NJ Health Exchange Premiums Estimated to Be Higher than National Average

In a report released this week by the Department of Health & Human Services (HHS), New Jersey health insurance premiums under the Exchange are estimated to be higher than the national average. On October 1, 2013, an estimated two-thirds of New Jersey's 900,000 uninsured residents will be eligible for health insurance. 

 

HHS estimates NJ residents will have an average of 29 different health plans to choose from in the marketplace, at several levels of coverage. The national average of plans per state is 53. The report estimates that New Jersey's benchmark silver plan, covering 70% of a family's health expenses, will cost approximately $385 monthly, compared to $322 per month nationally. 

 

Subsidies will be available to low and moderate income families, significantly reducing the premium costs through tax credit discounts. HHS reports that more than half of the nation's uninsured will be able to find coverage for less than $100 per month after such discounts and coverage through Medicaid plans. Read the full report:  CLICK HERE

Horizon Wrong Payee Issue- 5010 Problems Persist

Members are urged to review payments from Horizon, beginning in 2012, to ensure that payments went to the correct tax identification number. Last year several members reported that Horizon was remitting payments to the physicians’ social security numbers, instead of the practices’ tax identification numbers.Horizon was contacted regarding our concerns, including possible tax implications. Horizon indicated that the wrong payee issue was a result of the 5010 transition. The County and State Medical Societies was assured, on several occasions, that the systems issue was “identified and corrected” and that claims would be reprocessed.

Recently, BCMS and MSNJ was made aware that the issue is ongoing for some member practices and has resulted in continuing incorrect payments, corrections, and recoupments. We are concerned that many members may not be aware of the issue, due to EFT payments. We advise members to review the “Payee ID” number located at the top of explanations of benefits issued by Horizon, from the beginning of 2012 on, to confirm that payments went to the correct tax identification number. We advise that members review payments from Horizon, from 2012 on, to confirm that payments went to the correct tax identification number. We fear there may be IRS 1099 tax implications for payments sent to the physician’s social security number, when they should be remitted to the practice’s tax identification number. We sent a letter to Horizon again expressing our concern that the issue was not corrected; requesting that Horizon provide us with their plan to rectify the matter and asking Horizon to send notice to all affected physicians.

If you are currently experiencing this issue, please contact the State Medical Society at info@msnj.org and put “Horizon Wrong Payee” in the subject line.


BCMS  will keep members apprised of progress on this issue.

AMA: Last-Minute Action to Avert Cuts to Physicians Shows the Need for Meaningful Medicare Changes

Statement attributable to:
Jeremy A. Lazarus, MD
President, American Medical Association

“Congress averted a drastic cut of 26.5 percent from hitting physicians who care for Medicare patients on January 1. This patch temporarily alleviates the problem, but Congress’ work is not complete; it has simply delayed this massive, unsustainable cut for one year. Over the next months, it must act to eliminate this ongoing problem once and for all.

“This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients. This instability stalls progress in moving Medicare toward new health care delivery models that can improve value for patients through better care coordination. Physicians want to work with Congress to move past this ongoing crisis and toward a Medicare program that ensures access to care and the best health outcomes for patients and a stable, rewarding practice environment for physicians.”