Group Health Insurance in Texas

The Problem

Texans, who have individual health insurance coverage through the Affordable Care Act (ACA), have noticed they have only two carrier options to participate in Preferred Provider Organization (PPO) networks: Humana and Baylor Scott and White. Humana has one PPO plan that is a $6450 high deductible health plan (HDHP). Baylor Hospital merged with Scott and White Insurance Company to form, “Baylor Scott and White”. This duo offers an array of PPO as well as Health Maintenance Organizations (HMO) health policies. Outside of these two companies, all other plans offered by Aetna, Blue Cross Blue Shield, Cigna, Coventry and United Health Care are Exclusive Provider Organizations (EPO) and HMOs.

The Story

Lets assume that a doctor can only see 10 patients a day. The doctor has a pre-negotiated rate with PPO networks of $100/patient. The negotiated rate with HMO networks is $50/patient. If a doctor accepts 10 patients/day that are PPO plans, a doctor will make $1000/day. If a doctor accepts 10 patients/day that are HMO plans, a doctor will make $500/day. If half the doctor’s patients have HMO plans and the other half, have PPO plans, the weighted average is $750/day. Currently, only group health insurance in Texas offer PPO plans. Therefore, doctors must know their patient population before refusing a HMO patient. If a doctor’s patient population is made of 50% Individual health insurance policies and HMOs are dropped, the doctor’s daily income will drop to $500/day. On the other hand, if his patient population is all businesses that have group health insurance in PPO networks, the doctor’s income will be $1000/day. As a result, doctors must know patient populations before refusing HMOs. Understanding this make up could take as long as 6 months to a year, depending on his patients annual scheduled visits to a doctor. As a result, if doctors blindly refuse to accept HMOs, this could reduce daily income by 50% or more.

The Location

This has left many Texans in a jam, especially if they live in rural areas of the state where only one Carrier Company is present. As an example, Blue Cross Blue Shield of Texas is the only health carrier represented in all 254 counties in Texas. Blue Cross Blue Shield is the only carrier in Wichita Falls, Texas. As a result, if doctors in this city only accept PPOs, then people with individual coverage have no local usable medical insurance. They must travel to a nearby city where more than one Carrier Company operates to obtain medical care from a doctor or facility that will accept HMO or EPO plans.

The Partial Solution

One solution to this problem is temporary health insurance for Texans. Some carriers such as Cigna and Health Insurance Innovations have short-term health insurance plans. These plans last for as long as 360 days or as short as 30 days and are not guarantee renewable. They can be obtained anytime throughout the year, but are not considered qualified health plans that meet the Affordable Care Act mandates. Short-Term plans are considered full coverage, but leave out three of the Ten Essential Health Benefits, which are required by the Affordable Care Act. The three excluded benefits are: maternity, mental health and pediatric dental and vision coverage. Choosing this plan over an ACA plan will trigger a fine, but will give full PPO coverage which most doctors accept.

The Permanent Solution

A permanent solution for the acceptance of individual health insurance in Arlington or individual health insurance in Fort Worth is for doctors to accept HMO plans. HMO plans have been a long fixture in states such as California. HMOs have always been used to manage care, especially with companies such as Kaiser Permanente and Blue Cross Blue Shield of California. As doctors continue to lose revenue by not accepting HMO plans, it is expected that most doctors in Texas will slowly give in to manage care networks. This may span six months or a couple of years, but it will eventually happen.

Insurance4Dallas

(I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online, including Group Health Insurance in Texas. I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service. Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online. I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service. Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy.

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What’s in an Affordable Care Act Policy

The “Patient Protection and Affordable Care Act” or ACA for short and also known as Obamacare, affects all health insurance policies.  This would include large and small group health insurance as well as individual policies.  All ACA policies have no dollar limits on benefits, no pre-existing condition clauses that would reduce the quality or quantity of care and have mandated, “Ten Essential Heath Benefits” included in each policy.  The Ten Essential Health Benefits are:

  • Hospitalization
  • Prescription Drugs
  • Emergency Services
  • Laboratory Services
  • Ambulatory Patient Services
  • Maternity and Newborn Care
  • Pediatric Dental and Vision Care
  • Rehab and Facilitative Services & Devices
  • Preventative, Wellness & Chronic Disease Management
  • Mental Health, Substance Abuse and Behavioral Health Treatment

