TIME Obamacare

Got Obamacare? Your premiums are (probably) about to go way up

Health insurers on many state exchanges are requesting the right to increase premiums by upwards of 50%.

President Obama’s signature legislative achievement–the healthcare law popularly known as Obamacare–is facing a potentially existential fight in the Supreme Court in 2015.

But it’s not just the courts that supporters of the program need to worry about. According to a report published Friday in the The Wall Street Journal, health insurers are requesting the right in many states to increase premiums by upwards of 50%. Health Care Service Corp.–the leading health insurer in New Mexico, has asked state regulators to allow it to increase its premiums on average by 51.6%, for instance. Customers of CareFirst BlueCross BlueShield in Maryland may face an average premium increase of 30.4%.

Insurers will have to submit their premium-hike proposals to their state regulators, and potentially the federal government. Regulators will review the requests, and may deny the insurers requests if rising costs don’t justify premium increases. But big rate hikes could be necessary to prevent insurers from taking a loss. According to the report:

BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.

It’s not all bad news, however. Obamacare insurers in some states–like Indiana, Connecticut and Maine–are asking for minimal or no increases to their premiums.

 

 

MONEY Health Care

Now You Can Really Get Free Birth Control Under Obamacare

assortment of birth control pills
Ted Morrison—Getty Images

The Obama administration just tightened the law that says insurance companies must cover all types of contraceptives.

Following recent reports that many women still pay for birth control methods that should be covered by insurers under the Affordable Care Act, the government just released a new document clarifying and tightening the law.

“Insurance companies have been breaking the law and today the Obama administration underscored that it will not tolerate these violations,” Gretchen Borchelt, National Women’s Law Center vice president for health and reproductive rights, said in a statement. “It is past time for insurers to adhere to the law and stop telling women that their chosen method isn’t covered or that they must pay for it.”

Whereas previous government FAQs about Obamacare were not as clear about the types of birth control covered under the law, the new guidance includes an explicit list—printed below—of all the contraceptive methods insurers must cover.

Until now many women, including one MONEY staffer, have found that insurers have been able to skirt the law by lumping together certain categories of contraceptives and charging expensive co-pays on all but a small number of methods. Since the previous language was vague, insurance companies have been able to deny coverage of brand name contraceptives—even when an equivalent generic is not available.

In particular, the new rules are especially good news for those who use IUDs, patches, and vaginal rings, since those are the birth control methods that women have had the most trouble getting covered, according to a recent study by the NWLC.

If your insurer is still making you pay out of pocket for your preferred method of birth control—and a generic substitute is not available to or appropriate for you because of, say, side effects—you should fight back by first talking to your doctor, who could advocate for you to your insurer.

This should be especially effective since the rules make it clear that doctors get the final say over whether a particular birth control method is medically necessary.

According to the new statement: “If an individual’s attending provider recommends a particular service or FDA-approved item based on … medical necessity … the plan or issuer must cover that service or item without cost sharing. The plan or issuer must defer to the determination of the attending provider. Medical necessity may include considerations such as severity of side effects, differences in permanence and reversibility of contraceptives, and ability to adhere to the appropriate use of the item or service.”

If that doesn’t work, consider resources like the National Women’s Law Center: Its website has templates for appeal letters and a free hotline (866-745-5487) you can use to get further help.

Here is the list of contraceptive methods that are now fully covered. Insurers must cover at least one type of birth control in each of these 18 categories:

(1) sterilization surgery for women
(2) surgical sterilization implant for women
(3) implantable rod
(4) IUD copper
(5) IUD with progestin
(6) shot/injection
(7) oral contraceptives (combined pill)
(8) oral contraceptives (progestin only)
(9) oral contraceptives extended/continuous use
(10) patch
(11) vaginal contraceptive ring
(12) diaphragm
(13) sponge
(14) cervical cap
(15) female condom
(16) spermicide
(17) emergency contraception (Plan B/Plan B One Step/Next Choice)
(18) emergency contraception (Ella)

The new government statement also clarifies that insurers must cover preventive services for transgender people when such services are medically appropriate, anesthesia services during preventive colonoscopies, and preventive screening for mutations in the BRCA-1 or BRCA-2 gene.

TIME Innovation

The Epic Scale of Lobbying Cash

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. Corporations now spend more lobbying Congress than taxpayers spend funding Congress.

