Author: Mike Baczynski

The ‘Trump effect’ on your Obamacare coverage

Mike Baczynski Leave a comment

Happy Holidays from Medical Cost Advocate! As we enter a new year and new administration, change is inevitable on many fronts. Understandably people want to know what that means in regards to their healthcare. More specifically they want to know how they will be affected in light of the promised changes to Obamacare. Though we can only speculate at this point, a great overview by healthinsurance.org provides some insights based on what we know so far.

With our newly elected president threatening repeal of Obamacare, should you worry that your health insurance could go up in smoke?

By Louise Norris, healthinsurance.org contributor, November 12, 2016

Donald Trump will be our next president. What exactly does that mean for your health insurance coverage and access to healthcare? It’s a question that has drawn speculation from health policy wonks since the day after Trump’s election – but I’ve also been receiving many of these questions from clients who are curious about whether their coverage will change any time soon.

In truth, nobody can say for sure at this point, since there are still so many moving parts to the law. But we have some educated guesses, based on Trump’s positions and the actions Congress has taken over the last six years with regards to Obamacare.

Here are the best answers we have at the moment for some questions you might have, along with more details about what you can expect in the coming months and years:

Do you still need to buy ACA-compliant coverage?

Q: If Obamacare is going to be repealed, do I need to buy ACA-compliant coverage now?

A: Yes, you still need coverage for 2017, and now’s the time to buy it. On November 9, the day after Trump won the election, 100,000 people enrolled in coverage through HealthCare.gov, according to HHS Secretary Sylvia Burwell. That’s the largest number of sign-ups in a single day since open enrollment began on November 1, so there is considerable momentum in terms of people enrolling in coverage for 2017.

We can assume that Congress will pass legislation to repeal parts of the ACA (more details below), and that Trump will sign it into law. This is likely to happen in 2017. But it’s unlikely that it will have an effective date prior to 2019, as Congress will need time to implement its replacement plan, and the IRS will need time to establish the new tax system that will go along with whatever replaces the ACA (most likely, tax credits to offset the purchase of coverage).

So for 2017, you still need coverage. And subsidies — including premium subsidies and cost-sharing subsidies — are still available. Although they’re likely to be eliminated eventually, at least in their current form, that’s not likely to take effect in 2017. (more…)

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Healthcare Cost and Complexity Continue to Grow – Insurance Consultation and Claims Advocacy are Better Together in This Healthcare Climate

Mike Baczynski Leave a comment

As we enter a new open enrollment period, companies and individuals are reviewing their health care plans. The litany of regulatory and economic changes in our health care system has created a daunting challenge of navigating less choice and availability, along with higher costs. Add to this the uncertain future health care landscape under a new Trump Administration and the complexity multiplies. Healthcare advocacy services are becoming even more necessary to help families manage the ongoing insurance, billing and navigation issues they will inevitably encounter.

Contributed by Derek Fitteron, CEO Medical Cost Advocate

November 1 marked the beginning of the open enrollment period for many individual insurance plans. Open enrollment is the time when individually insured families must enroll in, or make changes to, their health insurance coverage. The individual insurance market has been largely subsumed by the Affordable Care Act (ACA) and the State Exchanges in recent years. This year, choice, availability, features and cost have all deteriorated. Many of the largest insurers are withdrawing from the individual marketplace for economic reasons. The resulting plans have narrower networks, higher deductibles, and fewer features; all for a higher price.

The laws of supply and demand do not apply anymore. Wealthy consumers as well as those requiring subsidies must choose from the same underwhelming plans. Nowhere is this more evident than in New York. Aetna has left the market and Health Republic has become insolvent, leaving only Empire Blue Cross Blue Shield, United Healthcare and three much smaller companies offering plans. Perhaps most startling, none of the available plans are PPO plans that offer out-of-network benefits.

Consumers clearly need help selecting the best plans among available alternatives, but now more than ever they need assistance optimizing their plans going forward.

Consumers who wish to obtain the best care will go out-of-network in increasing numbers and will be largely “self-pay.” They will be on their own to manage filing, billing and administrative complexity. Medical Cost Advocate is recognizing these issues. To provide more value for clients, we have started bundling Insurance Consultation with Comprehensive Bill and Claims Advocacy. The benefits are clear. We can help clients select the best plan available and manage the ongoing issues they will inevitably face. We review bills, resolve problems, file claims, negotiate reductions and provide advice on how to better utilize these plans. For a nominal fee above an Insurance Consultation alone, consumers can obtain the same consultation plus 3 hours per month of billing advocacy over the entire year.

Our clients are looking for solutions to manage complexity in the changing healthcare system. Medical Cost Advocate is an even more advisable solution for those who want to focus on their health, not insurance and billing.

For more information on how Medical Cost Advocate can help your family/company realize value from healthcare, please click here or call us at (201) 891-8989.

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