Senior & Medicare Beneficary Resources
Now is the time to oppose MACRA by writing a letter to our President. The collective voice of a special interest group can initiate change (letter template attached).
SENIOR CITIZENS ARE A SPECIAL INTEREST GROUP
The United States Constitution guarantees Americans numerous liberties and rights. Ensuring citizens with civil liberties are defined as freedom guaranteed to individuals such as freedom of religion and freedom of expression. Civil Rights are powers or privileges that government may not arbitrarily deny to individuals. In our government, citizens determine the extent of government activity through free elections and competitive political parties. Voting is central to democracy, and citizens must also be able to discuss politics, form interest groups, contact public officials, campaign for competing parties, protest government decisions.
For example, Senior Citizens take great political participation in the government. Political participation refers to those activities of private citizens that are more or less directly aimed at influencing the selection of government personnel and /or actions they take.
Senior citizens in the United States are influential in politics, and as a group, senior citizens exercise enormous political power. They are concerned with politics and government, as they prove when they participate in politics through voting, working in political organizations, and holding office. They seek to remain informed in politics, particularly because they are the object of governmental programs. They share a number of political concerns, and collectively they benefit from government programs based on old age or retirement status, such as Social Security and Medicare.
Not only do older people pay close attention to politics, they also vote more than younger adults. According to the American Association of Retired Persons, people over 65 exhibit the highest rate of voter turnout of any age group and continue to be very politically active which causes strong influence on the president.
Here is a link to H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015
Have you heard you’ll be getting a new Medicare card? Wondering when or why? This isn’t happening until April 2018 but scammers are already jumping on the confusion as an opportunity for fraud.
Due to Congress’ passage of the Medicare Access and CHIP Re-authorization Act (MACRA) in 2015, the Centers for Medicare and Medicaid Services is require to remove Social Security numbers from all Medicare cards.
This change is to help prevent fraud and protect your identity. Currently, most people’s Social Security number is their Medicare number, which makes collecting Medicare numbers an easy target for scammers to steal your identity, open new credit cards or take out loans in our name. The new number, however, will not be tied to your Social Security number and is therefore more secure.
CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.
So how may scammers use this change to their advantage? Some scammers call beneficiaries claiming to be Medicare and say they must confirm their current Medicare numbers before sending them a new card. Others call saying there is a charge for the new card and are collecting b3eneficiaries’ personal information. There is no charge for your new card and Medicare will never call you for your information. They already have it.
If you receive any such calls or suspicious solicitations, hang up and call the Senior Medicare Patrol at 1-855-613-7080.
For more information, please visit: https://www.cms.gov/medicare/ssnri/index.html
The Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research.
The Psychiatric Emergency Response Teams (PERT) consist of specially trained officers and deputies who are paired with licensed mental health professionals. Together, they respond on-scene to situations involving people who are experiencing a mental health related crisis and have come to the attention of law enforcement.
Hosted by the San Diego County Sheriff’s Department, the Take Me Home program is designed to minimize Law Enforcement response time and maximize search efforts to find a lost individual who cannot communicate. It includes but is not limited to persons with Autism, Dementia, Alzheimer’s, Down Syndrome, deafness or any other Developmental Disability.
Hosted by the San Diego County Sheriff’s Department, the You Are Not Alone Program is a free service for San Diego seniors who live alone and would benefit from a daily check on their welfare. The goal of YANA is to help enrollees feel safer while continuing to live independently.
On the Go is more than a ride—it’s independence, community connection, mobility, and dignity.
Seniors A Go Go reduces the number of missed appointments and helps older adults remain connected with their communities by providing transportation to essential locations. Contact ElderHelp of San Diego for more information and eligibility guidelines.
Does your Medicare Advantage plan include the SilverSneakers Fitness program? Ask us how to get it. The SilverSneakers network includes thousands of locally owned gyms and nationally recognized brands in fitness. You get access to a national network of 13,000 gyms and fitness centers with unlimited access.
Healthcare Reform & Industry Updates
SB 562 states it would establish a state-run single-payer health care system providing comprehensive health care to every California resident. “Resident” is defined as an individual whose primary place of abode is in the state, without regard to the individual’s immigration status. On the cover it appears promising. In the context of the bill is the facts and truths that include a funding model that will crush the backbone of this state, the small business owner.
The single-payer universal health care plan will replace:
- All employer sponsored benefit programs (union and non-union), and retiree
- The marketplace of private insurance policies
- Workers compensation
- Long term care
- The Medicare program
- The Medi-Cal program
The state would work to obtain approval (via section 1332 waivers) from Medicaid, Medicare, ACA and other federal programs to pay those federal funds and subsidies to the State of California.
