Today, the Centers for Medicare & Medicaid Services (CMS) is posting Frequently Asked Questions (FAQs) on Essential Health Benefits Coverage in response to the 2019 Novel Coronavirus (COVID-19) outbreak.
This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease
The FAQs are shared to ensure individuals, issuers and states have clear information on coverage benefits for COVID-19, detailing existing federal rules governing health coverage that apply to diagnosis and treatment of COVID-19.
You can access the FAQs here:
For further information contact:- Eric Walters – Cell -602-616-1660 or email: firstname.lastname@example.org.
FOR IMMEDIATE RELEASE
Contact: CMS Media Relations
CMS announces 2019 Medicare Parts A & B premiums and deductibles
Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.
“CMS is committed to empowering beneficiaries with the information they need to make informed decisions about their healthcare,” said CMS Administrator Seema Verma. “In addition to the information we recently released for Medicare Advantage, the program through which private plans provide Medicare benefits, today we are releasing information for fee-for-service Medicare, so enrollees understand their options for receiving Medicare benefits.”
As announced earlier this month, CMS launched the eMedicare Initiative that aims to modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families. Ahead of Medicare Open Enrollment – which begins on October 15, 2018 and ends December 7, 2018
CMS is making improvements the Medicare.gov website to help beneficiaries compare options and decide if Original Medicare or Medicare Advantage is right for them. Among the tools released as part of the eMedicare Initiative is a stand-alone, mobile optimized out of pocket cost calculator that will provide information on both overall costs and prescription drug costs.
Medicare Part B Premiums/Deductibles
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, a slight increase from $134 in 2018. An estimated 2 million Medicare beneficiaries (about 3.5 percent) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.
CMS also announced that the annual deductible for Medicare Part B beneficiaries is $185 in 2019, an increase from $183 in 2018.
Medicare Part A Premiums/Deductibles
Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.
The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,364 in 2019, an increase of $24 from $1,340 in 2018.
Medicare Advantage Premiums
Medicare beneficiaries can choose to enroll in fee-for-service Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement.
Last month, CMS released the benefit, premium, and cost sharing information for Medicare Advantage plans in 2019. On average, Medicare Advantage premiums will decline while plan choices and new benefits increase. On average, Medicare Advantage premiums in 2019 are estimated to decrease by six percent to $28, from an average of $29.81 in 2018.
For a fact sheet on the 2019 Medicare Parts A & B premiums and deductibles, please visit: https://www.cms.gov/newsroom/
For more information on the 2019 Medicare Parts A and B premiums and deductibles (CMS-8068-N, CMS-8069-N, CMS-8070-N), please visit https://www.federalregister.
Qualifying Life Event for a Special Enrollment Period!!
When the Affordable Care Act went into effect, it guaranteed that everyone who applied for individual health insurance would be approved for and enrolled in coverage. However, to prevent people from signing up for insurance only when they get sick, the ACA restricted enrollment to specific open enrollment periods—typically a period of three months from November to January.
If you want to purchase an individual health insurance policy, either on your own or because your employer offers a Qualified Small Health Reimbursement Arrangement (QSEHRA), you usually must wait until the next open enrollment period.
However, if you experience a qualifying life event, a special enrollment period will go into effect, and you can sign up for health insurance immediately.
These special enrollment periods apply to qualified health policies purchased through both the state and federal health insurance exchanges and outside the exchanges through a broker or health insurance website.
Qualifying life events that open a special enrollment period
A qualifying life event is an event in your life that makes you eligible for a special enrollment period. The special enrollment period generally lasts 60 days before or after the qualifying life event.
There are four basic types of qualifying events: loss of health coverage, changes in household, changes in residence, and other.
Here’s a full list of all life events that qualify for a special enrollment period, organized by those four categories. We’ll examine each of the events in the first two categories in more detail below. The events listed under the second two categories are self-explanatory.
- Loss of health insurance
- Losing job-based coverage
- Losing COBRA coverage
- Losing individual health coverage for a plan or policy you bought yourself
- Losing eligibility for Medicaid or Children’s Health Insurance Program (CHIP)
- Losing eligibility for Medicare
- Losing coverage through a family member
- Changes in household
- Getting married
- Having a baby, adopting a child, or placing a child for foster care
- Getting divorced or legally separated and losing health insurance
- Death of someone on your individual health insurance policy
- Changes in residence
- Moving to a new home in a new zip code or county
- Moving to the United States from a foreign country or U.S. territory
- Moving to or from the place you attend school, if you’re a student
- Moving to or from the place you both live and work, if you’re a seasonal worker
- Moving to or from a shelter or other transitional housing
- Other qualifying changes
- Changes that make you no longer eligible for Medicaid or CHIP
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
- Leaving incarceration
- AmeriCorps VISTA members starting or ending their service
Losing job-based coverage
If you lose health coverage through your company or a family member’s company, you might qualify for a special enrollment period.
