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NYS DFS 2024 Rates Approved

NYS DFS 2024 Rates Approved

Earlier today, the long-awaited NYS Dept of Financial Services approved 2024 health insurance rate requests. And it was worth it with small groups stabilized.  Small group rates increased by 7.4% and  12.4% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers. Despite only 3 months of mature claims data experience for 2023  health insurers’ original requests were noticeably above the average of 22%/individuals and 15.3% for small groups.

State Department of Financial Services officials asserted the rising cost of medical care — including in-patient hospital stays and rapid increases in drug prices — continued to be the main driver of health insurance premium increases. The final approved rates for 2024 would keep health insurers’ profit provisions at 1%, state officials added, noting they sought to limit those returns in light of ongoing inflationary pressures harming consumers. That said, in anticipation of spikes in claims submissions + overall inflation, a larger-than-average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial well-being of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ healthcare costs and the economy, held insurers’ profit provisions to a low 1%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 4.7% rate increase approval for next year. This is a sharp reduction from the original 15.5% request in part to disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

Small Group Market   

Almost 800,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 15.3% in the small group market, which DFS cut by 52% to 7.4% for 2024, saving small businesses $607 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

DFS SMALL GROUP MARKET RATE ACTIONS   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Indicates the Company will offer products on the NY State of Health Marketplace in 2024.

PEO Alternatives to Small Group

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEOs are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make a difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

 

 

 

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2021 Medicare Parts A & B Increase

2021 Medicare Parts A & B Increase

Medicare Part B premiums will increase by about 2.7% or $4 per month next year and high-income surcharges will also rise modestly in 2021, the Centers for Medicare and Medicaid Services announced last week.The wealthiest senior couples will be paying more than $12,000 a year in Medicare Part B premiums. Part B (the base and the surcharge) covers doctors’ and outpatient services.Medicare Part B Income-Related Monthly Adjustment Amounts.

Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly 7 percent of people with Medicare Part B. The 2021 Part B total premiums for high-income beneficiaries are shown in the following table:

Beneficiaries who file

individual tax returns with income:

Beneficiaries who file

joint tax returns with income:

Income-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $88,000Less than or equal to $176,000$0.00$148.50
Greater than $88,000 and less than or equal to $111,000Greater than $176,000 and less than or equal to $222,00059.40207.90
Greater than $111,000 and less than or equal to $138,000Greater than $222,000 and less than or equal to $276,000148.50297.00
Greater than  $138,000 and less than or equal to $165,000Greater than $276,000 and less than or equal to $330,000237.60386.10
Greater than $165,000 and less than $500,000Greater than $330,000 and less than $750,000326.70475.20
Greater than or equal to $500,000Greater than or equal to $750,000356.40504.90

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses:Income-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $88,000$0.00$148.50
Greater than $88,000 and less than $412,000326.70475.20
Greater than or equal to $412,000356.40504.90


Medicare Part B Premiums/Deductibles

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  

The standard monthly premium for Medicare Part B enrollees will be $148.50 in 2021, an increase of $3.90 from $144.60 in 2020. Recent legislation signed by President Trump significantly dampens the 2021 Medicare Part B premium increase that would have occurred given the estimated growth in Medicare spending next year. Medicare spending is estimated to grow due to people seeking care they may have delayed during the COVID-19 public health emergency, availability of more COVID-19 treatments, and availability of COVID-19 vaccines (for which CMS recently announced that there would be no out-of-pocket costs for seniors).

CMS also announced that the annual deductible for Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from $198 in 2020.

Medicare Part A Premiums/Deductibles

Part A Deductible and Coinsurance Amounts 
20202021
Inpatient hospital deductible$14081484
Daily coinsurance for 61st-90th Day$352$371
Daily coinsurance for lifetime reserve days$704$742
Skilled Nursing Facility coinsurance$176$185.50

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,484 in 2021, an increase of $76 from $1,408 in 2020.

Medicare Open Enrollment

Medicare beneficiaries can choose to enroll in fee-for-service Original Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans (Medicare Part D) are already finalized and are unaffected by this announcement.

