Volume 2, Number 5
Individual and Family Health Insurance News

Open enrollment begins today and runs through December 15 for a 1/1/19 effective date. 

During open enrollment an individual can purchase any ACA plan that’s available to him or her on or off the Health Insurance Marketplace and does not need to show proof of having a qualified life event (e.g . marriage, birth or adoption of a child, moving between counties or states, etc.)

However, individuals applying for subsidies may have to submit proof of income (they'll have 90 days to do this) or proof of immigration status or citizenship (they"ll have 95 days to do this). (This process is called “resolution of data matching errors.”) 

Coverage is effective as of 1/1/19 provided any required binder payment is paid by then. Failure to make a required binder payment by this date (note: some carriers may announce an extension of this date) will result in loss of coverage, and failure to resolve a data matching error by the time period indicated results either in loss of coverage or loss of the advance premium payment tax credit.

Last month I included information in the newsletter about average rate increases for next year. I mentioned that Florida Blue has increased premiums an average of 4%. While these increases are considerably less than those in prior years, note that these are averages:  some premiums have gone down and some, depending on the plan, have gone up as high as 15%. 

I hope to be in contact with all clients who have ACA plans before the second week of November but will certainly be in touch with ALL ACA clients well in advance of the time they need to make a decision and enroll in a plan for 2019. 

Those who have Florida Blue plans will have a simple process for renewing for 2019. A significant number of my clients have already renewed their plans for 2019. 

New rules have been published concerning the availability and maximum length of coverage for short-term health insurance policies. I’ll be in contact before December 8 with all clients who have short-term policies expiring in late December or early next year. This will give them an opportunity to enroll in an ACA policy before December 15 or elect either a short-term health policy, an insured limited benefits policy, or a medical cost sharing plan.

The tax penalty for not having a plan that meets ACA requirements will be eliminated effective January 1, 2019. 

You’ll probably be receiving mailings about new product offerings and receive calls from agents about these products. Please be very careful in evaluating the suitability of these products for your situation and make sure any insurance products you consider are offered by an insurance carrier admitted to do business in your state. 

While the vast majority of agents follow the rules and research the products they offer, unfortunately there are a number of unscrupulous agents selling these types of policies/coverages. Virtually all of these new products have pre-existing limitation provisions, but these provisions vary between products and carriers. If you’re approached by an agent to buy one of these policies, make sure the carrier you're considering is admitted to do business in your state, and carefully evaluate whether or not the proposed product meets your specific requirements.

Call us at 877-734-3884 for help in evaluating any proposals you receive regarding one of these products.
It’s official: The 2019 cost of living adjustment for Social Security will be 2.8%, according to the Social Security Administration.

The increase is the largest since 2012, when the COLA was 3.6%, and it tops the 2018 2% level. The average Social Security beneficiary collecting $1,404 a month will receive an additional $39 starting in January, as a result of the 2.8% increase.

The COLA is based on the change in the Consumer Price Index (CPI) for Urban Wage Earners and Clerical Workers, known as CPI-W, between the third quarter of 2017 and the third quarter of 2019.

In addition to the 2019 COLA, the SSA announced that the maximum earnings amount subject to the Social Security tax in 2019 will be $132,900. That’s 3.5% higher than the $128,400 maximum for 2018 and is based on the increase in average wages, according to the SSA.

See this article that explains the growing gap in Social Security benefits between high and lower-income beneficiaries.
Jerry Fedele, the CEO of Boca Regional hospital, announced his retirement last year (for an effective date this summer), and as his last major act he was asked to evaluate and guide the merger of Boca Regional Hospital with a major health system.

After extensive evaluations, Boca Regional first identified five potential partners (four from in-state and one from North Carolina) and selected Baptist Health System in Kendall and Cleveland Clinic as the two finalists. 

Baptist has very high client satisfaction scores and was deemed to be the better cultural fit and, accordingly, Boca Regional has decided to merge with Baptist effective January 1, 2019.

This merger will affect the hospital landscape in southern Palm Beach County. Bethesda East and West previously merged with Baptist, and already two prominent members of Delray Hospital’s cardiology unit have left to join Boca Regional’s unit. 

High customer satisfaction ratings affect HEDIS ratings and have impact on staffing and the kind of services hospitals provide.  Look for changes in the services and quality of the four hospitals—Delray Medical, West Boca Community, Bethesda, and Boca Regional—in South County.

The merger won’t affect current hospital contracts with carriers. However, Baptist hospitals (particularly Baptist Hospital in Kendall) have been tough negotiators, and the Kendall Baptist Hospital has not contracted with a number of major carriers. 

If this happens in Palm Beach County, this will affect what hospitals are covered in specific ACA and Medicare Advantage plans in the future.

Baptist is attempting to expand its footprint. Now that the Boca Regional situation is resolved, it’s been reported that Baptist is also negotiating possible mergers with hospitals in both Martin and St. Lucie counties.
About Paul Cholak
Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

We guide you through the steps of getting health and life insurance, and remain available to help you AFTER you've made your purchase decision.
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