Well, as an insurance agent I know we need reform and it would be nice to have a lot, many in the industry agree, but a year later here are some of the highlights of what has happened from cause and effect.

1. Medicare beneficiaries who hit the prescription drug coverage gap known as the “doughnut hole” received a one-time $250 tax-free rebate last year, according the U.S. Department of Health and Human Services. Seniors who hit the doughnut hole this year will receive a 50 percent discount on all brand-name drugs. Starting this year, annual wellness exams for Medicare recipients are covered free of charge. In addition, the law provides financial assistance for employers to maintain health coverage for early retirees who are not yet eligible for Medicare.
2. Under the law, insurance companies can no longer deny health insurance to children because they have a pre-existing medical condition and young adults who do not have employer-sponsored health coverage can also stay on their parents’ insurance plan until they’re 26.
   1. unfortunately it has caused rates to go up and child only or 18 and younger policies to go away.  So if you are divorced and need to insure a child you may be out of luck or you may have to use the ChiPs Medicaid program from the government, which already existed and certainly was not the intended purpose of the new law.
3. States were required to set up temporary high-risk insurance pools for people who can’t get affordable coverage because of a pre-existing condition.
   1. We had pools before and affordable is not the terminology anyone would use to describe them, although they could be an option!
4. And finally most everything else is supposed to happen in 2014…

Reference Chicago Sun Times Article and Marketplace

What is the Medicare Advantage Disenrollment Period that ends on February 14, 2011, you ask?!

Answer: if you have a Medicare Advantage Plan that isn’t working for you, you can use this period to switch back to Original Medicare.

How do you disenroll?

Answer: two ways to switch from your Medicare Advantage Plan to Original Medicare:

you can contact your Medicare Advantage Plan and disenroll that way.

Or, if your Medicare Advantage Plan included drug coverage, you can simply choose and join a Medicare Prescription Drug Plan. You’ll automatically be disenrolled from your Medicare Advantage Plan, and your health coverage will switch to Original Medicare.

This might be a good time to review what Medicare Covers and What Medicare Costs too Click Here

IRS 2011 changes to the employer contribution requirements (uniform percentage issue). According to the IRS current ‘final’ guidance, they were concerned with different percentage contributions between employees. Therefore, as long as the employee contribution percentage is consistent between employees, employers are not obligated to contribute to the dependents costs in order to qualify for the tax credit.

So therefore you can’t incentivize one employee and still get your tax credit!  Really?!  Well that is the rule and you will have to incentivize them some other way, because that tax credit is a great deal if you are a small business!

This applies to alot of insurance types, contact us to find out how you can save and incentivize your employees too!

The purpose of the grandfather regulation is to help people keep existing health plans that are working for them. Under the old rule this was maybe intended, but not being allowed if you changed insurance company’s for the same plan.

This amendment furthers that goal by allowing employers to offer the same level of coverage through a new issuer and remain grandfathered, as long as the change in issuer does not result in significant cost increases, a reduction in benefits, or other changes described in the original grandfather rule.

Here is the release today in the federal register click here

Here is the release from yesterday

The intent of the Patient Protection and Affordable Care Act (PPACA) was to get more people covered and drive down health care costs.  According to Texas officials and an article in the NY Times the PPACA may already be doing just the opposite in addition to the increased costs and reduced benefits already being seen by consumers on individual and company health plans right now.

TEXAS: Several Republican lawmakers are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program. The Heritage Foundation, a conservative think tank, estimates Texas could save $60 billion between 2013 and 2019 by opting out of Medicaid and the Children’s Health Insurance Program, dropping coverage for acute care but continuing to fund long-term care services. With 3.6 million children, people with disabilities and impoverished Texans enrolled in Medicaid and CHIP, the Texas Health and Human Services Commission will release its own study on the effect of ending the state’s participation in the federal match program.

Currently, the Texas program costs $40 billion per biennium, with the federal government footing 60 percent of the bill. As a result of federal health care reform, millions of additional Texans will become eligible for Medicaid as the government plan expands the number of people eligible for the plan over the next few years coming to 2014.

Well the much antiscipated day of Obama care and coverage for everyone…or so most people seem to think, came and went today.  Just in case you missed the festive event, here is what you got mandated effective for plans that go into effect after today, other wise it is see you in 2011 or maybe 2012 or 2013 or 2014 for the balance of the benefits promised to you.

I do not mean to sound terse in my writing it is just that I want to get the word out, it ain’t fixed yet, we need health care fixed, yes we do, but according to a recent poll and 50% or better of the population is under the impression that this new bill fixes thing now, well not exactly.

