U.S. Health Care Reform

Curious about the new health care laws recently enacted by President Obama?  Below is a break down by year from the myfloridacfo site, located here.

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• 2010
  People with health insurance

  • Insurers may not arbitrarily cancel your coverage when you get sick, except in cases of fraud. (effective September 23, 2010)
  • Insurers may not impose lifetime coverage limits and, until 2014, may only set restricted annual limits for essential health benefits.(effective September 23, 2010)
  • Insurers must cover preventive services with no co-payments or deductibles.(effective September 23, 2010)

  
  

  Children

  • Children who don't get health care coverage from their employers may stay on their parents' plans until age 26. (effective September 23, 2010)
  • Insurers may not deny coverage to a dependent child under age 19 because of preexisting conditions. The same will be true for adults and dependent children age 19 and older beginning in 2014. (effective September 23, 2010)

  
  

  Medicare beneficiaries

  • Eligible beneficiaries with Part D coverage who enter the "donut hole" in 2010 can receive a one-time $250 rebate to pay for prescription drugs that were purchased while in the donut hole. The rebate will be less for individuals earning more than $85,000 per year and for couples earning more than $170,000. The donut hole is the period of time during which some Medicare prescription drug plans won’t contribute anything toward your prescription costs. (began January 1, 2010)

  
  

  Uninsured

  • Individuals who have been without coverage for at least six months and who have a preexisting conditions may obtain coverage through a high-risk health insurance pool to be run by the state, the federal government, or a nonprofit. The risk pools are temporary until exchanges become effective in 2014. (effective July 2010)
  • A website set up by the federal government is scheduled to be available by July 1 to help consumers shop for coverage.

  
  

  Small businesses

  • Businesses with 25 or fewer full-time employees that pay for at least 50 percent of premiums and pay average annual wages below $50,000 may be eligible for a tax credit of up to 35 percent (25 percent for nonprofits) of the premiums the business pays. The credits increase in 2014. (began January 1, 2010)

  
  
• 2011
  Insurance companies

  • For small group and individual plans, insurers must spend at least 80 percent of revenue from premiums on medical services and programs directly related to improving health care quality. The amount increases to 85 percent for large group plans. Insurers that fail to meet the minimum payment requirements must provide refunds to enrollees.

  
  

  Medicare beneficiaries

  • Seniors with Part D coverage in the donut hole will begin receiving a 50 percent discount on brand-name drugs.
  • Co-payments and deductibles for preventive services will be eliminated.

  
  
• 2013
  Wealthier individuals and families

  • For individuals earning more than $200,000 per year and couples earning more than $250,000 per year, Medicare payroll taxes will increase.

  
  
• 2014
  Uninsured

  • Health care coverage will be required for U.S. citizens and legal residents. The tax penalty will be $95 or 1 percent of taxable income in 2014; $325 or 2 percent of taxable income in 2015; $695 or 2.5 percent of taxable income in 2016; and adjusted according to income every year after. There are exceptions for religious objectors, those who can't afford coverage, individuals below the tax-filing threshold, and various others.
  • States or the federal government will create insurance marketplaces, known as "exchanges," for individuals and small businesses to buy coverage. U.S. citizens and legal residents who are not incarcerated would qualify to buy coverage in an exchange. States can expand their exchanges to provide coverage for large employers in 2017.
  • Premium subsidies will be available for individuals and families with incomes between 133 percent ($14,404 for individuals and $29,326 for a family of four) and 400 percent ($43,320 for individual or $88,200 for a family) of the federal poverty level.
  • States will be required to expand Medicaid to individuals under age 65 (children, pregnant women, parents, and adults without dependent children) who are up to 133 percent of the federal poverty level. There is an option for states to expand Medicaid in 2011.

  
  

  People with health insurance

  • Insurers may not deny you coverage because of preexisting conditions. Similar provisions prohibiting insurers from denying coverage to children with preexisting conditions begin in 2010.
  • Insurers must accept everyone who applies for coverage when they apply during a defined enrollment period.
  • Insurers can only base premiums on age, tobacco use, geographic area, and whether coverage is for an individual or a family.
  • Insurers may not deny coverage because of a person's health status, medical condition, claims experience, medication history, genetic information, or disability.

