Archive for the ‘State Health Insurance’ Category.

Florida is a state with an historically complicated insurance landscape due both to its geographic location in terms of property and disaster insurance, and the diversity of its population with a high percentage of retirees in the realm of health insurance. As health care reform in the United States moves forward under the provisions of the 2010 Patient Protection and Affordable Care Act, there will be changes to state regulations to comply with federal statutes.

Under the provisions of the Affordable Care Act, children can no longer be excluded from health insurance policies due to pre-existing conditions and may remain on their parents’ policies up to age 26 even if they are not in school and have married. The protection against pre-existing condition exclusion will be afforded adults by 2014. In the meantime, the major responsibilities of the states in regard to health care reform involve the formation of high risk insurance pools and the implementation of health insurance exchanges.

General Insurance Regulations

In Florida, there are no coverage denials or limitations for group plans, and insurance companies cannot charge additional rates based on a health condition as long as there has been continuous coverage. Insurance companies can make group rates higher if a large number of employees are considered high risk. Guaranteed renewability ensures that once a policy is in place, it cannot be cancelled due to a medical condition as long as the terms of the contract are met.

In addition to the guaranteed renewability clause, Florida insurance companies can currently require that applicants meet a pre-existing clause. There is no limit to the exclusion period, but most Florida insurance companies fix it at two years. There is also temporary coverage available for people who are in-between jobs or need health insurance for a temporary time.

Creation of Health Care Exchanges

There has been no significant activity in the state toward the formation of a health care exchange and Florida is, in fact, the primary plaintiff in a lawsuit brought by 26 states seeking to have large portions of the Affordable Care Act declared unconstitutional.

Florida did enact a law on June 2, 2011, however, stipulating that any health care coverage purchased through an insurance exchange cannot cover abortions unless the case is an instance of incest, rape, or life endangerment. Separate coverage for abortions may be purchased from entities not supported by state or federal funds.

Pre-Existing Condition Insurance

The Florida high-risk pool or Pre-Existing Condition Insurance Plan program is administered by the U.S. Department of Health and Human Services. Covered benefits include hospital care and prescription drugs as well as specialty and primary care. Depending on age and option status, monthly premiums range from $118 to $505. Deductibles fall in a range of $1000 to $3000 and there may be a separate drug deductible. Copays for doctor’s visits are $25 and out-of-pocket expenses cannot exceed $7000 annually.

Florida Healthy Kid Program and Cover Florida

The Florida Healthy Kid Program (Kidcare) was created to help uninsured children and is supported by a variety of tax funds. The coverage protects children who otherwise would not have insurance.

The Cover Florida program accepts policyholders age 19-64 who have been without health insurance for at least 6 months and who do not qualify for Medicare or Medicaid.

Medicaid

All Medicaid eligibility is determined as a percentage of the Federal Poverty Level as are benefits derived from CHIP-funded Medicaid Expansions. In Florida, infants under the age of 1 qualify at 185% FPL, those 1-5 at 133%, and 6-19 at 100%. CHIP funds are available for infants under 1 year of age at 200% FPL.

Pregnant women can draw Medicaid benefits at 185% FPL, parents at 22%, and non-elderly disabled Social Security recipients at 75%.

As health care reform moves forward under the provisions of the 2010 Patient Protection and Affordable Care Act, many aspects of state regulations will change over the next two years. Children already enjoy protection against insurance exclusions and denials for pre-existing conditions, and adults will gain the same safety net in 2014. Additionally, children may remain on their parents health coverage until age 26 even if they are not currently enrolled in school, or if they have married. These and other federal mandates will affect state insurance regulations in coming months.

Basic Insurance Regulations

Currently, insurance companies in Delaware can review an applicant’s medical history going back five years to determine the presence of a pre-existing condition and then either deny coverage or insist a rider be attached to the health policy eliminating benefits for the specific condition.

Eligible employees cannot be denied group coverage in Delaware, but there is frequently a waiting period before job-related benefits become available. It’s especially important when changing jobs to have a temporary policy in place. Currently, an insurer can refuse coverage for a pre-existing condition if there is a lapse of more than 63 days in insurance coverage.

