July 24th, 2014
You could be one of the millions of Americans getting a refund from your health insurance company soon. The Affordable Care Act has a law called the 80/20 rule, where insurance companies have to spend at least 80% of total premium costs on medical care or improving the quality of health care for consumers. In The Boston Globe’s “Health Insurance Companies Refund $15B to Mass. Consumers,” Chelsea Rice talks about the refunds going out and the companies who will be paying them. The U.S. Department of Health & Human Services released this data showing that Massachusetts consumers will be getting the second highest amount of refunds in the United States. The total refund amount for the U.S. is $332 million, which will pay around $80 a family those those receiving refunds. Florida health insurance companies will be paying the most refunds with $41.5 million owed. Massachusetts residents will be paid out $15 million, which amounts to $133 per family getting a refund.
Almost all of Massachusetts’ residents have health insurance, most through their employer, but 1/4 of them still struggle with the burden of high health insurance costs. The ACA’s 80/20 rule brings transparency and competition to the health insurance marketplace. It also offers greater value to consumers in their health insurance plans. Large group plans have to follow an 80/15 rule. Insurance companies operate more efficiently when they are following this rule by cutting out unnecessary expenses. They have been able to lower premiums throughout the U.S. by $3.8 billion. Companies who do not follow the 80/20 rule during their fiscal year have to refund the excess they spent to consumers in their health insurance plan. Those receiving refunds will get them by August 1 either by check, a discount in next years premium, an account reimbursement or a direct reimbursement through their company.
In Massachusetts, more than 208,000 consumers will be receiving an average refund of $133 per family. This new 80/20 rule has made quite a shift in the amount of upfront value that consumers receive from their health insurance plans. The biggest shift by far has been in the individual health insurance market. Back in 2011, the HHS found that 61% of consumers in the individual market received upfront value from their plans. Just two years later, 81% of people are receiving upfront value from their individual health insurance plans. Ten health insurance companies in Massachusetts will be sending out refunds, including Fallon Community Health Plan, Neighborhood Health Plan Inc. and Tufts Associated HMO. If you are one of the Americans receiving a refund from your health insurance company, look for that in the next week.
July 20th, 2014
Residents of Indiana are getting some new health insurance choices in the state’s health insurance exchange. According to The Courier-Journal’s “Indiana health insurance market to see changes,” Maureen Groppe says that five additional companies will be selling plans in the state exchange this year. There are currently four companies offering plan choices in Indiana. Out of the 16 states that make their information public, Indiana has the most new entrants. There will be some rate changes by the four companies who are already selling in Indiana’s exchange. The highest change is a 96% increase and the lowest change is an 11% decrease in plan costs. More choices mean that Indiana residents who already have health plans could get rates that are significantly lower than their current plan rates.
More than 130,000 Indiana residents purchase health insurance outside of an employer program or Medicare. It’s possible that number could double next year as more uninsured Americans seek health insurance plans through the government exchanges and individual companies to comply with the individual mandate. CareSource is one of the new companies to Indiana’s exchange and plans to offer very low, competitive rates. Their rates are so low in fact, that the state regulators questioned the insurance company’s filing. Premium prices will not be set in stone until just before the November 15 open enrollment period. But the state filings help the market get a feel for what is going to happen in the fall.
Overall health care costs are increasing by 5.4%. Insurance companies have to justify increases in premiums that are much more than the increasing cost for health care. Some insurance companies face a greater amount of claims than others. Indiana is changing the way that their disabled residents qualify for Medicaid, so close to 7,000 people with higher medical expenses will be entering the individual health insurance market next year. Since these Affordable Care Act rules are fairly new, insurance companies are still trying to maneuver this health insurance market where they cannot deny coverage to people with preexisting conditions. Companies are seeking rate increases and also lowering premium costs based on regions in the state and the tier level of different plans. It will take a few years for health insurance companies to determine exactly what premium changes need to be made based on what happens each year with costs and new members.
