Here’s What the Health Insurance Renewals Process Looks Like

Between rising costs and health care reform, there are a lot of factors to consider for your renewal. With our visual presentation, it’s easy to understand all your options – and legal obligations – simplifying the conversation.

However, we understand you may be new to the renewal process or need a refresher on what it looks like, so we pulled this article from Just Works:

If your company provides health insurance plans to employees, or is considering offering it for the first time, you’ll have to become familiar with the annual renewals process.

Health insurance renewals are a yearly occurrence in which companies adjust their rates and offerings and allow employers to select the best plans. The process includes insurance companies, employers, and employees at various stages.

Why Do Health Insurance Renewals Happen Every Year?

For employees, renewals occur annually to allow you to change your plan based on your current needs. As an employee of your company, you’ll have the opportunity to switch plans, add a dependent, or opt out if needed. You can also keep things the same as they were in the previous year.

As an employer, renewals are an opportunity to change which plans your employees will have access to and your company’s contribution.

For insurance carriers, renewals happen annually to make sure plans are up-to-date with rules and regulations, adjust pricing to take into account inflation in the health insurance industry, and reassess risk.

What Does the Renewals Process Look Like?

  • Reassessment stage. Insurance companies reassess pricing for the upcoming year and then decide on any altered costs and services to the employer. These costs generally rise year-to-year with inflation rates in the healthcare industry due to technology, research, administrative costs, and other factors.
  • Presentation stage. Insurance providers present available plans to companies. You will be presented with the options your employees will have access to and pricing for the upcoming year.

  • Selection stage. You’ll have the opportunity to select the plans your employees will have access to. Your employees can have access to up to four plans, and you can make your selections online. Once you make your selections, you’ll choose your contribution amount (how much you want to contribute per plan for each of your employees).
  • Employee enrollment stage. Once you’ve selected which group plans your employees will have access to, open enrollment will begin for your employees. They’ll be presented the plans you’ve selected to be available for them. This is their opportunity to switch due to different life circumstances and based on their budgets.
  • Completion stage. Once your employees have selected their plans, coverage is effective on the date your insurance provider or PEO stipulates.

What is the Timeframe for Renewals?

Not all plans renew on the same calendar year schedule. If you’re with a PEO, you’re on a master policy that must renew at a specified time, regardless of when your company signed on. Although you can’t choose the renewal date, master policies are what allow PEOs to give small businesses enterprise-level rates.


 

 

Source:
JustWorks (1 September 2017). "Here’s What the Health Insurance Renewals Process Looks Like" [Web Blog Post]. Retrieved from address https://justworks.com/blog/healthcare-renewals-process


With Below Average Cost, Increasing Enrollment, CDHPs Have Big Impact

According to the UBA Health Plan Survey, enrollment in CDHPs continues to grow in most regions. Receive information like this but customized to your business by taking our Benchmark Survey.


When most experts think of group healthcare plans, Preferred Provider Organization (PPO) plans largely come to mind—though higher cost, they dominate the market in terms of plan distribution and employee enrollment. But Consumer-Directed Health Plans (CDHPs) have made surprising gains. Despite slight cost increases, CDHP costs are still below average and prevalence and enrollment in these plans continues to grow in most regions—a main reason why it was one of the top 7 survey trends recently announced.

In 2017, 28.6% of all plans are CDHPs. Regionally, CDHPs account for the following percentage of plans offered:

Prevalence of CDHP Plans

CDHPs have increased in prevalence in all regions except the West. The North Central U.S. saw the greatest increase (13.2%) in the number of CDHPs offered. Looking at size and industry variables, several groups are flocking to CDHPs:

Regional offering of CDHPs

When it comes to enrollment, 31.5% of employees enroll in CDHP plans overall, an increase of 19.3% from 2016, after last year’s stunning increase of 21.7% from 2015. CDHPs see the most enrollment in the North Central U.S. at 46.3%, an increase of 40.7% over 2016. For yet another year in the Northeast, CDHP prevalence and enrollment are nearly equal; CDHP prevalence doesn’t always directly correlate to the number of employees who choose to enroll in them. Though the West held steady in the number of CDHPs offered, there was a 2.6% decrease in the number of employees enrolled. The 12.6% increase in CDHP prevalence in the North Central U.S. garnered a large 40.7% increase in enrollment. CDHP interest among employers isn’t surprising given these plans are less costly than the average plan. But like all cost benchmarks, plan design plays a major part in understanding value. The UBA survey finds the average CDHP benefits are as follows:

CDHP benefits

 

Read the original article.

