Updated July 12th, 2017
CMS Allows the State of Alaska to Create Their Own Insurance Plan
Going into the 2018 open enrollment period, the people of the State of Alaska are faced with the reality that they only have one carrier option in the state – Premera Blue Cross. Alaskans have also suffered from sky rocketing premiums, year-over-year, which has made coverage very unaffordable. In total, Alaska has seen a 203 percent increase in their premium costs since Obamacare went into affect in 2010. On July 11th, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved the State of Alaska’s request to take steps to bring more coverage options that are affordable by essentially creating a state-run and funded insurance carrier.
The State of Alaska submitted a request for what is called a 1332 State Innovation Waiver, which is a provision under Obamacare that allowed states to basically create an insurance plan to offer their residents that is designed to bring more choice and stability to the market. CMS says in their announcement that they hope more states file applications for a 1332 State Innovation Waiver to help bring stability to the market. Under Obamacare, states had to wait until after January 1, 2017 to request these waivers, so this year was the first year that states had the option to take this action.
Under this 1332 State Innovation Waiver, Alaska will be allowed to create a state-operated insurance carrier that will offer plans for the next five plan years (starting on January 1, 2018) and these plans are designed to cover claims of people who have costly pre-existing conditions. The State of Alaska has identified 33 specific high cost conditions that it will cover under this new plan, meaning that anyone with one of these 33 specific medical conditions will get state-run insurance coverage now.
This high-risk pool plan will allow insurance carriers the opportunity to offer coverage to people who are healthier without fear of getting a sicker population, which will now be covered by the state’s plan. Knowing that you can market and insure a healthier group of Alaskans should compel carriers to come back into the marketplace in the state. The State of Alaska also predicts that by offering this state-operated plan to sicker Alaskans, the overall premiums for the state will come down by 20 percent in 2018.
The 33 medical conditions that will be covered are:
- HIV and AIDS
- Sepsis shock
- Metastatic cancer
- Lung, brain, pediatric acute lymphoid, leukemia and other severe cancers
- Non-Hodgkin’s lymphomas and other cancers and tumors
- Mucopolysaccharidosis (a metabolic disorder)
- Lipidoses and glycogenosis
- Amyloidosis, porphyria and other metabolic disorders
- End-stage liver disease
- Chronic hepatits
- Acute liver failure or disease and neonatal hepatitis
- Intestinal obstruction
- Chronic pancreatitis
- Inflammatory bowel disease
- Rheumatoid arthritis and other autoimmune disorders
- Hemolytic anemia including in newborns
- Sickle cell anemia
- Thalassemia major
- Coagulation defects and other hematological disorders
- Anorexia and bulimia nervosa
- Amyotrophic lateral sclerosis and other anterior horn cell diseases
- Quadriplegic cerebral palsy
- Cerebral palsy (not quadriplegic palsy)
- Myasthenia gravis/ myoneural disorders including Guillain-Barre syndrome and inflammatory and topic neuropathy
- Multiple sclerosis
- Parkinson’s disease, Huntington’s disease, sponocerebellar disease and other neurodegenerative disorders
- Cystic fibrosis
- End stage renal disease
- Premature newborns
- Stem cell and bone marrow transplants including complications from the procedures
- Amputation of limb including complications from the surgery
Updated July 3rd, 2017
Senate Version Of Trumpcare (BCRA) Just As Unpopular As House Version (AHCA)
It’s been a month since we last updated our visitors on what has become the rollercoaster of healthcare reform in America. After the House voted to pass the AHCA on May 4th, which punted the responsibility to the Senate, and the CBO released its score the plan – which was not as good as if Obamacare remained in place – the Senate decided to start from scratch and released their version of Trumpcare, which they named Better Care Reconciliation Act (BCRA), on June 22nd.
Unfortunately for the group of Republican Senators who slaved away drafting the BCRA behind closed doors, the CBO scored this plan almost as poorly as it did the House version. Subsequently the BCRA quickly became just as unpopular with Americans as the House version of Trumpcare, the AHCA, according to polls.
Senate Majority Leader, Mitch McConnell, intended to take the Senate version of healthcare reform to the floor for a vote before the July 4th vacation. Although the Republicans have a majority in the Senate, there’s no wiggle room for “No” votes from their side, so after realizing that he had at least four definite “No’s” from Ted Cruz, Rand Paul, Ben Sasse and Mike Lee (there was actually speculation of it being more like 10 “No” votes from Republicans), McConnell announced that he would delay the vote until after the holiday so that he could work on improving the bill.
While on the July 4th hiatus, the latest hype about healthcare is the sentiment that maybe Congress should shift strategies and worry about repealing Obamacare first and replacing it later. Ben Sasse and Rand Paul, who were both pretty firm “No’s” on the BCRA, are now firmly in the “repeal now, replace later” camp, along with a number of other GOP Senators. President Trump even went so far as to promote the idea, or threat, depending on whom you ask, on Twitter.
If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!
— Donald J. Trump (@realDonaldTrump) June 30, 2017
Americans may be surprised that the President is going along with this new suggestion considering the fact that he campaigned on a simultaneous repeal and replace plan of action. This was also his plan leading up to his inauguration, which he conveyed at his first news conference since the summer before on January 12th.
REPEAL AND REPLACE OBAMACARE!
— Donald J. Trump (@realDonaldTrump) October 26, 2016
Considering that it turns out that healthcare reform is actually incredibly complicated, and it is actually hard to draft healthcare legislation that will make the people happy, and that their representatives in Congress can vote for with a straight face, a “repeal now, replace later” course of action may be the only way to go in many GOP Senator’s minds.
The problem with “repealing now and replacing later” is that even if the repeal portion contains a long timeline, meaning that it will not take affect for several months or even a year, which gives Congress more time to get something else passed, the feeling among Americans will be that there is no healthcare law of the land and that they are simply not protected. This could be a disaster with respect to the upcoming 2018 midterm elections, that is of course if you’re trying to maintain your Republican seat. This is also bad for the healthcare industry that has been pleading with both sides of the political isle for some help in creating some stability in the health insurance marketplace.
Finally, this goes from bad to worse for Americans who will technically still have the opportunity to get insured and get subsidies during the 2018 Open Enrollment Period, but may fail to do so because the only headline running across their mind is that Obamacare was repealed and there was no replacement plan. Consumer confusion about the status of healthcare reform is very easy to generate and virtually impossible to subside. It’s also very detrimental because people who should get health insurance coverage and really need it, won’t get it because they are confused about whether it’s even available in the first place.
That’s the outlook for anyone who doesn’t even pay the least bit of attention to the politics, and or listen to their respective camps. Sprinkling in any level of political bias, or “focusing on party lines” behavior, that only complicates matters further for consumers.
We’ll have to wait and see what happens in the next week or so with constant dramatic saga that is, “healthcare reform” in 2017. Mitch McConnell eluded to there being a revised BCRA after he’s done watching the fireworks on the 4th . President Trump has even dropped some hints that a “great surprise” is coming with respect to the repeal and replacement of Obamacare.
In relatively short order we should know if McConnell has found a way to get more “Yes” votes from either side of the aisle, or whether he’s going to throw in the towel and and place his bet that a majority of Senators will vote “Yes” to repealing Obamacare first.
We advise you that you sign up for updates from us to ensure that you are up to date with all of the latest on Trumpcare. Or if you would like a link to another resource for information about healthcare reform under Trumpcare, visit Trumpcare.com.
Updated May 25, 2017
The CBO released their score of Trumpcare 2.0 and the news is just as expected
The Congressional Budget Office (CBO) announced their score for this version of the American Health Care Act and the news is good and bad. Here are the highlights:
- 14 million more people would be uninsured under Trumpcare than if Obamacare would remain in place in 2018.
- 51 million people would be uninsured under Trumpcare in 2026 versus 23 million under Obamacare.
- Anyone who used their tax credits, which are offered starting in 2020 under Trumpcare, to buy a non-major medical plan is part of the uninsured count because their coverage would not cover regular medical claims.
- Trumpcare would stabilize the market because insurers would be able to offer different kinds of plans and the subsidies offered until 2020 and the tax credits offered after that would attract healthy people; however people living in states that took the waivers to not cover the essential health benefits and to allow carriers to charge more for pre-existing conditions would be unstable under Trumpcare because coverage could be unaffordable even with additional financial help from the government.
- To this same point, the CBO believes that Trumpcare would not bring costs down for people who live in states that took those waivers, but that it would generally bring down premium costs after 2020. Before 2020, premium costs would rise.
- Finally, Trumpcare would save the country money and would bring down the deficit by $119 billion, but this amount is actually less than the first iteration of Trumpcare written. While rolling back Medicaid and subsidies would save money, the elimination of the individual mandate, the employer mandate and some Obamacare taxes that were designed to put money back into the program would be gone under Trumpcare.
The Senate was waiting for the CBO score to help weigh the pros and cons of the House’s version of the AHCA. The Senate promised that their revisions and redrafting of the bill would take some time and it remains to be seen whether the CBO score persuades them to keep or change different aspects of the law.
Updated May 17, 2017
CMS Announces Rule Change to Online Enrollment Process
If you were one of the millions of people who enrolled in a plan last Open Enrollment Period, you probably felt more frustrated than previous years in part because of the fact that the enrollment process was slow and confusing. Consumers or agents working on behalf of consumers on the phone were able to shop and start the application process in one place, but were required to go to Healthcare.gov to complete the identity and income verification piece of the process, before going back to the original website to finish up the application.
This handoff to Healthcare.gov may not seem like a big deal, but it was if the consumer was trying to navigate this process on their own and didn't understand why they ended up on a governmental website and it was definitely a big deal if an agent or consumer was trying to do this on a day when Healthcare.gov was having technical issues or experiencing high volume.
Thankfully for consumers and the industry, these problems should be gone during all future open enrollment periods with this new rule from CMS. Going forward, online broker websites and software being used by agents to complete enrollment will send the identity and income verification information to Healthcare.gov, on behalf of the consumer, behind the scenes and without any Healthcare.gov interaction.
This new enrollment process will not be available to consumers trying to enroll outside of the open enrollment period or who have a complicated situation with their income or identity that would require additional documentation proof.
CMS also stated in their published rule that this new, streamlined process was only a temporary fix and that they have plans for a more developed and integrated enrollment process with online brokers that will make things even easier in future open enrollments.
Updated May 4, 2017 at 9:05 p.m. EST
Republican Senators are Ready to Rewrite the AHCA
If House Republicans were hopeful that the Senate would be happy with and vote on their version of the AHCA, they are sorely mistaken according to the number of Republican Senators who have spoken out today following the passing of the American Health Care Act.
The Senate patiently awaited a healthcare reform bill from the House, but after seeing a version passed by such a narrow margin and less than 24-hours after the last piece was added, which increased the high risk pool funds used to provide financial assistance to people who are charged more for their coverage due to their pre-existing conditions, and before the CBO could analyze and provide a score, they made it clear that they would be handling this issue and responsibility differently.
They also plan to take their time. Several Senators commented today that they will only bring a bill to a vote once they know they have the 51 votes needed to pass it and they don't care how long that may take.
Updated May 4, 2017 at 2:20 p.m. EST
AHCA Vote Finally Happened
And.... it passed. Republicans needed 216 "Yea's" to pass the ACHA and they won it with a final vote of 217 - 213. Not a single Democrat voted for the ACHA.
On to the Senate.
Updated May 4, 2017
Today is the day - again - when Republicans in the House will try to pass an Obamacare replacement plan. The first version, the American Health Care Act (AHCA or Trumpcare), was pulled from the floor on March 24th. Since then, Paul Ryan and other Republicans have worked on amendments to the bill that would or could get passed. Keep in mind, even if it passes the House, it still has to go to the Senate where they can propose amendments and make changes.