July 13th, 2014
The last thing you are worried about when a parent dies is what will happen to your health insurance coverage. But unfortunately for many young people, they also lose their health insurance coverage when their spouse dies. This also holds true for spouses, including those with young children. In the U.S. News & World Report Health article “What to Do When You Lose Your Health Insurance,” Geoff Williams offers up options for those who lose their health insurance unexpectedly. The article gives the example of a 30-year old woman who lost her health insurance coverage when her father passed away in April. She has ulcerative collitis, a bowel disease that could cause serious complications without her medication and doctor visits. She found out that she had lost her health insurance when she tried to fill a prescription and her insurance was declined. It cost her $200 out of pocket just to buy the four pills that she needs for one day.
It’s not common for a 30 year old to have health insurance coverage under her Dad’s plan, so the woman in the example was lucky to have such a perk. In this particular instance, her Dad had carried individual health insurance with his carrier for so long that they allowed him to keep his daughter on his plan to age 31. She would have had to search for health insurance soon anyways, so she was likely already researching her options. If you don’t have health insurance coverage, you can shop for it at any time. The Health Insurance Marketplace open enrollment period is from November 15 to February 15, but the government dates aren’t necessarily written in stone. You can apply for a health insurance plan at any time when you have had a life change that took away your health insurance. You can also apply for health insurance with an individual health insurance company at any time during the year. Most companies have open enrollment periods similar to the government, but for a shorter period of time. You can make changes to your plan during that time, unless you have a life changing event some other time during the year.
Life changing events include death, the birth of a child, marriage, divorce, a change of income, relocation, or the sudden loss of health insurance. If any of these events happen to you, the government gives you a 60 day grace period to obtain health insurance in the exchange. You can get health insurance quotes from multiple companies here. You can also use an agent that works for one health insurance company or a broker that shops the health insurance marketplace for you. The last option is similar to shopping the market for health insurance with comparehealthrates.com. Medicaid and the Children’s Health Insurance Program are available to those with low income. COBRA is a health insurance option for people who have just lost their jobs, and therefore their health insurance coverage. If your parent dies and you lose your health insurance, there are options for you to find health insurance coverage. The woman in the article was able to get her insurance plan extended until August 1 so that her daily medication is covered, so she had a couple months to search for her own health insurance plan.
June 30th, 2014
Hobby Lobby is one of many companies who claim that the Affordable Care Act, aka “Obamacare”, is forcing them to do something they believe is unethical. In the article “Hobby Lobby: The Cost of Not Offering Health Insurance,” Andrew Abela and Irene Kim discuss the Supreme Court case Sebelius v. Hobby Lobby. Hobby Lobby’s argument is that the federal law has forced them to make what they call an impossible decision. They can either offer health insurance with coverage that they believe is unethical or they can pay fines to the government that they say could ruin their finances. A couple Justices have suggested that the company does have a third option which they haven’t considered. They could pay a $2,000 per employee fine and simply not offer their employees health insurance coverage at all. The Justices argue that the company wouldn’t be any worse off than with the first two options.
Hobby Lobby argues that in addition to paying the per employee fine they would also have to increase employee wages so that their employees could go out and purchase individual health insurance plans. But Justice Kagan said that whether the company chooses to offer health insurance plans that are against their religious beliefs or chooses not to offer health insurance to their employees and pay a fine, their costs will be just about the same. That is certainly debatable.
If the company were to stop offering health insurance plans to their employees, they would have to increase employees’ after tax pay by the approximate amount that it would cost for them to purchase their own health insurance. Premiums will cost more for a lot of individual and family plans than the discounted rate that Hobby Lobby would have received for a large group health insurance plan. In addition to higher premiums, individual plans typically have higher deductibles that they company will have to account for in their salary increases. Between the salary increases and the $2,000 per person penalty for 13,000 employees, the article estimates that Hobby Lobby will pay $60 million each year if they choose this option. That estimate is quite a bit more than the company would pay to offer their employees health insurance. But finances are not the only thing the company needs to consider. A loss of health insurance could decrease employee morale, even with a salary increase to pay for individual health insurance. The company also has a religious belief that they need to take care of their employees. Hobby Lobby will likely continue their fight against the federal government forcing them to offer insurance coverage for birth control that is against their religious beliefs.
