Friday, October 13, 2017

Obamacare - When Facts Don't Matter

Former White House COS and current Mayor of the Windy City has been quoted as saying "Never let a serious crisis go to waste.".

Taking a page from Rahmbo's playbook, the current WH resident is doing just that.

Obamacare is failing. Has been from day one. But the only folks who don't see that happening are folks that are either ignorant, those who believe the 44th president walked on water, or they are covering their ears and refusing to listen to facts.

If you are the Gordon Gekko of health insurance and believe that "Obamacare is good" no need to read further. Go to HuffPo or TMZ and have fun with that.

But the Twitterer in Chief who is not known for holding his tongue (or Twitter fingers) has thrown down the Obamacare gauntlet with this tweet.

The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix! - The Real Donald Trump

Never let it be said that the man is indecisive.

He calls a spade a spade.

But some folks can't handle the truth.

What is extremely entertaining (to me at least) is found in the comment section below the Real Donald's tweet.

Anyone with a pre-existing condition is going to see premiums skyrocket from TrumpCare. He isn't working with the facts here. Studies, plz!

Seriously, without name calling or rudeness, here are the facts: the ACA saves lives. You are making it worse for poor people and all of us.

I wonder why Obamacare is imploding! Weird! Not sabotage, right?

Well, you get the idea.

Unless you have been indifferent to facts and truth since this mess called Obamacare came into existence.

Obamacare IS in crisis.

Obamacare HAS BEEN in crisis mode since 2013, a full year before it was completely implemented.

At this point there is no way to fix it. Too late to save it for 2018 and possibly beyond. Act II will most likely be a federally funded expansion of Medicaid for anyone not covered by employer group health insurance.

If there are any carriers offering individual health insurance in 2019 it will be those who are able to offer plans that gut the high cost parts of Obamacare, such as guaranteed issue. Medicaid  would then be not only for those who fall below a designated income level but also function as a high risk pool for those with serious health issues.

Those who want to keep Obamacare have some serious denial issues and should seek counseling while they can.

#Obamacare #TrainWreck #Snowflakes




The First Cut is the Deepest

[Note: This is an insurance-free post]

For as long as I can remember, I've always owned good kitchen knives (Wusthof, Henckels, etc). A short time back, I participated in an Indiegogo campaign for a new brand, Misen (as in mise-en-place). This new venture promised high-quality knives at more affordable prices, and I thought it looked promising.

Well, I've had my chef's knife for some months (perhaps a year?) now, and I must say that it performs very well: nice balance, able to keep an edge, comfortable grip.

What isn't so great is how well it's "aging:"


See those spots? Rust, even though I carefully hand wash and dry it after each use.

So I sent an email about it to the Misen folks (including that picture), and this is their reply:

"Hi Henry,

Thanks for sending through that photo. While not common, small stains like this can occur (even on stainless steel knives) for any number of reasons, and they’re not something to worry about!

In my experience with some other knives I’ve used in the past, a product called Bar Keeper’s Best Friend is really effective at removing minor stains like the ones in the photo. Of course, if the issue does get any more serious, please let us know and we’ll be happy to help!

All the best,
Marco
"

To which I say: Bull Feathers.

As previously noted, I've owned similar knives for many, many years, and have never experienced this, let alone in one that's practically brand new.

So I ask, dear readers, am I justified in my disappointment, or unreasonable?

Thanks!

Thursday, October 12, 2017

A Better Pill ?

As a registered Democrat, I receive several emails a day from DNC telling me what to think and what to support and asking for money.  About a week ago, one of the DNC emails told me this about employer-sponsored medical insurance: 

“Today, the Trump administration announced that they're rolling back a mandate requiring employer-provided health insurance to cover contraception -- a rule that has helped at least 55 million women across the country access care.”

There are many sources (here’s one)  that discuss this rollback; it’s far more complex than DNC suggests. But whether the issue is simple or complex; whether details are offered or suppressed; and whether facts are understood or ignored - I think this issue will remain just as controversial, emotional, and resistant to logical analysis as it was before Obamacare.    

Why is that?  Because insurance for contraception has been politicized.  It's a good example how the expanding role of government in providing medical insurance, politicizes medical coverage decisions.  The experience in many other countries teaches that politicizing medical coverage decisions is usually not a good thing.

Keep in mind DNC raised the question of coverage for women who are employed and have incomes.  The great majority of working women can buy contraception using their own income.  For them, insurance is not necessary to access contraception.  So then why do some advocates insist that coverage is unacceptable if it pays a penny less than 100%?  Is $50 a month unaffordable for most working women?  $25 a month?  And why is my own party telling me that coverage less than 100% will reduce access to care for 55 million working women? 

Also consider that employers do not pay their employees above & beyond their wages to cover food, clothing, or utilities.  Is contraception a higher priority than food, clothing, or utilities?  Is there a persuasive argument that employers are denying their employees access to food, clothing, or utilities? I’ve not seen one. Or that the federal government must step in to mandate such extra payments in the name of employee access to food, clothing, or utilities?   I think not.  And that's why I doubt that “free” contraceptive coverage for working women is necessary.   