Common reasons for losing job-based coverage are:
- Your company drops coverage.
- You quit or were fired from a job where you had coverage.
- You experienced a reduction in work hours that caused you to lose your job-based coverage.
- Your job-based coverage doesn’t qualify as minimum essential coverage (MEC) and you’re eligible for a premium tax credit.
You won’t qualify for a special enrollment period if you lost your job-based coverage because you voluntarily dropped coverage during the plan year or you lost your coverage because you didn’t pay your premium.
Losing COBRA coverage
If you’re losing COBRA continuation coverage because the coverage ran out or your former company stops contributing, causing you to pay the full cost, you qualify for a special enrollment period.
However, you won’t qualify if you decide to end COBRA early and are paying the full cost yourself or if you lost your COBRA coverage because you didn’t pay your premiums.
Remember, you don’t need a special enrollment period if you voluntarily end COBRA during open enrollment. At that time, you can drop your COBRA policy and enroll in an exchange policy.
Losing individual health coverage for a plan or policy you bought yourself
If you lose individual health coverage, you may qualify for a special enrollment period in the following circumstances:
- Your insurance carrier stops offering your individual policy
- You lose eligibility for a student health policy
- You lose eligibility for a policy because you no longer live in the policy’s service area
- Your individual or group health policy’s coverage year ends in the middle of the calendar year and you don’t renew it
If you voluntarily drop coverage or lose your coverage because you didn’t pay your premiums or provide required documentation to the exchange when prompted, you won’t qualify for a special enrollment period.
Losing eligibility for Medicaid or CHIP
If you lose eligibility for Medicaid or CHIP, you might qualify for a special enrollment period. This could be due to a change in income, or because you become ineligible for pregnancy-related or medically needy Medicaid.
Additionally, if your child ages off CHIP, you may qualify.
Losing eligibility for Medicare
You may access a special enrollment period if you lose eligibility for premium-free Medicare Part A.
You won’t qualify, however, if you lose Medicare Parts B, C, or D only, or if you lose Medicare Part A because you didn’t pay your premium.
Losing coverage through a family member
Losing coverage through a family member, such as a parent or spouse, also qualifies you for a special enrollment period.
This could happen if:
- You turn 26.
- You are no longer a dependent of your parent or guardian.
- Your family member’s employer cuts health coverage for dependents.
- Your family member dies.
- You divorce or legally separate from the spouse through whom you have health insurance.
If you voluntarily drop coverage you have as a dependent, you won’t qualify for a special enrollment period. Similarly, you won’t qualify for coverage if neither you nor your family member pays the premium.
If you’ve gotten married in the past 60 days, you can apply for coverage through a special enrollment period. Pick a policy by the last day of the month for your coverage to begin the first day of the next month.
Having a baby, adopting a child, or placing a child for foster care
Apply for coverage within 60 days of having a baby, adopting a child, or placing a child for foster care. Your coverage will be retroactive to the day of the event.
Getting divorced or legally separated and losing health insurance
You only qualify for a special enrollment period if divorcing or legally separating from your spouse caused you to lose health insurance.
Death of someone on your individual health insurance policy
If someone on your policy dies and, as a result, you’re no longer eligible for your policy, you’ll be eligible for a special enrollment period.
Other cases that may qualify you for a special enrollment period
There are other special circumstances that may qualify you for a special enrollment period. Though these circumstances aren’t considered qualifying life events, they could open a special enrollment window for you.
We’ll list these complicated cases and explain them in more detail below.
- Experiencing an “exceptional circumstance”
- Experiencing an enrollment or policy information display error
- Previously having lived in a state that hasn’t expanded Medicaid and you became newly eligible for help paying for an insurance plan because of an increase in household income or move
- Being determined ineligible for Medicaid or CHIP
- Gaining or becoming a dependent due to a child-support or other court order
- Experiencing domestic abuse or violence or spousal abandonment
- Getting an appeal decision that’s in your favor
Experiencing an “exceptional circumstance”
If you faced a serious medical condition or natural disaster that kept you from enrolling during open enrollment, you’re entitled to a special enrollment period. Healthcare.gov lists as examples: unexpected hospitalization; temporary cognitive disability; or a natural disaster like an earthquake, massive flooding or a hurricane.
Experiencing an enrollment or policy information display error
You’re entitled to a special enrollment period if someone working in an official capacity kept you from enrolling in a policy, enrolling in the right policy, or getting the premium tax credit or cost-sharing reduction you were eligible for.