June 28th, 2014
Increasing healthcare costs have been a bone of contention for years. This was long before the Affordable Care Act became law and it’s continuing after the ACA went into effect. One of the biggest problems that many consumers have is that it’s just not clear where the extra money they have to pay is going. The cost of health insurance premiums is rising much faster than our incomes, so healthcare is really taking a hit on consumer budgets. Consumer Reports’ David Butler wrote an article for Fox Business titled “Make the pricing of health insurance more transparent.” If consumers know why they are paying more money and exactly where their money is going, people might not be so angry about paying higher premiums. Or it might make the health insurance industry function in a better way so that money is used wisely. Health insurance companies are already getting ready to set their premium prices for next year.
The open enrollment period for signing up for health insurance in the government exchanges is less than five months from now. It would make sense that consumers get a taste of what premium costs are going to be before searching for health insurance plans. Health insurance increases before the Affordable Care Act were often extreme and there weren’t any safeguards in place to prevent astronomical premium increases. This is why millions of Americans chose to avoid purchasing health insurance and take the risk that they wouldn’t get sick. President Obama’s goal in creating the Affordable Care Act was to get more Americans insured. One safeguard that the law put into place was an oversight of premium rates at both the state and federal level. The Department of Health & Human Services has the ability to review premium costs and increases that they deem unreasonably high.
The government is trying to make health insurance premiums more transparent, so that consumers can see potential increases before they are hit with them. Unfortunately the timing has not been quite right. 2013 information was recently released, although we are already paying for those premium increases. Now would be a good time to see the potential increases for next year, before open enrollment and before health insurance decisions have to be made. Making the information public before increases go into effect allows consumers and states to determine if the increases are justified. Another problem is that some insurance companies say that their information is confidential, so we aren’t able to have access to any transparency. It’s frustrating for consumers to feel in the dark and out of control when it comes to health insurance premium increases. Consumer Reports hopes to change the system by requiring full transparency of health insurance premium increases before they come into effect. If you are having a hard time finding affordable health insurance, search for quotes here.
June 19th, 2014
Whether you are looking for a new health insurance plan or already have one, there are some typical mistakes people make that you should try to avoid. MSN Money just posted the article “Don’t make these 10 health insurance mistakes,” by Allison Martin of Money Talks News. It’s wise to consider these ten things even if you are not shopping for individual health insurance coverage because you are likely contributing some of your health care costs even in an employer sponsored plan. It’s rarely the best decision to simply choose the cheapest health insurance plan. You should consider much more than just cost. The first mistake that people make when it comes to health insurance is basing their policy decision solely on the premium and deductible costs. Keep in mind that if your plan covers 80% of hospital or surgical procedures, the 20% that you owe could add up to a large chunk of money.
Also make sure that you read the fine print in any potential health insurance policy. Some of the most important things to look for are in-network or out-of-network coverage, HMOs, PPOs, different coverage options and whether referrals are needed. If there is coverage that you know you need or doctors that you don’t want to leave, check that before getting a new plan. It’s a big mistake not to shop around for health insurance from different health insurance companies. Read reviews from customers and others who have worked with the company. Believe it or not, purchasing COBRA coverage is often a big mistake. You pay more than 100% of the plan cost, when you paid around 25% with your employer sponsored coverage for the same plan. It pays to shop for a less expensive health insurance option, even if it only ends up being temporary.
Some people make the mistake of purchasing too much insurance coverage. If you don’t see the doctor often, a platinum level plan might be too much coverage for you. In the health insurance exchanges, as well as with private health insurance plans, there are lower levels of coverage options from which to choose. Health insurance plans are not one size fits all. Many coworkers just choose what their friends in the company have chosen, even though their insurance needs might be very different. Do not make the mistake of not getting health insurance because you are healthy. You never know when you will need coverage and many hospitals no longer treat those without insurance. Make sure to ask for discounts for things like quitting smoking or being in a wellness program. It costs a lot of money to see a provider who is not in your network, so think carefully before seeing an out of network provider. Some people opt for health insurance plans that do not have prescription drug coverage. This is one of the most common items that people regret when choosing a health insurance policy. Avoiding these ten health insurance mistakes could save you thousands of dollars in the long run, so do your homework.
