Ohio Benefits Group

The BCBS companies alleged that CVS had offered lower prices for “hundreds” of generic drugs and later told insurers that the prices were much higher than they actually were.
​___________________________________________
Blue Cross Blue Shield insurers in six states have sued CVS Health Corp. over an alleged scheme to overcharge them for generic drugs by submitting claims for payment at “inflated prices.”
The lawsuit, filed May 27 in the Rhode Island federal court, added to mounting pressure that CVS has been facing since 2015 over its cash discount programs, which it said were designed to compete with Walmart and other “big-box” discounted pharmacies.
According to the complaint, health insurers typically negotiate “lesser-of” contracts with pharmacy benefits middlemen to pay the lower cost of either the negotiated drug price or the cash price that insured patients would pay. But the BCBS companies alleged that CVS had offered lower prices for “hundreds” of generic drugs and later told insurers that the prices were much higher than they actually were.
 
“By intentionally submitting falsely inflated usual and customary prices, CVS knew that it was being overpaid for these generic drug transactions. In fact, as internal documents show, that was CVS’s plan all along,” BCBS’s attorneys from Partridge Snow & Hahn wrote in the 46-page complaint.
“CVS has now pocketed billions of dollars in ill-gotten gains through this unlawful scheme— including many millions from plaintiffs,” they said.
CVS, however, is not the only pharma firm to land in hot water over claims for prescription drug prices.
Last month, 50 independent pharmacies sued OptumRx, a major pharmacy benefit manager, in a proposed class action over its alleged failure to comply with state pharmacy claims reimbursement laws.
That suit claimed that OptumRx paid local pharmacies substantially less than it paid large chain retail pharmacies like CVS or Walgreens and knowingly reimbursed local pharmacies below wholesale cost to stock necessary generic prescription drugs.
Still, CVS is preparing for a planned trial later this year over substantially the same issue in the first class action to target the Woonsocket, Rhode Island-based company for overcharging for generic drugs.
CVS has said in financial filings that it is “defending itself against these claims.”
The BCBS suit has cited “internal documents” from public legal filings to argue that CVS concealed its alleged scheme from third-party payors for years.
“Had CVS been open and notorious about its fraudulent pricing scheme, it never would have succeeded—plaintiffs would have insisted that CVS submit the correct usual and customary price,” the complaint said. “Indeed, while carrying out this scheme, CVS internally feared that third party payors would learn of the deception and demand correction.”
The plaintiffs in the case, captioned Blue Cross and Blue Shield of Alabama v. CVS Health, are represented by Christian Jenner, Paul Kessimian and Phoebe Roth of Partridge Snow & Hahn.

​The coronavirus relief bill includes a direct payment to most Americans, but this has Medicaid recipients wondering how the payment will affect them. Because the payment is not income, it should not count against a Medicaid recipient’s eligibility. 
The Coronavirus Aid, Relief, and Economic Security (CARES) Act provides a one-time direct payment of $1,200 to individuals earning less than $75,000 per year ($150,000 for couples who file jointly), including Social Security beneficiaries. Individuals earning up to $99,000 ($198,000 for joint filers) will receive smaller stimulus checks. Payments are based on either 2018 or 2019 tax returns.  
The basic Medicaid rule for nursing home residents is that they must pay all of their income, minus certain deductions, to the nursing home. If the stimulus payment were considered income, it would likely have to go straight to the nursing home. Since in most states Medicaid recipients cannot have more than $2,000 in assets, there was also concern that the stimulus payments could put many recipients over the asset limit. 
In a blog post, the commissioner of the Social Security Administration (SSA) has clarified that the SSA will not consider stimulus payments as income for Supplemental Security Insurance (SSI) recipients, and the payments will be excluded from resources for 12 months. Because state Medicaid programs cannot impose eligibility requirements that are stricter than SSI requirements, the payments should not affect Medicaid eligibility.

