Drugs: Paying for firms’ gifts to doctors

This article appears in the Business Briefing of the Los Angeles Times dated June 21, 2016.

It discusses the harm caused to the patient when a physician accepts gifts from drug companies. This practice has been around for many years, hopefully with more scrutiny it will end.

DRUGS

Paying for firms’ gifts to doctors

As little as one free meal from a drug company can influence which drugs doctors prescribe for Medicare patients, according to a study using Medicare records and recently released data from the Affordable Care Act’s Open Payments program.

The study highlights subtle ways doctors may feel inclined to prescribe a drug after receiving just a small gift, even if the drug is more costly for patients and their insurance plans.

Researchers calculated that an estimated $73 billion a year could be saved if equivalent generics were prescribed instead of brand-name drugs, and patients pay for a third of that excess cost. The study was published Monday in the journal JAMA Internal Medicine.

Insurance premiums spark new front in Obamacare war

In this the second year of implementation of the Affordable Care Act, premiums have not stabilized but it is probably an unreasonable expectation of the giant upheaval in a the health insurance system. The coming years will be the litmus test, hopefully the trend of large rate increases will turn around.

Below is an article from the Washington Examiner, date July 6, 2015.

Republicans target big increases as evidence that healthcare law isn’t working

Insurance premiums have quickly become a new front in the Obamacare fight, with opponents pouncing on big increases and supporters and experts countering the increases won’t be so bad.

The fight started last month when insurers were required to disclose estimated 2016 rates of 10 percent or more for Obamacare customers. Some figures grabbed headlines, especially with certain insurers calling for 50 to 70 percent increases.

The premium spikes vary by state and insurer. For instance, some plans in Florida are actually proposing reduced premiums, but 13 plans want rate increases of 10 percent or more, including Time Insurance Co.’s 63 percent hike.

Republicans say the higher rates are evidence that the law is hurting Americans and not lowering healthcare costs.

“The whole point of Obamacare was to make health care more affordable. But premiums aren’t going down; they’re going up — way up,” said Rep. Paul Ryan, R-Wis., chairman of the House Ways and Means Committee, in a recent hearing.

“The model we’re on in the Affordable Care Act is not sustainable,” said Rep. Mike Kelly, R-Pa., at the same hearing.

This is the first time since Obamacare’s passage that insurers can look at a full year’s worth of claims data and calculate premiums, Rep. Pete Roskam, R-Ill., said at the hearing. He added that the premium spikes are not growing pains.

“The law created a number of temporary programs to pay out billions in taxpayer funds during the first few years to lower costs seen by individuals and to protect big insurance companies against financial losses,” he said. “But those programs are beginning to phase out, and as the government is slowly taking off the training wheels, Obamacare is looking pretty wobbly.”

Supporters counter that any increases aren’t finalized and will have a modest impact overall.

“We have just the bad news,” said Kathy Hempstead, who directs coverage issues for the Robert Wood Johnson Foundation.

One analysis found that Obamacare customers as a whole may only see a modest increase.

The research firm Avalere looked at proposed rate filings in seven states and the District of Columbia. The average premiums for silver plans, the second cheapest option and a popular choice for Obamacare enrollees, will increase nearly 6 percent, Avalere said.

Avalere also noted that the low-cost silver plan options are likely to be smaller than the silver plan as a whole. Premiums for the lowest- and second-lowest silver plans in the seven states and D.C. will increase on average 4.5 percent and 1 percent.

A separate analysis from the nonpartisan Kaiser Family Foundation found that in 11 major cities the cost of a regular silver plan would be on average 4.4 percent higher in 2016 than this year.

Premiums must be finalized by October. That way customers facing a high premium can choose a different plan during the next open enrollment this fall.

Another reason why the rates could change is states need to conduct reviews themselves.

Obamacare requires states to report on any premium increase trends and recommend whether certain plans should be excluded from the exchanges, according to the National Conference on State Legislatures.

In 2011, the federal government started to work with states to strengthen or alter their rate review programs. If a state doesn’t have the resources to conduct the required review, the Department of Health and Human Services will do it, the National Conference on State Legislatures said.

“The carriers really have to be able to explain their rates, and that is part of the point of the whole medical loss-ratio regulations,” Hempstead said.

The medical loss ratio is another new regulation installed under Obamacare. It requires insurers to devote 85 percent of the cost of a premium on medical care and the other 15 percent on administrative costs.

The ratio ensures that insurers don’t devote too much of their costs to overhead.

Amid the rhetoric over the premium increases are certain trends that could affect the insurance market as a whole.

Many Blue Cross Blue Shield insurers kept premiums in marketplaces comparatively low with small increases from year to year, but that varies considerably across the country, according to a study of trends for market place plans done by the foundation and the left-leaning think tank Urban Institute.

The report looked at the cheapest silver plans in 30 states. Some insurance companies were reluctant to enter the Obamacare marketplaces in 2014 and when they did the plans were more expensive.

