Most people who enroll in an exchange/Marketplace health plan are eligible for an advance premium tax credit (APTC). But it’s important to understand how this is reconciled with the IRS after the year is over.
colorado
Screening Colonoscopy Incorrectly Billed as Diagnostic
As long as you use an in-network facility, all costs associated with a screening colonoscopy should be paid by the health plan, including the bowel preparation drink, the facility fee, the doctor’s fee, and the anesthesiologist’s fee.
What is an Expanded Bronze Plan?
there is also an option to offer “expanded” bronze plans that can have higher AV than regular bronze plans. In order to be considered expanded bronze, a plan must
What is Silver Loading in the Connect for Health Colorado ACA Exchange?
On exchange with Silver Loading (no Cost Sharing Reduction) vs Off Exchange
Anthem Introduces New Accident And Critical Illness Benefits In Colorado
[…] For individuals and families who are healthy and rarely need their health insurance benefits, an accident may be their primary concern. Obviously we’re all susceptible to illness aswell, but accidents have a more “out of the blue” quality to them, and can happen to even the healthiest of people. We’ve never needed our health insurance due to illness, but we’ve had a few injuries over the years that have been pretty costly. Stitches and x-rays on our son’s finger alone came to $1,400. The charges can add up quickly when you’re in an emergency room, and if you have a high deductible health insurance policy, you’d be responsible for the entire bill for an incident like that. An accident supplement that will cover all or a portion of the deductible can help people feel more at ease with a high deductible (ie, less expensive) health insurance policy.
The accident supplement portion of Balance will coordinate with your health insurance, so it will pay you either your out-of-pocket amount or the Balance benefit maximum, which ever is lower. For example, if your out-of-pocket expenses for an accident – after health insurance has paid its portion – come to $1750 and you have the $2500 benefit Balance plan, you’ll get $1750 in supplemental coverage. But if your out-of-pocket expenses come to $4500, you’ll get the full $2500. The critical illness benefit is a lump-sum payment, but the amount paid depends on the specific diagnosis.
With the introduction of Balance, Anthem Blue Cross Blue Shield has added another solid plan to the options available for individuals and families in Colorado who are looking for an accident and critical illness supplement to go along with their health insurance policy.
Best Health Insurance Companies In Colorado
We recently got a call from a client who mentioned that he had done a Google search for the “best health insurance companies in Colorado” and his concern was that Anthem Blue Cross Blue Shield was not on the top ten list that he said came up as the first search result. We were a… Read more about Best Health Insurance Companies In Colorado
IRS 2013 HSA Contribution Limits
The IRS announced that the 2013 HSA contribution limit for an individual would increase by $150, from $3,100 to $3,250. The family contribution limit is increasing from $6,250 to $6,450 (+$200).
The maximum annual out-of-pocket increased as well. The individual out of pocket maximum is going from $6,050 to $6,250. The family out of pocket maximum is increasing from $12,100 to $12,500.
The minimum deductible on an HSA qualified plan also increases from $1,200 to $1,250 for individuals and increases from $2,400 to $2,500 for families.
What are the 2012 HSA Contribution Limits?
According to the Patient Protection and Affordable Care Act, OTC drugs may be reimbursed only if there is a prescription.
Non-medical withdrawals from an HSA are taxable income and subject to a tax penalty, which increased from 10% in 2010 to 20% in 2011 and remains the same for 2013.
Exception to the IRS tax penalty for non-medical withdrawals:
The tax penalty does not apply if the withdrawal is made after you:
1) Attain age 65;
2) Become totally and permanently disabled; or
3) Die.
More details and research about HSAs and HSA qualified plans.
Hospital Payment Assistance Program Will Benefit Colorado’s Uninsured Population
[…] SB12-134 will result in some significant changes in terms of how uninsured patients are billed when they receive treatment in a hospital (note that the bill only applies to hospitals – outpatient clinics, medical offices, and other non-hospital providers will not be impacted). Most people are aware that private health insurance carriers have negotiated rates that are lower than the “retail” price for medical services. Medicare and Medicaid have even lower negotiated prices. The reason SB12-134 is so important is that uninsured patients (usually those who have the least ability to pay medical bills) typically get charged the retail price. There is usually a cash discount available, but most uninsured patients typically don’t have enough cash sitting around to pay the whole bill up front. So – assuming they are able to pay the bill at all – they often end up on a payment plan (sometimes through a third party where interest rates can rival those of credit cards) and ultimately pay far more than any insurance carrier would pay.
