The Latest: House passes sweeping GOP tax overhaul
WASHINGTON (AP) — The Latest on House consideration of the tax overhaul (all times local):
1:50 p.m.
The House has passed a sweeping Republican tax bill cutting taxes for corporations and many people. It puts GOP leaders closer to delivering to President Donald Trump a crucial legislative achievement after nearly a year of failures.
The House voted 227-205 along party lines to approve the bill, which would bring the biggest revamp of the U.S. tax system in three decades.
Most of the House bill’s reductions would go to business. Both the Senate and House would slash the 35 percent corporate tax rate to 20 percent and reduce levies on millions of partnerships and certain corporations, including many small businesses.
Personal income tax rates for many would be reduced through some deductions, and credits would be reduced or eliminated. But projected federal deficits would grow by $1.5 trillion over the coming decade.
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12:15 p.m.
Democrats are using new projections by Congress’ nonpartisan tax analysts to call the Senate Republican tax bill a boon to the wealthy that boosts middle-income families’ taxes.
The Joint Committee on Taxation estimated that starting in 2021, many families earning less than $30,000 would have tax increases under the bill. By 2027, families earning up to $75,000 would face higher levies, while those earning more would get tax cuts.
Republicans say the new calculations reflect two provisions in the bill.
The Senate measure ends personal income tax cuts beginning in 2026 because Republicans needed to reduce the bill’s costs to obey the chamber’s budget rules.
It also abolishes the requirement under former President Barack Obama’s health care law that people buy insurance. That means fewer people getting federally subsidized coverage — which analysts consider a tax boost.
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11:35 a.m.
President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber.
The closed-door meeting comes as GOP leaders hope that by Christmas, they will give Trump and themselves their first legislative triumph this year.
House approval was expected later Thursday of the plan to slash corporate tax rates and reduce personal income tax rates while eliminating some deductions and credits.
The Senate Finance Committee is aiming to pass its separate version by week’s end. But some GOP senators want changes.
Republicans say the final measure will bestow lower levies on millions of Americans and spur economic growth by reducing business taxes. Democrats say the measure is disproportionately tilted toward corporations and the wealthy.
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10:45 a.m.
Republicans drove a $1.5 trillion tax overhaul toward House passage Thursday. But Senate GOP dissenters also emerged in a sign that party leaders have problems to resolve before Congress can give President Donald Trump his first legislative triumph.
Trump was heading to the Capitol for a pep rally with House Republicans, shortly before the chamber was expected to approve the measure over solid Democratic opposition. There were just a handful of GOP opponents in the House, unhappy because the measure sharply curbs deductions for state and local taxes, but all agreed that passage seemed certain.
Like a similar package nearing approval by the GOP-led Senate Finance Committee, most of the House measure’s reductions would go to business. Personal income tax rates for many would be reduced, but some deductions and credits would be reduced or eliminated. Federal deficits would grow by $1.5 trillion over the coming decade.
You can read the original article here.
Source:
Associate Press (16 November 2017). "The Latest: House passes sweeping GOP tax overhaul" [Web blog post]. Retrieved from address https://apnews.com/b3297c1e443b40049beebcd832aaadc8?utm_campaign=SocialFlow&utm_source=Twitter&utm_medium=AP
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Critical compliance changes for next year: An open enrollment checklist
Keeping up-to-date with health care is one of our top priorities. From HR Morning, here is a comprehensive list of everything you need to know so far going into 2018.
As HR pros immerse themselves in negotiating plan changes for this year’s open enrollment, it’s critical to keep these new 2018 regulation changes front and center.
To help, here’s a checklist of changes you’ll need to be aware of when making plan-design moves:
1. Mental Health Parity reg changes enforced
Beginning January 1, 2018, plans that require “fail first” or “step therapy” could violate the Parity Act’s “non-quantitative treatment limitation” (NQTL) rules. Under the NQTL rules, plans can’t be more restrictive for mental health/substance abuse benefits than they are for medical/surgical ones.
Here’s an example of a fail-first strategy: Requiring mental health or addiction patients to try an intensive outpatient program before admission to an inpatient treatment if the same restriction doesn’t apply to medical/surgical benefits.
2. New Summary of Benefits and Coverage (SBC) template
Under the ACA, plans were required to start using the new SBC template on or after April 1, 2017.
For calendar year plans, that means this is the first enrollment with the new template, which includes new coverage examples and updates about cost-sharing. You can find more details on and instructions for the new form here: bit.ly/temp544
3. Women’s preventive care
The Women’s Preventive Services Guidelines were updated for 2018 calendar plans to include a number of items that must be covered without any cost-sharing. The list includes breast cancer screenings for average-risk women, screenings for cervical cancer, diabetes mellitus and more.
See the original article here.
Source:
Bilski J. (17 October 2017). "Critical compliance changes for next year: An open enrollment checklist" [Web blog post]. Retrieved from address https://www.hrmorning.com/critical-compliance-changes-for-next-year-an-open-enrollment-checklist/
IRS to reject returns lacking health coverage disclosure
Where does the IRS stand on ACA (Affordable Care Act)? It's time to know. Check out this article from Benefits Pro for more information.
The Internal Revenue Service has announced that for the first time, tax returns filed electronically in 2018 will be rejected if they do not contain the information about whether the filer has coverage, including whether the filer is exempt from the individual mandate or will pay the tax penalty imposed by the law on those who don’t buy coverage.
Tax returns filed on paper could have processing suspended and thus any possible refund delayed.
The New York Times reports that the IRS appears to be acting in contradiction to the first executive order issued by the Trump White House on inauguration day, in which Trump instructed agencies to “scale back” enforcement of regulations governing the ACA.
The move by the IRS reminds people that they can’t just ignore the ACA, despite the EO. Although only those lacking coverage have to pay the penalty, everyone has to indicate their insurance coverage status on their filing.
According to legal experts cited in the report, the IRS is indicating that although the administration may have leeway in how aggressively it enforces the mandate provision, it’s still in effect unless and until Congress specifically repeals it.
While many people thought they didn’t have to bother with reporting, and many insurers have raised rates anticipating that the lack of a mandate would lead to lower enrollments and higher costs for them, that’s not the case. Initially the IRS did not reject returns because the law was new.
The penalty is pretty steep; for those who don’t have coverage, it can range from $695 for an individual to a maximum of $2,085 for a family or 2.5 percent of AGI, whichever is higher. Not everyone without coverage would be penalized, though; if their income is too low or if the lowest-priced coverage costs more than 8.16 percent of their income, they’ll avoid the penalty.
That said, it’s not known how stringently the IRS will be in enforcing the mandate. But at least taxpayers will know whether they’re exempt from the penalty or whether they’re obligated to buy coverage.
