Home Care Connections is seeking exceptional, reliable, warm and compassionate CNA's for assignments in Douglas, Cobb, Cherokee, Paulding and Fulton counties. We are an independent, non-medical, in-home care agency. Our CNA's help seniors to enjoy life in their own home; provide non-medical assistance with activities of daily living, meal preparation, social activities, light housekeeping, etc.
The following certifications are required:
1. Hold a current GA CNA license (if required for patient care)
2. Have a current CPR and First Aid Certificate
3. Have a negative TB test result or Chest X-ray
4. Have a reliable car, a valid driver's license and proof of auto insurance
5. Pass a national criminal background check
6. Must have a valid Social Security number
7. Must have regular access to the internet/email (optional)
Other job requirements include:
1. Available for 2-10 hours per day
2. A minimum of 2 or more years of personal care experience or Companion, PCA or CNA
3. Personal and professional references
4. Ability to speak, read and write English
5. Must be dependable and passionate about caring for others
Email Your resume Today!!! Healthconnectionga@gmail.com
Home Care Connection is a blog that is devoted to Home Care administration and clinical issues. Providing education and tips to those in the home Care market. Here, information is learned and ideas are shared.
Wednesday, January 8, 2014
Thursday, January 2, 2014
CMS Announced PECOS Activation for January 6, 2014
The Centers for Medicare & Medicaid Services (CMS) announced the full
implementation of the Provider Enrollment, Chain and Ownership System (PECOS)
edits onordering/referring providers in Medicare Part B, DME, and Part A home
health agency (HHA) claims. CMS will turn on the Phase 2 denial edits beginning
January 6, 2014. This means that Medicare will deny claims for services or
supplies that require an ordering/referring provider to be identified - and that
provider is not identified, is not in Medicare's enrollment records, or is not
of a specialty type that may order/refer the service/item being billed.
This will be the second attempt by CMS to implement the PECOS edits. CMS issued a Special Edition MLN Matters® Articleon March 1, 2013, that announced the full implementation of the PECOS edits effective May 1, 2013, however, due to technical issues delayed the implementation.
This announcement reiterates the rational for the requirement and CMS’ implementation policy for ensuring that only physicians who are eligible to order and refer home health services are reported on claims with a their associated national provider identifier (NPI). The following is an excerpt from the MLN Matters®:
CMS began Phase 1 of the PECOS edits on October 5, 2009, which alerts the billing provider, through informational messages on remittance advices, when the identification of the ordering/referring provider is missing, incomplete, or invalid, or that the ordering/referring provider is not eligible to order or refer.
Effective January 6, 2014, Phase 2 of the PECOS edits will begin. CMS will turn on the edits to deny Part B clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits.
CMS has clarified, in accord with Change Request 8356- Handling of Incomplete or Invalid Claims once the Phase 2 Ordering and Referring Edits are Implemented, that claims submitted identifying an ordering/referring provider and the required matching NPI is missing will be rejected.
Additionally, CMS has reversed their previous instructions to clarifythat claims be denied because they failed the ordering/referring edit will not expose a Medicare beneficiary to liability. Therefore, an Advance Beneficiary Notice is not appropriate in this situation.
The National Association for Home Care & Hospice will continue to report updated information related to PECOS edit implementation as it becomes available.
This will be the second attempt by CMS to implement the PECOS edits. CMS issued a Special Edition MLN Matters® Articleon March 1, 2013, that announced the full implementation of the PECOS edits effective May 1, 2013, however, due to technical issues delayed the implementation.
This announcement reiterates the rational for the requirement and CMS’ implementation policy for ensuring that only physicians who are eligible to order and refer home health services are reported on claims with a their associated national provider identifier (NPI). The following is an excerpt from the MLN Matters®:
“The Affordable Care Act, Section 6405,
“Physicians Who Order Items or Services are required to be Medicare Enrolled
Physicians or Eligible Professionals,” requires physicians or other eligible
professionals to be enrolled in the Medicare Program to order or refer items or
services for Medicare beneficiaries. Some physicians or other eligible
professionals do not and will not send claims to a Medicare contractor for the
services they furnish and therefore may not be enrolled in the Medicare program.
Also, effective January 1, 1992, a physician or supplier that bills Medicare for
a service or item must show the name and unique identifier of the attending
physician on the claim if that service or item was the result of an order or
referral. Effective May 23, 2008, the unique identifier was determined to be the
NPI. The Centers for Medicare & Medicaid Services (CMS) has implemented
edits on ordering and referring providers when they are required to be
identified in Part B clinical laboratory and imaging, DME, and Part A HHA claims
from Medicare providers or suppliers who furnished items or services as a result
of orders or referrals.
