The Ridgewood Blog Brings a Free Market Laissez-faire Point of View to Local, New Jersey State and National Issues.
the staff of the Ridgewood blog
Hackensack NJ, a looming contract dispute between New Jersey’s largest health insurer and the state’s largest hospital network could leave thousands of patients in limbo this summer.
Horizon Blue Cross Blue Shield of New Jersey (Horizon) and Hackensack Meridian Health have four months to negotiate a new agreement, as current coverage remains in place. However, with both sides standing firm, a resolution seems uncertain.
Over a period it is seen that the person might face many of the uncertainties in life, so it is better to be insured right from the beginning. In case there is any problem in the future the person is already prepared for that. One of the major things that will help in ensuring the uncertainties related to the health issues is to get a health insurance plan. Even in the market, there are family health insurance plans so you can easily go for the best family health insurance policy that will provide all the benefits required by the person in long term.
Continue reading Know-How to Buy Health Insurance for Family With This Guide
October 13,2017
the staff of the Ridgewood
Washington DC, President Donald J. Trump is taking action to improve access, increase choices, and lower costs for healthcare. The President thru executive action on Thursday , the president said , “The time has come to give Americans the freedom to purchase health insurance across state lines, which will create a truly competitive national marketplace that will bring costs way down and provide far better care.”
EXPANDING ACCESS TO MORE AFFORDABLE OPTIONS: President Donald J. Trump is taking action to increase the healthcare choices for millions of Americans, potentially allowing some employers to join together across State lines to offer coverage.
• President Trump signed an Executive Order to reform the United States healthcare system to take the first steps to expand choices and alternatives to Obamacare plans and increase competition to bring down costs for consumers.
• The order directs the Secretary of Labor to consider expanding access to Association Health Plans (AHPs), which could potentially allow American employers to form groups across State lines.
o A broader interpretation of the Employee Retirement Income Security Act (ERISA) could potentially allow employers in the same line of business anywhere in the country to join together to offer healthcare coverage to their employees.
It could potentially allow employers to form AHPs through existing organizations, or create new ones for the express purpose of offering group insurance.
o By potentially making it easier for employers to band together, workers could have access to a broader range of insurance options at lower rates in the large group market.
o Employers participating in an AHP cannot exclude any employee from joining the plan and cannot develop premiums based on health conditions.
• The order directs the Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost short-term limited duration insurance (STLDI).
o STLDI is not subject to costly Obamacare mandates and rules. One study found that on average STLDI costs one-third the price of the cheapest Obamacare plans.
o Despite its low cost, STLDI typically features broad provider networks and high coverage limits.
o The main groups who benefit from STLDI are people between jobs, people in counties with only a single insurer offering exchange plans, people with limited coverage networks, and people who missed the open enrollment period but still want insurance.
• The order directs the Departments of the Treasury, Labor, and Health and Human Services to consider changes to Health Reimbursement Arrangements (HRAs) so employers can make better use of them for their employees.
o HRAs are employer-funded accounts that reimburse employees for healthcare expenses, including deductibles and copayments.
o The IRS does not count funds contributed to an HRA as taxable income.
o Expanded HRAs could potentially give American workers greater flexibility and control over how to finance their healthcare needs.
OBAMACARE IS FAILING: The status quo is not delivering quality healthcare options for the American people, who are facing higher premiums and fewer options.
• The percentage of workers at small firms receiving coverage through their employer has declined from nearly half in 2010 to about one-third in 2017.
• In 2018, more than 1,500 counties (nearly 50 percent of all counties) are projected to have only one option on their individual insurance exchanges, according to the Centers for Medicare and Medicaid Services.
o This means 2.6 million Americans, or nearly 30 percent of exchange participants, will be left without a choice of insurers.
• From 2013 to 2017, average premiums for individual health insurance plans have doubled, increasing by $2,928 according to the Department of Health and Human Services.
o During this period, every State using www.healthcare.gov saw individual insurance premiums increase.
