Health Care, Wellness and the Affordable Care Act of 2010

As the valley’s premier Integrative Medicine and Wellness center, avecinia wellness center is committed to your care and well-being.  As such, we are committed to helping empower you so you can make the best choices when it comes to your healthcare and well-being.  Your choice in health insurance should never effect your decisions about improving your health and well-being.  However, since the cost of health insurance is an important factor, it is vital for you to be well informed so you can make the best choice for you and/or your family. We hope the following information helps guide you towards better health and well-being.

In March of 2010, the President signed into law the hotly debated Affordable Care Act.  Whether you agree with the act or not, it is now the law and many of its provisions and benefits kicked in September 23^rd.  But they only apply to new plans, or plans that begin on or after September 23, 2010.   Here is a summary of these benefits, benefits to come and how they affect you (we categorize them by who they affect).  As always recommended, call your insurance provider, employee benefits manager, or a licensed Health Insurance Broker if you have questions about your plan.

For everyone:

•   Preventive Care
• Plans starting on or after September 23, 2010 will cover all your costs for a Preventive Care visit.  That means you do not have to pay a copayment, co-insurance or any deductible for preventive health services such as recommend screenings, vaccinations and counseling.  Keep in mind that coverage is only for in-network providers, and is only applicable if the preventive service is the primary purpose of the visit.  If the preventive service is in addition to other services, your plan may require to pay for the visit. If you have questions, please call your health insurance provider to verify which services are considered preventive and are free to you (i.e., you have no copay, co-insurance or deductible).  When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  If you need to discuss any service or health issue outside what your health insurance plan covers as a preventive service, your provider has to submit that information to the health insurance plan and you may be billed for the visit because it is no longer considered a preventive visit.   
• An End to Pre-Existing Conditions for Children
•  Health Insurers cannot deny children (under 19 years old) health insurance because of preexisting conditions. A ban on adult discrimination will take effect in 2014.  That means if your plan went into effect after September 23, 2010 and in November your child is hospitalized because of a severe asthma attack.  Your new plan cannot deny payment for the hospitalization due to your child’s “pre-existing condition.”  Keep in mind that insurance companies are now reducing the number of children only plans. When looking for an insurance plan, make sure it covers your kids!
•  Coverage for young adults under the age of 26
• Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance plan until they turn 26.  This applies to your kids even if they are married or can get insurance from their employers group plan.  Your child does not have to be living with you or be financially dependent on you.   Keep in mind that you must enroll your children within the open enrollment period. 
• Doctor Choice & ER Access
• The Act helps preserves your choice of primary care physician within your health insurance plans network.  It also prohibits health insurance plans from requiring a referral before you can see a OB-GYN in your network.  Importantly, the Act prevents health insurance plans from requiring higher copayments or co-insurance for out-of-network emergency room services and it prohibits plans from requiring prior approval before seeking emergency room services from a provider or hospital outside of your plan’s network. Keep in mind that you will still be responsible for the difference between the amount billed by the out of network provider and the amount paid by your health insurance plan.
•   Insurance Cancellation
• Health Insurers cannot retroactively rescind (declare your policy invalid from the date you started your policy) your insurance policy for an honest mistake or missing information that has no bearing on your health.  That means if your plan went into effect after September 23, 2010 and you are later diagnosed with cancer, your health insurance provider cannot rescind your plan because you left out your hospitalization for a broken arm 6 years ago. Keep in mind that intentionally falsifying or misleading the insurance company still gives them cause to rescind your policy.  Your health insurance provider has to give you 30 days notice before it can rescind your policy so you can appeal the decision or find new coverage.
• Appealing Health Plan Decisions
• You now have the right to appeal your health insurance providers denial of payment, service or treatment.  If your plan upholds its denial, you have the right to ask for an independent review.  Keep in mind that your state may have additional rules/regulations that effect your appeal.  For more information in California, click here.
• Lifetime and Annual Limits
•  Lifetime limits on most benefits are prohibited on plans issued or renewed after September 23, 2010.  Annual Limit are being phased out as well.  No plan that begins after September 23, 2010 can set an annual limit lower than $750,000.  By January 1, 2014, no annual limits will be allowed on most covered benefits. Keep in mind that the ban on limits only applies to essential services.  Some plans may be eligible for a waiver if complying with the ban on the limit would mean a significant decrease in benefits or increase in premiums.

For Medicare:

• Preventive Care
• Medicare must now pay for 100 percent of the cost of annual physicals and other preventive care visits (see above for more information).
•  Seniors Receive “Donut Hole” Rebate
•  Seniors with Medicare prescription drug coverage that have reached their coverage gap in 2010 will get a 1 time tax free $250 rebate. Beginning in 2011, Medicare recipients will receive 50% off of covered brand-name drugs while in the “donut hole.”
•  Stronger Medicare Anti-Fraud provisions
• Visit www.stopmedicarefraud.gov to see how you can help curtail Medicare fraud.

For Businesses:

•  Small business tax credit for providing health insurance
• Small business with less than 25 employees may be eligible for a tax credit of up to 35% to offset the cost of providing health insurance to their employees.  If you are a small business owner, check with your accountant to see if you qualify or how you can qualify.
• Wellness Program Grants for Small Business
•  Small business with less than 100 employees may be eligible for grants to cover Wellness Programs that started after March 23, 2010.  Grants will be available in 2011.
• Early Retirement Reinsurance Program
• The Act provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.

To learn more about the provisions of the Affordable Care Act, visit www.healthcare.gov.  To learn more about Medicare, visit www.n4a.org.  
This video is a helpful summary

Choosing an Health Insurance Plan

If you are purchasing a health insurance plan on your own or your employer gives you the option to select from a variety of health insurance plans, visit the California Department of Insurance PPO Ratings to learn which plans had the best rankings. According to the Department of Insurance, Aetna PPO, CIGNA PPO and Health Net of California PPO rated the highest as rated by their members across a variety of standards.  As a practice, we have noticed that Aetna, CIGNA, and United Healthcare provide coverage for a wide range of services, have less administrative burdens, and are more consumer friendly and oriented than other health insurance companies.  You can also contact a licensed Insurance Broker who will help guide you through the insurance maze and help you find the plan that best fits your needs.  A broker will do this for you for free because they get a commission from the insurance company.  Overall, insurance companies pay the same amount of commission so a licensed broker should not be swayed towards one policy or another but should help you find the solution that is best for you.  If you are looking for a broker or have questions in general, contact Shane Moore at Valley Employee Benefits & Insurance Solutions.  He can be reached at (559) 325-2500 or by email at shane@valleyemployeebenefits.com.  If you have other questions, please call or email avecinia wellness center’s insurance specialist, Colette Vaquilar at (559) 450-7298 or billing@avecinia.com. Visit www.avecinia.com and "like" us at www.facebook.com/avecinia




For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!