About thehealthinsuranceanswerman

Kenton graduated in 1978 with a degree in Social Work from Indiana University and returned to Texas where he had lived in Tyler and McAllen as a youth. After working as a counselor for the Harris County Department of Mental Health and Retardation and the Texas Department of Health and Human Services as a Child Protective Services caseworker, he moved into the private sector where he had a five year career as a pharmaceutical sale representative for Adria Laboratories and Stuart Pharmaceuticals. In 1986, Kenton became a career agent for The Mass Mutual where he learned the life, health and executive disability market. Wishing to be independent, he moved to The Woodlands, Texas in 1991 and formed ALL PLAN MED QUOTE. In 1995 he was one of the first insurance agents to begin marketing health insurance via his original website Allplaninsurance.com, eventually becoming licensed in thirty three states. For the last twenty-two years he has specialized in medical insurance. In 2005--as his clients began to age into Medicare--he began to focus on the "Medicare related insurance market" in order to better serves their needs. After twenty-seven years in the industry, he remains committed to his profession and his clients, particularly to the latter as they transition through and adjust to the "Affordable Care Act" (ACA), commonly referred to as health care reform.

MEDIA WARNS CONSUMERS THEY WILL HAVE LESS HELP SHOPPING FOR 2019 HEALTH INSURANCE

(BUT THEY DIDN’T ASK ALL PLAN MED QUOTE OF THE WOODLANDS, TEXAS)

Navigators in a boiler room

By D. Kenton Henry Editor, Agent, Broker
29 October 2018

The media is proffering all manner of good news when it comes to the Open Enrollment Period for purchasing 2019 individual and family health insurance, just three days away. The doors open this Thursday, November 1st and will remain so through December 15th. During this time you, the consumer, will be able to review your options and make a decision to renew your existing policy or select a new one to become effective January 1. Whichever, that policy will cover you the coming calendar year.

The feature article appearing below, states there will be ” . . . fewer sources of unbiased advice and assistance to guide them through the labyrinth of health insurance.” To wit, it cites, the budget for insurance counselors, known as navigators, has been cut by 80%, leaving over one-third of navigators in 2,400 counties served by Healthcare.gov, unfunded. Thank you very much, New York Times. Somehow, they neglected to consult with me and my agency, ALL PLAN MED QUOTE. Reading the article in full, one can infer they feel the only meaningful assistance can come from the government (at taxpayers’ expense) and fail to credit the private industry, which has provided counsel and enrollment assistance within the domestic insurance industry some two hundred years plus. One token sentence in the article acknowledges the private industry’s presence to assist the consumer with procuring health insurance. In my estimation, this reflects the media’s general opinion and thesis that the government is the end-all solution to every conceivable personal financial issue. Which, again, in the mind of this editor, is precisely the philosophy, the perpetuation of which got us into this fix in the first place. Moreover, what exactly is that fix?

Current pre-midterm election media coverage informs us premiums have stabilized and are, in many cases, going down in 2019. While that may be true in some localities, the recently released premiums in southeast Texas reflect increases of 20% or more. If you obtain a subsidy, wherein you get a tax credit for a portion of your premium, the subsidy itself may be larger, but the balance may be as well. Also, for those not obtaining a subsidy (the vast majority of us) the increase will be born entirely by ourselves. The situation has made healthcare the number one concern of Americans heading into next week’s midterm elections according to a Fox News Poll.

For the record, ALL PLAN MED QUOTE and I have never been subsidized by taxpayer dollars. As an independent, self-employed broker/agent I am compensated when I successfully enroll someone in health insurance. I am not compensated when I fail at such. That is fine by me. In spite of continual cuts in agent compensation. I prefer autonomy to bureaucracy. My advice and guidance are objective. My goal is to succeed it getting you enrolled in a policy which makes sure you have access to the care and treatment you need, when you need it and are not financially devastated in the process. All this for the lowest possible premium. I do not care which insurance company you contract with, as long as you are satisfied you have obtained the best coverage for your given situation and needs. Ideally, it would also provide you access to all the doctors and medical providers you choose to utilize. Regrettably, that latter objective has become my biggest challenge and is one every insurance agent and counselor faces. To say it can be overcome in every instance would be misleading but I do my best. All 2019 individual and family options are Health Maintenance Organizations (HMO) policies, and this has been so since 2016. The HMO networks are narrow in comparison to what one may typically have experienced with employer-based HMO coverage. However, there are a very few plans (3 in my primary region) which operate very similar to a traditional Exclusive Provider Organization (EPO) policy in that they do cover treatment at a provider outside the network. Benefits are paid up to a limited percentage, and there is no cap on your maximum annual out-of-pocket but―for someone who wants to be assured they can obtain coverage from the provider of their choice―it is better than no coverage whatsoever. If you feel you must learn more about this option, please contact me.

To assist me in these ends, I am appointed with every company providing Patient Protection and Affordable Care Act-compliant health insurance company doing business in Montgomery, Harris, Fort Bend, and Galveston counties. BlueCross BlueShield of Texas (to my knowledge) does business in every corner of Texas, and I have been appointed with them twenty-seven years. In addition to Texas, I am licensed in Indiana, Michigan, and Ohio.

I offer short-term health insurance for those who do not get a subsidy and those who, whether they do or not, cannot afford credible health insurance. However, I do not represent it as covering pre-existing health conditions, as it does not. Nor do I represent it as a substitute for credible, compliant coverage. It is a short-term bridge to a long-term solution.

As always, the Open Enrollment Period will be a very busy and hectic time for anyone in my profession. To make things proceed more smoothly, I would appreciate you visit my quoting site to obtain spreadsheet comparison of your options from all the health insurance companies offering coverage in your county. Attempt to narrow your selection down to those plans you feel most closely approximate the coverage you need. You can search for in-network providers from the search button directly next to the premium quoted. If you are so confident a plan is right for you, please feel free to apply straight from the quote. However, many of you will have questions or appreciate my insight and experience with the plan details and application process. Those in need of a subsidy will find my assistance especially helpful. If this is you, please do not hesitate to contact me.

Again, for quotes and applications, you may go to my website at Http://TheWoodlandsTXHealthInsurance.com and click on “Health” in the top menu.

Alternatively, you may go directly to my spreadsheet quotes and an application by clicking on this link:
https://allplanhealthinsurance.insxcloud.com
*(it is not necessary to log in or register to obtain quotes or apply)

If you already know your interest is a policy from BlueCross BlueShield of Texas, you may go directly to their quoting and application page by clicking here:
https://retailweb.hcsc.net/retailshoppingcart/TX/census?ExpressLinkedAgentId=2V0boERIKNxDSESKunpc/w==

**(if these links do not function from this text, please copy and paste or type in your browser and hit enter)

If you apply for coverage through these links, I will be your agent and available to assist and commit to providing the best of service throughout the year. I bring my entire thirty-two years in medical insurance to bear for this purpose. I look forward to hearing from you and assisting you. Regardless, I hope you succeed in obtaining health insurance which suffices until Congress puts their heads together and provides us with more reasonable options.

