What could happen if Health Insurance Reform is overturned?
Individual Mandate and Insurance Reforms Overturned
Considered by most to be the most controversial (and vulnerable) portion of health care reform, the individual mandate is highest on the chopping block.
If the insurance reform pieces that require health insurance carriers to accept applicants with pre-existing conditions are also overturned but the remaining portions ofhealth insurance reform stay, the situation may play out as follows:
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Employers with greater than 50 employees required to offer affordable coverage to employees beginning in 2014 or pay a fine
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Childen able to stay on parents’ insurance policies until age 26
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Health insurance carriers required to spend 80% of revenue on medical expenses and quality improvements.
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Health insurance exchanges operate (with or without federal subsidies) and may deny applicants with pre-existing conditions
Individual Mandate Overturned - Other Pieces Remain
If the Supreme Court decides that the individual mandate is unconstitutional and the remaining portions of health care reform remain intact, significant pricing issues could arise for health insurance carriers due to the smaller overall pool consisting of presumably more unhealthy applicants. Health insurance costs would be almost certain to rise.
In response, the Obama administration (if re-elected) may implement financial incentives for individuals to purchase health insurance without delay.
Alternatively, there may be exemptions provided to insurance carriers to provide coverage to applicants with pre-existing conditions who waited until the illness was incurred prior to obtaining coverage.
Entire Health Care Reform Bill is Overturned
If the Supreme Court strikes down the entire health care reform bill, the unpopular components such as the individual mandate go away, but so do the more popular pieces such as the extension of parent coverage until age 26 and the requirement for insurance carriers to accept applicants regardless of health conditions.
A likely outcome of this decision would be smaller-scale reform to keep the more popular components.
Health Care Reform Remains As-Is
The individual mandate stands and individuals are required to purchase health insurance in 2014 or pay a penalty…of $95. Is this financial “penalty” the incentive the Obama administration was hoping would lead to the 49.1 million uninsured individuals in 2010 to purchase insurance?
AARP® Medicare Supplement Insurance Plans Question of the Week: Policy Termination
Question: A member is recently deceased. What is needed to terminate the policy?
Answer: A member of the plan member’s family, or an authorized person, may contact AARP® Medicare Supplement Customer Service at 1-800-523-5800 weekdays 7:00 a.m. – 11:00 p.m. and Saturdays 9:00 a.m. – 5:00 p.m. (EST) to provide the date of death. Generally, we do not require a death certificate. If you have a question to submit for an upcoming Question of the Week, please contact your AARP Medicare Supplement Insurance Agent.
If you or someone you know is uninsured and in need of help in finding an affordable health insurance policy, please contact a licensed and unbiased agent at Chaser Insurance Group at (877)775-4321 or email at AF@HealthInsuranceChaser.com
HHS releases preventive care list updates
Two weeks ago, an independent panel recommended that FDA-approved contraceptive methods and some other services be covered 100% as a preventive care service under health care reform. The Institute of Medicine developed this recommendation at the request of the Department of Health and Human Services (HHS).
On August 1, 2011, HHS released new guidelines outlining required preventive care services for women. The new guidelines call for nongrandfathered health plans (including ASO plans) to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012:
- Well-woman visits
- Screening for gestational high blood sugar
- Human papillomavirus DNA testing for women 30 years and older
- Sexually transmitted disease counseling
- Human immunodeficiency virus screening and counseling
- FDA-approved birth control methods and birth control counseling (certain religious employers are exempt from this rule)
- Breastfeeding support, supplies, and counseling
- Family violence screening and counseling
The guidelines call for coverage of birth control methods that have a prescription. The guidelines also appear to allow a value-based insurance design that lets plans charge for brand-name drugs where a generic is available. Also, the guidelines let plans use medical management programs to limit coverage when a recommended preventive health service does not name the rate, method, treatment or setting for that service.
