http://www.beckersasc.com/asc-coding-billing-and-collections/co-op-failures-adds-to-speculation-about-future-of-aca-4-things-to-know.html
Major Health Insurance Mergers May Leave Consumers “Worse Off”.
June 21, 2016 by
http://healthpayerintelligence.com/news/major-health-insurance-mergers-may-leave-consumers-worse-off
Checklist for Millennials Buying Health Insurance for the First Time.
March 30, 2016 by
Reaching the age of 26 is a new benchmark for Millennials, as they mark a new rite of passage of buying health insurance for the first time.
Gen Y-ers lose health insurance coverage under their parents’ plan once they turn 26 and must seek an individual plan, which is mandated by the Affordable Care Act (aka Obamacare).
Becoming 26 years old is counted as a qualifying life event under the ACA, and Millennials have a 60-day time period to research and purchase a health insurance plan. Millennials are required by law to buy their own coverage or face paying the tax penalty of $695 per adult or 2.5% of your taxable income in 2016, whichever is greater.
“Your parents have the option (not the obligation) to keep you enrolled in the family health insurance plan until you turn 26,” said Nate Purpura, vice president of consumer affairs at eHealth.com, an online health insurance exchange based in Mountain View, Calif. “Once you reach that age, however, you’re on your own when it comes to health coverage.”
You can also enroll during the nationwide open enrollment period, which began on November 1 and will continue through January 31, 2016. Millennials who are shopping now for their first health insurance plan should check to see if they qualify for government subsidies and follow these other guidelines.
All Plans Offer Free Preventative Care
One of the mandates of the ACA is that every single plan must include free annual checkups from your doctor, the flu shot and other important vaccines, said Noah Lang, CEO of Stride Health, the San Francisco health insurance exchange company. The preventative care is the same regardless if you buy a bronze, silver or gold plan.
“If you never see the doctor for anything but preventive care, you’re effectively getting the same coverage whether you have a bronze or a gold plan,” said Purpura. “However, if you get sick or need to pick up prescription drugs, you’ll find that your coverage is not the same. That’s where higher metal level plans show their value.”
Qualifying for Subsidies
Gen Y-ers are likely candidates to qualify for subsidies, which makes their insurance premium cheaper. Earning $47,000 a year or less means you are eligible for them.
One major caveat – if you wind up earning more money than what was estimated, save up some money to pay it back next spring when you are filing for taxes.
“Your subsidies will be based on the money you actually earn during the year you’re receiving subsidies, so be careful not to underestimate your income or you could end up paying some of your subsidies back at tax time.
If You Miss the Obamacare Deadline, Temporary Health Insurance Plans Are Available.
March 3, 2016 by
Missing the deadline to purchase health insurance does not mean consumers have to forego coverage for nearly a year until the next open enrollment season starts.
Short-term health insurance plans are one method to manage not having health coverage. After all, one trip to the ER can be an expensive one that can set you back for months or longer since unpaid medical bills is one of the top reasons consumers file for bankruptcy.
Although neither short-term, accident or critical illness insurance will meet the requirement for health insurance coverage under the Affordable Care Act and consumers are still subject to the tax penalty for being uninsured for two consecutive months or longer, these plans will put a cap on your financial liabilities. There are many qualifying life events that could make you eligible for buying health insurance under the special enrollment period such as moving to another state, getting married or divorced or turning 26 and aging out of your parent’s plan.
The short-term plans usually do not include coverage for preventive care like an annual physical or pre-existing medical conditions or prescription drugs. They can be a good option so that your expenses do not wind up insurmountable in case you are injured or wind up sick.
The short-term plans are often “significantly more affordable” than standard health insurance plans, he said. The monthly premiums can range from $50 to $150.
The coverage typically does not last longer than 6 to 12 months, but you can usually apply again at the end of that period. While this option can serve as a backup plan, also ask your doctor for their “cash” value of a visit, which is often affordable if you need a checkup or have a minor illness.
Six states currently do not allow the sale of short-term insurance – Minnesota, New York, Vermont, Massachusetts, Rhode Island, New Jersey and Maryland, said Noah Lang, CEO of Stride Health, the San Francisco health insurance exchange company. Other states such as California limit the length of the policy and consumers can only be covered for up to six months.
Accident insurance is designed to help consumers if they have a qualifying injury. The money is paid directly to consumers rather than to the doctor, which means you can do what you want with the payout such as paying medical bills or for your rent, said Purpura.
Critical illness insurance plans work similar to accident plans because consumers receive a payment if you are diagnosed with a qualifying illness such as cancer or heart disease.