My opinion: the fundamental issue here is less about the cost of contraception or the level of insurance coverage for it or even access to care.  Instead, the fundamental question is more about whether the federal government has a duty to mandate 100% coverage of contraception for working women.


My opinion:  coverage of contraception for employees is better left voluntary, purchased by employers who choose to purchase it (e.g., Hobby Lobby) based on their own employees' preferences and needs  And I think regardless of the employer’s choice whether to buy such coverage, it is not unreasonable to ask working women to share some part of the cost.  Maybe even the full cost.

Health Wonk Review: Pink edition

October is Breast Cancer Awareness Month, so please forgive this brief detour:

I'm raising money to fight breast cancer with my team: Love, Hope and Faith. Our walk is on Saturday, October 21st in Dayton, Ohio.

Will you please help out by making a donation - any amount helps.

Thank you!

And now, on with the show:

First up, Bradley Flansbaum isn't bullish on long term care: over 70% of seniors will need it at some time, and they're ill-prepared to pay for it. The good news is that Bradley offers some hopeful ideas about how to resolve that.

Next, Andrew Sprung makes the case that the ACA most closely resembles London after the Blitz, citing the Trump administration's meddling as the culprit, and he's not happy about the current situation, or sanguine about the program's future.

Uber Wonk Roy Poses offers his take on what he calls the Health Care Revolving Door. He's concerned about the seemingly endless stream of folks hopping from private industry into government advisory jobs, and vice versa.

HWR co-founder (and dear friend) Julie Ferguson is our guru of WC (Workers Comp), and offers us an insight into how WC costs and benefits are distributed amongst the 50 states. I know very little about WC, and found her information pretty interesting.

Our good friend (and fellow long-time HWR host) Louise Norris offers something I've never seen before. I'll let her explain:

"This post was written by myself and three colleagues: David Anderson, Charles Gaba, and Andrew Sprung. It's an overview of the different approaches that states and insurers have taken with regards to the CSR funding uncertainty for 2018, and the impact that those various approaches have on consumers and overall plan pricing."

Okay, so very interesting Henry, but what makes this unique?

Ah:

"We all published it concurrently on our blogs this morning."

Isn't that cool? I don't think I've ever seen a post co-written and then concurrently posted like this before.

Kudos!

Our friend Dr Dana Beezley-Smith has been published once again in The National Psychologist, this time on the subject of price transparency in health care (Spoiler Alert: she's for it).

Our own Mike Feehan has a scary pre-Halloween story to tell, as he warns us that the Health Insurance Fee that was temporarily put back on the shelf for 2017 will loom large next year. Why's that? Well, last year it cost insureds about $13 billion. So do the math.

The next 'Review is in two weeks over at David Williams' establishment.

Wednesday, October 11, 2017

Single Payer Blues

So let's see what our Friends Across the Pond© have been up to. Via our friend Rich W:

"A growing crisis in hospital safety is revealed in official figures showing a doubling in the number of legal warnings issued by NHS watchdogs."

Promising!

The number of "enforcement actions" (basically citations) has more than doubled in the past year, and it doesn't appear that that rate's slowing down:

"Recent actions include a warning notice to Royal Cornwall Hospitals trust after inspectors found patients dying and left to go blind after long waits for treatment."

But hey, free!

On the other hand, it's not as if our own hands are clean:

"VA conceals shoddy care and health workers' mistakes"

Ooops.

Fortunately for those who served our country, putting their lives on the line for all of us, VA healthcare professionals are top-notch.

Oh, wait:

"Medical experts from the Department of Veterans Affairs blamed one botched surgery after another on a lone podiatrist ... In 88 cases, the VA concluded, Franchini made mistakes that harmed veterans."

Good thing the VA bureauweenies caught him in time, and that he paid a severe penalty.

"They let him quietly resign and move on to private practice, then failed for years to disclose his past ... He now works as a podiatrist in New York City."

Oy.

Okay, well then, good thing this was just a one-off.

Sigh:

"In other cases, veterans’ hospitals signed secret settlement deals with dozens of doctors, nurses and health care workers that included promises to conceal serious mistakes ."

Words fail.

On the bright side, it's not as if single payer systems promote murdering patients to save precious and scarce health care dollars, right?

Um, you may want to be sitting down for this:

"Now, in Canada, a doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection."

"Free" health care: worth every penny you pay for it.

Tuesday, October 10, 2017

ObamaShanda

"Majority of Households Paying Obamacare Penalty Are Low and Middle-Income"

Almost 4 out of 5 of those penalized bring in under $50,000 a year.

Please remind me what the first "A" in PPACA stands for?

As we noted yesterday, folks who don't qualify for subsides (because they make just a tad too much, but not enough to get out from underneath this trainwreck) are facing record rate increases, and now those folks who can't even afford to buy insurance are getting hit with penalties for going bare.

Something's got to give.

