Insurance Companies Are Suing Trump!

When the Trump Administration announced a rule to stop cost-sharing subsidies to insurance companies, there were threats of lawsuits. The threats have now become a reality, with an insurance co-op recently filing a lawsuit against the federal government.

Cost-sharing reduction payments were set up under Obamacare to ensure that customers would be able to receive low deductibles and out of pocket costs. In return, the federal government would pay back the insurers. The Congressional Budget Office estimated that the government pays about $7 billion a year to all ACA insurers for cost-sharing reduction payments.

The federal government is now being sued by Maine Community Health Options, requesting the money owed to them by law. They are seeking $5.7 million in cost-sharing reduction payments. The insurance company did not raise premiums despite the end of the subsidy payments.

The co-op claims that they cannot change its health plan part way through the year to make up for the lack of reimbursements, and they took a financial hit.

Attorney Stephen McBrady of Washington, D.C. submitted the lawsuit that stated, ” “Section 1402 requires health plans to provide cost-sharing reductions to members, and then the health plans to be reimbursed by the U.S. government under the ACA. Insurers, in turn, are guaranteed by the ACA to be reimbursed by the government for the cost-sharing reductions they pay to their insureds. The law is clear, and the government must abide by its statutory obligations. Plaintiff respectfully asks the court to compel the government to do so.”

Since the ruling to halt the payments in October of 2017, 19 attorney generals filed a challenge against the president, but a federal judge denied the request. Many co-ops have closed because of financial losses due to the lack of reimbursements.

Community Health Options is the largest individual insurance provider in Maine. If they succeed in their lawsuit, they will receive the money from the U.S. Department of Treasury’s judgment fund.

Another lawsuit filed against the U.S. is by Common Ground Healthcare Cooperative of Wisconsin. If these co-ops win, it will no doubt open the door for other insurers to receive the reimbursements owed to them by the government.

The Maine co-op, Community Health Options, have yet to receive a hearing date; it will be a lengthy battle.


Medicare Part B Rates Fluctuating In 2018

The fourth quarter is when senior citizens learn about their social security benefits and Medicare. They find out if they will receive higher social security, and how much, also how much monthly premiums will be for Medicare. Most people with Medicare will face higher premiums in 2018.

Medicare Part B insurance covers outpatient care, preventative services, ambulance services, laboratory tests, and durable medical equipment.

The Part B premium increases will not only will this affect older adults who were stable due to their social security benefits, but it will affect a large number of low-income seniors who struggle on a fixed income.

“Hold Harmless”

In order to protect senior citizens living on fixed incomes, a federal law provision, “hold harmless,” prevents Medicare from raising Part B premiums more than their annual cost-of-living adjustment (COLA) from Social Security. The premiums are being automatically deducted from their Social Security checks. About 70 percent of Medicare enrollees are protected by the “hold harmless” rule.

In 2016, there was no Social Security COLA, so those under “hold harmless,” did not have their Part B premiums rise that year. Last year, Social Security gave enrollees .03 percent COLA, raising premiums from 104.90 to $109 for the hold harmless group. But, Medicare enrollees not in the group (30%) had to pay the full raise in premium, $134.

The Changes

In 2018, the cost-of-living adjustment will go up 2%, which is the highest raise in six years that senior citizens have received. This year, the Medicare Part B premium has remained unchanged from last year’s $134 a month. Because of the premium remaining unchanged, majority of seniors that were protected by the hold harmless provision will be get hit with a major increase in their premium. They will be expected to go from paying $109 a month, to $134 a month, a $25 a month increase. The $25 these senior citizens will be paying leaves them will little to no money for expenses.

Enrollees who are not part of the group, about 30 percent, will not see any additional costs because they already took the hit the previous year.

For high-income enrollees, the more you have the more you pay. Their Part B premiums will increase depending on their income, rising anywhere from $187.50 to $428.60.

Income (adjusted gross income plus tax-exempt interest income):
Single tax return Married filing jointly Monthly Part B premium (per person)
$85,000 or less $170,000 or less $134 (may be less if covered by the hold-harmless provision)
$85,001 to $107,000 $170,001 to $214,000 $187.50
$107,001 to $133,500 $214,001 to $267,000 $267.90
$133,501 to $160,000 $267,001 to $320,000 $348.30
More than $160,000 More than $320,000 $428.60

Other Alternatives

Head of the Centers for Medicare and Medicaid Services, Seema Verma said in a news release, “We encourage Medicare beneficiaries to explore their options to make an informed choice between original Medicare and Medicare Advantage before open enrollment ends on Dec. 7.”

It is a good time to begin exploring other options, to avoid the large financial hit from the increase of Part B premiums. Medicare Advantage plans, Part C, have become popular, offering all that Medicare offers, sometimes cheaper. Instead of having to enroll in Part A, and Part B, and buying a separate Part D (prescription drug plan), Medicare Advantage has all of these under one plan. Medicare Advantage also offers an annual out-of-pocket limit, meaning once you have reached this limit, you will have no more out of pocket expenses.

Another option to consider helping pay for Part B premiums is a Medicare Supplement plan. These plans help pay the 20% that Medicare leaves up to the individual to pay.

It may be confusing comparing plans and figuring out which will tailor your needs, on a budget. EZ.Insure ensures finding you the best Medicare Advantage or Medicare Supplement plan in your region, within your financial plan. Get a quote by entering your zip code in the bar above. You can also call 888-753-7207, or email will be assigned your own highly trained agent to fulfill your needs.