The benefits and pitfalls of buying insurance on health-care exchanges.

The benefits and pitfalls of buying insurance on health-care exchanges. 

As the state health insurance marketplaces, also called exchanges, get set to launch in October, many people have questions about the coverage that will be offered there. Here are a few that were posed to me recently:

Q. Are there unintended consequences of shopping through an exchange? For example, are the benefits of a plan with a lower monthly premium less comprehensive than the benefits of an expensive plan? And are there plans available only to people who qualify for subsidies, so that once income increases, the consumer must switch to a different plan?

A. All plans sold on the exchanges must cover 10 so-called essential health benefits, including prescription drugs, emergency and hospital care, and maternity and newborn care.

For the most part, the plans will differ not in which benefits they cover but in the proportion of costs that consumers will be responsible for paying.

There will be four basic types of plans: Platinum plans will pay 90 percent of the cost of covered medical services, on average; gold plans will pay 80 percent; silver plans will pay 70 percent; and bronze plans, 60 percent. Premiums will vary based on those percentages, so platinum plans generally will be pricier than bronze ones.

Individuals and families with incomes up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013) may be eligible for federal tax credits to help pay premiums.

Consumers “can use the premium subsidy to purchase any plan,” says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

If your income increases during the year, you may no longer qualify for the same level of assistance, but you won’t have to switch plans. However, you may have to repay any overpayments that were made to insurers if your projected income turns out to be higher than your actual income. On the other hand, if your income falls, you may be eligible for a larger tax credit. That’s why it’s important to report any income changes to the exchange promptly.

A second type of subsidy available on the exchanges will reduce the amount that people owe in co-payments, deductibles and other out-of-pocket costs. The cost-sharing subsidy is available to individuals and families with incomes up to 250 percent of the poverty level ($28,725 for an individual and $58,875 for a family of four in 2013). To qualify for this subsidy, you must buy a silver plan, Park says. If your income changes, however, you won’t be responsible for any overpayments.

 

Once the exchanges open, how much will an insurer be allowed to increase premiums annually? And are those increases based on claims?

Premium increases are driven by many factors, including medical costs and the health of the people covered by a particular plan.

The Affordable Care Act discourages insurers from imposing unreasonable premium increases in a couple of ways. Insurers in the small-group and individual markets that want to raise premiums by 10 percent or more must submit data, projections and other information to justify the increase to state or federal regulators, who review the requests and make the information available to the public at. Asking insurers to justify why they want to increase rates should act as a deterrent to unreasonable increases, experts say.

But the law doesn’t give regulators new authority to refuse rate increases, says Timothy Jost, a law professor at Washington and Lee University in Lexington, Va. It does, however, provide funding for states to beef up their rate-review processes.

The Department of Health and Human Services says that increased scrutiny of insurance rates has led to a decrease in rate increases, says Jost, “and that’s probably true.”

In addition, the law requires insurers to spend at least 80 percent of the money they collect in premiums on medical claims and quality improvements rather than on administrative activities such as marketing. If they exceed that limit, they must rebate the excess to consumers. Insurers will return $500 million to 8.5 million consumers — about $100 per eligible family — by mid-August of this year for overcharges in 2012, according to the Obama administration. Rebates may come in various ways, including a check or a reduction in the following year’s premium.

 

My parents are legal immigrants over 65 but not yet eligible to buy into Medicare because they haven’t lived in the United States for five years. Will they be able to buy health insurance on the federal exchange?

Yes, legal immigrants will be able to shop for coverage on the exchanges, where they may be eligible for premium tax credits if their income is no more than 400 percent of the federal poverty level ($62,040 for a couple in 2013). Immigrants living in the United States illegally, on the other hand, are not permitted to buy coverage on the exchanges even if they wish to pay the entire premium out of pocket.

Labor Unions: Obamacare Will ‘Shatter’ Our Health Benefits, Cause ‘Nightmare Scenarios’

Labor Unions: Obamacare Will ‘Shatter’ Our Health Benefits, Cause ‘Nightmare Scenarios’

Labor unions are among the key institutions responsible for the passage of Obamacare. They spent tons of money electing Democrats to Congress in 2006 and 2008, and fought hard to push the health law through the legislature in 2009 and 2010. But now, unions are waking up to the fact that Obamacare is heavily disruptive to the health benefits of their members.

Last Thursday, representatives of three of the nation’s largest unions fired off a letter to Harry Reid and Nancy Pelosi, warning that Obamacare would “shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.”

