Make Tax Day Also Enrollment Deadline, One Health Expert Says
Originally posted November 7, 2013 by Julie Appleby on kaiserhealthnews.org
With one small fix, the administration could satisfy calls from some members of Congress to extend the time people have to enroll in new health insurance through online marketplaces, a health policy expert says.
The fix would not create problems in the industry and would move the deadline to a point when many people have a little extra money, says Brian Haile, senior vice president for health policy at tax preparation firm Jackson Hewitt.
Haile says pushing the current March 31 deadline to April 15 would ensure more people have cash from tax refunds to buy insurance – and would not really change the effective date of coverage beyond the current deadline.
That’s because there is a mid-month cutoff for coverage to begin on the first day of the following month. Policies for those who sign up at the end of March or on tax day would be the same: May 1.
While no specific new open enrollment end date has been proposed by lawmakers, several members of Congress of both parties are considering legislation amid the ongoing difficulties with healthcare.gov, the federal insurance website operating in 36 states.
Insurers are generally opposed to an extension, saying they based their premium rates for next year on the idea that the enrollment period would end March 31. Delaying the penalty for not having coverage or extending the open enrollment period could result in higher premiums in the future, the industry’s trade lobby has warned.
Actuaries say that insurers assumed in their premium calculations that most people would sign up by mid-December for coverage to begin Jan. 1, granting them an entire year of premium revenue.
Insurers also are concerned that the problem-plagued federal healthcare.gov website has increased chances that the people who soldier through the hassles of enrolling are likely to be those with costly medical conditions who were shut out of coverage previously. Healthy customers are needed to balance the risk – and cost — in the insurance pool. Add to that the talk of extending enrollment deadlines, and insurers see more revenue slipping away, eaten up by medical inflation and fewer months to collect premium payments during the year.
Looking at expected medical inflation for next year, every month’s delay probably corresponds to an average of two-thirds of 1 percent higher cost for the insurers, said David Axene, fellow of the Society of Actuaries. “That starts to creep into the amount of margin built into rates.”
Haile, a former director of the Insurance Exchange Planning Initiative of Tennessee, argues that granting a short enrollment extension could help insurers pick up additional younger or healthier consumers. Some of those customers may have been sitting on the sidelines because they are strapped for extra cash until they get their tax returns.
Insurers “are not going to lose revenue, but will pick up some young invincibles,” Haile said.
Although federal officials are not talking about changing the enrollment period – they see getting the website fixed as the top priority — the administration has moved to resolve an issue about timing. The problem was that even though the law allows the enrollment season to continue until the end of March, anyone purchasing a policy after Feb. 15 would have faced a penalty. So the administration granted an extra six weeks for people to avoid a penalty in 2014 for not having coverage. The tax penalty is $95 or 1 percent of household income, whichever is greater.
Time for Open Enrollment
Originally posted by Susan M. Heathfield October 15, 2013 on https://humanresources.about.com
Open enrollment season is upon us, and as employers, we have an obligation to educate our employees about their benefits. Not just a "nice to," to help employees make good choices for their families, this education also lets employees know what their employer is spending for their benefits above and beyond their base salary. This helps employees understand and appreciate their complete compensation package.
How confused are employees about their benefits?According to Forbes, "How confusing is it? Three-quarters of Americans admit to making mistakes during open enrollment, according to a 2011 Aflac WorkForces Report. Just 40% of employees feel well-informed about the benefits their companies offer, and less than half (46%) feel their HR departments are extremely or very knowledgeable about those benefits, Aflac found."
This is why I have written about how educating employees is critical for their understanding and so they make good choices about coverage for themselves and their family. But, benefits are definitely misunderstood. In one recent study, employees estimated that benefits added 30% to their employer's costs to employ them. In fact, the figure was 43%.
I recommend an annual evening benefits review event, so spouses can attend, that emphasizes the cost of the benefits and how employees can best take advantage of the benefits they have for themselves and their families. You want to promote employee appreciation of their benefits.
