Health Care Coverage Cost Drivers. Association of WA Healthcare Plans January 2013
|
|
|
- Barnard Thornton
- 7 years ago
- Views:
Transcription
1 Health Care Coverage Cost Drivers Association of WA Healthcare Plans January 2013
2 A Look at Healthcare Costs & Spending Today s Healthcare Coverage Cost Drivers What Can We Expect with Healthcare Reform? WA Healthcare Plans Are Working to Support Quality & Affordability In Conclusion
3 A Look at Healthcare Costs & Spending
4 A Look at Healthcare Costs & Spending Soaring medical costs threaten our economic competitiveness, our public safety net, and the affordability of coverage for Washington families, individuals, and employers. Health care cost growth is one of the most important economic challenges facing our state --- however the relationship between healthcare costs and premiums is often misunderstood.
5 A Look at Healthcare Costs& Spending
6 A Look at Healthcare Costs & Spending Source: AHIP
7 A Look at Healthcare Costs & Spending
8 A Look at Healthcare Costs & Spending Medical care costs for commercial health insurance programs grew 74% Jan 2003 Aug U.S. spending on health insurance grew at an accelerated rate in 2011, breaking a two-year trend of smaller cost increases. Average Spending on Private Insurance Patient: 2010 $4, $4,547 Source: S&P Healthcare Economic Composite Index, Source: Institute of Medicine, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, , as reported in The Washington Post
9 A Look at Healthcare Costs & Spending
10 A Look at Healthcare Costs & Spending Health plans total profits as a percentage of total national expenditures were less than.005 % in 2010 and over the past decade have averaged.004 %. Continuing this trend into 1 st Qtr 2011, the health plan industry s average net profit margin was again within the industry s historic rage of 3-5% at 3.15%
11 A Look at Healthcare Cost & Spending Administrative Costs are Low and Decreasing % of Premiums Toward Admin Costs (Nationally) 14.5% 14.0% 13.5% 13.0% 12.5% 12.0% 11.5% 11.0% 10.5% 10.0% 14.06% 13.90% 13.41% 13.25% 13.10% 12.39% 11.11% % of Premiums Toward Admin Costs Source: AHIP
12 Today s Healthcare Coverage Cost Drivers
13 Today s Healthcare Coverage Cost Drivers Insurance Premiums Directly Reflect Healthcare Costs Reasons for Healthcare Coverage Cost Increases are Complex and Involve Many Factors, Including: Rising Medical Care Prices Expensive New Technologies Aging Population Cost Shifting Chronic Disease & Unhealthy Lifestyle Choices Taxes, Fees & Compliance
14 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
15 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices the common driver of increasing cost is the underlying cost of care the cost of seeing the doctor, going to the hospital, buying prescription drugs Milliman recently released a video examining health care costs, and the video noted:
16 Today s Healthcare Coverage Cost Drivers : Rising Medical Prices
17 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices As part of the federal health law, all states last year began reviewing premium increases of 10 percent or more, requiring insurers to justify the increases. There are no similar national efforts to examine price increases by hospitals or other medical providers. Kaiser Health News, Higher Prices Charged By Hospitals, Other Providers, Drove Health Spending During Downturn, MAY 21, 2012
18 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices Higher Prices By Hospitals, Other Providers, Drove 2011 Spending Increases Source: Health Care Cost Institute, as reported by Kaiser Health News, Julie Appleby, Sept 25, 2012
19 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices One of the cost-drivers for hospitals is due to the rise in uncompensated care. These costs get shifted to private insured patients.
20 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices According to the National Institute for Health Care Management: Higher spending for hospital care and physician and clinical services accounted for half of the increase in total national health spending between 2005 and 2009 and more than 80 percent of the increase in private insurance premiums over the period. According to Bob Kocher and Ezekiel Emanuel in the Journal of the American Medical Association: prices for hospital services are 13% to 25% higher in consolidated hospital markets.
21 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices Health Care Cost Institute Research Findings 2010 Component s Growth Rate Total Utilization Intensity-Adjusted Price Intensity Inpatient -3.3% 4.6% 0.7% 1.6% Outpatient Outpatient Visits -3.1% 5.3% 4.6% 6.7% Out. Procedures 2.0% 4.0% -2.3% 3.7% Professional -0.3% 3.1% 3.1% -0.5% Prescription Drugs 0.9% N/A N/A 4.0% Source: Health Care Cost Institute, Health Care Cost and Utilization Report: 2010,. Graph by Amber Bronnum Ana Sofia Sousa-Brindle June 8, 2012
22 Today s Healthcare Coverage Cost Drivers: Rising Medical Prices Pharmacy costs are impacting costs, especially as more branded biologics and specialty drugs enter the market place with patent protection for many years to come.
