Why the Obamacare 2016 Open Enrollment Stalled: The Big Unwritten Story About Obamacare––How Unaffordable It Is For the Working and Middle Class

Now that the most recent Open Enrollment period for the "Affordable Care Act" has ended, Bob Laszewski has written another article about the law and its impact that is right on the money.  The big "untold" story is about how it has impacted premiums for the segment of the individual market that do not qualify for subsidies and now have to bear the weight of astronomical premium increases.

You can read Bob Laszewski's blog post here . . . .

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

Healthcare.gov Offers New Shopping Feature - Sort of . . . .

Here's a link to the Kaiser Foundation Blog describing the new "shopping feature" on Healthcare.gov. 

Read the Kaiser Foundation Blog Entry here . . . .

Limited as the shopping feature is, I guess it's better than nothing.  How they could have developed a huge system like Healthcare.Gov and not understood that people want to see rates & plan information before deciding to create an account and then load a ton of personal information into the system blindly.

They wasted a lot of money on a dysfunctional system and are now having to spend more to remedy it without having to totally dismantle it.  In the meantime, people who may have wanted to purchase insurance there, cannot.  I guess people may have to phone in applications or do them on paper - you know, just like in the "good old days" . . .

System Glitches? Really?

Haven't been able to get into the Federal Exchange to peruse pricing or see if you qualify for a subsidy?  Most people haven't.   The website & the press keep saying it's due to traffic and I say - not so.  Now, there's finally confirmation in print of what some agents have been saying all week. 

Read the Story Here . . . .

The Center for Medicare and Medicaid Services (CMS), who is running the Federal Marketplaces in 36 states could barely handle agent training, and then had a security breach after some agents completed the coursework - sending agent information along with related social security numbers "into the wind" by "accident".

I would advise anyone who feels they need Federal Subsidy money to pay for their plan, to wait and see through the month of October.  Wait to see how this plays out and to be sure that the systems are working and have some level of security before putting in all of your personal information.

You have plenty of time - if you want your insurance policy to take effect on January 1, 2014, you need to apply no later than December 15.  Then, you still have until March 31 during this initial enrollment for plans to begin with effective dates after that.

No hurry - believe me, they need time to work this out.

For those who feel they won't qualify for the Federal money, and still need or want to buy a new ACA compliant plan for 2014, the options are actually greater outside of the exchange.  You have more choices of companies and plans, and the plans have slightly different benefits than those on the marketplaces.

If you'd like any help in looking at those in MO and KS, I'd be happy to assist, as always.

Monthly Premiums For A 'Benchmark' Silver Plan In Federally Run Insurance Marketplaces

Here we are one day before the October 1 enrollment through the Federal Marketplaces begins for those of you who are under the age of 65 and do not receive insurance through your employer.

I still do not have actual pricing from any of my carriers in Missouri or Kansas yet, so advising people as to what to do has been difficult, if not impossible. 

Some of you who have "grandfathered" plans - meaning your plan effective date was prior to March 23, 2010 - can keep the plan you currently have.

Those of you who do not have a "grandfathered" plan may be able to keep your existing policy for an additional year, depending on how your existing carrier is handling things.  In these cases you may have received a letter already indicating that this option will be available to you and that you'll simply sign an addendum in December, most likely, and agree to a small rate increase at that time.  This would allow you to continue with your plan through the end of December 2014.

Depending on what the new plan pricing looks like, the options above may be appealing.

Those of you who feel you will qualify for Federal subsidies will have to apply through the exchanges to receive the federal money.

I am certified to sell policies within the exchanges, but do not know what that process will look like yet, since the exchanges (or marketplaces, as the Federal Government is referring to them) do not exist yet.  Supposedly these will be online tomorrow, October 1.

Once I have detailed plan & pricing information, I'll share that with all of my individual and family clients.

The article from the Kaiser Foundation this morning offers an idea of what a Silver plan may cost in various "areas" within a state where the Federal Marketplace will be offering plans.  You can see that here . . .Benchmarks for Silver Plans through the Marketplaces.

Simply find your county and you'll see how rates compare with other areas of your state.

Within this article you'll also see the link for the subsidy calculator where you can play around with your numbers to see what might happen in real time once the Federal Marketplaces are operational.

