MEDICARE FOR ALL? (AND “THE TOOTH FAIRY PROMISES A 2 YEAR TREASURY NOTE PAYING 10.7% UNDER YOUR PILLOW IN 2020)

OpEd by D. Kenton Henry                                                                                           01 October 2019  HealthandMedicare.com

       VS.                 

I listened to the recent Democrat Presidential Primary Debates, as I listen to the daily sound bites in the media, as candidates try unabashedly to outdo each other. They do this in terms of the massive give-aways they promise us if elected in 2020. They promise these things not just to citizens, but everyone within the border of the United States. My incredulity, upon hearing such, exceeds even those bounds.

Their original promise is “free healthcare for all”. Healthcare free of premiums, deductibles, and copays. Medicare is the vehicle. To which I must ask myself, “Do these people even know the costs involved in Medicare?” “Do they really believe Medicare pays everything?” They would have you believe as much. They are counting on your naivety and lack of familiarity with the subject.

What makes Medicare a convenient and acceptable form of medical coverage for millions of people 65 and older (or disabled for 24 months or more) is it working in conjunction with private insurance plans. That, and thousands of licensed and “Certified” agents and brokers, helping to deliver comprehensive medical coverage at an affordable price. It is a hybrid package that provides as complete protection as available. The insurance plans would not exist without Medicare and, by itself, Medicare leaves the recipient/member exposed to significant liabilities.

Do these candidates, and the average voter know that in 2019:

A hospital admission requires the Medicare member to pay a $1,364 deductible each time they are admitted to the hospital as an inpatient for a separate medical condition, or the same medical condition separated by more than 60 days.

For days beyond 60, they pay $335 per day

Beyond day 90, they pay $682 per day

Eventually― say in the event of a stroke, paralysis, or being severely burned―they will pay all costs.

Part B Co-Insurance, Deductible and Premium

Relative to out-patient medical care, the Medicare member pays 20%, plus can be liable for excess charges above and beyond what Medicare deems “reasonable and customary”.

In addition, Medicare recipients pay an annual deductible of $185 for Medicare Part B (out-patient) medical care and a premium generally beginning at $135.50 per month and increasing to as high as $460.50. The latter depending on one’s adjusted gross income.

Perhaps most important, to take note of, in considering whether “Medicare For All” is even feasible, much less cost effective, is this. Medicare recipients have paid into the Medicare program their entire working careers via Medicare care taxes and payroll deductions. To qualify for Part A, (inpatient) coverage, they must have worked a minimum of 40 quarters or “buy in “with a premium as high as $422 per month.

So, you can see, Medicare is hardly free. And yet these candidates would have you believe it will be provided free of premiums, deductibles, and copays. (Now this is where even The Tooth Fairy raises her eyebrows!) It will be GIVEN, not to just those over 65, but to every man, woman, child, legal, and non-legal citizen or resident of the United States―whether they have paid a dime into the system or not.

Factor all that in and process this. Medicare now spends an average of about $13,600 a year per beneficiary, and in five years, the annual cost is expected to average more than $17,000, the report said.

According to CMS.gov (The Centers for Medicare & Medicaid Services ― refer to featured article 1 below*) The Medicare Board of Trustees predicts Medicare’s two trust funds, for Part A and Part B and D, respectively ― will go broke in 2026!

To put things in perspective, in 1960 there were about five workers for every Social Security beneficiary. The ratio of workers to beneficiaries fell to 3.3 in 2005 and then to 2.8 in 2016. It will decline further to about 2.2 by 2035, when most baby boomers will have retired, officials said.

The aging of the population is another factor in the growth of the two entitlement programs. The number of Medicare beneficiaries is expected to surge to 87 million in 2040, from 60 million this year, according to Medicare actuaries. And the number of people on Social Security is expected to climb to 90 million, from 62 million, in the same period.

The United States Treasury: U.S. Debt And Deficit Grow As Some See Government As The “BeAll and EndAll”.

All this and the candidates would have you believe our government can provide free health care to everyone? When it can’t even provide it to our current citizens who have paid into the system their entire working lives! And who exactly is the government? “We The People”. We the tax payers. You and I. Even some of the candidates, admit the proposal will call for more taxes from the middle class. More? Really! One projected cost for Medicare For All is 39 trillion dollars over the first ten year period. The national debt is currently $22 trillion and took since the end of President Andrew Jackson’s administration (1837 and the last time the national debt was fully paid-off) to accumulate that! The combined wealth of all American households is less than $99 trillion. One can only conclude that “Medicare For All” would be a “Welfare System For All”. It would push our country into a socialist economic system to a depth from which it would be impossible to extricate itself.

