What Everyone Needs to Know About Being Insured in 2014


The individual shared responsibility provision is part of the Affordable Care Act that includes the act itself, state governments, the federal government, employers, individuals and insurers. Each party has a shared responsibility to improve and reform the quality, affordability and availability of health coverage. In 2014, the shared responsibility provision requires every individual to carry minimum essential coverage, pay the tax penalty or qualify for an exemption.

Effective Date, Applicable Parties And Transition Relief
This provision takes effect on the first day of 2014 and is applicable for every calendar month. Both adults and children are applicable parties for this provision, and adults claiming dependent children are the responsible parties for providing coverage or paying the tax penalty if the children or individuals themselves do not have exemptions. Individuals who are eligible for employer-sponsored plans may qualify for transition relief from the shared responsibility payment. Employees or those who have relationships to employees who are eligible to enroll in employer-sponsored plans that are not based on calendar years may qualify for relief.

Minimum Essential Coverage
Minimum essential coverage does not include plans that cover only limited benefits such as dental, vision or disability. The following are considered minimum essential coverage:

– Coverage from the individual market such as qualified health plans.
– Employer-sponsored plans, retiree coverage and COBRA.
– The majority of Medicaid plans.
– Medicare Advantage plans and Medicare Part A coverage.
– Several types of VA coverage and Peace Corps insurance for volunteers.
– Children’s Health Insurance Program coverage and TRICARE.
– Refugee medical assistance from the ACF.
– State high-risk pools that fit outlined criteria.
– Self-funded coverage for university students that fit outlined criteria.

There are also several exemptions from obtaining minimum essential coverage. These include the following:

– People who are members of specific religious sects opposing insurance benefits.
– Members of recognized health care sharing ministries.
– Members of recognized Indian tribes.
– People whose income levels are below the income tax filing threshold.
– People who were without insurance for three consecutive months during one year.
– People who would have to pay more than eight percent of their income for premiums.
– People who meet the Affordable Insurance Exchange’s hardship criteria.
– Some U.S. citizens who are not physically living in the United States.
– People who are incarcerated.

Qualifying For Exemptions Or Obtaining Adequate Coverage
Most people who are currently insured will not need to do anything to be considered as adequately insured in 2014. People who are uninsured should discuss their options with an agent. For those who want an exemption, an agent will be able to provide information from the Health Insurance Marketplace for several exemption categories. However, those who are already exempt due to income will not need to take any further action. It is important to remember that both children and senior citizens must also be adequately insured or qualify for an exemption. A person who has coverage through a spouse’s employer-sponsored plan is also considered to be adequately insured. However, spouses and children can be covered under a different approved plan to qualify as well.

What To Expect Without Coverage In 2014
If a person without coverage needs care, everyone else will have to pick up the bill. This is why the health care law makes it mandatory for all people who can afford coverage to obtain it or pay a fine. Those who do not have coverage will have to pay the entirety of their individual bills, which may be high enough that they lead to bankruptcy in some cases. The fee in 2014 is one percent of a person’s income or $95 for each person. However, the fee amount will increase every year. By 2016, it will be $695 per person or 2.5 percent of annual income. The fee for uninsured children starts at $47.50 with a maximum of $285 regardless of the number of children a family has. Consumers must keep in mind that these are just fees and not coverage, so they are still responsible for all medical bills. For answers to further questions, call ACBI at 203-259-7580 or visit our website by clicking here.

Private Exchanges to Transform Health Insurance Landscape


By the time 2017 rolls in, about 30 million people – or one in every five Americans – will use a health insurance exchange under the Patient Protection and Affordable Care Act (PPACA) or Obamacare. This is according to a research by global management consulting, technology services and outsourcing firm Accenture, which forecasts that such phenomenon will radically transform the country’s health insurance landscape.

More overwhelming than the number of individuals projected to use health insurance exchanges to cater to their medical and wellness needs, however, is the apparent lack of awareness and preparedness of many Americans. The study shows that the lack of awareness applies to all demographics and to both public and private exchange concepts, as shown by its survey of 20,000 consumers.


Personalized Insurance Shopping Experience

A health insurance exchange in Obamacare’s context is a marketplace with competing providers where consumers can select plans of their choice. Public health exchanges are managed by public entities, while private exchanges are maintained by private companies. As with other public transactions, using public exchanges means navigating through government channels. With private exchanges, consumers can do business through an agent with whom they feel comfortable working and sharing information.

While public exchanges may have the advantage of tax credits over private exchanges, Accenture’s study forecasts that more consumers will be using private exchanges as early as 2018. The study reveals that consumers are likely to welcome private exchanges for their flexibility, range of choices and personalized shopping experience.

A private health exchange often includes a choice among at least two major medical health plans with health insurance advice and recommendation support. Billing is automatic and support should be on-going. If a consumer works for a private company, he or she can rely on the employer to pay for the coverage. For those who are not covered under a group plan at work or who are self-employed, they will have to shoulder the payment.

