How the States are Handling Health Insurance

There are many proposed and approved changes to our health care system at both the state update health insurancefederal and state levels, which may impact the cancer community. If you don’t live in one of these states, it’s important to know that these changes could come to your state next.

Health Insurance Marketplace Data:

We have heard a lot in the news about how the plans in the Health Insurance Marketplace are more expensive this year. The final enrollment report just came out and it showed that 7.5 million people qualified for financial assistance to purchase their plan. The average monthly premium for those plans was $89. This is actually less than the average from 2017, which was $107. Also, more people were able to get better coverage for less money, choosing more gold plans than last year. For example, in Wyoming, in 2018, 46% of plans chosen were gold, compared to 3% in 2017.

Other National News:

  1. The IRS has made some changes to Health Savings Accounts (HSAs). If you have an HSA, read more hereabout the changes to avoid any penalties and other IRS news.
  2. A new survey finds that 44% of people surveyed said they didn’t go to a doctor when they were sick or injured last year because of cost. 30% of people said that they had to choose between medical care and paying for basic necessities (food, heating, housing, etc.). And, 39% of people didn’t go to a dentist last year when they needed treatment. Read more here.
  3. Nearly 1 in 5 Americans has crippling medical debt. Medical debt is still the leading cause of personal bankruptcy in the United States. RIP Medical Debt is an organization that uses donations to purchase debt portfolios from collection agencies, to help people who need it the most. While you cannot apply to have your debt forgiven through RIP Medical Debt, there is an opportunity to add your name to their Debt Forgiveness Registry. If RIP Medical Debt is able to have your debt forgiven, they will notify you. Read more here.

Hawaii:

The Governor of Hawaii signed a bill that would allow physicians to prescribe life-ending medication to terminally ill patients. Adult patients who are terminally ill have to meet strict guidelines to get the medication, including:

  • Meeting with a counselor who must determine that the patient isn’t suffering from conditions that may interfere with decision-making, such as a lack of treatment for depression;
  • Making two oral requests for the medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom can’t be a relative; and
  • Two doctors have to confirm the patient’s diagnosis, prognosis, ability to make decisions, and that the request is voluntary. They must also agree that the patent has less than six months to live.

Hawaii joins California, Colorado, Oregon, Vermont, Washington, and the District of Columbia, which have death with dignity laws. Click herefor more information about state laws. Hawaii’s bill takes effect January 1, 2019.

Maine:

In November, voters in Maine passed a proposition to expand Medicaid coverage in Maine, under the ACA.  The state legislature has actually passed Medicaid expansion laws 5 times since the ACA was signed into law on March 23, 2010. Each time, the Governor of Maine, Paul LePage, vetoed the expansion. When the voters approved Medicaid expansion, the Governor immediately said he would not implement it, unless lawmakers in Maine came up with the money to pay for Medicaid expansion without raising any taxes. The Governor had a deadline of April 3, 2018. to submit an expansion proposal to the federal government for approval.  But April 3rdhas come and gone and there has been no action. It is now up to legislature to figure out how to handle the funding. Expansion is supposed to begin July 2, 2018. Read more about Medicaid in Maine here.

Massachusetts:

Read this articleabout the paid family and medical leave proposal currently being discussed by the state legislature.  If the legislature doesn’t approve a plan, then advocacy groups are working to get a voter proposition on the November ballot.

Paid Family leave programs are also being discussed in Connecticut and New Hampshire.

 Iowa:

Governor Kim Reynolds has signed a bill to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans. These “health benefit plans” would not be deemed “insurance,” so they are able to deny coverage or charge more for people with pre-existing conditions and would not be subject to regulation by the Iowa Insurance Division. With the change of a word, consumers lose access to many protections, especially those with serious medical conditions.

Many states are looking at this as an option. Tennesseewas actually the first state to allow farm bureau plans to be carved out of insurance protections.  These plans can ask people about their pre-existing conditions on the application, and reject people it expects to have high medical costs.

Utah:

Governor Gary Herbert signed a bill to give more than 70,000 Utahans access to Medicaid. Now the state waits for the Trump administration to sign off on their partial Medicaid expansion plan. If approved, it will likely be at least a year, before people will be able to sign up. This partial expansion covers adults making up to 100% of the federal poverty level (FPL), or $12,140 a year for an individual. The ACA’s Medicaid expansion covered adults up to 138% of the FPL, or $16,753 for an individual. It also includes a work requirement.

There are also advocacy efforts to collect signatures to put an initiative on the November ballot, which would expand coverage to adults with a household income up to 138% of the FPL. The deadline for collecting signatures was April 15.  We will see if this proposal gets on to the November ballot.

