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HHS offers new tools to help states lower Medicaid costs, provide better care

2011-05-11T10:13:00.000-05:00

The U.S. Department of Health and Human Services (HHS) today announced a series of initiatives to work with states to save money and better coordinate care for the 9 million Americans enrolled in both Medicare and Medicaid. The new initiatives include better access to Medicare data and better coordination of health care between Medicare and Medicaid. The initiatives will be led by the new Federal Coordinated Health Care Office (the Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively to improve patient care and lower costs.

“Medicaid costs are largely driven by the complex medical needs of low-income seniors and people with disabilities who are eligible for both Medicare and Medicaid. We know that by working together, we can provide better, more coordinated care while lowering health care costs and saving money for states,” said Centers for Medicare & Medicaid Services (CMS) Administrator Donald M. Berwick, M.D. “Medicare and Medicaid spends $300 billion each year to care for people enrolled in both programs. Better coordinated care for this vulnerable population could yield savings and improve care and coverage in Medicaid.”

Currently, 60-percent of Medicare-Medicaid enrollees, “dual eligibles,” have multiple chronic conditions and 43-percent have at least one mental or cognitive impairment. While only 15-percent of Medicaid enrollees are also Medicare beneficiaries, Medicare-Medicaid enrollees represented 39-percent of Medicaid spending in 2007. Medicaid spent about $120 billion on this group – about twice as much as Medicaid spent on the 29 million children it covered. The Medicaid spending per Medicare-Medicaid enrollee was $15,459 in 2007, over six times higher than the comparable cost of a non-disabled adult Medicaid-only enrollee ($2,541).

The Medicare-Medicaid Coordination Office today launched the Alignment Initiative, an effort to more effectively integrate benefits under the two programs. Currently, low-income seniors and people with disabilities must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of supplemental benefits such as long-term care supports and services. Medicaid also provides help with Medicare premiums and cost-sharing for those who need additional assistance.

A lack of alignment between the programs can lead to fragmented or episodic care for people with both Medicare and Medicaid coverage, which can reduce quality and raise costs. For example, Medicaid and Medicare have different coverage standards for those accessing durable medical equipment in the community. This can lead to fragmented care and coverage gaps that could result in patients losing access to the treatments and equipment that help them live at home or in the community. Even temporary coverage gaps can be disruptive if patients no longer have coverage for wheelchairs or other expensive medical care. The Medicare-Medicaid Coordination Office is seeking input and ideas about how to align in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals. Better alignment in these areas can reduce costs by improving health outcomes and making care coordination more efficient.

Today, HHS also announced a new process that provides faster state access to Medicare data to support care coordination. Access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for their highest cost beneficiaries. For example, a state that wants to expand its long term care and behavioral health care management program to serve low income seniors and people with disabilities needs data on their Medicare-covered hospital, physician, and prescription drug use. With Medicare data, states can identify high risk and high cost individuals, determine their primary health risks, and provide comprehensive individual client profiles to its care management contractor to tailor interventions.

“Navigating the two programs can be both complicated and burdensome for beneficiaries and their families and caregivers,” said Medicare-Medicaid Coordination Office Director Melanie Bella. “We are facilitating a national conversation on how to make these programs better serve the people that depend on them every day. We are working with states toward new levels of seamlessness so as to smooth the care journeys for these individuals.”

The first step in the Alignment Initiative is a notice for public comment that will be displayed in the Federal Register. The notice requests public input on priorities and key goals. Individuals wishing to submit comments have until July 11, 2011 to do so. For more information on the Alignment Initiative notice for comment, visit: www.ofr.gov/inspection.aspx. The Medicare-Medicaid Coordination Office will continue to engage with local stakeholders around the country on the Alignment Initiative through regional listening sessions.

The announcement of the new policy on state Medicare data for enrollees in Medicare and Medicaid will be published in a Center for Medicaid, CHIP and Survey & Certification (CMCS) Informational Bulletin today. The Bulletin is available at: www.cms.gov/CMCSBulletins/CMCSB/list.asp#TopOfPage.

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Most uninsured unable to pay hospital bills according to new HHS report

2011-05-10T11:39:00.000-05:00

A new report released today by the U.S. Department of Health and Human Services (HHS) shows that few families without health insurance have the financial assets to pay potential hospital bills. On average, uninsured families can only afford to pay in full for approximately 12-percent of hospital stays they may experience – and even higher income uninsured families are unable to pay for most potential hospital stays. Hospital stays for which the uninsured cannot pay in full account for 95-percent of the total amount hospitals bill the uninsured. Other studies have estimated that the bills for all types of health care that the uninsured cannot pay – the uncompensated cost of care – is up to $73 billion a year, a significant portion of which is shifted into higher costs for Americans with insurance and their employers.

“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth,” said HHS Secretary Kathleen Sebelius. “The result is families going without care – or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”

Approximately 50 million Americans are uninsured. The report found that most uninsured people have virtually no savings. In fact, the median financial assets for all uninsured families are just $20. Even among higher income families, assets are low. Half of families with income at 400-percent of the Federal Poverty Level (FPL), or $89,400 a year for a family of four in 2011, have financial assets below $4,100.

Every year, nearly 2 million uninsured Americans are hospitalized. With 58-percent of these hospital stays resulting in bills of more than $10,000, most uninsured people are unable to afford potential hospital bills. Even the top 10-percent of uninsured families with the most assets are estimated to be able to pay the full bill for only half of potential hospital stays. Uninsured families can, on average, afford to pay the full bills for only about 12-percent of the hospital stays they might experience, bills that account for just 5-percent of the total amount hospitals bill them.

“Health insurance is critical in helping protect families from unexpected hospital costs,” said Sherry Glied, HHS assistant secretary for planning and evaluation. “This report shows that even higher income uninsured families are struggling to meet the high costs of health care. No family should bear the burden of being one illness or accident away from bankruptcy.”

The high cost of hospitalization means that lacking health insurance poses a greater risk of financial catastrophe than lacking car insurance or homeowner’s insurance. Although people are 50-percent more likely to have car accident than to be hospitalized in a given year, the average bill for a hospital visit is over two and a half times higher than the average loss for a car accident. And, while the bill for a single hospitalization is about the same as the average loss from a house fire, a person is ten times more likely to be hospitalized than to experience a house fire.

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Assisted Living Costs Rising Faster Nationally Than in Georgia, Finds Genworth's Annual Cost of Care Survey

2011-05-10T09:35:00.000-05:00

/PRNewswire/ -- According to Genworth's 2011 Cost of Care Survey, assisted living cost inflation in Georgia is being outpaced by national cost increases. Overall, the cost of long term care services in Georgia is well below national levels.

The median hourly rate to receive care in the home, Americans' preferred long term care setting, is $17.50 an hour in Georgia for home health aide services and $19 per hour nationally. The cost for this type of care has increased 1.5 percent a year over the past six years in Georgia, and 1.4 percent nationally during this same period.

The cost for a private nursing home room in Georgia has risen 4.4 percent annually over the past six years, and in line with the national rate. The median annual rate in Georgia for a private nursing home room is $63,875 per year, less than the national rate of $77,745 per year.

Nationally, the median annual cost of long term care in an assisted living facility is $39,135, an increase of 6.0 percent annually over the past six years. In Georgia, the annual cost of assisted living care is $28,800 and costs have risen 0.7 percent per year over the same time period.

Click here for an interactive map of long term care costs in 15 regions across Georgia, as well as nationally.

Knowing Local Care Costs for Productive LTC Discussions

"Understanding local caregiving expenses is an essential first step for families faced with rising care costs," said Buck Stinson, president, U.S. Life Insurance Products at Genworth. "Genworth's Cost of Care Survey arms consumers with the knowledge to have informed conversations, whether they are speaking with a family member, a care provider or financial professional, about how they might realistically pay for care."

Now in its 8th year, Genworth's Cost of Care Survey not only provides Georgia residents with national and local long term care cost data, but also information on cost inflation over time. Armed with this information, consumers and their advisors can:

* Develop a comprehensive financial plan to cover anticipated future long term care costs
* Conduct an informed discussion with family members to address future long term care needs and preferences
* Negotiate more effectively with providers of long term care services

Negotiating With Care Providers: It Never Hurts to Ask

Some consumers may be surprised to learn that they have the power to negotiate with care providers to help contain costs. Care providers, particularly assisted living facilities and home care agencies, often face stiff competition in their local markets. Consumers should feel comfortable addressing the issue of costs, and the opportunity to lower them, when discussing care options with a provider of long term care services. Genworth's Cost of Care Survey provides localized cost data that empowers families to confidently discuss care costs and options with service providers.

Know What to Ask: Tips for Reducing Caregiving Costs

While nursing homes generally do not discount their rates because they are strongly influenced by the effect of Medicare/Medicaid on their overall business plans, assisted living facilities and home care providers are more apt to do so. Tips on where to start when negotiating with a long term care provider include:

* Know Local Costs: Genworth's Cost of Care Map provides the median cost of long term care across the U.S., including 15 regions in Georgia, to help consumers plan for the potential costs associated with the various types of long term care available in their preferred location and setting.

* Fee Waivers: Assisted living facilities often charge a one-time fee when a client first moves in. If the facility is in a competitive market, or has a surplus of vacant units, they may discount or waive this fee (or offer other discounts such as free rent for a period of time).

* Special Rates : Facilities will sometimes have a special rate if residents move in at the first of the month or during a time that is known to have higher vacancy rates.

* Vacancy Rates : Facilities may allow a resident to choose a more expensive room, at a lower price, if vacancies are currently high.

* Lower Hourly Rates: Home care agencies may lower their hourly rate if the services needed are easy to staff and long term, such as a weekday schedule that is predicted to last several months.

* Shop Around: If a home care agency's fees are at the high end of the local range, they may lower rates if they know the client is interviewing several agencies and cost is an important factor. Let care providers know if a lower rate has been quoted elsewhere for the same services.

* Premium Waivers: Agencies usually charge a premium for weekend services. For a client that also engages services for a significant amount of weekday hours, the agency may waive this premium.

* Ask for an Upgrade: Nursing homes generally do not discount their rates, however, certain extra amenities, or a private room upgrade, may be available under certain circumstances.

It is important to note that most of these price concessions are based on the availability of staff, or residential units, which is a factor that fluctuates often for some businesses. Contacting several providers before making a final decision offers the best chance of securing safe, appropriate services at a reasonable rate.

"While consumers should seek out quality and value when shopping for long term care, it is crucial that they have a financial plan in place to pay for long term care," said Stinson. "The cost of long term care remains one of the biggest risks to one's retirement security, especially with ever-increasing healthcare costs."

For consumers interested in learning more about the cost of care in their local market, Genworth offers an interactive map of long term care costs in 437 regions across all 50 states, including 15 regions in Georgia, at www.Genworth.com/CostofCare. The site offers a range of educational tools that help consumers compare costs across geographies, project future costs and share comparisons and calculations with family, friends or a financial professional.

Additional Resources:

* Genworth's "Let's Talk" campaign was developed to help families initiate conversations about long term care preferences, options, and strategies.
* Genworth Celebrates Caregivers Facebook Page: Caregivers can have their questions about caregiving challenges answered by a professional care advocate.
* An interactive Cost of Care press release containing downloadable content is available at:
http://multivu.prnewswire.com/mnr/genworthfinancial/49612.

About Genworth's 2011 Cost of Care Survey

Genworth's Cost of Care Survey, is the most comprehensive study of its kind, covering nearly 15,500 long term care providers nationwide. The survey includes 437 regions which cover all Metropolitan Statistical Areas defined for the 2010 U.S. census. Genworth annually surveys the cost of long term care across the U.S. to help Americans plan for the potential costs associated with the various types of care available in their preferred location and setting. CareScout®, part of the Genworth Financial family of companies, has conducted the survey since 2004. Located in Waltham, Massachusetts, CareScout has specialized in helping families find long term care providers nationwide since 1997. Genworth's 2011 Cost of Care Survey was conducted during January, February and March 2011.

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Blue Cross and Blue Shield of Georgia Extends Grace Period on Premium Payments for Members Affected by Tornados

2011-05-05T09:39:00.000-05:00

/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGa) today announced it is extending the grace period on premium payments to help members directly impacted by Georgia tornados on April 27 and 28. Extensive property damage, injuries and death are attributed to these storms.

A Governor's State of Emergency remains in effect, and a Presidential Disaster Declaration has been made for Bartow, Catoosa, Coweta, Dade, Floyd, Greene, Lamar, Meriwether, Monroe, Morgan, Pickens, Polk, Rabun, Spalding, Troup and Walker Counties. Additionally, the damage caused by the tornados and storms have had a significant impact on transportation throughout the state, including disruptions in mail service.

Mail delivery disruptions may have caused delays in BCBSGa receiving premium payments, and as a result, BCBSGa has extended the grace period on premium payments for Georgia members for payments due in April and May. Members impacted by the tornados that may receive a delinquency notice or cancellation notice need to contact BCBSGa to have the delinquency notice waived. Policies will not be cancelled for this timeframe if premium payments were delayed due to disruptions in mail service.

"This is a very tragic time for many Georgians and it is of the utmost importance that our members not experience additional hardships," said Morgan Kendrick, President, BCBSGa. "We are taking every precaution possible, including extending grace periods and shifting staff roles to assist in the processing of any premium payment backlogs."

If members have questions about their premium payment status due to mail disruptions caused by recent inclement weather conditions, they should call the customer service number on the back of their Member ID card, and if they do not have their card, they should call 1-866-417-7107.

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Newly Released Study Shows Insurance Barriers Blocking Access to Healthcare

2011-03-16T20:09:00.000-05:00

/PRNewswire/ -- Significant barriers to patient care implemented by the health insurance industry are difficult to navigate, have a negative impact on patient care and drive up the administrative costs of healthcare, according to a statewide survey of Georgia physician assistants. The survey, which was released today by the Georgia Association of Physician Assistants (GAPA), also indicated that most physician assistants (PAs) are proactively taking steps to help address the problems that plague the system, and feel there is a legislative role that can contribute to a solution.

According to the survey, a nearly universal 99 percent of PAs stated they have had to change the way they treat a patient as a result of restrictions imposed by an insurance company. An overwhelming majority, 94 percent, feels that health plans frequently or occasionally delay or deny diagnostic testing or prescription medications for their patients.

Not surprisingly, 93 percent of those surveyed stated they felt insurance requirements such as prior authorizations, pre-certifications, and step therapy protocols had some degree of a negative effect on their ability to treat patients.

"The lessons learned from this report are resounding, in that nearly all the physician assistants that responded to the survey cited major insurance hurdles they had to jump over before being able to provide the care they deemed appropriate for their patients," said Mary Vacala, ATC, PA-C, MSPAS, DFAAPA, and 2010-11 president of the Georgia Association of Physician Assistants. "Some cited several phone calls taking 45 minutes with an insurance company. Others noted that patients are forced to go without medication until the insurance company would approve the treatment already prescribed by the healthcare professional."

One-in-five respondents stated they or their staffs are required to interact with an insurance provider to obtain approval for a prescribed course of treatment or to determine the insurer criteria for prior authorization or step therapy protocols an alarming 150 times or more per month. Approximately one-in-five said the number was 61-100 and more than one-in-four stated the number of interactions as 21-60.

Understanding that each hour a provider spends on administrative tasks is an hour not spent evaluating patients, PAs are proactively taking steps such as utilizing newer technology to streamline the process. Currently, 64 percent of respondents have implemented Electronic Medical Records and 45 percent are using an e-prescription process on some level. At the same time, 90 percent of those surveyed agree that there should be enforceable legislation addressing restrictions that insurance companies place on health care providers.

"There are more than 2,000 physician assistants across the state of Georgia, and so many are using technology such as electronic medical records and e-prescribing, to promote better, more coordinated care," concluded Vacala. "As these technologies continue to be developed, the Georgia General Assembly should take steps requiring that patient formulary information be more transparent and that there be a uniform electronic process for obtaining medication approval. By taking simple steps, we will save significant time and resources while also having a healthier patient population in Georgia."

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States Urged to Pass and Defend Patient Protection Laws Requiring Insurers to Cover Costs of Colon Cancer Screening

2011-03-01T11:45:00.000-05:00

/PRNewswire/ -- Passage of laws requiring insurance providers to cover the costs of colon cancer screenings has stalled over the past two years and advocates are bracing to protect existing legislation in states that currently guarantee access to these lifesaving tests, a coalition of public health associations and medical professional societies reported today. The progress made in passing state-mandated coverage of colon cancer screening tests according to accepted medical guidelines has come to a near halt as state legislatures reconsider their role in the wake of the passage of the federal Affordable Care Act.

Only one state, Hawaii, passed coverage legislation in 2010. Combined with Vermont's legislation passed in 2009, only two states have improved their grade in the past two years as reported by the annual Colorectal Cancer Legislation Report Card – the slowest improvement since the report card launched seven years ago.

"The facts are clear – in states with laws mandating coverage of colon cancer screening, more people get screened and more lives are saved," said Lisa Paulsen, CEO of the Entertainment Industry Foundation, the 501(c)(3) non-profit organization of which the National Colorectal Cancer Research Alliance is a part. "State legislatures need to move to ensure that everyone who needs colorectal cancer screening has access to it. We know that the prevention or early detection that can result from screening saves lives, and will save health care dollars for the states in the long run."

With the addition of Hawaii in 2010, 23 states and the District of Columbia now require insurance coverage of colonoscopies and other procedures that follow accepted medical guidelines, earning them the grade of "A." Ten other states require varying degrees of coverage, with scores of B, C or D, while 17 states score an "F" for failing to mandate any coverage of the cost of colon cancer screening.

As of September 23, 2010, all new health plans are required to cover colorectal screening tests as part of the Patient's Bill of Rights in the federal Affordable Care Act (ACA). The coverage rules follow guidelines established by the U.S. Preventive Services Task Force, which require that insurance companies cover some colorectal cancer screening tests for those ages 50-75. However, those guidelines still leave high-risk populations under 50 without coverage options. In addition, grandfathered plans (those existing health plans in which a person was enrolled on the date of enactment of ACA), are not required to cover the tests.

Starting in 2014, as part of the ACA, all plans participating in state exchange programs will be required to provide coverage based on a federally mandated "essential benefits" package. It is expected that the package will also follow the U.S. Preventive Services Task Force guidelines – potentially leaving high risk populations that fall outside the guidelines without coverage options.

In the 17 states that currently do not guarantee screening coverage, many people will continue to fall through the cracks unless patient protections are established. In addition, many of the states that currently have guaranteed coverage have benefits that go above and beyond the U.S. Preventive Services Task Force guidelines and advocates do not want to see any of those guarantees rolled back.

"We have made tremendous strides in moving states to take action to protect the health and lives of their citizens by ensuring that colorectal cancer screenings are covered for all who need them," said John R. Seffrin, PhD, CEO, American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. "While the essential benefits package in the Affordable Care Act will go a long way in 2014 to guarantee coverage, the best way to ensure that everyone who needs screening tests have access to them is for states to continue to enact patient protections and maintain the strong laws they already have in place."

Colorectal cancer (also known as colon cancer) is the second-leading cause of cancer deaths for men and women combined in the United States. However, the disease can often be prevented entirely through the early identification and removal of pre-cancerous polyps. When colorectal cancer is diagnosed at an early stage, the five year survival rate is 90 percent. However, when it is not diagnosed until it has spread to distant organs, the five year survival rate is only 11 percent. In 2010, the American Cancer Society reported that the colorectal cancer death rate has continued to decline. Down approximately 3.9 percent per year in men from 2002 to 2006 and 3.4 percent per year in women from 2001 to 2006, colorectal cancers saw one of the largest declines in death rates of all leading cancers.

Research has shown that regular screening is crucial for all those over 50, as well as those under 50 at increased risk.

Despite widespread awareness about the importance of colon cancer screenings, insurance coverage is still a barrier to screening according to a 2009 survey undertaken by Harris Interactive on behalf of ACS CAN and the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance (EIF's NCCRA).

In fact, 70 percent of all survey respondents, including two-in-three (62 percent) of those 50 and older, said that if they knew that their insurance covered the entire cost of colonoscopy, they would be somewhat to much more likely to have the procedure at age 50, or earlier if their doctor recommended.

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New Rule Ensures Students Get Health Insurance Protections of the Affordable Care Act

2011-02-10T11:40:00.000-05:00

A new proposed regulation announced today by the Department of Health and Human Services (HHS) would ensure students enrolled in health insurance coverage through their college or university benefit from critical consumer protections created by the Affordable Care Act. Students enrolled in college plans would have the freedom from worrying about losing their insurance, or having it capped unexpectedly if they are in an accident or become sick.

"Thanks to the Affordable Care Act, college students will have more control over their health care," said Secretary Sebelius. "This rule would ensure that these plans remain a viable, affordable option for students while guaranteeing that they are regulated consistently and offer transparent benefits to students."

Student health plans are often purchased when family coverage is not available, or is unaffordable. Approximately 1,500-2,000 institutions of higher education across the country offer some type of health coverage; however, what benefits are covered by these plans, as well as how they're regulated vary widely. The proposed regulation would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act by clarifying that these plans will be defined as "individual health insurance coverage." Under the proposed rules, some of the new health insurance protections include:
* No Lifetime Limits on Coverage: Insurance companies would no longer be able to impose lifetime dollar limits on the amount they spend on health benefits in student health plans.
* No Arbitrary Rescissions of Insurance Coverage: Insurance companies can no longer drop coverage when student health plan enrollees get sick because of an unintentional mistake on an application.
* No Pre-Existing Condition Exclusions for Students Under Age 19: Insurance companies cannot deny or exclude coverage for students under age 19 because of a pre-existing condition.

Today, some student health plans, only offer limited benefits with low annual dollar limits on health care, or have limited networks of doctors, and other health care providers. For many students, these health plans are their only health insurance option.

The Affordable Care Act allows HHS to take steps to preserve market stability while ensuring student health plans remain affordable until all Americans have new coverage options through the state-based Exchanges that will be established in 2014. Under the proposed rule announced today, student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012. Student health plans with policy years beginning after that date must fully comply with the Affordable Care Act's annual limit restrictions.

The proposed rules would also require insurance companies to clearly tell students enrolled in student health plans whether or not their plan meets the new requirements laid out under the Affordable Care Act-bringing transparency to this marketplace and enabling students to understand the value and quality of the coverage they have.

As a part of the new proposed rule, HHS also is requesting comments on how other Affordable Care Act protections might apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules.

To find the new proposed rule, visit www.ofr.gov/inspection.aspx. For a fact sheet on the new proposed rule, visit www.HealthCare.gov/news/factsheets/students02092011a.html . For more information about the new patient protections created under the Affordable Care Act, visit www.HealthCare.gov.

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Georgia Seniors Get Very Low-Cost Medicare Supplement Insurance Policy

2011-02-10T11:31:00.000-05:00

(BUSINESS WIRE)--A new low-cost Medicare Supplement insurance policy is now approved for sale to seniors in Georgia. The Georgia Office of Insurance and Safety Fire Commission has approved a very low-cost Medicare Supplement insurance plan for seniors and Georgia is among the first states in the nation to allow this supplemental insurance plan to be offered to its citizens. The availability of this low-cost supplemental plan for Georgia seniors was announced today by State Mutual Insurance Company of Rome, GA.

“We have eliminated a substantial cost element in this process”

State Mutual President and CEO, Dee Yancey III, said that Georgia residents of Medicare age now have access to one of the lowest cost Medicare supplement insurance plans available anywhere in the nation. Yancey said that State Mutual Insurance Company will allow Medicare-age consumers to apply for the supplemental Medicare insurance policy online, without having to talk with an insurance agent. “They can go online (www.statemutualinsurance.com) to fill out a confidential application and only buy the coverage they determine for themselves that best supplements their Medicare,” he said. “They can go forward secure in the knowledge that no one is going to try to sell them anything,” he said.

