The Centers for Medicare & Medicaid Services released a proposed rule this week establishing proposed “Navigator” standards under the Affordable Care Act. Navigators are organizations that will be providing information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs. In other words, Navigators will be providing assistance to consumers shopping for coverage plans in the new Marketplace.
Posts Tagged ‘health insurance’
The US Dept. of Health & Human Services released 3 new Affordable Care Act proposed regulations this week… including: 1) A proposed Rule regarding coverage requirements for pre-existing or chronic conditions; 2) A proposed Rule outlining policies and standards for coverage of essential health benefits; and 3) A proposed Rule implementing and expanding employment-based wellness programs to promote health and help control health care costs.
It’s that time of year again. It is October, the pink ribbon shows up and you can find opportunities to buy just about anything created in pink; even small appliances. You know pink has truly taken hold when you see men at the gym wearing pink workout gear and football players wearing pink shoes. There can be so much promotion of the pink items that there is a danger of losing sight of what that pink ribbon actually represents.
October as Breast Cancer Awareness Month is a month dedicated to remembrance and awareness. As you go about your daily lives this month please take a few moments to remember . . .
Please remember loved ones we lost to breast cancer and the valiant families and loved ones who supported them. Please spend some extra time with a survivor. I am grateful that my grandma, my aunt, and my dear friend from high school, all survived their battles with breast cancer.
Remember that over 3,900 mothers, sisters, wives, girlfriends and daughters in Arizona were diagnosed with breast cancer in 2009. And know that men also get breast cancer; 64 men were diagnosed in 2009.
Remember that while the race to a cure continues, we still lose too many Arizonans to breast cancer each year. During 2009 Arizona lost 701 women and 8 men to breast cancer.
Be aware that getting screened regularly is key; early detection of cancer saves lives. Lack of health insurance does not have to get in the way of getting screened. The Well Woman HealthCheck Program provides breast cancer screening and diagnostics to uninsured women in Arizona.
Be aware that you can lower your risk of getting breast cancer through eating vegetables and fruits, maintaining a healthy weight, and being physically active. Research has shown increasing evidence for physical activity as a cancer prevention strategy, along with avoiding postmenopausal weight gain.
Be aware of resources that you can use and share with your family and friends.
Be aware that as of August 2, 2012, uninsured women in Arizona who have been diagnosed with breast or cervical cancer may be eligible for help through the Breast and Cervical Cancer Treatment Program.
In addition to taking care of yourself and your loved ones, you can take an active role in multiple events throughout Arizona that focus on breast cancer. Many ADHS staff will participate in the upcoming Making Strides Against Breast Cancer at Tempe Beach Park on October 27. If taking a walk with thousands of other dedicated people is just not your style, there is something you can do to support getting uninsured Arizona women screened for breast cancer. A pink ribbon license plate was created several years ago to support the Well Woman HealthCheck Program. The license plate costs $25, and $17 of that supports breast and cervical cancer screening for Arizona’s uninsured women.
October is no longer just the month for falling temperatures and Halloween decorations; it has become the month of pink. I invite you to take a moment to remember the significance of all those pink ribbons and to be aware of active steps you can take to make a difference; for you, your family and Arizona.
 Fat or fit: The joint effects of physical activity, weight gain, and body size on breast cancer risk. Cancer, Volume 118, Issue 19, pages 4860-4868, October 2012
Chronic diseases like heart disease, cancer, stroke, and diabetes cause 70% of deaths in the US these days… absorbing 75% of the $2.5T spent on annual medical care costs. When it comes to employee healthcare expenses- the indirect costs of poor health like absenteeism, disability, and reduced work output can be several times higher than direct medical costs. In fact, productivity losses from health problems cost employers $1,685 per employee per year!
One of the provisions in the Affordable Care Act includes incentives for employers to implement worksite wellness programs to help them keep their workforce healthier. When done well (using evidence-based and best practices) worksite health programs have a 3:1 payoff. Like the odds?
