Category: Insurance News & Topics


Amid much confusion, the glitch-filled health exchanges opened this month but technical problems have hampered enrollment in the online health insurance exchanges.  The problems resulted from the failure of a major software component, designed by private contractors, that crashed under the weight of millions of users.   The failure occurred in the part of the web site that lets people create user accounts at the beginning of the insurance sign-up process. The crash prevented many people from viewing any of their insurance options or gaining access to information on what federal subsidies might be available.

In some cases, the Web site does not recognize those who created accounts before Oct. 1, when the online marketplaces opened for consumers to shop for insurance. In other instances, users are prevented from establishing accounts.  Some who successfully established a marketplace account received an e-mail asking them to verify their e-mail addresses, but the link provided doesn’t work.

As the private contractors struggle to recover from the Web site’s failures, the partial shutdown of the federal government is also impacting the debut of President Obama’s health care law and has slowed work on a federal insurance marketplace for residents of more than 30 states.

The partial government shutdown has also hindered the health exchange rollout in other ways.  All insurers participating in the federal exchange are assigned an account manager, who serves as the primary point of contact with the exchange and assists insurers by clarifying their responsibilities, answering questions about web site, enrollment transactions and other operational matters.   But many of the account managers have been furloughed in the shutdown-leaving insurers with little help during the confusion.

As if that weren’t enough to make the health exchange debut a rocky one, regulators warn that the exchanges debut opened the door for those who would seek to line their pockets by misleading consumers.  The National Association of Insurance Commissioners advised consumers that bogus sites have been spotted and warned people to beware of unsolicited calls by people claiming they need personal information to help them enroll in the insurance exchange.

New Hampshire’s insurance commissioner sent a cease-and-desist letter to an Arizona company he accused of building a website to mislead health care shoppers into thinking it was the official marketplace. The site has since been taken down but more are popping up all over the web.  Regulators in Washington state and Pennsylvania have also ordered that some websites be changed that seemed likely to mislead consumers.

It’s safe to say the health exchange’s long awaited debut has not gone as planned.  Many feel that money would have been better spent ensuring the site could handle the high volume of traffic or prevention of misleading copycat sites rather than on celebrity endorsements.   America will have to wait out these glitches to see if the Affordable Care Act is here to stay.

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Colorado has released its’ insurance rates for the state health exchange which opens Oct. 1st to help customers shop for insurance. The health insurance exchange, called Connect For Health Colorado, has also hired “navigators” to explain the health insurance options at health fairs and community events to those shopping for insurance.

The Division of Insurance released rates of plans that comply with the health care overhaul. Eighteen insurance companies will offer 541 separate plans for individuals and small groups.  For the average individual customer, monthly premiums will range from $177 a month to $774 a month. The wide range of rates depends on the level of coverage and where in the state a person lives.

Each plan is categorized by the amount of coverage offered and are named accordingly with platinum plans offering the most extensive coverage, followed by gold, silver and bronze.  The ratings are based on the percentage of a person’s health expenses that the insurance will pay, compared with how much a person pays out of pocket in deductibles, co-pays and co-insurance.

A platinum plan would cover 90 percent of health expenses and the customer would pay 10 percent out of pocket. Gold covers 80 percent of health expenses, silver covers 70 percent, and bronze covers 60 percent, according to the Kaiser Family Foundation, an independent health policy institute.By 2015, insurers will also be charging different rates for smokers and nonsmokers.

The Insurance Division also approved rates for small group plans, affecting businesses with more than 50 employees. For the least expensive small group plan, monthly base rates for premiums range from $224 with Kaiser Permanente to $1,003 with Humana Insurance Co.   Rates were also released for 221 kinds of optional dental insurance. For individuals, the dental premiums range from $16 a month to $67 a month, again depending on level of coverage and location in the state.

Colorado has about 716,000 people without insurance. Many of them will be eligible for free health care through Medicaid, or subsidized health insurance depending on their incomes. Coloradans who aren’t eligible for free health care but choose to skip health insurance altogether will be fined at least $95 next year, with fines going up dramatically in subsequent years. 

