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The Difference Between ACA and Medicaid

Do you know the difference between the Affordable Care Act and Medicaid? On the ACA health exchange health insurance is payed in the form of subsidies from the federal government. It can be confusing as to how government-subsidized private health insurance is really all that different from government-funded Medicaid. Although the ACA (Affordable Care Act) does expand Medicaid coverage to more people, the Affordable Care Act is not an insurance plan, it is a set of regulations. The ACA’s purpose is to regulate the health insurance industry.

  • ACA is offered by private insurance companies. It provides assistance to businesses, individuals and families and it allows you to keep the insurance you already have if you chose to do so. Medicaid requires you to be on one of their government-funded insurance plans.
  • Medicaid is effective as soon as your approved. ACA goes into effect the following year.
  • ACA only allows you to enroll or switch health insurance carriers during open enrollment. Medicaid allows you to enroll all year around.
  • Medicaid is retroactive.
  • ACA requires Americans to either have qualifying health insurance or pay a tax penalty. Medicaid is considered health insurance.
  • Medicaid sends funding straight to the doctors. The ACA gives the power of health insurance back to the agents.
  • ACA or Obamacare programs have co-payments, coinsurance and deductibles. Medicaid is 100% free.
  • Medicaid is funded through federal and state taxes. ACA is market for purchasing private insurance.

If you have any questions,concerns or feedback please contact us today. We’d love to hear from you!

How Medicaid Expansion Can Help a State’s Economy

The U.S. Supreme Court ruled in 2012 that states can choose whether to expand their Medicaid programs under the Affordable Care Act (ACA), or Obamacare. To date, 32 states have decided to do so, finding that ultimately it would be beneficial to them. Studies, furthermore, show that the states opting out of Medicaid expansion are actually losing billions of dollars, thus reducing job growth and economic activity.

In 1965, President Lyndon B. Johnson signed into law Medicaid, a program jointly administered by the federal and state governments to provide free medical care to low-income Americans. Many Republicans consider it a form of welfare, an anathema to their traditional ideology that centers on limited government and fewer regulations and taxes to spur job growth.

Many claim that since taxpayers’ dollars fund Medicaid, rolling back the program would help the economy by saving taxpayers money. But, in what economists call “a multiplier effect,” it becomes evident that Medicaid expansion actually saves the states money.

The multiplier effect applies in this context to the money generated from the funds the federal government gives the states to expand their Medicaid programs. Some of the money goes to healthcare workers, who then spend their money on things like homes, restaurants, and theaters. This generates additional revenue, which then goes into the states’ coffers in the form of taxes.

When states decide against Medicaid expansion, they risk putting hospitals and clinics in financial jeopardy when uninsured people become unable to pay their medical bills. Also, when an uninsured person needs to see a doctor, they may end up going to the emergency room instead, in which case the hospital won’t turn them away. As John Holohan, a fellow at the Urban Institute, said, “You can’t make an economic case against expansion.”

For more information on Medicaid expansion, please contact us.

High Deductible Health Plans Made Easy

As health care costs continue to rise, more employers are offering high deductible health plans: health insurance coverage that offers negotiated service discounts with providers and pharmacies but doesn’t actually offset any costs until after the consumer has paid a hefty amount up front, typically greater than $1300 for an individual or $2600 for a couple/family.  In return, the employer may allow planholders to save pre-tax money towards the deductible in a Health Spending Account (HSA), or even contribute funds directly into such an account to be used for eligible health care expenses. Premiums for high deductible plans are lower than those for traditional PPO plans, which makes them a good choice for healthy people who don’t have frequent health care expenses.

What are the best ways to maximize savings with a high deductible plan? First, take advantage of a HSA if your plan is eligible for one.  Not only will your contributions be tax-free, but they can be withdrawn (also tax-free) for a wide variety of health-related expenses outside your health plan, like vision and dental costs. These funds, including those contributed by your employer, are yours to keep, even if you leave your job.  If you are under 65 and withdraw HSA funds for non-health-related expenses you will pay taxes and a hefty penalty.  If you are over 65,  you can withdraw funds from your HSA for any purpose without penalty, but you will need to pay taxes on the amount withdrawn.

