The State of Health Insurance for 2017 (or “If It Weren’t For Bad News . . .)

HEALTH BLOG PIC 1

By D. Kenton Henry, editor

 

We are more than half-way through 2016 and three months away from the scheduled beginning of the 2017 Affordable Care Act (ACA) individual and family health insurance Open Enrollment Period (OEP). All of which finds this broker and many of his clients still reeling from the this year’s OEP which ended in February.

By last September, the rumor was health insurance premiums would not be inflating. That was quite encouraging to myself and to my clients who inquired as to such. However, what was unsaid―and to our shock―was what we learned with the commencement of OEP, November 1. Specifically, all carriers in southeast Texas (my major market) were eliminating Preferred Provider Organization (PPO) plans and forcing all new policyholders to accept Health Maintenance Organization (HMO) plans in their place. Anyone who knows anything about the latter knows that, with this type of plan, the patient must obtain treatment within the network or have no coverage whatsoever. For the young and bulletproof this seemed no great compromise. But to the middle-aged and older, whose health problems are moderate to very serious, it was a huge one. My existing PPO plan clients who were not grandfathered, including myself, were forced by the state’s largest insurance carrier (among others) to accept HMO coverage as a substitute or lose coverage altogether effective January 1, 2016. I scrambled to find acceptable replacement coverage for over 150 of my clients from the 2017 HMO plan options. This endeavor materialized into a “Mission Impossible” style nightmare as the HMO networks made available to them had nothing approaching the larger number of provider doctors and hospitals to which the employees and dependents of large employer plans had access. My clients learned they would be unable to utilize the providers in their current (and now former) PPO plans. It was mostly an exercise in futility attempting to find all of a person’s providers in any one network and, even if that person were so lucky, the inconvenience of getting their Primary Care Physician to refer them to a specialist was another cumbersome hurdle most considered an unwanted liability. After first enrolling in a higher cost Silver Plan offering doctor’s office copays, I myself, before the close of OEP, switched to a lower cost Bronze (non-copay plan) with another company. This after realizing it was virtually impossible for my physician to successfully maneuver the referral process.  I made the decision it was best to take the premium savings involved in the benefit downgrade and have it for the occasional doctor’s visit which I have found to average $150. I save much more than this by having gone with a Bronze plan and―so far―it has worked out for me.

Since the close of OEP my phone rings throughout the week with people pleading with me to get them out of their HMO plan and into PPO coverage so they may see the doctor of their choice. I have only one PPO medical plan I can refer them to. This plan made itself available after the close of OEP but it is a hospital system plan which requires the patient remain in the system or face high out-of-network expenses. Furthermore, if the prospect has not had what the Department of Health and Human Services and ACA call a “Life Changing Event” they cannot change to a new plan at this time and must wait until October to enroll for a January 1 effective date. To add personal insult to injury, the plan does not even allow brokers and agents to be appointed with them for the purpose of doing business. Any business we refer or submit to them is done strictly on a “pro bono” basis. The only good news to be had for the consumer is that premiums not only stabilized but, in the case of those forced to migrate to HMO coverage, may have even gone down. Of course. Why shouldn’t they? The forced migration took client/patients from a position of having the final say on who their provider was to a position of having their providers, and therefore, treatment rationed. Most do not consider the trade off a worthy one. I know I do not. Of all my clients on individual and family PPO plans, forced to exchange such, some were small business owners. Those that had the minimum two W2 employees were able to switch to “Group” (employer based coverage) and maintain a PPO plan and provider network. If you fit this profile, please contact me. I can assist you in acquiring group coverage at any time throughout the calendar year.

My clients ask me if I expect PPO plans to re-enter the individual and family market in 2017. I tell them we will have to wait until the beginning of the OEP October 15th. But I advise them not to bet the ranch on it. If insurance companies do reintroduce PPOs, it will be only to entice policyholders to make a plan switch which would require a new contract (policy) in which brokers and agents would be excluded from compensation. This would be done in an effort to wipe the insurance companies books clean of the liability for our compensation. Their rationale is they can now put a great deal of the cost of enrolling people on the American taxpayer by directing prospective enrollees to the state and federal health insurance exchanges. The lion’s share will be directed to Healthcare.gov.

But what of the financial health and solvency of the insurance companies and their plans? Today’s feature article, from the New York Times (below) describes the push to ration provider access and treatment. Of course, they do not use those words, choosing instead to describe it as a move to “curb” cost in an effort to stabilize premiums. In spite of such, the insurers, for the most part, still struggle for solvency. The article explains that companies overestimated the number of ultimate enrollees and underestimated the cost of providing all the mandated care. To exacerbate their generally thin to negative profit margin, they did not receive all the government subsidies originally promised. Like so many programs, it would appear they cannot approach solvency without tax-payer funded subsidies.

Given all this, most of the insurance co-ops have failed and even major carriers are announcing withdrawal from the market. UnitedHealthcare, the nation’s largest health insurance carrier, has announced it will be pulling out of 90% of its current market in 2017. Anthem seeks to buy Cigna and Aetna seeks to merge with Humana. All this results in far less competition and . . . less competition means higher premiums for the consumer.

Stay tuned to see what the market offers us during this fall’s OEP. I will be focusing more and more on my “Medicare” clients who, much to my regret, were somewhat neglected during last fall’s scramble on my part to find new policies for 150 plus under-age 65 health insurance clients. Medicare recipients will be a priority this fall during their own OEP for Medicare Advantage and Part D Prescription Drug Plans. I hope the market allows me to play an active role in assisting families in obtaining health insurance.  . . . We shall see. Predicting what is going to happen next in terms of what the general public refers to as “Obamacare” is a lot like walking into a swamp. You’re not quite certain if your next step will land in quicksand or on top of an alligator. Terra firma would be a welcome and unexpected change for the consumer and this agent / broker.

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New York Times

Business Day

Health Insurer Hoped to Disrupt the Industry, but Struggles in State Marketplaces

By REED ABELSON JUNE 19, 2016

Oscar Health was going to be a new kind of insurance company. Started in 2012, just in time to offer plans to people buying insurance under the new federal health care law, the business promised to use technology to push less costly care and more consumer-friendly coverage.

“We’re trying to build something that’s going to turn the industry on its head,” Joshua Kushner, one of the company’s founders, said in 2014, as Oscar began to enroll its first customers.

These days, though, Oscar is more of a case study in how brutally tough it is to keep a business above water in the state marketplaces created under the Affordable Care Act. And its struggles highlight a critical question about the act: Can insurance companies run a viable business in the individual market?

Oscar has attracted 135,000 customers, about half of them in New York State. And some of its efforts with technology have been successful. But for every dollar of premium Oscar collects in New York, the company is losing 15 cents. It lost $92 million in the state last year and another $39 million in the first three months of 2016.

“That’s not a sustainable position,” said Mario Schlosser, chief executive at Oscar.

Companies like Oscar were initially attracted by the potential of millions of new customers added to the individual market by the health law. But the reality has been far messier.

In an effort to attract customers, insurers put prices on their plans that have turned out to be too low to make a profit. The companies also assumed they could offer the same sort of plans as they do through employer-based coverage, including broad networks of doctors and hospitals.

But the market has turned out to be smaller than they hoped, with 12 million signed up for coverage in 2016. Fewer employers have dropped health insurance than expected, for example, keeping many healthy adults out of the individual market.

And among the remaining population, the insurers cannot pick and choose their customers. The law forces them to insure people with pre-existing conditions, no matter how expensive those conditions may be.

As a result, most insurers are still trying to develop a successful business model. Last year, only a quarter of the insurers appear to have made money selling individual policies, according to a preliminary analysis from McKinsey, the consulting firm. Giant insurers like UnitedHealth Group have stopped offering individual coverage through the public exchanges in some states. And most of the new insurance co-ops, which were founded to create more competition, have failed.

A few times a week, Oscar Health serves a catered lunch for employees. The company has attracted 135,000 customers, but it is losing money. Credit Richard Perry/The New York Times

The heavy losses do not necessarily mean that the individual market is ready to implode. Some insurers, including large companies like Anthem, say they remain committed to the market, and some insurers have made money.

