Healthcare Blog

Posts tagged "ACA"

The Question Presidential Candidates Must Answer

The Affordable Care Act (ACA) seems to be a topic of discussion for Presidential candidates. Will the ACA still presidential candidatestay intact once the next President is elected into office? What changes will be made to the ACA? The biggest question stated by an article on Bloomberg View is, “How would they (Presidential Candidates) protect people with pre-existing conditions? Left to their own devices, after all, insurers have an incentive to charge higher premiums to potential customers who already have chronic health conditions – or not to offer them coverage at all.”

What the ACA has done well is to ban the refusal of coverage for individuals with pre-existing conditions. To protect the insurance providers the ACA has required ALL individuals and families to obtain coverage. This prevents those that are healthy from only enrolling in healthcare when something goes wrong, then dropping coverage once they are well again. Otherwise premium rates would skyrocket. It’s taking the good with the bad so that everybody is able to obtain coverage.

Several conservative plans offer a different option and still help people with pre-existing conditions as well as provide better options to healthy individuals. The proposal provides tax credits to help those who don’t have employer coverage, requires insurers to offer the same terms for sick and healthy as long as they are continually covered, and creates high-risk pools for anyone else. There are also ideas of rewarding those with continual coverage with protection from premium increases.

Many of the proposed options are trying to remove most of the federal spending and regulation. Bloomberg View states later in the article, “One could expect the need for the high-risk pools and the regulatory protections to diminish. They address problems that in large part result from the way federal and state policies have stunted the growth of the individual market.” All of the proposals on the table focus on allowing a more functional market to emerge. I’m looking forward to seeing the changes and how the ACA will develop with a new POTUS in office!

Read the full article on Bloomberg View HERE

 

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , ,

Good Decisions For Small Business Healthcare

Under the Affordable Care Act (ACA) a small business above 50 employees is required to provide healthcare for healthcaretheir employees. These companies that have 50 or more full-time employees must provide health insurance to 95% of their employees and dependents up to age 26 or risk paying a tax penalty of $2,000 per full-time employee. An article on Forbes says, “many small businesses still do provide health care for their employees, either out of a sense of responsibility or out of a desire to attract quality candidates (or both).” Although, depending on how those plans are paid for you could run into some trouble.

Kelly Phillips Erb a writer for Forbes goes over ways to make the best choices as a small business to avoid that trouble. She states, “If it doesn’t make good fiscal sense for you to provide health insurance coverage for your employees, or if the coverage you do provide is less than ideal, consider setting up an additional health benefits plan. A Section 105 plan…allows tax-free reimbursements for expenses.”  She also goes on later to recommend using a broker and lists the benefits.

The biggest issue is that companies aren’t informed of their options and there ARE options. It is no longer just the black and white opt in or opt out group plans available to businesses. As a company are you informed of the different options available to you? Is your current situation still affordable? Let me know and in the meantime look at the recommendations from Kelly’s article on Forbes HERE

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Posted by Lauren Yeager in All Posts, Health Insurance, Small Business and tagged , , , ,

The ACA Boasts Fewer Uninsured

The Affordable Care Act (ACA) has boasted an increase in healthcare enrollment, which is to be expected as it’s Uninsuredmandatory. What do those numbers look like on paper though? In Colorado alone the uninsured have been cut by more than half over the past two years. The disheartening news is that the drop is due almost entirely to a surge in Medicaid enrollment, according to Biz Journals.

The Colorado Health Institute (CHI) and The Colorado Trust released its findings from the 2015 Colorado Health Access Survey and the increase in Medicaid enrollment was one of many things the survey revealed. Another is the way that Coloradans are buying health insurance. In a once employer-sponsored dominant healthcare market it showed 42,000 fewer workers receiving health insurance from businesses of 50 or fewer employees. This is a drop of 12% from the previous year. I’m not a betting woman, but I am betting this is due to the rising cost of employer-sponsored insurance and the fact that the ACA does not require companies that employee less than 50 to offer insurance. “That does not mean that fewer small-business employees are insured, however, as many of those workers have moved from group insurance plans to individual plans or to Medicaid, whose eligibility levels were expanded by the state in 2014”, said Michele Lueck, CHI president and CEO.

