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 . . . .
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Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
Tuesday, February 2, 2016
Wednesday, April 15, 2015
FAQ: Congress Passes A Bill To Fix Medicare’s Doctor Payments. What’s In It?
Well, our Congress has finally reached a decision on SOMETHING . . . .this time it's about how to stop the madness around the decreases to physician's payment schedules under what was known as the SGR or "sustainable growth rate" formula. That's good news for physicians. Maybe not such good news for some Medicare beneficiaries.
They are always looking for ways to pay for their changes to the system, and that is valid - it's WHAT they look at sometimes that puzzles me. It is known that Insurance companies were caught increasing their risk scores (meaning that they over-inflated their numbers of high risk beneficiaries in their Medicare Advantage programs), so that they could receive more money to support those programs.
Instead of reigning in that type of fraud, they decided to take away things like first dollar coverage for Medicare supplement plans C and F. In other words, they are taking away more consumer choices, that have no impact on Medicare expenditures. In 2012, this very issue was looked at to see if having first dollar coverage led to "overutilization" of medical care. The National Association of Insurance Commissioners (NAIC) conducted its own study, concluding that it did not. And, logic says that it cannot, since Medicare supplement plans can only pay AFTER Medicare pays. So, if there is overutilization - it occurs at the Medicare payment level - not because someone has a first dollar Medicare supplement plan.
It's too bad we can't take away some of the wonderful choices around insurance that we provide to our legislators, while we tell them that we think that by taking away their choices, it will somehow "change their bad behavior".
There are other elements to the legislation that fixes the payments to physicians under Medicare. You can read more here
They are always looking for ways to pay for their changes to the system, and that is valid - it's WHAT they look at sometimes that puzzles me. It is known that Insurance companies were caught increasing their risk scores (meaning that they over-inflated their numbers of high risk beneficiaries in their Medicare Advantage programs), so that they could receive more money to support those programs.
Instead of reigning in that type of fraud, they decided to take away things like first dollar coverage for Medicare supplement plans C and F. In other words, they are taking away more consumer choices, that have no impact on Medicare expenditures. In 2012, this very issue was looked at to see if having first dollar coverage led to "overutilization" of medical care. The National Association of Insurance Commissioners (NAIC) conducted its own study, concluding that it did not. And, logic says that it cannot, since Medicare supplement plans can only pay AFTER Medicare pays. So, if there is overutilization - it occurs at the Medicare payment level - not because someone has a first dollar Medicare supplement plan.
It's too bad we can't take away some of the wonderful choices around insurance that we provide to our legislators, while we tell them that we think that by taking away their choices, it will somehow "change their bad behavior".
There are other elements to the legislation that fixes the payments to physicians under Medicare. You can read more here
Wednesday, February 11, 2015
A Detailed Analysis of the Republican Alternative to Obamacare
Bob Laszewski has offered a detailed look at the Republican's alternative to "Obamacare". I agree with Bob, that it may have been easier to accept "Obamacare" as the baseline, in need of major renovations - but it seems that it won't happen.
Some of the ideas in these proposals make perfect sense, but they will have different consequences for different consumers within the market. The other big challenge here is that these solutions proposed are also very complicated for the average person to really understand. What do you think?
Here's Bob's article . . . .Health Care Policy and Marketplace Review - Bob Laszewski
Some of the ideas in these proposals make perfect sense, but they will have different consequences for different consumers within the market. The other big challenge here is that these solutions proposed are also very complicated for the average person to really understand. What do you think?
Here's Bob's article . . . .Health Care Policy and Marketplace Review - Bob Laszewski
Friday, January 23, 2015
Congress Is Back And Looking At Limiting Your Health Insurance Choices - But Now It's About Medicare!
Yes, that's right! They are busy at work to begin examining ways to limit a Medicare Eligible person's insurance options. Like your Medicare supplement? Want to buy one that offers full coverage, and pays for gaps that Medicare does not cover? Well, you may not have that option anymore if certain members of Congress get their way.
