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 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.

NEW Medicare Diabetes Prevention Program Now Available

A Medicare Diabetes Prevention Program (MDPP) was announced by the CDC to begin in 2018. The model will be added as a covered benefit for Medicare enrollees who meet the criteria. The program started April 1, 2018.

New Medicare Programs For Diabetes Can Result In You Saving Big!

Diabetes affects more than 25% of seniors 65 and older in America, and Medicare has spent billions on beneficiaries with diabetes. But type 2 diabetes can usually be delayed or prevented with healthy lifestyle changes.

The model offers a classroom-style support group that has gone through many successful pilots which resulted in better management for diabetes patients. The services include core sessions during the first 6 months, core maintenance sessions during the second month, and ongoing maintenance sessions during the second year. Check-ins are to make sure the participants are sticking to a healthy lifestyle. CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway believes that programs like these can prevent disease and help people live healthier lives.

The MDPP model aims to prevent type 2 diabetes from developing among Medicare beneficiaries. It will provide coaching services to prediabetic patients and help them lose weight. The goal is to reduce their weight by at least 5% from baseline and they must achieve this by the end of the first year to be eligible for ongoing maintenance in the second year.

People who went to more sessions had a much higher percentage of weight loss than those that skipped classes.

In the pilot tests conducted, patients who followed the program reduced their body weight by around 5% and lowered their spending by $2650 over the course of 15 months. The patients who attended more sessions had higher weight loss, which is the main goal of the program. “The final payment structure values beneficiary weight loss most significantly, as weight loss is a key indicator of success among individuals participating in a DPP due to the strong association between weight loss and reduction in the risk of type 2 diabetes,” CMS said.

“For the first time CMS, is going to be reimbursing for diabetes prevention based on this evidence-based program,” says Robert Gabbay, M.D., Ph.D., FACP, and Chief Medical Officer at Joslin Diabetes Center. “Currently the challenge is that when we identify people who are prediabetic, which is easy to do with a simple blood test, we don’t have a program to enroll them in that is reimbursed.”

Providers/physicians will receive Medicare reimbursement for providing the services to eligible patients. If their patients do not meet the required minimum weight loss, they will receive lower reimbursement rates and lose out on $160 per patient. But, if a patient successfully does the programs and meets the requirements, the provider could receive $610 per patient. If the patient comes to all the sessions but does not meet the 5% weight loss goal, the patient will help accrue $195 reimbursement for the provider.

Patients are eligible for the MDDP only once in their life because the CMS believes that the one-time benefit will be more likely to motivate them rather than allowing them to re-enroll any time. But, if a patient develops diabetes at any time during the program, then they can keep receiving services.

Diabetes is a national issue and is growing among children, adults, and senior citizens. This program that will be a preventative covered benefit will open up the idea of developing healthier lifestyles, and reduce the onset of diabetes. It is a hopeful step forward for Medicare beneficiaries.

If you need help searching for a Medicare Supplement plan, EZ.Insure can make sure you have an agent who knows the ins and outs of all the coverage options, local programs, and up to date rates in your area. Our agents are trained for your region and will work with your to find you the best plan for your needs at an affordable price. Don’t get stuck worrying about how to find coverage, let us make it easy for you. Simply enter your zip code in the bar above to get a quote, contact an agent by emailing us at, or call 855-220-1144.

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 We will provide quotes and offer our help free of charge without hassle.

Cheaper Short Term Plans Can Now Last Up To 3 Years

The Trump Administration has finally finalized expanding insurance companies ability to sell short-term health insurance plans for up to 3 years (36 months). This will allow consumers to buy less expensive and less comprehensive insurance policies for a longer time. The old rule for short-term health insurance was that it cannot last for more than three months. This new rule will open these policies to consumers for up to 36 months, in hopes that more healthy people will utilize them. These plans may offer less coverage, but will be there for those who can not afford or do not feel that they need extensive coverage.

“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “Americans need more choices in health insurance so they can find coverage that meets their needs. The status quo is failing too many Americans who face skyrocketing costs and fewer and fewer choices. This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable for individual and family circumstances.”

In 2016, Obama restricted these plans by limiting them to just three months of coverage from 12 months.  Back in October, Trump issued an executive order to cut back the restrictions on these plans that limited them to three months. By removing these restrictions, Trump gave the public the ability to decide for themselves whether they need a more committal plan, or a short term plan for the next year. This is one of Trump’s first steps to achieving his promise of dismantling the ACA once and for all.

Some skeptics worry that the more healthy people leave the marketplace, the more expensive premiums will be for those still in the market. The premiums would increase and cause subsidies for policyholders to rise which in turn would cost the government more money.

