BULLETIN: Second Round of Obamacare Breaks From The Gate Starting Now!

HEALTH INSURANCE PREMIUMS 2015

(Announcement by D. Kenton Henry and HealthandMedicareInsurance.com)

Who will end up the winner ― you ― the insured, the insurance companies or Uncle Sam?

As a health insurance broker of 27 years, I and my peers have waiting with baited breath all year to see two things:

First ― will enrollments in 2015 health insurance plans, which begin at midnight tonight, the 15th of November, go more smoothly than last year’s embarrassing debacle that was the glitch plagued Healthcare.gov website which floundered in the death throes of end-stage technology through the entire first year “open-enrollment” period?

Secondly ― what are 2015 premiums and benefits going to look like? By the time you read this, you are about to know. I hope you will be happy with the options available to you, however, I hate to say, I cannot guarantee that. Rumor has it that premiums will be going up at varying rates relative to each of the fifty states. In Texas they are projected to rise an average of 14%  above 2014 rates depending on your age. If this is the case and you have coverage you feel is adequate―along with the option of keeping it―that is exactly what you should do. But if you are like a great number of my clients, who have been told your current plan will terminate 12.31.2014,  your only options are to forego coverage and pay the penalty (excuse me “shared responsibility tax”) when you file your 2015 tax return. Or purchase one of the new compliant plans.

I cannot control the options you will have but I can present, simplify and guide you to your best value in 2015 health insurance coverage. My quoting link will not only determine if you qualify for and calculate the amount of your subsidy (utilizing the same algorithm employed by Healthcare.gov) but, in the event you do qualify, will allow you to seamlessly take advantage of the subsidy and apply for your health plan selection for the reduced (net) premium. It will illustrate all your options from every carrier both on and off the federal exchange.

I am certain that after reviewing your options you will have numerous questions. I encourage you to email or call me with them. I will answer them and once you have decided upon your best value, I can make the enrollment process go as smoothly and comfortably as possible. I intend to work all through the weekend and make myself available to be best of my ability.

It is currently 10 p.m. CST on the 14th. After midnight click on this link to begin exploring your options and know I greatly anticipate working with you and making this transition period in the health insurance consumer market go as smoothly as possible for you.

Sincerely,

Kenton Henry

Broker, Agent, Editor

Email: Quote@allplaninsurance.com

Phone: 281.367.6565

Toll Free: 800.856.6556

CLICK HERE FOR 2015 HEALTH INSURANCE OPTIONS: https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

*Please return to this page and give us your opinion of your options.

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FEATURE ARTICLES:

NEW YORK TIMES

14 November 2014

Cost of Coverage Under Affordable Care Act to Increase in 2015

By ROBERT PEAR, REED ABELSON and AGUSTIN ARMENDARIZNOV. 14, 2014

“Consumers should shop around,” said Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal insurance exchange serving three dozen states. “With new options available this year, they’re likely to find a better deal.” She asserted that the data showed that “the Affordable Care Act is working.”

But Republicans quickly pounced on the data as evidence of the opposite.

“Last year, many who liked their plan were surprised to learn they couldn’t keep it,” said Senator Orrin G. Hatch of Utah, who is in line to become chairman of the Senate Finance Committee. “This year, many who like their plan will likely have to pay more to keep it.”

The new data means that many of the seven million people who have bought insurance through federal and state exchanges will have to change to different health plans if they want to avoid paying more — an inconvenience for consumers just becoming accustomed to their coverage.

A new Gallup Poll suggests that seven in 10 Americans with insurance bought through the exchanges rate the coverage and the care as excellent or good, and most were planning to keep it.

In employer-sponsored health plans, employees tend to stay with the same insurer from year to year. But for consumers in the public insurance exchanges, that will often be a mistake, experts said.

Nashville illustrates the need for people with marketplace coverage to look closely at the alternatives available in 2015.

Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal health exchange. Credit Doug Mills/The New York Times

A 40-year-old in Nashville, with the cheapest midlevel, or silver plan, will pay $220 a month next year, compared to $181 a month this year, for the same plan.

The least expensive plan is offered by another insurer, Community Health Alliance, one of the so-called co-op plans created under the federal law. It offers coverage for a monthly premium of $194.

But the lower premium means that consumers will have to pay a much larger annual deductible, $4,000, rather than $2,000. A policyholder who becomes seriously ill or has a costly chronic condition could pay hundreds of dollars in out-of-pocket expenses.

In addition, different health plans often have different networks of doctors and hospitals and cover different drugs, meaning that consumers who change plans may have to pay more for the same medicines.

Another problem for consumers is that if the price for a low-cost benchmark plan in the area has dropped, the amount of federal subsidies provided by the law could be less, meaning that consumers may have to pay more unless they switch.

The data, released by the Centers for Medicare and Medicaid Services, indicates that price increases will be modest for many people willing to change plans. In a typical county, the price will rise 5 percent for the cheapest silver plan and 4 percent for the second cheapest.