Source:
Olson B. (7 December 2017). "With Below Average Cost, Increasing Enrollment, CDHPs Have Big Impact" [Web blog post]. Retrieved from address http://blog.ubabenefits.com/with-below-average-cost-increasing-enrollment-cdhps-have-big-impact

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Health Resolutions You Can Stick To In 2018

 Picture: PA Photo/thinkstockphotos.
Picture: PA Photo/thinkstockphotos.
It has once again reached that time of year when we start to think of New Year resolutions to make and break. But do we ever really keep them?

We ask the experts which resolutions we should be making this year, and how we can actually stick to them.

Whether it's giving up smoking, exercising more, or getting our 5-a-day, most of us have usually given up before January ends.

But with a little help from the pros, you can live a happier, healthier life in 2018...

1. Drink more water

Health and fitness mentor Sarah-Anne Lucas (birdonabike.co.uk) says starting a daily ritual is the answer to New Year resolutions. She suggests drinking more water: "Water intake is massive. Most people do not drink enough, but what we'd all like is more energy. That comes down to what you put in, so increase your water intake. It's the first thing you put in your body in the morning. Go and get yourself a minimum of 100ml water and get it into you. To progress that practice, add lemon, to make the body alkaline. Lemon water is amazing, it also adds a bit of flavour."

2. Learn to meditate

Life-coach and mindfulness practitioner Dr Caroline Hough (aspiring2wellness.com) says we can train our minds to reduce stress, making us more likely to achieve our goals: "It involves sitting and meditating for 20 minutes. Bring yourself into the moment and be aware. That's an awareness of your external environment, so just looking at the flowers and the trees and the sunshine and appreciating it instead of rushing through life. Be aware of your internal environment, by noticing if you're very stressed, for example if you're clenching your muscles. We tend to live our lives at a level of stress which is unhealthy."

3. Start self-watching

Professor Jim McKenna, head of the Active Lifestyles Research Centre at Leeds Beckett University, advises we record our successes to motivate ourselves: "Whatever you want to do, whenever you achieve, write it down. You're trying to achieve it every day, so it needs to be nice and small, and all your job is then is to keep the sequence running. It's really as simple as that. What you're capitalising on there is positive self-regard, but also the fundamental process of self-watching. There's a lot of success in seeing your own achievements. When you collect all that up, you can start saying, 'Actually I've got nearly 10 occasions there when I did well, I'm doing well, I'm someone who can change'."

4. Look after your skin

Louise Thomas-Minns (uandyourskin.co.uk), celebrity skin therapist, recommends we pay more attention to protecting and caring for our skin: "Wash your skin nightly. Not removing make-up, daily dirt, oil, grime and pollutants from the skin every night will result in infections and outbreaks. Your skin regenerates at night too, so give it a helping hand. And don't pick! Picking at your skin will result in scarring and create more spotty outbreaks. Wear SPF every day to slow ageing and protect from the harmful effects of UV rays. Find out your skin type from a skin health expert, so you stop wasting time and money on incorrect products."

 

Read the original article.

Source:
Go Active (6 December 2017). "Health Resolutions You Can Stick To In 2018" [Web blog post]. Retrieved from address http://www.goactiveincumbria.com/get-started/other/article/Health-Resolutions-You-Can-Stick-To-In-2018-e9f9d40d-ca39-48ed-be2e-b2f88f4061eb-ds


FREE ACA RESOURCES FOR SMALL BUSINESSES

From The ACA Times, we've pulled this article that lists out some helpful resources for small businesses.


The federal government provides free online resources to help small businesses better understand the requirements of the Affordable Care Act (ACA) and how they might be able to offer health insurance to their employees. Here are some we thought might be helpful.

How the Affordable Care Act affects small businesses: This web page hosted by HealthCare.gov explains how the ACA can impact a small business with 1 to 50 full-time equivalent employees.