The version of AHCA that the House will vote on today looks a little different than what was originally proposed. Initially, the AHCA cut out any requirement that insurance carriers had to offer coverage that included the ten essential health benefits. This exclusion angered constituents around the country, who spoke up to their Representative and who, in turn, announced that they would vote "No" on the AHCA.
In response to this issue, Republican Tom MacArthur from New Jersey proposed what is now known as the MacArthur Amendment. The MacArthur Amendment makes the following changes:
- States can apply for a waiver to change the age ratio for premium costs. Under Obamacare, the age ratio was capped at 3:1. Under the MacArthur Amendment of the AHCA, the age ratio could be as high as 5:1, meaning that people of a certain age demographic could pay 5x more than another demographic if your state decided to allow it.
- Regarding the ten essential health benefits, the MacArthur Amendment would allow states to seek a waiver from requiring insurance carriers to cover it in their health plans. This would bring costs down for premiums.
- Finally, regarding the pre-existing conditions, the MacArthur Amendment would allow states to seek a waiver that would permit insurance carriers to charge people with pre-existing conditions more for their health insurance than someone without one.
The big take-away from the MacArthur Amendment is that it gives a lot more power to the states to make decisions on what insurance carriers operating in their state can or cannot do.
The last piece of the MacArthur Amendment on pre-existing conditions still caused a lot of issues for moderate Republicans and their constituents after it was proposed. In response, Rep. Fred Upton from Michigan and Rep. Billy Long from Missouri met with President Trump to discuss how they could better protect people who do have pre-existing conditions and who may be charged higher premiums for their health insurance. The result of that meeting was another amendment that added money to the pool of money already created by the MacArthur Amendment. The new agreement added another $8 billion, which comes out to a total of $138B for a five year period, to the fund designed to provide financial relief to people who have to pay more for their health insurance due to their pre-existing conditions.
After it was announced that the President agreed to this term, more Republicans shifted their vote and it was determined that the GOP may have the votes to pass the AHCA.
The vote is scheduled for March 4th. We’ll see what happens.
Updated April 25, 2017
Healthcare reform is still a big news item. Almost daily, the media is discussing what and how to replace Obamacare. The AHCA failed a few weeks ago and Americans are patiently awaiting the next plan, which the GOP promises they are working on currently. There’s another group patiently (or impatiently) riding out this healthcare reform wave too – health insurance carriers. For years, carriers have requested changes to Obamacare that would bring more young and healthy people to the pool of insured people, would stabilize the market and would bring down their costs, which would in turn bring down costs for the insured. CMS issued a final rule on Obamacare on August 13th that made changes designed to do all of those things.
Here’s a quick summary of those changes, which address 4 main categories: enrollment periods, giving carriers flexibility to create new types of plans, saving carriers money and saving Healthcare.gov money. The last three categories are designed to bring down the costs of health insurance and save Americans money.
Changes to the enrollment periods
Open Enrollment Period
Open enrollment will be shorted to last just forty-five days, from November 1st to December 15th each year. This means you have less time to window shop.
Special Enrollment Period
Enrolling outside of the open enrollment period will be more difficult under this rule. Previously, you would experience a qualified life event, enroll in a new plan and then you would have to provide proof of your life event, if that documentation was even requested at all. This method permitted a lot of people to enroll only when they really needed coverage because they were sick. This is an issue that carriers wanted CMS to fix. Under this rule, the new pre-enrollment verification process requires you to prove your life event to Healthcare.gov through documentation before the carrier has to issue you coverage.
If you get married or give birth, foster or adopt a child and need additional coverage for that person, you will only be allowed to add that person to your existing plan. This qualified life event does not permit you to change your carrier or change your plan entirely.
If you lose coverage because you did not pay your premium bill, you may not enroll in a new plan during the Special Enrollment Period. Losing coverage due to non-payment of a premium is not a qualified life event.
Changes that will give carriers more flexibility
Previously, carriers were required to offer a tiered level of plans that covered, on average, a set percentage of the costs. Carriers were unable to offer many different types of plans because they weren’t able to deviate very much from the percentage of costs they had to cover. Under this new final rule though, the average percentage is adjusted for each tier, which gives carriers the flexibility to create different types of plans that will work for different people.
Changes that will save carriers money, which will bring down the cost of health insurance
One big issue with the creation of Obamacare is that it created a lot more administrative work for carriers. Each new regulation and requirement created more paperwork and more work. This new final rule made changes to the requirements regarding the number of essential community providers (medical providers that service low-income and medically underserved communities) that carriers must contract with in each service area, which is ultimately designed to save carriers administrative dollars.
Another change implemented in this final rule is that carriers may withhold future health coverage of a person who still owes them money from a plan issued in the past. One big gripe by carriers is that people are keeping health insurance for as long as they need it and then they are dropping coverage. Carriers are required to continue to offer coverage during a grace period, even if they are not receiving premium payments. To resolve this issue, the rule now permits a carrier to deny coverage until the person pays them back the money they owed them for missed premiums.
Similarly, this rule allows carriers to apply the binder payment, the payment required for any new or renewed plan to take effect, to an outstanding payment due to that carrier by that insured. This is just another way for the carrier to make up some of the money that is owed to it and it should deter people from missing payments.
Changes that will save Healthcare.gov money, which will put more money back into the pool
There is a specific pool of money or budget set aside to implement all aspects of Obamacare. The more money that is spent on administrative and management functions, the less money that is available for subsidies, cost savings tax credits, Medicaid funding, and other programs that will ultimately improve the health of our nation and bring down the costs of healthcare. This rule changed the requirements placed on Healthcare.gov to validate the network of health plans, which will save taxpayer dollars. Under this new final rule, Healthcare.gov is permitted to defer to the State’s review and approval of a health plan’s network as being adequate and compliant with the law. There is no need any longer for Healthcare.gov to complete its own audit of the plan network.
Another interesting thing to note from this final rule is that CMS is exploring additional ways to get people to keep their insurance year-round. This concept of “continuous coverage” was a replacement for the individual mandate in the GOP’s Obamacare replacement plan – the AHCA. One example that CMS outlined in the final rule was making enrollment during the Special Enrollment Period contingent on the consumer proving that they had insurance coverage for the previous 6 or 12 months.
Updated March 25, 2017
"Obamacare is the Law of the Land"
After one stalled vote in the House, Speaker Paul Ryan informed President Trump shortly before the rescheduled vote on Friday, March 24th that he didn't have the votes to repeal and replace Obamacare with the American Health Care Act (AHCA). Minutes before the vote was set to start at 4:00 p.m. EST, it was announced that the President advised Speaker Ryan to take the bill off of the floor and cancel the vote.
In a statement made in front of the press a short time later, Speaker Ryan admitted that he was disappointed that they couldn't get a consensus amongst his party and that it was time to move on from healthcare. He also stated, very clearly, that Obamacare was the law of the land for the foreseeable future.
At an appearance in the oval office, in front of reporters, President Trump eluded to the fact that the AHCA would have been passed if it hadn't had been for concessions made to the Freedom Caucus the day before, which were to remove the ten essential benefits. They were also pushing to get rid of the pre-existing condition mandate as well.
So here is the present state of healthcare in case you are feeling just as confused as ever:
There will be an open enrollment period on November 1st, which is when you can shop for health insurance again. You are still required by law to be insured or else you will be penalized when you file your federal taxes.
If you didn't get insurance in 2016 because you thought that Obamacare would be repealed, there's a good chance you'll be penalized. Luckily the tax penalty is prorated by the number of months in a year that you're uninsured so if you have a qualifying life event and can get insurance soon, your penalty will be less than it would be if you waited until next year.
Your plan will cover you even if you have preexisting conditions and will provide you the ten essential health benefits. It will also cover your kids until age 26 and will not cut you off if you reach some annual or lifetime payout amount.
Medicaid expansion is also still in place so all of those millions of Americans who were going to lose their coverage under the AHCA will still be insured.
You can still get subsidies to help you pay your health insurance premiums.
As a number of Congresspeople stated today in various interviews with the press, now is the time for Republicans and Democrats to work together on improving what we have because everyone will admit that it needs to be fixed.
Take some time to write your representative and ask them to work on your behalf and not their party's behalf to bring down premiums, to compel carriers to reenter the market and to offer better plans.
Updated March 23th, 2017
Republicans Delay Trumpcare Vote Until Friday, March 24th, 2017
President Trump’s first legislative test is looking even more precarious as Republicans delayed a crucial House vote scheduled for Thursday, March 23, a date that should sound familiar to millions of Americans by now. This time seven years ago, former President Obama signed his signature healthcare reform bill into law.
Now, on the anniversary of that date, Republicans had been attempting to destroy the legislation that made up the Affordable Care Act by replacing it with a perplexing mix of bad proposals that few in Congress – Democrats or Republicans – support.
The American Health Care Act (AHCA), nicknamed Trumpcare, has been nothing short of bewildering since its introduction by GOP lawmakers on March 6th, 2017. Late Thursday afternoon, Republicans announced that they would be delaying the House vote because they lacked sufficient support to push their bill through the lower chamber. Ironically, opposition is coming in from all sides, most vocally from the House Freedom Caucus, an ultra-rightwing group determined to destroy every scrap of the ACA that they can, including popular provisions that some conservatives actually support, like the pre-existing conditions clause that is supported by upwards of 80% of Americans.
The Freedom Caucus has been unabashed in its opposition to Trumpcare, even more so than congressional Democrats, who object to the bill on ideological grounds. On the other side of the spectrum, Freedom Caucus members claim the Trumpcare doesn’t go far enough in eradicating the ACA. In a truly puzzling move, Republican lawmakers on Thursday conceded to caucus demands by offering to nix the essential health benefits provision of Obamacare. Unfortunately for Speaker of the House Paul Ryan, the bill’s chief cheerleader, even this concession wasn’t enough to sway caucus votes in the right direction.
Under Obamacare, insurers must cover 10 essential health benefits in major medical plans in order for them to be considered ACA-compliant. These benefits include basics like wellness checkups and emergency room visits, but they also cover less obvious medical services, such as laboratory testing, rehabilitation and mental health care. Republicans have argued for years that these essential benefits are costly and unnecessary. The average single man, for instance, would have no need for maternity care, nor would a woman past her childbearing years require contraceptive services. We do however have a massive opiod problem here within the United States, and stripping out care for addiction coverage is only going to make that national crisis much worse. Ironically, President Trump wants to build a wall on the Mexican border to keep heroin and narcotics out, but the individuals within the country with dependency issues on them, they're looking at not having any sort of health coverage to address getting off of these substances if the Freedom Caucus has anything to say about it.
But the essential benefits provision, aside from making health insurance more expensive, also protects people who do need these services. Without a provision requiring insurers to cover basic benefits, plans could be tailored to specific needs – at a much higher cost for the people who would use them. Including essential benefits in all major medical plans ensures that the costs get distributed throughout the entire risk pool, not just among people who need more care.
What is one of the most heartbreaking scenarios, and again truly puzzling as to whom the Freedom Caucus is trying to serve, are pregnant women. Prenatal care and care after child birth are currently one of the ten essential benefits. How on earth is any politician going to be able to explain why removing these protections and essential benefits that provide care for mothers and children, including children still being carried to term, is a good thing for Americans?
Adding to the hullaballoo is a recent report from the Congressional Budget Office (CBO), which is predicting an even worse outcome from Trumpcare than originally projected. Republicans in Congress attempted to gain support for the bill by introducing a number of changes on Monday, March 20, to meager success. After crunching the numbers with these amendments included, the CBO is now predicting that Trumpcare will only reduce the federal deficit by about $151 billion between 2017 and 2026 – a difference of about $200 billion over its initial estimate.