By Ezra Klein in Vox

2. Customer satisfaction and quality health care aren’t the same.

By Alexandra Robbins in the Atlantic

3. Here’s how manufacturers can cut costs and carbon emissions.

By Ken Silverstein in Forbes

4. Why is the U.S. condemned to have second-rate train service?

By Simon van Zuylen-Wood in National Journal

5. Scientists want to use lasers to shoot down space junk.

By Marissa Fessenden at Smithsonian magazine

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY Health Care

You May Still Have Time To Avoid the Health Law’s Tax Penalties

The tax-filing deadline may have passed, but it's not necessarily too late to get around the penalty for going without health insurance last year.

Even though the April 15 tax filing deadline has passed, you might be eligible for some health law-related changes that may save you money down the road.

•If you owed a penalty for not having health insurance last year and didn’t buy a plan for 2015, you may still be able to sign up for a marketplace plan, even though the open enrollment period ended Feb. 15. Many people who didn’t have insurance and didn’t realize that coverage is required under the law are eligible for a special enrollment period to buy a plan by April 30. If you sign up now, you’ll have coverage and avoid the 2015 penalty, which will be the greater of $325 or 2% of your household income.

•If you paid the penalty for not having insurance for some or all of last year and didn’t carefully check to see if you might have qualified for an exemption, it’s not too late. You can still apply for an exemption from the requirement by amending your 2014 tax return. It’s worth looking into since the list of exemptions is a long one. For example, if your 2014 income is below the filing threshold of $10,150—or $20,300 for a married couple—you don’t owe a penalty for not having coverage. Likewise if insurance would cost more than 8% of your income or if you’ve suffered financial hardships like eviction or bankruptcy.

•In February, the Centers for Medicare & Medicaid Services announced that 800,000 tax filers who received a federal subsidy to help pay their insurance premium and used the federal health insurance marketplace received incorrect 1095-A tax forms. These forms reported details about the advance premium tax credit amounts that were paid to insurers based on the consumers’ estimates of income. They were then used to reconcile those payments against how much consumers should have received.

If you filed your taxes based on information that was incorrectly reported by the government on the form, you generally don’t have to file an amended tax return even IF you would owe more tax. But you may want to at least recalculate your return, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities.

“You have the option to amend if it helps you,” she says. Unfortunately, the only way to figure that out may be to do the math on the tax form 8962 that you use to reconcile your income.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

TIME public health

Not All Birth Control Covered by Insurance Companies Under Obamacare

Woman taking birth controll pill
Frank May—picture-alliance/dpa/AP

A new study from the Kaiser Family Foundation finds not all birth control is covered without costs or copays, including some IUDs and emergency contraceptives

Most health insurance companies are offering the free birth control required under the Affordable Care Act, but gaps still remain, according to a new report.

The Kaiser Family Foundation examined 20 health insurance providers in five states and found women are still paying some contraceptives, including vaginal rings, patches and implants.

The free birth control requirement is both a key and controversial piece of President Obama’s signature health law, seen as one of the many ways the law helps lower health costs for women. The report found that while many insurance carriers in California, Georgia, Michigan, New Jersey and Texas are covering contraceptives cost-free, some do not fully cover Depo-Provera shots, the OrthoEvra patch, certain types of intrauterine devices or IUDs, and emergency contraception.

Without coverage, the contraceptives can be expensive. An IUD, for example, costs up to $1,000—which means that without insurance coverage, one of the most effective forms of birth control is unavailable to some of the women who want to use it.

“We encourage the administration to provide guidance and clarity to insurance companies to ensure all women can access the birth control methods that work for them without cost barriers, as the law intended,” Cecile Richards, the president of the Planned Parenthood Federation of America, said in a statement.

The Kaiser report notes that insurance carriers are permitted to limit the forms of birth control they cover under Obamacare, but the companies should still offer leeway to consumers who have a medical need for certain devices, the report found.

The report also found that despite the widespread attention to the effect the contraceptive mandate would have on religious institutions that oppose birth control, few groups have applied for a religious exception to the law.

Read more: Why You’re Still Paying for Birth Control Even Though It’s ‘Free’ Now

MONEY Health Care

Why Young Millennials Are Turning Down Health Coverage at Work

150414_FF_MILLHEALTHCOVERAGE
Getty Images—Getty Images I don't need health insurance, boss. I've got my mom's plan.

Thanks to Obamacare, they can probably get cheaper health insurance from mom and dad.

New college grads want a job, but they can take or leave the health insurance benefits that come with it. Less than half of all eligible employees under age 26 enrolled in an employer-provided health plan in 2015, according to a new report out today from the ADP Research Institute.