Potential individuals or groups in error could be an insurance company, an exchange navigator, or an insurance agent or broker. Misinformation, misrepresentation, misconduct, or inaction all qualify as enrollment errors.
You’re also entitled to a special enrollment period if you experienced a technical error when you applied on your public exchange. If you saw an error message when completing your application that prevented you from enrolling in a policy or your carrier from receiving your enrollment information, you can access a special enrollment period.
Similarly, if the wrong policy data was displayed on the exchange—such as benefit or cost-sharing information—when you selected the policy, you’ll qualify for a special enrollment period.
Previously having lived in a state that hasn’t expanded Medicaid and you became newly eligible for help paying for an insurance plan because of an increase in household income or move
If you previously lived in a state that hasn’t expanded Medicaid and you weren’t eligible because your income was too low, you can qualify for a special enrollment period if you moved or had an increase in household income that makes you newly eligible for Medicaid or advance payments of your premium tax credit within the last 60 days.
Being determined ineligible for Medicaid or CHIP
If you applied for Medicaid or CHIP during the open enrollment period and were deemed ineligible after open enrollment ended, you may qualify for a special enrollment period. This is true whether you applied through your local exchange or your state Medicaid or CHIP agency directly.
Gaining or becoming a dependent due to a child-support or other court order
You can access a special enrollment period if you either gained a new dependent or became a dependent of someone else due to a court order. Your coverage will start the effective date of the court order, even if you enroll in the policy up to 60 days afterward. In other words, your coverage would be retroactive to the date of the court order.
Experiencing domestic abuse or violence or spousal abandonment
The federal government grants special enrollment periods to survivors of domestic abuse and spousal abandonment who want to enroll in their own health policy. Dependents may also be eligible.
If you want to claim this special enrollment period, you need to contact the Marketplace Call Center. If you’re married to your abuser or abandoner, you can fill out your application as unmarried without being penalized for misstating your marital status. You’ll also be able to collect a premium tax credit if you qualify based on your income.
Getting an appeal decision that’s in your favor
You can enroll in or change policies if you file and win an appeal with your exchange after receiving an incorrect eligibility determination for a special enrollment period or an incorrect coverage effective date.
Applying for a special enrollment period
If you’ve experienced one of the events above and want to apply for a special enrollment period, you’ll need to do so through Healthcare.gov or your state exchange.
How you apply depends on whether you’ve had a qualifying life event or another special circumstance.
If you have a qualifying life event, you can apply online. If you’re not sure whether you qualify, Healthcare.gov can screen you by asking you a few questions on any events you’ve experienced that would open a special enrollment period.
Once you’ve determined you’re eligible, you can start a 2017 application for insurance coverage or log in to your existing account.
If you have a special circumstance rather than a qualifying life event, contact the Marketplace directly. You can reach the call center at 1-800-318-2596. The representative will ask about your situation and help you determine whether it qualifies you for a special enrollment period.
Filing an appeal
If your request for a special enrollment period is denied and you feel the decision is wrong, you can file an appeal.
To do so, select your state’s appeal form through Healthcare.gov, download it, and fill it out. If possible, attach a copy of your eligibility determination notice and any other official notice you received.
Mail the appeal to:
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
Be sure to include the last four digits of the zip code as this helps your appeal arrive faster.
Verifying your qualifying life event and enrolling in coverage
In most circumstances, you’ll have 60 days following your qualifying life event or special circumstance to choose and enroll in a policy. As part of this process, you may need to verify your qualifying life event or special circumstance through documentation.
You’ll be told whether you need to submit documentation before you submit your application for coverage. In some cases, you may not need to provide anything at all.
If you are asked, however, Healthcare.gov advises you to pick a policy first and submit documentation afterward. Once you pick a policy, you’ll have 30 days to submit the verifying documents.
Details and instructions on the type of documents you need to submit will appear on your eligibility results screen and in a notice you can download or get in the mail.
Once you’re ready to submit documents, upload them to Healthcare.gov or send photocopies of the original documents to:
Health Insurance Marketplace
Attn: Supporting Documentation
465 Industrial Blvd.
London, KY 40750-0001
In general, the documentation required depends on your qualifying life event. We’ll go over two common reasons people qualify for a special enrollment period, the documentation they should submit, the timeline for submitting that coverage and picking a policy, and the time coverage starts once the first premium payment is made.
For all other documentation concerns, as well as a full list of acceptable documents to verify special enrollment periods, see Healthcare.gov.
Losing health coverage
Whether you already lost your health coverage or you will in the future, you’ll have 60 days following the end of your coverage to choose a policy.