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NEW YORK TIMES

Estimate of Healthcare Enrollment Leaves Room to Grow

10 November 2014

WASHINGTON — The Obama administration on Monday offered a surprisingly modest estimate of the number of people who would sign up for health insurance in the second round of open enrollment, which begins on Saturday.

Sylvia Mathews Burwell, the secretary of health and human services, said she was working on the assumption that a total of 9.1 million people would have such coverage at the end of next year.

By contrast, the Congressional Budget Office had estimated that 13 million people would be enrolled next year, with the total rising to 24 million in 2016. In the past, the White House has used the budget office numbers as a benchmark for success under the Affordable Care Act.

This estimate appeared to be part of an effort by federal officials to lower public expectations, so the goal would be easier to meet and to surpass. In addition, the new number could indicate that administration officials believe it will be difficult to find and enroll many of the uninsured while retaining those who signed up in the last year.

“The number we are going to aim for this year is 9.1 million,” Ms. Burwell said on Monday during remarks at the Center for American Progress, a liberal research and advocacy group.

Ms. Burwell’s estimate was at the lower end of the range suggested by health policy experts in her department. In a report issued earlier Monday, the experts estimated that, at the end of next year, 9 million to 9.9 million people would have coverage purchased through insurance exchanges, or marketplaces.

Representative Marsha Blackburn, Republican of Tennessee, said the administration was “trying to manage expectations and rewrite its definition of success ahead of the second open-enrollment period.” Administration officials said they were just being realistic, in the light of experience with other health programs.

President Obama announced in April that eight million people had signed up for health insurance under the Affordable Care Act. Officials said Monday that enrollment had declined to 7.1 million after some people failed to pay their share of premiums and others were found to be ineligible because of unresolved questions about their citizenship or immigration status.

The Department of Health and Human Services estimated that enrollment, including renewals and new customers, would reach 10 million to 11 million by the end of the three-month sign-up period, which closes on Feb. 15.

However, if Ms. Burwell is right, the number would shrink to 9.1 million people at the end of next year. That would still be a 28 percent increase over the number believed to have marketplace coverage today.

Ms. Burwell’s estimate came as a surprise to insurance counselors, agents and brokers working with the Obama administration.

Anne Filipic, the president of Enroll America, a nonprofit group trying to expand coverage, said the goal of 9.1 million “seems reasonable.” She praised the administration for taking what she described as “a pragmatic, analytic approach” to setting a numeric goal.

Federal health officials said they had ended coverage for 112,000 people who could not demonstrate that they were United States citizens or legal immigrants entitled to insurance under the health care law.

In addition, they said, 120,000 households will lose some or all of the insurance subsidies they have been receiving because they could not adequately document their income. These households will face higher premiums.

In making their estimates, federal health officials said, they assumed that 83 percent of the people with marketplace coverage — 5.9 million of the 7.1 million people in “qualified health plans” — would renew their coverage.

The intense political debate swirling around the Affordable Care Act does not make the job of enrolling people any easier, officials said.

Republicans like Tom Cotton in Arkansas and Joni Ernst in Iowa won Senate races in which they emphasized opposition to the health care law, as did successful Republican House candidates like Mia Love in Utah and Ryan Zinke in Montana.

Senator John Barrasso of Wyoming, the chairman of the Senate Republican Policy Committee, said that people were skeptical of the law and “aren’t signing up because they realize it’s not a good deal for them.”

The Supreme Court said on Friday that it would consider a case challenging subsidies paid to more than four million people who obtained insurance through the federal marketplace.

Ms. Burwell said Monday that she did not see the legal challenge as a serious threat to the Affordable Care Act. “As we go into open enrollment,” she said, “nothing has changed.”

Federal health officials said they believed that marketplace enrollment would grow more slowly than projected by the Congressional Budget Office, which sees the total holding steady at 25 million from 2017 to 2024.

Administration officials noted that uninsured people could also get coverage by enrolling in Medicaid or by finding jobs with health benefits.

In a brief analysis of coverage trends, the Department of Health and Human Services said Monday that “most of the new marketplace enrollment for 2015 is likely to come from the ranks of the uninsured,” rather than from people who previously bought insurance on their own outside the exchanges.

“Happy Anniversary Healthcare.Gov!” (Do We Want A Divorce?)

Op-ed by D. Kenton Henry

BIRTHDAY CAKE

 

Happy anniversary, Healthcare.gov! Today, October 1st, marks the first anniversary of the premier of the originally beleaguered Federally Facilitated “Marketplace” (FFM), the federal government website for the purchase of Affordable Care Act (ACA) compliant health insurance plans in states which did not implement their own. And what of it now?

After a rollout, which was anything but smooth, and a current expenditure of approximately $2.1 billion dollars (after a winning bid of $90 million) the site seems to have solved the majority of its “front- end” issues. These involve opening an account; verifying identity and plan selection. But in light of notice that the time has run out for those who did not succeed in providing adequate proof of income for subsidy (“Premium Tax Credit”) purposes thereby resulting in their loss of coverage or―at least the subsidy―one is left wondering what if anything will change relative to this “back-end” issue for 2015. According to a September 15th article in the New York Times, approximately half a million insured face a forced plan change. “363,000 could lose their premium subsidies due to an inability to verify income, while 115,000 more could have their policies canceled because they have not proven their immigration status. Federal authorities have been working for months to resolve both backlogs.”

