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Individual/Family Health

Care Management Outsourcing

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[…] outsourcing of care management and the success of MedAssurant, a data-driven healthcare solutions company that works with provider organizations that care for more than a third of the US population.

With healthcare providers feeling the squeeze both in terms of reimbursements for care and time spent on administration, it makes sense that outsourced care management could be an important part of a medical office’s business plan. Utilizing economies of scale in this manner could save time and money for medical offices, and streamlined care management is likely to be popular with health insurance carriers too. As Jaan points out, MedAssurant has very savvy customers (including health insurance carriers and healthcare provider organizations) and a solid track record, so the service they are providing is obviously valuable and beneficial.

Taxes And Individual Health Insurance

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[…] Greg’s most recent article deals with the way that our tax code treats health insurance premiums. Medicare and Medicaid premiums are obviously subsidized by tax dollars. But group health insurance premiums are also subsidized, since the premiums that employers pay on behalf of their employees are not included in the employee’s taxable income.

People with individual health insurance usually don’t get such a benefit. The self-employed get to deduct individual health insurance premiums on the 1040, but there are plenty of people who purchase individual health insurance and are not self-employed. Early retirees are a good example, as are people who buy their own health insurance because their employer does not provide it.

Greg’s article goes beyond what we usually see on this topic (ie, pointing out the inherent unfairness of not allowing similar tax treatment for all health insurance premiums, regardless of whether the coverage is group or individual). He delves into what the possible implications could be for the individual health insurance market if the tax code were changed to a more equitable system. His prediction includes millions of additional people entering the individual market (thanks to a switch from group to individual coverage), more lenient underwriting standards in the individual market, more innovative products available to consumers, and more competition in the individual market. Check out his article for all the details – definitely some good food for thought.

Best Health Insurance Companies In Colorado

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We recently got a call from a client who mentioned that he had done a Google search for the “best health insurance companies in Colorado” and his concern was that Anthem Blue Cross Blue Shield was not on the top ten list that he said came up as the first search result.  We were a… Read more about Best Health Insurance Companies In Colorado

Kaiser Will Soon Be Available In Northern Colorado

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[…] The new Kaiser facilities will be in Fort Collins at Harmony and Ziegler, and in Loveland at I-25 and Hwy 34. For hospital services, Kaiser is partnering with Banner Health and members will be able to use McKee Medical Center in Loveland and North Colorado Medical Center in Greeley. The medical offices in Fort Collins and Loveland will offer a wide range of services (primary care, lab work, pharmacy, and x-rays, and mammograms will be available at the Loveland office), and are expected to begin providing care by the fall of 2012. A medical office is projected to open in Greeley by 2014. Between now and then however, northern Colorado Kaiser members will be able to see doctors at the Fort Collins and Loveland offices, as well as physicians on the Banner Health network.

Kaiser is planning to offer group coverage to employers in northern Colorado by October 1, 2012. Individual and family coverage should be available sometime next year.

IRS 2013 HSA Contribution Limits

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The IRS announced that the 2013 HSA contribution limit for an individual would increase by $150, from $3,100 to $3,250. The family contribution limit is increasing from $6,250 to $6,450 (+$200).

The maximum annual out-of-pocket increased as well. The individual out of pocket maximum is going from $6,050 to $6,250. The family out of pocket maximum is increasing from $12,100 to $12,500.

The minimum deductible on an HSA qualified plan also increases from $1,200 to $1,250 for individuals and increases from $2,400 to $2,500 for families.

What are the 2012 HSA Contribution Limits?

According to the Patient Protection and Affordable Care Act, OTC drugs may be reimbursed only if there is a prescription.

Non-medical withdrawals from an HSA are taxable income and subject to a tax penalty, which increased from 10% in 2010 to 20% in 2011 and remains the same for 2013.

Exception to the IRS tax penalty for non-medical withdrawals:
The tax penalty does not apply if the withdrawal is made after you:
1) Attain age 65;
2) Become totally and permanently disabled; or
3) Die.

More details and research about HSAs and HSA qualified plans.