As a new Medicare recipient, myself, I find the combination of the government program and private insurance working very well for myself and clients, from an insured standpoint. The program’s, and our nation’s, fiscal concerns are a more substantial matter and a topic for another time. With Medicare “Open Enrollment” a mere 15 days away, I can only say, “I hope whoever is President, and controls Congress, in future administrations―while providing a safety net for all American citizens―first and foremost, provides the capable, responsible, American taxpayer quality medical coverage―free of rationing of treatment and access to providers. At an affordable cost.”

D. Kenton Henry, editor HealthandMedicareInsurance.com, Agent, Broker

Email: Allplanhealthinsurance.com@gmail.com https://TheWoodlandsTXHealthInsurance.com https://Allplanhealthinsurance.com https://HealthandMedicareInsurance.com 

 

************************************************************************************Featured article:

Centers for Medicare & Medicaid Services

Press release

Medicare Trustees Report shows Hospital Insurance Trust Fund will deplete in 7 years

Apr 22, 2019 

Medicare Trustees Report shows Hospital Insurance Trust Fund will deplete           in 7 years

Today, the Medicare Board of Trustees released their annual report for Medicare’s two separate trust funds — the Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, and the Supplementary Medical Insurance (SMI) Trust Fund, which funds Medicare Part B and D.

The report found that the HI Trust Fund will be able to pay full benefits until 2026, the same as last year’s report.For the 75-year projection period, the HI actuarial deficit has increased to 0.91 percent of taxable payroll from 0.82 percent in last year’s report. The change in the actuarial deficit is due to several factors, most notably lower assumed productivity growth, as well as effects from slower projected growth in the utilization of skilled nursing facility services, higher costs and lower income in 2018 than expected, lower real discount rates, and a shift in the valuation period.

The Trustees project that total Medicare costs (including both HI and SMI expenditures) will grow from approximately 3.7 percent of GDP in 2018 to 5.9 percent of GDP by 2038, and then increase gradually thereafter to about 6.5 percent of GDP by 2093. The faster rate of growth in Medicare spending as compared to growth in GDP is attributable to faster Medicare population growth and increases in the volume and intensity of healthcare services.

The SMI Trust Fund, which covers Medicare Part B and D, had $104 billion in assets at the end of 2018. Part B helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who voluntarily enroll. It is expected to be adequately financed in all years because premium income and general revenue income are reset annually to cover expected costs and ensure a reserve for Part B costs. However, the aging population and rising health care costs are causing SMI projected costs to grow steadily from 2.1 percent of GDP in 2018 to approximately 3.7 percent of GDP in 2038. Part D provides subsidized access to drug insurance coverage on a voluntary basis for all beneficiaries, as well as premium and cost-sharing subsidies for low-income enrollees.  Findings revealed that Part D drug spending projections are lower than in last year’s report because of slower price growth and a continuing trend of higher manufacturer rebates.

President Donald J. Trump’s Fiscal Year 2020 Budget, if enacted, would continue to strengthen the fiscal integrity of the Medicare program and extend its solvency.  Under President Trump’s leadership, CMS has already introduced a number of initiatives to strengthen and protect Medicare and proposed and finalized a number of rules that advance CMS’ priority of creating a patient-driven healthcare system through competition.  In particular, CMS is strengthening Medicare through increasing choice in Medicare Advantage and adding supplemental benefits to the program; offering more care options for people with diabetes; providing new telehealth services; and lowering prescription drug costs for seniors.  CMS is also continuing work to advance policies to increase price transparency and help beneficiaries compare costs across different providers.

The Medicare Trustees are: Health and Human Services Secretary, Alex M. Azar; Treasury Secretary and Managing Trustee, Steven Mnuchin; Labor Secretary, Alexander Acosta; and Acting Social Security Commissioner, Nancy A. Berryhill. CMS Administrator Seema Verma is the secretary of the board.

The report is available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/index.html.

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*Featured Article #2

Politics

Health insurers ramp up lobbying battle against Medicare-for-all

By Ana Radelat

The CT Mirror |

Aug 12, 2019 | 6:00 AM

Health insurers have joined forces with their longtime foe, the pharmaceutical industry, as well as partnering with the American Medical Association and the Federation of American Hospitals, to form a coalition to fight Medicare-for-all proposals and other Democratic plans to alter the nation’s health care.

As Democratic presidential candidates embrace changes to the nation’s health care system that could threaten Connecticut’s health insurers, the industry is hitting back.

