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U.S. Government Proposes 1.84% Increase in 2018 Payments to Medicare Insurers

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.

Medicare Prices Steadily On The Rise

Details have emerged after a report was released on the investigation into Medicare drug prices. The report “Manufactured Crisis: How devastating drug price increases are harming America’s seniors,” and its findings were released by U.S. Sen. Claire McCaskill, Democrat-Missouri. This report talks about the hiked up drug prices for senior citizens and how it needs to be further investigated. Medications for seniors have gone up nearly 10 times more than the annual inflation rate.

The report stated that “Soaring pharmaceutical drug prices remain a critical concern for patients and policymakers alike. Over the last decade, these significant price increases have emerged as a dominant driver of U.S. health care costs — a trend experts anticipate will continue at a rapid pace.”

The cost of about 20 of the most prescribed drugs for Medicare have gone up significantly from 2012 to 2017 according to the report. The lowest increase being Zostavax going up 31%, to the largest increase being 477% for the drug Nitrostat. Twelve of the drugs investigated, increased over 50% during the five-year time span, while six of them increased over 100%. The rise has gone up so much that some Medicare enrollees are unable to pay for their meds.

Some Medicare Drug Prices Have More Than Doubled Each Year!

The Pharmaceutical Research and Manufacturers of America did not agree with the report and followed up with comments reported by CNN. “This is yet another misleading report that ignores the robust negotiation that occurs between Medicare Part D plans, middlemen, and biopharmaceutical companies,” Juliet Johnson, a spokeswoman for PhRMA, said in a written statement. “Negotiated rebates can reduce list prices by as much as 30 to 70 percent for medicines used to treat diabetes, high cholesterol, and chronic respiratory illnesses. Notably, half of the 20 brand medicines in this report are used to treat these chronic conditions.”

As stated, the medicines are used to treat chronic conditions, but the reality is that many seniors need these medications. A lot of Medicare enrollees have some sort of health issue, whether chronic or not that requires treatment and medication to stay healthy.

Juliet Johnson later stated “we agree more can be done to make Part D more affordable and predictable for seniors. One way to do that is to ensure seniors benefit from the significant negotiated savings when they pick up their medicine at the pharmacy.”

The prices of pharmaceutical drugs for seniors has been an ongoing issue, they are becoming more expensive every passing year. It can become too much for seniors to include in their budgets, which can be very harmful to their health. Medicare enrollees can purchase a Medicare Advantage plan or Medicare Part D plan to help pay for pharmaceutical drugs needed. But as drug prices continue to rise, the premium costs will go up as well to pay for the difference.

By law, Medicare is not allowed to negotiate drug prices, which is something Democrats have tried to change for a long time. Some sort of change or assurance must be given to seniors that these prices do not continue to climb and become unattainable. During Trump’s State of the Union address, President Trump states he will fight to make the drug prices go down. This will hopefully put a resolution of the soaring drug prices, and provide relief for seniors.

EZ.Insure will provide you with the best information on how to get the most out of your Medicare budget.. We provide you with your own personal advisor who is trained in your region to give you quotes and guidance on which plan will work best for you. To get a quote, email [email protected], enter your zip code in the bar above, or call 855-220-1144. It’s that simple and easy to start saving.

Short-Term Health Insurance VS Major Medical Health Insurance

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.

Plans Rates to Increase in 2018: Silver Costing More than Gold

Plans will be at least 34 percent higher in 2018 due to Trump’s decision to halt cost-sharing subsidy payments to insurers.

Because the Trump administration ceased these cost-sharing payments to insures, insurance companies raised premiums to compensate for the loss of these reimbursements. This termination of subsidies has also caused some insurers to drop out of the marketplace, leaving regions with only one insurer.

The changes

Silver plans pay for about 70 percent of customers’ health costs, with the remainder of payment left for the customer. These plans are purchased by nearly 80 percent of customers. The cost of silver plans is increasing an average of 34 percent next year.

Bronze plans, the second most popular plan, covers 60 percent of customers’ health costs. These plans are purchased by about 23 percent of customers. The cost of bronze plans is increasing an average of 18 percent in 2018.

Gold plans are usually the priciest, covering 80 percent of customers’ health costs. These plans are purchased by about 3 percent of customers. This year, the cost of gold plans are increasing an average of 19 percent.

Platinum plans are the most expensive plans, covering 90 percent of customers’ health costs. These plans are purchased by less than 1 percent of customers. The cost of platinum plans is rising by an average of 24 percent next year.

Gold plans usually have higher monthly plans and lower out of pocket costs than silver plans, but that has now changed. Now silver plans are more expensive than the gold plans that have lower deductibles.

Who this will affect

Customers who will be affected by these price increases are those who must purchase Obamacare because they do not have insurance through employers or Medicare. People who qualify for government subsidies will benefit from the premium increase of silver plans. As the premium increases for next year, enrollees will receive higher premium tax credits, allowing them to have a plan with a lower deductible, copays, and less out of pocket spending.

However, people who do not qualify for government subsidies will have to pay more for a silver plan. The least expensive gold plan for next year will be cheaper than the least expensive silver plan. So many people will probably opt to purchase the bronze or gold plan next year.

