HHS

Déjà Vu, Again – Small Group Transitional Relief Plans (pre-ACA) Extended Through 2020

Buried far below the most recent headlines related to eliminating the ACA, The Centers for Medicare and Medicaid (CMS) once again announced that employers in the small group market still enrolled in Transitional Relief Plans (pre-ACA) may keep their existing policies and plans for another year. CMS stipulates that ultimately the discretion for granting an extension again rests with state regulators and the respective participating insurance carriers who continue to make those plans available.  As we learned last year a few insurance carriers (e.g. Aetna) elected not to extend the Transitional Relief Plans beyond 2018. They instead chose to eliminate the option of renewing the old plans thus requiring impacted employers to move to ACA plans or one of the market compliant alternatives (e.g. level funding, MEWA, etc).

For more info click on the link below:

Extended Non-Enforcement of Affordable Care Act-Compliance With Respect to Certain Policies

65Plus Is The Hottest Labor Market Demographic. Here Are Key 2019 Medicare Costs That Employees And Employers Should Know.

Some say it’s the hottest demographic in the labor market — men and women ditching traditional retirement age to work into their 70s, 80s and sometimes beyond.   According to the Bureau of Labor Statistics the 65 and over crowd will make up the fastest-growing segment of the workforce over the next decade.  With that in mind, over the next few months we’ll be providing key bits of information that employers and employees may find helpful as they navigate the best and most cost effective options for health coverage for the 65Plus workforce and their dependents.

First off, 2019 cost considerations for “traditional Medicare”:

2019 Medicare Costs + Coverage

PART A PREMIUM (Hospital Insurance)
Most people don’t pay a monthly premium for Part A (paid Medicare taxes for more than 39 quarters.  If 39 or fewer quarters worked they’ll pay a premium of up to $437).

PART A DEDUCTIBLE + COINSURANCE
– $1,364 deductible for each benefit period
– Days 1-60: $0 coinsurance for each benefit period
– Days 61-90: $341 coinsurance per day for each benefit period
– Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
– Beyond lifetime reserve days: all costs

PART B PREMIUM (Medical Insurance)
The standard Part B amount is $135.50 (or higher depending on your income).

PART B DEDUCTIBLE + COINSURANCE
– $185 deductible per year
– After deductible is met, enrollees typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment (DME).

2019 PART B + PART D (Prescription drug coverage) INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (*IRMAA PREMIUMS)
An additional amount that some individuals whose modified adjusted gross income (MAGI) is above certain thresholds will pay for their monthly Part B and Part D premiums.

  • 2019 Medicare Part B (Medical Insurance) Income Related Adjustments
FILE INDIVIDUAL TAX RETURN FILE JOINT TAX RETURN FILE MARRIED + SEPARATE TAX RETURN MONTHLY PREMIUM IN 2019
$85,000 or less $170,000 or less $85,000 or less $135.50
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $189.60
above $107,000 up to $133,500 above $214,000 up to $267,000 Not applicable $270.90
above $133,500 up to $160,000 above $267,000 up to $320,000 Not applicable $352.20
above $160,000 and less than $500,000 above $320,00 and less than $750,000 above $85,000 and less than $415,000 $433.40
$500,000 or above $750,000 and above $415,000 and above $460.50
  • 2019 Medicare Part D (Prescription drug coverage) Income Related Adjustments
FILE INDIVIDUAL TAX RETURN FILE JOINT TAX RETURN FILE MARRIED + SEPARATE TAX RETURN MONTHLY PREMIUM IN 2019
$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $12.40 + your plan premium
above $107,000 up to $133,500 above $214,000 up to $267,000 Not applicable $31.90 + your plan premium
above $133,500 up to $160,000 above $267,000 up to $320,000 Not applicable $61.40 + your plan premium
above $160,000 and less than $500,000 above $320,00 and less than $750,000 above $85,000 and less than $415,000 $70.90 + your plan premium
$500,000 or above $750,000 and above $415,000 and above $77.40 + your plan premium

 

Next Up:  The eligible employee’s three main options when it comes to their employer-sponsored plan and/or Medicare coverage.