Below are examples of some of these types of claims:
- Claims from clinical laboratories for ordered tests;
- Claims from imaging centers for ordered imaging procedures;
- Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS; and
- Claims from Part A Home Health Agencies (HHA).
Only physicians and certain types of non-physician practitioners are eligible to order or refer items or services for Medicare beneficiaries. They are as follows:Physicians and others who are eligible to order and refer items or services need to establish their Medicare enrollment record and must be of a specialty that is eligible to order and refer. Physicians and others who are eligible to order and refer items or services need to establish their Medicare enrollment record with a valid NPI and must be of a specialty that is eligible to order and refer. If the ordering/referring provider is listed on the claim, the edits will verify that the provider is enrolled in Medicare. The edits will compare the first four letters of the last name. When submitting the CMS-1500 or the CMS-1450, please only include the first and last name as it appears on the ordering and referring file found here on the CMS website.
- Physicians (doctor of medicine or osteopathy, doctor of dental medicine, doctor of dental surgery, doctor of podiatric medicine, doctor of optometry, optometrists may only order and refer DMEPOS products/services and laboratory and X-Ray services payable under Medicare Part B.)
- Physician Assistants,
- Clinical Nurse Specialists,
- Nurse Practitioners,
- Clinical Psychologists,
- Interns, Residents, and Fellows,
- Certified Nurse Midwives, and
- Clinical Social Workers.
CMS began Phase 1 of the PECOS edits on October 5, 2009, which alerts the billing provider, through informational messages on remittance advices, when the identification of the ordering/referring provider is missing, incomplete, or invalid, or that the ordering/referring provider is not eligible to order or refer.
Effective January 6, 2014, Phase 2 of the PECOS edits will begin. CMS will turn on the edits to deny Part B clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits.
CMS has clarified, in accord with Change Request 8356- Handling of Incomplete or Invalid Claims once the Phase 2 Ordering and Referring Edits are Implemented, that claims submitted identifying an ordering/referring provider and the required matching NPI is missing will be rejected.
Additionally, CMS has reversed their previous instructions to clarifythat claims be denied because they failed the ordering/referring edit will not expose a Medicare beneficiary to liability. Therefore, an Advance Beneficiary Notice is not appropriate in this situation.
The National Association for Home Care & Hospice will continue to report updated information related to PECOS edit implementation as it becomes available.
Wednesday, October 2, 2013
What the Government Shutdown means for Home Health
NAHC: What the Government Shutdown Means for Home Health
by Alyssa Gerace on OCTOBER 2, 2013 in HHS, NEWS
Following the inability of the House, Senate, and White House to reach an agreement or compromise on funding for the Federal Government, the new fiscal year beginning October 1, 2013 started off with a government shutdown that has closed many departments or depleted their workforces.
However, the government shutdown will have only a minimal impact on the home health and hospice industries, says an industry trade group, thanks to Medicare and Medicaid’s status as entitlement programs that are deemed “mandatory spending.”
“[T]he home health and hospice community likely will be minimally affected since Medicare and Medicaid are entitlement programs that are deemed ‘mandatory spending’ and therefore not part of the government’s discretionary spending negotiations,” says the National Association of Hospice & Home Care. “At this point, it looks likely that Medicare payments to providers would continue unabated, yet slowdowns in payments are still possible depending on how CMS staff or contractors are affected.”
The Department of Health & Human Services (HHS) has furloughed more than half its workforce as a result of the shutdown. This could have an effect on programs and services that haven’t been categorized as mandatory, essential, or deemed as top priorities, NAHC cautions.
View the Department of Housing & Human Services Contingency Plan for more information.
Written by Alyssa Gerace
A Guide to the New Exchange for Health Insurance
A Guide to the New Exchanges for Health Insurance
Given all of the rhetoric about the Obama administration’s health care law,
it’s not surprising that many consumers are confused about how the new insurance
exchanges will actually work. Some states that oppose the law have gone as far
as intentionally limiting the information that trickles out to its residents.
But after much anticipation, the curtain will finally rise on the exchanges next week, providing millions of consumers with an online marketplace to compare health insurance plans and then buy the coverage on the spot.
The exchanges are likely to be most attractive to people who qualify for subsidized coverage. Individuals with low and moderate incomes may be eligible for a tax credit, which can be used right away, like a gift card, to reduce their monthly premiums. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). And all of the plans on the exchanges will be required to cover a list of essential services, from maternity care to mental health care.
“In today’s individual market, it’s like Swiss cheese coverage,” said Sarah Dash, a research fellow at the Health Policy Institute at Georgetown University. “Consumers should have an easier time figuring out what they are getting for their money.”
