by Admin. | Sep 30, 2013 | Health Care Reform, Health Exchanges, Individual Exchanges, individual health insurance, SHOP Exchanges
![Health Exchange Marketplace Top 10 List HIX TOP 10](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/09/Healthcare-Top-10.tiff)
Health Exchange Marketplace Top Ten List
The Health Exchange also known as The Health Marketplace or Obamacare Exchanges are set to open in less than 12 hours. Are you ready or aye you like most asking What is an Exchange? Starting Oct 1 you can enroll until March 31, 2014, though you’ll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov. The prices for the marketplace plans are likely to be similar to those sold privately. A plan that is also available on the exchange may be eligible for subsidies. Heres an easy top 10 list of what you need to know.
10. Locate your State Exchange
Look up your state’s exchange here and Healthcare.gov. Some states are running their own exchange, others are running it through the federal government see www.healthcare.gov. For NY Tri-State the sites are:
NYS – http://info.nystateofhealth.ny.gov See rates here
NJ – https://www.healthcare.gov/how-do-i-choose-marketplace-insurance
CT – https://www.accesshealthct.com See rates here
9. Individual Mandate Penalty
For 2014, the annual penalty is $95 or 1% of your income, whichever is greater. The penalty will increase over the first three years. Coverage can include employer-provided insurance, individual health insurance, Medicare or Medicaid.
Health Insurance Individual Penalty for Not Having Insurance
Pay the greater of the two amounts |
Year |
Percentage of Income |
Set Dollar Amount |
2014 |
1% |
$95 & $285/family max |
2015 |
2% |
$325 & $975/family max |
2016 |
2.5% |
$695 & $2,085/family max |
8. Individual Subsidies
Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level.
If you make under $45,960 or your family makes under $94,200, you could get a real break on health insurance costs More low-income people will also be eligible for free coverage under Medicaid For those eligible, the subsidies will cap the amount you pay for your exchange policy at between 2% and 9.5% of your income (on a sliding scale, based on your income). To find out how much you would pay, estimate your income for this year and plug it into any health subsidy calculator. You can also see estimate subsidies with these “health subsidy charts”.
7. Small Business Subsidy – SHOP Exchange
A key change is that the small business health care tax credits will only be available ONLY through the SHOP Exchange marketplace in 2014. Small businesses with 25 or fewer employees who receive less than $50,000 a year in wages may be eligible for tax credits if they purchase the plan through the SHOP marketplace. These credits will cover up to 50% of the employer’s cost (35% for non-profits) for the first two years of coverage. Click here to read more about the small business health care tax credits.
6. Your income
not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.
5. Pre-Existing Conditions Eliminated
Your insurer generally can’t drop you, as long as you keep up with your insurance premiums and don’t lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.
4. Essential Health Benefits Covered
Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you. More info here.
3. Ninety-Day Maximum Waiting Period
Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.
2. Annual or Lifetime Limits
Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits may exist in and after 2014 for non-essential benefits.
1. Not Everyone is Eligible
- Immigrants who are in the country illegally will be barred from buying insurance on the exchanges. However, legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four).
- members of certain religious groups and Native American tribes
- incarcerated individuals
- people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples)
Conclusion:
There has been a lot of news about individual Obamacare provisions getting delayed – Obamacare Employer mandate Delayed. Some people may assume that means the health law is being slowly dismantled, or put off for an additional several years. .The Affordable Care Act is an extremely complicated law with a lot of moving parts, but ultimately, the biggest provisions are still moving forward. There will likely be more hiccups along the way. As the enrollment period opens for Obamacare’s new exchanges, industry experts predict there will probably be other issues that need to be ironed out — but that doesn’t mean the whole law is collapsing
Still confused?
Don’t be. These are the common questions that we are working through with our clients daily. Am I better off going SHOP Exchange vs. Individual for my business? Am I better off going off Exchanges or onto Private Exchanges? Whats my minimum employer contribution? Do I have to cover employee and dependents? Is dental and vision included? What happens to my Healthy NY when it shuts down Jan 1, 2014? What employer notices must I be posting?
Please contact our team at Millennium Medical Solutions Corp if you have additional questions regarding how SHOP Exchanges and Individual Exchanges can benefit you Stay tuned to our site for updates as more information gets released. Sign up for latest news updates.
Looking for Affordable Health Insurance?