Details From Anthem On Preventive Care And Contraceptive Coverage

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Last week we added a post about contraceptive coverage under the PPACA and what changes people could expect to see starting in August. We just received an information sheet regarding this subject from Anthem Blue Cross Blue Shield, and wanted to share it with our readers. It will be useful for our Anthem clients, and is also helpful to give people a rough idea of how the contraceptive coverage will be implemented by most carriers. There may be some small variations from one carrier to another, but in most cases things will be similar across the board, since federal legislation is guiding the changes.

The Anthem preventive care info sheet is relevant in Colorado and nine other states where Anthem operates Blue Cross Blue Shield plans, and applies to individual health insurance as well as small and large group plans.

The Anthem info sheet specifically notes that sterilization procedures for men are not included in the new contraceptive coverage – which is the conclusion I came to last week after quite a bit of reading on the subject – since all of the guidelines apply to adding contraceptive coverage to preventive care for women rather than preventive care in general. […]

Contraceptive Coverage And The PPACA

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[…] Anyway, assuming that we’re talking about contraceptives for women, new health insurance policies – except those that are exempt based on religious reasons – will cover contraception with no copays or deductibles. Non-grandfathered plans (grandfathered means that the policy was in effect prior to the PPACA being signed into law and that the plan has not made any significant changes since then) will have to start covering contraceptives as of each plan’s renewal date. This is similar to how the state maternity mandate worked in Colorado last year. New policies had to start covering maternity on January 1, 2011. But existing policies added it throughout the year as each plan renewed (for example, my family’s health insurance plan renews each year in November, so our maternity coverage didn’t begin until November 2011). This brief from the Kaiser Family Foundation website has a lot of good information regarding contraceptive coverage and should help to clarify the issue a bit. […]

Despite IT Problems, Report Gives Colorado High Marks On Exchange Progress

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[…] On the upside, the Urban Institute report gives Colorado props for making good overall progress on setting up the health benefits exchange. Despite the political hot seat that health care reform has been for the past few years, Colorado lawmakers managed to work together to create the framework for our health benefits exchange last year. We have a board of directors in place and the state is moving forward as fast as possible to get things in place for the exchange to be up and running in 2014. A lot is still unknown with regards to the future of the ACA, since the Supreme Court still has to issue their ruling in June regarding the legality of the individual mandate. But if the ACA remains in place and the health insurance exchanges become reality across the country, it’s safe to say that Colorado will be ahead of the curve in terms of getting the bugs ironed out.

The Urban Institute report notes that Colorado had a head start on a lot of the reform issues thanks to the 2008 Blue Ribbon Commission Report. Remember back when that was the big news in health care reform in Colorado? Before health care reform became such a divisive topic across the country, Colorado was working to come up with solutions to many of the problems with our health care system. Some of the recommendations of the Blue Ribbon Commission are very similar to the new guidelines in the ACA, and Colorado had been taking active steps for the past four years to implement the Blue Ribbon recommendations. If the ACA remains in place, it should be a bit easier for Colorado to make the necessary transitions over the next few years, thanks to the progress the state has already made on its own.

A Possible Alternative To The Individual Mandate

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[…] Guaranteed-issue health insurance is expensive. When it’s enacted without a mandate requiring people to buy it, the premiums can become out of reach very quickly. In Colorado, group health insurance (all eligible employees are guaranteed enrollment, regardless of medical history) is significantly more expensive than individual health insurance (medical underwriting applies until 2014 when the guaranteed issue provisions of the ACA kick in). But since employers usually pay at least a chunk of the premiums, people aren’t generally aware of the full cost of group health insurance. In the individual market, that cost will be more transparent (subsidies – also created by the ACA – will be a significant help for a lot of families).

Any way you look at it, the claims expenses will be high once all health insurance is guaranteed issue. I would assume that individual health insurance premiums will start to look more like group premiums as the years go by. The goal of increasing premiums for late enrollees should be three-fold: To make the practice of waiting to purchase health insurance until one is sick seem less attractive; to make sure that there are enough total premium dollars collected to pay for the total claims submitted; and to make things as fair as possible for people who opt to have health insurance all the time, even when they’re perfectly healthy. Those people should not be paying the lion’s share of the total premiums.

