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Articles – healthinsurance.org

Will you owe a penalty under Obamacare?
If you decide not to purchase coverage and remain uninsured, you can use the calculator on this page to determine the size of the penalty you would pay. But here's the good news: many uninsured Americans are exempt from the penalty, and premium subsidies are making health insurance affordable - often for the first time - for millions of people.

POSTED NOVEMBER 14, 2017 8:30 AM
Obamacare penalty exemptions
According to the IRS, 7.9 million tax filers were subject to the penalty for being uninsured in 2014, but 12.4 million were able to claim an exemption from the penalty, despite being uninsured in 2014. Again in 2015, the number of exemptions surpassed the number of people who owed the penalty by a wide margin.

POSTED NOVEMBER 07, 2017 11:33 AM
10 reasons cost-sharing reductions are YUGE news
If you're like the vast majority of consumers, you may be hearing about CSRs for the first time and wondering why these subsidies are so important, and whether they actually affect your own coverage. Here's what you need to know:

POSTED OCTOBER 13, 2017 2:27 PM
Should you look outside the ACA’s exchanges?
The consumer protections in the ACA apply to all new individual policies, regardless of whether the coverage is sold in the exchange / marketplace.

POSTED SEPTEMBER 10, 2017 3:13 PM
CO-OP health plans: patients’ interests first
As of July 2017, only six of the original 23 CO-OPs were still operational. And just four of those intend to offer coverage for 2018. The other CO-OPs have failed for a variety of reasons, including premiums that were too low and the unexpected loss of federal funding that was retroactively eliminated.

POSTED AUGUST 27, 2017 1:49 PM
2018 Obamacare subsidy calculator
An impressive 85 percent of Americans shopping in the exchanges receive subsidies. If you're worried about the cost of premiums, use our subsidy calculator to see how much you'd save.

POSTED AUGUST 25, 2017 8:44 PM
Billions in ACA rebates show 80/20 Rule’s impact
Over the next few months, you could be receiving a nice rebate check from your health insurance. Last year, nearly 1,600 people in Hawaii ended up with rebate checks that averaged $1,339 per family — the highest average in the nation (which seems a little unfair – since if you live in Hawaii, most of us would already consider you lucky). It’s all thanks to the Affordable Care Act’s medical loss ratio (MLR) – a provision sponsored by Minnesota’s Sen. Al Franken that forces health insurance companies to use your premium dollars to provide actual health care and quality improvements for plan participants, or return that money to you. In 2016, insurers were required to pay nearly $397 million in rebates to more than 4.8 million people, bringing the total over five years of the program to nearly $2.8 billion. The Senate's Better Care Reconciliation Act (BCRA) would eliminate the federal requirement that insurers spend the majority of premiums on health care, but as of mid-July the bill doesn't appear to have enough support to pass.

Rebates? What rebates?

The rebates are tied to the medical loss ratio: the percentage of insurance premium dollars spent on actual health care – as opposed to marketing, administrative expenses, and CEO salaries. If an insurer spends less than 80 percent of individual and small-group plan premiums (85 percent for large-group plans) on providing medical care, they must rebate the excess dollars back to plan members and employers via checks that are sent out by September 30 each year. The majority of very large employers self-insure their employees' health coverage, and MLR rules do not apply to self-insured plans. There were also initially exemptions for non-profit insurers, although they had to begin complying with the MLR requirements in 2014. Although the MLR rules are an important regulatory tool, the majority of insureds do not receive a rebate check, as most insurers' administrative costs are less than the allowable amount. (About 4.8 million people received rebates in 2016; that's less than 1.5 percent of the population.) Come the first of August, you could be receiving a nice rebate check from your health insurance. It’s all thanks to the Affordable Care Act’s medical loss ratio (MLR) – a provision sponsored by Minnesota’s Sen. Al Franken that forces health insurance companies to use your premium dollars to provide actual health care for plan participants, or return that money to you.

