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
The Anthem Breach – One Year Later
A proposed class action suit against some of the Blue Cross and Blue Shield entities became smaller last week when a federal judge in California fully disallowed three Anthem affiliates from participation in the litigation. Seven more were partially removed, meaning part of the claims will be allowed to move forward. In February of 2015,… Read More
ABS Florida Regulator Approves Aetna’s Acquisition of Humana
The approval of the acquisition of Humana by Aetna was announced last week by Florida’s insurance regulator with conditions that by 2018 the carrier must offer their Obamacare marketplace plans in five additional counties. In addition, their plans must be available throughout the state by 2020. So far Aetna has received approval in 10 out… Read More
How Will Scalia’s Death Affect U.S. Health Care?
On February 13, 2016 United States Supreme Court Justice Antonin Scalia passed away unexpectedly, reportedly of a heart attack. He was on a hunting trip at a Texas ranch with friends and was reportedly alone at the time of his death. Recent conspiracy theories have emerged due to the circumstances surrounding his death; namely, that… Read More
New Obamacare Sign-Up Enrollment for Select Few Who Failed to File a 2014 Tax Return.
What we know Although the Obama administration said they would not extend the Obamacare open enrollment period beyond January 31, 2016, a select few may qualify to enroll up until March 31, 2016. This new sign-up applies only for those who failed to file taxes in 2014. Why the Extension People who failed to file… Read More