During the ongoing Medicare Open Enrollment – which began on October 15, 2020 and ends December 7, 2020, more than 60 million Medicare beneficiaries can compare coverage options like Original Medicare (Part A and Part B) and Medicare Advantage, and choose health and prescription drug plans for 2021. Medicare health and drug plan costs and covered benefits can change from year-to-year. CMS urges Medicare beneficiaries to review their coverage choices and decide on the options that best meet their health needs. Over the past three years, CMS has made it easier for seniors to compare and enroll in Medicare coverage. The redesigned Medicare Plan Finder makes it easier for beneficiaries to:

  • Compare pricing between Original Medicare, Medicare Advantage plans, Medicare prescription drug plans (Medicare Part D), and Medicare Supplemental Insurance (Medigap) policies;
  • Compare coverage options on their smartphones and tablets;
  • Compare up to three Medicare Part D drug plans or three Medicare Advantage plans side-by-side;
  • Get plan costs and benefits, including which Medicare Advantage plans offer extra benefits;
  • Build a personal drug list and find Medicare Part D prescription drug coverage that best meets their needs.

Highlights for 2021 Open Enrollment include:

  • A 34 percent decrease in average monthly premiums for Medicare Advantage plans since 2017. This is the lowest average monthly premium since 2007. Beneficiaries in some states, including Alabama, Nevada, Michigan, and Kentucky, will see decreases of over 50 percent in average Medicare Advantage premiums.
  • More than 4,800 Medicare Advantage plans are offered for 2021, compared to about 2,700 in 2017. Similarly, more Medicare Part D plans are available, and the average basic Part D premium has dropped 12 percent since 2017. 
  • Medicare beneficiaries can join a prescription drug plan that will offer many types of insulin at a maximum copayment of $35 for a 30-day supply. More than 1,600 Medicare Advantage and Part D prescription drug plans are participating in the Part D Senior Savings Model for 2021. People who enroll in a participating plan could save up to an

An estimated $446 a year in out-of-pocket costs on insulin. CMS has added a new “Insulin Savings” filter on Medicare Plan Finder to display plans that will offer the capped out-of-pocket costs for insulin. Beneficiaries can use the Medicare Plan Finder to view plan options and look for a participating plan in their area that covers their insulin at no more than a $35 monthly copay.

Part D Premium Decrease

CMS announced in July that the average basic premium for Part D, private health plans which cover prescription drugs, is $30.50 for 2021, down 12% from 2017. 

More Info

Already 65+? Good news, #Medicare Plan F still available. There is still 1 month left before Dec 7th Open Enrollment deadline. With the new 2021 open enrollment changes, it’s time to get the facts. Considering making changes to your coverage this fall or just want to learn more about this enrollment period? Schedule a 1-on-1 and get in touch now, more info.   

 

Plan Comparison Tool

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Learn more about your Medicare options please contact us at info@medicalsolutionscorp.com or (855)667-4621.

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NYS 2021 Final Rates Approved    

NYS 2021 Final Rates Approved    

NYS has approved 2021 health insurance rate requests yesterday. Small group rates increase 4.2% and 1.8% for individuals.

  1. As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2021 Rate Requests.  Despite only 3 months of mature claims data experience for 2020  health insurers’ original requests were noticeably below average.  Ultimately NYS reduced this request substantially by approximately 63%.

The 2021 small group rate increase was the second-lowest ever approved at 4.2% vs  2020’s approval of  7.9%. This reflects a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide.

Rate Factors

The state noted that the premiums increase main driver are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”

More than one million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of  11.4% in the small group market.  DFS cut the weighted average requested rate increases by 63% for 2020, saving small businesses over $565 million.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small businesses, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained.

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example. Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

Small-Group Market

Final Small Groupo Rates NYS 2021

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

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP.

NYS 2021 Rate Requests

NYS 2021 Rate Requests

The NYS 2021 Rate Requests filings were released today.  The total weighted average increase request was 11.4% for  Small Group Market with some citing Coronavirus as necessitating higher premiums next year.That figure is heavily influenced by the request of UnitedHealthcare’s Oxford, which has recently controlled about half the market and requested an 13.6% increase.  The total weighted Indiv market request is an 11.7%.

Background:

Health Insurers have been meeting the COVID-19 challenge by paying 100% for diagnosis and treatments at no cost to the consumers. Additionally, health insurers have been advancing cash payments to hospitals while also absorbing sustained premium losses. 

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.

A spokeswoman for the state Health Plan Association said insurers have worked to control costs, which have been driven up by rising prescription drug prices and state mandates that require coverage of certain services.

In the small-group market, national insurers such as UnitedHealthcare’s Oxford and Empire Blue Cross have requested 13.8% and 16.6% rate hikes. Recent start-up, Oscar Health has requested a 29.1% increase. Disappointingly, the google-backed health insurer has been a leader in health technology and had supposedly righted the ship with new plan designs.

Fortunately, the localized hospital-owned network such as Healthfirst has requested a modest 5.5% increase. This is consistent with last years 4.7% increase and their inflation busting average of 5% last 3 years. Similarly, the Fishkill-based, MVP Healthcare, is asking for only a 4.1% hike which is even lower than their 7% for 2020. MVP has averaged a stable 6% increase last three years. 