You’ll need to submit documents verifying that your coverage has ended or will end, along with the date it ends. Acceptable documents may be notices from your previous insurance company or your employer. You should submit these within 30 days of choosing a policy.
If your coverage has ended, your new coverage will begin the first day of the month after you choose the new policy. If your coverage will end in the future, your new coverage will begin the first day of the month after your old coverage ends and you choose a new policy.
Remember, your coverage won’t be go into effect unless your eligibility is confirmed and you make your first premium payment.
Moving to a new address and previously had insurance
If you’re moving to a new address, you’ll need to choose a policy within 60 days from the date you moved.
You’ll also need to provide documents confirming both your move and proof of former coverage. To verify your new address, you can submit government correspondence, utility bills, rental or mortgage documents, or homeowner’s insurance. The documents must include your new address and the date of your move.
To verify that health coverage, you must submit documents showing that you were covered at least 1 day during the 60 days before your move. These documents may be correspondence from your insurance company, employer, or health coverage provider. If you’re moving from a foreign country or U.S. territory, you don’t need to provide this documentation.
You must submit all documents within 30 days of choosing a new policy.
If you choose a policy between the first and fifteenth of the month, your coverage will start on the first day of the next month.
If you choose a policy between the sixteenth and the last day of the month, your coverage will start on the first day of the second month following policy selection. For example, if you choose a policy on July 20, your policy will go into effect August 1.
What to do if you don’t have a qualifying life event or special circumstance
If you want to sign up for health insurance outside of open enrollment and haven’t experienced an event on this list, then you’ll have to wait until the next open enrollment period starts.
There is some relief for people whose companies offer a QSEHRA, though. If you’re looking for a health insurance policy because your company is offering a QSEHRA, you won’t be able to purchase one until open enrollment—but you will be able to submit your qualified medical expenses for reimbursement. The only thing you need to do is include these reimbursements as part of your gross income. Once you get a policy, you’ll be able to receive these reimbursements tax-free.
Further information from: Eric Walters
States Attacking ACA Would Suffer Most If Preexisting Conditions Shield Gets Axed
“These states have been opposed to the ACA from the beginning,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “They’re hurting their most vulnerable citizens.”
Twenty Republican state attorneys general and governors challenged the constitutionality of the ACA in federal court in February. Last month, U.S. Attorney General Jeff Sessions and the Department of Justice made the unusual decision not to defend key portions of the law against this legal challenge.
The states’ lawsuit argues that because Congress eliminated the Obamacare tax penalty for not having insurance coverage, effective next year, the entire law is unconstitutional. By extension, the suit calls on federal courts to find the health law’s protections for people with preexisting conditions unconstitutional — and Sessions agrees.
Nine of the 11 states with the highest rates of preexisting conditions among adults under 65 have signed onto the lawsuit to strike down the ACA, according to data from insurance companies and the U.S. Centers for Disease Control and Prevention. The 2015 data, the most recent available, were analyzed by the Kaiser Family Foundation in 2016. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)
Those who support the lawsuit contend that there are other means of protecting people with preexisting conditions.
“If a court strikes down the constitutionality of the ACA, there are ways to repeal and replace without Arizonans with preexisting conditions losing their coverage,” said Katie Conner, a spokeswoman for Arizona Attorney General Mark Brnovich.
Conner said her boss, who is party to the lawsuit, believes preexisting conditions should “always be covered.” In Arizona, more than 1 in 4 adult adults under 65 have a preexisting condition, according to the data.
The state with the highest rate of adults with preexisting conditions is West Virginia — 36 percent of those under age 65. That means that about 1 in 3 of them could have a hard time buying insurance through the individual marketplace without the ACA protections.
The office of West Virginia Attorney General Patrick Morrisey, who joined the legal challenge against the ACA, declined to comment. But a spokesman for Morrisey’s re-election campaign told PolitiFact last month that “help should be provided to those who need it most, including those with preexisting conditions.”
Plaintiffs in the lawsuit “are paying lip service to these critical protections for people, but they are in fact engaged in a strategy that would get rid of those protections,” said Justin Giovannelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms. “Frankly, it’s hard to square what they’re saying on the one hand and what they’re arguing in the courts on the other.”
According to a poll released in June, also by the Kaiser Family Foundation, three-quarters of Americans say that maintaining protections for people with preexisting conditions is “very important.” This includes majorities of Democratic, Republican and independent voters.
Before the health law was adopted, insurance companies routinely denied coverage to millions of people with preexisting conditions who purchased insurance through the individual marketplace. If they didn’t deny coverage outright, some health plans charged consumers exorbitant premiums, or offered policies that excluded coverage for pricey conditions. (Although many people got insurance through their employers or public plans that covered preexisting conditions, they could have been left vulnerable if their employment status or other circumstances changed.)