It seems like a no-brainer to simply purchase a temporary plan and use it year-round if you are young and healthy, since you can save money each month, but there are a few catches: you are still liable for the tax penalty, they do not cover any pre-existing conditions and have payout limits of usually $1 million to $2 million, said Jack Hooper, CEO of Take Command Health, an online health insurance exchange based in Dallas.
“In the eyes of Obamacare, temporary insurance counts as being uninsured, meaning you’re liable for penalties and taxes,” he said. The tax penalty for not having health insurance coverage rose for 2016 and now consumers are liable for $695 or 2.5% of their income, whichever is greater.
Co-Pay? Deductible? Premium? What Does it all Mean? Health Plan Terms to Know Before you Choose a Plan.
September 15, 2015 by
Whether you are familiar with health plans or are shopping for one for the first time, deciphering different plans cans be confusing. Understanding the right terms is especially helpful when considering which plan is right for you, as many have cost implications associated with them. Here’s a rundown on the terms you’ll need to know to keep it all straight:
Affordable Care Act (ACA): The federal healthcare reform law passed in March 2010. Also known as Obamacare or healthcare reform.
Allowable charge: Also referred to as an ‘allowable amount’. The negotiated amount for which an in-network provider agrees to provide services. This amount is usually lower than the amount you would pay for the same service if you did not have health coverage.
Coinsurance: Your share of the fee for a service after you’ve met your deductible and before you’ve reached your out-of-pocket maximum. If your plan’s coinsurance share is 20%, you pay 20% of the allowable charge, and your plan pays the other 80% of the allowable charge.
Copay: A flat fee you pay at the time of service, such as an office visit. Copays apply toward out-of-pocket maximum.
Cost shares (or out-of-pocket costs): Costs that you pay for out of your own pocket for medical services, even if you have health coverage. Cost shares include deductibles, copays, and coinsurance.
Covered in full: Services your health plan pays for in full, at 100% of the allowable charges, and not subject to your deductible or coinsurance. For example, most preventive care is covered in full by many health plans.
Deductible: The amount you pay every year before the plan begins to pay for most services. This is similar to the deductible you pay for your car or homeowners insurance.
Exchange or marketplace: Another way to shop for health insurance, with a government (state or federal) website where you can compare plans from multiple companies and find out if you qualify for financial assistance. You can purchase your health coverage through the exchange or directly from Premera.
Formulary: A list of drugs for specific uses that the health plan covers.
Health savings account (HSA): Certain plans with higher deductibles allow you to open a special savings account to pay for many of your health care expenses. The money contributed to your account, by you or your employer, is not subject to federal income taxes when used for allowable healthcare costs, so the accounts offer tax advantages to some people. You generally have higher cost shares with these types of plans, so you should make sure you understand how they work before you consider them.
Network: A group of doctors, dentists, hospitals, and other healthcare providers that contract with your health plan to provide healthcare services at negotiated amounts, which are called allowable charges. Your costs are almost always lower when you get care from in-network providers.
Open enrollment period: The annual time period when you can apply for a new individual health plan or make changes to your current health plan. The open enrollment period for 2015 individual coverage is November 15, 2014 through February 15, 2015. If you experience certain life events, such as getting married, having a child, moving, or losing your employer’s health coverage, you can apply for coverage outside these dates.
Out-of-pocket maximum: A preset limit after which your plan pays 100% of the allowable charge.
Preferred provider organization (PPO): A health plan contracts with specific medical providers, such as doctors and hospitals, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use providers outside of the network, but you’ll pay a greater share of the cost.
Premium: The amount you and/or your employer pay (usually each month) for health coverage, regardless of whether you use any medical services.
Primary care physician (PCP): Your main or regular doctor or other healthcare provider. Some plans offer lower office visit copays if you notify them of your designated PCP.
Producer: A person or business that can help you shop for and choose health coverage. Often referred to as a broker or agent.
When Is Open Enrollment on Health Insurance Exchanges?
September 10, 2015 by
Don’t let the next Obamacare open enrollment slip by without signing up for health insurance on your health insurance exchange.
You can’t sign up for an Obamacare health plan on your state’s Affordable Care Act health insurance exchange whenever you want. Instead, there’s a limited open enrollment period during which you can sign up for a new plan or change your current plan.
If you miss Obamacare open enrollment, you may have to wait until the next year’s open enrollment period to sign up for health insurance.
So, When Is My Next Chance to Get Health Insurance?
The open enrollment period for 2015 health insurance coverage from the Affordable Care Act health insurance exchanges ended February 15, 2015.
However, the federal exchange at HealthCare.gov is permitting a one-time special enrollment opportunity for those who discover they must pay the penalty for being uninsured in 2014 and didn’t know about it. This one-time special enrollment period coincides with tax-filing season and runs from March 15, 2015 through April 30, 2015. Some, but not all, state-run health insurance exchanges have opted to provide this same special enrollment period.