D. Kenton Henry                                                                                                              All Plan Med Quote                                                                                                    Office: 281.367.6565                                                                                                     Text my cell @ 713.907.7984                                                                                   Email: Allplanhealthinsurance.com
For the latest in health and Medicare-related insurance, news go to Https://HealthandMedicareInsurance.com

COMMENTS OR QUESTIONS:

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FEATURED ARTICLE 

The New York Times
By Robert Pear
Oct. 27, 2018

Shopping for Insurance? Don’t Expect Much Help Navigating Plans

Affordable Care Act navigators helping patients during an enrollment event in 2016 at Southwest General Hospital in San Antonio.CreditCreditEric Gay/Associated Press
WASHINGTON — When the annual open enrollment period begins in a few days, consumers across the country will have more choices under the Affordable Care Act, but fewer sources of unbiased advice and assistance to guide them through the labyrinth of health insurance.
The Trump administration has opened the door to aggressive marketing of short-term insurance plans, which are not required to cover pre-existing medical conditions. Insurers are entering or returning to the Affordable Care Act marketplace, expanding their service areas and offering new products. But the budget for the insurance counselors known as navigators has been cut more than 80 percent, and in nearly one-third of the 2,400 counties served by HealthCare.gov, no navigators have been funded by the federal government.
“There is likely to be a lot of consumer confusion about the various plan options that may be available this year,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “It will be a bit of a Wild West — buyer beware!”
“Obamacare health plans,” short-term plans and “Christian health sharing plans” are all displayed on the same page of some shopping sites like Affordable-Health-Insurance-Plans.org, which describes itself as a free referral service for insurance shoppers.
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Consumers may have difficulty sorting through their options after the administration sliced the budget last summer for insurance navigators to $10 million this year, from $36 million in 2017 and nearly $63 million in 2016.
“Navigators play a vital role in helping consumers prepare applications to establish eligibility and enroll in coverage through the marketplaces,” the Department of Health and Human Services says on its website.
But 797 counties served by HealthCare.gov will not have any navigators this year, according to a tabulation of federal data by the Kaiser Family Foundation. That is a sharp increase from 2016, when 127 counties lacked such assistance.
“If you are confused and you want somebody’s help to try to figure out what’s right for you — what’s junk and what is legitimate — there will be fewer people to help you in most states,” Ms. Corlette said.
Federal officials said they were not providing funds for navigators in Iowa, Montana or New Hampshire because no organizations had applied for the money in those states.
Cleveland, Dallas and large areas of Michigan and other states will also be without navigators.
Texas will be hit hard. The state has the largest number and the highest percentage of people who are uninsured, with 4.8 million people, or 17 percent of residents, lacking coverage, according to the Census Bureau.
“North Texas remains one of the most uninsured areas in the country,” said the chief executive of Dallas County, Judge Clay Lewis Jenkins. “The administration’s decision to defund all navigators across North Texas will hurt our ability to enroll individuals in health insurance and result in some working families losing coverage. Only 45 of Texas’ 254 counties have any navigator coverage.”
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, defended the cuts.
After five years, she said, “the public is more aware of the options for private coverage” available through the marketplace, so “it is appropriate to scale down the navigator program.” In addition, she said, information and assistance are available from other sources, including insurance agents and brokers.
Consumers can sign up for health insurance under the Affordable Care Act starting Thursday. Last year, 8.7 million people enrolled at HealthCare.gov, and three million more selected plans on insurance exchanges run by states.
Consumers can go without insurance next year without fear of a penalty, as Congress repealed the unpopular tax surcharge imposed on people who lack coverage.
Many health policy experts say that federal financial assistance is more important than the individual mandate in inducing people to buy insurance. Those subsidies will still be available to low- and moderate-income people for insurance that complies with the Affordable Care Act and is purchased through the public marketplace. The subsidies cannot be used for short-term policies.
The vast majority of the people we serve, over 90 percent, are motivated to have insurance because they want coverage for their family and themselves,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit. “It’s not because they otherwise would have to pay a penalty.”
Average premiums for the most popular types of insurance purchased by individuals and families will be relatively stable next year and, in some states, will actually decline, the administration says.
Under new standards issued by the administration, navigators this year are encouraged to inform consumers of the full range of coverage options, including short-term plans that do not provide all of the benefits and consumer protections required by the Affordable Care Act.
President Trump has promoted the short-term policies as an inexpensive alternative to the Affordable Care Act, and he said those plans would be “much more widely available” as a result of an executive order he signed last year to overturn restrictions imposed by President Barack Obama.
Democrats have made health care a major theme in midterm election campaigns, and they say the short-term policies show how the Trump administration threatens protections for people with pre-existing conditions.
Short-term policies, which can extend up to 364 days and then be renewed for two additional years, often provide no coverage for pre-existing conditions, prescription drugs, pregnancy, maternity care or the treatment of mental disorders and drug abuse.
Indeed, Mr. Trump said, the short-term plans are cheaper because they are “not subject to any very expansive and expensive Obamacare coverage mandates and rules.”
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But, said Kirsten A. Sloan, a vice president of the American Cancer Society Cancer Action Network: “People may be attracted to short-term plans without understanding that the lower premiums come with less coverage. These plans may not cover the doctors and hospitals and drugs you need if you get sick.”
In another challenge this year, consumers may be deluged with robocalls offering cheap insurance.
Alex Quilici, the chief executive of YouMail, a company that offers software to combat robocalls, said he was seeing a huge increase in health insurance scams.
“Callers say ‘it’s open enrollment’ or ‘we can get you a better deal by looking at all the health insurance plans,’” Mr. Quilici said. “Callers ask for lots of personal information, and the unwitting consumer often gives their birth date, Social Security number and information for everybody in the family, in order to get a great deal. In reality, it’s identity theft or payment theft or both.”
Mr. Quilici’s company has recorded hundreds of robocalls. A typical call says that, with enrollment just “around the corner,” Mr. Trump has created short-term coverage options lasting up to three years, “so you and your family can get a great insurance plan at the price you can afford.”
It is difficult to identify the source of the robocalls, Mr. Quilici said, because callers often falsify information displayed on caller ID.
(A version of this article appears in print on Oct. 27, 2018, on Page A25 of the New York edition with the headline: Shopping for Health Insurance: Many Options but Little Guidance. Order Reprints | Today’s Paper | Subscribe)

HIGH SCHOOL CLASS OF ’72! – MEDICARE IS HERE FOR YOU!

By Don Kenton Henry – editor, broker

Fellow classmates of the High School Class of 1972! Congratulations! It’s been thirty-six years since we graduated and went on to build careers and raise families. During this time we dutifully paid into Social Security and paid Medicare taxes. Most of us will be turning age 65 during the next year if we have not already done so. As such, we will be “aging into Medicare”. Never, in my life, have I looked forward to getting older,―until now. Because―as such―I will be eligible for Medicare and finally have an alternative to the Under Age 65 Affordable Care Act (ACA) marketplace for health insurance purposes. As a Medicare-related, private insurance specialist,―knowing all my plan options―along with knowing which plans I will enroll in―I am elated to finally being able to take advantage of the following benefits not currently available to any of us not currently on Medicare:

I know I will I be able to go to any doctor or hospital that sees Medicare patients. Additionally, I will be out of nothing―or virtually nothing―for my Medicare eligible medical expenses, per se, throughout the calendar year! (By “per se”, I mean aside from the out-patient prescription drug costs I will pay at the pharmacy counter.)

