Play with the Pigskin
Mike and The congressman
Fact Sheet for "Justice (ification) for Public Health"
Fact Sheet for "Healthcare Poker: Barbara's Story"
Fact Sheet for "My Brother's Keeper-Billy Koehler's Story"
Fact Sheet for: "The healthcare serf: Linda's Story"
Fact Sheet For: "The Ritter Family"
Fact Sheet for "Where do we go from here?: The future solvency of medicare
Fact Sheet for "Is the PPACA killing Granny?"
Fact Sheet for "An ounce of prevention: Barbara's Story"
Fact Sheet for "Inside the 'Doughnut Hole': Barbara's Story"
Fact Sheet for Domestic Violence
Fact Sheet for Robert's Story
Fact Sheet for Guest Blogger: Barb Bloomfield
Fact Sheet for "The Bagel Shop"
Fact Sheet for "Health/Wealth Gap: Stacey's Story"
Free Preventive Services Covered by Medicare as of February 2012 (No cost to beneficiary): Cardiovascular Screenings (cholesterol, lipid, triglyceride levels), Breast Cancer Screenings (mammograms), Cervical and Vaginal Cancer Screenings (pap tests and pelvic exams), Colorectal Cancer Screenings (colonoscopy), Prostate Cancer Screeings (PSA test), Vaccinations (Flu, pneumonia, Hepatitis B), Osteoporosis Screenings, Diabetes Screeings (blood glucose), Medical Nutrition Therapy, Tobacco Cessation Counseling, HIV Screening, Abdominal Aortic Aneurysm Screening, Alcohol Counseling, Depression Screening, Obesity Screening and Counseling.
2011 "Doughnut Hole": If your drug costs exceed $2840 (costs paid by you and your plan), you will fall into the doughnut hole. Once in the doughnut hole, you will pay 50% of the cost of brand name prescription drugs and 93% of the cost of generic drugs until your total drug costs reach $6448. Once your drug costs reach $6448, you will have reached the catastrophic coverage limit. At that point, you are required to pay only 5%. Prior to the PPACA, once you reached the doughnut hole you had to pay 100% of prescription drugs until you reached the catastrophic limit.
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Bonus Payments for High Quality Medicare Advantage Plans: Plans that receive 4 or more out of 5 stars from the health plan quality rankings will receive bonus payments of 1.5% in 2012, 3% in 2013 and 5% in 2014 and later years. High quality plans in certain counties will receive double bonuses.
Limits on out of pocket expenses for Medicare Advantage Enrollees: at $6700
Bonus Payments for High Quality Medicare Advantage Plans: Plans that receive 4 or more out of 5 stars from the health plan quality rankings will receive bonus payments of 1.5% in 2012, 3% in 2013 and 5% in 2014 and later years. High quality plans in certain counties will receive double bonuses.
Limits on out of pocket expenses for Medicare Advantage Enrollees: at $6700
Annual Physical: at no cost to the beneficiary.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage (lapse of coverage) of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Mike and The congressman
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
State Based Exchanges (Individual and Small Business): a competative marketplace where those without job-based coverage or small businesses can easily shop for quality, affordable coverage.
Fact Sheet for "Justice (ification) for Public Health"
Age 26: As of January 2011, youth under the age of 26 can stay on their parent’s health insurance if they do not have access to insurance through an employer.
State Based Exchanges (Individual and Small Business): a competative marketplace where those without job-based coverage or small businesses can easily shop for quality, affordable coverage.
Essential Benefits: ambulatory care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease management and pediatric services.
"Doughnut Hole": If your drug costs exceed $2840 (costs paid by you and your plan), you will fall into the doughnut hole. Once in the doughnut hole, you will pay 50% of the cost of brand name prescription drugs and 93% of the cost of generic drugs until your total drug costs reach $6448. Once your drug costs reach $6448, you will have reached the catastrophic coverage limit. At that point, you are required to pay only 5%. Prior to the PPACA, once you reached the doughnut hole you had to pay 100% of prescription drugs until you reached the catastrophic limit.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage (lapse of coverage) of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage (lapse of coverage) of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
PA Fair Care is Pennsylvania
State Based Exchanges (Individual and Small Business): a competative marketplace where those without job-based coverage or small businesses can easily shop for quality, affordable coverage.
