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Never A Dull Moment When It Comes To The Affordable Care Act (ACA)

Never A Dull Moment When It Comes To The Affordable Care Act (ACA)

Constitutionality of the ACA

Last year, a federal judge in Texas ruled that the ACA was now unconstitutional because there is no more Individual Mandate penalty.

The judge found that all portions of the ACA are now void. That ruling has been appealed and is currently under review by the U.S. Court of Appeals for the 5th Circuit in New Orleans.

In response to the Texas ruling, The Trump administration had initially taken the position that only some parts of the ACA had to be repealed (those most closely linked to the Individual Mandate) while other parts of the law could stand. In a new filing by the Justice Department last week, the administration now says the Texas judge’s decision should be affirmed and all parts of the ACA should be invalidated. If the ACA were to be ruled unconstitutional, there is no replacement plan currently in place.

Association Health Plans

Last year, the Department of Labor (DOL) finalized new rules which relaxed regulations pertaining to association health plans (AHPs). The rules made it easier for self-employed persons and small businesses to join forces when purchasing health insurance plans. Under the new rules, AHPs are regulated similarly to large group health plans which are exempt from some ACA market reforms, including the requirement to cover all ten essential health benefits. Because AHPs don’t have to follow all the ACA market reforms, premiums are generally lower.

The legality of the new AHP rules were challenged by proponents of the ACA, and a federal judge ruled in their favor. The judge indicated that the new AHP rules are “clearly an end-run around the ACA.” A spokeswoman for the Justice Department indicated the Trump administration disagreed with the court’s decision. The administration can seek a stay and appeal the decision. This would allow the AHP rules to remain in force while an appeal is heard. The DOL could also revisit the rule and issue a different version of the previously finalized rules. It’s unclear at this point how the Trump administration will proceed.

Grandmothered Plans

Health plans in the individual and small group markets that were issued after March 23, 2010 and prior to January 1, 2014 are commonly referred to as grandmothered plans. Grandmothered plans were supposed to be terminated in 2014 because they failed to satisfy all of the ACA’ s market reforms, but the federal government has temporarily allowed these plans to continue. In an announcement, the Department of Health and Human Services (HHS) has indicated grandmothered plans can continue to be renewed for plan years beginning on or before October 1, 2020, provided the plans end by December 31, 2020. Absent this announcement, these plans were set to expire at the end of 2019. It should be noted that this extension is an option for states and carriers, not a requirement.

Aguirre, Christina M. with Flexible Benefit Service Corporation “Re: There’s never a dull Moment when it comes to the Affodable Care Act (ACA).” Message to Courtney Mecklenburg. 1 April 2019. E-Mail.

Rules and regulations surrounding health insurance will be a hot topic for the foreseeable future. Our insurance agency, Texas Medical Plans, has mastered the health insurance industry in the 30+ year we have been in business. We are experts in the insurance field and we ready to help you. An insurance advocate on your side has never been more important than it is NOW.

Our clients are matched with the best insurance benefits at the best price based on their needs. Don’t waste another minute trying to figure out your insurance, how your insurance works, where you can get care using your insurance, while trying to stay current with the constant changes that affect insurance and your care; CALL US at (512) 847-3164 TODAY. Texas Medical Plans Advisors are standing by to take your call now.



ACA Open Enrollment Expected To Provide Stable Premiums, More Choices For Consumers

ACA Open Enrollment Expected To Provide Stable Premiums, More Choices For Consumers

The AP  (10/31, Alonso-Zaldivar) reports that ACA open enrollment starts today “amid stabilizing premiums and more choice for consumers.” The article says overall, “average premiums are going up only by low single-digit percentages for 2019. In some states, and for some types of plans, premiums will decline.” Meanwhile, fewer consumers are expected to see higher premiums, and several insurers are expanding to new cities and/or states. The AP adds that it may “be more difficult finding help in enrolling, after the Trump administration sharply scaled back funding for sign-up counselors known as ‘navigators,’” although “independent community groups still guide consumers through the paperwork.” Another important change is the fact that the ACA’s individual mandate will no longer be in effect as of January 1, 2019.

