Wellmark Blue Cross has filed for a proposed rate increase with the Iowa Insurance Division. The proposed rates will go into effect on January 1st 2022 and must first be approved by the Iowa Insurance Commissioner. It is important to note that often, increased tax credit subsidies often off-set the increase in premiums on the Affordable Care Act plans. Wellmark states the following reasoning for their rate increase:
Pre-Affordable Care Act Plans
6% Increase in Claims over $50,000
16% Increase in Pharmacy Costs
47% Increase in Dermatology Costs
82% Increase in Specialty Prescriptions
Affordable Care Act Plans
15% Increase in Doctor Visits, Psychiatric Visits & Physical Therapy
18% Increase in Claims over $50,000
83% Increase in Mental Health Services
181% Increase in Ambulance Services
Proposed Rate Increases
Pre-Affordable Care Act Grandfathered HMO plans - 0.0%
Pre-Affordable Care Act Grandmothered HMO plans - 10.0%
Pre-Affordable Care Act Grandmothered PPO plans - 5.9%
Affordable Care Act plans - 11.1%
Supreme Court Upholds the Affordable Care Act As Constitutional: Summary - On Thursday, June 17, the U.S. Supreme Court dismissed a challenge to the Affordable Care Act for failure to show that the individual and state plaintiffs had standing to attack the law's requirement that individuals obtain minimum essential coverage (MEC), otherwise known as the individual mandate. The Court concluded that the plaintiffs failed to show a past or future injury traceable to the federal government's conduct enforcing the MEC provision they attack as unconstitutional. The Court reversed and vacated the Fifth Circuit's judgment in respect to standing and remanded the case back to the lower court with instructions to dismiss.
The case was decided by a 7-2 majority vote, with Justices Alito and Gorsuch dissenting. The Court did not reach the merits of the issue - i.e., whether the "individual mandate" to purchase insurance is unconstitutional with a $0 penalty; however, the fact that neither the states nor individuals have standing to sue should settle this issue. While there may be challenges to the ACA in the future, there appear to be no serious constitutional challenges in the pipeline that would overturn the ACA in its entirety. Therefore, it continues to be business as usual with respect to the ACA, including the employer mandate and form 1094-C/1095-C reporting.
Some Hospitals Deliberately Hide Pricing Required By Federal Law: Although Congress passed the No Surprise Act on December 27th 2020,which prevents providers (doctors, hospitals, etc) from billing patients excessive amounts and requires them to make public their pricing for various procedures, some hospitals have been caught deliberately hiding this pricing from the eyes of the public. Methods include anything from not showing the web page on their main website or even decoding the information so that it can not be found by search engines.
Iowa Extends Pre-Affordable Care Act Plans: For those still enrolled in the lower priced Pre-Affordable Care Act plans, the Iowa Insurance Division is allowing these plans to continue until 12-31-2022. At that point, the Affordable Care Act mandates this coverage will be terminated and these people will need to find new insurance. However, this termination mandate has been postponed several times and there is a high probability that will continue. The only 2 insurance companies that continue to offer these plans are Wellmark Blue Cross and United Health Care. Please note the Affordable Care Act prevents anyone enrolling in a Pre-ACA plan as a new customer.
Biden Extends Affordable Care Act "Special Enrollment": Typically the ACA Open Enrollment is from November 1st through December 15th of year. However, President Biden has opened a special enrollment that now lasts through August 15th. This allows anyone to see if they qualify for a tax credit or to switch ACA plans through a substantial amount of the year.
The American Rescue Plan Act Lowers Individual Health Insurance Premiums!
New and increased tax credits should be available April 1st for May 1st payment dates. This includes a tax credit for those people with too high of an income to receive a tax credit currently, and an increased tax credit for those already receiving a tax credit.
The new tax credits for unemployed people will be available "early July" according to Centers for Medicare & Medicaid Services.
The Special Enrollment Period enacted by President Biden originally ended May 15th. It has now been extended to August 15th.
There are 2 ways to receive the increased tax credit. Here are the options, along with the pros and cons:
1. You may login and update your plan via the account that was emailed to you when your originally enrolled or contact us at 800-383-6590 or by replying to this email.
Pros: Receive a lower monthly premium going forward for the rest of the year. Since the tax credit is retroactive to January 1st, any additional tax credit will be reimbursed to you at the end of the year. You can also select a new plan if you wish.