But the turbulence is certainly greater than expected. And it may well lead many insurers to seek double-digit percentage rate increases and tighten their networks.

“There was tremendous uncertainty that even the very established companies were flummoxed by,” said Larry Levitt, an executive with the Kaiser Family Foundation, which has been closely following the insurers’ progress.

Over all, insurance companies continue to make profits. The dearth of profits from the individual markets, though, show how challenging it is to make insurance affordable when it is not subsidized by the government or an employer.

The troubles in the individual market also underscore how some of the law’s provisions meant to protect the insurers have not worked as well as desired. Insurers did not receive all the payments they were due under one of the law’s provisions, and another provision, meant to even out the risk among companies to protect those that enroll sicker individuals, has been described as flawed by many health care experts. Federal officials have said they would tweak those formulas.

The companies that have fared best so far are those that have kept the tightest control over their costs, by working closely with low-cost providers or a limited group of hospitals and doctors. Many have abandoned the idea of offering the kind of access available through many employer plans. The successful companies have also avoided the very low prices found in some of the co-ops.

For most of the insurers, though, the math has just not added up, which is the case with Oscar.

In New York State, where Oscar is based, the company recently filed eye-catching requests to raise rates by a weighted average of nearly 20 percent for 2017. Regulators will make a decision in August.

“The market is over all too low in price,” Mr. Schlosser said. “We, like everybody else, have priced in a very aggressive way.”

Many of the big insurers, like Anthem, can rely on their other businesses to generate profits while they wait for this market to stabilize. Oscar does not have that luxury; it is focused on individual marketplaces. (In addition to New York, Oscar operates in California, New Jersey and Texas.)

Other new insurers that sell plans to employers or under government programs like Medicare have been a little more insulated. When Northwell Health, the system in New York previously known as North Shore-LIJ Health System, entered the insurance market, it created a new company. That company, CareConnect, has 100,000 customers, most of them individuals insured through both large and small employers.

“If we only had the individual market, we would have taken undue risk because we would not have understood that market,” said Alan J. Murray, CareConnect’s chief executive. He said the company is close to turning a profit.

Oscar says it plans to begin offering coverage to small businesses, but Mr. Schlosser was adamant that individuals will eventually be buying their own coverage, rather than relying on employers. The company is also racing to incorporate plans with smaller networks.

Bright Health, another start-up, also plans to work closely with health systems to offer consumer-friendly plans.

While Oscar has had to use another insurer’s network in New York, the company’s goal is to form partnerships with systems to create networks that specialize in managing care. The company began experimenting with these networks this year in Texas and California.

“Oscar talks about narrow networks like no one has seen one before,” said Dr. Sanjay B. Saxena, who works with insurers and health systems at the Boston Consulting Group.

Oscar has received $750 million from its investors, and Mr. Schlosser insists that the company understood how long it would take for the new insurance marketplaces to develop, calling these “very, very early days.”

Oscar points to its technological edge as a way to manage patients’ health better than the established insurers. It has created teams, including nurses, who are assigned to groups of patients and can intervene when its data flags a potentially worrisome condition like a high blood sugar level.

Promoting itself as a consumer-friendly alternative to the other insurers also has its risks. While Oscar has loyal customers, others say they are disappointed to find the insurer behaving like everyone else. Cosmin Bita, a real estate broker in New York, switched to Oscar from an insurer that had given him the runaround about whether it would pay for blood tests as part of his annual physical. Although Oscar said when he enrolled that the tests would be covered, he said, he found himself fighting with the company over whether everything was covered.

“The exact same thing happened,” Mr. Bita said.

Oscar executives said the company works hard to keep customers satisfied.

But so far, it has not proved that it has created a better model than the rest of the industry.

As Darren Walsh, a principal at Power & Walsh Insurance Advisors, said: “They haven’t invented a new mousetrap.”

http://healthandmedicareinsurance.com

MEDICARE RECIPIENTS DODGE A BULLET WHILE OBAMACARE INSUREDS PREPARE TO TAKE ONE!

By D. Kenton Henry

Perhaps a storm would be a better analogy but 2016 will deliver something more than a mild tropical depression to the coast of the “Individual and Family” health insurance market. At the same―the Cat 3 (minimum) hurricane projected to slam the Senior market of Medicare recipients appears to have been diverted. For now.

As we enter the third year of enrollment in health insurance plans compliant with the Affordable Care Act (ACA) the “Affordable” aspect of care or―more accurately―the cost of protecting oneself from the cost of health care―seems elusive and more and more a case of misrepresentation. As I have said many times in the past, if you qualify for a subsidy of your health insurance premiums you may find your options affordable. However, depending on where you live, you will surely be upset with the increasing cost of health insurance. 70% of all Obamacare members are enrolled in a Silver Plan. The Department of Health and Human Services (DHS), which oversees enforces the Act and oversees the health insurance industry, has designated the second lowest cost Silver Plan of any insurance company to be the default plan one must select in order to maximize the benefit of any subsidy. This could include a reduction in not only one’s premium but their deductibles and co-pays. As Fox News and the Washington Post report (see featured article below) the cost of these plans will rise by a national average of 7.5%. States such as Oklahoma will see an increase of 37.5%!

ACA ENROLLMENT 2016 2

In some states it is much worse.

ACA ENROLLMENT 2016 1

To add insult to injury many insurance companies, such as BlueCross BlueShield of Texas, have taken such losses―in spite of skyrocketing premiums―they have announced they are eliminating the Preferred Provider Organization (PPO) network option for their plans and member benefit. The only option will be to select a Health Maintenance Organization (HMO) network option wherein the company can ration your providers and treatment. While the young or otherwise very healthy may find this option acceptable, those of us who are older or dealing with existing illnesses or injuries are certain to be upset by this development. The insurance companies seem to be in agreement on the viability of PPOs and explain any premium increase necessary to assure they even break even on a PPO policy would be beyond the increase limit set by Obamacare. As such, it would therefore not be approved by their state insurance commissioner. So the question remains: what will your personal network and benefit options be for 2016 and what will they cost?

Virtually all insurance companies are keeping the answers close to their vest until this Sunday, November 1, the first day of OPEN ENROLLMENT wherein one may choose a health insurance plan for 2016. Enrollment will remain open until January 31st. Those without a plan at that time will be locked out for the remainder of the year and will pay a penalty equal to the higher of two amounts:

2.5% of your yearly household income (Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan

$695 per person ($347.50 per child under 18) The maximum penalty per family using this method is $2,085.

A banner follows which, as of Sunday, November 1st, you may click on and by simply entering your birth date, zip code and tobacco usage, obtain ALL your health insurance options from each and every insurance company issuing 2016 coverage in your state. It will also allow you to calculate what subsidy, if any, and enable you (if you choose) to log directly into the federal marketplace to acquire it and your insurance plan. If you have questions, as you most surely will, do not hesitate to contact me via my contact information via the link or below.

CLICK ON THIS BANNER TO OBTAIN 2016 HEALTH INSURANCE QUOTES:

Relative to Medicare recipients, it would appear a planned increase in the 2016 Medicare Part B premium and deductible has been taken off the table for the time being. The increase would have resulted in a huge spike in what higher income recipients and new enrollees in Part B Out-Patient coverage would pay in premium. The proposed premium increase would have been as presented here:

Income Limits, Medicare Part B Premiums for 2016

Single Married 2015 2016 Held Harmless 2016 Not Held Harmless
$85,000 or less $170,000 or less $104.90 $104.90 $159.30
$85,001 to $107,000 $170,001 to $214,000 $146.90 $223.00
$107,001 to $160,000 $214,001 to $320,000 $209.80 $318.60
$160,001 to $214,000 $320,001 to $428,000 $272.70 $414.20
Above $214,000 Above $428,000 $335.70 $509.80

The threat and legislation which averted this is described in detail in The Fiscal Times article below. As of today, it is still unclear to this editor whether the increase in the calendar year deductible has also been averted.

