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Open Enrollment For Individual Health Insurance Plans Starting in 2014

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Ever since the PPACA was first being discussed, the individual mandate has been touted as a buffer to protect health insurance carriers – and in turn, policyholders – from adverse selection that would otherwise certainly occur in a guaranteed issue individual market.  It seemed that as long as people were required to maintain health insurance coverage, adverse selection would be minimized and people would be unlikely to purchase health insurance only during periods of sickness. But there was still enough concern about adverse selection that HHS issued a proposal for open enrollment periods in the individual market starting next year.  This proposal was released at the end of November, and the specific details regarding the open enrollment period are on page 70595 of this Federal Register.

Open Enrollment For Individual Health Insurance Plans Starting in 2014To sum it up, they’re proposing an initial open enrollment period for individual/family health insurance that starts in October 2013 and runs through the end of March, 2014 (a six month window in order to accommodate the large influx of initial applications), and then open enrollment periods that mirror Medicare’s: October 15th until December 7th each year.  Beyond that window, only “qualifying event” applications would be allowed for […]

Colorado’s Medicaid Expansion Plans Make Sense

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Governor Hickenlooper’s announcement last week that Colorado plans to expand Medicaid eligibility to more than 160,000 childless adults has been met with much debate from both sides of the political spectrum.  The voices opposed to the expansion come mainly from an economic perspective, saying that we just can’t afford to cover more people with Medicaid.  And as is usually the case, there are wildly different estimates of how much the Medicaid expansion will cost and/or save the state over the next decade:  The Kaiser Family Foundation says that the move will cost Colorado $858 million over the next decade, while Governor Hickenlooper’s office says that it will save $280 million instead.

Colorado Medicaid Expansion DebateAfter all of the money talk from the CBO and all of the special interest groups over the last few years regarding various aspects of the ACA, I think a lot of people have become numb to the numbers.  Predictions of how much any healthcare legislation will cost or save over any lont-term time horizon really depend on who is doing the study and what variables they took into consideration.  And we have to bear in mind that laws and reforms and healthcare in general are not static entities; they’re constantly changing, which makes long-term financial predictions murky at best.  Even if we could control for every single current variable and come up with an accurate picture of the cost and/or savings implications of the Medicaid expansion, we can’t know what additional changes might be made in the future that will increase or decrease the predicted amounts.  Given that reality, as well as the dramatically different financial predictions out there, I think it’s best to assume that the actual numbers will […]

CLASS Act Officially Nixed From The ACA In Fiscal Cliff Deal

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[…] CLASS wasn’t going to be financially viable, and the first try just didn’t work. But that doesn’t mean we can just forget about it and move on. One way or another, long term care costs have to be addressed relatively soon. My prediction is that a new bill will be crafted in the next couple of years to create a solution similar to CLASS but hopefully with a more solid financial groundwork. But I think lawmakers might wait until 2014 – after the ACA has been more fully implemented and health insurance coverage is more widespread than it is today – to take action.

Senator Aguilar Pushes For Universal Healthcare In Colorado

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Senator Aguilar’s plan for universal healthcare in Colorado is based on a genuine need: even with current and planned state and federal healthcare reforms, there will still be a lot people in Colorado without health insurance. The CBO estimates that on a national level, we’ll have 30 million uninsured people in the US a decade from now. That’s taking into account the fact that SCOTUS struck down a provision in the ACA that would have required states to expand their Medicaid programs. States have flexibility with that now, and some will likely choose not to expand. Colorado, however, is expected to expand its Medicaid program (not surprising, given how much work the state has already done on that front). The uninsured population in Colorado hovers somewhere in the 600,000+ range, depending on how and when the samples are studied. If the ACA is expected to reduce the national uninsured population from 53 million to 30 million, and taking into account the fact that Colorado will likely be one of the states that opts for Medicaid expansion, I would say it’s reasonable to expect that the uninsured population here will be reduced by at least 50% once the ACA is fully implemented. But that still potentially leaves a few hundred thousand people – not an insignificant number by any stretch – with no health insurance. Those are the people Senator Aguilar is trying to help.