When asked about the concerns that the proposed rules would destabilize insurance markers Seema Verma, the administrator of the federal Centers for Medicare and Medicaid services said, “we don’t think there’s any validity”. She continued to state that federal officials believe that between 100,000 and 200,000 healthy people now buying insurance through those federal exchanges would switch to the short-term plans, as well as others who are now uninsured.

Once someone signs up for a short term plan for a year, they can now continue to renew it for up to three years. Insurers can ask medical questions and possibly reject consumers due to pre-existing conditions for a short-term policy. Once approved for the plan, if a consumer develops a ‘pre-existing condition’, then they can be rejected when it is time to renew.

Short term plans do not cover maternity care, so if you are considering getting pregnant you should take into consideration how much out of pocket costs you can handle.

Short term plans are less expensive, because they cover less, for example, maternity care and preventative care are not covered. It is ideally for those who are relatively healthy and do not need a lot of coverage. The hope is that the new rule will be more appealing for younger and healthier people.

The Trump Administration believes this will bring in an increase in premium revenues and profits because more people would sign up for a short-term insurance plan. This will allow the insurers to set prices to reflect a customer’s health risk of high medical costs. Trump believes that this 36 month extension is important because premiums more than doubled from 2013-2017 for health plans in the federal Marketplace Insurance exchange.

If you are looking for a short term plan or have questions regarding it’s 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, or call 855-220-1144. We guarantee we will be able to find you a plan that is affordable and meets your needs.

Medicare Prices Steadily On The Rise

Details have emerged after a report was released on the investigation into Medicare drug prices. The report “Manufactured Crisis: How devastating drug price increases are harming America’s seniors,” and its findings were released by U.S. Sen. Claire McCaskill, Democrat-Missouri. This report talks about the hiked up drug prices for senior citizens and how it needs to be further investigated. Medications for seniors have gone up nearly 10 times more than the annual inflation rate.

The report stated that “Soaring pharmaceutical drug prices remain a critical concern for patients and policymakers alike. Over the last decade, these significant price increases have emerged as a dominant driver of U.S. health care costs — a trend experts anticipate will continue at a rapid pace.”

The cost of about 20 of the most prescribed drugs for Medicare have gone up significantly from 2012 to 2017 according to the report. The lowest increase being Zostavax going up 31%, to the largest increase being 477% for the drug Nitrostat. Twelve of the drugs investigated, increased over 50% during the five-year time span, while six of them increased over 100%. The rise has gone up so much that some Medicare enrollees are unable to pay for their meds.

Some Medicare Drug Prices Have More Than Doubled Each Year!

The Pharmaceutical Research and Manufacturers of America did not agree with the report and followed up with comments reported by CNN. “This is yet another misleading report that ignores the robust negotiation that occurs between Medicare Part D plans, middlemen, and biopharmaceutical companies,” Juliet Johnson, a spokeswoman for PhRMA, said in a written statement. “Negotiated rebates can reduce list prices by as much as 30 to 70 percent for medicines used to treat diabetes, high cholesterol, and chronic respiratory illnesses. Notably, half of the 20 brand medicines in this report are used to treat these chronic conditions.”

As stated, the medicines are used to treat chronic conditions, but the reality is that many seniors need these medications. A lot of Medicare enrollees have some sort of health issue, whether chronic or not that requires treatment and medication to stay healthy.

Juliet Johnson later stated “we agree more can be done to make Part D more affordable and predictable for seniors. One way to do that is to ensure seniors benefit from the significant negotiated savings when they pick up their medicine at the pharmacy.”

The prices of pharmaceutical drugs for seniors has been an ongoing issue, they are becoming more expensive every passing year. It can become too much for seniors to include in their budgets, which can be very harmful to their health. Medicare enrollees can purchase a Medicare Advantage plan or Medicare Part D plan to help pay for pharmaceutical drugs needed. But as drug prices continue to rise, the premium costs will go up as well to pay for the difference.

By law, Medicare is not allowed to negotiate drug prices, which is something Democrats have tried to change for a long time. Some sort of change or assurance must be given to seniors that these prices do not continue to climb and become unattainable. During Trump’s State of the Union address, President Trump states he will fight to make the drug prices go down. This will hopefully put a resolution of the soaring drug prices, and provide relief for seniors.

EZ.Insure will provide you with the best information on how to get the most out of your Medicare budget.. We provide you with your own personal advisor who is trained in your region to give you quotes and guidance on which plan will work best for you. To get a quote, email, enter your zip code in the bar above, or call 855-220-1144. It’s that simple and easy to start saving.