Breaking news from Washington, D.C. says that President Trump is insisting on a House vote for Friday despite the fact that there are not enough Republican votes to pass the AHCA in its current form. It remains to be seen whether Ryan and other GOP lawmakers can convince fellow party members to back the bill. Analysts argue that even if Trumpcare somehow succeeds in the House, it will certainly hit a brick wall in the Senate.
Updated March 22nd, 2017
Freedom Caucus Sells Out To Koch Brothers Demands - Forces Trump To Most Likely Remove Essential Benefits From AHCA
Just when we thought things couldn't get much more absurd than they already are, the Freedom Caucus, which was already riding high from their public opposition to President Trump's healthcare reform, throws us another curveball. This pitch, is of course, being called by the co-managing team of Koch enterprises founders, Charles and David Koch.
In the latest twist, it seems that the Freedom Caucus has felt a sudden sense of empowerment to actually demand that President Trump remove from the AHCA, the ten essential benefits that health insurance carriers are obligated to provide.
Now first let's just get something out of the way, some elements of the Affordable Care Act, or Obamacare, are a little overkill. Some parts of the essential benefits are simply not applicable to everyone. So there are valid complaints when it comes to the Affordable Care Act. That said, people, countrymen, legislators, human beings with a soul, let's not throw the baby out with the bathwater.
While it doesn't make sense to provide women over 55 with contraceptives to prevent pregnancy, despite some instances where pregnancy does naturally occur even at that later stage in life, most women aren't going to use birth control when they're past a certain age. There are elements of the ACA when taken literally, and put into place by health plans, seem like overkill. We totally get it and agree. No one is arguing that there is massive room for improvement, but there is zero chance that any member of the Freedom Caucus would want to have to rely on the stripped down version of health insurance coverage that they are pushing for. There's even word coming forward that Freedom Caucus members are saying that they want the protections that don't allow insurance carriers to exclude for pre-existing conditions stripped out.
That said, the Freedom Caucus is making it sound as if health insurance premiums are going to plummet if the ten essential benefits are repealed. First of all, that's not how the health insurance industry works, and it simply isn't true. Don't take our word for it, these healthcare experts are all in agreement on the matter and don't think it will make any real significant impact.
Changes that impact pricing on on monthly premiums won't take effect for a very long time. Even if it did, we're not entirely sure that Americans would even want the coverage that they could sign up for. If what's being rumored actually passes the house and ends up being voted on the senate floor as is, well then the Koch brothers have effectively used their limitless pit of money to screw over the American people.
How did they do this? By having their political organizations announce last minute, that any republican member who opposes the AHCA in a house vote, will have their organizations financial backing and support come election day. It's amusing, brazen and just another reminder of how the "little people" just have zero chance against billionaires who can "Rent A Rep" at their leisure, especially those in the Freedom Caucus.
We're not going to get into all the details of the core of the ten essential health benefits, but here's one of the major ones that almost everyone should be able to appreciate. Under the AHCA, or Trumpcare, maternity care is considered an essential health benefit. This means providing adequate coverage for women who need medical care before and after a pregnancy. That's a benefit that is viewed as a reasonable requirement by all Americans. Allowing "kids" to stay on their parents plan until they are 26 is considered universally popular with a large majority of voters. Does the GOP really think that discriminating against pregnant women is really going to fly with voters? Of course not, but the Freedom Caucus is threatening to derail the entire legislative process if they don't.
Who doesn't love a pregnant woman? Apparently the Koch's, because they're forcing the administration to remove basic coverage from the AHCA that would ensure that women who are pregnant, or post pregnancy, don't pay 70% higher costs (or more) for health coverage.
We really don't know what to say at this point. It's clear that the Koch's are setting a trap for Trump and Paul Ryan to fall into, and they're either falling for it, or they're preparing for a battle in the senate once the bill passes the house.
There's zero chance that President Trump actually allows this "stripped for parts" healthcare bill to move forward beyond the house. He's rightly too concerned with following through with his campaign promises to actually allow this to happen. This wouldn't just leave people out in the streets to die, it would literally move things so far back, that the days when insurance carriers could simply reject people for pre-existing conditions would be a whimsical memory of better times with respect to healthcare in the United States of America.
If you would like to express your frustration to the thoughtful and dedicated representatives of the "Freedom Caucus", here's a link where you can find out exactly how to get in touch with them.
Updated March 21st, 2017
Conservative House Republicans Threaten To Derail The Trumpcare Train Despite Last Minute Changes To The Bill To Appease Them
With two days to go before the House votes on the American Health Care Act (AHCA), the latest effort by rightwing politicians to repeal and replace Obamacare, GOP lawmakers have made a few changes to the bill to sweeten the pot for unsupportive conservatives. The AHCA was released two weeks ago to lackluster support among Republicans and outright hostility from Democrats. Plenty of controversial provisions exist in the bill, but it was the Congressional Budget Office’s shocking estimate that created an uproar.
According to the CBO, 24 million more people would be uninsured by 2026 under Trumpcare than they would under Obamacare. Their estimate is based on voluntary canceling absent an individual mandate as well as limitations being imposed on Medicaid.
On March 20, Republican lawmakers announced key changes to the bill, no doubt an attempt to sway on-the-fence conservatives to vote for its passage. Initial objections to the AHCA came from all sides, but the most vigorous objectors were members of the House Freedom Caucus, an ultra-conservative group that sympathizes with the Tea Party movement. They believe that Trumpcare doesn’t go far enough in fulfilling the promise to upend the Affordable Care Act.
By contrast, some Republican lawmakers object to the bill on grounds that it strips too many people of access to health insurance, particularly those from states where conservative governors chose to expand Medicaid coverage. Congressional Democrats agree. Under Trumpcare, significant changes to Medicaid would impact funding and consumer access to coverage. The latest set of amendments to the proposed bill includes:
- Repealing Obamacare taxes earlier than scheduled: Under the ACA, certain taxes, including taxes on medical devices, have been levied to help fund the law’s income-based tax credits. The Republican plan seeks to eliminate those in 2018, but one of the changes issued Monday changes that date to 2017 in an effort to appeal to hard-right conservatives.
- Shifting Medicaid to a block-grant funded system: Medicaid is funded in an open-ended match system right now, meaning that for every dollar a state spends on Medicaid, the federal government matches it on a dollar-per-dollar basis. Instead, Republicans wanted to introduce a per-capita cap, which would cap federal assistance based on enrollment. Now, GOP lawmakers are proposing shifting the system to a block-grant system instead. Under block grants, states would be given a set amount of funding per year regardless of enrollment.
- Allowing states to impose work requirements for Medicaid: An additional change to the Medicaid proposals introduced on Monday is the provision to allow states the option to institute work requirements for able-bodied enrollees. Under the ACA, 31 states and the District of Columbia expanded their Medicaid programs to include able-bodied adults without children as long as they met the expanded income requirements (138 percent of the federal poverty line). Trumpcare would allow states to require those people to work in order to qualify for Medicaid, and there’s an added incentive for choosing this option. States would be given an extra 5 percent funding if they enforced work requirements for Medicaid recipients.
- Expanding tax credits for older Americans: While not officially among the amendments introduced to Congress this week, a Republican press release indicates that tax credits will be expanded for people aged 50 to 64. As it’s written, the AHCA changes Obamacare tax credits from income-based to age-based, with older people getting higher subsidies. But critics have pointed out that older people need costlier care, and age-based credits aren’t enough to bring down costs. In response, the GOP is offering additional sums to older Americans, which they’re hoping will appease advocate groups like AARP.
The AHCA goes to the House Rules Committee on March 22 and is expected to reach the House by March 23, which is the 7-year anniversary of the day that former President Obama signed his signature healthcare bill into law. Despite amendments introduced by Republicans this week, analysts aren’t sure that the changes will be enough to sway opposing conservatives, and they certainly do nothing to assuage the fears of congressional Democrats. President Trump and the AHCA’s chief supporter, House Speaker Paul Ryan, have been lobbying for conservative votes over the last two weeks. The bill is expected to hit significant road blocks in the Senate, assuming it passes a House vote on Thursday.
This could prove to be very dangerous for those within the Freedom Caucus, the main Republican opponents of the AHCA, which is also known as "Trumpcare". Apparently the CEO of ultra-conservative organization Heritage Action For America feels so confident that the House will not vote it forward that he felt he should tweet about it following a meeting in the house offices.
Barring additional changes, the AHCA keeps the architecture of ObamaCare (Title I regs) in place. Heritage Action will be keyvoting against.
— Michael Needham (@MikeNeedham) March 21, 2017
For those unfamiliar, Heritage Action has been involved with the fight to repeal the ACA for some time now. In fact, in August of 2010 the organization helped secure support from 170 other Republicans for a petition led by Rep. Steve King of Iowa. Yes, that Steve King of Iowa. For those unfamiliar, he recently let Americans know precisely how he feels about the contributions that immigrants make in the United States with tweets and follow up interviews that simply made matters worse. Most Republicans are quickly distancing themselves, along with most Iowans, from Steve King. His political future is certainly in question moving forward, at least in Iowa. Although according to reporting by USAToday, at least one person, David Duke of the KKK was supportive of King's comments.
Not to take anything away from other conservative groups who feel that the current update to the AHCA doesn't go far enough, the Koch Brothers backed Americans For Prosperity also tweeted that they plan to key vote against the bill.
Currently, we can't support the GOP healthcare plan. Without major changes, we'll key vote against it & stand with those that stand with us.
— AFP (@AFPhq) March 21, 2017
Just a quick reminder that the Koch brothers, who are owners of the second largest company in the United States, and have an approximate net worth of $ 50 Billion each, stand to save tens of millions, if not hundreds of millions in 2017 if the "Obamacare tax" imposed on the wealthy is repealed on a timeline that is more in line with "conservative" standings that support the free market.
We try to avoid the politics, we really do, but sometimes you just have to "call them like you see them". Across the board, both conservative and liberal groups, including the nonpartisan CBO, have expressed great concern that many parts of the AHCA will hurt those already living in poverty, along with Americans working jobs that barely allow them to keep a roof over their head, harder than anyone else.
From our vantage point, seeing as we understand the mechanics of the health insurance industry, everything being focused on right now is purely about partisan politics and grandstanding.
If you would like to express your opinion with your local representative within the house, feel free to use the following link.
House Of Representatives List
Updated March 14th, 2017
CBO Analysis Predicts That 24 Million Americans Will Lose Coverage Under Trumpcare By 2026
The Congressional Budgetary Office (CBO) finally released their findings and rating of the new healthcare reform proposal being called Trumpcare. Critics are quick to note that the CBO, although bipartisan (neutral and not politically leaning), which is currently headed by a conservative, is not always accurate in their findings (they haven’t been accurate with every estimate made about Obamacare for instance), but many more are warning that the CBO’s report should be taken seriously.
Here is breakdown of their analysis and what they found:
24 million Americans will be uninsured under Trumpcare within the next decade. 14 Million will be uninsured by 2018 and this is mostly due to the fact that Trumpcare doesn’t include a mandate to get health insurance and it also rolls back Medicaid expansion, which currently accounts for roughly 28% of all insured people in the U.S. (more than 74 million Americans).
The federal deficit would be reduced by approximately 337 billion dollars over the next decade, which would be due to the savings from the Medicaid program expansion and the fact that there are no more subsidies given.
Premiums would increase until 2020 and would then decrease, which is what they also found with Obamacare. By 2026, the average monthly premium would be 10% less than it would be if Obamacare would stay in place.
The CBO estimates that the healthy pool of people who don’t have high medical expenditures, would be attracted to Trumpcare and its tax credits and would be enticed to enter the market.
Insurance for older Americans would be higher than it would be under Obamacare because Trumpcare allows insurance carriers to charge older Americans 5x more a month in premium costs. Obamacare currently caps the premium multiple for older Americans at 3x more per month.
