There is good news in the SE Texas Medicare Advantage Market! It announces a new Medicare insurance plan which provides what is likely the greatest access to medical providers to date. It allows a member may go to any provider that sees Medicare patients. This equates access to that of the Medicare Supplement (Medigap) plans I typically encourage my clients to enroll in. And the out-of-pocket expenses are $0! There is not even the Part B annual out-patient deductible of $233 which applies to the most popular Medigap Plan G!
Additionally, it provides the convenience of Medicare Advantage Part D Drug (MAPD) plans because it includes Part D Prescription Drug coverage. This means one need not pay an additional premium for a standalone drug plan to accompany their medical coverage because your medical and drug coverage is included under the cover of one policy.
*(The details of this plan are described by the insurance company in the Feature Article below.)
FOR WHOM IS THIS PLAN BEST SUITED?
In my opinion, it is best suited for the older Medicare recipient for whom their Medigap and Part D drug plan premium now exceeds $215.40 – the monthly premium for this Medicare Advantage Plan. Someone who has just turned age 65 will find their Medigap premium combined with a low-cost Part D drug plan competitive for quite some time. However, as they get older, the total cost can greatly exceed the premium for this Advantage plan. Additionally, unless they have Medigap Plan F, they remain responsible for the annual Part B deductible noted above.
As we age, many of us acquire moderate to significant pre-existing medical conditions. In Texas, and most states, when their Medigap premium becomes burdensome, Texans cannot enroll in a new, and lower cost, Medigap plan and be guaranteed approval. They must go through underwriting and risk being declined due to their health history. With Medicare Advantage plans this cannot happen as approval is guaranteed during the eligible enrollment periods.
WHAT ARE THE DISADVANTAGES OF THIS MAPD PLAN?
First, as implied above, if someone is a relatively younger Medicare recipient – with little in the way of brand name drug usage – their combined premium for medical and drug coverage can be considerably lower than the premium for this MAPD plan.
Furthermore, because this plan combines one’s drug plan with their medical plan – one is tied, or captive to, its Part D drug coverage. Coverage which may not be the best drug coverage available to them in the Part D market.
Lastly, Medicare Supplement Plans (Medigap) are created by and standardized by the Centers for Medicaid and Medicare Services (CMS). They can only be changed by legislation. If legislation would result in a change in their benefits, the insured member would most likely be “grandfathered” or, otherwise, allowed to keep their existing coverage.
With this new “Flex PPO” plan from a major health insurance company, the company could decide to eliminate it in any new calendar year. CMS is not going to mandate an equivalent benefit Advantage Plan. And if none is available – the member is likely to find themselves with an alternative offering less access to providers and with out-of-pocket expenses. Or a member could move to a new area where equivalent coverage is not available.
These are all considerations that must be made before transitioning from Medigap – or another Medicare Advantage plan to this Advantage Plan. Regardless, unless one is just qualifying for Medicare due to age or disability – or losing access to another Medicare Advantage Plan – they will not be allowed to enroll in this new plan until this year’s Annual Election Period October 15th – December 7th.
When that time comes, do not hesitate to contact me for assistance in determining if this option is in your best interest and assistance in enrolling.
**(Due to compliance concerns the company will not be identified at this time. You may contact me for that information as well as all details of the plan. The following is their notice to agents and brokers.)
We want to remind you of our new Medicare Advantage Flex (PPO)SM plan that’s currently available for Medicare age-ins or those eligible for Special Enrollment.
Features include:$0 Copay/coinsurance, $0 deductible, no out-of-pocket costs – and it’s open access. Members can visit any provider nationwide who accepts Medicare. And it includes prescription drug coverage!
NOTICE DATED 04.25.2022 FROM:
Important Information Regarding Your Provider Plan Coverage Thank you for enrolling in the Medicare Advantage Flex (PPO)SM plan.
With this plan you can:
• See any provider accepting Medicare whether inside or outside the plan service area.
• See any health care provider, at no additional cost, when traveling nationwide.
• Access care from any provider who accepts Medicare assignment and bills Blue Cross and Blue Shield.
• You are not required to obtain authorization for out-of-network services, however, services must meet medical necessity criteria to be covered.
• We also offer a traveler benefit for members leaving the service area for six months or less. If you plan to travel and be away from home for up to six months, contact customer service. SAVE THIS Below is a provider notification card for you to keep and present when seeking care from a provider. This will ensure your medical claims are processed in a proper and timely manner. If you have any questions, please call the number on the back of your member ID card.
• Write your name and member ID number on the front of the provider notification card
• Carefully remove and fold card
• Keep this card with your member ID card
• Take both cards to all health care provider appointments Thank you for being a Medicare Advantage Flex (PPO) plan member. Carefully punch out and fold this card
Dear Provider:
• As a provider, you do not need to be a Medicare Advantage Flex (PPO)SM contracting provider to see and treat this member.
• Members can see any provider who accepts payment from Medicare.
• If you are a provider with any of our MA networks, authorization requirements apply.
• The member’s coverage level is the same whether or not a provider is in the network for the Medicare Advantage Flex (PPO).
• At a minimum, eligible claims will be reimbursed at the Medicare Allowed Amount.
(AETNA AND UNITEDHEALTHCARE RE-ENTER THE ACA INDIVIDUAL AND FAMILY HEALTH INSURANCE MARKET)
By Editor, Agent, Broker
D. Kenton Henry
It is that time of year and, once more, we find ourselves on the cusp of the “Annual Election Period” for Medicare Advantage and Part D Prescription Drug Plans. This is the period when any Medicare recipient may enroll or change their Advantage and / or drug plans for a January 1 effective date. The period runs from October 15th through December 7th.
As if this was not a busy enough time for Medicare insurance product brokers, many of us (like myself) must do “double duty”, during the holidays. This is because the “Open Enrollment Period” for those “Under the Age Of 65“, in need of Individual and Family health insurance, begins November 1 and runs through January 15th. This a one month extension from previous years. However, those wishing to have new coverage effective by January 1 must still enroll by December 15th.