All Californians will lose their current health plans, to be replaced by government run health care, with benefits yet to be determined, to be serviced by a government-run entity populated with political appointees yet to be identified, to include provisions yet to be named - all paid for by a doubling of your annual tax bill. This bill eliminates competition. Every provider in this state of California would receive the same reimbursement rate regardless of their quality of services. This provides zero incentive to improve quality or cost. This is not a Medicare for all health insurance policy with a robust provider network and a clearly defined covered list of services. This is Medi-Cal for all with limited access to care and ambiguous benefits.
SB 562 forces California to hand over at least $179 billion in new state taxes to pay for a government run health care system. This new $9,200 per person tax would be on top of every Californian's current tax bill.
Early cost estimates of a single payer measure reach as high as $350 billion in new taxes - a doubling of the annual state budget. At the Senate Health Committee hearing on April 26th, CalChamber Policy Advocate Karen Sarkissian quotes: “A payroll tax increase, such as the one needed to finance this bill, not only has a detrimental impact on businesses already in California; it also discourages companies from locating and establishing a business here. Just to cover the shortfall, the LAO estimated a tax of 16% on employers and employees would be needed, resulting in a multibillion-dollar tax increase on Californians.” My agency would be forced to close its doors with the implementation of these new taxes, and my family would be uprooted to relocate to another state.
Multiple state surveys performed this past April reflect that 80% of the population said they were “satisfied” with their coverage. With this kind of success, I vote to keep amending the Affordable Care Act to get that last 7% of the population insured, and NOT overturn all we have done that is right.
I believe that everyone should have access to affordable health care, and in California we are almost there. We are the most successful health care exchange in the country and have more choices in health care policies than almost any other state. Currently 93% of the state is enrolled in a health insurance plan and about 80% of those persons are covered through employer and union sponsored benefits. In the absence of benefit programs, employers and unions will lose their bargaining power and incentive programs for their employees and members and will shift those health care costs to the individual.
At a time when California has recovered somewhat from the Great Recession, and residents were just mandated to pay $69 billion in higher taxes for long-neglected education, water and transportation infrastructure repairs and upgrades, SB 562 will harm all of us with a limitless price tag and no guarantee of better health care for anyone.
This bill is currently being held at the Assembly desk per Speaker Anthony Rendon (63rd District). As our fiscally conservative Governor Jerry Brown is nearing the end of his term, and our next Governor is elected in 2018, this bill will come alive and be the hottest, most debated issue in California. Now is the time to understand what the future of SB562 means to you, your family, and your business.
I ask you to follow the facts, not the propaganda on social media. Write a letter or call your state legislation and be heard. Voice your concerns on quality of care, access to providers and new unnecessary taxes that would hurt you and your family.
✜ Single-payer abolishes private health insurance in California. Today, citizens know what their plan covers - and what it doesn’t. There are no specifics about what single-payer would cover, and those decisions are left to a government-run entity with political appointees.
✜ Single-payer mandates a government-run monopoly on all health care services in California. It eliminates private insurance, Medi-Cal, Medicare, Covered California, and the valuable advocacy services of insurance professionals and advisors.
✜ By eliminating employer paid health coverage, single-payer shifts health care costs to employees.
✜ Single-payer will increase your personal tax bill by almost $9,200 per person the first year it is in effect, and go higher each year. A $179 billion tax increase would essentially DOUBLE the size of the current state budget.
✜ A single-payer system like this makes California less attractive to doctors and health care providers. Our best providers would leave the state and we remain less attractive for new providers to practice in California.
✜ Single-payer puts 18% of California's workforce on the unemployment line. By giving Californians the highest state taxes in America, business will be forced to leave the state, making California a less attractive place to do business.
✜ While single-payer plans offer all citizens some kind of health care coverage, they cannot guarantee access to medical care.
✜ Single-payer inevitably control costs by rationing health care. Citizens in countries with single-payer models often wait months to see a doctor or specialist or to receive much-needed medical treatment. In some instances, citizens do not survive while waiting for care.
✜ Single-payer holds down costs by having one centralized government bureaucracy make all decisions with regard to health care services and prices. Single-payer means limited choices for consumers, discourages creativity, efficiency, quality, innovation and advancements in medical care.
✜ In government-run health care systems there is never enough money to provide timely care and the latest technology. That's because health care funds have to compete with other claims on government funds, such as education, welfare, water, and transportation infrastructure.
✜ Single-payer initiatives have failed in every state because the approach is not supported by most citizens. Californians want the legislature to focus on positive changes to reduce the cost of health care and health insurance in a public/private partnership.
A Federal Government Website managed by the U.S. Department of Health & Human Services. This is the best place to obtain more information on the Affordable Care Act (ACA), Covered California, enrollment and affordability FAQ’s.
The Henry J. Kaiser Family Foundation: Topics, perspective and regular newsroom updates.
