Having health insurance is vital to one’s health and financial well-being in the United States.  Out-of-pocket medical expenses are the leading cause of personal bankruptcy.  Even with new laws such as the Affordable Care Act (ACA)—aka “Obamacare”—11.7% of Americans remain uninsured.

Analysts have only recently been able to examine the data of uninsured rates prior to ACA’s implementation to now.  WalletHub released the stats for all 50 states and Washington DC and ranked each by their current uninsured rate; Massachusetts is ranked highest with only 3.28% uninsured, and Texas is ranked last with 19.06%.

In numbers, even the last-ranked state Texas reduced children’s uninsured rate by 23.88% and adult uninsured rate by 19.27% between 2010 and 2014. Even with the current highest rate of uninsured Americans, 827,997 people gained health insurance coverage in Texas in the years being analyzed.

Over 10,000,000 previously uninsured Americans are now covered under the ACA.  In a previous

Read more

Last month, we posted a blog about how many Americans are spending more than $50,000 or even $100,000 a year on medications—more  people than ever before. The information included insured Americans and found that insurance covered an average of 97% of prescription costs for those spending at least $50,000. At NeedyMeds, there are many assistance programs for those who are in need.  However, even with new laws and regulations there are those stuck in between.

There are patients in America that make too much money to qualify for assistance but still not enough to pay all their medical bills.  Patient Assistance Programs (PAPs) and non-profit organizations often have limits to how much income a person or family makes in a year to be eligible for their services.  Good jobs and good insurance can still leave patients paying huge amounts for prescribed medications.

Some medications for serious or chronic diseases such as lupus can cost $2500 per dose. Even with insurance that pays 80% of the drug price there is a $450 out-of-pocket payment, which does not include monthly insurance premiums or other medical costs.  One hepatitis

Read more

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%

Read more

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

Read more

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

    Read more