Enrollment up 6.6% for 2021 in states that use HealthCare.gov
Last Friday, CMS published preliminary enrollment data for the 36 states that used HealthCare.gov during the open enrollment period that ended last week. Across those 36 states, a total of 8.23 million people enrolled in private plans through HealthCare.gov. As Charles Gaba notes, that’s a 6.6 percent increase over last year, after we account for the fact that Pennsylvania and New Jersey are now running their own exchange platforms and will report their enrollment numbers separately. (Both also have ongoing enrollment periods, as noted above.)
As detailed by Andrew Sprung, private-plan enrollment via the exchange in states that have not expanded Medicaid is about 10 percent higher for 2021 than it was for 2020, while enrollment is slightly lower in states that have expanded Medicaid. Sprung offers several explanations for this, including the fact that many who lost their incomes in 2020 have transitioned to Medicaid, which is more likely to be an available option in states that have expanded Medicaid. Sprung has also tracked the significant increase in the number of people covered by Medicaid this year.
Trump administration finalizes rule changes for grandfathered group plans
Earlier this month, the Trump administration finalized new rules for grandfathered group health plans. The rule change is essentially the same as the changes that the administration proposed in July, but the effective date has been pushed out to mid-June 2021, as opposed to the originally proposed effective date of 30 days after the rules were finalized.
Under the new rules, grandfathered group plans that are HSA-qualified will be able to make cost-sharing increases necessary to retain their HSA-qualified status, even if the increases exceed the limits that would otherwise have applied to grandfathered plans. (This situation has not yet arisen, but if it does in the future, the rule change will allow these plans to keep both their HSA-qualified status and their grandfathered status.) And the new rules will also allow grandfathered group plans to increase their cost-sharing amounts by a larger threshold than previously permitted, with allowable cost-sharing expected to be about 3 percentage points higher under the new rule.
Congress passes legislation to protect consumers from surprise balance billing
The surprise balance billing legislation that we told you about last week was included in the Consolidated Appropriations Act, 2021, which passed earlier this week with strong bipartisan support in both the House and Senate. President Trump was widely expected to sign it as soon as it reached his desk, but he cast doubt on that via Twitter on Tuesday night, expressing displeasure at some aspects of the legislation. Trump didn’t say that he would veto the bill, but the video he shared on Twitter indicated that the current bill is no longer a sure thing.
In its current form, the massive bill includes government funding for the first three quarters of 2021, extensive COVID-19 relief, and numerous other provisions, including strong consumer protections against surprise balance billing that will take effect in January 2022. As the Kaiser Family Foundation’s Larry Levitt explains in this Twitter thread, the new legislation provides strong consumer protections, and – assuming it does get signed into law – will result in consumers having to pay just their normal in-network cost-sharing when they receive emergency care or unknowingly receive care from an out-of-network provider at an in-network facility.
Protections against surprise balance billing for ground ambulance charges are not included in the legislation, despite the fact that ambulance rides often result in surprise balance billing. But the legislation does call for a commission that will study ground ambulance charges in hopes of incorporating additional consumer protections in a future piece of legislation.
Congresses passes legislation to make health insurers subject to federal antitrust laws
The Competitive Health Insurance Reform Act of 2020 – H.R.1418 – passed in the Senate last night and is now headed to President Trump’s desk (it was passed by the House in September). Under the terms of this legislation, health insurance companies will be subject to federal antitrust laws, reversing a 75-year-old exemption that was granted in 1945 via the McCarran-Ferguson Act.
Sens. Steve Daines (R-Montana) and Patrick Leahy (D-Vermont) shepherded the bipartisan bill through the Senate. In announcing the passage of the bill, Daines noted that it “will ensure that health insurance issuers are subject to the same federal antitrust laws prohibiting unfair trade practices, such as price-fixing and collusion, as virtually every other industry in our economy.” The rest of the McCarran-Ferguson Act – which gives states the right to regulate their insurance markets — is unchanged by H.R.1418.
Ohio enacts legislation to end ‘fail first’ drug requirements for stage 4 cancer treatment
This week, Ohio Gov. Mike DeWine signed a new law prohibiting Ohio health insurance plans from imposing “fail first” requirements on drug coverage for people with stage 4 cancer. S.B.252 prohibits insurers from requiring these patients to try a cheaper medication first and then only cover another medication if the first did not work. These “fail first” requirements are often imposed on newer, cutting-edge therapies that tend to be more expensive than older medications, but Ohio’s legislation stems from the fact that time is of the essence with metastatic cancer.
Delaware proposal calls for increased investment in primary care
Delaware’s Insurance Commissioner, Trinidad Navarro, and the state’s Office of Value-Based Health Care Delivery have published a report that outlines proposals for improving access to primary care in the state without increasing healthcare costs. The report calls for health insurers in Delaware to increase their investments in primary care while decreasing price growth for some other services, including hospital care, and to transition to a value-based payment model instead of a fee-for-service model. The state is accepting public comments on the report until January 25, 2021.
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.
In most of the country, open enrollment for 2021 individual/family health plans ended yesterday. (HealthCare.gov gave people until 1:59 a.m., Pacific time, and due to high call volume, they gathered contact information for some callers and will be reaching out to those people over the next few days to help them complete their enrollments.) The Trump administration rejected numerous calls to extend open enrollment in light of the ongoing global pandemic. Although the Biden administration might reopen the enrollment window next month, enrollment is currently closed for people in most states who hadn’t at least begun the enrollment process or left their contact information with the marketplace by the end of open enrollment (unless they have a qualifying event).
But in twelve states and DC, open enrollment is still ongoing. This includes Connecticut, where the extension was announced on December 16, and Idaho, where an extension was announced on December 18; the rest of those states had announced their extensions several weeks ago.
In some of these states, people who are currently enrolling (after December 15) will have coverage effective in February or March, instead of January. But several are offering extended enrollment deadlines for a January effective date. Pennsylvania, California, Colorado and Idaho all announced such extensions this week. Here are the applicable enrollment deadlines:
California’s state-run exchange, Covered California, has permanently extended open enrollment through the end of January. But CoveredCalifornia is working to try to give more Americans access to an extended open enrollment window for 2021 coverage, asking CMS this week to extend open enrollment via HealthCare.gov until the end of December or even through January. Oregon and Wisconsin have recently made similar requests, but CMS has given no indication that they plan to offer an extended enrollment window.
As of December 5, when there were still at least 10 days remaining in open enrollment nationwide, 3.8 million people had enrolled in plans through HealthCare.gov in 36 states. And by December 9, nearly 1.2 million people had enrolled in plans through several of the state-run exchanges, although not all of them have published enrollment data yet. There is always a significant spike in enrollment activity in the final few days of open enrollment, and auto-renewals will be processed by HealthCare.gov now that open enrollment has ended.
COVID-19 vaccine added to covered preventive care benefits for non-grandfathered health plans
On Friday evening, the FDA granted an emergency use approval for the Pfizer-BioNTech COVID-19 vaccine. Within hours, the CDC’s Advisory Committee on Immunization Practices (ACIP) held an emergency meeting and voted to add the COVID-19 vaccine to the list of vaccines that are recommended for routine preventive care. CDC Director Robert Redfield soon signed off on the recommendation, clearing the way for the vaccine to be covered by nearly all health insurance plans in the United States.
Under the CARES Act, enacted last spring, non-grandfathered health insurance plans have to add coverage for COVID-19 vaccines (with zero-cost-sharing) within 15 business days of the ACIP recommendation. This is much faster than the normal timeline for adding new preventive care services to health insurance plans, and it will help to ensure that when the vaccine becomes available for various populations, their health insurance will cover the cost.
South Carolina lawmakers pre-file Medicaid expansion legislation
There are a dozen states that still have not accepted federal funding to expand Medicaid. One of them is South Carolina, where several Medicaid expansion bills have been pre-filed for the upcoming legislative session. House Bill 3226 and Senate Bill 210 call for the state to expand Medicaid as of January 1, 2022, under the terms of the Affordable Care Act. Senate Bill 83 and House Bill 3269 call for the state to hold an advisory referendum during the 2022 general election, which would ask South Carolina residents to weigh in on whether the state should expand Medicaid as of 2024.
Both chambers of South Carolina’s legislature have strong Republican majorities, and have spent the last decade rejecting Medicaid expansion. But as the number of non-expansion states dwindles to a small minority of the country, there’s increasing pressure on lawmakers to address the coverage gap, protect rural hospitals, and ensure access to medical care – especially in light of the ongoing global pandemic.
Legislation introduced in New Jersey to create an ‘easy enrollment’ system
Legislation to create an “easy enrollment” system was introduced last week in New Jersey’s Senate. The legislation is modeled on a similar program that Maryland debuted this year, and that Colorado will start to use in early 2022.
The idea is to use state tax returns to identify uninsured individuals and then determine, based on the tax returns, whether those individuals would qualify for Medicaid or financial assistance through the New Jersey exchange. If enacted, New Jersey’s bill calls for the state to implement the program starting with either the 2021 tax year (ie, the returns that people file in early 2022) or, if that’s not feasible, the 2022 tax year.
Surprise balance billing legislation gains bipartisan, bicameral support, but future still uncertain
Last Friday, leading Democrats and Republicans in committees in both the House and Senate reached an agreement on a legislative proposal, dubbed the “No Surprises Act,” that would end surprise balance billing in most situations. Loren Adler, Associate Director of the USC-Brookings Schaeffer Initiative for Health Policy, explains the details in this Twitter thread. ThinkAdvisor’s Allison Bell has a good summary of the proposal and its legislative prospects, as does Dylan Scott at Vox and Christopher Holt at American Action Forum.
There is widespread political and public support for taking consumers out of the middle of surprise balance billing situations, and this is an issue that regulators and lawmakers have grappled with for years. But there continues to be disagreement between health insurers and medical providers in terms of how the details should be handled. The No Surprises Act relies on arbitration to settle price disputes between providers and insurers, and America’s Health Insurance Plans has expressed concerns about that approach. The American Hospital Association has also expressed concerns about various aspects of the payment negotiation process.
Supreme Court issues a unanimous ruling that allows states to regulate pharmacy benefit managers
Last week, the Supreme Court ruled unanimously that Arkansas did not overstep its regulatory authority when it passed a law in 2015 that requires pharmacy benefit managers (PBMs) to pay independent pharmacies at least the wholesale cost of drugs, and that allows pharmacies to refuse to sell drugs at a loss. A consortium of PBMs had sued the state, claiming that they are regulated under ERISA instead, and that the state did not have regulatory authority. (Self-insured health plans are regulated by ERISA, and states do not have regulatory authority over them).
The Supreme Court’s ruling paves the way for other states to regulate PBMs in an effort to protect consumers’ access to independent pharmacies. (The court’s ruling was 8-0; the case was argued before Justice Coney Barrett was confirmed to the bench.)
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.
