2017 Medicare Parts A & B Premiums and Deductibles Announced. On October 18, 2016, the Social Security Administration announced that the cost-of-living adjustment (COLA) for Social Security benefits will be 0.3 percent for 2017. Because of the low Social Security COLA, a statutory “hold harmless” provision designed to protect seniors, will largely prevent Part B premiums from increasing for about 70 percent of beneficiaries. Among this group, the average 2017 premium will be about $109.00. A modest increase compared to $104.90 for the past four years.
For the remaining roughly 30 percent of beneficiaries, the standard monthly premium for Medicare Part B will be $134.00 for 2017, a 10 percent increase from the 2016 of $121.80. Because of the “hold harmless” provision covering the other 70 percent of beneficiaries, premiums for the remaining 30 percent must cover most of the increase in Medicare costs for 2017 for all beneficiaries. This year, as in the past, the Secretary has exercised her statutory authority to mitigate projected premium increases for these beneficiaries. While continuing to maintain a prudent level of reserves to protect against unexpected costs. The Department of Health and Human Services (HHS) will work with Congress as it explores budget-neutral solutions to challenges created by the “hold harmless” provision.
“Medicare’s top priority is to ensure that beneficiaries have affordable access to the care they need,” said CMS Acting Administrator Andy Slavitt. “We will continue our efforts to improve affordability, access, and quality in Medicare.” Medicare Part B beneficiaries below are not subject to the “hold harmless” provision. These groups represent approximately 30 percent of total Part B beneficiaries.
This includes beneficiaries who do not receive Social Security benefits
those who enroll in Part B for the first time in 2017
those who are directly billed for their Part B premium
those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies
those who pay an income-related premium
CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $183 in 2017 (compared to $166 in 2016). Premiums and deductibles for Medicare Advantage and prescription drug plans are already finalized and are unaffected by this announcement.
Breaking: All Health Republic plans (Group and Individual) ending on 11/30. according to early reports the healthcare Co-Op Health Republic NY will be shutting down Nov 30, 2015. New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the Centers for Medicare and Medicaid Services (CMS) announced additional actions regarding Health Republic Insurance of New York (“Health Republic”) and a transition plan for Health Republic customers.
Oct 28th – Utah Healthcare Co-Op shutting down end of 2015. This sis the 5th Co-Op to shut down
June 2015 – With a spike in rate increase of 15-20% for 2016 to reflect unexpected high costs of new 200,000 membership the most affordable health plan was experiencing difficulties. The insurer reported $130 million in losses during its first 18 months of operations, according to financial filings, even as it enrolled more customers than any other insurer. DFS did allow for a 13 percent increase in the second year and a 14 percent increase heading into 2016. Both were lower than what Health Republic requested, though, and were not enough to save the struggling insurer.
May 2015- Health Republic was dealt its death blow when it became clear that the Affordable Care Act’s risk corridor program would not be fully funded, said one source familiar with the company’s finances. A report from Standard & Poor’s in May said the program had only 10 percent of the funds needed to make payments.
Summer 2013 -Health Republic had borrowed $265 million to begin operations.
New Insurance Risk Corridors paid for by a combination of both consumer insurance premium surcharge tax of 2-3% and Health Insurers is suppose to reclaim capital to those that are less profitable. Health Republic was owed approximately $147 million but was told by the Centers for Medicare and Medicaid Services to expect less than half that according to sources.
Regrettably, we all suffer when an Insurer exits the market. Furthermore, it will be a while again when Federal funds earmarked to start a low cost affordable health plans will materialize again. We are pulling for neighboring co-op Health Republic of NJ and hope this trend discontinues.
Our agency will be working closely with our clients to mitigate this exposure and transition smoothly for Dec 1, 2015. Individuals on the Marketplace can contact the New York State Department of Financial Services Consumer Hot Line with questions regarding Health Republic by calling 1-800-342-3736. The Hot Line hours are weekdays (Monday through Friday) from 8:00 a.m. to 8:00 p.m., and Saturday from 9:00 a.m. to 1:00 p.m.