SB12-134 applies to medically necessary care provided to uninsured patients who have a family income of not more than 250% of the federal poverty level ($57,625 for a family of four in 2012). And SB12-134 applies only if the care is not eligible for coverage through the Colorado Indigent Care Program (CICP). For those patients, hospitals may not charge more than the lowest rate they have negotiated with a private health insurance plan. This is a huge change from the status quo.
SB12-134 also requires hospitals to clearly state their financial assistance, charity care, and payment plan information on their website, in patient waiting areas, directly to patients before they are discharged, and in writing on the patients’ billing statements. Hospitals will also have to allow a patient’s bill to go at least 30 days past due before initiating collections procedures. […]
Health Insurance Exchange Payroll and Admin Expenses
[…] One of the comments on the post was from Dede de Percin, the Executive Director of the Colorado Consumer Health Initiative (CCHI). […] Dede’s comment on my article referenced the point I made about consumers not having to pay additional fees to have a broker. Basically, health insurance is priced the same whether you go directly through a health insurance carrier (calling Anthem Blue Cross Blue Shield directly, for example) or through a broker (who will compare options from multiple carriers for you). Dede made this point:
“While a consumer or business doesn’t not pay a health insurance broker directly, broker fees and commissions are paid by the insurance companies – and rolled into […]”
Conflicting Data Regarding Medical Costs
[…] These numbers are much more in line with the rise in health insurance premiums that we’ve seen over the past few years. I have no explanation for why the data from the two sources is so dramatically different in terms of medical trend in 2010, but if the trend was really closer to 7.5% rather than 1.7%, the health insurance premium increases would be a lot easier to understand. […] In addition to the MLR rules, some states (including Colorado) have implemented strict review processes for rate hikes. The ACA now calls for insurers who propose a rate hike of 10% or more […]
The Opposite Of Transparent
[…] David also points out that the amounts allowed by his Blue Cross Blue Shield carrier don’t seem to have anything to do with the amounts billed by his physical therapies – the lowest allowed amount on his EOB was for the service that was billed with the highest price tag. We’ve also seen little rhyme or reason (that we can detect, anyway) in terms of how billed amounts and allowed amount correlate. […]
Stuck In A Mini-Med
[…] So he applied for an individual policy with Anthem Blue Cross for his family, and was approved. But then when he tried to cancel his mini-med plan, his employer told him that he couldn’t cancel it until the open enrollment period next April. It would seem that trapping enrollees into a year-long contract with a mini-med plan is not in line with the spirit of the HHS guidelines that call for full disclosure regarding the waivers and directives to steer enrollees towards healthcare dot gov if they are interested in getting a policy that does comply with the ACA rules regarding annual policy limits. […]
Grand Rounds – Colorado Fall Colors Edition
Henry Stern of InsureBlog brings us an interview with the whistleblower who has brought a lawsuit against LabCorp for allegedly charging a lower price to United HealthCare than to Medicare. The post is particularly interesting because Hank adds his own thoughts after the interview, and he sees things a little differently than Andrew Baker (the whistleblower). Hank agrees that it does look like LabCorp lowered their fees for UHC […]
Colorado Legislators Delay Health Benefits Exchange Grant Application
[…] That issue again appears to be a sticking point, with Colorado House Republicans blocking the health insurance exchange board from applying for a $22 million grant because the application mentioned changing Colorado regulations to “conform to federal requirements”. The grant application is due at HHS on Friday, and the exchange board will not be able to meet that deadline. They are hoping, however, to address the legislator’s concerns and be able to get the application submitted by the end of the year, to be considered in the second round of funding. […]
Colorado Health Insurance Exchange Board Hires Attorney General’s Office
[…] I’m confident that the Colorado Attorney General’s office will be able to provide competent legal advice to the exchange board. In addition, it appears that the board is getting an excellent value, since they’ll be paying less than $79/hour for a lawyer. But I assume that John Suthers is hoping to prevail in the lawsuit challenging the individual mandate, and I am a bit skeptical about whether the rest of the ACA (including the health insurance exchanges) could survive without the individual mandate.
