Interesting Short Term Medical news

Short Term Medical (STM) plans can be a real help for folks waiting on their new group coverage to kick in, or those who prefer a low-cost PPO-based alternative to unsubsidized HMO-only ObamaPlans. Of course they have their own limitations, including application fees (which I hate). Keep in mind also that (for better or worse) these plans are not ACA-compliant, based partly on the fact that there are typically no preventive care benefits.

United Healthcare has just announced that, as of May 1st, they're introducing a new line of "enhanced" STM plans (not available in all areas - yet) with some very cool features, including:

"[P]reventive care coverage on all plans, no limit on urgent care visits with a copay, and no application fees"

Sweet!

Telehealth: Mixed feelings

As we wend our way through this pandemic, I've become more and more convinced that the true 'winner' will ultimately be telemedicine (in whatever various flavors and forms). 

Case in point:

Yesterday was to have been my annual (routine) physical, and our family doc had already made arrangements with a Skype-like service which enabled us to carry on a decent conversation (shades of the Jetson's). His office had called last week to remind me to gather my vitals (as best I could) prior to the exam.

Ours is an older model, mechanical/spring scale, so I can't really vouch for its accuracy (right!), but our sphygmomanometer and thermometer are both digital, so pretty comfortable with the numbers they produce. And, of course, we've been monitoring our temps throughout this whole mess.

The exam went fine, as far as it could; that is, without all the regular "trimmings," it was, after all, merely a conversation. Towards the end, the doc reiterated CV-19 symptoms to be aware of - I pointed out that a lot of those could just be my seasonal allergies kicking in. So the appointment lasted less than 20 minutes, which is fine, and since there was no lab work (thanks to the statewide lockdown), there wasn't really all that much left to discuss.

Now, co-blogger Kelley has made a great point about the business model of telehealth:

"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."

And frankly, that's fair: for better or worse, it seems to me that the missing "hands on" aspect was worth that extra 40% for an in-person visit. This is of course no reflection on the doc: his hands were pretty much tied by the rules in effect for all of us. But Kelley's larger point is well taken: this particular version doesn't seem to be a sustainable model. That is, "Virtual Health" looks to be ideal for, say diagnosing a minor ailment, or even periodic check-ins for folks on maintenance meds, but I'm skeptical about its scalability.

Time will, of course, tell.

SCOTUS, ACA & Your Tax Dollars

Not that this is a big surprise, but:

"The Supreme Court ruled Monday that Congress cheated health insurance companies by reneging on a $12 billion promise made under the Affordable Care Act."

This was never seriously in doubt, as the plain letter of the law mandated that it be so. Much like the constitutional issues surrounding the mandate/penalty/tax fine, there has always been a simple remedy, the courage to undertake it notwithstanding.

Even Justice Sonia Sotomayor, hardly a right-wing shill, opined that this was "a principle as old as the nation itself: The Government should honor its obligations."

Seems pretty clear-cut to me.

[Hat Tip: FoIB Holly R]

Pelican State Blues

Well, Blue Cross/Shield of Louisiana, anyway:

BCBS of LA, made a change in the middle of this pandemic that will destroy the small group market. If your business is made up of a husband and wife, your coverage will eventually be terminated.
More bad news to the citizens of Louisiana!

— HAFA (@TheNolanGroup) April 22, 2020

Now to be fair, most carriers have long since discontinued "sole proprietor group" plans (which would generally include husband/wife small businesses). Pre-ACA, the only real advantage to these plans versus individual policies were maternity coverage (generally excluded under individual major med plans) and, often, coverage for folks with major health issues. Since ObamaPlans cover maternity and pre-ex, this advantage went away.

Recently, Ohio re-introduced MEWA/Association plans, and at least one (that I'm aware of) allows "one man group" plans (provided it's a legitimate business).

But let's get back to Louisiana; I reached out to a colleague 'in the know' about that Tweet, and she replied:

"The BX legal department has picked an odd time to start enforcing what I believe is clear ACA policy (a group with only husband and wife as “employees” is not a group) but since they only have a couple of thousand total members this could potentially affect, so unlikely to “destroy” any particular markets...my 2cents"

She followed up this morning:

"Update: the insurance commissioner has intervened and made a “finding” that spouse only groups are still groups no matter what the ACA says.  So appears that BX will keep renewing and writing them for now."

