Facebook Posting Does Double Duty On This Healthcare Blog

Healthandmedicareinsurance.com followers – I spent enough time responding to the left on my facebook posting – I thought the effort could serve double duty on this blog.
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Before preparing for my trip, I would first like to respond to Kathy: No, I won’t be lobbying for an expansion of Medicaid in Indiana (or any other state for that matter) that has not already expanded it beyond 100% of the Federal Poverty Level. If Medicaid were expanded, it would be to include individuals up to and including those with an income of 133% of the FPL or a maximum income of $15,521 for 2014. Deserving or not aside – while these individuals currently do not qualify for Medicaid in Indiana or Texas – THEY DO qualify for a subsidy of approximately 88% of their health insurance premium. If they elect the plan recommended by the Department of Health and Human Services (“benchmark” plan) it will be the second lowest cost Silver Plan in their area. They are required to pay no more than $40.41 per month. No, I don’t feel sorry for them. They are certainly already receiving food stamps and government subsidized housing and Medicaid is already in financial trouble in most states without further expansion. (Of course I am aware financial feasibility and a balanced state or federal budget is not your concern.)

The person I feel sorry for is the poor working stiff who is making in the $50 – $60,000 dollar range and actually earning his or her income. They don’t qualify a health insurance premium subsidy. (Food stamps I’m not certain of because our government has made those available to virtually everyone including illegal aliens.) Because this responsible working person doesn’t qualify for a subsidy, they will be forced to pay 100% of the Silver plan premium–with an average annual cost of $4,113–entirely on their own. That amounts to 8% of their annual income (at $50k) before taxes which the entitlement person isn’t paying! That’s the person I feel sorry for! Then try providing them with a plan that has their doctor in the network and the benefits they would really like and their cost and that percentage soars! In summation – you keep lobbying for the entitlement class; I’ll keep lobbying for the working American.

Now to address Scott: Glad to see you are finally making a prediction which I feel is pretty much on target. As I’m the one on the front line signing people up for Obamacare, no one knows better the “adverse selection” (bad risk disproportionately selected for participation) than I. But I remember a few of my predictions you tried to dismiss. First – I said Barrack Obama would be elected in 2008. You said, “no”. In 2010 – I said the Patient Protection and Affordable Care Act (PPACA or ACA for short) would pass. You said, “no way!”. Then, in June of 2012 – I said the Supreme Court is going to find a way to uphold the ACA as “constitutional”. You said, “not to worry!” God! I hate being right. (Almost as much as you hate being wrong!)
Anyway, I’m glad you are finally smelling the coffee which probably got to a stench with your latest health insurance premium increase. And, as such, this begs many questions – two of which I will address at this point:

(1) If the federal government cannot build a functional website, to insure the estimated 30 million uninsured, with 3 years lead time – How long is it going to take them to transition us to a “Medicare like” social welfare health insurance program that insures all 300 million plus Americans. And . . .

(2) If Social Security is on track to insolvency and Medicare is predicted to be insolvent by 2023 (nine years from now, people) – how the hell are they going to finance and subsidize healthcare for everyone? Redistribution. Because it wasn’t fair you’ve been so successful, Scott.

In my next blog post, I will address what I see as the specifics of why these things regarding the ACA are destined to transpire. In the meantime, I’m still going to Washington because the one thing we do know is – the person that never gets in the ring has already lost. The real issues I would like to confront our elected officials with are my suggestions for workable healthcare reform which guarantees coverage for pre-existing conditions while being financially responsible and feasible; term limits (I know, I know – when hell freezes over); amnesty and targeting of conservative groups by the IRS. I know they’ll try to get me back on point (theirs) – but not until I’ve made them say, “next question!”

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.


http://allplaninsurance.com

Your More Affordable 2014 Health Insurance Exchange Plan is Likely to Work Like an HMO or Medicaid

By Kenton Henry

If you have ever been covered on an employer’s group health insurance plan, you may have had to select your medical providers from a Health Maintenance Organization (HMO). If you were enrolled in a plan of this type – it was probably because it was your only option or because you were young and thought yourself bullet proof. And the reason is – most older people would not elect an HMO if given a choice. Because if your plan utilizes one – you either see a provider within the network or you have no coverage at all. Most older people know that when your health problem is anything more than a common runny nose (which is all young people believe they’re ever going to suffer from) – a person wants to be able to select their own doctor or hospital.