What better time to offer such an event as during open enrollment when employees are making changes? Employers are already making insurance representatives available to talk to employees - or they should be - as employers are not benefits experts and should trust professionals that they have vetted. Why not extend an educational opportunity?
To provide the basics about open enrollment and to emphasize some must do areas for employers, I email interviewed Erich Sternberg, president of AlwaysCare Benefits of Baton Rouge, Louisiana. Take a look at our interview for a concise overview of open enrollment. Additionally, Erich supplies a list of steps he recommends every employee take during open enrollment.
Additional information about open enrollment is available from About.com's Michael Bihari, MD.
Open Enrollment Tips Under Health Care Reform
Originally posted September 6, 2013 on https://www.thestreet.com
This year's open enrollment season for selecting workplace benefits comes just before some of the biggest changes of health care reform go into effect.
Never before has it been more important to pay attention as you choose a health plan for you and your family.
"You really need to do your homework this year," says Carol Taylor, an employee benefit adviser with D & S Agency Inc. in Roanoke, Va.
Here are 5 tips for open enrollment this fall.
1. Understand the health care reform individual mandate: You must have coverage.
Starting in 2014, federal law will require virtually everyone to have health insurance or face a tax penalty. So if your employer doesn't offer health insurance for next year or your company's health plan doesn't meet certain minimum standards, you'll need to shop for health insurance on your own. Your employer must let you know by Oct. 1 whether its health plan meets "minimum standards," says Taylor, a member of the National Association of Health Underwriters National Legislative Council.
To meet the minimum standards under health reform, employers must offer coverage at the "bronze level," which is one of the four levels of coverage defined under health reform provisions. The other three are silver, gold and platinum. They are based on actuarial value, which measures the amount of financial protection the policy offers, or the percentage of health costs a plan would pay for an average person. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. Enrollees, on average, would be responsible for paying 40 percent of the costs.
If you're shopping for an individual health plan, you can buy one from an insurance company directly or through your state's new health insurance marketplace. The online health insurance marketplaces, sometimes called exchanges, are scheduled to open for business Oct. 1. Coverage can begin Jan. 1.
If you're not eligible for coverage through an employer or your employer's plan doesn't meet government standards, then you might qualify for a tax credit to save money on premiums when you buy a marketplace plan. People who earn up to 400 percent of the federal poverty level -- that's $94,200 for a family of four in 2013 -- will be eligible for premium subsidies in the form of tax credits. People who earn up to 250 percent of the federal poverty level will be eligible for lower deductibles and copayments.
2. Don't assume your family will qualify to save money in the new marketplaces.
Think you can get a better deal in the new marketplace than what your employer is offering? Maybe not. If you and your family have access to affordable employer-sponsored health insurance that meets minimum standards, then you and your dependents are not eligible for premium tax credits or help with cost-sharing - which includes aid in paying deductibles, copayments or co-insurance -- in the new marketplaces. You can shop there, but you'll pay full price.
"Affordable" means you pay no more than 9.5 percent of your household income toward the coverage for yourself. The amount you pay for your dependents to be covered on the employer-sponsored plan isn't factored into the equation. So even if you have to pay a bundle to keep your dependents on the employer plan, they're still not eligible for subsidies in the marketplace if the portion you pay to cover yourself is deemed affordable and they have access to the employer plan.
That could put a lot of moderate-income families with a sole breadwinner in a financial bind, says Mindy Anderson-Wallis, president of Employee Benefit Solutions of Indiana in Lafayette, Ind.
3. Compare benefits and health insurance plan networks.
Check out the provider networks of the plans you're offered to make sure your doctors and preferred hospital system are included, especially if you have a serious or chronic condition and are undergoing treatment. Given all the standards that must be met, one way health plans may cut costs is to cut the provider networks, Taylor warns.
You pay substantially more out of pocket to see providers outside the network with a preferred provider organization (PPO) plan. Except in special circumstances, you typically pay for the full cost of services for providers outside the network with a health maintenance organization (HMO) plan.
