Obamacare: Coverage Costs Widely Vary by State

How much will individuals pay for health insurance through Obamacare? Although Obamacare is a nationwide healthcare initiative, the coverage costs will vary depending on each state.

According to data recently released by the Department of Health and Human Services, Americans under the age of 65 who purchase coverage through the new healthcare act will end up paying the highest rates in Wyoming, while those who opt into the program in Minnesota will end up spending the least. Meanwhile, the states of Kentucky and Massachusetts have not yet released their coverage rates.

When it comes to unsubsidized costs, Minnesota comes in with the lowest rates, and is the sole state offering middle-tier “silver” plans for less than $200 a month. Furthermore, the lowest tier of ACA coverage, also called the “bronze” plan, calls for average monthly premiums of $144. In comparison, the state of Wyoming offers the bronze plan at an average of $425, while its silver plans begin at $489.

Meanwhile, in all other states across the U.S., bronze plans are offered at an average of $249, while silver plans begin at $310. Aside from the fact that silver plans, on average, are priced at 16 percent less than the projected $392 per month, government officials report that 56 percent of uninsured participants will be able to pay $100 or less each month. Nevertheless, the monthly cost exceeds the prior projected price tag of $392 in seven states.

Another influential factor for determining coverage rates under Obamacare is age. The Department of Health and Human Services reports that the average cost for younger Americans will likely be lower than what older people will be required to pay. As a general rule of thumb, states with more competing insurers will be charged lower rates than those states with fewer participating insurers.

With the help of an online subsidy calculator, individuals can get a better idea as to how much they can afford to spend on health insurance. By inputting various factors such as income level, age, and family size, an estimate will be calculated to help determine an individual’s eligibility for subsidies.

ACA: Healthcare Coverage in the Online Marketplace

Now that federal and state online healthcare exchanges are live, questions are swirling about the available coverage for eligible consumers. How much will it cost? What will it cover? What if I don’t sign up?

The marketplaces will vary from state to state, even those run by the federal government at healthcare.gov. Variations include plan availability and pricing, Medicaid eligibility, and how the exchange itself is run.

However, there are consistent policies that will apply to consumers in all fifty states and the District of Columbia:

  • All plans will cover, at a minimum, ten benefits defined by the ACA as “essential.”
  • Five levels of coverage will be available with sliding price scales, from Catastrophic (only the most basic disaster coverage) to Platinum (plan pays 90 percent of costs)
  • No plan’s availability or price can be affected by pre-existing conditions
  • If you are not otherwise exempt, you will face an increasing annual fine for not having insurance…
  • BUT you may be eligible for tax credits or rebates to lower premiums and out-of-pocket costs, in some states by as much as half

Young people will absorb higher premiums than are currently available in every state on the federal exchange, though this goes hand-in-hand with the more comprehensive plans that will replace currently available coverage. In addition, older and sicker consumers who purchase coverage through the marketplace will benefit from lower premiums that are unaffected by pre-existing conditions or a dodgy medical history, as noted above. In all, healthcare pricing will depend on where you live, your age, and current tobacco use.

Tax subsidies for purchasing insurance are dependent on household income and the availability and cost of qualifying employer-provided insurance.

PRN Funding can help small to mid-sized healthcare vendors who do not qualify for tax subsidies to purchase insurance through their state’s marketplace. Healthcare factoring gives vendors immediate access to cash through the sale of their receivables, which they can then use to cover premiums and other expenses. Read more about PRN Funding’s factoring services.

Medicare Penalizing Hospitals for Readmission Rates Under ACA

In an effort to emphasize quality of hospital care over quantity, the Centers for Medicare & Medicaid Services (CMS) have reported their second round of reimbursement reductions under the Hospital Readmissions Reduction Program. This key provision of the Affordable Care Act went into effect October 1, 2012; this year, CMS will reduce Medicare and Medicaid reimbursements to more than two thousand hospitals nationwide.

The CMS’*Hospital IQR program has established a national average for readmissions for heart attacks, heart failure, and pneumonia, and has monitored hospitals’ performance on each, since 2009. Hospitals have been required to participate in the program for reporting purposes, but were not penalized for their actual performance prior to the Hospital Readmissions Reduction Program.

