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2018 Individual Marketplace Guidance

2018 Individual Marketplace Guidance

2018 Individual Marketplace Guidance

2018 Individual Marketplace Guidance

Health and Human Services had released earlier this year the final version of its 2018 Individual Marketplace Guidance.  Under the Affordable Care Act (ACA) this is issued annually. While the guidance is mostly related to the individual marketplace it does, however, include several items relevant to employers and group health plans.

Example:

  • Annual limits for cost sharing (out-of-pocket limits)
  • Marketplace eligibility notifications to employers
  • Marketplace annual open enrollment period
  • Small Business Health Options (SHOP) Exchange

Nov 2017 – How to Select a Broker on NYS of Health marketplace. 2018 Individual Health Insurance Market Open Nov 1 - Dec 15

Nov 2017- 2018 Individual Marketplace Guidance. 

Nov 2017- Indiviudal Enrollement  on Oscar or UnitedHealthcare Essential Plan.

Nov 2017 – Emnployer Reporting 2017 Updated 1094 & 1095 Now Available


On Exchange Maximum Household Income for Subsidy

Your decision on which will depend on your Household Income and the number of people in your household applying for coverage. In the chart below, if your HOUSEHOLD income (include all members or your tax household regardless of if they are applying for coverage or not) is below the limit shown based on the number in your household applying for coverage, then it is better for you to apply via your state marketplace such as the NY State of Health.

# of Household Members Applying for Coverage Maximum Household Income for Subsidy
1 $48,240
2 $64,960
3 $81,680
4 $98,400
Each Add’l. Household Member $16,720

MEDICAID EXPANSION: For those with incomes less than 200% of the Federal Poverty level you should also enroll via NYSOH as you might qualify for the United Healthcare Essential Plan.

ENROLLING ON NY STATE OF HEALTH

To enroll via NYSOH and have us as your broker use this link for instructions. How to Select a Broker on NYS of Health marketplace. 

Alternatively, If you earn too much to qualify for a subsidy we will enroll you OFF EXCHANGE. The application forms can be found using the Oscar link above. Download the FULL ENROLLMENT KIT and complete the necessary forms to send to us for processing.

2018 NY State of Health Open Enrollment Runs from 11/1/17 – 1/31/18. Special enrollment period runs throughout the rest of the year for qualifying events.

ANNUAL LIMITS FOR COST SHARING:

The annual out of pocket limits for plan years beginning on or after January 1, 2018 are $7,350 for individual coverage and $14,700 for family coverage.  These cost sharing limits apply to in-network essential health benefits offered under non-grandfathered health plans, both fully and self-insured.  Annual deductibles, in-network co-insurance and other types of in-network cost sharing accumulate toward the out-of-pocket limit, including prescription drug copayments.  Not included are premium payments, out-of-network cost sharing and spending on non-essential health benefits.

MARKETPLACE ELIGIBILITY NOTIFICATIONS TO EMPLOYERS:

Beginning in 2017, the Marketplace will notify an employer as soon as possible when one of its employee’s first enrolls in subsidized Marketplace coverage.  Since some employers may be liable for a penalty under the ACA’s employer mandate when an employee qualifies for a subsidized Marketplace coverage, this change to a more proactive notification process will hopefully provide employers with the opportunity to work with CMS in cases where an improper subsidy has been provided.

MARKETPLACE ANNUAL OPEN ENROLLMENT PERIOD:

Open Enrollment in the Health Insurance Marketplace, Healthcare.gov, for 2018 will take place from November 1, 2017 through January 31, 2018.

SMALL BUSINESS HEALTH OPTIONS (SHOP) EXCHANGE:

Beginning in 2017, small employers electing coverage in the SHOP Exchange will have the option of “vertical choice,” offering plans across all metal levels (platinum, gold, silver and bronze) from one insurer. States who opt out of the vertical choice option will continue to offer employers the choice of selecting health plans that are available at one single metal level of coverage.

Stay proactive and contact us today for a custmozied consult on how your organization can prepare  ahead  for ACA, Benefits, Payroll and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

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6 Changes to 2018 Individual Health Insurance Open Enrollment Period

6 Changes to 2018 Individual Health Insurance Open Enrollment Period

6 Changes to 2018 Individual Health Insurance Open Enrollment Period

HealthCare.com Offers Insight on 6  Changes to 2018 Individual Health Insurance Open Enrollment Period. The health insurance Open Enrollment Period for 2018 opens Nov 1st and now lasts only 45 days. HealthCare.com provides insight on the abbreviated timeline and other notable changes to watch out for.

