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.

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

Grandfathered Health Plans

April 29, 2014 by Frank West

The Affordable Care Act created a new set of minimum requirements for health insurance plans. These minimum requirements are known as the Essential Health Benefits a plan must have in order to be sold in the United States. However, there were exemptions given to health plans that were in existence on or prior to March 23, 2010. Plans that have these exemptions on meeting the requirements of the Affordable Care Act are known as “grandfathered health plans.”

Retiree health plans (i.e. plans whose membership are limited to retired employees of the sponsor with no active employees enrolled in the plan) are also exempt to the requirements of the Affordable Care Act. Dental plans, Medicare Supplement plans, and Long Term Care plans are also exempted from the requirements of the Affordable Care Act.

If My Plan Is Grandfathered, Are All Benefits Grandfathered?

Not necessarily. Determinations are made at the benefit level within a plan, not at the plan level. This means that some benefits within your health plan may be grandfathered while others may not and, as a consequence, meet the new standards of the Affordable Care Act. For example, even grandfathered health plans must comply with the following benefits regardless of their benefits at the time of grandfathering:

Must not apply lifetime dollar limits to key health benefits
Cannot cancel your coverage because of an honest mistake made on your insurance application
Must provide dependent coverage to your children until age 26

Can I Stay In My Current Health Plan?

Many consumers are concerned that there current health plan may be discontinued. The first step in determining whether you can stay in your plan is to contact your insurer and ask if your plan is grandfathered. If it is grandfathered, ask if the insurer expects the plan to remain grandfathered in 2014.

How Long Will My Plan Stay Grandfathered?

There is no clear answer to that question. Since grandfathered status is determined by the plan’s adherence to government regulations, the plan’s grandfathered status can be lost due to noncompliance. There is no official limit to how long a plan may remain grandfathered. The chart to the right illustrates a decrease in employees covered by grandfathered health plans between 2011 and 2012.

How Can A Plan Lose Its Grandfathered Status?

A health plan can lose its grandfather status for a variety of reasons. For example, grandfathered status will be lost if the insurance company:

Significantly increases beneficiary cost sharing (e.g. copayments, coinsurance, deductible) beyond the levels used by the plan on March 23, 2010
Cannot add an annual limit on benefits or reduce an existing annual limit on benefits
Eliminates substantially all benefits used in the diagnosis and treatment of a particular medical condition (e.g. muscular dystrophy)
Forces consumers to switch to another grandfathered plan that has lower benefits than the existing grandfathered plan
Merges with, or is bought by, another plan just so the plans can avoid the requirements of the Affordable Care Act

Additionally, a plan can also lose its grandfathered status if its sponsor (i.e. an employer or employee organization):

Switches to a new insurer
Decreases its contribution rate to the plan more than 5% below the sponsor’s contribution rate on March 23, 2010

What Happens If My Plan Loses “Grandfathered” Status?

If your plan loses its grandfathered status, you will need to enroll in a qualified health plan during the next applicable enrollment period.

Can I Enroll in a Grandfathered Health Plan?

New enrollment in a grandfathered group health plan is limited to family members of existing enrollees and new employees of the grandfathered plan’s sponsor. New enrollment in a grandfathered individual health plan is limited to family members of existing enrollees

Filed Under: Health Insurance, San Diego Health Insurance, Self Employed Health Insurance Tagged With: Grandfathered Health Plans

Health Insurance Options for Part-Time Employees

April 29, 2014 by Frank West

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.

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

Consumer-Driven Health Plans (CDHP)

April 29, 2014 by Frank West

Consumer-Driven Health Plans (CDHP) are a category of health insurance plans that combine a high deductible amount with a savings account to pay for a portion of medical expenses with pretax dollars. The pretax dollars set aside for medical expenses are kept in a Health Savings Account (HSA) or a Health Reimbursement Account (HRA). HSA savings accounts are only available to enrollees enrolled in a high deductible health plan.

If you are considering a health plan that offers the option of either a HSA or a HRA, see our article “HSA vs HRA” to determine which of these savings account options is right for your circumstances.

CDHPs can only use high deductible health plans to provide health insurance benefits. To qualify as a high deductible health plan for an individual, the deductible amount must be at least $1,250 in 2013. The minimum deductible for a family is $2,500 in 2013 in order to qualify as a high deductible health plan. High deductible health plans are associated with lower premiums as compared to health plans with smaller deductibles.

Three-Tiered Payment Systems

Consumer-driven health plans are sometimes referred to as three-tiered payment plans. This is because one of three entities can pay medical costs:

The savings account associated with the CDHP (e.g. HSA or HRA)
The consumer in the form of payments made out-of-pocket
The insurance plan

In order for the savings account to pay for medical bills, it must have sufficient funds in it.