Currently, insurance companies in Delaware can review an applicant’s medical history going back five years to determine the presence of a pre-existing condition and then either deny coverage or insist a rider be attached to the health policy eliminating benefits for the specific condition.

Federally Mandated Health Care Exchanges

Currently Delaware is studying options for the implementation of the health care exchange required under the Affordable Care Act. Although federal monies have been received and are in use to plan the necessary business and information technology to manage an exchange, no further progress has been made to date.

Pre-Existing Condition Insurance

The high-risk pool, or Pre-Existing Condition Insurance Plan, that will be in place in Delaware until January 1, 2014 is administered by the U.S. Department of Health and Human Services. The coverage will provide benefits for hospital stays, prescription drugs, and primary and specialty care among other services. By age and option class, premiums range from $109 to $219 with deductibles falling in the range of $1000 to $3000. There may be separate drug deductibles, and out-of-pocket limits go as high as $7000 if you are treated outside the network.

Medicaid Eligibility

Medicaid eligibility is determined as a percentage of the Federal Poverty Level as are benefits under the CHIP-funded Medicaid Expansions. Infants under 1 year of age may qualify for Medicaid Assistance at 185% FLP and 200% for CHIP. Under age 5, the level is 133%, and from age 6 to 19, 100%. (CHIP assistance is not applicable to those two groups.)

Pregnant women can qualify for Medicaid at 200% FPL; adults at 100%; and the non-elderly disabled on Social Security at 133%.

Medicare

In addition to standard federal Medicare benefits, there are 45 Medicare Prescription Drug Plans available in Delaware.

The business of buying and selling health insurance at all levels in the U.S. is currently in a state of flux as the 2010 Patient Protection and Affordable Care act is moving forward to full implementation in 2014. For the states, this has initially meant forming high-risk insurance pools for people with pre-existing conditions and reviewing options to create the federally mandated health insurance exchanges.

Many changes have already taken place that affect insurers’ policies, for instance the restriction against excluding children with pre-existing conditions from receiving health care benefits and the provision that children may be carried on their parents policies up to age 26 regardless of educational or marital status.

General Insurance Regulations

In Connecticut individual health insurance policies are not regulated. Insurance companies may offer benefits, coverage limits, deductibles and exemptions as they choose. However, some benefits, such as coverage for mammograms are state mandated. Connecticut insurance companies currently have the right to deny coverage based on past or current medical history.

Currently in Connecticut, if a person with a pre-existing condition is granted coverage, the policy may include an exclusion so that no benefit monies are paid for treatments relative to that condition for a specified period. When a policy is in place, however, it cannot be canceled due to a medical condition. The policy premiums must be current and this does not prevent insurance companies from raising the policy prices upon renewal of the contract. If you change insurance companies, there may be a secondary exclusion period imposed there is continuous coverage.

Current health status may be used as a basis to reject a health insurance policy application, and the cost of the premiums is also discretionary according to age or medical problems. In fact, insurers in the state can currently deny coverage for any reason except in cases where federal law supersedes state regulation.

HUSKY Plan

The Connecticut HUSKY Plan is a health insurance plan available for children up to age 19 and for eligible caregivers regardless of their income. The benefits help to pay for doctor visits, prescriptions, dental, and vision care. Additional services for children with special needs are also available, as is federally-subsidized, needs based Medicaid. Medical companies that comply with Medicaid law receive 50% reimbursement from the federal government.

Health Care Exchanges

In February 2012 Connecticut established an active purchaser health care exchange with separate pools for the small-group and individual markets. A task force has been formed to arrive at benchmark definitions for essential health benefits, which is due to report by September 2012.

Pre-Existing Condition Insurance

The high-risk insurance pool, officially the Pre-Existing Condition Insurance Plan, is run by the Connecticut Department of Social Services and the Health Reinsurance Association. Primary and specialty care benefits are included, along with hospital care and prescription drugs. Premiums are $381 a month with a medical deductible of $1,250 and a drug deductible of $250. The out of pocket limit is $4,250.

Medicaid

Medicaid benefits are disbursed to eligible recipients according to a qualifying percentage of the federal poverty level, which is 185% for children from birth to age 19. Pregnant women qualify at 250% FPL, parents at 185%, and disabled non-elderly Social Security recipients at 69%.

