Archive | State Health Exchanges

More People Turn to Faith-Based Groups for Health Coverage

In a trend that could challenge the stability of the Affordable Care Act, a growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance according to a Wall Street Journal article published last week on their wsj.com website.

The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an Affordable Care Act provision allowing participants in eligible ministries to avoid fines for not buying insurance.

But now, some insurance commissioners are concerned that the ministries could put consumers at risk if bills aren’t paid. The ministries aren’t overseen by state commissioners, which generally guard against unfair practices and ensure solvency.

  • Ministry officials say they aren’t offering insurance, don’t guarantee claims will be paid, and don’t need to be regulated. The nonprofits are well managed, according to ministry officials, with third-party audits and a sterling history of sharing members’ claims.
  • Ministries generally don’t allow members to sue and require disagreements to be settled by arbitration and mediation.
  • Most ministries don’t always share bills for certain pre-existing conditions, whereas the ACA requires insurers to cover anyone regardless of their past or current medical history.

State regulators also say health ministries disrupt the insurance market because they tend to attract healthier consumers, siphoning them from commercial plans that can be left with sicker or older customers. Insurance commissioners in some states have moved to shut down the ministries’ state operations.

Many of the estimated 50 health-care ministries in the U.S. are small operations, and some churches have their own programs limited to parishioners. There are several large Christian ministries, and at least two other ministries open to people regardless of specific religious faith.

Members typically must abide by Biblical principles such as not having sex outside of marriage, and may have to sign a statement of religious faith.

Some consumers say they joined ministries to avoid rising deductibles and premiums on the health law’s exchanges, and to be free from the law’s penalty, which starts at $695 for 2016.

Consumers generally pay a set monthly amount that goes into a general account or directly to others who have eligible medical bill. They can also submit their own eligible bills to be shared by other members. In some ministries, members make contributions directly to others—and tuck gifts, personal cards and get-well wishes into the envelopes. Preventive care in some cases isn’t covered.

There have been lawsuits by ministry members against a cost-sharing ministry, claiming particular medical bills that should have been shared were not. The cases were ultimately settled or resolved through arbitration.

*Modified from a wsj.com article and other online sources.

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2016 OPEN ENROLLMENT FOR INDIVIDUAL HEALTH INSURANCE

Open Enrollment for 2016 individual plans will begin on Monday November 1st, and continue until January 31, 2016. During this period of time, you will be able to change insurance carriers and your individual plan category (Bronze, Silver, Gold, Platinum).

All carriers have made minor changes to their individual plans based upon Obamacare mandates. There are low or moderate increases in premiums for plans offered through the Covered California State Exchange (for those who need a federal premium assistance subsidy), and for Off Exchange plans for those that do not qualify for the subsidy.

Based upon review of next year’s plans, only Anthem Blue Cross and Blue Shield of California will have PPOs available in every county in California. Both carriers have increased for 2016 the number of providers that make up their individual plan provider networks. In addition, both carrier’s individual plans will have access to the full Blue Cross / Blue Shield nationwide provider network.

Anthem and Blue Shield have added new Bronze and Silver plans available for Off Exchange enrollment. These plans have unique features, and lower non subsidized premiums than On Exchange (Covered CA) plans.

If you choose Covered California in order to obtain a federal premium assistance subsidy, you need to begin the enrollment process immediately, because of the paperwork required to prove your anticipated 2016 income level.

For Off Exchange enrollment, you have adequate time to review options. Your application must be submitted by December 15th to have a January effective date.

If you have questions regarding Off Exchange plans and enrollment, please call me at (626) 797-4618 or email me at john@healthinsbrokers.com.

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75% of Obamacare plans in California use narrow networks, study shows

A new study finds that 75% of California’s Obamacare health plans have narrow physician networks — more limited choices than all but three other states. The report examines health plans sold to consumers last year under the Affordable Care Act and shows wide variation in the prevalence of narrow networks across the country.

To hold down premiums under the health law, big insurers such as Anthem Inc. and Blue Shield of California cut the number of doctors and hospitals available to patients.

Consumers often have the ability to search for specific doctors before picking out a policy. But that information doesn’t tell a consumer how restricted an overall network may be for primary-care doctors or specialists.

Covered California, the state’s insurance marketplace, and its participating health plans have said networks have been expanding since the initial rollout in January 2014 to ensure patients’ needs are met. But 18% of exchange policyholders surveyed said a medical provider would not accept them as a new patient.

State and federal regulators have been grappling with how to respond to consumer complaints about skinnier networks and inaccurate information in provider directories. It took considerable time and effort to clean up insurance company provider lists before any analysis could be done.

Better data on exchange networks is essential so regulators can ensure patients have sufficient access to doctors and consumers can determine whether a lower-priced narrow network policy is a good deal.

