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Cadillac Tax Delayed Two Years

Cadillac Tax Delayed Two Years

Obamacare tax delayed

Cadillac Tax Delayed Two Years

We received the following communique from the Council of Insurance Agents & Brokers (CIAB)  a delay in the Cadillac Tax for two years as a result of the passage earlier today in the US Senate of the continuing resolution (CR) to fund government until February 8th

Implementation of the Cadillac Tax on health insurance plans will be delayed by two years, from 2020 to 2022, as part of a deal reached in Congress today to fund the government through February 8.

Repealing the Cadillac Tax is a top legislative priority for The Council and we’re pleased to see the two year delay included in this agreement. The agreement will also delay the medical device tax for two years and the health insurance tax for one year.

The Cadillac Tax imposes an annual 40 percent excise tax on plans with annual premiums exceeding $10,800 for individuals or $29,500 for a family. The Council strongly advocates for legislation that exclusively repeals the Cadillac Tax as championed by Senators Dean Heller (R-NV) and Martin Heinrich (D-NM), and Representatives Mike Kelly (R-PA) and Joe Courtney (D-CT).

The major hurdle to the effort continues to be the $87 billion cost associated with the bill, a figure with which The Council and our allies take issue. We will continue to work with our Congressional allies to see a full repeal of the tax.

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

On Dec. 20, Congress passed the Tax Cuts and Jobs Act, which makes significant changes to individual and corporate provisions of the U.S. tax code, including a reduction in the corporate tax rate to 21%, down from 35%, beginning in 2018. The bill includes permanent effective repeal of the Affordable Care Act (ACA) individual mandate, requiring individuals to purchase and maintain health coverage, by zeroing out the penalty beginning in 2019. For 2018, most individuals are still required to maintain coverage or pay a penalty when they file their 2018 federal income tax return.

The bill was negotiated by a conference committee comprised of representatives from both the Senate and House after each chamber passed their own versions of tax reform. The final bill was passed 51-48 by the Senate and 224-201 by the House before being sent to the President. President Trump is expected to sign the bill into law soon.

The bill also changes how certain tax thresholds will be indexed for inflation. Affected provisions, including the ACA “Cadillac” Tax (scheduled to take effect in 2020), will now be indexed to the Chained Consumer Price Index (CPI) instead of the regular CPI (the previous metric). That change makes it likely that more employer-sponsored plans would trigger the Cadillac tax sooner.

We will keep our clients advised of timely developments of the Tax Cuts and Jobs Act as it relates to employee beneifts. For now, though, it appears that the biggest impactsthe next couple years are likely to be with respect to the individual mandate repeal and the Cadillac Tax changes.

RESOURCE

 

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.

 

 

CareConnect Withdraws from NYS Market

CareConnect Withdraws from NYS Market

CareConnect Withdraws from NYS Market

CareConnect today has announced their intent to withdraw from the NYS 2018 market. The ACA Risk Adjustment Program was penalizing CareConnect again $100 Million for 2018 after a $112 million tax in 2017.

The problems CareConnect was facing were not new and was covered in last month blog. This problem has bipartisan recognition and Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program. While this tax or “risk adjustment penalty” was intended to increase competition it is blamed as the single largest bankruptcy cause for the 12 of 16  Obamacare Co-Ops such as the Health Republic of NY and for start-ups like Oscar and CareConnect.

The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as many claims data, and therefore their membership base looks healthier than it is. In a twisted way, the young companies in need of help were actually subsidizing mature Insurers with legacy data systems.

Who is CareConnect?

CareConnect is a physician/hospital-owned Insurer by Northwell Health also formerly known as North SHore LIJ.  Careconnect manages the health of 400,000 individuals, including 125,000 customers.  Outside of the risk adjustment penalty the Insurer was managing population health and would have posted a profit.  Their past rate increases were single digits.

