From the P&C Files: Freeze!

It may not seem like it now (at least here in southwest Ohio), but sub-zero weather is around the corner. And that means a lot of folks will be in danger of severe damage from their home's water pipes freezing and bursting.

The Cincinnati Insurance Company has thoughtfully provided this helpful video to share with our readers about how to prevent this from happening:


Prevent Frozen Pipes from The Cincinnati Insurance Company on Vimeo.

Thanks, CIC!

Bye, Bye Grandma!

We've written about Grandmothered plans (most recently here), focusing primarily on individual major medical policies. But these rules also apply to group plans, and the clock's ticking on them, too.

Grandmothered plans are those which were issued after ObamaCare was established, but were given a "hall pass" from many of its mandated "benefits." Much like the Doc Fix that kicked Medicare's provider reimbursement cuts down the road, Transitional Relief was ObamaCare's safety valve that allowed these plans a temporary reprieve. For the past several years, group clients have been able to re-cast their renewal date to continue to take advantage of it.

In theory, this will be last time (since no one really knows what's going to happen under the next administration). But, carriers are soldiering on; I received this in email today from United Healthcare:

"For many customers, there are significant cost implications in the change from Transitional Relief to ACA compliant plans ... you may be interested in changing your renewal to Dec. 31, 2017 ... This allows you to take advantage of the extension of Transitional Relief and keep the coverage you like for the maximum period currently allowed by law"

'Course, I'm old enough that I remember this.

In the event, UHC (and, of course, other carriers) is contacting its group clients to offer them a bit of relief.

Based on recent quotes I've seen, this is definitely an offer they shouldn't refuse.

MVNHS©: "We could tell you, but then..."

You can't make this stuff up (well, you could try, but then reality's still going to trump you):

"NHS chiefs are trying to keep plans to cut hospital services in England secret ... Managers were even told how to reject freedom of information requests"

Of course, now this particular cat's out of the bag, so it'll be interesting to see how successful MVNHS© bureauweenies will be in fighting off those FOI requests. And just what are they trying to cover up?

Well, according to leaked information, the cuts include the closure of at least one hospital in London, maternity and stroke services country-wide, and the forced merger of four hospitals in Merseyside, to name a few.

There are actually quite a few services and facilities on the chopping block, which is interesting because we've been told that nationalized health care schemes deliver better care than ours at a fraction of the cost, effectively bending the cost curve down.

How's that working out for the Much Vaunted National Health System©?

[Hat Tip: Ace of Spades]

Rx Ch-ch-changes

Interesting news from Medical Mutual of Ohio (via email):

"Ensuring Members’ Specialty Drug Costs Are Accurately Reflected in Benefit Accumulations

Beginning January 1, 2017, only the amount a member truly pays out of pocket for specialty drugs, when filled through one of our contracted specialty pharmacies, will accumulate toward the member’s annual deductible and/or maximum out of pocket (MOOP)."

Now, this applies only to ACA plans (on- and off-Exchange), but I'm guessing that these make up the bulk of MMO's current individual book of business. The impetus for this new process is the use of those ubiquitous manufacturers' coupons for pricey meds.

The example they gave was a drug that cost $500 but the insured had a manufacturer's coupon for $450, bringing their actual out-of-pocket cost for that scrip to $50. In that case, the insured's "balance" would be credited the actual amount paid.

MMO also pointed out that these coupons, while essentially disguising the true cost of a given med, may actually be leading to over-utilization:

"Over the past five years, the use of manufacturer’s coupons for high-cost brand-name drugs contributed to an additional $700 million to $2.7 billion in drug spending. We believe the amount of financial assistance received for specialty drugs by the Medical Mutual ACA plan population could exceed $3 million in 2017."

Hence, finally applying some brakes to this runaway train.

And I get that. As I mentioned to co-blogger Patrick:

"I have no problem with this.

1 – If they only spent $50, they only spent $50.

2 – I do wonder how much over-utilization results from mfrs sending out these coupons. OTOH, I 'get' that there are folks who couldn’t afford the med otherwise, and that gives me pause. On the gripping hand, there are no perfect solutions."

