Archive | State Health Exchanges

Health Insurers Warn on Premiums

  • Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation’s biggest firm projecting that rates could more than double for some consumers buying their own plans.
  • In a private presentation to brokers late last month, UnitedHealth Group Inc., the nation’s largest carrier, said premiums for some consumers buying their own plans could go up as much as 116%, and small-business rates as much as 25% to 50%
  • Other carriers have also projected steep rate increases during private meetings and conversations with brokers. Brokers say they are being told to prepare the marketplace for small-business and individual rate increases as carriers get ready to file specific rate proposals and plan designs with regulators.
  • An official with Blue Cross & Blue Shield of North Carolina told a gathering of brokers last week that individual premiums could go up by as much as 40% to 50%, according to brokers who were present.
  • Aetna Inc., in a presentation last fall to its national broker advisory council, suggested rates on individual plans not being grandfathered under the law could go up 55%, on average, and gave a figure of 29% for small business rates.

The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year—a subject of rigorous debate.

Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law.

The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human Services says that the law will “make health-care coverage more affordable and accessible,” pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower.

The gulf between the pricing talk from some insurers and the government projections suggests how complicated the law’s effects will be. Carriers will be filing proposed prices with regulators over the next few months.

Part of the murkiness stems from the role of government subsidies. Federal subsidies under the health law will help lower-income consumers defray costs, but they are generally not included in insurers’ premium projections. Many consumers will be getting more generous plans because of new requirements in the law. The effects of the law will vary widely, and insurers and other analysts agree that some consumers and small businesses will likely see premiums go down.

Starting next year, the law will block insurers from refusing to sell coverage or setting premiums based on people’s health histories, and will reduce their ability to set rates based on age. That can raise coverage prices for younger, healthier consumers, while reining them in for older, sicker ones. The rules can also affect small businesses, which sometimes pay premiums tied to employees’ health status and claims history.

The law’s 2014 effect on larger companies is likely to be more limited. Many of the big changes coming next year won’t touch them as directly as individual consumers and small businesses, though some will have to grapple with the cost of covering more workers or paying a penalty.

The possibility of higher premiums has become the latest focal point of the political tussle over the health law, which marks its third anniversary Saturday. Republican lawmakers have held hearings on the issue, and six GOP members of the House Energy and Commerce committee wrote last week to more than a dozen insurers asking them to turn over internal analyses on the law’s impact on premiums and costs.

The insurance industry has also been talking publicly about big potential premium increases in lobbying for tweaks to the law.

The individual market includes about 15 million people, and around 18% of the roughly 149 million with employer coverage were at small companies, according to 2011 figures from the Kaiser Family Foundation. The individual market is expected to grow to around 35 million people by 2016 as a result of the law.

. The company said the estimates were driven in part by growing medical costs not directly tied to the law. It also cited the law’s requirements that health status not affect rates and that plans include certain minimum benefits and limits to out-of-pocket charges, among other things.

Jeff Alter, who leads UnitedHealth’s employer and individual insurance business, said the numbers represented a “high-end scenario,” not an average. “There are some scenarios in which a member could see as much as a 116% increase or over,” he said, though others, such as some older consumers, could see decreases. He said the company dwelled on the possible increases because it was trying to prepare brokers to speak with clients facing big jumps.

Insurers are “not being shy that premiums are going to increase in 2014,” and are urging brokers to “brace our clients,” said John Lacy, vice president of group benefits at Bouchard Insurance, a brokerage in Clearwater, Fla. His firm has been hearing from carrier representatives that individual premiums in Florida could go up 35% to 50%, on average, and small-business rates around 30%, though it hopes to find strategies to blunt the impact.

There has long been debate, even among insurance experts, over how the law will affect premiums. Because the effect is likely to vary, different measurements can arrive at different conclusions. The CBO analysis cited by the administration determined that average premiums for consumers who buy their own coverage would be 14% to 20% lower because of the law—if the law didn’t change the types of plans they purchased.

But the CBO also suggested the law would lead to consumers buying more expensive plans, largely because it requires coverage to include certain benefits and limit charges such as deductibles. When this effect was taken into account, the average premiums would go up 10% to 13%, the agency said, though subsidies would ease the bite for most people. The agency also said small-business policies were likely to cost within a few percentage points of the amount they would have without the law.