SHOP Guide: This web page on Healthcare.gov provides information for small businesses on how they can offer a Small Business Health Options Program (SHOP) insurance to their employees. The web page has links to help businesses learn more about SHOP and whether they qualify to offer such coverage to employees.

The Small Business Health Care Tax Credit: Healthcare.gov, the Taxpayer Advocate Service and the IRS both provide web pages that provide information that helps small businesses determine if they are eligible to take advantage of tax credits if they offer SHOP to their employees.

The Future of SHOP: The Centers for Medicare and Medicaid Services (CMS) is providing information on how CMS will be exploring a more efficient implementation of the Federally-facilitated SHOP Marketplaces in order to promote insurance company and agent/broker participation and make it easier for small employers to offer SHOP plans to their employees, while maintaining access to the Small Business Health Care Tax Credit.

 

Read the original article here.

Source:
Sheen R. (21 November 2017). "FREE ACA RESOURCES FOR SMALL BUSINESSES" [Web blog post]. Retrieved from address https://acatimes.com/free-aca-resources-for-small-businesses/


WHY IT MATTERS THAT MORE PEOPLE SIGNED UP FOR ACA HEALTH COVERAGE IN 2018

From The ACA Times, let's take a look at ACA Health Coverage in 2018.


It was meant to have the opposite effect.

The Trump administration’s decision to undermine the Affordable Care Act (ACA) by shortening the annual open enrollment period to 45-days and cutting funding to promote open enrollment was predicted to reduce the number of people who might seek insurance coverage for 2018 on HealthCare.gov.

Instead, more than 600,000 people signed up for health insurance under the ACA in the first four days of enrollment. According to Reuters: “The Centers for Medicare & Medicaid Services, a division of the Department of Health and Human Services, said that during the period of Nov. 1 through Nov. 4, 601,462 people, including 137,322 new consumers, selected plans in the 39 states that use the federal website HealthCare.gov.”

Access to healthcare remains top of mind for Americans. For instance, exit polls in Virginia for state elections found healthcareto be the most pressing issue on the minds of voters who elected a Democratic governor in that state. And entrepreneurs and small businesses owners and employees are among those that benefit greatly from having access to healthcare insurance plans through the ACA.

For employers, all this, along with recent guidance from the IRS, points to the ACA continuing strong and the employer mandate being enforced. If you haven’t done so already, now is the time to assess your compliance with the ACA and what data you need to file ACA related forms with the IRS for the 2017 tax year.

 

Read the original article.

Source:
Sheen R. (20 November 2017). "WHY IT MATTERS THAT MORE PEOPLE SIGNED UP FOR ACA HEALTH COVERAGE IN 2018" [Web blog post]. Retrieved from address https://acatimes.com/why-it-matters-that-more-people-signed-up-for-aca-health-coverage-in-2018/


Tax Bill Shakes Up Health — From Medicare To The ACA To Medical Education

The tax bill that Republican lawmakers are finalizing would have wide-reaching effects on health issues. But the GOP still has negotiating ahead to get a bill that both the House and Senate will support. That hasn't stopped some party leaders from looking forward to additional plans to revamp programs such as Medicare and Medicaid.

The Associated Press: Q&A: Tax Bill Impacts On Health Law Coverage And Medicare The tax overhaul Republicans are pushing toward final votes in Congress could undermine the Affordable Care Act's health insurance markets and add to the financial squeeze on Medicare over time. Lawmakers will meet this week to resolve differences between the House- and Senate-passed bills in hopes of getting a finished product to President Donald Trump's desk around Christmas. Also in play are the tax deduction for people with high medical expenses, and a tax credit for drug companies that develop treatments for serious diseases affecting relatively few patients. (Alonso-Zaldivar, 12/5)

The Fiscal Times: 6 Critical Differences That Must Be Resolved in the Republican Tax Bills The Senate bill’s repeal of the Obamacare mandate saves about $318 billion over 10 years but threatens to destabilize the individual markets, resulting in higher premiums and millions fewer people with health insurance. While House Republicans aren’t likely to balk at including repeal in the final bill, it could still be a problem for Sen. Susan Collins (R-ME), a pivotal vote in the upper chamber, whose support for the final package could depend on Congress’s treatment of separate measures designed to stabilize the Obamacare markets. (Rainey, 12/4)