Essential Benefits: ambulatory care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease management and pediatric services.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Fact Sheet for "My Brother's Keeper-Billy Koehler's Story"
State Based Exchanges (Individual and Small Business): a competative marketplace where those without job-based coverage or small businesses can easily shop for quality, affordable coverage.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Fact Sheet for: "The healthcare serf: Linda's Story"
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Age 26: As of January 2011, youth under the age of 26 can stay on their parent’s health insurance if they do not have access to insurance through an employer.
Medicare Payroll Tax: The Medicare payroll tax will be raised by .9% on individuals making more than $200,000 and couples making more than $250,000 a year.
Fact Sheet for "Is the PPACA killing Granny?"
Free Preventive Services Covered by Medicare as of February 2012 (No cost to beneficiary): Cardiovascular Screenings (cholesterol, lipid, triglyceride levels), Breast Cancer Screenings (mammograms), Cervical and Vaginal Cancer Screenings (pap tests and pelvic exams), Colorectal Cancer Screenings (colonoscopy), Prostate Cancer Screeings (PSA test), Vaccinations (Flu, pneumonia, Hepatitis B), Osteoporosis Screenings, Diabetes Screeings (blood glucose), Medical Nutrition Therapy, Tobacco Cessation Counseling, HIV Screening, Abdominal Aortic Aneurysm Screening, Alcohol Counseling, Depression Screening, Obesity Screening and Counseling.
2011 "Doughnut Hole": If your drug costs exceed $2840 (costs paid by you and your plan), you will fall into the doughnut hole. Once in the doughnut hole, you will pay 50% of the cost of brand name prescription drugs and 93% of the cost of generic drugs until your total drug costs reach $6448. Once your drug costs reach $6448, you will have reached the catastrophic coverage limit. At that point, you are required to pay only 5%. Prior to the PPACA, once you reached the doughnut hole you had to pay 100% of prescription drugs until you reached the catastrophic limit.
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Bonus Payments for High Quality Medicare Advantage Plans: Plans that receive 4 or more out of 5 stars from the health plan quality rankings will receive bonus payments of 1.5% in 2012, 3% in 2013 and 5% in 2014 and later years. High quality plans in certain counties will receive double bonuses.
Limits on out of pocket expenses for Medicare Advantage Enrollees: at $6700
Bonus Payments for High Quality Medicare Advantage Plans: Plans that receive 4 or more out of 5 stars from the health plan quality rankings will receive bonus payments of 1.5% in 2012, 3% in 2013 and 5% in 2014 and later years. High quality plans in certain counties will receive double bonuses.
Limits on out of pocket expenses for Medicare Advantage Enrollees: at $6700
Annual Physical: at no cost to the beneficiary.
Free Preventive Services Covered by Medicare as of February 2012 (No cost to beneficiary): Cardiovascular Screenings (cholesterol, lipid, triglyceride levels), Breast Cancer Screenings (mammograms), Cervical and Vaginal Cancer Screenings (pap tests and pelvic exams), Colorectal Cancer Screenings (colonoscopy), Prostate Cancer Screeings (PSA test), Vaccinations (Flu, pneumonia, Hepatitis B), Osteoporosis Screenings, Diabetes Screeings (blood glucose), Medical Nutrition Therapy, Tobacco Cessation Counseling, HIV Screening, Abdominal Aortic Aneurysm Screening, Alcohol Counseling, Depression Screening, Obesity Screening and Counseling.
$250 Rebate Check: In 2010, beneficiaries who reach the "doughnut hole" (the gap between when basic coverage ends and catastrophic coverage begins) will receive a a $250 rebate check.
2011 "Doughnut Hole": If your drug costs exceed $2840 (costs paid by you and your plan), you will fall into the doughnut hole. Once in the doughnut hole, you will pay 50% of the cost of brand name prescription drugs and 93% of the cost of generic drugs until your total drug costs reach $6448. Once your drug costs reach $6448, you will have reached the catastrophic coverage limit. At that point, you are required to pay only 5%. Prior to the PPACA, once you reached the doughnut hole you had to pay 100% of prescription drugs until you reached the catastrophic limit.
