Tuesday, December 23, 2014
The Kaiser Family Foundation prepared a long list of FAQ on federal health reform. Topic areas for questions are in the list on the left
side of this page. There is also a Search box at the top to help find your answer.
Here in CT our Health Insurance Marketplace operates with the name Access Health CT. The CT web site includes a Tab to get help. You can insert your zipcode and locate a no cost to you health insurance professional in your area.
Questions on what any of these mean here in CT? Send a note to - LearnMore@JohnParker.agency
Thursday, October 23, 2014
When we look back over many years we find the cost of medical treatment has been increasing faster than many other services.
Why? There are many answers and no one big "bullet" to fix this.
There are however some steps being taken. This 29 page visual from the Commonwealth Fund provides an update on these steps.
Questions - Call my Google Voice - we can talking about things going on in CT and the impact on medical insurance plan. (860) 451-9793.
Monday, June 02, 2014
Some details on the 2015 plans were made available in the last couple weeks which I want to share.
First some background. Federal health reform required a change in the design of medical insurance plans. IOW the deductible, co-pays, and cost sharing amounts are used in a different way. These changes began January 1, 2014.
Medical insurance plans, whether purchased in the Individual or Small Group market, have to meet certain requirements. The basics of these changes are:
● Plans must cover 10 Essential Health Benefits (EHB). Two are new to Conn. Pediatric dental coverage (for age 19 and under) and what is called habilitative services. Rehabilitative services help an individual recuperate for example following hip surgery. This coverage stops when the person is no longer improving. Habilitative coverage helps a person who is no longer improving but their condition would decline if certain services were to stop. It’s only available for certain conditions.
● Each health insurance company must use a complex calculation to determine how much of a person’s medical treatment expenses the company pays and how much an individual will pay. This calculation results in what is called the plans Actuarial Value (AV).
There are four AV levels. Platinum, which has to cover 90% of the required EHBs. Gold covers 80%, Silver is 70%, and Bronze is 60%.
A person might think when looking, for example, at a Silver plan – oh my if I have $100,000 in medical expenses I will have to pay $30,000. The answer is NO. A person’s expenses, if a major treatment situation were to occur, are limited each plan year by the maximum out of pocket (MOP) provision. This limit is adjusted each year.
Second let’s look at the highlights of a person’s coverage during 2014, who is enrolled in the Standard Silver Individual plan through Access Health CT:
● No cost for a variety of preventive exams and tests.
● A $30 co-pay for a primary care doctor visit and $45 to see a specialist
● Other medical treatment is covered after a $3,000 deductible.
● A $400 deductible on prescriptions and then a $10 co-pay for Generics, $25 for preferred brands, $40 for non-preferred brands, and 40% cost sharing for specialty medications.
● A $75 co-pay for Urgent care and a $150 co-pay for an emergency room visit.
● A $500 co-pay for outpatient surgery
● A $500 per day co-pay for hospitalization up to $2,000 is applied after the medical deductible has been met.
● A MOP of $6,350 for Single coverage. The MOP is doubled when a person enrolls one or more dependents on their plan.
Third let’s look at the highlights of Access Health CT plans for the Standard Silver Individual plan in 2015:
● No cost for a variety of preventive exams and tests.
● A $40 co-pay for up to three primary care doctor visit and $50 to see a specialist.
● Other medical treatment is covered after a $2,600 deductible.
● Generic medications will have $5 co-pays, Preferred brands at $30, and non-preferred brands at $55 with no deductible. Specialty medications will have a $60 co-pay after a $25 deductible.
● A $75 co-pay for Urgent care, after the deductible, and a $150 co-pay for an emergency room visit.
● A $500 co-pay for outpatient surgery
● A $500 per day co-pay up to $2,000, for hospitalization after the medical deductible has been met
● A MOP of $6,600 for Single coverage. The MOP is doubled when a person enrolls one or more dependents on their plan.
There may be some variation in this coverage between the health insurance companies offering these plans effective January 1, 2015.
What companies will be available for 2015? It is anticipated additional companies will apply to offer plans through Access Health CT in 2015.
How much higher will the premiums be in 2015? A BIG unknown. The Access Health CT consultants indicated the 2015 plan changes should not result in much of an increase. Of course the big unknown is what impact the every increasing cost of medical treatment will have.
Questions - send a note to - LearnMore@JohnParker.agency
Monday, March 03, 2014
The media provided lots of coverage about signing up for medical insurance in the months leading up to January 2014. That coverage continues but what is being found – many people looking at their options do not understand the terms used to describe the new coverage!
