Friday, October 19, 2018

Making Strides Against Breast Cancer: Last Chance 2018

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is tomorrow morning (Saturday, October 20th) - and I'd really appreciate your support of this very worthy cause.

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

Thank You!!

Premium Financing: A Primer (From the P&C Files)

So the other day, I saw an interesting thread on Twitter about “Premium Financing.” It piqued my interest, and since we’ve never blogged on the subject, I asked the gentleman whose thread I was reading if he would mind explaining for our readers what it is and how it works.

Tim Randle is a Certified Financial Planner with 16 years’ experience in the financial services industry. He’s also an insurance agent, registered representative, and investment advisor representative, and lives in Alabama, with his wife, 2 kids, and 2 larger than expected dogs.

Take it away, Tim:

What is Premium Finance?

As a small business owner, I may suffer from being a bit of a control freak. Ever happen to you? With a financial planning firm that out of necessity grew its own insurance agency, we found using the available premium finance companies to be expensive and restrictive. How could we pick? Could we start our own? What were the rules on both?

To start, what is a Premium Finance Company (PFC)? At its root it’s a niche loan company that provides funding for businesses (and sometimes individuals) to purchase their larger commercial (business) insurance policies. If you’ve never purchased a commercial policy, you may be wondering “Why don’t they just select the monthly payment option like my auto insurance company offers?” Unfortunately, most commercial insurers don’t offer a periodic payment plan—and with premiums that can range from thousands of dollars to tens of thousands, it doesn’t always work well to put it on your credit card. On top of that, many companies don’t even take credit cards either…our recent investigation showed that it’s pretty typical for merchant services to cost 10 to 25 cents per transaction, plus up to about 2% of the amount charged. I guess they don’t mind paying the quarter, but the 2% of a $12,000 premium is painful! This is where premium finance companies (PFC) come in.

A PFC works by inserting themselves between the agent and the customer (insured). The customer typically pays 25% of the premium and all of the taxes and fees up front to the PFC. The PFC then pays any fees or taxes to whomever those monies are due, as well as paying the entire premium to the insurance company. The insured then pays back the PFC, typically in 8 payments starting the next month. If the customer doesn’t make their payment, the PFC has the right to contact the insurance company to cancel the policy. The PFC is hoping that the payments the customer has made plus the refund from the insurance company is enough to prevent a loss.

How to select a PFC:

As a customer, you want to take that one line that says ‘Fees, Taxes, Surcharges’ and see what’s buried there. Does the PFC charge a fee? Ok, that makes sense, I paid a mortgage origination fee…but is it a reasonable number? Does your agent charge a fee, and is it reasonable? What else is buried in there? If your agent waves his hand and says ‘taxes’ you should ask what the tax rate is and how it’s applied. Finally, there’s the service charge or the interest that the customer will be charged on the loan. Typically the larger the loan the lower the rate. High teens isn’t abnormal for low amounts, and I’ve seen as low as 8.5% on very large amounts. Some may be negotiable, some may not—a great piece of advice here is WORK EARLY. Some insurance companies give discounts for quoting policies several days before they go into effect. And if you decided you want to try a different agent or PFC, you may need a week or more to do it.

I hope that this helped you understand a little more about financing insurance premiums on the commercial side, and what impact the PFC is able to have on for both customers and agents.

Thanks, Tim!

Thursday, October 18, 2018

Boo! October's spooky (and wonderful) Health Wonk Review

Catch it over at Joe Paduda's place. Lots of good info on Open Enrollment, mental health and Big Pharma.

From the Annals of the MVNHS©: Part 2,736

Wednesday, October 17, 2018

Price Transparency

Some people make a big deal about price transparency in health care.

Others don't.

It seems the US may be bending to the will of the people and will move towards some kind of drug transparency, price regulation, or both.

The federal government said Monday that it wants to force drugmakers to disclose prices for prescription medicines in their TV commercials.

The drug industry's main trade group said drug companies are only willing to disclose the prices on their websites, not in commercials, and they'll start doing that next spring. - KYW

Almost every time DC tries to "help" they make things worse.

Less competition.

Higher prices.

Fewer choices.

The most feared words in the English language, "I am from the government and I am here to help you".

Regarding drug price transparency, Medicare prescription drug pricing has full disclosure. Cost reports for the Part D coverage illustrate the full retail price as well as the copay.

Drugs on the formulary are priced to the consumer at a discount.

Those not on the formulary are not.

