A Plea for Help

Our good friend Chris Van B is helping to raise funds for the Artemis Center for Alternatives to Domestic Violence, a really noble cause, especially with domestic violence apparently on the rise as a result of the lock-downs. The Artemis Center, in Dayton (OH) "empowers survivors of domestic violence to make decisions and choices that will establish and maintain safety for themselves and their children. By working collaboratively with other community services, Artemis Center advocates are able to coordinate needed services."

This is especially necessary in these uncertain times, and one of Chris' vendors is offering to match contributions up to a total of $1,000. But the clock is running out on that offer.

Please click here if you can spare a few dollars for a very worthy cause. Or, you you prefer to send a check, just drop us an email for details.

Thank you!

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HSA News: 2021 edition

Our good friends at FlexBank/Navia sent along this helpful info for 2021 planning (hey, a head start can't hurt):

The IRS just announced the 2021 maximum HSA contribution limits:

Single Coverage  $3,600
Family Coverage  $7,200

By the way, those represent an increase of $50 over 2020 for singles, $100 for families. Not a fortune, to be sure, but something.

As usual, there's a "Catch Up" provision for folks 55 and up: $1,000 per. In case you're wondering, that stayed the same from this year.

Oh! I thought this was interesting:

Special Rule” for Married Individuals

Married individuals (same and/or opposite sex) who are both HSA-eligible individuals may divide their annual HSA contribution limit in any way they want, including allocating nothing to one spouse.

Details here.

Cool beans!

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Strange Math: More means Less, ACA-syle

So, another day, another TwitterSpiration©:

"ACA Marketplace Plan Affordability Is Likely To Decrease For Subsidized Enrollees In 2020"

Okay, I'll bite: what gives?

Well, it seems that, across the board, 2020 ObamaPlan premiums have decreased a bit from last year.

Okay, Henry, that seems to be good news for folks stuck with them, why the glum face?

Well, it's because premiums have declined, so insureds are having to pay more.

Hunh?

I know, it's weird, but bear with me here. First, let's take a look at how Exchange-based ObamaPlans are priced:

One goes to the 404Care.gov site, set up an account, and determines subsidy eligibility. It's important to note that there are actually two very different kinds of subsidy: the one everyone know about, which is the Advance Premium Tax Credit (APTC), and the one that seems to always be under everyone's radar: Cost Sharing Reductions (CSR). We're going to focus on the former, because that's where the TwitterSpiraton© comes in.

Once one has determined subsidy-eligibility, the next step is to click through to the quoting engine, which provides a "menu" of various carriers and plans, complete with two prices for each plan: "retail" (no premium credit, so full cost) and "subsidized" (where the APTC is applied and you see how much the plan will cost you each month). There's a bit more to it, but this pretty much sets the stage.

The (online) dictionary defines 'counter-intuitive' as: "counter to what intuition would lead one to expect."

And so?

So the "glitch in the subsidy matrix" is that, contrary to what one might expect, when premiums decrease, the insured's monthly contribution increases.

Say what?

It turns out that "lower premium levels reduced premium spreads for subsidy-eligible individuals. Lower premium spreads mean that subsidy-eligible individuals will face higher premiums."

Yikes.

(If you're interested in the mechanics of how that works, do click on through to the linked article)

Heading further down the rabbit hole, I pondered just how many folks that might actually affect. Our friend Charles Gaba came through for us:

"About 84% of folks with ACA plans receive the Premium Tax Credit (APTC). That's 9.59 million out of 11.41 million nationally"

So more than 8 out of every 10 ObamaPlan enrollees receive premium subsidies. Wow, that's a lot of folks who may well be feeling additional pain this year (at least in terms of premiums).

So here's the $64,000 question:

How will this affect all those folks with plans now receiving premium reductions due to CV-19?

/gulp

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By the River of Babylon

Note: I really couldn't care less about this, but I have made a strong commitment to break any so-called "embargo" to which I have not previously and explicitly agreed.

So:

"NEWS EMBARGOED UNTIL WEDNESDAY, MAY 27, 6 AM CST

Passing along the embargoed news that Babylon has invested in consumer health engagement company Higi, leading its series B funding. Full press release around the news pasted below."

Any interested folks are free to click through to read the no doubt sordid details.

[Hat Tip: Kayleigh W]

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Silent Spring - 2020

The last 4+ months have provided a fair amount of persuasive evidence that a fully-centralized “universal national health” scheme would be a fiasco in modern America.

