Wednesday, September 18, 2013

Take A Deep Breathe

This past week was an absolute overload of all things healthcare. My long time office manager Cynthia hinted that I may have been near epic meltdown. Going off the grid this last weekend was a welcome relief.      Inhale...Exhale...

In this post I want to step back and relax a bit from the rules and regulations of the Affordable Care Act. There are certainly a number of things we do not have much control over right now concerning healthcare. The good news is we do have control over or own personal cost of care. I know, unfortunately, not the premiums. But absolutely the amount of healthcare we consume.

Many of you have already seen or will soon see an increase in premiums that will be significant. I know the premiums you pay are a burden for sure. The biggest culprit that contributes to that is the COST OF CARE. That's what the premiums you pay reflect.

What can you do about that ? Frankly...plenty. We do have a personal responsibility to care for ourselves as best we can. I know for a fact that I was a long term failure at that responsibility. Many of you as clients and friends remember that for a long time, I was "BIG" in sales...literally. I am quite pleased that I am now a substantially smaller portion than I was before.

I have been a long time member of the National Association of Health Underwriters and was recently honored to provide an article for our industry magazine. You can read it here:

CLICK HERE for "Wellness Begins at Home"

I hope my story will provide you with some laughter, entertainment or encouragement...or not!

Thanks for reading.


PS - Since that article was published - the grand total stands at 105 pounds lost.


Thursday, August 8, 2013

Why the Colorado Insurance Marketplace Could Be Your New Best Friend

As I mentioned in yesterday's video (above), Connect For Health Colorado is on schedule for opening October 1, 2013. Right now the biggest question still is "Will this save me money?" That should be answered soon.

The Colorado Division of Insurance has nearly completed their review of 750 individual and group plans that have been filed for approval. No small task for sure. The marketplace itself will have approximately 120 plans available depending on Division of Insurance approval. When you break that down further, we will have a much smaller number that will be presentable on the Western Slope, based on the physician network and affordability. The balance of plans approved will be available outside of the marketplace. Any plans purchased outside of the marketplace will not be eligible for any individual premium subsidy or employer tax credit.

Insurance brokers must be certified to sell plans in the marketplace. I am just now completing the online portion of this training and will be in the first two day classroom instruction on the 19th and 20th of this month. After the certification process is complete, any individual or employer group that would prefer the advice and assistance of a professional insurance broker (that would be me), will need to complete an agency agreement to represent them with their marketplace enrollment. Many others will continue their current insurance plans just as they do now outside the marketplace.

The marketplace for employers under 50 employees will be quite unique. You will have an opportunity, as an employer, to select one plan for all employees or offer multiple plans from different insurance carriers. Under a "Defined Contribution" plan, employers may budget a specific amount of money per employee to purchase the plan of the employees choice. Keep in mind that rates in the marketplace will be strictly age-rated only. Therefore a contribution of  $ xx.00 may be enough to pay for the choice of a younger employee but not near enough for an older employee.

I can not stress enough the importance that the premium subsidies will play for individuals and  families. For those that are not a part of an employer sponsored plan, the marketplace will certainly be your best friend. Keep in mind that the premium subsidies as well as the medical cost share subsidies will be strictly income based.

Good Health - That's the Plan!

Thursday, August 1, 2013

Obamacare Unplugged...A Deeper Look

As I mentioned in my recent video on this subject it was very difficult to express verbally what the delay in the employer mandate has caused. I am hoping the text of this blog will be more informative. I have been reading a multitude of articles regarding this subject and will be using a lot of  information from those reports in this blog.

One of the problems with the delay is the lack of reporting from the employers. Employers are being encouraged to "voluntarily" send the reports in anyway. I wonder how many will be doing that. Without that information the Federal Data Hub will not be able to determine who was eligible for a qualifying employer plan.

In addition they are not able to send an individuals income history to the State Exchanges to determine the amount of subsidy that individuals will be eligible for. Instead, state exchanges "may accept the applicants attestation form regarding enrollment in an eligible employer-sponsored plan...without verification". Also, for the first year of operation, "exchanges have discretion to accept an attestation of projected household income without further verification for subsidy eligibility. Do you see a potential for abuse here?

What might this delay cost?
  • The Congressional Budget Office estimates that the delay will result in $10,000,000,000 in lost employer penalties from those large group employers that were not going to provide coverage to their employees. Unfortunately, much of this money was earmarked to pay for the ACA subsidies.
  • It is also estimated that because of the delay 1,000,000 people will not be covered by employer sponsored plans. 
  • Half of those, however, will now be applying for subsidies at a cost of an additional $3,000,000,000. Three billion dollars that is not being collected from large employers.
The price tag here continues to climb...