However, the report projects insurers will lower premiums to keep prices low to attract enough customers buying insurance through the Obamacare marketplaces.

But for opponents of Obamacare, the proposed increases represent a long-standing criticism about the law’s ability to battle healthcare costs, which was levied even before the exchanges opened in 2014.

Roberts again shows independent streak

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This article from the Los Angeles Times dated June 26, 2015 is a follow up to the Supreme Court decision to uphold the Affordable Care Act.

WASHINGTON — Since becoming chief justice 10 years ago, John G. Roberts Jr. has been determined to show that the court he leads is made up of impartial jurists, not politicians in robes.   In the phrase he used at his confirmation hearings, each justice is “like an umpire” at a baseball game — not favoring one team over the other.   On Thursday, Roberts showed again his willingness to brush aside partisan politics and forge a middle ground on some of nation’s most divisive issues, writing a 6-3 decision that upheld the broad reach of President Obama’s healthcare law.   It was the second time in three years that Roberts had led the Supreme Court to uphold the Affordable Care Act, also known as Obama-care. The decision surprised and disappointed some of the conservatives who had once hailed his appointment.   “We might as well call the law … RobertsCare,” said Ilya Shapiro, a lawyer at the Cato Institute, a libertarian think tank in Washington.   When Roberts spoke of being an umpire, “a lot of people on the left sneered,” said Neal Katyal, who served as acting U.S. solicitor general in Obama’s first term. “Today’s decision shows he really meant what he said. It’s a profound statement about the difference between law and politics.”   Roberts cringes at the regular references to the “conservative bloc” or the “liberal wing” of the court. Last year, he was pleased when the justices were able to agree unanimously in a much higher percentage of their cases.   Thursday’s decision sent a particularly loud message about a nonpartisan court because the chief justice gave a generous reading to a liberal law passed by a Democratic-controlled Congress.   But the decision is not a sign that Roberts has become a liberal or shifted strongly to the left, as some allege.   On the same day, Roberts joined three conservatives in dissent when the majority held that the Fair Housing Act forbids practices that have a “discriminatory effect” on racial minorities even if there is no intentional discrimination. In 2013, he voted with conservatives to strike down part of the Voting Rights Act.   His decisions on easing campaign finance rules, including Citizens United, which gave corporations and unions the ability to make unlimited contributions to political causes, firmly established Roberts’ record as a conservative.   But on most issues, the chief justice has shown himself to be most comfortable in the moderate middle and unwilling to push the law too far to the right or too quickly.   In April, he joined with the court’s four liberal justices to uphold a Florida law that prohibited elected judges from personally soliciting campaign contributions. Roberts supports the 1st Amendment right to spend freely on campaigns, but judges are not politicians, he said.   In other alliances with liberals, he helped forge a 6-3 majority to rule that a police officer may not detain a car stopped for a traffic violation so a drug-sniffing dog may be brought to the scene. He also joined a 5-4 opinion by Justice Ruth Bader Ginsburg that freed a Florida fisherman from federal obstruction-of-justice charges for having tossed overboard several undersized red grouper.   Further evidence on how Roberts sees his role could come as early as Friday in the court’s decision on gay marriage. It’s widely expected that a majority of justices will declare the right of gays and lesbians to marry nationwide, but given Roberts’ growing independent streak, combined with the impact that case will undoubtedly have on his legacy, some are wondering whether the chief justice will find a way to side with liberals in what would be a landmark decision.   Roberts’ reasoning in the healthcare case showed several of his characteristic traits — a desire for moderation as well as a concern over the real-world impact of the court’s decisions, particularly on business.   Had the justices ruled for the conservative activists who sued the administration, more than 6.4 million people could have lost their health coverage. That in turn could “well push a state’s individual insurance market into a death spiral,” Roberts said.   It would be “implausible,” he said, to think the Congress that passed the healthcare law intended to limit its tax subsidies to the 13 states that established an exchange, or marketplace, of their own.   He rejected the claim brought by conservative activists who pointed to one part of the law that said subsidies were limited to insurance policies bought on an exchange “established by the state.” This hyper-technical reading of one phrase did not make sense and was contradicted by other parts of the law, he said.   “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he wrote.   Duke Law professor Neil Siegel called the majority opinion “a masterpiece of legal craft, good sense and fidelity to the law at a time when political polarization threatens to spill over into the judiciary.”   But the three conservative dissenters accused the majority of “interpretive jiggery-pokery” and “somersaults of statutory interpretation” to fix a political, not legal, problem.   “This court’s two decisions on the [healthcare] act will surely be remembered through the years,” wrote Justice Antonin Scalia, joined by Justices Clarence Thomas and Samuel A. Alito Jr. “And the cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”   In most cases, Roberts is still more likely to vote with the court’s conservatives. University of Chicago Law professor David Strauss said the final word about the Roberts court wouldn’t come until it weighs in on broad major issues like abortion and race.   “But the chief justice has made it clear that he meant what he said in his confirmation hearings: The big decisions should be made by the people who won an election, whether the court agrees with them or not, as long the justices don’t have to distort the law to do that,” Strauss said. david.savage@latimes.com

Getty Images   CHIEF JUSTICE reenforced his statement that each justice is “like an umpire.”

