Two Minute Drill

The HHS Move to Curtail the Availability of Short Term Health Coverage Will Hurt Consumers In Need of an Affordable Bridge To Other Coverage……

………Like Medicare or Other Employer-Sponsored Coverage.

Yesterday the Obama Administration and HHS announced they were significantly curtailing the availability and use of short-term health insurance.

Their reasons? Not exactly sure.

Maybe it’s due to the myriad of current issues in the individual market – rising rates, carriers pulling out, and actuarially not enough covered lives (especially healthy people) – and the need to get more healthy people to buy individual policies. Take away options and hopefully it’ll drive more people to buy on the exchange.

Maybe, it’s a shot at UnitedHealthcare (UHC is one of the main providers of short –term or temporary coverage). Retribution, possibly, for UHC pulling out of the exchanges?

Ohio’s Health Co-op (In-Health) Shut Down

In-Health, the Ohio health insurance Co-op established as a part of ACA, is shutting down.  Here’s an explanation of the co-op program. HCR Consumer Operated and Orientated Plan CO OP Program.

Although no BBG client is insured by In-Health, we wanted to let you know in case it hits your radar with employees that get their insurance from a source other than your employer sponsored plan.

In-Health insured approximately 23,000 Ohioans.
We will help anyone who needs it.

In the meantime,

Things to know:
– Claims are to be paid (according to the Ohio Department of Insurance)
– Members will be informed of how the run-down will work
– In the near future the members will need to shop for new insurance and will be provided an special open enrollment period

We hope this does not affect any of your people, but if it does feel free to let us know. We will help.

You can read more about the implications of InHealth’s shut down here.

“Dear Employer” Letter from Medicare (Part 2) – Compliance Overview

The CMS Data Match program determines whether an employer-sponsored group health plan has the responsibility for paying health care claims before Medicare. As discussed in last week’s post, with the number of workers age 65 and over steadily increasing, many employers are receiving letters from CMS asking for information about their employer-sponsored health coverage.  Employers are required to respond or be subject to penalties (fines).  This Compliance Overview summarizes these requests for information and highlights the corresponding steps for responding………………Medicare Secondary Payer IRS SSA CMS Data Match.

Medicare Secondary Payer IRS SSA CMS Data Match

 

Letters From CMS (Medicare) to Employers Regarding Group Health Plan Reporting Are Causing Some Confusion

Many employers are receiving letters from CMS (Medicare) requesting information and it’s causing some confusion. The actual title of the letter reads “Requirement to Submit the Group Health Plan Report for the IRS/SSA/CMS Data Project”.

Here’s an overview that may help clarify for you.

This letter from CMS is separate and apart from the new ACA employer reporting requirements that recently went into effect (employers with 50+ employees). Employers are required to provide the requested information but it’s pretty basic and, other than complying with the request, not anything to really be concerned about.

In Case You Missed It – HHS Has Again Extended the Small Group “Keep Your Plan” Provision of the Affordable Care Act

We know you get updated on a lot of healthcare issues.  Just in case you missed our previous announcement this is worth repeating for those employers in the under 50 segment who have kept pre-ACA plans in place.

For our under 50 employee groups, we were ramping up to help construct ways to continue the option of keeping your current plan (unless something better becomes available).  In the past, we have had to shift renewal dates or juggle “grandfathering” vs. “grandmothering” your plan.

This year we will not have to do any such juggling.

If You Want A Pragmatic Understanding of the Opioid Epidemic You May Want to Listen to This

This post follows up on last week’s primer on how abuse of prescription pain medications has led to what’s now recognized as a true national crisis. The new podcast Embedded provides a riveting inside look at how the use of one particularly powerful prescription painkiller, Opana, impacted life in a small Indiana town.

Pain Meds and The Opioid Epidemic: 10 Things To Know

There’s a lot in the news these days about what’s referred to as the opioid crisis or epidemic.

Just yesterday for instance —  highly respected healthcare consultant (and close friend) Joe Paduda, fresh off of speaking at a national drug summit in Atlanta, wrote an insightful but grave piece on the impact of opioid abuse for Managed Care Matters. Joe nets out the massive increase in the death toll stemming from prescription pain killers (opioids) and how the increased use of heroin has been driven by users who started with prescription opioids .

And, in an article appearing in Thursday’s Wall Street Journal (The Accidental Deadly Drug Prescription) a Baltimore physician writes how doctors and patients alike are unaware of the threat of accidental death posed when opioids interact with other frequently prescribed drugs.

