Posted on Tue, Aug 31, 2010
Today, about 2,000 organizations, ranging from small and large companies, educational institutions, unions, nonprofit organizations and local governments have received acceptance into a program that reimburses employee claims beginning this fall.
The Early Retiree Reinsurance Program was created by Healthcare Reform, and is meant to be a bridge between now and 2014, which is the date that medical insurance exchanges will be in effect. This program offers $5 billion to unions and employers to assist them in maintaining insurance coverage for retirees that retire early at age 55 or older, that aren't qualified for Medicare yet. These 2000 employers will get reimbursed for early retirees' health claims for themselves and their spouses, dependents, and surviving spouses.
This new program will lessen the cost of businesses' medical insurance costs for many retirees. The high cost of medical care has prohibited employers from providing affordable medical insurance for their retirees and employees, while still being competitive in their field. In 1988, 66% of large employers provided employees with retiree medical coverage; whereas in 2009, just 29% of large employers provided these benefits. Medical insurance costs for older employees and retirees are more than 4 times more costly than they're for younger employees. Likewise, the deductibles they pay is about 4 times higher than a company sponsored plan.
More applications for the next round of approvals are being reviewed each day. Beginning in September, applicants that have been approved in this first batch of approvals will be able to submit their claims that are dated back from the 1st of June, 2010. Then, beginning in October, reinsurance payments will begin to be dispersed to applicants that have been approved.
Posted on Fri, Aug 13, 2010
Finally, it looks like a medical insurance plan may be put into place in California in September for people who have pre-existing medical conditions that have prohibited them from obtaining medical insurance. This plan is meant to be a bridge until 2014, when people with medical conditions will no longer be declined coverage or be rated up for it. Applications for this medical plan will be taken starting in late August.
This new government insurance plan is part of the health care reform legislation, and will help people with pre-existing conditions. California's Managed Risk Medical Insurance Board will run the program, and it is funded by the government, costing $761 million over a 3 year period.
Analysts have estimated that about 25,000 residents of California will be covered by this insurance plan at any one time...which is a lot higher than the 7,100 person maximum that California's current high risk pool covers.
To give you an example of the rates, in Ventura County for example, children up to the age of 14 will have a monthly premium of $127. People between the ages of 60 and 64 will have a premium of $720 per month. The plan is considered a comprehensive medical insurance plan, with a $1500 annual deductible, and an out-of-pocket limit of $2500.
Compared to the current high risk pool plan in California, a 42 year old person living in Ventura county would spend quite a bit less on the new government run plan, paying $304 per month compared to $657.50 on the current high risk pool plan.
To be eligible, you must not have had any insurance for at least 6 months, and have a pre-existing condition that prohibits you from obtaining private medical insurance. While it's still expensive and probably only beneficial to the middle class, it's a great first step for getting many uninsured the coverage that they need.
Please contact us at (877) 812-5111 if you need additional options for guaranteed issue medical insurance.
Posted on Tue, Aug 10, 2010
The new health care reform law includes a provision that requires medical insurance companies to provide preventative services without any member cost sharing.
Non-grandfathered plans issued or renewed on or after September 23, 2010 will not include member cost sharing or copays for the following preventative care services provided in-network:
- Items or services that have an A or a B rating in the current recommendations of the United States Preventative Services Task Force. You can see a list of these services at: http://www.ahrq.gov/clinic/uspstf/uspsabrecs.htm.
- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. You can see a list of these immunizations at: http://www.cdc.gov/vaccines/recs/acip/default.htm
- Evidence-informed preventative care and screenings provided for in comprehensive guidelines for infants, children and adolescents that are supported by the Health Resources and Services Administration. You can view more information at: http://www.hrsa.gov/
- Evidence-informed preventative care and screenings for women not otherwise addressed by the U.S. Preventative Services Task Force recommendations that are supported by the Health Resources and Services Administration.
This impacts non-grandfathered plans issued or renewed on or after September 23, 2010, and it only applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.
Most of the recommended screenings, immunizations and exam services are already on Anthem's preventative services list. They are adding the new, required preventative services to this existing list. One example of a new preventative service is counseling for aspirin use, tobacco cessation, obesity and alcohol use. In addition, some services that are currently covered as a maternity benefit, such as recommended pregnancy screenings for pregnant women, will now be covered as a preventative service.
Posted on Tue, Jul 27, 2010
Here is a list of a few of the provisions that grandfathered medical insurance plans are mandated to comply with. Please note that this is not a complete list.
