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The Scoop: health insurance news – November 25, 2020

November 25, 2020

In this edition

  • Enrollments have surpassed 3 million nationwide
  • Get Covered 2021 coalition seeks to slow the spread of COVID, get uninsured Americans enrolled in coverage
  • KFF finds 40% of Americans eligible for free 2021 health coverage
  • Maine healthcare organization to gather signatures for universal coverage initiative on 2022 ballot
  • Healthcare sharing ministry fined $1 million by Washington, cease-and-desist order upheld
  • Appellate court hears Oscar suit challenging Florida Blue exclusive broker requirements
  • Brookings Institution paper analyzes strategies for reducing healthcare costs
  • Nevada health exchange director discusses increased enrollment

Open enrollment for 2021 health plans: Under 3 weeks remaining

If you or a loved one is in need of health insurance, or if you’re already enrolled in an individual-market (non-group) health plan, open enrollment is currently underway nationwide, and we’re past the half-way point. Enrollment started more than three weeks ago, and we now have under three weeks remaining.

open enrollment 2021

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

Open enrollment is an opportunity for people to newly enroll in health coverage – regardless of medical history or prior coverage – and it also allows people who are already enrolled to actively compare their available options for 2021 and select a different plan if it would serve them better.

(Even if the current plan is still the best choice, this is always a better approach than simply letting the plan auto-renew without checking the other options.)

Still have questions? Read our extensive overview of open enrollment.

Enrollments have surpassed 3 million nationwide

As of November 21, nearly 2.4 million people in 36 states had enrolled in coverage for 2021 through HealthCare.gov. A few of the state-run exchanges (used in Washington, DC, and the other 14 states) have also published enrollment updates:

  • Colorado: Nearly 30,500 enrollees as of November 20.
  • Connecticut: 4,237 new enrollees as of November 20.
  • Minnesota: 101,894 enrollees as of November 18, including new and renewing enrollees (This includes scheduled auto-renewals.)
  • Washington: More than 6,000 new enrollees as of November 16, with enrollment trending 4% higher than last year.

According to Charles Gaba – who’s tracking enrollments nationwide – enrollment stood at more than 3 million as of November 25, including several hundred thousand enrollees in state-based exchanges whose coverage has been auto-renewed for 2021. (These individuals still have an opportunity to pick a different plan if they choose to do so). Gaba’s tally includes the states that use HealthCare.gov as well as the handful of state-run exchanges that have reported enrollment data, but most of the state-run exchanges have not yet made their enrollment data public.

The daily enrollment pace via HealthCare.gov is higher than it was during the same time period last year, and that appears to be the case in the state-run exchanges as well. But we aren’t yet seeing a significant surge in enrollment that might be expected given the job losses and associated coverage losses caused by the COVID pandemic. However, enrollment in Medicaid has grown significantly this year, thanks to the ACA’s Medicaid expansion guidelines that allow people in most states to enroll in Medicaid if their income drops to under 138% of the poverty level, even if it was higher than that earlier in the year.

Get Covered 2021 coalition seeks to slow the spread of COVID, get uninsured Americans enrolled in coverage

Get Covered 2021 launched last week as a broad coalition of organizations with a two-part goal: keeping Americans safe amid the COVID pandemic, and spreading awareness about available health insurance options and the financial assistance that can make health coverage much more affordable than it would otherwise be. “Get Covered” is a reminder of the importance of wearing a mask to slow the spread of COVID, as well as the importance of having health insurance coverage.

Get Covered 2021 is chaired by Carrie Banahan, who directs Kynect in Kentucky, Peter Lee, who directs Covered California, and Joshua Peck, co-founder of Get America Covered. The Get Covered 2021 coalition includes 15 state-run marketplaces and numerous national health care and consumer advocacy organizations.

KFF finds 40% of Americans eligible for free 2021 health coverage

A new analysis published this week by KFF finds that about 40% of uninsured Americans are eligible for free or nearly free health coverage for 2021. About a quarter of the uninsured are eligible for Medicaid, which is free in most states and has nominal premiums in a few states. And another 16% are eligible for premium subsidies in the exchange that are substantial enough to allow them access to at least one private plan that would have no premiums at all.

