to you!

Living Your Healthiest Year!

Did you know that once you are covered under Obamacare, there are at least 15 FREE preventative services available with Obamacare and each year you have access to one wellness visit? 

Curious what is included?  Read on!

Annual Physical

Included in Obamacare, you have access to one well visit each and every year.  This annual trip to the doctor is an important one!  It provides a baseline measurement to your overall health status.  This baseline provides your doctor and healthcare professionals a picture of what your homeostatic state is.  Even more important, a baseline measurement of your health makes early detection of health issues a lot easier to recognize. 

Do Your Homework

Make yourself aware of what is covered under a well checkup/preventative care visit.  Anything outside the scope of the services listed below may result in copay fees.

When going for your annual physical, make sure your insurance company in being billed correctly by your doctor’s office.  For example, if you are visiting your doctor for a well check, make sure you ask the office how they are coding your visit and if they are coding for anything outside of why you visited.  If they code it differently than a well check, it may cause you to pay extra in copay and diagnostic fees.

FREE Preventative Care Services

Below is a comprehensive list of what is included in preventative well check visits to your doctor.

Adults

Adults have access to the following 15 preventative services while children have access to 26:

  • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol Misuse screening and counseling
  • Aspirin use to prevent cardiovascular disease for men and women of certain ages
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal Cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users

Women receive some specialized preventative care services like:

  • Anemia screening on a routine basis for pregnant women
  • Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
  • Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  • Breast Cancer Chemoprevention counseling for women at higher risk
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breast feeding supplies, for pregnant and nursing women
  • Cervical Cancer screening for sexually active women
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Domestic and interpersonal violence screening and counseling for all women
  • Folic Acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Sexually Transmitted Infections counseling for sexually active women
  • Syphilis screening for all pregnant women or other women at increased risk
  • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Urinary tract or other infection screening for pregnant women
  • Well-woman visits to get recommended services for women under 65

Preventative Services for Children

  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Cervical Dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Fluoride Chemoprevention supplements for children without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Hematocrit or Hemoglobin screening for children
  • Hemoglobinopathies or sickle cell screening for newborns
  • HIV screening for adolescents at higher risk
  • **Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenza type b
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus
  • Inactivated Poliovirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years ,11 to 14 years , 15 to 17 years.
  • Obesity screening and counseling
  • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years.
  • Vision screening for all children.

Preventative Services for Seniors

Medicare Part B (Medical Insurance) covers:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis C screening test
  • HIV screening
  • Mammograms (screening)
  • Nutrition therapy services
  • Obesity screenings & counseling
  • One-time “Welcome to Medicare” preventive visit
  • Prostate cancer screenings
  • Sexually transmitted infections screening & counseling
  • Shots:
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation counseling
  • Yearly “Wellness” visit

Did you know?

Know the facts about health insurance coverage!  Included in your Obamacare Health Plan are 10 Essential Health Benefits.  They are:

  1. Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3. Treatment in the hospital for inpatient care
  4. Care before and after your baby is born
  5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6. Your prescription drugs
  7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Your lab tests
  9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10. Pediatric services: This includes dental care and vision care for kids

“Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers.”

Source:  Healthcare.gov

Still have questions or concerns?  Contact me today!  I can be reached at (813) 391-3448 or Email me at Dave@YourObamacareGuy.com


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Healthcare and The Incoming Administration

The attached article – Donald Trump Walks Back His Stance On Obamacare shows a possible change in direction of the incoming administration and it’s not totally unexpected.


YOCG Tuesday 2 2 16 CANVAThere are so many people covered by insurance now that were never covered before it would almost be impossible to unwind what’s already been done and put something else in place that does not look like just about the same thing.  You know that old saying…if it looks like a duck and quacks like a duck…its a duck.   Maybe its a Trump duck instead of an Obama duck….but its still a duck.  
 

The affordable care act (Obamacare) was based on a few core principles. The most important ones in my opinion are…

1. No one should be turned down for any pre-existing medical condition

2. People who could not afford insurance would get subsidies or some kind of assistance to help with the cost

3. Everyone would be required to have insurance that consists of what is called MEC (Minimum Essential Coverage). This is also called the “Individual mandate”

It’s these principles that define Obamacare. Everything else in my opinion, surrounds these principles and if changed, really does not effect the basic core principles.  Some examples of things that could be changed that would lower the cost of coverage to most people include….