I agree with Jason that if this model were used, it should be up to the carriers – with regulatory oversight – to set the premium adjustments rather than having the government set the prices. But I think that if we use this model to try to accomplish all three of those goals I outlined, the premium adjustments for late enrollees would have to be pretty significant.

Colorado Expands Access to Medicaid For Adults With A Lottery System

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[…] Unfortunately, the eligibility guidelines will eliminate all but the very lowest income people. In order to qualify, an applicant has to have an income of no more than 10% of the Federal Poverty Level – that amounts to $90 a month for a single person or $125/month for a married couple. As low as those numbers are, officials estimate that there are 50,000 adults in Colorado who would qualify based on those income requirements. And the Medicaid program only has room to enroll 10,000 of them – hence the lottery system.

I have to wonder what percentage of those 50,000 people will submit applications though? Back when the ACA created high risk pool health insurance programs in every state, they predicted that up to 375,000 people might enroll in 2010 alone. But as of early 2012, the high risk pools had actually enrolled about 50,000 people. Obviously cost is an issue – the high risk pools have significant premiums that may be out of reach for a lot of uninsured people, and that shouldn’t be a factor for the Medicaid expansion program. But there’s still the problem of getting information out to the people who might qualify, and getting them to submit applications – especially if they know that submitting an application is no guarantee of coverage, since the program is going to use a lottery to select 10,000 people to enroll.

Even though the income requirements are extremely low and the program only has the means to insure 20% of the eligible population, this is another step that Colorado is taking to try to insure more people. We’re slowing making progress there, due largely to the state’s efforts to expand access to public health insurance programs. We have a long way to go (currently ranked 24th out of 50 states for the percentage of our population that’s uninsured) but small changes like this one are better than no change at all.

Health Insurance for Newborns in Colorado: Enrollment and Coverage

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Last week, we got a call from a lady who had several questions about maternity and newborn coverage. She lives here in Colorado and has her health insurance with one of the state’s large, reputable carriers. She had called her health insurance carrier to see how maternity coverage works (it’s a group policy) and the person she spoke with told her that her policy wouldn’t cover the baby after it’s born, since the baby isn’t named on the policy as a member.

Huh?

Colorado law requires health insurance carriers to add newborns to a parent’s policy as of the date of birth, with no medical underwriting. This automatic coverage is good for the first 31 days after the baby is born. In order to continue the baby’s coverage after the first month, the carrier has to be notified of the new addition to the policy within the first 31 days after the baby is born. No underwriting is allowed as long as the carrier is notified of the baby’s birth within that time frame. […]

Health Wonk Bloggers Think The Supreme Court Will Rule In Favor Of The ACA

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[…] When I browsed around on most of the mainstream media regarding the Supreme Court and the ACA, I kept seeing predictions that the Court will ultimately find the individual mandate unconstitutional and either strike down that part of the law or return the whole ACA back to congress for a re-do (based on perceived negativity towards the law on the part of the Justices). But interestingly enough, all three blog posts in the HWR that dealt with this issue had the opposite opinion (and of course, at this point, all we can do is speculate and have opinions – nobody really knows how the Court will rule). They all take the position that the court is likely to rule in favor of the ACA and the individual mandate, or at least that the reports saying that the mandate is doomed are greatly exaggerated.

Sage’s article also notes that the Justices seem to be well aware of the problem of adverse selection (an issue that we’ve written about numerous times – guaranteed issue without a mandate either results in significant adverse selection or exorbitant health insurance premiums and few options for coverage). This is one of the major concerns that arises if we talk about doing away with the individual mandate, so it’s good that the Supreme Court is taking it into consideration (Sage notes that the lower courts didn’t seem to do so).

Now we just have to wait three months to see who’s right.

