Predicting Health Insurance Rates for 2016 in Illinois

Predicting Health Insurance Rates for 2016 in Illinois

By Robert Slayton

One good thing that came out of the Affordable Care Act is that any insurance company that is going to raise premiums more than 10 percent for individual or small group medical plans is required to file with the Federal Government. This information is made public so we can review it.
Unlike other states, Illinois has no authority to prevent the increases from being implemented as requested (this isn’t necessarily a bad thing, but just the way it is in Illinois). Based upon those rate increase requests, we have a pretty good idea of who will be the competitive players in the market for 2016.

BCBS of IL has requested increases from 12.83% to 38.24% for ACA plans. As a result, BCBS of IL is eliminating the Blue PPO (large PPO network) option in 2016 for ACA plans. All members on this plan will be migrated to the smaller Blue Choice network (which has about 40% of the doctors/hospitals as the larger network). This will impact approximately 173,000 people. Also expect BCBS to eliminate other plans that have been unprofitable.

If you are on a transitional plan, (plans written after 3/23/2010 to 12/31/2014) you may see increases of over 46%.

Coventry, Humana, and Health Alliance have also requested increases. If you look at the table below, it shows, generally, which increase impacts which plan. If you are on a subsidized plan, you will not see as dramatic of an increase if your income has stayed the same. Subsidies are based upon the second lowest silver plan. The assumption is that this plan will be more expensive in 2016 therefore providing you with a bigger subsidy. For everyone else, it will be a choice of paying the increase or keeping cable.

Aetna (who owns Coventry), Land of Lincoln Health, and IlliniCare are not listed as requesting a rate increase even though I’ve heard rumblings that some have. If we go with the assumption that they will increase rates less than 10%, then these will be some of the players who will win business away from BCBS.

One unknown is Land of Lincoln Health. I’ve had conversations with a board member who says the financials look good (doesn’t mean that they made a profit as it is difficult for any start up to make a profit in the first several years). If they continue to perform as they have, I’d say they will be the company most move to.

Expect all insurance companies to modify the plans they offer. We probably won’t know what these will look like until open enrollment begins on 11/1.

Below are the rates increase requests for ACA compliant plans.

For Transitional plans, here’s the rate table.

Opportunities to Purchase a Health Insurance Plan after Open Enrollment

The grid below comes from BCBS of IL (but applies to ALL states) and articulates what is considered a special enrollment, who is impacted, the timeline, and when a new policy would be effective. If you are unsure, ALWAYS talk to me as this chart doesn’t cover all circumstances.

NOTE: You can always purchase a Short Term Medical policy outside of open enrollment and special enrollment periods. Contact me for more information.

NOTE2: You can sign up for Medicaid at any time if you qualify (there are no enrollment periods).

Qualifying events can initiate a Special Enrollment Period (SEP) under the Affordable Care Act (ACA), and may allow your clients a window of time to select a new benefit policy or make a change to an existing policy. Here are events, enrollment dates and effective dates that may trigger an SEP. Categories that warrant special enrollment periods may be added in the future if other appropriate circumstances, as determined by CMS, become known.

Qualifying Event	Enrollment Period	Effective Date
Applicable to both Marketplace and non-Marketplace (on- and off-Exchange) Policies
Gaining/losing a dependent through birth/adoption/foster care/placement for adoption	60 days	Date of event
Gaining a dependent through marriage		First day of the following month after the event
Loss of Minimum Essential Health Coverage (MEC)*
Loss of eligible coverage from: Legal separation/divorce Cessation of dependent status (aging out) Death Termination or reduction of working hours with employer
Loss of coverage through an HMO due to relocation (applicable to both group and individual markets)
Incurs claim that meets or exceeds lifetime limits on all benefits
COBRA coverage ends
Employer ceases contributions either to subscriber or dependents	60 days	First day of the following month after the event
Permanent move		If the selection of the plan happens between first and fifteenth – the effective date is the first of the next month. If the selection of the plan happens after the fifteenth – the effective date is the first of the second following month.
Newly eligible/ineligible for advanced payments of tax credits or change in eligibility from cost-sharing reductions
Qualified Health Plan (QHP) substantially violates a material provision of its contract
Enrollment in QHP is made in error
Applicable to non-Marketplace (off-Exchange) Policies Only
Enrollment in non-calendar year policy ends	30 days	Date of event
Applicable to Marketplace (on-Exchange) Policies Only
Native American status	60 days	Eligible to enroll or change QHP policies on monthly basis
Attaining citizenship		Date of event
Demonstration of exceptional circumstances, as determined by the Exchange		Date of event

*Does not include loss of MEC due to failure to make premium payment and situations for allowable rescissions.

