Obamacare Approaches 5th Anniversary - Changes & Challenges Approaching For 2015 That May Impact You

By Coleen Elkins

On March 1st 2015 The Affordable Care Act also known as Obamacare will begin it's 5th year.

For those of you on Medicare your doctors may be sending you letters letting you know they may no longer participate in Medicare and this is why. Doctors and hospitals have been encouraged to participate in "meaningful use" of e-records and e-prescribing systems. This very expensive addition to a practice is meant to make the doctors office more efficient and cut down on communication errors that can harm patients. The cost average cost for a physicians office to implement this change is about $165,000.00 for a five person practice in just the first year.

You may have seen some dramatic changes in your Medicare provider network or received a letter from your doctor telling you that you will need to find a new doctor. More than 270,000 doctors and 200 hospitals nationwide will experience funding cuts from Medicare for failing to meet new government requirements. Some have just decided to no longer contract with Medicare and change the focus of their practice. This causing a very angry reaction amongst the Medicare community of those that have been impacted.

The employer mandate takes effect for the first time this year. Employers with 100 or more employees must provide health insurance to their workers. Next year the mandate will be impacting employers of 50 and more employees. Many employers are restructuring or relocating to other countries and cutting workers hours to avoid the mandate.

If you are under age 65 and did not purchase health insurance in 2014 and expecting a refund get ready. Each person without insurance will pay $95 or a one percent income penalty which ever is greater. That amount will increase to 2 percent for 2015. The cash strapped IRS is the appointed watch dog to collect the penalties and monitor insurance status of businesses under the employer mandate. 

Primary care doctors will face pay cuts in 2015. The funding given to states by the Federal Government to encourage them to beef up their Medicaid programs will be decreasing by an average of 43 percent beginning this month. Doctors will have no choice but to turn away patients because of the high cost of treating Medicaid patients coupled with the reduced pay.

Finally CHIP a funding program for children on Medicaid is reauthorized until 2019 but only funded through September of next year. Members of Congress although supportive of the program have failed to take steps to fund the program. They are receiving pleas from governors who want to know now if the program will end.

Continue to follow our blog in 2015 to stay on top of the changes that my impact you! 

Always Heartbreaking News When Seniors Can't Afford Their Medications

By Coleen Elkins

We are in the business of helping people with their Medicare options and we get the opportunity to really listen to what is important. It is heartbreaking to meet with an aging member of our community and have them tell us they can't fill their prescriptions. Not taking prescriptions can be life threatening or shorten someone's life.

It is very stressful to be sick. It is even more stressful to be on a fixed and/or limited income and not being able to afford your medications.

How does a senior decide between paying their rent or mortgage and paying for their medications?

More than 300,000 American's are now taking medication with an annual cost of $50,000.00. Many  of the the Cancer medications cost $10,000.00 per month. Even with a Part D prescription plan the cost sharing is unaffordable. Then there is the "gap or the donut hole" where the burden is shifted back to the insured. They won't see any relief until they have spent $4700.00 out of pocket. Many of the newer drugs are not found on drug plan formularies meaning the are not covered by the plan at all.

Some can get extra help from VA benefits. Drug manufactures are offering financial assistance and often free medications to those who are the most needy. Those are not unlimited funds though and the benefits can be depleted quickly.

Many people don't know the true cost of their medications in the initial coverage stage because they are paying a copay. They are learning the hard way when they suddenly end up in the "gap".

We urge consumers that are unable to pay for their medications to let their legislators know. Call or write your Congressman. Speak out and be heard. If you don't tell them they don't know. If you don't know how to do that ask a family member or friend to help.

Going Without Health Insurance Could Have A Huge Price Tag

By Coleen Elkins



Whether you choose to call it a "tax penalty" or a "fine" in the year 2015 going without health insurance is going to be costly. The price tag is $325.00 for each adult or 2 percent of your family income, which ever is greater. This could cost a family $1,000.00 or more.

It has come down to going without health insurance is not only financially risky it is costly. The law has a mandate that the IRS is overseeing. You will answer questions on your tax return inquiring about the status of your health insurance. If you have children dental insurance is also mandatory and will automatically be added to your coverage.

There are hardship exemptions for those that fit the criteria to request an exemption. Completing forms are required to receive an exemption.