The Atlanta Journal-Constitution: Perdue Says Further Health Care Changes ‘Absolutely’ Needed As House and Senate lawmakers open another phase of negotiations over a $1.5 trillion federal tax overhaul, some Republicans are emboldened about pursuing new cuts to the system of health care entitlements. U.S. Sen. David Perdue said Monday that lawmakers should “absolutely” seek changes to the Medicaid and Medicare programs to help maximize the impact of the tax cuts. He echoed other Republican officials who have suggested a push for more spending cuts should be in the works. (Bluestein, 12/4)

 

Read the original brief.

Source:
Kaiser Health News (5 December 2017). "Tax Bill Shakes Up Health — From Medicare To The ACA To Medical Education" [Web blog post]. Retrieved from address https://khn.org/morning-breakout/tax-bill-shakes-up-health-from-medicare-to-the-aca-to-medical-education/


UBA Survey: Weary Families Get a Break While Singles See Out-of-Pocket Cost Increases

Below, our partner, UBA Benefits, has provided some insight from their 2017 Health Plan Survey. If you are an employer seeking customized results from the survey, we can help you. Please visit our survey page here.


While the rate impact of the regulatory environment plays out, one thing is clear from the 2017 UBA Health Plan Survey: employers continue to shift a greater share of expenses to employees through out-of-pocket cost increases. While this is just one of 7 mega trends uncovered in the survey, it is particularly interesting this year because singles were hit more heavily than families as compared to years past.

While average annual total costs per employee increased from $9,727 to $9,934, employees’ share of total costs rose 5%, from $3,378 to $3,550, while employers’ share rose less than 1%, from $6,350 to $6,401. The good news for employees is that, for a second year in a row, median in-network deductibles for singles and families held steady at $2,000 and $4,000, respectively. Similarly, some out-of-network deductibles remained unchanged, with families’ median out-of-network deductible remaining at $8,000 in 2017. Conversely, singles, who had been holding steady in 2014 and 2015 at a $3,000 median out-of-network deductible, saw a 13.3% increase to $3,400 in 2016, and another jump in 2017 to $4,000. Since deductible increases help employers avoid premium increases, we will likely see this trend continue, especially as insurance carriers are required to meet the ACA metal levels.

Both singles and families also are seeing continued increases in median in-network out-of-pocket maximums, up to $5,000 and $10,000, respectively. Families bore the brunt of the increase in median out-of-network out-of-pocket maximums between 2014 and 2016, going from $16,000 in 2014 to $18,000 in 2015, to $20,000 in 2016, but then holding steady at $20,000 in 2017. The maximum for singles, which had remained steady at $9,000 in 2015 and 2016, increased in 2017 to $10,000.

Interestingly, out-of-network expenses are not subject to ACA limitations, so it was theorized that they’d likely continue to skyrocket with more plans eliminating out-of-pocket maximums for non-network services. Perhaps to offset that, more employers adopted plans with no deductible for out-of-network services, while employees saw a massive decrease in the number of employers offering no deductible for in-network services. Looking at deductibles and out-of-pocket costs just among the ever-dominant PPO plans, in-network and out-of-network deductibles for families and singles are generally below average. However, the median in-network single deductible for PPO plans has held steady at $1,500 in 2016 and 2017, along with the family deductible at $3,000. The increases were seen in the out-of-pocket maximums, which rose in 2017 to $4,500 for single (up from $4,000 in 2016), and to $10,000 for family coverage (up $1,000 from $9,000 in 2016).

Read the original article here.

Source:
Olson B. (21 November 2017). "UBA Survey: Weary Families Get a Break While Singles See Out-of-Pocket Cost Increases" [Web blog post]. Retrieved from address http://blog.ubabenefits.com/uba-survey-weary-families-get-a-break-while-singles-see-out-of-pocket-cost-increases


Taking your time during enrollment pays off

Open enrollment season is fast approaching. Before you cringe at the thought of choosing benefits, give thought to the process. Open enrollment is like eating at a buffet restaurant; you get to pick and choose from various items until you’re satisfied.