Open enrollment for individual health plans is drawing to a close in most of the country. The deadline has been extended in 10 states and Washington, DC (although in most of those states, people still have to enroll by December 15 to have coverage that starts on January 1). But in the rest of the country, December 15 is the last day to enroll in an individual/family health plan for 2021. This is true regardless of whether you’re shopping in the exchange/marketplace or outside the exchange.
Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.
A handful of states – Connecticut, Idaho, Maryland, and Vermont – run their own exchange platforms (and thus have the option to extend open enrollment) but have thus-far opted to keep the December 15 enrollment deadline for people buying 2021 plans. Any of those four states could still issue an extension, and we’ll update our deadlines page and our open enrollment guide if they decide to do so.
In the rest of the country, an extended deadline is only possible if the federal government agrees to allow it via HealthCare.gov. Somestates have specifically asked for this, but HHS has not yet given any indication that they plan to offer an extension.
CMS announced last Thursday that a total of 2.9 million people had enrolled in 2021 coverage through HealthCare.gov during the first four weeks of open enrollment (through November 28), which is still trending higher than last year’s enrollment numbers. That accounts for 36 states; the other 14 states and Washington, DC, have their own enrollment platforms, and some of them have not yet publicized their enrollment data. But as of late November/early December, there were about 4 million confirmed enrollments nationwide – plus the enrollments in states that haven’t yet reported any data.
Biden selects California attorney general, ACA defender, to lead HHS
President-elect Joe Biden has chosen California Attorney General Xavier Becerra to be the secretary of Health and Human Services (a position currently held by Alex Azar). Becerra has spent years defending the Affordable Care Act from judicial attacks and pushing back against various health care measures implemented by the Trump administration.
The Kaiser Family Foundation has put together an extensive list of administrative changes the Biden administration can make in terms of healthcare reform. Assuming Becerra is confirmed by the Senate, we can expect that he’ll be leading the effort to implement many of those changes.
SCOTUS will hear arguments on legality of Medicaid work requirements
Last Friday, the Supreme Court agreed to take twocases (which are being combined) that are centered around the legality of Medicaid work requirements, with oral arguments expected to be set for late winter or early spring next year. These cases focus on the Medicaid work requirements that the Trump administration approved for New Hampshire and Arkansas, which were subsequently overturned by a federal judge.
Although work requirements have been approved in several states, none are currently in effect, due to a combination of court rulings and the COVID-19 pandemic. The Biden administration is unlikely to approve any of the pending work requirement waiver proposals, and could eventually rescind already-approved waivers, including the ones at the heart of the cases the Supreme Court has agreed to hear.
But the Court is the most conservative it’s been in several generations; if it rules that Medicaid work requirements are legal, that could come into play once a Republication administration is again in the White House.
Trump administration’s public charge rule changes blocked in DC and 18 states
Then last week, the Ninth Circuit Court of Appeals blocked the implementation, but only in 18 states and Washington, DC. In the rest of the country, the Trump administration’s changes to the public charge rule – which adds Medicaid (and several other low-income assistance programs) to the list of benefits that can classify a person as a “public charge” – can continue to be implemented while additional lawsuits proceed in the court system.
California lawmakers introduce bills to provide Medicaid to undocumented immigrants
California already provides Medicaid (Medi-Cal) coverage, regardless of immigration status, to low-income residents under the age of 26. But as the 2021 legislative session got underway in the state this week, a pair of bills were introduced that would extend Medi-Cal eligibility to more low-income adults, regardless of their immigration status.
Senate Bill 56 would allow people age 65 or older to enroll in Medi-Cal if they meet the rest of the eligibility requirements other than immigration status. Assembly Bill 4 would go further, granting Medi-Cal benefits to any California resident, of any age, who would otherwise be eligible except for their immigration status.
The lawmakers who sponsored these bills noted that the COVID pandemic has been particularly brutal for undocumented immigrants – many of whom work in jobs that don’t allow for social distancing and that are essential for keeping the economy and food supply on track. They point out that providing health coverage for these essential workers is the right thing to do, especially given the state’s budget surplus.
Massachusetts AG sues insurer for misleading consumers
Massachusetts Attorney General Maura Healey announced this week that her office is suing HealthMarkets and two of its subsidiaries for misleading consumers. The lawsuit alleges that the insurers’ recent deceptive marketing practices are in violation of state laws, but also in violation also a court order from 2009, when HealthMarkets and two different subsidiaries had to pay more than $15 million after engaging in similar deceptive practices.
Healey’s office noted an extensive list of violations that stem from the companies’ efforts to essentially trick people into buying “supplemental health insurance products of very limited value” when the consumer wanted or needed major medical coverage instead. According to the lawsuit, more than 15,000 Massachusetts residents have been affected since 2011, and the companies have collected more than $43.5 million in premiums for the low-quality plans, while spending less than 20 percent of revenue on members’ claims.
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.
In most of the United States, open enrollment for individual/family health plans is scheduled to end in just 13 days – on December 15. If you haven’t yet figured out your health coverage for next year, now’s the time to get that done!
Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.
There are four other states (Connecticut, Idaho, Maryland, and Vermont) that run their own enrollment platforms and thus have the option to extend open enrollment if they choose to do so, although it’s still scheduled to end on December 15 in each of those states. In the rest of the country, the federal government runs the exchange and has control over the timing of open enrollment, currently slated to end December 15.
Oregon’s bipartisan congressional delegation asks HHS to extend open enrollment
Oregon’s entire bipartisan congressional delegation sent a letter to HHS this week, asking the federal government to extend the open enrollment period on HealthCare.gov. Oregon, like most of the rest of the country, relies on the HealthCare.gov enrollment platform, which means the state is unable to extend the enrollment deadline on its own.
The Oregon lawmakers pointed out that the COVID pandemic and this year’s devastating wildfires in Oregon are making it harder for people to enroll in health coverage for 2021 in a timely manner. They’re asking HHS to grant some extra flexibility by giving people until the end of December – instead of December 15 – to enroll in a health plan for 2021.
Washington Healthplanfinder accepting public comments on standardized plan designs for 2022
After finding “thousands” of violations, Delaware regulators worked with the insurers to remedy the problems and create more equitable access to mental health coverage and care in the state.
Proposed health insurance rule changes include waiver allowing states to eliminate exchanges
Last week, CMS published the proposed Notice of Benefit and Payment Parameters for 2022 (summary available here). Many aspects of the ACA were left up to HHS/CMS to implement and require ongoing adjustments, so CMS issues this rulemaking guidance each year. There’s a 30-day public comment period, and it appears that the Trump administration is hoping to finalize the proposed rules before the Biden administration takes over on January 20, 2021.
The proposed benefit and payment parameters cover a wide range of issues, as is always the case. But the following proposals are the ones that are most likely to directly affect you and your health insurance coverage:
Allow states to eliminate their exchanges: This is generally considered the most dramatic change that CMS has proposed for 2022, and it’s very similar to the waiver approval that it granted to Georgia last month. If finalized, this rule change would allow states to eliminate their central exchange (HealthCare.gov or a state-run exchange) and switch to a system of direct enrollment via brokers, agents, and insurers. Many people already enroll in on-exchange plans via the enhanced direct enrollment pathway, utilizing a third party’s website instead of the exchange website. But there are widespread concerns that consumers will fall through the cracks in states that opt to abandon their exchange platforms altogether – potentially having to visit multiple websites in order to get comprehensive information, not being able to learn about their eligibility for programs like Medicaid and CHIP, or being sold lesser quality coverage, such as short-term health insurance.
Maximum out-of-pocket increasing to $9,100: Under the ACA, health plans that aren’t grandfathered or grandmothered (or excepted from ACA rules altogether) must cap in-network out-of-pocket costs for their enrollees. But this cap changes each year, under a formula that has evolved over time. This year, the maximum out-of-pocket for a single person was $8,150. Next year, it will be $8,550. And for 2022, CMS has proposed a maximum out-of-pocket limit of $9,100. (The family cap is always double the individual amount.) Many plans will continue to have lower out-of-pocket caps, although catastrophic plans have the maximum allowable out-of-pocket exposure, as do most bronze plans.
More flexible SEP for people who lose eligibility for premium subsidies: Under current rules, a person who is receiving a premium subsidy (premium tax credit) qualifies for a special enrollment period if they become ineligible for that premium subsidy mid-year (either due to an income change or a change in household size), but they’re limited to picking a different plan at the same metal level as the plan they already have. CMS is proposing a more flexible special enrollment period that would also allow the option of switching to a plan at a lower metal level in order to give people the opportunity to reduce their monthly premiums as much as possible. Here are all the details.
New SEP when employer terminates contributions to COBRA premiums: In some cases, employers subsidize the cost of COBRA benefits for a certain period of time – this has been particularly common this year amid the widespread layoffs that stemmed from the COVID pandemic. When that subsidy ends, the full cost of the COBRA coverage can be unaffordable, but there’s not technically a special enrollment period for this situation, as it’s not among the official triggering events. CMS notes that people enrolling through HealthCare.gov have been granted a loss-of-coverage SEP in this situation, but the proposed rule change would add this as an official qualifying event for individual market coverage, making it applicable nationwide, both on-exchange and off-exchange.
New affordability threshold for catastrophic plan eligibility: People who are 30 and older can only buy a catastrophic plan if they have a hardship/affordability exemption from the exchange, indicating that the lowest-cost metal-level plan available to them would cost more than a certain percentage of their income. In 2020, that threshold is 8.24 percent. For 2022, CMS has proposed an increase to 8.47 percent.
MLR rebates: Earlier this year, to address the COVID pandemic, CMS issued guidance that allowed insurance companies to issue medical loss ratio (MLR) rebates earlier than usual. CMS is proposing a rule change that would essentially make this year’s relaxed rules permanent, allowing insurers the option to prepay MLR rebates rather than waiting until the fall to issue them.
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.
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.
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.
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:
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.)
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.
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.
Early open enrollment data indicate individual-market enrollment is trending higher than last year
Open enrollment for individual/family health insurance has been underway nationwide since the start of November. It continues for nearly another month – through December 15 in most states – although the state-run exchanges in Washington, DC and ten states have extended enrollment deadlines.
Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.
As of November 7, total enrollment via HealthCare.gov (the exchange in 36 states) had reached 818,635. As Charles Gaba explains here, the daily enrollment pace is trending about 20 percent higher than last year, although we obviously only have a short segment of data thus far.
CMS typically publishes weekly enrollment data throughout the open enrollment period. The state-run exchanges tend to have more sporadic updates on their enrollment progress, but some have started to publicize data:
Washington’s exchange reported more than 6,000 new enrollees as of November 16. Enrollment in Washington is trending about 4 percent higher than this time last year, and more than a third of the new enrollees have selected one of the new Cascade Care plans that Washington rolled out this fall.
Pennsylvania’s brand-new exchange reported that 7,965 new enrollees had signed up for 2021 coverage as of November 15. Another 13,258 existing enrollees in Pennsylvania had actively renewed their coverage (or switched to a different plan for 2021).
