Tiptastic Tuesday: Medicare Advantage Plans To Go Up 1.25% In 2016

In a recent press release, CMS said that benchmark payment rates for Medicare Advantage health plans will increase by 1.25% on average in 2016. When factoring in the expected growth of risk scores coded by insurers, it is expected that payments will go up 3.25% on average. CMS also said that it will calculate 2016 Medicare Advantage risk-adjustment scores entirely under an updated model, decreasing rates paid to insurers. Medicare Advantage plans use a risk-coding model to adjust for different demographics and conditions. Each beneficiary’s health status incorporates the different categories to predict their future healthcare costs, and the risk score is then multiplied by the baseline rate to determine how much a plan will receive for a specific beneficiary.

Click here to see the press release.

Click here to view the CMS fact sheet.

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CT Bill Puts Limit On Patient Copays For Physical Therapy Services

On July 12, 2013, Connecticut Governor Dan Malloy signed into law HB 6546 (Public Act No. 13-307), which places a limit of $30 per visit on patient copays (for certain health insurance policies) for services provided by in-network physical therapists. This law has been in effect since January 1, 2015.

Click here for more information about the bill.

Tiptastic Tuesday: Dealing With Changes In Insurance Plans

There are big changes in the works for patients’ health insurance plans. If you’re worried about how staff will handle changes, look no further. We have a few suggestions you can implement to help your staff with plan changes.

These days, most patients have out-of-pocket expenses for office visits. Staff also has to help patients understand their new plans, verify coverage and answer other questions they may have. In order to properly train your staff, personalize the approach. A one-size-fits-all approach is usually not the most effective method.

Conduct individual training sessions with each employee. Explain changes, show them websites they can use to verify insurance and make sure they are signed up to access the sites. In a matter of time, your staff will start feeling much more confident about helping patients navigate their new insurance coverage!


That’s A Wrap! The Affordable Care Act, One Year Later Series Comes To An End

Throughout the month of October, HMS has explored the ins and outs of the Affordable Care Act. Our The Affordable Care Act, One Year Later Series has investigated both the positive and negative aspects of the new health law. It’s been one year since the implementation. Overall, how has the ACA impacted healthcare in America? Our final post in the series will examine if the health law did, in fact, do what it was intended to do-which is reduce the number of Americans without health insurance, make health insurance more affordable, and make Americans healthier.

According to a recent New York Times article, the ACA has indeed reduced the number of Americans without health insurance.  Although a perfect measurement of the number of people affected by the law is still difficult, most private sector surveys and government reports, including a Gallup poll, The Commonwealth Fund, and a CDC survey, reach the same basic estimates. The number of uninsured Americans has been reduced by 25 percent this year-that’s eight to 11 million people. More than half of that appear to be the newly insured who have signed up for Medicaid. Others are enrolled in private health plans through the new state insurance marketplaces. Three to four million people, mostly young adults, also became newly insured through ACA provisions that kicked in. The Congressional Budget Office estimates that by 2017, approximately 26 million more Americans will become insured through the law (lower than previously estimated).

Another question we all have: Is the Affordable Care Act actually affordable? According to the Obama administration, eighty-five percent of those who signed up during enrollment period qualified for federal subsidies to help pay premiums. The subsidies are estimated to have lowered the cost by 76 percent on average. However, the law has also required insurers to provide more benefits to cover people with pre-existing conditions, subsequently causing premiums to rise for some of those who already had insurance. Others plans were canceled or were not eligible for subsidies. On a more positive note, it has also been reported that premiums may actually become lower in the next year due to spurred competition among insurers.

Lastly, has the ACA made us healthier? Most experts believe it’s still too early to know. How will the ACA fare in the long run? Only time will tell!

*You can start shopping for health insurance on Saturday, November 15. If you want coverage to start on January 1, you’ll have to buy it by December 15. If you  miss the December 15 deadline, you can buy coverage, but it will not take effect until February 1 at the earliest.

Tiptastic Tuesday: 3 Ways To Improve Health Insurance Literacy

According to a recent survey conducted by the Associated Press-NORC Center for Public Affairs Research (with funding from the Robert Wood Johnson Foundation), about half of health consumers with private insurance admit to not fully knowing what their benefits cover. Due to poor healthcare literacy, patients may forego or delay care until their conditions become serious, and may also not be prepared to manage their out-of-pocket responsibilities when they do use services.

