Another CanuckCare© #InconvenientTruth

Show me the (Canadian) money:

"Canadians’ out-of-pocket health costs are nearly identical to what Americans pay — a difference of roughly $15 per month. In return, Canadians pay ... roughly $50 in additional taxes per dollar saved in out-of-pocket costs."https://t.co/3ZHdNW0dKC

— AssocAmerPhys&Surg (@AAPSonline) February 28, 2020

#Medicaid4All

What Happens When Your Travel Insurance Stops?

Say you are on a trip out of the country. You might even be on a cruise ship. You could be on the Diamond Princess. And the doctor thinks you might be infected with coronavirus.

No problem. You have a GeoBlue international travel medical insurance plan.

But the plan you chose only lasts 10 days. 

You find out you will have to be quarantined for at least 14 days.

Your coverage runs out while you are out of the country AND still sick.

No worries.

You can EXTEND your existing policy IF you contact GeoBlue BEFORE your current plan expires.

Special circumstances

EXTENSIONS

Members may request a coverage extension while overseas for single-trip plans only. This is only permitted if the member
purchased a plan prior to departure and would like to extend the current plan or would like to enroll in a subsequent plan.

The latter is permitted if the member enrolls before their initial coverage expires. If the member enrolls in a subsequent plan,
a new deductible, medical limit and pre-existing condition exclusion will apply.

Does YOUR travel medical plan offer this feature?

Better find out now, BEFORE you need it.
#Coronavirus #GeoBlueTravelMedical

Insuring Corona

No, sillies, not that corona, the coronavirus (aka COVID-19). As we noted the other day in our trip cancellation insurance post (and referenced yesterday in our latest travel medical insurance item), the disease and, more specifically, the threat it represents has become quite the hot button: lots of news articles about ships and planes being quarantined or re-routed, whole cities appellant on lockdown., and (of course) the travel and toruism industries are taking a big hit.

From an insurance perspective, there are of course a host of different issues, but this post will focus on the travel medical side. To that end, I reached out to our good friends at Global Underwriters, and FoIB Peter S provided me some much-needed and extremely helpful clarification.

For one thing, he taught me a new (and quite important) phrase: "known/public events." That is, those things that are either completely new or had previously flown under the radar becoming quite well known. And one can hardly think of a better recent example of this than the current coronavirous situation. As we noted in yesterday's post, pre-existing conditions are generally excluded under travel medical plans, but that's not really relevant here: this is so new that it's unlikely there were many insureds who had contracted the disease prior to buying coverage. So that clause wouldn't likely come into play.

But now that the disease is "out on the wild," that phrase ("known/public event") carries a whole new weight: as Peter says, "[r]emember that known/public events (e.g. coronavirus) are not insurable. Bottom line, you’re going to have a bunch of disappointed customers that didn’t read the fine print or exclusion section of a particular policy."

I also asked him about med-evac coverage (since this is usually included in travel medical policies). My question related to the possibility that one might be evacuated but then turned away from one's home country due to being diagnosed with the virus (or maybe just suspected of having it). There's a whole can of worms, of course: as Peter told me, "[o]bviously, we can’t evac someone that is being quarantined. But we would pay Evac & Repat expenses associated with their eventual release."

So there's that.

We'll likely have more as this develops, so stay tuned.

Travel Medical Update: Let's talk Pre-Ex

Travel Medical policies are for folks traveling outside the US, which is where most health insurance coverage ends. So for cruises or trips to Europe, or that Cancun get-away, savvy folks purchase plans to help with any medical issues (usually emergencies) which may arise.

This takes on particular importance in the current Coronavirus environment, but that's another post.

These plans generally either exclude or severely restrict coverage for Pre-Existing conditions, which makes sense.

But we now learn (via email) about a new feature available on GeoBlue Voyager Choice travel medical plans:

"Pre-existing conditions are covered under this plan as any other condition, subject to terms and conditions."