Once I see that enrollments are going smoothly I'll discuss options with my clients.  In the meantime, I'd advise waiting to see how the initial launch goes, before making changes.  (but, that's just my opinion . . . .)

There Will Be Fewer Medicare Advantage Plan Offerings for 2014

As we head into the Annual Enrollment period for Medicare eligible people, they will ultimately find that in some areas, some Medicare Advantage plans have withdrawn some plans they previously offered.  This article is a good synopsis of what's happening in this marketplace:

View the article here . . .

October will be a very busy month!

Is the Affordable Care Act Actually Affordable?

I've been wondering that myself as I complete the training associated with being able to assist clients as the law is implemented.

My conclusion is that maybe it won't be - especially for some segments of the population.  Even with the federal subsidy money, I've been wondering whether or not people with very limited incomes will be able to afford the portion of the health insurance premium that is left for them to pay once the subsidy is taken into account.  Apparently, I'm not the only one.

This article from AlterNet takes a closer look:

Read the full article here.

Enrollment for new, ACA compliant plans is scheduled to begin on October 1 and will continue through 12/31/2013.  This is an extended enrollment period, since the government realizes that there will be a lot of confusion in the marketplace about when they must enroll or make changes.  After this year, the annual enrollment period for individuals and families under the age of 65 will be from October 15 - December 7 each year.

As new information becomes available, I'll be sure to communicate it.

UPS Won't Insure Spouses of Some Employees

UPS is getting ready to remove thousands of spouses from their company provided group health insurance, in part due to the new healthcare law.  They have cited the Affordable Care Act as one of the reasons for its decision when explaining this to employees and others.  Read the article here . . . .

Many Consumers With High-Deductible Plans Are Concerned About Health Law Changes

For those of you who didn't know - unless your current individual or family health insurance policy is considered to be a 'grandfathered' plan - meaning, the plan effective date was prior to 3/23/2010 (when the new Health care law was signed) - you'll have to make some changes for plans effective on 1/1/2014.  Read more here . . .

Different companies are taking different approaches to this "migration", as they are calling it.  Some are simply ending your existing coverage as of 12/31/2013, and requiring you to purchase a new policy during annual enrollment - which takes place beginning October 1, 2013 for plans that will be effective on 1/1/2014.

Other companies are going to allow you to stay on your current 'non-grandfathered' plan, and they'll simply add essential health benefits and other features to make the plan compliant.  In those cases, companies will simply have you agree to that and any price changes, through the use of an addendum that the insured will sign, and you'd keep your plan through the end of 2014.

I am beginning to contact my clients to let them know what the options will be this fall.  Unfortunately, no pricing is available yet, so I'm only able to discuss potential situations, not real choices.  Some people will qualify for subsidies through the exchanges - if you're an individual and make up to $45,960 annually, you'd qualify.  The guideline is that there will be subsidies available for those making up to 400% above the poverty level.  In some geographic markets, that is a good amount of money, so many may qualify.

You can play around with the subsidy calculator below to get an idea of whether or not you & others in your household might qualify for subsidies being offered to help pay for new plans effective next year.

Health Insurance Subsidy Calculator

Pay Close Attention!!! You're Probably Being Overbilled For All Things Medical!!

Billing!!  Yes, billing is what's bothering me today.  I had an episode with poison ivy that landed me in the emergency room on Memorial Day.  I went in, saw a doctor for approximately 5 minutes - he looked at me, pulled out a prescription pad & wrote a scrip for prednisone.  I walked out & that was it.

When I received the hospital facility bill, the billed amount was $2,115.75!  They made a 'contractual adjustment' of $1,344.14.  The insurance company paid $498.09, and my portion was $274.52.

Then the separate bill for the physician arrived.  That bill was $440.00.  Insurance paid $352.00 and my portion is supposed to be the remaining $88.00.

When I called the hospital to ask if I could have an itemized breakdown of how 5 minutes translated into $2,115.75 I was put on hold for a long time.  I told them I had a right to understand exactly how anything could cost that much.  Was it $1000 for the doctor to stare at me?  Maybe $1100 to pull out a pad to write the prescription on?  What exactly is the breakdown?

