Posts Tagged ‘
Affordable Care Act ’
Friday, July 25th, 2014
* Guest-edited by Amanda Cole, owner of Yummy Mummy
We’ve all heard the phrase “ask and you shall receive.” When you’re pregnant you’re going to be asking about (and receiving) tips on strollers, car seats, baby monitors and more. While you’re at it, ask the right questions and you could maybe receive a free breast pump.
The Affordable Care Act requires most health insurance plans to cover women’s preventative services, including breast pumps, oftentimes with no cost to the mother. But coverage varies widely, not only from one insurance carrier to the next, but also from one plan to the next. So you have to ask the right questions to find out what you are entitled to.
1. Does your plan cover breast pumps?
Although the Affordable Care Act requires most insurance plans to cover breast pumps, a few plans have been “grandfathered in,” so the first thing to do is make sure your plan covers breast pumps. And despite some rumors out there, the breast pumps you receive through insurance are the same exact breast pumps you would buy at any retail store. They might not have all the fancy extras like tote bags and coolers, but the motor and mechanics are 100% identical. And there is no need to purchase additional accessories to start pumping! Just buy them later if you decide you need them.
2. What types of pumps are covered by your plan?
Some plans offer a double-electric breast pump, others offer only a manual pump, and some plans give members a choice. Some plans also allow you to rent a hospital-grade pump, but most often you or your baby must have a medical condition (such as a cleft palette) as well as a prescription in order to obtain a hospital-grade breast pump. Which leads us to question #3…
3. Do you need a prescription?
Some plans require your doctor to send in a prescription for any type of pump, so ask early to avoid delays later!
4. How and when do I get my pump?
For the most part, your insurance carrier will not let you go to just any store (or web site) to purchase your pump. They will require that you obtain your breast pump from an in-network provider. I am the founder and owner of Yummy Mummy, the largest Durable Medical Equipment supplier in the country specializing in breast pumps, so we may be in your network (we work with more than 25 insurance plans).
Your pump provider should ideally verify benefits on your behalf, offer you different brands of pumps to choose from, and ship the pump straight to your door. Some insurance plans will let you receive your pump at any point during your pregnancy, while others will only allow the pump to ship one month before your delivery or after you’ve delivered.
If you still have more questions, Yummy Mummy is here to help!
Seeking advice on what type of breast pump you should get or how many you should have? Watch this video introduction!
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Tuesday, May 21st, 2013
Last week was National Women’s Health Week, and I fully intended on writing a great blog post telling everyone that they should take a moment out of their busy schedules and focus on their health. The only problem was that my busy schedule got in the way.
Last Wednesday, my daughter needed to make it to her ENT, so I pushed my eye appointment off. I really didn’t want to miss two days of work in a week. But on Friday morning, I got a call that my godmother had a heart attack (she’s fine now, she just needs to remember to make time for her health), so I missed the entire day of work anyway. Now imagine if I’d actually made it to that eye appointment, I would have missed three days of work and I wouldn’t be squinting at my computer so early in the week spreading the urgent message that you should not let your schedule get in the way of your health.
But in all seriousness, when I watched my god sister sobbing after being asked if she was her mother’s proxy last Friday, it really did hit me. Neglecting our health to take care of everyone else actually hurts them in the end.
Even if you have lots of time, but no health insurance, thanks to the Affordable Care Act, many of the screenings women need are free. For example, the health care law requires coverage of well-woman visits, cervical cancer screenings, depression screenings, and more.
Visit WomensHealth.gov to learn more about living a healthier life.
I’ve rescheduled my eye appointment and I won’t cancel it this time. Take a moment out of your busy schedule this week, and take care of your health. Your kids are counting on you.
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Monday, January 7th, 2013
If you’re an expectant or a new mom looking to save money in the New Year, look no further than your insurer to save a few hundred dollars. A provision in the Affordable Care Act mandates that insurance companies cover breastfeeding support, supplies, and consulting–in conjunction with each birth–when health care plans began resetting on January 1.
Insurance companies, not the government, will cover the costs of the breast pumps but each company has a different plan for its members. Since the provision is rather new, and has no specification whether insurers should cover certain brands or types of supplies, many are still unsure as to how they’ll implement these benefits.