Medicare

In addition to the standard Medicare benefits, there are 48 approved Medicare prescription drug plans in Connecticut.

Like all states, existing Colorado insurance regulations will be affected by changes mandated under the 2010 Patient Protection and Affordable Care Act. Initially, those have involved the formation of temporary high-risk insurance pools, and key decisions about the creation of health care exchanges. Since 2010, insurers have been forbidden to exclude children on the basis of pre-existing conditions, and the same protection will be extended to adults by 2014. Additionally, children must now be covered by their parents work-related insurance benefits up to age 26 regardless of marital or educational status.

Health Care Exchange

The progress of forming the required health care exchange in Colorado illustrates the mixed bag of politics in the state. Currently Colorado is one of six states that have joined in a lawsuit seeking to overturn the 2010 Patient Protection and Affordable Care Act. There have, however, been significant strides in adopting the usage of electronic health records and organizing the efficient exchange of health information required under the law. In addition Colorado has established an insurance exchange on the clearing house model.

Pre-Existing Condition Insurance

The high-risk insurance pool in Colorado, known as the Pre-Existing Condition Insurance Plan, is run by Rocky Mountain Health Plans and Cover Colorado. Premiums average $139 to $763 a month with a medical deductible of $2,500; and a brand name drug deductible of $500. Out-of-pocket expenses are limited to $5,950.

Basic Insurance Regulations

Insurers in Colorado have wide latitude to deny coverage, and to base premium rates on individual and family medical history. Age, gender, and voluntary behaviors like smoking and alcohol consumption can all affect premium pricing. If an applicant who has a pre-existing condition is accepted for coverage, the company can attach a rider to the policy to exclude any benefit payments relative to the treatment of that issue.

Health insurance restrictions in Colorado are some of the most stringent in the nation, but on the whole residents are more healthy than their counterparts in other regions. This fact alone lessens the risk profile with which insurers are dealing. Once a health policy is in place in Colorado and all aspects of the contract including payment are honored, the insurer may not cancel the coverage. Premiums may be raised, however, in response to health complications, increasing age, and other factors.

Small businesses who employ 2-50 workers are guaranteed coverage under any group plan that is offered. The pricing is not restricted though and there may be a minimum level of participation for a group policy.

Medicaid

All Medicaid benefits are decided on income as a percentage of the Federal Poverty Level. In Colorado, infants under the age of 5 are eligible for Medicaid assistance at 133% FPL, with those 6 to 19 at 100%. Pregnant women can seek assistance with a qualifying 225% FPL, parents at 60%, and the non-elderly disabled on Social Security at 74 percent.

Medicare

Medicare benefits in Colorado are supplemented by 48 approved prescription drug plans, some with zero deductibles and others with premiums as low as $16.90. For more information see www.coloradomedicare.us.

As is the case in all states, insurance regulations in California will continue to evolve over the next two years as the full provisions of the 2010 Patient Protection and Affordable Care Act come online. Already, children are protected against exclusion from coverage due to pre-existing conditions, a shield adults will enjoy by 2014. Children up to age 26 can stay on their parents’ health insurance policies regardless of marital or educational status.

Primarily, states are now charged with running temporary high-risk pools and formulating plans to move forward with health insurance exchanges to be in compliance with federal health care reform. It is important for consumers to realize health insurance will continue to be a shifting landscape as we draw nearer to 2014 and beyond. Understanding applicable state regulations and provisions is essential to finding and maintaining affordable and comprehensive coverage and determining eligibility for safety net programs like Medicare, Medicaid, and CHIP programs for children.

Basic Insurance Regulations

State law in California protects existing policy holders from cancellation as long as they were truthful on their application and made all premium payments on time. Rates can still be raised, however, and under some circumstances specific types of coverage may be denied.

New laws now on the books in California protect non-English speakers in the state who have often received incorrect medication or a wrong diagnosis due to the language barrier. Every insurance company health plan must now offer free language services by phone, video, or through an on-site interpreter for plan members who are not fluent in English.

Although California has rigid insurance regulations that require all residents to have some type of health insurance coverage, 14 percent of Californians are without medical insurance. Currently, few protections extend to the purchase of individual plans, and companies may deny coverage for many reasons.