Secondly, do your homework on costs.  Research shows that costs for medical services and procedures vary significantly.  Your health plan may have cost data available for you to compare, or you may need to call around to find the best value.  These preparations are time-consuming, but they can be worth their weight in gold when it comes to paying the bill.

High deductible health plans are here to stay.  If you have any other questions about how they work or how to optimize yours, let us know.  We’ll work with you to figure out the best solution for your needs.

Why the Affordable Care Act May Not Go Away

Though many consider it inherently flawed, the Patient Protection and Affordable Care Act, also known simply as the Affordable Care Act (ACA), a bill President Barak Obama signed into law March 23, 2010 (hence the moniker Obamacare), has held its own despite numerous attempts by Republicans to repeal it. A CNN Poll conducted in March, 2010 showed that only 39 percent of Americans favored the ACA, while a whopping 59 percent disapproved.

The ACA’s Two Mandates

The controversy stems in part from two much-maligned provisions: the individual and employer mandates. The first compels people to buy health insurance or pay a fine.  The second, also under threat of a fine, requires a business with at least fifty people on its payroll to provide health insurance to its employees. While the ACA adds millions of people to the health insurance rolls, expands Medicaid, the insurance plan that provides free medical services to low-income Americans, bans denial of coverage because of a pre-existing condition, premiums for some have apparently skyrocketed.

Latest Attempt to Repeal the ACA

The GOP has made valiant attempts to overturn the bill, including the latest attempt, President Donald Trump’s glowing debacle in March, 2017, which cast an embarrassing light on the president and Republican House Speaker Paul Ryan. Now the ACA appears to have become baked in the system, with no sign that it will go away.


Public Opinion Changes Course

For one thing, public approval for the ACA soared to an all-time high this year, a signal that repealing it could be disastrous for the Republicans during the mid-term elections. The fog of complexity that envelopes this divisive issue may serve as an omen for those who wish to reverse it.

“Repeal and Replace”

In response to Trump’s promise to “repeal and replace” the ACA, Ryan introduced a healthcare plan that, according to the Congressional Budget Office (CBO), would have left 14 million Americans without health insurance by 2018, and 24 million by 2026.

Clash Within the GOP

Consequently, moderate Republicans, especially those whose constituents have benefited from the ACA, voted against the GOP’s newest repeal effort. Republicans in the far right wing of the party, however, didn’t think it went far enough. They wanted to slash more benefits. Consequently, they too voted no. This clash revealed intractably deep divisions in the Republican Party over healthcare. That and the wave of public sentiment supporting the ACA will likely present a hurdle in future repeal efforts.

For more information on the Affordable Care Act, please contact us. Thank you.

Finding the Medicaid Options That Work For You

Medicaid enrollment swelled following the passage of the Affordable Care Act. From 2013 through September 2016, the Kaiser Family Foundation counts a net increase of 15.7 million enrollees in both Medicaid and the children’s health insurance program CHIP. This growth occurred as some states expanded Medicaid eligibility, which brought beneficiaries into the program. The expansion, financially supported by the federal government, was envisioned as a way to meet the ACA’s goal of making some form of health insurance available to more Americans, particularly those with low incomes. Changes to Medicaid might be coming, but those changes don’t have to mean that people will lose access to the program altogether.

With more adults covered by Medicaid, some states saw economic gains in the form of savings, revenue growth for healthcare providers, or overall economic growth. The Medicaid expansion also played a large role in reducing uninsured rates. The rate of non-elderly Americans who are not covered by health insurance fell to a record low of 10 percent in early 2016, Kaiser Family Foundation said.

The change in political power in Washington, D.C., has sparked questions about the future of Medicaid. Repeal of the ACA was among the top the proposals of Donald Trump during the presidential campaign. Any changes to the ACA could change the eligibility requirements for Medicaid. If states return to the eligibility requirements that they had prior to the ACA’s passage in 2013, many adults could lose Medicaid eligibility in the states that had expanded coverage, according to the Kaiser Family Foundation. The foundation also says that changes to the ACA could reverse the trend of declining rates of uninsured people, particularly those who are Medicaid recipients.

While health policy changes appear to be coming, it’s important to note that Medicaid is not a one-size-fits-all program. Private health insurance and Medicaid can work together to help people cover their healthcare needs. Medicaid coverage is based on financial need, meaning that beneficiaries need to show that they can’t afford their monthly insurance premiums. But with demonstrated financial need, people who have private insurance coverage can also secure monthly premium support through Medicaid.

