ACA: Employer Deadline Approaching

While mid-size employers (those employing 50-99 full-time employees) have another year of breathing room, employers with 100 or more employees are quickly closing in on a large Affordable Care Act deadline.

The ACA’s Employer Shared Responsibility provision goes into effect on January 1, 2015 for large employers. By that date, those employers must offer a qualifying health insurance plan to at least 70 percent of their employees and dependents. A qualifying policy must:

  • Be affordable – cost less than 9.5 percent of an employee’s salary
  • Provide “minimum value” – cover the benefits considered by the ACA to be “minimum essential coverage”

The threshold for policy offerings rises to 95 percent of eligible employees in 2016.

Employers that do not offer a qualifying policy will be subject to fines: for non-coverage, they will owe $2,000 per full-time employee after the first 30. In addition, employers will be assessed a fine of $3,000 per full-time employee who qualifies for a subsidy on the healthcare marketplace. MI Health Answers offers a simple graphic to break down the Employer Shared Responsibility provision.

While consultants studying the implementation of the ACA estimate that most employers will eventually comply or do already, there are still many business owners nationwide who are weighing the costs of alternatives to providing qualifying policies. Options include cutting personnel and employee hours to remain exempt or paying applicable penalties.

Some employers fear that they will face penalties if their employees choose other, more affordable coverage; however, the benchmark for determining whether a policy qualifies as affordable is the law and not the actions of eligible employees.

Is your company facing the healthcare deadline, and are you prepared to offer the required coverage to your employees? If cost is keeping you from complying with the employer mandate, healthcare factoring can provide the necessary cash flow to cover the expense. PRN Funding has more than a decade of experience navigating the healthcare industry and can help you access the working capital you need to cover all of your employees. Visit us to learn more about healthcare factoring and apply today.

Many Employers to Offer “Skinny” Insurance Plans in 2015

According to a survey by the National Business Group released earlier this month, as many as 16 percent of large employers will seek to minimize their healthcare costs next year by offering low-benefit, or “skinny”, plans to their employees.

The companies that will offer skinny plans versus fully ACA-compliant plans were not identified by their industries in the survey; however, traditionally companies with a high percentage of low-wage employees have taken the most advantage of those plans. Skinny plans are considered “minimum essential coverage” by ACA standards by virtue of being employer-provided, but are often lacking other key features that roll into that distinction.

Skinny plans allow employers to avoid a penalty by simply offering a plan, and purchasing one allows the employee to avoid individual mandate penalties by enrolling in a healthcare plan with lower premiums. Unfortunately, the benefits to individuals end there. Some plans cover nothing but preventive care, and all plans feature exorbitant deductibles that can make actually seeking care an unaffordable option should the employee ever require it.

Another significant blow to employees at these companies is that they will not qualify for subsidies to purchase better coverage on state or federal exchanges because their employer offers an ACA-compliant plan, regardless of whether they enroll in that plan or not.

The effect of skinny plans on healthcare costs to providers and vendors remains to be seen.

PRN Funding offers a variety of customized healthcare factoring solutions to healthcare vendors in order to cover operating costs – including providing insurance. To learn more about healthcare factoring or medical receivables factoring and apply for service, contact PRN Funding today.

Should Voluntarily Uninsured Patients Lose Charity Care?

Now that the Affordable Healthcare Act’s healthcare marketplaces and policies are in effect, hospitals are considering whether those who decline health coverage should benefit from charitable care.

The issue of whether to discontinue charity care for the voluntarily uninsured is tricky and, according to some, more a question of whether their denial of insurance indicates unwillingness to pay or an inability to pay. Some patients fall into the gap between Medicaid coverage and affordable subsidized care, while others who may be eligible for subsidized insurance are still unable to afford the high deductibles featured in lower-tier plans.

Other questions include whether patients were aware of available coverage options or if they were able to sign up during open enrollment. On the other hand, a significant though unsubstantiated concern about charitable care programs is that uninsured patients will be dissuaded from enrolling in a healthcare plan if they know that charitable care is an option. This could result in greater financial difficulty for hospitals receiving less government assistance to cover uninsured patients, particularly in states that declined Medicaid expansion.