Even those of you who have had the benefit of employer-based group health insurance through throughout your working career ― have to had to meet a significant deductible before insurance benefits apply to your major medical expenses. In recent years, that has probably been at least $1,000 and, probably, more. Then you have been responsible for additional costs (coinsurance) thereafter!  Compare that to your share of a maximum of $183 per calendar year, should you go with the plan option I will most likely recommend for you!

Regarding Part D prescription drug plans ― you will have approximately three dozen to choose from. Each of these covers some drugs but does not cover others. And vice versa. The plan that is best for your spouse or neighbor is not necessarily the best plan for you. Our objective is to: (1) cover all your prescription drugs and (2) do so at your lowest possible total cost for both the plan and your prescription drugs for the calendar year. “Total Cost” is the sum of your plan premium, any applicable deductible, and your copays or coinsurance for your Rx drugs.

*If you would like me to identify your lowest cost Part D Medicare Prescription Drug Plan for 2019 email me, at Allplanhealthinsurance.com, a list of your current drug regimen and dosages. I will do so in the order received and forward the results via email.  

CHANGES TO MEDICARE PART D DRUG PLANS IN 2019:

  1. A) Stage 1, the Medicare Part D “Yearly Deductible Stage” is going to require a Medicare recipient member meet as much as a $415 deductible, up from $405. This does not mean a drug plan will increase your deductible, or even charge one in the first place. It simply means the Center For Medicare Services has informed the drug plans they may charge as much as that amount.
  2. B) Stage 2, the “Initial Coverage Stage” is going to $3,820. This is the limit your, and the plan’s, drug cost must reach before you enter the “Coverage Gap”.
  3. C) Your liability for your drug costs has been diminishing each year since 2011. This year, you will pay 25% of the cost of brand-name drugs, plus a dispensing fee, and 37% of the price for generic drugs.
  4. D) When your year to date personal drug costs reach $5,100 you enter the “Catastrophic Coverage Stage”. Therein, you will pay $3.40 of a drug that is treated like a generic and $8.50 or 5% of the cost of the drugwhichever is higher for all other drugs.

*****

MEDICARE PART B 2019

There has been no announcement on whether Medicare Part B’s calendar year outpatient deductible of $183 will be changing.

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CONSIDERING MEDICARE SUPPLEMENT VS MEDICARE ADVANTAGE to cover those medical expenses not paid by Medicare? Refer to today’s FEATURED ARTICLE 1 on “Denials of Care” below then call me for my opinion on one vs the other.

Should pharmacists be subject to a “gag” clause preventing them from telling you a lower cost for your drug is available at the pharmacy counter? See FEATURED ARTICLE 2, below:

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THOUGHT FOR THE DAY:

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Turning age 65 in April, I am right in this with you. I share a kinship, not only with my personal HS classmates, but everyone of my generation. I began my career out of college as social worker and then―believe it or not―a pharmaceutical sales person. I understand the perspective on brand name vs generic drugs, both from the drug companies’ and the consumer’s standpoint. (If you’d like to me to share this with you, off the record, please call me.)   I still like to help people and I get great satisfaction from ensuring I keep my client’s drug and medical costs to a minimum.

To assist you in this, I represent virtually every “A” rated (AM Best Rating) Medicare Supplement Plan and most of the Medicare Advantage and Part D Prescription plans I feel worthy of your consideration for 2019. I bring thirty-two years of experience in the industry to provide you an objective comparison of your options, simplify the enrollment process, and ensure you maintain the right plans for yourself, thereafter. I charge no fee for my services. I am compensated directly by the insurance company whose product you elect to utilize, and then―if, and only if―you elect to acquire that product through me. The key to you is―you are charged no more for that product than if went through the door of that insurance company to acquire it on your own. Additionally, when you call, text or email me, you know you are communicating with someone who knows your history and has a vested interest in keeping your business. Which means keeping you happy. This as opposed to a different faceless person at the other end of a toll-free number.

SoClass of ’72! Open enrollment begins October 15th for Medicare plans (and November 1st for your Under Age 65 family members in need of health insurance for 2019). Please call, text, email, or visit my websites for information and assistance. I’m certain our life experiences and objectives are much the same and I know peace of mind when it comes to our healthcare and costs is integral to our quality of life

Kenton Henry – Agent, broker, editor                                                                          Office: 281.367.6565                                                                                                  Text My Cell @ 713.907.7984                                                                                          Email: Allplanhealthinsurance.com@gmail.com                                  http://Allplanhealthinsurance.com                                  http://TheWoodlandsTXHealthInsurance.com          https://HealthandMedicareInsurance.com

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*FEATURED ARTICLE 1

BLOOMBERG

Private Medicare Plans Faulted by Watchdog Over Denials of Care

By  John Tozzi

September 26, 2018, 11:01 PM CDT

A new federal watchdog report warns that privately run Medicare health plans used by millions of older Americans may be improperly denying patients medical care.

Federal auditors have found “widespread and persistent problems related to denials of care and payment in Medicare Advantage,” the privately administered plans that insure more than 20 million people, according to the report from the Health and Human Services Office of Inspector General.

Medicare Advantage plans collect a fixed fee from the government for taking care of patients 65 or older who qualify for traditional Medicare coverage. The fixed per-patient rates the government pays may give plans “an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits,” the report said.

Medicare Advantage plans have become popular with consumers because they combine traditional Medicare benefits with additional coverage, such as vision, dental care, and prescription drugs.

The program paid $210 billion to Medicare Advantage plans last year. Companies including UnitedHealth Group Inc.Humana Inc., and Aetna Inc.are the largest sellers of the coverage. Enrollment in Medicare Advantage has roughly doubled in the past decade, and one-third of Medicare patients are now covered by the private plans.

In 2016, Medicare Advantage plans denied 4 percent of requests to approve treatment before it was provided, known as prior authorization, and 8 percent of requests for payment after treatment, according to the report.

Only 1 percent of patients disputed the insurers’ denials, but in those cases, the decisions were overturned three-quarters of the time, according to the report.

Improper denials “may contribute to physical harm for beneficiaries if they’re not getting access to services that they need,” said Rosemary Rawlins, the inspector general’s team leader on the report. Patients and doctors can also be harmed financially if not reimbursed for appropriate care, she said.

If plans aren’t providing the care they’re contracted to, it risks wasting taxpayers’ money. The government “has already paid to cover beneficiaries’ health care,” Rawlins said. Not every denial is an indication that patients are being blocked from needed treatment, however.

“You wouldn’t expect the denial rate to be zero,” Rawlins said. “Part of managing care is denying care that’s not needed.”