Trump administration relaxes Medicaid rules for additional COVID funding
Earlier this month, the Trump administration published an interim final rule to update earlier rulemaking related to the COVID pandemic. The new rules took effect immediately, but public comments are being accepted through January 4.
We’ve covered this in more detail here, but the takeaway point is that the new rule allows states to reduce Medicaid benefits during the COVID pandemic (within certain constraints) without losing the additional federal Medicaid funding that states have been receiving as a result of the pandemic. Families USA, a consumer advocacy group, has criticized the fact that this new rule will allow states to reduce Medicaid benefits in the midst of a global health crisis.
States are still not allowed to make their Medicaid eligibility requirements any more strict than they were at the start of 2020, so Medicaid work requirements would still be a no-go for states receiving the additional federal Medicaid funding. There are several states where Medicaid work requirements have been approved but are not yet in effect. For the time being, this will continue to be the case.
Healthcare emerges as key battle issue in Georgia run-off
Sen. Kelly Loeffler, R-Georgia, is campaigning to keep her Senate seat during a runoff election scheduled for January 5, and healthcare has emerged as a key issue in the race. Loeffler has long expressed opposition to the Affordable Care Act, while her Democratic opponent, Raphael Warnock, has called for the ACA to be strengthened and improved, supports a public option, and has long pushed for Georgia to accept federal funding to expand access to Medicaid under the ACA.
Last week, Loeffler unveiled her own healthcare reform proposal, which is a compilation of various pieces of legislation that she has sponsored or co-sponsored, as well as several additional ideas.
Loeffler’s proposal states that it would “ensure Americans with pre-existing conditions are protected,” but gives few details about how that would be accomplished. She calls for the expansion of health savings accounts and a “one-time federal tax credit toward HSA contributions for low-income families with pre-existing conditions,” but does not clarify how big that tax credit would be, or exactly how eligibility for it would be determined. The proposal also calls for the creation of “Guaranteed Coverage Plans to help cover patients with pre-existing conditions,” but does not provide any details on how such plans would work.
Loeffler’s proposal also calls for the passage of a bill she introduced last spring, which would codify the Trump administration’s relaxed rules for short-term health plans into federal law. In nearly all cases, short-term health plans do not provide coverage for pre-existing health conditions.
HRSA proposes ACA plans cover no-cost counseling aimed at preventing obesity in women age 40-60
Under the Affordable Care Act, all non-grandfathered health insurance plans are required to cover a wide range of preventive services with no cost-sharing (ie, no deductible, copay, or coinsurance). This includes services for all adults, as well as services that are specific to children and to women.
The Health Resources and Services Administration – responsible for determining which benefits must be provided at no cost to women – is currently collecting public feedback on its recommendation to add coverage for counseling aimed at preventing obesity in women age 40-60. The proposed recommendation calls for this counseling service to be added to the women’s preventive health care guidelines – meaning that non-grandfathered health plans would have to cover it without any cost-sharing. The counseling would be provided to women with both normal-weight and overweight women, with an aim of helping them maintain their body weight or prevent future weight gain.
If the recommendation is adopted by HRSA, non-grandfathered health plans would have to start covering the no-cost obesity prevention counseling. But there’s a one-year delay, as new preventive care rules take effect for plan years that start on or after one year after a recommendation is issued. Comments on the new recommendation can be submitted here, through December 9, 2020.
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.
“Will my health insurance cover me when I’m traveling?” It’s a question that most travelers have, but the answer varies depending on the type of coverage you have and where you’re traveling.
First things first: Before you plan any trip, it’s wise to contact your health insurer and ask specific questions about your coverage while traveling. Ask them to refer you to written documents (or send them to you), as you’ll want to have details in writing that clarify exactly what is and isn’t covered when you travel. Although we’ll provide a general overview here, there’s no substitute for finding out exactly how your specific policy covers you when you leave your home area.
Travel within the United States
If you’re traveling within the U.S., you’ll generally have coverage for emergency care provided in an emergency room in another state. This is true regardless of your plan’s network structure (EPO, PPO, HMO, or POS) or how extensive the network is.
If you’re traveling outside your home state, your health plan may or may not have in-network providers in your destination state. Employer-sponsored plans (especially those offered by large employers) often have nationwide networks, but individual market plans (the kind you buy on your own, either through the exchange or directly from an insurer) almost invariably now have localized networks that do not include nationwide in-network coverage.
So your access to in-network coverage outside your home state depends in large part on where you get your health insurance.
Assuming that you do not have in-network coverage when you’re in another state, there are a few things to keep in mind:
Your plan should cover you for emergency care, and should pay a reasonable amount towards the cost of such care. And all non-grandfathered health plans are required to limit your cost-sharing (deductible, copays, coinsurance) to the plan’s in-network amounts, even if the emergency room care is out-of-network.
HOWEVER, and this is a big caveat, there is nothing in federal law that prevents the out-of-network emergency room and/or physicians from sending the patient a bill for whatever portion of of their charges are above the amount that the insurer considers reasonable. This is in addition to the cost-sharing required by the patient’s health plan. Some states have implemented rules to protect consumers from balance billing in emergency situations, although this varies considerably from one state to another. But Congress is considering legislation in 2019 that would prevent surprise balance billing nationwide.
And there is no standard definition of what constitutes an emergency. Insurers can and do dispute the emergency nature of medical care, even if it’s provided in an emergency room. If the out-of-network care is not considered an emergency and your health plan doesn’t cover out-of-network care (HMOs and EPOs generally never cover non-emergency out-of-network care), you can expect to have to pay the full cost yourself.
Supplemental coverage
Some people purchase supplemental coverage to offset some of the potential costs that could be incurred if a medical situation arises while in another state:
Accident supplements will typically reimburse a policyholder a flat dollar amount, which can be used to pay out-of-network charges or balance bills in the event of a medical claim that arises from an accident or injury.
Critical illness plans also reimburse the policyholder a flat dollar amount, although the plan will only pay if the patient experiences a specific covered illness. These plans typically include coverage for things like heart attacks and strokes, so they can be useful to sudden scenarios that can arise while one is traveling and which necessitate emergency care (again keeping in mind that while your health plan will cover the emergency care, you can still be billed by the out-of-network medical providers for any amounts above the “reasonable” amount that your insurer pays them).
Supplemental plans are also useful for covering out-of-pocket costs that arise from in-network and non-emergency situations, so they’re suitable for maintaining as year-round, whether you’re traveling or not. But they should never be relied upon as stand-alone coverage (ie, you still need to have major medical coverage in addition to your supplemental coverage).
And although nobody heads out on vacation planning to end up stuck in the hospital for an extended amount of time, it can happen. This Wall Street Journal article is a sobering reminder that emergency medical situations can sometimes result in long hospital stays with the patient too ill to return home. Out-of-network balance billing can quickly reach unmanageable levels in situations like that, and although the billing can sometimes be resolved with negotiations and mediations, it can also sometimes end up pushing people into bankruptcy.
Will my current plan cover me at all when I’m outside the United States?
It depends on your plan. If you’re enrolled in Medicare, your Medigap plan might provide some coverage for international travel (Original Medicare doesn’t cover care outside the U.S., with very limited exceptions).
If you’ve got private coverage, it depends on your plan. On some plans, life or limb medical emergencies are covered, but the onus is on the patient to prove that the situation was truly an emergency, and the cost of medical evacuation back to the United States is rarely covered by standard U.S.-based health plans. (Travel insurance plans generally do cover medication evacuations).
Travel insurance: A widely available solution if you’re traveling abroad
Most U.S.-based health plans do not cover international travel. Fortunately, travel health insurance plans are widely available, inexpensive, and relatively easy to obtain.
Travel insurance plans are not regulated by the ACA, so they can still have annual and lifetime benefit caps, they do not have to cover pre-existing conditions, and coverage is not guaranteed issue. There’s also no requirement that plans cover the ACA’s ten essential benefits.
But travel medical insurance does provide peace of mind if you’re planning a trip abroad. Coverage is available for U.S. and foreign nationals traveling outside their home countries, and a wide range of plans are available to fit every budget.
Expat insurance: When you need coverage abroad for an extended period of time
If you’re going to be living abroad for an extended period of time, your health insurance needs will be different from those of someone who is taking a vacation overseas. If you’ve been hired by a company that is sending you abroad, they may have already made arrangements for your health coverage. But if you’re self-employed, taking a sabbatical, or retiring overseas, you’ll likely need to sort out your own coverage arrangements.
Fortunately, there are insurers that offer plans specifically tailored to the needs of expats and long-term travelers. These policies can be purchased to include coverage in the U.S. as well as coverage abroad, or to only provide coverage outside the U.S. (your needs may vary depending on whether you’re planning to also maintain your U.S.-based coverage). As is the case with general travel insurance, expat/long-term travel plans are not subject to the ACA’s regulations.
Renewing your travel coverage
Travel medical insurance is not guaranteed renewable, which means that if you need another policy after your first one ends, you’d have to reapply and go through medical underwriting again (similar to short-term insurance).
And since travel insurance is not considered minimum essential coverage, the termination of a travel policy does not trigger a special enrollment period to purchase a regular ACA-compliant health insurance plan in your home state. This is an important reason to make sure that your travel policy is purchased to supplement your regular health plan, not replace it.
If you live abroad and then move back to the United States, you’ll be eligible for a special enrollment period, triggered by your move, during which you can purchase an ACA-compliant plan. But be prepared to prove that you were actually living abroad, and not just on vacation (in guidance related to a permanent relocation, HHS has noted that people need to spend “an entire season or other long period of time” in a location in order to establish residency there).
In the past, regular health insurance had many of the same caveats as travel insurance. But the ACA’s reforms have made us more accustomed to guaranteed-issue coverage that doesn’t discriminate against pre-existing conditions or limit coverage for essential health benefits. So it’s important to read the fine print on any travel insurance policy you’re considering, as the nuances of the coverage may be far different from your normal coverage.
Travel insurance: Read all the fine print
Piper Kan and Reece Huculak-Kimmel both have stories that amount to a cautionary tale about the short-comings of travel insurance. Both little girls were born prematurely in foreign countries, and the extensive medical bills were not covered, despite the fact that in each case the parents had purchased travel health insurance policies and thought they were covered for any contingency.
The take-away? It’s important to pay careful attention to the written details and exclusions of the plan you’re considering. Don’t rely on verbal confirmations of benefits.
But that said, travel insurance is an excellent supplement to your regular policy, and will cover mishaps in foreign countries that would otherwise have to be paid out-of-pocket. Bon voyage!
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.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2019-08-29 03:10:382021-01-24 00:52:23Don’t forget to pack travel health insurance
You’ve probably heard of health savings accounts (HSAs), and you may have wondered if one would be a good fit for you. You aren’t alone.
According to a survey released in 2018, approximately 22 million Americans have chosen to use a health savings account coupled with a high-deductible health plan (HDHP) to pay for current and future healthcare costs. Plans that participated in the survey reported a 9.2 percent increase in HSA enrollment from 2016 to 2017.