The good news is that organizations can take steps to improve consumers’ healthcare literacy. Here are a few suggestions from a recent post by O’Dwyer’s:

  • Create and provide a glossary of healthcare/insurance terms. Put together a list of commonly misunderstood terms and define them in a way your patient population will understand.
  • Promote transparency. Identifying exact out-of-pocket costs upfront can be challenging, but the list of tools to help providers access such information is growing. Most recently, the state of Massachusetts began mandating health insurers to post costs of medical procedures for their enrollees.
  • Eliminate embarrassment. Keep patients and consumers involved in their care. Use games, videos, or blogs to educate people.

Click here to read more.

The Affordable Care Act, One Year Series: The Losers Part I

It’s been one year since the Affordable Care Act became law. In our last posts, we explored the positive impacts of the health law. In this post, we will take a look at those who didn’t fare nearly as well.

  1. Insurance companies. Insurance companies have been particularly affected by the ACA. Due to competition in the marketplace, the companies with the lowest monthly premiums appeal the most to those shopping for healthcare. According to a recent Huffington Post report, policyholders value lower premiums more than access to a wider network of doctors. Additionally, insurers that did not comply with ACA standards, sent out cancellation notices to thousands of customers.
  2. Employers. Starting in 2015, employers with over 100 employees will be required to provide health insurance to their employees. If they do not, they will be fined a penalty.
  3. Employees with modified benefits. Some employers are changing benefits to pass on more costs to employees in the form of higher premiums and higher deductibles and some are even cutting schedules to avoid providing health insurance under the employer mandate. Furthermore, many employees who work two part-time jobs are losing out since they may not receive insurance from either employer, but make too much to qualify for subsidized insurance on the exchanges.
  4. Insurance brokers. The health law has initiated numerous new changes in regards to health insurance, making education and compliance especially important during this time. Brokers will need to keep clients abreast of specific plan changes, new fees and taxes, reporting requirements, new rules regarding enrollments, non-discrimination and other changes. Being able to assist clients through this process and ensure that they understand the law and comply with it, will be particularly challenging during this transitional period.

Providers, Insurers Partnering To Launch Narrow-Network Plans

Across the country, providers and insurers are partnering to launch narrow-network plans. In some cases, these healthcare systems and insurers will offer the narrow-network plans on state exchanges with monthly premiums in line with other exchange options. According to experts, the ACA is driving the shift toward these narrow-network products. Because the health law standardizes health plan benefits and sets caps on out-of-pocket costs, providers and insurers use the networks as a “differentiator.” Experts say it will take “unique and appealing plan benefits and participating providers to attract consumers who are accustomed to broader choices of hospitals and doctors.”

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Potential Consequences of Forgiving Copayments

Back in the day, before health insurance entered the market, patients negotiated directly with healthcare providers and paid what they could afford, often on a sliding scale. Deductibles, copayments, and coinsurance developed as a check against overutilization once insurance companies became responsible for the bill.  These days, many insurance companies are increasingly checking up on the collection of copayments, deductibles and coinsurance by asking for proof of payment collection.  And in certain instances, especially in times of financial hardships, some providers do indeed waive copayments for their patients (yet still bill the insurance companies for services).

With the upcoming changes in the industry, it’s especially important for providers to understand the rules regarding the waiver of copayments.  Providers should be aware that forgiveness or waiver of copayments may violate policies of some insurers, both public and private.  It’s especially important to note that routine waiver of copayments may constitute fraud.  With the ACA rollout expected to be in full swing by the next year, providers should make it a priority to not only update their financial policies, but also to place an emphasis on patient responsibility.

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6 Tips for Picking the Right Health Insurance

If you’re still confused about picking the right health insurance, don’t worry! Here are some quick and easy tips to consider when picking an insurer:

  1. Look at options both on and off the exchange.
  2. Get the summary of benefits and coverage form (SBC) which lists information about the different health insurers.
  3. Look at the price, not just the price of the premium but also other out-of-pocket expenses like co-pays.
  4. Look at provider networks to see if your doctor is covered, especially if you need out of network benefits (from providers like psychologists and chiropractors, for example).
  5. Check to see if your medications will be covered and if they will, what the cost will be.
  6. If you are still confused about choosing the right provider, consult with an insurance broker.

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Bundled Payments Reduce Costs, Boost Transparency

Bundled payments have “generated increasing momentum across the healthcare industry as a way to reduce costs and boost transparency” according to surveys of insurers, patients, providers, and employers.  Bundled payments are known to improve outcomes and reduce costs, benefiting patients and employers, as well as payers and providers.  A survey by Booz & Company found 31 percent of the 58 participating insurers are pursuing them while 47 percent are interested in the payment model.

Click here for our series on bundled payments!

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