Semantics In The Supreme Court Healthcare Arguments

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[…] Although a lot of Americans have a problem with the idea of the government telling them they have to purchase a product like health insurance (and of course, there is concern that such a precedent could pave the way for other mandates that we haven’t thought of yet), the problem of providing unreimbursed healthcare for uninsured patients is a very real issue for providers. And unfortunately, the end result is that hospital overhead is higher (to cover the unreimbursed care) and those higher charges end up being passed on to health insurance carriers. Which means that health insurance premiums increase to cover the higher claims expenses. There is no “free” care. For all but the most wealthy among us, “self-insuring” really just means relying on luck. And luck doesn’t usually hold out forever.

Colorado AG Files Lawsuit Against Discount And Mini-Med Health Plan

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We’ve written several articles over the years about the importance of skepticism when an insurance product just seems too good to be true (ie, no medical underwriting and premiums that are a fraction of the cost of most policies on the market). Often, those policies are actually discount plans or mini-med coverage that won’t provide much of anything in terms of coverage when it’s actually needed.

The Colorado Division of Insurance has a good page with warnings and advice to consumers who are considering medical discount plans. These plans are generally legal, but buyers definitely need to understand what they’re getting into before they sign up – especially if they’re dropping a standard health insurance policy to switch to a discount or mini-med plan.

With shady medical benefits companies, the focus tends to be on consumers getting ripped off. In an interesting twist, the Colorado Attorney General has filed suit against a Highlands Ranch, Colorado LLC, Consolidated Medical Services, but the lawsuit isn’t regarding their product. It pertains to the way in which they recruit – and allegedly scam – their affiliate marketers. […]

Lack Of Public Understanding About Healthcare Reform Law

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This article from Public News Service highlights some of the hurdles the ACA faces in terms of public opinion. An attorney with the Colorado Center on Law and Policy notes that more than 50% of consumers think that the healthcare reform law is creating a new government-run health insurance policy. Given the general unpopularity of government-run programs in general, it’s not surprising that the healthcare reform law has struggled in the court of popular opinion. The public tends to be quite wary of new government programs, especially before they’re in place. Once they’re up and running – like Medicare for example -they sometimes get a bit more popular. But proposing a new government program is generally a good way to get people fired up.

If you’ve been paying attention to the mundane details of the ACA, you know that there’s no new government-run health insurance plan. The public option got nixed from the healthcare reform strategy right from the beginning. The law does expand some of our public health programs that already exist (like Medicaid and CHIP). It seeks to insure most of the currently uninsured population via increased enrollment in private health insurance plans and expanded access to public health insurance. The individual mandate and guaranteed issue individual health insurance will hopefully result in far fewer people without health insurance. In addition, the provision that allows young people to remain on their parents’ health insurance through age 26 is helping to cut down on the number of young Americans without health insurance. […]

1,000th Post

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This is our 1000th post. We started this blog in the fall of 2006. At the time, 100 posts seemed like a lot. And here we are at a thousand. We decided that needed something a little different from the fascinating commentary we usually provide, so here’s a picture of our dog, Lukky, and our cat, Larry. They’re best buddies, and on the few occasions that Lukky has had to wear the cone of shame, Larry has always been right there keeping her company. […]

The Subjective Nature Of The Affordability Of Health Insurance

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[…] Health insurance is definitely not cheap. For those who qualify for programs like Medicaid and CHP+, the subsidized or free coverage is likely a lifesaver. But what about middle class families who don’t qualify for public health insurance, but for whom health insurance premiums are a budget buster? Why is health insurance more of a priority for one family than for another (to the point that one family will cut their budget in other areas, like clothing and vacations and vehicles, in order to keep paying for their health insurance)? Is it all about personal experience? If you’ve had a medical scare or have a loved one who has had significant medical bills (especially at a young age, or for an out-of-the-blue medical condition), are you more likely to rearrange your priorities to make health insurance affordable, regardless of your income? If you’ve always been healthy, are you more likely to see health insurance as a money-pit and opt to spend your money elsewhere?

We know that the percentage of our income that is being spent on healthcare has climbed significantly over the past decade. For a lot of people, it’s becoming a much more significant monthly expense than it used to be. But whether or not it’s “affordable” really depends on the person being asked.

Would Premiums Without A Mandate Really Only Be 2.4% Higher Than With A Mandate?

