Tag Archives: marketplace

Frustration runs deep for those forced to routinely change health plans

Andrea Schankman’s three-year relationship with her insurer, Coventry Health Care of Missouri, has been contentious, with disputes over what treatments it would pay for. Nonetheless, like other Missourians, Schankman was unnerved to receive a notice from Coventry last month informing her that her policy was not being offered in 2017.

With her specialists spread across different health systems in St. Louis, Schankman, a 64-year-old art consultant and interior designer, said she fears she may not be able to keep them all, given the shrinking offerings on Missouri’s health insurance marketplace. In addition to Aetna, which owns Coventry, paring back its policies, UnitedHealthcare is abandoning the market. The doctor and hospital networks for the remaining insurers will not be revealed until the enrollment period for people buying individual insurance begins Nov. 1.

“We’re all sitting waiting to see what they’re going to offer,” said Schankman, who lives in the village of Westwood. “A lot of [insurance] companies are just gone. It’s such a rush-rush-rush no one can possibly know they’re getting the right policy for themselves.”

Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer.

“In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”

Forty-three percent of returning consumers to the federal government’s online exchange, healthcare.gov, switched policies last year. Some were forced to when insurers stopped offering their plans while others sought out cheaper policies. In doing so, consumers saved an average of $42 a month on premiums, according to the government’s analysis. But avoiding higher premiums has cost many patients their choice of doctors.

Jim Berry, who runs an internet directory of accountants with his wife, switched last year from Blue Cross Blue Shield of Georgia to Humana after Blue Cross proposed a 16 percent premium hike.

Despite paying Humana $1,141 in premiums for the couple, Berry, who lives in Marietta, a suburb of Atlanta, said they were unable to find a doctor in the network taking new patients. They ended up signing up with a concierge practice that accepts their insurance but also charges them a $2,700 annual membership, a fee he pays out of pocket. Nonetheless, he said he has been satisfied with the policy.

But last month Humana, which is withdrawing from 88 percent of the counties it sold plans in this year, told Berry his policy was not continuing, and he is unsure what choices he will have and how much more they will cost.

“It’s not like if I don’t want to buy Humana or Blue Cross, I have five other people competing for my business,” Berry said. “It just seems like it’s a lot of money every year for what is just basic insurance, basic health care. I understand what you’re paying for is the unknown — that heart attack or stroke — but I don’t know where the break point is.”

To be sure, the same economic forces — cancelled policies, higher premiums and restrictive networks — have been agitating the markets for employer-provided insurance for years. But there is more scrutiny on the individual market, born of the turmoil of the Affordable Care Act.

Dr. Patrick Romano, a professor of medicine at the UC Davis Health System in Sacramento, Calif., said the topic has been coming up in focus groups he has been convening about the state insurance marketplace, Covered California. Switching doctors, he said, “is a disruption and can lead to interruptions in medications.”

“Some of it is unintentional because people can have delays getting in” to see their new doctor, he said. “Some of it may be because the new physician isn’t comfortable with the medication the previous physician prescribed.”

Dr. John Meigs, an Alabama physician and president of the American Academy of Family Physicians, said that whatever the source of insurance, changing doctors disrupts the trust a patient has built with a physician and the knowledge a doctor has about how each patient responds to illnesses. “Not everything is captured in a health record” that can be passed to the next doctor, Meigs said.

There is little research about whether switching doctors leads to worse outcomes, said Dr. Thomas Yackel, a professor of medicine at Oregon Health & Science University in Portland. In some cases, he said, it can offer unexpected benefits: “Having a fresh set of eyes on you as a patient, is that really always a bad thing?”

With the shake-up in the insurance market, access to some top medical systems may be further limited. Blue Cross Blue Shield of Tennessee, which has included the elite Vanderbilt University Medical Center in its network, is pulling out of the individual marketplace in the state’s three largest metro areas: Nashville, Memphis and Knoxville. Bobby Huffaker, CEO of American Exchange, an insurance firm in Tennessee, said so far, no other carrier includes Vanderbilt in its network in the individual market.

In St. Louis, Emily Bremer, an insurance broker, said only two insurers will be offering plans next year through healthcare.gov. Cigna’s network includes BJC HealthCare and an affiliated physicians’ group, while Anthem provides access to other major hospital systems, including Mercy, but excludes BJC and its preeminent academic medical center Barnes-Jewish Hospital.

