If You Are Self-employed or Run Your Own BusinessThe proposed change to association health plans could spur small businesses to start offering insurance for their employees. And for the first time, it would allow people who are self-employed to band together to buy group health insurance.
These groups would have more bargaining power to negotiate lower prices. And they would be able to cut costs by not having to meet all the ACA mandates such as coverage for things like prescription drugs and hospitalizations. Association insurance also would be exempt from an ACA rule that insurers spend at least 80 percent of premium revenue on medical care.
The association plans would still retain consumer protections such as not letting a patient’s health status affect premium prices. But consumer advocates and patient groups say people could wind up with less coverage than they might need or face higher out-of-pocket costs. The alternate plans also could draw people away from the individual health insurance market, leaving those who still buy individual coverage on ACA exchanges with even higher premiums.
The public has 60 days to comment on the rule before it can be finalized.
If You Buy Your Own Health InsuranceThe administration is also calling for fewer rules on short-term health insurance plans. These plans typically have lower premiums because they don’t include all the ACA requirements such as maternity coverage or mental health care. The plans also don’t have to cover pre-existing health conditions or be required to renew your policy if you get sick.
A detailed rule hasn’t been released for comment yet. But President Trump has asked that short-term plans be available for just under one year instead of the current 90-days. That would allow people to use them for nearly year-round coverage.
Short-term plans have been around for decades. But with the elimination of the penalty for not having ACA-mandated insurance, these plans are likely to become more attractive to people who are healthier and want a less-expensive option. That could further siphon people out of the ACA’s individual market and cause those premiums to rise further.
If You Get MedicaidQualifying for benefits under Medicaid programs, which are run by states but also receive federal funding, may be harder under the new guidelines released by CMS. Now states that get waivers approved by the federal government could require non-disabled adults to work, volunteer, go to school, or be in a job training program to get benefits.
Friday, Kentucky became the first of 10 states that want to impose Medicaid work requirements to win approval from the federal government. Now to be eligible for Kentucky’s Medicaid program, you must complete 80 hours a month of “community engagement activities”, which could be working, job skills training, or community service. Also new: You may also have to pay monthly premiums, depending on your income.
It isn’t clear how many people would be affected by the work requirements since most people who are on Medicaid already are employed. Six in 10 non-disabled adults on Medicaid have a job and 78 percent of Medicaid recipients are part of a household with at least one person working full-time, according to the Kaiser Family Foundation. Many of those who don’t work are caregivers for other people but that would count as a form of work under the new guidelines.
But work requirements and other changes states are seeking, such as drug testing and eligibility time limits, could lead to fewer people in Medicaid over the long term, says Hempstead. Kentucky officials estimate that there will be 95,000 fewer people in its Medicaid program in five years. There are 1.4 million people in it now.
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