By Michael J. Millonig, LLC
(937) 438-3997

Ronilee Shye, PharmD, BCGP, BCACP, CDE
Roni Shye, PharmD, BCGP, BCACP, CDE is a licensed pharmacist in Florida, Ohio, and Pennsylvania.
Posted on December 18, 2019

​According to the Centers for Disease Control and Prevention, sickle cell disease affects about 100,000 people in the U.S. It’s a genetic disease that is more common in Hispanic Americans and African Americans. In most cases, medications treat disease complications but not the condition itself.
That’s about to change. The FDA recently approved 2 medications to directly treat sickle cell disease and its complications. Adakveo and Oxbryta, both approved in November 2019, provide new treatments for those affected. 
What is sickle cell disease?
Sickle cell disease is a rare blood disorder in which red blood cells are shaped like a sickle (C-shaped) instead of round. Red blood cells play an important role by carrying oxygen throughout the body. The abnormal shape of cells in people with the disease causes the cells to die faster, and it makes it harder for them to deliver oxygen to body tissues.
Some of the most common symptoms of sickle cell disease include:

• Pain
• Infection
• Tiredness
• Fever
• Yellowing of the skin

Additionally, sickle cell disease is often accompanied by complications like:

• Bone pain
• Chest pain
• Swelling in the hands and feet
• Coughing
• Difficulty breathing
• Stroke 
• Eye problems

What is Adakveo?
Adakveo treats a common and painful complication of sickle cell disease called vaso-occlusive crises, or pain crises. They are unpredictable and intense episodes of pain that can last 10 days or more. 
Adakveo is available as an intravenous infusion and is given once a month. The most common side effects include:

• Nausea
• Back pain
• Joint pain
• Fever

What is Oxbryta?
Oxbryta is the first medication to target the root cause of sickle cell disease. It works by preventing red blood cells from sticking together and turning into a sickle shape. It is available in 500 mg tablets and is taken once a day.
The most common side effects of Oxbryta include:

• Headache
• Diarrhea
• Stomach pain
• Nausea
• Tiredness
• Rash 
• Fever

How much do they cost?
Both medications come with hefty price tags. The best Goodrx price for Adakveo is around $2,400 per vial (most people will need to take 3 to 4 vials per month). The best GoodRx price for Oxbryta is $3,500 for 30 tablets (most people take 3 tablets per day).

Ronilee Shye, PharmD, BCGP, BCACP, CDE
Roni Shye, PharmD, BCGP, BCACP, CDE is a licensed pharmacist in Florida, Ohio, and Pennsylvania.
Posted on December 18, 2019
According to the Centers for Disease Control and Prevention, sickle cell disease affects about 100,000 people in the U.S. It’s a genetic disease that is more common in Hispanic Americans and African Americans. In most cases, medications treat disease complications but not the condition itself.
That’s about to change. The FDA recently approved 2 medications to directly treat sickle cell disease and its complications. Adakveo and Oxbryta, both approved in November 2019, provide new treatments for those affected. 
What is sickle cell disease?
Sickle cell disease is a rare blood disorder in which red blood cells are shaped like a sickle (C-shaped) instead of round. Red blood cells play an important role by carrying oxygen throughout the body. The abnormal shape of cells in people with the disease causes the cells to die faster, and it makes it harder for them to deliver oxygen to body tissues.
Some of the most common symptoms of sickle cell disease include:

• Pain
• Infection
• Tiredness
• Fever
• Yellowing of the skin

Additionally, sickle cell disease is often accompanied by complications like:

• Bone pain
• Chest pain
• Swelling in the hands and feet
• Coughing
• Difficulty breathing
• Stroke 
• Eye problems

What is Adakveo?
Adakveo treats a common and painful complication of sickle cell disease called vaso-occlusive crises, or pain crises. They are unpredictable and intense episodes of pain that can last 10 days or more. 
Adakveo is available as an intravenous infusion and is given once a month. The most common side effects include:

• Nausea
• Back pain
• Joint pain
• Fever

What is Oxbryta?
Oxbryta is the first medication to target the root cause of sickle cell disease. It works by preventing red blood cells from sticking together and turning into a sickle shape. It is available in 500 mg tablets and is taken once a day.
The most common side effects of Oxbryta include:

• Headache
• Diarrhea
• Stomach pain
• Nausea
• Tiredness
• Rash 
• Fever

How much do they cost?
Both medications come with hefty price tags. The best Goodrx price for Adakveo is around $2,400 per vial (most people will need to take 3 to 4 vials per month). The best GoodRx price for Oxbryta is $3,500 for 30 tablets (most people take 3 tablets per day).