“These networks have little or no overlap,” she said. “It means severing a lot of old relationships. I have clients who have doctors across multiple networks who are freaking out.”

Aetna said it will still offer policies off the healthcare.gov exchange. Those are harder to afford as the federal government does not provide subsidies, and Aetna has not revealed what its networks will be. In an email, an Aetna spokesman said the insurer was offering those policies to preserve its option to return to the exchanges in future years; if Aetna had completely stopped selling individual policies, it would be banned from the market for five years under federal rules.

Even before St. Louis’ insurance options shrunk, Bremer said she had to put members of some families on separate policies in order for everyone to keep their physicians. That can cost the families more, because their combined deductibles and maximum out-of-pocket payments can be higher than for a single policy, she said.

“Every year our plan disappears,” said Kurt Whaley, a 49-year-old draftsman in O’Fallon, Mo., near St. Louis. After one change, he said, “I got to keep my primary care physician, but my kids lost their doctors. I had to change doctors for my wife. It took away some of the hospitals we could get into.”

Brad Morrison, a retired warehouse manager in Quincy, Ill., said he has stuck with Coventry despite premium increases — he now pays $709 a month, up from $474 — because the policy has been the cheapest that would let him keep his doctor. “That’s the one thing I insisted on,” he said. “I love the guy.”

With Coventry leaving the Illinois exchanges, Morrison is unsure whether his alternatives will include his physician. His bright spot is that he turns 65 next spring. “I’m trying to hold out until I get to Medicare,” he said.

This report originally appeared in Money. It was made available by Kaiser Health News through a Creative Commons license. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Facebook launches app-based Marketplace shop

Facebook Inc launched Marketplace to allow people to buy and sell items locally as the social media network tries new ways to keep users engaged.

The feature will appear as a “shop” icon at the bottom of the Facebook app and will allow users to list or search for items on sale in their neighborhood.

The company will not facilitate the payment or delivery of items and will not take a cut from any transactions, Facebook said.

The new service will be rolled out in the United States, the UK, Australia and New Zealand for iPhone and Android users over the next few days, the company said in a blog post, adding that the feature will be available on the desktop version in the coming months.

More than 450 million people already visit Facebook groups that have items to buy and sell each month, the company said.

Last year, Facebook said it was testing several ad features that allow users to shop directly through its app, an effort to move further into e-commerce.

Facebook’s shares were little changed at $128.39 in morning trading on Monday on the Nasdaq.

How to …

Post Items for Sale in Just a Few Steps

Selling an item in Marketplace is just as easy as browsing for one. Simply:

Take a photo of your item, or add it from your camera roll

Enter a product name, description and price

Confirm your location and select a category

Post

 

Nonprofit insurers struggle in the health care marketplace

A smorgasbord of options and lower prices for consumers were two of the chief selling points for President Barack Obama as he promoted his overhaul of the nation’s health insurance industry, predicting Americans would see “competition in ways we haven’t seen before.” Companies were even started as a way to encourage innovation and competition, namely 23 consumer-run, co-op insurers created with the help of $2 billion in federal loans.

But rather than promote competition, the co-ops and smaller nonprofits in some states have languished behind major insurers, attracting in some cases minuscule shares of the market. While Obama celebrated an early projection this week of 7.1 million enrollees under the Affordable Care Act, it’s too early to say whether the law ultimately will foster sufficient competition to keep premiums and deductibles affordable for consumers.

Many of the nonprofit insurers are startups and have faced challenges as they tried to attract customers, including: the computer problems that plagued many of the signup websites; plans that weren’t priced to compete; and a failure to develop brand recognition, due in part to restrictions on advertising and lobbying that were a condition of the co-ops accepting the federal funding.

“Between no lobbying and no direct marketing, that’s what you get,” said Ken Lalime, CEO of HealthyCT, a co-op in Connecticut. “It’s kind of tough to get your name out there and get exposure.”

Like nonprofits in other states, HealthyCT watched in recent months as customers chose big-name insurers on the marketplaces created under the federal health care law. Before Monday’s enrollment deadline, HealthyCT had 3 percent of signups in the state.

