On keeping your plan if you like it

By now, posts on "grandfathered" and "grandmothered" plans must seem like old news. And yet, the hits keep on comin'. In email from Medical Mutual of Ohio:

"“T" Plans Now Available on MyBrokerLink/Converting Grandfathered "S" Plans to New Grandfathered "T" Plans"

Clear as mud, no?

This is what happens when the government takes over the health insurance industry (and make no mistake, if you exercise control over a market segment, you own that segment). And so we get authentic frontier gibberish like the above.

Oh, what does it mean?

Basically, the Feds have graciously (and illegally) allowed insurers to make modest changes to grandfathered/grandmothered plans, which MMO will be implementing as they renew. This particular email targets small group plans. The change is ostensibly an effort to help hold down premiums; let's just say that I'm not holding my breath.

Another One Bites The Dust

Obamacare continues to claim victims as it marches forward. Lost insurance coverage and job loss.

Employees of Assurant are about to be the latest victim.

With Milwaukee-based Assurant Health continuing to bleed red ink, its parent company announced in a Tuesday news release it will either sell the health insurer or exit the health insurance business. - Bizjournals

The company was established in 1892 and was profitable every year until 2013.

Assurant Health posted a $63.7 million operating loss in 2014. Assurant Inc. said Tuesday Assurant Health will report a net operating loss for the first quarter in the range of $80 million to $90 million.

Assurant has more than 1,000 employees and over 1 million policyholders.

If Assurant Inc. does not sell Assurant Health, the parent company will begin the process this year of exiting the health insurance market and will not participate in the next ACA open enrollment period beginning in November.

Goodbye.

#Obamacare  #Assurant

Covering Baltimore

As was the case in Ferguson last year, the riots in Baltimore over the past few days have caused widespread property damage, mostly to folks who had nothing to do with the proximate cause of them:

Homes, businesses and cars have been burned, looted and otherwise damaged, leaving owners wondering what, if any, insurance payments they can expect.

The Insurance Information Institute (III) has helpfully published a media advisory confirming that, generally speaking, such damage is considered a covered event, and claims will likely be honored:

"Auto, homeowners, and business insurance policies generally include coverage for property losses caused by riots and civil commotions, such as those occurring this week in Baltimore ... Standard business property insurance policies provide coverage for the structure of the building as well as the contents inside"

And for folks with Business Interruption coverage, "insurance reimburses losses when a covered peril forces a business to temporarily close its doors ... [and pays] employees and vendors, not to mention the rent and electric bills."

Whew!

As always, be sure to check with your own carrier to confirm whether or not these exposures are, in fact, covered.

Employer Sponsored Insurance: Behind the Little Tree is Obamacare's Forest

Obamacare was passed with a promise to reduce premiums, elevate the level of care we receive, and put an end to rising health care costs. It was also promised that everyone would have access to good insurance and that if we liked our plans we could keep them. These promises have gone empty, yet in the eye of public perception, the favorability/unfavorability of the law (according to the Kaiser Family Foundation Poll) is tracking close to even. However, the most important question that is asked, but not discussed, is what will lead to changes in views in the next few years.

For now, the favorable perception can be attributed to the fact that Obamacare is front loaded with warm and fuzzy feel good benefits. From "free" benefits like birth control and preventive visits, to the slacker rule - keeping your "kid" on insurance to age 26 - every provision of the law that has been implemented has a positive result.

On-the-other-hand, things that have a negative impact have been repealed, cancelled, delayed, or extended. We have had a repeal of the 1099's and CLASS Act, an offer to extend "transitional" policies (the lie that if you like your plan you can keep it), and numerous delays in employer reporting including a year long delay in the employer mandate. We also haven't felt the impact of "indexing" which will increase what people have to pay for premiums while reducing benefits.

In keeping with the "kick the can down the road" theme, two new pieces of legislation are gaining momentum. One is to repeal the Health Insurance Tax and the other - introduced today - is to eliminate the Cadillac Tax.

These taxes, reduced benefits, higher costs, and administrative burdens will increase over the next few years. Moreover, they will reach the employer sponsored markets impacting a much larger share of our population (roughly 55% of our population are covered by their employer). 

