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One Day at a Time
Posted by: Margaret Kreiner
December 12, 2011
Topic: Alzheimer

Patience is a key factor in keeping your sanity. Another detrimental key factor is fear. second guessing yourself brings on a lot of fear and anxiety. Am I doing everything right? Am I imagining these problems of forgetfullness on his part? Is it me that is not normal?

 I recommned a geriatric assessment so that one, you can establish your own credibility; two, you can set a base line to the dementia so you can follow the progression of the disease; and three, you can get an expert's opinion of what you are doing is right. In taking my spouse to Dr. Mary Jo Cleveland at Summa Geriatric Department, she confirmed the fact that he had Alzheimer's dementia, but also other kinds as well. In fact I learned that there are 51 kinds of demenitia. She explained it doesn''t matter what kind of dementia he has, because he has it and there is nothing one can do about it. She did have a face to face confrontation with him about giving up driving. He agreed reluctantly, and to my surprise he has not driven since that visit.

Having dementia is a serious problem, but sometimes you just have to laugh. He told me as we were leaving Dr. Cleveland's office that it was my fault he lost his driving privileges. He said that I should have told him about the testing so he could have studied up before the visit to her. Of course the testing, as some of you know, is drawing a clock and putting in the hands for what time she gives you. My spouse can read scinece journals and undersatnd them, but he cannot comprehend numbers at all. He can't add, or tell time. He doesn't understand any concept of numbers, such as I'll be back in 45 minutes.

Trying to obtain peace of mind for the healthy spouse is a goal in dealing with this dreadful disease that your love one suffers from. So patience and relief of anxiety are two very serious issues for the healthy spouse to set as a goal. This can only be accomplished by seeking a geriatric doctor to oversee your life and an attorney to protect your assets. I will talk about that in my next blog addition.

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Our New Healthcare Program
Posted by: Margaret Kreiner
September 21, 2011
Topic: Obama Care

The Patient Protection and Affordable Care Act, PPACA

On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014. Others have already begun

Statistics show that our 50 to 64 year olds have health insurance needs that may to date have gone unnoticed to the outcry of the elderly and children who have no benefits at all. About 8.6 million in the age category from 50 to 64v have no health insurance. In 2008, this number was about 7.5 million according to the survey conducted by N. Tilipman and B. Sampat of Columbia University for the Commonwealth Fund. The same survey showed 4.2 women to be uninsured. In this age group there are also about 9.7 baby boomers who have insurance but the deductibles are so high that they are in effect underinsured.

This new health care act is supposed to provide insurance to all US citizens in 2014 which will significantly improve the quality of health insurance in the USA. In 2009, 6.8 million of those 8.6 million uninsured in this age group will be eligible for subsidized insurance through Medicaid and an additional 1.4 million with higher incomes will have access to comprehensive health care plans with new consumer protections.

These statistics were comprised in December of 2010. On March 16, 2011, a mere three months later we have Governor John Kasich releasing his budget proposal. Now, I am not here to pass judgment on the governor's proposal and targets. But many of you here today fall into this age group and you may even be contemplating retirement. This is a new age. Those contemplating retirement to date looked at their financial portfolio and income streams to ascertain if they could retire, and what their life style would be if they did. Today, the focus is on health care, because it really does not matter how much money you may have, unless you are Bill Gates, it can be wiped out with one bout of illness unless of course you are a member of the government who have their own health plans that seem to take care of their needs while employed or when retired. In reality we should all live within our budgets. But when prices and the economy are not in your control, it is a problem to live within your budget.

I have elderly clients who choose between needed chemo and food. This is a decision no one in America should have to face. If you ever get a chance to have time to read a book, read Nickled and Dimed. A reporter in the Keys went undercover in Florida, Massachuesetts and Minnesota as a single woman who tried to exist on minimum wage. She had to find two or three jobs [Walmart, Molly Maids and waitressing] and even with that, she lived in a cheap motel room or her clunker car. Without cooking facilities, she was reduced to pigging out at buffets, gaining much weight. So when you go to a restaurant at night and the overweight waitress appears to be in another time zone, try to give her some slack. She may be one of those Americans who is holding down three jobs with no health insurance.

The point being if you aren't living within your budget and you have no control over your wages or prices, do you cut food out of your budget? Do you tell your kids they can't have those new sporty shoes or play football? Governor Kasich according to the Akron beacon Journal is cutting from the General Fund the following:

· 9.7% increase for Medicaid and other health and human services;

· 6% decrease for primary and secondary schools;

· 11.4% decrease for higher education;

· 2% decrease for payments to local governments;

· 7,2% decrease to state prisons and other justice protection services;

· 1.8% decrease to state government branches;

· 9.2% decrease to transportation and economic development;

· 35.8% decrease to environment and natural resources.

The federal government contributes about two thirds of the dollars for the Ohio Medicaid system. Medicaid costs are about 51.5% of the Ohio budget. In 2011, Medicaid will cost Ohio $12,618 and projected 2012 costs are $13,847.

Kasich is also cutting

· $2 million budget cut in public transit system in 8 cities including Akron and Canton;

· $93 million from the Ohio EPA budget;

He is selling or privatizing our prison and the sale of alcohol in Ohio. This is a strategic move in that it gives Ohio money in 2011 for the sale, but in years after Ohio also will not receive any revenue from these sources ever again. Jobs will be lost. Making enemies of the unions in Ohio will also be devastating for the Ohio voter. If Senate Bill 5 is passed and it is likely it has by this presentation, there will be a move to put a referendum on the ballot to overturn this piece of legislature by the voters of Ohio. If this happens, you will see such an onslaught of money poured into this state for campaign ads that you have never seen before. The unions from every state will contribute to overthrowing the legislature, since iof it succeeds in Ohio, it may succeed in other states. They cannot allow that. Ohio will be the focal point of much attention in the next few years, good or bad.