That’s because the people running it would be the same kinds of bureaucrats and political functionaries that we’ve witnessed running government agencies like CDC, and leading our large cities and even some of our largest States. 

Unprepared, confused, slow to respond, and ultimately dictatorial.

There is no reason to believe bureaucrats and politicians who run a national health scheme would perform or behave any differently. 

Even the most rabid supporters of national health care must now deal with the implications of  declining public trust in big government.  Certainly the decline is not all because of coronavirus.  And certainly China or The World Health Organization did not help. But China and WHO are political and bureaucratic, after all.   

Regardless, coronavirus required American experts to give timely, correct advice to our government leaders, and required those leaders to make sensible and practical decisions.  Many took too long.  Many went too wrong.  And too many people died.

I expect public trust in big government will not begin to recover until Americans begin to forget the panic and death  over the past 145 days or so. 

Meanwhile, it's a silent spring.

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CV-19 Alphabet Soup: Another Update

From our friends at FlexBank/Navia:

"The Internal Revenue Service released Notice 2020-29 and Notice 2020-33 dealing with cafeteria plan elections, grace periods for health flexible spending arrangements (FSAs) and increasing the $500 carryover amount for health FSAs."

It's kind of amazing the ripple effect CV-19 is having on different areas of the insurance business. From Business Interruption on the P&C side, to premium relief on the health side. And of course all the changes already happening on the financial side.

For example, plans (employers) may:

• Prospectively enroll employee or family member in employer sponsored health coverage without an event

• Prospectively change to another health plan option of the same employer without an event

But wait, there's more! They may also:

• Prospectively enroll, increase, decrease, or revoke FSA elections for any reason. Employers may limit decrease/revoke to the reimbursement already provided

Again, these are voluntary; an employer doesn't have to adopt any or them.

Oh, this is pretty nifty:

Temporary Relief from Use-Or-Lose Rule
Claim Grace Periods under Health FSAs and Dependent Care FSAs

Employers may amend their health FSAs and/or Dependent Care FSAs to provide (or extend) a claims grace period during 2020. 

There are some provisos attached, but still, a nice option.

For complete details click here.

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At Issue: ACA & HMO

For some time now, ObamaPlans available here in The Buckeye State (and, it seems, pretty much everywhere else) have been buitl on the HMO chassis:

"One way carriers have found to reduce their costs has been to offer ever-shrinking networks"

And with HMO's if you're out-of-network, you're also out-of-luck.

So recently, one of my ACA clients reached out to me with a problem:

"I've got several acute medical issues, and no nearby providers who can help me. For example, I've got some increasingly problematic thyroid issues, and the only nearby endocrinologist only sees diabetes patients. Plus, my Primary Care doc isn't even in-network. Help?!"

We spoke for quite some time, and agreed that there weren't a lot of options, but that I'd reach out to our carrier rep (I'm anonymizing the carrier here since they've done nothing wrong, this is purely to illustrate the frustration of this model, which the ACA basically drives).

To his credit, I quickly got this reply:

"Good Morning Hank,

I’m doing well thank you, hoping the same for you.

I did some research on endocrinologists, I used a 50 mile radius from [a nearby zip code]; you are correct, the closest provider to this zip code is related to the [Diabetes Center], however I also saw in the search the below listed provider:

[Alternate provider who appears to handle thryoid cases]

While he is located a bit farther, he is the only other endocrinologists appearing in the network.

The member is welcome to reach out to Customer Care and request services from a non-network provider but I would not expect them to approve since there is another provider of this type within a 50 mile radius.  I had a similar situation in months past and it was not approved."

My client was decidedly not happy:

"Wow… I am not in [that] area.  That is over 20 miles from my house, which I am not comfortable with going that far. They aren’t even close to the hospitals I would need to use if I have a further issue."

As I pointed out, there's nothing in the ACA that requires carriers to make convenience a factor when setting up their networks. It's further exacerbated by the fact that we have competing hospital networks in this market (as in others, of course), and this creates additional issues.

From our rep:

"As for the primary care provider, since they are in both the Premier and Kettering Health Network I’m going to assume they are independent and not owned and operated by either system.  With the Dayton HMO, Premier Health is exclusively the provider network, they provide MMO with the list of providers that are part of their contract. With these exclusive HMO contracts we do not contract outside of the list of providers that is provided to us by the contracting facility, in this case Premier Health."

The key there is that the carriers' hands are tied. To make matters worse, she's already met her annual deductible for 2020, so moving to another carrier (even if that was an option, which is really isn't) would be another disaster.

#ObamaCrap FTW.

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