And Patrick agrees:

"I think of it this way, under a PPO plan with $25 copay the member pays only that amount. The difference between negotiated and copay don't go toward the MOOP just the copay does. I know it's not exactly the same due to a "coupon" but the reality is not everyone gets the coupon. Members who do receive them should rejoice that they aren't paying the whole amount. Members who don't receive them have a greater expense and therefore should get credit toward the MOOP for what they pay."

Point being: you don't (shouldn't) get credit for expenses that you don't, in fact, incur.

Kudos to MedMutual. 

Why can no one spell?

Apparently, the folks at the Washington Free Beacon can't spell "$2,500 premium savings:"

"Obamacare premiums will increase by 27 percent next year ... the government’s increase of 22 percent “can be misleading” because most of the 2017 Obamacare plans will be new"

That's because carriers have been deleting plan after plan in order to find some way to staunch the flow of claims dollars. And of course, carrier after carrier has been leaving the market completely, to the point that "one-third of the country will only have one insurer to choose from in the exchanges."

Regardless of what the new administration does (or doesn't do) come inauguration day, the die has been cast - for at least a while - for folks signing up now.

Talk about train-wrecks.

#ObamaCareWinning

[Hat Tip: FoIB Holly R]

Car Insurance That Pays For Routine Maintenance

Wouldn't it be nice if our car insurance covered the cost of routine maintenance?

Get new tires for a small copay. Free oil changes, every time.

Radiator flush?

No problem. Send the bill to my auto insurance carrier.

But it doesn't work that way. And that is a good thing. If all you had to do for routine auto expenses was have the bill sent to you car insurance carrier I doubt many of us could afford car insurance.

Since your car insurance does not pay for routine services, there is a price chart on the wall when you take your car in for work. If what you need isn't on the wall you can ask and the service manager will quote you a price.

But it doesn't work that way for health care. And it probably never will.

Enter Trumpcare 

Some agents I know have been debating suggestions for Trumpcare which is expected to be a much improved version of Obamacare. When the new model is available in the show rooms, and whether people will want to trade in their old Obamacare plan for a shiny new Trumpcare plan is subject to speculation. When it happens we will see. Until then, suggestions for Trumpcare are simply fodder for discussion.

Price Transparency

One of the hotly debated items is price transparency. More than one member of our roundtable wanted to know why we don't have price transparency when it comes to health care.

If I need to get my car repaired, I know exactly how much it will cost before  I have the work done.

True.

But who will pay the bill?

The person who owns the car.

And who pays the doctor or hospital when you get sick?

The lions share, typically 80% or more, of your medical bills are paid by the insurance carrier.

Networks

There is no transparency because of provider networks. That's why 5 people can go to the doctor for the exact same procedure and pay 5 completely different amounts.

Networks can be frustrating but they also save us money.

Without network pricing we would never know if we were being overcharged or not.

Without networks we could be balance billed for amounts over and above what the carrier says is a reasonable charge.

No matter what your doctor or hospital charges for treatment, almost invariably someone will say they have been overcharged. Who are we (as patients) to say that $12,000 is too much to pay to take out a bum appendix? Does it really matter, as long as the pain stops and you are once again fully functional?

Networks set the pricing for removing an appendix. You may still think the doctor and hospital are overcharging but so what? You are paying 20% (or less) of that cost of your care.

Network pricing results in a pre-determined cap on how much you pay for the procedure. There is no balance billing.

And that is a good thing.

#Obamacare  #Trumpcare

Promising Health News

Some potential good news for fans of the Much Vaunted National Health System©: they may be able to move on from using maggots to treat MRSA.

How's that, you ask?

Well:

"A 25-year-old student has just come up with a way to fight drug-resistant superbugs without antibiotics."

The greatest challenge in treating these "superbugs" is that we keep throwing stronger and stronger anti-biotics at them (with who knows what effects on ourselves) and pretty soon they become inured to them (think Borg). Now, Ms Lam (a 25 year old Australian PhD student) has developed what seems to be a microscopic shuriken that literally rips the bugs to shreds.

It's still early days, so we likely won't be seeing this in use on humans soon, but very cool.