And what are those t's and c's?

Pretty simple, really:

"You must be concurrently covered by a primary health plan," which is defined as "an individual health benefit plan, or certain governmental health plan (including Medicare Supplements and Medicare Advantage plans) designed to be the first payor of claims." This would include group or individual medical plans, as well, but specifically not "Medicaid, state run Medicaid programs, and Veterans Administration health benefit plans."

Interesting, that last.

Anyway, something to check out when booking that next vacay.

[Thanks to FoIB Beth S]

But hey, Free: A Critical Look

An oft-repeated theme here at IB is that Coverage ≠ Care. That is, having insurance (or Medicaid) is no guarantee that one will successfully obtain the care one needs. To wit:

"Twenty percent of Ohio adults reported that they or a household member go without medical care because of the cost even though more than 90 percent of them have health insurance"

So that's half of the puzzle.

We also know that all of the current crop of Democrat-party Presidential contenders favor some form of "universal" health care (be it Single Payer, a Public Option, or some other variation on that theme), often citing CanuckCare© as a model.

And of course, we've demonstrated any number of ways that the Canadian model does not, in fact, actually deliver on its health "care" promise:

"Rationing—in the form of waiting lists—has left hundreds or even thousands of Canadians to die without surgeries."

So we can safely put that little gem to bed.

But what about the idea that our Northern neighbor's health care scheme saves money? This claim, by the way, has been made by several of the aforementioned front-runners (at least as regards to nationalized health care schemes in general).

Well, as it turns out, not so much:

"Canadians spend less on health care than Americans mostly because they are not allowed to use as much — not because they are getting a better deal."

But that was then (last Spring). Surely this is a one-off?

Um....no. As co-blogger Bob V informs us:

"[I]n Ontario, the country’s largest province, the cost of nationalized health care took up 46% of its entire budget in 2010. By 2030, that number is projected to be 80%."

But hey: Canadian moolah.

CanuckCare© Update

#Brampton has declared a Healthcare Emergency

Harsh Reality at EPI-CENTRE of #ONHealth & #HallwayMedicine Crises:

"They strung a white bedsheet up from IV poles to give a family in hallway privacy as their family member died. She passed in the hallway behind a sheet." @dockaurG pic.twitter.com/Bmhm4XDVso

— Your Ontario Doctors (@OnCall4ON) January 31, 2020

Sure, sure, but hey: Free!

And this, dear readers, is what's in store for us under #Medicaid4All.

[Hat Tip: Kulvinder Kaur MD]

Talk about a high deductible!

Offered without (further) comment:

Doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.

— Gavin Newsom (@GavinNewsom) February 21, 2020

#WhatCouldGoWrong

Thursday LinkFest

■ FoIB Shari G sends us this video from the esteemed (and oft-linked) Sally Pipes on the false Promise of #Medicaid4All:

■ FoIB Jeff M tips us to this un(?)-intended consequence of CON laws and tightening networks:

"[Fairmont Regional Medical Center ] announced that more than 600 physicians, nurses and staff will be shutting down after attempts to find a new buyer for the hospital failed."

This has apparently been in the works for several weeks, and points out some of the challenges of providing health care for our more rural citizens.

■ And finally, in email from FoIB Randy G, a note on the SECURE ACT:

"[T]he new law eliminates the concept of the “stretch IRA’s” which extend the tax-deferred status of an inherited IRA when passed along to a non spouse beneficiary ... the beneficiary would need to take the payments over 10 years ... This could create an enormous tax burden.

So, if you have clients expecting to inherit qualified funds, then you should consider re-positioning these funds into One America’s Asset Care Annuity Funding Whole Life plan. This plan will help in turning an inherited, taxable part of an estate into a tax free income stream for LTC expenses."

Cool beans!

■ BONUS Link:

Patient plays violin during her brain surgery.