What Do I do after March 31st if I still want a health insurance plan?

This Q & A comes from BCBS and is important to understand. If you don't sign up by March 31 2014 open enrollment deadline, you WON'T be able to purchase a health plan (except a short term medical which imposes a pre-existing condition clause), except by one of the below reasons.

See below.

Q What if a person’s situation changes and he needs health care coverage? Can he go to the Marketplace outside of the open enrollment period?

A  If a person loses his job or has another qualifying life event, he may qualify for a special enrollment period on the Marketplace. A person will qualify if:

• He loses minimum essential coverage, including through divorce.
• He gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption or foster care.
• He becomes a citizen, national or lawfully present individual.
• He is eligible to enroll but didn’t because of a mistake, misrepresentation or inaction of an officer, employee or agent of the Marketplace.
• The plan he enrolled in substantially violated a material provision of its contract with the individual.
• He becomes newly eligible for premium tax credits or cost-sharing assistance.
• He becomes ineligible for premium tax credits or cost-sharing assistance.
• He makes a permanent move and has access to new health plans.
• He is a member of an American Indian tribe (American Indians can enroll in a plan or change plans one time each month).
• He demonstrates to the Marketplace that he has other extenuating circumstances that qualify him for special enrollment.
• When any of these situations happen, he will have 60 days to go to the Marketplace to enroll in a health insurance plan or change plans.

Two Year Extension Granted on Canceled Health Plans   

 By Larry Grudzien

(AP) - Warding off the specter of election-year health insurance cancellations, the Obama administration Wednesday announced a two-year extension for individual policies that don't meet requirements of the new health care law.

The decision helps defuse a political problem for Democrats in tough re-election battles this fall, especially for senators who in 2010 stood with President Barack Obama and voted to pass his health overhaul.

The extension was part of a major package of regulations that sets ground rules for 2015, the second year of government-subsidized health insurance markets under Obama's law - and the first year that larger employers will face a requirement to provide coverage.

Hundreds of pages of provisions affecting insurers, employers and consumers were issued by the Treasury department and the Department of Health and Human Services. It will likely take days for lawyers and consultants to fully assess the implications.

The cancellation last fall of at least 4.7 million individual policies was one of the most damaging issues in the transition to a new insurance system under Obama's law. The wave of cancellations hit around the time that the new HealthCare.gov website was overwhelmed with technical problems that kept many consumers from signing up for coverage. It contradicted Obama's promise that you can keep your insurance plan if you like it.

The latest extension would be valid for policies issued up to Oct. 1, 2016. It builds on an earlier reprieve issued by the White House.

REGULATION HIGHLIGHTS

Other highlights of the regulations include:

- An extra month for the 2015 open enrollment season. It will still start Nov. 15, as originally scheduled, after the congressional midterm elections. But it will extend for an additional month, through February 15 of next year. The administration says the schedule change gives insurers, states and federal agencies more time to prepare. This year's open enrollment started Oct. 1 and ends Mar. 31.

- New maximum out-of-pocket cost levels for 2015. Annual deductibles and copayments for plans sold on the insurance exchanges can't exceed $6,600 for individuals or $13,200 for families. While not as high as what some insurance plans charged before the law, cost sharing remains a stretch for many.

-An update on an unpopular per-member fee paid by most major employer health plans. The assessment for 2015 will be $44 per enrollee, according to the regulations. Revenues from the fee go to help insurers cushion the cost of covering people with serious medical problems. Under the law, insurance companies can no longer turn the sick away. The per-person fee has been criticized by major employers. It is $63 per enrollee this year, and is scheduled to phase out after 2016. Some plans, including multi-employer arrangements administered by labor unions, will be exempt from fees in 2015 and 2016.

-Treasury rules for employers and insurers to report information that's crucial for enforcing the law's requirements that individuals carry health insurance, and that medium-to-large employers offer coverage. Although officials said the reporting requirements have been streamlined, businesses see them as some of the most complicated regulations to result from the health care law. The Internal Revenue Service will collect the information, because it is in charge of dispensing tax credits for individuals and small businesses to buy coverage as well as levying fines on those who fail to comply. The individual mandate is already in effect; the employer requirement begins to phase in next year.