Rebates consumers received in 2016

The rebates that were sent out by carriers in 2016 were based on the average MLR for the prior three years (2013 to 2015). The rebates that are sent out in 2017 will be based on each carrier's average MLR for 2014 to 2016, and so forth. 2016 was the fifth year of payouts through the 80/20 rule. From 2012 to 2014, total rebate amounts dropped significantly each year. But the total rebate amount in 2015 ($469 million) was higher than it was in 2014; for the individual market, the rebate amount in 2015 was the highest it had been since 2012 (the first year the rebates were sent out). In 2016, however, the total rebate amount dropped again, although it was still higher than it had been in 2014. Across all market segments, the majority of insurers are meeting or exceeding the MLR rules, which is why most people don't receive MLR rebate checks. According to the data that was calculated in 2016 (for plan years 2013-2015), the average individual market MLR was 91.8 percent and the average small group MLR was 85.6 percent (both well above the 80 percent minimum requirement). In the large-group market, the average MLR was 90.1 percent, also well above the 85 percent minimum requirement for that market segment. Total rebate amounts so far have been: In 2016, the 4.8 million consumers who received rebates were in 2.8 million families. Among them, the average family's rebate was $138 ($124 in the individual market, $142 in the small-group market, and $146 in the large-group market). Although fewer people received rebates in 2016 than in 2015, and the total amount that was rebated in 2016 was smaller, the average per-family rebate was a little larger in 2016 than it had been in 2015. (The average family's rebate was $129 in 2015 – $139 in the individual market, $134 in the small group market, and $102 in the large group market.) The highest average (per household) rebates among families that received them in 2016 were in Hawaii, where average rebates were $1,339 – nearly ten times as much as the national average. Hawaii also had much higher-than-average MLR rebates in 2015 ($1,597). In six states (up from four the year before), there were no MLR rebates necessary in 2016, because all of the insurers met the MLR requirements: Maine, Montana, North Dakota, South Dakota, Vermont, and Wyoming (incidentally, Wyoming had the highest average MLR rebates in 2015; in a small market like Wyoming, a few expensive claims can have a very significant impact on MLR numbers). See the statistics for your state below.

Premium rebates returned to consumers in 2016

State Total Rebates Consumers Benefiting Average per Family
Alaska $55,840 89 $235
Alabama $1,252,727 7,792 $249
Arkansas $3,928,423 86,923 $58
Arizona $5,750,456 58,430 $185
California $37,164,457 294,867 $233
Colorado $1,737,038 5,975 $376
Connecticut $44,646 1,353 $66
District of Columbia $18,066,004 252,986 $155
Delaware $190,367 4,050 $90
Florida $46,172,885 766,290 $95
Georgia $20,132,607 226,595 $141
Hawaii $1,167,943 1,598 $1,339
Iowa $1,512,470 20,058 $133
Idaho $80,459 219 $155
Illinois $2,924,775 37,719 $123
Indiana $11,850,559 261,183 $84
Kansas $1,881,472 4,994 $599
Kentucky $3,640,398 85,025 $52
Louisiana $419,989 3,220 $168
Massachusetts $353,864 61,274 $114
Maryland $45,755,797 296,255 $273
Maine $0 0 $0
Michigan $34,316,590 635,603 $120
Minnesota $65,797 1,508 $70
Missouri $20,912,406 273,246 $116
Mississippi $15,692,881 92,382 $256
Montana $0 0 $0
North Carolina $8,270,684 57,865 $203
North Dakota $0 0 $0
Nebraska $95,032 747 $254
New Hampshire $7,705,129 40,609 $304
New Jersey $2,634,720 116,900 $42
New Mexico $1,179 98 $4
Nevada $6,243,165 29,244 $363
New York $46,661,492 458,400 $149
Ohio $8,684,809 143,202 $89
Oklahoma $2,038,937 26,240 $143
Oregon $164,973 9,601 $26
Pennsylvania $859,761 13,941 $92
Rhode Island $1,954,106 15,651 $150
South Carolina $705,649 99,835 $150
South Dakota $0 0 $0
Tennessee $2,577,775 26,887 $161
Texas $7,847,249 21,015 $497
Utah $201,211 1,172 $287
Virginia $19,217,933 301,325 $102
Vermont $0 0 $0
Washington $464,382 3,328 $246
Wisconsin $742,480 23,502 $53
West Virginia $839,245 7,608 $211
Wyoming $0 0 $0
CMS has a further breakdown by individual, small group and large group markets.