Which takes us to the most important question asked when discussing public views on Obamacare:

"Would you say the health care law has directly helped you and your family, directly hurt you and your family, or has it not had a direct impact?"

It's not who has been helped (19%) or hurt (22%) by the law. It's the significant majority of respondents - 56%!!! - who have felt no direct impact.

It's not a coincidence that the respondent percentage is almost identical to those with employer insurance. It shows that until Obamacare is fully implemented and a majority feels an impact, public opinion will see little change.

But until then, we will still be focused on the trees and completely be overlooking the forest.

Monday Afternoon Link Potpourri

Some interesting items for your consideration:

■ "Nearly a fifth of the National Football League settlement approved this week compensating former players with head injuries could go to their health insurers instead"

Briefly, the NFL settled a players-filed lawsuit asking for compensation for life-altering head injures. The problem is, most of the costs associated with treating those injuries were borne by the players' health insurers. Under the concept of subrogation (a common feature in health, auto and other indemnity-based insurance products), the players waived their rights to any amounts rewarded that could go towards reimbursing those carriers. It's not really "news" except that most people haven't read their policies, and are unfamiliar with the principle.

■ Next up, this helpful info courtesy of FoIB Jeff M:

"COBRA considerations when Medicare-eligible. Clients may not realize the need to combine them."

A lot of folks who've recently retired (voluntarily or otherwise) opt for COBRA continuation of their previous coverage, since that's often the path of least resistance. But that may, in fact, be disastrous:

"With rare exceptions, COBRA coverage is secondary to Medicare Parts A and B ... The result is that when Medicare-eligible individuals do not have Medicare Parts A or B, they are left to pay 80% of their costs out of their own pocket."

And that's not all:

"Medicare has a window of opportunity to enroll in Medicare Parts A and B that lasts eight months after leaving employment."

Miss that special enrollment opportunity and you're facing a lifetime of fines once you do manage to sign up, which could also be a while.

Good info here.

■ Finally, some news on the viatical front:

"In 2013, the top 15 life settlement providers paid more than $362 million for unwanted life insurance policies."

That "investment" was worth a potential $2.2 billion in death benefits. It's also a major (29%) increase over the previous year. But what's driving this thriving [ed: really?] market?

According to the article, it's a rebounding economy, with institutional investors looking for better returns. I'm not convinced: it seems to me that more and more middle class folks, still hurting in a reduced labor market, are looking for ways to raise capital quickly, and what better way than to sell off unwanted (or unaffordable) policies, raising quick cash and easing the budget?

Running on Empty

California is running out of water and money.

Gov. Moonbeam blames global warming and wasteful usage on things like lawns and toilets for the water problem. But what about the money issue?

Covered California, the Obamacare exchange for residents (legal or otherwise) of Kalifornia, was built with seed money from Obama's fat wallet. Problem is, those funds are running dry.

Indeed, there’s no more money coming from Washington after the state exhausts the $1.1 billion it received from the federal government to get the Obamacare exchange up and running. And state law prohibits Sacramento from spending any money to keep the exchange afloat.

That presents an existential crisis for Covered California, which is facing a nearly $80 (billion) budget deficit for its 2015-16 fiscal year. Although the exchange is setting aside $200 million to cover its near-term deficit, Covered California Executive Director Peter Lee acknowledged in December that there are questions about the “long-term sustainability of the organization.” - OC Register

Unlike the federal govt, the Republik of Kalifornia cannot print their own money and must balance the budget.

What a novel idea.

But wait. There's more.

Covered California’s enrollment growth for 2015 was a mere 1 percent, according to a study this month by Avalere Health. That was worst than all but two other state exchanges. Meanwhile, California’s Obamacare exchange managed to retain only 65 percent of previous enrollees, the nation’s fourth-lowest re-enrollment rate.

Not only are they running through money like it was water, but they aren't doing a very good job of managing resources.

OK, maybe that water analogy was a cheap shot.

#Obamacare #CoveredCalifornia

Working for Free

Agents that dared venture into the Obamacare morass at healthcare.gov are discovering, in many cases, they

were donating their time and expertise for the cause.

If you want to get paid on business submitted through goodluck.gov the form that is transmitted to the health insurance carrier must have you identified by your NPN (National Producer Number). That number is the key to getting paid.

