Monday, April 06, 2020

Medicare Supplement G Plan 2020 - Learn About Medigap G Plan

Medicare supplement plan G 2020. Learn about Medigap G plan.

You don't have to be terminal to run up a lot of medical bills:

■ People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes. In the US over 34 million have diabetes.

■ An estimated 22 million people in the US have CVD (Cardio-Vascular Disease). The annual direct cost of care per person is $18,953; for related care the total is $39,036.

This chart shows annual cost of cancer care for those 65 and over.

Bottom line?

Limit your out of pocket costs with Medicare supplement plan G.

“Doing Twice the Work for 60% of the Pay”

COVID 19 has touched each part of our lives, none more so than medical practices. I have been following my medical administrative list serve groups and I am now reading about practices closing and laying off employees.  Doctors are adapting by doing telehealth, but this has proven difficult due to the billing rules and regulations changing daily. Additionally, the reimbursement is a fraction of what is normally paid for an office visit.

This title sums up the medical practice world today:  Doctors worried about survival of their medical practices: ‘This could be the death blow,’ says physician”. “Since the coronavirus outbreak began, the medical practice has seen patient visits drop to 20% of its regular workload.”

Not only are medical practices facing revenue shortfalls, but since elective surgeries have been stopped Surgery Centers have been forced to closed their doors and lay off employees.

Medical facilities are often working on a thin margin in good times. By now, the payments from their February appointments have come in and their March postings will be significantly less, depending on their ability to turn in person visits into telehealth visits, while navigating the numerous changes to the process.

Why is telehealth so difficult to set up? It has to do with the original rules. Telehealth was designed to assist with patients in rural communities that might not have access to specialists. The patient would go to a clinic, the clinic would connect the patient with a specialist and then the patient and specialist or other medical professional would discuss the issue. The provider would create an assessment and treatment plan that would be done at the local clinical site. Telehealth was never intended to be done at home with Skype. Due to the rules, most, if any telehealth, was done by mental health professionals, clinic to clinic.

Now, practices have to scramble to create telehealth platforms, learn the new rules for coding and billing, and create appointment protocols while trying to manage their business. In the best of times, a project of this scale would take months to complete and doctors are trying to do it in days.

Those practices that have been able to do the telehealth and bill correctly are now getting their reimbursement and are very disappointed at the payments coming in. What they have discovered is that they did the work without the monetary compensation, or doing twice the work for 60% of the pay.

Friday, April 03, 2020

You CAN Enroll In Health Insurance

News flash: ACA exchanges are open and all states have Special Enrollment Periods!

In a day and age when 240 characters is our limit for reading news, it becomes very important that we don't overlook the facts within the story. Unfortunately our media outlets would rather garner clicks and scare people than provide a real understanding of what people can do.

Look at these headlines:

Trump Rejects Obamacare Special Enrollment Period Amid Pandemic - Politico

Trump Rejects Opening Obamacare Enrollment for Uninsured Americans - Fox Business News

Obamacare Markets Will Not Reopen, Trump Decides - New York Times

The list goes on: The Daily Beast, Salon, Business Insider, NBC, all have headlines that create fear.

This shameful tactic is bad enough during normal times, but playing on people's emotions during a pandemic where many are losing their jobs and their benefits is downright f'ed up.

Instead of dwelling on a lost cause, I would like to share the facts. Not only the facts as it relates to Special Enrollment Periods (SEP) being available, but also the challenges an individual faces when signing up for coverage.

An SEP is an enrollment opportunity for individuals dealing with certain life events including losing health coverage, moving, getting married, having a baby, or adopting a child. Aside from an SEP, someone may also qualify for COBRA (likely high cost) or Medicaid/CHIP (income limits apply).

For now we will focus on losing health coverage.

When you lose your job you have 60 days before or 60 days following the event to enroll in a plan. To enroll you need to create an account at (or your state's exchange platform). When creating an account you are asked quite a bit about your demographics. Answering these questions are essential to your account and don't require much heavy lifting to complete.

The more challenging parts of the application process deal with providing your projected income, understanding your results, and uploading the proper documents to finalize your insurance.

During the application process you will be asked to provide your projected income for the year. This is the first challenge as nobody knows how much they will make in the future. It's important to note that many sources of income count including wages, tips, income from investments/rentals, Social Security, retirement/pensions, and unemployment. I highlight the last because it will likely be a focus for those losing employer based insurance.

Once you have completed the basic sections you will be able to "review your results". It is here where you find out if you qualify for a subsidy or not. Also in this document will be details on what you need to provide as proof you are losing insurance coverage. This document - once you receive it - will have to be uploaded and sent to Documents that can be submitted include a letter from the health insurance company, a letter from your employer, a letter regarding COBRA, or many others based on your situation.

From here you will determine how much of your subsidy you want to use on a monthly basis (we recommend all of it), review all plans and prices, make a plan selection, and then pay your initial premium.