23 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
24 Today s Healthcare Coverage Cost Drivers: New Technologies While a particular new technology may either increase or decrease health care spending, researchers generally agree that, taken together, advances in medical technology have contributed to rising overall U.S. health care spending, including: New treatments for previously untreatable terminal and or acute conditions, such as diabetes, end-stage renal disease, AIDS, and coronary artery bypass graft New procedures for treating secondary diseases within a disease Expanding indications for a treatment over time, increasing the patient population to which the treatment is applied Incremental improvements in existing capabilities, which may improve quality Extending scope of medicine to conditions once regarded as beyond its boundaries Source: How Changes in Medical Technology Affect Health Care Costs, Kaiser Family Foundation, March 2007
25 Millions Today s Healthcare Coverage Cost Drivers: New Technologies Health care technology advances often lead to improved outcomes, but also increase spending Congressional Budget Office estimates technology advance were responsible for approximately 50% of the rise in health expenditures over the past several decades $8,000 Medicare Spending on Imaging Services*, $6,000 $4,000 $2,000 $0 Advanced Imaging Standard Imaging Sources: Congressional Budget Office. (2008). Technological Change and the Growth of Health Care Spending; Government Accountability Office. (2008). Medicare Part B Imaging Services. Advanced imaging includes MRI, nuclear medicine, and CT. Standard imaging includes ultrasound, X-ray and other standard imaging, and procedures that use imaging.
26 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
27 Today s Healthcare Coverage Cost Drivers: Aging Population Population Over 65 as Share of Working Age Population
28 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
29 Today s Healthcare Coverage Cost Drivers: Cost Shift From Under Funded Public Programs Payment-to-Cost Ratios (Hospital Aggregate) 160% 140% Private Payer 120% 100% 80% 60% Medicare Medicaid 40% Source: Washington Department of Health, Center for Health Statistics Amber Bronnum Ana Sofia Sousa-Brindle June 8, 2012
30 Today s Healthcare Coverage Cost Drivers: Cost Shift From Under Funded Public Programs Payment Level Comparison Between Public Programs and Commercial Health Plans for WA State Hospitals Source: Fox, Pickering. Milliman 2006, Premera Report May 2006
31 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
32 Today s Healthcare Coverage Cost Drivers People with Chronic Conditions Account for 84% of National Health Care Dollars & 99% of Medicare Spending
33 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
34 Today s Healthcare Coverage Cost Drivers: 2% WA Premium Tax WA health insurers currently pay a 2% premium tax that goes to our state s General Budget Fund. In 2011, combined WA insurers paid $405,923,000 in premium taxes. The cost of this tax is necessarily passed on to WA individuals, families, and employers purchasing healthcare coverage.
35 Today s Healthcare Coverage Cost Drivers WSHIP Assessment 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Rising Medical Expensive Care Prices New Aging Technologies Population
36 Today s Healthcare Coverage Cost Drivers: WSHIP Assessment WA health insurers subsidize funding for the WA State High Risk Insurance Pool (WSHIP). For 2011, WSHIP assessments costs to WA health insurers totaled $64,053,527. Unlike high risk pools in other states, WA extends eligibility to many individuals who would otherwise be covered by state programs, thus shifting more cost risks to private insurers.
37 What Can We Expect with Healthcare Reform?
38 What Can We Expect with Healthcare Reform? The Affordable Care Act mandates a number of significant changes that will put upward pressure on premiums, including the following 2014 reforms: WA Medicaid Expansion (350,000 to 500,000 people) Rating Requirements Adjusted community rating Age Rate Bands (3:1) Guarantee Issue of Coverage/No Pre-Ex Expanded Benefit Mandate Requirement ( Essential Health Benefits ) Annual Limits Prohibition Risk Adjustment, Reinsurance, and Risk Corridors Health Insurance Tax (HIT)/ACA Assessments and Fees
39 What Can We Expect with Healthcare Reform? WSHIP Weak Assessment Incentives 2% WA Premium Tax Cost Shifting Chronic Disease & Lifestyle Sicker, Poorer Populations Expanded Benefits Mandate Rising Medical Care Prices Expensive New Aging Technologies Population Age Rating Health Insurance Exchange Assessment ACA Insurance Fees Maximum, Deductible, CoPay Elimination
40 What Can We Expect with Healthcare Reform? The Good News: Good News & Bad News Health reform will bring a significant expansion of people with health insurance. And, after tax subsidies, many people may experience premium decreases. The Bad News: On average, premiums almost certainly will go up --- with some people getting hit hard with large increases. At the Oct 2012 meeting of the WA Health Benefit Exchange (HBE) Board, a representative from the Office of Insurance warned that federal health care reform will create health insurance premium shock in 2014.
