Health Insurance Overhaul - Florida Trends

As the implementation date for the Affordable Care Act nears, employers are scrambling to understand what it means for their business.

Lilly Rockwell | 9/3/2013

The Affordable Care Act is poised to transform our health insurance system, encouraging more people to buy insurance. But as the full implementation date nears, health insurers are raising rates, and employers are scrambling to understand what it means for them.

Before Congress passed a major health insurance reform law, before President Obama was even elected, health insurance company Florida Blue anticipated the emergence of a different health insurance market, with more people buying individual health insurance policies instead of the employer-driven system that most Americans use today.

The Affordable Care Act...

» Requires all Americans to obtain health insurance or pay a tax penalty

» Offers subsidies for low-income Americans
to afford health insurance

» Prohibits insurers from declining coverage

» Largely prohibits charging substantially more based on age or health

» Creates online government-run health insurance exchanges for people and small businesses

» Increases tax credits for small businesses to offset health insurance costs

» Mandates minimum benefits offered, including hospitalization, maternity leave and prescription drugs

» Requires all large employers to offer health insurance or pay a penalty

Jacksonville-based Florida Blue, then called Blue Cross Blue Shield of Florida, decided to open a retail store to cater to individual customers. This was a radical idea for a health insurance company at the time — a major shift from a business-to-business sales model working directly with employers to a business-to-consumer sales model. The first store opened in 2006 in Jacksonville at the St. Johns Town Center shopping center.

The move into retail stores turned out to be prescient. Today, the health insurance company operates 11 retail stores in Florida, with plans to open five more by the end of the year. Florida Blue has grown the number of Floridians it covers by individual policies from 277,048 in 2007 to 381,445 in 2011 — a 38% increase, representing more than half of the individual insurance marketplace in Florida.

In fact, Florida Blue holds more individually purchased policies than its top three competitors (Humana, Cigna and United Healthcare) combined. The company credits the Patient Protection and Affordable Care Act, passed in 2010 with its expansion into the individual market. “It put us in a great position,” says Jason Altmire, Florida Blue’s senior vice president of public policy, government and community affairs.

The affordable care law encourages more people to purchase health insurance regardless of their employment status. But even though the goal of the law is to reduce the number of people without health insurance, many may opt out of getting health insurance, choosing to pay a tax penalty or simply lie about whether they’re covered. The tax penalty the first year is only $95, much cheaper than the average unsubsidized individual insurance policy of $5,500.

How many of the 3.8 million uninsured Floridians will jump into the health insurance market next year, when the individual mandate kicks in? No one knows. “We’re doing everything we can to try to predict what decisions people and employers will make,” Altmire says.

The Congressional Budget Office believes 14 million people nationwide will buy new health insurance policies next year — only a quarter of the total uninsured. The Kaiser Commission on Medicaid and the Uninsured predicts that somewhere between a quarter to half of all uninsured Floridians will obtain health insurance.

http://www.floridatrend.com/article/16052/insurance-overhaul

HHS Extends Equal Medicare Advantage Coverage to Same-Sex SNF Residents

Jason Oliva | September 2, 2013 | 

Same-sex residents in skilled nursing facilities (SNFs) that are beneficiaries in private Medicare plans will now have access to equal coverage when it comes to care in a nursing home where their spouse lives. 

The Department of Health and Human Services (HHS) issued a memo last week in response to the recent Supreme Court ruling, which found section 3 of the Defense of Marriage Act unconstitutional. 

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius in a statement. “[The] announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”

Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in skilled nursing facilities where their spouse resides. 

Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse, according to Marilynn Tavenner, administrator for the Centers for Medicare & Medicaid Services. 

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Tavenner. “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”

The recently issued guidance from HHS specifically clarifies a guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live. 

http://seniorhousingnews.com/2013/09/02/hhs-extends-equal-medicare-advantage-coverage-to-same-sex-snf-residents/