Click here for Link to article

If you are paying for your own insurance, you may think you do not need to sign up for Medicare when you turn 65. However, not signing up for Medicare Part B right away can cost you down the road. 
You can first sign up for Medicare during your Initial Enrollment Period, which is the seven-month period that includes the three months before the month you become eligible (usually age 65), the month you are eligible and three months after the month you become eligible. If you do not sign up for Part B right away, you will be subject to a penalty. Your Medicare Part B premium may go up 10 percent for each 12-month period that you could have had Medicare Part B, but did not take it. In addition, you will have to wait for the general enrollment period to enroll. The general enrollment period usually runs between January 1 and March 31 of each year.
There are exceptions to the penalty if you have insurance through an employer or through your spouse's employer, but there is no exception for private insurance. The health insurance must be from an employer where you or your spouse actively works, and even then, if the employer has fewer than 20 employees, you will likely have to sign up for Part B. 
If you don't have an employer or union group health insurance plan, or that plan is secondary to Medicare, it is extremely important to sign up for Medicare Part B during your initial enrollment period. Note that COBRA coverage does not count as a health insurance plan for Medicare purposes. Neither does retiree coverage or VA benefits.
For a New York Times column about a man with private insurance who didn’t realize he needed to sign up for Part B, click here.   

By Michael J. Millonig, LLC

DYNASTY TRUSTS: A Great Family Legacy
Modern trust law in many States permits a trust to exist for many generations and provide benefits to your grandchildren and their descendants or other desired beneficiaries. This type of trust can provide many benefits not possible with a typical revocable trust not the least of which is avoidance of estate tax for each generation. The trust can be designed to encourage education or other chosen values that you desire to instill in your descendants. For example, the trust could provide for a special distribution amount as a reward when a trust beneficiary obtains a college degree, works for a charitable cause, gets married, enters a particular profession or achieves some other desirable goal. These types of incentive provisions can foster your goals to positively enhance the lives of your descendants. The trust can also provide protection in the event a beneficiary gets divorced, files bankruptcy, gets sued, has financial problems, suffers a disability or other catastrophe.

In my experience talking with clients about trusts, I know that the first reaction of most clients is to be fearful of being locked into a trust or leaving your children or grandchildren in a position of not being able to exert some control over the trust and unable to receive the benefits. Fortunately, there are many ways to setup the dynasty trust to allow flexibility and control. A trust should not be thought of as a restrictive arrangement. Rather, it should be viewed as a positive way to continue your influence to better the lives of your descendants for generations to come. The Dynasty Trust can be a positive influence on your descendants that will enhance their lives and protect them from financial catastrophes.

For more information, please refer to the section on my website on Dynasty Trusts. http://www.michaelmillonig.com/practice-areas/trusts/#Dynasty

By Rebecca Moore​
The Internal Revenue Service (IRS) has issued Revenue Procedure 2018-27 which allows the $6,900 limitation as the maximum deductible health savings account (HSA) contribution for individuals with family coverage under a high-deductible health plan (HDHP) who contribute to an HSA to remain in effect for 2018.On May 4, 2017, the Department of the Treasury and the IRS released Revenue Procedure 2017-37, which provided that the annual limitation on deductions under section 223(b)(2)(B) for an individual with family coverage under an HDHP was $6,900. Subsequently, statutory amendments by “An Act to Provide for Reconciliation Pursuant to Titles II and V of the Concurrent Resolution on the Budget for Fiscal Year 2018,” enacted December 22, 2017, modified the inflation adjustments for certain provisions of the Internal Revenue Code, including the inflation adjustments under section 223.
On March 2, 2018, the Treasury Department and the IRS released Rev. Proc. 2018-18, to reflect the statutory amendments to the inflation adjustments under the Act, reducing the annual limitation on deductions under section 223(b)(2)(B) for an individual with family coverage under an HDHP to $6,850 for 2018.
The IRS says it is reversing the change to the limitation because stakeholders informed it that implementing the $50 reduction to the limitation would impose numerous unanticipated administrative and financial burdens. Specifically, stakeholders noted that some individuals with family coverage under an HDHP made the maximum HSA contribution for the 2018 calendar year before the issuance of Rev. Proc. 2018-18, and that many other individuals made annual salary reduction elections for HSA contributions through their employers’ cafeteria plans based on the $6,900 limit. Stakeholders informed the IRS that the costs of modifying the various systems to reflect the reduced maximum, as well as the costs associated with distributing a $50 excess contribution (and earnings), would be significantly greater than any tax benefit associated with an unreduced HSA contribution (and in some instances may exceed $50).

