Author Archives: Reeve Conover

Medicare And Prescription Changes

A lot is happening in the Rx Market this year.  In case you missed it, Aetna has been purchased by CVS health, which has been approved by the DOJ.  As part of this purchase, however, they have to sell Silverscript, the Medicare Rx Program.  This is set to happen around the first of the year, to WellCare.  In the meantime, Silverscripts prices have gone up and Aetna looks much more competitive, and we expect a lot of changes this year.

Walgreens bought Rite Aid and is in the process of consolidating stores and plans.  No word yet on what will happen to Rite Aids’ Envision Rx program, and Walgreens has maintained its deal with AARP.

It is important that Seniors check their prescriptions EVERY year, as this is the time of year when everything changes.  It is too late to change in January when you discover your medication is no longer covered!

 

 

Nebraska Farm Bureau offers First “Association” Health Plan

Nebraska Farm Bureau is trying to ease the financial stress on producer families already facing low commodity prices, an expiring farm bill, and a trade war that is especially affecting the state’s corn and soybean growers. The group recently announced they will offer the opportunity to join NEFB’s new large group Association Health Plan to members, many of whom are self-employed farmers and ranchers, and are faced with crippling insurance premiums.

Tim Hruby of Hemingford, Neb., serves on the Nebraska Farm Bureau Employee Insurance Consortium for the Northwest District, the group that was created to sponsor and manage the Nebraska Farm Bureau Member Health Plan and to help comply with state and federal laws for large group Association Health Plans. The consortium partnered with Medica to provide the new health insurance option, which is a way to lower health insurance premiums by grouping farmers, ranchers, and certain agribusinesses so they can be a larger, more risk-stabilizing pool.

Obmacare back in the courts

Three pending lawsuits have the potential to directly affect health plans and the individuals we serve:

    • Texas v. U.S.: As we have reported, 20 states’ Attorneys General have alleged Congress’s repeal of the individual mandate effective as of 2019 means the remainder of the ACA is unconstitutional. The Court heard oral arguments earlier this month and is expected to issue its decision soon. A countersuitrecently filed by Maryland’s Attorney General attempts to confirm the law’s constitutionality by directly addressing the issues arising in the Texas case.

 

    • The Association for Community Affiliated Plans (ACAP) v. U.S.: On September 14, seven health care industry and advocacy groups filed suit in a federal district court seeking to undo the Trump Administration’s short-term, limited-duration insurance (STLDI) regulation finalized earlier this summer. The suit alleges the rule, which expands the time an individual may be enrolled in an STLDI plan from three months to just under three years, unlawfully undoes many of the law’s requirements.

 

  • Texas v. U.S.: Another suit filed by the Texas Attorney General and six other states seeks recovery of funds paid to Medicaid health plans to account for their portion of the ACA’s Health Insurance Fee (also known as the Health Insurance Tax or HIT). The court ruled in the states’ favor in August. Additional motions have since been filed addressing how and when the states would receive relief. The court is expected to rule on these issues shortly.

Judge says U.S. is on the hook for Obamacare subsidies for insurers

The federal government had a clear obligation to reimburse insurers for assistance provided to low-income people under the Affordable Care Act, a federal judge says.
By ROBERT PEAR / The New York Times
A federal court ruled this month that a Montana insurer is entitled to federal compensation for subsidy payments under the Affordable Care Act (ACA) that President Donald Trump abruptly ended in October, a ruling that could reverberate through insurance markets and cost the government hundreds of millions of dollars.
At issue are payments for cost-sharing reductions, discounts that enhance the value of health-insurance policies purchased from the ACA’s marketplaces by reducing deductibles, co-payments and other out-of-pocket costs for low-income consumers. Trump ended the payments in October, one of a series of executive actions intended to undo President Barack Obama’s signature domestic achievement.
But Judge Elaine Kaplan of the U.S. Court of Federal Claims ruled this month that Trump’s actions violated a government promise to insurance companies participating in the health law. Although Congress never explicitly provided money for the subsidies, the court said, the government had a legal obligation to pay them.
The decision could have broad ramifications for health insurers. Several similar cases are pending in the Court of Federal Claims, a specialized tribunal that handles a wide range of monetary claims against the government. In April, another judge, Margaret Sweeney, certified a class action that allows insurers as a group to sue the government over Trump’s termination of the cost-sharing payments.

DPO Approves CINGA-Express Scripts Merger

The action brings together a major health insurer and a pharmacy benefit manager that some analysts say should help control costs by merging drug and medical benefits management.

To date, Cigna and Express Scripts have obtained clearances from departments of insurance in 16 states. The companies are working constructively with regulators in the remaining jurisdictions to obtain clearance for the merger. Cigna and Express Scripts continue to anticipate that the deal will close by year-end 2018, subject to the satisfaction of all closing conditions.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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