But don’t worry about the rest. Under the Affordable Care Act, young adults are allowed to stay on their parents’ health insurance plan until they turn 26. And that’s probably what many are doing, says Chris Ryan, vice president of strategic advisory services at ADP. “There are lot of people who do value health coverage very much, but they want to stay on their parents’ plan as long as possible,” Ryan says.

Why Young Workers Have More Options

The provision that lets young adults keep their parents’ health insurance until age 26 has been one of the most popular parts of Obamacare. It was also one of the first provisions to go into effect. Between September 2010 and December 2011, more than 3 million adults aged 19 to 25 got private health insurance largely thanks to the ACA, according to the Department of Health and Human Services.

A lot has changed since 2011. More millennials have entered the workforce, and a greater number have become eligible for health benefits. Today, 83% of employees under 26 are eligible for health insurance at work, up 8.5% from five years ago. Still, fewer millennials have actually enrolled in their employers’ plans. In 2011, almost 57% of young millennials who were eligible for employer-subsidized health coverage took it; this year, only 44% did.

One sign that many of these young adults are ditching their employer’s plans for their family’s plan: Once employees are too old to stay their parents’ plans, they’re much more likely to sign up for employer coverage. Three-quarters of eligible employees aged 26 to 39 enrolled in an employer health plan, the survey found.

Happily, after widespread concerns that young people would not sign up for health insurance, the vast majority are now covered one way or another. Nationally, 83.2% of Americans aged 18 to 25 now have health insurance, up from 76.5% in the last quarter of 2014, according to a recent Gallup poll. Today, there are 4.5 million more insured young adults who would not otherwise had coverage, according to the White House.

When Mom and Dad’s Plan Has the Edge

For millennials just starting out, however, health insurance premiums can still eat up a large part of their meager incomes. ADP found that employees earning $15,000 to $20,000 spent 9.5% of their annual income on premiums. Employees earning $45,000 to $50,000 devoted 5.8% of their income to premiums, while employees earning more than $120,000 spent just 2.3% of their income on premiums.

So even if young millennials have jobs with health benefits, the family plan is often the better deal. “Most millennials in their early 20s have entry-level salaries, so it’s attractive for our generation to get on a parent’s comprehensive plan for health and financial security,” writes Erin Hemlin, health care campaign director of Young Invincibles, a millennial research and advocacy group.

ADP found that individual premiums cost $486 a month, on average. But add two or more dependents to the plan, and premiums cost an average of $1,377 a month—which, split three or four ways, is less than an individual plan.

“There’s no question—it is usually cheaper for someone to be an additional dependent rather than pay for single coverage,” Ryan says. And then there are the tax benefits. “Because the premiums are on a pre-tax basis and parents are usually in a higher income bracket than their children, the parents are getting a better tax break, and the insurance overall is cheaper,” Ryan says.

Still, there are downsides to staying on a parent’s plan. If you don’t live near your parents, make sure you can find local doctors that are in your parents’ insurance network before you turn down health benefits at work. And consider if you want your bills and explanation of benefit statements mailed to your parents. Not sure what to do? Here’s more on how to decide— or shop for an individual plan on your own if you’re not getting coverage at work.

TIME Chris Christie

How Obamacare Makes Chris Christie’s Medicare Plan Possible

Chris Christie
Mel Evans—AP In this April 8, 2015 file photo, New Jersey Gov. Chris Christie addresses a gathering as he announces a $202 million flood control project for Union Beach, N.J.

New Jersey Gov. Chris Christie would like to raise the age to qualify for Medicare, part of a bold plan to reform entitlements that he released Tuesday morning.

The proposal was greeted with cheers from many conservatives, but there’s a twist. The main reason that slowly raising the retirement age from 65 to 69 is politically feasible is a law that many conservatives hate: Obamacare.

That’s because working-class Americans who lose health insurance at work when they retire at, say, age 65, would instead be eligible to receive modest subsidies on insurance exchanges set up by the Affordable Care Act. (Very low-income seniors could also sign up for Medicaid in some states or receive larger subsidies for coverage on the exchanges.)

“Obamacare soaks up the people who would otherwise be displaced by raising the eligibility age for Medicare,” said Avik Roy, a prominent Republican expert in health care policy who has argued that conservatives should use Obamacare to promote their own policies rather than repeal the law. “In the old days, if you raised the eligibility age for Medicare, then someone who is low-income at 65, but not eligible for Medicaid, are stuck in this gap, so what do you do?”

“But with [Obamacare], that safety net is there, so it’s much easier to raise the Medicare age,” added Roy.

