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Health Care

Certain Drugs In Obamacare Plans Carry Hefty Pricetags

Kaiser Health News - Mon, 03/24/2014 - 9:40am
Insurers selling Obamacare plans have set drug prices according to a tiered system that in some cases requires consumers to pay as much as 50 percent of the cost, The Associated Press writes. Meanwhile, The Philadelphia Inquirer reports that although a glitch that had disseminated incorrect subsidy information on healthcare.gov had been fixed, wrong information might still be given out by independent sites. Also, the administration signaled it would allow people to enroll in health plans after March 31 if they had tried but been unable to sign up because of glitches. 

The Associated Press: Obamacare Plans Bring Hefty Fees For Certain Drugs
Breast cancer survivor Ginny Mason was thrilled to get health coverage under the Affordable Care Act despite her pre-existing condition. But when she realized her arthritis medication fell under a particularly costly tier of her plan, she was forced to switch to another brand. Under the plan, her Celebrex would have cost $648 a month until she met her $1,500 prescription deductible, followed by an $85 monthly co-pay. Mason is one of the many Americans with serious illnesses — including cancer, multiple sclerosis and rheumatoid arthritis — who are indeed finding relatively low monthly premiums under President Barack Obama's law. But some have been shocked at how much their prescriptions are costing as insurers are sorting drug prices into a complex tier system and in some cases charging co-insurance rates as high as 50 percent. That can leave patients on the hook for thousands (Kennedy, 3/22).

Reuters: U.S. To Allow Some People To Enroll In Obamacare After Deadline 
The Obama administration will soon issue new Obamacare guidelines allowing people to enroll in health coverage after a March 31 deadline, but only under certain circumstances, according to sources close to the administration. The sources said the new federal guidelines for consumers in the 36 states served by the federal health insurance marketplace and its website, HealthCare.gov, would allow people to enroll after March 31 if they had tried earlier and were prevented by system problems including technical glitches (Morgan, 3/21).

Reuters: Insurers See Double-Digit Obamacare Price Rises In Many States Next Year 
U.S. consumers eligible for Obamacare health plans could see double-digit price hikes next year in states that fail to draw large numbers of enrollees for 2014, including some states that have been hostile to the healthcare law, according to insurance industry officials and analysts. The early estimates come as insurance companies set out to design plans they intend to sell in 2015 through the state-based health insurance marketplaces that are a centerpiece of the Affordable Care Act, President Barack Obama's signature domestic policy achievement that is widely referred to as Obamacare (Morgan and Humer, 3/21).

The Wall Street Journal: Expect Health-Insurance Premiums To Rise
You could continue to see prices increasing this year for your health-care coverage. Several recent studies point to provisions in the Affordable Care Act—such as the requirement that insurers cover sick individuals as well as preventive care, like mammograms—that could lead to higher prices, at least in the short term. The underlying cost of care itself, meanwhile, continues to rise at a steady clip (Johnson, 3/22).

The Washington Post: For Some Who Are Married But Filing Taxes Separately, Another Healthcare.Gov Hurdle
In May 2012, when the Internal Revenue Service proposed its rules for Americans to get government subsidies for health insurance, officials acknowledged that a legal quirk needed to be fixed: The Affordable Care Act was written in a way that inadvertently denied such help to some people who live apart from spouses who abuse them, are in prison or are on the cusp of a divorce. The problem is that the law’s authors, in creating tax credits to help pay for health plans bought through the new insurance marketplaces, had overlooked the fact that some married people file their tax returns separately (Goldstein, 3/23).

NPR: Insurance Chief Suggests Adding A New, Lower Level Of Health Plan
Rather than letting people keep their old health plans that don't comply with the new requirements of the Affordable Care Act, the head of the group that represents the nation's health insurance companies is floating an alternative: weakening the requirements. "If you take 10 categories of coverage," said Karen Ignagni, president and CEO of America's Health Insurance Plans, in an interview taped for C-SPAN's Newsmakers, "no matter how meritorious each and every one of those benefits may be ... you have a giant step up" from what many people had before, and wanted to pay for (Rovner, 3/21).