There’s a lot of variation in how often Medicare Advantage plan denials were overturned. In 2016, seven Medicare Advantage contracts had almost all of their denials reversed on appeal — more than 98 percent. Another 69 contracts had denial rates above 90 percent. The report doesn’t name specific companies or plans. Individual insurers can have more than one Medicare Advantage contract with the government.

Problems with denials of care aren’t isolated to a few plans, however. The Centers for Medicare and Medicaid Services, or CMS, audits different organizations each year, “but consistently find problems related to denials of care and payment,” Rawlins said.

The CMS audits are one of many factors that affect health plans’ star ratings, which are intended to help Medicare patients shop for plans based on quality. But starting in 2019, as the result of a change by CMS, the audits will no longer be a factor in the ratings, “which diminishes the usefulness of the star ratings system as a tool for beneficiaries,” the report said.

The inspector general recommended that CMS increase its oversight of Medicare Advantage plans and give patients better information about violations. The agency concurred with the findings.

A CMS spokesperson said in an email that the agency is committed to “strong oversight and enforcement of the Medicare Advantage program to ensure that plans are delivering care to Medicare beneficiaries” as required.

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FEATURED ARTICLE 2

WASHINGTON EXAMINER

Senate unanimously passes bill banning pharmacy ‘gag clauses’ in Medicare

by Kimberly Leonard

 September 05, 2018 03:03 PM

The Senate unanimously passed a bill Wednesday that would ban Medicare insurers from enforcing “gag clauses” that forbid pharmacies from telling customers about cheaper ways to buy drugs.

The Know the Lowest Price Act is intended to help patients covered under Medicare to find out if their prescription would cost less if they were to pay for it out of pocket rather than through their insurance plan.

“Passing this bill and eliminating gag clauses gives patients more power to lower their healthcare costs,” Sen. Bill Cassidy, R-La., who helped introduce the plan, said in a statement. “It makes prices transparent so patients can save money with less expensive prescriptions.”

The new rules explicitly apply to Medicare Part D, which pays for prescription drugs, and to Medicare Advantage, a healthcare plan managed by private insurers. Medicare is the program covering adults 65 and older and people with disabilities.

In the complexity of the system that involves pharmaceutical companies, drug reimbursements, middlemen known as pharmacy benefits managers, and health insurance companies, patients can sometimes end up paying more while others in the chain pay less. Private health insurers and pharmacy benefits managers use “gag clauses” in their contracts to prohibit pharmacists from informing customers that they can save money if they don’t go through their health plans.

Another bill passed in committee, known as the Patient Right to Know Drug Prices Act, would provide the same protections for people who have private health insurance coverage. The Trump administration has called for Congress to undo the gag clauses and pass other measures to help reduce what patients pay for drugs.

LOWER YOUR MEDICARE SUPPLEMENT PREMIUMS NOW

Medicare clients and friends of Kenton Henry and All Plan Med Quote,

Greetings! Please take a few minutes to read this in its entirety. Whether you have Medicare Supplement through me, or another agent, what I am proposing could save you up to 20%, or more, of what you are currently paying for coverage.  

To those who are current clients – thank you so much for your continued business. We made it through another Prescription Drug Plan Open Enrollment Period which ran, as always, from October 15th through December 7th. During that time (for those who requested assistance) I shopped for your best value in a 2018 Part Medicare Drug Plan. It is my goal to keep my clients in the lowest “total cost” drug plan available to them, and I moved many of you to that plan. Others were in that plan already, and I advised them to stay the course.

It was a very hectic period for everyone in my industry, made more hectic because it overlapped with the Open Enrollment Period for Under Age 65 (Obamacare) health plans. Personally, it was all I could do to meet everyone’s need as well as possible without hiring additional staff. A staff which I would only have to have let go―at the end of the 8 weeks. This, most as soon as I had them adequately trained. For those who have Medicare Supplement policies, I advised you that, once this busy period was over, I would be in a position to re-shop your Supplement plan to see if there is a better value for you. That time has come.

If you have had your Medicare Supplement policy three or more years, you have had a series of premium increases. These usually correspond with your policy anniversary and, hopefully, they have been reasonable. But, the reality is, you may now be paying more than necessary for equivalent or ideal coverage. I say “ideal” because things have changed. Many of you are with Supplement Plan F. This is because, historically, it was considered the best value. In 2016 that changed in that the Center For Medicare Services (CMS) informed the insurance companies they were phasing out plan F and mandated they cease offering it in 2020. At that time, those who have plan F will be “grandfathered“. In other words, they will be allowed to keep theirs. But no new plan F policies will be issued.

With this mandate, the insurance companies re-priced plan G, which is the second most comprehensive plan after plan F. Plan F pays all eligible expenses for a calendar year. The only thing plan G does not pay is the $183 Medicare Part B calendar year out-patient deductible paid by plan F. So―yes―if you have plan G―you will pay the first $183 for out-patient care each year. (This will most likely be for your first doctor’s visit and perhaps a portion of the second). But, guess what? Your annual premium savings is probably going to be as much as twice that deductible. Therefore, plan G makes better financial sense than F.

Couple the yearly inflation of your policy premium by the three-year mark―with the fact you may be in plan F―and I can probably save you substantial premium dollars if we move you to plan G based on new first-year rates. Or― if you have had your plan G three or more years―we can attempt to move you to a lower cost plan G.

Is there a catch? Yes. The catch is―because you are now past your period of “Guarantee Issue” which, in general, ended six months after you turned age 65 and entered Medicare Part B. This means you now have to answer health questions and be approved for new coverage based on your health history. While approval is not as difficult as it used to be for those applying for under age 65 health insurance, you are going to have been in at least moderately good health and had no major illnesses in the last two years or more. I want you to ask yourself if this applies to you. If so, I would like to see if we can move you to a lower cost Medicare Supplement Plan.

Here is an example of the typical health questions you must answer “negative” to be approved – taken from what is currently one of the most competitive Medicare Supplement policies:

OPTION I: at lower rates than OPTION II

  1. Have you been prescribed or taken any prescription medications within the past 12 months? If “YES,” please indicate below.

If “NO,” indicate “None.” Agent – This is to assist in preparing the Applicant to answer questions in sections 3 through 5.

APPLICANT A

Name of Medication, Date Prescribed and Condition

(Example: Vytorin, 10/2009, High Cholesterol)

APPLICANT B

Name of Medication, Date Prescribed and Condition

(Example: Vytorin, 10/2009, High Cholesterol)

  1. Personal History Questions:
  2. Have you ever been diagnosed with diabetes?
  3. Have you ever:
  4. been advised by a physician to have or are you currently waiting for an organ transplant?
  5. been diagnosed with, treated, or advised to receive treatment for Alzheimer’s Disease, dementia,

mental incapacity, organic brain disease or any other cognitive disorder?

  1. been diagnosed with, treated or advised to receive treatment for Lou Gehrig’s disease (ALS),

Huntington’s disease or any terminal medical condition?

  1. been diagnosed with, treated or advised by a licensed member of the medical profession to

receive treatment for Systemic Lupus, Osteoporosis with Fractures, or kidney disease or failure

requiring dialysis?

