Category Archives: Uncategorized

New York Presbyterian and Empire extend contract

From Anthem Health:

 

New York-Presbyterian and Empire BlueCross BlueShield have agreed to a multiyear deal to keep the 10-hospital health system in Empire’s network. The accord ends a public fight that stoked fears that about 300,000 NYP patients would face higher out-of-network charges next year.

The agreement will also maintain Empire members’ access to New York-Presbyterian’s medical groups, including Columbia Doctors and Weill Cornell Medicines. Their current agreement was set to expire on Dec. 31 and covered people in employer-sponsored, individual, Medicare and Medicaid plans.

A spokesman for NYP declined to disclose further details of the contract. The typically private nature of managed care negotiations spilled out into the open last week when the City Council scrutinized New York-Presbyterian’s prices.

“We are pleased that this agreement will allow patients to continue to choose to receive care from NewYork-Presbyterian and its affiliated physicians,” both sides said in a joint statement.

The union 32BJ, one of the city’s most politically active unions, whose membership includes cleaners, doormen and security guards, complained at a City Council hearing last week about the cost of care at NYP compared with other city hospitals. The union uses Empire to build its network.

NYP and Empire had struggled to agree on appropriate payment rates. Self-funded clients, such as 32BJ, had pushed Empire to negotiate better rates on services. The union made public that for 13 hip replacements it had paid the health system nearly $83,000 on average, more than $25,000 above what other city facilities charged. For vaginal deliveries, the union paid nearly $24,000—about $7,000 more than its average at other city hospitals.

New York-Presbyterian said a potential $200 million cut in reimbursement would have threatened its ability to invest in patient care and support the training of future physicians.

If the two sides had not reached a deal, NYP stood to lose a major source of patients, while Empire faced the prospect of selling policies without U.S. News’ top-rated New York hospital in its network. New York-Presbyterian had begun advising patients to consider other insurers on a website set up to notify them that its contract with Empire was set to expire.

CVS closes the Aetna Deal

From Bloomberg:

“(Bloomberg) – CVS Health has closed its $70 billion deal to buy health insurer Aetna, ending months of reviews by state and federal regulators.

The companies announced the takeover almost a year ago in December 2017, promising to create an integrated health-care company whose pharmacy locations could be hubs for medical services while better managing patients.”

 

It should be noted that this very complex merger has already resulted in the spinoff of the CVS Medicare Rx Program Silverscript.  It is unclear what other affects will follow.  –  Reeve

You can increase your Flexible Spending Contribution…

Employees can sock away another $50 in their flexible spending accounts next year.

The IRS announced that the annual contribution limit to FSAs will be $2,700 in 2019, up from the 2018 limit of $2,650. The increase also applies to limited-purpose FSAs that are restricted to dental and vision care services, which can be used in tandem with health savings accounts.

For a dependent care FSA, the 2019 contribution limit for an individual who is married but filing jointly is $2,500. For married couples filing jointly or single parents filing as head of household, the limit is $5,000. That limit is not changed from 2018.

MUSC expanding Statewide

MUSC is expanding in South Carolina, purchasing four community hospitals in Chester, Florence, Lancaster and Mullins.

This is likely the beginning of the hospital empire-building process that has already happened in the larger urban areas of the country.  In many areas of the US, the healthcare is dominated by 2-3 large hospital networks.  The advantage is it feeds their specialty centers, and allows some reduction in expenses.  However, it makes it harder for employees as they may not be able to find  a health plan that includes their doctors/hospital.

Medicare Supplement Changes- Rumor Control!

Upcoming changes in the federal laws will affect the availability of certain Medicare Supplement Plans for certain Medicare beneficiaries. A new federal law, called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will affect the availability of certain Medicare Supplement Plans issued to newly-eligible Medicare beneficiaries on or after January 1, 2020. The Medicare Supplement Plans affected by MACRA are ones that cover the Medicare Part B deductible.

Here are a few key points:

  • Existing Policyholders on Plans C, F, and HDF/F+ are NOT affected by this change. Their existing coverage continues so long as premiums are paid on time.
  • Medicare Supplement Plans C, F, and HDF/F+ will not be available beginning January 1, 2020, for newly-eligible Medicare Beneficiaries.
  • Newly-eligible Medicare beneficiaries are defined as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability, or end-stage renal disease on or after January 1, 2020.
  • New High Deductible Plan G to be introduced January 1, 2020.
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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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