Emergency Room Claims – Self-Diagnose or Pay the Price?

An emergency department sign.

While most of us know that emergency room (ER) care is more expensive that non-emergent care, you may not have realized just how much more. In some cases, you could be responsible for the entire cost of your hospital ER visit. We’re hearing an increasing number of stories from patients who are being billed for the… [Read More]

ACA Penalties for Failure to Provide or Have Coverage Are Still Around

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There is a lot of confusion out there concerning ACA penalties. The 2018 tax act did not eliminate any employer penalties for not offering health insurance coverage. The only change was reducing the individual coverage penalty to zero – however, this change does not go into effect until 1/1/2019. Applicable large employers (ALEs) with more… [Read More]

Participation: Is It a Good Thing or a Bad Thing?

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One of the central tenets of underwriting medical plans is to avoid adverse selection at all cost. Adverse selection results when a plan is designed or priced in such a way that it only adequately incentivizes sicker employees to enroll; failing to attract good risk to offset the bad. For this reason, most insurers historically… [Read More]

Chipping Away at the Affordable Care Act Isn’t Getting to the Real Issue

Health Care Reform sign

So, the Affordable Care Act’s (ACA’s) individual mandate penalty has been reduced to zero, the Cadillac Tax has been delayed for two more years (and may likely never be implemented) and the Children’s Health Insurance Program (CHIP) has been funded for six years. Now more than 1.75 million children in 20 states, who were at risk of losing their healthcare, can breathe… [Read More]

A Look at 2018 Healthcare Issues

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Price Waterhouse’s Health Research Institute released their 2018 Top Health Industry Issues report. 2017 was quite a year for healthcare as the industry tried to address controlling healthcare costs in light of the failure of legislative reform along with natural disasters, opioid abuse and cyber security – and all of those issues continue. With the inability… [Read More]

Wellness Incentive Rules – and the Saga Continues…

Close-up hand businessman give the small gift box

Yep, the Equal Employment Opportunity Commission (EEOC) is back to the drawing board, reworking and finalizing new wellness regulations for 2019. We know that all wellness programs must be deemed “voluntary” for employees to participate in; but employees can be penalized thousands of dollars for not doing a screening or answering personal health questions through… [Read More]

Donald J. Trump – To the Tune of “Alexander Hamilton”

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A common theme discussed in this blog this year has been remaking healthcare as we watch the twists and turns unfold in the legislative circus of healthcare reform. To close out 2017, we’ve put a musical spin on healthcare in America. SHARE THIS!

In Healthcare, the Art of the Deal is Not So Artful

In Healthcare, the Art of the Deal is Not So Artful

The Washington shenanigans continue as President Trump holds out the specter of supporting the bipartisan Alexander-Murray Senate bill which attempts to shore up the Affordable Care Act and set up a reinsurance fund for large claims. The president has also promised to back off his threat to cut off funding of cost-sharing subsidies. All this… [Read More]

What Repeal of the Individual Mandate Would Mean to Americans

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The Republicans are at it again. The latest negotiations in the Senate on their tax bill have led them back to a proposal to eliminate the individual mandate under the Affordable Care Act. The lure of more than $300 billion in tax savings as calculated by the nonpartisan Congressional Budget Office (CBO) is too big a number… [Read More]

ACA Penalties Are About to Hit Employers

ACA Penalties Are About to Hit Employers

Reach way back into your memory bank to the time when your broker presented you with a “pay or play” analysis to determine whether you comply with the employer mandate under the Affordable Care Act. There was the $2,000 penalty which applies to every full-time employee in the event there was no valid offer of… [Read More]