Democrats are urging Republicans and President Trump to go back to the drawing board after hearing the CBO’s findings.
Updated March 7, 2017
On March 6, 2017, House Republicans finally revealed their healthcare reform bill, which had been under a literal lock and key from the media and most of Congress for over a week. This bill is just a proposal or starting point and the features it offers Americans and the requirements it removes from Obamacare may look very different in the final version after negotiations from both sides of the aisle take place.
Americans who are eager to know what their new healthcare options will be and what will be required of them under Trumpcare will need to have some patience. Although negotiations and discussions open up next week in Congress about the law, it may still be several weeks or months before anything is approved and ratified by a vote.
For those who are curious about what the first proposed draft looks like, here are some bullet points:
- Subsidies are replaced by premium tax credits. Starting in 2020, Americans will no longer be offered subsidies to discount the cost of their monthly premium, but will rather qualify for premium tax credits that will decrease the cost of insurance as a person gets older, which means that younger people will get less assistance despite their income level. For instance, a person aged 29 and younger will only receive $2,000 a year in tax credits, but a person aged 50-59 years old will receive $3,500 a year in tax credits, but no family can receive more than $14,000 a year in tax credits.
- Prohibition on coverage denial for pre-existing conditions and other discriminatory reasons. No insurance carrier can deny coverage or a claim for a pre-existing condition just as was in place in Obamacare. Also similar to Obamacare, carriers are not allowed to discriminate by imposing higher premium costs and dependents may stay on their parents’ plan until age 26.
- Eliminate the individual mandate but impose a surcharge on premiums if an individual gets insurance after a lapse in coverage. Trumpcare eliminates the legal requirement that all Americans have health insurance, but imposes a 30% rate hike on the monthly premium amount for any American who goes without coverage for more than 63 days in a calendar year. This means if you decide not get health insurance and you are uninsured for more than 63 days in a year and then the following open enrollment period you decide to get health insurance and your monthly health insurance premium is $500, you will actually be charged an additional $150, for a monthly total of $650 because you were uninsured for more than 63 days the year prior.
- Retroactively eliminate tax penalty for uninsured Americans for 2016 tax year. If you were uninsured in 2016 you will not be taxed on your 2016 federal income taxes as was required by Obamacare.
- Medicaid expansion is eliminated. Starting in 2020, there is no longer an option for states to offer Medicaid coverage to adults that make up to 133% of the federal poverty level. This is one of the more divisive points within the bill that is expected to cause friction between republicans, democrats and more extreme members of the GOP who would prefer that medicaid be eliminated entirely.
- Keep Special Enrollment Period. Similar to Obamacare, Americans will be allowed to change their health insurance plan during an annual open enrollment period. If an individual loses coverage or has a qualifying life event outside of the open enrollment period (OEP), they may enroll in a plan or change their coverage during a special enrollment period (SEP), but they must be able to demonstrate that they had continuous coverage before the qualified life event occurred. Unlike Obamacare, there will no longer be Open Enrollment Periods after the 2018 Open Enrollment Period, because the requirement to simply have continuous coverage will kick in. This means that if you want to change your health insurance plan for no reason at all, you'll probably have to wait until your insurance policy's renewal anniversary (a year after you first signed up), which is similar to how it used to be.
- Legal immigrants are eligible for coverage under Trumpcare and tax credits. Similar to Obamacare, this law applies to U.S. citizens and legal immigrants who are not incarcerated.
- The tax credits can be applied to any type of health plan. Under Obamacare, the subsidies were only available for plans purchased on the exchange and that met the standards of the law. Under Trumpcare, the tax credits can be used towards any type of health plan, including a short term health plan, or one purchased off the exchange.
- Plans must still cover the 10 essential health benefits required under Obamacare. All qualified health plans offered on the exchange must cover the 10 essential health benefits first required by Obamacare. Additionally, Trumpcare keeps the requirements imposed by Obamacare that prohibited any lifetime or annual payout limits and for plans to offer and cover preventative benefits at no cost, which includes contraception for women.
- Qualified health plans will not cover abortions. Trumpcare does prohibit any tax credits to be applied to a health insurance plan that covers abortions unless the situation is necessary in order to save the mother’s life or in the case of rape or incest.
- Health Savings Accounts (HSAs) are encouraged and improved. Trumpcare increases the annual tax-free contribution limit for HSAs to $6,550 per individual and $13,100 per family in 2017. Previously it was $3,350 per individual and $6,750 per family in 2016.
- Employer mandate tax is eliminated. Any large employer that does not offer health insurance to their employees is no longer taxed and the tax credits offered to small employers who offer health insurance to their employees is also eliminated.
- State exchanges may still exist. States are still allowed to set up and maintain state exchanges, just like they did under Obamacare.
If you called Healthcare.gov on January 31st and left your contact information on the voicemail system, you now have extra time to complete enrollment
President Trump Instructs Healthcare.gov to Stop Outreach to Americans About Obamacare Deadline
President Trump has instructed CMS and Healthcare.gov, the federal healthcare exchange to no longer market the open enrollment deadline or to encourage people to sign up for health insurance coverage. This has been described as "sabotage" by some news outlets as well as those within government who oppose his decision, including former employees of Healthcare.gov.
While we do not agree with nor understand his decision, we have to face facts and accept it. While nothing has been announced and our preference is to not speculate on upcoming events. That said, based on his actions yesterday, we feel that it is very safe to assume that there will NO EXTENSION for open-enrollment.
We can not be any more clear than we are right now. Do not wait to enroll in a plan. If you do not wish to use the government health exchange that is fine, you can still sign up for coverage through a reputable third party health insurance website. Below is a form that will allow you to get pricing information on plans that comply with the ACA and are available in your area.
Updated Updated 1/25/2017
20th Century Fox Launches Viral Marketing Campaign That Is Confusing People Trying To Sign Up For Obamacare
We received some emails from Americans who were either frustrated or confused by the website HealthcureGov.com, that they accidentally clicked on after searching for "Obamacare Enrollment" in Google. After replicating this same thing within Google, we can confirm that it seems that some marketing team involved with the promotion for the upcoming release of the movie A Cure For Wellness has clearly decided to take advantage of the hot button issue that is on the minds of tens of millions of Americans, "Obamacare".
Running ads promoting a movie is one thing, but what you will find if you venture over to Healthcuregov.com which is obviously intentionally confusingly similar to Healthcare.gov, is a website that looks very similar to the government exchange. They've even gone so far as to create an almost 100% identical favicon.
This is really poor taste and it might not be exactly clear to 20th Century Fox marketing that this is not only going to upset a lot of people whose time they just wasted, but it could actually get them in a lot of trouble legally.
Registering the domain Healthcuregov.com is a violation of the cybersquatting law, which a single violation of can result in upwards of a $100,000 fine. You can also argue that the design of the site being so close to that of the actual government exchange, is violating copyright law and could not be considered "parody".
Really the most troubling part of this for us, as advocates for Americans who are simply trying to get healthcare coverage, is that the website could actually lead to many people missing the enrollment deadline of January 31st.
Why is that? Because this website that is promoting a movie, a website that is clearly designed and using a domain name in order to trick people into thinking it is a government website about healthcare, is misleading people into thinking that the deadline to enroll is 23 days away. Why is that?
Well that's because the release date for the movie A Cure For Wellness, comes out on February 17th, 2017.
This is incredibly irresponsible marketing on the part of 20th Century Fox and it is literally placing Americans lives in danger just to promote a movie. Domain registration records clearly indicate that 20th Century Fox registered the domain on January 18th of this year.
We're reaching out to the company directly to ask them to take the reckless website down as well as their marketing campaign.
For the record, the deadline to enroll in a major medical health insurance plan under Obamacare is January 31st, 2017. If you need coverage you should enroll now.
Story Update - Since we wrote about this yesterday and subsequently began alerting others within the industry, apparently 20th Century Fox took notice and decided to kill off this terrible idea. The domain now redirects to the movies main website and is no longer confusing Americans about the enrollment deadline.
Second Story Update - As of 1/27/2017, 20th Century Fox has continued to market A Cure For Wellness in an even more aggressive manner. This is reckless and is literally putting peoples lives in jeopardy.
Major News Outlets Are Encouraging People To Sign Up For Health Insurance
In case it hasn't become clear over the last week, but as things stand now, without question your ability to sign up for health insurance, could become quite challenged. President Trump signed an executive order that could potentially lead to the collapse of the current health insurance marketplace. I'm not referring to Healthcare.gov either. No, the underlying market supported by insurance carriers and their policy holders. This is why it is 100% critical that you do not delay, and find a way to enroll. You can use a trusted private marketplace like the one below. Or you could use the government exchange website mentioned above. Just get enrolled before it is too late.
Enroll Now - President Trump Has Signed An Executive Order For Obamacare
It Is Unclear How Much Longer You May Be Able to Get A Grandfathered Plan. Do Not Wait Any Longer To Get Coverage. Do Not Stop The Enrollment Process Until You Are Enrolled. This Is Urgent. Americans Must Take Action Immediately Or Face The Possibility Of Having Much Lower Quality Health Coverage Options.
2017 Obamacare Deadline & Important Enrollment Dates
1-31-2017 is the last day to sign up for private health insurance nationwide. If you qualify for Medicaid or CHIP you can sign up for coverage any time of the year. Coverage will start of Feb. 1 if you sign up and pay your premium by Jan. 15.After that, coverage starts on March 1.
If you live in one of the following areas, your deadline for open enrollment may change.
* Extension granted to all Minnesotans so long as they purchase insurance through state exchange
* Deadline extended to 6 p.m. on Friday for any Coloradoan who started the enrollment process on January 31st, but was unable to pick a plan and complete the application.
Special Enrollment Periods (SEP) are triggered by qualifying life events, like losing job-based coverage or having a baby, and typically last for 60 days after the event. Because of the potential repeal of Obamacare, you are better off to expect that there will not be any SEP following 1/31/2017.
Our advice is to enroll now because you have nothing to lose by doing so. If you are enrolled in an Obamacare plan by January 31st, you will be grandfathered into a plan at that point. You will not be able to lose coverage for all of 2017, but it is imperative that you enroll before the deadline. If you try to enroll on 1/31, which is always the busiest and most difficult day to enroll of the year, you may not be able to do so. That's a risk that you really should not take if you need health insurance.
Obamacare Repeal Is Becoming More And More Likely
Senate Republicans aren't listening to what the American people want, according to a recent poll by NPR and IPSOS. Just 14% of Americans polled want a repeal of Obamacare without a true replacement for it ready to go into effect at the same time. It's easy to understand why. There's millions of Americans who rely on prescriptions, like insulin for diabetics, including children with type 1 diabetes. These are essential benefits many now rely on in order to survive. If there is a true full repeal, and that repeal goes into effect immediately, it is unknown how long anyone with an existing plan will have coverage. This is entirely new territory for the health insurance industry within the United States. Health insurance executives are currently advising the government to not hastily enforce a repeal because it will most likely throw the entire healthcare system into total chaos, and the death spiral that's been predicted could become a reality very quickly.
Apparently no one that has an R next to their name within the Senate, excluding uber contrarian and original thinker Rand Paul is willing to listen. He voted against the repeal yesterday, as the only Republican holdout.
Here's our advice, enroll today, because you've got nothing to lose in doing so at this point. If you wait until the end of open-enrollment 1/31/2017 , you might not be able to get enrolled at all. On 1/30 and 1/31 it is going to be a chaotic scramble for millions and you are best to avoid that headache. We're throwing our hands up in frustration because this rush to repeal and hopefully replace, it's going to be a symbolic gesture on the part of the Republican Senate that literally serves to benefit no one. That is of course unless you're a Republican Senator, because then you get to finally follow through on doing that thing you've claimed to have wanted to do for years, repeal Obamacare.
