Anthem announced the development of a Narrow Network in Wisconsin. The narrow network is a limited preferred provider organization (PPO). This new network arrangement is not just for Wisconsin but the entire country. The health insurance industry is working on reducing costs and one way to do this is to negotiate deeper network discounts.  If an Insurance network can increase participation in a local hospital network then that gives the carrier the ability to reduce reimbursement rates.

With the development of any health insurance exchange in Indianapolis we could see the narrow network become common with those plans. If the policy is regional based then that gives the carrier the ability to negotiate.


The narrow bridge over Endrick Water
The narrow bridge

This could benefit the Indianapolis residents from a claims and premium standpoint. If cost of care goes down then so should the premium. The negative would be members would be restricted to that narrow network.  If a member was to go out of network they may still have coverage but be responsible for a much high portion of the claim. It would not be surprising if the out of network expense was based on Medicare reimbursement rates.

With any narrow network we could see a delay in care from primary care doctors.  Right now in Indianapolis we have shortage in general doctors. This could become even worse the expansion of health insurance.

There will be plans in the market place that do not have these narrow networks. To the Hoosiers that can afford these plans they may choose these plans so they are not restricted in who they can see.

The cost of care is going to have to be addressed. The Government has been unsuccessful in tackling this issue. The private industry will have no choice but to come up with new approaches in reducing the cost of care.

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  Indianapolis Affordable Care Act Pricing – Current Estimates

 ACA Insurer Fee:                   

       Effective 1/1/2014

       2.68% tax off fully insured premium

       Applies to Small and Large Group – fully insured only


       Affortable Care Act Reinsurance Fee:  

       Effective 1/1/2014

       $6.35 Per Member Per Month before state tax gross-up                                 

       Applies to ASO and fully insured (so in addition to ACA Insurer fee)

       CER Fees:                     

       $1 Per Member Per Year for plan years that start on or after 10/2/2011

       $2 Per Member Per Year for plan years that start on or after 10/2/2012 (and higher for >10/2/2013)

       Apply to both fully insured and ASO


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August 29th, my Mom was diagnosed with pancreatic Cancer stage 4.

The cancer was 4.3 cm on her pancreas and 1.2 cm on her liver.

My Mom has had 5 session of chemo therapy at this time. During this time we also started a regiment of supplements.  IP-6 inositol & Selenium.  Mom has been taking 3,000 milligrams of IP-6 per day & 600 milligrams of selenium a day. Essentially 2 pills 3 times a day for both supplements.

Her cancer blood count was up to 600. After a month of take the supplements, her cancer blood count has dropped to 130.

Micrograph of pancreatic ductal adenocarcinoma...
Micrograph of pancreatic ductal adenocarcinoma (the most common type of pancreatic cancer)

I don’t know if the chemo or the supplement or a combination of both has helped.  When the doctor saw the lower cancer blood count, her jaw dropped.

Mom had initially dropped 16 pounds because she could not eat. Last weight in at the doctors office, she has gained 2 pounds. She has been able to eat and digest foods.

We went to dinner last Friday night. I never thought I would have dinner with Mom again, after the diagnosis of Stage 4 Pancreatic Cancer.

My Mom came to the hockey rink last Saturday and watched her grand kids play hockey.

In my Heart I believe the IP-6 and the Selenium is making a huge difference in her treatment.

I know how deadly this disease and we still have a long way to go. This is a true glimmer of hope. We should have another Cat Scan in about 5 weeks. That will be a true bench mark of how the treatment is going.

If you are reading this then you may be faced with this frighting disease. You are not alone!

Speak with your Doctor and ask them if it OK to take these supplements. In our situation we felt we had nothing to lose.

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In 2014, the health insurance landscape is going to change a great deal in Indianapolis.

There is going to be new taxes on group health insurance plans. For fully insured group plans, there will be a 2.68% tax on those plans. On self funded plans, there will be $6.35 per member per month tax. These are significant tax increases that will impact every Hoosier.

