MEDICARE PART B AND WHEN TO ELECT

Turning 65 and being eligible to elect Medicare coverage can be a tricky time.  If you have medical coverage through your employer, you may want to delay the election of your Medicare Part B coverage as this costs money.  Medicare Part A is free.  In certain circumstances you will not want to wait to elect Part B.  When you employer has over 20 employees, Medicare is secondary, meaning it pays after your employer coverage. However, if there are less than 20 employees, Medicare is primary.  Why this is important is that if you wait to elect Part B because you have coverage through your employer, it may come back against you.  Part A covers Hospitalization and Part B covers the Physicians. Since Medicare is primary, all claims will go there first and then to the employer based plan. If you don't have Part B, those claims can't go to Medicare and will not be sent to the carrier, they will stop. Effectively you will have no coverage for anything that would have been paid through Part B, namely any physician fees. Therefore, if your employer has less than 20 employees and you or your employee is eligible to elect Part B, elect it.  You have three months prior to your effective date, the month of you effective date and three months after to sign up for Part B. 

For more information you can call Social Security at 1-800-772-1213 or go to the Social Security website .

Exchange Notice Requirement Under ACA

FLSA section 18B, added to the labor statute by the Patient Protection and Affordable Care Act (PPACA), requires employers that are subject to the FLSA (most employers) to provide to each of their employees, and to all new employees at the time of hiring, a written notice.  The notice is to remind employees of the availability of the health insurance exchange.  

The notice must be provided to each employee, regardless of plan-enrollment status or part-time or full-time status. Employers are not required to provide a separate notice to dependents or retirees, but an employer's obligation to provide the notice may extend to its independent contractors and leased workers, depending on the nature of their relationship with the employer as determined under the FLSA's "economic reality" test.  Below is a link for a Model Notice that can be used to satisfy the requirement.

http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf

IRS Delays 1094/1095 Reporting

 January 31st, 2016 for statements given to employees/individuals and February 29th for transmittal's filed to the IRS (and WAS March 31st if you are filing over 250 employee statements to employees).  Keep in mind, this is the information that the IRS will use to penalize the individual or the employer if they are not offering appropriate and affordable coverage and is used by the individual when preparing their personal tax returns. 

Now, the IRS announced that it will be giving employers additional time.  According to Notice Notice 2016-4, the IRS is delaying filing deadlines to allow employers, insurers and other providers additional time to get information together for the reporting.  The NEW deadlines are:

• Statements given to employees/individuals is now March 31, 2016 (Two Additional Months)

• Transmittal's filed to IRS (Paper) is now May 31st, 2016 (Three Additional Months)

• Transmittal's filed electronically in now June 30th, 2016 (Three Additional Months)

Hope you find this information helpful and Happy New Years!

Repeal of the "Cadillac Tax" under ACA

The Cadillac tax is slated to take effect in 2018 for individuals with health insurance plans worth more than $10,200 a year or families with plans worth more than $27,500. That's $850 for an individual plan and includes other things like Employer HSA contributions, Employer HRA Contributions, Wellness plans, pre-tax policies for specific disease or illness plans (Cancer Policy). The tax itself is a 40% non-deductible excise tax on any amount above these thresholds.  Under the tax, those plans that are fully insured, employers calculate and insurers pay the tax, for Self-funded plans, the employers calculate and "the person who administers the plan benefits" pays and under HSA's and HRA's Employers calculate and employers pay.

The tax was included in the law to curb the highly comprehensive, highly expensive health plans as well as help raise funding for the ACA, an estimate 87 Billion over the next ten years.

Now that we are getting closer to point of impact, even democrats are no longer supporting the tax because it's not really a tax on "Cadillac Plans" but many mid-level plans simply because of the rising cost of health care.

"The 'Cadillac Tax' will raise barriers that would deprive patients of needed cancer screenings, diagnostic tests and lifesaving treatment," said Rep. Joe Courtney, D-Conn., who is the sponsor of a House bill to repeal the tax.  "We must repeal this onerous tax before it diminishes the progress we have made since enactment of the ACA."   

Repeal of Definition of Small Employer Group back to 1-50 Employees under ACA

On October 8, 2015, the federal government repealed the legislation that had redefined employer groups with 51 to 100 full-time-equivalent employees as small groups for 2016 health insurance coverage.