Obamacare's Confusing Possible Repeal Is Causing Major Concern For Americans
We're going to take a break from being completely neutral with our perspective on the current status of Obamacare, because right now there's just too much at stake and no one within either political party is giving the American people answers.
Right now the senate is angling to find ways through the reconciliation process to repeal Obamacare, and what it intends to do with said repeal is currently up for debate. No one entirely knows at this point how a repeal would work, nor if it could actually be pulled off without taking coverage away from tens of millions of Americans. Even Republicans are in disagreement with one another on how long a repeal and replace plan would take to implement.
Our take on the matter is that the political infighting and grandstanding is going to continue without question beyond 1/20/2017 when Donald Trump is sworn into office, and certainly beyond the Obamacare Enrollment Deadline of 1/31/2017. Part of it simply has to do with elected officials trying give the perception that they're trying to serve their political party, without regard to the collateral damage it may cause American families. Mostly though it is simply because that's what politicians do in turbulent times, disagree with one another and ask for your support to help keep them in office in order to "fight on your behalf".
We're not entirely sure what is going to happen with respect to your healthcare options after 1/20/2017. That makes us nervous and that should make you even more nervous. It is entirely possible that health insurance carriers participating in the exchanges currently, announce a withdrawal from the marketplace within the next thirty days. While that won't go into effect until 2018, here's a scenario in which it could harm you if you do not have coverage by the deadline to enroll.
If insurance carriers announce a planned exit from the exchanges starting in 2018, it could make obtaining coverage after 1/31/2017 impossible if you want a major medical plan. Once the deadline for enrollment is up on 1/31/2017 you can only obtain coverage if you have a qualifying life event or for special circumstances. It is unlikely that if insurance carriers are exiting the exchanges, and if Obamacare is repealed, and or "repealed and delayed", that they would be required to enroll consumers in a plan outside of open-enrollment. If you or a family member is planning on having a baby, currently pregnant and or if you have complicated medical issues, obtaining coverage that will actually cover those expenses could be impossible after 1/31/2017.
So What Does This Mean?
It means that this year it is even more important that you enroll for coverage well before the deadline. Not having coverage is a far more risky proposition simply because of the uncertainty surrounding Obamacare and or a repeal. Making matters worse, is that CMS is now requiring all enrollments to be handled in some part with the assistance of the government exchange. This is bringing the enrollment process which in previous years could be a speedy task to accomplish, to an absolute crawl on big enrollment days. On 12/15/2016, there were more than one million consumers waiting on hold to enroll because of issues with the government exchange. This is precisely why CMS extended the December 15th deadline for coverage starting on 1/1/2017, for five days. Major bottlenecks in how everything is processed this year, resulted in more than 1 million people not being able to enroll on 12/15/2016.
If you wait until 1/31 to enroll, you should anticipate waiting on hold for six hours or more, and or not being able to complete enrollment. This has happened in past years with high traffic enrollment days, and there is a very strong probability it will happen this year in particular. Additionally we should note that historically more people try to enroll on 1/31 and or the final day of enrollment, than on any other. There are millions of people who are "waiting to see what happens" and have delayed enrolling in a plan or renewing their current plan. We highly advise because of everything mentioned above, that you not take that risk.
With respect to risk vs reward, there's no risk in signing up now. If there's some magical replacement plan that materializes on 2/1/2017 that's better than the plan you signed up for, then simply cancel the plan you purchased and go with that. That said, we can assure you that there will be no replacement plans for Obamacare, and or "Trumpcare" plans available for at least one year.
Please don't procrastinate, don't delay enrolling while the politics play out. Get coverage now and that way you have options for the future. Obtaining a full coverage major medical plan now, getting a grandfathered Obamacare plan now and then waiting to see what happens is a much less risky proposition.
CMS Seems Intent On Keeping Current Flawed System For Consumers To Enroll Online In 2017 and 2018
First we should absolutely note that the last two updates are getting a little into the weeds with respect to how everything works within the health insurance industry. You may or may not care too much about how exactly the "sausage gets made". That said, we're taking this opportunity to let you know, and the incoming administration, that if changes are not made that place the consumer experience first and foremost, any government based health insurance system is bound to fail. Specifically we're referring to the dreaded "double-redirect" that occurs when a consumer goes from shopping for a health insurance plan on any other website than Healthcare.gov. Essentially if you want to enroll in a subsidized health insurance plan, the government requires that the individual be handed off to Healthcare.gov to complete part of the enrollment process. In past years, this was done behind the scenes and consumers didn't have to try to make their way through the clunky experience that is Healthcare.gov. Now, not only do they have to be handed off to Healthcare.gov to verify data, they have to create a profile and then check their email for a link from Healthcare.gov.
It's like shopping in a store, getting to check out, and then when you want to pay first you are asked to leave and go to the DMV and wait in line to prove who you are. Then once you do that, then you can then go back to the store and complete your purchase.
That is an oversimplification for sure, but it's a fair description of government bureaucracy at work. Where things really fall apart because of this red tape, is when consumers have questions about a health plans specifics and there's no one to turn to at Healthcare.gov that is a licensed agent. There is an important distinction between a call center rep answering calls in an outsourced call center, and a fully licensed health insurance agent with years of experience.
It is entirely understandable why the current team at CMS wants Healthcare.gov to be the focus, and enforce the double-redirect that drives down enrollments and makes enrolling so much more difficult than it needs to be. Because if Healthcare.gov isn't the focus, and or required, then why were literally billions of tax payer dollars spent on getting all of this into place? If the free market can really handle creating the best consumer experience on its own, that makes keeping the current system in place all that much more difficult.
What oftentimes happens, and we believe is the case within CMS, is that while intentions are always good, the devil is in the details. In this case, the details are highly complicated health plans that are often being shopped by Americans for the very first time. Even before insurance carriers started leaving the exchanges, the abandonment rates of consumers leaving plans after a short period of time were exceptionally high. This is thought in large part to be from consumer dissatisfaction in plan selection, because there was not enough fundamental understanding on the consumers behalf in the first place.
Hopefully whatever changes are coming to the healthcare ecosystem, the primary focus is people, not politics or process, and certainly not justification of massive government contracts. Below is an excerpt from the just released guidance from CMS along with a link to the full PDF.
b. Enhanced direct enrollment pathways In the final 2018 Payment Notice63 and previous rules, CMS has begun to establish the regulatory framework to implement an enhanced direct enrollment process that would allow a consumer to apply for coverage on a non-FFM website without being redirected to HealthCare.gov. Under an enhanced direct enrollment process, the Marketplace would need to ensure an accurate eligibility determination and protect the privacy and security of all consumers that interacted with it via the direct enrollment partner. CMS will not implement this process until we can ensure technical readiness and sufficient oversight of the eligibility application processes. As such, we are maintaining the current “double redirect” direct enrollment approach for the 2018 plan year as we continue to explore program implementation details of an enhanced direct enrollment process. CMS must consider any additional risks an enhanced enrollment process may pose to consumer privacy and the security of the consumer data. We intend to conduct a privacy impact assessment as required by OMB Memorandum M-10-23. This will help to identify and assess any privacy and security risks presented by the enhanced direct enrollment pathway and will help identify necessary safeguards that need to be in place to protect the personal data that consumers would entrust to enhanced direct enrollment partners. These requirements would only apply upon implementation of any expansions made to the direct enrollment pathway.
Final 2018 Letter Regarding FFM
CMS Announces Obamacare Enrollment Deadline Extension Until 12/19/2016
Within the health insurance industry there are a lot of people who expected this. Reason being is that because of decisions made by CMS ahead of this open enrollment, the ability for brokers to efficiently enroll consumers online or over the phone has become incredibly more complicated than ever before. Average enrollment times for online or telephonic enrollment have increased by five times or more, particularly in peak times when a larger number of individuals are trying to get enrolled. CMS now (unnecessarily) requires consumers to be redirected to Healthcare.gov in order to complete an online enrollment with a web-based broker. This is almost the equivalent of asking someone trying to check out in a store, to leave the store and drive to verify their identity and payment information with their bank, and only then can they go back to the store to complete their purchase.
This has contributed to longer wait times for consumers over the phone who have questions about what plans are best for them, and subsequently made the process to connect with a licensed agent significantly more difficult. If CMS wants to reach their enrollment goals, and more importantly place priority on Americans, and not government red tape and politics, they should return to using the systems in place that worked in previous enrollment seasons. Consumers are the ones who are paying the price for the poorly timed decisions that CMS made ahead of this open-enrollment season. It is entirely possible that the decision to change course this year, was based on the strong assumption that Hillary Clinton would be elected as the next President of the United States, and there would not be a complete change over of management at CMS.
2017 Obamacare Enrollment Estimates Are In - Americans Are Enrolling - Just Not Quickly Enough
While the enrollment statistics below may give the Administration and the healthcare industry hope that consumers are in fact enrolling at a significant pace, what HealthNetwork is finding is that there are millions of consumers in the United States who are very confused about how the election of Donald J. Trump is going to impact their requirement to have health insurance this year and next. We have spoken with tens of thousands of American health insurance shoppers and more than 65% were incorrectly under the impression that they aren't going to be required to have health insurance starting next year, which means that many people believe that they don't really have to sign up for health insurance if they don't want to.
But nothing could be further from the truth - that is unless you don't want healthcare coverage and you don't mind paying, minimally, a $695 tax penalty, per person. Unfortunately while there are hundreds, if not thousands, of reporters covering the politics that are being played out right now about how to repeal and replace Obamacare, no one seems to be ending the news report with the most important detail for Americans to know. That little detail is this - in no way is the election going to have an impact on anyone's healthcare coverage requirements for all of 2017. Most likely there isn't going to be a scalable national rollout of whatever "Trumpcare" ends up offering for at least two years.
Additionally what we are also finding from conversations with consumers is that there are some unethical insurance agents advising consumers to simply enroll in a short term health plan. Apparently some of which are disingenuously calling short term health plans "Trumpcare Plans".
So let's recap the facts, not the fiction or the spin, for the American people.
- You are still required to have health insurance for all of 2017.
- There are no such things as "Trumpcare Plans". Short term health plans can be a good fit for some people, but not all, and they don't exempt you from the tax penalty. Trump has nothing to do with them. "Trumpcare" is a slang term for whatever it is President-Elect Donald J. Trump's healthcare reform policy ends up being.
- Health insurance plans will not decrease in price when President-Elect Trump is sworn into office on January 20th, 2017. Health insurance plan pricing is regulated and set and they will not change until the 2018 enrollment season.
- If you want health insurance coverage starting on January 1st, 2017, you have to enroll by December 15th, 2016.
- If you wait until the end of the open enrollment period to apply for a plan, particularly January 28th through January 31st, there is a very good possibility you may not be able to enroll. Or you should anticipate waiting on hold for at least a couple hours, possibly longer. Right now the federal data hub can have delays that backup enrollments for hours or even more than a day. On peak days the increased volume can bring the government exchange, as well as state exchanges to a crawl. We can not be more clear, this enrollment season will be much more challenging to enroll on the last few days.
If you would like a safe and secure way to determine what options are available to you, simply use the form below. You will not be harassed over the phone and HealthNetwork, a company which helps more than 17 million American households a year safely research their options, is not an insurance broker or a carrier.
Without Question The Election Has Impacted The Health Insurance Enrollment Season For This Year
Over 4 million people have signed up for health insurance since the 2017 open enrollment period started in November. The Centers for Medicare and Medicaid Services (CMS), which oversees the federal health care marketplace at HealthCare.gov, tracks enrollment numbers on a biweekly basis, calculated Sunday through Saturday of each week.
