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Obamacare How does it Affect Premiums and How is it Going to Affect Physicians?
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Obamacare How does it Affect Premiums and How is it Going to Affect Physicians?

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The U.S. Department of Health and Human Services (HHS) published the premium rates for Obamacare in its recent report titled ‘Health Insurance Marketplace Premiums for 2014’ as the enrollment begins …

The U.S. Department of Health and Human Services (HHS) published the premium rates for Obamacare in its recent report titled ‘Health Insurance Marketplace Premiums for 2014’ as the enrollment begins on October 1, 2013.

Published in: Business, Economy & Finance

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  • 1. Obamacare – How Does it Affect Premiums and How is it Going to Affect Physicians?
  • 2. The U.S. Department of Health and Human Services (HHS) published the premium rates for Obamacare in its recent report titled ‘Health Insurance Marketplace Premiums for 2014’ as the enrollment begins on October 1, 2013. The report which focuses on plans having the lowest premiums (as most of the consumers are likely to shop for low-cost plans) indicates that the average monthly premium for Obamacare is $328. This rate actually refers to the average second lowest silver plan as it is most popular for their balance of coverage and out-of-pocket costs. The HHS claims that this price is 16 percent lower than its projections over premiums. The premium rate will undoubtedly persuade the consumers to obtain coverage. But, how it will affect the physicians? The HHS report says that federal subsidies are given for consumers who earn up to 400 percent of the federal poverty level or a couple earning up to $62,040, to lower the premium rates further. For example, an average 27-year-old with an income of $25,000 in Texas will have to pay only $145 per month for the second lowest cost silver plan after tax credits. At the same time a family of four with an income of $50,000 in Texas will have to pay only $282 per month for the same plan after tax credits. Moreover, coverage will not be denied for anyone based on any pre-existing conditions. Both of these advantages can drive more consumers to enroll in Obamacare plans so that physicians can treat more patients with health coverage. Family Practice Physicians to Benefit For family physicians, there is the opportunity to gain income from previously uncompensated care. According to Ried Blackwelder, MD, president-elect of the American Academy of Family Physicians (AAFP), among the nearly 110,000 AAFP members, on an average physicians provide eight visits a week for people who don’t have insurance. That number should now drop drastically because family doctors will be having patients that have insurance coverage. They will also have new patients, and both of this will definitely enhance their payment structure. With screening much more accepted by Medicare as well as private payers, family practitioners can more easily screen patients and provide vaccinations which were never covered or weakly covered. Pain Management Doctors Are Accepting More Insurance Plans Pain management doctors are accepting more insurance plans and making effective, customized and successful treatment options available for patients. This is important in the light of the fact that almost one third of the U.S population is dealing with acute or chronic pain. According to a recent report, Los Angeles pain management doctors in the California Pain Network have started accepting more than 50 insurance plans that include Medicare, all major commercial PPO plans, Workers’ Compensation, Personal Injury Liens and Self Pay.
  • 3. Factors that Can Affect the Payment Structure of Physicians There are two factors that can affect the payment structure of the physicians. • Variations in Actual Premium Costs: The actual premium costs may differ according to the health plans, states and community. For example, the average premium cost for the lowest cost silver plan is $310, and for the lowest cost bronze plan it is $249. The cost for the second lowest silver plan in Tennessee is $245, while in Texas it is $305. The same plan ranges from $239 to $352 per month for a 40-year-old in Florida that has 67 different geographical rating areas. Physician practices set their fee schedule based on the costs for providing physician services which may depend upon the length of service, geographical area and other relevant factors. The varying premium rates may lead to varying healthcare costs and thereby have an impact on the physicians’ fee schedule. • ‘Narrow Networks’ Trend: According to insurers, most of the people shopping for insurance will be low/moderate income people who are budget conscious. To control costs insurers have created smaller networks of healthcare providers than the ones typical of commercial insurance. These providers will be paid less than what they are used to receiving from commercial payers. The Affordable Care Act does not drastically affect the general structure of the government’s physician payment system. However, it does expand their reach and includes new regulatory constraints. Physicians are looking at the various health insurance plans with real interest as well as concern. Physicians need to decide which plans to accept in their practices, so that they can run a profitable practice. Medical billing companies that serve physicians are also waiting to see how physician fee schedules will be after the new premium rates, and how it may actually affect their physicians. A medical billing company can thoroughly review the physician schedule and recommend measures to improve their physicians’ revenues.