The week in review October 11, 2013

Exchanges continue to work througth some initial growing pains, as the government teeters ever closer to default; while a pair of House hears seeks to shed some light on implementation efforts, and Medicare Advantage starts to feel the pinch. 
Exchange Marketplace is heading into its second week of open enrollment, the health insurance exchange marketplace continues to experience some gowing pains.  While polling suggests that American's initial impressionof the new marketplace has left some room for improvement, the Administrationcontinues to urge patience, attributing the early hiccups to overwhelming demand. 

Given the changes that continue to reverberate across the health care reform landscape, it's hardly surprising that few, if any, corners of the health care world should escape completely unscathed.  Already we've seen stakeholders-large employers to small businesses, hospitals and providers, state and local governments-step gingerly into this new landscape, uncertain of what les ahead. And while we already know the havoc that certain provisions threaten to wreak if ultimately unacted, we're only now starting to see some of the damage from what's already been put in place.  One such program, Medicare Advantage (MA), some believe now finds itself at the forefront of how these changes could ripple out.  Dispite its high satisfaction rate amongst beneficiaries and better reported quality of care, a new study from health care consulting firm, Avalere Health, projects that MA plans will decreases by 5.3% in 2014, amidst continued payment reductions under the health care low, monifications to the risk adjustment model my the Centers for Medicare & Medicaid Services (CMS) and the application of the health insurance tax (HIT).  

www.millerlewishemahelp.com

This website can show you your estimated subsidy. Also run your own quote. 

Call me with further questions. 

Subsidy Calculator

The Kaiser Foundation has come out with this subsidy Calculator that shows an estimate of what Premium Assistance for coverage in the Exchanges or Marketplaces. http://kff.org/interactive/subsidy-calculator This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or Marketplaces) creasted by the Affordable Care Act (ACA). Beginning October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available throught state based exchanges. IMPORTANT - Those who are NOT eligible for coverage through their employer! Additionally, states have the option to expand their Medicaid programs to cover all people makeing up to 138% of the federal poverty level (which is about $33,000 for a family of four). In state that opt out of expanding Medicaid, some people making below this amount will still be eligible for Medicaid, some will be eligible for subsidized coveage through Maretplaces, and others will not be eligible for subsidies.

Want productive employees? Keep them happy

n a memo to staff dated Aug. 30, Trader Joe’s CEO Dan Bane announced that the company would cut insurance benefits for those who log fewer than 30 hours a week. Bane said the company will cut part-timers a check for $500 in January and assist them in finding a new insurance plan under the Patient Protection and Affordable Care Act. In a statement to Huffington Post recently, a spokeswoman for the company said the changes “will be a benefit to all Crew Members working in our stores.” I’m not so sure the “Crew Members” feel the same way. It doesn’t take a Wharton grad who also doubles as a health insurance expert to figure out that this is — solely — a benefit for the corporation. Trader Joe’s, along with other companies, are using the Affordable Care Act as a scapegoat – an excuse to abolish benefits. True, it may not be cost-effective for the company to continue offering health care benefits, but it keeps employees happy. And luckily, there are actually a few individuals out there who realize that happy employees are critical to success. A few days ago, Robert Crisan, senior vice president for health care reform and strategic growth at Hylant, told me: “I recently worked with a 283-employee company that determined it would pay $506,000 in yearly penalties if it decided to drop health care benefits. Those fees would be a relative bargain compared to the firm’s current annual net cost of $1.8 million for employee health care. However, the company will likely stick with its current benefit offerings to keep its employees happy. If you’re the employer next door and you offer benefits, you’re going to get your pick of those employees.” Unhappy workers are unproductive workers, and, over time, unproductive workers cost even more money than what a company such as Trader (also known as Traitor) Joe’s may have forked over for health insurance for all workers. Want productive employees? Keep them happy.

Good news for Small Employers who use SHOP

If you’re a small employer with fewer than 25 full-time equivalent employees, there is good news. Did you know you may qualify for a tax credit worth up to 50% of your premium costs when you buy health insurance through the Small Business Health Options Program (SHOP)? Non-profit employers may qualify for a tax credit worth as much as 35% of premium costs. Here’s how the tax credit works. If you had 10 employees making $25,000 each and your contribution to employee premiums was $70,000, your tax credit amount would be $35,000— 50% of your contribution. For non-profit employers, the tax credit amount would be $24,500—35% of your contribution. This means you get health insurance for your workers, and keep more of your cash in your business. Call me for more information on how to figure if your employoees are considered full or part time. The rules have changed.