This year, open enrollment started on a Tuesday, which means two fewer days for reporting versus last year. Despite the deficit, more people have signed up for health insurance during this year’s enrollment period than at the same time in 2015. There have been 250,000 more signups during the first 40 days of this year’s enrollment period than last year’s.
Of the people who have signed up so far using the federal marketplace, 2.9 million are returning customers. The remaining 1.1 million enrollees are new to the marketplace this year. Enrollment has surged in the days leading up to the deadline to have coverage by January 1. Between Monday, December 12 and Tuesday, December 13, more than 700,000 people enrolled in a qualifying health care plan. Enrollment will continue through January 31, but December 15 marks the final day for people to sign up for a health insurance that starts on January 1.
This week’s snapshot includes enrollment tallies from designated market areas (DMAs) throughout the country. These DMAs represent local media markets and offer a better picture of enrollment nationwide. While some DMAs come from states that aren’t using the HealthCare.gov platform for enrollment, signup figures primarily are drawn from the federal marketplace and states that use it. The CMS will include enrollment numbers from state-based exchanges as the 2017 enrollment season progresses.
States with significant enrollment totals include Florida (over 878,670); Texas (449,094); North Carolina (238,414); Georgia (208,433); and Pennsylvania (190,719). Illinois, New Jersey, Tennessee, Michigan, Missouri, Wisconsin and Virginia have each had over 100,000 signups. In terms of DMAs, the Miami-Ft. Lauderdale market leads the pack with 343,473 signups. Atlanta, Dallas-Ft. Worth, Chicago, Orlando and Tampa also have high enrollment numbers.
CMS also tracks site usage in addition to enrollment figures. During weeks five and six, more than 6.5 million people visited HealthCare.gov while over 2.1 million people called in to the marketplace’s customer service center. It’s clear that people are looking for help when it comes to getting health insurance.
With the election of a new president for 2017, people have questions and concerns about the future of the American health care system. President-elect Trump and Republicans have promised to repeal Obamacare, but there’s been no consensus on a replacement plan to date. Uncertainty about getting covered for 2017 and beyond is no doubt driving enrollment numbers this year.
ACA-compliant plans cover pre-existing conditions, preventive care at no added cost and a host of other benefits. Most people on the marketplace – 85 percent according to the Department of Health and Human Services – also qualify for cost assistance, bringing average monthly premiums down to $75 a month or less. Consumers who need private health insurance have until January 31 to enroll in a qualifying health care plan on or off the marketplace.
Post Election Update Regarding Obamacare Enrollment In 2017
This is the only time of the year that you can change or enroll in a new health insurance plan. If you want or need new health insurance for January 1st, 2017, you MUST enroll in a new plan by December 15th, 2016. If you want or need health insurance at all in 2017, you MUST enroll during the Open Enrollment Period, which ends on January 31st, 2017.
The 2016 Presidential Election season has finally come to a close and the new President-Elect is Donald Trump. Whether or not he changes the law or intends to repeal Obamacare with an alternative does not change your requirements for this year.
As of 9:00AM Eastern Standard Time on November 9th, all health insurance exchanges and insurance carriers are experiencing record-setting traffic. Millions of Americans clearly still have concerns as to whether they will still being able to obtain health insurance post-election. Let us assure you that you can, in fact, still enroll in a health insurance plan. Nothing has changed with this 2017 open enrollment period and any changes that President Elect Trump may wish to make, will not go into effect until the first half of 2017.
We highly advise anyone who is seeking to obtain health insurance to sign up immediately because call volume and online enrollment traffic is already reaching record numbers. As we get closer to December 15th, it will only get more difficult and time-consuming to enroll in a plan.
If you want health insurance coverage for you or your family, you must get that coverage during the Open Enrollment Period. Otherwise you will be personally responsible to pay for your medical bills out-of-pocket.
If you are seeking information about President-lect Donald J. Trump's upcoming healthcare reform plan, which has been coined "Trumpcare" by the press, you can find some information at the following link. Trumpcare
The 2017 Open Enrollment Period is finally here. If you are currently without insurance, need to shop around for a more affordable plan or one with better medical coverage, or your insurance carrier is leaving the market, which is effecting approximately 2.5 million Americans this year, now is the time to shop for a new Obamacare health insurance plan.
If You Want To Quickly Compare What Your Options Are For 2017 Rates, Please Use The Following Link.
2.5 Million Individuals Will Need To Find New Obamacare Plans
Open enrollment starts on November 1, 2016 and will end on January 31, 2017. If you find a plan that works for you by December 15th, the coverage can begin on the first day of the new year, January 1, 2017.
If you are already enrolled in an Obamacare healthcare plan and relying on auto-renewal this year – think again. You should still review your options this year for several different reasons:
Carriers exiting the exchange, the individual or family market, or the entire state
- New personal circumstances or events that impact your income
- Changes in reported income
- Pricing variations to the plan
- Base plan changes that effect your benefits and pricing
- Discontinuation of the plan
The first item on the list may be the most vital reason to manually review your coverage and re-enroll this year rather than accepting any changes made by automatic renewal. New developments in 2016 have created headlines about major insurance carriers pulling their plans from the Affordable Care Act exchanges for the 2017 enrollment, and yours may very likely be one of them.
It is predicted that enrollees will be affected by the withdrawal of major insurance carriers, Aetna, United Healthcare, Humana, and four government-run CO-OPs.
Many regional insurers also withdrew with a little less publicity. Among these local providers, many have a much smaller number of enrollees, but some cover thousands and they will have a substantial impact on their members.
Why are Insurance Companies Leaving the Obamacare Marketplace?
In 2013, health insurance companies were trying to estimate the financial influence of an untested risk pool in the new Affordable Care Act (ACA) marketplace. Without being able to discriminate based on health status, people who were less healthy and using more medical services were going to be covered and medical claims would dramatically increase. Insurers needed to accurately project the number of younger and healthier enrollees entering the market and use their premiums to offset the increased claims expenses. The projections fell short and premiums were set too low to create the necessary balance, and insurance companies began losing revenue.
As companies withdraw from the Obamacare market to recoup losses, the effect is reduced competition and mergers between companies that monopolize and limit coverage options in certain areas of the country. The ACA encourages marketplace transparency and competition, without it, premium rates will rise with the 2017 Open Enrollment. This problem should resolve itself when there are more accurate numbers collected over a few years of enrollment, premium, and claims history. The current consensus suggests this will happen by 2018.
Until then, consumers need to log into the marketplace and review their plan to see if they are one of the thousands in their state looking for a new company and an affordable plan. Qualifying for cost assistance can reduce the financial impact of premium increases, but you need to have plenty of time to review the medical needs for you and your family, as well as your household income, to know the actual premium cost for the plan you have chosen. Marketplace representatives are available online and by phone 24/7 to answer questions and explain your options at no cost. Health insurance agents are also able to assist you with enrollment.
Who is Most Affected By These Changes For Obamacare in 2017?
People living in the Pinal County area of Arizona currently have no carriers contracted to sell exchange plans and the residents of Alabama, Alaska, Oklahoma, and Wyoming, all have only one carrier in their exchanges in the upcoming year.
If you are insured by one of the major insurers, Aetna now only has plans available in Virginia, New York, and Nevada and backed out of previous ideas regarding expansion. United Healthcare exited 31 state exchanges and their coverage also only extends to those states. Humana left four more states including Alabama, Arizona, Colorado, and Utah.
Some companies are simultaneously exiting, partially withdrawing, and entering the market in different states. Cigna is leaving Georgia and Texas exchanges, but entering the North Carolina exchange in 2017. Blue Cross Blue Shield of Kansas is pulling out of the Kansas exchange while other BCBS entities continue with plans. Priority Health Insurance Company is pulling out of the exchange in Michigan while still offering HMO plans on the exchange through another carrier entity.
There is a detailed list of smaller regional carriersand entities that are also exiting the exchanges at the end of 2017, including ACA-created CO-OPs. They are impacting the residents of different states and areas or counties within them. Going to your marketplace will give you the details.
While the overall trend is towards a reduction in the number of carriers offering plans in the exchanges, there will be new carriers joining some exchanges in 2017.
What Should You Do Now?
You need to make sure you’re getting the best health insurance plan for your buck. Premium prices are increasing and although 85% of Americans qualified for an average subsidy savings of $290 per month, it’s important to make sure that you’re getting the best medical coverage for the cost for your family.
With nearly 2 million Americans forced to shop for health insurance in addition to the millions already uninsured, it’s important not to wait until the very end of open enrollment period or on big deadlines like December 15th to figure out your options.
If you’re ready to shop for health insurance plans in your region or speak to a licensed health insurance agent, let us help! Call our toll-free phone number or provide us some basic enrollment information and we’ll get you on your way!
Updated 9/19/2016 Many Americans have been reading the recent headlines regarding the number of insurance carriers who have or have threatened to exit the exchange. Many people have emailed in regarding receiving cancelation notices from a number of insurance carriers. Currently United Healthcare, Humana, AETNA and Oscar have announced a major withdrawal from the federal exchange in certain states. It is not yet entirely known how this will effect what coverage options are available starting on 11/1/2016 when open-enrollment begins. We will continue to update this website as more information becomes available. Right now it is still possible for both AETNA and Humana to continue to offer coverage in most of the states they are currently providing plans in. Recently the administration and HHS has been making some significant effort to help keep insurance carriers within the marketplace. The next thirty days will prove to be a critical time for the health insurance industry and for more than 15 million families who have coverage under Obamacare.
Updated 4/21/2016 We have been receiving a lot of email from individuals requesting more detailed information about short term health insurance. Short term health policies and their surge in popularity as an alternative option to on-exchange or "Obamacare" health insurance plans, has received extensive media coverage. Despite this increase in coverage from various news sources, consumers have still had a difficult time determining if short term health insurance is a viable option for them. More specifically, many people have requested that we provide some real life examples of what ones cost would be for a short term health plan, vs an Obamacare plan. So, we have now updated our site to include a detailed Obamacare VS Short Term Health Insurance analysis. Within that page is a link to an unbiased site where you can compare different short term plans.
Comparing Short Term Health Insurance And Obamacare
Updated 2/24/2016 If you missed the Obamacare, or health insurance, enrollment deadline on January 31, 2016, you may have to wait until the next open enrollment period to get an on exchange health insurance plan with subsidies to help you pay your monthly premium. However, if you experienced a “qualifying life event” (QLE) you may still be eligible to enroll in a plan for 60 days following the date that the QLE occurred. You should take note that CMS just announced new qualifying life event eligibility requirements that are being put in place to prohibit individuals from signing up for health insurance outside of the open enrollment period when they are not actually eligible. Detailed Information on the New CMS Eligibility Requirements for Enrolling in Health Insurance Outside of Open Enrollment.
Updated on 2/10/2016 We have received information detailing that there may be an extension for Obamacare plans through Healthcare.gov that runs until March 31, 2016. This extension pertains only to individuals who were unable to enroll because of taxation and tax return filing issue that may have prevented a consumer from completing enrollment. Please see the following link for more information. 2016 Obamacare Extension
If you have a Qualifying Life Event, you will still be able to enroll in health insurance through Obamacare.
We have had a large number of people email us asking for help regarding the new 1095 form requirements. There are three different forms that you have to be aware of. We have a very detailed article outline everything pertaining to the 1095-A, 1095-B and 1095-C forms. Information can be found at this link. 2015 1095 Forms
While a few state exchanges have extended their deadline by a couple days to allow those who started enrolling before midnight local time, to complete enrollment, for the vast majority of Americans, if you are uninsured on February 1st, you may face the tax penalty. The good news is that if you have a Qualifying Life Event at any point this year, you may still enroll in a health insurance plan and get subsidies to help you pay your monthly premium.