Likewise, the Washington Post  (10/31, Goldstein) reports that the next ACA open enrollment season will feature “more stable health plan choices and rates, plus significant tests of the effects of recent Republican moves to undercut parts of the law.” The article says this will be the first time since the law took effect that consumers will not be penalized for not having healthcare coverage. In addition, this will be the first enrollment season “since the Trump administration has been taking steps to circumvent the ACA’s insurance requirements, making it easier for individuals to buy two inexpensive types of insurance that cover less care and lack certain popular consumer protections.” The Post quotes CMS Administrator Seema Verma as saying, “We have been working tirelessly to fulfill the promises we made to stabilize the market.”

Bloomberg News  (10/31, Tozzi, Dodge) reports that consumers seeking to purchase ACA plans this year will “find that health-care coverage prices are high but largely stable, after months of tinkering by the Trump administration.” The article says although many of the ACA’s “core elements remain intact, other pieces have been weakened or removed.” President Trump vowed “to ‘let ObamaCare implode,’ and cut some of the law’s subsidies,” while Congress repealed “a mandate to buy coverage, and the administration has promoted cheaper plans with fewer benefits.” Overall, “the premium for typical plans in the 39 states that use the federal website will drop 1.5 percent in Trump’s third year in office, the administration said.” HHS Secretary Alex Azar is quoted as saying the President “took decisive action to stabilize insurance markets and expand choices for American consumers.”

NPR  (10/31, Kodjak) reports that “the shopping and buying experience will vary widely, depending on where people live. In California, for example, where political leaders have always been supportive of the Affordable Care Act, legislators have allocated $100 million for outreach.” However, “in states that rely on the federal government’s insurance exchange – mostly conservative states whose leaders opposed the ACA – there won’t be nearly as much outreach to potential customers.”

The New York Post  (10/31, Fredericks) also covers the story.



IRS Releases Forms 1094 and 1095 for Early 2019 Reporting

IRS Releases Forms 1094 and 1095 for Early 2019 Reporting

The IRS has released the Forms 1094-C1095-C1094-B, and 1095-B that employers will use in early 2019 to report on the group health insurance coverage they offered during the 2018 calendar year. Instructions on how to complete Forms 1094-C and 1095-C and Forms 1094-B and 1095-B have also been released.

As a reminder, employers with 50 or more full-time employees (including full-time equivalent employees) generally must furnish a Form 1095-C to all full-time employees by January 31, 2019, and file Form 1094-C and all Forms 1095-C with the IRS by February 28, 2019 (or March 31, 2019, if filing electronically). Meanwhile, self-insured employers with fewer than 50 or more full-time employees (including full-time equivalent employees) generally must furnish a Form 1095-B to all responsible individuals by January 31, 2019, and file Form 1094-B and all Forms 1095-B with the IRS by February 28, 2019 (or March 31, 2019, if filing electronically).


Looking for more affordable health insurance options?

Looking for more affordable health insurance options?

Short-term medical plans could be the solution for you and now you can purchase them for the entire year.

In August, the Department of Health and Human Services (HHS) issued a final ruling on short-term medical (STM) plan durations. These plans can be purchased off the marketplace. In that ruling, 90-day plan limitations were lifted, meaning states will have the option to allow carriers to sell short-term medical health insurance policies lasting anywhere from 30 to 364 days. Texas will offer 364 days of continuous coverage on short-term medical plans.

Effective 9/28/18 Texans will be able to select 10/2/18 effective dates with the longer duration short-term medical policies for health insurance.

These options may be more affordable, but buyer beware!