2011 Medicare Part B Premiums
Most Medicare beneficiaries will continue to pay the same $96.40 or $110.50 Part B premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less ($170,000 or less for joint filers) will not have an increase in their Part B premium for 2011. For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. Social Security will use the income reported two years ago on your IRS income tax return to determine your premium (if unavailable, SSA will use income from three years ago). For example, the income reported on your 2009 tax return will be used to determine your monthly Part B premium in 2011. If your income has decreased since 2009, you can ask that the income from a more recent tax year be used to determine your premium, but you must meet certain criteria. The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty. Table 1: Part B Monthly Premium Beneficiaries who file an individual tax return with income Beneficiaries who file a joint tax return with income If Your Yearly Income Is $96.40 if beneficiary had SSA withhold in 2009 $110.50 if beneficiary was new in 2010 and had SSA withhold $115.40 for all others $85,000 or less $170,000 or less $161.50 (increased by $46.10 due to IRMAA) $85,001-$107,000 $170,001-$214,000 $230.70 (increased by $115.30 due to IRMAA) $107,001-$160,000 $214,001-$320,000 $299.90 (increased by $184.50 due to IRMAA) $160,001-$214,000 $320,001-$428,000 $369.10 (increased by $253.70 due to IRMAA) Above $214,000 Above $428,000 Table 2: Part B Monthly PremiumBeneficiaries who are married, but file a separate tax return from their spouse and lived with his or her spouse at some time during the taxable year $96.40 if beneficiary had SSA withhold in 2009 $110.50 if beneficiary was new in 2010 and had SSA withhold $115.40 for all others $85,000 or less $299.90 (increased by $184.50 due to IRMAA) $85,001-$129,000 $369.10 (increased by $253.70 due to IRMAA) Above $129,000 If you are having trouble paying your premiums, you should call your State Medical Assistance (Medicaid) office to see if you qualify for some help. Some states refer to the Medicaid office as the Public Aid office, the Public Assistance office, or the State Medical Assistance office. INCOME RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) The Internal Revenue Service supplies your tax filing status, your adjusted gross income, and your tax-exempt interest income to the Social Security Administration to determine if you have an income related monthly adjustment amount (IRMAA). The Social Security Administration will add your adjusted gross income together with your tax-exempt interest income to get an amount called the modified adjusted gross income (MAGI). The income-related monthly adjustment amount is effective from January 1 through December 31 each calendar year. The Social Security Administration will refigure your Medicare Part B premium amount again next year when the Internal Revenue Service updates the information. If you would like to receive affordable health insurance quotes from a licensed and independent agent, please contact Chaser Insurance Group at (877)775-4321 or email at AF@HealthInsuranceChaser.com.2011 Part B Premium Amounts for Persons with Higher Income Levels
Your 2011 Part B Monthly Premium Is
Your 2010 Monthly Premium is
Beneficiaries who are married but file a separate tax return from his or her spouse
Health Savings Account Tax Forms: How to Make sense out of the HSA tax forms
As a health insurance agent living in Cincinnati, Ohio and being the proud owner of an HSA (AKA: Health Savings Account), even I was confused about the new forms that I now had to file for my personal taxes. So here is a breif tutuorial of the who, what, when , where how of health savings accounts (HSA’s).
Combined tax forms 1099-SA and 5498-SA were mailed to HSA account holders. The information on these forms will be submitted to the IRS. Account holders receive these combined tax forms for their records only. Account holders use the information on these forms to complete IRS Form 8889. The 1099-SA and 5498-SA forms do not need to be attached to the account holder’s tax return.
Tax form 5498-SA: This form reports contributions made to an account holder’s Health Savings Account (HSA) by the account holder or by an eligible individual on the account holder’s behalf, as well as contributions made by their employer, if applicable. The IRS requires HSA providers to issue form 5498-SA to every account holder who had any contribution activity in their HSA during the previous tax year (2010).
Note: If an account holder makes a prior year (2010) contribution by April 18, 2011 they will receive an amended 5498-SA in May.
