Senators Push Carriers to Ease Coverage Rules for Vegas Victims

Reprinted from HEALTH PLAN WEEK, the most reliable source of objective business, financial and regulatory news of the health insurance industry. 

By Diana Manos, Senior Reporter

October 30, 2017 Volume 27 Issue 38

Two senators are pushing America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) to intervene in claims issues following the Oct. 1 Las Vegas shooting, which left 59 dead and more than 500 injured. But the request is difficult to comply with and somewhat out of the norm when it comes to claims practices following a disaster, says one insider.

Chantel Sheaks, a director at PwC who specializes in benefits, tells AIS Health that she has not encountered health plans doing what the senators have requested. “I have never heard of this, and I find it difficult on how you would actually verify,” she says. “Also, most policy documents would not provide for this, and I think it would be difficult to amend the policies and file with the states.”

Sens. Catherine Cortez Masto (D-Nev.) and Dean Heller (R-Nev.) argue in their Oct. 12 letter to AHIP CEO Marilyn Tavenner and BCBSA CEO Scott Serota that many of the victims had traveled to Las Vegas from other states and will need help from health plans to deal with potential out-of-network charges, copays and deductibles for the care they received following the shooting.

“[W]e fear that victims of this tragedy currently seeking badly-needed health care in the community could be hit with costly, out-of-network charges,” the senators said. “It is our hope that insurance companies will fully comply with the spirit of the Public Health Service Act and do whatever they can to support recovering families and waive any charges that may typically apply.”

Masto and Heller acknowledged that health plans have already set terms on copays and deductibles, but asked them to “thoroughly review these policies in light of the extenuating circumstances faced by victims and their families.”

The senators also encouraged insurers to consider additional initiatives that could ease “the costly burden of health care for victims of this tragedy.”

AHIP spokesperson Cathryn Donaldson says the organization has not yet completed its response to the inquiry. In the interim, she tells AIS Health, “We offer our sincere condolences to the families and friends of the victims and those injured in this horrific, tragic event. Health plans have extensive experience with emergency and disaster situations, and have procedures in place to meet consumers’ needs immediately and in the long term. With each crisis, plans coordinate with local, state, and federal officials to ensure access to care is protected for Americans affected by these events.”

“We are reaching out to our member plans to evaluate the potential impact and to learn more about additional efforts they are taking to support those in need. This includes outreach beyond our Nevada plans, as many of the victims traveled to Las Vegas from other states and therefore will need follow up care in their own communities,” Donaldson says.

In September, health plans in Texas responded to a call from the Texas Dept. of Insurance following Hurricane Harvey to “waive penalties and restrictions” on enrollees when they get “necessary emergency and nonemergency health and dental services out-of-network as a result of the disaster” (HPW 9/4/17, p. 1). Amerigroup Texas, which covers about 850,000 low-income Texans, eased provider network restrictions for its members, while Cigna Corp. and Aetna Inc. allowed members to renew prescriptions early.

Karen Kees, a spokesperson for the Florida Office of Insurance Regulation, tells AIS Health that the Florida agency did not issue a request for health plans to ease restrictions following the June 2016 mass shooting in the Pulse night club in Orlando, which killed 49 and wounded 58.

BCBSA did not respond to queries from AIS Health about the inquiry.

Read the Masto-Heller letter at http://bit.ly/2xhuzGW.

https://aishealth.com/archive/nhpw103017-03?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=119691232

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Quote of the Day

"In general, auto-assigned beneficiaries are not actively interested in care coordination from their drug plan — if they were, they'd likely opt to enroll in Medicare Advantage. These beneficiaries often view their drug plan as a vehicle to pay for their medications."

— Melissa Smith, vice president, stars and quality innovations, Gorman Health Group LLC, tells Drug Benefit News that Medicare Prescription Drug Plans lack the connection with beneficiaries needed to improve star ratings.

Straight Talk for Seniors®: The House Tax Reform Plan & Older Americans

By Howard Bedlin | 11.7.2017

Congress and the White House have turned their attention to major tax reform, and the bill being debated in the House would have a significant impact on Americans of all ages, including seniors.

The House Ways and Means Committee is expected to vote on the Tax Cuts and Jobs Act (HR 1) this week, with a floor vote expected by Nov. 16.

As with this year’s efforts to repeal the Affordable Care Act, the House will not hold any hearings on the bill before a vote. And the same budget reconciliation process will allow the Senate to pass a bill with a simple majority, without any Democratic support.

The goal is to have a bill ready for the President to sign by Christmas—much faster than any previous action ever taken on major tax reform.

What’s in the bill

NCOA and advocates for older adults are most concerned about how the bill would impact the federal deficit. It includes $5.5 trillion in tax cuts, yet it pays for only a portion of them, largely by increasing other taxes. An estimated $1.5 trillion in tax cuts over 10 years are notpaid for.

Increasing the deficit by such a large amount will result in major cuts to Medicare, Medicaid, and discretionary programs like the Older Americans Act—and may even be used as an excuse to cut Social Security. Roll Call interviewed several House Budget Committee members and fiscal conservatives, and “all said they anticipate mandatory spending cuts being a priority for the fiscal 2019 budget reconciliation process.”

