Monday, December 02, 2013

Looking at Access Health CT plans

Individuals can look at available plans on Connecticut's Health Insurance Marketplace by going to and following these steps:

● On the home page select the Individual icon and then enter basic info - County & age.

Note: In working within always use the Next button. Do not enter info and hit enter. The Next button saves your entry and goes to the next page.

● Once basic info has been entered a page with a summary of the Qualified Health Plans (QHP) will come up. This section has several pages of info. on the available plans. This info. can be sorted by the plans Premium, whether it is a Gold, Silver, or Bronze plan, the plan's Deductible, the QHP's Insurance Co., and the QHP's Quality rating. There is a button to compare and display all or a limited number of plans.

● Within the summaries there is a link to check doctors and other providers in the QHP companies network.

Call my Google voice line (860) 451-9793 for a free consultation on these QHPs and other questions about federal health reform here in Conn.

Monday, October 14, 2013

Pleased to answer questions on your current MediCARE Health plan coverage during 2013's Oct. 15 to Dec. 7 Open Enrollment for 2014.

You can gain by enrolling in a Medicare Advantage (MA), which is a MediCARE Part C plan:

MA plans are available from private medical insurance companies, which have a yearly contract with the Center for Medicare and Medicaid Services (CMS) and receive a fixed monthly payment for each person who enrolls.

Companies offering Medicare Advantage in Connecticut provide at least the same or more benefits than in original MediCARE including more extensive preventive care.

Some MA plans have no monthly premium and some charge a premium.

Individuals in a MA plan receive their medical treatment through the companies network of providers and most also include coverage for Part D prescription expenses. This makes them a MAPD plan and are the most common.

MAPD plans have co-pays for physician visits, emergency room visits, outpatient surgery, and for a certain number of days if hospitalized. This co-pay cost sharing is limited since the plan's include an annual maximum out of pocket (MOP).

MA plans are usually more economical than buying a MediGap plan plus a Part D plan. Thus, they are of interest to many individuals.

Surveys of people close to 65 tell us more than 50% are confused about Medicare and only about 10% understand Medicare's Part C!

I would like to - Ask you to call (860) 451-9793 - today if you are interested in increasing your understanding. We can meet for a no cost to you conversation.

Monday, September 02, 2013

What happens to my premium support if I go from part to full time?

People here in Connecticut can begin to sign up for individual medical insurance this fall, through Access Health CT, and at the same time apply for help paying their premium. Eligibility for help will be based on the household income they reported to the IRS for 2012. This new program, which I call premium support is technically an Advance Premium Tax Credit (APTC), begins January 1st for those that qualify. It will be managed by Access Health CT and monitored by the IRS.

Let’s look at how eligibility works. A Single person, after being in a part time position for a couple years, applies and gets help starting in January. Then they get a new full time job in May. The IRS will:

● Have received information on their APTC and on everyone who was approved.

● Reconcile income changes, such as going to full time, when the person files their tax return for 2014.

● Request full repayment of the tax credit for months when the new income is higher than 400% of Federal Poverty Level (FPL). This level is about $46,000 for a single person and $94,000 for a family of four.

● Request a limited repayment if the new household income continues to be below 400% of FPL. When a person’s tax credit was too high for certain months their max liability for the year is currently limited to:
+ $2,500 when income is 300% to 400% of FPL
+ $1,500 when income is 200% to 300% of FPL
+ $600 when income is less than 200% of FPL

The new help program also enrolls individuals whose FPL is 400% and below in a plan with a lower maximum out of pocket (MOP) on the expenses for which they are responsible. When income is below 250% of the FPL individuals are also enrolled in a plan with reduced co-pays and cost sharing. Any benefit payments received under these cost sharing reduction provisions will not have to be paid back if their income increases above these levels.

This summary has focused on the eligibility for help, which is based on a person’s household income. How much of their premium will be paid, or the amount of APTC, however is based on an individual’s age.

Let’s look at how this special payment works: Person A is age 32 & person B is age 62. Both are Single & each earns $40,000:

● The max amount A & B will pay each month is based on a percent of their household income, which is 9.5% at $40,000. Thus, A & B will both have to pay $316.66 each month.

● The APTC is determined by taking the premium for the second lowest priced Silver plan for that person and subtracting their share or the $316.66 in this example from the total. A person's premium is based on their age and geographic location and the plan they selected.

● The resulting APTC will be sent to the Health Insurance Company they selected and the company will then send both person A & B an invoice at home for their $316.66 each month. Their payment will be made on an after tax basis.

