One State Requiring Beneficiaries Contribute To Their Medicaid Benefits

By Coleen Elkins      website: 24-7 Health Insurance

Following the mandate of the Affordable Care Act some states have expanded their Medicaid program. The expansion allows those earning 138 percent of the federal poverty eligible for State Medicaid. Indiana has taken the program a step further expanding the benefits to vision and dental.

240,000 Indiana residents gained Medicaid health benefits under the expansion. Even those who have income under the Federal poverty level are expected to contribute to their benefits. In that category if the beneficiary fails to contribute they lose the dental and vision benefit. Those with income at or over 100 percent of the Federal poverty level can lose all their benefits if they do not contribute financially to their benefits. For some the contribution is as low as $1.00.

The Obama Administration has made it clear that Indiana is a test case. The administration has made the statement that much testing must occur before other states will be allowed to consider this model.
Anthem a private insurer participating in Indiana's Medicaid program is calling it a success.

Read more here: Indiana Medicaid Expansion

What Is Driving Up The Cost Of Our Prescriptions?

By Coleen Elkins      24-7 Health Insurance 

Health and Human Services estimate Americans spent about $457 in 2015. Meaning 16.7 percent was spent overall for personal health care services. For comparison in 2009 total expenditures were $354 Billion the percentage of usage was exactly the same. In 2018 projected spending is $535 billion with a percentage of 16.8. These number are much higher than the 10 percent the pharmaceutical industry estimates.

The government is looking at ways to regulate costs by adding ways to encourage physicians to prescribe to most effective drugs and reward the best results for patients.

Consumers rarely know the true cost of their prescriptions since it is cost shared by their insurance. Why isn't there a visible price on each prescription dispensed?  Why do we ask the costs of other things we purchase but not our medications?

Pharmaceutical company drug pricing is not regulated in any way. They are advertising daily on television to sell their products to Americans. The advertising is very expensive. Would the cost and usage of pharmaceuticals drop if the government regulated their advertising like they have for other products in the past?

BCBSTN Joins Other Carriers Announcing Large Losses Under The Affordable Care Act

Coleen Elkins      Visit our website 24-7 Health Insurance

Blue Cross Blue Shield of Tennessee joins other carriers announcing large losses under ACA for 2015.

The major issue for BCBST and all insurers is the average age of enrollees is 42. Fifty three percent of enrollees are female. The "young invincibles" age 18 to 34 are still choosing not to enroll.

The average rate increase for BCBST for 2016 is 36.3 percent. All of this has equated to a financial loss of $300M in two years. In 2015 83 percent of enrollees received a tax credit this year that number increased to 87 percent. Does this mean that those not qualifying for a subsidy are not insuring by finding exemptions or alternatives?

People are enrolling in multiple plans and then dropping or not paying for one. In 2015 BCBST enrolled 164,000 but by November 1st insured about 143,000.

The question all carriers are facing is how do the create a sustainable market for themselves facing these numbers?

Federal Government Suspends ACA Tax Paid By Insurance Carriers

By Coleen Elkins    Visit our website 24-7 Health Insurance

Costing the Federal government $13.9 million Congress made the decision to suspend the Affordable Care Act tax on health insurance companies for one year. As a result the Center For Medicare and Medicaid Services expects insurance companies to keep their premiums "in check" when they file for 2017. The tax has compelled insurers to raise premiums passing the cost on to their insureds.

Will this be enough to hold premiums or will carrier losses raise premiums higher?

Insurers blame rising premiums on prescription drug costs and ACA fees imposed on them. Harvard Pilgrim reported an operating loss of nearly $79 million for 2015 and a net loss after factoring in other income of almost $55 million. Health and Human Services said recently stated they will look into the losses reported by many insurers for 2015.