I have a client that uses Xarelto and refills in 90 day increments. The retail cost is listed at $1200 for 90 pills. The medication is on most plan formulary's.

For the first 2 refills she has a $0 copay. By the time she get's to her third refill she is entering the donut hole and will pay $130. Her last refill for the year is $380.

Yesterday she complained about having to "pay so much" later in the year and wanted a better plan. She completely ignored the fact she is getting $5,000 worth of medication for less than $500 per year.

Price transparency.

And yet, she still complains.

Tuesday, October 16, 2018

How to succeed at Obamacare Without, Well...

So I did my Marketplace re-certification this morning, enabling me to sell ObamaPlans in the upcoming Open Enrollment v6.0. I anticipate that comp will continue to be less than generous, but at least we have some choices this year. As part of the re-cert curriculum, I learned that CMS has a Circle of Champions" award package, which includes "a letter, badge, and access to a certificate" presumably suitable for framing. All for selling (IIRC) 20 or more plans during this Open Enrollment season.

But seems like someone may have found a short-cut. Thanks to co-blogger Bob V, we learn about this enterprising family:

"A father and son from California have pleaded guilty for their roles in a scheme that defrauded more than $27 million from Affordable Care Act programs in at least 12 states ...  the Whites fraudulently enrolled people in ACA plans in states where those people did not live."

They then signed these folks up for (expensive?) substance abuse programs and pocketed the reimbursement fees.

One wonders if they signed up enough folks to earn that sweet CMS swag.

2,000 Words

First, from FoIB Jeff M:

[click to embiggen]

Second, from Google:

Monday, October 15, 2018

Singer Quits, Medical Tourism Wins

Longtime entertainer and 4-time Grammy Award winner Michael Buble, whose hits include "Haven't Met You Yet" and "It's a Beautiful Day" has put his career on hold to care for his liver cancer-stricken son, Noah:

"Going through this with Noah, I didn’t question who I was, I just questioned everything else. Why are we here? 'Is this all there is? Because if this is all there is, there has to be something bigger."

A selfless act by a successful musician. Yasher koach, and may Noah experience a full recovery.

Which is all very noble, Henry, but what the heck does it have to do with insurance, let alone medical tourism?"

Well, as regular readers know, we have pointed out many times over the years that CanuckCare
© may be free, but that doesn't mean it's terribly good. And how do we know this? Because folks with the resources to do so choose American health care when lives are at stake:

"Both he and Luisana put their careers on hold to be there for their son - they jetted to the US so Noah could undergo treatment for hepatoblastoma." [emphasis added]

Of course, with a $46 million a year income, he and his family can afford to do so. But what about average Joe Poutine?

Gives one pause, no?

[Hat Tip: FoIB Michael Bertaut]

Making Strides Against Breast Cancer: v2018

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is coming up so quickly - this coming Saturday, October 20th - and I'd really like to break the $1,800 mark.

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

Thank You!!

Friday, October 12, 2018

CanuckCare©/Medicare4All: A study



"On a Slippery Slope, Canadian Hospital Unveils Physician-Assisted Suicide Plan for ‘Sick Kids’"

Hat Tip: FoIB The Political Hat

If it's too good to be true....

There's an old retailer's trick where one marks up the merchandise 75% (or more!), then announces a 50% off sale. It's tried and true, and coming to an ObamaPlan for you. From our friend Holly R:

"Obamacare premiums are going down for first time"

Oh frabjous day!

That's right, standard-bearer Silver level plans are set to go down a bit when Open Enrollment v6.0 takes off next month.

By about 1.5%. Which is nice, but then comes the not-so-fine print:

"[T]he decline comes after a 37% spike for this year's benchmark silver plan."

Which means that average $6 per month savings pales in comparison to the $1,200+ increase they ate last year, and will continue to pay even now.

Such a deal!

Thursday, October 11, 2018

Something new

So, we've discussed Direct Primary Care (DPC) for quite a while here at IB; some pro, some con. On balance, I think the idea has a lot of merit, and certainly potential.

But as Yoda says, "there is another:"

I've been reading a lot about Virtual Primary Care (VPC). Like DPC, it's usually a subscription-based model, offering direct access to a (presumably qualified) physician who can diagnose what ails ye, and even prescribe meds. One advantage to VPC is that, unlike your friendly neighborhood Direct Primary Care doc, it's available 24/7. Of course, you give up the inherent advantage of actual person-to-person direct access, but how often is that actually necessary?