Conclusion

Final rate approval are expected in early August. The past rate reductions averaged 10-50% savings. Last year, plans asked for an average increase of 9.2% and NYS 2020 Final Rates Approved at a 7.9% increase. 

Defined Contribution Choice:  Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange or a PEO.  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.

To be clear: These trends affect a small subset of the insurance market—non-group plans that cover less than 2 percent of the population. Many qualify for tax credits that lower their net costs and reduce or eliminate the impact of year-to-year rate increases.However, non-group customers with incomes above 400% of the poverty level ($48,560 for a single adult) get no subsidy—and feel the full brunt of any hikes.

Resource

  • For a custom analysis detailing YOUR upcoming 2019-2020 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.  
  •  See Health Reform Resource

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 2020 Final Rates Approved    

NYS 2020 Final Rates Approved    

NYS has approved 2020 health inusrance rate requests today.   Small group rates increase 7.9% and 6.8 8.6% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2020 Rate Requests.  Despite only 3 months of mature claims data experience for 2019  health insurers’ original requests were noticeably below average.  Ultimately NYS reduced this request substantially by approximately 55%.

The 2020 small group rate increase was in line at 7.9% vs  2019’s approval of  7.5%. This reflect a stabilizing ACA market. Insurers’ financial performance improved nationwide last year to its highest level since the passage of the law. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. That led to plans paying $800 million in rebates for failing to meet requirements on medical spending, according to the Kaiser Family Foundation

Rate Factors

The state noted that premiums increases  main driver are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”

More than one million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of 12.2% in the small group market.  DFS cut the weighted average requested rate increases by 4.3 percentage points, or 35%, from 12.2% to 7.9% for 2020, saving small businesses over $313 million. The federal ACA Health Insurance Tax, which was reimposed for 2020, accounts for approximately 3% of these rates.  Without this tax, the increase would have been 4.7%. A number of small businesses will also be eligible for tax credits that may lower those premium costs even further.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small business, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained. 

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example.Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

Small Group Market

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

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

HRA Final Rules

HRA Final Rules

On June 13, 2019, the Departments of Labor, Health & Human Services and Treasury released final rules concerning Health Reimbursement Arrangements (HRAs).  The 497-page rule includes the creation of two new types of HRAs, the “Individual Coverage HRA” and the “Excepted Benefit HRA.” 

Advantages of the Individual Coverage HRA

  • Funds can be used to reimburse the employee’s premiums for an individual health insurance policy.
  • Reimbursements made to employees do not count towards the employee’s taxable wages.
  • The employer can choose to roll-over unused amounts into the following year.
  • Coverage can be offered to different classes of employees (e.g.; full-time, part-time, seasonal, salaried, hourly)
  • An offer of the Individual Coverage HRA represents an “offer of coverage” under the employer mandate, however, contributions must meet affordability guidelines. The IRS will release further guidelines regarding this later.

Individual HRA restrictions: 

  • An offer of an Individual Coverage HRA cannot be made to any employee that is offered a traditional group health plan.
  • If an offer of coverage is made to a class of employees, there is a minimum class size that is required. Size is typically 10% of that specific class of employees. For example, if an employer has 200 employees, a minimum of 20 employees would have to be in a specified class.
  • Contributions can be in any amount that the employer chooses, but contributions must be consistent for all employees in a specified class.
  • The employer must provide notice of the Individual Coverage HRA to employees.
  • The employer must be able to substantiate that the employee is enrolled in an individual plan or Medicare (model notices are available).
  • The employer must notify employees on an annual basis that the individual health insurance is NOT subject to ERISA.

The final rule also created the “Excepted Benefit HRA” which, starting in January of 2020, will permit employers to finance additional medical care. Employees can use the HRA without having to be enrolled in the group’s traditional health plan. 

“Excepted Benefit HRA” include:

  • The annual contribution is capped at $1,800.
  • It must be offered in conjunction with a group health plan, but there is no requirement for the employee to enroll in that plan.
  • The “Excepted Benefit HRA” cannot be used to fund group health or Medicare premiums.
  • It can fund premiums for dental, vision, or short-term limited duration insurance.

Effective Date:

Employers who want to offer the “Individual Coverage HRA” for January 1, 2020, can do so but employees will need to enroll in an individual plan during the 2019 open enrollment period (November 1, 2019 – December 15, 2019). 

If you have any questions or would like additional information, please contact us at 855-667-4621 or info@medicalsolutionscorp.com.

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