41 What Can We Expect with Healthcare Reform? Premium Rate Shock Is On the Way Massive regulatory changes are underway due to recent state and federal reform efforts. Implementation of these reforms require major resource expenditures. These cost increases are on top of existing, underlying cost drivers such as rising medical care prices --- which are not being sufficiently addressed. A nationwide Milliman study found that nationwide individual premiums are likely to increase 8% -37% in with a cumulative increase of as much as 122% between 2013 and Premium rate shock will be experienced unevenly by WA residents and will depend on the type of coverage and eligibility for subsidies.
42 What Can We Expect with Healthcare Reform? Premium Rate Shock Is On the Way For Many Premium rate shock will be experienced unevenly by WA residents and will depend on the type of coverage and eligibility for subsidies. The Congressional Budget Office (CBO) says 57% of the people in Exchanges will get tax subsidies. That leaves 43% without subsidies to help offset any increase in premium.
43 WA Healthcare Plans Are Working to Support Quality & Affordability
44 WA Healthcare Plans Are Working to Support Quality & Affordability WA Health insurers are involved in numerous innovative projects around the state to improve quality of care and effectively utilize precious healthcare resources, including: Medical Homes Grant Funding for Community Health Projects Bundled Payment Pilots Wellness and Prevention Disease Management Patient Safety Initiatives Administrative Simplification Leadership Advocacy for Quality and Affordability
45 In Conclusion
46 In Conclusion Focusing solely on insurance premiums while failing to address the underlying factors behind today s rising costs will not make coverage more affordable now, or, with implementation of the new health reform law. We need to work together to gain control of major cost drivers --- especially the largest: escalating medical costs.
47 The Association of Washington Healthcare Plans (AWHP) is an alliance of licensed Health Maintenance Organizations (HMO), Health Care Service Contractors (HCSC), & Disability Insurers. Its diverse membership is comprised of local, regional, & national healthcare plans of varying size, serving the needs of consumers, employers, & public purchasers. Together, they provide health care coverage to over 4 million residents of Washington State. AWHP members include: Aetna Amerigroup CIGNA Columbia United Providers Community Health Plan of WA Coordinated Care Group Health Cooperative Kaiser Permanente Molina Health Net Health Plan of Oregon Premera Blue Cross Providence Health Plan Regence BlueShield Soundpath Health United Healthcare
Rising Health Care Costs What Factors are Driving Increases?
Rising Health Care Costs What Factors are Driving Increases? Rising health care costs and access to affordable coverage are prominent issues for Washington employers, health care providers, purchasers,
Accountable Care Organization Workgroup Glossary
Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.
Financial Planning. Patient Education Guide to Your Kidney/Pancreas Transplant Page 18-1. For a kidney/pancreas transplant.
Patient Education Page 18-1 For a kidney/pancreas transplant Kidney and pancreas transplants are expensive. Planning your finances, both your income and insurance, will be a key part of planning for transplant.