Cons: If you change your plan, or re-enroll in the same plan, you will be subject to a new deductible and out-of-pocket maximum. That means you are starting over and will need to meet the deductible and out-of-pocket maximum again.
2. You may continue to pay the same premium you are currently, then receive the tax credit when filing your 2021 taxes.
Pros: You will NOT have a new deductible or maximum-out-pocket. Any claims that have been credited to your deductible and maximum-out-pocket will remain.
Cons: You will pay your current premium throughout the rest of this year and receive the tax credit when you file your 2021 taxes. New premiums and tax credits will be assessed January 1st 2022.
We believe it will be in most client's best interest to wait until filing their 2021 taxes to receive the increased tax credits as long as they can afford their current premium. This avoids a resetting of deductible and maximum-out-of pockets, as well as avoiding any errors that may occur. These errors may include healthcare.gov not enrolling a plan correctly, submitting the wrong tax credit and premium to an insurance company, or not cancelling out the old plan. For the most part, people do not experience these issues. However, for those who have, it can be very time consuming trying to correct anything with healthcare.gov's customer service.
Please remember that information continues to be released and any of this could change.
Stimulus Package and Your Health Insurance:
The American Rescue Plan was signed into law by President Biden. Although there are many details to it, here is how it affects those with Affordable Care Act plans:
1. Larger subsidies for 100-400% Federal Poverty Limit (FPL). Most significantly, enrollees who are within 100 - 150% (FPL) are eligible for a $0 premium silver plan with substantial cost sharing reductions that lower deductibles.
2. Expanded Advanced Premier Tax Credit (APTC) eligibility to those above 400% FPL. The new bill caps the percentage of income paid for a Marketplace benchmark silver premium to 8.5%, which makes ACA coverage significantly more affordable for enrollees who traditionally had too high of an income to qualify for APTC.
3. APTC guarantees for enrollees receiving unemployment compensation. If an enrollee is receiving unemployment compensation, they will qualify for subsidies as if their income is 133% FPL. This means these enrollees are eligible for a silver plan with a $0 premium and significant cost sharing reductions.
4. These subsidies are retroactive to January 1st, 2021.
5. People who underestimated their income in 2020 will NOT need to pay back their APTC when they file their taxes. This is 1 time only.
Please keep in mind while politicians make rules, it takes a while for other federal agencies, insurance companies, etc to enact these rules. We will keep you updated via our newsletters and this progresses.
Congress Passes the No Surprise (Billing) Act on December 27th 2020: President Trump signed into law the No Surprise Act which prevents providers (doctors, hospitals, etc) from billing patients excessive amounts. For an example, someone goes the the emergency room and comes out with a ridiculous bill for which there is obvious price gouging. Effective 1-1-2021, the provider can no longer demand payment from the patient. Rather, they are required to work directly with the insurance company. The patient is only responsible for the copay, deductible or coinsurance that they would normally pay.
Errors in Wellmark Blue Cross Automated Payments: We have had several customers notice that Wellmark Blue Cross has missed their automated bank account payment. Wellmark states that they send out a notice to the member. However, none of our customers have ever received this notice. Please be aware of this situation and make sure that your premiums are withdrawn so that your coverage does not terminate. If you do notice a payment not withdrawn, please notify us right away. Wellmark should draft premiums on either the 1st of 5th of every month.
Biden to re-open Affordable Care Act Marketplace as early as February 1st! Announcement expected to be made this week.
Biden Administration To Reduce Options To Non-Affordable Care Act Plans: Many of you who are enrolled on the new 3 Year Traditional Plans offered by National General and United Health Care via President Trump's executive order are aware of the political drama that plays out with these "Annual Plans." Although they have a substantially lower premium than the Affordable Care Act plans for those who do not qualify for subsidies, we have received word that the Biden Administration will limit these plans as soon as the end of 2021. How much will that limitation be? That information was not provided. However, it was stated that any existing 3 Year Plans will not be terminated early. Meaning you may can continue your coverage for the remainder of the 3 years. At that point, we will need to renew your coverage in an alternative.
IRS Form 1095's Now Available: Everyone on an ACA plan should be receiving a 1095 this month from the Marketplace / Healthcare .gov. You will want to provide the 1095 to your tax preparer. If you do NOT have an individual ACA or Pre-ACA plan you will not receive a 1095. For our customers, we can access your 1095 if you do not receive a copy.
