ObamaCare Archives - Page 2 of 4

Double Check Your 2018 Information Now!

When enrolled in a Marketplace Insurance plan, it is important to make sure your household information is up to date every year. There may be benefits you are missing out on and possible consequences if you do not update.

What Changes To Report

Changes to your income for the year, whether a raise or demotion
Changes in health coverage: Whether someone in the household is getting job-based insurance, and/or receiving public coverage such as Medicaid, CHIP, or Medicare. Also, if someone is losing coverage that is job-based or public.
Changes to your household or individual members: If there is a birth or adoption, placement of a child for adoption or foster care. If someone becomes pregnant, and/or getting married or divorced. Child turning 26 years old. If there is a death, gaining or losing a dependent, and if you are moving to a permanent address.
Make sure names, date of births, and Social Security numbers are correct
Changes in status: Such as disability status, tax filing status, change in citizenship, whether there is American Indian member, and/or incarceration or released from incarceration.

Why You Should Report The Changes

If your income goes down or you gain a household member, then you may qualify for more saving than you are currently receiving. This can lower your monthly premium payments.

The flip side is if your income goes up or you lose a household member, then you could qualify for fewer savings. If you do not report this change, it will result in owing money when you file your federal tax return.

How To Update

Who you will contact for help is dependent on whether you got your plan from the Marketplace, or from a provider such as EZ.Insure. If you got a plan from one of our agents, you can always call 855-220-1144, or email us at replies@ez.insure to speak to your agent and update your information.

You can report any change by updating your application online after logging into your account on Healthcare.gov. Click on your application, choose “report a life change,” and then save it when done.
Contact a representative at the Marketplace Call Center at 1-800-318-2596. Or call your advisor at EZ.Insure.
If you move to a different state, log onto your account in HealthCare.gov, select a new application; select the year for coverage, and the new state. Finally, choose “apply or renew” to start a new application.
If you are switching to a job-based insurance plan, or to Medicare, make sure to cancel your current plan.

Do not forget to update your 2018 information, because it can cost you in the end when you file your federal tax return. And more importantly, you can possibly lose out on extra savings you should be receiving!

If you are looking for a new plan or have questions regarding your coverage, EZ.Insure can help. Our agents specialize in short term plans in your area and can answer any questions you have to find out if it is right for you. You will be given your own advisor who will go over different plans, and help sign you up free of charge. To start saving, enter your zip code in the bar above to get instant quotes, email us at replies@ez.insure, or call 855-220-1144. We guarantee we will be able to find you a plan that is affordable and meets your needs.

Trump Takes Action on Lowering Medicare Drug Prices

Medicare drug prices continue to increase making it harder for seniors to afford, President Trump decided to take action. Trump proposed a plan to bring down the prices of Medicare drugs by giving back to customers and focusing on raising foreign drug prices.

The federal government is not allowed to negotiate Medicare drug prices, so Trump said his plan will work without needing Congress’ approval. Insurers get discounts for the expensive name brand drugs, which are negotiated by pharmacy managers. Trump wants these rebates and discount distributed to the customers, which would help lower the prices. President Trump’s plan is to give at least one-third of the rebates to beneficiaries.

Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, stated that the rebates are a “convoluted system,” because they allow manufacturers to raise list prices. This, in turn, increases the amount of money that insurers and pharmacy benefit managers collect in rebates, giving them no incentive to keep prices down.

“When prices go up, patient cost-sharing also goes up,” she said in a speech before the American Hospital Association earlier this week. “We’ve all noticed the increase in the amount we have to pay at the pharmacy counter. For seniors who are sometimes on fixed incomes, the pain is real. This is not acceptable.”

The Trump administration wants to raise the prices of foreign drugs in order to reduce the drug prices at home. The reasoning for this is because foreign places keep their prices low while Americans continue to pay highly for their drugs. The foreign countries benefit from America paying high prices for these drugs and essentially their development. “The United States both conducts and finances much of the biopharmaceutical innovation that the world depends on, allowing foreign governments to enjoy bargain prices for such innovations,” the council’s report said. “Simply put, other nations are free-riding, or taking unfair advantage of the United States’ progress in this area.”

The Food & Drug Administration is focusing on trying to introduce more generic drugs that are identical to name brand drugs. This way customers can opt to buy the generic brand and save some money. The agency is hoping that by producing more generic drugs will increase competition and eventually bring down the pricing of brand-name drugs.

