It is not a problem, it is an opportunity!
It is finally here. It has been talked about by so many for so long and many thought there is no way anything can get done. The subject often came up and the discussion always indicated that we have to do something, but nothing ever got accomplished. Now it has passed and health care reform is here and we need to work with it. Regardless of your own political ideologies, we need to deal with it. It does not matter what has taken place in the past, or what took place during what time in the history of pharmacy, health care reform is here. Hopefully, some can lose that rear-view mirror like mentality and stop looking in the past and help shape this issue for the future. Its time has come. The time is now for a positive step forward for this opportunity.
There are many aspects within the health care reform that raise interest among our patients. A question that often comes up is “when will my son or daughter be eligible to be added to my health insurance policy?” Some may wonder, “Why this should be a concern of mine?” Well, the answer is goodwill. The key is in being prepared for questions from your patients. Goodwill is the intangible asset, the value that you give your pharmacy for the positive reputation that you provide as a good source of health information for your patients. This is an opportunity to be prepared. This is a key issue on the minds of some of your patients because of the situation the “millennials” are dealing with.
This group of young adults known as millennials are those who have come of age in the new century and are now struggling to get on their feet during our current economic slump. It is not an easy time because many can’t find jobs and of those who are employed, often health coverage is not included from their employer. This provision within the health care reform has even been referred to as the “Slacker Mandate,” but many have to realize this is not intended to deprive anyone of the timeless gift of self-sufficiency. This is help for those who have a definite need. Young adults make up one of the biggest groups of uninsured. The need is so real that 39 states already have some sort of dependent coverage expansion, but some have restrictions to specific populations. Actually, only 7 states (Connecticut, Florida, Illinois, New Hampshire, New Jersey, New York, and Utah) already extend coverage to non-students up to age 26 or older in both individual and group market plans. Therefore, the new federal law will provide a minimum basis of coverage for at least 2 million young people, but there are those who could buy coverage but don’t want to spend the money, and some think they shouldn’t have to. Currently, they don’t have to obtain coverage, but in 2014, that requirement will begin.
The Department of Health and Human Services is currently working on more specific regulations, but there are crucial specifics of the new law that patients need to keep in mind. The health care law will allow parents to keep a son or daughter on their family insurance policy until they turn age 26. Often on some family plans, once a full-time student graduates from school, they will lose health coverage on the very next day. As a result, families will face a four-month gap during which they will have to cover medical bills of a new graduate or find an alternative insurance option because the new law won’t take effect until September 23rd, six months after it was enacted. Additional key points:
• The new provision takes effect for plan years beginning on or after September 23rd.
• Plans that run on a calendar-year basis will have to start covering employee’s dependents up to age 26 on January 1st.
• For plans with an October start date, coverage will begin on October 1st.
• For plans that start on July 1st, they won’t have to start covering dependents up to age 26 until July 1, 2011.
• A young adult does not have to be in school or claimed as a dependent on the parent’s tax return to qualify until age 26 (HHS Department is still examining the definition of a dependent).
• The young adult can be married or have children and still be covered up to age 26, but the plan does not have to cover the young adult’s spouse or children.
• On September 23rd, a plan can exclude a young adult that has a job that offers health insurance, even if the young adult would prefer to stay on a parent’s plan. Starting in 2014, that limitation will expire and plans must cover employees’ dependents until age 26 even if the young adult has other group coverage.
• The coverage requirement ends on the dependent’s 26th birthday, but employers can continue this benefit until the end of the plan year.
Given the current economic condition that we are in and the high unemployment rate among young adults, this is an important provision of the new health care law. This will help a lot of young adults stay insured at a time when they have a high risk of being uninsured. This is an opportunity for many of us to be prepared with information and help in solving potential problems for some of our patients. Parents may look to you, an accessible member of the health care team, for answers to put their minds at ease. Be prepared and keep informed about health care developments. It can make a difference.