https://www.planadviser.com/irs-reverts-prior-hsa-limit-family-coverage/

.  Center for Medicare Services (CMS) and Premier Health Insurance Corporation  have entered into a Mutual Termination Agreement.
This does not effect Premier Health Care Medical providers only the "Insurance Corporation".
Affected Plans include:

• Premier Health Advantage (HMO)
• Premier Health Advantage VIP (HMO SNP)
• Premier Health Advantage Choice (HMO-POS)

Individuals enrolled in these plans are now Qualified for a Special Enrollment Period (SEP) until 31MAY2018. 
If no selection is made by 31MAR2018, beneficiaries will be automatically enrolled in Original Medicare and SilverScript Insurance Company's Ohio Silverscript Choice plan, a Part D plan selected by CMS for prescription drug coverage effective 1APR2018.
This is for part D, they will still be able to enroll in another Medicare Advantage Health plan or Original Medicare prior to the end of their SEP, 31MAY2018.
Please not the the beneficiary cost may be different with Original Medicare and the SilverScrip Choice Plan (Part D).
I am available for a individual or group meeting to help these individuals through the decision process.
Please feel free to share this information. 
 
--
Brad Nickels
Ohio Benefits Group
Brad@ohiobenefitsgroup.com
937-271-1848

Who knows you best? Your spouse? Son or daughter? Best friend? If your primary care doctor doesn’t make the list, you could be missing out on one of the most important relationships when it comes to your health and well-being.
Your primary care doctor may be more than just a doctor. Over time, he or she may learn the nuances of your medical history, your response to medications, your personality, your lifestyle and your treatment preferences.
That intimate knowledge can make a big difference to your health. Studies show that when people’s access to primary care doctors improves, their risk of dying of cancer, heart disease and strokes declines.
“Primary care doctors help you move through the continuum of life,” said Dr. Efrem Castillo, chief medical officer of UnitedHealthcare Medicare & Retirement, who practiced as a primary care doctor for 20 years. “As we get older, our needs change and our functional ability changes. It’s nice to have someone who knows you guide you through the health care system as that happens.”
Here are 10 tips on how to choose a primary care doctor.

1. Ask around.

The first step to finding a great doctor is to talk to your family and friends about their great doctors. A recommendation from someone you trust is a great way to identify a doctor you may want to consider. But remember, each person is different. Just because your neighbor or your best friend loves their doctor doesn’t mean that the same doctor is right for you.

1. Map it out.

Since you’ll be visiting your primary care doctor for everyday health needs, it’s important that he or she be located somewhere convenient to you. You won’t want to travel very far when you’re not feeling well. And if your doctor’s office is conveniently located, you may be more inclined to keep appointments for physicals and other preventive care when you’re healthy.

1. Make sure you’ve got coverage.

Once you’ve identified some possible candidates, check whether they work with your Medicare coverage. If you have Original Medicare, call the doctor’s office and ask if he or she accepts Medicare patients. If you have a Medicare Advantage plan (Part C), call your insurance provider or check your plan’s website to see if the doctor is in the plan’s provider network. Plans may charge more if you see a doctor outside the network, and some won’t cover out-of-network care at all, so it’s important to take this step before scheduling an appointment.

1. Do a quality check.

Chances are you wouldn’t hire someone to make repairs in your home without doing a little research into the quality of their work. So why would you choose a doctor without doing the same?
You can use the Physician Compare tool on Medicare.gov to see if your doctor has participated in any activities that indicate he or she provides high-quality care. You may also check to see whether your doctor is board-certified through the Certification Matters site, which the American Board of Medical Specialties maintains. Board-certified primary care doctors have not only met the licensing requirements of their states, but also passed comprehensive exams in internal medicine. Doctors also have to keep up with the latest developments in their fields to maintain their certification.                                        

1. Place a cold call.

Castillo advises that patients call a potential doctor’s office for a first impression.
“You can tell a lot by the phone etiquette of the office staff,” Castillo said. “Ask if they’re taking new patients and see how they answer. If they say, ‘The next appointment is in 90 days, have a great day,’ that’s a lot different than saying, ‘He’s really busy, and we always make time for existing patients, so it might take us some time to fit a new patient in.’”

