Posts Tagged ‘healthcare reform’

Affordable Care Act: Fact 4

Thursday, April 7th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

This is part 4 of our ongoing series, so please see Fact # 1 in a post dated, Feb 8, 2011, Fact # 2 in the post dated 2/24/11 and Fact # 3 in a post dated 3/8/11.

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and their families.

Fact # 4: The law will improve care for older adults in other ways besides changes to Medicare.

There are improvements beyond Medicare that will help you and your family.  In a previous blog post we discussed the long term care changes that will improve for older adults such as changes to Medicaid that will allow people the choice of home and community based care and regulations that will prevent a spouse from becoming impoverished if their spouse is receiving home and community based care through the Medicaid Program.

There are also measures written in the Affordable Care Act (ACA) that will help early retirees. To help offset the cost of employer-based retiree health plans, the new law creates a program to preserve those plans and help people who retire before age 65 get the affordable care they need. By providing financial relief to businesses that provide health coverage to early retirees, health reform will make it easier for early retirees to obtain health care coverage. Health insurance reform will guarantee that you will always have choices of quality, affordable health insurance even if you retire early and lose access to employer-sponsored insurance. It will create a health insurance exchange so you can compare prices and health plans and decide which quality affordable option is right for you.

The ACA also sets up protections for people with pre-existing conditions. The new law provides affordable health insurance through a transitional high-risk pool program for people without insurance due to a pre-existing condition. The Dept. of Banking and Insurance in NJ as already begun working on the high-risk pool program. Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September, and for adults in 2014. Insurance companies will be banned from establishing lifetime limits on your coverage, and use of annual limits will be limited starting in September.

And if you are concerned for the young people in your life who may be struggling to find a job in this economy, the ACA didn’t forget them either. According to the Law, young people up to age 26 can remain on their parents’ health insurance policy starting in September of 2011.

Information in this blog was gathered from the Affordable Care Act, Centers for Medicaid and Medicare and the National Council on Aging.

Healthcare Reform information from

The White House:

http://www.whitehouse.gov/assets/documents/Pages_from_Health_Insurance_Reform_PDF-4.pdf

Medicare

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

National Council on Aging

http://www.ncoa.org/public-policy/health-care-reform/straight-talk-for-seniors-on.html

Affordable Care Act (ACA) Facts: Fact # 3

Tuesday, March 8th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is part of our ongoing posts, so please see Fact # 1 in a post dated, Feb 8, 2011 and Fact # 2 in the post dated 2/24/11.

Fact: The law will make it easier to receive and pay for long-term care at home.

As we covered in our Medicare Myths post, Medicare does not cover long term care costs. Long term care in a facility or at home is often an out of pocket expense. The Affordable Care Act has some provisions (Section 2401-2403) that allow States to apply for Federal Funding to provide in home services. Some of these programs already exist in NJ and are open to those who have or are eligible for Medicaid. Starting in 2011, the Law allows States to apply for additional funding for these Medicaid programs, often referred to as, Waiver programs.

You may have heard about the new national long-term care insurance program called CLASS (Community Living Assistance Services and Supports). According to the ACA this will become available in 2013. Full and part-time workers with salaries of at least $1,200 per year will be eligible to participate in CLASS and may choose to have the premiums deducted from their paychecks. Non-working retirees are not eligible for the program. After you have participated in CLASS for at least five years and you can no longer perform basic activities (such as eating, dressing, or bathing, or if you have Alzheimer’s disease or other forms of dementia), you are eligible to receive a daily cash benefit. This cash benefit is expected to average $50 per day and can be used to pay for anything that will help you stay at home. Examples of things it will pay for include, home care services and equipment.

Beginning in 2014 the ACA specifies that more regulations be put in place to protect spouses of those who are receiving home care services. Sometimes referred to as, “Spousal Impoverishment” rules, some states, including NJ already have these in place for those who have a spouse living in a nursing home who needs to apply for Medicaid. What the regulations do is protect the money that the other spouse needs to remain living in the community, the ACA states that this should be extended to spouses that have an ill husband or wife at home who is in need of Medicaid services.

Information in this blog was gathered from the Affordable Care Act, Centers for Medicaid and Medicare and the National Council on Aging.

For more information:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

Details about the law at Heathcare.gov

http://www.healthcare.gov/law/about/index.html

Affordable Care Act (ACA) Facts: Part 2 in a Series

Thursday, February 24th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is our second post, so please see Fact # 1 in a post dated, Feb 8, 2011.

Fact # 2 The ACA will reduce Medicare spending growth, extend Medicare solvency and is projected to reduce the budget deficit.