Health Insurance And Genetic Testing

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[…] Is it fair to say that health insurance carriers shouldn’t be able to use genetic testing information during underwriting, but that they should have to pay for preventive healthcare that results from genetic testing? I don’t think there’s an easy answer there. It’s hard to put a price tag on health and life, and it’s difficult to say that a person who is making such a hard decision should also be faced with a potentially very large medical bill at the same time. But if we’re going to categorically state that genetic testing cannot be used to the advantage of health insurance carriers, it’s hard to turn around and say that the carriers should also be required to pay for treatment that comes about as a result of that same testing.

What do you think? As technology moves forward, I have no doubt that genetic testing will become more routine, and various preventive measures based on those tests will likely become fairly commonplace. If they become a larger part of our general healthcare process, I would say that it’s reasonable to assume they will also be covered more frequently by health insurance carriers. And as of 2014, some of the issues addressed by GINA will become moot points too, as health insurance will all be guaranteed issue. So this is a subject that might just work itself out naturally over the next decade or so. But for now, it does leave plenty of room for debate.

What Should Health Insurance Cover?

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The reason we have health insurance is to protect against the things we don’t expect to happen. The things we can’t foresee. The things that would blow though most households’ life savings very quickly. Doctor visits, routine medications, even the occasional trip to urgent care – these are relatively predictable. And relatively inexpensive, compared with the cost of care for a serious illness or injury.

If health insurance did cover everything, without any additional out-of-pocket costs for the insured, health insurance premiums would go up by about as much as people currently spend on out-of-pocket costs. Health insurance carriers would have to start generating enough revenue to cover those claims, and that would translate directly into higher premiums for everyone.

I know that the comparisons between health insurance and auto or home insurance have been made many times, but I’ll bring it up again here. When you buy car insurance, you don’t expect it to cover oil changes, new tires, or even a whole new engine if your car ends up needing one. When you buy home insurance, you don’t expect it to pay for home maintenance or repairs. In both cases, we expect the insurance to cover the unexpected. We know that if we have a car or a house, they’re going to need maintenance. And we know that we’ll have to budget for those things, however much we might dislike that fact. We hope that we never have to use our car insurance or our homeowner’s insurance. The same should be true of our health insurance. It’s there in case something unforeseen and expensive occurs (and it’s useful to remember that “expensive” is a relative term… although $1000 is “expensive” as far as most family budgets, it’s a tiny fraction of the total medical bill that would be incurred in the event of a major illness or injury). When you take that view of health insurance, it becomes a more realistic product. With most policies, the money you’re paying in premiums is not intended to cover routine, minor healthcare (with the exception of preventive care). But it will cover the potentially enormous claims that could result from a serious illness or injury.

Should Dental Insurance Be Included On Health Insurance Policies?

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[…] One possible solution would be for dental insurance to get wrapped in to health insurance policies, both private coverage and Medicare (the majority of seniors in Colorado have no dental insurance, because it’s not part of Medicare). If dental insurance were absorbed into health policies, the premium increases might not be significant. Maternity coverage is a good example of how this could work. In the past, maternity coverage was only available on a few individual health insurance policies in Colorado, as a separate rider that had to be added to the basic coverage. The cost for this rider was prohibitive, because the only people who were adding it were the ones who were planning to use it. But for almost two years now, all new individual policies in Colorado have included maternity coverage, and premiums have definitely not increased by as much as maternity riders used to cost (premiums have gone up, as they had done for years prior to the maternity mandate, but there are many factors involved). If dental coverage were included in health insurance policies, the administrative overhead for these plans could be rolled in with the administration of the health plans, and there would be more people who had coverage and weren’t using it often – their premiums could offset the cost of dental care for people with significant claims. […]

