Archive for Insurance News

The Impact of Health Care in 2011

December 29, 2011 tarpey Insurance News

Many people have heard of the 2010 health care law, but few actually realize the impact that it has made. Already, large segments of the new law have been enacted which are affecting millions of people. Don Berwick, the former administrator of the Center for Medicare and Medicaid Services, stated, “It’s complicated, but there are very many benefits affecting millions of people. They will not know it’s the Affordable Care Act, but it is.”

There are five major changes in health care that occurred in 2011 due to the health care law, as well as countless other smaller changes. The first one of these important changes is the recent crackdown on health care fraud. The government showed a 69% increase in cases prosecuted for health care fraud in 2011. This increase was a result of the law increasing prison terms for health fraud, an increase in strike force teams that specialize in this field, and greater funding for more advanced technology to detect suspicious patterns in claims.

The second major change is greater relief for those who are 25 years old or younger. This relief stems from the part of the law that allows those under 25 to remain on their parents’ health insurance policies. This will allow young people to take jobs they like, instead of taking jobs just for the benefits. It also prevents youth from attempting to live without health insurance because they are young and healthy and feel “invincible.” If a medical emergency does occur, they could be left in severe debt without insurance.

The health care law also benefits the opposite end of the spectrum: senior citizens. Not only has the cost of prescription drugs been reduced by half, but seniors are also eligible for annual exams and certain screenings without paying a co-pay. They can also receive free counseling if they screen positively for obesity in an effort to decrease the risk of heart disease, diabetes, and strokes.

Next, those who are privately insured can now go for annual exams, screenings, and immunizations with no co-pay, deductible, or co-insurance. However, many plans already offered these services with the hopes that preventing problems early will help save money later.

Finally, those with pre-existing conditions who were denied insurance coverage in the past could be eligible for the government’s Pre-existing Condition Insurance Plan. Those without insurance for at least 6 months can use this program. The program is now easier to join due to cheaper premiums and less strict requirements.

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Requirement To Carry Health Insurance Ruled Constitutional

November 16, 2011 tarpey Insurance News

Another challenge facing the 2010 health-care overhaul was overcome recently, giving the Obama administration more momentum before the Supreme Court sets out to determine the  law’s constitutionality. The challenge was directed towards “the law’s requirement that most Americans carry health insurance or pay a penalty” and was unanimously rejected by the U.S. Court of Appeals for the District of Columbia Circuit.

Judge Laurence H. Silberman issued a 37-page opinion, citing that the law is “part of the fundamental tension between individual liberty and legislative power.” However, Judge Brett M. Kavanaugh stated that the courts do not have jurisdiction until 2015 when the law’s tax penalties come into effect. This split increases the likelihood that the Supreme Court will ultimately hear the case.

Stephanie Cutter, who is an advisor to president, applauded the decision, saying that those “who claim that the ‘individual responsibility’ provision exceeds Congress’ power to regulate interstate commerce are simply wrong,”

USA Today clarified the gravity of the case’s decision.  ”The stakes are huge going into the case,” said law professor Pamela Karlan of Stanford University. “The case will determine how much power the federal government has to deal with life in the 21st century, health care being among the most important issues.”

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New York Now The 29th State to Require Insurers to Cover Autism Expenses

November 3, 2011 tarpey Insurance News

Beginning on November 1st, 2012, New York State will begin mandating that health insurers provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders (also known as ASDs). The Governor, Andrew Cuomo, signed the bill on November 1st, helping the families of autistic children to save tens of thousands of dollars in out-of-pocket expenses. This is great news for the 30,000 autistic children in New York and their families.

However, there is a drawback to this new bill. The state Health Plan Association speculates that premiums for businesses and families may increase so much that they may be priced out of coverage all together. For that reason, the association wants to reduce the coverage and costs before the law takes effect next year.

In response, Governor Cuomo said that there would be a $45,000 cap on the coverage that insurance companies would have to fund, and supporters believe that premiums will only increase by $1 a month for all New Yorkers.

Paul Macielak, president and CEO of the New York Health Plan Association, believes otherwise. He estimates that it could cost families hundreds and businesses thousands. However, the advocacy group “Autism Speaks” said that they believe the bill could ultimately save taxpayers $13 million over a six year time period due to the reduction of Medicaid costs and the money needed to fund early intervention and special education programs for autistic children.

