Friday, January 19, 2018
Health

Changes under the law, at a glance

What's in an Obamacare health insurance policy? You're still buying insurance from private companies, but what the policies must cover at minimum is mandated by the Affordable Care Act.

Also, you will be able to compare policies and companies much more easily than in the past.

Though all plans must cover the 10 essential health benefits, there are four categories of cost, ranging from lowest-premium "bronze'' plans to highest-premium "platinum" plans.

The essentials

Requiring that certain services be covered will make health plans more costly than bare-bones policies. But they'll also be more comprehensive.

Starting next year, the rules will apply to all plans offered to individuals or to employers with 50 or fewer workers. The essential-benefits requirement does not apply to plans offered by larger employers, which typically offer most of these already.

The covered benefits are:

• ambulatory patient services

• emergency services

• hospitalization

• maternity and newborn care

• mental health and substance abuse services, including behavioral health treatment

• prescription drugs

• rehabilitative services and devices

• laboratory services

• management of chronic diseases, and preventive and wellness services

• pediatric services, including dental and vision care (which are not included for adults)

Pre-existing conditions

This is a major change under the law. Starting in 2014, most plans — whether obtained through an employer or on the marketplace — cannot deny coverage or charge more money because of a pre-existing health condition. Nor can plans charge more to women than men. But in most states, including Florida, they may charge more based on age and smoking status.

If you have a grandfathered individual plan — a plan you buy yourself that was in existence before March 23, 2010, and has not changed — then the pre-existing condition rule would not apply. So check the details of your plan and consider shopping around.

Pick your metal

People will be able to choose from insurance plans with differing levels of coverage and varying costs for copays and premiums. The categories do not reflect the quality or amount of care the plans provide.

It's an important choice: Do you go for a "bronze'' plan with lower premiums, knowing that it covers only 60 percent of typical medical costs? Or do you pay higher premiums for a silver, gold or platinum plan that will cover a higher percentage of your costs?

Until you go to the marketplace and see what the various plans will cost — they can vary, even in the same category, among insurers and states — and what kind of subsidies you may qualify for, you can weigh your health care needs. In general, plans with higher coverage levels are a better bet for people who use more health services.

The marketplace also offers lower-cost "catastrophic" plans to people under 30 and to some people with very low incomes, but these do not include the 10 essential benefits, and you can't use a subsidy to offset their cost.

Out-of-pocket costs, lifetime limits

Under the law, the amount of money people will have to pay out of pocket each year for medical and prescription drug costs will be capped at $6,350 for individuals and $12,700 for a family. These limits are separate from the monthly premiums people pay. The limits take effect in 2014 for those buying insurance on the state health insurance exchanges. For those with employer-based coverage, the restrictions will be fully in place in 2015.

Also, most insurance plans will be prohibited from setting lifetime cost limits on coverage for essential health benefits. This means your insurer cannot deny you coverage because your medical bills have gone over a certain amount.

Adult children

One popular provision of the health care law already is part of most insurance plans — allowing young people to stay on their parents' insurance plans until age 26. Starting in 2014, younger people can remain on a parent's or caregiver's plan even if they have an employer option of their own.

Comments
This 66-year-old is about to run seven marathons in seven days on seven continents

This 66-year-old is about to run seven marathons in seven days on seven continents

When Robert Owens’s father was 75, he gave his son some advice. "He said, ‘You know, son, the sad part is when you get old they just put you on a shelf and you become irrelevant. Fight to stay relevant. Fight to stay in the game, otherwise they will ...
Published: 01/18/18
5 things we learned about Trump from his medical checkup

5 things we learned about Trump from his medical checkup

Five things we learned about President Donald Trump from Navy Rear Adm. Ronny Jackson, the doctor who oversaw Trump’s first medical checkup in office. SLEEP Trump doesn’t get much shut-eye. Jackson guessed that Trump snoozes four to five hours a nig...
Published: 01/17/18
A century after the 1918 pandemic, science takes its best shot at flu

A century after the 1918 pandemic, science takes its best shot at flu

WASHINGTON — The descriptions are haunting. Some victims felt fine in the morning and were dead by night. Faces turned blue as patients coughed up blood. Stacked bodies outnumbered coffins. A century after one of history’s most catastrophic disease o...
Published: 01/17/18
A popular school fundraiser is just ‘junk-food marketing to kids,’ experts say

A popular school fundraiser is just ‘junk-food marketing to kids,’ experts say

For 43 years, schoolkids and their parents have clipped the labels from cookie bags and cracker boxes as part of a popular rewards program called Labels for Education.Through this and similar programs — think Tyson’s Project A+ or General Mills’ Box ...
Published: 01/17/18
Pinellas is at the center of a rise in Florida flu outbreaks

Pinellas is at the center of a rise in Florida flu outbreaks

Feeling a little sniffly or scratchy or stuffed up? It may be the flu, and you don’t want to wait around to see a doctor this year. This is not the time to write off flu-like symptoms, Tampa Bay area health officials and doctors warn. The influenza v...
Published: 01/16/18

CDC says ‘There’s lots of flu in lots of places.’ And it’s not going away anytime soon.

A nasty flu season is in full swing across the United States, with a sharp increase in the number of older people and young children being hospitalized, federal health officials said Friday.The latest weekly data from the Centers for Disease Control ...
Published: 01/12/18
Mease Countryside Hospital begins $156M expansion project

Mease Countryside Hospital begins $156M expansion project

SAFETY HARBOR — Mease Countryside Hospital is launching a $156 million expansion to build a four-story patient tower with all private rooms and a four-story parking garage.The tower will include 70 private patient rooms, a 30-bed observation unit, cr...
Published: 01/11/18
Flu shot? This is why you should still get one this year

Flu shot? This is why you should still get one this year

This year’s flu season is shaping up to be a bad one. Much of the country endured a bitterly cold stretch, causing more people to be crowded together inside. The strain that has been most pervasive, H3N2, is nastier than most. And, we’re being told, ...
Published: 01/11/18
He was 21 and fit. He tried to push through the flu — and it killed him.

He was 21 and fit. He tried to push through the flu — and it killed him.

Kyler Baughman seemed to be the face of fitness. The 21-year-old aspiring personal trainer filled his Facebook page with photos of himself riding motorbikes and lifting weights. He once posted an image of a kettlebell with a skeleton, reading: "Cros...
Published: 01/11/18
Serena Williams tells scary story of childbirth complications

Serena Williams tells scary story of childbirth complications

The image on the cover of the February issue of Vogue features Serena Williams proudly showing off her adorable daughter.The story she tells of the changes wrought on her life by the arrival of Alexis Olympia, whom she calls by her middle name and ...
Published: 01/11/18