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The Last Few Months in HealthCare: Employers, Individuals & Medicare

The Last Few Months in HealthCare: Employers, Individuals & Medicare

Telephone: 1-818-508-7177

Blessings for a wonderful day, The last few months have been really busy for us here at A+ Insurance. We’ve been focused on wrapping up the third Open Enrollment, dealing with the Employer Mandate and Compliance Rules and Regulations, and organizing the Special Open Enrollment for qualified enrollees. I personally traveled heavily to meet legislators from both parties, Democrats and Republicans, in Washington and in Sacramento. Somewhere within that flurry of activity, I managed to take a little time off to rest and recharge in the sacred land of India.

Naama and our Insurance Commissioner Dave Jones, Assembly member Mike Gatto District 34, and Congresswoman Mimi Walters, 45th Congressional District.

As we are getting closer to the upcoming presidential election, I encourage you to keep updated on what’s going on in the healthcare industry so you can make the best healthcare decisions for you and your family. Everyone needs to stay informed about health care in the State of California, whether you’re an employer, employee, head of household, or individual under 65 or 65+. No matter what you do or who you are, our healthcare system influences so many aspects of your wellbeing. As we learn to take better care of ourselves, we are working together to transform our healthcare system. It is all connected. On this note, I would like to share some exciting news with you. The California Department of Insurance has approved a class that I proposed for CE (Continuing Education for the Insurance Professional Industry). The new class is called “Lowering HealthCare Cost with Yoga & Meditation” and I’m going to begin teaching it in California. The goal of the class is to encourage and instruct people on how to start their own meditation and yoga practices. I am truly humbled by this opportunity and can’t wait to start. As most of you know, I strongly believe such a practice can change lives. Recently, Covered California unveiled reforms to its contracts with insurers, seeking to improve the quality of care, curb costs, and increase transparency. It’s all about quality. One of the biggest proposed changes would require health plans “to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.” (Los Angeles Times). This effort “to impose quality and cost standards on health plans, doctors, and hospitals appear to be the first by any Obamacare exchange in the nation.” The bottom line is that we are all in this together and we must make room for change. Our healthcare starts within each and every one of us. If we work together, everyone can make a difference. Take care of your personal health. Stay away from harmful addictions and practices. Be kind to yourself and be open to new methods of healing. Treat yourself with mindfulness. Meditation and the practice of yoga will allow you to thrive in ways you might never imagine. Healing our mind and soul creates peace and harmony within. A few reminders:

Employers:

There are few important bills currently at the Federal and State level of which you should be aware. Some changes need to be made to ensure access, choice, and affordability. Our goal is to lead the way of healthcare stability and to make the market more efficient and more responsive to all employers and individual health consumers. Employer Coverage is more attractive than ever for the tax deduction benefits. Employer Retention is necessary to meet penalty guidelines. Employer Benefits still offers a wide network of providers, in many cases with full network and lower out-of-pocket options.

Currently in Washington:

H.R. 2712 and S. 1996, to address new challenges related to counting employees and complying with employer reporting requirements.
H.R. 762 and S. 379, to increase the effectiveness and structure of the Small Business Tax Credit.
H.R. 879, H.R. 2050, S.2045 and S.2075, to permanently repeal the “Cadillac Tax”. “Cadillac Tax” will impose 40% excise tax on health plans that exceed certain cost thresholds beginning in 2020, following the 2- year delay passed in December 2015.
H.R. 928 and S. 183, to permanently eliminate the National Premium Tax (HIT tax). This will add more than $500 annually in costs to the typical family.

Employers have many questions and concerns about how marketplace changes will impact them moving forward. We are here to support you in choosing and making the most of your new coverage options by providing you with trusted advice and service. As we are already in the midst of preparing for Open Enrollment 4, I can tell you that in spite of the rate increase, rules changing, and the movement of employees to the ACA compatible plans, Employer Plans still remain the #1 choice.Most employers in the U.S. are keeping the coverage and purchasing new coverage for their team. It is still the most vital decision any employer can make.