  1. used insulin to treat or control diabetes?
  2. had any type of Diabetes with Complications including retinopathy, neuropathy, nephropathy,

peripheral vascular disease, heart disease, stroke, transient ischemic attack (TIA), high blood

pressure, or skin ulcers?

  1. been in a diabetic coma or had or been advised to have an amputation due to disease or disorder?
  2. been diagnosed with, treated or advised to receive treatment for Cirrhosis, Emphysema, Chronic

Obstructive Pulmonary Disease (COPD) or other chronic pulmonary disorders?

  1. been diagnosed as having or told by a medical doctor that you have AIDS, HIV, or ARC disorders?
  1. been diagnosed, treated or advised to receive treatment for any neurological disease or disorder

such as Myasthenia Gravis, Multiple or Lateral Sclerosis, or Parkinson’s disease?

  1. Within the past 2 years have you:
  2. been advised to or do you currently use a wheelchair?
  3. been advised to enter or do you reside in a nursing home, assisted living facility, long term

care facility, received hospice, attended an adult day care facility, required home health care, or

been bedridden?

  1. been admitted to a hospital 3 or more times or are you currently admitted to a hospital?
  2. been diagnosed, treated or advised to receive treatment for cancer (other than basal cell carcinoma)?
  3. been diagnosed, treated or advised to receive treatment for alcoholism or drug abuse, mental or

nervous disorder requiring psychiatric care?

  1. been diagnosed, treated or advised to receive treatment for heart attack, coronary or carotid artery

disease (not including high blood pressure), peripheral vascular disease, congestive heart failure

or enlarged heart, stroke, transient ischemic attacks (TIA) or heart rhythm disorders?

  1. been diagnosed, treated or advised to receive treatment for degenerative bone disease impacting

multiple joints, crippling/disabling or rheumatoid arthritis or been advised to have a joint

replacement?

  1. been advised to have surgery, medical tests, treatment or therapy that has not yet been performed

or undergone testing by a medical professional for which the results have not yet been received?

  1. Have you been advised by a physician that surgery may be required within the next 12 months for

cataracts or have you used or been advised to use oxygen equipment, respirator or a catheter?

If any question in 3, 4 and 5 is answered “YES,” please STOP. The Applicant is NOT eligible for underwritten Medicare Supplement.

Take note of that last line. If you answered “yes” to any of these questions you are not going to be approved for the lowest cost plan of your choice. However, this does not mean I cannot get you approved with a new plan. I have a second company whose underwriting requirements are significantly more lenient. There are far fewer health questions to be answered, and no information regarding prescription drug use is requested. Mostly, this company is concerned with whether you have been hospitalized in the last 90 days and have you suffered any major health issues in the last 2 years. If you can answer “negative” to these, you will be approved at their lowest cost. Answer in the affirmative and you may still be approved but at a higher premium. Either of these premiums may or may not be lower than your current premium.  This company’s health questions appear next. Only consider them if you feel you would not qualify for Option I:

********************************************************************************************************************************

OPTION II: BUT AT RATES HIGHER THAN OPTION I (BUT WHICH MAY STILL BE LOWER THAN YOUR CURRENT PREMIUM)

4A. Within the past 2 years, did a medical professional provide treatment or advice to

you for any problems with your kidneys?

Yes No Not Sure

4B. Within the past 2 years, did a medical professional tell you that you may need any of

the following?

  • hospital admittance as an inpatient
  • joint replacement
  • organ transplant
  • surgery for cancer
  • back or spine surgery
  • heart or vascular surgery

Yes No Not Sure

If you answered YES or NOT SURE to any question in Section 4, we will contact you for further information.

5A. Within the past 90 days, were you hospitalized as an inpatient (not including

overnight outpatient observation)? Yes No Not Sure

5B. Are you currently being treated or living in any type of nursing facility other than an

assisted living facility? Yes No Not Sure

5C. Has a medical professional told you that you have End-Stage Renal (Kidney) Disease

or that you require dialysis? Yes No Not Sure

Answering YES to any question in Section 5 will result in a denial of coverage.

If your health status changes in the future, allowing you to answer NO to all of the

questions in this section, please submit a new application at that time.

If you answered NOT SURE to any question in Section 5, we will contact you

for further information.

*This company has LEVEL 1 RATES (lower) for clients who answer “No” to the health questions. And LEVEL 2 RATES (higher) for those who have not provided a response which would result in a declination but

did answer “Yes” to any question in Section 6. This last scenario would result in you being approved but at a higher rate which may be higher or lower than what you are currently paying for Medicare Supplement insurance.

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Based on all this, if you feel optimistic, here is what I would like you to do:

To save the time required to pull your file (for current clients), please provide me the following in response to this email:

 

1) Your name

2) Your residential zip code

3) Your birth date

4) your tobacco usage

5) Your current Medicare Supplement Company and plan letter designation, e.g., F or G

6) For which new plan would like to seek approval? The lowest cost (harder to be approved) plan or the higher cost plan with less stringent approval criteria?

7) What is your current Medicare Supplement Premium?

Upon receipt, I will quote both options. The first will be for your lowest cost plan G option (unless you request a different letter designation). When I quote, I will include the application for that plan unless you have informed me it is appropriate to seek approval for the higher cost option. That option will be your second quote and, where you have indicated it is appropriate, I will include its application.

As to those of you who have Medicare Advantageyou are locked into your current plan for this calendar year. We can re-shop your coverage this fall (October 15th to December 7th) for 2019. To that end―and for those who have Medicare Supplement plans and simply cannot bear the premium increases and / or cannot qualify for new Supplement coverage―I have a new website for those willing to accept the copays and provider limitations of Medicare Advantage. You will be able to get quotes and apply for these options this fall. Click on this link or – if necessary – copy and paste into your browser:

https://medicareful.com/AgentKentonHenry

I anticipate this letter will generate an increase in activity on my part. As such, my phones may be very busy. If it is important you speak with me right, and  convenient for you, you may want to text me during this period. My cell phone number appears below. I look forward to keeping you as a client or acquiring you as one in the first place. I commit to working to limit your medical and Medicare-related insurance expenses and providing the best of service. Thank you for reading and carefully considering this correspondence.

Sincerely,

Kenton Henry

Office: 281.367.6565

Text my cell @ 713.907.7984

Email: Allplanhealthinsurance.com@gmail.com

Http://Allplanhealthinsurance.com

Http://TheWoodlandsTXHealthInsurance.com

For the latest in health and Medicare relative news, follow my blog @ Https://HealthandMedicareInsurance.com

Medicare Part D Prescription Plans: What you Need to know

 

Greetings! To those of you who are current clients, thank you so much for your continued business. It’s that time of year again! Medicare’s Open Enrollment Period runs through December 7th. Most of you know, during this time, a Medicare recipient may analyze how their prescription drug usage or their current Part D Prescription Drug plan may have or will be changing for the coming calendar year.