But it’s still going to take some time to analyze the plans and their costs, which are expected to vary widely across the states. And the coverage may still pinch many families’ budgets. Fortunately, there’s a six-month window, from now to March 31, for people to figure it all out.
Here’s some information to get you started:
Q. Where can I apply or get more information on the exchanges?
A. To avoid fraud artists, enter through the front door: Healthcare.gov. From there, you can find links to the exchange offered in your state. There may be technical glitches as the program gets started, so alternatively, you can call 1-800-318-2596.
Q . When does coverage go into effect?
A. You can apply as early as Oct. 1, but coverage won’t begin until Jan. 1. The enrollment period for coverage in 2014 closes on March 31, 2014. After that, you can enroll only if you have a major life event like a job loss, birth, marriage or divorce.
Q. What sort of coverage will be offered?
A. All plans will have to provide the same set of essential benefits, including prescriptions, preventive care, doctor visits, emergency services and hospitalization (this also applies to most individual and small-employer group plans sold outside of the exchanges). But plans can offer additional benefits, or different numbers of services like physical therapy, so you’ll need to do a side-by-side comparison to see what fits your needs — or at least the needs you can anticipate.
Q. Are the plans sold on the exchange more comprehensive than plans outside?
A. There are four plan levels, each named for a precious metal. They all generally offer the same essential benefits, but their cost structures vary. The lower the premium, the higher the out-of-pocket costs.
The bronze level plan, for instance, has the lowest premiums, but will require consumers to shoulder more costs out of pocket. They generally cover 60 percent of a typical population’s out-of-pocket costs, and include deductibles, co-payments and coinsurance. The silver plans cover 70 percent; gold, 80 percent; while platinum covers 90 percent (and therefore carries the highest premiums).
If you buy a plan on an exchange, your annual out-of-pocket costs cannot exceed $6,350 for individuals and $12,700 for a family of two or more in 2014. Catastrophic plans are also available to people under age 30 or those suffering a financial hardship. These carry high deductibles (equivalent to the out-of-pocket maximum, or $6,350 for a single person, in 2014). You cannot apply tax credits to these plans, either.
Premiums will vary across the states because of a variety of factors, like market competition, the underlying cost of care and the negotiating power of the exchanges, according to Kaiser research.
Q. If the costs with plan levels are similar, how will plans differ within the metal levels?
A. Networks of doctors and hospitals will differ, and cost-sharing structures may also vary. One plan might have lower deductibles and higher co-pays, whereas another plan might have a separate deductible for prescriptions. Various medications may also be covered differently. “If you are someone who is taking medicines, make sure you know what your drugs will cost in the various plans being offered,” said Cheryl Fish-Parcham, deputy director of health policy at Families USA, a Washington consumer advocacy group.
Q. Will I be eligible for a premium tax credit (subsidized coverage)?
A. People with income between 100 percent of the poverty line (or about $23,550 for a family of four) and 400 percent of poverty ($94,200 for a family of four) are eligible for a tax credit to defray premium costs. (All income eligibility is based on your modified adjusted gross income; the online version of this column links to a guide explaining how that is calculated).
The tax credits are set up so that consumers will not have to pay more than a certain percentage of their income, ranging from 2 percent for those with incomes of up to 133 percent of the poverty level ($15,282 for a single and $31,322 for a family of four) to 9.5 percent for those with income of 300 to 400 percent of the poverty level, according to the Center on Budget and Policy Priorities. The dollar amounts of the credits are calculated based on the costs of the second-to-lowest-cost silver plan available to you.
Kaiser has a calculator that can give you an idea of your eligibility.
Q. Can I get help with my out-of-pocket expenses, like deductibles?
A. People with incomes between 100 percent of the federal poverty line ($23,550 for a family of four) and 250 percent ($58,875 for a family of four) are also eligible for cost-sharing reductions, which means you’ll pay less for items including deductibles and co-payments, and you’ll have lower out-of-pocket maximums.
There is a big caveat: you can qualify for the reductions only if you buy a silver plan. When choosing a silver plan — and compare them closely, because they will differ — the exchange Web site will automatically show what you will pay, with the cost-sharing reductions included, according to the Center on Budget and Policy Priorities.
Even if you’re tempted by the bronze plans’ lower premiums, remember you’ll probably end up paying more for out-of-pocket costs. For people who qualify for both premium and cost-sharing subsidies, the silver plan will usually be the better deal, Ms. Fish-Parcham said.
