Healthcare Blog

Posts tagged "health insurance"

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 , , , , ,

Goodbye Employer Provided Health Insurance

health insuranceAn article from Market Watch highlights Rick Lindquist and Paul Zane Pilzer, co-authors of “The End of Employer-Provided Health Insurance.” The book goes over why group health insurance is a thing of the past and why individuals, their families, and their employers are all benefiting from moving away from group health insurance options.

Group health insurance rates continue to rise and that’s where Zane Benefits steps in. Zane Benefits is not a health insurance company, but a company that administers defined-contribution plans. What is that you might be asking? It is a benefit plan that gives employees a set amount of money each month that they can use for reimbursement of their health insurance premiums. This plan allows employees to have choice in selecting their health insurance plan. The employer is removed from the selection and allows the employee to shop for an insurance plan that custom fits them and their family.

In Lindquist and Pilzer’s book they project that by 2017, the majority of small businesses will switch to defined-contribution. This shift is being led by small business owners, but they aren’t the only ones dropping health insurance and looking for other options. Verizon and AT&T leaked documents saying they were considering dropping health insurance plans as well.

With the potential savings benefit of this plan why wouldn’t all companies choose this option. Well simply said, you don’t know what you don’t know. Companies don’t understand how a defined-contribution plan could benefit them, not only savings on the part of the employer and the employee, but also helps employee retention as well. What employee wouldn’t want to choose their own health insurance rather than have somebody choose for them?

Read the full Market Watch article HERE and let me know if this is an option you would look into for your company!

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

Healthcare Cost Keeps Rising

Healthcare cost continues to rise and the Affordable Care Act (ACA) isn’t exactly affordable at all. The inflation of healthcare is rising faster than the American economies natural inflation rate. What is making healthcare rise faster than everything else? There are many contributing factors and one of the major ones is supply and demand. The demand for healthcare didn’t happen organically, it happened over night. When the ACA was passed the entire United States population had demand, but the supply stayed the same. Sadly the healthcare provider market hasn’t expanded much in response to the demand.

There are some new health insurance carriers that are trying to hedge their way into the market, but the successful ones get bought out by the larger more established companies. The inflation for healthcare is not just attributed to supply and demand though, it is also the result of political decisions and increased regulations as well as the cost of prescriptions, medical devices, and hospital care, according to an article on Forbes. Some of these were already an issue to rising healthcare costs before the ACA was passed, so why did congress put a 2.3% tax on medical devices under the ACA’s law? Doesn’t make much sense when you are trying to keep healthcare cost “affordable.”

Here is a graph that we pulled from Forbes comparing the natural rate of inflation against the healthcare rate of inflation. Will healthcare increases outrun our incomes if more competition doesn’t halt the monopolized lack of supply for the ever increasing demand? What are your thoughts on healthcare costs?

healthcare cost
Read the full Forbes article HERE

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

What is Zane Benefits?

Zane BenefitsHere at Design Health we partner with a company called Zane Benefits. As we continue to look at and promote small businesses I wanted to introduce you to one that is on the cutting edge of what healthcare is and will be. As group health insurance fades away you will see Zane Benefits name more and more often. What’s so innovative and great about this company and who are they? Let me tell you with their own introduction from their website, “Zane Benefits is the leader in individual health insurance reimbursement for small businesses. Since 2006, Zane Benefits has been on a mission to bring the benefits of individual health insurance to business owners and their employees.”

This company enables companies to save 20 to 60 percent annually compared to traditional employer-provided health insurance. That’s significant as the cost of group health keeps rising. How do they do that? Instead of companies providing a one size fits all plan to their employees and compensating them for all or a portion of the premium employees are now able to find insurance that fits their needs and cost on their own. Once the employee has chosen the plan that is best for them their company works with Zane Benefits to set up monthly healthcare allowances for each employee. The employee then supplies documentation to Zane Benefits to prove the healthcare they purchased is in compliance and once all documentation checks out the employee receives the reimbursement amount set by the company up to the full amount of the employees premium.

This is such a simple concept and one that is being embraced by many employers around the country. As a small business owner do you want your employees to have more choice as well as lessen the weight of rising group health costs on your back? It’s a new way of doing things and it’s better to be on the cutting edge of change rather than straggling in the door behind the curve. We are happy to speak to you about your options as a company. Let us know if you have any questions, and in the meantime check out Zane Benefits HERE


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Posted by Lauren Yeager in All Posts, Small Business 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 , , , , , ,

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 that you can read HERE.

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

What Is A Section 105 Plan?

Health insurance When the Affordable Care Act (ACA) was passed there was a lot of confusion on what companies could or could not pay for when it came to individuals health insurance plans. As employer sponsored health plan prices continue to rise companies needed another option. A section 105 plan enables employers to reimburse employees tax-free for their own individual health plan.

According to Zane Benefits, “Section 105 plans are a tax-advantaged employee benefit as outlined in the Internal Revenue Code section 105.” For an employer this means, reimbursements are tax-deductible and payroll taxes (FICA/FUTA) are lowered. This option is much better than offering employees a taxable raise that end up costing the company more to compensate for the taxes.  This ends up saving money for both employees and business owners, making it the perfect solution for small business health insurance.

As an employer there could be worry that an employee is taking advantage of the section 105 plan because the company no longer has knowledge of the health plans chosen by employees. With this type of plan an employee may only be reimbursed if they provide proof of their premium payment. Then the employee is reimbursed up to a set amount by the employer. This still gives control to the employer allowing them to decide what the money is spent on.

A section 105 plan is also tax free for the employee. As an employee enrolls in a qualified ACA health plan they are then no longer subject to the tax penalty at the end of the year for not having health insurance. Moreover they are paying for part or all of their health plan premium from the reimbursable funds given to them by their employer.

Do you have any other questions on sections 105 plans? Let us know and we would be happy to answer them.

Read the full article on Zane Benefits HERE



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