Blog Archive

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Healthcare Executive Order signed by President Trump

President Trump signed an executive order on Thursday, October 12, 2017 promoting healthcare choice and competition.

What Is in the Executive Order?

The National Association of Health Underwriters (NAHU) reports that the executive order signed by President Trump directs the secretary of Labor, R. Alexander Acosta, to consider proposing regulations or revising guidance to expand Association Health Plans. The intent of this directive is to allow employers in the same line of business anywhere in the country to join to offer healthcare coverage to their employees. It could potentially allow employers to form Association Health Plans through existing organizations, or create new ones for the express purpose of offering group insurance. This could lead to the sale of insurance across state lines through Association Health Plans; however, more action will need to be taken by the Department of Labor before this option can be available, and NAHU has urged the Administration to work closely with state insurance commissioners across the country to ensure that the rules that are enacted to allow such plans are able to address concerns by state policymakers regarding Association Health Plans crossing into the markets within their borders.

The executive order signed by President Donald Trump directs the Secretary of Health and Human Services, Eric D. Hargan, Secretary of Treasury, Steven Terner Mnuchin, and Secretary of Labor to consider proposing regulations or revising guidance to expand short-term health insurance – limited duration insurance. This directive would allow the agencies to revisit the rule enacted by President Obama’s Administration that limited the length of short-term health insurance plans to three months. The three-month duration limit on short-term health insurance was implemented on April 1, 2017. Prior to April 1st, short-term health insurance plans could be enforced anywhere from 30 days up to twelve months.

The executive order signed by President Trump directs the secretaries of Health and Human Services, Treasury, and Labor to consider proposing regulations or revising guidance to expand Health Reimbursement Arrangements. The intent of this directive is to allow employers to contribute more to their employees’ Health Reimbursement Accounts. Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for healthcare expenses, including deductibles and copayments. The Internal Revenue Service does not count funds contributed to an Health Reimbursement Account as taxable income. The intent of this directive is to expand Health Reimbursement Accounts, which could provide employees with more flexibility in how their healthcare is financed.

What Happens Next?

The executive order signed by President Trump directs the secretary of Labor to act within 60 days to consider proposing regulations or revising guidance on Associated Health Plans. It also directs the secretaries of Treasury, Labor and Health and Human Services to act within 60 days to consider proposing regulations or revising guidance on Short term – limited duration plans, and for the agencies to act within 120 days to consider changes to Health Reimbursement Arrangements.

Within 180 days, the secretary of Health and Human Services, in consultation with the secretaries of Treasury, Labor and the Federal Trade Commission, must report to the president on state and federal laws, regulations and policies that limit healthcare competition and choice, as well as on actions that federal and state governments could take to increase competition and choice and reduce consolidation in healthcare markets.

The executive order signed by President Trump for healthcare does not direct the agencies to adopt specific regulations; therefore, for any policies to change, the agencies will have to go through the traditional rulemaking procedures of providing a proposed rule for public comment before being able to enact any final rules.

What about Open Enrollment for 2018?

At this time, nothing in the executive order sign by President Trump for healthcare will affect open enrollment for 2018 unless regulatory action is taken by the agencies. Until any such regulations are enacted, the Affordable Care Act “Obamacare” and all of its regulations, penalties and enforcement remain the law of the land.

MUST READ NAHU’s Statement on Today’s Executive Order, National Association of Underwriters, 12 October 2017, Accessed 12 October 2017.

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Teacher Retirement System of Texas (TRS) 2018 Health Insurance Benefits

TRS health insurance benefits are changing for 2018 and our new alternative health insurance options could be a better option. Teachers are accustomed to changes from a school’s curriculum to testing standards, students, and most recently their retiree benefits. What most former educators may not know is that there could be better insurance options available to them besides TRS.

At the beginning of this year’s regular legislative session, TRS-Care came to the Legislature with a $1.1 billion shortfall, asking for supplemental funding to help maintain benefits for retirees. (1).

When TRS launched in 1985, it was expected to remain solvent for a decade with additional funding as needed. But its funding formula has not changed since 2005, a legislative joint interim committee reported last year.

Tim Lee, executive director of the Texas Retired Teachers Association, testified before the committee in March 2016 that without the additional allocations, retirees’ TRS health insurance premiums could have tripled by Sept. 1. The office of the Texas Comptroller of Public Accounts said rising costs, a growing retiree population and an outdated contribution system led to the funding shortfall. (2).

Lawmakers knew they needed to act differently and made drastic updates to TRS-Care. They cut the plans offered for those age 65 and younger from three options—one of which was free to retirees each month —to one option that would cost an enrollee $200 in monthly premiums.