Texas Medical Plans works with several Texas health insurance carriers to offer short-term medical policies, but we want to be sure you understand what you are enrolling in. Contact us at (512)847-3164 to speak with an adviser to see if a short-term medical insurance plan may be the best fit for you. Advisors are standing by to take your call now.


Beware of Health Insurance Sales Phone Scam

Beware of Health Insurance Sales Phone Scam

Blue Cross and Blue Shield of Texas has learned about robocalls being made by people falsely claiming to be sales reps of Blue Cross or Blue Cross and Blue Shield. The robocallers claim to be selling health insurance. BCBSTX is not making any automated prerecorded sales calls.

  • Those calls are not from us. We don’t yet know who is placing these calls. They appear to be trying to get you to give out personal or financial information.
  • This is reported as a nationwide scam.
  • If you get one of these calls, hang up right away. Don’t give out your personal information. Don’t respond to prompts asking you to “press 1” or “press 2.”
  • Open Enrollment for individual health insurance ended Dec. 15, 2017. Unless you qualify for special enrollment, you can’t get health insurance until the next Open Enrollment which starts Nov. 1, 2018.
  • Read more about health care fraud  and protecting your personal and financial information.

5 More Reasons to Have Life Insurance with Living Benefits

5 More Reasons to Have Life Insurance with Living Benefits

Why more Americans are not purchasing life benefits with a chronic illness or long-term care rider is beyond me! It should be a no brainer, a slam dunk. Where else can you create a pool of money so quickly, with the first payment, that will take care of you while you are living or take care of your loved ones when you die?

Here are just a few stats that should make our hair stand up on end:

  • Approximately every 40 seconds, an American will have a heart attack.
  • 92% of older adults have at least one chronic disease; 77% have at least 2.
  • Every 40 seconds someone in the US has a stroke.
  • Every 66 seconds someone develops Alzheimer’s Disease – see resources

The average couple retiring at age 65 can expect to pay $260,000 to cover their health care costs in retirement. This is for their health care costs only! What about everything else? It is estimated that 20 years from now the cost for assisted living in the state of Texas will from $3,500 monthly to $6,321 based on 3% inflation. Care in a nursing home semi-private room goes from $4,563 monthly to $10,932! That is staggering! How can anyone afford to pay for that? Most Americans have little savings and no long-term care benefits! (Check out this handy Cost of Care tool.)

Enter life insurance with living benefits, or as I like to say, You have the opportunity to create a pool of money for life and your loved ones by discovering the power of living benefits.”

Here are 5 great reasons for life insurance with living benefits:

  • You understand that you need to have something in place to help take care of health care costs as you age. You just have not gotten down to doing it or think long-term care insurance is too expensive. Life insurance with living benefits may be a perfect fit. You just need to ask about it!
  • If you are already considering life insurance, adding living benefits does not add that much to the cost.
  • You don’t lose it if you don’t use it. One of the arguments you may have heard about long-term care insurance is “What if I don’t use it?” This policy will pay you while you are living or if you don’t need the living benefits, it will help support your loved ones when you pass.
  • It is not that difficult to understand. If you cannot perform 2 or the 6 activities of daily living and have a chronic diagnosis by a doctor (not all policies require the “chronic” diagnosis anymore) you will receive your monthly benefit amount based on the policy rider. I realize this is pretty basic and each policy has stipulations, but that really is it.
  • Not many people are aware this product exists. Although living benefits on life insurance policies is gaining traction, not that many people are aware of them because not many agents are offering them.

Life insurance with living benefits may not fit for everyone, but how will you know if you don’t ask?

If you would like to learn more about how life insurance with living benefits works, simply give me a call and I would be happy to discuss it with you.


New Medicare Cards

New Medicare ID Cards are Coming Soon 

The Social Security Number (SSN) based Health Insurance Claim Number (HICN) from Medicare ID cards are being removed to help prevent fraud and fight identity theft.

The Centers for Medicare & Medicaid Services (CMS) will mail out new Medicare ID cards between April 2018 and April 2019 with a unique new Medicare number.

