Many Employers to Offer “Skinny” Insurance Plans in 2015

According to a survey by the National Business Group released earlier this month, as many as 16 percent of large employers will seek to minimize their healthcare costs next year by offering low-benefit, or “skinny”, plans to their employees.

The companies that will offer skinny plans versus fully ACA-compliant plans were not identified by their industries in the survey; however, traditionally companies with a high percentage of low-wage employees have taken the most advantage of those plans. Skinny plans are considered “minimum essential coverage” by ACA standards by virtue of being employer-provided, but are often lacking other key features that roll into that distinction.

Skinny plans allow employers to avoid a penalty by simply offering a plan, and purchasing one allows the employee to avoid individual mandate penalties by enrolling in a healthcare plan with lower premiums. Unfortunately, the benefits to individuals end there. Some plans cover nothing but preventive care, and all plans feature exorbitant deductibles that can make actually seeking care an unaffordable option should the employee ever require it.

Another significant blow to employees at these companies is that they will not qualify for subsidies to purchase better coverage on state or federal exchanges because their employer offers an ACA-compliant plan, regardless of whether they enroll in that plan or not.

The effect of skinny plans on healthcare costs to providers and vendors remains to be seen.

PRN Funding offers a variety of customized healthcare factoring solutions to healthcare vendors in order to cover operating costs – including providing insurance. To learn more about healthcare factoring or medical receivables factoring and apply for service, contact PRN Funding today.

Should Voluntarily Uninsured Patients Lose Charity Care?

Now that the Affordable Healthcare Act’s healthcare marketplaces and policies are in effect, hospitals are considering whether those who decline health coverage should benefit from charitable care.

The issue of whether to discontinue charity care for the voluntarily uninsured is tricky and, according to some, more a question of whether their denial of insurance indicates unwillingness to pay or an inability to pay. Some patients fall into the gap between Medicaid coverage and affordable subsidized care, while others who may be eligible for subsidized insurance are still unable to afford the high deductibles featured in lower-tier plans.

Other questions include whether patients were aware of available coverage options or if they were able to sign up during open enrollment. On the other hand, a significant though unsubstantiated concern about charitable care programs is that uninsured patients will be dissuaded from enrolling in a healthcare plan if they know that charitable care is an option. This could result in greater financial difficulty for hospitals receiving less government assistance to cover uninsured patients, particularly in states that declined Medicaid expansion.

For the moment, many hospitals are considering the effects of a change and have therefore not made any updates to their charitable care policies. Hospitals that have changed their programs have done so in a number of ways:

  • Reducing income threshold for additional assistance
  • Requiring a “nominal” contribution for care
  • Requiring patients to apply for coverage before they can benefit from charitable care (note: this is an existing practice in most hospitals)
  • Disqualifying aid to patients that refuse to enroll in coverage for which they are eligible (including Medicaid)

Regardless of hospitals’ decisions, all hospitals are required to clearly state their charitable care policies in compliance with the ACA and they must make “reasonable efforts” to qualify patients for aid before pursuing them for collections.

As hospitals absorb the financial changes of full ACA implementation, healthcare vendors must be prepared for any changes in payments. PRN Funding’s dynamic healthcare factoring options help healthcare vendors working with hospitals, doctors’ offices, and other healthcare facilities to shore up their cash flow by converting open invoices into immediate cash. Contact PRN Funding today to learn how healthcare factoring can help your company and to get started right away.

Would “Copper” Healthcare Plans Actually Be Worthwhile?

Several months ago, Senator Mark Begich (D) of Alaska proposed that the Obama administration add a new tier to the Affordable Care Act’s available healthcare plans. While the administration and other legislators weigh the benefits, significant potential issues have presented themselves.

The new “copper” plans would feature lower premiums than those for bronze plans – currently the least expensive full coverage available – and would cover 50 percent of consumers’ health costs. Patients would be required to pay the balance out of pocket. Copper plan subscribers would likely have a higher spending limit on out-of-pocket expenses than the current $6,350 individual/$12,700 family cap but would also be eligible for tax credits and subsidies.

