States to Establish Health Insurance Exchanges

The Affordable Care Act of 2010 meant to provide universal health care for all Americans by January 1, 2014, has given to the states the task of establishing a health insurance exchange.  A health insurance exchange is an organized marketplace which provides consumers with a central place to review, compare and purchase health insurance from a pool of insurance companies.

States may choose the model of health insurance exchange, set the minimum standards  of services, and ensure transparency of offerings and premiums.  They may act as facilitator by establishing guidelines for different offerings and designating who may participate.  States may also choose to be active participants such as in accepting or rejecting plans, number of insurance participants or as active purchasers on behalf of consumers.

The oldest model of a health insurance exchange is the Massachusetts exchange called the Health Connector formed by the Massachusetts Health Care Reform Act of 2006.  The Health Connector administers the Commonwealth Care program for persons with income of 300 per cent of  the federal poverty limit or below who meet certain guidelines, sets premium subsidy levels for Commonwealth Care, provides a marketplace for persons not eligible for their employer sponsored plans, persons who are unemployed or those who work for businesses with no insurance plan (50 employees or less.)  It also establishes a tax penalty on those who do not participate unless they have a waiver.

The Utah Health Exchange which became operational in 2009 is another model.  It serves as an electronic portal by which consumers can research and compare health plan offerings and provide an electronic enrollment process.  It is based on the principles of personal responsibility,private markets and competition.  It provides the consumer with information on health care choices, costs, and health insurance plan services and premiums.  It also relieves employers of the burden of having to administer their own employee health plan.

In October 2010, Governor Arnold Schwarzenegger signed the California Health Benefit Exchange into law which provides for the creation of an independent public health exchange entity governed by a five member board.  Whatever model California implements will be important because the state is  home to ten per cent of the US population.

The US Department of Health and Human Services recently announced that it will release to the states new funding grants and guidelines for implementation of health exchange models.

How to Find Student Health Insurance

Already burdened with the expense of college tuition and food and lodging, students also have to worry about medical care. Here are some important considerations when looking for student health insurance:

• If you are covered by your parent's health insurance, stay on it.  The recently enacted Affordable Care Act now allows parents to keep their children in their medical insurance plan until age 26.  This does not apply to employed children eligible to participate in their employer's health insurance plan. Since most students only work part time or temporary jobs, they are likely not eligible for employer medical insurance plans.
• Check out your college or university student health insurance plans.  Since most schools require students to have health insurance, many schools offer student health plans with their tuition payments.Be sure to check what is covered, deductibles, co-insurance and co-payments.  Some universities such as the University of Nebraska do offer a wide variety of benefits.  Some schools fully cover services offered within the university setting such as counseling in the student counseling center but have co-insurance for services obtained privately.
• If you have current health insurance, stay on it.  It is likely to have better coverage than the average student health insurance.
• Check with insurance brokers both in your locality and online.  They generally work with different medical insurance companies that offer student health insurance and can guide you on what is best for you.  be sure to exercise due diligence to be sure you are dealing with a reputable company.
• Before choosing a student health insurance plan, analyze your needs and resources.  If you are healthy and have enough savings to cover doctor visits, medicines and labs, you could opt for plans with high deductible and lower monthly premiums.In this case, you are simply insuring for catastrophic illness where you might require hospitalization.
• Be sure to analyze not only the benefits and services covered by your student health insurance plan but also the exclusions and limitations. The New Affordable Care Act has lifted the lifetime cap on medical benefits and by 2014, the annual cap on medical usage will also be phased out.  However, there are still coverage exclusions and limitations that companies impose.
• Colleges and universities usually require students from foreign countries to show proof of health insurance.  The considerations above can apply to them as well.
• Lastly, exercise due diligence in your choice of student health insurance plans.  There are outright fraudulent insurance companies out there who take your money and do not actually have you insured. You can always check with the state insurance regulator to be sure you are dealing with a reputable insurer.

Know Your Patient's Bill of Rights when Signing Up for Medical Insurance

http://edlabor.house.gov/blog/2010/09/a


On March 30, 2010 President Barack Obama signed the Affordable Care Act which came into effect on September 23, 2010.  This historic law affords insured patients important protections which put more control of  medical insurance coverage  in their hands.  This is known as the Patient's Bill of Rights.


Patient's Bill of Rights:

• Children can no longer be denied coverage because of pre-existing medical condition.  Previously, children born with or who develop costly medical illness could be denied coverage.The law now prohibits this and by 2014, all Americans will have this protection as well. The White House expects 72,000 uninsured children will benefit from this law.

• Insurance companies can no longer retroactively drop coverage for a sick insured member because he made an unintentional mistake in his application (unless fraud can be proven.) This has affected some 10,700 patients each year whose medical insurance coverage were dropped at a time when they most needed it.

• The lifetime cap of medical usage and benefits has been lifted.  Often patients max out on their lifetime benefit because of illness and are left to pay medical bills on their own.  The law affords this protection.The annual benefit limit will gradually be phased out and will be totally lifted by 2014..

• Patients may now choose their own physicians within their network. Women may choose their obstetrician and parents can choose the pediatrician for their child without first obtaining a referral from their primary care doctor.

• Parents may choose to keep their adult children in their health insurance plan until age 26, unless the child is employed and eligible to participate in his employer's medical insurance plan.

• In emergency conditions, patients may now use the closest emergency room even if it is out of network. Insurance plans are obligated to pay in network rates whereas in the past, the patient was penalized by having to pay higher cost sharing co-insurance for going to out of network emergency rooms.

• Patients now have the right to both an internal (within the insurance company) and an external (independent third party) appeal when the medical insurance plan denies a service.  In the past,patients could only go through the internal appeals process.

• Patients may now receive preventive services without having to pay deductibles, co-insurance and co-pay.  These services include mammograms, colonoscopies, prenatal care, immunizations and well baby care. Many Americans missed out on necessary preventive care due to the added expense.

 
Watch for more on the Affordable Care Act in this blog.