KENTON AT CAPITOL 2 (2)

Editor, Broker, Agent ― D. Kenton Henry

Office: 281.367.6565

Cell (call or text): 713.907.7984

http://allplanhealthinsurance.com

http://thewoodlandstxhealthinsurance.com

Blog: http://healthandmedicareinsurance.com

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FEATURED ARTICLES:

Health & Science

THE WASHINGTON POST

26 October 2015

2016 Affordable Care Act insurance rates are climbing

By Amy Goldstein October 26

The prices for a popular and important group of health plans sold through the federal insurance exchange will climb by an average of 7.5 percent for the coming year, a jump nearly four times bigger than a year ago, according to new government figures.

The rate increase for 2016 compares with average growth of 2 percent, from 2014 to this year, in the monthly premiums for a level of coverage that serves as the benchmark for federal subsidies that help most consumers buying coverage under the Affordable Care Act.

A “snapshot” of insurance rates, released Monday by the Department of Health and Human Services, also shows that the rate increases for next year vary substantially around the country. Although there are exceptions, more populous states and metropolitan areas tend to have more modest premium increases for the coming year than smaller areas. 

The changes for next year have a wide range — from premium increases averaging 35 percent in Oklahoma and Montana to a decrease of nearly 13 percent in Indiana.

The analysis is based on hundreds of health plans sold in local markets within 37 states that use HealthCare.gov, the federal online insurance marketplace. It excludes plans in other states that have created separate ACA insurance marketplaces. The rates reflect the prices of the second-least expensive health plan in each market for 2016 in a tier of coverage known as silver. ACA health plans are divided into four tiers, all named for metals, depending on the amount of customers’ care that they cover. Silver plans have proven by far the most popular. Officials at HHS issued the analysis as less than a week remains before the start on Nov. 1 of a third open-enrollment season for Americans eligible to sign up for health plans under the insurance marketplaces created by the 2010 health-care law. The exchanges are intended for people who cannot get affordable health benefits through a job.

In their analysis, federal officials contend that the health plans sold through the exchanges will be affordable to people willing to shop for the best rates. The cost to consumers, HHS officials emphasize, is cushioned by the fact that nearly nine in 10 are eligible for tax credits.

Taking the subsidies into account, nearly four in five people who already have gotten insurance through these marketplaces will have access for 2016 to a health plan for which they could pay no more than $100 in monthly premiums, the analysis found. The analysis does not address other costs to consumers, such as co-payments and deductibles, which tend to be more expensive in ACA health plans than in employer-based health benefits.

The figures in the analysis reinforce a theme that Obama administration officials introduced last year and have revived as the third sign-up period approaches: the usefulness of researching the best and most affordable coverage, even if it means switching insurance from year to year. “If consumers come back to the Marketplace and shop, they may be able to find a plan that saves them money and meets their health needs,” Kevin Counihan, the HHS official who oversees the health exchanges, said in a statement.

The new figures show that existing customers who went back last fall to HealthCare.gov and picked a different plan at the same level of coverage saved an average of nearly $400 in premiums over the course of this year. Slightly fewer than one-third of those who bought such coverage for a second time switched health plans, according to the analysis. During this open enrollment, Obama administration officials are striving both to attract existing customers again and to ferret out Americans eligible for the exchanges who remain uninsured even though the law requires them to have coverage. Although many consumers can be largely shielded from rate jumps through subsidies and shopping around, the increases ratchet up the government’s expenditures on the tax credits that the law provides, health policy analysts point out.

Analysts have expected that premiums for the coming year would grow more rapidly than they did for 2015. “This is the first year that insurers actually have a full year of experience with how much care people use,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a health policy organization. “In the first two years of the program, insurers were essentially guessing.” In addition, Caroline Pearson, senior vice president at Avalere, a health-care consulting firm, said that, as some health plans have attracted a significant share of customers, “the need to price really low diminishes a little bit.” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s main trade group, said that “averages don’t tell the whole story” and that insurance rates hinge on “location and the cost of providing care to individuals in particular markets.” In particular, Krusing said, last year was “a record-breaking year for prescription drug prices. That trend is likely to continue.”

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Seniors Exhale as Congress Blocks Huge Medicare Increase

By Eric Pianin October 27, 2015 3:17 PM

Responding to pressure from seniors’ and labor groups as the 2016 campaign season heats up, congressional leaders and the White House have blocked a huge, 50 percent increase in the Medicare Part B premium for nearly one third of the 50 million elderly Americans who depend on the program for health services.

The bipartisan solution will block all but a tiny fraction of the premium increase. It is contained in the two-year budget and debt ceiling bill negotiated by House Speaker John Boehner (R-OH), House Minority Leader Nancy Pelosi (D-CA) and the White House and that awaits ratification by the two chambers – likely by the end of this week.

Related: Millions Facing a Hefty Increase in Medicare Premiums in 2016

The threatened sharp premium increase – reported back in August by The Fiscal Times – was triggered by a quirk in federal law that penalizes wealthier Medicare beneficiaries, newcomers to the program and lower income Americans with complicated chronic health problems. It kick in any time the Social Security Administration fails to approve an annual cost-of-living adjustment – as will be the case next year.

Medicare Part B and the Social Security trust fund are interconnected, and most seniors on Medicare have their monthly premiums deducted from their Social Security checks. Because the federal law “holds harmless” about 70 percent of Medicare recipients from premium increases to cover unexpected increases in healthcare costs, the remaining 30 percent of Medicare Part B beneficiaries suffer the consequences by being made to pay higher premiums.

Without intervention by Congress, roughly 15 million seniors and chronically ill people currently claiming both Medicare and Medicaid coverage would have seen their premiums increase from $104.90 per month to $159.30 for individuals, according to Medicare actuaries. The actuaries also predicted an increase in the annual deductible for Part B of Medicare, from $147 in 2015 to $223 next year.

Related: Social Security Ruling Drives Up Medicare Costs for Millions

Estimates of the cost of legislation to blunt or block a premium increase have ranged from $7.5 billion to $10 billion. Under the budget agreement unveiled late last night, that cost will be covered by a loan of general revenue from the U.S. Treasury to the Supplemental Medical Insurance Trust Fund.

In order to repay that loan, the 15 million people who are not subject to the “hold harmless” protection will be required to pay an additional $3 a month in premiums – a token amount — until the loan is repaid years from now, according to a House budget document describing the deal. Medicare beneficiaries who currently pay higher income-related premiums would pay more than $3, based on their income levels.

If there is no Social Security cost of living adjustment increase for 2017, this provision will apply again.

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BlueCross BlueShield of Texas Tells Clients “Say Good-Bye To Your PPO Plan”

By D. Kenton Henry

Don’t worry. This doesn’t apply to you if you have coverage through an employer’s group plan. But if you (like myself) are one of 370,000 insured members with an individual or family health insurance plan―be prepared to choose your provider from a different menu. And rest assured it will be portion controlled.

BlueCross will continue to offer Health Maintenance Organization (HMO) Plans where you must elect and utilize a provider within their HMO network or you will have no coverage whatsoever. This is where rationing begins. With your provider. You can expect the number of doctors and hospitals to be significantly limited relative to the selection currently available to you in the Preferred Provider Organization (PPO) network where you may go in or out of the network at your discretion and still be covered. Although details are yet to be unveiled, these HMO plans will most likely require you to select a “Primary Care Physician” with whom all medical care must be initiated. If so, you will have to obtain a referral from that primary care provider in order to see a specialist. And that is where rationing of care continues. With your treatment. HMO providers have contractually agreed to accept a lower payment in return for providing you treatment in the first place. Referring you (away) to a specialist results in a total loss of payment.

BlueCross explains they paid $400,000,000 more in claims then they collected in premium from their PPO members in 2014. And they add (exclamation point mine) “that is unsustainable!” Their rationale is―the insurance company will be better able to “manage” the care we members receive and what we are charged for care, helping to reduce health insurance premiums. Those currently enrolled in a “grandfathered” (written prior to the March 2010 passage of the Affordable Care Act) plan or HMO network policy will be happy to know you will probably be able to maintain your coverage option (deductible, co-pays) into 2016, assuming the premium remains affordable. Those, like myself, who want total discretion as to our providers are certain to be disappointed.

