Health Care Reform Information
The passage by Congress of the Patient Protection and Affordable Care Act will result in many changes affecting health insurers and their members. While many of the details of these changes are still being developed and are not fully known, we recognize that you may have questions about health care reform and how it affects you.
We are reviewing the new law and, while we don’t yet have answers to every question you might have, we are committed to sharing health reform-related information and responding to your inquiries as quickly as possible. We are moving ahead aggressively to implement the changes of the new federal law in as timely and effective manner as possible.
We want to be responsive to your questions and concerns about how these reforms may affect you, your family or your business. Check this page regularly for the latest information and updates on major changes affecting CareFirst members and other information on health care reform.
Health Reform News
New Interactive Tool Provides Answers on Health Reform
Still have questions about how the new federal health care reform will affect you or your business? A new online, interactive tool – AskBlue Health Care Reform, Your personal guide to understanding the basics of reform (SM) – is now available in the Resources section of CareFirst’s Federal Health Care Reform Information section.
Developed by the Blue Cross and Blue Shield Association (BCBSA), AskBlue Health Care Reform provides individuals and employers simple, straightforward explanations of health care reform. By answering just a few simple questions, AskBlue provides personalized information about which reform changes will be the most meaningful for them. Upon completing a session, users receive a summary of what they’ve learned, with the option to print or e-mail their summary, and access to additional resources such as www.healthcare.gov.
AskBlue Health Care Reform also is a resource for business owners to understand what reform will mean for their business and employees, including a small business tax credit calculator developed in partnership with H&R Block to help determine if a business is eligible for a health care tax credit. A Spanish-language version of the tool is under development.
HHS Announces New PCIP Choices for 2011
The U.S. Department of Health and Human Services (HHS) is offering new choices for individual consumers enrolling in the Pre-Existing Condition Insurance Plan (PCIP) for 2011. This temporary program makes coverage available to uninsured individuals with pre-existing medical conditions during the transition period until health insurance exchanges are established in 2014.
The new plan choices, which seek to boost enrollment in the program, will be available in those states where the program is federally administered, including Virginia and the District of Columbia. Beginning in 2011, individuals in these states can choose among three plan options:
- Standard Plan: The current 2010 Standard Plan has a single, combined medical and pharmacy deductible of $2,500. The 2011 Standard Plan offers two separate deductibles – a $2,000 medical deductible and a $500 drug deductible – and premiums that are almost 20 percent lower than premiums for the 2010 Standard Plan.
- Extended Plan: The new Extended Plan will have a $1,000 medical deductible and a $250 drug deductible.
- Health Savings Account Option: The new Health Savings Account Option will have a $2,500 deductible and premiums that are 16 percent lower than 2010 premiums.
HHS also announced that families will be able to enroll their eligible children up to age 18 in PCIP at child-only rates. Additional information about eligibility and benefits under the PCIP program can be found at www.pcip.gov.
Temporary Coverage for Those with Pre-existing Conditions
Has your pre-existing medical condition prevented you from purchasing commercial health insurance? If so, you now have options for coverage under a new high-risk pool, established and funded under the federal health care reform law.
The pool – officially known as the Pre-existing Condition Insurance Plan (PCIP) – is a stop-gap measure designed to help people with pre-existing health conditions to purchase health insurance coverage until Jan. 1, 2014, when health insurance companies will be required to sell insurance coverage to all applicants, regardless of pre-existing medical conditions.
Congress has allocated $5 billion in funding to subsidize health insurance for people whose health conditions have prevented them from buying affordable coverage.
The federal program complements and augments existing high-risk pools in 34 states that cover about 200,000 people nationwide. Benefits and premiums for the federal plan vary from state to state and states with existing high-risk pools will continue offering their own plans separately from the federal plan, with different eligibility requirements, benefits and premiums.
In CareFirst’s market service area, Maryland operates the federal high-risk pool under the Maryland Health Insurance Plan (MHIP), which is administered by CareFirst BlueCross BlueShield. For more information, visit www.marylandhealthinsuranceplan.state.md.us.
Virginia and the District of Columbia have opted to have the U.S. Department of Health and Human Services (HHS) administer their respective federal pool programs. For more information on eligibility, benefits and costs, visit https://www.pcip.gov. Applications for PCIP and information about other state-level high-risk pool plans also can be found at www.healthcare.gov.
|Still Have Questions About Health Reform? We have just posted in our Health Reform Resources section a new interactive tool – Health Reform Timeline – developed by the Kaiser Family Foundation that explains how and when various provisions of the health reform law will be implemented over the next several years. Click on the year, then click on a provision to get more information about it.|
What Will Your HSA Cover Beginning January 1, 2011?
If you have a Health Savings Account (HSA), the federal health care reform law will affect what your HSA will cover, beginning January 1, 2011.
Expenses for over-the-counter (OTC) medications will no longer be eligible for payment or reimbursement from your HSA unless you have a doctor’s prescription. OTC medical supplies that will continue to be eligible for purchase through your HSA (without a doctor’s prescription) include: adhesive bandages, braces and supports, catheters, contact lens supplies and solutions, contraceptives, denture adhesives, diagnostic tests and monitors, elastic bandages, first aid supplies, reading glasses, wheelchairs, walkers and canes.
No prescription is required to use your HSA to cover insulin and diabetic supplies.
A different provision of the Patient Protection and Affordable Care Act imposes a tax penalty for HSA withdrawals that are not used for qualified medical expenses. The tax penalty for non-qualified HSA distributions will increase from the current 10 percent to 20 percent, effective January 1, 2011.
New rules also will affect consumers who have Flexible Spending Accounts (FSAs) and Health Reimbursement Accounts (HRAs). After December 31, 2010, distributions from health FSAs and HRAs will be allowed to reimburse the cost of over-the-counter medicines or drugs only if they are purchased with a prescription. This new rule does not apply to reimbursements for the cost of insulin, which will continue to be permitted, even if purchased without a prescription.
Visit the Internal Revenue Service’s website for more detailed information about how the new reforms may affect your HSA, FSA or HRA.
Check out earlier news postings in the Reform News Archives section.