What is an Accountable Care Organization (ACO) and What Will it do?
An accountable care organization (ACO) is a new health care delivery model envisioned by theAffordable Care Act (ACA) in which a group of doctors, hospitals and other health care providers work together to coordinate care for people enrolled in Original Medicare. Many Medicare beneficiaries have several chronic conditions and see several different doctors. As often as not, the doctors don’t […]
What’s the Difference Between Brand Name and Generic Drugs?
You probably know that generic drugs are a lot cheaper than brand name drugs, but you may wonder why. Are they lower quality? Less effective? The FDA requires that a generic drug have the same active ingredient, quality and strength as the brand-name equivalent. The cost difference between brands and generics comes from the cost […]
What’s the Difference Between Prescription Discount Plans and Prescription Drug Insurance?
There are two basic and very different types of drug plans: prescription discount plans and prescription drug insurance. In a discount plan, you typically pay a monthly or annual fee and get a card. You present your card when you fill a prescription, and the pharmacy gives you a certain percentage off the cost of […]
Are Employers Required by the Affordable Care Act to Purchase Group Insurance for Their Employees?
Yes, the Affordable Care Act requires large employers to provide coverage to full-time employees or pay a penalty. This provision, called the “play or pay” rule, goes into effect Jan. 1, 2014. Small employers – those with fewer than 50 employees – are exempt from the coverage requirement and penalty. As a side note, be aware that the […]
What is a Specialty Drug?
Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Specialty drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion). Patients using a specialty drug often must be monitored closely to determine if the therapy is working and to […]
How Does the Marketplace Verify Your Identity?
The Marketplace must ensure you’re eligible for a health insurance plan through the government program. To do so, several pieces of your personal information are pulled from federal agencies, as approved by the Department of Health and Human Services (HHS). The following sources, and perhaps several more, may be used to verify your identity: Social […]
Lipitor Goes Generic – What That Means for You
Lipitor, one of the most frequently prescribed medications for lowering cholesterol and preventing heart disease, is now available in generic form. Access to atorvastatin – the generic name for the drug – is going to save residents thousands of dollars. Here’s how: According to the American Heart Association, heart disease is the leading cause of […]
Indiana Level Funded Group Health Plan
Indianapolis has seen the introduction of several new group health products designed for companies with between 10 and 250 employees. What makes these plans intriguing is that they are self-funded health insurance vehicles. In a traditional self-funded plan, the employer pays for its own medical claims directly. Meanwhile, a third-party administrator administers the health plan […]
Why The Health Care Reform Employee Tax Subsidies Could Cost You More
The Hill Under the new health care reform law, if an employer’s group health insurance is considered unaffordable — a cost to the employee of more than 9.5% of household income — the employee would be eligible for tax subsidies through a health insurance exchange. As the law was originally interpreted, if the employee was […]
Independent Payment Advisory Board
One of the hot topics of the recent health care reform debate was the creation of the Independent Payment Advisory Board (IPAB). The board would have the power to implement changes to reduce the growth rate of Medicare, though Congress would have the power to overrule the IPAB decisions. The Independent Payment Advisory Board would […]