This begs the question: What will our options be with other insurance companies? Unfortunately, like BlueCross, most companies are yet to reveal the details of their policies. I will be introduced to these changes over the remainder of October and―rest assuredwhatever your best options are for 2016―I will have them. And you will be able to elect them with the beginning of OPEN ENROLLMENT (OE) November 1st―through the end January 31st. If you involve me, I will take into consideration your providers and do my best to find an affordable plan which allows you to continue to utilize them. If this entails you qualifying for and needing a premium subsidy from Healthcare.govI will assist you in navigating that process and serve as an advocate in your behalf. As I have done for 29 years this month, my objective is to ensure you obtain and maintain your best possible health care coverage at the lowest cost. Even in this age of increasing insurance premiums and less provider options.

Please refer to the featured article below and, lastly, to the Questions And Answers at the end of today’s post. Additionally, do not hesitate to call me or email me in order to prepare for these coming changes.

D. Kenton Henry (Editor, Agent, Broker)

AllPlanHealthInsurance.com

Office: 281.367.6565 or Toll Free: 800.856.6556

Cell: 713.907.7984

Email: Allplanhealthinsurance.com@gmail.com

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Blue Cross to drop PPO plan covering 367,000 Texans

SAN ANTNIOEXPRESS NEWS

By Peggy O’Hare

July 27, 2015 Updated: July 27, 2015 8:34pm

Blue Cross Blue Shield of Texas is eliminating in 2016 its…

Health insurance carrier Blue Cross Blue Shield of Texas next year will eliminate a PPO health plan that 367,000 consumers statewide now depend on for health benefits.

The company’s decision to drop its Blue Choice PPO plan will affect only customers in the individual market — not those covered by Blue Cross PPO group plans through their employers. About 148,000 consumers whose PPO plans were grandfathered in 2010 also won’t be affected.

The change is being made because the insurance company paid out $400 million more in claims than it collected in premiums for its Blue Choice PPO product in 2014.

“We felt like the PPO was not going to be a sustainable option,” said Dr. Dan McCoy, chief medical officer and divisional senior vice president for Blue Cross Blue Shield of Texas.

The move will not interrupt customers’ coverage before the end of the year.

The insurance carrier expects to offer another product when open enrollment for 2016 begins Nov. 1 in the individual market. No details on that new product were available Monday since it still is awaiting federal approval. Consumers won’t be able to view and compare their options on the federal exchange until Oct. 10, the company said.

“A new product has been filed that we believe will give you a flexible choice for your clients,” Blue Cross Blue Shield of Texas said in a communication to insurance brokers last week. “We will be able to share information about that product if and when it is approved by the Centers for Medicare & Medicaid Services closer to open enrollment.”

The carrier has not yet started sending notices to customers affected by the change, aside from posting a general notice on its website, a spokeswoman said. However, they should receive notices by early October.

Only a small fraction of the carrier’s total 5.5 million customers in Texas are covered by individual Blue Choice PPO plans, but the product has proven popular with consumers who want flexibility on which doctors they can visit.

Loretta Camp, an independent health insurance agent at Davidson Camp Insurance Services and a member of the San Antonio Association of Health Underwriters, said she is bracing for a flood of questions from consumers.

“We pretty much expected there to be just a huge amount of feedback,” Camp said of Blue Cross’ announcement, “and we’ve gotten hardly any. I don’t think people have really grasped what that means.

“It‘s a huge impact to my client base,” Camp said, noting that 88 percent of her customers buying health plans for themselves or their families inside or outside the federal exchange selected PPOs — preferred provider organization plans that allow consumers greater freedom on which doctors to visit.

Customers with PPOs pay lower rates if they use doctors or hospitals considered to be “in network” and incur additional costs if they see providers “out of network.”

Such plans are generally pricier than the more restrictive HMOs — health maintenance organization plans that only cover care from doctors and hospitals “in network” and won’t cover services outside the network at all unless it’s an emergency.

“We have a number of clients that moved … to a PPO plan because they were having difficulty finding providers that would take the HMO plans,” Camp said.

In its communication to brokers last week, Blue Cross acknowledged there will be some physicians and providers no longer considered “in network” as a result of individual Blue Choice PPO plans being discontinued.

“The number of providers not in network due to the discontinuance may be greater in 2016,” said the notice to brokers. “We have ensured that we have an adequate network to provide the physicians and hospitals needed to serve our retail members in each market, and we continue to have discussions with additional providers.”

Keeping the individual PPO plans intact and raising the price would have forced the insurance company to raise everyone’s rates in the individual market.

Under the Affordable Care Act, “individual business is rated using a single risk pool, meaning all individual plans had to be looked at together,” the carrier said in its notice to brokers last week.

Like most carriers, Blue Cross was venturing into uncertain territory when the Affordable Care Act made health insurance available to everyone beginning in 2014, McCoy said.

“This is really a new era in American insurance,” McCoy said Monday. “And clearly we entered this marketplace with not a lot of information.”

That meant serving a large number of new customers and complying with the new federal law. “This was a group of people, many of which had never had health insurance before,” McCoy said of the new beneficiaries, “coupled with the Affordable Care Act that contained a lot of new provisions and additions to care.”

“You combine that with the fact that health care costs in the United States have continued to grow. So clearly the premiums were not enough to make up for the health care expenditures that occurred.”

Blue Cross officials sidestepped questions Monday about whether it will continue selling its Blue Advantage HMO plans in the individual market in Texas next year. The company also declined to say how many consumers now now covered by Blue Advantage HMO plans, calling that proprietary information.

However, the federal HealthCare.gov website shows the carrier requested a rate increase of almost 20 percent for its Blue Advantage HMO plans in 2016. That proposal is still under review by the Centers for Medicare & Medicaid Services. Blue Cross officials wouldn’t comment.

Blue Cross Blue Shield of Texas noted it was the only insurance carrier to offer a PPO product in all 254 counties in Texas during the first two years of open enrollment in 2014 and 2015. Company officials said they will continue to offer other options in all 254 counties both inside and outside of the marketplace.

pohare@express-news.net

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QUESTIONS AND ANSWERS:

What to Expect for Open Enrollment for 2016 Plans

Jul. 23, 2015

We’re getting ready for Open Enrollment for 2016. Blue Cross and Blue Shield of Texas (BCBSTX) will offer individual coverage options in every market in the state, both on and off the exchange. If you have an individual health plan or are looking to buy one in 2016, here are some of the changes you need to know.

When is Open Enrollment?

Open Enrollment for individuals runs from November 1, 2015 through January 31, 2016. If you are looking to buy your own health insurance plan for 2016, you can do so during this time.

If you already have health insurance, this is also the time you can:

  • Look at other plan choices
  • Compare plans and prices
  • See if you can get financial help

You’ll be able to see what plans will be available starting in October, when the “window shopping” period begins. This will give you time to weigh your options, ask questions and decide what will work best for you – before it’s time to sign up.

What will be different for individual plans in 2016?

There are some changes in the plans we intend to offer in the individual market in 2016. We won’t be offering PPO insurance plans in the individual, retail market. However, we intend to continue to offer HMO plans. This change does not affect our employer group customers or the grandfathered PPO individual plan members.

Why is Blue Choice PPO going away?

BCBSTX was the only insurer to offer an individual PPO insurance plan across the state to individuals in 2014 and 2015. Since the Affordable Care Act began, the market has changed. We found that the individual PPO plan was no longer sustainable at the cost it was being offered. Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.

Why couldn’t you just keep offering the individual PPO plans and raise the rate for them?

The law requires that we set our individual plan rates based on all of our individual members’ claims history. This means that if the costs of one plan are high, it will raise the rates of all other plans, not just the high-cost plan. If we kept the Blue Choice PPO, this would have raised the rates so much for all our other plans that most people wouldn’t be able to afford them. By dropping the PPO, we can still offer our other plans at reasonable rates.

