Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts

Wednesday, March 24, 2010

Healthcare and YOU

Originally posted at Desk of Brian: http://sites.google.com/site/thedeskofbrian/state-of-the-nation/thehealthcarebillyou

Analysis from WebMD (only from a benefits stand point, NOT cost or taxes etc...)

Beginning immediately:
  • Children up to the age of 26 can remain on their parent's plan
  • People with "pre-existing" conditions are eligible for a government federally funded "High Risk" insurance plan
  • Small businesses could qualify for a tax credit for the cost of premiums
  • Insurance plans will no longer have lifetime caps
  • Insurance companies can no longer cancel policies if a patient gets sick
  • Pre-existing conditions for children cannot be banned or prohibited

Four years from now, 2014:
  • Insurance marketplaces, called "Exchanges" will be set up instates to offer competitive pricing on health policies for individuals and small businesses that don’t have coverage
  • People with any pre-existing condition would no longer be denied coverage
  • All lifetime and annual limits on coverage would be eliminated Medicaid would be expanded to cover more low-income Americans

Also in 2014:

  • ANY person who did not obtain medical coverage would pay a penalty of $95 or 1% of income, whichever is greater (that penalty would rise to $695 or 2.5% of income by 2016)
  • The bill would exempt the lowest-income people from that insurance requirement
  • Medicaid would be expanded to cover those under age 65 with an income of up to 133% of the federal poverty level
  • To make coverage more affordable, the legislation would offer premium subsidies for people with incomes more than 133% but less than 400% of the federal poverty level ($29,327 to $88, 200 for a family of four)
  • People in their 20s would have the option to buy a lower-cost "catastrophic" health plan
Small Businesses:

  • Employers with 50 or more workers would face fines for not providing insurance coverage
  • Businesses with smaller workforces, though, would be exempt
  • Companies would get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000
Large Employers:

    • Large employers would run their health plans as they do now, so there won’t be much change. Even though they have more insurance-buying clout, large businesses have seen steadily rising insurance premiums over the past decade without reform, as medical costs have increased. That pattern isn’t likely to change much, at least immediately.

All per WebMD, not me.

Regarding the uninsured, here's the Washington Post's Ezra Klein breaking that down for us:

About a third of the remaining uninsured are illegal immigrants, who are ineligible for coverage through the program. Then there are some folks who have incomes below the individual mandate threshold. Under the terms of the individual mandate, if coverage would cost more than 8 percent of their monthly income, they can skip it. Other people will decide to pay the individual mandate's $750 penalty rather than purchase insurance. Still others will be eligible for public programs such as Medicaid but won't sign up. So the population of the uninsured will be far reduced, and primarily composed of illegal immigrants, the few people who can't afford their insurance and aren't getting subsidies to help them purchase it, and people who have decided to pay the penalty rather than purchase insurance.


I want ever fact and aspect of this proposal to be put forth, so as it self-destructs, we can come back and show them why this failed, why we are NOT supporting go forward with MORE socialized medicine -- it will happen.

It happened with Medicare, Medicaid and even Social Security.

Americans wanted reform, just not this reform. We cannot afford it, it still leaves countless holes, destroys the private insurance companies' ability to do business and put an enormous burden on taxpayers to carry this financial burden.


http://www.webmd.com/healthy-aging/news/20100322/faq-how-health-care-reform-will-affect-consumers-employers

http://voices.washingtonpost.com/ezra-klein/2010/03/who_is_left_uninsured_by_the_h.html

Thursday, October 29, 2009

Medicare WORST at denying claims!


This AMA data1 was released awhile ago and I haven't made time to comment or present some of the interesting findings. I understand many commentators (such as Glenn Beck) have mentioned it.

We've heard over and OVER and OVER again about those evil insurance companies and the liberals cry about empathy needed or that health care coverage is actually a RIGHT.

So the AMA data show the claims, denials and % of denials -- would it surprise you that Medicare rejects more claims than their private insurance counterparts?

From the report:

Description: What percentage of records submitted are denied by the payer for reasons other than a claim edit?

A denial is defined as: allowed amount equal to the billed charge and the payment equals $0.

Payer / Count of records / Denied records / % of claim lines denied
Aetna 637,239 / 43,317 / 6.80%
Anthem 250,070 / 11,546 / 4.62%
CIGNA 263,728 / 9,060 / 3.44%
Coventry 20,487 / 590 / 2.88%
Health Net 4,975 / 193 / 3.88%
Humana 143,026 / 4,142 / 2.90%
Medicare 6,938,431 / 475,566 / 6.85%
UHC 1,127,691 / 30,177 / 2.68%

Date Range: 03/01/2007 – 3/10/2008


Page 11 of the AMA report explains some of the denials and 20% of the Medicare Rejections are simply designated as "NOT MEDICALLY NECESSARY"

So the government, just like private insurance is already engaged in an intense analysis for cost control and evaluating what your doctor believes is needed. Most of the rejections from the private payers come before the claim process (e.g. pre-existing conditions) and those payers have contracts, fee schedules and payment arrangements with the physicians, hospitals, laboratories etc...

Medicare gets a pass for being the biggest culprit on denying coverages.

This is in large part why so many seniors have enrolled in secondary insurances like AARP's Medigap or Medicare Advantage. They are designed to pick up the tab for the NON-COVERED services and prescriptions that MEDICARE DOES NOT COVER.


Is the health care reform going to fix this?

The answer is a resounding NO!

More government intervention, another government run "public option" will be crippled by the same problems, cost control measures etc...

The health care reform bills cut Medicare coverages further, targeting Medicare Advantage directly and will reduce choices for seniors.




1. http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

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