Dan Walterman interviewed by Roger Able of the "Behind The Wealth" podcast. What will the election bring for health insurance options? What health insurance options are available for 2021? What health insurance plan is right for me?
Oscar Health will be the 3rd option available in Iowa as far as Affordable Care Act plans go. While we are still waiting on premium information, we have received the new 2021 plan information. The lowest deductible is $4200 and there are several plans that include various doctor and prescription copays. The plan does utilize a network that is predominantly Mercy providers and hospitals.
Wellmark Blue Cross & Blue Shield has announced a 42% DECREASE on their Affordable Care Act plans effective January 1st, 2021!
Per National General:
On July 7, 2020, Allstate announced their intent to acquire National General Holdings Corp. The deal is the largest of Allstate's acquisitions to date and will make the combined entity the fifth-largest carrier in the independent agency market. Like National General, Allstate has a record of making acquisitions that complement their strategic objectives and drive growth.
Through this acquisition, we expect the combined entity will leverage National General's leading technology platform for the independent agency and broker channels. The acquisition will capitalize on the best that each organization brings to the market to drive scale through widened product offerings and distribution channels for both P&C and A&H markets.
Additionally, upon close, Allstate intends for National General's leadership to oversee the integration of Encompass into National General. Together, we will build products that will enable Allstate to convert existing AIA relationships to National General.
By leveraging best in class capabilities from each organization, we strive to provide agents and brokers with a leading carrier capable of writing non-standard auto to packaged auto and home to accident and health.
This is an exciting time for National General, with the deal expected to close in the first quarter of 2021. Until then, we will continue to operate and engage with you as we have, and you can expect the same service experience and focus that got us to this important milestone in our company's history.
Wellmark has filed proposed rate increases of 0 - 8.7% for plan year 2021 on their Pre-Affordable Care Act plans with the Iowa Insurance Division. If policy holders are forced to move to Affordable Care Act plan, Wellmark states the average rate increase is estimated to be 94.2% for their customers.
Grandfathered plans: 0.00% (Originally purchased prior to March 23, 2010)
Grandmothered plans 8.7%
Part of the reason is that the reinsurance taxes embedded in the premiums you paid, were never paid out as reinsurance to offset the increased claims under the ACA. Instead, it was spent elsewhere. Resulting in insurance companies cancelling plans or having massive triple digit premium increases.
Statement from Medica:
We are committed to ensuring our Individual & Family plan (IFB) members have uninterrupted access to the health care and medications they need during these challenging times. We will be communicating to IFB members that if they are having trouble paying their monthly premium, they can reach out to Medica for help.
If you have any questions, please contact Broker Services at 1-866-752-0945
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, 2020, contains important updates on the use of health savings accounts (HSAs).
The CARES Act restores the ability to use HSAs, FSAs and HRAs to purchase certain Over-The-Counter drugs and medications that was removed with the Affordable Care Act. These OTC drugs include aspirin and other pain medications, allergy medication, etc., without a doctor's prescription.
For the first time, menstrual care products are considered qualified medical expenses for payment or reimbursement with an Health Savings Accounts, Flex Spending Account or Health Reimbursement Account.
Both provisions for OTC and menstrual products apply to amounts paid or expenses incurred on or after January 1, 2020 and are ongoing without an expiration date.
Wellmark will allow Individual and Small Business policyholders to request a 60-day grace period when making premium payments for due dates between March 17th and June 30th. If circumstances change, they may need to revisit the extensions offered. Wellmark will work with any Mid-size or Large groups on a case-by-case basis to determine appropriate and flexible payment timeframes to ensure premium payments are made as timely as possible.
Individual & Family Plans:
Any member who is unable to pay their premiums due to impacts of COVID-19 should send an email to IndividualBilling@wellmark.com, including their full name and subscriber ID. They need to state that they are unable to pay premiums due to COVID-19. A billing representative will reach out to collect further information and work to ensure benefits remain active.
The group must request the extension. They need to send an email to FullyInsuredBilling@wellmark.com with the Group ID and Group name. Wellmark will also need the name of a contact person at the group and their email address. They need to state in the email they cannot pay due to the effects of COVID-19. They can also call the billing department directly with this information at 800-348-6430.
Congress passed a $2 trillion economic stimulus package by an overwhelming vote in the Senate and the House. President Trump is expected to sign the bill immediately.
