DOJ Tells Court to Nullify ACA; What’s Next?

| posted in Blog

After a period of relative stability, the future of the Affordable Care Act has once again been thrown into uncertainty. In a surprise move, the Department of Justice announced that it would not further pursue appeal of a ruling by U.S. District Court Judge Reed O’Connor, and instead asked the 5th U.S. Circuit Court of Appeals to affirm the decision he made in December 2018. O’Connor had ruled that Congress eliminating the penalty for not complying with the law’s individual mandate had in fact made the entire law invalid. But, even though the DOJ won’t be pursuing defense of the…
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5 Reasons Healthcare Costs Are on the Rise

| posted in Blog

It’s not your imagination. Healthcare is expensive and costs continue to rise. According to the Journal of the American Medical Association, costs increased by almost one trillion dollars between 1996 and 2015. The rise in healthcare costs cannot be attributed exclusively to any one cause. Rather, there are a number of causes that, put together, are responsible for the rise. All of the following, plus more, have a role.

Employers Double Down on Employee Benefits

| posted in Blog, Newsletter

As the job market tightens and competition for workers becomes fiercer, a majority of employers are boosting their employee benefits offerings and are paying less attention to reducing associated costs, according to a new study. The changes reflect the shifting priorities of the workforce and the newest generation to enter the job market. The challenge for employers is controlling benefit costs, while at the same time being able to attract and retain talent as competition for workers increases. The “2018 Benefits Strategy & Benchmarking Survey” by Gallagher Benefits found that U.S. employers were most concerned with: Attracting and retaining talent….
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Employers Say Pharmacy Benefit Manager Contracts too Complex, Opaque

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Three in five employers think their contracts with pharmacy benefit managers are overly complex and not transparent, according to a new study. The study, which found that employers would prefer that PBMs are more transparent with their pricing and would like them to focus less on rebates and value-based designs, comes as PBMs are under increased scrutiny for their opaque pricing practices. The survey of 88 very large employers, “Toward Better Value: Employer Perspectives on What’s Wrong with the Management of Prescription Drug Benefits and How to Fix It,” was conducted by Benfield and commission by the National Pharmaceutical Council….
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Protect Yourself from Unexpectedly High Retirement Health Care Costs

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More than 40% of retirees encounter health care costs that are greater than they had anticipated or planned for. That’s according to a new study from the LIMRA Secure Retirement Institute. Here are LIMRA’s key findings: • Retirees spend 13% of their income on health and long-term care expenses, on average. • 43% of those with retirement plans still underestimate health care expenses in their golden years. Furthermore, seniors should plan for continued increases in health care costs, over and above the effects of inflation. According to HealthView Services’ 2017 Retirement Health Care Costs Data Report, health care costs are…
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Senate Works to Save CSR Payments, but Too Late for 2018

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The Affordable Care Act requires insurers to reduce cost sharing (deductibles and copays) in silver-level plans for marketplace enrollees with incomes below 250% of the federal poverty line. Until now, insurers have relied on offsetting payments from the federal government to provide this feature. These payments amounted to $7 billion for fiscal year 2017, $10 billion for 2018 and will reach $16 billion by 2027. However, the Trump administration in August moved to end the controversial set of payments to the insurance industry designed to encourage carriers to remain in the ACA exchanges. These payments – known as “cost-sharing reduction…
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After IRS Tweak Be Careful that You’re Complying with Affordability Test

| posted in Blog

Now that the final attempt (this year) at dismantling the Affordable Care Act came to a quiet end in the last week of September, employers need make sure that they stay on track with compliance. First and foremost is that the ACA’s employer mandate and shared responsibility provisions still stand. That includes the affordability test, to which employers need to pay special attention, as increases in premium can put some of your employees over the edge into “unaffordable” coverage territory. And this year there’s a twist that you need to be aware of. As it’s almost time for open enrollment,…
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Breaking News: POTUS Signs Executive Order on Healthcare

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This morning, President Trump signed an Executive Order intended to improve access, increase choices and lower costs for healthcare. Below is a brief summary of what we know so far. Directs the Labor Secretary to consider regulations/guidance – within 60 days – expanding Association Health Plans, for the purpose of allowing employers in the same line of business anywhere in the country to join together in offering healthcare coverage to their employees. This potentially allows employers to form AHPs through existing organizations, or create new ones for the express purpose of offering group insurance. This could lead to the sale…
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How Many Seniors Get Medicare Open Enrollment Wrong

| posted in Blog, Newsletter

Medicare can be hard to navigate, even if you’ve been enrolled for years. As open enrollment approaches – it starts Oct. 15 and runs through Dec. 7 – you’ll want to pay attention to some of the most common mistakes people make. Not understanding the difference between Original Medicare and Medicare Advantage – With Original Medicare, there is typically no premium for Part A coverage if you or your spouse paid Medicaid taxes while you were working. However, you do pay monthly premium for Part B coverage. Also, with Original Medicare, you can usually see any doctor or specialist you…
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