The ACA ended those practices.
Common conditions that led insurance companies to deny coverage included high blood pressure, cancer, obesity, diabetes and depression, among many others. Some people were denied for having acne, asthma or for being pregnant.
The KFF analysis estimated that at least 27 percent of adults under 65 — more than 50 million Americans — had at least one preexisting condition that would have jeopardized their coverage pre-ACA. The foundation said its estimates were an undercount because some diseases that insurers cited when declining coverage are not in the survey data. Also, each insurance company set its own rules and conditions for denials, making accurate counts of those who could be affected hard to nail down.
Less precise estimates by other researchers and the Department of Health and Human Services show that up to half of all adults under age 65 have at least one preexisting condition.
Investors in health savings accounts will see a small bump in contribution limits for the calendar year beginning in 2019, according to the IRS.
Individual investors in HSAs tied to high-deductible health plans will be able to contribute up to $3,500 next year, a $50 increase from the 2018 limit. HSAs tied to family HDHPs will see the contribution cap raised $100, to $7,000.
Catch-up contributions for workers over age 55 will remain at $1,000.
The adjustments reflect the application of the Chained Consumer Price Index, or Chained CPI, inflation gauge to HSAs and other tax deductions, which was legislated with the signing of the Tax Cuts and Jobs Act last December.
Previously, the Consumer Price Index, or CPI, was used to set HSA contribution increases.
After implementation of the tax law, the IRS had to make an adjustment to HSA contribution limits for 2018, which were set before the tax bill passed.
Under the original CPI application, the cap on family HSAs was $6,900, but was revised to $6,850 when the Chained CPI was applied. Use of the Chained CPI did not affect caps on individual contributions.
Contributions to HSAs are made on a pre-tax basis, grow tax-free over time, and withdrawals are not taxed when they are used for qualifying health expenses. They must be used with qualifying high-deductible health plans.
For calendar year 2019, high-deductible plans will be defined as those with at least a $1,350 deductible on individual plans and a $2,700 deductible on family plans, both unchanged from 2018.
Qualifying high-deductible plans will have to cap out-of-pocket expenses—deductibles and co-payments, but not premiums—at $6,750 for individuals and $13,500 for family plans, an increase of $100 for individuals and $200 for families from 2018, according to IRS figures.
You should report the changes listed below to the Marketplace as soon as possible.
- Certain changes may qualify you for a Special Enrollment Period, allowing you to change plans outside Open Enrollment.
- The changes may affect the savings and coverage options you qualify for. See how your changes may change your savings.
Ready to report changes? Log in to your account.
Changes to report
- Changes to your expected income for the year
- Changes in health coverage:
o Someone in your household getting an offer of job-based insurance, even if they don’t enroll in it
o Someone in your household getting coverage from a public program like Medicaid, the Children’s Health Insurance Program (CHIP), or Medicare
o Someone in your household losing coverage, like job-based coverage or Medicaid
- Changes to your household or individual members:
o Birth or adoption
o Placing a child for adoption or foster care
o Becoming pregnant
o Marriage or divorce
o A child on your plan turning 26
o Gaining or losing a dependent some other way
o Moving to a permanent address in your state.
- Note: Don’t update your application if you move out of state. See what to do when you move out of state.
- Corrections to name, date of birth, or Social Security number
- Changes in status:
o Change in disability status
o Change of tax filing status
o Change of citizenship or immigration status
o Change in status as an American Indian/Alaska Native or tribal member
o Incarceration or release from incarceration
For further information call: Eric Walters
U.S. Rep. Mike Kelly (R-PA) hopes to make health care more affordable for Americans by giving their employers better benefit options to offer them under improved Health Savings Accounts (HSAs).
Rep. Kelly on March 1 introduced the Bipartisan HSA Improvement Act, H.R. 5138, which would improve access to health care through updated HSAs, according to a summary provided by his office. The bill was co-authored by U.S. Rep. Earl Blumenauer (D-OR) and includes cosponsors U.S. Reps. Erik Paulsen (R-MN) and Brian Fitzpatrick (R-PA).
“With so many people increasingly choosing HSA plans, it is important that federal rules allow employers to provide the best benefits possible for their employees,” said Rep. Kelly. “By modernizing HSA policy, this bipartisan bill will promote flexibility, encourage innovation, and expand access to these cost-saving plans for many more Americans.”