The letter was penned by James P. Hoffa, general president of the International Brotherhood of Teamsters; Joseph Hansen, international president of the United Food and Commercial Workers International Union; and Donald “D.” Taylor, president of UNITE-HERE, a union representing hotel, airport, food service, gaming, and textile workers.

“When you and the President sought our support for the Affordable Care Act,” they begin, “you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat…We have been strong supporters of the notion that all Americans should have access to quality, affordable health care. We have also been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision. Now this vision has come back to haunt us.”

‘Unintended consequences’ causing ‘nightmare scenarios’

The union leaders are concerned that Obamacare’s employer mandate incentivizes smaller companies to shift their workers to part-time status, because employers are not required to provide health coverage to part-time workers. “We have a problem,” they write, and “you need to fix it.”

“The unintended consequences of the ACA are severe,” they continue. “Perverse incentives are causing nightmare scenarios. First, the law creates an incentive for employers to keep employees’ work hours below 30 hours a week. Numerous employers have begun to cut workers’ hours to avoid this obligation, and many of them are doing so openly. The impact is two-fold: fewer hours means less pay while also losing our current health benefits.”

What surprises me about this is that union leaders are pretty strategic when it comes to employee benefits. It was obvious in 2009 that Obamacare’s employer mandate would incentivize this shift. Why didn’t labor unions fight it back then?

Regulations will ‘destroy the very health and wellbeing of our members’

The labor bosses are also unhappy, because of the way Obamacare affects multi-employer health plans. Multi-employer plans, also called Taft-Hartley plans, are health insurance benefits typically arranged between a labor union in a particular industry, such as restaurants, and small employers in that industry. About 20 million workers are covered by these plans; 800,000 of Joseph Hansen’s 1.3 million UFCW members are covered this way.

Taft-Hartley plans, they write, “have been built over decades by working men and women,” but unlike plans offered on the ACA exchanges, unionized workers will not be eligible for subsidies, because workers with employer-sponsored coverage don’t qualify.

Obamacare’s regulatory changes to the small-group insurance market will drive up the cost of these plans. For example, the rules requiring plans to cover adult children up to the age of 26, the elimination of limits on annual or lifetime coverage, and the mandates that plans cover a wide range of benefits will drive premiums upward.

But the key problem is that the Taft-Hartley plans already provide generous and costly coverage; small employers now have a more financially attractive alternative, which is to drop coverage and put people on the exchanges, once the existing collective bargaining agreements are up. That gives workers less reason to join a union; a big part of why working people pay union dues is because unions play a big role in negotiating health benefits.

So the labor leaders are demanding that their workers with employer-sponsored coverage also gain eligibility for ACA subsidies. Otherwise, their workers will be “relegated to second-class status” despite being “taxed to pay for those subsidies,” a result that will “make non-profit plans like ours unsustainable” and “destroy the very health and wellbeing of our members along with millions of other hardworking Americans.” ‘The law as it stands will hurt millions of Americans’

The leaders conclude by stating that, “on behalf of the millions of working men and women we represent and the families they support, we can no longer stand silent in the face of elements of the Affordable Care Act that will destroy the very health and wellbeing of our members along with millions of other hardworking Americans.”

President Obama, of course, pledged that “if you like your plan, you can keep your plan.” But the labor leaders say that, “unless changes are made…that promise is hollow. We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions. We are looking to you to make sure these changes are made.”

Avik Roy, Contributor  Forbes, July 15, 2013

New California Health Insurance Exchange Marketplace.

In the next few months you will be hearing about “Exchanges” for businesses & individuals on TV
and radio.  The California health insurance exchange will begin to offer plans and enrollment after October 1st. with coverage taking effect January 1, 2014.  The new marketplace will offer California Exchange and Off-Exchange health plans in addition to existing private plans.   All new health plans will be offered on a guaranteed acceptance basis with all pre-existing conditions covered.   More Exchange & Off-Exchange benefit details and rates should be available by August .   It usually will only make sense for you to move to a health plan in the State Exchange if you are eligible for a tax subsidy.  The Cal State exchange premium assistance offered is only for those who fall between 133% to 400% of the Federal Poverty Level based upon household income.
You can count on us!  We’re your key health reform and exchange resource.  We are ready to assist you every day–on the phone and in person providing you with time and cost saving programs.  Please call us before  you do anything with your current coverage and I will advise you on the best course of action that will provide quality coverage and save you money.

You may be better off keeping your existing health plan or alternatively consider the Off-Exchange and California Health Insurance exchange plans which may save you money and provide enhanced benefits.  Our services will assist you in applying for a possible tax subsidy, selecting the best health plan, and enrollment process.

Thank you again for the pleasure of being of service and for your business!

