Healthcare

When does the affordable part of the affordable care act start?

Insurers Plan to Significantly Raise Premiums – Citing huge losses on ACA plans.

Continued Disapproval Of ACA – A new survey released by the Pew Research Center found that 54 percent of consumers still disapprove of it. Data show 31 percent of respondents believe the ACA “has had a mostly negative effect on them and their families.”

An End To Protections For People With Serious Illnesses, Pre-Existing Conditions. – The ACA’s protections for people with pre-existing conditions are raising costs and limiting options for everyone. Under the ACA, insurers cannot charge higher premiums for people with serious illnesses, or deny coverage because of pre-existing conditions. Suggestions are to end these protections, and create risk pools by states so that these consumers “can get affordable coverage. … You dramatically lower the price for everybody else. You make health insurance so much more affordable, so much more competitive and open up competition.”

Medicare Physician Reimbursement Proposal Could Reduce Number Of Practices. – A new proposal “designed to change how Medicare pays clinicians represent[s] the most sweeping overhaul the CMS has made in a long time to the business of running a physician practice.” The objective is to have most Medicare reimbursements “flow through payment models that reward doctors for the quality of care they deliver, not just how many patients they see.” These changes could “upend the way medicine is practiced today, accelerating the move toward hospital employment and making the small group practice a thing of the past.”

Audit Finds IRS Overpaid Some ACA Plan Enrollees By $8 Million. – An audit conducted by the Treasury Inspector General for Tax Administration found the “IRS mistakenly overpaid more than $8 million to HealthCare.gov customers and Obamacare users in California, and cheated tens of thousands of others out of nearly $2 million in 2015 because the government relied on incorrect information to figure their taxes.” Data show some “70,850 filers received $8.3 million in federal subsidies that they didn’t deserve, while roughly 69,400 taxpayers missed out on $1.9 million they should have got.” The article says the issue resulted “from erroneous forms the government sent to about 800,000 customers, which used the wrong benchmark to measure what their Obamacare payments should have been.”

More Employers Hiring Freelancers Due To Costs Associated With ACA. – Employers are getting rid of health benefits by shrinking their full-time workforce and hiring freelancers due to the increase in costs caused by the Affordable Care Act. Data show about “one-third of companies intend to work towards ‘eliminating’ healthcare benefits because of the ACA…and 60 percent of companies intend to hire more freelance employees than full-time employees.”

 

Obamacare, Obamaco$t – What you’re not hearing

Here are some headlines you’re nor hearing unless you’re paying really close attention to the ACA (Affordable Care Act), aka Obamacare.

12 failed co-ops which were created under the Affordable Care Act could cost taxpayers $1.2 billion – Four of the remaining co-ops created under the Affordable Care Act are experiencing weak enrollment, which is another indication that the startups remain on shaky ground. Data show these four co-ops have not yet signed up a minimum of 25,000 members, a crucial threshold which allows them to cover costs.

UnitedHealthcare to Drop Obamacare Exchanges in most states by 2017 – UHC expects to loose $650mm this year.

Despite ACA, Patients Still Subject To Surprise Medical Bills – Surprise medical bills happen most often in an ER visit when a hospital contracts with medical providers – including doctors, surgeons, anesthesiologists, lab technicians – that do not accept the same insurance plans the hospital does.

The maximum out-of-pocket costs will rise – Consumers can expect to pay more for healthcare costs. OOP expenses will rise to $7,150 for an individual / $14,300 for a family. Placing a significant financial burden on middle-income Americans who need a substantial amount of care.

State Medicaid Agencies Want Congress to Repeal ACA Insurance Tax – Medicaid agencies want lawmakers to permanently repeal the tax on health insurers. The article says “most private health insurance plans have had to pay the tax themselves,” but “states that contract with Medicaid managed-care plans have had to cover the premium tax to ensure that the health plans receive actuarially sound rates.” Some 38 states and Washington, DC contract with Medicaid managed-care plans.

HealthCare.gov Continues To Be Vulnerable To Hackers – The GAO reports that security flaws ‘will likely continue to jeopardize the confidentiality, integrity and availability of HealthCare.gov.

It’s been six years since the ACA was signed into law. How’s it going?

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

The Grandson’s Burden

Sixty-four year-old grandfathers incur nine times more medical expenses than their eighteen year-old grandsons. But under small group ACA adjusted community rating, their health premiums can be no more than three times the cost charged to their second generation progeny, who now pay more to subsidize their forefathers.

Female rates have always been within the 3:1 age ratio due to the expenses of childbearing years. So the major impact of ACA adjusted community rating falls on the cost of young men.

The ACA also eliminated health risk rating for small groups. Thus small employer groups composed chiefly of young male or healthy employees are paying much higher health premiums than necessary to cover their risk.

Many small employers are migrating from fully-insured plans that are priced by adjusted community rating to partially self-funded plans that are priced for their own employees’ actual age, gender, and health risk profile.

Employee Benefit Advisors can help you with Level Funding, Traditional Self-Funding, and Employer Group Stop Loss Captives. Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

A special thanks to TCC Benefits Administrators for the content in this blog.

IRS Guidelines – Indexed Figures for 2016

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) $6,550 / $13,100

Health Savings Accounts
Individual / Family $3,350 / $6,750
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
54 cents per mile for business miles driven (down from 57.5 cents for 2015);
19 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations
Parking (monthly) $255
Mass Transit Passes (monthly) $255

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

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Cadillac (n.) best of its kind; standard of excellence

What else would you expect big government to call a 40% tax that is expected to hit 25% of employees in 2018 and 42% by 2028? The last major piece of Obamacare will impact consumers, corporations and union members.

