Category Archives: Health Insurance

Turning 21? How to avoid a big hike in health insurance premiums

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small_13316398214By Michelle Andrews
KHN

For young people, turning 21 is generally a reason to celebrate reaching adulthood.

If they’re insured through the federal health insurance marketplace that operates in about three dozen states, however, their birthday could mean a whopping 58 percent jump in their health insurance premium in 2015, according to an analysis by researchers at the Center on Budget and Policy Priorities.

The reason: They’re no longer considered children under the age-rating rules insurers use to set premiums.

Many 21-year-olds who qualify for premium subsidies will be able to sidestep the rate increase if they re-evaluate their coverage options on the federal marketplace before Feb. 15, when the annual open enrollment period ends.

When children turn 21, the insurer begins to compute their premiums based on an adult age-rating factor, which results in that 58 percent premium increase.

If they don’t, they’ll generally be automatically renewed into the same plan and with the same premium tax credit they had in 2014.

“If they don’t come back to the marketplace, they’re going to get a premium tax credit that’s based on their age rating as a child, and that premium difference is going to hit them,” says Judith Solomon, a vice president for health policy at the budget center.

Families with federal marketplace plans whose now 21-year-old children are covered as dependents will face a premium jump as well. Continue reading

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Administration warns employers: Don’t dump sick workers from plans

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Ban_signBy Jay Hancock
KHN

As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere.

Such a move would unlawfully discriminate against employees based on their health status, three federal agencies said in a bulletin issued this month.

Brokers and consultants have been offering to save large employers money by shifting workers with expensive conditions such as hepatitis or hemophilia into insurance marketplace exchanges established by the health law, Kaiser Health News reported in May.

Image courtesy of Xm1702 under Creative Commons license. 

Continue reading

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Humana and Multicare launch accountable care program

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image003MultiCare Health System and Humana Inc. will launch a new accountable care partnership for Humana’s Medicare Advantage members in South King County and Pierce County, the companies announced this week.

Accountable care partnership will provide Humana membership with more coordinated care that will emphasize preventive services, the companies said.

Humana offers Medicare Advantage HMO plans, a prescription drug plan and Medicare supplement policies to Medicare recipients in the Tacoma area.

MultiCare is made up of five hospitals including Allenmore HospitalAuburn Medical CenterGood Samaritan HospitalMary Bridge Children’s Hospital and Tacoma General Hospital as well as outpatient specialty centers, primary and urgent care clinics.

The not-for-profit health care organization has more than 10,500 employees and a comprehensive network of services throughout Pierce, South King, Thurston and Kitsap counties.

Humana aims to work closely with doctors and hospitals through its Accountable Care Continuum, the companies said.

For a Primer on Accountable Care Organizations go here.

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Shop around before automatically renewing your health plan

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Marketplaces Will Automatically Renew Consumers’ Plans But Take A Look First

Shopping CartBy Michelle Andrews
KHN

So far, the open enrollment period on the federal and state marketplaces—which started Nov. 15 and continues until Feb. 15 for 2015 coverage—is proceeding much more smoothly than last year. But people remain confused about plans, premiums and provider networks. Here are answers to several readers’ questions.

Q. I understand the federal marketplace will renew my coverage automatically this year. That seems really simple. Is there any reason I shouldn’t do it?  Continue reading

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Minimum wage a health issue? States take a broader view of health disparities.

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Minnesota_population_map_croppedBy Michael Ollove
Stateline

MINNEAPOLIS, Minn.— For years, proposals to raise the minimum wage in Minnesota bogged down over economic concerns: Would a raise impel businesses to leave the state? Would it decrease employment? Would it touch off inflation?

The supporters’ main argument, that raising the minimum wage would put more money into the pockets of low-wage workers and their families, fell short.

This year, proponents seized on a new strategy: They convinced the legislature to ask the Minnesota Department of Health to analyze the health impact of the state’s minimum wage of $6.15 an hour, which is among the lowest in the country.

The department’s subsequent analysis revealed that health and income levels were inextricably linked. Whether it was rates of adequate prenatal care, infant mortality, diabetes, suicide risk, or lack of insurance, the results for poorer Minnesotans were vastly inferior to residents with higher incomes.

In fact, Minnesotans living in the highest income areas of the Twin Cities region lived eight years longer than those living in the poorest.

The report virtually ended the debate. The legislature voted to phase in an increase in the minimum wage to $9.50—one of the highest in the country—with automatic subsequent increases indexed to the rate of inflation. Continue reading

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Wall Street is ‘bullish’ on 2015 Obamacare enrollment

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bullish-enrollment-obamacare-570By Julie Appleby
KHN

A group of Wall Street analysts predicted Friday that enrollment in health law insurance plans will be higher than the 9 million projected by the Obama administration because insurers are aggressively courting new customers and more small businesses are likely to send workers to the online exchanges in 2015.