New PPACA Requirement for employers effective Oct 1st

A new Patient Protection and Affordable Care Act (PPACA) requirement will be in effect for employers beginning October 1, 2013. In order to comply, employers must provide written notice informing the employee about health care coverage options at the time of the employee’s hire. Additionally, employees hired prior to October 1, 2013, must be provided the written notice or before October 1, 2013. The PPACA requires that employers must provide the notice to each employee, regardless of full- or part-time status or whether or not the employee has previously elected to participate in the company health care coverage options. The notice may be delivered electronically or via first-class mail and must include the following: 1. Information about the existence of state or federal benefits exchanges (Exchanges/Marketplaces) 2. Explanation that if the employer plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent, the employee may be eligible for a federal premium tax credit if the employee elects to purchase a qualified health plan through an Exchange/Marketplace. 3. A statement informing the employee that if he or she purchases a qualified health plan through an Exchange/Marketplace, he or she may lose the employer contribution to any health benefits plans offered by the employer. The statement must also inform the employee that all or a portion of such contribution may be excludable from income for federal income tax purposes. The notice must be written so that the average employee can understand its contents. The Department of labor (DOL) provided two model notices as part of Technical Release 2013-02, dated May 8, 2013; one for employers that provide health care benefits and the other for employers that do not. Employers may modify the model language so long as the modified notice satisfies the content requirements previously described.

Limit on Consumer Costs delayed in Health Care Law

New York Times WASHINGTON - In another setback for President Obama's health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care. The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014. The grace period has been outlined on the Labor Department's Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language - which appeared as an answer to one of 137 "frequently asked questions about Affordable Care Act implementation" - department officials confirmed the policy. The discovery is likely to fuel continuing Republican efforts this fall to discredit the president's health care law. Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors' services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager. Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient's out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday. The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another. A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply." Health plans are free to set out-of-pocket limits lower than the levels allowed by the administration. But many employers and health plans sought the grace period, saying they needed time to upgrade their computer systems. "Benefit managers using different computer systems often cannot keep track of all the out-of-pocket costs incurred by a particular individual," said Kathryn Wilber, a lawyer at the American Benefits Council, which represents many Fortune 500 companies that provide coverage to employees. Last month the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees. Valerie Jarrett, Mr. Obama's senior adviser, said that the delay of the employer mandate showed "we are listening" to businesses, which had complained about the complexity of federal reporting requirements. Although the two delays are unrelated, together they underscore the difficulties the Obama administration is facing as it rolls out the health care law. Advocates for people with chronic illnesses said they were dismayed by the policy decision on out-of-pocket costs. "The government's unexpected interpretation of the law will disproportionately harm people with complex chronic conditions and disabilities," said Myrl Weinberg, the chief executive of the National Health Council, which speaks for more than 50 groups representing patients. For people with serious illnesses like cancer and multiple sclerosis, Ms. Weinberg said, out-of-pocket costs can total tens of thousands of dollars a year. Despite the delay, consumers in 2014 will still have many new protections. They cannot be denied health insurance or charged higher premiums because of pre-existing conditions, and many will qualify for subsidies intended to lower their costs. In promoting his health care plan in 2009, Mr. Obama cited the limit on out-of-pocket costs as one of its chief virtues. "We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick," Mr. Obama told a joint session of Congress in September 2009. Advocates for patients said the promise of the law was being deferred. "We have wonderful new drugs, the biologics, to treat rheumatoid arthritis, but they are extremely expensive," said Dr. Patience H. White, a vice president of the Arthritis Foundation. "In the past, patients had to live in constant pain, often became disabled and had to leave their jobs. The new drugs can make a huge difference, and we were hoping that the cap on out-of-pocket costs would make them affordable. But now many patients will have to wait another year." The American Cancer Society shares the concern and noted that some new cancer drugs cost $100,000 a year or more. "If a prescription drug plan does not currently have a limit, then it will not have to have one in 2014," said Molly Daniels, deputy president of the lobbying arm of the American Cancer Society. "Patients who require expensive drugs could continue to have enormous financial exposure, despite the clear intent of the law to limit a patient's total out-of-pocket exposure." Federal officials said they were offering transition relief to certain health plans in 2014. But, they said, by 2015, health plans must comply with the law and must have an overall limit on out-of-pocket costs for medical, drug and other benefits combined. Theodore M. Thompson, a vice president of the National Multiple Sclerosis Society, said: "The promise of out-of-pocket limits was one of the main reasons we supported health care reform. So we are disappointed that some plans will be allowed to have multiple out-of-pocket limits in 2014." The law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs. Federal rules say that a free-standing dental plan must have "a reasonable annual limitation on cost-sharing." In states where the new health insurance marketplace will be run by the federal government, the limit on out-of-pocket costs for pediatric dental benefits can be no more than $700 for coverage of one child and $1,400 for a plan covering two or more children in the same family.