Fact Sheet for "As we turn to a higher power"2011 "Doughnut Hole": If your drug costs exceed $2840 (costs paid by you and your plan), you will fall into the doughnut hole. Once in the doughnut hole, you will pay 50% of the cost of brand name prescription drugs and 93% of the cost of generic drugs until your total drug costs reach $6448. Once your drug costs reach $6448, you will have reached the catastrophic coverage limit. At that point, you are required to pay only 5%. Prior to the PPACA, once you reached the doughnut hole you had to pay 100% of prescription drugs until you reached the catastrophic limit.
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Rate Review:a process that will review the increases in healthcare premiums and require plans to justify increases.States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Fact Sheet for Domestic Violence
Domestic Violence Screenings and Counseling: under the Essential Benefits component of the PPACA there are "Preventive Health Provisions in Women's Health" that insurance companies must now include in all insurance packages. Screening and Counseling for domestic abuse is one of them.
Essential Benefits: ambulatory care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease management and pediatric services.
Essential Benefits: ambulatory care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease management and pediatric services.
Mental Health and Substance Abuse Treatment: is included as part of Essential Benefits. Insurance companies have to include them in a policy.
Fact Sheet for Guest Blogger: Barb Bloomfield
Basic patient Protections: Individual and group plans now must:
• Eliminate lifetime limits (2010) and annual limits on coverage (2014).
• Prohibit rescissions of contract coverage (2014).
• Eliminate waiting periods for coverage of greater than 90 days (2014).
• Eliminate pre-existing condition exclusions (by 2014).
Individual Exchanges: a competitive marketplace where those without job-based coverage can easily shop for quality, affordable coverage.
Nutrition Labels in Chain Restaurants: as of March 2011, all chain restaurants with 20 or more establishments and vending machines must post calorie information. Establishments in which selling food is not their primary role (ie: movie theaters and bowling alleys) are exempt.
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Fact Sheet for
“Has the Silly Season Begun?”
Payroll
tax for wealthier Americans: The Medicare payroll tax will be raised by .9% on individuals
making more than $200,000 and couples making more than $250,000 a year.
Unearned
income tax for wealthier Americans: 3.8% tax on unearned income
(interest, dividends, rent) over $200,000 for individuals and $250,000 for
couples
Fees
on medical and drug industry: 2.3% tax on medical devices
(2013)
10%
tax on tanning salons: 10% fee on indoor tanning services (2010)
$2000
fine:
Employers with more than 50 employees that do not provide health insurance and
have employees receiving subsidies in order to purchase on the exchange will be
fined $2000.
Individual
Exchanges/Marketplace: a competitive
marketplace where those without job-based coverage can easily shop for quality,
affordable coverage.
Cutting down on Waste and Fraud: measure build in to
save money on medicare such as higher fines and investigation of fraudulent
offenses.
End overpayments to Medicare Advantage: Medicare Advantage is
NOT medicare. It is a supplemental
private insurance that the government has been paying 115% more than it pays
for regular medicare. The law will rein
in overpayments so money can now go to prevention and drugs for seniors.
Excise
tax on high end health plans (Cadillac Plans): 40% tax applied to the
cost of plans that equal $10,200 for individuals/$27,500 for families. (2018)
Individual
Mandate:
Everyone must have health insurance by 2014 (income and religious exemptions).
Fine of $695 or 2.5% of income if you do not have insurance (2016)
Health
Savings Accounts: A 20% tax on money withdrawn from a health savings account that
is NOT used for health related services. Also a $2500 year limit on
contributions to a Health Savings Account (2013). Can no longer use HAS for
over the counter drugs.(2011)
Age
26: As
of January 2011, youth under the age of 26 can stay on their parent’s health
insurance if they do not have access to insurance through an employer.
Small Business Tax Credit: eligible small
businesses that purchase coverage through the state SHOP exchange. Credit can
provide up to 50% of the employer’s contribution towards employee’s health
insurance premium if the employer contributes at least 50% of the total premium
cost (2014).