Seniors have been struggling to obtain the medications they need due to how expensive they are. Some have to make drastic changes in order to get these medications because they can die without them. There are still talks amongst the Trump administration about reducing Medicare drug prices and they are hoping to make some positive changes in 2019.

Higher Minimum Wage Could Lead To A SMALLER Check

Americans have been striking and pushing for a higher minimum wage from $7.25 to $15 an hour. Higher minimum wage would have many unforeseen negative effects, especially on taxes and health insurance benefits. With a higher wage for their employees business owners would be less likely to offer benefit packages. The employee would also end up paying more in taxes, adding that to the fact that they would also have to pay for their own insurance and benefits, it might cost more than you think to get that raise.

Saving could become even harder with a higher minimum wage due to an increase in out of pocket expenses!

The problem with raising the minimum wage so much is the funnel of confusion that it creates for already established businesses. Raising the minimum wage means a business would also have to raise the hourly wages for the employees who have been with the company for several years. If they leave their wages the same someone who has been with the company for five years could end up making less than, or the same as someone who just started. This means the business would have to lower their profit margins and take a cut in order to account for paying everyone. For larger businesses this is no problem, but when you look at small business it could be detrimental. For a business that already has slim profit margins they could end up losing money just to pay their employees. This limits the number of employees a business will take on, puts more stress on employees because they can end up understaffed, and prevents any growth in the business. If they also have to take away benefit packages offered to employees because of their new wages this also decreases the likelihood of an employee staying. This in turn could push out unhappy employees creating a higher turnover rate, which costs businesses even more money to interview, hire, and train the right people.

Companies would not only have to limit how many people they hire, they would have to cut back on the healthcare they once offered. According to research, if the minimum wage was increased by $1, then 9-50 percent of the employees wages were offset by a decline in the employer’s health insurance coverage. Employer-provided health insurance would begin to diminish in order to save money. A 2014 study of 400 US Chief Financial Officers (CFOs) by Campbell Harvey, Ph.D., J. Paul Sticht Professor of International Business at Duke University, found that 40% of CFOs would reduce employee benefits if the minimum wage were raised to $10 an hour.

If employers are be less likely to offer health insurance coverage, employees are left to cover their own insurance and studies show employees are less likely to go and get their own coverage through the ACA, even if they were entitled to subsidies. Employees would rather go without coverage than seek insurance from the exchange.

Increasing wages also affects the amount of government assistance people recieve. If someone is working a minimum wage job and is offsetting their income with government programs, tax refunds, and assistance than this wage increase could actually end up costing them more. <You needed an introduction for this. You never mention these affects and just jump into an example about them. For example, a single mother making $7.25 an hour would receive more of her pay than those who made $10 an hour. Raising wages results in that mother losing about $70 in earned income tax credit refunds, and $528 in child care subsidies. She then ends up paying $37 more in payroll taxes and $45 more in state income taxes. This happens because the more an employee makes, the more they pay into benefits and increases their tax payments, and decreases their eligibility for government programs .

While raising the minimum wage sounds like the perfect solution to raising everyone’s quality of life it actually creates a whirlwind of new problems. People could lose their jobs, their health insurance, and their tax credits which would in turn cause them to take home even less than they had with the current minimum wage. On top of affecting the individual it will make it nearly impossible for small businesses to thrive next to larger corporations and will put many smaller companies out of business. Instead of simply raising the wages the economy has to find a better solution, one that allows people to not ‘make more’ but to take home more.

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.

U.S. Government Proposes 1.84% Increase in 2018 Payments to Medicare Insurers

The US government and the Centers for Medicare and Medicaid Services, CMS, have proposed an increase in Medicare Advantage payment rates. The increase will be an average of 1.84 percent. This increase is up from the 0.45% that plans got last year from the government. Health insurers will receive these payments to help benefit the seniors eligible for Medicare.
The CMS stated that the average Medicare Advantage payment rate will increase by 3.1% after factoring in how members’ diagnoses are coded by health plans. This makes the increase 2.95% from last year.

Medicare Advantage enrollment data by the CMS shows a growth in medicare advantage enrollees of 9%, nearly 20.9 million in 2018. The estimate is that more than one-third of all Medicare enrollees, or 34%, will enroll in a Medicare Advantage plan.