• Americans are departing the Obamacare exchanges and millions are choosing to pay the law’s penalty instead.
o 500,000 fewer Americans enrolled in an Obamacare plan in 2017 compared to the prior year.
o Current exchange enrollment is 60% below what the Congressional Budget Office expected when the law took effect.
o 6.7 million Americans chose to pay the Obamacare penalty in 2015 rather than purchase insurance on the exchanges. 37% of penalized households made less than $25,000, and 79% of penalized households made less than $50,000.
“Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever,” Jonathan Gruber, a professor at MIT and an architect of Obamacare
Rep.Scott Garrett :Time find solutions that will increase actually make health care more affordable and accessible for everyone.
“While we were promised affordable prices and increased competition with ObamaCare, we’ve only seen premium prices spike and insurance companies exit the unworkable exchanges. You’ve probably heard a number of news reports this week about the increased healthcare costs many people are facing as a result of this disastrous law. Unfortunately, New Jersey is no exception.
If you are one of the thousands of residents here in the Garden State expected to participate in ObamaCare open enrollment that starts this week, chances are you’ve been hit by massive sticker shock. You’ve probably also noticed that you’ve had less choice than you had in the past as only two insurance companies remain in New Jersey’s exchanges. It’s obvious that ObamaCare isn’t working for New Jersey’s families.
Supporters of ObamaCare told us that it would save the average family $2,500 a year on premiums. Instead, we are finding out that premiums will increase by an average of 25 percent. We were also told, “if you like your doctor, you can keep your doctor.” Instead, at least 76,000 New Jerseyans are now forced to switch insurance providers. And these families are quickly finding out that switching insurance providers is difficult. New plans may mean leaving the family doctor you’ve seen for years and interrupting ongoing medical treatment.
The Affordable Care Act is not affordable and it is forcing American families to make unwanted compromises about their healthcare.
New Jerseyans shouldn’t have to pay the price for ObamaCare’s broken promises. That is why I will continue to fight to repeal ObamaCare and work in a bipartisan manner to find solutions that will increase actually make health care more affordable and accessible for everyone.”
Sincerely,
Scott Garrett
October 25,2016
the staff of the Ridgewood blog
Ridgewood NJ, Today, Independent Women’s Voice announced that Rep. Scott Garrett (R-NJ) has signed the ObamaCare Repeal Pledge. Garrett currently represents New Jersey’s 5th Congressional district.
As it turns out, pretty much nothing that Obama and his healthcare “experts” predicted about Obamacare actually came true. With 2017 rates now finalized across the country, in fact, Obamacare premiums are expected to increase an average of 25% nationally according to data from the Kaiser Foundation. Meanwhile, the 10 hardest hit states will see premiums increase an average of 62% while Arizona is officially the biggest loser with rates in Phoenix soaring 145%
Reg. Scott Garrett’s signature on the Pledge is a clear demonstration of his commitment to the full and complete repeal of ObamaCare and to end the harm that it is inflicting upon American families,” said Heather R. Higgins, President and CEO of Independent Women’s Voice.
“Scott understands that ObamaCare is hiking insurance premiums, diminishing quality of care, and reducing our choice and control in health care decisions,” added Higgins. “He understands that ObamaCare means bigger government and less freedom. For these reasons, and many more, it must be repealed.”
“ObamaCare has unequivocally failed,” said Rep. Scott Garrett. “Many Americans have lost their health insurance, and premiums and deductible costs have increased for families. I believe healthcare choices need to be in the hands of patients and doctors. I want to encourage innovation and competition while giving people more freedom and flexibility to make their own healthcare decisions. I want to take concrete steps to replace ObamaCare to achieve these better results for all Americans.”
“The Repeal Pledge was designed as a litmus test to help the American public understand which candidates and office holders are serious about repeal, versus those who claim to be but won’t actually take action,” continued Higgins. “With this commitment, Cong. Scott Garrett passes that test.”