So, good news for micro-groups in The Bayou State.

ABR and CV-19

It's been a while since we've discussed Accelerated Benefits Riders (ABRs), which have been pretty much ubiquitous in life insurance policies for quite some time. To recap, these riders "enable the policyholder to "access" the face amount as a living benefit." There are some policy and tax implications, but the general idea is sound, and has proven quite beneficial to, for example, cancer or AIDS patients, as well as others.

Which is nice, Henry, but why bring that up now?

Well, because I got an interesting email from a carrier [full disclosure: I can't recall ever actually writing a case with them, but we do get their emails, so maybe?] with this very relevant (and helpful!) message:

"An important message from our Medical Director

An Accelerated Benefit Rider (ABR) provides the potential to receive a partial or full accelerated life insurance benefit if the Insured contracts the coronavirus [or is diagnosed with COVID-19] and experiences all of the following:

1. Hospitalization;

2. Inability to complete certain activities of daily living for a period of 90 days (under the Chronic Illness Rider) or irreversible damage to an organ (lungs, liver, kidneys, or heart) secondary to the severity of the disease (under the Critical Illness Rider); and

3. Significant decrease in life expectancy.
While some Insureds may fall into this category after a severe infection, it is relatively uncommon. Contracting the coronavirus and experiencing symptoms will not necessarily result in an ABR payment."

Hunh. I hadn't made that connection, so I ran it by my field guy for our primary carrier (FoIB Major B), who noted that it "might be a good reminder that most policies have the benefit available." Which is true, and which is the point of this post.

So, if you have a policy which includes this rider (as many - perhaps most - do) and you've been diagnosed with CV-19 (and suffering from it), seems like a good idea to pull out that policy (or those policies) and check it out.

You may be entitled to compensation.

One more on BI vs CV

So yeah, we've been spending a lot of time blogging on this issue, but each week, it seems, brings a new facet. For those just tuning in, Business Interruption coverage "is supposed to help reimburse lost revenue due to a covered, physical loss (such as a fire, or a flood, etc). The issue at hand is whether or not a business forced to close because of the current pandemic is entitled to such reimbursement, since the physical structure remains intact (and distinct from a claim arising from actual contamination)."

There has been a growing chorus calling for the government (whether at the state or national level isn't always quote clear) to force carriers to provide this coverage and begin processing, and paying, BI claims based on mandated closures, but no actual physical loss.

One can see the problem here, of course: this coverage was never offered, underwritten, or issued by the carriers, and no premium for it was ever collected by them. In this case, truly free coverage.

It's not hard to imagine the consequence:

"Chubb Ltd. Chief Executive Officer Evan Greenberg has a stark warning for policy makers pushing insurers to pay out some uncovered business-interruption losses.

“The insurance industry is a fundamental part of the economic plumbing of this country,” Greenberg said in an interview Thursday. Forcing insurers to foot the bill for losses not covered by policies “would do great damage. It would bankrupt the industry.” [emphasis added]

Well, that certainly gets one's attention.

But surely there must be a middle ground between this all or (literally) nothing conundrum, and indeed there may well be:

"[Two leading industry groups] are calling on our federal lawmakers to adopt the COVID-19 Business and Employee Continuity and Recovery Fund (the “Recovery Fund”). The Recovery Fund would establish a streamlined and tailored federal fund to provide rapid liquidity to small businesses and commercial sectors impaired by COVID-19 through a business interruption claims adjudication process."

While I am generally not a fan of "may I have some more" from the Feds, this seems like the most judicious approach: after all, as we noted in the post at that first link, this is exactly the type of role government should be playing in this kind of situation.

Will it be enough?

Well, only time will tell, but this is the first reasonable proposal I've seen so far.

FWIW.

[Hat Tip for Chubb link: FoIB Bill M]

#KitchenSafety: CV-19 edition

One of the more obvious effects of this lockdown situation is that so many of us have become much more active in the kitchen, which is not (necessarily) a bad thing. One suspects that Food Network ratings are currently through the roof.

On the other hand, and this is especially true for those who may be newbies (or just inexperienced), the kitchen is also fraught with danger (and I don't just mean an awful omelet). And so the good folks at Cincinnati Insurance offer some helpful safety tips:

• A clean cooking environment is critical. Make sure before you start and after you finish that all surfaces are wiped clean and no ignitable food or grease is on the countertop.