Downsides To Raising The Medicare Eligibility Age

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[…] The wealthiest older Americans can probably easily wait until 67 for Medicare. In 2014, individual health insurance will be guaranteed issue, and if paying the premiums is not a problem, that’s a viable alternative for some people. But most Americans are not wealthy enough for those premiums to be easily affordable, even with premium subsidies. More than a few 65 and 66 year olds would likely opt to go uninsured until they reached the new Medicare age, and that brings it’s own host of problems – for the individuals and for taxpayers, hospitals and the entire healthcare system. For people struggling to make ends meet, an extra two years of either being uninsured or stretching to pay health insurance premiums could be a very big deal indeed. And as Maggie points out, it doesn’t even end up saving money.

The proposal to raise Medicare eligibility to 67 is short-sighted and based on the premise that Medicare is an “entitlement” (what about the fact that recipients have been paying into it for decades, to cover the cost of previous retirees’ care?). I suppose it makes sense – at first glance – that we can reduce the amount spent by Medicare if we make people wait an extra two years to enroll. But the practical realities would be a different story: people putting off medical care until age 67 (at which point illnesses might be more progressed and more expensive to treat), people going uninsured, higher premiums within the Medicare system without the younger members enrolled, higher costs borne by employers who cover the cost of healthcare for workers and retirees, and the list goes on. […]

Health Insurance Premiums Mirror Healthcare Costs

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[…] Colorado has taken a much more proactive and transparent position in terms of the rate review process, and we’ve written about it several times.  Although rate increases on health insurance policies are frustrating when they continue to far outpace inflation, they’re being driven largely by the increases in the cost of healthcare.  But most of us are very insulated from the cost of our healthcare.  Since the bills go to our health insurance carriers, many people don’t really know how much it costs to have any sort of significant medical treatment.  We know how much our health insurance costs though, and when the price goes up, we feel it.  Even though the price increase is directly linked to the increases in healthcare spending, we’re much more likely to focus on the Health Insurance Premiums Mirror Healthcare Costshealth insurance premiums, since those are the bills we pay ourselves (this is especially true for people who buy their own individual health insurance, without assistance from an employer). […]

Rocky Mountain Health Plans 2013 Rate Increase Announced

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Rocky Mountain Health Plans announces the 2013 new business rate increase for the “SOLO” individual/family health insurance plans in Colorado is 18%. As with all carriers, for existing clients on open plans, rate changes may be different due to age attainment and trend. Carriers may adjust rates differently for closed plans effective January 1, 2013.

RMHP posted the disclosure of the increase for new and renewing business on healthcare.gov.

For clients who pay monthly:

  • January renewals were mailed Friday, November 30, 2012.
  • February renewals will be mailed the end of December.
  • March renewals will be mailed the end of January.

How the Affordable Care Act Affects You

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For the first couple years after the Affordable Care Act was signed into law, everything seemed to be a bit up in the air.  There was almost constant bickering about the subtle nuances of the legislation, along with uncertainty from both sides of the political spectrum insofar as whether or not the law would stand the test of time.  The Supreme Court had to weigh in, and we also had a major election cycle midway between the signing of the law and the enactment of many of its main provisions.

Most of that has settled down now.  SCOTUS upheld the law.  And there was no election upheaval in Congress to tilt the legislative body towards a crowd that would be likely to repeal it.  States – like Colorado – that had been working towards setting up a health benefits exchange can continue to do so without as much worry that their work might be in vain (there had been How the Affordable Care Act, Obamacare, Affects Yousome concern that the law would be tossed after states had invested a lot of time and money in the exchange-creation process).  We are just over a year out now from January 2014, when many of the major provisions of the ACA will go into effect; it seems relatively certain at this point that the ACA will continue to move forward now that some of the potential roadblocks are in the rearview mirror.

