Here is a brief overview of
what has happened. If you know this or
don’t want to read it all, make sure you read the last part.
Maryland Health Care and Insurance
Reform Act of 1993
-
Guarantee small business access to health insurance
- Reduced premiums by about 30%
- Set consumer protection
- Eliminated medical underwriting & pre-existing condition exclusions
- Required insurance companies to offer similar plans
- Required premiums to be determined by age and geography
Why rates were going up before the ACA
-
Health care benefits increased 72% since 2000
- Population is aging
- Rise in obesity and chronic illnesses
- Introduction of new treatments
- More diagnostic testing
- Defensive medicine
- Higher premium tax costs of regulatory medicine
What were the major changes with the ACA?
- Preventive services are free
- Individuals are required to have insurance or pay a fine
- An exchange must be created
- Individual subsidies based on income
- Employers with 50+ employees must offer health insurance
- Expansion of Medicaid
Ok, so we dealt with
this. Now what? Most group renewals in the last half of 2015
had increases of no more than 5%.
Individual coverage for January 2015 had modest increases (maybe
15%). Look out for 2016! We have heard that individual increases are
10% - 55%! What about group plans? The rates are being promoted as lower. In many cases, that will be true. Pay attention or you may be shocked! Here is an actual case for a January 1, 2016
renewal.
HMO Plan $1,500 Deductible
January
1, 2015 January 1, 2016
Copays $30/$30 $25/$50
Hospital Inpatient Charge $250 per admission $500 per DAY
Out of Pocket Maximum $4,000/$8,000 $6,550/$13,100
Emergency Room $100 $250
Using a simple example of
someone taken to the Emergency room and then being admitted to the hospital for
10 days would look something like this.
Hospital Inpatient Charge
2015: $250
2016: $5,000
Hopefully, it won’t impact
too many people. But if it is you or an
employee, it will leave a lasting impression.