In addition to the extension of the ACA enrollment period, an interesting and positive turn is that Aetna and Unitedhealthcare are re-entering the marketplace in SE Texas for 2022 after a six year hiatus! This brings welcome competition to a market which was vacated by every major carrier – other than BlueCross BlueShield – in January of 2016. While we will not have insight into the details of their health plan options until just before November 1, their names and reputation should garner a lot of attention, not only from consumers but medical providers. It is my hope that more high quality doctors and hospitals will elect to participate in the insurance companies’ provider networks. With Preferred Provider Organization (PPO) network plans eliminated, Health Maintenance Organization (HMO) network plans have been the consumer’s only option since 2016. And with the expansion in the availability of the Advance Premium Tax Credit and Cost Share Reductions, for many, their greatest challenge is no longer being able to afford health insurance but finding their providers in an insurance plan’s network.
And it is the same for me. As an agent / broker with 34 years in medical insurance, my greatest challenge isn’t finding a plan the consumer can afford or the benefits they’re seeking. It’s finding my client’s, and prospective client’s, medical providers participating in a network. While this isn’t a major issue to those new to the area, those of us who have resided here for years, have long established relationships with providers we are reluctant to part with.
I would be extremely pleased if some of the companies in the marketplace elect to offer PPO plans in 2022. But make no mistake, I in no way expect this to happen. The problem for a company considering offering PPO coverage is that if all their peers do not also, they “adversely select” against themselves. In other words, if they are the “only game in town” when it comes to PPO plans, they are going to attract, and garner, an inordinate number of “bad risks”. In other words, insured members with serious pre-existing conditions who need access to a greater number of providers will flock to them vs the insurance company offering access to an HMO network only. They will submit higher and more frequent claims, thereby compounding the potential for “loss” to the insurance company. This is why insurance companies ceased, in unison, offering PPO coverage, in most regions of the United States, in 2016. They want to limit your access to providers, and thereby limit your access to what is likely to be more expensive treatment. Enrolling people in HMO plans is the easiest way to do this. Regardless, my duty, as your agent, is to do my best to find your providers participating in the network of a plan whose benefits meet your needs.
The good news is – two new major carriers will uncertainly increase the number of options available to the consumer in terms of premiums, benefits, and providers. Additionally, several of the insurance companies are lowering copays and deductibles and the Department of Health and Human Services, which oversees the sale of all ACA health insurance, has made it much easier to qualify for a “subsidy” to reduce the policyholder’s share of the premium due, especially for anyone who claimed unemployment benefits any time during 2021.
In the Medicare related insurance market, increases in variables for 2022 are estimated to be higher than in recent years. Some were not definite as of the end of September. The Part A In-patient deductible is projected to increase but, as of this date, I have no definitive cost. The Part B Out-patient deductible is estimated to be going from $203 to $217 per calendar year and it’s premium is projected to go from $148.50 to $158.50 per month.
There are currently 30 different Part D Drug plans for Texans to choose from. Each covers some drugs but not others. The plan which is best for you is entirely dependent on the drugs you use. Not the drugs your spouse, neighbor, or I use – but the ones you use. The Part D deductible is going from $445 to $480 for the calendar year. A drug plan may choose to have deductible ranging from $0 all the way to$480 before your drugs become available for a copay. With many plans, the deductible will not apply to Tier 1 and Tier 2 generic drugs. The threshold for entering the “GAP” will occur when the member and plan have paid $4,430. During this time, the member will pay 25% of the cost of their drugs. They will cross over into “CATASTROPHIC COVERAGE” if, and when, the member has personally expended $7,050. At this point, a member will pay $3.95 for a generic drug and $9.85 or 5% of the cost of a brand name drug – whichever is higher.
As a broker for my clients, and prospective clients, my goal is to identify the Medicare Plan, whether Medicare Supplement, Advantage or Part D Drug Plan which is most likely to result in their lowest total out of pocket cost for the calendar year while providing them access to all their providers. The “total cost” is the sum of their premium, any applicable deductible or deductibles, and copays or coinsurance. Our objective is the lowest sum and that plan, or plans, will usually be my recommendation.
To this end, I encourage anyone interested in enlisting my help, to contact me. If you would like me to identify your lowest total cost drug plan for 2022, based on your current or anticipated drug use, email me a list of your Rx drugs and, preferably, the dosages. The latter can make a difference. If you know you want Medicare Advantage, send me a list of doctors and hospitals you feel you must have access to. Please recall that with Medicare Supplement coverage you may obtain treatment from any doctor, hospital, lab, or medical provider, that sees Medicare patients. There are no networks with which to concern yourself. However, with Supplement, unlike most Medicare Advantage plans, you will have to acquire a Part D Prescription Drug Plan to accompany it. For those using little or only low cost generic drugs, the lowest premium plan for Texans in 2022 will be $6.90 per month.
*(READ FEATURED ARTICLE BELOW ON WASHINGTON’S EFFORTS TO LOWER RX DRUG COST FOR MEDICARE RECIPIENTS)
The name of my insurance agency I opened in 1991, after being in the medical and life insurance industry since 1986, is All Plan Med Quote. It is located in The Woodlands, Texas. In 1995, I created one of the first websites in the country to market health insurance via the internet. It still exists as Allplanhealthinsurance.com. In 2015, I expanded my web presence with TheWoodlandsTXHealthInsurance.com. The primary objective in naming the first two was to convey that (while I work, for the consumer) I am appointed (contracted) with virtually every “A” rated, major and minor insurance company doing business in your geographic region. But the insurance companies do not pay me a guaranteed wage or salary. They compensate me fairly if, and only if, you elect to go through me to acquire their products. But, without my clients, I have no income. So certainly my clients are my priority. Not the insurance companies. And, as my client, you are charged no more by going through me to obtain their product then if you walked through their front door and acquired it directly from them.
Here is a partial list of the companies whose products may, or may not, be appropriate for you, I may introduce to you:
AARP Unitedhealthcare
Aetna
Ambetter
Anthem
BlueCross BlueShield of Texas
Caresource
Cigna
Community Health Choice
Friday
Humana
KelseyCare Advantage
Molina
Mutual of Omaha
Oscar
Scott and White
Unitedhealthcare
Wellcare
D. Kenton Henry Office: 281-367-6565 Text my cell 24/7: 713-907-7984 Email: Allplanhealthinsurance.com@gmail.com
Democrats’ signature legislation to lower drug prices was defeated in a House committee on Wednesday as three moderate Democrats voted against their party.