I will keep you updated as more things are implemented and changes occur.  Please call or email me/us anytime to find out the latest in greatest for health insurance, medicare or other insurance questions.  So here’s what you get today:

• Covering dependent children to age 26
  All plans must cover dependent children up to the age of 26. This is regardless of the dependent’s marital status, financial dependence, student status, or employment status. Grandfathered plans do not have to cover dependents who are eligible for employer coverage other than through their parents. Read More
• 100 percent coverage of preventive care services
  All plans (except grandfathered plans) will provide coverage with no member cost sharing for recommended preventive care services, when provided in network.   This based on  the preliminary final guidance (that is a positively exact term by the government isn’t it? Their words, not mine) released by the Department of Health and Human Services (HHS) in July 2010.
• Annual and lifetime limits
  Removed lifetime and annual dollar limits for essential benefits with the exception of Limited Benefit Plans: There is an exception for limited benefit plans.  HHS has agreed to waive the restricted annual benefit limits for qualified limited benefit plans until other affordable options become available in 2014.

• Pre-existing conditions – make sure you are clear on this!  Removing of the ability for plans (except grandfathered plans) to limit or exclude benefits or coverage based on pre-existing conditions ONLY APPLIES TO for enrollees under the age of 19.
• Choice of health care professionals
  The law says health plans must allow members to choose any participating primary care provider. Plans must allow women to access ob/gyns without a referral or preauthorization, and allow pediatricians to be named as a child’s primary care provider.

This is meant as a summary for you of the changes for today.  Read the full info on the bill at This link to the government site

Another reminder of how well intended legislation is not the best answer if done in haste.  If you have a HSA’s (Health Savings Accounts), FSA’s (Flexible Spending Accounts) or a HRA’s (Health Reimbursement Arrangements), you have been figurative shot in the foot under the new health care bill!

Yes that right, the deal you had to save and use pre-tax dollars for your medicines is gone in most cases, thanks government!  The cost of over-the-counter drugs or medicine can no longer be reimbursed under these plans unless a prescription is obtained, with a few exceptions.

For example, the following items are still eligible 213(d) expenses:

• Insulin (even if purchased without a prescription)
• Medical devices
• Eye glasses
• Contact lenses
• Co-pays
• Deductibles

The new standard will only apply to purchases made on or after January 1, 2011. Medicines and drugs purchased over-the-counter prior to the effective date are still eligible to be reimbursed in the 2011 plan year.  What a difference a year makes see post from October 2009

Link to government site

Well there have been a lot of changes or at least a lot of talk about changes in health insurance and coverage this year. With the passage of the health care reform signed by President Obama, March 23, 2010 you get extra choices, some good, some bad and some unknown. As you consider your renewal options this year, you have one more thing to think about: how your decisions will affect your benefits and costs in the future?

The recently passed federal health reform law includes special rules for plans that were in effect before March 23, 2010. These plans are called “grandfathered” plans. Even a simple change to your deductible could exempt you from the “grandfathered” status. So what do you do? Is a “grandfathered” plan in your favor?  If you keep it then:

• You won’t be affected by some post-reform changes. For example, if premiums go up for plans sold after reform due to requirements in the law, these increases won’t apply to your plan.
• You’ll still be eligible for some of the consumer protections and health plan changes mandated by the reform law.

Only you can make a change that would cause you to lose this important status, by changing plans.  So should you or not?  Call us 817-898-1301 or click here for a quote and see what the new plans look like.

Here is a summary of some ways that you CAN lose your ‘grandfathered’ status.

• You switch to a plan that pays a lower percentage of your costs — that percentage is called “coinsurance” — compared to the plan you had on March 23, 2010. For example, if you move from a plan that covers in-network services at 80 percent to a plan that covers these services at 70 percent, you could lose grandfathered status.
• You increase your deductible by more than 18 percent compared to the deductible you had as of March 23, 2010. For example, moving from a $1,000 deductible to a $2,500 deductible would cause a loss of grandfathered status.
• You choose a plan with higher copayments. If your copayment for any service goes up by a certain amount — generally speaking, by more than $5 or 15 percent — you could lose grandfathered status.
• You choose a plan that eliminates all or most benefits for a particular condition. For example, if you move to a plan that doesn’t cover mental health, you could lose your grandfathered status.
• You enroll in a new plan with an effective date anytime after March 23, 2010. This would apply whether it’s a new plan or a plan from a different insurance company.

What WON’T cause you to lose grandfathered status.  As long as these changes aren’t associated with one of the items above, they won’t affect your status:

• You add or remove coverage for a family member.
• You increase your benefits — for example, by moving to a plan with a lower deductible or higher coinsurance.
• Your insurance company makes a change to comply with state or federal law, including the health care reform law.
• Your insurance company changes the premium for your current plan.