Just 5 percent of enrollees in Washington state’s marketplace had chosen community nonprofit insurers by the end of February. In California, more than 95 percent of people signing up for coverage went with four major insurance companies rather than seven regional or community nonprofits. About 97 percent of Oregon’s enrollees have selected plans offered by the larger insurers in the state while 3.3 percent chose the two co-ops. In New Mexico, an estimated two-thirds of those signing up selected one of three major insurers. And through February in North Dakota, where Blue Cross Blue Shield had 80 percent of the market before the law went into effect, just 516 people chose coverage offered by the nonprofit Medica.

“When you had the lion’s share before, you’re going to have the lion’s share again,” said Neil Scharpe, a service contract specialist with North Dakota Center for Persons with Disabilities, who coordinates enrollment outreach workers.

The federal government, which operates the insurance marketplaces for 36 states, has not released data on what type of insurers people enrolled with on those marketplaces, said Courtney Jenkins, a spokeswoman for the Centers for Medicare and Medicaid Services. In the absence of federal data, The Associated Press surveyed the status of nonprofit insurers in numerous states, primarily those running their own marketplaces, or exchanges. In some states, some of the larger insurers are also not-for-profit.

And while the federal government has loaned $2 billion to the 23 co-ops, officials are not expressing concern with their enrollment figures or their ability to repay the loans. Jenkins said her agency is encouraged so far but will be monitoring the co-ops’ progress.

The struggles have been pronounced for the newly created co-ops, and some congressional Republicans have voiced concern about their long-term financial viability. HealthyCT, for example, only ran TV ads after it began bringing in money from premiums. Near the end of March, it had signed up about a quarter of its original, modest goal of 10,000 customers. The two major insurers on the state’s exchange, including Anthem Blue Cross Blue Shield, had 97 percent of the market.

For Maryland’s Evergreen Health Co-op, lackluster enrollment numbers – about 650 people had signed up for coverage through early March – were blamed on technical issues with the exchange’s website. Until recently, the exchange failed to even give shoppers the actual costs of Evergreen’s policies that included out-of-pocket expenses.

The slow starts prompted some smaller nonprofits to adjust their enrollment goals and change their business plans. HealthyCT is now selling insurance outside the state’s marketplace to larger employers and hopes to educate the public about its patient-centric model of care in time for the next open enrollment in November. Evergreen changed gears to focus more on offering small group insurance plans rather than individual ones and enrollment picked up, said Dr. Peter Beilenson, its CEO and president.

Beilenson said he’s confident the added business will enable his co-op to enroll greater numbers of people with less effort, and he hopes Evergreen will be able to return to its priority of offering high-quality care to working and middle class families, once Maryland’s enrollment system is improved.

“I would hope that it works vastly better next year than this year,” he said.

But if enrollments do remain low, there are some protections over the next several years. The law included temporary programs that basically provide money to participating insurers to help them financially balance the risk and offset rising insurance premiums, said Dylan H. Roby, director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research.

The competition to date might not be what Obama envisioned but it’s also not fatal to the exchanges because the law is so new. But all nonprofits selling plans on the exchanges, including the co-ops, will need market share eventually, acknowledged Roby.

Sharp Health Plan, owned by a San Diego regional health care provider, has received about 10,000 applications, or a 10 percent market share. CEO Melissa Hayden-Cook said the financial viability of competing on the Covered California health exchange won’t be clear until months after the first year people have policies.

“It takes time to know how the business model is going to perform,” she said. “But with federal protection to help offset some of those risks, we’re cautiously optimistic.”

Most people buying plans through the exchanges are getting subsidies that lower their premium costs, but deductibles remain costly, so the enrollment numbers will likely grow as people become more aware of the law’s requirement to have coverage or risk larger and larger financial penalties.

“You’ll probably see more people biting the bullet and signing up,” Roby said.

Some states’ smaller nonprofits stand out as bucking the trend. Nonprofits and regional insurers appear to be competitive in Wisconsin, though the companies have long histories in the state, and thus name recognition. And nearly 80 percent of everyone who signed up on Maine’s exchange through the beginning of March, or about 20,000 residents, chose the one nonprofit co-op offering plans, Maine Community Health Options.