For the moment, many hospitals are considering the effects of a change and have therefore not made any updates to their charitable care policies. Hospitals that have changed their programs have done so in a number of ways:

  • Reducing income threshold for additional assistance
  • Requiring a “nominal” contribution for care
  • Requiring patients to apply for coverage before they can benefit from charitable care (note: this is an existing practice in most hospitals)
  • Disqualifying aid to patients that refuse to enroll in coverage for which they are eligible (including Medicaid)

Regardless of hospitals’ decisions, all hospitals are required to clearly state their charitable care policies in compliance with the ACA and they must make “reasonable efforts” to qualify patients for aid before pursuing them for collections.

As hospitals absorb the financial changes of full ACA implementation, healthcare vendors must be prepared for any changes in payments. PRN Funding’s dynamic healthcare factoring options help healthcare vendors working with hospitals, doctors’ offices, and other healthcare facilities to shore up their cash flow by converting open invoices into immediate cash. Contact PRN Funding today to learn how healthcare factoring can help your company and to get started right away.

Would “Copper” Healthcare Plans Actually Be Worthwhile?

Several months ago, Senator Mark Begich (D) of Alaska proposed that the Obama administration add a new tier to the Affordable Care Act’s available healthcare plans. While the administration and other legislators weigh the benefits, significant potential issues have presented themselves.

The new “copper” plans would feature lower premiums than those for bronze plans – currently the least expensive full coverage available – and would cover 50 percent of consumers’ health costs. Patients would be required to pay the balance out of pocket. Copper plan subscribers would likely have a higher spending limit on out-of-pocket expenses than the current $6,350 individual/$12,700 family cap but would also be eligible for tax credits and subsidies.

Higher out-of-pocket costs are just one major concern with the idea of copper-level plans. Another associated issue is whether copper plans would be able to offer lower prices and still offer the comprehensive coverage required by the ACA. Jay Angoff of the Department of Health and Human Services questions whether passing on half of the cost of care to consumers can legitimately constitute “decent coverage”.

Furthermore, enrollment statistics through the March 31 deadline this year indicate that consumers are not particularly fond of low premium-high deductible plans. Approximately 65 percent of consumers chose subsidized or unsubsidized silver plans in the marketplace, while only 20 percent enrolled in bronze plans. Enrollment in catastrophic plans was even lower, at only two percent.

Copper plans would also pose a threat to healthcare spending in facilities and systems, turning back the reductions in spending reported by many systems thanks to newly enrolled patients. As copper plans are meant to attract young adults and others who have found even the bronze plans to be unaffordable, the risk of defaulting on higher deductibles is akin to the risk of non-payment by uninsured patients.

If the administration allows the creation of copper plans, consumers should expect to wait until at least the 2016 enrollment period to see these plans for purchase on the marketplace.

Does your healthcare company need more working capital to provide quality health coverage to your employees? Healthcare factoring helps vendors working with hospitals and other healthcare facilities to close the cash flow gap and invest in their business and employees – including in their health. Read more about PRN Funding’s healthcare factoring programs and contact us to begin today.

Survey: ER Visits Increase During Early 2014

A survey completed by the American College of Emergency Physicians shows that emergency room visits have increased since January 1.

Approximately 46 percent of ER respondents noted an increase in patient visits and another 27 percent reported constant rates. Nearly a quarter of respondents reported decreased patient visits. According to the survey, the patient demographic is shifting toward fewer patients with private insurance but more patients with Medicaid coverage. The increase is also not restricted to certain states or any geographic area.

While proponents of the Affordable Care Act hoped that the law would decrease ER visits by expanding insurance coverage, studies of Oregon’s and California’s healthcare system overhauls in the last several years indicate that the expectation may have been unrealistic. At the same time, the survey suggests that the ACA has in fact played a role in the shifting numbers over the last three months.

The first and most significant reason is that coverage does not equal or lead to access. Many newly insured patients have little access to a primary care physician or clinic for regular care, either because they are not informed about their options or because PCPs in the area are already overwhelmed with volume. The Association of American Medical Colleges estimates that the PCP-patient gap will reach 30,000 next year and continue growing after that.

Emergency care is equally difficult to access in many states. The American College of Emergency Physicians released their 2014 Report Card which gave 21 states an F rating in the “Access to Emergency Care” category.

That said, patients who do have access to emergency rooms – insured or uninsured – may choose the setting because they cannot be turned away; because they are experiencing potentially serious symptoms; or because they need immediate care when other providers are unavailable (that is, on evenings and weekends).