June 7th, 2014
A recent study done by the Commonwealth Fund found that health insurance premiums have been increasing for years. The nonprofit group performed this study to determine what had been happening in the health insurance industry before the implementation of the Affordable Care Act changes. They wanted to show the public the whole picture so that people aren’t blaming all of the health insurance increases on Obamacare. This information comes from Maggie Fox’s NBC News article, “Health Insurance Premiums Have Been Increasing Since 2008.” They studied health insurance premiums in the private health insurance markets. Those are the individual and family health insurance plans that Americans find and pay for out of their own pocket, not through a group or employer. The study found that health insurance premiums have been steadily increasing since 2008.
Individual insurance premiums increased by at least 10% per year from 2008-2010. We are still waiting to see what the premium prices will be for 2015, but most experts agree that they will be higher than this year’s prices. The study results point out that premium increases really cannot solely be attributed to mandatory changes brought about by the Affordable Care Act because premium prices were rising 10% per year before the law took effect. Premiums almost have to increase because health insurance companies have to cover much more than they covered before the ACA took effect. Insurers can no longer deny coverage to people with preexisting conditions either, so it costs them much more money to offer insurance plans. They can’t exclude maternity coverage from plans or charge cancer patients more for their insurance policies, so premium prices across the board are likely to increase.
State and federal run health insurance exchanges started offering plans this year. Before these exchange plans were an option, an estimated 14 million people bought individual health insurance plans outside of the workplace. This is either because they don’t have a job or their employer doesn’t offer them health insurance coverage. Eight million people have bought insurance plans through the exchanges this year, according to the President’s administration. A Gallup poll found that the number of Americans without health insurance went from 18% in December to 13.4% in May. It’s going to take years before we know the true effect of the Affordable Care Act on the health insurance industry, especially because of the plans that have been allowed to continue offering sub-standard policies for two more years. It will just be important to keep in mind that health insurance plans were rising before the ACA as well. Increases in 2008, 2009 and 2010 were 9.9%, 10.8% and 11.7%, respectively.
May 29th, 2014
There is a new partnership in central Florida that hopes to make it easier for Floridians to get health insurance and hospital care. They also want to improve Floridians’ overall healthcare experience. This includes the overall health of the community, the care they receive, and the per person cost of healthcare. According to Yahoo! Finance article, “US News & World Report’s #1 Hospital & NCQA’s #2 Insurance Company, Partner Together to Better Serve the Community,” this partnership has the potential to help a lot of people. It started as a way to bring the new Medicare Advantage plans to central Florida residents. Health First Health Plans was ranked 2nd in Florida by the National Committee for Quality Assurance for their Medicare Advantage Plans. They have consistently received 4.5 out of 5 stars by the Centers for Medicare & Medicaid Services.
Back in January of this year, Health First started working with Florida Hospital to reach a wider range of Floridians seeking Medicare Advantage plans. These particular plans are known as Florida Hospital Care Advantage. Florida Hospital was recently ranked #1 by US News & World Report for Florida hospitals. The partnership between these two organizations should help keep healthcare affordable and local for Florida residents. They are also looking to create sustainable community health systems. It’s important to keep up with healthcare reform changes, especially on a local level. The partnership between Florida Hospital and Health First will expand through different phases, the first of which was the Medicare Advantage plan phase. Although they started in central Florida, they will likely move to other regions of the state as well. If you are looking for more information about Florida health insurance, click here.
May 21st, 2014
A lot of people who get their health insurance from their large group employers might just be searching for insurance coverage elsewhere soon. While it certainly wasn’t the intention of the Affordable Care Act to make it more difficult for employers to offer insurance to their employees, that has been an effect of the health insurance mandate often referred to as Obamacare. In the Forbes article, “Obamacare Increases Large Employers’ Health Costs“, Sally Pipes tells us about recent study findings. S&P Captial IQ’s study determined that 90% of workers in America who currently have health insurance through a large employer will be searching for a policy in the government exchanges by 2020. That figure seems extreme, but the harsh reality is that the taxes, fees, and added insurance mandates placed on large employers are hurting them. Many of these employers simply don’t think that they can afford to offer health insurance if something doesn’t change. They are currently mandated to offer you health insurance plans, so that is something that will have to be considered as well.