Without it, you get nada.

CMS recently identified that healthcare.gov is not always passing the agent's name and National Producer Number (NPN) to health insurance carriers. As a result, Highmark cannot assign agent and agency numbers to these policies, and commission cannot be paid.
If producers believe this information is missing, they should contact their General Agency (GA). The GA should then check the daily activity reports and commission statements to see if this information was sent to Highmark, prior to taking any additional action. Please note - the producer hotline cannot verify if the agent's name or NPN is on an application. - URLINS

Is this a glitch or something deliberate?

Could be either. No way to know.

There have been rumors that hc.gov enrollers are being instructed to strip NPN's from the file if they have any direct contact with the applicant during the application stage.

But it could be something as simple as a hard drive crash ............... or the server being stripped of this information.

From the Life Files

So about 30 years ago, my since-retired colleague wrote a policy on a 30 year old client (whom we'll call Gene). Gene's wife was named as the beneficiary, and all was well.

A few years - and two children - later, Gene and his wife divorced, and Gene changed the beneficiary of his policy to his brother.

Problem is, he never told his brother (or his kids) that he was doing so. Recently, Gene passed away, and his ex-wife called me to inquire about the policy. I called the home office and confirmed that a) he did, in fact, have a policy (and it was in force) and b) his brother was the beneficiary (again, news to all of us).

Fortunately, the brother lives relatively close by, and was in town attending to the funeral arrangements and such. I was able to connect with him, and we met yesterday to complete the claims paperwork (we're still awaiting the official death certificate, without which the claim can't be paid).

That's when I learned that not only did Gene never tell his brother about the policy, but that he died without a will (aka intestate for all you legal-beagles). The brother had no idea what Gene wanted to do with the proceeds of the policy (well, the balance after final expenses), nor of his house or other belongings. He's decided that he'll just divvy up the balance with his nieces once all the (modest) estate costs are settled.

This is just so sad: Gene died alone, and never made his wishes known to those that were (ostensibly) closest to him. I suppose there's a lesson here, somewhere, but danged if I know what it is. Any suggestions?

Health Wonk Review - Windy Spring edition

HWR co-founder Joe Paduda hosts this week's outstanding round-up of wonky blog posts, with an emphasis on the ACA. Come for Louise Norris on coverage gaps, stay for Dr Jaan Siderow's "pretty cool" moment.

News from Ms Burntwell

Actually, there are quite a few ObamaTax-related items cluttering the in-box. In no particular order:

■ A dataset which purports to provide "the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the [404Care.gov] platform." It includes basic plan info about which plans folks in a given area selected during Open Enrollment. It's not clear how many (if any) of these folks actually bought a plan at all.

■ A handy little (one page!) .pdf letting us proles know how much HHS collected from reinsurers in 2014 to offset costs of the Transitional Reinsurance program. Spoiler alert: thus far, less than 75% of target.

■ The death of the insurance agent's role has been more than a little exaggerated. Case in point:

"The drafters of the [ObamaTax] seemed to think that brokers were mostly a waste of money ... For a look at how the new, humbled SHOP exchange system has done since then, read on."

Please do.

The reality is that (competent, professional) agents do far more than just suggest plans designs. They are an integral conduit between the client (individual or employer) and the carrier. Of course, that sales role can't really be underplayed, as witness the fate of the SHOP (Small group insurance exchange):

"HHS has been notoriously reluctant to release any numbers hinting at how many employers or workers might be using SHOP plans"

Any bets on whether that would hold true were it a rousing success?

Thought not.

Now, I happen to be one of those (competent, professional) agents who is authorized to sell SHOP plans. I can tell you that I have yet to experience any employer asking me for a SHOP quote (neither current clients nor prospects). I have suggested to a few current clients that we at least look into it, but when they learn what's involved, well, any interest seems to fade away quickly.

It may be the cumbersome (but intrusive!) data entry process, it may be the confusing requirements, or some combination of these and other factors. But it's certainly not surprising.

And speaking of cost of care....

Yesterday, we noted trends in cost of healthcare over the next decade. But what about the cost of Long Term Care? Well, the folks at Genworth have just released their latest "Cost of Care Survey," including an interactive map and state specific data.