I was then told that they probably overbilled me!  (ya think?)  Turns out that these bills are coded according to a "level" scheme that is used as a guideline from the American College of Emergency Physicians.  My hospital bill was coded as a level 4, while the doctor bill was coded as a level 3.

When I asked what a level 4 encompassed, they said they couldn't share that with me.  Why, exactly, I don't know - but apparently everything is a big secret.  We're all just supposed to pay & shut up.

I asked her what level it would be if I had presented in the emergency room with a heart attack & she said level 5.  So, I asked how poison ivy could possibly be only one level below a life threatening condition like a heart attack & she said, again - that I was probably over billed.

I looked up the levels myself (www.ACEP.org), and it turns out that my bills most likely should have been coded as a level 2, which encompasses things like "rashes, sunburn, etc.".  Also, probably for a much more reduced charge.

I then called the insurance company so that they can flag the account, since I'm now having both bills audited.  Insurance technically should have examined it & potentially denied the claim, but the answer I got from them is that since they didn't know exactly what took place in the emergency room, they often simply pay the bill. And yes, it's true - how would they know exactly what services were provided?  They have to trust the provider to some degree, since they are administering the medical care & should be allowed to proceed as needed in an emergency situation.

So, ever wonder why everything is so expensive?  The providers are robbing the insurance companies blind, and then that cost is being passed along to YOU the consumer of health care - both in the form of higher premiums and in the form of higher portions of co-insurance.  Shameful!! 

Take this as a warning - Pay very close attention to any billing you receive - you may not owe as much as you think you do.

Health Insurance Exchange Subsidies Will Be Granted on the Honor System!––Is There Something Wrong With "ObamaCare's" Federal Data Hub?

Author of the "Health Care Policy and Marketplace Review" blog, Bob Laszewski has reported a whopper of a story on his blog about a little known change to the requirements for determining whether or not an individual applying for health insurance through the exchanges will qualify for a subsidy.  Information on income for individuals was supposed to come from the Federal Data Hub, but now that information can effectively be "ignored" if it conflicts with what the applicant is telling the navigator at the exchange!  In other words, if I think I need/qualify for a subsidy, they'll just 'take my word for it'. . . .

I think everyone really needs to know & understand that the average, honest tax payer will end up paying for the "free money" that is sure to be given out once some people understand how to manipulate the system.  No subsidy money should be given unless incomes & eligibility can be accurately verified.

Read Bob's Post on his "Health Care Policy and Marketplace Review" blog . . .

Income -- Not Assets -- Will Determine Subsidies In Online Insurance Marketplaces

As the enrollment for health insurance plans that will begin in January 2014 rapidly approaches, information about subsidies to purchase the insurance that will be offered in the new insurance exchanges that the federal & state governments are setting up, is being clarified.

Kaiser foundation published a helpful blog entry today regarding that subject.  You can read more about it here:  Questions Regarding Subsidy Eligibility

The links within the article are "live", so further information is available there.

Keep in mind that the health insurance plans referenced are for individuals and families- not businesses or people who have Medicare coverage.

There will be plans offered outside of the exchanges or "marketplaces" provided by the government, but if you need to obtain a subsidy to pay for your insurance, you have to buy the insurance through the government run marketplace.

Medicare Seeks To Limit Number Of Seniors Placed In Hospital Observation Care

The "observation care" designation is a thorny one - for the providers, as well as, the Medicare beneficiary.  The patient often doesn't realize that they haven't been admitted, and end up with increased financial obligations because of it.  If a person has a Medicare Advantage plan, this can be especially troubling, since in many of the plans on the market, the patient would be responsible for 20% of all outpatient services received, rather than a straight 'hospital inpatient' daily co-pay.

The difference between the two can be enormous, especially if expensive tests are done while the person is considered to be an "outpatient".  There are other implications as well, related to requirements to be admitted into a nursing home after a hospital stay.  The requirement to have coverage in that instance is that the patient has been an "inpatient" for 3 consecutive days.  Outpatient status doesn't count.  Read more in the Kaiser Foundation & Washington Post article here . . .