Individuals and Businesses: The CARES Act functions largely as an economic stimulus by providing cash payments to individuals below a certain income, providing extra unemployment benefits and allowing self-employed individuals to apply for unemployment. For businesses, aid is provided through emergency grants, forgivable loans and relief for existing loans. These provisions are intended to assist employers to help them stay in business, keep employees on their payroll, and allow them to continue to support employees through employee benefits and health insurance.
Healthcare: The CARES Act also includes $100 billion for hospitals and $150 billion for state and local governments to combat the COVID-19 pandemic. The bill expands coverage beyond what was in last week's Families First bill by requiring health insurers to pay for coronavirus testing beyond those that are FDA-approved, including lab and state-developed tests as well as other tests approved by HHS.
Accessibility for telehealth is also expanded. High-deductible health plans with HSAs may now allow pre-deductible coverage for telehealth and other remote services, as well as allowing the use of HSAs for the purchase of over-the-counter medications without a prescription.
Very limited action was also taken to address surprise medical bills. Under the CARES Act, all health insurance plans would reimburse a COVID-19 test provider at the in-network rate put in place prior to the pandemic. If the provider is out of network, the health plan is to fully reimburse the provider based on the provider's own "cash price," which must be made publicly available while the public health emergency is still declared. Providers that do not post their test price publicly could be fined up to $300 a day.
In response to the current Corona virus (COVID-19) situation, and the requirements / recommendations of both Governor Reynolds and the CDC, the offices of Premier Health Insurance of Iowa will not be open to the public. We feel this is in the best interest of both the clients and staff.
Rest Assured: We are still open and ready to assist you. Please use preference in emailing, faxing to 319-363-3757 or calling our office at 800-383-6590.
At times, we may be working remotely with all calls and contacts still funneling through the office according to the Premier Health Insurance of Iowa contingency plan.
As the world continues to work its way to a solution, we will continue to keep you updated. Please watch our social media posts, or check our Blog for updates.
Good news for those on the lower priced pre-Affordable Care Act plans through Wellmark and United Health Care. Centers For Medicare & Medicaid Services has allowed an extension on these plans until January 1st, 2022 in the state of Iowa until their coverage will be terminated under the Affordable Care Act guidelines.
Premier Health Insurance of Iowa Recognized by the Marketplace / HealthCare.gov and the Centers For Medicare & Medicaid Services: Premier Health Insurance of Iowa & Dan Walterman were recognized by Randy Pate, Deputy Administrator of the Centers for Medicare & Medicaid Services, and the Marketplace / HealthCare.gov for their leading roll in the 2020 ACA Open Enrollment.
Iowa Insurance Division No Longer Allows 3 Month Short Term Plans. In 2015 President Obama limited short-term "annual" plans from 364 days to 90 days. On October 2nd 2018, President Trump extended these plans out to 3 years. In November 2018 the Iowa Insurance Division eliminated all options longer than 3 months. Now they have extended these plans back out to 3 years and have eliminated any options 3 months or less ....well.....at least we're in the right direction this time!
Dan Walterman interviewed by Adam Sullivan of The Gazette concerning the new 3-year short term limited duration plans offered by President Trump to combat the extreme costs of the Affordable Care Act plans for those who do not qualify for tax credit subsidies. It is interesting that the Kaiser Family Foundation's estimates the lowest priced Silver plan in Iowa is $211 for an individual and $746 for a family of 4. The reality is the lowest priced Affordable Care Act plan for a 45 year old individual is $642 and $1964 for a family.
The Iowa Insurance Division has approved National General to offer the new 3 year short-term limited duration plans. These plans provide a much lower price than the Affordable Care Act plans for those who do not qualify for a tax credit subsidy. A variety of plans are offered, including copay plans and more catastrophic deductible plans. Contact us for quotes and plan information.
I think we can all agree that health care providers should be required to provide the cost of their services and procedures to patients. When we purchase a gallon of milk at the store we know the price. Why can't we receive the price of what a hospital charges until we receive our actual bill? Anyone who has ever tried to inquire about the pricing of a specific procedure knows the run-around one receives between the hospital and insurance companies. Luckily for the consumer, this is about to end. Federal regulations that were finalized November 15th 2019 will require hospitals to make public their prices starting in 2021.