The other appeal to VPC is its low price, often much lower than DPC (caveat: be mindful of "you get what you pay for"). It seems to me that these plans would work well with so-called "high-deductible plans" (scare quotes because true "cat plans" are illegal under ObamaCare), especially those with limited or no office visit co-pays.

We've arranged to offer one such plan to IB readers - the subscription fee is a modest $20 a month (regardless of whether it's just you, or a family). You can get all the gory details in the "Teledoc [NEW]" link in the side-bar.

Wednesday, October 10, 2018

The cost of compliance

First off, I realize that anecdote ≠ evidence, but this seems like a really simple, effective and meaningful way to describe the impact of full ACA-compliance on small group plans:

Both Employers A and B are insured with the same carrier, are about the same size and with similar plan designs, and boast a January 1 renewal date. Employer A's plan is Grandmothered (doesn't fully comply with all ObamaCare requirements), Employer B's is not.

Yesterday, I received both renewals.

Company A's premium actually decreased (by pennies, but still...). I haven't seen that for many, many years.

Company B's premium increased by about 17%. Now, I've seen worse, but it's not as if they can now just go out and raise their service rates by almost 20% to cover that difference. And that 17% is, basically, the cost of ACA compliance.

The more you know...

Tuesday, October 09, 2018

What happened?

How could this be?
'Tis a poser.

Monday, October 08, 2018

Monday Round-Up

We noted last month that surprise medical bills, primarily from out-of-network providers, continue to be a plague and a menace. As a result, there's at least one legislative effort to curtail them, but will the cure be worse than the disease?

Our friends at Health Agents for America tipped us to this article that offers a clue:

"Legislation limiting a provider’s ability to negotiate prices could ultimately result in reduced access to care for consumers"

One step forward....

Short Term Medical plans continue to be a popular ObamaPlan alternative, offering lower premiums and greater flexibility. But so-called Blue States seem to have a problem with choice. Our friends at Inside Health Policy pointed out this handy info:

"A federal judge in DC on Tuesday (Oct. 2) scheduled a hearing for Oct. 26 on stakeholders' motion to immediately suspend the administration's short-term health plan rule."

Will be interesting to see the outcome.

Regular readers know about the zeroing-out of the (Evil) Mandate/Tax for the 2019 plan year (assuming there's no drastic change due to next month's mid-term's). But what most of us likely didn't know was just what burden that tax levied on those least able to afford it:

Finally, a bonus. Via email from the folks at All Health PR:

"Sperm Counts Drop Across U.S. - Except New York"

According to new research, the sperm counts of male residents of six major US cities went down over the past ten years, except for those in New York City.

Yeah, I don't believe that, either.

Friday, October 05, 2018

Pot, Kettle, LifeLock©

So this happened:

[click to embiggen]

This in email from a Mr Ed Sutton at Symantec. His proposed solution?

"If employees are not enrolled in LifeLock, this is a good reminder for them to do so now."

Really, Ed?

Here was my reply:


That the same LifeLock that exposed millions of its own customers' data?

That LifeLock?

What. A. Joke

Odds on him responding?

Yeah, no.

Thursday, October 04, 2018

An Unspoken ObamaCare Shanda: Bye, Bye PPO

As we mentioned a few weeks ago, Anthem is diving back into the individual major medical market for Open Enrollment '19; although there's no official word yet on product details, it's a safe bet that they'll be using the ubiquitous (and problematic) HMO model. And we've just recently learned that Medical Mutual is also re-joining the Ohio market, and they've confirmed that theirs is, indeed, an HMO product.

So what's the big deal, Henry? Shouldn't you be grateful that (at least) two more options will exist for your fellow Buckeyes? And isn't this incentive enough to dive back in yourself?

If only it were that simple. Yes, I suppose it's gratifying to see carriers dipping their toes back into the individual medical pool. But it's disheartening - if completely understandable - that all of the choices available for the upcoming season are HMO's, with zero PPO options even available.

Ok, but you still haven't answered the question: So. What?

Back in the day, the PPO (Preferred Provider Organization) was dominant: under this model, one got the "biggest bang for the buck" by accessing care in-network, but there was always this safety net, or out-of-pocket cap, on non-network services. Sure, it stung a little more, but at least one wasn't footing the entire bill.

Under the HMO model, there is essentially zero coverage for non-life-threatening situations outside of the (now even narrower) network. This means that unless one is basically bleeding out on the front steps of the out-of-network facility, there's likely to be no coverage.

