Good Neighbor Insurance, Inc (www.gnazhealth.com) is keeping up with the changes in our US health care system and will be, over the course of the next months and years, expanding this section with up-to-date information. Health care overhaul will bring change but it is going to happen slowly. There will be a lot of minor as well as major changes over the course of the next few years with a bulk of these changes happening in 2014 and the last parts being implemented by 2018. However, keep in mind that there will probably be additional regulation(s) coming in the next few years to expand on what has become law this month, March 2010.
CHANGES IN 2014
GENERAL
* States must have established Exchanges
* States must organize “exchanges” where individuals and small businesses can purchase insurance if their employer does not provide it. Requirements for a minimum set of benefits are outlined in the legislation, including provisions for preventive care and mental health services. Subsidies are provided to help low- and moderate-income individuals, as well as small businesses, buy insurance.
* All non-grandfathered and Exchange health plans required to meet federally mandated levels of coverage
* States must cover parents /childless adults up to 138% of poverty on Medicaid, receive increased FMAP
* Employers with more than 200 employees can auto‐enroll employees in health coverage, with opt-out
* Tax credits available for Exchange‐based coverage, amount varies by income up to 400% of poverty
* Modified community rating: individual or family coverage by insurance companies and any government run plans, exchanges, and other State programs; geography; 3:1 ratio for age; 1.5 :1 for smoking
UNDER 65
* Insurance companies will be barred from turning adults down with medical problems. Insurers will be required to take all applicants and all applicants will be charged the same depending on their age.
* The government will provide tax credits to help millions of working families buy coverage they cannot afford now.
* All Americans will be required to carry health insurance, either through an employer, a government program, or by buying their own. Those who refuse will face fines from the IRS starting at $695 or 2.5% of income, which ever is greater, annual fee which will go up each year.
* Tax credits to help pay for premiums will start flowing to middle-class working families.
* Limits out-of‐pocket cost sharing (tied to limits in HSAs, currently $5,950/$11,900 indexed to COLA).
* Insurance plans must include government defined “essential benefits” and coverage levels
* OPM must offer at least two multi‐state plans in every state
* Impose tax on nearly all private health insurance plans
MEDICARE (65 and over)
* Medicare Part D of the Rx coverage the “doughnut hole” will slowly close and be eliminated. The prescription coverage gap will be totally closed in 2020. At that point seniors will be responsible for 25% of the cost of their medications until Medicare’s catastrophic coverage kicks in, dropping their copayments to 5%.
* To pay for these cost Medicare Advantage (option under Part C) plans the US government will cut funding on these private insurance plans which generally offer lower out-of-pocket costs. That has been possible since the government pays the plans about 13% more than it costs to cover seniors in traditional Medicare A and B. The reason for these extra costs is because Medicare Advantage covers more than what the government covers on Part A and B.
* More Medicare cuts to home health begin
* Government board (IPAB) begins submitting proposals to cut Medicare
* Medicare payment cuts for hospital‐acquired infections begin (starts fiscal year 2015)
MEDICAID (under 65 for low income individuals and families)
* Requires States to expand Medicaid to include childless adults.
* Federal government pays 100% of cost for covering newly eligible individuals through 2016
BUSINESS (small and large)
* Small businesses, self-employed, and the uninsured can pick a health insurance plan offered through the new State-based purchasing pools called exchanges or insurance supermarkets.
* Individuals and families between 133% and 400% of the poverty level will receive subsidies if they want to participate in the exchange. But they must not be eligible for Medicare, Medicaid, and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.
* There will be also be exchanges created just for small businesses to purchase coverage for their employees and dependents.
* Federal government will have funding available to States to establish exchanges with one year of enactment until 1-1-2015.
* Exchanges will offer the same kind of purchasing power that employees of big companies and government workers benefit from. Employees working in medium and large firms would not see any major changes and if they leave their place of employment they may be eligible for insurance through the exchange
* Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any of the workers receive federal subsidies to purchase health insurance.
* Employers can offer some employees free choice vouchers for health insurance in the Exchange
CHANGES IN 2015
MEDICARE (65 and over)
* More Medicare cuts to home health begin
CHANGES IN 2016
GENERAL
* States can form interstate insurance compacts if the coverage with HHS approval
CHANGES IN 2017
GENERAL
* Physician pay-for-quality program begins for all physicians
* States may allow large employers and multi‐employer health plans to purchase coverage in the Exchange.
* States may apply to the Secretary for a limited waiver from certain federal requirements
CHANGES IN 2018
GENERAL
* Impose “Cadillac tax on “high cost” plans, 40% tax on the benefit value above a certain threshold: ($10,200 individual coverage, $27,500 family or self‐only union multiemployer coverage)
For Arizona health insurance quotes go to our two Arizona web sites at www.gnazhealth.com and www.gnhealthplan.com or feel free and call Doug Gulleson and his agents at 480-633-9500 or stop by our office in Gilbert.
Doug Gulleson loves to scuba dive overseas and he makes sure he always takes his Amex card AND international travel insurance. Visit Good Neighbor Insurance at www.gninsurance.com for your next overseas trip and get a FREE quote.
