A Little Help for My Friends

Sometimes you just have to share some advice with those who don't ask for it...

There are at least five options Ms. Bruenig could choose yet her solution to changing jobs is that we need Medicare for All.

1. COBRA - While the costs could be too high for her, this could be the best option for one wanting comprehensive coverage. Her insurance through The Washington Post (prior employer) would provide the least change. The plan she had the day she was last employed would continue. There would be no change in benefits or network. However, she would lose the employer contribution. Paying full boat is eye opening for most who leave employment and see their COBRA notice.
2. Special Enrollment Period (SEP) - Under PPACA a loss of coverage constitutes a qualifying event. She could easily create an account through the DC Exchange and purchase a plan. If her income is low enough (doubt it) then she could potentially qualify for an Advanced Premium Tax Credit.
3. Short Term Medical - This could be an affordable option. In DC these plans are limited to 90 days and have to cover pre-existing conditions. This could be viable because her new plan has to start on or before the 90th day of employment.
4. Christian Sharing Ministry - While she would have to apply and could be denied, it's still an option that could have appeal. Her bio says she's Christian so I would assume that she can meet the requirements for participation. The costs are low and with the limited amount of time she needs coverage this platform could fit the need.
5. Pay out of Pocket - Here's a novel idea...based on what premiums and benefits could cost it might make sense to pay for her healthcare costs directly to the physicians, labs, facilities, and pharmacies she uses during her period of time without coverage. Immunizations and a visit to the closest "minute clinic" for an ear infection may be less expensive than paying a month of premiums for COBRA or an individual plan. 

Maybe she should have consulted her health care reporter colleague Sarah Kliff? Or maybe not? Just sayin'.

Walking Away

Got a call this morning from a nice gentleman whose wife, through whom the couple have their health insurance, is retiring, and due to the nature of the business (not-for-profit hospital system) said employer is not required to offer COBRA continuation. As such, they'll be losing this coverage when she pulls the trigger, and they're looking for an individual health insurance plan to be in place once that event occurs.

Regular readers know that, outside of Open Enrollment, there is no agent compensation available (at least here in The Buckeye State) for ACA plans, and so there's really no way for us to help folks in these circumstances (I briefly considered, and quickly rejected, offering a Short Term Medical plan based on the caller's answers about their health). Now, I'll happily make an exception for existing agency clients, and those referred by colleagues, but I just can't afford to do so for call-ins.

I do feel bad about this, but the onus is on the carriers (which continue to defraud their insureds by not reducing premiums to reflect no agent compensation)  and on the politicos and Departments of Insurance who turn a blind eye to it.

Shame on them!

CORRECTION: I've been told by my friends at Cornerstone that at least two carriers are in fact now paying off-OE commissions.

I apologize for the error.

Illinois 2nd State to Regulate Insulin Prices

"Colorado passed a similar bill in May 2019. The Illinois law limits out-of-pocket insulin costs to $100 for a 30-day supply.

"Health care is a right for all, not a privilege"

Health care is NOT a right, but making health care affordable is an admirable goal. Problem is, when govt tries to dictate change in the private market it rarely happens as promised (and hoped).

Obamacare was supposed to "bend the curve" on health care and make it affordable for everyone while encouraging more competition and lower premiums. Buying health insurance would be as easy as buying an airline ticket.

And if you liked your doctor you could keep your doctor. If you liked your plan you could keep your plan.

Carrier kudos: GR/UHC edition

About 15 years ago, I wrote a Golden Rule (now UHC) Medicare Supplement policy on a nice lady, who subsequently suffered a fairly significant stroke, and whose daughter called me this morning with the sad news that her mother had passed away on the 15th. She had received the quarterly billing statement that would be due early next month, and needed advice on how to handle this.

My initial counsel was to simply write "Virginia passed on [DATE], please cancel as of that date" and send it in.

But on further reflection, it occurred to me that she would most likely be due a partial refund, and of course there would likely be some claims still pending.

So, I told the daughter to stand by, and that I would call her back after I'd had a chance to speak with the Home Office. After a brief hold, Elandra asked how she could help, and I explained our concerns to her. After she'd had an opportunity to confirm with her supervisor, she told me that everything was taken care of, the daughter would be receiving a partial refund (for premiums paid forward) and that she could disregard the bill, and that the folks at Golden Rule were sorry for her loss.

No additional paperwork, forms or death certificates necessary.