This is a major issue for folks with significant and/or chronic health issues: what if your oncologist isn't in your plan's network? Yeah, a problem. And it's a direct result of ObamaCare rules which leave carriers with few options to rein in costs. Of course I'm not holding them entirely blameless, but this is really the only rational choice.


Wednesday, October 03, 2018

Phrasing: An LTCi story

Recently, I had an interesting Twitter conversation about Long Term Care insurance. It all started when our friend Allison Bell tweeted:

"While a lot of insurers are hiding from stand-alone long-term care insurance... National Guardian Life is out there getting its product Partnership program approvals."

[ed: Partnership-compliant plans have special powers]

I replied:

"Good for them! Challenge: They still use Service Days for Elimination Period."

And that's when things got interesting.

A Twitter friend responded "Educate us please... What is that, and why bad?"

So I explained:

"Long Term Care insurance (LTCi) plans have a "deductible" in the form of waiting periods until benefits begin. Some (most?) are based on *calendar* days; that is, I've been eligible for benefits for 90 days now, go ahead and send those checks.

NGL, though, uses service days; that is "I've been eligible for benefits for 90 days, but have only had care for 60 of those, so I still have 30 more days receiving care before I'm eligible.

It's not good/bad, just different, but I much prefer calendar to service. Often get benefits much quicker."

Our friend Scott Olson (a recognized LTCi guru) chimed in:

"My relative had a home health aide come to the house everyday for 90 days... just a short visit of a few hours. That satisfied the service day elimination period in only 90 calendar days and it didn't cost much."

I replied that I had nothing against service day plans, but that I preferred calendar-based ones. I then pointed out that home health care is not free; around here, it runs about $20 an hour. Based on a 90 day elimination period (by far the most popular option), that would cost about $3,600 just to access the claims process.

Scott agreed, but suggested that this could be offset by lower premiums on service day plans. My experience has been that this is rare (I've actually never seen it happen 'in real life.'). Still, worth considering.

Tuesday, October 02, 2018

Tuesday Linkage

Hey Ohio Gov John "The Mailman's Son" Kasich:


Britain's Much Vaunted National Health System© still hates young people:

"A Teesside school choir has created a hit record - to raise much-needed funds for an Eaglescliffe teenager."

Recently graduated Evie Whittaker has been fighting an uphill battle against cancer, complicated by a stroke. She's still unable to sit up, and has been told by the caring, compassionate government bureauweenies who run the MVNHS© that she's no longer eligible for that awesome free health "care." As a result, her friends and family are trying to raise money to get her to Germany for treatment.

Consider the irony of that.

[Hat Tip: @flintbedrock]

Finally, our friend Shari G tips us to a summary of who's really to blame for the train-wreck that is Obamacare, and this singularly explosive (not to mention dead-on accurate) assessment:

"The individual market comprises just 7% of the total insurance market. And of those, only a much smaller fraction had ever been denied coverage due to pre-existing conditions before ObamaCare"

Baby, bathwater: Indeed.

Monday, October 01, 2018

More from The Standard

The innovative folks at The Standard strike again. Readers may recall our post last month about the carrier's Family Care Benefit:

"[H]elp your client take time for caregiving. This benefit provides cash to replace lost income due to working fewer hours and earning less income to care of a family member."

I could see that as a sort of Long Term Care insurance supplement, as well.

Anyway, they have a new bennie available that seems like it could be very helpful for folks with college debt. Via email this morning:

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

I could see this as particularly helpful for attorneys and physicians, who can rack up big student loan bills and take a while to start earning enough to begin chipping away at the debt.

Very cool!

[Hat Tip: Diversified Brokerage]

Friday, September 28, 2018

Darn those Boomers....

And their Wacky Tobacky! Via email this morning from Mutual of Omaha:

"MutualCare Solutions underwriting guidelines for marijuana use has changed.  Effective 10/1/18 we will consider occasional recreational use."

So I must admit, when I first read this, I thought "what the ... college kids aren't buying Long Term Care insurance!" And then it hit me: it's not Joe College, it's Ned and Nancy Boomer, taking tokes at Bridge Club.


UHC all-in on wearables

This past summer, I had my annual physical. Okay, to be more accurate, I had a physical for the first time in  [too many] years. As a result of which, we've transitioned to a low-carb diet, and I've joined The Cult of the FitBit©. It's not so bad, really, and I've noticed that I feel better (although I don't seem to have instantly shed substantial poundage). I bring this up because, as we noted last week, insurance companies are really pushing widgets like mine:

"John Hancock, one of the oldest and largest North American life insurers, will stop underwriting traditional life insurance and instead sell only interactive policies that track fitness and health data through wearable devices."

