Employers cutting worker hours to avoid PPACA.

March 24, 2015 by Frank West

About one in five U.S. employers either have reduced hours for workers they consider to be part-time, or will do so, in response to requirements of the Patient Protection and Affordable Care Act. That’s what a survey of some 740 human resources professionals conducted by the Society for Human Resource Management found.

The vast majority — nearly three-quarters — of respondents haven’t altered schedules to avoid providing health insurance for part-timers working 30 or more hours a week on average. But 14 percent have, and another 6 percent told SHRM they intend to.

It’s still a significant number as some previous studies have found that most large employers will not circumvent coverage extension by reducing full-time workers’ hours. SHRM’s survey results come as PPACA marks its 5th anniversary this week.

PPACA mandates large employers offer health care coverage to employees working 30 hours or more per week or face a penalty.

When it comes to trying to reduce full-time worker hours or reducing the number of full-time employees to duck under the requirement, SHRM reported that only about 10 percent have considered going down that road.

“As organizations learned more about the law, they found that their coverage levels were already the same or more than what the law required, minimizing the adjustments that some anticipated employers would need to make when the ACA was created,” said Evren Esen, director of SHRM’s survey programs.

Among other outcomes:

54 percent of employers require employees to work 30 hours a week to be eligible for coverage, an increase from 44 percent in 2014 and 39 percent in 2013. Another 26 percent require employees to work more than 30 hours a week to be eligible.
66 percent said their organization offered the same level of health care benefits as before PPACA was enacted.
77 percent said that their health care coverage costs increased from 2014 to 2015, and 6 percent saw a decrease.

Filed Under: Affordable Care Act, Health Insurance, Health Insurance Exchange, insurance broker Tagged With: Affordable Care Act, independent insurance agent

Health Insurance: It’s Not Too Late To Get Covered.

March 24, 2015 by Frank West

Health Insurance: It’s Not Too Late to Get Covered – Special Enrollment Period Now Open

(Fremont County, Wyo.) – Up to six million Americans are expected to pay a tax penalty this year for not having health insurance coverage in 2014. To help families avoid future penalties, a special enrollment period for the Health Insurance Marketplace opened on March 15 and will close April 30.

This special enrollment period is an additional time outside of open enrollment during which you and your family can sign up for health coverage. This will be your last chance this year to receive health coverage through the Health Insurance Marketplace and avoid a tax penalty for next year.

Why is health coverage important?

Health coverage helps cover the cost of medical services, tests and treatments that assist you in getting and staying healthy. The required basic level of coverage includes preventive care, health screenings, well woman and prenatal care, immunizations for adults and children, treatment for pre-existing conditions, and the cost of some prescription medications.

What fees might I owe if I’m not covered?

Surveys have shown that nearly half of uninsured adults are unaware of the penalty associated with not having health coverage. In 2014, the penalty for not having the required minimum level of health coverage was up to $95 per uninsured person or 1% of a household’s income. For 2015, this amount will more than double, with the penalty per uninsured person reaching $325 or 2% of a household’s income.

There are exemptions available to those who cannot afford coverage or who have experienced hardship. Consult Healthcare.gov or a certified application counselor to see if you qualify for an exemption.

Who’s eligible for the special enrollment session?

The special enrollment period is designed for the following:

Those who don’t currently have health coverage for 2015;
Those who paid a penalty as part of their 2014 federal income tax returns for not having health insurance in 2014; and
Those who became aware of the individual mandate penalty after the regular 2015 enrollment window closed.

Filed Under: Affordable Care Act, Health Insurance, Health Insurance Exchange, insurance broker, San Diego Health Insurance Tagged With: Health Insurance Exchange, Health Insurance Self Employed, insurance broker

Open enrollment: Tips for selecting health insurance.

October 7, 2014 by Frank West

Open enrollment is the time each fall when most Americans select or change their health benefits for the following year.

Choosing health-care coverage is one of the most important decisions people make. Therefore, it’s essential that consumers fully understand their options during open enrollment so they can choose a plan that will help them enhance their health and possibly save money.

Even with health insurance coverage now available in many states through government exchanges, the vast majority of Americans, nearly 158 million, will continue to obtain health benefits through their employer. Many companies set aside a two-week period between October and December for when their employees can select health benefits, so now is the time to start getting prepared.