A patient at King's College Hospital in London played the violin while surgeons operated on her brain to remove a tumour.#Violin #surgery https://t.co/zeLV8VFVDE pic.twitter.com/bYnx0K9HEO

— Dutch Rojas (@DutchRojas) February 19, 2020

Wow!!

AussieCare© FTW

We haven't written a lot about health care Down Under (most recently here), so a short recap seems in order:

"Medicare is the publicly funded universal health care insurance scheme in Australia operated by Services Australia. Medicare is the main source of payment of health care in Australia"

As here, some care is financed by private insurance, but most is paid for by the Australian taxpayer through the country's Medicare program.

As with all such schemes, this involves rationing, in this case of essential primary health services. As FoIB Holly R alerts us, this can spell special trouble for at-risk women:

"Canberra women awaiting crucial genetic information left in limbo as BRCA breast cancer test waitlist blows out to 12 months."

Again we see rationing in the form of time management; that is, it's obvious that the philosophy is that, by making patients wait long enough, some (many?) will die before services are actually rendered.

Or, for the more right-brained among us:

[click to embiggen]

#Medcaid4All

Puzzling Fraudster Tricks

We've written before about would-be Moriarty's trying to scam insurance companies. Some, of course, are more successful than (the vast majority of) others:

"Judge rules Denver man who 'killed his wife' can use up to $500,000 from her life insurance to pay for his defense"

Others, well, not so much:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

But this one, courtesy of co-blogger Bob V, takes the (proverbial) cake:

"Boston man pretended brother was still alive, opened life insurance policies for him, in attempt to claim $5 million in benefits"

Yikes.

The first thing that strikes me is that total face amount. How does one purchase that much coverage, in what appears to be record time, without getting caught out? As we've mentioned before, life insurance underwriting, especially at that lofty level is going to require any number of physical and financial exams. And it gets even more weird (not to mention ironic):

"Investigators found witnesses in China that said Zheng’s brother died two to three years earlier of a sudden heart attack suffered on Tomb Sweeping Day."

Heh.

It's still not clear to me how the perp actually pulled this off. The story mentions that he'd renewed his (then-deceased) brother's driver's license, and used the deceased's bank accounts, but the actual mechanics go unreported.

Great job, MSM.

(Although, on second thought, maybe it's just as well)

Subsidized Folks Heads' Up

From CMS:

[click to embigen]

I have a client whose spouse is a legal permanent resident, and who qualifies for a subsidy (Advance Premium Tax Credit, APTC), and his subsidy eligibility notice says:

“• By March 8, 2020, send documents to confirm:
• [Spouse's] immigration status”

And a list of acceptable documentation.

I just sent him an email to remind him.

Have you checked your notice?

It's not too late....

Attention Old Line Staters: ACA News (Really!)

Our friend Sheron Sidbury alerts us to this helpful info:

Maryland has a new SEP. If you are uninsured you still have a chance to enroll in health insurance coverage. It is as easy as checking a box on your Maryland State tax return. You will only have 35 days to act and not 60 like in a regular SEP. https://t.co/ro83tyfBKB

— Sheron E Sidbury (@SheronESidbury) February 10, 2020

Who knew?

Food Pyramid Update 2020.1

Well, it's been a while since we noted the health-improving properties of certain comestibles and potables:

"A new study published in JAMA Internal Medicine on the health effects of resveratrol – a compound found in red wine, dark chocolate and some fruits and vegetables – has generated a lot of sensational headlines"

Resveratrol is thought to help protect one's body from "damage that can put you at higher risk for things like cancer and heart disease."

And now, thanks to co-blogger Bob V, we learn that one of my favorite vegetables is also pretty nifty:

"Using Eggplant to Lower Your Blood Pressure"

Turns out, eggplant "contains an agent that inhibits angiotensin converting enzyme (ACE). As a result, eggplant is working ... through the same mechanism as blood pressure medicines like lisinopril."

I'll have mine grilled, thank you!