The biggest changes for retirees over age 65, those eligible for Medicare, is that the cost to insure dependents has risen drastically. The cost to insure a spouse is rising several hundreds of dollars in some instances (1).

For Medicare eligible retirees and their Medicare eligible dependents TRS supplements their Medicare with a TRS-Care Medicare Advantage plan. Replacing the TRS-Care Medicare Advantage with a Medicare Supplement plan is now a better option for more Medicare eligible retirees. A Medicare Supplement plan can offer better coverage at lower monthly premiums. Texas Medical Plans is contracted with all the major Medicare Supplement insurance carriers in Texas meaning we find you the best coverage for the lowest rate. We do a complete overview to compare your TRS health insurance benefits with all the health insurance alternatives to ensure you and your family have the best coverage.

Premium costs went up for everyone, but for retirees under the age of 65 and not eligible for Medicare, their deductible is increasing as well.

As part of House Bill 3976, which Gov. Greg Abbott signed into law June 12, TRS-Care is no longer required to offer a $0 monthly premium health plan to retirees under 65 years old. The bill also said the state would contribute 1.25 percent of active employees’ salaries, up from the previous 1 percent contribution.

Katy ISD’s district contribution to TRS-Care also increased from 0.55 percent of payroll to 0.75 percent. KISD staffers are not contributing more per paycheck to TRS-Care, but HB 3976 cost the district $980,000, KISD Chief Financial Officer Chris Smith said. “So it took away $980,000 of what we could be doing for kids in Katy ISD,” Smith said. “It’s going to a good cause—it’s going to our retirees—but it’s not helping educate kids that are looking at us every day.”

Smith said he saw no immediate evidence KISD employees will delay retirement in order to avoid paying more for health insurance. Meanwhile, the district has about 250 retired employees who came back to do part-time work in KISD.

Young blamed the state and said retirees with fixed incomes are especially susceptible to the change in plan contributions. “[That is] a big problem—oversight and not anticipating the future,” Young said. (2).

On Friday, Sept. 1, 2017, TRS’ Board of Trustees passed a motion to apply additional funding from the special legislative session to reduce deductibles from $3,000 to $1,500 for TRS-Care non-Medicare participants and decrease premiums for TRS-Care Medicare-eligible participants. In addition, premiums for retirees with disabled children were reduced by $200. The Teacher Retirement System of Texas was allocated an additional $212 million after its leadership initially requested $1.35 billion to resolve a budget shortfall for its medical offering, TRS-Care.

Plan participants will receive additional information including an invitation to an in-person information session in their area and new plan guides by mid-November with details about the 2018 plans.

What does this all mean? Retired teachers 65 years and over and their dependents and retired teachers 64 and under and their dependents have new and more affordable health insurance options besides TRS. Do not miss out in getting the best insurance for you and your family before it is too late. Call our Licensed Texas Health advisors now at (512)847-3164. We are ready to review your coverage to get you the best!

2018 TRS-Care health benefits if you are not eligible for Medicare

2018 TRS-Care health benefits if you are eligible for Medicare

  1. Emily Donaldson, “TRS-Care experiences changes that will affect way retired teachers access health care in January”, Community Impact Newspaper, 7 Sept. 2017,  see full article here, Accessed 3 Oct. 2017.
  2. Amelia Brust, “Teacher Retirement System changes keeping agency afloat, but at a cost to younger retirees”, Community Impact Newspaper, Updated 26 Sept. 2017, see full article here, Accessed 3 Oct. 2017.
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Aetna is pulling out of Texas

Aetna is one of the few individual health insurance companies in Texas selling individual health insurance plans/ family health insurance plans for 2017. Aetna is also one of the even fewer companies offering an EPO provider network. An EPO provider network does not require referrals for specialist like other health insurance carrier’s HMO provider networks do. For 2018 Aetna has just announced that they will be pulling out of Texas as well as many other states.

If you currently have an Aetna health insurance policy then your current coverage will not be impacted until December 31, 2017. You will be unable to renew your policy for 2018. You will need to select another health insurance plan during the annual open enrollment period.

The open enrollment period for 2018 will begin November 1, 2017. Aetna is notifying their members that they will qualify for a special enrollment period due to “loss of coverage” which will allow them until December 31, 2017 to select another individual health insurance carrier. We at Texas Medical Plans do not recommend waiting until then to secure new health insurance coverage for 2018.

Our recommendation is that Aetna members contact their health insurance agent no later than December 15,2017 to ensure they have new coverage effective January 1, 2018. If you are an Aetna member without a trusted health insurance agent please contact our office, Texas Medical Plans, for assistance at (512)847-3164.

Aetna has also recently been in the news for their data breach that has impacted 522 Texas residents. Please read more here.

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CMS issues final rule to increase choices and encourage stability in health insurance market for 2018

The Centers for Medicare & Medicaid Services (CMS) reports the follow (visit the CMS website for the full report):

Today, CMS, issued the final Market Stabilization rule, to help lower premiums and stabilize individual and small group markets and increase choices for Americans. Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits.* The CMS rule is designed to provide some relief for patients and issuers now.

“CMS is committed to ensuring access to high quality affordable healthcare for all Americans and these actions are necessary to increase patient choices and to lower premiums,” said CMS Administrator Seema Verma. “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”

The final rule makes several policy changes to improve the market and promote stability, including:

  • 2018 Annual Open Enrollment Period: The final rule adjusts the annual open enrollment period for 2018 to more closely align with Medicare and the private market. The next open enrollment period will start on November 1, 2017, and run through December 15, 2017, encouraging individuals to enroll in coverage prior to the beginning of the year.
  • Reduce Fraud, Waste, and Abuse: The final rule promotes program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and help to lower premiums.
  • Promote Continuous Coverage: The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.
  • Ensure More Choices for Consumers: For the 2018 plan year and beyond, the final rule allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.
  • Empower States & Reduce Duplication: The final rule reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the federal government. The rule returns oversight of network adequacy to states that are best positioned to evaluate network adequacy.

CMS also made a number of other announcements today regarding the process that issuers must follow to meet the law’s requirements for the 2018 plan year. The additional guidance released includes updates that would make the guidance consistent with today’s final rule and information needed by issuers in order to have their plans certified for 2018, including: Key Dates for 2017; Issuer Guidance on Uniform Rate Review Timeline; Good Faith Compliance Guidance; QHP Certification Guidance for States; and Final Actuarial Value (AV) Calculator for 2018 and Methodology.

The final rule can be found, here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-07712.pdf

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Immediate steps to take after you have enrolled in health insurance

You are enrolled in health insurance, so what is next? If you have chosen an individual health insurance plan or a group health insurance plan and completed your health insurance application these are important steps to take:

  1. Make you’re your health insurance first month’s premium payment. Typically, your first month’s premium payment is collected at the time you complete your health insurance application, however some insurance carriers will allow you to make the initial premium payment after you submit your application. Contact your insurance carrier to pay your first month’s premium immediately. Your individual health insurance policy WILL NOT go into effect until the initial payment is received and processed. Confirm that your bank records show that your health insurance premium payments have been received by your health insurance carrier.
    1. Initial premium payments MUST BE received before the effective date for your policy to be issued. Health insurance carriers will not send insurance cards until they have received the first premium payment. Keep in mind that during the annual open enrollment period processing times are longer. This means it takes longer to process your payment and longer for you to receive your insurance cards.
    2. Your monthly health insurance premium payments must be received and processed prior to the month that you want coverage. This means that if you go to see your in-network doctor on April 1st, then your premium for April must be submitted and processed by your health insurance carrier no later than March 31st. If you do not make payments on time you take the risk of not being able to verify your insurance when you need to use it and potentially take the risk that your insurance policy will be terminated for non-payment.
  2. Terminate other insurance. Just because you received a letter that your plan is going away or premiums are going up does not mean that your other insurance will automatically cancel and that they won’t draft your account.
    1. If you are on automatic payments call the insurance carrier or login to your online member portal and cancel those immediately. Usually this request must be received several days before the draft date in order to cancel the automatic payments.
    2. Cancel your old policy with your previous health insurance carrier for the day prior to your new health insurance effective date. For example: if your new health insurance policy with Blue Cross Blue Shield of Texas starts January 1st then you need to cancel your old Blue Cross Blue Shield of Texas health insurance policy and make sure they have stopped any automatic payments.
    3. Some carriers will automatically renew your policy into something similar, so it is important to make sure that they are not “mapping” you into another plan. You may need to request that they cancel the policy they are “mapping” you into as well.
    4. If your health insurance is through healthcare.gov, also known as the Marketplace or the Exchange then depending on your application selections you may be automatically rolled into another plan each year. This plan may or may not meet your medical needs, so we advise that you actively reviewing your health insurance every year. Your application answers may also affect tax credits received. It is important that you are updating your application each year to ensure it is correct and current.
  3. Create an online account. Most insurance carriers have a member website or member phone app where you can create an account. Member online accounts allow you to access you and your family’s health insurance information. This information can be temporary ID cards, provider networks, online payment options, and claims information. Providers like Blue Cross Blue Shield have even added a “call a doctor” benefit through MD LIVE that you can access online. It may seem like a pain to add another account to your array of accounts, but these online health insurance tools are truly beneficial. You have almost everything regarding your health insurance at your fingertips. This allows you to avoid long hold times to contact the insurance carrier.
  4. Not truly happy with your health insurance? You have until January 31st to make changes to your health insurance. Be certain you know how your insurance works, your benefits and your coverage area. If your insurance does not meet your needs, we can help you explore alternatives. Call us at (512)847-3164.
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Know how to use your insurance

You have enrolled in a health insurance plan, now what? Health insurance can be confusing and overwhelming, so here are a few tips to help you use your health insurance correctly.

  1. KNOW YOUR NETWORK! Check doctors, hospitals, and urgent care in-network. Be proactive about your medical needs and check for the doctor’s and facilities that are close to you that are in your health insurance network. Each insurance carrier has an online tool where you can search providers by name, specialty, location. This is useful to have so that you know exactly where you can go in the event of an emergency.
    1. Each carrier has a multiple “networks”, so know what network you are in i.e. Blue Cross Blue Shield Blue Advantage HMO, Aetna Rosebud EPO or HMO, Memorial Hermann HMO or PPO, United Healthcare Choice, PHCS, Humana HMOx San Antonio/Houston, etc.
    2. When confirming your network with your provider ensure that you are using the specific network to confirm. Sometimes it may be best to speak to a providers billing or managed care representative (the person that handles their insurance contracts) to ensure you are receiving the correct information.
  2. Get established with a primary doctor. If you are having to switch doctors or have not established a relationship with a primary doctor in your network get an appointment now.
    1. Some doctor’s will only see new patients on certain days, so it can take a while to get an appointment. You want to be certain that you your doctor is the right fit for you.
    2. If you have enrolled in an HMO we recommend that you find out what your primary doctor’s referral process is like if you need to be referred to a specialist.
  3. CHECK THE FORMULARY FOR YOUR MEDICATIONS!
    1. Make sure that you review your health insurance carrier’s prescription drug formulary for any medications you take. This will give you an idea of what your costs will be.
    2. Make sure that you are also going to pharmacy’s that are in your health insurance carriers network.
  4. Not truly happy with your health insurance? You have until January 31st to make changes to your health insurance. Be certain you know how your insurance works, your benefits and your coverage area. If your insurance does not meet your needs, we can help you explore alternatives. Call us at (512) 847-3164.
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Medicare Announces 2017 Premiums and Deductibles

The Centers for Medicare and Medicaid Services announced Thursday, new premiums and out of pocket costs for 2017. This information comes after some beneficiaries have already made plan choices for 2017 based upon 2016 figures for out of pocket costs and premiums. Medicare is notorious for announcing changes late in the game, well after the year’s OEP/AEP (Open Enrollment Period/ Annual Election Period) have already begun.

The annual Medicare Part B deductible for all Medicare beneficiaries for 2017 will increase to $183, up from $166 in 2016. This is the deductible that anyone with a Standard Medicare Supplement Plan G is responsible for before their supplement plan’s benefits are triggered. For those who have Medicare Supplement Plan F, the plan will continue to cover the Part B deductible in full for the member.

The Part B premium rates will increase for about 30 percent of beneficiaries. The new monthly Medicare Part B premium for 2017 will be $134, up from $121.80 in 2016; an increase of 10 percent. Most beneficiaries will be protected from the hold harmless provision which locks in their Part B rate. Those protected are beneficiaries are those already receiving Social Security, and dual eligible participants having their premiums paid by Medicaid. Seniors that are newly eligible for Medicare in 2017 and those that are not receiving Social Security and being billed directly for Medicare will have to pay the higher premium.

In addition to increased Part B premiums and Part B annual deductible, Medicare has also increased other out of pocket costs such as the Part A deductible and per day costs for skilled nursing and Part A coinsurance. People with Medicare Supplement plans typically have benefits to cover these costs. The agents at Texas Medical Plans can review your Medicare Supplement policy benefits to see if you are effected by some or all of these changes. A Licensed agent can help you make an informed decision about you supplement policy and review it regularly to help you stay ahead of Medicare changes for years to come.

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How will a Trump Presidency affect Obamacare and health insurance?

Donald Trump has promised that he will repeal and replace the Affordable Care Act, Obamacare, as the Unites States President. This change is possible, but to get a true repeal and replace he needs 60 votes in the Senate. It may be more plausible that he will implement the series of measures he proposed during his campaign through smaller legislative changes.