WIN MCNAMEE Associated Press   JOHN G. ROBERTS JR. says he dislikes the references to the “conservative bloc” or the “liberal wing” of the U.S. Supreme Court, which he’s led for a decade.

Cancellation of Individual and Family Medical Policies For Non Payment of Premium

Insurance Companies no longer reinstate individual and family plans for non payment of premium.

Individual and family plans can only be purchased during open enrollment which is closed until November2015.

Individuals and families who qualify for a Special Enrollment Period can purchase plans. Non payment of premium is not a qualification for a Special Enrollment Period.

The Internal Revenue Service will impose a penalty if you do not have a medical insurance plan that may amount to thousands of dollars.

Please pay your premiums when your bill is received.

If you have not paid your premium by this time of the month, I would strongly encourage you to call the membership services number on your ID card and pay the bill. A late or lost check may result in a cancellation for non payment.

Healthcare law defense tailored for key justices

The Supreme Court is about to hear arguments concerning the Patient Protection and Affordable Care Act,  also referred to as Obamacare. The issue is whether those who purchase their health insurance from federal exchanges are entitled to receive subsidies. Language for this allowance was left out of the original law which states that subsidies are available through state exchanges/marketplaces such as Covered California.

The following article from the Los Angeles Times, dated February 26, 2015 is a very good discussion on this issue.

Healthcare law defense tailored for key justices

Subsidy backers may argue states’ rights in the Supreme Court.
BY DAVID G. SAVAGE

WASHINGTON — With President Obama’s healthcare law once again facing possible unraveling at the hands of the Supreme Court, the administration and its allies have developed a novel argument tailor-made to appeal to conservative justices: states’ rights.

The high court is set to hear arguments March 4 to determine the legality of Affordable Care Act subsidies for approximately 7 million Americans who receive coverage from federally run health insurance marketplaces, also known as exchanges.

Lawyers for the Competitive Enterprise Institute, a small libertarian group in Washington, are challenging the subsidies, pointing to a passage in the law that says such tax credits may go to those who buy insurance on an “Exchange established by the state.”

Only 13 states fully operate their own online healthcare marketplaces.

The other 37 rely on the HealthCare.gov   site run by the federal government. If the justices rule for the challengers, consumers in most or all of those states would lose their subsidies, making health coverage unaffordable for most of them.

The Obama administration and healthcare advocates are arguing that the law, when read as a whole, makes clear that the subsidies were intended to be available nationwide for low-and moderate-income people, not just those in certain states.

But if the justices doubt that reading, supporters of the law have a legal backup plan that highlights the “clear notice” rule for states. It says that when Congress passes a new law and seeks cooperation from the states, it must not withhold important information.

The principle was spelled out in a 1981 opinion by then-Justice William H. Rehnquist, the same year John G. Roberts Jr. served as one of his law clerks.

Liberals hope it will persuade Roberts, now chief justice, and some of his colleagues to uphold the tax subsidies in the 37 states that rely on the federal exchange.

This focus on the federal-state balance of power appears targeted at Roberts, whose vote was crucial in upholding the law’s constitutionality in 2012, and Justice Anthony M. Kennedy, a longtime champion of the states who has cited the “clear notice” principle in the past.

Supporters of the law say that even if Congress meant to restrict subsidies to marketplaces created by the state, no one warned state officials that relying on the federal version would deprive their residents of millions of dollars in insurance subsidies.

Late last month, lawyers for 22 states, including Virginia, Illinois, Pennsylvania and North Carolina, told the justices they were blindsided by the claim that federal subsidies might be cut off because they failed to establish state marketplaces.

“Surprising states with a dramatic hidden consequence” violates a basic principle of fair dealing between Washington and the states, the state lawyers said in the court brief. Congress “does not hide elephants in mouse holes,” they added, quoting a comment by Justice Antonin Scalia in a previous case.

Oklahoma and five other states sided with opponents of the law. Their lawyers said the “plain text” bars subsidies for their residents, since they did not establish state marketplaces.

California, New York, Connecticut and Maryland, which are among the 13 states that fully operate their own marketplaces, have endorsed the broad view that tax subsidies should be available nationwide.

Of the 37 states using the federal healthcare site, a few have either technically established their own marketplaces or have partnership agreements with the federal government. The justices could choose to treat those states differently than the rest, allowing their residents to keep subsidies.

But supporters of the healthcare law say they are more hopeful now of prevailing entirely in the high court, in part because of the “clear notice” argument. Washington lawyer Walter Dellinger, a solicitor general under President Clinton, said this federalism or states’ rights argument is likely to get the attention of several justices.

