Tiptastic Tuesday: February 15 Last Day To Sign Up For Marketplace Health Insurance!

We would like to remind everyone that Sunday, February 15, 2015 is the last day of open enrollment for health coverage. If you have not enrolled by February 15, you generally can’t buy Marketplace health coverage for 2015 unless you qualify for a Special Enrollment Period.

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Many Nonprofit Hospitals Sue Poorest Patients

Recently, NPR and ProPublica have been reporting about nonprofit hospitals that seize the wages of lower-income and working-class patients. Each year, hundreds of patients get their paychecks docked by hospitals and their debt collection arms. One family interviewed by NPR should have qualified for free medical care under the hospital’s own charity care policy. Instead, the family has been getting their wages seized for nearly 10 years, and still owes $25,000. Senator Chuck Grassley, the chairman of the Senate Judiciary Committee, says hospitals could be breaking the law by suing patients and docking their pay.

Grassley, R-Iowa, says he is “astounded” by these collection practices. Grassley has been working to make nonprofit hospitals more accountable for the huge tax breaks they get. Nonprofit hospitals don’t pay federal income tax or local property tax and in order to justify their tax-exempt status, must “earn” it by “taking care of people who couldn’t provide for their own health care.” Grassley says that under the ACA, a hospital has responsibility to make a determination: Can the person pay, or can they not? The ACA requires that hospitals take the initiative to determine whether patients qualify for aid and should not shift that burden onto patients. Grassley is now focusing on sending a wider message to nonprofit hospitals that he believes are being too aggressive collecting bills from patients who can’t afford to pay. According to Grassley, if hospitals don’t get the message, the health law may need to be strengthened so the poorest patient receive financial assistance.

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ACA Open Enrollment Deadline A Month Away!

Open enrollment in the Health Insurance Marketplace ends on February 15, 2015. Directions for signing up, including details on fees, exemptions, enrollment periods, and information on what to do if you miss the ACA deadline can be found here.

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.

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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Tiptastic Tuesday: Medicare Beneficiaries and the New Health Law

  • Medicare beneficiaries do not need to apply to the new health law’s exchanges: exchanges are online marketplaces for uninsured individuals and small employers to find coverage. Medicare is not a part of the insurance exchanges.
  • The health law offers new benefits to Medicare recipients such as preventative care services, mammograms, colorectal screening, savings on prescription drug coverage, and by 2020, beneficiaries will be responsible for 25 percent of their prescription drug costs.
  • In the next decade, the health law will cut Medicare spending by $715 billion due to lower reimbursement rates to nursing homes, hospitals, home health agencies and other providers.  It will also cut payments to Medicare Advantage plans to bring the payments closer to what Medicare pays. Officials ensure the spending decrease will not decrease benefits.
  • Medicare recipients with income’s more than $85,000 ($170,000/couple) will pay more for their prescription drug coverage.
  • The House Energy and Commerce Committee, the House Ways and Means Committee and the Senate Finance Committee are working on legislation which would change the “doc fix” (the payment formula Medicare has used to pay physicians) or SGR but as of yet, nothing has been finalized.

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