1. Ask about logistics…and consider scheduling an in-person meeting.

On that initial call, Castillo also recommends asking about office practices to get a sense of how it runs. How does the office handle prescription refills? How do they let you know about test results? Can you email your doctor or schedule appointments online? Will the office call to remind you if you’re overdue for an annual screening or a flu shot?
When he was in practice, Castillo said some patients would ask for quick in-person conversations before making an appointment. Not all doctors will be able to accommodate such requests, but it doesn’t hurt to ask.

1. Keep your needs in mind.

Every person has unique health care needs, and those needs change as people age. Castillo suggests asking your doctor about his or her specialties or areas of interest.
“Some primary care doctors are really good at sports medicine, but if you’re not a serious athlete in your senior years, that may not be helpful to you,” Castillo said. “Some doctors, on the other hand, may have a special interest in diabetes care or have a large population of diabetics in their practice. Those are things to ask when you call.”
And if you have multiple complex medical issues, you may benefit from seeing a geriatrician, Castillo said. Geriatricians specialize in the care of older patients.

1. Look at the bigger picture.

At the first visit, it’s important to make sure your doctor’s philosophy of care lines up with your own. Consider asking questions such as: Why did the doctor decide to go into primary care? What is his or her favorite thing about being a doctor? What does he or she wish more patients would do after they leave his or her office?
If your doctor’s outlook on patient care meshes nicely with your preferences, you may be more likely to follow his or her recommendations in between appointments. So take this into consideration when deciding whether to stick with a doctor following your first appointment.

1. Avoid culture shock.

Every culture has its own customs, ideas and taboos about medical care, so it’s important to find a doctor who not only speaks your language, but is sensitive to your cultural and religious convictions.
“In some cultures, it’s very easy to joke around, and in other cultures, that is just not the way you do things,” Castillo said. “It’s important that your doctor is culturally aware.”

1. Trust your gut.

Your primary care doctor is going to help solve problems and be an important advocate for your health. It’s critical that you trust him or her and feel comfortable asking questions.
The American Academy of Family Physicians recommends that after your first appointment, you ask yourself the following questions:

• Do you feel at ease with this doctor?
• Did you have enough time to ask questions?
• Did he or she answer all your questions?
• Did he or she explain things in a way you understood?

If something seems off, trust your instincts and look for a new doctor, Castillo advised.
“You should be comfortable with your primary care doctor,” Castillo said. “It’s really about what you expect and need. It’s okay to say, ‘This person is not the right fit for me.’”

Click here for UHC blog Link

AARP calls on Congress to repeal limits on physical, speech, occupational treatmentsby Dena Bunis, AARP, January 24, 2018

Millions of Medicare beneficiaries who need physical, speech or occupational therapy to help them recover from strokes or deal with chronic illnesses will have to pay thousands of dollars more for that care unless Congress acts soon.
For two decades, Medicare has capped how much it will pay for physical, speech and occupational therapy. But ever since the limits were imposed, Congress has passed an automatic exception that allows Medicare to pay for care beyond the caps when the treatments are deemed medically necessary.
The latest exception expired Dec. 31, which means the caps of $2,010 for physical and speech language therapy and $2,010 for occupational therapy are now being enforced. These services fall under Medicare Part B, which covers doctor visits and other outpatient services. When the exceptions were in place, Medicare beneficiaries paid only the 20 percent coinsurance that Part B requires.
Without the exceptions, Medicare beneficiaries must pay the entire therapy bill once they exceed the threshold. According to AARP, some beneficiaries with high-cost conditions could reach the annual caps in the coming weeks.
AARP is part of a coalition of provider, consumer and advocacy organizations urging Congress to repeal the therapy caps. “The caps prevent beneficiaries from receiving the rehabilitation care they need from therapists in a timely fashion,” Joyce Rogers, AARP senior vice president for government affairs, wrote in a December letter to Senate Finance Committee leaders. “Delaying or reducing care can diminish an individual’s independence in his or her home and community.” 
The caps apply to the therapy that Medicare covers whether delivered in a provider’s office, a patient’s home or an outpatient therapy center. It’s very common for someone who has had a stroke or a hip or other fracture to need intensive therapy to learn how to speak and walk again or feed themselves. Patients who suffer from conditions such as arthritis, Parkinson’s disease or multiple sclerosis also often need therapy to manage the tasks of everyday living.
According to a recent analysis commissioned by the American Occupational Therapy Association, nearly 6 million Medicare beneficiaries accessed outpatient therapy services in 2015. Of those, nearly 1 million required care that exceeded the combined cap on physical and speech therapy, while nearly 250,000 surpassed the occupational therapy threshold. 
Without rehabilitation care, more older Americans won’t be able to maintain their independence, making them more likely to move into a nursing home or face frequent and costly hospitalizations.
“The level of anxiety among patients, their families, caregivers and providers is definitely rising,” says Justin Elliott, vice president of government affairs for the American Physical Therapy Association. “Every day the caps are in place they’re going to potentially reach it and not get the care they need.” 