The Repeal Pledge is a project of Independent Women’s Voice, a 501(c)(4) nonpartisan, nonprofit organization.
For more information on The Repeal Pledge, including a complete list of signers, please visit www.TheRepealPledge.com.
Ridgewood NJ, Valley Hospital continues to raise objections to Horizon’s OMNIA two tier hospital rating designations .
In and email Valley Pointed out , “Horizon’s OMNIA plan set up a two-tiered system that rewards some hospitals with Tier 1 designations and essentially punishes others by designating them as Tier 2 and imposing higher copays on many patients. Horizon’s scheme uses huge hospital systems as its Tier 1 base, while excluding some of the state’s best and highest-rated hospitals.
There was no public process or known criteria by which hospitals and physicians were ultimately assigned to a tier, nor is there any public path to move to another tier. And Horizon still refuses to publicly divulge its mysterious selection process.
It’s no wonder why a recent poll indicated that voters and Horizon customers indicated strong trust concerns with New Jersey’s insurance giant. According to an Anzalone, Liszt, and Grove research poll,1 61 percent agree that Horizon “puts profits ahead of people,” while 55 percent of Horizon’s customers who were surveyed also agreed. In fact, 57 percent of those polled also agreed that Horizon “has too much influence and power in New Jersey,” while 61 percent of Horizon’s own customers who were surveyed said the same thing.”
MAY 13, 2015, 8:18 PM LAST UPDATED: WEDNESDAY, MAY 13, 2015, 8:24 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
Consumers would be protected from surprise medical bills when they go to the hospital under a measure to be unveiled Thursday in Trenton by a group of powerful Democratic lawmakers.
Out-of-network charges to insurers would be capped. And in an unprecedented push for transparency, the state would publish a list of the average prices for almost every service, based on data the insurers would be required to submit. When hospitals or doctors and insurers disagree on the appropriate amount for an out-of-network bill, the measure calls for “baseball arbitration” — a state-appointed arbitrator to choose one side’s final offer.
The financial stakes are enormous, and a high-powered offensive from those whose revenues or income would be diminished by the measure is expected, including specialist physicians and hospitals.
“I think it’s going to be a fight,” for passage, said Assemblyman Gary S. Schaer, a Passaic Democrat who chairs the Assembly Budget committee and helped draft the “The Out-of Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” to be introduced today at a noon news conference.
But he pointed to the high-ranking Democrats who drafted the legislation, including state Sen. Joseph Vitale, chairman of the Senate Health Committee, and Assemblyman Craig Coughlin, chairman of the Assembly committee in charge of health insurance, both Wood-bridge Democrats — as well as Assemblyman Troy Singleton of Mount Laurel. Schaer is chairman of the Assembly Budget Committee.
Most lawmakers are expected to agree, he said, that “significant remedial action needs to be undertaken to tackle this issue, which contributes a lot to the rise in health-care costs,” as well as bankruptcies among state residents.
An important way insurance companies control costs is by negotiating contracts with hospitals, doctors, and other health-care providers who agree to accept their reimbursement and become part of their network. Some health plans include coverage for care received from providers who are not part of the insurer’s network.
The out-of-network charges billed by some New Jersey hospitals are among the highest in the country, and insurers say that they drive up premiums for everyone. In addition, patients who receive care from hospital-based physicians – over whom they have no choice – often are surprised to learn that they were out-of-network providers and charge much more than expected.
New York health insurer Oscar to pay members who walk more
By Caroline Humer
Mon Dec 8, 2014 2:10pm EST
(Reuters) – Oscar Health Insurance, which sells health plans on Obamacare exchanges in New York and New Jersey, said it will pay members up to $240 per year in Amazon.com Inc gift cards for the thousands of steps they take each day.