5 Health Care Terms You Need to Know
We talk about health care A TON, but sometimes it's good to refer back to the basics of it all. Do you understand the meaning of deductible, premium or HSA? If so, give yourself a pat on the back. If not, don't worry! This blog post has got you covered.
Health care is confusing, but one thing's for certain: It's expensive. And health insurance companies don't always make it easy to understand what's covered, what's not, and how much you'll be on the hook for paying.
Deductible: The amount you pay before your insurance coverage kicks in. It resets annually.
Copay: The amount you pay after you have met your deductible. It's a fixed price for services and medications, and can vary by the type of physician you visit, the class of medication you're taking, and other factors.
Out-of-pocket maximum: The top limit of what you'll spend in a year out of pocket for deductibles and copays.
Premium: Your monthly fee for health insurance. If your employer provides you coverage, then you probably pay a portion of the premium, while your employer pays the rest. A higher premium may mean a lower deductible; on the other hand, a lower premium may mean a higher deductible.
Health savings account (HSA): A type of pre-tax savings account for health expenses. Funds roll over year to year, and some accounts even gain interest.
You can read the original article here.
Source:
Health.com (4 April 2017). "5 Health Care Terms You Need to Know" [Web blog post]. Retrieved from address https://www.health.com/mind-body/healthcare-terms-coinage
Health-Care Cost Expert Kathryn Votava on Buying Long-Term-Care Insurance
Health care can be an expensive matter, especially when seeking long-term solutions. We thought it'd be beneficial to find an article from the perspective of an expert on long-term insurance, enabling those looking into the solution to have a better idea of what they're getting into. From Health.com, here is an interview from Kathryn Votava.
You can read the original article here.
"The earlier you purchase a policy, the healthier you are and the more likely you are to qualify for insurance."(KATHRYN VOTAVA)
Many people rely on family and friends to provide care for them when they can no longer do it themselves. But at some point, the care required can be too much for these informal networks to handle. That's where long-term-care insurance comes in. Caregiving expenses are usually not covered by health insurance, and they can be staggeringa semi-private room in a nursing home, for instance, can run about $70,000 a year, and in-home care can reach as high as $350,000 for round-the-clock help. We asked Kathryn Votava, PhD, assistant professor of clinical nursing at the University of Rochester in New York and president of Goodcare.com, a company that analyzes health-care costs, for advice on how to shop for the best long-term insurance policy.
Q: What does long-term-care insurance cover?
A: Depending on what kind of policy you choose, it will pay for a nursing home, assisted-living facility, community programs, or for someone to come to your home to care for you. It can offset some of the costsnotice I said some. Most people think that if they have a long-term-care insurance policy, they're covered completely. Not only is the average policy not enough to cover the cost of this type of care, but people don't take health-care inflation into account. And you will still need to pay for your Medicare Part B, Medigap plan, prescription drugs, and doctor visits just as before. Those expenses don't go away and long-term-care insurance doesn't cover them.
Q: How much coverage should I get?
A: The average policy covers $149 a day. Now, if you live in some parts of Texas or Louisiana, that might cover your long-term-care needs. But in a place like New York City, the average is more than twice that. Get an understanding of what the costs are in your area. The two big surveys of nursing-home prices are from Genworth Financial and MetLife Financial. That will give you a ballpark figure, but even those underestimate how much it actually costs. I'd call a good nursing home or home health-care agency that you might like to use eventually. Find out what the daily cost might be, for example $300 a day, and buy the coverage that's closest to that daily cost. When it comes to 24-hour care at home, you will find that a long-term-care insurance benefit will not come close to covering that level of cost, because extensive in-home care is costly. Remember that once you have exceeded two to four hours a day, seven days per week of in-home care, you will probably be paying more for long-term-care than if you were in a nursing home. Therefore, if you need more than two to four hours per day of in-home care, your long-term insurance benefit may provide more long-term-care if you are in a nursing home.
Q: How long should my coverage last?
A: You can purchase a policy that pays a set dollar amount per day for either some period of time or as a continuous lifetime benefit. I advise people that the most economical choice is to purchase a plan that provides benefits for five years. Only about 20% of people stay in a nursing home for five years or more. That's the minimum coverage you should have. If you have more money to spend, then certainly buy coverage for a longer time period or a bigger benefit so that if you're certain that you want in-home care, you will have more money to pay for it. Take the money you'll save on the shorter coverage period and buy a shorter waiting period, benefit for home care (as many policies pay out only 50 cents on the dollar for long-term-care at home), and compound-inflation protection riders. Don't give up coverage on the front end for something you are much less likely to collect on the back end. Once you have the minimum coverage, if you have more money to spend, then you can buy coverage for a longer time period.
Q: What additional features are worth paying for?
A: Get a compounded inflation rider. A "simple" inflation rider does not keep up with inflation nearly as well. One basic problem is that health-care inflation runs at 8.1% a year; the maximum inflation protection you can usually get in a long-term-care insurance policy is 5%thats the best you can do. While that 5% rate will not keep up entirely with health-care inflation, it will give you a better chance of being able to afford your long-term-care when the policy pays out. I also like to see people have a 30-day waiting period or lessthats the amount of time from when the insurance company determines that a person is eligible to use their long-term-care benefit to when the company begins to actually pay out for the benefit. All policies have some waiting period. People often get a 90-day or a 100-day waiting period because it lowers their premium, but you could end up paying thousands of dollars during the time you're waiting for coverage to start. Finally, I recommend a nonforfeiture-of-benefit rider. Typically, you're only eligible for the insurance benefits as long as you pay your premium. But the nonforfeiture rider lets you maintain some value in a policy even if you decide not to continue paying for it. That could be very important if the insurance company you're with decides to go out of this business and sells your policy to someone else who jacks up your premium so much you can't afford it anymore. The non-forfeiture rider means you will get some amount of the policy benefitnot all, but somedepending what you paid in over time. One last thing: Make sure the insurance company you choose has a solid track record. Call the National Association of Insurance Commissioners at (866)-470-6246 and get the phone number for your state health-insurance department. Then contact your state insurance department to find out if there are any reported problems with an insurance company you are considering.
Q: When should you buy the insurance?
A: At the latest, I'd say late 40s or early 50s. It's still affordable then. The premium is based on your heath status first, then your age. Generally speaking, the earlier you purchase a policy, the healthier you are and the more likely you are to qualify for insurance. People who have serious, chronic conditions may find their rates to be really high or they may even be uninsurable. The costs vary greatly from policy to policy, state to state, and person to person. Usually someone in his or her late 40s or early 50s will pay about $3,000 to $6,000 a year. That's for a very good policy. Someone in his 60s could pay several thousand dollars a year more for the same policy.
Q: When does the coverage start?
