WebMD has a to-the-minute countdown on their ACA resource page. It's just 50 more days until the exchanges open.
Educate yourself today so you won't be caught flat-footed at the end of this year.
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WebMD has a to-the-minute countdown on their ACA resource page. It's just 50 more days until the exchanges open.
Educate yourself today so you won't be caught flat-footed at the end of this year.
First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in theFederal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.
According to the Congressional Research Service, as of November 2011, the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act. Here are the details on the latest one.
Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.” Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.
Out-of-pocket caps drive premiums upward
There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted.)
These mandates have already had drastic effects on a number of colleges and universities, which offer inexpensive, defined-cap plans to their healthy, youthful students. Premiums at Lenoir-Rhyne University in Hickory, N.C., for example, rose from $245 per student in 2011-2012 to between $2,507 in 2012-2013. The University of Puget Sound paid $165 per student in 2011-2012; their rates rose to between $1,500 and $2,000 for 2012-2013. Other schools have been forced to drop coverage because they could no longer afford it.
According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones. But in February, the Department of Labor published a little-noticed rule delaying the cap until 2015. The delay was described yesterday by Robert Pear in the New York Times.
Delay needed to align ‘separate computer systems’
Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”
The reason for the delay? “Federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”
The best part in Pear’s story is when a “senior administration official” said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?
It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether. For economically rational businesses, it’s a reason to self-insure, in order to get out from under these costly mandates.
Patient groups upset
While insurers and premium-payers will be happy with the delay—whose legal justification is dubious once again—there are groups that grumbled. Specifically, groups representing those with chronic diseases, and the pharmaceutical companies whose costly drugs they will use. “The American Cancer Society shares the concern” about the delay, says Pear, “and noted that some new cancer drugs cost $100,000 a year or more.” But a big part of the reason those drugs cost so much is because manufacturers know that government-run insurers will pay up.
“The promise of out-of-pocket limits was one of the main reasons we supported health reform,” says Theodore M. Thompson of the National Multiple Sclerosis Society . “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis,” said Patience H. White of the Arthritis Foundation. “But they are extremely expensive.”
The progressive solution to expensive problems? More subsidies. But subsidies don’t reduce the underlying cost of care. They only excuse the high prices that manufacturers and service providers already charge.
It’s one of the many aspects of Obamacare that should be repealed, if we are to combat the rate shock that the health law imposes on tens of millions of Americans. But that will require Republicans to come up with a smarter strategy than shutting down the government.
http://www.forbes.com/sites/theapoth...ed-until-2015/
What a train wreck.
It was always meant to be... They knew they weren't even close to passing a single payer system.. so make a "compromise" system they knew would eventually fail and who will have to pick up the pieces? The government will save us!Quote:
Originally Posted by Tgo01
"This system doesn't work.. we have no choice but to push through a single payer system.. it's the only solution!"
It is as if you are cynical and lack faith in the ability of the U.S. government to act in your best interests.Quote:
Originally Posted by Parkbandit
This is what they're referring to from the February 20, 2013, FAQ on the government website..Quote:
Originally Posted by Parkbandit
Plans must still comply with the out-of-pocket maximum for major medical, regardless of whether not the employer uses multiple service providers.Quote:
Q2: Who must comply with the annual limitation on out-of-pocket maximums under PHS Act section 2707(b)?
As stated in the preamble to the HHS final regulation on standards related to essential health benefits, the Departments read PHS Act section 2707(b) as requiring all non-grandfathered group health plans to comply with the annual limitation on out-of-pocket maximums described in section 1302(c)(1) of the Affordable Care Act.[3]
The Departments recognize that plans may utilize multiple service providers to help administer benefits (such as one third-party administrator for major medical coverage, a separate pharmacy benefit manager, and a separate managed behavioral health organization). Separate plan service providers may impose different levels of out-of-pocket limitations and may utilize different methods for crediting participants' expenses against any out-of-pocket maximums. These processes will need to be coordinated under section 1302(c)(1), which may require new regular communications between service providers.
The Departments have determined that, only for the first plan year beginning on or after January 1, 2014, where a group health plan or group health insurance issuer utilizes more than one service provider to administer benefits that are subject to the annual limitation on out-of-pocket maximums under section 2707(a) or 2707(b), the Departments will consider the annual limitation on out-of-pocket maximums to be satisfied if both of the following conditions are satisfied:
- The plan complies with the requirements with respect to its major medical coverage (excluding, for example, prescription drug coverage and pediatric dental coverage); and
- To the extent the plan or any health insurance coverage includes an out-of-pocket maximum on coverage that does not consist solely of major medical coverage (for example, if a separate out-of-pocket maximum applies with respect to prescription drug coverage), such out-of-pocket maximum does not exceed the dollar amounts set forth in section 1302(c)(1).