My BlueCross BlueShield of Texas clients who have “grand-mothered” plans just received notice dated today that “The health plan you now have will no longer be available and cannot be renewed”. Grand-mothered plans are those which have been modified in anyway, such as a change in deductible, but purchased prior to January 1 of this year when all new policies were required to be ACA compliant. Termination will be effective the end of 12.31.2014 and the client, insured will have until that date to enroll in a new plan for seamless coverage beginning January 1. These policyholders are instructed to log in starting November 15th to review their options and elect new coverage through BlueCross BlueShield. What will the benefits look like and what will be the cost? Well, we won’t know until November 15th. The consensus seems to be that premiums in all but a few locations will be increasing somewhat across the market compared to this year’s ACA compliant plans but at less than the average rate of medical inflation in recent years. (Call me skeptical.) But what about compared to their grand-mothered plan? No way. By the time you add in the additional cost of mandated coverage for benefits such as pediatric dental and vision, maternity and the rest of the “minimum essential health benefits” along with guarantee issue for pre-existing conditions, there is no way these policyholders are going to be pleased with the premiums their new options will cost. If they had thought the marketplace offered better options, they would have elected them for 2014. I am certain the words, “If you like your plan, you can keep your plan. Period.” will be ringing in their ears as they peruse their new options.

On the upside, an estimated 25% additional insurance companies will be providing coverage for 2015 both in and out of the marketplace and state exchanges. This increased competition will give consumerd more options and will hopefully help offset some of the inflationary aspects of mandated coverage in future years.

On the downside, what of the “It’s a penalty … not a tax!” ― now known as the “Shared Responsibility Payment” ― for not having coverage in 2015? That increases to $325 per adult and $162.50 per child or 2% of household income ― whichever is higher. (Family maximum is $975.) It will increase every year hereafter, tied to the rate of inflation beyond 2016.

Additional variables remain to be seen such as “provider selection”. While pressure is being put on insurance companies to increase the number of in-network providers available to the insured, surveys seem to indicate more providers are electing not to join. They feel payments have dropped to low to make it worth their while to participate. Insurance companies are going have to find alternative ways to control costs and since they cannot control the risk they are forced to assume (elative to pre-existing conditions and the mandated “loss ratio”) they are going to ration our providers and our treatment.

On a final note, the enrollment period for 2015 plans will be half as long as for 2014 and will end February 15th. So get ready to be like the sheep, in the Wild Kingdom segment, passing through the anaconda. It’s going to be a tight squeeze! And once again . . . “Happy Anniversary to Healthcare.gov!”

By all means, please contact me if you feel I can make the celebration cake a little more palatable!

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FEATURED ARTICLE:

The New York Times

U.S. to End Coverage Under Health Care Law for Tens of Thousands

By ROBERT PEAR SEPT. 15, 2014

WASHINGTON — The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified.

The 115,000 people “will lose their coverage as of Sept. 30,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal insurance marketplace.

Some of them may be able to have their coverage reinstated retroactively if they produce the documents that they were repeatedly asked to provide in recent months, Mr. Slavitt said.

At the end of May, the administration said, 966,000 people were found to have discrepancies in their immigration and citizenship records. Most sent in documents as requested. In mid-August, the administration sent letters to about 310,000 people who had failed to respond. They were supposed to submit documents by Sept. 5, but the 115,000 consumers failed to do so, Mr. Slavitt said.

Many consumers and lawyers who work with them said that they had tried to submit immigration and citizenship papers, but that they experienced problems transmitting documents through HealthCare.gov. Other people said they sent the documents by mail to a federal contractor in Kentucky but never heard back from the contractor or the government.

“We heard from lots of consumers who told us they sent in their documents multiple times or tried to upload them through HealthCare.gov,” said Mara Youdelman, a lawyer at the National Health Law Program, an advocacy group for low-income people.

Jenny Rejeske, a health policy analyst at the National Immigration Law Center, which represents immigrants, said: “It is unduly harsh to terminate coverage while there are still technical problems with the federal system for verifying citizenship and immigration status. And there has not been adequate notice to people who speak languages other than English and Spanish.”

Florida leads the list of states whose residents are losing coverage because of immigration and citizenship issues, with 35,100. Federal officials said they were ending coverage for 19,600 people in Texas, 6,300 in Georgia, 5,300 in North Carolina, 5,200 in Pennsylvania, 4,000 in Illinois and 2,400 in New Jersey. The numbers released on Monday are for 36 states using the federal insurance marketplace. They do not include terminations in California, New York and other states running their own insurance exchanges.

Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. But in many cases, the government could not verify the incomes people reported when they applied for subsidized insurance.

