Plenty of changes are coming to your healthcare plan in 2015, but the changes that you are about to experience will be more significant than the changes you have experienced in this past year of 2014. The main changes to healthcare plans dwell in financial avenues, meaning that some of the costs will go up for healthcare subscribers.
Let’s review some of the changes that were made to healthcare plans in this year of 2014 first. Some of the changes included a guaranteed issuance of coverage. Health plans had to sell coverage, regardless of pre-existing conditions, and health plans couldn’t charge consumers more based on their health or gender. 2014 also saw the establishment of health insurance marketplaces. Every state in America was mandated to have insurance exchanges, organized marketplaces where individuals and small business owners could select from all the qualified private health plans that were made available in their area. Consumers were allowed to make any changes to their health plans via online, through brokers, on the phone, or with the help of Navigators who serve as personal assistants.
An individual mandate was put in place in 2014. Everyone had to own some form of health insurance by registering for one of the available programs, which varied from Medicare and Medicaid to Veterans Affairs, Tricare and Indian Health Service. If an individual did not own any form of health insurance by a certain deadline then they would be forced to pay a penalty. Another change was the act of establishing premium rebates. Insurers were ordered to spend at least 80% of premiums on medical care for their individual and small group (under 50 employees) plans. The cut-off was 85% for large group plans and if insurers were unable to reach this mandate, then they were to refund the difference to consumers by way of direct refunds or reduced costs to their plans.
2014 also experienced the inclusion of standard disclosure forms. All health plans were required to use a standardized consumer-friendly form to provide a uniform summary of benefits and coverage, such as information on copayments, deductibles and out-of-pocket limits. This made it easier to compare plans. Insurers could calculate and disclose a patient’s out-of-pocket cost when it specifically related to issues like having a baby or treating Type 2 Diabetes.
Caps were also placed on flexible spending accounts. Employers could previously set limits on their FSAs at any level they chose (mainly from $2,500 to $5,000), which could be set aside tax-free for expenses (mainly around $2,500), with the cap increasing by the annual inflation rate in following years. Patients could not use FSAs to pay for over-the-counter drugs unless they had prescriptions from their doctors. Lastly, a new Medicare tax for high earners was implemented in 2014, which featured individuals who earned more than $200,000 (or $250,000 for couples), the Medicare payroll tax increased from 1.45% to 2.35%. Individuals also paid a new 3.8% Medicare tax on unearned income, which included investments, interest, dividends, veteran’s benefits, and qualified retirement plan distributions such as those from 401 (k) and IRA.
Now what about the year that is ahead of us? What changes will be made to healthcare in 2015? For starters, there will be a change in payment rates. Centers for Medicare and Medicaid (CMS) announced an increase of 1.7% in Medicare reimbursements to hospital outpatient departments (HOPD). Reimbursements for inpatient payment rates will also increase by 1.4% with an opportunity to increase by an additional 2.2% depending on individual hospital standards. All of these increases are intended to translate into a $1 Billion increase in hospital revenues.
Another change coming to healthcare in 2015 would be the Employer Mandate. Full implementation of this mandate will not occur until January 1, 2016, but partial implementation of this mandate is set to begin on January 1, 2015. This mandate mainly affects employers that have over 100 active employees and the healthcare coverage’s that they have for that company.
There are requirements that employers must meet in order to avoid penalties. They first need to offer coverage to 70% of full-time employees, and secondly, the coverage must meet the minimum value and the affordability guidelines. Employees working 30 hours per week are considered to be full-time workers and 60% actuarial value is along the lines of the minimum value. Maximum penalties include $2,000 a year per employee if fewer than 70% of full-time employees are offered coverage, and $3,000 a year per employee if the coverage doesn’t provide the minimum value.
When it comes to coverage affordability, employees will pay no more than 9.5% of wages for self-only coverage for the lowest possible cost plan. There are time periods to look at when reviewing financial statistics and health plans. The Measurement (or Look Back) Period involves employers checking on health insurance availability on a 6 to 12 month time period to evaluate which employees must be offered health insurance in 2015. This must be done to avoid potential financial penalties. The Administrative Period is an up to 90 day time period to evaluate the data collected by the Measurement Period. The Stability Period is the length of time health insurance must be offered to employees that are deemed full-time to avoid penalties. This must be at least of the duration used for the Measurement Period.
If a patient’s plan no longer exists in 2015, the patient will be enrolled in another product offered by the same insurer whenever it becomes available. Even if patients have the same plan, 1,700 of 2,800 healthcare plans of 2014 will exist in the same form in 2015. However, patients will not be guaranteed to receive the same benefits with these stable plans. Insurers cannot increase all charges since that would make general spending on health plans completely unbalanced. Some plans have changed the wording of their benefits, such as adding a newly made term called “Copay After Deductible”, which means that insurers will not pay for any portion of an ER visit until customers meet their deductible, which would be thousands of dollars.
There are 3 tiers of health plans that people need to be aware of. Bronze health plans account for 60% of their members’ overall health services, whereas silver plans account for 70% and gold plans account for 80%. For example, the Coventry Health Care silver plan in the Kansas City, Kansas region is decreasing costs of primary care visits from $10 to $5, however on the flip side, medical deductibles have been increased from $2,000 to $2,750, out-of-pocket minimum payments have been increased from $6,350 to $6,600, and the cost of generic drugs have been increased from $10 to $15. Premiums are also slated to increase in 2015.
There is controversy surrounding emergency department operations, and particularly when it involves HCA Holdings. HCA experienced such controversy and according to an investigation held by the Tampa Bay Times newspaper, HCA Holdings has been overcharging its patients in the 6 Level II trauma centers in the state of Florida. The company charges an average of $40,000 more per patient than the average at other trauma centers. The Tampa Bay Times also claims that the hospital overcharges for services like scans, lab tests and drugs. These charges specifically fall under the description of “trauma response fees”.
Despite this controversy, HCA Holdings has established 160 Urgent Care Clinics in California, 100 clinics in both Florida and Indiana, 85 clinics in Texas and 80 in Georgia and has captured the market share in the $15 Billion urgent care clinic market field by focusing on acquiring or establishing standalone urgent care clinics.
Most of the issues regarding healthcare are reliant on adjusting financial figures and it’s important for everyone who has health plans to stay up to date on the changes that are made to their health plans. Some health plans cease to exist from one year to the next, and more significant changes need to be made to acquire a stable health plan in this scenario. Properly calculating payments will go a long way in determining which coverage is best suited for various kinds of patients and consumers. It depends largely on how much a consumer is willing to spend in order to get the kind of coverage that fits their needs.