WHAT MAY BE THE MOST CONVENIENT MEDICARE ADVANTAGE PLAN TO DATE!

By D. Kenton Henry editor, agent

26 April 2022

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.

D. Kenton Henry

Office: 281-367-6565

TEXT my cell 24/7 @ 713-907-7984

Email: Allplanhealthinsurance.com@gmail.com

Https://TheWoodlandsTXHealthInsurance.com

Https://Allplanhealthinsurance.com              

Https://HealthandMedicareInsurance.com

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FEATURE ARTICLE 1

**(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.

• Find providers by going to http://www.medicare.gov/care-compare. A few things to keep in mind:

• 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.

WILL MEDICARE RECIPIENTS FINALLY GET A BREAK? . . . WHY MARKETPLACE INSURED PROBABLY WON’T

By D. Kenton Henry Broker, editor 19 April 2022 

While inflation has costs for necessities, such as gas and food items, skyrocketing to an average of 8.5% in March and much higher for the aforementioned items – Social Security saw fit to only increase the Income Benefit to SSI recipients to 5.9%. Seniors, many of whom are subsisting on fixed incomes, might be able to cut their need for gasoline, but I do not know any who can get by without food, shelter, and electricity. Many are struggling to pay their bills already, and inflation shows little sign of abating.  

This was only until 09/2021, at which time, apparently only apples inflated lower than our current rate of inflation. 

But how about the argument that all this inflation is due to Putin and the war in Ukraine? Russia launched a full-scale assault on Ukraine February 22. One month after the end of the timeline in the chart below. 

When was our current president inaugurated? . . . Answer: January 20, 2021. Take a look at the green line above charting the Consumer Price Index on that date. (I will leave it at that.) 

To add insult to injury, the Centers for Medicare and Medicaid Services (CMS) increased Part B (outpatient care) premiums by 15% to a base premium -for those with an annual income of less than or equal to $91,000 – to $170.10 per month. Thank you very much!  

However, as described in Feature Article 1 below, due in part to a 50% cut in the cost of a $56,000 Part D covered drug, CMS is considering reducing that Part B Premium. My experience is that the government seldom gives back what they are already receiving . . . but one can only hope. 

For those involved in Marketplace medical coverage – health insurance for individuals and families under the age of 65 – the opposite action on the part of the Department of Health and Human Services may occur. Specifically, the extended enhanced premium tax credits made available by the American Rescue Plan, which enabled an additional 3 million Americans to receive a subsidy lowering their net monthly premium to as low as $0, are set to expire at the end of the year. As described in Feature Article 3 below, it is estimated 4.9 million more people will go uninsured if enhanced benefits are not extended. Never mind it is estimated the extension of such would increase the federal deficit by $305 billion dollars. Of course, the Treasury can simply print more money, further increasing inflation and diminishing the buying power of one’s paycheck or Social Security Income. 

Lastly, medical expenses are no exception to inflation. If you wonder why health insurance premiums or out-of-pocket costs for healthcare are being affected, refer to article 3 below. They start high and increase as one goes from a doctor’s office to an Urgent Care facility to a hospital emergency room. Avoid the latter unless it is a true emergency because it will cost an average of $444 for low to moderate severity treatment. Heaven, forbid you have an overnight stay in a hospital without medical insurance because the average cost is $11,700. As cited in the chart below, it only goes up depending on the type of insurance you have. 

 Should your stay extend to three days, expect to cost to be an average of $30,000. And what if you don’t have health insurance? Here are the average costs of various treatments.

Take a look at what you might pay for each hospital bill without insurance: 

 *(Data from the Agency for Healthcare Research and Quality) 

While I cannot guarantee we have seen the worst of inflation – let alone that the government is going to provide us any meaningful relief in the immediate future. But I am here to assist you in acquiring medical coverage, which gives you access to the care and treatment you need to regain or preserve your health without being financially ruined. I will do my best to help you maintain access to as many of your preferred medical doctors and hospitals as the present market allows. I do not charge a fee for my services. There is no additional cost for the insights and value of my 36 years of experience in the health and Medicare-related insurance market. Neither is there any additional cost in acquiring an insurance product through me than if you walked through the door of your preferred insurance company and purchased their product directly from them. There is no obligation to take my learned advice.  

Please give me a call and let’s discuss your situation before the very busy “Open Enrollment” Periods are upon us and everyone is scrambling to mitigate what are almost certain to be the increasing costs of health care

.

Office: 291-367-6565 Text my cell 24/7 @ 713-907-7984 Email: Allplanhealthinsurance.com@gmail.com Https://TheWoodlandsTXHealthInsurance.com Https://Allplanhealthinsurance.com 

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FEATURED ARTICLE 1 

FIERCE HEALTHCARE 

CMS, FDA present united front against criticism of Aduhelm coverage decision 

AHIP applauded CMS for covering the drug and “related services such as PET scans if required b the trial protocol.” 