Once the deductible amount is satisfied, the CDHP operates similarly to a traditional health plan where the insurance pays the majority of a covered medical service and the enrollee pays a copayment or coinsurance fee.

Consumer-Driven Healthcare

CDHPs are part of a larger set of practices known as “consumer-driven heathcare.” Consumer-driven healthcare seeks to introduce competitive market forces to healthcare by exposing a larger portion of costs to consumers and, by doing so, encourage price shopping. While the consumer pays more out-of-pocket, they typically enjoy lower insurance premiums while still gaining protection from catastrophic healthcare costs associated with a major medical event or condition. However, in order for consumer-driven healthcare to be effective it requires consumer access to medical costs. At present this costs are not always available to consumers.

The opposite of consumer-driven healthcare is found in many pre-reform health plans where consumers have no incentive to comparison shop costs when healthcare prices are hidden from them by flat fee copayments that are the same regardless of which healthcare provider is used. Critics of consumer-driven healthcare argue that high out-of-pocket costs result in lower short-term medical utilization that results in more expensive lifetime healthcare costs. Present research has not been able to support that claim.

Filed Under: Affordable Care Act, Health Insurance, Health Savings Account Tagged With: Affordable Care Act, HSA

Health insurance tax faces challenge.

September 10, 2013 by Frank West

The health insurance industry and business allies are stepping up their campaign to repeal another new Obamacare tax this fall — one that they argue will hit consumers smack in the health care part of their wallet.

As Congress returns from recess, expect to hear more about the health insurance tax, or HIT, as it’s known, a levy in the health care law to raise $116 billion through 2023. That money, in turn, is America’s Health Insurance Plans, the U.S. Chamber of Commerce, an insurance brokers association and other groups launched a digital advertising and social media campaign last month to stir opposition to the tax, especially in states of the lawmakers who might do something about it.

The campaign will formally launch inside the Beltway later this month, after having attracted several additional trade groups to the initial coalition.

The ads focus on the tax but not the health care law itself. The message is that the tax counters the goals of health reform by making insurance more expensive, and therefore less affordable. The cost is expected to be passed on to consumers.

But the tax is also a large piece of the funding for the insurance expansion — which, in turn, will create millions of new customers for insurers, many with government subsidies.

The health insurance tax won’t hit the premiums of people who work for many large employers — which cover a great majority of working Americans. Most big employers already offer coverage through something called self-insurance — meaning they actually use their own dollars to pay the medical bills and use the insurers to administer the health plans. The employer, not the insurer, carries the risk.

The tax does apply to insurance companies that pick up the tab, including the private Medicare Advantage plans and those that will be sold to individuals on the new state-based Obamacare exchanges. It applies to most small-business plans, which are less likely to self-insure.

Author:Brett Norman (bnorman@politico.com

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

America’s biggest employers, from GE to IBM, are increasingly moving retirees to insurance exchanges.

September 10, 2013 by Frank West

(Bloomberg) — America’s biggest employers, from GE to IBM, are increasingly moving retirees to insurance exchanges where they select their own health plans, an historic shift that could push more costs onto U.S. taxpayers.

Time Warner Inc. said Sunday it would steer retired workers toward a privately run exchange, days after a similar announcement by International Business Machines Corp. General Electric Co. last year said it, too, would curb benefits in a move that may send some former employees to the public insurance exchanges created under the 2010 Affordable Care Act.

While retiree health benefits have been shrinking for years, the newest cutbacks may quickly become the norm. About 44% of companies plan to stop administering health plans for their former workers over the next two years, a survey last month by consultant Towers Watson & Co. found. Retirees are concerned their costs may rise, while analysts predict benefits will decline in some cases.

“Things are going to change dramatically,” said Ron Fontanetta, a partner at New York-based Towers Watson, which advises GE and other large companies. “Over the next two to three years, we see a much more aggressive rethinking of what employers are going to provide.”

The adjustments come as insurers have increased access the past few years to Medicare Advantage plans that provide benefits beyond the U.S. government health program for the elderly. Additionally, the health-care law promises to make it easier for those younger than 65 to buy insurance that’s guaranteed and subsidized by taxpayers.

Private Exchanges

The private exchanges are designed to join with companies to find the best deals for the former workers. The public exchanges established under ‘Obamacare,’ set to open Oct. 1, were created to provide insurance for millions of uninsured Americans. In both cases, enrollees will be able to select from a menu of private health plans.

Companies argue that many retirees can find more choice and a better deal on the exchanges, said John Grosso, head of the retiree health task force at Aon Hewitt LLC, a Chicago-based consultant. Instead of taking a one-size-fits-all company plan, a healthier retiree might find a less expensive policy with a higher deductible, or one that saved money by favoring generic drugs, he said in a telephone interview.