Questions on the premium support program or other parts of federal health reform? Call (860) 451-9793.

John C Parker, RHU, LTCP
Niantic CT

Saturday, August 24, 2013

Should I continue with my employer plan or go to Access Health CT for a discount?

This is a common question these days so I want to share a short article from WebMD with some things to think about.

To provide some information about Connecticut lets look at what a Single person might pay as their share of the medical insurance plan's monthly premium. A plan through Access Health CT for a person who earns 30k will cost them $237.50 a month. Some one at 40k will pay $316.66 each month. Couple points about this new way to obtain health insurance:

● The amounts above are more than the contribution many employees pay each month under their current Single coverage.

● Individuals with these incomes will qualify for premium support and this amount, which is called an Advance Premium Tax Credit (APTC), will be sent each month to the health insurance company they selected.
Note: A person's APTC is based only on income. Whether they are 32 or 62 if their income is the same their APTC will be the same.

● These individuals will get a bill each month from their plan and pay their share with after tax dollars.

● Individuals enrolled in a group medical benefit plan through their employer normally pay their share of the monthly premium with before tax dollars.

BTW - a Single person with incomes like above who currently has an Individual medical insurance plan will benefit from the new premium support program.

Question? Call (860) 451-9793 or send a note to

Sunday, August 18, 2013

Why can’t everyone have lower cost medical insurance?

Someone recently raised this question so I am sharing some comments.

The direct answer – federal health reform legislation does not provide a reason why the income based levels for help were selected.

BTW - if you have questions about any part of what federal health reform means to us here in Conn. Post your question.

The premium support program: Section 1401 of the law, which is entitled – Refundable Tax Credit Providing Premium Assistance For Coverage Under A Qualified Health Plan, includes details on the program. Various comments have been made about this since the law was signed in March 2010 and provide some insights. A couple points:

● It’s purpose is to lower the number of uninsured individuals.

● Another focus was to help individuals whose income is above the level for MedicAID eligibility and thus are a big part of the uninsured. The contribution or share of the premium for those with a lower income is smaller than for a person with a higher income.

Note: Perhaps the answer to the question is in the speculation of some - if additional individuals had been included, the cost to the federal government would have been too high to get the law passed. Eligibility was thus limited to people whose income is at 400% of Federal Poverty Level (FPL) and lower. Anyway 400% equals about $46,000 for a single person and $94,200 for a family of four.

The new “help to pay for coverage” program starts January 1st and has two parts:

First - federal funds will be sent each month to the person’s health insurance company. Technically this payment is an Advance Premium Tax Credit, the IRS will record it in the person’s record, and they will include it in their annual 1040 filing.

Second - the amount a person, who qualifies for help, has to pay their health insurance company each month is based on a percentage of their annual income. Their payment amount is subtracted from their plan’s age based premium to determine the amount of their premium support.

The level of help changes with income: The amount individuals who qualify will pay, based on different ranges of household income, is shown in the list below. The FPL percent amount is found in Section 1401 of the law in a chart which shows income ranges “expressed as a percent of poverty”. I converted the percent of annual income amount into the monthly contribution for people with this income. The first amount is what a Single person at that income level will pay each month, next is the payment for a Couple, than for a Family of 3, and the fourth amount is for a Family of 4.

● When at 133% of FPL a person pays 3% or $37 - $50 - $63 - $77

● When at 150% of FPL a person pays 4% or $56 - $76 - $95 - $115

● When at 200% of FPL a person pays 6.3% or $117 - $159 - $200 - $242

● When at 250% of FPL a person pays 8.05% or $187 - $254 - $320 - $387

● When at 300% of FPL a person pays 9.5% or $265 - $359 - $453 - $547

● When at 400% of FPL a person also pays 9.5% or $354 - $479 - $605 - $730

One other point about federal health reform. Regretfully very little in the law addresses the real problem we face today. What is that? Health insurance is expense because the rapidly growing cost of medical treatments is very expensive.

It is also important to understand another big reason medical insurance is so expensive - lifestyle choices. For example, people who smoke have higher treatment costs and big costs result from the obesity problem we face today since many adults and children do not follow an effective diet. Costs from lifestyle choices use up 70% or more of each premium dollar.

Friday, August 09, 2013

What's this about lower cost medical insurance for eligible individuals

Individuals in Conn will be able to submit an application when Open Enrollment begins this October to determine eligibility for lower cost medical insurance. They can apply for coverage to begin January 1, 2014 through Connecticut’s Health Insurance Marketplace, which is an on line enrollment site operating with the name Access Health CT.

