Here’s an article out of Benefits Pro that I was quoted in. Â Thank you Kathryn Gaglione from NAHU!
http://www.benefitspro.com/2013/12/18/whats-ahead-in-2014-for-ppaca
Individual Health Insurance
Understanding ObamaCare
Here is some information to help you navigate Obamacare.
1 – Does your current health insurance plan need to change?
If you have a grandfathered plan your going to be able to keep your plan (as long as the health insurance company you have your grandfathered plan with allows you to do so).
If you have what they call a “transitional plan” you’ll be able to keep that plan until your renewal date in 2014. Â Once your renewal date hits in 2014, you will then be required to buy a plan that meets all of the essential health benefits.
If you buy a plan with an effective date of January 1, 2014, that plan will meet requirements.
2 – How will you pay for your health insurance in 2014?
Depending on your household income, you may be able to qualify for payment assistance that make insurance more affordable. Â The only way you can obtain assistance, is if you purchase your plan from either the state or federal exchange. Â If you buy a plan “off exchange” you will not received payment assistance or special discounts.
3 – What is the difference between on and off exchange plans?
In my opinion, the only reason you would go to either the state or federal marketplace (the government prefers this word, but it’s the fancy word for exchange) is if you qualify for payment assistance. Â If your income is over the assistance limit, then going off exchange is the way to go. Â I say this because you won’t have to prove your income, and answer all of the questions that the state and federal government require from you.
For example, here in Kentucky, Humana offers some plans that aren’t available on the state exchange. Â These plans have a more comprehensive network, then the current on exchange plans have.
4 – What type of plans are available?
Networks, co-payments, deductibles, and out of pockets differ between all the carriers. Â You must decide for yourself what is most important to you, and then work with an agent or broker (Zinser Benefit Service, Inc. would be one) who should be able to guide you to the right plan.
5 – When can you buy coverage?
The new open enrollment period for a January 1, 2014 effective date started in Oct 2013 and ends on December 23rd 2013. Â Once this date passes, you’ll have dates similar all the way up through March of 2014. Â If you miss during this time, you will have to have a qualifying event in order to enroll in a plan during 2014. Â A qualifying event would be any of the following:
- Loss of essential health coverage
- Change of family structure – gain or become a dependent because of a marriage, death, birth, or adoption of a child
- Change of citizenship status
- Government error
- Change in subsidy eligibility – so if you make more money or lose some of your income, this could trigger a qualifying event
- Move to a new coverage area – state, county, etc.
This is just a brief overview. Â I hope it helps!
Three More Changes to Health Reform Law
This was taken from a Humana email I received late yesterday.
Three more changes to reform law
In the past two weeks, the Obama administration has announced three major changes.
- Consumers will now have until Dec. 23 to enroll in coverage to begin on Jan. 1. The deadline had been Dec. 15, “but since so many people have had difficulty buying coverage, they’re moving it back a week,” wrote Sarah Kliff in the Washington Post. “The key thing to watch here is how well the insurance companies are able to handle this compressed deadline.”
AHIP spokesman Robert Zirkelbach says pushing the deadline back by eight days “makes it more challenging to process enrollments in time for coverage to begin on Jan. 1. Ultimately it will depend on how many people enroll in those last few days.”
- The beginning of next year’s open enrollment period has been pushed back from Oct. 15 to Nov. 15. White House press secretary Jay Carney said this will help insurers: “This gives them more time to assess the pool of people who are getting insurance through the marketplaces and make decisions about what rates will look like in the coming year.”
As many pundits and politicians have noted, however, pushing the date back a month also means starting enrollment after the November elections. “If Obamacare is so great,” said House Republican leader Eric Cantor of Virginia, “why are Democrats so scared of voters knowing its consequences?”
- The launch of the online small business insurance marketplace, known as the SHOP exchange, has already had two delays. The administration further delayed its launch, announcing the day before Thanksgiving that online enrollment will be delayed for a year, until November 2014, in states where the federal government is running the exchange.
The Washington Post wrote, “Administration officials characterized the decision as one made necessary as they prioritized fixes to the individual health exchange.”
Small businesses can still get subsidized coverage, but instead of enrolling online through healthcare.gov, they have to “go directly to an agent, broker, or to an insurance company with plans certified by the marketplace,” a Q&A document from CMS explains.
“This new delay announcement is a disappointment but not a surprise,” said the president and CEO of the National Federation of Independent Business. “Small businesses continue to be low on the priority list during the Obamacare implementation process.”