A: In order for the policy to kick in, you must have a certain level of need. Most providers define that as not being able to perform at least two of what are called "activities of daily living," in insurance-speak. Those are: bathing, eating, dressing, toileting, and transferring from bed to chair. So, you might have a hard time giving yourself a bath, and it might take you all day to do and then you're completely exhausted, but to the insurance company you're not compromised enough to use the insurance for that. The exception to that rule is folks with dementia. They may be able to perform those tasks, but they need supervision, so the insurance company will often pay out for their care.
Q: Can you run into problems collecting your insurance?
A: It's gotten better. Some of the companies that were the most difficult to deal with were on shaky financial ground, and they've gone out of business. Remember, the person who comes to do the assessment of whether you're able to perform the activities of daily living works for the insurance company, not for you. They'll be looking at your case through that lens. If you run into trouble getting them to pay benefits, you might want to enlist an advocate, like a geriatric care manager, if more than a simple follow-up phone call is necessary.
You can read the original article here.
Source:
Polyak I. (25 January 2011). "Health-Care Cost Expert Kathryn Votava on Buying Long-Term-Care Insurance" [Web blog post]. Retrieved from address https://www.health.com/health/article/0,,20456208,00.html
Collaborative Innovation Is Necessary To Advance In Health Care
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As health needs grow, it is imperative that innovation is at the frontier of change, to keep the health needs and requirements of the 21st century scalable. For innovation in health care to be sustained at an economically and fiscally responsible pace, it has to be a collaborative effort, requiring input from diverse stakeholders and key players in the industry. A collaborative health care system that includes information sharing, cross-industry cooperation and open innovation can lead to beneficial industry practices like cost reduction and time efficiency. Together, these practices set a precedent for growth and development at a more rapid pace.
An Efficient Method Of Doing Things
Toeing the line of technology advancements, innovation within the health care system has pioneered the development of cost-efficient, highly-optimized pragmatic solutions to many industry and individual health challenges. Artificial retinas, robotic nurses and gene therapy are just a few examples of plentiful recent innovations. These innovative technologies pose solutions to medical feats that, in the past, have overwhelmed medical practitioners, and thereby are expected to permit better health care delivery to patients and the global population. However, for these new advancements to be successfully implemented and established within the health care system, they must be met with collaboration and cooperation.
Creating A Synergistic Environment
Open, collective innovation like Project Data Sphere, designed to collate big data and bridge the distant segments of the health care industry, markup the necessity of innovation in the sector. In the case of Project Data Sphere, the goal is to facilitate the creation of a connected health care network bereft of the many loopholes characteristic of the system. Interoperability between key segments of the industry has always been a rate limiting factor. A unified platform capable of linking these segments together can have a significant impact on the sector.
Multiple companies are undertaking projects to build "cloud-based, big data platform" solutions that manage data to give the health industry the necessary edge it needs to manage itself. This ranges from cloud-based platforms powered by libraries of clinical, social and behavioral analytics utilized for sharing information across multiple hospitals, to using big data and advanced analytics for clinical improvements, financial analysis and fraud and waste monitoring.
Collaborating To Go Digital
Concurrent with the world’s continued adoption of digital technologies is the rapid expansion of the digital health care market — an expansion fostered by collaboration among global leaders of digital innovation in the health care industry. The partnership between major players in both the private and public sectors has engineered a growing list of innovative digital health care solutions.
Just last year an Israeli-based pharmaceutical company joined forces with Santa Clara, California-based Intel to develop wearables that routinely record and analyze symptoms of Huntington’s disease. The data collected is processed to help grade motor symptom severity associated with the disease.
Most times, singular organizations lack the human and financial resources to orchestrate grand schemes of innovation alone — but collaboration presents a practical route to overcoming the limitations that hinder novelty, leading to quicker turnarounds and advancements.
Scaling The Barriers To Innovation
If the push for innovation in the health care system is to thrive, then the complexities and obstacles that have continually stifled progress must be confronted. Aside from collaboration, other notable barriers to innovation include:
• The immediate return mentality: By default, most leaders show a preference for innovative solutions that offer immediate financial rewards. Innovative solutions with brighter prospects but long term financial incentives are in most instances placed on a back burner.
• Bureaucracy in the distributive network:Innovators have to wade through multiple third parties if they are to stand any chance of getting their products to the end user, a process that is not only daunting but financially implicative.
• Stringent regulatory practices: In addition to scaling through the bureaucracy, innovative solutions looking to make a market appearance have to pass several screenings, some of which have been tagged redundant by experts.
Innovation is a necessary tool in the health care sector that gives an essential boost to scale insurmountable obstacles and limitations. For health care to evolve into a more sophisticated and efficient system, cross-industry collaboration and inter-professional cooperation must become the norm.
You can read the original article here.
Source:
Pando A. (19 September 2017). "Collaborative Innovation Is Necessary To Advance In Health Care" [Web blog post]. Retrieved from address https://www.forbes.com/sites/forbestechcouncil/2017/09/19/collaborative-innovation-is-necessary-to-advance-in-health-care/2/#6743d07669c9
Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind
How are the rising costs of Medicare Part B affecting Seniors? Don't be left in the dark. Find out more in this article.
Millions of seniors will soon be notified that Medicare premiums for physicians’ services are rising and likely to consume most of the cost-of-living adjustment they’ll receive next year from Social Security.
Higher 2018 premiums for Medicare Part B will hit older adults who’ve been shielded from significant cost increases for several years, including large numbers of low-income individuals who struggle to make ends meet.
“In effect, this means that increases in Social Security benefits will be minimal, for a third year, for many people, putting them in a bind,” said Mary Johnson, Social Security and Medicare policy consultant at the Senior Citizens League. In a new study, her organization estimates that seniors have lost one-third of their buying power since 2000 as Social Security cost-of-living adjustments have flattened and health care and housing costs have soared.
Another, much smaller group of high-income older adults will also face higher Medicare Part B premiums next year because of changes enacted in 2015 federal legislation.
Here’s a look at what’s going on and who’s affected:
The Basics
Medicare Part B is insurance that covers physicians’ services, outpatient care in hospitals and other settings, durable medical equipment such as wheelchairs or oxygen machines, laboratory tests, and some home health care services, among other items. Coverage is optional, but 91 percent of Medicare enrollees — including millions of people with serious disabilities — sign up for the program. (Those who don’t sign up are responsible for charges for these services on their own.)
Premiums, which change annually, represent about 25 percent of Medicare Part B’s expected per-beneficiary program spending. The government pays the remainder.
In fiscal 2017, federal spending for Medicare Part B came to $193 billion. From 2017 to 2024, Part B premiums are projected to rise an average 5.4 percent each year, faster than other parts of Medicare.
‘Hold Harmless’ Provisions
To protect seniors living on fixed incomes, a “hold harmless” provision in federal law prohibits Medicare from raising Part B premiums if doing so would end up reducing an individual’s Social Security benefits.
