MEDIGAP INSURANCE MARKETS: STRUCTURE, CHANGE, AND IMPLICATIONS FOR MEDICARE

Size: px
Start display at page:

Download "MEDIGAP INSURANCE MARKETS: STRUCTURE, CHANGE, AND IMPLICATIONS FOR MEDICARE"

Transcription

1 MPR Reference No.: MEDIGAP INSURANCE MARKETS: STRUCTURE, CHANGE, AND IMPLICATIONS FOR MEDICARE December 13, 2001 Submitted to: Office of the Secretary Assistant Secretary for Planning and Evaluation U.S. Department of Health & Human Services 200 Independence Avenue, SW Washington, DC Submitted by: Mathematica Policy Research, Inc. 600 Maryland Avenue, SW Suite 550 Washington, DC Telephone: (202) Attention: Stephen Finan Contracting Officer Contact Person: Deborah Chollet

2 MEDIGAP INSURANCE MARKETS: STRUCTURE, CHANGE, AND IMPLICATIONS FOR MEDICARE by Deborah Chollet Mathematica Policy Research and Adele Kirk University of California at Los Angeles A. INTRODUCTION The market for private insurance to supplement Medicare (Medigap) is both large and complex. In 1999, Medigap insurers covered 10.4 million lives, equal to 27 percent of all Medicare beneficiaries, elderly or disabled. The market includes both group and individual policies, and both and "prestandard" product designs. In addition, markets vary across states, which have jurisdiction to regulate Medigap policies in conformance with federal law. Some states impose additional restrictions on Medigap insurers, affecting how they underwrite risk and rate policies. This report describes the Medigap market in 1999, both nationally and by state. It also compares the national profile of the states= Medigap markets in 1999 with that in 1997 to offer a picture of how Medigap markets are changing. The information is based on data that the National Association of Insurance Commissioners (NAIC) compiles from the standard reports that insurers file in every state. Because these data are insurer-based (not population-based), at least two caveats are in order. First, people who have multiple Medigap policies are counted in the data multiple times. While it was the intent of OBRA-90 to eliminate duplicative coverage by standardizing Medigap policies, its success is undocumented even in the standardized segment of the market. More than a quarter of individual Medigap policies in force are pre-standard, and these probably represent some multiple coverage. Nevertheless, population-survey estimates of Medigap coverage and insurers reports of covered lives in 1999 are nearly 1

3 identical. 1 Thus, we presume that Medigap policyholders typically have only one policy, and we use the terms covered lives and policyholders interchangeably. Second, as reported by insurers, group-covered Medigap lives include people enrolled in insured employer-sponsored retiree plans and also people enrolled in association plans, such as that sponsored by AARP and others. In contrast, population surveys generally regard Medicare beneficiaries enrolled in association plans as individually insured. Because the total number of covered lives that Medigap insurers reported is nearly identical to the number of Medicare beneficiaries who, in population surveys, report Medigap coverage, we presume that virtually all of the group business reported by Medigap insurers is association business. By inference, we presume that employer-sponsored retiree benefits are nearly always self-insured, and therefore they are not reflected significantly in this report. The following sections describe enrollment, marketing and pricing of Medigap insurance products in We describe the general distribution of enrollment in individual and group (association) policies, and then turn exclusively to individual policies the much larger segment of the market to explore insurer marketing and premiums in the aggregate and by state. We then discuss the changes in the Medigap market that occurred between 1997 and 1999, comparing insurer reports of covered lives and average premiums in each year. Finally, we offer some concluding comments about the Medigap market and possible implications for the Medicare program. However, first we offer some context about Medigap markets to provide a basis for the understanding descriptive sections that follow. B. UNDERSTANDING THE MEDIGAP MARKET Competition in the Medigap market appears to be extremely limited. Indeed, Federal law and most state laws define Medigap markets that are highly rigid, certainly in product design, but also in the rules that insurers may use to protect their business from adverse selection. In effect, these rules lock most policyholders into both a carrier and a specific policy one year after they initially choose a Medigap policy at age 65. Except to enter (or within one year, to leave) a Medicare+Choice plan, most Medicare 1 Tabulations of the Medicare Current Beneficiary Survey indicate that 26 percent of Medicare beneficiaries had individual Medigap coverage in 1998 (Poisal and Murray, 2001). The ratio of group and individual covered lives (as reported by Medigap insurers) per Medicare beneficiary (as reported by HCFA) was 27 percent in

4 beneficiaries may have no real option ever to change their insurer or particular Medigap policy for the rest of their lives. Specifically, unless otherwise constrained by state law, insurers may: C deny initial coverage to any applicant who has been enrolled in Medicare longer than 6 months; C deny current policyholders from moving (within carrier) to any other policy form 12 months after initial enrollment; 2 C deny beneficiaries leaving Medicare+Choice plans or retiree health insurance plans 3 coverage in any policy form except A, B, C or F (none of which cover prescription drugs); C C deny applicants leaving Medicare+Choice or employer-sponsored retiree coverage any policy except A, if more than 63 calendar days have elapsed; and restart a 6-month waiting period for coverage of preexisting conditions when a beneficiary changes Medigap policies. 4, 5 Moreover, many insurers price Medigap policies on an entry-age (or issue-age) basis. Entry-age premiums are front-loaded. In effect, they require policyholders to pay higher initial premiums in order to 2 Within 12 months of Medigap enrollment, insurers must guarantee issue to current policyholders every policy form that they sell. However, as described later in this report, most insurers sell only one or two policy forms in a state, other than policy form A (which all individual Medigap insurers are required to sell). In practice, many insurers may allow current policyholders to trade down to policy form A without underwriting, although in general state regulation does not require them to do so. 3 Specifically, insurers must guarantee issue selected policy forms (A, B, C and F), if they sell those policy forms at all, to Medicare beneficiaries within 63 days of leaving either a Medicare-approved managed care plan for designated reasons or an employer-sponsored retiree health plan because the plan was terminated or benefits were reduced. 4 The 1997 Health Insurance Portability and Accountability Act (HIPAA) exempts supplemental health insurance policies from its portability provisions. However, the NAIC model regulations prohibit Medigap insurers from excluding coverage for conditions that existed only before the six months prior to coverage, and from excluding coverage for any preexisting condition longer than six months. 5 Massachusetts offers a notable exception to these rules. Massachusetts requires Medigap insurers to hold an annual 2-month open enrollment period during which the insurer must offer to any Medicare beneficiary (except ESRD enrollees) any policy that the insurer currently sells. However, insurers may apply a surcharge for applicants who first apply for Medigap coverage after the first six months of Medicare Part B enrollment, who have a break in Medigap coverage longer than 30 days, or who are upgrading coverage. 3

5 minimize annual premium increases. A policyholder who cancels an entry-age-rated policy after age 65 forfeits an asset: the higher initial premiums already paid. Thus, entry-age rating may further discourage Medicare beneficiaries from moving among Medigap policies, even if they would pass the insurer s underwriting screen. If other available Medigap policies also are entry-age rated, older Medicare beneficiaries hoping to change policies may find no alternative that is less expensive for the same coverage. 6 In summary, Medicare beneficiaries are constrained in many ways from moving among Medigap carriers and policies after they first select a Medigap policy at age 65. In most states, policyholders have very little opportunity to respond to differences in prices or service, or to register a change in their demand for coverage. The underwriting barriers that insurers apparently have erected to discourage policyholders from moving from one plan to another after age 65 are so significant that prevailing patterns of Medigap coverage are unlikely to have any relationship to current market circumstances. 7 As a result, it is not surprising that competitive patterns of coverage or prices would fail to emerge for beneficiaries older than age 65, and therefore that they would not be apparent in the Medigap market as a whole. C. ENROLLMENT IN MEDIGAP POLICIES In this section we describe relative enrollment in individual and group (that is, association) Medigap plans, and in standard and pre-standard plans. Medigap policyholders in the individual market are more likely than group policyholders to be enrolled in standard policy forms. In both markets, standard enrollment is concentrated in just three policy forms: F, C and B. 6 Insurers may rate Medigap policies on an entry-age basis, attained age basis, or community-rated basis. Because attained-age premiums are not front-loaded, they may be lower than entry-age rates at age 65 (all else being equal). However, attained-age premiums may rise more steeply over the policyholder s lifetime. Community-rated policies (such as those marketed through AARP) average the cost of coverage over the whole group (irrespective of health status) and they also may soften or eliminate the age gradient. Thus, communityrated policies may be either more or less expensive at age 65 than policies priced an entry-age (front-loaded) basis, but they probably are less expensive in later years than an attained-age-rated policy. Of 43 states that responded to a NAIC survey in 1999, six states prohibited Medigap insurers from using entry-age rating, ten prohibited attained-age rating, and eight required community rating (NAIC, 2000). 7 In 1996, the GAO reported that 16 of the 25 largest national Medigap insurers underwrote all or some of their policies (GAO, 1996). The report did not distinguish between individual and group policies issued by these insurers or among states where insurers wrote coverage. 4