Like picking unhealthy foods that leave you feeling unfulfilled, taking little time to analyze what you need during open enrollment season can expose you to unintended risk. If you’re contemplating what benefit options to select this year, here’s how taking your time pays off in the long run.

Know Your Benefit Options

Depending on your employer, you likely have many benefit options to select. Unum, for example, offers eight different options with additional variations in many of those options. Many know about health or dental coverage but may not know why they may need Accident, Critical Illness or Hospital Indemnity insurance. If you don’t know why you may need certain coverage, ask your Human Resources department for assistance.

Additionally, don’t let the options overwhelm you to the point of inaction or lack of thought. Instead, be thoughtful in your choices. “Take your time. There’s a lot of information to review and factors to consider as you make benefits decisions. If you rush through it, you may miss some important coverage, or end up over-insured,” says MC Guenther, Director, Employee and Corporate Communications.

Employers typically allow several weeks for Open Enrollment season, so make sure to take your time and become informed on your choices.

The Benefit of Picking the Right Benefits

Picking the best fit for your benefit needs doesn’t simply come down to cost. Yes, cost is important, but there are other advantages to selecting the right benefit, such as:

• Staying in good overall health. Health insurance obviously has an impact on this but so does dental insurance, and to a lesser extent vision insurance.

• You have the appropriate coverage in time of need. Disability insurance, for example, is something you never hope to use but is very beneficial when you need it.

• You save money. You may find by comparing two benefit options that one plan offers savings not found in the other, while also providing the same coverage.

Ultimately, taking your time and doing your due diligence will help you be better informed of the options and pick the best benefits package for you and your family.

Know How Your Benefits Work

As mentioned previously, knowing how a chosen benefit works is key to proper coverage. However, many don’t have a full understanding of how their plan works. In fact, the International Foundation of Employee Benefits reports that only 19 percent of organizations believe their employees have a high-level understanding of their benefits. If you don’t have a full understanding of how a benefit works, ask your Human Resources area – they are there to help you.

Let’s take a look at one example in how a lump sum benefit works. You can find lump sum benefits in things like Accident, Critical Illness or Hospital Indemnity coverage options.

The lump sum benefit provides the entire coverage in one payment. Guenther explains how this works, “If you are diagnosed with a covered illness and have a $20,000 critical illness policy, for instance, you’ll receive all $20,000 at once. This lets you decide when and how to spend the money with no strings attached.”

This differs from a fixed sum option found in some benefits that only offer payment to cover the actual expense. There are other differences in benefit options, of course, so it pays to understand the differences to pick the best benefits package for your family.

Overlooked Benefit Options

Most individuals know the importance of taking advantage of health, dental or life insurance benefits. Those only scratch the surface of available benefits. You also have other things to keep in mind like disability, vision or wellness programs – and it doesn’t end there.

“Some benefit vendors may offer some free value-added services to their benefits. These could include an employee assistance program, free financial planning and education tools, or emergency travel assistance,” says Guenther, adding that a wide array of options may be available for little to no cost.

Your needs will vary from others in your organization, but it pays to take advantage of all the benefits made available to you as you never know how they may help you in a time of need. As Guenther adds, “Think of your benefits as pieces of a puzzle. Together, they form a strong safety net against the financial impacts of illness or injury.” Make sure to patiently put your puzzle together to set yourself in the best situation possible.

Open Enrollment season can be overwhelming, but with a bit of work and using the resources made available to you, it’s possible to form a great benefits package for your family.

 

You can read the original article here.

Source:
Schmoll J. (6 November 2017). "Taking your time during enrollment pays off" [Web blog post]. Retrieved from address http://workwell.unum.com/2017/11/taking-your-time-during-enrollment-pays-off/?utm_sq=flhc3tx9gh&utm_source=Twitter&utm_medium=social&utm_campaign=workwelltweets&utm_content=Benefiting+you


Pressure Builds To Cut Medicare Patients In On Prescription Deals

In this article from Kaiser Health News, the stupendous rise of prescription costs is finally addressed. What steps are being taken to reduce costs for Medicare patients? Find out below.


