Health Care #1


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  • 10/23/11
  • Health Care #1

    1. 1. Health Care Reform Act 2010 Patient Protection Act Affordable Health Care Act
    2. 2. Health Care Reform <ul><li>Are these opinions true: </li></ul><ul><li>this legislation is socialist, unconstitutional and will bankrupt Medicare ? </li></ul><ul><li>this legislation is a declaration of war on doctors and bring about a healthcare apocalypse? </li></ul>Simplified Facts for Individuals
    3. 3. Health Care Reform Act <ul><li>Facts for individuals : </li></ul><ul><li>forces insurance companies to change unfair policies. </li></ul><ul><li>forces Medicare and Medicare Advantage to reward quality of services not volume of services. </li></ul><ul><li>enables millions to get health insurance. </li></ul>
    4. 4. Already in 2010 <ul><li>Insurance companies: </li></ul><ul><li>cannot drop your coverage if you become seriously ill. </li></ul><ul><li>cannot place “Lifetime Limits” on payments due to illness. </li></ul><ul><li>cannot place “Annual Limits” on payments due to illness. (Gradual Increase Annual Limits 2010-14) </li></ul>
    5. 5. Already in 2010 <ul><li>Insurance company plans must allow: </li></ul><ul><li>children to remain on their parents policy until 26. </li></ul><ul><li>previously children over 19 or college graduates were dropped, leaving many younger adults uninsured. </li></ul><ul><li>Included are Grandfathered Plans and young adults who no longer qualify as “dependents” </li></ul>
    6. 6. Already in 2010 <ul><li>Insurance company plans: </li></ul><ul><li>cannot deny children under 19 coverage due to Pre-Existing conditions (Such as diabetes, asthma or injuries). </li></ul><ul><li>By 2014, Insurance plans </li></ul><ul><li>cannot deny or raise premiums for adults with Pre-Existing conditions (Such as cancer, high blood pressure, or heart conditions). </li></ul>
    7. 7. In 2011 <ul><li>Any “New” Insurance company plans: </li></ul><ul><li>must include “Preventative Services” for free, with no out-of-pocket costs. (Pre-natal, Well-Baby, Vaccines, Blood Pressure and Cholesterol) </li></ul><ul><li>Not include are Grandfathered Plans. There are many “loopholes” to this Preventative Services section until 2018. </li></ul>
    8. 8. By 2012 <ul><li>Insurance companies must: </li></ul><ul><li>standardize billing. </li></ul><ul><li>implement electronic health information. </li></ul><ul><li>any increases health insurance premiums must be tied directly to medial care and quality improvements (Premium Ratio) </li></ul>
    9. 9. Already in 2010 <ul><li>Seniors with Medicare (Age 65 or older) </li></ul><ul><li>Part D or Private Advantage Prescription Plans no longer have “Donut Hole Gap” $2,700 - $6,154. </li></ul><ul><li>Seniors receive 50% discount on Brand Name drugs within this $4,000 gap. </li></ul>
    10. 10. In 2011 <ul><li>Seniors with Medicare </li></ul><ul><li>- Insurance must cover full cost of “Annual Wellness Visits and Cancer Screenings” </li></ul><ul><li>Government payments to “Advantage Plans” frozen at 2010 levels (Private insurers who manage portion Medicare programs) </li></ul><ul><li>These laws should help reward “quality of care” instead of “volume of services”. </li></ul>
    11. 11. By 2012 <ul><li>Seniors with Medicare </li></ul><ul><li>Medicare begins tracking Re-Admission Rates to hospitals. </li></ul><ul><li>Physicians encouraged to form Accountable Care Organization. These groups should coordinate care between doctors, hospitals, and social services </li></ul><ul><li>These actions should help elderly and chronically ill avoid repetitive emergency room visits and hospital stays” </li></ul>
    12. 12. Finally 2014 <ul><li>Critical Facts for Individuals </li></ul><ul><li>must have Medical Insurance or be fined </li></ul><ul><li>(Individual $95 or 1% income). </li></ul><ul><li>By 2016, fines increased to $695 or 2.5% income. </li></ul><ul><li>Exemptions made for Financial Hardship or Religion </li></ul>
    13. 13. Finally 2014 <ul><li>Critical Facts for Individuals: </li></ul><ul><li>Employers not offering insurance or Employees that cannot afford insurance can purchase from National Carriers within SHOPS. </li></ul><ul><li>Anyone earning less 400% FPL qualify for free choice voucher from employer to pay for SHOP’s. </li></ul><ul><li>(400% FPL Individual <$11,800 Families < $24,000) </li></ul><ul><li>SHOPs (Small Business Health Option Programs) State Run Health Insurance Exchanges. </li></ul>
    14. 14. Finally 2014 <ul><li>Critical Facts for Individuals </li></ul><ul><li>Self Employed qualify for “Refundable” Tax Credit. </li></ul><ul><ul><li>(Phase Out Individual >$43,320 Family >$88,200) </li></ul></ul><ul><li>Earning less 133% FPL qualify for Medicaid </li></ul>
    15. 15. <ul><li>Facts for individuals : </li></ul><ul><li>forces insurance companies to change unfair policies. </li></ul><ul><li>forces Medicare and Medicare Advantage to reward quality care not volume services. </li></ul><ul><li>enables millions to get health insurance. </li></ul>Health Care Reform
    16. 16. Go forth and passionately state your opinions!