This article explains some of the options that were discussed at the hearing to discuss ways to solve the physician pay "sustainable growth rate" (SGR) problem - or "doc fix" as some call it:
"Why Medigap Sellers' Ears are Burning"
I guess I am mystified as to how limiting the purchase of a private insurance plan that only pays after Medicare pays its share, or eliminating certain types of private coverage help reign in Medicare spending on the whole. The argument is that if you give someone the option to buy "first dollar" coverage, they will over-utilize medical care.
I know that based on the people I deal with regularly in my own client base, many of my people who purchase first dollar coverage for themselves do not over-utilize care. If anything, many of them are healthy people. They have the means to buy the best coverage that they can, and do so - for peace of mind.
That should be their option. If you have the money, and want a good plan - you should be able to purchase it.
When the whole notion of limiting over-utilization in the under 65 health insurance market were done after the advent of "high deductible" health plans were introduced, studies showed that in some instances, medical expenditures actually rose due to the fact that people delayed seeking care when they really needed it. Some ended up spending more on reactive care that could have been prevented if they had sought care initially.
The Congressional representatives who always talk about this issue of "over-utilization" continually talk about the patient having more "skin in the game". This always strikes me as ludicrous coming from a set of people who have no "skin in the game" at all.
They have coverage provided to them via the Federal Government that we all pay for. Maybe they should have their own "skin in the game" and have to purchase insurance on the open market like the rest of us.
If members of Congress had to go to Medicare at age 65, and then find ways to supplement their coverage - don't you think most of them would be purchasing first dollar coverage for themselves? They can certainly afford it.
In addition, if they had to have Medicare as their primary means of insurance coverage, they would have to acquire Medicare Part B, which at their salary levels would also result in them having to pay the Income Related Monthly Adjustment Amount or IRMAA.
Forcing members of Congress - and all Federal employees and retirees for that matter - to go into full Medicare at 65 could be a better way to fund the SGR problem. With the extra money from their part B premiums, and the IRMAA that would also be collected, we could probably bring enough money into the basic Medicare program to fund it without denying the rest of the American public choices on the private market that work for them.
But - don't worry, even though no patient advocacy groups were represented at the hearing, I'm sure Congress will consider the needs of the American public first! Right? . . . .
This article explains some of the options that were discussed at the hearing to discuss ways to solve the physician pay "sustainable growth rate" (SGR) problem - or "doc fix" as some call it:
"Why Medigap Sellers' Ears are Burning"
I guess I am mystified as to how limiting the purchase of a private insurance plan that only pays after Medicare pays its share, or eliminating certain types of private coverage help reign in Medicare spending on the whole. The argument is that if you give someone the option to buy "first dollar" coverage, they will over-utilize medical care.
I know that based on the people I deal with regularly in my own client base, many of my people who purchase first dollar coverage for themselves do not over-utilize care. If anything, many of them are healthy people. They have the means to buy the best coverage that they can, and do so - for peace of mind.
That should be their option. If you have the money, and want a good plan - you should be able to purchase it.
When the whole notion of limiting over-utilization in the under 65 health insurance market were done after the advent of "high deductible" health plans were introduced, studies showed that in some instances, medical expenditures actually rose due to the fact that people delayed seeking care when they really needed it. Some ended up spending more on reactive care that could have been prevented if they had sought care initially.
The Congressional representatives who always talk about this issue of "over-utilization" continually talk about the patient having more "skin in the game". This always strikes me as ludicrous coming from a set of people who have no "skin in the game" at all.
They have coverage provided to them via the Federal Government that we all pay for. Maybe they should have their own "skin in the game" and have to purchase insurance on the open market like the rest of us.
If members of Congress had to go to Medicare at age 65, and then find ways to supplement their coverage - don't you think most of them would be purchasing first dollar coverage for themselves? They can certainly afford it.
In addition, if they had to have Medicare as their primary means of insurance coverage, they would have to acquire Medicare Part B, which at their salary levels would also result in them having to pay the Income Related Monthly Adjustment Amount or IRMAA.
