Follow Barack Obama prior and during his tenure as the 44th President of the United States. Read about my personal observations along with every day facts as they happen. This blog will only submit factual information about the first black President, now in his 2nd term of office.


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Security and Stability under the New Obama Health Care Plan

Sunday, November 22, 2009

In another post listed on this blog, listed are the highlights of the Obama health care plan, if you have or do not have insurance. A further explanation of the highlights is listed immediately below...

For more security and stability in your health insurance, the following is what President Obama is proposing in the latest bill now being debated by the Senate.

* Ends discrimination against people with pre-existing conditions.

Insurance companies for the longest time have chosen whom they want to insure, especially when the person applying for the insurance of already has insurance with their company has a pre-existing condition. Then they reserve the right not to cover medical bills associated with that pre-existing condition. Why should you worry what is covered in your policy or not? If the company takes premiums from you so that they provide coverage, then they should cover you for your illness, no matter when you acquired it. This especially affects elderly people who have a condition suddenly that is explained to be from a pre-existing condition. All insurance companies should be liable to pay for any condition that they would normally pay for, pre-existing or not.

*Limits premium discrimination based on gender and age.

Insurance companies decide on what your premium should be, depending if you are a male or female and depending on what your age is. This is discrimination to its highest, and people of the United States have been allowing insurance companies do this for decades. Now is the time for insurance companies to stop premium discrimination and charge the same amount equally across the board, no matter your age or gender. Why should a woman pay more for insurance if a man her same age can get the same insurance for less? Why should an elderly person who no longer has viable employment because of retirement have to pay more than someone who has a good job?

* Prevents insurance companies from dropping coverage when people are sick and need it most.

Insurance companies for years seem to think about profits and their viability then the protection of the people that they cover. Just because you have a serious illness that may cost hundreds of thousands of dollars doesn't give them the right to drop you because you cost them too much. After all, that's why you have them insure you in the first place. It is to protect you from having to pay the outrageous premiums that the doctors charge for their services. Doctors will eventually have to stop charging ridicules prices for their services.

*Caps out-of-pocket expenses so people don't go broke when thy get sick.

People acquire insurance especially if for some gastly reason they require an illness that would bankrupt them because of the cost of their medical expenses. However, most insurance companies will provide and 80% coverage to the cost, verses 20% that you must pay. As an example, if your bills run upwards to a million dollars, then you would have to pay $200,000 out of your own pocket. How many people have that much saved for health insurance coverages? I sure don't. The cap would be to prevent insurance companies from charging this percentage due by the patient if the costs become high. A set amount most likely will be given in the health care plan.

*Eliminates extra charges for preventative care like mammograms, flu shots and diabetes tests to improve health and save money.

Recently, it was stated that women could wait another 10 years before getting yearly mammogram checkups. Why? My guess is to stop a majority of payouts for the mammogram. That is wrong. Women need to continue to get the mammogram tests, flu shots and diabetes tests, in a preventative way to eliminate the possibility of cancer and high medical bills in the future. The charges need to be fair, and the physicians should not have the right to set a ridicules charge on such services. Insurance companies should benefit from this because they would only have to pay a set amount for such services, not what the doctor would like to collect.

*Protects Medicare for seniors.

For years people have stated that medicare will not be around much longer. The Presidents bill would insure that Medicare would be around a long time. Ironically, it was the Republicans that were against Medicare from the inception. Now they are saying that this bill will hurt Medicare. It's like the conservatives are 'deaf'. The President time and time again tells the people that this bill would not hurt Medicare, that it would protect it. Why would they think that Obama would pass any bill that would hurt anyone? This is a man who has won the 'Nobel Peace Prize'. Does it sound like a person who would want to hurt anyone, for any reason?

* Eliminates the "donut-hole" gap in coverage for prescription drugs.

The legislation would eliminate the following instance.

Once the initial coverage limit is reached, the beneficiary is subject to another deductible, known officially as the Coverage Gap but referred to more commonly as the "Donut Hole," in which they must pay the full cost of medicine. When total out-of-pocket expenses on formulary drugs for the year, including the deductible and initial coinsurance, reach $4050 (now $4350 in 2009[8]), the beneficiary then reaches catastrophic coverage, in which he or she pays $2.25 for a generic or preferred drug and $5.65 for other drugs, or 5% coinsurance, whichever is greater. The $4050 amount is calculated on a yearly basis, and a beneficiary who amasses $4050 in out-of-pocket costs by December 31 of one year will start his or her deductible anew on January 1. Most low-income subsidy patients are exempt from all or part of the donut hole and the deductible.

The only out-of-pocket costs that count toward getting out of the coverage gap or into catastrophic coverage are True Out-Of-Pocket (TrOOP) expenditures. TrOOP expenditures accrue only when drugs on the enrolled-in plan's formulary are purchased in accordance with the restrictions on those drugs. Any other purchases do not count toward either the coverage gap or catastrophic coverage. Monthly premium payments do not count towards TrOOP.


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