BCRA's threat to premium rebates

The Better Care Reconciliation Act (BCRA) was the Senate's version of HR1628, which passed the House in May 2017. The BCRA would repeal or change many aspects of the ACA, but it initially failed to gain enough support among Republicans in the Senate, and Majority Leader Mitch McConnell announced on July 17 that the Senate would instead reconsider the possibility of repealing some ACA provisions without an agreed-upon replacement. Within a few days, however, the BCRA was back under consideration. The effort to repeal the ACA without a replacement didn't fare well at first either, with three GOP Senators announcing their opposition to the proposal. But McConnell has also continued to push for a vote on a motion to proceed on that bill. As of mid-July, it's unclear where GOP lawmakers will go next in terms of health care reform, although there's a lot that the Trump Administration can do to undermine the ACA without support from Congress. The BCRA would eliminate the federal MLR guidelines. States would instead become responsible for the regulation of insurers' administrative costs. (This is similar to the approach that the Trump Administration is taking with regards to insurers' network adequacy). The CBO estimates that about half the U.S. population lives in states where the current federal MLR rules would have been maintained if the BCRA were to be implemented, and the other half live in states where the rules would be relaxed. "Relaxed" rules would have led to increased premiums (and of course, smaller MLR rebates), particularly for people who don't qualify for premium subsidies in the exchange.

Could the MLR still be 'neglected?'

The repeal-and-delay measure that McConnell was pushing in mid-July is based on 2015's HR3762, which passed the House and Senate in 2015, but was subsequently vetoed by President Obama. HR3762 did not address the MLR rule – either because it wouldn't have passed the Byrd Rule, or because lawmakers didn't consider repealing it to be important enough at the time. It's unclear where we'll go from here, but for the time being, the MLR rules remain in effect. Timothy Jost, Emeritus Professor at the Washington and Lee University School of Law, noted that it's possible, however, that the Trump Administration might not be as diligent in gathering MLR data and enforcing the rules as the Obama Administration was. This summer, you could be receiving a nice rebate check from your health insurance carrier. It’s all thanks to the Affordable Care Act’s medical loss ratio (MLR) – a provision sponsored by Minnesota’s Sen. Al Franken that forces health insurance companies to use your premium dollars to provide actual health care for plan participants, or return that money to you.

POSTED AUGUST 02, 2017 2:34 PM
Miss open enrollment? You’ve got options.
Open enrollment for 2018 will run from November 1, 2017 to December 15, 2017. Outside of those dates, enrollment on and off the exchange is only available if you experience a qualifying event. Short-term coverage is the closest thing you can get to "real" health insurance if you find yourself needing to purchase a policy outside of open enrollment without a qualifying event, but new short-term plans are now limited to less than three months in duration.

POSTED JUNE 29, 2017 5:05 AM
Qualifying events that can get you coverage
Even if you missed the general open enrollment, you could still have an opportunity to enroll in an ACA-compliant plan this year if you experience a qualifying event. In that case, you have a special open enrollment period – generally 60 days – during which you can enroll in a new plan on or off-exchange, or switch to a different plan. Be aware, however, that new market stabilization rules have tightened up the rules that apply to special enrollment periods.

POSTED APRIL 18, 2017 5:01 AM
The ACA’s cost-sharing subsidies
While the Affordable Care Act's premium subsidies help pay the cost of the health insurance itself, cost-sharing subsidies help to reduce out-of-pocket spending for eligible enrollees when they select Silver plans. The guidelines have been adjusted slightly for 2017 (and again for 2018), but the result is still an excellent deal for people with income up to 250 percent of the poverty level, if they pick silver plans. The future of cost-sharing subsidies is uncertain, however, due to a pending lawsuit.

