Archive | Health Care Bill – Washington

ANTHEM BLUE CROSS CUTS COVERAGE IN CALIFORNIA

On Monday August 1st, Anthem Blue Cross announced that it is pulling out of the individual insurance market in California, except for three regions in Northern California: Redding, Santa Clara County, and Stockton/Modesto.

  • All other ACA individual Anthem plans will be terminated December 31,2017. This decision does not affect those who have employer based insurance or individuals enrolled in “grandfathered” plans (plans purchased before March 2010).

Anthem’s Medicare Supplement, Medicare Advantage, Part D Drug Coverage, and individual dental, vision, and life policies will be continued to be offered in California.

According to Covered California’s most recent enrollment snapshot from March, Anthem currently covers about 252,560 Obamacare customers, 61% of whom live in regions where the carrier will pull out of the market.

Those numbers do not include people who have purchased Anthem plans outside of the exchange. A Covered California spokesman said in an email that an additional 150,000 Anthem plans are estimated to be in place outside the exchange.

  • How will the termination of your Anthem policy affect your coverage?

On-Exchange plans through Covered California will be moved to another carriers’ plan offering similar coverage if the member does not take any action during the Open Enrollment period to directly change carriers and plans.

The full details of how this will work is still being formulated, and more details should be released shortly.

For those with Off-Exchange plans, you must move to another carrier offering plans in your zip code. The enrollment must take place on or before December 15th, to have a January 1st effective date.

In 2018, Blue Shield of California will be the only carrier offering both a PPO, and HMO plans throughout the state. All other carriers will only offer some form of narrow network plans such as an HMO or Exclusive Provider Organization (EPO).

  • All carriers offering On-Exchange and Off-Exchange plans are indicating double digit rate increases for 2018.

As an example, in Southern California Blue Shield has filed for rate increases of between 18% to 22% for their PPO plans and 9% for their ACO/HMO plans. Other carriers will be releasing information on rate increase during the next few weeks.

In addition to higher rates, most carriers will also narrow their provider networks by only offering HMO or EPO plans with specific provider networks. These plans will not reimburse for any out of network services; therefore, members may be required to change some or all their doctors.

California is still one of the few states where a carrier, Blue Shield of CA, still offers PPO plans. In Arizona, Nevada, and Colorado the only options for individual plans is some form of HMO/EPO.

In addition, California has at least one carrier offering individual coverage in all counties and zip codes in the state. This is not the case in in Arizona and Colorado.

If you are a current Anthem client with an Off-Exchange plan terminating December 31st, please call me (John Barrett) at 626 797-4618, and I will answer your questions.

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THESE TWO NEW OBAMACARE RULES WILL AFFECT YOUR OPEN ENROLLMENT OPTIONS FOR 2018

Your Open Enrollment for 2018, will not be impacted by any potential Congressional changes to the ACA (Obamacare). However, you need to be aware of two major changes the U.S. Department of Health & Human Services has made to the Open Enrollment process for 2018.

1. OPEN ENROLLMENT FOR 2018 HAS BEEN SHORTENED TO 45 DAYS. THE PERIOD WILL BEGIN NOVEMBER 1ST, AND END DECEMBER 15TH.

• This means if you intend to change insurance carriers or category of your plan (Bronze, Silver, etc.) you will need to make your decision during the shortened Open Enrollment period.

2. THE SECOND MAJOR CHANGE RELATES TO UNPAID HEALTH INSURANCE PREMIUMS.

Under current rules if your health insurance is cancelled by the carrier for non-payment of premium, you can re-enroll with the same carrier during Open Enrollment without consideration of any past owed premiums.

• Under the new rules an insurance company can deny coverage until all the back premiums owed have been paid before you will be able to enroll.

As an example, assume you are covered by an Anthem Silver EPO with a $400 monthly premium, and your last payment was for the month of May. However, you fail to pay your June payment, and after approximately 45 days your policy is cancelled for non-payment effective June 1st.

If you want to enroll in any Anthem plan for 2018, you will be required to pay all the back premiums owed for 2017 ($2800 – June 1st – December 31st).