Please Click here to read the full Press Release from NYDFS.
Stay posted, more news to follow. Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please contact us firstname.lastname@example.org today.
With first new star rankings released yesterday by CMS (Center for Medicare & Medicaid Services) this will be a little easier for consumers. The role of Government in medical transparency have long been touted as a qualitative and cost factor. The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality.
The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:
• How well nurses and doctors communicated with patients
• How responsive hospital staff were to patient needs
• How clean and quiet hospital environments were
• How well patients were prepared for post-hospital settings
Only 251 hospitals–or 7 percent of those ranked–received a five-star rating under the new system, Kaiser Health Newsreported. The largest share of hospitals (40 percent) received three stars, including highly respected institutions such as Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan and Northwestern Memorial Hospital in Chicago. Only 3 percent of hospitals netted one star.
Consumers will now see 12 HCAHPS Star Ratings on Hospital Compare, one for each of the 11 publicly reported HCAHPS measures, plus a summary star rating that combines or rolls up all the HCAHPS Star Ratings. These star ratings will be updated each quarter. Also, the Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality.
United Healthcare Dropping Medicare Docs. United Healthcare has notified 10-15% of its Medicare Advantage Providers that they will be dropped from their network this February.
Providers are calling the move by the insurer to increase their star rating in order to increase Medicare (CMS) reimbursements. Quality-incentive payments to insurers under CMS’ five-star rating system for health plans will get stricter in 2014, eliminating payments to any plan earning fewer than four stars. Over the past two years, plans with 3 or 3.5 stars received payments.
According to today’s WSJ article UnitedHealth Culls Doctors From Medicare Advantage Plans – The company said it is managing its network, in part, to provide more value for members, particularly given Medicare’s new five-star rating system that ties bonus payments for insurers to certain measures of cost and quality.”That’s what’s driving our actions,” said Austin Pittman, president of UnitedHealth’s networks. He also said, “It’s no secret that we are under substantial funding pressure from the federal government.”
According to a study by the Kaiser family Foundation, United received $540 million in bonus payments in 2012 — the largest share for any single carrier. United had a CMS rating of 3.17 stars that year, according to the study.
This is important as AARP endorses the popular AARP Medicare Advantage Insurance Plans, insured by UnitedHealthcare Insurance Company. According to WSJ article AARP issued a
statement saying it “has heard from a small number of our members regarding this decision” and was encouraging anyone with concerns to contact UnitedHealth directly.
The article points out “Medicare Advantage, an alternative to traditional Medicare, combines hospital and doctor coverage and often includes prescription drugs and perks like gym memberships. Enrollment has more than doubled since 2004 to 13 million in 2012, which represents about 27% of Americans on Medicare.” Also worth noting, “providers have the right to an appeal within 30 days.”
2014 Medicare Open Enrollment is here. Medicare Open Enrollment for 2014 ends Dec 7th. We, at Millennium Medical Solutions Inc, are working closely with affected members to help them find new providers and that patients enrolled in its commercial, Medicaid and Medicare supplement plans are not affected by the changes. Some members may turn back to original Medicare as a result of possibly losing their Doctors.
Download a Copy Of The Medicare and You 2014 Handbook Here.
Is your Doctor still in the network? Is Medicare Advantage still right for you? Please contact us for immediate review at (855) 667-4621. Please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
The sheer technological volume of it all could bring “rolling brown outs” similar to electrical grids. Try to imagine a scenario of credit union Experien working with IRS then Social Security & Center for Medicare & Medicaid Services’s dated mainframe computer system while balancing HIPAA and privacy sensitive information. All this while millions of people converge simultaneously onto the information highway. Visualize all of the U.S. Daily Commuters driving into Manhattan today.