NCOA and senior advocates also are concerned with the proposed repeal of the Medical Expense Deduction, which allows taxpayers to deduct qualifying expenses above 10% of their adjusted gross income. Almost 5 million taxpayers aged 65+ use the deduction to reduce potentially bankrupting out-of-pocket medical expenses, such as paying for expensive nursing home care, which averages over $97,000 annually for a private room. Repealing the deduction could also increase Medicaid costs, by accelerating the spend-down process.

Other provisions in the bill would:

·         Collapse the number of income tax brackets from seven to four—12%, 25%, 35%, and 39.6%—reducing revenues by $1.09 trillion over 10 years

·         Double standard deductions from $6,350 to $12,000 for individuals and $12,700 to $24,000 for couples—reducing revenues by $921 billion over 10 years

·         Reduce corporate tax rates from 35% to 20%—reducing revenues by $1.46 trillion over 10 years

·         Repeal current $4,050 per-household-member personal exemptions—increasing revenues by $1.09 trillion over 10 years

·         Double the estate tax exemption from $5.5 million to $11 million and eliminate it in 2024—reducing revenues by $172 billion over 10 years

·         Repeal the Alternative Minimum Tax—reducing revenues by $696 billion over 10 years

·         Cap home mortgage interest deductions at $500,000 vs. the current $1 million

·         Limit deductions for state and local taxes by only allowing property tax deductions up to $10,000.

An estimated 45% of the tax cuts in 2027 would go to households with incomes above $500,000 (fewer than 1% of filers).

On the positive side, the bill would maintain:

·         Retirement savings incentives such as 401(k)s and Individual Retirement Accounts

·         The charitable contribution deduction for donations to charities and nonprofit organizations

·         The Earned Income Tax Credit, which provides important tax relief for low-income working Americans

·         The Low-Income Housing Tax Credit that encourages businesses to invest in affordable housing

See a summary of the bill.

The path ahead

Most Republican members of Congress who have historically opposed large deficits are expected to support the bill. Very few or no House Democrats are expected to back it.

Meanwhile in the Senate, the Senate Finance Committee, chaired by Sen. Orrin Hatch (R-UT), may release its tax bill later this week, and there are expected to be some differences from the House version. It’s unclear whether the committee will consider the bill before or after Thanksgiving.

Once the House and Senate approve the legislation, any differences will need to be negotiated, after which votes will be taken on identical bills.

Stay tuned for more details as they emerge, as well as opportunities to take action.

https://www.ncoa.org/blog/straight-talk-seniors-house-tax-reform-plan-older-americans/?utm_source=newsletter&utm_medium=email&utm_campaign=11072017_NCOAWeek

Is it Medicare or Medicaid?

Posted on November 16, 2017 by Jim Borland, Acting Deputy Commissioner for Communications

A lot of people have a difficult time understanding the difference between Medicare and Medicaid. Both programs begin with the letter “M.” They’re both health insurance programs run by the government. People often ask questions about what Medicare and Medicaid are, what services they cover, and who administers the programs.

Let’s start with Medicare. Medicare is the earned-benefit program for Americans aged 65 or older or disabled. Workers pay into Medicare throughout their working years. The Centers for Medicare & Medicaid Services is the agency in charge of both Medicare and Medicaid, but you sign up for Medicare A (Hospital) and Medicare B (Medical) through Social Security.

You can apply for Medicare online from the convenience of your home at the link on our website: www.socialsecurity.gov/medicare/. If you’re already receiving Social Security retirement benefits when you reach age 65 or are in the 25th month of receiving disability checks, we will enroll you automatically.

Medicare Part C (Medicare Advantage) and Part D (Prescription Drug) plans are available for purchase in the insurance marketplace. Social Security administers a program called Extra Help to help people with low income and low resources pay for premiums, co-pays, and co-insurance costs for Part D plans. You can find out more about Extra Help and file for it at www.socialsecurity.gov/medicare/prescriptionhelp. Each year, The Centers for Medicare & Medicaid Services publishes Medicare and You available online at their website at www.medicare.gov/medicare-and-you/medicare-and-you.html. This publication is a user’s manual for Medicare.

Each state runs its own Medicaid program under guidance from the Centers for Medicare & Medicaid Services. Medicaid offers care for the most vulnerable among us. While it does not require paying taxes while working, it does have guidelines about how much income and resources you can have to qualify. Medicaid provides coverage for older people, people with disabilities, and some families with children. Each state has its own eligibility rules and decides which services to cover. The names of the Medicaid program may vary from state to state. You can read about each state’s Medicaid program at www.medicaid.gov/medicaid/by-state/by-state.html. You can find each state’s Medicaid contact information at www.medicaid.gov/about-us/contact-us/contact-state-page.html.

Medicare and Medicaid are two of the major insurance programs that provide healthcare to the American public. Understanding each program, as well as how the two programs differ, can help you and those you care about find the right healthcare program.

https://blog.socialsecurity.gov/is-it-medicare-or-medicaid/

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