Tuesday, March 31, 2015

Explosive Renter's Coverage?

Last week's terrible explosion claimed 2 lives (so far) and left scores homeless. Jeanne Salvatore, of the Insurance Information Institute, explains how renter's insurance helps in these circumstances:

My Answers.com article has a more detailed explication of this valuable coverage, as well.

Tuesday Potpourri

Interesting items for your early week perusal.

Item 1 - Not exactly a surprise:

"[A] survey of 743 personnel executives by the Society of Human Resource Management ... Nearly 14% of firms have cut part-time hours for workers ... and another 6% plan to do so."

But hey, free health care.

Item 2 - And some more good news (for certain values of "good"):

"The death spiral isn’t just a theory. Eight states learned this the hard way in the 1990s when they enacted two policies known as “community rating” and “guaranteed issue ... Obamacare includes both community rating and guaranteed issue"

Three guesses where this is heading (and the first two don't count).

Item 3 - As we head into the tax season home stretch, the IRS has "put out a plea for consumers and their tax preparers to look on HealthCare.gov for advice about exemptions from the [ObamaTax]."

Of course, since they ask for zero documentation, one wonders how many folks will just go ahead and check "yes." Trying to figure out the downside of that.

Happy Tuesday!

Monday, March 30, 2015

Face-Palming HIX Tricks

Regular readers may recall Bob's post a week or so ago lambasting the folks running the ObamaTax for shortchanging citizens by effectively locking out their agents and brokers:

"[T]there is also a concern for the lack of informed advice available to the consumer that dialogues with a navigator who has barely a few weeks of training (if that) buys through the exchange. What kind of counsel are they getting? Do the navigators understand the nuances of a PPO plan vs. HMO? And what about drug formularies?"

Of course not, but because the "agents are unnecessary (if not evil)" meme was fully entrenched, it seemed that folks who could truly benefit from having access to a knowledgeable, accountable agents were outta luck.

The good news is that at least one state, Washington, has seen the light:

"If you want to get people insured, you go to agents and brokers ... the board notes it is working to increase broker participation, and therefore increase enrollment participation."

And it gets even better: the folks running the beleaguered Maryland Exchange "said they were looking to brokers to reach those remaining uninsured. That including rotating brokers into their call centers." [ed: not sure how well that'll work, since agents work best independently, but perhaps time will tell].

Are eyes being opened at long, long last?

Sunday, March 29, 2015

Yeah, 'bout those ObamaTax Sign-ups

Saw an interesting comment at another blog I frequent:

"Did [my taxes] early, with TurboTax. If I explained why, you would definitely not suspect I was some kind of overachiever. I was expecting a bunch of paperwork to prove I had health insurance, but all there was was some sort of affirmation and no further hassle.

Which tells me that the stats about who has health insurance and who does not will be lies

And then I thought back to ours, and remembered I was surprised that no documentation was required (nor was there any indication that it could be attached).

I'm mildly disappointed in myself for failing to make the connection the commenter did.

But it's spot on, no?

Friday, March 27, 2015

More March (Open Enrollment) Madness

As we noted a few weeks ago, Our Betters in DC© have (illegally) extended Open Enrollment season for those who flaunted the (evil) Individual Mandate last year:

"The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment

Aetna has emailed a helpful "message for the brokers" to let us know that "[t]his Special Enrollment Period is for on-exchange business only and all applications must go through the Marketplace." That's actually a helpful bit of info: it means that one can only satisfy the requirement this way by going to the buggy, security-challenged Exchange.

The carrier also "expects premiums to be paid prior to the member’s specified due date. Exchange rules require a payment grace period. Although this is not a new term, the grace period for Exchange premium payments will differ between non-subsidized and subsidized members."

Which is a rather long-winded way of saying that some insureds are more equal than others. You'll also note that they don't specify exactly how some are more equal, presumably to avoid giving folks any ideas about gaming the system (heh). The bottom line is that, if you're eligible for and take a subsidy, your grace period is 3 times greater than the rest of us proles.

Isn't that special.