Health and Human Services officials say competition among insurers, as well as provisions to limit their financial risk from attracting high-cost consumers, will exert downward pressure on premiums, and point to the tax subsidies that will limit many consumers’ costs.

Subsidies will be available on a sliding scale for people with incomes of up to four times the federal poverty level—currently $45,960 for a single person and $94,200 a year for a family of four. More than half of the 35 million people expected to be in the individual market by 2016 are likely to qualify for credits. People whose incomes are around the poverty level could see almost all of the cost of their insurance subsidized, while people at the upper end will get only a small discount toward their premiums.

*Modified from a WSJ article

0

More Docs Plan to Retire Early

Six in 10 physicians said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years.

Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found.

  • Six in 10 physicians (62 percent) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found. That perception is uniform across age, gender, and specialty, it said.
  • Another 55 percent of surveyed doctors believe others will scale back hours because of the way medicine is changing, but the survey didn’t elaborate greatly on how it was changing. Three-quarters think the best and brightest may not consider a career in medicine, although that is an increase from the 2011 survey result of 69 percent.
  • A quarter of physicians would place new or additional limits on accepting Medicare patients if there were payment changes.

“Physicians recognize ‘the new normal’ will necessitate major changes in the profession that require them to practice in different settings as part of a larger organization that uses technologies and team-based models for consumer (patient) care,” the survey’s findings stated.

About two-thirds of the survey responders said they believe physicians and hospitals will become more integrated in coming years. In the last 2 years, 31 percent moved into a larger practice, results found. Nearly eight in 10 believe midlevel providers will play a larger role in directing primary care.

Four in 10 doctors reported their take-home pay decreased from 2011 to 2012, and more than half said the pay cut was 10 percent or less, according to Deloitte. Among physicians reporting a pay cut, four in 10 blame the Affordable Care Act (ACA), and 48 percent of all doctors believed their income would drop again in 2012 as a result of the health reform law.

Other findings:

26 percent believe Medicare’s sustainable growth rate formula will be repealed in the next 1 to 3 years
One in 10 believe medical liability reform will pass Congress in the next 1 to 3 years
55 percent of physicians believe the hospital-doctor relationship will suffer as admitting privileges are put at risk to comply with hospital standards of meaningful use
31 percent gave the U.S. healthcare system a favorable grade of “A or B” compared with 35 percent in 2011

Despite those pessimistic views, seven of 10 said they were satisfied about practicing medicine, although that number was lower for primary care providers and higher for younger age groups, the survey found. Dissatisfaction was attributed toward less time with patients, long hours, and dealing with Medicare, Medicaid, and government regulations.

Speaking of the ACA, fewer physicians (38 percent in 2012) believe the ACA is a step in the wrong direction compared with 44 percent in 2011. The number who think the law is a good place to start remained the same.

Two-thirds of physicians in the Deloitte survey say they use an electronic health record (EHR) that meets meaningful use stage 1 requirements, but that number has been lower in other surveys. Three in 5 respondents were satisfied with their EHR.

Deloitte mailed the survey to more than 20,000 physicians selected from the American Medical Association’s master file. Just 613 returned completed surveys, giving a margin of error of 3.9 percent at the 0.95 confidence level.

*Modified from an EveryDay.com article

0

Obamacare Insurance Plans Will Be Bare Bones — And Expensive

There’s mounting evidence that come fall, the health plans sold through the Obamacare exchanges will be bare bones affairs – with narrow networks of providers to select from, and heavy co-insurance once patients go “out of network.”

In many ways these plans will be a throwback to insurance schemes of the late 1990s, when managed care was dominant and restrictive networks standard fare. With one difference: The Obamacare plans won’t be cheap.

Quality of coverage is just one issue. Price is the other. There’s mounting evidence that even though the new health coverage will be austere, it’ll still be pricey.

Health plans have ample incentives to price the Obamacare coverage high, which is precisely what they’re likely to do.