Reps. Kurt Schrader (D-Ore.), Scott Peters (D-Calif.), and Kathleen Rice (D-N.Y.) voted against the measure to allow the secretary of Health and Human Services to negotiate lower drug prices, a long-held goal of Democrats.
The vote is a striking setback for Democrats’ $3.5 trillion package. Drug pricing is intended to be a key way to pay for the package. Leadership can still add a version of the provision back later in the process, but the move shows the depth of some moderate concerns.
The three moderates said they worried the measure would harm innovation from drug companies and pushed a scaled-back rival measure. The pharmaceutical industry has also attacked Democratic leaders’ measure, known as H.R. 3, as harming innovation.
The three lawmakers had long signaled their concerns with the drug pricing measure, but actually voting it down in the House Energy and Commerce Committee is an escalation.
A separate committee, the House Ways and Means Committee, did advance the drug pricing measures on Wednesday, keeping the provisions in play for later in the process.
Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) had implored the three lawmakers to vote in favor of the measure to at least keep the process going.
“Vote to move forward today,” he said to the moderates in his party. “Vote to continue the conversation.”
Still, Pallone said he is confident that some form of measure to lower drug prices will make it into the final package. The House legislation was already expected to change before the final version, given moderate Democratic concerns in the Senate as well. Senate Democrats are working on their own bill, which is not yet finalized but is expected to be less far-reaching.
“I know it is going to have drug pricing reform,” Pallone said of the final bill, noting that negotiations with the Senate would continue over the coming weeks.
Still, the move on Wednesday is a show of force from the moderates.
Henry Connelly, a spokesman for Speaker Nancy Pelosi (D-Calif.), said Democrats were not giving up on including drug pricing measures.
“Polling consistently shows immense bipartisan support for Democrats’ drug price negotiation legislation, including overwhelming majorities of Republicans and independents who are fed up with Big Pharma charging Americans so much more than they charge for the same medicines overseas,” he said in a statement after the vote. “Delivering lower drug costs is a top priority of the American people and will remain a cornerstone of the Build Back Better Act as work continues between the House, Senate and White House on the final bill.”
Peters and Schrader both cited concerns about harming drug companies’ ability to develop new drugs, citing the industry’s record during the COVID-19 crisis.
Peters warned that “government-dictated prices” under the bill would cause harm to the “private investment” that backs drug development.
Schrader said the bill would mean “killing jobs and innovation that drives cures for these rare diseases.”
Advocates said the lawmakers were simply beholden to the pharmaceutical industry.
“Reps. Peters, Rice, and Schrader are prioritizing drug company profits over lower drug prices for the American people, particularly for patients with chronic conditions such as diabetes and multiple sclerosis,” said Patrick Gaspard, president of the left-leaning Center for American Progress. “To the contrary of what they contend, their opposition to the drugs proposal threatens the entirety of President Joe Biden’s Build Back Better agenda, which Democrats have campaigned on for years and that they previously voted for.”
Savings from the drug pricing provisions are a key way of paying for other health care priorities in the $3.5 trillion package, including expanding Medicaid in the 12 GOP-led states that have so far refused, expanding financial assistance under ObamaCare, and adding dental, vision, and hearing benefits to Medicare.
The Congressional Budget Office found that H.R. 3 would save about $500 billion over 10 years. Depending on what Senate Democrats can find agreement on, the final drug pricing legislation is expected to be less far-reaching, meaning it will result in fewer savings, though how much less is unclear.
The Senate bill would still allow Medicare to negotiate lower drug prices, but it is expected not to include another provision that would cap drug prices based on the lower prices paid in other wealthy countries. That provision has drawn particular pushback from some moderate Democrats.
Allowing Medicare to negotiate drug prices is extremely popular with voters, with almost 90 percent support in a Kaiser Family Foundation poll earlier this year. Many vulnerable House Democrats support the idea.
Are you recently faced with a choice between the high cost of COBRA or going without health insurance? Perhaps we can help.
As if the jobs lost due to lay-offs, furloughs, and the closing of businesses stemming from the coronavirus quarantine wasn’t bad enough, the concurrent and additional losses due to the precipitous drop in the price of oil, have made unemployment rates in Texas soar. For those, like myself, who were present at the time, the situation conjures memories of the oil bust of the 1980’s. The resulting home foreclosures, vehicle repossessions, and mass migration from our state were catastrophic, and our state didn’t fully recover until the mid-’90s. But, as terrible as things were, we never saw oil prices drop “to the negative” as they did a few short weeks ago. We can only hope and take heart in the reality that―because financial fundamentals were so strong prior to the pandemic―this crisis will be much shorter once herd immunity has turned the corner on it―and Saudi Arabia and Russia have ceased attempting to crush the market for the sake of driving out the competition.
UNEMPLOYMENT LINES IN WAKE OF CORONAVIRUS
Regardless, this mass unemployment has resulted in thousands losing their health insurance and has left them faced with accepting the high cost of COBRA or (if employed by companies with less than 20 employees) state-continuation health insurance. If accepting either, the former employee is typically responsible for 100% of the retail premium (inclusive of the portion previously paid by their employer) plus an administrative fee of 2%.
An alternative is to enter the “Individual and Family” health insurance market. If one applies within 60 days of losing their employer-based, credible coverage, they will be guaranteed approval and coverage for any pre-existing health conditions on the first of the month following application. You may obtain quotes for all credible ACA (Affordable Care Act) compliant individual and family plans available to you―as well as an estimate of any subsidy for which you may qualify―by clicking on the link below. Then call us for answers to your questions and assistance in applying for coverage*:
*(you do not need to log-in in order to obtain quotes)
Even when a subsidy is available, many find the premiums for these plans to be unaffordable. For those, “Short-Term” or “Temporary” health insurance may be the answer. As premiums for long-term health insurance continue to rise, more and more people find this to be the case. The advantages are, it can become effective immediately, and you can purchase it for periods up to just short of two years. Because the insurance company knows it will only be obligated to pay claims for a limited period―the premiums will be dramatically lower than those of long-term ACA health insurance. The disadvantage of short-term health insurance is that you first must be approved, and the coverage will not cover pre-existing health conditions. So, if you, or a family member, have any moderate to significant health conditions, you may be declined for coverage or find your pre-existing conditions waived for coverage. But, if you have no health issues or can be approved for coverage and can afford to self-insure for your conditions, you will find this coverage much more affordable!