This change was requested by the insurance carriers to ensure individuals would maintain coverage (and premiums) throughout the year. Carriers had complained that an insured would enroll in a policy, have a medical procedure, and drop coverage for the remainder of the year. This became an issue because policyholders could drop coverage during the year, and enroll in new coverage during Open Enrollment for the next year without regard to pre-existing conditions or any past premiums owed.

The obvious solution for someone who owes past premiums is to change to another carrier for 2018.

If you have questions, please email me at john@healthinsbrokers.com or call me at (626) 797-4618.

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DON’T LET YOUR HEALTH INSURANCE BE CANCELLED FOR NON-PAYMENT OF PREMIUM!

Open Enrollment has closed for 2017, and for those of you enrolled in individual coverage your plans are either effective or will be by March 1st.

It is vital that you understand that if your individual policy is cancelled for non-payment it will not be reinstated.

There are usually three reason for cancellations:

  1. Intentional nonpayment of premiums because of financial hardship.
  2. The inability of the carriers to debit the credit card or bank account established to pay the premiums.
  3. The failure to send in an actual check in a timely manner to the insurance company.

It’s important for those of you with Off Exchange plans (those without a Federal subsidy or on MediCal), to understand the grace periods offered by insurance companies for late payments.

  • IF YOU DO NOT GET A FEDERAL SUBSIDY, YOU HAVE 31-DAY GRACE PERIOD FOR MAKING PAYMENTS.

Your monthly premium payments are due the first of each month. If the premium payment is not received by approximately the 7th of the month, you will be mailed a late payment notice.

The grace period for payment begins the POSTMARKED DATE of the warning notice that your premium is overdue. It is not when you receive the letter, which can be anywhere from two days to a week after the actual letter’s postmark.

The letter will tell you when your grace period ends, and warns that you will lose coverage unless the full past due amount is paid before the 31-day grace period ends. After the grace period ends, the carrier has the right to cancel the policy, even if you have mailed in your premium payment.

If you receive a late notice, react immediately by contacting your insurance broker or the carrier directly. Do not wait until you discover your policy has been cancelled, by then it will be too late.

  • IF YOUR POLICY IS CANCELLED YOU WILL BE REQUIRED TO WAIT UNTIL THE 2018 OPEN ENROLLMENT PERIOD TO ENROLL IN INDIVIDUAL PERMANENT COVERAGE.
  • Your only option if your policy has been cancelled is short term medical coverage to bridge you to January 2018, or to an event such as going on group or student coverage. Short term coverage will not cover any pre-existing conditions diagnosed within the twelve months prior to enrollment.    

If you have questions, please call me at (626) 797-4618

or email john@healthinsbrokers.com

 

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HIGHER PREMIUMS FOR HEALTH INSURANCE PLANS IN CALIFORNIA

Are you prepared for 2017 rate increases of your individual health insurance plans?

Obamacare premiums are set to skyrocket an average of 22% for the benchmark silver plan in 2017, per a government report released Monday. In California, the Covered California Exchange, and the Department of Insurance have reported these rate increases average around 13%.

Covered California maintains the premium increases won’t affect those who purchase their coverage through the Exchange to receive a Federal Premium Subsidy or are covered by Medi-Cal. While that may be true regarding Covered California, it is not true for millions who purchased their coverage Off Exchange directly with the insurance company.

 There are three reasons why premiums are going up so much.

  1. More sick people than anticipated enrolled. Insurers are just catching up to the fact that premiums weren’t covering their costs.
  2. The end of the reinsurance program, which was designed to make up losses incurred by insurance companies accepting very sick enrollees. That expires at the end of this year; therefore, they must raise premiums to account for the end of that program.
  3. Health care costs seem to be trending upward.

Those without a Subsidy will pay a hefty increase in their 2017 premiums.

If you live in Southern California rates will increase substantially higher than 13%.

  • In the five Southern California counties of Los Angeles, Orange, San Bernardino, Riverside, and San Diego the rate increase ranges from 18% to 37%. The average rate increase for Blue Shield is approximately 20%, while the rate increases for Anthem averages 25%, with some rates 37% higher than 2016 rates.

