Nearly 7M Might Enroll Outside HIX Open Enrollment

Despite open enrollment for Affordable Care Act plans not starting until November 15, a new report estimates that nearly 7 million adults may be able to enroll through special enrollment periods. READ MORE » AMS ENROLLMENT AND PLANS

Medicare Open Enrollment starts November 15th

Looking for or to reconsider your Medicare Insurance options or if you’re satisfied with your current coverage, you needn’t do anything—your coverage will renew automatically. If not, Contact us for a Medicare Supplement Plan.

Now, before open enrollment begins November 15, is the time to learn more about your options.

Your Medicare Options

Medicare-eligible individuals have two options for obtaining health insurance: original Medicare or a Medicare Advantage plan.
Original Medicare, the government insurance program geared primarily for seniors, has three parts:

• Part A, hospitalization insurance. Medicare Part A helps cover inpatient care in hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care. It does not cover custodial or long-term care. U.S. citizens and lawfully admitted aliens who have lived in the U.S. for a five-year period when they turn 65 automatically qualify for Part A coverage. Individuals who develop end-stage renal disease or certain other disabilities may also qualify. Most people do not pay a premium.
• Part B, medical insurance. Medicare Part B helps pay for doctors’ services and outpatient care. It covers some other medical services. These include physical and occupational therapist services and some home health care when medically necessary. For most people, the federal government pays about 75 percent of the cost of Part B coverage; enrollees pays the rest. Higher-income people (about 5 percent of beneficiaries) will pay higher premiums.
• Medicare Part D, prescription drug insurance. The Part D monthly premium varies by plan and your income—higher-income consumers may pay more. The Centers for Medicare & Medicaid Services (CMS) estimated average 2014 premiums for basic Medicare Part D plans at $31 per month. As with Part B, higher-income people will pay more.
• Medicare supplement (“Medigap”) plans. Unlike Medicare Parts A, B and D, private insurers underwrite Medigap policies. They must adhere to specific plan designs that cover a specific set of benefits. In most states, policies are identified by letters. Not all plans are available in all states.
  As the name suggests, Medicare supplement plans supplement the coverage under traditional Medicare. These policies can help pay some of the out-of-pocket costs you’ll have with original Medicare, such as copayments, coinsurance and deductibles. Some Medigap policies also cover services that original Medicare excludes, such as medical care when you travel outside the U.S. If you have original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

Get a quote today:  ONE STOP QUOTE

Private Exchanges:

The New Business Model for Insurers and Employers

Private Exchanges: The New Business Model for Insurers and Employers examines the details of how private exchanges work, which models are most successful at gaining members, and the pros and cons for insurers of taking part in nonproprietary exchanges versus building their own. This report is filled with valuable, practical intelligence from several national private exchange experts, on topics such as:

• The business model for private exchanges and how insurers expect to prosper by operating their own proprietary exchanges or selling coverage on other marketplaces.
• How defined contribution is playing into employer decision making and the ramifications of shifting health benefits to private exchanges.
• The differences between private exchanges and traditional "slice" business.
• The opportunities and threats that private exchanges present for insurers.
• The membership tradeoff for insurers — membership gain from previously closed relationships (such as an employer with another carrier) vs. potential loss of membership in exclusive employer relationships.
• How much revenue insurers can generate with the potential move of employers from self-insured to fully insured benefit plans.

Contact to learn more on how a PRIVATE EXCHANE will enhance you benefit package.

info@amsinsure.com

This week's health care reform news:

Enrollment verifications expected to reduce Exchange numbers

The administration is sending letters to more than 300,000 people warning that health coverage purchased through an exchange could be cut off unless eligibility issues, such as immigration status, are resolved. Similar eligibility follow‐ups are expected soon for reported income.

Preparing employers for 2015 health plan enrollment growth.

By Kathleen Koster

August 8, 2014

Open enrollment rates for employer-sponsored health plans in 2014 remained flat, but advisers and their employer clients are already putting strategies in place to prepare for expected growth in 2015 enrollments. 