Our feature article below outlines the trend toward purchasing Short-Term health insurance and the reasons for it. It also introduces a company the clients of TheWoodlandsTXHealthInsurance.com have turned to for years to acquire coverage. From the following link, you can choose from a multitude of deductibles and benefit levels to elect a plan specific to your needs and budget. Once you have narrowed your selection, please call us for answers to your questions and assistance in applying.
You may find you only require this coverage until this unprecedented coronavirus/oil market crisis is behind us or until you obtain your next job with benefits. Regardless, we are here to see you obtain the best coverage for your situation and the best of service thereafter.
CLICK HERE FOR SHORT-TERM HEALTH INSURANCE QUOTES:
For customized quotes with from a subsidiary of Unitedhealthcare, inclusive of:
· Enhanced Short Term Medical – with preventive care coverage on all plans, no limit on urgent care visits with a copay, and no application fees – are now available in 17 states!
· TriTerm Medical – nearly 3 years of continuous health insurance with coverage for doctor visits, prescriptions, and preventive care – now available to quote in 16 states.
· HealthiestYou by Teladoc® members now have access to behavioral health and dermatology services (for an additional per-use fee). Using the same convenient app and phone number, they can access these new services in addition to 24/7 access to doctors. *This product is not insurance.
Call us. We will help you sort through all your options in order to elect the best health insurance or your situation.
D. Kenton Henry Editor, Agent Broker TheWoodlandsTXHealthInsurance.com Office: 281-367-6565 Text My Cell 24/7 @ 713-907-7984
Survey: Short-Term Health Insurance Demand Increasings
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Pivot Health, a division of HealthCare.com, which is a leader in technology-enabled health insurance solutions, has released new customer survey data that reveals 26% of short-term medical plan purchasers were long-time uninsured, while 29% had recently lost their insurance due to unemployment.
Only 5% of purchasers had moved from an Obamacare plan to a short-term medical insurance plan. The survey also showed 75% of the people who lost employer coverage did not choose COBRA because of cost.
Nearly half (46%) of members selected a short-term plan because they didn’t qualify for a subsidy or they needed something quickly. The survey also found 21% of those who purchased a short-term health insurance plan were influenced by the global coronavirus pandemic.
When asked what is the greatest concern facing the health insurance market today, survey participants said out-of-pocket costs were the No. 1 issue they are concerned about when it came to healthcare.
· 64% are concerned about the high monthly cost of insurance.
· 51% worry about paying for medical bills out of pocket.
· 45% are concerned about high deductibles.
One customer said, “Most Americans cannot afford high-cost insurance. Anything over $100 a month is too much.”
“The survey data reveals that customers are more comfortable buying short-term health insurance plans than they ever have been,” said Jeff Smedsrud, chief executive officer of Pivot Health. “Since Congress has failed to pass legislation to subsidize COBRA plans, which put the entire financial burden on the employee, short-term health plans are becoming a general preference for individuals who need a budget-friendly healthcare solution as they maneuver through life transitions, unemployment or just need economical coverage.”
HealthCare.com is an online health insurance company providing a data-driven shopping platform that helps American consumers enroll in individual health insurance and Medicare plans. HealthCare.com also develops and markets a portfolio of proprietary, direct-to-consumer health insurance and supplemental insurance products under the name Pivot Health. Founded in 2014, the company is headquartered in New York City and is backed by PeopleFund and individual investors including current and former executives of Booking.com and Priceline. HealthCare.com is a 4-time honoree of the Inc. 5000 list of America’s fastest-growing companies and has been recognized by Deloitte as one of the fastest-growing technology companies in North America.
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 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:
************************************************************************************************ 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)
Perhaps a storm would be a better analogy but 2016 will deliver something more than a mild tropical depression to the coast of the “Individual and Family” health insurance market. At the same―the Cat 3 (minimum) hurricane projected to slam the Senior market of Medicare recipients appears to have been diverted. For now.
As we enter the third year of enrollment in health insurance plans compliant with the Affordable Care Act (ACA) the “Affordable” aspect of care or―more accurately―the cost of protecting oneself from the cost of health care―seems elusive and more and more a case of misrepresentation. As I have said many times in the past, if you qualify for a subsidy of your health insurance premiums you may find your options affordable. However, depending on where you live, you will surely be upset with the increasing cost of health insurance. 70% of all Obamacare members are enrolled in a Silver Plan. The Department of Health and Human Services (DHS), which oversees enforces the Act and oversees the health insurance industry, has designated the second lowest cost Silver Plan of any insurance company to be the default plan one must select in order to maximize the benefit of any subsidy. This could include a reduction in not only one’s premium but their deductibles and co-pays. As Fox News and the Washington Post report (see featured article below) the cost of these plans will rise by a national average of 7.5%. States such as Oklahoma will see an increase of 37.5%!
In some states it is much worse.
To add insult to injury many insurance companies, such as BlueCross BlueShield of Texas, have taken such losses―in spite of skyrocketing premiums―they have announced they are eliminating the Preferred Provider Organization (PPO) network option for their plans and member benefit. The only option will be to select a Health Maintenance Organization (HMO) network option wherein the company can ration your providers and treatment. While the young or otherwise very healthy may find this option acceptable, those of us who are older or dealing with existing illnesses or injuries are certain to be upset by this development. The insurance companies seem to be in agreement on the viability of PPOs and explain any premium increase necessary to assure they even break even on a PPO policy would be beyond the increase limit set by Obamacare. As such, it would therefore not be approved by their state insurance commissioner. So the question remains: what will your personal network and benefit options be for 2016 and what will they cost?