Kudos, Ms Lam!

[Hat Tip: Ace of Spades]

Another ObamaCare Success Story

For certain values of "success" (via Dr John Goodman):

"The IRS demanded John payback the subsidies he had already received which amounted to $6,900 hit on his taxes. In order to pay back what he owed John took out a 2nd mortgage on his home."

The victim citizen (called "John" in the post to protect his identity) found, through a series of unfortunate events, that his previously "affordable" coverage was no longer such a deal, and as a result of clawback was forced to cough up almost $7 large. Adding insult to injury [ed: do ObamaPlans cover those?] their insurance plan now costs over $7,000 a year, and then another $12,000 in out-of-pocket.

But hey, Mrs John gets free birth control convenience items.

So, success.

On Veteran's Day 2016

[Jennifer Agnello, President of Cornerstone, has graciously granted us permission to share her profound, heart-felt thoughts on this day honoring those who've served]

"In honor of Veterans Day...

After a big week in our country, (no matter how you voted), tomorrow is a day where we should all be especially thankful.  In honor of Veterans Day, please take some time to remember that it is because of our veterans we all enjoy the freedom to express our own opinions and choose to vote however we individually see fit.  Please pause to recall the sacrifices that our Soldiers, Sailors, Airmen, Marines, and Coast Guardsmen have and will continue to make, serving our Nation where and whenever they have been called upon. These courageous and brave individuals have sacrificed family life, their careers and potentially their lives by willingly taking on the greatest responsibility, upholding our freedom.  They have voluntarily joined the ranks of America's Armed Forces, fully aware of their obligations as citizens and the risks they are taking in order to stand for what our country believes in and what it was founded upon.  They serve and have given their lives for the USA with courage and unquestioned commitment, for all of us.

Through their sacrifices they have secured for millions of others the blessings of freedom, democracy, and the unmatched opportunity that we enjoy in the United States today.

Please thank and/or remember those special folks.  Cornerstone has several employees who have served (Eric Pouncy, Hal Demmerle and Miles Massey) and many more have family members currently serving or whom have served in the past and they deserve to be recognized and respected.

We have chosen to give our own Veterans ½ day off on Friday afternoon to show our appreciation corporately.

Thank you to our employees and families for making this sacrifice.  We are grateful to you for allowing us to continue to live in a thriving, peaceful, FREE country.  Have a safe Veterans Day, and as always, God bless the United States of America.

...Please take the time to THANK A VETERAN."

[Thank you, Jennifer. HGS]

Omens & Portents, Part Two

Via email an hour or so ago:

"Important Notice: Discontinuance of Individual LTC Insurance Sales

To our LTC Distribution Partners and Producers:

After a recent analysis of the macro-economic trends facing the long-term care (LTC) insurance industry, we have made the difficult decision to discontinue sales of our individual LTC insurance policies in all states.  As many of you well know, the distribution landscape for LTC insurance has shrunk significantly since the peak of the industry in 2002.  Today, there are far fewer outlets through which individual LTC insurance is sold, impacting the growth potential of the product.  In addition, consumer demand for individual LTC insurance has fallen and remains stagnant. These trends, combined with the significant capital requirements of the LTC insurance business, are the primary reasons for this decision, which was not taken lightly."

Hancock has been an 800-pound gorilla in the Long Term Care insurance market for as long as I can recall.

So I reached out to our friend and LTCi guru Ray C for his thoughts, and he reminded me that "several years age, ManuLife purchased John Hancock.

I believe this change is now saying, they wanted Hancock for life and annuity - investments and not long-term care.

We stopped doing John Hancock three years ago.

So, we see no negative impact on our business - but another black eye on the industry."

I'm glad he reminded me of this, because I then went back and saw this in a post from '13:

"Executives at Manulife Financial ... think the benefits of staying in the private long-term care insurance (LTCI) market outweigh the benefits of getting out."

Looks like they've had a change of heart.

Omens & Portents

I haven't commented on the fate of ObamaCare in the wake of Tuesday's election, nor do I currently have any plans to do so. But I was intrigued by one specific electoral result:

"Amendment 69, the ballot measure known as ColoradoCare that would have created a universal health care system in Colorado, was soundly defeated Tuesday night."