This provision applies to about 70 percent of people enrolled in Part B. Included are seniors who’ve been enrolled in Medicare for most of the past year and whose Part B premiums are automatically deducted from their Social Security checks.
Excluded are seniors who are newly enrolled in Medicare or those dually enrolled in Medicaid or enrolled in Medicare Savings Programs. (Under this circumstance, Medicaid, a joint federal-state program, pays Part B premiums.) Also excluded are older adults with high incomes who pay more for Part B because of Income-Related Monthly Adjustments (see more on this below).
Recent Experience
Since there was no cost-of-living adjustment for Social Security in 2016, Part B monthly premiums didn’t go up that year for seniors covered by hold harmless provisions. Instead, premiums for this group remained flat at $104.90 — where they’ve been for the previous three years.
Last year, Social Security gave recipients a tiny 0.3 percent cost-of-living increase. As a result, average 2017 Part B month premiums rose slightly, to $109, for seniors in the hold harmless group. The 2017 monthly premium average, paid by those who weren’t in this group and who therefore pay full freight, was $134.
Current Situation
Social Security is due to announce cost-of-living adjustments for 2018 in mid-October. Based on the best information available, it appears to be considering an adjustment of about 2.2 percent, according to Juliette Cubanski, associate director of the program on Medicare policy at the Kaiser Family Foundation. (Kaiser Health News is another, independent program of the Kaiser Family Foundation.)
Apply a 2.2 percent adjustment to the average $1,360 monthly check received by Social Security recipients and they’d get an extra $29.92 in monthly payments.
For their part, the board of trustees of Medicare have indicated that Part B monthly premiums are likely to remain stable at about $134 a month next year. (Actual premium amounts should be disclosed by the Centers for Medicare & Medicaid Services within the next four to six weeks.)
Medicare has the right to impose that charge, so long as the amount that seniors receive from Social Security isn’t reduced in the process. So, the program is expected to ask older adults who paid $109 this year to pay $134 for Part B coverage next year — an increase of $25 a month.
Subtract that extra $25 charge for Part B premiums from seniors’ average $29.92 monthly Social Security increase and all that be left would be an extra $4.92 each month for expenses such as food, housing, medication and transportation.
“Many seniors are going to be disappointed,” said Lisa Swirsky, a policy adviser at the National Committee to Preserve Social Security and Medicare.
Higher Income Brackets
Under the principle that those who have more can afford to pay more, Part B premium surcharges for higher-income Medicare beneficiaries have been in place since 2007. These Income-Related Monthly Adjustment Amounts (IMRAA) surcharges vary, depending on the income bracket that individuals and married couples are in. Nearly 3 million Medicare members paid the surcharges in 2015.
For the past decade this is how surcharges have worked:
Bracket One: Individuals with incomes of $85,001 to $107,000 were charged 35 percent of Part B per-beneficiary costs, resulting in 2017 premiums of $187.50.
Bracket Two: Incomes of $107,001 to $160,000 were charged 50 percent, resulting in 2017 premiums of $267.90.
Bracket Three: Incomes of $160,001 to $214,000 were charged 65 percent, resulting in 2017 premiums of $348.30
Bracket Four: Incomes of more than $214,000 were charged 80 percent, resulting in 2017 premiums of $428.60.
(Information for married couples who file jointly can be found here.)
Now, under legislation passed in 2015, brackets two, three and four are adopting lower income thresholds, a move that could raise premiums for hundreds of thousands of seniors. Bracket two will now consist of individuals with incomes of $107,001 to $133,500; bracket three will consist of individuals making $133,501 to 160,000; and bracket four will include individuals making more than $160,000. (Thresholds for couples have been altered as well.)
As John Grobe, president of Federal Career Experts, a consulting firm, noted in a blog post, this change “will add another layer of complexity” to higher-income individuals’ decisions regarding “electing Part B.”
You can read the original article here.
Source:
Graham J. (5 October 2017). "Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind" [web blog post]. Retrieved from address https://khn.org/news/despite-boost-in-social-security-rising-medicare-part-b-costs-leave-seniors-in-bind/
Long-Term Disability Insurance Gets Little Attention But Can Pay Off Big Time
Is disability coverage worth it? At Saxon, we love to keep you updated on the latest news in the retirement world, and today, we want to dive into disability coverage. Check out this engaging and helpful article we pulled from KHN.
“It won’t happen to me.” Maybe that sentiment explains consumers’ attitude toward long-term disability insurance, which pays a portion of your income if you are unable to work.
Sixty-five percent of respondents surveyed this year by LIMRA, an association of financial services and insurance companies, said that most people need disability insurance. But the figure shrank to 48 percent when people were asked if they believe they personally need it. The proportion shriveled to 20 percent when people were asked if they actually have disability insurance.
As the annual benefits enrollment season gets underway at many companies, disability coverage may be one option worth your attention.
Some employers may be asking you to pay a bigger share or even the full cost. That can have a hidden advantage later, if you use the policy. Or you may find that your employer has automatically enrolled you — or plans to — unless you opt out. A growing number of employers are going that route to boost coverage that they feel is in their employees’ best interests, not to mention their own, since insurers usually require a minimum level of employee participation in order to offer a plan.
Benefits consultants agree that although long-term disability coverage lacks the novelty appeal of some other benefits that companies are offering these days — hello, pet insurance — it can prove much more valuable in the long run.
“This is a really critical safety-net benefit,” said Rich Fuerstenberg, a senior partner at human resources consultant Mercer.
If you become disabled because of accident, injury or illness, long-term disability insurance typically pays 50 to 60 percent of your income, while you’re unable to work. The length of time the policy pays varies; some policies pay until you reach age 65.
Long-term disability generally has a waiting period of three or six months before benefits kick in. That period would be covered by short-term disability insurance, if you have it.
Many long-term disability claims are for chronic problems such as cancer and musculoskeletal conditions. According to the Council for Disability Awareness, the average duration of a claim is nearly three years — 34.6 months.
Not everyone has savings to support them through that time. When the Federal Reserve Board surveyed adults about household economics in 2015, 53 percent said they don’t have a rainy day fund that could cover them even for three months. More troubling, nearly half of respondents — 46 percent — said that faced with a hypothetical $400 emergency expense, they didn’t have the cash to cover it.
According to the Social Security Administration, 1 in 4 people who are 20 years old now will be disabled before they reach age 67.
Overall, 41 percent of employers offer long-term disability insurance, according to LIMRA, though the proportion of larger employers who offer it is generally much higher. Compared with health insurance, premiums cost a pittance — $256 annually in 2016 on average for group plans, LIMRA says. Many employers pick up the whole tab or charge workers a small amount.
However, as employers continue to shift benefit costs onto employee shoulders, long-term disability is no exception. Increasingly, they’re offering the coverage as a “voluntary” benefit, meaning employees pay the entire premium.
The upside is that if employees pay for the coverage themselves with after-tax dollars and they ever become disabled and need to use the coverage, the benefits will be tax-free.