 
Has your income ever been at the poverty level or below? If so then you probably qualified for Medicaid. That’s the government’s health plan administered by the states for the poor. And if you were covered by Medicaid, you know how difficult it was to find doctor’s to take Medicaid, get into an appointment or see a specialist.

 
Now comes Obamacare. And when the premiums for the new health care compliant plans become available for individuals and families to choose from October 1 for a January 1 effect date – be prepared for sticker shock. Without going into projections of an unknown quantity, suffice it to say, the word on the insurance street is the cost of these plans is going to make people in most states “have a cow”!

 
So naturally, you’re going to review the lowest cost plans – the bronze or “catastrophic” options and hope they meet your needs. And when you do – you best hope you ARE young and bullet proof because you are probably going to find your selection of providers is going to be what you had available in a larger group plan HMO divided by 10 . . . or more. Be prepared to wait a long time for appointments and heaven forbid you need to see a specialist or a special procedure because–if you do–you are probably going to have to get the President to issue another of his executive orders to make it happen.

 
And what if you’re not young and bullet proof? Get used to rationing. Because Obamacare doesn’t like specialists and who do you want to see when you have a serious problem? Who do you think is going to authorize a more sophisticated (expensive) procedure? I love my family doctor but when he thinks I need a more expensive procedure – he refers me to a neurologist or an orthopedic surgeon, etc. But be prepared for your new health plan pre-certification department to tell you – “There must be a pill for that.”

 
In conclusion, you’d better hope you qualify for the subsidy so you can add all or a portion of your premium to the national debt. If not . . . be prepared to pay Cadillac prices for what at best will be an Oldsmobile.

 
(For more a perhaps more objective take on this – go to:
THE WALL STREET JOURNAL; BUSINESS AUGUST 14, 2013:
Many Health Insurers to Limit Choices of Doctors, Hospitals
By Anna Wilde Mathews @ http://online.wsj.com/article/SB10001424127887323446404579010800462478682.html

 

http://allplaninsurance.com

The Chameleon Which Is The Affordable Care Act

08.14.2013

The Affordable Care Act, like a chameleon, is capable of changing its color or otherwise morphing to fit the pragmatic motives of its creator.

As I have said before, the Patient Protection Affordable Care Act (PPACA) (or ACA for short) is law. Therefore, of late, I have attempted to focus on the reality of it and its ramifications for all of us whether we are currently uninsured, covered by our employer’s plan or have our own individual or family health insurance plan. The primary purpose of this blog is to educate and inform– not to editorialize. If the latter were my objective, I would establish a separate blog where I would rant and rave ad infinitum about all I see wrong with the Act and big government in general. But it is not, so writing for The MedPlus Messenger, I try to remain objective and minimize expression of my feelings. But it is difficult. Increasingly so. Each day I try to put more lipstick on this pig but each day I awaken to more news the White House has selectively chosen another segment of the ACA not to implement in 2014 pursuant to the law.
Yesterday’s headlines broke news that the caps on insured’s out-of-pocket (OOP) maximums–set to go in effect in 2014–have been delayed until 2015. This potentially doubles (or worse) the liability of an insured and benefits the insurance company by allowing it to avoid covering expenses above the current OOP’s. Do you believe that is the objective of the White House? To benefit the insurance companies? And I thought the whole reason for the ACA was to better protect the patient, consumer, insured member. After all, it is the Patient Protection … … … Act is it not?
So what was the motive behind the White House’s reprieve for insurance companies? “General Math” provides the answer. I.e.:
Lower patient out-of-pockets = higher insurance premiums
Higher insurance premiums = less participation in coverage and greater backlash against the ACA

 

Greater backlash = trouble for the Democrats in the 2014 mid-term elections
Conclusion = this reprieve was politically motivated

 

Reader and followers – if you can argue this to a different conclusion – please feel free to do so here for my erudition and that of the rest of us.

