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Do unto others…Not unto me

Harvard’s professors are getting a taste of their medicine, and it’s not going down to well. Reports are that members of the faculty are a little “peeved” over health plan changes that will require them to share more of their health care costs. The enrollment guide states that it “must respond to the national trend of rising health care costs, including some driven by…the Affordable Care Act,” which many of the faculty “championed.”

The obvious irony: Professors are angry that the policies they’ve recommended for years are now being applied to them. The Harvard plan still pays about 91 percent of medical costs, on par with the richest plans available on the ACA exchanges.

In a Bloomberg op-ed, Megan McArdle looks at the “whining” professors, saying that “…Obamacare is the reason that these changes are probably necessary. This is what cost-control actually looks like” and recommends that Americans shed the delusion that there are no trade-offs.

IRS Guidelines – Indexed Figures for 2015

FICA
Social Security 6.2% to $118,500
Medicare unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,300 / $2,600
Maximum Out-of-Pocket Limit (Individual/Family) $6,450 / $12,900

Health Savings Accounts
Individual / Family $3,350 / $6,650
Catch-up Contribution $1,000

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,550
Dependent Care Spending Account Maximum $5,000

Mileage & Transportation
Standard Mileage Rate
57.5 cents per mile for business miles driven
0.23 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations
Parking (monthly) $250
Mass Transit Passes (monthly) $130
Bicycle Commuting (monthly) TBD – 2014 amount was $20

Compensation
Compensation Limit $265,000
Highly Compensated Employee Salary Amount $120,000
Annual Compensation for Key Employee $170,000
Defined Benefit Plan Limit $210,000
Defined Contribution Plan Limit $53,000

Retirement Plans
401(k) $18,000
401(k) Catch-up $6,000
403(b) $18,000
457(b)(2) and 124(c)(1) $18,000
457(b) Catch-up $6,000

Useful Website: healthgrades

The website, www.healthgrades.com, allows individuals to search for a doctor based on name, specialty, condition, procedure, and/or geographic location. Users can filter results by many options including Insurance Provider. While the home page does not have a field to input insurance, once you enter a search (see screen shot below), on the far right you will see an “other criteria” section where a consumer can filter by insurance carrier. However, If you input a specific provider the insurance accepted is hard to find. It is buried under phone and address – you need to scroll to the bottom of the page.

Caveat: Be sure to check with the provider that they are in-network. i.e. They may be listed as accepting Blue Cross Blue Shield of Florida, however BCBS-FL has three different networks; BlieOptions, BlueCare and BlueSelect. The site does not give you a carrier’s specific network choice. (The company tells me they are looking to add plan level detail to in the future.)

2015 HSA Contribution Limits

A health savings account (HSA) is a tax-advantaged savings account available to those who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual.

HSA 2015 annual contribution limits
HSA annual contributions limits – Single $3,350 / Family $6,650
HSA catch-up contributions – $1,000 for an accountholder age 55 or older

2015 Plan Design Requirements
Minimum deductible  –   Single $1,300 / Family $2,600
Maximum out-of-pocket expenses – Single $6,350 / Family $12,700

(Other HSA-eligibility criteria apply including: cannot be enrolled in Medicare, have received VA medical benefits in the past three months, or be eligible to be claimed as a dependent on someone else’s tax return.)

Fat People Have Issues!

Medical issues

Before offending anyone – I posted the politically incorrect title in hopes of getting more people to read. I like fat people, many of my friends are fat. So please take it in good humor. I don’t need hate mail. I also recognize some people have genetic challenges.

The following was posted by one of my fellow CEBS (Certified Employee Benefit Specialist) colleagues. Employee Benefit Advisors has seen, time after time with my own clients, that weight loss is the number one factor to controlling health care costs.

“One of the most effective ways to ensure quality healthcare services is to not need it in the first place… All those overweight, please raise your hand. All those currently being treated for a preventable healthcare issue raise your hand.

My husband is 68 years old and was on high blood pressure, diabetes and cholesterol meds–pretty typical at this age. Oh, yes, and frequently had terrible heart burn. Lost 38 pounds and just had his annual physical. Doc took him off all his prescription meds and he no longer ever has heart burn. Go figure… How’d he do it? Cut way back on consumption of carbs/sugar. That’s it. Pretty simple. Nothing else…not even exercise. Now that he feels so good he has started to exercise on a regular basis.

Those of us paying taxes to support Medicare say, Thank you! “

Supreme Court to Hear Subsidies Case

Employee Benefit Advisors blogged Oct 9, 2013 and July 7, 2014 about court cases that had been falling under the radar. EBA said “These cases could dismantle health care reform as we know it.”

