Forum Fall 2013 - page 6

Cutaneous Lymphoma Foundation
6
An ounce of prevention is worth a pound of cure...
We’ve already seen SOME of the positive impact of the Affordable Care
Act (ACA) on preventative care measures. Some of these preventative care
measures include no cost / no co-pay routine screenings (depending on your
age) such as, blood pressure and diabetes screenings, cancer screenings
including mammography and colonoscopy, smoking cessation and nutrition
counseling, regular well-baby and well-child visits from birth to age 21, and
vaccinations including measles, polio and meningitis. And, if you are over 65,
and a Medicare beneficiary, Medicare will pay for part or all of your influenza
(flu), pneumococcal (pneumonia) and hepatitis B vaccines.
All of this change attempts to shift focus from crisis-oriented acute care
to preventive measures that will help decrease incidences of cancer,
uncontrolled chronic diseases like hypertension and diabetes, and diseases that are totally avoidable with vaccination.
Never before has the U.S. healthcare system placed this much emphasis on the prevention of disease.
See you later pre-existing condition clauses!
Perhaps the biggest impact on cancer patients beginning in 2014 is the end of pre-existing condition exclusions. Starting
January 1, 2014, an insurance company can no longer deny or limit coverage to adults based on a pre-existing condition.
Pre-existing condition exclusions for children have been prohibited since 2010 under the ACA. Also, insurers can not
charge more for coverage to those with a pre-existing condition.
Kick that annual/lifetime coverage cap to the curb...
Under the ACA, lifetime caps on health insurance coverage for MOST benefits are prohibited for any health plan or
insurance policy issued or renewed on or after September 23, 2010. This means that an individual can no longer max out
of their insurance coverage for LIFE after a catastrophic illness.
Annual caps for coverage are also being phased out; and as of January 1, 2014 no annual caps can be imposed on most
covered benefits.
Get your donut holes at Dunkin Donuts, not the pharmacy...
The ACA also includes a mandate to slowly close the Medicare donut hole, increasing the coverage liability of
manufactures/pharmaceutical companies and the government while systematically decreasing the individual’s out of
pocket expenses. This slow closing of the donut hole will occur over the next six years with completion in 2020. Over the
course of the next six years, recipients with Part D coverage will receive discounts on medications while they are in the
coverage gap/”donut hole” period. For example, in 2014, the discount for brand name medications while in the donut hole
will be 52.5 % and the discount for generic drugs will be 28%. This can represent significant savings for high dollar cost
cancer medications. A great resource to help you understand the interplay between Medicare and the ACA can be found at
The potential expansion of Medicaid...
Another important mandate of the ACA was the option for states to expand Medicaid eligibility to those making less than
133% of the federal poverty level (in 2013 = $14856 for an individual). The expansion of Medicaid would be almost
entirely funded by the Federal Government. Sadly, many states have opted out of this provision and patients who are still
fairly low income will be forced to seek out coverage through exchanges. So far, only 21 states have elected to expand
Medicaid while 26 states are unclear or leaning against expansion. To learn more about your state’s status, see
.
cbpp.org/files/status-of-the-ACA-medicaid-expansion-after-supreme-court-ruling.pdf
The Healthcare Marketplace...
Healthcare exchanges also known as the healthcare marketplace opened on October 1, 2013 through the healthcare.gov
The Affordable Care Act: The Basics Cancer Patients Need to Know
Christina Bach,
MBE, MSW,
LCSW, OSW-C
is a Clinical
Oncology Social
Worker at the
Abramson
Cancer
Center, Penn
Presbyterian
at University of
Pennsylvania
Health System
1,2,3,4,5 7,8,9,10,11,12
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