Chief Justice John Roberts and the Affordable Care Act Chief Justice John Roberts’ decision salvaged the Affordable Care Act.  Ironically, many of those who are euphoric about his decision have neglected to read his comments which are so highly critical of the Act.  A few excerpts from his opinion follow.  Comments in parentheses are mine as is the decision to bold certain sentences. Justice Roberts: We do not consider whether the Act embodies sound policies.” The guaranteed-issue and community –rating reforms (everyone can get

Medicare Part D Drug Plan Open Enrollment October 15 – December 7 The federal reform legislation which passed in 2010 has many controversial elements.  The reform legislation, however, is what brings us a new Medicare Part D Open Enrollment schedule which is very sane and welcome.  In all but the first year of the program, 2006, the annual enrollment season has been crammed into a November 15th to December 31st timeframe.  That narrow window made it difficult for plans to effectively handle changes

More on Shrinking Out-Of-Network Benefits – The Claims Filing Deadline Trap In an earlier communication we addressed the value, although dwindling value, of the out-of-network benefit. Remember, if you don’t have out-of-network coverage, and seek care from a provider outside of your Plan’s network, you won’t be covered. As a result, out-of-network benefits are an important protection even though payment rates from insurers have been driven down. Another issue to remember when using out-of-network benefits is your Plan’s claims filing deadline. Unlike in-network

Obamacare Moving Ahead Despite Setbacks On July 2nd, the Obama administration announced a one year delay in implementing the requirement that large employers, those with 50 or more employees, provide employees health insurance or pay a fine. The delay is an embarrassment to the administration and follows delays in implementing small business insurance exchanges in most states and abandoning the Affordable Care Act’s long term care program altogether. Nevertheless no one should doubt that on (or perhaps near) October 1st, 2013, insurance exchanges

Long Term Care Coverage What is Long Term Care Coverage? Long Term Care Coverage is an insurance product that provides coverage for nursing home stays and home health care service. Will my Medical or Medicare coverage pay for those services? Only when you are recovering from an illness or injury and need short-term services from skilled professionals. Services covered through long term care policies are typically provided by individuals who lend you assistance for so-called activities of daily living because you are too frail

Medicare and Obamacare 2014 We have received many inquiries from those on Medicare wondering what they have to do to prepare for the provisions of the Affordable Care Act (Obamacare) going into effect on January 1, 2014. The short answer is, NOTHING. It’s not that Obamacare doesn’t affect individuals on Medicare, but the primary provisions of Obamacare that take effect in 2014 are: Everyone will qualify for insurance, regardless of health status. Coverage will meet minimum essential benefits. Neither of these apply to those on Medicare. We have received

Doctors Abandoning Medicare? The Wall Street Journal reported on July 19, 2013, that 9,539 doctors opted out of Medicare in 2012 according to the Center for Medicare and Medicaid Services. Should this be a concern to those on Medicare? Yes and no. Out of a nationwide pool of some 685,000 doctors, 9,539 is about 1.4%, a rather miniscule number. But the trend is scary because it is triple the number of doctors who opted out several years ago and “Baby Boomers” are now

The Dumb Myth that Young Americans Don’t Need Health Insurance “I’m young and healthy and can’t afford health insurance. I’m getting off to a reasonable start but just making ends meet. If I get sick, they have to treat me in the emergency room, right? And I don’t have any assets, so there’s nothing for a hospital or doctor to take if they come after me for money.” This attitude is foolhardy madness. Here’s why. Illness and Injury Young adults are not all in

State Health Insurance Marketplaces Not For Seniors On August 26, a Kaiser Health News article clarified the fact that those on Medicare should not be shopping for health insurance on the new insurance marketplaces which are open as of October 1st. This is correct. People on Medicare should not shop on the new state insurance exchanges. The Wall Street Journal recently reported that IBM retirees on Medicare will be shopping for their retiree coverage on private exchanges but those private exchanges

Health Care Coverage and DOMA – No News Yet In June of 2013, the Supreme Court overturned DOMA, the Defense of Marriage Act. Prior to this Supreme Court ruling, only heterosexual couples were recognized by federal law as being married. As a result of the ruling, the Treasury Department announced in August that gay and lesbian couples who are married can file joint Federal tax returns. The IRS has indicated that is true even for couples who currently reside in states