At the end of June 2015 the Centers for Medicare and Medicaid Services (CMS) announced that they had boosted the reimbursement for high cost health care claims to health insurance companies participating in the ACA reinsurance program from 80% to 100% for 2014. The increase in coverage resulted from fewer requests for coverage of high […]
Individuals and families who have enrolled in health plans through Healthcare.gov, or a state exchange like Covered California face new challenges as they report income and household changes. Families reporting changes to household size and income may also be triggering changes to their health plan. These changes may result in the entire family becoming eligible for Medicaid, being shifted into a different Enhanced Silver plan or losing the Advance Premium Tax Credit all together.
In what has become routine for Covered California, they alerted agents to another CalHEERS enrollment website problem late on a Friday afternoon. The latest email notified agents that the system has been calculating the wrong Advance Premium Tax Credit (APTC) on submitted applications. While the Covered California email blast wasn’t real specific, it sounds like the APTC number is wrong when the applicant confirms the health plan purchase, but correct in the “Eligibility Results” page.
With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.
Covered California has provided basic statistics and pretty pie charts on enrollment numbers into the ACA health plans that they offer. But what is left out is the statistical data that economists and demographers would like to have to ascertain if the Affordable Care Act is merely working or if it is actually fulfilling the promise to reduce health disparities in our communities with affordable health insurance.
Health Net notified all their California agents by a letter dated January 29th, that effective March 1, 2014, they will slash the sales commission by over 50% on four of their five individual and family plans offered in California. This further reduction in compensation for agents since the ACA was passed continues to make customer service oriented health insurance agents a “family of dinosaurs” who will quickly become extinct.
The Individual Mandate of the Affordable Care Act psychologically chafes folks who don’t appreciate the government telling them what they have to purchase. Count me in that segment. If one of the goals of the Individual Mandate is to make people take responsibility for expensive health care, an alternative might be an unforgivable tax liability on those people who have chosen to forego health insurance and incur large medical expanses that go unpaid.
When the insurance companies are having their risk for unexpectedly high health care expenses subsidized they should not have the luxury of creating tight doctor and hospital networks. The restrictions on network providers for cost containment purposes is exceptionally irritating when it is the plan members that are helping fund part of the risk reduction provisions by having to pay for the reinsurance fee on qualified health plans. Restricted networks and new EPOs are just a “work around” solution to allow health insurance companies to selectively limit health care like they have done in the past.
One of the hidden dangers of the Affordable Care Act’s Advance Premium Tax Credit (APTC) provision to lower the cost of health insurance is the possibility of having too much tax credit issued for the tax payer’s final income. If the ACA applicant doesn’t report increases to the household income during the year, which triggers a corresponding decrease in premium assistance, the tax payer will be liable to pay the excess back. Fortunately, there are limits to the repayment of excess APTC based on household income.
The Affordable Care Act regulations preclude individuals and families from receiving tax credits to lower health insurance premiums bought through an exchange if they are offered employer sponsored health insurance that is deemed to be affordable and meets minimum value. This rule is actually denying some families access to affordable health insurance and is set to penalize other families with a huge IRS tax bill in 2015.