The Continued Need for Reform: Building a Sustainable Health Care System
The Continued Need for Reform: Building a Sustainable Health Care System Sustainable reform must address cost and quality, while expanding coverage through a vibrant and functional marketplace As the largest
The facts about rising health care costs Underlying medical costs drive growth
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions The facts about rising health care costs Underlying medical costs drive growth October 2012 00.03.966.1-L11 A
www.booneinsuranceassociates.com Copyright by BIA 1 MEDICARE MADE SIMPLE BIA 1/14/2016 Boone Insurance Associates Education Guide: New
www.booneinsuranceassociates.com Copyright by 1 MEDICARE MADE SIMPLE Boone Insurance Associates Education Guide: New Today s Agenda 2 About Introduction & History of Medicare Medicare Parts A, B, C, D
The Affordable Care Act Impact to those with Chronic conditions in Washington State
The Affordable Care Act Impact to those with Chronic conditions in Washington State Four Buckets of the ACA Coverage Continuum Classic Medicaid For Current Medicaid Recipients Medicaid Expansion 0% - 138%
The Affordable Care Act
The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier
ASO. BlueCross BlueShield of Oregon HOW AN ADMINISTRATIVE SERVICES ONLY (ASO) PLAN CAN WORK FOR YOU AN INTRODUCTION FOR GROUPS OF 51-99 MT HOOD
BlueCross BlueShield of Oregon ASO HOW AN ADMINISTRATIVE SERVICES ONLY (ASO) PLAN CAN WORK FOR YOU AN INTRODUCTION FOR GROUPS OF 51-99 Regence BlueCross BlueShield of Oregon is an Independent Licensee
Retiree Considerations Medicare 101. June 26, 2012
Retiree Considerations Medicare 101 June 26, 2012 Agenda Goal: Present information regarding Medicare and related products to assist you in evaluating options Key Topics: Eligibility Rules Enrollment Rules
Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100
Health Care Reform Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 *Tobacco-related disease *Poor diet *Lack of exercise *Excessive use of alcohol *American
Retiree Drug Coverage under the MMA: Issues for Public Comment to Maximize Enhancement in Drug Coverage and Reductions in Drug Costs for Retirees
Retiree Drug Coverage under the MMA: Issues for Public Comment to Maximize Enhancement in Drug Coverage and Reductions in Drug Costs for Retirees Discussion Paper: CMS Employer Open Door Forum I. Summary:
ACA Implementation Timeline
ACA Implementation Timeline Published: March 5, 2013 Updated: July 5, 2013 Producer: Sophie Novack Director: Jessica Guzik National Journal Presentation Credits Most ACA Reforms Implemented 2013-2014 Jan.
LEVERAGING VOLUNTARY BENEFITS AS A STRATEGIC APROACH TO HR
LEVERAGING VOLUNTARY BENEFITS AS A STRATEGIC APROACH TO HR The City of Atlanta and Healthier You! Yvonne Cowser Yancy Commissioner, Human Resources yyancy@atlantaga.gov November 9, 2015 Overview The City
Medicare Economics. Part A (Hospital Insurance) Funding
Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),
Performance Results for Health Insurance Plans
WASHINGTON STATE COMMON MEASURE SET FOR HEALTH CARE QUALITY AND COST Performance Results for Health Insurance Plans DECEMBER 2015 Table of Contents Introduction... 3 About the Results... 4 How to Read
Ohio Health Plans. Maximizing best practices & leading reform efforts. Search. Ohio Association of Health Plans
Ohio Association of Health Plans File Edit View History Bookmarks Tools Window Help http://www.oahp.com Ohio Health Plans Search Maximizing best practices & leading reform efforts HELPING OHIOANS GET NEEDED
Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
Member Fact Sheet Medicare Secondary Payer Small Employer Exception
Member Fact Sheet Medicare Secondary Payer Small Employer Exception The Episcopal Church Medical Trust (Medical Trust) is providing eligible employers with the option to apply for the Medicare Secondary
Health Plan Enrollment Shifting Toward Government-Sponsored Programs
1 of 6 2/4/2013 11:36 PM Health Plan Enrollment Shifting Toward Government-Sponsored Programs 1/25/2013 by Debra A. Donahue Medical membership for the leading U.S. health insurance plans increased 2.6%
Kaiser Permanente Guide to Medicare Basics
Kaiser Permanente Guide to Medicare Basics The National Medicare program, which was created in 1965, has given people peace of mind and the security of knowing they ll have access to health coverage. Medicare
Health Insurance Options for Small Business Employers
Health Insurance Options for Small Business Employers April 2, 2008 Insure the Uninsured Project Rebecca Pizzitola and Lucien Wulsin, Jr. www.itup.org Funded by: L.A. Care Health Plan The California Endowment
Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.
Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
Washington Health Benefit Exchange. Leading Age 2014 Annual Conference. Phil Dyer Board Member
Washington Health Benefit Exchange Leading Age 2014 Annual Conference Phil Dyer Board Member DISCLAIMER; The views and information expressed are my personal opinions and perspectives and do not represent
Health Coverage Cost Per Covered Life: Government vs. Employment- Sponsored Programs. By Tevi D. Troy and D. Mark Wilson
2014 Health Coverage Cost Per Covered Life: Government vs. Employment- Sponsored Programs By Tevi D. Troy and D. Mark Wilson 2014 American Health Policy Institute (AHPI) is a non-partisan 501(c)(3) think
Why Accept Medicaid Dollars: The Facts
Why Accept Medicaid Dollars: The Facts If we accept federal Medicaid dollars, nearly 500,000 North Carolinians will gain access to health insurance. As many as 1,100 medically unnecessary deaths per year
How To Determine The Impact Of The Health Care Law On Insurance In Indiana
ACA Impact on Premium Rates in the Individual and Small Group Markets Paul R. Houchens, FSA, MAAA BACKGROUND The Patient Protection and Affordable Care Act (ACA) introduces significant changes in covered
How Will the Medicaid Expansion Benefit New Mexico?