Visit your insurer’s website to find out how you can obtain breastfeeding supplies (and determine which ones are covered on your plan) and lactation consulting for no out-of-pocket expenses.
For more information about the ACA and how it affects your family, read our interview with Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services.
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Monday, November 5th, 2012
How can you keep your family healthy—and what’s it going to cost? In September, Kathleen Sebelius, Secretary of the U.S. Department of Health & Human Services, visited Parents to talk about the Affordable Care Act, or ACA, which went into effect in March 2010. As more features and benefits of the law roll out—including eight new preventive services for women that will be covered in plans that renew on or after August 1, 2012—it’s more crucial than ever that families understand what they’re entitled to. We put out a call on Facebook asking exactly what you wanted to know, and your questions helped shape our conversation with Secretary Sebelius.
Parents: Which parts of the Affordable Care Act most directly affect women and families?
Kathleen Sebelius: In September 2010, preventive services started to be offered without co-pays. This was a way to encourage things like immunizations, folic acid supplements, and mammograms, because we know that preventing a problem [or detecting one early] is cheaper and healthier than treating a problem.
Then, in August 2012, we rolled out a series of benefits aimed specifically at women. They affect your health at every stage of your life, with HIV screening, contraception, and the assurance that your plan will include maternity benefits such as pre- and post-natal care. This includes free gestational diabetes screenings and breastfeeding supplies and support. If you are not in a grandfathered health plan (a plan already in place when the Affordable Care Act was enacted that has not been changed in certain ways) you will receive these benefits without co-pays.
Too many women have been faced with a policy that doesn’t cover maternity care. If, God forbid, something goes wrong along the way—they end up with an emergency C-section, or they have a baby who has complications and is in the NICU—it could mean bankruptcy. Beginning in 2014, most plans will be required to cover maternity care and millions of women will have peace of mind.
[Editors’ note: For more information on grandfathered plans, visit healthcare.gov]
Under the ACA, will families who already have insurance need to get new coverage?
If you like your insurance, you don’t have to do anything. Your coverage is not going to go away. But starting in 2014, if you’re shopping for coverage on your own, or you’re a small-business owner who can’t find affordable coverage for yourself or your employees, you’re going to have some additional choices. Insurance companies are going to operate under different rules for changing premiums and dealing with preexisting conditions. Each state will have what’s called an Affordable Insurance Healthcare Exchange that will accept applications, provide eligibility determinations for health benefits coverage, and provide a way to purchase health benefit coverage online. [Editors’ note: Consumers can log on, see what they’re eligible for, and compare plans.]
Earlier this year the Supreme Court ruled on the provision of the ACA that requires people to pay a penalty for not having health insurance; they found that it was constitutional and upheld the law. But it seems clear that if President Obama is not re-elected, the ACA will be vulnerable again. What’s the reality?
The President is committed to full implementation of the act. The other candidates [Romney and Ryan] say they want to repeal. How successful that could be, what that would look like, I really have no idea. We’re just looking ahead, assuming that the law will be fully implemented. [Editors’ note: We asked Robert Field, Ph.D., J.D., M.P.H., professor of health management and policy, School of Public Health, at Earle Mack School of Law at Drexel University, what it would take to overthrow the law, and how likely that is. “An out-and-out repeal seems unlikely,” says Dr. Field. “In order for that to happen, both houses of Congress would have to pass the legislation and the President would have to sign it.” Even if Governor Romney wins the election and Republicans take control of Congress, they’d be up against many passionate consumers who support parts of the law as well as lobbyists from drug companies, hospitals, and insurance companies who would fight to keep the new customers they’ve gained under the ACA. However, even if the law were not fully overturned, it might not remain intact the way it’s currently written. A Romney administration could do a lot to impede the full implementation. “Some of the parts of the law are discretionary, and Romney could decide to defund or under-fund them,” says Dr. Field. And though the ACA requires preventive care services to be provided without deductibles or co-pays, a Romney administration could redefine preventive care to exclude more controversial elements, such as contraception.]
What else is ahead that families should know about?