Ken Voorhees, of Litchfield, south of Maine’s capital of Augusta, said he chose the co-op’s plan over Anthem Blue Cross and Blue Shield for the $130 a month savings over his previous coverage, its benefits, including a health coach, and its status as a local business.

The 58-year-old, who operates a business that builds timber frames, said he feels like his money is more likely to trickle down to the services he receives, rather than funding corporate executives’ salaries.

“It’s nice to keep the money in the community,” said Voorhees.

Gay couples find uneven access to health care coverage

Nearly every day for three months, Carl Bechdel had to make calls or send emails to try to get family insurance coverage for his husband and himself under President Barack Obama’s landmark health law.

The Harrisburg, Pa., couple had sent an insurer their application and a month’s premium in early December but heard nothing. Weeks later, they were told their application was not processed because Pennsylvania doesn’t recognize same-sex marriage. So Bechdel pushed back, repeatedly explaining their predicament in phone calls and emails. Finally, they got a call and apology from the president of the insurance company last month, plus a family plan that started in March.

“It was never a matter of price. It was a matter of respect,” said Bechdel, a 60-year-old retired attorney who married Dan Miller in 2012 in Washington, D.C.

For gay couples, access to family insurance plans under the law is not guaranteed this year, and their options run the gamut, mirroring in part the patchwork of state laws governing same-sex marriage that have changed rapidly in recent years.

In Iowa, where gay marriage is legal, insurers selling plans in the marketplace created under the law offer policies to gay couples and families. But the major company in Tennessee’s marketplace does not offer coverage at all to same-sex couples. Policies vary by insurer in Florida. And in Ohio, a couple sued for access to family insurance plans.

The federal government has belatedly sought to solve the inconsistencies, telling insurers this month that if they offer spousal coverage to heterosexual couples, they must provide that benefit to legally married, same-sex couples. But that doesn’t become a requirement until next year, and doesn’t address coverage for couples in civil unions and domestic partnerships.

In the meantime, the administration has encouraged companies to comply with the new policy voluntarily. Federal regulations do not require insurers to offer any family policies. And when companies do, they have some flexibility in how they define family members.

In Aberdeen, N.C., Thomas Hafke, 30, went online in December and bought a family plan for his husband and himself from Blue Cross and Blue Shield of North Carolina.

But the Chapel Hill-based company then canceled family coverage it sold to Hafke and about 20 other same-sex couples through the marketplace because of contract phrasing that defined “spouse” as “opposite sex.”

“It felt like legalized discrimination,” said Hafke, a server, who married 32-year-old Chad Higby in Washington, D.C., last fall.

Blue Cross and Blue Shield reversed course in January, saying it would offer the coverage to same-sex married couples and domestic partners.

“It was very important for these people to be able to purchase family coverage,” said Michelle Douglas, a Blue Cross and Blue Shield spokeswoman. “In recognition of that, the company made the decision to make that coverage available.”

Knowing that a partner can get coverage is one of the more effective messages in getting those in the LGBT community to enroll in a plan under the law, said Katie Keith, a researcher at Trimpa Group, a consulting firm that works with gay rights advocates.

“Even though it’s not a requirement for 2014, it makes it more of a possibility for people,” Keith said.

While it will be months before insurers are obligated to offer such coverage, gay rights groups have praised the administration’s move, saying it brings some clarity to the issue and will ease access for gay couples when the requirement takes effect next year.

“Many same-sex married couples and their families are hurting right now because they’ve been refused access to more affordable family health insurance plans,” Rea Carey, executive director of the National Gay and Lesbian Task Force, said in a statement.

Bechdel and his husband sought coverage from one of Pennsylvania’s biggest insurers, Pittsburgh-based Highmark Inc. The insurer is now reworking its policies there and in West Virginia to let same-sex couples and domestic partners purchase family coverage, a spokesman said. In the meantime, the company has worked with about 15 couples in the two states to get them family policies.

“Originally, the products were developed following the guidelines of recognized marriage of state laws,” said Aaron Billger, a Highmark spokesman.

In Delaware, where Highmark also offers plans and same-sex marriage is legal, the insurer already provides such coverage for gay couples.