Sadly, this is a tremendous consumer market hit.  Their growth was predicated on delivering excellence of care while still mindful of consumer affordability, see chart below.  Not only were they on average 20-30% less expensive but their benefits were typically enhanced.  Example:  A Tradition Gold plan member would NOT have a deductible nor coinsurance for surgeries and hospital stays at a time when all competing Gold plans did.

Regrettably, no State appeal has been victorious as of yet.  With logger-head federal conflicts in Government today on repairing Obamacare flaws the victims will once again be the middle-class consumer.

See Press release:

https://www.northwell.edu/about/news/press-releases/while-preserving-its-population-health-commitment-northwell-withdraw-careconnect-nys-insurance-market

CareConnect Leaving NY Market 2018CareConnect Individual rates

Next Step:

Please sign up for the Sept 13th webinar below on CareConnect Exit & Next Steps for Your Group.

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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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Breaking: House Passes Obamacare Repeal & Replace

Breaking: House Passes Obamacare Repeal & Replace

Breaking: House Passes Obamacare Repeal & ReplaceBreaking: House Passes Obamacare Repeal & Replace

In a first step toward repealing and replacing Obamacare ie. Affordable Care Act (ACA), the  House of Representatives narrowly passed the American Health Care Act (AHCA) today by a vote 217-213. Every House Democrat and 20 House Republicans opposed the measure. The bill will now be sent to the U.S. Senate. Until this legislation is passed by the U.S. Senate and signed into law by President Trump, all existing ACA requirements remain in effect, including penalties for noncompliance.
Notable Provisions of the American Health Care Act
If signed into law, the American Health Care Act would, among other changes, make the following revisions to key features of the ACA over the next three years:

SIMILARITIES

  •  Pre-Exissting Conditions Covered: Under the Affordable Care Act, insurance companies are required to cover pre-existing conditions. This is still the case under the AHCA, but the creation of High Risk Pools, funded with $8 billion dollars was an added amendment to the AHCA.  Pools provide coverage if you have been locked out of the individual insurance market because of a pre-existing condition, and are subsidized by a state government. The premium is up to twice as much as individual coverage. Individuals who have a lapse in coverage of more than 63 days will be required to pay a 30 percent premium surcharge for 12 months when coverage is purchased.
  • Adult Coverage to Age 26 Covered: People who are under 26 years old can stay on their parents’ health insurance plan under both the ACA and the AHCA.
  • No Lifetime Cap: People who are under 26 years old can stay on their parents’ health insurance plan under both the ACA and the AHCA.

CHANGES

  • “Pay or Play”: Penalties for noncompliance with the “pay or play” coverage requirement (which mandates, in general, that employers with 50+  FT
    GOP Repeal & replace Provisions

    Click Image

     employees [including full-time equivalent employees] must offer affordable, minimum value coverage to their full-time employees, or pay a penalty tax) are zeroed outHowever, the Form 1094 & 1095 reporting requirements are unchanged by the bill.

  •  Individual Mandate: Penalties for noncompliance with the individual mandate are zeroed out, effectively repealing the mandate. In its place, the bill requires issuers in the individual or small group markets to impose a 30% penalty on the health insurance premiums of individuals who do not maintain continuous health insurance coverage.
  • Essential Health Benefits:   AHCA eliminates the requirement for Essential Health Benefits. The AHCA allows limited policies that are only in case of major illness or injury.
  •  HSA Contribution Limits: Limits on contributions to health savings accounts (HSAs) are increased to equal the inflation-adjusted annual out-of-pocket expenses limitation imposed on high deductible health plans (currently $6,550 (self-only coverage)/$13,100 (family coverage)).
  •   Health FSA Contribution Limits: Limits on contributions to health flexible spending arrangements (health FSAs) are eliminated.
  •  Tax Credits for Individual Coverage: Replaces the ACA’s premium tax credits for individual market coverage with advanceable, refundable tax credits adjusted for both age and income.
  •  Market Reforms: Permits states to seek waivers from the ACA’s essential health benefits and age and health status community rating requirements.
  • Medicaid: Allows states to elect to receive federal Medicaid funding via a block grant or per capita allotment, and alters the ACA’s Medicaid expansion.