Friday, Nov 7, 2014, the Supreme Court announced that they will take up the challenges to whether subsidies should be available to consumers in federally facilitated marketplace (FFM) states. The case argument is that the statute, which states that subsidies are only to be made available in exchanges “established by states,” prohibits consumers in FFM and partnership states from being able to access subsidies, as the federal government is overseeing any non-state-based exchange.

With the basis of both the employer and individual mandates on the line, and therefore, the primary enforcement mechanisms of the healthcare reform law, this case has significant potential to destabilize healthcare reform. A ruling by the Supreme Court striking down subsidies in federal exchanges could have far-reaching effects to the entire health reform structure. If consumers are unable to purchase affordable coverage without subsidies they would not be compelled by or subject to the individual mandate to purchase coverage, and if employees are unable to obtain subsidized coverage through the marketplace then employers would not be subjected to the employer mandate, as the employer mandate is only triggered when a large employer does not offer affordable coverage and an employee receives subsidized coverage, and therefore may drop coverage altogether in states using the federal exchange.

HiRes

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the King’s horses, and all the King’s men
Cannot put Humpty Dumpty together again.

…so apropos

 

 

 

 

 

 

Thanks to the National Association of Health Underwriters for providing the substance of the blog.

1 Month Orientation & 90 Day Waiting Periods

For plan years beginning in 2015, employers may require an employee to satisfy a one-month orientation/evaluation period in addition to a 90 day waiting period before he or she becomes eligible for benefits. The orientation period must be a reasonable and bonafide employment-based condition of eligibility in a position that is otherwise eligible for coverage and not a deliberate attempt to avoid the 90-day maximum waiting period. This period must be used for the employee and the employer to evaluate each other and to engage in orientation and training. This applies to grandfathered and non-grandfathered plans alike, as well as to self-insured and insured plans. 

The orientation period starts on the employee’s start date, and all calendar days count, including weekends and holidays.  One month is determined by adding one calendar month to the employee’s start date and subtracting one day. For example, if an employee starts working on May 3, the last permitted day of the orientation period is June 2.  Special rules apply if there is not a corresponding date in the next calendar month.

While an employee could conceivably be on the payroll for 120 days before becoming eligible for benefits, the maximum waiting period is still considered to be 90 days, because it does not begin until the day following completion of the orientation period.

Large employers should be aware that utilizing a one-month orientation period and a 90-day waiting period could cause them to be in violation of the employer play-or-pay mandate. The play-or pay mandate requires an employee to be covered by the first day of the fourth full calendar month of employment. For example, an employee who starts work on January 6 must be covered by May 1. If the employer starts coverage on May 6–one month plus 90 days after the date of hire–it would be in compliance with the 90 day requirement, but in violation of the play-or-pay mandate.

Information provided by ErisaPros.

Voting? – Average Health Premiums “Skyrocketed” After ACA

The Washington Times is reporting  that a new study of insurance policies before and after the implementation of the Affordable Care Act “shows that average premiums have skyrocketed, for some groups by as much as 78 percent.” Average premiums for the 23-year-old demographic rose “dramatically,” with men in that age group seeing a 78.2 percent price increase before government subsidies, and women seeing premiums rise 44.9 percent, according to a report by HealthPocket to be released Wednesday. The study, shared Tuesday with the Times, also found that premium increases for 30-year-olds increased 73.4 percent for men and 35.1 percent for women.

The article says that reasons for the premium increases include the ACA’s “prohibition on rejecting applicants with pre-existing conditions” and the heightened benefit mandate under the law.

Thanks to the NAHU Newswire for forwarding the information from the Washington Times.

Useful App: Medfax (Listed as One of the Best New Apps)

Need an independent, unbiased source of medical information about doctors, drugs, medical devices and hospitals?

MedFax can be used to verify doctors, prescription drugs, medical devices and hospitals. It provides reports that allow consumers to make well-informed decisions regarding their healthcare. One of the largest information sources of its kind, MedFax has combined and cross-referenced information from hundreds of sources, including state and federal agencies, the FDA, state health departments, county and federal courts and more. The result is over 1.5 million reports that present vital information right at the consumer’s fingertips.

  • Doctor Search – How well do you know your doctor? Check licensing, disciplinary record, malpractice history, etc…
  • Drug Search – Get complete information about your medications and their side effects.
  • Device Search – Complete information about the use and safety of medical devices.
  • Hospital Search – Find out how your hospital rates for patient satisfaction and safety.

Medfax brings unbiased, independent data source, Current information, continuous updates, Millions of records at your fingertips.

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