Policy rates are determined on three characteristics; age, zip code and tobacco use.  Therefore, no one can be declined coverage based on health.  In addition, adult children can remain on their parent’s policy until their 26th birthday.   When looking for a plan, you must first understand when to apply, the categories of insurance, the definitions of networks, subsidies, cost sharing, Out-of-Pocket expenses and how they function.  Even though the ACA affects all policies, this article will focus on individual policies, especially in high populated areas in Texas such as Dallas health insurance, Arlington health insurance and Fort Worth health insurance.  These areas were singled out in Texas because there will be many changes in the type of networks and metal plans.   Open Enrollment vs. Special Enrollment Period   The Health Insurance Marketplace Exchange has open enrollment between November 1st and January 31st of each year.  The effective day of coverage starts on January 1st if the application is completed before December 15th.  If the application is completed between December 16th and January 15th, the effective day of coverage would start February 1st; and if the application is completed between January 16th and January 31st, the effective day of coverage will be March 1st.  This will be the only time to acquire an individual health insurance policy unless you have a Qualifying Life Event.  There are several Qualifying Life Events such as job loss, marriage, childbirth, divorce, or a move from another state to name a few.  The sign up period for a Qualifying Life Event is 60 days from the time of the event.  This is known as a Special Enrollment Period or SEP for short.  SEPs are year round for individual coverage. Persons’ starting a new job that offers health insurance has 60 days to be insured through that job.  Once leaving a job, a person has 60 days from the day of termination to acquire health insurance.  Outside of this window, you will have to wait until Open Enrollment to acquire an individual insurance policy.   Subsidies, Cost Sharing and Out of Pocket Expenses A subsidy is when the Federal Government contributes to the payment of premiums based on household income.  Cost Sharing is when your deductible is lowered or eliminated based on household income.  A co-pay is the set amount an insured individual must pay for a benefit such as Doctor’s office visits or prescription drugs.  Co-insurance is the percentage of covered expenses an insured individual shares with the insurance company after the deductible is paid.  Total Out-of-Pocket expense will include all of your expenses associated with the policy with the exception of monthly payments.  This includes the deductible, co-payments and co-insurance.  Applications submitted to the Health Insurance Market Place will be eligible for a subsidy, cost sharing and a reduction in the total Out-of Pocket expense based on house hold income. The Metal Tiers of Insurance The Marketplace has divided insurance plans into categories.  The health plan category you choose determines how you and your selected plan will share the costs of care. These categories have nothing to do with the quality or amount of care you get. There are 5 categories or “metal levels” of coverage in the Marketplace. Plans in each category pay different amounts of the total costs of an average person’s care. This takes into account the plan’s monthly premiumsdeductiblescopaymentscoinsurance, and out-of-pocket maximums. The actual percentage you’ll pay in total or per service will depend on the services you use during the year.

  • Bronze: Your health plan pays 60% on average. You pay about 40%.
  • Silver: Your health plan pays 70% on average. You pay about 30%.
  • Gold: Your health plan pays 80% on average. You pay about 20%.
  • Platinum: Your health plan pays 90% on average. You pay about 10%.
  • Catastrophic: Catastrophic coverage plans pay less than 60% of the total average cost of care. They’re available only to people who are under 30 years old or have a hardship exemption.

All of this information are things to keep in mind when purchasing Health Insurance on the exchange.   This is very important as networks change in Texas. Insurance4Dallas, (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online.  I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service.  Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy.

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Obamacare Affects Arlington, Desoto and Fort Worth Texas Health Insurance Reimbursements

More people have insurance but less people can see a doctor.  It’s because doctors are not taking many of the insurance plans offered on the Health Insurance Exchange.  This is not to say doctors are not accepting any of the insurance plans from the exchange, but many on-exchange plans doctors exclude.

Most doctors are members of one, two or all of the following networks; Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO) and/or Point of Service (POS).  On-exchange and off-exchange plans use these networks.  However, many of the on-exchange plans have low reimbursement rates to doctors.  Low rates make on-exchange plans attractive to Health and Human Services (HHS), the administrators of health plans, but unattractive to doctors.  HHS uses these plans to provide health insurance subsidies to low income un-insured persons.  As a result, many doctors view on-exchange plans as money losers.  Let’s examine why.