Stay tuned for the latest news  . . .

Is Short-Term Insurance the Solution?

Last week, we shared a number of changes that states are looking to make to our health Short term health insurance policy on a table. care system. This week, we bring you a major change that has been proposed nationally.

Short-Term Insurance Plans

First, the U.S. Department of Health and Human Services (HHS) has released a proposed rule to allow the sale of short-term health insurance plans with coverage for any period less than 12 months.

Short-term health insurance plans are plans that only provide coverage for a certain period of time, less than a year. These plans were only intended to provide coverage for people who were between jobs or needed temporary coverage for other reasons.

These plans are not required to comply with the ACA’s consumer protections, which means that they can deny people with pre-existing conditions, can require people to complete medical questionnaires on the application, can charge people more because of an individual’s health history, and do not have to cover essential health benefits.  For example, a plan could exclude mental health care, preventive care, substance abuse treatment, or maternity care. They also are not required to have an out-of-pocket maximum, which means that people with serious medical conditions like a cancer, will pay significantly more for their medical expenses.

Because they don’t have to comply with these consumer protections, these plans are often referred to as “junk insurance.” These plans generally appear cheaper than other individual health insurance plans. The lower monthly premiums make them attractive for people who are healthier.  However, cancer is unpredictable.

The other challenge with these short-term plans, is that when they end, they do not have ‘guaranteed renewability.’  This means that an insurance company does not have to offer an individual a new policy when the term of coverage ends.  Furthermore, because these plans do not comply with the ACA, they are not creditable coverage. So when they end, it does not trigger a special enrollment period to buy a plan in the Health Insurance Marketplace. If no other coverage is available (e.g., going on a parent’s plan if they are under 26 years old), someone who has been diagnosed with cancer may have to wait for coverage until the next open enrollment period.

HHS’s previous rule from 2016, limited these short-term insurance plans to a maximum of three months. HHS is now allowing these plans to last for any time period up to 12 months, meaning that they can last up to 364 days.

Advocates have three main concerns about this change:

  1. Unsuspecting consumers who are healthier will leave the Marketplace to buy these cheaper plans, which will drive up the costs of plans in the Marketplace
  2. If these healthier individuals are diagnosed with serious medical conditions, they may find they are not adequately covered by their short-term plan and may lose access to insurance when their term ends
  3. People with pre-existing conditions won’t be able to purchase these cheaper short-term plans, which means they will be stuck in the marketplace with more expensive plans

While expanding access to these short-term plans does increase the number of options available to consumers, there is a concern that the expansion of these plans allows insurance companies to do another end run around the consumer protections laid out in the ACA, ultimately leaving consumers with less coverage and more cost.

People have until April 23, 2018, to comment on this proposed rule, and then HHS will release a final rule at some point after that. We will keep you posted. Stay tuned.

Congress Takes Steps to Undermine the ADA

Many have heard of the Americans with Disabilities Act (ADA), but may not know all of the details. The ADA is the federal law that protects people with disabilities from discrimination in a variety of ways.

The ADA was passed by Congress in 1990, more than 28 years ago.  Congress improved protections in the ADA in 2008 by passing the ADA Amendments Act.  Most people are familiar with its physical access requirements, such as having accessible parking spots, ramps into buildings, and accessible restrooms. However, despite its age, many who are protected by the ADA, don’t know it.

In addition to physical access requirements, the ADA also provides protections for people with disabilities in the workplace.  Title I of the ADA requires that covered employers provide eligible employees with protection against discrimination and rights to privacy, as well as access to reasonable accommodations. For more information about these protections and how they apply to individuals diagnosed with cancer AND their caregivers, visit: http://TriageCancer.org/employment.

The ADA also provides protections for children, adolescents, and young adults with disabilities in school, including those diagnosed with cancer.

Approximately 36% of adults ages 65 and over have some type of disability. Learn 7 facts about Americans with disabilities.

This month, Congress took a step to erode the protections in the ADA.  The U.S. House of Representatives passed (252-192) the ADA Education and Reform Act, which forbids individuals with disabilities from suing a business for violating their rights under the ADA, unless they first:

  1. Provide written notice to the business that they are in violation of the ADA
  2. Wait 6 months to see if the business fixed the violation

Opponents of the bill argue that this allows businesses to refuse to comply with the ADA, until an individual with a disability sends them a written complaint and then they get another 6 months to comply. Meanwhile, the individual with a disability is unable to access that hospital, doctor’s office, restaurant, store, movie theater, hotel, or other public place.

Advocates for people with disabilities are skeptical that businesses need more time to comply with a law that was enacted almost thirty years ago.