If you make more than the poverty line, in some states, a gold plan will cost less and have a lower deductible. Also, a high deductible bronze plan will have lower premiums. For example, a 40-year-old individual making $30,000 and eligible for a tax credit will pay 54 percent less in 2018 for their premium of the lowest-costing bronze plan, 9 percent less for the lowest-costing silver plan, and 16 percent less for the lowest-costing gold plan.

Gold plans are a better option in some states such as Pennsylvania, Wyoming, New Mexico, Kansas and Texas. Below is a map of highlighted states where gold plans are lower than silver plans by $25 or more.

Need Help?

Comparing plans for the upcoming year, and choosing one can be difficult. EZ.Insure can help you compare all the plans in your area, and assist you in choosing the ideal plan. Whether gold or silver is the cheapest, or bronze or platinum will suit you, EZ.Insure will make it an easy decision. Enter your zip code in the bar above to receive instant quotes in your area. You can also email [email protected] or call 888-350-1890 to get started!

2017 Health Insurance Open Enrollment Has Been Shortened!

Shortened Open Enrollment Period- When Is The Deadline & What This Means For You

This year the government has decided to shorten the Open Enrollment Period from three months to only six weeks, lasting from November 1, 2017 to December 15, 2017. If you sign up during this period, coverage does not start immediately, it begins January 1, 2018. With a shortened amount of time, it is important to be diligent and look into plans as early as possible. If not, you can end up getting stuck with a plan that does not suit your needs, or even worse, miss out on signing up for a plan altogether.

Some states have extended their open enrollment period to allow people more time in choosing a plan. These nine states are highlighted on the map below:

2017 Open Enrollment Period has been shortened in most states. Only 9 States have extended deadlines.

California – November 1, 2017 to Jan. 31, 2018
Colorado – November 1, 2017 to Jan. 12, 2018
Connecticut – November 1, 2017 to December 22, 2017
District of Columbia – November 1, 2017 to Jan. 31, 2018
Florida – November 1, 2017 to Dec. 31, 2017
Massachusetts – November 1, 2017 to January 31, 2018
Minnesota – November 1, 2017 to January 14, 2018
New York – November 1, 2017 to January 31, 2018
Rhode Island – November 1, 2017 to December 31, 2017
Washington – November 1, 2017 to January 15, 2018
Select Georgia Counties – November 1, 2017 to Dec. 31, 2017
- Camden, Charlton, Chatham, Coffee, Glynn, Liberty, McIntosh
Select Texas Counties – November 1, 2017 to Dec. 31, 2017
- Aransas, Austin, Bastrop, Bee, Brazoria, Caldwell, Calhoun, Chambers, Colorado, DeWitt, Fayette, Fort Bend, Galveston, Goliad, Gonzales, Grimes, Hardin, Harris, Jackson, Jasper, Jefferson, Karnes, Kleberg, Lavaca, Lee, Liberty, Matagorda, Montgomery, Newton, Nueces, Orange, Polk, Refugio, Sabine, San Jacinto, San Patricio, Tyler, Victoria, Walker, Waller, Wharton

Not all states can change their open enrollment period, but there are three more states that can extend at anytime. These three states are Idaho, Maryland, and Vermont.

Not only has the open enrollment time been reduced, but there are also added provisions

1. Special Enrollment Period- When the open enrollment period is over, people may enroll during the special enrollment period. These circumstances are such as when you adopt or have a child, get married, lose coverage from employer, or move outside network area. With the change of a shorter enrollment period, came a stricter ruling on special enrollment. Now you need to send documentation in a short period of time to prove your circumstance, whereas before they just took your word on it.
2. Non Payment Loopholes Removed- Some people learned a loophole to save money during open enrollment. They would stop paying their premium in the months leading up to enrollment so their plan gets cancelled. But now with new provisions, you cannot switch coverage unless your old coverage is paid in full. Due to this rule, a lot of people who are behind on payments will not be able to sign up.

How Does This Affect You

In the previous year, when the open enrollment period was 3 months, more people signed up later in the open enrollment period. During the second half of the 3 months (about 7-12 weeks) is when 60% of new enrollments occurred and when people switched plans. With only 6 weeks open, people are forced to make a quicker decision in choosing a plan, and some might miss out completely. Enrollees who signed up in January, and had a Feb. 1 effective date, were healthier on average than those with a Jan. 1 effective date. People who are healthy may procrastinate and miss out on open enrollment this period, and these healthy procrastinators are the ones who balance the risk pool and lower premiums.

How This Will Affect The Healthcare System

Insurers do not favor longer open enrollment periods. This is because people will wait until they are sick before they apply for coverage, and then insurers will have to cover their pre-existing conditions. Insurance companies fear of going broke due to all the sick individuals they must cover. If the healthy procrastinators do not sign up because they missed the opportunity, then the premiums will go up in order to cover those who are sick.

Given the shorter amount of time to sign up for insurance, it is very important to go over plans and choose the best one for you, rather than making a rushed decision. In order to better prepare yourself, you need to consider some things when purchasing a health insurance plan. You need to consider past health needs, future health needs, pharmaceutical needs, and your financial situation. Ez.Insure will help you choose the plan that suits all those needs. Simply put your zip code in the bar above to get started, or contact us through email at [email protected] or call 888-350-1890 . One of our agents are always ready to help you at no charge, with no obligation.

Tag: Healthcare