I am so impressed with how this was handled: professionally, courteously, compassionately and easily.

Kudos!

Potential Good News, Rx edition

From our friend Holly R:

Blue Cross insurers to help launch nonprofit drug company to lower prices https://t.co/sLJvW3IfIA pic.twitter.com/Mhf7nkrQfX

— The Hill (@thehill) January 23, 2020

BigPharma© has become quite the bugaboo of late, and of course the ever-increasing price of often life-saving meds has been an issue for quite some time. Nice to see one of the 800 pound insurance gorillas bringing its own guns to bear on the problem:

"Health insurers usually just pay for drugs that are made by drug companies, but now a group of 18 Blue Cross Blue Shield health insurers is helping to create a nonprofit drug company to make certain generic drugs itself, targeting medicines where there is a lack of competition and a need to bring down prices."

Of course, this is hardly an altruistic move (the carriers themselves acknowledge this), but at least there's some positive action being undertaken.

Kudos, BX!  

ACA/OE Puzzler

From CMS in this morning's email:

[click to embiggen]

Pretty sure that that ship has long since sailed:

I spoke with Medical Mutual about this a while back, and they assured me that the grace period only extends to in-force plans, and so if the initial premium wasn't paid by January 1, the plan would not, in fact, be put in-force.

Hmmm.

And now for some *Good* news:

From co-blogger Bob V:

New Birth Missionary Baptist Church, partnering with RIP Medical Debt, has arranged for over $1.3 million of medical debt to be wiped clean:

"I jumped up and down and started praising God for this letter,” said Malcome, 58, who is disabled. “Other than my mother and God, no one has ever done anything for me like this. Oh, it was such a blessing.”

In a remarkable gesture of faith and generosity, the church's Senior Pastor, Jamal Harrison Bryant says:

"We are blessed to be a blessing and this effort has truly helped families start the new year without the stress, worry and concern that often accompanies looming medical bills and calls from debt collectors."

#Kudos to Pastor Bryant and his comminity.

What a convoluted mess (not to mention the circumstances)

I really don't even know where to start with this.

Okay, here:

"[Courtney Wilson] had moved to St. Thomas ... “for a change in, well, everything: scenery, culture, weather, people, way of life and of course the beauty of it.”

She took a waitressing job, but passed on buying health insurance.

Some three years later, she was in what appears to have been a very serious car accident, and she was careflighted to a Miami (FL) hospital for treatment. There, she was treated (uninsured, so she accepted full financial responsibility) and when she had recovered sufficiently, she "took a flight home to Paso Robles, California."

Umm, does anyone else see the glaring contradiction here?

Okay, moving along:

Once back in California, she applied for, and was retroactively accepted in, that state's Medicaid program. When she informed the Miami hospital of this change in circumstances, and requested that they bill MediCAL instead, they demurred:

"[T]he health system told her it does not bill out-of-state Medicaid programs outside of neighboring states like Georgia and Alabama."

Seems reasonable. After all, she had chosen to self-insure, and they were simply respecting her initial wishes.

Now comes the kicker (and the denouement we're all supposed to applaud):

"After the Herald inquired about Wilson’s case, she said UM reversed its billing decision."

How nice for her.

But notice this:

She moved away from California and took up residence in St Thomas, and then, when she faced substantial medical bills, she moved back  to graciously allow Golden State taxpayers to foot her bill.

Gee, kudos for sure.

[Hat Tip: FoIB Holly R]

More #Winning from the MVNHS©

Three patients a day die from malnutrition, thirst or choking on NHS wards, official figures show.

You will not be successful I suing the federal government. #M4A @DeptVetAffairs #healthcare https://t.co/KDYgrlSFg3

— Dutch Rojas (@DutchRojas) January 17, 2020

But remember: Free!

#Medicaid4All

Looking Ahead: A Life Insurance Poser

Recently, had a client refer her adult daughter to me for some life insurance. She's relatively young, and single, and without much debt, so I asked why she was even considering a policy. She replied that she wanted to lock in her rates while she was young and healthy (which was what I wold have suggested to her, so kudos to this bright young lady). She originally asked about several hundred thousand dollars in coverage, and specified that she wanted a whole life plan (we'll circle back to this). So I collected what information I needed from her to run some quotes, and got to work.