Kaiser Health News: Capsules: AHIP President Calls For New Level Of Insurance Under Health Law
A new tier of coverage should be added to the health law’s online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry's trade group said Sunday (Carey, 3/24).

The Philadelphia Inquirer: Latest Obamcare Glitch Fixed, But Other Sites May Repeat The Error
A glitch in the Obamacare window-shopping tool that incorrectly responded "not eligible" to queries about financial help from households just above the poverty line was fixed hours after the administration learned of the issue, officials said Friday. For 35 days, Healthcare.gov used the wrong year's federal poverty-level guidelines for informal assessments of eligibility. … similar mistakes uncovered at independent sites raise the possibility that wrong information is still being disseminated less than 10 days before open enrollment ends for the year. (Sapatkin, 3/23).

Fox News: Another Glitch: Newly Discovered HealthCare.Gov Error Giving Bad Info On Premium Aid
A newly discovered glitch in the main ObamaCare website reportedly is giving thousands of people the wrong information about whether they qualify for premium subsidies. The Philadelphia Inquirer discovered the glitch while entering hypothetical incomes into the calculator on HealthCare.gov. The newspaper found that the calculator is using the wrong year's poverty guidelines -- a simple mistake that, for months, has resulted in would-be enrollees getting inaccurate guidance. Because of the glitch, some people may be initially told they qualify for subsidies when they don't. Others may be told they don't qualify when they do (3/21).

Categories: Health Care

First Edition: March 24, 2013

Kaiser Health News - Mon, 03/24/2014 - 7:27am

Today's early morning highlights from the major news organizations examine the final week for health law enrollment, the Supreme Court case this week about the law's contraceptive mandate and the fourth anniversary of the enactment of the controversial overhaul.

Kaiser Health News: FAQ: What Are The Penalties For Not Getting Insurance?
Michelle Andrews, writing for Kaiser Health News, reports: "If you’re uninsured, now’s the time to buy a plan. March 31 is the end of the annual open enrollment period when people who don’t have coverage through their employers can sign up on or off their state’s marketplace. With limited exceptions, people who miss this enrollment window will be unable to sign up for health insurance until next fall for coverage that starts in January 2015. In addition to being uninsured, they’ll face a penalty for not having coverage. The fine may be bigger than they expect. Here are the details" (Andrews, 3/24).

Kaiser Health News: Draft Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors
Susan Jaffe, writing for Kaiser Health News in collaboration with The Washington Post, reports: "Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other health care providers. The proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall" (Jaffe, 3/24).

Kaiser Health News: Connecticut Customers Rush To Retail Store To Buy Insurance
WNPR’s Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: "Mike Dunn stands inside a store in downtown New Haven, Conn., looking through the big glass windows at his future customers outside. He's not selling phones or food or clothes. He's selling Obamacare. There's one week left to get health insurance through the Affordable Care Act marketplaces, and states have gone to great lengths to enroll as many people up as possible. In Connecticut, the exchange has opened two retail storefronts where people can walk in and sign up" (Cohen, 3/24).

Kaiser Health News: Capsules: AHIP President Calls For New Level Of Insurance Under Health Law
Now on Kaiser Health News' blog, Mary Agnes Carey reports: "A new tier of coverage should be added to the health law’s online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry's trade group said Sunday" (Carey, 3/24).

The Wall Street Journal: Are Firms Entitled To Religious Protections?
Tuesday's Supreme Court hearing will be the second time the health law will be scrutinized by the justices. At issue is whether for-profit companies such as Hobby Lobby are entitled to the same religious protections as people or churches. Hobby Lobby covers most forms of contraception in its health plan, including the pill and sterilization. It objects to a requirement that it include certain emergency contraceptives and intrauterine devices, which Hobby Lobby's owners consider a form of abortion. The case is distinct in a couple of ways from legal challenges to the law brought by some Catholic schools and charities, now winding their way through lower courts (Adamy, 3/21).