Small group health insurance plans are expected to have a have about 35% increases.  This will impact about 45% of the current small group health plans negatively.  The healthy groups will have the biggest increases where the unhealthy group may see a decrease.  Community ratings will be one of the driving forces for these increases.

Individual and Family health plans are projected to go up 42%. This is a result of guaranteed issue. No Indianapolis resident can be declined coverage. We will also see an increase in covered services. The essential benefits and community rating will have a large impact on these policies.

There will be an established health insurance exchange. We will see a Federal Exchange in Indianapolis and we will see the launch of the private exchange model. Both exchanges models with have Federal subsidies.

There are predictions that one of the plans in the exchange would be premium free for those who qualify for subsidies. This is the Bronze plan with a 60% actuarial value.

With the health care reform it is projected that 35% of the uninsured in Indianapolis will have coverage.

There is real fear that we could see the erosion of the group health insurance model in Indianapolis.

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Skyline of Indianpolis. This photo was also ta...

Indianapolis Delays Essential Health Benefits

The Essential health benefits must include items and services within the following 10 categories: Ambulance, Emergency Services, Hospitalization, Maternity, New Born Car, Mental health and substance abuse, behavioral health, Prescriptions, Rehabilitative, Laboratory, Preventive, Disease management, Pediatric with oral and vision.

This is a very big part to the Affordable Care Act. These coverage’s will have a huge impact on both cost and quality of care. At first, the federal government was to establish the benefits. They decided to pass the responsibility down to the state level.

The essential benefits is one of the main aspects that will impact health insurance premiums. If a gastric bypass surgery was to consider an essential benefit. Every Hoosier that needed this surgery would have it covered. Does not matter if you are on a private insurance plan, Medicaid, or Medicare it would have to be covered. Having this one benefit covered could increase the premium for everyone by 1%. 1% does not sound that bad! Now think about more than a hundred different procedures or services that have to be covered. Now we are talking about 100% increase in premium cost! This is the impact the essential benefit will have on every Hoosier and US citizen.

Indianapolis Department of Insurance is delaying the establishment of the essential benefits. They are listing the lack of clarity from the federal government as the reason why. They also list 16 questions that the federal government has not answered.

The questions range from clear deadline for establishing the benefits to premium tax credits for individual dental plans. To most Hoosiers this is boring insurance law but this is so very important to every one of us. This will impact cost and care to all of us.

To have 16 big questions unanswered at this time is very concerning.

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English: Front of the Applied Health Science A...
Front of the Applied Health Science Annex, located at 309 N. Woodlawn Avenue in Bloomington,. Built in 1930,

This is a very broad question because one has to know what is important to them with their health insurance.

When searching for a health insurance company it is best to see advice from a local broker. The local broker will represent multiple companies and know market conditions. This is important knowledge that will lead you to the best health insurance.

Once you know what type of plan you want then you can get quotes. Quotes will vary from carrier to carrier.   You want the best priced health insurance product.  Not all health insurance products are equal. There is a huge variation in coverage’s.  Make sure you are getting quotes for apples to apples plan designs.

Every health insurance company has competitive areas. If you are in the market for a Health Saving Account plan a Golden Rule policy could fit your need.  With diminishing deductibles this has been a strong product. If you are looking for a rich co pay plan, then Anthem may fit those needs.

The best health insurance can come from either a national health insurance company or a regional health insurance company.

To find the best health  company, first decide what you want from a health insurance policy. That is your starting point in finding the best health insurance policy.

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Seal of the United States Internal Revenue Ser...
Seal of the United States Internal Revenue Service.

Under the Affordable Car Act there will be penalties for not having health insurance.

In 2014, the penalty for not caring health insurance will be $95, or 1% of taxable household income.

By 2016, the penalty will rise to $695 per person, with a cap of $2,085  per family or 2.5% of house hold income.

It has been estimated by Government watchdog groups, that 1% of the US population will charged for not having health insurance.

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Senate Passes Insurance Industry Aid Bill

NY Times reported a interesting view on health care reform.  They are reporting a glitch in the health care law.

