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June 26, 2015

SCOTUS Upholds ACA Tax Credits in 6-3 Decision

The Supreme Court has upheld a key provision of the Affordable Care Act allowing federal tax credits for those who are eligible and enrolled in health plans through the federal insurance marketplace.  Chief Justice John Roberts joined the majority in a decision that has been eagerly anticipated for months.

If the provision had not been upheld, Americans in the 34 states that have federally-facilitated exchanges would have lost tax credits that make coverage more affordable for those who are eligible.  (New York is one of 14 states that have their own exchanges, so the tax credits would not be affected.)

Justice Scalia wrote the dissenting opinion and was joined by Justices Alito and Thomas.

Read more here or get the full transcript here.

April 20, 2015

CMS Rates Hospitals

The Centers for Medicare and Medicaid Services has surveyed adult patients after a stay in the hospital to ask their opinions and to give star ratings based on 11 aspects of patient experience including how well their pain was relieved, staff communication with patients and whether they would recommend the hospital to others.  To see how hospitals in your state rated, click here.

Read more.

November 10, 2014

SCOTUS Agrees to Hear Challenge to ACA Subsidies

The Supreme Court has accepted the case of King v. Burwell which challenges the Federal subsidies received by those who enroll in an insurance plan through the Federal Exchange.  The Affordable Care Act (ACA) language provides for subsidies (in the form of tax credits) for those who obtain coverage through state-run exchanges.  It does not specifically state that the subsidies are also allowed in the Federal Exchange for people who live in states that did not establish an exchange.  Supporters of the law argue that the language can be interpreted in different ways, while opponents see the subsidies that millions of Americans have received as illegal.

Arguments in the case should begin in March of 2015 with a decision expected by July.  Read more

August 22, 2014

The Individual Coverage Mandate

The Affordable Care Act requires individuals who do not obtain health coverage and are not eligible for an exemption to pay a penalty beginning in 2014. The penalty is the greater of $95 or 1% of applicable income and increases each year. For more information, click here.

July 1, 2014

Supreme Court Rules on ACA Contraceptive Mandate

The U.S. Supreme Court ruled on June 30, 2014 that the Affordable Care Act (ACA) requirement that employer-provided health plans include certain contraceptive coverage without cost-sharing violates the Religious Freedom Restoration Act (RFRA).

The ruling applies only to “closely held corporations” that object to the mandate based on religious beliefs.  It does not apply to publicly traded corporations or to any other insurance coverage mandates.   Such corporations cannot be required to provide contraceptive services that are contrary to their religious beliefs. (Religious non-profit organizations are already exempt from providing contraceptive services that violate their religious beliefs, and their employees still have access to the same contraceptive services and coverage as those of non-objecting employers.)

For more information, you read the text of the ruling on www.supremecourt.gov under Burwell v. Hobby Lobby Stores, Inc.

May 12, 2014

Updated COBRA Notice for Employers

All employers are required to inform their employees of COBRA and options to continue health insurance after a qualifying event causes loss of coverage. 

The Department of Labor has issued a revised COBRA Model Election Notice for employers to distribute to employees who are terminated or lose coverage due to a qualifying event. The new notice includes information on the option to obtain coverage through the Health Insurance Marketplace (aka The Exchange) rather than to continue on the employer group plan.  Depending on income and other eligibility requirements, a lower cost option may be available through the online Marketplace. In New York, the nystateofhealth.ny.gov site has information on plans available to individuals and their families.

April 8, 2014

NY State of Health 2014 Enrollment

The deadline for individuals to enroll in a health plan through the New York State of Health online insurance marketplace was March 31, 2014. According to the site, 865,487 people have enrolled in plans.  Others who have started the process but encountered difficulties may be eligible to complete the enrollment process by April 15th.  Difficulties include:

  • Technological Issues
  • Customer Service Center delays
  • Delay in getting an appointment with an assistor
  • Trouble with identity proofing

Media outlets report that roughly half of the enrollment numbers are Medicaid coverage and the other half private insurance.  Nationally, President Obama announced that 7.1 people have enrolled.

Those individuals who want to enroll through the New York exchange before this fall’s open enrollment period must have a qualifying event such as marriage, having a baby, loss of coverage, or moving to a new area. (Medicaid-eligible individuals can enroll at any time, and children can also obtain coverage at any time.) Open enrollment begins November  15, 2014 for coverage beginning January 1, 2015.  For more information go to: www.nystateofhealth.ny.gov

October 3, 2013

Obamacare vs. the Affordable Care Act?

Making the rounds on social media is a video showing people being interviewed on their views regarding Obamacare and the Affordable Care Act (ACA).  Highlighted respondents, unaware that the two are synonymous, pan Obamacare and eagerly support the ACA.

While it makes us laugh, the video illustrates not only our ignorance about the law but how easily we are influenced by partisan spin doctors.  It’s a good reminder for us to educate ourselves about the Affordable Care Act by researching reputable sources that are neither blindly in support of nor firmly against the law.  Learn the facts then decide what is best for you and your family. 

August 13, 2013

Limit on Out of Pocket Costs Delayed Until 2015

A major consumer protection provision in the Affordable Care Act has been delayed until 2015.  The limit on out of pocket costs, which was supposed to be implemented for 2014, was slated to be $6,350 for an individual and $12,700 for a family.  The one year grace period for insurers stems from problems combining medical and prescription benefits that are administered by separate companies.

Read more

July 17, 2013

Employer Mandate Penalty Delayed Until 2015

  • On July 2, 2013 the Department of the Treasury announced that the health reform law’s employer shared responsibility payments will be delayed until 2015.  On July 9, 2013, the IRS released Notice 2013-45 with further guidance on the delay.
  • The payments, which are also called “employer mandate penalties”, will be assessed by the IRS against large employers (with 50 or more employees) who don’t offer medical coverage or offer coverage that is deemed unaffordable.
  • Although information reporting by employers and health insurers regarding employer-sponsored coverage will not be mandatory until 2015, the mandate itself still applies, and large employers are encouraged to maintain or expand medical coverage in 2014.
  • As of now, other provisions of the PPACA will be implemented in 2014 as planned including:
    • The individual mandate that all U.S. citizens and legal residents purchase medical insurance (although the IRS has relaxed the income verification requirement)
    • The New York State Health Benefit Exchange will begin enrollment in October of 2013 for January 2014.  Employers are required to provide notice of the exchange to employees by October 1, 2013.
    • All medical insurance plans must offer the Essential Health Benefits.
    • Eligibility waiting periods for coverage are limited to 90 days.
    • Summary of Benefits and Coverage (SBC’s) must be provided to employees who are eligible for medical coverage.

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