Kind Regards,
Frank West

For fast online quotes, benefit details, & applications for health,
group health, medicare supplement, dental, and life insurance
please visit: https://frankwestinsurance.com

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Check Out The Following Informative Summaries: 
Health Care Reform: What is a health insurance
exchange?

https://frankwestinsurance.com/health-care-reform-what-is-a-health-insurance-exchange/#comments

Individual Health Care Mandate Q&A
https://frankwestinsurance.com/individual-health-care-mandate-qa/#comments

Affordable Care Act Hits Another “Glitch,” Mid-Term Elections.

Affordable Care Act Hits Another “Glitch,” Mid-Term Elections

July 8, 2013

Actions speak louder than words. The Obama administration knows the health care law is a train wreck.

WASHINGTON, July 3, 2013 /PRNewswire/ — Tuesday the Obama administration has announced it would give employers until 2015 to provide insurance to employees.  Officially, the administration made its decision for two reasons: 1) to give themselves time to ease up on the rigorous reporting standards that will be required of employers; and 2) to give employers an extra year to comply, since the employer mandate is based on the reporting standards.

FreedomWorks President Matt Kibbe responded with the following statement:

“Concerns about paperwork seem a weak excuse for a full year’s delay, especially since the employer mandate was not set to go into effect until next year.  The administration’s sudden concern for businesses is clearly an attempt to assuage hard feelings about the Affordable Care Act as the 2014 elections draw near, and to avoid the potential political fallout of significant layoffs and hour reductions at companies looking to avoid the extra costs of mandatory coverage.  Requiring all mid-size and large employers to cover all their full-time employees is a disaster, both for businesses and for workers. The cost burden to employers will result in hours cut and jobs lost, as companies scrounge to make ends meet.

“Actions speak louder than words. The Obama administration knows the health care law is a train wreck. They rammed it through in 2010 claiming it was urgently needed – so urgent, in fact, that they had ‘to pass the bill so [we] can find out what’s in it,’ as one representative infamously declared. Now, three years later, it still isn’t “ready.

“Obamacare is an unwieldy, unwise and un-American piece of legislation. It places undue burdens on employers and threatens countless jobs. Worse, it threatens the freedoms we hold dear as Americans.”

 

SOURCE FreedomWorks

Administration quietly announces another PPACA delay.

For a year, consumers will be on the honor system for subsidies under the Patient Protection and Affordable Care Act.

That’s what the Obama administration quietly announced Friday, days after unexpectedly announcing they would delay the employer mandate penalty for another year.

In a new 606-page rule published Friday, the administration said they would significantly scale back on the law’s requirements that the new exchanges verify consumers’ income and health insurance status until 2015, when stronger verification systems are in place.

In the meantime, the government will rely on consumers’ self-reported information.

Health insurance exchanges set up under PPACA are set to begin open enrollment Oct. 1. Enrollees with incomes ranging from 100 percent to 400 percent of the federal poverty line are eligible to receive tax subsidies to help them buy insurance. They also must not have access to insurance through their employer to qualify.

“The exchange may accept the applicant’s attestation regarding enrollment in eligible employer-sponsored plan . . . without further verification,” according to the final rule.

The administration has said they would conduct random checks to verify whether new applicants receive employer-sponsored insurance benefits, while also verifying income status.

But the new regulations from the Department of Health and Human Services said the 17 state-based exchanges would have until 2015 to do random checks, citing “legislative and operational barriers.”

In all 50 states, though, the federal government will scale back oversight of what applicants say they earn.

That move, some critics say, could lead some consumers to under report their income in order to qualify for federal tax subsidies, at least in states that are not expanding Medicaid coverage.

In the same rule, the government said it would give states until 2015 to roll out electronic notices because “states are at different places in the development of their eligibility and enrollment systems,” HHS said.

The rule is the latest setback in the health care overhaul law.

Last week, the administration announced it would not require employers with 50 workers or more to provide insurance benefits until 2015, a move business groups applauded but Republicans slammed as confirmation that “Obamacare costs too much and it isn’t working the way the administration promised.”

The administration has said the exchanges and other parts of the law are on target, and they are making delays and changes to better suit the public and employers.

Troy Underwood, CEO of Benefits Connect in Rancho Cordova, Calif. said, though, that he expects to see more PPACA delays and missed deadlines as the months go by.

“Platitudes, political favors and hope never replace a solid and realistic plan,” Underwood said. “As an expert in the processing and administration of employee benefits I can tell you the government’s efforts, even if well-intentioned, are grossly inefficient.

Health insurance carriers fear many young people will opt to go without coverage.