Ned Calonge, president and CEO of the Colorado Trust said, “The first big intent of the Affordable Care Act was to expand coverage. It’s achieved that. Those next pieces need the coverage piece to happen in order to work on that. We’re exactly where we need to be.” The numbers are there for individuals who are enrolled in healthcare, but now the number of under-insured individual’s needs to be looked at.

All in all the ACA has done well as its first goal was to insure Americans that were uninsured or under insured. What other areas of the ACA do you see that need to be fine-tuned?

Read the full article on Biz Journals HERE.

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , , ,

Pro or No Vaccine?

vaccinateThe battle continues from parents on Pro or No Vaccine. As the school year starts there are many children walking through the doors without their recommended vaccines due to medical, religious or philosophical reasons. Parents who are pro-vaccine believe that those that don’t vaccinate their children are putting their children at risk. Please inform me of something though, if their children are vaccinated they are no longer at risk, so why are they worried? It is the parents that don’t vaccinate their children that are putting each others children at risk and they all sit on the same side of the fence, so why the big issue?

The Centers for Disease Control and Prevention (CDC) suggests vaccination schedules for children and adults but there are no federal requirements. All states have their own policies to require children to be vaccinated, but parents are able to obtain exemptions. After a large outbreak of measles that originated at Disneyland in California those that don’t vaccinate have come under more ridicule. California and Vermont have now taken away the choice of parents to exempt their children for religious or philosophical reasons.

The possible excuse of not having or not being able to afford healthcare is eliminated as well due to the Affordable Care Act (ACA). Preventative care is typically covered at no cost to the individual and includes routine vaccinations against diseases. The CDC puts out a recommended vaccination list for all ages and can be found HERE. If it is an issue of healthcare coverage I urge you to look into health plans for your family to ensure that your family is protected if you desire to be.

If you are one that is anti-vaccination let me know, why do you choose not to vaccinate your child? If you do vaccinate your child please tell me, what are your thoughts on those that don’t and why you choose to vaccinate?

 

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , ,

1/3 The Healthcare Providers?

In a recent Washington Post article it was reported that, “Consumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage” This is not necessarily a negative though as the smaller networks are typically negotiated contracts with the healthcare provider to offer lower costs which results in a lower premium price.

Healthcare Providers
An analysis by Avalere Health said, “Compared with traditional employer coverage, exchange plans had networks with 42 percent fewer cancer and cardiac specialists; 32 percent fewer mental health and primary-care doctors, and 24 percent fewer hospitals.” As stated above the negotiated contracts between healthcare providers and insurance carriers helps control cost. There are plans on the healthcare exchange that provide broader networks, but you are paying for that network in higher premium.

The real issue is not that the network is small, but whether a doctor stays on the network for the entire calendar year. At Design Health we have seen instances where an individual signs up for their health plan in January and their doctor is in network, but by March the doctor has ended their contract and is no longer participating in that network. Unfortunately a consumer is locked into their health plan for the calendar year, unless there is a qualifying event, whereas the healthcare provider can jump ship.

Often times consumers are informed of the network access their health plan provides and understand that there are both in and out of network providers. When the consumer is informed they go to great lengths to make sure their provider is in-network so they do not end up with a full out of pocket payment for services. Although, for those not informed they believe they can go to any doctor because they have insurance. In this instance it doesn’t matter if the network is narrow or broad, if a consumer doesn’t do their research they run the risk of paying much higher prices.

Are you a consumer that understands your healthcare network? When you enrolled in healthcare did you make sure that your doctors were included in the health plan you chose?