The percentage insurers receive affects how much they will charge for their premiums and benefits. This percentage also reflects how much these insurance companies will profit. The government pays this percentage to these insurers in order to cover their member’s healthcare costs. So if the insurance companies do not get much of the percentage, then the member’s will not receive as much towards their healthcare costs. This means that the healthcare member will be charged more by their insurer, and have to pay more out of pocket.

With such a large percentage payment proposal coming in 2019, insurers will be able to provide more to their members. Benefits will be extended to their customers to include things like wheelchair ramps and other assistive devices in order to help reduce the effects of major health conditions. These benefits are hoped to help the customers live a more comfortable life and prevent conditions from worsening.

The CMS conducts Risk Adjustment Factors on a regular basis in order to keep track of their enrolled beneficiaries and their needs. These risk factors take part in how they pay for plans based on the beneficiaires needs, so that they can make the exact payments for enrollees with differences in expected costs. The risk adjustment allows the CMS to use bids as a base payment to plans. According to the CMS, the payment increase is based on better use of encounter data, which is information about the care that a beneficiary got from a provider. With this data, they can determine risk scores for plans.

The risk scores for 2019 will be based 75% on fee-for-service data, and 25% based on encounter data. The scoring was based on 85% on fee-for-service data and 15% encounter data in 2018.

The CMS states the payment increase will promote stability and the resources needed to support beneficiaries. “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma.
Medicare Advantage has always competed with the traditional Medicare fee-for-service program. But due to the “baby boomer” generation, has increased enrollment in both Medicare and Medicare Advantage. In fact, Medicare Advantage enrollment is at an all-time high right now and continues to gain popularity with high satisfaction ratings.

If you would like to find out more about this increase and how it will impact you, EZ.Insure will be more than happy to help. One of our highly trained agents that specialize in your region will help you with all of your Medicare needs. You will be provided with your own personal advisor free of charge to guide you through the shopping process. To get started contact us by email at replies@ez.insure or call 855-220-1144. You can also get an instant quote by entering your zip code in the bar above, it’s that easy.

Legal Challenges Ahead For ACA

The Affordable Care Act is once again facing a new challenge, this time by Republican states trying to dismantle it once and for all. The basis of the claim filed is that since the individual mandate was removed, it makes the whole ACA unconstitutional. The individual mandate is the ruling that people must have insurance or sign up for it within an amount of time or they would face a penalty fine during tax season.

Ever since President Trump was elected, one of his goals was to repeal and replace the Affordable Care Act which was signed into law by President Obama in 2010. One of the provisions of the ACA, the individual mandate, has been challenged by Republicans since 2012. They claimed it was an unconstitutional expansion of the government’s power. However, the Supreme Court upheld that the individual mandate tax was the government’s right. Chief Justice John G. Roberts Jr. stated the government “does not have the power to order people to buy health insurance, but it does have the power to impose a tax on those without health insurance.”

In December 2017, President Trump came one step closer to dismantling the ACA by ridding the mandate. His administration was able to change the individual mandate penalty to $0 beginning January 1, 2019. Because of this, as of February 26, 2018, Texas Attorney General Ken Paxton and 19 other states filed a lawsuit stating, “the country is left with an individual mandate to buy health insurance that lacks any constitutional basis. . . . Once the heart of the ACA — the individual mandate — is declared unconstitutional, the remainder of the ACA must also fall.”

In one of the cases against the ACA, King v. Burwell, Chief Justice John G. Roberts Jr. noted that “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former and avoids the latter.”

Judge Reed O’Connor will be hearing the case filed by the Texas Attorney General and other states. O’Connor was appointed by President George W. Bush in 2007 and has ruled against the ACA in past cases.

This is all happening during the time insurers must figure out the pricing for next year’s premiums and rates so they can file it with state regulators. Insurers are concerned because they do not know how much to raise rates if they will charge the same price to healthy and sick people, or whether to pull out of the marketplace.

While the marketplace in in panic about how much their prices should go up and if they will even still be in business, it is smart to seek quotes and plans from private insurers. EZ.Insure is able to provide you with affordable plans with ease. We offer the stability of insurance within your region by one of our highly trained and educated agents. To receive a quote, call 855-220-1144 to speak your own advisor, enter your zip code in the bar above, or email us at replies@ez.insure. We will provide quotes and offer our help free of charge without hassle.