Methinks Maxine was right all along.

[Hat Tip: AssocAmerPhys&Surg]

Monday, October 09, 2017

ACA #Winning: More Lies

You may have seen #FakeNews items like this floating around the 'net, with glaring, fear-mongering headlines:

"Steep Premiums Challenge People Who Buy Health Insurance Without Subsidies"

Don't be fooled by them, we know the truth:

Making Strides Against Breast Cancer

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is on Saturday, October 21st in Dayton, Ohio.

Will you please help out by making a donation - any amount helps.

Thank you!

Friday, October 06, 2017

Borrowing a Ride(r)

This is interesting, from the folks at The Standard insurance company:

"With the Student Loan Rider, if you become totally disabled and can’t work, we’ll reimburse all or a portion of your student loan payments so you don’t fall behind."

Now, we've seen imaginative disability insurance products before:

"But what if, because I’m disabled, I’m not earning any income? Even if I could afford to do so (and how many disabled folks are?), I’m not allowed to contribute to my plan until and unless I’m back to work."

Hence, MassMutual's RetireGuard product, which puts money aside for your retirement for you if you're disabled. This new product from The Standard is actually a rider available to physicians and dentist, rather than a standalone policy.

How does it work?

Well, if you're a doc (or dentist) and your Standard DI plan includes this rider, then they'll "reimburse you for your monthly student loan payments if you suffer a total disability and are unable to work." So it's a paid-as-you-go arrangement.

Interesting, really: just when you thought that there's nothing new under the sun, a carrier will come along and prove you wrong.

NTTAWWT.

Thursday, October 05, 2017

From the annals of the MVNHS©

The Much Vaunted National Health Service© continues its proud tradition:

"Most recently, Professor Ted Baker-- the new chief hospital inspector-- declared it was “not fit for the 21st century.”

Ooops.

Turns out, the bureauweenies who actually run the hot mess seem perfectly okay with "[normalizing] wholly unsatisfactory treatment that endangers patients and guard against unacceptable and unsafe practices."

Examples, please?

Sure:

- Piling patients into hallways
- lack of proper patient monitoring
- shortage of oxygen and medical supplies
But hey: "Free!"

Wednesday, October 04, 2017

MidWeek LinkFest

Our friend Dr Dana Beezley-Smith has been published once again in The National Psychologist, this time on the subject of price transparency in health care (Spoiler Alert: she's for it):

"We could create cost-unconscious consumers in virtually any industry in the country if we introduced third-party coverage."

Yup - Recommended.

Via FoIB Rich W, a thousand words on the failure of Single Payer:

In email from Anthem, some good news:

"Anthem, Inc., has reached a settlement to resolve the multi-district class action litigation relating to the 2015 cyber attack against the company. The settlement did not include any finding of wrongdoing, and Anthem did not admit any wrongdoing or that any individuals were harmed as a result of the cyber attack."

Whew.

On the other hand:

"Equifax says 2.5M additional individuals potentially victimized during data breach."

Ooops.

ProTip: LifeLock (with special 10% IB discount)

Finally, remember that explicit "If you like your plan..." promise? Well - and you'll want to sit down for this - that guy lied:

"In the face of significant uncertainty surrounding the future direction of U.S. health care policy, Premier Health Plan will discontinue Premier HealthOne Off-Exchange plans on December 31, 2017. This follows Premier Health Plan's June 2017 announcement regarding the 2018 exit from the On-Exchange marketplace"

#ACAWinning #ACACompetition

Monday, October 02, 2017

And some more anecdata

Another in our (seemingly unending) series.

Amy has had her grandmothered United Healthcare HSA-compliant plan since 2013. It sports a $3,000 annual deductible, after which all covered expenses are paid for at 100%. And since it's a PPO plan, she has coverage both in and out of network.

Her current rate of $252 a month is going up by 5%, to $267 a month.

I've suggested that she kiss UHC on the mouth.

Why?

Well, she doesn't qualify for a subsidy, so the least expensive comparable Exchange plan (offered by Anthem, believe it or not) is just shy of $300 a month, but it does have a $6,550 deductible/out-of-pocket. Plus, it's an HMO plan, which means that there is essentially zero out-of-network coverage.

Now, she does have some options: for example, she can increase her deductible to $4,000 and save just shy of $400 a year, which might make some sense. We shall see.

Friday, September 29, 2017

More from the 3000% Rate Decrease Dept

Shot (via co-blogger Bob V):

"[Peach State] insurance officials Wednesday gave approval to premium increases of more than 50 percent for the four insurers participating in next year’s insurance exchange in Georgia."

That's actually higher than their original rate hike request.

Chaser:

"In 47 of 50 cities, ObamaCare coverage will be 'unaffordable' in 2018 by law's definition"

Not exactly #BreakingNews, of course, but here's why this is important: folks that are affected by this become exempt from the ObamaTax penalty fee fine tax. Of course, we've never been told how many folks have actually ponied up their ObamaTax obligation.

Wonder why....