Many Americans will find themselves in a category of people whose incomes exceeds that which qualifies them for Medicaid coverage yet is still not enough to afford insurance coverage through the exchanges.  Those that fall into this category known as the “Medicaid Gap” will likely opt to go without coverage and pay the fines imposed by the federal government.  This is expected to cause premiums to skyrocket because the ACA was not set up for only sick people buying coverage while the young and healthy opt to pay a fine. 

With the Oct 1st Health Exchange debut getting closer, many Americans are anxious to see what the future holds for The Affordable Care Act.

The legislation that authorized the Health Coverage Tax Credit (HCTC) expires on January 1, 2014; and the tax credit will no longer be available.  The HCTC was designed to make health insurance more affordable for eligible individuals and their families by paying 72.5% of qualified health insurance premiums.  Visit this page http://www.irs.gov/Individuals/The-Health-Coverage-Tax-Credit-(HCTC)-Program  to find out if you’re eligible and use the links to help determine if the monthly or yearly option works best for your family.

As of October 1, 2013, the HCTC Program will no longer accept new registration forms for individuals or qualified family members who wish to be enrolled into the monthly HCTC program. Forms received by October 1st that include all the required supporting documentation will be processed in a timely manner.  If you meet all HCTC eligibility requirements and continue to pay premiums directly to your qualified health plan during 2013, but do not meet the October 1st registration deadline, you can claim the Yearly HCTC by filing Form 8885, Health Coverage Tax Credit, with your 2013 federal income tax return.

Finding out if you qualify and filing the necessary documents before the deadline is especially important for individuals and families who intend on shopping for health insurance coverage on the health exchanges but can’t afford the monthly premiums each month.  Otherwise, these individuals will have to wait until they file their taxes for a reimbursement. 

If you aren’t sure if you qualify, visit the link provided to find out and apply now before the deadline-especially if you’re worried about how you’ll pay for monthly premiums.  If  your documents are filed before the Oct 1st deadline, the tax credit is instant and will help individuals afford their monthly premiums.  This does not affect those who get insurance through their employers. 

Families eligible for tax credits to help purchase health insurance in the new exchange created by the Affordable Care Act will receive an average of $5,548 in instant tax credits.  These instant tax credits will be available to people earning less than four times the poverty level–about $94,000 for a family of four. This means that 48 percent of people who currently buy insurance for themselves will be eligible for reduced premiums. Eligible families will receive an average of $5,548 per family. When all consumers are taken into account, the average subsidy is $2,672 per family.

The new marketplace or Health Exchanges open on October 1 for consumers to shop for health insurance for coverage starting in 2014.   These subsidies will reduce monthly premium costs by about 32 percent for people buying individual health insurance coverage through the exchange. The immediate credits will apply directly to individuals’ and families’ premiums, making coverage instantly more affordable for those who do not get health care through their employer.

 

On Monday August 5th, Connecticut residents  got their first at the price of health insurance plans to be sold on a state public health exchange this fall for coverage next year.    Health insurance premiums have to be approved by the department before they can be sold on the health exchange, called Access Health CT.

The process started in May when insurers such as Aetna, Anthem Blue Cross and Blue Shield of Connecticut, ConnectiCare, UnitedHealthcare and HealthyCT submitted their proposals for health plans to be sold through the new online health exchange.  The state Insurance Department regulators reviewed rates proposed by insurers, made modifications to them and released all of the approved monthly rates.

In Connecticut, anyone can shop for health insurance starting Oct. 1 on Access Health CT to buy coverage for the 2014 calendar year. People who already have health insurance through an employer or a government-funded plan, such as Medicare or Medicaid, are not affected and may keep the coverage available to them.

Each plan is categorized by the amount of coverage offered and are named accordingly with platinum plans offering the most extensive coverage, followed by gold, silver and bronze. Platinum rates were not published yet.  The ratings are based on the percentage of a person’s health expenses that the insurance will pay, compared with how much a person pays out of pocket in deductibles, co-pays and co-insurance.

A platinum plan would cover 90 percent of health expenses and the customer would pay 10 percent out of pocket. Gold covers 80 percent of health expenses, silver covers 70 percent, and bronze covers 60 percent, according to the Kaiser Family Foundation, an independent health policy institute.