Right now, a lot of women can be charged up to 50 percent more for exactly the same coverage that a man has—even if that coverage doesn’t include maternity care—because the practice of “gender rating” is legal until 2014. But after that, insurers will not be able to charge women more for their health coverage.
Also, starting in 2014, no one can be denied coverage because they have a pre-existing condition. For women, a pre-existing condition could mean you’re a breast cancer survivor, you’re a victim of domestic violence, or you’ve had a Cesarean section in the past. Right now, insurance companies can refuse to insure you or refuse to pay for any kind of complication that may arise in the future from those circumstances. But those rules will change across the board. What I like to say is, “Being a woman will no longer be a pre-existing condition.”
People will also have more flexibility when it comes to leaving their jobs. I know women who work only for the insurance. They may hate their job, but they or a family member have a health condition, and they say, “I can’t leave.” Those choices will be a thing of the past. You will be reassured that, no matter the circumstance, whether you have a pre-existing condition, have difficulty paying for health insurance, or lose or change jobs, the law will help you get access to affordable coverage.
This brings us to a reader named Kristin Lupo, who asks, “Will the law help cover expenses such as groups or therapies for kids with autism or other developmental delays?”
Certainly there are some specific screenings for autism recommended by experts for children at a very young age that will be covered without any co-pay or co-insurance [in non-grandfathered plans]. The right services will be determined by the family and their health care provider, but the provisions in the Affordable Care Act will remove financial barriers for recommended services in behavioral health. And a young adult [a child under age 19] who has an autism diagnosis can’t be locked out of the market, and can stay on a parent’s plan until 26—as can any young adult without his or her own coverage—and will be able to fully participate in the insurance market, which isn’t an option now.
How will the act affect reimbursement for members of the military?
It doesn’t. TRICARE is the federal government’s program that covers the military and their families. The ACA affects private insurance plans, so TRICARE is not impacted in this.
This question from our reader Stephanie Dixon may sum up how many moms feel: “It seems like even people who think that the ACA is a good idea are very scared of how it’ll affect their family’s budget. Most of us, regardless of our political bent, are struggling. How will it help the average working-class citizen?”
We know that it’s far less expensive for a family and for employers to pay for preventive care than to pay the costs when people get sick. Families currently have co-pays, and pay out of pocket every time they get flu shots and every time they get their kids immunized. Under ACA that ceases to exist. Also—and a lot of people don’t know this—people who have insurance are paying for people who come into the emergency room and have no insurance at all. When an individual is uninsured and cannot afford to pay for care, the cost of that care is absorbed and passed on in the form of higher premiums to those who are in a position to pay, which drives medical costs up across the board. So having everybody with some coverage actually lowers the costs for everyone. In the two and a half years since the law has been passed, we are seeing the slowest rise in health costs that we have had in the last 30 years.
Is there anything else you’d like to get across?
We want to encourage people to use their preventive health services throughout the year. For example, October is Breast Cancer Awareness Month. We know that if breast cancer is detected early, the survival rate is close to 100 percent; the survival rate for late detection is closer to 23 percent. Between private insurance and Medicare, there’s no co-pay—there really are no financial barriers anymore. So get screened. [Editors’ note: For more information about breast cancer screening, prevention, diagnosis, and treatment, visit womenshealth.gov]
How does your role as a mother and new grandmother [to 13-week-old grandson] inform the work you do with healthcare?
A lot of things that were statistics on a page are now very meaningful to me. I watched my son and daughter-in-law plan for a baby, want to conceive a baby, have the experience of going to prenatal care, think about birthing, and use lactation-support services. Watching all of this up close and personal at every step along the way, I thought about how many parents would not have had that coverage if the ACA had not been passed and signed into law. We had gone to the Institute of Medicine and asked doctors, researchers, and experts to look at health plans and tell us what the gaps were for women’s services. A lot of health plans had no maternity coverage; a lot of women don’t even think about that until they get pregnant, and then it’s too late, so they’re doing it 100 percent out of pocket, or don’t get screened for gestational diabetes, or have to pay for infants’ immunizations. Now, 47 million women will have access to preventive services without out-of-pocket costs. That’s a huge deal.