I looked at both Whole Life and Guaranteed Universal Life, and sent her the quotes. She thanked me, but then wondered if perhaps she'd be better off buying a smaller amount now, and then increasing it later. I explained that one can't really do that (well, not on a guaranteed basis, anyway), but that we could write a smaller plan now, and then buy additional coverage down the road (assuming her continued good health).

But then I got to wondering: it seemed to me that we used to have a Future Increase or Guaranteed Purchase Option rider, but that was long ago, does that even exist anymore?

So I reached out to our friends at Issue Insurance, to whom we turn for products and/or carriers outside our normal, day-to-day needs. Tana said that no, she didn't know of any carriers that offered that with the Guaranteed UL product, but that our own primary carrier had one on their Whole Life plan.

I hadn't even looked - Yikes!

Sure enough,m there it was, the Insured Insurability Rider:

"This rider allows you to increase the specified amount of the policy on each option date, without evidence of insurability. This rider expires in year 11."

So, 10 "bites at the apple."

Here's how I explained it to my young client (and her mother):

"So looking at permanent plans (that is, where the rate never increases, and the coverage lasts to age 100+), there are basically two "flavors:" Whole Life (WL) and Guaranteed Universal Life (GUL). The biggest difference is that the WL plan will accumulate a cash value over time, while the GUL does not. This means that the WL is going to be more expensive, because you're paying for two things: death benefit *plus* cash value. Not a huge deal, but important to understand.

"Off the shelf," neither plan will let you increase the face amount (death benefit) as/when you get older, you'd have to buy additional policies to do that. BUT: The WL plan offers an inexpensive rider that lets you buy additional insurance each year until (until the 11th year- so 10 "additions") at $10k each. So if you exercised all those options, your plan would increase from (for example) $50k (originally) to $150k (original plus 10 times the $10k additions). Of course, the premium would increase each time you did that (because more insurance). But that's the only plan I could find that let you do that.

So, numbers:

GUL (just insurance), $50k is $30/month.

WL ("off the shelf"), $50k is $40.moth (so paying $10/month more to build some cash vaue over time).

WL with "Additions Rider," as described above, starts at $41/month (the rider costs about $1/month). Of course, each time you increase the policy $10k, the premium will increase some, as well."

She's currently traveling, so I don't know which way she'll go (if at all), but thought that readers might find it helpful.

[Major Thanks to FoIB Tana H at Issue Insurance]

Medicare Part D: Explained

Co-blogger Bob V has another outstanding vid, this time on how to navigate drug plans:

More Canadian Health "Care"

Partner of Ottawa man with brain injury says he faces 'inhumane' wait for specialized care | CBC News https://t.co/c6kxCaURa3

— Chad Savage, M.D. (@chadsavagemd) January 15, 2020

Sure, sure, but hey: Free!

A Few Short (Term) Words

I have mixed feelings about using Short Term Medical plans for long term needs:

Qualifying ACA plans are best for individuals with pre-existing conditions, but what are the rules around healthcare alternatives if you only need temporary health coverage? #HealthInsurance #healthcare #ACA pic.twitter.com/5AJ7dWY96j

— Pivot Health (@PivotHealthLLC) January 14, 2020

That is, they were originally developed for limited durations, such as group plan probation periods, that kind of thing. And, for a long time, the maximum policy period was generally 180 days (6 months). A while back, the Feds clamped down on even that, limiting them to no more than 90 days (3 months).

Recently, that cap was lifted, and a number of carriers now offer 360 or even 364 day plans (essentially a year).

But what happens at the end of that policy if one has developed a medical issue?

STM plans, unlike their ACA counterparts, are underwritten, and exclude any pre-existing conditions. This means they're generally a lot less expensive, and can offer a lot more benefit design options. But it also means that if, for example, one develops asthma during one policy term, then that condition will be excluded if/when a new policy is written; plans can be re-written, but not "renewed."

One of the cooler things I've seen lately has been a feature offered by at least one carrier (I'm sure there are others, just haven't had a need to look): concurrent plans.

That is, one can write a 364-day plan, and when that's up, can re-write  a second one, and anything that cropped up under the first plan is not considered pre-ex for the second. Nice.

The carrier that I've been using, Pivot Health, offers this option with a fairly modest extra "processing fee" (about $20 per policy). I like that a lot. My only real quibble with them is that they limit their policy maximum to $1 million. That's not a deal-breaker, but UHC (for example) offers a $2 million policy maximum.