Other stakeholders said that now the coverage decision has been finalized it is time for CMS to take action on lowering Part B premiums. 

CMS has yet to announce any final decision on Part B premiums, which is increased by 15% for 2022. A key reason was the $56,000 price tag for Aduhelm. 

However, Department of Health and Human Services Secretary Xavier Becerra announced in January that the agency was rethinking the 15% hike after Biogen halved the price of Aduhelm in December.  

Becerra told reporters on Tuesday before the coverage decision that he was waiting to see what “CMS gives back to us in terms of their assessment and then once we get that information we will see where we go.” 

 CMS told Fierce Healthcare on Friday that it has yet to decide on a redetermination for the premium. 

But advocates are hoping the agency moves faster on scaling back the premium hike. 

“Medicare beneficiaries struggling to pay their bills need relief from this year’s premium increase as soon as possible,” said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare. 

Pharma and Alzheimer’s disease patient advocacy groups slammed the decision, however, noting that it will hamper access to the drug. 

“CMS has further complicated matters by taking the unprecedented step of applying different standards for coverage of medicines depending on the FDA approval pathway taken, undermining the scientific assessment by experts at FDA,” said Nicole Longo, spokeswoman for the Pharmaceutical Research and Manufacturers of America, in a statement.

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FEATURED ARTICLE 2 

BENEFITSPRO.COM 

End to ACA tax credits could leave 3 million uninsured 

But extending the enhanced credits would increase the federal deficit by $305 billion over 10 years. 

By Alan Goforth | April 08, 2022 at 09:32 AM 

    

Congress would need to act by midsummer to give marketplaces, insurers and outreach programs time to prepare for the 2023 open enrollment period. 

More than three million people could lose insurance coverage if enhanced premium tax credits included in the American Rescue Plan expire at the end of this year, according to a new report from the Urban Institute. The American Rescue Plan Act of 2021 increased credits for Marketplace insurance coverage and extended eligibility to more individuals. 

“If Congress does not extend these benefits, marketplace enrollment will most likely fall and the number of people uninsured will increase,” said Jessica Banthin, senior fellow at the organization. “Our findings show that 4.9 million fewer people will be enrolled in subsidized Marketplace coverage in 2023 if the enhanced credits aren’t extended. This comes at a pivotal time when millions of people will be losing Medicaid as the public health emergency expires.

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FEATURED ARTICLE 3

 Average charges for 8 common procedures across ER, retail and urgent care settings 

Alia Paavola – Wednesday, March 30th, 2022  

In 2020, the median charge for a 30- to 44-minute new patient office visit ranged from $164 in a retail clinic to $234 in an urgent care center, according to a March report from Fair Health. 

For the report, Fair Health, an independent nonprofit focused on enhancing transparency of healthcare costs and health insurance information, analyzed billions of private healthcare claims records from its database. 

Below is the average charge for eight common procedures, as identified by CPT code, performed in retail, urgent care and emergency room settings: 

Retail 

  • Office outpatient visit 20-29 minutes (99213): $114 
  • Streptococcus test (87880): $36 
  • Immunization administration (90471): $33 
  • Office outpatient visit 30-39 minutes (99214): $159 
  • Office outpatient, new, 30-44 minutes (99203): $164 
  • Flu test (87804): $42 
  • Office outpatient, new, 15-29 minutes (99202): $131 
  • Flu vaccination (90686): $31 

Urgent care 

  • Office outpatient visit 30-39 minutes (99214): $232 
  • Office outpatient visit 20-29 minutes (99213): $174 
  • Office outpatient, new, 30-44 minutes (99203): $234 
  • Streptococcus test (87880): $43 
  • Office outpatient, new, 45-59 minutes (99204): $313 
  • Flu test (87804): $46 
  • Therapeutic, prophylactic or diagnostic injection (96372): $59 
  • Office outpatient visit, new, 15-29 minutes (99202): 178 

Emergency room 

  • Emergency department visit — high severity/life-threatening (99285): $1,262 
  • Emergency department visit — high/urgent severity (99284): $919 
  • Emergency department visit — moderate severity (99283): $624 
  • Electrocardiogram (93010): $54 
  • Single-view chest X-ray (71045): $58 
  • CT head/brain without contrast material (70450): $323 
  • Two-view chest X-ray (71046): $69 
  • Emergency department visit — low/moderate severity (99282): $444 

ENTRY OF AETNA AND UNITEDHEALTHCARE IN 2022 ACA HEALTH INSURANCE MARKET; $ INCREASES IN MEDICARE PREMIUMS AND DEDUCTIBLE

TIME IS RUNNING OUT FOR A JANUARY 1 EFFECTIVE DATE!