Q. Should I use all of my subsidy at once? How can I avoid owing taxes?
A. The premium subsidies are delivered in the form of a refundable tax credit, which can be used immediately to reduce your monthly premiums.
You can use it all right away, or you can use part of it, or none at all. If you expect your income to remain the same, you might use the entire credit. But if your income is likely to rise, it may pay to use only a portion of the subsidy. That way, you’ll avoid owing money to the I.R.S. at tax time.
If your income does change, report it to the exchange. If your income drops, you may be eligible for a larger credit. Changes in family size should also be reported. “It will all get reconciled on your taxes in the spring of 2015,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
Q. How can I find out if my doctor accepts exchange-based insurance?
A. Many of the insurance providers’ networks of doctors and hospitals will be narrower than are typically found in commercial insurance, as my colleague reported this week. So just because your doctor accepts, say, a Blue Cross plan provided by your employer, that doesn’t necessarily mean the doctor will take the same carrier’s plan offered on the exchange.
The plans will be required to provide a directory that lists their network’s providers, Ms. Pollitz said, so inspect them carefully.
Q. How will I know if my drugs are covered by the plans?
A. The exchanges must include a summary of benefits and coverage for each plan. That includes information about what your co-payments would be for generic, brand name and specialty drugs. It should also provide a Web link to the plan’s list of covered drugs and how they are categorized by a particular plan, said Ms. Fish-Parcham.
Q. If I have employer-based coverage, can I go to the exchange for coverage?
A. You can, but you probably won’t want to. Your employer’s plan is usually a better deal. Many employers heavily subsidize your premiums and you can pay for your coverage using pretax dollars, something you can’t do if you buy coverage on the exchange.
“Plus, employer plans are typically fairly generous,” said Lynn Quincy, a senior policy analyst at Consumers Union.
Besides, if your employer offers you coverage, you probably won’t qualify for a tax credit unless your share of the premium (for the lowest-cost plan for individual coverage offered by your employer) is more than 9.5 percent of your modified adjusted gross income, Ms. Quincy explained.
If your employer’s insurance plan doesn’t cover 60 percent of medical costs, on average (what’s known as “minimum value”) you may also qualify for subsidized coverage. Your employer is supposed to let you know where the plan falls in terms of minimum costs. “If you are spending huge amounts out of pocket each year and you have a high deductible, it’s worth looking at what your possibilities are,” said Sara R. Collins, vice president of the health care coverage and access program at the Commonwealth Fund.
Q. Am I eligible for Medicaid?
A. The health care law aimed to expand Medicaid so that everyone under age 65 would qualify if they earned up to 138 percent of the federal poverty level (that’s about $16,000 for an individual and $32,500 for a family of four in 2014). But the Supreme Court ruled in June that the decision to expand Medicaid is up to the states — and only 26 states have decided to move forward, according to Kaiser.
Q. So if I’m poor but not eligible for Medicaid, can I get insurance on the exchange?
A. Yes, but unfortunately, many people in this situation won’t be able to afford it. People who don’t qualify for their state’s Medicaid program but earn too little to qualify for subsidies on the exchange will have to pay full price for the coverage offered on the exchanges. So if you can’t get Medicaid and your income is below 100 percent of the poverty level, you will not be eligible for subsidized coverage on the exchange.
Q. What if I’m self-employed or own a small business?
A. If you’re self-employed with no employees, you can shop for coverage on the exchange.
If you have fewer than 50 employees, you can get coverage for yourself and your workers though the Small Business Health Options program, known as the SHOP Marketplace. “Small employers have always wanted to have the buying clout of a large employer and the SHOP exchanges offer them just that,” said Kevin Lucia, project director at Georgetown University’s Health Policy Institute.
Q. What are the penalties for not having coverage? Are there any exceptions?
A. Most people will be required to have insurance, with some exceptions. You are not required to buy insurance if: the cost of insurance premiums would exceed 8 percent of your income, your income is below the threshold for filing taxes, you have a certified hardship, or you would have qualified for Medicaid but live in a state that did not expand the program. Illegal immigrants, the incarcerated, members of Indian tribes and those who qualify for certain religious reasons are also exempt.
Everyone else will pay a penalty. In 2014, it will cost you $95 or approximately 1 percent of your income, whichever is greater. The penalties will rise each year.
But after much anticipation, the curtain will finally rise on the exchanges next week, providing millions of consumers with an online marketplace to compare health insurance plans and then buy the coverage on the spot.
The exchanges are likely to be most attractive to people who qualify for subsidized coverage. Individuals with low and moderate incomes may be eligible for a tax credit, which can be used right away, like a gift card, to reduce their monthly premiums. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). And all of the plans on the exchanges will be required to cover a list of essential services, from maternity care to mental health care.