However, the federal legislation still allows individual states the option to expand the definition of small group from 1 to 100 employees in 2016, which is the definition currently set by the Virginia and District of Columbia legislatures.

Following the federal announcement to repeal the decision to redefine employers with 51-100 employees as small groups, Maryland issued bulletin (15-27) stating that Maryland's definition of small group will align with the federal changes and remain at the 1-50 employee level.

Bulletin 15-27 states, "Since Maryland law has been drafted to follow the federal law, for plan years that begin on or after January 1, 2016, small employers will be those that during the preceding calendar year employed an average of not more than 50 employees.”

Excerpt from Kaiser Foundation Health plan

This is good news as groups over 50 Full-Time and Full Time Equivalents were being pushed down to small group which historically has had higher rates and more ACA mandates.

Insurer Mega Mergers: What It May Mean To You

Not too long ago Coventry was gobbled up by Aetna, then Aetna grabbed Humana and now Anthem making a deal to purchase Cigna.  With these mega-mergers what should we expect?  Will rates rise because we have less competition?  Will, the now, larger insurers decide to merge and move us even closer to a socialist single-payer system?  


Excerpt by Chad Bray, NewYorkTimes 7-24-15....

The health insurer Anthem said on Friday that it had agreed to acquire its rival Cigna for $48.3 billion in a deal that would further concentrate the United States market to just a few major players.The combined company would have estimated revenue of about $115 billion and serve more than 53 million people with medical coverage.A flurry of deals are reshaping the industry. Earlier this month Aetna agreed to acquire Humana, the smallest of the big five insurers, for $37 billion in cash and stock. If both transactions are completed, the number of major health insurers in the United States will shrink to three.Health insurers are seeking to consolidate to gain greater scale to reduce costs and capitalize on growing opportunities in the government and individual markets. A major force has been the Obama administration’shealth care overhaul, which has bolstered revenues. But greater transparency in pricing and less generous funding of government plans have also put profit margins under pressure.
It is possible that regulators in the United States could block some mergers: Antitrust officials at the Justice Department and the Federal Trade Commission have shown an increasing willingness to do so if they believe the alliances could hurt consumers.
Analysts have said that antitrust regulators would probably allow only some deals to go forward, and that they could stop others if they decided that too much power was being concentrated in too few hands.

1.1 Million Carefirst Members In D.C-Data Breach

As many as 1.1 million Washington, D.C., BlueCross BlueShield members may have had their information accessed in a cyber-breach that occurred in June of 2014.

CareFirst BlueCross BlueShield announced Wednesday it had been the target of a "sophisticated cyberattack," the company said in a release.

The attackers could have potentially acquired members' names, birth dates, email addresses and subscriber identification numbers.

However, CareFirst said its user names must be used in conjunction with a member-created password to gain access to underlying member data on the website.

The database that was breached did not include these passwords, which were encrypted and stored in a separate system as a safeguard against such attacks.

That means the attackers did not have access to member Social Security numbers, medical claims, employment, credit card, or financial information, CareFirst said.

The company is blocking member access to the accounts that might have been compromised, and is asking members to create new user names and passwords for them.

All affected users will be sent letters granting them two years of free credit monitoring and identity theft protection, the company said in a statement posted on its site.

The attack came to light when CareFirst hired Mandiant, the cyber-forensics unit of computer security company FireEye, to review its security in the wake of recent cyber attacks on other health insurers.

"The intrusion was orchestrated by a sophisticated threat actor that we have seen specifically target the health care industry over the past year," said Charles Carmakal, managing director of Mandiant.

The fact that the health care company's members are primarily based in Northern Virginia, Maryland and Washington D.C. is not lost on people in the security community.

"Obviously, we know what's there," said Rick Holland with Forrester Research, contemplating the heavy concentration of government, military and contractors in the region.

There has been speculation that previous health care computer breaches could also be linked to China, including those at Anthem, Premera and Community Health System.

Industrial spying by China is well known. On Tuesday federal prosecutors made public charges against a Chinese espionage ring that included two professors who studied together at the University of Southern California. The ring stole trade secrets and gave them to Chinese companies.

 Elizabeth Weise, USATODAY6:31 p.m. EDT May 20, 2015