But that's on the life insurance side. Today's email brings us this news from United Healthcare and the health insurance side:

"Help clients get fit for less: Savings on Samsung wearable devices."

That is, UHC policyholders are now eligible for some significant price breaks on Samsung's versions of these devices (about 40% off).

Sweet (and healthy)!

Thursday, September 27, 2018

September Health Wonk Review is up

Andrew Sprung hosts this month's collection of health care wonkery, including an interesting post on reinsurance and a podcast about Big Pharma and cost controls.

Truly a smorgasbord of informative content.

Wednesday, September 26, 2018

LIAM Quote of the Month

LIAM, of course, referring to Life Insurance Awareness Month (which is still with us for the next few days).

I just got off the phone with a long-time client who was calling about her husband's soon-to-expire 20 year term life policy. She started the conversation with his beautiful, stealable remark:

"I'm calling with good news about his life insurance policy. It's been 20 years, and we haven't used it."
Doesn't get much better than that.

Thanks, Rene!

Would You Like Fries With That?

Who is offering you advice on Medicare options? Your friends, relatives or neighbors? How about the person who styles your hair?

Maybe you feel better talking with or a volunteer at a not-for-profit organization. Surely they are impartial.

WHERE you go for information and WHO you talk to is important. Otherwise you could make a costly mistake.

You might have done just as well asking the person who served your fast food meal.

Agents don't charge for their advice. If you talk to the right one you will probably save money.

#GeorgiaMedicarePlans #GAMedigapQuotes #Turning65

Tuesday, September 25, 2018

MVNHS© takes a hit

Science: How does it work?

"NHS sued for failure to help transgender patients with fertility"

No kidding?

This time, it's really not the Much Vaunted National Health Service© at fault, though. The rocket surgeons at Britain's Equality and Human Rights Commission is suing the Service because it doesn't pay for the (non-existent) fertility rights of those who choose to change genders (they seem to have no problem paying for the sex-change surgery, however).

The Commission has put the MVNHS© on notice that before the surgery physicians must offer to extract and store ovum and sperm of the victims patients. Unfortunately, that process hasn't been a covered expense, and some folks can't afford it.

One wonders when the British anorexic community will sue to be provided with diet pills.

[Hat Tip: Co-blogger Mike]

Monday, September 24, 2018

Speaking of LIAM

No, not that Liam (although he's probably getting a life insurance quote from his agent), but rather Life Insurance Awareness Month.

And FoIB Brian D has his own really interesting and helpful post about how easy it is to figure out how much life insurance you really need, and what to do with that information.

Here's a taste:
"As for the uncomfortable thought of losing a loved one, turn the idea around. Ask yourself “will my family be able to survive financially after I am gone?” If you view life insurance as taking care of your family, you gain a better perspective on the need for life insurance."


Do check it out.

Not my monkeys...

So, interesting Twitter discussion over the weekend:

I agreed up to a point, but asked for a clarification of what "vital services" meant.

To which I received this reply:


Here's what's so frustrating to me: pro-choice folks want me to pay for their abortions, pro-lifers want me to pay for their maternity care*, neither of which have anything to do with medical insurance. Long-time readers may recall the IVF Kerfluffle of 'Aught Five:
"Susan opined that In Vitro Fertilization (IVF) should be a covered medical expense, and others soon joined the chorus.

I demurred, thus setting off the swarm.

Because I am an insurance critter, I tend to see these things through the simple lens of “risk.” Risk is defined as “the chance or possibility of loss,”and insurance is all about managing risk. I am of the opinion that lifestyle choices such as IVF do not fall under the aegis of risk management."
Seems pretty clear-cut to me. One of the reasons that our current premiums are so high is that we keep adding coverage for things that are not - or more accurately, shouldn't be - insurable risks. As we've so often declaimed, what do people think would happen to home insurance rates if carriers had to pay for new air conditioners and dishwashers?

Now she does raise an interesting point: if we do "carve out" these services from insurance, there's no reason that those primary docs (DPC) couldn't provide most (if not all) of those services. I'd be interested to see how DPC advocates would respond to this challenge.

*To be clear, I am not suggesting that this is Ms Elder's position, merely that she brings it into play.