Oh, and ICYMI, only those who meet these criteria are eligible at all:

  • Are not already enrolled in a 2015 plan.
  • Were unaware or did not understand the implications of the fee for not enrolling for 2014 until after the end of open enrollment (February 15, 2015).
  • Owe a fee for not having coverage in 2014

Thursday, March 26, 2015

Outstanding Carrier Trick

A few months ago, I "inherited" a small group from a colleague transitioning out of that side of the business. One of the challenges with this process is that the new agent doesn't have any of the original paperwork (applications, etc) to refer to should the need arise.

Yesterday morning, I received a frantic call from the employer: one of her employees had recently changed doctors, and needed to have a prescription filled. For some reason (I'm still unclear on the specifics), the pharmacist couldn't get the okay from the insurer because the employee's birth date didn't match what the carrier had on file.

The employer called me to see if there was anything I could do to resolve this as quickly as possible, preferably by the end of the day. I explained that insurance companies (very) rarely move that fast, but that I'd see what I could do.

Fortunately, I had the contact info for the carrier's rep. Even though this wasn't his area (he toils on the individual side), he was able to access the original application to confirm that the records didn't match. He quickly helped me get to the proper department, where I explained the problem to a very nice lady, who told me that all she needed was an email with some basic info (group and ID number, and correct date of birth) and that we needed this resolved ASAP. I immediately fired that off, and let the employer know that we'd at least gotten a good start, I also advised her that she should urge the employee to wait until (at least) today to try getting the scrip filled, since it generally takes a while for these things to resolve.

Oh me of little faith!

About an hour later, I got an email telling me that "[t]he correction has been made to the drug system.  She can pick up her Rx now."


So, kudos to Medical Mutual of Ohio, and especially Mike B and Nancy K for a job (very) well done.

And The Winner Is ........

Obamacare is 5 years (and a few days) old.

If you listen to the administration, and news media, this is a popular program.

Of course the same administration thought it was a good idea to swap 5 terrorists for a deserter.

So how is Obamacare really doing? Who is benefiting? Who isn't?

Glad you asked.

Much has been made about income inequality. In an off the cuff remark by candidate Obama to Joe the plumber Obama said it was a good idea to spread the wealth around.

Candidate Obama also said, "At some point you have made enough money".

But few paid attention.

Maybe they are listening now.
A whopping 76 percent of Obamacare-eligible individuals who earned between $11,770 and $17,655 annually actually signed up for a plan this year on the federally run insurance exchange HealthCare.gov, which serves 37 states, Avalere found. That income group represents the low end for qualifying for Obamacare subsidies, and as a rule those people would receive the largest amount of financial aid.
But there were steep declines in the next two income groups, even though those people receive not only help paying their monthly premiums, but as with the lower earners remain eligible for financial assistance to cover out-of-pocket medical expenses.
Just 41 percent of eligible people earning between 151 and 200 percent of the federal poverty level bought HealthCare.gov plans. And just 30 percent of eligible people in the next income group, earning up to 250 percent of the poverty level, bought such a plan. - CNBC

Looks like this spread the wealth around idea is working.

Just can't figure out why they had to dismantle a working system that most people liked and replace it with something that is costly, dysfunctional and mostly unpopular.

Health Wonk Review: We're not really in Daytona edition

Over at Wing of Zock (which, as we've noted before, would make a great name for a band), Jennifer Salopek hosts this week's outstanding round-up of health care wonkery, covering a panoply of topics from who owns our health records to the recent travails at California Blue Cross (about which our own Bill Halper has written).

It's a grand edition, and worth perusing.

Wednesday, March 25, 2015

Medicaid & Long Term Care: An Update

FoIB Holly R tips us to this from the folks at NPR:

"The Morgans live in Stockton, California. They are in their early 60s and are retired, aside from Rod’s occasional construction jobs ... In 1993, Congress passed a law requiring states to recover the costs of long-term care services spent on Medicaid recipients over the age of 55 after they die, the exact burden the couple was hoping to avoid."

No kidding.

In fact, we've noted this issue many times (most recently a few months ago). Unlike the ObamaTax clawback problem, this one's entirely reasonable: if your fellow taxpayers are footing your long term care bills, then we have a right to be reimbursed from your remaining assets. Fair's fair.