But if retirees who, at 65, would have qualified for Medicare, which is relatively cheap, shift en masse to private insurance, which is relatively expensive, does Christie’s plan of raising the eligibility age actually save any money?

That answer has been hotly debated for years, since the cost of providing health care to 65-69 year-olds wouldn’t just disappear, it would shift to another part of the federal budget.

Some argue that it would save money, since the subsidies under the Affordable Care Act get smaller as seniors’ income rises, while Medicare serves seniors of all incomes the same.

“In general, raising the eligibility age for Medicare will save money for the federal government because seniors with relatively higher incomes wouldn’t be eligible for any other federal subsidies,” said Michael E. Chernew, a professor of health care policy at Harvard Medical School. “That’s the simple analysis.”

A 2011 Kaiser Family Foundation study estimated that raising the eligibility age for Medicare from 65 to 67 would save the federal government as much as $5.7 billion in the short term. But it could also cost 65- and 66-year-olds $3.7 billion in out-of-pocket expenses, and employers $4.5 billion in retiree health-care costs. (And that’s to say nothing of how the policy could negatively affect the cost of Medicaid and Medicare Part B premiums, according to the Kaiser study.)

Chernew added that raising the Medicare age comes with other, more complex ramifications, including the type and quality of care available, and whether such a policy would encourage more older Americans to remain in the workforce for longer. Another part of Christie’s plan directly incentivizes Americans to keep working past the age of 65 by eliminating the payroll tax for workers 62 and older.

But the broader question is whether conservatives want to make use of the Affordable Care Act to make their own changes to the health care system or whether they want to repeal the law and start from scratch.

Roy, who has advocated for “transcending Obamacare,” argues that that Christie’s policy proposal is a smart political play. “He’s staking out ground as a credible, bipartisan entitlement reformer,” he said.

TIME Healthcare

Americans Spent a Record Amount on Medicine in 2014

TIME.com stock photos Health Pills
Elizabeth Renstrom for TIME

Medicine spending in the U.S. rose at the highest rate since 2001, a new report shows

Correction appended, April 14

Americans filled 4.3 billion prescriptions and doled out nearly $374 billion on medicine in 2014, according to new data from the IMS Institute for Healthcare Informatics.

The data shows that American men and women’s spending on medicine hit the highest level since 2001, up 13% in 2014 compared with the year before.

In states that expanded Medicaid eligibility under the Affordable Care Act, patients filled 25.4% more prescriptions than in 2013; in states that did not expand eligibility, that rate was 2.8%. Overall, doctors’ office visits declined 3% and dispensed prescriptions increased 2.1% in 2014. “It is clear that the U.S. health care system is in a state of flux,” wrote IMS Health executive director Murray Aitken in the report. “The past year brought fundamental changes and heightened uncertainty to patients, payers, providers, government and lawmakers.”

The report authors also note that the impact of patent expirations also happened to be lower in 2014, so the drop in costs was smaller than drops experienced in other years. The report shows that the impact of patent expiries in 2014 was around $8 billion less than 2013 and $17 billion less than what it was in 2012.

The report suggests that specialty drugs and innovative medicines accounted for a large part of the medication spending, with specialty medicines making up a third of all medication spending. Some of these drugs were new treatments for diseases like hepatitis C, multiple sclerosis and cancer. New oral hepatitis C drugs, for example, have made treating the disorder easier than taking the daily injections that were previously required. However these new drugs can have a high price tag — around $1,000 for a single daily pill in some cases. The report says new treatments for hepatitis C increased spending by $11.3 billion.

MORE: Why Hepatitis C Drugs May Soon Get Far Less Expensive

“The number of patients seeking treatment for hepatitis C jumped nearly tenfold in 2014, from 17 to 161 thousand, owing to new treatments with cure rates over 90% and dramatically fewer side effects,” the report reads.

According to IMS Health, 18 orphan drugs — ones designed specifically to treat a rare disorder — were launched in 2014. The unprecedented high was likely due in part to the tax breaks and other financial incentives for developing them.

All of these factors made 2014 an especially notable year for medicine spending and new innovative medicine, IMS Health said.

Correction: The original version of this story misstated the number of prescriptions Americans filled in 2014. It was 4.3 billion.

TIME Healthcare

About 90% of U.S. Adults Now Have Health Insurance

The uninsured rate has fallen under Obamacare

Amost 90% of American adults now have health insurance, according to a new survey released Monday.

