I currently have health insurance coverage with Blue Cross Blue Shield of Michigan. Do I need to do anything now?

No. The new law will be implemented over the next several years. Blue Cross Blue Shield of Michigan will continue to provide excellent service and will work to implement the new health care laws to best serve our members. We are reviewing the legislation and any potential impact on our members. We are also working to ensure a smooth transition with state and federal regulators who will be drafting many state-level regulations.

When will these new reforms become effective?

Beginning in July 2010, consumers with health problems who have been uninsured for 6 months may be eligible to obtain coverage through a new high-risk pool program. Also, a temporary reinsurance program will be set up to help employers who provide coverage to their retirees maintain that coverage.

Beginning in plan years on or after Sept. 23, 2010, pre-existing condition exclusions are prohibited for children under 19, dependents up to age 26 will be able to obtain coverage through parents' health plans, routine preventive care will be covered without cost-sharing and limits on lifetime coverage will be eliminated. Blue Cross Blue Shield of Michigan already maintains coverage for dependents until the end of the calendar year for insured customers and is working with self-insured customers who want to do the same this year prior to Sept. 23, 2010. We will also work with customers to add back dependents up to age 26 who previously rolled off their parents' policies in accordance with the law's requirement to do so beginning with plan years starting on or after Sept. 23, 2010.

In 2014, individuals and small businesses will be able to purchase coverage through state-based exchanges. Consumers will be able to purchase health insurance regardless of health status and premiums cannot vary because of health status. Individuals will be required to purchase health insurance or pay a penalty. Subsidies will be available on a sliding scale to help individuals or families with incomes up to 400 percent of the federal poverty level to purchase insurance through new state-based exchanges.

Will insurers have to cover everyone regardless of their health status?

Yes. Blue Cross Blue Shield of Michigan has always provided health insurance coverage to anyone regardless of health status. Beginning in 2014, the new law requires that all individuals have coverage and insurers must offer coverage to anyone regardless of health status and cannot vary premiums based on health status.

How will health reform affect my premiums?

There are a number of factors that are driving health insurance premiums. Increasing use of health care services due to an aging population; obesity and chronic illnesses; new treatments; prescription drugs and expensive new technologies are the biggest causes of increasing health care premiums. The new law establishes a few pilot programs, but does not aggressively attempt to control rising health care costs.

We believe that premiums will increase as a result of provisions in the reform legislation that will guarantee richer levels of benefits than most consumers who obtain their own insurance purchase today. Insufficient discounts for the young and healthy will encourage many of them to forgo coverage. New fees and taxes mandated by the new law will also likely increase the cost of premiums as they are phased in.

Blue Cross Blue Shield of Michigan already works with doctors, hospitals, employers and consumers to rein in costs and insurance premiums while improving access to quality health care. In doing so, we've be able to reduce unnecessary hospital readmissions, eliminate infections acquired during hospital visits and promote paying doctors and hospitals for quality outcomes to help achieve this goal. We will of course continue these efforts.

I am currently uninsured. How will I obtain coverage in the future?

Blue Cross Blue Shield of Michigan offers many health insurance options that you may be able to enroll in today. Visit this site, bcbsm.com, for more information.

Beginning in 2014, state health insurance exchanges will enable consumers to compare benefits, prices and networks of providers and purchase coverage.

Prior to the establishment of state exchanges in 2014, a temporary high-risk pool program for purchasing coverage will be created in Michigan to provide coverage to high-risk individuals who have not been covered during the prior six-month period or do not have access to coverage. As soon as more details are available about who will qualify for coverage in the high-risk pool, we will provide them here.

I am graduating from college this year. Will I be able to obtain coverage under my parents' health plan?

Beginning in plan years after Sept. 23, 2010, the new law allows dependents up to age 26 to obtain coverage under their parents' plans that offer dependent coverage. Blue Cross Blue Shield of Michigan already maintains coverage for dependents until the end of the calendar year for insured customers and is working with self-insured customers who want to do the same this year prior to Sept. 23, 2010. We will also work with customers to add back dependents up to age 26 who previously rolled off their parents' policies in accordance with the law's requirement to do so beginning with plan years starting on or after Sept. 23, 2010.

What if I can't afford to purchase coverage?