POSTED APRIL 11, 2017 7:34 AM

The Medicare Blog

It’s always time to quit tobacco
Smoking tobacco can cause many health problems, including heart disease, respiratory diseases, and lung cancer —the leading cause of cancer death in the U.S. Close to 40 million people in the U.S. still smoke tobacco, but quitting can help prevent these health problems. You can quit smoking today, and Medicare wants to help. Besides being […]

POSTED NOVEMBER 16, 2017 5:00 AM
COPD – Learn more, breathe better
Chronic obstructive pulmonary disease (COPD) is a group of diseases that cause breathing problems, like emphysema, chronic bronchitis, and asthma. People with COPD are more likely to have difficulty walking or climbing stairs, be unable to work, and have other chronic diseases, like diabetes or heart disease. To help you detect COPD early, when treatment […]

POSTED NOVEMBER 14, 2017 9:31 PM
Saving money on health care costs: Extra Help
If you have limited income and resources, you may qualify for Medicare’s Extra Help program. You might be able to get help paying your Medicare drug plan’s monthly premiums, yearly deductibles, and prescription copayments. Drug costs in 2018 for most people who qualify will be no more than $3.35 for each generic drug and $8.35 […]

POSTED NOVEMBER 14, 2017 5:01 AM
Know when to use antibiotics
It’s that time again—flu season! If you get sick, antibiotics won’t always help you. If you get a cold or flu, antibiotics could do more harm than good. That’s because these are viral infections, and antibiotics only cure bacterial infections. Every time you take antibiotics, they kill sensitive bacteria, but resistant germs can survive to grow and […]

POSTED NOVEMBER 13, 2017 5:01 AM
Caregivers need help, too
Are you caring for an aged, ill, or disabled family member? If so, you’re one of about 43.5 million Americans who care for loved ones with a chronic illness, disability, or frailty. Family caregivers provide an average of 24 hours of care per week – when you’re the caregiver, that can make it hard to […]

POSTED NOVEMBER 08, 2017 5:01 AM
Medicare Open Enrollment: The Value of Convenience
When choosing a health plan, sometimes convenience matters. In addition to cost, coverage, and benefits, here are some other things you may want to consider as you compare Medicare options this year: Doctor and hospital choice Do your doctors accept the coverage? Do you pay less if you choose your hospital and health care providers […]

POSTED NOVEMBER 07, 2017 5:01 AM
Hospice care: Supporting you and your family
There are many difficult decisions that come with a terminal illness, like considering whether hospice is right for you. The thought of hospice can be scary, but it’s important to learn about your options. Medicare covers hospice care to help terminally ill patients spend the last moments of their lives with dignity and comfort, among […]

POSTED NOVEMBER 01, 2017 3:48 PM
Fight lung cancer with Medicare
More men and women in the United States die from lung cancer than any other type of cancer. More than 220,000 people are diagnosed with lung cancer every year. The best way to lower your chances of developing lung cancer is to quit smoking and stop using tobacco products. If you use tobacco, Medicare Part […]

POSTED NOVEMBER 01, 2017 4:02 AM
Diabetes—Are you at risk?
Millions of Americans have or are at risk for diabetes, one of the leading causes of death in the United States. The disease can lead to kidney failure, amputations, and blindness. November is American Diabetes Month, the perfect time for you to find out if you’re at risk and learn about the benefits Medicare covers […]

POSTED NOVEMBER 01, 2017 4:01 AM
Medicare Open Enrollment: Peace of mind with Medicare coverage
Having health insurance with covered benefits that you can count on can bring peace of mind. If you have Medicare, you get benefits like: A host of preventive tests and screenings — including cancer screenings — most at no cost to you A discount of 65% on covered brand-name drugs with Part D if you […]

POSTED OCTOBER 31, 2017 3:30 PM

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