The Ridiculous Cost of Health Care

This article by Brian Klepper through "Care and Cost" online, is very good summary about health care costs & potential ways to begin normalizing them.  He begins by describing his own personal experience with an outpatient procedure and how ridiculous the charges were for a diagnostic procedure. 

I have just gone through major surgery myself - the bills are beginning to roll in & even with good insurance (which I've never used, because I was always healthy), the costs and then the 'adjustments' to those costs are mind boggling.  I've only received the billing for the preliminary "outpatient" procedures that were simply to get a diagnosis and I'm sitting at about $3000 so far (that's MY expense after all insurance discounting & adjustments were made to the ridiculous, original charges).  I'm bracing myself for the in-patient hospital stay and the major surgery bill . . . .

Will the Bubble Burst?

Docs Unhappy with Health Care Reform

Interesting snippet about how doctors are feeling about health care reform and regulations in general.  There is a lot of anticipated anxiety from physicians about the pending measurement system that will determine Medicare payouts based on "results" rather than the current fee for service model.  To date, no one is sure how measurements will be determined and how disparate groups of physicians can be compared to one another.  I'm sure that we'll see much more related to these issues in the coming months.  Stay tuned . . . . .

Docs unhappy with Health Care Reform

Patients Want To Read Doctors' Notes, But Many Doctors Balk

This is a fascinating article about viewing your own patient records.  As I advise my clients, everyone should check their chart at the Doctor's office - preferably after each appointment.  You do need to see what a doctor is writing about you - his or her notes can often make you ineligible for insurance.  I've had many clients encounter problems when medical records are requested by the insurance company, and they find that something was written about them that either wasn't true, or was simply erroneous.  If you read the comments associated with this article, you see examples of other issues occurring - including potential medical mistakes and errors in how you - the patient - are actually treated.

Read the actual article here . . . .

Health Care & the Super Committee - the Cost of Failure

This article by Joe Paduda lays out some dire implications if the Super Committee doesn't come to an agreement in the time allotted.  Very realistic and pretty awful predictions of what could happen here . . . .

http://careandcost.com/2011/11/18/health-care-and-the-super-committee-the-cost-of-failure/

I still constantly wonder, who on the Hill is actually working for the people anymore? . . . .

States Continue to Cut Medicaid - Hospital Stays Reduced Due to Cost

Once again, Medicaid is the target of cuts that will most likely result in the rest of us bearing the cost of hospitals "eating" the costs they incur that are not reimbursable.  They cannot turn those that are already sick or in need of treatment away, as they can't just flip people already in the hospital out of their beds when an arbitrary date comes around.  If they have to absorb those costs, the rest of us will end up paying for it in higher insurance rates & in other ways - maybe even through other cuts to programs we may want sustained over time, like Medicare.

Maybe one big cost we could cut here in the US would be the cost of healthcare benefits for our members of Congress . . . .I'm tired of paying for them . . . . .

Read more here:  http://www.zanebenefits.com/blog/2011/10/425/States+Continue+to+Cut+Medicaid+-+Hospital+Stays+Reduced+Due+to+Cost

Bad Language: Words One Patient Won’t Use (And Hopes You Won’t Either)

This is a really good article about language that is currently being used in the general public discussions regarding healthcare.  The names they use for "patients" and "people" have been engineered to make it sound has if the patient, or "consumer" of health care services has more power in our system than they actually have.  This all feeds into the notion that people have a lot of personal choice within the existing healthcare system, when in reality, they don't.  This leads to situations where "choice" translates into extra burdens for the patient on a number of fronts - whether it's insurance coverage particulars and/or the quality of the medical care being received - it now becomes the patient's responsibility to know everything and become the manager of his/her own care - usually while ill.

In this article, the author, Jesse Gruman, discusses what those labels really mean and how that translates into actual reality for the patient or person being affected.  To read the entire article, click this link:
http://careandcost.com/2011/08/11/bad-language-words-one-patient-wont-use-and-hopes-you-wont-either/

We Are Reaping What We Have Sown—The Debt Standoff

Here's a good article regarding the current Debt Standoff.  Given that whatever agreements are made are sure to impact health care coverage in the future, it's important that we understand what's happening here and how it will affect us personally.

http://healthpolicyandmarket.blogspot.com/2011/07/we-are-reaping-what-we-have-sewnthe.html