HHS

HHS announces important Medicare information for people in same-sex marriages

Dept. of Health & Human Services

04/03/2014

Today, the Department of Health and Human Services (HHS) announced that the Social Security Administration (SSA) is now able to process requests for Medicare Part A and Part B Special Enrollment Periods, and reductions in Part B and premium Part A late enrollment penalties for certain eligible people in same-sex marriages. This is another step HHS is taking in response to the June 26, 2013 Supreme Court ruling in U.S. v. Windsor, which held section 3 of the Defense of Marriage Act (DOMA) unconstitutional. Because of this ruling, Medicare is no longer prevented by DOMA from recognizing same-sex marriages for determining entitlement to, or eligibility, for Medicare.

Read more about today’s announcement here …

The ACA Has Spurred The Largest Expansion In Health Coverage In America In Half A Century

Yesterday marked the last day of the six-month open enrollment period for people to get insurance coverage through the state and federal marketplaces. Despite technical challenges and staunch ideological opposition, it has already been a huge success with over six million people enrolling. But in the last several days, the interest in signing up and the outreach efforts to those not yet covered has reached new heights.

Take a look at the final surge by the numbers:

  • 9.5 Million: Number Of Uninsured That Now Have Insurance Thanks To The ACA. A new analysis of enrollment data has found that almost ten million people who were previously without health insurance now are covered. The report estimates that two million have enrolled in private coverage on the new marketplaces; about 4.5 million previously uninsured people have gained public coverage through Obamacare’s Medicaid expansion; and about three million previously uninsured young people are now covered on their parents’ insurance plans. The law, as written by the Los Angeles Times, “has spurred the largest expansion in health coverage in America in half a century.”
  • 10 million: Number Of Visits To Heathcare.gov In The Past Week. The Washington Post tallied 8.7 million in the past week through Monday morning, with 2 million visiting this weekend alone. Today, the Department of Health and Human Services tweeted that there had been another 1.2 million visitors just by noon–”record volume.”
  • 125,000: The Number Of Concurrent Users On Healthcare.gov On Monday. An unprecedented level of traffic on the website has led to an unprecedented number of people using the site to sign up for health insurance.
  • 4,000: Number Of Grassroots Events To Help People Enroll In March. For all the money spent over the airwaves, grassroots organizing was a huge component of outreach efforts to get people signed up for coverage. Events took place all over the country, with a focus on reaching the uninsured to make sure they had the information they needed to enroll.
  • 300: Number of Radio Interviews Administration Officials Have Given In The Past Six Weeks. While there have been enormous efforts to use new media to promote the law, good old-fashioned radio has been a go-to source for top White House officials: from Chief-of-Staff Denis McDonough and Senior Adviser Valerie Jarrett to President Obama himself.
  • 49 Percent: Public Support For The ACA. According to a ABC News/Washington Post poll out today, support for the law is at 49 percent, its highest level in months. Back in November, just 40 percent supported and 57 percent opposed the law; today the picture looks much different:

BOTTOM LINE: If there’s any indication that the Affordable Care Act is in high demand, this is it. The law is working, it’s here to stay, and it’s delivering on its promise to provide quality, affordable health coverage that will be there when consumers need it most. Conservatives will continue their repeal-at-all-costs agenda, but the success of these past six months will make it harder because people do not want to go back to the way it was.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe.

Nearly 2.2 million Americans selected plans in the Health Insurance Marketplace from October through December

Thirty percent of those who selected plans were under age 35

Nearly 2.2 million people have selected plans from the state and federal marketplaces by Dec. 28, 2013 (the end of third reporting period for open enrollment), Health and Human Services Secretary Kathleen Sebelius announced today.

A new HHS report provides the first demographic information about enrollees. December alone accounted for nearly 1.8 million enrollees in state and federal marketplaces. Enrollment in the federal Marketplace in December was seven-fold greater than the combined total for October and November – and eight-fold greater for young adults ages 18 to 34.

“Americans are finding quality affordable coverage in the Marketplace, and best of all, because coverage began on New Year’s Day, the promise and hope of the Affordable Care Act is now a reality,” Secretary Sebelius said. “Our outreach efforts have ramped up, so whether it’s through public service announcements, events, our champions or other means, we are doing all we can to find, inform and enroll those who can benefit from the Marketplace.  There is still plenty of time for you and your family to sign up in a private plan of your choice, so visit HealthCare.gov to learn more and sign up now.”

Key findings from today’s report include:

  • Nearly 2.2 million (2,153,421) people selected Marketplace plans from Oct. 1 through Dec. 28, 2013
  • These signups in the state and federal marketplaces represent a nearly five-fold increase from October-November, including nearly 1.8 million (1,788,739) people who selected a plan in December (compared with the previous two-month cumulative total of 364,682 through Nov. 30, 2013).
  • Of the almost 2.2. million:
    • 54 percent are female and 46 percent are male;
    • 30 percent are age 34 and under;
    • 24 percent are between the ages of 18 and 34, and;
    • 60 percent selected a Silver plan, while 20 percent selected a Bronze plan; and
    • 79 percent selected a plan with Financial Assistance.