Creation of the Required Health Care Exchanges

California was the first of the states to implement its health care exchange, opting for the active purchaser model and serving as an example to other states in addressing complex issues like coordination with existing public programs and achieving a cost conscious final product.

Pre-Existing Condition Insurance

California’s Pre-Existing Condition Insurance Plan is administered by the Managed Risk Medical Insurance Board. Premium levels are based on the age of the subscriber and their region of residence within the state. As an example, a premium for a 50-year-old subscriber who is a resident of San Francisco would average $480, with an annual deductible for medical services within the network of $1,500 ($3,000 outside of the network.) Deductibles for brand-name prescriptions are $500 across the boards, and maximum out-of-pocket charges set at $2,500 inside the network.

Medicaid

Each state determines its own qualifying income levels for Medicaid eligibility as a percentage of the current Federal Poverty Level. For infants under 1 year, the Medicaid level is 200% FPL; children 1-5 qualify at 133%; and age 6-19 at 100%.

Pregnant women can access Medicaid benefits at 300% FPL, with qualified uninsured parents at or below 200% eligible to access aid through the Coverage Initiative under California’s Medi-Cal Hospital Uninsured Care Act. Qualified parents under traditional Medicaid are covered at 100% FPL; adults at 200%; and non-elderly disabled citizens on Social Security at 102%.

Medicare
Approximately 4,470,000 residents of the state are enrolled in the California Medicare program with more than 1,547,000 using state-approved Medicare Advantage plans to supplement the standard level of federal benefits. About $31,000 is spent per California residence in Medicare benefit payments.

Aspects of the 2010 Patient Protection and Affordable Care Act are already changing the way insurance is written and sold in every state. For instance, it is no longer legal to exclude children from health coverage on the basis of a pre-existing condition, although adults will not enjoy this same protection until 2014. Dependent children, however, must now be carried on their parents’ health policies through age 26 regardless of marital or educational status.

Given these and other factors like the establishment of temporary high-risk insurance pools and the creation of insurance exchanges, state insurance policies are in flux. What is legal and allowed today may be different in six months. This means that being informed about the specifics of your state’s policies is now more important than ever if you want affordable and comprehensive coverage. This is especially true for low-income residents who need the assistance of federal programs like Medicare and Medicaid or the CHIP insurance coverage for children.

Basic Insurance Regulations

Currently, in Arkansas, a pre-existing condition can be any condition or ailment for which the applicant has received care in the previous five years. If, however, the insurer does agree to provide coverage, a rider can be attached to the policy so that no expenses relative to that condition will be covered. Even if the applicant has had previous coverage, a new insurer can still exclude for a pre-existing condition for up to two years.

All Arkansas health insurance plans must provide a renewability guarantee. This prevents insurance companies from denying a request to renew an insurance contract due to a medical condition. Arkansas has a high rate of premature death due to cancer and obesity. Additionally, the immunization coverage in the state is low. As you age or your health declines, insurers in Arkansas have the right to increase your rates.

There is no state regulation of insurance prices, but, if the premiums on a policy have been paid, the policy holder is guaranteed the right to renew. The state also provides temporary insurance during gaps in coverage. These “conversion” policies have fewer benefits, however, and the rates are high. Employers are not required to cover part-time employees in a group insurance plan, but pre-existing conditions are guaranteed acceptance.

Health Care Exchanges and High Risk Pools

Arkansas has decided against creating a health care exchange, but eligible residents may apply for the state’s Pre-Existing Condition Insurance Plan program run by the Arkansas Comprehensive Health Insurance Pool. For non-smokers, premiums range from $117 a month to $526, with a deductible of $1000 and no more than $1000 additional out-of-pocket expenses annually.

Medicaid Eligibility

Although Medicaid is a federal program, states determine the income qualifications for those benefits as well as the levels for the Children’s CHIP-funded Medicaid Expansions. Infants and children up to age 5 qualify at 133% of the Federal Poverty Level for Medicaid, and 200% for CHIP benefits. Recipients age 6 to 19 qualify at 100% and 200% respectively.

Pregnant women may draw Medicaid benefits at 200% of the FPL, with parents and caretaker relatives qualifying at 15%, parents with some waivers at 200, all adults at 200, and non-elderly disabled Social Security recipients at 74%.

