Healthcare.gov to add Network-Breadth Ratings
Starting in 2017, consumers will be able to obtain information on network breadth ratings when comparing health care plans. This rating will show the number of doctors, hospitals, and specialists, within each network to help consumers can make informed decisions when choosing the best health plan for their needs. The third annual health care open-enrollment… Read More
CMS to Allow States to Monitor Adequacy of Health Plan Network
The Centers for Medicare & Medicaid took a step back from their proposed strict federal level regulation of the adequacy of health plan networks and instead will allow states the time to adopt a proposal from the National Association of Insurance Commissioners. The NAIC proposal addresses the issue over narrowing network plans that are particularly of concern… Read More
Why U.S. Drug Costs Are Out of Control
In his New York Times article “New Dosages of Old Drugs are used to Raise Their Prices,” Barry Meier addresses the controversial trend in the drug industry in which newly manufactured dosages of common drugs are being introduced into the marketplace to circumvent cost controls. The ulterior motive? Egregious markups, whose resulting profits end up… Read More
ISideWith.com: Take their Quiz
If you are interested in seeing how your favorite candidates match up with your ideas on the issues, visit www.ISideWith.com. This interactive site asks you questions on the popular issues such as health care, taxes, gun control, abortion, the national debt, economy, and the environment. When you take the ISideWith quiz, instead of answering a… Read More
Why Hospitals and the AMA are Against the Anthem-Cigna & Aetna-Humana Mergers
The pending mergers of Anthem and Cigna as well as Aetna and Humana, are something hospitals across the country hope they can prevent as they continue to apply pressure to the Justice Department to put a stop to the deals. Hospitals said the mergers would give undo strength to Blue Cross Blue Shield, an independent… Read More
Trump’s Heath Plan
GOP presidential candidate Donald Trump has released his version of a health care plan that would, if he were elected, replace Obamacare. Made up of seven points, his first steps would be to completely repeal the Affordable Care Act. He also plans to eliminate the individual mandate for health insurance coverage despite previous comments that… Read More
Medicare Advantage Plan Rate Increase Proposed for 2017
Insurers offering Medicare Advantage plans may see a slight increase in rates for 2017. According to the Centers for Medicare and Medicaid Services, federal regulators proposed an increase of approximately 1.35% over last year’s rates. Insurers such as Humana and UnitedHealth are two of the nation’s largest insurers offering Medicare Advantage plans. The plans make… Read More
2016 Healthcare Reform FACTS – Did you Know?
Many employers and consumers alike are unaware of the compliance regulations regarding reimbursement arrangements for health insurance under the Affordable Care Act. Here are several facts to keep in mind: An employer may NOT offer cash to reimburse employees for the purchase of individual market plan policies. Why? First, the practice does NOT comply with… Read More
Healtcare.gov Susceptible to Fraud?
The Government Accountability Office announced in a report published February 23, 2016, that the “CMA should act to strengthen enrollment controls and manage fraud risk.” The 62 page report showed that during undercover testing, the federal marketplace was vulnerable to fictitious enrollees who were able to secure subsidies despite the fact that fictitious information, or… Read More
HUMANA BULLETIN TO AGENTS Regarding Unlike Plan Changes 2/1/16 –Delayed Second Commission Payments
CMS recently provided updated guidance regarding when an agent should be paid full or pro‐rated initial year compensation. This new guidance impacts Humana’s payment process. For unlike plan changes (e.g., MA‐PD to PDP or PDP to Cost Plan) occurring after January 1 in which there is indication that the beneficiary had prior plan history (regardless… Read More