Health insurers have joined forces with their longtime foe, the pharmaceutical industry, as well as partnering with the American Medical Association and the Federation of American Hospitals, to form a coalition to fight Medicare-for-all proposals and other Democratic plans to alter the nation’s health care.

The Partnership for America’s Health Care Future, funded by the insurance industry and its allies, is running digital and television ads aimed at undermining support for Medicare-for-all proposals and plans for a “public option,” a government-run health plan that would compete with private insurance plans.

The partnership was formed a little more than a year ago to protect the nation’s current health care programs, mainly the Affordable Care Act, Medicare and Medicaid.

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The organization’s executive director, Lauren Crawford Shaver, said diverse groups in the coalition found a common cause in 2017 — opposing an attempt by congressional Republicans to repeal the Affordable Care Act.

“We came together to protect the law of the land,” she said.

That battle was won. Coalition members determined they should continue to band together to ward off other political dangers.

“There’s a lot of things we might fight about, but there’s a lot we can agree on,” Crawford Shaver said.

Sens. Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts have called for a Medicare-for-all through a single-payer system, in which all Americans would be enrolled automatically in a government plan.

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Warren was among several candidates during the most recent Democratic debates who took aim at health insurers.

“These insurance companies do not have a God-given right to make $23 billion in profits and suck it out of our health care system,” she said.

Other candidates prefer a more modest approach, offering a “public option” or Medicare buy-in plan that would allow Americans to purchase government-run coverage, but unlike Medicare-for-all would not eliminate the role of private insurers.

That split among Democrats also runs through Connecticut’s congressional delegation, with Sen. Richard Blumenthal, D-Conn., and Rep. Jahana Hayes, D-5th District, endorsing Medicare-for-all plans and the other lawmakers supporting Medicare buy-in or public option plans.

The nation’s health insurers oppose all of the Democratic proposals discussed during the two nights of debates.

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The insurers’ message is simple: The Affordable Care Act is working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a big new public program. Further, they say, more than 155 million Americans have employer-sponsored health coverage and should be allowed to keep it.

Insurers also say that public option and Medicare buy-in plans would lead the nation down the path of a one-size-fits-all health care system run by bureaucrats in Washington D.C.

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They say offering a public option or a Medicare buy-in would prompt employers to drop coverage for their workers and starve hospitals, especially those in rural areas, since government-run health plans usually reimburse doctors and hospitals less for medical services than private insurers. They also say Medicare-for-all and other Democratic proposals will lead to huge tax increases to pay for the plans.

“Whether it’s called Medicare for all, Medicare buy-in or the public option, the results will be the same: Americans will be forced to pay more and wait longer for worse care,” said Crawford Shaver.

The Partnership for America’s Health Care Future ran its first television ad on CNN just before and after the cable channel ran last week’s debates.

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The commercial showed several “ordinary Americans” at home and work decrying “one-size fits-all” health plans and “bureaucrats and politicians” determining care.

“We need to fix what’s broken, not start over,” the final speaker says.

Members of the Partnership for America’s Health Care Future have a lot of money and influence to wield on Capitol Hill. They spent a combined $143 million lobbying in 2018 alone, according to data from the Center for Responsive Politics.

And coalition members appear eager to spend even more lobbying money this year.

In the first six months of this year, America’s Health Insurance Plan, a health insurer industry group and member of the partnership, spent more than $5 million on lobbying expenses, and is on the way to surpassing the $6.7 million it spent in lobbying last year.

To underscore the health insurance industries’ importance to local economies, AHIP releases a state-by-state data book each year that details coverage, employment and taxes paid.

In Connecticut, the industry employs 12,296 workers directly and generates another 13,586 jobs indirectly, AHIP says. The payroll for both these groups of workers totals over $3.8 billion a year, AHIP says, and the average annual salary in the business is $112,770. The Connecticut Association of Health Plans puts the number higher, saying Connecticut has 25,000 direct jobs related to the health insurance industry, and another 24,000 indirect jobs.

AHIP also estimates that Connecticut collects nearly $200 million a year in premium taxes on health care policies sold in the state.

Connecticut’s reliance on health insurers – and their continuing influence – was on full display during the last legislative session when the insurance companies, led by Bloomfield-based Cigna, derailed

DENTAL INSURANCE: WORTH THE PREMIUM YOU PAY … OR SIMPLY A “TIME PAYMENT PLAN”?

 

 

 

Op-ed by D. Kenton Henry

“Is dental insurance really worth the premium I pay?” is one question I am asked frequently. It is often followed, almost instantly, by―”Or am I simply paying for my dental work on a time a payment plan?”