“In today’s individual market, it’s like Swiss cheese coverage,” said Sarah Dash, a research fellow at the Health Policy Institute at Georgetown University. “Consumers should have an easier time figuring out what they are getting for their money.”
But it’s still going to take some time to analyze the plans and their costs, which are expected to vary widely across the states. And the coverage may still pinch many families’ budgets. Fortunately, there’s a six-month window, from now to March 31, for people to figure it all out.
Here’s some information to get you started:
Q. Where can I apply or get more information on the exchanges?
A. To avoid fraud artists, enter through the front door: Healthcare.gov. From there, you can find links to the exchange offered in your state. There may be technical glitches as the program gets started, so alternatively, you can call 1-800-318-2596.
Q . When does coverage go into effect?
A. You can apply as early as Oct. 1, but coverage won’t begin until Jan. 1. The enrollment period for coverage in 2014 closes on March 31, 2014. After that, you can enroll only if you have a major life event like a job loss, birth, marriage or divorce.
Q. What sort of coverage will be offered?
A. All plans will have to provide the same set of essential benefits, including prescriptions, preventive care, doctor visits, emergency services and hospitalization (this also applies to most individual and small-employer group plans sold outside of the exchanges). But plans can offer additional benefits, or different numbers of services like physical therapy, so you’ll need to do a side-by-side comparison to see what fits your needs — or at least the needs you can anticipate.
Q. Are the plans sold on the exchange more comprehensive than plans outside?
A. There are four plan levels, each named for a precious metal. They all generally offer the same essential benefits, but their cost structures vary. The lower the premium, the higher the out-of-pocket costs.
The bronze level plan, for instance, has the lowest premiums, but will require consumers to shoulder more costs out of pocket. They generally cover 60 percent of a typical population’s out-of-pocket costs, and include deductibles, co-payments and coinsurance. The silver plans cover 70 percent; gold, 80 percent; while platinum covers 90 percent (and therefore carries the highest premiums).
If you buy a plan on an exchange, your annual out-of-pocket costs cannot exceed $6,350 for individuals and $12,700 for a family of two or more in 2014. Catastrophic plans are also available to people under age 30 or those suffering a financial hardship. These carry high deductibles (equivalent to the out-of-pocket maximum, or $6,350 for a single person, in 2014). You cannot apply tax credits to these plans, either.
Premiums will vary across the states because of a variety of factors, like market competition, the underlying cost of care and the negotiating power of the exchanges, according to Kaiser research.
Q. If the costs with plan levels are similar, how will plans differ within the metal levels?
A. Networks of doctors and hospitals will differ, and cost-sharing structures may also vary. One plan might have lower deductibles and higher co-pays, whereas another plan might have a separate deductible for prescriptions. Various medications may also be covered differently. “If you are someone who is taking medicines, make sure you know what your drugs will cost in the various plans being offered,” said Cheryl Fish-Parcham, deputy director of health policy at Families USA, a Washington consumer advocacy group.
Q. Will I be eligible for a premium tax credit (subsidized coverage)?
A. People with income between 100 percent of the poverty line (or about $23,550 for a family of four) and 400 percent of poverty ($94,200 for a family of four) are eligible for a tax credit to defray premium costs. (All income eligibility is based on your modified adjusted gross income; the online version of this column links to a guide explaining how that is calculated).
The tax credits are set up so that consumers will not have to pay more than a certain percentage of their income, ranging from 2 percent for those with incomes of up to 133 percent of the poverty level ($15,282 for a single and $31,322 for a family of four) to 9.5 percent for those with income of 300 to 400 percent of the poverty level, according to the Center on Budget and Policy Priorities. The dollar amounts of the credits are calculated based on the costs of the second-to-lowest-cost silver plan available to you.
Kaiser has a calculator that can give you an idea of your eligibility.
Q. Can I get help with my out-of-pocket expenses, like deductibles?
A. People with incomes between 100 percent of the federal poverty line ($23,550 for a family of four) and 250 percent ($58,875 for a family of four) are also eligible for cost-sharing reductions, which means you’ll pay less for items including deductibles and co-payments, and you’ll have lower out-of-pocket maximums.
There is a big caveat: you can qualify for the reductions only if you buy a silver plan. When choosing a silver plan — and compare them closely, because they will differ — the exchange Web site will automatically show what you will pay, with the cost-sharing reductions included, according to the Center on Budget and Policy Priorities.
Even if you’re tempted by the bronze plans’ lower premiums, remember you’ll probably end up paying more for out-of-pocket costs. For people who qualify for both premium and cost-sharing subsidies, the silver plan will usually be the better deal, Ms. Fish-Parcham said.