Medicare

In addition to normal federal Medicare benefits, there are 49 approved Medicare prescription drug plans available in Arkansas.

State insurance laws will change over the course of the next two years as legislatures work to come in line with the provisions of the 2010 Patient Protection and Affordable Care Act. This progressive series of health care reforms includes the temporary creation of high risk pools in each state to address the needs of citizens who cannot get health insurance due to pre-existing conditions. In 2014, these will be supplanted by competitive health insurance exchanges.

In the meantime, changes are already occurring. Children can no longer be excluded from coverage due to pre-existing conditions, and must be carried on their parents’ policies until the age of 26. It is more important than ever to stay abreast of insurance regulations in the state in which you currently live, or the state to which you’re planning a move. The only way to provide comprehensive, affordable coverage for yourself and your family is to understand the available plans, including potential benefits under federal safety nets like Medicare and Medicaid.

Basic Insurance Regulations

In Arizona, insurers are currently allowed to deny health coverage for pre-existing conditions to adults. In group insurance plans, if Arizona residents had previous coverage, they must be given credit towards a new policy, but there are no restrictions on premium rates. However, if the contract terms of a policy have been met and the premiums have been paid, an existing policy cannot be cancelled due to illness.

Any company with 2-50 employees can offer group coverage to employees who work 20 hours a week and who have been with the company for a minimum of six months. Anyone meeting those requirements is guaranteed coverage, and cannot be excluded entirely due to a pre-existing condition. A six-month exclusionary period is allowed, and insurers may raise premium rates if a high percentage of employees have pre-existing conditions or risk factors.

Creation of Health Care Exchanges

Arizona is currently studying options for the creation of the state’s health insurance exchange. Two initial bills failed at the close of the 2011 legislative session, but the state did enact a statute prohibiting any exchange that is formed from offering abortion coverage except in cases of severe health impairment or endangerment of life.

Pre-Existing Condition Insurance

The state’s temporary Pre-Existing Condition Insurance Plan, popularly known as the “high risk pool,” is administered by the U.S. Department of Health and Human Services. Premiums are set by age and option level. For the “standard” coverage they range from $104 to $334. Deductibles range from $1000 to $3000. After the deductible is met, co-payments for doctor’s visits average $25, with prescription drugs costing $4 to $40. Combined out-of-pocket expenses inside and outside the network cannot exceed $7,000 annually.

Medicaid Eligibility

All Medicaid benefits are based on a percentage of the Federal Poverty Level though limits vary by state, In Arizona infants under the age of 1 are covered at 140% FPL, children 1-5 at 133%, and those 6-10 at 100%. Parents have coverage at 200%, childless adults at 100%, non-elderly blind and disabled Social Security recipients at 100%, and Social Security related elderly at 100%.

Medicare Benefits

In addition to the standard federal Medicare benefits, Arizona offers Medicare Advantage plans on the HMO and PPO models via private companies approved by the Medicare administration.

The insurance landscape in the U.S. is in a state of flux in the wake of the passage of the 2010 Patient Protection and Affordable Care Act. The provisions of the health care reform it designs will continue in stages through 2014 and beyond through a series of joint state and federal initiatives. Currently, states are administering high risk pools for individuals who have been excluded from health coverage on the basis of pre-existing conditions, and they are weighing the design of the health insurance exchanges that must, by law, go into effect by 2014.

Because of these changes, many aspects of state law will have to change over the next two years to comply with federal statutes. Keeping up with insurance regulations in your state, especially if you are a new resident, is vital to securing affordable, comprehensive medical care for yourself and your family. This is also true if you are one of the millions of Americans who needs assistance via one of the federal or state “safety net” programs like Medicare, Medicaid, and various programs to ensure children are receiving the health care they need.

Basic Insurance Regulations

Health insurance policies in Alaska cannot be canceled so long as the premiums are paid. Additionally, the policy language must include a provision of guaranteed renewability. Insurers are allowed to design the policy according to the company’s best interests, however, and they can eliminate riders.

Employers are not required to provide insurance coverage to part-time employees, but group insurance is to be made available for companies with 2-50 workers. Entities with more than 50 employees do not have to guarantee insurance coverage.

