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period for Medicare eligible people, they will ultimately find that in some areas, some Medicare Advantage plans have withdrawn some plans they previously offered.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!
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Friday, September 27, 2013
Tuesday, September 3, 2013
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.
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.
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
Thursday, July 25, 2013
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.
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.
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.
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