“If you are Congress, you don’t impose a penalty on the states and then hide it in an obscure provision involving the tax code that no one noticed at the time,” he said. This strongly suggests, he said, that Congress did not intend to punish states that decided to rely on a federal marketplace.

Other provisions of the law carry the same message, supporters say. A section titled “State flexibility” says that states shall establish an exchange so residents can compare prices for insurance and buy policies, and that if states elect not to do so, “the secretary [of Health and Human Services] shall establish and operate such exchange” within the state.

Citing this passage, officials from the 22 states said they understood this to mean they could run an exchange on their own, or use the federal version, but the choice would have no effect on their residents.

Attorneys for the Obama administration argue that the term “such exchange” means that the federally run exchange would simply function in place of one created by the state, with no differences in operation.

Defenders of the law recognize they face a struggle in winning over the court’s conservatives, who have been skeptical of Obama’s signature healthcare program.

Four justices — Scalia, Kennedy, Clarence Thomas and Samuel A. Alito Jr. — voted to strike down the entire law in 2012. If Roberts joins them this time, they could deal it a severe blow.

In 2012, a majority led by Roberts rendered a split decision. They upheld the mandate to buy insurance, but they also said states may refuse to expand free health insurance under the Medicaid program.

In a second decision last year, they ruled by a 5-4 vote that corporate employers citing their religious faith may refuse to pay to cover certain contraceptives for their female employees.

The latest case began with what some called a “glitch” or “wording flaw” in the long and complicated bill. Jonathan Adler, a libertarian law professor at Case Western Reserve University who helped launch the suit, argued the law should be interpreted based on its exact words, not the grand aims of its Democratic sponsors.

“The proper question is: What did Congress say? And the words ‘established by the state’ are pretty clear,” he said. “People didn’t focus on this in 2010 or 2011because no one took seriously that so many states would say ‘no.’”

Ilya Shapiro, a lawyer at the libertarian CATO Institute, says the blame lies with the Democrats who wrote the law.

“This is a consequence of the frenzy to get something passed on a razor-thin partisan vote,” he said. “No one knew what was in it. Maybe the states’ lawyers missed it, or they were misled by the feds.”

Administration officials were surprised when about three dozen states — both red and blue — chose not to establish marketplaces of their own. They were also alarmed when the Supreme Court voted Nov. 7 to take up the current case, King vs. Burwell, just three days after Republicans won full control of Congress.

Challengers won a round last summer when a U.S. appeals court panel in Washington, in a 2-1 vote, interpreted the law as limiting subsidies to the 13 states that fully run their own marketplaces. On the same day, an appellate court in Virginia reached the opposition conclusion, ruling that nationwide subsidies were allowed.

In recent weeks, a new round of legal briefs from the administration, state officials, former members ofCongress and leading law professors have argued that there was no glitch and that the law, read as a whole, provides insurance subsidies to eligible Americans regardless of where they live.

“They put the text of the statute front and center, and it shows the absurdity of the plaintiffs’ argument,” said Elizabeth Wydra, attorney for the Constitutional Accountability Center, a liberal group that supports the law. “When [the justices] read the briefs, I think it would be hard for them to rule against the government, even though they may not like the law.”

For instance, the law’s supporters say, one provision permits subsidies for any applicable taxpayer whose income is less than 400% of the poverty rate, without making reference to whether the marketplace was established by the state or federal government.

Another provision defines a “qualified individual” as someone who “resides in the state that established the exchange.”   The provisions show that the federally run exchange was intended to serve as the de facto state exchange, U.S. Solicitor Gen. Donald Verrilli Jr. said in a court brief. Otherwise, if the second provision were read in isolation, it would imply that a federal exchange “would literally have no customers” since no potential applicants would live in a “state that established the exchange.”   Why, he asked, would states have been told by Congress that they had the flexibility to rely on the federal exchange, only to learn later none of their residents could actually use it? david.savage@latimes.com   Twitter: @DavidGSavage

JOE RAEDLE Getty Images   HEALTHCARE ENROLLMENT is advertised this month in Miami. The Supreme Court is to hear a case next week on federal subsidies for 7 million people.

Individual Plan 2015 Open Enrollment

Below is an article from the November 16, 2014 Los Angeles Times Business Section. It is very well written with  important exceptions;

If you are not eligible for a subsidy, you should not apply through Covered California.

Smaller provider networks may not give you enough premium reduction, explore off exchange policies where you will have more choice of companies and plans.

HEALTHCARE WATCH

How to shop for health plans

BY LISA ZAMOSKY

Starting this weekend, anyone interested in changing an existing health insurance policy or buying a new one can do so during the second open enrollment period under Obamacare.

Those interested in having a plan in place by Jan. 1 must make their selection by Dec. 15. And the final deadline is Feb.15.

Diana Newton, 31, shopped Covered California for health insurance last year for her and her husband.

