Affordable Care Act

Health Care Reform Update: Fighting Health Care Fraud

No matter who is in control of the White House or Congress, one bipartisan activity that will continue in the coming years is the fight against health care fraud.  Both Democratic and Republican Administrations have supported a number of anti-fraud programs to identify criminal activities that hurt consumers and cost U.S. taxpayers dearly.   

Recently, the U.S. Department of Health and Human Services (HHS) and Department of Justice (DOJ) announced the launch of another round of initiatives to fight health care fraud, including hosting fraud summits in several cities.  A HHS press release published on November 5th explains “(t)he summits are part of a larger effort on behalf of the Obama Administration to root-out waste, fraud, and abuse within the U.S. health care system.”  In 2009, HHS reports that “anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund resulting from civil recoveries, fines in criminal matters, and administrative recoveries.”

Author: Scott Kirksey

Low Enrollment for Pre-Existing Condition Insurance Plan

One of the biggest obstacles with obtaining health care was the limited access that people with pre-existing conditions had to health care coverage.  A new plan – the Pre-Existing Condition Insurance Plan – was launched this summer as part of the Affordable Care Act. It’s meant to provide access to health care for those denied coverage due to pre-existing conditions.

To meet the criteria, a person must have problems getting health insurance because of a medical condition and have been uninsured for at least six months.

When putting together this plan, government economists predicted 375,000 people would enroll and gain coverage this year alone. They questioned if the $5 billion allotted for this program would be sufficient.

It turns out it’s more than sufficient.

Author: Scott Kirksey

On Health Care Reform’s 6 Month Anniversary – Have Opinions Changed?

Talk of repealing the health care law is nothing new. Republicans have requested the law be revoked since the moment it passed. As the November elections close in, Republicans feel that their call to rescind the law will gain them votes. After all, many Americans still do not like the legislation that passed.

What is surprising is just why many do not agree with the Affordable Care Act. According to a new Associated Press poll, 30 percent of respondents favor the law, another 40 percent oppose it and another 30 percent remain neutral.

In fact, many feel that the law doesn’t go far enough. 4 in 10 adults thought the law should go further, regardless if they support the current law, oppose it or remain neutral, while 2 in 10 think the government shouldn’t have been involved in health care in the first place.

Author: Michael Gomes

First Round of Health Care Changes Go Into Effect

More than six months after the bill was signed, some aspects of the new health care law go into effect. As of yesterday, September 23, any insurance plan that is new or renewed will have to follow the new guidelines as outlined by the Affordable Care Act.

Curious what the provisions entail? Any new or renewed plan must incorporate the following into their plans:

  • Elimination of lifetime maximums for services.
  • Offer coverage to children with pre-existing conditions.
  • Broaden preventive care to provide certain preventive services without co-pays or
        cost-sharing.
  • Allow adults up to age 26 to remain on their parents’ health plans.
  • Prohibited from canceling or rescinding coverage.
Author: Scott Kirksey

Insurance Agents/Brokers Role as a “Trusted Advisor” Gains NAIC Attention

When the Affordable Care Act was initially passed, there was quite a bit of concern on the part of insurance brokers and agents throughout the country. How would this effect the industry? What would be the impact on business and commissions?

The Act calls for “Navigators” to help educate the public and provide impartial information on plans. A big worry that arose is the qualifications of these Navigators asking the question whether consumers would be put at risk by having unlicensed, minimally-trained Navigators in place performing part of the function that has traditionally been done by agents and brokers.

To prevent this from happening, the National Association of Insurance Commissioners (NAIC) just passed a resolution recognizing brokers’ and agents’ roles in the country’s health care delivery system. This will limit the Navigator’s role to directing Exchange consumers to government agencies and licensed insurance professionals.

Author: Michael Gomes

Town Hall Meeting on Medicare

Once again, President Obama hosted a town hall meeting to discuss health care reform. This time it was held at a Senior Center in Maryland, with most of the focus being placed on the changes in Medicare.

As mid-term elections approach, President Obama was looking to shift focus away from the oil spill and place it on health reform and its positive aspects.

Author: Bernard DiFiore
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