Fact
Sheet for Eric’s Story
Age
26: As of
January 2011, youth under the age of 26 can stay on their parent’s health
insurance if they do not have access to insurance through an employer.
Fact Sheet for
Sheila’s Story
Nurse Practitioner
Funding: $31 million over the next 5
years in the form of student stipends to train NPs.
Physician Assistants: $30 million over the next 5 years in the form
of student stipends to train PAs.
Nurse Led Clinics: $15 million over the next 3 years for nurse
led clinics in medically underserved areas.
Resources for
workforce development:
·
$5.6 million to states for primary care
workforce development.
·
Support for newly graduated nurses to become
faculty.
·
National Healthcare Workforce Commission: oversee education, training and assess
barriers to care at federal, state and local levels.
Support for existing nursing
infrastructure:
·
$1.5 billion to National Health Service Corp
(NHSP) to allocate in the form of scholarships and loan forgiveness to NPs who
work in rural and underserved areas.
·
$11 billion to already existing health centers
that serve low income areas.
·
%10 bonus to primary care that serve medicare
patients between 2010-201
Women's Health Series: Lebanon Family Health Services
Fact Sheet Contraceptive Services
Contraception: All FDA-approved contraceptive methods as prescribed for all women with reproductive capacity with “non-grandfathered”plans beginning August 1, 2012. Certain religious employers exempt from this requirement. Includes sterilization procedures, patient education and counseling.
Essential Benefits: ambulatory care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease management and pediatric services.
Preventive Care: Insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Lebanon Family Health Services
Fact Sheet (Breastfeeding provisions)
Essential
Benefits: ambulatory care,
emergency care, hospitalization, prescription drugs, maternity and newborn
care, mental health and substance abuse treatment, rehabilitative care,
laboratory services, preventive and wellness services, chronic disease
management and pediatric services.
Preventive
Care: Insurance plans now have
to cover prevention services such as check-ups, blood pressure, cancer
screenings, hearing and vision screenings for children, certain immunizations,
colonoscopies, contraception and mammograms.
Breastfeeding
Counseling and Equipment Rental:
pre and postnatal breastfeeding education, formal breastfeeding
evaluations undertaken by trained caregivers in the hospital and out-patient
care settings,, followed by interventions to correct problems as needed.
Reasonable Break
Time for Mothers: Employers are
required to provide unpaid, reasonable break time for an employee to express
breast milk for her nursing child and provide a private place, other than a
bathroom, which may be used by an employee to express breast milk.
Women's Health Series:
Lebanon Family Health Services
Fact Sheet (Tobacco Cessation)
Essential Benefits: Insurance companies must cover ambulatory care, emergency care, hospitalizaiton, prescription drugs, maternity an newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease managment and pediatric services.
Free Preventive Care: insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Preventive Services for Women: Includes Prenatal visits, tobacco cessation/counseling during pregnancy, Rh incompatibility screening, Gestational diabetes screening, Folic Acid supplements, Iron Deficiency screenings, Breastfeeding supports, STI and HIV screening and counseling, Contraception.
Lebanon Family Health Services
Fact Sheet (Maternal and Newborn Care)
Essential Benefits: Insurance companies must cover ambulatory care, emergency care, hospitalizaiton, prescription drugs, maternity an newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease managment and pediatric services.
To Mandate or Not to Mandate
Individual Mandate: By 2014, everyone must have health insurance (there are income and religious exemptions). Those who chose not to obtain coverage will pay a penalty of $95 or 1% of income, whichever is greater. This jumps to $325 or 2% of income in 2015 and then $695 or 2.5% of income in 2016.
Small Business Tax Credit: eligible small businesses that purchase coverage through the state SHOP exchange. Credit can provide up to 50% of the employer’s contribution towards employee’s health insurance premium if the employer contributes at least 50% of the total premium cost (2014).
SHOP: Small business Health Options Program will be administered by a state governmental agency or non-profit organization through which small businesses with up to 100 employees can purchase qualified health coverage (2014).
Basic patient Protections: Individual and group plans now must:
· Eliminate lifetime limits (2010) and annual limits on coverage (2014).
· Prohibit rescissions of contract coverage (2014).