Hypothetically, if doctors have eight hours a day to see 10 patients and each patient is on a plan paying the maximum allowable for a particular procedure, the doctor will maximize income and cover expenses with each patient.  However, if patients are injected into a doctor’s schedule with lower reimbursement rates, doctors will make less.  This will happen more than less, for the number of persons having on-exchange plans will be greater than the number with off-exchange plans.  In Texas, there are still millions of uninsured residents who would qualify for a subsidy.  As Texas residents receive subsidized plans, many will have health insurance with few doctors participating in the networks.  As for these doctors who do accept on-exchange plans, their queue will increase for their numbers are few.  This is most probable in neighborhoods with minorities, many of which live in Arlington, Fort Worth and Desoto Texas who may be most susceptible to subsidies.

One way to mitigate this issue is to increase the number of facilities that accept patient care and do not use doctors, but physician assistants (PAs) and/or nurses.  This patient care model is occurring in pharmacies such as CVS, Wallgreens and Wallmart.  These establishments administer care for minor ailments that may not need a doctor.  They focus on sicknesses such as colds, fevers, ear aches and other minor illnesses.  This patient care model freezes resources at doctor offices for major illnesses and injuries.  Also, this model reduces costs, for hourly rates in these facilities are less.

Another way to increase the number of persons receiving treatment is “increase reimbursement rates to doctors”.  This will encourage doctors to accept all insurances.  However, by doing this the medium used to extract money for subsides such as taxes on – group health insurance policies and fees on manufactured medical devices will increase. These fees and taxes are already being contested and lobbied against in the US Congress.

Finally, a third way to reduce doctors’ costs is to eliminate doctors’ student loans, thereby making reimbursement rates reasonable.  Doctors need high reimbursement rates to cover expenses.  Some expenses include financed student loans totaling $250,000 or more.  Reduce this expense and reimbursement rates will follow.

This brings us back to the title of this article, “Obamacare Affects Arlington, Desoto and Fort Worth’s Health Insurance”.  In the long run, Arlington health insurance, Desoto health insurance, and Fort Worth Health insurance  can all receive positive effects from more persons being insured.  If each suggestion to reduce cost mentioned above is endorsed, the cost of care would be steady; with more doctors accepting on-exchange insurance plans.  Overall, this would reduce the cost of insurance.  Persons who may have used the emergency room will now have access to a primary care physician; routine physicals will discover chronic illnesses early, thereby reducing the cost of treatment and increasing the quality of care.  To interject a positive note, health insurance in Arlington, Desoto and Fort Worth Texas could ultimately be in good shape in the years to come if changes are made to the overall system.

Insurance4Dallas, (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online. I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service. Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy.

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Arlington Texas uses Christian Organization to Provide Health Insurance as an ACA Alternative

Many Christians have found an alternative to federally mandated insurance, but it required a leap of faith.

This group of Christians is part of a small but fast-growing number of people who have joined healthcare sharing religious alternatives to replace federally mandated insurance in which members pool monthly payments to help cover one another’s medical expenses. So, unlike most uninsured Americans, the Believers did not have to buy health insurance in Arlington TX or risk a fine under the Affordable Care Act (ACA).

The cost to give birth in a hospital is roughly $10,000, with costs all taken care of. These healthcare networks, which have been around for more than two decades, are seeing a jump in membership, particularly among believers who object to some of the requirements of the healthcare law.

The purpose of the organization is for Christians to come together and support each other when needed most, says one of the director’s of membership development for Samaritan Ministries, a network that includes members in Arlington, Texas.

To join, members promise to abide by a lifestyle that includes frequent church attendance, little drug or alcohol use, and absolutely no premarital or gay sex. Monthly fees at Samaritan range from under $200 for an individual to around $400 for a family, with members paying $300 of their first dollar amount covering their out of pocket expenses for medical bills.

Samaritan members send medical bills to the ministry, which in turn directs other members to mail their monthly payments to the person in need. If there is not enough money available in a given month, members receives a percentage of their request and hope to be reimbursed later when there is more money to go around.

There are disadvantages. The organizations are largely unregulated because they are not considered insurance groups, though federal officials often refer to them as “optional health insurance organizations.” In addition, members are essentially putting their conviction, and medical bills, in the hands of the network without assurances that they will be paid. Most members also face a lifetime cap of $250,000 per medical condition — an amount that can be easily spent if a person is seriously injured or faces a long-term illness.