Readmission applies to any patient who visits any hospital within 30 days of their initial discharge the same complaint, unless it is a planned readmission. Hospitals reporting excessive reimbursements will face reimbursement reductions calculated by algorithms available on the CMS Web site. CMS’ goal in implementing the HRRP is eliminate the “double dipping” incentive for hospitals to readmit patients by providing incomplete care during their initial admission.

Hospitals facing higher penalties are disproportionately located in underprivileged communities. Patients in these facilities are more susceptible to “preventable” causes of readmission, including the inability to purchase costly medication or to follow necessary but untenable discharge instructions. Slightly more than half of the hospitals facing reduction, however, have lowered their penalty amount due to procedural changes such as improved technology and discharge planning for patients.

One of the most important discharge instructions is follow-up with a physician. Some hospitals have begun locating a primary care provider for patients without one; others have opened their own clinics to provide post-discharge care to patients who cannot otherwise access a PCP.

Proposed rules for fiscal years 2014 and 2015 will include COPD, elective total hip arthroplasty, and total knee arthroplasty in future readmission calculations.

If you do work for a hospital facing reduction, PRN Funding’s healthcare factoring program can help you maintain a steady cash flow despite reimbursement reductions at the hospitals you serve.

Learn more about healthcare factoring and apply today.

Online Health Insurance Marketplaces Face Tech Hurdles

The rollout of online health marketplaces was marked with technological difficulties at various stages of the process.

Users attempting to access the federal marketplace via healthcare.gov experienced glitches when signing up for an account, which the Center for Medicare and Medicaid Services attributes to overwhelming visitor traffic during the first several hours the exchange was live. While the CMS claims they addressed initial issues right away, the marketplace was still fraught with issues well into the afternoon and eventually shut down.

State-run marketplaces in 17 different states also reported high traffic and sporadic glitches. Users may seek assistance via the live chat function or call centers, or they may contact a local healthcare representative. Unfortunately, these avenues will not allow customers to compare plans or view more detailed information regarding each plan’s deductibles and coverage. Some states are still experiencing issues today.

While not unexpected, these issues have frustrated and dismayed many consumers who are eager to realize the promise of affordable healthcare. Still, a number of people have successfully used the marketplace to purchase insurance, and consumers still have plenty of time to sign up for insurance – the deadline for coverage beginning January 1 is December 15, and the open enrollment period will continue until March 31, 2014. Officials maintain that glitches are normal for any large-scale tech rollout (see: Apple); for the moment, consumers may be better off just waiting it out.

Currently, approximately 15 percent of the population is expected to use the marketplace to purchase insurance in the absence of employer-provided health plans or benefits from the VA, Medicare, and Medicaid.

Learn how factoring can provide the cash flow to provide insurance to your employees.

Obamacare Out-of-Pocket Caps Provision Delayed

Another important provision of the Affordable Care Act has been postponed. The provision that would set caps for out-of-pocket insurance costs will be delayed for more than one year. Under Obamacare, the limit on out-of-pocket costs like deductibles and co-payments was not supposed to exceed $6,350 for individuals and $12,700 for a family. Now, it appears that a one year grace period has been granted to some insurers which enables them to raise limits, or in some cases, set no limits until 2015. Also, if a drug plan doesn’t currently set out-of-pocket limits, they won’t have to impose any until 2015.

The delay will leave some consumers paying much more for health insurance and drug coverage. The lag allows many group health plans to maintain separate out-of-pocket limits.

Why the health care reform delay? The New York Times reported that federal officials wanted to provide insurers and employers more time to comply because they used “separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”

The chief executive of the National Health Council said the delay will “disproportionately harm people with complex chronic conditions and disabilities.” For those with chronic illnesses like cancer, out-of-pocket costs can swell to tens of thousands of dollars each year. The same applies to prescription drug plans. Many patients will have to wait for access to affordable prescription drugs because of the out-of-pocket cost cap delay. The American Cancer Society noted that some new cancer drugs can cost more than $100,000 per year.

Obamacare still affords some consumer protections. Consumers can’t be denied insurance or face higher premium costs due to pre-existing conditions. Subsidies may be available to help bring down costs as well.