2018 DEDUCTIBLE – INITIAL COVERAGE – GAP – CATASTROPHIC THRESHOLDS

Each year, virtually every drug plan changes something material about their coverage. It may be the premium, deductible, drug tiers, copays, or the drugs they cover or don’t cover. It could be all these things. If you don’t read your ANNUAL NOTICE OF CHANGE from your current Part D plan carrier (which you are due by September 30th each year) you could be in for some surprises with your coverage in the coming calendar year!

COMMONLY OVERLOOKED DETAILS:

a) Many people get fixated on the premium and go with the lowest. It’s easy to do. They do this without factoring in applicable deductibles and copays. My lowest premium Part D plan in 2018 is $16.70 per month. Most often, the plan with the lower premium has a higher deductible and copays, so―especially if you are using expensive brand name drugs―you end up paying more for your coverage, and drugs, overall. The same applies to the plans with no deductible.

b) While an annual deductible as high as $405 may apply before your Rx drugs are available for their copays, very often, the deductible does not apply to Tier 1 Preferred Generics and Tier 2, Non-Preferred Generics. That makes a big difference for most people. This is an example of where it pays to carefully review the plan’s SUMMARY OF BENEFITS.

c) When tempted to go with a Medicare Advantage Prescription Drug plan, keep in mind you will have to accept whatever drug coverage is tied to your Medical plan. If you are using expensive drugs, that means you may not necessarily end up with your lowest cost for your drugs. As you would when you let me identify that in the “stand-alone” Part D market.

d) As I explained in a previous post―especially when it comes to brand name drugs―it pays to always ask the pharmacist “what is this pharmacy’s lowest cost for this drug?”. Often that cash price is actually lower than your plan’s copay. In which case ― just pay cash!

Part of the service I provide my clients is running their prescription drug regimen through my a program to identify whether a superior Part D Drug plan exists for them for the coming year. My goal is to have you on a plan which results in all your prescription drugs being covered at your lowest total “out-of-pocket” (TOOP) expense. TOOP is the sum of your premium, any applicable deductible, and the copays you pay for your drugs at the pharmacy counter or through the mail. If we are fortunate enough that your current drug plan still results in meeting these objectives, you simply stay the course and let your plan roll right into 2017! If it no longer results in your lowest TOOP, I will identify the plan that is and (with your instruction) enroll you in it.

Some of you have already seen a version of this (and some of you have been preemptive) and provided me your regimen. For you, I have been working most nights and weekends since October 15th providing you 2018 plan recommendations. If you received one, you need read no further unless you are yet to request that I apply on your behalf. In which case – request the application be emailed to you or – in the case of Aetna and Humana applications – simply request I apply on your behalf with your information I have on record. Please do not apply without my involvement. Mine is a volume business, and I don’t stay in business without it going through me. Even Kenton has to eat! So your business is greatly appreciated!

To accomplish this, I need each of you (who have not already done so) to respond to this email with a list of current drugs and dosages. I am quoting each person’s plan in the order received. Remember, we have until December 7th but applying early is always better than later. So, please, forward your drug regimen, and I will quote you as soon as possible.

As to those of you with Medicare Advantage Plan, who like your coverage, you need do nothing. Just keep paying the premium and let your coverage roll right into the new year. Most of my clients have Medicare Supplement. For those whose policies are no more than two years old, you can be fairly certain it remains competitively priced, and there is little to regain in changing plans. For those of you whose policy is older than two or three years, I am volunteering to re-shop* your plan, beginning in mid-January when all my client’s Part D plans and Under Age 65 health insurance is put to bed. It is simply too much to address during the Open Enrollment Period for both Medicare and Obamacare! The government puts me in the untenable role of having to process 12 months worth of business in 8 weeks. There is no point in hiring additional help. By the time I got them trained, I would have to lay them off!

As my phones will be very busy, you may want to text me during this period if it is important you speak with me right away. My cell phone number appears below. I look forward to keeping you as a client and working to limit your medical and Medicare-related insurance expenses!

Thanks so much!
Kenton Henry
Office: 281.367.6565
Text my cell @ 713.907.7984
Http://Allplanhealthinsurance.com
Http://TheWoodlandsTXHealthInsurance.com

For the latest in health and Medicare relative news, follow my blog @ Https://HealthandMedicareInsurance.com

*Remember – because all of you are six months past your enrollment in Medicare’s Part B – it will be necessary for you to answer a series of health questions and qualify (based on your health) for a new, replacement, Medicare Supplement policy. When the time comes, I can email you sample applications so you may review those questions.

 

2018 Health Insurance Open Enrollment: Game On

Today is November 1, the first day of OPEN ENROLLMENT for Individual & Family 2018 health insurance coverage. This is not going to be my usual Op-Ed or commentary. Things are what they are for now, and I will let the numbers and the available benefits speak for themselves. We can go back to the dialogue once everyone has decided what is in their best interest for the coming year and elected a plan.

Because my phone ― and that of every agent and broker ― specializing in this market ― is going to be ringing off the hook the first few weeks, I am going to provide you some guidance to make this as easy as possible, on all of us.

Please go my quoting and application site. It has just been loaded with all your available plan options. Whether you receive a subsidy and have gone through Healthcare.gov and think you need to – or not ― you should begin here. You can get the quotes; estimate your applicable subsidy; and, seamlessly, enter into Healthcare.gov. Or, if you don’t qualify for or desire a subsidy, you may apply. If you need my assistance, you may save your work. I will see it and can pick up where you left off, to help you finish. You may email me and, if preferring to speak immediately and you cannot reach me on my desk phone, text me on my cell and I will get in touch with you, as soon as possible. If you need me immediately and cannot reach me on my desk phone, text me on my cell and I will get in touch with you, as soon as possible. My cell number is 713-907-7984. I will answer your questions and assist you in completing the process. (The voice-mail on the office line will be checked but, on the cell phone, will remain full.) It will help us both immensely if you review your options before contacting me.

CLICK HERE FOR 2018 HEALTH INSURANCE QUOTES AND PLAN OPTIONS:

https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

Here are the options I have to assist you from my quoting site:

(CLICK ON IMAGE TO ENLARGE)

Good luck and don’t hesitate to let me assist you with this year’s Open Enrollment!

D. Kenton Henry

Email: Allplanhealthinsurance.com@gmail.com

Office: 281-367-6565

Cell: 713-907-7984

https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

http://TheWoodlandsTXHealthInsurance.com

https://HealthandMedicareInsurance.com

MEDICARE CHANGES IN 2018 AND HOW THEY MAY AFFECT YOU

By D. Kenton Henry, Editor, Broker, Agent

Each year Medicare recipients and their agents and brokers prepare for upcoming changes in Medicare. This is because all changes have the potential to impact the member’s pocketbook. They may directly affect it or trickle down to the products they use to supplement Medicare.

Here is what we know is changing:

In 2017 you pay:
$1,288 Medicare deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $322 coinsurance per day of each benefit period
• Days 91 and beyond: $644 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days: all costs

In 2018 you will pay:
$1,316 Medicare deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $329 coinsurance per day of each benefit period
• Days 91 and beyond: $658 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
• Beyond lifetime reserve days: all costs

PART B DEDUCTIBLE:
The Medicare Part B deductible is $183 in 2017. It is expected to rise in 2018, but the Center For Medicaid and Medicare Services has not, and is not expected to, release that figure until closer to the end of this calendar year.

