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Dear Addy: Pre-Existing Condition Insurance Plan

Dear Addy, I have a young child with substantial medical costs. For the past couple of years I have spent 20-40% of my income on medical bills. Unfortunately my income is “too high” for Medicaid. I live in Texas and I currently have PCIP (pre-existing condition insurance plan) insurance which ends this month. What do […]

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Dear Addy: Open Enrollment

Dear Addy, It is open health insurance enrollment time for my company. Do I still have to worry about qualifying for coverage because I have a pre-existing condition? Open Enrollment Jitters in Minnesota ___________________________ Dear Jitters, The cold in Minnesota should make you shake more than the issue of pre-existing conditions in 2014. Starting in […]

Are You Prepared for the Healthcare Insurance Marketplace?

The countdown to the launch of the new online Health Insurance Marketplace is on. Are you ready? If you, like many Americans, have questions about what the Marketplace is and what it does, there are excellent resources available to help answer these questions. Here are some of the most frequently asked questions: “The Marketplace” The […]

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Dear Addy: Individual Mandate

Dear Addy, I just turned 27 and have lots of debt. Instead of purchasing health insurance, I would rather use the money I make to pay down what I owe. I have mild hemophilia and I have not had a bleed in a year. Do I still need to have health insurance under the new […]

Physician Payment Sunshine Act Sheds Light on Payments Made to Doctors

A little-discussed provision of the Affordable Care Act is making physicians, hospitals and manufacturers in the health care industry reconsider how they do business.  The Physician Payment Sunshine Act requires certain drug, medical device and biological manufacturers to disclose to the Centers for Medicare & Medicaid Services (CMS) any payments or other transfers of value to physicians […]

Essential Health Benefits: What are they and who decides?

As we have discussed in previous posts, beginning in 2014, under the Affordable Care Act (ACA), Medicaid plans and small group and individual plans sold inside and outside of the Health Insurance Marketplace must cover a package of 10 categories of items and services known as Essential Health Benefits (EHBs).  These categories include: Ambulatory patient […]

Health Insurance Options in 2014

In a recent post, we discussed the insurance mandate itself.  That is, the requirement that most people have health insurance beginning in 2014 or face a financial penalty.  We also briefly mentioned the insurance options that will be available to you in order to fulfill this requirement.  They are— Have employer-sponsored insurance Be covered by […]

Out of Pocket Maximums and the 2014 Transition Year

Beginning in 2014, the Affordable Care Act (ACA) will set maximum limits on how much consumers can be required to pay out-of-pocket annually for their health care.  Under the law, the maximum amount a consumer with single coverage will pay out-of-pocket will generally be $6,350, while a family could pay up to $12,700. In 2015, […]

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Medicaid Expansion in Your State

  The Medicaid program is a federal and state partnership to provide health insurance for those who are financially and medically needy. It is a vital safety net in our health care system. Federal law sets a baseline of eligibility categories for states to follow, but states have the flexibility to cover above that baseline […]

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The Wilkes Family, “Thanks ObamaCare”

My son Thomas was born in 2003. After his circumcision, he continued to bleed. Within a day, my husband Nathan and I were told that our newborn son had severe hemophilia, a genetic blood clotting disorder. A local hematologist was at our bedside within 30 minutes of us getting the call. She was there to […]

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