The Affordable Care Act contains some elements that will make worksite wellness programs more common and robust over the next couple of years. There are basically 2 kinds of worksite wellness programs. I’ll call them Wellness and Wellness Lite. A “Wellness Lite” program doesn’t require a participant to meet any standard related to health status to receive a reward. For example… a wellness program could include a gym membership or tobacco cessation program but doesn’t require participants to actually lose weight or quit smoking.
A Wellness program requires people to meet a health status standard to get a reward. For example- an employer could ask employees to certify that they haven’t smoked during the previous year. Enrollees who don’t could be assessed an annual surcharge of 20% of cost of the employee’s health insurance coverage. Rewards may be in the form of premium discounts or rebates, lower cost-sharing requirements, waiving a surcharge, etc. Under the Affordable Care Act, wellness program rewards can be as high as 30% of the cost of the employee health plan- potentially going to 50% in the future.
Our AZ Healthy Worksites web page provides businesses with information and tools to help them develop and implement an effective worksite wellness program. For example, the Program Design page lists the eight steps for developing, implementing, and evaluating a comprehensive worksite program. We’ve also contracted with the Arizona Small Business Association & Viridian Health Management to develop a new toolkit for AZ businesses. Viridian and the Arizona Small Business Association will teach businesses how to do effective wellness programs, understand their own particular issues/data, and develop effective strategies. In all, our contract tasks the team to train 500 AZ employers. Finally- the CDC is jumping into the fray with a variety of resources, which you can see at their worksite wellness hub website.
Several prevention-related health services will be covered without cost sharing in new health plans as of a couple of weeks ago as a result of the Affordable Care Act. The changes are designed to help lower costs and outcomes for a variety of preventative women’s services. Previously, some insurance companies didn’t cover some of the new preventive services, while some women had to pay deductibles or co-pays. The new rules in the health care law requiring coverage of these services take effect at the next renewal date.
Some of the new services include: 1) Well-woman visits; 2) Gestational diabetes screening for pregnant women; 3) Domestic violence screening and counseling; 3) Breastfeeding support, supplies, and counseling; and 4) Sexually transmitted infections and HIV counseling for sexually-active women. The list of required services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. These preventive services will be offered without cost sharing beginning today in all new health plans. Group health plans and issuers that have maintained grandfathered status and certain nonprofit religious organizations (like churches and schools) aren’t required to cover the new services.
If you did, you can thank the Affordable Care Act. When you buy health insurance- the percentage of your premium dollars that your insurance company spends on providing you with health care (as opposed to what it spends on administrative, overhead, and marketing) is called a “Medical Loss Ratio”. The Affordable Care Act limits how much of your premium dollar your insurer can spend on things besides your care. They’re supposed to give you a rebate on the portion of premium that was over the limit. The law requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care (and efforts to improve the quality of care). Insurers selling to large groups (usually 50 or more employees) need to spend 85% on care and quality improvement.
The Medical Loss Ratio part of the Affordable Care Act kicked in this year. So far, about 400,000 Arizona residents with private insurance coverage received a total of almost $28M in refunds from insurance companies.
The Affordable Care Act will establish health insurance exchanges in each state- providing folks (and small business employees) an additional opportunity to get health insurance coverage starting 1/1/14. The future exchanges will provide marketplaces for folks to directly compare and buy private health insurance based on price, quality, and other things. All the plans will need to cover all of the state-specific essential health benefits.
Various tiers of health insurance coverage will be available in the exchanges. The baseline “tier” will be a minimum amount of coverage that people need to have to satisfy the federal mandate to have health insurance (or face a tax penalty). Insurers will be required to offer plans that fit within four levels (tiers) of coverage: bronze, silver, gold, and platinum. I posted a little more about these tiers last week.
You all probably know that there’s a mandate that requires everyone to have health insurance or pay a tax penalty. Some people will be enrolled in Medicaid and some will have their own insurance or insurance through work— and others will get it through the health plans on the exchange. Folks with incomes above 100% but less than 400% of the federal poverty level will receive a premium subsidy when they get insurance via the exchange. Folks earning less than 150% of the poverty level will be subsidized via tax breaks so their premium is only 2% of their income ($50 per month for a family of four). This report provides a graph that includes the details of the sliding scale for premium subsidies.