In 2014, all of the law's provisions go into effect. Families, depending on their incomes, will receive either gain coverage under Medicaid, subsidized private coverage through the insurance exchanges or health insurance plans through the exchanges. Excluding people or charging exorbitant premiums will not be allowed.

Loss in coverage of this age group is mostly due to unemployment. About 2.2 million workers age 55 and older became unemployed in November of 2010. We are not a well nation. As you know obesity is a fight for all of us. Looking for a plan that was not exorbitant in price was non-existent. COBRA insurance is too high for the out of work baby boomer to afford. Besides not being able to afford the premiums, these baby boomers also forego prescriptions, skipping needed medical tests, and follow up doctor visits. Once old enough for Medicare, these people need significantly more medical care to make up for the previous lack of treatment.

Insurance companies are now paying for women to have covered PAP tests. And people over 50, covered colon cancer tests. It's cheaper to pay for these preventative tests than to pay for the treatment of the cancer itself. What a surprise.

Not having money for medical needs, also affects saving for retirement. Couples with different ages can't retire when the first reaches 65, since that worker may be the insurance carrier for the family.

Isn't it amazing that one area can affect everything else? Isn't it also common sense? Where did we think we could beat the system and get away with it?

Older adults will gain coverage under the affordable plan as well. These are:

· Offering new plans for people with preexisting conditions who cannot get health insurance, beginning in 2010;

· Banning lifetime limits on insurance policies beginning in 2010;

· Requiring health plans to insure all who apply, preventing health plans from charging higher premiums to sicker people, and limiting how much premiums can rise by age, beginning in 2014;

· Requiring coverage of preventative are and immunizations without cost-sharing, beginning in 2010;

· Helping t preserve employer-based coverage for employees retiring between the ages of 55 and 65, beginning in 2010;

· Creating a new long term care insurance program beginning in 2012;

· significantly expanding Medicaid eligibility to cover all adults with incomes below 133 per cent of the federal poverty level, beginning in 2014; and

· Creating new state health exchanges with subsidized private insurance for people with low and moderate incomes, up to 400% of poverty, beginning in 2014.

Two out of five adults in ages 50 to 64 tried to buy individual insurance but were turned down, charged a higher price or were excluded because of a preexisting condition according to the Commonwealth Fund Biennial Health Insurance Survey (2007).

In 2014, loss of a job, or a spouse will no longer mean a loss of health insurance. Any one will have access to comprehensive health insurance. From now until 2014, earlier provisions will bridge the gap until these provisions take place.

In 2010 the act installs the following:

· Pre-existing condition insurance plans;

· Early retire reinsurance for adults who have retired but do not yet qualify for Medicare;

· Preventative services coverage without cost sharing;

· Ban on lifetime benefit caps;

· Phased out ban on annual limits.

From 2011 to 2013 the act installs:

· Establishment of class program;

· Designation of class benefit plan;

· Phased in ban on annual limits.

And in 2014:

· Medicaid expansion;

· State insurance exchanges;

· Insurance market reforms, including no rating on health, limits on age rating;

· Essential benefit standard;

· Premium and cost sharing credits for exchange plans;

· Individual requirement to have insurance;

· Employer shared responsibility payments.

Preserving Doctor Choice and Ensuring Emergency Care

The Affordable Care Act helps preserve your choice of doctors by guaranteeing that you can choose the primary care doctor or pediatrician you want from your health plan's provider network and that you can see an OB-GYN doctor without needing a referral from another doctor. The law also ensures that you can seek emergency care at a hospital outside your plan's network without prior approval from your health plan.

Tax Credit for Small Businesses that Insure their Employees

The Affordable Care Act helps small businesses and small tax-exempt organizations afford the cost of covering their employees.

If you have fewer than 25 employees and provide health insurance you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will make the cost of providing insurance much lower.

Eliminating Lifetime and Annual Limits on Your Benefits

The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The Act also restricts and phases out the annual dollar limits a health plan can place on most of your benefits-and does away with these limits entirely in 2014.

What This Means for You

Before the Affordable Care Act, many health plans set an annual limit-a dollar limit on their yearly spending for your covered benefits. Many plans also set a lifetime limit-a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits.

· Under the new law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed onor after September 23, 2010.

· The new law restricts and phases out the annual dollar limits that all job-related plans, and those individual health insurance plans issued after March 23, 2010, can put on most covered health benefits. Specifically, the law says that none of these plans can set an annual dollar limit lower than:

$750,000-for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.

$1.25 million-for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.

 $2 million-for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.

· No annual dollar limits are allowed on most covered benefits beginning on January 1, 2014.

Some Important Details

· Be aware that plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not "essential."

· If the new rules apply to your plan, they will affect you as soon as you begin a new plan year or policy year on or after September 23, 2010. (For example, if your policy has a calendar plan year, the new rules would apply to your coverage beginning January 1, 2011).

· If you have a "grandfathered" individual health insurance policy, your health plan is not required to follow the new rules on annual limits. (A grandfathered individual health insurance policy is a plan that you bought for yourself or your family; that you did not receive through your employer; and that was issued on or before March 23, 2010). If you're not sure whether your plan is grandfathered, ask your insurance company.

· The ban on lifetime dollar limits for most covered benefits applies to every health plan-whether you buy coverage for yourself or your family, or you receive coverage through your employer.

· Some plans may be eligible for a waiver from the rules concerning annual dollar limits, if complying with the limit would mean a significant decrease in your benefits coverage or a significant increase in your premiums

Curbing Insurance Cancellations

The Affordable Care Act stops health plans from retroactively canceling your insurance coverage solely because you or your employer made an honest mistake on your insurance application.

