Changes from 2015 to 2016... Rules, Premiums, Plans, Exchanges, Etc.

[AllenChicago]

June 4, 2015

Starting on January 1, 2016, Group Plans must have an individual Out-of-Pocket maximum that matches the maximum ACA individual OOP maximum for IFPlans.

Ref: New Out-Of-Pocket Maximum Rule Affects Most Group Health Plans Sponsored By Nonprofit Organizations - Employment and HR - United States

Is it common for Group plans to not have an individual OOP maximum? I haven't sold a group since 2003.

 

[RayNY]

Is it common for Group plans to not have an individual OOP maximum? I haven't sold a group since 2003.

They all have a max, but some let an individual hit the family limit (2x individual) instead of capping each member at the individual level.

I can't speak to how common it is nationally, but apparently it happens enough to make regulations against it.

 

[FLM2]

One change (one of the few positive ones) is that the healthcare.gov application is far easier to navigate now than last year-it's much more like an online health insurance app with many questions on one screen.

I did a SEP application for a client (single) yesterday in about 10 minutes. The biggest time waster remains the email account validation, once that is complete it's pretty easy and won't be an issue during OEP with the carrier direct links.

 

[AllenChicago]

June 4, 2015

A new HC.gov tool is coming for 2016 enrollment. This will show consumers what the likely Out-of-Pocket costs will be for their medical care, depending on which plans they're considering.

CMS Announcement: http://www.cms.gov/CCIIO/Resources/...-Cost-Comparison-Tool-Bulletin_06-03-2015.pdf

Note: When you see CMS use the word "Tool"... translate it to "Consumer Confusion". Bottom line is that Agent Advice and Guidance will be needed more than ever this coming Open Enrollment.

 

[sman]

June 4, 2015 A new HC.gov tool is coming for 2016 enrollment. This will show consumers what the likely Out-of-Pocket costs will be for their medical care, depending on which plans they're considering. CMS Announcement: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/OOP-Cost-Comparison-Tool-Bulletin_06-03-2015.pdf Note: When you see CMS use the word "Tool"... translate it to "Consumer Confusion". Bottom line is that Agent Advice and Guidance will be needed more than ever this coming Open Enrollment.

They do a similar thing on the Medicare website for Medicare Advantage plans. It's absolutely worthless since each person's situation is unique.

 

[AllenChicago]

They do a similar thing on the Medicare website for Medicare Advantage plans. It's absolutely worthless since each person's situation is unique.

Right. Just another government method for creating consumer dismay and anger after experiencing medical claims. "Hey doc, HC.gov told me that the brain surgery you performed would only cost $1,218.53!"

 

[AllenChicago]

Subj: EMBEDDED OOP Limits for 2016

YAgents touched on this subject in another thread 2 weeks ago... Contained within a broader 2/27/2015 rule, HHS is requiring that all 2016 plans use "embedded" OOP $$ limits. Here's a plain language description:

"This embedded rule means that plans (including self-funded plans) will now have to have embedded out-of-pocket limits for each individual covered under family coverage.

For example, using the 2016 limits, if a family plan has an annual out-of-pocket limit of $10,000 and one family member incurs an expense of $20,000, that family member would be responsible for expenses up to $6,850 (the self-only out-of-pocket limit), and the remaining $13,150 would be paid in full by the plan. Additional expenses incurred by that family member would be paid by the plan with no cost sharing for the remainder of the plan year.

Although it is not stated expressly in the preamble, the other family members (or a single family member) should be responsible for the remaining $3,150 of expenses under the family cap of $10,000. Of course, after the family group reaches the $10,000 out-of-pocket limit, the group has no further cost sharing for the rest of the plan year."

Source: Bryan Cave Benefits and Executive Compensation Blog

June 8, 2015

Since HHS is requiring a materially significant change to how family's out-of-pocket maximums are addressed in 2016...

1.) Will families be compelled/mandated to purchase a new policy to stay compliant? (No auto-renewing allowed)

OR

2.) Will those who have 2014 / 2015 purchased QHPlans be able to keep them as they are...i.e. grandfathered QHPs with no benefit changes?

OR

3.) Families keep the plan they have, but insurers must send out "addendums" to be placed with the policy.

HHS comes out with rules that increase insurer's administrative expenses, without even considering (or caring) that the already-filed 2016 premium requests couldn't take these new requirements into account. Since health insurers can't increase premiums in mid-stream, whose pocket will they pick to pay these un-planned admin expenses? Agents?...Nah!

 

[AllenChicago]

Here's a good read that explains why the expected large 2017 premium increases are actually coming on 1/1/2016.

Story: Why Are The 2016 Obamacare Rate Increases So Large?

 

[FLM2]

Here's a good read that explains why the expected large 2017 premium increases are actually coming on 1/1/2016.

Story: Why Are The 2016 Obamacare Rate Increases So Large?

Interesting article-my feeling is that if a large increase for 2016 winds up stabilizing the market so that rate increases in 2017 begin to emulate the increases before ACA that's fine as long as commissions remain at current levels.

 

[RayNY]

Interesting article-my feeling is that if a large increase for 2016 winds up stabilizing the market so that rate increases in 2017 begin to emulate the increases before ACA that's fine as long as commissions remain at current levels.

Stabilize the market

Since when are you a comedian?