Explaining the growth in enrollment isn’t difficult when one takes a closer look at this financial tool and an impressive array of benefits they offer to people willing and able to use them.
Click on image for full-sized infographic.
Who can utilize HSAs?
In order to contribute to an HSA, you need to be covered under a high-deductible health insurance plan, either obtained through your employer or purchased on your own. The majority of large employers offer an HDHP option (70 percent did so in 2018), and HDHPs are available for purchase in the individual market nearly everywhere in the country. (That means you can have an HDHP and HSA even if you buy your own health insurance. An employer doesn’t have to be involved.)
Once you’re enrolled in an HDHP, you can open an HSA (or sign up for the one your employer uses) and begin making contributions. And if you’re on the fence about whether it’s the right move for you, here are some things to keep in mind:
1. HSAs offer a triple tax advantage
The HSA is a rare breed in terms of tax-advantaged accounts:
The money you put into your HSA is pre-tax.
While the money is in your HSA, there’s no tax on investment gains or interest earned in the account.
And then when you withdraw the money, it’s still tax-free – as long as you use it to pay for qualified medical expenses.
Contributing to your HSA reduces your modified adjusted gross income, which is important to keep in mind if you’re buying your own coverage and trying to qualify for premium subsidies. There’s an upper limit on how high your income can be for subsidy eligibility (400 percent of the FPL), and you might find that an HSA contribution makes you eligible for a premium subsidy when you would otherwise earn too much — or eligible for a larger subsidy, if you were already subsidy-eligible before the HSA contribution. Here’s more about how this works.
2. Paying medical expenses with pre-tax dollars
Once you’ve put money in your HSA, you can withdraw it at any time to pay for a qualified medical expense. And qualified medical expenses go well beyond the out-of-pocket costs for services that are covered by your health insurance plan. They also include includes things like dental and vision costs, as well as products like sunscreen (SPF 30+), bandages, and lip balm.
If you don’t have an HSA, you can only deduct medical expenses by itemizing your deductions on your tax return. And even if you itemize, you can only deduct medical expenses that are in excess of 10 percent of your income (for 2017 and 2018, the threshold was 7.5 percent of your income).
3. Your HSA can be a backup retirement account
If you withdraw money from your HSA before you turn 65 and you’re not using it to pay for qualified medical expenses, you’ll have to pay income tax and a 20 percent penalty. (Don’t do this unless it’s a dire emergency!)
But once you turn 65, that 20 percent penalty no longer applies. You can continue to use your HSA funds for medical expenses, avoiding taxes altogether on the withdrawals. But if you choose to withdraw the money for other purposes, you’ll just pay income tax. This is similar to how a traditional IRA works in terms of taxes. (Note that with a traditional IRA, you can start to withdraw money penalty-free at age 59.5, whereas with an HSA, you have to be 65.)
And unlike traditional IRAs, you’re not required to start taking money out of your HSA when you turn 70.5. If you want to leave it in the account to continue to grow, you can do that.
4. Pre-tax contributions … regardless of your income
Although you can think of your HSA as a backup retirement account, there is no income limit – on the low end or the high end – for deducting HSA contributions.
This is not the case for IRAs: There’s an income limit for Roth IRA contributions, a lower income limit for being about to contribute pre-tax money to a traditional IRA, and both require you (or your spouse) to have enough earned income to cover the contributions.
With an HSA, there’s no “use it or lose it” provision. This is one of the primary differences between an HSA and an FSA. If you put money in your HSA and then don’t withdraw it, it will remain in the account and be available to you in future years.
6. … and you can choose how your HSA grows
HSA funds can be kept in basic interest bearing accounts – similar to a regular savings account at a bank or credit union – or, if you choose an HSA custodian that offers it, you can invest your HSA funds in stocks, bonds, or mutual funds.
There’s no single right answer in terms of what you should do with the money in your HSA before you need to use it. If you’re planning to withdraw all or most of your contributions each year to fund ongoing medical expenses, an FDIC-insured institution might be the best choice. The account will likely only generate small amounts of interest, but it will also be protected from losses.
On the other hand, if you’re looking at your HSA as a long-term investment and your risk tolerance is suited to the stock market’s volatility, you might prefer to invest your HSA funds.
If you buy your own HDHP, you can select from any of the available HSA custodians. (Pay attention to fees, investment options, and expense ratios, as is always the case with investment accounts.)
If you have an HSA through your employer, you might be limited to using the HSA custodian that your employer has selected, at least as far as your employer’s contributions go. And HSA contributions made via payroll deduction are typically free of income tax and payroll tax. You can’t avoid payroll taxes if you make your own HSA contributions outside of your employer’s payroll.
But you’re free to establish a separate HSA on your own, and transfer money out of the HSA your employer selected, and into the one you picked yourself. The IRS considers this a transfer, instead of a rollover, so there are no limits on how often you can do this.
Ready to try out a Health Savings Account?
7. You can leave your job and take your HSA
If you have an HSA through your employer, the money in the account is yours. When you leave your job, you get to take the remaining HSA balance with you. (This is another difference between FSAs and HSAs.)
You can choose a new HSA custodian and transfer the money if you wish. There are no taxes on the HSA money you take with you when you leave your job, unless you withdraw the money and don’t use it for medical expenses.
8. Deductibles aren’t necessarily higher than other plans
You must have a high-deductible health plan (HDHP) in order to contribute to an HSA. And it’s understandable that the term “high-deductible” makes people nervous. But the deductibles aren’t necessarily higher than the deductibles for non-HDHPs, and in some cases, they’re even lower.
In 2019, IRS regulations require HDHPs to have deductibles of at least $1,350 for an individual and $2,700 for a family. These minimums will increase slightly in 2020, to $1,400 and $2,800. But average deductibles for Bronze and Silver plans in the individual market are considerably higher than that. Among people who have employer-sponsored plans that include deductibles (more than 80 percent do), the average deductible for a single employee is nearly $1,600.
So although HSA-qualified plans are officially “high-deductible,” they sometimes have deductibles and out-of-pocket limits that are lower than other available plans. And it’s possible to find HSA-qualified plans at the Bronze, Silver, and Gold metal levels if you’re shopping for your own coverage.
And HDHPs may soon start to cover more services before the deductible, for people with certain chronic conditions. Until 2019, HDHPs were limited to covering only preventive care before the deductible (ie, prior to the insured meeting the minimum deductible amount that the IRS sets each year), and the definition of preventive care was updated in 2013 to align with the preventive services that the ACA requires all non-grandfathered health plans to cover.
But in July 2019, in response to a recent executive order, the IRS issued new guidelines for preventive care that can be covered before the deductible on an HDHP without forfeiting the plan’s HSA eligibility. The new rules took effect immediately, but insureds aren’t likely to see plans with enhanced preventive care benefits until at least 2020, and maybe 2021, as most insurers had already developed their plans for 2020 by the time the new guidelines were issued.
Under the new rules, an HDHP can cover, pre-deductible, certain specific health care benefits for people with certain chronic conditions and the health plan can remain HSA-eligible (assuming it meets all of the other requirements for HSA-eligibility. For people with the following chronic conditions, these services can be covered before the deductible on an HDHP:
Note that although the IRS has provided transitional relief through the end of 2019 for HDHPs that cover male contraception before the deductible, that exception will expire as of 2020 and the new guidance does not change anything about that. So unless the IRS takes additional action, health plans that cover male contraception pre-deductible will no longer be HSA-eligible as of 2020.
Also note that HDHPs will not be required to offer any of these benefits pre-deductible, unless a state decides to require it on state-regulated plans. These are benefits that go above and beyond the federally-required preventive care services, so whether to offer these services pre-deductible will be up to each insurer. But offering them will not cause a plan to lose HDHP status, which would have been the case prior to July 2019.
9. There’s no deadline for reimbursing yourself from your HSA
When you pay a medical bill and you have an HSA, there’s nothing that says you have to pull money out of your HSA to cover the medical bill. And there’s also no time limit on when you can reimburse yourself. As long as the medical expense was incurred after you established the HSA, and you didn’t take it as an itemized deduction, you can reimburse yourself years or decades later — after letting your HSA funds grow in the meantime.
So imagine that you’re contributing to your HSA each year, and also spending a few hundred or a few thousand dollars each year in medical expenses. You pay those bills from your regular bank account, keeping careful track of how much you pay and retaining all of your receipts.
Now let’s say that you decide you want to retire a few years early, before you can start withdrawing money from your regular retirement account. At that point, you can gather up all of the receipts from all the medical expenses you’ve paid since you opened your HSA, and reimburse yourself all at once (this is why it’s so important to keep your receipts — if you’re ever audited, you’ll need to be able to show that the amount you withdrew from your HSA was equal to the amount you had paid in medical bills over the years).
The money you withdraw is still tax-free at that point, since all you’re doing is reimbursing medical expenses (again, be careful not to withdraw more than you’ve spent in medical expenses; if you do, you’ll have to pay income tax and a 20 percent penalty on the excess withdrawal). But because you waited a few decades to reimburse yourself, you’ve given the money in your HSA many years to grow, tax-free, resulting in a potentially larger stash of funds.
10. Your HSA can be your long-term care fund
If you’re healthy and don’t have much in the way of medical expenses, you can think of your HSA as a really long-term investment. You’ll have to stop contributing to it once you’re enrolled in Medicare, but the money that’s already in the account at that point can continue to grow from one year to the next during your retirement.
You might find that you want to use your HSA funds, tax-free, to pay Medicare premiums. (That’s Part A if you’re not eligible for premium-free Part A, as well as Part B and Part D. You can also pay Medicare Advantage premiums with HSA funds, but you cannot pay Medigap premiums with tax-free HSA money.) Or you might need the HSA funds to cover out-of-pocket medical expenses during retirement.
But if you end up needing long-term care, the cost is likely to dwarf the out-of-pocket medical expenses you had earlier in your retirement. Medicare doesn’t cover long-term care, and Medicaid only steps in if you’re low-income and have exhausted almost all of your assets.
You can buy private long-term care insurance, but some people opt to treat an HSA as an investment earmarked for potential long-term care bills incurred late in life. If you don’t end up needing long-term care, your HSA can be passed on to your heirs, similar to a retirement account.
Clearly, there are a lot of advantages to an HSA. If you’re enrolled in an HDHP, it’s definitely in your best interest to set up an HSA and fund it. And if you don’t currently have HDHP coverage, it’s well worth considering as a future option.
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.
https://www.maddoxinsured.com/wp-content/uploads/2019/07/health-savings-account-advantages-infographic-1.jpg17791761wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2019-07-20 16:00:382021-01-24 00:50:49Top 10 reasons to use health savings accounts
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
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.”