State Mutual was founded in 1936 and is licensed in 41 states and the District of Columbia. Yancey said that by using the Internet and allowing consumers to fill out their own applications online, the company has been able to substantially reduce its costs and the price it charges to consumers. “Consumers can also call the company for assistance in filling out applications,” he said.

A quick random comparison of Medicare supplement policies available in a number of states shows that the State Mutual policy is generally the lowest cost in most categories, and in some cases, costing less than half the price of the most expensive policies for the same coverage.

The online program allows an interested customer to review and select a policy, see a price quote, submit an application, receive confirmation of coverage and receive his or her policy in a few minutes of online time. Most policies will be issued within a working day, rather than the customary one- to two-month wait for underwriting review and processing. The customer can also download his or her policy and store it for review at any time. Consumers who wish to speak to a customer service representative, either to obtain information or to apply for a policy, can do so by calling 1-855-764-4000.

Yancey said that the low-cost of the State Mutual Insurance Company policy is achieved by empowering the customer to go online for most, if not all, of the information and application phase of obtaining Medicare supplement insurance. “We have eliminated a substantial cost element in this process,” he said. “This benefits the consumer who can obtain a superior insurance policy from an established company very quickly and inexpensively,” he said.

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Two Year Anniversary of Children's Health Insurance Law Sees Millions of Newly Insured Children, Families

2011-02-04T09:32:00.000-05:00

Two years after President Obama signed the Children's Health Insurance Program Reauthorization Act (CHIPRA), HHS Secretary Kathleen Sebelius today announced that more than two million more children were served by Medicaid or the Children's Health Insurance Program (CHIP) at some point over the past year.

Together, the two programs serve more than 42 million children who would otherwise not have access to regular medical care. CHIPRA was signed into law on February 4, 2009.

"The increase in the number of children served by these two vital programs is especially significant in the face of the recent economic downturn states are experiencing," said Secretary Sebelius. "Even in times of hardship states have demonstrated their commitment to the health of children by continuing efforts to identify and enroll them in coverage."

To continue to advance coverage for children, Secretary Sebelius today also announced $40 million in new grants to states, community-based organizations, school systems and others to support their outreach and enrollment activities. The grants will help states further modernize and streamline their administrative systems, as well as create and implement school-based outreach strategies and approaches for identifying children who have historically been hard to reach.

Today's grant announcement builds on $206 million in enrollment bonuses earned by 15 states last year that increased enrollment above specific target levels. The bonus funds help states cover the cost of enrolling additional children in Medicaid.

"As we mark the second anniversary of one of President Obama's first actions as President, we can be confident that CHIPRA has proven to be a tremendous success," said Sebelius. "Now we must build on our accomplishments. Today, I am again calling on leaders across the country - from federal, state and local officials to private sector leaders - to join our effort to insure more children. We all have a stake in America's children and together, we will ensure millions more children get the care they need."

States were able to increase enrollment in the two programs in part because of boosts in federal support provided by the American Recovery and Reinvestment Act (ARRA). ARRA temporarily increased federal matching funds for state Medicaid programs during the recession.

While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level in more than two decades, an estimated five million uninsured children are thought to be eligible for one of these programs, yet not covered.

The Secretary's Challenge: Connecting Kids to Coverage, launched last year, will continue support efforts to reach more children by providing leaders with critical information and support as they work to insure more children in their communities and by closely monitoring progress.

"States' continued progress toward enrolling all eligible children in coverage is a significant step in cushioning the recession's impact on access to health insurance," said Cindy Mann, director of the Center for Medicaid CHIP, and Survey & Certification within the Centers for Medicare & Medicaid Services (CMS). "As families lose employment or have their hours cut back they may lose the health coverage benefit that came with that job. If not for these two programs, millions more children would go without critical health care services."

In its second annual report on CHIP and Medicaid enrollment, CMS notes that:

. More than 2 million children gained Medicaid or CHIP coverage during federal fiscal year 2010 (October 1, 2009 - September 30, 2010). In total, Medicaid and CHIP served more than 42 million children last year. This steady increase in enrollment is evidence of the important role that Medicaid and CHIP play for children, especially during economic downturns. The uninsured rate for children continues to decline at a time with the rate for adults is climbing. The increase in children's enrollment demonstrates that Medicaid and CHIP are serving the purpose for which they were created - providing high quality health coverage for lower-income families.

. Thirteen states implemented eligibility expansions in 2010 and many others simplified their enrollment and renewal procedures. Forty-six states and the District of Columbia now cover children with incomes up to 200 percent of the federal poverty level (FPL) in Medicaid and CHIP; with 24 of those states and the District of Columbia covering children with incomes up to 250 percent of the FPL. Twenty-one states now offer coverage to lawfully residing immigrant children and/or pregnant women, enabling states to receive federal funding for this coverage.

. CHIPRA Performance Bonuses have encouraged states to adopt and augment simplification measures in Medicaid and CHIP. Fifteen states qualified for a total of $206 million in performance bonuses for FY 2010; this is a significant increase over 2009 where 10 states received bonuses totaling $75 million. These bonuses provide additional federal financial support each year to states that successfully boost enrollment above target levels among previously eligible but uninsured children in Medicaid. To qualify, a state not only has to enroll more children, but must also have implemented program features that are designed to promote enrollment of eligible children.

. States are increasing their use of technology to facilitate children's enrollment and retention. Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications. Six states have received approval to enroll children through the "Express Lane Eligibility" option created by CHIPRA. Express lane eligibility allows states to use data gathered for other programs such as housing assistance or food stamps to determine Medicaid or CHIP eligibility. And 33 states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.

. Outreach and enrollment grants have advanced coverage and led to public-private partnerships throughout the country to enroll more children. Sixty-eight grantees across 41 States and the District of Columbia are working diligently to facilitate children's enrollment in health coverage.

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FRC Praises Florida Judge for Striking Down Entire Health Care Law

2011-01-31T22:18:00.002-05:00

Family Research Council praised today's ruling by Federal Judge Roger Vinson of the U.S. District Court for the Northern District of Florida that strikes down the entire health care law that President Obama signed into law in 2010, including the individual mandate. The law mandates that individuals purchase health insurance, and also funds abortion with federal tax dollars.

Family Research Council's amicus brief, drafted by FRC's Special Counsel Ken Klukowski, argued that if the "individual mandate" is unconstitutional, then the entire law must be struck down.

Judge Vinson quoted Klukowski (pg. 32 and footnote 27 on pg. 64) in his opinion. Judge Vinson wrote that he borrowed "heavily"from FRC's amicus brief and said the brief "quite cogently and effectively sets forth the applicable standard and governing analysis of severability." FRC filed the only amicus brief focusing exclusively on how the individual mandate cannot be severed from the law.

Klukowski, who also serves as Director of FRC's Center for Religious Liberty, made the following comments:

"Today's ruling makes clear that as long as the mandate is in place, the entire law rests on an unconstitutional foundation. If the foundation crumbles, the whole law falls.

"We applaud Judge Vinson for striking down the entire law, recognizing that the individual mandate cannot be severed from the other 450 sections of the statute. The individual mandate is the essential heart of this legislation. We are grateful that Judge Vinson agreed with our argument that controlling Supreme Court precedents require striking down the entire law.

"No part of the Constitution empowers the federal government to command American citizens to spend their own personal money to purchase health insurance.

"We urge the Senate to follow the lead of the House of Representatives and move to repeal this unconstitutional law in its entirely, not merely to tinker with various provisions," Klukowski concluded.

Click here to read a DC Examiner opinion piece by FRC Special Counsel Ken Klukowski explaining why Obamacare's individual mandate cannot be severed to save the rest of the law. http://www.frc.org/op-eds/striking-down-individual-mandate-would-mean-ending-obamacare

Click here to read FRC's brief in the multi-state Florida lawsuit. http://www.frc.org/fl-hhs

Sebelius announces three million Medicare beneficiaries have received prescription drug cost relief under the Affordable Care Act

2011-01-21T09:08:00.000-05:00

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that three million Medicare beneficiaries nationwide have received prescription drug cost relief through the Affordable Care Act. To date, three million eligible beneficiaries who fell into the drug coverage gap known as the donut hole during 2010 have been mailed a one-time, tax-free $250 rebate check.

“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”

Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.

Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.

The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:

* As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.

* In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.

* Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.

People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov.

Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.

* An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.

* The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.

· The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.

For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.

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New report: 129 million Americans with a pre-existing condition could be denied coverage without new health reform law

2011-01-18T12:51:00.000-05:00

Health and Human Services Secretary Kathleen Sebelius today released a new analysis showing that, without the Affordable Care Act, up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, would be at risk of losing health insurance when they need it most, or be denied coverage altogether. Under the full range of policies in the Affordable Care Act to be enacted by 2014, Americans living with pre-existing conditions are free from discrimination and can get the health coverage they need, and families are free from the worry of having their insurance cancelled or capped when a family member gets sick, or going broke because of the medical costs of an accident or disease. Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it.

“The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions,” said Secretary Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”

The analysis found that:

· Anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Examples of what may be considered a pre-existing condition include:

· Heart disease

· Cancer

· Asthma

· High blood pressure

· Arthritis

· Older Americans between ages 55 and 64 are at particular risk; 48 to 86 percent of people in that age bracket live with a pre-existing condition.

· 15 to 30 percent of people under age 65 in perfectly good health today are likely to develop a pre-existing condition over the next eight years.

· Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.

Prior to the Affordable Care Act, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36 percent of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.

A number of protections are already in place thanks to the Affordable Care Act. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.

Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those locked out of the insurance market because of a preexisting condition. The PCIP program – which has already saved people’s lives by covering services like chemotherapy – serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition. There is a Pre-existing Condition Insurance Plan available in every state, and more information can be found at www.HealthCare.gov or by calling 1-866-717-5826.

In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through competitive marketplaces called health insurance exchanges.

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New Study: Medicaid Pays Nursing Homes Less Than Minimum Wage

2011-01-12T18:16:00.000-05:00

/PRNewswire/ -- A new study released today finds that Medicaid programs in states across the country underfunded nursing facility care by $5.6 billion in 2010, paying on average $7.17 per hour per patient, less than the nation's current minimum wage of $7.25 per hour. A lifeline for many elderly and disabled, Medicaid funds 64 percent of the care provided in America's skilled nursing facilities nationally.

"This report reveals a truth many would not believe – today's nursing facilities are paid less than the minimum wage," stated Mark Parkinson, President & CEO of the American Health Care Association (AHCA). "That must change if we ever hope to serve the needs of a Baby Boom generation that will only stress our care delivery system further."

Compiled by the research group Eljay -- a nationally-recognized expert in long term care -- the report identifies which states are most affected by the rising pressure on state Medicaid budgets, both in terms of highest aggregate Medicaid underfunding and highest per patient per day underfunding. States topping those lists are New York, Illinois, Massachusetts, Minnesota, New Jersey and Wisconsin.

Nursing home providers are often forced to rely on funding from other sources – primarily Medicare – to fill in the funding gaps resulting from inadequate Medicaid payments. With so many of the nation's governors facing difficult choices surrounding budget cuts, Parkinson cautioned at the danger of allowing an already squeezed Medicare system to prop up Medicaid payment rates.

"There is a vast gap between the actual cost of providing quality eldercare and what the Medicaid program truly finances," Parkinson stated. "As Baby Boomers begin to ponder their long term care needs in the future, it is simply unsustainable for Medicare to continue filling that financial gap. As current trends indicate, this problem will only grow worse in the coming years."

The following charts highlight the states with the largest aggregate Medicaid underfunding and largest per patient per day underfunding:

Largest aggregate Medicaid underfunding

1. New York - $1,396,494,595
2. Illinois - $378,779,709
3. Massachusetts - $310,871,237
4. New Jersey - $304,430,314
5. California - $288,599,289
6. Pennsylvania - $277,609,403
7. Ohio - $248,513,290
8. Wisconsin - $181,237,562
9. Minnesota - $151,611,752
10. Missouri - $137,412,649

Largest Medicaid per patient day underfunding:

1. New York - $47.95
2. New Hampshire - $31.25
3. Massachusetts - $31.22
4. New Jersey - $29.29
5. Washington - $28.18
6. Wisconsin - $26.54
7. Minnesota - $24.70
8. Wyoming - $23.67
9. Delaware - $22.86
10. Illinois - $21.95

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Long Term Care Pharmacy Alliance Concerned with Proposed CMS Rule; New Study Confirms LTCPA Position

2011-01-12T12:21:00.000-05:00

/PRNewswire/ -- The Long Term Care Pharmacy Alliance (LTCPA) expressed concern with CMS's proposed rule on short-cycle dispensing within the long-term care (LTC) setting. In comments submitted to CMS Tuesday, LTCPA explained that any cost savings generated by implementing a short-cycle, 7-day fill dispensing regimen, would be overwhelmingly eliminated by additional dispensing fees resulting from the quadrupling the number of dispenses needed to move from 30-day to 7-day cycles.

A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.

"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.

The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.

In addition to the increased cost to payers, other key findings included:

* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.

In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.

In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.

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With Federal Support, States Hold Steady in Medicaid and CHIP Coverage Policies for Low-Income Children and Families Despite Recession

2011-01-11T10:12:00.000-05:00

/PRNewswire/ -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children's Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs' ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU).

The 10th annual KCMU 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, this year conducted with the Georgetown University Center for Children and Families, found that coverage policies held steady or in some cases expanded, particularly for low-income children. However, eligibility for their parents and other low-income adults continued to lag behind. The stability of such programs during a recession that has produced sharp increases in unemployment and declines in state tax revenues arises in large part from the temporary federal fiscal relief for Medicaid provided by the American Recovery and Reinvestment Act of 2009 (ARRA).

That enhanced federal assistance, which will end in July, was tied to requirements for states to maintain Medicaid coverage policies. To help provide a base for the future Medicaid expansion, the health reform law also requires states to maintain public coverage for adults until broader health reform goes into effect in 2014 and until 2019 for children. However, in the coming year states continue to face significant budget pressures as demand for the programs remains high and state revenues continue to be depressed amidst the slow economic recovery.

"Millions of American families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. "Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured, and will be key to ensuring the success of health reform implementation over the next few years."

Coverage Policies Held Steady or Expanded in 2010, Especially For Children

The survey found that 49 states, including D.C., held steady or made targeted improvements in their Medicaid and CHIP eligibility rules and enrollment procedures. A total of 13 states expanded eligibility, largely for children, and 14 states made improvements in enrollment and renewal procedures to reduce burdens on families and streamline administrative processes.

Without the enhanced federal funding and maintenance-of-effort requirements in the ARRA and health reform laws, it is likely that more states would have made cutbacks in coverage to cope with budget pressures. Two states -- Arizona and New Jersey -- did make reductions that were not subject to the requirements in the laws.

Coverage for Low-Income Adults Continues to Lag Behind

The survey finds that as of January 1, 2011, 25 states, including D.C., cover children in families with incomes at least up to 250 percent of the federal poverty level ($45,775 for a family of three in 2010), continuing a decade of progress in covering children. However, coverage for their parents lags behind. The median Medicaid eligibility threshold for parents nationally remains at 64 percent of the federal poverty level, and 16 states limit eligibility for parents to those in families that earn below 50 percent of the federal poverty level ($9,155 for a family of three in 2010).

Until health reform passed, states could not cover adults without dependent children in Medicaid programs without a waiver. The new law ends the historic exclusion of these adults through a Medicaid eligibility expansion to a national floor of 133 percent of the federal poverty level ($24,352 for a family of three and $14,404 for an individual in 2010). Although the law won't take full effect until 2014, last year Connecticut and D.C. took advantage of the new option to begin covering these adults by moving into Medicaid low-income adults whom they had previously covered only with state and local dollars. Also, California received approval for a waiver to continue and expand county initiatives that cover low-income adults. A few other states, including Minnesota, also have pending plans to take advantage of the new option to provide Medicaid coverage to adults. Even with these efforts, as of January 1, only seven states (Arizona, Connecticut, Delaware, D.C., Hawaii, New York and Vermont) provided Medicaid or Medicaid-equivalent benefits to adults without dependent children.

In the absence of further expansions over the next couple of years, most uninsured, low-income adults will remain unable to qualify for Medicaid until health reform goes into effect in 2014.

States are Incorporating Technology into Their Programs, but Have More Work Ahead

The survey finds that states continue to adopt technology to modernize their programs. Many of these improvements have helped to reduce barriers to enrollment and renewal for families, while also streamlining administrative processes and achieving administrative efficiencies. For example, about half of the states (29) took advantage of a new option to rely on an electronic data match with the Social Security Administration to more efficiently and accurately verify citizenship status of applicants for Medicaid and CHIP. The survey also found states making progress in using electronic data matches to verify other aspects of eligibility.

Yet states still have a significant amount of work to do, the survey finds. The new health reform law calls upon states to implement an integrated, web-based, technology-driven enrollment process for Medicaid, CHIP, and coverage in the new health insurance Exchanges. While all states make their Medicaid application available online, only slightly more than half (29) allow for the application to be electronically submitted with an electronic signature and most of these still require families to submit paper documentation via mail or fax. In light of a rule proposed by the Administration at the end of 2010 to provide states with a 90% federal matching rate to prepare their Medicaid eligibility systems for health reform, new grant funding, and the likelihood of additional guidance and funding opportunities in the months ahead, more activity in this area is expected in the coming year.

Today's report, Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010-2011, and related materials from today's public briefing on the survey findings, are available online at: http://www.kff.org/medicaid/Medicaid-CHIP-Coverage-Recession-Health-Reform.cfm. In addition, an archived webcast of a public briefing will be available on the website after 4 p.m. ET today.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.

The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.

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Shocking! 80 Million Swamp Medicare by 2030

2011-01-11T10:04:00.000-05:00

Baby boomers skyrocket costs to $1 trillion/year by 2020

While the Obama administration very quietly backed off making end-of-life consultations party of the annual Medicare doctor-patient discussion, the coming swell of baby boomers leaves little doubt that Medicare will be able to continue operating unless government-paid health-care services are rationed, as the largest number of seniors ever to retire in America begins retiring this year.

"It's been a long, strange trip from Woodstock to the nursing home, but baby boomers are getting there - and soon," wrote Health Day reporter Amanda Gardner in Bloomberg Businessweek.

In 2011, the first round of baby boomers born in 1946 begins turning 65 and qualifying for Medicare, at a rate of approximately one every eight seconds.

In total, approximately 76 million baby boomers are expected to go on Medicare, with the result that Medicare will grow from 47 million today to 80 million in 2030, even factoring in death rates over that period, USA Today reported.

At the same time, health-care costs are expected to accelerate in coming years, with the result that Medicare is projected to cost nearly $1 trillion a year by 2020, an 80 percent increase over today.

Not enough doctors

According to Dr. Bruce Koeppen, founding dean of Quinnipiac University School of Medicine in Hamden, Conn., the problem is also that 40 percent of physicians themselves are approaching retirement and are becoming eligible for Medicare.

According to the American Geriatrics Society, there are now 7,029 board-certified geriatricians in the United States, or about one for every 2,699 Americans aged 75 or older, Gardner reported in her article. But that ratio is expected to drop to one geriatrician per 5,549 seniors by 2030.

Obamacare is also certain to produce a shortage among primary-care givers in health services as millions of Americans are instructed they have an entitlement "right" to government-paid medical care.

Even today, many physicians in private practice do not take Medicare patients because it's not profitable to do so.

This situation is certain to become even worse if Obamacare results in the 2011 cuts to Medicare that are called for in the legislation.

Medicare faces trillions of dollars in unfunded obligations

WND has also reported that the true negative net worth of the federal government was $70.7 trillion in 2009, largely because of unfunded obligations in Social Security, Medicare and Medicaid.

In other words, the total U.S. obligations, including Social Security and Medicare benefits to be paid in the future, have effectively placed the U.S. government in bankruptcy, even before we take into consideration any future and continuing social welfare obligations that may be embedded within the Obama administration's planned massive overhaul of health care.

Under cash accounting, the government makes no provisions for the future Social Security and Medicare benefits in the year in which those benefits accrue.

The approximately 76 million U.S. children born between 1945 and 1964 represent some 28 percent of the U.S. population.

"Simply said, holding revenues constant, required Medicare, Medicaid and Social Security spending and the related deficit financing costs will far exceed the Government's ability to pay," the Citizens' Guide to the 2007 Financial Report of the United States Government concluded.

The Congressional Budget Office notes that in 2010, 21 percent of federal spending went to Medicare and Medicaid, with the expectation that 31 percent of the federal budget will be spent on the two programs by 2020, as reported by CBS MoneyWatch.com.

The problem is that there is no end in sight

The CBO also estimates that spending on Medicare and Medicaid will grow from 7 percent of U.S. gross domestic product in 2020 to 12 percent in 2050.

Even with Medicare, retirees will need substantial personal financial resources to cover medical-care costs.

The Employee Benefit Research Institute has estimated that to have a 90 percent chance of having enough savings to cover health costs in retirement, a man would need $211,000 in personal savings that can be applied to cover health costs and a woman would need $242,000, if no former employer were available to subsidize private health insurance to supplement Medicare in retirement.

By Dr. Jerome Corsi
(c) 2010 RedAlert.WND.com

Reprinted with permission.

ABOUT THE AUTHOR: Jerome R. Corsi received a Ph.D. from Harvard University in political science in 1972. He is the author of the #1 New York Times bestselling books THE OBAMA NATION: LEFTIST POLITICS AND THE CULT OF PERSONALITY and the co-author of UNFIT FOR COMMAND: SWIFT BOAT VETERANS SPEAK OUT AGAINST JOHN KERRY. He is also the author of AMERICA FOR SALE, THE LATE GREAT U.S.A., and WHY ISRAEL CAN'T WAIT. Currently, Dr. Corsi is a Senior Managing Director in the Financial Services Group at Gilford Securities as well as a senior staff writer for WorldNetDaily.com.

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New Affordable Care Act rules shed light on high health insurance rate hikes

2010-12-21T10:08:00.000-05:00

New proposed Affordable Care Act regulations announced today by the U.S. Department of Health and Human Services (HHS) will bring new transparency and scrutiny to proposed health insurance rate increases. These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

“Year after year, insurance company profits soar, while Americans pay more for less health care coverage,” said Secretary Sebelius. “The Affordable Care Act is bringing unprecedented transparency and oversight to insurance premiums to help reign in the kind of excessive and unreasonable rate increases that have made insurance unaffordable for so many families.”

Health insurance premiums have risen rapidly over the past decade, straining pocketbooks for American families and businesses. Since 1999, average premiums for family coverage have risen 131 percent.

The Affordable Care Act has already begun to help states strengthen or create rate review processes. On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the health reform law makes available to states to take action against insurers seeking unreasonable rate hikes.

Today’s proposed regulations will build on these efforts by requiring insurers in all states to publicly justify any unreasonable rate increases beginning in 2011. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable. After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state. Insurance company’s justifications for unreasonable increases will be posted on HealthCare.gov and the insurance plan’s website.

“The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified,” said Jay Angoff, director of HHS’ Office of Consumer Information and Insurance Oversight.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them. Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes.

In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.

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60 Participants in Fulton County Retirement Plan Take Advantage of MassMutual's LifeBridge(SM) Free Life Insurance Program

2010-12-08T11:01:00.000-05:00

/PRNewswire/ -- As part of MassMutual's LifeBridge(SM) Free Life Insurance Program, 11,500 individuals across the country have received $575 million in free life insurance, including employees of Fulton County, Georgia. To date, the program has provided 60 participants in the Fulton County Defined Contribution 401(a) Plan each with a $50,000 free term life insurance policy, totaling $3 million in free coverage from MassMutual.