“We signed up for a plan and thought it was pretty reasonable, and it had both of my doctors in my network,” says the Pilates studio owner from Los Angeles.

With a rare form of rheumatoid arthritis, it was crucial Newton’s health plan covered the two doctors she relies on most for care. All looked good with her new policy … until it didn’t.

“When I went back for my second visit in February they stopped me at the door and told me, ‘Sorry, you can’t have a visit. We’ve dropped out of your network. And by the way, you have an outstanding bill [of $1,800] from your visit in January,’” she says.

Like Newton, many consumers have complained this year about confusion over their provider network, unforeseen medical bills and other challenges with their new policies. In a rush to sign up for coverage, many simply missed the fact that doctors, big health systems or medications they needed were not included in the plans they selected.

Now millions of Californians have an opportunity to switch to a plan that better meets their needs, re-up with their existing plan, or pick one for 2015 if they missed open enrollment the first time around.

Experts offer shopping recommendations for open enrollment.

Watch for changes. Because benefits and prices change each year, it’s important for everyone to review their plan options for 2015, says JoAnn Volk, senior research fellow with the Georgetown University Health Policy Institute.

“Even if you’re happy with your plan it may not be the same for next year,” she says.

Go back to make sure that your plan hasn’t changed the amount you’ll pay in premiums and out-of-pocket costs, and that it still meets your healthcare needs.

Some plans that were in place this year won’t be offered in 2015. If your plan is affected, you should have already received notice from Covered California. Take action and sign up for a new plan or you’ll be without coverage Jan.1.

“The thing is to not ignore the letter and to figure out what you need to do and see what’s available,” says Patrick Burns, president of the California Assn. of Health Underwriters.

Check your eligibility. This year, more than 1 million Californians received federal subsidies to help pay for medical coverage. If you’re among them, be aware that any changes to your income or household size — such as a new baby or divorce — need to be reported to the exchange.

You may be entitled to more help than you’re getting if your income is lower than anticipated. On the other hand, if your income was higher than you initially reported, you could be getting too much financial help.

“Come April 15, if you understated your income, then you may have to pay money back on your taxes because you didn’t qualify for all the subsidy that you said you would qualify for. That is going to be a possible area of concern for a lot of folks,” Burns says.

Double-checking income. If you applied for insurance through Covered California last year, you were asked for consent for up to five years to have your income confirmed with the Internal Revenue Service and other sources. If you said yes, and you still qualify, your coverage will be automatically renewed, along with the appropriate subsidy, says James Scullary, spokesman for Covered California.

However, if you declined, you’ll have to go back into the system to complete a renewal packet for 2015; otherwise, even though your plan will be automatically renewed, your financial assistance will be cut off. You’ll be billed for the full cost of your insurance premium.

Covered California will send a notice about your plan renewal and whether you’ll continue to receive financial help, and how much, Scullary says.

Networks: Check and check again. Generally, plans sold on the exchange will continue to offer limited provider networks with access to fewer doctors and hospitals.

On the upside, says Carolina Coleman, research director with Insure the Uninsured Project in Santa Monica, “Narrower networks generally are going to be cheaper.”

The key, she says, is to understand the trade-offs between lower premiums and more choice, and how your plan’s provider network will affect your costs and access to medical care.

“If you care very strongly about a particular provider, you have to triple check” that he or she is in your plan’s network, Coleman says. That means reviewing the provider directory on each health plan’s website, and calling both the insurance company and the provider directly to confirm participation.

And don’t forget to carefully check the list of pharmacies and drugs each plan covers. If you take a lot of medications or require high-priced specialty drugs, you may save in the long run by buying a Gold or Platinum-level plan that covers more out-of-pocket costs when you go to fill prescriptions.

Help is available. Covered California will have about 1,300 service center representatives to help you renew or select a plan when open enrollment starts Nov.

15. You can reach one by calling (800) 300-1506.

You can also work with a certified enrollment counselor or insurance agent. Go to www.coveredca.com   and click “Find Help Near You.”

Newton, who owns the Pilates studio, was able to change policies before open enrollment closed this year to one that covered her doctors. She says she knows shopping her options for next year is a good idea. But after last year’s experience, she’s hesitant.

“I want to look, but I’m very scared,” she says.

Her curiosity may win out, though. “I would love to know if there’s something better for me out there.” healthcare@latimes.com

Zamosky is the author of

“Healthcare, Insurance, and You: The Savvy Consumer’s Guide.”