  • For one thing, insurers will want to protect against the risk that individuals entering the exchanges are those who most need health insurance because of pre-existing illness. If this sort of “adverse selection” occurs, it will raise costs to insurers. To guard against this, insurers are likely to price the coverage at a premium.
  • Second, health plans want to reduce uncertainty around how all the risk-sharing provisions in Obamacare will eventually play out. The legislation puts in place mechanisms that forces Washington to share with health plans some of the cost of the covering the sickest beneficiaries. But the regulations outlining these parameters were only released last Friday. Nobody yet trusts how they’ll work.
  • Third, health insurers will want to reduce the incentive for employers to drop coverage and dump employees into the exchanges. This is especially true when it comes to insurers’ lucrative small group and large group segments. If insurers price the exchange products too low, they’ll give employers another inducement to do this sort of dropping. By pricing exchange products higher relative to the insurance offered in the private market, they reduce this incentive.
  • Finally, the providers that Obamacare plans must contract with are unlikely to offer significant price cuts to attract this volume. Since the Obamacare plans are likely to pay providers less than rates offered by standard private coverage (and maybe even less than Medicare rates) many doctors could also refuse to accept Obamacare, just like they refuse Medicaid. Or refuse to offer insurers discounts for these patients.

To mitigate uncertainty, plans will price their products high. Insurers know that any excess profits they earn will have to be paid back to the government, anyway (owing to caps that Obamacare places on how much profit health plans can earn). Health plans are better off aiming high, and owing money back, then getting underwater. After all, Washington takes away “excess” profits, but it doesn’t share in losses.

The architects of Obamacare designed the scheme without much thought to how its overlapping incentives would discourage competition on the price of the new coverage. Health plans will try to drive down costs by offering very narrow networks of providers that they can more easily control. It will be a race to the bottom to see which plan can offer the cheapest benefit, while still meeting minimum standards. But it won’t be a race to the bottom on price.

Plans have too many reasons to price their products cautiously, and not automatically pass along any cost savings to consumers.

If the Obamacare plans are priced higher than initial assumptions made by the Congressional Budget Office, it will burst the estimates placed on Obamacare’s total costs. It could also make these plans unappealing to consumers.

 
* Modified from a RealClearMarkets.com article by Scott Gottlieb

 

0

Another Big Step in Reshaping Health Care

Hospitals and health insurers are locking horns over how much health-care providers will get paid under new insurance plans that will be sold as the federal health law is rolled out.

The results will play a major role in determining how much insurers will ultimately charge consumers for these policies, which will be offered to individuals through so-called exchanges in each state.

  • The upshot: Many plans sold on the exchanges will include smaller choices of health-care providers in an effort to bring down premiums.
  • Exchange plans will take effect in 2014. In that first year, health plans sold on the exchanges could have 11 million to 13 million enrollees and generate $50 billion to $60 billion in premium revenue, according to an estimate from PwC’s Health Research Institute, an arm of PricewaterhouseCoopers LLP.
  • Plans with smaller choices of health-care providers are a big focus for insurers, partly because many other aspects of exchange plans, including benefits and out-of-pocket charges that consumers pay, are largely prescribed by the law, giving them few levers to push to reduce premiums.
  • “The need for a smaller network with lower pricing was critical,” said Juan Davila, an executive vice president at Blue Shield of California, which said it hopes to offer a preferred-provider-organization plan for individuals on the exchange. It would be built around a provider network around 40%-45% of its traditional PPO scope.

To keep costs low, the insurers are pressing for hospitals to grant discounts from the rates hospitals usually get in commercial plans. In return, participating hospitals would be part of smaller networks of providers. Hospitals will be paid less by the insurer, but will likely get more patients because those people will have fewer choices. The bet is that many consumers will be willing to accept these narrower networks because it will help keep premiums down.

  • Tenet Healthcare Corp., one of the biggest U.S. hospital operators with 49 hospitals, Tuesday said it had signed three contracts for exchange plans that would involve either narrow or “tiered” networks, in which people pay more to go to health-care providers that aren’t in the top tier.

Tenet said that in exchange for favorable status in these plans, it granted discounts of less than 10% to the three insurers, which it said were Blue Cross & Blue Shield plans covering 15 of its hospitals, or around 30%.