The free private plans are generally Bronze plans, although there are free Gold plans available in some areas. Selecting the free plans is not always the best option – some of these individuals will be better off with a Silver plan that includes cost-sharing reductions, even if they have to pay a higher monthly premium. But enrolling in free health coverage is certainly a far better option than remaining uninsured for the coming year.

Maine healthcare organization to gather signatures for universal coverage initiative on 2022 ballot

Three years ago, Maine made history when the state became the first to have Medicaid expansion approved via a ballot measure passed by voters; several other states have since followed suit. Now Maine Healthcare Action – a nonprofit focused on universal healthcare in Maine – has announced that it will begin gathering signatures in 2021 for another ballot measure, which would direct the legislature to create a universal health coverage system for the people of Maine by 2024.

In order to get the measure on the 2022 ballot, 63,067 valid signatures are needed, although advocates are hoping to gather at least 80,000. They will have a year in which to get enough signatures to get the measure on the 2022 ballot.

Healthcare sharing ministry fined $1 million by Washington, cease-and-desist order upheld

For well over a year, Washington Insurance Commissioner Mike Kreidler has been seeking a $1 million fine against healthcare sharing ministry Aliera Healthcare, Inc. Kreidler had ordered the company to stop issuing memberships in Washington in the spring of 2019. (Other states have also stepped in to issue cease-and-desist orders for Aliera.)

Aliera had appealed Kreidler’s cease-and-desist order, but it was upheld earlier this month. And this week, Aliera was ordered to pay the $1 million fine, although the company has 90 days to appeal that as well.

Appellate court hears Oscar suit challenging Florida Blue exclusive broker requirements

Last fall, we told you about a lawsuit involving Oscar and Florida Blue, stemming from Florida Blue’s requirement that brokers who offer their products refrain from offering products from any other insurance company. This is far from the norm; brokers in most states are allowed – and generally encouraged – to become appointed with a variety of insurance companies, in order to offer their clients a broad selection of plans from which to choose.

Oscar sued, alleging that Florida Blue’s exclusive broker requirement amounts to coercion and unfair market practices, but a judge sided with Florida Blue last September. Last week, the case was argued in front of a three-judge panel for the 11th Circuit Court of Appeals in Atlanta, but it’s not yet known when the judges will issue a ruling on the case.

Brookings Institution paper analyzes strategies for reducing healthcare costs

The Brookings Institution’s Matt Fiedler has published a new paper that analyzes various options for reducing healthcare costs, including capping out-of-network prices, capping both in-network and out-of-network prices, and creating a public option. Start with Fiedler’s Twitter thread about this, and then dig into the summaries and the paper itself.

The short story? It’s complicated and there are numerous pitfalls to avoid, but there are strategies that could successfully lower healthcare prices.

Nevada health exchange director discusses increased enrollment

This week, Megan Messerly of the Nevada Independent interviewed Heather Korbulic, the executive director of Nevada’s health insurance exchange (Nevada Health Link). Korbulic and Messerly cover a wide range of topics, including increased enrollment during special enrollment periods earlier this year, the increased plan availability during the current open enrollment period, and the potential impact of the pending Supreme Court ruling on the ACA.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post The Scoop: health insurance news – November 25, 2020 appeared first on healthinsurance.org.

https://www.maddoxinsured.com/wp-content/uploads/2021/01/open-enrollment-2021-400x203-1.jpg 203 400 wpmaddoxins https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.png wpmaddoxins2020-11-25 11:21:512021-01-22 14:19:45The Scoop: health insurance news – November 25, 2020

Healthcare sharing ministries: A leap of faith?