Virtually all insurance companies are keeping the answers close to their vest until this Sunday, November 1, the first day of OPEN ENROLLMENT wherein one may choose a health insurance plan for 2016. Enrollment will remain open until January 31st. Those without a plan at that time will be locked out for the remainder of the year and will pay a penalty equal to the higher of two amounts:
2.5% of your yearly household income (Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan
$695 per person ($347.50 per child under 18) The maximum penalty per family using this method is $2,085.
A banner follows which, as of Sunday, November 1st, you may click on and by simply entering your birth date, zip code and tobacco usage, obtain ALL your health insurance options from each and every insurance company issuing 2016 coverage in your state. It will also allow you to calculate what subsidy, if any, and enable you (if you choose) to log directly into the federal marketplace to acquire it and your insurance plan. If you have questions, as you most surely will, do not hesitate to contact me via my contact information via the link or below.
CLICK ON THIS BANNER TO OBTAIN 2016 HEALTH INSURANCE QUOTES:
Relative to Medicare recipients, it would appear a planned increase in the 2016 Medicare Part B premium and deductible has been taken off the table for the time being. The increase would have resulted in a huge spike in what higher income recipients and new enrollees in Part B Out-Patient coverage would pay in premium. The proposed premium increase would have been as presented here:
Income Limits, Medicare Part B Premiums for 2016
Single
Married
2015
2016 Held Harmless
2016 Not Held Harmless
$85,000 or less
$170,000 or less
$104.90
$104.90
$159.30
$85,001 to $107,000
$170,001 to $214,000
$146.90
$223.00
$107,001 to $160,000
$214,001 to $320,000
$209.80
$318.60
$160,001 to $214,000
$320,001 to $428,000
$272.70
$414.20
Above $214,000
Above $428,000
$335.70
$509.80
The threat and legislation which averted this is described in detail in The Fiscal Times article below. As of today, it is still unclear to this editor whether the increase in the calendar year deductible has also been averted.
The prices for a popular and important group of health plans sold through the federal insurance exchange will climb by an average of 7.5 percent for the coming year, a jump nearly four times bigger than a year ago, according to new government figures.
The rate increase for 2016 compares with average growth of 2 percent, from 2014 to this year, in the monthly premiums for a level of coverage that serves as the benchmark for federal subsidies that help most consumers buying coverage under the Affordable Care Act.
A “snapshot” of insurance rates, released Monday by the Department of Health and Human Services, also shows that the rate increases for next year vary substantially around the country. Although there are exceptions, more populous states and metropolitan areas tend to have more modest premium increases for the coming year than smaller areas.
The changes for next year have a wide range — from premium increases averaging 35 percent in Oklahoma and Montana to a decrease of nearly 13 percent in Indiana.
The analysis is based on hundreds of health plans sold in local markets within 37 states that use HealthCare.gov, the federal online insurance marketplace. It excludes plans in other states that have created separate ACA insurance marketplaces. The rates reflect the prices of the second-least expensive health plan in each market for 2016 in a tier of coverage known as silver. ACA health plans are divided into four tiers, all named for metals, depending on the amount of customers’ care that they cover. Silver plans have proven by far the most popular. Officials at HHS issued the analysis as less than a week remains before the start on Nov. 1 of a third open-enrollment season for Americans eligible to sign up for health plans under the insurance marketplaces created by the 2010 health-care law. The exchanges are intended for people who cannot get affordable health benefits through a job.
In their analysis, federal officials contend that the health plans sold through the exchanges will be affordable to people willing to shop for the best rates. The cost to consumers, HHS officials emphasize, is cushioned by the fact that nearly nine in 10 are eligible for tax credits.
Taking the subsidies into account, nearly four in five people who already have gotten insurance through these marketplaces will have access for 2016 to a health plan for which they could pay no more than $100 in monthly premiums, the analysis found. The analysis does not address other costs to consumers, such as co-payments and deductibles, which tend to be more expensive in ACA health plans than in employer-based health benefits.
The figures in the analysis reinforce a theme that Obama administration officials introduced last year and have revived as the third sign-up period approaches: the usefulness of researching the best and most affordable coverage, even if it means switching insurance from year to year. “If consumers come back to the Marketplace and shop, they may be able to find a plan that saves them money and meets their health needs,” Kevin Counihan, the HHS official who oversees the health exchanges, said in a statement.
The new figures show that existing customers who went back last fall to HealthCare.gov and picked a different plan at the same level of coverage saved an average of nearly $400 in premiums over the course of this year. Slightly fewer than one-third of those who bought such coverage for a second time switched health plans, according to the analysis. During this open enrollment, Obama administration officials are striving both to attract existing customers again and to ferret out Americans eligible for the exchanges who remain uninsured even though the law requires them to have coverage. Although many consumers can be largely shielded from rate jumps through subsidies and shopping around, the increases ratchet up the government’s expenditures on the tax credits that the law provides, health policy analysts point out.
Analysts have expected that premiums for the coming year would grow more rapidly than they did for 2015. “This is the first year that insurers actually have a full year of experience with how much care people use,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a health policy organization. “In the first two years of the program, insurers were essentially guessing.” In addition, Caroline Pearson, senior vice president at Avalere, a health-care consulting firm, said that, as some health plans have attracted a significant share of customers, “the need to price really low diminishes a little bit.” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s main trade group, said that “averages don’t tell the whole story” and that insurance rates hinge on “location and the cost of providing care to individuals in particular markets.” In particular, Krusing said, last year was “a record-breaking year for prescription drug prices. That trend is likely to continue.”
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Seniors Exhale as Congress Blocks Huge Medicare Increase
By Eric Pianin October 27, 2015 3:17 PM
Responding to pressure from seniors’ and labor groups as the 2016 campaign season heats up, congressional leaders and the White House have blocked a huge, 50 percent increase in the Medicare Part B premium for nearly one third of the 50 million elderly Americans who depend on the program for health services.
The bipartisan solution will block all but a tiny fraction of the premium increase. It is contained in the two-year budget and debt ceiling bill negotiated by House Speaker John Boehner (R-OH), House Minority Leader Nancy Pelosi (D-CA) and the White House and that awaits ratification by the two chambers – likely by the end of this week.
