We hear of so much bad news in health care these days: Premiums rising, not enough physicians to go around, health plans covering less and less, etc. Well, the good news from the health reform front is that many plans must now provide a number of preventive care services free of cost. This means that cancer screenings, diet counseling, or your child’s immunizations could all be covered 100%.

There are a number of rules and limitations to watch out for though, so don’t expect a free-for-all next time you’re at the doctor’s office. Here’s a crash course on what’s covered, what’s not, and how to know.

Who does this apply to?

These benefits only apply to people with individual plans or plans sponsored by their employer, which were created after March 23, 2010.  When your new policy year begins (usually on January 1^st), the benefits become effective. Plans that existed prior to March 23, 2010 are known as grandfathered health plans and unfortunately, they are exempt from some of these new rules. However, you’re not completely out of luck if you think you are in an older plan: If the plan makes significant changes to the policy, which either reduces your benefits or increases your costs, it can lose its grandfathered status.

The best way to find out whether you have these preventive benefits is to check your plan documents (they must disclose whether the plan is grandfathered), or call the provider (or the plan administrator if you have an employer-sponsored plan). If you are connected to a site like Simplee or Cake Health, you can also check your plan coverage there.

If you have Medicare, many preventive services are also free. For a list, visit Medicare.gov.

What’s covered?

The list of covered services is pretty long: Several dozen screenings, tests, immunizations, and counseling, including some benefits specific to women and children. Keep in mind that some services are limited to people who are at risk for certain diseases. For example, type II diabetes screenings are only covered for adults with high blood pressure.

For a full list of covered services, visit Healthcare.gov.

Network rules still apply.

If you have an HMO or PPO, don’t try to go to an out-of-network provider. It won’t be covered (or for a PPO, you’ll still have co-insurance).  The same rules still apply.

But watch out for add-ons…

Free really does mean free: You won’t have to pay any co-pays, co-insurance or even meet your deductible first. However, the reality is that preventive care services don’t always come as a stand-alone service.

Picture this: You want to get a bone mass screening because you know that women your age are at risk for osteoporosis. Would you make an appointment just for this? Odds are, you would combine it with another appointment. If this is the case, the physician can bill you for an office visit, even though the osteoporosis screening itself will not be charged.

Or, let’s say you get a colorectal cancer screening and the results call for additional testing. Any related follow-up may not be included as a free benefit. That being said, be aware of billing methods and ask about whether any additional tests or checkups are included as part of the original service.

He really can, it turns out. After more than a year of fiery debate on Capitol Hill and heated town hall meetings throughout the country, President Obama is finally getting ready to sign off on the centerpiece of his political agenda – the health care reform bill.

The House of Representatives passed the historic bill late Sunday with a 219 to 212 vote. (Not a single Republican voted Yes and 34 Democrats voted No.) A companion bill now heads to the Senate floor and, after an expected approval vote, goes to President Obama’s long-anticipated signature.

Speaking at the White House shortly after the vote, President Obama said that the House vote Sunday “answers the prayers of every American who has hoped deeply for something to be done about a health care system that works for insurance companies, but not for ordinary people.”

Rhetoric aside, what every American likely cares about is: How will health care reform affect my health policy (or the lack of it) and my financial bottom line?

The highlights certainly sound grand.

• By 2019, the new legislation will provide coverage to an estimated 32 million uninsured Americans – at a cost of a whopping $940 billion.
• Insurance companies will no longer be allowed to deny coverage on the basis of having a preexisting condition – or hike your premiums if you get sick.  (Right now, the number of people who have been unable to get insurance because of a preexisting condition are staggering: an estimated 12.6 million people, or 36% of adults 19 to 64 years old who have individual insurance or have tried to buy one in the past three years, according to a survey by health policy think-tank The Commonwealth Fund.) 
• Insurers will no longer be allowed to impose ceilings on annual or lifetime benefits, which often causes individuals who require expensive treatment to incur bankrupting out-of-pocked costs.
• Young adults, up until now left on their own as soon as they graduate from college, will qualify for coverage under their parents’ policies until the age of 26.

Pooling In The Uninsured

Today, nearly 46 million Americans do not have health coverage, either because they cannot afford it or because health insurance companies flat out refuse to sell them a policy. Ensuring that the majority of those individuals can get insurance at an affordable cost addresses the biggest problem in the system, says Sara Collins, vice president for the Affordable Health Insurance Program at The Commonwealth Fund. “Right now, most people get coverage through their employer,” she says.  “If you lose that coverage, it’s hard to find a plan that meets your needs.”

The new legislation will expand Medicaid eligibility and create so-called insurance exchanges where people will be able to buy insurance at subsidized premiums, provided they meet the income requirements. For a family of four, those are:

• If your annual household income is $29,000 or below, you will qualify for Medicaid regardless of where you live. Medicaid coverage will be extended to families earning up to 130% of the poverty level: a significant improvement over the current situation, which varies dramatically across states, says Collins. Currently, for example, adults who don’t have children do not qualify for Medicaid–regardless of their income–in 35 states. (Where more generous than those established by the new legislation, state eligibility requirements will remain unchanged.)
• If your annual household income is between $30,000 and $88,000, you will be able to purchase coverage through an insurance exchange, at subsidized premiums. The amount of the subsidy will be income-based, with those earning less getting higher subsidies, Collins says.  (A family earning $55,000 a year, for example, would have premium expenses capped at 8% of income, while a family earning $33,000 would have a cap at 4%.)