The Departments note, however, that existing regulations implementing Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)[4] prohibit a group health plan (or health insurance coverage offered in connection with a group health plan) from applying a cumulative financial requirement or treatment limitation, such as an out-of-pocket maximum, to mental health or substance use disorder benefits that accumulates separately from any such cumulative financial requirement or treatment limitation established for medical/surgical benefits. Accordingly, under MHPAEA, plans and issuers are prohibited from imposing an annual out-of-pocket maximum on all medical/surgical benefits and a separate annual out-of-pocket maximum on all mental health and substance use disorder benefits.
More...
As the debate rages over who benefits from the Affordable Care Act, one thing is becoming clear: The controversial program is a dream come true for rip-off artists.
Consumer experts warn that the program has created a huge opportunity for swindling people by stealing their money and their sensitive personal information.
"Any time you roll out a big government program like this, confusion is inevitable," said Lois Greisman, an associate director in the Bureau of Consumer Protection at the Federal Trade Commission. "This confusion creates a tremendous opportunity for the fraudster."
Scammers have been at it for more than a year now, but consumer advocates and security experts warn that the problem will worsen as we get closer to Oct. 1. That's when the millions of uninsured Americans can use a health insurance exchange, set-up by their state or by the federal government, to shop for coverage.
"I believe the incidents are going to skyrocket as that date approaches," said Eva Velasquez, president and CEO of the nonprofit Identity Theft Resource Center. "And even people who are smart and savvy could get taken, so we are very concerned about the potential for some serious financial harm."
The Affordable Care Act created a Health Insurance Marketplace, also referred to as the Health Insurance Exchange. Policies in the exchange have been preapproved by each state's insurance commissioner.
"There are fake exchanges already up and running on the Internet," said Monica Lindeen, Montana's Commissioner of Securities and Insurance. "If you do a search and type in 'exchange,' you'll find all sorts of websites that claim to be in the exchange when they are not."
(Read more: Why latest Obamacare delay angers critics and fans)
These health insurance exchanges don't open for business until Oct. 1, so no one can sell you insurance through an exchange until then.
Scam artists got an early jump on national health care reform. Since last year, they've been calling, faxing and emailing people across the country claiming to be with Medicare, Obamacare or some agency of the federal government.
They often say they need to "verify" some personal information (typically a bank account or Social Security number) to ensure you get the proper benefits. In some cases, fraudsters tell victims they need to buy an insurance card to be eligible for coverage under the new program.
Such calls can be especially intimidating to seniors, said John Breyault, who runsFraud.org , a project of National Consumers League.
"We've heard about cases where the scam artists have threatened people with jail if they don't purchase the fake insurance cards," Breyault said.
(Read more: Watch out for the 'change my address' scam)
Americans don't need a new Medicare card, and no one from the government is calling and asking for personal information or money. Under the individual mandate provision of the Affordable Care Act, people who don't buy insurance could have to pay a penalty, but that provision does not take effect until next year. There is no jail penalty in the law.
A con artist can claim to be anyone, for instance a "navigator" who can help you apply for coverage through an exchange. They gain your trust and then ask for personal information to buy nonexistent policies. Fraud.org reports that some victims have been persuaded to wire money or send funds via prepaid debit card to get their full benefits.
(Read more: Hate robocalls? Here's how you can block them)
Thousands of legitimate navigators are being trained and certified to guide people through the process of applying for coverage through an exchange. These navigators are prohibited from recommending a particular plan. They will never ask for personal information or for money in any form. The navigator program hasn't started yet, so no one is making calls.
Don't get taken
There is only one place to shop for a qualified health plan: HealthCare.gov, the site run by the Center for Medicare and Medicaid Services. You also want to start your search here if you live in one of the places (17 states, District of Columbia, Guam or American Samoa), that set up its own exchange. Customer service representatives are available at 1 (800) 318-2596.
These tips, provided by consumer groups and government, will help you spot a fraud:
—There is no card associated with health care reform.
—There is no new Medicare card, and you do not have to update any personal information.
—The Health Insurance Marketplace (those exchanges) doesn't open until Oct. 1, so you can't buy coverage under the Affordable Care Act until then.
—Don't respond to a cold call of any kind, especially one that asks for personal information or money. And don't trust caller ID, which can be rigged to make it look as if the call is coming from a government office.
—Don't let anyone rush you. The rates in the exchange have been preapproved and won't change during the initial enrollment period, Oct. 1 to March 31. Anyone promising a "special price" or "limited time offer" or who tells you "spots are limited" is lying.