Wednesday, September 27, 2017

Wednesday Linkapalooza: FoIB edition

First up, via our friend Joe K, a story of subsidy #Clawback and a (non?)dependent son:

"Junior did not live with Mom and Dad. Junior was on his own and working, but applied for Section 36B largesse. All this unbeknownst to Senior and Delores. Until."

So he applied for, and received, a subsidy, unbeknownst to Mom and Dad. Who then got nicked for the balance.

Oh, and the boy is a real winner:

"Junior puts in an affidavit, but never shows for the trial."

Gee, thanks, son.

Next comes this post from The Political Hat:

"Now, in Canada, a doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection"

And no, that's not hyperbole, nor is it much of  surprise. As we noted earlier this year:

"Euthanasia became legal in Canada in June and by December Quebec bioethicists had already published an article in the Journal of Medical Ethics calling for organ donation after euthanasia."

To be fair, parts is parts.

On a happier note, and in the waning days of Life Insurance Awareness Month, Allison Bell tells us that:

"Young Consumers' Life Activity Rises ... says U.S. individual life insurance application activity for consumers under age 45 increased 0.2%, year over year."

That's according to the folks at the MIB.

Good news!

Tuesday, September 26, 2017

Underwriting Annuities

Please bear with me here: although this may seem a bit "inside baseball," there's actually a larger point to be made (and we'll get to it shortly).

In brief, annuities are simply money vehicles issued by insurance carriers. They look and act a lot like CD's, with two important distinctions: first, the interest builds up on a tax-advantaged basis, and when the time comes, the money can be paid out in an income stream that you can't outlive.

Because they're essentially savings accounts (although some are designed to mimic mutual funds and the like) they're not generally underwritten; that is, the carrier doesn't really care if you run marathons or are on chemo.

But this creates an interesting problem (and the point to which I alluded): the fact that one's lifestyle plays no part puts some folks at a disadvantage.

How's that?

Well, let's say you smoke a pack or two a day. The annuitization factors (the values the carrier uses to determine the amount of that lifetime income stream) don't take that into account, but you're more likely to receive much less income than your non-smoking twin. That's because you're more likely to die sooner than he is, and thus receive much less value. Same would hold true for someone already being treated for cancer or AIDS.

Which is why I was so intrigued by this email from our friends at Issue Insurance:

"Explore the Advantages of Underwriting for Clients in Poor Health."

Apparently, Genworth is rolling out an underwritten annuity product that "can work in favor of those who are in poor health or in need of care now." It'll be interesting how that does, and if other carriers follow suit.

Kudos, Genworth!

Sunday, September 24, 2017

The Obamacare Health Insurance Fee. It's baaaaaack!

The so-called "Health Insurance Fee" levied as part of Obamacare was given a moratorium for one year, 2017, but will apply again in 2018.

This Fee increased overall premiums by around $13 billion during 2016, $0 in 2017, and is expected to increase premiums by more than $14 billion in 2018 according to consultants Oliver Wyman

That one-year moratorium on the HIF was an important factor to insurance companies.  It meant a significant cost did not have to be included in their 2017 premiums - which of course insurers had to calculate and announce well before year-end 2016. (In other words, prior to the 2016 elections.  But why be divisive and mention that?)  And for 2018, the end of the one-year moratorium means the HIF cost must again be added to premiums.

Oliver Wyman and others expect the 2018 HIF will raise overall premiums by about 3%.  That will be on top of whatever increase is attributable to the continuing increases in unit costs of medical services, plus the effect of generally higher utilization of medical services.

The exact impact of HIF on any specific policy may be more or less than 3% and depends on many factors, such as whether you are buying as an individual, or as part of a group; whether your group sponsor subsidizes your premiums and, if so, by how much; and whether your coverage will change as of January 1.

Whatever, the return of HIF helps explain why we are already reading of high medical insurance premium increases for 2018. Here is one source.  There are others.

UPDATE September 26, 2017:  FYI, the estimated 2018 per person, per month HIF will be about $35.  That is 3% of the 2017 Medicare A and B per person, per month premium of just under $1,200.  The Medicare premiums for 2018 have not yet been announced.

Friday, September 22, 2017

Medicare Open Enrollment 2018

Medicare 2018 Open Enrollment starts on October 15th and ends on December the 7th. Where can I get answers to my questions? What can I change? What can't I change? Why should I change?


Where can I get answers about Medicare Open Enrollment 2018?

Almost anywhere.

1-800-MEDICARE or Medicare.gov is where many look for answers. Others will call a carrier. Some will talk with SHIP volunteers while others prefer an agent.

You can also ask your hair stylist, your mechanic, the person who mows your yard.

The list is endless.

The more appropriate question is, "Where can I find reliable information that is useful?".


What can I change?

Your Medicare Advantage plan, your drug plan.


What can't I change?

Your supplement plan UNLESS you answer health questions and are approved by an underwriter.


Why should I change?

Depends.

If you have a Medicare Advantage plan and don't like your 2018 benefits and/or provider networks, consider other options.