“Network composition is a major way in which insurance companies can attempt to control costs in the marketplace, and for consumers there is often a tradeoff between access and price,” said the director of health coverage issues at the Robert Wood Johnson Foundation.

Health researchers also mapped how narrow networks vary within states with the prevalence far higher, for instance, in several areas of Southern California.

It also differs by plan type. More than 90% of California’s HMO networks for individual coverage were narrow, compared to a third of PPO plans in the state.

*Modified from a LA Times.com article, Covered California, and other online sources.

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Health Insurers Seek Hefty Rate Boosts

Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact.

One state, New Mexico is asking for an average jump of 51.6% in premiums for 2016. Insurance carriers in several states have proposed 36.3%, 30.4%, and 25% rate increases. In dozens of other larger states carriers have applied for increases averaging 10%.

  • Insurers in California have not announced the percentage increase in their rates; however they have begun the process of filing their rates with state insurance regulators.

All insurance carriers cite high medical costs incurred by people newly enrolled under the Affordable Care Act.

Under that law, insurers file proposed rates to their local regulator and, in most cases, to the federal government. Some states have begun making the filings public, as they prepare to review the requests in coming weeks.

  • Insurers say their proposed rates reflect the revenue they need to pay claims, now that they have had time to analyze their experience with the law’s requirement that they offer the same rates to everyone—regardless of medical history.

Health-cost growth has slowed to historic lows in recent years, a fact consumer groups are expected to bring up during rate-review debates. Insurers say they face significant pent-up demand for health care from the newly enrolled, including for expensive drugs.

  • “This year, health plans have a full year of claims data to understand the health needs showing enrollees are generally older and often managing multiple chronic conditions,” said a spokeswoman for America’s Health Insurance Plans, an industry group. “Premiums reflect the rising cost of providing care to individuals and families, and the explosion in prescription and specialty drug prices is a significant factor.”

The federal government subsidizes premiums for some consumers, based on income, and the validity of those subsidies in most of the country is the subject of a lawsuit the Supreme Court is expected to decide in late June.

  • The filings from insurers are based on the assumption that those subsidies remain in place.

Obama administration officials weathered a storm as some younger, healthier consumers saw their premiums jump when the law rolled out, but were also able to point to modest premiums overall as insurers focused on other ways to keep costs down, such as narrow provider networks.

For 2015 insurance plans, when insurers had only a little information about the health of their new customers, big insurers tended to make increases of less than 10%, while smaller insurers tried offering lower rates to build market share.

Modified from a WSJ.com article

 

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44% of Covered California customers report difficulty paying premiums

A new survey shows that 44% of Covered California policyholders find it difficult to pay their monthly premiums for Obamacare coverage. And a similar percentage of uninsured Californians say the high cost of coverage is the main reason they go without health insurance.

The issue of just how much people can afford will loom large as the state exchange prepares to negotiate with health insurers over next year’s rates.

  • Many analysts are predicting bigger premium increases for 2016 in California and across the country. Insurers have more details on the medical costs of enrollees, and some federal programs that help protect health plans from unpredictable claims will be winding down.

This latest pulse on consumer attitudes is drawn from a Kaiser Family Foundation survey of 4,555 Californians from September to December 2014. It examined the experiences of people in Covered California, Medi-Cal, other private coverage and the uninsured.

  • Forty-four percent of exchange policyholders surveyed said it’s somewhat or very difficult to afford their premiums. That’s compared with 25% of adults who had employer-based or other private health insurance.

Peter Lee, executive director of Covered California, acknowledged that many Californians find it hard to fit health insurance premiums into their household budget, even when they qualify for generous federal subsidies.

“If you are making $25,000 a year that $70 premium is still a struggle,” Lee said. “The Affordable Care Act is providing nobody with a free lunch. This issue of making healthcare affordable is not easy.”

  • Anthem Blue Cross, Kaiser Permanente and other health insurers have submitted their proposed 2016 rates for individual policies to Covered California, and negotiations are expected to begin next month.

The final statewide rates should be announced in July, Lee said. For 2015, the average rate increase was 4.2%.

Modified from a LATimes.com article.

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Many Uninsured Choose Penalty Over Enrollment Offer Under Health Law

Tax preparers, and several surveys find tepid response to the Obama administration’s effort to boost sign-ups. A special enrollment period to obtain health insurance for millions of uninsured people who owe a tax penalty under the Affordable Care Act is off to a slow start.

About 11.7 million people have already signed up on state and federal exchanges this year, though not all of them have yet paid premiums.

The health law requires most Americans to have insurance or pay a fine at tax time. The open enrollment period under the health law ended Feb. 15, but the Obama administration said it would allow people who discover they owe a fine to sign up for coverage through April, at the end of the tax season.