Forcing members of Congress - and all Federal employees and retirees for that matter - to go into full Medicare at 65 could be a better way to fund the SGR problem. With the extra money from their part B premiums, and the IRMAA that would also be collected, we could probably bring enough money into the basic Medicare program to fund it without denying the rest of the American public choices on the private market that work for them.
But - don't worry, even though no patient advocacy groups were represented at the hearing, I'm sure Congress will consider the needs of the American public first! Right? . . . .
Thursday, June 12, 2014
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 . . . .
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 . . . .
Wednesday, April 2, 2014
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.
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.
Sunday, October 20, 2013
Missouri Exchange Rates - A Snapshot
Many of my clients in MO have been wondering what rates for the new ACA compliant insurance plans will cost. Here is a quick snapshot of what the rates currently look like.
Snapshot of Missouri Exchange Rates
Those who are eligible for a subsidy, would be able to have some help paying for these plans. You can use the calculator below to determine how much help you might receive. I've posted this before, but here it is again.
Kaiser Foundation Subsidy Calculator
Since Healthcare.gov hasn't been accessible, using the tools above may be a quick way to estimate what your premiums might be under the new system.
If you don't need the federal money, there are plenty of plans that you can buy "off-exchange" if you need to purchase insurance.
If you already have insurance, you may want to keep your current plan, if you are able to do so.
As always, my clients can always e-mail me or call with questions.
Snapshot of Missouri Exchange Rates
Those who are eligible for a subsidy, would be able to have some help paying for these plans. You can use the calculator below to determine how much help you might receive. I've posted this before, but here it is again.
Kaiser Foundation Subsidy Calculator
Since Healthcare.gov hasn't been accessible, using the tools above may be a quick way to estimate what your premiums might be under the new system.
If you don't need the federal money, there are plenty of plans that you can buy "off-exchange" if you need to purchase insurance.
If you already have insurance, you may want to keep your current plan, if you are able to do so.
As always, my clients can always e-mail me or call with questions.
Saturday, October 19, 2013
Should the Administration shut down Healthcare.gov?
Bob Laszewski asks that very question in his blog post today. Another insightful entry from Bob about the computer system and its continued failing.
As I've stated before, if you do not need the federal subsidy money and can keep your current individual health insurance policy, do so for as long as you're able. Based on what I've seen, the new ACA compliant plans are more expensive overall in this geography (Kansas City metro).
If you do have to shop - there are plenty of "off exchange" plans (plans sold outside of the federal marketplace) where you can purchase an ACA compliant plan for individuals and families. The carriers have plans up on most of their own websites now, and eventually, I'll be able to run side by side quotes for these new plans. To date, it's been impossible to do so, since most data resources at the insurance carriers and other entities (like the quoting engines most agents use) have been overwhelmed.
That said, I do believe visibility to plans outside of the federal marketplace will increase greatly during the coming month or so. So - for those who have been unable to buy health insurance in the past due to medical conditions, you'll definitely be able to fulfill the requirement to carry insurance. The jury is still out as to whether or not you'll be able to get online at the Healthcare.gov website.
Read Bob's blog post here . . . .
As I've stated before, if you do not need the federal subsidy money and can keep your current individual health insurance policy, do so for as long as you're able. Based on what I've seen, the new ACA compliant plans are more expensive overall in this geography (Kansas City metro).
If you do have to shop - there are plenty of "off exchange" plans (plans sold outside of the federal marketplace) where you can purchase an ACA compliant plan for individuals and families. The carriers have plans up on most of their own websites now, and eventually, I'll be able to run side by side quotes for these new plans. To date, it's been impossible to do so, since most data resources at the insurance carriers and other entities (like the quoting engines most agents use) have been overwhelmed.
That said, I do believe visibility to plans outside of the federal marketplace will increase greatly during the coming month or so. So - for those who have been unable to buy health insurance in the past due to medical conditions, you'll definitely be able to fulfill the requirement to carry insurance. The jury is still out as to whether or not you'll be able to get online at the Healthcare.gov website.
Read Bob's blog post here . . . .
