When the Trump Administration announced a rule to stop cost-sharing subsidies to insurance companies, there were threats of lawsuits. The threats have now become a reality, with an insurance co-op recently filing a lawsuit against the federal government.
Cost-sharing reduction payments were set up under Obamacare to ensure that customers would be able to receive low deductibles and out of pocket costs. In return, the federal government would pay back the insurers. The Congressional Budget Office estimated that the government pays about $7 billion a year to all ACA insurers for cost-sharing reduction payments.
The federal government is now being sued by Maine Community Health Options, requesting the money owed to them by law. They are seeking $5.7 million in cost-sharing reduction payments. The insurance company did not raise premiums despite the end of the subsidy payments.
The co-op claims that they cannot change its health plan part way through the year to make up for the lack of reimbursements, and they took a financial hit.
Attorney Stephen McBrady of Washington, D.C. submitted the lawsuit that stated, ” “Section 1402 requires health plans to provide cost-sharing reductions to members, and then the health plans to be reimbursed by the U.S. government under the ACA. Insurers, in turn, are guaranteed by the ACA to be reimbursed by the government for the cost-sharing reductions they pay to their insureds. The law is clear, and the government must abide by its statutory obligations. Plaintiff respectfully asks the court to compel the government to do so.”
Since the ruling to halt the payments in October of 2017, 19 attorney generals filed a challenge against the president, but a federal judge denied the request. Many co-ops have closed because of financial losses due to the lack of reimbursements.
Community Health Options is the largest individual insurance provider in Maine. If they succeed in their lawsuit, they will receive the money from the U.S. Department of Treasury’s judgment fund.
Another lawsuit filed against the U.S. is by Common Ground Healthcare Cooperative of Wisconsin. If these co-ops win, it will no doubt open the door for other insurers to receive the reimbursements owed to them by the government.
The Maine co-op, Community Health Options, have yet to receive a hearing date; it will be a lengthy battle.
The US government and the Centers for Medicare and Medicaid Services, CMS, have proposed an increase in Medicare Advantage payment rates. The increase will be an average of 1.84 percent. This increase is up from the 0.45% that plans got last year from the government. Health insurers will receive these payments to help benefit the seniors eligible for Medicare.
The CMS stated that the average Medicare Advantage payment rate will increase by 3.1% after factoring in how members’ diagnoses are coded by health plans. This makes the increase 2.95% from last year.
Medicare Advantage enrollment data by the CMS shows a growth in medicare advantage enrollees of 9%, nearly 20.9 million in 2018. The estimate is that more than one-third of all Medicare enrollees, or 34%, will enroll in a Medicare Advantage plan.
The percentage insurers receive affects how much they will charge for their premiums and benefits. This percentage also reflects how much these insurance companies will profit. The government pays this percentage to these insurers in order to cover their member’s healthcare costs. So if the insurance companies do not get much of the percentage, then the member’s will not receive as much towards their healthcare costs. This means that the healthcare member will be charged more by their insurer, and have to pay more out of pocket.
With such a large percentage payment proposal coming in 2019, insurers will be able to provide more to their members. Benefits will be extended to their customers to include things like wheelchair ramps and other assistive devices in order to help reduce the effects of major health conditions. These benefits are hoped to help the customers live a more comfortable life and prevent conditions from worsening.
The CMS conducts Risk Adjustment Factors on a regular basis in order to keep track of their enrolled beneficiaries and their needs. These risk factors take part in how they pay for plans based on the beneficiaires needs, so that they can make the exact payments for enrollees with differences in expected costs. The risk adjustment allows the CMS to use bids as a base payment to plans. According to the CMS, the payment increase is based on better use of encounter data, which is information about the care that a beneficiary got from a provider. With this data, they can determine risk scores for plans.
The risk scores for 2019 will be based 75% on fee-for-service data, and 25% based on encounter data. The scoring was based on 85% on fee-for-service data and 15% encounter data in 2018.
The CMS states the payment increase will promote stability and the resources needed to support beneficiaries. “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma.
Medicare Advantage has always competed with the traditional Medicare fee-for-service program. But due to the “baby boomer” generation, has increased enrollment in both Medicare and Medicare Advantage. In fact, Medicare Advantage enrollment is at an all-time high right now and continues to gain popularity with high satisfaction ratings.
If you would like to find out more about this increase and how it will impact you, EZ.Insure will be more than happy to help. One of our highly trained agents that specialize in your region will help you with all of your Medicare needs. You will be provided with your own personal advisor free of charge to guide you through the shopping process. To get started contact us by email at [email protected] or call 855-220-1144. You can also get an instant quote by entering your zip code in the bar above, it’s that easy.