What is your reaction to the new bill? Post your comment and let us know what you think.

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Medicare Premium Increase for 2012 is Surprisingly Small

November 3, 2011 tarpey Insurance News

The recent announcement about Medicare premium increases was met with positive and satisfied reactions. The increase was announced to be smaller than expected. Multiple news outlets reviewed the story and added their own opinions and perspectives on this developing story.

 

The New York Times clarified how the increase for monthly Medicare premiums for beneficiaries would only increase by $3.50, meaning they will pay $99.00 a month. From a political standpoint, the appraisal of the small increase by administration officials could help President Obama “as he tries to win the votes of older Americans in his bid for re-election.”

 

The Wall Street Journal makes a note of a remark made by Kathleen Sebelius, secretary of Health and Human Services. She said that the higher Social Security benefit, in combination with the smaller-than-expected Medicare premium increase, means the typical retiree could have about $40 more to spend each month.Also, while this new Medicare premium is an increase for about three-quarters of seniors and disabled people, “people who turned 65 in 2009, 2010 or 2011 have been paying $115.40 a month.” For those people, their premiums will decrease.

 

Sebelius also claimed that this lower-than-expected increase was “the latest round of good news” mostly due to the Affordable Care Act.

 

Most of those affected by Medicare were pleased by this small increase. It is allowing administrators to offer people better, more affordable Medicare.The Washington Post wrote that “The announcement was the third piece of good news about Medicare premiums this year.” AARP’s legislative policy director, David Lerner, stated, “This small increase is welcome news.”

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New Rules For Health Insurance Exchanges

August 16, 2011 tarpey Insurance News

The Obama administration recently released three proposed rules that will be critical to the establishment of health insurance exchanges. For those unfamiliar, the overarching purpose of health insurance exchanges is to make health insurance easier to purchase by individuals and small businesses, while making it more affordable. By pooling insurance risks and premiums, it is expected that these new exchanges will allow individuals and small businesses to have the same purchasing power as big businesses.

The department o f Health and Human Services (HHS) created two of these three rules. The first rule outlines exchange eligibility and employer standards. In other words, it determines who is eligible for exchange participation. The second addresses the Medicaid eligibility increase and the proposed enrollment system. The Internal Revenue Service (IRS) proposed the third rule which provides guidance on premium subsidies for coverage obtained through exchanges. These three rules will be important to shaping these enchanges and will impact those who are affected by them.

Additionally, buying a health plan in the future will become similar to the process of shopping for an airline ticket or booking a hotel online. By 2019, it is predicted that 24 million Americans who do not get health insurance from their employment will obtain their insurance using these exchanges.

These rules are merely propositions at the time. Comments on all three rules are being accepted until October 26, 2011.

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Recent Debt-Ceiling Agreement May Impact Medicare

August 3, 2011 tarpey Insurance News

According to a recent report from the Wall Street Journal, the recent debt ceiling agreement reached by Congress may impact older Americans reliant on Medicare or those with disabilities. Legislators may begin using means testing (in which wealthier people pay more for the program) and raising the eligibility age for Medicare.  Hospitals might even have to eliminate services due to a deal provision which would allow reimbursement cuts to clinicians treating Medicare patients. The deal also included a fall back spending-cut provision which includes Medicare cuts capped at 2%. While this directly impacts healthcare professionals, some medical groups say they cannot make these cuts without seriously affecting patients.

Washington wants more savings from medical providers, hospitals, and doctors in this debt deal that President Obama signed Tuesday (8/2/11). This deal is designed to protect seniors and others who rely on Medicare, but may in fact hurt those who need it most. If Congress cannot create a plan to reduce the deficit by $1.5 million dollars over the next ten years, the aforementioned debt ceiling plan will require a 2% across-the-board reduction in payments to Medicare providers beginning in 2013. Even though this Medicare cut is small, advocates for the elderly fear that this reduction could cause medical providers to reduce their services or stop serving them entirely.