Negotiating Premiums Doesn’t Lower The Cost Of Healthcare
[…] How would it help to have health insurance exchange boards negotiating with health insurance carriers to try to lower premiums – without addressing the root problem, which is the ever-increasing cost of healthcare? […] Much of the focus of the healthcare reform rhetoric has been on health insurance (availability, premiums, etc.), and some important issues have been addressed in the process. But we cannot continue to focus primarily on the cost of health insurance (or try to artificially lower it) without reducing the cost of healthcare.
Decline And Rate Up Statistics – Interesting But Confusing
[…] Your policy will cost the same amount regardless of whether you use a broker, but an experienced broker will be able to help you make sense of the plan comparison information, including the underwriting statistics. A policy or carrier’s statistical likelihood of declining or rating up any one application isn’t really relevant to each specific client… what is relevant however, is each carrier’s underwriting guidelines for the particular pre-existing condition the applicant has. […]
Colorado DOI Improving Transparency Of Rate Review Process
[…] This should help boost public participation in the rate review discussion, and add to the general understanding of how the rate review process works. The DOI is obviously working hard to create as much transparency as possible with regards to rate increases. Rates will continue to increase as long as the cost of health care continues to climb (and as long as we continue to increase our utilization of health care) but at least the logic behind the rate increases will be more clear.
Low Enrollment And Adverse Selection In High Risk Pools
[…]CoverColorado – the high risk pool that Colorado has had in place since the early 90s – instead allows eligible applicants to enroll as soon as they are without another coverage option, but makes them wait to receive coverage for pre-existing conditions if they have been uninsured prior to applying. That system encourages people to sign up as soon as they are eligible rather than waiting until they need care. It would seem that the federally-funded high risk pools might be able to boost their enrollment and also avoid adverse selection by switching to a similar eligibility model.
Federal Requirements For State Exchanges
[…] The guidelines that HHS set forth were designed to make sure that state-specific exchanges meet basic minimum standards, while still allowing the states to accomplish many of those standards however they see fit. And although some would criticize HHS for being too restrictive, others have said that the agency did all they could to keep things as simple and flexible as possible. […]
COBRA Subsidies Coming To An End
[…] The subsidy program was extended to help people who were involuntarily terminated on or before May 31, 2010, and allowed them to receive up to 15 months of COBRA premium assistance. For most people who qualified for the subsidies, the 15 months has already ended. But for the last people who qualified – those who were laid off in the final days of May, 2010 – the 15 months of premium assistance will come to an end next week. […]
Balancing Interests In The Colorado Health Insurance Exchange
[…] The Colorado exchange has received some early criticism based on the make-up of the board, as several board members have ties – direct and indirect – to the health insurance industry. I’ve noted that my own opinion is that it would tough to implement a successful exchange without the knowledge of the health insurance industry that those board members bring to the table. But I think that the board’s election of Hammer to lead them does help to balance things out and make sure that the consumer voice is heard alongside that of the health insurance industry. […]
Thoughts On Direct-Pay PCPs
[…] Those are a few of the thoughts that come to mind when I think about direct-pay medical care. I can see pros and cons to the idea, and I’m sure that there are many PCPs who would love the chance to focus more on medicine and less on administration/payer issues. But I think that most PCPs also want to make sure that everyone – regardless of financial status – has realistic access to medical care. And I’m just not sure that would be the case if more PCPs started pulling out of the health insurance networks – especially the networks that serve low income populations.
Seeking Certainty
[…] And finally, if the Supreme Court is going to hand down a ruling like the one we got from the Appeals Court last week, we need to know that as soon as possible too. If the individual mandate does indeed end up being tossed out, the health care reform law will need an awful lot of compromises and revisions in order to make it tenable. Perhaps I’m being overly pessimistic, but given the level of compromise we’ve seen from the political system over the last decade or so, I have a hard time seeing how the PPACA could go on with one of its major provisions deleted. […]
Standardized Policy Descriptions Coming Soon
The Colorado Health Plan Description Form isn’t exactly the same as the forms that HHS will require carriers to make available next year, but it’s similar in many ways, and carriers in Colorado have been issuing these standardized plan summaries for nearly 14 years. As well as outlining the coverage provided, the new forms will include “coverage examples” that will show potential customers how the plan would cover three common medical scenarios: breast cancer, maternity care, and diabetes. […]