Here are three important tips for a successful open-enrollment season:

• Tip 1. Review your options. It may sound simple, but taking the time to review your options is very important. Ask questions. In many cases, people who review their health plan options may find ways to save money on their health-care costs — whether it’s through selecting a plan that will cover more of their expected health costs for a major event (such as having a baby or surgery), evaluating prescription drug coverage, or having the opportunity to enroll in an incentive-based wellness program.

Some insurers offer wellness programs or incentive programs that may help you lower your cholesterol, quit smoking or lose weight. These incentives may include gym membership discounts, lower premium costs or merchant gift cards.

• Tip 2. Make sure your doctor is in-network — it can usually save you money on out-of-pocket costs. Even if you don’t plan to make any changes to your health insurance this year, it’s always good to ensure that any doctor you see, or plan to visit in the coming year, is in your plan’s care provider network.

Many insurers offer a broad choice of local in-network health-care professionals, and these in-network care providers agree in advance to what they’ll charge for specific procedures. You should also call before your procedure to verify the care providers are in-network. If you plan to visit a doctor or hospital outside the network, be sure to understand how your costs will differ from those of an in-network care provider.

• Tip 3. Don’t forget about specialty benefits. Specialty benefits like dental and vision plans are often available at a minimal cost and cover annual teeth cleanings and eye exams. Many vision plans also offer reduced pricing on frames and lenses. Research suggests that there is a connection between oral health and overall health, so adding a dental plan may help prevent more serious medical problems.

Filed Under: Affordable Care Act, Health Insurance, Health Insurance Exchange, San Diego Health Insurance Tagged With: Affordable Care Act, Health Insurance Exchange

What Is Disability Income Insurance?

September 24, 2014 by Frank West

Disability Insurance, or DI, is a type of health insurance that pays a monthly income to the policyholder when he or she is unable to work because of an illness.

Short-term disability (STD) plans provide insurance coverage and benefits for a couple of weeks or as long as two years.

Long-term disability (LTD) policies typically cover an individual for a couple of months but could be purchased to provide benefits for the rest of the insured’s life.

STD and LTD policies have waiting periods that insureds must satisfy before receiving benefit payments. Waiting periods for STD policies typically last a couple of weeks while LTD plan waiting periods may last a couple of months. In some instances, the waiting periods can be waived if the disability is evident, such as a broken arm. Disability policies may allow insureds to stop paying premiums if they are disabled for longer than 90 days (waiver of premiums) and increase coverage amounts at a later time (additional purchase benefit).

Filed Under: Disability Income Insurance, Paycheck Protection Tagged With: Professional Disability Income Protection

What Is Medicare?

September 24, 2014 by Frank West

Overview

Medicare is a federal health insurance program that covers millions of Americans. In general, you are eligible for Medicare if you are 65 or older, or you are younger than 65 and meet criteria for certain disabilities, or have End-Stage Renal Disease (ESRD).

The Medicare basics have four main components:

Medicare Part A helps pay for inpatient hospital care, skilled nursing care, some home-health services, and hospice care.

Medicare Part B helps pay for physician services, outpatient hospital care, and other medical services not covered by Part A. Together, Parts A and B are known as Original Medicare.

Medicare Part C, usually known as Medicare Advantage, is offered by private health care organizations. These plans cover all services under Parts A and B and usually offer additional benefits.

Medicare Part D helps pay for outpatient prescription drugs and is available through private health care organizations such as Kaiser Permanente. Part C plans often include Medicare Part D coverage.

Filed Under: Medicare Advantage, Medicare Supplement Plans, Medigap Insurance Tagged With: Medicare Insurance Plan, Medicare Supplement

Short Term Health Insurance

September 9, 2014 by Frank West

What is Short-Term Health Insurance?

Some consumers without subsidized health coverage benefits may be unable to afford the costs of full health coverage on their own. In those circumstances, temporary health insurance is one of the options that could cover the gap between being entirely uninsured and being insured under a traditional health plan.

Typically, short-term health insurance plans last from one month to a year and cannot be renewed or extended. The majority of short-term plans will not cover pre-existing conditions and may exclude preventative care like routine medical visits. Plans are designed to cover only major medical events and will not provide treatment for mental illness or substance abuse. If consumers need to purchase a second short-term plan after the first has expired, the new plan may not cover pre-existing conditions that developed during the first plan’s term.