6 1. Individual vs. Group Enrollment In 1999, 75 percent of Medigap policyholders were enrolled in individual policies; all other policyholders were enrolled in group policies, which we assume are association plans. The relative likelihood of holding an individual or group policy varies markedly from state to state (see Table 1). In nine states, 8 most Medigap policyholders were in group policies; in California and New Jersey, more than twothirds were in group policies. But in 22 states and the District of Columbia, at least 90 percent were in individual Medigap policies. The reasons for these differences among states are unclear. As described earlier, they may relate to historical differences in Medigap marketing and pricing, and not principally to current market circumstances. They also may reflect differences in the states regulation of individual versus group policies. However, there is no source of information that documents the extent of such differences in either insurer practice or state regulation of Medigap insurers. 2. Standard Versus Pre-standard Policies OBRA-90 standardized new Medigap coverage in the individual market and also in the segment of the group market that is comprised of association plans. 9 OBRA-90 established ten standard policy forms that differ in the scope of coverage and the amount of cost-sharing they entail. Policies that were issued before OBRA-90's effective date, July 1992, were grandfathered. That is, insurers have been able to renew pre-standard policies since July 1992, but they cannot issue new pre-standard policies. Thus, all pre-standard policyholders are now at least age 74. In 1999, about one-third of all Medigap policyholders were in pre-standard plans (see Table 2). While the benefit design of pre-standard policies is in fact unknown, many may have some coverage for prescription drugs. 10 If so, this might in part explain the apparent reluctance of pre-standard policyholders to move into the standardized market, even if they were able to pass insurers underwriting screens. 8 Arizona, California, Hawaii, Massachusetts, New Jersey, New Mexico, New York, Ohio and Vermont. 9 Employers and unions are, in effect, exempt from OBRA-90 rules. Employers that sponsor retiree benefits may contract with insurers to cover specific wrap-around benefits that may not conform to any standard plan design. However, insurers may not broadly market such products. 10 The number of covered lives in pre-standard policies in 1999, combined with the number in standard H, I, or J policies, is very similar to available survey estimates of Medicare beneficiaries who report individual Medigap coverage for prescription drugs about 40 percent (Poisal and Murray, 2001). 5

7 Most policyholders in either standard or pre-standard plans held individual policies, but prestandard policyholders were more likely to be in group plans than were standard policyholders. In 1999, 35 percent of pre-standard policyholders were in group policies, compared to just 20 percent of standard policyholders. Many group pre-standard policies may be the product that AARP sold before That product provides very limited coverage for prescription drugs: a $50 deductible, 50% coinsurance and a $500 limit on covered drug expenses. In 1999, the distribution of policyholders between standard and pre-standard policies varied widely across states (see Table 3). In four states (California, Connecticut, Maryland, and New Jersey) more than half of Medigap policyholders were in pre-standard plans, and (except in Maryland) usually in pre-standard group plans. Conversely, in six states (Alabama, Arkansas, Idaho, Maine, North Dakota and Utah), fewer than 15 percent of policyholders were in pre-standard plans. 3. Enrollment in Alternative Standard Policy Forms As described above, Medigap insurers have been allowed to issue only 10 standard policy forms since Policy form A includes only the standard Abasic benefits@ that are common to all Medigap policies. 12 The most popular policy forms are F, C, and B. 13, 14 These three policy forms accounted for 48 percent of all Medigap policyholders in 1999, and 76 percent of all standard policy holders (see Table 4). On the whole, individual policyholders (54 percent) were more likely to have one of these three policies than were group policyholders (31 percent). 11 Gerry Smolka, AARP Public Policy Institute, personal communication, June These are: Part A coinsurance, plus coverage for 365 additional days of hospitalization after Medicare benefits end; Part B coinsurance (generally 20 percent of Medicare-approved expenses) or, in the case of hospital outpatient services under a prospective payment system, applicable copayments; and the first three pints of blood each year. 13 In addition to core benefits, policy form F covers Medicare=s Part A and Part B deductibles, all Part B excess charges, and SNF coinsurance, and may be sold with no deductible or with a high deductible. Policy form F also pays for emergency covered services during foreign travel; but it does not cover home health care, preventive services or prescription drugs. Policy form F=s high-deductible option includes a deductible of $1,530 per year for covered expenses net of the plan=s separate foreign travel emergency deductible. 14 Compared to policy form F, policy form C does not cover Part B excess charges, and there is no highdeductible option. 6

8 Notably, fewer than 6 percent of all Medigap policyholders and just 9 percent of standard policyholders were in any of the standard policy forms (H, I or J) that cover prescription drugs (see Table 5). 15, 16 That is, of all Medicare beneficiaries who have bought a Medigap policy since 1992 (and retained it into 1999), 9 percent bought any policy that covers prescription drugs. While F, C and B plans account for nearly half of Medigap enrollment nationwide, in Alabama and North Dakota more than 90 percent of Medigap policyholders were in these policy forms (see Table 6). In Alabama, 76 percent were in B plans; and in North Dakota, 85 percent were in F plans. However, in four states California, Connecticut, Delaware and Hawaii and in the District of Columbia, fewer than one third of all Medigap policyholders were in F, C or B policy forms. 17 The reasons for this apparently vary. In California, Connecticut and in the District of Columbia, enrollment in pre-standard policies was unusually high (41 to 67 percent of total enrollment). In Delaware and Hawaii, other standard policy forms (D and A, respectively) accounted for unusually high proportions of Medigap coverage. Reflecting low rates of drug coverage among standard Medigap policyholders nationally, this coverage is rare among standard policyholders in nearly every state. Only in Alaska, New York and Vermont were as many as 15 percent of Medigap policyholders in standard H, I or J plans in 1999 (see Table 7). In Vermont, nearly 28 percent of policyholders had standard drug coverage, a rate that greatly exceeded that in any other state. But in Alabama and North Dakota, only about 1 percent of Medigap policyholders were enrolled in standard plans that covered prescription drugs. That is, in these two states, only about 1 percent of all Medigap policies purchased and then renewed during the last decade covered 15 In addition to the basic benefits, policy forms H, I and J all cover skilled nursing coinsurance and foreign travel emergency services. Policy forms H and I cover prescription drug expenses up to $1,250 per year. Policy form J covers prescription drug expenses up to $3,000 per year, and also the Part B deductible and preventive care. 16 Massachusetts, Minnesota and Wisconsin regulate Medigap plans under a waiver of Federal law; each has a different set of standard policy options. In Massachusetts, one of three standard policies covers drugs. In Minnesota, drug coverage is sold either as an optional rider to the basic policy, or as a covered expense in extended basic policies. In Wisconsin, the basic benefit covers drugs with a $6,250 drug deductible, and additional drug coverage may be purchased as an optional rider. Enrollment and premium data for standard policy forms unique to these states are not available from NAIC. 17 In the three states that operate under waivers of federal law standardizing benefits Massachusetts, Minnesota and Wisconsin, enrollment in most standard policy forms probably includes only policyholders who moved to these states and retained a standard policy issued in another state. 7

9 prescription drugs. In 25 states (including the three waivered states) fewer than 5 percent of Medigap standard policyholders had coverage for prescription drugs. If we assume that half of all pre-standard policies may have some coverage for prescription drugs probably a high estimate the picture for Medigap policyholders is brighter in some states, but not most. 18 In nine states 19 and the District of Columbia, about one third of Medigap policyholders may have had coverage for prescription drugs in However, in Alabama, North Dakota, Arizona and Idaho, fewer than ten percent may have had any drug coverage; and in all but six states, at least half of all policyholders who may have had any coverage for prescription drugs would have been holding pre-standard policies issued before Nationwide, 3 of every 4 Medigap policyholders with coverage for prescription drugs in 1999 would have been enrolled in a pre-standard Medigap plan and would have been age 72 or older. The following sections examine patterns of enrollment and prices specifically in the individual market, which contained 75 percent of all Medigap policyholders in We first look at enrollment in open policies as an indication of the choices available to Medicare beneficiaries at age 65. We then turn to enrollment in guaranteed issue plans and in plans that accept disabled Medicare beneficiaries. Enrollment in these plans is a useful indicator of the plan choices available, respectively, to Medicare beneficiaries older than 65 who have health problems and to disabled Medicare beneficiaries. 4. Individual enrollment in open products Most insurers in the Medigap market offer products that are open to new enrollment. However, many insurers run only closed products that is, they renew coverage but do not issue new coverage in some or all policy forms. Enrollment in open products is an important measure of a state=s Medigap market for at least two reasons. In markets with a greater variety of open products, Medicare beneficiaries may have greater choice among policy forms (at least at age 65 when all Medigap policies are guaranteed issue). All else 18 By assuming that all pre-standard policies include some coverage for prescription drugs, insurers reported covered lives very nearly matches estimates of prescription drug coverage among Medicare beneficiaries, as measured by the Medicare Beneficiary Survey (Poisal and Murray, 2001). However, earlier research (Rice et al., 1997) examining prestandard Medigap policies issued in six states, suggests that the rate of prescription drug coverage in Medigap plans before standardization (in 1991) was as low as 13 percent. An estimate of 50 percent here would be consistent with bias in the retention of pre-standard policies, favoring retention of policies that covered prescription drugs. Many (if not most) of these policies may provide lower levels of drug protection than standard policies and, therefore, on an age-rated basis would be less expensive than standard policies. 19 Alaska, California, Connecticut, Maryland, New Jersey, Vermont, Virginia, and Washington. 8