While Medicare spending will continue to grow, over the next 10 years the healthcare law will slow the overall rate of growth. Average spending per person will grow at about 2% per year, according to the Congressional Budget Office (CBO) this is compared to the current rate of 4% per person per year. This slight decrease will be a result of reductions in waste, fraud and abuse.  The CBO also projects that the ACA will save Medicare about $400 billion over 10 years and will extend the solvency of the Medicare Trust Fund until 2026.

What you need to know:

In 2011, the ACA will slow payment increases that are made to Medicare providers such as, hospitals, nursing homes and home health agencies. Please note that doctors are not included in that group. The ACA does not reduce payments to your primary care doctor.

Also in 2011, payments to Medicare Advantage (MA) will be reduced. Approximately 25% of seniors are enrolled in MA plans, HMOs or PPOs offered by private insurance companies, the other 75% have traditional Medicare. The ACA will gradually lower payments made to MA plans, which on average cost 13% more than original Medicare. Another change that ACA makes to Medicare Advantage (MA) plans is that those plans will not be able to charge you more than what you would pay if you were on original Medicare for services such as kidney dialysis, chemotherapy, or skilled nursing home care.

Because of these laid out in the Law, MA plans may cut some of the extra benefits they offer that are not covered by traditional Medicare and some may increase their premiums. Please note that MA plans cannot cut any basic benefits under Medicare, such as doctor visits and hospital care. You will also have the same right to switch out of your MA plan to original Medicare, the new law will not affect your right to Medicare benefits.

Another way that Medicare savings will occur according to statements in the Affordable Care Act, is for higher income individuals to pay higher prescription drug premiums. This will affect about 5% of Medicare recipients in 2011, single people with incomes above $85,000 and couples with adjusted gross incomes above $170,000.

The ACA states that in 2014 a Payment Advisory Board will be created. This board of experts will recommend specific ways to reduce Medicare costs without cutting benefits or increasing out-of-pocket costs.

Information in this blog was gathered from the Affordable Care Act,  Congressional Budget Office, Centers for Medicaid and Medicare and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

Affordable Care Act (ACA) Facts: Follow this Series

Tuesday, February 8th, 2011

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare.

Fact # 1 ACA will not cut your basic Medicare benefits.

There are actually some improvements to Medicare benefits as a result of ACA. One immediate improvement, according¬†to the Law,¬†is more help with prescription drug coverage. In Medicare prescription drug coverage there is something commonly referred to as ‚Äúthe donut hole‚Äù which refers to a coverage gap where seniors end up paying 100% of prescription drug costs. The new law helps you pay these costs right away. If you enter the donut hole this year, Medicare will send you a check for $250. You don’t have to do anything to get the check. It will arrive around 45 days after you reach the gap. In 2011, if you enter the donut hole, you’ll pay only half of what your plan charges for brand-name drugs‚Äîa 50% discount. By 2020, the donut hole will be slowly phased out and completely eliminated because of the Affordable Care Act.

Also as a result of ACA, a free annual well visit is now available in 2011. The free annual wellness checkup will allow you and your doctor to develop a prevention plan to keep you healthy. And a range of prevention services, such as cancer and diabetes screenings, will be provided free, no more cost sharing.

Another improvement related to the ACA, better care when you get sick! 80% of older Americans, have at least one chronic medical condition such as heart disease, high blood pressure, or diabetes. If you are one of them, you probably see several doctors, who may not always work together. The law will invest in testing new models of care for people with chronic conditions in order to provide better care, better coordination, and more patient-centered services. If you must be hospitalized, the law also will help you return home successfully, and avoid going re-hospitalization, by providing incentives for hospitals to make sure that you get the services you need in your community and by teaching you ways to take good care of yourself.

There are more facts that seniors need to know about how the new healthcare legislation will impact you and your Medicare coverage, stay tuned for more information from NJFA.

The information in this blog was gathered from language in the Affordable Care Act, the Center for Medicare and Medicaid and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

Acupuncuture

Wednesday, February 2nd, 2011

You Don’t Have to Do It Alone

Acupuncture is a practice originating in China in which needles are inserted into various metaphysically determined points of the body also known as, acupuncture points, and then manipulated. Practitioners claim that it relieves pain, treats infertility, treats disease, prevents disease, promotes general health, or can be used for therapeutic purposes. ¬†The practice dates back to at least the 2nd century B.C. in China. Acupuncture typically incorporates traditional Chinese medicine as an integral part of its practice and theory. Different variations of acupuncture are practiced and taught throughout the world. Acupuncture is based on a belief that flowing through the body is a kind of energy called ‚Äúqi‚Äù (pronounced “chi”). The acupuncture points are located on what are claimed to be paths or meridians where the qi is believed to flow.