Most short-term plans define pre-existing conditions as those for which a consumer has been treated, consulted a health-care professional or took medications for in a set period of time prior to the start of the policy. The length of time varies between states, but generally ranges from 6 to 36 months. Note that this definition may differ from the one used by long-term healthcare plans.

The Affordable Care Act (ACA), sometimes referred to as Obamacare, requires insurers to sell health insurance to virtually everyone (often called “guaranteed issue”) regardless of health status. As a result, an Obamacare plan would accept insurance applications from those denied short-term medical insurance due to pre-existing conditions. ACA plans can be purchased beginning in October of 2013 and will begin coverage in January of 2014.

Short-term health insurance, otherwise known as temporary health insurance or short-term medical insurance, does not meet the coverage standards under the Affordable Care Act. Consequently, starting in 2014 if an individual has temporary health insurance he or she will be subject to a fine of $95 or 1% of adjusted gross annual income, whichever is larger. For some individuals, the premium savings of short- term health insurance versus an Obamacare health plan would exceed the cost of the penalty. To learn more about the Affordable Care Act’s tax penalty for the uninsured and how the amount changes over time, see our article on the Obamacare tax penalty.

Advantages of Short-Term Health Insurance

Plans can bridge the gap in coverage while waiting for a complete health plan to begin
Premiums for short-term plans are usually more affordable than traditional coverage
Many plans do not have a preferred healthcare provider requirement. This means enrollees can be covered for visits to any hospital or healthcare professional in the country
Most plans take effect within 24 hours of the application date

Disadvantages of Short-Term Health Insurance

Temporary health insurance plans are exempt from HIPAA, meaning that pre-existing conditions can be used to deny or exclude coverage
Starting in 2014 enrollees in temporary health insurance will be subject to a tax penalty
Many plans refuse to sell coverage to those over 65
Vision, dental care, and preventive coverage are excluded by most plans
Plans are not guaranteed to be renewable
Enrollees that are eligible for COBRA may lose that eligibility if they purchase a short-term plan

Filed Under: Short Term Medical Coverage Tagged With: Short term medical plan

About Medigap (Medicare Supplement) Coverage.

September 9, 2014 by Frank West

What is Medigap?

Original Medicare Part A and Part B has a variety of deductibles, co-payments, and other out-of-pocket costs. Medicare Supplement insurance plans, also known as Medigap plans, can pay for those out-of-pocket costs which can simplify your healthcare expenses. These insurance plans work alongside Medicare Part A and Part B.

Types of Medigap Plans

You must be enrolled in Medicare Parts A and B in order to purchase a Medigap plan. In 47 states, there are 10 standard designs of Medicare Supplement Insurance. They cover different levels of out-of-pocket costs within Original Medicare Parts A & B. Using the links below, you can see what is covered by each of the 10 Medicare Supplement plan types.

Filed Under: Medicare Supplement Plans, Medigap Insurance Tagged With: Medicare Insurance Plan, Medicare Supplement

Medicare Advantage

September 9, 2014 by Frank West

What is Medicare Advantage

The Medicare Advantage program was created by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) which was passed in 2004. The program was designed to bring more affordable healthcare and prescription drug coverage to Medicare beneficiaries, expand health options and preventive care services and improve health access for those living in rural areas. Medicare Advantage plans replaced “Medicare + Choice” plans, an alternative to Original fee-for-service Medicare, and that is why Medicare Advantage plans are also known as Medicare Part C. An important aspect of Medicare Advantage plans is a mandatory maximum out-of-pocket amount for all Original Medicare services. After a beneficiary reaches the maximum out-of-pocket limit in a given coverage year, the plan must cover 100% of your remaining Original Medicare-covered costs for the remainder of the year. The mandatory maximum out-of-pocket limit for 2014 Medicare Advantage plans is $6,700 or less.

A Medicare Advantage Plan is a Medicare health insurance policy offered by a private insurance company. Medicare reimburses the insurance companies a fixed monthly amount for each member according to factors such as Medicare Advantage risk scores. Medicare enrollees often decide to receive healthcare coverage through a Medicare Advantage plan because many of these Medicare Part C plans can include more benefits (such as vision, dental, hearing, and health/wellness plans) than Original Medicare and most Medicare Advantage Plans provide prescription drug coverage.¹ Medicare Advantage beneficiaries may have to pay a monthly premium for their additional benefits and most Medicare Advantage plans require copays for services. Some copays are lower than what a beneficiary would have to pay if they were enrolled in Original Medicare but copays for certain services can cost more.

