Health Insurance Update

Here is a brief health insurance update; trying to prepare you for now and the next twelve months.  You need to stay informed so that you can make the right decisions regarding health insurance coverage for you and your family.

Health Insurance and the Federal Government

1. The biggest announcement to be discussed in this health insurance update is the Supreme Court’s decision regarding the subsidies for Obamacare recipients.  Discussions about changes or Obamacare are far from over but recipients don’t have to worry about additional payments required of them by having the subsidies removed.

2.  The 37 states whose current health insurance exchanges were established jointly with the Federal government must run their state exchanges independently beginning in 2016. Whether the states will lease the current platform from the Feds or purchase/lease the programs from a software developer, it is going to be another financial burden which most states, including Illinois, are going to have difficulty absorbing.  Stay tuned as this discussion continues to evolve.

What Is The Real Figure for Those Insured/Uninsured?

1. About 85% of 2015 enrollees into Obamacare policies on the healthcare exchanges are receiving financial assistance (subsidies) to buy health insurance.  The Obama administration announced at the end of May, 2015 that approximately 500,000 insured had dropped their coverage or failed to pay their health insurance premiums.  A family of four earning about $97,000 qualifies for subsidies.

2. Rand Corporation recently reported that Americans without health insurance has declined by almost 17 million since the introduction of the Affordable Care Act (Obamacare). That still leaves at least 17 million or more without medical insurance based on the original statistics provided before the Health Exchanges opened.

Health Insurance Premiums Expected to Increase in 2016

Be prepared for possible double digit increases in premium rates for some policies. Those who have obtained health insurance for the first time in many cases are seeking medical care for chronic illnesses and other medical problems for which they have received little or not treatment previously.  This is resulting in insurance companies paying more in claims. Insurance companies are now adjusting their rates based upon actual experience with the policies offered on the exchange and those purchasing this coverage.

Medicare Physician Reimbursement Program Finally Enacted

In May, 2015 Congress finally passed legislation which permanently sets reimbursement rates for physician providing care under Medicare. Doctors will be paid on quality of care, not quantity of care for a patient; with quality targets set and monitoring of patients for improvement in their health.

This long unresolved issue was a major reason physicians stopped accepting Medicare patients. If this law had not passed, Medicare reimbursements to doctors would have been reduced 21% beginning in April, 2015.

The additional costs will be paid in part by raising Medicare B premiums for wealthier enrollees.

This bill also extends CHIP for 2 years (Children’s Health Insurance for low and moderate income families).

What’s Next?

Many more changes are occurring daily in the health care industry: insurance company mergers, health system mergers, physicians selling their practices to health systems, etc. Much to talk about and consider in the months ahead before open enrollment becomes available for 2016 health insurance coverage.

Take the time to become familiar with your own health insurance coverage before you need it: review the plan benefit document which can be found on your insurance provider’s website for your specific group coverage. Or, contact your plan administrator at your company for a copy of this document if you are covered through your employer.




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