2018 Individual Marketplace Guidance:

HHS released final 2018 Notice of Benefit. Contact us today at (855) 667-4621 or info@medicalsolutionscorp.com.


6 Changes to 2018 Individual Health Insurance Open Enrollment Period

MIAMI and NEW YORK, Oct. 27, 2017 /PRNewswire/ — Despite efforts from the federal government to reform the Affordable Care Act, the 2018 health insurance Open Enrollment Period – the time when Americans can change Obamacare health insurance plans or a join a new plan for the upcoming year – will still begin on November 1, 2017. But this has left most Americans confused about how this year’s open enrollment differs from the previous three.

2018 Individual Health Insurance Market Open Nov 1 - Dec 15

Unlike previous Open Enrollment Periods, which each occurred over a 90-day window, this year’s open enrollment will last just 45 days – starting on November 1 and lasting until December 15. The shortened timeframe means Americans will have less time to make decisions about their healthcare. While some U.S. states have extended the enrollment periodfor their individual state exchanges (notably, California and New York), most states will follow the condensed 45-day enrollment window.

There are several major changes to the open enrollment process in addition to the condensed 45-day enrollment window. It’s likely that many consumers will be caught off-guard, as these changes to open enrollment have not been well publicized. HealthCare.com cofounder and CEO, Howard Yeh, explains how these open enrollment changes may affect consumers and the coverage options available to them.

1. Changes to Re-Enrollment:

“In previous enrollment periods, people were provided with several government notices to compare their current plan with other healthcare plans on the Marketplace. This year, it’s unclear whether consumers will be provided those notices. That’s why it’s important to shop around for a different health insurance plan during open enrollment. If consumers don’t compare their plan options, they run the risk of being re-enrolled in the same plan. This is the case even after the enrollment period has already passed. If their current plan’s monthly premium is set to increase, they may get stuck with a plan that doesn’t fit their needs, or is otherwise unaffordable.”

2. The End of Subsidies Towards Cost-Sharing Reductions:

“The Trump administration has decided to stop financing cost-sharing reduction (CSR) subsidies to insurance companies. Most insurers predicted this in fact.  The prices for Silver plans (the only plans for which these cost-sharing reductions were made available). This means higher insurance premiums and out-of-pocket costs for some. This also means, though, that people in some areas of the country may encounter Gold and Platinum plans that cost just as much or even less than Silver plans.”

3. Fewer Insurers, Fewer Options:

“Several insurers have filled in the gaps left by the exit of major insurance companies like Aetna and Anthem from the Marketplace. While this ensures that consumers across the country have healthcare options available to them.  In reality, the options are significantly slimmer than those in previous years. In many areas of the country, only one ACA health plan option will be available to consumers. Most plans are costlier that may be prohibitive for many.”

4. Higher Costs Overall:

“Costs for ACA plans overall will be higher compared to previous years – with insurers charging, on average, 20% more on premiums. These costs have outpaced income growth. Leading to a unique affordability gap – where people make too much to qualify for Obamacare tax credits, but make too little to actually afford a Bronze plan. Under the law, those unable to afford a Bronze plan are exempt from paying the penalty for not having health insurance, “Marketplace affordability exemption”). This year, we expect more than 1.5 million people to qualify for that exemption – a significant increase from the 600,000 two years ago.”

5. Less Government Assistance:

“The federal government has also slashed funding for different initiatives intended to encourage and support people enrolling in Marketplace coverage. Notably, there will be less help available from ‘navigators’ and government spending on Obamacare outreach and advertising is now virtually nonexistent. This means it’s up to consumers to actively seek out help when signing up – and it’s up to nonprofit organizations and private companies to step up and make sure consumers get the information they need.”

6. Decrease in Participation Due to Rise of Alternatives to Traditional Health Insurance:

“Motivated by increasing costs and limited options, more consumers are moving towards alternatives to ACA health insurance. Relatively unknown healthcare options, like association plans and faith-based healthcare, are becoming more popular. And people may start using short-term health insurance plans – which typically serve as temporary coverage solutions. They may reult in full-time replacements to traditional coverage, especially due to the President’s executive order. The short term plans may now last up to a year (compared to the previous limit of three months).”

Approximately 20 million people will shop for health insurance during this Open Enrollment Period. HealthCare.gov a top destination for consumers looking to shop around for the best-priced plan on Marketplace health insuranc.  Additonaly, alternatives to ACA coverage (like short-term health insurance plans) are included.

