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Mouthguards: Add One to Your Student Athlete’s Back-to-School List

Posted Aug 24, 2016
By Jenifer Dorsey

Mouthguards: Add One to Your Student Athlete’s Back-to-School List

 

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Will Obamacare Cost Sharing Reduction Subsidies Be Available in 2017, Or Are They Ending?

Posted Aug 23, 2016
By Jenifer Dorsey

Will Obamacare Cost Sharing Reduction Subsidies Be Available in 2017, Or Are They Ending?

 

As we approach the 2017 open enrollment period, the Affordable Care Act continues to face scrutiny and challenges. Last summer’s Supreme Court Decision in the King v Burwell case determined the fate of advanced premium tax credits—they remain in place for coverage purchased both the state-based and federally facilitated exchanges.

This year’s case: House v. Burwell. On the line this time: the cost sharing reductions that lower out-of-pocket healthcare costs for consumers who earn up to 250 percent of the federal poverty level and purchase silver plans through state-based and federally facilitated exchanges.

 

 

Legality of cost sharing reductions in question

Here is how cost sharing reductions currently work:

  • A consumer purchases a silver plan through a state-based and federally facilitated exchange and applies for Obamacare subsidies to help reduce her monthly premium and out-of-pocket expenses. Because she earns less than 250 percent of the federal poverty level, she qualifies for both an advanced premium tax credit and a cost sharing subsidy.
  • Her plan’s cost sharing subsidy further reduces her out-of-pocket share of covered healthcare expenses, including deductible, coinsurance and copay amounts. When this consumer visits the doctor, she is billed by her health insurance plan according to her plan’s usual benefits as well as the percentage of cost sharing reduction for which she is eligible.
  • Her health insurer picks up the tab and rather than pass the extra costs on to other consumers. The company then bills and is reimbursed by the federal government.[1]

So, what exactly is the key issue in House v. Burwell? The U.S. House of Representatives brought forth the lawsuit, claiming that, according to Article I of the Constitution, the executive branch cannot spend money without congressional appropriation.[2]

House v. Burwell decision

On May 12, 2016, Judge Rosemary Collyer of the federal district court for the District of Columbia ruled in favor of the House.[3] However, she has allowed for an appeal to a federal court of appeals or the Supreme Court and has not yet put a stop to the spending. As such, cost sharing reductions (i.e., CSRs) remained available at the time this article was published.

CSRs available now, but what about 2017?

With the administration currently appealing the decision, there is no way of knowing what the future holds.

 

 

What could happen if cost sharing subsidies go away?

If Collyer’s decision is upheld, the impact could affect consumers, health insurance companies, and the federal government.

There is a range of possible scenarios. Among them, it is said that if the decision is upheld on appeal, high-level Obamacare officials could face criminal charges if a subsequent President or Attorney General were to pursue them.[4] As far as insurance companies go, experts speculate that they may raise premiums if government reimbursement ceases.[5]

The Commonwealth Fund estimates that, in 2016, as many as 7 million Americans have health insurance with cost-sharing reductions.[6] HHS data shows the following breakdown for consumers receiving cost sharing reductions[7]:

  • 59 percent live in states with federally facilitated exchanges
  • 46 percent live in states with state-based marketplaces that use the HealthCare.gov platform

No comprehensive estimate for the 13 states with entirely state-based exchanges is available at this time.[8]

Obamacare changes for 2016

It is unlikely changes that result from an upheld decision would immediately impact consumers or 2017 open enrollment.[9] However, consumers who face increased out-of-pocket costs—whether due to a future House v. Burwell decision or 2017 plan changes—may want to consider supplemental products such as a medical gap, critical illness, and telemedicine plans.

These products are available year-round and can be combined with Obamacare plans to help you pay your out-of-pocket share of medical bills and healthcare your plan doesn’t cover.

How much are supplemental plans? Get a free, no-hassle quote.

No contact information required unless you apply.

Call the number at the top of your screen to speak with a licensed health insurance producer who can answer your questions and help you find additional benefits.

