Month: October 2011

FSA versus HSA

What is an FSA?

  •     Used to pay for medical expenses not paid for by insurance for example this deductibles, copayments, and coinsurance
  •     Can also be used for qualified medical expense, such as dental and vision expenses and over the counter drugs
  •     “Use it or lose it”  money must be spent by the end of the year or the money is lost

Healthcare Reform Impact on FSAs

  •     In 2011 over the counter drugs require a prescription in order to be FSA eligible such as Advil
  •     Beginning in January 2013 a new maximum dollars allowed into account beginning in 2013 of $2500

What is an HSA?

  •     Must also be enrolled in a high deductible health plan
  •     Unlike a FSA the funds roll over year to year if not spent.
  •     Account is owned by the individual
  •     may be used for any qualified medical expense.

Medicare Donut Hole

The Medicare donut hole is the coverage gap in Medicare Part D Drug Coverage, where you are not insured for the cost of drugs

• The gap amount, or dollar threshold where you lose coverage for 2012 is $2930.

This number is calculated on retail costs of the drugs, not what you personally spend, i.e. co-pay or co-insurance.

• You exit the Donut Hole when your total out of pocket expenses reaches $4,700.

This number was calculated in a new way beginning in 2011

• In 2011, and continuing in 2012 when you are in the Donut Hole you will receive discounts of 50% on Brand drugs and 7% on Generic drugs, this will keep you in the hole longer though.

For exiting the donut hole, calculations include not only what you have paid toward your prescriptions, but also what specific extra help programs have paid toward your medication costs.

• After you have spent $4,700 (left the donut hole) catastrophic coverage kicks in and you will have to spend $2.60 per month for generics / $6.50 per month for name brand medications or 5% of the medication’s retail cost, whichever cost is higher.

• Healthcare reform plans on eliminating the Donut Hole in 2020

Obama Tries to Speed Response to Shortages in Vital Medicines

By: George Harris, The New York Times

WASHINGTON — President Obama will issue an executive order on Monday that the administration hopes will help resolve a growing number of critical shortages of vital medicines used to treat life-threatening illnesses, among them several forms of cancer and bacterial infections.

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Still No Relief in Sight for Long-Term Needs

By Gardiner Harris and Robert Pear, The New York Times

WASHINGTON — The law that many Americans had hoped would transform the nation’s dysfunctional system of long-term care for the swelling ranks of people with disabilities and dementia quietly died this month, a victim of its own weaknesses, a toxic political environment and President Obama’s re-election campaign focus on jobs.

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What’s Ahead for Health Plans

By Anna Wilde Mathews, The Wall Street Journal

We ain’t seen nothin’ yet.

The key provisions of the federal health overhaul take effect in 2014, including a requirement for most people to have health insurance; a ban on insurance companies considering individuals’ health status when they sell plans; and the creation of new health-coverage marketplaces called “exchanges.”

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Wal-Mart Cuts Some Health Care Benefits

By Steven Greenhouse and Reed Abelson, The New York Times

After trying to mollify its critics in recent years by offering better health care benefits to its employees, Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff.

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Medicare will cut Social Security’s “raise” in 2012

By Reuters

After two years without an inflation adjustment, the Social Security Administration is expected to announce a 2012 cost-of-living adjustment (COLA) of more than 3 percent next week. That would be a sizable raise in this economy, and very welcome news to seniors hit hard by rising costs, slumping home equity and very low returns on fixed-income investments.

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U.S. Moves to Cut Back Regulations on Hospitals

By Robert Pear, The New York Times

WASHINGTON — The Obama administration moved Tuesday to roll back numerous rules that apply to hospitals and other health care providers after concluding that the standards were obsolete or overly burdensome to the industry.

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Massachusetts Tries to Rein in Its Health Cost

By Abby Goodnough and Kevin Sack

BOSTON — On the Republican campaign trail, the health care debate has focused on the mandatory coverage that Mitt Romney signed into law as governor in 2006. But back in Massachusetts the conversation has moved on, and lawmakers are now confronting the problem that Mr. Romney left unaddressed: the state’s spiraling health care costs.

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Pre-existing Conditions Exclusions

When HealthCare Reform goes into full effect starting January 1, 2014 no healthplan, either sold privately or through the …

Health Insurance Exchange Markets: What You Need To Know

By Susan E. Matthews, Everyday Health Staff Writer MONDAY, September 30, 2013 — Congress may still be debating particulars …

Important healthcare benefit information for federal employees

  Federal Employee Health Benefits and Healthcare Reform As it stands today only those federal employees who are members …