It's important to remember that if you have already lost insurance that you must pick a plan within 60 days of losing coverage, submit documents within 30 days of picking a plan, and your new plan won't start until the first of the month after you have picked a plan.

This is a very cumbersome process for most and there are many pitfalls that come along with trying to navigate the website on your own. Above everything I would recommend finding a licensed agent in your area to help you through the process. In many areas there is no cost for this assistance as compensation is built in to the insurance premiums you pay.

One last note, if you are looking for insurance make sure you complete the process within the required timeframe. Failing to do so will result in you having to wait until open enrollment which doesn't start your coverage until January 1, 2021.

MVNHS© Goes Bare

Not all heroes wear capes.

Or even clothes, for that matter:
"The British company MedFet, which describes itself as the "only online store 100% dedicated to medical fetish, kink, and roleplay," donated medical scrubs to a hospital to help its staff protect themselves from the virus while treating an influx of patients."

Here in the states, we're seeing company's like MyPillow making masks, and GM building ventilators, so this is definitely a bit ... er ... different.

Still, it speaks to the fallacy that nationalized, single-payer healthy "care" schemes are somehow better up to the daunting task than our admittedly flawed system.


Thursday, April 02, 2020

Is this something?

New guy on the block:

On the surface, it's a (now) standard  MEWA/AHP for self-employed Lone Star Staters, but also a hybrid of insurance & DPC.

The FAQ says doesn't price for pre-ex, which is nice, as well.

I reached out to their CEO, who assured me that:

"It’s not underwritten at all. We ask your age, your zip code, and whether you smoke. Our plans cover comprehensive EHBs too. You need to be self-employed to sign up"

And there's this: the versions of this that are available in my market require membership in an association or chamber of commerce, which can add substantially to the actual cost (one such runs $1,000/year in chamber fees!). Decent's differtent:

"You become part of the Texas Freelance Association, which is free to join, when you choose one of our plans."


And I also like that they do use agents/brokers for marketing.

I do have some concerns about the product labeling, but not a huge deal.

Will be interesting to see if this catches on.

So, mystery solved?

Maybe, maybe not:

Earlier this week, we pondered how (and/or if) off-label uses of certain meds might be covered. I reached out to one of our carriers (whose rep was willing to at least kick this up the food chain for me). In the meantime, a commenter points out:

"The FDA issued an emergency-use authorization late Sunday for chloroquine and its next-generation version, hydroxychloroquine, as treatments for the novel coronavirus"

So it will be interesting to see how that plays out.

Oh, I have now heard back from my "inside source," who offers this helpful perspective on the general subject:
"Once a physician writes a prescription and the member has it filled by a pharmacy, the pharmacist won’t know specifically what is the patient’s diagnosis, or whether or not the physician prescribed something for the patient that is prescribed for an off label use.

Many specific drugs have programs such as Prior Approval and Step Therapy associated with them. The latter will require the physician to submit to Anthem for a prior authorization, indicating why a member needs a specific medication - or in the case of Step Therapy, the patient would have to try a medication in that same class, before what is written can be filled. The latter typically halts the use of “off label” prescribing for most of the higher cost brand medications."

Thank you!

Wednesday, April 01, 2020

3 Point Conversion?

No, not at all, but a conversion opportunity nonetheless.

Many folks choose term life products as a biggest-bang-for-the-buck life insurance option. These plans feature lower premiums than their permanent coverage brethren (eg Whole and Universal, etc), and the premiums are guaranteed for a specific number of years, after which the rates tend to sky-rocket. By then, of course, many (most?) folks no longer need all that coverage, and at least a few who do need it no longer qualify health-wise for a new plan.

What to do?

Well, one really helpful feature of most term life plans is their convertibility feature, which allows one to purchase a like amount (or less, if desired) of permanent insurance with rates that are guaranteed for the rest of one's day's on this mortal coil. Yes, they can be a bit pricey, as well, but there are some unique benefits, as described by FoIB Brian D:

"So, what can you do when you realize you need all or a portion of your life insurance to last beyond the initial length of your term?It means that any time after the first policy year, you can change from a limited-time benefit to a permanent one without answering health questions, having bloodwork or any other physical examination. In most cases, the death benefit for the new permanent policy will be in force until age 121, providing you with lifelong coverage."

Highly recommended reading (no foolin'!).

Tuesday, March 31, 2020

Breaking: *Full* COVID-19 coverage

This is HUGE - Humana waiving all CV-19 costs, treatment included:
"[C]osts related to subsequent treatment for COVID-19—including inpatient hospital admissions— will be waived for enrollees of Medicare Advantage plans, fully insured commercial members, Medicare Supplement and Medicaid.The waiver applies to all medical costs related to the treatment of COVID-19 as well as FDA-approved medications or vaccines when they become available."