10 being equal, greater enrollment in open products also may indicate that these products are actively marketed and relatively easy for consumers to find. (As discussed in a later section, many insurers do not actively market their open products.) Conversely, high enrollment in closed products suggests that Medigap insurers may be having serious problems. Insurers generally will close a product when its cost experience is deteriorating, and therefore, premiums are rising steeply. In such a situation, insurers fear an adverse selection spiral (sometimes called a death spiral ) a phenomenon in which rising premiums discourage healthy policyholders from maintaining coverage, and the higher cost experience of remaining policyholders drives still higher premiums. Insurers experiencing adverse selection may close their insurance products to new enrollment, and in the direst cases they may cancel policies and exit the market. However, because the Medigap market is so extensively underwritten, it is unlikely that any state regulator would allow a Medigap insurer to cancel policies without guaranteeing that another insurer would accept all policyholders without a steep premium increase. The difficulty (and expense) of such guarantees apparently holds most Medigap insurers in the market, even though all or most of their products are closed. Including enrollment in pre-standard policy forms (which have been closed to new enrollment since 1992), fewer than half of individual Medigap policyholders (48 percent) were enrolled in open products in 1999 (see Table 8). Including only policyholders in standard policies, just two-thirds (68 percent) were in open products. On average, a low percentage of enrollment in policy forms that cover prescription drugs (H, I and J) were in open products, despite the apparent determination of regulators in most states to maintain at least one open H, I or J product. In 1999, just 21 percent of enrollees in H policies (presumably the most affordable Medigap drug plan) were in open products, and only about half of enrollees in I and J policies were in open products. These rates compared to a nationwide average of 79 percent of F policyholders the most popular standard policy form in open products. The relatively low rate of enrollment in open H products nationally reflects extremely low rates of enrollment in open products (and relatively high rates of enrollment in closed products) in eight states: Arizona, Maine, New Hampshire, New York, North Carolina, Pennsylvania, Utah and Vermont. In each of these states, fewer than 5 percent of H policyholders were in open products. In many states, the percentage of Medigap policyholders in open products is surprisingly low across all policy forms. In 21 states, fewer than half of all individual policyholders were enrolled in open products, 9

11 standard or pre-standard. Considering only standard policy forms, fewer half of policyholders were in open products in twelve states. 20 In Maine and Montana, fewer than 10 percent of all policyholders were enrolled in open products; and in Maine s standard Medigap market, just 7 percent were in open products. 5. Individual enrollment in products that are guaranteed issue or accept disabled Very little of the individual Medigap market, nationally or in most states, is guaranteed issue except at age 65. In 1999, just 12 percent of Medigap policyholders in any individual plan (open or closed, standard or pre-standard) were enrolled in open products that guaranteed issue after age 65 (see Table 9). Among policyholders enrolled only in standard policy forms, just 18 percent were in guaranteed-issue products. Even these low numbers, however may reflect reporting error, and should be considered high estimates of enrollment in guaranteed-issue products. 21 Policy forms that offer coverage of prescription drugs (weighted by enrollment) were much less likely to guarantee issue after age 65. Fewer than 3 percent of H or I enrollees, and just 11 percent of J enrollees, were in guaranteed-issue products in Overall, Medigap policies that accept disabled Medicare beneficiaries are even rarer than products that are guaranteed-issue after age 65. In 1999, just 11 percent of Medigap policyholders (elderly or disabled) were in open products that accepted disabled beneficiaries. Among policyholders in standard policy forms, just 16 percent were in products that accepted disabled beneficiaries. However, policies that cover prescription drugs were more likely to accept disabled than to be guaranteed issue after age 65. In 1999, 15 percent of H and I policyholders, and 9 percent of J policyholders, were in products that accepted disabled Medicare beneficiaries. The proportion of individual Medigap policyholders enrolled in guaranteed-issue products is presented by state in Table 10. In 38 states and the District of Columbia, less than 10 percent of enrollment in standard policy forms was guaranteed-issue in Conversely, in four states C Connecticut, Illinois, Kansas and New York C more than two-thirds of enrollment in standard policy forms were guaranteed- 20 Alabama, Hawaii, Maine, Montana, New Hampshire, New Jersey, North Carolina, North Dakota, Pennsylvania, Utah, Vermont and Washington. 21 Some insurers may have misconstrued this question and indicated that the product was guaranteed issue to some applicants (Mary Beth Senkewicz, personal communication). All standard Medigap policy forms are guaranteed issue to Medicare beneficiaries within 6 months of initial enrollment in Part B. 10

12 issue. In general, these higher rates corresponded to very high rates of guaranteed-issue enrollment in policy form F and (in all states but New York) also in A. In New York, 72 percent of individual enrollment in standard policy forms was guaranteed-issue; and nearly all enrollment in policy forms B, D, and G was guaranteed issue. The differences among states in guaranteed-issue Medigap enrollment probably relate to differences in regulatory practice either statutory or informal. However, no available study has attempted to document differences in state regulatory practice. While enrollment in standard policy forms that cover prescription drugs is uniformly low, in some states, these policy forms are often guaranteed-issue. In seven states, 22 at least 40 percent of enrollment in either H or I policy forms was guaranteed-issue in 1999 including Hawaii and New Jersey, where all enrollment in H policies was guaranteed-issue. Policy holders in J plans are rare, and guaranteed issue policyholders rarer still, but in 4 states (Mississippi, New Jersey, Texas and Vermont) more than threefourths of enrollees in J policies were guaranteed issue in 1999; in New Jersey and Vermont, all J enrollment was guaranteed issue. D. MEDIGAP INSURERS The following sections describe the structure of supply in the Medigap market. We review the number of insurers with individual policies in force, and also the number of active insurers C those who have sold Medigap policies recently. All of the information presented below indicates the availability of insurance at the state level. There is no source of information that would indicate whether an insurer restricts its business to only some areas of the state, although many insurers may do so. 1. Number of Insurers In every states, there are many insurers with policies in force. In 1999, the Aaverage@ state had 43 insurers with group policies in force and 147 insurers with individual policies in force (see Table 11). In both markets, many insurers appeared to be writing coverage in the state only because they were licensed there and were renewing coverage for a single policyholder who had moved there. The ability of insurers to survive in the Medigap market while writing very few lives in many of the states in which they maintain policies allows for considerable variation among states in the number of 22 Hawaii, Idaho, Missouri, New Hampshire, New Jersey, New Mexico and Virginia. 11

13 insurers per covered lives. 23 For example, Hawaii C with just over 3,000 covered lives in its Medigap market C had 82 insurers with individual policies in force and 40 insurers with group policies in force. In the individual market, Hawaii had more than twice the rate of insurers as Alaska and six times the average across all states. 2. Number of Active Insurers The NAIC reporting form asks insurers to identify how many of the policies they have in force were newly issued during the three years ending with the reporting year. Table 12 identifies in each state the number of insurers that were active between 1997 and These insurers are a subset of insurers with open products. Averaged across the states, fewer than half of insurers in either the group market (45 percent) or the individual market (49 percent) in 1999 reported having sold a new policy since The proportion of Medigap insurers that were active varied widely among states. In the group market, the percent of insurers that were active ranged from just 20 percent in Massachusetts and the District of Columbia, to more than 60 percent in Mississippi, Nebraska and South Carolina. In the individual market, the percent of insurers that were active ranged from 27 percent in New Jersey and Massachusetts to 68 percent in Rhode Island. In general, states with more insurers overall had a lower percentage of insurers actively marketing policies, especially in the group market. 24 The following two sections focus specifically on the structure of insurers in the individual market, which covers 7 in 10 Medigap policyholders nationwide. We consider the number of insurers with open products across policy forms nationally and by state, as well as the number of insurers that offer guaranteed issue products or accept disabled Medicare beneficiaries. 3. Insurers with Open Products in the Individual Market In 1996, most insurers ran open products, and most policy forms were available in every state (if not in every locale within the state). Averaged across policy forms and states, 86 percent of insurers ran 23 The statistical correlation between the number of insurers writing coverage and the number of covered lives is only moderate in the group Medigap market (0.32), but stronger in the larger individual market (0.51). 24 The statistical correlation between the proportion of insurers that actively sold coverage and the number of insurers with policies in force was negative in both the group market (-0.49) and in the individual market (-0.07). The lower likelihood that group insurers would actively market in states may indicate a greater reluctance among group insurers to market actively in states where they have only a very small base of business. 12

14 open products in 1999 (see Table 13), although many of these insurers were not actively marketing. The two most popular policy forms nationally C respectively, F and C C also corresponded to the greatest number of insurers with open products. However, insurers writing these policy forms were about as likely to be running open products as insurers writing other policy forms. Among the states, the percent of insurers with open products, averaged across policy forms, varied from a high of more than 25 insurers in Florida, Illinois, Ohio, Oregon and Texas, to fewer than 5 insurers in Hawaii and New York. Adjusted for covered lives, the greatest number of insurers with open products (again averaged across policy forms) were in Alaska, Hawaii, Rhode Island and the District of Columbia. The fewest insurers with open products relative to the number of covered lives were (among states with standard policy forms) in New York and Pennsylvania. 4. Insurers with Guaranteed-Issue Products in the Individual Market Only about 17 percent of the insurers that ran open products in the individual market in 1999 offered any products guaranteed-issue. As many as a third of insurers selling policy forms H, E and J offered guaranteed-issue products a higher rate than in any of the other standard policy forms (see Table 14). However, few Medigap policyholders were enrolled in H, E, and J policies in The percentage of insurers that offered any products guaranteed-issue varied markedly by state, generally reflecting the state-to-state differences in guaranteed-issue enrollment that were noted earlier. In New York, more than 80 percent of insurers (averaged across policy forms) offered at least some policy forms guaranteed issue (see Table 15). In Minnesota, 61 percent offered at least some policy forms guaranteed issue. However, in all other states, fewer than half of insurers offered guaranteed-issue products; and in 30 states, fewer than 20 percent offered guaranteed-issue products. In Nebraska and South Dakota, just 1 or 2 insurers (fewer than 12 percent) offered any policy form guaranteed issue. Not surprisingly, the number of insurers with guaranteed-issue products, averaged across policy forms, was greatest in states with larger numbers of insurers (and population size) overall, although in general lower proportions of insurers offered guaranteed-issue products in those states. 25 In Florida, Texas, 25 The Pearson correlation between the number of individual insurers with guaranteed issue products in the state and the proportion of all insurers offering guaranteed issue in 1999 was