I have a PPO plan. What will this mean for me?

If you have an employer group PPO plan, this will not affect you. If you enrolled in the individual Blue Choice PPO plan last year, you won’t be able to keep your PPO plan in 2016. We’re sharing this information well in advance of the required notification date so that you have plenty of time to research the plan options that best suit your needs. We will work with you and your doctors to lessen the impact of this change to your ongoing care.

My Blue Choice PPO plan is “grandfathered.” Is it being discontinued too?

No. If you have a grandfathered individual PPO plan, it will still be available in 2016. Grandfathered individual plans are plans that existed on March 23, 2010, when the Affordable Care Act became law. If you don’t know if your plan is grandfathered, check your plan details or call the customer service number on the back of your BCBSTX member ID card.

Will I be able to keep my doctor and/or hospital if I switch plans?

Currently, we have two provider networks for our individual plans: Blue Choice PPO and Blue Advantage HMO. Some providers are only in the Blue Choice network, and some of them have decided not to join the Blue Advantage HMO network in 2016. So, with the Blue Choice PPO individual plans going away, these providers will no longer be an in-network option for most of our individual members. If you have a grandfathered plan, you will still have access to the Blue Choice network.

If your doctor is not in the Blue Advantage network, we will work with you and your doctor to lessen the impact of this change to your ongoing care.

When can I see 2016 plan details and rates?

Individual plan details and rates will be available in October 2015. Open Enrollment begins November 1, 2015

http://allplanhealthinsurance.com

http://healthandmedicareinsurance.com

HEALTH INSURANCE “OPEN ENROLLMENT” PERIOD 2014 – 2015: DEJA VU ALL OVER AGAIN (AND THEN SOME)?

So you thought last year’s open enrollment period (the limited time frame in which an individual may enroll in a health insurance plan for the coming calendar year) was a fiasco? Consider the words of Kevin Counihan, head of the federal insurance marketplace who says 2015’s hurdles may outstrip 2014’s. “Part of me thinks that this year is going to make last year look like the good old days,” said Counihan in an interview with the New York Times. Now that’s a scary thought indeed.

No one expects the Federal Health Insurance Marketplace website, Healthcare.gov, to have all the technological problems it had last year. (Although this agent and editor experienced an exasperating number in attempting to enroll clients through the website just in the last six weeks.) Rather the problems will result from, among others, two things:

1) Price matters. And, in large part, premiums will not be going down. BlueCross Association plans, for instance, have requested steep increases in general, up to 17.6% for Florida Blue. Double-digit―up to 30% increases may be common among those competitive last year and others, previously not competitive, may offer equally lower premiums. In those states where prices will increase predominately, and the consumer does not qualify for a subsidy, affordability will be an issue and cost a deterrent to enrollment in spite of the penalty for not purchasing health insurance. The penalty will increase to 2% of family income or $325 per adult and $162.50 per child, whichever is higher. The reality is most insurers are filing their proposed 2015 health insurance premiums for approval now, even though claims experience for the current year remains unknown with four months remaining. Will premiums increases be warranted? Will decreases be mere wishful thinking? The good news is, the number of companies participating in the market is going up and there will be 1.6 times more plans to choose from.

2) The open enrollment period will be cut in half. Three months down from six to be exact. This period will run from November 15th to Febraury15th. What this means is, not only will all those who wish to enroll in a plan for the first time be attempting to navigate the system, but all those who wish to change plans will also. With the administration’s objective of signing up an additional 5 million subscribers this year, the process may end up resembling a stampede of cows all trying to enter the Fort Worth stock yard chute simultaneously. Let us hope the end result is more pleasant for the participants.

Actuarial concerns relative to the fiscal viability of the Affordable Care Act (of great concern to this editor) aside, the consumer can expect this fall, through February 15th, to present a host of challenges from knowing which plan is best for them to being able to afford it. All the more reason for the consumer to seek the counsel of an independent health insurance specialist who is licensed (passed their state’s insurance exam); maintains errors and omissions insurance for your protection; has met his or her state’s continuing education classes and may have (as in the case of this agent) decades of experience in the health insurance market. These qualifications as opposed to government enrollers or “navigators” for whom none of this may apply.

― D. Kenton Henry, editor, agent, broker

KENTON AT CAPITOL 2 (2)

http://allplaninsurance.com

http://thewoodlandstxhealthinsurance.com

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FEATURED ARTICLES:

The New York Times

Business Day |​NYT Now

Bracing for New Challenges in Year 2 of Health Care Law

By REED ABELSON SEPT. 2, 2014

The first year of enrollment under the federal health care law was marred by the troubled start of HealthCare.gov, rampant confusion among consumers and a steep learning curve for insurers and government officials alike.

But insurance executives and managers of the online marketplaces are already girding for the coming open enrollment period, saying they fear it could be even more difficult than the last.

One challenge facing consumers will be wide swings in prices. Some insurers are seeking double-digit price increases, while others are hoping to snare more of the market by lowering premiums for the coming year. At the same time, the Obama administration is expected to try to persuade about five million more people to sign up while also trying to ensure that eight million people who now have coverage renew for another year.

Adding to the complexity is the shorter time frame for choosing a new policy: three months instead of six.

“In some respects, it’s going to be more complicated,” said Kevin Counihan, the former chief executive of Access Health CT, Connecticut’s online marketplace, who was just named as the head of the insurance marketplaces for the federal government. Connecticut’s marketplace was among the most successful state-based exchanges, sharply reducing the number of uninsured in the state. “Part of me thinks that this year is going to make last year look like the good old days.”

Kevin Counihan, head of the federal insurance marketplaces, says 2015’s hurdles may outstrip 2014’s. Credit Christopher Capozziello for The New York Times

No one expects to face last year’s technological hurdles, in which consumers sometimes could not navigate the federal or state websites to buy a policy. HealthCare.gov is running relatively smoothly, and the states have been working to address technical problems with their marketplaces.

“The exchange can’t work worse than it did last year,” said Dr. Peter Beilenson, chief executive of Evergreen Health Co-op, an insurer in Maryland, where a faulty state-run marketplace prevented many people from signing up.

But the upheaval in insurance markets, with new carriers entering and the price of plans changing significantly, may make the coming year no easier than the last. While federal rules allow people to renew their coverage automatically for the next year in the same plan, many customers, especially if they were eligible for federal tax credits, will want to resurvey the landscape.

Just as there was an uproar when some people found out last year that their policies had been canceled, individuals this year may be surprised to find that they could be asked to pay much more for the same plan because their carrier is raising its prices or the amount of the federal tax credit they will receive is changing.

People will be renewing at the same time that others are enrolling for the first time, starting a week and a half before Thanksgiving, on Nov. 15. To ensure that they have a new plan by the beginning of the year, those who renew will have to sign up by Dec. 15. Exactly how the renewal process will work has not yet been determined.

“We’re still waiting on the details of the process,” said Paula Steiner, chief strategy officer for Health Care Service Corporation, which offers Blue Cross plans in five states. “We haven’t gone through any testing yet of any changes to the system for 2015.”

“I think there’s a possibility that there’s equal or more confusion this fall,” she said.

Those responsible for the federal marketplace say they are working hard to make the process as easy as possible. “We’re putting in place the simplest path for consumers this year to renew their coverage,” said Andrew Slavitt, principal deputy administrator for Medicare, which oversees the insurance marketplaces. Those who prefer to stay with the same plan will be able to renew their coverage automatically, as many do with employer coverage. People can renew by doing “absolutely nothing,” he said.

The federal online marketplace is being continuously improved, according to Mr. Slavitt, who said the government was updating the website to allow renewals. “We’re in a very different position than we were last year,” he said.

Dunia Padrino, left, with her sons Rolando Vega and Hanoy Castellon, learning about insurance under the Affordable Care Act last November in Hialeah, Fla. Credit Joe Raedle/Getty Images

Compared with this year, from the 19 states for which information is available, 30 carriers have requested entrance into the marketplaces for 2015 and 1.6 times more plans are being offered, with prices for 2015 likely to remain varied, as they were the previous year, according to McKinsey & Company’s Center for US Health System Reform, which is analyzing the insurance filings as they become available. Prices are rising about 30 percent for some plans, while decreasing by the same amount for others, depending on the market and policy. “We are definitely seeing a lot of volatility in pricing,” said Erica Hutchins Coe, a McKinsey expert.

