Today, about 2,000 organizations, ranging from small and large companies, educational institutions, unions, nonprofit organizations and local governments have received acceptance into a program that reimburses employee claims beginning this fall.
The Early Retiree Reinsurance Program was created by Healthcare Reform, and is meant to be a bridge between now and 2014, which is the date that medical insurance exchanges will be in effect. This program offers $5 billion to unions and employers to assist them in maintaining insurance coverage for retirees that retire early at age 55 or older, that aren't qualified for Medicare yet. These 2000 employers will get reimbursed for early retirees' health claims for themselves and their spouses, dependents, and surviving spouses.
This new program will lessen the cost of businesses' medical insurance costs for many retirees. The high cost of medical care has prohibited employers from providing affordable medical insurance for their retirees and employees, while still being competitive in their field. In 1988, 66% of large employers provided employees with retiree medical coverage; whereas in 2009, just 29% of large employers provided these benefits. Medical insurance costs for older employees and retirees are more than 4 times more costly than they're for younger employees. Likewise, the deductibles they pay is about 4 times higher than a company sponsored plan.
More applications for the next round of approvals are being reviewed each day. Beginning in September, applicants that have been approved in this first batch of approvals will be able to submit their claims that are dated back from the 1st of June, 2010. Then, beginning in October, reinsurance payments will begin to be dispersed to applicants that have been approved.
Last March, Anthem Blue Cross had filed rate increases with the CA Dept. of Insurance that was declined due to miscalculations on Anthem's part. Originally, medical insurance rates were expected to be increased by as much as 39%.
Since then, Anthem Blue Cross has revised and resubmitted their rates for October 1, 2010. These new medical insurance rates have been approved, and rates will be increased by 14% up to 20% for their members that were scheduled to have rate increases is March, April, May, June, July and August.
According to Anthem, they have said that there is a lot of misinformation in the media regarding their rate filings. They clarified that the miscalculations were mostly related to the way that they had estimated future medical costs, and that their original March rate filings met the requirements of CA law for 7 out of 8 of their products.
Going forward, Anthem has taken many steps to improve their internal rate review processes to make sure that their rate filings are accurate. They have enhanced the outside 3rd party evaluation, and have enforced a meticulous internal evaluation process by actuaries that are independent of Anthem Blue Cross's individual business. They have also been helping people to understand what goes into their rates, by publishing information on their website at www.anthem.com/ca, to improve transparency.
With these new rates, Anthem expects to lose at least $100 million in 2010, following another loss in revenue that occurred in 2009.
According to the University of California at Los Angeles Center for Health Policy Research, the number of people without medical insurance in California jumped in all counties due to the recession.
The state of California's uninsured rate averages about 24.3%. However, 37 counties ranging from Shasta to Kern to Imperial had higher uninsured rates than the average.
The majority of people who lost their medical insurance was in Southern California counties, such as San Bernardino, Riverside and Imperial. All counties within the San Joaquin Valley, and most counties within the Northern/Sierra areas (except Humbolt and Sutter) had uninsured rates higher than 24.3%
The loss of medical insurance within these areas was mostly due to drastic increases in unemployment, employer sponsored coverage being dropped, and household incomes dropping as a result.
Aetna Insurance Company has introduced a cutting-edge service which gives their members access to online tools and resources that are simple, relevant and customized to their needs. It's called SmartSource, and it is a free service that's based on each member's profile and Aetna medical insurance plan.
In a snapshot, it can give you information regarding prescription medications you've filled in the past, doctor office visits you've had, and can even proactively suggests search topics based upon the medical conditions that are listed in a member's personal health record, if that member has one.
The intuitive service gives you specialized doctors in your area that treat a certain condition, commonly prescribed medications for a certain medical condition, treatment options, estimated health care costs out of your pocket based upon your medical insurance plan, and programs and discounts that help you to manage your healthcare needs.
For more information, visit www.AetnaTools.com.
Finally, it looks like a medical insurance plan may be put into place in California in September for people who have pre-existing medical conditions that have prohibited them from obtaining medical insurance. This plan is meant to be a bridge until 2014, when people with medical conditions will no longer be declined coverage or be rated up for it. Applications for this medical plan will be taken starting in late August.
This new government insurance plan is part of the health care reform legislation, and will help people with pre-existing conditions. California's Managed Risk Medical Insurance Board will run the program, and it is funded by the government, costing $761 million over a 3 year period.
Analysts have estimated that about 25,000 residents of California will be covered by this insurance plan at any one time...which is a lot higher than the 7,100 person maximum that California's current high risk pool covers.
To give you an example of the rates, in Ventura County for example, children up to the age of 14 will have a monthly premium of $127. People between the ages of 60 and 64 will have a premium of $720 per month. The plan is considered a comprehensive medical insurance plan, with a $1500 annual deductible, and an out-of-pocket limit of $2500.
Compared to the current high risk pool plan in California, a 42 year old person living in Ventura county would spend quite a bit less on the new government run plan, paying $304 per month compared to $657.50 on the current high risk pool plan.
To be eligible, you must not have had any insurance for at least 6 months, and have a pre-existing condition that prohibits you from obtaining private medical insurance. While it's still expensive and probably only beneficial to the middle class, it's a great first step for getting many uninsured the coverage that they need.
Please contact us at (877) 812-5111 if you need additional options for guaranteed issue medical insurance.
The new health care reform law includes a provision that requires medical insurance companies to provide preventative services without any member cost sharing.
Non-grandfathered plans issued or renewed on or after September 23, 2010 will not include member cost sharing or copays for the following preventative care services provided in-network:
- Items or services that have an A or a B rating in the current recommendations of the United States Preventative Services Task Force. You can see a list of these services at: http://www.ahrq.gov/clinic/uspstf/uspsabrecs.htm.
- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. You can see a list of these immunizations at: http://www.cdc.gov/vaccines/recs/acip/default.htm
- Evidence-informed preventative care and screenings provided for in comprehensive guidelines for infants, children and adolescents that are supported by the Health Resources and Services Administration. You can view more information at: http://www.hrsa.gov/
- Evidence-informed preventative care and screenings for women not otherwise addressed by the U.S. Preventative Services Task Force recommendations that are supported by the Health Resources and Services Administration.
This impacts non-grandfathered plans issued or renewed on or after September 23, 2010, and it only applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.
Most of the recommended screenings, immunizations and exam services are already on Anthem's preventative services list. They are adding the new, required preventative services to this existing list. One example of a new preventative service is counseling for aspirin use, tobacco cessation, obesity and alcohol use. In addition, some services that are currently covered as a maternity benefit, such as recommended pregnancy screenings for pregnant women, will now be covered as a preventative service.
All of Blue Shield's individual and family medical insurance plans, except Essential Plans and Access+ HMO plans, are considered grandfathered if the policy was in effect on or before March 23, 2010 and the plan meets all grandfathering qualifications. In addition, all small group plans (2-50 employees) are considered grandfathered plans if the policy was in effect on or before March 23, 2010 and the plan meets all grandfathering qualifications.
Lifetime coverage limits are being removed as well. If you have reached your lifetime maximum dollar maximum, you will be allowed to re-enroll at your renewal without a dollar value limit. Blue Shield is making efforts to reach those members who have reached their benefit maximum.
However, if you have met your lifetime maximum, then you should contact us for re-enrollment.