Why do I have to purchase Pediatric Dental if I don’t have kids or need it?

By Michelle AndrewsImage

OCT 25, 2013

Q. My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn’t provide proof that he has it they will automatically enroll him in a plan. We don’t have children, so why would we have to have pediatric dental insurance?

A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts. The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.  

Pediatric dental coverage is sometimes offered as part of a regular health plan, but it’s also often sold on a standalone basis. So even though the health law requires that children in individual and small group plans have access to dental coverage, people are not required to buy separate pediatric dental coverage if they buy a plan on the state health insurance marketplaces, or exchanges, unless their state specifically requires it.

But people who buy plans outside the state marketplace may not have the same flexibility, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project.   

Outside the exchange, “There’s no exemption for that requirement to have pediatric dental coverage,” he says. “So if you’re buying insurance outside the exchange you may have to meet it.” 

It sounds as if your husband’s plan is a non-exchange plan. If that’s the case, he could shop for a plan on the exchange if he wants to avoid buying pediatric dental coverage.

What Did CBO Really Mean By 2 Million Jobs Lost?

This week, messaging was the name of the game. On Tuesday, the nonpartisan Congressional Budget Office (CBO) released an economic reportsaying that the healthcare law may cause Americans to work fewer hours — enough to be the equivalent of 2 million fewer jobs in 2017, which is nearly three times as high than what CBO has reported in the past. But the devil is always in the details. Yes, the report said that the equivalent of jobs lost would equal 2 million, but it also said it’s in large part about the number of hours people choose to work, not actual job loss. The report’s purpose is an analysis of the impact of PPACA on the supply of labor, or how many people chose to enter into the workforce. Basically, the CBO report was a report of incentives, whether or not PPACA increases or decreases incentives for Americans to work, and no one really knows how this will all play out over time.Image

As you can imagine, Republicans, once the report was released, went crazy with Facebook posts, tweets and public statements about how the president’s signature healthcare law is hurting the American workforce. As expected in response, the White House almost immediately published a blog post and began making their own public statements to put their spin on the report. Their basic argument is that PPACA will allow people who want to work less to do so because they will be able to get health insurance through the exchanges rather than through an employer. According to the White House, the law stops “job lock,” the phenomena where a person is afraid to quit a job and say start a small business because they will lose benefits. Conventional wisdom says the White House can spin all they want, though, and the 2 million number will still loom large over the 2014 election cycle.

The report also highlighted other important statistics that were overshadowed by the job loss numbers. CBO lowered the predicted exchange enrollment numbers from 7 million down to 6 million for this year. While it is a significant drop, we’re actually a little surprised it didn’t plunge a little further given how well the exchange websites have been working. Additionally, CBO reported that the risk corridors would save $8 billion in the long term. Why would it save so much money? Because the program is supposed to pay health insurers that have higher-than-expected costs, but the money flows both ways. So if insurers’ costs are lower than expected, the health plans are supposed to pay the government, resulting in cost-savings. CBO predicts that it will collect more from insurers than it actually gives to them in the first place.  Time will tell…

HHS Releases Updated Exchange Enrollment Numbers: Emerging Trends Continue to Raise Some Concerns

JANUARY 19, 2014 – 10:24 PMImage

On January 13, the U.S. Department of Health and Human Services (HHS) released updated enrollment figures for the Affordable Care Act’s (ACA) Exchanges during the first three months of operation. The report outlines the number of Americans who have accessed a state-based or federally facilitated Exchange as well as a demographic breakdown of new enrollees.   This blog highlights some of the key Exchange enrollment trends.

Federal Exchange Enrollment Tops State-Based Exchange Numbers

Federal Exchange enrollment outpaced state-based Exchange enrollment with 1.2 million of the 2,153,421 individuals selecting a federal Exchange policy, and 950,000 choosing a state-based option during the October 1 – December 28, 2013, open enrollment period. This is a significant difference from just a few weeks as the state-based exchanges had shown larger numbers most likely as a result of reporting timing.

One of the likely reasons the federal Exchange has enrolled more Americans is the demographic composition of where the Exchanges operate. There are currently 34 states, representing a majority of the country’s population, using the federally facilitated Exchange, while just 16 states (plus the District of Columbia) operate their own Exchange. Further there are generally larger numbers of uninsured Americans living in states using the federal system. Of the 17 states with the greatest proportion of uninsured people, 14 are using the federal Exchange. It follows that there would be larger enrollment in places where more people need insurance.