Affordable Care Act Could Lower Insurance Costs for Some Small Businesses

Numerous small business employers and owners are worried about their insurance costs rising under the health law next year. However, for some businesses, especially those with older workers or those who have employees who have been ill, costs may actually decrease according to business owners and insurance brokers.

Under a stipulation of the Affordable Care Act (ACA), which goes into effect in January, insurers will be forbidden from setting rates for healthcare coverage based on the health status of employers or their employees are at businesses with less than 50 or 100 workers, depending on the state. Rather, the rates will be announced on government-run health insurance marketplaces, or online exchanges, which are meant to extend the additional costs of insuring higher-risk policyholders, like those with prior sicknesses or pre-existing medical conditions.

A survey conducted in April by The Wall Street Journal and San Diego-based executive mentoring group Vistage International Inc., found that 12% of 783 businesses with less than $20 in yearly revenue believe their insurance premiums will be cheaper or stay roughly the same under the ACA. Similarly, a survey by eHealthInc. done in February found that 11%of 259 small business employers, most with less than 10 workers employed at their businesses, said they think their rates will go down next year.

Some business owners say costs could go down if the exchanges produce cheaper rates on individual plans, which would lead some employees to drop their employer-sponsored plans completely.

Both early renewals and self-funded plans will end up keeping more groups off the exchanges, which will reduce the savings for high-risk policyholders. Besides that, any savings from the exchanges will be contingent on whether they’re up and running by Oct. 1, the deadline for offering coverage that will be effective come January.

The federal government’s own health-insurance exchange for small businesses, called the Small Business Health Options Program, or SHOP, which it will supervise in 33 states, isn’t expected to be fully operational and available until 2015.

Employer Mandate is Delayed, but Individual Mandate Stands

The employer mandate provision of the Affordable Care Act (ACA) has been delayed by a year, but the individual mandate still stands as law. The individual mandate portion of the ACA states that uninsured individuals must have insurance by January 1, 2014 or face penalties (most likely 1% of family income). The uninsured will be eligible for federal subsidies of up to $5,000 depending on income to purchase insurance on healthcare exchanges. Those in the very low income brackets could qualify for Medicaid.

House Republicans are pushing for an individual mandate delay, but won’t likely get very far when it comes to overturning this portion of the law. Most major physician groups stand behind the Obamacare individual mandate because requiring everyone to have insurance lowers healthcare costs for all.

The employer mandate delay leaves about a million people to find insurance coverage to meet ACA requirements, according to the Urban Institute. A source at the Urban Institute noted that the point of the employer mandate was to make sure that employers offered coverage rather than forcing employees into the state-run insurance exchanges, but that’s pretty much the case due to the delay.

AMA Declares Obesity a Disease – The Impact for Employers

The American Medical Association has voted to reclassify obesity from a condition to a disease “requiring a range of medical interventions to advance obesity treatment and prevention,” according to an AMA statement. Essentially, physicians will be professionally obligated to diagnose and treat obesity.

Obesity increases risk factors for many serious conditions like heart disease, high blood pressure, stroke and type 2 diabetes. Nearly 30 percent of US adults are considered obese. Since most forms of insurance don’t cover obesity, the policy could improve access to obesity treatment such as nutritionists and trainers. Insurance may even begin to reimburse the time doctors spend talking to patients about nutrition and exercise. The bill would also increase obesity treatment options for Medicare patients and expand the types of providers allowed to offer obesity counseling.

Not only will the AMA decision impact patient care, it may also impact the staffing and employment industry. As of now, the Americans with Disabilities Act (ADA) does not prohibit employers from discriminating on the basis of weight. Staffing agencies should watch carefully as the ADA deems nearly all diagnosed medical conditions as “disabilities.” Could it mean that employers will have to make reasonable accommodations for employees who fall into the obese category? Could obese employees seek additional protection from discrimination and terminations based on weight? An article on Workforce.com believes so.

According to Forbes magazine, the new classification may even make employers more hesitant to hire obese workers, especially since health insurance coverage is required under the Affordable Care Act. Some employers may also try to lower wages to offset the higher health insurance costs of obesity. It also may impact workplace wellness programs that offer financial incentives tied to weight management and obesity.