Blue Cross Blue Shield of Michigan offers many different options, including many that are much more affordable than many people realize. Visit this site, bcbsm.com, for more details. Beginning in 2014, consumers who purchase coverage on their own may qualify for federal subsidies to help offset higher premiums. Federal agencies must work out how subsidies would be paid. The Congressional Budget Office estimates that about 20 million American households will be eligible for subsidies. In addition, eligibility in Medicaid, the federal-state program that provides health coverage to millions of Americans, will expand to cover families with incomes up to 133 percent of the federal poverty level.

Where can I find more information about how health care reform could affect me?

We will provide updated information here as it becomes available and there are links below to some additional resources.

• See the Reform Alerts page for the most up-to-date information.
• See the Blue Cross and Blue Shield Association's Healthcare Reform Reference Guide (PDF).
• Most of our members received an article about the near-term benefit changes and special enrollment period in their August issue of Living Healthy magazine for BCBSM members (PDF) or Good Heath magazine for BCN members (PDF).

Additional resources for individuals:

• Kaiser Foundation
• Blue Cross Blue Shield Association

What immediate changes should I expect as an employer?

One of the earliest changes for employer-provided coverage is the requirement that for plan years starting on or after Sept. 23, 2010, employers provide preventive coverage without cost sharing, including immunizations, breast cancer screening and certain recommendations of the U.S. Preventive Services Task Force and other agencies such as the Centers for Disease Control. Blue Cross Blue Shield of Michigan is working with its customers to determine how best to implement this near-term requirement.

Effective plan years on or after Sept. 23, 2010, children dependents up to age 26 will be allowed to remain on their parents' policies. Blue Cross Blue Shield of Michigan already continues coverage for dependents that are currently enrolled in our fully insured plans if they are under age 26. We are working with self-funded groups that wish to comply with this requirement in advance. BCBSM will work with customers to have a special enrollment period to add back dependents up to age 26 who previously aged off their parents' policies.

Another requirement effective plan years beginning on or after Sept. 23, 2010 is that employers may no longer set lifetime dollar limits on essential benefits. "Restricted" annual dollar limits on essential benefits are permitted until 2014. The Secretary of the U.S. Health and Human Services will define "restricted" limits and "essential benefits."

Employers with more than 200 employees must automatically enroll full-time employees as soon as they are eligible for health care coverage. Employees, however, may opt-out of coverage.

Does the new law require that all employers offer health care coverage?

Small businesses with fewer than 50 employees are not required to offer coverage. However, beginning in 2014, businesses with 50 or more employees that do not offer coverage and have at least one full-time employee who receives a federal tax credit to purchase health insurance on his own through an Exchange must pay the federal government a $2,000 per employee penalty. The first 30 employees would be excluded from this assessment.

Employers with 50 or more employees that do provide coverage, but have at least one full-time employee who receives a federal tax credit to purchase health insurance on his own through an Exchange, will be assessed a penalty that will be the lesser of $3,000 per employee receiving a premium tax credit or $2,000 for each full-time employee, excluding the first 30 employees.

I own a small business and want to provide health insurance for my employees and their families. Are there subsidies or other assistance to help me afford to coverage?

Many small businesses will be eligible for tax credits of up to 35 percent. Businesses that employ fewer than 25 employees, pay average annual wages of $50,000 per full-time employee, and pay at least half the cost of single coverage for employees may be eligible to receive a tax credit.

Employers with 10 or fewer employees that pay annual average wages of $25,000 or less per full-time employee per year may be eligible for up to a 35 percent tax credit in 2010.

In 2014, the tax credit for eligible small businesses will increase to 50 percent of premiums paid, but will only be available to small employers who purchase coverage on an Exchange.

More information is available in our Small Business Tax Credit Reform Alert. Full eligibility details are available from the Internal Revenue Service. You should review and discuss the full criteria with a tax professional to determine whether your business will qualify.

Can I keep the plan I currently offer my employees?

Yes, but there are certain rules that may apply. Plans in existence on March 23, 2010 are "grandfathered," meaning that they do not have to comply with certain provisions of the new law unless they are changed. Federal officials released regulations on what "grandfathering" means and how it impacts customers and members. For specifics, please refer to our Grandfathering Reform Alert.

My company provides health insurance coverage to our retirees. Will the new law make retiree coverage more affordable?

