HHS Launches Marketplace tools

HHS Launches Health Insurance Marketplace Educational Tools

June 24, 2013 The Obama administration today kicked off the Health Insurance Marketplace education effort with a new, consumer-focused HealthCare.gov website and the 24-hours-a-day consumer call center to help Americans prepare for open enrollment and ultimately sign up for private health insurance.  The new tools will help Americans understand their choices and select the coverage that best suits their needs when open enrollment in the new Health Insurance Marketplace begins October 1. "The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families-or their businesses," said Health and Human Services Secretary Kathleen Sebelius. "The re-launched Healthcare.gov and new call center will help consumers prepare for the new coverage opportunities coming later this year," said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. "In October, HealthCare.gov will be the online destination for consumers to compare and enroll in affordable, qualified health plans." HealthCare.gov is the destination for the Health Insurance Marketplace.  Americans may now access new educational information and learn what they can do to begin to get ready for open enrollment this fall.  The website will add functionality over the summer so that, by October, consumers will be able to create accounts, complete an online application, and shop for qualified health plans.  For Spanish speaking consumers, CuidadoDeSalud.gov will also be updated to match HealthCare.gov's new consumer focus. Key features of the website, based on consumer research and online commercial best practices include integration of social media, sharable content, and engagement destinations for consumers to get more information.  The site will also launch with web chat functionality to support additional consumer inquiries. The website is built with a responsive design so that consumers may access it from their desktops, smart-phones, and other mobile devices. In addition, the website is available via an application interface at www.healthcare.gov/developers. Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning Oct. 1, 2013, will assist consumers with application completion and plan selection.  In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service.  Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance. To view the new look and new focus of the website, visit www.HealthCare.gov. HHS is on target for open enrollment in the Marketplace, which begins Oct. 1, 2013, and other key milestones approaching in the months ahead.  Coverage will begin Jan. 1, 2014.

"Pay or Play"-An Employer's biggest decision

The most critical decision employers face under Health Care Reform is this:
Will the Employer offer health care coverage to employees, or pay a penalty instead?
This decision must be made in time for employees to begin receiving coverage in 2014.

Many factors go into this decision.  Not all employers are required to "pay or play" and not all employees are required to have coverage.  To determine whether they need to pay a penalty, and how much that penalty will be, employers need to determine:

• Whether they are large enough for the law to apply to them
• Whether the coverage they offer (or plan to offer) provides essential health benefits and is affordable

Companies must have 50 or more full-time equivalent employees and 31 or more actual full-time employees to be subject to the pay or play penalty.

Actual full-time employees are individual people who work at least 30 hours per week or 130 hours per month.  But a company may have more full-time equivalent (FTS) employees, based on the number of hours part-time and seasonal workers, work in a month. 

Sounds confusing?  I can help work this out.  Call or email and I will set up an appointment to meet with you or your HR. 

Jeff@JeffreyMetzger.com

Dependent Coverage to Age 26

The PPACA requires dependents under age 26 be covered regardless of marital, student, residency or financial status. The Department of Health and Human Services requires plans to cover those:

• Currently enrolled on the plan
• Previously terminated from the plan
• Never enrolled on the plan

Spouses and children of dependents are not eligible unless the plan already covers these individuals.

Until 2014, grandfathered plans are not required to cover dependents that have access to another employer-sponsored plan.

Cover that College Debt

It's June, and there is another crop of college graduates starting their first job out of school.  A recent article from the Pew Research Center states that among households headed by someone younger than 35, a record 40% had student loan debt outstanding.  The average student loan balance outstanding for the graduating class of 2013 was $35,200, according to a new study from Fidelity, but 10% of student debtors owed more than $61,894.  Students leaving college upon graduation today have the highest debt level they've ever had. 
Any new College Graduates:  Cover the debts you have with life insurance.  A $50,000 life policy could run less than a dollar a day.  A $100,000 policy will run less than $10 per week.  This will give you as a college grad, a base of permanent life insurance coverage. 
And to the Parents of recent high school graduates:  As your kids head off to college in the fall think that they will be the ones that will have to deal with the increasing cost of college education.  It is likely that their college education could cost $100,000 or more over a four or five year period.  Much of that cost will be paid through student loans.


With a purchase of a term life insurance plan, all this debt can be covered, and the student can start to build a base of life insurance coverage for latter after graduation. 
In one sense this is protection for the parents.  The parents are the ones that will be ultimately responsible for paying off the student loans if something unexpected happens to the student because the parents are generally required to co-sign for the loans.  Covering the debt with life insurance makes sense. 
Term insurance would be an obvious choice in this situation because it provides the coverage needed at the lowest out-of-pocket cost.  A $200,000, 20 year level term on an 18 year old male would run about $18.53 per month with Waiver of Premium included.  The parent can pay the premium while the student is in school, then turn the policy over to him or her after graduation.