I am pleased to share some points on eligibility and what the regulations to implement federal health reform say about how this new program will work:
● Eligibility is based on the person’s modified adjusted income (MAGI) and what it's percent of the Federal Poverty Level (FPL) is. Single individuals whose MAGI is at 400% of FPL (about $46,000) and below will be eligible.
● Individuals with dependents can also receive help based on their families combined MAGI. The maximum MAGI for a family of four would be $94,200. This is the 400% of FPL for a family.
● The share of the plan's premium for a single person making $40,000 is equal to 9.5% of their annual MAGI or $316.66 a month. The monthly share for a family of four whose MAGI is $94,200 would be $745.75. The monthly share for a person 22 and one who is 62 will be the same if each has the same income.
● The amount a person will be eligible for, which I call premium support, is calculated by subtracting, for example, the above Single individual’s $316 share from the premium for their age. If the premium was $600 it would be $284. Technically the amount a person qualifies for is an Advance Premium Tax Credit (APTC) and as a tax credit it will be reported to the IRS. Thus, a person will be responsible to reconcile this credit as part of their annual 1040 income tax report.
● The premium support or APTC amount is not based on the plan a person selects but only on the monthly premium of their second lowest cost Silver plan.
● The federal level Health and Human Services will send the individual's premium support to the medical insurance company they selected each month. This amount will vary based on a person’s age and the number of individuals they cover.
● The health insurance company will invoice them at home each month and they will pay their share on an after tax basis.

Initial plans for the application process was for a person to go to Access Health CT, enter personal and financial information, and while this was being done the system would:
● Interact with federal agencies, such as Homeland Security (citizenship), Social Security, and the IRS through a federal level data hub.
● Come back to them in real time and indicate, while still on line, if eligible for help and the amount they would have to pay each month. e.g. the above $316.
● Move them to the next step to review medical insurance plans from the three companies participating in the Individual plan part of Access Health CT. Eligible individuals will be able to select a plan, other than the second lowest cost Silver plan, which has more coverage by paying the additional premium.
● Then move them to the medical insurance company they selected to complete their enrollment.

As of today we do not know how much of the fully automated enrollment process will be available initially.

Want to take a look at whether you would be eligible for a premium discount and what your share might be? Go to There is a link to a savings calculator on the home page.

Monday, August 05, 2013

Will the new plans coming in January cover everything?

There are two parts to this question. The first is are all medical treatments covered – the answer is just about! The state of Connecticut has more mandates on the kinds of treatments, which have to be covered, than most states. If I recall we are the 5th highest in the US. This means whether a person enrolls in a plan in the Individual or Small Group market the kinds of medical treatment coverage will be extensive.

The second part of the question on coverage is – will people who enroll have to pay co-pays and cost sharing? The answer is Yes. For many reasons much of the cost of medical insurance in Conn is connected to the cost of medical treatment. Small group medical insurance plans for example are some of the most expensive in the US. Thus, the only way to control the cost of premiums is to include individual cost sharing in the plan design.

Federal health reform requires Individual and Small Group market plans, whether available in the current market, which I am calling “outside” or plans in the "inside" market have to meet certain coverage requirements. Plans in the inside market will be available through Connecticut's Health Insurance Marketplace, which is marketing under the name Access Health CT.
● The first – plans must include what the law calls Essential Health Benefits (EHB) and there are 10. Two of them, which are not currently in plans in Conn, are pediatric dental coverage (for age 19 and under) and what is called habilitative services. Plans today cover the rehabilitative services an individual needs to recuperate for example following hip surgery but coverage stops when the person is no longer improving. Habilitative coverage is for those who are no longer improving but their condition can fall back if the services were to stop.

● Health reform also introduced a complex calculation to review the plan’s design and determine how much the health insurance company has to pay and how much an individual will pay. This calculation determines what reform calls the plans Actuarial Value. As part of this plans are divided into four levels of coverage. They are Platinum, Gold, Silver, and Bronze.

● Some additional information about the four “metal” level plans.
+ Platinum has to cover 90% of the required EHBs. Gold is 80%, Silver is 70%, and Bronze is 60%.