My answer to both questions is a definitive, “Maybe.”

If you, as the majority do, have dental insurance through your employer, that employer is subsidizing all or part of your premium. This convenience makes for a solution to the equation, more favorable to you. In contrast―if you are self-employed, retired, or otherwise personally have to pay the full amount of a dental insurance premium―the opposite may be true. That is unless you take some straightforward advice, I am about to provide. If you do not, you most likely will only be spreading your cost for dental work over time. Even worse, dental insurance could prove to be a “loss item” in that you will have paid more in premiums than you will ever receive in benefits.

Short of taking a long drive and crossing the Rio Grande into Mexico to obtain your dental work, what can you do to offset the cost of say, a dental implant, which, on this side of the border, is going to run from $3,500 to $7,000?

Let me preface this by with a premise or three:

#1) With no insurance company is “the sky the limit”. I’m referring to the fee they are going to pay a dentist for a particular dental procedure. For example, no insurance company is going to accept a fee of $10,000 for a single porcelain crown. Not even their share of that cost, which is typically 50%. So what is the limit of a fee the insurance company will cover? That limit must be contractually defined, and the limit most insurance companies abide by is, “reasonable and customary” or “reasonable, usual, and customary”. These are empirical standards an insurance company uses to determine whether to pay a fee. Or how much of a fee to pay. If the dentist charges the general prevailing rate in your geographical area, they are going to pay the portion for which they are contractually obligated. Basically, it’s the average charged in your neighborhood. You will be charged more in Beverly Hills, California and less in Brenham, Texas “where the cows think it’s heaven”. Additionally, if “usual” is part of the definition, the fee has to be in line with what this particular dentist charges for a particular procedure. If fee is disproportionate either, or, both, ways―the maximum amount paid by the insurance company will be the limit set in their fee schedule.

#2) A dental insurance plan is either a provider network plan or a non-network plan. If it is a network plan, it is usually either a Dental Preferred Provider Organization (DPPO) Plan or a Dental Health Maintenance Organization (DHMO) Plan. If it is the first, you may go outside the network of dentists with which the insurance company has contracted but will most likely pay a higher cost for doing so. With the latter, you must remain within the network of dentists or, you have no insurance coverage whatsoever. For either of these options, you pay a lower premium than if you purchase a non-network or “any dentist” plan. The reason is that you agree to utilize or, at least, consider utilizing a dentist with whom the insurance company has contracted to charge you a lower fee than they would without the contract. This limits the insurance companies losses and brings increased traffic to the dentist.

#3) This is perhaps the most important part. If you purchase a non-network dental insurance plan, you can, almost, be assured you will be charged more than the insurance company deems acceptable. Additionally, you will be responsible for any dollar amount above their “reasonable and customary” rate. However, if you purchase a network plan, and go within the network of dentists, you will not be held responsible for any “excess” charges. Any charges above the reasonable and customary rate, the dentist will be forced to “write off”. In this situation, you will never have to worry about a surprise bill or claim. If a policy says your share of the bill is 20% or 50%, it will be that and not 20% or 50% plus any excess charges.

Assuming you accept you must acquire a network plan, in order to limit you own losses and surprise dental bills, the challenge becomes, “How do you find a quality dentist willing to accept a lower fee for treating you?” The typical HMO dental provider is typically someone straight out of dental school or who otherwise needs to build their patient base. In return for sending patients their way, the dentist is willing to accept a meaningfully lower fee. If the dentist is a PPO provider, they may have been in business longer, have more experience, and perhaps a reputation for having better skills. But they are willing to accept a somewhat lower fee in return from the many employees a large company may send their way. The dentist who isn’t willing to participate in any network apparently feels they have all the clients they need. That or their reputation is so great it will draw all the traffic they require.

The problem is, unlike a large oil company, as an individual, or family, you don’t bring enough “volume” to the table to bargain for a lower dental fee. At least not by yourself. Therefore, you have to identify and purchase your dental insurance from an insurance company which has the reputation of insuring a large number of employees of that oil company. As well as having a reputation for paying their claims in a timely and efficient manner. A manner such that the dentist wants to be contracted with them. From your standpoint, you want that insurance company to have a reputation for the same when it comes to you and not have to worry about claim disputes.

Another challenge is, at $6,000 for a dental implant, your dental benefit may not go too far. Secondly, does your insurance plan cover implants in the first place? Again, the sky is not the limit. The average dental plan covers a maximum of $1,000 of dental treatment per year. You can pay a higher premium for incremental benefits up to a maximum of $5,000. But a policy which pays that much in year one would cost a fortune and there is typically a twelve-month wait for major dental work to be covered. As such, you may want to find a plan which increases to that limit with each passing year and is available at what you consider a reasonable cost.