Below is an article from the November 16, 2014 Los Angeles Times Business Section. It is very well written with  important exceptions;

If you are not eligible for a subsidy, you should not apply through Covered California.
Smaller provider networks may not give you enough premium reduction, explore off exchange policies where you will have more choice of companies and plans.
HEALTHCARE WATCH
How to shop for health plans
BY LISA ZAMOSKY

Starting this weekend, anyone interested in changing an existing health insurance policy or buying a new one can do so during the second open enrollment period under Obamacare.    Those interested in having a plan in place by Jan. 1 must make their selection by Dec. 15. And the final deadline is Feb.15.    Diana Newton, 31, shopped Covered California for health insurance last year for her and her husband.    “We signed up for a plan and thought it was pretty reasonable, and it had both of my doctors in my network,” says the Pilates studio owner from Los Angeles.    With a rare form of rheumatoid arthritis, it was crucial Newton’s health plan covered the two doctors she relies on most for care. All looked good with her new policy … until it didn’t.    “When I went back for my second visit in February they stopped me at the door and told me, ‘Sorry, you can’t have a visit. We’ve dropped out of your network. And by the way, you have an outstanding bill [of $1,800] from your visit in January,’” she says.    Like Newton, many consumers have complained this year about confusion over their provider network, unforeseen medical bills and other challenges with their new policies. In a rush to sign up for coverage, many simply missed the fact that doctors, big health systems or medications they needed were not included in the plans they selected.    Now millions of Californians have an opportunity to switch to a plan that better meets their needs, re-up with their existing plan, or pick one for 2015 if they missed open enrollment the first time around.    Experts offer shopping recommendations for open enrollment.    Watch for changes. Because benefits and prices change each year, it’s important for everyone to review their plan options for 2015, says JoAnn Volk, senior research fellow with the Georgetown University Health Policy Institute.    “Even if you’re happy with your plan it may not be the same for next year,” she says.    Go back to make sure that your plan hasn’t changed the amount you’ll pay in premiums and out-of-pocket costs, and that it still meets your healthcare needs.    Some plans that were in place this year won’t be offered in 2015. If your plan is affected, you should have already received notice from Covered California. Take action and sign up for a new plan or you’ll be without coverage Jan.1.    “The thing is to not ignore the letter and to figure out what you need to do and see what’s available,” says Patrick Burns, president of the California Assn. of Health Underwriters.    Check your eligibility. This year, more than 1 million Californians received federal subsidies to help pay for medical coverage. If you’re among them, be aware that any changes to your income or household size — such as a new baby or divorce — need to be reported to the exchange.    You may be entitled to more help than you’re getting if your income is lower than anticipated. On the other hand, if your income was higher than you initially reported, you could be getting too much financial help.    “Come April 15, if you understated your income, then you may have to pay money back on your taxes because you didn’t qualify for all the subsidy that you said you would qualify for. That is going to be a possible area of concern for a lot of folks,” Burns says.    Double-checking income. If you applied for insurance through Covered California last year, you were asked for consent for up to five years to have your income confirmed with the Internal Revenue Service and other sources. If you said yes, and you still qualify, your coverage will be automatically renewed, along with the appropriate subsidy, says James Scullary, spokesman for Covered California.    However, if you declined, you’ll have to go back into the system to complete a renewal packet for 2015; otherwise, even though your plan will be automatically renewed, your financial assistance will be cut off. You’ll be billed for the full cost of your insurance premium.    Covered California will send a notice about your plan renewal and whether you’ll continue to receive financial help, and how much, Scullary says.    Networks: Check and check again. Generally, plans sold on the exchange will continue to offer limited provider networks with access to fewer doctors and hospitals.    On the upside, says Carolina Coleman, research director with Insure the Uninsured Project in Santa Monica, “Narrower networks generally are going to be cheaper.”    The key, she says, is to understand the trade-offs between lower premiums and more choice, and how your plan’s provider network will affect your costs and access to medical care.    “If you care very strongly about a particular provider, you have to triple check” that he or she is in your plan’s network, Coleman says. That means reviewing the provider directory on each health plan’s website, and calling both the insurance company and the provider directly to confirm participation.    And don’t forget to carefully check the list of pharmacies and drugs each plan covers. If you take a lot of medications or require high-priced specialty drugs, you may save in the long run by buying a Gold or Platinum-level plan that covers more out-of-pocket costs when you go to fill prescriptions.    Help is available. Covered California will have about 1,300 service center representatives to help you renew or select a plan when open enrollment starts Nov.    15. You can reach one by calling (800) 300-1506.    You can also work with a certified enrollment counselor or insurance agent. Go to www.coveredca.com   and click “Find Help Near You.”    Newton, who owns the Pilates studio, was able to change policies before open enrollment closed this year to one that covered her doctors. She says she knows shopping her options for next year is a good idea. But after last year’s experience, she’s hesitant.    “I want to look, but I’m very scared,” she says.    Her curiosity may win out, though. “I would love to know if there’s something better for me out there.” healthcare@latimes.com      Zamosky is the author of    “Healthcare, Insurance, and You: The Savvy Consumer’s Guide.”

Open Enrollment for 2015 Individual Health Plans

If you would like to review your plan options for 2015 we need to set up a phone appointment during Open Enrollment. Open Enrollment begins November 15th and will continue until December 15th for a January 1, 2015 effective date. Open Enrollment will close on February 15, 2015 with the last effective date being March 1, 2015. Individual health insurance policies cannot be purchased beyond March 1, 2015 unless one qualifies for a Special Enrollment Period.