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A federal judge concluded that Aetna dropped Obamacare coverage in certain markets to help its merger, not for business purposes like the company stated.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2017-01-24 12:36:332021-02-06 14:07:43Judge: Aetna lied about quitting Obamacare
Cyberbullying insurance from Chubb will help clients recover if online trolling leads to financial losses.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2015-12-18 10:12:312021-02-06 14:07:45Cyberbullying insurance now available for the rich
New parents at eBay will be able to take a lot more paid time off starting next year. Dads too.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2015-12-04 16:54:582021-02-06 14:07:46eBay to give new moms 6 months of paid leave
A single 20-year-old pays 21% more than a married driver the same age for car insurance.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2015-03-26 10:06:172021-02-06 14:07:46Singles pay more for car insurance
The insurance company is allegedly offering different coverage plans to drivers who are low-income, single, without a college degree, and previously uninsured.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2015-02-13 15:32:232021-02-06 14:07:47Geico accused of discriminating against low-income drivers
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2015-01-24 19:54:112021-02-06 14:07:47Obamacare website reins in personal data sharing
The Federal Housing Administration is dramatically cutting the premiums it charges for mortgage insurance. As a result the typical first-time home buyer should save about $900 a year.
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2015-01-07 15:39:272021-02-06 14:07:48FHA to lower cost of mortgage insurance
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2014-10-27 14:29:492021-02-06 14:07:49One property insurance claim can hike your premiums by hundreds
https://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance.png512512wpmaddoxinshttps://www.maddoxinsured.com/wp-content/uploads/2020/12/maddox-insurance-agency.pngwpmaddoxins2014-10-24 20:31:022021-02-06 14:07:49Icahn to casino workers: Give up healthcare
The Scoop: health insurance news – December 23, 2020
In this edition
Open enrollment continues in 11 states, Washington, DC
Although open enrollment for 2021 individual and family health insurance ended last week in most states, and ended last night in Minnesota, open enrollment is still ongoing in 11 states and Washington, DC, with the following enrollment deadlines:
Enrollment up 6.6% for 2021 in states that use HealthCare.gov
Last Friday, CMS published preliminary enrollment data for the 36 states that used HealthCare.gov during the open enrollment period that ended last week. Across those 36 states, a total of 8.23 million people enrolled in private plans through HealthCare.gov. As Charles Gaba notes, that’s a 6.6 percent increase over last year, after we account for the fact that Pennsylvania and New Jersey are now running their own exchange platforms and will report their enrollment numbers separately. (Both also have ongoing enrollment periods, as noted above.)
As detailed by Andrew Sprung, private-plan enrollment via the exchange in states that have not expanded Medicaid is about 10 percent higher for 2021 than it was for 2020, while enrollment is slightly lower in states that have expanded Medicaid. Sprung offers several explanations for this, including the fact that many who lost their incomes in 2020 have transitioned to Medicaid, which is more likely to be an available option in states that have expanded Medicaid. Sprung has also tracked the significant increase in the number of people covered by Medicaid this year.
Trump administration finalizes rule changes for grandfathered group plans
Earlier this month, the Trump administration finalized new rules for grandfathered group health plans. The rule change is essentially the same as the changes that the administration proposed in July, but the effective date has been pushed out to mid-June 2021, as opposed to the originally proposed effective date of 30 days after the rules were finalized.
Under the new rules, grandfathered group plans that are HSA-qualified will be able to make cost-sharing increases necessary to retain their HSA-qualified status, even if the increases exceed the limits that would otherwise have applied to grandfathered plans. (This situation has not yet arisen, but if it does in the future, the rule change will allow these plans to keep both their HSA-qualified status and their grandfathered status.) And the new rules will also allow grandfathered group plans to increase their cost-sharing amounts by a larger threshold than previously permitted, with allowable cost-sharing expected to be about 3 percentage points higher under the new rule.
Congress passes legislation to protect consumers from surprise balance billing
The surprise balance billing legislation that we told you about last week was included in the Consolidated Appropriations Act, 2021, which passed earlier this week with strong bipartisan support in both the House and Senate. President Trump was widely expected to sign it as soon as it reached his desk, but he cast doubt on that via Twitter on Tuesday night, expressing displeasure at some aspects of the legislation. Trump didn’t say that he would veto the bill, but the video he shared on Twitter indicated that the current bill is no longer a sure thing.
In its current form, the massive bill includes government funding for the first three quarters of 2021, extensive COVID-19 relief, and numerous other provisions, including strong consumer protections against surprise balance billing that will take effect in January 2022. As the Kaiser Family Foundation’s Larry Levitt explains in this Twitter thread, the new legislation provides strong consumer protections, and – assuming it does get signed into law – will result in consumers having to pay just their normal in-network cost-sharing when they receive emergency care or unknowingly receive care from an out-of-network provider at an in-network facility.
Protections against surprise balance billing for ground ambulance charges are not included in the legislation, despite the fact that ambulance rides often result in surprise balance billing. But the legislation does call for a commission that will study ground ambulance charges in hopes of incorporating additional consumer protections in a future piece of legislation.
Congresses passes legislation to make health insurers subject to federal antitrust laws
The Competitive Health Insurance Reform Act of 2020 – H.R.1418 – passed in the Senate last night and is now headed to President Trump’s desk (it was passed by the House in September). Under the terms of this legislation, health insurance companies will be subject to federal antitrust laws, reversing a 75-year-old exemption that was granted in 1945 via the McCarran-Ferguson Act.
Sens. Steve Daines (R-Montana) and Patrick Leahy (D-Vermont) shepherded the bipartisan bill through the Senate. In announcing the passage of the bill, Daines noted that it “will ensure that health insurance issuers are subject to the same federal antitrust laws prohibiting unfair trade practices, such as price-fixing and collusion, as virtually every other industry in our economy.” The rest of the McCarran-Ferguson Act – which gives states the right to regulate their insurance markets — is unchanged by H.R.1418.
Ohio enacts legislation to end ‘fail first’ drug requirements for stage 4 cancer treatment
This week, Ohio Gov. Mike DeWine signed a new law prohibiting Ohio health insurance plans from imposing “fail first” requirements on drug coverage for people with stage 4 cancer. S.B.252 prohibits insurers from requiring these patients to try a cheaper medication first and then only cover another medication if the first did not work. These “fail first” requirements are often imposed on newer, cutting-edge therapies that tend to be more expensive than older medications, but Ohio’s legislation stems from the fact that time is of the essence with metastatic cancer.
Delaware proposal calls for increased investment in primary care
Delaware’s Insurance Commissioner, Trinidad Navarro, and the state’s Office of Value-Based Health Care Delivery have published a report that outlines proposals for improving access to primary care in the state without increasing healthcare costs. The report calls for health insurers in Delaware to increase their investments in primary care while decreasing price growth for some other services, including hospital care, and to transition to a value-based payment model instead of a fee-for-service model. The state is accepting public comments on the report until January 25, 2021.
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 – December 23, 2020 appeared first on healthinsurance.org.
The Scoop: health insurance news – December 16, 2020
In this edition
Open enrollment continues in 11 states and DC
In most of the country, open enrollment for 2021 individual/family health plans ended yesterday. (HealthCare.gov gave people until 1:59 a.m., Pacific time, and due to high call volume, they gathered contact information for some callers and will be reaching out to those people over the next few days to help them complete their enrollments.) The Trump administration rejected numerous calls to extend open enrollment in light of the ongoing global pandemic. Although the Biden administration might reopen the enrollment window next month, enrollment is currently closed for people in most states who hadn’t at least begun the enrollment process or left their contact information with the marketplace by the end of open enrollment (unless they have a qualifying event).
But in twelve states and DC, open enrollment is still ongoing. This includes Connecticut, where the extension was announced on December 16, and Idaho, where an extension was announced on December 18; the rest of those states had announced their extensions several weeks ago.
In some of these states, people who are currently enrolling (after December 15) will have coverage effective in February or March, instead of January. But several are offering extended enrollment deadlines for a January effective date. Pennsylvania, California, Colorado and Idaho all announced such extensions this week. Here are the applicable enrollment deadlines:
California’s state-run exchange, Covered California, has permanently extended open enrollment through the end of January. But CoveredCalifornia is working to try to give more Americans access to an extended open enrollment window for 2021 coverage, asking CMS this week to extend open enrollment via HealthCare.gov until the end of December or even through January. Oregon and Wisconsin have recently made similar requests, but CMS has given no indication that they plan to offer an extended enrollment window.
As of December 5, when there were still at least 10 days remaining in open enrollment nationwide, 3.8 million people had enrolled in plans through HealthCare.gov in 36 states. And by December 9, nearly 1.2 million people had enrolled in plans through several of the state-run exchanges, although not all of them have published enrollment data yet. There is always a significant spike in enrollment activity in the final few days of open enrollment, and auto-renewals will be processed by HealthCare.gov now that open enrollment has ended.
COVID-19 vaccine added to covered preventive care benefits for non-grandfathered health plans
On Friday evening, the FDA granted an emergency use approval for the Pfizer-BioNTech COVID-19 vaccine. Within hours, the CDC’s Advisory Committee on Immunization Practices (ACIP) held an emergency meeting and voted to add the COVID-19 vaccine to the list of vaccines that are recommended for routine preventive care. CDC Director Robert Redfield soon signed off on the recommendation, clearing the way for the vaccine to be covered by nearly all health insurance plans in the United States.
Under the CARES Act, enacted last spring, non-grandfathered health insurance plans have to add coverage for COVID-19 vaccines (with zero-cost-sharing) within 15 business days of the ACIP recommendation. This is much faster than the normal timeline for adding new preventive care services to health insurance plans, and it will help to ensure that when the vaccine becomes available for various populations, their health insurance will cover the cost.
South Carolina lawmakers pre-file Medicaid expansion legislation
There are a dozen states that still have not accepted federal funding to expand Medicaid. One of them is South Carolina, where several Medicaid expansion bills have been pre-filed for the upcoming legislative session. House Bill 3226 and Senate Bill 210 call for the state to expand Medicaid as of January 1, 2022, under the terms of the Affordable Care Act. Senate Bill 83 and House Bill 3269 call for the state to hold an advisory referendum during the 2022 general election, which would ask South Carolina residents to weigh in on whether the state should expand Medicaid as of 2024.
But advisory referendums are not binding. And unlike other states where Medicaid expansion has been implemented via ballot measures in recent elections, South Carolina does not have a mechanism that would allow voters to approve Medicaid expansion via a ballot initiative. (Of the remaining states that have not expanded Medicaid, only Mississippi and Florida have a ballot initiative process.)
Both chambers of South Carolina’s legislature have strong Republican majorities, and have spent the last decade rejecting Medicaid expansion. But as the number of non-expansion states dwindles to a small minority of the country, there’s increasing pressure on lawmakers to address the coverage gap, protect rural hospitals, and ensure access to medical care – especially in light of the ongoing global pandemic.
Legislation introduced in New Jersey to create an ‘easy enrollment’ system
Legislation to create an “easy enrollment” system was introduced last week in New Jersey’s Senate. The legislation is modeled on a similar program that Maryland debuted this year, and that Colorado will start to use in early 2022.