How do you find a dental policy which does not subject you to “excess” costs; allows you to see a highly skilled dentist, utilizing the latest technology and performing the most advanced form of treatment; all at a competitive premium? And this from a company which pays the claims they are contractually obligated to pay while doing so in a timely fashion?

This is where I, and my thirty-three years experience in the medical and dental insurance business, come in. My experience as a patient and consumer is even longer. After being in braces for eight years, I had all my front teeth knocked out in an auto accident when they impacted the steering wheel. I was wearing a seat belt, which saved my life, but not a shoulder strap. I’ve had to have the dental work replaced on three occasions since that senior year of high school. This year, I proceeded with what will be one double crown and, ultimately, two implants. (Ouch, is right!) I was not willing to accept this type of work from a mediocre dentist―and certainly did not care to pay cash for it! So I found a policy, issued by a large, financially sound insurance company, with a reputation for excellent customer and claim service. Then I found a policy which ultimately pays the maximum $5,000 annual benefit. In order for it to be affordable to me, it started, December 1 of 2018, at a calendar year benefit of $1,500―immediately went to $2,500 January 1, of this year―and will go to a $5,000 benefit this coming January. So I only paid for a $1,500 benefit for one month before it jumped to a $2,500 benefit! During this year I acquired the double porcelain crown and the bone graft and post for one dental implant. In 2020, I will have the crown for the implant post attached, when my calendar year benefit is $5,000. The second implant is optional, and I will probably have that work done in 2021 when my benefit remains $5K.

Once I knew what company to go with, the final step in selecting my dental insurance policy required finding the right dentist. I reviewed the insurance company’s list of network providers and researched the dentist’s reputation via credentials and reviews. I won’t belabor that but, suffice it to say, I found a dentist who met my requirements. He is very conveniently located relative to any resident of The Woodlands or Spring and, in my opinion, is well worth going to if you reside anywhere in Montgomery County or Northwest Harris County. He utilizes the latest technology, has a great and skilled staff, and a decent, very professional, if not overly effusive, chairside manner.*

 

In summation, in order to make dental insurance worth your while, you need to:

1) accept you need to acquire a “network provider” dental plan

2) find a policy which pays a reasonable benefit based on your foreseeable need, at an affordable premium and

3) allows you to go to a skilled dentist convenient to you

I have done all the homework for you. For over three decades, I have specialized in medical, Medicare-related, and dental insurance. I provide objective quotes from established “A” rated companies and quality customer service. Among the companies I represent are Aetna, Ameritas, Anthem, BlueCross BlueShield, Cigna, Delta Dental, Humana, and UnitedHealthcare. I am located in the heart of The Woodlands and am accessible from my websites Allplanhealthinsurance.com and TheWoodlandsTXHealthInsurance.com. You may also feel free to contact me at my numbers below.

I look forward to working with and assisting you in acquiring any of the above referenced products.

D. “Kenton” Henry                                                                                                               Editor, Agent, Broker Office: 281-367-6565                                                           Text my cell @ 713-907-7984                          http://TheWoodlandsTXHealthInsurance.com                              http://Allplanhealthinsurance.com                                   http://HealthandMedicareInsurance.com https://linkedin.com/in/kentonhenryinsuranceconsultant

*(Neither I nor my agency and websites are affiliated in any way with a particular dentist or dental office. Neither do we receive compensation from the same for any recommendation we may make.)

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.

*****

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:

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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.

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

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.

 

Health Insurance Plans and Premiums For 2017

health-insurance-premiums-2017

Well, here we are, two days from Obamacare Open Enrollment. Tuesday, November 1st, the starting gun goes off for Americans to shop for 2017 health insurance and we cross the finish line January 31st, at which point, our health insurance―barring a significant life change―will be locked in the remainder of the year. This month is my 30th year in the industry and it is my job to help you identify and elect your best health insurance option for 2017.

Here are the challenges ahead of us. As those of you who were in Under Age 65 health insurance market last year well know, you were forced off your PPO plan (assuming you were in one) and into HMO coverage. And you learned it was extremely difficult to find your doctors and hospitals in any HMO plan network. (In an HMO plan, you must utilize providers in your network or you have no coverage whatsoever.) Hence, you found your doctors, hospitals, and, effectively, your treatment rationed. Previews of the 2017 plans and premiums indicate most insurance companies have withdrawn from the market and those remaining are continuing to offer HMO coverage only. To add insult to injury, they are offering it at dramatically higher premiums. In Texas, premiums are 25% higher on average. And they are much higher in many other states.

