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Banyan Administrators have been providing us with beneficial information about several different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans.  Over the past few weeks, Banyan has provided answers to many questions regarding Medicare and how the reform affects you. If you missed the first two articles in this series, make sure to check them out – Article #1 and Article #2. We are sure you will find the information valuable.

The following information is provided by Banyan Administrators:

Arguably the greatest volume of reforms through the Patient Protection and Affordable Care Act (“Affordable Care Act”) signed into law on 03/23/2010 involve Medicare. Some of the provisions are direct reforms to Medicare while other provisions of the Affordable Care Act may have an indirect, but intentional, impact on the program. The following Q&A will give you an overview of the reforms to the Medicare program and how they are all intended to work together.

1.  What are the Medicare Part D reforms?

The first Medicare Part D reform is the closing of the “donut hole”. For Medicare Part D enrollees in 2010, coverage breakdowns as follows: 

• $2,830 – After the enrollee pays the first $310 in drug costs (the deductible), the plan pays 75% of the drug cost up to $2,830 with the enrollee paying the other 25%, then
• $2,831-$4,550 – The “donut hole” – The enrollee pays 100% of their drug costs up to $4,550, then
• $4,551+ – “catastrophic coverage” – The enrollee pays a $2.40 copay for generic drugs. For other drugs the enrollee pays either $6.00 or 5% of the drug cost, whichever is greater.

Beginning in 2010, the reforms going into effect to address the donut hole are: 

• 2010 – Enrollees in the “donut hole” received $250 rebate checks from Medicare
• 2011 – If an enrollee reaches the donut hole, they will be given a 50% discount on the total cost of the brand name drugs while in the gap. Medicare also will phase in additional discounts on the cost of both brand name and generic drugs.
• By 2020 – Effectively close the donut hole so that the plan pays 75% of the drug cost with the enrollee paying the remaining 25%.

The second Medicare Part D reform is the elimination of the Medicare Part D Subsidy paid to employers who sponsor a retiree drug plan.  (continue reading…)

Banyan Administrators have been providing us with beneficial information about several different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans.  Over the next few weeks, Banyan will be providing answers to many questions regarding Medicare and how the reform will affect you. We are sure you will find the information valuable.

If you missed the first article in this series that was posted last week, click here.

The following information is provided by Banyan Administrators:

Arguably the greatest volume of reforms through the Patient Protection and Affordable Care Act (“Affordable Care Act”) signed into law on 03/23/2010 involve Medicare. Some of the provisions are direct reforms to Medicare while other provisions of the Affordable Care Act may have an indirect, but intentional, impact on the program. The following Q&A will give you an overview of the reforms to the Medicare program and how they are all intended to work together.

1.  What is the future of Medicare?

What could not have been foreseen in 1965 when Medicare was created was that the United States was coming to the end of the post-World War II “Baby Boom”. More “Baby Boomers” are reaching Medicare eligibility than are being replaced in the work force by younger workers.  With Medicare being funded by FICA taxes, at some point, it mathematically becomes impossible to fund all the benefits for all the Medicare enrollees. (continue reading…)

Banyan Consulting LLC has been providing us with beneficial information about different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans. 

To view this article in PDF format, click here.

The following information is provided by Banyan Consulting LLC:

What You Need to Know Now About:  Lifetime and Annual Limits

The Patient Protection and Affordable Care Act (“Affordable Care Act”) signed into law on 03/23/2010 includes changes to any limits on the benefit amount payable on a per participant basis by an employer-sponsored group health plan.  These provisions take effect on the first day of the first plan year following 9/23/2010.  Lifetime limits on a per participant basis will be prohibited.  Annual limits on a per participant basis will still be permitted on a restricted basis until 2014 when those, too, are prohibited.

1. Does the health care reform provision on Lifetime and Annual Limits apply to “grandfathered” health plans?

Yes, this provision applies to both grandfathered and non-grandfathered health plans.  Also, your plan’s funding arrangement, fully-insured or self-funded, does not impact your requirement to comply.

2. Currently, my employer-sponsored group health plan has a $1,000,000 lifetime maximum.  What do I need to do in order to be compliant?

Effective with the first day of your next new plan year after 9/23/2010, you must remove the $1,000,000 lifetime maximum and replace it with an unlimited lifetime maximum.

