Healthcare in America 16-Apr-2019
Can “Limited Funding” reduce your health insurance costs? 3-Apr-2019
Federal Court Unravels Association Health Plans
As part of our ongoing efforts to help keep your personal information as safe as possible, we want to remind you to stay on the lookout for the many security threats making the rounds in cyberspace today.
Recently, we learned about a massive Equifax breach in which more than 143 million consumers may have had their information compromised, including:
- Social security numbers
- Dates of birth
- Driver’s license numbers
- Credit card information (for approximately 209,000 consumers)
Due to the high potential impact of this breach, we recommend taking the following steps:
1) Determine whether you may have been affected. Through Equifax’s self-service portal, you can quickly determine whether your information may have been compromised. Enter your last name and the last six digits of your social security number, and you’ll find out whether Equifax believes you’ve been affected. This process takes only a couple of minutes.
2) Enroll in Equifax’s credit monitoring and identity theft protection. Equifax is now offering one free year of TrustedID Premier, its credit monitoring and identity theft protection product, to all U.S. consumers, even if you aren’t a victim.
Once you enter your information in Equifax’s self-service portal, you’ll be given the option to enroll in TrustedID Premier. Click Enroll, and you’ll be provided with an enrollment date. Be sure to write down this date and return to the site on or after that date.
3) Be wary of e-mails that come from Equifax. Because of the high number of victims, Equifax is notifying only the 209,000 consumers whose credit card information may have been affected via postal mail. Do not trust e-mails that appear to come from Equifax regarding the breach. Attackers are likely to take advantage of the situation and craft sophisticated phishing e-mails.
4) Monitor your accounts for suspicious activity. Equifax’s free TrustedID Premier service can help you monitor your credit—but be sure to monitor your other important accounts for any suspicious activity.
For more information, visit Equifax’s FAQs page regarding the incident.
Rest assured that we are always concerned about information security.
There is good news for small groups looking for insurance options in 2018. Humana recently announced their partnership with health insurance start up Oscar. Oscar is not new to health insurance, they have been selling policies in Texas, California and New York for many years, now it's time to branch. The easiest way to do that is partner with a larger company in the market you are interested in.
Welcome Humana. Humana has long been a friend to small businesses with their employee benefit programs but recently they have had a hard time getting good provider contracts in middle Tn. The fresh approach Oscar brings is changing that as hospitals are once again welcoming Humana in with new and better contracts. That means better pricing and good provider networks for you as a member and your employees.
Oscar brings technology, wellness and easy, affordable access to care. By embracing technology and customer service they are giving members the tools they need to find answers and access to care at their fingertips.
We will start quoting their plans in early October. We would love to talk with you about your employee benefits and show you how the Humana/Oscar partnership can help bring down your healthcare costs.
David Moore 615-724-1698
Middle Tennesseans just lost the last good ACA compliant health insurance option for 2018. Farm Bureau offered health insurance with a PPO network that included all the major hospitals across the state, that option will not be available in 2018. Those needing individual health insurance in 2018 are going to find their options very slim and expensive. Here is a good article written by Alex Tolbert that shares light on the subject and discusses the few options remaining.
Unfortunately the carriers have exclude brokers from helping individuals find quality insurance options. We hope there are changes for the positive coming in the near future and will keep you posted as we learn more.
After a very frustrating, strenuous and divisive attempt to overturn ObamaCare, the carriers had to make decisions and get plans and pricing ready for 2018. There are several big unknown factors that could significantly affect carriers, plans, pricing and consumers in the individual and subsidized markets. Will congress approve benefit subsidies, premium subsidies and/or do away with the Shared Responsibility Payments or penalties for not having qualified health insurance? Since we don't know the final answer, carriers are assuming the worst and pricing these changes into thier policies.
Carriers are finally releasing their "requested" rate increases for 2018. In Tennessee, Cigna is asking for a 42.1 percent average increase, while Blue Cross/Blue Shield wants a 21.4 percent increase. While those numbers are down from 2017 (Blue Cross/Blue Shield asked for and was granted a 62 percent increase last year), the marketplace is still unstable, according to Rep. Marsha Blackburn (R-TN), who represents the state's 7th congressional district.
She said it’s "no secret the individual marketplace is collapsing."
"It’s no longer a question of if it will fail, but when it will fail completely," Blackburn told Patient Daily. "These provisional increases are the latest in a long line of examples of why we need to repeal the ACA and address the real cost-drivers of health care and coverage."
"Coverage under the ACA is already unusable for far too many due to sky-high deductibles, premiums or never-ending co-pays." said the Congresswoman. "Now, I fear premiums will continue to rise until Americans are simply forced out of the market."