Health insurance premiums and deductibles can become costly, and continuously go u p every year depending on the plan. There are ways to help ease the burden of a high premium/deductible plan that is cost-effective while receiving the medical services you need.
Compare Plans
More than 90% of people end up not looking into their plan for the following year and renew last year’s plan by default. Not researching this can cost you greatly into the following year because your monthly premiums can increase, and/or what is covered can be changed.
Shopping around is probably the most important way you can save money. Prices can vary from not only plan to plan but from provider to provider. This is why it is important to not only shop around for price, but for the quality of services, and coverage also.
Plans with low premiums will have higher out-of-pocket expenses like deductibles and copays. These plans are more sensible for people who did not come close to meeting their deductible. Then there are plans with a higher premium and lower deductible that would be more sensible if you meet your deductible quickly.
Comparing plans with one company makes it easier. Every agency will give you the same plans, so EZ.Insure shows you all of your options in one place!
Shopping around and comparing different insurers and plans can become time-consuming, unappealing, and strenuous. EZ.Insure does all the work for you with our highly trained agents that specialize in your region. Your advisor will do the work for you and even sign you up for a plan that matches your criteria for coverage and price, all at no cost to you.
Use What’s Free
Free preventative care services are offered at no charge as long as you are within your insurance network. There are a lot of no-cost routine services to keep you healthy and catch problems early on before it becomes serious. Colonoscopies, mammograms, vaccinations, depression screenings are all free in insurance plans. Many people are unaware of these free services and thus avoided preventative tests. Make sure to go to the doctor and use these free services to stay healthy and prevent serious health issues and expenses later.
Choose Your Doctor
Make sure you choose a doctor that works with your plan. Some offices cost more than others, and some only accept a certain percentage of benefits!
A primary doctor can help you save money, which is why it is wise to do some homework an choose the right one. When you use a primary doctor who charges less then you can also find cheaper prices for outpatient services, specialist, and lab services. Talking to your doctor can lead to reliable information when it comes to quality care at a reasonable price. Your doctor can offer ideas on how to save money and help you find/refer you to less expensive prescription drugs, or diagnostic tests.
Avoid Unnecessary Bills
When talking to your doctor, there are questions to be sure to ask about medical tests and treatments that are overused. Many of them might waste your money. Some people choose to go to the hospital for an MRI or lab work which ends up costing you. Try to utilize Lab Corp or Quest Diagnostic independent labs to avoid high costs. Hospitals will charge you double the cost of an independent provider.
Leverage Tax Breaks
Putting money into a health savings account (HSA) will help with high out-of-pocket medical costs. The account will let you put aside tax-free money to cover your medical costs. HSA allows you to put up to $3,400 for individuals and $6,750 for families within a year. You can use the money to pay for your deductible and other qualified medical expenses, and whatever you do not use will roll over into the following year tax-free.
The Affordable Care Act is once again facing a new challenge, this time by Republican states trying to dismantle it once and for all. The basis of the claim filed is that since the individual mandate was removed, it makes the whole ACA unconstitutional. The individual mandate is the ruling that people must have insurance or sign up for it within an amount of time or they would face a penalty fine during tax season.
Ever since President Trump was elected, one of his goals was to repeal and replace the Affordable Care Act which was signed into law by President Obama in 2010. One of the provisions of the ACA, the individual mandate, has been challenged by Republicans since 2012. They claimed it was an unconstitutional expansion of the government’s power. However, the Supreme Court upheld that the individual mandate tax was the government’s right. Chief Justice John G. Roberts Jr. stated the government “does not have the power to order people to buy health insurance, but it does have the power to impose a tax on those without health insurance.”
In December 2017, President Trump came one step closer to dismantling the ACA by ridding the mandate. His administration was able to change the individual mandate penalty to $0 beginning January 1, 2019. Because of this, as of February 26, 2018, Texas Attorney General Ken Paxton and 19 other states filed a lawsuit stating, “the country is left with an individual mandate to buy health insurance that lacks any constitutional basis. . . . Once the heart of the ACA — the individual mandate — is declared unconstitutional, the remainder of the ACA must also fall.”
In one of the cases against the ACA, King v. Burwell, Chief Justice John G. Roberts Jr. noted that “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former and avoids the latter.”