I understand that most of you are waiting for the plan designs and pricing for the individual and small group exchange in Colorado. Today I learned that the Division of Insurance has postponed releasing those rates for another 2 we will all have to wait to see what the insurance premiums look like for January 2014.

Until next time...


Wednesday, April 24, 2013

The Navigator...No Fueling Required...

 I recently posted a video regarding this topic (click here to view) but wanted to provide additional comments in this blog. The point and purpose of the navigator program is to reach the under-served lower income and non-English speaking consumers in communities that have not been reached by agents and brokers in the past. The lack of contact by agents and brokers is directly related to affordability. Obviously it is difficult to enroll someone in health insurance coverage if they do not have the money to pay for it.

Colorado is  expected to increase medicaid eligibility to 133% of federal poverty level. This will give navigators an estimated 160,000 residents to find and provide information on government assisted health plans. In addition they will engage others to determine any premium or cost share subsidy they may be eligible for and direct them to enrollment in the individual health insurance exchange.

Grant applications for navigator organizations were due last week. The Colorado exchange was expecting  11 or more organizations to apply. Once the grants are released they will go about the training process to educate these navigators in the subsidy process as well as the plans available in the exchange. These folks will NOT be licensed to enroll anyone for insurance coverage. Nor will they be allowed to recommend a particular plan of benefits.They will however be more "boots on the street" to ensure that all residents get the opportunity to have medical coverage. In Colorado it is likely navigators will be referred to as application assisters or something along that line. One thing they won't be is long on experience.

A recent article I read in the New York Times indicates that of the alleged 30 million uninsured Americans, the feds believe 14 million will gain coverage next year. Well that may be easier said than done. I mentioned in my last video that California will be looking for around 21,000 navigators. That seems reasonable, as long as they have folks to speak 10 plus languages and cover 163,000 miles of real estate. Good luck with that.

I had an interesting comment from my brother after the last video went out. He asked  "Is the creation of these navigators going to create a whole new kingdom for some people at taxpayers expense?" My goodness older brothers are really smart.


Wednesday, February 27, 2013

First Health Plan Throws In The Towel!

Which plan is giving up? Anthem BC/BS...CIGNA...Rocky Mt Health Plans? Nope, its the Federal Gov't  Pre-Existing Coverage Insurance Plan (PCIP). I guess to be fair the proper language here is the plan has "suspended acceptance of new applications until further notice" effective February 16, 2013. Since about half of these plans were directed by states, some state plans are still accepting enrollment. Colorado is not one of them.

PCIP was established under The Affordable Care Act (ACA) and began enrollment in August 2010 to provide coverage for people that had been turned down for health insurance because of significant pre-existing conditions. Initial estimates from the Gov't expected this plan to reach 375,000 people. Actual enrollment has amounted to just over 100,000 people, 2227 were from Colorado.

This is not " Free Obamacare:" People are responsible to pay premiums for the coverage. In addition to the premiums paid, 5 billion dollars was set aside by the Gov't for claims and plan administration to fund the plan until January 1, 2014. After that the major provisions of The ACA will be in effect and all these folks could be covered by a guarantee issue plan in the insurance exchange. So the plan was designed to go away. Maybe not quite this soon though.

What went wrong? People were REAL sick. A review of the 2012 annual report provides the data to back that up. The average cost per enrollee was $32,108 per year and varied by state, from a  low of $4,276 per enrolled member to a high of $171,909 per enrollee. Not chump change for sure. In one year, 4.4 percent of the PCIP enrollees accounted for over 50 percent of the claims paid from the plan.

The report also went on to say that under the federally administered programs, the Gov't tried to reduce claims exposure by finding a new network provider that accepted a lower reimbursement schedule. They also changed the coverage for specialty drugs to allow only those pharmacies and providers that were most cost effective. Lastly, they reduced the plans offered from three plans to one and increased the consumer out of pocket costs from $4,000 to $6,250 annually.

At the end of the day the PCIP was a victim of its own success. It is unlikely that enrollment will be opened up again. The plan needs to remain solvent to provide benefits to all those currently enrolled through the end of this year. The Gov't should breathe a sigh of relief that it never came close to the 375,000 people it expected. Had enrollment been greater, the plan may not have survived past the first year.

Keep in mind ALL plans will be guarantee issue and cover pre-existing conditions just like the PCIP starting January 1,2014. When you factor in the addition of HEALTHY people along side of the sick people in the insurance pool we should expect a better result. Nobody wants the short history of the PCIP plan to be repeated in the future.