On the one hand, I've always championed the 58-state laboratory model; that is, rather than the one-size-fits-very-few ObamaCare debacle, that each state should be free to try out its own proposed solution(s). So I was actually rather happy to see Colorado put it on the ballot.

On the other hand, many of us have said all along that Single Payer was the ultimate goal of ObamaCare in the first place, so the results of this ballot measure are telling: it went down in flames 4:1 (~80% to 20%). That's a clear repudiation in a state that went pretty solidly for Mrs Clinton.

So what message should one take from this?

Well first, it seems to vindicate the state-by-state laboratory model (as if it needed vindication). And second, the end-game of ObamaCare might not be as  inevitable as its proponents may have believed.

Election Day Special

[Originally published March 3, 2009, re-posted today in honor of this "very special" election]

The Americans With No Abilities Act
Washington , DC - (Dateline March 3, 2009) President Barack Obama and the Democrat controlled Congress are considering sweeping legislation that will provide new benefits for many Americans. The Americans With No Abilities Act (AWNAA) is being hailed as a major legislative goal by advocates of the millions of Americans who lack any real skills or ambition.

"Roughly 50 percent of Americans do not possess the competence and drive necessary to carve out a meaningful role for themselves in society," said California Senator Barbara Boxer - Democrat. "We can no longer stand by and allow People of Inability (POI) to be ridiculed and passed over. With this legislation, employers will no longer be able to grant special favors to a small group of workers, simply because they have some idea of what they are doing."

In a Capitol Hill press conference, House Majority Leader Nancy Pelosi – Democrat, and Senate Majority Leader Harry Reid – Democrat - pointed to the success of the U.S. Postal Service, which has a long-standing policy of providing opportunity without regard to performance. Approximately 74 percent of postal employees lack any job skills, making this agency the single largest U.S. employer of Persons of Inability.

Private-sector industries with good records of non-discrimination against the Inept include retail sales (72%), the airline industry (68%), and home improvement warehouse stores (65%). At the state government level, the Department of Motor Vehicles also has an excellent record of hiring Persons of Inability (63%).

Under AWNAA, more than 25 million mid-level positions will be created, with important-sounding titles but little real responsibility, thus providing an illusory sense of purpose and performance.

Mandatory non-performance-based raises and promotions will be given so as to guarantee upward mobility for even the most unremarkable employees.. The legislation provides substantial tax breaks to corporations that promote a significant number of Persons of Inability into middle-management positions, and gives a tax credit to small and medium-sized businesses that agree to hire one clueless worker for every two talented hires.

Finally, the AWNAA contains tough new measures to make it more difficult to discriminate against the non-abled, banning, for example, discriminatory interview questions such as, "Do you have any skills or experience that relate to this job?"

"As a Non-abled person, I can't be expected to keep up with people who have something going for them,"said Mary Lou Gertz, who lost her position as a lug-nut twister at the GM plant in Flint , Michigan , due to her inability to remember rightey tightey, lefty loosey."This new law should be real good for people like me," Gertz added. With the passage of this bill, Gertz and millions of other untalented citizens will finally see a light at the end of the tunnel.

Said Senator Dick Durbin (Democrat-IL), "As a Senator with no abilities, I believe the same privileges that elected officials enjoy ought to be extended to every American with no abilities. It is our duty as lawmakers to provide each and every American citizen, regardless of his or her inadequacy, with some sort of space to take up in this great nation and a good salary for doing so."

Life to the Max, Opportunity Missed

We've blogged on Pension Maximization before (most recently here); briefly, it's using life insurance to cover the shortfall if one chooses the "no period certain" option at pension decision time.

In that case, the gentleman in question was able to retroactively resolve a potentially disastrous situation.

Today, I learned of a situation with a much sadder ending:

Susie, my longtime client, asked if I would help her recently widowed mother with her health insurance. Even though I've sent the bulk of my clients to Cornerstone for assistance, Susie and I determined that this case needed a more personal, hands-on touch, and so I met with them this morning. As I expected, Nancy (her mom) is every bit as lovely and bright as her daughter, and we started discussing her needs. What I had not known prior to this morning was that Nancy's husband (Susie's dad) had passed away, unexpectedly, in July.