- Ban on Annual Limits and Lifetime Limits: Beginning with plan years of September 23, 2010 and after, insurers are not allowed to place lifetime limits on essential health benefits. Group medical plans are allowed to place a reasonable yearly limit on essential medical benefits until January 2014. At that point, all group medical plans must get rid of all annual limits.
- Prohibition of Rescissions: Beginning with plan years of September 23, 2010 and after, insurers may not rescind medical insurance coverage after enrolling a member, with the exception of fraud or other limited circumstances.
- Ban on Preexisting Conditions Exclusions: Beginning with plan years of September 23, 2010 and after, insurers cannot decline children under the age of 19 due to preexisting conditions. On January 1, 2014, medical insurers will not be allowed to decline anyone medical coverage due to preexisting conditions.
- Required Coverage for Adult Children: Beginning with plan years of September 23, 2010 and after, insurers that provide dependent coverage are required to cover adult children up to the age of 26 without any conditions of dependency. However, grandfathered health insurance plans may still exclude coverage for adult children with other employment-based coverage available until January 1, 2014.
- Prohibition on Excessive Waiting Periods: Beginning on January 1, 2014, group medical insurance plans cannot impose a waiting period for eligible employees to join an employer plan of no more than 90 days.
Posted on Mon, Jul 26, 2010
While most of Health Care Reform's provisions will go into effect in 2014, there have been some provisions of the Health Care Reform Act that will come into effect this year.
For example, children up to the age of 19 will no longer be declined health insurance beginning with plan years (or a policy year) of September 23, 2010 and later. However, grandfathered individual medical insurance plans are exempt from this provision, but there may be limited exceptions to this exemption. A grandfathered medical plan is a plan that you had in place on March 23, 2010 when the health care reform bill was signed. Grandfathered group health insurance plans are not exempt from this provision.
Another provision is that insurance companies will no longer be allowed to rescind policies unless there is evidence of fraud or intentional misrepresentation of material facts. An insurer will only terminate someone's coverage if it's due to a mistake in eligibility, without any fraud or misrepresentation on the member's part. If the policy is rescinded, the insurance company must notify the member 30 days ahead of the rescission. This provision is applicable to non-grandfathered and grandfathered plans.
Anthem Blue Cross is also making changes to their annual and lifetime dollar limits. They are removing the limits, and will no longer have any annual dollar limits on certain "essential health benefits". The definition of "essential health benefits" has not yet been determined.
Members of Anthem Blue Cross who have already reached their annual or lifetime maximum will be offered a special enrollment time to re-enroll in benefits. Anthem will let their members and terminated members know who are no longer receiving benefits for this reason, so that they can take advantage of the special re-enrollment period. The enrollment period for groups will commence during the group open enrollment at the time of the group's renewal. This provision only applies to pharmacy and medical benefits and does not impact vision or dental coverage.
Anthem Blue Cross will be adopting all patient protection provisions for all of their plans, including grandfathered plans.
For example, for all of Anthem Blue Cross plans that require primary care physicians, including grandfathered plans, Anthem will allow the member to choose any available in-network primary care physician, including participating pediatricians for kids. Also, Anthem will allow individuals to obtain care from an in-network obstetrician/gynecologist without any pre-authorization or a referral. However, pre-authorization for certain obstetrician/gynecologist services will still be allowed.
Another patient protection provision applies to emergency room services. For instance, a pre-authorization will not be required for ER services, in-network or out-of-network. Also, Anthem will be covering out-of-network emergency room services, and the copays and coinsurances for these services cannot be more than those for in-network emergency room services. However, deductibles and out-of-pocket limits will be allowed for out-of-network ER services if it's the same used for other out-of-network benefits.
We will continue to pass along Health Care Reform information as we receive it. Please feel free to call us at 1-877-812-5111 if you have any questions.
Posted on Thu, Jun 24, 2010
As it stands now, your chances of fighting and winning against an medical insurance company to get a denied claim paid is slim. There are very few options for disputing a medical insurer's decision. The appeals process can be very time consuming. Most people cannot sue the medical insurer for damages that resulted from the denials and treatments that were delayed.
Beginning this fall, people will be able to challenge claim denials through a procedure that's conducted independently at the state level. This has previously been unavailable to employees of employers that cover their workers' medical claims directly.
As more than 50% of all covered employees are in a self funded plan, this change is huge. However, this new law is not applicable to grandfathered plans, which are the plans that were in place on March 23, 2010.
