What the Affordable Care Act’s 80/20 Rule Means for Your Health Insurance

What the Affordable Care Act’s 80/20 Rule Means for Your Health Insurance

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Health insurance can feel complicated, but one of the most consumer-friendly protections built into the Affordable Care Act (ACA) is something called the 80/20 Rule. This rule, also known as the Medical Loss Ratio (MLR) requirement, was designed to make sure you get the most value out of the money you spend on health insurance premiums.

What is the ACA’s 80/20 Rule?

Under the ACA, insurance companies must spend the majority of the premium dollars they collect on actual medical care and health-related services, not on profits or administrative expenses. Specifically:

  • For individual and small group plans, insurers must spend at least 80% of premium dollars on medical care and quality improvement.
  • For large group plans (usually offered by bigger employers), that requirement increases to 85%, leaving only 15% for overhead and profit.

This means that when you pay your health insurance premium each month, most of that money goes directly towards covering doctor visits, hospital stays, prescriptions, and programs that improve health outcomes.

The 80/20 Rule protects employees in several ways. First, it ensures that the money you contribute towards health insurance is being used primarily for your care, rather than administrative costs like advertising or executive salaries. This creates more value for employees and families, helping to keep coverage focused on health rather than profits.

Second, the Rule promotes transparency. Insurance companies are required to report how they spend premium dollars each year. If they don’t meet the 80/20 standard, they must issue rebates. Sometimes these rebates go directly to employees, but often they are sent to employers, who are then obligated to use the funds to benefit their workers, such as reducing premium contributions or enhancing coverage options.

For example, if your insurer collects $1,000 in premiums, at least $800 must be used to pay for medical care and health services. Only $200 can be used for overhead or profit. If the insurer only spends $750 on care, it hasn’t met the standard, and the difference must be refunded to policy holders.

For employees, this rule offers reassurance that your health insurance premiums are truly working for you. It also keeps insurance companies accountable, ensuring that health coverage remains more affordable and consumer friendly.

The Affordable Care Act’s 80/20 Rule may not be something you hear about every day, but it is a powerful protection. It guarantees that most of your premium dollars are invested directly into your health care, and if an insurance company falls short, you could receive a rebate.

For more information, please visit: Rate Review & the 80/20 Rule | HealthCare.gov

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FFR Top AR Services Provider 2024 | CFO Tech Outlook

FFR Top AR Services Provider 2024 | CFO Tech Outlook

First Financial Resources
A Boutique Approach to Debt Recovery

An organization’s financial stability and profitability hinge on its successful debt collection strategies. In their pursuit of running business operations, serving clients, and managing organizational priorities, many companies often find it challenging to collect unpaid dues.

First Financial Resources (FFR) serves as a valuable partner in accounts receivable management (ARM) with its trained and certified team of collectors actively engaging in proactive communication with consumers facing debt obligations. 

Drawing on over 32 years of expertise in debt recovery solutions, FFR offers personalized, customer-centric solutions with compassionate assertiveness. Ensuring regular and clear interaction, FFR collaborates with debtors to identify effective solutions to facilitate payment of their unpaid dues.

FFR’s solutions for unpaid dues including pre-collections and skip-tracing services, delivering boutique and locally-focused customer service nationally.

“Having recently expanded to national level, we take immense pride in our ability to treat each client with the same level of care as if we were in their neighborhood,” says Terry Merrell, President and COO of First Financial Resources.

As a family-owned, contingency-based business, FFR holds a diverse portfolio encompassing over 1,300 businesses with expertise in consumer and commercial work across various industries. The primary challenge for clients is the time constraints in addressing past-due accounts. In the medical industry for instance, recent regulations prevent credit reporting on medical debt until it’s one year old and exceeds $500. This poses additional challenge for clients in initial debt collection and subsequent recovery efforts.

Having recently expanded to national level, we take immense pride in our ability to treat each client with the same level of care as if we were in their neighborhood

To address this, FFR ensures its collectors undergo rigorous training and certification through the American Collectors Association. They receive training to comprehend the debtor’s financial situations and are adept at handling every debt recovery. FFR engages in collaborative efforts to help consumers move forward from their financial obligations.

To manage clients and their customers efficiently, FFR prioritizes consumer rights and conducts respectful interaction, be it over the phone, via email, or through texting. It also serves as a broker between clients and consumers, establishes custom payment plans, and potentially facilitates their accounts settlement.

One of FFR’s specialty is serving clients in the healthcare sector, it supports medical billing for specialists, medical practices and EMS companies. Through effective ARM, FFR helps dental groups, MRI and radiology facilities, fertility clinics, and ambulance 911 services recover debts. FFR also offers recovery services to educational institutions, like private universities and colleges, CPA and legal firms, town and city services, property taxes, and various commercial sectors.

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In August 2022, FFR transitioned to a new online platform that facilitates automated data exchange beyond SFTP files through custom APIs with clients, empowering them to generate reports independently, review account activity, and report direct payments. It also facilitates access to past invoices, sending or receiving direct messages on accounts, and uploading new accounts without the need to contact the agency. Its leading-edge technology enhances the overall recovery process and optimizes results for its clients.

Upon switching to the new technology platform, FFR reached out to its top 40 clients, emphasizing the significance of obtaining cell phone numbers and email addresses to fast-track the debt recovery process, recognizing the mutual benefit of maintaining comprehensive consumer information for early-stage debt resolution.

As a third-party debt recovery agency, FFR’s success is largely due to hiring based on core values like compassion, assertiveness, positive energy, and humility. It prioritizes candidates with experience with the right personality to be part of a team, delivering exceptional customer service and building lasting customer relationships.

Successful debt recovery generates a positive ripple effect in the economy, resulting in reduced interest rates, increased job opportunities, and lower prices. As the go-to agency, First Financial Resources continues to bolster clients’ growth through its exceptional national-scale debt recovery services delivered with care and a boutique-style approach. 

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