· Eliminate waiting periods for coverage of greater than 90 days (2014).
· Eliminate pre-existing condition exclusions (by 2014).
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care. If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Rate Review: a process that will review the increases in healthcare premiums and require plans to justify increases. States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Payroll tax for wealthier Americans: The Medicare payroll tax will be raised by .9% on individuals making more than $200,000 and couples making more than $250,000 a year.
Unearned income tax for wealthier Americans: 3.8% tax on unearned income (interest, dividends, rent) over $200,000 for individuals and $250,000 for couples
10% tax on tanning salons: 10% fee on indoor tanning services (2010)
Excise tax on high end health plans (Cadillac Plans): 40% tax applied to the cost of plans that equal $10,200 for individuals/$27,500 for families. (2018)
Health Savings Accounts: A 20% tax on money withdrawn from a health savings account that is NOT used for health related services. Also a $2500 year limit on contributions to a Health Savings Account (2013). Can no longer use HAS for over the counter drugs.(2011)
Fees on medical and drug industry: 2.3% tax on medical devices (2013)
Individual Mandate: Everyone must have health insurance by 2014 (income and religious exemptions). Fine of $695 or 2.5% of income if you do not have insurance (2016)
$2000 fine: Employers with more than 50 employees that do not provide health insurance and have employees receiving subsidies in order to purchase on the exchange will be fined $2000
Fact Sheet on Tom and Karen
(Ghosts of Midnight)
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Fact Sheet on Bill's Story
Age 26: Keeps young adults covered by requireing insurers to allow all dependents to remain on their parents; plan up to age 26 even if they are married or live out of state. (2011) If the parent's plan is better than employer-provided insurance, they can stay on their parent's plan. (2014)
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Free Preventive Care: insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Rate Review:a process that will review the increases in healthcare premiums and require plans to justify increases.States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Essential Benefits: ambulatory care, emergency care, hospitalizaiton, prescription drugs, maternity an newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease managment and pediatric services.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Free Preventive Care: insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Expansion of Medicaid: low income working adults with no employer provided benefits can qualify for medicaid if they are below 133% of the Federal Poverty Level (FPL)
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
$2000 Fine: Employers with more than 50 employees that do not provide health insurance and have employees receiving subsidies in order to purchase on the exchange will be fined $2000.
Workforce Development and Training Opportunities for Direct Care Workers: funding and oversight for training, recruitment retention, quality, wages and benefits for direct-care workers.
Free Preventive Care: insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Medical Loss Ratio: Insurance companies will have to spend 80-85% of a patient’s premium dollars on care.If they spend the money on other things like CEO bonuses or advertising, they will have to issue the consumer a rebate.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Rate Review:a process that will review the increases in healthcare premiums and require plans to justify increases.States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Fact Sheet for Gary's Story
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Essential Benefits: ambulatory care, emergency care, hospitalizaiton, prescription drugs, maternity an newborn care, mental health and substance abuse treatment, rehavilitative care, laboratory services, preventive and wellness services, chronic disease managment and pediatric services.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges.Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Free Preventive Care: insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Rate Review:a process that will review the increases in healthcare premiums and require plans to justify increases.States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Fact Sheet for Tyler's Story
Age 26: Keeps young adults covered by requireing insurers to allow all dependents to remain on their parents; plan up to age 26 even if they are married or live out of state. (2011) If the parent's plan is better than employer-provided insurance, they can stay on their parent's plan. (2014)
Individual Exchanges: a competative marketplace where those without job-based coverage can easily shop for quality, affordable coveage.
Premium tax credits: to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges. Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
$2000 Fine: Employers with more than 50 employees that do not provide health insurance and have employees receiving subsidies in order to purchase on the exchange will be fined $2000.
Free Preventive Care: insurance plans now have to cover prevention services such as check-ups, blood pressure, cancer screenings, hearing and vision screenings for children, certain immunizations, colonoscopies, contraception and mammograms.
Basic Patient Protections: individual and group plans must adhere to benefit standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Rate Review: a process that will review the increases in healthcare premiums and require plans to justify increases. States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Fact Sheet for Laura and Micheal's Story
SHOP: Small
business Health Options Program will be administered by a state governmental
agency or non-profit organization through which small businesses with up to 100
employees can purchase qualified health
coverage (2014).