Judge Reed O’Connor will be hearing the case filed by the Texas Attorney General and other states. O’Connor was appointed by President George W. Bush in 2007 and has ruled against the ACA in past cases.
This is all happening during the time insurers must figure out the pricing for next year’s premiums and rates so they can file it with state regulators. Insurers are concerned because they do not know how much to raise rates if they will charge the same price to healthy and sick people, or whether to pull out of the marketplace.
While the marketplace in in panic about how much their prices should go up and if they will even still be in business, it is smart to seek quotes and plans from private insurers. EZ.Insure is able to provide you with affordable plans with ease. We offer the stability of insurance within your region by one of our highly trained and educated agents. To receive a quote, call 855-220-1144 to speak your own advisor, enter your zip code in the bar above, or email us at [email protected]. We will provide quotes and offer our help free of charge without hassle.
The Trump Administration has finally finalized expanding insurance companies ability to sell short-term health insurance plans for up to 3 years (36 months). This will allow consumers to buy less expensive and less comprehensive insurance policies for a longer time. The old rule for short-term health insurance was that it cannot last for more than three months. This new rule will open these policies to consumers for up to 36 months, in hopes that more healthy people will utilize them. These plans may offer less coverage, but will be there for those who can not afford or do not feel that they need extensive coverage.
“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “Americans need more choices in health insurance so they can find coverage that meets their needs. The status quo is failing too many Americans who face skyrocketing costs and fewer and fewer choices. This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable for individual and family circumstances.”
In 2016, Obama restricted these plans by limiting them to just three months of coverage from 12 months. Back in October, Trump issued an executive order to cut back the restrictions on these plans that limited them to three months. By removing these restrictions, Trump gave the public the ability to decide for themselves whether they need a more committal plan, or a short term plan for the next year. This is one of Trump’s first steps to achieving his promise of dismantling the ACA once and for all.
Some skeptics worry that the more healthy people leave the marketplace, the more expensive premiums will be for those still in the market. The premiums would increase and cause subsidies for policyholders to rise which in turn would cost the government more money.
When asked about the concerns that the proposed rules would destabilize insurance markers Seema Verma, the administrator of the federal Centers for Medicare and Medicaid services said, “we don’t think there’s any validity”. She continued to state that federal officials believe that between 100,000 and 200,000 healthy people now buying insurance through those federal exchanges would switch to the short-term plans, as well as others who are now uninsured.
Once someone signs up for a short term plan for a year, they can now continue to renew it for up to three years. Insurers can ask medical questions and possibly reject consumers due to pre-existing conditions for a short-term policy. Once approved for the plan, if a consumer develops a ‘pre-existing condition’, then they can be rejected when it is time to renew.
Short term plans do not cover maternity care, so if you are considering getting pregnant you should take into consideration how much out of pocket costs you can handle.
Short term plans are less expensive, because they cover less, for example, maternity care and preventative care are not covered. It is ideally for those who are relatively healthy and do not need a lot of coverage. The hope is that the new rule will be more appealing for younger and healthier people.
The Trump Administration believes this will bring in an increase in premium revenues and profits because more people would sign up for a short-term insurance plan. This will allow the insurers to set prices to reflect a customer’s health risk of high medical costs. Trump believes that this 36 month extension is important because premiums more than doubled from 2013-2017 for health plans in the federal Marketplace Insurance exchange.
If you are looking for a short term plan or have questions regarding it’s coverage, EZ.Insure can help. Our agents specialize in short term plans in your area and can answer any questions you have to find out if it is right for you. You will be given your own advisor who will go over different plans, and help sign you up free of charge. To start saving, enter your zip code in the bar above to get instant quotes, email us at[email protected], or call 855-220-1144. We guarantee we will be able to find you a plan that is affordable and meets your needs.
When it comes to determining if a short-term health insurance plan or a major medical health insurance is best for you, there are many factors you must consider. Two of the main things to consider are how long you want coverage and what you want to be covered. Short-term plans aid people when a catastrophic issue arises, such as a sudden injury or illness. With short-term health insurance, you can choose how long you need coverage, and what price you want to pay. Major medical health insurance provides more comprehensive care than short term insurance. Major medical plans include things such as preventative care and wellness checks. Unlike short term plans major medical plans lasts longer than a year and are usually more expensive.
Short-Term Health Insurance
The purpose of a short-term plan is to cover medical and travel expenses from 3 – 12 months. These health insurance plans are also called travel insurance plans because if you are traveling outside of the US, short-term plans will offer you basic coverage for a limited time.