The Washington Post: High Court With Vocally Devout Justices Set To Hear Religious Objections To Health-Care Law
There’s something that makes the current Supreme Court different from some of its recent predecessors. The justices got religion. Or at least they seem more open about their faith, appearing before devout audiences and talking more about how religion shaped their lives or guides them now. As the court this week weighs religious conviction vs. legal obligation in the latest challenge to the Affordable Care Act, those who study the court say the change is hard to quantify but easy to notice (Barnes, 3/23).

The Washington Post: Even While Overseas, The Obamas Urge Americans To Get Covered
While Barack and Michelle Obama will be overseas this week, the White House is ensuring they will have a virtual presence in targeted media markets across the country before the Affordable Care Act's initial enrollment period ends March 31. ... The Obama administration has devoted most of its outreach efforts for the past several months on a handful of constituencies: young people, women and Hispanics, often in the two dozen U.S. cities that have a disproportionately high numbered of uninsured residents. In many ways, the approach mirrors what Obama’s staff did during his two presidential campaigns, where they used local and niche media outlets to reach targeted voting blocs (Eilperin, 3/23). 

The Wall Street Journal: Worries Over Fines Aid Health-Insurance Sign-Ups
In launching the Affordable Care Act, the Obama administration has emphasized the appeal of inexpensive insurance policies and financial subsidies to lure people to new online marketplaces. But what seems to be motivating many as the final deadline for signing up looms is more the fear of financial penalties (Radnofsky, 3/23).

The Associated Press: Millions On The Sidelines For Big Health Care Push
Millions of people in the United States will remain uninsured despite this week's final, frenzied push to sign them up under the health law. Their reasons are all over the map. Across the country, many of the uninsured just don't know much about the health overhaul and its March 31 deadline for enrolling in plans that can yield big discounts, researchers say. ... But the complexities of the Affordable Care Act can stymie even the well-informed (Cass, 3/23).

The New York Times: Names Of Health Plans Sow Customer Confusion
As Americans race to sign up for health insurance in the final days of open enrollment, many consumers and consumer advocates say the names of plans are unhelpful, confusing and in some cases misleading. A number of insurers sell their plans under names like Select, Preferred, Premier, Exclusive, Enhanced, Essential, Essential Plus, Prime, Ultimate and Deluxe. Multiple offerings from one company may have the same benefits and cover the same share of a consumer’s costs, but go by different names (Pear, 3/22).

Politico: Obamacare Enrollment Rides A Bus Into The Mississippi Delta
In the poorest state in the nation, where supper is fried, bars allow smoking, chronic disease is rampant and doctors are hard to come by, Obamacare rolls into town in a lime green bus. It took some real convincing by the Obama administration and a leap of faith by one state Republican official to get one of the nation’s largest insurance companies — Humana — to set up shop across Mississippi. Virtually no other insurer was willing to do so, discouraged by the acute health needs here and most elected officials’ outright hostility to the law. Four months and more than 200 bus stops later, enrollment numbers here remain dismal. Only 9 percent of the state’s Obamacare-eligible population have signed up, putting it near the bottom of yet another national statistic (Haberkorn, 3/22).

USA Today: Voices: Afraid To Apply For Health Care For Their Kids
For Esperanza Cuevas, the phone call has become disturbingly common. Undocumented immigrants balk at registering their U.S.-born children under the Affordable Care Act, because they fear furnishing the information will lead to their deportation (Gomez, 3/23).