PART B PREMIUMS:
COST OF LIVING ADJUSTMENT (COLA), I.e., the Social Security Income Payment Adjustment, numbers for the coming year have not been released as of yet. But it’s widely expected that there will be a COLA of around 2 percent for 2018 (as opposed to 0.3 percent for 2017, and zero percent for 2016). CMS has not yet set Part B premiums for 2018, but it’s likely that premiums will level out for all enrollees (except those with high incomes, who always pay more). This because any necessary rate change will be covered by the COLA. In other words, the increase in Part B premiums will be offset by an increase in income payments for low-income recipients.

For high-income Part B enrollees (income over $85,000 for a single individual, or $170,000 for a married couple), premiums in 2017 range from $187.50/month to $428.60/month, depending on income. They will likely rise again for 2018, but there’s another change coming that will affect some high-income Part B enrollees in 2018. As part of the Medicare payment solution that Congress enacted in 2015 to solve the “doc fix” problem, new income brackets were created to determine Part B premiums for high-income Medicare enrollees, and they’ll take effect in 2018.

The high-income brackets start at $85,001 for a single individual and $170,001 for a married couple. Enrollees with income between $85,001 and $107,000 ($170,001 and $214,000 for a married couple) won’t see any changes to their bracket.
But enrollees with income above those limits might be bumped into a higher bracket in 2018, which means their premiums could jump considerably. The highest bracket (i.e., with the highest Part B premium) will now apply to those with income above $160,000 ($320,000 for a married couple), whereas the highest bracket didn’t apply in 2017 until an enrollee’s income reached $241,000 ($428,000 for a married couple). As with the deductible, Medicare Part B premiums for 2018 have not yet been set, but slightly less wealthy Medicare enrollees will begin paying the highest prices for Medicare Part B in 2018.

Here are Medicare Part B Premiums for 2017 (based on a 2-year look-back to 2015):

If your yearly income in 2015 (for what you pay in 2017) was You pay each month (in 2017)

File individual tax return File joint tax return Married Filing Separately
$85,000 or less $170,000 or less $85,000 or less = $134
above $85,000 up to $107,000 above $170,000 up to $214,000 N/A = $187.50
above $107,000 up to $160,000 above $214,000 up to $320,000 N/A = $267.90
above $160,000 up to $214,000 above $320,000 up to $428,000 N/A = $348.30
above $214,000 above $428,000 above $129,000 = $428.60

PART D PRESCRIPTION DRUG PLANS:
The Part D Annual Deductible is $405 in 2018, up from $400 in 2017
Premiums in the State of Texas, e.g., range from a low of $16.70 to a high of $197.10
* On the positive side, the Affordable Care Act is gradually closing the donut hole -technically known as the Gap – in Medicare Part D. In 2018, enrollees will pay just 35% of the plans cost for brand-name drugs while in the donut hole, and 44% of the cost of generic drugs.

2018 PART D COVERAGE GAP STAGE:
Begins after the total yearly drug cost (including what Your plan has paid and what you have paid) reaches $3,750. After you enter the coverage gap, you pay 35% of the drug cost for covered brand-name drugs and 44% of the drug cost for covered generic drugs until your out-of-pocket costs (not including your premiums) total $5,000, which is the end of the coverage gap. Not everyone will enter the coverage gap.

2018 Catastrophic Coverage Stage:

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and mail-order) reach $5,000, you pay the greater of:

5% of the cost, or
$3.35 copay for generic drugs (including brand drugs treated as generic) and $8.35 copay for all other drugs.

 

*Tip of the 2018 Part D Open Enrollment Period:
When purchasing your prescription drugs at the pharmacy counter, always ask your pharmacist for the lowest possible cost for your drug through their pharmacy. NBC Today Show did a segment today (10.17.17) in which they revealed that many times your copay for the drug, through your insurance, is higher than the lowest cost from the pharmacy. As the photo at the top of this article depicts, sometimes the difference is quite significant. A pharmacist in Magnolia, Texas, explained that a contractual “Gag” order exists between the pharmacy and the pharmacist (or employee) which prevents the latter from disclosing this to the customer. However, once questioned, the pharmacist or employee must disclose accurate information. If the cash price is lower, by all means, pay the cash price and do not let the purchase go through your insurance.

I will keep followers of my blog apprised of, as yet, unannounced changes in Medicare as they become available. In the meantime, to those of you who are my current clients, I would like to extend a sincere thank you for your business and the confidence you have placed in me.

ASSISTANCE IN IDENTIFYING YOUR LOWEST TOTAL COST PART D DRUG PLAN:

You, and those who would consider my services may email or―for those who feel it a more secure method―may fax a list of your prescription drugs and dosages to my secure fax. (I am the only one with access to it.) I will submit your drug regimen to the quoting system which will identify the plan which covers all your drugs at the lowest total cost for the coming calendar year. The lowest-total-cost is the sum of the plan premium, any applicable deductible, and your drug costs. Whether you elect to go through me to acquire it, is at your discretion.

Please email Kenton at:
allplanhealthinsurance.com@gmail.com
or
Fax to my secure fax at:
281.367.4772

I am processing quote requests in the order received.
Thank you so much for taking the time to stay abreast of these relevant changes affecting, and so important to, Medicare recipients. I know many of you are living on fixed incomes, and keeping your costs for protecting yourself from increases in medical care, and insurance, is of vital importance to you.

 http://TheWoodlandsTXHealthInsurance.com   https://HealthandMedicareInsurance.com

Obamacare: Are All Bets Off For 2018 Open Enrollment?

By D. Kenton Henry, Editor, Broker, Agent

Last evening I began to receive texts and messages inquiring how President Trump’s executive order (EO) on Thursday, October 12th, would impact both the near and long-term future of Obamacare. Before retiring for the evening, I responded – “In the long run, dramatically. But in the short run, not so much because it will take quite awhile for the insurance industry to respond appropriately.” At that time, all I had learned was, the President ordered regulators to allow consumers to shop across state lines for health insurance along with the ability individuals of like professions, careers, and risk profiles, to band together in associations for the purpose of acquiring individual and family health insurance. Theoretically, the first would allow the consumer to shop for their best value among a far greater number of companies and plans, thus restoring competition to the market. The second would allow pooling a large number of people, and the resulting volume would lower risk to the insurance companies, thus allowing them to charge lower premiums to the members. The same principle and effect currently available to employer groups. And that was all I was aware of regarding the EO. Additionally, the EO loosens the restrictions on “Short-Term” health insurance, allowing it to serve as a viable alternative to long-term coverage for the young and/or healthy.