If you have a stand alone drug plan, and especially if you have not changed it in several years, you are probably paying too much for your medications. For more detail on this visit Medicare Open Enrollment 2018 at Georgia Medicare Plans and scroll down to"Medicare Drug Plans Are Confusing".

Medicare supplement plans can be changed any time (subject to medical underwriting). My advice on changing supplement plans is to do it any time of the year OUTSIDE OF Medicare open enrollment.


#MedicareOpenEnrollment #MedicarePartD

Thursday, September 21, 2017

And now for something completely different...

If you're a gamer, you need to see this from the masters of terrain (and Friends of InsureBlog), Fat Dragon Games:



Kickstarter now open...

Wednesday, September 20, 2017

Who Lives, Who Dies

Talk radio host Dennis Prager enlightens me in ways others do not. While most talk radio focuses on politics or news, his show is different. It does address current issues but also offers up topics like the Male-Female Hour that discusses gender differences. Another is the Ultimate Issues Hour that plumbs the depths of human conscious.

One thing I really enjoy is the way Dennis weaves life lessons in his discussions punctuated with references to Jewish and Christian values. He is a practicing Jew and teacher who has studied many of the world religions, including Christianity. Frequent references to the Torah and Bible are interjected into his topics but his show is not a religious show. It is extremely educational and thought provoking.

Tonight is the beginning of Rosh Hashanah. I am not Jewish, nor am I an expert on their customs. For that I defer to Hank.

Jewish prayers intrigue me. The depth of emotion is captivating and insightful. One of the High Holy Day prayers is about "Who lives, who dies and who tells your story". Fascinating topic.

the creative tension centers on the question:  who drives the story of your life?  Is the story of your life fundamentally what you do, the choices you make, the path you chart, the relationships you forge, the work you do that is either meaningful to you or just a paycheck, the health you do or do not take care of,  the family ties you do or do not nurture?  Or, is life what happens to you? - Temple Emanuel 

Is there more to life than a bank account, social status or a career?

Who drives your story?  You can call it the fates, you can call it good luck or bad luck, you can call it God if that happens to be your theology, but it is clear that stuff happens, the vicissitudes of health and wealth and career, happen to you, and that has a decisive impact on your story.

I encourage you to click the link and read the Rabbi's life lesson. Notice how he mixes the story of Hamilton, the essence of the prayer and closes with sharing how Sheryl Sandberg dealt with the sudden loss of her husband.

Read, learn, explore your life story at a level that perhaps you never have before.



Navigator Funding and Agent Commissions

Obamacare supporters and Democrats in congress are outraged to learn that President Trump is cutting funding for an arm of Obamacare's outreach known as "Navigators". These unlicensed individuals who don't have professional liability insurance have been responsible for enrolling 81,426 people into Obamacare policies since 2014. They have also played a role in educating the public through various activities.

Since the rollout of goodluck.gov, Navigators have received funding of:  $67 million for 2014, $60 million for 2015, $67 million for 2016, and $63 million for 2017. That's a cool grand total of $257,000,000. Breaking this number down it works out to a per enrolled person per month fee of $65.75.

With Trump cutting their funding to $36 million for 2018 many of these programs are being forced to reduce workforce and find alternative ways to perform outreach and enrollment. 

Meanwhile, professional health insurance agents are licensed, carry liability insurance, and annually certify to sell Obamacare policies. We also play a vital role in educating the public through various activities. In 2014 agents enrolled over 500,000 people in California alone.

Unlike navigators, insurance agents can ask people specific questions about their health, budget, and then recommend a specific plan or insurer. There are so many variables for consumers to review before making an informed decision. That's why agents have a discussion on provider networks, deductibles, copays, drug costs and other insurance provisions long before talking about premiums.

Since the rollout of goodluck.gov agents have seen our commissions cut - and in some cases - eliminated. Even when we are paid it's not even close to what navigators have received. According to the Kaiser Family Foundation back in 2013 the average commission agents received on a per person per month basis was $12.24.

There was no outrage when our "funding" was cut. There was no media coverage showing support for licensed professionals.

Yet many of us persevere. We do so because we know how vital we are to the clients we serve. We do so because we know the value of the product we sell and the service we provide. We are the conduit between insurance companies, providers, and our client.

There are so many things that Navigators can't do. But professional insurance agents, we do it - and at a fraction of the cost.

Tuesday, September 19, 2017

Yeah, about that promise

You may recall it:



Well...

First, in email from Anthem:

"Small Group plans will not be offered on SHOP in 2018

Anthem will no longer offer Small Group plans on the federally-facilitated SHOP (Small Business Health Options Program) Marketplace in Ohio for 2018
."

To be fair, it's not like the SHOP program's been such a rousing success.

Of far greater import, however, is this:

"63 Counties Projected to Have No Obamacare Insurer in 2018"

And almost 1,500 are down to one insurer (so much for choice. Or competition). This is actually more significant than one might think: back in June, there were only 47 counties projected to have no carrier choices for '18; this represents a 30+ percent increase in just a few months.