4. Understand that your employer doesn't have to offer coverage in 2014, and it won't have to offer coverage to your spouse.
Starting in 2015, the Patient Protection and Affordable Care Act will require employers with at least 50 workers to provide affordable health insurance for workers and their dependents or pay a penalty. The so-called employer mandate was supposed to go into effect in 2014, but the Obama administration delayed implementation for a year.
Still, most employers are gearing up for the mandate, and there's one tricky technicality you should know. The federal government will define dependents as children, not spouses. So even when the employer mandate goes into effect, your workplace won't have to offer coverage to your spouse.
Nobody knows yet how this will play out, but Anderson-Wallis says she doesn't think the definition of "dependent" will have much impact.
"I don't think we'll see large employers not continue to cover spouses," she says. "Benefits are seen as a way to attract and retain employees."
If your spouse isn't eligible for employer-sponsored coverage, then he or she will qualify for a tax credit to save money on a health plan in the new marketplace if your household income is less than 400 percent of the federal poverty level.
5. Crunch the numbers and pick the health insurance plan with the best value.
Compare the out-of-pocket costs of each health plan if your employer offers a choice of plans. Your costs include:
- Deductible.
- Doctor visits, urgent care and emergency room copayments.
- Co-insurance -- the percentage the health plan pays after you satisfy the deductible.
- Prescription drug copayments or co-insurance.
- Your portion of the premium.
Consider how often you go to the doctor, the medicines you take and what services you might need in the next year. Run some scenarios to see how much each health plan would cost, and choose one that meets your unique needs.
"Don't just roll the dice without calculating," Anderson-Wallis says.
Be Prepared For Fall Open Enrollment Changes
Originally posted September 3, 2013 by Amy Gallagher on https://www.golocalworcester.com
The healthcare reform law requires employers to notify employees of available health exchange options by October 1. That means employees will face new health plan choices - and decisions - during open enrollment this year.
Education is Key
With new options comes the need for more education. And that doesn't just mean the health exchange option notice employers are required to provide, which is likely to confuse employees.
Since employees will get to choose between employer-sponsored plans or those offered by the exchanges for the first time, employers should make an extra effort with their communication plans for this fall's open enrollment. And employees should step up their participation in the process as well.
Employee questions...and answers
Employers should provide informative, detailed materials that will enable employees to evaluate their choices and make the best decisions. When reviewing open enrollment resources, employees should follow these five steps:
1. Review the benefits and costs of the employer-sponsored plan. Understand what the employee’s share of the cost is in dollars - an amount that's deducted pre-tax from your paycheck at whatever tax bracket you fall in. For example, an employee who pays $250 monthly of a $500 total monthly individual plan cost will have a deduction (assuming a 30% tax bracket) around $175 monthly.
2. Compare the employee costs above to an individual plan offered through a state-run exchange.Employees who are Rhode Island residents may visit www.HealthSourceRI.com and those who reside in Massachusetts can go to www.mahealthconnector.com for details. Keep in mind that employees who purchase an individual plan through the exchange must pay the full cost of the plan unless you qualify for tax credits to offset, or eliminate, the cost.
3. Determine tax credit by using an online tool and estimating family income for 2014 (before taxes), telling the age of the oldest adult in the family, and entering the total number of adults and children in the household. Generally, employees may be able to get a subsidy if they are single and make up to $45,960, or are a family of four and earn up to $94,200. The exact amount of the subsidy is determed by size of family and level of income, so the less someone makes, the more they will receive.
4. Employees who receive the subsidy should subtract the earned tax credits from the total cost of the exchange plan to determine their total premium cost. Then compare this amount to what you would pay for an employer-sponsored plan.
5. Last, all employees must understand that, starting January 1, 2014, they are mandated to be insured.Whether through an employer or exchange plan, it’s up to you to get coverage, or pay penalties at tax time.
The Exchanges Really will Open Oct. 1st
Source: https://www.benefitspro.com
By Allison Bell
Photo: United States Mission Geneva / Wikimedia Commons / CC-BY-2.0
U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius on Friday assured yet another congressional panel that the Patient Protection and Affordable Care Act exchanges will be opening on schedule.
"We are moving ahead," Sebelius said at a House Energy and Commerce health subcommittee hearing on the HHS fiscal year 2014 budget request. "We are definitely going to be open for open enrollment starting Oct. 1 of 2013."
Federal fiscal year 2014 will start Oct. 1.
Sebelius has given similar assurances about progress at the HHS PPACA exchange development program at HHS budget hearings organized by the Senate Finance Committee's Health, Education, Labor and Pensions (HELP) Subcommittee and at the House Ways and Means Committee.
PPACA calls for HHS to work with state regulators to start exchanges, or health insurance supermarkets for individuals and small groups.
Senate Finance Committee Chairman Max Baucus, D-Mont., suggested at the HELP hearing Wednesday that it looks as if the exchange program may be headed for a "train wreck."
Congress has provided only $1 billion of the $10 billion that analysts originally said HHS would need to set up the exchange program, Sebelius said.
"We've judiciously used those resources," and efforts to set up the "Hub," the data center and call center to be at the heart of the exchange system, are going well, Sebelius said.
HHS will transfer money from prevention programs to fund exchange education and enrollment efforts, Sebelius said.
Rep. Frank Pallone Jr., D-N.J., said Sebelius should speak more frankly about the funding obstacles that Republicans have put in the way of PPACA implementation.
"They can't come back and criticize if the outreach doesn't occur if they're not funding it," Pallone said.
Republicans on the subcommittee asked whether Sebelius really has to use prevention fund money to pay for PPACA exchange outreach programs.
Rep. Michael Burgess, R-Texas, a medical doctor, asked Sebelius about the HHS decision to abruptly suspend enrollment in the Pre-existing Condition Insurance Plan (PCIP) program, a health insurance program for uninsured people with health problems that make buying medically underwritten coverage difficult.
He referred to a woman with lymphoma who said she learned HHS had shut down the PCIP program the day before she had been about to submit her application.
"Is it Obamacare or Obamadon'tcare?" Burgess asked. "Rather than spending [prevention fund money] on advertising for a program that may not even work on Oct. 1, or Jan. 1, why should we not transfer money from that fund to actually help the people that you promised to help -- the people with pre-existing conditions?"
Sebelius said Americans like the woman with lymphoma will benefit greatly starting Jan. 1, 2014, because, after that date, "no American will ever again be locked out of a health program because of a pre-existing condition."
PCIP was always supposed to be a temporary program, not a permanent solution, and it would not exist if the Republicans had succeeded with their many efforts to repeal PPACA, Sebelius said.
At another point, an exchange between Sebelius and Rep. Joe Pitts, R-Pa., the chairman of the health subcommittee, hinted at the problems that even members of Congress and their staffers may be having with keeping up with PPACA implementation details.
Pitts asked why the PPACA exchanges would not give small businesses a choice of health plans in 2014.
Sebelius had to explain that HHS has decided to let the Small Business Health Options Program (SHOP) small-group exchanges put off giving employers a chance to offer employees a multi-carrier coverage option.
Each SHOP exchange will still offer the employers themselves a chance to choose from a menu that includes plans from all of the carriers that have agreed to sell plans through that exchange, Sebelius said.
Sebelius Says We Have Built the Exchange Hub
Source: https://www.lifehealthpro.com
By Allison Bell
Photo: United States Mission Geneva / Wikimedia Commons / CC-BY-2.0
U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius told members of the House Ways and Means Committee that the exchanges are coming.
"We are confident we will launch the health insurance exchanges," Sebelius testified today at a hearing the committee organized on the Obama administration's HHS budget proposal for fiscal year 2014. "We will be open for open enrollment Oct. 1."
The data hub to be at the heart of the exchange system is "basically completed and paid for," Sebelius said.
The Obama administration has asked for $78 billion in discretionary budget authority for HHS for 2014. HHS could be responsible for a total of $967 billion in outlays over the next 10 years.