As I write, plan and premium change notices are arriving in the mail and pushing the edge out of the sticker shock envelope. My own arrived, and while a 23% increase sounds good relative to what many of my clients are experiencing, the insurance company is also raising the deductible on my plan by a thousand dollars. A client left a message in my voicemail late Friday evening informing me his premium is increasing 58.9%. He went on to say, “That is unsustainable and I will pay the penalty before I pay that premium! We will have to find something else!” What he may not know yet―and what I will have to inform him―is that he will only have plans for two companies to choose from in his county. One is the company he is with. Regardless, all the options he will have are at significantly higher premiums than last year. Since 2014 (the first year Americans whose net income fell below a certain threshold were able to receive subsidies to offset a portion of their health insurance premium) I have said―if you qualify for a significant one―you may be happy with your health insurance premium. However, if you are one of the millions of hard working Americans making just above that threshold―in all likelihood―you are, like my client who left the voicemail, distraught over what is happening to your health insurance costs.

That being said, and as was already said, it is my job to help you identify your best option. And to do so without foregoing health insurance protection and paying the ensuing penalty for doing so. The strategy I employed for myself in 2016 is the same I will be utilizing in 2017. It is not what I would prefer, but what I would prefer is not an option. It is, however, the best option in light of the circumstances. Finances may not be your concern but access to your providers may be. Or, access to your providers may not be your concern but finances may be. Both may be your concern. My strategy may work for you or it may not. But I feel it provides the least compromise and is the best for adapting to this current state of affairs. At least until better options avail themselves in the individual and family health insurance market. Please contact me at 2813676565 to discuss it. If you feel it, or another approach, is the way you would like to proceed, I can make the application process go as quickly and smoothly as possible. And that is whether you qualify for a subsidy or not and without you having to personally deal with healthcare.gov.

ATTENTION SMALL BUSINESS OWNERS: You have possible recourse regarding the poor options in the individual and family health insurance market. If you are the owner of a legal business entity, e.g., LLC or corporation, you have an alternative. During the Small Business Open Enrollment Period (SBOEP)―from November 1 through December 15th―you may enroll your employer group and still have access to quality coverage and, more importantly, quality PPO provider networks where you are in control of who your providers are and, therefore, your treatment. During this SBOEP you will not have to meet the participation or contribution requirements which apply to small business group enrollment during the remainder of the year. In other words, you need only cover a minimum of two employees and you can require they pay 100% of their personal and family premium which will then be payroll deducted from their compensation. Please contact me if you have an interest in pursuing this strategy.

For those who are strictly in the market for individual and family health insurance, as of Tuesday, you may go to my website at http://TheWoodlandsTXHealthInsurance.com to review your options. While this site focuses on our hometown, it will provide quotes for residents of all 50 states. I can be the agent for residents of Texas, Indiana, Ohio and Michigan. Once there, you may apply online or call me to discuss the details of the options you see and I can submit your application for you. I the meantime (as of this moment), if you know―or believe―you qualify for a subsidy of your premium, you may go to my second quoting site where you may calculate the subsidy you qualify for or the penalty for not purchasing health insurance in 2017. You mag go on to obtain your quote and, if applying, log directly into healthcare.gov and apply. If doing so, when asked if you are working with anyone else on your coverage, select Agent or Broker and list my agent (legal) name, Donald Kenton Henry, and my National Producer Number (NPN) 387509. If you do this, I will be able to assist with any incomplete applications or outstanding requirements. If you become my client, in most cases, I can handle service related issues throughout the year without you having to deal with the personnel at healthcare.gov or an insurance company. The important thing I would like for you to appreciate is – you are charged not one penny more in premium by going through me for your health insurance than if you were to go directly through the front door of the insurance company whose product you wish to acquire and purchased it directly. And I charge no fee for my service. I only hope that, if I introduce you to a product you wish to utilize or a strategy, you wish to employ, you will acquire the product through me as your agent.

Click on this link to calculate penalties, subsidies and preview the plans available Tuesday, November 1: https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

I look forward to working with you and to, if becoming your agent, providing you the best of insurance service throughout the year. Again, please call me at 2813676565.