• The No. 1 cause of kitchen fires is inattention. Fire can spread significantly in a short time. Whether you are cooking, roasting or frying, do not leave food unattended. If you leave the kitchen, turn off the stove.

• Do not leave young children unattended near the stove or oven.

• Do not throw hot grease into the garbage can.

And that's just a sampling.

Do click on through for even more.

One for the good guys

One of my small business clients reached out to me for help in his application for the Paycheck Protection Program. One of the requirements was apparently proof that he had been paying his group health insurance premiums. Because he's on auto-withdrawal (EFT) he didn't have cancelled checks, and so was in a quandary. Added to his stress was a looming deadline....

One of my favorite parts of this job is being able to help my clients, and this turned out to be easier than I'd thought:

I popped over to the carriers agent portal, signed in, brought up his account, and clicked the "Billing" tab, which showed a list of premiums, when they were due, and when they were paid. I took a screen-shot and emailed it over to my client, who just let me know that the screen-shot worked, and his application is being processed.

Is this a big deal? Well, for my client it certainly is, as it may be what ultimately keeps his doors open. And for me, the satisfaction that I was able to help, in however small a way, to make that more likely.

So, a good day.

When Low Premium Isn't a Good Idea

No one likes paying too much, especially for insurance. Seems like everyone is constantly shopping for the best rates.

Nothing wrong with that. I always tell folks when you pay more you don't get more, you simply paid too much.

But it is also possible to pay too little for insurance. When you do, more often than not it comes back to bite you.

More often than not consumers would be wise to pay a few dollars more and get a plan without so many "gotcha's".

#PayingTooMuchForInsurance

LTCi on pause?

Co-blogger Bob emailed us with this info he learned from a trusted source:

"I was told this today...with an effective date of applications starting tomorrow. I have several folk 65+ who are trying to apply, and I have to say sorry, but I have more expensive options for you to look at.

Throughout the rapidly evolving pandemic, Mutual of Omaha has been continuously evaluating our underwriting and new business practices to support business continuity, deliver a consistently high level of service, and maintain our financial strength.

As a result, effective Thursday, April 16, 2020, we are implementing a temporary change. We will not be accepting LTC applications for individuals age 65 and older. All LTC cases not already approved or issued will be postponed and processed as an incomplete application.

We will continue to prequalify applicants 64 and younger. The prequalification will be good for 60 days. If the health of the client changes or the prequalification is past 60 days, you will need to prequalify the applicant again."

I then confirmed this with FoIB Randy G, who added:

"MOO, TransAmerica, NGL, and Thrivent are not accepting any applications for those over the age of 65.

They say temporarily….

Reason is that individuals over the age of 65  will require a home face to face interview.

The nurses who conduct those interviews don’t have sufficient PPEs to enter homes.

Anyway, that’s the story I got.

The companies will still accept applications for those 64 and under. However, there are restrictions to this as well."

Thanks, Herman and Randy!

Oh, my take?

I think it's bullcrap: have none of these carriers ever heard of Skype?

Refund Update [UPDATED]

As we noted the other day, many auto insurance carriers have installed discount/refund programs as a result of the pandemic's stifling effect on driving:

"In general, insurers that represent four out of five auto insurance policies sold in the United States have offered to refund some portion of driver premiums."

But that was just a small sampling. This time, FoIB Bill M tips us to a comprehensive list of many (most?) such programs. For example:

■ Amica: 20% credit on April and May premiums

■ The Hartford: 15% refund on April and May premiums (but only for policies in effect as of April 1)

■ Mercury Insurance: 15% credit on April and May premiums

And of course many others. Do click on over to see what your carrier's offering.

UPDATE: One carrier that didn't make the list is Western Reserve Group, which has just announced:

"[W]e are adjusting discounts and reducing rates for our personal lines auto policyholders, once we receive regulatory approval which we are expediting for review. By reducing rates, we are lowering premiums by more than $3.7 million for personal auto policyholders in addition to the almost $2.0 million in rate reductions offered to policyholders effective March of this year."

Can I Have Medicare and an HSA?

Is it OK to have an HSA plus Medicare? Can I still make contributions once I enroll in Medicare? How about my younger spouse? What else do I need to know?