As reported below by Reuters’ Sharon Begley Obamacare 1.0: States brace for Web barrage when reform goes live: “Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), could fail for many reasons, including participation by too few of the uninsured and a shortage of doctors to treat those who do sign up. But because its core is government-run marketplaces selling health insurance online, the likeliest reason for failure at the opening bell is information technology snafus, say experts who are helping with the rollout.”
(Reuters) – About 550,000 people in Oregon do not have health insurance, and Aaron Karjala is confident the state’s new online insurance exchange will be able to accommodate them when enrollment under President Barack Obama’s healthcare reform begins on October 1.
What Karjala, the chief information officer at “Cover Oregon,” does worry about, however, is what will happen if the entire population of Oregon – 3.9 million – logs on that day “just to check it out,” he said. Or if millions of curious souls elsewhere, wondering if Oregon’s insurance offerings are better than their states’, log on, causing Cover Oregon to crash in a blur of spinning hourglasses and color wheels and an epidemic of frozen screens.
Multiply that by another 49 states and the District of Columbia, all of which will open health insurance exchanges under “Obamacare” that same day, and you get some idea of what could go publicly and disastrously wrong.
Obamacare, formally known as the Patient Protection and Affordable Care Act (ACA), could fail for many reasons, including participation by too few of the uninsured and a shortage of doctors to treat those who do sign up. But because its core is government-run marketplaces selling health insurance online, the likeliest reason for failure at the opening bell is information technology snafus, say experts who are helping with the rollout.
Although IT is the single most expensive ingredient of the exchanges, with eight-figure contracts to build them, experts expect bugs, errors and crashes. In April, Obama himself predicted “glitches and bumps” when the exchanges open for business.
“This is a 1.0 implementation,” said Dan Maynard, chief executive of Connecture, a software developer that is providing the shopping and enrollment functions for several states’ insurance exchanges. “From an IT perspective, 1.0’s come out with a lot of defects. Everyone is waiting for something to go wrong.”
Two states that intended to build their own exchanges, Idaho and New Mexico, announced this spring that because of the tight timeline and daunting challenges they would have the federal government operate their IT systems.
“Nothing like this in IT has ever been done to this complexity or scale, and with a timeline that put it behind schedule almost before the ink was dry,” said Rick Howard, research director at the technology advisory firm Gartner.
WHAT COLOR WAS YOUR VOLVO?
The potential for problems will begin as soon as would-be buyers log onto their state exchange. They’ll enter their name, birth date, address and other identifying information. Then comes the first IT handoff: Is this person who she says she is?
To check that, credit bureau Experian will check the answers against its voluminous external databases, which include information from utility companies and banks on people’s spending and other history, and generate questions. The customer will be asked which of several addresses he previously lived at, for example, whether his car has one of several proffered license plate numbers, and what color his old Volvo was.
It’s similar to the system that verifies identity for accessing personal Social Security information. If someone gets a question wrong, he will be referred to Experian’s help desk, and if that fails may be asked to submit documentation to prove he is who he claims to be.
The next step is determining if the customer is eligible for federal subsidies to pay for insurance. She is if she is a citizen and her income, which she will enter, is less than four times the federal poverty level. To verify this, the exchange pings the “federal data services hub,” which is being built by Quality Software Services Inc under a $58 million contract with the Centers for Medicare & Medicaid Services (CMS).
The query arrives at the hub, which does not actually store information, and is routed to online servers at the Internal Revenue Service for income verification and at the Department of Homeland Security for a citizenship check.
The answers must be returned in real time, before the would-be buyer loses patience and logs off. If the reported income doesn’t match the IRS’s records, the applicant may have to submit pay stubs.
These federal computer systems have never been connected before, so it’s anyone’s guess how well they’ll communicate.
“The challenge for states,” said Jinnifer Wattum, director of Eligibility and Exchange Solutions at Xerox’s government healthcare unit, is that they have to build “the interfaces needed with the federal data services hub without knowing what this system will look like.” That makes the task akin to making a key for a lock that doesn’t exist yet.