Reasons Behind the ACA Employer Mandate Delay

The Affordable Care Act employer mandate has been delayed by a year to 2015, announced the U.S. Treasury Department on July 2. The reprieve will give businesses some breathing room as they are now able to postpone offering worker health insurance for another year. Though the official reasoning behind the delay was to help businesses begging for more time, left unstated was the fact that the federal government hadn’t written key guidelines for employers, according to current and former administration officials, and computer systems that were supposed to run the program were not yet operational.

“The administration’s decision… to delay the implementation of the employer mandate is welcomed by the business community and will help avoid some serious near-term economic consequences of this law,” said U.S. Chamber of Commerce President and CEO Thomas Donohue in a statement.

The Affordable Care Act (ACA) passed in 2010, and was set to go into effect on January 1, 2014. It required businesses with over 50 full time workers to offer affordable healthcare to them. The ACA demanded employer coverage just for those who work over 30 hours per week for a period of a month. Depending on the size of the company and the state in which it’s located, a business may be able to buy a less expensive small group policy through a standardized insurance exchange. If a company has fewer than 25 employees but they choose to offer insurance anyway, the ACA will provide a tax credit to balance the price. Smaller companies also have more incentive to self-insure, in which the businesses take on the financial risk of offering health benefits to its workers. Rather than paying premiums to insurers, they pay claims filed by workers and health care suppliers. Larger corporations with hundreds of employees or more often self-insure as well because they have the cash on hand to pay the majority of the claims filed right away.

The government’s computer systems are being tested now, but experts say there’s no way to tell how well they will work before the launch October 1.

According to an official in Obama’s administration, the Treasury Department realized they couldn’t address concerns and questions raised by employers in time for the employer mandate to go into effect, so they had to push the date back. He said the postponement was caused partially by the limited staffing and the wait for the Supreme Court’s review results.

“They were so late putting out regulations, and even as of today they have not produced proposed regulations, they knew it was not realistic to expect employers and insurers to implement their system changes,” said Catherine Livingston, a former health care counsel at the IRS.

According to the Treasury, the latest change won’t affect the individual mandate which demands most taxpayers buy insurance or pay a government fine. The timeline hasn’t changed for the application of the individual and small businesses exchanges – which are marketplaces where people and business owners can shop for insurance at the state level. The Department of Health and Human Services insists they’re prepared to open the exchanges as planned.

Health Care Reform May Lower Insurance Costs for Some Businesses

Numerous small business employers and owners are worried about their insurance costs rising under the health law next year. However, for some businesses, especially those with older workers or those who have employees who have been ill, the Wall Street Journal reports that costs may actually decrease according to business owners and insurance brokers.

Under a stipulation of the Affordable Care Act (ACA), which goes into effect in January, insurers will be forbidden from setting rates for healthcare coverage based on the health status of employers or their employees are at businesses with less than 50 or 100 workers, depending on the state. Rather, the rates will be announced on government-run health insurance marketplaces, or online exchanges, which are meant to extend the additional costs of insuring higher-risk policyholders, like those with prior sicknesses or pre-existing medical conditions.

A survey conducted in April by The Wall Street Journal and San Diego-based executive mentoring group Vistage International Inc., found that 12% of 783 businesses with less than $20 in yearly revenue believe their insurance premiums will be cheaper or stay roughly the same under the ACA. Similarly, a survey by eHealthInc. done in February found that 11%of 259 small business employers, most with less than 10 workers employed at their businesses, said they think their rates will go down next year.

Some business owners say costs could go down if the exchanges produce cheaper rates on individual plans, which would lead some employees to drop their employer-sponsored plans completely.

“If I insure fewer people, my benefit costs go down,” says Kurt Gabrick, who runs a software-consulting firm in Tucson, Ariz., with eight full-time employees. Right now, Gabrick says he pays half of his employees’ health-insurance costs—a total of around $4,000 a month—as part of a small group plan.

Both early renewals and self-funded plans will end up keeping more groups off the exchanges, which will reduce the savings for high-risk policyholders. Besides that, any savings from the exchanges will be contingent on whether they’re up and running by Oct. 1, the deadline for offering coverage that will be effective come January.

The federal government’s own health-insurance exchange for small businesses, called the Small Business Health Options Program, or SHOP, which it will supervise in 33 states, isn’t expected to be fully operational and available until 2015.

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