 

 



[1] Chandler, Seth. “The Impact Of Judge Collyer’s Ruling In House v. Burwell.” Forbes. May 15, 2016. http://www.forbes.com/sites/theapothecary/2016/05/15/the-impact-of-judge-collyers-ruling-in-house-v-burwell

[2] Blasé, Brian. “Judge Rules Administration Illegally Delivering Funds to Insurers Participating In Obamacare.” Forbes. May 12, 2016. http://www.forbes.com/sites/theapothecary/2016/05/12/judge-rules-administration-illegally-delivering-funds-to-insurers-participating-in-obamacare

[3] Denniston, Lyle. “Judge: Billions Spent Illegally on ACA Benefits.” SCOTUSblog. May 12, 2016. http://www.scotusblog.com/2016/05/judge-billions-spent-illegally-on-aca-benefits/

[4] Chandler, Seth. “The Impact Of Judge Collyer’s Ruling In House v. Burwell.” Forbes. May 15, 2016. http://www.forbes.com/sites/theapothecary/2016/05/15/the-impact-of-judge-collyers-ruling-in-house-v-burwell

[5] Schencker, Lisa. “House Republicans Won Their ACA Lawsuit. Here’s What Happens Next.” Modern Healthcare. May 12, 2016. http://www.modernhealthcare.com/article/20160512/NEWS/160519949

[6] S. R. Collins, M. Gunja, and S. Beutel, How Will the Affordable Care Act's Cost-Sharing Reductions Affect Consumers' Out-of-Pocket Costs in 2016? The Commonwealth Fund, March 2016. http://www.commonwealthfund.org/publications/issue-briefs/2016/mar/cost-sharing-reductions

[7] U.S. Department of Health & Human Services. Office of the Assistant Secretary for Planning and Evaluation. “Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report.” March 11, 2016. https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report

[8] Ibid.

[9] Schencker, Lisa. “House Republicans Won Their ACA Lawsuit. Here’s What Happens Next.” Modern Healthcare. May 12, 2016. http://www.modernhealthcare.com/article/20160512/NEWS/160519949

This document is for general informational purposes only. While we have attempted to provide current and accurate information, this information is provided "as is" and we makes no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.

SHORT-TERM MEDICAL EXPENSE (STM)
THIS IS A SHORT TERM HEALTH BENEFIT PLAN THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS POLICY INCLUDES A PRE-EXISTING CONDITION EXCLUSION PROVISION.

About The IHC Group
Independence Holding Company (NYSE: IHC) is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual disability, specialty and supplemental health, pet, and life insurance through its subsidiaries since 1980. The IHC Group (including through its 92% ownership of American Independence Corp. (NASDAQ: AMIC)) owns three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company), a majority of Ebix Health Administration Exchange, Inc., a fully insured third party administrator, and IHC Specialty Benefits, Inc., which is a technology-driven insurance sales and marketing company that creates value for insurance producers, carriers and consumers (both individuals and small businesses) through a suite of proprietary tools and products (including ACA plans and small group medical stop-loss). All products are placed with highly rated carriers.

IHC Specialty Benefits, Inc.
IHC Specialty Benefits, Inc., doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products via general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit http://www.HealtheDeals.com.

Continue Reading: Will Obamacare Cost Sharing Reduction Subsidies Be Available in 2017, Or Are They Ending?


What Makes Obamacare Affordable?

Posted Aug 19, 2016
By Jenifer Dorsey

What Makes Obamacare Affordable?

 

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Is the Obamacare smoking penalty working?

Posted Aug 16, 2016
By Jenifer Dorsey

Is the Obamacare smoking penalty working?

When it comes to tobacco use and smoking, the Affordable Care Act includes a couple of key provisions:

Continue Reading: Is the Obamacare smoking penalty working?


Do I Need Dental Insurance If I Have an Obamacare Plan?

Posted Aug 15, 2016
By Jenifer Dorsey

Do I Need Dental Insurance If I Have an Obamacare Plan?

 

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Are Immunizations Free Under Obamacare?

Posted Aug 12, 2016
By Jenifer Dorsey

Are Immunizations Free Under Obamacare?

 

What Vaccines Are Covered By ACA Health Insurance Plans

Immunization vaccines are considered an important part of preventive healthcare for children and adults.[1] As such, the Affordable Care Act requires private group and individual health insurance plans to include vaccines among covered preventive services—covered preventive services are offered to insured adults and children at no additional cost beyond their monthly plan premium.

Need insurance now?