The threatened sharp premium increase – reported back in August by The Fiscal Times – was triggered by a quirk in federal law that penalizes wealthier Medicare beneficiaries, newcomers to the program and lower income Americans with complicated chronic health problems. It kick in any time the Social Security Administration fails to approve an annual cost-of-living adjustment – as will be the case next year.
Medicare Part B and the Social Security trust fund are interconnected, and most seniors on Medicare have their monthly premiums deducted from their Social Security checks. Because the federal law “holds harmless” about 70 percent of Medicare recipients from premium increases to cover unexpected increases in healthcare costs, the remaining 30 percent of Medicare Part B beneficiaries suffer the consequences by being made to pay higher premiums.
Without intervention by Congress, roughly 15 million seniors and chronically ill people currently claiming both Medicare and Medicaid coverage would have seen their premiums increase from $104.90 per month to $159.30 for individuals, according to Medicare actuaries. The actuaries also predicted an increase in the annual deductible for Part B of Medicare, from $147 in 2015 to $223 next year.
Estimates of the cost of legislation to blunt or block a premium increase have ranged from $7.5 billion to $10 billion. Under the budget agreement unveiled late last night, that cost will be covered by a loan of general revenue from the U.S. Treasury to the Supplemental Medical Insurance Trust Fund.
In order to repay that loan, the 15 million people who are not subject to the “hold harmless” protection will be required to pay an additional $3 a month in premiums – a token amount — until the loan is repaid years from now, according to a House budget document describing the deal. Medicare beneficiaries who currently pay higher income-related premiums would pay more than $3, based on their income levels.
If there is no Social Security cost of living adjustment increase for 2017, this provision will apply again.
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:
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 Good–Bye 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 assured―whatever your best options are for 2016―I 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!
Don’t worry. This doesn’t apply to you if you have coverage through an employer’s group plan. But if you (like myself) are one of 370,000 insured members with an individual or family health insurance plan―be prepared to choose your provider from a different menu. And rest assured it will be portion controlled.
BlueCross will continue to offer Health Maintenance Organization (HMO) Plans where you must elect and utilize a provider within their HMO network or you will have no coverage whatsoever. This is where rationing begins. With your provider. You can expect the number of doctors and hospitals to be significantly limited relative to the selection currently available to you in the Preferred Provider Organization (PPO) network where you may go in or out of the network at your discretion and still be covered. Although details are yet to be unveiled, these HMO plans will most likely require you to select a “Primary Care Physician” with whom all medical care must be initiated. If so, you will have to obtain a referral from that primary care provider in order to see a specialist. And that is where rationing of care continues. With your treatment. HMO providers have contractually agreed to accept a lower payment in return for providing you treatment in the first place. Referring you (away) to a specialist results in a total loss of payment.
BlueCross explains they paid $400,000,000 more in claims then they collected in premium from their PPO members in 2014. And they add (exclamation point mine) “that is unsustainable!” Their rationale is―the insurance company will be better able to “manage” the care we members receive and what we are charged for care, helping to reduce health insurance premiums. Those currently enrolled in a “grandfathered” (written prior to the March 2010 passage of the Affordable Care Act) plan or HMO network policy will be happy to know you will probably be able to maintain your coverage option (deductible, co-pays) into 2016, assuming the premium remains affordable. Those, like myself, who want total discretion as to our providers are certain to be disappointed.
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. I will be introduced to these changes over the remainder of October and―rest assured―whatever your best options are for 2016―I 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. If you involve me, I will take into consideration your providers and do my best to find an affordable plan which allows you to continue to utilize them. If this entails you qualifying for and needing a premium subsidy from Healthcare.gov―I will assist you in navigating that process and serve as an advocate in your behalf. As I have done for 29 years this month, my objective is to ensure you obtain and maintain your best possible health care coverage at the lowest cost. Even in this age of increasing insurance premiums and less provider options.
Please refer to the featured article below and, lastly, to the Questions And Answers at the end of today’s post. Additionally, do not hesitate to call me or email me in order to prepare for these coming changes.
Blue Cross Blue Shield of Texas is eliminating in 2016 its…
Health insurance carrier Blue Cross Blue Shield of Texas next year will eliminate a PPO health plan that 367,000 consumers statewide now depend on for health benefits.
The company’s decision to drop its Blue Choice PPO plan will affect only customers in the individual market — not those covered by Blue Cross PPO group plans through their employers. About 148,000 consumers whose PPO plans were grandfathered in 2010 also won’t be affected.
The change is being made because the insurance company paid out $400 million more in claims than it collected in premiums for its Blue Choice PPO product in 2014.
“We felt like the PPO was not going to be a sustainable option,” said Dr. Dan McCoy, chief medical officer and divisional senior vice president for Blue Cross Blue Shield of Texas.
The move will not interrupt customers’ coverage before the end of the year.
The insurance carrier expects to offer another product when open enrollment for 2016 begins Nov. 1 in the individual market. No details on that new product were available Monday since it still is awaiting federal approval. Consumers won’t be able to view and compare their options on the federal exchange until Oct. 10, the company said.
“A new product has been filed that we believe will give you a flexible choice for your clients,” Blue Cross Blue Shield of Texas said in a communication to insurance brokers last week. “We will be able to share information about that product if and when it is approved by the Centers for Medicare & Medicaid Services closer to open enrollment.”
The carrier has not yet started sending notices to customers affected by the change, aside from posting a general notice on its website, a spokeswoman said. However, they should receive notices by early October.
Only a small fraction of the carrier’s total 5.5 million customers in Texas are covered by individual Blue Choice PPO plans, but the product has proven popular with consumers who want flexibility on which doctors they can visit.
Loretta Camp, an independent health insurance agent at Davidson Camp Insurance Services and a member of the San Antonio Association of Health Underwriters, said she is bracing for a flood of questions from consumers.
“We pretty much expected there to be just a huge amount of feedback,” Camp said of Blue Cross’ announcement, “and we’ve gotten hardly any. I don’t think people have really grasped what that means.