Young Adult Representation Lacks Luster

Enrollment demographics have received much attention since the consensus is that a large number of new enrollees must be younger, healthier Americans. This population tends to amass fewer claims, allowing their premiums to subsidize older consumers within a health plan. According to reports during the early phases of open enrollment, the government was hoping the younger population would represent at least 40% of the newly insured. The January 13 report points out that 24% of Exchange enrollees through December 28, 2013, were between the ages of 18 and 34. This is proportionate to the number of Americans in this age group (26%), but lower than the proportion of uninsured people in this demographic (about 38%).

The report also indicates young adults may be waiting longer than the rest of the population to enroll in coverage. “The general expectation is that people who are older and sicker are more likely to select coverage earlier in the initial enrollment period,” the report states, “while younger and healthier people will tend to wait until towards the end of the open enrollment period (which concludes March 31, 2014).” 
The growth in enrollment for young adults from October to December was larger than growth in other age groups, indicating that the overall share of young adults enrolling in plans is growing. Perhaps the initial technological difficulties caused some young consumers to disengage from the Exchange websites. Now that those glitches have largely been fixed, some may be giving the system a second chance.
While the main takeaway of the HHS report is the lower than expected young adult enrollment, there are other important facts to emerge from the first half of open enrollment.

Silver Plan Option Most Popular

In deciding what level of coverage to purchase, 60% of Americans have opted for “silver level” plans, meaning an average of 70% of health care expenses will be paid by the health plan. All other metal levels were significantly less popular: bronze (20%), gold (13%), platinum (7%), and catastrophic (1%).

Nearly 80% Receive Federal Subsidy

It’s also notable that 79% of consumers who have selected a health plan through an Exchange will receive a federal subsidy. Subsidies are available to those who do not qualify for Medicaid, but earn below 400% of the federal poverty line.
We will continue to keep you apprised of any updates to the enrollment figures and any additional information on demographic trends relevant to our clients. In the meantime, please visit www.BeWellInsurance/wordpress.com to view past blogs and Legislative Alerts. Or you may visitwww.HealthcareExchange.com for more blog posts, polls, surveys and numerous resources.

It’s important to note that the federal health care reform initiative discussed in this blog is referred to by several different acronyms including ACA, PPACA and ObamaCare. No matter what the term, Be Well Insurance Solutions will continue tracking and reporting on key health care reform trends that are impacting Brokers, payroll personnel and key stakeholders. 

[Author:  Michael Gomes, Executive Vice President, BenefitMall]


Producers vindicated as House slams navigators

After months of feeling ignored in favor of government-funded navigators, producers are finally enjoying their time in the spotlight. They’re also enjoying a bit of sweet vindication as a Republican-led House panel releases a report accusing navigators of committing significant errors and risking privacy.

Navigators, which were appointed in the Affordable Care Act rollout to help consumers enroll in health plans, have been giving enrollees bad information and haven’t done enough to protect privacy, the report said.

“Documents call into question the effectiveness of the Navigator program and the Obama administration’s ability to safeguard consumer information,” the House Oversight Committee concluded.  Click Here for full story:  http://bit.ly/1bQmn0z

The Importance of Getting a Broker for Health Care Coverage

The Importance of Getting a Broker for Health Care Coverage.

The Importance of Getting a Broker for Health Care Coverage

Why use a Navigator or Enrollment Counselor who does not have the vast education, knowledge, experience, continuing education, and E&O coverage to assist you? We understand the market place better than anyone who might assist you on a 1-800#; and if you apply on your own you may be purchasing a product on price that may not meet your needs. Why not call a Certified and Licensed Agent/Broker who is experienced and qualified to ask you the right questions and assist you with finding the plan that best fits your needs. Call Today 1-408-615-1280

Summary of the week… What We’re Reading

Finger pointing, spoofs and shameless self-promotion. Who wouldn’t want to read what we are reading this week?

Guess what? According to internal “war room” memos, healthcare.gov enrolled less than 250 people in its first few days? And most of the overall enrollees so far are for Medicaid

For you visual learners, here is a handy flow chart showing who is blaming who for this mess.

Kathleen Sebelius’ testimony before the House Ways and Means Committee this week was entertaining, but personally we preferred her remarks onSaturday Night Live

It’s exciting when you are quoted in a story that’s on the front page of the New York Times website, even for a few hours. 

Dedicated readers know we’ve been concerned about the enforceability of the law’s individual mandate since the idea started getting serious national political consideration (we ballpark this at about 2006). The worries of this health nerd have finally gone main stream with USA Today writing about it this week. 

Here’s the latest on congressional staff health insurance coverage options.

Finally, to leave for the weekend on a high note, The Onion has the scoop on how well the “tech surge” is working.