An HSA is a type of savings account that allows a person to set aside money on a pre-tax basis to pay for qualified medical expenses. Using untaxed HSA dollars to pay for deductibles, copays and other expenses allows people to lower their health care costs, according to the U.S. Centers for Medicare and Medicaid Services. Currently, more than 20 million Americans are enrolled in HSA-qualified plans, Kelly said, which puts them “in the driver’s seat of their health care, helping them save money and stay healthy.”
Among other provisions in the proposed bill, H.R. 5138 would allow HSA plans to offer HSA dollars that people could use for wellness benefits, including exercise; and to offer pre-deductible coverage for medication and services that help manage chronic conditions, and for health services provided at both onsite employee clinics or retail health clinics, according to the summary.
“By expanding access to affordable care, promoting wellness and strengthening innovation, this legislation will help Americans stay healthy while saving money,” Rep. Blumenauer said.
H.R. 5138 has been referred to the House Ways and Means Committee for its consideration.
IRS announces 2018 family contribution changes for HSAs
Today, the IRS published Internal Revenue Bulletin (IRB) 2018-10 that contains Revenue Procedure (Rev. Proc.) 2018-19.
Effective for calendar year 2018, the family contribution limit for HSAs has been lowered to $6,850 from the previously set amount of $6,900. This change came as a result of the tax reform law (P.L. 115-97) that changed the annual inflation adjustment factor from the Consumer Price Index (CPI) to a new factor known as ‘chained CPI’. This change was anticipated to slow the rate of changes in all programs under the tax code, including HSAs.
For any further information call: Eric Walters
ACA Bog site: www.azhealthinsuranceblog.com
Trump Administration to abandon 90-Day Ruling for Short Term Medical coverage!
Proposed rule to allow short-term, limited-duration insurance for longer periods providing increased choice at a lower cost
In direct response to President Trump’s October 2017 Executive Order, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) issued a proposed rule today that is intended to increase competition, choice, and access to lower-cost healthcareoptions for Americans.
The rule proposes to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months. The proposed rule, if finalized, will provide additional options to Americans who cannot afford to pay the costs of soaring healthcare premiums or do not have access to healthcare choices that meet their needs under current law.
Short-term, limited-duration insurance, which is not required to comply with federal requirements for individual health insurance coverage, is designed to provide temporary coverage for individuals transitioning between healthcare policies, such as an individual in between jobs, or a student taking a semester off from school.
This announcement builds on the President’s October 2017 Executive Order 13813, “Promoting Healthcare Choice and Competition Across the United States,” which directs the Departments to consider proposing regulations or revising guidance to expand the availability of short-term, limited-duration insurance and allow it to cover longer periods.
The Departments published a final rule in 2016, which restricted short-term, limited-duration insurance to less than three months. Key stakeholders, including state regulators, have expressed concerns that the current limit could cause harm to some consumers, limit consumer options, and have little positive impact on the risk pools in the long run.
Today’s proposed rule would address these concerns by reverting to the previous definition of short-term, limited-duration insurance which permits coverage for nearly a full 12 months.
The link to the proposed rule can be found here: https://www.federalregister.gov/documents/2018/02/21/2018-03208/short-term-limited-duration-insurance,
Comments on the proposed rule are being accepted now.
Contact: Eric Walters
December 20, 2017
Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019
On Dec. 20, Congress passed the Tax Cuts and Jobs Act, which makes significant changes to individual and corporate provisions of the U.S. tax code, including a reduction in the corporate tax rate to 21%, down from 35%, beginning in 2018.
The bill includes permanent effective repeal of the Affordable Care Act (ACA) individual mandate, requiring individuals to purchase and maintain health coverage, by zeroing out the penalty beginning in 2019.
For 2018, most individuals are still required to maintain coverage or pay a penalty when they file their 2018 federal income tax return.
The bill was negotiated by a conference committee comprised of representatives from both the Senate and House after each chamber passed their own versions of tax reform. The final bill was passed 51-48 by the Senate and 224-201 by the House before being sent to the President. President Trump is expected to sign the bill into law soon.
The bill also changes how certain tax thresholds will be indexed for inflation. Affected provisions, including the ACA “Cadillac” Tax (scheduled to take effect in 2020), will now be indexed to the Chained Consumer Price Index (CPI) instead of the regular CPI (the previous metric). That change makes it likely that more employer-sponsored plans would trigger the Cadillac tax sooner.
Phoenix Tops US in Population Growth
Phoenix is tops in the U.S. for population growth, according to new data from the U.S. Census Bureau.
Phoenix added 32,113 persons to its population between July 2015 and July 2016. That’s more than any other city in the U.S.
Los Angeles added 27,173, San Antonio 24,473 and New York 21,171 persons during the same time frame, according to the Census data. The population data is for cities and not metro areas.