The special enrollment period applies to people who have to pay a penalty for going without coverage in 2014, and also face a penalty in 2015. They must pay any penalty they owe for not having coverage but can use the special enrollment period to obtain coverage and not generate any more fines.

  • It is still early, since the special enrollment period launched Sunday, but research also suggests that many people who lack health insurance will pay the penalty and not get covered this year.
  • Only 12% of uninsured people would buy policies if informed of the penalty, according to a survey of 3,000 adults polled through Feb. 24 by McKinsey & Co.’s Center for U.S. Health System Reform.
  • At H&R Block Inc., “our analysis indicates that a significant percentage of taxpayers whose household members were not covered for at least a portion of 2014 are opting” to pay the penalty, said a vice president of health-care enrollment services at the tax-preparation firm.
  • “It was a good PR move and aligns enrollment with tax season, but we’re not seeing a massive rush,” said a spokesman with Jackson Hewitt Tax Service Inc. “It’s been pretty unremarkable.”

A retired employee of United Parcel Service, Inc. found out he will pay a $250 penalty for going without insurance. He said won’t take advantage of the special enrollment period because it is cheaper for him to pay out-of-pocket for health care than to buy insurance on the exchange.

He said he shopped on the exchange but would have to pay $400 a month for a plan with a $6,000 deductible.

“I think it’s wrong I have to pay the penalty… “But it beats paying more than $10,000 a year.”

Modified from a wsj.com article, and other online sources

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California love for ACA only goes so far as sign-ups sag

California led the nation in embracing the health-care law, and in enrolling its citizens for 2014 coverage. This year, however, sign-ups for private health plans in California, New York and other states that opted to build and run their own insurance markets has stagnated.

  •  In California, enrollment was flat, with about 1.4 million signed up, the same as in 2014.
  •  In more conservative parts of the country that declined to participate and where enrollment is run by the federal government, sign-ups have surged.

As an example, for 2015, 1.6 million Floridians chose insurance plans sold through the federal healthcare.gov system, 62% more than a year before, according to an analysis by Charles Gaba, in Bloomfield Hills, Mich., who has accurately predicted enrollment under the law.

  • The development is made stranger because California had more uninsured people than any other state in 2013, the year before the health law’s insurance expansions began – 5.8 million, according to the Kaiser Family Foundation, a health research group. About 3.6 million people were uninsured in Florida.

In the 37 states that used the U.S.-run website, growth in sign-ups from 2014 to 2015 ranged from 25% to 81%, according to Gaba. Among states that run their own exchanges, only Massachusetts and Hawaii did better – in part because those two states struggled with technology failures in 2014.

  • Medicaid may be one reason why. Any comparison of enrollment in California and Florida should include people in the program for low-income people, said Dana Howard, a spokesman for Covered California, the state’s Obamacare agency.

California and New York both expanded Medicaid to cover the working poor in 2014. Florida, Georgia, North Carolina and 19 other states didn’t, and as a result some low-income adults in those places who would have been eligible for Medicaid are instead enrolled in private coverage. California’s uninsured population has been halved since last year, including its Medicaid expansion, Howard said.

Modified from an Employee Benefit Advisor article, Bloomberg.com, and other online sources.

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How Obamacare Will Impact Your 2014 Taxes

The Affordable Care Act is supposed to make health care coverage universal and more affordable to millions of Americans, but it might also make filing your 2014 taxes more cumbersome and more expensive.

“This tax season is the first time people will experience the financial consequence of the individual mandate, and it will bring additional paperwork and some surprises for taxpayers,” remarked Michael Mahoney, healthcare expert and senior vice present of consumer marketing for GoHealth, a health insurance technology platform.

  • For the vast majority of tax filers, the changes will only mean checking a box to indicate that they had health coverage during 2014. But some of those who signed up for Obamacare will need to take additional steps when filing their taxes this year.
  •  Consumers who signed up for health care through a marketplace will receive a new form this month, called 1095-A, which they’ll have to fill out and will be needed for filing Federal taxes.
  •  On form 1095-A, you’ll be asked to figure out whether you received the correct amount of financial assistance, whether you are subject to a penalty and whether you can claim an exemption among other things.

Advance Premium Tax Credit

The government has been providing financial assistance to some Americans to lower the monthly cost of health insurance on an advanced basis. These credits have been applied directly to monthly health insurance premiums.

  • The tax credit is determined based on your estimate of your household income. It needs to be reconciled taking into account your actual household income when you file your tax return.
  • You may owe money if you’ve underestimated your income, reducing your refund, while it could increase your refund if you’ve overestimated it.