Medicare enrollees, who have watched their out-of-pocket spending on prescription drugs climb in recent years, might be in for a break.

Federal officials are exploring how beneficiaries could get a share of certain behind-the-scenes fees and discounts negotiated by insurers and pharmacy benefit managers, or PBMs, who together administer Medicare’s Part D drug program. Supporters say this could help enrollees by reducing the price tag of their prescription drugs and slow their approach to the coverage gap in the Part D program.

The Centers for Medicare & Medicaid Services (CMS) could disclose the fees to the public and apply them to what enrollees pay for their drugs. However, there’s no guarantee that such an approach would be included in a proposed rule change that could land any day, according to several experts familiar with the discussions.

“It’s obvious something has to be done about this. This is causing higher drug prices for patients and taxpayers,” Rep. Earl “Buddy” Carter (R-Ga.), a pharmacist, said this week.

While Medicare itself cannot negotiate drug prices, the health insurers and PBMs have long been able to negotiate with manufacturers who are willing to pay rebates and other discounts so their products win a good spot on a health plan’s list of approved drugs.

Federal officials described these fees in a January fact sheet as direct and indirect remuneration, or DIR fees.

In recent years, pharmacies and specialty pharmacies have also begun paying fees to PBMs. These fees, which are different than the rebates and discounts offered by manufacturers, can be controversial, in part, because they are retroactive or “clawed back” from the pharmacies.

The controversy is also part of the reason advocates, such as pharmacy organizations, have lobbied for this kind of policy change.

PBMs have long contended that they help contain costs and are improving drug availability rather than driving up prices.

Pressure has been building for the administration to take action. Earlier this year, the federal agency’s fact sheet set the stage for change, describing how the fees kept Medicare Part D monthly premiums lower but translated to higher out-of-pocket spending by enrollees and increased costs to the program overall.

In early October, Carter led a group of more than 50 House members in a letter urging Medicare to dedicate a share of the fees to reducing the price paid by Part D beneficiaries when they buy a drug. Also in the House, Rep. Morgan Griffith (R-Va.) introduced a related bill.

On the Senate side, Chuck Grassley (R-Iowa) and 10 other senators sent a letter in July to CMS Administrator Seema Verma as well as officials at the Department of Health and Human Services asking for more transparency in the fees — which could lead to a drop in soaring drug prices if patients get a share of the action.

A response from Verma last month notes that the agency is analyzing how altering DIR requirements would affect Part D beneficiary premiums — a key point that muted previous political conversations.

But advocates say the tone of discussions with the agency and on Capitol Hill have changed this year. That’s partly because Medicare beneficiaries have become more vocal about their rising out-of-pocket costs, increasing scrutiny of these fees.

Ellen Miller, a 70-year-old Medicare enrollee in New York City’s borough of Queens, sent a letter to the Trump administration demanding lower drug prices. Miller’s prescription prices went up this year, sending her into the Medicare “doughnut hole” by April, compared with October in 2016. With coverage, Miller pays about $200 a month for several prescriptions that help her cope with COPD, or chronic obstructive pulmonary disease, as well as another chronic illness.

In the doughnut hole, where coverage drops until catastrophic coverage kicks in, her out-of-pocket costs climb to $600 a month.

It’s “ridiculous, and that doesn’t count my medical bills,” Miller said.

The number of Medicare Part D enrollees with high out-of-pocket costs, like Miller, is on the rise. And in 2015, 3.6 million Medicare Part D enrollees had drug spending above the program’s catastrophic threshold of $7,062, according to a report released this week by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Supporters of the rule change say making the fees more transparent and applying them to what enrollees pay would provide relief for beneficiaries like Miller.

The Pharmaceutical Care Management Association (PCMA), which represents the PBMs who negotiate the rebates and discounts, says changing the fees would endanger the Part D program.

“In Medicare Part D, you have one of the most successful programs in health care,” said Mark Merritt, president and chief executive of PCMA. “Why anybody would choose to destabilize the program is beyond me.”

CMS declined to comment on a vague reference to a pending rule change, which was posted in September.