Several provisions of the Affordable Care Act – ACA have already been implemented over the past two years:  Young adults can remain on their parents’ health insurance policy until […]

Individual Health Insurance After Donating A Kidney

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This recent AARP article caught my attention last week.  My father lost his kidneys in 2001 as a result of Wegener’s Granulomatosis, a rare autoimmune disease.  In August, he was the recipient of a kidney generously donated by the family of a young man who had passed away.  And this fall, for the first time in 11 years, he’s been able to go about his life without being tethered to a dialysis machine every evening.  So I’m drawn to stories about kidney transplants, living donors, or families who choose to donate a deceased loved ones organs.

To sum it up, Radburn Royer is a healthy 57 year old who donated a kidney to his daughter four year ago, after her own had failed as a result of lupus.  Prior to donating a kidney, Royer was covered by Blue Cross Blue Shield of Minn.  It’s unclear what his health insurance status was in the interim, but last year he reapplied for coverage with them and Individual health insurance kidney donorwas turned down.  He’s appealed several times, but for now he’s covered by his state’s high risk pool (he has to pay $130 more per month for his coverage and has a higher deductible, both of which are common in high risk pools).

Individual health insurance in Colorado is underwritten just as it is in Minn., but underwriting guidelines usually vary from one state to another and from one carrier to another.  So we contacted three of the top individual health insurance carriers in Colorado to see how they would underwrite an applicant who had previously donated a kidney.  Cigna, Humana and Anthem Blue Cross Blue Shield all said that as long as the donor had been released from medical care and had normal blood pressure and blood lab results, the most likely underwriting outcome would be acceptance with a standard rate.

At first glance, this seems to be at odds with the situation experienced by Royer, but maybe it’s not.  The AARP article notes that Royer underwent […]

[…] In the context of kidney donation, it’s important that potential donors not be inadvertently scared off by AARP’s article.  Kidney donors are heroes – anyone who had received a transplant will attest to that fact – and they save lives.  The study that I linked to above followed donors for 20 – 37 years after their transplants.  While some donors did end up having kidney problems, the majority had normal kidney function 20 – 37 years out from surgery, and would likely not have a problem obtaining individual health insurance, even prior to it being guaranteed issue in 2014.  Most people who are healthy enough to be accepted as a donor will continue to be healthy after they donate a kidney.

I wish my health insurance _____________?

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I understand the trade off we got when we switched to a really inexpensive high deductible plan when even our high deductible HSA qualified plan was too rich and expensive. So I wish my health insurance had a monthly credit card billing option. Our current health insurance company, Anthem Blue Cross of Colorado used to have it, like most health insurance companies did. But then, like most other companies also did, they stopped offering that as an option about a year ago.

What would you change about your health insurance company or plan? It could be the coverage, billing, customer service, anything…

2012 Obamacare Premium Rebates (Infographic)

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Did you receive a health insurance premium rebate this year? If so, how much was it? We created a simple visualization of how the PPACA (Obamacare) health insurance premium rebates break down between the individual/family, small group and large group markets and how Colorado’s rebates compared to the national average.

2012 Obamacare Colorado Health Insurance Rebates

No 2013 CoverColorado Assessment

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CoverColorado announced that there will be no assessment in 2013 on Colorado health insurance carriers. The 2012 assessment was roughly $3.79/month/contract for individual/family insureds.

Anthem Blue Cross of Colorado has also announced that their membership this year was higher than expected this year. They were making up for a shortfall by charging $4.36/month/contract in 2012. Due to the higher enrollment, Anthem BCBS has enough funding to satisfy December without billing subscribers a CoverColorado assessment.