A potentially significant drawback of the ACEP’s survey is the limited number of respondents: many states had too few responses to register as a percentage of the total responses, and in the top participating state – California – only 10 percent of facilities submitted responses. This indicates a great deal of missing data that could impact the survey’s findings. In addition, the survey’s focus on only the first three months of 2014 makes it insufficient to make any far-reaching assumptions about continuing trends.

If ER visits continue to increase it could create greater demand for healthcare vendors to cover staffing and equipment shortages. PRN Funding’s healthcare factoring programs can prepare your healthcare company for future growth by giving you immediate access to working capital. Learn more about our healthcare factoring services and apply today to get started!

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Medicaid Expansion Reduces Uninsured Hospital Visits

States that chose to expand their Medicaid services under the Affordable Care Act are seeing significant reductions in uninsured hospital visits.

A review of publicly traded hospitals’ earnings calls by The Washington Post shows that uninsured (self-pay) hospital visits dropped between 28 and 33 percent at some of the largest hospital systems in the country in states that took advantage of the federally-funded Medicaid expansion. At the same time, Medicaid admissions increased anywhere from 4 to 22 percent at those same facilities.

The story is less encouraging in the 24 states that refused Medicaid expansion. Non-expansion states saw upticks in both self-pay ER visits and uninsured admissions, and some actually had decreased Medicaid admissions. Hospitals have pushed for Medicaid expansion, arguing that even Medicaid’s lower reimbursement rates are better than what they (often do not) collect from uninsured patients.

Many states have also dragged their feet in preparing for the ACA’s broader implementation of presumptive eligibility, a system by which hospitals can preemptively enroll families with qualifying income in a Medicaid program to provide them care up-front. The state Medicaid agency then processes the complete application, putting many otherwise uninsured families on the path to coverage.

There are troubling financing implications for the uneven expansion of Medicaid around the country. The increase of self-pay patients in non-expansion states increases the amount of potentially uncollectible funds owed to those hospital systems and facilities, which also raises the risk to a healthcare factoring company.

Factors collect from insurance, Medicaid, and Medicare, but not from individual patients; therefore, more self-pay accounts reduce the number of valid invoices that a hospital can factor to offset the gap in federal reimbursements. If the above numbers continue their current trajectories, there is a very real possibility that healthcare factoring companies may tighten their requirements for working with clients in non-expansion states – or decline to work with them altogether.

We will continue to provide updates on Medicaid expansion and its impact on facilities in both expanded and non-expanded states.

PRN Funding offers healthcare factoring services to vendors providing a variety of healthcare services to hospitals and other healthcare facilities. Learn more about the different healthcare factoring options we provide and fill out our easy online application to begin.

ACA: Enrollment Passes 8 Million, Uninsured Rate Lowest Since 2008

The Obama administration announced last month that enrollments in the ACA exchanges topped eight million.

As of April 19, 8.019 million people had signed up for Obamacare plans – an impressive national average despite a large disparity between individual state enrollments. Some states missed their enrollment targets by a wide margin, while others more than doubled their goal.

In addition to marketplace policies, 4.8 million consumers enrolled in Medicaid plans in their states between October 1 and April 19, and nearly five million consumers purchased policies outside the exchanges. Altogether, the administration estimates that up to 18 million consumers have purchased new healthcare policies during the six-month enrollment period measured.

While some consumers may have been previously insured, a majority of marketplace users who requested subsidies self-reported that they did not have insurance when they applied. Further evidence is in the numbers: a Gallup poll reports that the uninsured rate by the end of the first quarter is down to 13.4 percent, the lowest level since the recession began in 2008 and down from 17.3 percent in January.

Health care executives presented preliminary payment information to the House Energy and Commerce oversight subcommittee last week that shows between 80 and 90 percent of new premiums are paid, well above the 67 percent reported by members of the same committee the week prior.

PRN Funding offers healthcare factoring solutions to help providers control costs – including health care. Learn more about our healthcare factoring services and apply for a free factoring quote today!

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ACA: The Cost of Non-Enrollment

With the March 31 enrollment deadline looming, the Obama administration is working overtime to encourage uninsured Americans to purchase coverage in state or federal marketplaces. Approximately 50 percent of uninsured consumers plan to remain uninsured for a number of reasons, raising the important question: what is the cost of not enrolling in a valid healthcare plan?