Short-term plans are a more flexible option for people looking for coverage for no longer than a year. Short-term plans, unlike regular health insurance plans, are charged a daily rate which lets you buy a plan for the time you need, whether it be a month or more. The plan can go into affect anywhere from the day after applying to 14 days later. These insurance plans are generally nonrenewable, but you can reapply if needed with some restrictions.
Short-term plans are usually up to 50% cheaper than long-term plans. Savings vary by person, for example, a man who does not smoke can purchase the cheapest short-term plan for $110 a month, while the cheapest long-term plan will cost him about $270 a month. The savings are even more significant if you are under the age of 30 and plan on traveling out of the United States. People under the age of 30 can get short term health insurance plans for as low as $38 a month.
These plans are less expensive and much easier to obtain. The application does not require a medical exam and only asks a handful of yes or no health questions in order to get approved. Short term health insurance plans, unlike normal health insurance plans, also offer plans for older customers. You can apply for a plan up to the age of 89, while normal health insurance plans are not offered after age 75.
Pros & Cons of short term health insurance
Who Should Apply For Short Term Health Plans
According to the National Association of Insurance Commissioners, short-term policy utilization has increased from 108,000 people in 2013 to 148,000 people in 2015. Short-term plans have been gaining popularity among those who need coverage but cannot afford long-term health insurance. It is ideal for anyone who waited too long to purchase long-term and missed the open enrollment period, young adults who can no longer be on their parents’ health plans, people in between jobs, and those that are waiting for their employer or government benefits to begin. Some people buy short-term insurance to cover the deductible period before their long-term insurance starts paying. Others purchase these plans to fill in the gaps of Medicare coverage.
Major Medical Health Insurance
Major medical insurance is a long-term plan that offers more comprehensive coverage. These plans help manage day to day expenses and are convenient for those that require routine medical work , such as medication, lab work, and inpatient and outpatient services. Major medical health insurance complies with the ACA requirements which means it provides the ten essential health benefits. These ten essential benefits are: ambulatory patient services, prescription drugs, emergency care, mental health services, hospitalization, rehabilitative services, preventative and wellness services, laboratory services, pediatric care, and maternity and newborn care. However, most health insurance plans do not cover dental, vision and hearing, so you must purchase a separate plan for any of these forms of coverage.
Major medical policies offer peace of mind in knowing that you are covered in case of emergency or future conditions. These plans allow you to choose your own policy and deductible, but require you to answer health questions and conduct a medical exam to determine if you are qualified for benefits. Your policy rates depend on your age, gender, marital status, and the amount of coverage you desire. As of January 1, 2014, people who purchase major medical plans cannot be turned down or have rates raised due to pre-existing conditions.
Unlike short-term health insurance plans, major medical plans offer more extensive coverage and you will not be issued a tax penalty because it abides by ACA guidelines. These plans can be renewed annually unlike short-term plans which only last up to a year. You must enroll during open enrollment which is from November 1st to December 15 this year. If you miss open enrollment, then you will have to wait until the next enrollment period, unless you qualify for special enrollment. These special circumstances are when you adopt or have a child, get married, lose coverage from an employer, or move outside network area. If you attempt to purchase a plan outside of open enrollment, it will cost you a lot more.
Major Medical Health Insurance Pros & Cons
Who Should Apply For A Major Medical Health Plan
Major medical insurance is important to have for everyday health coverage, for both an individual or a family. It helps people whose employer or spouse’s employer does not offer health insurance. If you are pregnant or planning to become pregnant, this plan is your best option because it will cover your medical expenses and the newborn is generally put on the plan automatically. Short term health plans do not offer any type of coverage for pregnancy expenses. When you are over 26 years old and are no longer on your parent’s plan, then a major medical plan is best if you are looking for preventative care and wellness checks.
If you need help comparing different types of health insurance plans EZ.Insure will help you. We will connect you with a highly trained agent that will help you discover what health insurance plan is best for you. To get started, you can put your zip code in the link to the right, email us at [email protected], or give us a call at 855-400-0489.
Health insurance premiums and deductibles can become costly, and continuously go u p every year depending on the plan. There are ways to help ease the burden of a high premium/deductible plan that is cost-effective while receiving the medical services you need.
In December 2017, President Trump came one step closer to dismantling the ACA by ridding the mandate. His administration was able to change the individual mandate penalty to $0 beginning January 1, 2019. Because of this, as of February 26, 2018, Texas Attorney General Ken Paxton and 19 other states filed a lawsuit stating