The company expects to offer family coverage in the early spring in Pennsylvania and West Virginia.

Other gay couples have found uneven access to family plans.

Al Cowger Jr. and Tony Wesley Jr. of suburban Cleveland sued the state of Ohio and U.S. government after hours-long phone calls and months of trying to get family coverage through the federal insurance marketplace.

The couple, who have been together for 28 years, married in 2012 in upstate New York and have a 7-year-old adopted daughter. They say that because of Ohio’s gay marriage ban, they have been denied a family plan under Obama’s law in violation of their constitutional rights.

In their lawsuit, Cowger said he talked to help-desk personnel with healthcare.gov who told him that he and Wesley had been approved for family coverage in the marketplace. But a problem surfaced when the representative tried to purchase the policy and couldn’t.

Cowger said he was then told he couldn’t get family coverage because Ohio does not recognize his marriage. But the insurance company, Medical Mutual of Ohio, says it offers family coverage to same-sex couples both on and off the exchange.

“After 28 years,” Cowger said recently, “we’re just so sick of having to jump through hoops and get around all these restrictions, all the stuff that comes with these prohibitions, to be treated like a family.”

New year, big tests for Affordable Care Act

The new year brings the big test of President Barack Obama’s beleaguered health care law: Will it work?

The heart of the law springs to life on Jan. 1, after nearly four years of political turmoil and three months of enrollment chaos. Patients will begin showing up at hospitals and pharmacies with insurance coverage bought through the nation’s new health care marketplaces.

The course of 2014 will show whether Obama can get affordable care to millions of people in need, without doing intolerable damage to the 85 percent of U.S. residents who already were insured.

Lots of Americans are nervous.

Will their new coverage be accepted? It’s a concern because insurers have reported problems with the customer information they’ve gotten from the government, including missing data and duplication.

How many more people will see old individual plans that they liked canceled? Will a flood of newly insured patients cause doctor shortages? Will businesses respond to the law by ditching their group plans or pushing more health costs onto workers?

About three-fourths of people who face changes to their job-based or other private coverage in 2014 blame the health law, a recent AP-GfK poll found. Yet the trend of employers trimming costly health benefits predates the law now widely known – by critics and advocates – as Obamacare.

Many people should benefit immensely.

People previously locked out of individual insurance by high prices or pre-existing health problems can get coverage to stave off the threat of medical bankruptcy. More low-income workers will come under Medicaid, in states that agreed to expand the safety-net program. Middle-class families without workplace coverage can get tax subsidies to help pay for their insurance. How much patients like the new plans, and whether they can afford the co-pays and deductibles, will become clear as they start visiting doctors.

The new year also launches the most contentious aspect of the law: the mandate that nearly everyone in the U.S. have health coverage, or pay a fine.

All this will unfold during the super-heated politics leading to November’s midterm elections.

Republicans and Democrats will jostle all year to influence the public’s assessment of changes to American health care not matched since Medicare and Medicaid were launched nearly a half-century ago.

Some dates – and moving parts – to watch in 2014:

JAN. 1

Coverage begins. Many low-income Americans who didn’t qualify for Medicaid in the past can use it now. People who signed up for private insurance in a state or federal marketplace by Dec. 24 (or later in some states) and have paid their first premium are now covered, too.

Coverage begins for workers at companies that have signed up for new small business plans through the marketplaces, also called health care exchanges.

Coverage lapses for people whose existing plans were canceled, if they haven’t signed up for a replacement or received an extension. At least 4.7 million people got cancellation notices, despite Obama’s promise that Americans with insurance they like could keep their old plans. Obama recently gave insurance companies the option of extending old plans for existing customers for a year, but only where state insurance commissioners give their OK.

The clock starts on the “individual mandate.” Nearly all U.S. citizens and legal residents are required to have “minimum essential coverage” for most of 2014, or pay a penalty. Most people already are insured through their jobs, Medicare, Medicaid, or military coverage and so don’t need to do anything.

Insurance companies are no longer allowed to turn away people in poor health or kick customers out of plans when they get sick.

Women and people with pre-existing conditions pay the same rates as healthy men in the new plans. The law also limits how much more insurers can charge older people.

New insurance plans can’t put an annual dollar limit on care, or require individuals to pay more than $6,350 in out-of-pocket costs per year.