Four of the largest Christian Healthcare Organizations in operation since 1999, including Samaritan, qualify as alternatives to insurance under the federal health law, according to the federal Centers for Medicare and Medicaid Services.

As of April of 2015, over 18,200 Texans are members said Glenn Hegar, the Texas comptroller and a Republican state senator who has tracked the Christian healthcare organization. Samaritan’s membership alone has grown more than 30 percent since 2013. Those figures pale in comparison to the more than 700,000 Texans who signed up for private insurance on the federal exchange, and the roughly 1 million uninsured Texans whose incomes are too low to receive subsidies on the exchange because the state declined to participate in an expansion of Medicaid.

Many Christians join Samaritan from recommendations from different faith based Christian churches’, with most being in good health. They may get additional vision and dental insurance from a jobs group health insurance plan.

Members know they are expected to pay for services like yearly checkups.“You’re dealing with like-minded people who are committed to this concept of helping each other out,” say a Senior Samaritan official. “They don’t have to be supporting something that is in conflict with their values. That’s big.”

Many Samaritan members do not care for the Affordable Care Act because they are uncomfortable paying into an insurance plan that covered services, like some forms of contraception, that objects to their religious beliefs. The ACA insurance mandate opened their eyes to a Christian alternative. Samaritan member concerns echo a national discussion about the government’s role in regulating health coverage for people with diverse religious beliefs. Last June, the U.S. Supreme Court ruled that the federal health law could not force family-owned corporations with religious objections to pay for insurance coverage of contraception.

In June of 2015, the Supreme Court will rule on legality of government subsidies to states that do not have State run exchanges.  If the court rules against the government run exchanges, this in itself could make the Samaritan plan that more mainstream.

Insurance4Dallas, (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online.  I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service.  Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy.

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IRS TO DELAY REPORTING GROUP HEALTH INSURANCE MANDATES FOR EMPLOYERS IN 2015

Dallas, Texas, MAY 11, 2015 – At the start of January 2014, the Affordable Care Act required each individual to have basic health insurance coverage known as ‘minimum essential coverage’ or MEC. If they did not, they were to pay an additional tax referred to as ‘a shared responsibility payment’ or SRP. Exemptions, which may only be obtained from a health care exchange or from the IRS, are available under the ACA, but only for the MEC requirement.

According to a new government report, however, delays in the reporting for employer’s group health Insurance and insurer of health insurance information have impeded the IRS’s ability to determine whether taxpayers and their dependents have the basic health insurance requirements as mandated under the Affordable Care Act’s individual mandate.

The report, conducted by the Treasury Inspector General for Tax Administration’s office, recommends making it easier for taxpayers to find out if they owe a “shared responsibility payment” by having the IRS offer an online tool to taxpayer’s that would allow them to input  the necessary data and then calculate and how much they would owe. Such a tool is already available toIRS examiners and works well at estimating the payment. The TIGTA report suggests this same tool be provided on IRS.gov to taxpayers. While the IRS has agreed with TIGTA’s recommendation, plans to provide the online tool for estimating the shared responsibility payment have not yet progressed further.

TIGTA found that the Treasury Department has played a part by delaying employer and insurer reporting of group health insurance information until March 2016. The IRS, an arm of the treasury department, has thus not developed processes and procedures to verify compliance with the MEC requirements for the 2015 filing season.

“Many taxpayers are unfamiliar with their obligations under the Affordable Care Act,” said TIGTA Inspector General J. Russell George in a statement. “As an obligation to taxpayer’s who will have to pay, the Internal Revenue Service should provide an online tool to assist them in calculating the amount of the shared responsibility payment owed.”

To help tax examiners, the IRS developed a tool to compute the SRP as tax examiners assess MEC compliance on tax year 2014 tax returns, identified through normal examination compliance activity. The TIGTA report indicated that it found this tool to accurately compute the SRP and recommended the tool as helpful to taxpayers. They also recommended it should be made available on IRS.gov.

Additionally, the IRS plans to use information obtained during the 2015 filing season to develop post-processing compliance strategies to be used in future years.

“We would note that, for the 2015 filing season, when there is no apparent error on a tax return, the IRS will use its normal post-filing compliance processes to verify exemptions claimed,” wrote IRS Affordable Care Act director Carolyn A. Tavenner, in response to the report. “Our plans include the use of information obtained during the 2015 filing season to develop post-processing compliance strategies which will then be used in subsequent years.”