Open enrollment for 2016 begins November 1, 2015 and ends January 31, 2016.
Open enrollment for 2017 and beyond runs from October 1 through December 15 of the year before.
For example, if you want health insurance coverage starting January 1, 2018, you can sign up for that coverage anytime between October 1, 2017 and December 15, 2017.
When Will My Coverage Start If I Sign Up During Next Open Enrollment?
For 2016:
- Sign up by December 15, 2015; coverage starts January 1, 2016.
- Sign up December 16, 2015 to January 15, 2016; coverage starts February 1, 2016
- Sign up January 16, 2016 to January 31, 2016; coverage starts March 1, 2016.
For 2017 and beyond, sign up any time during open enrollment and your coverage will start on January 1 of the following year.
What If I Miss Open Enrollment?
If you miss open enrollment on your health insurance exchange, you won’t be able to sign up until the next open enrollment period unless you qualify for a special enrollment period. Learn how to qualify for a special enrollment period, and learn what you’re in for if you don’t get a special enrollment period in “I Missed Obamacare Open Enrollment. What Now?”
If you’re losing your current health insurance and it’s not Obamacare open enrollment, you don’t have to go without health insurance. To learn your options, check out “Lost Your Health Insurance? Not Obamacare Open Enrollment? What Now?”
If you currently have health insurance you bought on your health insurance exchange, but missed open enrollment for the upcoming year, you’ve neglected to sign up for health insurance next year. You could be in luck, though; your current health plan might be automatically renewed, preventing you from being uninsured next year. Learn more about this in “What Is Automatic Renewal of Health Insurance & How Does It Work?” and “Weighing the Pros & Cons of Automatic Health Insurance Renewal.”
Employers cutting worker hours to avoid PPACA.
March 24, 2015 by
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.
Health Insurance: It’s Not Too Late To Get Covered.
March 24, 2015 by
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.
Open enrollment: Tips for selecting health insurance.
October 7, 2014 by
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.
Health Insurance Options for Part-Time Employees
April 29, 2014 by
The Affordable Care Act (ACA), also referred to as Obamacare, does not require employers to offer health insurance to part-time employees Part-time employees are defined as those who work less than 30 hours a week, and employers without healthcare coverage for part-timers will not be penalized.
The Individual Shared Responsibility Provision of the ACA that goes into effect in January 2014 requires that all individuals, including part-time workers, must either have creditable health coverage or qualify for an exemption. Individuals that do not meet either requirement will be assessed a penalty on their income tax return for the year. Part-time workers without access to job-based coverage will be responsible for obtaining their own healthcare if they do not wish to pay the tax penalty.
Individuals and families will have several options for purchasing their own health insurance. Individual plans may be purchased directly from private insurance companies. Beginning in January 2014, insurers will not be able to deny applicants that have a pre-existing condition, which may be beneficial to those individuals that are not able to work fulltime due to illness.
Part-time workers may be able to purchase health insurance via their state’s Health Insurance Marketplace, also known as the state exchange. Individuals and families may qualify for lower costs on monthly premiums based on household size and annual income. Part-time workers can also purchase insurance from a private exchange, particularly those that include on-exchange and off-exchange health plans for maximum consumer choice.
Monthly premiums for health plans purchased via a state exchange may be partially subsidized via premium tax credits. Generally these credits will be extended to non- elderly families with annual incomes of 100 to 400 percent of the federal poverty line. About half of the non-elderly population has an annual income in that range, but this varies depending on geographical location and family size.
Premium credits will only be extended to consumers who are not offered health insurance through an employer. Since about 95% of all companies that employ over 50 full-time workers already provide healthcare to those workers, subsidies will not be available to most of those who do full-time work. Full-time employees would be eligible for lower costs via subsidies only if their job-based coverage isn’t considered affordable or doesn’t meet certain minimum standards of care.
Healthcare coverage is generally considered to be affordable according to ACA standards if an employee’s premium cost is less than 9.5% of their yearly household income. The minimum standards of care are called the Essential Health Benefits, which cover 10 medical coverage categories that must be offered by every insurance plan.
Part-time workers may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Eligibility guidelines for these programs vary by state, but are usually determined by annual income and household size.
Individuals and families that use their state exchange sites can explore their coverage options and learn whether they qualify for premium tax credits, Medicaid, or CHIP. Many states offer a free-to-use Navigator program that provides assistance in comparing and applying for healthcare. Small businesses that employ less than 50 full-time workers can use the Small Business Health Options Program (SHOP) to explore their options for employee coverage.