+ When looking, for example, at a Silver plan a person might think – oh my if I have $100,000 in medical expenses I will have to pay $30,000. The answer is NO. The percent of coverage a person pays only applies to initial treatment. In a major treatment situation their expenses are limited by the plans maximum out of pocket (MOP) provision. This limit is adjusted each year to follow the maximum expense provisions of health savings account plans. During 2013 the MOP for Single coverage is $6,250.

Lets look at the Silver plan through Access Health CT. Regulations say premium support will be based on the premium of the Silver plan from the company with the second lowest premium. A person enrolled for Single coverage will have:
+ A $3,000 deductible on medical treatment
+ A $400 deductible on prescription coverage
+ A $30 co-pay for a primary care doctor visit and $45 to see a specialist
+ A $150 co-pay for an emergency room visit
+ A $500 per day for hospitalization, after the medical deductible has been met
+ A maximum out of pocket (MOP) of $6,250 for Single coverage.

When a Single person’s income is at 400% of the federal poverty level (FPL) or lower the MOP is reduced. It drops in three steps for lower income. When income is at 250% of FPL the plans co-pays and cost sharing are also reduced.

Friday, August 02, 2013

Will rates for older individuals be going down?

Some background. Today when a person buys a plan in the Individual and Small Group medical insurance market it is not unusual for a 62 year old's premium to be five times higher than for someone age 22. One change in Federal health reform is to restrict the maximum difference for a 62 vs a 22 to no more than three times.

So to answer the question. If today’s plan coverage were to continue and these new age based rules where applied the rates for someone say close to 60 would come down and the rate for individuals in their 20s and 30s would go up quite a bit. However, today's coverage will be changing. Health reform requires all Individual and Small Group market plans to cover 10 essential health benefits plus meet limits on how much the plan pays and how much an individual will have to pay.

Let’s look at how premiums will be developed beginning January 1, 2014. For illustration I will use a family where the Father is 52 and the Mother is 48. They have several children:

Child One is age 23 and in College. Child Two is also in College and 21. Child Three is 19 and in high school. Child Four is 17 and Child Five is 15 and both are in high school. Child Six who is a late arrival to the family is 7!

Starting January 1, 2014:
● In a situation where just Mother and Dad were covered for example on Plan abc the premium will no longer be based on Dad’s age as now, whether covered on a small group plan or under an individual plan. There will also no longer be male and female premium amounts and each age will have a separate rate. Thus, in this situation the two amounts are added to get Mom and Dad’s monthly premium for Plan abc.

● In a situation where Mom and Dad are going to cover themselves and just Child One and Child Two each will be charged the Plan abc rate for their age. BTW, the premium for someone age 21, 22, 23, & 24 will be the same. Thus, these two amounts will be added to Mom and Dad’s premium.

● In a situation where the couple wants to cover themselves and just Child Three, Four, Five, and Six, shown above, there are special rules for children age 20 and under. The Plan abc premium will be .635 of the age 21 amount for Child Three, Four, and Five. These three amounts will be added to Mom and Dad’s premium.

● What about Child Six above? When a family has Child Four or more, age 20 or under, there is no additional cost.

Each medical insurance plan has to use the new year by year rates, which start at age 21. This is the base rate and considered to be a Factor of one. Starting at 25 the factor will increase a certain amount for each age until age 64, which will be a Factor of 3. Thus, the amount for the person 64 will be three times higher than someone age 21.

Specific premiums have not been finalized here in Connecticut but initial insights indicate we will see:
● Individual plans continuing to be less expensive than small group plans.

● Not a lot of difference (generally) in the premium charged by different health insurance companies for the same plan.

● A variation in premium based on location, as it now does, with Fairfield County tending to be the most expensive. Premiums here in New London County may also be higher for certain companies than in some other counties.

Federal health reform also brings us a new online place for Individuals and small employers to review plans from different companies, select one, and enroll for coverage. It is called a Health Insurance Marketplace and here in Connecticut it will operate under the name Access Health CT. The details on how much of the application and enrollment process will initially be fully automated are still in the to be determined pile.

The Access Health CT online marketplace is the only place where a person can apply and perhaps, based on their income, receive a premium discount. You can learn more about it here.

The companies currently selling medical insurance plans in Connecticut’s individual and small group “outside” market will continue to offer plans. Individuals may have options in the “outside market” in addition to what is offered “inside” Access Health CT.

John C Parker, RHU, LTCP

Wednesday, July 24, 2013

What is the story on the discounts for medical insurance to be available next January?

Here in Conn and other states individuals will be able to go online and find out if they qualify for premium support on medical insurance. Some call it a premium discount and it is based on a persons family income. The online system is scheduled to be available for viewing this October and the premium support will be starting in January.