Required Coverage

ACA-compliant health insurance policies must meet the law’s requirements for minimum essential coverage, which includes all government-administered plans as well as new and grandfathered employer plans and coverage offered by universities. While other plans may also meet the minimum essential coverage standard, consumers who hold non-compliant policies will be subject to the same penalty as uninsured consumers. Vision and dental-only plans, workers’ compensation, and healthcare savings accounts do not qualify as compliant policies.

Most consumers are required to carry a compliant healthcare plan; however, the ACA provides a number of exemptions for consumers who are unable to afford a qualifying plan or who fit other criteria.

How does the penalty work?

The 2014 penalty for uninsured consumers is the greater of $95 per adult/$47.50 per child, up to $285 per family, or one percent of your family’s gross adjusted income above the tax return filing threshold. (If your income is not high enough to require a tax filing, you are exempt from the individual mandate.)

Despite the focus on the $95 flat fee, more consumers earn more than the $19,650 that matches the $95 fee and will be required to pay a higher amount. For example, a family earning $50,000 annually would have to pay $297, or one percent of their eligible AGI – $12 more than the flat fee maximum. Though penalties are capped at approximately $9,800, many families do not make enough to meet this cap and will be on the hook for their entire penalty.

Can I enroll after the March 31 deadline?

Your ability to enroll in the federal marketplace after the deadline depends on a number of conditions. Currently, consumers who have attempted to purchase a healthcare plan prior to March 31 will be granted a limited extension to complete their enrollment. Once extensions have ended, you must wait until the next open enrollment period unless you have a change in life situation that qualifies you to enroll.

If you signed up for a policy before March 31 that features a gap in coverage (i.e. does not start immediately), you will not have to pay the penalty. Also, if you are without insurance for less than three months after the deadline you will not have to pay the penalty. For periods longer than three months but less than a year, you will be responsible for each month’s portion of the annual penalty for as long as you are uninsured.

For questions about your specific healthcare needs and plans that are available, visit Healthcare.gov.

With Deadline Looming, ACA Enrollments Fall Short

One week from today marks the Affordable Care Act deadline for individual consumers to have an ACA-compliant policy from their employer or the online health marketplaces. Consumers who have not enrolled in coverage by March 31 will face a penalty on their taxes and will be prevented from signing up for subsidized healthcare until next year.

However, despite the time crunch only a quarter of Americans at this point had accessed the exchanges by January and many thousands of others are still uninformed about their responsibility to obtain coverage. Unfortunately, the majority of uninformed consumers are those who would benefit the most from tax credits and subsidies.

Misinformation is a major source of public reluctance to use the online health exchanges. The political debate over the Affordable Care Act is well-documented, and additional state laws governing the implementation of the individual mandate have further complicated the process.

The Obama administration is elbow-deep in a campaign to inform consumers and encourage them to apply for insurance. Volunteers are contacting households via phone banks, email, and door-to-door canvassing with pamphlets and applications. Canvassers hope that by educating consumers they will be able to dispel some of the myths surrounding the cost of health care plans and demonstrate the importance of having a compliant policy by next week’s deadline.

PRN Funding offers factoring services to cover expenses such as health insurance premiums for companies that work with hospitals and other medical facilities. To learn more about healthcare factoring, contact us today.

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Young Consumers Not Using Healthcare Exchanges

According to reports from the Obama administration about healthcare enrollment in the online marketplace through January, only 25 percent of consumers who have purchased healthcare plans fall into the critical 18-34 demographic. The figure is far lower than the number of young consumers who have created accounts on the exchanges.

Many experts and administration officials have touted the importance of young consumers using the healthcare exchanges to balance the cost of care for older patients. While insurance companies can vary costs to a certain degree based on age, it is not enough on its own to control the difference in healthcare needs between the two demographics. A continued slump of young enrollees could prompt insurance providers to raise premiums significantly within the coming years, which would put a strain on the entire system.

One potential explanation for the lack of enrollment in the younger demographic is its overlap with another provision of the Affordable Care Act which allows parents to keep adult children up to age 26 on their own health insurance. The overlap affects nearly half of the exchanges’ target demographic, specifically college students and young post-graduates.

The federal government is not alone in fretting over low enrollment; states running their own exchanges, such as Minnesota, are also experiencing enrollment that skews toward the older demographic.

If you fear rising healthcare costs could threaten your company’s cash flow, consider healthcare factoring through PRN Funding. We can create a customized factoring program to fit your company’s needs and offset your cash concerns, with approval in as little as 3-5 business days. Apply now to get started.

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