Much of the spending would be on programs related to the Patient Protection and Affordable Care Act of 2010 (PPACA). PPACA calls for HHS to work with the states and the District of Columbia to set up a system of exchanges, or Web-based health insurance markets, in all 50 states and the District of Columbia by Oct. 1, with the first coverage sold to take effect Jan. 1, 2014.
In response to questions about some states' resistance to participating in the exchange program, Sebelius said that 31 states and the District of Columbia are either setting up their own exchanges or working with HHS to set up "partnership" exchanges.
In some other states, officials are saying that their states might take over exchange services once HHS sets up the exchanges, Sebelius said.
Rep. Charles Rangel, D-New York, asked about the possibility that congressional resistance to funding the exchange program could interfere with efforts to get the exchanges started on time.
"It would be helpful" if Congress responds positively to HHS requests for funding, Sebelius said.
But "I think we are definitely on track to implement the law as it is anticipated," Sebelius said.
In response to reports that employers are worried about what PPACA will do to insured and self-insured group health plans, Sebelius said she is meeting regularly with employers to allay the concerns and hopes that, once the exchanges are open, employers will like them.
For some employers that are now unable to find or afford coverage, the new PPACA system might increase their ability to offer health benefits, Sebelius said.
Eight tips for employees during open enrollment
Source: https://www.benefitspro.com
It's open enrollment time again.
And with new regulations in place because of health reform, as well as ever increasing health costs, employees can use all the help they can get.
“Employers are making more changes than ever to their benefits plan designs and as a result employees need to take extra precautions to assure that they have the benefits coverage they expect, for a price they can afford, during this year’s open enrollment period,” says Cynthia Weidner, vice president H&W consulting, HighRoads.
HighRoads offers eight tips to employees so they can make the most of their benefits plans, while saving money.
Get your plan materials.
Pay attention to how your employer is making your SBCs and the traditional Summary Plan Descriptions available to you. Many are making them more accessible online, via mobile apps as well as on paper. It’s good to know how you can access this information during open enrollment and throughout the year, in case you want to review it again when you are in need of a particular medical service.
Do your homework.
Take the time during open enrollment to truly read through your plan materials, including the SBCs and SPDs, to make yourself familiar with each of your plan options. Reading each of these materials will give you the detailed plan descriptions you need to decide on the best plan for you and your family in the coming year.
Calculate your costs.
Many employers provide cost calculators to help project your total cost for the coming plan year. The total cost includes the premium you pay as well as your share of the deductible and coinsurance. Take the time during open enrollment to think through your potential medical needs and calculate your anticipated expenses before selecting a plan. It may save you hundreds in the long run.
Consider an account.
If your employer offers you the option of a health care account, whether it is a flexible spending account, a health reimbursement account or a health savings account, take a good look at it. These accounts can help you save money on qualified medical expenses that aren’t covered by your health care plan, such as deductibles and coinsurance. Each account has a different set of rules about how and when you can spend the money, but each are worth considering because the savings you’ll see can add up quickly.
Ask if you have a grandfathered plan.
One of the benefits of health care reform is an extended list of preventive care benefits that must be offered by new health care plans for free. Preventive services such as colonoscopy screenings for colon cancer, pap smears and mammograms for women, well-child visits and flu shots for all children and adults must be offered without out-of-pocket costs.
However, these benefits are only for new health plans and don’t apply to “grandfathered” plans that haven’t significantly changed in a few years. Find out if your plan is considered to be “grandfathered” and identify exactly what preventive services are covered for free.
Prepare for the unexpected.
Everyone needs to be prepared for the unexpected, including job loss, divorce or other life-changing events. Be sure you know what the benefits plan costs might be if you need to pay for it under COBRA.
COBRA requires that most employers with group health plans must offer employees the opportunity to continue temporarily their group health care coverage under their employer's plan if their coverage otherwise would cease due to termination, layoff, or other change in employment status (referred to as “qualifying events”). However, COBRA insurance must be paid entirely by the former employee. Be certain that if you need to continue your company’s health coverage that you are comfortable with the full premium cost should you need to pay for it on your own.