The idea is to use state tax returns to identify uninsured individuals and then determine, based on the tax returns, whether those individuals would qualify for Medicaid or financial assistance through the New Jersey exchange. If enacted, New Jersey’s bill calls for the state to implement the program starting with either the 2021 tax year (ie, the returns that people file in early 2022) or, if that’s not feasible, the 2022 tax year.
Surprise balance billing legislation gains bipartisan, bicameral support, but future still uncertain
Last Friday, leading Democrats and Republicans in committees in both the House and Senate reached an agreement on a legislative proposal, dubbed the “No Surprises Act,” that would end surprise balance billing in most situations. Loren Adler, Associate Director of the USC-Brookings Schaeffer Initiative for Health Policy, explains the details in this Twitter thread. ThinkAdvisor’s Allison Bell has a good summary of the proposal and its legislative prospects, as does Dylan Scott at Vox and Christopher Holt at American Action Forum.
There is widespread political and public support for taking consumers out of the middle of surprise balance billing situations, and this is an issue that regulators and lawmakers have grappled with for years. But there continues to be disagreement between health insurers and medical providers in terms of how the details should be handled. The No Surprises Act relies on arbitration to settle price disputes between providers and insurers, and America’s Health Insurance Plans has expressed concerns about that approach. The American Hospital Association has also expressed concerns about various aspects of the payment negotiation process.
Supreme Court issues a unanimous ruling that allows states to regulate pharmacy benefit managers
Last week, the Supreme Court ruled unanimously that Arkansas did not overstep its regulatory authority when it passed a law in 2015 that requires pharmacy benefit managers (PBMs) to pay independent pharmacies at least the wholesale cost of drugs, and that allows pharmacies to refuse to sell drugs at a loss. A consortium of PBMs had sued the state, claiming that they are regulated under ERISA instead, and that the state did not have regulatory authority. (Self-insured health plans are regulated by ERISA, and states do not have regulatory authority over them).
The Supreme Court’s ruling paves the way for other states to regulate PBMs in an effort to protect consumers’ access to independent pharmacies. (The court’s ruling was 8-0; the case was argued before Justice Coney Barrett was confirmed to the bench.)
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 – December 16, 2020 appeared first on healthinsurance.org.
The Scoop: health insurance news – December 9, 2020
In this edition
In most states, open enrollment ends in six days
Open enrollment for individual health plans is drawing to a close in most of the country. The deadline has been extended in 10 states and Washington, DC (although in most of those states, people still have to enroll by December 15 to have coverage that starts on January 1). But in the rest of the country, December 15 is the last day to enroll in an individual/family health plan for 2021. This is true regardless of whether you’re shopping in the exchange/marketplace or outside the exchange.
Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.
A handful of states – Connecticut, Idaho, Maryland, and Vermont – run their own exchange platforms (and thus have the option to extend open enrollment) but have thus-far opted to keep the December 15 enrollment deadline for people buying 2021 plans. Any of those four states could still issue an extension, and we’ll update our deadlines page and our open enrollment guide if they decide to do so.
In the rest of the country, an extended deadline is only possible if the federal government agrees to allow it via HealthCare.gov. Some states have specifically asked for this, but HHS has not yet given any indication that they plan to offer an extension.
CMS announced last Thursday that a total of 2.9 million people had enrolled in 2021 coverage through HealthCare.gov during the first four weeks of open enrollment (through November 28), which is still trending higher than last year’s enrollment numbers. That accounts for 36 states; the other 14 states and Washington, DC, have their own enrollment platforms, and some of them have not yet publicized their enrollment data. But as of late November/early December, there were about 4 million confirmed enrollments nationwide – plus the enrollments in states that haven’t yet reported any data.
Biden selects California attorney general, ACA defender, to lead HHS
President-elect Joe Biden has chosen California Attorney General Xavier Becerra to be the secretary of Health and Human Services (a position currently held by Alex Azar). Becerra has spent years defending the Affordable Care Act from judicial attacks and pushing back against various health care measures implemented by the Trump administration.
California, led by Becerra’s office, has been the lead state in defense of the ACA in the California v. Texas (formerly Texas v. U.S.) lawsuit, which was argued at the Supreme Court last month.
The Kaiser Family Foundation has put together an extensive list of administrative changes the Biden administration can make in terms of healthcare reform. Assuming Becerra is confirmed by the Senate, we can expect that he’ll be leading the effort to implement many of those changes.
SCOTUS will hear arguments on legality of Medicaid work requirements
Last Friday, the Supreme Court agreed to take two cases (which are being combined) that are centered around the legality of Medicaid work requirements, with oral arguments expected to be set for late winter or early spring next year. These cases focus on the Medicaid work requirements that the Trump administration approved for New Hampshire and Arkansas, which were subsequently overturned by a federal judge.
Although work requirements have been approved in several states, none are currently in effect, due to a combination of court rulings and the COVID-19 pandemic. The Biden administration is unlikely to approve any of the pending work requirement waiver proposals, and could eventually rescind already-approved waivers, including the ones at the heart of the cases the Supreme Court has agreed to hear.
But the Court is the most conservative it’s been in several generations; if it rules that Medicaid work requirements are legal, that could come into play once a Republication administration is again in the White House.
Trump administration’s public charge rule changes blocked in DC and 18 states
There has been a lot of back and forth on the Trump administration’s changes to the “public charge” rule in recent weeks. Last month, the administration’s changes to the public charge rule were briefly vacated, nationwide, by a federal judge, but an appeals court stayed that decision just two days later, allowing the rule changes to continue to be implemented.
Then last week, the Ninth Circuit Court of Appeals blocked the implementation, but only in 18 states and Washington, DC. In the rest of the country, the Trump administration’s changes to the public charge rule – which adds Medicaid (and several other low-income assistance programs) to the list of benefits that can classify a person as a “public charge” – can continue to be implemented while additional lawsuits proceed in the court system.
California lawmakers introduce bills to provide Medicaid to undocumented immigrants
California already provides Medicaid (Medi-Cal) coverage, regardless of immigration status, to low-income residents under the age of 26. But as the 2021 legislative session got underway in the state this week, a pair of bills were introduced that would extend Medi-Cal eligibility to more low-income adults, regardless of their immigration status.
Senate Bill 56 would allow people age 65 or older to enroll in Medi-Cal if they meet the rest of the eligibility requirements other than immigration status. Assembly Bill 4 would go further, granting Medi-Cal benefits to any California resident, of any age, who would otherwise be eligible except for their immigration status.
The lawmakers who sponsored these bills noted that the COVID pandemic has been particularly brutal for undocumented immigrants – many of whom work in jobs that don’t allow for social distancing and that are essential for keeping the economy and food supply on track. They point out that providing health coverage for these essential workers is the right thing to do, especially given the state’s budget surplus.
Massachusetts AG sues insurer for misleading consumers
Massachusetts Attorney General Maura Healey announced this week that her office is suing HealthMarkets and two of its subsidiaries for misleading consumers. The lawsuit alleges that the insurers’ recent deceptive marketing practices are in violation of state laws, but also in violation also a court order from 2009, when HealthMarkets and two different subsidiaries had to pay more than $15 million after engaging in similar deceptive practices.
Healey’s office noted an extensive list of violations that stem from the companies’ efforts to essentially trick people into buying “supplemental health insurance products of very limited value” when the consumer wanted or needed major medical coverage instead. According to the lawsuit, more than 15,000 Massachusetts residents have been affected since 2011, and the companies have collected more than $43.5 million in premiums for the low-quality plans, while spending less than 20 percent of revenue on members’ claims.
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 – December 9, 2020 appeared first on healthinsurance.org.
The Scoop: health insurance news – December 2, 2020
In this edition
Open enrollment ends in 13 days in most states
In most of the United States, open enrollment for individual/family health plans is scheduled to end in just 13 days – on December 15. If you haven’t yet figured out your health coverage for next year, now’s the time to get that done!
Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.
In 10 states and Washington, DC, the end of open enrollment has been extended, with deadlines that vary by state and continue well into January in some cases.
There are four other states (Connecticut, Idaho, Maryland, and Vermont) that run their own enrollment platforms and thus have the option to extend open enrollment if they choose to do so, although it’s still scheduled to end on December 15 in each of those states. In the rest of the country, the federal government runs the exchange and has control over the timing of open enrollment, currently slated to end December 15.
Oregon’s bipartisan congressional delegation asks HHS to extend open enrollment
Oregon’s entire bipartisan congressional delegation sent a letter to HHS this week, asking the federal government to extend the open enrollment period on HealthCare.gov. Oregon, like most of the rest of the country, relies on the HealthCare.gov enrollment platform, which means the state is unable to extend the enrollment deadline on its own.
The Oregon lawmakers pointed out that the COVID pandemic and this year’s devastating wildfires in Oregon are making it harder for people to enroll in health coverage for 2021 in a timely manner. They’re asking HHS to grant some extra flexibility by giving people until the end of December – instead of December 15 – to enroll in a health plan for 2021.
Washington Healthplanfinder accepting public comments on standardized plan designs for 2022
Washington State rolled out standardized plans in the individual market for the first time this fall. For the last month, some consumers in the state have been enrolling in these plans for 2021 coverage, but Washington’s exchange has already done much of the work to complete the standardized plan designs for 2022. They have publicized the draft plan designs, and are accepting public comments on the proposed plan designs through December 29. Comments can be emailed to standardplans@wahbexchange.org.
Delaware fines insurers nearly $600,000 for mental health parity violations
Delaware’s recently re-elected insurance commissioner, Trinidad Navarro, has imposed nearly $600,000 in fines for mental healthy parity violations by health insurers in the state. The Delaware Department of Insurance conducted a review of all four of the state’s major health insurers, checking for compliance with state and federal mental health parity requirements. (In general, the plan requirements and benefits provided for mental healthcare cannot be any more strict than the requirements and benefits that apply to other medical care.)
After finding “thousands” of violations, Delaware regulators worked with the insurers to remedy the problems and create more equitable access to mental health coverage and care in the state.
Proposed health insurance rule changes include waiver allowing states to eliminate exchanges
Last week, CMS published the proposed Notice of Benefit and Payment Parameters for 2022 (summary available here). Many aspects of the ACA were left up to HHS/CMS to implement and require ongoing adjustments, so CMS issues this rulemaking guidance each year. There’s a 30-day public comment period, and it appears that the Trump administration is hoping to finalize the proposed rules before the Biden administration takes over on January 20, 2021.
The proposed benefit and payment parameters cover a wide range of issues, as is always the case. But the following proposals are the ones that are most likely to directly affect you and your health insurance coverage:
At Health Affairs, Katie Keith has three detailed articles about the proposed benefit and payment parameters: One addressing rules related to the health insurance exchanges, a second addressing the MLR rules, and a third addressing the rules related to risk adjustment.
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 – December 2, 2020 appeared first on healthinsurance.org.