Life Insurance can help pay Death Taxes

Death Taxes must be paid in cash to the State and Federal Governments when they fall due. 
The Government doesn't want your house, your business, or your stocks and bonds.  It wants
cold, hard cash and wants it within nine months of your death.

If you have made arrangements for an executor to take charge of your affairs after your death, have you provided him or her with the necessary cash to pay these charges??
If not, he may be forced to sacrifice a part of your estate by disposing of it for less than actual value in order to raise the money quickly.

We all know people that have died too soon, and have not provided for their loved ones. They just died to soon!  and had just not had time to plan yet!!

I can discuss a plan to help you preserve your hard-earned estate for your family.

Proper planning, for those times, will save your estate and make it easier for those who are left behind.  Nothing would be worst that those loved ones having to make those hard decisions. 

CMS, HHS, DOL, EHBs, OOP, ACA-OMG!

On February 20, 2013, a new round of rules was released by the Centers of Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS) and the Department of Labor (DOL), collectively referred to as the "The Departments." 
Be aware of these three departments as we move towards implementation of ObamaCare.

Effective for new and renewing plans on and after January 1, 2014, all "Non-Grandfathered" fully insured small group and individual health plans must cover essential health benefits (EIBs). 

Also effective for new and renewing plan on and after January 1, 2014, all health plans, regardless of group size or funding type, must apply all member cost share for in-network srevices and out-of-network emergency services to the in-network out-of-pocket (OOP) maximum, which cannot exceed $6,350/$12,700. 

All copayments, coinsurance and deductible amounts for EHSs must apply to the out-of-pocket maximum.  No annual or lifetime dollar limits are allow on EIBs but other types of limits can be put in place, including:

• Visit limits
• Day limits
• Occurrence limits
• per episode or per service limits

EHB Categories of Benefits:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs  (Must cover the greater of either one drug in every US Parmacopea (USP) category and class, or the same number of prescription drugs in each category and class as the EHB-Benchmark plan.
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care-services for individuals under the age of 19.

Large group and self-funded (ASO) health plans do not need to offer all of these 10 categories of Essential Health Benefits, or meet actuarial value requirements that non-grandfathered small group and individual policies have to meet.  The rule is still important to large group and self-funded (ASO) plans because they are subject to many rules tied to EHBs such as:

• The out-of-pocket maximum applies to EHBs
• EHSs covered by a large group or self-funded (ASO) plan cannot have annual or lifetime dollar limits.

Why Life Insurance?

If you are thinking about life insurance and have questions, call me. 

I will be able to evaluate your family's current and future financial obligations and determine what amount and type of insurance will allow them to maintain their quality of life in the event of your premature death.

There is no substitute for evaluating one's needs with a the aid of a qualified insurance professional.  A good rule of thumb is to buy life insurance equal to ten to twenty times your annual gross income. This is only an estimate because no one's needs are the same.  I will be sitting down with you and your family to determine your specific needs.

But what kind of coverage do you need?  There are many kinds of life insurance, but they generally fall into two categories:  Term insurance and permanent insurance.  Term insurance provides protection for a specific period of time (the "Term") and pays a benefit only if you die during the term.  In contrast, permanent insurance provides protection for as long as you pay the premiums (and no loans, withdrawals or surrenders are taken).  Because it is designed to last a lifetime, permanent life insurance pay accumulate cash values and is priced for you to keep it over a long period of time. 

If someone depends on you, you probably need life insurance.  If you to die today, life insurance would provide cash to your dependents that can help meet everyday living expenses, pay down the mortgage, finance longer-term goals like education and retirement, and generally maintain their quality of life. 

Health Care Reform-Small Business Concerns

Health Care Reform

Small Business Concerns: With so much uncertainty darkening their horizons, it should perhaps come as no surprise that sentiment regarding the Affordable Care Act amongst small businesses runs towards the pessimistic.  In a Gallup poll released earlier this month, almost half of respondents (48 percent) believed that the health care law will be bad for business, compared to the just 9 percent who said the opposite.  Additionally, 55 percent of these small employers said they anticipate their costs to rise, while 52 percent also expect the quality of the health care benefits they currently provide to their employees to be reduced as a result of the law.  Separately, many small business owners worry that a little known component of the Affordable Care Act, the new health insurance tax (HIT) on insurance providers, will result in higher premiums for them.  While revenue from this new tax is meant to help cover the costs of the health care overhaul, it has been acknowledged that small firms will likely “shoulder most of the burden.”  In fact, a recent study by the National Federation of Independent Business (NFIB) suggests that the HIT could result in hundreds of thousands of job losses over the next decade, more than half of which would be borne by small businesses.  While some argue that the forecast need not be quite so bleak, it’s clear to others that the law has already forced a new decision-making model on business owners coming to grips with their new obligations under its sweeping reach.