15 Louisiana and Illinois states with many Medigap insurers at least 5 insurers offered guaranteed-issue products in at least one policy form. E. PREMIUMS IN THE INDIVIDUAL MARKET Medigap premiums in the individual market averaged $1,316 per year in 1999, for both open and closed products (see Table 16). Premiums varied markedly between standard and pre-standard policies, across standard policy forms, and from state to state. Among states with standard Medigap products, and averaged across all policy forms, Medigap policyholders in California, Florida and Indiana paid more than $1,600 per year for coverage. Conversely, in New Hampshire, Pennsylvania and Utah, Medigap policyholders paid less than $900 per year. In Montana, policyholders paid an average annual premium of just $244 in Obviously, some of the difference in average premiums across states relates to differences in the policy forms that policyholders select (for example, F and C policies are quite inexpensive in Montana). In turn, differences among states in the average price of a policy form may relate to demographic differences in the covered populations such as average age that are not observable in the data reported by insurers. However, average premium differences may also relate to a failure of competition to control local Medigap prices, as has been noted elsewhere. 26 For policy form A (the basic benefit), average annual premiums varied as much as threefold from state to state. Average premiums for A policies in Montana, New Hampshire, and Idaho were less than $350 per year. But in Alabama, California, Florida, Louisiana, Missouri, Texas and the District of Columbia, average premiums for A policies were more than $1,000 per year. Average premiums for standard policy forms that cover prescription drugs C H, I or J C typically ranged higher than $1,000 per year, nationally about 35 percent higher than the average premium for standard coverage that did not pay for prescription drugs. In sixteen states, 27 policyholders on average paid 26 Weiss Ratings, Inc. (1999) reported standard rates for plan A for a man at age 65 in Bakersfield, CA that varied from $496 (quoted by Labor Union Life) to $1,220 (quoted by Bankers Life and Casualty Company). In Billings, MT rate quotes for a J plan (again for a man at age 65) included $1,518 (Blue Cross Blue Shield of MT) and $3,453 (National States Insurance Company). 27 Alabama, Arkansas, Arizona, California, Florida, Georgia, Iowa, Illinois, Louisiana, Missouri, Mississippi, New York, Ohio, Pennsylvania, South Dakota, and Tennessee. 14

16 at least $2,000 per year for a standard policy that covers prescription drug, and (in Arizona and South Carolina) as much as $3,600 for the more extensive standard (J) drug coverage. Finally, the difference between average premiums in pre-standard and standard policies undoubtedly contributes to pre-standard policyholders apparent reluctance to move into standard policy forms, even if they were able to pass insurers underwriting screens. In all but three states (Connecticut, Maryland and New York), pre-standard premiums were less than premiums for standard products, averaged across all standard policy forms. In three states C Indiana, North Carolina and New Hampshire C average standard premiums were at least $1,000 per year higher than average standard premiums in However, in most states (all but fifteen), the average premium for pre-standard Medigap policies exceeded the average premium for standard coverage that included prescription drugs in New Hampshire, by more than $1,300. Higher average prices for pre-standard coverage (which probably offer less, if any, coverage for prescription drugs than the standard H, I, or J coverage) may reflect underwriting barriers that prevent pre-standard policyholders from moving to standard coverage. However, higher pre-standard prices probably also reflect the older average age of policyholders in pre-standard plans. F. CHANGES IN ENROLLMENT AND PREMIUMS FOR MEDIGAP POLICIES The standard report that insurers file with each state provides information about Medigap policies in force that were first issued in the last three years and, separately, about policies in force first issued in any prior year. The information presented in this section is based on tabulations of that information distinguishing old from more recent business in 1999, and also on a comparison of 1999 policies in force with comparable information reported in Together, these tabulations offer a picture of how the Medigap market changed between 1997 and However, because the insurer reports that underlie the NAIC data are unaudited, changes measured across years should be regarded as suggestive, not definitive. The following sections present information about new issue in the group and individual Medigap markets; the net change in covered lives in the larger, individual segment of the market; and the change in average premiums for all Medigap policies between 1997 and

17 1. Group Versus Individual Enrollment While the vast majority of Medigap policyholders are in individual plans, enrollment in group policies accelerated between 1997 and During that period, 40 percent of all newly issued (and subsequently renewed) policies were group policies, compared to just 14 percent of policies that were issued before 1997 (see Table 17). As a result, 70 percent of group policies in force in 1999 were recently issued, compared to just 37 percent of individual Medigap policies. Nevertheless, insurers continued to issue approximately three individual policies for every two group policies that they issued. Various factors may drive new issue in either the individual or group market: enrollees may change plans or carriers within the individual or group market, they may move between markets, and new Medicare beneficiaries may enter either market. Thus, a number of factors may favor new issue in the group market relative to new issue in the individual market. For example, new Medicare beneficiaries may have preferred enrollment in group plans, driving up recent issue in the group market faster than in the individual market. But Medicare beneficiaries in the individual market also may be more cautious than group plan administrators, and therefore less likely to change Medigap policies after age 65. Finally, insurers may be more fearful of adverse selection in the individual market and, therefore, more likely to entry-age rate individual policies. In general, entry-age rating deters policyholders from changing plans either within the individual market or by moving into the group market. 2. Individual Enrollment in Alternative Policy Forms Despite significant rates of new issue in the individual market, reported enrollment in individual policies declined markedly between 1997 and 1999, both in standard and pre-standard policy forms (see Table 18). In 1999, insurers reported 22 percent fewer covered lives in individual policies than in 1997, including a drop of nearly 30 percent in covered lives in pre-standard policy forms. The larger decline in pre-standard covered lives is consistent with the older ages of pre-standard policyholders; in 1999, all prestandard policyholders were at least age 72. Net enrollment in the most popular standard policy form (F) increased 6.5 percent between 1997 and However, net enrollment in two other relatively popular policy forms (C and B) declined substantially (respectively, 22 percent and 35 percent). In standard plans that cover prescription drugs, net enrollment declined 60 percent driven largely by an 83-percent decline in enrollment in policy form H. At least some of the decline in individual H enrollment might be attributable to the acceleration of 16

18 Medicare+Choice enrollment in many markets. A rising majority of Medicare+Choice plans offered prescription drug coverage during that period, most with zero premium Premiums for Individual Medigap Policies Between 1997 and 1999, average premiums increased for every policy form (see Table 18). Averaged nationwide, the changes were modest varying between a half-percent (for G policies) and 3 percent (for H policies) nationwide. Average premiums for F policies increased just 1 percent. However, these modest averages hide much larger changes in average premiums at the state level. Viewed state by state, the median change in average premiums for F policies between 1997 and 1999 was more than 14 percent; for H policies, the median change in average premiums was 15 percent. Ironically, the fastest growth was for the narrowest coverage, which presumably appeals to the lowest-income Medicare beneficiaries: the median increase in premiums for A or B coverage was 20 percent and 23 percent, respectively. G. SUMMARY AND IMPLICATIONS FOR MEDICARE Little information has been available about the details of coverage in the Medigap market. Indeed, the only source of detailed information about this market comes from insurer reports, and historically these reports have not been analyzed to provide a picture of this market. This paper uses those reports for 1999 and 1997 to compile a picture of coverage in the Medigap market and a sense of how this market is changing. These data document various major features of the Medigap market: Pre-standard Medigap policies account for a significant share of the Medigap market: in 1999, one-third of all Medigap policies in force were pre-standard. The most popular standard policy forms continue to be F, followed by C and B. Combined enrollment in these standard policy forms accounted for 48 percent of all Medigap enrollment in Gold, M. (July/August 201). Medicare+Choice: An Interim Report Card. Health Affairs 20(4):

19 Very few Medicare beneficiaries are enrolled in standard policy forms that cover prescription drugs (H, I or J). In 1999, fewer than 6 percent of Medigap policyholders were enrolled in these policy forms. By inference, only 6 percent of all Medigap purchasers since 1992 selected and retained a policy that covered prescription drugs. Most Medigap policyholders buy coverage in the individual market, not through associations. In 1999, individual policyholders accounted for 75 percent of all Medigap policyholders. Many Medigap policyholders are in closed products that are not enrolling new members. In 1999, 32 percent of standard policyholders nationwide were in closed policy forms. In 12 states, more than half of standard policyholders were in closed products. A high proportions of enrollment in closed products may indicate problems of access to Medigap coverage and a narrowing of choice among insurers and policy forms. Nationwide, guaranteed-issue Medigap policies are rare. In 1999, just 12 percent of all Medigap policyholders were enrolled in guaranteed issue standard products. Medigap products that accept disabled beneficiaries are rarer still, accounting for just 11 percent of Medigap enrollment in In every state, many insurers offered Medigap coverage, but many covered just a few policyholders. Moreover, even among insurers with significant business, many ran only closed products or were inactive reporting no new issues in the last several years. In 1999, fewer than half of all Medigap insurers ran open products and were active. Only 17 percent of insurers that ran open Medigap products in 1999 offered any product guaranteed issue to Medicare beneficiaries older than age 65. Among insurers running open F products, only 10 percent offered it guaranteed-issue. Insurers that ran guaranteed-issue H products were relatively common among those with open products (38 percent), suggesting an effort by state regulators to maintain access to minimal drug coverage in the Medigap market. Average premiums in the individual Medigap market in 1999 were high: $1,316 nationwide. Moreover, average premiums overall and within policy forms varied substantially from state to state; for policy form A, as much as three-fold. Average premiums for policy forms that covered prescription drugs typically ranged above $1,000 per year, and in 16 states exceeded $2,000 per year. Nationally, these policies were priced about 35 percent higher than standard policy forms that did not cover prescription drugs. 18