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[…] Keep in mind that all of those prices are based on the fact that the individual policies are medically underwritten (which means that the rates can be increased during underwriting or the application can be denied based on medical history), while the group plans are guaranteed issue and the rates cannot vary based on the group’s health status. There’s a huge range of options available, both in the individual and small group markets. But the premiums in the small group market for our family of four (parents in their 30s with two young children) would be roughly double what they are in the individual market.

Although I realize that the RAND study is important and useful, I wonder why the real-life scenario of individual versus small group premiums is so different. And although the ACA does put a cap on how much greater premiums can be for older people versus younger people, it doesn’t stipulate what the base premiums have to be for the younger people. Premiums have to follow the MLR rules (with insurers spending at least 80 – 85% of premiums on medical expenses), but they will reflect claims expenses pretty closely. […]

Will The Colorado Health Benefits Exchange Be Integrated With Public Assistance Programs?

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[…] Last summer, lawmakers in Colorado were concerned that federal requirements that visitors to the exchanges be screened for eligibility for Medicaid, CHIP and federal health insurance subsidies would increase enrollment in Colorado’s safety-net health insurance programs. Given the budget woes that those programs have had, the lawmakers were hesitant to make the exchange a “one stop shop” for public assistance programs. But much has also been said about the importance of integrating the exchanges with public benefits programs in order to close the gaps that people can fall into if their incomes fluctuate between eligibility for federal health insurance subsidies and eligibility for Medicaid. This proposal calls for the exchange and the public benefits programs to be interoperable as of January 1, 2014 and integrated as of December 15, 2015. For the sake of simplicity and protecting the needs of low-income families, it seems that the more seamless we can make the health insurance enrollment process (particularly for those who go back and forth between Medicaid and private health insurance), the better.

It will be interesting to see how the separate/interoperable/integrated scenarios for the health benefits exchange and Colorado’s public assistance programs play out over the next couple years as the exchange is created and implemented.

Preauthorizations And Legal-eze: Why Health Insurers Have To Use Them

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[…] Starting in 2014, health insurance will be guaranteed issue and all of us will be required to have coverage. But until then, individual health insurance is priced based on medical underwriting and (in most cases) slightly less comprehensive benefits than group policies. That’s why it’s less expensive to have an individual policy than a group policy or a guaranteed issue policy like CoverColorado. If health insurance carriers (both individual and group) don’t go over their claims closely and utilize preauthorizations, they run the risk of being defrauded – which will only drive premiums higher than they already are. If they don’t use the specific legal-eze required by state regulations, they will run afoul of the Division of Insurance.

There are plenty of examples of health insurance carriers using unfair or deceptive practices. We’re lucky in Colorado to have a strong Division of Insurance that works hard to protect consumers. Regulations that protect patients and insureds from unfair business practices are largely beneficial (and tend to weed out the shady insurance carriers). But Jaan’s article highlights the fact that health insurance carriers also have to protect themselves. If they don’t, they will end up with premiums that are far higher than the rest of their competition – and that isn’t sustainable.

Health Wonk Review At The Healthcare Economist

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[…] One of the most interesting pieces in this edition comes from Avik Roy, writing at Forbes about the historical relationship between political conservatives and individual mandates for health insurance. It’s a long article, but definitely worth reading. The individual mandate is going to be on everyone’s radar this year (if it wasn’t already) once it gets taken up by the Supreme Court. Roy’s piece gives us a bit of perspective on how political viewpoints regarding an individual mandate have changed over the decades.

Jon Stewart Interview With Sebelius Focuses Mostly On Health Insurance

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[…] I get the point that Stewart and Sebelius were making. They were addressing the aspects of the ACA that most directly impact people, since health insurance tends to be where most of us interact with healthcare costs. And the interview did – very briefly – touch on healthcare costs when Stewart mentioned that one of the reasons wages have stagnated is because “healthcare costs keep going up.” That is a key point, but they seemed to only be addressing it from the standpoint of health insurance premiums continuing to go up. It’s true that the actual check the employer writes each month to cover healthcare is paid in the form of health insurance premiums. But we have to address the root cause here, rather than just trying to figure out how to reign in premiums.

