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

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 help out by making a donation - any amount helps.

Thank you!

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?

Tuesday, September 05, 2017

It's Working (and Better Than Expected)!

Uh-oh. Looks like someone misspelled "3000% rate decrease:"

"Millions who buy health insurance brace for double-digit increases"

The article says that this most directly hits those of us who don't qualify for subsidies, but that's not really true: we end up paying it twice.

How's that, you ask?

Well, if we make enough not to qualify for a subsidy, then we're paying taxes, and thus subsidizing those who do qualify. Their rates are doubling, too - they just don't feel the pinch quite as bad.

Thanks to thee and me, of course.

[Hat Tip: FoIB tsrblke‏]

Friday, September 01, 2017

It's LIAM Again!

As in Life Insurance Awareness Month: