In the past five years since the passage of the Affordable Care Act (ACA), there have been strong supporters and fierce opponents.  No matter what side of the ACA one falls, it’s hard to deny the positive results it has had in some people’s lives. Since 2013, uninsured rate dropped by 31% among Americans ages 50-64.

Elderly Americans are among the most underserved populations in the country, and are at risk of struggling with poverty and disparity in health care.  The ACA expanded access to health insurance coverage to 50- to 64-year-olds through several provisions, including expanding eligibility for Medicaid, subsidies for consumers purchasing coverage through the new health insurance Marketplaces, prohibiting insurance companies from denying coverage or charging higher rates based on medical history, and restricting how much insurers can increase premiums for older consumers.  Prior to the ACA this age group often went without access to health insurance due to high costs, denials based on pre-existing conditions, and limited Medicaid eligibility.

Between December 2013 and December 2014, uninsured rates dropped from 11.6%

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Here at NeedyMeds we regularly refer people to their state’s Medicaid program, and in today’s blog post we are going to explain exactly what Medicaid is and how it functions. Are you currently enrolled in Medicaid? Share your experience with us in the comments section.

How is it Financed?

Medicaid, sometimes called Medical Assistance, is a joint federal and state entitlement program for people with limited income that helps to pay for medical costs. It receives a combination of funding from both the state and federal government. The amount paid to each state by the federal government, also known as the Federal Medical Assistance Percentage or FMAP, varies depending on multiple criteria, notably per capita income. From Medicaid.gov,The regular average state FMAP is 57%, but ranges from 50% in wealthier states up to 75% in states with lower per capita incomes. FMAPs are

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We’ve been getting a lot of questions from our readers about how the resources we list on our website, especially the pharmaceutical patient assistance programs, will be affected by the Affordable Care Act. While we are still far away from having all the answers, we do have some additional information we can provide you after attending a recent PAP Conference. The overarching consensus is that PAPs will continue to exist to help those in need that fall into the gaps.  Here is an overview of what we learned at the CBI PAP 2014 Conference, held in Baltimore on March 6-7.

Background

→ There are currently no shared processes between programs.

→ Open Enrollment ends March 31st

  • Negative image of Affordable Care Act in the media.
  • For those working with the disabled – visit the National Disability Navigator Resource Collaborative for resources http://www.nationaldisabilitynavigator.org.
  • Many advocates are having trouble enrolling the population that has been uninsured for a long time, as they are not informed about how health insurance works at all.

→ Medicaid Donut Hole

  • In the states that have not expanded Medicaid, there are going to be folks too poor to be eligible for subsidies under the marketplace and not poor enough to qualify for Medicaid in their states.

→ Not everyone between 100% and 400% of Federal Poverty Level are eligible for subsidies. This, for example, can depend on age.

Pharma Priorities and Considerations

→ Priorities are to contain costs, increase quality, encourage innovation while enhancing patient access.

→ Legal Considerations.

  • Anti-kickback statute – always a legal issue for companies. Pharmaceutical companies cannot induce (or even appear to induce) patients to use a certain drug.
  • November 2013
    • HHS Secretary Kathleen Sebelius wrote a letter saying that plans purchased on a state or federally run market place are not counted as government sponsored programs.
    • Absent further guidance – these plans are going to be treated as private plans by Patient Assistance Programs (PAPs), foundations, etc.

    → Lingering question – what happens when someone doesn’t pay or defaults on their premium? There is currently a grace period to

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It’s February 5, 2014, and the Affordable Care Act is still here.

There have been lots of changes over the last few weeks, in a few different areas:

  • Marketplaces pushed back the deadline to enroll in a Marketplace plan for coverage to December 23, in order for coverage to begin on January 1.  And some states went even further!
  • Marketplaces have pushed back payment deadlines (allowing people more time to pay their January premiums).  For example, California’s Marketplace pushed back the payment deadline to January 15.  Some health plans are also deciding on their own to give people more time to pay.

So, check with your marketplace or your health plan for your own specific deadlines.

And two weeks ago, the U.S Department of Health & Human Services (HHS) announced that people, who have health insurance coverage through the Pre-Existing Condition Insurance Plan (PCIP), can now keep their plan through March 31, 2014.  These plans were originally supposed to end on December 31, 2014.  However, HHS wanted to give people more time to find a new plan in the Marketplace.  For more information, click here.

If you are on a PCIP plan and want to move to a Marketplace plan before your coverage ends on March 31, then you need to sign up for a Marketplace plan by March 15, in order for your new coverage to begin on April 1.

And for those of you who want some light reading and desperately want to know what a “Risk Corridor” is or who a “Dual Eligible” might be, visit this Affordable Care Act dictionary!

Disclaimer

This post originally appeared on

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Healthcare related costs are a major problem for many Americans who are uninsured and underinsured, even if they are relatively healthy. For people with a serious medical condition these financial problems can be even worse. One diagnosis that finds many patients in an expensive position is HIV/AIDS. A diagnosis of HIV or AIDS comes with a hefty price tag, according to study on NBC news, “An American diagnosed with the AIDS virus can expect to live for about 24 years on average, and the cost of health care over those two-plus decades is more than $600,000, new research indicates… The researchers estimated the monthly cost of care at $2,100, with about two-thirds of that spent on medications.” For patients without insurance these costs are extremely daunting. Luckily, there is a program to help uninsured and underinsured AIDS patients – the Ryan White HIV/AIDS Program, formerly known as the Ryan White CARE (Comprehensive AIDS Resource Emergency) Act.

Who was Ryan White?

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