Some barriers for those thinking about acupuncture include cost and being uncomfortable having it done in a room alone with just a practitioner. Community acupuncture clinics have begun to pop up and some patients have found them to be a great opportunity to receive acupuncture in a relaxed group setting and at a lower cost. Those who have used a community acupuncture clinic state that having other people present while they receive the treatment makes it a less tense. The group clinics are described as quiet despite there being multiple patients, Acupuncture for All in Baltimore, MD features a water fountain, relaxing music, calming blue walls, dimmed lights and reclining seats. A patient at Acupuncture for All say it is like being in your own living room. Treatments last approximately 45 minutes and some patients even fall asleep during that time.

Costs at community acupuncture clinics can range from $15 to $40 per treatment, this is a much lower cost than the up to $90 per visit you could pay at a traditional acupuncture office. Some clinics even offer sliding scale fees so that those who cannot afford a $20 per visit fee can still benefit from acupuncture. Fred Wolfson, who operates Acupuncture for All said the concept of community acupuncture is based on models of clinics in Asia, which are typically low cost. Patients are drawn to these clinics for the low cost and accessibility. These clinics are helpful for patients who might not otherwise be able to afford acupuncture or afford frequent visits.

With all that good news, you may be wondering, how can I benefit from group acupuncture? There is an online community to answer all your questions and help you find a clinic. At this time they only list one clinic in New Jersey. http://www.communityacupuncturenetwork.org/

Medicaid Myths in Long Term Care

Monday, January 17th, 2011

You may have heard a friend, family member or neighbor tell a story about an elderly relative that had “all their money taken by a nursing home” or “the state took all their money when they went into the nursing home”.  This is another one of those myths regarding coverage of long term care, like the one we covered in the last blog about Medicare.

Unlike Medicare, Medicaid does cover long term care, but you have to qualify. Medicaid both in the community and in a nursing facility is a program for low-income individuals who must qualify by meeting the income guidelines. When it comes to paying for nursing home care, you have to meet the medical criteria showing that you need the physical assistance, as well as, showing that you have no more than $4,000 is assets and no more than $2,000 in monthly income.

When someone states “the nursing home took all of my mother’s money”, most likely the Medicaid guidelines were not properly explained to them or it was oversimplified by the person explaining it. Often when someone is admitted to a nursing home for long term care, the nursing home must look at their financial records to see how they will pay for the care, they will counsel the person and /or their family on how much care at the facility costs and should help them determine if and when they will need to apply for Medicaid. When a person has enough money to pay, but knows they may run out in six months to a year, they call this a “spend down period” which means you pay the nursing home the monthly rate and when you’ve “spent down” your funds to the Medicaid eligibility level, you can apply for Medicaid.

There may be people who are under the false impression that Medicaid or some other program, will automatically cover you when you need nursing home care, similar to the false belief that Medicare covers long term care costs. We pay for goods and services all the time, but when it comes to long term care there is much confusion and false assumptions.

Medicare Myths

Wednesday, December 22nd, 2010

According to a study done by Prudential in 2009 37% of people think that Medicare will cover their long-term care costs. This is false. Medicare does not pay for long-term care. Medicare is also not free, there is a monthly premium associated with Medicare Part B.

Here are the facts about Medicare.  Medicare is for people 65 years of age or older (or people with disabilities). Medicare Part A (also known as hospital insurance) covers hospital stays, short-term skilled nursing care, hospice and home care services. Medicare Part A does not have a premium (if you or your spouse have paid Medicare taxes).

Medicare Part B (also known as Medical Insurance) does have a premium that is paid monthly. Part B covers doctor’s services, outpatient care, home care services and some preventive services.

Back to long-term care, what Medicare does cover, under Part A is Skilled Nursing Facility care on a short term basis. There are several guidelines for that coverage that you should also be aware of. After a 3 day minimum hospital stay, you are eligible under Medicare Part A for a short-term stay in a Skilled Nursing Facility, for rehab and nursing services. The goal is to get the individual strong enough to return home.