-Notice of a potential delay, optional for states, in a promised feature of new health insurance markets for small businesses. The feature would allow individual employees - not the business owner - to pick their coverage from a list of plans. The health insurance exchanges for small businesses have been troubled by technical issues this year. Small Business Majority, a group that supports the health care law, said it's disappointed. The administration says no final decision has been made.

HOW MANY AFFECTED?

It's not clear how many people will actually be affected by the most closely watched provision of the new regulations, the two-year extension on policies that were previously subject to cancellation. The administration cites a congressional estimate of 1.5 million, counting individual plans and small business policies.

About half the states have allowed insurance companies to extend canceled policies for a year under the original White House reprieve. The policies usually provided less financial protection and narrower benefits than the coverage required under the law. Nonetheless, the skimpier insurance was acceptable to many consumers because it generally cost less.

"It's not likely to affect a large number of people but it certainly avoids difficult anecdotes about people having their policies canceled," said Larry Levitt of the nonpartisan Kaiser Family Foundation, an expert on insurance markets. "I think it's a small and dwindling number of people who are affected."

For More Information:

If you have any comments or questions regarding any of above information, please do not hesitate to call me at 630-779-1144 or Larry Grudzien at (708) 717-9638 

Obama's "You Can Keep Your Plan" Announcement Isn't Up to Him

It's been awhile since I've posted due to trying to see every client I have along with renewing most of my groups with a December renewal date, but I thought I'd jump into the fray.

1. I've been amazed at how many times the Oval Office has made an announcement changing the law without due process. If a law is passed and someone wants to amend it, typically an amendment needs to be written and approved. This has not been the case with the Affordable Care Act (sorry, it's a beef of mine - I believe in following due process).

2. Now that the President has stated that insurance companies may be allowed to continue their plans up to the end of 2014, both the Directors of Insurance of each state AND the insurance companies within each state now need to make decisions.

3. The Director of Insurance (DoI) is the person who can decide whether to allow insurance companies to continue existing plans within that state. If the DoI chooses to disallow it, then it will be as if the President didn't make that announcement.

4. If the DoI says yes, the individual insurance companies can still say no. Insurance companies need to weigh the split in risk pools this may cause (or if they are pooling the risk pools, how the decrease in premium for existing plans will impact it). One of the reasons to force people onto the new plans is to get enough healthy people in the risk pool to pay for the unhealthy people. The whole risk model will change if this is the case and insurance companies need to carefully assess whether this makes sense. Furthermore, if insurance companies have already cancelled plans or people have chosen plans to migrate to, will the insurance companies be willing to go back and allow people to back on their old plans?

5. Let's say that insurance companies choose to continue existing plans. Policyholders should still see an increase in their premiums due to the new taxes that the Affordable Care Act has imposed. You have the $5.25/month belly button tax (transitional reinsurance fee paid for each person on a health insurance plan), person's portion of the health insurer tax (around 3% - 4% of the cost of the plan), and patient centered research outcome fee of $2/year. For a family of 4 whose current premium is $1000/month, this will mean the following extra costs: $21/month, $35/month (estimated at 3.5% health insurer fee), and $0.17/month pcori fee ($57.17/month total) assuming no other items included.

New World, New Rates for Obamacare (Affordable Care Act). How it impacts Me.

The first thing I did this morning when I got to the office was to try to get into healthcare.gov. When that didn't work, I knew I could still get rates via each individual carrier. So I worked and got the three closest plans to what I have now to compare current plans and rates to plans and rates 1/1/2014. Here is what I found.

My current plan is a $5200 family deductible HSA plan via Blue Cross Blue Shield of Illinois. It pays 100% after I meet the deductible. My current premium is about $600/month for a family of 4.

Below is a snapshot of the three closest plans I could find. (Land of Lincoln, BCBS of IL, and Aetna respectively).

The first thing I noticed was that I COULD NOT find a plan similar to what I have now. Furthermore, the smallest out of pocket maximum for a family was OVER $12,000 for an HSA compatible plan.

You may say that $758.97/month is reasonable, but please remember that I was paying less than $600/month for better coverage ($5200 maximum out of pocket for everything instead of $12,700 maximum out of pocket).