Thursday, February 14, 2013

Under 30? Obamacare Needs You

Oh to be young again...Well maybe not where health insurance premiums are concerned. As I had mentioned in a previous post, health insurance premiums are certainly going to be increasing for a number of people. Those under the age of 30 are potentially going to endure the brunt of that.

One of the reasons will be the change in ratios that are used by insurance carriers for  premium costs. Insurance carriers use age tables to determine premium. The highest premium is for the oldest person, and the lowest premium for the youngest person. Currently, premiums run at about a 6 to 1 ratio, meaning that the oldest age bracket's premium is six times that of the youngest age bracket. As a simple example, using a 6 to 1 ratio: The top premium (highest age bracket) is $600, and the low premium (youngest age bracket) will be $100.

Under the Affordable Care Act that ratio is reduced to 3 to 1. So now, the top premium will be $450 for those older folks and the low premium will be $150 for those young folks. This example is hypothetical of course until we actually know what the real rates will be. But if you do the math here, it clearly is a 50% increase in the lowest age tier. Unpleasant to say the least.

The good news is for those under 30 and folks with proven hardships there will be a catastrophic health plan available that will probably be your lowest price option. In addition the income qualifications are in place for subsidized government (taxpayer) paid premiums as well as cost share reductions for health plan out of pocket costs for those that qualify.

The younger American is truly needed in the overall scheme of the health plan. Without enough of them enrolled in the program the premiums will see significant increases as those with dire health problems strain the system for payment of claims. As the President would say, "We all need to pitch in and pay our fair share". Uncle Sam Needs You !

REALLY...its the only way this will work. Until next time.


Thursday, February 7, 2013

The "Calm" Before The Storm?

 I just returned from Denver after a large gathering of stake holders in the health care business. Calm was not the best description but it will work for a topic of discussion at least. More information continues to surface  regarding the implementation of The Affordable Care Act. Five of the top insurance providers in the State of Colorado were there to provide updates and take questions regarding their progress in compliance with the ACA  It is VERY clear that storm clouds are building that are going to rain down on many people with individual/family health plans.

One of the areas of concern in the meeting was the size of rate increases that are expected in the individual/family health insurance market starting 01/01/2014. Speculation was that those plans could see a 20% increase in new business prices at the beginning of next year. One insurance carrier's response was "20% would be great". "Great" I believe was to try and make us feel good about 20%. It may be higher than that.  To compound that concern was the fact that I just received March renewals for some of my individual/family clients that will see their rates go up 27%. When you add that to the expected 20% for 01/01/2014 it begins to sound like REAL money. 

 What is going on here? For the past couple of years in the Grand Junction area, group insurance plans for the most part have seen very small if any rate increases at all. That's been some good news for sure. The individual/family market however has been priced well below the group market for some time. The reason is those individual/family policies were subject to full medical screening. The insurance company could make those rates more affordable since they were able to see your entire medical history and determine you or a family member were NOT about to blow a gasket and cost a pile of money to treat. Group insurance policies have not had that luxury for sometime. Enter the Affordable Care Act. Now ALL policies are guarantee issue. No medical screening what so ever. The only exception will be tobacco use (even higher rates). 

 Those folks that have  not been covered by an employer sponsored plan will see their rates climb to meet the rates of group insurance policies in the near future.

Get out your umbrellas...Premium showers are ahead.


Tuesday, January 8, 2013

Obamacare...A readers dream...

Happy New Year and welcome to another year of health care transformation and implementation. The IRS gave a nice post-Christmas gift with the release of additional rules and regulations for implementing the employer mandate. The IRS calls it  Employer Shared Responsibility Provisions. That has a much better tone than MANDATE which of course is what it is. Questions and answers for the rules here.

It seems appropriate that the IRS released these provisions. I wonder who will be charged with making sure any groups that have 50 or more employees are compliant?

Upon seeing the release of new solid information I wanted to get up to speed and see what it contained. The article I was viewing had two options - view a summary or full provisions. The summary itself was 13 single spaced pages.

The full provisions are 144 pages long...Wow...this is ONE item of the entire health care bill that started out as 2,500 pages of content. The additional rules and regulations could push the readability of this missive to over 20,000 pages, I assume. Not being a bookworm, I have paid for a service provider that will provide me the cliff note versions and white papers of anything and everything Obamacare-related.

The saddest part of all of this is the fact that the law will require most individuals as well as businesses to make a choice for their plan of health care or pay a penalty. It will be very difficult if not  impossible for most normal law abiding citizens to comprehend the scope of this. As an insurance broker I am quite overwhelmed with the mammoth amount of information I will need to know to best advise my clients. I look forward to the challenge...I will prevail...