Several healthcare reform proposals being considered would significantly change the way that Iowans receive their health insurance. One of these proposals - Medicare for All - would eliminate private insurance and create a healthcare system fully run by the government. Now, a proposal called the Medicare "public option" is being discussed as an alternative. But this proposal would also have far reaching impacts - and according to a new study, would drive out most of the private plans we know today.
Not only would the public option change the Medicare system as we understand it, the proposal would create government-run plans acting alongside the existing private marketplace. A study by FTI Consulting and the Partnership for America's Healthcare Future further explains:
The public option would create government healthcare plans, which individuals can buy into. These plans would mostly likely be set up with artificial prices determined by the government, forming a "two-tier" system. Because government payments pay providers much lower than private plans, the public option would "crowd out" private coverage and eventually lead to a one-size-fits-all system - just like Medicare for All but on a longer timeline, reducing consumer choice and decreasing quality of care.
The study found that by 2050, Iowa could end up being one of over 30 states to likely lose all private insurance plans. When examining the changes in our healthcare system, it's important to look at the long-term impacts of your own plan.
Centers for Medicare and Medicaid Services has announced the opportunity for certain states to offer additional wellness benefits for those enrolled in Affordable Care Act Plans.
Once again Premier Health Insurance of Iowa has qualified for the Healthcare. gov / Marketplace Circle of Champions by assisting consumers in lowering their health insurance premiums through available tax credits and subsidies.
Listen to an Interview with Jeff Stein of KXEL concerning Medicare-For-All, public option, rising health care costs, and the new 3 year plans available in October.
Iowa Insurance Commissioner states "ACA individual health insurance market has become unaffordable..." All new lower priced 3 year Non-ACA plans with essential benefits will be offered! Contact us for more info!
Iowa has been the center of attention when it comes to healthcare reform. Many proposals, including Medicare for All, a public option, or a Medicare buy-in would drastically change the way our healthcare system works. Not only do many Iowans rely on private or employer health plans, but Iowa also has a low Medicare reimbursement rate that serves as a continued challenge within the state.
A new study covered by the Cedar Rapids Gazette highlights the impact of what one of these one-size-fits-all proposals would look like in Iowa. A public option proposal has been touted as an alternative to single-payer health care, but new challenges would arise within Iowa's healthcare system.
The Partnership for America's Healthcare Future published this study completed by Navigant, which determined that 52 of Iowa's 90 rural hospitals will be at a "high risk of closure" under a public option plan.
Wellmark Blue Cross and Blue Shield has requested a 0% rate increase for the Pre-Affordable Care Act Grandfathered plans. Unfortunately, the Affordable Care Act longer no allows these plans to be purchased. However, those one them experience substantially lower premiums compared to the Affordable Care Act plans when not receiving a tax-credit subsidy. Please be aware, that these plans may still have an age based rate increase.
No, that was not a typo. Medica has filed for an average 11% decrease in their 2020 ACA premiums.
The IRS has allowed additional preventative care benefits for HSA participants to be covered without requiring them to meet a deductible.
Wellmark has filed a proposed January 1st 2020 rate increase with the Iowa Insurance Division due to additional Affordable Care Act taxes, more significant health conditions, and increased prescription use.
A public hearing has been scheduled for Wellmark's requested rate increase on their Pre-Affordable Care Act plans.
Drug prices are skyrocketing and there is a complete lack of transparency within the industry. This creates high costs to consumers, increases health insurance premiums and finger pointing in every direction. Congress has passed the Patient Right to Know Drug Prices Act and the Know the Lowest Price Act to help combat these high prices. In addition, President Trump is proposing an executive order to create medical transparency and remove the industry's secret negotiations and pricing. We encourage everyone to watch the video below to see how drug pricing actually occurs.
As many of you know, these have been not only a great way to reduce premiums by 50 - 75% of Affordable Care Act plans, but also a hot political debate. President Obama limited them to only 3 months. President Trump extended them to 36 months contingent upon state approval. The state of Iowa allowed 12 month plans for a short time, then limited them back down to 3 months. However, Iowa has now agreed to 36 month plans, and allow them to offer better coverage as well. There are several insurance companies that have filed to offer these plans in Iowa. We are currently waiting for the Iowa Department of Insurance to approve them.
Once eliminated by the Affordable Care Act, these plans allow for employers to provide tax-free reimbursement to employees for health insurance premiums and other health care expenses. US Departments of Health & Human Services, Labor & Treasury issued a new policy allowing for HRAs once again. We will keep you informed of the final rules. For more information "View Here"