If you would like to set up a phone appointment please let me know. Here is what I will need before setting the appointment;

If you think you are eligible for a subsidy, send me your ESTIMATED 2015 MODIFIED ADJUSTED GROSS INCOME (MAGI). Your tax consultant should be able to help you determine the amount.

If you know you do not qualify for a subsidy or are not interested please let me know.

I will send you several options of dates and times for an appointment once I have this information. Please understand that appointments book very quickly so I encourage you to respond as soon as possible.

Health Insurance Review

If you would like to review your health insurance policy moving forward into 2104 please send me an e mail with various dates and times beginning 12/9 that you would be available for a phone appointment.

Thanks,

Dennis David

Certified Covered California Agent # 2000001789

Please take a moment and click the URL to view my website dennisdavidhealthplans.com. It helps my business grow!

 

LIFE  HEALTH  DISABILITY  ANNUITIES  LONG TERM CARE

COMMERCIAL    WORKERS COMPENSATION

Thank you for your business!

Your referrals are always appreciated!

Please let me know if you have changed your e mail address.

I do not receive text messages.

Dennis David
PO Box 548
Culver City, CA 90232
Voice 310 836 9893
Fax 310 836 3840

CA License #0668857
Texas License #1774174

Flexible Spending Accounts- New Federal Government Rules

The US Treasury and the IRS will now allow employees who have flexible spending accounts to carry over $500 from one year to another. A great idea to encourage the proper use of flexible spending accounts.

An article below from the Los Angeles Times dated November 1, 2013 provides more information.

Health spending rule is eased

U.S. officials allow account holders to carry over as much as $500 to the next year.

BY CHAD TERHUNE

   Workers faced with forfeiting unused money in their flexible spending accounts for healthcare expenses may be getting some relief under a new federal rule.

   The U.S. Treasury Department and Internal Revenue Service changed the use-it-or-lose-it rule for flexible spending arrangements, or FSAs, to allow account holders to carry over as much as $500 from one year to the next without penalty.

   Many workers have been reluctant to put money into the plans for fear of losing whatever they don’t use, resulting in long-standing complaints about how the pretax FSAs work.

   Typically, they must estimate before the year starts how much they might spend on healthcare, and employers regularly deduct money from their paychecks before taxes. Any amount left over at the end of the year would go back to the employers.

   With less risk of such forfeitures now, experts predicted that more workers, particularly lower- and moderate-income employees, would take advantage of the deductions for everyday medical expenses, such as co-pays, over-the-counter drugs and other items not normally covered by health insurance.

   “We are always looking for ways to provide added flexibility and commonsense solutions to how people pay for their healthcare,” Treasury Secretary Jacob Lew said Thursday.

   Treasury officials began taking public comments on the change last year, and they said the response was overwhelmingly in favor of giving workers more leeway.

   The new rules go into effect immediately, but they aren’t mandatory for employers. Firms can decide whether to make the change and when to make it.

   In a recent survey of large employers, 86% offered FSAs for healthcare expenses , but only 23% of workers participated, according to Mercer, a benefits consulting firm. In all, federal officials estimated that 14 million American families use the spending accounts.

   Federal officials said employers could take advantage of this new rule as soon as this year. But benefits consultants said it will be difficult for most employers to make the switch that fast with open enrollment season already underway at most companies.

   “Starting Jan. 1, 2015, I think there will be greater uptake simply because of the timing,” said Laura Baker, a principal at Mercer.

   Because the funds are deducted from paychecks on a pretax basis, less of a worker’s earnings are subject to tax.

   The average worker contribution was $1,484 last year, according to Mercer’s survey of large employers. The percentage of overall dollars forfeited was 4%.

   Treasury officials said they didn’t have figures on how much is lost annually, but they said the new rule could eliminate most forfeitures, which are often below $500 in value.

   One benefits administrator, Alegeus Technologies in Waltham, Mass., estimated that1in 4 flex-spending participants suffers a forfeiture each year.

   “The Treasury Department has eliminated the most significant barrier to FSA participation, namely consumers’ fear of losing their money,” said Bob Natt, executive chairman of Alegeus. “This will certainly lead to growth in FSA adoption.”

   Employers are not allowed to return the money to individual employees. Health experts said most use it to offset the cost of administering employee benefit programs.

   The rule change also could reduce the incentive by workers for unnecessary spending at year-end to avoid losing the money set aside.

   Some employers offer a grace period to workers, allowing them to use prior-year balances until March 15 of the following year. Treasury officials said employers would have to pick between a grace period or the rollover option because they won’t be allowed to do both.

   Sen. Orrin Hatch (R-Utah) praised the new flexibility from the Obama administration.

   “Allowing Americans who have one of these accounts to roll $500 over to the following year just makes sense,” Hatch said. chad.terhune@latimes.com  

Health Care Reform Open Enrollment

Open Enrollment as required by the Affordable Care Act (ACA) begins tomorrow, October 1, 2013 for a January 1, 2014 effective date.