According to the Executive Summary:

■ The National Median Hourly Rate for home ehalth aides is $20
■ Adult Day Care now runs about $69 a day
■ Assisted Living Facilities now north of $3600 a month
■ And full on nursing care is $220 a day (semi-private room)

Now's an excellent time to review your current coverage, or to contact a reputable, independent agent with experience in this market.

In the meantime, you can stop by Genworth for even more in depth analysis and information, including the aforementioned maps and charts,.

[Hat Tip: FoIB Randy G]

What a difference a decade makes...

With the spate of folks expected to retire in the near future, and their (understandable) concern about how they're going to pay for their health care, the folks at LifeHealthPro have put together 5 helpful charts that seek to predict how much that care's going to cost.

Here's the first one, from the perspective of a 65 year old couple:

[click pic to embiggen]

There are a handful more here.

Most Excellent Perm vs Term Review

Over at LifeHealthPro, an insurance agent (and financial planner), eviscerates populist "advisor" Dave Ramsey on the latter's arguments against permanent insurance versus term.

Highly recommended.

Two caveats:

First, I sell a decent amount of term insurance, as it does, in fact have its uses; permanent plans are no panaceas in and of themselves.

Second, I think Michael misses the real problem with the 'buy term and invest the difference" scenario: almost all the folks who buy into this end up spending the difference, not saving it.

An important message from...Brussels?

So this arrived in email:

"Anthem is committed to providing our brokers with best-in-class service, and we are always looking for ways to make it easier for you to do business with us – and to help you better serve your clients. Currently, we’re working with a research firm called North American Testing Organization (NATO) to conduct an online broker satisfaction survey to help us better understand your needs."

I must admit to a bit of a spit-take upon reading that I might be contacted by (that other) NATO, but must settle for these wannabe's.

Be interesting to see what they ask ... I was told there'd be no geography.

How NOT to do Narrow Networks

We've long noted that one of the negative - and completely foreseeable - consequences of the ObamaTax is the rise of so-called "narrow" networks:

"Nationwide, about half of all exchange plans feature narrow networks ... Those narrow network plans cost up to 17% less on average than plans with broad networks."

It also means that you're less likely to be able to keep your doc, or even find one willing to take on new patients.

And it certainly doesn't help when a doctor decides to implement his own version:

"A Long Island cardiologist had the office of another doctor torched, then hired someone who turned out to be an undercover police officer in a failed attempt to have the doctor hurt or killed"

Geeze, doc, have a heart!

Yeah, about keeping your Doc

As we've long documented, increasing the demand for care (more folks with insurance) will of necessity run into the brick wall of supply of said care. That is, when everyone has access to "free" healthcare, who's going to provide it, especially with narrow networks reimbursing providers less and less?

Well, some enterprising Golden State folks have come up with an intriguing (if ill-fated) idea:

"Physician Retraining and Reentry (PRR) an online program designed to give experienced, medically licensed physicians and specialists, retired or otherwise, the opportunity to practice adult outpatient primary care in understaffed clinics across the country."

So the first question would be: um, why now, when reimbursements are at an all-time low and headed south? Follow-up: why do you suppose all these folks retired in the first place? (Hint: see Question #1)

But all is not lost, dear readers, because they've come up with a fool-proof way to fill in the gaps:

"The program has also given new hope to disabled surgeons who are no longer able to practice surgery"

To be fair, the folks at PRR aren't (necessarily) advocating that disabled surgeons start operating again, merely "treat patients in a primary care setting." What, exactly, that would entail is left to the imagination of the reader.

(Sorry 'bout that)

While I certainly applaud the group's willingness to think outside the box, I'm just not seeing a path to success here.

[Hat Tip: Gabriela Torres-Soler]

Who is Reading Your Medical File? The more things change (Part 2)

Last week, we broke the story of how some medical records, particularly those stored on off-shore servers, are likely not protected by HIPAA's privacy reg's. I reached out to Dr Rob Lamberts (whom we've previously interviewed) for his thoughts on this as a provider:

Very troubling issues here.  The question of “who has the record” is the most important one.  There needs to be a certainty of who has access to the records unless the patient is made aware of that insecurity and gives consent.  An example of insecurity is the use of Google Spreadsheets for monitoring blood pressure, etc which people sometimes share with their doctors.  They should be aware that there is an insecurity of these records, and their consent to use them can be seen as acceptable in a narrow usage.  Similarly, the tendency of patients in my practice to communicate via email must be covered by some sort of agreement in which the patient agrees that their use of email is “at their own risk” and that our practice will make every effort to only communicate securely.