The Gallup-Healthways Well-Being Index shows that the uninsured rate has dropped to 11.9% for the first quarter of 2015. That’s down one percentage point from the previous quarter and down 5.2 percentage points since the end of 2013, when the expansion of coverage under President Obama’s health care reform law went into effect.

“The uninsured rate is the lowest since Gallup and Healthways began tracking it in 2008,” Gallup said. The rate of uninsured Americans rose to more than 17% by 2011, and peaked at 18% just a couple years later. It dropped significantly when the health care law was implemented.

The survey shows that while the uninsured rate has dropped among all groups, the greatest declines came for lower-income Americans and Hispanics.

MONEY Taxes

Last-Minute Tax Filers: Beware of This Obamacare Scam

pill bottles with money in them
Adrianna Williams—Getty Images

If you don’t have health coverage, you pay a penalty to the government. And scammers are ready to take advantage of that.

For all stripe of rip-off artist, tax season might as well be called open season. Scams are legion, and navigating a solution after the fact can be somewhere between maddening and negotiating an Iran deal that everyone likes. Last month the IRS issued a warning that received scant attention from the media, but nonetheless could impact millions of taxpayers this year — particularly targeting low-income, elderly and Spanish-speaking taxpayers.

The scam takes advantage of the Individual Shared Responsibility Provision of the Affordable Care Act. It’s a penalty, but one with many exemptions. Because it is somewhat complicated, the new provision has become the object of many fraudsters’ affections, especially during tax season.

This is the first year that taxpayers must confront this new liability. In the simplest of terms, if you don’t have health coverage, you pay a penalty to the government.

The provision is intended to induce people to get coverage, since individual shared responsibility is all about increasing the number of Americans enrolled in health insurance plans in order to enlarge the pool to spread risks and reduce costs. Regardless of what you think of that theory, that’s the informing principle.

So what is the penalty? While at first blush it doesn’t sound like a huge amount of money, it’s not nothing either — especially to a family who is forced to live paycheck to paycheck. It can be 1% of a family’s annual income (minus the tax return filing threshold for your filing status), with a maximum penalty being the national average cost of a bronze plan, or it can be calculated as $95 per adult and $47.50 per child under the age of eighteen, capping out at $285 for a family. The amount per adult will increase each year. In 2016, it will be $695 per adult and $347.50 per child, capping at $2,085 per family.

For an unscrupulous tax preparer the Shared Responsibility penalties can add up to quite a caper. How so? Because the scam involves A) taking advantage of the inherent complexity of the exemptions and B) pocketing the penalties. Sometimes the scammer claims he or she can reduce the cost of the penalty because they have created a pool for leverage, or they simply claim that paying them directly instead of the government is “how it’s done.”

The only thing you need to know is: That’s not how it’s done. The easiest way to avoid this scam is to remember one rule: Only pay the IRS. Period.

There is some good news. While you are required to report whether or not you have health care coverage on your tax return, the majority of filers will not have an issue here. It has been estimated that only four million of the estimated 30 million uninsured will have to pay the Shared Responsibility Provision in 2016. But here is where fraudsters see their honey pot, using complexity to fleece honest taxpaying citizens while exposing them to penalties when the IRS circles back to get money that was stolen from them.

Are you off the hook for paying the penalty? Here’s the list of exemptions to see if they might apply to you (consult your tax preparer as this column is not meant to serve as a substitute for professional tax advice):

  • There were no “affordable” options for you, because available annual premiums were in excess of 8% your household income.
  • You had a gap in coverage less than three consecutive months.
  • Your household income was below the return-filing threshold ($10,150 for an individual on a 2014 tax return).
  • You are not a U.S. citizen, a U.S. national, nor an alien lawfully present in the United States.
  • You belong to a health care sharing ministry.
  • You belong to a federally-recognized Native American tribe.
  • You are in a jail, prison or another qualifying institution — such as a psychiatric hospital, etc.
  • You belong to a qualifying religion existing prior to December 31, 1950, recognized by the Social Security Administration (SSA).
  • You qualify for a hardship exemption.

Hopefully it’s not news that you need to choose a tax preparer wisely. There are many fly-by-night operations that are literally gone in the blink of an eye the minute April 16th rolls around.

That said, most tax preparers work hard to get you the best possible refund (or the lowest possible amount due) while remaining scrupulous and sticking to the letter of the law—and that is no easy task given the complexity of the Internal Revenue Code of 1986. If you are unsure about a tax preparer, you should ask for references or, even better, consult the IRS’s searchable database of tax preparers that are recognized by the agency.

This story is an Op/Ed contribution to Credit.com and does not necessarily represent the views of the company or its partners.

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