www.hemophilia.org , www.hemopiliafed.org , www.uneedpsi.org

2010

Employers: Small businesses can receive tax credits if purchising insurance for employees.

Insurers: Cannot impose pre-existing condition exclusions on coverage for children. Must cover preventive services without copays. Cannot remove coverage when a person becomes ill. Cannot impose lifetime coverage limits.

Uninsured: Individuals with pre-existing conditions receive immediate access to coverage through a high-risk pool. Dependent children can remain on parents’ plans until age 26.

Early retirees: Employers to provide coverage for retirees and their spouses, surviving spouses and dependents over age 55 and not eligible for Medicare.

Medicare Part D enrollees: A $250 rebate check received for those entering the “doughnut hole” gap in coverage in 2010. Rebate payable by April 1, 2011.

2011

Insurers: Required to spend at least 80 percent of premiums on medical services.

Medicare Part D enrollees: Receive a 50 percent discount on brand-name prescription drugs when in doughnut hole coverage gap.

Those with health care savings accounts: Federal tax on those who spend health care savings account money on ineligible medical expenses increases to 20 percent.

Over-the-counter drugs: Except for insulin OTC drugs without a prescription are not reimbursable from an FSA or HRA, and are not a tax-free reimbursement from an HSA.

W-2: The value of your health coverage must be disclosed on your W-2 form.

2012-2013

Taxpayers: Medicare payroll taxes increase to 2.35 percent for individuals earning more than $200,000 and families earning more than $250,000.

Those with flexible savings accounts: A federal limit of $2,500 for individual pretax contributions per year.

2014

Employers: Companies with 50 or more employees must provide affordable coverage or pay a penalty.

Insurers: Prohibited from refusing to sell or renew policies, can no longer deny coverage for adults with pre-existing conditions, limits ability to set prices on the basis of sex, health status or other factors and prohibited from imposing annual limits.

Uninsured: Most Americans required to buy health insurance or pay fines of $95 per individual and up to $285 per family. Families will pay half the amount for children. Families can receive subsidies to buy insurance if they earn no greater than four times the federal poverty level

(about $88,000 per year for a family of four). Individuals and small businesses can buy packages through state exchanges.

2015

Uninsured: Penalties for not carrying insurance increase to $325 per individual and up to $975 per family. Families will pay half the amount for children

2016

Uninsured: Penalties for not carrying insurance increase to $695 per individual and up to $2,250 per family or 2.5 percent of taxable family income – whichever is greater. Families will pay half the amount for children.

2018

Taxpayers: A 40 percent excise tax imposed on high-cost employer-provided policies ($10,200 for individual coverage or $27,500 for family coverage).

2020

Medicare Part D Enrollees: Prescription drug coverage gap eliminated.

Sometime ago Andy put together this great list of things you should know about your insurance coverage that is primarily targeted at people who have hemophilia and are struggling with their hemophilia health insurance issues. We hope this will help those of you seeking guidance on this subject.

Things you should know about your insurance coverage 

1.      What are my benefits and do I have a choice of providers?

          a.  Do I have a HMO, PPO?

          b.  Do I have a PBM or designated pharmacy? 

 2.     What is my in network benefit compared to my out of network benefits?

 3.     Where is my factor paid?

           a.  Major medical

           b.   Pharmacy through a PBM?

 4.     What is my lifetime insurance cap?

          a.    If I have a PBM/pharmacy benefit, does it count towards the lifetime cap

          b.    Does it cross over to my major medical?

          c.     Difference in co-pays if I use my PBM compared to major medical.

 5.     Do I have the option of cobra if I leave or am laid off? 

          a.    If so, am I prepared to pay for it?

          b.    Have I contacted PSI for assistance or other organizations that could help?

 6.     Do I have a plan B if I lose my job or insurance?

          a.    Does my state have a high risk pool?

          b.    What are the benefits?

          c.     Can I get private insurance on my own? (not usually)

 7.     If I do change plans, how does this change my benefits and does it give me more or less choices on:

          a.    Factor Providers

          b.    In Network doctors and hospital. (i.e. your HTC)

 8.     Who do I contact at my employer in case I have questions or have a problem?

 9.     What are the best companies to work for and do I know where to find them? Fortunes top 100 best companies to work for (just do a Google search for that)

 10.  Lastly, what other assistance is available?

          a.    State programs like Medicaid

          b.    Federal programs like Medicare?

          c.     Could I qualify?

          d.    What manufacture programs am I eligible for if I lose my insurance?

Lifetime Caps Bill Introduced  

On Friday, February 13, 2009, Anna G. Eshoo (D-CA) and Jim Langevin (D-RI), along with Senators Byron Dorgan (D-ND) and Olympia Snowe (R-ME) introduced the Health Insurance Coverage Protection Act (H.R. 1085; S442).  The legislation, introduced in both houses in 2008, will set a $10 million minimum lifetime cap on health insurance, with future increases based on inflation.

The National Hemophilia Foundation (NHF) played a vital role in encouraging the legislation and assembling a coalition of more than 50 patient advocacy and health organizations currently working for its passage. “However, nothing could happen without the critical leadership of the members of Congress who recognized this problem and decided to do something about it,” said Val Bias, NHF CEO. “We applaud these leaders for identifying this critically needed piece of healthcare reform and moving it forward.” On Thursday, February 26, 2009, more than 350 people affected by bleeding and clotting disorders will gather on Capitol Hill for our annual Washington Days advocacy event. We will express our support for this important legislation and discuss other key healthcare issues with members of Congress and their staff.

“Having an inadequate lifetime cap defeats the purpose of health insurance and forces those with disabilities and chronic illnesses into an impossible situation,” Dorgan said. “Low caps also end up costing the taxpayer because once people with illnesses hit their cap, they often turn to government programs for their care. This legislation will raise lifetime insurance caps and allow those with illnesses to focus on recovering—not worrying about how they are going to pay for their treatment.”

“This bill addresses a critical lack of coverage for those with disabilities or chronic illnesses,” said Eshoo. “It’s a travesty to think that people are job-hopping in order to switch insurance plans or quitting their job all together to access Medicaid. Increasing the minimum lifetime cap will result in a net savings for federal and state governments because individuals with high medical costs can maintain private health insurance. As medical treatment costs continue to increase, the issue of lifetime insurance maximums will become even more important. This legislation will protect individuals who are struggling to pay for the expensive medical treatments that are a result of a disability or chronic illness.”

NHF applauds the efforts of the bill’s sponsors and co-sponsors. We will keep you informed of further action on this bill after Washington Days.

POSTED BY: DAVID

POSTED BY: DAVID

POSTED BY: DAVID