And no end in sight.

[Hat Tip: Ace of Spades]

Monday, September 18, 2017

More ObamaPlan Anecdata

So, two (more) examples:

■ Email from Betty:

"Don't know if you'll remember me, but in April/May 2016 you had helped me evaluate health insurance for me with my husband retiring.  It ended up that going through his COBRA was the best option for me at the time.  Well, I'm now coming to the close of that (have coverage through Jan. 2018), but I know sign up for the ACA is Nov. 1. - Dec. 15 so I need to start the process again.  Are you still available to help me?"

In reply, I told her about my decision to hand these off to trusted partner Cornerstone.

She responded:

"I'm sorry, but I really don't understand your response.  This sounds different from they way things were when we sat down and talked before.  At that time you had looked into different insurance companies to see what they offered, etc.  Now are you saying you know of someone else who would do this for me?  You had helped me search out options instead of me going on the ACA website myself."

So I sent her the link to my post last year on why I've decided to sit out (for the most part) Open Enrollment.

I wasn't terribly surprised to receive this:

"Per your blog, I would like to talk to the folks at Cornerstone.  Please forward my info to them for referral.  Thanks!"

And of course I will.

■ A few days later, Sheila called me about her health insurance needs. She immediately launched into a request for a detailed description of the various companies we represent, as well as plan options and costs.

I cut her off as quickly as I could, telling her "no, I can't do that."

There was a moment of stunned silence, and she asked "Why not? I work at a schoold and they've always provided that to me." I explained that they're a rather large organization that can afford to do that, and that I no longer sell plans in between Open Enrollment (she and her children seem to qualify for a Special Open Enrollment).

She immediately understood, and asked if  could refer her to another agent. I told her that I don't know of any other local agents still selling health insurance outside of Open Enrollment. She took that in, and then asked "well, what can I do?"

I didn't want to leave this poor lady just twisting in the wind, so I directed her to the 404Care.gov site, and gave her some pointers about navigating it (SWIDT?).

Thus life under ObamaCare.

Friday, September 15, 2017

LifeLock: Color me underwhelmed

So, the Equifax risk-checking tool confirmed that I was likely part of that elite group of 143 million Americans whose info was hacked. I'd been looking for an excuse to pull the trigger on LifeLock, so popped over (using the special IB link that generates an automagic 10% discount).

There was a welcome ("splash") screen, and at the top of the page I clicked "Enroll Now" (I already knew which plan I wanted). The process was pretty straightforward: you put in your name and address and so on, then the info for dependents (if any). One of the key requirements is an active email address, which I happily provided.

At the end, it asked about which credit card I wanted to use, warning me that it would be charged immediately.

Okay, whatever, let's get this thing done.

I finished up, hit "Complete" and ... that was the last I've ever heard from them.

No confirmation email. No notification that our application was being processed. No Welcome to LifeLock. Nada. Zip. Zilch.

I had just agreed to spend several hundred dollars with them, and they couldn't even be bothered to say "okay, got your info, stand by."

The only way I knew we'd been approved (and thus effective) was checking into the site every few hours. A full day later I saw that the plan would become effective October 1 (which, by the by, would have been nice if that'd been more conspicuously disclosed upfront).

By way of contrast, I recently ordered a $3.67 item from Walmart. I immediately received a confirmation email, then a follow-up when it shipped, and then notification when it arrived.

That's how it's done.

I realize that - so far - LifeLock has no credible competitors, but eventually they will, and I will bail on them in a heartbeat.

By the way, this doesn't exactly engender a great deal of confidence about how I'm going to be treated now that they have my money.


ADDENDUM: So, a very nice lady from LifeLock (finally) returned my call, asking how she could be of assistance. I thanked her, and then explained that that ship had sailed, and expressed (as nicely as I could) why and where they had failed.

She tried to explain the lack of communication, and I immediately shut her down: there is no excuse for such deplorable customer "service."

Here's a clue: If you have to explain why your customer service experience is so poor, #You'reDoingItWrong.

Thursday, September 14, 2017

Happy Fun Time Insurance

The other day, we discussed what we've been calling "Special Event" insurance. And that's an accurate designation, up to a point. That type of plan falls under the category of "indemnification" (being made whole).

But there's another type of Special Events coverage, one that covers liability.

Hunh?

Here's an example:

A good friend of mine hosted his daughter's wedding reception at a local luxury car museum. He knew that there would be alcohol, as well as little children running around. And he knew that there were millions of dollars’ worth of antique luxury cars protected by, at most, a velvet rope.

So he (wisely) purchased this second kind of Special Events cover.

Why?

Well:

"Markel’s special event cancellation and event liability insurance protects event hosts and honorees from losses they may face, should the unfortunate occur. Policies start as low as $75"

(I'm going to focus on the liability aspect of this plan, because I think the cancellation part falls into the indemnification/"baseball insurance" camp)

Think about all the different kinds of events to which this would apply: weddings, of course, but Bar/Bat Mitzvah celebrations, auctions, and offsite business meetings, for starters.