The FTC's Lois Greisman urges you to file a complaint if you spot a problem, get a suspicious call or fall victim to a health care insurance con artist.
http://www.cnbc.com/id/100963714
The IRS has a new website about Obamacare. It has a lot more details on the tax issues than the other websites.
http://www.irs.gov/uac/Affordable-Ca...rovisions-Home
Unions To White House On Obamacare, Taft-Hartley Plans: 'You Made The Problem, You Fix It'
Quote:
WASHINGTON -- Signaling a growing rift between some unions and the White House over the Affordable Care Act, the Nevada State AFL-CIO passed a stinging resolution Wednesday that criticized the administration for its handling of their concerns with the health care reform law. The resolution claims the law could end up "destroying" the unions' multi-employer health plans if the administration doesn't come up with a regulatory fix.
"[O]ur union members and their families originally offered strong political and moral support for the promise of the Affordable Care Act because it would expand health care coverage for more Americans," the resolution read. But when it came to dealing with the unions' concerns, "the Administration has postured on proposals to address the problem, but no proposal to date will actually solve the problem. Our health plans only get worse."
Several unions -- UNITE HERE, the United Food and Commercial Workers and the Teamsters -- have already voiced their worries that the law will undermine their multi-employer health care plans, known as Taft-Hartley plans. But Wednesday's resolution formalizes a major state labor federation's grievances just ahead of the AFL-CIO's national convention next month -- and just as the White House prepares for the law's rollout amid attacks from the right.
The critique also creates some political awkwardness not only for the Obama administration but for Senate Majority Leader Harry Reid (D-Nev.). One of the unions taking the lead on the issue, the 60,000-member Culinary Workers Union Local 226, a UNITE HERE affiliate, is the largest union in Nevada and a major political force in the state.
Long used by unionized workers in the building trades and service industries, Taft-Hartley plans are nonprofit health care plans jointly administered by participating companies and unions. The plans have traditionally allowed workers in transient industries to move between employers while still maintaining the same health care. Due to unions' seat at the table, the plans tend to offer strong coverage at a low out-of-pocket cost to workers.
In an interview, UNITE HERE President D. Taylor said the union has been in talks with the White House and the Treasury Department over how Taft-Hartley plans should be interpreted under the law. According to Taylor, if workers under Taft-Hartley plans aren't eligible for subsidies, employers will see little reason to remain a part of such plans down the road, potentially forcing workers to purchase their own health care on the state-run exchanges, which are unlikely to offer so much coverage at such low rates.
The Treasury Department has signaled that it views the Taft-Hartley plans as equivalent to other employer-based plans, which aren't eligible for subsidies. Taylor said Taft-Hartley plans should be seen differently because they're nonprofit.
"We've been working for over two years with essentially all aspects of the government, including Treasury, which wants to interpret [Taft-Hartley] as an employer plan, and it's not," Taylor said. "The Affordable Care Act has clearly been devised so that it would make our nonprofit Taft-Hartley plans completely uncompetitive."
"We want to hold the president to his word that you can keep the plan you like," Taylor added.
Obamacare has been assailed by the right since the day it was signed. The House GOP has made 40 doomed efforts to repeal the law, and nearly half of states -- all with Republican governors or GOP-majority legislatures -- have refused to participate in the Medicaid expansion, a crucial component in getting health care coverage to the poor.
Unions' concern over the law's effects on their Taft-Hartley plans has added a rare bit of criticism from the left, giving fodder to the law's Republican critics. Like other progressives, organized labor widely supported the health care law when it was crafted and signed, and many of the unions that don't participate in Taft-Hartley plans have remained quiet on the issue.
Tim Schlittner, a UFCW spokesman, said it wasn't unions' duty to worry about whether or not they're giving someone political fodder by raising concerns with the law.
"Our responsibility is not to the political left or right, it's to our members," Schlittner said. "As far as this law is concerned, we think if it's not fixed, it could cause harm to our members who've bargained for health care. These are not rich people, they're workers in grocery stores."
But because of how the law was crafted, it may not leave much room for the White House to interpret Taft-Hartley plans as unions would like, according to Paul Secunda, a professor at the Marquette University School of Law who specializes in employee benefits and labor. The problem, Secunda said, is that the law states that only people who go on the open exchanges will be eligible for subsidies. Taft-Hartley plans "aren't open to all comers," he said.
"I understand where the UFCW and UNITE HERE and the Teamsters are coming from ... They're making a good point that the operation of the law will have a detrimental impact on union health plans," Secunda said, adding that about 20 million workers are on such plans. "But there's nothing in the law as it was enacted that gives the administration the ability to interpret the law how unions want it to be interpreted."
Timothy Jost, an expert on health law at Washington and Lee University School of Law, agreed that the administration may have little wiggle room.
"I think it's a problem with the legislation; it's not a regulatory problem," Jost said. "But that doesn't mean I don't sympathize with them."
The Congressional Research Service, a nonprofit legislative analysis group, published a paper saying Taft-Hartley plans likely wouldn't be eligible for subsidies based on the way the law is written.