Health Insurance Premiums And The ACA

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[…] We wrote a couple years ago about the Colorado Division of Insurance bulletin that laid out the reasons for rate increases in 2010 – almost all of them were the same factors that had been driving health insurance premiums for the previous decade; only 5% of the total premiums could be attributed to the ACA. […] The predicted long-term cost savings from the ACA are definitely not a sure thing. But we need to keep in mind that many of the substantial changes included in the law have not yet taken effect. And many of the changes that have been implemented are those that tend to increase short-term costs and/or utilization of care. […]

Individual Health Insurance Mandate From A Perspective Of Compassion

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[…] I’ve usually addressed the issue of the individual health insurance mandate in terms of how guaranteed issue health insurance would impact premiums in the absence of an individual mandate.  The mandate – regardless of its popularity – just seems like the most practical way to go if we’re in agreement that individual health insurance should be guaranteed issue.

Maybe we should also be looking at the individual health insurance mandate from a more compassionate, human angle too.  There has long been a bit of a harsh undertone in the healthcare reform discussions when it comes to people who are […]

Healthcare Fact Checking the Presidential Debate in Denver

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I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.

Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options. […]

How Does Health Care Reform Impact HDHPs and HSAs?

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Will HSA qualified health insurance plans and Health Savings Accounts (HSA) still exist after the majority of the remaining PPACA changes are implemented in 2014?  That’s a question that we often hear from Colorado health insurance clients who are concerned about their existing HSA qualified high deductible health plan (HDHP)/HSA, as well as people who are considering an HDHP but uncertain about the future of that type of health insurance.

In terms of direct impact, the PPACA changes very little about HDHPs and HSAs.  There are only two […]

Colorado Kaiser Permanente Recognized By HHS For Hypertension Control

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Nationally, more than half of hypertension cases are not under control (36 million uncontrolled cases out of 67 million total cases).  In 2008, Kaiser Permanente members in Colorado had a 61% control rate, and that number has climbed to 82.6% thanks to an intensive effort on the part of Kaiser Permanente to continually work with patients to control hypertension.  Sebelius said that Kaiser Permanente’s efforts have proven that “… by making high blood pressure[…]

More About Colorado’s Kaiser Permanente Benchmark Health Insurance Plan

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Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.

This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions.  It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans.  The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.

The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics.  We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30).  It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program.  The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan.  The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014.  In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation.  And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.

If Colorado had not selected a benchmark plan, HHS would have picked one for us.  HHS would have […]

Most Colorado Residents Have Health Insurance

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This article about the state of healthcare and health insurance in Colorado is an interesting one, and it provides plenty of good, factual information.  However, I was a bit perplexed by a quote from Dr. Ned Calonge, president and CEO of The Colorado Trust, who says “We’re reaching a tipping point where there will be more people who are uninsured than are insured.”  This comes after some statistics that highlighted the decline in the number of Colorado residents who get health insurance from their employers:  currently 57.8% of employers, compared with 63.7% two years ago.

I’m not really clear about the meaning of Dr. Calonge’s quote about a “tipping point”.  I am not in any way minimizing the importance of increasing the number of people in Colorado who have health insurance and improving access to healthcare for everyone.  Those are certainly the goals we should be working towards.  But we are in no way close to a point where Colorado will have more uninsured people than insured people.  The state currently has a population of 5.1 million people.  Although the number of uninsured people in Colorado is quite high (829,000), it’s nowhere near half of the population.  We are not close to having more uninsured people than insured people.

I wonder if the distinction was regarding the number of people who get their health insurance from an employer?  If the current trends continue, we could indeed see a point in the near future when the number of people who get their health insurance from an employer will be lower than the number who don’t.  But it’s important to keep in mind that the people who don’t get health insurance from an employer are not necessarily uninsured.  In fact, most of them have health insurance.  Some get it from the government (eg. Medicare, Medicaid, CHP+) and some purchase individual policies.  The article I linked to above includes a graph that shows where people in Colorado get their health insurance, and although it’s true that the percentage of uninsured residents increased while the percentage of people who get their health insurance from an employer decreased, we should also note that the percentage of people with individual health insurance, Medicare and Medicaid all increased in that same time frame (2009 to 2011).

So although Colorado has a long way to go in terms of getting everyone in the state insured, we’re not close to a point where the uninsureds outnumber the insureds.