The  storage of records in an off-site setting where the actual location and potential access to them is unknown to both physician and patient is troubling.  If the vendor is selling the doctor something that claims to “meet HIPAA security requirements” (which many 3rd party vendors do), then the onus is on the vendor.

I told Rob that I wasn't sure I agreed with that last part: It seems to me that, if I'm coming to you as a patient, I'm presuming that you have my records under lock-and-key, or at least in-house. Why is it my obligation to ask if that's the case? Rob replied:

The contract between a provider and an IT vendor is one where they take on the task of IT security (among others) in exchange for payment.  Legally, the physician has gone into that agreement in good faith, and so the vendor would be liable should there be a breach.  That is the same thing the patient does with the physician, overall.  They assume the doctor is acting in a way that is responsible with the medical records.  While I agree that there is a certain right of knowing where the records are stored, in some way we must trust that those making the sausage are being overseen by others who will make sure only reasonable things are being put into that sausage.  There is a reasonable degree of trust we must all have (which is no excuse for naiveté or gullibility).

Okay, that makes good sense from the provider's POV. I'm still not convinced that a doc using a vendor with off-shore servers isn't obligated to notify his patients of such. Now, one might argue "well, Henry, how's the doc to know?" To which I'd reply "simple: ask."

Why not?

And a Special IB Thank You to Dr Rob for his insights and willingness to share them!

The 4% Solution

Heh:

"Only 4% of people who signed up for ObamaCare got the correct subsidy"

Oops.

Expected, of course; actually, I'm surprised the "success" rate was that high. After all, calculating one's subsidy necessarily meant that one was guesstimating the next year's income. Since I've never seen a Ouija board with a $ sign on it, this always seemed...unlikely.

And it didn't help that the IRS sent out faulty forms to over three quarters of a million suckers filers, "nearly all of [whom] are being told they'll have to wait, maybe until Oct. 15, to straighten it out."

Oh goodie!

The good news (for certain values of "good") is that folks will get to repeat this process again in a mere 12 months. One wonders if a) the IRS will finally have the correct forms available and b) significant numbers of suckers citizens will choose to play again.

Time will tell.

[Hat Tip: RedState]

War on Women

The battle cry for the last few years revolves around a so-called "war on women". One political party seeks to manipulate sentiment for their side by proclaiming there is a war on women promulgated by the other party.

Incendiary comments are rife in politics and neither side has cornered the market. But in the case of the war

on women, apparently one side has a short term memory problem.

In a response to the March letter sent by Senate Health, Education, Labor and Pensions (HELP) Committee ranking member Sen. Patty Murray (D-Wash.) with 36 signatures, HHS Secretary Sylvia Mathews Burwell said the agency does not have “the legal authority to establish pregnancy as an exceptional circumstance” to create a special enrollment period.

Burwell said pregnant women could enroll in Medicaid and the Children’s Health Insurance Program (CHIP).

“Women with low and moderate incomes can enroll in these programs at any time if they qualify,” she wrote. “And, like all other qualified individuals, pregnant women can enroll in the Marketplace during the annual open enrollment period.” - The Hill

Apparently rewriting Obamacare by decree is only convenient if this is an election year.

• granting "free" birth control
• exemption waivers granted without regard to the law
• delaying employer and individual penalties for non-compliance
• extending and expanding the annual Obamacare enrollment period
• creating a new way to define a health insurance purchase
• allowing exchange enrollers to create an SEP in places where the law says otherwise
• granting extensions and waiving tax penalties
• blah, blah, blah ...............

#Obamacare #SEP  #pregnancy

HillaryCare -> ObamaTax

So, who made this promise:

"If you like Blue Cross, you can keep your Blue Cross"

If you guessed President Obama, well: close, but no cigar.

That one comes from a 1994 meeting laying out strategy for the future SoS's health care "initiative:"

[click picture to embiggen]

 Time after time....

[Hat Tip: Ace of Spades]