For more about the ACA, including a timeline of what’s changing and when, visit healthcare.gov.
Editors’ note: This conversation was edited for space.
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Wednesday, August 1st, 2012
Unless you’ve been living under that ol’ proverbial rock, you’ve probably heard about the Affordable Care Act. But even with all the buzz, you may still not fully understand everything that’s included, or how exactly it impacts you and your family. Plus, new things are being added. Today, a rule comes into effect that will grant women, with health plans renewing on or after today, access to eight prevention-related health services, at no cost to them. And that, as I understand it, is great news, especially for any woman who’s put off or avoided potentially life-saving preventive care because of cost. If you’re one of the 47 million eligible women, you’ll now receive the following, free of charge:
- Well-woman visits
- Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.
- Domestic and interpersonal violence screening and counseling
- FDA-approved contraceptive methods, and contraceptive education and counseling
- Breastfeeding support, supplies, and counseling
- HPV DNA testing, for women 30 or older
- Sexually transmitted infections counseling for sexually-active women
- HIV screening and counseling for sexually-active women
These are in addition to 14 other health care services already covered under the Affordable Care Act. As Kathleen Sebelius, secretary of health and human services, writes on HealthCare.gov, “women deserve to have control over their health care.” I’m not going to argue with that.
Image: Doctor with female patient via Shutterstock
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Monday, June 11th, 2012
Last Thursday I had the pleasure of attending a Women’s Health Town Hall at The White House. The goal was to discuss the many ways that the Affordable Care Act (ACA) has benefited Americans, particularly women and families. As Health & Human Services Secretary Kathleen Sebelius described life before ACA, “Insurers could deny women coverage for being a breast-cancer survivor, for having had a c-section, for being a victim of domestic violence. In effect, being a woman was a pre-existing condition. The Affordable Care Act has put basic fairness in place.” Some of the health care law’s biggest benefits, all in effect right now:
Insurance companies are no longer allowed to deny coverage to children because of pre-existing conditions, such as asthma or diabetes. Considering that there are 7 million children in the U.S. with asthma, and another 215,000 people under age 20 have either type 1 or type 2 diabetes, this provision is vital. In 2014, ACA will make it illegal for anyone to be denied coverage for a pre-existing condition, not just children.
Insurers can’t put a lifetime limit on how much they will pay if you become ill. We saw the importance of this provision firsthand, when we met 8-month-old Jax, a twin who was born with a genetic disorder. The cost of his first day in the NICU alone was $150,000–imagine . Because there’s no lifetime limit on his healthcare coverage, his parents have one fewer concern (and a gigantic one at that) to worry about. Watch this video to meet Jax and his mom, Robyn.
Children younger than age 26 can stay on their parents’ plan. Again, we saw precisely how crucial this is when Abby spoke to us. A 20-year-old student at the University of Minnesota with a rare congenital disease, Abby doesn’t have to stress over how she’ll pay for her preventive care and any upcoming surgeries she’ll need (she’s already had the shunt in her head replaced four times.) I was touched when we saw a video with Abby’s story and her mom said, “There’s things I can’t do about the future, but this has really helped her future.” It made me think about how powerless and scared I would feel if one my daughters had a lifelong health condition–and how grateful I would feel to know I could actively help her by providing her with healthcare for years after she graduated college.
Of course, the ACA is in real danger of being overturned by the Supreme Court because the requirement for minimum health-insurance coverage and the expansion of Medicaid is considered by some states to be unconstitutional. The Supreme Court could strike down those two provisions, or they could wipe out the entire law, or they might do something else altogether. A decision is expected by the end of the month.
If you’ve been confused by what the ACA offers, and how it might help your family, go to healthcare.gov. You’ll find lots of information, including a timeline of what’s changing and when. And if you want to share your story of how ACA has made a difference in your life, go to the MyCare section of the site. The Department of Health & Human Services definitely wants to hear from you.
Shameless personal photo op: me at the iconic podium of the press briefing room!
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Affordable Care Act, Health Care, insurance, Kathleen Sebelius, pre-existing conditions, The White House | Categories:
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