20 It appears that the Medigap market is changing rapidly. Between 1997 and 1999, the rate at which new issue of group policies were issued greatly exceeded that of individual policies although most new issues were individual policies. Insurers also reported many fewer covered lives in the individual market in Individual enrollment in standard policies that cover prescription drugs dropped most precipitously (60 percent), driven largely by declining enrollment in H plans. This trend may relate to rising Medigap+Choice enrollment during those years. Average premiums for individual Medigap coverage appear to be volatile. Averaged across all states, the growth in average premiums in every policy form was modest ranging from less than one percent to about 3 percent, depending on the policy form. However, viewed at the state level, premium changes were much more dramatic: median premium changes ranged from less than 1 percent (in policy form J, where enrollment typically is very low) to more than 23 percent in policy form B. The median increase in average pre-standard premiums was nearly 16 percent. While the Medigap market is very complex and different for policyholders in different states and even different communities within states, several general lessons for policymakers concerned about this market and its relationship to Medicare seem apparent. First, the rules that govern the Medigap market appear virtually to eliminate competition, especially for Medigap policyholders after age 65 but also even at age 65 when all open products are guaranteed issue. As a result, competitive patterns of price and coverage often fail to emerge. In short, it appears that many consumers pay high prices for standard coverage when lower prices are available to them or to others. If Medigap coverage represented only a marginal supplement to ample Medicare benefits, failure of competition in this market might be overlooked. However, Medigap policyholders pay significant premiums for coverage and, where Medicare+Choice plans are unavailable to them, have no other option for achieving the overall insurance protection that is widely available to the nonelderly population in either employer-based or individual plans. Thus failure of competition in the Medigap market would seem to merit far more consideration by policymakers than it has received. Second, the very low take-up of standard Medigap coverage that covers prescription drugs is problematic. Among all Medicare beneficiaries who purchased and renewed Medigap coverage between 1992 and 1999, fewer than 6 percent bought a Medigap policy that covered prescription drugs. If most pre-standard Medigap policies provide some coverage for prescription drugs (as would be inferred from population survey data), then 4 of every five Medigap policyholders with prescription drug coverage in 1999 were in pre-standard policies. Because all pre-standard policyholders are now over age 74, this 19

Medigap Coverage for Prescription Drugs. Statement of Deborah J. Chollet, Senior Fellow Mathematica Policy Research, Inc.

Medigap Coverage for Prescription Drugs. Statement of Deborah J. Chollet, Senior Fellow Mathematica Policy Research, Inc. Medigap Coverage for Prescription Drugs Statement of Deborah J. Chollet, Senior Fellow Mathematica Policy Research, Inc. Washington, DC Testimony before the U.S. Senate Committee on Finance Finding the

More information

High Risk Health Pools and Plans by State

High Risk Health Pools and Plans by State High Risk Health Pools and Plans by State State Program Contact Alabama Alabama Health 1-866-833-3375 Insurance Plan 1-334-263-8311 http://www.alseib.org/healthinsurance/ahip/ Alaska Alaska Comprehensive

More information

Public School Teacher Experience Distribution. Public School Teacher Experience Distribution

Public School Teacher Experience Distribution. Public School Teacher Experience Distribution Public School Teacher Experience Distribution Lower Quartile Median Upper Quartile Mode Alabama Percent of Teachers FY Public School Teacher Experience Distribution Lower Quartile Median Upper Quartile

More information

STATE-SPECIFIC ANNUITY SUITABILITY REQUIREMENTS

STATE-SPECIFIC ANNUITY SUITABILITY REQUIREMENTS Alabama Alaska Arizona Arkansas California This jurisdiction has pending annuity training legislation/regulation Annuity Training Requirement Currently Effective Initial 8-Hour Annuity Training Requirement:

More information

Impacts of Sequestration on the States

Impacts of Sequestration on the States Impacts of Sequestration on the States Alabama Alabama will lose about $230,000 in Justice Assistance Grants that support law STOP Violence Against Women Program: Alabama could lose up to $102,000 in funds

More information

Three-Year Moving Averages by States % Home Internet Access

Three-Year Moving Averages by States % Home Internet Access Three-Year Moving Averages by States % Home Internet Access Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana

More information

State Specific Annuity Suitability Requirements updated 10/10/11

State Specific Annuity Suitability Requirements updated 10/10/11 Alabama Alaska Ai Arizona Arkansas California This jurisdiction has pending annuity training legislation/regulation Initial 8 Hour Annuity Training Requirement: Prior to selling annuities in California,

More information

NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST

NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST ** Utilize this list to determine whether or not a non-resident applicant may waive the Oklahoma examination or become licensed

More information

GAO MEDIGAP INSURANCE. Plans Are Widely Available but Have Limited Benefits and May Have High Costs. Report to Congressional Committees

GAO MEDIGAP INSURANCE. Plans Are Widely Available but Have Limited Benefits and May Have High Costs. Report to Congressional Committees GAO United States General Accounting Office Report to Congressional Committees July 2001 MEDIGAP INSURANCE Plans Are Widely Available but Have Limited Benefits and May Have High Costs GAO-01-941 Contents

More information

STATE DATA CENTER. District of Columbia MONTHLY BRIEF

STATE DATA CENTER. District of Columbia MONTHLY BRIEF District of Columbia STATE DATA CENTER MONTHLY BRIEF N o v e m b e r 2 0 1 2 District Residents Health Insurance Coverage 2000-2010 By Minwuyelet Azimeraw Joy Phillips, Ph.D. This report is based on data

More information

Workers Compensation State Guidelines & Availability

Workers Compensation State Guidelines & Availability ALABAMA Alabama State Specific Release Form Control\Release Forms_pdf\Alabama 1-2 Weeks ALASKA ARIZONA Arizona State Specific Release Form Control\Release Forms_pdf\Arizona 7-8 Weeks by mail By Mail ARKANSAS

More information

Model Regulation Service January 2006 DISCLOSURE FOR SMALL FACE AMOUNT LIFE INSURANCE POLICIES MODEL ACT

Model Regulation Service January 2006 DISCLOSURE FOR SMALL FACE AMOUNT LIFE INSURANCE POLICIES MODEL ACT Table of Contents Section 1. Section 2. Section 3. Section 4. Section 5. Section 6. Section 1. Model Regulation Service January 2006 Purpose Definition Exemptions Disclosure Requirements Insurer Duties

More information

BUSINESS DEVELOPMENT OUTCOMES

BUSINESS DEVELOPMENT OUTCOMES BUSINESS DEVELOPMENT OUTCOMES Small Business Ownership Description Total number of employer firms and self-employment in the state per 100 people in the labor force, 2003. Explanation Business ownership

More information

Changes in the Cost of Medicare Prescription Drug Plans, 2007-2008

Changes in the Cost of Medicare Prescription Drug Plans, 2007-2008 Issue Brief November 2007 Changes in the Cost of Medicare Prescription Drug Plans, 2007-2008 BY JOSHUA LANIER AND DEAN BAKER* The average premium for Medicare Part D prescription drug plans rose by 24.5

More information

State-Specific Annuity Suitability Requirements

State-Specific Annuity Suitability Requirements Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Effective 10/16/11: Producers holding a life line of authority on or before 10/16/11 who sell or wish to sell

More information

NAIC ANNUITY TRAINING Regulations By State

NAIC ANNUITY TRAINING Regulations By State Select a state below to display the current regulation and requirements, or continue to scroll down. Light grey text signifies states that have not adopted an annuity training program. Alabama Illinois

More information

Licensure Resources by State

Licensure Resources by State Licensure Resources by State Alabama Alabama State Board of Social Work Examiners http://socialwork.alabama.gov/ Alaska Alaska Board of Social Work Examiners http://commerce.state.ak.us/dnn/cbpl/professionallicensing/socialworkexaminers.as

More information

MAINE (Augusta) Maryland (Annapolis) MICHIGAN (Lansing) MINNESOTA (St. Paul) MISSISSIPPI (Jackson) MISSOURI (Jefferson City) MONTANA (Helena)

MAINE (Augusta) Maryland (Annapolis) MICHIGAN (Lansing) MINNESOTA (St. Paul) MISSISSIPPI (Jackson) MISSOURI (Jefferson City) MONTANA (Helena) HAWAII () IDAHO () Illinois () MAINE () Maryland () MASSACHUSETTS () NEBRASKA () NEVADA (Carson ) NEW HAMPSHIRE () OHIO () OKLAHOMA ( ) OREGON () TEXAS () UTAH ( ) VERMONT () ALABAMA () COLORADO () INDIANA

More information

Chex Systems, Inc. does not currently charge a fee to place, lift or remove a freeze; however, we reserve the right to apply the following fees:

Chex Systems, Inc. does not currently charge a fee to place, lift or remove a freeze; however, we reserve the right to apply the following fees: Chex Systems, Inc. does not currently charge a fee to place, lift or remove a freeze; however, we reserve the right to apply the following fees: Security Freeze Table AA, AP and AE Military addresses*

More information

Age and Health Insurance: Pricing Out the Decades of Adult Life Looking at the difference in health insurance premiums between ages 20 and 60.

