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What Does the Affordable Care Act Really Mean?

With the United States facing significant changes in many areas, including health care, trying to understand what the Patient Protection Affordable Care Act (ACA) may evolve into is an unknown.

According to many industry watchers, since the ACA was enacted, over five millions people saw their health insurance policies discontinued because they did not meet ACA standards. Those plans were labeled as being unsatisfactory. However many scrapped plans offered more and were more valuable to customers than what was being sold under the auspices of the ACA.

What are the possible differences between the ACA and what may happen if it is repealed?

  • The ACA plans are focused on preventive care
  • According to the law, many of the services are covered without co-pay
  • Many of the services are not subject to co-insurance
  • Many of the services do not have a deductible
  • These services are supposedly free, but as benefits, they add to premium costs
  • Added premium costs are paid for by policy holders on the front end
  • Health Savings Account-like plans are in the Bronze category under the ACA with a family deductible of over $12,000

The number of claims an insurance carrier gets determines premium costs. There is no underwriting under the ACA, which increases an insurance company’s claim expenses. Increased costs for the increased risks translate into higher premiums. To bring costs down many carriers have restricted their networks of hospitals and doctors — a turn of events that means Americans may have to change doctors or change insurance carriers.

If the ACA is repealed and a different kind of health care system comes into play, such as the system in existence before the ACA was passed into law, the following may be implemented:

  • Insurance plans would focus on major medical
  • Health Savings Accounts with a High Deductible Health Plan or plans similar in nature may return
  • Prescription drug coverage and doctor visit co-pays were applied to the deductible
  • Monies in the savings account could pay for drugs and doctor visits
  • Many people can pay $100 to $200 to visit a doctor

The possible repeal of the ACA and what would replace it is unknown. If the old system is revitalized, consumers may well see more choices and competitive rates and plans.

While the repeal of ACA is ongoing, the prospect for more fair insurance rates and a return to better plans may be hovering on the horizon.

Posted on Monday, February 20th, 2017. Filed under Health Insurance.

Repeal and replace the ACA?

The incoming administration is determined to repeal and replace the Affordable Care Act (ACA). It is difficult to know yet, what is to replace it and how the new system will work. Some provisions from the ACA may be kept in place like keeping kids on a parent’s health plan until they are 26 years-old and not denying people health insurance if they have pre-existing conditions. But the question remains how is the Trump administration going to accomplish this?

Because there is no established system that keeps track of who signed up for insurance and who did not. The question is how to determine who did get insurance, who did not, who was possibly forced into buying it and who still does not have insurance.

Some pundits claim that the ACA gave coverage to 20 million Americans who had never had insurance before. Others say, that it was 14 million counting those who were insured but lost their insurance and had to buy new plans under the ACA. Many people feel cheated and overcharged with their health insurance plans under the ACA.

What is next? Some Americans hope that the Trump administration will repeal the and replace the current healthcare system with something that will lower insurance costs, lower premiums and open the market up with more insurance choices.

Posted on Monday, February 6th, 2017. Filed under Health Insurance.

What Health Care in the United States May Look Like in the Future

According to president-elect Donald Trump, Americans have suffered under the weight of a massive economic burden brought about by the Affordable Care Act (ACA).

Apparently the Affordable Care Act was passed into law without much foresight, resulting in out-of-control costs, non-functional websites, higher premiums, less competition in the insurance industry and a greater rationing of care. As a result of the legislation, every American was allegedly faced with uncertainty of the ACA collapsing, causing even greater economic concern and hardship when it came to health care.

President Donald Trump’s administration suggests that on day one of a new administration free market reforms would be introduced into the health care industry by completely repealing the ACA. Replacing the repealed legislation would be the next task and the administration indicates it would have such reforms ready that closely follow free market principles geared to restore certainty and economic freedom to all Americans. Free market principles combined with sound public policy are intended to broaden health care access, improve the quality of care and make it more affordable.

The proposed seven-point plan touted by president-elect Donald Trump to make health care more affordable for all Americans will allegedly:

  • Lower health care costs for every American
  • Remove uncertainty about health care
  • Offer financial security for Americans
  • Tackle other policy revisions to lower the cost of health care
  • Enforce immigration laws to relieve economic pressures on Americans in health care
  • Stop fraud and waste and energize the American economy
  • Reduce the number of people accessing programs such as Children’s Health Insurance, Medicaid
  • Work on growing the economy by bringing jobs and capital back to the United States
  • Reform mental health services

It appears that the plan to reform health care in the United States is ambitious and may result in some significant changes for Americans. While it is not precisely clear how many of the proposed reforms are to be implemented and what may be designed to replace existing health care legislation, there are many industry pundits who feel that change may be a good thing to stimulate the economy.

The country is on the brink of a new era and it appears that approaching health care with a different point-of-view may produce some interesting results, not only for the people, but also for the insurance industry as a whole.

Posted on Tuesday, January 31st, 2017. Filed under Health Insurance.

Does a free market benefit the individual or the health care provider?

The insurance industry is complex and adjusting how its products are marketed may have a negative impact on consumers. Economists swear by a free market environment as being beneficial to all who participate in it.

But would a free market environment work for the insurance industry? To answer that question, a group of economists studied Medicare Advantage, where beneficiaries chose from alternative cost-sharing arrangements and restricted provider networks. A healthy 32 percent of seniors have opted for Medicare Advantage where the government pays insurers a fixed fee to cover patients, not a separate service fee as in traditional Medicare.

Based on the growing numbers of seniors opting for Medicare Advantage, it appears they find the competition for their business and the choices they are offered to be very appealing and beneficial. According to House Speaker Paul Ryan, choice and competition are better options when it comes to selecting health insurance. It appears research supports his contention.