Friday, September 21, 2018

End o'The Week LinkFest

Regular readers may recall this post from 3 years ago:

"Once you sign up, John Hancock [Life Insurance Company]sends you a Fitbit monitor as one way to track your fitness. You earn Vitality Points for your activities. As you accumulate points ... the more you save each year on your life insurance premiums."

Well, our friend Holly R tips us that the venerable carrier has gone "all in" on both the tech and the pricing:

The folks at the Income Protection Resource Group tip us to this interesting new product from The Standard that enhances their already outstanding disability insurance products. Via email:

"Most income protection policies pay benefits only when your client can't work due to their own injury or sickness. But what if their family member becomes seriously injured or seriously sick?"

Turns out, there's an app, er, a rider for that:

"The Family Care Benefit can help your client take time for caregiving. This benefit provides cash to replace lost income due to working fewer hours and earning less income to care of a family member."

It's included standard (heh) with their Platinum Advantage series plans. Very nice, indeed.

And finally, our friends at Global Underwriters have this heads' up:

"Most tour groups and many Countries are now Requiring that International Travel Medical Insurance be purchased prior to arrival in their country."

This makes sense, as medical emergency or other issue tends to be disruptive (and often expensive). And of course, plans that include Medical Evacuation are especially helpful, since this can cost travelers thousands of additional travel dollars.

Wednesday, September 19, 2018

Medicare Supplement Rate Increases

Why are Medicare supplement renewal rates so high? How come no one TOLD you this would happen?

If you bought from a household name carrier on the belief you would not get stuck, well . . . you guessed incorrectly.

No one is talking about the shell game Medigap carriers are playing.

No one, except this guy  . . .


Tuesday, September 18, 2018

Clearing the Spindle

First up, Co-Blogger Bob has acquisition news:

"Western & Southern agrees to buy Gerber Life Insurance"

The deal, valued at a little over $1.5 Billion is interesting if only because one doesn't think of old-line, steady-ship W&S as particularly "hungry" for expansion. Gerber Life, of course, is famous for it's $1 premium juvie life insurance plans.

Next is a very thoughtful piece from our friend Michael Bertaut, who crunched some numbers regarding plans that "carve out" prescription drug coverage, rather than have that benefit administered by the health insurance carrier. Regardless of the idea's other merits, it appears that any cost savings are quickly eaten up by other claims:

"In the short term, some of our companies are saving money on the drug portion of their health plan by moving it to another vendor. But, we’ve found that over time, breaking off this important part of real-time health information has caused medical costs in these same groups to spike."

One step forward....

And finally, via our friend Joe Kristan, we learn that Cash for Clunker Co-Op's is still going strong. Turns out that, even though the Republican Congress quickly cut off funding for Co-Op cost-sharing arrangements, the judiciary has other plans:

"The bottom line was that the government did have an obligation to pay Montana Health Co-op cost sharing reimbursements for 2017."

In short, pony up funds that were never actually allocated.

Seems legit.

Monday, September 17, 2018

Dodging the Mandate Bullet

As we noted earlier this year, the recent tax law essentially neutered the (evil) Mandate:

"Quite simply put, the mandate still exists. It's still in the law. What has changed is the penalty for not purchasing health insurance has been zeroed out"

Note well, however, that:

1) This applies to plan year 2019 and after; the tax/penalty/fine remains in place for 2018, and

b) It's a certainty that the tax/penalty/fine will be reinstated should the Congress change hands in November.

That being said, there is some other good news out of DC:
"The Centers for Medicare & Medicaid Services announced on Wednesday a new opportunity for those who failed to comply with the individual mandate in 2018 to avoid the corresponding tax penalty.

The new policy allows hardship exemptions to be claimed without "the documentary evidence or written explanation generally required."

That is, "because I say so" becomes a legit deferral mechanism. And since this is an implementation under the Executive branch, it seems pretty Congress-proof to moi.


[Hat Tip: FoIB Steve Downey]

Friday, September 14, 2018

Speaking of Flood Claims

This is an extraordinary visualization of the Florence storm surge:

To our East Coast readers: Stay safe!

Medicare4All to see


What could possibly go wrong?

[Hat Tip: FoIB @NARNfan]

Thursday, September 13, 2018

Another ACA cancer shanda

From co-blogger Bob:

And yet, male breast cancer screening isn't considered Essential Health Benefits under Obamacare.

That stinks.