This caused Nancy some major collateral damage: when Joe had retired 18 months before, he'd chosen the pension option with the greatest monthly payout, which stopped when he did. To further compound the problem, this also meant that she was no longer eligible to keep the health insurance. And adding insult to injury, while Joe had told her that he had $200,000 in life insurance, the policy was actually only $25,000, a good chunk of which went to pay for his funeral.

The good news (for certain values of "good") is that she qualifies for a pretty substantial health insurance subsidy next year. The bad news is that she never replaced her health insurance, which ended in early August. Now it's too late (she missed the window for a special open enrollment opportunity). She likely qualifies, however, for a hardship exemption from the ObamaTax.

Still, had she and Joe sat down with a professional agent (*cough*) when they were getting ready to pull the retirement trigger, perhaps she could have avoided this unfortunate situation.

Food for thought.

SHOP Sweat

How desperate are the rocket surgeons in DC to make something - anything, really - of the Small Business Health Options Program (SHOP)? This desparate (via email from CMS):

"Do you know that from November 15 through December 15, small businesses can enroll in SHOP Marketplace coverage without meeting a Minimum Participation Rate (MPR) requirement? Think about your new and existing clients who may not otherwise be able to meet the minimum participation requirement."

Now why is this a big deal?

Well, let's just say that the response to the program has been underwhelming:

"After nearly two years in operation and millions of dollars spent in development ... about 85,000 people, from 11,000 small businesses, have coverage through the [SHOP]."

So now we know why the gummint would (illegally, natch) lift its own requirements. But then one is faced with the dilemma of Chesterton's Fence:

Carriers require certain participation levels because of "adverse selection;" that is, if only those with health problems sign up, then the carrier is going to be losing money very quickly since there's no corresponding offest from healthy employees.

But then, understanding basic insurance principles was never a strong suit of O'care proponents in the first place.

"In the end, there can be only one"

In email from our friends at Cornerstone:

"In 2017, the Centers for Medicare and Medicaid Services (CMS) will automatically re-enroll individuals of discontinued “on exchange” plans into similar plans offered by other carriers still selling in the marketplace."

To be sure, with so many carriers ditching the marketplace for the 2017 plan year (and, perhaps, beyond), such a streamlined process makes a certain amount of sense. And as we're also seeing, Blue Cross seems to be the one carrier still left standing in state after state.

Still, doesn't it seem a bit...presumptuous for a government entity to so brazenly (and without much fanfare, really) automagically assume that citizens prefer that the choice be taken from them?

Or, as FoIB Allison B so wryly observes, "Anthem gets everybody."

Indeed.

Obamacare Gaming Edition

Obamacare is almost 3 years old and an even bigger mess than ever. The billion dollar website still crashes and is not fully functional. Navigators and "enrollment assistants" are nothing more than phone jockey's trained (in a manner of speaking) on how to key in questions and read answers off a computer monitor.

Most have no clue about the difference in a PPO, POS or HMO plan. Of course with most of the PPO/POS plans going away that will make their job easier.

Drug formularies are another story.

But this is to be expected when health insurance agents with years of experience are forced out of the market only to be replaced by former minimum wage workers who have gone through 2 weeks of training and are now earning a "livable wage" of $17 per hour.

Savvy consumers who are not subsidized and are now facing monthly insurance premiums higher than mortgage payments and STILL required to shoulder tens of thousands in out of pocket expenses before the carrier pays a single dime are saying ENOUGH!

Consider the case of Will Denecke.

Will Denecke, a self-employed urban planning consultant in Portland, Ore., said he planned to skip buying health insurance for 2017 because the premium had shot up to $930 a month. Instead, the 63-year-old man said if he developed a medical issue sometime during the year, he would go to the Affordable Care Act marketplace and buy a plan outside the open-enrollment window, which he's aware he's not supposed to do. 