 

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Critical Illness Insurance Calculator

July 8, 2011 tarpey Insurance News

Employers may be noticing that the demand for critical illness (CI) insurance is rising. Likewise, employee curiosity about what CI insurance entails is increasing as well. CI insurance provides a financial cushion to cover the everyday expenses of the insured person who survives and ultimately recovers from their critical illness. When someone is diagnosed with a critical illness, this insurance helps fill gaps in medical coverage in addition to aiding with everyday costs such as rent and food. As an employee, you may be interested in learning more about how to obtain this insurance coverage. Talk to your employer today.

For businesses and companies seeking to offer critical illness insurance to employees, it is important to know how much CI insurance each employee will need since it varies for each person. To help determine this, use the formula below:

Mortgage/rent + Credit Card Payment + Car payments/maintenance + Out-of-pocket medical costs + Kids and parents + Other monthly expenses =Dollars of protection you need per month of recovery*

*multiply by the number of months to get a monthly projection

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Limited “Doughnut Hole” Coverage Still An Issue

July 6, 2011 tarpey Insurance News

According to CNBC, “The federal health care overhaul delivers deep price cuts this year that will benefit Medicare prescription drug customers who fall into a coverage gap known as the ‘doughnut hole.’ But limited coverage still may pose a financial challenge for a few more years.”

For those unfamiliar, the term “doughnut hole” refers to the gap in Medicare prescription drug coverage that occurs when customers and their drug plans spend $2,840. After this point, the next $3,608 in costs must be picked up by the beneficiary. It is not until after this point that they become eligible for catastrophic coverage.

In order to compensate for the costs incurred due to the doughnut hole, $250 checks were given to those who fell into this coverage gap last year. This year, in order to further diminish the effects of this gap, “companies that make brand-name pharmaceuticals are providing 50-percent discounts, and plans that offer Medicare Part D prescription drug coverage will pick up 7 percent of the cost of generics.”

However, even with this effort to close the gap, there are still extra costs that remain. Part D beneficiaries can take steps to save even more money. For example, they can compile a list of the drugs their plan covers and ask their doctor if there are cheaper, non name brand alternatives.

It is predicted that the federal overhaul will close this gap by 2020. But until then, the doughnut hole will still exist to some extent.

Know of any strategies or steps that you have taken to help diminish the cost of prescription drugs? Share them in the comments below.

Still have questions? Feel free to contact the Tarpey Group.

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New Healthcare Laws May Cause Older Workers To Pay More

July 1, 2011 tarpey Insurance News

The Chicago Tribune recently reported that President Obama’s health care law has yet another quirk. Due to complex legislation, older adults that are the same age with the same income and similar medical histories could end up paying drastically different amounts for private health insurance. This difference could account for over $1,000. The inequity is created because those who take early retirement get a significant break on their health insurance premiums. Those who do not take early retirement have to pay more. This difference stems from the fact that the early retirees’ Social Security benefits do not count as income.

This hang-up mainly affects older adults who have reached the age of 62, the age in which adults qualify for early retirement from Social Security but are still too young for Medicare. In fact, the disparities appear to be even greater for married couples and families in which at least one member is getting Social Security. Both the cost of coverage and the federal subsidies involved are much larger in a bigger household.

The Obama administration is aware of this issue, and is currently working to remedy the problem. Hopefully, this error can be fixed to avoid further controversy over Obama’s health care overhaul.

To learn more about employee benefits, insurance, and Medicare, do not hesitate to contact the Tarpey Group.

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Aetna’s Medicare Marketing and Enrollment Suspension Lifted

June 28, 2011 tarpey Insurance News

In April of 2010, regulators suspended Aetna from marketing to and enrolling new beneficiaries into its Medicare Advantage (MA) and Prescription Drug plans. Medicare Advantage plans are privately run versions of the government’s Medicare program. These plans offer basic Medicare coverage with added extras or premiums lower than standard Medicare rates.

However, on Monday (6/13), Aetna Inc. reported that The Centers for Medicare & Medicaid Services (CMS) lifted this suspension. As a result, Aetna announced that it will immediately begin selling its MA and Medicare Part D Prescription Drug plans beginning on July 1st. The initial reason for this suspension was because the insurer changed its Part D plan from an “open formulary to a closed one, which involves payment tiers and in some cases, favors generic drugs over brand names.” CMS stated that Aetna did not transition some customers to the new payment tier correctly, which resulted in some subscribers being incorrectly denied medications.

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