Heath Care Reform

Young adults in Massachusetts can now stay under their parent’s policy. The new health law mandates health insurance companies to allow parents to keep their children in their policy until age 26. 20,294  young adults in Massachusetts have benefited from this plan (as of June 2011).

“Because of the new law, Medicare members no longer need to worry about their extra prescription cost. Once they reach the donut hole in 2010, they are sent a check for a $250 rebate. 70,524 seniors in Massachusetts received the rebate to offset the cost of their prescription drugs. A 50 percent discount was also given for brand name drugs once they’ve hit the donut hole. This resulted to an average savings of $36,897,940  for Massachuset Medicare members. The Affordable Care Act aims to close the donut hole by 2020.

One of the provisions of the health care reform is to provide preventive care services free of charge for Medicare members and free from cost-sharing for those enrolled under private plans.  In 2011, 780,099 Medicare members and
1,324,000 private plan members in Massachusetts have received free preventive care services like colonoscopies and mammograms.

The new health law protects consumers’ money through the medical loss ratio which mandates insurers to spend 80 percent of their premium dollars on medical care and only 20 percent on administrative costs. 1,777,000 Massachusetts
residents are now able to maximize their premium.

The new health law requires insurance companies who want to raise their rates by atleast 10 percent to make public the details as to why there is a need for rate increase.

Insurers are no longer allowed to impose a lifetime limit on their members’ benefits. 2,520,000 Massachusetts residents are now free from having lifetime limits on their coverage. Patients with chronic diseases don’t have to worry about
maximizing their limit because of their accumulating medical costs.

Through the Pre-Existing Condition Insurance Plan, Massachusetts residents who have pre-existing condition can now have affordable coverage. As of 2011, 5 residents now have a Massachusetts health insurance. Without this provision, they would still remain uninsured.

Massachusetts has received $48.2 million in grants for the planning and development of their health insurance exchanges. They also received $42.7 million to promote health programs and $73.3 million to create more health centers.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Massachusetts peace of mind. Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 9,830 individuals in Massachusetts who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $76.7 million federal dollars are available to Massachusetts starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 333 Community Health Centers in Massachusetts but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 7% of Massachusetts’s population who live in an underserved area.

New Medicaid options for states. For the first time, Massachusetts has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 9,830 individuals in Massachusetts who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $76.7 million federal dollars are available to Massachusetts starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 333 Community Health Centers in Massachusetts but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 7% of Massachusetts’s population who live in an underserved area.

New Medicaid options for states. For the first time, Massachusetts has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.