JAN. 10

Payment due. In most cases, marketplace customers who signed up by Dec. 24 have until now to pay the first month’s premium and get coverage for their January medical bills. Major national insurers agreed to accept payments 10 days into the month because of technical troubles plaguing online enrollment at HealthCare.gov. But buyers should check early with their insurance companies – some may not honor the grace period. A few states running their own marketplaces are granting even more time. Those who miss their deadline can get coverage starting Feb. 1.

JAN. 31

A temporary program for people denied coverage because of poor health ends. Tens of thousands of Americans with serious illnesses such as heart disease and cancer were in the special program and needed new coverage for 2014. The Pre-Existing Condition Insurance Plan, originally set to expire Dec. 31, was extended one month to help sick people whose enrollment was stymied by HealthCare.gov computer crashes.

Some people could lose coverage for a prescription they’ve been taking. The Obama administration urged insurers to temporarily let customers keep filling prescriptions covered by a previous plan, but not their new one, through January.

LATE MARCH

The patched-up health care website will face a major test if too many people rush to sign up in the final days of open enrollment. Watch for a possible return of rampant crashes and error messages.

On the other hand, low enrollment signals another danger. The law’s design relies on younger, healthier enrollees to offset the cost of older and sicker consumers. If the numbers stay low, it’s likely that enrollees will be disproportionately people with more expensive medical needs, putting a financial strain on insurers. The White House set a goal of 7 million sign-ups for private coverage. More than 1 million had enrolled by Dec. 20, Obama said.

MARCH 31

Last chance for open enrollment through the federal marketplace or 14 states running their own exchanges. Late March enrollees will be covered beginning May 1. (It’s possible the administration could decide to extend open enrollment, if major website problems resurface and interfere with sign-ups.)

This is the deadline for most people to get coverage to avoid a fine. The Obama administration says, however, that those whose existing health insurance was canceled because of the Affordable Care Act will be exempt from the penalty. People who lose coverage during the year can go without for three months before facing a penalty.

The enrollment deadline doesn’t apply to people signing up for Medicaid or the Children’s Health Insurance Program, based on income. People can apply for those programs at any time and coverage begins at once.

The March 31 deadline also won’t stop those who need to sign up later in 2014 because of a “qualifying life event.” The events include things like getting married, having a baby, or leaving a job that provided insurance. Qualifying events trigger a special enrollment period lasting 60 days.

APRIL 15

No worries yet. Those who go without insurance won’t owe penalties until federal taxes are due in 2015 for the previous year’s income. Tax returns filed in 2015 will include health insurance information; insurers will send notices to confirm that taxpayers were covered in 2014. People who bought plans in the marketplaces and received either too little or too much in premium subsidies during the year also will square things with the IRS in April 2015.

NOV. 4

The midterm elections will be yet another referendum on the health care law passed in March 2010 with no Republican support. Obama will still be in the midst of his final term, however. So even if Republicans emerge with control of both chambers of Congress, they will still face two more years with Obama in the White House to veto attempts to undermine his signature law.

NOV. 15

Open enrollment for 2015 begins. Americans can sign up for insurance or switch to a different plan. And they’ll see what rate increases are in store for the coming year.

DEC. 31

The extension ends today for people who were able to keep their old individual plans for an extra year, even though the coverage wasn’t up to the law’s minimum standards.

COMING IN 2015

JAN. 1

Large employers – those with more than 50 employees – that don’t offer health plans face a possible tax penalty. The penalties are designed to discourage businesses from dropping their existing health plans, although some have already begun to do so.

JAN. 15

Open enrollment for 2015 ends.

APRIL 15

Penalties for individuals who weren’t insured in 2014 kick in. The penalty is $95 or 1 percent of income, whichever is higher. It goes up in later years. The IRS can deduct the penalty from a taxpayer’s refund.

COMING IN 2018

So-called “Cadillac health plans” offered by some employers come under a new tax. It hits plans that spend more than $10,200 per worker or $27,500 for a family. Most job-based coverage isn’t that generous, but corporate executives get such plans, and so do some workers in jobs with strong union contracts. Some companies will pass the tax on to workers and others may trim employee benefits to avoid it.