It will still be difficult for people to file a lawsuit for pain and suffering or punitive damages. The Employee Retirement Income Security Act of 1974 states that employees or their families that are covered by company medical plans can only sue for the cost of the benefit that's been denied.
With the current system, insurers must have a process of internal appeals. Usually, this process has multiple levels of appeals, but most times the original denial remains a denial.
Most of the states in the U.S. have a review of denials that's independent, but the new law will give that option to each state and to self-funded medical plans. These independent reviewers rule on the consumer's side half of the time but most people do not take advantage of these reviewers because they don't know that they exist, and they usually have to go through many layers of levels internally before they get to that point.
There are a few states that make consumers spend up to 50% of the cost of an independent review, and some states allow the medical insurer to stop coverage during the process of appeals. There are hopes that the new law will address some of these concerns.
Posted on Wed, Jun 23, 2010
Last week, administrators in California came to some early decisions regarding the costs and deductibles of the high risk medical insurance pool that will be established on September 1, 2010. The intention is to administer that federal program simultaneously with the CA high risk medical insurance pool that is already in existence.
There are differences in prices between the state pool that's already in existence and the federally subsidized high risk pool. For example, a woman who lives in San Francisco who is 50 years old would pay a monthly premium of $915 for the existing state pool coverage, and only $575 monthly for the federal plan.
It is estimated that the subsidy from the federal government will aid about 16,000-44,000 residents in California. These numbers will not be finalized until they see how sick these people are and the medical costs associated with caring for them.
It was also decided that there will be a $1500 annual deductible on the federal medical plan.
These high risk medical insurance pools are meant to bridge the time period between now and when insurers will no longer be able to decline applicants because of pre-existing conditions in 2014.
$5 billion has been put aside for these high risk insurance pools, with California receiving about $761 million. It is estimated that this money will help to cover about 200,000 for a period of 3 years. All of the states are stating that it is not enough to last, and not enough to help the many 50 million uninsured Americans.
California's existing high risk pool has a waiting list because it caps enrollment at 7,100 Californians. The new federal pool could have a waiting list as well.
The federal high risk pool is only for people that have not had any insurance for the past 6 months, and nobody knows if and when a waiting list will be formed.
Posted on Wed, Jun 23, 2010
Even though medical insurance reform laws passed in March, the U.S. could have a major crisis before many of the provisions of the law become law in 2014.
Many state governments that have been struggling because of the recession are considering more cuts in medical care help for the poor, even though more money is promised to these states by the federal government.
Meanwhile, there are millions of people in the U.S. that have been using assistance from the federal government as a way to hold onto their medical insurance that will be losing their coverage within the next few months since that assistance will be expiring. Those people that have jobs are facing more cost shifting to employees in regards to the medical insurance that their company has, or their company is considering dropping the coverage altogether.
Everyone is facing increasing medical care costs and rising medical insurance premiums. In some areas of the U.S., people's medical insurance premiums are increasing at double-digit rates in 2010.
The White House Office of Health Reform has acknowledged that medical insurance premiums will continue to rise, and some Americans will still lose their insurance coverage.
From now until 2014, it is a bridge period, until Americans receive medical coverage that's guaranteed and federal subsidies that amount to billions of dollars in 2014.
Since the law has been passed, the government has been offering new tax credits to small companies in order to sway them into offering medical coverage to their employees. The government has also been developing regulations that will oversee medical insurance companies and to stop huge rate increases from happening.
States have been working with the Department of Health and Human Services to establish high risk pools. These high risk pools will help people obtain coverage who have been declined coverage. However, preliminary research states that the $5 billion that's set aside for these new high-risk pools is not enough.
A survey that was conducted in March of this year showed that among 507 large companies, their premiums would increase by 6.5% on average this year. That is about 3 times faster than prices in the entire economy are rising.
Therefore, many large companies are having their employees pick up more of the share of cost of these medical insurance premiums. Small companies typically are not as likely to offer their workers medical insurance because of the costs, some of which are being increased by at least 20% in some areas of the U.S. Many of these companies are slashing benefits or laying off employees to help offset the increasing costs of medical care.
In 2009, Congress authorized about $2 billion to go towards medical benefits for about 2 million Americans that had been laid off. However, there is a lot of pressure to contain this spending. It is likely that Congress will stop the COBRA aid, which gave laid off employees a 65% subsidy to help them keep their Cobra coverage. Without this assistance, laid off workers will have to pay the entire cost of the premiums, which is prohibitively expensive for most.
