Keeping Your Old Health Insurance Plan (AKA Transitional Relief)

Part of the Affordable Care Act (ACA) includes the termination of any transitional health insurance for individual and small businesses with 50 or fewer employees.   We have been fortunate that the deadline for this change has been extended again.  This termination will not occur until December 31, 2017.   

 

So, wondering what all of that means?  Here’s our best effort to make sense of it:

If you purchased group or individual health insurance before March 23, 2010 AND haven’t made any changes to that plan, you are on a “Grandfathered” plan.  You are exempt from all of this!  Go celebrate!

If you purchased individual health insurance after March 23, 2010 but before January 2014 AND haven’t made any changes to that plan, you are on a “Grandmothered” plan.

If you purchased group health insurance after March 23, 2010 but before January 2014 and have made no changes or only small changes, you are on a “Grandmothered” plan.

A Grandmothered Plan is the same as a Transitional plan.

Grandmothered = Transitional

Ok – we’ve got that part down.  Moving on to the big change:

The recent change means you can definitely keep your current plan until at least January 1, 2018. (Assuming things don’t change again…)

However on January 1, 2018 ALL individuals and small groups that have transitional plans will have to switch to an ACA plan.  This change will occur on January 1, 2018, NOT when you currently renew.  If you are an individual, you will need to go through the open enrollment process in November 2017.   Small businesses will need to meet with your broker before November to review your options.

Bottom line, on January 1, 2018 there is a very good chance that your rates will increase substantially.  (Don’t kill the messenger – we are just passing along the information.)

InHealth Mutual Update

We received the information below in an email today from InHealth Mutual.  If you currently have coverage through them, this email has a lot of important information.   If you a have questions, please don't hesitate to contact us at 740.967.0210 or InHealth at 8003.580.8502.  Thank you!

Meeting the health needs of our membership is our top priority.  We understand the network change announcement has resulted in many questions. We also know from the calls and emails we are receiving that there’s some confusion around emergency services and continuity of care. Here’s information that will help address these concerns. 

EMERGENCY SERVICES: 
Please remind your clients that Emergency Service benefits are processed as In-Network regardless of the facility the members go to. If members need emergency care, they should go to the nearest facility. Click here for additional information regarding Emergency Care Services


CONTINUITY OF CARE:  

• We will assist InHealth’s members who are pregnant, currently undergoing a course of treatment, or with a current authorization for health care services with one of the affected facilities or providers to ensure continuity of care.
• This means our impacted members receive the health care services they need without interruption and at In-Network cost-share levels. However, providers may still choose to balance bill members for services.
• Additionally, for members not currently undergoing a course of treatment with an affected provider, physicians affiliated with an OhioHealth-owned hospital will arrange for transition and admission to alternate hospitals that are In-Network.

If your clients need assistance or have questions, please have them contact our Customer Care team at 1-800-580-8502 or email networkservices@inhealthohio.org.

TEMPORARY INHEALTH ID CARDS
Members can obtain a temporary ID card by logging into the member portal of our website www.inhealthohio.org and clicking the Print Temporary ID Card/Order Replacement ID Card as indicated below in the screen shot.  Then they will have access to the temporary id for everyone on their policy, including insured children over 18.  For those who have pediatric dental, temporary dental ID cards can be accessed here as well.

 




HEALTHSMART CHECK LIST
Help your clients save money with a reduction off their 2016 deductible. As part of our focus on keeping members healthy over the long run, we encourage everyone to complete the HealthSmart Check List now located on line by logging into the member portal of our website www.inhealthohio.org. It is a simple form that lets members tell us more about their health so we can reach out with wellness, prevention and disease education to help promote healthy living.  Members who complete and return their HealthSmart Check List during the first sixty (60) days of coverage are eligible for a one-time reduction of $250 off their Plan Year 2016 annual deductible.  Families are eligible for a maximum reduction of $500.  Restrictions and conditions may apply.  Contact InHealth with questions and encourage members to complete their HealthSmart Check Lists!



Thank you for your ongoing support and business.

Sincerely,
The InHealth Sales Team

2016 Medicare Parts A & B Premiums and Deductibles Announced

Release November 10, 2015 By CMS

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be "held harmless" from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

Beneficiaries not subject to the "hold harmless" provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the "hold-harmless" provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016.

Because of slow growth in medical costs and inflation, Medicare Part B premiums were unchanged for the 2013, 2014, and 2015 calendar years. The "hold harmless" provision would have required the approximately 30 percent of beneficiaries not held harmless in 2016 to pay an estimated base monthly Part B premium of $159.30 in part to make up for lost contingency reserves, according to the 2015 Trustees Report. However, the Bipartisan Budget Act of 2015 mitigated the Part B premium increase for these beneficiaries and states, which have programs that pay some or all of the premiums and cost-sharing for certain people who have Medicare and limited incomes. The CMS Office of the Actuary estimates that states will save $1.8 billion as a result of this premium mitigation.