The Hill: Dems Ramp Up Offense On ObamaCare
The White House and congressional Democrats are ramping up a coordinated effort to celebrate ObamaCare’s fourth anniversary this weekend, looking to go “on offense” ahead of the final week of open enrollment. The effort includes a social media campaign by members of Congress and administration officials, enrollment events featuring lawmakers and Senate floor speeches marking the four-year anniversary. The tightly coordinated final push was the result of work between the White House and House and Senate “healthcare strike teams,” which were created in the aftermath of the botched ObamaCare rollout to push back against a flood of bad headlines. The White House has provided members of Congress with packets that detail state-by-state benefits of the law, and what the cost of repeal would mean for constituents within their districts (Sink and Viebeck, 3/22).

NPR: Health Law's 4th Birthday Divides Democrats, Unites GOP On Message
With the fourth anniversary of President Obama's signing of the Affordable Care Act this weekend, if you were a Democrat boasting about the health law, you were more than likely a party official or lawmaker with a seat so safe you could publicly celebrate the occasion. ... Meanwhile, Republican lawmakers, and even GOP candidates not in Congress but hoping to get there, are observing the anniversary with events that underscore the long-running Republican message: The health law is causing more harm than good (James, 3/21).

Los Angeles Times: After Setbacks, Tea Party Members Vow To Reinvent Movement
Five years after it emerged as the most potent force in conservative American politics since the Reagan revolution, the tea party is at a crossroads — and some critics have declared the movement all but dead. Insisting that they've learned from the setbacks, however, stalwarts are vowing to reinvent their defiant brand of politics to ensure they stay part of the debate in Washington and particularly in the Republican Party. ... And they plan to take the fight to repeal Obamacare to the state level, pushing legislatures to enter into interstate health compacts that they say would allow states to ignore federal regulations and enact their own reforms. Though dismissed as a long shot by some, proponents hope the strategy will render the Affordable Care Act inoperable in those states and give compact members control over federal healthcare dollars (Memoli, 3/23).

The Washington Post: Virginia Lawmakers Return To Richmond To Try To Break Impasse Over Medicaid Expansion
Virginia’s pitched battle over Medicaid expansion returns to the Capitol on Monday with no indication that Gov. Terry McAuliffe is any closer to a deal on his top priority. Two weeks after an impasse over Medicaid prevented passage of a two-year, $96 billion budget, the legislature is coming back to Richmond to try again in a special session (Vozzella, 3/22).

The New York Times: Virginia Governor Finds Jollity Is No Guarantee Against Gridlock
The sticking point forcing the special session is Mr. McAuliffe’s desire to expand Medicaid to up to 400,000 of Virginia’s poor and disabled under the Affordable Care Act. The proposal was a centerpiece of his campaign last year and his top priority in office, and on Thursday at a clinic in the Washington suburbs that serves the uninsured, he was unequivocal. “I promise you in this room we will get this done this year,” he told patients, doctors and administrators at Alexandria Neighborhood Health Services. His opponents are just as dug in, noting that in the three weeks since Republicans defeated expansion in a test vote in the House, 67 to 32, there have been no defections on their side (Gabriel, 3/23).

The Washington Post: Biden: GOP Governors Will Eventually Take Medicaid Expansion
Vice President Biden predicted Friday that Republican governors who have declined the federal Medicaid expansion will eventually be forced to reverse course and take the expansion because of political pressure. Speaking to the National Association of Community Health Centers in Washington, Biden criticized the GOP governors who have declined the extra funding but said he expects them to come around. "I'm convinced, as a practitioner of the so-called art of politics, that they ... will not be able to sustain the heat," Biden said. (Blake, 3/21).