 Youth weighing a $100 fine against the cost of insurance.

Dan Lopez rarely gets sick and hasn’t been to a doctor in 10 years, so buying  health insurance feels like a waste of money.

Even after the federal health overhaul takes full effect next year, the  24-year-old said he will probably decide to pay the $100 penalty for those who  skirt the law’s requirement that all Americans purchase coverage.

“I don’t feel I should pay for something I don’t use,” said the Milwaukee  resident, who makes about $48,000 a year working two part-time jobs.

Because he makes too much to qualify for government subsidies, Lopez would  pay a premium of about $3,000 a year if he chose to buy health insurance.

“I shouldn’t be penalized for having good health,” he said.

Persuading young, healthy adults such as Lopez to buy insurance under the  Affordable Care Act is becoming a major concern for insurance companies as they  scramble to comply with the law, which prohibits them from denying coverage  because of pre-existing conditions and limits what they can charge to older  policyholders.

Experts warn that a lot of these so-called “young invincibles” could opt to  pay the fine instead of spending hundreds or thousands of dollars each year on  insurance premiums. If enough young adults avoid the new insurance marketplace,  it could throw off the entire equilibrium of the Affordable Care Act. Insurers  are betting on the business of that group to offset the higher costs they will  incur for older, sicker beneficiaries.

The nonpartisan Congressional Budget Office estimates that about 6 million  people of various ages will pay the tax penalty for not having insurance in  2014, the first year the law championed by President Barack Obama will be fully  implemented.

It’s hard to estimate how many of those will be the young and healthy adults  that insurers are trying to reach, but that subgroup makes up a very small  portion of the overall market. Even though it’s small, experts say it could be  enough to throw the system’s financing off-kilter.

About 3 million 18-to-24-year-olds in the U.S. currently purchase their own  insurance. Many pay high prices for scant benefits, with high deductibles and  co-pays because they make too much to qualify for Medicaid and have no coverage  options from their employers or parents. The Urban Institute estimates that the  majority of adults in their 20s will qualify for government subsidies under the  Affordable Care Act.

Premium hikes could be a disincentive for young people weighing their  options. Premiums for people aged 21 to 29 with single coverage who are not  eligible for government subsidies would increase by 42 percent under the law,  according to an analysis by actuaries at the consulting firm Oliver Wyman. By  comparison, an adult in his or her early 60s  would see about a 1 percent  average increase in premiums under new federal health rules.

“The key to keeping health care affordable is you really want to balance the  pool, where you have enough young and healthy people to balance off the care of  the older, sicker people who are likely to utilize much more health care  services,” said Justine Handelman, the Blue Cross and Blue Shield Association’s  vice president for legislative and regulatory policy.

She said younger people use about a fifth of the services that older  beneficiaries do.

Jonathan Gruber, an economics professor at the Massachusetts Institute of  Technology who helped craft that state’s law, said he thinks the first-year  federal penalty should be higher.

The penalty under the Massachusetts law, which served as the model for  Obama’s overhaul, was $218 the first year in 2007. Gruber said that amount  proved effective.

“People hate paying money and getting nothing for it,” he said.

Francois Louis, a 20-year-old college student in South Florida who works  part-time, can’t remember the last time he went to the doctor and gets by on  over-the-counter medication whenever he’s sick. He’d love to get a checkup, but  says it’s too expensive on his income of less than $15,000 a year.

“I probably would do the $100 fine because it’s just cheaper and you don’t  have to worry about paying off monthly costs,” said Louis, a student at Broward  Community College near Fort Lauderdale.

By Kelli Kennedy
The Associated Press

 

Patient Protection and Affordable Care Act (PPACA) Trainwreck.

The Obama administration’s move to delay until 2015 a requirement that employers offer health insurance or else face stiff penalties is yet another indication that the embattled law is a failure and  should be repealed, Republicans and conservatives said on Tuesday.

“The president’s healthcare law is already raising costs and costing  jobs,” House Speaker John Boehner said. “This announcement means  even the Obama administration knows the ‘train wreck’ will only get worse.

“I hope the administration recognizes the need to release American families from the mandates of this law as well,” the Ohio Republican  said. “This is a clear acknowledgment that the law is unworkable,  and it underscores the need to repeal the law and replace it with  effective, patient-centered reforms.”

“Obamacare costs too much and it isn’t working the way the administration promised,” said Senate Minority Leader Mitch McConnell of Kentucky. “The White House seems to slowly be admitting  what Americans already know: Obamacare needs to be repealed and  replaced with common-sense reforms that actually lowers costs for Americans.”