Op-ed by D. Kenton Henry Editor, Broker 26 November 2021

In September, I learned Aetna and Unitedhealthcare would be reentering the Texas ACA Underage 65 health insurance market for the first time since 2015. Since then, BlueCross BlueShield has been the only “household name,” a large, financially sound insurance company in the southeast Texas market. This was most welcome news, and I was hopeful these additional peer companies would allow my clients and fellow Texans access to more doctors and hospitals. Finding my client’s preferred doctors and hospitals in a plan network has been my client’s and my greatest challenge since the departure of all PPO network options six years ago. Alas, the hoped-for provider expansion in 2022, at this point, has failed to materialize. From 2015 into 2021, the St. Lukes Hospital system has been the only major hospital system participating in most insurance companies’ HMO networks. Such will remain the case for 2022.

Additionally, the entry of Bright Insurance Company (for the first time) doesn’t even appear to do that. They will limit their policyholder’s access to hospitals will be limited to smaller HCA local community hospitals. At least for the time being.

Doctors have practicing privileges at one or more hospitals. Of course, it follows that when an insurance company has fewer hospitals in their network, they will have fewer participating doctors. And so it seems. Only one health insurance company in the southeast Texas ACA health insurance market allows its clients access to the three major hospital systems in the area. Those hospitals are St. Luke’s, Memorial Hermann, and Houston Methodist. And then, only if you acquire their more expensive Silver or Gold plans. 

However, there is a bit of good news for all Americans in the “Individual and Family” health insurance market. The federal government’s American Rescue Plan has increased the amount of Advance Premium Tax Credit (subsidy) and Cost Sharing Reduction (reduction of deductibles, copays, and coinsurance) available to a household. It also expanded the eligibility for these subsidies. As the feature article below explains, this will qualify more people for both types of savings.  

Furthermore, unemployment effects and increases your potential premium tax credit! The American Rescue Plan exempts up to $10,200 in UI benefits from federal income tax. People who receive UI benefits in 2020 will be able to reduce their adjusted gross income by up to that amount, and so reduce their federal income tax liability.

Please get in touch with me to learn the details on the aforementioned company providing the greatest access to providers and how the expanded subsidies and Cost-Sharing Reductions may improve your health insurance situation.

If you choose to be proactive and would like to do some reconnaissance before calling me for assistance and details, you may click on my quoting link immediately following. When the page opens, ignore the login button. You need not log in. Enter your information. I.e., birth date, zip code, etc. On the next page, click on the top box “SELECT ALL” to clear the selections. Then select “MEDICAL” only, to get started. Otherwise, you will be overwhelmed with options and information. You can always return for dental, etc.)

Click “YES” if you would like to estimate whether you qualify for a subsidy. If so, enter your estimated annual income in 2022 and click “CALCULATE”. It will estimate your subsidy. The estimates are usually accurate to within $3.00. From there, click “NEXT”. You will then see all your plan options and be able to LOOKUP PROVIDERS and see plan details. Or simply call me to do all this for you! 

CLICK HERE TO SEE ALL YOUR ACA HEALTH INSURANCE OPTIONS (IF NECESSARY, COPY THE LINK IN YOUR BROWSER AND HIT ENTER):

https://allplanhealthinsurance.insxcloud.com/

MEDICARE RECIPIENTS:

As the cost for everything, including medical treatment, is going up, so too are Medicare’s premiums and deductibles. As our second feature article below illustrates, the Medicare Part B (outpatient) basic premium is going from $148.50 to $170.10 and it’s calendar year deductible is going from $203.00 to $233.00! You can do the math, but, needless to say, so much for 5% inflation rate projected by the current administration which also does not appear to apply to our cost for gasoline, meat, and energy and food, in general! You’ve already spent the increase in your Social Security Benefit! 

The details of how your Medicare Part B basic premium will may titrate upward relative to your income are clearly outlined in Feature Article 2, just published by the Centers For Medicare and Medicaid Services.

Lastly, if you are making the decision whether to go with a Medicare Advantage Prescription Drug Health Plan vs. a Medicare Supplement policy coupled with a Part D Prescription Drug Plan – please read Feature Article 3 (say it ain’t so, Joe!) below, and carefully weigh your decision. 

Again, please contact me for guidance in how to minimize the impact of these changes and maximize your both your access to providers and quality health care. My 35 years specializing in the health and Medicare related insurance industry have provided me insights beyond that of the average agent/broker/generalist; and my clients access to a far greater number of products and solutions.

D. Kenton Henry TheWoodlandsTXHealthInsurance.com                                                              

Allplanhealthinsurance.com@gmail.com

Office: 281-367-6565

Text My Cell @ 713-907-7984

Https://TheWoodlandsTXHealthInsurance.com Https://Allplanhealthinsurance.com Https://HealthandMedicareInsurance.com

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FEATURE ARTICLE 1:

11.24.2021

Cost Sharing Reductions on Silver Plans

Two types of Marketplace subsidies:

Advanced Premium Tax Credits(APTC):Lowers the cost of premiums and can be used on any Marketplace plan except for catastrophic plans.

