Consumer Cost Protection in Obama Health Plan Is Delayed.

August 15, 2013 by Frank West

Federal regulators have delayed a consumer protection in President Barack Obama’s signature health law that limits the out-of-pocket costs of people with insurance.

The one-year postponement of the annual limit on costs that patients must pay above what their insurance covers is another setback for a health-care law that has met resistance from Republicans and faced delays in enforcement of other key provisions.

The White House announced on July 3 that it would postpone, also for one year, the so-called employer mandate, which requires companies with 50 or more workers to provide health insurance to employees.

The limit on out-of-pocket costs, such as deductibles and co-payments, was supposed to be $6,350 for an individual and $12,700 for a family beginning in 2014. Federal officials now will allow some insurers to wait until 2015 to comply with the consumer protection.

The one-year postponement applies only to group health plans such as those offered by employers and unions and only to plans which use independent managers to handle pharmaceutical or other benefits, said an administration official who asked not to be identified speaking about internal deliberations.

Individual policies sold in the new marketplaces created by the health care law still must comply on schedule with the overall limits on out-of-pocket costs included in the health care law, the official said.

In About-Face, Aetna Backs Away from State-Based Exchanges.

August 13, 2013 by Frank West

At least one big insurer is rethinking its plans to sell healthcare policies through the state and federal online marketplaces next year.

Aetna has dropped plans to offer health policies through the insurance exchanges in Ohio and its home state of Connecticut, the company revealed last week.

The Buckeye and Nutmeg state exchanges are the latest to join a growing list of local markets in which the carrier has reversed course and decided not to participate. Since June, it has also backed off plans to sell coverage via the exchanges in six other states, including California, Georgia, Maryland, New York, Tennessee and Texas.

In the case of Connecticut, at least, the decision was made “reluctantly,” according to a letter to the state’s Insurance Department signed by Bruce Campbell, Aetna’s senior actuary. “Please be assured this is not a step taken lightly, and was made as part of national review of our Exchange strategy,” Campbell wrote.

As in some other states, Aetna abandoned its plans after Connecticut regulators questioned the rates it proposed to offer through the state’s exchange, known as Access Health CT or AHCT. Three insurers will still offer individual coverage through AHCT, including Anthem, ConnectiCare and the nonprofit HealthyCT.

“The good news today is that consumers and businesses will retain several, high quality choices, and today’s decision also shows we at AHCT are doing our best to hold rates down,” Kevin Counihan, the chief executive of AHCT, said in a statement. “Our goal is clear: we want to bring affordable, quality health care to Connecticut’s residents and small businesses.”

The story is similar in Maryland, where the insurer said the state’s requirements for rate reductions would force it to operate at a loss. “Unfortunately, we believe the modifications to the rates filed by Aetna and Coventry would not allow us to collect enough premiums to cover the cost of the plans,” Aetna said in a letter to insurance commissioner Therese Goldsmith. Eight other carriers will continue to offer individual policies through Maryland’s web-based insurance market.

In Ohio, Aetna said it’s withdrawing from the individual exchange market for 2014, but plans to continue offering its individual products from its Coventry subsidiary on the exchange. The carrier also said it will continue to provide its individual product in Ohio’s off-exchange market.

Aetna’s decision will leave 12 companies offering 200 individual health insurance plans on the Ohio exchange.

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

Detroit Looks to Obamacare to Cover Pensioners’ Health Care.

July 30, 2013 by Frank West

Detroit is hoping to lean on the Affordable Care Act to pick up its massive retiree health care tab as it tries to dig it out of bankruptcy.

The Motor City is reportedly considering shifting its unfunded $5.7 billion in health-care costs of retired workers that aren’t yet eligible for Medicare to the health insurance exchanges that are set to hit the market next year under Obamacare.

The $9 billion in pension liabilities to 21,000 retirees is the greatest cost to the city, which is currently $18 billion in debt, according to the Detroit Free Press.

If the current pension health-benefits are cut, the majority of retirees will either receive care via Medicare if they are at least age 65, or through online insurance exchanges. Those who are at or below 400% of the federal poverty limit will be eligible for subsidies.

“It will actually be discriminatory,” says Gary Burtless, labor expert at the Brookings Institute. “Suppose you are a retiree and you believe you had access to Detroit-provided health insurance plans, but your family income is over four-times the poverty line. You will not get any subsidy and will have to pay for the full cost of the plan without any help of the government, in any form, whatsoever.”

He adds that Detroit retirees are lucky in one sense, since they are Social Security-eligible. In some states, including Massachusetts, public workers cannot collect Social Security benefits because they do not pay into the system. With that said, Detroit retirees depending on a pension might be forced to claim Social Security benefit early, and thus reducing their payments.

But what may be good news for Detroit retirees who are eligible for the health-care subsidy, is bad news for taxpayers, who are helping pay for this coverage for an unnamed amount of pensioners in the city who are not yet Medicare eligible, says Michael Tanner, Cato Institute senior fellow.