December 18, 2018
  • Sharing ministry plans have seen rapid growth in membership.
  • Membership dues are much lower than the cost of an unsubsidized ACA-compliant plan.
  • But they’re not health insurance.
  • Plans are not subject to state and federal health insurance regulations.
  • Medical underwriting is permitted.
  • Plans have limits on the benefits they’ll provide.
  • Patients can see any provider, but there’s no guarantee they’ll find a provider willing to accept their sharing ministry coverage.

As health insurance premiums rise, so does the popularity of cheaper alternatives to covering medical expenses. That’s one reason why healthcare sharing ministries – which can average less than half the cost of traditional health insurance plans – have seen a major membership surge in the past few years.

Healthcare sharing ministries are faith-based non-profit organizations that pool members’ money to share medical expenses. As long as the ministry has been in existence since December 31, 1999, participation exempts members from the Affordable Care Act’s individual mandate to have health insurance (that’s no longer an issue after the end of 2018, as the federal individual mandate penalty won’t apply in 2019 or future years).

These organizations generally require members to make a promise to adhere to certain biblical values and to participate regularly in worship or prayers. As a result, some health conditions don’t comport, leaving members to pay out-of-pocket for illnesses stemming from the use of tobacco, alcohol, and drug addiction, for example. They typically don’t pay for mental health services, out-of-wedlock pregnancies, contraceptives or abortion either.

Since the Affordable Care Act became law, membership for healthcare sharing ministries has grown at a rapid rate. The Commonwealth Fund reports that there were an estimated one million people enrolled in health care sharing ministry plans as of 2018, up from about 200,000 as of 2010 (the year the ACA was implemented). More than 100 health care sharing ministries are in operation in the US, although nearly all of them are affiliated with small Mennonite churches; most health care sharing ministry members are enrolled in coverage offered by Samaritan Ministries, Medi-Share, Christian Healthcare Ministries, and Liberty Healthshare.

Desire for cheaper plans fuels interest

Why the rapid growth? Health care sharing ministry plans are far less expensive than ACA-compliant coverage for people who aren’t eligible for premium subsidies in the exchange. As long as they’re healthy, can agree to a sharing ministry’s lifestyle requirements, and aren’t concerned with the coverage gaps and reduced regulatory oversight, they can pay a lot less each month for their coverage by using a sharing ministry plan.

For example, a single person between the age of 30 and 64 who signs up with Liberty HealthShare ministry will pay $299/month. A couple will pay $399/month, and a family will pay $529/month. The plan will share up to $1,000,000 per incident, and there’s an “unshared amount” (similar to a deductible) that ranges from $1,000 to $2,250.

A single 50-year-old enrolling in Medi-Share (Christian Care Ministry) will pay between $176/month and $484/month, depending on their health and the unshared amount that they select. For a family of four with 50-year-old parents, the Medi-Share monthly cost will range from $301 to $959.

Compare that to average monthly premiums through the ACA marketplaces of $668 for a 50-year old individual purchasing a silver on-exchange plan for 2019 without any premium subsidies. A family of four (50-year-old parents and two teenage kids) will pay an average of nearly $2,000/month for a silver plan in the exchange if they aren’t eligible for premium subsidies in 2019. And silver plans can have out-of-pocket exposure as high as $7,900 for an individual and $15,800 for a family

It’s worth noting here that most middle-class families do qualify for premium subsidies in the exchange; subsidies are available for a household of four people with an income of more than $100,000 in 2019. And “income” refers to the ACA-specific calculation for modified adjusted gross income (MAGI): Contributions to retirement plans and a health savings acount will result in a lower MAGI and potentially larger premium subsidies.

But if there’s no way you’re eligible for subsidies, the monthly costs might make a sharing ministry plan look like a good option. But before ditching your ACA-compliant health insurance policy, here are five things to know about healthcare sharing ministries.

1. They’re not health insurance

Although designed to help consumers cover the cost of medical expenses, healthcare sharing ministries differ in significant ways from health insurance policies that comply with the Affordable Care Act.

“It’s voluntary and cooperative and motivated by compassion and the urge to assist another person in need. That’s really what drives it versus an insurance arrangement where there is a contract of indemnity. That’s the essential difference,” says Dale Bellis, Liberty Health Share’s executive director.