The new health care reform law creates a temporary retiree reinsurance program that will reimburse employers for qualifying retiree medical expenses. Employers may be reimbursed for up to 80 percent of expenses between $15,000 and $90,000 per retiree. Retiree expenses of employees over age 55, but not yet eligible for Medicare will be eligible. Employers must submit claims to the Secretary of Health and Human Services for reimbursement. The program will be up and running by July 2010. Details and directions about how employers can apply will be posted on the new Health and Human Services web portal. For more information about BCBSM's efforts to help customers apply for early retiree reinsurance, see our Early Retiree Reinsurance Program Reform Alert.

I have a lot of employees, but most only work on a part-time basis. Will I still be required to offer insurance coverage?

Groups with 50 or more full-time employees (or equivalents of 50 full-time employees) are required to offer coverage or face a penalty. Part-time employees will count toward this threshold on a prorated basis based on the number of hours worked.

As an employer, what else do I need to know?

There are many implications for employers to consider as they work to enact reform. BCBSM prepared a handbook for employers that may be helpful.

Where can I get more information?

We will provide updated information here as it becomes available, and there are links below to some additional resources.

• See the Reform Alerts page for the most up-to-date information.
• See the Blue Cross and Blue Shield Association's Healthcare Reform Reference Guide (PDF).
• Most of our members received an article about the near-term benefit changes and special enrollment period in their August issue of Living Healthy magazine for BCBSM members (PDF) or Good Heath magazine for BCN members (PDF).

Additional resources for employers:

• Detroit Regional Chamber
• Kaiser Foundation
• Michigan Business Professional Association
• National Association of Health Underwriters
• Small Business Association of Michigan

How does the role of agents change?

Blue Cross Blue Shield of Michigan believes agents play a vital role in the health insurance purchasing process and we see that role continuing in the post-reform world.

How will the early retiree reinsurance program work?

The early retiree reinsurance program will pay employer-based plans 80 percent of the cost of certain claims between $15,000 and $90,000 for early retirees, their spouse and dependent, between the age of 55 and 64. The program will be running by July 2010. Details and directions about how employers can apply will be posted on the new Health and Human Services web portal. For more information about BCBSM's efforts to help customers apply for early retiree reinsurance, see our Early Retiree Reinsurance Program Reform Alert.

What provisions in the health care reform law pertain to agents?

There are several sections of the reform law that refer to agents, highlighting the fact that agents will continue to play a vital role in the health insurance process. Health and Human Services plans to establish procedures under which the state of Michigan can allow agents and brokers to enroll individuals and small groups in products on the Exchange when it becomes available in 2014. The law also says agents can assist individuals in applying for premium tax credits and cost-sharing reductions for plans sold through an Exchange.

Where can I get more information?

We will provide updated information here as it becomes available and there are links below to some additional resources.

• See the Reform Alerts page for the most up-to-date information.
• See the Blue Cross and Blue Shield Association's Healthcare Reform Reference Guide (PDF).

Additional resources for agents:

• Detroit Regional Chamber
• Kaiser Foundation
• Michigan Business Professional Association
• National Association of Health Underwriters
• Small Business Association of Michigan

The Patient Protection and Affordable Care Act became law on March 23, 2010. Blue Cross Blue Shield of Michigan and Blue Care Network are examining the law to figure out how doing business with us may be different for you. We will post information on this website as it becomes available, so check back often. We will also provide information in The Record and BCN Provider News.

Here’s what we know now*

Insurers are required to:

• Cover preventive services and immunizations with no member cost-sharing. This will be effective for most groups and individuals on Jan. 1, 2011.** Please ask to see the member’s ID card and check eligibility and benefits on web-DENIS to see when this becomes effective. (More information on Medicare Advantage-covered preventive services is listed in the next bullet.)
• Preventive care and immunizations alert (PDF)
• Health reform article
• Medicare Supplemental requirements (PDF)
• Preventive codes are available on web-DENIS. For BCBSM, go to Health Reform — Information under Newsletters and Resources at BCBSM Provider Publications and Resources. For BCN, go to Health Reform under BCN Provider Publications and Resources.
• Phase-out the Medicare Part D coverage gap (“donut hole”) and other Medicare Advantage changes.
• How Medicare Advantage will change
• Extend dependent coverage up to age 26. Extended coverage
• Remove lifetime dollar limits for essential services. “Patient’s Bill of Rights”
• Remove pre-existing condition exclusions for children up to age 19. “Patient’s Bill of Rights”
• Clarify emergency services. “Patient’s Bill of Rights”
• Require prescriptions for over-the-counter drugs and other items that members want reimbursed by their medical savings accounts. Changes to consumer-driven health care accounts
• Revise the appeals process for members. Appeals process standardized