When you enroll in Medicare Part A or B, you can no longer contribute to your Health Savings Account. When your Medicare begins, your account administrator should change your contribution to your HSA to zero. If you have a spouse who also has an HSA, money can be deposited for him or her. A Health Savings Account is a bank account, not insurance. HSA's have a single owner. Joint ownership is not an option.

You may continue to withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses, such as deductibles, (some) premiums, copayments, and coinsurances. If you use the account for qualified medical expenses, its funds will continue to be tax-free.

If you sign up for Part A after turning 65, Medicare will automatically backdate your Part A effective date by up to 6 months. If you enroll in July, your Part A will be effective January 1 of that year but not before your 65th birthday.

Winners from the P&C World

One of the side effects of the forced shut-down is that folks are driving less - a lot less. And this, in turn, has given auto insurers a good reason to refund at least some of our premiums (less driving = fewer accidents). As we've noted previously, some carriers have been pretty good about this:

"Allstate and American Family Insurance have begun discounting car insurance premiums since many drivers aren’t using their cars as much due to stay-at-home policies aimed at slowing the spread of the coronavirus."

But they're not the only ones and, in fact, some are even better about how they're handling this opportunity. FoIB (and P&C Guru) Bill M tips us to this list of the 10 Best such:

"In general, insurers that represent four out of five auto insurance policies sold in the United States have offered to refund some portion of driver premiums."

Nice!

Leading off in the #10 spot is MapFre, a carrier I've only recently heard of (our eldest is insured with, and speaks very highly of, them). I definitely recommend clicking through to see if your carrier is listed (and in what spot).

Give those groceries a Lyft?

We've written before about the evolution of coverage for Uber and Lyft drivers, but of course they're not the only ones active in the so-called 'gig-economy.' With social distancing a (hopefully temporary) way of life, more and more folks are turning to services like InstaCart to traverse the various aisles and endcaps, searching for wild game (or cans of soup and maybe a roll of TP or 6). What a lot of folks (myself included!) probably didn't know is that these folks rely on their own transportation to ferry their customer's merch their doorways.

One of our regular readers emails us me about the disturbing truth:

"I want to do some work for Instacart. They do not offer a master insurance policy the way Uber does, you have to provide your own coverage. I have two vehicles, one is covered by a commercial policy, the other is under a regular auto policy.

For the former, commercial coverage is written to cover one type of work, so I can't operate outside of that, thus I have no coverage for Instacart.

For the latter, my broker told me that many insurance companies covering personal vehicles are extending coverage for gigs such as Instacart, but not mine.

My broker pretty much told me that I would have to buy a new commercial policy if I want to do Instacart. I probably won't. And can you imagine how probably 100% of people doing Instacart don't have proper coverage, if any?"

Thank you!!

Easter - Someone to Listen

Easter means many things to different people, and to some it has no meaning at all.

The colloquial view is bunnies, colored eggs, baskets, new "Sunday" outfits and of course, shiny new shoes. Patent leather if you are a girl.

Just as Passover (Pesach) is a tradition with deep meaning for observant Jews, Easter (Pascha in Greek) is significant to Christians.

Both Passover and Easter are 8 day celebrations excluding Lent which starts 40 days before Easter.

This year Passover and Easter holidays overlap for the first time since 2012.

Perhaps it is more than just a coincidence.

ObamaCare turned 10: 1,000 words

Courtesy of FoIB Scott M, a belated "Happy" Birthday to ObamaCare:

[click to embiggen]

Passover 2020/5780

The archetypical celebration of freedom and redemption, Passover, begins this evening.

Because of the pandemic, we have been forced to cancel our traditional - and highly anticipated - seders this year. But we can still enjoy this musical interlude from the Israeli Philharmonic:

חג פסח שמח

Carrier Kudos

We spend a lot of time dunking on insurance companies for boneheaded, sometimes egregious behavior.

So it's nice to also point out examples of good corporate behavior, as well. Like the folks at Companion Life:

[click to embiggen]

And they're not the only carrier behaving well. Our friends at OneAmerica Life have announced their CV-19 lapsed policy stance:

"If a life insurance policy lapsed AFTER the policyowner’s resident state issued a moratorium on lapses, then:

1. OneAmerica is automatically extending coverage on these impacted life insurance policies until June 1, 2020. 
2. No action is required by you or the policyowner. It is automatic."

