Tag Archives: marketplace

Did You Forgo Health Insurance, You May Receive a Tax Penalty

If you decided to skip health insurance this year, consider this: Unless you can prove you have a valid excuse, you will be liable for a penalty during the coming tax season — and the time to start making your case is now.

That’s not all. People who bought subsidized insurance through one of the marketplaces may have new tax forms to complete, while paying the penalty itself may demand some serious number-crunching.

The Internal Revenue Service is gearing up to answer questions, but it warns that only half of the callers may get through — and those who succeed may have to wait a half-hour or more.

“There are quite a number of moving parts that taxpayers have not had to deal with,” said Kristin Esposito, technical tax manager for the American Institute of Certified Public Accountants.

The Obama administration’s Affordable Care Act — including its penalty provision — is in effect for the first time this year and will be reconciled through a person’s tax return.

For most taxpayers, this will simply mean checking a box on a tax return indicating they had insurance for the full year. But millions of others will have to grapple with new tax forms and calculations that may generate unexpected results.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

H.M.O Plans Have The Lowest Premium Increase

Health insurers are selling more than 100,000 plans at a county level through the Affordable Care Act’s marketplaces, at radically different prices and varied designs. The carriers range from established local Blue Cross plans and national for-profit behemoths to upstarts like local hospital systems and the new consumer-oriented co-ops that were created under the federal law.

Many people will see their premiums increase significantly for 2015 if they haven’t yet taken the advice of my colleague, Margot Sanger-Katz, to shop around. But a new analysis from the McKinsey Center for U.S. Health System Reform suggests insurers had some luck in holding down prices if they offered plans that limited a consumer’s choice of doctors and hospitals.

Plans featuring health maintenance organizations or restricted networks of providers typically had the lowest year-over-year premium increases, according to McKinsey, which sifted through information on the 223,000 plans offered in the marketplaces at the county level over the last two years. Plans featuring an H.M.O. had a median increase of only 2 percent. The more widely known P.P.O., or preferred provider organization, plans, which typically allow people to go outside their plan’s network if they are willing to pay a greater share of the cost, had a median increase of 9 percent.

The same contrast was found in comparing the median price increases for plans designed around a narrowed network, in which people are limited to a smaller group of hospitals or are asked to pay more when they go to an expensive facility. While plans featuring broad networks had a median increase of 8 percent, narrowed network plans increased just 4 percent.

Plans that limit a patient’s choice of where to go to seek care are not without controversy, of course. H.M.O.s experienced a backlash in the early 1990s after employers embraced them as a solution to rising health care costs, and patients and doctors complained about strategies they said were aimed at keeping patients from getting the care they needed.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The New York State Department Extends December 15th Deadline

The New York State Department of Health today announced an extension of the December 15 deadline for enrolling or renewing individual & family health insurance coverage through the NY State of Health (NYSOH) Marketplace. The deadline to apply for or renew coverage that takes effect January 1 has been extended through December 20. This affords consumers 5 additional days to complete these transactions. With the recent adverse weather conditions in parts of New York, consumers may have experienced delays in enrolling, and this extension aims to give everyone extra time to get covered.

This is for the Individual Marketplace only – This extension DOES NOT apply to the Small Business Marketplace which will close on 12/15/14 for a January 1st effective date as planned

A link to the state’s press release is here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Are These Marketplaces Affordable?

In the Affordable Care Act marketplaces, which now serve 7.3 million Americans, some premiums are going up while others are going down. Based on data available so far, we reported last week that the average premiums for last year’s most popular plans would rise 8.4 percent, but that people willing to switch plans could get much better deals — an average 1 percent increase, and even decreases in some markets.

But is 8.4 percent an alarming increase or a good deal for a plan you like? Is a 1 percent increase a disappointment or a terrific bargain? To put both increases in context, we’ve assembled some historical data on insurance markets that existed before the Affordable Care Act.

None are a perfect comparison group — there are many reasons the new marketplaces and the people shopping there are different from customers in the older markets. But, taken together, they can give us some sense of whether the health law is giving customers a good deal on insurance.

The overall assessment: By nearly any comparison, the average 1 percent premium increases available to consumers willing to switch plans is remarkably low. We are in a period of record-low health-care spending growth. But even in this period, premium increases lower than inflation are unusually good news.

Even the average 8.4 percent increase for people who renew in the most popular plans falls within the range of historical increases in the individual market. It’s not on the low end, but it’s not in the category of runaway premium growth that many critics of the Affordable Care Act warned might be coming.

Recall that back before January, when the marketplace plans launched, the individual insurance market was a very different place. Insurance companies were free to exclude customers with previous illnesses. People tended to cycle in and out of coverage very frequently as their income and employment status changed.

And regulations in some markets limited the amount that insurers could vary premiums by age, making products unaffordable for many young, healthy customers.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary