Tag Archives: open enrollment

Obama administration backs off on ACA rules for 2017 health plans

In a major win for the industry, health insurers will not be forced to have minimum quantitative standards when designing their networks of hospitals and doctors for 2017, nor will they have to offer standardized options for health plans.

The CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry.

Monday’s rule relaxes those aggressive proposals, a move that likely will raise the ire of consumer groups that have pushed for stronger insurance protections for patients. It does, however, include some victories for transparency advocates. The federal government, for example, will now have to publish all changes to premium rates, not just increases that are subject to review.

The rule addresses several other issues, including surprise medical bills and the 2017 open-enrollment period.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Affordable Care Act Plans Get 1 Million New Subscribers

A million new customers have signed up for health insurance during the Affordable Care Act’s third open-enrollment season, Obama administration officials said on Wednesday, and call centers have been deluged with requests from others eager to enroll.

The officials brushed aside reports of rising premiums and deductibles and concerns expressed by UnitedHealth Group and other insurers that say they are losing money in the new online insurance marketplaces, or exchanges.

“We are now seeing a surge of interest as we get closer to the deadline,” said Andrew M. Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services, which runs the federal marketplace. “Each day has been bigger than the day before.”

Consumers need to sign up by Tuesday to ensure coverage that takes effect on Jan. 1. The open enrollment period runs through Jan. 31; those signing up by Jan. 15 will be enrolled on Feb, 1; those signing up by Jan. 31 will be enrolled on March 1. People who go without insurance next year may be subject to tax penalties of $695 a person or more, although some may be able to qualify for hardship exemptions.

To read the full story, 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

2015’s Open Enrollment Faces Several Hurdles

Fall open enrollment for the 2015 group health plan year is being dominated by employer frustration and uncertainty about implementing coverage and IRS reporting requirements under the health care reform law’s employer coverage mandate.

“Open enrollment is going to present employers with some huge challenges this year,” said Steven Friedman, shareholder and employee benefits practice group co-chair at Littler Mendelson P.C. in New York. “There are quite a few hidden traps in the reform law’s mandate that could ensnare employers.”

The mandate requires employers with 50 or more employees to offer health care benefits to 70% of their full-time workers — defined as any employee who works an average of 30 or more hours a week — beginning in January, and 95% of full-time workers in 2016.

Experts say much of benefit managers’ concern has been focused on the Patient Protection and Affordable Care Act’s rules requiring most employers to certify that benefits-eligible employees and their dependents have been offered minimum essential coverage, and that employees’ premium contributions fall within cost-sharing limits established under the law.

“The reporting requirements under ACA are probably the No. 1 issue that we’re dealing with right now,” said Adam Solander, a Washington-based associate at Epstein Becker & Green P.C.

Starting in January, employers will need to track benefits eligibility of their full-time employees and submit annual reports to the IRS to document their group plans’ compliance with the law. The first reports are due in early 2016 for employers with at least 100 employees.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

High Number of Young Adults Signing Up For Health Insurance

The Affordable Care Act’s supporters and detractors have consistently agreed on one thing: the success or failure of the law hinges on the whether young adults, who tend to be healthier and less expensive to insure, enroll. New data released last week shows that more young people are getting health coverage, and in stunning numbers.

New U.S. Census data released last week shows that the number, and rate of young adults, who lack health insurance has fallen significantly since the Affordable Care Act became law in March 2010. An estimated 3.9 million more 18 to 34 year-olds were insured in 2013 than in 2009.

During that same time period, the rate of uninsured young adults has fallen, too, from 28.1 percent in 2009 to 25.2 percent in 2013. In just one year, — between 2012 and 2013 — the number of uninsured 18 to 34 year-olds dropped by over 367,000 people.

The new estimates don’t even include over a million young adults who signed up for health plans on their state’s Health Insurance Marketplace during Open Enrollment. That’s because the Census finished collecting this set of data at the end of 2013.

Open Enrollment started on October 1, 2013, but the vast majority of young adults — 1.7 million of the 2.2 million — signed up on state health exchanges after January 1, 2014. That’s 78 percent of enrollments that we won’t be able to account for until 2014 data gets released next fall.

While we will have to wait for further data to show the Marketplace system’s impact on youth insurance rates, the ACA implemented scores of systemic reforms to our health system that could account for more young adults getting covered. Systemic reforms that were in full effect, include: the provision allowing young adults to stay on a parent’s health plan until the age of 26, small business tax credits that provide health insurance to small business workers, new coverage options for people with pre-existing conditions, and the elimination of lifetime limits on coverage.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

What You Need to Know About 2015 Renewals

If you have health insurance on your job, you probably don’t give much thought to each year’s renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises.

Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts.

If those amounts are too low, consumers could get sticker shock over their new premiums. Too high, and they’ll owe the tax man later.

Automatic renewal was supposed to make the next open-enrollment under President Barack Obama’s health care overhaul smooth for consumers.

But unless the administration changes its 2015 approach, “they’re setting people up for large and avoidable premium increases,” said researcher Caroline Pearson, who follows the health law for the market analysis firm Avalere Health.

It could be a new twist on an old public relations headache for the White House: You keep the health plan you like but get billed way more.

“It was our preference for (the administration) to have the capacity to update people’s subsidy information, but they haven’t been able to get that built,” said Brendan Buck, a spokesman for the industry trade group America’s Health Insurance Plans.

Here’s the issue, in a nutshell:

To streamline next year’s open enrollment season, the Health and Human Services Department recently proposed offering automatic renewal to 8 million consumers who are already signed up.

But the fine print of the HHS announcement said consumers who auto enroll will get the “the exact dollar amount” of financial aid they are receiving this year.

That’s likely to be a problem for a couple of reasons, not to mention inflation.

First, financial aid is partly based on premiums for a current benchmark plan in the community where the consumer lives. Because more plans are joining the market and insurers are submitting entirely new bids for 2015, the benchmark in many communities will be different.

Second, financial aid is also based on household income. If your income goes down, you are entitled to a bigger health insurance tax credit. If it goes up, you get less. The 2014 amounts could well be out of date and incorrect for many people. Financial assistance is also affected by age, family size and where people live.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary