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Posts Tagged ‘AFFORDABLE CARE ACT’

Advocates Say Proposed Cuts to Medicaid Will Harm Seniors and People with Disabilities

Tuesday, July 11th, 2017

Health care legislation currently being considered by Congress includes steep cuts to the Medicaid program, which advocates for seniors and people with disabilities say will cause tremendous harm.

The U.S. House of Representatives passed its version of the legislation, the American Health Care Act, on May 4, 2017. The U.S. Senate is now considering its amended version, which is called the Better Care Reconciliation Act (BCRA). The bill is a move by Republican lawmakers to repeal major parts of the Affordable Care Act, passed under President Obama.

The nonpartisan Congressional Budget Office said that under the BCRA, the number of uninsured people would increase by 15 million next year, and by 22 million by 2026.

Critics have numerous objections to the bill, but advocates for seniors and people with disabilities have focused on the harm they say will be caused by cuts to Medicaid, the joint federal and state program that insures nearly one in five Americans.

The Affordable Care Act expanded eligibility for Medicaid, though states could opt out. The BCRA would phase out that expansion by 2024, and would make further cuts as well, by permanently restructuring the program. Medicaid is a partnership between the federal government and the states, and the new legislation would cap the amount contributed by the federal budget, leaving states to make up the difference or cut benefits.

Medicaid is the nation’s largest government health care program, covering more people than Medicare. Medicaid covers 64 percent of all nursing home residents, 60 percent of all children with disabilities, 30 percent of all adults with disabilities, 76 percent of poor children and 49 percent of all births.

Some nursing home residents could be forced out by the cuts. Under federal law, state Medicaid programs must cover nursing home care, but the Center for Medicare Advocacy predicted that under the budgetary pressures that would be imposed under the BCRA, states would have to limit how much they pay, or restrict eligibility. The AARP said that under the new legislation, older adults could also be charged up to five times more for health insurance than younger people. Under the Affordable Care Act, rates are capped at three times more.

People with disabilities say that cuts to Medicaid would be devastating, likely resulting in reduced access to home and community-based services that allow many to live independently rather than in institutions.

The BCRA is opposed by the Arc, the AARP, the American Hospital Association, the American Medical Association and the American Cancer Society’s action network.

Concerned citizens can contact their representatives in Congress by calling the U.S. Capitol switchboard at 202-224-3121.

 

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The Medicare “Donut Hole” Explained

Monday, September 21st, 2015

Seniors and others with Medicare prescription drug coverage (Part D) should be aware of the coverage gap known as the “donut hole,” so that they can plan properly for the cost of their medication.

Most Medicare prescription drug plans have a “donut hole” coverage gap, which means that when you have spent a certain amount on medication, your coverage will be reduced until your costs reach a higher amount where coverage picks up again. The Affordable Care Act reduced the effects of the donut hole, but it can still result in a significant cost for seniors. Here is exactly how the donut hole comes into play with Medicare prescription drug coverage: Littman Krooks Elder Law

First, you are responsible for 100 percent of your deductible (not more than $320 in 2015 and not more than $360 in 2016). After you have paid the deductible, you are covered (meaning you are only responsible for your co-payments or coinsurance), until you and your plan have spent a combined total on covered drugs that reaches a certain limit ($2,960 in 2015; $3,310 in 2016). Above that limit, you have entered the “donut hole” coverage gap.

Previously, Medicare Part D beneficiaries were responsible for paying 100 percent of drug costs in the donut hole. Now, under the Affordable Care Act, you pay 45 percent of the price for brand-name drugs; however, 95 percent of the price counts toward getting out of the donut hole. For generic drugs, you pay 65 percent of the price in 2015; that percentage will drop each year until it reaches 25 percent in 2020. However, for generic drugs, only the price you pay counts toward getting out of the donut hole.

You exit the donut hole when you’ve spent above a certain limit ($4,700 in 2015; $4,850 in 2016). At that point, catastrophic coverage begins, and you will pay a small copayment or coinsurance for covered drugs for the rest of the year.

Expenses that do not count toward the coverage gap include your monthly premium, pharmacy dispensing fees, and any amount you pay for drugs that are not covered.

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What Household Employees Should Know About the Affordable Care Act

Tuesday, September 23rd, 2014

By Tom Breedlove, HomePay by Breedlove

Nannies, senior caregivers, housekeepers and other in-home providers are in a unique situation compared to most employees. They don’t work for a large company with a Human Resources department looking out for their best interest. So when it comes to something like purchasing health insurance, it’s not as simple as filling out a form and letting someone else do all the work on the back end. And with the implementation of the Affordable Care Act, many household employees have questions about what is required of them.

While millions of people signed up for health insurance policies via the federal and state online exchanges last October, many others did not and will have a decision to make once again in the next few weeks. Open enrollment for health coverage starting in 2015 is scheduled to begin on November 15th – both for those buying policies for the first time and those whose policies are set to expire at the end of the year.

The most important thing for employees to understand is that the law itself is not changing in 2015 compared to 2014. That means all individuals are still required to have health insurance policy in place or pay a fine. For 2014, the fine is $95 or 1 percent of income for those that remain uninsured, whichever is higher. For 2015, this fine increases to either $325 or 2 percent of income, whichever is greater. For example, someone earning $35,000 per year would face a fine of $700.

However, there is a silver lining to this cloud. There are subsidies that many employees will qualify for based on their income level that will allow them to obtain health insurance at a discounted rate. The Kaiser Family Foundation has a helpful calculator tool that any employee can use to estimate the subsidy they could receive. It takes into account several factors, including income, number of adults enrolling in coverage, number of children, the employee’s resident state, and others.

IMPORTANT NOTE: In order to qualify for a subsidy, the employee must have documented wages – meaning they have to be paid legally. In most trust situations and many senior care employment arrangements, this is already taken care of, but it warrants a reminder that this subsidy is available for those working so hard to care for a family’s loved one. It’s just another benefit of legal pay to go along with others, such as Social Security income, Medicare health coverage, unemployment benefits, disability benefits, and the ability to secure loans/credit.

To learn more about health insurance coverage, please visit Care.com or go to healthcare.gov.

To learn more about helping seniors and their families plan for the future, visit www.elderlawnewyork.com. If you liked this article, please like it on our Facebook page.

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Retirement Benefits: How Social Security, Medicare and Retirement Accounts Change in 2014

Thursday, January 30th, 2014

Medicare, Social Security retirement benefits, and individual retirement accounts all change in small but important ways in 2014, and people too young for Medicare will have new health insurance options. Here is what is changing.

First, thanks to the Affordable Care Act, people retiring before age 65 can now purchase health insurance on the new state health insurance exchanges. People can no longer be denied health insurance because of a pre-existing condition, and subsidies may be available for low and middle income earners.

For people on Medicare, the Part D prescription coverage gap has lessened in effect. Once a Medicare beneficiary has spent $2,850 on medication, then there is a gap until catastrophic coverage kicks in after $4,550 in costs for medication. In that gap, beneficiaries were required to pay 79 percent of drug costs, but that decreases to 72 percent in 2014.

Social Security benefits go up by 1.5 percent in 2014, due to the annual cost-of-living increase. The average increase will be $19 per month for individuals and $31 per month for couples who are both receiving benefits.

Social Security taxes increase for some in 2014. Workers usually pay 6.2 percent of their income into the system until they reach the $113,700 tax cap for the year. For 2014, that cap rises to $117,000.

Finally, the income limits for those eligible to contribute to individual retirement accounts (IRAs) and 401(k)s have increased. Investors who have workplace 401(k)s and also want an IRA can claim a tax deduction for IRA contributions until their adjusted gross income (AGI) reaches between $60,000 and $70,000, an increase of $1,000 over last year. For married couples, the income limits are now between $96,000 and $116,000. The income phaseout range for investors whose spouses have a 401(k) is up $3,000 from last year, to between $181,000 and $191,000. For Roth IRAs, the income phaseout range increased by $2,000, to between $114,000 and $129,000, or for married couples between $181,000 and $191,000.

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The Supreme Court’s Affordable Care Act Ruling is Good for Senior Citizens

Thursday, July 5th, 2012

The U.S. Supreme Court case Florida v. Department of Health and Human Services, which challenged the constitutionality of the Patient Protection and Affordable Care Act has been covered heavily by mainstream and online media outlets. The Court heard arguments on the case in a historical three day session March 26-28, 2012.

The U.S. Supreme Court has upheld the individual mandate and most provisions of the Affordable Care Act. A federal penalty on states not cooperating with the Medicaid expansion provision of the law was deemed unconstitutional, but Chief Justice John Roberts gave Congress a constitutional antidote with his opinion.

While most news outlets have focused on the political outcome of the Court’s decision, they have failed to cover an issue that genuinely matters to a large portion of Americans:  how the ruling affects the lives of senior citizens. Had the Court overturned the law in its entirety, senior citizens would have lost many benefits.

Under the law, Medicare recipients are entitled to a free annual physical and can receive screenings for colorectal cancer and breast cancer without paying a deductible or co-pay.

One of the most popular aspects of the health-care reform bill is the Money Follows the Person program (MFP). With MFP, Medicaid will provide funding for alternative living options for adults that require assisted living. It is with this benefit that seniors can enjoy comfortable, familiar, environments rather than being forced to live in a nursing home. New York is one of 43 states participating in the Money Follows the Person program.

The law also strengthens the Medicare Trust Fund making it solvent through 2029.

For more information, visit www.medicaid.gov. For information on elder law, visit www.littmankrooks.com or www.elderlawnewyork.com.

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