By Grace Nicklin, DaVita® Insurance Retention
Disclaimer: This article is for informational purposes only and is not intended to be a substitute for financial or legal advice.
Healthcare reform, or the Patient Protection Affordable Care Act, was signed into law March 23, 2010. If you or a family member lives with kidney disease, you may wonder how this law could affect you and your loved one. This is a brief overview of the provisions that are most likely to impact you. If you are a DaVita dialysis patient, please speak to an insurance management teammate or your social worker if you would like more information. If you are not a DaVita patient, please visit the websites referenced in the article for additional information.
Medicaid will be expanded to certain individuals whose income is up to 133% of federal poverty level; in 2010 this would mean individuals who make less than $14,400 annually. Each state will continue to have different enrollment qualifications, but if you have tried to enroll in Medicaid in the past and were denied due to income level, you may now be able to enroll. All states will be required to participate in the expansion in 2014, but some states are starting early. As of July 2010, Connecticut and Washington, D.C. have had their expansion plans approved by the Department of Health and Human Services.
In plan years that begin on or after Sept. 23, 2010, insurers may not exclude coverage based on pre-existing conditions for anyone under the age of 19.
For those 19 or over who have not been able to access commercial insurance for the past six months due to a pre-existing condition, enrolling in the newly created Pre-Existing Condition Insurance Plan (PCIP) may be an option. Many states are already accepting applications and all states will be open for enrollment by the end of summer 2010, although exact dates will vary by state. Please note that the plan is temporary and will only operate until 2014, when insurance exchanges open. Insurance exchanges are state-run and eligible participants will be able to compare coverage options. Participants must be U.S. citizens.
People under the age of 26 will be able to stay on or enroll in a parent’s commercial coverage, as long as the parent’s plan covers dependents. This provision will officially go into effect with plan years that start on or after Sept. 23, 2010, but many major insurance companies have agreed to implement it early. Check with your employer to see if you or your dependent qualifies for early coverage.
If your insurance policy currently has a maximum amount you can spend in a lifetime or over the course of a year, you’re in luck. Starting with plan years that begin on or after Sept. 23, 2010, lifetime limits will be eliminated and annual limits will be regulated.
Until annual limits are completely eliminated in 2014, the following guidelines will be used:
People enrolled in the Medicare Part D prescription drug insurance, who are reaching their coverage gap (the “donut hole”) may be eligible for a $250 rebate. Rebate checks will be sent to eligible people’s homes, so there is no need to register. If someone contacts you or your family member for personal information regarding Part D rebates, please consider reporting them for suspicion of fraud at www.stopmedicarefraud.gov.
Each year from 2012 to 2020, the Department of Health and Human Services will take a new step to help people who fall into the donut hole. In 2011, Medicare beneficiaries in the donut hole will receive a 50% discount on brand name prescriptions.
As of July 1, 2010, www.healthcare.gov is up and running. Visit this website to compare your coverage options or learn more about Medicaid expansion, pre-existing conditions, dependent coverage, lifetime and annual limits, Medicare Part D rebates, and other topics that affect your health care.
Healthcare reform may seem complex, so it’s good to have the tips and tools to help you navigate the changes. When you have kidney disease and are on dialysis, education is a key part of treatment, and that includes knowing how insurance works. Talk to your social worker for further assistance.
This site is for informational purposes only and is not intended to be a substitute for medical advice from a physician.
Please check with a physician if you need a diagnosis and/or for treatments as well as information regarding your specific condition. If you are experiencing urgent medical conditions, call 9-1-1