The Affordable Care Act

Website columnist Anthony Ferraro has good news and bad for his readers this month. The good news? Starting next year, every state is required to establish an Insurance Exchange that offers individuals and businesses apples-to-apples comparisons of fees, features, companies, terms and conditions for minimum essential coverage in four standard plans: bronze, silver, gold and platinum. The bad news? “There’s still no fix in sight for the devastating cost of nursing home care!” Anthony writes. For the rest of the story, visit www.franoi.com, click on ADVICE at the bottom of the home page, then on ELDER LAW ADVOCATE.

Get ready, because on January 1, 2014, all states are required to establish Insurance Exchanges. Individuals and small businesses will be able to go to a standardized Exchange and find insurance policies offered by the various commercial insurance companies.

The private insurance that will be offered through the Exchange is supposed to be done on a basis that allows an “apples to apples” comparison of fees, features, companies and terms and conditions with basic minimum essential coverage in 4 standard plans: bronze, silver, gold and platinum. The plans provide coverage and cost in incremental amounts.

Another significant event that will take place on January 1, 2014 is the elimination of pre-existing conditions for everyone, not just children, as the law exists now.

Until then, people with pre-existing conditions can gain access to health insurance through the temporary high-risk pools that exist.

The bad news? There’s still no fix in sight for the devastating cost of nursing home care!

One shortcoming of the Affordable Care Act, is that the CLASS Act (the first attempt at standardized long-term care insurance) has been removed from the ACA. The federal government determined that it was unsustainable.

Instead, President Obama has established a 15-member entity called the Commission on Long-Term Care. Their objective is to come up with a sustainable program to provide solutions for the long-term care of all U.S. citizens. They have six months to come up with a plan. What they are able to produce remains to be seen.

Some argue that long-term care is transitioning from nursing home care to home and community-based care. However, at the present time, there are very few governmental resources that can offer this home and community-based care.

Illinois has something called the Community Care Program, but it is limited in providing no more than 3 to 5 hours a day to individuals who meet very, very low asset limits ($14,000). This plan may enable you to remain in your home when it is medically possible. Advocates are arguing for more robust types of plans like this so that more care can be delivered in home and community settings, rather than in institutional settings. These solutions do not exist yet.

Until the U.S. has more complete and robust home and community-based long-term care plans, there are only 3 solutions:

1. Long-term care insurance, for those who qualify and can afford it.

2. Pay for long-term care out of your own pocket (OUCH!).

3. Attempt to qualify for the Medicaid program, which requires the assistance of elder care counsel to establish a legal and ethical income and asset protection plan.

There you have it: the good news and bad news, with more to come. We’ll keep you posted.

For more, call 847-292-1220, e-mail abferraro@abferrarolaw.com or visit www.ABFerraroLaw.com.