There are different paths that people can take to secure the insurance coverage that they need. For help navigating your health insurance options, please contact us.

A Quick Guide to the Health Insurance Marketplace

If you find yourself newly in need of insurance because of a change in life circumstance, like turning 26 or are changing to a job that no longer offers coverage, or if you need to make adjustments to your current health care coverage, you can visit the health insurance marketplace. Here are a few quick pointers on how the health insurance marketplace works.

1. When Can You Apply?

The health insurance marketplace is open from the first of November until the end of January. This is called the open enrollment period. If you do not enroll during the open enrollment period, you must have a special life circumstance to be eligible to enroll. Special circumstances include having a child, getting married, changing jobs or turning 26, which is the cutoff for using your parent’s health coverage.

2. How Can You Apply?

Once you take your time researching the best health insurance plan for you and your family, you can apply for coverage through the marketplace. You can apply for your chosen health insurance plan online, over the phone, in-person with help or with a mailed-in paper application.

3. How Much Does it Cost?

The cost of your plan through the health insurance marketplace depends on your income, how many dependents you have and other life factors, like whether or not you are a college student for example.

If you need insurance, it is important to do your research so you pick the best plan for your lifestyle. The marketplace lets you find and sign up for health insurance policies. If you have more questions about the marketplace, contact us at National Health Insurance Agencies, where our goal is to help you find the best coverage at the best price.

3 Key Considerations for Choosing a Health Insurance Plan

Affordable healthcare is a necessity. If you or a family member have ever experienced an unexpected illness and faced the burden of mounting medical bills, you know this all too well. Choosing a health insurance plan may seem a bit confusing but understanding a few basics about health insurance may help.

  1. The cost of health insurance–Getting adequate healthcare shouldn’t mean breaking your budget. If you are struggling financially, one option is to choose a basic plan that covers essential medical exams and procedures. You can always expand your plan and add more coverage options when you can afford it.
  2. What is covered–It is essential to have health insurance but you want to make sure you are purchasing a policy that will cover medical expenses you are likely to incur. For instance, do you or any family member have a condition or illness? If so, it may be wise to check into plans that cover pre-existing medical conditions.
  3. Can I choose my doctor–Many patients do not feel comfortable with having a healthcare provider chosen for them. You want the freedom to visit a doctor you know and are comfortable seeing. Some health plans will allow you to choose your own doctor. However, you may want to consider using a doctor within the company’s Preferred Provider Network (PPO). For plans that use PPOs, you can save significantly on certain medical procedures and services by choosing a provider within the network. The choice is ultimately up to you.

It will take a little homework to find a health insurance provider that will meet you and your family’s unique medical care needs. You are your family’s health are too important a matter to leave to chance. If you feel you need more help in finding affordable health care options, contact a health insurance professional to discuss your options.

The Future of Obamacare with a Trump White House

With the pending change of leadership in the White House consumers, media, healthcare professionals, and health insurers have many questions about the future of Obamacare. Their questions are timely as the open enrollment period for 2017 coverage under the Affordable Care Act draws to a close December 15th.

During President-Elect Trump’s campaign he was clear in his intent to repeal the Affordable Care Act. Since being elected his message has changed a bit, recently stating that he intends to keep some of the components of the plan. According to an interview with the President-Elect on 60 Minutes, Trump wants the revised Act to “force insurers to cover people with pre-existing health conditions and allow parents to cover children under their plan into their mid-20s.”

President-Elect Trump has tapped Tom Price as his health and human services secretary. Price is an U.S. Representative and orthopedic surgeon from Georgia. According to a recent New York Times article, each year for the past six, including while Democrats were still working on the plan, Price “has introduced bills offering a detailed, comprehensive replacement plan.” Further, Reuters reports, “Price’s plan would also roll back the 2010 law’s expansion of Medicaid for low-income people, a change that helped Obamacare cut the number of uninsured Americans to 29 million in 2015 from 49 million in 2010.” His plan “endorsed converting Medicare from a program that covers set benefits to a voucher-style program to help people buy coverage.”

Please contact us for more information or assistance finding the healthcare coverage you and your family need.

