New York State of Health, the state’s official health plan marketplace, has announced its 2018 insurance options. Open enrollment begins Nov. 1 and ends Jan. 31.
Tag: health insurance
I am a 50-year-old woman, a mother of three, a partner to a wonderful woman, a daughter, sister and a good friend. I am a hard-working taxpayer and an active member of the school and local community. In December, I received a devastating cancer diagnosis, necessitating immediate aggressive treatment in order for me to have any chance of survival.
A secretary answers the phone at a local insurance agency Monday afternoon, but her voice is so hoarse she can hardly speak.
As the deadline to purchase health insurance under the Affordable Care Act nears, officials announced some leeway will be granted for those who begin the process by the end of the day March 31 — the original deadline. (more…)
CARRIE MILLER PHOTO | ‘Cover yourself and protect your business,’ advised Alysia Doerbecker, senior district manager for ADP payroll services, at last Wednesday’s conference on health care and small businesses in Wading River.
As employers, employees and the unemployed across America continue to wrap their heads around new federal health insurance mandates – known to many simply as Obamacare — owners of local businesses, both large and small, were asking plenty of questions last week at a symposium designed to clue them in to the new rules and regulations and how it could affect their business models moving forward.
Experts at the event, “Taming Healthcare 2014,” gave a dose of advice to the business community Oct. 16 at the Inn & Spa at East Wind, offering tips for navigating the newly reformed health care system — which they described as a “moving target.”
Starting in 2015, businesses employing 50 or more full-time equivalent workers will be required to offer those employees affordable health insurance coverage or face penalty fees.
Andrew Mitchell, CEO of PBMC Health, delivered the keynote speech at the event – presented by the Riverhead Chamber of Commerce, the Riverhead Industrial Development Agency and Peconic Bay Medical Center. He said employers are required to offer an insurance plan that covers at least 60 percent of medical expenses, which is the same percentage covered by the lowest plan on the public health insurance marketplace. At the same time, the plan’s monthly premium must be no more than 9.5 percent of the employee’s household income – otherwise it is considered “unaffordable,” according to the reform law.
This means what is affordable to one employee may not be to another, which in turn means added paperwork and oversight for employers to ensure they are in compliance, said Alysia Doerbecker, senior district manager for ADP payroll services.
“There is a laundry list of information that you need to be prepared for,” Ms. Doerbecker said.
As a result, she said, a proficient human resources system to keep tabs on all the information could be vital.
Should a company slip up, it may be subject to penalties or open itself to a lawsuit, said John Hudson, president of True Benefit, LLC, an employee benefits brokerage and consulting firm.
After 90 days, new employees become eligible to join the company’s health care plan, should they offer one, Mr. Hudson said. “You better track [those] employee[s] accurately. If they should have been offered coverage, it’s going to come back to you as an employer from a lawsuit perspective.”
To enforce the new regulations, Michael Vigliotta, an attorney at The Law Offices of Thomas M. Volz, said the Internal Revenue Service is hiring more than 6,500 new employees to ensure businesses are in compliance.
Susan Flatley, manager of North Fork Radiology, which has 60 full-time employees, said she was expecting added oversight, “but not to the extent of what I heard here today.”
And for those considering not offering affordable care, “the penalties are larger than I had anticipated,” she said. The penalty is generally equal to $2,000 for each full-time employee, excluding the first 30 employees. Should an employee enroll in the marketplace and qualify for a government subsidy, additional fees could be incurred.
Bruce Talmage, owner of Talmage Agway in Riverhead, has about 17 full-time employees, which puts him in the small business category.
“It sounds like I am not required to provide a health plan, but I currently do, and I am trying to understand the rules,” Mr. Talmage said. He said many of his questions have to do with his ever-changing work force because the store gets busier during the spring and summer landscaping seasons.
Talmage wears an interesting couple of hats, as he’s also involved with the nonprofit Riverhead Volunteer Ambulance Corps, which has about 17 full-time employees. While the nonprofit has not offered health coverage in the past, he said they are looking into getting it.