You can use this SINGLE PAGE form to get affordable health insurance quotes outside exchange and save money. If you are above 64 years, then use this link to Get FREE Medicare quotes from the most trusted carriers.![](https://www.lduhtrp.net/p3101uuymsqBJDELFFHBDDFHHFHK)
Resource:
![Click Above](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2013/07/Health-Care-Reform-Update.ashx_.gif)
- Click Above
Federal government health care site: www.healthcare.gov
Kaiser Health Reform Subsidy Calculator:http://healthreform.kff.org/subsidycalculator.aspx
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by Admin. | Jul 2, 2013 | Health Care Reform, Health Exchanges, individual health insurance, MEDICARE, Obamacare, State Exchanges
Obamacare 1.0: Rolling Brown Outs?
The sheer technological volume of it all could bring “rolling brown outs” similar to electrical grids. Try to imagine a scenario of credit union Experien working with IRS then Social Security & Center for Medicare & Medicaid Services’s dated mainframe computer system while balancing HIPAA and privacy sensitive information. All this while millions of people converge simultaneously onto the information highway. Visualize all of the U.S. Daily Commuters driving into Manhattan today.
As reported below by Reuters’ Sharon Begley Obamacare 1.0: States brace for Web barrage when reform goes live: “Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), could fail for many reasons, including participation by too few of the uninsured and a shortage of doctors to treat those who do sign up. But because its core is government-run marketplaces selling health insurance online, the likeliest reason for failure at the opening bell is information technology snafus, say experts who are helping with the rollout.”
By Sharon Begley
NEW YORK | Sun Jun 30, 2013 7:03am EDT
(Reuters) – About 550,000 people in Oregon do not have health insurance, and Aaron Karjala is confident the state’s new online insurance exchange will be able to accommodate them when enrollment under President Barack Obama’s healthcare reform begins on October 1.
What Karjala, the chief information officer at “Cover Oregon,” does worry about, however, is what will happen if the entire population of Oregon – 3.9 million – logs on that day “just to check it out,” he said. Or if millions of curious souls elsewhere, wondering if Oregon’s insurance offerings are better than their states’, log on, causing Cover Oregon to crash in a blur of spinning hourglasses and color wheels and an epidemic of frozen screens.
Multiply that by another 49 states and the District of Columbia, all of which will open health insurance exchanges under “Obamacare” that same day, and you get some idea of what could go publicly and disastrously wrong.
Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), could fail for many reasons, including participation by too few of the uninsured and a shortage of doctors to treat those who do sign up. But because its core is government-run marketplaces selling health insurance online, the likeliest reason for failure at the opening bell is information technology snafus, say experts who are helping with the rollout.
Although IT is the single most expensive ingredient of the exchanges, with eight-figure contracts to build them, experts expect bugs, errors and crashes. In April, Obama himself predicted “glitches and bumps” when the exchanges open for business.
“This is a 1.0 implementation,” said Dan Maynard, chief executive of Connecture, a software developer that is providing the shopping and enrollment functions for several states’ insurance exchanges. “From an IT perspective, 1.0’s come out with a lot of defects. Everyone is waiting for something to go wrong.”
Two states that intended to build their own exchanges, Idaho and New Mexico, announced this spring that because of the tight timeline and daunting challenges they would have the federal government operate their IT systems.
“Nothing like this in IT has ever been done to this complexity or scale, and with a timeline that put it behind schedule almost before the ink was dry,” said Rick Howard, research director at the technology advisory firm Gartner.
WHAT COLOR WAS YOUR VOLVO?
The potential for problems will begin as soon as would-be buyers log onto their state exchange. They’ll enter their name, birth date, address and other identifying information. Then comes the first IT handoff: Is this person who she says she is?
To check that, credit bureau Experian will check the answers against its voluminous external databases, which include information from utility companies and banks on people’s spending and other history, and generate questions. The customer will be asked which of several addresses he previously lived at, for example, whether his car has one of several proffered license plate numbers, and what color his old Volvo was.
It’s similar to the system that verifies identity for accessing personal Social Security information. If someone gets a question wrong, he will be referred to Experian’s help desk, and if that fails may be asked to submit documentation to prove he is who he claims to be.
The next step is determining if the customer is eligible for federal subsidies to pay for insurance. She is if she is a citizen and her income, which she will enter, is less than four times the federal poverty level. To verify this, the exchange pings the “federal data services hub,” which is being built by Quality Software Services Inc under a $58 million contract with the Centers for Medicare & Medicaid Services (CMS).
The query arrives at the hub, which does not actually store information, and is routed to online servers at the Internal Revenue Service for income verification and at the Department of Homeland Security for a citizenship check.
The answers must be returned in real time, before the would-be buyer loses patience and logs off. If the reported income doesn’t match the IRS’s records, the applicant may have to submit pay stubs.
These federal computer systems have never been connected before, so it’s anyone’s guess how well they’ll communicate.
“The challenge for states,” said Jinnifer Wattum, director of Eligibility and Exchange Solutions at Xerox’s government healthcare unit, is that they have to build “the interfaces needed with the federal data services hub without knowing what this system will look like.” That makes the task akin to making a key for a lock that doesn’t exist yet.