What This Means for You

Before the Affordable Care Act, if your insurance company found that you'd made a mistake on your insurance application, the insurance company might "rescind" your benefits-that is, declare your policy invalid from the day it began. Your insurance company might also ask you to pay back any money already spent for your medical care.

Under the new law, an insurer cannot rescind your coverage simply because you made an honest mistake or left out information that has little bearing on your health.

Example

When her insurance application asked for "anything else relevant to your health that we should know about," Katy forgot to mention two visits to a psychologist she had 6 years earlier. Katy was later diagnosed with breast cancer, and submitted claims to her insurance company for breast cancer treatment. After receiving Katy's claim, her plan discovered the two psychologist visits. Before the new law, Katy's mistake might have prompted her health insurer to rescind, or retroactively cancel her coverage. But under the new law, Katy's insurance plan cannot rescind her coverage, because Katy did not intentionally misrepresent significant information.

Some Important Details

· This provision applies to all health plans, whether you get coverage through your employer or purchase it yourself.

· This provision applies to plan years or policy years that begin on or after September 23, 2010. To find out when your plan year or policy year begins, ask your insurer or plan administrator.

· Your insurance company can still rescind your coverage if you intentionally put false or incomplete information on your insurance application, and it can cancel your coverage if you fail to pay your premiums on time.

· Your insurance company must give you at least 30-days notice before it can rescind your coverage, so that during that time you may be able to appeal the decision or find new coverage.

Appealing Health Plan Decisions

Your Benefit Appeal Rights Under the Affordable Care Act

If your health plan was created after March 23, 2010, the Affordable Care Act ensures your right to appeal, or to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules, now in effect, govern how your plan itself must handle your initial appeal. If your plan upholds its decision after its internal review, the law permits you to appeal to an independent reviewer who does not work for your health plan.

What This Means for You

· When an insurance plan denies payment for a treatment or service, you can appeal to the plan to review its own decision. Your plan must explain how to appeal when it informs you of the denial.

· When you appeal, your plan must give you its decision within:

 72 hours for denials of urgent care.

 30 days for denials of non-urgent care you have not yet received.

 60 days for denials of service you have already received.

· If the plan still denies your request, it must explain why and tell you how to appeal for an independent review of the decision. In some cases involving urgent care, you may be able to have the internal and external review take place at the same time.

· If you do not speak English, you may be entitled to receive all appeals-related information in your native language.

Some Important Details

· The appeals provision applies to all health plans created or purchased after March 23, 2010 and affects each plan as that plan starts a new "plan year" or "policy year" on or after September 23, 2010.

· How much the law will change your appeal rights depends on the state you live in and the type of plan you have.

· Some employers' plans may have more than one internal review before you're allowed to seek an external review.

· If you have questions about whether the appeals provision applies to you, ask your health plan or state insurance regulator. Your state may also have a health care consumer assistance program that can help.

Insurance Protections for Children in the Affordable Care Act

Under the Affordable Care Act, health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a "pre-existing condition"-that is, a health problem that developed before the child applied to join the plan.

What This Means for You

Until now, plans could refuse to accept anyone because of a pre-existing health condition, or they could limit benefits for that condition. Now, under the new law, health plans that cover children can no longer exclude, limit or deny coverage to your child under age 19 solely based on a health problem or disability that your child developed before you applied for coverage. This new rule applies to all job-related health plans as well as individual health insurance policies issued after March 23, 2010. The rule will affect your plan as soon as it begins a plan year or policy year on or after September 23, 2010.

Some Important Details

•· This rule applies whether or not your child's health problem or disability was discovered or treated before you applied for coverage.

· The new rule doesn't apply to "grandfathered" individual health insurance policies. A grandfathered individual health insurance policy is a policy that you bought for yourself or your family (and is not a job-related health plan) on or before March 23, 2010 (the date that the new law was passed).

· These protections will be extended to Americans of all ages starting in 2014.

Example

On October 1, 2010, Sally purchased a new individual health policy for herself and her 13-year-old child, Miranda, who has been treated for asthma in the past. The new health policy excludes coverage for treatment of pre-existing conditions for all enrollees. On November 1, 2010-one month after coverage began for Sally and Miranda-Miranda is hospitalized for an asthma attack. Her insurance company denies payment for the hospitalization, because under the policy Miranda's asthma is considered a pre-existing condition.

Under the new law, the insurer can't deny payment for the hospitalization based on Miranda's pre-existing asthma condition. Miranda is under the age of 19; Sally's policy is new and therefore subject to the pre-existing condition rules of the new health care law. Sally's policy year began after September 23, 2010, when the law's rules on pre-existing conditions began to take effect.

Preventive Services Under Medicare

Under the Affordable Care Act, if you have Original Medicare you may qualify for a yearly wellness exam and many preventive services for free.

What This Means for You

Starting January 1, 2011, you will pay nothing for many preventive services if you get the services from a doctor or other health care provider who accepts assignment. The services that qualify are listed below.

· Yearly wellness exam. If you are new to Medicare, your "Welcome to Medicare" physical exam is now covered without cost sharing during your first 12 months of Part B coverage. This exam is a one-time review of your health as well as education and counseling about preventive services and other care. If you've had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors.

· Tobacco use cessation counseling. This benefit is now considered a covered preventive service, whether or not you have been diagnosed with an illness caused or complicated by tobacco use. While still a covered service, the coinsurance and deductible will apply if you have already been diagnosed with a tobacco related illness.

· No more Medicare Part B deductible or copayment for these screenings if certain coverage criteria apply

. Bone mass measurement

. Cervical cancer screening, including Pap smear tests and pelvic exams.