A few examples of Qualifying Life Events are:
- You got married or divorced
- You had or adopted a baby
- You lost your employer-sponsored health insurance
- You had a change in income that now allows you to get a subsidy or does not allow you to get a subsidy or you are no longer eligible for Medicaid or CHIP due to an income change
- You moved to a different location and your insurance is no longer available
- You left incarceration
- You became a legal resident or citizen of the United States
If you have one of these or another type of Qualified Life Event that allows you to enroll in health insurance outside of the regular, annual enrollment period, you will have sixty-days from the date of the event to shop and enroll in new insurance. If you do not enroll during those sixty-days, you may face the tax penalty for being uninsured.
If you find yourself without or between health insurance for only a short period of time and need to find coverage in case of an emergency, you can always look at a short term health insurance plan. Please be aware that if you have a pre-existing condition, carriers that offer short term health insurance plans may deny your coverage from the beginning or may deny to cover certain claims. Short term health insurance plans do not comply with the Affordable Care Act either and you may still face the tax penalty for being uninsured even though you have a short term health insurance plan.
Some people find short term health insurance plans valuable because having it is cheaper and safer that having no insurance at all while they are between major medical plans. You can shop and enroll in short term health insurance plans here as well.
The Federal Government has already announced that there will be no Open Enrollment Period deadline extension that will go through the tax season like last year and there’s no indication or guarantee that they will extend the deadline at all past the scheduled January 31st deadline, so do not delay enrolling in a new health insurance plan.
2016 Open Enrollment Period started on November 1, 2015 and ends on January 31, 2016. During this time, Americans are being encouraged to shop around for new rates and new health insurance plans. Even if you are happy with your health plan from last year, there may be a plan out there that is a better match for you or your family’s financial and medical needs. Updated rates are now online and available so you can quickly determine what the average 2016 Obamacare cost is right now.
Think you need a little extra help and guidance picking the right plan for your family? That is not a problem; it's an opportunity to learn from a licensed health insurance professional. Simply call the phone number below and we’ll connect you with a knowledgeable and helpful health insurance agent that can provide you specialized advice, free of charge.
If you are seeking information about the federal poverty level for 2015, please use that link.
Prefer to shop and enroll online? Well, we’ve got you covered there too! Just fill out the enrollment form below and we’ll get you right on your way.
Update 12/15/2015: The Centers for Medicare & Medicaid announced on December 15th that any American who lives in a state that relies on the Federal Marketplace (FFM) will have until December 17th to enroll in a health insurance plan that will start on January 1st. Read more about the 2016 Obamacare Deadline
If you want health insurance coverage that begins on January 1st, make sure you enroll by December 15th, 2015; otherwise your plan will not begin until February 1st at the earliest. If you don’t enroll in a plan until the end of the 2016 Open Enrollment Period, your coverage will not begin until March 1st, 2016.
There’s no guarantee and we do not anticipate that there will be an extension for enrollment beyond January 31st, 2016 so don’t delay your enrollment. You can avoid long wait times by enrolling today.
Obamacare Deadline Information Updated
The 2015 open enrollment period finally closed on April 30th, after a brief extension was given to Americans who got their income taxes done and realized that they were assessed a penalty for being uninsured in 2014 and would certainly face the increased penalty in 2015. The Department of Health and Human Services revealed that nearly 12 million Americans enrolled in health insurance either through the Federal Marketplace or the state exchange during the enrollment period. This number exceeded the government's projections by almost 3 million people.
If you recently lost your health coverage or are just wishing you could shop for a different plan, you either need to wait for the 2016 open enrollment period to begin November 1, 2015 or you need to wait until you experience an event that would be considered a Qualifying Life Event. Qualifying Life Events are described as circumstances that happen in people's lives that would allow them to enroll in a new health insurance plan either on the Marketplace or through a carrier direct and to even get a subsidy if they were eligible, without having to wait for the next enrollment period. Some examples of these events are:
- You get married or divorced
- You have a child
- You lose your previous health coverage for some reason like your COBRA benefits end or you lose your employer-based health insurance
- You move to a different state or location and your previous plan is not offered in your new area
There are several other examples of Qualified Life Events that exist and whether or not you have experienced one of these events is tricky to understand. It is often best and easiest to discuss your life circumstances with a local health insurance agent as they are the best suited to listen to your situation and determine whether you meet the requirements of a Qualifying Life Event. Remember, if you do experience a Qualified Life Event, you have 60 days from the date of the event to enroll in a new health insurance plan. If you do not do it during that period of time, you may be penalized with a tax when you file your federal income taxes.
Another option for people currently without health insurance coverage is to take on a short-term health plan. Unfortunately, short-term health plans are not regulated the same way as regular, major medical plans under the Affordable Care Act and carriers that offer short-term plans can do things like consider whether you have a pre-existing condition, limit your annual payout for medical claims, and offer higher deductibles and coinsurance payments before the plan with kick in its part. The benefit of a short-term health plan is that you can have the peace-of-mind that you are covered in the event that something unexpected occurs. These types of plans also offer more flexibility in that you can sign up at any time of the year and can choose to keep the policy for as little as one month or for only six months.
The 2016 Open Enrollment Period will start on November 1, 2015. If you want your health insurance coverage to start by January 1, 2016, you must enroll by December 15, 2015. The last day to get insurance is January 31, 2016 unless the government or your individual state issues another extension.
The regular 2015 Open Enrollment Period closed out on February 15th and the results were staggering. More than 11 million Americans are able to call themselves insured individuals after enrolling in a health insurance policy on the state or federal marketplaces.
After the 2015 OEP closed out, many states and even the federal government extended deadlines to enroll because many individuals faced technical problems completing their application before the midnight deadline. The requirement for a person to enroll during this special extension in many, but not all circumstances (some states had exceptions to this rule), was that the individual must have started their application on the exchange's website for with a representative at the federal or state exchange call center before the February 15th deadline passed.
Even though this extended enrollment period for the federal marketplace passed on February 22nd and many of the extended state exchange deadlines also passed at the end of February, but despite this, the government realized that there would be many people who would not realize that they really needed to enroll in health insurance until they got their 2014 taxes done and were told that they would face a tax penalty for being uninsured during the 2014 calendar year and would also face a penalty for not enrolling for 2015 either.
Due to this predicament, the government announced another special enrollment period, which is commonly being called the Tax Special Enrollment Period. This enrollment period started on March 15th and runs until April 30th and many of the state exchanged, the exception of only a few, have followed step and also created a Tax Special Enrollment Period for their residents.
Keep in mind that even if the Tax Special Enrollment Period, you may enroll in a new health plan if you experience a Qualifying Life Event. If you do experience one of the events below, you must enroll within sixty-days in order to avoid a tax penalty.
Examples of a Qualifying Life Event are:(This article was updated on October 13, 2014)
Americans felt the effect of growing prices in the economy, a deflated job market and the recession in many different but personal ways. One such way was the fact that many Americans could no longer afford health care for themselves or their families either because they were without a job or simply without health insurance, or because they could not afford the increasing costs of seeing a doctor, going to the hospital or getting medicine.
Speak with a Healthcare Professional 1-800-920-4994
On March 23, 2010, President Obama signed into legislation the Affordable Care Act (“ACA”), which is also commonly referred to as Obamacare. Obamacare.Net is an informational, unbiased and non-political resource to learn about Obamacare. Additionally, Obamacare.Net offers its visitors access to an exceptional network of Obamacare compliant healthcare policies and brokers that are very knowledgeable about healthcare and the new requirements under Obamacare.
Obamacare was not well received by many Americans, including their representatives in Congress, but the Obama Administration knew that a severe and swift regulatory overhaul of the U.S. healthcare system was necessary and overdue to protect the well-being of every American. Since its inception, Obamacare has faced many significant challenges from the opposition, including dozens of attempts to repeal the ACA in Congress, numerous lawsuits in federal courts across the country and an infamous Supreme Court ruling that paved the way for the penalty imposed on any American who fails to comply with the ACA’s mandate to get compliant health insurance by certain annual deadlines.
The first open enrollment period for individuals to shop and sign up for health insurance through Healthcare.gov or a state exchange commenced on October 1, 2013 and the numbers were steady. Many Americans experienced frustration and dissatisfaction with the Healthcare.gov website, which experienced a very public lashing after users were faced with numerous downtime. Within a short period of time the Administration was able to get the Healthcare.gov website back on track and Americans were able to sign up for insurance plans that would commence on January 1, 2014.
Despite the negative press and constant opposition to Obamacare, the U.S. Department of Health and Human Services (“HHS”) proudly reported on May 1, 2014 that after the extended deadline to finish an application closed on April 15, 2014 (the deadline to start an application was March 31, 2014), more than 8 million Americans were able to call themselves “insured” – 8,019,763 people to be exact. 2.2 million of those who signed up for Obamacare were between the ages of 18-34 years old, which equates to approximately 28% according to HHS. The reasons why this demographic is important is discussed in further detail below. Additionally, HHS reported that 4.8 million people enrolled under the newly expanded requirements for Medicaid and CHIP (Medicaid for children).
If you enrolled in a plan in 2014, you can rest assured that unless you want to change your plan, your currently healthcare plan will renew for 2015. If you missed the 2014 deadline to sign up for insurance and are anxiously awaiting the opportunity to get coverage for 2015, open enrollment starts on November 15, 2014. You may also be able to obtain an Obamacare compliant insurance policy if you have experienced a Qualifying Life Event that will allow you to sign up for insurance and avoid the tax for non-compliance or an exceptional circumstance that will excuse non-compliance by the deadline. These concepts will be discussed further below as well.
What is the individual mandate?
The main purpose of Obamacare is to make sure that all Americans are either insured by their employer or are self-insured and that the costs associated with being insured are affordable. Although to their benefit, not every American would willingly and voluntarily take the steps necessary to obtain an Obamacare compliant health insurance policy unless there was some sort of consequence, which is where the infamous Individual Mandate steps in.
The Obamacare Individual Mandate requires all American citizens to obtain health insurance by a certain deadline. For the 2015 calendar year, open enrollment will begin on November 15, 2014 and the deadline to sign up will be February 15, 2015. Of course the Administration could always extend that deadline as well.
The Obamacare Act states that should an American citizen who is not insured under a policy offered by their employer choose not to sign up for an ACA compliant plan by the deadline, they will be taxed $325.00 per adult and $162.50 per child or 2% of the adult’s income, whichever is greater. This particular tax amount only applies to non-compliant Americans during the 2015 calendar year. The tax amount will increase each subsequent year that a person is not in compliant with Obamacare. In 2016 the tax penalty will increase to $695.00 per adult or 2.5% of that person’s annual income whichever is greater. This tax will either be deducted from or imposed on the person when they file their federal tax return for that calendar year.
As mentioned previously, the Individual Mandate was very controversial and the question of whether or not it was constitutional was heard and decided by the U.S. Supreme Court in June 2012. Our Justices returned a 5-4 vote in favor of the constitutionality of the Individual Mandate, including the tax provision for non-compliance, and reasoned that the Federal Government’s power to tax its citizens authorized the taxing provision of the Obamacare Act.
The Individual Mandate does not apply to everyone living in the United States however. The Obamacare Act outlined certain categories of people who will not be required to obtain an Obamacare compliant health insurance policy. Those people are: 1) Americans who are exempt from filing a Federal Income Tax Return; 2) Native Americans receiving healthcare from a different governmental program; 3) Americans who have only been without health insurance for three months or less; 4) Americans that are imprisoned; 5) Americans that qualify for a religious exemption; 6) Americans that are under the age of 26 and are still on their parent’s health insurance policy; or 7) illegal immigrants living within the United States.