Click her for AARP Article

a Larkin

Senate Republicans recently approved the repeal of Obamacare’s individual shared responsibility penalty as part of the 2017 reconciliation act. While the tax cut does not repeal the individual mandate itself, it zeros out both the dollar amount and percentage of income penalties imposed by the mandate.
The details of the repeal may be confusing for your clients, so we have put together a resource of talking points to simplify the repeal and what it means, sourced from a recent article from Health Affairs:

• Both houses of Congress have now voted to repeal the Affordable Care Act’s (ACA) individual shared responsibility penalty, effective for 2019, as part of the 2017 tax reconciliation act.
• Individuals remain responsible for having insurance or paying the penalty for the 2017 filing season and for 2018.
• The IRS announced it will reject electronic filings of 2017 tax returns that do not claim coverage or an exemption or include payment of the penalty.
• Important:  the individual mandate was not repealed.  Section 5000A of the individual mandate provides the legal requirement for individuals to purchase minimum essential coverage even though the penalty for not doing so has been repealed.
• Employers providing “minimum essential coverage” must still report info to the IRS for the covered individuals and provide evidence of coverage to the individual or be subject to penalties if they fail to report.
• Provisions for individuals to apply for exemptions from the mandate (to exchanges or the IRS) are still in place but it’s unlikely that individuals will apply for exemptions after the penalty is repealed in 2019.
• There are two employer mandate penalties that remain in place:
  • a penalty imposed on employers who fail to offer minimum essential coverage to full-time employees if any employee receives premium tax credits to enroll in coverage through an exchange, calculated on a per-employee basis for all full-time employees; and
  • a larger penalty imposed on employers who offer minimum essential coverage but fail to offer “minimum value” coverage, which applies to each full-time employee who in fact receives premium tax credits for exchange coverage.
• Premium tax credits will continue to keep coverage affordable for consumers with incomes below 400 percent of the poverty level.
• Coverage will continue to be available to all consumers regardless of preexisting conditions.
• Premiums will not depend on health status, and a risk adjustment system will penalize insurers who attract primarily healthy enrollees.
• The remaining eight titles of the ACA remain operative, including provisions closing the Medicare donut hole.

http://www.crnstone.com/news/talking-points-for-addressing-the-tax-bill-and-the-individual-mandate/

By Jeff Smedsrud
The U.S. Department of Health Human Services has just completed work on regulations that could make big changes in how the U.S. individual health insurance market.
One change will cut the open enrollment period for 2018 in half, to just 45 days. The open enrollment period will now end Dec. 15, not Jan. 31.
Another big change will set tougher rules for how the Obamacare exchange system will verify the eligibility for people trying to buy an Obamacare plan during the special enrollment period. People will have to provide documentation that they have gone through a life-changing event, such as a marriage, that gives them a chance to buy insurance after the open enrollment period deadline.

These changes might help insurers push health people to get covered during the open enrollment period, and it might help them avoid having to cover special enrollment period applicants who were intentionally trying to game the system.
It could also make getting your clients covered more complicated.

Here are five ways the new enrollment rules might force you to come up with new strategies for helping your clients.

