ACA: Employer Mandate Receives New Extension

Earlier this week, the IRS released its final rule on the employer mandate. Among provisions regarding employee transition periods and how to classify employees for counting purposes was a new extension of the employer mandate.

After a previous extension moved the start date to January 1, 2015, the mandate is now postponed until 2016 for employers with 50-99 full-time employees. In addition, while large companies with more than 100 employees are still subject to the mandate in 2015, they only have to offer coverage to 70 percent of their full-time workforce for the first year the mandate is in effect.

The Obama administration explained the extension as an effort to give affected companies additional time to come into compliance with the mandate. Two percent of U.S. companies are classified as mid-size and two percent are large, but those companies employ as much as 70 percent of the total labor force in the United States.

Criticism of the announcement centers on frustration that the individual mandate, seen by many to be more of a burden than the employer mandate, went into effect on its originally schedule date of January 1, 2014. Consumers still have six weeks, until March 31, to enroll in a qualifying healthcare plan. The delay of the employer mandate could push a number of those consumers to the online marketplaces if they are unable to obtain a policy through their employer.

The staffing industry is also frustrated with other provisions of the IRS final rule, which limit staffing agencies’ ability to classify their employees as variable-hour or to take advantage of look-back periods to determine their status for insurance purposes. This could potentially raise healthcare costs for these agencies if they are required to provide coverage to employees who are later determined to be variable-hour or part-time.

If you have a nurse staffing agency or work in the medical field and are worried about rising healthcare costs, PRN Funding’s healthcare factoring program can help you turn your receivables into immediate cash. Learn more about healthcare factoring and contact us to get started today.

Dropping Spouses from Healthcare May Increase Employer Costs

The Employee Benefit Research Institute published a study in this month’s issue of their Notes that suggests that the employer trend of excluding spouses from health care coverage may cost them more in the long run.

As many as 15 percent of employers nationwide have already eliminated spousal coverage in cases where the previously-covered spouse has access to health care through his or her own employer. NPR reports that a continuing trend of such cuts may offset any short-term savings as their own employees lose spousal coverage picked up by other companies.

A simple example: Company A and Company B both offer spousal health care coverage. Company A currently covers Employee A and Spouse A, who works for Company B. Company B covers Employee B and Spouse B, who works for Company A. If both companies eliminate spousal coverage, Spouse A and Spouse B will return to their own company’s health care plan, which means that at the very least the companies have not saved any money.

Further, if the companies have traditionally subsidized a lower amount for spouses then each will face higher health care costs by covering two of their own employees.

Situation: Each Company Covers Spouses (cost to company)

Company A

Company B

Employee A: $5,000/year

Employee B: $5,000/year

Spouse A: $3,500/year

Spouse B: $3,500/year

Situation: Neither Company Covers Spouses (cost to company)

Company A

Company B

Employee A: $5,000/year

Employee B: $5,000/year

Spouse B: $5,000/year

Spouse A: $5,000/year

*The figures above are purely hypothetical and are only meant for illustrative purposes.

According to a weekend report in Forbes, meanwhile, more full-time employees are enrolling in employer-provided health care to take advantage of better coverage at lower costs than the plans provided on the health care exchanges. These new enrollees may also contribute to rising employer costs, even without an influx of employees who have lost coverage under their spouses’ plans.

Is your company prepared for rising healthcare costs? PRN Funding offers a variety of healthcare factoring programs that can give your company the immediate cash to meet those costs as they occur. Learn more about our healthcare factoring services and contact us today to get started.

ACA: Consumers Face “Sticker Shock” with New Healthcare Plans

Consumers signing up for new ACA-compliant healthcare plans may choose a lower-tier plan to save money, but the decision comes at a high price – that is, increased deductibles and other out-of-pocket costs.

As previously reported, available plans fall into one of five cost categories that feature increasing premiums but offer decreasing deductibles in exchange. Premiums for all plans are higher than 2013 premiums, but individuals who earn up to four times the national poverty level can qualify for tax credits to offset their premiums.

Consumers who purchase at least a silver plan and who earn up to 2.5 times the poverty level can apply for additional credits to offset deductible and out-of-pocket costs, further relieving the burden of care. However, consumers who cannot receive the extra assistance may bet on their own health and choose a more affordable monthly payment over better coverage.

Higher deductibles could create scenarios in which patients forego needed care to avoid a hefty bill, which runs contrary to the purpose of the ACA, or they receive care and are later unable to pay the bill which contributes to hospitals’ bad debt.