Higher out-of-pocket costs are just one major concern with the idea of copper-level plans. Another associated issue is whether copper plans would be able to offer lower prices and still offer the comprehensive coverage required by the ACA. Jay Angoff of the Department of Health and Human Services questions whether passing on half of the cost of care to consumers can legitimately constitute “decent coverage”.

Furthermore, enrollment statistics through the March 31 deadline this year indicate that consumers are not particularly fond of low premium-high deductible plans. Approximately 65 percent of consumers chose subsidized or unsubsidized silver plans in the marketplace, while only 20 percent enrolled in bronze plans. Enrollment in catastrophic plans was even lower, at only two percent.

Copper plans would also pose a threat to healthcare spending in facilities and systems, turning back the reductions in spending reported by many systems thanks to newly enrolled patients. As copper plans are meant to attract young adults and others who have found even the bronze plans to be unaffordable, the risk of defaulting on higher deductibles is akin to the risk of non-payment by uninsured patients.

If the administration allows the creation of copper plans, consumers should expect to wait until at least the 2016 enrollment period to see these plans for purchase on the marketplace.

Does your healthcare company need more working capital to provide quality health coverage to your employees? Healthcare factoring helps vendors working with hospitals and other healthcare facilities to close the cash flow gap and invest in their business and employees – including in their health. Read more about PRN Funding’s healthcare factoring programs and contact us to begin today.

2015 Health Insurance Rates Vary by State

As health insurance companies begin establishing premium rates for the 2015 enrollment year, some insurers are pursuing substantial hikes while others are proposing modest increases and even some reductions.

Increases proposed by CareFirst in Washington, D.C. range from as little as four percent for higher-tier plans to more than 24 percent for a catastrophic plan. Other providers are also proposing mixed updates to increase certain plan premiums and reduce others. At the same time, UnitedHealthcare is proposing a reduction in all of their rates. Meanwhile, the average increase in New York is around 13 percent according to the state’s Financial Services Department.

Rate proposals in these and other states appear to be heavily tied to a number of factors, including the number of buyers who chose plans on different tiers during this year’s open enrollment period and the rising cost of medical care. Many insurers are attempting to compensate for larger populations of sick patients who use more care and for differences in health care markets.

However, some states’ proposals are more encouraging for consumers. Georgia, for example, has one statewide provider on their healthcare exchange but will welcome two more for the 2015 enrollment period. In addition, the current provider – Blue Cross and Blue Shield – has proposed statewide rate decreases.

Initial rate proposals are typically revised downward during pre-approval reviews by state regulators, so it is unlikely that the highest rates among those reported will go through as proposed. Also, patients who qualify for federal insurance subsidies through the healthcare marketplace will likely see those subsidies rise to match any rate increases.

Small business owners are likely to see at least modest increases in healthcare rates for 2015, among other rising costs of care. If you need a boost in working capital to meet these expanded operating costs, healthcare factoring with PRN Funding can close the gap. Explore the many healthcare factoring options for your company and contact us today to get started.

With Deadline Looming, ACA Enrollments Fall Short

One week from today marks the Affordable Care Act deadline for individual consumers to have an ACA-compliant policy from their employer or the online health marketplaces. Consumers who have not enrolled in coverage by March 31 will face a penalty on their taxes and will be prevented from signing up for subsidized healthcare until next year.

However, despite the time crunch only a quarter of Americans at this point had accessed the exchanges by January and many thousands of others are still uninformed about their responsibility to obtain coverage. Unfortunately, the majority of uninformed consumers are those who would benefit the most from tax credits and subsidies.

Misinformation is a major source of public reluctance to use the online health exchanges. The political debate over the Affordable Care Act is well-documented, and additional state laws governing the implementation of the individual mandate have further complicated the process.