Q. Should I use all of my subsidy at once? How can I avoid owing taxes?
A. The premium subsidies are delivered in the form of a refundable tax credit, which can be used immediately to reduce your monthly premiums.
You can use it all right away, or you can use part of it, or none at all. If you expect your income to remain the same, you might use the entire credit. But if your income is likely to rise, it may pay to use only a portion of the subsidy. That way, you’ll avoid owing money to the I.R.S. at tax time.
If your income does change, report it to the exchange. If your income drops, you may be eligible for a larger credit. Changes in family size should also be reported. “It will all get reconciled on your taxes in the spring of 2015,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
Q. How can I find out if my doctor accepts exchange-based insurance?
A. Many of the insurance providers’ networks of doctors and hospitals will be narrower than are typically found in commercial insurance, as my colleague reported this week. So just because your doctor accepts, say, a Blue Cross plan provided by your employer, that doesn’t necessarily mean the doctor will take the same carrier’s plan offered on the exchange.
The plans will be required to provide a directory that lists their network’s providers, Ms. Pollitz said, so inspect them carefully.
Q. How will I know if my drugs are covered by the plans?
A. The exchanges must include a summary of benefits and coverage for each plan. That includes information about what your co-payments would be for generic, brand name and specialty drugs. It should also provide a Web link to the plan’s list of covered drugs and how they are categorized by a particular plan, said Ms. Fish-Parcham.
Q. If I have employer-based coverage, can I go to the exchange for coverage?
A. You can, but you probably won’t want to. Your employer’s plan is usually a better deal. Many employers heavily subsidize your premiums and you can pay for your coverage using pretax dollars, something you can’t do if you buy coverage on the exchange.
“Plus, employer plans are typically fairly generous,” said Lynn Quincy, a senior policy analyst at Consumers Union.
Besides, if your employer offers you coverage, you probably won’t qualify for a tax credit unless your share of the premium (for the lowest-cost plan for individual coverage offered by your employer) is more than 9.5 percent of your modified adjusted gross income, Ms. Quincy explained.
If your employer’s insurance plan doesn’t cover 60 percent of medical costs, on average (what’s known as “minimum value”) you may also qualify for subsidized coverage. Your employer is supposed to let you know where the plan falls in terms of minimum costs. “If you are spending huge amounts out of pocket each year and you have a high deductible, it’s worth looking at what your possibilities are,” said Sara R. Collins, vice president of the health care coverage and access program at the Commonwealth Fund.
Q. Am I eligible for Medicaid?
A. The health care law aimed to expand Medicaid so that everyone under age 65 would qualify if they earned up to 138 percent of the federal poverty level (that’s about $16,000 for an individual and $32,500 for a family of four in 2014). But the Supreme Court ruled in June that the decision to expand Medicaid is up to the states — and only 26 states have decided to move forward, according to Kaiser.
Q. So if I’m poor but not eligible for Medicaid, can I get insurance on the exchange?
A. Yes, but unfortunately, many people in this situation won’t be able to afford it. People who don’t qualify for their state’s Medicaid program but earn too little to qualify for subsidies on the exchange will have to pay full price for the coverage offered on the exchanges. So if you can’t get Medicaid and your income is below 100 percent of the poverty level, you will not be eligible for subsidized coverage on the exchange.
Q. What if I’m self-employed or own a small business?
A. If you’re self-employed with no employees, you can shop for coverage on the exchange.
If you have fewer than 50 employees, you can get coverage for yourself and your workers though the Small Business Health Options program, known as the SHOP Marketplace. “Small employers have always wanted to have the buying clout of a large employer and the SHOP exchanges offer them just that,” said Kevin Lucia, project director at Georgetown University’s Health Policy Institute.
Q. What are the penalties for not having coverage? Are there any exceptions?
A. Most people will be required to have insurance, with some exceptions. You are not required to buy insurance if: the cost of insurance premiums would exceed 8 percent of your income, your income is below the threshold for filing taxes, you have a certified hardship, or you would have qualified for Medicaid but live in a state that did not expand the program. Illegal immigrants, the incarcerated, members of Indian tribes and those who qualify for certain religious reasons are also exempt.
Everyone else will pay a penalty. In 2014, it will cost you $95 or approximately 1 percent of your income, whichever is greater. The penalties will rise each year.
Tuesday, October 1, 2013
Government Services During the Shutdown
Aviation – The Federal Aviation Administration continues to ensure the safety of air travelers in the United States.
Border Security – Border patrol programs and operations as well as ports of entry operations, including cargo security and revenue collections, continue.