I want to share a post which mentions a recent Atlantic article, It included some points about this lack of understanding and the impact it is having. It brings out:
● “- - - more than 77 million people have difficulty with common health-related reading tasks.”
● “Not only is it more difficult for individuals to understand and take action in their own health, but it contributes to higher healthcare costs.”
Many people have enrolled but others may still be thinking about this important kind of “medical treatment expense protection”.
If you want to look and gain a clear understanding of how the various options work the most effective approach is to contact a health insurance professional.
How to contact a professional: The Connecticut Chapter of the National Association of Health Underwriters has a feature on their web site, which takes you to the national association’s Find an Agent page. Using this resource is easy - just enter your zipcode.
Doing this means you can find a health insurance professional in your area to work with to fully understand this important coverage. They will simplify the language and complexities and be sure you select a plan, which will meet your interest and budget. There is no cost for this professional help and you gain on going help through-out the year for any questions, which come up.
Saturday, February 15, 2014
Sharing some recently reported information from the Robert Wood Johnson Foundation (RWJF) on steps to improve the nation’s health. The RWJF convened the Commission to Build a Healthier America in 2008. It’s Co-Chair Mark McClellan, MD, PhD made this point in a talk last week:
“To become healthier and reduce the growth of public and private spending on medical care, we must create a seismic shift in how we approach and the actions we take.”
The Commission full report can be found here.
I have heard him speak at different occasions, one of which was several years ago when he was head of the Center for Medicare and Medicaid Services. Mark is a sharp and insightful person and I can state the above words are important. He also indicated in the talk:
“As a country we need to expand our focus to address how to stay health in the first place.”
To accomplish this he believes the “critical needed changes include”:
● Improve opportunities [for people] to make healthy decisions where we live, learn, work.
● Improve access to a good education, jobs, and health care.
● Work across sectors, collaborating to improve the health of all Americans.
● Make investing in America’s youngest children a high priorit.
● Fundamentally change how we revitalize neighborhoods, full integrating health into community development.
● Adopt new health “vital signs” to access noin-medical indicators for health such as jobs, income, housing, transportation and access to healthy food.
● Create incentives tied to reimbursement for health professional and health care institutions to address non-medical factors that affect health.
Saturday, January 04, 2014
Federal health reform became law in March 2010 followed by the issuing of numerous regulations on details on how the new legislation will all be implemented. These requirements apply to plans at the end of their current policy year in 2014. Some of the new requirements are highlighted here:
● The new Advance Premium Tax Credit (APTC) for those who qualified based on their income and who enrolled for coverage through Access Health CT. The way this works:
+ the person pays a certain amount for their share of the premium, which is based on a percent of their income.
+ The APTC is the amount after the persons share of the premium is subtracted from the actual premium which is based on their age.
+ The APTC amount is sent each month to the health insurance company the person selected. They then bill the person each month for their share.
● Penalty for not having medical insurance: Individuals who do not enroll in a qualified individual or employer plan will have to pay a penalty at the end of 2014. It equals 1% of their income. It will increase to 2.5% in a couple years.
● Plan design requirements: Medical insurance plans can no longer have a lifetime limit and the maximum out of pocket expenses now follow the health savings account annual limits.
● How premiums are determined: The premium for a 62 year old can be no more than three times the rate for a 22 year old. Rate bands have been eliminated. The premium now goes up for each age. Rates for males and females are the same when the age is the same. The rate for a child from birth to age 20 is now .635 of the age 21 rates for the plan.
● MedicAID expansion: Connecticut has been very generous in providing medical coverage for children through the state’s Husky program. Adults whose income was around 70% of the federal poverty level (FPL) were also eligible for MedicAID coverage. Health reform increased the eligibility for adults to 138% of FPL.
● Small Business Tax Credit: Certain small businesses can quality for this tax credit if the coverage is purchased through the employer part of Access Health CT. The credit increases to 50% of the premium for 2014. An employer can qualify for the maximum credit if they have 10 or fewer employees, excluding the owner, and average salary for these employees is $25,000 or lower. Employers with up to 25 employees and whose average salary is $50,000 or lower can qualify for a lesser credit. The amount does not slope down from 25k to 50k but falls off rapidly. Many employers will not qualify for the max credit because they do not offer medical insurance.
● Taxes on medical insurance: When an person receives a quote for an individual medical plan three taxes, included in the premium are shown. A Health Insurance tax, a tax to support Access Health CT, and a reinsurance tax.
We’ve been C
● New employee waiting period. The maximum waiting period is now 90 days.
Questions on these new requirements? Call my Google voice line (860) 451-9793 for a free consultation on how federal health reform will work here in Conn.