QSEHRA Revives Employer Payment Plans For 2017

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On December 13, 2016, President Obama signed the 21st Century Cures Act into law. Called “the most important bill of the year,” the bipartisan Act makes changes to a wide range of healthcare issues. These include allocating billions for cancer research, easing the FDA drug approval process, and allowing doctors to test medical devices without a patient’s informed consent in certain situations. One item that will be of interest to finance and human resource professionals at small employers ...

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Study finds Wisconsin has high healthcare prices

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A study released this month by the nonprofit Health Care Cost Institute found that Wisconsin has the second highest healthcare prices among the 41 states it surveyed. The study was based on claims data from UnitedHealthcare, Aetna, and Humana, which the Institute said represents 34% of total commercial claims in Wisconsin. The study found that prices in Wisconsin for over 200 common medical services were on average 81% higher than the national average, and that the ...

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National Uninsured Rate Falls Below 10%

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Two national surveys show that the percentage of people without health insurance has dropped steadily since the Affordable Care Act’s public insurance exchanges launched in 2013. A separate analysis focused on Wisconsin concluded that while the state now has fewer uninsured than it did in 2014 and a lower uninsured rate than the national average, progress has not been as great as hoped. These findings come at a time when all viable legal challenges to the law have been resolved ...

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GAO Probe Focuses on Healthcare.gov Fraud

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The nonpartisan Government Accountability Office (GAO) reported to Congress last Thursday that it has concluded an undercover investigation into the fraud detection capabilities of the federal health exchange website, www.healthcare.gov.

The GAO’s Director of Forensic Audits, Seto Bagdoyan, told the Senate Finance Committee that his investigators submitted applications for eighteen fictitious individuals last year. Of those eighteen, eleven successfully enrolled in a subsidized health insurance plan. And of those eleven, six were flagged as suspicious and terminated ...

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ACA Subsidies Upheld

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This morning, the U.S. Supreme Court issued its opinion in the case King v. Burwell. The Court ruled 6-3 that individuals who purchase health insurance through the federal exchange, www.healthcare.gov, can received subsidies based on their income.

The plaintiffs in the case argued that only individuals who purchased coverage through a state-based exchange should be eligible for subsidies because the text of the Affordable Care Act (ACA) says subsidies are available to people who enroll through an ...

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Arise to offer AboutHealth plans

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AboutHealth, one of two new health system partnerships in Wisconsin, recently announced plans to sell health plans to individuals and employer groups through a co-branding agreement with Arise Health Plan. Early announcements from AboutHealth have focused on efforts to improve clinical integration and cooperation among its members. The agreement with Arise marks the first instance in which AboutHealth member systems have negotiated a single contract with a health insurance company.

Arise Health Plan is a wholly owned subsidiary of ...

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King v. Burwell arguments begin Wednesday

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The U.S. Supreme Court will begin hearing oral arguments in the King v. Burwell case on Wednesday, March 4. The case represents the most serious legal challenge to the Affordable Care Act (ACA) since the Court largely upheld the law in 2012. If the Court sides against the government, it has been estimated that more than 8 million people in 34 states (including Wisconsin) could lose their premium subsidies and go back to being uninsured.

In the case, four ...

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Getting to Know Form 1095-A

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If you enrolled in a Qualified Health Plan (QHP) through the public Health Insurance Marketplace last year, you may have recently received a new document from the Internal Revenue Service (IRS) called Form 1095-A. Form 1095-A is a tax form that is sent by the Marketplace to allow consumers to complete Form 8962, which they will use to calculate their premium tax credit and reconcile it with any advance payments of the premium tax credit they may have received.

If the ...

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2015 Public Exchange open enrollment begins Saturday

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Public exchange open enrollment will begin on Saturday November 15 for both individual and SHOP plans on healthcare.gov. The Public Exchanges allow for direct comparisons of qualified health plan (QHP) options on the basis of price, quality and other factors. QHPs are grouped into four “precious metal” tiers based on their actuarial value: platinum, gold, silver, and bronze. The Public Exchanges also coordinate eligibility for subsidies such as premium tax credits and cost-sharing reductions.

The first public exchange open ...

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Consumers on the Hook for Subsidy Over Payments

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Due to website glitches, consumers eligible for subsidies on the public exchange used the “honor system” to estimate their income during open enrollment in 2014. Consumers that inaccurately or fraudulently estimated their income will repay the federal government with a reduction in their 2014 federal tax refund.

The federal government recently announced that different levels of repayment will be required for different consumers.  Repayments will be capped for low income, but full repayment will be required for those found with incomes above ...

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