 

2019 Medicare_and_You_2019

 

The Check’s in the Mail — MLR Premium Rebate Checks and What Do We Do with Them

Some BBG employer clients are reporting that they have received MLR rebate checks from their carrier.

What are MLR rebate checks and why do only some employers receive them?

Affordable Care Act rules stipulate that insurance carriers must spend a certain percentage of health insurance premiums on medical claims and other specified related activities. This is referred to as a Medical Loss Ratio (MLR).

The MLR ratio for small groups is 80/20, For large groups it’s 85/15.

If an insurance company spends less than the MLR amount designated by Obamacare then the insurance company must rebate the unspent portion back to the employer sponsoring the plan.

Wondering what to do if you are one of those employers receiving an MLR rebate check?

There are rules established by the Department of Labor governing distribution. Employers must use these as guide when allocating and distributing the rebate dollars. The rules can be found here http://dol.gov/ebsa/newsroom/tr11-04.html.

In a nutshell:

Employer groups are required to treat the rebate as a plan asset.  Uses may include, but are not limited to, reducing future premiums or premium increases, or rebating a portion back to the subscribers.  The rebate is required to be used for the benefit of the subscribers in one of the following ways:

• To reduce subscribers’ portion of the annual premium for the subsequent policy year for all subscribers covered under any group health policy offered by the plan;
• To reduce subscribers’ portion of the annual premium for the subsequent policy year for only those
subscribers covered by the group health policy on which the rebate was based; or
• To provide a cash refund only to the subscribers who were covered by the group health policy on which the rebate is based.

A more thorough review of what to do with MLR Rebate Checks can be found by clicking here How Employers Should Handle MLR Rebates

Clients can contact BBG for assistance.

Example Rebate Check

Now That ACA Remains in Place Maybe We Should Keep An Eye On This Recent HHS Letter to Governors.

“……We are seeking to empower states with new opportunities that will strengthen their health insurance markets.”

Thomas E. Price, M.D., The Secretary of Health and Human Services (HHS), A Letter To Governors, dated March 13, 2017

 

On March 13, 2017, the Department of Health and Human Services (HHS) sent a letter to state governors to highlight Section 1332 of the Affordable Care Act (ACA). Beginning in 2017, Section 1332 allows states to apply for a State Innovation Waiver from certain ACA requirements.

With the lawmakers firmly stuck in the healthcare mud, one wonders if some states might start to make health insurance changes on their own. Under a little known provision of the Affordable Care Act (Section 1332) called the State Innovation Waiver, states have the ability to make changes by applying for waivers from certain major provisions of the law beginning this year (2017).  These waivers are intended to allow states the flexibility to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance, while retaining some of the consumer protections of the ACA.

Examples of things that may be waived include:

  • Establishment of qualified health plans (QHPs);
  • Consumer choices and insurance competition through the Exchanges;
  • Premium tax credits and cost-sharing reductions for plans offered within the Exchanges;
  • The employer shared responsibility rules; and
  • The individual mandate.

While this provision and Price’s recent letter on the subject seemingly flew under the radar, you have to wonder if we might start to see some states initiating their own changes to Obamacare. If this is going to happen, we’ll likely start hearing about it in the next few months.  Sometime this summer is when carriers submit rate increases or announce intentions to withdraw from the individual market all together.  Analysts are predicting both to happen.  It’s anticipated carriers will request huge rate increases — sticker shock on steroids — for individual plans on and off exchange.  And, more carriers are expected to be leaving the individual market.  Aetna and UnitedHealthcare are already out, and Bloomberg recently reported that Anthem (BlueCross and Blue Shield in 14 states) is leaning toward exiting in most if not all of its markets.

I doubt anyone really knows where all this is going, or where it will end up. Maybe some states will act, maybe not.

One thing that’s almost certain: Access to employer sponsored health plans will be more important than any time since Obamacare (ACA) became law.

Here’s a link to more info:  HHS Promotes ACA Section 1332 Waivers

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