The Impact? Middle-class workers could see a reduction in benefits. Companies in areas with high medical costs are more likely to be subjected to the Cadillac tax than those in lower-cost areas. Same for employers with unionized workers. Under scrutiny to be cut from the benefit package are the FSA, HSA and HRA accounts which provide tax-free dollars for out-of-pocket health costs. The law counts those contributions toward the thresholds for triggering the tax.

The Cadillac tax is 40 percent of the value of employer-sponsored plans that exceeds $10,200 for individual coverage and $27,500 for family coverage. The tax is levied on insurers and plan administrators, who are expected to pass it back to employers. The 40 percent rate is well above the income tax rates for most workers. If they don’t know it already, employees will learn, Obamacare came with Obamaco$t.

 

Employee Benefit Advisors provides employee benefits. We are a broker helping companies with their Health & Welfare Benefits. We also help companies revaluate PEO Services, deciding if a PEO is a good choice and if so selecting and implementing the PEO.

The Future of Vision

6 eye care and eye wear innovations that will alter your view of vision benefits

    1. Accu-Fit Technology – reads the shape of your eyes and automatically recommends the best prescription
    2. Glasses.com – takes a 3D image of your face and allows you to look at up to four pairs of frames from every angle
    3. Onsite or pop-up clinics – setting up a store right in your office/plant, offering onsite exams; promotes both the importance of regular eye exams and your company’s wellness program
    4. “Healthy” wearable tech – your glasses will be your hub for your personal health and wellness providing you with your blood pressure blood sugar levels, etc… and automatically share the data with your doctor
    5. Smart Contacts – contact lenses that use tears to measure blood sugar levels for patients with diabetes (no more pricking your finger); for glaucoma patients lenses that measure intraocular pressure sending an alert to your smartphone that it’s time to administer eye drops
    6. Online Exams – emerging technology that allows for a refraction (used to determine the level of correction) to be tested online

Thank you Shauna Whittingham, Eyemed.

Employee Benefit Advisors provides employee benefits. We are a broker helping companies with their Health & Welfare Benefits. We also help companies revaluate PEO Services, deciding if a PEO is a good choice and if so selecting and implementing the PEO.

Obamaco$t – What is hiding in the numbers.

Aetna’s Health Reform Weekly published a New Kaiser Family Foundation research found that single and family premiums for employer-sponsored health insurance in 2015 rose by an average of 4 percent, but the survey also found that workers’ out-of-pocket costs are rising at a much faster rate, with a 67 percent increase in deductibles since 2010. – The hidden cost of Obamacare. Ouch!

Obamacare – 5 Years Later

Conclusion: If we look at the three main points of Obamacare we see (1) although there has been an increase in the number of insureds, it was minimal;  (2) costs have increased (vs. the decrease we were promised); and (3) the ability to keep your doctor has not held true for many Americans.

A new Centers of Medicare and Medicaid Services (CMS) report shows final enrollment in 2015 marketplace plans across the country stands at 10.2 million; 6.4 million Americans receive subsidies in the federally facilitated marketplaces. Weiss ratings looked at Obamacare 5 years after it was passed into law, here’s what they found.

Although the number of insured has increased, doctor visits have gone up as well as days spent in the hospital. Pro-Obamacare, the increase in usage makes sense since there are more people covered by insurance. Anti-Obamacare, more people overwhelm the healthcare system and make it more expensive for everyone.

In addition Weiss Reports, “Unfortunately, as we predicted some years ago, there are now fewer but larger health insurers, which has reduced competitive pressures. Additionally, the 15 percent of premiums allowed for expenses and profits offers no incentive to the insurers to keep health costs lower and perversely encourages them to increase spending. Consequently, Obamacare, ironically, has encouraged higher healthcare spending. However, once the challenge of medical expenses is addressed, we look forward to the day when healthcare is cheaper and more affordable.” (EBA says wishful thinking if you believe last point.)

Inevitably, if health expense issues, which were a major exclusion from Obamacare, are not addressed, prices will continue to rise. And that means costs (premiums) will get a lot worse before they get better.

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(EBA’s commentary – We were told 43-47 million were uninsured prior to the ACA and Obamacare would insure all but about 13 million. Now we hear 30 million will remain uninsured. End result, far short of expectations and not worth the expense.)

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Pre-Active Medicine – CompanionDx

Anywhere between 40 and 75 percent of drugs are ineffective for individual patients. That means a large portion of patients may not only be wasting their money—but they may not be receiving the treatment or the results they seek.

Pre-Active medicine is a new diagnostic discipline that uses genetic insights to help prevent adverse drug reactions, misdiagnosis or other negative consequences of inadequate medical discovery.

CompanionDx™ is one of the only providers of both pharmacogenomics evaluations and cancer companion diagnostic testing. When used separately or in conjunction, these two types of tests are giving physicians the resources they need for more comprehensive patient treatment profiles—and that means more certainty when it comes to effective therapeutic decisions.

Tests include:
Pharmacogenomics testing
Cancer companion diagnostics testing
Colorectal cancer screening
NextGen Sequencing testing (in development)
 
You’ll receive easy-to-read test reports within 3-7 days.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Clean up your mouth!

 The following was posted on the wall when I visited my dentist recently. – Glad to report my teeth and gums are healthy.

Periodontal infection increases risk

Heart disease
Infectious endocarditis
Carotid artery stenosis
Stroke
Diabetes
Rheumatoid arthritis
Mouth and throat cancer
Pancreatic cancer
Colon cancer
Kidney infection lung infection/COPD
Low fertility in men
Erectile dysfunction
Brain abscesses
Cognitive dysfunction/ Alzheimer’s
Infectious mononucleosis
Pre-term babies
Yeast infections
Multiple sclerosis
Osteoporosis

periodontal (adjective) of, denoting, or affecting the gums and other tissues surrounding the teeth: periodontal disease

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

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