Surprises Lurk for People Re-Enrolling on HealthCare.gov

This year, there may be surprises in store for those who do not do a subsidy "re-determination", and then shop for new plans and coverage.  If you were given subsidy money to purchase a policy under the new Affordable Care Act through Healthcare.gov last year, you may need to go back in and do a subsidy re-determination - especially if you believe your income for 2015 will be different than what you have projected for 2014.

Even if income stays the same, the plan choices and level of subsidy offered for the same income could differ considerably.

The Wall Street Article below spells it out pretty well. 

Surprises Lurk for People Re-Enrolling on Healthcare.gov 

I know that in the Kansas & Missouri markets there will be additional insurers entering the Federal Exchange/marketplace that were not present last year.  Insurers will also be offering some new plan designs that may impact what choices people make - even if they have been satisfied with their current coverage.

"Off-Exchange" policies will also offer more choice, for those who already know they will not qualify for subsidies.  If you do not qualify for a subsidy, there's really no good reason to shop through Healthcare.gov - unless you really want to go through the entire income verification process before you can purchase.

If you know you're going to purchase "off-exchange", you can go directly to the carrier to purchase, or work through an agent/broker (like me) who can run side-by-side quotes for you to choose from.

Open enrollment for individuals and families begins on 11/15/2014 and goes until 2/15/2015.  If you need to have coverage in place for a January 1 effective date, you'll need to be enrolled in a plan no later than 12/15/2014.

The Next Chapter of Obamacare

As we approach this next enrollment period (11/15/2014 - 02/15/2015) for individuals and families under the Affordable Care Act there are some things to be considered.

People who are receiving subsidies today, are being told that they can "do nothing" and automatically be re-enrolled in the plan they have today.  If that plan isn't going to be available for 2015, the insurance carrier will place you in a plan that's close.

But - even if you do want to keep the plan you have, you must keep in mind that if you do nothing, the subsidy amount you are currently receiving will stay the same and your share of the premium that you'll have to pay could increase.

So, most ACA subsidy recipients, should really go to the website (Healthcare.gov) when the enrollment period begins to re-apply and do a subsidy re-determination at that time for the year 2015.  If you don't, you may be surprised when the January 2015 bill comes.

In addition, you may want to re-visit things, simply because there will be some new plan offerings and, in some cases, some new carriers available on the exchange in your area.

Some of the Pre-ACA plans will only extend through the end of 2014 for some, so even if you are not receiving any subsidy money, you'll need to go shopping for a plan to begin on January 1.  If you don't qualify for the subsidy money, you can purchase "off-exchange" plans from a variety of sources - including your local agent or broker.

If you do qualify for subsidy money, then you can get assistance from a Navigator, Agent, or broker to review the process, help you access the local exchange in your area, and assist you with selecting plans.

People who had grandfathered plans (meaning, they were effective prior to 3/23/2010) can keep them as long as they desire.  Some others have received extensions of pre-ACA style plans that are not grandfathered beyond the year 2014.  Even though people can keep these plans - they must pay attention to note any rate activity on the plans that they currently have.  That may affect a decision on what to do in the coming year.

Each of you should be receiving some type of communication from your insurance carrier regarding your personal situation.

 - For policies to be effective on January 1, 2015 (i.e., for those who will absolutely lose coverage at the end of December 2014), you'll have to shop and be enrolled no later than December 15, 2014.

 - If you enroll by 1/15/2015, you'll have an effective date of 2/1/2015.  If you enroll by 2/15/2015, then your insurance will be effective on 3/1/2015.

 - If you do nothing, your insurance will continue and any price changes will be reflected in your first billing cycle in 2015.

Bob Laszewski's latest blog post outlines many things to be considered.  Read the blogpost here . . . .

Tax refunds may get hit due to health law credits

Get ready - here it comes!  Now that we're approaching the end of the year it's time to consider whether or not those of you who are benefitting from Advanced Tax Credits to pay for their health insurance underestimated their 2014 income.  If so, you may be subject to claw-backs at tax time.

This consideration also must be taken into account before the upcoming enrollment period, which is from 11/14/2014 through 2/15/2015.    During this next enrollment, you'll have to "estimate" your 2015 income.  If you've miscalculated for 2014, you'll want to be sure you don't build on that mistake.

Read the AP Article here . . . .

FAQ: Hospital Observation Care Can Be Costly For Medicare Patients

I have addressed this issue with many of my Medicare clients, so that they can ask the right questions regarding their status if they go to a hospital and are told to stay overnight.  A variety of difficulties can arise when your status is considered to be "outpatient". 

This becomes especially acute when someone is on a Medicare Advantage plan, as most of those plans in recent years have classified all "outpatient services" as requiring 20% coinsurance from the client.  If held in an "observation" mode in a hospital, that means the patient would be billed 20% of each charge incurred while in the hospital's care.  This can lead to thousands of dollars of coinsurance that the patient may not understand he or she owes.

Just because you're in a bed, and staying overnight in the hospital does not necessarily mean that you've been admitted.