RELATED LINKS: For important updates throughout open enrollment, follow us medicalsolutionscorp.com on Facebook, Twitter, or visit our call us  855-667-4621 for more customized information.

 

 

NYS 2018 Final Rates Approved

NYS 2018 Final Rates Approved

NYS 2018 Final Rates Approved   2018 NYS healthcare_costs_scrabble_1333568743

NYS has approved  2018 Final Rates last week. Small group rates will increase 9.3% while the individual rate average increase will be 13.9%.

As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2018 Rate Requests.  With only 3 months of mature claims, experience for 2017  health insurers’ requests are historically above average.  Ultimately the State reduces this request substantially. This year, however, NYS acknowledged that medical costs increased, citing a 7-percent average increase on the individual market and an 8.5-percent increase on the small group market. The administration also acknowledged drug prices have impacted insurers, pointing specifically to blockbuster drugs for Hepatitis C.

OTHER STATES

The national rate trend, however, has been much higher than in past years due to higher health care costs  Like other states throughout the nation, the 2017 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program.  The loss of the program’s a.k.a. federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.

How are neighboring States doing? In NJ, not that bad.  According to a review of filings made public last week the expected rate increase will likely be half.  Example: Horizon Blue Cross Blue Shield requested a 4.8% increase on their OMINA Plans.  For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases.

While the individual mandate is still the law, Washington has made it clear that they aren’t going to enforce the mandate. That means fewer people will buy health insurance raising the prices for those who do.

 A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.

Finally, a tax on health insurance premiums is due to be reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested last year.

SMALL GROUP MARKET VS.  INDIVIDUAL MARKET

The new premium hikes ranged from as little as .8% percent for Hudson Valley’s Crystal Run Health Insurance Company to a whopping 20.4% percent increase for  Albany region’s CDHP.  Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit.

Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see –  Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.

The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.

NYS 2018Health Insurance Rates Approved

* All amounts are rounded to the nearest 1/10.

**Indicates that the company makes products available on the “New York State of Health” marketplace.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

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NYS 2018 Rate Requests

NYS 2018 Rate Requests

NYS 2018 Rate Requests

Yesterday, NYS 2018 Rate Requests filings were released. The total weighted average increases were 11.5%  small groups and 16.6%  individual market.  This early filing request deadline request requirement is not an Obamacare requirement.  As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.

These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year. The news comes as insurance companies across the country brace consumers for another year of large rate hikes, owing in part to the composition of the individual market, and in part to the uncertainty over the future of the law under the Trump administration.

Background:

By comparison last year  NYS 2017 Rate Request early filings were higher at 12.3% small group and 19.3% for individuals.  The final filing rates were lower  NYS 2017 Final Rates were 8.3% small group and 16.6% for individuals.  The NYS 2016 Rates final rates were 9.8% small group and 17.1% for individuals.  Using these past figures one projects a 2018 Final Rates of 7% small groups and 14% individuals.

With only 3 months of mature claims in 2017 to work of off Insurance Actuaries have little experience to predict accurate projections. Simply put the less credible information presented to actuarial the higher the uncertainty and higher than the expected rate increase.  The national rate trend, however, has been much higher than in past years due to higher health care costs and the loss of Federal reinsurance fund known as risk reinsurance corridor.

Individuals:

NYS 2018 Filing Request for Individuals

Individual rates are expected to be higher than the small group market. The national rate trend, however, has been much higher than in past years due to higher health care costs  Like other states throughout the nation, the 2018 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program.  The loss of the program’s aka federal risk reinsurance corridor funds accounts for 5.5 percent of the rate increase.

This is one of the reasons why the individual market is significantly more costly to operate than the small group as per recent Aetna and United Healthcare pull out of most State Individual Exchanges.   Another local example was last year’s Oscar Health Insurance which had lost $105 million and is asking for up to 30% rate increase.  The 3-year-old company said the increase was necessary because medical costs have risen, government programs that helped cover costs are ending, and its members needed more care than expected.  For 2018, with successful pivotal changes, Oscar is asking below average 11% individual increase and a decrease of 3.2% small group next year.

Small Groups:

While small group rates are better risk and naturally lower rates.  There is some rate shock with notably Careconnect.  CareConnect, the financially struggling health insurance arm of Northwell Health, has asked the Cuomo administration to allow an average 30 percent premium hike on the individual market in 2018. The company, which lost $157 million in 2016, is asking for small group increases that range between 9 and 24 percent.NYS 2018 Rate Requests

THE THREE R – RISK CORRIDOR, RISK ADJUSTMENT & REINSURANCE designed to mitigate the adverse selection and risk selection. The problem, according to many insurance companies, is that the formula is flawed, and CareConnect executives have consistently complained that they are at an unfair disadvantage. The Cuomo administration has taken steps to ameliorate some of those problems, giving the DFS the authority to essentially overrule the federal numbers.  In its first-quarter financial report, executives made clear that the risk adjustment penalty was a threat to its business.