1. Mid-Year Coverage Upgrade Problems
John pays for his own health insurance. He has a Bronze plan (less expensive, but less coverage). In January, he marries Sue and soon thereafter Sue becomes pregnant. Because they are newly married, Sue can automatically enroll in John’s plan. But they decide they want better coverage (there is a baby on the way) and so in the middle of the year they switch to a Gold plan.

Under the old rules: Switching healthcare plans in the same calendar year would be allowed.

Under the new rules: Not allowed.

2. Unpaid Health Coverage Premium Headaches

Tim has a variety of part-time jobs at tiny businesses. None of them offer him employer-sponsored health insurance so he buys his own health plan. Of the $400 a month in premium, he gets a subsidy from the government that covers all but $50 a month. Late in the year, Tim stops paying his premiums for the last three months of the year. His insurance is cancelled. A few months later, Tim decides he wants coverage again, and applies for a plan with the same company.

Under the old rules: His insurance company must cover him.

Under the new rules: They can deny coverage until he pays them the back premium for the 3 months in which he was covered but didn’t pay.

3. Moving Documentation Headaches

Sam lives in small town in western Montana. He moves south to Wyoming. His old insurance says his health care providers in Wyoming are out-of-network. Because he has moved outside of his network coverage area, Sam can apply and be accepted for health insurance after his official move date for the next 60 days.

Under the old rules: Sam tells his insurance company that he moved, and his new plan covers him immediately.

Under the new rules: Sam has to submit evidence to the government that he moved to Wyoming and that he’s no longer in his old plan’s coverage area. Sam won’t have coverage until the evidence is verified, and his pending coverage can only be backdated by up to 30 days.



4. Baby Blues

Sydney and Mary adopt a Jessica, baby with special needs, and they want Jessica to have the lowest possible out-of-pocket expenses.

Under the old rules: They simply need to verify Jessica’s birth and change their coverage.

Under the new rules: Baby Jessica must have her own insurance, with a separate deductible and co-pay. Once insured during a calendar year, consumers can’t “improve” their coverage.

5. Strict Deadlines
Natasha likes to wait until the last second. When enrolling for health insurance each year she shops around and often buys on the last day of open enrollment. This year, the last day falls in the middle of Hanukkah. The last day of Open Enrollment is on Friday, Dec. 15. In all the bustle of the season, she forgets to enroll.

Under the old rules: Jessica could still apply for coverage that starts on Feb. 1, 2018 or March 1, 2018, even if she missed the final day to apply in the prior year.

Under the new rules: Sorry, Jessica –  one strike and you’re out.

Implications of the New Rules

These changes might help insurers lower their rates about 2%.

They might also dramatically increase consumers’ confusion.

Remember the old saying: Confused people don’t buy. Some consumers (especially the healthiest) will react by not buying coverage at all. Those with health problems will plod through all the new requirements.

Many of the consumers who do still want coverage will need professional help, and, possibly, advice about major medical coverage alternatives, such as short-term health insurance, hospital indemnity insurance and health care discount cards.
 
http://www.thinkadvisor.com/2017/04/17/5-ways-the-new-aca-rules-will-change-health-insura?eNL=58fa8690150ba06253d39c68&utm_source=TA_LifeHealthWeekender&utm_medium=EMC-Email_editorial&utm_campaign=04232017&page_all=1