And especially if these involve serving alcohol:

"Host liquor liability included."

And as the brochure points out "[m]any venues require liability insurance." I have to admit, I hadn't even thought of that. But it makes sense, no?

Oh, one last thing, which now seems obvious:

"Policies ... can be purchased any time at least one day before the event date" [emphasis added]

No kidding.

Special IB Thanks to Bill M for suggesting this topic and helping put together this post.

Legislation Summer Health Wonk Review

Our friend Louise Norris hosts this week's eclectic collection of health care punditry. As usual, she provides excellent context with each link.

Kudos, Louise!

Wednesday, September 13, 2017

About that "bending the cost curve down" promise

Turns out, as with pretty much everything ObamaCare, its proponents - get this - lied to us about the cost of meds

"Out-of-pocket costs for specialty drugs under the Affordable Care Act increased 16 percent from 2016 to 2017."

As folks have been learning for some time now, just because plans are required to cover prescriptions, they aren't required to cover all of them. Here's why:

"For a plan to help pay for a drug, the drug must first be included on the health plan's formulary."

We noted this almost a dozen years ago:

"Health insurance is competitive. Most consider it a commodity and compare based on price alone.


Drug formularies are just one way to accomplish this."

La plus ca change...

And since these med's aren't covered, buying them on one's own nickel means that their purchase doesn't count towards the plan's out-of-pocket.

But hey, free birth control convenience items.

[Hat Tip: FoIB Jeff M]

Tuesday, September 12, 2017

Home Run Insurance

Over the years, we've talked about Marathon insurance, Football insurance, even Snow insurance. But this is a new one: Baseball insurance.

"Earlier this season, local window company Universal Windows Direct offered an intriguing promotion: any purchases made in the month of July would be refunded in full if the Indians notched a 15-game winning streak before the end of the season."

Well, they've already surpassed that, which is bad news for the window folks.

Or is it?

As you've probably guessed, there is no such thing as Marathon or Snow insurance, let alone Baseball. But the folks who run the company had purchased "Special Event" coverage, which cost "$75,000 ... to cover the $1.7 million," truly a bargain.

As we noted back in Aught Nine:

"Special Event insurance is just that: coverage to protect one from a sudden loss during some unusual activity or promotion. Think "$1 million Hole In One Contest."

And Bob's your uncle.

Monday, September 11, 2017

The MVNHS© Bites

Or, perhaps more accurately, gums. The British, never really known for their dental hygiene, seem to have reached a milestone:

"A couple in need of dental care say they had to pull out their own teeth because no NHS dentist will treat them."

This, by the way, is why Medicaid doesn't actually work, and why the newest crop of ObamaPlans are subpar as well: what good is health (or dental) insurance if you can't use it?

In the case of the Much Vaunted National Health System© vs molars, et al, there just aren't enough dentists to go around, and the ones still in practice aren't taking on new patients. This kind of self-dentistry, though, definitely seems over-the-top.

Still, what alternative did they have?

Oh, and Brits receive medical care for "free" but have what is essentially a co-pay for dental care visits. In England, that can run about $27.

And there's this:

"The vast majority of dentists are self-employed so the government doesn't pay our staff or our overheads like a hospital."

Imagine that...

Sunday, September 10, 2017

Darned if you do...

All roads lead to Single Payer.

Says who?

Says ObamaCare's architect:



[Hat Tip: FoIB Rich ]

Friday, September 08, 2017

Show us the money

As we've mentioned before (here, for example), most carriers have ceased paying commissions for folks signing up during the off-season (those who qualify for Special Open Enrollments). Now, Premier Health has upped the ante.

From email this morning:

"Premier Health Plan like many other health care coverage providers has made the difficult decision that we will no longer pay broker commissions for any enrollments beyond premium collected for December 2017."

Thus further validating my previously stated position.

And once again, the silence from both the Department of Insurance and the NAHU are deafening. I'm particularly puzzled as to why lawmakers continue to let carriers defraud their insureds in this manner (where are the rebate checks for unpaid commissions they keep?).

I realize that the paltry $15 or $20 isn't much, but multiply that over hundreds of thousands (or even millions) of policyholders.

Not exactly peanuts.

Credit Alert

In case you haven't heard, credit reporting agency Equifax recently "experienced" a rather substantial security breach, affecting at least 143 million of its, well, "customers:"

"Equifax said data on 143 million U.S. customers was obtained in a breach (which) occurred on July 29
."

So kudos for the quick alert.

Oh, wait.

Adding insult to injury, it also appears that at least a few of the company's execs decided to exercise some stock options just before they let the rest of us know.

Purely a coincidence, I'm sure.

The good news (for certain values of "good") is that the company is offering no-cost credit monitoring for those of us affected by the breach.

Not sure whether this applies to you?

Well, just click here to determine if you're at risk, and to be automagically signed up for the free monitoring.