The Associated Press: Obamacare Plans Bring Hefty Fees For Certain Drugs
Breast cancer survivor Ginny Mason was thrilled to get health coverage under the Affordable Care Act despite her pre-existing condition. But when she realized her arthritis medication fell under a particularly costly tier of her plan, she was forced to switch to another brand. Under the plan, her Celebrex would have cost $648 a month until she met her $1,500 prescription deductible, followed by an $85 monthly co-pay. Mason is one of the many Americans with serious illnesses — including cancer, multiple sclerosis and rheumatoid arthritis — who are indeed finding relatively low monthly premiums under President Barack Obama's law. But some have been shocked at how much their prescriptions are costing as insurers are sorting drug prices into a complex tier system and in some cases charging co-insurance rates as high as 50 percent. That can leave patients on the hook for thousands (Kennedy, 3/22).

The Wall Street Journal: Expect Health-Insurance Premiums To Rise
You could continue to see prices increasing this year for your health-care coverage. Several recent studies point to provisions in the Affordable Care Act—such as the requirement that insurers cover sick individuals as well as preventive care, like mammograms—that could lead to higher prices, at least in the short term. The underlying cost of care itself, meanwhile, continues to rise at a steady clip (Johnson, 3/22).

NPR: Insurance Chief Suggests Adding A New, Lower Level Of Health Plan
Rather than letting people keep their old health plans that don't comply with the new requirements of the Affordable Care Act, the head of the group that represents the nation's health insurance companies is floating an alternative: weakening the requirements. "If you take 10 categories of coverage," said Karen Ignagni, president and CEO of America's Health Insurance Plans, in an interview taped for C-SPAN's Newsmakers, "no matter how meritorious each and every one of those benefits may be ... you have a giant step up" from what many people had before, and wanted to pay for (Rovner, 3/21).

The Washington Post: For Some Who Are Married But Filing Taxes Separately, Another Healthcare.Gov Hurdle
In May 2012, when the Internal Revenue Service proposed its rules for Americans to get government subsidies for health insurance, officials acknowledged that a legal quirk needed to be fixed: The Affordable Care Act was written in a way that inadvertently denied such help to some people who live apart from spouses who abuse them, are in prison or are on the cusp of a divorce. The problem is that the law’s authors, in creating tax credits to help pay for health plans bought through the new insurance marketplaces, had overlooked the fact that some married people file their tax returns separately (Goldstein, 3/23).

The New York Times: Lawmakers Attack Cost of New Hepatitis Drug
A new drug to treat hepatitis C that costs $1,000 a pill has caused rising concern among insurers and state Medicaid programs. It has now also spurred interest from Democratic congressmen whose queries about the drug prompted a sell-off in biotechnology stocks on Friday. Three Democratic members of the House Energy and Commerce Committee have demanded that Gilead Sciences, the developer, justify the price of its drug, which is called Sovaldi (Pollack, 3/21).

Los Angeles Times: Gilead Sciences' $84,000 Price For Hepatitis Drug Is Scrutinized
U.S. lawmakers have asked Gilead Sciences Inc. to justify the price of its new $84,000 drug for hepatitis C patients amid growing concern about the high cost to taxpayers and consumers. In a letter to the Foster City, Calif., company, Rep. Henry A. Waxman (D-Beverly Hills) and two other Democratic lawmakers asked Gilead Chief Executive John C. Martin to explain the rationale for selling Sovaldi for $1,000 per pill (Terhune, 3/21).

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Categories: Health Care

Connecticut Customers Rush To Retail Store To Buy Insurance

Kaiser Health News - Mon, 03/24/2014 - 5:53am

Mike Dunn stands inside a store in downtown New Haven, Conn., looking through the big glass windows at his future customers outside. He's not selling phones or food or clothes. He's selling Obamacare.

There's one week left to get health insurance through the Affordable Care Act marketplaces, and states have gone to great lengths to enroll as many people up as possible. In Connecticut, the exchange has opened two retail storefronts where people can walk in and sign up.

"So, it's just about 10 o'clock when we open up, and we're just starting to see lines forming for people coming in as soon as we open," he says.

Access Health CT opened the first retail storefront for a state exchange in New Britain, Conn., in November (Photo by Jeff Cohen/WNPR).