Got me thinking. Despite all the news, despite being in a healthcare related field and working with prescription drug plans, and despite having had family, friends, and colleagues at work touched by this crisis, I realized I don’t really know nearly enough about the overall issue. I wanted to better comprehend the basics and so I dug in a little bit to get a better grasp. Thought I’d share in case you’re in the same boat as me.

Here are 10 things about the growing pain med problem that may help you better understand:

1.) Per the National Institutes for Health (NIH), Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain by diminishing the effects of a painful stimulus. In other words, they reduce the patient’s perception of pain.

2.) Medications in the opioid class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs.

 3.) Hydrocodone products are the most commonly prescribed for a host of painful conditions, including dental and injury-related pain.

 4.) Morphine is often used before and after surgical procedures to alleviate severe pain.

 5.) Codeine is often prescribed for mild pain. In addition to their pain relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea. (In other words, just about anyone could have been prescribed an opioid at one time or another.)

 6.) Addiction may develop due to the euphoric response some people experience when taking opioid medications. The drugs affect the brain regions involved in reward. Those who abuse opioids may look to step up and intensify their experience by taking the drug in ways other than those prescribed or switching to heroin after becoming addicted because heroin may be less expensive and or more easily accessible.

 7.) Over the course of almost two decades overprescribing of opioids has led to a huge increase in the frequency of opioid addiction. This in turn has led to the steep rise in overdose deaths and increased heroin use. Use of hydrocodone has more than doubled and consumption of oxycodone has increased by nearly 500%. The number of deaths due to opioid overdose death nearly quadrupled.

 8.) This acceleration in the prescription and use of opioids was fueled in large part by the combination of the introduction of OxyContin in 1995, more aggressive identification and treatment of pain, and, an overall increase in emphasis on Pain Management as a treatment modality.

 9.) The group with the highest death rate from opioid prescription pain meds is the 45-to-54 age group — more than four times the rate for teenagers and young adults. The rate of overdose deaths for adults ages 55 to 64 has soared sevenfold.

 10.) Everyday 46 Americans die from using prescription painkillers.

I guess my take away is for me to tune in more. And, encourage our team and our clients and their employees to tune in more.  Maybe at one time it seemed mostly just on the streets. Not any more. It’s at the office; it’s at home; and it’s over the roads. From classrooms to locker rooms to board rooms, pain med addiction has become a real and costly issue that in some way shape or form has touched most of us.

“Who’s Exempt from the ACA Individual Mandate to Have Health Insurance?”

During several recent meetings this question was posed a number of times by curious employees and a few their employers. It seems many folks are still unclear about the exemptions. Many also were unclear on the amount of the penalties.

Below is a summary on exemptions and individual penatlies published recently in a Kaiser Health News article addressing these FAQs:

Who’s Exempt from the Requirement to Have Insurance?

 The list of possible exemptions is a long one. You may be eligible for an exemption if:
• Your income is below the federal income tax filing threshold.
• The lowest priced available plan costs more than 8.05 percent of your income.
• Your income is less than 138 percent of the federal poverty level (about $16,105 for 2015 coverage for an individual) and your state did not expand Medicaid coverage to adults at this income level as permitted under the health law.
• You experienced one of several hardships, including eviction, bankruptcy or domestic violence.
• You are a member of an Indian tribe, health care sharing ministry or a religious group that objects to insurance.
• You are in jail.
• You are an immigrant who is not in the country legally.

Many also asked about the penalties. More from the KHN article:

Penalties: How Much?

For 2016, the penalty will be the greater of $695 or 2.5 percent of income.
Although much of the discussion is often about the flat dollar penalty – $325 in 2015 — many people will be paying substantially more than that. A single person earning more than $26,550 would not qualify for the $325 penalty ($26,550 – $10,300 = $16,250 x 2 percent = $325.) So the 2 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose modified adjusted gross income is $35,000, the penalty would be $494 ($35,000 – $10,300 = $24,700 x 2 percent = $494. That same individual would have paid $249 in penalties for 2014.

The penalty is capped at the national average price for a bronze plan, which the IRS announced was $2,484 for an individual and $12,240 for a family of five or more in 2015.

To read about other ObamaCare FAQ’s go to FAQ: What Are The Penalties For Not Getting Insurance?

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