“caps would be placed on patients’ yearly health care costs”
So once that “cap” is in place and a patient’s health care bill goes up and above the cap – will they just tell the cancer to dissapear? What will happen with people that have serious illnesses that go above that cap? I think what is meant is a cap on out-of pocket expenses- but I will need to check on that – until then – forget it for now.
UPDATE – OK, here it is:
All plans must provide preventive and primary care, emergency services, hospitalization, physician services, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings (including x-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that at least meet minimum standards set by Federal and state laws. In addition, plans could charge no cost-sharing (e.g., deductibles, copayments) for preventive care services, except in cases where value-based insurance design
is used. Plans could also not include lifetime limits on coverage or annual limits on any benefits. Any insurer that rates on tobacco use must also provide coverage for comprehensive tobacco cessation programs including counseling and pharmacotherapy (prescription and non-prescription). The provisions in this paragraph would all be within the actuarial value of the appropriate benefit level.
Ok, I understand that. I am a bit shaky on this one here:
Definition of Levels.
For those between 100-200 percent of FPL, the benefit will include an out-of-pocket limit equal to one-third of the HSA current law limit. For those between 200-300 percent of FPL, the benefit will include an out-of-pocket limit equal to one-half of the HSA current law limit.
The bronze benefit package, which would represent minimum creditable coverage (MCC), would be equal to the actuarial value of 65 percent with an out-of-pocket limit up to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010) indexed to the per capita growth in premiums for the insured market as determined by the Secretary of HHS. The silver benefit package would have an actuarial value of 70 percent with the out-of-pocket limits for MCC. The gold benefit package would have an actuarial value of 80 percent with the out-of-pocket limits for MCC. The platinum benefit package would have an actuarial value of 90 percent with the out-of-pocket limits for MCC. A separate ―young invincible‖ policy would be available for those 25 years or younger. This plan would be a catastrophic only policy in which the catastrophic coverage level would be set at the HSA current law limit, but prevention benefits would be exempt from the deductible.
Care to explain? My German brain just isn’t making sense of it.
Just FYI —
Some info I found on the web:
- bone-marrow transplants cost around $260000
- average cost of one round of chemotherapy is $150,000
- $2,187 average monthly health care cost for prostate cancer
- $7,616 average monthly health care cost for pancreatic cancer
- $41,000 health care costs per premature born child during their first year of life
- a minimum of $5000 cleft lip surgery and/or cleft palate repair
- $39,891 average cost to Medicaid for INITIAL lung cancer treatment
- $41,134 average cost to Medicaid for INITIAL prostate cancer treatment
- $20,964 average cost to Medicaid for INITIAL breast cancer treatment
- Avastin for the treatment of recurrent breast cancer costs about $55,000 a year for a Medicare patient
- minimum estimated cost for a regular delivery in a hospital $7800
- $4306 median annual medical cost for children with ADD/ADHD
- average heart bypass-procedure cost $20673 not nclkuding follow up treatment, medication, etc.
- caring for an individual with autism can cost more than $3 million in their lifetime
- $13243 average annual healthcare cost for a person with diabetes
- $28436 average annual healthcare cost for chronically homeless individuals
- $33007 average annual healthcare cost for someone older than 65 with Alzheimer’s Disease or another form of dementia