Until the insurance exchange program goes into effect in 2014, anyone who has been uninsured for six months or longer because of a preexisting condition will be able to enroll in a national high-risk pool program.

Taxing High-Cost Employer-Sponsored Plans

If you have insurance through your employer, chances are you won’t be affected by the new legislation – unless your company’s insurance plan is deemed too expensive. Beginning in 2018, employers who pay more than $10,000 for individual coverage or $27,500 for a family will be charged a special tax.  The idea is to discourage compnies from purchasing expensive health insurance, which in turn should ultimately prevent insurers from hiking their rates or offering expensive plans altogether, Collins says. (Most companies don’t pay that much. Currently, the average cost of a family policy in an employer-based plan is around $13,000.) These thresholds will be adjusted to factor higher premiums based on the average age or location of the insured group, Collins says.  In fact, starting in 2014, insurers will be restricted from increasing premiums on the basis of age.

Questioning reform

To be sure, the bill has its fair share of opponents. Industry consultant Robert Laszewski, the president of Health Policy and Strategy Consultants, writes in a recent blog post that the bill “doesn’t even come close to deserving to be called ‘health care reform’.”  He labels the bill unsustainable, argues that it will do little to change the status quo for those who profit most under the current system (the way physicians are paid, for example, will not change), and points out that “there is little in this bill that will mitigate or control” unaffordable health insurance rate increases because very little will be done to impact the underlying health care costs.

Do you think health care reform will ultimately improve your financial bottom line? Tell us how in the comments below.

Source:kokopinto

Health insurance premiums in the US have increased in cost by almost 100% since the year 2000, a growth rate three times larger than wage increases over the same period of time. At the same time, one out of every three Americans is uninsured, or underinsured. Moreover, health insurance premiums are more than double for Americans than they are for citizens of the second highest cost nation, Norway.

These daunting facts leave little doubt that health care costs in America have spun out of control and the financial health of each American, and the country as a whole, is dependent upon smart health care reform. What’s not as clear is the right way to go about it. Details on the health care legislation currently making the rounds are sparse and very fluid at this point, but we’ll try to dissect some of the basics and how the plan may impact you if it were to pass in its present form.

What are the basics of the Obama Administration’s health care reform legislation?
So far, this is what can be decoded from the constantly changing legislation.

1. All Americans would be required to be covered by health care insurance – either through out-of-pocket or government subsidy.
2. A new health care insurance exchange market would be created. You can think of this as a gigantic group plan, monitored by the government.
3. You can keep your employer’s plan, if you’d like (and they decide not to drop their plan for the cheaper exchange).
4. Insurance companies would be required to provide a basic level of insurance for everyone who signs up for the exchange. Premiums cannot be increased for those with pre-existing conditions.

When would the reform go into effect?

The Obama Administration had been leading a big push to get a health care reform bill passed quickly by the Senate. However, the details and resulting consequences of legislation of this impact have stamped out that possibility. On Thursday, Senate Majority Leader Harry Reid (D-Nev.) announced that the Senate will not vote on health care reform legislation by the August recess, saying that it is “better to have a product based on quality and thoughtfulness rather than try to jam something through,” as reported by the AP/Boston Globe.

Despite the delay, if the legislation were to pass later this year under the same timeline as proposed, it would go into effect in 2013.

Who stands to benefit the most from Obama’s health care reform?

It’s unclear how the bill will benefit the majority of Americans who already have employer sponsored health care plans at this point. In theory, premiums should be decreased because the insured are no longer footing the bill for the uninsured. The reform aims to immediately help:

1. Those without any insurance.
2. Those who have paid for expensive individual policies on their own.
3. Employees of small businesses that have trouble affording the cost of joining a group plan.
4. Low income Medicare participants who are left paying for whatever is not covered by Medicare for their medical bills and prescriptions.

Whether intended or not, the legislation could also mean more profits for insurance companies by making it a requirement for all Americans to purchase an insurance policy, be it by subsidy or out-of-pocket.

How much is this going to cost?

The legislation is expected to cost $1 trillion over 10 years. Obama insists that it would be revenue neutral, meaning that it would not be an expense added to the budget deficit.

Who is going to pay for it?

The entire tax burden is expected to be placed on the shoulder’s of the very wealthy. Originally, it was to come from a surtax on American households earning over $250,000 annually. However it was recently bumped to those earning over $350,000, and even more recently, those earning over $1 million.

What will happen to my doctor?

Nothing. You can still go to them, and they’ll still be living large in the wealthiest zip codes in your locale.

Who is opposing the present version of the legislation?

1. Republicans: This goes without saying, right? Any new taxes on the wealthy or are sure to meet Republican opposition. This legislation is no different.
2. Democrats: Wow, really? Yes. Some of the more liberal Democrats, led by Dennis Kucinich, have been pushing for the addition of a single payer option. The United States is currently the only high-income industrialized country in the world that does not have some version of a single payer, public health insurance. Single payer refers only to health insurance and payments for health service being funded by a single public fund. Kucinich and others want this option to be included in the legislation.
3. The Obscenely Wealthy: More taxes means less luxury goods and $900 bottles of wine vs. $1,000. Can you blame them?

Where can I find out more?

The White House has created a public site dedicated to providing information and news on health care reform – at healthcarereform.gov.

For more of GE Miller’s writing, visit personal finance blog 20somethingfinance.com.