Getting everyone new Medicare cards will take time. Medicare member’s will receive their cards at different times over the next year. One member’s card might arrive at a different time than their friend’s or neighbor’s card.

If you have a Medicare Supplement Insurance Policy in addition to Medicare, your insurance member ID cards and policy number are not impacted by this change. You do not need to notify your insurance carrier of the new Medicare number.


10 things to know about your new Medicare card

1. Your new card will automatically come to you. You don’t need to do anything as long as your address is up to date. If you need to update your address, visit your mySocial Security account.
2. Your new card will have a new Medicare Number that’s unique to you, instead of your Social Security Number. This will help to protect your identity.
3. Your Medicare coverage and benefits will stay the same.
4. Mailing takes time. Your card may arrive at a different time than your friend’s or neighbor’s.
5. Your new card is paper, which is easier for many providers to use and copy.
6. Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
7. If you’re in a Medicare Advantage Plan (like an HMO or PPO), your Medicare Advantage Plan ID card is your main card for Medicare—you should still keep and use it whenever you need care. However, you also may be asked to show your new Medicare card, so you should carry this card too.
8. Doctors, other health care providers and facilities know it’s coming and will ask for your new Medicare card when you need care, so carry it with you.
9. Only give your new Medicare Number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare on your behalf.
10. If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare Number online.


Watch out for scams

Medicare will never call you uninvited and ask you to give them personal or private information to get your new Medicare Number and card. Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call Medicare directly at 1-800-MEDICARE (1-800-633-4227).  Learn more about the limited situations in which Medicare can call you.


Health Insurance, Income Tax Returns, & Repeal of the Individual Mandate

Not all 1095 forms have been issued at this time!

  • Please look for your 2017 1095-B or 1095-C form from your insurance company, if you had coverage outside of the Health Insurance Marketplace.
    Deadline for insurance company to provide forms  – March 2, 2018.
  • Short-term insurance plans do not satisfy the insurance mandate as minimum essential coverage; meaning you will not receive a tax form if you were enrolled in this type of plan in 2017.
  • For those with coverage through The Health Insurance Marketplace in 2017, 1095-A forms have already been mailed and can also be accessed via your marketplace login.

1095 forms provide information needed to report on the income tax return that you, (your spouse, and individuals you claim as dependents) had qualifying health insurance coverage (referred to as “minimum essential coverage”) for some or all months during the year. Individuals who do not have minimum essential coverage and do not qualify for an exemption (see table below) from this requirement may be liable for an individual shared responsibility payment, also referred to as a tax penalty.

Minimum essential coverage includes government-sponsored programs, eligible employer-sponsored plans, individual market plans, and other coverage the Department of Health and Human Services designates as minimum essential coverage. For more information about the tax provisions of the Affordable Care Act (ACA) visit the IRS website or call the IRS Healthcare Hotline for ACA questions (1-800-919-0452).


to avoid paying a tax penalty!

Form 1095-A

Health Insurance Marketplace Statement. The Health Insurance Marketplace (also known as an Exchange) sends this form to individuals who enrolled in coverage there, with information about the coverage, who was covered, and when.

Form 1095-B
Health Coverage. Health insurance providers (for example, health insurance companies) send this form to individuals they cover, with information about who was covered and when.

Form 1095-C
Provided Health Insurance Offer and Coverage. Certain employers send this form to certain employees, with information about what coverage the employer offered. Employers that offer health coverage referred to as “self-insured coverage” send this form to individuals they cover, with information about who was covered and when.

The IRS has extended the due date for employers and providers to issue health insurance coverage forms to individuals in 2018.

Insurers, self-insuring employers, other coverage providers, and applicable large employers now have until March 2, 2018, to provide Forms 1095-B or 1095-C to individuals, which is a 30-day extension from the original due date of Jan. 31.

Click here to download a PDF of this table



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.


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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