“It’s a shift of the cost to these [retired] workers and to the taxpayers at large,” Tanner says. “If Detroit went to Congress and asked them to pay for their plans, Congress would say, ‘no.’ They are getting a bailout from taxpayers.”

The average pension check, per month for a retiree in Detroit is under $1,200 according to the Detroit Free Press. Using the Kaiser Family Foundation’s subsidy calculator, a single, 63-year-old worker receiving a $1,200 check per month, or $14,400 pre-tax per year, would be at 125% of the federal poverty level. This worker seemingly does not smoke, and has no children or other family members on the health-care plan.

Kaiser’s calculator has the unsubsidized annual premium for our fictional worker at $3,018, and the worker paying $288 for care per year.

Other cash-strapped cities and municipalities are watching the situation in Detroit closely, as it may provide financial options to unfunded pension systems, says Tanner.

“This is being talked about in a number of cities,” he says. “The fact is that Detroit will have to cut its health-care plans and this is a way of shifting those costs.”

And if Detroit pulls this off successfully, Burtless thinks many other cities will follow suit.

“If Detroit pulls this off, why shouldn’t other cities and states not evade their responsibilities and commitment?”

Whether this is the solution the city opts for will all depend on its bankruptcy restructuring plan, Tanner says. City Emergency Manager Kevyn Orr has discussed a potential $120 allowance for retirees who were set to receive full health-care benefits before the Chapter 9 filing, says Steven Kreisberg, director of collective bargaining at Detroit’s AFSCME union.

Kreisberg says if the shift occurs, it will bring a reduction in benefits for retirees.

“The ACA has various ranges of coverage, but it will depend on what the retirees are willing to pay,” he says. “You are moving from a situation where employees earned the right to retiree health care to [a situation] where that will be completely withdrawn.”

Solutions to the city’s pension and retiree benefits are still very much in the “discussion” phase, says Kreisberg.

“It’s a significant loss,” he says. “The coverage employees had was seamless from employment to retirement and was very comprehensive. “

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

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

July 30, 2013 by Frank West

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.

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

New California Health Insurance Exchange Marketplace.

July 13, 2013 by Frank West

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

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

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https://frankwestinsurance.com/individual-health-care-mandate-qa/#comments

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

Administration quietly announces another PPACA delay.

July 9, 2013 by Frank West

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.

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

Can a state force business onto an health exchange?

July 3, 2013 by Frank West

Can a state force business onto an health insurance exchange?

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.

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

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

July 3, 2013 by Frank West

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.”

“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.

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

White House delays employer mandate requirement until 2015.

July 3, 2013 by Frank West

White House delays employer mandate requirement until 2015

By Sarah Kliff, Updated: July 2, 2013

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)

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.

Filed Under: Affordable Care Act, Group Health Benefits, Group Health Insurance, Health Insurance Exchange Tagged With: Affordable Care Act, Group Health, Group Medical Insurance, Health Care Reform, Health Insurance Exchange, Obamacare

Health Insurance for the Self Employed .

June 27, 2013 by Frank West

Health Insurance for the Self Employed

Medicine Bottles Being self-employed is a liberating feeling for those who make it a part of their lifestyle. These people have the autonomy to set their own schedule, and enhance their careers as much as possible without having to deal with mundane office politics. A self-employed person can manage their own career, without having to wait to be promoted. There is one thing however, that is tough to manage, which is health insurance.

When first starting out in a new career, it can be especially difficult to carry health insurance. Although many people would love to become self-employed, and plan carefully for such an event, most do not realize the actual monthly expense of health insurance. Before you make this decision, it is crucial to figure out exactly how much you will be paying for health insurance. Collect as much information as possible, for example the rates you need to pay to cover yourself and possible dependents, and how that fits into your budget.

Being self-employed does not allow you to take advantage of bulk rates that are normally set aside for employers paying to cover their employee’s health insurance costs. This is one of the reasons why the insurance rates are so high. Through careful research, you may find you have access to low bulk insurance rates through a non-corporate affiliation. Possible solutions include programs related to educational institutions you may be associated with, or perhaps your religious background will allow you to get a discount from certain organizations.

Consider joining a group that can help get you an affordable insurance rate. The Freelancer’s Union was formed partly to help the self-employed get health insurance at discounted rates by bringing freelancers together. Take into account nationwide organizations like the Freelancer’s Union as well as local community organizations that will give you options for insurance rates. It’s just a matter of being resourceful and creative to find health insurance as a self-employed person.

Filed Under: Health Insurance, Health Insurance Self Employed, Self Employed Health Insurance Tagged With: Health Insurance Exchange, Health Insurance Self Employed, HSA

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

Can a state force business onto an health insurance exchange?

White House delays employer mandate requirement until 2015

By Sarah Kliff, Updated: July 2, 2013

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