Oh well, can't have everything.

2:1, an ACA:Medicaid Story

So:

People covered under the ACA equate to under 8% of our population.

ACA exchange 8.3 million https://t.co/IHHa5xKeTH

Medicaid expansion enrollees 17.1 millionhttps://t.co/9P9RAiQxmm@TPPF @RightOnHC @Free2CareHC

— David Balat (@DavidBalatHC) January 13, 2020

By the way, that 8.3 million is folks who signed up during this year's Open Enrollment. As noted, almost twice as many folks qualified, and signed up, for Medicaid, which, as we've long pointed out, is not insurance.

But hey: Free.

Ooops: "Capitalist" vs "Socialist" Health Care

Or, what happens when one lets the agenda distort the facts:

The photo labeled "capitalism" is the government-run Sunbury Health Centre in Surrey, England.

The photo labeled "socialism" is St. Luke's Hospital in Bethlehem, Pennsylvania with modern equipment developed by the General Electric corporation. https://t.co/rF5fMCO9MH

— Donny Ferguson 🗽 (@DonnyFerguson) January 10, 2020

404Care.gov Enrollment v 7.0: Final Results

[click to embiggen]

 
So, just over 8 million people signed up, of which about 25% were newly "insured."

How many new Medicaid enrollees were there, do you suppose?

Asking for a friend.

Oh, click here for details.

Un(?)-intended Consequences, Continued

Your tax dollars at "work:"

Another fact. Emergency room services covered as In Network for all plans with ACA.... Emergency Room billing have increase 555%. yes 555% in past 7 years.

— lori kern (@chestertown3) January 8, 2020

Oy Canada (A Continuing Series)

Shot:

Chaser:

Medically assisted deaths provide boost to organ donation in Ontario https://t.co/PsABbMdOUb pic.twitter.com/YYcAgHA1Jq

— Ottawa Citizen (@OttawaCitizen) January 6, 2020

#Medicaid4All

[Hat Tip: Amy Curtis] 

british dad, dead patient, revenue loss

Hunh: Government Agency Makes Sense

Just now in email:

"The Ohio Department of Insurance requests that when adding a date to Ohio course completion certificates or any other Department related document, do not abbreviate the year to just “20”. Please write the year as “2020”.  This is because the date of January 3, 2020 written as 1/3/20 could be modified to 1/3/2018 or 1/3/2019."

Okay, that tracks.

#Firsts

Perfection

An article in the Daily Mail caught my attention with the headline:

“’Women don’t do well here’: Sexist ad calling for a doctor ‘with a bock bone’ for an Arizona medical staffing firm is removed amid outrage.”

This is the “offending” portion of the ad:

“The advert posted by Ascend Medical Staffing said: 'Tough facility; medical staff must have back bone and be diplomatic, excellent customer service skills. Women don't do well here.'”

While civilians may be outraged by this ad, this is the ad that EVERY Medical Practice Manager wants to place. The reality is that medical facilities and offices are “den[s]of scum and villainy”. Medical staff are often mean to other staff. Tears are very common among staff in medical facilities brought on by other staff and doctors.

As a Manager I have had the F-bomb dropped on me by Doctors, I have had staff and employed Doctors work behind the scenes to sabotage me, I have been called vulgar names by patients and if I had a nickel for every patient that threatened to sue me I could retire.

I salute whoever had the balls to write this ad, as I am sure this was their parting shot as they exited this facility.

Sure, sure, but hey: Free!

More #Winning from the Much Vaunted National Health Service©:

NHS patients "waiting to be treated for the potentially blinding eye condition glaucoma are facing waits of more than a year before being seen..." https://t.co/1opn0XkdYK

— AssocAmerPhys&Surg (@AAPSonline) January 2, 2020

And from the comments at that post:

"Folks should read and absorb whole article. Headline incorrectly calls this delay in TREATMENT;  No, it’s a 15 month wait to be SEEN.

Waits for actual treatment, (including laser and traditional surgery) doesn’t even start till after assessment.

Meanwhile...just go blind...."

But it's not just glaucoma patients being pushed aside:

"NHS hospitals in England are performing worse than ever as latest statistics show record delays in A&E and for cancer treatment." https://t.co/IMloMmEnMa

— AssocAmerPhys&Surg (@AAPSonline) December 27, 2019

They can't even meet the modest goal of treating patients in a few hours.

#Medicaid4All FTW!