Here's a good Frequently Asked Questions article from the Kaiser foundation that explains this phenomenon in more detail:

Medicare Observation Care FAQ

Home is where the money is for Medicare Advantage plans

Many of my Medicare clients have questioned the "home visits" offered by Medicare Advantage plans.  Some clients who have had the experience, thought it worked out well, and they appreciated the ability to talk with a nurse practitioner directly.  Other clients were hesitant to have someone come into their home, so they declined the visits.

All of the Medicare Advantage plans that I represent, currently offer the opportunity for a home visit to the members of the plan.  Whether you accept or decline, is up to you.

This article explains more about the home visits and how the data may be used.  It's worth a look.

Here's the full article . . . .

CMS Proposal Would Penalize More Than 2600 Hospitals

This article points out some of the problems with penalizing hospitals for readmission of patients. One thing I've seen my clients experience personally is the phenomenon of being "held for observation" as an outpatient resulting in the Medicare patient being stuck with 20% outpatient coinsurance for everything that happens - which can be thousands of dollars in billing.  In their zeal to cut back on "short stays" in hospitals and "readmissions" -hospitals are hesitant to admit anyone as an inpatient.  As the article points out, they aren't clear on what parameters they are being measured on in the first place - they find out when they get the penalty.

You can read the complete article here:

Researcher Says CMS Proposal Would Penalize More Than 2600 Hospitals

IRS and Department of the Treasury Release Guidance Related to Healthcare & Insurance

This week, the IRS and Department of Treasury released frequently asked questions to assist agents, brokers, and employers on provisions of the Affordable Care Act. The link below provides additional guidance on employer shared responsibility, seasonal worker coverage, minimum value, and small business healthcare tax credits. The new FAQs can be accessed, along with existing FAQs, from the IRS Q&A index page at the link below. The new questions are accessible in the employer shared responsibility, small business tax credit, and employer health care plans sections. http://www.irs.gov/uac/Newsroom/Affordable-Care-Act-Tax-Provisions-Questions-and-Answers If you'd like information regarding the Premium Tax Credits for Individuals and Families see the following link: http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit   Centers for Medicare & Medicaid Services (CMS) has sent this Y1 AB MLN Curriculum Update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.

Are ObamaCare's Tax Credits Harmless? The Little Understood Dark Side Of The Subsidies

Now that the first annual enrollment through the new Health Care Exchanges has ended, it's important to understand how the subsidies that many have received to assist with paying their insurance premiums will be handled by the IRS.  Forbes published a good article regarding how fluctuations in income and other life changes, could affect how the subsidy that you receive can change. 

If your income changes, or your life circumstances change that can affect household income levels, YOU are required to notify the health insurance marketplace (exchange), so that the subsidy can be adjusted accordingly.  If you do not do that, the government will make the adjustments at tax time.

Read more about the way the subsidies work here . . . .

Many have benefitted from the subsidy allocation, but with that benefit comes a responsibility to report any changes that could significantly impact your household income - otherwise there will be tax implications.

What Are The Penalties For Not Getting Insurance By The March 31st Deadline?

Here's a very good synopsis of how the penalty works under the new healthcare law.  As we enter the last phase of the enrollment, many who have not purchased insurance may still be contemplating whether or not to buy it, or whether they should just pay the penalty.  This may help clarify that decision.

Individual Insurance Mandate & Associated Penalty Calculation

There is still a full week left to obtain coverage.  I'm busy helping people this week, but you can also go directly to Healthcare.gov or to a local Navigator to obtain coverage.

Obamacare: To Buy Or Not To Buy–––An Entrepreneur Would Have Done It Differently

Bob Laszewski's blogpost today discusses how the plans under the new Affordable Care Act were built and whether or not people will actually purchase them.  I have had discussions about this with my clients, as to what they will decide to do at the end of 2014, when they will no longer be able to hang on to their 2013 style insurance plans any longer.

Many of these people are self-employed, and do not qualify for any type of subsidy.  Most of them are relatively healthy, and have always carried health insurance on their own.  And yes, it was "real" insurance - not sub-standard coverage.  When the time comes for them to choose an ACA style plan next year for coverage to take effect in the year 2015, they are going to find that their premiums without a subsidy will double in many cases.  The reason for that is that all of the current plans include all of the "essential health benefits" that the government built into every health plan, whether you deem it essential or not.

That is not to say that plans previously didn't have their problems - access to maternity coverage was a huge problem in the individual market.  Often, it was not even offered as an option.  But, maybe they could have found a solution like having every insurance company offer a maternity "option", that people who wanted the coverage could purchase - rather than build it into every plan.  Same for things like pediatric dental.  There were many other ways to have offered these benefits to people rather than baking them into every plan.

As an individual in the marketplace, I should have the right to purchase a catastrophic plan if I so choose, but that right was also taken from me, in the government's zeal to have everyone own a plan that looked very much like employer based plans look and feel.  Well, that's great, if you have an employer either paying for the plan, or kicking in 50% or more.  For those of us who are self employed, or work in places where no health insurance is offered, buying a Cadillac is just not a feasible proposition.

Keep in mind too, that the self employed also pay the maximum amount already on things like social security contributions and Medicare contributions in the form of self-employment tax, since they don't have an employer kicking in a portion of that.  Read Bob's Blogpost Here . . . .