Category Archives: Exchanges for Health Care

February 2015: The Good, Bad and Ugly of ObamaCare

GoodBadUglyHealthcareAs mentioned in previous blogs, the profession of providing health insurance for individuals changes monthly, sometimes weekly, and even daily! As of February 2015, here are the latest developments in ObamaCare and how it will impact people who have enrolled or are looking to enroll for coverage on the Federal Marketplace, healthcare.gov.

The “Good”
Anyone who hasn’t had health insurance coverage in 2014 and was assessed a tax penalty will have an opportunity to enroll between March 15 and April 30, as a “special enrollment” according to the Center for Medicare and Medicaid (CMS), the Federal agency that oversees the Federal Marketplace. Eligibility rules will apply, so please log on to www.healthcare.gov for more information.

The “Bad”
Last Friday, the Federal Government announced they sent out “incorrect” tax information to 800,000 people enrolled through the Federal Marketplace, namely the tax Form 1095-A.  In an effort to stave off incorrect tax filings, the Administration is contacting affected people by phone and email.  They are also advising consumers to log into their accounts on  to see if they were affected.  All corrected forms should be available by early March, officials said.

The “Ugly” 
According to the Associated Press, perhaps at least 50,000 of those affected have already filed their taxes!  The Government is promising to now work with those affected to correct the problem.

Stay tuned for more updates in the coming weeks as these issues start to unfold.

Healthcare Updates for January 2015: Renewals, Changes, Enrollments

HiResHappy New Year, and what a year it’s been!  Two open enrollments, lots of special enrollments, and a whole lot of “early renewals” to be done within about a 30-day window! I can’t believe that we actually were able to renew every single client from October 15 (open enrollment for our Medicare clients), to December 31.  A special thank you to all of our clients, for your patience during that time! It’s a new world in the health insurance industry. Gone is efficiency. We were overwhelmed with only 30-days to renew all of our individual clients, and now the insurance companies are in the midst of trying to enter (or renew) all of the business!  Please be patient with the carriers as they revise the billings and enrollment changes!

Last week, the Department of Health & Human Services released a report stating that 87% of those who enrolled (or re-enrolled) through www.healthcare.gov were qualified to be eligible for Federal subsidies.  Truth be told the only persons who should be enrolling through the federal website are those who are eligible for the tax credits. Otherwise, it’s a very cumbersome way to buy individual health insurance.  If a client is deemed to be over the 400% of the Federal Poverty Level, we help them enroll directly with the insurance carrier. No need to provide the Federal Government all of your income and household information unless necessary. Overall, there needs to be more consumer awareness of the Federal Poverty guidelines.

Considering the cumbersome tax forms that will now need to be filed (starting this month) if you do receive the Federal tax credits, what was thought of earlier this year as “free money” to help subsidize health insurance premiums, may cost more, because of the required tax filing. I consult with many clients who have been unaware that the tax credits actually are tax refund dollars that you can use today to “buy down” or lower the cost of your monthly health insurance premiums.

I think that this winter will prove a most interesting time, not only in our industry, but also in the tax world.  Remember, the Affordable Care Act was designed as “insurance” and “tax reform”.

PCORI Fees Go Up Again

The IRS will raise PCORI fees for plans Ending October 1, 2014

The Patient Centered Outcomes Research Institute (PCORI) fee has gone up from $2.00 for each enrolled individual to $2.08 for plans ending on or after October 1, 2014 and before October 1, 2015.

To view the report of increase from the IRS, click here

As in previous years, our local health insurance carriers will pay the PCORI fee on behalf of fully-insured group health plans. Some of our clients see the additional fees on their own statements, which means the additional fees are being passed on to them.

According to IRS notice 2014-56, sponsors of self-insured group health plans, including some HRAs and health FSAs, must complete the filing process themselves using IRS Form 720.

The PCORI fees are set to continue until 2019. For more information, visit the FAQ section of the IRS website.

If you have any questions about this fee notice or know of someone in need of Health Insurance, call us at 955-1040. We are here to help you navigate through the maze of health insurance complexities.

Rules and Regulations More Complex Than ACA Law

ACA and regulations“If you like your plan, you can keep it”…..well sort of!  Since the passage of the Affordable Care Act in 2010, there is one constant to be sure.  Anything can and will probably change, so stay tuned!