In addition to the rate increases, carriers have also narrowed their 2017 provider networks. For 2017, the only carrier with a full PPO throughout California will be Blue Shield. All other carriers will have a narrower provider network, such as an HMO or Exclusive Provider Organization (EPO). To control their costs Blue Shield also offers, for the first time, Silver through Platinum HMO plans.

In Southern California, Anthem changed from a PPO or Tiered PPO back to an EPO. Anthem will only keep their PPO structure in several Central and Northern counties.

As with an HMO, an EPO will not pay for any medical services out of network. Any medical expense out of network will require the insured to pay 100% of the costs with no reimbursement.

Because all carriers offering individual plans have two distinct networks individual and group, it requires the person seeking individual coverage to determine if a provider will accept a specific carrier’s individual plans.

  • In Orange and San Diego counties there is a further complication because the Anthem EPO will not have some of the top hospitals in network. As an example, in Orange County 24 hospitals have been eliminated from the network. Major hospitals such as Hoag, St Joseph, St Jude, and Mission are not in network for the EPO. In San Diego County, 11 hospitals have been eliminated, including the Scripps group of hospitals.

For 2017, even though the categories of plans remain the same (Bronze, Silver, Gold, Platinum), deductibles and co-insurance have increased making the maximum financial liability for a family with a Bronze plan as high as $14,300. Silver and Gold plans have increased their total financial liability for a family to more than $13,000. Only Platinum plans have remained the same with a maximum financial liability for a family of $8,000.

  • Open Enrollment for 2017 (November 1st – January 31st), will allow the enrollment in new coverage, changing carriers, and changing categories of plans. It is important for those who enroll in Off Exchange plans to understand that rates are higher for PPO plans than for the narrower HMO plans of the same category.

If you purchase your health insurance Off Exchange without a Subsidy you will need to make a choice between premiums vs. networks. If you desire a more liberal choice of providers, you will select a PPO with a higher premium. If a want a lower premium you will select a narrow network HMO or EPO plan. The difference in rates between a PPO and HMO/EPO for the same category of plans ranges from 15% to 20%.

If you have questions regarding 2017 Open Enrollment, call me at (626) 797-4618 or email me at john@healthinsbrokers.com

 

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Penalties For Not Having Insurance Have Failed, And The Result Is Higher 2017 Premiums For Everyone

The most controversial part of Obamacare — the mandate that people buy health insurance — is also the glue that was supposed to make the whole scheme work.

An article appearing on lifezette.com, and other information provided by the Wall Street Journal details the mounting evidence that indicates the mandate is failing. The failure of the mandate is causing insurance companies to raise their premiums substantially for 2017.

Congress got insurance companies to go along with the Affordable Care Act in 2010 by striking a grand bargain — private insurers would accept new rules and restrictions in exchange for millions of new customers, many low-cost healthy people who would not break the bank.

The government offered subsidies to help lower-income Americans afford the premiums and threatened to fine people if they did not comply.

But the stick was not enough, and critics contend that the Obama administration weakened it further by wielding it with less-than-enthusiastic vigor.

“Nobody really wants to enforce it … Enforcing the individual mandate is going to hurt politically,” said a health policy counsel for the American Action Forum.

“The size of the penalty is not enough for someone who’s relatively healthy to think it’s worth it for them to pay for insurance,” said a senior research fellow at George Mason University. “Congress took all of the IRS’ enforcement tools away”.

  • Although Congress authorized penalties for failure to purchase health insurance, it limited the ability of the IRS to enforce it. The agency cannot sue, file criminal charges, or place liens on bank accounts to collect. It can send a warning letter or withhold money from tax refunds — if the taxpayer is owed a refund.

The government could crack down. “But aggressive enforcement could backfire politically”, said a senior policy analyst at The Heritage Foundation. “In order to enforce this, it would be pretty ugly”.

  • The analyst said it is not just the stick of enforcement that has proved inadequate — it’s also the carrot of insurance. He said it has been difficult to persuade young and healthy people “to pay for something they might not want or need … A lot of people value holding onto their own money and eating the mandate.”