According to the Access Health CT website http://www.accesshealthct.com/ the lowest-cost plans for individuals are offered by ConnectiCare Benefits Inc. They have been approved to sell individual plans at the following monthly base rates: $215.17 for bronze, $269.66 for silver and $309.64 for gold. These are base rates only and could be different for individuals based on age and where a person lives in Connecticut.

Anthem and HealthyCT also were approved to offer individual plans on the state exchange.  Anthem’s rates were $236.59 for bronze, $299.21 for silver and $346.91 for gold. HealthyCT’s rates are $245.45 for bronze, $310.02 for silver and $321.22 for gold. Aetna withdrew its application Friday after rejecting the Insurance Department’s modifications to its rates.

The base rates don’t take into consideration federal discounts, or subsidies, for people whose income is as much as 400 percent of the federal poverty level. The discounts are offered on a sliding scale for individuals earning as much as $44,680, or for a family of four earning up to $94,200.

 

The insurance giant Aetna, Inc. which offers one of the largest nationwide networks of Doctors and Hospitals has dropped out of the Georgia, Ohio, Maryland and Connecticut state health exchanges.  Aetna policy holders who acquired coverage through an employer will not be affected but those shopping for individual policies through the exchanges will now have less plans to choose from.

Health insurance exchanges are being created under President Obama’s health care reform law.  Under the law, often called Obamacare, states will have an online exchange where Americans will be able to buy insurance plans, starting on Oct. 1.

Aetna was one of several carriers poised to sell through these exchanges but withdrew their applications to offer policies through the exchanges.  A company spokesperson stated that cuts made by insurance regulators to the rates they had proposed would not allow them to collect enough premiums to cover the cost of the plans.  The decision was not taken lightly and was part of a national review of our exchange strategy.  Aetna and the Insurance Departments’ disagreed over how Aetna’s proposed rates were calculated.

Aetna CEO Mark Bertolini said the company was cautious about the rollout of the exchanges and was considering whether to cut back on its participation in them in 14 states.  In May, they announced the decision to hold off on joining the California Health Exchange.  In time, they may decide to participate once they are able to see how the exchanges are run and can better evaluate how they can participate.  Aetna still plans to participate in private exchanges being run by benefits companies and are currently working on launching its own exchange for Aetna products. 

Aetna headquarters is based in Hartford, CT and provides health care, dental, pharmacy, group life, disability, and long-term care insurance and employee benefits, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. It’s estimated that they cover over 18 million members nationwide.  More of their business is focused on large employers, where consumers receive their health coverage through employer sponsored health plans.

 

Many states are still in ongoing debate’s because last year’s Supreme Court ruling that the Medicaid expansion was an option, not a requirement, has left the decision up to state lawmakers.  According to supporters, the Affordable Care Act requires three key elements to its’ success; setting up a health exchange, expanding Medicaid and providing a basic health plan for those whose income falls between qualifying for Medicaid and being able to afford health insurance through the exchanges. 

So far, the only state to provide all three elements is Minnesota.  While other states have created exchanges and will expand Medicaid programs, none have created a basic health.  Many believe Medicaid expansion is needed for the ACA to work but not all state lawmakers are ready to make that change. 

Some state lawmakers argue that they simply can’t afford to expand their Medicaid program while opponents argue it can only help low income residents.  Some states are tangled up in political debates over issues like financing and dependency on the government.  To complicate things, there’s no deadline for states to decide whether to expand Medicaid, although Americans will have to make decisions about their own coverage by Jan. 1 when the Affordable Care Act goes into effect.

Options are limited for many poor people in states that don’t expand Medicaid.  Those who are below the poverty level won’t be eligible for tax credits which means those in non-expanding states will still be uninsured, even as their wealthier neighbors qualify for tax credits to buy coverage. 

Twenty-six states and the District of Columbia have decided to expand Medicaid.  Many states are expanding through plans they have built as a compromise to the federal government’s expansion plan.  Arkansas, Tennessee, Indiana and Iowa are also expanding Medicaid but through a “model” plan which covers newly eligible enrollees with health insurance policies offered through the exchanges with the federal government agreeing to cover 100% of the premiums for the first three years.