Despite the unpleasant news, the ACA also caps annual out-of-pocket expenses (including co-pays) for an individual at $6,350 – a large number, but significantly lower than past plans that may not have capped expenses at all. This may ameliorate some of consumers’ sticker shock, particularly for patients whose cost of care quickly exceeds that threshold due to serious injuries or chronic conditions. Also, well check visits and prescriptions are covered at varying levels as minimum essential benefits and are deductible-free in some cases.

The best advice for individuals still shopping for the right health care plan is to consider not only the up-front cost of a monthly premium, but also the real cost of using the plan should the need arise.

Medical receivable factoring can help facilities preparing for the potential financial impact of higher patient deductibles. Contact PRN Funding to learn more.

New Obamacare Plans Result in Drug-Cost Sticker Shock

With the rollout of Obamacare, many patients with chronic illnesses are taking advantage of the new healthcare law. However, these patients, who are projected to be some of the biggest beneficiaries of the new initiative, may encounter sticker shock with drug costs. Under the new law, out-of-pocket expenses associated with the new exchanges could vary widely.

The new healthcare act enables patients with pre-existing conditions to obtain affordable coverage. Additionally, these patients can’t be penalized with higher rates than healthier participants. In terms of out-of-pocket expenses, the maximum set for individuals is $6,350, and $12,700 for families. Once these amounts are reached, insurers will then pick up the full tab.

Nevertheless, patients taking costly prescription drugs are more likely to reach these levels fast. While certain medications for serious conditions can cost thousands of dollars a month, some plans under the new exchanges may place as much as 50 percent of the cost on patients. Basically, plans with lower monthly premiums require patients to bear higher portions of drug costs.

In addition to premiums, many other factors impact drug costs for patients. Among these factors is a drug’s tier, or level of coverage. Tiers vary from plan to plan, and can be classified into different categories: generic, brand, preferred and specialty drugs. In order to determine tiers, insurers and drug manufacturers negotiate prices for each particular drug. Drug costs are greatly impacted by these tiers, which can make all the difference in patient costs.

As a result, high price tags and costly co-pays are associated with high-tiered drugs. According to insurance-industry experts, many businesses are anticipating larger numbers of sicker, costlier patients to sign up for the exchanges. This trend could lead to financial troubles if an inadequate number of healthier customers sign-up and balance out those costs. Regardless, insurers are not allowed to impose higher charges on chronically ill patients. Therefore, in order to keep monthly premiums lower, patients are forced to pay more for high-tier drugs.

Obamacare Sign-Ups Booming After Website Fix

Ever since the Obamacare enrollment site was revamped, sign-ups for the new healthcare plans have been on the rise. In November alone, nearly 100,000 people elected coverage through Healthcare.gov. Additionally, when compared to the enrollment numbers from October, about four times as many people enrolled for Obamacare coverage via federal exchanges last month.

Although the numbers are impressive, the Obama administration said it is still far from reaching its original goal. Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services, previously reported that the administration had set their hopes for reaching 800,000 total enrollees throughout the months of October and November.

In October, more than 100,000 people enrolled for healthcare coverage under Obamacare. The majority of the enrollees came from state-run exchanges, while only about 27,000 signed up for coverage through the federal website, HealthCare.gov.

Nevertheless, thanks to the recent website fix, 29,000 Americans were able to enroll in healthcare coverage throughout the past few days. The number of sign-ups is higher than those tracked from October, providing evidence that enrollment via HealthCare.gov is rising as a result of the massive repairs completed on the site. Furthermore, administration officials reported that they had achieved their deadline for fixing the healthcare enrollment site, making it readily accessible for the vast majority of users.

Meanwhile, younger uninsured Americans are still hesitant to enroll. Currently, less than one-third of them say that they plan to sign-up for healthcare coverage under the new marketplace, according to a new poll. If this data remains relevant, tremendous problems could be in store for the new healthcare law.

The Affordable Care Act is highly dependent upon younger, healthier enrollees who can help keep coverage costs down by offsetting costs for older, sicker individuals. Nevertheless, a poll released by the Harvard Institute of Politics revealed that only 29 percent of uninsured Americans between the ages of 18 and 29 said they would definitely or likely sign-up for coverage through the healthcare exchanges.

Obama: Individuals May Keep Cancelled Insurance Policies for Now

Obamacare established new standards for health insurance coverage in the U.S. As a result, millions of Americans were presented with policy cancellation notices, forcing many people to drop their current coverage and opt for a new health insurance plan. In order to help alleviate this troublesome situation, the president made an announcement yesterday that his administration would not enforce the Obamacare provisions that led to policy cancellations throughout the country.