The plan is the latest effort by venture-capital backed Oscar to distinguish itself in the individual insurance market, where it is rare to offer members incentives to improve their health. Employer-sponsored health plans regularly use incentives such as lower premiums or higher contributions as part of their “workplace wellness” programs.
Oscar made its debut in New York last year with the rollout of President Barack Obama’s Affordable Care Act, and now has 17,000 members. The national healthcare law bars insurers in the individual market from discriminating against consumers on the basis of their relative health or age, and provides subsidies for low-income households to buy coverage.
https://www.reuters.com/article/2014/12/08/us-usa-healthcare-oscar-idUSKBN0JM25F20141208
Some doctors wary of taking insurance exchange patients
Now that many people finally have health insurance through the Affordable Care Act exchanges, some are running into a new problem: They can’t find a doctor who will take them as patients.
Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.
“The exchanges have become very much like Medicaid,” says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business very long.”
Kleinman says his members complain rates can be 50% lower than commercial plans. Cigna and Aetna, however, say they pay doctors the same whether the plan is sold on an ACA network or not. United Healthcare spokeswoman Tracey Lempner says it’s up to their physicians whether they want to be in the exchange plan networks, which have “rates that are above Medicaid.” Medicaid rates are typically below those for Medicare, which in turn are generally lower than commercial insurance plans.To prevent discrimination against ACA policyholders, some insurance contracts require doctors to accept their exchange-plan patients along with those on commercial plans unless the doctors’ practices are so full they simply can’t treat any more people. But lower reimbursement rates make some physicians reluctant to sign on to some of these plans or accept too many of the patients once they are in the plans.
Upstarts join New Jersey health insurance market dominated by big three
OCTOBER 12, 2014, 11:00 PM LAST UPDATED: SUNDAY, OCTOBER 12, 2014, 11:03 PM
BY LINDY WASHBURN
STAFF WRITER
THE RECORD
For decades, the world of health insurance in New Jersey has been dominated by huge companies with billions of dollars in assets and millions of customers. But later this year, residents who shop for their own insurance will have a choice of two new companies — one launched by young tech entrepreneurs and the other a non-profit cooperative.
The two upstarts are Oscar Insurance, the brainchild of Joshua Kushner, scion of the Kushner real estate fortune, and Health Republic Insurance of New Jersey, conceived by the Freelancers Union, an association of independent workers, and funded with loans from the federal government. If they succeed, they may just goad the traditional behemoths of insurance into a different way of doing business. And by increasing the competition for people who buy their own coverage, they may already be helping to hold down premiums.
“These innovative new entrants are shaking things up for the entire industry,” said Ceci Connolly, managing director of PriceWaterhouseCoopers’ Health Research Institute, which recently released a report asking, “Who will be the [health care] industry’s next Amazon.com?”
– See more at: https://www.northjersey.com/news/upstarts-join-new-jersey-health-insurance-market-dominated-by-big-three-1.1107824#sthash.VaD64Zjx.dpuf
OK Missed the Deadline Where You Can Buy Health Insurance After Today
Amy Payne
March 31, 2014 at 6:30 am
UPDATE (April 2): We wrote on March 31 (below) that Americans would still be able to buy health insurance in the individual market—outside Obamacare’s exchanges—after the Obamacare deadline. The Associated Press reported the same thing on April 1:
Buyers can always go directly to an insurance company, but it may be expensive. Plans bought outside the marketplaces don’t come with government subsidies that hold down the cost for people with low or mid-level incomes. But they do include the law’s consumer protections. For example, insurers can’t turn down customers because of pre-existing medical conditions.
Even after the deadline, buying a plan that meets the law’s essential coverage standard reduces the penalty owed, which is based on the number of months without coverage.
When the law was passed, Obamacare indicated that insurance companies offering coverage in the individual market would have the leeway to determine their own enrollment periods, if desired. But now that the open enrollment period has closed for the Obamacare exchanges, it appears that in most states, so has enrollment in the individual market.