In what other area of society do we allow a business to ignore a law until someone sends them a written complaint?

Oh, wait.  That sounds a lot like health insurance appeals.

The bill now awaits a vote in the U.S. Senate. For more information about how to be an effective advocate, visit http://triagecancer.org/advocacy. Stay tuned.

 

 

 

Six Key Things You Need to Know During Open Enrollment

Open enrollment for plans sold in the Marketplaces started yesterday and we have Six Key Things to Know Open Enrollmentbeen hearing that there is still a lot of confusion. As a reminder, open enrollment is the time of year consumers can shop for a new plan or make changes to existing plans. For Marketplace and Medicare plans the plan won’t start until January 1, 2018. Employer plans may have different start dates, so check with your employer. Here are six key things you need to know during open enrollment:

  1. Health insurance can be confusing.
    1. Make sure you understand the key terms used in your health insurance policy. Watch our new video – Triage Cancer Presents: Health Insurance Basics to learn more. This information is useful regardless of where you get your health insurance coverage.
  2. Financial assistance still exists for most people who purchase plans in the marketplace.
    1. For 2018, 8 in 10 people have Marketplace health insurance options for $75 or less, a month. This is mostly due to the premium tax credits available to people based on their income level.
    2. Even though the Administration has said that they will no longer pay the insurance companies back for providing cost-sharing subsidies (aka cost-sharing reductions), the insurance companies still have to provide those discounts to consumers.
  3. Individuals shopping for insurance (regardless of where they get it – Medicare, employers, private companies), should be sure to do the math when comparing options!
    1. Often times we only look at the monthly premium of a plan. However, to accurately determine what a plan with cost you for the year, you have to do the math! Assuming that a consumer will reach their out-of-pocket maximum during the year, the way to do the math is to multiply the monthly premium by 12, then add that amount to the plan’s out-of-pocket maximum. You may be surprised to find that the bronze plan may not be your most affordable option.
    2. Consumers should also look at the network of doctors and hospitals, the other costs (e.g., co-payments, deductibles, etc.), and prescription drug coverage.
    3. For more information on how to pick a plan watch our webinar, Choosing Wisely: How to Pick an Insurance Plan or visit CancerFinances.org.
  4. Individuals who are eligible for Medicare are not eligible to purchase plans in the Marketplace. Visit http://medicare.gov for more information about plan options.
  5. Be wary of short-term health insurance plans.
    1. These plans may look attractive based on their low cost, but they are not considered creditable coverage and when they end, consumers typically aren’t eligible for a special enrollment period to buy a plan in the Marketplaces, which could leave them with a gap in coverage. Additionally, they do not have to include the consumer protections in the ACA and may be able to charge people with cancer more, or exclude covering cancer treatments.
  6. Open enrollment dates may vary depending on where you live.
    1. The federally run Marketplace will be open from November 1 – December 15; however, some states have extended their open enrollment periods.
    2. There are also some extensions available for people who were affected by the recent hurricanes. (see the link above)

Only a few days left to buy health insurance!

Do you need health insurance coverage for 2016?Triage Cancer Only a few days left to buy health insurance for 2016

Good news is that you still have a few days (until December 15th) to pick a plan on your state’s health insurance marketplace and have your coverage start January 1st.

Want even more good news? According to HealthCare.gov 8 out of 10 people who enroll through the Affordable Care Act’s Health Insurance Marketplaces qualify for financial help to lower the cost of their monthly premiums.

If you’re not sure what to be thinking about when shopping for a plan, take some time to watch our webinar on picking a health insurance policy.

Ready to start your application? Visit HealthCare.gov and pick your state from the drop down menu.

Make the Most of Health Insurance Open Enrollment!

Open Enrollment for the Health Insurance Marketplace is now open!

Having a good health insurance plan can be a real life and wallet saver and as you may know it is also a requirement! The Open Enrollment period for 2016 health care coverage runs from November 1, 2015, to January 31, 2016. If you want your coverage to begin by January 1, 2016, you have to enroll or change your plan by December 15, 2015.

Triage Cancer - 4 Ways to Get Covered

The requirement to have health insurance coverage is often referred to as the Individual Mandate Penalty. This penalty almost doubles in 2016, for those who don’t have health insurance, to $695 per person or 2.5% of your household income, whichever amount is more.

Triage Cancer - Obamacare Open Enrollment Facts

Source: Obama Care Facts, 2015.

Even if you already have a health care plan that works for you, it is always good to compare different plans. Shopping around can’t hurt, even if you have health insurance coverage through your employer. Plans and pricing can change every year, so you may be able to find new coverage that is more affordable or better fits your needs.