Read the full article from the Washington Post HERE

 

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , ,

A New Job Doesn’t Mean A Qualifying Event

When the Affordable Care Act started, health insurance enrollment was limited to a three month cycle each year. For 2016 open enrollment is November 1st, 2015- January 31st, 2016, with the first date of coverage able to start on January 1st, 2016. Any enrollment outside of that time has to be triggered by a qualifying event (QE). Although, many Americans find themselves in a rock in a hard place as they are outside of employment and believe that they can get coverage when they start their new job. Unfortunately a new job is not considered a qualifying event.

First I will explain why we now have open enrollment. Before the ACA individuals were dependent on medical underwriting for health insurance. The insurance carrier decided if the individual was qualified to purchase health insurance, and had the possibility of being denied coverage. After the passing of the ACA all policies are considered guaranteed issue, meaning that nobody has to qualify to have health insurance. If you are a living and breathing individual you now qualify. This puts a greater risk on health insurance companies as they are now insuring individuals with no prior knowledge of their health status. Open enrollment protects the health insurance companies to instill confidence that an individual will not  enroll in a policy then drop their policy as soon as they have completed their medical needs.  Thus creating a need for a Special Enrollment Period (SEP) for life events outside of the three month cycle.

qualifying event timeline
When I think of a QE I think of anything life changing like a move, marriage, baby, and a NEW JOB, but the ACA does not consider having a new job as a qualifying event. A QE gives an individual a sixty day SEP to enroll in a new plan or change their current plan. If you have ever had employee sponsored group insurance then you should be familiar with this type of enrollment, but those that haven’t could be caught off guard.

As you go into 2016 the best way to make sure you and your family are covered is to enroll within open enrollment dates. This way you can see if you are eligible for a subsidy (tax credit) to help with the cost of your health insurance and ensure that you and your family are covered. This will also remove doubt that the “qualifying event” that you were relying on to make changes to coverage or obtain new coverage from is not truly a QE.

If you do find yourself in this specific circumstance all is not lost as you can look into short term policies to cover your family, but these policies will not keep you from a tax penalty at the end of the year. If you have questions on what a qualifying event is there is a great article on HealthInsurance.org that you can read HERE.

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Posted by Lauren Yeager in All Posts, Did You Know? and tagged , , , ,

Less Than A Month Away For A January 1st Enrollment Date

There is less than a month left for a January 1st start date so don’t miss out on the December 15th enrollment deadline. If you are someone that understands health insurance plans backwards and forwards then you are way ahead of the game, but many Americans do not understand the other language that is “health insurance.” I encourage you to reach out to a broker that is well versed on the language and let the help you understand.

Once you enroll in a health plan during Open Enrollment for 2016 you are locked into that plan for the entire calendar year unless you have a qualifying even like a birth, marriage, or major move. open enrollmentOpen Enrollment goes through January 31st this year.  The important deadlines and dates to remember are:

November 1st, 2015: First day to enroll in a health plan for a January 1st, 2016 start date.

December 15th, 2015: Last day to enroll in a health plan for a January 1st, 2016 start date.

January 1st, 2016: First day of coverage for those that enrolled in health plans from November 1st, 2015-December 15th, 2015

January 15th, 2016: Last day to enroll in a health plan for a February 1st, 2016 start date.

January 16th-January 31st: Enrollment days for a March 1st, 2016 start date.

January 31st: The last day to enroll in a health plan for 2016 without a qualifying event.

Check the HealthCare.gov website HERE for all dates, deadlines, and news for Health Plans.

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Posted by Lauren Yeager in All Posts, Did You Know?, Health Insurance, In The News and tagged , , , ,

Help is Coming for Small Businesses

houseWhen the ACA was written the law has come with its fair share of challenges and there have been many changes. When the law was passed the I.R.S. drafted a regulation that imposes fines on small business for doing what the very law is meant to do, help individual and families afford health insurance. Kevin Kuhlman, policy director for the National Association of Independent Business said, ” Reimbursing employees for the cost of insurance or medical services is a way for small businesses to help their workers without the administrative headaches of setting up a costly group plan.” The IRS has said for doing so they will impose a $100 a day, per employee fine, that’s $36,500 per employee a year.