Steward did ask – in his usual joking manner – whether we all need to start exercising and eating better, which also touches briefly on the idea that a healthier nation would have lower healthcare costs. But overall, nearly the entire interview focused on how the ACA will impact health insurance. While that makes for an interesting interview, it also presents the ACA (at least as far as pop culture is concerned) as health insurance reform rather than healthcare reform. While there were definitely aspects of health insurance that needed reform, addressing health insurance as if it’s the crux of the issue is very much putting the cart before the horse.

A Look At Canadian And US “Mini-Med” Health And Dental Insurance

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[…] Glenn notes that although most people there have provincial health insurance policies, they often get additional coverage from their employers for things like prescriptions and dental care. And he points out that all too often, people think that they’re “covered” just because they have a health insurance card in their hands – even though the coverage might have very low annual limits. Of course that only becomes a problem when you have a catastrophic claim, which is of course when you need your health insurance the most.

Although the ACA has nixxed lifetime benefit maximums on health insurance policies here in the US, significantly increased annual maximum thresholds, and designated several categories of “essential benefits” that must be covered at specified levels, HHS has granted plenty of waivers for employers who are offering “mini-med” policies to their workers. These policies are far from being a safety net in the event of a catastrophic illness or injury, and often only cover a few thousand dollars in benefits per year. They remind me a lot of the type of policies Glenn is describing. […]

A Visual Of Our Healthcare Spending

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[…] This RAND Corporation infographic paints a pretty clear picture of how healthcare costs have increased over the past decade (specifically, the data refers to 1999 – 2009). Healthcare spending nearly doubled in that time frame, from $1.3 trillion to $2.5 trillion, but the second graphic shows how our complicated method of paying for healthcare makes it harder for the average family to see how their own healthcare costs have been impacted. The last graphic in the series shows what the average family could have done with the extra $2880 they would have had in 2009 if healthcare costs had grown during the 2000’s at the same rate they did in the 1990’s (GDP + 1%). Given how cash-strapped a lot of families have been for the past few years, I’m sure an extra three grand could have made a big difference. […]

Health Wonk Review – Campaign 2012 Edition

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All of the vote candidates are well qualified and knowledgeable about healthcare, from many different angles.  And they all write quite convincingly.  Some take polar opposite positions, while others lean more toward the center.  I’ll summarize each candidate’s platform, and you can get all the details by clicking on the names.  Once you’re finished, cast your vote for your favorite in the comments.  Be warned, however – you will have a hard time choosing!

Ladies and gentlemen, here are your candidates for Wonkiest Health Wonk 2012:

Anthony Wright‘s camp is taking issue with Rep. Dave Camp’s position that the ACA is the reason for the decrease in the percentage of employers who offer health insurance benefits and the increase in premiums (both trends that were well established long before the ACA was crafted, and as Anthony points out, most of the provisions of the ACA haven’t been implemented yet).  Rep. Camp quoted Wright on his website, and mis-used the words to support his position that the ACA is to blame for the current problems.  Anthony is – quite understandably – unimpressed.

Joe Paduda‘s platform is all about taking aim at Mitt Romney’s enjoyment of firing people – and insurance companies.  Although it sounds nice (and very “free-market-y”) to say that if you don’t like your health insurance company you can just fire them, that isn’t usually the case.  Joe explains how most people have limited options (if any at all) when it comes to their health insurance, particularlySIA2008-1616 if they have any health conditions.  Firing ones health insurance carrier isn’t really a possibility for most of the population.  Joe’s common sense approach should win over a lot of voters.

Gary Schwitzer‘s campaign is focused on calling out half-truths and shoddy journalism.  He cites an example of an ABC News segment that purports to be a journalistic look at a new “lifesaving” technology.  But it might just be blatant self-promotion on the part of the doctor being interviewed.  And even worse, it might convince countless viewers that they need the same high-tech test (along with several others that are mentioned in the story), despite the far less flashy stories about the comparative effectiveness data that indicate that the tests in question aren’t really useful for low-risk individuals.  And that leads to over-utilization of healthcare.  Which leads to increased healthcare spending.  Which leads to higher health insurance premiums.  Which leads to more people […]