Today’s report also details state-by-state information where available.  In some cases, only partial datasets were available for state marketplaces.

The report features cumulative data for the three-month period because some people apply, shop, and select a plan across monthly reporting periods.  Enrollment is measured as those who selected a plan.

To read the report visit:  http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

To hear stories of Americans enrolling in the Marketplace visit:  http://www.hhs.gov/healthcare/facts/mystory/index.html

HHS strengthens community living options for older Americans and people with disabilities

 

imagesThe Centers for Medicare & Medicaid Services (CMS) issued a final rule today to ensure that Medicaid’s home and community-based services programs provide full access to the benefits of community living and offer services in the most integrated settings. The rule, as part of the Affordable Care Act, supports the Department of Health and Human Services’ Community Living Initiative. The initiative was launched in 2009 to develop and implement innovative strategies to increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living.

Under the final rule, Medicaid programs will support home and community-based settings that serve as an alternative to institutional care and that take into account the quality of individuals’ experiences.  The final rule includes a transitional period for states to ensure that their programs meet the home and community-based services settings requirements.  Technical assistance will also be available for states.

“People with disabilities and older adults have a right to live, work, and participate in the greater community.  HHS, through its Community Living Initiative, has been expanding and improving the community services necessary to make this a reality,” said HHS Secretary Kathleen Sebelius. “Today’s announcement will help ensure that all people participating in Medicaid home and community-based services programs have full access to the benefits of community living.”

In addition to defining home and community-based settings, the final rule implements the Section 1915(i) home and community-based services State Plan option. This includes new flexibility provided by the Affordable Care Act that gives states additional options for expanding home and community-based services and to target services to specific populations.  It also amends the 1915(c) home and community-based services waiver program to add new person-centered planning requirements, allow states to combine multiple target populations in one waiver, and streamlines waiver administration.

For more information about the final rule, please visit:  http://cms.gov/Newsroom/Search-Results/index.html?q=&filter=Press%20Releases+Fact%20Sheets&date-from=&date-to=

For more information regarding the Home and Community-Based Services available under Medicaid, please visit:http://www.medicaid.gov/HCBS

For more information regarding the Community Living Initiative, please visit:http://www.hhs.gov/od/community/index.html

###

By The Numbers: the First Reporting Period of Open Enrollment

By Kathleen Sebelius, Secretary of Health and Human Services

Today we released our most detailed report to date about the results of the first reporting period of open enrollment in the Health Insurance Marketplace. The numbers show that interest in the Health Insurance Marketplace remains strong and the promise of quality, affordable coverage is becoming a reality for hundreds of thousands of Americans.

Marketplace Open Enrollment: 1st Reporting Period: October 1st Through November 2nd 106,185 Americans have enrolled in a plan through the Marketplace. 975,407 Americans have made it through the process and have not yet selected a plan. 502,466 Americans are positioned to have health coverage starting in 2014 through Medicaid/CHIP. 26,876,527 unique visitors to Marketplace websites. 3,158,436 calls to the federal & state call centers. “The promise of quality affordable coverage is increasingly becoming reality for this first wave of applicants to the Health Insurance Marketplaces. There is no doubt the level of interest is strong. We expect enrollment will grow substantially throughout the next five months, mirroring the pattern that Massachusetts experienced. We also expect that the numbers will grow as the website, HealthCare.gov, continues to make steady improvements.” – Secretary Kathleen Sebelius HealthCare.gov.

Between October 1 and November 2, 2013, 106,185 individuals selected plans from the Marketplace and another 975,407 applied and received an eligibility determination, but have not yet selected a plan. An additional 396,261 were determined eligible for Medicaid or the Children’s Health Insurance Program (CHIP).  In total, 502,446 Americans will be positioned to have health coverage starting in 2014.

As we’ve seen in Massachusetts’s efforts to expand coverage, I expect the number of newly insured to grow substantially throughout the open enrollment period. Our efforts to improve HealthCare.gov will be critical to driving new enrollments and meeting consumer demand.

As a further indication of high consumer interest, web traffic and call center volume also continues to be very heavy. During the first reporting period, there have been over 26 million unique visitors to Marketplace websites and over 3.1 million calls to the call centers.

While we know there is still a lot of work to do to make sure every American that wants access to affordable coverage can have it, there are many encouraging takeaways from today’s report.

For the full text of the report, “Health Insurance Marketplace: November Enrollment Report,” please visit:  http://aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/rpt_enrollment.pdf

Nevada has a state supported exchange, meaning we don’t need to use the national website.  We can go to our own exchange website.  If you don’t have employer provided insurance and will need to enroll for insurance, VISIT THE NEVADA HEALTH LINK NOW TO APPLY today.