Single individuals with income of up to about $46,000 will be eligible for premium support. The most a Single person earning say $42,000 would pay is 9.5% of their annual income. This comes out to be a monthly payment of $332.50. When income is below $30,000 the percent they pay will be lower. Whether they are age 32 or 62 does not matter.

Individuals living in Conn can take a look at what they may pay by going to Connecticut's online enrollment site. The home page directs you to the Savings calculator, which will make a projection.

The theory of the system is you go to an online site, enter personal and financial information, and in real time learn if you are eligible. The system is to check, as your information is entered, with what is called a federal hub and include agencies such as the IRS, Social Security, Homeland Security (to confirm citizenship). How much will be available in real time starting this fall is not yet known.

Interested in all the technical details on how premium support will work? How a person will have to reconcile the tax credit they receive? Take a look at this July 24th blog.

BTW - what a person technically will receive is an Advanceable Premium Tax Credit (APTC). If a person qualifies for premium support the system will send money to the medical insurance company the person selected and that company will send them a balance due invoice each month.

Questions? Call (860) 451-9793

John C Parker, RHU, LTCP
Niantic CT

Sunday, July 14, 2013

What's this about delays in federal health reform

Starting just before the July 4th holiday federal agencies announced various changes or delays in health reform's implementation timeline.

My note today is to share a couple things which affect employers:

● The penalty for employers with over 50 employees who do not offer medical insurance will not be imposed beginning Jan 1, 2014. Instead the effective date will change to Jan 1, 2015. The requirement to offer coverage or pay penalty is still there - just not going to be enforced.

● The requirement for employers and health insurance companies to make various reports was also been delayed.

Couple things, which will affect individuals who are applying for premium support through the Health Insurance Marketplace. The Connecticut marketplace is calling itself Access Health CT.

● Individuals will be asked to attest if they currently have employer based medical insurance. Individuals will also be asked about the level of their coverage and it's cost. The planned online verification process will be delayed.

● An individual will also enter their income to determine what, if any, premium support for which they qualify. This will not be verified through the online enrollment system as planned. However, similar to other tax related reporting the confirmation will be made as part of a person's annual 1040 tax return. If an individual receives premium support, which is technically a refundable tax credit, and they are not eligible it will have to be paid back. If negligent reporting is found an individual can also be fined up to $25,000.

Contact if any questions. (860) 451-9793

Sunday, June 30, 2013

A look at Access Health CT's role in federal health reform

Access Health CT is working, under federal health reform regulations toward becoming a new option to select and enroll in a medical insurance plan. Open Enrollment for Individuals and Small Employers in Conn begins October 1st for coverage effective January 1, 2014. Some information:

● The media campaign to increase awareness of this new option is now underway.

● Residents, as part of the enrollment process on the Individual part of Access Health CT site, may qualify for premium support. This support is based on income and is technically a tax credit. Information on the income range can be seen here.

● The page on the above link includes a calculator. By entering income information it will show what your share of the monthly premium will be.

This pdf summary highlights 10 points about the Access Health CT program.

● Small businesses will be able to go to the Small Business Health Options Program or “SHOP” part of Access Health CT. Some information can be seen here.

● Certain small employers may be eligible for a tax credit to offset part of the expense of their medical benefit plan. In 2013 any small employer can apply for a tax credit of up to a 35%. This changes to 50% in 2014 and is only available if the firm selects a plan through the SHOP part of Access Health CT.
Note: The maximum credit is only be available if an employer has 10 or fewer employees, excluding the owner, and the average salary for these employees is $25,000 or less. The credit drops quickly and is not available to firms with 25 or more employees or if the employee average salary is $50,000 or higher.

Contact me - (860) 451-9793 - if questions about Access Health CT or the medical plans for Individuals or Small Employers, which are anticipated to be available.

John C Parker, RHU, LTCP
Niantic CT

Monday, June 17, 2013

Goings on with medical treatment and what these costs mean to medical benefit costs.

The healthcare industry, both on the delivery and financing side, is way behind others such as banking in the use of technology. Many have made statements like this over recent years so let’s take a look at what is going on today.

The June 2013 issue of the HealthLeaders magazine includes an article “Seeking the Strategic Sweet Spot” and brings out some steps providers are now or need to take to reform the way they operate. I want to share some points from the article on what this means for the way primary care will be provided:

● A team of people with varied talents working toward the same goal – management of populations

● Physicians working with high risk patients and funneling low-risk, low-acuty patients to physician assistants and nurse practitioners.