That is good news for the real estate industry, home and apartment builders and business recruiters. It also shows the Phoenix market is getting back to pre-recession norms after the last real estate and economic crash.
Population growth stalled during and right after the recession.
The Phoenix metro area and Arizona as a whole have long depended on population growth to fuel construction, retail and restaurants and business services. A larger population also means Phoenix is in line for more federal funding for transportation, infrastructure and security dollars for programs based on population.
The city of Phoenix is expanding its Metro light rail system and also wants to bring more residents to its downtown core. A growing population can help convince developers and builders to do that.
The city of Phoenix’s population now totals more than 1.6 million persons. That ranks fifth among U.S. cities and ahead of Philadelphia (1.57 million).
New York is the largest U.S. city at 8.5 million followed by Los Angeles at 3.98 million and Chicago with 2.7 million.
The Phoenix metro area has 4.66 million persons. That ranks 12th nationally.
Maricopa County also topped the list of U.S. counties for population growth during the same time frame.
Lee McPheters, an economist with Arizona State University’s W.P. Carey School of Business, is projecting 2 percent population growth for the Phoenix metro this year. That comes after 2.1 percent growth in 2016 and 2 percent in 2015. A growing population certainly shows economic attractiveness and strength and appeals to employers looking for workers, home and apartment builders as well as real estate investors.
The Valley’s large labor pool is attractive to back-office and call centers and distribution hubs.
JPMorgan Chase & Co. (NYSE: JPM), Amazon.com Inc. (Nasdaq: AMZN), Bank of America (NYSE: BAC) and Wal-Mart Stores (NYSE: WMT) all have large operational footprints in the Phoenix market.
The West Valley city of Buckeye also ranks as one of the fastest growing U.S. cities posting 4.8 percent growth between July 2015 and July 2016. Buckeye has 64,629 residents, according to the Census Bureau.
That growth ranks Buckeye seventh nationally. Conroe, Texas near Houston had the highest growth at 7.8 percent. Frisco, Texas near Dallas was second with 6.2 percent population growth.
Overall most of the population growth in the U.S. is in the South and West.
“Overall, cities in the South continue to grow at a faster rate than any other U.S region,” said Amel Toukabri, a demographer with the Census Bureau. “Since the 2010 Census, the population in large southern cities grew by an average of 9.4 percent. In comparison, cities in the West grew 7.3 percent, while cities in the Northeast and Midwest had much lower growth rates at 1.8 percent and 3 percent respectively.”
The Arizona Senate approved SB 1441 on Wednesday, which would allow patients to challenge an unexpected medical bill after an emergency room visit, according to the Arizona Daily Sun.
Under current Arizona law, patients do not have any type of support to fight insurance companies that refuse to pay for procedures or services a patient received from out-of-network physicians.
SB 1441, authored by Sen. Debbie Lesko (R-Peoria), would allow patients to ask the Arizona Department of Insurance to intervene in cases where patients feel they are being unfairly charged, according to the report.
State intervention, however, would only be available in cases where patients could not check prior to the procedure whether a physician was in or out-of-network.
Arbitration will be available if a healthcare provider does not disclose upfront whether it is considered in-network, charges more than the estimated total cost and does not give the patient a chance to waive their rights to dispute the bill, according to the report.
Sen. Lesko said under SB 1441, patients would only be responsible for the normal co-pay amount and the deductible, in most situations. If the patient agrees ahead of time to a specific out-of-network cost, the legislation will not be applicable, according to the report. However, if the medical bill ends up being more than the agreed upon amount, the patient will have access to the procedure outlined in the legislation.
The Department of Insurance will have until 2019 to create the procedure for the review process if the legislation passes.
Eric Walters Insurance Services
Scottsdale, Az 85260
The major differences between the 2 health plans before the Senate has reviewed the Trump proposals.
Individual Mandate: (X Repeal)
Obamacare: All Americans are required to have health insurance or pay a tax penalty.
Republican plan: The mandate is repealed, but individuals who forgo health insurance for more than 63 days must pay a 30% surcharge on their insurance premiums for a year.
Employer mandate (X Repeal)
Obamacare: Companies with more than 50 employees are required to offer health insurance or pay a penalty.
Republican plan: This mandate is repealed.
Taxes (X Repeal)
Obamacare: Raised Medicare taxes on the wealthy and imposed new taxes on medical devices, health insurers, drug companies, investment income, tanning salons and high-end health insurance plans.
Republican plan: Repeals most Obamacare taxes and delays implementation of the tax on high-end health insurance plans to 2026.
Insurance for dependents ( √ Keep)
Obamacare: Requires insurers to allow children under age 26 to be covered by their parents’ policies
Republican plan: Maintains this requirement.