Another important part of Obamacare and the burden it imposed on many Americans who chose not to have healthcare previously due to financial concerns is that the government is offering subsidies or tax credits on insurance plans for people who make under a certain amount of money each year. Effectively, the government will help you pay your insurance premiums each month unless and until you make enough money to pay for it on your own. An individual who makes between $11,670 and $45,680 and a family of four that makes between $23,850 and $95,400 may qualify for a subsidy on their healthcare premiums. Healthcare.gov has laid out the income requirements for different family sizes on its website. The dollar amount of the subsidy will be identified after you fill out the enrollment application.
There is a second type of subsidy available for families who earn less than 250% of the FPL and who enroll in a silver-level plan. This tax credit is issued to families on their tax return and is designed to reimburse people for their insurance-related out-of-pocket expenses for things such as the annual deductible, copays and coinsurance payments.
What Are Qualifying Life Events?
When planning the execution and carrying out of the first Obamacare Open Enrollment period, the Administration anticipated certain circumstances whereby a person should be excused for not being able to enroll in an Obamacare compliant plan by the deadline. Under Obamacare, people that experience these exceptional circumstances or other complications are exempt from the tax penalty so long as they report the circumstance and then sign up for a compliant policy.
The list of contemplated, exceptional circumstances and complications is: you experienced an unexpected hospitalization or experienced temporary cognitive disability, you experienced a natural disaster, there was a system error, outage or display error on Healthcare.gov that prevented enrollment, you were not qualified for Medicaid and were transferred to the Marketplace with not enough time to enroll or you were a victim of domestic abuse that prevented timely enrollment.
More common than experiencing an exceptional circumstance or complication that prevented compliance is the fact that a person experienced a Qualifying Life Event that caused them to not be insured. If one the of the following Qualifying Life Events occurred in an American’s life, Obamacare provides that the person can sign up for a plan for themselves and/or their children, post-deadline, without fear of being taxed for non-compliance. A Qualifying Life Event under Obamacare is: having or adopting a baby, getting married or divorced, losing healthcare for some reason such as becoming unemployed, a change in income that now makes a person eligible or ineligible for a subsidy, a person moved to a new state or a person became a U.S. citizen, national or gained lawful status and can now apply for Obamacare.
What is an ACA compliant health insurance plan?
One important aspect of the Obamacare Act is that insurance companies are now required to provide a minimum amount of protection to their customers. This new minimum standard is undoubtedly a great improvement from the healthcare standards imposed before Obamacare. For instance, it is now illegal under Obamacare for an insurance company to deny you coverage based on a pre-existing health condition. Previously, an American currently living with a health condition that required attention would regularly be denied coverage and more than likely always denied affordable coverage due to their unfortunate health conditions. Today, that worry is no longer a factor in whether or not a person can be insured.
Additionally, Obamacare now allows for children under the age of 26 years old to be covered by their parent’s insurance policy. Obviously if the under 26-year-old is afforded healthcare through an employer they will have to accept that coverage in lieu of staying on their parent’s policy. Considering the fact that more young adults are opting to extend their education in lieu of entering the workplace where they could ordinarily obtain their own health insurance, this new provision of Obamacare is greatly appreciated by concerned parents and their cash-strapped students.
Another great provision of Obamacare, which is oftentimes a problem faced by Americans will an illness or injury that requires extensive or prolonged medical attention, is that insurance companies can no longer cap the amount of money available to a customer for coverage on a yearly or lifetime basis. This means that no matter how much money a person racks up in insurance claims in a year or in their lifetime, their insurance company must continue coverage. In addition, insurance companies cannot arbitrarily cancel any policy simply because a person gets sick under the new Obamacare requirements.
Finally, Obamacare provides that the insurance company must offer their customers free preventative care. Therefore, despite whether you’ve met your yearly deductible, an American adult can go to their doctor and receive the following care without paying a single cent. The free preventative care services under Obamacare are: Abdominal Aortic Aneurysm one-time screening for men who have ever smoked, alcohol misuse screening and counseling, access to Aspirin to prevent cardiovascular disease, blood pressure, obesity, HIV, tobacco use, cholesterol, colorectal cancer, depression and diabetes (Type 2) screening, diet counseling for those at a higher risk for chronic disease, immunization vaccines and finally sexually transmitted infection prevention counseling and screening for syphilis specifically.
There is also a long list of preventative care services available to woman and children that are similar in nature to the list described above, which is available for all adults. During the 2014 open enrollment period, many companies challenged one particular preventative care service offered to women under Obamacare, contraception, because they believed it violated their religious rights. The Supreme Court examined this issue after two lawsuits were brought up for review and held that companies with a specific religious opposition to paying for a healthcare plan for their employees that included contraception, can simply offer plans that do not include contraception coverage.
Medicaid expansion and CHIP (Children's Health Insurance Program)
One of the many reasons that there were so many uninsured people in America was because insurance was not attainable by many lower income people. In 1965, the government created Medicaid to aid families earning an income that was insufficient to pay for healthcare. Prior to Obamacare, the qualifications for eligibility into the Medicaid program were more strict; however Obamacare expanded the income requirements for Medicaid from persons under the age of 65 that were under 100% of the federal poverty line, which amounts to approximately $11,670 a year as a single person or $23,850 for a family of four, to persons under 65 who make under 133% of the federal poverty line, which equates to $16,105 a year for a single person or $32,913 for a family of four. Because of the way that the income is calculated, people who make under 138% of the FPL are actually eligible for Medicaid in states that expanded the requirements. The above incomes reflect the correct percentage of FPL.
Initially the Obamacare Act attempted to require that all states expand the Medicaid guidelines to include a larger percentage of people. For any state that did not comply the Obamacare Act threatened to take away any federal funding allotted for that state, for the Medicaid program. Since Medicaid is partially funded by the Federal Government and partially by the states, this provision and the resulting penalty for non-compliance faced a lot of opposition. In addition to reviewing whether the Individual Mandate and the resulting tax for non-compliance by an individual was constitutional, the Supreme Court also reviewed the issue of whether the Obamacare Act can mandate a Medicaid expansion in every state or suffer the consequences. The Supreme Court ultimately ruled that the government did not have the authority and power to impose this requirement and resulting sanction for non-compliance upon states and struck the provision down as unconstitutional.
The result of this Supreme Court holding is that each state could individually decide whether or not it wanted to expand the guidelines for Medicaid. If a person under 65 lives in a state that expanded the requirements, they could be eligible if they were under 133% of the federal poverty line. If a person under 65 lives in a state that did not adopt the expanded guidelines, they could only qualify if they were under 100% of the federal poverty line. Presently, a little less than half of the states have opted not to expand the guidelines of Medicaid.
Before Obamacare, many people were under the belief that a Medicaid policy was a deficient or bare bones policy that would not cover very much. However, under Obamacare, every Medicaid policy will offer Essential Health Benefits. For states that are expanding Medicaid, Essential Health Benefits include: ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services and treatment, prescriptions drugs, rehabilitative services and devices, lab services, preventative and wellness services along with chronic disease management and pediatric services that include oral and vision care.
Related to the Medicaid program is CHIP, which stands for the Children’s Health Insurance Program. This program is separate from the Marketplace and is used to provide healthcare to child whose parents earn too much to qualify for Medicaid. CHIP and Medicaid work hand-in-hand and is offered by every state in the United States. Each state has their own income requirements for CHIP eligibility and also requires that the child be under the age of 18 years old, be a U.S. citizen and be the citizen of that particular stat. Some states also offer CHIP to parents of children already covered by CHIP and to pregnant women.
Under Obamacare, every state must offer routine check-ups, immunizations, coverage of doctor visits, prescription drugs, dental and vision care, hospital care, laboratory and x-ray services and emergency services under CHIP. Some states also offer additional services. The cost of CHIP varies per state but under Obamacare, all routine wellness doctor visits and dental visits are free and no state can charge a parent more than 5% of their total annual family income for CHIP.
The official website for CHIP is insurekidsnow.gov. Although a family cannot sign up for CHIP through the Marketplace, after they fill out and submit a Marketplace application on Healthcare.gov, the website will advise the applicant if any of their children are eligible for coverage under CHIP in their state.
Other Provisions of Obamacare
Obamacare revised, overhauled, or had an effect on almost every aspect of healthcare and the health insurance industry. One such additional effect was on Medicare, which is healthcare coverage for Americans over the age of 65 years old, those who receive disability benefits under Social Security (SSI) or the Railroad Retirement Board (RRB) or people who have been diagnosed with End-Stage Renal Disease or Lou Gehrig’s Disease.
Under Obamacare, Medicare is now required to cover a long list of preventative and screening services. Additionally, hospitals that offer exceptional service to its Medicare patients, which are measured by the rate of re-admittance, will be rewarded with additional funding.
Obamacare also imposes a minimum coverage standard on Medicare customers. If a person has Medicare Part A, they have reached the minimum essential coverage required. Medicare Part A covers hospital stays, skilled nursing facilities, hospice care and some home health care facilities. If a person only has Medicare Part B and no other coverage, they have not met the essential health coverage required under Obamacare and will be taxed for non-compliance. Medicare Part B generally covers doctor’s services like lab tests and supplies that are medically required to treat a disease or condition and preventative services. The only way to then be in compliance with a Medicare Part B plan is to take on a Medicare Part A plan as well.
An American would not shop for a Medicare Part A or B plan on the Marketplace but must still be aware of the minimum standards and deadlines imposed under Obamacare. An American can shop for a Medicare Part C plan on the Marketplace however. Medicare Part C is a policy written by a private, corporate insurance company that offers substantially the same coverage as Medicare Part A and B and may also include additional perks such as a prescription drug coverage that is similar to Medicare Part D. The Open Enrollment period for Medicare commences on October 15 and will close on December 7.
In addition to Medicare, Obamacare also had a huge effect on small and larges businesses and the responsibilities they now take on and mandates they must follow under Obamacare. Obamacare cannot require all businesses to insure their employees but has implemented a provision of the Act whereby some larger companies will have to make an Employer Shared Responsibility Payment if they choose not to provide their employees with Obamacare compliant insurance coverage. Any business that has less than 50 full-time employees is exempt from making this payment for not providing healthcare at all or supplying insufficient healthcare to their employees. Whether or not a company is required to make an Employer Shared Responsibility Payment is dependent on circumstances that can be researched through the Treasury Department or the Internal Revenue Service.
Obamacare also created a separate Marketplace for business owners to shop for healthcare for their employees. This Marketplace is called the Small Business Health Options Program, or SHOP for short. Companies with less than 50 full-time employees can start using SHOP in 2014 to find insurance for their employees. SHOP will be available for companies that employ up to 100 full-time employees in 2016.
In an effort to help small business owners provide their full-time employees with coverage that the company can afford, the Obamacare Act provides a tax credit that amounts to 50% of the company’s premium costs for policies purchased through SHOP.
Why is the 18-34 Year-Old Demographic So Important to Healthcare?
As mentioned before, it was impressive for HHS to report that 28% of all new Obamacare enrollees were 18-34 years old. The reason that this is an important statistic is because without the typically healthy 18-34 year olds signing up, paying for and participating in Obamacare, the entire system would crumble. The reason that this demographic of Americans is so vital and desirable to insurance companies is because they will keep the money steadily flowing into the pool of premiums paid without taking much out to pay for medical claims. The 18-34 year old demographic of people is just simply healthier than their counterparts who are dealing with the medical requirements of aging and illness. Therefore, they cost less money to keep healthy unlike people of an older demographic who take more out of the pool of premiums paid in to pay insurance claims.
The very reason that President Obama discussed and promoted the Affordable Care Act on programs like “Between Two Ferns” with Zach Galifianakis and visited our favorite late night talk shows is because he was trying to speak to the 18-34 year old demographic on the programs they were already watching. Apparently his efforts were successful because 2.2 million Americans in that demographic signed up for a compliant healthcare plan in 2014.