Cost Sharing Reductions(CSR):Lowers the cost of deductibles and can only be applied to Marketplace Silver plans.

This year, many people will qualify for both types of savings!

Why are subsidies more generous this year:

The American Rescue Plan Act increased the amount of APTC and CSR available to a household, and it also expanded the eligibility for these subsidies.

Silver plans vs. other metal levels:

All Marketplace health insurance plans are broken into five types: Platinum, Gold, Silver, Bronze and Catastrophic. You can expect the same level of care fromall metal levels. The difference is how your healthcare costs will be split between you and the insurance company. Metal levels Premium Platinum Highest Gold Silver Bronze Catastrophic Deductible Higher Middle Lower Lowest Lower Middle Higher Highest. If you are eligible for a CSR, you must choose a Silver plan!

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FEATURE ARTICLE 2:

Key Points:

Part B premium for 2022 is $170.10, up $21.60 from 2021.

The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.

Follow the link below for more information and the 2022 Medicare Part B Income-Related Monthly Adjustment Amounts

OR SIMPLY READ THE ARTICLE IMMEDIATELY BELOW 

https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-and-deductibles2022-medicare-part-d-income-related-monthly-adjustment

Nov 12, 2021 

Centers for Medicare & Medicaid Services

Nov 12, 2021

Fact sheet


2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts

Nov 12, 2021 

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On November 12, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income-related monthly adjustment amounts.

Medicare Part B Premium and Deductible

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. 

Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.

The increases in the 2022 Medicare Part B premium and deductible are due to:

  • Rising prices and utilization across the health care system that drive higher premiums year-over-year alongside anticipated increases in the intensity of care provided.
  • Congressional action to significantly lower the increase in the 2021 Medicare Part B premium, which resulted in the $3.00 per beneficiary per month increase in the Medicare Part B premium (that would have ended in 2021) being continued through 2025.
  • Additional contingency reserves due to the uncertainty regarding the potential use of the Alzheimer’s drug, Aduhelm™, by people with Medicare. In July 2021, CMS began a National Coverage Determination analysis process to determine whether and how Medicare will cover Aduhelm™ and similar drugs used to treat Alzheimer’s disease. As that process is still underway, there is uncertainty regarding the coverage and use of such drugs by Medicare beneficiaries in 2022. While the outcome of the coverage determination is unknown, our projection in no way implies what the coverage determination will be, however, we must plan for the possibility of coverage for this high cost Alzheimer’s drug which could, if covered, result in significantly higher expenditures for the Medicare program.

Medicare Open Enrollment and Medicare Savings Programs

Medicare Open Enrollment for 2022 began on October 15, 2021, and ends on December 7, 2021. During this time, people eligible for Medicare can compare 2022 coverage options between Original Medicare, and Medicare Advantage, and Part D prescription drug plans. In addition to the recently released premiums and cost sharing information for 2022 Medicare Advantage and Part D plans, the Fee-for-Service Medicare premiums and cost sharing information released today will enable people with Medicare to understand all their Medicare coverage options for the year ahead. Medicare health and drug plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices annually and decide on the options that best meet their health needs.

To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs help millions of Americans access high-quality health care at a reduced cost, yet only about half of eligible people are enrolled. The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance, and copayments for those who meet the conditions of eligibility. Enrolling in an MSP offers relief from these Medicare costs, allowing people to spend that money on other vital needs, including food, housing, or transportation. People with Medicare interested in learning more can visit: https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs.

Medicare Part B Income-Related Monthly Adjustment Amounts

Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly 7 percent of people with Medicare Part B. The 2022 Part B total premiums for high-income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with modified adjusted gross income:Beneficiaries who file joint tax returns with modified adjusted gross income:Income-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $91,000Less than or equal to $182,000$0.00$170.10
Greater than $91,000 and less than or equal to $114,000Greater than $182,000 and less than or equal to $228,00068.00238.10
Greater than $114,000 and less than or equal to $142,000Greater than $228,000 and less than or equal to $284,000170.10340.20
Greater than $142,000 and less than or equal to $170,000Greater than $284,000 and less than or equal to $340,000272.20442.30
Greater than $170,000 and less than $500,000Greater than $340,000 and less than $750,000374.20544.30
Greater than or equal to $500,000Greater than or equal to $750,000408.20578.30

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses, with modified adjusted gross income:Income-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $91,000$0.00$170.10
Greater than $91,000 and less than $409,000374.20544.30
Greater than or equal to $409,000408.20578.30

Medicare Part A Premium and Deductible

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,556 in 2022, an increase of $72 from $1,484 in 2021. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2022, beneficiaries must pay a coinsurance amount of $389 per day for the 61st through 90th day of a hospitalization ($371 in 2021) in a benefit period and $778 per day for lifetime reserve days ($742 in 2021). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $194.50 in 2022 ($185.50 in 2021).