“If an employee can choose to pay for coverage on a post-tax basis, or is paying on a voluntary basis, it’s better for them,” said Jackie Reinberg, national practice leader for absence, disability management and life at benefits consultant Willis Towers Watson.
Some employers may pay for a core basic benefit that replaces 40 or 50 percent of income and offer workers the opportunity to “buy up” to more generous income replacement of 60 or 70 percent.
Although voluntary coverage has a tax advantage, disability consultants are concerned that leaving it up to employees, especially if they’re choosing among several other voluntary coverage options like cancer insurance, critical illness coverage and yes, pet insurance, increases the odds they’ll skip buying long-term disability coverage.
“These coverages all feel the same, and if you’re going to choose one at all you tend to go with the one that’s cheapest and the one that you think you might use,” said Carol Harnett, president of the Council for Disability Awareness, a membership group of disability insurers that does education and outreach about disability issues.
Auto-enrollment can make a big difference. Employers that auto-enroll employees in voluntary long-term disability plans may get 75 percent of employees to participate, compared with 30 percent for employers that leave it completely up to workers, said Mike Simonds, CEO of disability insurer Unum US.
If you were offered long-term disability coverage when you were hired and didn’t sign up, it may be tougher to do so during the open enrollment period, said Fuerstenberg. A growing number of health plans require employees to show “evidence of insurability,” meaning they must answer a series of health-related questions before they’re approved. Some long-term disability policies may also have preexisting condition provisions that won’t pay benefits for a condition for up to a year, for example.
You can read the original article here.
Source:
Andrews M. (10 October 2017). "Long-Term Disability Insurance Gets Little Attention But Can Pay Off Big Time" [web blog post]. Retrieved from address https://khn.org/news/long-term-disability-insurance-gets-little-attention-but-can-pay-off-big-time/
An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges
Each year insurers submit filings to state regulators detailing their plans to participate on the Affordable Care Act marketplaces (also called exchanges). These filings include information on the premiums insurers plan to charge in the coming year and which areas they plan to serve. Each state or the federal government reviews premiums to ensure they are accurate and justifiable before the rate goes into effect, though regulators have varying types of authority and states make varying amounts of information public.
In this analysis, we look at preliminary premiums and insurer participation in the 20 states and the District of Columbia where publicly available rate filings include enough detail to be able to show the premium for a specific enrollee. As in previous years, we focus on the second-lowest cost silver plan in the major city in each state. This plan serves as the benchmark for premium tax credits. Enrollees must also enroll in a silver plan to obtain reduced cost sharing tied to their incomes. About 71% of marketplace enrollees are in silver plans this year.
States are still reviewing premiums and participation, so the data in this report are preliminary and could very well change. Rates and participation are not locked in until late summer or early fall (insurers must sign an annual contract by September 27 in states using Healthcare.gov).
Insurers in this market face new uncertainty in the current political environment and in some cases have factored this into their premium increases for the coming year. Specifically, insurers have been unsure whether the individual mandate (which brings down premiums by compelling healthy people to buy coverage) will be repealed by Congress or to what degree it will be enforced by the Trump Administration. Additionally, insurers in this market do not know whether the Trump Administration will continue to make payments to compensate insurers for cost-sharing reductions (CSRs), which are the subject of a lawsuit, or whether Congress will appropriate these funds. (More on these subsidies can be found here).
The vast majority of insurers included in this analysis cite uncertainty surrounding the individual mandate and/or cost sharing subsidies as a factor in their 2018 rates filings. Some insurers explicitly factor this uncertainty into their initial premium requests, while other companies say if they do not receive more clarity or if cost-sharing payments stop, they plan to either refile with higher premiums or withdraw from the market. We include a table in this analysis highlighting examples of companies that have factored this uncertainty into their initial premium increases and specified the amount by which the uncertainty is increasing rates.
Changes in the Second-Lowest Cost Silver Premium
The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. The table below shows these premiums for a major city in each state with available data. (Our analyses from 2017, 2016, 2015, and 2014 examined changes in premiums and participation in these states and major cities since the exchange markets opened nearly four years ago.)
Across these 21 major cities, based on preliminary 2018 rate filings, the second-lowest silver premium for a 40-year-old non-smoker will range from $244 in Detroit, MI to $631 in Wilmington, DE, before accounting for the tax credit that most enrollees in this market receive.
Of these major cities, the steepest proposed increases in the unsubsidized second-lowest silver plan are in Wilmington, DE (up 49% from $423 to $631 per month for a 40-year-old non-smoker), Albuquerque, NM (up 34% from $258 to $346), and Richmond, VA (up 33% from $296 to $394). Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Providence, RI (down -5% from $261 to $248 for a 40-year-old non-smoker) and remain essentially unchanged in Burlington, VT ($492 to $491).
As discussed in more detail below, this year’s preliminary rate requests are subject to much more uncertainty than in past years. An additional factor driving rates this year is the return of the ACA’s health insurance tax, which adds an estimated 2 to 3 percentage points to premiums.
Most enrollees in the marketplaces (84%) receive a tax credit to lower their premium and these enrollees will be protected from premium increases, though they may need to switch plans in order to take full advantage of the tax credit. The premium tax credit caps how much a person or family must spend on the benchmark plan in their area at a certain percentage of their income. For this reason, in 2017, a single adult making $30,000 per year would pay about $207 per month for the second-lowest-silver plan, regardless of the sticker price (unless their unsubsidized premium was less than $207 per month). If this person enrolls in the second lowest-cost silver plan is in 2018 as well, he or she will pay slightly less (the after-tax credit payment for a similar person in 2018 will be $201 per month, or a decrease of 2.9%). Enrollees can use their tax credits in any marketplace plan. So, because tax credits rise with the increase in benchmark premiums, enrollees are cushioned from the effect of premium hikes.