Defined Contribution Choice:

Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange.  This is a true defined contribution empowering employees with the choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as THE RISK OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.

You may view the NYS 2018 Rate Requests DFS press release, which includes a recap of the increases requested and approved by clicking here.

For a custom analysis detailing YOUR upcoming 2017-2018 renewal please contact our team at Millennium Medical Solutions Corp  (855)667-4621.  We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles.   We have Spanish, Russian, and Hebrew speakers available.  Quotes can also be viewed on our site.

Summary of 2018 Requested Rate Actions

INDIVIDUAL MARKET

Company Name 2018 Requested Rate Action
Affinity 23.5%
Care Connect 29.7%
CDPHP 15.2%
Crystal Run Health Plan, LLC 8.7%
Emblem (HIP) 24.9%
Empire ** N/A
Excellus 4.4%
Fidelis 8.5%
Healthfirst Insurance Company, Inc. 13.0%
Healthfirst PHSP, Inc. 22.1%
HealthNow New York 47.3%
IHBC 25.9%
MetroPlus 7.9%
MVP Health Plan 13.5%
Oscar 11.1%
UnitedHealthcare of New York Inc 38.5%
Total Weighted Average 16.6%

SMALL GROUP MARKET

Company Name 2018 Requested Rate Action
Aetna Life 14.2%
Care Connect 19.3%
CDPHP 21.1%
CDPHP UBI 8.6%
Crystal Run Health Insurance Company 0.0%
Crystal Run Health Plan, LLC 3.9%
Emblem (HIP) 8.5%
Empire Healthchoice Assurance 12.9%
Empire Healthchoice HMO 13.8%
Excellus 8.0%
Healthfirst Health Plan, Inc. 10.0%
Healthfirst Insurance Company, Inc. 10.0%
HealthNow New York 8.9%
IHBC 14.5%
MetroPlus 5.1%
MVP Health Plan 8.5%
MVP Health Services Corp 11.7%
Oscar -3.2%
Oxford Health Insurance Inc 11.4%
UnitedHealthcare Ins Company of New York 15.2%
Total Weighted Average 11.5%

*These averages may change based on DFS’s review of the rate applications.

** Empire submitted a filing that DFS is evaluating.

2017 Individual Open Enrollment

2017 Individual Open Enrollment

2017 Individual Open Enrollment

Everything you need to know ahead of tomorrow’s 2017 Individual Open Enrollment.  This Open Enrollment  marks the 4th anniversary of Obamacare a.ka. The Affordable Care Act.  As a helpful resource, the new NY and NJ rates with important deadlines are listed below.   33 States such as NJ use the healthcare.gov website or at https://medicalsolutionscorp.demo.hcinternal.net/individual/individual/homePage.  States such as NY and CT use their own Marketplace –  NYS of Health and AccessHealth CT.  Importantly,  individuals not expecting a subsidy may also apply Off-Exchange which in many case has  more options and Insurers.

2017 NY Individual Health Plans

2017 Individual Open EnrollmentThese rates are for New York City unless otherwise indicated, and for a single person. For a family premium, multiply by 2.85, Husband/Wife
multiply by 2.0 and Parent/Children multiply by 1.70.  The non single deductibles are  out of pocket maximums are doubled. These are for standard plans, which two-thirds of customers enrolled in during 2016.

While deductibles for platinum, gold and silver plans have stayed the same, many bronze plan deductibles have increased 33 percent. That means consumers who purchase a bronze plan — presumably for its lower monthly premium — are paying more out of pocket for their medical costs before their insurance company kicks in a dime. A family of four that purchased a bronze plan will have an $8,000 deductible in 2017, up from $6,000 in 2015. For someone young and relatively healthy, that might be OK, but that person is vulnerable to a very large bill if he or she needs expensive medical care. It’s the platinum plans where New York State really shows itself to be a national outlier. Roughly 18 percent of New Yorkers chose a platinum plan in 2016, compared to 2 percent across the nation, according to the Kaiser Family Foundation.