Triage Cancer offers a free tool to you find health insurance options as well as information about other benefits you may be eligible for at the federal, state, and local levels.

By taking the time to compare your current plan with new options, you may find a cheaper plan or find out that you’re entitled to other benefits, like financial assistance. Based on where you live and your household income you may qualify for your state’s Medicaid program or a premium tax credit that lowers your out-of-pocket costs when you chose a health insurance plan from a private health insurance company.

5 key things to look for when choosing a health insurance plan:

  1. Monthly premium cost
  2. Deductible cost
  3. Out-of-pocket maximum cost
  4. Are my health care providers covered by the plan
  5. Are my prescription drugs covered by the plan

We know that these terms and choosing the right health insurance policy can be confusing, so to answer any questions you may have watch our latest FREE webinar recording that covers tips on how to choose a plan that works for you.

Progress has been made on increasing the number of people with health insurance. According to the US Census Bureau, in 2009, before the ACA was passed, about 15.7% of the population was uninsured. Recently, a study done by the CDC using 2015 Census data showed that the total uninsured rate has dropped to 9.2%. In California alone, 4.5 million new people enrolled in health care plans between 2013 and 2015. Even though these numbers are cause for excitement, there is still work to be done. If enrollment rates continue to increase, insured patients can look forward to their health needs being met, and less problems paying for health services than when they were uninsured.

There are so many benefits to selecting the perfect health care plan for you and your family, be sure to make the most of this year’s Open Enrollment and discover the plan that will best suit your needs. Triage Cancer will be posting valuable information about health insurance coverage throughout Open Enrollment.

Here are some other helpful tools:

References:

  1. ObamaCare Enrollment Numbers. http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/. Accessed October 28, 2015.
  2. Insure the Uninsured Project Blog Post. Open Enrollment: Lessons from the Field; October 20, 2015. http://itup.org/blog/2015/10/20/open-enrollment-lessons-from-the-field/. Accessed: October 28, 2015.
  3. Insure the Uninsured Project Blog Post. Summary of the Kaiser Family Foundation Survey of California’s Uninsured; August 11, 2015. http://itup.org/blog/2015/08/11/summary-of-the-kaiser-family-foundation-survey-of-californias-uninsured/

Do you qualify for Medicaid? It depends on where you live.

As a follow up to last week’s blog about the 50th birthday of Medicare and Medicaid, we 50th Medi Bdaywanted to share some additional resources on Medicaid.

This fact sheet explains the difference between Medicare and Medicaid: www.medicare.gov/Publications/Pubs/pdf/11306.pdf.

The Centers for Medicare & Medicaid Services has also created a series of fact sheets for consumers to help people understand more about Medicaid.

Medicaid is the federal health insurance program that covers people who have low-incomes and meet certain categories of eligibility. Medicaid eligibility varies by state.

Some states expanded their Medicaid programs under the Affordable Care Act, and some did not. The fact sheets are specific to the state in which you live and are available in English and Spanish. Here are some examples:

For states expanding Medicaid: www.medicaid.gov/medicaid-chip-program-information/by-topics/outreach-tools/downloads/11809_medicaidenrollanytimeflyer_familymedexp_508.pdf.

For states who have not expanded Medicaid: www.medicaid.gov/medicaid-chip-program-information/by-topics/outreach-tools/downloads/11801_medicaidenrollanytimeflyer_family_508.pdf.

You can enroll in Medicaid at any time during the year and get coverage right away.

Nearly 70 million Americans receive health insurance coverage through Medicaid.

Happy Birthday to Medicare & Medicaid!

50th Medi BdayOn July 30, 1965, President Lyndon Johnson signed Medicaid and Medicare into law at a ceremony in Independence, Missouri. Congress passed the Social Security Amendments of 1965, after three previous Presidents had fought for the creation of a national health plan.

Former President Truman was issued the very first Medicare card during the signing ceremony. 19 million Americans signed up for Medicare during its first year.

At the time, these two federal programs were a groundbreaking way to provide basic insurance options for Americans without health insurance.

Medicare is the federal health insurance program that covers eligible people who:

  • Are 65 years are older;
  • Have been receiving Social Security disability benefits for 2 years; or
  • Have end-stage renal disease (ESRD) or ALS.

Medicaid is the federal health insurance program that covers people who have low-incomes and meet certain categories of eligibility. Medicaid eligibility varies by state.

Over the years, these government health insurance programs have continued to change, covering more Americans and providing additional benefits.