(Donald) Kenton Henry ― editor, broker

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FEATURE ARTICLE

The New York Times

Health Law Tax Penalty? I’ll Take It, Millions Say

By ROBERT PEAR OCT. 26, 2016

The decision by many healthy people not to sign up under the Affordable Care Act, even if it means a tax penalty, is undermining the plan. CreditKaren Bleier/Agence France-Presse — Getty Images

WASHINGTON — The architects of the Affordable Care Act thought they had a blunt instrument to force people — even young and healthy ones — to buy insurance through the law’s online marketplaces: a tax penalty for those who remain uninsured.

It has not worked all that well, and that is at least partly to blame for soaring premiums next year on some of the health law’s insurance exchanges.

The full weight of the penalty will not be felt until April, when those who have avoided buying insurance will face penalties of around $700 a person or more. But even then that might not be enough: For the young and healthy who are badly needed to make the exchanges work, it is sometimes cheaper to pay the Internal Revenue Service than an insurance company charging large premiums, with huge deductibles.

“In my experience, the penalty has not been large enough to motivate people to sign up for insurance,” said Christine Speidel, a tax lawyer at Vermont Legal Aid.

Some people do sign up, especially those with low incomes who receive the most generous subsidies, Ms. Speidel said. But others, she said, find that they cannot afford insurance, even with subsidies, so “they grudgingly take the penalty.”

The I.R.S. says that 8.1 million returns included penalty payments for people who went without insurance in 2014, the first year in which most people were required to have coverage. A preliminary report on the latest tax-filing season, tabulating data through April, said that 5.6 million returns included penalties averaging $442 a return for people uninsured in 2015.

With the health law’s fourth open-enrollment season beginning Tuesday, consumers are anxiously weighing their options.

William H. Weber, 51, a business consultant in Atlanta, said he paid $1,400 a month this year for a Humana health plan that covered him and his wife and two children. Premiums will increase 60 percent next year, Mr. Weber said, and he does not see alternative policies that would be less expensive. So he said he was seriously considering dropping insurance and paying the penalty.

“We may roll the dice next year, go without insurance and hope we have no major medical emergencies,” Mr. Weber said. “The penalty would be less than two months of premiums.” (He said that he did not qualify for a subsidy because his income was too high, but that his son, a 20-year-old barista in New York City, had a great plan with a subsidy.)

Iris I. Burnell, the manager of a Jackson Hewitt Tax Service office on Capitol Hill, said she met this week with a client in his late 50s who has several part-time jobs and wants to buy insurance on the exchanges. But, she said, “he’s finding that the costs are prohibitive on a monthly basis, so he has resigned himself to the fact that he will have to suffer the penalty.”

When Congress was writing the Affordable Care Act in 2009 and 2010, lawmakers tried to balance carrots and sticks: subsidies to induce people to buy insurance and tax penalties “to ensure compliance,” in the words of the Senate Finance Committee.

But the requirement for people to carry insurance is one of the most unpopular provisions of the health law, and the Obama administration has been cautious in enforcing it. The I.R.S. portrays the decision to go without insurance as a permissible option, not as a violation of federal law.

The law “requires you and each member of your family to have qualifying health care coverage (called minimum essential coverage), qualify for a coverage exemption, or make an individual shared responsibility payment when you file your federal income tax return,” the tax agency says on its website.

Some consumers who buy insurance on the exchanges still feel vulnerable. Deductibles are so high, they say, that the insurance seems useless. So some think that whether they send hundreds of dollars to the I.R.S. or thousands to an insurance company, they are essentially paying something for nothing.

Obama administration officials say that perception is wrong. Even people with high deductibles have protection against catastrophic costs, they say, and many insurance plans cover common health care services before consumers meet their deductibles. In addition, even when consumers pay most or all of a hospital bill, they often get the benefit of discounts negotiated by their insurers.

The health law authorized certain exemptions from the coverage requirement, and the Obama administration has expanded that list through rules and policy directives. More than 12 million taxpayers claimed one or more coverage exemptions last year because, for instance, they were homeless, had received a shut-off notice from a utility company or were experiencing other hardships.

“The penalty for violating the individual mandate has not been very effective,” said Joseph J. Thorndike, the director of the tax history project at Tax Analysts, a nonprofit publisher of tax information. “If it were effective, we would have higher enrollment, and the population buying policies in the insurance exchange would be healthier and younger.”

Americans have decades of experience with tax deductions and other tax breaks aimed at encouraging various types of behavior, as well as “sin taxes” intended to discourage other kinds of behavior, Mr. Thorndike said. But, he said: “It is highly unusual for the federal government to use tax penalties to encourage affirmative behavior. That’s a hard sell.”

The maximum penalty has been increasing gradually since 2014. Federal officials and insurance counselors who advise consumers have been speaking more explicitly about the penalties, so they could still prove effective.