CV-19 & Labels

Well, off-label, actually:

I've been asked how carriers might handle the off-label use of meds like Chloroquine (generally used as an anti-malarial drug, and also for lupus) . That is, would this "off-label use" still be considered a valid/covered expense?

To that end, I've reached out to one of our carriers (and been trying to do so with others) to see how this issue has historically been addressed. By way of example, I've posed this:
"Researching a post on how carriers *might* handle use of chloroquine for COVID-19. NOT asking how y'all will handle that issue specifically, but just how/if cover off-label use of meds for medically-necessary issues. For example, using Colchicine (gout med) for Pericarditis (pericardium inflammation). *In general*, is this kind of thing usually covered?"
As one might imagine, carriers are (understandably) reluctant to pre-adjudicate a hypothetical claim, and so I've been very carefiul to emphasize that I'm looking only for a historical perspective, which may be of value in the current situation.

So far, I've been kicked up the food chain, but still awaiting an on-point response.

If you are in a position (or know someone who is) to help us with an answer, I would be very grateful for your help. And, of course, confidentiality is a given.

COVID, Fraud and You

From our friends at the Ohio Insurance Agents association:

"Phishing emails are a great way for hackers to gain access to your system. Phishing is a cyber-crime term that describes how criminals pose as legitimate institutions or a trustworthy entity/individual to trick you into providing sensitive data such as login ID’s and passwords.

Due to the COVID-19 outbreak, cyber-criminals are using fear and uncertainty to prompt people to click on emails that promise supplies of paper products, hand sanitizer, and other products that are in short supply. Some reports are indicating that consumers are giving credit card information thinking they are buying supplies for their household.  Phishing doesn’t come in just the form of emails; you need to be aware that phishing can happen via text and phone calls as well

So what can you do?

Well, for one thing, always check the return address on these emails, they'll often (usually?) be an obvious fake. And before clicking any links, check with your (or your company's) IT folks for verification.

Be careful out there!!

Monday, March 30, 2020

CV-19 vs P&C: Grace Period Update

A few days ago, we mentioned that (at least) one of our carriers was offering to "adjust the customer’s current bill and to waive any late fees for any premium payments due between March 16 and April 30."

Well that was then, and this is now, and it's no longer just a nice gesture on the carriers' part. Our friends at the Ohio Insurance Agents association just tipped us:
"This bulletin pertains to all insurers (“Insurers”) providing property and casualty, life, and long term care insurance policies (“policies”) in the State of Ohio. The purpose of this bulletin is to notify Insurers that they must provide their insureds with at least a 60-day grace period to pay insurance premiums or submit information."

As with the similar decree about group insurance (and from the Feds on ObamaPlans), it's critical to keep in mind that this is a deferral, not a waiver: at some point the bill will come due. So think long and hard about your financial status now vs early summer.


Got this from our primary P&C carrier:

"Employers must report COVID-19 illness in workplace."

Which makes sense, but (as I pointed out at that post) seems to contradict HIPAA/privacy requirements, as well as guidance we noted the other day:
"Applicable law limits Anthem’s ability to share an individual’s protected health information with an employer absent an authorization or certain extenuating circumstances. As a result, Anthem is limited by law in its ability to disclose individual’s protected health information to an employer."

So how to square that circle?

Friday, March 27, 2020

Business Interruption vs CV-19: Revisited

This is what I love (and hate) about the insurance biz: to paraphrase a former POTUS, it depends on what the meaning of "covered loss" is.


Well, last week we posted what we thought was the definitive answer to the question of whether one's Business Interruption coverage would be triggered by the current Pandemic:

"In the event of my absence, if anyone for commercial lines calls and asks if there is any business income coverage due to their business shutting down during the Coronavirus outbreak, the answer is "No"."

And that, it seemed (at the time, at least) was that.

But maybe not:

"By way of example, some policies require “direct physical loss of or damage to” property. “Loss” and “damage” are not synonymous and may require separate analysis. Such wording could arguably trigger coverage where there is a loss of the premise’s use (even if the property is not physically damaged)."

That is, maybe BI cover does extend, even absent a "direct, physical loss."

The article notes, for example that if "a property has been contaminated by an infected person, or because COVID-19 is in the airspace or on surfaces, this will likely constitute direct physical damage." I would argue that this alone doesn't seem to reach the threshold, but then, I'm not the judge or the claims adjustor.

And, of course, that particular cite pertained to a New Jersey Appellate Court decision, so its relevance in other jurisdictions is up for grabs.

And there's this:

"Depending on the circumstances, the governing law, and the applicable policy’s language, they may very well be wrong. By way of example, some policies require “direct physical loss of or damage to” property. “Loss” and “damage” are not synonymous and may require separate analysis."

Will be interesting to see how this shakes out.

As always, consult with your own agent about how your policy may (or may not) handle this.