Friday, October 11, 2013
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" . . .
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" . . .
Monday, September 30, 2013
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 . . . .)
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 . . . .)
Wednesday, August 21, 2013
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 . . . .
Tuesday, August 6, 2013
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
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
Monday, July 8, 2013
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 . . .
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 . . .
Tuesday, July 2, 2013
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.
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.
Thursday, June 27, 2013
Implementation of the Health Care Law is Quickly Approaching . . .
As the full implementation of the Health Care law draws near, I'm getting a lot of questions about what may be happening. To date, there's not a lot to report. I'm hoping that more concrete details will be available soon. The carriers are working to develop compliant "qualified" health plans that will be sold inside and outside of the state based exchanges (or marketplaces). One thing that many are not aware of is the fact that there's an "open enrollment" period being established for individual and family plans. This is new -- currently in the individual and family market, people are able to purchase new insurance whenever they want to - they are not bound by 'enrollment periods'.
The initial enrollment period will begin on October 1, 2013 and will last through March 31, 2014. Enrollment will be for plans with an effective date of 1/1/2014 or later. After that, the annual enrollment period will coincide with the Medicare Annual enrollment period - which is from October 15 through December 7 of each year. If a person doesn't sign up during an annual enrollment period, they will not be able to buy a plan again until the next one, unless they qualify for a special enrollment period. Qualification is based on things like major life events/changes - marriage, birth of a child, etc.
There are still many questions to be answered. One is whether or not the exchanges will be open & ready for business on October 1. There was an interesting article about this topic and the software that will be used to sign people up for insurance. Read about it here . . .
As more specifics are communicated to me, I will be sure to post items of note here for my clients and friends.
The initial enrollment period will begin on October 1, 2013 and will last through March 31, 2014. Enrollment will be for plans with an effective date of 1/1/2014 or later. After that, the annual enrollment period will coincide with the Medicare Annual enrollment period - which is from October 15 through December 7 of each year. If a person doesn't sign up during an annual enrollment period, they will not be able to buy a plan again until the next one, unless they qualify for a special enrollment period. Qualification is based on things like major life events/changes - marriage, birth of a child, etc.
There are still many questions to be answered. One is whether or not the exchanges will be open & ready for business on October 1. There was an interesting article about this topic and the software that will be used to sign people up for insurance. Read about it here . . .
As more specifics are communicated to me, I will be sure to post items of note here for my clients and friends.
Friday, May 31, 2013
Here's what's "got my goat" today about our Medical system . . . .
I had a Doctor's appointment scheduled for next week, and today got a call from the office today stating that when I come in I'd have to bring $100 "earnest money". I've never been asked for this before, since I have a $40 co-pay to see a specialist. But - since the practice was sold to the adjacent hospital, they are now saying that my doctor is an "outpatient clinic" and the co-pay no longer applies. Therefore, I'd have to pay out of pocket until meeting my deductible.
Basically, they've redefined what an office visit is or is not - simply to suit themselves. No one cares that I've paid for my insurance & included features like co-pays because I was willing to pay the premium for them.
With the advent of health care reform arriving on the scene, I've been seeing more consolidation - on the insurance company side of the business & now on the provider side. As providers begin to consolidate, it seems they are re-defining what certain visits are, as well as, how certain hospital stays can be billed.
One example of what's happening with 'in-facility' stays, is the new phenomenon of keeping someone overnight (mainly after a visit to the emergency room) for "observation", and giving the impression that the patient has been admitted, when in fact, they have not. What happens here can make a huge difference to some of my Medicare Advantage beneficiaries, since they pay a daily hospital rate if they are an inpatient that includes everything that happens while they are there (all tests, surgeries, etc). If they are kept in an outpatient status, that same Medicare Advantage beneficiary would be subject to paying 20% of everything that happens there - so it's very much like 'a-la-carte' billing - resulting in a much higher bill.
Today, the patient has to be ever vigilant & ask very pointed questions about how they will be billed prior to having procedures done. We're entering an age where none of this is about the patient & patient care, but is all about the money and the various corporate entities that are deciding everything about how care will be administered.