President Obama’s Announcement
This was sent to me in an email from Humana – gives a nice summary of President Obama’s announcement last week about keeping your current coverage.
The biggest news in the health care arena has been President Obama’s announcement regarding the treatment of discontinued 2013 health plans.
Policy holders across the country have been receiving letters from their health insurers telling them their current health plans do not comply with the health reform requirements that go into effect on Jan. 1 because (1) they don’t meet the reform law’s new minimum benefit requirements, and (2) they aren’t eligible to be grandfathered (regulations allowed for some old health plans to be locked in). The notifications affected individual and small business health plans.
Some health insurers like Humana, where it was permitted under state law, gave policy holders a choice.
- They could “early renew” their current, non-health reform compliant coverage, which meant signing up for a year-long policy before the end of 2013.
- They could end their current coverage at the end of the year and sign up for a new reform-compliant version of their health plan for 2014.
- They could compare other options on the health insurance marketplace.
Many other insurers simply explained that policy holders’ current coverage was being cancelled.
The arrival of those letters took many Americans by surprise, since the President had repeatedly promised, “If you like your health plan, you can keep it.”
So last Thursday, the President responded to the public and political pressure to make his promise true. “I’m offering an idea that may help,” he said: He proposed that for 2014 – one year – health insurers be allowed to continue to sell health plans that were due to be cancelled at the end of 2013. “State insurance commissioners still have the power to decide what plans can and can’t be sold in their states,” Obama explained. “There’s going to be some state-by-state evaluation of how this (proposal) is handled.”
- The industry group America’s Health Insurance Plans (AHIP) immediately released a statement saying, “Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers.”
- The National Association of Insurance Commissioners released a statement reiterating AHIP’s concerns and added, “It is unclear how, as a practical matter, the changes proposed today…can be put into effect,” since rates and plans for 2014 had already been approved in many states.
- Insurance consultant Robert Laszewski explained the challenge in a note to clients: “This means that the insurance companies have 32 days to reprogram their computer systems for policies, rates and eligibility, send notices to policyholders…ask the consumer for their decision…and then enter those decisions back into their systems.”
- An analyst with Citigroup wrote in a report, “The complexity of trying to uncancel millions of canceled individual policies with only six weeks left in the year is staggering.” He predicted the “enormous administrative burden” would mean many insurers would choose not to extend coverage.
As the New York Times wrote, “It remained unclear just how much impact the fix delivered by an apologetic Mr. Obama would actually have. …There is no guarantee that insurers will…allow people to stay on their existing plans…or that states will allow such renewals.”
Some health plans may have an easier time than others implementing the President’s proposal. Humana, for example, has already reached out to members in states where permitted and offered them the option to retain their current health plans, extending their current coverage to the end of 2014.
States are reacting to the President’s announcement in different ways. For example, the insurance commissioners in the states of Rhode Island and Washington immediately responded they would not follow the President’s proposal to allow the continuation of 2013 policies into 2014. Kentucky and Ohio said they would work to help health plans provide their members with the option of renewing their 2013 policies.
The executive director of the industry group California Association of Health Plans said he was opposed to the idea of reversing course. “The entire underlying premise of the ACA – balancing costs of the young, old, sick and healthy – has been left adrift with this announcement,” he said.
Individual Mandate Delayed
Individual mandate penalty delayed
October 30, 2013
The part of the Affordable Care Act (ACA or health care reform law) with the biggest impact – the individual mandate – is getting a lot of attention lately. Under the law and regulation as written, people who buy health insurance as individuals (an individual plan) can go three months without health insurance and not have to pay the individual mandate penalty. Now that individual market open enrollment goes until March 31, 2014, coverage can start as late as May 1. The Obama Administration felt like it needed to fix the problem where someone who buys insurance in the last 45 days of open enrollment still would have ended up paying part of the penalty. Because of a change to the regulation this week, this will no longer be the case in 2014. As long as people buying individual plans are signed up for insurance by March 31, 2014, they will not get hit with the penalty.
The Centers for Medicare and Medicaid Services put out guidance on October 28 that gives more information on the “hardship exemptions†for the individual mandate penalty. The Department of Health and Human Services is putting such an exemption in place for people who sign up for insurance before the open enrollment period ends on March 31, 2014. Without this exemption, individuals would have had to be covered by health insurance by March 31, meaning they would have had to sign up for it by February 15, 2014. Now, people who have signed up by March 31 will be able to claim a “hardship exemption†(without asking for it from the marketplace) on their taxes and not pay the penalty for the months in 2014 that they did not have health insurance.
A regulation with more detail should be released very soon. We will share more news when we have it.