It seems that the general public is still very confused about the criteria of fulling the requirements of the law.

If you have questions about the law you can seek the services of a licensed insurance specialist focused the Affordable Care Act.  Since some of the law is related to tax penalties your tax advisor will be able to talk to you about the tax requirements of the law.


To learn more about the law visit our website 

Slowing Of Healthcare Spending Does Not Help Most Americans

By Coleen Elkins

If you noticing the cost of your health insurance increasing you are not alone. The reported slowing of healthcare cost spending is proving to not be related to the cost of health insurance. As American's are learning what their health insurance is going to cost for 2015 they are becoming more and more angry. 

American's receiving employer based benefits are spending a larger portion of their paychecks paying for it. Family health insurance costs jumped a whopping 73 percent in a ten year span from 2003 to 2013. It is similar for individuals paying for their own health insurance. At the same time deductible have more than doubled. In fact they have increased over 300 percent in the last year. 

The structure of health plans has also changed most no longer have fixed copays for doctors visit and prescription drug benefits. 

At the same time cost is going up for the consumer it is also going up for the employer and the employer is shifting cost on to the employee. If an employer plan does not meet the criteria for affordability and minimum essential coverage under The Affordable Care Act the employee may be eligible for coverage through an exchange. 

150 million Americans receive benefits from their employer. Only 7 million people have enrolled through exchanges as a result of the Affordable Care Act. That is a large contrast and somewhat dims the light of the Affordable Care and it's cost to administrate it. 

If the cost continues to rise for Americans to have benefits people may find themselves in a quandary. Purchasing health insurance that doesn't actually help pay for out pocket expenses for chronic medical conditions and prescription drugs doesn't make sense to most people. 

The Supreme Court Will Hear Challenges On ACA Subsidies

By Coleen Elkins

Only thirty seconds was given to this piece of news on the television on Friday so if you blinked you may have missed it. It was however widely covered in print.

The Supreme Court will be hearing challenges to the Affordable Care Act for a second time after determining it Constitutional in a previous hearing.

This is very serious as the challengers say that the administration is violating the plain language of the law. In question is if subsidies should have only been available to those purchasing insurance through their state exchanges.  The language in the law being challenged is where it states subsidies offered in the form of tax credits, will be offered in exchanges "established by the states". In other words it is unlawful for the federal health insurance exchange to offer subsidies.

There is not just one challenge to the law but four separate challenges.

The federal government operates more than two-thirds of the exchanges.

In July the D.C. appeals panel ruled that as written the healthcare law allows tax credits to be offered only in state-run exchanges. The administration had expected states to create their own exchanges but only 14 states did so. The court said the IRS went to far in allowing participants in other states seeking benefits from the federal exchange to qualify for billions of dollars in government assistance.

The Court will be hearing the case in the June session.


Read more here

Medicare Cuts Payments To Home Health Care By $60M

By Coleen Elkins



Home health care offers peace of mind and increases your ability to heal after an illness or procedure. Home based medical services are received by approximately 3.5 million Medicare beneficiaries each year.

Medicare recently finalized a $60 million cut to the agencies that provide this valuable service. Groups representing home health care providers unsuccessfully lobbied to stop the cuts.

Medicare says the cuts will will advance the goal of delivering better healthcare at lower costs. As part of the changes Medicare now requires a face to face appointment with a physician for a patient to receive home health care benefits.

Read more here: Home health care cuts

Affordable Care Act Insurer's New Contracts Contain An "Opt Out Clause"

By Coleen Elkins

The Supreme Court has been asked to determine if subsidies are legal in the Federal health insurance exchange. There have been multiple challenges to the way the law was written. Many read the law to say that subsidies are only legal in the state run exchanges. 

These challenges to the language in the law are coming to the attention of many who follow the law. If the Supreme Court rules that those whom receive reduced premiums and increased benefits through Federal subsidies can no longer do so their policies will revert to the retail price. People qualify for subsidies if they are low or moderate income households and paying retail may not be an option.

The insurers participating in the exchanges are being cautious as they know that most receiving subsidies will be unable to pay the retail price and will cancel coverage. Insurers are asking for the opportunity to opt out of offering benefits if that is the case. In some states they may still be forced to keep the policies in place.

It is important for the public to know and understand that these challenges could change their premiums and level of benefits.