He said the ACA rules sharply limiting such midyear enrollment are easy to get around. Last time he simply claimed a change of income. “I've done it before, and my broker helped me - Modern Healthcare 

Obamacare is three years old and DC still hasn't closed all the loopholes. Agents, the few that have not left the business, are sticking it to the government and carriers every day.

Too bad Obama and company pissed off some of the most talented people this industry has ever known.

#ObamacareFail

If you like your doctor...

Remember this:



Ah, good times, good times.

Reason I ask is this:

"The number of physicians who say they’re accepting health insurance plans offered on Obamacare’s federal and state marketplaces has plummeted nearly 20 percentage points"

Now, we've blogged on this for a long, long time, but as we head into Open Enrollment v4.0, it's not enough to make sure your plan is affordable, but that it's actually useable. That is, all those "freebies" (colonoscopies, mammograms, routine physicals)? Well, they're not going to be free if your doc doesn't take your plan. And good luck finding a new provider:

"[O]nly about 57 percent of doctors said they'll be taking new patients insured by the plans next year"

That's less than two-thirds, and may be even worse in some areas.

#ObamaCareWinning

[Hat Tip: HotAir]

Game 7 Health Wonk Review is up

Brad Wright hosts this week's World Series (and election) themed collection of the best health care wonkery on the 'net.

And, like the Cubs this year, a winner indeed.

Heads' I win...

There's a popular meme circling the 'net that says the rate increases really won't affect most people because their subsidies will cover the spread:

"Yet most Obamacare participants won’t feel the full price hike or anything near it. Nationally, 85% of those enrolled receive a tax credit"

This is why I get so frustrated with the media, which seeks to isolate the Marketplace (Exchange) from the big picture: all ACA-compliant plans are ObamaPlans, not just those on the Exchange. That is, if it's ACA-compliant, then it's ObamaCare. By trying to split "ACA compliant" from "bought on the Exchange" these oh-so-clever "journalists" seek to put daylight between the two that doesn't actually exist.

The reality is that yes, most folks who buy on the Exchange are going to be getting subsidies (aka "a several hundred dollar health insurance gift card from taxpayers"), which is the only reason one should even consider buying there. But this completely misses the point that most folks don't buy on the Exchange or receive subsidies, and thus feel the full brunt of these fully operational Death Stars rate hikes.

And these same reporters also ignore the fact that even those "shielded" from rate hikes are still going to feel the MOOP pinch.

What's "the MOOP pinch," you ask?

That's the newly increased Maximum Out of Pocket limit. Care to see how this works in the real world?

Well, FoIB Jeff M has graciously forwarded his own plan rates and specs for this year and next:

So not only does he have the privilege of paying almost $3,000 a year more in premium, but his out-of-pocket increased by $300.

One supposes he doesn't feel "shielded."

[Hat Tip: HotAir]

O'Care Implosion (Anecdotal)

So got a call yesterday from a very nice lady who was looking for information on health insurance, and specifically an HSA plan. Seems she and her husband have been uninsured for several years, paid the tax penalty fine, but were thinking maybe it's time. She'd apparently been calling around, and no one was returning her calls.

I explained to her that if this had been a few short years ago, I would have been surprised, but that times have changed. Nevertheless, I was willing to see if we could help her out.

First, I completed a referral form to send to Cornerstone. She was concerned that, due to their ages, she and her husband would find premiums, even for an HSA-compliant plan, unaffordable. I think she was expecting me to pooh-pooh that, but of course I did not (could not). All I could say was that the fine folks at Cornerstone would do the best they could for her.

She had mentioned that they were self-employed, and that her husband was the minister of a small congregation. So I asked if they'd looked into a health care sharing ministry; she said they'd had a very bad experience with one such, and so I dropped that and asked if she was aware of the Direct Primary Care model.

She was intrigued.

So I offered to see if  we could help connect her with a DPC provider in her area, which was fine with her. I reached out to Dr Rob, of course, but also others I know in that field. Within a few hours I had a handful of leads for her, which I of course passed along.

I've asked her to keep me apprised of what she ends up doing; she's under no obligation to do so, of course, but I'm really curious to see how this turns out. Developments here as they occur.