. Cholesterol and other cardiovascular screenings

. Colorectal cancer screening (except for barium enemas.)

. Diabetes screening

. Flu shot, pneumonia shot, and the hepatitis B shot

. HIV screening for people at increased risk or who ask for the test

. Mammograms

. Medical nutrition therapy to help people manage diabetes or kidney disease.

. Prostate cancer screening (except digital rectal examinations.)

Some Important Details

· For some preventive services, you will pay nothing. You may have to pay co-insurance (a part of the cost) for the office visit when you get these services.

· Your first yearly wellness exam can't take place within 12 months of your "Welcome to Medicare" physical exam.

· If you're in a Medicare Advantage Plan, check with your plan to see if these benefits will also be free for you.

Grandfathered Health Plans under the Affordable Care Act

The Affordable Care Act exempts most plans that existed on March 23, 2010--the day the law was enacted--from some of the law's consumer protections. This will preserve consumers' rights to keep the coverage they already had before health reform.

What This Means for You

If you have health coverage from a plan that existed on March 23, 2010--and that has covered at least one person continuously from that day forward--your plan may be considered a "grandfathered" plan.

This is true whether you are covered by an individual health insurance policy that you had on that date, or you are covered by a job-based health plan that your employer first established before March 23, 2010. This is true even if you enrolled in that job-based plan sometime later.

A grandfathered health plan isn't required to comply with some of the consumer protections of the Affordable Care Act that apply to other health plans that are not grandfathered.

Here's a look at which consumer protections do and don't apply to grandfathered plans.

Consumer Protections in the Affordable Care Act that DO Apply to Grandfathered Plans

Many of the Act's consumer protections that took effect on September 23, 2010 apply to all plans, whether or not the plans are grandfathered.

Please note that these consumer protections will be added to your plan when it begins a new plan year or policy year on or after September 23, 2010.

All health plans:

· Are prohibited from applying lifetime dollar limits to key health benefits.

· Are not permitted to cancel your insurance coverage solely because of an honest mistake that you or your employer made on your insurance application.

· Must extend dependent coverage to an enrollee's adult children until they turn 26 years old (with one temporary exception: Click here for more details).

Consumer Protections in the Affordable Care Act that DO NOT Apply to Grandfathered Plans

Unlike other health plans, job-based plans and individual insurance policies that are grandfathered are not required to:

· Provide certain recommended preventive services at no additional charge to you.

· Offer new protections for consumers who are appealing claims and coverage denials.

· Protect your choice of health care providers and your access to emergency care.

Consumer Protections in the Affordable Care Act that DO NOT Apply to Grandfathered INDIVIDUAL Plans

Grandfathered individual health insurance policies are not required to adopt the provisions of the law that:

· Phase out annual dollar limits on key benefits.

· Eliminate pre-existing condition exclusions for children under 19 years old.

Some Important Details

Grandfathered plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers. (Read more about changes that will cause a health plan to lose grandfathered status).

Although grandfathered plans can make only limited changes to the percent of the premium the employer contributes, grandfathered plans may still increase their total premium amount without losing grandfathered status.

If your plan loses its grandfathered status, all of the Affordable Care Act consumer protections would apply to you when your plan begins a new plan year or policy year.

To find out if your health plan is grandfathered:

· Check your plan's materials. Beginning with the first plan or policy year startingon or after September 23, 2010, health plans must disclose their grandfathered status in any plan materials describing the plan's benefits that are distributed to beneficiaries or primary subscribers. These materials must also contain contact information for questions and complaints.

· Check with your employer and/or your health plan's benefits administrator. If you are in a group health plan, the date you joined may not reflect the date the plan was created. New employees and new family members may be added to a grandfathered group plan after March 23, 2010.

If you experience significant changes in the benefits you receive and/or the costs you pay and you have a grandfathered employer-based group health plan, contact The U.S. Department of Labor at 1-866-444-3273 or

Getting Value for Your Premium Dollar

Many Americans worry about getting their money's worth when it comes to health care. The Affordable Care Act requires insurance companies to spend your premium dollars primarily on health care.

What This Means for You

The percentage of your premium dollars that an insurance company spends on providing you with health care and improving the quality of your care (as opposed to what it spends on administrative, overhead and marketing costs) is known as "medical loss ratio."

To make sure your premium dollars are spent primarily on health care, the new law limits how much of your premium dollar your insurer can spend on things other than providing, and improving the quality of, health care. If your insurance company exceeds that limit, it must provide a rebate of the portion of premium dollars that exceeded this limit.

Some Important Details

· The law requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care and efforts to improve the quality of care. Insurers selling to large groups (usually 50 or more employees) must spend 85% of premiums on care and quality improvement.

· This rule does not apply to employers who operate what is called a self-insured plan. If you're not sure whether your plan matches this description, ask your employer or check your plan materials.

· Your health insurance company must report yearly to the Secretary of Health and Human Services on the share of premium dollars spent on health care services and quality improvement and any rebates required. The first report, covering calendar year 2011, will be filed June 1, 2012.

· Insurers will be required to make the first round of rebates to consumers in 2012. If you are owed a rebate you will receive a reduction in your premiums, a rebate check, or, if you paid by credit card or debit card, a lump sum reimbursement to your account. If your employer paid all or part of your premium, the same share of any rebate may go to your employer.

Changes in Flexible Spending Accounts/Health Reimbursement Accounts (FSAs/HRAs)

Beginning January 1, 2011, the costs of over-the-counter medications will be reimbursed under a Flexible Spending Account (FSA) or Health Reimbursement Account (HRA) only if the medications are purchased with a doctor's prescription.

These restrictions do not apply to the purchase of insulin.

What This Means for You

· You select the doctor: The new rules permit you to choose any available participating primary care provider as your doctor and to choose any available participating pediatrician as your child's primary care doctor.

· No health plan barriers to OB-GYN services: The new rules also prohibit health plans from requiring a referral from a primary care provider before you can seek coverage for obstetrical or gynecological (OB-GYN) care from a participating OB-GYN specialist.

· Access to out-of-network emergency room services: In the past, some health plans would limit payment for emergency room services provided outside of a plan's preselected network of emergency health care providers, or they would require that you get your plan's prior approval for emergency care at hospitals outside of its networks. This could mean financial hardship if you get sick or injured while away from home. The new rules prevent health plans from requiring higher copayments or co-insurance for out-of-network emergency room services. The new rules also prohibit health plans from requiring you to get prior approval before seeking emergency room services from a provider or hospital outside your plan's network.

Some Important Details

· These rules apply to all group health plans and individual health insurance policies created or issued after March 23, 2010. These rules do not apply to "grandfathered health plans."

· If your health plan or health insurance policy was created or issued after March 23, 2010, your plan will be affected as soon as it begins a new "plan year" or "policy year" on or after September 23, 2010.

· Please note that you still may be responsible for the difference between the amount billed by the provider for out-of-network emergency room services and the amount paid by your health plan.

Ban on health care limits and rescissions

Almost 100 million people in the US are enrolled in health plans that limit payment to enrollees who become very sick or injured. About 102 million people have health insurance policies that feature limits on the amount their plans will pay over a lifetime and 18 million have limits on the amount their policy will pay annually.

Pre-existing Condition Insurance Plans: PCIPS

The 35 million projected older adults who have pre-existing conditions are covered by affordable PCIPs. In all 50 states and DC, PCIPs are open to people who have been uninsured for at least six months and who have a health problem that makes it difficult for them to gain health insurance. These policies

•· Cover a broad range of health benefits, including primary and specialty care, hospitqla cre, and prescription drugs;

•· Premiums are set for a standard population in the individual insurance market and cannot vary by more than a factor of four, base on age;

•· Required o cover no less than 65% of medical costs and to limit out of pocket costs to the standards defined by health savings accounts- $5,950 for individuals.

•· Cannot impose preexisting condition exclusions or waiting periods.

States can form their own PCIPs, supported by the federal subsidies to cover the difference between premiums and the cost of claims. Ohio is one of these states. States have flexibility in setting the size of the deductible, the level of coinsurance or copayments, and the scope of benefits, so there is variation in PCIPs from state to state.

Eligible residents of Ohio can apply for coverage through the state's Pre-Existing Condition Insurance Plan program run by Medical Mutual through the Ohio Department of Insurance.

To qualify for coverage:

•· You must be a citizen or national of the United States or residing in the United States legally.

•· You must have been uninsured for at least the last six months before you apply.

•· You must have a pre-existing condition or have been denied coverage because of your health condition.

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it's to treat a pre-existing condition.

Ohio plan

TIMELINE FOR THE NEW HEALTHCARE PROVISIONS

2010

NEW CONSUMER PROTECTIONS

•· Putting Information for Consumers Online. The law provides for an easy-to-use website where consumers can compare health insurance coverage options and pick the coverage that works for them. Effective July 1, 2010.

•· Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions. The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans.

•· Prohibiting Insurance Companies from Rescinding Coverage. In the past, insurance companies could search for an error, or other technical mistake, on a customer's application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23, 2010.

•· Eliminating Lifetime Limits on Insurance Coverage.Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23, 2010.

•· Regulating Annual Limits on Insurance Coverage. Under the new law, insurance companies' use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23, 2010.

•· Appealing Insurance Company Decisions. The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Effective for new plans beginning on or after September 23, 2010.

•· Establishing Consumer Assistance Programs in the States. Under the new law, states that apply receive federal grants to help set up or expand independent offices to help consumers navigate the private health insurance system. These programs help consumers file complaints and appeals; enroll in health coverage; and get educated about their rights and responsibilities in group health plans or individual health insurance policies. The programs will also collect data on the types of problems consumers have, and file reports with the U.S. Department of Health and Human Services to identify trouble spots that need further oversight. Read a list of those who have received CAP grants. Grants Awarded October 2010.

IMPROVING QUALITY AND LOWERING COSTS

•· Providing Small Business Health Insurance Tax Credits. Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35 percent of the employer's contribution to the employees' health insurance. Small non-profit organizations may receive up to a 25 percent credit. Effective now.

•· Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug "Donut Hole." An estimated four million seniors will reach the gap in Medicare prescription drug coverage known as the "donut hole" this year. Each such senior will receive a $250 rebate. First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap.

•· Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010. Learn more about preventive care benefits

•· Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy - from smoking cessation to combating obesity. Funding begins in 2010.

•· Cracking Down on Health Care Fraud. Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in fiscal year 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP. Many provisions effective now.

INCREASING ACCESS TO AFFORDABLE CARE

•· Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions. A new Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. National program effective July 1, 2010.

•· Extending Coverage for Young Adults. Under the new law, young adults will be allowed to stay on their parents' plan until they turn 26 years old (in the case of existing group health plans, this right does not apply if the young adult is offered insurance at work). While the provision takes effect in September, many insurance companies have already implemented this new practice. Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23.

•· Expanding Coverage for Early Retirees. Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. Applications for employers to participate in the program available June 1, 2010. For more information on the Early Retiree Reinsurance Program, visit http://www.errp.gov/.

•· Rebuilding the Primary Care Workforce. To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants. These include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses receiving payments made under any State loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Effective 2010 .

•· Holding Insurance Companies Accountable for Unreasonable Rate Hikes. The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases will be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new health insurance Exchanges in 2014. Grants awarded beginning in 2010.

•· Allowing States to Cover More People on Medicaid. States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents. Effective April 1, 2010.

•· Increasing Payments for Rural Health Care Providers. Today, 68 percent of medically underserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Effective 2010.

•· Strengthening Community Health Centers. The law includes new funding to support the construction of and expand services at community health centers, allowing these centers to serve some 20 million new patients across the country. Effective 2010.

2011

IMPROVING QUALITY AND LOWERING COSTS

•· Offering Prescription Drug Discounts. Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. Effective January 1, 2011. Download a brochure to learn more (PDF, 3.6 MB)

•· Providing Free Preventive Care for Seniors. The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare. Effective January 1, 2011.

•· Improving Health Care Quality and Efficiency. The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These methods are expected to improve the quality of care, and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Additionally, by January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including by these programs. Effective no later than January 1, 2011.

•· Improving Care for Seniors After They Leave the Hospital. The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities. Effective January 1, 2011.

•· Introducing New Innovations to Bring Down Costs. The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care. Administrative funding becomes available October 1, 2011.

INCREASING ACCESS TO AFFORDABLE CARE

•· Increasing Access to Services at Home and in the Community. The new Community First Choice Option allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes. Effective beginning October 1, 2011.

HOLDING INSURANCE COMPANIES ACCOUNTABLE

•· Bringing Down Health Care Premiums. To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% ofthe premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers. Effective January 1, 2011.

•· Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage. Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care. Effective January 1, 2011.

2012

IMPROVING QUALITY AND LOWERING COSTS

•· Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients' perception of care. Effective for payments for discharges occurring on or after October 1, 2012.

•· Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form "Accountable Care Organizations." These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012.

•· Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012.

•· Understanding and Fighting Health Disparities. To help understand and reduce persistent health disparities, the law requires any ongoing or new Federal health program to collect and report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities. Effective March 2012.

INCREASING ACCESS TO AFFORDABLE CARE

•· Providing New, Voluntary Options for Long-Term Care Insurance. The law creates a voluntary long-term care insurance program - called CLASS -- to provide cash benefits to adults who become disabled. The Secretary shall designate a benefit plan no later than October 1, 2012.

2013

IMPROVING QUALITY AND LOWERING COSTS

•· Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013.

•· Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment "bundling," hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a "bundled" payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.

INCREASING ACCESS TO AFFORDABLE CARE

•· Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013.

•· Providing Additional Funding for the Children's Health Insurance Program. Under the new law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2013. 2014

NEW CONSUMER PROTECTIONS

•· Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual's pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.

•· Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014.

•· Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.

IMPROVING QUALITY AND LOWERING COSTS

•· Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100 percent and 400 percent of the poverty line who are not eligible for other affordable coverage. (In 2010, 400 percent of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It's also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014.

•· Establishing Health Insurance Exchanges. Starting in 2014 if your employer doesn't offer insurance, you will be able to buy insurance directly in an Exchange -- a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too. Effective January 1, 2014.

•· Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50 percent of the employer's contribution to provide health insurance for employees. There is also up to a 35 percent credit for small non-profit organizations. Effective January 1, 2014. .

INCREASING ACCESS TO AFFORDABLE CARE

•· Increasing Access to Medicaid. Americans who earn less than 133 percent of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing to 90 percent federal funding in subsequent years. Effective January 1, 2014.

•· Promoting Individual Responsibility. Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014.

•· Ensuring Free Choice. Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new health insurance Exchanges. Effective January 1, 2014.

2015

IMPROVING QUALITY AND LOWERING COSTS

•· Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.

Ohio - Early Retiree Reinsurance Program - Provisions

Rising health care costs have made it difficult for employers to provide quality, affordable health insurance for workers and retirees while also remaining competitive in the global marketplace. The percentage of large firms providing workers with retiree health coverage has dropped from 66 percent in 1988 to 29 percent in 2009.¹ Health insurance premiums for older Americans are over four times more expensive than they are for young adults,² and the deductible these enrollees pay is, on average, almost four times that for a typical employer-sponsored insurance plan.³

The Affordable Care Act creates a new program called the Early Retiree Reinsurance Program to help address this challenge that employers and older employees are facing. The Early Retiree Reinsurance Program provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.

Businesses, other employers, and unions that are accepted into the program will receive reimbursement for medical claims for early retirees and their spouses, surviving spouses, and dependents. Savings can be used to reduce employer health care costs, provide premium relief to workers and families, or both. Applicants who are approved into the program receive reinsurance for the claims of high-cost retirees and their families (80 percent of the costs from $15,000 to $90,000). The program ends on January 1, 2014 when State health insurance Exchanges are up and running.

HHS has approved the following sponsors from Ohio. More applications are being approved each day.

•· 4th District IBEW Health Fund

•· Schulman, Inc.,

•· ABX Air, Inc.

•· AK Steel Corporation

•· American Electric Power Service Corporation

•· American Financial Group, Inc.

•· American Greetings Corporation

•· Asbestos Workers Local No 3 Health and Welfare Fund

•· Bard Manufacturing Company Inc.

•· Battelle Memorial Institute

•· Board of Trustees Canton Electrical Welfare Fund

•· Board of Trustees for the Building Laborers Local 310 Health & Welfare

•· Board of Trustees for the Iron Workers Local 17 Insurancce Benefit Plan

•· Board of Trustees Insulators Local 84 Health Care Plan

•· Board of Trustees of Ohio Conference of Teamsters & Industry

•· Bridgestone Americas, Inc.

•· Canton Drop Forge Inc

•· Carpenters Health Fund of West Virginia

•· Chart Industries, Inc.

•· Cincinnati Bell Inc.