Even if Trump moves to change the Affordable Care Act and repeal Obamacare this will not happen overnight. The Affordable Care Act was written into law two years and three months after President Barak Obama took office. It took another four years for the Affordable Care Act to be implemented into individual health insurance and group health insurance.

In January 2011 pieces of the Affordable Care Act were implemented into new health insurance plans. Amongst the first of the changes we saw were adding preventative / wellness benefits, the elimination of coverage caps, and the ability to leave children on a parents individual health insurance or group health insurance policy until they are twenty-six years of age.

Other pieces of the Affordable Care Act that were implemented in 2014 were that individual health insurance plans and group health insurance plans removed waiting periods, they covered pre-existing conditions, and the medical loss ratio (MLR). Pieces of the Affordable Care Act are still not implemented today. More than seven years after the law was written we are still in the implementation phase.

People want to know; will President Donald Trump get rid of Obamacare and will insurance go back to the way it was. The simple answer is there is no way to know. Even if he does make changes to Obamacare we may not see those changes until years later.

The GOP has a replacement plan to Obamacare detailed out in their A Better Way – Health Care Policy Paper, By The Numbers, and Fact Sheet.

What we at Texas Medical Plans have seen is that for most people looking at individual health insurance plans have fewer health insurance companies to choose from, monthly health insurance premiums have increased, and the health care provider networks continue to change. We have worked hard in 2016 to explore all the available options for your health insurance needs in 2017. There are other options available outside of Obamacare. If you are healthy it may be better to pay the health insurance tax penalty and get medical insurance that covers less than Obamacare. A Healthcare sharing ministry or accident plan may be a better fit for you in 2017. If you are a small business owner or our self-employed then you might be able to set up health insurance through your business as a group health insurance plan. It is now simple to set up a group with one or two people. Group health insurance plans can offer you a PPO again and access to a Nationwide network at possibly a better price than individual health insurance.

We welcome the opportunity to review all your options and will make recommendations to fit your budget. Call us at (512)847-3164. See more on our YouTube, Facebook, or Instagram pages.

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Insurance and Health Plan Options Grid

  Cost Covers Pre Existing Covers Pregnancy Satisfies Insurance Mandate Can have Subsidized Premiums PPO HMO Details
Affordable Care Act Indivudal & Family $-$$$ check-markYes check-markYes check-markNo Penalty check-markMust Qualify x-markNo check-markYes ObamaCare
Qualified Health Plan (QHP)
Group Employer or Small Business $$$ check-markYes check-markYes check-markNo Penalty x-markNo, but may be deductible check-markYes check-markYes Qualified Health Plan (QHP)
Major Medical – Short Term $$ x-markNo x-markNo x-markPenalty x-markNo check-markYes x-markNo Covers Major Occurrences
NON-Qualified Health Plan
Limited Benefit $$ x-markNo x-markNo x-markPenalty x-markNo check-markYes x-markNo Covers Minor Occurrences
NON-Qualified Health Plan
Accident Only $ x-markNo x-markNo x-markPenalty x-markNo dollar-signCash dollar-signCash Covers Accidents Only
NON-Qualified Health Plan
Specified Disease
(Cancer/ Heart Attack/Stroke)
$ x-markNo x-markNo x-markPenalty x-markNo dollar-signCash dollar-signCash  Covers Specified Diseases Only
NON-Qualified Health Plan
Healthcare Sharing Ministry $$ x-markWaiting Period check-markRestrictions Apply check-markReligious Exemption x-markNo check-markYes x-markNo Must abide by religious principles
NON-Qualified Health Plan
Not Insurance, No Guarantees

 

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ObamaCare is falling apart

The next ObamaCare Open Enrollment Period begins one week before the presidential election, and it ends about a week after our next president is inaugurated. November 1st is going to bring more bad news for Obamacare with even higher rate increases than we have seen in the past years. The next president is going to inherit this crisis.

Many insurers are already proposing substantial increases or others say they are going to leave the market all together. With all of the uncertainty you should know that there are alternatives to the ObamaCare marketplace exchanges for some. These options include short-term major medical plans, health care sharing ministries and small group employer plans.

Many analysts have said that the first five years of ObamaCare would be a struggle. They warned that the market could take years to balance out to a point that we would start really seeing reduced costs for health care and better outcomes for patients. They were right, as we enter the fourth year of open public and federal exchanges; things are still only getting worse.

As ObamaCare continues to fall apart, agents and brokers are working harder than ever to present clients with viable alternatives to the Affordable Care Act (ACA) plans that more and more people just cannot see as an affordable option anymore.

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