The TIGTA recommended also that the director of the IRS’s Affordable Care Act Office add the online SRP calculation tool to IRS.gov for the 2016 filing season, as a continued effort to provide taxpayers with self-assistance interactive tools. The IRS agreed with this recommendation and plans to assess the feasibility and cost of providing the tool.

The IRS also has plans for dealing with taxpayers who qualify for an exemption from the individual mandate.

     For more information, visit www.insurance4dallas.com.

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Insurance4Dallas, (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online.  I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service.  Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy.

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Group Health Insurance Dallas Employs a Cadillac Tax, “The Next Big Affordable Care Act Battle”

Mix of business groups and labor unions pushing the next big Affordable Care Act fight: killing its so-called Cadillac tax embedded within Group Health Insurance.

DALLAS, TX – APR 25, 2015 – One of the last big parts of the Affordable Care Act to go into effect, the Cadillac tax embedded within Group Health Insurance. Lawmakers delayed the levy until 2018, in part because it is so controversial, but companies are wrestling with it now as they plan employee benefits with some already negotiating with unions over benefits that could spill into 2018. While nixing the levy could produce as much as an $87 billion budget hole, many expect it to be the next protracted battle over the Affordable Care Act — one that threatens to become a headache for Democrats, many of whom never liked the tax despite more general wide-ranging support of the law. It is, though, the type of legal “fix” on which both Republicans and Democrats can agree.

Last month, the Internal Revenue Service (IRS) began detailing how exactly the tax will work, though it left out many of the details employers say they need. Specifically at issue is the 40 percent excise tax on the health benefits companies provide their workers above a certain threshold. In 2018, the tax will hit insurance and related perks valued at more than $10,200 for singles and $27,500 for families. So for family benefits valued at $30,000, the tax would apply to the $2,500 that’s above the limit.  It appears as if the tax will be less evasive for group health insurance in the Midwest in cities such as Dallas, TX.

While the Obama administration has long argued it is only a modest step to get health care costs under control, Obama economic adviser Jason Furman wrote in a 2009 White House blog post noting that it “will affect only a small portion of the very highest-cost health plans — a total of 3 percent of premiums in 2013”.

That may prove unfortunate for businesses eager to attract workers and unable to increase pay. Companies have turned to expanding fringe benefits such as health insurance, but economists of all stripes have complained the open-ended tax break companies get for providing that coverage drives up health care costs while disproportionately benefiting the affluent.

This is mainly because the threshold at which the tax kicks in is higher than the current average premium rates, according to the nonpartisan Kaiser Family Foundation. The typical family plan cost $16,834 last year, according to Kaiser, while the average individual plan cost $6,025.

Experts maintain, though, that the tax is more onerous than it appears, in part because it hits more than just traditional health insurance. It applies to health savings and flexible spending accounts also, including money workers now sock away tax-free for medical expenses. Supplemental insurance plans are also to be included and, potentially, on-site health clinics that companies set up for workers according to the IRS.

This will result in the tax ensnaring more companies over time, with some even likening it to the alternative minimum tax, a tax originally aimed at the very wealthy but which trickled to those further down the income ladder. That’s a good thing, say many, noting that overly generous insurance shields beneficiaries from costs, encouraging them to use more services, driving up prices for everyone.

It’s a matter of fairness, some say, because forgoing taxes on health care benefits amounts to a major break for those with jobs offering coverage. According to a March survey by Mercer, a benefits consulting firm, one-third of employers will be hit by the tax in 2018 if they do nothing to change their plans. By 2022, almost 60 percent will be facing the levy.

Businesses have already been pushing their workers out of high-cost plans and into ones with bigger deductibles while at the same time offering them health savings accounts in order to help them cope with the increased costs. Both would be subject to the levy.

Connecticut lawmaker Courtney noted that “You could have parts of the country where [they] have the most lavish coverage and not be subject to the tax,” while in other areas “people will get hammered and forced into some pretty bad choices.”

The levy, projected to generate $87 billion over a decade, ramps up slowly, but is estimated to eventually produce so much money that it alone will cover the cost of providing insurance subsidies through the program’s exchanges, a big reason why Congress’ independent budget scorekeepers have said the Affordable Care Act won’t add to the deficit, and why the tax will be tough to repeal.

Insurance4Dallas, (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online. I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service.

