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The American Recovery and Reinvestment Act of 2009 (HR 1) includes subsidies for health insurance for people who recently lost their jobs. Those eligible will only have to pay 35 percent of the cost of health insurance under COBRA. The subsidy will last for 9 months. People who have missed the 60 day period to elect COBRA will be given another 60 days from the date the bill is enacted to elect COBRA with the lower premium.
Title III of HR 1, entitled “Health Insurance Assistance for the Unemployed Act of 2009” specifies the criteria one must meet in order to qualify for the health insurance subsidy. To qualify a worker must have:
1) Worked for an employer with 20 or more employees which must comply with COBRA;
2) Been “involuntarily terminated” between September 1, 2008 and December 31, 2009;
3) Attested that their same year income will not exceed $125,000 for individuals or $250,000 for families; and,
4) Not been able to enroll in Medicare or another employer’s health insurance plans.
Additionally, the legislation gives states the opportunity to expand health insurance coverage to individuals who previously worked at companies which do not have to comply with COBRA (e.g., under 20 employees.)
The U.S. Department of Labor will develop model notices for employers to assist with compliance.
Preliminary discussions had been that employers would obtain credit from employer paid FICA taxes to offset the 65 percent subsidy of the COBRA health insurance premium. The specifics on how the subsidy would reimburse employers has not been released.
If the subsidy takes money from the Medicare Hospital Insurance Trust Fund, that would be tragic. The 2008 projection is that the Medicare Hospital Insurance Trust Fund will be insolvent by 2019. Add the aging baby boomers retiring; fewer work age employees paying into the system; ever-escalating costs for medical care; and you have a recipe for the insolvency of Medicare. Let’s hope that our elected representatives do something to fix this fast approaching problem.
With this video I tried to combine all of the aspects of the previous videos and to show people how to compare two different health insurance plans. I created the “Health Insurance Comparison Chart” many years ago and I have found that it helps to focus on the most important aspects of a medical insurance plan. Because there are so many features in a health insurance plan such as the cost of doctor office visits; hospitalization; prescription medicine; durable medical equipment, etc., this chart helps to strip away all but the most important elements, i.e.,: how much you pay in the best case (annual premium) and how much you pay in the worst, catestrophic case (premium plus the out of pocket limit.) My hope is that people who watch these videos and complete the chart will select a plan that works well for them. At the very least, I hope that they understand how their California medical insurance plan works and how best to use it.
Trying to explain complicated terms like “out of pocket limit” “deductible” and “co-insurance” in less than 2.5 minutes is difficult. I thought that the image of someone really hurting himself by diving into a swimming pool was a good way to convey the importance of the protection that health insurance provides when catastrophy strikes. I have seen many instances where health insurance companies have paid hundreds of thousands of dollars for people who have had serious injuries or illness. With this video I tried to explain these complex terms with pictures to help convey the message.
I’ve found that many people aren’t exactly sure what an HMO and PPO are. With this video I wanted to show how they work and what the differences are. I have used the graphics in this video for many years when I sit down with business owners or individuals and we discuss health insurance options. I’ve found that it helps when people see the how the patient (you) fits in with the doctor or primary care physician (PCP) and hospitals, specialists, medical groups and insurance companies. A picture seems to be worth a thousand words.
How a health insurance plan pays for prescription medicine (Rx) is important. Unfortunately, standard descriptions rely on a lot of technical terms. With this video I wanted to make those terms understandable in a graphic or visual way.
One of the best benefits of a health insurance plan is the discount you get from in-network doctors and hospitals. It is often overlooked when people select a health insurance plan because the selection criteria shown are benefits and monthly price (or premium.) Many people forget to consider which doctors and hospitals will give them discounts on a particular plan. In this video I want to remind people to consider the provide network when they select a plan and most importantly, to stay in the network when they have a plan and access care. Staying “in network” saves people a ton of money.
With this video I want to help people understand the differences between the health insurance companies. I also want to let people know that there are some really good protections for people with individual and small group health insurance in California. The current system is far from perfect, but there are some very good aspects of our system. A lot of people are not aware of the low cost of health insurance in California and the price controls in the small group market. Hopefully this video will help people better understand the current system.