Of course, some folks don't see it that way:

"Pat McGinnis, the executive director of California Advocates for Nursing Home Reform, says estate recovery hurts the people who need inheritance the most."

No doubt, but that's where planning and risk management come into play: Partnership-compliant Long Term Care plans help defray the cost of long term care and preserve part (maybe most) of your estate.

Something to think about.

Tuesday, March 24, 2015

Tangled Webs

Maybe it's the troubled economy, or perhaps folks are really pressed for funds to pay their ObamaTax, but it seems like there's been a spate of fraudulent life insurance death claims of late. A few months ago, it was a "widow" filing for $2 million worth of life insurance; turned out, her "late" hubby was very much alive. That one was truly a family affair: "Her son ... was charged with actively concealing the fraudulent scheme." That one included another nice touch: "At her request ... the body was cremated."

One way to get rid of evidence.

But even that well-planned scheme pales in comparison to the intriguing case of The Gorman and The Fox:

"When a man was found dead in a Houston-area motel room of apparent natural causes in January, police figured it would be an open-and-shut investigation ... the man — whose fingerprints identified him as Gerard Joseph Gorman — was suspected of murder in Colleyville."

And it just gets worse from there; it appears that Mr G and his son "stalked and killed Anita Fox, an elderly Alvarado housekeeper."

Grisly, yes. Tragic, of course. But what has any of this to do with life insurance, let alone fraud?

Well, ya see, Danny boy, the Gorman's were Irish Travelers, "a secretive and nomadic ethnic group whose members often garner their wealth by doing dubious repair work and executing scams — and by taking out exorbitant life insurance policies on one another."

In this case, it appears that the late Anita Fox was no stranger to these schemes, even as she fell victim to one.

Here's my question, though: Mrs Fox is described as "an elderly Alvarado housekeeper;" how, exactly, did someone convince the carrier to issue a million dollar policy on a maid? Generally speaking, a policy that large is going to require at least some "financial underwriting;" that is, one's income and/or assets have to justify such a large (even by today's inflated standards) amount.

As an aside, I really hate it when reporters just take their subject's word for something, as if either one of them had an actual clue:

"In America, there’s a clause which allows you to insure anyone with a blood connection"

This is simply wrong: no such "clause" exists, and it doesn't even pass the smell test: Really? An insurance company will let me buy a $1 million insurance policy on my second cousin, in another state, no questions asked? So "insurable interest" is trumped by blood?

I don't think so, Deanna. Next time, do a bit more research.

Something just doesn't add up.

Medicare - The Fix Is In

Well, almost.

Congress admists SGR (Sustainable Growth Rate), the "permanent" fix for controlling Medicare costs, isn't working.

Every year the SGR triggers a cut in payments to medical providers.

Every year Congress caves in and votes for a lesser cut.

And then kicks the can further down the road.

Now there are no less than 4 (and probably more) proposed "fixes" for the Medicare problem. Kaiser Health takes a look.

Their goal is to cut $200 billion from Medicare over the next 10 years.

The White House wants to cut $423 billion.

How will they do that?

By making seniors on Medicare pay more.

Higher premiums.

Higher deductibles.

Higher out of pocket expenses.
Starting in 2018, wealthier Medicare beneficiaries (individuals with incomes between $133,500 to $214,000, with thresholds likely higher for couples) would pay more for their Medicare coverage, a provision impacting just 2 percent of beneficiaries, according to the summary.
Starting in 2020,   “first-dollar” supplemental Medicare insurance known as “Medigap”  would not be able to cover the Part B deductible for new beneficiaries, which is currently $147 per year but has increased in past years. - KHN
Sorry Charlie.

We paid into Medicare all our working lives, and now they expect us to pay more?

Don't think so.

DC logic.
Experts contend that the “first-dollar” plans, which cover nearly all deductibles and co-payments, keep beneficiaries from being judicious when making medical decisions. According to lobbyists and aides, an earlier version of the “doc fix” legislation that negotiators considered would have prohibited “first dollar” plans from covering the first $250 in costs for new beneficiaries.
If we have to pay more to see the doctor we may not go as often.

What could possibly go wrong with that?