 

 

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Group Health Insurance Dallas Still Used to Insure Young Adults

Dallas, TEXAS, APR 11, 2015 – Perhaps an overlooked statistic, although important nonetheless, the facts pointing to the higher rate of wealthy uninsured in the young adult category since the roll-out of the Affordable Care Act. Previously, young adults had to fend for themselves after ages 18 or 21, but a provision within the act allowed young adults to remain on their parent’s plans until age 26 which helped insure many low-income and middle-income young adults, according to a new study.

Just released this past Monday, a second report in the Journal Health Affairs, indicated that the young adult populations was still most likely to not be insured as compared with the rest of the general population. This statistic remains troubling for the segment labeled ‘The Invincible’ after the Act has been in effect for several years now.

“Until now,” said Stacey McMorrow, an Urban Institute researcher and co-author of the report, “Young Adults have been recorded as having an astonishingly high proportion of uninsured.”  Statistics point to a large drop-off more recently.

Prior to the passage of the Affordable Car Act in 2009, statistics showed that 30% of those in the 19-25 age range were recorded as uninsured. This dropped to 19% by June 2014, the closure of the first year of Affordable Care Act private insurance plan open enrollment period. By early 2015, the uninsured pool for the entire American population was down to 12.3 percent.

This particular study indicates the massive decline in young adult uninsured’s depended entirely on income. Most of these young adults have previously depended on group health insurance for coverage, especially in red states and cities such as Dallas, Texas.

Within the higher income brackets, from 2010 to 2013, young adults registered a decrease in their uninsured rates disproportionately. This was directly tied to the Affordable Care Act provision allowing those under age 26 to remain on parental health plans.

During the 2010-2013 time frame, according to the report, for those earning just four times the poverty level, the uninsured rate fell from 15.7 to just 6.1 percent. Even for those who earned as much as 139 to as high as 400 percent, a substantial drop was recorded, although proportionately less, perhaps due to less earning in that income bracket over all. That drop fell to 26.4 from 37 percent.

However, with new provisions which were rolled out in 2014,  the in between income bracket saw a reduction in uninsured rates in the 19-26 age group, especially in states which worked with the federal program to expand Medicaid to include most poor adults. Non-expansion states did not experience such results. Although numbers were also reduced through the launches of government-run insurance exchanges as states began selling health plans subsidized under the new provisions.

“Low-income young adults are much less likely to have parents with accessible private health plans therefore restricting their ability to stay on such a plan until age 26,” she said.

“However,” she continued, “higher-income young adults would be ineligible for things such as Medicaid or subsidies on Affordable Care Act private insurance exchanges, as they are likely to earn too much to qualify for either program. Approximately 400,000 more people between the ages of 18 and 25 purchased Affordable Care Act plans in 2015. While that number is higher than in years previous, it is unknown how many of those were uninsured prior.”

Nearly 50 percent of currently uninsured young adults have been shown to have incomes 138 percent below that of the national poverty level, making them eligible for the expanded Medicaid program in states where that expansion was completed. Statistically, however, it has been found that about 60 percent of the 19-26 age group uninsured actually live in one of the 22 non-Medicaid program expansion states.

The conclusion could then be inferred that if those states expanded their Medicaid programs, more young adults would be insured. The Affordable Care Act penalty for failing to have health coverage could also drive down the rate. The penalty, which is determined as the higher of $325 or 2 percent of one’s taxable household income for tax year 2014, rises to $695 per adult, or 2.5 percent of household income, in 2016.

For more information, visit Insurance4Dallas.

Insurance4Dallas, (I4D) helps insure all of Texas and provides consumers with detailed information and the ability to apply for insurance online. I4D provides a full spectrum of health, dental, vision, life and other ancillary insurance products providing a diverse selection of price and benefit options complemented by personable customer service. Available via phone, email or fax, Insurance4Dallas answers consumer questions throughout the purchasing process and utilization of the health insurance policy.

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Until Medicare Was Introduced

Until Medicare was introduced, Canadian health care costs were growing as fast as those in the United States. But “the period of the most rapid escalation ended with the establishment of universal coverage” paid for from public funds. Even more startling is the fact that public spending on health care accounts for virtually the same proportion of each country’s total economy. Yet, Canada covers the whole population and the United States covers only the elderly, the very poor, the military, and some of the disabled.