The chart below summarizes some of the significant changes made by the AHCA.

Affordable Care Act (ACA)

American Health Care Act (AHCA)

Mandates

  • Individual mandate
  • Employer mandate on applicable large employers (ALEs)
  • No individual or employer mandate effective retroactive to Jan. 1, 2016
  • Insurers can impose a one year 30% surcharge on consumers with a lapse in continuous coverage (individual and small group market)

Assistance

  • Income-based subsidies for premiums that limit after-subsidy cost to a percent of income
  • Cost sharing reductions for out-of-pocket expenses
  • Age-based refundable tax credits for premiums, phased out for higher incomes
  • No cost sharing reductions for out-of-pocket expenses
  • ACA subsidies phased out after 2019; AHCA credits effective in 2020

Medicaid

  • Matching federal funds to states for anyone who qualifies
  • Expanded eligibility to 138% of poverty level income
  • Federal funds granted to states based on a capped, per-capita basis starting in 2020
  • States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons

Premium Age Differences

  • 3:1
  • 5:1 (and the MacArthur amendment would allow a higher ratio)

Health Savings Account Limits

  • $3,400/$6,750
  • Contribution limits increased to maximum out-of-pocket limit for HDHP coverage
  • $6,550/$13,100 (effective retroactively to Jan. 1, 2017)

“Cadillac” Tax

  • Cadillac tax on high-cost employer plans implemented in 2020
  •  Cadillac tax on high-cost employer plans delayed until 2026

Other Taxes

  • 3.8% tax on net investment income
  • Limit placed on contributions to flexible spending accounts
  • Annual health insurance provider tax
  • Over-the-counter medication excluded as qualified medical expense
  • 0.9% Medicare tax on individuals with an income higher than $200,000 or families with an income higher than $250,000
  • Repeal of these taxes retroactive to the beginning of 2017 (except for the repeal of the Medicare tax, which would begin in 2023)

Essential Health Benefits

  • Individual and small group plans are required to offer ten essential health benefits
  • Under the MacArthur amendment, individual and small group plans are required to offer the ten essential health benefits, but a waiver option is available
  • Some Medicaid plans are not required to offer mental health and substance abuse benefits

MacArthur Amendment

The following chart summarizes the changes made to the AHCA by the MacArthur amendment.

Insurance Market Provisions

The MacArthur amendment:

  • Reinstates Essential Health Benefits (EHB) as the federal standard (removes ability of states to define EHBs, but see waiver option)
  • Maintains the following provisions of the AHCA:
    • Prohibition on preexisting condition exclusions
    • Prohibition on discrimination based on gender
    • Guaranteed availability and renewability of coverage
    • Coverage of adult children to age 26
    • Community Rating rules (but see waiver option)
Limited Waiver Option States may obtain waivers from certain federal standards, in the interest of lowering premiums and expanding the number of enrollees. States could seek waivers from:

  • Essential Health Benefits (states could set their own definition of EHBs for the individual and small group markets starting in 2020, and increase the age rating ratio above 5:1 starting in 2018)
  • Community rating rules, except for the following categories, which are not waivable:
    • Gender
    • Health Status (unless the state has established a high-risk pool or is participating in a federal high risk pool)
Limited Waiver Requirements States must explain how the waiver will benefit the insurance market in their state, such as reducing average premiums, increasing enrollment, stabilizing premiums for individuals with pre-existing conditions, or increasing the choice of health plans.,Applications are automatically approved within 60 days unless denied by HHS.

 

As always, please contact us info@medicalsolutiosncorp.com for a compliance review of your benefits offering. Click here to read the American Health Care Act in its entirety.