This does not mean that they provided false information or were ineligible for assistance. The government tried to verify incomes by checking 2012 tax return information, but consumers may have switched jobs or received pay raises since filing those returns. As a result, officials said, the information in their applications may not match the data in federal files or in sources available to the government.

Mr. Slavitt said that on May 30 there were roughly 1.2 million households (and a total of 1.6 million people) with “data-matching issues.”

Since then, the government said, it has closed cases for 467,000 households with data discrepancies, and 430,000 cases are “currently in the process of being resolved.”

“There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals,” Mr. Slavitt said. They will soon receive letters from the government asking for proof of income, and if they do not reply by Sept. 30, they may lose some or all of their subsidies.

They would still be eligible for coverage, but in many cases could not afford it. In some cases, they would also have to repay some or all of the subsidies they received.

It is also possible that some people could receive larger subsidies if their incomes are lower than what they expected when they applied.

(A version of this article appears in print on September 16, 2014, on page A18 of the New York edition with the headline: U.S. to End Coverage Under Health Care Law for Tens of Thousands.)

http://allplaninsurance.com

http://thewoodlandstxhealthinsurance.com

A Timely Warning! Do Not Underestimate Your Income In Order To Qualify For Health Insurance Subsidy! (inadvertantly or otherwise)

Attention! All potential visitors to your state’s insurance “Marketplace” (formerly health insurance exchange) should heed this warning as the time approaches when you may go there to apply for coverage. Do not underestimate your 2014 (and subsequent tax years) income or you could owe a “sizable” refund to the government. This will occur if you accept their subsidy based on an income later proven to be larger than what you estimated for subsidy purposes.

 
As today’s feature article explains by example:
If a family of four receives a year-end bonus that puts them over the 400% (of the Federal Poverty Level) income threshold – they could owe a repayment of more than $7,000!

 
Admin. – Kenton Henry
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FEATURE ARTICLE:

 
Los Angeles Times

Consumers could be surprised at tax time due to federal health law

By Chad Terhune
September 9, 2013, 1:00 p.m.
Some families may end up owing Uncle Sam a sizable refund if they accept government help on buying health insurance next year under President Obama’s Affordable Care Act.
A study published Monday in Health Affairs estimates that 38% of families that qualify for federal premium subsidies might have to repay some portion if changes in their household income aren’t reported to the government.
These subsidies are a crucial part of the federal healthcare law intended to help make insurance more affordable for lower- and middle-income people. Individuals earning less than $46,000 a year, and families below $94,000 annually may qualify for these premium tax credits.
But a raise, bonus or other unexpected income during the year could alter a person’s eligibility and subsidy amount, triggering a repayment when the person files income tax forms for 2014. Some policy experts worry that experience could sour people on the healthcare expansion.
“There’s the potential for some sizable repayments,” said Ken Jacobs, the study’s lead author and chairman of the UC Berkeley Center for Labor Research and Education.
“Even if a small number of people owe a lot of money back that could generate fear of taking the subsidies. You don’t want to scare people from enrolling,” Jacobs added.
At particular risk of refunds, researchers said, are people who are near the eligibility cutoff for the subsidies. The tax credits are on a sliding scale basis up to 400% of the federal poverty line.
For instance, a family of four in California that receives a year-end bonus that puts them over that 400% income threshold could be required to repay more than $7,000, according to Jacobs.
The subsidy repayments are capped for lower-income people under the law.
The study said prompt notification of income changes so the subsidies can be adjusted could reduce the number of people who owe repayments by as much as 41%. Also, the size of the typical repayment could be cut by as much as 60%, according to the study.
“Timely reporting will make a very big difference,” Jacobs said.
In most cases, the federal government will pay the monthly subsidy directly to the customer’s private health insurer and the policyholder will pay any remaining premium.
In Washington, D.C., Jacobs said, the district’s exchange has set the default subsidy to 85% of the full amount to give people some financial cushion against receiving too much throughout the year. Even in that case, he said, consumers can still elect to take the full amount if they want.
Peter Lee, executive director of Covered California, said the state’s health exchange will work hard to educate residents about how the subsidies work and the importance of promptly reporting changes in income to avoid surprises later on.
“We don’t want to be on the paternalistic side of saying, ‘We think you should save more to the end,'” Lee said. “But we do want to reach out and let people know what the risks are. It is a big deal.”


http://allplanhealthinsurance.com

Health Insurance Premiums To Increase 72% in State Exchange

07.19.2013

So much for the “affordable” part of the Affordable Care Act. At least in some states, like Indiana, where along with Texas and Ohio, I have many clients. As October 1st winds nearer, the date when the Federal and State Health Insurance Exchanges must unveil the new health care compliant policies for 2014 that individuals, families and small groups must choose from – it is evident costs will skyrocket. According to the Indiana Department of Insurance rates there will increase 72%! (See Feature Article below.) In Texas–which is one of 34 states which elected not to establish a state exchange–the Federal Exchange will be the (default) exchange from which to elect coverage. It’s premiums are yet to be revealed but are predicted to be at least 30% higher than for those who currently have health insurance in Texas.