Another AHP Success Story

As I was explaining the other day to an acquaintance, one of the biggest challenges regarding the ACA viz insurance is the lack of a risk-assessment mechanism. In both the individual and group markets, this means that there are no health-related questions allowed, rates are based solely on age, sex and location (and, in the individual market, on tobacco use as well).

Which is equivalent to an auto insurer having to charge the same rate for a guy with 3 DUI's and 4 speeding tickets, and the soccer mom with a clean sheet.

But that's all theory and concept; how does this apply in "the real world?"

Readers may recall my recent post about my client who had just lost another valued employee to a competitor who offered health insurance ("benefits"), and who was for the first time considering taking the plunge himself. He turned to me for help, and I explained that there were two "paths" to consider: the simple (but expensive) ACA one, and the potentially cost-savings one (AHP):

Rates for ACA plans require merely a list of employees, their ages, sex and marital status, and the nature and location of the business. No medical info is necessary. So groups with 3 employees on chemo and 4 on dialysis pay the exact same rate as those with relatively healthy employees.

On the other hand, AHP plans require medical histories, current meds and the like, and thus the process requires more effort (by the agent and by the employer and employees). But healthier groups can benefit greatly (one can argue the "fairness" of this, but that's another post). And sometimes, they can benefit 'bigly.'

In this case,the benchmark ACA plan we looked at would have a total monthly premium of about $3,700 (keep in mind, this is a 3-employee group, two singles and a family plan).

By contrast, the AHP quote came in at less than half of that: $1,550 per month.

And all it really took was maybe an hour's extra work, total.

Sweet, no?

Ahoy there, Mate! Travel Insurance Alert

Last time we took a detailed look at Travel (Interruption) Coverage was almost a decade ago:

"More commonly known as "trip interruption insurance," this type of coverage falls under the Property/Casualty rubric."

By now, we're pretty much all aware of the havoc that the Coronavirus is having on folks' travel plans:

"A Holland America cruise ship with more than 2,200 people aboard was denied entry to Thailand on Tuesday over fears that passengers may be carrying the new coronavirus, bringing the total number of ports from which it has been turned away to at least five."

And of course that list is expected to grow unless/until we get a handle on the disease.

But then, a number of travel insurance-related questions arise:

What if you're stuck on such a ship?

What if you're scheduled to embark on that honeymoon cruise next week?

What if you're in the middle of a trip around Southeast Asia and need to cut that short?

Well, for these and more we turned to our good friends at Global Underwriters where head honcho Peter S provided some helpful insights (courtesy of Travelex, a carrier specializing in travel insurance):

"This outbreak is now a known event and Travelex Insurance plans underwritten by Berkshire Hathaway Specialty Insurance would need to be purchased prior to 1.21.2020 for trip cancellation or interruption coverage to apply.

It is important to note that fear of travel, travel advisories and destination being inaccessible due to this illness are not covered risks under the Travelex Insurance policies. In order to cancel or interrupt a trip due to quarantine, the traveler or traveling companion would need to be physically quarantined themselves."

Keep in mind, this is for Travel/Trip Cancellation coverage, which is generally separate from Travel Medical insurance (although it may be available as a rider, as well).

To continue:

"Plans where the Cancel for Any Reason upgrade has been purchased allows travelers to decide for themselves whether to travel or cancel their trip according to the terms of the plan."

This is an important reminder; I recently quoted such a plan, and noticed that absent this clause, there were only very specific instances where cancelled trip costs could be eligible for reimbursement. Of course, it also included a hefty difference in premium, but one can understand why.

Peter also included some related info from the CDC, including:

■ CDC recommends that travelers avoid all nonessential travel to the People’s Republic of China (this does not include the Special Administrative Regions of Hong Kong and Macau, or the island of Taiwan).

■ CDC recommends that travelers avoid all nonessential travel to China. In response to an outbreak of respiratory illness, Chinese officials have closed transport within and out of Wuhan and other cities in Hubei province, including buses, subways, trains, and the international airport.  Additional restrictions and cancellations of events may occur.