Some of the large insurers, like some of the Blue Cross plans, have requested steep increases. Florida Blue, for example, expects to raise its rates by an average of 17.6 percent for 2015. Others, like some of the co-op plans, have been keeping prices low or even reducing rates.

Molina Healthcare, a company that has traditionally offered Medicaid coverage and now sells exchange policies, says its renewal strategy for the coming year is to emphasize that its members need not be concerned that the plan they selected will be more expensive. “One thing you can count on is the rates are flat or down,” said Lisa Rubino, senior vice president of exchanges for Molina.

In California, the state exchange is trying to get a step ahead by allowing people to begin renewing their plans Oct. 1. But anyone who wants to switch plans will still have to wait until Nov. 15, and many individuals may well want to shop around. In the Sacramento area, for example, someone who selected an H.M.O. plan from Anthem for 2014 faces a possible increase of nearly 17 percent, compared with a 2 percent increase for an H.M.O. plan from Kaiser Permanente in the same area.

Consumer advocates and others say nearly everyone with coverage should review their options ( https://www.brokeroffice.com/quote/quoteengine.jsp?login=insurnet) as well as whether their federal tax subsidy is likely to shift — either because their income may have changed or because the cost of the benchmark plan used to calculate the tax credit has changed.

Experts like Sabrina Corlette, a policy expert at Georgetown University’s Center on Health Insurance Reforms, say persuading those who did not sign up for coverage during the last open enrollment period to get coverage for 2015 will also present a significant challenge. People in this group were unaware they could get assistance with the cost of their premiums, decided the coverage was not worth the cost or simply found the process of enrolling too challenging.

“Most people assume in the first year they got the low-lying fruit,” Ms. Corlette said. Insurers and others “do have to widen the net,” she said, targeting hard-to-reach populations with what in the second year will often be “fewer resources and less time.”

Dr. Martin E. Hickey, chief executive of New Mexico Health Connections, a co-op that will rely on low prices to continue to attract members, said it was “a lot easier to retain a consumer than chase a new one.” In his state, many individuals failed to take advantage of the subsidies that reduced the cost of coverage substantially. “We didn’t communicate the affordability,” he said.

Even in California, which enrolled nearly 1.4 million people in its first open enrollment, there is acknowledgment that more effort is needed.

“We have a heavy lift again,” said Dana Howard, a spokesman for the state’s exchange, Covered California.

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THE HILL

Home | Policy | Healthcare

HealthCare.gov CEO sees challenges ahead

By Elise Viebeck – 09/03/14 10:50 AM EDT

The newly appointed CEO of HealthCare.gov is predicting fresh challenges for the system’s second enrollment period this November. Kevin Counihan, former head of Connecticut’s exchange, cited concerns such as the shorter sign-up period for 2015 plans that could create problems for officials and consumers alike.

“In some respects, it’s going to be more complicated,” Counihan told The New York Times in an interview. “Part of me thinks that this year is going to make last year look like the good old days.” The comment highlights the heady task facing federal health officials as they work to prevent a repeat of last year’s first enrollment period. Last year, technical flaws at HealthCare.gov and other exchanges plunged the enrollment process into chaos and created an enormous political headache for the Obama administration. Counihan did not indicate that his fears related to the technology, which has undergone extensive repairs since last October. The 2014 sign-up period was six months long, but with just three months to enroll more consumers, this year’s process could prove a tough climb as insurers and the government seek to convince hard-to-reach populations to buy health plans.

Existing policyholders are likely to encounter changes in their premium prices that could also cause confusion.

http://thehill.com/policy/healthcare/216496-healthcaregov-ceo-sees-challenges-ahead

 

The White House Doubles Down On Republicans Request To Delay The Individual Mandate

LONELY OBAMACARE NAVIGATOR (2)

Pictured: Navigator Dealing With The Public’s Not So Mad Rush To Enroll

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The White House has doubled down on the Republican’s November request to delay the “Individual Mandate” of the Affordable Care Act.

At least a major portion of it.

The only thing predictable about implementation of the Affordable Care Act is that . . . nothing is predictable. On Wednesday, the Obama Administration played “tooth fairy” to Democrat candidates up for re-election this November and gave American individuals and families with pre-2014 health insurance policies a reprieve on the mandate to purchase ACA compliant coverage for two years through 2016. Last fall the House argued and passed a bill allowing American individuals and families who liked their current health plan – to keep their health plan. As the President had originally promised they could do. But for just one year. Now, in what appears to be an entirely self-serving and purely political move to mitigate a loss of Democratic seats in the up-coming mid-term elections, the Administration Obama says . . . “Errrr – of course! You can keep your plan for two more years!” It is quite apparent the Democrats have correctly determined the backlash from plan cancellations mandated by law could be devastating in terms of their election. Therefore, they speculate, with this aspect of the law deferred they will fair much better at the polls.

As a health insurance broker, I must admit I feel this is something of reprieve for myself and many of my clients. My clients can keep their lower cost plans which, in Texas, average approximately 40% higher than pre-compliant plans (approximately 80% higher in Indiana and Ohio – not to mention a dearth of PPO options as opposed to the restrictive HMO options). As for me, I can cease worrying, for now, about losing clients en masse who would otherwise be forced off their existing plans and might go elsewhere for replacement coverage. I can also anticipate obtaining entirely new clients who choose to elect a new plan in order to cover a pre-existing condition or just to comply with the law. And therein lies the rub. Just because the White House says those who have a plan can keep their plan, does not mean the individual states or the insurance companies will agree to this. And for many, it is far too late – their policies already having been canceled. But–furthermore–this reprieve apparently does not carry over to those who have no coverage whatsoever. They must still acquire coverage by March 31st or be assessed the penalty and locked out of insurance for the remainder of 2014. (Unless, of course, they are also eventually granted clemency by the President.)

And how does your editor feel about this from an actuarial standpoint relative to the insurance companies and the ACA itself? In four words: “Politically Pragmatic Voodoo Economics”. Even Obamacare architect Ezikiel Emanuel, stated Wednesday while on MSNBC, that while he denounced the policy implications of yet another Obamacare delay, “for the political gain, it’s worth it”. Unabashedly self-serving.

If the insurance companies comply, they are once again forced to flex at the last minute and be left with two separate blocks of business. One old block containing less claim’s risk. And one new block where the only motivation to insure oneself will be to transfer personally large risk to the insurance company. This will be in terms of pre-existing conditions which were previously manageable or that arise for the first time. As evidence of this, in an attempt to limit the disruption to the insurance industry precipitated by this latest modification, the Department of Health and Human Services also announced yesterday that the “risk corridor” program (which has been described as a bailout to insurers) would be further modified to channel more money to the insurers in states affected by the change. This only reinforces my opinion that those behind this bill are not economists and never cared about the financial viability of this law. They are, however, very concerned with maintaining their political lives at all cost.

Admin. – Kenton Henry

http://allplanhealthinsurance.com

http://thewoodlandstxhealthinsurance.com

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FEATURE ARTICLE:

THE NEW YORK TIMES

Politics

Consumers Allowed to Keep Health Plans for Two More Years

By ROBERT PEARMARCH 5, 2014

WASHINGTON — The Obama administration, grappling with continued political fallout over its health care law, said Wednesday that it would allow consumers to renew health insurance policies that did not comply with the new law for two more years, pushing the issue well beyond this fall’s midterm elections.

The reprieve was the latest in a series of waivers, deadline extensions and unilateral actions by the administration that have drawn criticism from the law’s opponents and supporters, many saying President Obama was testing the limits of his powers.

The action reflects the difficulties Mr. Obama has faced in trying to build support for the Affordable Care Act and the uproar over his promise — which he later acknowledged had been overstated — that people who liked their insurance plans could keep them, no matter what.

