One of the primary questions about Congress’ moves towards healthcare reform is how they are planning to pay for it. A variety of budget cuts and tax increases have been proposed by the House of Representatives and the Senate in order to provide affordable health care. Many are especially worried about the impact of the Senate’s proposed decrease in Medicare health insurance plan spending. However, a prominent senior citizen association recently announced that they support the Democratic bill, which includes approximately $460 billion in Medicare cuts. Why would they back legislation that may harm people over the age of 65, half of whom are card-carrying members?
Detractors would point to their history of supporting many laws proposed by Democrats, and say that the group is too cozy with that party. The group takes a different view; CEO A. Barry Rand told its members that the proposal would not reduce any guaranteed benefits associated with the government-sponsored health insurance plan. Moreover, he pointed out that Medicare has recently been plagued by inefficiency, waste, and fraud–eliminating such expenses should cover most of the shortfall. Some believed that such wasteful spending is inevitable when the federal government is involved, making their support of a public option (effectively taking the form of “Medicare for all” health insurance plan) ludicrous.
Republicans such as Senator John McCain warn that the cuts will target some of the add-on benefits many seniors have come to expect from Medicare Advantage. These benefits often include gym memberships to maintain their fitness, in addition to higher quality vision and dental care. A Medicare Advantage health insurance plan is sold by private insurers as a supplement to standard Medicare. Proponents of the healthcare reform bill admit that Medicare Advantage programs will face the bulk of the cuts in federal funding, but accuse the health insurance plan providers of using the partially subsidized premiums primarily to finance corporate profit margins for their shareholders and exorbitant salaries of their executives.
There is definitely some opportunity for cost saving. Studies show that a senior citizen covered by a private health insurance plan (e.g. Medicare Advantage) costs the government 14% more than one on regular Medicare. It remains to be seen if the benefits to seniors outweigh the continuous additions to the budget deficit. McCain admonished the the group for using Medicare funding as a “piggy bank” to pay for other health care programs, thereby driving it closer to bankruptcy. The organization has also been criticized for not recognizing the wishes of their own membership: there is no doubt some overlap between their membership roster and attendance at the town hall rallies earlier this year.
The Senate is expected to vote on the Medicare cuts today, prior to debate on the complete healthcare reform bill. Democratic Sen. Michael Bennet has proposed an alternative amendment that would result in all guaranteed Medicare benefits being spared–a move which he recognizes could cost him his seat. His proposal could see more support from Democrats wary of alienating the most consistent demographic of voters. Meanwhile, McCain has proposed his own amendment to change the language of the Medicare-related provisions and send the bill back to senatorial committees. They are accustomed to their health insurance plan and understandably resistant to change.
Are they likely to succeed in their goal? The likelihood is high. It is 40 million members strong, and has been a powerful lobbying group for decades. Even a fraction of them writing letters or making phone calls can have a significant effect on pending legislation. The impact such a move will have on co-branded health insurance plan offerings remains to be seen.
By: Yamileth Medina
Posts Tagged ‘Health Insurance Plan’
Pre-Existing Conditions in Florida Health Insurance
January 13th, 2010
Pre-existing conditions in Florida health insurance is an area of health insurance that seems to suffer from a murky cloud of confusion. What is a pre-existing condition? How are pre-existing conditions handled in Florida? Are there differences in how pre-existing conditions are handled depending on whether it is a Florida group health insurance plan or a Florida individual health insurance plan? All of these are valid questions concerning pre-existing conditions and their effect on obtaining health insurance coverage in the state of Florida.
The obvious first question is, “What is considered a pre-existing condition in Florida?” Typically, most health insurance companies in Florida will look at an applicant’s health history going back as far as 10 years to determine an applicant’s health status (in the case of an application for individual health insurance; group health insurance in Florida will not levy quite as much scrutiny towards a pre-existing condition). Therefore, in the strictest type of scenario; any adverse medical conditions or medical issues within the 10 years prior to the application being submitted is considered a pre-existing condition. (This is not the case for all areas of pre-existing conditions as in the case of certain conditions the health insurance company is only concerned with say high cholesterol [just an example] or nicotine use [just an example] in the past 5 years or 2 years rather than the full 10 years). Generally speaking, any type of medical condition or issue that happened further back than 10 years ago does not exist for the sake of the Florida health insurance application.
The obvious follow up question is, “How are these pre-existing conditions handled by the health insurance company that one is applying with?” The classic attorney answer happens to fit in this instance, “That depends.” The way that a specific pre-existing condition is handled in an application for individual health insurance in the state of Florida is solely at the discretion of the underwriting department of the health insurance company. Of course, common sense would tell us that a pre-existing condition of cancer will be treated much differently than a pre-existing condition of the tendency to develop a cold: just as Diabetes will be treated much differently from hay fever.
There are probably 3 main general groupings of pre-existing conditions in the state of Florida when it comes to individual health insurance. There are the pre-existing conditions that will signal an automatic decline by the health insurance company such as diabetes, cancer, extreme obesity, and rheumatoid arthritis (only a few examples), those that will prompt the insurance company to either not cover the particular pre-existing condition (exclude that specific condition but cover everything else – a “rider”) or charge an additional premium (“rate – up” or rate increase) such as asthma/allergies, back disorders, and high cholesterol (only a few examples), and then there are those pre-existing conditions that present a risk so minor that the health insurance company will cover everything and not charge an additional premium (such as infections, disorders, or surgeries where there has been a Doctor certified 100% recovery, common cold, common childhood ailments, etc) (again, only a few possible examples).
The important thing to do if you have a serious pre-existing condition and have health insurance is to NOT cancel your health insurance coverage! There may still be other options available to you such as a HIPAA guaranteed issue plan (cannot be declined due to pre-existing conditions) or a group health insurance plan. There are a number of criteria that you must meet in order to be eligible under HIPAA. Consult with a knowledgeable Florida independent health insurance agent that will be able to assist you in finding appropriate Florida health insurance coverage.
By: Joel Ohman