BILL TEXT: https://www.congress.gov/bill/115th-congress/house-bill/1628
|HR 1628 May 4, 2017 - Differences and similarities between the ACA and AHCA|
|ACA||AHCA (March 2017)||AHCA (May 2017)|
|Insurance mandates||Individual mandate and an income tax penalty for not having insurance||No individual or employer mandate|
|Employer mandate on larger companies||Insurers can impose a one-year 30% surcharge on consumers with a lapse in coverage of more than 63 days|
|Aid for premiums||Income-based subsidies for premiums that limit after-subsidy cost to a percent of income||Age-based refundable tax credits for premiums, phased out for higher incomes|
|Aid for out-of-pocket expenses||Tax credits for out-of-pocket expenses||No tax credits for out-of-pocket expenses|
|Annual limits on coinsurance, copays, and other costs|
|Medicaid||Matching federal funds to states for anyone who qualifies||Federal funds granted to states based on a capped, per-capita basis starting in 2020|
|Expanded eligibility to 138% of poverty level income||States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons|
|Lets state impose work requirements on Medicaid recipients|
|Premium age differences||Insurers can charge older customers up to three times as much as younger customers||Insurers can charge older customers up to five times as much as younger customers||Insurers can charge older customers up to five times as much as younger customers; states can apply for waivers exempting insurers from this limit|
|Health Savings Accounts||Individuals can put $3,400 and families can put $6,750 into a tax-free health savings account||Individuals can put $6,550 and families can put $13,100 into a tax-free health savings account|
|"Cadillac" tax||Cadillac tax on high-cost employer plans implemented in 2020||Cadillac tax on high-cost employer plans implemented in 2025|
|Other taxes||3.8% tax on investment income||Repeal of all four taxes|
|0.9% tax on individuals with an income higher than $200,000 or families with an income higher than $250,000|
|Fee on health insurance providers firms based on plans|
|2.3% tax on medical devices|
|Essential health benefits||Insurers are required to offer ten essential health benefits||Private plans are required to offer the ten essential health benefits.||States can apply for waivers exempting insurers from the essential health benefits requirement|
|Some Medicaid plans are not required to offer mental health and substance abuse benefits|
|Pre-existing conditions||Insurers are banned from denying coverage for pre-existing conditions||States are permitted to opt-out of mandating coverage for pre-existing conditions|
|Dependents staying on plan||Dependents can stay on health insurance plan until age 26|
Assembly Bill 72 was signed into law by Governor Brown on September 23, 2016. As of July 1, 2017, this new law will impose additional balance-billing prohibitions on “non-contracted” physicians beyond the current balance-billing prohibition for emergency services to patients covered by health care service plans.
The basic balance-billing prohibition imposed by the new law takes steps to ensure compliance. The law requires health plans and insurance companies to inform non-contracted physicians of the “in-network cost sharing amount” for which patients are responsible. The law establishes an independent dispute resolution process to determine the amount health plans and insurance companies must pay non-contracted physicians.
There are four essential elements for the application of the new law:
· A covered patient
· A contracted facility
· A non-contracted physician
· Covered services
If any one of these essential elements is missing, then the new balance-billing prohibition does not apply.
First, the patient must be covered by a health care service plan or an insurance policy. This could include Medicare managed care plans, but the new law expressly excludes Medi-Cal managed care. The law does not apply to self-funded “ERISA” plans. This can make things difficult, because it is not uncommon for payers such as Aetna or Anthem Blue Cross to administer self-funded plans as well, typically for the employees of larger employers. The fact that “Aetna” or “Anthem Blue Cross” is on the patient’s card does not definitively establish this first element.
The facility in which the services are provided must be contracted with the patient’s health plan or insurer. Facilities are generally limited to hospitals, surgery centers, primary care clinics, accredited outpatient settings where general anesthesia or deep sedation is administered, laboratories, and imaging centers.
The term “non-contracted individual health professional” includes medical professionals who are not contracted with the patient’s “health care service product.” The use of the word “product” suggests that IF you are not part of a payer’s narrow network, and IF the patient has chosen a narrow network product, then you will be deemed “non-contracted” under the new law.
The services rendered to the patient must be covered by the patient’s health care service product. If, for example, the patient’s health care service product does not cover general anesthesia for endoscopic procedures, then the covered service element would not apply for the endoscopic procedure.
Finally, the services rendered to the patient must not be “emergency services and care.” If the procedure is an emergency, then the new balance-billing prohibition would not apply. Keep in mind, however, that the current balance-billing prohibition can still apply for emergency services rendered to a patient covered by a health care service plan regardless of the setting.
When all four essential elements are present, the patient need pay no more than the “in-network cost sharing amount”. The patient should not be billed for this amount until the plan has informed the “non-contracting individual health professional of the in-network cost sharing amount owed” by the patient. This is the essence of the new balance-billing prohibition.