Analysts said Tenet’s disclosures, which came during an earnings call with analysts, are the most explicit from any hospital chain so far about how the negotiations are shaping up. “It’s the clearest statement they’ve gotten about exchange products, pricing and impact,” said Sheryl Skolnick, an analyst with CRT Capital Group LLC.

Stonegate Advisors LLC, a research firm that works for health insurers, has been testing clients’ plans with consumers in a mock-up version of an exchange, which is an online insurance marketplace.

  • The tests have found that premiums are the most important factor in consumers’ choices, he said, with more than half typically opting for a narrow-network product if it cost them at least 10% less than an equivalent with broader choice.

So far, insurers and hospitals have sent differing signals on what kinds of discounts the hospitals might grant for the exchange plans, which would vary by market. Publicly traded hospital chains have said they are pressing to get paid approximately what they receive for traditional commercial health insurance.

Some insurers talk about steeper discounts from hospitals. WellPoint Inc. has said it is aiming to pay providers somewhere between Medicaid and Medicare rates, and sees talks trending toward rates close to Medicare. Medicare rates are often substantially lower than commercial prices. An Aetna Inc. official at an investor conference Monday suggested the rates might settle somewhere between Medicare and commercial.

For their part, hospitals have to weigh whether discounts they grant for exchange products pose a risk to the richer pricing they get for traditional commercial health plans, which include those now offered by employers.

*Modified from a WSJ article by Anna Wilde Mathews and Jon Kamp

0

Key Facts About The Medical Insurance Premium Tax Credit

Starting in 2014, individuals and families can take a new medical premium tax credit to help them afford health insurance coverage purchased through a state-based Health Insurance Marketplace.

How much is the tax credit?

The credit amount is generally equal to the difference between the premium for the benchmark plan and the taxpayer’s expected contribution.

•The expected contribution is a specified percentage of the taxpayer’s household income. The percentage increases as income increases, from 2% of income for families at 100% of the FPL to 9.5% of income for families at 400% of FPL.

•The benchmark plan is the second-lowest-cost plan that would cover the family at the “silver” level of coverage.

Are there any special rules?

Yes – the credit is advanceable (i.e. advance payments are made directly to the insurance company on the family’s behalf). The advance payments are then reconciled against the amount of the family’s actual premium tax credit, as calculated on the family’s federal income tax return.

4 Key Facts About The Medical Premium Tax Credit

Broad Middle-Class Eligibility

The premium tax credit is generally available to individuals and families with incomes between 100% and 400% of the federal poverty level. The Congressional Budget Office estimates that, when the Affordable Care Act is fully phased in, the premium tax credit will help 20 million Americans afford health insurance.

Larger Tax Credits for Older Americans who Face Higher Premiums

The amount of the premium tax credit is tied to the amount of the premium, so that older Americans who face higher premiums will receive a greater credit.

The Tax Credit Controls Health Care Costs by Incentivizing Families to Choose More Cost-Effective Coverage

The amount of the premium tax credit is generally fixed based on a benchmark plan (which may be age adjusted within Affordable Care Act limitations), so families that choose to purchase coverage that is less expensive than the benchmark plan will pay less towards the cost of that coverage.

The Credit Is Refundable So Even Families with Modest Incomes Can Benefit

The premium tax credit is fully refundable, so even moderate-income families who may have little federal income tax liability (but who may pay a higher share of their income towards payroll taxes and other taxes) can receive the full benefit of the credit.

*Modified from ZaneBenefits.com article

0

White House Issues Final Rule on ACA’s Essential Health Benefits

On Wednesday, the Obama administration issued a final rule outlining 10 broad categories of essential health benefits that most health insurance plans must offer in 2014 under the Affordable Care Act.

About the Final Rule

Under the ACA, health plans in state health insurance exchanges must provide coverage for 10 broad categories of benefits, such as maternity care, prescription drugs and preventive care. HHS in November 2012 released a proposed rule on the minimum benefits (California Healthline, 11/21/12).

The final rule goes beyond what regulators initially proposed and applies to non-grandfathered plans for individual and small group markets inside and outside of the health insurance exchanges.