When leaving a home to your children, you can avoid probate by using either joint ownership or a revocable trust, but which is the better method? 
If you add your child as a joint tenant on your house, you will each have an equal ownership interest in the property. If one joint tenant dies, his or her interest immediately ceases to exist and the other joint tenant owns the entire property. This has the advantage of avoiding probate.
A disadvantage of joint tenancy is that creditors can attach the tenant's property to satisfy a debt. So, for example, if a co-tenant defaults on debts, his or her creditors can sue in a "partition proceeding" to have the property interests divided and the property sold, even over the other owners' objections. In addition, even without an issue with a creditor, one co-owner of the property can sue to partition the property, so one owner can force another owner to move out.
Joint tenancy also has a capital gains impact for the child. When you give property to a child, the tax basis for the property is the same price that you purchased the property for. However, inherited property receives a "step up" in basis, which means the basis is the current value of the property. When you die, your child inherits your half of the property, so half of the property will receive a "step up" in basis. But the tax basis of the gifted half of the property will remain the original purchase price. If your child sells the house after you die, he or she would have to pay capital gains taxes on the difference between the tax basis and the selling price. The only way to avoid the tax is for the child to live in the house for at least two years before selling it. In that case, the child can exclude up to $250,000 ($500,000 for a couple) of capital gains from taxes.
If you put your property in a revocable trust with yourself as beneficiary and your child as beneficiary after you die, the property will go to your child without going through probate. A trust is also beneficial because it can guarantee you the right to live in the house and take into account changes in circumstances, such as your child passing away before you.
Another benefit of a trust is with capital gains taxes. The tax basis of property in a revocable trust is stepped up when you die, which means the basis would be the current value of the property. Therefore, if your child sells the property soon after inheriting it, the value of the property would likely not have changed much and the capital gains taxes would be low.
In general, a trust is more flexible and provides more options to protect you and your child, but circumstances always vary. You should talk to your attorney about how to pass down your property.
Michael J. Millonig, LLC
7929 Washington Woods Dr. | Dayton, OH 45459
Phone: (937) 438-3977
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The Centers for Medicare & Medicaid Services said Monday it expects its payments to Medicare Advantage plan issuers to increase an average of 0.45% over 2017 levels in 2018.
CMS put that figure in its final call letter announcement for 2018.
The expected change in the per-enrollee subsidy is up from an increase of 0.25% included in a draft program proposal for 2018 posted in February, according to a 2018 call letter summary sheet.
(Related on ThinkAdvisor: 10 counties where Medicare Advantage looks like a wimp)
CMS assumes that typical 2018 enrollees will be somewhat older and sicker than 2017 enrollees, giving those enrollees higher average diagnostic intensity codes. The combination of the underlying subsidy level increase and the increasing intensity in diagnostic codes should increase overall 2018 per-enrollee revenue an average of 2.95%, CMS said.
That's up from an overall increase of 2.75% in the draft proposal.
The Medicare Part C Medicare Advantage program gives insurers the ability to sell plans that serve as an alternative to traditional Medicare A hospitalization coverage and Medicare Part B physician and outpatient services coverage.
Another program included in the final call letter announcement, the Medicare Part D prescription drug program, gives insurers the ability to sell prescription drug coverage to Medicare enrollees.
Seema Verma, President Donald Trump's newly confirmed CMS administrator, said in a statement accompanying the call letter announcement that Medicare program managers want to strengthen the Medicare Advantage and Medicare drug plan programs by "supporting flexibility and efficiency."
"These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs," Verma said.
Although CMS calls the new document a "final call letter," the true final terms of the Medicare Advantage bidding process could still be subject to change, depending on the reaction of insurers and consumers.
Margaret Murray, the chief executive officer of the Association for Community Affiliated Plans, a group for nonprofit plans, put out a statement saying CMS has done a good job of trying to help member plans serve the low-income Medicare enrollees who also qualify for Medicaid.
Marilyn Tavenner, the president of America's Health Insurance Plans, who previously was the CMS administrator, said in a statement from AHIP that CMS had made some adjustments in policies.
"We believe more must be done to ensure beneficiaries are well supported in achieving their best health," Tavenner said. "We look forward to working with the agency to reduce unnecessary regulatory burdens, enhance program flexibility and innovation, and promote delivery system reform and patient engagement."
Anthem, the biggest insurer still in AHIP, is based in Indianapolis. Before Verma went to work for CMS, she ran a health coverage program consulting firm in Indiana for years.
www.thinkadvisor.com/2017/04/04/cms-sets-2018-medicare-advantage-subsidy?eNL=58e39c3a150ba09f7839616c&utm_source=TA_LifeHealthDaily&utm_medium=EMC-Email_editorial&utm_campaign=04042017

As you may be aware, the Centers for Medicare & Medicaid Services (CMS) imposed intermediate sanctions against Cigna-HealthSpring. CMS did not create a Special Election Period (SEP) for members, but it is considering requests for an SEP on a case-by-case basis. If Cigna members want to choose another plan, they must call CMS. What happens if Cigna members move to another carrier through 1-800-MEDICARE?