That's become normal, he says, as the March 31 deadline for enrolling in Obamacare approaches. With just days to go, Connecticut's exchange, Access Health CT, has done a better job than most states at enrolling people who are eligible. Strategies such as opening a retail store like this one may have played a role in that.

A few dozen people have come to check out their health insurance options. Debra White, 63, pays $300 a month to cover herself and her husband. That's about a quarter of her monthly income. She can manage. But it's not easy.

"I do have insurance, but I'm coming to see if I can lower the payment because I'm on a fixed income," she explains.

Many say what drew them in was the idea of signing up for insurance in person — not on the phone, not on the computer, nor the smartphone.

"It makes it easier for me to converse with another person," White says. "When I'm on the computer and everything, it's confusing. Frustrating. Especially this time. I had a stroke, so at this time in my life it's a little difficult."

White is here with her grandson, Robert Taylor, 21. He works retail part time, and he goes to community college. He doesn't have insurance at all and he's here to get it.

"I'm healthy and I really don't make too many trips to the doctors," he says. "It's just, when I do, I'd like to have a different way of paying for it other than coming out of my pocket."

Michelle Perez is next in line for someone who speaks Spanish. She says she's here to figure out if the new health insurance law can help her save some money.

She's holding a medical bill for a recent doctor's visit. She's diabetic and unemployed. And she's here so someone can explain her options to her.

Also waiting for a broker is DeLisa Tolson. She lost her insurance when she got divorced three years ago. Since then, she's gone to the emergency room and to mobile health vans for care.

"Even though they did a lot for me on the medical van, there were just some things they just couldn't do," she says. "And so, as far as mammograms and Pap smears, and being over 40, I decided it was time that I came down here and got Access Health."

That was three weeks ago. Starting April 1, she'll pay $86 a month for her insurance. That's a lot better than the roughly $240 a month she had priced before the exchange plans were available.

Today she's back, bringing a friend in to enroll.

"I came home and I explained to ... all of my friends how easy it was and how comfortable it was," Tolson says. "It didn't take long at all, either. I was in-and-out within like 45 minutes to an hour. I felt very welcome. It was a very warm environment. It was nice."

The state's health care exchange says that Tolson is one of 10,000 people to have walked into one of its two retail stores — and that she's one of 5,000 to have actually enrolled.

This story is part of a reporting partnership that includes NPR, WNPR and Kaiser Health News.

Categories: Health Care

FAQ: What Are The Penalties For Not Getting Insurance?

Kaiser Health News - Mon, 03/24/2014 - 5:01am

If you're uninsured, now's the time to buy a plan. March 31 is the end of the annual open enrollment period when people who don’t have coverage through their employers can sign up on or off their state’s marketplace. With limited exceptions, people who miss this enrollment window will be unable to sign up for health insurance until next fall for coverage that starts in January 2015. In addition to being uninsured, you will face a penalty for not having coverage. The fine may be bigger than you expect. Here are the details:

Is everyone required to have health insurance this year or pay a fine?

This year, most people who can afford to buy health insurance but don’t do so will face a penalty, sometimes called a "shared responsibility payment." The requirement to have health insurance applies to adults and children alike, but there are exceptions for certain groups of people and those who are experiencing financial hardship.

What kind of insurance satisfies the requirement to have coverage?

Most plans that provide comprehensive coverage count as "minimum essential coverage." That includes job-based insurance and plans purchased on the individual market, either on or off the exchange. Most Medicaid plans and Medicare Part A, which covers hospital benefits, count as well, as do most types of Tricare military coverage and some Veterans Administration coverage. 

Insurance that provides limited benefits generally doesn’t qualify, including standalone vision and dental plans or plans that only pay in the event someone has an accident or gets cancer or another specified illness.

If I don’t have health insurance, how much will I owe?