Less healthy workers or those who need more comprehensive coverage may not fare as well, Grosso said.

‘Gold-Plated’ Plans

“Some of them may not be as well off because they had a really gold-plated plan, but others who are paying a meaningful contribution to their own plan now can right-size the coverage,” he said.

At the same time, retirees have expressed concern that subsidies provided by companies in private exchanges may not keep up with rising medical costs, potentially putting them at financial risk in the future. And an influx of retirees could put added pressure on public exchanges that provide taxpayer-supported subsidies.

Retirees aren’t the only ones feeling the pinch. Last month, United Parcel Service Inc. told workers it would no longer provide health care for 15,000 spouses who can get benefits through their own employer. The company cited rising medical costs in general as well as the added expenses and new insurance options created by the health law.

IBM’s Decision

IBM said last week it will shift about 110,000 Medicare-eligible retirees to Tower Watson’s Extend Health, the largest private Medicare exchange. Former workers will find more options than the business could provide through its own plan, IBM, the third-largest U.S. employer according to data compiled by Bloomberg, said in a statement e-mailed Sept. 7. Caterpillar Inc. and DuPont Co. also have moved Medicare-age retirees onto the Extend exchange.

For most, coverage will come “at the same or lower cost” than they pay now. The Armonk, New York-based company will still make contributions to a tax-free health retirement account for the workers.

IBM capped its subsidies to retirees in the 1990s and “didn’t make this change to save money,” Doug Shelton, a spokesman, said in an e-mail. “It does not reduce our costs.” Rather, the company is making the change to help former workers, whose premiums and out-of-pocket charges are projected to triple by 2020 under the current plan, Shelton said.

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

Some unions now angry about PPACA.

August 30, 2013 by Frank West

WASHINGTON (AP) — When President Barack Obama helped push the Patient Protection and Affordable Care Act (PPACA) through Congress, he counted labor unions among his strongest supporters.

But some unions leaders have grown frustrated and angry about what they say are unexpected consequences of PPACA — problems that they say could jeopardize the health benefits offered to millions of their members.

The issue could create a political headache next year for Democrats facing re-election if disgruntled union members believe the Obama administration and Congress aren’t working to fix the problem.

“It makes an untruth out of what the president said, that if you like your insurance, you could keep it,” said Joe Hansen, president of the United Food and Commercial Workers International Union. “That is not going to be true for millions of workers now.”

The problem lies in the unique multiemployer health plans that cover unionized workers in retail, construction, transportation and other industries with seasonal or temporary employment. Known as Taft-Hartley plans, they are jointly administered by unions and smaller employers that pool resources to offer more than 20 million workers and family members continuous coverage, even during times of unemployment.

The union plans were already more costly to run than traditional single-employer health plans. PPACA has added to that cost — for the unions’ and other plans — by requiring health plans to cover dependents up to age 26, eliminate annual or lifetime coverage limits and extend coverage to people with pre-existing conditions.

“We’re concerned that employers will be increasingly tempted to drop coverage through our plans and let our members fend for themselves on the health exchanges,” said David Treanor, director of health care initiatives at the Operating Engineers union.

Workers seeking coverage in the state-based marketplaces, known as exchanges, can qualify for subsidies, determined by a sliding scale based on income. By contrast, the new law does not allow workers in the union plans to receive similar subsidies.

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

Obamacare Navigators get $67 million in grants.

August 15, 2013 by Frank West

CHICAGO (AP) — President Barack Obama’s administration has announced $67 million in awards to organizations that will help people sign up for insurance under the new health care law.

Health and Human Services Secretary Kathleen Sebelius announced Thursday the Navigator grant awards to 105 organizations in states that are letting the federal government run their online insurance marketplaces.

The Navigator program will be particularly important to the health law’s success in some Republican-led states that aren’t doing any state-directed outreach to the uninsured.

The grant winners don’t have much time to hire and train outreach workers. Enrollment for the health law’s new coverage options starts Oct. 1, and benefits kick in Jan. 1.

Navigators must complete a training program developed by the federal government and pass an exam.

PPACA navigators to earn $20-$48 an hour.

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

If My Plan Is Grandfathered, Are All Benefits Grandfathered?

Can I Stay In My Current Health Plan?

How Long Will My Plan Stay Grandfathered?

How Can A Plan Lose Its Grandfathered Status?

What Happens If My Plan Loses “Grandfathered” Status?

Can I Enroll in a Grandfathered Health Plan?

Three-Tiered Payment Systems

Consumer-Driven Healthcare

Author:Brett Norman (bnorman@politico.com

PPACA navigators to earn $20-$48 an hour.

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