CMS’s contractors are working to finish the hub, but “much remains to be accomplished within a relatively short amount of time,” concluded a report from the Government Accountability Office (GAO), the investigative arm of Congress, in June. CMS spokesman Brian Cook said the hub would be ready by September, and that the beta version had been tested for its ability to interact with the exchanges Oregon and Maryland are building.
The federal hub has to verify even more arcane data, such as whether the insurance offered to a buyer through his job is unaffordable, in which case he may qualify for federal subsidies, and whether the buyer is in prison, in which case she is exempt from the mandate to purchase insurance.
If someone’s income qualifies him for Medicaid, or his children for the Children’s Health Insurance Program (CHIP), software has to divert him from the ACA exchange and into those systems. Many of the computers handling Medicaid and CHIP enrollment are, as IT people diplomatically put it, “legacy systems,” meaning old, even decades old.
Many are mainframes, lacking the connectivity of cloud computing. They typically process eligibility requests in days, not seconds.
The legacy systems “rely on daily or weekly batch files to pass information back and forth,” and often require follow-up phone calls, said Wattum of Xerox, which is working to configure Nevada’s exchange so it can interface with the federal hub.
‘NO WRONG DOOR’
A “we’ll call you” message is unacceptable under Obamacare, which has a “no wrong door” goal: A buyer must never come to a dead end. If she is diverted to Medicaid, for instance, she must not be required to resubmit information, let alone wait a week for an answer about whether she’s now enrolled.
State IT systems must therefore “be interoperable and integrated with an exchange, Medicaid, and CHIP to allow consumers to easily switch from private insurance to Medicaid and CHIP,” said an April report from the Government Accountability Office (GAO), the investigative arm of Congress.
To make all those systems communicate, the state exchanges must either develop entirely new systems or use application programming interfaces (APIs) that work with the legacy systems to exchange data in real time. APIs are programming instructions for accessing Web-based software applications.
GAO’s Stan Czerwinski compares the necessary connectivity to adapters that let Americanelectronics work with European outlets.
State officials told the GAO that verifying eligibility, enrolling buyers and interfacing with legacy systems are the most “onerous” aspects of developing their exchanges, “given the age and limited functionality of current state systems.”
A key goal for exchange officials is keeping would-be buyers in the portal so they don’t give up and use a state’s ACA call center, which could quickly be swamped.
To avoid this, Oregon brought in potential users to test design prototypes, recorded what people did and where they had trouble, and tweaked the consumer interface to make it as user-friendly as possible, said Karjala.
“Even with that, if you have a family of four and you’re eligible for a tax credit to offset your premium,” he said, “you could be sitting at the computer for a long time.”
What everyone hopes to avoid is a repeat of the early days of the Medicare prescription-drug program in 2006. Some seniors who tried to sign up for a plan were mistakenly enrolled in several, while others had the wrong premium amounts deducted from their Social Security checks.
Another challenge is capacity. Websites regularly crash when too many people try to access them.
“I had no choice but to be extremely conservative” in estimates of how many simultaneous users Cover Oregon has to be prepared for, Karjala said. “Building capacity is the only way to avoid the spinning hourglass or the site freezing, so in our performance testing we’re seeing what happens if the whole U.S. population came to Cover Oregon to check it out.”
This summer, state exchanges will test their ability to communicate with the federal data hub, whose security frameworks and connectivity protocols are still works in progress. But whether Obamacare 1.0 flies won’t be known until the new health plans take effect on January 1. Robert Laszewski, president of Health Policy and Strategy Associates Inc, a consulting firm, said he wouldn’t be surprised if some patients showing up at doctors’ offices next year with Obamacare policies are told their insurers never heard of them.
(Additional reporting by Caroline Humer; Editing by Michele Gershberg and Prudence Crowther)
by Admin. | Feb 12, 2013 | Health Care Reform, Health Exchanges, Individual Exchanges, individual health insurance, Small Business Group Health
Poor health plan for middle class?
An interesting NYT article today “Slower Growth of Health Costs Eases U.S. Deficit” describes the good news that actual spending has been reduced by 15% or $200 Billion than projected 3 years ago. New data also show overall health care spending growth continuing at the lowest rate in decades for a fourth consecutive year.
Its any ones guess to the exact cause of this good news I will venture to say a good part of is the severe escalating out of pocket costs. With average office copays $50 and $200 for ER and many replacing these plans with high deductibles is it any wonder there is lower utilization? One might argue are poor health plans the cause for middle class leading to lower usage? To get an updated picture of todays NY Small Business rates once can get instant quote on our site and implement strategies in “How to Reduce My Health Care Costs“. In some instances people are turning to self insured Health Savings Accounts carrying deductibles as high as $5000 Individual and $10,000 Family.