New Hampshire and South Dakota have thrown the issue to committees. Utah is looking at a system proposed in Arkansas that would allow poor people to buy private insurance with Medicaid dollars. In Arizona, where expansion was pushed through recently, a move is afoot to repeal it.

Pennsylvania lawmakers have flip flopped on whether to expand Medicaid, first vowing to oppose it, then coming up with a compromised plan only to veto it all together.  State officials say they still have plans to keep up negotiations with the federal government over a potential Medicaid expansion in Pennsylvania. 

In Florida, lawmakers supported a plan to take the federal money and let Floridians obtain insurance through a state-subsidized system. Some House members insisted on an alternate plan to use $300 million in state money to buy basic coverage for 130,000 low-income residents but in the end, the two chambers were unable to make a deal — and passed on billions of dollars in federal funds.  Although federal officials renewed calls for Florida lawmakers to accept an estimated $50 billion over the next 10 years to expand Medicaid, debate sessions in that state are closed until the Fall.  An estimated 1.2 million people in Florida who would be left with no coverage at all because of assumptions in the healthcare law that states would expand Medicaid.

It’s estimated that one in four adults experience a mental illness during the course of a given year-that’s about 55.7 million people.  Many Americans believe the Mental Health Care System in this country is a broken system in need of an overhaul in order to sufficiently treat patients.  While the Affordable Care Act’s goal of having every American insured may help provide coverage for such care, the system in which they receive it is flawed.  

Mainly due to a severe shortage in Mental Health Care Professionals and because the cost of care is unaffordable-leaving millions untreated.  The Bureau of Labor Statistics estimated in 2010 that the country had 156,300 mental health counselors which shows that access to mental health professionals is worse than for other types of doctors.  Eighty-nine million Americans live in federally-designated Mental Health Professional Shortage Areas, compared to 55.3 million Americans living in similarly-designated primary-care shortage areas.

According to a study in 2011, the United States spends $113 billion on mental health treatment which is about 5.6 percent of the national health-care spending.  But when budgets are cut, mental health care always seems to make it on the table.  Over $4.3 billion has been cut from state mental health budgets in the past three years, even as private practices are shrinking.  Many providers no longer take insurance because it does not cover their costs.  The mental health-care system in the United States is a multibillion-dollar industry that is still not big enough to serve all those who need it. Costs are a big barrier to treatments — but so are attitudes about mental health.

A quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, according to one survey that looked at services from 2005 to 2009. The majority of those who did seek outpatient treatment had out-of-pocket costs between $100 and $5,000.  A study showed 47 percent of those who suffered a mental illness but did NOT seek treatment cited cost as a barrier.  Sadly, 66 percent surveyed said the decision also had to do with attitude.  They thought the problem would get better on its own or that they could solve their own issues.

The ACA has provisions that will help many Americans afford care more easily, such as making mental health & substance abuse one of the “essential categories” of coverage on all plans, wiping out the pre-existing condition clause and providing tax credits to better afford coverage.  The major road blocks we still have not overcome are the attitude toward mental illness, how it should be treated and the severe shortage of professionals in the industry. 

 

 

 

 

One state set to reap some benefits of the Affordable Care Act is New York.  New York state residents will be able to get health insurance coverage thru the health exchanges for half the cost of plans today.  The health exchanges, a key element of the ACA, are set to open in October with coverage beginning in January 2014.  The ACA will require people to obtain insurance coverage in the New Year or pay a penalty. 

The New York rates are the latest to be disclosed as state and the federal government gets ready to enroll residents in state-based exchanges.  While coverage varies in each region, all of the state will see a 50% decrease in premiums.  The cost of a “silver” plan — which covers at least 70% of medical costs, on average will drop to as little as $359 a month for a single adult Manhattan resident according to a rate sheet recently released by state officials.  Right now, the cheapest plan a city resident can buy on the individual market is around $1,000.  Health care costs per capita are about 18% higher in New York than elsewhere in the nation.

Seventeen insurers will offer coverage thru the exchanges, which will come in four tiers.  The bronze plan, the lowest and cheapest, the silver, gold and platinum (the most expensive). Each plan will have a standard set of benefits, allowing people to choose between insurers based on price.