What Medicare Part A covers is up to 100 days of this skilled care at a nursing facility. You may not need the entire 100 days. The staff at the nursing facility will estimate the amount of time needed to rehabilitate the patient based on Medicare guidelines for Physical, Occupational and Speech Therapies, as well as, medical interventions given by nursing staff. It is also important to note that there is a benefit period associated with your 100 days of Skilled Nursing Care. This means that if you use your 100 days, you will not be eligible for another 100 days (even if you have another 3 day hospital stay) for 60 days. During those 60 days you must not have received any Skilled Nursing services. So, keep this in mind when planning your discharge from the Skilled Nursing Facility. Another thing to keep in mind is that after 20 days in the Skilled Nursing Facility you are responsible for a 20% co-pay per day. The co-pay is based on the per day rate approved by Medicare. If you have a supplemental or Medi-Gap policy, this may cover your co-pay, call your insurance plan to verify this. It is very important when being admitted to a Skilled Nursing Facility to provide all of your insurance information, including you supplemental coverage.

In closing, Medicare covers many inpatient and outpatient services through Part A & Part B, but they do not cover long term care, also referred to at custodial care. It is important to know what Medicare covers when thinking of your short term and long term health needs.

For more information visit:

 www.medicare.gov Рto view the 2011 Medicare and You Handbook,

or call 1-800-633-4227 to request a Handbook.

http://www.medicare.gov/publications/pubs/pdf/10153.pdf – for a handbook on Medicare Coverage of Skilled Nursing Facilities

2010 Conference Session: Ethical & Legal Response: Identifying and Reporting Elder Abuse

Thursday, July 15th, 2010

At NJFA’s 12th Annual Conference on June 10th we were pleased to offer a workshop titled, “The Ethical and Legal Response: Identifying and Reporting Elder Abuse, Neglect and Exploitation”. This session featured, David Ricci, State Coordinator of Adult Protective Services; Pat Bohse, Manager, NJ4A; Linda Murtagh- Social Work Supervisor, Ocean County Board of Social Services; and Vincent Olawale- Human Services Division Manager FOCUS, Hispanic Center of Community Development, Inc. The presenters advised the group on how to identify elder abuse and the different forms it takes. Elders can experience abuse in many ways, physical, mental/emotional, financial and also through neglect. 

Also in the discussion was NJ Laws regarding elder abuse and reporting, as well as, the states rules and regulations regarding referrals made to Adult Protective Services. The law regarding Adult Protective Services applies to any “vulnerable adult”, meaning anyone over 18 years of age or older who resides in a community setting and who, because of a physical or mental illness or disability, lacks sufficient understanding or capacity to make or carry out decisions concerning his or her well-being. When reporting elder abuse, you should provide the name and address of the adult and as much information as possible about the concern and the person responsible for any abuse. The report should be investigated within 72 hours according to NJ State Law. Depending on what is found, the adult protective services worker may refer the older adult to services and may contact other Departments, such as the Office on Aging or Division of Developmental Disabilities.

The new NJ State Law regarding the reporting of abuse that was discussed in this session. The law makes it mandatory for certain professionals to report elder abuse, such as optometrists, psychologists, podiatrists, and physical therapists. The new law establishes mandatory reporting for these healthcare professionals and first responders because they are likely to come in contact with vulnerable adults.

Another part of the presentation included Pat Bohse of NJ4A and Bohse & Associates, showing a video about elder abuse. The video shows professionals, elders and family members talking about specific examples of elder abuse as well as numerous facts and figures about the problem. The point of the video is to raise awareness about the problem of elder abuse and encourage people to report it so that more elders can get help if they are in an abusive situation.

 Evaluations from the session indicate that attendees found the presentation informative and that the speakers were engaging. We’d also like to take this opportunity to again thank our wonderful presenters for taking the time to put together this session on a very important subject.

More about NJFA’s 12th Annual Conference!

Thursday, June 24th, 2010

Offering welcoming remarks at the New Jersey Foundation for Aging’s conference this year was Patricia Polansky, Assistant Commissioner from the Dept. of Health and Senior Services.  We were pleased to have Pat join us and kick off the day! Her remarks began with comments about the budget and fiscal concerns for the State. However, the Assistant Commissioner transitioned to big changes coming to NJ as a result of Healthcare reform. Ms. Polansky advised that as a result of President Obama signing into law the healthcare reform bill, also known as the Affordable Care Act, “$60 million in grants are being made available for states to help individuals and their caregivers better understand and navigate their health and long-term care options”.  Adding, “the purpose of this grant program authorized by the Affordable Care Act is to create streamlined, coordinated statewide systems of information, counseling and access that will help people find consumer-friendly answers they seek to meet their health and long-term care needs”.