On March 23, 2010, President Obama signed the Patient Protection & Affordable Care Act (P.L. 111-148) into law. The Act contains a provision (Sec. 1101) for a new federal high risk health insurance pool program to be established (the Federal Pool). To qualify, an individual must be a citizen or national of the United States, or lawfully present, must have a preexisting medical condition and must have been uninsured for at least 6 months before applying for the federal program. An enrollee in the Federal Pool will pay a premium rate equal to standard market rates. Moreover, Federal Pool coverage will not be subject to any preexisting condition exclusion.

According to the U.S. Dept. of Health & Human Services (HHS), August 1, 2010 is now the target date for coverage to be available through the Federal Pool, known as the Preexisting Condition Insurance Plan (PCIP). Go to www.pcip.gov or call 866-717-5826 for information on the Federal Pool if you have been without coverage for at least 6 months.

Texas also has a risk pool www.txhealthpool.org here is a link to the application and rates Click Here for Application and here are the Click Here for the Rates.

The premium rates for the PCIP Federal Pool will be approximately half the rates that Texas law requires for the State Pool. The Federal Pool will not impose a preexisting condition exclusion waiting period on a new enrollee. The State Pool, in contrast, must impose a 12-month preexisting condition exclusion waiting period on new enrollees who did not have creditable coverage in place during the 12 months prior to enrollment. This State Pool exclusion period is, however, reduced by the number of months the enrollee did have coverage in force during the year immediately prior to enrollment in the State Pool, and it is fully waived if the enrollee had creditable coverage in place during the full year prior to enrollment.

As mentioned above, the PCIP Federal Pool will be available only to individuals who have been uninsured throughout the 6-month period prior to their application to the Federal Pool.

You should determine which risk pool program–state or federal–best serves your needs, based on your individual circumstances. If you have any questions about the State Pool, or the information contained in this Notice, please call our Customer Service Unit at 1-888-398-3927.

Under the health care bill passed in March, tax credits will be granted to some small employers for a part of the health insurance premiums the employer pays. The purpose of this credit is to encourage employers to offer their employees health care coverage for the first time, and to encourage those who do currently offer it, to continue to do so.

Effective 2010 through 2013, the IRS will provide a tax credit of up to 35% for small businesses and 25% for tax-exempt organizations that provide health insurance for their employees. A small business is eligible for this tax credit if the employer:

Employs 25 or fewer “full-time equivalent” employees (FTE Full Time Equivilent)

Pays average annual wages of less than $50,000 per FTE

Contributes a uniform percentage of the premium cost of coverage which must not be less than 50%, based upon the premium rates for single coverage

In 2014, the tax credit for small businesses will increase to 50% and 35% for taxexempt organizations. This tax credit is designed to help small businesses afford health care coverage, specifically those who employ low to medium income workers. Employers can claim this 2010 tax credit when they file their income taxes in 2011. In order to determine the total 2010 tax credit, there are specific qualifications that must be met.

Here is a link to IRS website to see how this impacts your business

Some key highlights which you will need to discuss with your accountant:

• If an employer only pays a portion of the cost of the premiums, only the employer-paid portion of the premiums is counted towards the credit, and premiums paid through a salary reduction arrangement are not treated as paid by the employer for this purpose.
• employer will not receive a tax deduction for the health insurance premiums it pays for which it receives this tax credit. Thus, an employer will not receive both a tax credit and a tax deduction for the same premiums it pays.
• When determining the average number of FTE’s and the average annual wages, the following persons are excluded: sole proprietors, partners in a partnership, two percent or greater shareholders in an S corporation and all owners of more than five percent of a business. In addition to excluding these persons for purposes of determining the number of FTEs and average wages, the premiums paid on their behalf are excluded when determining the tax credit.

Example
The credit is calculated as follows:
For 2010, a qualified employer has 12 FTEs and average annual wages of $30,000. The employer pays $96,000 in health care premiums for those employees (which does not exceed the average premium for the small group market in the employer’s state) and otherwise meets the requirements for the credit.

(1) Initial amount of credit determined before any reduction: (35% x $96,000) = $33,600
(2) Credit reduction for FTEs in excess of 10: ($33,600 x 2/15) = $4,480
(3) Credit reduction for average annual wages in excess of $25,000: ($33,600 x $5,000/$25,000) = $6,720
(4) Total credit reduction: ($4,480 + $6,720) = $11,200
(5) Total 2010 tax credit: ($33,600 – $11,200) = $22,400

Qualifying employers will claim the tax credit on their 2010 tax return. In early April 2010, the IRS published a series of FAQs on the new tax credit.
Check the IRS website for a copy of the FAQs: http://irs.gov/newsroom/article/O,,id=220839,00.html.