The initial law included 2,700 pages of language. Since it’s implementation, the rules and guidelines are at 35,000 pages and growing by the day.

Recent guidelines and mandates that have hit Wisconsin, through the Office of the Commissioner of Insurance (OCI), has been the interpretation of “keep your plan” option. Since March 2014, OCI has issued guidance to the insurance carriers in our region on “how to” actually abide this latest ruling.

Most group clients (and individual clients) chose to “renew” early (last December 2013) to keep their current plan(s) and bypass many of the new 2014 ACA-compliant mandates. There was speculation on what 2014 will bring for renewal options, and although many carriers were still working on the idea that not only could you renew early again 2014, but that you “might” have alternate plan design options (just like the old days) all still outside the ACA mandates. Not so, with the newest information coming out of HHS.  You will be able to renew your plan(s) as is, but not make any adjustments to what you have in place, without rolling into the new ACA-compliant plans.

My personal opinion is that we have to deal with what we know today, and it’s anyone’s best guess what the guidelines will be by this fall. This is a moving target folks. Don’t get worried until you have to (next renewal date).  We will always have options for you to consider. We have close relationships with all the carriers, their representatives, and the OCI.

So, on that note, relax this summer and enjoy all the other aspects of your business and life. The headaches with the ACA (and cold weather) will be here soon enough!

The “Expedia.com” of Healthcare is not Delivering

2012/04/12TraceyWe have been gearing up for over three years for October 1, 2013, with continuing education, on-line training modules, testing and certification, and broker summits/trainings in order to be prepared and ready to sell on the online Healthcare Exchange (www.healthcare.gov). With all the preparation and anticipation, here we sit today with no ability to sell on the Exchange, let alone quote or even view any plans!  Many of our individual clients in Wisconsin have been calling us, sharing their frustration, and we are no less frustrated as well.  Individuals in other states are penning articles about their experiences, just like Maggie Thurber for Ohio Watchdog.

We are taking healthcare reform one day and many times, one hour at a time, as we all continue to “navigate” through a new world of health insurance purchasing.  Our HIRSP clients have now received letters stating that their policies will be terminating December 31, and yet, here we are not able to help them fully.

Under these circumstances, here is my advice for health insurance seekers. If you (or your employees) are not eligible for the Federal subsidy (premium reduction) because of your household income, then there is no reason to remain frustrated with www.healthcare.gov. We can assist with quoting and enrollment directly with the insurance carriers, who are operating off of the Exchange.  And there are more options off the Exchange than on!  How’s that for more competition?

SHOP Exchanges For Small Businesses Hits a Snag!

Business person in a snag As we near the “opening day” of the Federally-Facilitated Health Care Marketplaces (Exchanges), yet another delay comes out of Washington.  The Small Business Health Options Plan (SHOP) that was scheduled to be functional the same day that the individual Marketplace is scheduled to open is now delayed. Surprised? I’m not in the least. And we still have four more days to the official opening of the on-line Marketplace that we have all been anxiously waiting for.  I wonder what else might happen in the next four days?

According to the Wall Street Journal, the Obama administration acknowledged for the first time yesterday (Thursday) that a “technical” problem is forcing them to delay the rollout of the SHOP, and that it will be unable to accept on-line enrollments/applications.  They go on to say that people close to the situation are also skeptical that the online marketplace for individuals will be ready.

My own experience in just trying to register on the Centers for Medicare and Medicad Services website/portal as a licensed agent and user of the Marketplace was a disaster and took more than one phone call. Therese in our office was told numerous times by numerous people (this after many phone calls) that I was in fact a minor and not eligible to be a user!  If just agent/agency registration was this cumbersome, what’s going to be next?

Model Notices for Health Care Reform: “Much Ado About Nothing?”

Shakespeare with computer.It’s another good day to “take a breath” in the world of Health Care reform, as we can now relax, knowing that employers are not going to be penalized for NOT distributing the Model Notices provided by the Department of Labor. Here is the proof of what I just shared, right on the Department of Labor’s (DOL) website.

The Department of Labor was quick to relay a few months ago that employers would be penalized if they did not adhere to the ACA guidelines of informing all employees (FT, PT and even seasonal) of the Federally-Facilitated Marketplace (aka Exchange) here in Wisconsin by October 1, 2013! Business owners were scrambling for find the right information to comply.