● A big move to telemedicine among younger patients.

● “About 80% of the office visits done right now by primary care can be done by midlevel providers and 80% of what the midlevels do can be done over the telephone”.

I found this last one of considerable interest. It represents one of the important steps for employers – to help employees understand the best way to deal with medical related situations.

Another factor, which is affecting providers, is the continuing trend of more and more consolidation among physicians and hospitals. A point was made on why this is happening:

● In narrow operating margin industries, which healthcare is destined to become, because of cost pressures “you need economies of scale and scope”.

We also find across the U.S. and here in Connecticut medical treatment costs, which some say are increasing at more than twice the rate of normal inflation. One part of this, which is having a very big impact, is the use of expensive medications.

What does all this mean for employee medical benefits? Increasing treatment costs result in higher plan premiums, which has a direct impact on an employer’s business and on the amount employees are asked to contribute as their share of plan costs. In addition, to increasing treatment costs medical benefit plan costs will face higher costs as federal health reform is implemented in the coming months.

Some steps employers are using to offset the ever increasing cost of the medical benefit plan:

● Working to help employees understand how lifestyle choices result in higher costs for them and the firm. They are also providing incentives for employees to work for better health.

● Encouraging, through employee contributions, the selection of cost effective health plans.

● Introducing a defined contribution approach as a step to control future costs.

Please contact if any questions on what these issues mean to individuals and employers here in Connecticut.

John C Parker, RHU, LTCP – (860) 451-9793

Thursday, June 06, 2013

Employers in Conn required to provide, by Oct. 1, all employees a letter on federal health reform

Federal health reform includes a requirement for all employers to notify their full and part time employees about the coming availability of the Health Insurance Marketplace. Here in Conn our Marketplace is known as Access Health CT. Information is available here.

Model letters on what is to be included in the letters was issued by the federal Department of Labor in early May. One letter is for employees who currently have medical insurance from their employer. The second is for employees who do not have employer provided medical insurance.

Note: Even though model letters were issued some of my professional association contacts in Washington DC indicate the letters may be changed. Then too, it is normally more effective to communicate to employees close to the time they can do something so it may be best to wait.

Call today if any questions on the federal requirement to notify employees about health reform. (860) 451-9793

In regard of Access Health CT. Four health insurance companies have submitted an application to become a Qualified Health Plan and offer medical insurance plans to individuals here in Conn. Aetna, Anthem BC & BS of CT, ConnectiCare, and HealthyCT. HealthyCT is a new type of health insurance company created by federal health reform, which is called a Consumer Operated and Oriented Plan (CO-OP). Here is some info on the Conn CO-OP. started by the Connecticut State Medical Society.

Monday, May 20, 2013

Looking around at what health reform means in Connecticut

My note is to review and comment on some of the things we do know about the impact federal health reform will have here in Connecticut. There is a lot more for employers and individuals to learn, from not yet released regulations.

● The Health Insurance Marketplace here in CT, called an Exchange in the legislation, changed it's name to Access Health CT. Individuals can go to this site and review medical insurance plan options beginning in October and select coverage, which will be effective January 1, 2014.

● Federal health reform requires various market reforms in the Individual and Small group markets:
One is - all plans available, whether through Access Health CT or direct from a company, will be placed in one of four levels. Platinum, Gold, Silver, and Bronze. The coverage must meet 10 essential benefits. One of which is preventive dental coverage for children. Individual plans will no longer be subject to a review of medical history or pre-existing conditions and will include maternity coverage. These two requirements will result in the premium being higher.

Another - The premium for a person age 21 will have a factor of 1. The factor will increase year by year up to a factor of 3 for a person age 64. A couple on the same plan will each have a different premium if their age is different and there will no longer be male and female rates. Children from birth to age 20 will have a factor of .635. Today the spread from 20s up to 60s is about 5 to 1 which tells us the change to 3 to 1 means individuals in their 20s and 30s will see an increase in premium. Connecticut will allow the premium, for a person in the Individual market who smokes, to be increased up to 50%. The smoker factor will not be applied initially in the Small group market.

● Access Health CT approved the plan designs for the Individual plan market. The Silver level, the plan premium support is based on, has a $3,000 deductible. Preventive treatments are not applied to the deductible and do not have any cost to an individual. Expenses for various diagnostic office visits will not go toward the deductible but will have co-pays. Hospitalization will be applied to the deductible and will also have co-pays for the first few days of being admitted.

