Does anyone know how the Affordable care Act plans cover Diabetic supplies?
I have searched everywhere and I can not find any reference to Pumps or Pump supplies. My current insurance covers 80%, but are treated totally separately from regular prescriptions. I don't want to make any changes until I know what it will cost me. My premiums are high now but I get reasonable coverage,
Of course all the exchanges are completely bogged down, so I can not get through to them. I would appreciate it if someone knows this info, they could post it.
ACA isn't, itself, any type of insurance coverage. The insurance will still be provided by the same insurance companies that provide them before ACA goes into effect. So, what services provided will depend on the level of coverage you choose and the provider you choose.
You won't actually see any changes to your plan until, presumably, next January if implementation goes forward as scheduled, so you still have time to review your options. It's nothing that has to be done right now. The California site just went live and, luckily, I am able to take a look at the offerings. There's a lot of general information based on level and company, but I also have a lot of question regarding specifics. I imagine that I we will have to speak to representatives directly or see it written into the plan before we know what each plan offers specifically.
Actually I see large differences in things, copays and deductibles etc from my current plan, That is the part that makes me nervous about signing up for something till I know exactly what it covers. If I went Silver maybe pumps supplies are not covered or maybe covered 70% , maybe gold cover 80%. I have no way of knowing.
I know the ACA is not an insurance plan, but they make the rules. I just wish I had a clearer picture.
That’s pretty much everyone’s question… Somehow the law is 2,000 pages and accompanying regulations approaching 30,000 pages yet nobody has read it or even remotely understands it
I personally see a disaster in the making with ACA. Not saying something doesn't need to be done with health care, just you said it yourself Sam 2,000 pages of law and close to 30,000 pages of regulations and NO ONE has a clue what its about or how it works, or better yet has even read it. When you have Pelosi saying I guess you have to pass it to know what's in it...can we say "RED FLAGS".
Under ACA I am looking at $12k for premiums each year, plus a $12k deductible. I haven’t been able to shop specific plans, the system logs me out every time I try to shop plans. I’m assuming the $12k / $12k quote that I received from the website is for the bronze plan. No word on catastrophic cap, but isn’t $24k per year enough? I don’t really see where “affordable” fits in here.
It only took 4 comments to head off into the weeds. What about "This is a very charged topic for many of us, but this discussion is not for political debate. Let's just help each other understand what's coming down the pike." is unclear?
All I knows. about it is that if you don’t sign up and have no insurance you are fined by the IRS. It provides care to uninsurable people plus if you do sign up you pay the IRS.
Also, the benefits include a hefty deductible. As for what coverage you get, from what’s known about it now, you will find out when you submit a claim.
The maximum fine is $285 per year for a family, $95 for individual. This is a insurance exchange, you choose the deductibles and coverage. This works like many employer based insurance plans. The main difference is that the preventative and routine things are not subject to deductibles. The lifetime max is no longer an issue. I am uninsured and currently unable to get coverage due to preexisting condition exclusion. I am thrilled to finally have a choice. Those who are bashing this law should get the facts and stop using one liners from facebook and politicians trying to scare those who don't have the means to fact check. The law is by no means perfect, but lets tweek it instead of whining about it and putting out inflammatory comments that are misleading and sometimes incorrect.
Wondering what motivates you to put out incorrect info....You are attempting to mislead people into thinking this is a bad thing. A catastrophic plan is much less than what you are claiming. For Platimum coverage my family of four will pay under $500(plus I will get some help with tax credits paid directly to the insurance co.)this is for a plan similar(80% with $1000 deductible)to the employer based cobra plan we had that we paid $800 for...the highest deductible for bronze is $5000 with good coverage for basic preventative procedure and routing exams. Everyone check it out for yourselves Affordable Care Act and register to put in your individual info to get an accurate picture of cost and coverage.
There is not enough information in your post, Timothy, to let us know what your situation is. If you are carrying private insurance, your insurance company should all ready ahve notified you if they are continuing the private policy you have, or whether they will be issuing new policies, or if you will need to go to the exchange in your state. There are only two exchanges that would be applicable to any one citizen. That is, if your state has set up its own exchange, as California has, or you would go to the federal exchange if your state is not participating in the ACA. If your policy is issued through an employer or a group, then they will have information about new policies during your open enrollment period. Since the ACA mandates better coverage, it is unlikely that diabetes supplies will be adversely affected. I also noticed all ready in this thread that many are posting political views rather than actually providing any information or asking questions. I think the original thread beginning asked not to get political. That would be good since we are all here to help each other, not to carp about our political viewpoints. The one big thing about the ACA that anyone with diabetes should be happy about is that insurance companies can no longer refuse to cover you. In California, insurance companies must cover diabetes supplies and that isn't changing. (Although they still don't mandate coverage of the CGM in most cases, and I wish they would add that.) Now, for the first time, anyone and everyone with diabetes can get coverage.
We're self employed and I purchase my insurance without a broker. We renew Feb. 1. Typically by now I would have a package of plans to look over. That has not arrived. I was told the individual (non employer) policies for pre-existing, will be higher than I pay now (which is $1000 for two of us). We can barely afford this, higher wont help. I dont believe all existing employer plans will continue, that will vary greatly I think. Also,our local university system, which has a health plan for low income, is stopping the program January 1. I hope those people find help because there are many. I know they cater to a large number of diabetics.
It may or it may not, depending on your individual situation. For example, many people that have group coverage have already been told that their benefits will be reduced, their premiums are going up, or that their working spouses will no longer be covered under their plans. Some people are also receiving notice that their policies have been cancelled because they didn't comply with the new regulations.
That is exactly correct Zoe. If you get your coverage through your employers, etc. you can keep it. You do not need to do anything.
What's changed for all plans is (a) No pre-existing coverage exclusions (i.e. like diabetes or cancer), (b) kids can stay on till 26 (c) no more yearly of lifetime benefit limits (d) Preventive care must be covered 100% (e) they can't cancel your coverage if you get sick.
One important thing to consider is that if you have a family and your employer offers affordable (by the law's guidelines) coverage for singles, you are automatically disqualified from getting subsidy assistance if you want to buy different insurance. It doesn't matter if the family coverage through your employer is reasonably priced or not. It doesn't matter if they double premiums for family coverage. If your employer offers affordable single coverage, you don't get a subsidy. So don't drop any existing policy until you know your options and all the necessary details.
I don't know if my comment will help anyone or not, but I will give my pennies worth here. For my Type I daughter who is 11 years old - she is covered under Medicaid which will not change for her so I am told - ( I am in the state of PA). Just yesterday I had an appointment at a Highmark office because the plan My husband and I have will not longer be valid starting in Jan. We had a plan called Blue Shield Special Care which was based on our income level and household size. Because the plan did not cover Prescriptions it is being discontinued.
The rep. showed me compatibe plans similar to what we have, only now we have deductables to meet, which we did not have before, BUT we will have prescription coverage.
Again, based on our income level and size of household we qualified for a severe reduction in our premiums and deductables - for example instead of having a 12,000.00 deductable due to our income and household size it was knocked down to 200.00. Instead of paying a 450.00 premium it will be reduced probably what we are close to paying curently.
As far as what prescriptions were covered - The rep was able to look up in his database
for a specific prescription - in our case, my husband uses Advair. We have not been able to pay for it out of pocket because it is well over 300.00 per month - with our new
plan it was not covered which would have cost us 45.00, however due to the plan we would get a discount which knocked the prescription down to 95.00.
HOWEVER - the rep could not get on the gov't website - so nothing is written in stone.
It is a bit scary - but I want to encourage you all - trust God.
That's what we are doing.
Peace