As a small business, he is not required to offer health insurance, but there are tax incentives for small businesses that do so, according to the Small Business Assistance Program, a state-run nonprofit supporting affordable health insurance.
“If I do continue to offer one, does it have to be to every single employee? Is there a limit on the number of hours they work?” Mr. Talmage asked.
According to the law, as long as his work force does not exceed 50 full-time workers for more than 120 calendar days, he will still be considered a small business.
Raising even more questions for Talmage, the insurance plan he currently offers his employees will no longer be offered come Jan. 1, so it’s as if he is starting at square one, he said.
There are also unanswered questions on the health care provider side.
An estimated 57 million uninsured people stand to gain access to affordable health care, however there are already shortages of primary care physicians to provide it, said Dr. George Ruggierio, chief of family medicine and director of medical education at PBMC.
“Primary care physicians are already under strain. Who’s going to see these people?” Dr. Ruggierio said.
The U.S. Department of Health and Human Services estimates that the physician supply will increase by only 7 percent in the next 10 years, far less than the more than 36 percent increase in the patient population, according to the Association of American Medical Colleges.
“There are concerns across the board – the insurance industry, hospitals and doctors trying to deliver care,” Dr. Ruggierio said.
Unfortunately, not all of the questions are answered yet, said Randy Blum, a representative from United Healthcare – an insurance provider offering coverage on New York’s insurance exchange. “At this point nobody knows what’s going to happen.”
While much remains uncertain for health care providers, small business owners seeking the right plan and employees themselves, Lauren McKissick, owner of Prominent Swimming Pools Inc. of Calverton – which has just a handful of employees – said that either way, she believes offering health benefits is important to keeping loyal employees.
“You don’t want to lose good people over insurance issues,” she said. “But is it going to be more affordable to workers if we break off and no longer offer it?”
Empire Blue Cross Blue Shield is dropping its small group health insurance plans in New York effective next April 1, and although the company’s decision will impact many thousands of people and businesses, brokers are divided over the severity of the potential impacts.
A state-wide insurance brokers trade group describes the move as “nothing short of catastrophic,” but one local broker said there’s little, if anything to fear.
Karl Washwick, the owner of the Washwick insurance agency in Riverhead, said Empire’s decision, which does not need state approval, would eliminate all but four of its small group plans. Two of the four are so costly none of his customers are enrolled in, he said.
The two his agency handles are Healthy New York, a state-subsidized plan for starter businesses and lower income residents, and the Empire HMO. He said the bulk of his Empire customers are enrolled in the company’s Prisim and HSA programs, which are to be eliminated.
He disagrees with the New York State Association of Health Underwriters, which offered its “catastrophic” assessment in a letter to the state Department of Financial Services.
“There are viable options,” he said. “Nobody should panic.”
Mr. Washwick said he received work of Empire’s plans on Monday and on Tuesday suggested that his affected customers immediately start considering alternative insurance carriers.
“The disruption of Empire leaving isn’t a catastrophe yet,” he said. Empire customers can turn to Oxford, Etna, Emblem and HIP, which he said offer similar coverage at similar costs.
“The premiums are all about the same,” he said. “They won’t be paying any more than if Empire stayed in the market.”
His one concern is the potential for any of those companies following Empire’s lead and also dropping small group coverage.
“I don’t have a crystal ball, but if I did what I’d see is pretty dark,” he said. “You need competition and people need choices, but the long-term trend is toward consolidation.”
The health underwriters group shares that fear.
“Multiple small employers with literally tens of thousands of employees are going to be left without coverage, as there will be only two to three other carriers left in which brokers may try to place coverage,” the group said in its Nov. 2 letter. “If the other carriers follow suit, the availability of coverage will dry up entirely.”
Empire is reportedly cutting back in reaction to state denials of multiple rate hike requests.