What does the future hold? It may be interesting to see what happens when the transition from one administration to another completes.

Posted on Monday, January 30th, 2017. Filed under Health Insurance.

What does the Congressional Budget Office research show about premium support?

In 2013 the Congressional Budget Office (CBO) researched how premium support, as suggested by House Speaker Paul Ryan’s “A Better Way,” would impact the federal budget, beneficiaries’ payments and choices.

The results of their research revealed that under the two different proposed premium support plans, that both would “reduce federal spending for Medicare net of beneficiaries’ premiums and other offsetting receipts.” Put another way, introducing premium support would adjust the current health care system and permit the free market to offer seniors the ability to pick plans suited to their health needs.

Based on this research, House Speaker Paul Ryan hopefully forecasts that by 2024, Medicare beneficiaries may see private insurers compete for their business on a proposed new Medicare Exchange. The futuristic plan would allegedly have no disruptions in the Medicare Fee For Service program for retired individuals or those about to retire. These individuals would also have the option to enroll in the new premium support program.

With research backing up Ryan’s conclusions that a free market choice is more beneficial to those seeking health insurance it appears that competition and choice may be the future of health care in the United States.

Posted on Friday, January 27th, 2017. Filed under Life Insurance.

The debate over privatizing the provision of public insurance continues

There are two points that say privatization of public insurance is good in that it offers consumers more options and increases competition in the insurance industry. Proponents for privatization say both those changes would be financially beneficial for consumers in the long run.

House Speaker Paul Ryan whose alternative proposal, A Better Way, is being touted as a possible solution to revamping the health care system, says “The Medicare premium support payment would be adjusted so that the sick would receive higher payments if their conditions worsened; lower-income seniors would receive additional assistance to help cover out-of-pocket costs; and wealthier seniors would assume responsibility for a greater share of their premiums.”  

One of the main reasons for the drive to make changes to Medicare is the continued aging of the population and the ratio of those employed to those retired declines. Disparities such as this contribute to an economic conundrum that the new administration hopes to bring under control.

While the way may not yet be clear, Paul Ryan’s “A Better Way” may offer some viable solutions.

Posted on Thursday, January 26th, 2017. Filed under Health Insurance.

What do the changes to Medicare mean?

The new administration plans to push health care reform, and in the process overhaul Medicare, by eventually implementing what they refer to as premium support. What does that mean for Americans? It means that premium support would increase competition among health care providers, thus offering beneficiaries the choice of where to spend their money when choosing providers.

House Speaker Paul Ryan formulated one of the proposed plans that may replace Medicare. Should the Better Way plan come into being, it would move Medicare away from the current single-payer status. Right now the government pays for seniors’ health care into a system that inhibits health care costs by creating more competition from suppliers wanting the business.

Does this mean Medicare stands the chance of being eliminated? That remains to be seen. There are too many factors for any type of a clear answer to surface. The bottom line with Medicare as to whether it is phased out or replaced with a premium support plan rests on budgetary concerns.

Posted on Wednesday, January 25th, 2017. Filed under Medicare.

Health care support may be based on age

There is a good possibility that the new form of health care for the nation may provide health support based on age. As explained by House Speaker Paul Ryan, the idea would be that older Americans who are very ill would get more support, as would lower income individuals. Those with higher incomes would thus not receive the same kind of support since they could afford to pay for it.

The new administration has plans to make significant changes to Medicare. Many incoming politicians feel Medicare is responsible for a huge hole in the budget due to the misuse and abuse of the program. Having said that, Speaker Ryan also pointed out that the longer Medicare runs without any changes or pending changes in place, the delay just makes things worse.

Americans who use Medicare are advised to be aware of any potential changes that may affect them. It is hard to predict what changes may be proposed and how they would benefit Medicare recipients, and whether or not those suggested revisions may come to pass.

Posted on Tuesday, January 24th, 2017. Filed under Health Insurance.

The Affordable Care Act’s future for 2017

With a new administration promising to repeal the Affordable Care Act (ACA), 2017 may be a different year. However, with all large changes that may be coming, it is virtually guaranteed that repealing the ACA and replacing it with something else requires, in the words of House Speaker Paul Ryan, “a good transition period.” No matter how much Americans want change that change will need to accommodate the over 20 million people who did buy health insurance under the ACA.

A replacement plan has to be put into place before the ACA could be repealed. While there is a replacement plan on the table, it is not clear if that plan will be sufficient for American families and seniors to keep affordable health insurance that suits their needs. In the meantime, things remain unaffected, pending changes.

One portion of the ACA, referring to coverage for individuals with pre-existing conditions and young adults staying on their parents insurance until they turn 26 may be kept and/or tweaked as new plans are formulated.

Speaker Ryan was not clear on how long a transition period would last, but some reports indicate that it might take up to three years to accomplish the kind of massive shift in health care.

Posted on Monday, January 23rd, 2017. Filed under Health Insurance.

Missing Part D enrollment does not always mean your customer loses out

In many instances, those who miss out on signing up for Part D must look elsewhere to find lower cost drugs. There are exceptions to this general rule of thumb. For instance, your customer may qualify for a Special Enrollment Period. The senior may have moved out of the service area, had other circumstances beyond their control that precluded them signing up for Part D or they were involuntarily dropped from their Medicare Advantage Plan.

When dealing with upset and distraught customers who have missed out on signing up for Part D, always ask for the backstory to see if they may fall under one of the “exceptions.” Taking care of your existing and potential customers and being a respected insurance agent is something earned by going the extra mile for your customers.

Posted on Friday, December 30th, 2016. Filed under Medicare.