Age and Health Insurance: Pricing Out the Decades of Adult Life Looking at the difference in health insurance premiums between ages 20 and 60. Age and Health Insurance: Pricing Out the Decades of Adult Life Looking at the difference in health insurance premiums between ages 20 and 60. Contents 2 3 3 4 4 5 6 7 7 8 9 10 11 12 13 14 Table of Contents

More information

January 2011 Census Shows 11.4 Million People Covered by Health Savings Account/High-Deductible Health Plans (HSA/HDHPs)

January 2011 Census Shows 11.4 Million People Covered by Health Savings Account/High-Deductible Health Plans (HSA/HDHPs) 2011 Census Shows 11.4 Million People Covered by Health Savings Account/High-Deductible Health Plans (HSA/HDHPs) June 2011 www.ahipresearch.org TABLE OF CONTENTS Summary... 1 Highlights of the 2011 Census

More information

Chapter 3: Promoting Financial Self- Sufficiency

Chapter 3: Promoting Financial Self- Sufficiency Chapter 3: Promoting Financial Self- Sufficiency For most people, financial self-sufficiency is achieved through a combination of employment earnings and savings. Labor markets derived from the products

More information

Facing Cost-Sensitive Shoppers, Health Plan Providers Must Demonstrate Value

Facing Cost-Sensitive Shoppers, Health Plan Providers Must Demonstrate Value w Reports: Health Insurance Marketplace Exchange Enrollment Satisfaction Improves Significantly in Second Year Facing Cost-Sensitive Shoppers, Health Plan Providers Must Demonstrate Value WESTLAKE VILLAGE,

More information

Net-Temps Job Distribution Network

Net-Temps Job Distribution Network Net-Temps Job Distribution Network The Net-Temps Job Distribution Network is a group of 25,000 employment-related websites with a local, regional, national, industry and niche focus. Net-Temps customers'

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...

More information

STATISTICAL BRIEF #273

STATISTICAL BRIEF #273 STATISTICAL BRIEF #273 December 29 Employer-Sponsored Health Insurance for Employees of State and Local Governments, by Census Division, 28 Beth Levin Crimmel, M.S. Introduction Employees of state and

More information

American C.E. Requirements

American C.E. Requirements American C.E. Requirements Alaska Board of Nursing Two of the following: 30 contact hours 30 hours of professional nursing activities 320 hours of nursing employment Arizona State Board of Nursing Arkansas

More information

NAIC Annuity Suitability Requirements by State

NAIC Annuity Suitability Requirements by State NAIC Annuity Suitability Requirements by Specific Alabama Alaska 10/16/2011 TBD Arizona Arkansas If you obtained a life insurance license prior to 10/16/11, you must complete the NAIC course by 4/16/12.

More information

EXECUTIVE OFFICE OF THE PRESIDENT. The Burden of Health Insurance Premium Increases on American Families

EXECUTIVE OFFICE OF THE PRESIDENT. The Burden of Health Insurance Premium Increases on American Families EXECUTIVE OFFICE OF THE PRESIDENT The Burden of Health Insurance Premium Increases on American Families SEPTEMBER 22, 2009 Health insurance premiums for American families continue to skyrocket. A report

More information

Small Group Health Insurance in 2008

Small Group Health Insurance in 2008 Small Group Health Insurance in 2008 March 2009 A Comprehensive Survey of Premiums, Product Choices, and Benefits CONTENTS Summary...2 I. Introduction: The Small Group Market in Context...4 II. Premiums

More information

Real Progress in Food Code Adoption

Real Progress in Food Code Adoption Real Progress in Food Code Adoption The Association of Food and Drug Officials (AFDO), under contract to the Food and Drug Administration, is gathering data on the progress of FDA Food Code adoptions by

More information

Sources of Health Insurance Coverage in Georgia 2007-2008

Sources of Health Insurance Coverage in Georgia 2007-2008 Sources of Health Insurance Coverage in Georgia 2007-2008 Tabulations of the March 2008 Annual Social and Economic Supplement to the Current Population Survey and The 2008 Georgia Population Survey William

More information

With Medicare+Choice plan withdrawals

With Medicare+Choice plan withdrawals MONITORING MEDICARE+CHOICE OPERATIONALInsights October 2003, Number 11 The Medigap Market: Product and Pricing Trends, 1999-2001 With Medicare+Choice plan withdrawals and reductions in employersponsored

More information

Englishinusa.com Positions in MSN under different search terms.

Englishinusa.com Positions in MSN under different search terms. Englishinusa.com Positions in MSN under different search terms. Search Term Position 1 Accent Reduction Programs in USA 1 2 American English for Business Students 1 3 American English for Graduate Students

More information

NAIC Annuity Suitability Requirements by State

NAIC Annuity Suitability Requirements by State NAIC Annuity Suitability Requirements by Specific Alabama Alaska 10/16/2011 TBD Arizona Arkansas If you obtained a life insurance license prior to 10/16/11, you must complete the NAIC course by 4/16/12.

More information

NOTICE OF PROTECTION PROVIDED BY [STATE] LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION

NOTICE OF PROTECTION PROVIDED BY [STATE] LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION NOTICE OF PROTECTION PROVIDED BY This notice provides a brief summary of the [STATE] Life and Health Insurance Guaranty Association (the Association) and the protection it provides for policyholders. This

More information

How To Vote For The American Health Insurance Program

How To Vote For The American Health Insurance Program ACEP HEALTH INSURANCE POLL RESEARCH RESULTS Prepared For: American College of Emergency Physicians September 2015 2015 Marketing General Incorporated 625 rth Washington Street, Suite 450 Alexandria, VA

More information

Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant

Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Issue Summary The term dual eligible refers to the almost 7.5 milion low-income older individuals or younger persons with disabilities

More information

Data show key role for community colleges in 4-year

Data show key role for community colleges in 4-year Page 1 of 7 (https://www.insidehighered.com) Data show key role for community colleges in 4-year degree production Submitted by Doug Lederman on September 10, 2012-3:00am The notion that community colleges

More information

Medicare Advantage Plan Landscape Data Summary

Medicare Advantage Plan Landscape Data Summary 2013 Medicare Advantage Plan Landscape Data Summary Table of Contents Report Overview...3 Medicare Advantage Costs and Benefits...4 The Maximum Out of Pocket (MOOP) Benefit How It Works...4 The Prescription

More information

Understanding the Affordable Care Act

Understanding the Affordable Care Act Understanding the Affordable Care Act The Affordable Care Act (officially called the Patient Protection and Affordable Care Act) is the law that mandates that everyone in the United States maintain health

More information

Workers Compensation Cost Data

Workers Compensation Cost Data Workers Compensation Cost Data Edward M. Welch Workers Compensation Center School of Labor and Industrial Relations Michigan State University E-mail: welche@msu.edu Web Page: http://www.lir.msu.edu/wcc/

More information

How To Regulate Rate Regulation

How To Regulate Rate Regulation Rate Regulation Introduction Concerns over the fairness and equity of insurer rating practices that attempt to charge higher premiums to those with higher actual and expected claims costs have increased

More information

Zurich Term Death Benefit Protection With Options

Zurich Term Death Benefit Protection With Options Zurich Term Death Benefit Protection With Options Offered by Zurich American Life Insurance Company Zurich Term life insurance provides death benefit protection plus a contractual right to convert to any

More information

Model Regulation Service July 2005 LIFE INSURANCE MULTIPLE POLICY MODEL REGULATION

Model Regulation Service July 2005 LIFE INSURANCE MULTIPLE POLICY MODEL REGULATION Table of Contents Section 1. Section 2. Section 3. Section 4. Section 5. Section 6. Section 1. Model Regulation Service July 2005 Purpose Authority Exemptions Duties of Insurers Severability Effective

More information

********************

******************** THE SURETY & FIDELITY ASSOCIATION OF AMERICA 1101 Connecticut Avenue, N.W., Suite 800 Washington, D. C. 20036 Phone: (202) 463-0600 Fax: (202) 463-0606 Web page: www.surety.org APPLICATION Application

More information

What to Know About State CPA Reciprocity Rules. John Gillett, PhD, CPA Chair, Department of Accounting Bradley University, Peoria, IL

What to Know About State CPA Reciprocity Rules. John Gillett, PhD, CPA Chair, Department of Accounting Bradley University, Peoria, IL What to Know About State CPA Reciprocity Rules Paul Swanson, MBA, CPA Instructor of Accounting John Gillett, PhD, CPA Chair, Department of Accounting Kevin Berry, PhD, Assistant Professor of Accounting

More information

Module: 3 Medigap (Medicare Supplement Insurance)

Module: 3 Medigap (Medicare Supplement Insurance) Module: 3 Medigap (Medicare Supplement Insurance) Inside front cover. Module 3: Medigap (Medicare Supplement Insurance) Policies Contents Contents Introduction... 1 Session Objectives... 2 Lesson 1: What