The result is much lower sign-up rates than experts initially forecast. The Congressional Budget Office forecast 21 million enrollees by 2016. The Urban Institute projected 23.1 million. The Centers for Medicare and Medicaid Services guessed 24.8 million. And the Rand Corp. estimated 27 million.

The actual number was about 12.7 million. With attrition that occurs throughout the year, the number by the end of 2016 is likely to be 10 million to 10.5 million. The people who find the health plans most attractive are those who receive subsidies that cover most of the cost and those who use a lot of medical services.

  • The Urban Institute report from January 2015 projected that 36 percent of enrollees this year would have household incomes below 200% of the federal poverty line, and therefore be eligible for a subsidy. The actual percentage was 66%.

But while the Urban Institute projected that a 25% of enrollees would have incomes above 400% of the poverty line and thus be ineligible for subsidies, the actual share is just 2%. As one analyst said, “If you have a really expensive medical condition, Obamacare made insurance a good deal for you,”. “If people spend their own money, they don’t value the product.” “We know that insurers have enrolled a much more expensive pool than they expected,”. “We know that because they’ve had huge losses.”

To make up the difference, insurance companies have increased premiums. Preliminary research indicates that the average increase was 15% to 16.5% between 2015 and 2016, and that the increase for 2017 will be “much worse.”

*Modified from a lifezette.com article, WSJ.com articles, and other data provided by various online sources.

If you have questions, please call me at (626) 797-4618 or email john@healthinsbrokers.com

 

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California Obamacare Rates To Rise 13% In 2017, More Than Three Times The Increase Of Last Two Years

Premiums for Californians’ Obamacare health coverage will rise by an average of 13.2% next year — more than three times the increase of the last two years and a jump that is bound to raise debate in an election year.

The big hikes come after two years in which California officials had boasted that the program helped insure thousands of people in the state while keeping costs moderately in check.

On Tuesday, officials blamed next year’s premium hikes in the program that insures 1.4 million Californians on rising costs of medical care, including expensive specialty drugs and the end of a mechanism that held down rates for the first three years of Obamacare.

Two of the state’s biggest insurers — Blue Shield of California and Anthem Inc. — asked for the biggest hikes.  Blue Shield’s premiums jumped by an average of more than 19%, according to officials, and Anthem’s rates rose by more than 16%.

  • The rates vary significantly by region and insurer. Los Angeles and the rest of southwest Los Angeles County will see an average increase of almost 14%.

Blue Shield’s preferred provider organization rate in Los Angeles, chosen by 21% of those using the exchange, is increasing by an average of 19.5%.

Blue Shield, in an email to brokers, stated three reasons for the increase:

  • Underpricing of 2016 Rates: 2016 pricing was completed in the first quarter of 2015 and relied heavily on the favorable 2014 healthcare expense experience to set rates.
  • Higher than Anticipated Member Utilization of Healthcare Benefits: According to data, the higher trend was driven by prescription drugs and by members who joined during the special enrollment period. The SEP population had up to 30% higher utilization than members who joined during the standard open enrollment period.
  • Removal of ACA Reinsurance: The reinsurance program had provided funds to plans with higher-cost enrollees to offset those medical costs and guarantee coverage regardless of health status. The end of this program alone added 4.6% to our 2017 rates.

An Anthem spokesman stated “Factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in healthcare costs.”

Covered California officials defended the system Tuesday, saying that the competition between insurers offering coverage on the exchange was working to keep rates lower than they otherwise would be.

Around the country, several insurers, including giant UnitedHealth, have stopped selling health plans on the exchanges, and a number of new nonprofit health insurance coops have gone out of business.

Americans who make too much to qualify for subsidies are likely to feel the brunt of the premium hikes. That may increase pressure to review the exchanges in 2017, for ways to make health plans more affordable.

If you have questions, please call me at (626) 797-4618 or email john@healthinsbrokers.com

*Modified from LATimes.com and Hotair.com online articles; Blue Shield notification to brokers.

