Health Care Reform

Overview

On March 23rd, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. Senator Lieberman, along with 59 of his Senate Colleagues, voted for the bill on December 24th, 2009. As a follow up to this historic legislation, Congress, with Senator Lieberman’s support, passed The Health Care and Education Reconciliation Act on March 25th, 2010. This bill was signed into law by the President on March 30th, 2010.

Together, these pieces of legislation will make health insurance coverage accessible and affordable for 32 million more Americans and will reduce our nation’s deficit by $143 billion over the next ten years. Both current and future Medicare beneficiaries can take comfort that these laws will allow Medicare to continue to offer benefits for nine years longer than it could have if these bills were never passed. In addition, the health insurance industry will soon not be allowed to charge more based on how sick you are, impose caps on the benefits you receive, or rescind your coverage if and when you become ill. Individuals will be required, by 2014, to obtain health insurance, but the government will help those who still cannot afford it. Individuals and families with income up to 400% of the Federal Poverty Level (approximately $43,320 per year for individuals and $88,200 for families) will begin to receive tax credits in 2014 so they can have access to comprehensive health care insurance. Small businesses will also have access to tax credits so they can provide better benefits to their employees.

The Senator is proud to be a resource to constituents for information on health care reform. Please continue to check the website as information is updated. If your question is not answered, please do not hesitate to call our Hartford (860-549-8463) or D.C. (202-224-4041) offices and someone will assist you.

 

Implementation of the Affordable Care Act

Health care reform is already making a difference in Connecticut and nationwide.

• In April 2010, the IRS began notifying over four million small business owners that they could be eligible for a health care tax credit this year to help them provide health insurance for their employees.  Nearly 54,000 Connecticut businesses could be eligible for these tax credits.

•On June 10, 2010, seniors who fell into the Medicare Part D coverage gap known as the "donut hole" began recieving $250 rebate checks.  As many as 46,700 seniors in Connecticut could receive a check this year.

•On June 21, 2010, Connecticut became the first state in the country to expand its Medicaid program to include 45,000 low income adults.  This expansion will result in a savings of $53 million to Connecticut's budget.

• In September, the Department of Health and Human Services approved dozens of businesses and municipalities from Connecticut to participate in the Early Retiree Reinsurance Program, which provides $5 billion in financial assistance to employers and unions to help them pay for coverage for early retirees age 55 and older who are not yet eligible for Medicare. Businesses will receive reimbursement for medical claims for early retirees and their families. These savings will alleviate the strain placed on businesses by health care costs. 

• On September 23, 2010, six months after passage of the Affordable Care Act, several critical new consumer protections went into effect.  These new reforms include:

 

·         No Discrimination Against Children with Pre-Existing Conditions

Insurance plans cannot discriminate against children with pre-existing conditions.  Up to 72,000 uninsured children are expected to gain coverage because of this change in the law. 

 

·         Insurance Companies Cannot Drop Coverage

Insurance companies are now banned from cutting off coverage due to an unintentional mistake on an application.  Approximately 10,700 people whose coverage is dropped each year because they get sick or make a technical mistake on their application, will be protected under the new health care law. 

 

·         No Lifetime Limit on Coverage

Insurers can no longer put a lifetime limit on the amount of coverage they provide.  Up to 20,400 people who typically hit their lifetime limits, along with the nearly 102 million enrollees who have policies with lifetime limits, will no longer have to worry about hitting their benefits caps. 

 

·         Covering Young Adults on Parent’s Plan 

Young adults are now allowed to remain on their parent’s plan until their 26^th birthday, unless they are offered coverage at work. Up to 2.4 million young adults, up to 1.8 million who are currently uninsured and nearly 600,000 who purchase coverage in the individual market, could gain coverage through their parents.

 

·         Free Preventive Care

Recommended preventive care will be covered with no out-of-pocket cost.  Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance.  Up to 88 million people will have access to preventive care with no out of pocket costs.

 

Temporary High Risk Pool – Connecticut

Q: What is a Temporary High Risk Pool?

A: In accordance with the health care reform legislation that was passed on March 23, 2010, a new federally funded, state administered program was created to provide health insurance to people with pre-existing conditions who have been without such coverage for at least six months.

Q: How do I apply for the Temporary High Risk Pool?

A: Beginning August 1, 2010, Connecticut will start accepting applications through the website www.healthcare.gov.

Q: What is HealthCare.gov?

HealthCare.gov is the first central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans. Consumers can receive information about options specific to their life situation and local community.

Q: Are there any prerequisites?

A: Yes. You must be without insurance for at least the last six months before you apply. You must have a pre-existing condition which has made it difficult for you to get health insurance, and you must also be a citizen or national of the United States or lawfully present in the United States.

Q: When does coverage start?

A: Applicants could be covered as early as September 2010.

Q: Why is it temporary?

A: The intention is for these pools to provide coverage until access to the health insurance exchanges is available in 2014.

Q: What will the premiums be?

A: The premiums will range from $285 per month for adults under 30 to $893 per month for those 65 and older. Monthly premium rates by age group are as follows:

Child            $242.66
Under 30      $285.16
30-34           $315.10
35-39           $323.81
40-44           $358.71
45-49           $413.32
50-54           $507.08
55-59           $627.78
60-64           $776.52
65+              $893.00

Q: Will there be any deductibles?

A: Yes. The deductibles will be as follows for each member:

Medical Deductible: $1,250 in-network, $3,000 out-of-network
Drug deductible: $250
Out-of-pocket limit: $4,250 in-network, $15,000 out-of-network

Q: Doesn’t Connecticut have an existing program that covers people with pre-existing conditions?

A: Yes. Charter Oak Health Plan is a state funded, state run program whose goal is to provide affordable health care coverage to Connecticut adults, aged 19-64, of all incomes.

Q: What is the difference between this program and Charter Oak?

A: Both programs accept applicants with pre-existing conditions. However, a main difference of the Temporary High Risk Pool program will be unlimited pharmacy and medical benefits, as opposed to annual and lifetime maximum caps. On the other hand, the Temporary High Risk Pool has an absolute six-month waiting period, with no exceptions, between the time a person has active health coverage and is accepted into the program. Charter Oak- while also featuring a six-month waiting period- has a list of exceptions to the general rule, including financial hardship. Also, the Temporary High Risk Pool program will only accept only people with pre-existing medical conditions, while the Charter Oak Health Plan accepts applicants regardless of whether they have a pre-existing condition.

Q: How do I apply for the Charter Oak Health Plan?

You may visit www.charteroakhealthplan.com or you may call 877-77CTOAK (877-772-8625).

Q: Does the recent health care reform legislation affect my appeals rights?

A: Yes, consumers in new health plans in every state will have the right to appeal decisions, including claims denials and rescissions, made by their health plans. This includes the right to appeal decisions made by a health plan through the plan’s internal process and, for the first time, the right to appeal decisions made by a health plan to an outside, independent decision-maker, no matter what state a patient lives in or what type of health coverage they have.

For more information about the recent health care reform legislation, click here

For more information on the Connecticut Pre-Existing Condition Insurance Plan, and to download an application, click here

For more information about the new appeals regulations, click here.