Gay Marriage Ruling to Impact Healthcare Benefits

June 27, 2013

A lot still needs to be sorted out, but here are someRainbowflag quotes from experts on how the U.S. Supreme Court ruling requiring the federal government to recognize gay marriage impacts healthcare benefits.  The ruling only applies to states that have legalized gay marriage.  But the rainbow genii is out of the bottle, and all I can say is it’s about time.

Aon Hewitt: “Under the ruling, employees will have expanded access to employer-sponsored health and retirement benefits, depending on plan design, in the 12 states and District of Columbia that recognize same-sex marriage. This includes…Health Savings and Flexible Spending Accounts… COBRA continuation coverage…HIPAA special enrollment rights…Ability to pay for health benefits with pre-tax dollars and receive an employer contribution towards a same-sex spouse’s coverage without being taxed on such coverage (also referred to as taxation on “imputed” income).”

The Williams Institute: “Same-sex couples working in the private sector pay, on average, $1000 more than different-sex couples in taxes for employer-sponsored healthcare. Same-sex spouses in federally recognized marriages might no longer be subject to this additional tax burden….Same-sex spouses of federal employees could be eligible for employee benefits that are currently provided to employees with different-sex spouses.

Sarah Kliff, The Washington Post: “With the United States recognizing same-sex marriage, a same-sex couple can be counted by the federal government as one family unit. Instead of two separate individuals applying for health benefits, each judged by the federal poverty line for one person, they’re now a team. Their federal poverty line is $15,510.”

Jackson Hewitt Tax Service: “Same-sex partners with similar incomes may lose out.  For example, same-sex partners who each have an income of $40,000 may be eligible for the premium assistance tax credits under the ACA – but only if they remain single.  If they marry (in those states that allow same-sex marriage), then they would lose eligibility because their income would be over the threshold for a household of two.”

However, Brian Haile, senior vice president for healthcare policy at Jackson Hewitt, notes that same-sex couples with disparate incomes may gain.  In the example he provides, “one member of the household make zero and the other makes $60,000.  If they live in a state that does not expand Medicaid, then the person that makes zero wouldn’t be eligible for Medicaid and wouldn’t be eligible for the tax credit.  The person who makes $60,000 would not be eligible for the tax credit.  If they got married, they would both be eligible for the tax credit.”

President Obama: Politics Now reports, “The federal government should broadly interpret its laws to guarantee benefits to the maximum number of same-sex married couples, President Obama said, as he praised the Supreme Court decision.”


CMS Vendor Contracts for Exchange Development Hit $394 Million

June 24, 2013

As reported in last week’s issue of Health Plan Market Trends, CMS had committed $394 million as of March 31 through contracts with various vendors to develop federally facilitated insurance exchanges for rollout later this year.  The figure doesn’t include related CMS salaries and administrative expenses.

According to CMS, the largest contract—$88 million—went to CGI Federal for information technology and technical assistance to support federal exchange development.  A $55 million contract went to Quality Software Services to help build the federal data hub.  Other vendor projects include the website, call center, and technical assistance for the federal exchanges.


Health Insurance Exchanges Conference Announces Agenda

June 19, 2013

The CRG conference on Insurance Exchange Strategies for Health Plans, Sept. 20 in Boston, is shaping up to be a good one. Below is a list of some featured speakers (in order of appearance).  For a copy of the full agenda, click here.

Alan Hughes
EVP and Chief Operating Officer

Paul Wingle
Head of Exchange Strategy and Implementation

Mary Hennings
Senior Director, Market Planning, Innovation and Implementation

Raymond Smithberger
General Manager, U.S. Individual and Family Plans

Stephen Ringel
SVP, Market and Product Group

Lisa Rubino
SVP, Medicare, Duals and Marketplace

David Kerrigan
Director of Business Development

Alan Hughes of BCBS-NC to Keynote Exchanges Conference

June 7, 2013

I’m very happy to announced that Alan Hughes, EVP and chief operating officer of Blue Cross Blue Shield of North Carolina will be the keynote speaker at our Sept. 20, 2013 conference in Boston on Insurance Exchange Strategies for Health Plans.  BCBS-NC is a major player in North Carolina’s individual and small group markets and will have a significant exchange presence.

Health insurance exchanges will revolutionize the market for individual and small group coverage—with dramatic implications for health plan market share, membership growth and profitability.  The most successful plans will have formulated a flexible and scalable strategy involving a diversity of elements—product design, pricing, marketing, evaluating the viability of various exchange markets, assessing the likely impact on profit margins, and investing in information technology and other important skill-sets. 

During this keynote address, you’ll learn how one health plan has pulled it all together into an exchange strategy bound to win in the marketplace.

Quote of the Day: Dan Mendelson

June 6, 2013

Dan Mendelson, chief executive of Avalere Health, on the company’s recent study showing that two-thirds of young adults (30 and under) will receive premium subsidies to offset rate shock in the individual insurance exchanges.

Most of the people who are going to be purchasing insurance on the exchanges are poor or near-poor.

Carrots and Sticks in Employee Wellness Programs

June 5, 2013

From a Midwest Business Group on Health survey of 94 self-insured employers nationwide.



WellPoint Prices Fairly Aggressively on CA Exchange

June 4, 2013

WellPoint controls a big chunk of California’s individual health insurance market, so it’s no surprise the company is being fairly aggressive in its exchange plan pricing.

I put together the following chart on how the company’s prices stack up against the competition in some key regions of the state.

The company’s Anthem PPO, for example, is the lowest price silver plan in Sacramento and the second lowest in Alameda, L.A. South, San Diego and San Francisco. It is also the lowest priced bronze plan in Sacramento and the second lowest in Alameda, San Diego and San Francisco. In contrast, WellPoint’s gold and platinum plans tend to be among the highest priced–which is generally considered a good thing because of the risk of adverse selection in the high metal levels.

Based on price, “WellPoint is well positioned” to win at the bronze and silver levels, says Justin Lake of J.P. Morgan. He adds, “At face value this would potentially indicate that WellPoint is likely to attract better risk and higher margins.”


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