Citizenship and Immigration Services – U.S. Citizenship and Immigration services continues to operate. Applications, forms, wait times, and more remain available online (except for E-Verify).
Coast Guard – The U.S. Coast Guard continues to operate, including military functions, port security, search and rescue, and maritime safety.
Emergency Management – The Federal Emergency Management Agency (FEMA) will continue to operate disaster relief operations and the national flood insurance program.
Energy – The U.S. Department of Energy continues operations with limited personnel.
Environment – Limited personnel from the Environmental Protection Agency will remain on duty to respond to emergencies.
Federal Courts – The federal court system continues to operate.
Federal Reserve – The Federal Reserve remains open with normal staffing.
Food Safety – Meat and poultry inspections continue.
Food Stamps – The Supplemental Nutrition Assistance Program, also known as food stamps, continue to operate.
Free Application for Federal Student Aid (FAFSA) – The Department of Education continues to accept and process FAFSA applications.
Health Insurance Marketplace – Consumers can go to HealthCare.gov to find the state marketplace to serve them; and can apply and choose a plan, with coverage beginning as early as January 1, 2014.
Home Loan Guarantees – The Federal Housing Administration is not making new home loan guarantees during the shutdown.
Immigration Enforcement – Immigration enforcement and removal operations will continue.
Jobs – Government jobs will be available and updated on USAJobs.gov. Job applications may not be processed at advertising agencies until the government reopens.
Library of Congress – Facilities are closed to the public.
Mail and Postal Services – Mail services continue and post offices remain open.
Medicare and Medicaid – Medicare and Medicaid benefits continue, though benefits could be affected in the event of an extended shutdown.
Military Personnel and DoD Civilians – Military service members continue to work. Only DoD civilians performing essential activities continue to work.
National Institutes of Health (NIH) – NIH's clinical center is not taking new patients or initiating new clinical trials. However, trials that were in process before the government shutdown continue.
National Parks and Landmarks – National parks and landmarks are closed to the public.
National Zoo – The National Zoo is closed to the public.
Operating Status – Visit the U.S. Office of Personnel Management for the most up-to-date operating status of the federal government.
Passports – Expedited passports that were already in progress will be processed, but no new passport applications will be accepted during the shutdown.
Patents and Trademarks – The U.S. Patent and Trademark Office remains operational.
Presidential Libraries – All Presidential Libraries are closed to the public.
Small Business Loans – The Small Business Administration is not processing applications of business loans during the shutdown.
Smithsonian Institution – The Smithsonian Institution is closed to the public.
Social Security – Some services will be unavailable, but Social Security payments will continue to go out.
Transportation Security – The Transportation Security Administration continues passenger, baggage screening and operation of the Federal Air Marshal Service.
Travel Warnings – The State Department continues to issue travel warnings and emergency services for U.S. Citizens abroad.
Veterans' Services – Medical services will continue to be provided by the Department of Veterans Affairs, but benefit programs may be affected.
Weather – The National Weather Service continues to issue weather alerts, forecasts, and warnings.
Women, Infants, and Children – Federal grants to States for assistance to low-income women, infants, and children continues.
Monday, September 30, 2013
Middle Income Baby Boomers Say Home Care is Their Top Pick
Today’s “middle income” baby boomers, or those falling into the income bracket between $25,000 and $75,000 annually, say their preference for receiving care in retirement is to receive care in their homes.
They’ve also redefined their retirement expectations, according to a report from the Center for a Secure Retirement.
More than half of these upcoming retirees believe their retirement care will not be the same as it was for previous generations, Largely, this population, defined by the study as Americans ages 49 to 67, in the middle income bracket, believes it will be more active and more satisfied in retirement, but that it will not be able to rely on care from family members or insurance provided by former employees.
Further, a majority—at 84%—say they wish to age in their homes, while 30% say they prefer an independent living community as a place to receive care in retirement.
And of those surveyed, only 8% have a detailed plan for retirement, versus 72% who have no plan and one in five who have a “rough plan.”
The survey was conducted in April 2013 by the Bankers Life and Casualty Company Center for a Secure Retirement. View the survey results.
Written by Elizabeth Ecker
They’ve also redefined their retirement expectations, according to a report from the Center for a Secure Retirement.
More than half of these upcoming retirees believe their retirement care will not be the same as it was for previous generations, Largely, this population, defined by the study as Americans ages 49 to 67, in the middle income bracket, believes it will be more active and more satisfied in retirement, but that it will not be able to rely on care from family members or insurance provided by former employees.
Further, a majority—at 84%—say they wish to age in their homes, while 30% say they prefer an independent living community as a place to receive care in retirement.
