Volume 2, Number 4
Individual and Family Health Insurance News
IN THIS ISSUE...

  • HOW HIGH WILL ACA PREMIUMS BE IN 2019?
  • WHAT’S THE STATUS OF SHORT-TERM INSURANCE PLANS?
  • BIPARTISAN GROUP OF SENATORS TO INTRODUCE LEGISLATION LIMITING SURPRISE MEDICAL BILLS
HOW HIGH WILL ACA PREMIUMS BE IN 2019?
Alison Kodjar reported in this article published in Health News From NPR on September 3 that health premiums for ACA plans will stabilize for 2019 and that consumers will be pleasantly surprised.

Final approvals from State Insurance Commissions (which in most cases must approve premium increases) have not yet occurred, but Florida Blue, for instance, estimates that their gross annual premium increase (excluding tax subsidies) will be 4% next year. They also estimate that rate increases from their largest competitors will be between 8 and 16%. This is considerably less than in any year since 2014 when ACA-qualified plans were first introduced.

Carriers are beginning to understand how they can make money by offering ACA plans, and new carriers (e.g. Oscar in Central Florida) are starting to enter the market. Centene (Ambetter) is also expanding coverage in some Central Florida locations. New and existing carriers are starting to offer coverage in other states next year, as well, as indicated in Kodjar’s article.

I personally had expected premiums to increase significantly more. The reason they didn’t in Florida was because the Insurance Commission required carriers to increase premiums over 30% last year in response to the Federal Government’s decision not to fund Cost Share Reduction plans.

Kodjar’s article contends that ACA premiums would actually have decreased next year had legislation not been passed to eliminate the tax penalty for not having an ACA plan.   (Actually the law still includes the tax penalty; the legislation passed to “eliminate” the penalty still contains the penalty but establishes the penalty as zero.)

Florida Blue will be the only carrier to offer PPO plans in Florida, and their “off-exchange” open enrollment will start October 1 and end December 31. 

“On-exchange” enrollment will begin November 1 and run only 45 days until December 15 for all carriers.

Renewing plans will be very easy for next year. Clients will be able to utilize a very simple passive renewal process in most cases. 

We recommend that individuals who have subsidies update their applications and take appropriate action if they haven’t filed their 2017 tax returns (they won’t be eligible for subsidies unless their return is filed early enough so the Marketplace can verify both tax filing status and income information and can provide applicants with their subsidy information in time for them to make plan elections prior to December 15). 

Similarly, individuals who didn't check the box on the application that permits the government to check with the IRS and other agencies for up to five previous years will need to update the box on the application that will permit such checking (or else these people won’t be eligible for subsidies). 

Others receiving subsidies should update their applications if they expect their income to change in 2019 or if there are any changes in family status.  
Applications should be updated prior to November 15 in order to prevent problems in establishing correct subsidies; call us at 561-734-3884 or 877-734-3884 for help in updating your marketplace application.
WHAT’S THE STATUS OF SHORT-TERM INSURANCE PLANS?
The restriction limiting short-term insurance plans to durations of three months was lifted in August with the stipulation that new short-term plans could be sold starting October 2 if requisite state approvals were obtained by then (state insurance commissions have the authority to regulate short-term plans and approve premium increases).

The State of Florida limits short-term plans to durations of 180 days (they do permit renewals, however), but insurers can get around these limitations by establishing Association plans, having those plans approved in other jurisdictions, and then filing as an Association plan in Florida. Rules and regulations differ between states.

At least three carriers have announced short- term plans that will permit coverage from between 360 and 364 days (maximum permitted under federal law) and will begin selling those plans in October. We haven't received specific details (e.g. effective dates, coverage specifics, etc.) as of the date of this newsletter, but we'll notify existing clients when we can determine what their coverage alternatives are. 

Short-term plans almost always have pre-existing condition limitations; generally do not offer maternity coverage;, provide no or limited preventive care and no prescription drug coverage (but some carriers provide prescription discount cards); and in most cases provide very limited (or no) office visit co pay coverage.

Short-term plans are an alternative for those who can’t afford to pay ACA premiums or who do not want ACA plans, but they are not for everyone. Premiums for these plans are lower than they are for ACA plans (unless the individual is highly subsidized). 

People with significant pre-existing condition limitations are not good candidates for these types of plans. Carriers are permitted to ask underwriting questions and in most cases can ask about health conditions. Even in cases where carriers can’t ask about health conditions, they can still refuse to pay for pre-existing conditions.

Most carriers who will be offering short-term plans will be somewhat conservative in their offerings for 2019 and will want to find out what their loss experience is before they consider liberalizing the coverage offered through these types of policies.
BIPARTISAN GROUP OF SENATORS TO INTRODUCE LEGISLATION LIMITING SURPRISE MEDICAL BILLS
A bipartisan group of senators is unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care.

The measure would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan.

The insurer, not the patient, would have to pay additional charges, which are limited under the proposal.

The draft legislation is being circulated for discussion purposes, and sponsors are not considering introducing legislation until early next year.

Read the entire article here.
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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