Under the program, MassMutual pays all insurance premiums for a $50,000 10-year term life insurance policy. If an insured parent or legal guardian dies during the term of the policy, $50,000 will be put in trust to pay the educational expenses of his or her children. The program is available to all parents between the ages of 19 and 42 who meet the criteria of the program. Individuals need not participate in a retirement plan administered by MassMutual or be a client of MassMutual's to apply.

"MassMutual offers this great program, not just to its retirement plan clients, but to any working parent in the country who qualifies. Our MassMutual retirement plan relationship manager made us aware of this program and we're thrilled that so many of our employees have been able to take advantage of it," says Tammy Goebeler, Investment Officer of Fulton County. "As a parent, you want the best education possible for your children. This program can give a parent peace of mind in the event that something unexpected happens. Our hope is that other working parents in our community will explore the LifeBridge Program and take advantage of this great program as well," says Goebeler.

"We're pleased that so many Fulton County employees were able to take advantage of this great program," says Elaine Sarsynski, executive vice president of MassMutual's Retirement Services Division and chairman and CEO of MassMutual International LLC. "By offering group meetings for its employees, Fulton County has helped raise awareness of this valuable free life insurance program among its retirement plan participants. We encourage every MassMutual retirement plan sponsor to inform their employees about the availability of the LifeBridge program," she adds.

MassMutual also offers a convenient onsite application event for large groups. For more information about the LifeBridge Free Life Insurance Program, please call (800) 272-2216 or visit www.massmutual.com/lifebridge. Existing MassMutual Retirement Services clients interested in learning more about the program can also request information from their MassMutual relationship manager.

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State-Run Property Insurers Lose Customers but Gain Risk

2010-11-29T11:00:00.000-05:00

/PRNewswire/ -- Florida and Louisiana have reduced the number of high-risk policyholders covered by their state-run property insurers of last resort since 2008 while still leaving non-coastal property owners vulnerable to paying for these same insurers' potential coastal losses, according to the Insurance Information Institute's (I.I.I.) recently updated Residual Market Property Plans: From Markets of Last Resort to Markets of First Choice.

Florida Citizens Property Insurance Corporation, the largest property insurer of last resort in the U.S., provides insurance to residential and commercial property owners unable to purchase coverage in the standard market. Yet Florida Citizens saw the number of its total policies in force drop to 1.2 million at year-end 2009, down 14 percent from 1.4 million at year-end 2008. Meanwhile, Louisiana Citizens Property Insurance Corporation, the fourth largest state-run property insurer of last resort in the U.S. in terms of total policies in force behind Texas and Massachusetts, has seen an even more dramatic reduction in its total policy count. Louisiana Citizens had about 165,000 policies in force in June 2008, a figure that dropped to 127,000 policies as of June 2010, a reduction of around 40 percent.

"However, this year's report by the Insurance Information Institute, like the reports of the last two years, records the ongoing growth in the exposure base of the residual market property insurers along with the still-precarious financial condition of some plans. This growth comes despite a collapse in the housing sector that has brought development in many catastrophe-prone areas to a near standstill," write the report's co-authors, Dr. Robert Hartwig, president of the I.I.I. and an economist, and Claire Wilkinson, vice president of Global Issues at the I.I.I.

The I.I.I. estimates that, even as the number of policyholders in Florida, Louisiana and the 32 other Fair Access to Insurance Requirements (FAIR) Plans for which data are available dropped to 2.47 million from 2.62 million between 2008 and 2009, their cumulative exposure to loss grew to $614.9 billion in 2009 from $612.7 billion in 2008. The nation's FAIR plans account for by far the majority of policies and exposure in the U.S. overall residual property market. But when the FAIR Plan exposures are added to those incurred by Beach and Windstorm Plans, such as those in place in states such as Alabama and Mississippi, the U.S. residual market exposure to loss grows to $703 billion (2009) from $696 billion, according to the Property Insurance Plans Service Office (PIPSO).

"As long as [these] plans continue to grow, state finances will remain under threat and ultimately taxpayers, many of whom live nowhere near the coast, will continue to face the prospect of increased assessments in the years ahead," Dr. Hartwig and Ms. Wilkinson state.

Since state property insurers of last resort often charge premium rates that do not reflect the risk they are incurring on the policyholder's behalf, the claims paying capacity of FAIR, Beach or Windstorm Plans is relatively limited, and often exhausted quickly in the event of a severe storm. Should this occur, a number of capital-raising options are available to state-run property insurers. The two main options—levying assessments on all policyholders and issuing bonds that must be paid back by all state taxpayers—often result in higher costs for all of the state's policyholders, no matter where they live, as these costs are passed along in the form of premium surcharges or higher taxes. Every homeowners insurer doing business in a particular state is generally a member of a state-run residual market program, just as auto insurers join forces to spread the risks involved in covering problematic drivers through assigned risk programs.

"Increasingly plans are being bailed out by a diversion of tax revenues," the I.I.I. report states, pointing to the fact that in 2008, after Hurricane Ike struck the Texas coastline, $230 million of the $430 million in assessments incurred by the Texas Windstorm Insurance Association's (TWIA) member insurers were subject to premium tax credits. TWIA is the state's insurer of last resort for wind and hail coverage in 14 coastal Texas counties and parts of Harris County.

The report also notes that Mississippi enacted legislation in 2007 to allow a one-time diversion of $80 million in federal and state funds to the Mississippi Windstorm Underwriting Association (MWUA), one of the state's two residual market plans, to boost the MWUA's reserves for windstorm damage claims and protect MWUA policyholders against rate increases.

The I.I.I. report also offers a detailed analysis of the residual market plans in North Carolina and South Carolina, as well as the states cited previously, a list which includes Florida, Louisiana, Massachusetts, Texas, Alabama and Mississippi. Policymakers and other interested parties seeking an update on the pending federal pieces of legislation on the issue of natural catastrophe risk should consult the I.I.I. report's Appendix, which can be found on the final two pages of the 51-page document.

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New Affordable Care Act rules give consumers better value for insurance premiums

2010-11-27T11:57:00.000-05:00

New regulations issued November 22 by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money.

“Thanks to the Affordable Care Act, millions of Americans will get better value for their health insurance premium dollar,” said HHS Secretary Kathleen Sebelius. “These new rules are an important step to hold insurance companies accountable and increase value for consumers.”

Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the Affordable Care Act, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs, starting in 2011. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.

In 2011, the new rules will protect up to 74.8 million insured Americans and estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Average rebates per person could total $164 in the individual market. Important details regarding the new regulation are included below.

The medical loss ratio regulation outlines disclosure and reporting requirements, how insurance companies will calculate their medical loss ratio and provide rebates, and how adjustments could be made to the medical loss ratio standard to guard against market destabilization.

Beginning in 2011, the law requires that insurance companies publicly report how they spend premium dollars, providing meaningful information to consumers. Also beginning in 2011, insurers are required to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies that are not meeting the medical loss ratio standard will be required to provide rebates to their consumers. Insurers will be required to make the first round of rebates to consumers in 2012.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the States, and other key stakeholders,” said Jay Angoff, director of the Office of Consumer Information and Insurance Oversight at HHS. “As we build a bridge to 2014, when better, more affordable options are available to consumers, these rules will help make health insurance fairer for consumers now.”

The Affordable Care Act required the National Association of Insurance Commissioners (NAIC) to develop uniform definitions and methodologies for calculating insurance companies’ medical loss ratios. Insurance commissioners in every State have a responsibility to protect the interests of the general public, policyholders, and enrollees within their respective States. Today’s regulation certifies and adopts the recommendations submitted to the Secretary of HHS on October 27, 2010 by the NAIC. It also incorporates recommendations from a letter sent to the Secretary by the NAIC on October 13, 2010.

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Misleading Postcards Are Not From Medicare

2010-11-19T22:50:00.000-05:00

The Department of Human Services urges older adults to be on the alert for misleading post cards titled “Important: Projected Medicare Changes.” The cards are sent on behalf of insurance salespeople and are not endorsed by Medicare.

“Private insurance companies request signatures, ages, and other details on these post cards and then use the information to make sales calls and visits to people’s homes,” said Dr. James J. Bulot, Director of the Georgia Department of Human Services (DHS) Division of Aging Services. “If consumers have questions about Medicare changes, they should contact the GeorgiaCares network.”

The GeorgiaCares State Health Insurance Assistance Program (SHIP) offers individuals free, one-on-one help provided by trained local counselors. The program is managed statewide by the DHS Division of Aging Services and Georgia’s 12 Area Agencies on Aging. To contact GeorgiaCares, call 1-800-669-8387 toll-free or visit www.MyGeorgiaCares.org.

Callers may request personalized information about Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, the resolution of billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.

The GeorgiaCares team is ready to answer questions now about open enrollment for Medicare Part C (prescription drug coverage) and Part D (Medicare Advantage plans). Enrollment began November 15th, and recipients will have until December 31, 2010, to make their choices. After this period, beneficiaries may make limited changes during the annual Disenrollment Period of January 1 - February 14th of each year. Beneficiaries who do not want to make a change can remain in their plan from 2010.

GeorgiaCares SHIP counselors will answer hotline calls from individuals and provide community education sessions for any group throughout the state to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.

GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.

For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
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Many Important Health Insurance Choices Must Be Made Now in Georgia

2010-11-17T20:28:00.000-05:00

PRNewswire/ -- For employees who work for companies that offer health insurance benefits through late November/early December, this is usually the time when important health plan decisions must be made for the upcoming year - 2011. Interestingly, studies show consumers typically spend more time researching car and computer purchases than they do when selecting a health insurance plan. These studies also indicate that most people spend an hour or less reviewing their insurance plan options and often default to the plan they had the previous year.

With health care reform changes in the mix, the comprehensive long-term impact is still uncertain. Nevertheless, employees must make educated and well-thought-out decisions for their 2011 benefits now, using the information that is currently available to them. Equally important, employers must do everything they can to provide their employees with the information necessary to make an informed decision. And, since open enrollment season is upon us, this is the best time to share tips to help employees navigate through the choices they must make.

Many of Georgia's companies offer more than one health insurance plan option, which typically have different costs to the employees, both in the amount deducted from their paychecks and the total cost of the coverage for deductibles, co-pays and co-insurance during the course of the year. In addition, many employers are offering base coverage plans and then offer a 'buy up' plan option where employees can purchase additional coverage not covered by the employer.

"It's a mistake not to review your health plan options each year and carefully weigh which plan will be the best fit for you and your family," said Morgan Kendrick, President, Blue Cross and Blue Shield of Georgia (BCBSGa) who noted that often consumers choose the plan that has the least impact on their paycheck when that option may not be the best choice overall.

Plans with higher monthly premiums and lower co-pays and deductibles might be best for those who anticipate using a lot of health care services throughout the course of the year. On the other hand, young and healthy employees without kids might save more with a plan that features low premiums and a high deductible.

We encourage employers to provide their employees with the tools and resources needed to help them make informed decisions about their health care coverage. Below are a few things employers can do to make this process easier:

1. Encourage Healthy Behaviors. Research shows that approximately 85 percent of ill health comes from poor health choices. Therefore, open enrollment provides a great opportunity for the promotion of health and wellness programs and incentives, including smoking cessation or weight management courses, gym subsidies, etc. Not only will this help contain company costs long-term, it also helps employees feel and perform better.
2. Hold open enrollment meetings. If possible, make them mandatory, but make them fun and interactive. Bring in an account manager from your insurance carrier or have an onsite benefits manager/HR representative explain the various health care options and answer questions on-the-spot.
3. Avoid acronyms when communicating with employees. Use simple terms and definitions, and communicate early and often. An Institute of Medicine report showed that nearly half of all U.S. adults have difficulty understanding healthcare benefits information. As a result, the materials go unread and plan selections are made haphazardly.
4. Help Familiarize Employees with Consumer-Driven Health Plans (CDHPs). CDHPs continue to gain popularity because they help employers and employees control health care costs. CDHPs provide you with health account options to help you pay for the costs of health care such as Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). Companies that are the most successful in introducing and migrating to CDHPs take time to explain these plans to employees up front, which usually results in higher adoption rates.

Here are some items employees should keep in mind when choosing a health insurance plan:

1. Do your homework and take advantage of the tools offered to you. If your company holds open enrollment meetings, attend at least one and be prepared with questions. Take the information home and review the details in a more relaxed environment. Make sure to follow up with your company benefits advisor if you have additional questions – that's what the benefits advisor is there for.
2. Understand and learn what basic health insurance terms mean. Use online tools provided by your current health plan or other tools such as www.wikipedia.org as a reference. For example, make sure you can answer the following:
-What is the difference between co-payment and co-insurance?
-What does deductible mean and how could it impact your out-of-pocket costs?
-What does it mean to seek "out-of-network" services?
3. Examine your family's past health care spending. An excellent way to determine a good plan fit for 2010 is to understand what health care services your family used in 2010 and take into consideration what expenses may occur in the coming year—like having a child or if you will have to deal with a chronic health condition like diabetes.
4. Before continuing on your current plan, read the details. What you signed up for last year may have changed. Have the co-pays and deductibles increased? Often employers will adjust these levels as a result of the increasing cost of health care services. Pay attention to the details in order to avoid surprises down the line.
5. Verify in advance that your physician and hospital are part of the network for the plan you are choosing. This is especially important if the insurance company is changing or if you are switching to a different health plan.
6. Take advantage of your HSA, HRA or Flexible Spending Account (FSA) if appropriate. Make sure you understand the difference between an HSA, HIA, HRA and an FSA, as well as any changes in access to these funds, for example, FSA accounts have new prescription requirements surrounding over-the-counter medications.

"In the past, consumers may have quickly looked over their benefit options and made a selection without seriously considering the comprehensive financial impact it could have on them and their family," said Kendrick. "But this year, with the additional economic pressures consumers are facing and new health care reform mandates, it makes sense to really study all plan options in order to make the best choice to meet their needs."

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Good News for National Diabetes Month: People with Type 1 Diabetes Have Better Life Insurance, Long Term Care Insurance Options

2010-11-17T07:07:00.000-05:00

(BUSINESS WIRE)--During National Diabetes Month, there is good news about insurance options for people living with type 1 diabetes. “Many people who in the past have been declined life insurance and long-term care insurance (LTC) solely on the basis of their type 1 diabetes diagnosis are now seeing some of the barriers come down,” said Danny Mensh, president of Mensh Insurance “Under certain circumstances, several major carriers are now willing to underwrite and issue both long-term care insurance and term life insurance policies.”

In the past, insurance carriers did not know how to price the risk on life insurance and long-term care insurance for people with type 1 diabetes and automatically declined their applications. However, within the last 24 to 36 months, the insurance industry has become more lenient on this chronic condition. “Due to improved medications, advancements in the manner in which they are distributed and more precise blood sugar level monitoring, underwriters are increasingly more comfortable with the longer life prospects and health maintenance of those with stable histories of type 1 diabetes,” Mensh said.

Some of the basic underwriting criteria for issuing policies to a person with type 1 diabetes include:

* Controlled A1c < 8
* < 60 units of insulin
* Controlled height and weight
* Average fasting blood sugar < 200
* Blood pressure, 140/90
* No transient ischemic attacks (TIAs) within past five years
* No smoking within last two years
* No cardiac complications or retinopathy associated with eye impairments
* No chronic steroid usage

“Many people with type 1 diabetes are very stable and can easily demonstrate via medical records that they should qualify for approval from major insurance carriers,” Mensh said. “It has been exciting to open up the options for future financial planning to people with this chronic condition.”

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Open Enrollment for 2011 Medicare prescription drug and health plans begins Nov. 15th

2010-11-15T11:43:00.000-05:00

The Centers for Medicare & Medicaid Services (CMS) is encouraging all Medicare beneficiaries to take advantage of the annual Open Enrollment period to make sure they have the best coverage available to meet their health care needs in 2011.

The Medicare Open Enrollment Period this year begins on November 15th and runs through December 31st. During the Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meet their needs.

"The Affordable Care Act will make Medicare stronger and more sustainable. There will be new benefits available to nearly every person with Medicare starting in January 2011, including free annual wellness visits and free recommended preventive services like mammograms and colonoscopies. Seniors who fall into the donut hole in 2011 will be eligible for a 50 percent discount on brand-name prescription drugs. These new benefits make this year's Medicare Open Enrollment Period especially important," said HHS Secretary Kathleen Sebelius. "Every year, the Medicare Open Enrollment Period gives Medicare beneficiaries a chance to evaluate their current plans and see what other options might be out there that serve their needs, especially if their health status has changed. Those enrolled in Medicare can think of the Open Enrollment Period as a yearly coverage "check-up." It is important for people with Medicare to look closely at their plan, look at the options available to them, consider their health status, and find what works for them."

"There's never been a better time for Medicare beneficiaries to check out their Medicare coverage," said CMS Administrator Donald Berwick, M.D. "With better plan choices available for 2011, Medicare beneficiaries can think of Open Enrollment as their yearly coverage 'check-up'."

"During Open Enrollment, AoA's national network of community-based organizations will work with seniors, individuals with disabilities and their caregivers across the country to help them understand the new benefits available under the Affordable Care

Act," said Kathy Greenlee, Assistant Secretary for Aging. "In addition, we urge seniors to protect themselves from potential fraud and identity theft. We know there are people who use this time to scam seniors and rip off Medicare. Seniors should protect their Medicare number the same way they do their Social Security number or credit cards."

Resources for Medicare Beneficiaries
People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:

. Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder and Medicare Options Compare tools have been enhanced for an efficient review of plan choices. Multilingual Open Enrollment information and counseling is available.

. Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048.

. Reviewing the 2011 Medicare &You handbook. It is also accessible at www.medicare gov and has been mailed to the homes of people with Medicare benefits.

. Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
o At http://www.medicare.gov/contacts/organization-search-criteria.aspx or
o On the back of the 2011 Medicare &You handbook or;
o By calling Medicare at 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048)
o Through a listing of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp

Medicare beneficiaries who cannot meet the costs of prescription drugs may be eligible for additional resources. Based on eligibility for "extra help," some people Medicare will pay no more than $2.50 for each generic drug and no more than $6.30 for each name brand drug. The program, called Medicare's Limited Income Newly Eligible Transition (NET) Program, can also help pay for premiums and other out-of-pocket costs.

There is no cost to apply for this extra help. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Protecting Against Fraud and Identity Theft

The new health care law also provides better tools to help fight waste, fraud and abuse to help protect Medicare. CMS offers tips to help beneficiaries protect themselves against fraud and identity theft during the Open Enrollment period. Medicare recommends thatpeople treat their Medicare number as they do their social security number and credit card information.

Beneficiaries should not give personal information to anyone arriving to their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). More information is available at www.stopmedicarefraud.gov.

More information is available at www.healthcare.gov, a new web portal from the U.S. Department of Health and Human Services.

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Humana to Offer Savings and Broad Choice with 2011 Medicare Plans

2010-11-12T10:07:00.000-05:00

(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) will offer a wide variety of Medicare Advantage (MA) and Prescription Drug Plans (PDP) to people with Medicare in 2011, including the new Humana Walmart-Preferred Rx Plan (PDP) that offers the nation’s lowest monthly premium in all 50 states and Washington, D.C.

Humana will offer people with Medicare choices that include MA plans with more benefits than Original Medicare, an affordable monthly premium, an extensive list of doctors in many areas, and predictable costs that are easy to budget.

The Annual Election Period when Medicare beneficiaries will select their Medicare coverage for 2011 runs from Nov. 15 through Dec. 31, 2010. In recent years, people with Medicare were allowed to change plans during the first three months of the year. Beginning in 2011, the January-to-March enrollment period has been eliminated.

“At a time when people are still coping with the impact of our challenging economy, especially senior citizens and disabled people living on a fixed income, it is critical to have medical and prescription-drug coverage that’s affordable,” said Tom Liston, senior vice president, senior products, and the leader of Humana’s Medicare organization. “Humana continues to offer a variety of choices across the country enabling Medicare beneficiaries to select a plan that meets their needs while receiving comprehensive benefits and value people have come to expect from Humana.”

Medicare Advantage Plans

Humana’s MA plans can help people get more out of their health care dollar. Most Humana MA plans:

* Offer additional benefits beyond Original Medicare
* Have copayments offering predictable costs that are easy to budget no matter which health care services are used
* Come with worldwide coverage for emergency care

With drug coverage, health-and-wellness offerings and disease-management programs also available with MA coverage, Humana MA plans remain an excellent value in 2011. Plans, benefits and premiums vary by state and county. Plans include local and regional PPO plans, as well as HMO and Private Fee-For-Service plans. Humana is committed to informing its members of the various benefits and savings options that are available to them for 2011. All Humana MA plans have annual out-of-pocket maximums in 2011, protecting beneficiaries against catastrophic costs.

Benefits with most Humana MA plans include:

* Care coordination and disease-management programs
* Affordable deductibles
* Affordable copayments
* 24-hour nurse hotline
* SmartSummary Rx benefits statement (available to both MA and PDP members)
* No-cost preventive services
* No-cost diabetic-monitoring supplies, including test strips, lancets and glucometers

Well-Being Benefits for Members

Humana is dedicated to supporting its Medicare members on their lifelong pursuit of well-being. As evidence of this commitment, most Humana MA members enjoy access to programs that encourage healthy behaviors such as gym memberships through SilverSneakers or Silver & Fit, and the WellDine Food Program, which delivers meals following a hospitalization. Over the long-term, these programs aid members in achieving a greater quality of life.

Prescription Drug Plans

In all 50 states, Washington, D.C. and Puerto Rico, Humana offers stand-alone PDPs, meaning they’re separate from Medicare medical coverage. Stand-alone PDPs enable people with Medicare to add drug coverage to their Original Medicare coverage.

New this year is the Humana Walmart-Preferred Rx Plan, which features a monthly premium of just $14.80, making it the lowest-premium plan available in all 50 states and Washington D.C. Copayments start at just $2 for preferred generic prescriptions filled at any Walmart, Sam’s Club or Neighborhood Market pharmacy. Copayments of $0 are available for many generic drugs filled via Humana’s home-delivery (mail-order) pharmacy, RightSource. Humana and Walmart estimate that the new co-branded plan will save members an average of more than $450 a year.

People with Medicare who prefer first-dollar coverage (no annual deductible) for preferred generics and a broader network of pharmacies should consider Humana’s Enhanced PDP Plan. With more than 62,000 pharmacies in Humana’s national pharmacy network, and $0 copayments for many generic drugs when using mail-order, this plan typically appeals to people who want that additional coverage.

Also New in 2011

In addition to the new Humana Walmart-Preferred Rx Plan (PDP), Humana is offering new MA plan options in multiple markets across the U.S. Here’s an overview of the various plan options Humana is offering for 2011:

* HMO plans in 27 states and Puerto Rico
* Local PPO plans in 39 states and Puerto Rico
* Regional PPO plans in 23 states (in 14 Medicare Advantage regions)
* Full−network Private Fee-for-Service (PFFS) plans in 34 states. All services are available in and out of network, taking full advantage of any Humana contracted discounts when the member uses in-network providers.
* Partial-network PFFS plans (networked for ancillary services only) in 28 states
* Non-network PFFS plans in 2 states
* PDP offerings approved for 2011 are statewide in 50 states, the District of Columbia and Puerto Rico and include the new nationwide PDP co-branded with Walmart.

For more information about Humana’s 2010 Medicare offerings, visit www.humana-medicare.com or call toll free 1-800-611-1481. TTY users call 1-877-833-4486.