And Barney Keller, spokesman for the Club for Growth, called the delay “a transparently political ploy to help the Democrats who voted for it avoid the consequences at the ballot box in 2014. This just helps make the case that Obamacare should be completely  repealed — period, exclamation point.”

The IRS, which is charged with implementing Obamacare, remains under fire for widespread mismanagement and for the targeting of tea party, conservative, and religious groups in evaluating their applications for tax-exempt status.

And the American Action Forum, a Washington advocacy group, said that Obamacare had so far cost a total of $30.8 billion and 111.4  million hours for completing paperwork alone.

The group said 55,742 employees — working 2,000 hours per year — would be needed to process all the red tape associated with  Obamacare.

While the employer mandate was delayed with Tuesday’s announcement,  the individual mandate — which requires individuals to obtain health  insurance — presumably remains on schedule for 2014.

Can a state force business onto an health exchange?

 

Can a state force business onto an health insurance exchange?

        Rep. Darrell Issa, R-Calif. (File photo)                   Rep. Darrell Issa, R-Calif. (File photo)

Republicans are asking whether officials in Vermont and the District of Columbia really have the authority to force some or all health insurance business onto the new Patient Protection and Affordable Care Act (PPACA) exchanges.

Rep. Darrell Issa, R-Calif., and other leaders of the House Oversight and Government Reform have sent a letter asking about local officials’ ability to shut down non-exchange markets to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius.

The lawmakers also have sent similar letters asking about the matter to officials in Vermont and the District of Columbia.

D.C. officials are trying to get all individuals to buy coverage through its district-based exchange, and for all small groups to get their coverage through the exchange by 2015. Health insurance agents and brokers could still sell the coverage but would have to work with the exchange.

Vermont is trying to move its individual and small-group markets onto the Vermont exchange.

The D.C. proposal and the Vermont proposal are “inconsistent with principles of consumer choice and competition,” Issa and colleagues wrote in the letters.

State or D.C. efforts to eliminate non-exchange markets conflict with PPACA, which states that nothing in PPACA is supposed to keep companies from selling coverage outside an exchange or to keep individuals from buying coverage outside an exchange, the lawmakers said.

The D.C. and Vermont efforts to shut down non-exchange markets “violate the principle of voluntary participation in exchanges that was codified in PPACA and reaffirmed in your guidance when you wrote that ‘participation in a [small business exchange] is strictly voluntary for small employers,” the lawmakers told Sebelius.

D.C. officials have argued that they need to unify their individual and small-group markets on the district’s exchange because the district is too small to have successful, separate exchange and non-exchange markets.

In Vermont, state officials told the Associated Press that they believe PPACA gives states broad authority over regulation of any non-exchange health insurance markets under their jurisdiction and clearly gives states the authority to impose rules that are more strict than the rules imposed by PPACA.

Boehner: Obamacare ‘Train Wreck,’ ‘Unworkable’.

The announcement tonight of the delay of part of the implementation of Obamacare prompted Speaker of the House John Boehner to release this statement, saying the entire bill is a “train wreck” and “unworkable.”

boehner, john 

 

“The president’s health care law is already raising costs and costing jobs. This announcement means even the Obama administration knows the ‘train wreck’ will only get worse. I hope the administration recognizes the need to release American families from the mandates of this law as well. This is a clear acknowledgment that the law is unworkable, and it underscores the need to repeal the law and replace it with effective, patient-centered reforms,” the statement reads.

White House delays employer mandate requirement until 2015.


White House delays employer mandate requirement until 2015

By Sarah Kliff, Updated:

The Obama administration will not penalize businesses that do not provide health insurance in 2014, the Treasury Department announced Tuesday.

Instead, it will delay enforcement of a major Affordable Care Act requirement that all employers with more than 50 employees provide coverage to their workers until 2015.

(Photo by Jessica Rinaldi/Reuters)

(Photo by Jessica Rinaldi/Reuters)

The administration said it would postpone the provision after hearing significant concerns from employers about the challenges of implementing it.

“We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark Mazur, Assistant Secretary for Tax Policy, wrote in a late Tuesday blog post. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so.”

The Affordable Care Act requires all employers with more than 50 full-time workers provide health insurance or pay steep fines. That policy had raised concerns about companies downsizing their workforce or cutting workers’ hours in order to dodge the new mandate.

In delaying the enforcement of that rule, the White House sidesteps those challenges for one year. It is also the second significant interruption for the Affordable Care Act, following a one-year delay on key functions of the small business insurance marketplaces.

Together, the moves could draw criticism that the administration will not be able to put into effect its signature legislative accomplishment on schedule.

 

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