ACA ObamaCare 2018 - Rules, Premiums, Info, Etc.

[Yagents]

from FL DOI newsletter:

Insurance Insights - January 2018 - Case Notes

Case: An insurer alleged an agent routinely misled his clients to believe that in order to be eligible to purchase health insurance through the Affordable Care Act (ACA), they needed to buy life insurance policies. To avoid disclosure of life insurance application forms to the consumer, the agent fraudulently signed the insureds' names without their knowledge or consent. In at least one instance, the agent grossly understated a consumer's true income on ACA forms so the consumer would qualify for a higher government subsidy, which later created a large tax liability for the consumer. Investigators obtained statements from affected consumers and documentation from the insurer during the course of the investigation of the agent's activities.

Disposition: Suspended for two years and ordered to pay $1,615 restitution.

 

[junkman]

The agent above should be put in jail. Absolutely no excuse for that.

Re following Medicare Advantage policy, I asked my Dr. whether he could survive on Medicare reimbursement rates. He can but said "The hospital probably can't. People with insurance subsidize Medicare. "

This Doc is involved in the hospital management so would be privy to more than casual information.

 

[Azi Amirkhani]

The health insurance market has changed drastically since the implementation of the
Affordable Care Act (ACA) under the Obama administration nearly ten years ago. Since then, there has been an increase in health insurance plans known as high deductible health plans (HDHP). As the title suggests, these plans often have high premiums and require high deductibles and out-of-pocket costs from patients (PHNP, 2018). These plans are being implemented under the statement of saving cost for both consumers and insurance companies, but these claims have not been clearly founded.

These plans are marketed as being centered around the consumer, when too often they
are creating an economic burden on the consumer in exchange for health coverage. In the Health Services Research models, it was found that HDHPs were associated with decreasing emergency room use, increasing prescription medication use, and no correlation with a change in outpatient costs (Cecil, Chang, Kasteridis, Mirvis, Waters, 2011, 162). While analyzing this study alone, limited emergency room use can translate to either fewer injuries or illnesses to lead to the emergency room, yet it can also mean that because of high costs, emergency room visits are fewer because patients are discouraged from seeking treatment and paying high deductibles. Higher prescription use can similarly be analyzed in a number of complex ways. Two conflicting explanations for prescription use can be summarized as either increasing because of increasing health issues or inversely increasing use as a preventative measure.
In addition to HDHPs being marketed in a consumer-centric way, they also put an
emphasis on prevention and consumer-responsibility. While preventative medicine needs to be a greater component of healthcare in America, HDHPs often leave patients with pre-existing conditions vulnerable. Those with pre-existing conditions often need the most care yet under these plans are also required to pay high deductibles each time they seek care. The financial impact HDHPs leave on those with pre-existing conditions are one of the most troubling aspects of the policies.

HDHPs also significantly limit networks for their patients—a phenomenon that can be especially hurtful for those who need to see specialists and have trouble doing so. "In a recent HRI survey, 64 percent of respondents with employer-based coverage who are enrolled in an HDHP said they would select a non-HDHP next year, even if it meant paying a higher premium"
(Stiver, 2018). Despite HDPHs being favorable choices for employers providing health insurance to their employees, HDHPs are problematic for patients in a variety of ways. Whether it be limiting networks, squeezing finances, or changing health behaviors, these impacts have to be factored in to considering HDHPs in the country's health care framework.

 

[junkman]

Our agency went to HDHP the 1st renewal that they were available. They are the least total cost option when an insured is paying the entire premium and out of pocket. They are akin to having a fully insured plan that is similar to a self funded plan with specific and aggregate stop loss for the individual and family.

We always fully funded our HSA and considered most of it to be from the premium differential between the copay plan and the HDHP. TN carriers use the same network available to other plans and arent more restrictive. We look 1st at network, then out-of-pocket then carrier service then premium in that order.

A major problem over the last 35 years that I have been licensed is to constant 8-10% trend increases. HDHP and even the ACA has done nothing to address trend. My friends in administration at hospitals say they don't raise prices by 10% so the explanation must be a combination of procedure price and utilization.

Carriers simply made available less rich plans, agents presented them and employers choose them.

The fact that ACA is the insurer of last resort makes the higher premiums expected. The mostly Republican driven removal of the coverage mandate and resulting adverse selection has driven claims and by definition premiums higher still causing individuals to drop coverage leading to more adverse selection and premium increases. The only group of people with knowledge and incentive to enroll were taken out of the equation when carriers stopped paying commissions.

We have data from our 800-1000 member groups that indicates the monthly claims at that size do not track the carrier presented renewal. Carriers say they are "100% credible" while simple regression analysis that can be done on anyone's computer indicates more in the realm of 65% credibility with a large standard deviation.

The sickest 3-5% of the working insureds account for 40% of total claims. This means that we need the other 95% of the healthy enrolled.

I'm mostly just retired and on the highly subsidized Medicare plan. The only people who "like that plan" are those who don't pay for it- which is everyone enrolled.

I'm off to today's 35 mi bike ride. You have fun keeping other people insured.

Zippy do da!