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New report shows Affordable Care Act savings of $3,500 for Medicare beneficiaries

2010-11-05T09:34:00.000-05:00

A new analysis issued today (November 4) by the U.S. Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher - as much as $12,300 over the next 10 years - for seniors and people with disabilities who have high prescription drug costs.

"The Affordable Care Act makes Medicare stronger and reduces the burden of health care costs on some of our most vulnerable citizens," said Secretary Kathleen Sebelius. "The law improves benefits for seniors and people with beneficiaries who rely on Medicare and ensures that Medicare will be there for current and future generations by extending the life of the Medicare Trust Fund. These benefits and savings are only possible with the continued implementation of the Affordable Care Act."

The analysis, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), shows that the Affordable Care Act helps lower costs for those on Medicare by slowing the growth of cost-sharing in Medicare. Closing the Part D coverage gap known as the "donut hole" will produce the greatest cost savings. Already, more than 1.8 million seniors and people with disabilities who have reached the donut hole in 2010 received a one-time $250 rebate check, and checks will continue to be distributed to those who enter the donut hole this year. Next year, people in the donut hole will receive 50 percent discounts on covered brand name Part D prescription drugs. Also starting next year, seniors and people with disabilities on Medicare will have access to a number of recommended preventive services and annual wellness visits at no additional cost.

Although all seniors and people with disabilities in Medicare are likely to see savings, the savings will be greatest for those with costly medical conditions or high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary with spending in the donut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020.

"The savings that seniors and people with disabilities on Medicare are seeing are due to critical improvements the Affordable Care Act makes to Medicare," said Assistant Secretary for Planning and Evaluation, Sherry Glied. "Reducing waste, fraud and abuse, improving the quality of care beneficiaries receive, and making the program more efficient all contribute to lower cost increases across the system."

The full analysis is available at http://www.healthcare.gov/center/reports/affordablecareact.html.

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What Now, for Health Reform?

2010-11-04T08:10:00.000-05:00

/PRNewswire/ -- The following is released by Lockton:

Human resource and benefits managers--and perhaps a lot of CEOs and CFOs--who in recent weeks had begun thinking seriously about the impact of federal health reform on their profitability, workforce structure and health plan viability, may have awoken Nov. 3 asking, "What now?"

What now, indeed. As Republican candidates in federal, state and local races swept into office in historic numbers, promising a change in the course of government, attention has centered on the impact of the election results and on the future of the federal health reform law.

The answer is: Don't expect much in the way of change. At least not yet.

Repeal is Not an Option...For Now

There was a never a chance that Republican mid-term victories, under the most optimistic of projections, would or could unravel the health reform law. Even had Republicans managed to capture control of the Senate in addition to their reclamation of the House, the health reform law was in no danger of repeal. Any attempt by Congress to do that would be vetoed by President Obama, and the Republicans lack the 67 Senate votes necessary to override a Presidential veto. Any serious attempt at repeal must await the results of the 2012 elections. Repeal will require the complete reversal of 2008: Republican control of the White House and both chambers of Congress.

If the GOP cannot now outright behead the law, can they strangle it by denying it funding? To be sure, the funding issue is the law's weak underbelly. The law requires federal funding of more than 100 key components of the bill, most notably grants to states to establish insurance exchanges by 2014, and of course the $500 billion necessary to provide subsidies toward individuals' purchases of insurance in the exchanges. Federal taxpayers are also picking up, for the first several years, all or nearly all of the additional Medicaid expenses associated with the expansion of Medicaid eligibility.

Risky Business

But holding up the federal budget - threatening the shutdown of the government - is risky business. Many voters are weary of partisanship and are looking for Congress to make something good happen. Republicans must remember that according to a number of exit polls, voters identified the economy as their main concern, by a wide margin (about 62% of voters picked the economy as their primary issue; only 18% cited the health reform law). The American electorate wants results.

The new makeup of the Congress doesn't bode well in that regard. Among the many Democrats swept out of the House are a significant number of self-styled moderates, known as "Blue Dogs." This purging of Democratic moderates means we'll now have in the Congress, particularly on the Democratic side of the aisle, a caucus whose center of gravity is a fair bit farther left than before. Throw in a Republican majority infused with new blood drawn from the mid- to far-right, and you have all the makings of political gridlock.

What's in Store?

So what will happen, then? Our best guess, for the short term, is that Republicans in the House will pass a symbolic bill repealing the health reform law, a bill that will go nowhere in the Senate. Again, here the Republicans must be prudent. Voters, particularly those in the all-important political center, are likely to have little tolerance for symbolic gestures while the nation's economy festers. For the same reason, if Republicans allow themselves to become bogged down over fringe issues, they will have misread the lessons of the election results.

Some nibbling around the soft edges of the health reform bill is likely. The business community is rightly aghast at the new Form 1099 reporting requirement appended to the law. The requirement compels businesses to issue a Form 1099 to every vendor - from copy repairmen to bartenders - to whom the company pays $600 or more during a year. House Republicans will move swiftly to repeal that provision, and will likely attract enough Senate Democrats - spooked by the election bloodletting - to get it done.

There is talk of attempting to do even more, perhaps repealing the "Individual Mandate" (the provision that compels nearly all Americans to have minimum health coverage by 2014 or face a modest penalty) or the "Free Rider Surcharge"(the penalty employers will pay beginning in 2014 if they fail to offer affordable coverage to full-time employees who instead obtain subsidized coverage in the insurance exchanges).

Such actions, like the health reform bill itself, may have unintended consequences. The health reform law requires insurers to issue policies to all applicants, without pre-existing condition restrictions. That works only if the nation gets everyone in the risk pool. Otherwise, people will simply wait to buy insurance until they get sick. Removing the individual mandate without relieving carriers of the obligation to issue a policy to all applicants, without restrictions, makes it even more difficult for private insurance companies to survive.

Business has many reasons to oppose the Free Rider Surcharge. But if the insurance exchange concept survives until 2014, and employers find then that their employees have another, taxpayer-subsidized option for health coverage available, and no surcharge binding the employers to their existing group health plans, a great many more employers may simply terminate their group coverage. That will improve employers' bottom lines (although many employees will fare worse in the exchanges), but not the nation's.

The Congressional Budget Office, when estimating the first decade's cost of the bill at $1 trillion, assumed only about 4-5 million Americans (net) who have group insurance today will lose it by 2019, as a result of the health reform law. A recent study suggests that the cost of federal subsidies in the insurance exchanges rises about $300 billion for every additional six million Americans who seek exchange-based coverage. If the 4-5 million estimate balloons to 40-50 million, the first decade's cost of the program leaps to $2.5 - $3 trillion, a number that is simply not sustainable.

Stay the Course

So we shall see. Experienced political pundits say that prognostications based on mid-term election results are almost always wrong. In other words, we should not read too much into the results, although there is still much to make of them. Our advice to employers who are beginning to assess the impact of health reform and chart a course to address the issues it poses, is to "stay the course." There is still much to do, and health reform isn't going anywhere, at least not for a while.

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Our Nation's Veterans Have Options for Health Care Coverage

2010-11-04T08:03:00.000-05:00

/PRNewswire/ -- As the nation pauses to honor its veterans on Nov. 11 for their patriotism, love of country, and willingness to serve and sacrifice for the common good, Blue Cross and Blue Shield of Georgia (BCBSGA) wants our veterans to be taken care of, especially when it comes to their health. Those who have served their country through the United States military have several options surrounding their health care coverage.

Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at BCBSGA's parent company. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at an affordable or no cost."

"VA and Medicare offer different, yet valuable, benefits to veterans," stated Morgan Kendrick, President of BCBSGA.

Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than eight million people covered by the VA Health Care System.

Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by a private insurance company, like Blue Cross and Blue Shield of Georgia, rather than the government. These plans may also include Part D, which is drug coverage.

Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.

Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.

On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.

Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.

Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.

There are additional benefits to having a Medicare Advantage plan. These advantages vary by insurer, but may include some or all of the following:

* Limits to total out-of-pocket costs
* Fitness programs, such as free gym memberships
* Preventive dental and vision care
* Programs that help people with chronic diseases, such as diabetes and asthma.
* Discounts on non-covered health-related products
* Chiropractic and podiatry services

It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Similarly, the VA generally cannot pay for the same service paid for by Medicare

"Obviously, this can get very complicated," said Kendrick. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Blue Cross and Blue Shield of Georgia we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."

For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at http://www4.va.gov/healtheligibility/ and click on " Medicare Information for Veterans ."

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Open Enrollment Goes Virtual: Blue Cross and Blue Shield of Georgia Launches Virtual Open Enrollment Center, Allowing Companies to More Easily Engage Employees

2010-10-29T07:53:00.000-05:00

/PRNewswire/ -- For medium and large organizations, providing employees with complete, comprehensive and consistent information during open enrollment can be challenging. To help businesses reach and engage their employees more easily, Blue Cross and Blue Shield of Georgia (BCBSGA) has launched a Virtual Open Enrollment center, an easy to use, easy to understand interactive 3-D environment, which can be found at: http://tinyurl.com/23hkhqg.

"The virtual enrollment center is another way that Blue Cross and Blue Shield of Georgia is delivering the best value to our customers and the members we serve," said Morgan Kendrick, President, BCBSGA. "Many businesses tell us they want to improve their systems to more effectively and efficiently communicate important benefit information to their employees. The BCBSGA virtual open enrollment center, designed with input from businesses, was created to meet this need. Ultimately, we believe this will help individuals make the best benefit choices to fit their unique circumstances."

With the virtual enrollment center, employees can access benefits information at their convenience in a single intuitive and interactive location. Upon entering the site, a user will see a 3-D design with their company's logo and a video spokesperson delivering personalized messages. The center has scrolling marquees providing up to date messaging. The user can easily find enrollment information through simple key word searches. In addition, the virtual enrollment center has a content library, housing enrollment materials, documents that can be downloaded, and web links to additional information such as health plan details, provider lists, prescription information and other available health programs.

This is also a valuable resource for human resource departments as they can easily maintain and publish content. The virtual enrollment center gives them the ability to efficiently reach all employees, increase visibility within the organization, track the number of visitors and monitor the usage.

"BCBSGA's virtual open enrollment center has been a great resource for our business and our employees," said Hazel Davis, manager, health and welfare plans for Albemarle Corporation. "We began using this new system last week and already our employee engagement has increased, and the employee feedback has been overwhelmingly positive. Our employees are able to access the center at their convenience, helping them to more effectively select the best benefits for themselves and their families. We have been looking for a way to increase employee engagement and Blue Cross and Blue Shield of Georgia's virtual open enrollment center has been a perfect solution."

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HHS announces nearly 700 additional employers and unions to receive help providing health coverage to early retirees and their families

2010-10-28T10:23:00.000-05:00

Nearly 3,600 employers and unions approved to participate in the Affordable Care Act's Early Retiree Reinsurance Program to date; applications still being accepted

The U.S. Department of Health and Human Services (HHS) today released a list of additional employers and unions accepted into the Affordable Care Act's Early Retiree Reinsurance Program. Nearly 700 additional large and small businesses, state and local governments, educational institutions, non-profit organizations, and unions have been accepted into the program, which reimburses employers for a portion of the cost of health benefits for early retirees' and their families. Today's announcement brings the total number of organizations participating in the program to nearly 3,600.

"By helping employers and unions continue to offer coverage for early retirees, we're helping them compete -- while providing a measure of certainty and security for their former workers at a time when it could not be more important," said Secretary Kathleen Sebelius. "The Early Retiree Reinsurance Program seeks to shore up the financial foothold for employers and unions who want to provide coverage to their retirees."

Created by the Affordable Care Act as another bridge to the new health insurance exchanges in 2014, the Early Retiree Reinsurance Program provides $5 billion in financial assistance to employers and unions, to help them maintain coverage for early retirees ages 55 and older who are not yet eligible for Medicare. Businesses and other employers and unions that are accepted into the program will receive reimbursement for a portion of the costs of health benefits for their early retirees and their spouses, surviving spouses, and dependents. Savings may be used to reduce employer or union health care costs, provide premium or out-of-pocket relief to workers, retirees, and their families, or both. The program ends on January 1, 2014, when the state-based health insurance exchanges will be up and running.

HHS' Office of Consumer Information and Insurance Oversight has approved nearly 3,600 employer and union plans, representing a broad range of employers and unions from all 50 states and the District of Columbia, for participation in the Early Retiree Reinsurance Program, with more applications being reviewed every day. HHS has set up a website, www.ERRP.gov, where sponsors can begin submitting information today to qualify early retirees, spouses, surviving spouses, and dependents for claims reimbursements.

Employers and unions interested in the Early Retiree Reinsurance Program should visit www.ERRP.gov or call 1-877-574-3777 or 877-574-ERRP. Employers and unions can find the application form and application instructions, as well as other relevant guidance and regulations from HHS, online.

More information about the Early Retiree Reinsurance Program, a full alphabetical list of participants, and an interactive map displaying participants by state is available online. This list is updated regularly. To find this information, please visit:
http://www.healthcare.gov/news/factsheets/early_retiree_reinsurance_program.html.

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Medicare Open Enrollment Starts November 15th

2010-10-13T15:40:00.000-05:00

The GeorgiaCares State Health Insurance Assistance Program (SHIP) is helping Medicare recipients make informed decisions about which prescription drug and Advantage plan options are best for them. Beginning on October 15, consumers can compare available plans by visiting www.Medicare.gov. They may also call GeorgiaCares toll-free at 1-800-669-8387 for personalized assistance.

Open enrollment for Medicare Part C and D begins November 15, and recipients will have until December 31, 2010, to make their choices. With so many options available, choosing the right one is important. This is the first year that there will be one election period for both Part C and D plans. After this time, plan changes can be made during the annual Disenrollment Period of January 1 - February 15th of each year. During the Disenrollment Period, beneficiaries will only be allowed to leave a Medicare Part C plan and return to Original Medicare (Parts A and B) with the option of choosing a prescription drug plan.

“The GeorgiaCares SHIP network provides one-on-one assistance, so that callers can get personalized help as they compare their options and decide on which plans best meet their needs,” said Dr. James J. Bulot, director of the DHS Division of Aging Services.

GeorgiaCares SHIP counselors are available through the statewide network of Area Agencies on Aging and will provide community education sessions and answer hotline calls to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.

GeorgiaCares SHIP and the Centers for Medicare and Medicaid Services (CMS) advise people who wish to make a change to do so as close as possible to the November 15 opening date to ensure their coverage will be available on January 1, 2011. Companies began marketing their plans on October 1.

GeorgiaCares SHIP services are free and also assist Medicare beneficiaries on Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, resolution to billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.

GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who do not want to make a change can remain in their plan from 2010.

Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.

For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).

Oxendine: Choose Carefully During Open Enrollment

2010-10-07T06:44:00.000-05:00

Insurance Commissioner John W. Oxendine urges consumers who are part of a group health plan to be prepared to make the right choices during health insurance open enrollment.

“It's the time of year when many companies across the country hold open enrollment periods for their group health insurance plans,” Oxendine said. “Consider the options carefully to be sure you and your family are properly covered.”

Open enrollment refers to the period of time during which all members of your group health insurance plan have the opportunity to enroll in certain benefit programs. During this period, insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally only held once a year, so if you miss it, you likely will not be able to enroll in your employer-sponsored health insurance program until next year. Certain exceptions apply for new employees or employees with life-changing events.

Make sure to check with your human resources department to see when your company’s open enrollment period begins and ends, and when your policy goes into effect.

There are many different types of major medical plans typically offered by employers. For help understanding the fundamental differences between preferred provider organizations (PPO), health maintenance organizations (HMO), point of service plans (POS) or indemnity plans, visit our website at www.oci.ga.gov/publicInformation/healthInsuranceFAQ.aspx.

Before making a choice:
Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not.
Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
If you take prescription medications, check them against the list of approved drugs in each plan booklet.
If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.

If you are not satisfied with the answers to your questions, contact Oxendine’s Consumer Services Division for help and advice at 1-800-656-2298.

In this uncertain market, it’s important to carefully evaluate your healthcare costs when making your annual enrollment decisions. While one option might have high monthly premiums and a low deductible, and another might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best for you until you do the figures.

To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning.

Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of out-of-pocket expenses that you are responsible to pay. Remember, if you use a medical provider that is out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations.

Finally, decide how much you can afford to pay. Other things to keep in mind:
Check for any annual limits and prior authorization requirements.
Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost to you.
If your dependents have health insurance coverage through their employer, school or the Veteran’s Administration, compare their costs and benefits to the family plans you are considering to ensure that you choose the best plan for every member of your family. Make the same type of comparisons for any dental or vision care plans that you are offered.

Once enrolled in a health plan, you will not be able to make changes until the next open enrollment period, unless there is a life changing event such as divorce, a job change, marriage or the birth or adoption of a baby.

If you do not receive insurance cards and/or enrollment information, contact your HR administrator, or call the insurance company.

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How health care reform affects your Medicare enrollment

2010-10-05T06:53:00.000-05:00

(ARA) - Health care legislation passed earlier this year may make Medicare annual enrollment season particularly challenging for the millions of baby boomers aging into Medicare and for seniors already enrolled who are considering different coverage for 2011. Annual enrollment runs from Nov. 15 to Dec. 31, allowing people to select their Medicare coverage for 2011.

"Choosing a Medicare plan can be overwhelming in any year," says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and those 65 and older. "However, this year there are not only the usual changes, such as premium and coverage changes, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage."

According to Muralidharan, the most important ways the new health care legislation will affect Medicare beneficiaries for 2011 include:

* Prescription drug costs should be lower in the "doughnut hole." For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug doughnut hole.

* Medicare Part B (medical insurance) will fully cover preventive care. Beginning in 2011, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam.

* More beneficiaries may have higher costs for Medicare Part B and Part D (prescription drug) coverage. The Part B income threshold freezes at the 2010 levels through 2019. As a result, individuals with modified adjusted gross income (income) exceeding $85,000 and married couples with income exceeding $170,000 will have to pay higher premiums. Because this will not adjust with inflation, it's likely more people over time will be subject to higher premiums. In addition, the law reduces the Medicare Part D premium subsidy for individuals with incomes above these levels.

* Opportunities to change coverage after the annual enrollment period will be more limited. Historically, an open enrollment period ran from Jan. 1 through March 31, immediately after annual enrollment ended. During open enrollment, people were able to switch from their existing Medicare plans to similar Medicare coverage, choosing from "like to like" options.

Now, open enrollment has been replaced with a shorter annual disenrollment period, which runs from Jan. 1 through Feb. 14. During this period, the only change that can be made is to disenroll from a Medicare Advantage plan in order to enroll in traditional Medicare and join a Medicare Part D plan. Other selections will not be available to consumers.

"It's easy to get confused over the various Medicare enrollment periods," Muralidharan says. "However, it's now more important than ever to look at annual enrollment as your main opportunity to choose your coverage."

Reasons to review your medicare coverage

Changes brought on by health care reform are just one reason people should evaluate their Medicare coverage. Each year, individuals with Medicare should consider different health care coverage if they experience any of the following:

* Your health situation has changed in the past year.

* Your provider situation has changed (for example, you hospital or physician left your plan).

* Your coverage has changed (for example, certain drugs, procedures or conditions are no longer covered).

* Your plan premiums and/or co-payments have increased.

* You have moved to a new location.

* Your current plan no longer will be available.

Additionally, people now turning 65 and becoming Medicare-eligible for the first time should carefully review their options - and make certain they follow the enrollment guidelines. Failing to do so can trigger costly penalties and may mean certain coverage is unavailable in the future.

"The choices you make about your Medicare coverage can have a significant effect on your health care and your finances," says Muralidharan. "If you are uncertain about which Medicare plans are available to you, or which would best meet your needs, seek help before enrolling." More information on Medicare plan selection assistance is available at Medicare.Allsup.com or (888) 271-1173.

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Care Improvement Plus Releases 2011 Medicare Health Plan Benefits for Georgia

2010-10-02T08:16:00.000-05:00

/PRNewswire/ -- Care Improvement Plus, operator of the largest special needs plan in Georgia, is standing by its commitment to serve chronically ill and underserved Medicare beneficiaries with the release of its 2011 Medicare health plan benefits in preparation for the upcoming Medicare annual election period, which begins November 15th.

"At a time when there is concern over unpredictable change in healthcare, Care Improvement Plus remains committed to our members and the underserved Medicare beneficiaries of Georgia," said Frederick C. Dunlap, chairman and chief executive officer of XLHealth, which owns and operates Care Improvement Plus. "For 2011, we are continuing to build upon our innovative model of care, providing specialized services that go well beyond what Original Medicare and most Medicare Advantage plans offer -- improving quality of care and controlling healthcare costs."

The details of Care Improvement Plus' 2011 Medicare health plan benefits include stable plan premiums with $0 options, and the continuation of valuable additional benefits and services, such as:

* Vision, dental, transportation, and Over-The-Counter benefits
* Care management program including nurse coaching and a 24-7 nurse hotline
* Free annual in-home health assessments with a licensed practitioner
* Personalized counseling sessions with plan pharmacists
* Assistance with accessing social support services
* An open access provider network with no referral required for Medicare-covered services
* $0 copays for important preventive care services

Beneficiaries with chronic conditions such as diabetes and heart failure complex healthcare needs requiring a patient-centered focus, making Care Improvement Plus an important option for more than 1,218,887 eligible Georgians to consider.

"During a time when some Medicare Advantage companies are either discontinuing or reducing their coverage, we will continue to serve Georgia Medicare beneficiaries with stability in cost and benefits," continues Dunlap.

Care Improvement Plus will open enrollment on November 15, 2010 for services effective January 1, 2011. Those interested in learning more about Care Improvement Plus may call 1-800-711-1656, or visit www.careimprovementplus.com for more information.

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Affordable Care Act gives consumers new tools, makes health insurance market more transparent

2010-10-01T10:11:00.000-05:00

The U.S. Department of Health and Human Services (HHS) today announced that new information and tools have been added to HHS' consumer website www.healthcare.gov that will make the health insurance market more transparent, increase competition and help lower costs for individuals.

For the first time ever, price estimates for private insurance policies are available, allowing consumers to easily compare health insurance plans - putting consumers, not their insurance companies, in charge by providing one-stop shopping and taking the guesswork and confusion out of buying insurance.

To help consumers make more informed choices, the site includes new information including two notable metrics never before made public:
* Insurance providers are required to provide the percentage of people who applied for insurance and were denied coverage.

* Insurance companies are required to provide the percentage of applicants who were charged higher premiums because of their health status.

"Millions of Americas have already logged-on to www.HealthCare.gov's Insurance Finder to see what health coverage options are available to them," said Secretary Kathleen Sebelius. "This already unprecedented ability to search and compare coverage options is getting better with the new benefits and price information now available. These changes will help Americans find coverage that meets their needs and that gives them value for their dollars now."

Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information and links to health insurance plans into one place to make it easy for consumers to learn about and compare their insurance choices. HHS' Office of Consumer Information and Insurance Oversight (OCIIO) worked to define and collect detailed benefits and premium rating information from insurers across the country, and starting October 1, 2010, consumers will also be able to find information about health insurance options such as:
* Monthly premium estimates;
* Cost-sharing information, including annual deductibles and out-of-pocket limits;
* Major categories of services covered;
* Consumer's share of cost for these services;
* Percent of people in the plan who pay more than the base premium estimate due to their health status; and
* Percent of people denied coverage from a health plan;

More than 225 insurance companies have provided information about their individual and family plans for more than 4,400 policies, including policies in every state and the District of Columbia. Consumers can search for and compare information on plans available to them based on their age, gender, family size, tobacco use and location.

"We applaud the insurance companies that have provided us this information about their products. Together, we are improving competition in the insurance marketplace," said Jay Angoff, director of the Office for Consumer Information and Insurance Oversight. "This type of transparent competition is critical to improving quality of coverage and lowering costs for consumers."