The Assistant Commissioner went on the describe what NJ is already doing, “New Jersey has achieved excellent results in building on existing programs and implementing new approaches for supporting home and community based services”. Pat was referring to the Independence, Dignity and Choice in Long-Term Care Act, stating that, “the state’s long-term care funding structure is being adjusted to provide more options for older adults through budgetary rebalancing”. She followed up this statement by pointing out that there is a growing population of older and disabled persons who desire to stay at home with care rather than going into a nursing home, she stated that policy changes have been made to support that.

Pat added, “The State’s effort to expand home and community based services options for individuals who qualify for Medicaid Institutional Care, started with consolidating 3 Medicaid Waiver Programs into a single line item now know as Global Options for Long-Term Care. Pat added, “we have seen an increase of 1,840 or 23% more participants served; yet well within the SFY 2010 budget”.  She informed the crowd that GO serves 10,000 aging and disabled clients, but that is was actually a cost savings.  She pointed out to the audience, “The average Medicaid rate for a NJ nursing home is $63,541 per year, whereas the annual cost is $17,112 for the Medicaid Waiver, Global Options. Clearly this demonstrates a more cost-effective approach”.

The conference attendees were glad to have heard these valuable updates from the Assistant Commissioner. Many people came up to us during the day to say how wonderful it was to have the Assistant Commissioner share these details with the group.

We hope you have also found this synopsis of the remarks offered by the Assistant Commissioner helpful and informative, please stay tuned for more details and excerpts from the conference.

Healthcare Reform and New Jersey

Thursday, December 17th, 2009

Healthcare Reform and New Jersey

As you may know, the Senate is currently debating healthcare reform.  The many amendments that are pending each require 60 votes to pass. We’ve all witnessed much debate and questioning on this topic, what we aim to do here is breakdown some of the key issues as well as, discuss what reform would mean in New Jersey.

First, a new report from the Center for Medicare and Medicaid (CMS) shows that healthcare reform bill could be a cost savings for many. According to a recent White House Blog, the bill could add years to the life of Medicare, lower costs for seniors and slow the rate of healthcare cost growth. Specifically, the report speculates that it can extend the life of the Medicare trust fund by nine years. In regard to their statement about saving seniors money, CMS reports that by 2019, the bill would save seniors nearly $700 per couple, reducing premiums by more than $300 per year and out of pocket costs by another $370 per year. CMS also predicts that as savings from reform kick in national health expenditures are projected to increase at a slower annual rate.

Some of the other areas that experts have indicated additional cost savings in are injecting accountability, competition and choice into the system through the insurance exchange; giving providers incentives to coordinate care; and transforming Medicare payment policies to reward quality of care (not quantity).

That leads us to the “exchange”, otherwise known as the public option. Some say the insurance exchange is a key element in providing coverage to the currently uninsured and making insurance more affordable for those who buy coverage on their own. Simply stated the exchange would be an entity that offers a choice of plan in an organized and competitive market. The exchange could also establish some common rules regarding offering and pricing of insurance coverage and provide the consumer with information to help them understand what is available. Much controversy surrounds the idea of a public, government-run plan being included in the exchange, as amendments are made and voted on, only time will tell if this will be an option or not. A hope expressed by many, including New Jersey Representative Rush Holt, is that the exchange, with or without a government-run plan, will allow more Americans to access coverage that currently is not available to them. That may mean including income-based plans other than Medicaid for those that find themselves above the income guideline for that program, but still can’t afford commercial insurance coverage.

So, you may be wondering, what does that mean for New Jersey? According to the Employers Association of New Jersey (EANJ), 95% of the state’s businesses employ 50 or fewer employees; this represents nearly 1.36 million people. Many uninsured adults are employed by small businesses that find healthcare too costly. Healthcare reform, specifically the “exchange”, would allow for those individuals to obtain affordable healthcare coverage.  EANJ also reports that healthcare premiums in New Jersey rose almost 5 times faster than wages in the past decade. If healthcare reform is able to create some rules and standards regarding the cost of coverage and companies abilities to deny coverage, perhaps this disparity would not be so great.

Lastly, Representative Rush Holt has done much to educate his constituents about healthcare reform; his website contains many links with information about the bills. Some of the statements regarding how New Jersey could benefit from the passing of healthcare reform are: improving employer based coverage, credits to help pay for coverage for households that are uninsured, allowing small businesses to obtain affordable health care coverage and providing tax credits to help reduce health insurance costs, improving Medicare, including closing the prescription drug donut hole and reducing the cost of uncompensated care for hospitals and health care providers by $38 million.

Want more information? Have something to add or a question to ask? Please contact your Senator!

Frank Lautenberg

Robert Menendez

Please share your thoughts with us via the comment option below!