10 Insurance Coverage Trends for Healthcare Providers to Know
Here are 10 trends in health insurance coverage for healthcare providers to know.
1. Insurance premium increases are projected to vary widely among states, and some states will handle changes from the Patient Protection and Affordable Care Act better than others. A new report from RAND Corp., found that five of the 10 states examined saw no changes in individual health insurance premiums under PPACA, but three others could see premium increases of up to 43 percent. The report predicted premiums will skyrocket in states where the federal government will facilitate health insurance exchanges.
2. HHS issued a final rule containing regulations for the new health insurance exchanges to outline eligibility appeals, verification of eligibility for minimum essential coverage and handling incomplete applications. The rule also creates additional privacy and security protections for consumers and clarifies the role of agents, brokers and issuer application assistants. The rule allows states to establish and operate small business exchanges without also running individual exchanges in 2014.
3. A new study in the Journal of the American Medical Association found that commercial accountable care organizations can produce Medicare savings. The researchers examined Blue Cross of Blue Shield of Massachusetts' Alternative Quality Contract and found Medicare billing was 3.4 percent lower than expected from the 11 AQC providers in the study.
4. Another study from the Kaiser Family Foundation shows that annual premiums for employer-sponsored health insurance exchanges increased by 4 percent for family coverage and 5 percent for single coverage over the past year. The average annual premium from January to May 2013 was $5,884 for single coverage and $16,351 for family coverage. The study also found 78 percent of covered workers paid a general annual deductible, up 6 percent from last year.
5. New projections estimate that 8.5 million uninsured Americans will purchase coverage through insurance exchanges that will begin enrolling Oct. 1, 2013, according to a USA Today report. There are 19 states set to open exchanges and California alone projects 5.3 million enrollees.
6. The employer mandate provision of the Patient Protection and Affordable Care Act, originally slated to take effect Jan. 1, 2014, has been delayed one year. According to a RAND Corp., study, the delay won't have a significant impact on health insurance coverage, only resulting in 300,000 fewer people with access to affordable health coverage next year. The mandate will require employers with 50 or more employees to offer insurance or pay a penalty. However, the federal government is expected to lose $11 billion in revenue due to the delay.
7. The Internal Revenue Services final regulations on purchasing insurance requires individuals who do not have insurance coverage to pay a fine of $95 or 1 percent of their household income — whichever amount is larger. The individual mandate goes into effect Jan. 1, 2014 and will increase to $325 for each uninsured adult or 2 percent of household income in 2015. The next year, the penalty is set at $695 per person or 2.5 percent of household income.
8. Many employers say they will make changes to their benefits programs for employees over the next two years because of the Patient Protection and Affordable Care Act. A report from Towers Watson shows that 72 percent of employers plan to change health benefits moderately or significantly by 2016 for full-time employees and retirees, looking at private exchanges as a delivery channel for health benefits. However, around 75 percent said they want evidence that private exchanges will deliver greater value than the self-managed model.
9. Some insurance companies across the country believe people purchasing insurance on the new health exchanges won't mind losing some flexibility and provider choice if they are able to pay lower premiums. BCBS of Illinois plans to sell limited provider network plans on the exchange that will cost as much as 30 percent less than other plans it sells on the marketplace, according to a report from The Wall Street Journal. In 13 states analyzed in a report from McKinsey & Co., 47 percent of the plans offered on the exchange were HMOs or similar policies.
10. Medicare coverage has expanded to same-sex couples. HHS issued a memo requiring private Medicare plans to give beneficiaries access to equal coverage in nursing homes where spouses live, even if they are same-sex couples.
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