A Report from New Mexico s Internal Medicine Physician Specialists: How Will the Medicaid Expansion Benefit New Mexico? Introduction In light of the Supreme Court s ruling on the Affordable Care Act s
Medi-Pak Advantage: Frequently Asked Questions
Medi-Pak Advantage: Frequently Asked Questions General Information: What Medicare Advantage product is Arkansas Blue Cross Blue Shield offering? Arkansas Blue Cross and Blue Shield has been approved by
How To Improve Health Care For All
TIMELINE FOR IMPLEMENTATION OF THE AFFORDABLE CARE ACT 2010: NEW CONSUMER PROTECTIONS Eliminated pre-existing coverage exclusions for children: under age 19. Prohibited insurers from dropping coverage:
Why a State s Health Insurers Should Support Expanding Medicaid
Why a State s Health Insurers Should Support Expanding Medicaid September 2012 Since the Supreme Court s decision gave states the choice of whether or not to expand Medicaid under the Affordable Care Act,
MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente
MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente Sylvia Weathers Service Consultant Keenan & Associates Nancy C. Voltero Retiree Programs Consultant Kaiser Permanente License
Chapter Seven Value-based Purchasing
Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It
Medicare & Senior Advantage Guide for Retiring Physicians
Medicare & Senior Advantage Guide for Retiring Physicians Medicare Basics Medicare is a federal health insurance program that pays for hospital and medical care for: Individuals who are age 65 or older
Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion
Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation
Washington State Health Insurance Pool - Board Education March 2012
- Board Education March 2012 What are the new 3 R s? The 3 R s are the risk leveling programs required by the Affordable Care Act (ACA) to help protect insurers in the individual and small group markets
Helping you stay covered. with Kaiser Permanente
Helping you stay covered with Kaiser Permanente What s inside How do I stay covered?... 2 When do I need to enroll?... 4 What are my options?... 6 Kaiser Permanente for Individuals and Families... 8 Medi-Cal...11
Ohio s Health Insuring. Corporations Report. Ohio s Health Insuring. Corporations Performance Report. Executive Summary. Overview AUGUST 2014
Ohio s Health Insuring Corporations Performance Report Ohio s Health Insuring Corporations Report AUGUST 2014 Executive Summary During 2013, Ohio s Health Insuring Corporations (HICs) saw an increase in
Solutions for Today Flexibility for Tomorrow.
Solutions for Today Flexibility for Tomorrow. Medicare Products and Services For More Information call our Senior Care Specialist, Raun Lynch at 856.380.5079 Or visit us on the web at www.cbdi-inc.com
Why Are Health Care Costs Rising? Leading Experts/Real-World Data Identify Multiple Factors Across the System. March 2010
Why Are Health Care Costs Rising? Leading Experts/Real-World Data Identify Multiple Factors Across the System March 2010 Multiple Factors Driving The Cost Of Health Care There is no single cause of the
UNITED STATES OFFICE OF PERSONNEL MANAGEMENT
UNITED STATES OFFICE OF PERSONNEL MANAGEMENT STATEMENT OF JONATHAN FOLEY DIRECTOR, PLANNING AND POLICY ANALYSIS U.S. OFFICE OF PERSONNEL MANAGEMENT before the SUBCOMMITTEE ON FEDERAL WORKFORCE, U.S. POSTAL
Health Care Implementation Timeline
Health Care Implementation Timeline The massive healthcare (H.R. 3590) and its companion reconciliation bill (H.R. 4872) passed by the Senate and House in early 2010 will go into effect over several years.