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Statement on the application of medical loss ratio standards to certain health plans under the Affordable Care Act

2010-10-01T07:35:00.000-05:00

Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, within the U.S. Department of Health and Human Services (HHS) released the following statement September 30, regarding the application of medical loss ratio standards to certain health plans under the Affordable Care Act:

"As many employers and insurers consider health insurance options for 2011, one question that has been raised is the applicability of provisions of the Affordable Care Act to health plans and coverage with special circumstances. HHS remains committed to implementing the law in a way that minimizes disruption to coverage that is available today while also ensuring that consumers receive the benefits the Act provides.

"For example, pursuant to the Affordable Care Act and our regulations, HHS recently announced an expedited process for plans to apply for a waiver from the requirement in the Affordable Care Act establishing minimum annual limits where such limits would result in decreased access or increased premiums. HHS has approved dozens of these waiver requests, most often filed by so-called "mini-med" plans, and in doing so, has ensured the continuation of health coverage for workers and their families. Complete waiver applications were generally processed in 48 hours.

"More recently, the issue of the applicability of the medical loss ratio requirements to plans such as mini-med plans has come up. HHS has not yet issued regulations implementing the medical loss ratio requirements because the Affordable Care Act tasks the National Association of Insurance Commissioners (NAIC) with first making recommendations to the Secretary.

"Although the NAIC is close to completing its work, we understand that some employers must soon make decisions regarding coverage options for 2011. As such, we fully intend to exercise her discretion under the new law to address the special circumstances of mini-med plans in the medical loss ratio calculations. According to the Affordable Care Act, medical loss ratio "methodologies shall be designed to take into account the special circumstance of smaller plans, different types of plans, and newer plans." We recognize that mini-med plans are often characterized by a relatively high expense structure relative to the lower premiums charged for these types of policies. We intend to address these and other special circumstances in forthcoming regulations."

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Humana and Walmart Announce Innovative Medicare Part D Prescription Drug Plan with Lowest National Monthly Premium Offered in all 50 States and D.C.¹

2010-10-01T06:52:00.000-05:00

(BUSINESS WIRE)--Today, Humana Inc. (NYSE: HUM) announced an innovative Medicare Part D prescription drug plan, co-branded with Wal-Mart Stores, Inc. (NYSE: WMT) or (“Walmart”), that can provide significant savings on monthly plan premiums and prescription medicine copayments and cost-shares for Medicare beneficiaries, including seniors and people with disabilities.

The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS¹, the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $450² in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions³, the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”

“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”

Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details

* One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
-According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
-The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums⁴.

* Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
-In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
-Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.

* A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.

How to Enroll in the Plan: Call, Click or Go

Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:

* Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
* Click on humana-medicare.com or medicare.gov to enroll.
* Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
* Visit a Walmart store to speak to a Humana representative.
o Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.

Medicare Part D Background

Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States⁵.

References

1 “Centers for Medicare & Medicaid Services.” Click on the “2011 Drug Plan Information - State Fact Sheets” under “Spotlights.” September 2010. http://www.cms.gov/center/openenrollment.asp

2 Savings estimate is based on a comparison between 1) the projected average nationwide out-of-pocket costs for the 2011 benefit year for the average Medicare beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) and fills their prescriptions in-store at preferred pharmacies like Walmart, Sam's Club, and Neighborhood Market pharmacies, and 2) the projected average nationwide out-of-pocket costs for the 2010 benefit year for the average Medicare beneficiary. Calculations based in part on industry average PDP premium and benefit information from the “Medicare Part D 2010 Spotlight, Medicare Prescription Drug Plans in 2010 and Key Changes over Five Years”, an independent review and analysis of CMS data by the Kaiser Family Foundation (September 2010). Actual savings may vary. For some beneficiaries, actual out-of-pocket costs may be more. Savings estimate may be updated when 2011 benefit year data becomes publicly available.

3 “The Henry J. Kaiser Family Foundation.” Medicare: A Primer. Chart: Prescription Drug Coverage Among Medicare Beneficiaries, 2010, Page 8. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf

4 “The Henry J. Kaiser Family Foundation.” Medicare Part D 2010 Data Spotlight. Chart: Exhibit 2: Weighted Monthly PDP Premiums, 2006-2010, Page 9. September 2010. http://www.kff.org/medicare/8096.cfm

5 “Families USA.” Cost Overdose: Growth in Drug Spending for the Elderly, 1992 – 2010; Figure 1: Seniors Consume a Disproportionate Share of Drug Expenses, Page 2. July 2000.

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Forty-eight states receive new resources to build competitive health insurance marketplaces

2010-09-30T14:46:00.000-05:00

The U.S. Department of Health and Human Services (HHS) today awarded nearly $49 million to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. A key part of the Affordable Care Act, starting in 2014, health insurance exchanges - new, competitive, consumer-centered private health insurance marketplaces - will put greater control and greater choice in the hands of individuals and small businesses.

"Today, too many individuals and small businesses are on their own in dealing with insurance companies. They pay higher costs than Americans who get their insurance through big companies or other large employers because they can't pool their costs or spread the risk," said Secretary Kathleen Sebelius. "That's why the Affordable Care Act helps states create exchanges, so individuals and small businesses can band together, have the same purchasing power as those big employers, and get a fairer deal when it comes to their health care. Today, we're providing critical resources to help states take the first step toward creating these competitive marketplaces."

The state-based exchanges will make purchasing health insurance easier by providing eligible consumers and businesses with "one-stop-shopping" where they can compare and purchase health insurance coverage. Americans will have the same health care choices as members of Congress - who will also purchase coverage through the exchanges. Individuals and families purchasing health insurance through exchanges may also qualify for tax credits and reduced cost-sharing depending on their income.

These grants of up to $1 million each will give states the resources they need to conduct the research and planning needed to build a better health insurance marketplace and determine how their exchanges will be operated and governed, including:
. Assessing current information technology (IT) systems and infrastructure and determining new requirements.
. Developing partnerships with community organizations to gain public input into the exchange planning process.
. Planning for consumer call centers to answer questions from their residents.
. Determining the statutory rules needed to build the exchanges.
. Hiring key staff and determining ongoing staffing needs.
. Planning the coordination of eligibility and enrollment systems across Medicaid, the Children's Health Insurance Program (CHIP), and the exchanges.
. Developing performance metrics, milestones and ongoing evaluation.

Although state exchanges are not required to be operational until 2014, these planning grants begin the path toward 2014 when health insurance exchanges will take what is now a very complicated and confusing process and turn it into a simple, easy to navigate experience that benefits consumers, not insurance companies.

The Department of Health and Human Services is working closely with states in implementing the Affordable Care Act. This is just the first round of state planning and establishment grants, which are one of several resources available to states to help with implementation of the Affordable Care Act. Already, 46 states have received resources from the Affordable Care Act to help improve the oversight of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes, and ensure consumers receive value for their premium dollars. To learn more about the Affordable Care Act please visit www.HealthCare.gov.

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Medicare beneficiaries in donut hole will see 50-percent discount on brand name drugs in 2011

2010-09-23T12:22:00.000-05:00

Vice President Joe Biden, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) today announced that the nation's pharmaceutical manufacturers will provide 50 percent discounts on the cost of covered brand-name prescription drugs for beneficiaries in the Medicare Part D coverage gap, or donut hole, starting in 2011.

Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.

"Thanks to the Affordable Care Act, millions of people with Medicare who will fall into the Part D donut hole next year will pay less for their prescription drugs," said Vice President Biden. "The discount manufacturers will pay on brand-name drugs, helping millions of seniors who are struggling to make ends meet at the end of the month, and it's just one of the ways the new health care law helps make Medicare stronger."

The Affordable Care Act has helped reduce costs for Medicare beneficiaries, beginning with one-time rebate $250 rebate checks for beneficiaries who hit the donut hole in 2010.

"More than 1.2 million beneficiaries who have hit the donut hole so far this year have received their $250 rebate checks as part of the cost savings provisions in the Affordable Care Act, and millions more are on deck to get a check," said HHS Secretary Kathleen Sebelius. "Now, with these new agreements, people who rely on Medicare will see even more savings off their drug costs next year, and savings will continue even after the coverage gap is closed in 2020."

Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year - an increase of $1.

"Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more - like those plans that are offering benefits that help fill the donut hole," said CMS Administrator Donald Berwick, M.D. "They will find that the Affordable Care Act improves the value of drug coverage they get next year."

Beneficiaries will soon receive their 2011 Medicare & You handbook and find updated information at www.medicare.gov and 1-800-Medicare in mid-October. Users of the Medicare Plan Finder, available at www.medicare.gov, will be able to compare plans' quality summary rating from the previous year, identify which drugs are included on a plan's formulary, and compare the cost ranges for plans available in their communities.

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NAIC: Few Aware That Additional Health Care Reform Provisions Take Effect This Month

2010-09-13T08:18:00.000-05:00

/PRNewswire/ -- Earlier this year, Congress passed sweeping reforms designed to revamp the health care system and increase access to care for many Americans. Yet, according to a new survey by the National Association of Insurance Commissioners (NAIC), many consumers are confused about the provisions and unsure of timing for actual implementation.

When asked to choose from four dates for which the first health care reform provisions officially take effect, only 14 percent correctly identified Sept. 23, 2010.

"Our survey findings are a clear indicator that most Americans are not aware of how soon some of the early health care changes may impact them," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline. "It's essential for consumers to understand what to expect and when to consult their state insurance departments for more information."

When asked about specific reform provisions that take effect Sept. 23, most respondents correctly identified provisions concerning children. Specifically, 72 percent knew that children with pre-existing conditions may not be excluded from coverage and 70 percent understood that individuals up to age 26 may be covered under their parents' insurance.

However, half of the respondents were under the impression that employers with fewer than 50 employees will have to offer coverage to employees, and 47 percent incorrectly thought that all health insurance plans must cover approved preventive care and checkups without co-payment.

In reality, employers with fewer than 50 employees are not required by the new law to provide health insurance to staff, and all co-payments for preventive care and checkups are not eliminated. However, those qualifying for Medicare will receive new preventive care benefits that will include annual visits free of co-payments, but this is not mandated for all health insurance plans.

"The results show that while most consumers are well attuned to provisions specifically affecting their children's health care, they do not grasp the overall reform framework," said Cline. "It's promising to see this, but we feel it necessary for consumers to fully understand the changes and get informed about what to expect."

To keep up with the complex health reform process that includes multiple implementation phases in the coming years, the NAIC urges consumers to contact their state insurance department with questions. Go to http://map.naic.org/ to find your state contact information.

In addition, the NAIC website has a special section dedicated to health care reform questions and resources. Visit http://www.naic.org/index_health_reform_section.htm to learn more.

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Guidance on New Hospice Benefits for Terminally Ill Children Hailed by Hospice and Palliative Care Community

2010-09-13T08:15:00.000-05:00

/PRNewswire/ -- The families of dying children who are covered under Medicaid or the Medicaid expansion Children's Health Insurance Program (CHIP) will no longer face the choice of stopping curative treatments in order for their terminally ill child to receive quality end-of-life care from hospice.

The provision in The Patient Protection and Affordable Care Act requiring state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatments has been widely applauded by the hospice and palliative care community. In an important step to implement the law, the Centers for Medicare and Medicaid Services issued a letter of guidance on Thursday, September 9, 2010.

"This provision is a very important step forward for children with life-threatening illness. No longer will families need to make an agonizing choice to give up cure-directed treatment in order to receive the multiple benefits offered through a comprehensive hospice program," said Sarah Friebert, MD, Director of the Haslinger Division of Pediatric Palliative Care at Akron Children's Hospital.

J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, remarked, "NHPCO has been a longtime advocate for the provision, previously working with Senators Jay Rockefeller (D-WV)and Susan Collins (R-ME) to include the language in their Advance Planning and Compassionate Care Act."

Throughout the various stages of health care reform deliberations, NHPCO went on record as supporting the inclusion of the pediatric concurrent care provision and actively lobbied for its continued inclusion in the final version of the legislation.

The law does not change the criteria for receiving hospice services. In order to qualify for the hospice service in either Medicaid or CHIP, a physician must certify that the eligible person is within the last six months of life.

In the letter issued by CMS, Cindy Mann, federal Medicaid Director, wrote, "We believe implementation of this new provision is vitally important for children and their families seeking a blended package of curative and palliative services. This provision will increase utilization of hospice services since parents and children will no longer be required to forego curative treatment."

"Care for children and families facing serious illness and death are an important population that should not be overlooked," noted Schumacher. "This law is the right thing to do for families facing the tragedy of a dying child."

Friebert further added, "We have further work to do to secure reimbursement for services for children with chronic, complex and/or life-threatening illness who do not qualify for hospice, and need the same protection to receive concurrent palliative care and cure-directed therapy."

To further support the care of young people with serious and life-limiting illness, NHPCO and the Children's Project for Palliative/Hospice Services (ChiPPS) developed and published The Standards of Practice for Pediatric Palliative Care and Hospice and released a report "Facts and Figures on Pediatric Palliative Care and Hospice." Additionally, the first module of a series of ten online courses on pediatric palliative care was launched on NHPCO's web-based E-Online education portal.

Learn more about the Pediatric Standards, ChiPPS, or download the facts and figures report at www.nhpco.org/pediatrics.

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Oxendine: Renters Insurance for Students a Smart Move

2010-09-02T08:57:00.000-05:00

As the start of the college school year approaches, students moving out of the house or off campus may want to consider purchasing renters insurance.

According to Georgia Insurance Commissioner John W. Oxendine, renters insurance can cover the loss of computers, stereos, musical instruments, jewelry and much more in the event of theft, fire or some other unforeseen disaster.

"If your college student is moving away to school with expensive computers or other valuables, buying renters insurance is a smart move," Oxendine said. “The landlord may have insurance on his building, but that won’t cover replacement of a renter’s possessions.”

Oxendine suggests discussing the needs of your student with an insurance agent who can tailor a renters policy to your individual needs. Everything from property damage caused by fire, hail or smoke, to liability suits brought by guests slipping on stairs or in the bathroom can be included in a policy.

Consumers may get more information on renters insurance by calling an insurance agent or by contacting Commissioner Oxendine's Consumer Services Division at 404-656-2070, or toll-free 1-800-656-2298.

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Nearly 2,000 employers and unions approved into new program to provide health coverage to early retirees

2010-08-31T11:55:00.000-05:00

Affordable Care Act program will help pay health benefit claims for early retirees; applications still being accepted

The U.S. Department of Health and Human Services today announced the first round of applicants accepted into the Early Retiree Reinsurance Program. Nearly 2,000 employers, representing large and small businesses, State and local governments, educational institutions, non-profits, and unions have been accepted into the program and will begin to receive reimbursements for employee claims this fall.

Created by the Affordable Care Act as a bridge to the new health insurance Exchanges in 2014, the Early Retiree Reinsurance Program provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare. Businesses and other employers and unions that are accepted into the program will receive reimbursement for medical claims for early retirees and their spouses, surviving spouses, and dependents. Savings can be used to reduce employer health care costs, provide premium relief to workers and families, or both. The program ends on January 1, 2014 when State health insurance Exchanges are up and running.

"In these tough economic times, it is difficult for employers to keep up with skyrocketing health care costs for employees and retirees. Many Americans who retire before they are eligible for Medicare see their life savings disappear because of medical bills and exorbitant rates in the individual health insurance market," said Health and Human Services Secretary Kathleen Sebelius. "The Affordable Care Act's Early Retiree Reinsurance Program will make it a little easier for employers to
provide high-quality health benefits to their retirees as we work to put in place market reforms to lower costs for all."

"In conversations with business leaders throughout the country, I hear over and over again about the escalating health care costs for employees and retirees," U.S. Commerce Secretary Gary Locke said. "The new reinsurance program in the Affordable Care Act will directly reduce companies' health premiums for many retirees, offering critical cost relief for American businesses in a difficult economy and an important bridge for early retirees who are not yet eligible for Medicare."

Rising health care costs have made it difficult for employers to provide quality, affordable health insurance for workers and retirees while also remaining competitive in the global marketplace. The percentage of large firms providing workers with retiree health coverage has dropped from 66
percent in 1988 to 29 percent in 2009. Health insurance premiums for older Americans are over four times more expensive than they are for young adults and the deductible these enrollees pay is, on average, almost four times that for a typical employer-sponsored insurance plan.

The Department of Health and Human Services' Office of Consumer Information and Insurance Oversight has approved nearly 2,000 plans representing a broad range of employers from all 50 States and the District of Columbia into the Early Retiree Reinsurance Program in this first round of approvals with more applications being reviewed every day. Starting in September, approved applicants can begin submitting claims dating back to June 1, 2010 and, starting in October, approved
applicants will begin to receive reinsurance payments on those claims. This policy allows more health benefit claims to qualify for reinsurance payments for plans this year.

The approved applications represent nearly every sector of the economy: 32 percent of applications came from businesses, 26 percent from State and local governments, 22 percent from union sponsors, 14 percent from schools and other educational institutions, and 5 percent from non profits. For a list of approved applications by State, visit http://www.healthcare.gov/news/factsheets/early_retiree_reinsurance_prog ram.html.

"There has been a tremendous amount of interest from businesses and organizations from across the country since the Early Retiree Reinsurance Program was announced just a few months ago," said Secretary Sebelius. "We have received applications from more than 50 percent of Fortune 500 companies, all major unions, and government entities in all 50 States and the District of Columbia, and we are delighted to be able to notify our first round of successful applicants here today."

The nearly 2,000 approvals announced today are a subset of applications that have been received. HHS' Office of Consumer Information and Insurance Oversight is continuing to accept and review additional applications in the order in which they were submitted.

In addition to announcing these approved applications, HHS announced today two new information tools for employers and unions interested in the Early Retiree Reinsurance Program - a new website (www.ERRP.gov) and a new hotline (877-574-3777 or 877-574-ERRP). Employers and unions can
find the application form and application instructions online, as well as other relevant guidance and regulations from HHS.

For more information about the Early Retiree Reinsurance Program and an interactive map displaying the employers that have been accepted into the Early Retiree Reinsurance Program please visit:
http://www.healthcare.gov/news/factsheets/early_retiree_reinsurance_program.html.

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Sebelius announces 1 million Medicare beneficiaries have received prescription drug cost relief under the Affordable Care Act

2010-08-30T11:13:00.000-05:00

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that more than 1 million Medicare beneficiaries have received prescription drug cost relief through the Affordable Care Act. As part of the health insurance reform law's step-by-step efforts to close the Medicare Part D prescription drug coverage gap, eligible beneficiaries who fall in this "donut hole" this year are mailed a one-time, tax-free $250 rebate check. More than a quarter of the 4 million checks Medicare expects to distribute have been received by eligible Medicare beneficiaries.

"Many seniors and people with disabilities on Medicare face extraordinary prescription drug costs, and too often stop following the drug regimens that their doctors have recommended as a result," said Secretary Sebelius. "These checks will make a difference in helping seniors continue to get the medications they need, and are one of many ways that the Affordable Care Act is helping seniors."

Nationwide, 1 million Medicare beneficiaries have already been mailed their rebates and more beneficiaries will be receiving checks in the coming months as they enter the coverage gap. Eligible beneficiaries receive these checks automatically in the mail when they reach the donut hole, and they don't have to sign-up to be eligible for the rebates.

Rebate checks will help people with their drug costs this year. Next year, those who fall into the donut hole will receive a 50-percent discount on covered brand name medications while in the donut hole. Every year, the amount Medicare beneficiaries pay in cost sharing will decrease markedly until the coverage gap is closed.

The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor. All beneficiaries will receive free preventive care services like mammograms and certain colon cancer tests and a free annual physical starting in 2011 in Original Medicare. Additionally, seniors can expect to save an average of nearly $200 per year in premiums by 2018 compared to what they would have paid without the new law, and most beneficiaries will also see a significant reduction in their Medicare coinsurance as a result of the Affordable Care Act.

The Affordable Care Act also contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. Last week, HHS and the Department of Justice held their second regional fraud prevention summit in Los Angeles that brought together law enforcement experts, providers and seniors to help utilize these new tools to fight fraud and protect seniors.

The Affordable Care Act strengthens the screenings for health care providers who want to participate in Medicaid or Medicare, enables enforcement officials to see health care claims data from around the country into a single, searchable database, and strengthens the penalties for criminals. The reduction in waste, fraud and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future.

Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information, or go to www.stopmedicarefraud.gov.

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Health Reform Costs, Benefits Explained in NCPA Consumer's Guide

2010-08-25T12:46:00.000-05:00

/PRNewswire/ -- The first detailed and objective consumer's guide on the impact of the Patient Protection and Affordable Care Act has just been released by the National Center for Policy Analysis (NCPA), titled "What Does Health Care Reform Mean To You? A Detailed Analysis"

"The guide does not ignore the benefits of the Affordable Care Act, but it also does not deny the costs," said NCPA President, CEO and Kellye Wright Fellow John C. Goodman. "This is the first unbiased summary of health care reform costs and benefits, and it's a unique resource."

"The consumer's guide answers questions about the coming changes and costs in Medicare, Medicaid, health insurance, employer coverage, and income tax returns," added Goodman.

Guide: http://www.ncpa.org/pdfs/What-Does-Health-Reform-Mean-for-You-A-Detailed-Analy sis.pdf

The research analyzes the costs, benefits and drawbacks of health reform changes, including:

-- Health insurance requirements and fines for individuals and employers
-- Expanded health coverage for up to 34 million people
-- Projected shortages of doctors, nurses and hospitals
-- Free health plan preventative services
-- New coverage protections for patients with pre-existing conditions
-- Reporting family income totals to your employer
-- Benefit and spending cuts for the elderly and disabled on Medicare
-- New taxes on private health insurance, drugs, medical devices
-- Insurance subsidies and changes in coverage options

To educate patients, doctors and all those affected by the new health care law, the NCPA has also produced a shorter version of the guide in a summary pamphlet, also titled "What Does Health Care Reform Mean To You?" The pamphlet is a succinct and unbiased overview of the Affordable Care Act changes, in layman's terms, to help consumers understand what to expect from health care reform.

The National Center for Policy Analysis (NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. The NCPA's goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector. Topics include reforms in health care; Medicare and Social Security;
retirement; taxes; small business policy; and energy and environmental regulation.

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Unemployed See COBRA Costs Increase in 2010, While Current Workers Brace for More Health Care Cost Shifting in 2011, Says Aon Consulting

2010-08-25T11:17:00.000-05:00

/PRNewswire/ -- As the national unemployment rate continues to hover around 10 percent, health care costs for those jobless Americans have seen a year-over-year increase, according to Aon Consulting, the global benefits and human capital consulting business of Aon Corporation (NYSE:AON) .

Aon Consulting surveyed 1,079 employers nationwide in its 2010 Benefits Survey, and found an increase in monthly COBRA* contributions for terminated employees. Specifically, the average monthly cost for employee-only HMO coverage for a terminated worker is $429 this year, compared to $399 for the same coverage in 2009. For employee plus family, the former employee is paying $1,251 a month this year, compared to $1,171 per month last year. As for PPO coverage, the average monthly cost for employee only is $449 in 2010, compared to $439 in 2009, and for employee plus family, the cost tops out at a monthly average of $1,310 this year, versus $1,275 last year. (Click on the following link to see charts on a detailed year-over-year comparison: http://aon.mediaroom.com/index.php?s=43&item=1998)

"The increased frequency and duration of COBRA use is creating a significant strain on the program, leading to higher costs," said John Zern, executive vice president and Health & Benefits Practice director with Aon Consulting. "Those who are unemployed, and facing uncertainty about employment prospects and future COBRA availability, are utilizing the program more than we've traditionally seen to treat a variety of conditions prior to potentially losing coverage. This coupled with the high unemployment rate, is placing the COBRA program in a unique and unprecedented position."