Therefore, individuals who were in favor of their current coverage plans may be able to keep them for another year. However, once midterm elections are complete, plans that are not in accordance with the new healthcare law will get canceled again.

The new transitional policy introduced by the administration will enable people who were happy with their insurance to remain on their current plans, as long as their policies were effective on Oct. 1 of this year. Furthermore, another stipulation for this newly-enacted policy is that insurers provide free advertisements for their competitors on Obamacare’s online exchanges.

Aside from the 25 million Americans who opt for their own coverage through the individual market, several employees covered by employer-based insurance will also encounter cancellations. Currently, 156 million people obtain healthcare through their employers.

In addition to this particular provision, there are many other  aspects  of Obamacare that will not be enforced yet, such as postponing the employer mandate for a year. These and other unilateral actions are being announced by the White House, since the administration wants to avoid the potential for Congress to pass legislative amendments to the new healthcare law.

In order for this cancellation fix to actually work, insurers must find some way to rush their old products into the marketplace by January 2014. This will be extremely difficult for insurers to pull off. Since new reimbursement rates for 2014 would have to be negotiated with doctors and hospitals, insurers would have to submit these plans to state insurance regulators in order to obtain approval.

Despite the proposed cancelation fix, a new Gallup poll released this week revealed an increase in disapproval rates for the Affordable Care Act, rising from 47 percent to a high of 55 percent. Additionally, the president’s overall approval ratings have fallen between the high 30s and 40s.

Even with the change, the administration is leaving it up to each individual state to determine whether or not residents can keep coverage plans that are not in accordance with the new healthcare initiative. As a result, state insurance commissioners, along with other health policy experts, have established the fact that insurance plans will greatly vary across the country.

ACA Changes Mental Health Treatment

Mental health is a critical but oft-ignored component of health care. Patients in need of mental health treatment face the double blow of social stigma and lack of insurance coverage, making effective treatment an unaffordable option. Provisions of the Affordable Care Act will make mental health treatment more accessible than before, with the potential to completely overhaul the current mental health system.

Insurers have traditionally excluded mental health coverage from their health plans, citing mental issues as a pre-existing condition. With costs as high as $150 or more for a single office visit – not counting costly prescription medication – many more patients are forced to go without care in lieu of paying those costs out of pocket.

The ACA, however, includes mental health in its list of ten Essential Health Benefits and will require insurers to offer coverage on par with other medical and surgical benefits. This will not only benefit millions of uninsured Americans with mental health concerns, but also the many insured Americans whose policies do not currently provide equal mental health coverage.

Mental health providers will face a number of challenges in January when the ACA is fully implemented. One major challenge, of course, is the ratio of available providers to the estimated number of newly enrolled patients they will see. A care gap may persist as providers scramble to provide services to as many as possible.

In addition, the inclusion of insurers as payers for mental health care adds a level of complexity to providing care that will drive many solo practitioners into group practices. Solo therapists who collect cash are able to charge higher fees and often save costs associated with billing software and office space, choosing instead to work out of their homes. However, accepting insurance will require them to get up to speed with medical billing and coding and to accept lower fees per session as part of their agreement with insurers.

A larger practice offers cost-sharing benefits in which many professionals can go in together for expensive software and real estate, though working with insurance companies can take away from the autonomy that many therapists currently enjoy. Another possibility, however, is joining a traditional medical practice to create an integrated approach to healthcare. Having a mental health professional in a group practice gives general health providers another diagnostic option that will allow them to provide better – and less costly – care.

Mental health providers considering a shift in their practice can ease the burden of insurance collections with medical receivables factoring. Factoring allows you to turn your claims into immediate cash that you can invest in the necessary software, real estate, and logistics to continue providing quality treatment to your patients. PRN Funding can get you started in a medical receivables factoring program that fits your needs – contact us today to learn more.

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Health Coverage under Obamacare May Prove Costly to Individual Buyers

With the introduction of new healthcare reforms enacted by the Affordable Care Act, many Americans covered by health insurance in the individual marketplace will be forced to enroll in new coverage plans. People will be required to opt for new insurance since many of these plans are not in accordance with newly established standards set by the new healthcare law. As a result, many insurers will be forced to either tack on benefits, or cancel policies altogether.

The new offerings are associated with higher rates for individual buyers, since coverage is more comprehensive and must be available to individuals affected by pre-existing conditions. Nevertheless, several insurers have managed to maintain lower rates by providing plans with higher deductibles and minimal benefits. Additionally, these insurers could be pickier in the approval process by only selecting the healthiest applicants.