If you are covered by a small group health plan, new regulations taking effect January 1, 2018, could impact the amount of premium insurers charge for your covered children under the age of 21. For small employers, this change could complicate the administration of their health plans and open enrollment planning.
The Affordable Care Act (ACA) established “fair health insurance premium” rating rules for individual and small group plans. For example, under these rules, premium rates for adults (individuals age 21 and over) cannot exceed a 3 to 1 ratio. In other words, an insurer cannot charge a 64-year-old more than 3 times what it charges a 21-year-old.
The rules also state that, when setting rates within the 3 to 1 ratio, insurers may use one-year age bands for individuals age 21 through age 63. Thus, for each year of age, the insurer may charge more. The individual’s age as of the date a policy is issued or renewed is used to determine which age band applies. As a result of the one-year age band rule, an employee who (for example) is 56 may pay more for coverage than an employee who is 55, and so on. For individuals age 64 and older, however, only a single age band may be used; thus, all individuals age 64 and older are charged the same amount. These rules are not changing.
For children (defined, for purposes of this rule, as individuals from 0 to 20 years of age), insurers have been required to use a single age band. Consequently, whether a child is 2 or 20, under existing ACA rules the insurer charges the same premium amount.
As we explain below, new regulations will be changing this age band rule for children, impacting how insurers calculate premiums for dependent children age 20 and under.
The New Rule: Multiple Age Rating Bands for Children
As a result of regulations issued by the Centers for Medicare and Medicaid Services (CMS) last December, one age band for all children from 0 to 20 years of age will no longer be used. Instead, under the new rule, insurers may use:
- A single age band for individuals age 0 through 14.
- One-year age bands for individuals age 15 through 20.
So, all children from birth to age 14 will be assessed the same premium amount. However, if your child is 15, and your co-worker’s child is 14, the insurer could charge you more for dependent coverage. Similarly, because the insurer can set rates using one-year age bands for children between the ages of 15 and 20, your co-worker with a 16-year-old could pay more in premium than you pay for your 15-year-old.
This change will take effect for plan or policy years beginning on
or after January 1, 2018.
Under the regulations, when determining the premium for family coverage under a per-member rating system, the total premium is determined by adding the premium cost for each family member. With respect to family members under the age of 21, “the premiums for no more than the three oldest covered children must be taken into account in determining the total family premium.”
While this new rule is most likely to be felt by employees who pay for dependent coverage, the age bands apply to all individuals who are 20 or younger–whether they are covered as employees or dependents.
Which Plans Will Be Affected?
The new rule applies to both individual and small group health plans, whether they are offered through Covered California or outside the exchange. The new rule does not, however, apply to grandfathered plans. Whether the new rule applies to grandmothered (transitional) plans will depend on state law; in California, grandmothered plans have not been reauthorized.
As a reminder, in California, an employer with between 1 and 100 employees will be covered by a small group health plan. (Aggregated (control) group rules apply.)
What Does This Mean for Open Enrollment?
As noted, for plan and policy years starting in 2018, insurers will be able to charge individual employees different amounts for dependent coverage, depending on the age of their children. These variations could complicate the open enrollment process. Because premium costs will vary, it could be more challenging for the employer to explain to employees and document how much dependent coverage will cost, and that could then make it more difficult for employees to assess the cost of enrollment for the upcoming year.
Advance planning will be necessary. Employers should contact their health insurance agents and /or insurers to determine how they intend to proceed in light of the new rule, and how much information will be available prior to open enrollment so that employers can accurately communicate to employees how implementation of the new age bands could impact them.
CMS Age Band Rating Curve
How much will premiums vary per age band? Unless a state establishes its own “rating curve” (and California has not), insurers must use the age rating curve established by CMS. If you like crunching numbers, or want to get a sense of how much difference the new rule could make in premium rates between age bands, CMS’s default age rating curve for each age band is available at this link (page 4).
The Affordable Care Act, or health care law, contains benefits and responsibilities for employers. The size and structure of your workforce determines what applies to you. An employer’s size is determined by the number of its full-time employees, including full-time equivalents.
As a small-business owner, you may qualify for a federal tax credit to help offset the cost of providing health insurance to your employees by purchasing coverage with Covered California for Small Business. To qualify for a tax credit, employers must contribute at least 50 percent of their employee premium costs.
HR 360 New Law Exempts Certain Small Employer HRAs from ACA Market Reforms.
Allows small employers to offer new "qualified small employer health reimbursement arrangements" to reimburse employees for qualified medical expenses, including individual health insurance premiums.
Health and Wellness Resources
A great source for honest information to help you eat right, exercise, and do what's best for your body and mind.
You can join a FREE Healthy Living Class —In English or Spanish - designed just for you - to help you make positive, lasting changes in your life. During these sessions, Scripps experts will teach you about foods and exercise that protect against lifestyle-related diseases like Type 2 diabetes, Cancer and Heart Disease.