I tried quoting Coventry, but their website said there were no plans available and Health Alliance's rates were high and not as graphic as above because they just have rate sheets. Of course those two carriers are not available in DuPage County, so that is another reason I didn't list them here. DuPage County only has BCBS of Illinois, Aetna, and Land of Lincoln.

Now you may be saying that these are unsubsidized rates and you'd be correct. We need to keep in mind that SOMEBODY is paying for the plan, even if your share is at 50%. Note also that two out of 3 plans are Bronze level plans meaning that the costs are less than a Silver plan. Unfortunately, there were no Silver plans that were similar to what I have now. They just weren't offered. 

I'll be curious to see the comparison once the government website is up and running. More posts as the time goes on.

How to Navigate the Health Insurance Exchanges (Marketplace)

As we haven't been allow to see the steps involved with the Marketplace website (healthcare.gov, in Illinois you can also try getcoveredillinois.gov), here are some general ideas for you to be aware of.

1. You can go directly to each health insurer's website (that is in the Exchange) and look for health insurance both within the Exchange and outside of the Exchange.

2. You can go to healthcare.gov for any Federally Facilitated Marketplace or State/Federal Marketplace.

3. You will need an idea of what you think you will make in 2014. The rules state income is based upon Modified Adjusted Gross Income. They did not give details as to what that means, but for all practical purposes, think "Adjusted Gross Income." Estimate conservatively. If your income is much greater, then inform the Exchange to dial back your subsidy. The reason to do this is because the subsidies are actually forward looking tax credits. This means that the IRS will settle up with you at the end of the year. If the government has overpaid for your health insurance, they will ask for the money back! Of course if you had a bad year, the opposite is true too.

4. BE CAREFUL OF THE PLAN DESIGNS!!!!! I cannot stress this enough. The plans you will be viewing will be DIFFERENT that what you are used to.

• Some will include extremely high prescription drug deductibles (for example, you pay a $1500 drug deductible before the drug copay kicks in). 
• Others will include PER OCCURRENCE DEDUCTIBLES. Simply put, you pay this IN ADDITION to your normal deductible for things such as hospitalization, outpatient surgery, etc. An example would be you'd pay an extra $1000 each time you were admitted into a hospital, then you'd pay your deductible. 
• Silver level plans will have HIGH DEDUCTIBLES. Insurance companies did this to keep the costs down. You will need to choose between having a $4000+ individual deductible for a reasonable premium or a higher premium and lower deductible.
• THERE IS LESS CHOICE in the Exchange. If you do not qualify for a subsidy (you and your family make over 400% of Federal Poverty Level), then search for NON-EXCHANGE plans. In DuPage County, there are 3 insurance companies on the Exchange. Off-Exchange there are at least 5 with many more plans available. The rates for the same plan on and off the exchange will be exactly the same.
• PEDIATRIC DENTAL will be a question on the applications. If you say you do not have a dental plan, then they will charge you extra for including dental coverage for children. My best guess is that if you do not have children on the health insurance plan and don't have dental, you shouldn't be charged extra, but we won't know until tomorrow.
• IF YOU DON'T QUALIFY FOR A SUBSIDY consider getting a plan that starts 12/1/2013 with one of the insurance companies that will allow you to keep the plan for 1 full year. This will delay the increase in costs due to Health Reform for that much longer.
• PLEASE - USE AN AGENT!!! There is no cost to use an insurance agent certified to sell in the exchange. The rates are exactly the same and they will be able to help you avoid the pitfalls of choosing a plan that doesn't work for you. What you don't know WILL hurt you.

Please call me if you want help. My phone is 630-779-1144.

Thanks,

Robert Slayton

Pediatric Dental with the Affordable Care Act – What does this mean? Do I need to Buy it?

Pediatric Dental with the Affordable Care Act – What does this mean?

Today I will be talking about State Federal and Federally Facilitated Exchanges (also known as Marketplaces). State Based Exchanges will come up with their own rules so are not included here.

Pediatric Dental is one of the 10 Essential Health Benefits required to be on a health insurance plan starting in 2014. Below is what I've been able to figure out so far. As changes happen, this will be changing.

What is Pediatric Dental?