The Obama administration is elbow-deep in a campaign to inform consumers and encourage them to apply for insurance. Volunteers are contacting households via phone banks, email, and door-to-door canvassing with pamphlets and applications. Canvassers hope that by educating consumers they will be able to dispel some of the myths surrounding the cost of health care plans and demonstrate the importance of having a compliant policy by next week’s deadline.

PRN Funding offers factoring services to cover expenses such as health insurance premiums for companies that work with hospitals and other medical facilities. To learn more about healthcare factoring, contact us today.

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Young Consumers Not Using Healthcare Exchanges

According to reports from the Obama administration about healthcare enrollment in the online marketplace through January, only 25 percent of consumers who have purchased healthcare plans fall into the critical 18-34 demographic. The figure is far lower than the number of young consumers who have created accounts on the exchanges.

Many experts and administration officials have touted the importance of young consumers using the healthcare exchanges to balance the cost of care for older patients. While insurance companies can vary costs to a certain degree based on age, it is not enough on its own to control the difference in healthcare needs between the two demographics. A continued slump of young enrollees could prompt insurance providers to raise premiums significantly within the coming years, which would put a strain on the entire system.

One potential explanation for the lack of enrollment in the younger demographic is its overlap with another provision of the Affordable Care Act which allows parents to keep adult children up to age 26 on their own health insurance. The overlap affects nearly half of the exchanges’ target demographic, specifically college students and young post-graduates.

The federal government is not alone in fretting over low enrollment; states running their own exchanges, such as Minnesota, are also experiencing enrollment that skews toward the older demographic.

If you fear rising healthcare costs could threaten your company’s cash flow, consider healthcare factoring through PRN Funding. We can create a customized factoring program to fit your company’s needs and offset your cash concerns, with approval in as little as 3-5 business days. Apply now to get started.

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ACA: Consumers Face “Sticker Shock” with New Healthcare Plans

Consumers signing up for new ACA-compliant healthcare plans may choose a lower-tier plan to save money, but the decision comes at a high price – that is, increased deductibles and other out-of-pocket costs.

As previously reported, available plans fall into one of five cost categories that feature increasing premiums but offer decreasing deductibles in exchange. Premiums for all plans are higher than 2013 premiums, but individuals who earn up to four times the national poverty level can qualify for tax credits to offset their premiums.

Consumers who purchase at least a silver plan and who earn up to 2.5 times the poverty level can apply for additional credits to offset deductible and out-of-pocket costs, further relieving the burden of care. However, consumers who cannot receive the extra assistance may bet on their own health and choose a more affordable monthly payment over better coverage.

Higher deductibles could create scenarios in which patients forego needed care to avoid a hefty bill, which runs contrary to the purpose of the ACA, or they receive care and are later unable to pay the bill which contributes to hospitals’ bad debt.

Despite the unpleasant news, the ACA also caps annual out-of-pocket expenses (including co-pays) for an individual at $6,350 – a large number, but significantly lower than past plans that may not have capped expenses at all. This may ameliorate some of consumers’ sticker shock, particularly for patients whose cost of care quickly exceeds that threshold due to serious injuries or chronic conditions. Also, well check visits and prescriptions are covered at varying levels as minimum essential benefits and are deductible-free in some cases.

The best advice for individuals still shopping for the right health care plan is to consider not only the up-front cost of a monthly premium, but also the real cost of using the plan should the need arise.

Medical receivable factoring can help facilities preparing for the potential financial impact of higher patient deductibles. Contact PRN Funding to learn more.

An Abbreviated Guide to the Healthcare Exchanges

The online health care marketplaces have been up and (mostly) running for nearly a month, but a lack of information in many states is leaving consumers confused about their responsibilities and the coverage available to them. Below is some basic information to help you navigate the health care exchanges, and links to more information.

Do I have to use the exchange?