I wrote a blog update on August 16, relaying that although the notices were due October 1, I wasn’t in any big hurry to get clients too excited about complying, that there would indeed be plenty of time in late September to get these notices to their employees. My impetus for this was because of the other delays that we had already witnessed, namely the one year delay in the 50+ employee mandate of “play or pay”.

Interestingly enough, this update on the DOL website has very quietly been released with no fanfare no media frenzy or anything.  Do you wonder why?  I do, and I have a theory about it. However, at this point, I may keep the theory to myself and just watch this all unfold, as we count down the days to October 1st.  Does it ever feel like this is a case of deja vu?  Sounds like “Y2K” to me. No, the sky won’t fall, but I have to wonder what else may happen between now and October that we all might be thinking that it was “much ado about nothing.”

Wisconsin Insurance Commissioner Office Reviews Rates from Insurers in the Exchange

DollarsignupThe Wisconsin insurance commissioner’s office has reviewed the rates submitted to them by the 13 insurance companies participating in the Health Care Exchange. The analysis looked at the percent increase from pre to post January 1, 2014. Their published findings reviewed individual rates for a 21-year-old, 40-year-old and 63-year old, with a $2,000 deductible and prescription drug coverage. Eight major markets were reviewed for individuals of those ages, including Appleton.

Commissioner Ted Nickel said, “From our analysis, it appears premiums will increase for most consumers. And, while there is no question that some consumers will have subsidies and may not pay these higher rates, someone will pay for the increased premiums whether it is the consumer or the federal government.”

As we have stated to our clients, insurance companies are required to provide the same rate for individuals obtaining health insurance in or out of the Health Care Exchange. If you are concerned what a rate may be for you or someone you know, they can come to us for an individual insurance cost comparison. We do this every day to help people navigate through the maze of insurance decisions.

When Should A Business Send Employee Notices for ObamaCare?

With the Affordable Care Act (aka ObamaCare), businesses will be required to give all employees notification (no later than October 1, 2013), explaining their option to purchase health insurance (if they choose) through the Health Insurance Marketplace (aka Exchange) here in Wisconsin.

This notice provides employees basic information about the new Health Insurance Marketplace. We do have some clients here in Northeast Wisconsin working on these notices as I write this blog post. However, my personal opinion and concern with being efficient now and getting these notices out is this: What if the Federal Government delays the Exchanges at the eleventh hour?  What we have been witnessing over the past few months is any part of the Affordable Care Act can change and in many instances has changed.

My advice for business owners is to create a template for the notice to employees and wait to distribute them until we are sure that the Exchanges will be operational on October 1. For a small fee, we can help create those documents for clients who are interested.

Whatever we know about health insurance today is sure to change within the next three months. We all need to remain informed and try out best to stay calm while we prepare for the upcoming change!

One Health Insurance Plan? The First of Many ObamaCare Myths

My main purpose as a health insurance agent is to help individuals and business owners navigate through the complexities of health care plans. That’s why it is so concerning to me to hear how much confusion there is surrounding “ObamaCare”.

Several individuals I have met with, who are concerned about their individual rates going up, look at ObamaCare as a singular option for them (i.e. if I don’t take my current coverage, my second choice is ObamaCare). Their understanding is ObamaCare is a health plan choice. What they don’t realize is that there are regulations and mandates that all health plans will have to include as of January 1, 2014. There will be options both in the Exchange (Marketplace), as well as the private marketplace for the same cost.

Now that we have the first myth debunked (ObamaCare is one plan), let’s move forward in explaining which insurance companies in Northeast Wisconsin have selected to offer their health care plans in the (Federally Facilitated) Exchange.

The health care insurance companies in Northeast Wisconsin are:

  • Compcare Health Services Insurance Corporation (a division of Anthem Blue Cross/Blue Shield)

  • Prevea 360 (a division of Dean Health Plan, Inc.)

  • Arise Health Plan (parent company WPS Health Plan, Inc.)

Note: The State of Wisconsin Insurance Commissioner‘s office did not release rate information or coverage area details.

Do you know which of these three plans on the ObamaCare exchange are right for you? That’s where a licensed insurance agent (something I’m proud to be) will help you navigate through the complexities. Now how has ObamaCare made health insurance any easier for individuals?