Today, I awakened to learn the Department of Health and Human Services announced late last night that the EO includes the cessation of federal payments for Cost-Sharing Reductions (CSRs) to insurance companies. “Immediately.” This, according to Secretary Eric Hargan and Medicare administrator, Seema Verma. And―with that―all bets are off! The Administration claims this can be done because Congress never appropriated funds for the CSRs. These funds were used to reimburse insurers for the CSRs which result in reductions in deductibles, copays, and out-of-pocket maximums for eligible individuals. However, while the insurers will lose these subsidies (amounting to $7 billion this year), they remain obligated to continue offering them to eligible customers! Eligible customers mostly include those qualifying for subsidies and electing “Silver” plans through the Marketplace, Healthcare.gov. At the very least, halting the payments could trigger a spike in premiums, at some point, for the coming year, unless Congress authorizes the money. The next payments are due around October 20th. The Congressional Budget Office estimates, without the subsidies, premiums could go up by as much as 20%. That is on top of the 15-20% average increase anticipated with the subsidies in place! Nearly 3 in 5 Healthcare.gov customers qualify for help. If you qualify for a premium subsidy, the increase will simply be paid for by your fellow taxpayers as it has the last four years. The person or family who does not qualify will have to pay for it entirely out of their own pocket. As always, it is the hard working middle class who could be hurt the most. Those who make just enough to get by, but a little too much to qualify for government assistance.

Will this break Obamacare altogether and, if so, when? What impact will it have on 2018 individual and family health insurance premiums? Rates had to be (and were) submitted to state health insurance commissioners, as required, on September 30th. Can insurance companies pull out of the market at this point? Will they? Apparently, Premium Subsidies (separate from CSRs), designed to lower premiums, per se, for qualified individuals – as well as though qualifying for tax credits upon filing – will not be affected. However, here is what the Washington Post (article below) had to say about the cessation of CSR subsidies, alone: “Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some state’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.” In my opinion, it is too late to submit new rates for approval in time for Open Enrollment, just around the corner. But it is not too late for an insurance company to pull out of the market altogether. What options will that leave the consumer, including my clients, for coverage in 2018 and beyond?

I agree with the administration; this is their move to force the hand of Congress to reverse the policies of Obamacare, restore competition and consumer choice, to the market. It will allow elements of a free market to regulate the variables, most important of which are, benefits, choice of provider, and premium. How long it will take for this action on the part of the Trump to accomplish this, I can’t say. The Executive Order is almost certain to be challenged by state Attorney Generals and litigated in federal courts. This could take months, or more, to play out, and probably will.

I apologize that, at this point, I have more questions than answers. In the meantime, I, and, my clients have yet to learn what our 2018 health options and premiums would be (or would have been) without the ramifications of the Executive Order. Rest assured, I will be watching in earnest for the details as this situation evolves.

As always, please feel free to phone me at 281.367.6565; text me at 713.907.7984 or email me at allplanhealthinsurance.com@gmail.com. The closer we get to November 1, the more I will know. And whatever is available to you, I will have. Along with your best option. Bear in mind, “best” is a relative term.

http://TheWoodlandsTXHealthInsurance.com https://HealthandMedicareInsurance.com

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Featured article:

WASHINGTON POST
By Amy Goldstein and Juliet Eilperin By Amy Goldstein and Juliet Eilperin
Health & Science
October 13 at 9:42 AM

President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision coincides with an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.
The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. Another statement a short time later by top officials at the Health and Human Services Department said the cutoff would be immediate. The subsidies total about $7 billion this year.
Trump has threatened for months to stop the payments, which go to insurers that are required by the law to help eligible consumers afford their deductibles and other out-of-pocket expenses. But he held off while other administration officials warned him such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans, according to two individuals briefed on the decision.
Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will start in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to damage the marketplaces — and the law.
Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some states’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.
A spokeswoman for America’s Health Insurance Plans, an industry trade group that has been warning for months of adverse effects if the payments ended, immediately denounced the president’s decision. “Millions of Americans rely on these benefits to afford their coverage and care,” Kristine Grow said.
And California Attorney General Xavier Becerra (D), who has been trying to preserve the payments through litigation, said the president’s action “would be sabotage.” Becerra said late Thursday that he was prepared to fight the White House. “We’ve taken the Trump Administration to court before and won, and we’re ready to do it again if necessary,” he said in a statement.
Trump’s move comes even as bipartisan negotiations continue on one Senate committee over ways to prop up the ACA marketplaces. Both Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have publicly said the payments should not end immediately, though they differ over how long these subsidies should be guaranteed.
The cost-sharing reductions — or CSRs, as they are known — have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established them does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. President Trump signed an executive order on the Affordable Care Act on Oct. 12. (Photo: Jabin Botsford/The Washington Post)
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. (The Washington Post)
“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”
In a filing Friday morning, the administration informed the court that HHS had “directed that cost-sharing reduction payments be stopped because it has determined that those payments are not funded by the permanent appropriation.”
House Speaker Paul D. Ryan (R-Wis.) said in a statement that the administration was dropping its appeal of the lawsuit — something the White House did not mention in its announcement. Ryan called the move to end to the court case “a monumental affirmation of Congress’s authority and the separation of powers.”
Meanwhile, the top two congressional Democrats, House Minority Leader Nancy Pelosi (Calif.) and Senate Minority Leader Charles E. Schumer (N.Y.), excoriated the president’s decision. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said in a joint statement. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”
For months, administration officials have debated privately about what to do. The president has consistently pushed to stop the payments, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former HHS secretary Tom Price, cautioned that this could exacerbate already escalating ACA plan premiums, these Republicans said. But some government lawyers argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.
Acting HHS secretary Eric Hargan and Seema Verma, administrator of the department’s Centers for Medicare and Medicaid Services, said they were stopping the payments based on a legal opinion by Attorney General Jeff Sessions. “It has been clear for many years that Obamacare is bad policy. It is also bad law,” their statement says. “The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.”
While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.
One person familiar with the president’s decision said HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.
The cost-sharing payments are separate from a different subsidy that provides federal assistance with premiums to more than four-fifths of the 10 million Americans with ACA coverage.
Word of the president’s decision came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.
The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House’s announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.
Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.
The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” — a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.
In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.
Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health re-imbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules — another reversal of Obama policy.
In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”
Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”
But in an early morning tweet Friday, Trump reached out to Democrats with an appeal to somehow work together on a health-care “fix.”
“The Democrats ObamaCare is imploding,” Trump wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”
The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal — giving each state more discretion over matters of insurance.
Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted — his directive will provide “millions of people with Obamacare relief,” he said.
Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers — or refuse to insure them.
A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.
Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Selling health plans from state to state without separate licenses — the idea underlying much of the president’s order — has long been a Republican mantra. It has gained little traction in practice, however.
Half a dozen states — before the ACA was passed in 2010 as well as since then — have passed laws permitting insurers to sell health policies approved by other states. And since last year, the ACA has allowed “compacts” in which groups of states can agree that health plans licensed in any of them could be sold in the others. Under such compacts, federal health officials must make sure the plans offer at least the same benefits and are as affordable as those sold in the ACA marketplaces.
As of this summer, “no state was known to actually offer or sell such policies,” according to a report by the National Conference of State Legislatures. A main reason, experts say, is insurers’ difficulty in arranging networks of doctors and other providers of care far from their home states.