The Affordable Care Act will establish various tiers of health insurance coverage beginning in 2014. The baseline “tier” will be a minimum amount of coverage that people need to have to satisfy the federal mandate to have health insurance (or face a tax penalty). Insurers will be required to offer plans that fit within four levels (tiers) of coverage: bronze, silver, gold, and platinum.
The levels of coverage aren’t defined using specific deductibles, co-pays, and coinsurance- they’ll use something called “actuarial value”. For example, a plan with an actuarial value of 70% (referred to as a “silver” plan) means the plan will pay 70% of a standard population’s health care expenses with the enrollee paying 30% through things like deductibles, co-pays, and/or coinsurance. The higher the actuarial value the less patient cost-sharing the plan will have on average.
Bronze plans will have more out-of-pocket costs, and platinum plans will have least. Bronze plans will cover 60% of enrollee costs, silver 70%, gold 80% and platinum 90%. Young people (under 30) will be able to buy “catastrophic” plans with an even lower actuarial value. Each plan (even catastrophic) needs to cover the state’s essential benefit package. Insurers don’t have to offer plans in all four levels, but within the exchange all insurers must offer at least one silver and one gold plan. You can read a lot more about actuarial value in this HHS bulletin.
There are also benchmarks for premium and cost-sharing subsidies that go to lower and middle income people buying their insurance in the exchange. I’ll cover that next week.
The future health insurance exchange under the Affordable Care Act will need to offer an Essential Benefit Package. In fact, most health insurance plans will need to cover each state’s Essential Benefit Package starting New Year’s Day in 2014. There are 10 key service categories that future plans will need to cover- including behavioral health services.
States need to pick a plan from a set of existing options as their “benchmark” plan- which will serve as the state-specific essential benefit package. The options to choose from include: 1) the largest plan by enrollment in any of the three largest small group insurance products in the small group market; 2) any of the largest three state employee health benefit plans by enrollment; 3) any of the largest three national federal employees health plans; or 4) the largest insured commercial non-Medicaid HMO in the State. If the benchmark plan doesn’t include all the 10 key service categories then it needs to be supplemented.
The due date for states to pick a benchmark plan is September 30 of this year. If a state doesn’t want to pick a benchmark plan, the Fed’s will make the choice for them- and they intend to choose “… the largest small group market product in the State’s small group market” which (in Arizona) is Aetna’s PPO plan. Once a state picks the benchmark plan (or has it picked for them)- it becomes a “reference plan” for the state for a couple of years- meaning that future exchange health plans must be “substantially equal” to the benchmark plan in the scope, limitations and exclusions (e.g. visit limits).
Obviously there’s a lot more to it than that… and you or your Stakeholders can get a lot more in-depth info about what an Essential Health Benefit is and what it means in this document that provides an Arizona specific analysis of the issues and the various services that are covered by potential benchmark plans.
The Affordable Care Act (aka health care reform) will establish health insurance exchanges in each state- providing folks (and small business employees) an opportunity to get health insurance coverage starting 1/1/14. The future exchanges will provide competitive marketplaces for folks to directly compare and buy private health insurance based on price, quality, and other things.
The law gives states some flexibility in the design and operation of their exchange. States can operate their own or they can let the Fed’s do it for them. There’s also a partnership option. The Governor kicked off a process to review the options regarding the implementation of the Act (including the exchanges) a couple of weeks ago. Several Stakeholder meetings have already been conducted and there are more to come.
This week, HHS’ Centers for Medicare & Medicaid Services issued their “Final Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges”. It’s a Blueprint for states to use as part of their planning and provides guidelines for states to show how their planned exchange will offer the required range of private health insurance options. It also outlines the process to do a “partnership” exchange. States that want to do their own exchange need to turn in their blueprint by November 16, 2012 for their exchange to be certified in time.