● Individuals whose income is up to 400% of the federal poverty level (FPL) can qualify for premium support if the buy a plan through Access Health CT. The maximum a person at 400% FPL, which is about $45,000 for a single person, will have to pay as their share of the premium is 9.5% of their W2 income.

● Individuals with a lower income will pay a lower percentage and those at about 250% of FPL will have lower plan co-pays and other improvements. The amount a person who qualifies for premium support pays is not connected to their age. Premium support will be sent from a federal agency to the medical insurance plan the individual selected. The company will then bill the individual, at home, the balance due (the 9.5% above) each month.

Monday, March 18, 2013

A look at the “no cost” Preventive care individuals can receive

Individuals under age 65, with Individual Medical or Employer based Medical insurance, can receive a variety of tests. Some are for all, some based on age, some for females, and some for children. Details are on this page of the site.

Individuals eligible for Medicare: During the first 12 months of Medicare’s Part B coverage a person can receive a “Welcome to Medicare” preventive visit. During the following years a person can receive a wellness visit. The site indicates:

“This exam is a one-time review of your health as well as education and counseling about preventive services and other care. If you’ve had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. “

Friday, March 15, 2013

What some consumers are thinking about medical treatment costs?

When people get more involved in their health and take steps to make improvements the result usually is a better life and fewer medical treatment costs. This thinking is common in employers who have implemented various kinds of wellness efforts to encourage better health and to decrease the cost of their medical benefit plan.

Regretfully however a study reported in last month’s Health Affairs Journal indicated – “a majority of patients didn’t want to factor costs into their medical decisions, nor did they want their doctors to do so.” The study investigated the attitudes of 211 participants in focus groups held in Washington DC and Santa Monica CA.

There was one point in the findings I am all to familiar with. “People did not generally understand how insurance works and felt little personal responsibility for helping to solve the problem of rising health care costs.”

The article also reported on a conversation with Susan Dorr Goold a professor of internal medicine and health management and policy at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. She was the co- author of this study.

She was asked several questions about the findings. One was:

“You found that some participants seemed motivated to choose expensive care ‘out of spite’ because they were antagonistic toward their insurance company. What’s going on there?”

Professor Goold indicated:
There was almost a vengeful attitude toward insurance companies, the idea that “I’ve been paying in now I am going to get what I’m owed or I’m going to get them back for all the money I’ve paid in all these years.

She also indicated more research is needed in this area. “The motivation that I’m sick and I don’t want to think about the money, ”that’s understandable. But “I want to hurt the insurance company.” Why? Those health care payments come from money all of us have paid to insurers.

The exact questions and the way participants were asked is not known. However, these findings cannot be considered a “not to worry” situation. They are important considerations which employer benefit specialists, medical insurance company staff, and health insurance professionals, like myself, must focus on.

John C Parker, RHU, LTCP

(860) 662-3000

Thursday, March 07, 2013

Impact of federal health care reform on the cost of coverage

With more and more details being firmed up on federal health reform I wanted to share the conclusion from a March 2013 report prepared by three Congressional committees. It is based on a review of over 30 studies. (I added bold to some text.)

Taking into account empirical evidence from past state-level experiences, as well as future projections, upon implementation Obamacare will make coverage dramatically more expensive and unaffordable for individuals and families. In short, Obamacare breaks its core promise to make health care coverage affordable as Americans across the country swallow higher premiums. From young adults to middle class families, higher premiums will soon be the harsh reality of Obamacare.

The Committees that published this March 2013 report are:
+ House Committee on Energy and Commerce, Majority Staff,
+ Senate Committee on Finance, Minority Staff, and
+ Senate Committee on Health, Education, Labor & Pensions, Minority Staff

Wednesday, January 30, 2013

Signing up for medical insurance in the Health Insurance Marketplace

Looking to the end of this year current plans are for individuals to be able to review medical insurance plans and the enroll through the Health Insurance Marketplace's online system. Thus, questions are being asked.

● One of the most common is - how will all this work. This video provides some insights.

● Others are asking about what type of information will have to be submitted. The short answer is lots of personal and financial information about yourself and others in your family. The system will allow an individual to complete an application on line but this paper draft will provide an idea of what will be required.

Contact if anyone in Connecticut has questions - (860) 662-3000

John C Parker, RHU, LTCP

Thursday, January 24, 2013

An update on medical insurance plans coming to Connecticut next January.