As more and more people have been receiving policy cancellation notices paired with new offerings provided by their insurer for 2014, the sticker shock has brought on increased feelings of aggravation among those impacted. Many are unhappy with the options offered in the  marketplace. Some face climbing premiums and costly increases in deductibles. Some report their current deductibles of $1,500 are expected to rise to $5,000 under Obamacare for similar policies.  It isn’t just deductibles, visits to the doctor and prescriptions are also subject to increase.

Nevertheless, a small number of existing plans will become grandfathered. In order to obtain this status, two qualifying factors must be met. First, members must have been enrolled in these policies before the passage of the ACA back in March 2010. Additionally, no significant policy changes should have been made to the plans until now, ranging from alterations in co-pays and deductibles to coverage costs.

Currently, Blue Cross Blue Shield is one of the major healthcare providers within the individual insurance marketplace, as well as the exchanges. Kim Holland, the trade group’s executive director of state affairs, said that the majority of existing individual plans offered by Blue Cross will soon be altered or discontinued. As a result, some customers will be forced to enroll in new coverage plans.

Although customers may receive letters indicating significant increases in premiums, they won’t exactly know what to expect in regards to payments until they actually explore the exchange. Generally, if an individual brings in less than $46,000 a year or $94,200 for a family of four, federal subsidies will be available to decrease monthly expenses.

Online Health Exchanges Will Take a Month to Fix

After a laundry list of glitches have made it difficult – if not impossible – for consumers to use the online health exchanges, the Obama administration has announced a repair timetable that will have the sites fully operational by the end of November.

The administration has hired private firm Quality Software Services Inc. to fix the more than 100 issues with the exchange server that have frustrated consumers since the exchanges opened October 1. QSSI, an arm of UnitedHealth Group, is one of three contractors originally engaged to create the system. Among the reported issues are inaccurate reports and the failure of as many as 30 percent of consumers to successfully complete the enrollment process.

Though the proposed timeline is shorter than originally anticipated, it still cuts very close to the December 15 deadline for purchasing coverage to begin January 1. As a result, many lawmakers have called for extending the individual mandate deadline or deferring penalties for non-enrollment. The current deadline to avoid a tax penalty is March 31.

Issues with the exchange have frustrated consumers who are already unsure about the impact of the ACA and have prompted criticism from both sides of the aisle. The Obama administration is facing political fallout as well as a public relations quagmire: Health and Human Services Secretary Kathleen Sebelius has been called upon to step down, and President Obama has addressed ongoing concerns with varying success.

Troubleshooter Jeffrey Zients remarked that the exchanges will “get better” by the week until it “will work smoothly for the vast majority of users” at the end of November.

Consumers should be prepared for a shortened enrollment period if an extension is not enacted. If you are one of the millions who will purchase insurance on the exchange, PRN Funding can provide the cash flow you need to be ready when the exchanges are fully functional. Learn more about our healthcare factoring programs and contact us today to get started.

Who is to Blame for Healthcare Exchange Glitches?

The rollout of online health exchange site Healthcare.gov at the beginning of the month has been stymied with glitches preventing millions of consumers from creating accounts or completing the enrollment process, along with as many as 100 additional flaws found in the system. Testimony before a panel convened by the House of Representatives has provided an object of public blame for these glitches: contractor from Canadian firm CGI Group Inc.

Cheryl Campbell, senior VP of the unit responsible for site design, testified before the House that more time should have been devoted to end-to-end testing and refused to give a set date for the site to be fully functional. Campbell claimed that the Centers for Medicare and Medicaid Services – the Health and Human Services agency responsible for the health exchanges – made the final decision to take the site live despite inadequate testing. She also testified, however, that CGI did not make a recommendation to delay the site launch.

Other contractors testified that they were only given two weeks to perform testing, far shorter than the industry standard of months. Each contractor maintained that they fulfilled their part of the project and disavowed responsibility for the final product, and none could provide a definitive date for the glitches to be resolved.

Experts in the tech world, meanwhile, have suggested that the issues with Healthcare.gov could be a technical “black swan” event, or a project that faces out-of-control costs and extreme consequences that could spell failure – in this case, a failure for the Obama administration. President Barack Obama has publicly decried the situation, claiming “Nobody’s madder than me.”

Testimony will continue throughout the week and possibly into next week, but the administration has already appointed a contractor to repair the site as quickly as possible.

PRN Funding’s factoring programs for healthcare vendors provide necessary cash flow to invest in offering quality healthcare goods and services to healthcare providers nationwide. Contact us to find out how healthcare factoring can save your company from creating its own “black swan”.

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