As for current employees, they can expect to shoulder more of the expense related to health coverage in 2011, according to this survey. In fact, 65 percent of employers plan to increase cost sharing next year for things such as deductibles, co-pays and out-of-pocket maximums. What's more, 57 percent of companies say they will ask employees to contribute more for the overall cost of health care in 2011. The amount of cost sharing implemented by employers varies. On plan design (e.g., deductibles, co-pays and out-of-pocket maximums), 46 percent of employers are shifting costs to employees equal to the overall renewal increase, while an additional 46 percent are shifting costs to workers that are less than the overall renewal increase. For overall health plan cost, 40 percent of employers say the additional worker contributions will be equal to the 2011 renewal increase, and 49 percent indicate that workers will be asked to pay less than next year's renewal increase.

"We believe the new health reform law will increase health care costs by 2 percent to 4 percent during the next three years," said Tom Lerche, senior vice president with Aon Consulting. "In addition, we expect to see new costs related to excise taxes and potential cost shifting from reductions in Medicare reimbursement to providers, which will be on top of existing long-term medical trend inflation. These factors will lead many employers to consider increased employee contributions for health coverage, as well as plan design cost sharing."

To learn more about Aon Consulting's 2010 Benefits Survey, please visit www.aon.com/2010survey.

* COBRA - refers to the Consolidated Budget Reconciliation Act of 1985, and includes provisions for members of company health plans who have lost their coverage due to a "qualifying event" to continue coverage at the employee's expense for a period of time.

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136 Members of Congress Demand that Medicare Release Key Information about Controversial Bidding Program for Home Medical Equipment

2010-08-24T18:38:00.000-05:00

/PRNewswir/ -- A bipartisan group of 136 members of Congress recently requested that the federal Centers for Medicare and Medicaid Services (CMS) disclose the list of homecare providers whose bids were used to calculate home medical equipment reimbursement rates under the Medicare "competitive" bidding program. See letter at www.aahomecare.org.

"Without knowing the identity, as well as the appropriate overall qualifications of these providers, we cannot evaluate the program's impact in terms of quality and access to care for seniors we represent," states the congressional letter to CMS Administrator Donald Berwick, M.D.

While CMS intends to release this information in the fall after contracts are finalized, members of Congress are calling on CMS to share this information now to make sure that the disastrous mistakes of the 2008 Round One of bidding are avoided and to uphold President Obama's pledge of "transparency and open government."

"We want to ensure that qualified providers have been chosen to provide these items and services to our constituents," said the congressional letter to CMS. "The healthcare community will again have very serious problems if it turns out once more that these companies are unable to provide sufficient access to quality items and services or do not have the financial ability to operate under the new contracted rates."

When CMS held its Round One bid for home medical equipment in 2008, Congress halted implementation and called for a re-bid of the program after numerous problems emerged. For example, under the Round One bidding in 2008, Medicare contracts were granted to providers that were not appropriately licensed and lacked experience with the devices for which they were awarded contracts.

The American Association for Homecare, which represents durable medical equipment providers, is encouraged by the House letter and urges CMS to comply with this important request. The congressional letter, sent on August 11, asked CMS to respond by August 20. At the time of this press release, the Association is not aware of any response so far by the agency.

"We are pleased that so many members of Congress understand the need for transparency and the urgency of this request," said Tyler Wilson, president of AAHomecare. "Transparency for the bid process is critical given past problems with this whole program. If CMS delays the release of information until fall, it will impede the ability to assess the impact of the bidding program on Medicare patients.

"One of our concerns is that providers who submitted low, desperation bids out of their perceived need to remain a Medicare supplier could well determine the government's reimbursement rates - even if those companies ultimately declined to actually provide the equipment at those rates."

The Medicare bidding program for home medical equipment uses a degree of economic coercion to force homecare providers to submit bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at reimbursement rates low enough to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program may be unsustainable, reducing competition in the long term and reducing seniors' access to care and choice of providers.

In the first round of the bidding program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items. Congress delayed the implementation of the initial bidding program in 2008 to allow for needed changes. The home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut. However, CMS ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now charging headlong into the program in 9 of the 10 largest metropolitan statistical areas in the U.S. An additional 91 areas will be subjected to the bidding process next year.

A bipartisan bill pending in Congress, H.R. 3790, calls for the repeal of the Medicare bidding program for home medical equipment and it would substantially reduce reimbursement rates for the equipment but preserve the nation's vital, cost-effective homecare infrastructure. That bill is supported by 255 members of the U.S. House of Representatives.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.

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New insurance finder web tool simplifies the process of searching for health coverage

2010-08-24T15:37:00.000-05:00

The U.S. Department of Health and Human Services (HHS) today announced the release of a new HealthCare.gov web tool available for download that makes searching for coverage options even easier than before.

"HealthCare.gov is a valuable resource for small businesses, consumers, and their families to search for coverage options and understand the new benefits under the Affordable Care Act," HHS Secretary Kathleen Sebelius said. "By putting the power of information at your fingertips, HealthCare.gov is helping American families everywhere to take control over their health care and make the choices that are right for them."

The Insurance Finder "widget" enables anyone with a website or blog to embed a tool on their site allowing users to begin the process of searching for coverage options. The tool asks users two initial
questions: "select a state" and "which best describes you." Users then click on "next steps," and are redirected to a page on HealthCare.gov that continues with the insurance finder process based on answers to their specific questions.

To view the widget and the embed code, visit this page:
http://www.healthcare.gov/stay_connected.html

HealthCare.gov allows consumers to search for both public and private health coverage options through an easy to use health insurance finder tool. Based on answers to a series of questions, the coverage finder produces a menu of potential coverage choices personalized for the user.

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CLASS Act Analysis Reveals America's Long-Term Care Future

2010-08-17T12:47:00.000-05:00

/PRNewswire/ -- The Community Living Assistance Services and Supports (CLASS) Act -- a largely overlooked component of the 2010 Patient Protection and Affordable Care Act -- has the potential to transform long-term care financing in the United States from a welfare-based to an insurance-based system, according to the latest issue of Public Policy & Aging Report (PPAR).

With funding from The SCAN Foundation, this installment of PPAR features seven articles that recount the origins of the CLASS Act, analyze the legislation's key provisions, and explore potential hurdles of implementation.

"We consider this issue of PPAR to represent the best of what the publication has to offer," said PPAR Editor Robert Hudson, PhD, chair of the Department of Social Policy at the Boston University School of Social Work. "It is timely, informed, and cutting edge. It goes beyond the headlines and delivers detailed accounts of the emergence of the CLASS Act to a broad audience of policy and academic leaders."

The CLASS Act introduces a voluntary, federally administered insurance program designed to provide middle-class Americans the new choice to plan ahead for personal care and supportive service needs in the face of functional impairment. Enrolled individuals no longer will have to be demonstrably poor or spend themselves into poverty to receive long-term care protection.

According to the U.S. Department of Health and Human Services, at least 70 percent of Americans over the age of 65 will need long-term care services at some point in their lives.

"CLASS is about allowing working Americans to take personal responsibility for planning ahead so they can age with dignity and independence," said Bruce Chernof, MD, president and CEO of The SCAN Foundation. "CLASS enrollees will have the power to choose the services they want in the setting most appropriate to their needs."

The current issue of PPAR, published by the National Academy on an Aging Society, is available for purchase at www.agingsociety.org. The authors include Lisa Shugarman, PhD, of The SCAN Foundation; Joshua Wiener, PhD, of RTI International; Walter Dawson of Oxford University; Barbara Manard, PhD, of the American Association of Homes and Services for the Aging; Anne Tumlinson, MMHS, of Avalere Health; Rhonda Richards of AARP; and Kathryn Roberts, PhD, of Ecumen.

More information about the individual grantees and The SCAN Foundation can be found at www.thescanfoundation.org.

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Consumer Advocates Ask for White House/HHS Probe of Health Insurers' Reduced Medical Care Spending, Even As Premiums Spike

2010-08-12T10:59:00.000-05:00

/PRNewswire/ -- Consumer Watchdog and the Center for Media and Democracy today asked the Obama administration to investigate how the major for-profit health insurance companies are reducing their proportion of spending on health care in advance of health reform, even as premiums spike upward. In a letter to Health and Human Services chief Kathleen Sebelius, the groups compared insurers' actions to those of credit card companies, which spiked annual interest rates last year in advance of new federal regulations that would curb corporate abuses.

"Insurance companies appear to be making sure that when new federal rules for spending on health care kick in next year, they can keep their administrative bloat and profits intact," said Judy Dugan, research director of Consumer Watchdog.

The groups noted in the letter that insurance companies are lobbying intensely to distort new rules meant to require increased medical spending -- 80% of premium dollars for individual and small group policies and 85% for large group policies. The insurers seek to redefine billions of dollars in overhead and administration expenses as health care. By cutting their medical ratio now, they can make room for the redefined overhead expenses next year and meet but not exceed the 80% to 85% minimums.

Co-signer Wendell Potter of the Center for Media and Democracy said that red flags went up when Cigna, the last major insurer to report 2nd quarter results, showed a startling 6.4% drop in its medical spending ratio (also called medical loss ratio, or MLR) to 78.8%, a cut that appears unprecedented for a large insurer.

Read the full letter at http://www.consumerwatchdog.org/resources/sebeliusletterCWDCMD081110.pdf

The letter said:

"We write jointly as advocates for consumer rights and transparency to urge you to examine health insurers' reports of reductions in their proportion of medical spending in recent quarters, even as premiums have risen substantially in advance of the new health reform law. The major insurance companies' behavior looks suspiciously like that of credit card companies, which spiked annual interest rates in advance of consumer protection laws intended to restrict the conditions under which rates could go up.

"Like the credit card companies, health insurers assume that they can get away with what amounts to bilking their customers now to set up higher profits in the future. The health insurers appear to be cutting the proportion of premium dollars spent on medical care, in the case of CIGNA by likely record proportions, in advance of regulations intended to make them spend a higher proportion on care, and less on administrative bloat.

"Unlike with credit card companies, you have the power to curb their gaming of the system. The regulations that you put in place to enforce the new health law requirement that they spend 80% to 85% of customers' premium on health care will decide whether the companies cater to Wall Street or to their patients.

"The outcome of the regulations that are now being written will depend on your resistance to a massive lobbying effort by the insurance industry.

"As you know, insurers already expect that changes in the [medical loss ratio] calculation specified in the Patient Protection and Affordable Care Act will allow more insurer activities to be defined as 'health quality improvements' and counted as health care. At least some and possibly all of their state and federal taxes will also be deducted from premium revenue. The combined effect, depending on vagueness or laxness in final regulations, could amount to a 5% or larger insurer 'bonus' in calculating the MLR.

"See Consumer Watchdog comment on tax deduction regulation at http://www.naic.org/committees_lhatf_ahwg.htm

"The result of this bonus is that it pays for an insurer to suppress MLR as much as possible now, to keep future MLR at -- but not above -- 80% for individual and small business policies, and 85% for large groups. It is not possible for the public to accurately determine how the company's drastic reduction in MLR -- which increases its value to Wall Street--was accomplished.

"The Center for Media and Democracy and Consumer Watchdog ask that HHS demand much more detail about the nature of the MLR reductions from CIGNA and lesser reductions by other insurers, and make the results public. The examination should seek to determine if financial coercion of employers and individuals (through unaffordable and unjustifiable spikes in the rates of less profitable plans, or the targeted closure of some plans) was part of any shift to higher-deductible and lower benefit plans.

"HHS should also seek to tighten new definitions of what can be included in the medical loss ratio. The National Association of Insurance Commissioners, which is finalizing proposed regulations to decide how medical loss ratios are defined, is being lobbied by insurers and their lawyers with an intensity that makes the lobbying of Congress pale by comparison. As the proposed regulations are being finalized, they risk being further weakened. It will be up to HHS to right the balance.

"Presumably the MLR reductions at CIGNA and other companies involved what insurers call 'aggressive medical management' to reduce the amount of care provided enrollees. However, it likely also involved the movement of more enrollees into plans that require greater cost sharing and provide less care, through marketing or price coercion."

Insurers and their lobbyists count on the technical detail of financial reports and regulatory actions to mask their intent, said Consumer Watchdog and the Center for Media and Democracy.

Consumers don't notice until their premiums shoot through the roof and their health benefit are reduced. Regulators must resist corporate lobbies and act to protect ordinary citizens, the groups said.

Consumer Watchdog and the Center for Media and Democracy are nonprofit, nonpartisan consumer advocates. For more information, see www.consumerwatchdog.org and www.prwatch.org

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How Local Governments Are Addressing Retiree Health Care Funding

2010-08-05T12:46:00.000-05:00

/PRNewswire/ -- A new issue brief from the Center for State and Local Government Excellence finds that the economy has slowed the ability of local governments to address long-term funding of their retiree health care obligations.

The brief follows up on a 2009 survey in which 206 local governments indicated they were likely to adopt a long-term strategy to strengthen their retiree health care funding, including:

-- establishing a Section 115 trust (governmental); medical subaccount
[401(h)]; or Voluntary Employee Beneficiary Association (VEBA) trust
[501(c)(9)];
-- issuing OPEB bonds;
-- increasing the years of service for vesting for RHC;
-- increasing the age at which RHC is available;
-- terminating retiree health care for all new hires.

Since then, the economy, insufficient revenues, and competing budget priorities have posed the greatest impediment to their plans.

The new brief finds that many jurisdictions are making sweeping changes in their retiree health care plans:

-- 36 percent have increased or plan to increase the years of service
required to vest.
-- 11 percent have increased the retirement age.
-- 39 percent have eliminated or plan to eliminate retiree health
benefits for new hires.

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Lessons Learned From Hurricane Katrina Can Help Insure Against Future Disasters as Fifth Anniversary Approaches

2010-08-05T10:48:00.000-05:00

/PRNewswire/ -- With predictions for a severe 2010 hurricane season, coastal residents should heed the lessons learned from Hurricane Katrina by making sure to have the right type and amount of insurance, according to the Insurance Information Institute (I.I.I.).

August 29 marks the fifth anniversary of Hurricane Katrina, the most costly insured disaster in United States history, which caused more than $41 billion in insured damage to homes, cars and businesses in Louisiana, Mississippi, Alabama, Florida, Tennessee and Georgia. The National Flood Insurance Program (NFIP) paid an additional $16.1 billion for flood-related losses.

The devastation caused by Hurricane Katrina demonstrates the costly ramifications of not properly preparing for a disaster.

1. Some individuals and business owners neglected to purchase flood
insurance. Lack of flood insurance resulted in uncovered losses to
thousands of homes and businesses.
2. Many business owners, who had spent years building up their companies,
did not purchase the right type and amount of coverage, including
business interruption (business income) insurance. Many were never able
to open their businesses again.
3. Some homeowners and business owners did not invest in making their
property hurricane-resistant by installing storm shutters, hurricane
clips, and other loss-mitigation measures, which could have saved their
property.
4. Many policyholders failed to take a home or business inventory prior to
the disaster, which could have made the claims process easier.
5. Many business owners did not have a disaster preparedness plan. As a
result, those businesses were unable to resume operations.
6. Many homeowners and business owners did not update their insurance
policies to reflect the current cost of rebuilding or replacing damaged
property and were left underinsured as a result.
7. Some individuals did not evacuate, especially when told to do so by
authorities. At least 1,836 people perished in the hurricane and
subsequent floods, making it the deadliest U.S. hurricane since 1928.

"The more prepared you are for a hurricane or other major disaster, the greater the possibility you and your loved ones will survive the storm both physically and financially," said Jeanne Salvatore, senior vice president and consumer spokesperson for the I.I.I.

The I.I.I. videotaped several Hurricane Katrina claimants who were able to get their lives back to normal after Hurricane Katrina because they had purchased the proper insurance. To view the video, see Five Years After Hurricane Katrina.

Just how prepared are Gulf Coast residents five years later? According to a 2010 I.I.I. poll, 74 percent of Louisiana and Mississippi residents who had filed an insurance claim from Hurricane Katrina considered themselves more prepared now than in 2005, compared with about half of the residents of those states who did not file a claim. In addition, seven out of 10 Hurricane Katrina claimants now have an inventory of their possessions to document their losses after a disaster, compared with 50 percent of the nation as a whole.

However, the survey also found some disturbing views: 32 percent of respondents in Louisiana and Mississippi think their homeowners policy covers damage from flooding during a hurricane -- that is double the percentage in the nation as a whole, but still represents a surprisingly high number of people who remain uninformed about flood insurance.

"It's astonishing that so many people who lived through Hurricane Katrina still don't understand that flood insurance is not covered under a home or business policy," pointed out Salvatore.

The I.I.I. noted four important steps homeowners and business owners can take now to protect themselves and their property:

1. Review Your Insurance Coverage

The time to review your insurance policy is before you have to file a claim. Make sure that you have both the right amount and type of insurance:

-- Amount of insurance. You should have enough insurance to rebuild your
home or business and replace all of its contents. If you have made a
major alternation or improvement to your home or business, get in
touch with your agent or company representative to update your policy.
Homeowners should find out how much coverage is available for
Additional Living Expenses (ALE). These expenses could include the
cost of a temporary rental home or hotel room, restaurant, meals and
any other expenses incurred in the event your home is uninhabitable
while it is being repaired or rebuilt. Some policies provide coverage
for 20 percent of the amount of insurance you have on your house.
Others may specify a time period. Additional coverage is generally
available for an additional cost.
-- Type of insurance. Ninety percent of all natural disasters involve
some form of flooding. Flood damage is not covered by standard home
insurance policies, but is available from the National Flood Insurance
Program and from some private insurance companies. Excess flood
insurance is also available from private insurance companies if you
need more coverage than the NFIP offers. For more information on flood
insurance, see FloodSmart.gov.

2. Create a Home/Business Inventory

A home or business inventory is a list of all of your personal or business possessions and their estimated value. An up-to-date inventory will help you:

-- Purchase the right amount of insurance.
-- Speed up the claims process by substantiating losses.
-- Provide documentation for tax purposes or disaster assistance.

In order to make the process of creating and updating an inventory, the I.I.I. has developed the Web-based Know Your Stuff software for homes and businesses. For more information on the process of creating an inventory, see the I.I.I.'s home inventory video podcast and brochure.

3. Protect Your Property

Hurricane-proof your home by keeping wind and water out. Invest in storm shutters and reinforced garage doors. Secure roof shingles and seal any openings, cracks and holes. Gable end walls and roof sheathing should be strongly attached and braced, and double doors should have heavy duty anchors at the top and bottom and a dead bolt at least 1 inch long. The Institute for Business & Home Safety has additional tips to protect your home against wind and other disasters.

4. Have an Evacuation Plan

When a hurricane is approaching, advanced planning really matters. Decide ahead of time where you will go and how you will get there, and have more than one option. If you have pets, contact your veterinarian for a list of preferred boarding kennels and facilities or ask your local animal shelter if they provide emergency shelter or foster care for pets. Also identify hotels or motels outside of your immediate area that accept pets. For more information see Protecting Your Pet During a Disaster.

The I.I.I. also recommends practicing your evacuation plan by doing a test run: giving yourself just 10 minutes to pack up your family, pets and important items and get out -- possibly for good. For a video on the subject, see Ten Minute Challenge.

"By taking these four steps now, you stand the best chance of getting your life back in order after a disaster," explained Salvatore.

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Medical Tourism Association Releases Healthcare Reform White Paper

2010-08-04T08:15:00.000-05:00

(PR.com)-- The Medical Tourism Association has released an educational White Paper on Healthcare Reform, detailing what positive and negative effects healthcare reform is expected to have on both inbound, outbound and domestic medical tourism. Healthcare Reform passed into law in March 2010 and has both immediate implications and those to go into full effect in 2014. Many expect the reform will continue to raise healthcare and health insurance costs in the United States. As healthcare costs and health insurance costs rise in the United States this will push American patients to choose to travel domestically for medical tourism, a new term coined towards the provision of more affordable healthcare services within the US, or to leave the United States to travel abroad for medical care.

As stated by Devon Herrick of National Center for Policy Analysis, USA, “The recent Health Reform legislation contains virtually nothing to encourage patients and providers to control costs. By contrast, medical tourism represents global competition in health care, where providers compete on price and quality. Medical tourism is our best opportunity to encourage competition within the health care industry.”

The Healthcare Reform white paper is meant to give guidance and understanding on how the different aspects of healthcare reform will interact with medical tourism. The Medical Tourism White Paper can be read in the Healthcare Reform Updates section of the Medical Tourism Congress website. http://medicaltourismcongress.com/en/healthcare-reform-updates.html

“We have released this white paper in order to provide insight into healthcare reform and its different provisions, projecting how it may affect medical tourism. Many people around the world do not understand the lengthy healthcare reform document passed in the US and mistakenly think that it provides more affordable healthcare to Americans and that it will lower healthcare costs. Costs will likely go up under healthcare reform and this was reaffirmed in the recent medical tourism survey the MTA conducted with almost 100 insurance companies and employers, where almost 100% of respondents found that they believe costs will rise,” said Jonathan Edelheit, CEO of the Medical Tourism Association.

The healthcare reform and medical tourism white paper will be available at the MTA’s annual conference, The World Medical Tourism & Global Healthcare Congress, which will have a large focus on Healthcare Reform this year in Los Angeles, California from September 22-24th. The conference will focus on how healthcare reform affects employers, insurers, insurance agents, healthcare providers and patients and will peel back the onion of the thousands of pages of healthcare reform bill to look at how different aspects of health care reform will really work. www.medicaltourismcongress.com

The Medical Tourism Association also conducted a survey of over one hundred US insurance companies and US employers on the effect medical tourism will have upon them. The survey, “Healthcare Reform Survey Among Industry Stakeholders Discovers Similar Concerns,” July, 2010, shows a sample of the future growth potential of the medical tourism industry. 71 percent of insurance companies and employers felt healthcare reform was extremely positive for the medical tourism industry and more Americans would travel overseas under the new law. Employers and insurance companies know that healthcare reform will increase costs and medical tourism is one of the few ways to lower those costs. http://medicaltourismmag.com/article/healthcare-reform-survey.html

The Medical Tourism Association (Medical Travel Association), also known as the Global Healthcare Association, at http://www.MedicalTourismAssociation.com is the first international non-profit association comprised of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment. Our Association promotes the interests of its healthcare provider and medical tourism facilitators members. The Medical Tourism Association has three mission-driven tenets: Education, Communication and Transparency.

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Court Ruling Vindicates Lawsuits Against ObamaCare

2010-08-03T13:08:00.000-05:00

/PRNewswire/ -- The first decision in the many lawsuits against ObamaCare, in a case brought by the State of Virginia, has just been handed down. It is a resounding repudiation of the arguments against this litigation.

Promoters of a Big Government/ Big Insurance takeover of American medicine have claimed that constitutional challenges to ObamaCare are frivolous and baseless. They say the unprecedented government intrusion is fully constitutional, citing the power of Congress to impose taxes and to regulate interstate commerce. But the federal court in Virginia rejected the arguments made by the Secretary of the U.S. Department of Health and Human Services.

In a scholarly, 32-page opinion, the court held that "No reported case from any federal appellate court has extended the Commerce Clause or Tax Clause to include the regulation of a person's decision not to purchase a product, notwithstanding its effect on interstate commerce."

Forcing all Americans to buy costly insurance that they do not want is the foundation on which ObamaCare rests. Without it, ObamaCare collapses. Other lawsuits, including the one brought by the Association of American Physicians and Surgeons (AAPS) in the District of Columbia, and one brought by a number of States in Florida, also challenge this mandate.