Health sector analyst Carl McDonald of Citi Investment Research said he expects about 11 million people to enroll in individual health plans, based on his firm’s survey of clients in October.

“I’m more optimistic,” McDonald said at the 19th annual “Wall Street Comes to Washington” roundtable, sponsored by the Jayne Koskinas Ted Giovanis Foundation for Health and Policy.

More aggressive outreach by insurers and fewer glitches with the online marketplaces will create a “robust 2015,” agreed Ralph Giacobbe, an analyst at Credit Suisse. Continue reading

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Seniors’ obesity-counseling benefit goes largely unused

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ScaleBy Phil Galewitz
KHN

Three years ago, the Obama administration offered hope to millions of overweight seniors when it announced Medicare would offer free weight-loss counseling.

Officials estimated that about 30 percent of seniors are obese and therefore eligible for counseling services, which studies have shown improve the odds of significant weight loss.

But less than 1 percent of Medicare’s 50 million beneficiaries have used the benefit so far. Experts blame the government’s failure to promote the program, rules that limit where and when patients can go for counseling as well as the low fees for providers.

Since November 2011, about 120,000 seniors have participated, including about 50,000 last year, according to federal data.

“It’s very disappointing,” said Dr. Scott Kahan, an obesity medicine specialist at George Washington University.

“It’s a huge lost opportunity,” said Bonnie Modugno, a registered dietician in Santa Monica, Calif., who advises doctors how to provide weight loss counseling.

By  comparison, about 250,000 seniors last year used Medicare’s tobacco cessation counseling benefit, which started in 2005 and offers greater flexibility about how providers can offer it. Nationally, 9 percent of seniors smoke, while 30 percent are obese. Continue reading

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Boeing’s new accountable care health plans with UW Medicine and Providence-Swedish take off – Puget Sound Business Journal

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boeing-logoThe accountable care plans aim to lower costs for both employees and the company by incentivizing employee wellness and creating a more coordinated system to provide health care. By creating contracts directly between the employer and the health systems, the goal of these new systems is to reduce costs and confusion that often come from dealing with third parties while also improving care.

via Boeing’s new health plans with UW Medicine and Providence-Swedish take off – Puget Sound Business Journal.

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New Medicaid rule could hinder shift away from nursing homes

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A younger man holds an elderly man's handBy Christine Vestal
Stateline

For more than 30 years, states have been finding new ways to care for aged and disabled Medicaid beneficiaries without confining them to nursing homes.

In fact, the number of people living in skilled nursing facilities has declined significantly over the last decade, despite a marked increase in the ranks of the elderly in the U.S.

Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes—such as assisted living facilities, continuing care retirement communities, group homes and adult day care—work with residents and their families to develop individual care plans specifying the services and setting each resident wants.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one and to give residents choices about their care.

While nearly everyone supports the concept, states, providers and even some consumer advocates are complaining that the rule could make it difficult for health care providers to fulfill increasing demand for long-term care outside of nursing homes.

Under the rule, for example, elderly people with dementia who enter assisted living facilities should not be subjected to constraints, such as locked exits, unless they are at risk for wandering.

But if they share living space with other residents with dementia who do need to be prevented from wandering, it will be difficult to allow them to leave the building whenever they want without jeopardizing the safety of others.

“The goal was completely laudable,” said Martha Roherty, director of the National Association of States United for Aging and Disabilities, which works to help elders and people with disabilities live in their communities for as long as possible.

“Unfortunately, what’s happened is that it is limiting individuals’ choice of what and where to receive (long-term care) services rather than broadening it, especially as it relates to seniors,” she said. Continue reading

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Big changes for 2015 workplace plans: Watch out for these six possible pitfalls

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sixBy Jay Hancock
KHN

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans — where most working-age folks get coverage — are changing too.

Rising costs, a looming tax on rich benefit packages and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015.

“If there’s any year employees should pay attention to their annual enrollment material, this is probably the year,” said Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don’t blow off the human resources seminars. Ask these questions.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”  Continue reading

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Small business plans now available on the SHOP marketplace

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431px-Lewis_Hine_Power_house_mechanic_working_on_steam_pump

Small business owners: SHOP coverage is now available online at HealthCare.gov.

Start your SHOP application 

Need help? You can contact a SHOP-registered agent or broker in your area or call 1-800-706-7893 (TTY: 711), Monday – Friday 9am – 7pm ET.

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Obama urges Americans to sign up for health insurance:

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Obama urges Americans to sign up for health insurance:

“From November 15 to February 15, Americans across the country can sign up for a plan at HealthCare.gov and join the 8 million Americans who got covered last year. Need coverage? Go to HealthCare.gov to get started. Already covered? This is where you want to be. Share the facts and meet the faces of health care, then commit to get your friend, family member, or someone you know covered for 2015.”

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