| Table 1: Monthly Silver Premiums and Financial Assistance for a 40 Year Old Non-Smoker Making $30,000 / Year | ||||||||||
| State | Major City | 2nd Lowest Cost Silver Before Tax Credit |
2nd Lowest Cost Silver After Tax Credit |
Amount of Premium Tax Credit | ||||||
| 2017 | 2018 | % Change from 2017 |
2017 | 2018 | % Change from 2017 |
2017 | 2018 | % Change from 2017 |
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| California* | Los Angeles | $258 | $289 | 12% | $207 | $201 | -3% | $51 | $88 | 71% |
| Colorado | Denver | $313 | $352 | 12% | $207 | $201 | -3% | $106 | $150 | 42% |
| Connecticut | Hartford | $369 | $417 | 13% | $207 | $201 | -3% | $162 | $216 | 33% |
| DC | Washington | $298 | $324 | 9% | $207 | $201 | -3% | $91 | $122 | 35% |
| Delaware | Wilmington | $423 | $631 | 49% | $207 | $201 | -3% | $216 | $430 | 99% |
| Georgia | Atlanta | $286 | $308 | 7% | $207 | $201 | -3% | $79 | $106 | 34% |
| Idaho | Boise | $348 | $442 | 27% | $207 | $201 | -3% | $141 | $241 | 70% |
| Indiana | Indianapolis | $286 | $337 | 18% | $207 | $201 | -3% | $79 | $135 | 72% |
| Maine | Portland | $341 | $397 | 17% | $207 | $201 | -3% | $134 | $196 | 46% |
| Maryland | Baltimore | $313 | $392 | 25% | $207 | $201 | -3% | $106 | $191 | 81% |
| Michigan* | Detroit | $237 | $244 | 3% | $207 | $201 | -3% | $29 | $42 | 44% |
| Minnesota** | Minneapolis | $366 | $383 | 5% | $207 | $201 | -3% | $159 | $181 | 14% |
| New Mexico | Albuquerque | $258 | $346 | 34% | $207 | $201 | -3% | $51 | $144 | 183% |
| New York*** | New York City | $456 | $504 | 10% | $207 | $201 | -3% | $249 | $303 | 21% |
| Oregon | Portland | $312 | $350 | 12% | $207 | $201 | -3% | $105 | $149 | 42% |
| Pennsylvania | Philadelphia | $418 | $515 | 23% | $207 | $201 | -3% | $211 | $313 | 49% |
| Rhode Island | Providence | $261 | $248 | -5% | $207 | $201 | -3% | $54 | $47 | -13% |
| Tennessee | Nashville | $419 | $507 | 21% | $207 | $201 | -3% | $212 | $306 | 44% |
| Vermont | Burlington | $492 | $491 | 0% | $207 | $201 | -3% | $285 | $289 | 2% |
| Virginia | Richmond | $296 | $394 | 33% | $207 | $201 | -3% | $89 | $193 | 117% |
| Washington | Seattle | $238 | $306 | 29% | $207 | $201 | -3% | $31 | $105 | 239% |
| NOTES: *The 2018 premiums for MI and CA reflect the assumption that CSR payments will continue. **The 2018 premium for MN assumes no reinsurance. ***Empire has filed to offer on the individual market in New York in 2018 but has not made its rates public. SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. |
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Looking back to 2014, when changes to the individual insurance market under the ACA first took effect, reveals a wide range of premium changes. In many of these cities, average annual premium growth over the 2014-2018 period has been modest, and in two cites (Indianapolis and Providence), benchmark premiums have actually decreased. In other cities, premiums have risen rapidly over the period, though in some cases this rapid growth was because premiums were initially quite low (e.g., in Nashville and Minneapolis).
| Table 2: Monthly Benchmark Silver Premiums for a 40 Year Old Non-Smoker, 2014-2018 |
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| State | Major City | 2014 | 2015 | 2016 | 2017 | 2018 | Average Annual % Change from 2014 to 2018 | Average Annual % Change After Tax Credit, $30K Income |
| California | Los Angeles | $255 | $257 | $245 | $258 | $289 | 3% | -1% |
| Colorado | Denver | $250 | $211 | $278 | $313 | $352 | 9% | -1% |
| Connecticut | Hartford | $328 | $312 | $318 | $369 | $417 | 6% | -1% |
| DC | Washington | $242 | $242 | $244 | $298 | $324 | 8% | -1% |
| Delaware | Wilmington | $289 | $301 | $356 | $423 | $631 | 22% | -1% |
| Georgia | Atlanta | $250 | $255 | $254 | $286 | $308 | 5% | -1% |
| Idaho | Boise | $231 | $210 | $273 | $348 | $442 | 18% | -1% |
| Indiana | Indianapolis | $341 | $329 | $298 | $286 | $337 | 0% | -1% |
| Maine | Portland | $295 | $282 | $288 | $341 | $397 | 8% | -1% |
| Maryland | Baltimore | $228 | $235 | $249 | $313 | $392 | 15% | -1% |
| Michigan* | Detroit | $224 | $230 | $226 | $237 | $244 | 2% | -1% |
| Minnesota** | Minneapolis | $162 | $183 | $235 | $366 | $383 | 24% | 6% |
| New Mexico | Albuquerque | $194 | $171 | $186 | $258 | $346 | 16% | 1% |
| New York*** | New York City | $365 | $372 | $369 | $456 | $504 | 8% | -1% |
| Oregon | Portland | $213 | $213 | $261 | $312 | $350 | 13% | -1% |
| Pennsylvania | Philadelphia | $300 | $268 | $276 | $418 | $515 | 14% | -1% |
| Rhode Island | Providence | $293 | $260 | $263 | $261 | $248 | -4% | -1% |
| Tennessee | Nashville | $188 | $203 | $281 | $419 | $507 | 28% | 2% |
| Vermont | Burlington | $413 | $436 | $468 | $492 | $491 | 4% | -1% |
| Virginia | Richmond | $253 | $260 | $276 | $296 | $394 | 12% | -1% |
| Washington | Seattle | $281 | $254 | $227 | $238 | $306 | 2% | -1% |
| NOTES: *The 2018 premiums for MI and CA reflect the assumption that CSR payments will continue. **The 2018 premium for MN assumes no reinsurance. ***Empire has filed to offer on the individual market in New York in 2018 but has not made its rates public. SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. |
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Changes in Insurer Participation
Across these 20 states and DC, an average of 4.6 insurers have indicated they intend to participate in 2018, compared to an average of 5.1 insurers per state in 2017, 6.2 in 2016, 6.7 in 2015, and 5.7 in 2014. In states using Healthcare.gov, insurers have until September 27 to sign final contracts to participate in 2018. Insurers often do not serve an entire state, so the number of choices available to consumers in a particular area will typically be less than these figures.