Last week a very well respected Executive Vice President of an insurance company said “Anyone telling you they know what is happening in 2014 is deluded, lying or does not know what they are doing.”

This past Friday I attended an eight hour certification course for Covered California the Health Insurance Exchange/Marketplace. Some comments from the instructor were;

“There is a tidal wave coming.”

“We will have to make the best decisions with imperfect information.”

“We cannot be experts on a moving target, there are changes every day.”

Peter Lee, the Executive Director of Covered California has said “There will be bumps along the way.”

The reason I quoted these individuals is to illustrate that there are problems with open enrollment. As of now I do not have enough information to help you make informed decisions on your health insurance. There is not enough information from insurance companies in terms of rates and benefits. Covered California’s online system is not entirely up to speed and the online system of the IRS which is needed to verify subsidy information for those who qualify has glitches.

There are some steps you can take that will be helpful. Covered California is the Exchange/Marketplace that will allow one to apply for premium and cost sharing subsidies. The insurance companies that will participate in Covered California are Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser. Local medical groups will also participate. Benefits will be standardized and rates will be set by the participating companies. The same benefits and rates will be sold off Covered California in the open market. The only reason that one would apply through Covered California is to receive a subsidy. Some companies have indicated that they intend to offer other policies with a different set of benefits, for example Cigna is not participating in Covered California and has indicated they intend to mirror benefits of Covered California and have an entirely different set of benefits.

I have attached two documents for your review which relate to subsidies. The first is The ACA: Understanding Subsidies. The Chart has a dark area, a medium shaded area and a light area and describes annual household income for 2012 and household size. If your income is in the dark area you are entitled to Medi-Cal at no cost. I am not involved with Medi-Cal but I am told there are good benefits. The problem is finding providers who accept Medi-Cal. If you do not opt for Medi-Cal  you can purchase any plan available, however, you will not be eligible for a subsidy. If your income falls in the medium shaded area you are eligible for premium and cost sharing subsidies. If your income falls in the lighter shaded area you are eligible for a premium subsidy. In the two later examples we should send your application to Covered California. If your income exceeds the amounts in the lightest area you are not eligible for a subsidy and should not apply through Covered California, instead your coverage should be in the open market off the Covered California Exchange/Marketplace. The second document is to determine your Modified Adjusted Gross Income or MAGI for 2012 under the ACA. This is the income that will be used to determine if you qualify for a subsidy. Please discuss this with your tax preparer if you think you fall in the income range for a subsidy.

There is a provision in the ACA for those who have a current change in income. For example if your income in 2012 was $150,000 which exceeds the level for a subsidy and your current income is $30,000, Covered California will review your situation and possibly approve your subsidy request. It is important to note that if you receive a subsidy and your income increases or exceeds the subsidy threshold it is your responsibility to notify Covered California and the IRS. Your subsidy will be reduced or cancelled. If you do not comply the IRS will add the appropriate amount to your next tax liability. Subsidies can be applied to your monthly insurance premium whereby you will receive a reduced premium or be credited to you at the end of the year.

I previously sent information on networks. As a reminder all Covered California plans and those plans off Covered California with the same benefits will have smaller networks of doctors and hospitals. This will have to be taken into consideration when choosing a plan. The companies that market benefits that do not mirror Covered California benefits should have a broader network of doctors and hospitals.

If your coverage is “grandfathered”, policies sold before March 23, 2010, you do not have to enroll in an ACA mandated plan. You can keep your plan which will have less benefits but will have the full network of providers that you have today. This will be part of our decision making process.

The information above does not apply to Medicare. Some Medicare enrollees have family members who are under 65 and are affected by the ACA.

Please be patient.

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The Dennis L. David Insurance Agency | Long Term Care Insurance, Los Angeles Medical Insurance, Anthem Blue Cross Healthcare Insurance, Whole & Term Life Insurance Policies, Cigna, Disability Insurance, Blue Shield of CA, Group Health Plans, Aetna, Group Medical Insurance, Skilled Nursing Insurance, Medicare Supplement Insurance, Medicare Part D Prescription Drug Plans, In-Home Care, Disabled Work Insurance, Disability Benefits, Culver City Health & Life Insurance, Family & Individual Health Insurance, Health Care Reform & Affordable Care Act Assistance, Obamacare, Covered CA Health Insurance, Health Plans, Kaiser Insurance, Genworth Life, John Hancock Life, Culver City Long Term Care & Disability, Employee Benefits, Beverly Hills, Hollywood, West Hollywood, Santa Monica, Pacific Palisades, Marina Del Rey, West Los Angeles, Los Angeles, El Segundo, Sherman Oaks, Encino, Los Angeles, Manhattan Beach, Los Angeles County CA, California

CA Insurance License Number:  0668857

TX Insurance License Number:  1774174