And more.

If you're scheduled to travel abroad any time soon, it's probably a good idea to check with your carrier (both transportation and insurance) to see what coverage is available.

Safe travels, and Thanks Peter!!

Well isn't *that* special?

Special needs, that is.

Got an interesting email the other day from MassMutual about a topic that we've only tangentially touched upon previously (and, perhaps ironically also involved MassMutual):

"MassMutual and Easter Seals are once again teaming up to increase awareness of the important decisions and financial challenges facing families with special needs members."

In that instance, it was a wonderful fund-raising effort that resulted in a lot of money going to help out Special Needs Families.

The latest message was a bit more personal:

"Henry, have your clients thought about what would happen if they, or other caregivers, were no longer around to make sure that their family member with special needs was able to maintain their quality of life?"

A most cromulent question. I do, in fact, have a client in that situation (well, her husband is, long story). And I'm aware of other folks in my circle of friends and acquaintances that have or are caring for a special needs dependent. And although the "normal" worry is "how are we going to make it through this day," there's at least a sense of the dilemma that will come about if (and for a parent, more likely a when) the caregiver predeceases his or her charge.

I've long know about this risk, just never had the opportunity (or need) to do anything about it. But as we live longer, and as medical science continues to evolve such that these folks live longer, I fear  that this is a burgeoning problem (and/or market, one supposes).

And that's where MassMutual's latest email come in:

"Higher survival rates, greater life expectancies, and more extensive [ed: and expensive] therapies can mean more costs for a longer period of time."

Indeed.

So what to do about that?

Well, MassMutual (and to be fair, there may well be other carriers doing this, as well) offers a Survivorship Whole Life Legacy policy that seems custom-built for this niche:

"The proceeds from a Survivor Legacy life insurance policy owned inside of a special needs trust can help provide for the continued needs of a person with special needs after their caregiver is gone."

Wow!

They sent along a handy Agent's Guide, but one supposes they have one for 'normal' folks, too.

Kudos, MassMutual!

[Hat Tip: FoIB Mara F]

Frozen out by the MVNHS©

That's COLD, even by Britain's Much Vaunted National Health Service© "standards:"

Sure, sure, but hey: Free!

BBC News - NHS winter pressures: Doctor says staff in 'very deep hole' https://t.co/LR8l8HpK1N

— Chad Savage, M.D. (@chadsavagemd) February 5, 2020

Sure, sure, but hey: Free!

#Medicaid4All

Pitch Perfect Take on ACA/Trump

FoIB (and noted actuary) Greg Fann offers an extraordinarily wise insight into the "Trump vs ACA" discussion:

 [click to embiggen]

Size Matters

Shot:

How Four Pages Could Transform Health Care https://t.co/ztZfy7F1g7

— Chad Savage, M.D. (@chadsavagemd) February 4, 2020

Chaser:

"[A]s officially published by the Government Printing Office, PPACA is **906** pages long ." [emphasis added]"

Maybe Free Health Care Isn't Such a Good Thing

Who hasn't heard of coronavirus? But how many people know the story of the folks who live in Wuhan (Hubei Province), China where health care is free . . . but overwhelmed?

China’s Hubei province, the landlocked region of 60 million people where the new coronavirus dubbed 2019-nCoV was first identified in December

Hubei -- known for its car factories and bustling capital Wuhan -- is paying the price, with the mortality rate for coronavirus patients there 3.1%, versus 0.16% for the rest of China.

If the province was not sealed off, some people would have gone all around the country to try to get medical help, and would have turned the whole nation into an epidemic-stricken area - Bloomberg


Free isn't always a good thing.

#coronavirus

Who did *not* see *this* coming?