Many health policy experts say the penalties would be more effective if they were tougher. That argument alarms consumer advocates.

“If you make the penalties tougher, you need to make financial assistance broader and deeper,” said Michael Miller, the policy director of Community Catalyst, a consumer group seeking health care for all.

http://www.nytimes.com/2016/10/27/us/obamacare-affordable-care-act-tax-penalties.html?smid=fb-share&_r=0

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MEDICARE PREMIUM AND DEDUCTIBLE INCREASES AND BLUECROSS PPO ELIMINATION SLATED FOR 2016!

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By D. Kenton Henry

Clients and Friends of Kenton Henry and ALL PLAN MED QUOTE,

It is that time again. We are approaching the end of the calendar year and I write to thank you for your business and for the trust you placed in me to represent your health insurance needs to the best of my ability. This month marks my 29th year in the industry and that would not be possible without you.

Because there are so many changes coming your way-not only for Medicare recipients but for my Under Age 65 clients-following me here will be the easiest way to be informed of vital information affecting your coverage as it becomes available to me. This is your one source for the good, the bad and the ugly of the Medical insurance market. I will be posting the good part later when I determine what that is. Happy New Year.

BREAKING NEWS FOR MEDICARE RECIPIENTS: On Thursday, October 15, the Social Security Administration announced that there will be no cost of living adjustment (COLA) for 2016. At the same time, the Medicare Part B Premium and deductible is expected to increase significantly for some people next year. The Part B basic premium is expected to go from $104.90 to $159.30 per month Additionally, the Medicare Part B calendar year deductible is slated to also increase from $147 to $223! This latter increase would affect approximately the entire Medicare population of 17 million and will in turn trigger premium increases from the supplemental insurances such as Medicare Supplement and Medicare Advantage which pay that deductible for the insured person! Together, these increases could cause people to drop their Medicare Part B insurance resulting loss of coverage for doctors visits, diagnostic testing, lab work and out-patient surgeries. For more details and information on just who this affects please watch this video of a FOX NEWS LIVE report by Martha MacCallum video I recorded just today:

MEDICARE PREMIUM INCREASE 2016

https://youtu.be/9DVGiEa074E

  • Additionally, if you are Part D Prescription Drug Plan client of mine (or not) email me a list of your current prescription drug regimen (drug and dosage) and I will scan the market to identify your lowest total of pocket cost plan and make my recommendation. allplanhealthinsurance.com@gmail.com

UNDER AGE 65 INDIVIDUAL AND FAMILY NEWS:

Most relevant at this time for individuals and families under the age of 65 is the elimination of BlueCross BlueShield of Texas’s “Individual and Family” Blue Choice PPO network which over 370,000, insured members (including myself) utilize. I informed all my clients (sharing this coverage) in a letter mailed via the US Postal Service just a few days ago. I also addressed this issue in my latest blog post entitled “BlueCross BlueShield of Texas Tells Clients ‘Say GoodBye To Your PPO Plan’”. (The more sarcastic side of me considered entitling it, “Take A Bite Of This Sandwich” but my more professional self intervened.) In the letter and post, I informed those who have HMO coverage their policy would not be affected other than an anticipated rate increase. It turns out that is not the case as I was just informed that many who have HMO coverage will also have to select another version. And so it seems that, with my assistance, many of you will be seeking alternative coverage for 2016.

This begs the question: What will our options be with other insurance companies? Unfortunately, like BlueCross, most companies are yet to reveal the details of their policies. Within the next few days, I hope to have a quoting link available to you from which-in the very near future-you will be able to obtain all your 2016 options, subsidy or no subsidy, on or off the Federal Marketplace otherwise known as Healthcare.gov. Regardless, I will be introduced to these changes over the remainder of October and these, along with the quoting link, will be posted on my blog in real time. Rest assuredwhatever your best options are for 2016I will have them. And you will be able to elect them with the beginning of OPEN ENROLLMENT (OE) November 1st―through the end January 31st.

Do not hesitate to call me as we prepare for these changes. And to assure you will be informed of the latest information relative to your coverage – please click “follow” on my blog as I post all coverage changes and preview the options you will have.

If you are currently a client—thanks once again for your business. It is greatly appreciated  as will readership of healthandmedicareinsurance.com!

Sincerely,

BUSINESS PHOTO FINAL FOR BLOG 10 15 2015

Kenton Henry  Blog Administrator, Broker, Agent

Office: 281.367.6565; Toll Free: 800.856.6556

Email: allplanhealthinsurance.com@gmail.com

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Blog: http://healthandmedicareinsurance.com

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