Explore New Roads Gap Medical. May Insurance Broker Meeting September 2015
Explore New Roads Gap Medical May Insurance Broker Meeting September 2015 1 Why Explore New Roads? The New Road Marketplace changes Broker opportunities Customer needs Timely solutions ACA unfolding Shrinking
HEALTH INSURANCE CONSULTING FEBRUARY 21, 2013
1 HEALTH INSURANCE CONSULTING FEBRUARY 21, 2013 2 INSURANCE BROKER TOOLKIT Medical Dental Life Disability Vision Employee Assistance Program (EAP) Supplemental (AFLAC) Flexible Spending Account (FSA) Health
focus Retiree Open Enrollment What s New for You in FY17? Open Enrollment is May 11 th to May 25 th Open Enrollment Information Meetings
Retiree Open Enrollment focus What s New for You in FY17? It s here again! This May s Open Enrollment is the opportunity for pre-medicare retirees and Medicare retirees to make insurance changes. Any change
Ronald Riner, MD. The Riner Group, Inc. 5811 Pelican Bay Blvd., Suite 210 Naples, FL 34108 800.965.8485 www.rinergroup.com
Impact of Healthcare Reform on Small Business January 12, 2011 Ronald Riner, MD The Riner Group, Inc. 5811 Pelican Bay Blvd., Suite 210 Naples, FL 34108 800.965.8485 www.rinergroup.com Healthcare Reform
Profiles in Coverage: Arizona Healthcare Group
May 2007 S t a t e Co v e r a g e I n i t i a t i v e s Profiles in Coverage: Arizona Healthcare Group Overview Healthcare Group of Arizona (HCG) was created by the Arizona State Legislature in 1985 to
S e c t i o n 4 - P S E R S P o s t e m p l o y m e n t H e a l t h c a r e P r o g r a m s
S e c t i o n 4 - P S E R S P o s t e m p l o y m e n t H e a l t h c a r e P r o g r a m s Health Options Program... Tab 17 Premium Assistance Program... Tab 18 This page intentionally left blank Pursuant
Healthcare Cost Drivers White Paper June 2015
Healthcare Cost Drivers White Paper June 2015 The National Association of Heath Underwriters (NAHU), a professional trade association representing more than 100,000 health insurance agents, brokers and
This glossary provides simple and straightforward definitions of key terms that are part of the health reform law.
This glossary provides simple and straightforward definitions of key terms that are part of the health reform law. A Affordable Care Act Also known as the ACA. A law that creates new options for people
THAT S RIGHT FOR YOU PLATINUM BLUESM WITH RX (COST) Medical and prescription drug benefits you want. Value you deserve. FIND THE PLAN CORE CHOICE
2016 PLATINUM BLUESM WITH RX (COST) Medical and prescription drug benefits you want. Value you deserve. OPTIONS YOU WANT Platinum Blue can help pay the deductibles, copayments and coinsurance Original
Risk adjustment and shared savings agreements
Risk adjustment and shared savings agreements Hans K. Leida, PhD, FSA, MAAA Leigh M. Wachenheim, FSA, MAAA In a typical shared savings arrangement, claim costs during the measurement or experience period
PPACA, COMPLIANCE & THE USA MARKET
PPACA, COMPLIANCE & THE USA MARKET INTRODUCTION The USA healthcare market is the largest in the world followed by Switzerland and Germany It consists of broad services offered by various hospitals, physicians,
Health Care Reform Frequently Asked Questions
Health Care Reform Frequently Asked Questions On March 23, 2010, President Obama signed federal health care reform into law, also known as the Patient Protection and Affordability Act. A second, or reconciliation
Making Sense of Medicare
Making Sense of Medicare Stephanie M. Turnbull Manager, Member Benefits 1 Highlights Medicare Eligibility Types of Medicare Coverage Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicare
Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.
Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should
The Patient Protection and Affordable Care Act. Implementation Timeline
The Patient Protection and Affordable Care Act Implementation Timeline 2009 Credit to Encourage Investment in New Therapies: A two year temporary credit subject to an overall cap of $1 billion to encourage
2012 Health Insurance Premium Rate Review Final Decision Detailed Tables
2012 Health Insurance Premium Rate Review Final Decision Detailed Tables Introduction The following tables provide detailed information regarding the requested and approved health insurance premium rate
UNPRECEDENTED GROWTH, QUESTIONABLE POLICY: THE 340B DRUG PROGRAM
WORKING PAPER SERIES UNPRECEDENTED GROWTH, QUESTIONABLE POLICY: THE 340B DRUG PROGRAM BY STEPHEN T. PARENTE, PHD, MINNESOTA INSURANCE INDUSTRY CHAIR OF HEALTH FINANCE, DEPARTMENT OF FINANCE & MICHAEL RAMLET,
Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) APRIL 2013
Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) APRIL 2013 http://berkeleyhealthcareforum.berkeley.edu 1 Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) See Appendix
Insurance Coverage Provisions of the Affordable Care Act CBO s February 2014 Baseline
Insurance Coverage Provisions of the Affordable Care Act CBO s February 2014 Baseline Table 1. Effects on the Deficit of the Insurance Coverage Provisions of the Affordable Care Act Table 2. Effects of
Bancorp Insurance Medicare Vocabulary
Bancorp Insurance Medicare Vocabulary Advance Beneficiary Notice (ABN) A notice indicating the cost of a service that Medicare might not cover. Accepting Assignment Your Doctor agrees to accept payment
o The bipartisan Joint Committee on Taxation says that eliminating the tax would reduce family premiums. 2
The Health Insurance Tax Will Hurt. The new health insurance tax will increase the cost of health care benefits, harming those who need help the most: small businesses, families who work for a small business
To: Mayor and City Council Date: 1/20/11. Findings and Recommendation by Healthcare Task Force Committee
To: Mayor and City Council Date: 1/20/11 Via: From: Gary Jackson, City Manager Healthcare Task Force Committee Subject: Findings and Recommendation by Healthcare Task Force Committee Summary Statement:
An Internist s Practical Guide to Understanding Health System Reform
An Internist s Practical Guide to Understanding Health System Reform Prepared by: ACP s Division of Governmental Affairs and Public Policy Updated October 2013 How to cite this guide: American College
ACA imposes a 40 percent excise tax on the cost of coverage exceeding $10,200 for single coverage and $27,500 for family coverage.