According to state officials, the plans will also differ on the range of doctors and medical facilities included in their networks.  The wide spread decrease in premiums for next year is largely because insurers have to base their 2014 rates on models and not actual costs.  Officials expect the differences to narrow in the future.

The significant decrease in rates in New York will likely not be seen in many other states because New York is one of the few states that already required many of the basic benefits of the ACA.  The state does not allow insurers to reject people because of pre-existing conditions and required every plan to provide a standard set of deductibles, co-pays and benefits, including hospital care, lab tests and prescription drugs.

Only 17,000 New Yorkers buy their own insurance right now, while 2.6 million people lack coverage.  The state is expecting more than 600,000 people to enter the exchanges, with about 70% of them eligible for federal subsidies. 

 

Idaho’s Medicaid expansion may help businesses.  According to the Idaho Association of Commerce and Industry, a decision not to broaden Medicaid’s reach would cost between  $12.3 million to $18.5 million a year in penalties for large companies that don’t insure their employees and unspecified amounts for other businesses as their insurance and taxes continue to subsidize care for the uninsured.

The Affordable Care Act required states to expand their Medicaid programs, though last year’s Supreme Court decision made that expansion optional.  At any point Idaho can decide to offer Medicaid to its poorest adults, but lawmakers have made no moves toward expanding the program by next year.  Under the expansion, a single person working 30 hours a week at minimum wage or less, would qualify for Medicaid coverage.

Idaho has the largest portion of minimum-wage workers in the nation, with about 1 in 13 employees earning minimum wage ($7.25 hourly) or less.  Many can’t afford health insurance and starting in 2015, employers may face the choice between offering them insurance or paying a large fine.  Businesses with 50 or more full-time equivalent employees must offer health insurance benefits starting in 2015 or be subject to federal tax penalties.

If their employees qualify for Medicaid, the businesses wouldn’t have to provide health benefits and would avoid the fines.  Idaho’s decision on Medicaid expansion could provide a multimillion-dollar savings for the state’s businesses since many full-time employees would qualify.   Right now, there are few who qualify, leaving them uninsured and their employers facing huge fines in the future. 

According to U.S. Census Bureau data from 2009, about 91,000 Idaho residents between ages 18 and 64 had incomes low enough to qualify Medicaid under an expanded system.   Nearly half of them were without any insurance coverage.

The Medicaid program would gain thousands of patients, many with untreated chronic illnesses. Federal taxpayers would pay 100 percent of the cost for the first few years, then shift slowly to the state, with the state required to pick up 10 percent starting in 2020.  If Idaho based businesses don’t offer low-premium plans to workers, they may be fined thousands of dollars for each employee who buys a subsidized health plan to comply with the rule that all Americans be insured—a substantial cost that could force many businesses to close their doors.

 

 

With many Americans still uninformed about the changes brought about by the Affordable Care Act, two large corporations have teamed up to educate consumers.   Deerfield-based Walgreen Co. and the Blue Cross and Blue Shield Association, an umbrella group for state-based Blue Cross plans across the country, launched a national educational campaign on the health care overhaul law in an effort to bring consumers up to speed on the coverage they’ll soon be required to carry.

With open enrollment for health insurance exchanges less than three months away, the nation’s largest drugstore chain and the largest association of health care plans in the country have joined forces in a campaign labeled the largest effort by any entity to promote the health care law.  The focal point of the campaign is to encourage people to use state-based insurance marketplaces to shop for health coverage.  The new campaign uses in-store advertisements and informational brochures that direct consumers to a new website, http://www.learnaboutreform.com 

Walgreen relied upon Blue Cross for state-specific information in the promotional materials, but it does not direct customers to the insurer’s plans or make specific coverage recommendations.  The campaign hopes to offer a resource of user friendly information about the health care reform changes for the estimated 6 million people visit who visit one of Walgreen’s  8,500 stores each day.

Even without a direct benefit for the association, it stands to gain from the campaign to raise awareness of the exchanges. Many of its 38 state and local health plans have committed to providing plans on the state-based insurance marketplaces next year.   The campaign is not expected to be a direct revenue generator for the chain but much is at stake for health care providers like Walgreen, which stand to gain millions of new customers under the law.

Hopefully the campaign will help educate some of the millions of Americans that don’t understand the changes coming their way.