 
Admin – Kenton Henry
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Feature Articles:
Washington Times
By Tom Howell Jr.
Tuesday, August 13, 2013
President Obama has granted yet another part of his health care law a delay, quietly announcing a one-year grace period before imposing a strict limit on consumers’ out-of-pocket medical expenses.
The delay means some health care plans in the group market will have until 2015 to begin paying for all expenses exceeding $6,350 for an individual’s out-of-pocket spending, or $12,700 for a family.
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SPECIAL COVERAGE: Health Care Reform
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Language on the delay has been posted on the Labor Department’s website since February, but it did not surface in the political arena until The New York Times reported on it Tuesday.
Mr. Obama used the limits as a key selling point when he pushed the Affordable Care Act through Congress in 2010. Now, Republicans are using the delay as part of last-ditch bids to dismantle the law before key implementation dates this fall.
“Burying this announcement online in a ‘maze of legal and bureaucratic language’ shows little concern for the promises with which this law was sold,” said House Speaker John A. Boehner, Ohio Republican, borrowing language from the Times article. “What else in the law isn’t working that we don’t yet know about?”
The Obama administration also announced in a pre-July Fourth blog posting that it was delaying the mandate that requires employers with at least 50 full-time employees to provide them with health care coverage.
For the Obama administration, the setbacks are ill-timed and leave officials trying to convince consumers that the delays don’t signal an inability to carry out other parts of the law.
Erin Shields Britt, spokeswoman for the Department of Health and Human Services, said the health care law is still implementing historic consumer protections from “the worst insurance company abuses, by banning discrimination based on pre-existing health conditions, ending lifetime and annual limits on what an insurance company will cover, and capping out-of pocket spending to protect Americans and their families.”
“The February guidance builds on these landmark consumer protections by requiring that health plans limit out-of-pocket spending for major medical coverage for the first time, in 2014, on time,” she said. “This single limit will apply to additional benefits in 2015.”
The newly reported delay arose because some employers and insurers use separate companies to administer major-medical coverage and drug benefits, resulting in separate out-of-pocket limits.
Because of this fractured landscape, parties needed time to streamline their data systems . The rule says that, for the first plan year after Jan. 1, 2014, the annual limit on out-of-pocket expenses will be satisfied if a group health plan that uses more than one service provider complies with the cap on major medical coverage and maintains a similar cap on the non-major medical coverage.
Even as it delays some parts, the administration has said the individual mandate requiring most Americans to have coverage remains in effect. Officials also are working feverishly to implement by Oct. 1 state-by-state health care exchanges where those without employer-based coverage can buy insurance with the help of tax credits.
A recent inspector general report suggested that Health and Human Services is months behind in setting up the federal data hub that will allow federal and state agencies to synchronize information about consumers on the exchanges.
Senate Minority Leader Mitch McConnell, Kentucky Republican, wrote to the Obama administration Monday to suggest that it delay the rollout of the exchanges.
Conservative lawmakers are waging a rhetorical war against Obamacare ahead of a spending showdown on Capitol Hill in September.

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Forbes

Pharma & Healthcare |

8/13/2013

Yet Another White House Obamacare Delay: Out-Of-Pocket Caps Waived Until 2015

WASHINGTON, DC – MARCH 18: U.S. President Barack Obama (L) speaks as Assistant Attorney General of Justice Department’s civil rights division Thomas Perez (R) listens during a personnel announcement March 18, 2013 at the East Room of the White House in Washington, DC. Perez has succeeded Hilda Solis as the U.S. Secretary of Labor. (Image credit: Getty Images via @daylife)

First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.

According to the Congressional Research Service, as of November 2011, the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act. Here are the details on the latest one.

Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.” Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.

Move up http://i.forbesimg.com t Move down

Obamacare Increases Costs of College Health Plans by as Much as 1,112% Avik Roy Contributor

There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted.)

These mandates have already had drastic effects on a number of colleges and universities, which offer inexpensive, defined-cap plans to their healthy, youthful students. Premiums at Lenoir-Rhyne University in Hickory, N.C., for example, rose from $245 per student in 2011-2012 to between $2,507 in 2012-2013. The University of Puget Sound paid $165 per student in 2011-2012; their rates rose to between $1,500 and $2,000 for 2012-2013. Other schools have been forced to drop coverage because they could no longer afford it.

According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones. But in February, the Department of Labor published a little-noticed rule delaying the cap until 2015. The delay was described yesterday by Robert Pear in the New York Times.

Delay needed to align ‘separate computer systems’

Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”

The reason for the delay? “Federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”

The best part in Pear’s story is when a “senior administration official” said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?

It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether. For economically rational businesses, it’s a reason to self-insure, in order to get out from under these costly mandates.                         Patient groups upset

While insurers and premium-payers will be happy with the delay—whose legal justification is dubious once again—there are groups that grumbled. Specifically, groups representing those with chronic diseases, and the pharmaceutical companies whose costly drugs they will use. “The American Cancer Society American Cancer Society shares the concern” about the delay, says Pear, “and noted that some new cancer drugs cost $100,000 a year or more.” But a big part of the reason those drugs cost so much is because manufacturers know that government-run insurers will pay up.

“The promise of out-of-pocket limits was one of the main reasons we supported health reform,” says Theodore M. Thompson of the National Multiple Sclerosis Society National Multiple Sclerosis Society. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis,” said Patience H. White of the Arthritis Foundation. “But they are extremely expensive.”

The progressive solution to expensive problems? More subsidies. But subsidies don’t reduce the underlying cost of care. They only excuse the high prices that manufacturers and service providers already charge.

It’s one of the many aspects of Obamacare that should be repealed, if we are to combat the rate shock that the health law imposes on tens of millions of Americans. But that will require Republicans to come up with a smarter strategy than shutting down the government.

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http://allplaninsurance.com

What is Coming with Your Health Insurance Between Now and January 1!

Just Practical Information On What is Coming with Your Health Insurance Between Now and January 1!

08.12.2013
This is not an editorial. Today’s post is simply non-political, practical information regarding coming changes in health insurance between now and 2016 and beyond. The Patient Protection and Affordable Care Act (PPACA) is law and is on schedule to be fully implemented (for all but groups of 50+) January 1, 2014. For this reason it is my responsibility to inform my clients – and followers of this blog – of what they can expect in the coming months. Specifically, their insurance options and the mechanics involved in transitioning to health plans that provide minimum “essential benefits” that are in compliance with the PPACA. In this post, I will be addressing individuals and families which includes the self-employed and those who have a personal policy because their employer does not provide coverage. All others, including those covered by group plans for less than 50 employees will be addressed in subsequent posts.
First – those of you who currently have a personal or family policy will be allowed to keep your policy until your policy anniversary in 2014. You should check your anniversary date or–if you are my client–call me. Many companies have changed your anniversary date to December 1. This allows you to keep your current plan until December 1, 2014. After that, you must convert to a health care “compliant” plan which will be described below. I can simplify and assist you in this process when the time comes.
If you do not currently have health insurance you must purchase a health policy to be effective January 1 or pay a penalty on your tax return for 2014 and beyond. Another reason you may want to purchase a plan is if you have previously been unable to acquire a policy which covers your pre-existing health condition(s). Your new compliant plan must cover them and health issues will not factor into your cost.
When October 1 arrives (the earliest date you may apply for compliant coverage) I will provide you a link where you will enter your estimated income for 2014. It will instantly tell you whether you qualify for a subsidy. If you do – you are going to want to choose from and apply for plan options in your state health insurance exchange. If your state has not established a state exchange (as is the case in Texas) – you will select from plans in the Federal Health Insurance Exchange. If you do not qualify for a subsidy (which is the case if your income is 400% or greater than the Federal Poverty Level*) – you are probably going to choose a policy offered outside an exchange and direct from an insurance company. The reason being, it is anticipated these plans will offer the same benefits at a lower cost. I can assist you with this option as well.
Below, I will offer further and detailed information on exchanges, plan options and more. Please do not hesitate to call me for clarification or to discuss this information.