In conclusion, if you do not qualify for a federal subsidy for at least a portion of your coverage–prepare yourself for a significant rate increase. What does it take to qualify for a subsidy? Your annual reportable income must be less than 400% of the Federal Poverty Limit. *Refer to the chart below that limit, increasing increments and the accompanying subsidy.

Admin. – Kenton Henry

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FEATURED ARTICLE:

In Indiana, Individual Health Insurance to Cost 72% More Due to Obamacare

8:15 AM, Jul 19, 2013 • By DANIEL HALPER

Obamacare will be costly for Hoosiers who already have health insurance, according to a report from Indystar.com.

“Insurance rates in Indiana will increase 72 percent for those with individual plans and 8 percent for small group plans under President Barack Obama’s healthcare overhaul, according to the state’s insurance department,” reads the report.

“The spike in costs is due primarily to new mandates under the law, which requires insurers to cover those with pre-existing conditions and to offer a minimum level of benefits, said Logan Harrison, chief deputy commissioner with the Indiana Department of Insurance under Republican Gov. Mike Pence. New taxes and fees under the law also contributed, Harrison said.

The Indiana governor tells the paper: “This new data regrettably confirms the negative impact of the Affordable Care Act on the insurance market in Indiana. … The Affordable Care Act requires many Hoosiers to purchase more comprehensive and more expensive health insurance than they may want or need. These rates call into question just how affordable health insurance will really be for many Hoosiers.”

Costs for individual plans is expected to increase from an average of $255 per member per month in 2012 to $570 in 2014, when the most aspects of the law go into effect.

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*2013 Federal Poverty Guidelines



48 Contiguous States and DC

Note: The 100% column shows the federal poverty level for each family size, and the percentage columns that follow represent income levels that are commonly used as guidelines for health programs.

 Household   Size

 100%

 133%

 150%

200%

 300%

400%

 1

$11,490

$15,282

$17,235

$22,980

$34,470

$45,960

 2

15,510

 20,628

23,265

  31,020

46,530

62,040

 3

19,530

 25,975

29,295

  39,060

58,590

78,120

 4

23,550

 31,322

35,325

  47,100

70,650

94,200

 5

27,570

 36,668

41,355

  55,140

82,710

110,280

 6

31,590

 42,015

47,385

  63,180

94,770

126,360

 7

35,610

 47,361

53,415

  71,220

106,830

142,440

 8

39,630

 52,708

59,445

  79,260

118,890

158,520

 For   each additional person, add

$4,020

 $5,347

$6,030

  $8,040

$12,060

$16,080


Alaska

 Household Size

 100%

    133%

 150%

200%

 300%

 400%

 1

$14,350

$19,086

$21,525

$28,700

$43,050

$57,400

 2

19,380

25,775

29,070

38,760

58,140

77,520

 3

24,410

32,465

36,615

48,820

73,230

97,640

 4

29,440

39,155

44,160

58,880

88,320

117,760

 5

34,470

45,845

51,705

68,940

103,410

137,880

 6

39,500

52,535

59,250

79,000

118,500

158,000

 7

44,530

59,225

66,795

89,060

133,590

178,120

 8

49,560

65,915

74,340

99,120

148,680

198,240

 For   each additional person, add

$5,030

$6,690

$7,545

$10,060

$15,090

$20,120


Hawaii

 Household   Size

 100%

 133%

  150%

 200%

 300%

 400%

 1

$13,230

$17,596

$19,845

$26,460

$39,690

$52,920

 2

17,850

23,741

26,775

35,700

53,550

71,400

 3

22,470

29,885

33,705

44,940

67,410

89,880

 4

27,090

36,030

40,635

54,180

81,270

108,360

 5

31,710

42,174

47,565

63,420

95,130

126,840

 6

36,330

48,319

54,495

72,660

108,990

145,320

 7

40,950

54,464

61,425

81,900

122,850

163,800

 8

45,570

60,608

68,355

91,140

136,710

182,280

 For   each additional person, add

$4,620

$6,145

$6,930

$9,240

$13,860

$18,480

Source: Calculations by Families USA based on data from the U.S. Department of Health and Human Services

Courtesy of All Med & Life Quote

http://allplanhealthinsurance.com

http://allplaninsurance.com

Welcome to The MedPlus Messenger Blog!

THE MEDPLUS MESSENGER

VOL I, ISSUE 1, 16 JULY 2013

THE MEDPLUS MESSENGER blog is for the dissemination and discussion of information regarding health, Medicare and life insurance legislation; laws; trends; products and related topics. It is intended to be of use to the general public; clients and prospective clients of ALL PLAN MED & LIFE QUOTE the parent company of ALLPLANINSURANCE.COM: http://allplaninsurance.com; ALLPLANHEALTHINSURANCE.COM; ALLPLANINTERNATIONALHEALTHINSURANCE.COM and IndianaHealthInsurance4U.com.