Each healthcare sharing ministry operates a bit differently, but generally the money collected from members each month is placed into an account. The ministry then facilitates the direct sharing of medical costs among members.

“Each month members can see the names of other members who have benefited from their monthly share amount,” says Michael Gardner, director of marketing and communications for Christian Care Ministry, a healthcare sharing ministry in Melbourne, Florida.

2. State and federal regulations don’t apply

Consumers who face problems with a healthcare sharing ministry, such as when a claim is paid or a service is not covered, aren’t protected by their state’s insurance department.

As of 2018, there are 30 states with laws that exempt health care sharing ministries from laws that apply to health insurance. So members of healthcare sharing ministries in those states don’t get the benefit of regulatory oversight from the insurance department. That’s because healthcare sharing ministries are not health insurance companies and do not technically offer health insurance

So there are no guarantees that certain services or treatments, such as preventive visits and contraceptives, mental healthcare and treatment associated with drug or alcohol use or abuse, are covered. And in many cases, some of those services are specifically excluded. The ACA’s consumer protections don’t apply to health care sharing ministries, so essential health benefits don’t have to be covered.

Most health care sharing ministries do have formal appeals processes in place, but they aren’t enforced by federal or state law.

LibertyShare, for example, alerts members on its website about their rights when grievances over uncovered medical costs occur, and when attempts at resolving the dispute don’t work in the member’s favor.

This program is not an insurance company nor is it offered through an insurance company. This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such, this program should never be considered as a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this program continues to operate, you are always liable for any unpaid bills.

“It’s buyer beware. If you have health costs not covered there is very little recourse for you. You can’t go to a government agency to complain,” explains Sabrina Corlett, with the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute. And as the fine print clearly notes, the sharing ministry plan should not be considered a substitute for health insurance.

3. Underwriting is permitted

One common practice the ACA outlawed was the ability of health insurers to turn away people with pre-existing health conditions, or to charge them more for coverage.

Not so with healthcare sharing ministries.

Medical underwriting is allowed and pre-existing health conditions can be excluded from coverage.

4. There are limits to coverage

Unlike health insurance, there are generally limits to the amount of medical expenses healthcare sharing ministries will cover – in some cases, a maximum payout of $125,000 per incident and $1,000,000 per diagnosis.

Although healthcare sharing ministries report that most members’ “sharable expenses” are covered, they are clear to say there is no guarantee.

“Neither Medi-Share nor any of its members assume any obligation to pay another member’s medical bills,” Gardner says. Medi-Share’s policy is common among other ministries.

5. No limits on access to doctors, hospitals, but also no guarantee they’ll accept sharing ministry coverage

Christian Care Ministry is one of a few organizations with a provider network it suggests members tap for care. According to Gardner, staff is better able to negotiate a discounted rate when members see one of the more than 700,000 providers participating with the organization nationwide. However, members are allowed to see any provider they wish.

In most cases, ministries will negotiate prices on members’ behalf. And, it’s a good deal for both the patient and providers, they say. According to Bellis, 97 percent of all doctors and hospitals take the reimbursement they negotiate.

But there’s another side to this as well: Doctors and hospitals can treat sharing ministry members as cash-paying patients, which means they might not accept them at all, if the patient is expected to rack up a significant bill. To be clear, doctors and hospital like cash-paying patients if the patient pays up front or the bill is relatively small and there’s an expectation that the patient will be able to pay it without much trouble. But when a bill is expected to be substantial and isn’t paid up front, a patient without a solid insurance policy backing them might experience difficulties in getting the hospital to provide treatment.

Look before a leap of faith

Corlette of Georgetown University’s Health Policy Institute says anyone considering a healthcare sharing ministry in place of an ACA-compliant health insurance plan just needs to enter with their eyes wide open.

“What I would say about health sharing ministries is they are a leap of faith, both literally and figuratively.”

The post Healthcare sharing ministries: A leap of faith? appeared first on healthinsurance.org.

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