Tax form 1099-SA: This form reports distributions made from an account holder’s HSA. The IRS requires HSA providers to issue Form 1099-SA if account holders took a distribution from their HSA during the previous tax year (2010).
IRS form 8889: Account holders must obtain, complete and file IRS Form 8889 as part of the federal tax filing by April 18, 2011. It is downloadable from www.irs.gov. If both spouses have an HSA, then two forms are required (one for each account).
Missouri High Risk Pool Information and Application - Anthem Blue Cross and Blue Shield
The cost for the MHIP-PCIP federal pool program is a monthly premium and varies according to the age of the enrollee. Premiums can be billed and paid monthly or quarterly. Premiums can also be automatically deducted from the enrollee’s bank account. The Patient Protection and Affordable Care Act (PPACA) mandates that premiums be set as if for a standard population without a higher health risk.
Effective February 1, 2011, the MHIP-PCIP federal program will offer three benefit plans (plans I through III) to choose from. These plans will only vary by deductible amount and premium. Please also note that the below link shows rates effective February 1, 2011.
Missouri Health Insurnace High Risk Pool Application with Anthem Blue Cross and Blue Shield
Adult and Child Preventative Services List
Child Preventive Care (Birth to 18 years)
Preventive physical exams
Screening tests include:
- Vision screening2
- Hearing screening
- Oral health assessment
- Screening for lead exposure
- Screening for anemia
- Screening for tuberculosis
- Pelvic exam and Pap test, including screening for cervical and ovarian cancer
- Newborn screenings including sickle cell anemia
- Developmental and behavioral assessments
- Cholesterol and lipid level screening
- Screening for depression
- Screening and counseling for obesity
- Behavioral counseling to promote a healthy diet
Screening for sexually transmitted infection
Immunizations:
- Hepatitis A
- Hepatitis B
- Diphtheria, Tetanus, Pertussis (DtaP)
- Varicella (chicken pox)
- Infl uenza (fl u shot)
- Pneumococcal Conjugate (pneumonia)
- Human Papilloma Virus (HPV)
- Hib Infl uenza type b
- Polio
- Measles, Mumps, Rubella (MMR)
- Meningococcal Polysaccharide
- Rotavirus
Adult Preventive Care (19 years and Older)
Preventive physical exams
Screening tests include:
- Eye chart vision screening2
- Hearing screening
- Cholesterol and lipid level screening
- Depression screening
- Diabetes screening
- Prostate cancer screenings including digital rectal exam
- and PSA test
- Breast exam, breast cancer screening,
- including mammography
- Pelvic exam and Pap test, including screening for cervical
- and ovarian cancer
- Screening for sexually transmitted diseases
- HIV test
- Bone density test to screen for osteoporosis
- Colorectal cancer screening including fecal occult
- blood test, barium enema, fl exible sigmoidoscopy
- and screening colonoscopy
- Routine blood and urine screenings
- Aortic Aneurysm screening
- Pregnancy screenings (including hepatitis, asymptomatic
- bacteriuria, Rh incompatibility, syphilis, iron defi ciency
- anemia, gonorrhea, chlamydia)
Intervention services to include counseling and
education including the following:
- Screening and counseling for obesity
- Counseling related to genetic testing for breast and ovarian cancer Behavioral counseling to promote a healthy diet
- Primary care intervention to promote breastfeeding
- Counseling related to aspirin use for the prevention of cardiovascular disease
- Screening and behavioral counseling related to tobacco use
- Screening and behavioral counseling related to alcohol abuse
Immunizations:
- Hepatitis A
- Hepatitis B (expanded codes)
- Tetanus, Diphtheria (Td)
- Varicella (chicken pox)
- Infl uenza (fl u shot)
- Pneumococcal Conjugate (pneumonia)
- Human Papilloma Virus (HPV)
- Measles, Mumps, Rubella (MMR)
- Meningococcal Polysaccharide
- Herpes Zoster (shingles)
Individual Health Insurance Policies and Maternity Coverage
When choosing a health insurance plan and also planning to have children you must take many variables into consideration. Individual health insurance policies will not include maternity coverage unless you elect to add it on as a rider to a policy. But it is also important to consider not only adding it on to a policy, but if you are able to add it on based on what carrier you choose. Here are a few things to consider:
- In 2007, average expenses for maternity care - including nine months of prenatal care and three months of postpartum care for a delivery without complications - were $10,652, according to a study done for the March of Dimes.