Group health plan sponsors pay a new fee to help fund the government sponsored Patient Centered Outcomes Research Institute (PCORI). This organization tests the effectiveness of certain medical treatments and Medicare uses the results to determine what they will cover for their patients. Some skeptics worry that results could be twisted to support lower cost treatments over more effective, but higher cost ones. Another fee that large employers have to pay is a Temporary Reinsurance Fee. This fee is supposed to stabilize premiums in the individual health insurance marketplace. The American Health Policy Institute estimates that $15.3 million will be collected by this fee in just two years. In 2018, large employers will start paying a 40% excise tax on health insurance plans that are deemed “expensive”. Individual premiums above $10,200 and family premiums above $27,500 are considered “expensive”. One company estimates that this excise tax will cost them $378 million over the course of five years.
In addition to the direct taxes, there are indirect tax increases for employers as well. There is the mandate for companies to offer health insurance to full time workers within the next year or two. If they don’t, they will pay a fine. Companies also have to allow children to remain on their parents’ health insurance until the age of 26 now. That last mandate alone has increased employer insurance costs between 1 and 3%. Mandating full coverage of preventative care services, such as immunization and birth control is drastically increasing employer health care costs as well. The AHPI survey estimates large employer health care costs to rise by 4.3% in 2016, by 5.1% in 2018, and increase by 8.4% in 2023. This equates to hundreds of billions of dollars extra that large employers will have to shell out over the next decade or so.
Unfortunately, what this means to Americans with health insurance from their large employer is that their costs will likely increase as well. More than 80% of large employers have already increased their employees’ deductibles, or plan to do so soon. Some employers might stop offering health insurance altogether and pay the fine for not offering plans. They might actually save money by doing that, although employee morale could decrease from such a move. Companies may also offer incentives for sick employees to search for health insurance in the exchanges instead of using the company plan, saving both the employer and employee money. But if all of the sickest employees head into the health insurance exchanges, costs within those will increase for everyone. The potential destruction of employer health insurance plans was certainly not a goal of the Affordable Care Act, but it might just be a consequence. If you are worried about losing your employer health insurance, you can compare health plans and rates here.
May 13th, 2014
There was a time, not very long ago, that you were hard pressed to find health insurance as a pregnant woman. This pre-existing condition was the only reason needed for a health insurance company to deny a pregnant woman’s application for coverage. The Affordable Care Act has changed this former reality, according to “Health law gives pregnant women more options“. In the Associated Press article, it says that Medicaid will help to supplement private insurance plans bought in health insurance exchanges. Pregnant women who recently purchased private health insurance plans through the government exchanges will also be able to access Medicaid coverage from their state as well. This applies to lower-income women, but the income limits vary significantly from state to state. Some state limits are close to the poverty level, while others are more like a middle class income.
Did you know that Medicaid already pays for almost half of the births in the United States? This new expansion of Medicaid services to pregnant women will be effective in every state, even if they have not opted to expand their overall Medicaid system under the Affordable Care Act. Unfortunately the logistics of this Medicaid expansion are fairly complicated. States and the federal government are trying to iron out the details, so it is still complex for consumers to navigate. Overall though, it’s a good thing for women because they will end up paying less out of pocket. They have the option of using only their private health insurance, only Medicaid, or a combination of both plans if that is what will be best for their pregnancy scenario.
While the cost of insuring more women is going to be higher, there are anticipated lower costs overall. Taking care of a woman and her unborn child with good prenatal services helps to avoid the larger expense related to premature births and birth defects. Pregnant women without health insurance often don’t seek prenatal care and can’t be treated for problems that they don’t know exist. The Affordable Care Act made it so that health insurance companies must offer maternity coverage, even if the woman is seeking health insurance while she is already pregnant. For those lower-income women who bought private plans in the health insurance exchanges using federal subsidies, the original law stated that they were no longer eligible for Medicare. Then there was a ruling that said Medicare coverage did not meet the “minimum essential coverage” that the law requires because it is temporary and states can deny certain services. Now they can use their private plan along with Medicaid coverage. A woman might benefit from using both plans because her coverage will continue after she has the baby, but the Medicaid coverage could help with cost-sharing.
If you are looking for health insurance with maternity coverage, you can find affordable health insurance in any state.