Use wellness incentives.
More employers than ever before are offering incentives to employees and their family members for health improvement. These incentives may come in the form of medical premium discounts, access to certain low deductible plans or even incentives and prizes. Some employers even offer to put money in an employee's medical account as an incentive. Take the time to learn everything your employer offers. You may find that you are already leaving money on the table because you have a gym membership or participate in a weight loss program that qualifies for an incentive from your employer.
Know your deadlines.
No matter what changes you may make, if any, during this year’s open enrollment period, don’t let your selection deadlines slip by without action. Doing nothing could end up costing you hundreds in 2013 in higher premium costs, lower coverage, or missed opportunities to optimize your health care dollars. Missing your open enrollment deadline will mean that you have to wait it out a full year before making changes that can help pad your bank account.
3 Open enrollment lessons
Source: ebn.benefitnews.com
By Ed Bray
- Develop and distribute a wallet-sized carrier contact card. There are many times when I’ve said (and been asked by employees), “what's the dental insurance or vision insurance or EAP or FSA Administrator’s phone number?” Providing a wallet-sized card to employees with all of your carrier’s contact information is an easy, low-cost way to provide the information they need at their fingertips, which will also reduce calls and emails to your desk.
- Provide a pre-open enrollment benefits confirmation statement to each employee. There are a number of opportunities for printing and distributing pre-open enrollment benefits confirmation statements to employees but two that I have found most useful are: 1) Providing an opportunity for employees to recognize and correct any missing or inaccurate data (e.g., home address, dependent social security numbers, etc.) and 2) Highlighting the value of any benefits the employee is not currently enrolled in (e.g., company match if not participating in 401(k), pre-tax flexible spending account benefits)
- Include any carrier discount opportunities in employee open enrollment packets. Outside of their core product offering, many carriers offer free and/or discounted services to employees that are not commonly advertised. Such offerings often include discounts on fitness, alternative medicine, weight management, LASIK, etc. Check with your carriers to determine if such services are available to your employees (there is a good chance your medical carrier will offer something) and then provide any brochures, etc., in the open enrollment packets.
Workers Flounder with Health Care Decision
By Editorial Staff
Source: https://eba.benefitnews.com
Open enrollment deadlines are just around the corner, and a new survey suggests the choices aren’t getting any easier for many workers.
According to a report from Aetna, Americans rank choosing health care benefits as the second most difficult life decision, behind only saving for retirement. Aetna’s survey shows those who stress over health benefits decisions cite confusing and complicated information (88%), conflicted data (84%) and difficulty knowing which plan is right for them (83%).
“The … results showed that consumers understand the importance of health benefits. However, they don’t feel they have the resources they need to make an educated decision,” says Mark T. Bertolini, Aetna’s chairman and CEO “We need to make the process of choosing and using health benefits easier for consumers.”
Conducted in July with results released last week, the survey finds Americans split on the Patient Protection and Affordable Care Act, though 75% think that all of its key elements are important for them or their families. Forty-one percent of respondents said they need more information on health care reform to understand its impact.
Reducing medical costs remains a major economic and political issue, even though 42% of Americans reportedly never or rarely monitor out-of-pocket health care expenses. This is despite the fact that more than one in five respondents had to dip into their savings in the past year to help cover medical bills.
The survey further finds that more than 40% of respondents have skipped a prescription dose, halted their medication or delayed a needed medical procedure. What’s worse, those in fair or poor health (76%) or with chronic conditions (57%) are the most likely to engage in those dangerous behaviors.
Wendy Shanahan-Richards, national medical director for Aetna, says the survey illustrates the need for health plans data to walk the line between concise and digestible and thorough and comprehensive information.
“The [survey] results help us better understand the challenges that consumers are facing today,” Shanahan-Richards says. “We want to arm consumers with as much useful, easy-to-understand information as possible to help them make more informed health benefits choices and take better control of their health.”