Premium tax credits: to eligible
individuals and families with incomes between 133-400% of the Federal Poverty
Level to purchase insurance through the exchanges. Premium levels will be limited to the
following percentages of income (2014):
o
Up
to 133%FPL=2% of income
o
150-200%FPL=4-6.3%
of income
o
200-250%FPL=6.3-8.05%
income
o
250-300%FPL=8.05-9.5%
income
o
300-400%FPL=9.5%
of income
Free
Preventive Care: insurance plans now have to cover prevention
services such as check-ups, blood pressure, cancer screenings, hearing and
vision screenings for children, certain immunizations, colonoscopies,
contraception and mammograms.
Medical Loss Ratio:
Insurance companies will have to spend 80-85% of a patient’s premium
dollars on care. If they spend the money
on other things like CEO bonuses or advertising, they will have to issue the
consumer a rebate.
Basic
Patient Protections:
individual and group plans must adhere to benefit
standards:
- Eliminate lifetime limits (2010) and annual limits on coverage (2014)
- Prohibit recissions of contract coverage (2014)
- Eliminate waiting periods for coverage of greater than 90 days (2014)
- Eliminate pre-existing condition exclusions (2014)
Rate
Review: a process
that will review the increases in healthcare premiums and require plans to
justify increases. States will need to
report on trends in premium increases and recommend whether certain plans
should be excluded from the exchanges based on unjustified premium increases
(2010).
Fact Sheet for Susan’s Story
SHOP: Small Business Health Options Program (Small Business Exchange) will be administered by a state governmental agency or non-profit organization through which small businesses with up to 100 employees can purchase qualified health coverage (2014).
Small Business Tax Credit for eligible small businesses that purchase coverage through the state SHOP exchange. Credit can provide up to 50% of the employer’s contribution towards employee’s health insurance premium if the employer contributes at least 50% of the total premium cost (2014).
Premium tax credits to eligible individuals and families with incomes between 133-400% of the Federal Poverty Level to purchase insurance through the exchanges. Premium levels will be limited to the following percentages of income (2014):
oUp to 133%FPL=2% of income
o150-200%FPL=4-6.3% of income
o200-250%FPL=6.3-8.05% income
o250-300%FPL=8.05-9.5% income
o300-400%FPL=9.5% of income
Rate Review: a process that will review the increases in healthcare premiums and require plans to justify increases. States will need to report on trends in premium increases and recommend whether certain plans should be excluded from the exchanges based on unjustified premium increases (2010).
Basic Patient Protections: individual and group plans are required to have basic benefit standards such as:
oEliminate lifetime limits (2010) and annual limits on coverage (2014).
oProhibit rescissions of contract coverage (2014).
oEliminate waiting periods/lapse of coverage for greater than 90 days (2014).
oEliminate pre-existing condition exclusions (by 2014).
Fact Sheet for My Story
· Basic Patient Protections:
individual and group plans are required to have basic benefit standards such as:
o
Eliminate
lifetime limits (2010) and annual limits
on coverage (2014).
o
Prohibit
rescissions of contract coverage (2014).
o
Eliminate
waiting periods/lapse of coverage for greater than 90 days (2014).
o
Eliminate
pre-existing condition exclusions (by 2014).
· Appeal: Patients
have the right to appeal health plan decisions from an ‘external appeal’ if you
are denied payment on a service, end a covered service or reduce the amount of
coverage. (2011)
· Medical Loss Ratio:
Insurance companies will have to spend 80-85% of a patient’s premium
dollars on care. If they spend the money
on other things like CEO bonuses or advertising, they will have to issue the
consumer a rebate.
· Rate Review:
a process that will review the increases in healthcare premiums and
require plans to justify increases.
States will need to report on trends in premium increases and recommend
whether certain plans should be excluded from the exchanges based on unjustified
premium increases (2010).
- Employees who are offered coverage by an employer are eligible for a premium credit if the employee share of the premium exceeds 9.5% of their income. (2014)