Consumers who do not receive health coverage through their employer or their spouse’s employer may be required to purchase insurance on the marketplace. In addition, if employer coverage does not meet the ACA’s requirements or costs more than 9.5 percent of the consumer’s income then the consumer may purchase more affordable insurance on the exchange.

There are exemptions. You are not required to purchase insurance if you:

· Would qualify for Medicaid under the expanded income limits, whether or not your state expanded coverage;

· Are not required to file a tax return;

· Receive insurance through your employer, your spouse’s employer, or other government-provided coverage (including VA benefits)

If you are a sole proprietor with no employees, you are considered an individual and are required to purchase insurance on the exchange unless you meet one of the exemption criteria. If you have fewer than 50 employees, you can purchase coverage for your company on the Small Business Health Options (SHOP) Marketplace and may qualify for tax incentives to do so.

What coverage can I purchase?

Open enrollment continues through March 2014, and plans will take effect beginning January 1, 2014. The health plans available on the marketplaces fall into one of five categories:

· Catastrophic – only available to consumers under 30 who are looking for low-cost disaster coverage

· Bronze – the lowest level of comprehensive coverage available; plans will pay up to 60 percent of costs

· Silver – “standard” coverage, with plans paying up to 70 percent of costs

· Gold – higher-level coverage, paying up to 80 percent of costs

· Platinum – the best coverage available, paying up to 90 percent of costs

As you move up through the plan levels, premiums increase but deductibles and out-of-pocket costs decrease. In addition, higher-level plans feature wider provider networks and better pharmaceutical coverage. Every plan level offers minimum essential coverage as required by the ACA.

Plans on the marketplace are required to cover at least the ten defined essential health benefits.

How do I know what’s covered?

Each exchange is required to provide a summary of included benefits, coverage, and applicable co-pays for services and medications at the generic, brand name, and specialty levels. The plans must also provide a list of in-network providers, as some providers may not accept all plans available on the marketplace.

What if I can’t afford coverage?

There are tax credits and subsidies available to a portion of the population to make health care affordable. For other low-income individuals and families, expanded Medicaid coverage will provide a free healthcare option. Consumers who are not already insured or exempt will fall into one of four categories:

· Consumers who are eligible for Medicaid benefits, whether or not the program has been expanded in your state. If it has, you will be able to enroll; if it has not, as mentioned above, you are exempt from the individual mandate.

· Consumers who are ineligible for Medicaid but earn below 100 percent of the poverty level. Unfortunately, these consumers are ineligible for the tax credit and must purchase health care at the full cost.

· Consumers who are eligible for tax credits to reduce premiums, earning between 100 and 400 percent of the poverty level. These consumers should be aware when shopping for insurance that tax credits are calculated based on the second least expensive silver plan available.

About half of the consumers who fall into this category will also be eligible for cost-sharing reductions to help with deductibles and other out-of-pocket costs. The maximum threshold for these benefits is 250 percent of the poverty level.

· Consumers who earn above 400 of the poverty level will be required to purchase insurance without assistance.

Find out if you qualify for a subsidy using Kaiser’s interactive calculator.

How does a subsidy work?

Refundable tax credits will be immediately available to eligible consumers, who can use some or all of the money to pay for premiums.

If you are self-employed or have fluctuating income, it may be wise to reserve part of your tax credit in the beginning or to overestimate your income to compensate. If you earn more than you estimated you may be required to pay back some or all of the tax credit at filing time, though you may qualify for a higher subsidy if you earn less than you projected. This is also a great reason to report changes in employment, income, or family size to the health exchange as soon as they occur.

Where do I begin?

To explore your state’s marketplace and enroll in healthcare coverage, visit www.healthcare.gov – this is the federal portal and the safest way to avoid scammers.

If poor cash flow will make it difficult for you to purchase health care, PRN Funding’s healthcare factoring programs can give you immediate access to the cash you need. Get started today to beat enrollment deadlines and secure peace of mind.

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