Author Archives: Reeve Conover

NY Presbyterian leaves Oscar Network

From Oscar 10/30/15:

We’re writing to let you know about an important change to our provider network. Effective December 1, 2015, NewYork-Presbyterian facilities and affiliated providers, including New York Methodist and Weill Cornell Medical Center, will no longer be part of the Oscar network.

We made this decision to support our goal of providing affordable plans while maintaining high quality care through our network of top New York hospitals. We will be contacting existing Oscar members who have received care from a NewYork-Presbyterian affiliated provider or facility to help them find care through this transition.

Should you have a question about a doctor’s network status, we encourage you to visit our doctor search or call us at 1-855-OSCAR-55.

CMS sending notices to Employers

Starting in the spring of 2016, the Health Insurance Marketplace (federally facilitated marketplace/FFM) will notify employers who have employees enrolled in Marketplace coverage and are receiving advanced premium tax credits (APTC). Employers will get notices if any employee received APTC for at least one month in 2016 and if the employee entered the employer’s address on his or her Marketplace application.
The notice will identify the specific employee and include a statement that the employee is enrolled in Marketplace coverage with APTC. The notices will not contain the employee’s personal health information or federal tax information.
These notices from the Marketplace are for information only. They do not determine if an employer has any liability under the employer shared responsibility provision. However, the IRS will independently determine if an employer has any such liability, regardless of whether the employer received a notice from the Marketplace or engaged in any appeals process.
An employer may appeal the Marketplace employer notice within 90 days of receiving it. The employer must assert that it provides access to affordable, minimum value coverage or that its employee is enrolled in employer coverage and is therefore ineligible for APTC. If the appeal is successful, the Marketplace will send a notice to the employee asking the employee to update his or her Marketplace application to reflect that he or she has access to or is enrolled in other coverage. The notice will also explain that failure to update the application may result in a tax liability.
For more information, please read the CMS FAQ.

2016 COLA for Retirement Plans Released

Elective Deferral Limit 402(g)(1)

$ 18,000.00
Catch-Up Limits for 401(k) Plans (Age 50+)

$ 6,000.00
Defined Contribution Dollar Limit 415(c)(1)(A)*

$ 53,000.00
Maximum Compensation Limit 401(a)(17)

$ 265,000.00
Highly Compensated Employee Definition 414(q)(1)(B)**

$ 120,000.00
2016 Social Security Taxable Wage Base

 $ 118,500.00

PACE Act changes small group definition back to 50 or less, except in NY

While almost every state in the country has opted to continue with the current rules – small group is 2-50 employees – New York’s Governor still refused to sign off on legislation.  This means that – for the employer with 51-99 employees, you will be considered a large group at renewal time.  This could work in your favor, or be to your detriment, depending on alot of factors.  Group census, claims experience, and current rates all will play into decisions this coming year.

Medicare Premiums to rise, but no cost of living increase this year!

New Medicare Beneficiaries, and high earners, are going to get hit with substantially higher premiums.  Those currently on Medicare that are not high-earners will continue to pay $104.90 this coming year.  New Medicare Beneficiaries will pay $159 in 2016.

From the Wall Street Journal

“The rise in premiums seems increasingly likely because the Social Security Administration is expected to announce Thursday that low inflation means Social Security beneficiaries won’t get a cost-of-living increase for 2016.

About 3.1 million more participants would be subject to the rise because of their incomes. The Medicare trustees projected that single individuals earning between $85,001 and $107,000—and couples earning $170,001 to $214,000—would see monthly premiums rise from $146.90 a person this year to $223 in 2016.”

For the full article, click here.

From the New York Times:

“A quirk in the laws governing Medicare and Social Security will expose millions of Americans to a staggering 50 percent increase in their premiums for the part of Medicare that covers doctors’ bills, known as Medicare Part B. It is imperative that Congress pass legislation to protect low- and middle-income people who cannot pay that much.

The problem is that Social Security recipients will not get a cost-of-living increase in 2016, but Part B premiums are projected to rise. The roughly 70 percent of beneficiaries who are “held harmless” will pay the same premium as last year. That means the increased cost will have to be made up by the other 30 percent, because of the rule that premiums must cover one-quarter of Part B costs. This group includes 2.8 million new enrollees, 1.6 million people who don’t collect Social Security benefits and 3.1 million higher-income beneficiaries.”

For the full article, click here


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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. - SIPC - Brokercheck