It’s always been fascinating to me how different California is from the rest of the U.S., but this year truly feels as we live on a different planet.
Just as a reminder for us all prior for digging into the vision—our healthcare industry has become more controversial and complicated. As a result, we—the ones that deliver the system! need to let go of the past, and give up the hope that the past could be any different. Letting go is a choice. We truly need to make sure we deliver a current, up-to-date health system that is healing us all and making a difference. We need to make sure to find the ultimate best solution, and coverage for each and every individual, employer, employee and senior client. We further need to keep a positive attitude and adjust to change compassionately. We need to do everything we can to help clients take advantage of today’s marketplace and stop thinking about yesterdays.
So, summer might be a time for playing and taking vacations. For other people. But since 2013, summer for many of us in the healthcare industry—brokers, agents, consultants, advisors, carriers’ leaders—is the time to prepare, learn, certify and make sure we understand the new market for Open Enrollment season. This year is no different.
Vision for 2020
Here I’ll concentrate on the upcoming Covered California vision for 2020, regardless of whether you offer benefits through Covered California. After all, the California market adjusts almost entirely based on Covered Cal’s decisions, expansion and support.
First, California reversed the federal undercutting of the Affordable Care Act. The state restored the requirement that consumers get health insurance if the cost of coverage does not exceed a certain percentage of their income. California is essentially going back to the penalty that was enacted for 2018. So, effective Jan. 1, 2020, if you elect not to have coverage, you will pay either a fixed penalty ($695 per adult and $347.50 per child in 2018) or 2.5% of income, whichever is greater.
HRAs (Health Reimbursement Arrangements) may now be used to pay for individual market premiums. As a result, we will see an expansion of HRAs. For employer group plans that means it can be used to purchase health insurance in the individual market. Employees will be eligible to receive advanced premium tax credits if the HRA is determined unaffordable and the employee opts-out of the HRA.
Starting Jan. 1, 2020, Californians will get financial help to obtain health insurance from the state, in addition to the financial help they may be eligible to receive from the federal government. The limit on qualifying annual income ranges for additional state financial help for 2020 will increase from 400% of the federal poverty level (FPL) to 600%. So, consumers who earn between 400 and 600% of the FPL will receive an average of $144 per household, per month, which will help them save an average of 30% on their medical insurance premiums. Bottom line, some middle class consumers will receive subsidies for the first time, or higher ones than before.
Executive orders were signed by the Trump administration to tackle runaway expenses for medical procedures. In response, the Department of Health and Human Services (HHS), among other agencies, must pursue rulemaking and administrative actions to address hospital price transparency, including:
- Require hospitals to publicly post actual cost information
- Develop a Health Care Quality Roadmap
- Align and improve reporting on data and quality measures across various federal programs
- Increase access to de-identified data, particularly taxpayer-funded healthcare programs, to facilitate the development of tools that empower patients to be better informed
- End surprise medical billing
- Expand use of high-deductible health plans with health savings accounts
- Make certain medical arrangements (direct primary care arrangements, and healthcare sharing ministries) into eligible medical expenses for personal tax deductions
- Increase the amount of flexible spending arrangement funds that can carry over without penalty
It is important to keep yourself up to date. Reach out to industry experts and make sure that you always remember that we are all on this ride together. I personally recommend joining the National Association of Health Underwriters (NAHU) family. This community supports us all whether you are a member or not. Together, we can make a difference and make sure to deliver healthcare products that increase employee satisfaction, enhance health and performance, and keep us all happy and healthy.
Blessings for a great rest of this summer.
Naama O. Pozniak, a member of the Cal Broker editorial advisory board, is Valley Village-based Paz Holding Inc.’s ( dba A+ Insurance Service) CEO. Pozniak has been delivering employer benefits for over 30 years. She’s a mother, a yogi, a speaker, a consultant, a healthcare strategic innovator and a meditation instructor, certified by the Chopra Center. She is currently a certified healthcare reform, Medicare certified specialist, and Covered CA Champion Certified agent. Pozniak was recognized by Employee Benefit Advisor (EBA) magazine in their 2016 and 2017 list of Most Influential Women in Benefit Advising. She is a Top of the Table producer and holds a lifetime Soaring Eagle Award. Pozniak was the recipient of the NAHU Distinguished Service Award for 2018, the EBA’s 2019 Wellness Adviser of the Year Award and is currently the NAHU Region 8 Media chair and LAAHU HUPAC Media Chair.
Find Naama on LinkedIn at: https://www.linkedin.com/in/naama-o-pozniak-69b5913/