There are only 1093 days left until ObamaCare plunges the nation into a socialist dystopia insurers can no longer deny health insurance on the basis of pre-existing conditions, coverage will be mandated and subsidies will be available for those with low incomes to make health insurance company CEO's even richer help pay for insurance. Unless, of course, the Republicans or the Supreme Court repeal the law thereby saving the country causing middle-class Americans to all go bankrupt paying through the nose for junk insurance plans.
Whether you, as does the polled public, think a) the law should be repealed (44%), b) it doesn't go far enough (13%), or like Goldilocks, c) it is just right (43%), there are a number of provisions that kicked in starting January 1, 2011, that you might want to know about. Some of these provisions have been covered in a diary from yesterday but there are other things that weren't covered and which might be important to you or someone you know.
- Regulations take effect for many with 'new' plans beginning January 1.
- Federal High Risk Pools now more flexible and less expensive.
- New website for childrens' health care.
- Medicare drug coverage improved.
- Medical Loss Ratio regulations begin. Will they have any effect?
Remember all the hoopla on September 23rd, 2010 when all sorts of new regulations took effect? You don't? That might be because they didn't effect you, or because they didn't take effect on your policy immediately. If you're like a lot of people your policy rolls over on the new year, and therefore these new regulations and restrictions didn't effect you until now. (Unless they still don't, because your plan was 'grandfathered' (like mine) (don't ask), or your plan doesn't roll over until later in the year.)
So it is quite possible that as of January 1st, your kids can't be prevented from being put on your policy if they have pre-existing conditions; there is no longer a lifetime limit on benefits written into your policy; you will receive free preventative services; and your adult children can stay on your policy until they reach age 26, among other things.
The Federal High Risk pools are now offering more flexibility and lower premiums. If you live in a state which has a high risk pool administered by the federal government and you qualify for the pool, you now have a choice of three different options instead of being restricted to a 'one-size-fits-all' policy. You can choose the standard plan, an extended plan with higher premiums and lower deductibles, or a plan which includes a Health Savings Account which has tax advantages. Standard plan rates have been reduced by almost 20% from last year.
You can see whether your state has a federal program here -- states in orange do, and if so you can check out the rates for the new options by clicking on your state. You can also find more detail that you could possibly want to know about these different options here (pdf).
Notwithstanding the rate reductions, if you're not young any more and really need insurance via a high-risk pool, you best option might be to move to Pennsylvania. That state plan gives you coverage independent of how old you are (unlike every other state and federal high risk pool rate structure) for $283/month with a $1000 deductible. Hawaii's pool, run by the Federal government, also has pretty low rates for older people, and let's face it, would you rather live on the beach on Maui or in Altoona?
New website: If you have (or know of) a child that needs coverage, you can check out HHS's nifty new website set up just for this purpose: Insure Kids Now. There's even a hotline: 1-877-543-7669.
If you are receiving Medicare, the donut hole is beginning to close. Slowly, to be sure, but surely, to be slow. By 2020 it will be closed completely. For the nonce, you'll get a 50% discount on brand-name drugs and a 7% discount on generic drugs while in the coverage gap range (aka donut hole). These savings rates will increase until they reach 100% in 2010.
And last, perhaps least, perhaps most importantly, the regulations concerning restrictions on Medical Loss Ratio go into effect.
The Medical Loss Ratio is the percentage of a plan's premiums the insurer pays out as benefits; the rest goes to administrative overhead and profit.
Many health insurance plans will now have to pay out as benefits 80% or 85% of the monies they receive in, whereas previously companies could skim off as much money for profit and administrative expenses as they could get away with (sometimes as much as 50% or more). If they fail in this regard, the law says they will owe rebates back to their customers.
Now you might ask "Well, if insurers were previously paying out 70% of their revenues as benefits, and now they are required to pay out 80%, why did my insurance rates increase by a bazillion bananas this year?"
That's a very good question. And I have no answer (denominated in either bananas or dollars). We are just going to have to wait and see how strictly Health and Human Services enforces this new regulation. Will any insurance companies end up paying any substantial rebates to their customers at the end of this year? Or will they have outsmarted the new regulations and outmaneuvered oversight at HHS, ending up having their cake increased rates while eating it too managing to hide their profits in schemes too deep for mere mortals to unravel?
While I have been impressed with how Sebelius and HHS have implemented the health care law so far, my money is on the evil ingenuity of the insurance companies on this. If more than a token number of insurance companies pay more than token amounts of rebates based on their 2011 income and outgo, I will eat this diary. But I sure as hell wouldn't mind a diet of ascii for a day if that means I am getting back 10% of the premiums I will have paid!
So there it is. When you look at the timeline for implementation of the PPACA, there isn't much left between now and 2014 that's going to affect most anyone directly. What's there is what the country is going to have to live with, for better or worse, for the next three years.
And, Thy will be done, from the insurance companies deliver us, O Lord.