Under the Affordable Care Act, if an employee has access to group health benefits, then their dependents are not eligible for subsidies through the exchange. This is basically the short version of the argument. This aspect of the law have been interpreted by both the IRS and Congressional Joint Committee on Taxation.

The so called “glitch” is that a employee may be able to afford their portion of the premium, on a employer sponsored health plan but not the dependent portion.  In Indianapolis, an employee only contribution, maybe below $1,000 a year. Now if we add the dependents to the plan the cost may very well jump to $7,000 year. A lot of Indianapolis small group and mid size companies, the employer has gone with the philosophy to pay the for the employee. The lower pay employees, then are unable to afford to put their families on the plan. This is 100% a legit issue.

These dependents will not qualify for subsidies under the health care reform. The reason the law was written this way is to keep some type of retention on employer sponsored plans.

In Indianapolis, we are going to see a lot of employers with under 50 employees consider dropping group health coverage in 2014.  There is going to be many health insurance and legal factors a decisions maker will consider. If the employee base are low wage earners, then the employer may be doing the employees a favor by dropping coverage. This will give the low paid employees full access to subsidies. So the argument could be made that if this is not fixed then it will lead to groups dropping coverage.

This is just one of many issues we are going to face in Indianapolis when it comes to health care reform

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Mike Pence recently sent his letter to Gov. Daniels regarding the development of  a state based exchange.

Governor Elect Mike Pence, has choose not to establish a state based exchange.  He stresses the lack of clarity coming out of the federal government. Indianapolis developed the health Indianapolis plan that has been very successful, form a cost stand point while keeping insureds satisfied. There are over 40,000 Indianapolis residents on this plan. The state of Indianapolis wanted to be able to offer this plan in a state based exchange. At this time, that plan is not an option with in the exchange.

The letter also points out the tax increase that will impact Indianapolis residents and businesses.  We are going to see tax increases for medical devices manufacturers, individual mandate, employer mandate, Medicare tax, & tax on investment properties.  Every Indianapolis resident is going to feel the impact of these tax increases.  There is a new 3.8% tax on investment property income. No one except Mike Pence is talking about this tax increase.

Mike Pence states in the letter that the health care law is going to lead to more dependence on federal subsidies for Hoosiers. This could happen as individual health insurance premiums almost double.  Under the health care law there will be subsidies available and a majority of people could qualify for this assistance.

The letter also state the uncertainty of how a state based or federal exchange is going to operate. There is a fear of the Federal Government is going to micro managing a state based exchange.  If  Indianapolis does not have the flexibility to add the Health Indianapolis Plan that is a huge red flag.

The cost of operating the exchange is a huge unknown. There have been estimates from $44-$88 million a year. The current state administration does not know where that funding is going to come from.

If Mike Pence becomes the next Governor of Indianapolis, you can expect to have a Federal Facilitated Exchange. At this time we do not know how the exchange will operate.  In the next few months more details should come out on how the Federal Exchange will operate.

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US Federal Exchange

It has been reported that Governor elect Mike Pence is not going to establish an Indianapolis State Based Health Insurance exchange.  If the state does not elect to set up our own exchange then a Federally-Facilitated Exchange will be set up without state partnership.

HHS will establish and operate the Federal Exchange.  Indianapolis will still have options to coordinate with CMCS on decisions and protocols for either eligibility assessment or eligibility determination model with in the federal exchange. HHS intends to work with in collaboration with them, where appropriate, to ensure the best, most effective experience for Hoosier residents.

If Indianapolis does not notify HHS by November 16, 2012, the HHS will operate the federal exchange.

1.  Indianapolis will not be able to administer a reinsurance program.

2.  The Individual and small group markets will be merged into one risk pool.

3.   Indianapolis’s definition of small group employer will be followed.

At this time HHS has released few details on how the federal exchange will operate.  We do not know if the Insurance carriers are going to participate. We also don’t know how the policies will be distributed.

The current administration has made reference to using local agents and brokers to distribute the Federal Exchange.  We should see a online application that not only will allow you to enroll into the exchange but determine if you are eligible for subsidies.

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