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Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
U.S. to Retirees on health insurance
Chicago has proposed a plan to migrate most of its 30,000 under-65 retirees to the state exchanges by 2017. The ACA's exchanges offer employers a way to cap or reduce their exposure to rising retiree health costs, most often without actually reducing the benefits provided.
"Companies are looking to save money, but not materially change the benefits retirees receive," says John Grosso, who leads a task force on retiree health care at Aon Hewitt. Only 7 percent of private sector employers offered health benefits to early retirees in 2010, and 6 percent offered it to Medicare-eligible retirees, according to the federal Agency for Healthcare Research and Quality (AHRQ). It's much more common among large companies: at businesses with 1,000 or more workers, 32 percent offered health coverage to Medicare-eligible retirees in 2011, and 38 percent offered it to early retirees.
The percentage of state government units offering retiree health insurance to Medicare-eligible workers was 63 percent in 2010, down from 89 percent in 2003, according to AHRQ.
Most retirees over 65 are enrolled in Medicare Part A (hospitalization) and Part B (outpatient services). Some employers are replacing in-house retiree drug coverage with group Part D plans. Meanwhile, for pre-Medicare retirees, the ACA's exchanges offer tax credits to offset premiums costs for families with incomes between 100 percent and 400 percent of the federally defined poverty guideline. "Employers aren't comfortable just putting retirees out there figure out how to evaluate 30 different plans in their zip code," Grosso says.
For Medicare-eligible retirees who lose employer coverage, the first decision is whether to stick with traditional fee-for-service Medicare or enroll in an all-in-one Medicare Advantage plan, says Paula Muschler, manager of the Allsup Medicare Advisor, a Medicare plan selection service.
Most Medicare Advantage plans are managed care health maintenance organizations (HMOS) or preferred provider organizations (PPOs). Muschler notes that a loss of employer-provided supplemental coverage triggers a 63-day open enrollment for Medigap, no matter your age, from the time you lost employer-provided coverage.
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Healthcare Reform to End
Oberai, 62, works with at-risk pregnant women for a nonprofit agency in Port Charlotte, Florida. The health insurance choices for workers like Oberai will change dramatically next year with final implementation of national healthcare reform. The Affordable Care Act (ACA) prohibits insurers from turning away applicants for pre-existing conditions, and that's expected to turn the key for workers facing "job lock" - people who need to leave their jobs but can't afford to lose healthcare coverage.
Nearly half (47 percent) of workers retire earlier than planned, and 55 percent cite a health or disability issue as the cause, according to the Employee Benefit Research Institute.
"I've talked with a lot of people who need to leave their jobs because of health problems - but they need the health insurance," says Kathleen Stoll, director of health policy for Families USA, a nonprofit health care advocacy group. A recent study by the Urban Institute's Health Policy Center and Georgetown University's Health Policy Institute forecast that health reform will boost the number of self-employed people by 1.5 million. Older workers who want to jump ship also will benefit from provisions of the ACA designed to control the cost of insurance purchased in new state health insurance exchanges - markets where Americans will be able to shop for a healthcare plan, comparing benefits and prices. Insurers are permitted to set premium rates three times higher for applicants over the age of 50. Tax credits are available to families with incomes between 100 percent and 400 percent of the federally-defined poverty guideline. The law also offers reduced copayments and deductibles for families up to 250 percent of the poverty level. How does that compare with existing group coverage offered by employers? Last year, the average worker contribution for an individual policy was $951, according to the Kaiser Family Foundation. For workers buying family coverage, the average contribution was $4,316.
In the exchanges, Kaiser estimates that a household with two 55-year-old adults and 2014 income of $50,000 would pay $4,750 for a "silver" plan, which covers 70 percent of healthcare costs. Are the workers mostly older?
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Mix-up 8 Great Health Reform
Fiction: Everyone must purchase health insurance beginning in 2014, no exceptions.
There's also one other large set of people who won't need to buy health insurance.
"Everybody who is eligible for Medicaid or Medicare does not have to purchase additional coverage," notes Deborah Chollet, a senior fellow at Mathematica Policy Research in Washington, D.C., who is helping states set up the new health exchanges.
"The Urban Institute and others have estimated that only about 3% of Americans will be subject to the penalty," says Kathleen Stoll, director of health policy for the health care consumer group Families USA. Fiction: If you're insured through your employer, health care reform won't affect you.
Fact: On the contrary, many new consumer protections under the Affordable Care Act are already benefiting people with job-based health insurance.
For example, the health care reform law bars insurers from placing lifetime limits on what they will pay for a worker's medical care, plus there are new restrictions on annual benefit limits. "If you have employer coverage, health care reform will actually make your life a little better," says Chollet.
New government insurance?
Fiction: The Affordable Care Act creates a new government-run insurance plan.
Fact: The health care reform law includes no such provision.
Rather than centralize health insurance into what's termed a "single-payer" system, health care reform accomplishes many of the same goals through its interwoven expansion of the existing Medicaid program, increased federal regulation of the health insurance industry and tax credits to make private insurance more affordable.
"There will be new insurance plans, but they're not government-run," explains Chollet. Business befuddlement
Fiction: All businesses will be required to provide employee health insurance.
Fact: The Affordable Care Act does not require employers to provide health coverage.
However, it does impose a penalty on larger employers that either do not offer a federally qualified plan or offer unaffordable coverage and whose workers subsequently purchase plans through their state exchange.
According to the Centers for Medicare & Medicaid Services, the Affordable Care Act specifically exempts firms with fewer than 50 employees -- 96% of all firms in the United States -- from any employer responsibility requirements. "Conversely, small businesses that offer health insurance to their employees may be eligible for tax credits," says Scott Holeman, spokesman for the National Association of Insurance Commissioners.
The health care law features a variety of incentives meant to encourage small businesses to insure their employees. The combination of tax credits and access to more affordable plans through new Small Business Health Options Programs, or SHOPs, within the exchanges are designed to give small businesses the same clout as large employers when it comes to purchasing insurance.
Immigrant inaccuracy
Fiction: Undocumented immigrants will receive federal aid to purchase health insurance.
Fact: Undocumented immigrants are excluded from health care reform.
Persons residing illegally in the United States have neither rights nor requirements to purchase health insurance under health care reform. Just as they are ineligible to receive Medicaid insurance for the poor, they are prohibited from purchasing health insurance on the new state exchanges, either with federal subsidies or with their own money.
Fiction: Health reform creates a "death panel" to make decisions about end-of-life care for seniors.
Fact: Early drafts of health care reform would have allowed Medicare to reimburse physicians for time spent talking with older patients about advance care planning. "Advance care planning gives the patient more control over his or her health care," says Stoll. "Unfortunately, opponents distorted a provision that would have allowed Medicare to pay health care providers for the time they spend talking with a Medicare beneficiary about what kind of care he or she would like at the end of life."
"In 2003, President George W. Bush signed into law the Medicare Modernization Act, which allows Medicare to cover advance care planning as part of the Welcome to Medicare physical exam," she explains. Medicare scare
Fiction: Health care reform will reduce Medicare benefits to all seniors.
Health care reform does reduce payments to privately administered Medicare Advantage plans to bring them more in line with traditional Medicare. States on the sidelines?
Fiction: States that don't set up health exchanges will be exempt from the Affordable Care Act.
Fact: If states fail to establish a health exchange, the federal government will set up and run one for them.
On Oct. 1, the first-ever, state-based health insurance exchanges are scheduled to debut online, offering open enrollment to individuals and small businesses for health coverage to begin Jan. 1, 2014.
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