Most of the rules include benefits that commonly are covered by plans, including:

Ambulatory patient services;
Chronic disease management;
Emergency care;
Hospital services;
Laboratory services;
Maternity and newborn care;
Prescription drugs; and
Preventive wellness services.

However, some changes represent an expansion of coverage to include rehabilitative care in the santa cruz residential recovery program, pediatric dental care and pediatric vision care. Further, the rule expanded coverage and federal parity protections for mental health and substance use disorder services, including behavioral health treatment, to both the individual and the small group market.

HHS Secretary Kathleen Sebelius described the rule as a major expansion of mental health coverage, noting that millions of individuals will gain access to mental health care and an additional 30 million individuals who already have some mental health coverage will see their benefits become more generous.

  • The final rule also prohibits insurers from discriminating based on an “individual’s age, expected length of life, present or predicted disability, degree of medical dependency, quality of life or other health conditions”. In addition, the rule sets four levels of coverage that new health policies offered on health insurance exchanges must offer.

Consumers choosing bronze plans — the least generous policy — will pay an average of 40% of the costs of covered benefits, while insurers will pay the remainder. Those choosing platinum plans — the most generous policy — will pay 10% of the costs, and the insurer will pick up the rest.

However, the administration did not set a national standard and allowed states to set specific requirements for the minimum benefits to be covered in each essential health benefit category. Under the rule, each state could select a benchmark plan reflecting coverage typically offered by the largest plan by enrollment for employers.

In addition, insurers in each state typically will be required to cover all benefits required under state laws adopted prior to Dec. 31, 2011. States can require insurers to cover additional benefits, but they will have to cover the extra costs themselves.

Although states will be responsible for ensuring that insurers comply with the rule, the federal government said it will step in if a state is not adequately protecting consumers.

Cost of Coverage

Insurers and some business groups had lobbied the federal government to scale back the scope of mandated coverage categories because of concerns that such coverage would make policies too costly, the Wall Street Journal reports. However, rather than scale back benefits, the rule includes several ways to limit the costs to consumers, such as capping total out-of-pocket costs and limiting the deductible amount for plans offered in the small-group market to about $2,000 for an individual and $4,000 for a family. Consumers could face extra costs if the seek care outside of their plan’s network of physicians and hospitals.

Health insurers have been waiting for the final rule and other pending regulations before finalizing plans and pricing them. Further, state insurance regulators must also approve the plans before they can be marketed.
*Modified from a California Healthline article

0

California Sets Benefit Standards for Health Plans in Exchange

On Wednesday, California became the first state to set benefit standards for health plans offered through its state health insurance exchange.

Background

The Affordable Care Act requires states to launch online insurance marketplaces by 2014. California’s exchange — named Covered California — primarily will serve individuals and small businesses. The exchange is expected to open for registration in October.

In January, exchange officials told Gov. Jerry Brown (D) and the Legislature that health plans offered through Covered California will be classified by “metal ratings” — including platinum, gold, silver and bronze — based on the coverage they offer.

  • Platinum plans will offer 90% coverage
  • Gold plans will offer 80% coverage
  • Silver plans will offer 70% coverage
  • Bronze plans will offer 60% coverage

Plan members will have to pay out of pocket for the percentage not covered by the plan.

Details of Standardized Rates

  • Platinum and gold plans will have no annual deductibles and will charge as low as $25 for physician office visits
  • Silver plans will have $2,000 in annual deductibles and will charge $45 for physician office visits
  • Bronze plans will have $5,000 in annual deductibles and will charge $70 for physician office visits

Monthly premiums will vary, based on the plan chosen and the income level of the policyholder. For example, a family of four with an income between $22,000 and $35,000 annually would pay between $39 and $118 each month for a silver plan.

Tax credits are available for individuals and families who meet certain income requirements and do not have access to affordable health insurance through their employer or another government program.

There are some key facts about tax credits.

Tax credits lower the cost of your premium. Tax credits reduce the amount of the premium you will pay for insurance

Tax credits help low- and middle-income individuals and families. Tax credits are available to individuals and families who meet certain income requirements.