Insurers said that when they were requesting premium rates, they factored in uncertainty, particularly over cost sharing subsidies and whether the individual mandate will remain in place, the repeal of which could lead to more healthy people leaving the marketplace. However, they also cited increased medical costs and rising drug prices as a reason for the high premium requests.
The deadline for insurers to file their initial rate requests for 2018 was June 21. More rate requests from states may be made public throughout the rest of summer and into fall. However, final rates won’t likely be announced until later in the year.
It is important to note that BCBST is picking up the slack in Knoxville where Humana pulled out leaving no carriers to provide insurance to those residents. This will be the only major market where BCBST is offering individual policies.
The cost of prescriptions is the fastest rising cost in healthcare today. Cigna estimates annual trend at over 15% with no sign of slowing down. There are several reasons this is happening: direct to consumer advertising, specialty drugs that were not available in the past, extreme price increases from the manufacturers and lack of knowing your options.
Just speaking from personal experience when a doctor prescribes a medicine for a specific condition, I generally don't question that decision. Or at least I didn't in the past. The problem I am beginning to understand is doctors have no idea what one medicine costs vs. another and a drug representative is only telling why their medicine is the best. The truth is, for many medical conditions there are numerous different medications that will effectively treat the condition for prices that vary greatly.
How do you find out what options there are and at what cost?
This is what has helped me and many of our clients - GoodRx www.goodrx.com is a website with not only great information about every medication, it will show you actual costs from drug stores in your area. A disclaimer here is these prices will be different based on your insurance plan but it will give you a very good idea.
Coupons, there are many coupons that you can use even if you have health insurance. This will save you real money.
Knowing the cost of the medicine before you leave the doctors office. GoodRx has an app you can download to your smartphone to see the cost of the medicines the doctor is prescribing for you so you can ask "is there another medicine I can use that does not cost as much?" I have done this on many occasions and have never had a doctor not try to save me money.
Another great use of this app is to lookup the cost of the medicines continually advertised on TV. This will give you a much better understanding of why health insurance costs so much. This advertising works! Doctors don't have time to educate you about why an older, lower cost Medlicine will be as effective for you. Unfortunately, it's easier to let you try this new, latest, greatest and very expensive medicine rather than risk losing a patient.
Increasing prescription costs is a real problem in the cost of health insurance today. By becoming aware and shopping smartly we can all make a difference.
Thanks for reading, have a great day!
The Tennessean ran a great story written by Sherri Zink the Chief Data Officer for BCBST this weekend. A few takeaways I think you will be interested in are"
- In 2016 BCBST paid out $13.9 Billion for health care services
- This covered care for 3,4 million members for an average cost of $4,088 each
- Costs were 8.4% higher in 2016 than they were in 2015
- Pharmacy costs have increased by 81% from 2013 to 2016
- In 2016, half of all medical costs were attributed to 25% of the members who were treated for cancer or one of five chronic conditions (diabetes, cardiovascular disease, asthma, COPD or congestive heart failure
What is BlueCross BlueShield of TN doing to combat this trend and try to control costs? First is the direct negotiation with providers and working to shift payment methods to reward better health outcomes. Many complain when the "newest" prescription they ask for is denied but this is an out of control cost and in many cases this "new medicine is no better than the old one for a patient, it only costs 10x more. BCBST is working harder to to stay in touch with those who have chronic conditions to ensure they are getting the care they need and are compliant on medications.
To read the entire story click here
We are getting a lot of questions about the end of Obamacare and “when will my premiums go down?” There have been many changes to our individual and small group health insurance plans over the past five years. The Trump administration has spoken loud and clear that they want to do away with Obamacare, we can already see it won’t be quite that easy. We do expect several changes over the next 12 months but overall we think many of the current provisions will continue.
Trumps healthcare agenda
We don’t expect a full repeal of Obamacare but there are a number of changes we think will happen over the coming year.
- Allowing carriers to sell insurance across state lines
- Association health plans and an expansion of self-insured small group plans
- Delay the Cadillac Tax until 2026
- Eliminate employer shared responsibility penalties
- Allow individuals to use subsidy dollars for any health plan
- Increase HSA contributions to nearly double the current limits
What won’t change even if Trump gets his way?
- Pre-existing condition exclusion
- Ability to cover children to age 26
- Preventive services covered at 100%
- No annual or lifetime limits
- Limits on out of pocket maximums for large claims
There are also a few things that could go either way
- Limiting the pre-tax treatment of employee deductions for medical and dental plans
- Allowing tax deductions for individual policies
- Allowing employers to pay for individual policies with deductible dollars
- Allowing states to made decisions about Essential Health Benefits
You can see, there are a lot of moving parts and with every change there are winners and losers. What we do know is right now is it’s business as usual and you must continue to comply with the current rules. Carriers are making decisions right now about what types of policies they will offer in 2018 and who they will offer them to. Without a clear direction from the current administration we fear most will find it easier to walk away than continue to lose money in the individual market.