But Taylor and Schlittner said they believe it is within the administration's power to interpret the Taft-Hartley plans as eligible for subsidies.
In a piece last month, Talking Points Memo wrote that unions were essentially asking for a "double subsidy" through their interpretation of the law: Employer contributions to Taft-Hartley plans are already tax-deductible and employee contributions are paid pre-tax, while unions also want the tax credits that go with qualified buyers on the exchanges.
Taylor argued that it wasn't appropriate for the subsidies to help only buyers in a for-profit marketplace.
"Why is it that the only people getting subsidies are for-profit?" he asked.
Citing the administration's decision to delay employer penalties under the law for a year -- as well as a regulatory tweak that will keep health care costs down for Hill staffers -- Taylor said the "only people who've gotten special treatment are the business community and Capitol Hill."
"Here's what we're saying: 'You made the problem, you fix it,'" Taylor said. "Here we have situation where you can't blame the Republicans."
Aetna Pulls Out Of Another Obamacare Health Exchange
Obamacare is so awesome that EVERYONE wants to be a part of it.Quote:
Aug 29 (Reuters) - Aetna Inc has decided not to sell insurance on New York's individual health insurance exchange, which is being created under President Barack Obama's healthcare reform law, the fifth state where it has reversed course in recent weeks.
The third-largest U.S. health insurer has said it is seeking to limit its exposure to the risks of providing health plans to America's uninsured, but did not give details about its decision to pull out of specific markets.
"We believe it is critical that our plans not only be competitive, but also financially viable, in order to meet the long-term needs of the exchanges in which we choose to participate. On New York, as a result of our analysis, we reluctantly came to the conclusion to withdraw," Aetna spokeswoman Cynthia Michener said.
The New York decision comes as states finalize the roster of health plans that will be offered to millions of uninsured Americans beginning on Oct. 1.
Aetna and its newly acquired Coventry Health unit, a low-cost provider that caters to individuals and Medicaid beneficiaries and provides private Medicare policies, still have applications to sell coverage in 10 states, based on publicly available information.
Michener said the full list of state exchanges where Aetna will participate is still being finalized.
The new online insurance exchanges are the lynchpin of Obama's healthcare reform, representing a massive technology build-out that has run up against multiple delays and political opposition in many states. In their first year, the exchanges aim to provide coverage to 7 million uninsured Americans, many of whom will be eligible for government subsidies.
Aetna's large competitors, such as UnitedHealth Group Inc and WellPoint Inc, have also planned limited entries into the new exchanges while they wait and see whether they operate smoothly and whether enough healthy people sign on to offset the costs of sicker new members.
"We've got this period where the exchange experience, the exchange sentiment, and news headlines are probably not going to be very flattering and that's not going to have a positive impact on turnout," said Jefferies & Co analyst David Windley.
"Longer-term, those kinks will get ironed out, more people will get comfortable and in (the next few years) more people will be accessing their health insurance through an exchange of some sort," he said.
'RISK-BASED APPROACH'
Aetna signaled last month that it was considering withdrawing some applications because of its purchase of Coventry, which also had filed documents to sell insurance plans on exchanges around the country.
"We have taken a prudent risk-based approach to both our overall exposure and exposure within a given marketplace," Chief Executive Officer Mark Bertolini said on a conference call with analysts at the time.
Since then, it has withdrawn applications in Maryland, Ohio, Georgia, and Connecticut, where it is based. In Maryland, Aetna's decision came after state regulators ordered the company to lower rates dramatically from what it had proposed.
Aetna also has filed applications in Florida, Arizona and Virginia, where the federal government will operate the exchanges, and in Washington, D.C., which is running its own exchange.
Coventry filed applications to sell insurance in Florida, Iowa, Kansas, Louisiana, Nebraska, North Carolina, Ohio and Virginia, according to those states' insurance departments. Iowa is working with the government on its exchanges while the rest are being run entirely by the federal government.
Coventry withdrew its applications in Georgia and Maryland when Aetna bowed out but it remains in Ohio. It also withdrew earlier this month from Tennessee.
Aetna and Coventry may also have filed plans in other states that have not released any information about participants.
Insurance plans in the 33 states that have defaulted to the federal government exchanges must be approved by the Department of Health and Human Services (HHS), and then insurers sign off on them. Earlier this week, HHS delayed the sign-off deadline to mid-September after originally aiming for early next month.
Michener said the company will continue to serve small business and large business customers in New York and will offer products to individual consumers outside of the exchanges.
Only 17,000 or so people in New York currently buy individual insurance, but the exchange is expected to bring in 1 million people during the first three years. The exchange announced insurance participants on Aug. 20. Aetna was not on the list.
Obamacare basically asks insurance companies to take the risks and shoulder part of the financial burden for our massive healthcare spending, why is anyone surprised that they aren't jumping at the chance to do so?