  
  

  Businesses

  • Large employers who don't offer employee health care coverage will pay $2,000 for each full-time worker who receives a tax credit for health insurance through a state exchange.
  • Tax credits for small employers increase to 50 percent (35 percent for nonprofits) of the health care premiums the business pays.
  • Businesses with more than 200 employees must automatically enroll employees in a health insurance plan. Employees can opt out.

  
  
• 2020
  Medicare beneficiaries with Part D coverage

  • The donut hole is eliminated.

Health Reform in Florida

Health reform has passed both the House of Representatives and the Senate. However, there are differences between the Senate version of the bill and the House version of the bill. Both chambers will elect members to convene a conference to reconcile differences between the two versions of the bill. The new version of the bill that emerges from the conference must then be voted on again by each chamber. If the bill is approved by both chambers, the president may sign the final version turning it into law.

To answer how the bill will affect Floridians, the government web site, www.healthreform.gov has listed several elements from both bills that benefit individuals and families in Florida, such as:

• Insurance companies will no longer be able to place lifetime limits on the coverage they provide, use of annual limits will be restricted, and they will not be able to arbitrarily drop coverage.
• 10 percent of people in Florida have diabetes, and 28 percent have high blood pressure – two conditions that insurance companies could use as a reason to deny health insurance coverage. Reform will establish a high-risk pool to enable people who cannot get insurance today to find an affordable health plan.
• Roughly 565,000 Medicare beneficiaries in Florida hit the “doughnut hole,” or gap in Medicare Part D drug coverage that can cost some seniors an average of $4,080 per year. Reform legislation will provide a 50 percent discount for brand-name drugs in this coverage gap.
• Without reform, individuals and families in Florida will spend increasing amounts of money out-of-pocket to cover premiums, deductibles, and co-payments, from $19.4 billion today to up to $35.4 billion in 2019. Through health insurance reform, 2.5 million Florida residents could be eligible for premium credits to ease the burden of these high costs.
• Health insurance reform will create a new voluntary long-term care services insurance program, which will provide a cash benefit to help seniors and people with disabilities obtain services and supports that will enable them to remain in their homes and communities.

Since both versions of the bill have yet to be reconciled, some of these elements may increase or decrease.  To see the full list for Florida, visit the healthreform.gov site, here.

Below is a message about health reform from the Secretary of Health & Human Services, Kathleen Sebelius.

Help With Medicare Assistance

Are you currently enrolled in Medicare and need some assistance?

The Social Security Administration may be able to assist you.  They offer a program to help individuals who enrolled in Medicare with their costs.  This program is not a replacement for enrolling in a Medicare Part D drug program.  If you're eligible, you can get extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug program. However, you must be enrolled in a Medicare Prescription Drug plan to get this extra help.

The guidelines for eligibility and the application are located HERE as well as contact information for any questions you may have.  To see if you're eligible, go HERE.

Flu Shots in Pasco County

The Pasco County Health Department is giving seasonal flu shots.
Flu Shots will cost $25 payable by cash or check. With proof, Medicare clients will be given their shot for free and their insurance will be billed. For Medicare HMO and all other insurance there will be a $25 charge. Receipts will be given to file with insurance companies.
Shots will be given at these locations:
•Dade City Clinic, 13941 15th St., (352) 521-1450. Appointments are advised. Walk-ins are accepted from 7:30 a.m. to noon Thursday
•Hudson Clinic, 11511 Denton Ave. (727) 861-5661. Shots are by appointment only.
•Land O' Lakes Clinic, 4135 Land O' Lakes Blvd., (813) 558-5173. Walk-ins are accepted from 7:30 a.m. to 3 p.m. Monday and Tuesday and 7:30 to 10 a.m. Friday
•New Port Richey Clinic, 10841 Little Road, (727) 861-5260, ext. 268. Shots are by appointment only.
•Zephyrhills Clinic, 4717 Airport Road, (813) 780-0740. Walk-ins are accepted from 7:30 a.m. to 5:30 p.m. Monday through Thursday. Wednesday is recommended. Appointments can be made.
These shots do not prevent swine flu. For more information on the H1N1 Swine Flu call 877-352-3581 between 8 AM to 8 PM, 7 days a week. Information is available in English, Spanish and Creole.


Click here for H1N1 Flue (Swine Flu): Resources for the deaf and hard of hearing.