It simply means that all children under the age of 19 will have coverage for preventative, basic, major/restorative, and most will include “medically necessary” orthodontics. Picture your current dental plan. It usually looks like the following (this would be considered a “high plan” under the new rules):

Network		e.g. Delta Dental
Deductible Individual/ Family		$50/$150
In Network/Out Network %
Preventative Care		100%/100%
Basic Care		80%/80%
Major Care		50%/50%
Orthodontia		50%
Annual Maximum		$1,000.00
Lifetime Orthodontia  Max		$2,000.00

Pediatric dental plans can be offered both as a standalone product (similar to the above) within the exchange or embedded within the medical plan.

Stand Alone

If the plan is offered as a standalone product, it will look similar to the above plan (with different percentages). The big difference is that the annual out of pocket maximum will be $700 for one child and $1400 for 2+ children. This means that if orthodontia is deemed as medically necessary, the most someone would pay in one year would be $700. Furthermore, there is NO ANNUAL MAXIMUM for children (not adults). So if a child needs $4000 of covered work done, then the child’s family would pay only $700 within that year.

Embedded within a Medical Plan

We are still waiting to see how this may look. A health insurance company can have pediatric dental’s deductible be the same as the medical deductible or have it be separate.

Do I need to buy Pediatric Dental?

Technically yes. Some states will be including it with all plans. Most states will offer a standalone dental benefit that can be combined with a separate medical plan. They will also be offering medical plans with dental included within the medical plan.

Technically, all states will require “reasonable assurance” that you own a dental plan that covers children. If you are on a Federally Facilitated Marketplace (Exchange) website, it will allow you select a medical only plan and check out without selecting a separate dental plan. It will ask you whether you have other dental and if you say yes, then you can continue. Currently there is no verification as to whether you actually have a pediatric dental plan.

If I don’t have Pediatric Dental, but do have Medical, will I be subject to the Individual Mandate?

Probably not as I believe the question on the tax return will be whether you have been covered by a health insurance plan and not ask whether your plan includes pediatric dental. Furthermore, people on grandfathered plans will not be required to have pediatric dental and will not be subject to the Mandate.

What if my company offers dental already?

Chances are that pediatric dental will NOT be part of your company’s medical plan in 2014 as the requirement states that if a company offers a standalone dental plan that covers children, then they do not need to include pediatric dental within their medical plan.

Why the Individual Mandate won't work for Health Reform

We've heard a lot about the individual mandate in the Affordable Care Act. The first year it will be 1% or $95 (whichever is more). It then goes up to 2.5% or equal to the lowest cost Bronze Level plan (whichever is more). Refer to page 12 of the following: http://www.irs.gov/PUP/newsroom/REG-148500-12%20FR.pdf.

There are a number of exemptions available which people haven't talked about, but are very important. Here they are (taken from http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision):
-----

6. What are the statutory exemptions from the requirement to obtain minimum essential coverage?

1. Religious conscience: You are a member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.
2. Health care sharing ministry: You are a member of a recognized health care sharing ministry.
3. Indian tribes: You are a member of a federally recognized Indian tribe.
4. No filing requirement: Your household income is below the minimum threshold for filing a tax return. The requirement to file a federal tax return depends on your filing status, age, and types and amounts of income. To find out if you are required to file a federal tax return, use the IRSInteractive Tax Assistant (ITA).
5. Short coverage gap: You went without coverage for less than three consecutive months during the year. For more information see question 22.
6. Hardship: A Health Insurance Marketplace, also known as an Affordable Insurance Exchange, has certified that you have suffered a hardship that makes you unable to obtain coverage.
7. Unaffordable coverage options: You can’t afford coverage because the minimum amount you must pay for the premiums is more than eight percent of your household income.
8. Incarceration: You are in a jail, prison, or similar penal institution or correctional facility after the disposition of charges against you.
9. Not lawfully present: You are neither a U.S. citizen, a U.S. national, nor an alien lawfully present in the U.S.

-----

Unaffordable Coverage Option (#7)

I'd like to focus on just one of the 9 exemptions, the Unaffordable coverage option (#7). If you surf out to the Kaiser Family Foundation's subsidy calculator (http://kff.org/interactive/subsidy-calculator/) and plug in a family of 4. The projected premium is $12,887/year for the second lowest Silver Plan. The projected premium for a Bronze level plan is $10,681/year.