Since the recession started, there has been an enormous increase in the enrollment in Medicaid programs. Democrats have been trying to give extra funding to states, but for a lot of states, that extra funding will not be enough.
In California, officials are intending to place revised limits on the amount of prescriptions and physician visits for Californians on its MediCal program. Officials in North Carolina have slashed payments to physicians and other medical providers and are considering ways to cut down the amount of people that are eligible for certain services, like home health care. State leaders in New Mexico, who have also cut payments to physicians and other medical providers, are now looking at methods to cut some prescriptions and long term care services.
Posted on Wed, Jun 23, 2010
A recent survey conducted by Kaiser found that medical insurance rate increases averaged 20% in the individual and non-group medical insurance markets
About three quarters of people without group coverage said that they had a rate increase with their current medical insurance company or with a previous insurance company they were insured with. Of those, about 16% changed insurance plans at the time of the rate increase and they bought either a less costly medical insurance plan or they switched medical insurance companies. After everything considered, these same people who had rate increases ended up dishing out 13% more money than previously.
The reason they're spending more now is because those people that changed to a less expensive medical insurance plan aren't getting as comprehensive of coverage compared to before. When people changed plans, they were 4 times more likely to state that their new medical insurance plan has worse benefits compared to their prior plan compared to people that said that their new medical insurance plan's benefits are increased.
There are roughly 14 million Americans that obtain their medical insurance through the individual market or non-group market. About 57% of these people with individual insurance said that their policies just cover themselves and nobody else. Their premiums that they pay average about $3,606 per year, which is less than what the average premium for group sponsored coverage is, which is $4,824. However, group insurance typically offers more comprehensive coverage. For people who insure their families on their plan, their medical insurance premium averages $7,102 for the year.
Premiums vary by age, and older Americans have reported paying much higher premiums compared to younger people.
About 26% of these people have a high deductible of $5,000 and more. About 6% have a deductible that's $10,000 and more. For a single person policy, the average deductible is $2,498, but on a company sponsored PPO plan, the average deductible is $634. People that have a family plan have to meet their individual deductible, which averages $2,959. But for people that have a family deductible, which is the deductible that is required to be met by any combination of family members before benefits kick in, their average family deductible is $5,149.
People who buy their own coverage worry about their ability to pay for medical care compared to people with company sponsored coverage. In fact, 40% of people who purchase their own medical insurance say that they're not too sure or not at all sure if they'll be able to keep up with their medical bills, which is twice the amount of people with company sponsored coverage that said the same thing. Just 17% of those who purchased their own medical insurance plan said that they're very confident that they can pay their medical bills, compared to more than double that amount (36%) with employer sponsored coverage that said the same thing.
Over the previous year, 22% said that they themselves or a member of their family covered by their medical insurance plan didn't receive the medical care that they needed because of the high cost involved. Similarly, 20% said that they did not fill a prescription because of the cost involved.
People with pre-existing conditions were two times as likely as people without pre-existing conditions to skip medical care that's needed because of the high cost or not getting a prescription filled because of the costs associated with it.
About 38% of people reported at least a single problem with having their medical insurance company pay a medical bill. This was because either the medical policy paid less than what they were expecting, or the policy wouldn't pay towards a bill that they believed was covered, or they met the limit of what the policy pays for a certain illness or injury.
Posted on Wed, Jun 23, 2010
Anthem Blue Cross, Blue Shield of California, Health Net and Aetna will now be subject to an additional review of their proposed rate increases by actuaries that are independent of these medical insurance companies.
These four medical insurance companies cover approximately 90% of the individual medical insurance market in California.
This is in response to Anthem Blue Cross's proposed rate increases of up to 39% this past March. The California Department of Insurance had sent the rate increase filing to an actuary outside of the insurer, and discovered errors in its filing. They found that Anthem Blue Cross had tried to bill customers 50% more than the state of California allows. Because of this, Anthem Blue Cross did not go through with the proposed rate increases.
Auto and homeowners insurance plans need to have approval by the state insurance department before adjusting its rates, yet in California, medical insurance companies have not been required to get approval. However, the law in CA requires that each insurer maintain a 70% loss ratio, which means that 70 cents of every dollar that is obtained through premiums is to be used on medical benefits.
Medical insurers state that the premiums that they charge are in direct correlation with the increasing cost of medical care. Research organizations in California that are non-partisan have said that there is a huge market power of hospitals which are driving the costs up.