- Some health insurance carriers do not have maternity at all.
- You may be restricted as to which plan you can choose based on adding a maternity rider to your health insurance plan.
- How is the plan going to perform after you have the child. Will it be suitable?
- Is the deductible embedded? In other words, will you have to pay the individual deductible or the family deductible?
- It will potentially cost between $250-$450 to add maternity coverage on a plan as a rider.
- If you are pregnant at the time of your health insurance application, you and your spouse will be a decline for health insurance coverage.
- There is a 270 waiting period before the maternity benefit would become effective.
These are just a few things to consider as you prepare to purchase an individual health insurance policy with maternity. Most importantly, never assume you will be covered for maternity and discuss it with your health insurance agent and make sure you have chosen the right plan for your specific situation.
If you would like to receive affordable health insurance quotes from a licensed and independent agent, please contact Chaser Insurance Group at (877)775-4321 x4 or email at AF@HealthInsuranceChaser.com.
Pre-existing Condition Credits on Short Term Health Insurance Plans
Unlike traditional major medical plans, short term health insurance policies do not provide pre-existing conditions credits. Simply put, pre-existing conditions are not covered.
Although short term plans can provide a good option to fill a gap in coverage, I would recommend going with a traditional major medical health insurance plan if you are eligible and can get approved. They are month to month plans and can be cancelled at any time and can serve the same function while providing a much greater level of benefit.
If you would like to receive affordable health insurance quotes from a licensed and independent agent, please contact Chaser Insurance Groupat (877)775-4321 or email at AF@HealthInsuranceChaser.com.
Explanation of the new “annual wellness visits” that are coming to Medicare in 2011?
Starting next year, Medicare will cover an annual wellness visit, which will be similar to an annual physical, except with a higher emphasis on preventive care. The exam is similar to the Welcome to Medicare exam, except beneficiaries are able to have a free visit every year, rather than just once within the first year of enrolling.
During the visits, doctors will work with beneficiaries to create a personalized prevention plan, and the following services will be covered in exam:
- Routine measurements such as height, weight, blood pressure, and body-mass index (or waist circumference, if appropriate)
- Review of medical and family history, including medications and current care by other healthcare providers
- A personal risk assessment (including any mental health conditions)
- A review of the beneficiaries functional ability and level of safety, including an assessment of any cognitive impairment and screening for depression
- Set up a schedule for Medicare’s screening and preventive services for the next 5 to 10 years
- Any other advice or referral services that may help intervene and treat potential health risks.
In addition, the following preventive services that Medicare currently covers will be provided free of charge to the patient, including:
- Mammograms every 12 months for eligible beneficiaries age 40 and older
- Colorectal cancer screening, including flexible sigmoidoscopy or colonoscopy
- Cervical cancer screening, including a Pap smear test and pelvic exam
- Cholesterol and other cardiovascular screening.
- Diabetes screening
- Medical nutrition therapy to help people manage diabetes or kidney disease
- Prostate cancer screening
- An annual flu shot, a vaccination against pneumococcal infection (that may cause pneumonia), and the hepatitis B vaccine
- Bone mass measurement
- Abdominal aortic aneurysm screening to check for a bulging blood vessel
- HIV screening tests for people of who are at increased risk or who ask for the test
If you have questions regarding your Medicare Advantage plan, or Medicare supplements that are available to you, please feel free to contact a licensed Medicare Specialist at Chaser Insurance Group by calling (877)775-4321 or email at AF@HealthInsuranceChaser.com.