•· Cleveland Bakers and Teamsters Health and Welfare Fund

•· Cleveland Clinic Foundation

•· Cleveland Newspaper Publishers Union Local 473 Wel

•· Cliffs Mining Co, Managing Agent of Hibbing Joint Venture

•· Cliffs Natural Resources, Inc.

•· Cliffs North American Coal LLC

•· cognis corporation

•· Commercial Vehicle Group, Inc.

•· Convergys Corporation

•· Cooper Tire & Rubber Company

•· Dana Non-Union Retiree VEBA Trust

•· Dealer Computer Services, Inc. d/b/a The Reynolds and Reynolds Comp

•· East Ohio Conference of The United Methodist Church

•· Eaton Corporation

•· Eaton Corporation

•· Electrolux Home Products, Inc.

•· Empire Iron Mining Partnership

•· Faurecia Exhaust Systems, Inc.

•· Federal Home Loan Bank of Cincinnati

•· Ferro Corporation

•· Fifth Third Bancorp

•· First Citizens Banc Corporations

•· FirstEnergy Corp

•· FirstMerit Corporation

•· Health & Welfare Fund of Teamsters Union Local N0 73

•· Highway Patrol Retirement System

•· Honda of America Mfg., Inc.

•· Horizon Telcom, Inc

•· IBEW Local No. 212 Health and Welfare Fund

•· IBEW-648 Health and Welfare Fund

•· Insulators Local 45 Health Care Plan

•· International Brotherhood of Electrical Workers Local No. 129 Health and Welfare Fund

•· International Brotherhood of Electrical Workers No. 38 Health and Welfare Fund

•· Iron Workers District Council of Southern Ohio & Vicinity Benefit Trust

•· John Maneely Company

•· Jones Day

•· Kao America Inc.

•· Kenyon College

•· KeyCorp

•· Lake Superior & Ishpeming Railroad Company

•· Libbey Inc.

•· Licking Rural Electrfication, Inc.

•· Lima Area Local No. 776 Health and Welfare Plan and Trust

•· Macy's, Inc.

•· Mahoning and Trumbull County Building Trades Welfare Trust Fund

•· Major League Baseball Players Welfare Plan

•· Marathon Oil Company

•· Marietta Memorial Hospital

•· Marlite, Inc.

•· Medical Mutual of Ohio

•· Mettler-Toledo, Inc.

•· Moen Incorporated

•· Motorists Mutual Insurance Company

•· Nationwide Mutual Insurance Company

•· NewPage Corporation

•· NewPage Wisconsin System, Inc.

•· Nordson Corporation

•· Northshore Mining Company

•· Northwestern Ohio Plumbers and Pipefitters

•· Novelis Corporation

•· Oberlin College

•· Ohio Bankers Benefits Trust

•· Ohio Bricklayers' Health & Welfare Plan

•· Ohio Carpenters' Health Fund

•· Ohio Conference of Plasterers & Cement Masons Health & Welfare Fund

•· Ohio Education Association

•· Ohio Laborers' District Council - Ohio Contractors' Association Insurance

•· OHIO OPERATING ENGINEERS HEALTH & WELFARE PLAN

•· Ohio Valley Electric Corporation

•· Ormet Corporation

•· OVERLOOK MUTUAL HOMES, INC

•· Owens Corning

•· Owens-Illinois Inc.

•· Painting Industry Insurance Fund

•· Park National Corporation

•· Parker Hannifin Corp

•· PCC Airfoils, LLC

•· Pilkington North America, Inc.

•· PIPE FITTERS #120 INSURANCE FUND

•· Plumbers & Pipefitters L. 219

•· Plumbers & Pipefitters Local 189 Health & Welfare Fund

•· Plumbers & Pipefitters Local 94 Health & Welfare Plan

•· Plumbers & Steamfitters Local 42 Health & Welfare Trust Fund

•· Plumbers & Steamfitters Local Union No. 396 Health & Welfare Fund

•· Plumbers and Steamfitters Local No. 521 Health and Welfare Fund

•· Plumbers Union Local 55 Health & Welfare

•· Plumbers, Pipe Fitters & MES Local Union No 392 Health & Welfare Fund

•· Porter Wright Morris & Arthur LLP

•· Preformed Line Products Company

•· Public Employees Retirement System of Ohio

•· Refrigeration Sales Corporation of Cleveland

•· RMI Titanium Company

•· Robbins & Myers, Inc.

•· Rocky Brands, Inc.

•· School Employees Retirement System of Ohio

•· Severstal Warren, Inc

•· Sheet Metal Workers Intl Assoc. of Dayton OH Local Union 224

•· Sheet Metal Workers Local 33 Youngs District Healt

•· Sheet Metal Workers Local No. 110 Health Fund

•· Sheet Metal Workers Local No. 24 Greater Cincinnat

•· Sheet Metal Workers Union Local 33 Cleveland District Health Benefits Fund

•· Southwest Ohio District Council of Carpenters Health & Welf Fund-DA

•· State Automobile Mutual Insurance Company

•· State Teachers Retirement System of Ohio

•· STERIS Corporation

•· Teamsters Health & Welfare Fund Local 377

•· Teamsters Local Union #348 Health & Welfare Fund

•· Teamsters Local Union No.20 Insurance and Health W

•· Teamsters Union Local No 92 Health and Welfare Fund TR

•· Teamsters Union Local No. 52 Health & Welfare Fund

•· The Andersons, Inc.

•· The David J. Joseph Company

•· The Dispatch Printing Company

•· The Goodyear Tire & Rubber Company

•· The Gorman-Rupp Company

•· The House of LaRose,lnc.

•· The Kroger Co.