How Does Medicaid Work?

Medicaid is the health care system in the United States that provides coverage for certain low-income, blind and disabled people.  Medicaid is funded by both federal and state dollars, and every state has different rules about who is eligible and which services are covered.  Since 1982, all 50 states have participated in Medicaid, and many of them have expanded Medicaid coverage since the launch of the Affordable Care Act (Obamacare) in 2010.

The majority of Medicaid services in most states are provided at no cost to the recipient; payment is made directly by the state to the doctors, pharmacies, hospitals and ancillary providers on behalf of the person being treated. In some states there are small cash co-pays for some services.

To find out what benefits and services are covered by Medicaid in your state, the client must work directly with the local benefits office to enroll. Medicaid is typically handled in the same office where other public assistance programs like SNAP (food stamps), job training assistance and cash assistance are administered, often at the county level.

Applying for Medicaid requires submission of a paper or computerized form describing the client’s financial situation, including place of residence and personal/household income and expense scenarios. Claims made on the application must be verified with supporting documentation: lease, pay stubs, copies of bills, etc.

Once the application is completed, there will be a waiting period until it is approved; the local benefits office can estimate how long this will be when they accept the completed application. Upon approval, a Medicaid card will be sent to the applicant.  In some states, Medicaid care will be coordinated by a separate Managed Care Organization (MCO); if this is the case, a separate medical card for the MCO will also be mailed to the applicant. This is the card to be presented at medical appointments and when picking up prescriptions.

Medicaid eligibility must be verified at regular intervals and whenever a recipient’s income, household or expense situation changes.  If eligibility is terminated, the Medicaid and/or MCO cards will no longer be accepted by doctors and other providers.  For this reason, it is important attend all scheduled appointments with the local benefits office and to bring all relevant documentation. If Medicaid is not approved and there is reason to believe that an error has been made, there are appeals procedures available.

Because Medicaid has different rules in every state, benefits only apply in the state where they are applied for and approved.  If a recipient moves across a state line, benefits will not be available until the old state’s Medicaid has been terminated and a new application has been approved.

For individuals who qualify for Medicaid, it is the most cost-effective and accessible plan available.  Now that many states have expanded their Medicaid eligibility guidelines as part of the ACA, individuals who previously would have been limited to a commercial policy may now be Medicaid eligible.  For those who lose their Medicaid eligibility due to improved employment or other status changes, an NHIA agency may be able to assist with locating the best plan for continued, affordable coverage.

Insurer Pullback from Health Insurance Marketplace Threatens Market’s Competitiveness

The insurance choices for many people who select plans from the health insurance marketplace will become will become fewer in 2017. Aetna, one of the largest health insurance providers, announced that next year it would not offer plans in 11 of the 15 states where it offers coverage through the marketplace. It’s a dramatic shift from the company’s public sentiments expressed just months ago. In April, CEO Mark Bertolini described the Affordable Care Act to shareholders as a good investment, according to Vox. And as recently as May, the company was planning on expanding into five new markets.

Now Aetna’s strategy shift will leave the insurer in just four states starting next year. The reason, Vox explains, is that the company believes that these marketplace plans were losing the company too much money. The company attributes these financial losses to the markeup of its customer base. Too many of the enrollees were older and sicker, and thus more expensive to cover, according to Vox.

Aetna isn’t the only company pulling back on its coverage in certain states. Humana has also said that it withdraw from eight of the 19 states where it currently offers coverage, leaving it in just 11 states next year. The most dramatic change is coming from UnitedHealth Group. The company, which currently offers plans through the marketplace in 34 markets, now says that it will be in three or fewer markets next year, Slate reported. These insurance companies are all claiming reasons similar to those cited by Aetna. All five major health insurers now expect to lose money from plans offered on the federal marketplace, the Wall Street Journal reported. Aetna’s loss is projected to top $300 million.

Aetna’s decision will reduce competition in the states where it withdraws coverage. Competition was one of the main objectives of the Affordable Care Act. But it’s also possible that other insurers will step up to fill the void left by Aetna. The insurance companies that do choose to remain in the health insurance marketplace will likely adjust their insurance plans to better reflect the kinds of options that people are looking for. To stay on top of the latest developments regarding insurance plans available on the insurance marketplace, contact us.