Monthly Archives

November 2017

Children’s Health Program In Texas Is Weeks Away From ‘Chaos,’ Advocates Warn

By | Health Insurance
  NOV 14, 2017

The families of roughly 400,000 children in Texas could be receiving letters from state officials in a matter of weeks, letting them know their health care is ending.

Funding for the Children’s Health Insurance Program (CHIP) expired at the end of September, and Congress still hasn’t reauthorized the program. Legislation aimed at shoring up the program has bipartisan support, but there’s disagreement in Congress about how to pay for it.

In Texas, it’s hard to tell when money will run out. So far, state officials say it could happen as early as January

Advocates say that means in just a few weeks a Texas law could kick in, requiring officials to give families on CHIP a 30-day notice before the program ends.

“It is very likely that sometime in the month of December – and it could be as early as Dec. 1st – families in Texas will start receiving letters about coverage termination,” says Laura Guerra-Cardus, deputy director with the Children’s Defense Fund in Austin.

Guerra-Cardus helps families enroll in CHIP, which provides health care for children in mostly working-class families. She says some families are already stressed about the possibility of the program shutting down.

“Even getting a letter like that, even if the program is eventually re-funded, it’s going to cause incredible levels of stress for most families and chaos for some who cannot afford to have a gap in coverage for their children,” she says.

Children who are receiving ongoing therapies or rely on prescription medications would be most affected by a coverage gap, she says.

Another issue before state health officials, advocates and families relying on CHIP is that little is known about what will happen after those letters are sent out. For example, state law isn’t entirely clear about what happens if the money gets reinstated.

“I don’t think state law ever got that granular,” says Anne Dunkelberg, associate director with the Center for Public Policy Priorities and an expert on Medicaid and CHIP policy in Texas.

Dunkelberg says there’s very little policy that explicitly lays out what happens when the state starts to shut down the program.

“Nobody was anticipating this kind of circumstance,” she says. “So, we have just never gotten this close to a deadline.”

Right now, the plan is to shift the families who lose coverage under CHIP to the online marketplace created by the Affordable Care Act. Dunkelberg says there are few scenarios where this shift won’t cause a gap in coverage, though.

For one thing, the timing is really tight. It’s possible that enrollment for the marketplace will be over by the time families get termination letters. Dunkelberg also says not all families will qualify for subsidies to help pay for plans in the marketplace. She says that means it’s unlikely those families will be able to enroll at all.

Why I don’t want an HMO even if the government pays more than half cost!

By | Health Reform

out-of-network-emergency-1200-1-768x432HMOs are basically a version of socialized medicine — making health care look low cost to consumers but adding an elaborate behind-the-scenes rationing scheme to control costs.

For example: You can see only doctors who have been hired by the HMO. The doctors can get financially punished for providing “too much” care. The plans pay for only certain drugs.

HMO’s are not new.  In fact, in 1996 HMOs accounted for almost a third of the employer market.  But then horror stories of limited networks, bureaucratic hassles and care denials spread, and by 2014 the HMO market share plunged to 13%.

Over those same years, PPOs — preferred provider organizations — took off. These plans offer much better coverage if you stay in network, and still provide benefits for out-of-network doctors. Consumers get to choose their doctor…and the best doctors are available through PPOs.

In today’s ObamaCare exchanges, PPO plans are an endangered species. Those enrolling in Houston last year had a choice of 19 PPOs; this year, they have none.

Since HMOs only contract with a certain number of doctors and hospitals in any one particular area, and insurers won’t pay for healthcare received at out-of-network providers, the biggest disadvantages of HMOs are fewer choices and potentially, higher costs. The problem with fewer choices – you might be locked out of seeing the best doctors are getting care from the best hospitals.  Other drawbacks to HMOs include needing to obtain a primary care referral before seeing a specialist, and annual limits on the number of office visits, tests, and certain treatments – like colonoscopies and mammograms.

The biggest problem with HMOs?  If you need an out-of-network care provider you have to pay for them yourself…and depending on the provider the costs could force you into medical bankruptcy.  Imagine getting into an accident requiring emergency care in an area that will not accept your HMO coverage.  What choice do you have at that critical time but to accept the treatment?  Now imagine that as you are recovering you find out your insurance will not cover the expensive healthcare you needed.  That’s the REAL risk of an HMO – limited coverage that leaves you responsible for astronomical unforeseen medical expenses.

We have alternatives to HMO’s – Call us 1-800-257-1723 or click here to schedule an appointment. 

Senate Plans to End Obamacare Mandate in Revised Tax Proposal

By | Health Reform
Article Excerpt from the NY Times.  By THOMAS KAPLAN andJIM TANKERSLEYNOV. 14, 2017
Senator Orrin G. Hatch, Republican of Utah, delivered opening remarks Tuesday during a Senate Finance Committee hearing. CreditTom Brenner/The New York Times

Senator Orrin G. Hatch, Republican of Utah, delivered opening remarks Tuesday during a Senate Finance Committee hearing. CreditTom Brenner/The New York Times

WASHINGTON — Senate Republicans have decided to include the repeal of the Affordable Care Act’s requirement that most people have health insurance into the sprawling tax rewrite, merging the fight over health care with the high-stakes effort to cut taxes.

Repealing the mandate, a longstanding Republican goal, would save hundreds of billions of dollars over the next decade. That would free up money that is earmarked to expand middle-class tax cuts.


2018 Update – How To Be Legally Exempt from the Obmamcare Penalty

By | Health Reform

2017 TaxesTax filers want to pay attention to the rules involving the Affordable Care Act on their 2017 tax returns, even as President Trump and Congress eye changes in the healthcare law.

In a reversal, the Internal Revenue Service (IRS) has indicated that it will not accept electronically filed tax returns where the taxpayer does not address the health coverage requirements of the Affordable Care Act (ACA). This is in contrast to the 2017 filing season when the IRS took the position that it would accept and process tax returns where a taxpayer is silent on coverage. The tax agency said, at that time, that the treatment was consistent with their previous policy.

However, for the 2018 tax season, that will not be the case. According to the IRS, electronically filed tax returns will not be accepted “until the taxpayer indicates whether they had coverage, had an exemption or will make a shared responsibility payment.” Additionally, paper tax returns “may be suspended pending the receipt of additional information and any refunds may be delayed.”

The IRS said, about the change in position, that “[t]his process reflects the requirements of the ACA and the IRS’s obligation to administer the health care law.”

Earlier this year, President Trump signed an executive order giving the Department of Health and Human Services and “other executive departments and agencies” the authority and discretion to roll back certain aspects of the ACA. This year, Republicans in Congress have so far been unsuccessful in their attempts to repeal and replace – or even just repeal – ACA. That means that ACA remains good law.

Taxpayers that don’t have coverage must claim a waiver, exemption (typically based on hardship), file for a low cost christian sharing – This one has rates as low as $45 a month for a Bronze sharing option – Use this link to get a quote and learn more – or be subject to a penalty called the shared individual responsibility payment. For the 2017 tax year, that penalty is equal to 2.5% of your adjusted gross income (AGI), or $695 per adult and $347.50 per child, up to a maximum of $2,085, whichever is higher. That amount will be figured and reported on your 2017 tax return, payable in 2018.

You Might Be Exempt

If the lowest-priced plan available to you, through either a Marketplace or Job-based plan, would cost more than 8.16% of your household income you might be exempt from having to enroll in a qualified insurance plan.  Learn more by clicking here.

If you are outraged by the high cost of Obamacare and don’t have a serious pre-existing medical condition – call us today at 1-800-257-1723 or click here now to schedule an appointment.  Let us show you a better way to insure yourself and your family.