ADDRESSING: HEALTH AND MEDICARE RELATED INSURANCE ISSUES INCLUDING THE AFFORDABLE CARE ACT (ACA); COMPLIANCE WITH THE AFFORDABLE CARE ACT; STATE AND FEDERAL HEALTH INSURANCE EXCHANGES; CURRENT BEST VALUES IN HEALTH INSURANCE; IMPACT OF THE ACA ON EMPLOYERS; DECLINATION DUE TO PRE-EXISTING CONDITIONS; MEDICARE AND MEDICARE RELATED INSURANCE (MEDIGAP); PART D PRESCRIPTION DRUG PLANS

While The MedPlus Messenger has existed for sometime as an industry and marketing newsletter–today is the first time we have existed and published as a blog. The reasons for this are numerous but the greater ones are: the tremendous amount of confusion, on the part of the public, regarding the ACA and its implementation; the diverse opinions and perspectives on it; apprehension as to its effects on the quality of health care; the cost of insuring for medical expense and the options for doing so available to employer groups, individuals and families and Medicare recipients. Only through intelligent discourse of these topics can our subscribers transition through implementation into optimal utilization of health care, as well as protection against the cost for such, with as little inconvenience as possible. Only by discussing your concerns, , perspective, frustrations and opinion can Allplanhealthinsurance.com better meet your needs in this rapidly changing marketplace. Already the availability of health insurance has become an entitlement by law and its issue and administration may well be on the brink of falling within the exclusive confines of another federal program. For these reasons, not only are your insights and questions welcomed but your disagreements and protests encouraged as well.    

OUR MISSION:

It has and will remain the goal of Allplaninsurance.com to provide the most objective health, Medicare related, life and dental insurance quotes–along with the very best of service to the our policyholders. We serve residents of all fifty states (US) and the international community. We see it as our responsibility to monitor the state of the national and international insurance and the political process as it relates to such. It is our objective and, we feel–our duty–to inform the public of such matters. ALL PLAN MED & LIFE QUOTE has been based in The Woodlands, Texas since 1991.

THE MEDPLUS MESSENGER is not copyrighted and articles and analysis presented in THE MEDPLUS MESSENGER may be reproduced at your discretion. However, articles and analysis should not be construed as representing the policy, endorsement or opinion of ALL PLAN MED & LIFE QUOTE, or its agents, unless so stated. Although carefully verified, data are not guaranteed as to accuracy or completeness. ALL PLAN MED & LIFE QUOTE cannot be held directly responsible for any direct or incidental loss incurred by applying any of the information in this publication.

DIRECT QUESTIONS OR SUGGESTIONS TO FIELD OFFICES:

TEXAS & ALL OTHERS: 800.856.6556; quote@allplaninsurance.com

CALIFORNIA: 800.200.5278; insurnet@snowcrest.net

NEW YORK: 888.766.6932; sonny@onestopinsuranceshopping.com

IMPORTANT PHONE NUMBERS AND LINKS:

THE AFFORDABLE CARE ACT, SECTION BY SECTION (U.S. Department of Health and Human Services Website): http://www.hhs.gov/healthcare/rights/law/index.html

CENTERS FOR MEDICARE & MEDICAID SERVICES: 1.800.633.4227: http://www.medicare.gov

U. S. (Federal) Pre-Existing Condition Health Insurance Plan:  https://www.pcip.gov/

The United States Senate: http://www.senate.gov/general/contact_information/senators_cfm.cfm

Texas Department of Insurance: 800.252.3439: http://www.tdi.state.tx.us/

Texas Health Insurance Risk Pool (for those uninsurable by private health insurance):

888.398.3927; TDD 1.800.735.2989: http://txhealthpool.com/

New York Department of Insurance: 800.342.3736: http://www.ins.state.ny.us/

Illinois Department of Insurance: 217.782.4515: http://www.idfpr.com/

Indiana Department of Insurance: 317.232.2410: http://www.state.in.us/idoi/

California Department of Insurance: 916.322.3555: http://www.insurance.ca.gov/

United States Treasury Health Savings Account Guidelines:  http://www.treasury.gov/

Doctor Comparison:  http://www.bcbstx.com/bluecompare/tour/index.html

National Association of Health Insurance Underwriters:  http://www.nahu.org/

VISIT OUR WEB SITES AT:

http://allplaninsurance.com

http://allplanhealthinsurance.com

http://allplaninternationalhealthinsurance.com

http://indianahealthinsurance4u.com

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TODAY’S ISSUE OF DISCUSSION:

The Affordable Care Act (ACA) and its current state of implementation; the impact of such on health insurance premiums and the delayed Employer Mandate.

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FEATURE ARTICLES:

Op-Ed:

The ensuing articles demonstrate that efforts to implement the Affordable Care Act remain behind schedule and the mechanisms in place to ensure such were never for this herculean task. It is logical to conclude this is, in large part, due to the burden of  comprehending the content and demands of two thousand plus pages of the act itself and nine thousand plus pages of accompanying regulations. Both the public and private sector responsible for implementation are obviously overwhelmed with massive work this requires. This, along with the greatly underestimated costs of implementation and regulation, does not bode well for a smooth and efficient transition into compliance. Even less assured is  the long term solvency of the ever-decreasing number of participating health plans or the feasibility of guaranteed health care.