And of those surveyed, only 8% have a detailed plan for retirement, versus 72% who have no plan and one in five who have a “rough plan.”
The survey was conducted in April 2013 by the Bankers Life and Casualty Company Center for a Secure Retirement. View the survey results.
Written by Elizabeth Ecker
Tuesday, August 27, 2013
Shrinking Caregiver Supply to Impact In-Home Care: AARP
Shrinking Caregiver Supply to impact In Home Care
A dramatically shrinking supply of caregivers will have major implications on how long-term supports and services are delivered to seniors, says AARP, and it will impact peoples’ ability to remain at home if they develop long-term care needs.
“Family caregivers—including family members, partners, or close friends—are a key factor in the ability to remain in one’s home and in the community when disability strikes,” says the AARP Public Policy Institute in an Insight report. “More than two-thirds of Americans believe that they will be able to rely on their families to meet their [long-term services and supports] needs when they require help, but this belief may collide with the reality of dramatically shrinking availability of family caregivers.”
The United States is less than two decades away from what’s been called “the 2030 problem”—when a large number of boomers enter late old age at the same time that the caregiving population is in steep decline, says AARP.
“These trends have had major implications for public programs that provide LTSS assistance,” says the report.
What’s happening is a plummet in the “caregiver support ratio”—the number of potential caregivers between the ages of 45 and 64, for each person aged 80 and older. The 80-plus demographic is the most likely to need LTSS, says AARP, while the boomer generation is currently functioning as the most common age range for caregivers.
Between 2010 and 2030, the caregiver support ratio will go from seven potential caregivers for each person in the “high-risk” years of 80-plus, down to four.
“The departure of the boomers from the peak caregiving years will mean that the population aged 45–64 is projected to increase by only 1 percent between 2010 and 2030,” says the paper. “During the same period, the 80-plus population is projected to increase by a whopping 79 percent.”
Seven in 10 people aged 80 and older had some kind of disability in 2010, AARP says, while nearly 56% have a severe disability and about a third need assistance from others with one or more activities of daily living.
Timely policy action is needed to meet the expected needs of the growing senior population, says the report.
“Rising demand and shrinking families to provide support suggest that the United States needs a comprehensive person- and family-centered LTSS policy that would better serve the needs of older persons with disabilities, support family and friends in their caregiving roles, and promote greater efficiencies in public spending,” AARP concludes. “The challenges that face us are real, but they are not insurmountable—if we begin now to lay the foundation for a better system of LTSS and family support for the future.”
Written by Alyssa Gerace
A dramatically shrinking supply of caregivers will have major implications on how long-term supports and services are delivered to seniors, says AARP, and it will impact peoples’ ability to remain at home if they develop long-term care needs.
“Family caregivers—including family members, partners, or close friends—are a key factor in the ability to remain in one’s home and in the community when disability strikes,” says the AARP Public Policy Institute in an Insight report. “More than two-thirds of Americans believe that they will be able to rely on their families to meet their [long-term services and supports] needs when they require help, but this belief may collide with the reality of dramatically shrinking availability of family caregivers.”
The United States is less than two decades away from what’s been called “the 2030 problem”—when a large number of boomers enter late old age at the same time that the caregiving population is in steep decline, says AARP.
“These trends have had major implications for public programs that provide LTSS assistance,” says the report.
What’s happening is a plummet in the “caregiver support ratio”—the number of potential caregivers between the ages of 45 and 64, for each person aged 80 and older. The 80-plus demographic is the most likely to need LTSS, says AARP, while the boomer generation is currently functioning as the most common age range for caregivers.
Between 2010 and 2030, the caregiver support ratio will go from seven potential caregivers for each person in the “high-risk” years of 80-plus, down to four.
“The departure of the boomers from the peak caregiving years will mean that the population aged 45–64 is projected to increase by only 1 percent between 2010 and 2030,” says the paper. “During the same period, the 80-plus population is projected to increase by a whopping 79 percent.”
Seven in 10 people aged 80 and older had some kind of disability in 2010, AARP says, while nearly 56% have a severe disability and about a third need assistance from others with one or more activities of daily living.
Timely policy action is needed to meet the expected needs of the growing senior population, says the report.
“Rising demand and shrinking families to provide support suggest that the United States needs a comprehensive person- and family-centered LTSS policy that would better serve the needs of older persons with disabilities, support family and friends in their caregiving roles, and promote greater efficiencies in public spending,” AARP concludes. “The challenges that face us are real, but they are not insurmountable—if we begin now to lay the foundation for a better system of LTSS and family support for the future.”
Written by Alyssa Gerace
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