Nicely done!

But wait - There's more!

"Allstate and American Family Insurance have begun discounting car insurance premiums since many drivers aren’t using their cars as much due to stay-at-home policies aimed at slowing the spread of the coronavirus."

It's important to note that this is entirely voluntary on the carriers' part, with Allstate estimating their contribution at $600 million, and AmFam's at about a third of that.

And please let us know about how other carriers are stepping up - Thanks!

CV-19 Perspective

This:

December: Do you want health insurance?

29 million people: No

April: The government will cover COVID-19 costs if you remain uninsured, & other services you would use insurance for will be considered 'elective' and will be postponed. Do you want health insurance?#ACA #Obamacare

— Greg Fann (@greg_fann) April 7, 2020

The more things change: CV-19 & BI

I know, I know, another Business Interruption post - enough, enough!

Except, well, not really:

To recap, Business Interruption coverage is supposed to help reimburse lost revenue due to a covered, physical loss (such as a fire, or a flood, etc). The issue at hand is whether or not a business forced to close because of the current pandemic is entitled to such reimbursement, since the physical structure remains intact (and distinct from a claim arising from actual contamination). As we've previously mentioned, the answer would presumably be 'No,' but that has since morphed to 'potentially Maybe.'

/sigh

So there's been a loud hue and cry from affected businesses that are facing significant cash flow (as in, zero or very little) problems because they've been forced to close (or drastically pull back). And of course there's increasing pressure on The Powers That Be© to "do something."

But is this wise, let alone appropriate? What should the government's role in this conundrum be (if any)?

Well, let's set the Wayback Machine to almost eleven years ago:

"It’s still far from the norm, but governments around the world are becoming increasingly involved in providing terrorism reinsurance. In addition to catastrophe cover, some are addressing business interruption ... Government involvement has become necessary ... as private insurers and reinsurers would otherwise step back from these risks – either by reducing their exposure or eliminating it completely."

Please note that last: "eliminating it completely."

But is that what really happened?

Well, as our friend and P&C Guru Bill M tips us, pretty much:

"[M]ost companies will probably find it difficult to get an insurance payout because of policy changes made after the 2002-2003 SARS outbreak ...  led to millions of dollars in business-interruption insurance claims ... As a result, many insurers added exclusions to standard commercial policies for losses caused by viruses or bacteria."

With the (predictable) result that carriers have what appears to be a bullet-proof claims-denial capability.

So, as with the airline and travel industries (among others), there's a concerted, vocal effort for government intervention:

"[P]roperty and casualty insurance companies are facing growing pressure to tap the industry’s $822 billion in cash reserves.

Lawmakers in New Jersey, Massachusetts and Ohio are considering forcing retroactive policy changes to cover coronavirus business-interruption claims."

Counter-balanced against that, of course, is the (inconvenient?) fact that such coverage was never underwritten, and for which no premium has ever been paid.

#WhatCouldGoWrong?

But is this actually necessary? That is, what if there already existed a policy to cover these circumstances? Surely these would sell like corndogs at the state fair, right?

"Pandemic business insurance — complete with virus coverage — is offered by the broker Marsh."

Oh, that's great! So problem solved, right?

Turns out, not so much:

"It launched its outbreak insurance in 2018.

A few companies in the hospitality and gaming industries showed interest.

But not a single policy was sold."

So, given that, is there some role for government here?

One more trip in the WBM:

"[T]he Terrorism Risk Insurance Act of 2002 to create a “temporary” federal backstop against catastrophic losses. This program subsidized private risk with public funds through a cost-sharing program for which the government does not receive any compensation."

So, government as BI backstop may yet be "a thing."

Guess we'll just have to wait and see.

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.

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 Healthcare.gov (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 healthcare.gov. 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.

#Medicaid4AllFail

Is this something?

New guy on the block:

Looking for health insurance outside of Open Enrollment? @Decent's Chief Health Plan Officer @Molly23Moore explains your options. If you're self-employed in Austin, we have the only comprehensive plans for sale year round at https://t.co/8eZ1l17obM. Either way, we can help. pic.twitter.com/mPbsnyYhgl

— Nick Soman (@nicksoman) April 1, 2020

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."

Nice!

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!

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'!).