•· The Lubrizol Corporation

•· The Minster Machine Company

•· The Ohio Automobile Club (DBA AAA Ohio Auto Club)

•· The Ohio Police and Fire Pension Fund

•· The Ohio Valley Coal Company

•· The Procter & Gamble Company

•· The Pulaski Rubber Co. - wholly owned subsidiary Of R.C.A. Rubber Co.

•· The R.C.A. Rubber Company

•· The Sherwin-Williams Company

•· The Timken Company

•· The University of Akron

•· The Western and Southern Life Insurance Company

•· Tilden Mining Company L.C.

•· Toledo Electrical Welfare Fund

•· Toledo Newspaper Union - Blade Health and Welfare

•· UFCW Local Unions & Employers Benefit Plan of SW Ohio Area

•· UFCW Union-Employee Health & Welfare Fund

•· UFCW Unions'and Employers' Health and Welfare Plan of Central Ohio

•· Union Construction Workers Health Plan

•· Union of Roofers Waterproofers & Allied Workers Local #44 Welfare Fund

•· United Taconite LLC

•· University of Cincinnati

•· Western Reserve Farm Cooperative, Inc.

•· White Castle System, Inc.

•· Wittenberg University

•· Youngstown Area Electrical Welfare Fund Trustees

•· Excavating & Building Material Drivers Union Local #436*

•· IBEW Local 82 *

•· Lake Hospital System*

•· The J.M. Smucker Company*

•· The Scotts Company LLC*

Consumer Help Under the Health Care Act

Many states offer help to consumers with health insurance problems. The Affordable Care Act improves these services with grants that help states start or strengthen Consumer Assistance Programs (CAPs). The states and territories that applied for these grants have received funds to provide residents direct help with problems or questions about health coverage.

If your state does not have a Consumer Assistance Program grant, some state and federal government offices may still be able to help you. The U.S. Department of Labor can answer questions about some employer-provided plans, for example. Your state health insurance regulator may be able to help with individual insurance policy problems.

Ohio Health Insurance Consumer Help

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First Day at a Time
Posted by: Margaret Kreiner
September 21, 2011
Topic: Alzheimer

This Alzheimer's blog is depicted as one day at a time, because that is the survival mechanism for the caregiver of a loved one afflicted with Alzheimer's disease. As in a twelve step program or a weight watcher's plan, it is proven that small steps keep you targeted and positioned for success. If you saw the whole process laid out before you to achieve your goal, most people would give up before they started. So this one day at a time mentality is a sanity lifeline.

Alzheimer's comes like a thief in the night, pinching off minute pieces of our mind which in the beginning makes us feel foolish when we falter especially in front of family or friends. These "magic moments" are overlooked and explained away as silliness, or inebriation, or sleep deprivation, or personality quirks. But in time, people start to notice the odd behavior for what it is. The pathetic irony is that the afflicted also begin  to recognize what it is. If Oscars were given to any class of people, they should be awarded to those afflicted with this disease. For they become very good at hiding their shortcomings, even to the point of making you doubt that you are seeing what you are seeing. Your own sanity comes into question.

I was told that that there are 51 types of dementia. We called anyone in the past who was losing their marbles senile. But today as people live longer, we are finding that senility is just another word for dementia. Dementia is a disease that can be caused by head injuries, frontal lobe problems, arterialscolosis and Alzheimer's disease which involves the synaptic links in the brain, to name a few. But it really isn't as important for the caregiver to know what caused the dementia as it is to know that your loved one has it. The first item on the agenda is to have a geriatric assessment performed by a trained physician. This allows the caregiver to stop questioning and doubting the idea of whether the person has the disease or not. It allows the caregiver to take the next step to start a plan to deal with the disease and its future ramifications. This sounds like an easy step, but it is not. No one wants to go willingly to have a test to see if they are crazy. No one  wants to deal with that reality. If you aren't labeled yet, you aren't crazy yet. So by trickery or persuasion, the care giver must somehow make the assessment appointment and get the loved one to participate.

I often joked with my husband about both of us going for a crazy test. But eventually he did go. I had tried to take the car keys from him a year earlier, but to no avail. After four accidents, the rule was that he could drive his own car, but if we were both going out, I was to drive. He hadn't been with the doctor for more than half an hour when she came to see me to ask me if I wanted to tell him he could no longer drive, or should she tell him. That answer was clear to me. When she told him, he wanted to know why. The accidents he had were snow related in his mind, and not his fault. He claimed I was yelling at him which caused him to drive through a neighbor's garage door. I was yelling, I admit. But yelling stop didn't abort the accident. He also told me later that it was my fault he couldn't drive anymore. It was unfair of me to take him to see this doctor without my giving him the test questions so he could study them first. The test that he failed was to draw lines from scattered numbers on a page starting from one to two and so forth to twenty. He couldn't get past four after three minutes.

This also brings to mind two situtations in my past about testing for dementia. My 89 year old grandmother was asked who the president of the United States was. She proudly in her Slovak broken English replied President General Motors. Our president at the time was President Ford.  Confused but not demented. The second was a client whose family had called me to see their grandmother at a nursing home.The staff told the family that she needed a guardianship because she was incompetent. Arriving there first, I started to converse with her about generalities like the weather etc. I told her that it was a really fine sunny summer day outside. She replied that she liked the facility. I asked her how her health was, and she stated that she missed her late husband. The answers were getting more bizarre as we chatted. Finally I wrote a question on a piece of paper and she answered it perfectly. I asked her how long had it been since she wore her hearing aids. She had not seen them since the second day she moved into the facility.

Life is not easy for any caregiver, but especially not for someone taking care of a dementia victim. There are two victims here, not one. 

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Post
Posted by: Margaret Kreiner
September 21, 2011
Topic:

Post entry

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