CalCPA ProtectPlus

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]

The following information is from the United States Department of Labor’s web site. Since this COBRA article (or booklet, as the article refers to it) from dol.gov has an abundance of information, we will break the article up into sections over the next few weeks. We hope that you find the information valuable.

An Employee’s Guide to Health Benefits Under COBRA – The Consolidated Omnibus Budget Reconciliation Act

Note: This publication contains information about the COBRA premium reduction provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). This publication has not been updated for recent amendments made to ARRA. For updated information on ARRA and its amendments, please see the COBRA Premium Reduction Fact Sheet.

Premium Reduction Following Involuntary Termination

If you involuntarily lost your job at any time from September 1, 2008 through February 28, 2010, you and/or each member of your family may be eligible for a COBRA premium reduction under the American Recovery and Reinvestment Act of 2009 (ARRA), as amended by the Department of Defense Appropriations Act, 2010 (2010 DOD Act). For individuals who are eligible, it is a 65 percent reduction in COBRA premiums for periods of coverage beginning on or after February 17, 2009. The premium reduction for an individual ends after 15 months of the reduction, upon eligibility for other group coverage (or Medicare), or when the maximum period for COBRA coverage ends, whichever occurs first. Individuals paying reduced COBRA premiums must inform their plans if they become eligible for coverage under another group health plan or Medicare.

You and/or each member of your family are eligible for the premium reduction if:

• You have a qualifying event for continuation coverage under COBRA or a State law that provides comparable continuation coverage (for example, so-called “mini-COBRA” laws) that is the employee’s involuntary termination at any point from September 1, 2008 through February 28, 2010; and
• You elect the COBRA coverage timely.

You are not eligible for the premium reduction if you are eligible for other group health coverage (such as a spouse’s plan) or Medicare. (continue reading…)

Approximately 3 months before your 65th birthday you will receive a letter from Banyan Administrators, LLC outlining your options. ProtectPlus is not a Medicare supplement and in most cases we do not recommend maintaining your ProtectPlus coverage once you are eligible for Medicare. However, factors that may affect your decision include: the size of your firm, whether or not you have a younger spouse and/or dependent children and when you plan to retire. You may contact Banyan Administrators, LLC  at 877-480-7923 to discuss your options.

[Image Source]

The following information is from Medicare.gov.

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date.

You may refuse Part B coverage. However, if you decide to pick up Part B coverage at a later date, but before you turn 65, you may have to pay a 10% surcharge in addition to the Part B premium. Also, please be aware that you will automatically be re-enrolled in Part B when you turn 65, even if you previously refused Part B coverage. You may again refuse coverage, but if you keep it you will not have to pay a surcharge.

Note: A Special Enrollment Period is available if you waited to enroll in Medicare Part B because you or your spouse was working AND had group health coverage through a current employer or union. If this applies, you can sign up for Medicare Part B:

• While you are still covered by an employer or union group health plan, through your or your spouse’s employment, or
• During the 8 months following the month when the employer or union group health plan coverage ends or when the employment ends (whichever comes first).

The Social Security Office can answer questions about applying or appealing Social Security Disability benefits. They can also answer questions about when you will be eligible to receive Medicare.

Your 24-month waiting period will be waived if you have been diagnosed with ALS (Amyotrophic Lateral Sclerosis). This disease is commonly known as Lou Gehrig’s Disease.

Home Health Agencies are home health care providers which are licensed according to state and local laws to provide skilled nursing and other services on a visiting basis in your home, and recognized as home health providers under Medicare and/or accredited by a recognized accrediting agency such as the Joint Commission on the Accreditation of Healthcare Organizations.

Medicare Secondary Payer (MSP) Reporting May 2009 Update, see UPDATES post for more information.

FREQUENTLY ASKED QUESTIONS

Q: What’s changing?
A: Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 replaces the voluntary data exchange agreement (VDEA) in which Anthem Blue Cross (Anthem) currently participates. Section 111 removes the voluntary label associated with the VDEA by requiring participation via the MSP reporting initiative. Mandatory participation for group health plan (GHP) enrollees coupled with requirements for social security numbers (SSN), group tax identification numbers (TIN), employer group size and penalties for noncompliance comprise the majority of the mandate.

Q: What is “MSP”?
A: “MSP” refers to “Medicare Secondary Payer.” According to Medicare law, there are situations in which another payer — primarily an insurance company or self-funded group health plan — must pay first (primary) for services rendered to a Medicare beneficiary before Medicare pays as “secondary”. The purpose of the law is to save Medicare money, since it will enable the Centers for Medicare and Medicaid Services (CMS) to pay claims accurately the first time by determining primary versus secondary payer responsibilities. When Medicare is “secondary payer,” it will only pay after the member’s “primary” payment has been exhausted or if it does not exist. (continue reading…)

In an effort to reduce Medicare costs, Congress passed the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) on December 29, 2007. Because Medicare has been unable to identify primary payers consistently, Section 111 of the new Act (MMSEA) imposes mandatory reporting requirements for fully insured and self-funded group health plans.

These requirements impose an obligation on primary payers to identify claimants entitled to Medicare and to report those claims to Medicare electronically.

As of July 1, 2009. Health plans are required to report specific member eligibility data for members who meet certain age or disability criteria. The reporting rules apply to covered individuals age 45 and older for groups with 20 or more full or part-time active employees. (continue reading…)

(This News Article via California Healthline June 26th, 2009)

California clinics this week lost their court battle against the state’s plan to eliminate funding for adult dental care and several other services.

A Sacramento County Superior Court judge ruled that the state Legislature had the right to cut adult Denti-Cal and other benefits when it voted in February on various measures to reduce state spending. A lawsuit filed in April by the California Primary Care Association and two clinic groups argued that eliminating some Medi-Cal benefits, including adult Denti-Cal, violates federal law.

Denti-Cal is the dental benefit provided through Medi-Cal, California’s Medicaid program.

The suit, aimed at preventing the state from ending Medi-Cal payments for services at federally qualified health centers and rural health centers, claimed that state and federal law requires such centers to provide dental care and other services to all residents, regardless of income.

Reimbursements for dentistry, optometry, podiatry and chiropractic programs is scheduled to stop July 1, as is funding for other optional Medi-Cal benefits, including speech therapy and some mental health services.

Clinicas del Camino Real, a group of 10 clinics for low-income people in Ventura County, filed the lawsuit along with Southern Trinity Health Services in Northern California and the statewide California Primary Care Association, which represents hundreds of clinics throughout the state.

Officials for Clinicas del Camino Real said the loss of Medi-Cal reimbursements could result in layoffs of as many as 150 people and the closure of two of its clinics.

California lawmakers are taking a closer look at Medi-Cal spending as they work to address the state budget deficit. Here’s a look at other legislation under consideration in Sacramento.  Continue to original source.

It’s a haunting fear that most of us share in one form or another: You step off the curb in a foreign city, trip, and a sharp pain shoots up from your ankle. It might be broken. In another version, you’re enjoying a Caribbean cruise, and suddenly you have a high fever and feel nauseated. It could be something you ate or the flu, or it might be appendicitis. There are other scenarios too: you leave your carry-on bag with your prescription medicines in the taxi in Melbourne, or you crack a tooth chewing the ice in your drink in Puerto Vallarta.

All these scenarios share a common element—you’re abroad and you need medical help. Fortunately, friendly people guide you to the help you need. In addition, you are able to pay your bills with a credit card or a pile of traveler’s checks, or you arrange a wire transfer of funds from your bank. But now, you have a whole new set of concerns and questions: (continue reading…)