Congress is trying to modify the rulesenate with H.R. 2911. There is also legislation in the Senate, S.1697, to modify the rule. With bi-partisan support for modifications there is hope that action will be taken quickly.  Kuhlman stated later, ” There’s no real justification for penalizing small businesses that do what the law’s strongest supporters claim to want, which is to help employees obtain coverage or pay medical bills…” There is a anticipation that this modification as well as many other modifications to the ACA will take place now that the King Vs. Burwell case has been ruled on.

Here at Design Health we have immersed ourselves in the laws and regulations that surround the ACA, and there is a solution for small businesses to provide a reimbursement to employees for individual health insurance compliant with the ACE. Read more about this solution on ZANE BENEFITS

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Posted by Lauren Yeager in All Posts, In The News, Small Business and tagged , , , , , ,

Did You Know, Not All Doctors are In Network?

doctorIn network Dr.You enroll in your health plan and choose an option that is affordable and seemingly everything you are looking for, but is it really? I come from personal experience when I discuss this as I was extremely naive to how health coverage works when I first started working in this industry.

I received my health cards last year and noticed a doctor printed on my card but failed to look at the fine print. I thought nothing more of what was printed on my card.  A few months later I was sick and needed to see a doctor, so I called a providers office that a friend of mine had recommended and asked if they took my health insurance and was told YES. When my bill came that was not the case, they accepted my carrier, but not my specific plan.
I now know to make sure I see an IN NETWORK doctor so I am not paying a full out of pocket expense and the health plan that I enrolled in can be utilized. I advocate for using a broker to help you find your health plan as they can check to make sure the Dr.’s and facilities that you want to have access to are covered on the plan prior to enrolling. Don’t get stuck like I did between a rock and a hard place. Do the research to save yourself the frustration and cost. Have you run into an issue of seeing an out of network doctor and been stuck with the entire bill as I was?

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Posted by Lauren Yeager in All Posts, Health Insurance and tagged , , , , , , ,

Open Enrollment Starts Today

Open Enrollment is here for 2016 health plans. According to an article on The Street, individuals spend less than 30 minutes researching their benefits. If you are someone that understands health insurance plans backwards and forwards this sounds like a decent amount of time to spend, but many Americans do not understand the other language that is “health insurance.” This kind of care less response to choosing something incredibly important could have a huge impact when you find yourself filing claims for a medical procedure that you weren’t expecting.

Once you enroll in a health plan during Open Enrollment for 2016 you are locked into that plan for the entire calendar year unless you have a qualifying even like a birth, marriage, or major move. open enrollmentOpen Enrollment goes through January 31st this year.  The important deadlines and dates to remember are:

November 1st, 2015: First day to enroll in a health plan for a January 1st, 2016 start date.

December 15th, 2015: Last day to enroll in a health plan for a January 1st, 2016 start date.

January 1st, 2016: First day of coverage for those that enrolled in health plans from November 1st, 2015-December 15th, 2015

January 15th, 2016: Last day to enroll in a health plan for a February 1st, 2016 start date.

January 16th-January 31st: Enrollment days for a March 1st, 2016 start date.

January 31st: The last day to enroll in a health plan for 2016 without a qualifying event.

In a recent Aflac survey it was found that many people would rather complete tedious chores than research benefits with 38% who would rather clean out their email inbox, 23% would rather clean their toiled, 21% would rather pull weeds, 18% would rather do their taxes, and 12% would rather have a dental cavity filled. These tasks are ones that nobody in their right mind would sign up to do, but in comparison to choosing a health plan people chose that over their health plans. If choosing a health plan is that daunting to you then it’s encouraged to seek out a broker that has familiarized themselves with the ins and outs of health plans. Moreover they can break down the “health insurance language” into plain English allowing you to shop your health plan with understanding.

If you have had issues this year with your health carrier or your health plan make sure this year open enrollment is easier and seek out somebody whose job it is to understand each plan and what, who and how much it covers.

Read the full article on The Street HERE

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Posted by Lauren Yeager in All Posts, Did You Know?, Health Insurance and tagged , , , ,