 – Should pregnancy coverage be included in all policies?

 – Should mental health coverage be included in all policies?

 – Should rehab coverage be included in all policies?

YOCG Tuesday 11 24 15 CANVAMaybe these coverage’s should be options like when you buy a car.  Everyone gets the basic car but if you want a radio it’s extra, if you want bigger tires it’s extra, if you want a sunroof it’s extra, you get the point.

I think we need to bring healthcare coverage back to its original intent, to cover you for what you want to be covered for and not what the government says that you should be covered for.  Of course everyone should have at least basic well-care and hospitalization coverage but should everyone have to pay for all the options? 

Read the article HERE


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Understanding the Different Health Insurance Options Available To You

When it comes time to select an insurance plan, which will you choose?  An HMO? PPO? EPO?  What do the acronyms mean and what are the differences?  This blog article will give you clear, concise understanding so you can make an informed decision when it comes time to choose or change your healthcare plan.

HMOs:  Health Maintenance Organization Plans

yocg-wednesday-10-26-16-canvaThis plan centers around a Primary Care Physician or a PCP.  Essentially, your PCP manages and coordinates your healthcare, referring you to specialists and hospitals within a designated network.  It is important to note that only those in-network services referred by your PCP will be covered by the plan.

PPOs:  Preferred Provider Organization Plans

PPO plans allow you and your family to receive care from any health care provider they choose within the insurance company’s network.  This list of providers can include specialists.  The major difference with a PPO is that a referral from your primary care physician or PCP is not required.  This type of plan is generally preferred by those individuals who tend to se a specialist on a regular basis.

EPOs:  Exclusive Provider Organization

This type of plan gives you access to all the providers and specialists within the EPO network.  EPO plans usually do not offer coverage outside of the network unless it is an emergency.  

POS:  Point of Service Plans:

This plan acts as a hybrid between the HMO and PPO.  In this type of plan, you usually select a primary care doctor for routine visits such as check ups as well as for specialist referrals.  The difference is, you are permitted to utilize providers outside of the network, but, you can expect your out-of-pocket expenses to be hight.  Additionally, you will be subject to copays and deductibles.  This type of plan works well for those who like the extra flexibility and who are willing to pay a little be more.

HDHP:  High Deductible Health Plan

yocg-thursday-10-20-16-canvaThis type of insurance plan has high deductibles which you must meet before the health insurance coverage actually goes into effect.  People attracted to this type of plan are those who want to save money on the monthly premiums.  These are also people who don’t intend on using their medical coverage as often as others.

This type of plan may also be used with a Health Savings Account or an HSA where the individual contributes to the account on a pre-tax basis allowing them to pay for healthcare expenses and deductibles.

Now that you are aware of the various plans available to you during open enrollment, you can make an informed decision.

Still have questions or concerns?  Contact me today!  I can be reached at (813) 391-3448 or Email me at Dave@YourObamacareGuy.com


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2017 Open Enrollment…Are you READY?

It’s that time of year again!  Get ready to start thinking about open enrollment and what you need to do to make sure you and your family have health insurance coverage.

Here is what you need to know!

2016:

Open enrollment for 2016 is CLOSED.  BUT, If you still need coverage for the rest of 2016, you can get it but, only if you qualify. 

To qualify you need to meet one of these two criteria:

  • Special Enrollment Period due to a life event — like losing health coverage, getting married, or having a baby.
  • You qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

You can apply for these programs any time throughout the year.

Let’s Brush Up On The Marketplace

About The Marketplace:

Who is it for?  The Marketplace is for individuals who do not have health coverage for the coming year.  That means, you do not have coverage through:

  • Your employment
  • Medicare
  • Medicaid
  • The Children’s Insurance Program (CHIP)
  • Another source providing qualifying coverage

How Much It Costs:

Health insurance through the Marketplace depends on your estimated income for the coverage year.  Did you know?  In 2017, roughly 8 out of 10 of uninsured people who are eligible for Marketplace coverage will qualify for financial assistance.*  The financial assistance  provided goes towards lowering the cost of the monthly premiums and in some cases is can also help with things like deductibles and copays.  Get an idea of what that could mean for you HERE.