"The decision by the court in Virginia confirms the legitimacy of challenging the constitutionality of ObamaCare in court," states AAPS General Counsel Andrew Sechlafly. "This is a victory for freedom, and a real setback to the enemies of freedom in medicine."

The court reiterated that "the existence of congressional findings is not sufficient, by itself, to sustain the constitutionality of Commerce Clause legislation." As Virginia pointed out, "a decision not to purchase a product, such as health insurance, is not an economic activity. It is a virtual state of repose--or idleness--the converse of activity."

Although the majority of practicing physicians oppose ObamaCare's massive intrusion into medical practice, and a large percentage have indicated that they may quit practicing as a result, AAPS is so far the only long-established, national medical association to ask a court to overturn a key provision of the law (see www.aapsonline.org/hhslawsuit/). Where is the American Medical Association (AMA) when physicians and patients need it most?

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Many Americans Still Confused About New Healthcare Reform Law and its Provisions

2010-07-29T09:59:00.000-05:00

/PRNewswire/ -- Not sure what's in--and not in--the new healthcare legislation signed into law by President Barack Obama in March? You're not alone. More than 2,100 adults were given a list of 18 reform items and asked to identify what's included and what's not included in the law. Only four items were correctly identified by the majority of those polled.

Most (58 percent) know that the reform package will prohibit insurers from denying coverage to people because they are already sick; 55 percent know the law permits children to stay on their parents' insurance plan until age 26; and 52 percent realize that people who don't have insurance will be subject to financial penalties. Additionally, half are aware that employers with more than 50 employees will have to offer their workers affordable insurance.

These are some of the major findings of today's HealthDay/Harris Poll, conducted between July 15 to 19, 2010 among 2,104 adults (aged 18 and over).

Among other findings: 82 percent think the bill will result in rationing of health care or that it might (it won't); 79 percent don't know or aren't sure if drug companies will pay an annual fee, (they will); 73 percent don't know the law establishes a new tax on the sale of medical devices; 66 percent don't know or aren't sure if the legislation will result in insurance exchanges where people can shop for insurance, (it will); and 63 percent either aren't sure or don't know if the new law will increase the number of people eligible for Medicaid, (it will).

"The problem for the (Obama) administration is healthcare reform is fiendishly complicated because the healthcare system is fiendishly complicated, and it is not politically feasible to tear up the system and build it again," said Humphrey Taylor, chairman of the Harris Poll, Harris Interactive's long-running public opinion poll. "Instead you have to build on the system that you have. When you try to build on a fiendishly complicated system, you have fiendishly complicated reforms."

Another cause of the confusion is due to the long and heated political debate that surrounded the bill before it was passed, Taylor said.

"The level of ignorance and misinformation is sort of astounding," he said. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don't actually know what is or is not in the actual legislation."

For more information, click here to read the full report and methodology. HealthDay's news report is available here. Full data on the poll and its methodology are available at Harris Interactive.

TABLE 1
            KNOWLEDGE OF ITEMS THAT ARE INCLUDED IN REFORM BILL (PPACA)
  "Please indicate if you believe each of the following is included (or
  will result from) or is not included (or will not result from) the
  health care reform bill that was signed by President Obama in March
  of this year.  If you don't know, please do not guess but
  check "Not sure."
  Base: All adults

                                                        Is Not
                                        Is Included/   Included/
                                        Will Result    Will Not
                                            From     Result From  Not
                                                                  Sure
  Not allowing insurers to deny
   coverage to people                 %           58            9      34
  because they are sick
  Allowing children to stay on their
   parents' insurance until           %           55            9      35
  they are 26 years old
  Financial penalties for all
   individuals who do not have or     %           52            9      39
  do not buy insurance
  All employers with more than 50
   employees must offer               %           50            9      41
  their employees affordable
   insurance
  Tax credits for small business to
   provide insurance to               %           43           14      43
  their employees
  Increasing the number of people who
   are eligible for                   %           37           13      50
  Medicaid
  Insurance exchanges where people
   can shop for                       %           35           14      52
  insurance
  A new tax on the sale of medical
   devices                            %           27           13      60
  An annual fee to be paid by drug
   companies                          %           21           14      65


  Note: Percentages may not add up exactly to 100% due to rounding.





                                     TABLE 2
            BELIEF THAT ITEMS NOT IN REFORM BILL (PPACA) ARE INCLUDED
  "Please indicate if you believe each of the following is included (or
  will result from) or is not included (or will not result from) the
  health care reform bill that was signed by President Obama in March
  of this year.  If you don't know, please do not guess but
  check "Not sure."
  Base: All adults

                                                       Is Not
                                       Is Included/   Included/
                                       Will Result    Will Not
                                           From     Result From  Not
                                                                 Sure
  An increase in the federal
   government's budget deficit       %           45           13      42
  Higher income taxes for the middle
   class                             %           37           22      41
  All Americans will have health
   insurance                         %           36           29      35
  New ways to ration health care     %           36           18      46
  A new government run health plan
   to compete with                   %           36           22      43
  private insurance plans
  A cut in Medicare benefits         %           33           21      45
  Higher tax deductions from
   workers' pay                      %           33           16      50
  Panels to decide what care very
   sick, older people                %           30           26      44
  should receive
  Illegal aliens will have health
   insurance                         %           28           27      45

Note: Percentages may not add up exactly to 100% due to rounding.

Methodology

This survey was conducted online within the United States July 15 to 19, 2010 among 2,104 adults (aged 18 and over). Figures for age, sex, race/ethnicity, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was also used to adjust for respondents' propensity to be online.

All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Interactive avoids the words "margin of error" as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100% response rates. These are only theoretical because no published polls come close to this ideal.

Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the adult population. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated.

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U.S. Files Suit Against Georgia Medical Center and Physician; Allegedly Submitted Claims for Worthless Services to Federal Health Care Programs

2010-07-27T19:54:00.000-05:00

/PRNewswire/ -- The United States has filed a complaint under the False Claims Act against Dr. Najam Azmat and the Satilla Regional Medical Center in Waycross, Ga., the Justice Department announced today. The complaint, filed in U.S. District Court for the Southern District of Georgia, alleges that the defendants submitted false or fraudulent claims to federal health care programs, such as Medicare. Specifically, the United States contends that certain operative procedures performed by Dr. Azmat at Satilla, and hospital services provided by Satilla in connection with those procedures, were not reasonable and necessary, were incompatible with standards of acceptable medical practice, and were of no medical value. The United States further alleges that the defendants' misconduct endangered the lives of federal health care program beneficiaries.

The government's complaint alleges that in the Spring of 2005, Satilla recruited Dr. Azmat, a general surgeon by training, to relocate to Waycross and join the hospital's medical staff. Shortly after Dr. Azmat came aboard, Satilla allowed him to begin performing endovascular procedures - highly specialized operative procedures that require formal training - in Satilla's Heart Center cath lab. Satilla did so despite the fact that Dr. Azmat lacked training to perform such procedures, was not qualified or competent to perform such procedures, had never performed such procedures before at any of the hospitals where he had been on staff, and did not even have privileges at Satilla to perform such procedures.

The complaint further alleges that it was obvious to the cath lab nursing staff that Dr. Azmat was not qualified or competent to perform endovascular procedures. The nurses repeatedly voiced their concerns to Satilla's management, but the hospital took no formal action for at least five months, during which patients were seriously injured and one patient died from hemorrhagic shock following an endovascular procedure during which Dr. Azmat perforated her renal artery. The complaint also states that not only did Satilla's management ignore its nurses' concerns for several months, but it also performed no formal oversight of Dr. Azmat, categorically excluding all of his endovascular procedures from Satilla's peer review process.

"When health care providers cut corners by allowing unqualified doctors to perform complicated medical procedures, patients suffer," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Here, we allege individuals were endangered because of these defendants. The seriousness of this case illustrates why we remain committed to protecting patient safety and the integrity of our federal health care programs by aggressively enforcing our health care fraud laws."

"The filing of this complaint is but one example of the willingness of the Department of Justice to take action to protect the health and safety of the American people. The United States Attorney's Office will take the necessary legal actions to comply with our vigorous enforcement responsibilities under the False Claims Act," said Edward Tarver, U.S. Attorney for the Southern District of Georgia

This lawsuit was originally filed by Lana Rogers, a nurse who formerly worked in Satilla's Heart Center. Under the qui tam, or whistleblower, provisions of the False Claims Act, a private citizen can file an action on behalf of the United States and receive a portion of any recovery. In April of this year, the United States intervened in the lawsuit, and today filed its own complaint. Under the False Claims Act, the government may recover up to three times the amount of its losses, plus civil penalties based on the number of false claims filed

The suit is entitled United States ex rel. Lana Rogers v. Najam Azmat, M.D. and Satilla Health Services Inc., dba Satilla Regional Medical Center.

The United States' intervention is part of the government's emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $4 billion.

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Six Key Tips for Caregivers Navigating the System on Behalf of Their Parents, Grandparents and Others

2010-07-23T09:00:00.000-05:00

/PRNewswire/ -- According to the National Alliance for Caregiving, more than 65 million people in the United States serve as informal caregivers, typically for family members, which equates to more than one out of every four people serving as unpaid caregivers.

A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Blue Cross and Blue Shield of Georgia's parent company.

"At Blue Cross and Blue Shield of Georgia (BCBSGA), we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," said Monye Connolly, President, BCBSGA. "There are some themes that are common among them."

Gathering Information

The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:

-- Medicare card (if eligible)
-- Health plan membership card
-- A list of doctors, including specialists
-- A list of medicines and dosages
-- Information about the person's medical conditions both treated and
untreated.

This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.

Getting Permission

Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.

"People are sometimes surprised to learn that companies like Blue Cross and Blue Shield of Georgia cannot readily disclose a person's health information, even to their own spouse or child," said Connolly. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."

Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.

These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.

Enrolling in a Chronic Disease Program

Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.

"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."

Knowing Your Rights

Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.

If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit http://www.medicare.gov/ to get a free copy of "Your Rights and Protections."

Investigating 'Extra Help'

As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to www.socialsecurity.gov/extrahelp.

Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site www.benefitscheckuprx.org has compiled information about these resources in one convenient online location. The site, which counts Blue Cross and Blue Shield of Georgia among its sponsors, tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.

Caring for Yourself

The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.

According to the Alzheimer's Association, research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.

"Caregivers need to know that there's no shame in asking for help," said Connolly.

For more information about care giving and Medicare, including helpful forms, please visit www.medicare.gov/caregivers.

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AHRQ State Snapshots Expanded To Include New Data on Health Insurance Coverage

2010-07-22T14:43:00.000-05:00

Editor Note: According to this new database, Georgia has improved its health care quality from "weak" to a low "average."

/PRNewswire/ -- The Agency for Healthcare Research and Quality's annual release of state-by-state quality data has been expanded to include new data on health insurance, including data on health care quality categorized by source of payment, including private insurance, Medicare, Medicaid and those without insurance.

The new health insurance section allows users to compare payer-specific quality rates as well as differences among payers. For example, a state can compare the quality of care received by Medicaid or uninsured patients with that received by these same patients nationally. In addition, a state can assess whether its insurance-related disparities are larger or smaller compared with the nation as a whole.

The 2009 State Snapshots provide state-specific health care quality information, including strengths, weaknesses and opportunities for improvement. State-level information used to create the State Snapshots is based on data collected for the 2009 National Healthcare Quality Report. Overall, states get mixed reviews for the quality of care they provide. As in previous years, AHRQ's 2009 State Snapshots show that no state does well or poorly on all quality measures.

Maine, Maryland, Wyoming, South Carolina and the District of Columbia showed the greatest improvement. The five states showing the smallest improvement were North Dakota, Texas, West Virginia, Nebraska and Washington State. For each state, specific clinical conditions could be identified that account for different rates of improvement.

"The addition of the insurance information to the State Snapshots adds one more dimension to the picture of health care quality and disparities in individual states and regions," said AHRQ Director Carolyn M. Clancy, M.D. "The 2009 State Snapshots continue to evolve into an invaluable resource for state officials and other stakeholders."

The 2009 State Snapshots summarizes health care quality in three dimensions: types of care (preventive, acute and chronic care), settings of care (hospitals, ambulatory settings, nursing homes and home health care) and clinical conditions (cancer, diabetes, heart disease, maternal and child health and respiratory disease). There are also special focus areas on diabetes, asthma, Healthy People 2010 objectives, clinical preventive services and disparities.

Additional features in the 2009 State Snapshots provide more ways to analyze the quality of health care for each state compared with all states, as well as with states in the same region. New and enhanced features include enhanced sections on asthma care, diabetes care and health care disparities.

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Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care

2010-07-14T14:34:00.000-05:00

The Departments of Health and Human Services (HHS), Labor, and the Treasury issued new regulations today, requiring new private health plans to cover evidence-based preventive services and eliminate cost sharing requirements for such services. The new rules will help Americans gain easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children.

"Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs," said HHS Secretary Sebelius. "From the Recovery Act to the First Lady's Let's Move Campaign to the Affordable Care Act, the Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy."

Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation's health spending - and often are preventable. Nationally, Americans use preventive services at about half the recommended rate. An estimated 11 million children and 59 million adults have private insurance that does not adequately cover immunization, for instance. Cost sharing, including deductibles, coinsurance, or copayments, has been found to reduce the likelihood that preventive services will be used.

"Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure," said First Lady Michelle Obama. "And good preventative care will also help tackle an issue that is particularly important to me as First Lady and as a mother - and that is the epidemic of childhood obesity in America today. These are important tools, and now it's up to us to use them."

"One of the best ways to improve the quality of your life - and control health care costs - is to prevent illness in the first place," said Dr. Jill Biden. "Focusing on prevention and early treatment makes more sense than trying to play catch-up with a potentially deadly disease. Quite simply, these preventative services will save lives."

Under the regulations issued today, new health plans beginning on or after September 23, 2010, must cover preventive services that have strong scientific evidence of their health benefits, and these plans may no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider. Specifically, these recommendations include:

* Evidence-based preventive services: The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a "grade" of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

* Routine vaccines: Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices ranging from routine childhood immunizations to periodic tetanus shots for adults.

* Prevention for children: Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These guidelines provide pediatricians and other health care professionals with recommendations on the services they should provide to children from birth to age 21 to keep them healthy and improve their chances of becoming healthy adults. The types of services that will be covered include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

* Prevention for women: Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by August 1, 2011.

Today's announcement builds on other provisions in the Affordable Care Act that support prevention, including the creation of a first-ever National Prevention, Health Promotion and public Health Council tasked with developing a national strategy and a Prevention and Public Health Fund to invest in prevention initiatives and, this year, policies to increase the number of primary care professionals to help ensure access to these services. The Affordable Care Act also helps make it easier and more affordable for Americans enrolled in Medicare or Medicaid to access critical preventive screenings and services.

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Enactment of New FSA Restriction Will Pose Problems for Consumers, Retailers and Benefit Providers

2010-07-13T09:01:00.000-05:00

/PRNewswire/ -- A provision of health care reform could blindside consumers and create an administrative nightmare for providers and retailers as its January 1, 2011 implementation date draws closer. Without intervention, the Patient Protection and Affordable Health Care Act, passed earlier this year, will require consumers to obtain a physician's "prescription" in order to use their pre-tax flexible spending accounts (FSAs) to pay for over-the-counter (OTC) medicines other than insulin. Rep. Earl Pomeroy (D-ND) and industry groups have called for clarification of the new regulations to give providers and retailers an opportunity to educate consumers and develop compliance procedures.

In a letter to U.S. Treasury Secretary Timothy Geithner, Rep. Pomeroy encouraged the Treasury "...to work with consumers and stakeholders to address certain compliance issues in advance of the mandated implementation date." Without clarifying the policy, "...consumers are left confused and frustrated and benefit administrators and retail merchants will be left with increased processing and consumer service costs," wrote Rep. Pomeroy.

An industry group responsible for establishing standards for electronic payment processing for health spending accounts, such as those used to identify eligible OTC purchases, argues additional guidance is needed to clarify how the new regulations will work in practice before it can be implemented. The law currently states that only "prescribed" OTC drugs are eligible for reimbursement; however, it does not specify whether a prescription is required or if a letter of medical necessity will suffice.

"Without clarification on the type of permission needed for FSA reimbursement for OTC drugs, consumers, retailers and third party administrators will be confused and unlikely to fully comply with the new regulations by the start of the new year. Meanwhile, we're likely to see doctor's offices overwhelmed with patients seeking prescriptions to use their spending accounts for Claritin, Zyrtec and other OTC items," said Jody Dietel, president and chair of the Special Interest Group for Inventory Information Approval System Standard (SIGIS). "A delay in implementation will provide time for all parties to be better educated on the issue and prepared to comply with the new rules."

Both Rep. Pomeroy and SIGIS warn that forcing retailers to quickly change their distribution practices for a January 1, 2011 start date will be difficult given the current electronic systems structure, which, in turn, will lead to processing errors, consumer frustration and major challenges for FSA administrators.

"This restriction will hurt millions of consumers who rely on their FSAs to manage their out of pocket health care costs and pay for necessary over-the-counter therapies," noted Joe Jackson, CEO of WageWorks Inc., a benefits company based in San Mateo, California. "If Congress is intent on putting this provision into effect, they should at least push back the deadline so that consumers and especially retailers are ready for the transition."

Currently, consumers may contribute money to their FSAs to cover out-of-pocket medical expenses not covered by insurance, including co-pays and over-the-counter items such as asthma and allergy supplies, aspirin and flu medications.

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Oxendine: Flood Insurance Program Resumes Issuing Policies

2010-07-07T14:35:00.000-05:00

Insurance Commissioner John W. Oxendine said the National Flood Insurance Program has been reauthorized by Congress, and flood policies are again available through your homeowners insurance agent or company.

Flood coverage is federally backed by the NFIP. The National Flood Insurance Extension Act extends the NFIP through September 30 of this year, and is retroactive back to June 1, 2010. The program had been inactive since May 31.

Oxendine said a flood policy can be a valuable addition to standard homeowners coverage.
“Purchasing flood insurance is an important consideration for Georgia consumers, even if you think a flood is unlikely in your area,” Oxendine said. “Twenty-five percent of flood claims occur in areas considered medium or low-risk for floods.”

Oxendine said flood insurance is available for up to $250,000 for damage to your home. A standard flood policy will cover the basic structure as well as the furnace, water heater, air conditioner, floor surfaces (carpeting and tile) and debris clean up.

You can buy NFIP flood insurance directly from your property and casualty insurance agent or insurance company, if your community participates in the NFIP. Your insurance agent or insurance company can confirm whether flood insurance is available to you and what it would cost. You can buy flood insurance for your home or business regardless of whether the property is in or out of a floodplain, as long as the property is located in a participating community.

It is very important to plan ahead; a flood insurance policy will not go into effect until 30 days after you buy the policy. You can obtain more information about flood insurance at http://www.floodsmart.gov.

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Medicare Proposes New Rules to Ensure Equal Visitation Rights for All Hospital Patients Patients to Designate Their Own Visitors, Including Domestic Partners

2010-07-05T07:16:00.000-05:00

The Centers for Medicare & Medicaid Services (CMS) on June 23 proposed new rules for hospitals that would protect patients' rights to choose their own visitors during a hospital stay, including visitors who are same-sex domestic partners.

The new proposed rules implement an April 15, 2010, Presidential memorandum, in which the President tasked HHS with developing proposed standards for Medicare- and Medicaid-participating hospitals (including critical access hospitals) that would require them to preserve the rights of all patients to choose who may visit them when they are inpatients of a facility.

The proposed rules would require every hospital to have written policies and procedures detailing patients' visitation rights, as well as instances when the hospital may restrict patient access to visitors based on reasonable clinical needs.

A key provision of the proposed rules specifies that visitors chosen by the patient (or his or her representative) must be able to enjoy visitation privileges that are no more restrictive than those for immediate family members.

"Every patient deserves the basic right to designate whom they wish to see while in the hospital," said HHS Secretary Kathleen Sebelius. "Today's proposed rules would ensure that all patients have equal access to the visitors of their choosing-whether or not those visitors are, or are perceived to be, members of a patient's family."

The proposed rules would update the Conditions of Participation, which are minimum health and safety standards all Medicare- and Medicaid-participating hospitals and critical access hospitals must meet.

Specifically, the proposed rules would add new requirements for hospitals and critical access hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, or a domestic partner (including a same-sex domestic partner), as well as the right to withdraw such consent at any time.

"This proposed rule is an important step forward in the rights of all Americans to expect equal rights and privileges from the health care system, regardless of their personal and familial situations," said Marilyn Tavenner, CMS acting administrator. "In the environment of inclusion that this rule promotes, patients and providers can expect improved patient experiences of care."

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Statement from Secretary Sebelius on Proposed CMS Rule to Expand Medicare Preventive Services and Expand Access to Primary Care

2010-07-05T07:00:00.000-05:00

On June 25, the Centers for Medicare & Medicaid Services (CMS) took another important step to help improve the health status of Medicare beneficiaries. The proposed regulation will implement the new preventive health benefits created under the Affordable Care Act for the seniors and persons with disabilities who rely on Medicare for their health care coverage.

The new rule proposes to make two significant improvements to preventive care benefits under Medicare: Beginning January 1, 2011, Medicare will cover annual wellness visits so that doctors and patients can develop a personalized prevention plan that takes a comprehensive approach to improving the patient’s health. Also beginning January 1, 2011, Medicare beneficiaries will no longer have to pay any out-of-pocket costs for most preventive services – including that annual wellness visit.

To help make sure that Medicare beneficiaries have access to primary care doctors, the rule would also boost payments for primary care services. The proposed regulation would also increase access to services by creating payment incentives for general surgeons as well as expand access to other types of health care providers.

Improving access to preventive services and primary care is a top priority for HHS. The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries – and all Americans. We recently announced the allocation of $500 million from the Prevention and Public Health Fund – created by the Affordable Care Act – to invest in the training and development of primary care professionals as well as preventive care activities and public health infrastructure.

With these new benefits under Medicare, and investments in our health care system, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease.

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HHS Secretary Sebelius Announces New Pre-Existing Condition Insurance Plan

2010-07-04T16:45:00.000-05:00

The U.S. Department of Health and Human Services (HHS) announced on July 1 the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

The Pre-Existing Condition Insurance Plan, which will be administered either by a state or by the Department of Health and Human Services, will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.

Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges. In 2014, Members of Congress will also purchase their insurance through Exchanges.

“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Secretary Kathleen Sebelius. “Today, the Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”

The Affordable Care Act provides $5 billion in federal funding to support Pre-Existing Condition Insurance Plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their Pre-Existing Condition Insurance Plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’ new consumer website, www.HealthCare.gov.

“Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight (OCIIO) which is overseeing the program. “The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”

In order to give states the flexibility to best meet their needs, HHS provided states with the option of running the Pre-Existing Condition Insurance Plan themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.

Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program.

All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.

“The Pre-Existing Condition Insurance Plan is an important next step in the overall implementation of the Affordable Care Act,” said Richard Popper, Director of Insurance Programs at OCIIO. “We have been working closely with the states and other stakeholders to make sure this program reaches uninsured Americans struggling to find coverage due to a pre-existing condition.”

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.

Like the popular Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing condition. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is no state matching requirement and the federal government will cover the entire cost of the Pre-Existing Condition Plan. While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.

Information on how to apply for the Pre-Existing Condition Insurance Plan is available at www.HealthCare.gov. Americans who live in a state where the U.S. Department of Health and Human Services is running the Pre-Existing Condition Plan will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply on www.HealthCare.gov.

