Since the Affordable Care Act was signed 3 years ago, more than 370 innovative medical practices called “accountable care organizations” have sprung up all over the USA , with over 150 more planned.

Several of these organizations are located in Los Angeles and surrounding areas and they are doing something very unique in the health industry.  At these centers, Medicare or private insurers reward doctors financially when their patients stay healthy.  The doctors actually make money when their patients require fewer hospital stays, emergency room visits and surgeries.  This is the opposite of what doctors have traditionally been paid to do.  The more money the organization saves, the more money its participating providers share.

Just how exactly are they doing this?  These organizations are using information technology to monitor the patients most at risk.  Using patient records, they are looking for patients who are overdue for checkups and finding out which patients have not been filling their prescriptions.  Then, using teams of doctors, health coaches, care coordinators and nurse practitioners, they work with the patients and encourage them to live healthier lives.

At one center in North Carolina, patients with a history of congestive heart failure get a daily phone call from a nurse asking them to step on a scale and report their weight (a good, early indicator of an impending emergency).  Another provider in California offers Medicare patients free dance lessons, healthy cooking classes and other fun activities.  A Buffalo clinic is building a gym and a teaching kitchen for its patients.

These organizations are setting the trend for the future – preventative health care.   Now, having health insurance coverage isn’t just about help for medical emergencies anymore.

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In Los Angeles, as well as the rest of California, “counselors” are now being prepared to help the flood of applicants who will be signing up for health care coverage.  Many of these “counselors” will have no health insurance background.  How much sense does it make to have an inexperienced person advise you on what type of insurance is best for you and your family?

Individuals have until December 15^th, 2013, to be signed up for coverage, starting January 1.   They will not the only ones to be fined for not having insurance.  Many companies will also have to make health care available to all full-time employees.  Businesses will have until 2015 to comply or face fines.

Now is the time to speak to a qualified insurance agent and get all the facts.  Don’t wait until last minute when the insurance industry is flooded with applicants.

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• No more denial of insurance because of pre-existing conditions.  This does not go into effect until 2014, but anyone who would like coverage now, can apply to the state to get temporary health insurance coverage.
• Insurance companies must get “OK” from the state government before raising premiums.
• Obama Care says that insurance companies must spend at least 80% of premiums on providing actual medical services.  If they spent it elsewhere (i.e. salaries or marketing), they have to pay it back to the policy holder.
• Most families will no longer have to make co-payments on wellness or pregnancy exams.
• If an insured member gets sick, they cannot be dropped from their plan.
• Parents can add their adult children, up to age 26, to their plans.
• If a child is chronically ill, a new insurance company cannot deny coverage for the child.
• Obama Care requires that 50 procedures recommended by the” U.S Preventative Services Task Force”, be covered as preventative services.    These include well-women visits, domestic violence screening, and support for breastfeeding equipment and contraception.
• Maternity and Newborn Care is categorized as preventative care, and must be provided at no cost.
• Though most plans currently provide services and devices to help with injuries, disabilities or chronic conditions, Obama Care will also cover goods and services  to help  maintain a standard of living if a person contracts a chronic disease.
• Obama Care plans cover 100% of preventative lab tests.  This does not include tests that have been ordered if a person has already been diagnosed with a disease.

A new era for health insurance is about to begin.  Talk to one of our insurance expert about your options

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