2013 Medical Loss Ratio Checks were mailed recently.  This money is released after 2013 claims were paid by carriers  The PPACA mandates that an insurance carrier who does not spend at least 80% of premiums on claims must provide a refund to the consumers.  

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller / SHOP Marketplace Enroller from Grand Rapids, Michigan.

CLICK to DOWNLOAD this handy little guide to answer basic questions about PPACA Healthcare Reform from United Healthcare.
Please contact me for any questions not covered in the booklet.

Health care reform requires that all individual and small group health plans offer these 10 essential benefits starting in January 2014. Many of the benefits weren't provided or fully covered in the past, so including them means more benefits with more protection for you.

Ambulatory patient services - Care you receive without being admitted to a hospital - such as at a clinic, physician's office or same-day surgery center.

Emergency services - Care for conditions which, if not immediately treated, could lead to serious disability or death.

Hospitalization - Care you receive as a patient in a hospital, such as room and board, care from doctors and nurses, and tests and drugs administered during your stay.

Maternity and newborn care - Care provided to women during pregnancy and during and after labor; care for newly born children.

Mental health and substance abuse disorder services - Care to evaluate, diagnose and treat mental health and substance abuse issues.

Prescription drug coverage - Drugs prescribed by a doctor to treat an acute illness, like an infection, or an ongoing condition, like high blood pressure.

Rehabilitation and habilitation services and devices - Services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills.

Laboratory services - Testing blood, tissues, etc., from a patient to help a doctor diagnose a medical condition and monitor the effectiveness of treatment.

Preventive and wellness services and chronic disease management - These services include routine physicals, screening and immunizations. Chronic disease management is an integrated approach to manage an ongoing condition, like asthma or diabetes.

Pediatric services - The other nine essential benefits are provided to children along with dental and vision care.

Resources For Health Care Reform Updates - Websites To Check In With
www.KFF.org

www.AHIP.com  

www.HHS.gov

www.CBO.gov  

www.NAIC.org  

www.statereforum.org/states  

www.ncpa.org       

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

Under the new health care reform laws, there will be some changes coming in the way you pick, purchase and pay for your plan. Here are some of the upcoming steps and dates to remember:

October 1 The Health Insurance Marketplace opens for business for coverage effective Jan. 1, 2014. It is optional for you to participate if you already have coverage.  Most carriers are not forcing any changes to current coverage until 1/1/15 for individual plans.  Group insurance benefits must upgrade to the new benefit requirements effective the renewal date next year.  The enrollment form does not include health status with the exception of tobacco use. 

Plans will be more uniform since they must conform to Essential Health Benefits of the "metal" plans: Bronze (60%), Silver (70%), Gold (80%), Platinum (90%), and Catastrophic (available to those in certain situations, under age 30).  We encourage you use our services for comparing your options an enrolling in a new plan if it is a better option for you.

Open enrollment starts Oct. 1, 2013.
We will be able to enroll you in a non-medically underwritten plan for 1/1/14.  For the initial year only, open enrollment lasts from 10/1/13 to 3/31/14.  Coverage begins wither 1/1/14, or the 1st of the following month (for next year only), to ensure no gap in coverage.  If you do not purchase insurance, most will have to pay 1% of their adjusted gross income as a penalty.  We can assist you in calculating your subsidy so you know what your net cost is anticipated to be.  You have an option of having the insurance carrier receive monthly payments from the government, or you can get a refundable tax credit if you do not receive a monthly subsidy.  In most cases, subsidies are not available for those with group insurance options.

January 1 Tax credits (or subsidies) become available. Go to http://kff.org/interactive/subsidy-calculator/ and use theSubsidy Calculator Tool to see if you qualify.

Be forewarned, there are a lot of moving parts to this and it's getting more complicated than ever.  Your accountant may have recommendations for your situation due to income projections changing for 2014.  Keep in mind that open enrollment ending means that you won't be able to purchase coverage anytime during the year, without a qualifying condition.  A qualifying condition would be loss of group coverage due to job loss or change of family status (birth, divorce, adoption, marriage).  The next open enrollment would be October 1st, 2014 for January 1, 2015 effective date.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

How does the Patient Protection and Affordable Care Act (PPACA) affect people?

Since 2010, insured have enjoyed free wellness care, as long as it fits the guidelines set forth in PPACA.  (See www.Heathcare.gov/prevention for details of the wellness treatments you are eligible for.)

To ensure he didn’t have any concern for lung cancer, my friend, a former smoker, asked during his recent wellness visit for a chest x-ray and was denied.  The doctor said it wasn’t necessary.  His mother died of cancer at age 62.  He is turning 57 this year and felt it was necessary for his peace of mind.  He is willing to pay for it and couldn’t get the Doctor to order the x-ray.  Only 1% of lung x-rays show cancer, but what if he is the 1%?

The bigger picture is that behind the scenes, PPACA is changing Doctor’s compensation from a “fee for service” (where providers profit from providing more services) to “capitated” payments (where providers profit by providing fewer services) or some hybrid.   Meet the new final authority for health care in America.  It’s not Congress, not the Court, and not “We the People”.  It’s an Independent Payment Advisory Board (IPAB), an unelected, unaccountable 15-member panel empowered to set healthcare standards for spending, care and efficiency that will affect all of us.  It is quite possibly the most dangerous aspect of the entire PPACA law.  IPAB is not required to hold any public hearings and its decisions are not subject to administrative or judicial review.  It has the power to tax and ration care.  This is all by design.  The authors of Obamacare decided to take the difficult matters away from politicians.  The “quality and efficiency” standards set by IPAB affect ALL health care, not just Medicare and Medicaid.  This means your utilization of your private health insurance will be affected, even if you are willing and able to pay for treatment.  There will be one standard of care for all.   IPAB has determined too much money is spent in the last year of life. 

Furthermore, as IPAB is reducing compensation to Medicare/Medicaid providers, fewer Doctors can afford to continue serving this population.  There is a silent exodus already in motion from Doctors.  This movement is the beginning of rationed care. 

So how does PPACA affect you?  It will depend on your age, wealth and health.   

*“Hidden Dangers of Obamacare” was used as a resource to this article.

Jeanine Kinzie - Licensed Health and Life Insurance Agent
If you would like to talk to an expert about what this means for your and how you can best protect yourself and your family in the future, Contact Jeanine!

In case you haven't heard, major reform implementation is coming in October 2013. This change is optional for you this year.  We will be agents for you whether you are entitled to a subsidy through the exchange or not.  We will provide you with options for keeping your current plan and what new plans are available.

The Affordable Care Act is expected to help increase access to health care. Health insurance exchanges will be an important part of that.

Most people get health insurance through their employers. But people without this option will now be able to shop for health insurance on exchanges, as an alternative to buying coverage directly from individual health insurers. Exchanges will be open for business in October 2013, allowing consumers to shop for health plans that will begin on January 1st.

Click on the video below to watch and find out more.

Experts predict that by 2016, more than 25 million people will use exchanges to buy health insurance.