Tax credits can be used when you enroll. Tax credits can be applied to the cost of your health plan when you enroll – you do not need to wait until you file a tax return at the end of the year.

Tax credits are only available through Covered California. You must enroll in a health plan through Covered California if you want to use your tax credits.

Tax credits are paid directly to your health plan. These tax credits are paid by Covered California to your health plan to keep your costs low.

Tax credits will be adjusted at the end of the year based on your actual income. At the end of the year, the tax credits may be adjusted if your income is different than you anticipated. This means that you will want to notify Covered California if your income changes.

*Modified from a California Healthline and www.coveredca.com website

 

 

0

Health Care Reform Checklist for Individuals and Families

Whether you are uninsured, or just want to explore new options, the new Health Insurance Marketplaces will give you and your family choice.

Starting October 1st, 2013, you will be eligible to enroll in health insurance via the new health insurance marketplaces (for coverage starting January 1st, 2014).

Here’s step-by-step check list to ensure you are prepared for the October 1st, 2013 open enrollment.

Step 1 – Find out whether your employer will offer group health insurance post-2014

There are two primary categories of health insurance to choose from:

Individual health insurance,

Group health insurance.

1) Individual Health Insurance

Individual health insurance plans are health insurance plans purchased by individuals to cover themselves or their families. Anyone can apply for individual health insurance. In 2014, insurance companies will no longer be able to decline individuals for individual health insurance based on a pre-existing medical condition. Also, starting in 2014, there are new special tax incentives available to businesses and employees when employees purchase individual health insurance.

2) Group Health Insurance

Group health insurance plans are a form of employer-sponsored health coverage. Costs are typically shared between the employer and the employee, and coverage may also be extended to dependents. In certain states, self-employed persons without other employees may qualify for group health insurance plans.

  • Many small businesses are expected to terminate group health insurance (in favor of individual health insurance) in 2014.

Step 2 – Learn about different types of health insurance

Whether you’re looking at individual health insurance or group health insurance, there are several different types of health plans available. The four you should know are:

PPO Health Insurance Plans,

HMO Health Insurance Plans,

HSA-Qualified Health Insurance Plans, and

Indemnity Health Insurance Plans.

  • The plan type that is best for you and your employees depends on what you and your employees want, and how much you are willing to spend. 

Step 3 – Make sure you understand the health insurance terminology

When shopping for a health insurance plan, one of the challenges people face is understanding health insurance terminology. Here are five key health insurance terms you and your employees need to understand:

“Premium” – The premium is the amount you pay to the health insurance company each month to maintain your health insurance.

“Copayment” – Your copayment, or “co-pay,” is the specific dollar amount you may be required to pay up front for a specific type of service.

“Deductible” – Your annual deductible is the amount you may be required to pay out-of-pocket before the insurance company will begin paying for your covered medical claims.

“Coinsurance” – Coinsurance is the amount that you are obliged to pay for covered medical services after you’ve satisfied any copayment or deductible required by your health insurance plan.

“Max Out-of-Pocket (OOP) Costs” – Your maximum out-of-pocket cost sets a limit to your annual financial liability.

Step 4 – Make a list of questions to ask your broker 

Some questions you might want to ask include:

Can I stay with my current doctor?

Will this plan cover my health costs when I’m traveling?

Will I be eligible to contribution to an HSA?

How will this cover my pre-existing condition?

Step 5 – Gather basic information about your household income

Beginning 2014, individuals will have access to tax subsidies to buy private health insurance through the public exchange. These subsidies will be for those who enroll in a silver plan through the exchange.

  • The subsidy caps the cost of individual health insurance at 2% – 9.5% of their household income if their household income is less than 400% above the federal poverty line. This equates to roughly $90,000 per year for a family of four.

*Modified from a Zanebenefits.com article

0

What is the Health Insurance Marketplace?

Recently, HHS re-branded health insurance exchanges as “Health Insurance Marketplaces”. Here’s an overview of the new Health Insurance Marketplace.

About The Health Insurance Marketplace

When key parts of the health care law take effect in 2014, there’ll be a new way for individuals, families and small businesses to get health insurance.