Private Exchanges to Dominate the Market by 2018

Millions of Americans are expected to start enrolling in public exchanges on October 1st. Only about 1 million consumers will enroll in private exchanges within 2013, but the study anticipates this number to quickly grow to about 40 million by 2018 – even higher than the estimated 31 million consumers that will enroll in public exchanges in the same period. The rapid growth will make private exchanges the dominant option in the next five years, accounting for 56 percent of the total exchange market.

The shift in consumer behavior when it comes to using private exchanges will change the health insurance landscape, where consumers are able to “shop” for their own health benefits. This means that – ┬ámore than ever – they will need to have a full understanding of their options and decisions.

To learn more about private health insurance exchanges and their impact on your health plans, call ACBI at 203-259-7580 or visit our website by clicking here.

Insurance Fraud Schemes Every Individual Should Know About


According to statistics from the Federal Bureau of Investigation, there are more than 7,000 insurance companies collecting over $1 trillion every year through premium charges. The large size of the insurance industry is part of the reason why insurance fraud is such a big issue today. Insurance fraud costs more than $40 billion every year, which means the average family pays as little as $400 or as much as $700 per year due to premium increases. There are several common fraud schemes used.

Fee Churning
With this type of scheme, several intermediaries accept commissions by way of reinsurance agreements. Initial premiums are reduced until there is no more money for paying claims, and this is done using repeated commissions. Conspirators often set up companies and leave them to pay the claims. Every transaction by itself appears to be legitimate. However, the use of fraud is not apparent until after consideration of the cumulative effect.

Premium Diversion
This involves embezzling insurance premiums and it is the most common type of fraud used. With this scheme, the insurance agent does not send the premiums to the underwriter but keeps the money instead. In some cases, an individual may try to sell insurance without a license, collect premiums and avoid paying any claims.

Asset Diversion
This is the stealing of an insurance company’s assets, and it often happens during mergers or acquisitions of existing companies. It may include acquiring control of insurance companies using borrowed money. Following a purchase, subjects use the items they received to pay the debt. Any leftover assets are diverted to the subject.

Workers’ compensation fraud is another popular scheme where some people claim to provide benefits at lower costs and misappropriate premiums without providing insurance. When powerful storms hit, the fraudsters come out of the woodwork. During the famous Hurricane Katrina in 2005, over $100 billion in damages was sustained. There were well over 1.5 million insurance claims filed, which totaled a little less than $34.5 billion for insured losses. Insurance fraud costs consumed more than $5 billion of the $80 billion in government funds allowed for reconstruction. There several different forms of fraud schemes used after natural disasters. These include the following:

– Exaggerated or false claims filed by policyholders.
– Claims filed by people who do not live in the immediate area.
– Contractor bid rigging and falsification of the cost of repairs.
– Charity fraud scams that waste funds donated for disaster relief.
– Flood damages that are misclassified as fire, theft or wind damage.
– Contractors who require upfront payments for services they fail to perform.

Insurance fraud is something that all people and business owners should be aware of and familiar with. To learn more about this topic, call ACBI at 203-259-7580 or visit our website by clicking here.

HSAs in a Five-Year Healthcare Study


A recent survey looked at a major employer in the United States that used a health plan featuring a high deductible with a health savings account for all workers, and the survey analyzed this employer’s data over the span of five years. The study showed one of the longest periods of observation with a full-replacement CDHP. It was a rare study in its category due to its matched control group.

During the initial year that employees used the HSA plans, their employer’s aggregated spending for health care was lessened by more than $525 per worker. The study shows that there was a significant reduction in spending during the first year of the HSA plan, and this included pharmacy, total claims categories and medical. In addition to this, the impact of the cost savings was higher during the initial year but still remained steady at a slightly lower pace over the following three years.

Total spending was reduced by about 25 percent during the first year for the full-replacement HSA plan. There was a significant reduction during the first year of the plan for each category of health spending. However, the one exception to this rule was spending on hospital stays classified as inpatient care. Spending for laboratory services and for prescription drugs were the two categories with the largest declines. Laboratory services spending decreased by more than 35 percent, and prescription drug spending decreased by more than 30 percent.

When experts looked closely at each component of the spending study separately, they realized that laboratory spending and pharmacy were the two categories that were lower over the span of four years after the adoption of the HSA plan. During the first year of the HSA plan, individuals’ spending reductions for pharmacy items were between 40 percent and 47 percent. This applied to everyone who was not in the highest quintile of spending. The quintile for pre-HSA health spending was examined, and the biggest effects during the first year were seen during quintile three and quintile four. During the first year, the biggest pre-HSA quintile saw reductions that were not sustained. When the fourth year arrived, pharmacy spending was reduced in the HSA plan. However, the third quintile still experienced reduced spending in comparison with the year prior to the adoption of the HSA plan. For answers to any questions or to learn more about how these health savings plans work, call ACBI at 203-259-7580 or visit our websiteby clicking here.