"Irony can be pretty ironic sometimes:"

The 10,000 people who work for Maximus at ACA call centers to sign us all up for health care can't afford health care themselves. How dystopian are things now? https://t.co/3AWNKbfE4O

— Amy Shefrin (@AmyShefrin) February 3, 2020

 NB: They're  not signing anyone up for health care.

Coverage ≠ Care.

Brilliant* Carrier Tricks

*For certain values of "Brilliant:"

So I recently submitted an app with a (relatively-new-to-me) carrier for a small case that seemed like a good fit. My client (whom we'll call Suzy) is a very sweet, mild-spoken woman in her late 60's, looking to make sure that, when the time comes, her final expenses won't be a burden for her children.

Okay, no worries: rate calculated, app competed and submitted, now just wait for approval.

Except I receive this in email this morning:

The above mentioned application has been received; however, processing cannot continue until the following items are received:

• Cover Memo: Please see attached, complete and return.

• Premium Verification:  The application quoted a premium of $49.89; however, we have calculated the premium at $86.52. Our calculation was based upon a 69/Male/non-tobacco/Premier/$10,000. Unfortunately, this difference in premium is significant and we are unable to draft without written consent of the policy owner and payor. If not received prior to policy issue, the needed premium will be requested upon delivery of the policy contract.

Hunh.

Perhaps it wasn't quote clear on the app?

Oh:

[click to embiggen]

Hunh.

I immediately notified them of their (egregious, obvious) error (there may or may not have been some snark involved) and will breathlessly*  await their reply.

(*Full Disclosure: I will not, in fact, be holding my breath)

Stupid, Faithless Agent tricks

The good news is that I've moved from seething to very disappointed.

Regular readers may recall my post this past Spring on the subject of life insurance policy claims:

"In consulting with colleagues around the country, it seems that I am a bit behind the times on insisting on delivering the claim check personally (where possible). And I'm okay, albeit disappointed, with that."

My primary carrier's default position on the subject has long been to send the check to the beneficiary unless directed otherwise by the agent. I don't like this, but they've also built in a process where, if I tell them upfront to send it to me, they will.

Except: they didn't. And then they compounded it:

A long-time (and I mean long time: 30+ years) client passed away recently of natural causes.

It happens.

I met with his son (the beneficiary) and we completed and submitted  the paperwork, on top of which I stapled my customary memo reminding the claims folks to send the check to me.

Some weeks go by, and I email the claims department for a status update (what's taking so long?). Here's their reply:

"The claim has been processed. I do apologize the check was sent directly to the beneficiary on 1/24/2020 instead of sending to you for delivery."

And when, exactly, were they going to inform me?

(Spoiler Alert: That would be the 12th of Never)

So I replied to her (and my field rep):

"I’m sorry, but this is completely unacceptable.

I specifically requested in the cover letter that the check come to me, and I had already discussed this with your department.

And you didn’t notify me that it was sent.

I am VERY unhappy."

Now the truth is that they don't really care that I'm unhappy, they're likely more concerned that they've been caught out. My field rep happened to be in the home office as all this transpired, and he called to let me know that they didn't do this on purpose (which I knew) but that it just didn't matter to them (I know this not because he explicitly said so, but because he told me that he had been shown the folder, which had bright yellow highlights confirming that the check was to be sent to the agent). It reflects a culture that doesn't understand (or, apparently, care) that these are my clients, not theirs.

So why am I not naming the carrier? After all, we've done that many, many times for egregious violations (as this most certainly is).

The only reason I'm demurring here is because, sadly, this is apparently not only wide-spread industry practice, but apparently also enjoys robust agent support. That is, most agents apparently don't want to be part of this process (and thereby completely bail on an explicit promise they made to their client). So how can I blame the carriers for acceding to their agents' wishes?

So as disappointed as I am with the carrier(s), I am disgusted with what seems to have become of the agent force.

#Shanda

(Oh, perhaps I'm being too harsh in claiming above that they just don't care? No, it's pretty simple: had they cared, they would have realized that they'd screwed up, and reached out to apologize to me at the time)