Due to the minimal penalties for failing to purchase health insurance during the next two years, it is predicated participation by those currently choosing to be uninsured will be negligible. When compared to the cost of insuring which is predicted to increase in many cases by as much or more than 100%–it is reasonable to conclude most will simply choose to pay the penalty. This will disprove the assumption that a huge influx of young, healthy insured members will subsidize the cost of insuring the older, and generally less healthy, individuals which the was the main premise on which feasibility arguments were based.

We can see from recent legislative action that portions of the bill which would impede implementation have been suspended. This, at worst, appears politically motivated and, at best, an effort to make certain as many as possible sign up for individual and family coverage through an exchange. Whether or not you are in favor of the latter is probably dependent on whether you would like to see a “single payer” health insurance system in place as, I feel, this will be the ultimate result of the exchanges and their plan mandates. In the meantime, The ACA is law. Suspension of portions of a passed act inconvenient to implementation of the act itself is unprecedented to my knowledge and there appears no legal basis for doing so.

The featured articles below begin with an overview of the distinction between “Minimum Essential Coverage” and “Essential Health Benefits” and conclude with recent abatements in enforcement of certain portions of the law. That these abatements, suspensions, moratoriums are convenient is unquestionable. The question remains, “for whom?”

Kenton Henry

Administrator, Editor: The MedPlan Messenger

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OVERVIEW MINIMAL REQUIRED COVERAGE AND PENALTIES FOR NON-COMPLIANCE

Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.

What type of coverage satisfies the individual mandate?

“Minimum essential coverage”

What is minimum essential coverage?

Minimum essential coverage is defined as:

  • Coverage under certain      government-sponsored plans
  • Employer-sponsored      plans, with respect to any employee
  • Plans in the individual      market,
  • Grandfathered health      plans; and
  • Any other health      benefits coverage, such as a state health benefits risk pool, as      recognized by the HHS Secretary.

Minimum essential coverage does not include health insurance coverage consisting of excepted benefits, such as dental-only coverage.

How does “Minimum Essential Coverage” differ from “Essential Health Benefits”?

Essential health benefits are required to be offered by certain plans starting in 2014 as a component of the essential health benefit package.  They are also the benefits that are subject to the annual and lifetime dollar limit requirements.

This is different than minimum essential coverage, which refers to the coverage needed to avoid the individual mandate penalty.  Coverage does not have to include essential benefits to be minimum essential coverage.

What is the penalty for noncompliance?

The penalty is the greater of:

  • For 2014, $95 per      uninsured person or 1 percent of household income over the filing      threshold – whichever is greater
  • For 2015, $325 per      uninsured person or 2 percent of household income over the filing      threshold – whichever is greater
  • For 2016 and beyond,      $695 per uninsured person or 2.5 percent of household income over the      filing threshold –whichever is      greater

There is a family cap on the flat dollar amount (but not the percentage of income test) of 300 percent, and the overall penalty is capped at the national average premium of a bronze level plan purchases through an exchange.  For individuals under 18 years old, the applicable per person penalty is one-half of the amounts listed above.

Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.

Who will be exempt from the mandate?

Individuals who have a religious exemption, those not lawfully present in the United States, and incarcerated individuals are exempt from the minimum essential coverage requirement.

Are there other exceptions to when the penalty may apply?

Yes.  A penalty will not be assessed on individuals who:

  1. cannot afford coverage      based on formulas contained in the law,
  2. have income below the      federal income tax filing threshold,
  3. are members of Indian      tribes,
  4. were uninsured for      short coverage gaps of less than three months;
  5. have received a      hardship waiver from the Secretary, or are residing outside of the United      States, or are bona fide residents of any possession of the United States.

*Further Clarification of the Applicable penalty
The individual one-time penalty under ACA in 2014 will be $95 per adult, or one percent of your income, whichever is greater. So say your annual income is $50,000, you’d pay $500. For every uninsured child, the penalty is $47.50. The family maximum is $285.
Coverage is assessed on a monthly basis, So if you were uninsured for six months, you’d owe half the otherwise applicable penalty.”
She said that the government has given a wide window – from Oct. 1, 2013 to March 31, 2014 – for enrollment this time, but from next year on there will only be a three-month window to sign up.
Will people take the gamble and skip coverage, hoping that their youth or good health will protect them?
If the state of Massachusetts, which passed a landmark health care law in 2006, which became the blueprint for the 2010 ACA, is any indication the number of people who will refuse to get some form of coverage will be low.
In Massachusetts, “there’s a culture of coverage. Most people want to comply with the law.”