Discover What The Marketplace Insurance Covers:

Essential health benefits – Every plan must include the following:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
  • Pre-existing conditions, including pregnancy
  • Preventive care
  • Birth control coverage
  • Breastfeeding coverage

Pre-existing conditions, including pregnancy

Preventive care

Get a list of what that includes for:

What If You Do Not Get Health Insurance?

If you can afford health insurance and fail to obtain qualifying health coverage for the 2017 year, you may be fined.  This fine is referred to the “individual shared responsibility payment”. 

Fees are calculated in two different ways.  They are:

  • A percentage of your house hold income
  • Per person

You will be required to the highest rate calculated.

Fines for 2017 have not been released as of yet.

Do you have questions about your health insurance coverage for 2017?  I can help!  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com

* source:  http://www.HealthCare.gove/quickguide


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Open Enrollment & Obamacare Changes YOU Need to Know About!

Healthcare Open Enrollment is RIGHT Around the Corner! 

There are LOTS of Changes YOU Need to Know About!

yocg-tuesday-9-6-16-canvaHealthcare open enrollment begins on November 1, 2016 and runs until January 31, 2017 and it won’t be business as usual.  There will be several carrier changes for 2017. 

Before we get into the specific changes, there are some dates you need to put on your calendar for the open enrollment period:

  • November 1, 2016:  Open Enrollment Begins
  • December 15, 2016:  Meet this enrollment deadline to ensure coverage begins on January 1, 2017
  • December 31, 2016:  Coverage ends on this date.  If you have NO changes to your plan, your plan will be auto-renewed
  • January 31, 2017:  This is the VERY LAST day you can apply for 2017 healthcare coverage

If you miss these deadlines, you cannot enroll again until November 1, 2017 unless you have special “life event” changes take place.  Life event changes include:  having a baby or losing your job.

Did you know?

If you do not enroll in Obamacare or have an approved form of health insurance during 2017, you will be fined 2.5% of your income or $695 per adult – whichever is higher.  Please note that the amounted listed is only an estimation as the higher 2017 dollar amount has not been released as of yet.

Those living at poverty levels can enroll at any time in the Medicaid or CHIP (Children’s Health Insurance Program).  These programs do not have a specific enrollment period or timeframe to adhere to.  Please note, there are some restrictions to adhere to such as income restrictions.

Changes…

yocg-wednesday-9-1-16-canvaAt the beginning of this article, I noted there were going to be changes in the Florida Marketplace.  There will be some carriers leaving and some new additions too!

Let’s first say good-bye to:

  • United-Healthcare
  • Aetna

Say Hello to:

  • Cigna – they exited the Florida Exchange in 2015 but are coming back in 2017
  • Molina – They are expanding from South Florida to the Tampa Bay area
  • Harken Health (a subsidiary of United Healthcare) is planning to enter the exchange in the Miami and and Fort Lauderdale area

Of Note:

Humana plans to scale back it’s participation in the Marketplace but will remain in the Florida Exchange system. 

Other changes coming down the pike in 2017 include rate changes that have not been approved by the state yet.   

Other Obamacare changes people can expect to see in 2017 are:

MORE INFO!

When you select a healthcare plan, there are usually two things you ask:

1)  How much is it going to cost me

2)  Is my doctor or the hospital I prefer in my plan

A common complaint last year was inaccurate doctor and hospital information.  The new rules mandate that:

  • Insurance providers are required to give consumers a 30-day notice when a doctor is being removed from a network
  • If a doctor/provider is being removed from a network and a patient is in active care/treatment with the physician being removed, the insurance company must allow for up to 90 days treatment under the physician’s care

Reduction in “Surprise” medical bills from out-of-network providers

Many patients have complained about receiving unexpected invoices and bills from out-of-network doctors, even when the patient thought the doctor was in network.  The new rule calls for:

  • Ancillary care amounts to be applied towards a patient’s yearly out of pocket maximum expenses

Note, this rule only applies to those instances where the insurer has not given patients the correct notification that they will be receiving care from individuals outside of the network.  The general rule is that a patient must be notified that they will receive care from an out of network provider within 48 hours.

Better Explanation of Out-Of-Pocket Expenses/Costs

During 2017, insurers are to offer plans with a standard set of coverage costs (deductibles and copays).  With this information easily attainable, the patients will better understand the out-of-pocket fees associated with the plan they select.

Do you have specific questions about open enrollment and how the 2017 marketplace changes could affect you?  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com