“It‘s a huge impact to my client base,” Camp said, noting that 88 percent of her customers buying health plans for themselves or their families inside or outside the federal exchange selected PPOs — preferred provider organization plans that allow consumers greater freedom on which doctors to visit.
Customers with PPOs pay lower rates if they use doctors or hospitals considered to be “in network” and incur additional costs if they see providers “out of network.”
Such plans are generally pricier than the more restrictive HMOs — health maintenance organization plans that only cover care from doctors and hospitals “in network” and won’t cover services outside the network at all unless it’s an emergency.
“We have a number of clients that moved … to a PPO plan because they were having difficulty finding providers that would take the HMO plans,” Camp said.
In its communication to brokers last week, Blue Cross acknowledged there will be some physicians and providers no longer considered “in network” as a result of individual Blue Choice PPO plans being discontinued.
“The number of providers not in network due to the discontinuance may be greater in 2016,” said the notice to brokers. “We have ensured that we have an adequate network to provide the physicians and hospitals needed to serve our retail members in each market, and we continue to have discussions with additional providers.”
Keeping the individual PPO plans intact and raising the price would have forced the insurance company to raise everyone’s rates in the individual market.
Under the Affordable Care Act, “individual business is rated using a single risk pool, meaning all individual plans had to be looked at together,” the carrier said in its notice to brokers last week.
Like most carriers, Blue Cross was venturing into uncertain territory when the Affordable Care Act made health insurance available to everyone beginning in 2014, McCoy said.
“This is really a new era in American insurance,” McCoy said Monday. “And clearly we entered this marketplace with not a lot of information.”
That meant serving a large number of new customers and complying with the new federal law. “This was a group of people, many of which had never had health insurance before,” McCoy said of the new beneficiaries, “coupled with the Affordable Care Act that contained a lot of new provisions and additions to care.”
“You combine that with the fact that health care costs in the United States have continued to grow. So clearly the premiums were not enough to make up for the health care expenditures that occurred.”
Blue Cross officials sidestepped questions Monday about whether it will continue selling its Blue Advantage HMO plans in the individual market in Texas next year. The company also declined to say how many consumers now now covered by Blue Advantage HMO plans, calling that proprietary information.
However, the federal HealthCare.gov website shows the carrier requested a rate increase of almost 20 percent for its Blue Advantage HMO plans in 2016. That proposal is still under review by the Centers for Medicare & Medicaid Services. Blue Cross officials wouldn’t comment.
Blue Cross Blue Shield of Texas noted it was the only insurance carrier to offer a PPO product in all 254 counties in Texas during the first two years of open enrollment in 2014 and 2015. Company officials said they will continue to offer other options in all 254 counties both inside and outside of the marketplace.
We’re getting ready for Open Enrollment for 2016. Blue Cross and Blue Shield of Texas (BCBSTX) will offer individual coverage options in every market in the state, both on and off the exchange. If you have an individual health plan or are looking to buy one in 2016, here are some of the changes you need to know.
When is Open Enrollment?
Open Enrollment for individuals runs from November 1, 2015 through January 31, 2016. If you are looking to buy your own health insurance plan for 2016, you can do so during this time.
If you already have health insurance, this is also the time you can:
Look at other plan choices
Compare plans and prices
See if you can get financial help
You’ll be able to see what plans will be available starting in October, when the “window shopping” period begins. This will give you time to weigh your options, ask questions and decide what will work best for you – before it’s time to sign up.
What will be different for individual plans in 2016?
There are some changes in the plans we intend to offer in the individual market in 2016. We won’t be offering PPO insurance plans in the individual, retail market. However, we intend to continue to offer HMO plans. This change does not affect our employer group customers or the grandfathered PPO individual plan members.
Why is Blue Choice PPO going away?
BCBSTX was the only insurer to offer an individual PPO insurance plan across the state to individuals in 2014 and 2015. Since the Affordable Care Act began, the market has changed. We found that the individual PPO plan was no longer sustainable at the cost it was being offered. Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.
Why couldn’t you just keep offering the individual PPO plans and raise the rate for them?
The law requires that we set our individual plan rates based on all of our individual members’ claims history. This means that if the costs of one plan are high, it will raise the rates of all other plans, not just the high-cost plan. If we kept the Blue Choice PPO, this would have raised the rates so much for all our other plans that most people wouldn’t be able to afford them. By dropping the PPO, we can still offer our other plans at reasonable rates.
I have a PPO plan. What will this mean for me?
If you have an employer group PPO plan, this will not affect you. If you enrolled in the individual Blue Choice PPO plan last year, you won’t be able to keep your PPO plan in 2016. We’re sharing this information well in advance of the required notification date so that you have plenty of time to research the plan options that best suit your needs. We will work with you and your doctors to lessen the impact of this change to your ongoing care.
My Blue Choice PPO plan is “grandfathered.” Is it being discontinued too?
No. If you have a grandfathered individual PPO plan, it will still be available in 2016. Grandfathered individual plans are plans that existed on March 23, 2010, when the Affordable Care Act became law. If you don’t know if your plan is grandfathered, check your plan details or call the customer service number on the back of your BCBSTX member ID card.
Will I be able to keep my doctor and/or hospital if I switch plans?
Currently, we have two provider networks for our individual plans: Blue Choice PPO and Blue Advantage HMO. Some providers are only in the Blue Choice network, and some of them have decided not to join the Blue Advantage HMO network in 2016. So, with the Blue Choice PPO individual plans going away, these providers will no longer be an in-network option for most of our individual members. If you have a grandfathered plan, you will still have access to the Blue Choice network.
If your doctor is not in the Blue Advantage network, we will work with you and your doctor to lessen the impact of this change to your ongoing care.
When can I see 2016 plan details and rates?
Individual plan details and rates will be available in October 2015. Open Enrollment begins November 1, 2015
Happy anniversary, Healthcare.gov! Today, October 1st, marks the first anniversary of the premier of the originally beleaguered Federally Facilitated “Marketplace” (FFM), the federal government website for the purchase of Affordable Care Act (ACA) compliant health insurance plans in states which did not implement their own. And what of it now?