Daniel’s Story: Finding Affordable Coverage for $70 a Month

By Salim Zymet, Digital Advisor, Department of Health and Human Services

Enrolling just a day after the Health Insurance Marketplace opened, Daniel, a 22 year old from Orlando, Florida, is one of the millions of Americans eligible for affordable health coverage through the Health Insurance Marketplace.

Daniel says he’s “thrilled” to get coverage at the price he got it, and is relieved to be covered:

“I already had health insurance, but I just wanted to see if I could do a little bit better on the marketplace, and I did. I was able to pick a much higher quality plan, and because of my income as a student, I’ll only pay about 70 bucks a month for health insurance.”

To compare plans in your area, weigh your options, and get enrolled for coverage beginning January 1st, apply on HealthCare.gov by December 15th.

There are 4 basic ways consumers can apply for and enroll in Marketplace coverage: 

  1. Online at HealthCare.gov;
  2. Over the phone by calling the 24/7 customer service center (1-800-318-2596, TTY 1-855-889-4325);
  3. Working with a trained person in your local community (Find Local Help); or by
  4. Submitting a paper application through the call center or downloading a copy at marketplace.cms.gov.

HHS Strategic Plan Draft for 2014-2018 Open for Comment

Every 4 years, HHS updates its strategic plan, which describes its work to address complex, multifaceted, and ever-evolving health and human service issues. Under the Government Performance and Results Modernization Act, Federal agencies are required to consult with the Congress and to solicit and consider the views of external parties. We welcome your input on the draft HHS Strategic Plan for FY 2014-2018. The comment period will close on October 15, 2013. Comments can be submitted from the website, or in several ways:

E-mail: strategicplanning@hhs.gov
Fax: (202) 690-8252
U.S. Mail:

U.S. Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
Strategic Planning Team
Attn: Strategic Plan Comments
200 Independence Avenue, SW, Room 446F.8
Washington, DC 20201

HHS announces first guidance implementing Supreme Court’s decision on the Defense of Marriage Act

Today, the Department of Health and Human Services (HHS) issued a memo clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.  This is the first guidance issued by HHS in response to the recent Supreme Court ruling, which held section 3 of the Defense of Marriage Act unconstitutional.

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius.  “Today’s announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner.  “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”

Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in, among certain other skilled nursing facilities (SNFs), the SNF where their spouse resides (assuming that they have met the conditions for SNF coverage in the first place, and the SNF has agreed to the payment amounts and other terms that apply to a plan network SNF).  Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse.

Today’s guidance clarifies that this guarantee of coverage applies equally to all married couples.  The guidance specifically clarifies that this guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live.
###

“Profit-Motive” Is Negatively Impacting Your Healthcare: Medicare Provider Charge Data

As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released by HHS (Health & Human Services) that show significant variation across the country, even within communities as to what hospitals charge for common inpatient services.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.”  For example,

  • In Dallas, Las Colinas Medical Center billed Medicare an average of $160,832 for a lower joint replacement. The price was $42,632 five miles away, at Baylor Medical Center.
  • Average inpatient charges for services for a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.
  • Average inpatient hospital charges to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.
  • Ventilator: $115,00 George Washington University vs. $53,000 at Providence (just 5.4 miles apart)
  • Lower limb replacement: $117,000 at Richmond CJW Medical Center vs. 25,600 at Winchester Medical Center
  • Pneumonia: $124,051 in Philadelphia vs. $5,093 in Water Valley, Mississippi.

According to Ron Pollack, executive director of Families USA, hospital pricing is “the craziest of crazy quilts.” He went on to say, “It is absurd — and, indeed, unconscionable — that the people least capable of paying for their hospital care bear the largest, and often unaffordable, cost burdens.”

Medicare has begun paying providers based on quality rather than just the quantity of services they furnish by implementing new programs, such as value-based purchasing and re-admissions reductions.  HHS awarded $170 million to states to enhance their rate review programs, and since the passage of the Affordable Care Act (ACA), the proportion of insurance company requests for double-digit rate increases fell from 75 percent in 2010 to 14 percent so far in 2013.

The ACA also makes available many tools to help ensure consumers, Medicare, and other payers get the best value for their health care dollar.  To make data from these tools useful to consumers, HHS is also providing funding  to data centers to collect, analyze, and publish health pricing and medical claims reimbursement data.  The data centers’ work helps consumers better understand the comparative price of procedures in a given region or for a specific health insurer or service setting. Businesses and consumers alike can use these data to drive decision-making and reward cost-effective provision of care.

Data are available in Microsoft Excel (.xlsx) format and comma-separated values (.csv) format.