Essential health benefits (… Change)
Obamacare: Requires all insurance plans to cover certain health conditions and services, such as emergency room visits, cancer treatment, annual physical exams, prescription drug costs and mental health counselling.
Republican plan: Allows states to define what benefits are mandated or opt out of the requirement entirely.
Pre-existing condition coverage ( … Change)
Obamacare: Prohibits insurers from denying coverage or charging more to individuals who have pre-existing medical conditions.
Republican plan: States can let insurers charge as much as they like to sick people. Allocates $8bn to help subsidise those patients.
Medicaid (… Change)
Obamacare: Expanded Medicaid health insurance for the poor to cover more low-income individuals.
Republican plan: Phases out Medicaid expansion to reduce federal funding on the programme by $880bn over the next decade, and gives states greater flexibility in administering the programme in exchange for fixed federal spending.
Women’s healthcare (… Change)
Obamacare: Insurance companies prohibited from charging women more than men for the same health plan and must provide core services including maternity care and contraceptives.
Republican plan: Insurance companies still banned from charging women more, but states could allow insurers to drop maternity care and contraceptives from basic benefits. Also bans women from using federal tax credits to buy a plan that covers abortion.
Older Americans (… Change)
Obamacare: Insurers can charge older Americans no more than three times the cost for younger Americans
Republican plan: Insurers can charge older Americans five times as much as younger Americans. States would also be able to set their own ratio.
Subsidies (… Change)
Obamacare: Provided refundable tax credits for low-income individuals who purchased their insurance on government-run marketplaces and support for some out-of-pocket medical expenses.
Republican plan: Alters formula for tax credits, which will expand the benefit to more middle-class Americans but probably raise the costs for some elderly and less-affluent individuals.
All types of individual and group (employee benefits) health plans available including alternative coverage with new innovative plans with and without employer contribution!
ACA Blog: www.azhealthinsuranceblog.com
CMS Officially Shortens 2018 Individual Health Enrollment Period(before an GOP changes)
A new final rule also includes tougher enrollment eligibility screening
President Donald Trump’s administration has formally adopted regulations that could help increase the stability of the individual major medical insurance market, and the Affordable Care Act exchange system, in 2018.
One big change in the new package of regulations will move the end of the open enrollment period for 2018 individual major medical coverage to Dec. 15, 2017 from Jan. 31, 2018.
The Centers for Medicare & Medicaid Services (CMS), the agency that put out the packet of regulations, also has made a final decision to:
• Require all consumers who apply for “special enrollment periods,” or exceptions to the usual individual major medical open enrollment period deadline, through HealthCare.gov to provide documents showing they qualify for SEPs before they get health coverage in place.
• Let states that have shown they take evaluating health provider networks seriously continue to set provider network adequacy standards for the exchange plans in their states.
• Give exchange plan issuers a little more wiggle room when it comes to meeting ACA health plan actuarial value standards.
CMS began formal work on the new regulations after Trump took the oath of office, but they appear to reflect changes that CMS officials began to develop while Barack Obama was still president.
CMS assumes in the regulations that existing laws, regulations and batches of informal guidance related to the ACA exchange system and ACA individual major medical rules will stay in place.
The ACA has blocked health insurers from considering personal health factors other than age and location when issuing coverage, pricing coverage or designing benefits since Jan. 1, 2014.
Regulators, insurers and ACA exchange plan managers developed the open enrollment period calendar, or limits on when people can buy individual health coverage without showing they have what the government classifies as a good reason to do so, to discourage healthy people from waiting until they get sick to pay for coverage.
In the past, health insurers and patient advocacy groups have clashed over whether some consumers were abusing the system in ways that helped those consumers wait until they got sick to pay for coverage.
CMS officials said in the introduction to the new final regulations that they believe the shorter 2018 enrollment period and tighter SEP eligibility verification rules will improve the quality of the risk pool and help persuade insurers to stay in the individual market.
Seema Verma, the newly confirmed Trump CMS administrator, said in a statement included with the CMS announcement about the new final regulations that CMS is “committed to ensuring access to high quality affordable health care for all Americans.”
The changes made in the new regulations “will help stabilize the individual and small-group markets,” Verma said. “They are not a long-term cure for the problems that the Affordable Care Act has created in our health care system.”
CMS officials acknowledged in a discussion of the new regulations that the SEP verification requirements could cause problems for some consumers who cannot obtain the documentation required.
“Therefore, we will permit consumers to send us the details about their qualifying event with an explanation of why they are unable to submit requested documentation, and we will take their letters into consideration when deciding whether to exercise reasonable flexibility,” officials said.
NOTE: These changes are before any GOP changes/repeal of Obamacre.