Penalty

  • If you don’t have health insurance and don’t qualify for an exemption, you’ll have to pay the higher amount between a flat fee penalty and a percentage penalty.
  • The penalty will be $96 for an adult and $47 for a child for 2014, up to $285 per household, or 1 percent of your annual household income. The 2015 penalty for lacking insurance is $325 or 2 percent of household income.

This could mean a smaller refund or you might owe more in taxes. “This will be an unpleasant surprise to people who are still unaware that virtually everyone is now required by law to have health insurance,” said Mahoney.

Exemptions

You could lower this penalty or eliminate it if you qualify for one of the exemptions based on financial hardships, religious affiliations and gaps in coverage among others. Just remember that you may need to apply for some exemptions and receive approval.

Modified from an article in The Fiscal Times, and other online sources.

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Small Firms Start to Drop Health Plans

In 2015, if you work for a small company with less than 50 employees, be prepared to obtain your own individual health insurance.  Small companies are starting to turn away from offering health plans as they seek to reduce costs and increasingly view that individual coverage is an inviting and affordable option for workers.

The health law doesn’t penalize companies with fewer than 50 workers that don’t offer coverage, and those with fewer than 100 employees won’t face fines until 2016.

  •  Anthem Blue Cross recently stated that its small-business-plan membership is shrinking faster than expected. It has lost about 300,000 people since the start of the year, leaving a total of 1.56 million in small-group coverage.
  • Anthem said it had projected that it would take about five-years to significantly reduce small-employer membership, but it now thinks the drop-off will be compressed into two years.
  • Some other insurers have seen a similar trend. Aetna said the company was seeing erosion at the bottom of the market among employers with two to 10 workers. Kaiser Permanente said that it is seeing some contraction in the small-group market, particularly in places where insurers are offering cheap individual plans.
  •  A number of small California companies with less than 50 full-time employees have discontinued their health plans during 2014. This trend will continue next year as companies direct their workers to individual plans issued either through Covered California or directly by an insurance company.  
  • Insurers, for their part, are moving to recapture the lost business by signing up employees to their individual plans. As an example, one carrier said it is seeing the strongest shift away from offering health benefits among the smallest employers with just two to four workers, and is working to ease the transition for companies that want to move from a group plan to individual coverage.

Workers with pre-existing health conditions can now buy coverage on their own, and insurers can’t charge them more based on their health history, as they could before the law took effect.

  •  For many small companies, the increasing paperwork to administer small group plans has become a burden. In addition, the increase in premiums has forced companies to either require an employee pay for a greater percentage of coverage or drop the group coverage altogether.
  •  Many employers are changing how much they will contribute to the premium for employee coverage. A number of companies have begun paying a larger percentage of the employee’s portion but are requiring the employee to pay up to 100% of dependent’s coverage.

Some employers are facing premium increases to keep offering coverage as they shift to plans that meet the law’s requirements—though this impact has been delayed for many because the Obama administration has allowed states and insurers to keep older plans in effect.

*Data obtained from the WSJ online, and other online sources.

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DOCTOR NETWORKS TO STAY LIMITED IN 2015 UNDER OBAMACARE

If you are having difficulty finding doctors willing to accept your new Obamacare plans in 2014, finding a doctor who takes Obamacare coverage could be just as difficult in 2015.

Even as California’s enrollment grows, many patients continue to complain about being offered fewer choices of doctors, and having no easy way to find the ones that are available.

Based upon information provided by Covered California, and the carrier’s recent information provided to insurance brokers the general consensus is:

  • The state’s largest health insurers are sticking with their narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to an analysis of company data.
  • Insurers say they can pass along savings by paying doctors less, and rewarding the limited network of doctors with higher patient volume.
  •  Covered California, still has no comprehensive directory to help consumers match doctors with health plans. There’s no timetable for a state provider directory after the exchange scrapped an initial version that was riddled with errors. Instead, Covered California refers people to insurance company websites that vary in usefulness.
  • In addition to shedding doctors, Anthem Blue Cross and Blue Shield of California, the state’s biggest insurers have promoted more restrictive policies known as EPO, or exclusive-provider organization. Unlike a more generous PPO, an EPO typically does not provide any coverage for out-of-network providers. Consumers would be responsible for the full charges if they left their network.
  • Health Net has proposed the most dramatic change for 2015, the data show. It’s dumping the current PPO network, and switching to a plan with 54% fewer doctors and no out-of-network coverage, state data show.
  • For 2015, Blue Shield has proposed two health plans with up to 4% fewer physicians in the areas where they’re sold. Blue Shield includes about two-thirds of its regular PPO doctors in its broadest exchange network.
  •  Anthem, which has added nearly 7,000 doctors since January, intends to maintain the current size of its networks; however the carrier is maintaining its EPO structure in parts of California.

 

*Modified from an LA Times article, Insurance Company information, and various online articles.

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