You will also need to determine if there has been any plan participants who had reached the $1,000,000 lifetime maximum and were dropped by the plan.  You will need to contact them, alert them of the new unlimited lifetime maximum, and offer them the opportunity to re-enroll into the health plan effective on the first day of your next new plan year after 9/23/2010.

3. Do the lifetime and annual maximum changes apply only to in-network providers?

The Interim Final Regulations issued by the Department of Labor on 6/23/2010 are not entirely clear on this subject; however, the interpretation of the regulations is that there is no distinction for network participation.  The lifetime and annual limits are on a per participant basis and provider network affiliation does not factor into the reform provision. (continue reading…)

The following information is from www.healthcare.gov:

Under the Affordable Care Act, you and your family may be eligible for some important preventive services —which can help you avoid illness and improve your health—at no additional cost to you.

What This Means for You:

If your plan is subject to these new requirements, you would not have to pay a copayment, co-insurance, or any deductible to receive preventive health services, such as recommended screenings, vaccinations, and counseling.

For example, depending on your age, you may have free access to such preventive services as:

• Blood pressure, diabetes, and cholesterol tests;
• Many cancer screenings, including mammograms and colonoscopies;
• Counseling from your health care provider on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use;
• Routine vaccinations against diseases such as measles, polio, or meningitis;
• Flu and pneumonia shots;
• Counseling, screening, and vaccines to ensure healthy pregnancies;
• Regular well-baby and well-child visits, from birth to age 21. (continue reading…)

Today marks the 6^th month anniversary of the signing of the health care reform bill (Affordable Care Act).  President Obama will mark this anniversary of the law’s enactment by meeting with individuals and employers from across the United States and learning from them how the new legislation has benefited them personally or their company. These stories, along with vital information about the Affordable Care Act, will be presented in a new website provided by the White House, www.WhiteHouse.gov/HealthReform. Today, President Obama will also recognize the implementation of the new Patient’s Bill of Rights that is a part of the Affordable Care Act.

Due the complexity of the many changes the Affordable Care Act will bring to us over the next several years, many Americans are still confused as to what changes will occur and when. Below is a list of the protections provided under the Patient’s Bill of Rights, which will be take effect today, September 23, 2010. We will do our best to keep you up to date as more rules of the Affordable Care Act come into effect.

Starting September 23, 2010 Insurers Will No Longer Be Able to:

Discriminate Against Children with Pre-Existing Conditions:

For most plans, discrimination against children (under age 19) with pre-existing conditions will be banned.   In 2014, no one seeking coverage can be discriminated against because of a pre-existing condition. It is estimated that up to 72,000 uninsured children who have been denied coverage due to a pre-existing condition, are expected to gain coverage. Coverage for up to an estimated 90,000 children will no longer exclude benefits because of a pre-existing condition.   

Drop Your Coverage Without Proving Fraud:

Insurance companies can no longer stop your coverage due to an illness or a mistake on your application. Approximately 10,700 people’s coverage, that is dropped each year when they become ill or make an error on their application, will now be protected under the new law.  (continue reading…)

The following information is from Healthcare.gov:

How the Affordable Care Act will make Medicare stronger into the future

• The life of the Medicare Trust fund will be extended to at least 2029, a 12-year extension as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare. This will provide you with future cost savings on your premiums and coinsurance.
• Medicare will take strong action to reduce payment errors, waste, fraud, and abuse in Medicare. The President has made a commitment to reduce Medicare fraud 50 percent by 2012. The Affordable Care Act makes an historic, ten-year, $350 million investment to prevent, detect and fight fraud in Medicare, Medicaid and the Children’s Health Insurance Program—including criminal efforts to exploit the new law. Visit Stop Medicare Fraud for more information.
• In 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name drugs. Every year after, you will pay less for your prescription drugs in the donut hole until there’s complete coverage of the donut hole in 2020. Between now and then, you will get continuous Medicare coverage for your prescription drugs.
• The coordination of care between doctors and the overall quality of care will improve so that you will be less likely to experience preventable and harmful re-admissions to the hospital for the same condition.
• Hospitals will have new, strong incentives to improve your quality of care.
• Starting in 2014, the Affordable Care Act offers additional protections for Medicare Advantage Plan members by taking strong steps that limit the amount these plans spend on administrative costs, insurance company profits, and things other than health care.

 [Information Source]