Additional resources and information for health care professionals:

• The Blues’ health reform website main page
• American Medical Association***

* This is not a complete list of the mandates, but a list of those affecting health care providers.
** These changes will become effective for groups and individuals on the start date of their plan year between Sept. 23, 2010, and Sept. 22, 2011. For most, this will take place on Jan. 1, 2011.
***Blue Cross Blue Shield of Michigan and Blue Care Network do not control this website or endorse its general content.

What is the state's role in enacting reform in the near future?

The state of Michigan has a large role in enacting reform. It has already indicated it will leverage available federal funding to establish a temporary high-risk pool by June 23, 2010 for people with pre-existing conditions who’ve been without coverage for more than six months. This will be to help people get coverage prior to 2014, when all insurers will be required to take everyone, regardless of health status. The state of Michigan will also seek federal funds to set up a health insurance consumer assistance office or ombudsman program and work to connect consumers with the Health and Human Services Internet portal that will include information about health insurance coverage options available in Michigan.

What is the state's role in enacting reform in the longer term?

After guarantee issue and the prohibition of pre-existing condition exclusions take force in 2014, the state is required to establish a non-profit reinsurance entity to help cover the costs of high-risk individuals to be in place until 2016. This is to prevent rate shock. States will also be required set up Exchanges in 2014 that provide coverage options to individuals and small businesses. Exchanges have been likened to "Orbitz for health insurance" as they are meant to be an online market place with a variety of health insurance options for individuals and small businesses.

As a legislator, what else do I need to know?

BCBSM prepared a summary brochure (PDF) for legislators that may be helpful to you.

Where can I get more information?

We will provide updated information here as it becomes available, and there are links below to some additional resources.

• See the Reform Alerts page for the most up-to-date information.
• Learn more about what Blue Cross Blue Shield of Michigan is doing to create a healthier Michigan (PDF).
• See the Blue Cross and Blue Shield Association's Healthcare Reform Reference Guide (PDF).

Additional resources for legislators:

• Center for Healthcare Research & Transformation Policy Brief
• Kaiser Foundation
• National Association of Health Underwriters
• Small Business Association of Michigan
• Detroit Regional Chamber

Will my Medicare benefits be cut under the new law?

No, the Patient Protection and Affordable Care Act (PPACA) does not eliminate or reduce benefits provided under Medicare.

I currently have a Medicare Advantage plan. Will I be able to keep it?

Yes. The reform law does not require individuals to drop their Medicare Advantage coverage. It should be noted, however, that Medicare Advantage plans are not guaranteed renewable. Carriers may pull out of a market at the end of the year, forcing enrollees to change carriers or return to Medicare. The law does cut payments to Medicare Advantage plans, which could result in carriers pulling out of more areas.

My prescription drug costs push me into the "doughnut hole" every year. Will I receive any relief under the new law?

Seniors who reach the gap in prescription drug coverage known as the "doughnut hole" will receive a $250 rebate in 2010. Beginning in 2011, those in the "doughnut hole" will receive a 50 percent discount on branded prescription drugs and the gap will be phased out until it is eliminated in 2020. More specifics about how rebates will be distributed are available in our Medicare Part D Reform Alert.

When will the new preventive care improvements begin?

Under the reform law, all Medicare Advantage plans are strongly encouraged to offer preventive services without cost-sharing beginning Jan. 1, 2011.

I have a Medicare Supplement (Medigap) plan. Must I make any changes to my plan under the new law?

No, the reform law does not require seniors to change their Medigap coverage. However, the law will be adding cost-sharing requirements to plans C and F that are sold after Jan. 1, 2015.

Where can I get more information?

We will provide updated information here as it becomes available, and there are links below to some additional resources.

• See the Reform Alerts page for the most up-to-date information.
• See the Blue Cross and Blue Shield Association's Healthcare Reform Reference Guide (PDF).

Additional resources for seniors:

• Kaiser Foundation
• American Medical Association
• National Council on Aging