Whether you’re uninsured, or just want to explore new options, the Marketplace will give you more choice and control over your health insurance options.

The Health Insurance Marketplace is designed to help you find health insurance that fits your budget, with less hassle.

Get Ready to Enroll In The Health Insurance Marketplace

  • Enrollment in the Marketplace starts in October 2013.

Whether you’re uninsured, need insurance for your small business, or just want to explore your choices, the Health Insurance Marketplace can help you find a plan that’s right for you.

Get a Break On Health Insurance Costs

  • More people than ever will qualify for free or low cost health insurance in 2014. 

When key parts of the health care law take effect in 2014, more people than ever before will qualify for health insurance that fits their budget. You may be eligible for a free or low-cost plan, or a new kind of tax credit that lowers your monthly premiums right away.

Thanks to new rules and expanded programs, even working families will be able to get help through the Health Insurance Marketplace.

Most people will be able to get a break on costs through the Marketplace, even if you think your income is too high to get help. One application, one time, and you’ll see all the programs you qualify for.

Different financial assistance programs will be directly linked into the Health Insurance Marketplace when enrollment starts in October 2013. In the meantime, you or your child or teen may qualify NOW for no-cost or low-cost health insurance through Medicaid and the Children’s Health Insurance Program (CHIP).

Insurance Plans Run By Private Companies

When you shop at the Marketplace, everything you need is laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you’re paying and what you’re getting before you make a choice.

Under the health care law, there will also be new protections for you and your family. Health insurance companies can’t refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.

Small Businesses

Today, small employers like you have a tough time finding and affording coverage that meets the needs of your employees. Starting in 2014, you’ll have more choice and control over your health insurance spending through the Small Business Health Options Program (SHOP), a new program designed to simplify the process of finding health insurance for your small business.

You choose the level of coverage you’ll offer, and define how much you’ll contribute towards your employees’ coverage.

You’ll also have exclusive access to an expanded Small Business Healthcare Tax Credit. This tax credit covers as much as 50% of the employer contribution toward premium costs for eligible employers who have low- to moderate-wage workers.

When you get insurance through the SHOP, it makes it easy for you take advantage of other tax breaks too including the chance for you and your employees to use pre-tax dollars to make your premium payments.

You and your employees will also benefit from new protections that help you get real value for your premium dollars. There are new limits on the higher premiums insurers can charge businesses with older employees, and an employee with high health care costs no longer increases your group’s premium. There are also new limits on the share of premiums going to insurers’ profits and administrative costs.

The health insurance plans available in the SHOP will be run by private health insurance companies, the same way small group plans are run now. All plans will offer the same benefits as a “typical” employer plan, including real protection against financial catastrophe.

Plans will present their cost and coverage information in a standard format, using plain language that’s clear and easy for you to understand. You and your employees will be able to easily compare plans based on price, coverage, quality and other features that are important to you.

You can use your existing insurance broker to access the SHOP, or you can shop for plans yourself, without a broker. You can review pricing and coverage in apples-to-apples comparisons, complete a single application, and choose the level of coverage that works for your budget, your business, and your employees.

*Modified from a Zanebenefits.com article

0

Seven million will lose insurance under Obama health law

President Obama’s health care law will push 7 million people out of their job-based insurance coverage — nearly twice the previous estimate, according to the latest estimates from the Congressional Budget Office released Tuesday.

  • CBO said that this year’s tax cuts have changed the incentives for businesses and made it less attractive to pay for insurance, meaning fewer will decide to do so. Instead, they’ll choose to pay a penalty to the government, totaling $13 billion in higher fees over the next decade.

But the non-partisan agency also expects fewer people to have to pay individual penalties to the IRS than it earlier projects, because of a better method for calculating incomes that found more people will be exempt.

Overall, the new health provisions are expected to cost the government $1.165 trillion over the next decade — the same as last year’s projection.

With other spending cuts and tax increases called for in the health law, though, CBO still says Mr. Obama’s signature achievement will reduce budget deficits in the short term.

During the health care debate Mr. Obama had said individuals would be able to keep their plans.

*Modified from a Washington Times article

0