Our staff visited eHealthInsurance.com, where individual policies are usually available, testing one ZIP code for every state. For all but two states, we received this message: “Now that the Open Enrollment Period (OEP) has ended, you’ll need to experience a qualifying life event to enroll in a qualified health insurance plan.” (Qualifying life events include marriage, loss of a job, and the birth of a child, for example.)
In these early days of April, Oregon and Nevada were the two states where policies were still available for purchase. We know that the Oregon Obamacare exchange extended its signup deadline to April 30 because of its own website woes.
It makes sense for insurers to follow the same enrollment period as Obamacare, because one of the law’s mandates is that insurers must issue a policy to anyone at any time, regardless of pre-existing conditions. Observing a set enrollment period makes it more difficult for people to wait until they are sick to buy coverage.
Note: People who are eligible for Medicaid and the Children’s Health Insurance Program (CHIP) can apply for those programs year-round.
The original post follows.
Photo: AFP PHOTO/MANDEL NGAN/Newscom
Today is kinda-sorta the deadline to sign up for Obamacare, though if you want to say you’re “in line” for coverage, the administration is okay with that. (If your state is running its own Obamacare exchange, it may be keeping its deadline firm, so check with your state.)
When we wrote about the Obamacare deadline and penalty recently, a reader brought up a great question: Can you still buy health insurance after March 31?
She asked, “If I chose to go uninsured, but end up with a massive medical issue,” could she “just buy insurance and be covered, you know, since they must cover pre-existing conditions”?
The answer is yes. If you don’t have Obamacare-compliant health insurance by today, you could pay the penalty for this year—depending on the amount of flexibility the administration decides to offer in its latest delay—or you could still purchase a policy anytime in the individual market outside the Obamacare exchanges. The amount of time you go without coverage determines your penalty—or as the IRS calls it, your “shared responsibility payment.”
Under Obamacare, the new pre-existing conditions rule means that you can wait until you develop a health problem to get your policy. This isn’t great for the system, because healthy people’s premiums are needed to pay for the sick people. So if fewer healthy people buy health insurance, the system has a problem.
That’s why the Obamacare system has a mandate forcing everyone to buy insurance, a (somewhat) set enrollment period, and a financial penalty to back it up.
If you don’t already have employer-sponsored insurance or coverage through a government health program, your options are the Obamacare exchange or the individual marketplace. Policies in both have to comply with all of Obamacare’s rules and benefit mandates, so the big difference is the taxpayer-funded subsidies.
The subsidies are supposed to be the big draw of the Obamacare exchanges—but it turns out they aren’t as simple as they seem. And holding onto a subsidy can encourage people to stay stagnant in a job—or worse, not seek employment. As Heritage experts have explained and the Congressional Budget Office has confirmed, “The law gives millions of Americans new incentives not to work—or not to raise their income levels—because they may lose federal insurance subsidies.”
Today’s deadline marks the end of the open enrollment period to buy subsidized coverage in the exchange. Enrollment for subsidized coverage doesn’t officially start again until November 15 of this year.
As we’ve noted, however, there are now quite a few ways you can qualify for an exemption from the individual mandate, in addition to the new box you can supposedly check on HealthCare.gov to indicate that you need more time to sign up.
Whether it’s your state or the federal government running your nearest Obamacare exchange,the goal remains the same. Heritage experts Robert Moffit and Ed Haislmaier described the transition from the old individual market to “private coverage in name only”:
The primary goal of the Obamacare exchanges is to establish federal control over state health insurance markets by enforcing new federal insurance rules and requiring federal standardization of health benefits.
And policies in the remaining individual market must, by law, look exactly the same. You can buy them anytime, but the benefit design isn’t likely to be much different. (Just watch how long you go without coverage, or the penalty for being uninsured will kick in.) Obamacare doesn’t improve on the old health insurance market—which is why we need patient-centered reformsthat give people more choice.