| Table 3: Total Number of Insurers by State, 2014 – 2018 | |||||
| State | Total Number of Issuers in the Marketplace | ||||
| 2014 | 2015 | 2016 | 2017 | 2018 (Preliminary) | |
| California | 11 | 10 | 12 | 11 | 11 |
| Colorado | 10 | 10 | 8 | 7 | 7 |
| Connecticut | 3 | 4 | 4 | 2 | 2 |
| DC | 3 | 3 | 2 | 2 | 2 |
| Delaware | 2 | 2 | 2 | 2 | 1 (Aetna exiting) |
| Georgia | 5 | 9 | 8 | 5 | 4 (Humana exiting) |
| Idaho | 4 | 5 | 5 | 5 | 4 (Cambia exiting) |
| Indiana | 4 | 8 | 7 | 4 | 2 (Anthem and MDwise exiting) |
| Maine | 2 | 3 | 3 | 3 | 3 |
| Maryland | 4 | 5 | 5 | 3 | 3 (Cigna exiting, Evergreen1 filed to reenter) |
| Michigan | 9 | 13 | 11 | 9 | 8 (Humana exiting) |
| Minnesota | 5 | 4 | 4 | 4 | 4 |
| New Mexico | 4 | 5 | 4 | 4 | 4 |
| New York | 16 | 16 | 15 | 14 | 14 |
| Oregon | 11 | 10 | 10 | 6 | 5 (Atrio exiting) |
| Pennsylvania | 7 | 8 | 7 | 5 | 5 |
| Rhode Island | 2 | 3 | 3 | 2 | 2 |
| Tennessee | 4 | 5 | 4 | 3 | 3 (Humana exiting, Oscar entering) |
| Vermont | 2 | 2 | 2 | 2 | 2 |
| Virginia | 5 | 6 | 7 | 8 | 6 (UnitedHealthcare and Aetna exiting) |
| Washington | 7 | 9 | 8 | 6 | 5 (Community Health Plan of WA exiting) |
| Average (20 states + DC) | 5.7 | 6.7 | 6.2 | 5.1 | 4.6 |
| NOTES: Insurers are grouped by parent company or group affiliation, which we obtained from HHS Medical Loss Ratio public use files and supplemented with additional research. 1The number of preliminary 2018 insurers in Maryland includes Evergreen, which submitted a filing but has been placed in receivership. SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. |
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Uncertainty Surrounding ACA Provisions
Insurers in the individual market must submit filings with their premiums and service areas to states and/or the federal government for review well in advance of these rates going into effect. States vary in their deadlines and processes, but generally, insurers were required to submit their initial rate requests in May or June of 2017 for products that go into effect in January 2018. Once insurers set their premiums for 2018 and sign final contacts at the end of September, those premiums are locked in for the entire calendar year and insurers do not have an opportunity to revise their rates or service areas until the following year.
Meanwhile, over the course of this summer, the debate in Congress over repealing and replacing the Affordable Care Act has carried on as insurers set their rates for next year. Both the House and Senate bills included provisions that would have made significant changes to the law effective in 2018 or even retroactively, including repeal of the individual mandate penalty. Additionally, the Trump administration has sent mixed signals over whether it would continue to enforce the individual mandate or make payments to insurers to reimburse them for the cost of providing legally required cost-sharing assistance to low-income enrollees.
Because this policy uncertainty is far outside the norm, insurers are making varying assumptions about how this uncertainty will play out and affect premiums. Some states have attempted to standardize the process by requesting rate submissions under multiple scenarios, while other states appear to have left the decision up to each individual company. There is no standard place in the filings where insurers across all states can explain this type of assumption, and some states do not post complete filings to allow the public to examine which assumptions insurers are making.
In the 20 states and DC with detailed rate filings included in the previous sections of this analysis, the vast majority of insurers cite policy uncertainty in their rate filings. Some insurers make an explicit assumption about the individual mandate not being enforced or cost-sharing subsidies not being paid and specify how much each assumption contributes to the overall rate increase. Other insurers state that if they do not get clarity by the time final rates must be submitted – which has now been delayed to September 5 for the federal marketplace – they may either increase their premiums further or withdraw from the market.
Table 4 highlights examples of insurers that have explicitly factored into their premiums an assumption that either the individual mandate will not be enforced or cost-sharing subsidy payments will not be made and have specified the degree to which that assumption is influencing their initial rate request. As mentioned above, the vast majority of companies in states with detailed rate filings have included some language around the uncertainty, so it is likely that more companies will revise their premiums to reflect uncertainty in the absence of clear answers from Congress or the Administration.
Insurers assuming the individual mandate will not be enforced have factored in to their rate increases an additional 1.2% to 20%. Those assuming cost-sharing subsidy payments will not continue and factoring this into their initial rate requests have applied an additional rate increase ranging from 2% to 23%. Because cost-sharing reductions are only available in silver plans, insurers may seek to raise premiums just in those plans if the payments end. We estimate that silver premiums would have to increase by 19% on average to compensate for the loss of CSR payments, with the amount varying substantially by state.
Several insurers assumed in their initial rate filing that payment of the cost-sharing subsidies would continue, but indicated the degree to which rates would increase if they are discontinued. These insurers are not included in the Table 4. If CSR payments end or there is continued uncertainty, these insurers say they would raise their rates an additional 3% to 10% beyond their initial request – or ranging from 9% to 38% in cases when the rate increases would only apply to silver plans. Some states have instructed insurers to submit two sets of rates to account for the possibility of discontinued cost-sharing subsidies. In California, for example, a surcharge would be added to silver plans on the exchange, increasing proposed rates an additional 12.4% on average across all 11 carriers, ranging from 8% to 27%.
| Table 4: Examples of Preliminary Insurer Assumptions Regarding Individual Mandate Enforcement and Cost-Sharing Reduction (CSR) Payments |
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| State | Insurer | Average Rate Increase Requested | Individual Mandate Assumption | CSR Payments Assumption | Requested Rate Increase Due to Mandate or CSR Uncertainty |
| CT | ConnectiCare | 17.5% | Weakly enforced1 | Not specified | Mandate: 2.4% |
| DE | Highmark BCBSD | 33.6% | Not enforced | Not paid | Mandate and CSR: 12.8% combined impact |
| GA | Alliant Health Plans | 34.5% | Not enforced | Not paid | Mandate: 5.0% CSR: Unspecified |
| ID | Mountain Health CO-OP | 25.0% | Not specified | Not paid | CSR: 17.0% |
| ID | PacificSource Health Plans | 45.6% | Not specified | Not paid | CSR: 23.2% |
| ID | SelectHealth | 45.0% | Not specified | Not paid | CSR: 20.0% |
| MD | CareFirst BlueChoice | 45.6% | Not enforced | Potentially not paid | Mandate: 20.0% |
| ME | Harvard PilgrimHealth Care | 39.7% | Weakly enforced | Potentially not paid | Mandate: 15.9% |
| MI | BCBS of MI | 26.9% | Weakly enforced | Potentially not paid (two rate submissions) | Mandate: 5.0% |
| MI | Blue Care Network of MI | 13.8% | Weakly enforced | Potentially not paid (two rate submissions) | Mandate: 5.0% |
| MI | Molina Healthcare of MI | 19.3% | Weakly enforced | Potentially not paid (two rate submissions) | Mandate: 9.5% |
| NM | CHRISTUS Health Plan | 49.2% | Not enforced | Potentially not paid | Mandate: 9.0%, combined impact of individual mandate non-enforcement and reduced advertising and outreach |
| NM | Molina Healthcare of NM | 21.2% | Weakly enforced | Paid | Mandate: 11.0% |
| NM | New Mexico Health Connections | 32.8% | Not enforced | Potentially not paid | Mandate: 20.0% |