In 2014 Individual Health Exchanges will offer a subsidized rate for lower income. For example, a $25,000 Individual filer would get approximate 80% subsidized rate and pay approx. $100/month. However salaries are not geo-sensitive and the average NY Middle Class Household will not see this subsidy. There are a number of questions outstanding such as the quality of the network. Also some Governors such as Christy Has Rejected Exchange is capable of running this Exchange version.
On the higher end according to CBO “tax expenditures disproportionately benefit the most well-off. As Figure 2 shows, the most affluent 20 percent of Americans receive 66 percent of all tax expenditure benefits (the richest 1 percent alone getting 24 percent of the benefits), while the middle 60 percent of households received just 31 percent of the benefits. In contrast, the middle 60 percent of households receive a proportionate share (58 percent) of the benefits of entitlement programs on the spending side of the budget (see Figure 3). The poorest fifth of households receive 32 percent of these benefits.”
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But the greatest looming concern are costs. is behavior changing? Are people initiating preventive care more readily? Are they enrolled in wellness programs, managing chronic conditions, seeking Urgent Care vs. ER, using generics vs brands? Is technology playing a greater role such as mobile devices in managing care? Are modern medicine efficiencies such as avoiding testing redundancies and EMR helping?
No one argues that medical costs are a drag on the economy and are directly linked to our prosperity. “Slower cost growth would have ramifications far beyond the deficit. According to calculations by White House economists, slowing the annual growth rate of health care costs by 1.5 percentage points might increase economic output by 2 percent in 2020 and 8 percent in 2030. It might also lead to higher wages for workers and more room for productive investments in the budget.”
The hope is medical care is becoming more efficient. Whether or not the rate is subsidized it is still being paid for by someone. With this new finding it does offer hope but unless there are added incentives such a preventive medications under an Health Savings Account card covered without a deductible the concerns are Middle Class families will be reluctant to access care and we all end up paying for this.
You can self quote on our site. Contact us at 1-855-667-4621 for more customized information.
by Admin. | Jul 16, 2012 | COBRA, Health Care Reform, individual health insurance, PPACA
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The Con Ed lockout this Summer couldn’t come at a more heady time. I’m not referring to the obvious temperature swelter but more to the employee health benefits that are at the back bone of virtually every recent Labor dispute. With the Con Ed dispute, Management’s has acquiesced on the health insurance . “Con Ed did accede to “public pressure” on Sunday by reinstating health insurance for the 8,500 members of Local 1-2 of the Utility Workers Union of America, a company spokesman said. The workers have been collecting unemployment benefits for two weeks but had to pay for their own prescription medicine and doctor visits because the company cut off health coverage when the old contract expired, at midnight June 30.”
Interestingly, Unions are major stakeholders in Healthcare as their benefits have been traditionally rich incentives attracting to workers. However, with A.C.A. (Affordable Care Act) otherwise known as Obamacare their health programs are very much in danger of additional taxation or member withdrawal. Unions estimate these provisions will raise the cost of health coverage by an additional $1,000 a year. In fact, a Union members may fare better on the Individual Mandated Exchange with projected individual direct insurance dropping 70% things will open up. A lower/middle income member will likely qualify for an additional discount credit. A more affordable health plan just may be a possibility.
There are other reasons the Individual Health Plan may be better:
- Unions as other self insured group must now comply with added benefits for preventive care, maternity care, Age 26 dependent care, pre-existing condition waivers.
- No Annual Limits on essential benefits by 2014
- No Lifetime Limits
- No more mini-med plans – discount health plans are prohibited. The movie John Q , based on a true story, where a father is told his son’s transplant will not be covered based on th elicited mini-med plan covering him up to $20,000. Large companies such as McDonald’s have also sponsored mini meds.
- Cadillac Tax – By 2018 a 40% excise tax on health plans that exceed $10,200(single) and $27,500 (family).
The original Cadillac Tax was pushed back by the behest of Unions to 2018 from the original proposed 2014 date. Most Unions with generous health care packages would not be complaint within that time frame.
However, not all is grim for Unions. HHS has issued waivers to 1,625 plans covering 3,914,356 individuals were exempt from these mandates through 2014. According to Heartland “More than half of the approximately four million individuals receiving waivers are union members, including 82.9 percent of those covered in the most recently updated list of waivers.”
With current administration posts coming from Union there wouldn’t be much surprise if these allowances continue. Would it be that bold to predict for Union Members in 2014 will be allowed to use their Individual Exchange income tax credits for their Union benefits packages? Small businesses may not be as lucky.