Here are the 2017 rates:

2017-nys-marketplace-rates-1

2017 NJ Individual Health Plans

NJ Dept of Banking and Insurance posted the 2017 NJ  individual health plans Monday. Only two carriers will offer plans on the state’s Obamacare marketplace next year: Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth.

Additional insurers are participating  off-exchange or outside the Marketplace.   Examples:  Aetna, CIGNA and Oxford.  There are additional 20 plan options available off exchange. A notable new entrant, Health Republic of NJ, will no longer be available for 2017.  See – Health Republic NJ Shutting Down.

Here are the 2017 rates:

2017-new-jersey-individual-health-benefits-plans-and-rates

 

Health Republic NJ Shutting Down

Health Republic NJ Shutting Down

Health Republic NJ Shutting Down

HRNJ Co-Op closing Down

Health Republic NJ Shutting Down

 

In yesterday’s surprise announcement, NJ regulators will be shutting down  Health republic NJ for 2017 “because of its hazardous financial condition”.  This marks the demise of the second Metro area healthcare co-op with the same name-sake Health Republic but different managed healthcare co-op, see Health Republic NY Shutting Down Nov 30.

Since Obamacare’s rollout in the fall of 2013, 16 co-ops that launched with money from the federal government have collapsed. Now, just six co-ops—Wisconsin’s Common Ground Healthcare Cooperative; Maryland’s Evergreen Health Cooperative; Maine Community Health Options; Massachusetts’ Minuteman Health; Montana Health Cooperative; and New Mexico Health Connections—remain.

In a bizarre twist of fate or unintended Affordable Care Act design flaw small affordable startups not only have to gain new client footholds but also support large Obamacare Failed Co-Opsestablished companies “with sicker patients”. Start-ups, by contrast, with much lower rate of diagnosed sick patients essentially pay into this tax. This tax is part of the risk adjustment program intended to stabilize Insurers who took on sicker patients and spread this risk.  While some correctly blame too low pricing and some miscalculated business decision-making the inherent extra tax doomed the majority of the original 16 co-ops.
Health Republic in fact grew steadily and made money the first 9 months of 2015.  However, HRNJ lost 17.6 million end of 2015 and is choking off at this $46.3 million payment to the government through the risk adjustment program.  This is considered one of the 3 R’s of the reinsurance program – risk corridor, reinsurance and risk adjustment that were intended to level the playing field. The first “R”—“reinsurance”—subsidizes insurers that attract individual customers who rack up particularly high medical bills. The second—“risk adjustment”—requires insurers with low-cost patients to make payments to plans that share the benefits with those who insured higher-cost ones. And the third, called “risk corridors,” is a program to subsidize health plans whose total medical expenses for all their Obamacare customers overshoot a target amount.
 The co-ops received less money than they initially anticipated last year under Obamacare’s risk corridor program, which resulted in the collapse of at least five co-ops and a $5 billion class action lawsuit filed by 6 state’s co-ops – ” Oregon-based insurer Moda Health Plan Inc., Blue Cross Blue Shield of North Carolina, Pittsburgh-based Highmark Inc., and the failed CoOportunity Health, which was based in West Des Moines, Iowa, and Health Republic Insurance Co. of Oregon, which was based in Lake Oswego.”

From Politico’s “Obamacare’s sinking safety net”:

 “The risk corridor program, however, has been an unmitigated debacle. In December 2014, the Republican Congress voted to prohibit the Obama administration from spending any money on the program, decrying it as a bailout for the insurance companies. Sen. Marco Rubio, then thought to be a leading GOP presidential contender for 2016, was particularly vocal in pillorying the program.

Unlike all those symbolic “repeal Obamacare” votes, Congress actually succeeded in blocking those risk corridor payments, and it hit Obamacare hard. Insurers filed claims seeking $2.9 billion, but under the limits imposed by the GOP there was less than $400 million available to make good on those payments. The end result: insurers initially received only 12.6 cents for each dollar they had counted on. Many of the new Obamacare co-op plans that went out of business blamed their collapse in part on the fact that they’d been counting on the full payments to keep them solvent.”

Regrettably, in a Presidential year no one wants to touch this burning hot potato. Perhaps NJ’s handling of this pressure cooker and taking 2017 off may be the best course of action after all.

 

9/16/16 Addendum:

As of Monday, September 19, 2016, the portal for Health Republic Insurance will be shut down, as they are no longer accepting new business for the year.

The New Jersey State Department of Banking and Insurance has also provided a list of FAQs related to the shutdown and how it affects individuals, small employers, brokers and providers. For more information, click here.

As always, our team is here to assist you and to help you grow your business.