| OR* | BridgeSpan | 17.2% | Weakly enforced | Potentially not paid | Mandate: 11.0% |
| OR* | Moda Health | 13.1% | Not enforced | Potentially not paid | Mandate: 1.2% |
| OR* | Providence Health Plan | 20.7% | Not enforced | Potentially not paid | Mandate: 9.7%, largely due to individual mandate non-enforcement |
| TN | BCBS of TN | 21.4% | Not enforced | Not paid | Mandate: 7.0% CSR: 14.0% |
| TN | Cigna | 42.1% | Weakly enforced | Not paid | CSR: 14.1% |
| TN | Oscar Insurance | NA (New to state) | Not enforced | Not paid | Mandate: 0%, despite non-enforcement CSR: 17.0%, applied only to silver plans |
| VA | CareFirst BlueChoice | 21.5% | Not enforced | Potentially not paid | Mandate: 20.0% |
| VA | CareFirst GHMSI | 54.3% | Not enforced | Potentially not paid | Mandate: 20.0% |
| WA | LifeWise Health Plan of Washington | 21.6% | Weakly enforced | Not paid | Mandate: 5.2% CSR: 2.3% |
| WA | Premera Blue Cross | 27.7% | Weakly enforced | Not paid | Mandate: 4.0% CSR: 3.1% |
| WA | Molina Healthcare of WA | 38.5% | Weakly enforced | Paid | Mandate: 5.4% |
| NOTES: The CSR assumption “Potentially not paid” refers to insurers that filed initial rates assuming CSR payments are made and indicated that uncertainty over CSR funding would change their initial rate requests. In Michigan, insurers were instructed to submit a second set of filings showing rate increases without CSR payments; the rates shown above assume continued CSR payments. *The Oregon Division of Financial Regulation reviewed insurer filings and advised adjustment of the impact of individual mandate uncertainty to between 2.4% and 5.1%. Although rates have since been finalized, the increases shown here are based on initial insurer requests. 1Connecticare assumes a public perception that the mandate will not be enforced. SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. |
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Discussion
A number of insurers have requested double-digit premium increases for 2018. Based on initial filings, the change in benchmark silver premiums will likely range from -5% to 49% across these 21 major cities. These rates are still being reviewed by regulators and may change.
In the past, requested premiums have been similar, if not equal to, the rates insurers ultimately charge. This year, because of the uncertainty insurers face over whether the individual mandate will be enforced or cost-sharing subsidy payments will be made, some companies have included an additional rate increase in their initial rate requests, while other companies have said they may revise their premiums late in the process. It is therefore quite possible that the requested rates in this analysis will change between now and open enrollment.
Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty. They must soon sign contracts locking in their premiums for the entire year of 2018, yet Congress or the Administration could make significant changes in the coming months to the law – or its implementation – that could lead to significant losses if companies have not appropriately priced for these changes. Insurers vary in the assumptions they make regarding the individual mandate and cost-sharing subsidies and the degree to which they are factoring this uncertainty into their rate requests.
Because most enrollees on the exchange receive subsidies, they will generally be protected from premium increases. Ultimately, most of the burden of higher premiums on exchanges falls on taxpayers. Middle and upper-middle income people purchasing their own coverage off-exchange, however, are not protected by subsidies and will pay the full premium increase, switch to a lower level plan, or drop their coverage. Although the individual market on average has been stabilizing, the concern remains that another year of steep premium increases could cause healthy people (particularly those buying off-exchange) to drop their coverage, potentially leading to further rate hikes or insurer exits.
Methods
Data were collected from health insurer rate filing submitted to state regulators. These submissions are publicly available for the states we analyzed. Most rate information is available in the form of a SERFF filing (System for Electronic Rate and Form Filing) that includes a base rate and other factors that build up to an individual rate. In states where filings were unavailable, we gathered data from tables released by state insurance departments. Premium data are current as of August 7, 2017; however, filings in most states are still preliminary and will likely change before open enrollment. All premiums in this analysis are at the rating area level, and some plans may not be available in all cities or counties within the rating area. Rating areas are typically groups of neighboring counties, so a major city in the area was chosen for identification purposes.
CenterStage...Open Season for Open Enrollment
In this month’s CenterStage, we interviewed Rich Arnold for some in-depth information on Medicare plans and health coverage. Read the full article below.
Open Season for Open Enrollment: What does it mean for you?
There are 10,000 people turning 65 every single day. Medicare has a lot of options, causing the process to be extremely confusing. Rich – a Senior Solutions Advisor – works hard to provide you with the various options available to seniors in Ohio, Kentucky and Indiana and reduce them to an ideal, simple, and easy-to-follow plan.
“For me, this is all about helping people.”
– Rich Arnold, Senior Solutions Advisor
What does this call for?
To provide clients with top-notch Medicare guidance, Rich must analyze their current doctors and drugs for the best plan option and properly educate them to choose the best program for their situation and health. It’s a simple, free process of evaluation, education, and enrollment.
For this month’s CenterStage article, we asked Rich to break down Medicare for the senior population who are in desperate need of a break from the confusion.
Medicare Break Down
Part A. Hospitalization, Skilled Nursing, etc.
If you’ve worked for 40 quarters, you automatically obtain Part A coverage.
Part B. Medical Services: Doctors, Surgeries, Outpatient visits, etc.…
You must enroll and pay a monthly premium.
Part C. Medicare Advantage Plans:
Provides most of your hospital and medical expenses.
Part D.
Prescription drug plans available with Medicare.
Under Parts A & B there are two types of plans…
Supplement Plan or Medigap Plan
A Medicare Supplement Insurance (Medigap) policy can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles, coverage anywhere in the US as well as travel outside of the country, pay a monthly amount, and usually coupled with a prescription drug plan.
Advantage Plan
A type of Medicare health plan that contracts with Medicare to provide you with all your Part A and Part B benefits generally through a HMO or PPO, pay a monthly amount from $0 and up, covers emergency services, and offers prescription drug plans.
How does this effect you?
Medicare starts at 65 years of age, but Rich advises anyone turning 63 or 64 years of age to reach out to an advisor, such as himself, for zero cost, to be put onto their calendar to follow up at the proper time to investigate the Medicare options. Some confusion exists about Medicare and Social Security which are separate entities. Social Security does not pay for the Supplement or Advantage plans.
Medicare Open Enrollment: Open Enrollment occurs between October 15th and December 7 – yes, right around the corner! However, don’t panic, Rich and his services can help you if you are turning 65 or if you haven’t reviewed your current plan in over a year – you should seek his guidance.
Your plan needs to be reviewed every year to best fit your needs. If you’re on the verge of 65, turning 65 in the next few months, or over 65, you should consult your Medicare advisor as soon as possible. For a no cost analysis of your needs contact Rich, Saxon Senior Solutions Advisor, rarnold@gosaxon.com, 513-808-4879.