  • For example, in 1972, President Nixon expanded the coverage of Medicare to people under the age of 65 with long-term disabilities and individuals with
  • In 2003, President George W. Bush signed the Medicare Prescription Drug Improvement and Modernization Act, which created Medicare prescription drug coverage.
  • And in 2010, President Obama signed the Patient Protection and Affordable Care Act, which expanded Medicare to cover free preventive and wellness services and improve prescription drug coverage.
  • Click here to view a video about the history of Medicare.

Today, nearly 50 million Americans receive health insurance coverage through Medicare alone.

Nearly 70 million Americans receive health insurance coverage through Medicaid.

To learn more about Medicare, visit www.Medicare.gov or read www.socialsecurity.gov/pubs/EN-05-10043.pdf. Each year, Medicare also releases Medicare & You, which includes details about Medicare, including costs, benefits, and how to find plans in your area.

To learn more about Medicaid, visit www.healthcare.gov/medicaid-chip. For more in depth information about Medicaid, visit http://kff.org/health-reform/issue-brief/medicaid-moving-forward.

Yesterday, Medicare and Medicaid celebrated their 50th birthday. As our health care system and health insurance options continue to evolve over time, it is important to keep perspective and remember that when Medicare and Medicaid were first introduced, they were not welcomed by many people. But today, they are well-established ways for Americans to get access to health care.

View this video about the history of Medicare & Medicaid.

MediMedi Birthday

Retiree Health Insurance Plans

Has a neighbor told you that his daughter is still covered by his health insurance plan, even though his daughter is 24?

Wondering why you haven’t gotten any information that your son, who is 23, can?

Do you have a retiree-only health insurance plan?

If so, some of the recent consumer protections in the Patient Protection & Affordable Care Act (ACA) may not apply to you and your health plan.

These are all examples of ACA protections that do not apply to retiree-only plans:

For more information, visit: http://kff.org/report-section/retiree-health-benefits-at-the-crossroads-implications-of-recent-legislation-for-retiree-health-coverage.

And for those of you who like to get in the weeds, here is a handy chart with additional information about ACA provisions that don’t apply to specific types of health plans: http://www.proskauer.com/files/uploads/Documents/Applicability-of-PPACA-to-Health-Plans.pdf

This Week: The Supreme Court May Make Your Health Insurance Too Expensive!

Do you have a health insurance plan that you bought from HealthCare.gov?

If so, this blog is especially for you . . .

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

The cancer community is anxiously awaiting the U.S. Supreme Court’s decision on the King v. Burwell case, in which the plaintiff argues that individuals who buy health insurance from a “federally-facilitated” health insurance marketplace, should not be entitled to financial help to buy insurance plans.

The decision is expected to be announced on Thursday, June 25, or Monday, June 29. To read the oral arguments of the King v. Burwell case, which occurred in March, visit: http://www.supremecourt.gov/oral_arguments/argument_transcripts/14-114_1bo2.pdf.

This case depends on how the 9 members of the Supreme Court look at one sentence in the Patient Protection and Affordable Care Act (ACA), which says that the financial assistance will be available for people “enrolled through an Exchange established by the State.”

Although, the ACA intended for every state to create their own state health insurance marketplace, aka exchanges, more than half of the states chose not to do so. This left the federal government to create marketplaces for those states.

This chart shows the type of marketplace in each state, for 2015:

State Marketplace Chart June 2015

If the Supreme Court agrees with the plaintiff in this case, then people who live in a state without a state marketplace will lose their financial help to buy health insurance.

It is estimated that 8.2 million people will lose their health insurance coverage, because they will not be able to afford their monthly premiums without the financial assistance provided by the ACA. In Florida, for example, 93% of people with a marketplace plan get financial assistance. Nationwide, 88% people with marketplace plans receive financial help, which on average, cuts the cost of monthly premiums by 72%.

With fewer people participating in the marketplaces, it will increase the premiums for everyone who continues to buy their coverage from the marketplaces. Some estimates suggest Alaska, Wyoming, Delaware, Wisconsin and South Carolina will be hardest hit.

For more details and research about the impact of a Supreme Court ruling for the plaintiff, visit: www.urban.org/features/king-v-burwell.

For detailed, state-by-state information on the potential effects of the King v. Burwell ruling, visit: http://kff.org/interactive/king-v-burwell-effects.

As of now, there is no plan in place to deal with a Supreme Court decision eliminating the financial assistance. It’s unclear if that would mean that the financial assistance would end the minute the Supreme Court makes their decision, if it would end at the end of the month, or even at the end of the year.

Despite such an important decision looming, most people aren’t paying any attention to how this decision is going to impact their daily lives.

For more information about marketplaces in general read this blog post.

Stay tuned . . . We will post a blog update once we have a Supreme Court decision!