Affordable Care Act In Focus: Provisions Impacting Employer-Sponsored Health Coverage Through 2020 While many employers are wondering if self-funding is the right solution for their business, a number
City of Houston Long-Range Financial Management Task Force Healthcare Benefits Questions
1. Who administers the City s healthcare plan? Is the City self-insured or does it use an insurance company to process its claims? Effective May 1, 2011, Cigna was selected to be the administrator for
Ohio Health Benefits LLC. Your health insurance partner!!
December 16, 2014 Presented by Steve Clark & Scott Prior Patient Protection and Affordable Care Act of 2010 Obamacare or ACA or PPACA or Health Care Reform (HCR) Signed in to law on March 23, 2010 The
The Affordable Care Act in Texas: Five Years and Counting
The Affordable Care Act in Texas: Five Years and Counting David W. Hilgers October 21, 2014 ACA Timeline Bill Passed 3/23/2010 2010 Eliminated pre-existing conditions for children Limited cancellation
Kaiser Permanente Northwest Region Enrollment Service Area
Kaiser Permanente v Kaiser Permanente Northwest Region Enrollment Service Area Kaiser Permanente Senior Advantage Medicare Plan The Value of Kaiser Permanente Sr. Advantage Medicare Plan and PHIP Partnership
The Blue Spectrum of Services. Factors Impacting Health Care Affordability
The Blue Spectrum of Services Factors Impacting Health Care Affordability Information about the drivers of health care costs from Anthem Blue Cross and Blue Shield for New Hampshire customers, accounts,
Insurance Coverage Provisions of the Affordable Care Act CBO s March 2015 Baseline
Insurance Coverage Provisions of the Affordable Care Act CBO s March 2015 Baseline Table 1. Direct Spending and Revenue Effects of the Insurance Coverage Provisions of the Affordable Care Act Table 2.
Health Reform: The Cost of Failure and the Implications of Success
Health Reform: The Cost of Failure and the Implications of Success Bowen Garrett John Holahan June 17, 2010 National Association for Business Economics www.healthpolicycenter.org The Affordable Care Act
Natalie Pons, Senior Vice President, Assistant General Counsel, Health Care Services. CVS Caremark Corporation
Prepared Statement of Natalie Pons, Senior Vice President, Assistant General Counsel, Health Care Services CVS Caremark Corporation Before the Subcommittee on Regulatory Reform, Commercial and Antitrust
Health Care Reform: Policy Implications for the Future
Health Care Reform: Policy Implications for the Future Michigan Primary Care Association Douglas M. Paterson, MPA Director of State Policy Promoting, supporting, and developing comprehensive, accessible,
An Overview of Health Insurance Exchange and What It Means to Your Business
WEDI Virtual Event Medicare Advantage: Lessons Learned An Overview of Health Insurance Exchange and What It Means to Your Business Presented By: Dawn Carter, EDS Product Manager, Verisk Health About Our
NO DEDUCTIBLE FOR MANY SERVICES
How Deductible plans work Deductible plans generally offer lower monthly premiums in exchange for higher out-of-pocket payments for covered services. With these plans, you pay full charge for certain covered
MEDICARE. Understanding the basics of the Medicare Program.
MEDICARE 101 Understanding the basics of the Medicare Program. Table of Contents 01. 05. 13. 17. 25. 29. The History of Medicare What is Medicare? Who is Eligible? Medigap Plans Medicare Advantage (MA)
The Patient Protection and Affordable Care Act ( ACA ): What s Next?