Inpatient Charge Data, FY2011, Microsoft Excel version
Inpatient Charge Data, FY2011, Comma Separated Values (CSV) version

Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service. The Total Payment amount includes a Medicare Severity Diagnosis Related Group (MS-DRG) amount, bill total per diem, beneficiary primary payer claim payment amount, beneficiary Part A coinsurance amount, beneficiary deductible amount, beneficiary blood deducible amount and DRG outlier amount.

Data provided by CMS (Centers for Medicare/Medicaid Services) include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the MS-DRG for FY2011.

DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges. Average charges and average Medicare payments are calculated at the individual hospital level. Users will be able to make comparisons between the amount charged by individual hospitals within local markets, and nationwide, for services that might be furnished in connection with a particular inpatient stay.

There is some debate about how much patients, insurance providers and the government actually end up paying. “It’s true that Medicare and a lot of private insurers never pay the full charge,” said assistant professor at the University of California at San Francisco Medical School, Renee Hsia, “You have a lot of private insurance companies where the consumer pays a portion of the charge. But, for uninsured patients, they face the full bill. In that sense, the price matters.”

To view the new hospital dataset, please go to: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html.

To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA # 93.511.

For more information on HHS efforts to build a health care system that will ensure quality care, please see the fact sheet “Lower Costs, Better Care: Reforming Our Health Care Delivery System,” athttp://www.cms.gov/apps/media/press/factsheet.asp?Counter=4550.

To read a fact sheet about the Medicare data showing variation in hospital charges, please see:http://www.cms.gov/apps/media/fact_sheets.asp.

Related Posts:

Holding Insurance Companies Accountable for High Premium Increases

— by Kathleen Sebelius, Secretary of Health and Human Services

The Affordable Care Act (ACA) prohibits some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.  It provides families and individuals with new protections against discriminatory rates due to pre-existing conditions, holds insurance companies accountable for how they spend your premium dollars, and prevents insurance companies from raising your insurance premium rates without accountability or transparency.

For more than a decade before the ACA health insurance premiums had risen rapidly, straining the pocketbooks of American families and businesses.  Oftentimes, insurance companies were able to raise rates without explanation to consumers or public justification of their actions.

One of the provisions of the ACA is that insurance companies must now reveal the percentage of premium dollars they actually spend on health care and how much they spend on administration (e.g., salaries and marketing. Prior to ACA, this type of information was a closely held secret and insurance companies pocketed a good percentage of your premium dollars. With ACA in place, that’s no longer the case. If an insurance company spends less than 80% of premiums on medical care and quality (or less than 85% in the large employer, large group market), it must rebate the portion of premium dollars that exceeded this limit. This 80/20 rule is commonly known as the Medical Loss Ratio (MLR) rule

Chart showing the percent of rate filings that requested increases of 10 percent or more. 2009: 72%, 2010: 75%, 2011: 51%, 2012: 34%, 2013: 14% Rate Review in Action
The ACA brought an unprecedented level of scrutiny and transparency to health insurance rate increases by requiring insurance companies in every state to publicly justify their actions if they want to raise rates by 10% or more.  Insurance companies are required to provide easy to understand information to their customers about their reasons for significant rate increases, and any unreasonable rate increases are posted online.

And it’s working.  A new report released today shows that the health care law is helping to moderate premium hikes.  Since this rule was implemented, the number of requests for insurance premium increases of 10% or more has dropped dramatically, from 75% to 14%.  The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggest that this slowdown in rate increases has continued into 2013.

Moreover, when an insurer does decide to increase rates, consumers are seeing lower rate increases than what the insurers initially requested.  In the review of rate requests for 10% or more, over 50% resulted in customers receiving either a lower rate increase than requested or no increase at all.

States have received $250 million in Health Insurance Rate Review Grants to help strengthen and improve their rate review processes thanks to the Affordable Care Act.  Of the 44 states that received rate review grants, 40 have reported enhancements to their rate review websites.  These website enhancements include searchable rate filings, new public comment options, live streaming of rate hearings, and plain language explanations of rate review and rate filings.

The Effective Rate Review program is one of many in the health care law aimed at protecting consumers.  The rate review program works in conjunction with the 80/20 rule, which requires insurance companies to generally spend 80% of premiums on health care or provide rebates to their customers. Insurance companies that did not meet the 80/20 rule have provided nearly 13 million Americans with more than $1.1 billion in rebates. Americans receiving the rebate will benefit from an average rebate of $151 per household.

Additionally, today we issued a final rule that implements five key consumer protections from the Affordable Care Act, including protection against denial of health coverage because of a pre-existing condition.  This rule makes the health insurance market work better for individuals, families and small businesses, and it also increases the transparency brought to rate increases by directing insurance companies in every state to file all of their rate increase requests.

For more information about the Affordable Care Act, visit http://www.healthcare.gov/index.html.

Related Posts