Filed Under: Medicare Advantage, Medicare Supplement Plans, Medigap Insurance Tagged With: Medicare Advantage, Medicare Supplement

Gallup Poll: More Americans Buy Health Insurance on Their Own.

May 13, 2014 by Frank West

More and more U.S. adults get health insurance on their own or through a family member, a new Gallup poll finds.

The survey regularly examines the type of health care coverage chosen by Americans. Before open enrollment for the Affordable Care Act’s online insurance exchange, the survey shows, 16.7 percent paid for insurance plans on their own or were financed by a family member. That number grew to 20 percent by April.

Medicaid, the federal-state health program for low-income Americans, also rose: 9 percent of adults said they were on Medicaid compared with 6.8 percent before open enrollment.

The health law, known as Obamacare, expanded access to Medicaid by requiring all states to increase eligibility. After the Supreme Court struck down that requirement, several states opted to offer their programs to more residents.

Employer-sponsored insurance edged down from 44.4 percent of adults to 43.1 percent during the same period. Gallup said the decline could come from several factors, such as employers dropping coverage for employees, workers opting out of employer plans, or Americans leaving the workforce altogether.

Overall, the percentage of uninsured Americans dropped to 13.4 percent last month, Gallup noted.

Filed Under: Affordable Care Act, Health Insurance, insurance broker Tagged With: Affordable Care Act, Health Care Reform

Health Insurance Coverage for Children (Minors & Young Adults)

May 12, 2014 by Frank West

The Affordable Healthcare Act (ACA) includes provisions specifically designed to address the medical insurance needs of children and young adults. These changes extend health coverage to millions of previously uninsured young Americans and also guarantee insurance to children with pre-existing conditions. Several other changes are scheduled to take effect in 2014 that will expand coverage to those over 26 years of age.

Up to 17 million children under 18 may have some sort of pre-existing condition that could have prevented them from obtaining health insurance before the ACA took effect. Now insurance companies may not deny, exclude, or limit coverage to children with a pre-existing condition. This protection also extends to all individual and job-related policies that are grandfathered. In 2014, the prohibition against rejecting a health insurance application on the basis of a pre-existing condition will cover Americans of all ages.

The new insurance requirements created by the ACA also affect The Children’s Health Insurance Program (CHIP), which is the component of the Medicaid program that provides low-cost or free health insurance to children. The current eligibility standards for CHIP will remain in place through 2019 and financial funding for CHIP is now guaranteed through 2015. However, given health insurance subsidies from the government along with an expansion of Medicare eligibility, there are questions regarding how the CHIP program may need to evolve in the future.

Additional ACA changes increase the age at which young adults can be removed from their parents’ insurance plan. It is estimated that this policy has already enabled up to 3 million Americans between 19-25 that were previously uninsured to gain health coverage. Previously, insurance companies could require families to remove children from their plans at age 19. This limit is now raised to age 26 and applies to young adults across the board even if they are not living at home or are currently married.

This increased coverage for young adults also provides for those children in the foster care system over age 19 to remain eligible for the Medicaid program through age 26. There is one exception to the age limit increase. If a young adult is eligible for coverage through his or her employer and their parents’ plan is grandfathered, the parents’ insurance provider is not required to observe the new age limit increase. This exception will expire in 2014.

These age limit changes include tax benefits for those parents whose employer-provided health coverage includes their adult child in their insurance plan. Generally, healthcare coverage for adult children up to age 27 is now tax-free in most cases. These tax benefits currently extend to various workplace and retiree health plans and some self-employed consumers.

Employees with cafeteria plans, or plans that allow consumers to pick from a menu of tax-free benefit options and cash or taxable benefits, may now begin to make pre-tax payments for the health coverage of their young adult children. Since insurance plans usually expire at the end of the calendar year and coverage for adult children expires on their 26th birthday, these benefits are designed to ease the financial necessity of continuing to pay for a plan for which the adult child can no longer use.

Filed Under: Affordable Care Act, Health Care Reform, Health Insurance, San Diego Health Insurance Tagged With: Affordable Care Act, Health Insurance Exchange

Health Insurance: It’s Not Too Late to Get Covered – Special Enrollment Period Now Open

Overview

What is Short-Term Health Insurance?

Advantages of Short-Term Health Insurance

Disadvantages of Short-Term Health Insurance

What is Medicare Advantage

Quick Links