If you divide $10,681 by 0.08, you'd need to make more than $133,512.50/year to receive a penalty if you decide to forego coverage (8% of $133,512.50 equals $10,681). That means there are a lot of people who will NEVER be faced with a penalty. Of course if you were, you'd just have to fill out the religious exemption section listing something like being a Christian Scientist or other religious organization that does not believe in traditional medicine.

How the IRS Collects the Penalty

Furthermore, the only way the IRS can collect this penalty is via your income tax return. If you don't pay income tax, then it's pretty hard for them to come after you as they are not allowed to garnish wages or freeze bank accounts. The last statistic I heard about the percentage of Americans who don't pay income tax was 47% (see http://abcnews.go.com/Politics/OTUS/mitt-romneys-47-percent-pay-income-taxes/story?id=17263629). So this mandate won't impact almost 1/2 the country.

So, whatever the CBO scores say about the number of people who will pay a penalty, my guess is that it will be much lower than expected.

Heck, if I were a young invincible, I'd happily pay the $95/year to save $2000/year in premium. That would be extra beer money. As I didn't have any assets and low income, there really is nothing for the doctors and hospitals to take from me if I had an illness (BTW, it's already a law that if you show up at the Emergency Room, they must treat you). The challenging part would be if I had expensive medications, but that's easily remedied through programs with the major pharmaceutical companies to supplement the cost to low income people. Then at open enrollment time, I'd sign up for a plan that starts January 1st of the following year. As there are no pre-existing conditions anymore, my conditions would be covered.

Of course if I wanted insurance sooner, I could just marry someone. This is considered a qualified reason (gaining a dependent) which allows me to get the insurance sooner. Once I had the insurance, we could get the marriage annulled (yet another qualified reason).

So why buy health insurance?

Health insurance is important because of the potential of taking your life savings on a major illness (I've seen it numerous times). It also helps give access to the top doctors and hospitals. If the government wants people to buy health insurance, they must focus on the reasons to buy and not on the penalties.

Frankly, there are three kinds of personal insurance coverage needed to protect against catastrophic loss due to health/death. The first is health insurance, the second is life insurance (to keep your beneficiaries living in the same lifestyle instead of having to sell everything), and disability insurance. The most overlooked is disability insurance.

Cash Machine

Imagine you had a cash machine in your home. It legally produced $1,000 -- $10,000/week every week of the year. My question is how much would you spend to make sure that income came in every week for the next 10 - 40 years? Would you spend $50/week?, $500/week?, or more to assure it keeps coming in?

If you would spend the money to protect the machine, then disability insurance makes sense. You are that cash machine. If you can't work, the money won't come in and you'll have nothing to live on.

The reason why people go into bankruptcy due to medical debt is because they have no income coming in during the illness. If you don't have money to pay for your premiums (because you are buying food or paying rent), then the policy lapses. Once the policy lapses, you are on the hook for all subsequent expenses. 

Questions

If you have questions on health reform, need a help with any of the above insurance products (for both individuals and businesses), please give me a call or shoot me an email.

Latest News on the Affordable Care Act

I've compiled a series of interesting articles this week about different aspects of the Affordable Care Act.

First, this piece on the Federal Pre-Existing Condition Insurance Plan’s solvency (or lack thereof). The Federal Government totally under estimated the claims of those people who went on it.

http://newsmanager.commpartners.com/nahuw/issues/2013-05-24/index.html

Second is a study of the current cost of health insurance. Please look at the dollars that are currently being spent and tell me whether this is sustainable.

http://newsmanager.commpartners.com/nahuw/issues/2013-05-24/2.html

Third is Chicago Politics as its best. What do politicians do once they are elected? They hire all of their supporters of course. It looks like if you’d like a job as an assister, go talk to HHS.

http://newsmanager.commpartners.com/nahuw/issues/2013-05-24/3.html

Oops, the Government forgot that some people don’t have bank accounts with which to pay for their premiums.

http://www.npr.org/blogs/health/2013/05/21/184814772/latest-health-hurdle-buying-insurance-without-a-bank-account

Here’s something that came to my attention last week. This is in California, but may apply to other states. Doctors may be stuck with paying for patients’ care due to non-payment of health insurance premiums.

http://www.sacbee.com/2013/05/21/5438115/loophole-in-health-care-law-could.html

Unions are figuring out that they are being treated like everyone else in regards to Health Reform. Businesses don’t get special treatment, but Unions believe they should.

http://thehill.com/business-a-lobbying/300881-labor-unions-break-ranks-on-health-law

Here’s an interesting study on the impact of increasing premiums and young adults purchasing insurance. Note that this is from an organization that doesn't like the ACA.

http://americanactionforum.org/topic/young-adults%E2%80%99-insurance-decisions-dependent-cost

Obama Administration simplifies, significantly shortens application for health insurance

Obama Administration simplifies, significantly shortens application for health insurance

By Larry Grudzien, Attorney-At-Law

April 30, 2013

 

The Centers for Medicare & Medicaid Services (CMS) today announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduce by two-thirds. The consumer friendly forms are much shorter than industry standards for health insurance applications today.