Admin. – Kenton Henry

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FEDERAL POVERTY LEVEL GUIDELINES 2013
http://allplanhealthinsurance.com
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STEP 1:
Note these key dates and deadlines in your calendar:
If your employer offers health insurance, get key dates from your HR department. These are key dates if you’re planning to buy health care through your state’s Marketplace, which is available through a web site, a call, or an in-person visit.
• Oct. 1, 2013: First day you can enroll in a health plan on your state’s Marketplace
• Dec. 31, 2013: Last day you can enroll in a health plan and have your coverage start Jan. 1, 2014
• Jan. 1, 2014: First day you have insurance coverage if you buy a plan in the Marketplace — if, of course, you buy before this date
• March 31, 2014: The last date you can enroll in a plan on your state’s Marketplace to be covered for part of 2014
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Requirements:
* Be a citizen or legal resident.
• Buy your coverage through your state’s or Federal new health insurance Marketplace, also called an “Exchange”.
• Make about $11,490 to $45,960 a year if you are single – or $23,550 to $94,200 a year if you are in a family of four.
If you make less than the lowest amount, you may be eligible for Medicaid. Medicaid will cost you less than you’d save with a tax credit.
Unfortunately, if your state is not expanding Medicaid based on the guidelines in the Affordable Care Act, you may not be able to enroll in Medicaid or be able to get a tax credit. It’s possible that if you make less than $11,490 in 2013, which is the poverty level, you may not qualify for Medicaid if you live in a state that isn’t expanding Medicaid.
In general, you’re not eligible for the tax credits if you could get coverage through a workplace. However, the coverage offered by your employer must be considered affordable. If your company offers a plan that costs more than 9.5% of your income, or that does not cover at least 60% of the cost of covered benefits, you can look for a more affordable plan through your state’s Marketplace and may receive tax credits to lower your costs.
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Insurance Exchanges
State Didn’t Set Up a Marketplace? Relax
You may have heard that not all states will have their own health insurance Marketplace, also called an Exchange. If your state doesn’t set up a Marketplace, what does that mean for you?
Rest assured that no matter which state you live in, you can buy insurance through a Marketplace starting October 2013.
The way you use the Marketplace will be similar in every state. You’ll access a web site, or call, or see someone in person. And you’ll have tools to compare health plans.
But Marketplaces won’t all be the same in every state. There are three ways your state’s Marketplace can be managed — and this affects your choice of health plans and coverage.
1) State-run Marketplaces
Seventeen states are creating their own Marketplaces. These states will have a lot of local control.
Each state will decide which insurance companies can sell policies on its Marketplace.
States also choose the core benefits each plan has to offer. They can set extra requirements for health plans, like benefits that are more generous or more affordable limits on your out-of-pocket costs.
The state is also in charge of getting people to use the Marketplace.
*Indiana and Ohio will have their own State Exchange. Residents of these states should call Kenton Henry @ 800.856.6556
2) Partnerships Between a State and the Government
A few states are teaming up with the federal government to develop Marketplaces.
The federal government:
• Sets up the Marketplace web site and in-person sites
• Decides which health plans will be sold in the partner state
• Sets the benefit levels
• Runs the Marketplace
The states:
• Monitor health plans
• Help people find the best insurance for their needs *(Call Kenton Henry @ 800.856.6556)
• Handle complaints
Federal-run Marketplaces
Some states decided not to set up their own Marketplaces. In those states, the federal government will step in to run the marketplaces directly. It will make all the decisions: how the Marketplace will work, what plans are sold, and how to promote the Marketplace. Each state is considered separately and has its own Marketplace web site. (Texas residents call Kenton Henry @ 800.856.6556)
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Your Insurance Choices in a Marketplace: FAQ