CMS also announced that the annual deductible for all Part B beneficiaries will be $166.00 in 2016. Premiums for Medicare Advantage and Medicare Prescription Drug plans already finalized are unaffected by this announcement.  

Since 2007, beneficiaries with higher incomes have paid higher Part B monthly premiums. These income-related monthly adjustment amount (IRMAA) affect fewer than 5 percent of people with Medicare. Under the Part B section of the Bipartisan Budget Act of 2015, high income beneficiaries will pay an additional amount. The IRMAA, additional amounts, and total Part B premiums for high income beneficiaries for 2016 are shown in the following table:

Beneficiaries who file an individual tax return with income:	Beneficiaries who file a joint tax return with income:	Income-related monthly adjustment amount	Total monthly premium amount
Less than or equal to $85,000	Less than or equal to $170,000	$0.00	$121.80
Greater than $85,000 and less than or equal to $107,000	Greater than $170,000 and less than or equal to $214,000	48.70	170.50
Greater than $107,000 and less than or equal to $160,000	Greater than $214,000 and less than or equal to $320,000	121.80	243.60
Greater than $160,000 and less than or equal to $214,000	Greater than $320,000 and less than or equal to $428,000	194.90	316.70
Greater than $214,000	Greater than $428,000	268.00	389.80

Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax return from their spouse:	Income-related monthly adjustment amount	Total monthly premium amount
Less than or equal to $85,000	$0.00	$121.80
Greater than $85,000 and less than or equal to $129,000	194.90	316.70
Greater than $129,000	268.00	389.80

Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,288.00 in 2016, a small increase from $1,260.00 in 2015. The Part A deductible covers beneficiaries' share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. The daily coinsurance amounts will be $322 for the 61^st through 90^th day of hospitalization in a benefit period and $644 for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 in a benefit period will be $161.00 in 2016 ($157.50 in 2015).  

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Part A. Individuals with 30-39 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $226.00 in 2016, a $2.00 increase from 2015. Those with less than 30 quarters of coverage pay the full premium, which will be $411.00 a month, a $4.00 increase from 2015.

Deductibles and Coinsurance for 2016

Part A Deductible and Coinsurance Amounts for Calendar Years 2015 and 2016 Type of Cost Sharing
	2015	2016
Inpatient hospital deductible	$1,260	$1,288
Daily coinsurance for 61st-90th Day	315	322
Daily coinsurance for lifetime reserve days	630	644
SNF coinsurance	157.50	161.00

Don't Lose Your Subsidy in 2016

If you received premium subsidy in 2014, please be aware that you need to file IRS form 8962 with
your 2014 taxes.  If you did not file form 8962 you need to file this form by August 31, 2015 or you may lose your premium subsidy in 2016.

Here is the link to form 8962

OTC Nexium Prompts Drug Formulary Changes

NEXIUM® 24HR (esomeprazole 20 mg) became available as an over-the-counter (OTC) 14-day treatment for frequent heartburn in May 2014. As a result, most drug formulary (list of covered drugs) are changing.  The following drugs will be moving (or have moved) to a higher formulary Tier.

• Nexium 
• Esomeprazole 
• Lansoprazole 

King v. Burwell U.S. Supreme Court Ruling: Payment of Premium Subsidies Upheld

Good News! This morning the Supreme Court made an important decision about the Health Insurance Marketplace. Their ruling means that consumers will continue to receive quality affordable health care coverage no matter where they live.

For consumers getting their coverage through the Health Insurance Marketplace, this means that nothing has changed. You will still continue to receive your subsidy. 

If you have any questions please don't hesitate to contact Tiffany or Bud.

You can watch the president’s address here and read the Supreme Court’s ruling here.

Additional information about what the Supreme Court decision means for you can be found online at: HealthCare.gov/Decision. 

Information from:Centers for Medicare & Medicaid Services (CMS)

ACA Requiring Insurance Companies to Collect Social Security Numbers

Beginning this year, health insurers have to send the Internal Revenue Service (IRS) information about health plan members and their insurance coverage, including their Social Security number (or other tax identification number). It’s one of the requirements of the Affordable Care Act (ACA).

The ACA requires that everyone have qualifying insurance, qualify for an exemption, or potentially pay a tax penalty. The IRS will cross-check the information in tax returns against the information health insurers are required to submit for every person they cover. This IRS review will confirm that individuals have the required coverage and don’t have to pay a tax penalty.

Many insurance companies have been phasing out the use of SSNs for member identification. However, with the ACA requirements, health insurers will now be sending letters or otherwise reaching out to plan members asking for that information if they don’t already have it.