CMS’s contractors are working to finish the hub, but “much remains to be accomplished within a relatively short amount of time,” concluded a report from the Government Accountability Office (GAO), the investigative arm of Congress, in June. CMS spokesman Brian Cook said the hub would be ready by September, and that the beta version had been tested for its ability to interact with the exchanges Oregon and Maryland are building.
The federal hub has to verify even more arcane data, such as whether the insurance offered to a buyer through his job is unaffordable, in which case he may qualify for federal subsidies, and whether the buyer is in prison, in which case she is exempt from the mandate to purchase insurance.
If someone’s income qualifies him for Medicaid, or his children for the Children’s Health Insurance Program (CHIP), software has to divert him from the ACA exchange and into those systems. Many of the computers handling Medicaid and CHIP enrollment are, as IT people diplomatically put it, “legacy systems,” meaning old, even decades old.
Many are mainframes, lacking the connectivity of cloud computing. They typically process eligibility requests in days, not seconds.
The legacy systems “rely on daily or weekly batch files to pass information back and forth,” and often require follow-up phone calls, said Wattum of Xerox, which is working to configure Nevada’s exchange so it can interface with the federal hub.
‘NO WRONG DOOR’
A “we’ll call you” message is unacceptable under Obamacare, which has a “no wrong door” goal: A buyer must never come to a dead end. If she is diverted to Medicaid, for instance, she must not be required to resubmit information, let alone wait a week for an answer about whether she’s now enrolled.
State IT systems must therefore “be interoperable and integrated with an exchange, Medicaid, and CHIP to allow consumers to easily switch from private insurance to Medicaid and CHIP,” said an April report from the Government Accountability Office (GAO), the investigative arm of Congress.
To make all those systems communicate, the state exchanges must either develop entirely new systems or use application programming interfaces (APIs) that work with the legacy systems to exchange data in real time. APIs are programming instructions for accessing Web-based software applications.
GAO’s Stan Czerwinski compares the necessary connectivity to adapters that let Americanelectronics work with European outlets.
State officials told the GAO that verifying eligibility, enrolling buyers and interfacing with legacy systems are the most “onerous” aspects of developing their exchanges, “given the age and limited functionality of current state systems.”
A key goal for exchange officials is keeping would-be buyers in the portal so they don’t give up and use a state’s ACA call center, which could quickly be swamped.
To avoid this, Oregon brought in potential users to test design prototypes, recorded what people did and where they had trouble, and tweaked the consumer interface to make it as user-friendly as possible, said Karjala.
“Even with that, if you have a family of four and you’re eligible for a tax credit to offset your premium,” he said, “you could be sitting at the computer for a long time.”
What everyone hopes to avoid is a repeat of the early days of the Medicare prescription-drug program in 2006. Some seniors who tried to sign up for a plan were mistakenly enrolled in several, while others had the wrong premium amounts deducted from their Social Security checks.
Another challenge is capacity. Websites regularly crash when too many people try to access them.
“I had no choice but to be extremely conservative” in estimates of how many simultaneous users Cover Oregon has to be prepared for, Karjala said. “Building capacity is the only way to avoid the spinning hourglass or the site freezing, so in our performance testing we’re seeing what happens if the whole U.S. population came to Cover Oregon to check it out.”
This summer, state exchanges will test their ability to communicate with the federal data hub, whose security frameworks and connectivity protocols are still works in progress. But whether Obamacare 1.0 flies won’t be known until the new health plans take effect on January 1. Robert Laszewski, president of Health Policy and Strategy Associates Inc, a consulting firm, said he wouldn’t be surprised if some patients showing up at doctors’ offices next year with Obamacare policies are told their insurers never heard of them.
(Additional reporting by Caroline Humer; Editing by Michele Gershberg and Prudence Crowther)