It’s important to understand that most of the pain is in the individual market. This is where the huge premium and benefit subsidies are being paid and the lack of enrollment, eligibility and guarantee issues rules have made it all but impossible for insurance carriers to manage claims and losses. Here in Tennessee we have been BlueCross BlueShield of TN pull out of the large markets leaving in many cases just one carrier for people to choose from. As of today, Knoxville and the surrounding counties will not have any insurance companies to choose from leaving them unable to get any coverage at all. Hopefully another carrier will fill the void but at what cost?
So, I messed my shoulder up skiing and after two months decided it's not getting better. Went to the orthopedist and he agree, I most have torn something. We need an MRI Post Arthrogram. Ok, that sounds expensive wonder what it will cost and where I should get that done since I have a HDHP and Health Savings Account and will be paying that toward my deductible. The nurse talked to the Imaging Center and got an estimate of $1,200, she agreed it's a lot of money.
Since I tell our clients all the time to shop around to make sure you are paying a "fair" price I decided I needed to shop around. We use BCBST for our medical coverage here so I started on their website with the new Cost Estimate tool. This knows the plan I have, where I am on my deductible and the discounts. I was pretty excited to use it until I did. I searched for an MRI upper joint with contrast and they did not have enough cost information in the database to help me, bummer.
Next I let my fingers do the walking with the help of Google. I searched for the MRI providers in my area, very few came up. I called those who did and though most were trying to help me, most could not give me even an estimate. I did have two who took my insurance information and called me back but could not ensure me it was the same test my doctor had ordered (Arthrogram is pretty specialized).
Heath Care BlueBook - This brought me to a new kind of pricing tool, not perfect but the best I have seen so far. Again, I put in my location and could choose the exact treatment I was looking for. Now I can see a low, medium an high cost and what the "fair" price is for my area. Turns out, $1,150 is a fair price and that is what I paid. Take a look for yourself at www.healthcarebluebook.com
There is so much talk about repealing and replacing the Affordable Care Act (ACA) and the fear this kind of broad sweeping statement makes. Yes, there are major problems and coverage is now unaffordable unless you get substantial subsidies from the Government. It’s important to note that there are some good parts of the ACA, there are many that are not so good, let’s work on those.
I am a longtime member of the National Association of Health Underwriters www.nahu.org and these ideas/statements are coming from their March, 2017 magazine. The article featured many different recommendations of changes to make immediately and others to implement them over time. These are a few of what I think are the best ideas.
- Open enrollment – The first thing is to only have one primary open enrollment period rather than an open enrollment every year. There would also credible life events like marriage, divorce, birth, adoption and job changes to create an open enrollment event. If you do not sign up at open enrolment and later sign up as a “late enrollee” you will now be subject to late enrollment penalties, pre-existing conditions and waiting periods. This creates a real incentive to maintain coverage and preserves guarantee issue. This eliminates an easy way to abuse the system with today’s flexible and unenforced open enrollment rules.
- Create hybrid high-risk pools – These pools would not issue coverage but insure risks for carriers who are insuring those who have not maintained continuous coverage. Late enrollment penalties would be paid to the pool for ceding risk from the carriers. The advantage is late enrollees would not be turned down for pre-existing conditions with this risk being passed to the pool. Because there is a mandatory waiting period before claims will be covered there is additional stabilization to the market.
- Allow states to increase competition by offering coverage from carriers domiciled in other states. Coverage offered must reflect the same essential benefits and mandates where the coverage is being offered.
- Allow states to increase competition by allowing association health plans. Coverage offered must reflect the same essential benefits and mandates where the coverage is being offered.
- Increase flexibility for HSAs by allowing a limited number of office visits to be covered by co-pays before the deductible each year. This will encourage more people to try an HSA qualified plan letting them see the advantages of an HSA combined with a HDHP as the underlying plan.
- Remove the metallic limitations of plan designs allowing carriers to offer plans they can better control and that make more sense in their specific market.
These are just a few of the ideas and recommendations to stabilize and improve the individual and small group health insurance market. One thing is for sure, we will see many ideas and proposals coming in the next couple of weeks. Hang on, it will be a bumpy ride but in the end we will all be ok.
Humana just announced they will not offer individual health insurance in 2018. "There isn't enough money in the ACA as it's structured, even with its fees and taxes, to support the population that needs to be served" say Aetna CEO Mark Bertolini.
This changes hits Tennesseans especially hard with Humana being the only insurer in thee of the states largest communities. In the Knoxville area alone there would be 40,000 Tennesseans losing coverage says Julie McPeak the TN insurance commissioner.