Under pressure from Democratic candidates, who are struggling to defend the president’s signature domestic policy, Mr. Obama in November announced a one-year reprieve for insurance plans that did not meet the minimum coverage requirements of the 2010 health care law.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

Wednesday’s action goes much further, essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate what White House officials called substandard insurance and junk policies.

The extension could help Democrats in tight midterm election races because it may avoid the cancellation of policies that would otherwise have occurred at the height of the political campaign season this fall.

In announcing the new transition policy, the Department of Health and Human Services said it had been devised “in close consultation with members of Congress,” and it gave credit to a number of Democrats in competitive races, including Senators Mary L. Landrieu of Louisiana, Jeanne Shaheen of New Hampshire and Mark Udall of Colorado.

Kathleen Sebelius, the secretary of health and human services, said Mr. Obama was trying to “smooth the transition” to a new system, using flexibility that exists under the law.

The move reflects the administration’s view that a divided Congress would not be willing to make changes to the law, but lawyers questioned the legitimacy of the action and said it could have unintended consequences in the long run.

“I support national health care, but what the president is doing is effectively amending or negating the federal law to fit his preferred approach,” said Jonathan Turley, a law professor at George Washington University. “Democrats will rue the day if they remain silent in the face of this shift of power to the executive branch.”

Mr. Turley said Mr. Obama was setting precedents that could be used by future presidents to delay other parts of the health care law or to suspend laws dealing with taxes, civil rights or protection of the environment.

Republicans said the move confirmed their contention that parts of the health care law were ill conceived and unworkable.

The number of people with noncompliant coverage is not known. Insurers sent out perhaps 4.5 million cancellation notices last fall, but some of the policyholders have bought new coverage that complies with the law. Administration officials said that the number of people with noncompliant policies would shrink by attrition in the next two years.The health care law sets dozens of federal standards for insurance, requiring coverage of services in 10 specific areas and providing many consumer protections not found in older policies.Under the transition policy announced by Mr. Obama in November, insurers “may choose to continue coverage that would otherwise be terminated or canceled.” Insurers were allowed to renew existing policies even if they did not provide the “essential health benefits” prescribed by law. In addition, the administration said, insurers could continue charging women more than men for those policies and could charge higher premiums based on a person’s health status, in violation of the new law.

A White House official said Wednesday that it would allow insurers to continue existing policies with renewals as late as Oct. 1, 2016, so individuals and small businesses could have noncompliant coverage well into 2017.

Under another policy announced by the administration on Wednesday, certain health plans will be exempt from new fees imposed on insurance companies and on many self-insured group health plans. Labor unions had been lobbying for such an exemption, saying the fees could be “highly disruptive” to Taft-Hartley plans administered jointly by labor and management representatives in construction, entertainment and other industries.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

Wednesday’s action goes much further, essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate what White House officials called substandard insurance and junk policies.

The extension could help Democrats in tight midterm election races because it may avoid the cancellation of policies that would otherwise have occurred at the height of the political campaign season this fall.

In announcing the new transition policy, the Department of Health and Human Services said it had been devised “in close consultation with members of Congress,” and it gave credit to a number of Democrats in competitive races, including Senators Mary L. Landrieu of Louisiana, Jeanne Shaheen of New Hampshire and Mark Udall of Colorado.

Kathleen Sebelius, the secretary of health and human services, said Mr. Obama was trying to “smooth the transition” to a new system, using flexibility that exists under the law.

The move reflects the administration’s view that a divided Congress would not be willing to make changes to the law, but lawyers questioned the legitimacy of the action and said it could have unintended consequences in the long run.

“I support national health care, but what the president is doing is effectively amending or negating the federal law to fit his preferred approach,” said Jonathan Turley, a law professor at George Washington University. “Democrats will rue the day if they remain silent in the face of this shift of power to the executive branch.”

Mr. Turley said Mr. Obama was setting precedents that could be used by future presidents to delay other parts of the health care law or to suspend laws dealing with taxes, civil rights or protection of the environment.

Republicans said the move confirmed their contention that parts of the health care law were ill conceived and unworkable.

But Republicans denounced the change. “The administration’s decision to carve out its union cronies from the Obamacare fee is beyond egregious and will leave others with self-insured plans on the hook to foot the bill,” said Senator John Thune, Republican of South Dakota.

Robert Laszewski, a consultant who works closely with insurers, said the reprieve for noncompliant policies “tends to undermine the sustainability of Obamacare” by reducing the number of people who will buy insurance through the exchanges.

The administration acknowledged that its transition policy could lead to “higher average claims costs” for people who buy insurance that complies with the Affordable Care Act. But health officials said the 2010 law provided several “shock absorbers” to help stabilize premiums.

http://thewoodlandstxhealthinsurance.com

http://allplanhealthinsurance.com

Who Needs the Healthcare.gov Website?

HEALTHCARE DOT GOV 2

Op-ed by Kenton Henry

If the administration and main stream media will not tell you–I will:

You can go through me–or any licensed health insurance agent or broker to acquire health insurance. NOW. And this is whether you qualify for a subsidy or not. And, importantly, there will be no, I repeat – $0 difference in your cost (premium) for doing so vs. the government website Healthcare.gov or a private insurance company’s. Period. Now where have you heard “Period” before and it turned out to be true? Well . . . in this case it is.

There is only ONE reason to go to the still basically inoperable, security in doubt, aforementioned federal government health insurance website known as The Marketplace:

1) You qualify for a subsidy of your 2014 health insurance premium and you would like to take advantage of that subsidy as you pay your premiums. I.e., you qualify and would like the premium you pay to your insurance company to be reduced by the amount of your subsidy as you pay the premium. (This as opposed to paying the gross premium (cost before your subsidy is applied) then declaring your subsidy on your 2014 tax return and having your tax liability reduced accordingly.)

If you this does not describe you – there is absolutely no reason to go to healthcare.gov!

Neither do you need to go through a state appointed, federally funded Navigator, hired by the State and required to complete only 20 hours of online education and be subjected to no background check. Why replicate and risk the possible insecurity of your personal information which includes your address; birth date; social security number and reported income by going through someone not even vetted by the Department of Health and Human Services (HHS) or the Center for Medicare Services (CMS)? As the Secretary for HHS, Kathleen Sebelius, admitted under oath and questioning from Texas Senator John Cornyn during Congressional, hearings just last week – “It is possible (for a convicted felon to be hired as a Navigator and take your personal and vital information).”

This begs the question: Why is the administration and main stream media not advertising, and barely mentioning, that a health insurance shopper can go through a licensed and vetted insurance agent who has passed a background check with every company with whom they are appointed and do so at no additional cost? Or that the shopper can then have all the expertise that that agent’s time in the industry (27 years in my case) brings to bear on their needs and situation? Or how about a “go to” advocate in their behalf they can call whenever there is an issue relating to claims; rates or general service related issues such as changes in address or dependents. This as opposed to a different unknown service rep at the end of a toll free number each time they call an insurance company directly?

I will let you speculate on the answers to these questions but (while the purpose of this blog is to educate the follower on issues relating to health and Medicare insurance) indulge me while I for once engage in a little shameless self-promotion on behalf of myself and all licensed agents and brokers:

If you reside in Texas; Indiana; or Ohio – please visit my website at http://allplaninsurance.com and click on the bold red “Get A Quote!” button on the home page or–better yet–call me toll free @ 800.856.6556 and let’s have an intelligent dialogue about your true wants and needs relative to coverage and then get some meaningful quotes and information for you. All without submitting the equivalent of a home mortgage application!

If you reside in any other state – do yourself a favor and call a well recommended licensed health insurance agent or broker in your community.

Again, call me even if you do qualify for a subsidy. I can help you just the same and–as without a subsidy–your cost for insurance will be the same. If you do not want to take the subsidy now but would rather take it on your 2014 tax return (when you actually know what your income will have been) we can apply for you now and have your coverage issued immediately.