The Patient Protection and Affordable Care Act ( ACA ): What s Next? Kristin Nealey Meier 2 Obamacare Video http://kff.org/healthreform/video/youtoons-obamacare-video 3 What Happens in 2014? Individual
Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans
Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans Issues & Trends in Medicare Supplement Insurance 2012 Conference Presented by: T. Scott Bentley, FSA, MAAA Consulting
MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
United States Government Accountability Office Report to Congressional Requesters June 2015 MEDICARE PART B DRUGS Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM
THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM National Congress on Health Insurance Reform Washington, D.C., January 20, 2011 Elise Gould, PhD Health Policy Research Director Economic
Virginia. A guide for individuals and families. The health insurance benefits you want, at a cost you can afford
Virginia A guide for individuals and families CoventryOne is an individual product (for individuals and families) offered by Coventry Health Care, an Aetna company. The health insurance benefits you want,
The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending?
The Cost of Care for the : What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending? Issue Update 2004 Jack Hadley, Ph.D. and John Holahan, Ph.D. Prepared for the Kaiser Commission
Factors Affecting Premiums in 2017 Individual Exchange Marketplace
Factors Affecting Premiums in 2017 Individual Exchange Marketplace ISSUE BRIEF MAY 2016 KEY TAKEAWAYS Premium rates reflect many complex factors, and there is significant variation in rates across states
Affordable Care Act at 3: Strengthening Medicare
Affordable Care Act at 3: Strengthening Medicare ISSUE BRIEF Fifth in a series May 22, 2013 Kyle Brown Senior Health Policy Analyst 789 Sherman St. Suite 300 Denver, CO 80203 www.cclponline.org 303-573-5669
Dual Eligibles and State Innovations in Care Management
Dual Eligibles and State Innovations in Care Management Ann Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org
Risk Adjustment: Implications for Community Health Centers
Risk Adjustment: Implications for Community Health Centers Todd Gilmer, PhD Division of Health Policy Department of Family and Preventive Medicine University of California, San Diego Overview Program and
The Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion
November 2013 Edition Vol. 7, Issue 10 The Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion By Gordon Gochenauer, Director, Oncology Commercial Strategies,
BARACK OBAMA S PLAN FOR A HEALTHY AMERICA:
BARACK OBAMA S PLAN FOR A HEALTHY AMERICA: Lowering health care costs and ensuring affordable, high-quality health care for all The U.S. spends $2 trillion on health care every year, and offers the best
Medicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases.
Medicare Part D The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added voluntary prescription drug coverage to Medicare, the federal health insurance program for seniors
Regence Medicare Advantage PPO Plans. Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association
DECISION GUIDE 2015 Medicare Advantage PPO Plans BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association Y0062_07978 Approved OR PPO 2015 GET STARTED READ.
Aetna Savings Plus plan guide
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Savings Plus plan guide New health plans designed with Florida businesses in mind For businesses with 2-100
Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012
Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM David Johnson jdjohnson@rcmd.com November 15, 2012 0 Topics for Discussion 1. Recap of Supreme Court Decision on Affordable
Health Insurance Premiums What are you paying for? May 2013
Health Insurance Premiums What are you paying for? May 2013 Health insurance companies have been making headlines because of the skyrocketing prices consumers are paying for coverage. The national organization
!"#$%$&!"'()*+,-".-,/ &01*+("12"31+4156"$,+0"!*7("819".5(<(/4*<("&,5( :(()";(,-40"&,5( !"#$%$&!",/)"'()*+,5(
submitted anytime during the year to your institution HR/Benefits Office, and the tobacco premium will be waived beginning the first of the month following submission of the form. Important: A member is
The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO
The Changing Face of Healthcare: Challenges & Solutions Mark Stauder, President/COO Disclosure of Relevant Financial Relationship with Commercial Companies/Organizations Mark Stauder has disclosed financial
Determining the Role for Value-Based Insurance Design in Healthy Michigan
Determining the Role for Value-Based Insurance Design in Healthy Michigan A. Mark Fendrick, MD University of Michigan Center for Value-Based Insurance Design www.vbidcenter.org @um_vbid Value-Based Insurance
Click this button to place your order.
Medicare 33rd Edition 2016 What you need to know about Medicare in simple, practical terms. Click this button to place your order. 2016 MEDICARE CONTENTS 1 2 3 4 5 6 Published By PAGE INTRODUCTION Are
Medi-Growth Medicaid, Medicare Poised to Expand
C H A P T E R 7 Medi-Growth Medicaid, Medicare Poised to Expand More than 100 million Americans rely upon Medicaid and Medicare for insurance coverage. Medicaid, the government s insurance program for