In 2014, the penalty is the greater of a flat $95 per adult and $47.50 per child under age 18, up to a maximum of $285 per family, or 1 percent of your family’s modified adjusted gross income that is over the threshold the requires you to file a tax return. That threshold is $10,150 for an individual, $13,050 for a head of household and $20,300 for a married couple filing jointly.

Next year the penalty increases to $325 per adult or 2 percent of income, and in 2016 it will be the greater of $695 or 2.5 percent of income.

The $95 penalty has gotten a lot of press, but many people will be paying substantially more than that. A single person earning more than $19,650 would not qualify for the $95 penalty ($19,650 - $10,150 = $9,500 x 1% = $95). So the 1 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose MAGI is $35,000, the penalty would be $249 ($35,000 - $10,150 = $24,850 x 1% = $249). 

The penalty is capped at the national average price for a bronze plan, or about $9,800, says Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service. The vast majority of taxpayers’ incomes aren’t high enough to be affected by the penalty cap, he says.

Many more people will be able to avoid the penalty altogether because their income is below the filing threshold. 

Are there any special circumstances that allow me to get insurance outside the annual open enrollment period?

Yes. If you have a change in your life circumstances such as getting married, adopting a child or losing your job and your health insurance, it may trigger a special enrollment period when you can sign up for or change coverage and avoid paying a fine. In addition, if your income is low  and meets guidelines in the law, you can generally sign up for your state’s Medicaid or CHIP program at any time. 

I’m uninsured and signed up on the exchange in March for a plan that starts May 1. Will I owe a penalty for the first four months of the year?

No. In October, the Department of Health and Human Services released guidance saying that anyone who signs up for coverage by the end of the open enrollment period on March 31 will not owe a fine for the months prior to the start of coverage. 

What if I have a gap in coverage this year after open enrollment ends? Will I have to pay a fine?

It depends. If the gap in coverage is less than three consecutive months, you can avoid owing a penalty. Subsequent coverage gaps during the year, however, could trigger a fine.

If you have coverage for even one day during a month, it counts as coverage for that month. The penalty, if there is one, would be calculated in monthly increments.

Are parents responsible for paying the penalty if their kids don’t have coverage?

They may be. If you claim a child as a dependent on your tax return, you’ll be on the hook for the penalty if the child doesn’t have insurance. In cases where parents are divorced, the parent who claims the child as a tax dependent would be responsible for the penalty. 

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 (see above).

  • The lowest priced available plan costs more than 8 percent of your income.

  • Your income is less than 138 percent of the federal poverty level (currently $15,856 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.

  • Your individual insurance plan was cancelled and you consider plans on the marketplace are unaffordable.

  • 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.

For a more complete list go to the exemptions page at  healthcare.gov or the questions and answers page on shared responsibilities provisions on the IRS website. 

When should I claim or file for an exemption? 

There’s no one-size-fits-all answer. You can claim some of the exemptions when you file your tax return in 2015, but for others, you will have to complete an exemption application available at healthcare.gov

If you believe you may be eligible for an exemption for financial reasons, experts recommend filling out the paperwork now, if possible, based on your current income and other information. That way, if your circumstances change later in the year -- if your income goes up, for example, and you no longer qualify for an exemption based on plan affordability -- having a certificate of exemption should enable you to avoid owing the penalty. In addition, losing a hardship exemption triggers a special enrollment period to buy a plan outside the annual open enrollment period, but only if you have a hardship exemption in hand.  

“From a consumer perspective, even though it’s kind of a burden to go through the process, it makes sense to get the hardship exemption certificate, to be safe,” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. 

Are U.S. citizens living overseas subject to the penalty for not having insurance? 

If you live abroad for at least 330 days during a 12-month period, you aren’t required to have coverage in the States. 

What happens if I don’t pay the penalty?

The IRS may offset your income tax refund to collect the penalty, but that’s about it. Unlike other situations where the tax agency can garnish wages or file liens to collect unpaid taxes, the health law prohibits these activities in cases where people don’t pay the penalty for not having insurance.

