US Healthcare - Trends 2013

In Previous year 2012 lot many things happened in U.S. health insurance industry. The Affordable Care Act (ACA) continued to charge ahead despite widespread controversies including a ruling by the Supreme Court and became charged with a fresh line of life when President Obama won his second term in office.

Last year we witnessed the rise of private health exchanges, payer-provider mergers, Accountable Care Organizations (ACOs), 2013 is now poised to see some important developments and new trends in the U.S. healthcare sector. Some of the landmark changes that are sure to gain dominance in 2013 include:


1. The Year of the State Health Insurance Exchanges – Although the ACA has declared January 1, 2014 as the official Go-Live date for state health insurance exchanges, both state and federal exchanges are expected to open for public enrollment in the last quarter of 2013. As current controversies and conflicts around health exchanges spill into 2013, exchanges are expected to remain the hot topic of debate throughout the year.

2. Increased Measures to reduce Healthcare Costs – Lot many Federal programs such as “Pay-for-Performance” and Medicare’s “Hospital Re admissions Reduction Program” sought to reduce healthcare costs in 2012 through improved efficiency and quality in administered care. With healthcare costs reigning at the top of the industry’s primary challenges, 2013 will likely yield stringent measures aimed at restraining growth in healthcare costs.

3. Growth in Private Health Insurance Exchanges – Private health insurance exchanges is gaining popularity in group markets, providing visible advantages such as increased flexibility in health coverage and higher predictability in costs as compared to ACA-mandated public exchanges that are still shrouded in uncertainties. Increased employer demand for Defined-Contribution Plans led to the launch of several private health insurance exchanges in 2012, with the trend expected to continue strong into 2013.

4. Surge in Employer-sponsored Wellness Services – With employers’ healthcare costs sky rocketing at alarming rates, employee wellness programs have been pushed to the forefront of health benefits. As employee engagement gains unprecedented popularity, insurance carriers and wellness providers are adapting their health benefit portfolios to encourage healthy lifestyles among employees.

Despite several nerve-racking events, President Obama’s healthcare law survived last year. As we step forward into 2013, the U.S. healthcare industry is expected to become fraught with increased activity as federal and state exchanges gradually emerge onto the U.S. landscape, private exchanges gain ground in group markets, Medicare and Medicaid receive an overhaul, and consumers get acquainted with the new, digital way of purchasing their health insurance.

The U.S. healthcare industry’s journey through 2013 will be a sight to watch as trends continue to emerge.

US Health Care Law

In US Health Care Law plays very important role . These are the laws passed or you can say approved by federal government to make Medical Healthcare/ Healthcare Insurance market work better for individuals , families, students , retired persons , old peoples . Almost covering each and every human being present in country .

As per new Health Care Law in US it protects consumers against worst insurance practices. After New US Health care law health insurance protections for all Americans moves forward. As per new Healthcare law in US issued they implemented five key consumer protections from the Affordable Care Act and makes the health care insurance market better for individuals, families and small businesses.

As per Secretary Kathleen Sebelius " being sick will no longer keep you ,your family or your employees from being able to get affordable health coverage".

As per these reforms all individuals and employees have the right to purchase health insurance coverage regardless of their health status.  In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

This final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans:

Guaranteed Availability
Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.

Fair Health Insurance Premiums
Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal.  The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.

Guaranteed Renewability
Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick.  You may renew your coverage at your option.

Single Risk Pool
Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools.  Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.

Catastrophic Plans
Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market.  Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

In preparation for the market changes in 2014 and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program.  And, HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests.   A new report has found that the law’s transparency provisions have already resulted in a decline in double-digit premium increases filed: from 75 percent in 2010 to, according to preliminary data, 14 percent in 2013.

In addition, U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or cost-sharing reduction as a result of participating in a Health Insurance Exchange, or Marketplace