We've got questions

So as a membership "perk," the National Rifle Association includes an "insurance policy"* that covers some self-defense legal costs (perhaps similar to those about which we've written before). In its infinite wisdom, the California Department of Insurance has ordered them to give that up:

"The state Department of Insurance on Tuesday issued a cease and desist order saying that the NRA sold an unlicensed insurance product in the state."

I have no dog in this fight, but I do wonder how a membership perk = selling insurance.

Will keep an eye on this.

[Hat Tip: FoIB The Political Hat]

* I'm using quotes here temporarily as I follow up on some details. There seems to be some daylight between what the article claims and what the NRA website says. In the meantime, I've reached out to the NRA folks for clarification. HGS

Wednesday, September 12, 2018

This *may* change everything

Well, not everything, but now I have a decision to make.

Regular readers know that I bailed on the individual (ACA) medical market some time ago, and that decision continued to make sense, especially since for the past year or so the only carriers in my market didn't pay comp.

That's changed now, both AM Better and Molina will be using (and paying) agents for this year's Open Enrollment season.

That's the good (?) news.

The even better news is that Anthem is back, with both ACA-compliant and Short Term Medical plans.

As in years past, I'd already planned on re-qualifying for on-Exchange sales anyway, so I'm now seriously considering jumping back into that market.

We shall see.

[Hat Tip: FoIB Geoff B]

Monday, September 10, 2018

Drew's $100,000 Heart Attack

Drew Calver took out his trash cans and then waved goodbye to his wife, Erin, as she left for the grocery store the morning that upended his picture-perfect life.
Minutes later, the popular high school history teacher and swim coach in Austin, Texas, collapsed in his bedroom from a heart attack. He pounded his fist on the bed frame, violent chest pains pinning him to the floor.
The next day, doctors implanted stents in his clogged “widow-maker” artery. - Kaiser Health Network

Drew didn't know it but he was about to enter the world of balance billing.

Managed care can quickly become mangled care without warning. First created by Congress in 1973 as part of the HMO Act. By the early 80's the practice of incentivizing and directing care to "preferred" providers was going mainstream.

The idea of saving money on health care by encouraging those with health insurance to use more "cost effective" avenues of health care may have seemed benign at first but as this monster grew it became punitive.

In the case of Drew Carver, this is what happened.
$164,941 for a four-day hospital stay, including $42,944 for four stents and $10,920 for room charges. Calver’s insurer paid $55,840. The hospital billed Calver for the unpaid balance of $108,951.31.

His insurance did what it was supposed to do, it made a fair and reasonable offer for the care received.

St. David's Healthcare, part of the HCA system, is not a participating provider in Drew's health plan. Most health care plans have allowances for out of network bills incurred as a result of a life threatening illness or injury. Many times the non-par penalty is waived by the health care plan and the provider agrees to accept a "reasonable" offer as "paid in full".

That did not happen in this case.

St. David's stuck to their guns and refused to budge. It did not matter that such a large unpaid bill could cause serious financial harm to Mr. Carver.

The hospital wanted what they felt like was a fair price for saving Mr. Carver's life.

In fact, the hospital had the nerve to blame the Austin School District for offering such "a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network."

Frankly I am surprised the hospital didn't also blame Drew for having the heart attack at an inconvenient place. Had the attack occurred closer to a participating hospital this would never have been a problem for Drew or St. David's.

Then there is this . . .

Industry analysts and consumer advocates say St. David’s has a reputation for exorbitant billing and for trying to collect big payouts as an out-of-network provider. “This is a well-known, problematic provider. We’ve seen multiple bills from them and they are always highly inflated,

"Always" is quite a damning term but if the shoe fits . . .

A few states, including Texas, have passed laws designed to protect insureds against balance billing. 

So why didn't the law protect Drew?
But there’s a huge loophole: Those state-mandated protections typically don’t apply to people, like the Calver family, who get their health coverage from employers that are self-insured, meaning the companies or employers pay claims out of their own funds.  Federal law governs most of th ose health plans — and it does not include such protections.
About 60 percent of people with employer health benefits are covered by self-insured plans, but many don’t even know it, since employers typically hire an insurer to administer the plan and employees carry a card bearing the name of Blue Cross Blue Shield or another major insurer.
States have the right to regulate INSURED products issued within the state boundary. But they have no authority over self funded health plans such as the one offered by Austin School District.

Roughly 70% of people turning 65 have coverage through an employer health insurance plan. The linked article claims 60% of those plans are self funded.