Categories: Health Care

Political Cartoon: 'Youth Will Be Served?' By Nate Beeler, The Columbus Dispatch

Kaiser Health News - Mon, 03/24/2014 - 5:01am

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March 20, 2014

 

You can see more of Nate Beeler's work at The Columbus Dispatch.

Cartoons are the property of their respective artists and are subject to copyright laws. Do not reproduce or redistribute this cartoon without permission of the artist.

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Categories: Health Care

Draft Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors

Kaiser Health News - Mon, 03/24/2014 - 5:01am

Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other health care providers.

The proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall.

The government's response is part of the 148-page announcement of proposed rules and payment rates for next year’s Medicare Advantage plans released last month by the U.S. Centers for Medicare & Medicaid Services. Officials say that the terminations only a few weeks before Medicare's Dec. 7 enrollment deadline may not have given seniors enough time to find new doctors, choose a different plan or rejoin traditional Medicare, which does not restrict beneficiaries to a limited network of providers.

The proposals would give beneficiaries more than 30 days' advance notice of network changes and providers at least 60 days' advance notice of a contract termination. Even Medicare officials need more advance notice – "no less than 90 days" – so they can ensure that the remaining providers "will continue to meet required network standards." Officials are soliciting suggestions on how plans should prove that their reconfigured networks are adequate.

The physician terminations sparked protests to Medicare and UnitedHealthcare from patients, as well as physician groups across the country, state officials and members of Congress.

Nearly 16 million people, about a third of Medicare beneficiaries, are enrolled in private Medicare Advantage plans, which are an alternative to traditional Medicare. The government reimburses insurers to care for these seniors.

Although the announcement does not name any insurance companies, officials prefaced the proposals by writing, "Recent significant mid-year changes to MAOs' [Medicare Advantage organizations’] provider networks have prompted CMS to reexamine its current guidance on these requirements and to consider augmenting such guidance in response to such changes."

Medicare Advantage rules allow beneficiaries to change plans if they move out of the coverage area or for other special reasons, but not if they lose their doctors or hospitals. Otherwise, they can switch plans only once a year, during the annual seven-week, fall enrollment period. Since most beneficiaries are locked into their plans, CMS is considering whether to restrict insurers' ability to drop doctors during the plan year.

If insurers expect to drop providers in the coming year, they should say so in the letter highlighting changes that they are required to send to plan members every year before the open enrollment season. CMS would also add "required language" to the letter explaining patients' rights in the event that network providers leave the plan during the plan year.

Final rules are expected as early as April 7.

"These are exactly the things we talked about with CMS back in the fall," said Mark Thompson, executive director of the Fairfield County (Conn.) Medical Association, which, along with the Hartford County Medical Association, sued UnitedHealthcare to block the terminations. The American Medical Association and 35 state medical associations and physician advocacy groups filed legal papers in support of the doctors.

"Someone was paying attention and listening to us," Thompson said.

A federal court judge in December issued an injunction halting the cancellations in those counties and a panel of three federal appeals court judges in February upheld that decision until the doctors had time to challenge their terminations before independent arbitrators.

Representatives for UnitedHealthcare and Humana, the two leading Medicare Advantage insurers, declined to answer questions or provide copies of their comments to CMS related to the proposals. UnitedHealthcare said earlier the cancellations were partly the result of cuts in federal reimbursements required by the Affordable Care Act and also part of an effort to improve quality and reduce costs.

However, America's Health Insurance Plans, which represents more than 1,300 health insurers, warned CMS that the proposed rules could hinder insurers' contract negotiations with providers, which "occur throughout the year" and could also weaken enforcement of contract terms that allow for provider terminations. In addition, notifying beneficiaries of potential terminations before contracts may be successfully completed "would be unnecessarily disruptive," the group says.

Contact Susan Jaffe at Jaffe.KHN@gmail.com 

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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