A health insuranceMarketplace, also known as an Exchange, is a one-stop shop for affordable insurance in your state. Your state’s Marketplace has tools to make it easy for you to compare your choices and pick the best for your needs.
On a state Marketplace site, health plans are grouped by levels of coverage — how much the plan will pay for your health care and what services are covered.
Each level is named after a type of metal:
• Bronze
• Silver
• Gold
• Platinum
Bronze plans offer the least coverage and platinum plans offer the most.
How do the bronze, silver, gold, and platinum levels differ?
The metal plans vary by the percentage of costs you have to pay on average toward the health care you receive.
Here are the percentages of health care costs you pay for each type of plan:
• Bronze plan: 40%
• Silver plan: 30%
• Gold plan: 20%
• Platinum plan: 10% of your health care costs.
The way you pay your portion of these costs is in deductibles and copayments or co-insurance.
In general, the more you are willing and able to pay each time for health care service or a prescription, the lower your premium. A premium is your monthly payment to have insurance.
As an example, when you compare the bronze and platinum plans:
With a bronze plan: You pay the most each time you see your doctor or get a medicine. This is also called having higher “out-of-pocket” costs. But in a bronze plan you pay the least premium each month.
With a platinum plan: You pay the least each time you see your doctor or get a medicine. But in a platinum plan you pay the highest premium each month.
How does coverage from a metal plan compare to my current insurance?
The bronze through platinum coverage levels are new. So you probably don’t know how the benefits of the plan you use today compare to them. The coverage level you have now depends on whether you bought your plan:
• From an employer: Your coverage level is likely between a gold and platinum level.
• On your own: Your coverage level is likely between a bronze and silver level.
Having a sense of how the insurance you’re used to compares with the new plans will help you decide on a plan. You should compare the out-of pocket costs you are currently paying, the services provided (including prescription drugs), and anticipated changes in your health.
If you shop for insurance on your state’s Marketplace, you’ll see the health plans organized in this way:
• 1st by metal level: Bronze, silver, gold, or platinum
• 2nd by brand, such as Blue Cross, Cigna, Humana, Kaiser, United, and others
• 3rd by type of health plan, such as HMO, PPO, POS, or high-deductible plans with a health savings account.
The type of health plan affects how much choice you have in providers, the amount of paperwork you have, and your out-of-pocket costs.
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Tax Penalty At-a-Glance: Who Will Pay The Penalty & How Much Is It?
By law, you need to have health insurance by 2014. If you already get insurance through your employer or your partner’s employer, you’re all set. But what happens if you don’t follow this requirement from the Affordable Care Act?
If you can afford health insurance and don’t buy it, you’ll pay a fine when you file your 2013 income taxes in April 2014.
For the first year of the new law, 2014, the fine for not having insurance is the lowest it will be. After that, it goes up steeply in 2015 and again in 2016.
In 2014: There are two ways the government calculates what you owe. You have to pay whichever amount is higher.
• One way is to charge you $95 for each adult and $47.50 for each child, but not more than $285 total per family.
• The other way is to fine you 1% of your family income. If your family makes $50,000 a year, the fine will be $500.
In 2015: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.
• One way is to charge you $325 for each adult and $162.50 for each child, but no more than $975 total per family.
• The other way is 2% of your family income. If your family makes $50,000 a year, the fine will be $1,000.
In 2016 and beyond: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.
• One way is to charge you $695 for each adult and $347.50 for each child, but no more than $2,085 per family.
• The other calculation is 2.5% of your family income. If your family makes $50,000 a year, the fine will be $1,250.


http://allplanhealthinsurance.com

Democrats Can See Their Hometowns From the Steps of the Capitol!

08.09.2013

Sarah Palin was made the butt of jokes – which were later extended to include Republican Paul Ryan – when she proclaimed Medicare recipients would be subjected to “death panels” if the Affordable Care Act’s Independent Payment Advisory Board (IPAB) or Medicare’s cost cutting board remained part and parcel to the statute.

Now it seems even Howard Dean and other notable Democrats are concurring. Like the President, these Democrats are attempting to excise key components of a statute (already law) by repealing the board’s power. In light of next year’s mid-term’s their effort appears politically motivated. Perhaps the Senators and Representatives cited in today’s Feature Article can see their hometowns from the steps of the Capitol Building! It seems they are more concerned with their political lives than the welfare of their constituents. Otherwise, why did they pass the bill with this liability to their constituents in it in the first place? Oh–I forgot–they had to pass it before they could read it!

Admin. – Kenton Henry

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Feature Article:

The Hill

ObamaCare ‘death panel’ faces growing opposition from Democrats

By Elise Viebeck – 08/08/13 05:00 AM ET

ObamaCare’s cost-cutting board — memorably called a “death panel” by Sarah Palin — is facing growing opposition from Democrats who say it will harm people on Medicare.

Former Democratic National Committee Chairman Howard Dean drew attention to the board designed to limit Medicare cost growth when he called for its repeal in an op-ed late last month.