Creation of Health Care Exchanges and Temporary High Risk Pool

Although Alaska is one of several states suing the federal government for the overturn of the Affordable Care Act, the state is still moving forward to implement some aspects of the health care reform package. There has been no significant progress at this time toward the establishment of the required health care exchange, but residents can apply for coverage under the state’s Pre-Existing Condition Insurance Plan administered by the Alaska Comprehensive Health Insurance Association. Premiums range from $425 to $1,806 a month with a deductible of $1,500 and an out-of-pocket limit of $3,000.

Medicaid Benefits

Medicaid benefits and those provided through the Children’s CHIP-funded Medicaid Expansions are expressed as a percentage relative to the Federal Poverty Level. For infants under the age of one, the percentages are 150 and 175 respectively for each program. For children 6 to 19, the FPL levels are 150 and 175%.

Pregnant women can draw Medicaid benefit in the state at 175% FPL, parents at 80%, and the non-elderly disabled on Social Security at 80%.

Medicare Benefits

In addition to standard federal Medicare benefits, there are 41 Medicare Prescription Drug Plans available in the state, 16 of which have $0 deductibles. The lowest monthly premium currently available is $23.80.

In March 2010 the signing into law of the Patient Protection and Affordable Care Act introduced a progression of health care reform measures that will, for the most part, be fully in effect by 2014. This health care reform has changed the way individual and group insurance is written in the U.S. and has extended additional “safety net” benefits under existing programs like Medicare and Medicaid. Many of the law’s provisions, like those to establish high risk pools and, ultimately, health insurance exchanges are guided by federal policy, with the individual states making decisions about specific methods of implementation.

Many aspects of state law that now affect insurance issues like exclusions for pre-existing conditions will be made null and void by 2014 when such exclusions are forbidden. (Children are already protected against loss of insurance for such conditions.) Over the next two years, many state laws will change in the light of federal reforms, so it is more important than ever to track insurance changes in your state, and to educate yourself about insurance regulations when moving to another state. The most fair statement to make is that health insurance coverage in the U.S. as a whole is in a state of flux, and will remain so for the foreseeable future.

Coverage Exclusions and Premium Rates

In a state that is home to 4.5 million citizens, approximately 672,000 Alabamans have no health insurance whatsoever. Currently, state law in Alabama allows insurers to deny coverage, or to exclude a pre-existing condition from coverage, for a period of up to 24 months. Premiums are not regulated and the determination of premium rates is dependent on: the cost of medical care, age, general health, life habits, location, and occupation of the applicant, among other factors.

Alabama Health Insurance Plan

The Alabama Health Insurance Plan is a specific state program intended to address the needs of people who have exhausted their coverage options via a group plan and who are not eligible for coverage under programs like Medicare or Medicaid. The state-administered AHIP offers a traditional indemnity Blue Cross policy as well as a managed care option through United Healthcare to residents who fulfill the stated qualifications. The program is compliant with the terms of the 1996 Health Insurance Portability and Accountability Act (HIPAA).

In order to comply with the provisions of the Affordable Care Act calling for the implementation of insurance exchanges, Alabama is currently weighing its options, with a commission set to make recommendations to serve as the basis for legislation likely to be taken up in the 2012 session.

The state’s temporary high -risk pool for people who have been excluded from health coverage due to pre-existing conditions is managed by the federal Department of Health and Human Services with an allocation of $69 million. The Pre-Existing Condition Insurance Plan covers a range of benefits from primary to specialty care, and includes benefits for hospitalization and prescription drugs.

Medicare

Medicare is, of course, a federally-managed health benefit primarily for citizens age 65 and older. Alabama Medicare Supplements are designed to work with the federal Medicare program to fill in coverage gaps. There are ten plan designs, all federally standardized. Although initially confusing, it’s important to compare these plan offerings to ensure that your medical needs are being met and that the coverage will work with the doctors and facilities you prefer to use.

Medicaid

As is the case in all states, eligibility limits for low-income families under the Medicaid program are determined as a percentage of the federal poverty level. In Alabama, the percentage is 133 for children from birth through age 5, and 100 percent from age 6 until 19. Pregnant women can gain medical assistance via Medicaid at 133 percent of the FPL, parents at 12.8, and non-elderly disabled individuals who are drawing Social Security at 75.7 percent.