Look alert! Make sure that if you have any type of serious illness or ongoing need for care, you involve a family member or friend to advocate on your behalf. When you become seriously ill, you just won't have it in you to fight the good fight.
As for my situation, I told them to cancel my appointment and that I'd find another doctor who would honor my insurance with the features that I've been paying for. . . .
Basically, they've redefined what an office visit is or is not - simply to suit themselves. No one cares that I've paid for my insurance & included features like co-pays because I was willing to pay the premium for them.
With the advent of health care reform arriving on the scene, I've been seeing more consolidation - on the insurance company side of the business & now on the provider side. As providers begin to consolidate, it seems they are re-defining what certain visits are, as well as, how certain hospital stays can be billed.
One example of what's happening with 'in-facility' stays, is the new phenomenon of keeping someone overnight (mainly after a visit to the emergency room) for "observation", and giving the impression that the patient has been admitted, when in fact, they have not. What happens here can make a huge difference to some of my Medicare Advantage beneficiaries, since they pay a daily hospital rate if they are an inpatient that includes everything that happens while they are there (all tests, surgeries, etc). If they are kept in an outpatient status, that same Medicare Advantage beneficiary would be subject to paying 20% of everything that happens there - so it's very much like 'a-la-carte' billing - resulting in a much higher bill.
Today, the patient has to be ever vigilant & ask very pointed questions about how they will be billed prior to having procedures done. We're entering an age where none of this is about the patient & patient care, but is all about the money and the various corporate entities that are deciding everything about how care will be administered.
Look alert! Make sure that if you have any type of serious illness or ongoing need for care, you involve a family member or friend to advocate on your behalf. When you become seriously ill, you just won't have it in you to fight the good fight.
As for my situation, I told them to cancel my appointment and that I'd find another doctor who would honor my insurance with the features that I've been paying for. . . .
Wednesday, January 23, 2013
Back to the Future? . . . . .
This article from the Kaiser Foundation and USA today discusses possible ways that insurers will manage risk, once they have to accept all applicants regardless of health history. It projects that they may choose to manage risk by limiting the types of services & more costly medical approaches through the introduction of tightly managed plans that have narrower networks.
Read the article here . . .
What are your thoughts on this?
Read the article here . . .
What are your thoughts on this?
Wednesday, December 5, 2012
What will Health Insurance Cost in 2014?
This article from Bob Laszewski's Health Care Policy blog is a good synopsis of what could happen to the price of insurance under the new Affordable Care Act. It clearly outlines items that will drive cost & how that will impact the consumer.
The Affordable Care Act: 10 Months to Launch "Obamacare" - Get Ready for Some Startling Rate Increases
The Affordable Care Act: 10 Months to Launch "Obamacare" - Get Ready for Some Startling Rate Increases
Friday, September 14, 2012
Repealing Obamacare - What are the consequences?
Bob Laszewski's review of what might happen if Romney were to win the presidency and make good on his promise to repeal or defund the Health Care Reform law (PPACA), is a concise analysis of some of the difficulties with either scenario and the unintended consequences.
Usually the Congress attempts to fix troublesome aspects of larger pieces of legislation, rather than this "all or nothing" stance that seems to prevail now. "All or Nothing" is usually not a realistic scenario.
A lot of money has already been spent implementing this law, and more is on the table in both the public and private sectors. Will all of that be for nothing? Bob raises many issues and questions that need to be considered. I could only hope that Mr. Romney might read Bob's blog post . . . .
Read Bob's Article here . . . .
Usually the Congress attempts to fix troublesome aspects of larger pieces of legislation, rather than this "all or nothing" stance that seems to prevail now. "All or Nothing" is usually not a realistic scenario.
A lot of money has already been spent implementing this law, and more is on the table in both the public and private sectors. Will all of that be for nothing? Bob raises many issues and questions that need to be considered. I could only hope that Mr. Romney might read Bob's blog post . . . .
Read Bob's Article here . . . .
Monday, August 27, 2012
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?
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?
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