If you want the subsidy applied upfront, to reduce the premium you pay each month, we will still have to enter the healthcare.gov website. But we will do so only after we have obtained your gross quotes via my website. I know the formula and can do a pretty fair job of estimating your net premium (after your subsidy is applied). If this scenario describes you,  as the federal website is still inoperable, we should wait and see if HHS and CMS have the site fixed and secure by November 30th as promised. Let’s keep our fingers crossed and–if so–we should sail (wink, wink) through the application and have your coverage issued by January 1. But remember, if all government deadlines remain as now, we will need to complete your application no later than December 15th!

Admin. – Kenton Henry

http://allplanhealthinsurance.com

It Was My Impression The Current Administration Has Always Supported Greater Regulation!

Please correct me if I am wrong, but I recall that ever since President Obama took office in 2009–in the midst of the housing crisis; failed savings and loans and with the legacy of Enron still looming fresh in the memories of stockholders everywhere– he has said more government regulation through stricter laws and scrutiny (among a host of other burdensome and expensive supposed remedies) was necessary to protect the consumer and public in general. Now–in a narrative of unabashed hypocrisy his administration speaks out and intervenes to prevent Texas’s Governor Rick Perry from doing that very thing.

 
Perry directed the Texas Department of Insurance to establish strict rules to regulate Navigators trained to help Texans purchase health insurance under the Affordable Care Act (ACA). (These rules are outlined in our feature article below.) Remember – when you go through one these Navigators to enroll in an ACA compliant health plan for an effect date of January 1 – you will be required to divulge your income; your birth date; social security number; address; credit card and checking account information. Do you really want just anyone taking this information? Do you really want the person taking it to not be subject to criminal and financial background checks? Insurance agents licensed in the State of Texas are subject to all these requirements. Why would the administration which always argues for more protection of the individual from the misfeasance, malfeasance and just plain greed of the big corporations, e.g., health insurance companies – now be opposed to such? Why is this regulation so suddenly a liability? Please weigh in and help me understand this. The arguments presented by the fed below do not.

 
Admin. – Kenton Henry
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Feature Article
The Texas Tribune
Wednesday, September 18, 2013
Perry Directs TDI to Regulate Federal Navigator Program
Gov. Rick Perry has directed the Texas Department of Insurance to establish strict rules to regulate so-called navigators trained to help Texans purchase health coverage under Obamacare.
While the governor says the extra regulations will ensure that people handling Texans’ private financial and health information are properly trained and qualified, the rules could present a significant roadblock to organizations helping to implement the federal Affordable Care Act.
“This is blatant attempt to add cumbersome requirements to the navigator program and deter groups from working to inform Americans about their new health insurance options and help them enroll in coverage,” Fabien Levy, a spokesman for the U.S. Department of Health and Human Services, said in an email.
Along with many other provisions in President Obama’s signature health reform law, the individual mandate to purchase health insurance is set to take effect on Jan. 1. Texas’ Republican majority, which vehemently opposes the federal health law, declined to establish a state-based insurance marketplace. The federal government is doing it instead, launching an Orbitz-like online insurance exchange starting Oct. 1. That exchange will require individuals to input sensitive tax information, including their Social Security numbers and estimated annual income, to determine whether they qualify for tax credits to purchase coverage.
To help uninsured Texans use the complicated new system, the federal government awarded nearly $11 million in August to local organizations charged with hiring and training navigators, who will help consumers input their financial information and pick a health plan through in the exchange, must undergo 20 to 30 hours of training, pass a certification test and renew their certification annually, according to the U.S. Department of Health and Human Services.
For Perry, those ground rules are not enough.
“The U.S. Department of Health and Human Services has repeatedly delayed explaining how its navigators were going to be created, how they were going to operate and how they were going to be regulated,” Perry wrote in a letter to Insurance Commissioner Julia Rathgeber. “Because of the nature of navigators’ work and because they will be collecting confidential information, including birth dates, social security numbers and financial information, it is imperative that Texas train navigators on the collection and security of such data.”
In the letter, Perry specifically directed TDI to establish rules that require navigators to complete at minimum of 40 hours of state training in addition to the federal training requirements. He also demanded that navigators pass a rigorous exam based on that training, refrain from influencing a consumer’s insurance choice by recommending a specific plan or comparing benefits offered by different plans, and submit to periodic background and regulatory checks and show state identification while on the job.
He also directed TDI to maintain a database of registered navigators, including background checks and fingerprints; set limits on when and where navigators can enroll people in the exchange; charge fees to provide navigator training and registration; and establish the department’s authority to suspend or revoke navigators’ registration for failing to comply with state requirements.
“TDI agrees that the navigators in Texas have to be well trained and competent in what they’re doing,” said Ben Gonzalez, an agency spokesman. “Our goal is for them to be accountable and be conscientious about the confidential information that they’re going to be collecting.”
Federal officials said some of the rules Perry ordered the state insurance department to implement are forbidden under U.S. law. For example, navigators are not allowed to retain or report information on consumers who sign up for coverage through the exchange; therefore, they could not submit that information to TDI, as Perry has requested. The federal agency also emphasized that navigators are not allowed to access consumers’ information after it has been submitted to the exchange.
Levy said the U.S. government has similar programs already set up to help counsel people applying for Medicare, and that those have “never faced this kind of bullying from Texas.”
“This is clearly an ideologically-driven attempt to prevent the uninsured from gaining health coverage,” Levy said. “But despite the state’s attempts, we are confident that navigators will still be able to help Texans enroll in quality, affordable health coverage when open enrollment begins on Oct. 1.”
Given the governor’s directive, the department will begin putting together the rules with some urgency, Gonzalez added. The rule-making process can take several weeks, as the state is required to hold public meetings and solicit stakeholder input before the rules are drafted. After a draft is approved, the rules must be posted on the Texas Register to receive official comment before they can be codified.
“It’s our expectation the rules and training be in place by Jan. 1, when insurance can be purchased through the exchange,” Rich Parsons, a spokesman for the governor’s office, said via email.
The federal health exchange has a six-month open enrollment period — from Oct. 1 to March 31 — in which navigators can help the uninsured find health coverage to comply with the insurance mandate. Individuals who do not purchase insurance during the open enrollment period could be subject to federal tax penalties. If the state’s regulations take effect on Jan. 1, the navigators will be required to undergo additional training during the open enrollment period, which could present significant challenges.
To address the privacy concerns raised about the navigator program, some grant recipients are already requiring navigators to undergo additional training on privacy protection. United Way of Tarrant County, in collaboration with 17 other organizations, received $5.8 million, the largest federal navigator grant in Texas. Tim McKinney, the organization’s chief executive officer, said the organization is requiring navigators to undergo an additional hour-and-a-half of training on how to comply with the federal privacy law HIPAA.
Lawmakers signed off on Perry’s call for greater regulation of the navigator program in the last legislative session when they passed Senate Bill 1795, which authorizes TDI “to regulate navigators if it determined that federal standards did not ensure they were qualified to perform their duties or avoid conflicts of interest,” according to a legislative report. The new state law allows the department to enact rules that protect patient privacy and prohibit navigators from accepting payments from health insurance companies or posing as an insurance agent. At least 16 other states have also enacted or are considering laws to regulate navigators, according to a USA Today report.
Texas Attorney General Greg Abbott and 12 other state attorneys general have also raised concerns that the federal navigator program could pose risks to patients’ privacy. In a letter sent to U.S. Health and Human Services Secretary Kathleen Sebelius in August, the attorneys general asserted that the federal government’s screening process does not require uniform background or fingerprint checks, meaning convicted criminals or identity thieves could become navigators. They also expressed concerns that navigators would not undergo sufficient training.
Some medical professionals and advocates have objected to the privacy concerns raised by conservatives, suggesting they are politically motivated. For example, navigators must already comply with state and federal laws governing the privacy of sensitive medical information. If they do not adhere to strict security and privacy standards, including how to handle and safeguard consumers’ Social Security numbers and identifiable information, they are subject to criminal and civil penalties at both the federal and state level. The federal government imposes up to a $25,000 civil penalty for violating its privacy and security standards.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


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