Despite the Affordable Care Act’s requirement that individuals seek health insurance coverage in 2014 and the fact that employers are already preparing for the health reform law’s employer shared responsibility provision, open enrollment levels for employer-sponsored health plans remained mostly unchanged from 2013, new research from Mercer shows. On average, 69.3% of employees enrolled in employer-sponsored health plans in 2014, up only slightly from 69.1% in 2013.
In 2015, researchers expect there will be at least some growth; especially since the individual mandate penalty for obtaining coverage will be higher and more employers will open their plans to newly eligible employees under the ACA shared responsibility rules.
Benefit advisers have already begun to work with employers to put strategies in place to diminish the burden of increased health care costs an enrollment surge could bring.


Managing growth in eligibility
To manage a potential uptick in employees eligible for health coverage in 2015, 10% of employers will decrease the number of employees working 30+ hours per week by next year, the Mercer survey found. Another 14% are making additional adjustments to their workforce strategies.
The survey found retail and hospitality industries, which have a higher proportion of low-wage, part-time workers, are most concerned about higher enrollment in plans. These groups are followed by the higher education sector, in which adjunct professors make up a significant portion of the faculty, yet typically are not eligible for health benefits.
What’s more, employers are concerned about becoming “dependent magnets” and attracting additional dependents and spouses, as more employees become eligible for coverage and the individual mandate penalty stiffens. About 20% of employers said they would raise the employee contribution for dependent coverage in 2014.
To further curb the number of dependents on their plans in 2015, employers are considering special provisions for employees’ spouses who have other coverage available. Currently only one-fifth of employers have such a provision in place —12% require a surcharge and 8% exclude spouses with other coverage entirely. However, this practice may gain in popularity as many employers are considering it —16% considering a surcharge and 12% considering a spousal exclusion, the survey found.

Health care reform: Know the rules and penalties of the individual mandate

May 29, 2013
The individual mandate starts in January 2014 and is an important part of the Affordable Care Act. The individual mandate requires people legally living in the U.S. to buy a minimum amount of health coverage unless they are exempt. In general, people who don’t have to file taxes due to low income are exempt from the individual mandate.
But how does it work? And what are the penalties for people who don't get coverage?
How the individual mandate works
When your clients file their 2014 taxes in 2015, they’ll need to report whether or not they had health coverage in 2014. If they did have coverage, they will need to report if they qualified for a tax credit or subsidy. Health coverage includes a group plan, an individual plan, Medicare or Medicaid. If they don’t have health coverage, they could face a tax penalty. Each year, the penalty increases.
What are the tax penalties?
If a person doesn’t have a health plan, he or she will pay a tax penalty as follows:.

• 2014: Penalty is the larger amount - $95 or 1% of taxable earnings
• 2015: Penalty is the larger amount - $325 or 2% of taxable earnings
• 2016: Penalty is the larger amount - $695 or 2.5% of taxable earnings
 

What happens if your clients can’t pay for a plan?
Your clients may qualify for a tax credit through the exchange based on their incomes. People earning between 100% and 400% of the federal poverty level can qualify if they are not eligible for other sources of minimum essential coverage, including government-sponsored programs such as Medicare and Medicaid.
This includes:

• Individuals with modified adjusted gross incomes of $11,490 to $45,960 a year
• Families of four with modified adjusted gross incomes of $23,550 to $ 94,200 a year.

Your clients may qualify for cost-sharing subsidies based on their income. This includes:

• Individuals with modified adjusted gross incomes of $11,490 to $28,725 a year.
• Families of four with modified adjusted gross incomes of $23,500 to $58,875 a year.

HR Tip of the Month

HR Tip of the Month

Family Medical Leave Act (FMLA) allows employers to require employees to substitute vacation, sick or other paid leave for all or part of the 12 weeks of unpaid FMLA leave.

Employers Consider Expanding Voluntary Benefits

Critical illness insurance, identity theft coverage and financial counseling services are among the voluntary benefits companies are considering offering to employees, a recent survey found. Critical illness and accident insurance are increasingly seen as complementary to consumer-driven health plans and have driven voluntary sales over the past year, research shows. Employee Benefit News (8/4) read more