That's a lot of folks left out in the cold in situations experienced by Drew Carver.

For all this turmoil and angst it seems there is a happier ending, albeit one that came as a result of public shaming.
UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.”

The takeaway from this seems to be, if you are covered by a self funded plan and have a medical emergency, don't go to a non-par provider. They may not be as generous and forgiving as St. David's.

Sunday, September 09, 2018

Welcoming 5779

Tonight we welcome in the New Year, hoping and praying that it will be even better than the last.

It's customary to greet each other with this warm wish:

לְשָׁנָה טוֹבָה תִכָּתֵבוּ וְתֵּחָתֵמוּ

"L'shanah tovah tikatev v'taihatem (May you be inscribed and sealed for a good year)."

So, dear readers, may the new year be one of peace, joy and health for each of you and yours.

And for a little humor:

An elderly Jewish man in Miami called his son in New York and says, “I hate to ruin your day, but I have to tell you that your mother and I are divorcing; forty-five years of this misery is enough.”

“Pop, what are you talking about?” the son screamed.

“We can’t stand the sight of each other any longer. We’re sick of each other, and I’m sick of talking about this, so you can call your sister in Chicago and tell her,” and the father hung up.

Frantic, the son called his sister, who exploded on the phone. “Like hell they’re getting divorced,” she shouted, “I’ll take care of this.”

She called her father immediately, and screamed at him, “You are NOT getting divorced. Don’t do a single thing until I get there. I’m calling my brother back, and we’ll both be there tomorrow. Until then, don’t do a thing, DO YOU HEAR ME?” and hung up.

The old man hung up and called to his wife, “Okay, they’re coming for Rosh Hashanah. Now what do we tell them for Pesach?” 

Friday, September 07, 2018

The mask has slipped

I'm old enough to remember when this guy promised me that if I liked my plan, I could keep it:


LIAM Video - The Power of Life Insurance

Powerful mesage:

Thursday, September 06, 2018

Travel Medical: Where *not* to land

We've written before about both Travel Medical plans (not to be confused with medical tourism), and the Organisation for Economic Co-operation and Development (OECD). But we've never put them together like the folks at GetGoing, who've come up with an impressive list of where not to get sick or injured (if at all possible).

For example:

"The Worst Places to Fall Ill on Holiday Revealed

Get Going Travel Insurance uncover the cost of Care in OECD countries

• Mexico, Poland and Estonia are some of the riskiest places to fall ill on holiday, whilst Japan and the USA are by far the priciest

• Norway has the most developed local healthcare service in the OECD, with approximately 1 doctor to every 45 residents"

And even more at the link.

[Hat Tip: FoIB Katheryn W]

Wednesday, September 05, 2018

LIAM September

Life Insurance Awareness Month, that is. We'll be sprinkling the blog with (hopefully) interesting life insurance-related posts throughout September, starting with this one:

To which I'll add only this: why her? What connection does she have to our industry? At least Evel Knievel was an actual (successful) life insurance agent.

Tuesday, September 04, 2018

Swedes enjoy world-class healthcare - when they get it

This article about access to medical care in Sweden contains a lot of boilerplate about Sweden's nationalized medical care delivery system.  We've seen similar stuff before.
But I think there is something new, virtually hidden down in the 14thparagraph:
Swedes also complain about not being able to see their own regular general practitioner
This is different – and seems to me fresh, important information. 
Why different?  Why important?  Because nationalized medical care delivery systems are usually careful to provide easy and universal access to primary care.  Rationing generally focuses on the much more costly specialty and hospital care, e.g., surgery.
This strategy means most citizens will be satisfied with the care they receive because most medical encounters involve primary care. It also means objections to rationing are concentrated within a relatively small percentage of the population. Thus the strategy ensures that public opinion polling will reflect generally favorable satisfaction scores.  Advocates of nationalized medical delivery systems for Americans  - e.g., "Medicare for All" - constantly emphasize polls that say how much people in other countries love their nationalized systems of delivering medical care.  
And that is where the new information down in the 14th paragraph becomes relevant.  Swedes are meeting increasing restrictions to access for primary care.  They don't like it.  They also don't like electronic access as a substitute for their personal practitioner.  It seems to me that if diminished access to traditional primary care spreads in Sweden, and perhaps elsewhere in Europe, public satisfaction toward nationalized medical systems is also very likely to diminish.  
If that occurs in Europe it will surely affect the debate over nationalized medical care in America.