PRESCRIPTION PRICES SOAR, CONTINUING TO INCREASE OUT-OF-POCKET COSTS

Not only do Americans have to be concerned with rising premiums and higher deductibles, but the increasing cost of prescription drugs is continuing to take a toll on budgets across the country. Within the last three years alone, individuals have had to pay an average of 30 percent more for their prescriptions, according to a Wall Street Journal report.

“It’s easy to talk about the cost today, the cost to the plan, the cost to the premium – but we also have to look at the cost to society, when people are losing their jobs and having to shift to government programs for support,” Annalise Dolph, National Multiple Sclerosis Society senior directory of advocacy said in a Lund Report article.

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Gap Insurance Rising in Popularity as Deductibles Increase

Instead of relying on a savings account to help cover the financial burden of high deductibles, many insurance companies are offering additional policies to cover excessive out-of-pocket costs. Gap Insurance is a coverage option that can be purchased by consumers who are currently enrolled in high deductible plans.

Gap plans typically have limited benefits that regardless of an individual’s situation, the policy will pay funds up to a specific amount. With high deductible plans on the rise, individuals are looking for other options to cover themselves to avoid paying a $6,000 deductible, and more in some circumstances.

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HHS: HIPAA Limitations as Technology Advances

When it comes to electronic medical and personal information, data security continues to be a high priority of all entities within the health care industry. Ensuring that records remain intact and that security breeches are a low risk is the goal of everyone from payers to providers.

First enacted in 1996, HIPAA has provided guidelines on patient privacy and data security. The legislation addresses who must comply with the law, privacy rights and identifies electronic standards for transmitting health data.

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Anti-Trust Concerns with Cigna-Anthem Merger

The $50 billion merger between insurance giants Cigna and Anthem has been in the works for almost a year now. Although critics have been doubtful that this merger will go through due to anti-trust issues, it seems that federal regulators are publicly demonstrating disdain for this move.

As the companies continue to wade through regulatory push back, another major deal is also being reviewed, which is much smaller by comparison. The Aetna-Humana merger is a $37 billion deal that appears to have less obstacles to tackle due to it being a smaller transaction.

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AHIP Runs Pilot Program for Physician Directory

When it comes to searching for doctors, most people take to the internet in search of a provider in their area, while others defer to their primary physician to recommend a specialist. Concern has been raised in the past that online sources may not have accurate information and up-to-date records on each physician and specialist.

To prevent miscommunicating inaccurate information, America’s Health Insurance Plan, or AHIP, is collaborating with providers and health plans to develop a program that features a comprehensive provider directory. The program is an industry first and would allow a seamless avenue to acquire physician’s information and background.

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ICD-10 Progress Report

It has been over four months since ICD-10 was officially implemented into the health insurance system. All entities inside U.S. health care, payers, providers and coders, are required to utilize this new and extensive set of codes. Although the industry as a whole has been preparing for the shift to ICD-10 for years, the transition was expected to create some obstacles.

One of the biggest concerns during this transitional phase was that medical claims would be denied due to incorrect coding. Although there have been some denials due to coding errors, it appears that overall the activation of ICD-10 has gone rather smoothly.

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Open Enrollment Coming to a Close

January 31 will officially mark the end of the health insurance open enrollment season. Individuals that have enrolled in coverage between Jan. 16 through Jan. 31 will begin receiving benefits starting on March 1.

For those who have failed to sign up for coverage, whether through their employer or the federal marketplace, they will be subject to a fine when their 2016 taxes are filed next year. The penalty, which has gone up to $695 per adult and $347.50 per child or 2.5% of the household income, has increased in value in an effort to motivate Americans to apply for coverage. Unlike last year, there will not be a special enrollment period to help those who are uninsured enroll to avoid the fee.

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