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UnitedHealth To Stop Selling Obamacare Coverage In California

UnitedHealth Group Inc. told brokers that it has filed paperwork to offer plans in just six states’ health-law marketplaces next year, providing the most complete picture so far of its previously announced widespread withdrawal.

The biggest U.S. health insurer said in April that it would pull out of all but a handful of the 34 states where it was selling the Affordable Care Act exchange plans, in the wake of mounting losses in that business.

Since then, the insurer’s 2017 exchange decisions have been emerging piecemeal as various state regulators disclosed that UnitedHealth wouldn’t be in their exchanges next year.

Tuesday, California officials became the latest to say UnitedHealth was leaving, when a spokesman for the Covered California exchange confirmed that the insurer wouldn’t participate in 2017.

  • The carrier also told brokers that during the next few weeks it would begin informing consumers enrolled in its exchange plans in states where it will pull out. Existing plans are effective through the end of 2016, and consumers can switch to different insurers during the fall’s open enrollment period.

In a statement Tuesday, UnitedHealth said “the smaller overall market size and shorter term, higher risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis.” But it said the company is “an advocate for more stable and sustainable approaches to serving exchange markets and those who rely on it for care.”

  • Overall, insurers’ approach to the exchanges for next year is mixed, in the wake of financial results that have been disappointing for many companies. Several insurers, including state Blue Cross Blue Shield plans, have reported similar challenges in recent months. And more than a dozen nonprofit insurance cooperatives created through the law have closed because they were overwhelmed by medical claims they couldn’t afford.

Many other insurers are sticking with the new marketplaces, though state filings have shown that several are seeking significant rate increases for next year.

  • Many consumer groups welcomed UnitedHealth’s arrival in Covered California in order to give people more choice and inject more competition into the market. The top insurers in the exchange, led by Blue Shield of California and Anthem Inc., control more than 90% of Covered California enrollment.

The state exchange had limited UnitedHealth to selling exchange plans in several smaller markets for 2016 because it didn’t participate the first two years

*Modified from online articles from WSJ.com, LAtimes.com, CNNmoney.com, Townhall.com, and other online data sources.

 

 

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Obamacare Premiums Expected To Rise Sharply Amid Insurer Losses

Health insurance companies are laying the groundwork for substantial increases in ObamaCare premiums, opening up a line of attack for Republicans in a presidential election year.

Many insurers have been losing money on the ObamaCare marketplaces, in part because they set their premiums too low when the plans started in 2014. The companies are now expected to seek substantial price increases.

“There are absolutely some carriers that are going to have to come in with some pretty significant price hikes to make up for the underpricing that they did before,” said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reforms, while noting that the final picture remains unclear.

Insurers are already making the case for premium increases, pointing to a pool of enrollees that is smaller, sicker and costlier than they expected.

The Blue Cross Blue Shield Association released a widely publicized report last month that said new enrollees under ObamaCare had 22 percent higher medical costs than people who received coverage through their employers.

“The industry is clearly setting the stage for bigger premium increases in 2017,” said Larry Levitt, an expert on the health law at the Kaiser Family Foundation.

The proposals for premium increases, which will be rolled out over the next couple of months, still have to be approved by state insurance commissioners. The ultimate impact on consumers will be hard to determine, as ObamaCare’s tax credits often soften the blow.

“Companies are either going to have to raise their prices significantly or drop out,” said Sen. John Barrasso (R-Wyo.), pointing to a poll from NPR that found a quarter of the public says the health law has personally hurt them.

“UnitedHealth has announced it is pulling out of the Obamacare exchanges,” one Senator wrote in a statement. “That’s the latest in a string of Obamacare failures that have led to American families losing their doctors, having few or no insurance options, and facing skyrocketing premiums and deductibles.”

“In almost every year I remember since 2013 started, there were projections of double-digit premium [increases] that turned out not to be correct,” said Chris Jennings, a former Obama White House adviser on healthcare reform. “Now, do I believe this year may be a little bit different? I think it could be.”

About 15 percent of ObamaCare enrollees do not receive a tax credit, so they would bear the full burden of price hikes, though they, like other enrollees, can shop around for the best deal.