After a rollout, which was anything but smooth, and a current expenditure of approximately $2.1 billion dollars (after a winning bid of $90 million) the site seems to have solved the majority of its “front- end” issues. These involve opening an account; verifying identity and plan selection. But in light of notice that the time has run out for those who did not succeed in providing adequate proof of income for subsidy (“Premium Tax Credit”) purposes thereby resulting in their loss of coverage or―at least the subsidy―one is left wondering what if anything will change relative to this “back-end” issue for 2015. According to a September 15th article in the New York Times, approximately half a million insured face a forced plan change. “363,000 could lose their premium subsidies due to an inability to verify income, while 115,000 more could have their policies canceled because they have not proven their immigration status. Federal authorities have been working for months to resolve both backlogs.”
My BlueCross BlueShield of Texas clients who have “grand-mothered” plans just received notice dated today that “The health plan you now have will no longer be available and cannot be renewed”. Grand-mothered plans are those which have been modified in anyway, such as a change in deductible, but purchased prior to January 1 of this year when all new policies were required to be ACA compliant. Termination will be effective the end of 12.31.2014 and the client, insured will have until that date to enroll in a new plan for seamless coverage beginning January 1. These policyholders are instructed to log in starting November 15th to review their options and elect new coverage through BlueCross BlueShield. What will the benefits look like and what will be the cost? Well, we won’t know until November 15th. The consensus seems to be that premiums in all but a few locations will be increasing somewhat across the market compared to this year’s ACA compliant plans but at less than the average rate of medical inflation in recent years. (Call me skeptical.) But what about compared to their grand-mothered plan? No way. By the time you add in the additional cost of mandated coverage for benefits such as pediatric dental and vision, maternity and the rest of the “minimum essential health benefits” along with guarantee issue for pre-existing conditions, there is no way these policyholders are going to be pleased with the premiums their new options will cost. If they had thought the marketplace offered better options, they would have elected them for 2014. I am certain the words, “If you like your plan, you can keep your plan. Period.” will be ringing in their ears as they peruse their new options.
On the upside, an estimated 25% additional insurance companies will be providing coverage for 2015 both in and out of the marketplace and state exchanges. This increased competition will give consumerd more options and will hopefully help offset some of the inflationary aspects of mandated coverage in future years.
On the downside, what of the “It’s a penalty … not a tax!” ― now known as the “Shared Responsibility Payment” ― for not having coverage in 2015? That increases to $325 per adult and $162.50 per child or 2% of household income ― whichever is higher. (Family maximum is $975.) It will increase every year hereafter, tied to the rate of inflation beyond 2016.
Additional variables remain to be seen such as “provider selection”. While pressure is being put on insurance companies to increase the number of in-network providers available to the insured, surveys seem to indicate more providers are electing not to join. They feel payments have dropped to low to make it worth their while to participate. Insurance companies are going have to find alternative ways to control costs and since they cannot control the risk they are forced to assume (elative to pre-existing conditions and the mandated “loss ratio”) they are going to ration our providers and our treatment.
On a final note, the enrollment period for 2015 plans will be half as long as for 2014 and will end February 15th. So get ready to be like the sheep, in the Wild Kingdom segment, passing through the anaconda. It’s going to be a tight squeeze! And once again . . . “Happy Anniversary to Healthcare.gov!”
By all means, please contact me if you feel I can make the celebration cake a little more palatable!
WASHINGTON — The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified.
The 115,000 people “will lose their coverage as of Sept. 30,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal insurance marketplace.
Some of them may be able to have their coverage reinstated retroactively if they produce the documents that they were repeatedly asked to provide in recent months, Mr. Slavitt said.
At the end of May, the administration said, 966,000 people were found to have discrepancies in their immigration and citizenship records. Most sent in documents as requested. In mid-August, the administration sent letters to about 310,000 people who had failed to respond. They were supposed to submit documents by Sept. 5, but the 115,000 consumers failed to do so, Mr. Slavitt said.
Many consumers and lawyers who work with them said that they had tried to submit immigration and citizenship papers, but that they experienced problems transmitting documents through HealthCare.gov. Other people said they sent the documents by mail to a federal contractor in Kentucky but never heard back from the contractor or the government.
“We heard from lots of consumers who told us they sent in their documents multiple times or tried to upload them through HealthCare.gov,” said Mara Youdelman, a lawyer at the National Health Law Program, an advocacy group for low-income people.
Jenny Rejeske, a health policy analyst at the National Immigration Law Center, which represents immigrants, said: “It is unduly harsh to terminate coverage while there are still technical problems with the federal system for verifying citizenship and immigration status. And there has not been adequate notice to people who speak languages other than English and Spanish.”
Florida leads the list of states whose residents are losing coverage because of immigration and citizenship issues, with 35,100. Federal officials said they were ending coverage for 19,600 people in Texas, 6,300 in Georgia, 5,300 in North Carolina, 5,200 in Pennsylvania, 4,000 in Illinois and 2,400 in New Jersey. The numbers released on Monday are for 36 states using the federal insurance marketplace. They do not include terminations in California, New York and other states running their own insurance exchanges.
Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. But in many cases, the government could not verify the incomes people reported when they applied for subsidized insurance.
This does not mean that they provided false information or were ineligible for assistance. The government tried to verify incomes by checking 2012 tax return information, but consumers may have switched jobs or received pay raises since filing those returns. As a result, officials said, the information in their applications may not match the data in federal files or in sources available to the government.
Mr. Slavitt said that on May 30 there were roughly 1.2 million households (and a total of 1.6 million people) with “data-matching issues.”
Since then, the government said, it has closed cases for 467,000 households with data discrepancies, and 430,000 cases are “currently in the process of being resolved.”
“There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals,” Mr. Slavitt said. They will soon receive letters from the government asking for proof of income, and if they do not reply by Sept. 30, they may lose some or all of their subsidies.
They would still be eligible for coverage, but in many cases could not afford it. In some cases, they would also have to repay some or all of the subsidies they received.
It is also possible that some people could receive larger subsidies if their incomes are lower than what they expected when they applied.
(A version of this article appears in print on September 16, 2014, on page A18 of the New York edition with the headline: U.S. to End Coverage Under Health Care Law for Tens of Thousands.)
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