In addition, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children's Health Insurance Program (CHIP) and tax credits that will help pay for premiums.

The applications released today, which can be submitted starting on October 1, can be found here:

http://cciio.cms.gov/resources/other/index.html#hie

"Consumers will have a simple, easy-to-understand way to apply for health coverage later this year," said CMS Acting Administrator Marilyn Tavenner. "The application for individuals is now three

The online version of the application will be a dynamic experience that shortens the application process based on individuals' responses. The paper application was simplified and tailored to meet personal situations based on important feedback from consumer groups.

Consumers can apply online, by phone or paper when open enrollment begins October 1, 2013. There will be clear information provided about how to complete the application, and how to access help applying and enrolling in coverage.

This consumer-focused approach will facilitate the enrollment of millions of Americans into affordable, high quality coverage while minimizing the administrative burden on states, individuals and health plans.

For more information about the Health Insurance Marketplace, visit: www.HealthCare.gov pages, making it easier to use and significantly shorter than industry standards. This is another step complete as we get ready for a consumer-friendly marketplace that will be open for business later this year."

For More Information:

If you have any comments or questions regarding any of above information, please do not hesitate to contact me at 630-779-1144 or Larry at (708) 717-9638.

IRS Issues Guidance on Health Insurance Premium Tax Credit -Clarification

IRS Issues Guidance on Health Insurance Premium Tax Credit -Clarification

February 5, 2013

By Larry Grudzien, Attorney-At-Law

The IRS issued a final regulations on when an employer-sponsored plan is considered "affordable" for an individual related to the employee for purposes of eligibility for a premium tax credit. Under Health Care Reform, employees may be eligible for a premium tax credit to purchase health insurance through the future health insurance exchanges if, among other reasons, the employer plan is deemed unaffordable.

The final regulations clarify that for taxable years beginning before January 1, 2015, an eligible employer-sponsored plan is affordable for related individuals if the portion of the annual premium the employee must pay for self-only coverage does not exceed 9.5% of the taxpayer's household income.

An employer plan will be affordable for family members if the cost of self-only coverage does not exceed 9.5% of the employee's household income. In other words, for purposes of whether family members are eligible for tax credits, the affordability of family coverage is not taken into account; all that matters is that the cost of self-only coverage is affordable to the employee

For purposes of applying the affordability exemption from the individual

mandate in the case of related individuals, the required contribution is based on the premium the employee would pay for employer-sponsored family coverage.

For an employee eligible under an employer plan, affordability (for individual mandate exemption purposes) will be based on whether the cost of self-only coverage exceeds 8% of the employee's household income. For a related individual (such as a spouse or child), however, affordability for this purpose will be based on whether the cost of family coverage exceeds 8% of household income. Under these rules, members of an employee's family may qualify for an individual mandate exemption, even though the offer of affordable employer coverage to the employee would require the employee to enroll or risk paying a penalty.

These final regulations apply to taxable years ending after December 31, 2013.

For a copy of the final regulations, please click on the link below:

 http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02136.pdf

If you have any comments or questions regarding any of above information, please do not hesitate to call me (Robert Slayton) at 630-779-1144 or Larry Grudzien at (708) 717-9638.

Look to the state of Washington to see what a health insurance death spiral looks like.

Here's an older article talking about what happened in the state of Washington. Focus on the pre-ex clause. Even with an individual mandate (which doesn't impact 47% of the population and the rest will be a very minor penalty). If we don't impose a pre-existing condition clause on a person who chooses NOT to take coverage during an "open enrollment period" then we will have the same issues as Washington did. It's not the individual mandate, it's also the pre-ex that can kill insurance.

http://www.forbes.com/sites/aroy/2012/03/30/want-to-see-a-health-insurance-death-spiral-visit-washington-state/