The new plans:

● Will have four levels of coverage - Platinum, Gold, Silver, and Bronze and be available from private health insurance companies in the Individual and the Small group market. These plans can be purchased from a company, as today, or through an organization health reform created and called an Exchange. The Exchange is now called a Health Insurance Marketplace. Here in Connecticut the entity which was set up to perform this function is a quasi-public organization.

● Will include coverage for the 10 Essential Benefits (EB) outlined in the federal health reform legislation and needed to become what reform calls a qualified health plan. Two of the EBs, pediatric dental coverage and Habilitative coverage, which is an expansion of what is now included in Rehab coverage, are not now in medical insurance plans in Connecticut. Some actuaries have indicated adding the 10 EBs, which include maternity, to individual plans along with the elimination of today’s review of medical history means the premium will go up a significant amount! ! !

● Will have a required Actuarial Value (AV) for each of the four levels. This means when a person enrolls in a Platinum plan the coverage must be designed so 90% of the AV of all the 10 EBs and other treatments, tests, etc. will be paid Thus, if they encounter a major medical treatment situation their only expenses would be for co-pays, etc. up to 10% of the AV. Of course because a Platinum plan will have almost full coverage the premium will be very high. Gold level plans are required to have a 80% AV. Silver a 70% AV and Bronze a 60% AV.

● Cannot have a premium, which varies more than 3 to 1 from age 21 up to 64. In the current small group market it’s about five times higher. The proposed regulations to implement this indicate a person age 21, whether male or female, will have a factor of 1 and the factor will increase for each age up to 64, which will have a factor of 3. These new market requirements indicate a smoker can be charged 50% more! How this will relate to today’s rates is not known. Some actuaries project the premium for someone in their 60s will drop some but there will be a big increase for younger individuals.

● Will have the same premium whether a certain one is offered in or out of the Health Insurance Marketplace. Connecticut’s new quasi public organization and those in other states have to be self-supporting after one year of federal funding. Since the anticipated budget for Connecticut’s organization is about 30 million its Board is developing plans to raise the needed income by adding a FEE of around 3% on top of the premium for all plans purchased through the Exchange!

How will people enroll in these plans?

Lets look first at the Individual part of the Health Insurance Marketplace:

● A person will access these plans through an online portal and input personal and financial information. Coverage will not be available until January 1, 2014 but plans call for an open enrollment period starting this October.

● The system, while information is being entered, will access a federal hub and check with federal agencies such as Homeland Security to confirm citizenship and the IRS to check income.

● The enrollment system will notify the person in real time whether their income level means they qualify for Medicaid or can receive premium support.

● If eligible for Medicaid the system will handle their enrollment into Connecticut’s Husky program. Currently Husky covers adults up to about 70% of the federal poverty level (FPL). Health reform provides states with funding for a couple years, if the state approves, to cover what are called newly eligible adults. These are individuals whose income is up to 138% of FPL. It is not known today if automatic enrollment will be available initially.

● Individuals whose income is between 138% and 400% of FPL will be eligible for premium support, which will require they pay a certain percentage of their income toward the premium. It will range from around 3% for a low income up to 9.5% for a person who is just under 400% of FPL. BTW – that is around $44,000 today. They can select the plan and medical insurance company they are interested in and which meets their budget based on the amount of support they will receive. Their selected medical insurance company will receive the premium support directly from the federal government and then bill the person at home for the balance. This amount will be paid with after tax dollars.

The small employer part of the system:

● An employer can select certain plans to offer and then their employees can select one of the firm selected plans. It is anticipated the defined contribution approach will be common e.g. tell employees the firm will pay $xxx for medical insurance. The employees can then, if desired, pay any difference in what their plan costs through the firms payroll system. The monthly bill will come from the health insurance company to the employer.

● There will be no premium subsidies through the small group part of the Health Insurance Marketplace and it will be the only way, after Jan 1. 2014, a firm can apply for the small business medical insurance tax credit. Note: This tax credit currently provides the employer up to 35% of the premium, or of the state adjusted amount, for firms with 10 or fewer employees and whose average salary (not counting the owner) is 25 k or under. The amount will go up to 50% next January. The current credit falls off rapidly when a firm has more than 10 employees. This tax credit is not available to firms with 25 employees or if the firms average salary is 50 k or more.

More information about the impact of federal health reform on individuals and small employers will be shared as it becomes available.

Contact if anyone in Connecticut has questions - (860) 662-3000

John C Parker, RHU, LTCP