More information

State Tax Information

State Tax Information State Tax Information The information contained in this document is not intended or written as specific legal or tax advice and may not be relied on for purposes of avoiding any state tax penalties. Neither

More information

A/B MAC Jurisdiction 1 Original Medicare Claims Processor

A/B MAC Jurisdiction 1 Original Medicare Claims Processor A/B MAC Jurisdiction 1 Jurisdiction 1 - American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands Total Number of Fee-For-Service Beneficiaries: 3,141,183 (as of Total Number of Beneficiaries

More information

ADDENDUM TO THE HEALTH INSURANCE MARKETPLACE SUMMARY ENROLLMENT REPORT FOR THE INITIAL ANNUAL OPEN ENROLLMENT PERIOD

ADDENDUM TO THE HEALTH INSURANCE MARKETPLACE SUMMARY ENROLLMENT REPORT FOR THE INITIAL ANNUAL OPEN ENROLLMENT PERIOD ASPE Issue BRIEF ADDENDUM TO THE HEALTH INSURANCE MARKETPLACE SUMMARY ENROLLMENT REPORT FOR THE INITIAL ANNUAL OPEN ENROLLMENT PERIOD For the period: October 1, 2013 March 31, 2014 (Including Additional

More information

State Pest Control/Pesticide Application Laws & Regulations. As Compiled by NPMA, as of December 2011

State Pest Control/Pesticide Application Laws & Regulations. As Compiled by NPMA, as of December 2011 State Pest Control/Pesticide Application Laws & As Compiled by NPMA, as of December 2011 Alabama http://alabamaadministrativecode.state.al.us/docs/agr/mcword10agr9.pdf Alabama Pest Control Alaska http://dec.alaska.gov/commish/regulations/pdfs/18%20aac%2090.pdf

More information

Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013

Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013 Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013 The Centers for Medicare and Medicaid Services (CMS) recently announced proposed rules that would cut payments

More information

Attachment A. Program approval is aligned to NCATE and is outcomes/performance based

Attachment A. Program approval is aligned to NCATE and is outcomes/performance based Attachment A The following table provides information on student teaching requirements across several states. There are several models for these requirements; minimum number of weeks, number of required

More information

STATISTICAL BRIEF #435

STATISTICAL BRIEF #435 STATISTICAL BRIEF #435 April 2014 Premiums and Employee Contributions for Employer-Sponsored Health Insurance: Private versus Public Sector, 2012 Karen E. Davis, MA Introduction Employer-sponsored health

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide

Exploring the Impact of the RAC Program on Hospitals Nationwide Exploring the Impact of the RAC Program on Hospitals Nationwide Overview of AHA RACTrac Survey Results, 4 th Quarter 2010 For complete report go to: http://www.aha.org/aha/issues/rac/ractrac.html Agenda

More information

(In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES FECA LHWCA

(In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES FECA LHWCA (In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES Full Medical Benefits** Alabama Indiana Nebraska South Carolina Alaska Iowa Nevada South Dakota

More information

2014 National Training Program. Wo r k b o o k. Module: 3 Medigap (Medicare Supplement Insurance)

2014 National Training Program. Wo r k b o o k. Module: 3 Medigap (Medicare Supplement Insurance) 2014 National Training Program Wo r k b o o k Module: 3 Medigap (Medicare Supplement Insurance) Module Description Centers for Medicare & Medicaid Services National Training Program Instructor Information

More information

List of State Residual Insurance Market Entities and State Workers Compensation Funds

List of State Residual Insurance Market Entities and State Workers Compensation Funds List of State Residual Insurance Market Entities and State Workers Compensation Funds On November 26, 2002, President Bush signed into law the Terrorism Risk Insurance Act of 2002 (Public Law 107-297,

More information

LPSC Renewable Energy Pilot y RFPs issued by Utility Companies by Order of Commission, November 2010

LPSC Renewable Energy Pilot y RFPs issued by Utility Companies by Order of Commission, November 2010 Renewable Energy LPSC Renewable Energy Pilot y RFPs issued by Utility Companies by Order of Commission, November 2010 y Searching for various forms of renewable energy and their actual cost in Louisiana

More information

State Individual Income Taxes: Treatment of Select Itemized Deductions, 2006

State Individual Income Taxes: Treatment of Select Itemized Deductions, 2006 State Individual Income Taxes: Treatment of Select Itemized Deductions, 2006 State Federal Income Tax State General Sales Tax State Personal Property Tax Interest Expenses Medical Expenses Charitable Contributions

More information

JOINT ECONOMIC COMMITTEE DEMOCRATS

JOINT ECONOMIC COMMITTEE DEMOCRATS JOINT ECONOMIC COMMITTEE DEMOCRATS SENATOR JACK REED (D-RI) RANKING DEMOCRAT ECONOMIC POLICY BRIEF SEPTEMBER 2005 THE NUMBER OFAMERICANS WITHOUT HEALTH INSURANCE GREW BY 860,000 IN 2004, INCREASING FOR

More information

Module 3 Medigap (Medicare Supplement Insurance)

Module 3 Medigap (Medicare Supplement Insurance) Module 3 Medigap (Medicare Supplement Insurance) Section Objectives Explain what Medigap policies are Understand key Medigap terms Relate steps needed to buy a Medigap policy Define the best time to buy

More information

States Ranked by Alcohol Tax Rates: Beer (as of March 2009) Ranking State Beer Tax (per gallon)

States Ranked by Alcohol Tax Rates: Beer (as of March 2009) Ranking State Beer Tax (per gallon) States Ranked by Alcohol Tax Rates: Beer (as of March 2009) Ranking State Beer Tax (per gallon) Sales Tax Applied 1 Wyoming $0.02 4% 2 4 8 10 Missouri $0.06 4.225% Wisconsin $0.06 5% Colorado $0.08 2.9%

More information

california Health Care Almanac Health Care Costs 101: California Addendum

california Health Care Almanac Health Care Costs 101: California Addendum california Health Care Almanac : California Addendum May 2012 Introduction Health spending represents a significant share of California s economy, but the amounts spent on health care rank among the lowest

More information

Medicare Hospice Benefits

Medicare Hospice Benefits Large Print Edition Medicare Hospice Benefits a special way of caring for people who have a terminal illness This booklet explains... The hospice program and who is eligible. Your Medicare hospice benefits.

More information

Real Progress in Food Code Adoption

Real Progress in Food Code Adoption Real Progress in Food Code Adoption August 27, 2013 The Association of Food and Drug Officials (AFDO), under contract to the Food and Drug Administration, is gathering data on the progress of FDA Food

More information

Low-Profit Limited Liability Company (L3C) Date: July 29, 2013. [Low-Profit Limited Liability Company (L3C)] [July 29, 2013]

Low-Profit Limited Liability Company (L3C) Date: July 29, 2013. [Low-Profit Limited Liability Company (L3C)] [July 29, 2013] Topic: Question by: : Low-Profit Limited Liability Company (L3C) Kevin Rayburn, Esq., MBA Tennessee Date: July 29, 2013 Manitoba Corporations Canada Alabama Alaska Arizona Arkansas California Colorado

More information

Child Only Health Insurance

Child Only Health Insurance United States Senate Committee on Health, Education, Labor and Pensions Michael B. Enzi, Ranking Member RANKING MEMBER REPORT: Health Care Reform Law s Impact on Child-Only y Health Insurance Policies

More information

We do require the name and mailing address of each person forming the LLC.

We do require the name and mailing address of each person forming the LLC. Topic: LLC Managers/Members Question by: Jeff Harvey : Idaho Date: March 7, 2012 Manitoba Corporations Canada Alabama Alaska Arizona Arkansas California Colorado Arizona requires that member-managed LLCs

More information

January 2012 Census Shows 13.5 Million People Covered by Health Savings Account/ High-Deductible Health Plans (HSA/HDHPs)

January 2012 Census Shows 13.5 Million People Covered by Health Savings Account/ High-Deductible Health Plans (HSA/HDHPs) January 2012 Census Shows 13.5 Million People Covered by Health Savings Account/ High-Deductible Health Plans (HSA/HDHPs) May 2012 SUMMARY An annual census by America s Health Insurance Plans (AHIP) of

More information

Primer: The Small Business Health Options Program (SHOP) Angela Boothe October 21, 2014

Primer: The Small Business Health Options Program (SHOP) Angela Boothe October 21, 2014 Primer: The Small Business Health Options Program (SHOP) Angela Boothe October 21, 2014 Introduction On November 15th, 2014 healthcare.gov established by the Affordable Care Act (ACA) will launch an online

More information

Overview of School Choice Policies

Overview of School Choice Policies Overview of School Choice Policies Tonette Salazar, Director of State Relations Micah Wixom, Policy Analyst CSG West Education Committee July 29, 2015 Who we are The essential, indispensable member of

More information

Hawai i s Workers Compensation System; Coverage, Benefits, Costs: 1994-2004

Hawai i s Workers Compensation System; Coverage, Benefits, Costs: 1994-2004 Hawai i s Workers Compensation System; Coverage, Benefits, Costs: 1994-2004 Lawrence W. Boyd Ph. D. University of Hawaii-West Oahu Center for Labor Education and Research January 12, 2006 1 Introduction

More information

How To Pay Medical Only Claims On Workers Compensation Claims

How To Pay Medical Only Claims On Workers Compensation Claims Workers Compensation Small Medical-Only Claims: Should an employer pay them or turn them in to the insurance company? by Maureen Gallagher The most common question an insurance agent gets from employers