Dean was quickly criticized by supporters of the Independent Payment Advisory Board        (IPAB) who noted his ties to the healthcare industry as an adviser to a major D.C. lobbying firm.

But the former Vermont governor is not the only Democrat looking to kill the panel.

A wave of vulnerable Democrats over the past three months has signed on to bills repealing the board’s powers, including Sen. Mark Pryor (Ark.) and Reps. Ron Barber (Ariz.), Ann Kirkpatrick (Ariz.), Kyrsten Sinema (Ariz.) and Elizabeth Esty (Conn.).

All five are considered vulnerable in next year’s election, highlighting the stakes and the political angst surrounding the healthcare measure.

The four House Democrats faced criticism from their party in July after voting with Republicans to delay ObamaCare’s individual and employer mandates — moves widely interpreted as political positioning ahead of 2014.

Two of the lawmakers explained their opposition by suggesting the board would limit care for Medicare patients.

But the National Republican Congressional Committee (NRCC) blasted the four Democrats for “desperately trying to jump off the ObamaCare train.”

The cost-cutting board has been dogged with controversy over the last three years.

Major healthcare interests like the American Medical Association, the American Hospital Association and the pharmaceutical lobby have supported IPAB repeal, saying the panel would cut providers’ pay arbitrarily.

Public awareness of the board shot up last year when Palin called it a “death panel,” connecting the IPAB to her previous attacks on a proposal to encourage end-of-life planning in the Affordable Care Act.

“Though I was called a liar for calling it like it is, many of these accusers finally saw that ObamaCare did in fact create a panel of faceless bureaucrats who have the power to make life and death decisions about healthcare funding,” Palin wrote on Facebook.

This claim experienced a revival on the right after Dean published his op-ed, which argued that the board would ultimately ration care for Medicare patients.

“The IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them,” Dean wrote in The Wall Street Journal.

“Getting rid of the IPAB is something Democrats and Republicans ought to agree on.”

The piece quickly went viral, prompting conservative bloggers and Fox News hosts to cheer: “Dean confirms that Sarah Palin was right!”

The IPAB is designed to kick in when Medicare cost growth grows above a specified rate. It is charged with making recommendations on how to reduce Medicare spending, and its proposals are required to be fast-tracked through Congress.

The Affordable Care Act prevents the IPAB from making recommendations that would directly ration care. But critics say reducing provider reimbursements would have the same result by making it difficult for healthcare professionals to make money in Medicare.

While it’s unlikely the board will be convened soon, Medicare cost growth is not high enough to trigger its work, and any nominees would face long confirmation fights in the Senate, Dean’s op-ed renewed focus on bills to repeal the IPAB.

The Senate and House measures currently have 32 and 192 co-sponsors, respectively, including 22 Democrats in the House. Co-sponsors include lawmakers like Rep. John Barrow (D-Ga.), a longtime GOP target.

But calls for repeal are not taking up the whole debate.

Dean’s piece also drew strong arguments in favor of the panel from supporters like Peter Orszag.

The former White House budget director said the IPAB is necessary in light of Medicare’s transition to new payment models that are meant to lower costs while improving care.

It’s preferable to the “old way,” which saw Congress “simply slash Medicare payments” to providers, Orszag wrote in a column for Bloomberg.

“The point of having such a board — and here I can perhaps speak with some authority, as I was present at the creation — is to create a process for tweaking our evolving payment system in response to incoming data and experience, a process that is more facile and dynamic than turning to Congress for legislation,” he wrote.

In the meantime, the Democratic National Campaign Committee (DCCC) is warding off criticism of the anti-IPAB Dems with a push to turn the ObamaCare tables on the GOP.

The committee pointed to evidence Wednesday that resisting the healthcare law could hurt Republicans in the next election.

A new poll commissioned by the Service Employees International Union found that undecided voters prefer an anti-repeal Democrat over a pro-repeal Republican in a generic match-up.

“Instead of fighting old political battles on healthcare, polling shows that Americans want Republicans to work with Democrats to implement Obamacare and move on to focus on creating good jobs,” said Emily Bittner, a spokeswoman with the DCCC.

“The public strongly disapproves of Republicans’ plan to give insurance companies free rein over our health care.”

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http://allplaninsurance.com/medicare/medicare-supplement.htm