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FORBES

Pharma & Healthcare |

7/06/2013 @ 6:25PM |290,284 views

Not Qualified For Obamacare’s Subsidies? Just Lie — Govt. To Use ‘Honor System’ Without Verifying Your Eligibility

If you thought the delay in the employer mandate was bad news for Obamacare, just wait. On Friday, Sarah Kliff and Sandhya Somashekhar of the Washington Post discovered that the Obama administration had buried in the Federal Register the announcement that the government won’t be able to verify whether or not applicants for Obamacare’s insurance exchange subsidies are actually qualified for the aid, in the 16 states that are setting up their own exchanges. Instead, until at least 2015, these states will be able to “accept the applicant’s attestation [regarding eligibility] without further verification.”

Without employer mandate, Feds to rely on applicant ‘attestations’

If you’ve been following the latest news around Obamacare, you know that on Tuesday evening, just before the Independence Day holiday, the White House announced that it would be delaying the implementation of the health law’s employer mandate—requiring all firms with more than 50 employees to provide health coverage to their workers—until 2015.

I, and several others at the time, said “wait a minute.” According to the law, you aren’t eligible for Obamacare’s subsidies if your employer has offered you what the government considers “affordable” coverage. But if employers are no longer going to report whether or not they’ve offered “affordable” coverage, how can the government verify whether or not workers are eligible for subsidies?

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DELAYED EMPLOYER MANDATE THE LATEST CHANGE FOR INCREASINGLY UNSTEADY HEALTH-CARE LAW

July 4, 2013 | Washington Post

The Obama administration has postponed one of the fundamental provisions of the health-care reform law, responding to mounting concerns from business owners who would have been required to start providing health coverage to their employees next year. On Tuesday evening, Treasury Department officials announced the government would not penalize businesses that fail to provide health insurance next year, delaying what is known as the “employer mandate” component of the law until 2015. Starting then, firms with more than 50 employees will be required to provide at least a minimum level coverage to their workers or pay a steep fine to the federal government. Officials made the decision to push the requirement back after fielding a flood of complaints from business owners about its implementation. “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 blog post announcing the postponement, later adding that the administration plans to use the additional time to “consider ways to simplify the new reporting requirements” for business owners. The newly delayed mandate has been a major point of contention for small business owners and lobbyists since it was approved as part of the Affordable Care Act in 2010. Many warned that it would cause administrative nightmares for small employers and discourage those near the cutline from expanding beyond 50 workers. Meanwhile, some firms have started scaling back their payrolls to get underneath the cap. “Small companies have told us they are confused by the law and are simply finding it difficult to comply with, no matter when it goes into effect,” Rep. Sam Graves, chairman of the House Small Business Committee, said in an email to The Washington Post. “Instead of providing relief for businesses, this simply kicks the can down the road.” A White House official said the added time would help small business owners adapt to the changes, arguing that the law will still drive down prices for coverage on Main Street. “This allows employers the time to .?.?. make any necessary adaptations to their health benefits while staying the course toward making health coverage more affordable and accessible for their workers,” Valerie Jarrett, an adviser to Obama, wrote in a blog post on Tuesday. This latest delay is the most consequential in a series of setbacks for the president’s signature law, which has shown signs of fragility as the initial deadline for full implementation approaches at the end of the year. In April, the administration announced it would delay for one year a key cost-cutting feature of the law’s new small business health insurance marketplaces. Initially, the exchanges were supposed to allow employers to choose different plans for different workers; now, for the first year, they must select only one plan from a single carrier for their entire business. More recently, the Government Accountability Office announced that federal and state officials have fallen well behind schedule setting up the marketplaces, which are scheduled to open for enrollment in October. “This is simply the latest evidence that implementation of this terrible law is going to be difficult if not impossible, and the burden is going to fall on the people who create American jobs,” Amanda Austin, director of federal public policy at the National Federation of Independent Business, said in a statement. The NFIB, a small business lobbying group, has pushed back against the health care law since it was making its way through Congress, later spearheading an effort to repeal the legislation that ended at the hands of the Supreme Court. The group has since focused on repealing some of the provisions it considers most detrimental to businesses on Main Street, including the employer mandate and a new tax on insurers. Instead of delayed, Austin argued the mandate should be eliminated altogether. “Temporary relief is small consolation,” she said. “We need a permanent fix to this provision to provide long term relief for small employers.” – See more at: http://congress.org/2013/07/04/delayed-employer-mandate-the-latest-change-for-increasingly-unsteady-health-care-law/#sthash.JwCb3wWY.dpuf

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Now is a good time to remind you, if you do not like the options and laws as they apply to insurance consumers, the time to vote your opinions is nigh. For a continually updated list of legislative and state-wide candidates, or to view more election information such as where to vote, visit: http://www.sos.state.tx.us/elections/index.shtml

To let your opinion be known to your Senators go to: http://www.senate.gov/general/contact_information/senators_cfm.cfm

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ALL PLAN MED & LIFE QUOTE and ALLPLANINSURANCE.COM sincerely appreciate your participation.

Please take care and voice your concerns and opinion here.

Sincerely,

Kenton Henry

Administrator; Editor

PHONE: 800.856.6556

http://allplanhealthinsurance.com