For actual protection, though, you may want to consider enrolling in LifeLock. And IB readers get a special 10% discount for doing so.

Sweet.

Thursday, September 07, 2017

Helpful Hurricane Harvey news

Via co-blogger Bob V:

 "Retirement Plans Can Make Loans, Hardship Distributions to Victims of Hurricane Harvey"

The IRS [ed: ever notice how that spells "Theirs?"] says that "Participants in 401(k) plans, employees of public schools and tax-exempt organizations with 403(b) tax-sheltered annuities, as well as state and local government employees with 457(b) deferred-compensation plans may be eligible to take advantage of these streamlined loan procedures and liberalized hardship distribution rules."

So, if you're in Texas, prayers for you and yours, and here's some potentially good news. If you don't, but know someone who does, please pass this along.

On Clawbacks, Taxes and "Gifts"

We've written before about ObamaPlan subsidy clawbacks:

"The IRS demanded John payback the subsidies he had already received ... In order to pay back what he owed John took out a 2nd mortgage on his home."

John may have gotten off lucky. Thanks to longtime FoIB Joe Kristan, we learn about the McGuires:

"In 2013, the McGuires had consulted with their state ACA exchange, Covered California which determined ... they were entitled to an advance premium assistance credit of $591 per month"

[ed: APAC/APTC = subsidy]

They dutifully took CC's word for it, and signed up for a plan with a $1,200 per month premium [ed: redefining the term "Affordable Care" in the process], but for which they were only responsible for about half. The other $600 came out of your and my pockets.

It's critical to remember that this whole kerfluffle took place in 2013, which, as regular readers will recall, was Open Season v1.0. So what came next should come as no surprise:

The family's fortunes took a turn for the better later in the year, when Mrs McG landed a job that paid her enough money that it kicked the family out of the subsidy eligibility pool. Which they would have known if they'd bothered to read their mail...

Oh, wait:

"Unfortunately the McGuires never received the letter ... during Covered California's first open enrollment period, Covered California was so busy that it was not uncommon that changes were not implemented."

Turns out, the family had moved, and had been trying - unsuccessfully, it turns out - to notify the rocket surgeons at their state's Exchange. Since that never happened, they never got their letter. The upshot of which is a rather hefty example of the aforementioned clawback:

"The IRS, of course, did know about the credit and ... determined that [The McGuires] did not qualify for the $7,092 credit and increased their tax liability by that amount.  As is routine the IRS threw in an accuracy penalty."

Because of course they did.

The McGuires of course protested, but to little avail. The bottom line is that, through no (apparent) fault of their own, they're going to have to repay the $7,092 credit (but the penalty was waived).

But that's not really the point of this post.

Hunh??

Well, it was important to lay out the facts, but gets us only so far ("necessary but not sufficient").

So, kudos to Mr Reilly for doing a great job explaining the who and when, and (to the extent possible) the why.

But I'm calling a flag on this play::

"I kind of object to the "Pay Back".  It implies that the McGuires received something." [emphasis added]

Um, Peter?

That's because they did; there's no "implication" about it. Plain and simple. No one "earns" a subsidy, they're "eligible" for it. They don't even have to take it. This is the very definition of "relying on the kindness of strangers:" they are tax dollars paid for by thee and me.

Or at least me.

'Nuff said.

Wednesday, September 06, 2017

In case you’re wondering why your health insurance is so expensive.…

Two weeks ago, I woke up with a minor pain in my back, which rapidly got worse. I had a small kidney stone.

I went to the local ER, spent three excruciating hours(!) pacing the waiting room and finally got in to see someone.  One CAT scan and IV later, they sent me home…it was 3mm in size and below the threshold for further intervention. 

The bill submitted to Anthem…$24,985.  

And that’s not counting the ER doc, radiologist, urologist and whatever else is paid separately.  

Anthem won’t pay that much, but seriously…$25 THOUSAND DOLLARS???  I’m waiting for the EOB to see the contractual rate.

Heh: So *NOW* They Like Me

Apparently, the folks at CMS aren't big IB fans, or at least they missed this memo:

"Due to the significant changes carriers have made to their compensation schedules (aka commissions), I don’t believe that I can continue to offer the kind of comprehensive service to which I, and you, have become accustomed."

To be fair, I did complete the (New! Improved! Streamlined!) training last year, and most likely will do so again this year, if only to keep open some options (and for blog fodder, of course).

But now I have an even stronger incentive to do so. The rocket surgeons piloting the Exchange are making me an offer I can't ... well, interesting if not enticing. Since I've been accredited since the beginning:

"Thank you for partnering with the Marketplace since the beginning! The Centers for Medicare & Medicaid Services (CMS) wants to recognize you for enrolling consumers since the Marketplace launched.Once you complete registration and training ... CMS will add a new, special designation next to your name on the Find Local Help tool ... This can help distinguish you from other agents and brokers and let consumers know you’re experienced"

How nice.

Oh, and what does this "special designation" look like?

This, apparently:

[click to embiggen]
Underwhelming, no?