More information

SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS. The Board of Governors of the Federal Reserve System (Board), the Federal Deposit

SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS. The Board of Governors of the Federal Reserve System (Board), the Federal Deposit SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS The Board of Governors of the Federal Reserve System (Board), the Federal Deposit Insurance Corporation (FDIC), and the Office of the Comptroller of the Currency

More information

Q1 2009 Homeowner Confidence Survey. May 14, 2009

Q1 2009 Homeowner Confidence Survey. May 14, 2009 Q1 2009 Homeowner Confidence Survey Results May 14, 2009 The Zillow Homeowner Confidence Survey is fielded quarterly to determine the confidence level of American homeowners when it comes to the value

More information

State Insurance Department Websites: A Consumer Assessment

State Insurance Department Websites: A Consumer Assessment State Insurance Department Websites: A Consumer Assessment By J. Robert Hunter Director of Insurance November 2008 1 of 10 EXECUTIVE SUMMARY This report analyzes Internet websites for the nation s 51 major

More information

Supplier Business Continuity Survey - Update Page 1

Supplier Business Continuity Survey - Update Page 1 Supplier Business Continuity Survey - Update Page 1 Supplier Business Continuity Survey A response is required for every question General Information Supplier Name: JCI Supplier Number: Supplier Facility

More information

2015 National Training Program. Wo r k b o o k. Module: 3 Medigap (Medicare Supplement Insurance) Policies

2015 National Training Program. Wo r k b o o k. Module: 3 Medigap (Medicare Supplement Insurance) Policies 2015 National Training Program Wo r k b o o k Module: 3 Medigap (Medicare Supplement Insurance) Policies Module Description Centers for Medicare & Medicaid Services (CMS) National Training Program (NTP)

More information

Census Data on Uninsured Women and Children September 2009

Census Data on Uninsured Women and Children September 2009 March of Dimes Foundation Office of Government Affairs 1146 19 th Street, NW, 6 th Floor Washington, DC 20036 Telephone (202) 659-1800 Fax (202) 296-2964 marchofdimes.com nacersano.org Census Data on Uninsured

More information

Your Guide to Medicare Private Fee-for-Service Plans. Heading CENTERS FOR MEDICARE & MEDICAID SERVICES

Your Guide to Medicare Private Fee-for-Service Plans. Heading CENTERS FOR MEDICARE & MEDICAID SERVICES Heading CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Private Fee-for-Service Plans This official government booklet has important information about Medicare Private Fee-for-Service Plans

More information

SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS. or branches outside of its home state primarily for the purpose of deposit production.

SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS. or branches outside of its home state primarily for the purpose of deposit production. SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS The Board of Governors of the Federal Reserve System, the Federal Deposit Insurance Corporation, and the Office of the Comptroller of the Currency (the agencies)

More information

The Obama Administration and Community Health Centers

The Obama Administration and Community Health Centers The Obama Administration and Community Health Centers Community health centers are a critical source of health care for millions of Americans particularly those in underserved communities. Thanks primarily

More information

State Tax Information

State Tax Information State Tax Information The information contained in this document is not intended or written as specific legal or tax advice and may not be relied on for purposes of avoiding any state tax penalties. Neither

More information

Schedule B DS1 & DS3 Service

Schedule B DS1 & DS3 Service Schedule B DS1 & DS3 Service SCHEDULE B Private Line Data Services DS1 & DS3 Service... 2 DS-1 Local Access Channel... 2 DS-1 Local Access Channel, New Jersey... 2 DS-1 Local Access Channel, Out-of-State...

More information

REPORT SPECIAL. States Act to Help People Laid Off from Small Firms: More Needs to Be Done. Highlights as of April 14, 2009

REPORT SPECIAL. States Act to Help People Laid Off from Small Firms: More Needs to Be Done. Highlights as of April 14, 2009 REPORT April 2009 States Act to Help People Laid Off from Small Firms: More Needs to Be Done In the past two months, several states have taken action to make sure state residents who lose their jobs in

More information

A PUBLICATION OF THE NATIONAL COUNCIL FOR ADOPTION. HEALTH INSURANCE FOR ADOPTED CHILDREN by Mark McDermott, J.D. with Elisa Rosman, Ph.D.

A PUBLICATION OF THE NATIONAL COUNCIL FOR ADOPTION. HEALTH INSURANCE FOR ADOPTED CHILDREN by Mark McDermott, J.D. with Elisa Rosman, Ph.D. Adoption Advocate NICOLE FICERE CALLAHAN, EDITOR CHUCK JOHNSON, EDITOR NO. 19 DECEMBER 2009 A PUBLICATION OF THE NATIONAL COUNCIL FOR ADOPTION HEALTH INSURANCE FOR ADOPTED CHILDREN by Mark McDermott, J.D.

More information

MINIMUM CAPITAL & SURPLUS AND STATUTORY DEPOSITS AND WHO THEY PROTECT. By: Ann Monaco Warren, Esq. 573.634.2522

MINIMUM CAPITAL & SURPLUS AND STATUTORY DEPOSITS AND WHO THEY PROTECT. By: Ann Monaco Warren, Esq. 573.634.2522 MINIMUM CAPITAL & SURPLUS AND STATUTORY DEPOSITS AND WHO THEY PROTECT By: Ann Monaco Warren, Esq. 573.634.2522 With the spotlight on the financial integrity and solvency of corporations in the U.S. by

More information

Question for the filing office of Texas, Re: the Texas LLC act. Professor Daniel S. Kleinberger. William Mitchell College of Law, Minnesota

Question for the filing office of Texas, Re: the Texas LLC act. Professor Daniel S. Kleinberger. William Mitchell College of Law, Minnesota Topic: Question by: : Question for the filing office of Texas, Re: the Texas LLC act Professor Daniel S. Kleinberger William Mitchell College of Law, Minnesota Date: March 18, 2012 Manitoba Corporations

More information

State by State Summary of Nurses Allowed to Perform Conservative Sharp Debridement

State by State Summary of Nurses Allowed to Perform Conservative Sharp Debridement State by State Summary of Nurses Allowed to Perform Conservative Sharp Debridement THE FOLLOWING ARE ONLY GENERAL SUMMARIES OF THE PRACTICE ACTS EACH STATE HAS REGARDING CONSERVATIVE SHARP DEBRIDEMENT

More information

Mandated report: Medicare payment for ambulance services. Zach Gaumer, David Glass, and John Richardson September 6, 2012

Mandated report: Medicare payment for ambulance services. Zach Gaumer, David Glass, and John Richardson September 6, 2012 Mandated report: Medicare payment for ambulance services Zach Gaumer, David Glass, and John Richardson September 6, 2012 Mandated report on Medicare payment for ambulance services MedPAC directed to study:

More information

State Tax of Social Security Income. State Tax of Pension Income. State

State Tax of Social Security Income. State Tax of Pension Income. State State Taxation of Retirement Income The following chart shows generally which states tax retirement income, including and pension States shaded indicate they do not tax these forms of retirement State

More information

County - $0.55/$500 - $.75/$500 depending on +/- 2 million population 0.11% - 0.15% Minnesota

County - $0.55/$500 - $.75/$500 depending on +/- 2 million population 0.11% - 0.15% Minnesota 22-Apr-13 State Deed Transfer and Mortgage Tax Rates, 2012 Alabama State Tax Description Transfer Fee Rate Deeds $0.50/$500 0.10% Mortgages $0.15/$100 0.15% Alaska Arizona $2 fee per deed or contract Flat

More information

MEDIGAP: Spotlight on Enrollment, Premiums, and Recent Trends. Jennifer Huang Policy Analyst, Program on Medicare Policy Kaiser Family Foundation

MEDIGAP: Spotlight on Enrollment, Premiums, and Recent Trends. Jennifer Huang Policy Analyst, Program on Medicare Policy Kaiser Family Foundation MEDIGAP: Spotlight on Enrollment, Premiums, and Recent Trends Jennifer Huang Policy Analyst, Program on Medicare Policy Kaiser Family Foundation AcademyHealth 2013 Annual Research Meeting Tuesday, June

More information

EMBARGOED UNTIL 6:00 AM ET WEDNESDAY, NOVEMBER 30, 2011

EMBARGOED UNTIL 6:00 AM ET WEDNESDAY, NOVEMBER 30, 2011 A State-by-State Look at the President s Payroll Tax Cuts for Middle-Class Families An Analysis by the U.S. Department of the Treasury s Office of Tax Policy The President signed into law a 2 percentage

More information

The Health Insurance Marketplace 101

The Health Insurance Marketplace 101 The Health Insurance Marketplace 101 National Newspaper Association 127th Annual Convention & Trade Show September 13, 2013 Office of the Regional Director Community Resource California-Based Arizona,

More information

MASS MARKETING OF PROPERTY AND LIABILITY INSURANCE MODEL REGULATION

MASS MARKETING OF PROPERTY AND LIABILITY INSURANCE MODEL REGULATION Table of Contents Model Regulation Service January 1996 MASS MARKETING OF PROPERTY AND LIABILITY INSURANCE MODEL REGULATION Section 1. Section 2. Section 3. Section 4. Section 5. Section 6. Section 7.

More information

Current State Regulations

Current State Regulations Current State Regulations Alabama: Enacted in 1996, the state of Alabama requires all licensed massage therapists to * A minimum of 650 classroom hours at an accredited school approved by the state of

More information