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Georgia's New Healthcare Budgets Precariously Balanced

2010-06-22T08:45:00.000-05:00

In order to tackle the large deficit and significant revenue declines while still protecting Medicaid, lawmakers enacted a temporary hospital provider fee to prevent significant rate cuts to hospitals, doctors, nursing homes, and other health care providers and balance the budget for the upcoming fiscal year. This and other aspects of the healthcare budgets are discussed in the Georgia Budget & Policy Institute's latest analysis: Lawmakers Protect Medicaid, Serious Funding Gaps Loom for 2012.

Thanks in large part to the enhanced federal Medicaid funding made available to all states through the Recovery Act in 2009, Georgia is not implementing major cuts to Medicaid eligibility or services in FY 2011.

But now Georgia is in a tough position.

Georgia is among 30 states that have built its state budget assuming that enhanced Medicaid funding will be available through next June, when our budget year ends. The U.S. Congress is currently considering legislation to extend this funding until then, but unless they act soon to extend the enhanced Medicaid funding, Georgia's budget will be short $375 million.

If, instead of finding additional state revenue, lawmakers cut the Medicaid program to save $375 million, the state would also forgo more than $650 million in federal funds that are in the state's Medicaid base budget.

"The Great Recession has caused more Georgians to seek help for their families through Medicaid and losing a billion dollars would devastate a Medicaid budget that already relies significantly on temporary funding in FY 2011," said Timothy Sweeney, the Institute's senior healthcare analyst and author of the healthcare budget analysis.

"The cuts necessary to balance the budget without these funds would be devastating for individual Georgians and for the healthcare sector that depend on an adequately funded Medicaid program. In addition, many local economies rely significantly on their healthcare industry."

Other notable changes lawmakers made for this upcoming fiscal year are:

*10% cut to state grants to county health departments
* Increasing premiums families pay for children in PeachCare
*Increased funding for mental health services

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U.S. Departments of Health and Human Services, Labor, and Treasury Issue Regulation on "Grandfathered" Health Plans under the Affordable Care Act

2010-06-15T06:50:00.000-05:00

Allowing Americans to Keep Current Health Plans or Choose a New Plan While Extending Important New Benefits to All Consumers

The U.S. Departments of Health and Human Services, Labor and Treasury today issued a new regulation that makes good on President Obama's promise that Americans who like their health plan can keep it.

The new regulation protects the ability of individuals and businesses to keep their current plan while providing important consumer protections that give Americans - rather than insurance companies - control over their own health care. The new regulation also provides stability and flexibility to insurers and businesses that offer health insurance coverage as the nation transitions to a more competitive marketplace in 2014 when businesses and consumers will have more affordable choices through exchanges.

"The Affordable Care Act gives American families more control over their health care by providing greater benefits, cost savings and protections," said Secretary of Health and Human Services Kathleen Sebelius. "Today, with the announcement of the new 'grandfather' rule, we're providing the market stability and flexibility to ensure that families and businesses can make the choices that work best for them."

While the Affordable Care Act requires all health plans to provide important new benefits to consumers, under the law, plans that existed on March 23, 2010 are exempt from some new requirements. The "grandfather rule" issued today makes it clear that these plans can continue to innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status. Plans will lose their "grandfather" status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers - and consumers in plans that make such changes will gain new consumer protections.

"The rule we are announcing today will allow employers to make routine and modest adjustments to co-payments, deductibles and employer contributions to their employees' premiums without forfeiting grandfather status. This flexibility will encourage employers to continue offering health coverage to their employees and help to ensure coverage for all Americans," said Secretary of Labor Hilda Solis.

All health plans - whether or not they are grandfathered plans - must provide certain benefits to their customers for plan years starting on or after September 23, 2010 including:

* No lifetime limits on coverage for all plans;

* No rescissions of coverage when people get sick and have previously made an unintentional mistake on their application; and

* Extension of parents' coverage to young adults under 26 years old;

For the vast majority of Americans who get their health insurance through employers, additional benefits will be offered, irrespective of whether their plan is grandfathered, including:

* No coverage exclusions for children with pre-existing conditions; and

* No "restricted" annual limits (e.g., annual dollar-amount limits on coverage below standards to be set in future regulations).

"The Affordable Care Act positions consumers, instead of insurance companies, as decision makers when it comes to their health care," said Assistant Treasury Secretary for Tax Policy Michael Mundaca. "The rule we're announcing today preserves individuals' ability to keep their current plan and provides strong consumer protections that give Americans more control over their health insurance choices."

Grandfathered health plans will be able to make routine changes to their policies and maintain their status. These routine changes include cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with State or other Federal laws. Premium changes are not taken into account when determining whether or not a plan is grandfathered.

Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. If a plan loses its grandfathered status, then consumers in these plans will gain additional new benefits including:

* Coverage of recommended prevention services with no cost sharing; and

* Patient protections such as access to OB-GYNs and pediatricians without a referral by a separate primary care provider.

Details about what routine changes insurers and employers can make without losing their grandfathered status, and the projected impact on large and small employer plans and the individual plan market can be found at http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html.

Most of the 133 million Americans with employer-sponsored health insurance through large employers will maintain the coverage they have today. Additionally, large employer-based plans already offer most of the comprehensive benefits and consumer protections that the Affordable Care Act will provide to all Americans this year - such as preventing rescission of coverage.

The roughly 42 million people insured through small businesses will likely transition from their current plan to one with the new Affordable Care Act protections over the next few years. Small plans tend to make substantial changes to cost sharing, employer contributions, and health insurance issuers more frequently than large plans. To help small businesses afford employee coverage, the Affordable Care Act includes a tax credit for up to 35% of their premium contributions.

The 17 million people who are covered in the individual health insurance market, where switching of plans and substantial changes in coverage are common, will receive the new protections of the Affordable Care Act sooner rather than later. Roughly 40 percent to two-thirds of people in individual market policies normally change plans within a year. In the short run, individuals whose plan changes and is no longer grandfathered will gain access to free preventive services, protections against restricted annual limits, and patient protections such as improved access to emergency rooms.

In 2014, small businesses and individuals who purchase insurance on their own will gain access to the competitive market Exchanges. These Exchanges will offer individuals and workers in small businesses with a much greater choice of plans at more affordable rates - the same choice as members of Congress. In fact, the Congressional Budget Office (CBO) has estimated that, on an apples-to-apples basis, premiums will be 14- 20 percent lower than they would be under current law in 2016 due to competition, lower insurance overhead, and increased pooling and purchasing power. Small businesses also will have more affordable options. CBO has estimated that a family policy for small businesses would be available in the Exchanges at a premium that is $4,000 lower than under current law in 2016.

These reduced premiums do not take into account the tax credits available to small businesses and middle class families to help make insurance affordable. These additional new choices and cost savings may further lower the likelihood that small businesses workers will remain in grandfathered health plans. Consumers insured through large employers are more likely to remain in grandfathered plans in 2014 and beyond.

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Deloitte Survey: Majority of Insured Consumers Satisfied With Current Health Plan -- But Concerned About Changes Health Care Reform Act May Bring

2010-06-10T09:03:00.000-05:00

/PRNewswire/ -- Of the 82 percent of consumers surveyed who consider themselves "well" or "adequately" insured, nearly all (96 percent) are somewhat or very satisfied with their health plans overall, according to a new Deloitte poll. (www.deloitte.com/us/consumerhealthpulse) Many are concerned the new health reform law will bring about significant changes to their current coverage. Of those enrolled in employer-sponsored health plans, 61 percent believe their employer will reduce benefits for dependents and retirees and 32 percent think employers will probably pay the penalty and discontinue health coverage for employees altogether.

"Anxiety about current and future health insurance coverage will continue to be a major issue for American consumers as health care reform is implemented nationally," stated Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions. "For example, our research shows that consumers who are covered through Medicare are more highly satisfied with their health care services than those in employer-sponsored plans."

Among survey respondents who consider themselves "very knowledgeable" about the Patient Protection and Affordable Care Act, many also indicated concerns over the impact of health reform on access to quality health care. They believe that some hospitals and medical practices will close (72 percent) and that their employers may drop their coverage (51 percent).

The cost of care is also an issue for the majority of consumers. Survey respondents anticipate increases in taxes (76 percent), health insurance costs, including premiums and out-of pocket expenses (65 percent), hospitals and physicians services (66 percent), and the cost of medications (54 percent) as reform is implemented.

Age is a major factor contributing to opinions about health care reform. In general, younger adults are more positive about health reform than older consumers. According to the survey, more than half (51 percent) of 18-34 year-olds believe that the reform bill will reduce health care costs in the long term, compared to respondents 45-54 years old (23 percent), 55-64 years old (36 percent), and 65 years old and above (30 percent).

"Younger consumers are beginning to embrace a new norm for health care," said Keckley. "Those in the younger age groups, (18-44 years old), are increasingly aware that the health care reform process has many moving parts and that they may find themselves entering into a new pact with employers."

The Deloitte survey also identified that consumers with employer-sponsored coverage seem to be the most skeptical and expect to experience negative impacts from the implementation of reform. This segment of survey respondents agree with the following:

-- The cost of the health reform act will be higher than expected (82
percent), which is significantly different from those who are
individually insured (68 percent).
-- The health reform act will not reduce health care costs in the
long-term (58 percent), which is significantly different from the
uninsured (43 percent).
-- Employers will pass the increased cost of health benefits through to
their employees (80 percent).

"Our research indicates that health insurance plans and employers may need to collaborate more than ever to help ease the anxiety of plan participants and employees as new health reform measures are implemented," said John T. Bigalke, vice chairman and Deloitte's health sciences and government industry leader.

Additional key findings from the survey include:

-- Eighty-four percent of all consumers surveyed have health insurance.
-- More than half (56 percent) of those surveyed believe that incentives
for doctors and hospitals to use electronic medical records will be
effective or very effective at improving the overall performance of
the health care system.
-- Cutting the rate of growth of Medicare costs will be only somewhat or
not effective at improving the overall performance of the health care
system according to 60 percent of those surveyed.
-- Sixty-nine percent of those surveyed believe the issue is not whether
an organization is for-profit or not-for-profit -- it's what they do
that matters.
-- Sixty-one percent of respondents agree that a mix of for-profit and
not-for-profit organizations stimulates positive competition and
innovation.

Methodology:

This survey was conducted via telephone interviews within the United States by Harris Interactive on behalf of the Deloitte Center for Health Solutions from May 21-24, 2010 among 1,019 adults ages 18 years old and above. Results were weighted to reflect the U.S. adult population. The survey results have a sampling error of +/- 3 percentage points at the 95% confidence level.

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Secretary Sebelius Announces $51 Million in Affordable Care Act Grants to Innovate, Improve and Enhance Health Insurance Premium Rate Review

2010-06-08T08:24:00.000-05:00

New grant program providing $250 million to states over next five years will strengthen oversight of insurance premiums and rate hikes

HHS Secretary Kathleen Sebelius today (June 7) announced the availability of $51 million in Health Insurance Premium Review Grants through the Affordable Care Act. These funds are the first round of grants available to states through a new $250 million grant program to create and strengthen insurance rate review processes.

"This is an important step in putting consumers back in control of their health care," said Secretary Sebelius. "These new grants will help states protect consumers and small employers by holding insurers accountable for unreasonable insurance rate increases that have made coverage unaffordable for many American families. By strengthening oversight of insurance premiums, these grants will help put affordable coverage back within the reach for Americans who have been hit hard by skyrocketing costs."

All states and the District of Columbia are eligible for this first round of rate review grants. To receive a grant, a state must submit a plan for how it will use grant funds to develop or enhance its process of reviewing and approving, disapproving, or modifying health insurance premium requests. States with successful applications will receive a $1 million grant during the first round.

"These funds will help states strengthen their oversight capabilities and will allow states that do not currently review rates to establish a program," said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight. "By subjecting rates to new public scrutiny, the oversight of premium increases will ultimately help ensure that consumers receive substantial value for their insurance dollars."

In early May, Secretary Sebelius sent a letter to Governors and State Insurance Commissioners urging them to review the authority they have under their state laws to determine whether they have all of the regulatory tools needed to approve health insurance rates before they take effect.

Several provisions in the Affordable Care Act strengthen HHS' and states' oversight of insurance premiums and rate hikes. These include the Medical Loss Ratio, requiring insurers in the individual and small group markets to spend at least 80 percent of the premium dollar on health care, and insurers in the large group market to spend at least 85 percent of the premium dollar on health care; rate review, requiring insurers to justify unreasonable premium increases to state regulators and the Secretary of Health and Human Services; and grant funds for states to help create or strengthen reporting and review processes.

The Health Insurance Premium Review Grants that will be available during FY 2010 are only the first in a five-year grant program. HHS will take applications for a second round of state grants beginning in Fiscal Year 2011, after new regulations regarding rate review take effect. Second-round grants will allow states to further strengthen their rate review, and begin to provide the Secretary of HHS with the rate data required under the law.

This grant solicitation can be found at grants.gov.

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HHS Announces Availability of $60 Million in Affordable Care Act Grants to Help People Navigate their Health and Long-term Care Options

2010-06-03T14:53:00.000-05:00

HHS Secretary Kathleen Sebelius announced the availability of $60 million in Affordable Care Act grants to states and communities to help individuals and their caregivers better understand and navigate their health and long-term care options.

Through this opportunity made possible by the Affordable Care Act HHS' Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) will work collaboratively to award funds for an integrated approach that focuses on the unique needs of seniors, disabled Americans and their caregivers as they seek health care and long-term care.

"The Affordable Care Act seeks to lower health care costs, improve the quality of health care and perhaps most importantly give people more control over their own care. These new grants, authorized under the new law, will help seniors, individuals with disabilities and their families get better quality care and more control. We've also streamlined the process for states and people who rely on these funds," said Secretary Sebelius.

"We know how difficult it can be for caregivers and patients to try and deal with a sudden illness or chronic disease while at the same time trying to navigate through a complex health care system to figure out where you can get help. These new funds that we have bundled together will help promote better opportunities for coordination of health and long-term supports," said Sebelius.

The purpose of this new grant program authorized by the Affordable Care Act is to create streamlined, coordinated statewide systems of information, counseling, and access that will help people find consumer-friendly answers they seek to meet their health and long-term care needs. AoA and CMS will administer the funding through separate announcements, but will coordinate implementation and monitoring through a single process.

Some specific areas of focus will include assisting individuals who are under-served and hard to reach with information about their Medicare and Medicaid benefits, helping older adults and individuals with disabilities live at home or in settings of their choosing with the right supports, assisting people transition from hospital or nursing home stays back into the community, and strengthening linkages between the medical and social service systems.

"When it comes to long-term health care, each patient has a unique mix of complex medical and social needs that must be considered when seeking care," said Marilyn Tavenner, acting CMS administrator. "Our health care system can offer many options to meeting those needs from traditional nursing home care to home and community-based services. Making patients and their families aware of these options will help them make inherently difficult decisions about long-term care. This integrated program will help families make informed choices and make sure patients have more control over their own care."

AoA and CMS have provided grants to states for several years to develop person-centered systems of information, counseling and access to make it easier for individuals to learn about and access their health and long-term services and support options. This grant program through the Affordable Care Act strengthens and enhances the ability of states to truly integrate the medical and social services care models.

"AoA's national network of community-based organizations has long served as the central place for individuals and families seeking information and help to address health and long term care challenges. This collaborative opportunity between AoA and CMS will further strengthen the network's capacity to help people in a more coordinated and comprehensive way in the communities where they live," said Kathy Greenlee, assistant secretary for aging.

Funds will be available to states, area agencies on aging (aaa's), State Health Insurance Assistance Programs (SHIPs) and Aging and Disability Resource Centers (ADRCs). Through the grant program, states and local aging and disability programs will receive funds to:

* provide outreach and assistance to Medicare beneficiaries on their Medicare benefits including prevention;
* use additional funds through a competitive process to provide Options Counseling on health and long-term care through ADRCs;
* use additional funds through a competitive process to strengthen the ADRCs role in Money follows the Person program and support state Medicaid agencies as they transition individuals from nursing homes to community-based care; and
* coordinate and continue to embed tested Care Transition models that integrate the medical and social service systems to help older individuals and those with disabilities remain in their own homes and communities after a hospital, rehabilitation or skilled nursing facility visit.

"CMS and AoA share a long-standing goal of expanding access to community-based care for the elderly and individuals with disabilities. The Affordable Care Act provides significant resources for state Medicaid agencies and providers to balance the nation's long-term care systems and assure that individuals have a choice of where and how they receive their services," said Cindy Mann, director of CMS's Center for Medicaid, CHIP, and Survey and Certification.

The announcement combines funding opportunities from several provisions in the Affordable Care Act signed into law by President Obama on March 23, 2010, including the Role of Public Programs (Title II, Sections 2403 - Money Follows the Person and 2405 - Funding for Aging and Disability Resource Centers) and Improving the Quality and Efficiency of Health Care (Title III. Section 3306 - Funding for Outreach and Assistance for Low-Income Programs).

These grants also complement President Obama's "Year of Community Living Initiative," which focuses on better serving those individuals with disabilities who need ongoing services and support programs in the community such as those provided by AoA, CMS and other HHS agencies.

The deadline for applications is: Monday, July 30, 2010. Grants will be awarded in September 2010. For more information about this grant opportunity, please visit http://www.aoa.gov/AoARoot/Grants/Funding/index.aspx or www.grants.gov.

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ObamaCare: Giant Meteor Scheduled to Strike in 2014

2010-06-02T14:23:00.000-05:00

/PRNewswire/ -- Some argue that ObamaCare isn't ripe for legal challenge, since the most onerous requirements won't be in effect until 2014. By then, the machinery for implementation, and associated "stakeholders," will be cemented in place and much harder to dislodge.

The effect, however, is already being felt, argues attorney Andrew Schlafly, writing in the summer issue of the Journal of American Physicians and Surgeons (http://www.jpands.org/vol15no2/schlafly.pdf). Schlafly is general counsel for the Association of American Physicians and Surgeons (AAPS), which filed suit in the District of Columbia on March 26, three days after the Patient Protection and Affordable Care Act (PPACA or "ObamaCare") was signed into law (www.aapsonline.org/hhslawsuit).

"By analogy," he writes, "if we knew that a giant meteor would crash into the Earth in 2014, it would have a huge immediate impact on behavior today."

After enactment of PPACA, there was a 10 percent drop in the value of health-related stocks, while the rest of the stock market was rising.

Some physicians are planning an early retirement, and bright students will forgo a medical career because they want to practice "innovative medicine in the free market rather than Post Office-style medicine controlled by government bureaucrats."

Likely physician shortages may keep businesses from relocating to rural areas, and anticipated new costs may keep businesses from expanding.

AAPS argues that it is an unconstitutional "taking" to force individuals to buy insurance they do not want, and which may not cover the medical care that they eventually do need.

Mandatory insurance has failed in Massachusetts, where there have been relatively few uninsured, and imposing that approach on a nation 50 times as large as and less wealthy than Massachusetts is likely to be a still bigger failure.

Schlafly cites a reason for cautious optimism: free enterprise could still expand "amid the rubble and ruins wrought by this legislation."

In addition to overturning the insurance mandates, the lawsuit asks the Court to demand an honest accounting of the solvency of the Medicare and Social Security programs, and to invalidate a rule that seniors must forfeit all Social Security benefits if they decline to participate in Medicare Part A, with its increasingly draconian restrictions.

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Blue Cross and Blue Shield of Georgia Announces It Will Unilaterally Implement Key Provisions of the 'Breast Cancer Patient Protection Act'

2010-05-26T22:52:00.000-05:00

/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Representative Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.

The adoption of these provisions builds on BCBSGA's existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of BCBSGA's members already receive the standard of care indicated in the legislation. However, BCBSGA believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, BCBSGA will standardize clinical guidelines for women recovering from mastectomy, and will continue to offer a voluntary 48-hour minimum in-hospital stay.

"Women recovering from breast cancer surgery, in consultation with their physicians, will decide whether hospitalization for 48 hours is required," said Robert McCormack, Medical Director, BCBSGA. "We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It's important for us and our members that BCBSGA continues to lead in this area," he added.

"We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments that will shape improvements in care for women diagnosed and living with breast cancer, or who are in remission," said McCormack. "Our goal is to ensure that our members receive optimal care."

BCBSGA also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, BCBSGA is taking steps to provide more straight-forward explanations of benefits so that members more clearly understand their treatment options.

"BCBSGA works diligently to ensure that all of our members are getting best practice care," said Monye Connolly, President, BCBSGA. "We are especially proud of our record in improving care for women with breast cancer and believe these added measures will increase the quality of care that our members receive."

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Blue Cross and Blue Shield of Georgia's New Medicare Supplement Plans Offer More Choice and Financial Flexibility to Georgia's Growing Medicare Population

2010-05-26T19:49:00.000-05:00

/PRNewswire/ -- Today Blue Cross and Blue Shield of Georgia (BCBSGA) introduced new "modernized" Medicare Supplement plans that have been updated to consider the needs of today's Medicare beneficiaries.

BCBSGA's new Medicare Supplement plans will offer a portfolio of options ranging from comprehensive coverage that bridges Medicare gaps, to the availability of packages offering affordable monthly premiums and more predictable copayment structures that encourage wellness by making doctor's visits more affordable for beneficiaries. Consumers in Georgia can select from five plans: A, F, High deductible F, G and N with an effective date of June 1, 2010.

"The updates to the Medicare Supplement health benefit plans are welcome news for Medicare beneficiaries during these tough economic times because the plans align the benefits with the recent updates made to the Medicare program," said Krista Bowers, president of BCBSGA Senior Business. "The new 'modernized' Medicare Supplement plans offer peace of mind, practicality and affordability that is in tune with today's Medicare landscape."

The new Medicare Supplement plans are a result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 that authorized a new set of Medicare Supplement insurance plans to reflect the needs of today's Medicare beneficiaries.

A Medicare Supplement policy (sometimes referred to as Medigap) is a supplemental health insurance plan sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medicare Supplement policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. If an individual is enrolled in the Original Medicare Plan and has a Medicare Supplement policy, then Medicare and Medicare Supplement will pay both their shares of covered health care costs. BCBSGA and its affiliated health plans are among the largest providers of Medicare Supplement health plans in the nation.

Although as of June 1, 2010 the current Medicare plans referred to as "standardized" plans will no longer be open for new sales or new membership, Medicare beneficiaries who are currently enrolled in a "standardized" or "pre-standardized" Medicare Supplement plan can retain their current plans as long as their premium payments are current.

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WellPoint Announces It Will Unilaterally Implement Key Provisions of the 'Breast Cancer Patient Protection Act'

2010-05-26T09:58:00.002-05:00

/PRNewswire/ -- WellPoint, Inc. (NYSE:WLP) , the nation's largest health insurer by medical membership, announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Representative Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.

The adoption of these provisions builds on WellPoint's existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of WellPoint's members already receive the standard of care indicated in the legislation. However, WellPoint believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, WellPoint will standardize clinical guidelines for women recovering from mastectomy to offer a voluntary 48-hour minimum in-hospital stay.

"Women recovering from breast cancer surgery, in consultation with their physicians, will decide whether hospitalization for 48 hours is required," said Sam Nussbaum, Chief Medical Officer, WellPoint. "We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It's important for us and our members that WellPoint continues to lead in this area," he added.

"We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments to shape improvements in care for women with breast cancer," said Nussbaum. "Our goal is to ensure that our members receive optimal care."

WellPoint also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, WellPoint is taking steps to provide comprehensible, straight-forward explanations of benefits so that members more clearly understand their treatment options.

"WellPoint works to ensure that all of our members are getting best practice care," said Dijuana Lewis, Chief Executive Officer of WellPoint's Comprehensive Health Solutions business unit. "We are especially proud of our record in improving care for women with breast cancer in this country and believe these added measures will increase the quality of care that our members receive."

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