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

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.

-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP

Care Improvement Plus Releases 2011 Medicare Health Plan Benefits for Georgia

/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.

-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP

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

/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.

-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter:  @GAFrontPage

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

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.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter:  @GAFrontPage