With the government as the main purchaser of services, health care is not only cheaper for individual taxpayers. It is also cheaper for employers, especially for those employers facing unions strong enough to successfully demand full health care coverage. In the United States, Chrysler pays more for health care than it pays for steel. In Canada, Chrysler does not have to pay for basic hospital or medical costs and therefore its employee costs are lower. Workers’ compensation in Canada does not have to cover these basic costs either, and thus this protection too is cheaper for the Canadian employer.

With the single-payer scheme for many essential services, Canadians have a one-tier system. The rich and the poor go to the same hospitals and doctors. Neither receives a bill and the rich cannot buy quicker access, preferred status, or better facilities. What is covered by the public insurance system cannot be covered by a private insurer and doctors are not allowed to bill above the prescribed rate for services covered by the public insurance. Sharing facilities and services means that the entire population has a vested interest in maintaining the quality of care.

For more than a quarter century, Canada has been providing this comprehensive, accessible and high-quality care, without billing individuals for services or relating care to financial status. Equally important, it has done so more efficiently and at least as effectively as the competitive system serving an illness market in the United States. It is not surprising, then, that 96 per cent of Canadians prefer their system to the American way. It is somewhat more surprising that a majority of Americans also prefer the Canadian system to that in the United States. After all, health care services are very similar on both sides of the border.….. This blog will be continued next week featuring exerts from the book, “Universal Health Care”.

To get a quotation on Group Health Insurance for your company, call us at (972) 219-6004 or visit us at www.Insurance4Dallas.com

Insurance4Dallas
Health Insurance Blogger

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Part 2 (A Canadian Love Affair)

The most important explanation for this support can be found in what are known as the five principles of the Canada Health Act.  These are criteria for funding set out by the federal government, criteria the provinces must follow in order to receive financial support for their heath care services.  Simply put, these principles require that core medical services be universal, portable, accessible, comprehensive, and publically administered.  In other words, all Canadians must include all that is medically necessary, and must be provided regardless of age, prior condition, location, or employment.  And they must be provided without regard to ability to pay.  Canadian Medicare was designed to allocate care on the basis of need, not individual finances. 

And it worked.  The system has delivered on the promised access to care.  While “the number of uninsured Americans had risen to more than 40 million in 1995, virtually every Canadian is covered for essential care.  This contract in access to care can be traced to the basic philosophical approach used to fund services in Canada.  As one 1981 task force put it, “Canadians are endeavoring to develop a health care system directed at health needs – not a competitive system to serve an illness market.”

This is made possible by the single-payer system.  For the most part, health care in Canada is not provided by the government.  It is paid for by governments.  It is a public insurance system, a system in which governments at various levels pay for health services.  Most of these services themselves are provided by nonprofit organizations or by doctors working on a fee-for-service basis.  It is public payment for private practice and private provision.  This single-payer system has made care in Canada cheaper than in the United States, both because it significantly reduces administrative cost and because it allows for more coherent management of services….. This blog will be continued next week featuring exerts from the book, “Universal Health Care”.

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Health Insurance Blogger

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A Canadian Love Affair

Ask any Canadian, “What is the difference between Canada and the United States?”  Virtually every one of them will say “health care”.

A remarkable 96 percent of Canadians prefer their health care system to the U.S. model.  And this support is not simply a reflection of Canadian nationalism in the face of a very large neighbor, although Medicare certainly plays a central role as a defining national characteristic.”  Over the years, poll after poll has repeatedly demonstrated that health care is Canada’s best-loved social program.  An overwhelming majority of Canadians persistently say they want to keep their health care system.

In 1994, the Canadian government appointed a National Forum on Health to examine the current state and future possibilities of the health system.  The focus groups and surveys conducted by the forum found that “the provision of health care services continues to receive strong and passionate support” among Canadians.  Similarly, the president of a major polling firm reported recently that among government programs “only the health care system received approval from a majority of Canadians.”  He went on to point out that the support even crosses social class lines.  Otherwise strong differences in class values “don’t occur to the same extent in the area of health care, perhaps because everyone can see themselves as becoming sick at some point.

The current system is so popular that all Canadian politicians represent themselves as defenders of this sacred trust.  Perhaps more surprisingly, so do many corporations in the private sector.  Indeed, a major health insurance company has declared in a recent advertisement that it “believes strongly in the sanctity of Canadian Medicare.”…. This blog will be continued next week featuring exerts from the book, “Universal Health Care”.

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