The Scoop: health insurance news – November 25, 2020
In this edition
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.
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:
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.
The Scoop: health insurance news – November 18, 2020
In this edition
Early open enrollment data indicate individual-market enrollment is trending higher than last year
Open enrollment for individual/family health insurance has been underway nationwide since the start of November. It continues for nearly another month – through December 15 in most states – although the state-run exchanges in Washington, DC and ten states have extended enrollment deadlines.
Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.
As of November 7, total enrollment via HealthCare.gov (the exchange in 36 states) had reached 818,635. As Charles Gaba explains here, the daily enrollment pace is trending about 20 percent higher than last year, although we obviously only have a short segment of data thus far.
CMS typically publishes weekly enrollment data throughout the open enrollment period. The state-run exchanges tend to have more sporadic updates on their enrollment progress, but some have started to publicize data:
All three states also have tens of thousands of current enrollees whose coverage will be auto-renewed if they don’t select a new plan for 2021.
Got questions about open enrollment? Our comprehensive guide has answers. And Kaiser Family Foundation has an excellent overview of why this year’s open enrollment period is so important, written by Cynthia Cox, Karen Pollitz, and Daniel McDermott.
Trump administration relaxes Medicaid rules for additional COVID funding
Earlier this month, the Trump administration published an interim final rule to update earlier rulemaking related to the COVID pandemic. The new rules took effect immediately, but public comments are being accepted through January 4.
We’ve covered this in more detail here, but the takeaway point is that the new rule allows states to reduce Medicaid benefits during the COVID pandemic (within certain constraints) without losing the additional federal Medicaid funding that states have been receiving as a result of the pandemic. Families USA, a consumer advocacy group, has criticized the fact that this new rule will allow states to reduce Medicaid benefits in the midst of a global health crisis.
States are still not allowed to make their Medicaid eligibility requirements any more strict than they were at the start of 2020, so Medicaid work requirements would still be a no-go for states receiving the additional federal Medicaid funding. There are several states where Medicaid work requirements have been approved but are not yet in effect. For the time being, this will continue to be the case.
Healthcare emerges as key battle issue in Georgia run-off
Sen. Kelly Loeffler, R-Georgia, is campaigning to keep her Senate seat during a runoff election scheduled for January 5, and healthcare has emerged as a key issue in the race. Loeffler has long expressed opposition to the Affordable Care Act, while her Democratic opponent, Raphael Warnock, has called for the ACA to be strengthened and improved, supports a public option, and has long pushed for Georgia to accept federal funding to expand access to Medicaid under the ACA.
Last week, Loeffler unveiled her own healthcare reform proposal, which is a compilation of various pieces of legislation that she has sponsored or co-sponsored, as well as several additional ideas.
Loeffler’s proposal states that it would “ensure Americans with pre-existing conditions are protected,” but gives few details about how that would be accomplished. She calls for the expansion of health savings accounts and a “one-time federal tax credit toward HSA contributions for low-income families with pre-existing conditions,” but does not clarify how big that tax credit would be, or exactly how eligibility for it would be determined. The proposal also calls for the creation of “Guaranteed Coverage Plans to help cover patients with pre-existing conditions,” but does not provide any details on how such plans would work.
Loeffler’s proposal also calls for the passage of a bill she introduced last spring, which would codify the Trump administration’s relaxed rules for short-term health plans into federal law. In nearly all cases, short-term health plans do not provide coverage for pre-existing health conditions.
HRSA proposes ACA plans cover no-cost counseling aimed at preventing obesity in women age 40-60
Under the Affordable Care Act, all non-grandfathered health insurance plans are required to cover a wide range of preventive services with no cost-sharing (ie, no deductible, copay, or coinsurance). This includes services for all adults, as well as services that are specific to children and to women.
The Health Resources and Services Administration – responsible for determining which benefits must be provided at no cost to women – is currently collecting public feedback on its recommendation to add coverage for counseling aimed at preventing obesity in women age 40-60. The proposed recommendation calls for this counseling service to be added to the women’s preventive health care guidelines – meaning that non-grandfathered health plans would have to cover it without any cost-sharing. The counseling would be provided to women with both normal-weight and overweight women, with an aim of helping them maintain their body weight or prevent future weight gain.
If the recommendation is adopted by HRSA, non-grandfathered health plans would have to start covering the no-cost obesity prevention counseling. But there’s a one-year delay, as new preventive care rules take effect for plan years that start on or after one year after a recommendation is issued. Comments on the new recommendation can be submitted here, through December 9, 2020.
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 18, 2020 appeared first on healthinsurance.org.
Don’t forget to pack travel health insurance
Key takeaways
Know the specifics of your health plan
“Will my health insurance cover me when I’m traveling?” It’s a question that most travelers have, but the answer varies depending on the type of coverage you have and where you’re traveling.
First things first: Before you plan any trip, it’s wise to contact your health insurer and ask specific questions about your coverage while traveling. Ask them to refer you to written documents (or send them to you), as you’ll want to have details in writing that clarify exactly what is and isn’t covered when you travel. Although we’ll provide a general overview here, there’s no substitute for finding out exactly how your specific policy covers you when you leave your home area.
Travel within the United States
If you’re traveling within the U.S., you’ll generally have coverage for emergency care provided in an emergency room in another state. This is true regardless of your plan’s network structure (EPO, PPO, HMO, or POS) or how extensive the network is.
If you’re traveling outside your home state, your health plan may or may not have in-network providers in your destination state. Employer-sponsored plans (especially those offered by large employers) often have nationwide networks, but individual market plans (the kind you buy on your own, either through the exchange or directly from an insurer) almost invariably now have localized networks that do not include nationwide in-network coverage.
So your access to in-network coverage outside your home state depends in large part on where you get your health insurance.
Assuming that you do not have in-network coverage when you’re in another state, there are a few things to keep in mind:
Supplemental coverage
Some people purchase supplemental coverage to offset some of the potential costs that could be incurred if a medical situation arises while in another state:
Supplemental plans are also useful for covering out-of-pocket costs that arise from in-network and non-emergency situations, so they’re suitable for maintaining as year-round, whether you’re traveling or not. But they should never be relied upon as stand-alone coverage (ie, you still need to have major medical coverage in addition to your supplemental coverage).
And although nobody heads out on vacation planning to end up stuck in the hospital for an extended amount of time, it can happen. This Wall Street Journal article is a sobering reminder that emergency medical situations can sometimes result in long hospital stays with the patient too ill to return home. Out-of-network balance billing can quickly reach unmanageable levels in situations like that, and although the billing can sometimes be resolved with negotiations and mediations, it can also sometimes end up pushing people into bankruptcy.
Will my current plan cover me at all when I’m outside the United States?
It depends on your plan. If you’re enrolled in Medicare, your Medigap plan might provide some coverage for international travel (Original Medicare doesn’t cover care outside the U.S., with very limited exceptions).
If you’ve got private coverage, it depends on your plan. On some plans, life or limb medical emergencies are covered, but the onus is on the patient to prove that the situation was truly an emergency, and the cost of medical evacuation back to the United States is rarely covered by standard U.S.-based health plans. (Travel insurance plans generally do cover medication evacuations).
Travel insurance: A widely available solution if you’re traveling abroad
Most U.S.-based health plans do not cover international travel. Fortunately, travel health insurance plans are widely available, inexpensive, and relatively easy to obtain.
Travel insurance plans are not regulated by the ACA, so they can still have annual and lifetime benefit caps, they do not have to cover pre-existing conditions, and coverage is not guaranteed issue. There’s also no requirement that plans cover the ACA’s ten essential benefits.
But travel medical insurance does provide peace of mind if you’re planning a trip abroad. Coverage is available for U.S. and foreign nationals traveling outside their home countries, and a wide range of plans are available to fit every budget.
Expat insurance: When you need coverage abroad for an extended period of time
If you’re going to be living abroad for an extended period of time, your health insurance needs will be different from those of someone who is taking a vacation overseas. If you’ve been hired by a company that is sending you abroad, they may have already made arrangements for your health coverage. But if you’re self-employed, taking a sabbatical, or retiring overseas, you’ll likely need to sort out your own coverage arrangements.
Fortunately, there are insurers that offer plans specifically tailored to the needs of expats and long-term travelers. These policies can be purchased to include coverage in the U.S. as well as coverage abroad, or to only provide coverage outside the U.S. (your needs may vary depending on whether you’re planning to also maintain your U.S.-based coverage). As is the case with general travel insurance, expat/long-term travel plans are not subject to the ACA’s regulations.
Renewing your travel coverage
Travel medical insurance is not guaranteed renewable, which means that if you need another policy after your first one ends, you’d have to reapply and go through medical underwriting again (similar to short-term insurance).
And since travel insurance is not considered minimum essential coverage, the termination of a travel policy does not trigger a special enrollment period to purchase a regular ACA-compliant health insurance plan in your home state. This is an important reason to make sure that your travel policy is purchased to supplement your regular health plan, not replace it.
If you live abroad and then move back to the United States, you’ll be eligible for a special enrollment period, triggered by your move, during which you can purchase an ACA-compliant plan. But be prepared to prove that you were actually living abroad, and not just on vacation (in guidance related to a permanent relocation, HHS has noted that people need to spend “an entire season or other long period of time” in a location in order to establish residency there).
In the past, regular health insurance had many of the same caveats as travel insurance. But the ACA’s reforms have made us more accustomed to guaranteed-issue coverage that doesn’t discriminate against pre-existing conditions or limit coverage for essential health benefits. So it’s important to read the fine print on any travel insurance policy you’re considering, as the nuances of the coverage may be far different from your normal coverage.
Travel insurance: Read all the fine print
Piper Kan and Reece Huculak-Kimmel both have stories that amount to a cautionary tale about the short-comings of travel insurance. Both little girls were born prematurely in foreign countries, and the extensive medical bills were not covered, despite the fact that in each case the parents had purchased travel health insurance policies and thought they were covered for any contingency.
The take-away? It’s important to pay careful attention to the written details and exclusions of the plan you’re considering. Don’t rely on verbal confirmations of benefits.
But that said, travel insurance is an excellent supplement to your regular policy, and will cover mishaps in foreign countries that would otherwise have to be paid out-of-pocket. Bon voyage!
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 Don’t forget to pack travel health insurance appeared first on healthinsurance.org.
Top 10 reasons to use health savings accounts
Key takeaways
You’ve probably heard of health savings accounts (HSAs), and you may have wondered if one would be a good fit for you. You aren’t alone.
According to a survey released in 2018, approximately 22 million Americans have chosen to use a health savings account coupled with a high-deductible health plan (HDHP) to pay for current and future healthcare costs. Plans that participated in the survey reported a 9.2 percent increase in HSA enrollment from 2016 to 2017.
Explaining the growth in enrollment isn’t difficult when one takes a closer look at this financial tool and an impressive array of benefits they offer to people willing and able to use them.
Click on image for full-sized infographic.
Who can utilize HSAs?