Get a quote for short term coverage

Find out if you qualify for special enrollment—call the number at the top of your screen for assistance

ACA-covered immunization vaccines

The Advisory Committee on Immunization Practices recommended which immunization vaccines for adults and children should be among Obamacare’s covered preventive services.[2] These vaccines include the following and apply to all major medical plans effective on or after Sept. 23, 2010, whether they are purchased in the private market or from a state-based or federally facilitated health insurance exchange:

Adults[3]

  • Diphtheria
  • Hepatitis A
  • Hepatitis B
  • Herpes zoster
  • Human papillomavirus (HPV)
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis (whooping cough)
  • Pneumococcal
  • Rubella
  • Tetanus
  • Varicella (chickenpox)

2016 recommended immunizations for adults, by age (ages 19 and older)

Children[4]

  • Diphtheria, tetanus, pertussis (whooping cough)
  • Haemophilus influenzae type B
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus (PVU)
  • Inactivated poliovirus
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella (chickenpox)

2016 childhood immunization schedule (birth through 6 years old)

2016 adolescent immunization schedule (7 through 18 years old)

Immunizations covered by Medicare, Medicaid, CHIP

If you and your family members are covered by Medicare, Medicaid, CHIP or other health insurance plans that may or may not qualify as minimum essential coverage under Obamacare, check with your plan to determine immunization benefits.

A note on ACA-covered immunization vaccines schedules, doctor recommendations

Vaccine doses, the recommended age at which they are received and the populations that should receive them may vary. Your healthcare provider will suggest an immunization schedule appropriate for you.

Even with Obamacare’s essential health benefits and covered preventive services, health insurance benefits differ by plan. Always check with your health insurance plan to confirm your current benefits for immunizations and other healthcare. 

Uninsured?

Learn about your coverage options.

Or, call the number at the top of your screen to speak with a licensed health insurance producer.

 

 

 

Originally posted September 2, 2015. Last reviewed and updated August 12, 2016.



[1] U.S. Department of Health & Human Services. “The Affordable Care Act and Immunization.” Last updated Jan. 20, 2012. http://www.hhs.gov/healthcare/facts/factsheets/2010/09/The-Affordable-Care-Act-and-Immunization.html

[2] Ibid.

[3] HealthCare.gov. “Preventive Care Benefits for Adults.” Accessed Aug. 8, 2016. https://www.healthcare.gov/preventive-care-adults/

[4] HealthCare.gov. “Preventive Care Benefits for Children.” Accessed Aug. 8, 2016. https://www.healthcare.gov/preventive-care-children/

SHORT-TERM MEDICAL EXPENSE (STM)
THIS IS A SHORT TERM HEALTH BENEFIT PLAN THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS POLICY INCLUDES A PRE-EXISTING CONDITION EXCLUSION PROVISION.

About The IHC Group
Independence Holding Company (NYSE: IHC) is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual disability, specialty and supplemental health, pet, and life insurance through its subsidiaries since 1980. The IHC Group (including through its 92% ownership of American Independence Corp. (NASDAQ: AMIC)) owns three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company), a majority of Ebix Health Administration Exchange, Inc., a fully insured third party administrator, and IHC Specialty Benefits, Inc., which is a technology-driven insurance sales and marketing company that creates value for insurance producers, carriers and consumers (both individuals and small businesses) through a suite of proprietary tools and products (including ACA plans and small group medical stop-loss). All products are placed with highly rated carriers.

IHC Specialty Benefits, Inc.
IHC Specialty Benefits, Inc., doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products via general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit http://www.HealtheDeals.com.

Continue Reading: Are Immunizations Free Under Obamacare?


Who Sells Short Term Health Insurance?

Posted Aug 05, 2016
By Jenifer Dorsey

Who Sells Short Term Health Insurance?

Short term medical insurance is a temporary coverage option for when you are between major medical insurance plans. They provide benefits that help you pay for healthcare expenses due to unexpected illnesses and injuries. 

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Pokemon Go Injuries, Selfie Spills and Smartphone Safety

Posted Aug 04, 2016
By Jenifer Dorsey

Pokemon Go Injuries, Selfie Spills and Smartphone Safety

 

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Dental Checkups: A Back-to-School Essential

Posted Aug 01, 2016
By Jenifer Dorsey

Dental Checkups: A Back-to-School Essential

 

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You Need Health Insurance Now — A Plan Option with Temporary Benefits for One Month or Until 2017

Posted Jul 29, 2016
By Jenifer Dorsey

You Need Health Insurance Now — A Plan Option with Temporary Benefits for One Month or Until 2017

 

Continue Reading: You Need Health Insurance Now — A Plan Option with Temporary Benefits for One Month or Until 2017