For now, though, according to the CMS fact sheet, the fees pose two compounding problems for seniors and the agency:

  • Enrollees pay more out-of-pocket for each drug, causing them to reach the program’s coverage gap quicker. In 2018, the so-called doughnut hole begins once an enrollee and the plan spends $3,750 and ends at $5,000 out-of-pocket, and then catastrophic coverage begins.
  • Medicare, thus taxpayers, pays more for each beneficiary. Once enrollees reach the threshold for catastrophic coverage, Medicare pays the bulk cost of the drugs.

CVS Health, one of the nation’s top three PBMs, released a statement in February calling the fees part of a pay-for-performance program that helps improve patient care. The fees, CVS noted, are fully disclosed and help drive down how much Medicare pays plans that help run the program.

“CVS Health is not profiting from this program,” the company noted.

Express Scripts, also among the nation’s top three PBMs, agreed that the fees lower costs and give incentives for the pharmacies to deliver quality care. As for criticism from the pharmacies, Jennifer Luddy, director of corporate communications for the company, said, “We’re not administering fees in a way that penalizes a pharmacy over something they cannot control.”

Regardless, even if a rule is changed or a law is passed, there is some question as to how easily the fees can translate into lower costs for seniors, in part because the negotiations are so complicated.

When the Medicare Payment Advisory Commission, which provides guidance to Congress, discussed the negotiations in September, Commissioner Jack Hoadley thanked the presenters and said, “In my eyes, what you’ve revealed is a real maze of financial … entanglements.”

Tara O’Neill Hayes, deputy director of health care policy at the conservative American Action Forum, said passing on the discounts and fees to beneficiaries when they buy the drug could be difficult because costs crystallize only after a sale has occurred.

“They can’t be known,” said Hayes, who created an illustration of the negotiations.

“There’s money flowing many different ways between many different stakeholders,” Hayes said.

 

Source:
Tribble S. (10 November 2017). "Pressure Builds To Cut Medicare Patients In On Prescription Deals" [Web blog post]. Retrieved from address https://khn.org/news/pressure-builds-to-cut-medicare-patients-in-on-prescription-deals/


ANALYSIS: More than Half of Uninsured People Eligible for Marketplace Insurance Could Pay Less for Health Plan than Individual Mandate Penalty

Things are not looking up for the uninsured. Pay less and reach out to your health insurance professionals today. Want more facts? Check out this blog article from Kaiser Family Foundation.

A new Kaiser Family Foundation analysis finds that more than half (54% or 5.9 million) of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage.

Within that 5.8 million, about 4.5 million (42% of the total) could obtain a bronze-level plan at no cost in 2018, after taking income-related premium tax credits into account, the analysis finds.

Most people without insurance who are eligible to buy marketplace coverage qualify for subsidies in the form of tax credits to help pay premiums for marketplace plans (8.3 million out of 10.7 million). Among those eligible for premium subsidies, the analysis finds that 70 percent could pay less in premiums than what they’d owe as a tax penalty for lacking coverage, with 54 percent able to purchase a bronze plan at no cost and 16 percent contributing less to their health insurance premium than the tax penalty they owe.

Among the 2.4 million uninsured, marketplace-eligible people who do not qualify for a premium subsidy, 2 percent would be able to pay less for marketplace insurance than they’d owe for their 2018 penalty, the analysis finds.

The Affordable Care Act’s individual mandate requires that most people have health coverage or be subject to a tax penalty unless they qualify for certain exemptions. The individual mandate is still in effect, though Congress may consider repealing it as part of tax legislation.

Consumers can compare their estimated 2018 individual mandate penalty with the cost of marketplace insurance in their area with KFF’s new Individual Mandate Penalty Calculator.

The deadline for ACA open enrollment in most states is Dec. 15, 2017.

 

You can read the original article here.

Source:

Kaiser Family Foundation (9 November 2017). "ANALYSIS: More than Half of Uninsured People Eligible for Marketplace Insurance Could Pay Less for Health Plan than Individual Mandate Penalty" [Web blog post]. Retrieved from address https://www.kff.org/health-reform/press-release/analysis-more-than-half-of-uninsured-people-eligible-for-marketplace-insurance-could-pay-less-for-health-plan-than-individual-mandate-penalty/