State regulators may be forced to approve some hefty rate increases for next year, given the need for insurers to stop losing money.

*Modified from Hill.com, IBD.com, WSJ.com articles, and other online sources.

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Obamacare Enrollees Sicker, Causing Premiums to Soar Again

A study finds that a larger portion of recent Obamacare enrollees are sicker and far more costly to cover. As a result, the insurance industry is seeking yet another series of premium hikes to cover the quickly rising costs.

According to The Washington Post, Obamacare enrollees in Blue Cross Blue Shield (BCBS) had higher instances of diabetes, more propensity for heart disease, and had higher rates of depression than previous, pre-Obamacare members of the plan.

Newer enrollees who came into BCBS through the Affordable Care Act’s (ACA) insurance marketplaces, commonly called Obamacare, caused costs to rise 22 percent on average more than plan members who received their insurance through an employer.

“Average monthly medical spending per member was $559 for individual enrollees in 2015, for example, versus $457 for group members,” the Post wrote.

The report is the best evidence to show why premiums have soared and why they are showing no signs of stopping since President Obama’s signature takeover of the nation’s healthcare insurance system was implemented.

Since insurance companies are no longer allowed to deny pre-existing conditions, payouts for medical services have wildly increased, and the study is likely to serve as a basis for the industry to submit its next wave of higher premiums.

Obamacare proponents say the skyrocketing medical costs were fully expected and that the law was written expecting the influx of young people forced to buy insurance to cover the higher costs of service to older, sicker enrollees.

But the bigger problem young people face is that they often have far less income to afford the much higher insurance costs they are now being forced to pay due to the passage of the ACA. Therefore many are not signing up and preferring to pay the tax penalties.

Because of these spiraling costs, people under 35 have lagged in signing up, compared to older ACA enrollees. And while it was recently reported that more young people had begun the enrollment process to avoid the tax penalties in the law, the numbers are still not balancing what is needed to pay the greater costs for the older, sicker plan members already enrolled.

“If participation among young adults had matched their share of the population, then 4.8 million young adults would have enrolled — but just 3.25 million selected plans.”

But even that 3.25 million is an inflated number because a large number of younger enrollees never completed signing up and did not end up paying for the new, more expensive healthcare policies.

*Modified from a WSJ.com and Washington Post articles, and other online sources

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2016 OPEN ENROLLMENT IS COMING TO AN END

Have you taken advantage of Open Enrollment for individual health insurance for 2016?

If not, you have until January 31st to complete your enrollment in an ACA (Obamacare) compliant plan.

Open Enrollment will also give you the opportunity to change carriers or categories of plans (Bronze, Silver, Gold, and Platinum), even if you have already selected a plan that went into effect January 1st.

If you enroll on or before January 15th, your effective date will be February 1st. From January 16th until January 31st, your effective date will be March 1st.

After January 31st, you will not be able to enroll in an ACA approved plan until next year’s Open Enrollment.

The only exception to this rule is the occurrence of a “qualifying event”, which will allow you to enroll in coverage outside of Open Enrollment.

For those living in California the most common “qualifying events” are losing employer based group coverage, marriage, divorce, or the birth of a child. You will have 60 days from the date of the event to enroll in a new individual policy. If you miss the 60-day window you will be required to wait to enroll in a plan until the next Open Enrollment.

If you fail to enroll in a plan for 2016, the penalty for not being covered has increased. For an individual it’s THE GREATER of $695 or 2.5% of household income, not to exceed the average national cost of a Bronze plan of approximately $2700.

For a family calculation of the penalty is bit more complicated: $695 for adults, and $347.50 per child up to $2,085 OR 2.5% of household income, up to a maximum of approximately $13,300, WHICHEVER IS GREATER.

If you miss Open Enrollment you can still obtain short term medical coverage, hospital coverage plans, and other types of coverage for accidents or other specific occurrences.

However, these plans do not serve as a substitute for ACA approved plans, which means you still will be subject to the Obamacare penalty for lack of proper coverage.

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