In order to contribute to an HSA, you need to be covered under a high-deductible health insurance plan, either obtained through your employer or purchased on your own. The majority of large employers offer an HDHP option (70 percent did so in 2018), and HDHPs are available for purchase in the individual market nearly everywhere in the country. (That means you can have an HDHP and HSA even if you buy your own health insurance. An employer doesn’t have to be involved.)
Once you’re enrolled in an HDHP, you can open an HSA (or sign up for the one your employer uses) and begin making contributions. And if you’re on the fence about whether it’s the right move for you, here are some things to keep in mind:
1. HSAs offer a triple tax advantage
The HSA is a rare breed in terms of tax-advantaged accounts:
Contributing to your HSA reduces your modified adjusted gross income, which is important to keep in mind if you’re buying your own coverage and trying to qualify for premium subsidies. There’s an upper limit on how high your income can be for subsidy eligibility (400 percent of the FPL), and you might find that an HSA contribution makes you eligible for a premium subsidy when you would otherwise earn too much — or eligible for a larger subsidy, if you were already subsidy-eligible before the HSA contribution. Here’s more about how this works.
2. Paying medical expenses with pre-tax dollars
Once you’ve put money in your HSA, you can withdraw it at any time to pay for a qualified medical expense. And qualified medical expenses go well beyond the out-of-pocket costs for services that are covered by your health insurance plan. They also include includes things like dental and vision costs, as well as products like sunscreen (SPF 30+), bandages, and lip balm.
If you don’t have an HSA, you can only deduct medical expenses by itemizing your deductions on your tax return. And even if you itemize, you can only deduct medical expenses that are in excess of 10 percent of your income (for 2017 and 2018, the threshold was 7.5 percent of your income).
3. Your HSA can be a backup retirement account
If you withdraw money from your HSA before you turn 65 and you’re not using it to pay for qualified medical expenses, you’ll have to pay income tax and a 20 percent penalty. (Don’t do this unless it’s a dire emergency!)
But once you turn 65, that 20 percent penalty no longer applies. You can continue to use your HSA funds for medical expenses, avoiding taxes altogether on the withdrawals. But if you choose to withdraw the money for other purposes, you’ll just pay income tax. This is similar to how a traditional IRA works in terms of taxes. (Note that with a traditional IRA, you can start to withdraw money penalty-free at age 59.5, whereas with an HSA, you have to be 65.)
And unlike traditional IRAs, you’re not required to start taking money out of your HSA when you turn 70.5. If you want to leave it in the account to continue to grow, you can do that.
4. Pre-tax contributions … regardless of your income
Although you can think of your HSA as a backup retirement account, there is no income limit – on the low end or the high end – for deducting HSA contributions.
This is not the case for IRAs: There’s an income limit for Roth IRA contributions, a lower income limit for being about to contribute pre-tax money to a traditional IRA, and both require you (or your spouse) to have enough earned income to cover the contributions.
But to contribute to an HSA, you just need coverage under an HSA-qualified high deductible health plan (HDHP) without any additional major medical coverage, and you can’t be claimed as a dependent on someone else’s tax return. Your income isn’t a factor.
5. The money in your HSA continues to grow …
With an HSA, there’s no “use it or lose it” provision. This is one of the primary differences between an HSA and an FSA. If you put money in your HSA and then don’t withdraw it, it will remain in the account and be available to you in future years.
6. … and you can choose how your HSA grows
HSA funds can be kept in basic interest bearing accounts – similar to a regular savings account at a bank or credit union – or, if you choose an HSA custodian that offers it, you can invest your HSA funds in stocks, bonds, or mutual funds.
There’s no single right answer in terms of what you should do with the money in your HSA before you need to use it. If you’re planning to withdraw all or most of your contributions each year to fund ongoing medical expenses, an FDIC-insured institution might be the best choice. The account will likely only generate small amounts of interest, but it will also be protected from losses.
On the other hand, if you’re looking at your HSA as a long-term investment and your risk tolerance is suited to the stock market’s volatility, you might prefer to invest your HSA funds.
If you buy your own HDHP, you can select from any of the available HSA custodians. (Pay attention to fees, investment options, and expense ratios, as is always the case with investment accounts.)
If you have an HSA through your employer, you might be limited to using the HSA custodian that your employer has selected, at least as far as your employer’s contributions go. And HSA contributions made via payroll deduction are typically free of income tax and payroll tax. You can’t avoid payroll taxes if you make your own HSA contributions outside of your employer’s payroll.
But you’re free to establish a separate HSA on your own, and transfer money out of the HSA your employer selected, and into the one you picked yourself. The IRS considers this a transfer, instead of a rollover, so there are no limits on how often you can do this.
7. You can leave your job and take your HSA
If you have an HSA through your employer, the money in the account is yours. When you leave your job, you get to take the remaining HSA balance with you. (This is another difference between FSAs and HSAs.)
You can choose a new HSA custodian and transfer the money if you wish. There are no taxes on the HSA money you take with you when you leave your job, unless you withdraw the money and don’t use it for medical expenses.
8. Deductibles aren’t necessarily higher than other plans
You must have a high-deductible health plan (HDHP) in order to contribute to an HSA. And it’s understandable that the term “high-deductible” makes people nervous. But the deductibles aren’t necessarily higher than the deductibles for non-HDHPs, and in some cases, they’re even lower.
In 2019, IRS regulations require HDHPs to have deductibles of at least $1,350 for an individual and $2,700 for a family. These minimums will increase slightly in 2020, to $1,400 and $2,800. But average deductibles for Bronze and Silver plans in the individual market are considerably higher than that. Among people who have employer-sponsored plans that include deductibles (more than 80 percent do), the average deductible for a single employee is nearly $1,600.
And the maximum out-of-pocket limits for HDHPs are lower than the maximum out-of-pocket limits for other plans – a difference that is getting wider with each passing year. In 2019, the HDHPs have to cap out-of-pocket costs at no more than $6,750 for an individual, and $13,500 for a family. In contrast, ACA regulations allow non-HDHPs in 2019 to have out-of-pocket limits as high as $7,900 for an individual, and $15,800 for a family. For 2020, the maximum out-of-pocket caps for HDHPs will increase to $6,900 and $13,800, while the upper limit on out-of-pocket costs for non-HDHPs will be $8,150 and $16,300.
So although HSA-qualified plans are officially “high-deductible,” they sometimes have deductibles and out-of-pocket limits that are lower than other available plans. And it’s possible to find HSA-qualified plans at the Bronze, Silver, and Gold metal levels if you’re shopping for your own coverage.
And HDHPs may soon start to cover more services before the deductible, for people with certain chronic conditions. Until 2019, HDHPs were limited to covering only preventive care before the deductible (ie, prior to the insured meeting the minimum deductible amount that the IRS sets each year), and the definition of preventive care was updated in 2013 to align with the preventive services that the ACA requires all non-grandfathered health plans to cover.
But in July 2019, in response to a recent executive order, the IRS issued new guidelines for preventive care that can be covered before the deductible on an HDHP without forfeiting the plan’s HSA eligibility. The new rules took effect immediately, but insureds aren’t likely to see plans with enhanced preventive care benefits until at least 2020, and maybe 2021, as most insurers had already developed their plans for 2020 by the time the new guidelines were issued.
Under the new rules, an HDHP can cover, pre-deductible, certain specific health care benefits for people with certain chronic conditions and the health plan can remain HSA-eligible (assuming it meets all of the other requirements for HSA-eligibility. For people with the following chronic conditions, these services can be covered before the deductible on an HDHP:
Note that although the IRS has provided transitional relief through the end of 2019 for HDHPs that cover male contraception before the deductible, that exception will expire as of 2020 and the new guidance does not change anything about that. So unless the IRS takes additional action, health plans that cover male contraception pre-deductible will no longer be HSA-eligible as of 2020.
Also note that HDHPs will not be required to offer any of these benefits pre-deductible, unless a state decides to require it on state-regulated plans. These are benefits that go above and beyond the federally-required preventive care services, so whether to offer these services pre-deductible will be up to each insurer. But offering them will not cause a plan to lose HDHP status, which would have been the case prior to July 2019.
9. There’s no deadline for reimbursing yourself from your HSA
When you pay a medical bill and you have an HSA, there’s nothing that says you have to pull money out of your HSA to cover the medical bill. And there’s also no time limit on when you can reimburse yourself. As long as the medical expense was incurred after you established the HSA, and you didn’t take it as an itemized deduction, you can reimburse yourself years or decades later — after letting your HSA funds grow in the meantime.
So imagine that you’re contributing to your HSA each year, and also spending a few hundred or a few thousand dollars each year in medical expenses. You pay those bills from your regular bank account, keeping careful track of how much you pay and retaining all of your receipts.
Now let’s say that you decide you want to retire a few years early, before you can start withdrawing money from your regular retirement account. At that point, you can gather up all of the receipts from all the medical expenses you’ve paid since you opened your HSA, and reimburse yourself all at once (this is why it’s so important to keep your receipts — if you’re ever audited, you’ll need to be able to show that the amount you withdrew from your HSA was equal to the amount you had paid in medical bills over the years).
The money you withdraw is still tax-free at that point, since all you’re doing is reimbursing medical expenses (again, be careful not to withdraw more than you’ve spent in medical expenses; if you do, you’ll have to pay income tax and a 20 percent penalty on the excess withdrawal). But because you waited a few decades to reimburse yourself, you’ve given the money in your HSA many years to grow, tax-free, resulting in a potentially larger stash of funds.
10. Your HSA can be your long-term care fund
If you’re healthy and don’t have much in the way of medical expenses, you can think of your HSA as a really long-term investment. You’ll have to stop contributing to it once you’re enrolled in Medicare, but the money that’s already in the account at that point can continue to grow from one year to the next during your retirement.
You might find that you want to use your HSA funds, tax-free, to pay Medicare premiums. (That’s Part A if you’re not eligible for premium-free Part A, as well as Part B and Part D. You can also pay Medicare Advantage premiums with HSA funds, but you cannot pay Medigap premiums with tax-free HSA money.) Or you might need the HSA funds to cover out-of-pocket medical expenses during retirement.
But if you end up needing long-term care, the cost is likely to dwarf the out-of-pocket medical expenses you had earlier in your retirement. Medicare doesn’t cover long-term care, and Medicaid only steps in if you’re low-income and have exhausted almost all of your assets.
You can buy private long-term care insurance, but some people opt to treat an HSA as an investment earmarked for potential long-term care bills incurred late in life. If you don’t end up needing long-term care, your HSA can be passed on to your heirs, similar to a retirement account.
Clearly, there are a lot of advantages to an HSA. If you’re enrolled in an HDHP, it’s definitely in your best interest to set up an HSA and fund it. And if you don’t currently have HDHP coverage, it’s well worth considering as a future option.
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 Top 10 reasons to use health savings accounts appeared first on healthinsurance.org.
Healthcare sharing ministries: A leap of faith?
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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