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Posts tagged insurance

Millions of Americans will soon become eligible for a new tax credit, the so-called health care subsidy, but many of them are not aware they may qualify for it.

Nearly 26 million Americans will qualify for the federal subsidy under the Affordable Care Act (ACA), according to Families USA, a nonprofit and nonpartisan consumer advocacy group. Its number crunching showed that a family of four with an income as high as $94,200 will be eligible for the government subsidy.

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“But the idea of cutting $716 billion from Medicare to be able to balance the additional cost of Obamacare is, in my opinion, a mistake.” — Romney

Mitt Romney and Paul Ryan have both used the figure $716 billion in their debates. That’s the amount that the Congressional Budget Office (CBO) estimates will be cut from Medicare to pay for some of the costs associated with the ACA. In fact, Romney and Ryan brought up that number a combined 13 times during the first 3 debates this month. The CBO, in a report prepared for House Speaker John Boehner, concluded that repealing the ACA would increase spending for Medicare from 2013 to 2022 by $716 billion, reducing the amount cut or saved.

What Romney and Ryan have not made clear is that the cuts to Medicare will come from reducing payments to insurance companies operating Medicare Advantage plans, hospitals, and other providers (except for physicians), and not from reducing benefits for seniors. For example, reimbursements to hospitals will be cut by $260 billion. However, there is uncertainty as to whether these cuts hurt access to care. In other words, will hospitals and other providers stop accepting new Medicare payments once reimbursements are cut? The Obama administration says that increased enrollment in Medicare, Medicaid, and private health insurance, spurred on by the ACA, is expected to bring in revenue and balance out the cuts.

Ryan’s healthcare plan similarly includes $700 billion in savings from Medicare, but that was not mentioned by the candidate.

Short answer: Romney’s statement is true but vague, and possibly was meant to worry seniors into thinking that their Medicare services will be cut, although these cost-savings in the program may not affect them.

Ouch! Did you know one of the fastest ways to go broke in America is to go to the hospital. As a physician-in-training, I see a lot of patients with similar stories, but I have noticed that these days it seems like almost everyone has an outrageous hospital bill story to share, myself included.

It is getting to the point where most people are deathly afraid to go to the hospital. All the financial progress that you have made in recent years can literally be wiped out in just a matter of hours. For example, you are about to read about an Arizona woman that was recently charged $83,046 for a three hour hospital visit. How in the world is anyone supposed to pay a bill like that? I have a really hard time understanding why a visit to the doctor should ever be more than a couple hundred bucks or why a hospital stay should ever be more than a couple thousand dollars.

The outrageous cost of healthcare, and hospital bills in this country are a real pet peeve of mine. What makes all of this even more infuriating is that Medicare, Medicaid and the big insurance companies are often charged less than 10 percent of what the rest of us are billed for the same procedures.

There is a reason why 41 percent of all working age Americans are struggling with medical debt right now. It is because our health care system has become a giant money making machine.

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As a physician-in-training, specializing in Emergency Medicine — I thought I’d chime in on the Patient Protection and Affordable Care Act (PPACA). First off, this “mandate” everyone is talking about basically says if you can afford insurance but do not get it, you will be charged a fee — or in other words, taxed.

For some healthcare organizations, physicians, and hospital departments, today’s ruling will have significant implications — hospital emergency departments will be greatly affected.

In the ED, we’ll most likely experience a little increase in reimbursements, as 20 percent of the patients are uninsured. Basically, uninsured individuals, who have been paying for healthcare services independently —- the lowest form of reimbursement for hospitals and EDs —- will have access to insurance through Medicaid and state exchanges.

Aside from that, the EDs will most likely see volumes increase for two reasons.

First, the mere fact that more individuals will be covered by insurance will bring more patients to the ED, especially since the uninsured population has healthcare needs on reserve.

Second, there is not a primary care practice excess in the country. The odds are that newly insured individuals will not be able to see primary care practitioners and instead will visit an emergency room — thus contributing to even more emergency department overcrowding!

We already have our emergency departments full — when I’m in the ED, I constantly see beds in the hall. With PPACA, it will only lead to even more ED crowding, poorer access to emergency care for the truly vulnerable, and more losses for hospitals. It’s not just about the money — if we’re turning patients away due to capacity constraints, we won’t be able to provide adequate emergency care.

The recipient’s insurance covers the tab for both the donor and the recipient for the procedure. The donor needs regular follow ups for the rest of his/her life to make sure that one kidney is in tip top shape. The recipient’s insurance drops coverage because they can’t cover this tab forever. They cut the donor off. And then the donor is left with the bill.

Only in America. Our healthcare system is embarrassing.

via NPR

(Source: jayparkinsonmd)

Most health insurance payments to providers are for routine services that, strictly speaking, are not insurable events. The real purpose of insurance is to protect you against sudden, unexpected, unaffordable events, for instance, a heart attack or cancer diagnosis. Yet that’s not how most of us use our health insurance these days. We use it to pay regular, predictable expenses such as office visits, diagnostic tests, dental cleanings and eye exams.

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Major new health reform benefits take effect today to help keep health insurance companies accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

Starting today, insurers will be required to:

• Keep you covered when you get sick: Simple mistakes or typos will no longer be grounds for insurance companies to cancel your insurance.
• Cover kids with pre-existing conditions: Your kids can no longer be denied health coverage just because they have a pre-existing condition like hay fever, asthma, or previous sports injuries. This protection extends to all plans, except “grandfathered” plans in the individual market.
• Allow young adults to stay on their parents’ plan up to age 26: Even if their first few jobs don’t provide health benefits, your kids can still remain covered by your insurance.
• Remove lifetime limits: You will no longer need to worry about your health insurer limiting the amount of coverage available through their plan if you face an expensive medical condition. This will help Americans who develop chronic conditions from taking drastic measures to avoid medical bankruptcy.
• Phase out annual limits: Many plans include annual dollar limits on how much medical coverage can be obtained per year. On all non-“grandfathered” plans in the individual market, these limits will be phased out over the next three years.

For any insurance plan that goes into effect after September 23, 2010, your insurance company must:

• Pay for preventive care like mammograms and immunizations: Addressing problems before they start can help keep you healthier, and new insurance plans will now cover many preventative tests and immunizations without any copayment.
• Give you a better appeals process for insurance claims: Now you’ll have a guaranteed and fair path to help you receive the benefits you paid for if insurance companies deny your claim.
• Let you choose your own doctor: Health reform makes it clear that you can choose any available participating primary care provider as your provider, and any available participating pediatrician to be your child’s primary care provider.
• Provide easier access to OB-GYN services: Women will no longer be required to have a referral from a primary care provider before seeking coverage for obstetrical or gynecological (OB-GYN) care from a participating OB-GYN specialist.
• Allow you to use the nearest emergency room without penalty: If an emergency arises while you’re away, you will no longer have to drive home to your in-network provider to receive in-network benefits.

Many other new benefits of the law have already taken effect, including rebate checks for seniors in the donut hole and tax credits for small businesses. Keep watching, as more rights, protections and benefits for Americans are on the way now through 2014.

To learn more about how health care reform is helping you, visit healthcare.gov.