Individual Market -- On and Off Exchange:

It’s probably not news to you but in 2015 the average cost of family healthcare was over $25,000 for a family of four. The estimate for 2016 is even higher, at $25,826. The projection for this year includes the average cost of health insurance paid by employers and employees, as well as deductibles and out-of-pocket expenses for the most common types of healthcare plans. Furthermore, The Milliman Medical Index “estimates that employers will spend an average of $14,793 this year to provide health benefits for a family of four.” Insurers Expected To Raise 2017 Premiums Significantly: Covered California is talking about a 9% increase but I must tell you that I think it will be much higher than that. We should prepare ourselves for a significantly high rate increase for 2017. As much as we don’t like the increased costs, we Californians are better off than the residents of Colorado. I visited Colorado recently and learned that four of the Colorado carriers are leaving the market. While rate increases are daunting, it’s still better than learning that your health insurance carrier will no longer provide coverage. The main reason for the cost increase is that the major insurers have taken significant financial losses over the last few years due to lower than expected enrollment in the Affordable Care Act and new customers requiring more care than anticipated. High utilization and low enrollment require market stabilization. About 10 million consumers will receive subsidies through the ACA, but those who earn more than $47,520 for an individual and $97,200 for a family of four will not qualify. In addition, those who obtain private insurance or offered employer coverage “outside of HealthCare.gov or a state marketplace” are not eligible for subsidies at all. There are few important bills in California of which you want to be aware:

AB 533 will protect consumers from unexpected medical bills if they are treated by an out-of-network provider at an in-network facility. This is extremely important for all of us. If you’ve ever needed medical care and have experienced out-of-network claims, you know exactly how painful it is. This bill will shield us from disputes between our plan and the providers.
AB 2436 seeks to add new, unnecessary paperwork mandates and new department of Managed Health Care Regulations on a prescription process that requires consumers to be notified of the wholesale cost of medication at the point of sale, among other provisions.

Affordability is a key to the success of any health care reform. Making coverage affordable for everyone doesn’t mean providing subsidies to help pay for coverage. It means examining what’s causing the cost of coverage to skyrocket and taking a frank look at the true cost of medical care. We can make a difference as we take steps towards a healthier lifestyle. Peter V. Lee, executive director of Covered California, said millions of people have benefited from wellness programs. Mr. Lee maintains "California is succeeding in this new era of health care by using all the tools of the Affordable Care Act, expanding Medi-Cal, and launching a state-based exchange that brings quality and value to our consumers." Currently, more than 12 million people are enrolled in Medi-Cal and about 1.57 million are enrolled in Covered California. Opportunity remains for thousands to enroll in health coverage through Covered California or the private market. Although Covered California’s third open-enrollment period ended Jan. 31, the door is not closed to uninsured Californians who have experienced life-changing events like having a baby, losing health insurance that had been provided by their job, or moving a long distance. It’s Covered California’s Special Enrollment Period, a time when eligible consumers can sign up for coverage outside of open enrollment, as long as they do so within 60 days of the qualifying life event.

Medicare:

As we are getting ready for the upcoming 2017 Medicare Advantage Open Enrollment from 10/15/16-12/07/16, there is one H.R. proposition of which to be aware.

H.R. 588/2581. Legislation to restore the Open-Enrollment period for Medicare Advantage enrollees.

In addition, there is a discussion to allow COBRA coverage to count as credible coverage for Medicare beneficiaries just as employer-sponsored coverage currently does. Remember that all Medicare supplements and Advantage plans cover you 100% for all preventative checkups and routine exams.

Wellness:

A higher number of employers are now investing in Wellness Programs. Please be sure to take advantage of these programs. We should all invest in our futures by investing in our health. Please feel free to call, drop by the office, or send us an e-mail with any question or concerns. We are here for you and truly care. It is our goal to help you live a long and fruitful life. The future of healthcare is on the line. The next few months will be crucial to our future. We must make sure we are kept up to date on all the changes to come. Stay tuned. From our heart to yours, joy ~ ♥ Naama O. PozniakCertified Healthcare Reform Specialist www.rightplan.com  | Tel: 818.508.7177  | Fax: 818.508.7197

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