Part A Deductible and Coinsurance Amounts for Calendar Years 2021 and 2022
by Type of Cost Sharing
 20212022
Inpatient hospital deductible$1,484$1,556
Daily coinsurance for 61st-90th Day$371$389
Daily coinsurance for lifetime reserve days$742$778
Skilled Nursing Facility coinsurance$185.50$194.50

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $274 in 2022, a $15 increase from 2021. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $499 a month in 2022, a $28 increase from 2021.

For more information on the 2022 Medicare Parts A and B premiums and deductibles (CMS-8077-N, CMS-8078-N, CMS-8079-N), please visit https://www.federalregister.gov/public-inspection.

Medicare Part D Income-Related Monthly Adjustment Amounts

Since 2011, a beneficiary’s Part D monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly 8 percent of people with Medicare Part D. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary from plan to plan and roughly two-thirds are paid directly to the plan, with the remaining deducted from Social Security benefit checks. The Part D income-related monthly adjustment amounts are all deducted from Social Security benefit checks. The 2022 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with modified adjusted gross income:Beneficiaries who file joint tax returns with modified adjusted gross income:Income-related monthly adjustment amount
Less than or equal to $91,000Less than or equal to $182,000$0.00
Greater than $91,000 and less than or equal to $114,000Greater than $182,000 and less than or equal to $228,00012.40
Greater than $114,000 and less than or equal to $142,000Greater than $228,000 and less than or equal to $284,00032.10
Greater than $142,000 and less than or equal to $170,000Greater than $284,000 and less than or equal to $340,00051.70
Greater than $170,000 and less than $500,000Greater than $340,000 and less than $750,00071.30
Greater than or equal to $500,000Greater than or equal to $750,00077.90

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses, with modified adjusted gross income:Income-related monthly adjustment amount
Less than or equal to $91,000$0.00
Greater than $91,000 and less than $409,00071.30
Greater than or equal to $409,00077.90

Oct 21, 2021

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Sep 30, 2021

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FEATURE ARTICLE 3:

11.08.2021

Medicare plans: Be wary of Joe Namath, other celebrity pitchmen | Steve Israel

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Steve Israel for the Times Herald-Record

Mon, November 8, 2021, 7:24 AM·3 min read

In this article:

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Joe Namath

American football player

Explore the topics mentioned in this article

Joe Namath may have delivered the New York Jets’ last Super Bowl championship, but the old quarterback is throwing a bunch of bull on his TV commercials for private Medicare plans.

He’s one of a slew of pitchmen and women selling Medicare Advantage plans to the more than 54 million Americans 65 or over eligible for Medicare. That includes more than 100,000 of us in Orange, Ulster and Sullivan counties.

Joe Namath may have delivered the New York Jets’ last Super Bowl championship, but the old quarterback is throwing a bunch of bull on his TV commercials for private Medicare plans.

Those pitches, which also flood our mailboxes during this enrollment period that ends Dec. 7, complicate what can be a mind-boggling array of insurance choices.

First, some basic facts:

Medicare Advantage is the all-in-one alternative to original Medicare health insurance. Original Medicare includes coverage for hospitalization (Part A), medical visits and procedures (Part B) and, at additional cost, prescription drugs (Part D). Before you enroll in Advantage plans, you must have original Medicare, and you still must pay the Part B premium of $148.50 (in 2021). While Medicare Advantage plans include medical, hospital and drug coverage, they can also feature extra benefits not offered by traditional Medicare, such as dental, hearing and vision coverage with no additional premium.

Especially in those pitches from celebrities like Namath, William Shatner and Jimmie Walker, they can also promise everything from free meal delivery to money deposited in your Social Security account.

But …

“Buyer beware,” says Erinn Braun, Orange County Office for the Aging’s Health Insurance Counseling and Assistance Program coordinator. She provided much information for this column.

Pitches like Namath’s can be misleading or downright deceptive, starting with the red, white and blue colors that insinuate the ads are from the government, as do the state logos on some mailers. While the plans themselves are perfectly legal and may be great for many of the 27 million Americans enrolled in them, they often don’t deliver everything those pitches seem to promise. Plus, those pitches don’t come close to telling the full story of the benefits of those plans – many of which aren’t even offered in your area.

For instance:

Unlike original Medicare, which is accepted by virtually all doctors and hospitals, Medicare Advantage plans include a network of doctors and hospitals you must visit to be insured. So if you hear about a great gastroenterologist in New York City and she isn’t in your Advantage plan’s network, your insurance may not cover your visit. Plus, unlike original Medicare, you may need prior approval for coverage of a medical procedure or equipment such as insulin pumps.

And while the dental and vision coverage of Medicare Advantage plans sounds great, some plans in your area may only include routine visits, not more expensive items like dental implants and eyeglasses. Plus, the average yearly coverage limit of Advantage dental plans ranges from about $1,000 to $1,300, according to the Kaiser Family Foundation. The dentists and eye doctors you visit must also be in the plan’s networks – meaning your eye doctor or dentist may not accept your plan.

Steve Israel

As for those meals and money Joe Willie is pitching?

Again, buyer beware.

A few Advantage plans may offer meal delivery for the qualified but only one or two plans in your county may offer those benefits. And your doctors or hospital may not accept those plans. Same thing goes for that money Namath says could go into your Social Security account. Not only does that money go toward the required payment for Part B of original Medicare, very few plans – if any – in your area may feature that benefit, and those plans may not include your doctors.

Finally, when you call the number provided by Namath and other pitch folks, you’ll reach a salesperson who’s in business to … you guessed it … sell you a Medicare Advantage plan.

For help selecting the right Medicare plan for you, contact your county’s Office of the Aging. Orange: 845-615-3710, Sullivan: 845-807-0241, Ulster: 845-340-3456. A trusted health insurance agent can also help. Medicare.gov and 1-800-Medicare provide a wealth of information.

steveisrael53@outlook.com

This article originally appeared on Times Herald-Record: Medicare pitches: Joe Namath, other celebrities don’t have best advice

MEDICARE ADVANTAGE, DRUG PLANS, AND ACA INDIVIDUAL AND FAMILY HEALTH INSURANCE OPENING FOR 2022 ENROLLMENT

(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.

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MEDICARE IN 2022

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

https://thewoodlandstxhealthinsurance.com https://allplanhealthinsurance.com https://healthandmedicareinsurance.com

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*(FEATURE ARTICLE)

Democrats suffer blow on drug pricing as 3 moderates buck party

BY PETER SULLIVAN – 09/15/21 03:11 PM EDT

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.

https://thewoodlandstxhealthinsurance.com https://allplanhealthinsurance.com https://healthandmedicareinsurance.com

HAS CORONAVIRUS OR PRICE OF OIL RESULTED IN YOUR LOSS OF HEALTH INSURANCE?

by D. Kenton Henry

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*:

https://allplanhealthinsurance.insxcloud.com

*(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:

https://www.pivothealth.com/product/short-term-health-insurance/agent/89958/?utm_source=89958&utm_medium=Allied&utm_campaign=agents

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

http://thewoodlandstxhealthinsurance.com

http://allplanhealthinsurance.com/Health/Individual-and-Family/

https://HealthandMedicareInsurance.com

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insurancenewsnet

April 30, 2020 Top Stories

FEATURE ARTICLE

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.”

Download a summary of the survey findings.

About Pivot Health (a division of HealthCare.com)

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.

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 

 

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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.)

How Do I Calculate My Obamacare Premium Subsidy?

Well folks, here we are into the third week since the highly touted, much anticipated opening of the federal and state exchanges for purposes of enrolling in a health care act compliant insurance plan for 2014. And guess what? While a few state exchanges are experiencing some, generally small, measure of success – the federal exchange, or Marketplace, remains a dismal failure. It is, however, an excellent painful and protracted self-flagellating exercise in frustration. For an analogy–imagine having a root canal absent anesthesia while listening to Debbie Boone’s, “You Light Up My Life” on a continuous sound track loop through the entire procedure. Just to make the comparison more accurate, imagine you are Dustin Hoffman’s character who is tortured with a dentist’s drill in the movie Marathon Man but your experience is enhanced as your hygienist pulls your toe nails out with a pair of needle nose pliers in order to distract you from your oral discomfort. And that, I believe, is a pretty fair comparison to the enjoyment of opening an account and obtaining quotes for health insurance in the Marketplace to date. The tax payer’s cost to deliver this electronic equivalent of a Halloween visit to a House of Horrors? Current estimates are over $500 million and growing as desperate measures are being made to fix all its glitches as this goes to press. This after the Department of Health and Human Services accepted the low bid of $55 million with a ceiling of $93.7 million from Canadian software company, CGI Federal. Canadian? Really? All that U.S. taxpayer money to a Canadian firm? (I’m not even going there.)

But relax, dear patient. Let’s apply a little Novocain to your orifice. Let’s give you a subsidy to help ease the pain you will suffer when you see the highly inflated cost of health insurance you are now commanded to purchase under threat of penalty.

People making between 100 and 400 percent of federal poverty level can qualify for the premium tax credit health insurance subsidy. Federal poverty level changes every year, and is based on your income and family size.

Using 2013 FPL levels, you’ll qualify as an individual with an income range of $11,490-$45,960, a couple with an income of $15,510-$62,040, and a family of three earning $19,530-$78,120.

Just how do you calculate your subsidy?

In order to calculate how much your premium tax credit (subsidy) will be – you have to know 2 things:

(A) Your expected contribution toward the cost of your health insurance (available at the end of this article); and

(B) The cost of your BENCHMARK health plan. (Your health insurance exchange–assuming you succeed in opening an account and obtaining quotes–can tell you which plan this is and how much it costs. Your benchmark plan is the silver-tiered health plan with the second lowest monthly premiums in your area. The Affordable Care Act classifies health plans based on how much of your health care costs they’re expected to cover. A bronze health plan will cover about 60 percent of the average person’s health care costs. A silver health plan will cover about 70 percent.)

Your subsidy amount is the difference between your expected contribution and the cost of the benchmark plan. But just because the benchmark plan is used to calculate your subsidy doesn’t mean you have to buy the benchmark plan. You may buy any plan listed on your health insurance exchange, but your subsidy amount stays the same.

If you choose a more expensive plan, you’ll pay the difference plus your expected contribution. If you choose a plan that’s cheaper than the benchmark plan, you’ll pay less since the subsidy money will cover a larger portion of the monthly premium. If you choose a plan so cheap that costs less than your subsidy, you won’t have to pay anything for health insurance. However, you won’t get the excess subsidy back.

If you’re trying to save money so you choose a plan with a lower value, (like a bronze plan instead of a silver plan), you’ll likely have higher coinsurance and copays when you use your health insurance.

There’s another reason to choose a silver-tier plan. There’s a different subsidy that lowers copays, coinsurance, and deductibles for some low-income people. Eligible people can use it in addition to the premium tax credit subsidy. However, it’s only available to people who choose a silver-tier plan.

One question I am frequently asked is, “Do I have to wait until I file my income tax return in order to get the subsidy?”

Answer: “No”

You can get the premium tax credit in advance. If your income is so low you don’t have to file a tax return, you can still get the subsidy. But bear in mind–if you underestimate your income and take a subsidy–you will be forced to pay it back or, if you are due a refund, have it reduce such respectively when you file your return. (Income verification was put back in 2014 subsidy provisions after being suspended for one year along with the Administration’s one year suspension of the mandate that large employers must purchase health insurance for their employees. And remember–the IRS is in charge of monitoring your enrollment and expenditure.)

Consider opting to get the subsidy along with your tax refund if:

  • Your income is very      close to 400 percent of FPL.
  • Your income varies from      year to year so you’re not sure how much you’ll make.

When the subsidy is paid in advance, the amount of the subsidy is based on an estimate of your income for the coming year. If the estimate is wrong, the subsidy amount will be incorrect.

If you earn less than estimated, the advanced subsidy will be lower than it should have been. You’ll get the rest as a tax refund.

If you earn more than estimated, the government will send too much subsidy money to your health insurance company. You’ll have to pay back part or all of the excess subsidy money when you file your taxes. Even worse, if your actual income ended up more than 400 percent of FPL, you’ll have to pay back every penny of the subsidy. This could be thousands of dollars.

If you get your subsidy when you file your income taxes rather than in advance, you’ll get the correct subsidy amount because you’ll know exactly how much you earned that year. You won’t have to pay any of it back.

The Marketplace’s software will (supposedly) calculate your subsidy. Perhaps, as time goes by, it will even do so accurately. But for those of you who scored at least 600 on your high school SAT math test and enjoy such things – here is the exact formula for keeping the government honest:

  1. Figure out how your income compares to FPL.
  2. Find your expected contribution rate in the table below.
  3. Calculate the dollar amount you’re expected to contribute.
  4. Find your subsidy amount by subtracting your expected contribution from the cost of the benchmark plan.

Here is an example:

Mary is single with an income of $22,800 per year. FPL for 2013 is $11,490 for single people.

  1. To figure out how Mary’s income compares to FPL, use: income ÷ FPL x 100.
    $22,800 ÷ $11,490 x 100 = 198.4.
    Mary’s income is 198 percent of FPL.
  2. Using the table below, Mary is expected to contribute 4-6.3 percent of her income. Since she’s almost at the top of her category in the table, she uses the 6.3 percent figure.
  3. To calculate how much Mary is expected to contribute, use this equation: 6.3 ÷ 100 x income.
    6.3 ÷ 100 x $22,800 = $1,436.
    Mary is expected to contribute $1,436 per year, or about $120 per month,      toward the cost of her health insurance. The premium tax credit subsidy      pays the rest of the cost of the benchmark health plan.
  4. The benchmark health plan at Mary’s health insurance exchange costs $3,900 per year or $325 per month. Use this equation to figure out the subsidy amount: cost of the benchmark plan – expected contribution = amount of the subsidy.
    $3,900 – $1,436 = $2,464.
    Mary’s premium tax credit subsidy will be $2,464 per year or about $205 per month.

If Mary chooses the benchmark plan, or another $325 per month plan, she’ll pay $120 per month for her health insurance. If she chooses a plan costing $425 per month, she’ll pay $220 monthly for her health insurance. If she chooses a plan costing $225 per month, she’ll only pay $20 per month for her health insurance.

FEDERAL POVERTY LIMIT BASED ON NUMBER OF FAMILY IN HOUSEHOLD:

(Click on image to enlarge.)

FEDERAL POVERTY LEVEL GUIDELINES 2013

Table of Your Expected Contribution Percentage:

If your income is

Your expected contribution will be

100%-133% of FPL

2% of your income

133%-150% of FPL

3%-4% of your income

150%-200% of FPL

4%-6.3% of your income

200%-250% of FPL

6.3%-8.05% of your income

250%-300% of FPL

8.05%-9.5% of your income

300%-400% of FPL

9.5% of your income

 

I hope your weather is not as beautiful as it is here in my part of Texas on this Sunday afternoon. If so, you are probably regretting you took the time to get this far into this hopefully informative piece. If it is – do not blame me and certainly–do not shoot the messenger.

As for me, I’m getting out on my motor bike and will take my mind off this monumental cross I bear being . . .

Yours in disclosure,

Admin. – Kenton Henry

http://allplanhealthinsurance.com

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10/14/2013 @ 11:39AM |1,067,949 views

Obamacare’s Website Is Crashing Because It Doesn’t Want You To Know How Costly Its Plans Are

                        Avik Roy, Contributor

The Healthcare.gov website requires that individuals looking for coverage enter personal information before comparing plans. IT experts believe that this requirement is causing the website to crash.

A growing consensus of IT experts, outside and inside the government, have figured out a principal reason why the website for Obamacare’s federally-sponsored insurance exchange is crashing. Healthcare.gov forces you to create an account and enter detailed personal information before you can start shopping. This, in turn, creates a massive traffic bottleneck, as the government verifies your information and decides whether or not you’re eligible for subsidies. HHS bureaucrats knew this would make the website run more slowly. But they were more afraid that letting people see the underlying cost of Obamacare’s insurance plans would scare people away.

HHS didn’t want users to see Obamacare’s true costs

“Healthcare.gov was initially going to include an option to browse before registering,” report Christopher Weaver and Louise Radnofsky in the Wall Street Journal. “But that tool was delayed, people familiar with the situation said.” Why was it delayed? “An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.” (Emphasis added.)

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How Obamacare’s Exchanges Turned Into A ‘Third World Experience’ Avik Roy Contributor

Double Down: Obamacare Will Increase Avg. Individual-Market Insurance Premiums By 99% For Men, 62% For Women Avik Roy Contributor

CMS on Obamacare’s Health Insurance Exchanges: ‘Let’s Just Make Sure It’s Not a Third-World Experience’ Avik Roy Contributor

Enrollment In Obamacare’s Federal Exchange, So Far, May Only Be In ‘Single Digits’ Avik Roy Contributor

As you know if you’ve been following this space, Obamacare’s bevy of mandates, regulations, taxes, and fees drives up the cost of the insurance plans that are offered under the law’s public exchanges. A Manhattan Institute analysis I helped conduct found that, on average, the cheapest plan offered in a given state, under Obamacare, will be 99 percent more expensive for men, and 62 percent more expensive for women, than the cheapest plan offered under the old system. And those disparities are even wider for healthy people.

That raises an obvious question. If 50 million people are uninsured today, mainly because insurance is too expensive, why is it better to make coverage even costlier?

Political objectives trumped operational objectives

The answer is that Obamacare wasn’t designed to help healthy people with average incomes get health insurance. It was designed to force those people to pay more for coverage, in order to subsidize insurance for people with incomes near the poverty line, and those with chronic or costly medical conditions.

But the laws’ supporters and enforcers don’t want you to know that, because it would violate the President’s incessantly repeated promise that nothing would change for the people that Obamacare doesn’t directly help. If you shop for Obamacare-based coverage without knowing if you qualify for subsidies, you might be discouraged by the law’s steep costs.

So, by analyzing your income first, if you qualify for heavy subsidies, the website can advertise those subsidies to you instead of just hitting you with Obamacare’s steep premiums. For example, the site could advertise plans that cost “$0″ or “$30″ instead of explaining that the plan really costs $200, and that you’re getting a subsidy of $200 or $170. But you’ll have to be at or near the poverty line to gain subsidies of that size; most people will either not qualify for a subsidy, or qualify for a small one that, net-net, doesn’t make up for the law’s cost hikes.

This political objective—masking the true underlying cost of Obamacare’s insurance plans—far outweighed the operational objective of making the federal website work properly. Think about it the other way around. If the “Affordable Care Act” truly did make health insurance more affordable, there would be no need to hide these prices from the public.

Subsidy verification created a traffic bottleneck

Comparable private-sector e-commerce sites, like eHealthInsurance.com, allow you to shop for plans and compare prices simply by entering your age and your ZIP code. After you’ve selected a plan you like, you fill out an on-line application. That substantially winnows down the number of people who rely on the site for network-intensive tasks.

The federal government’s decision to force people to apply before shopping, Weaver and Radnofsky write, “proved crucial because, before users can begin shopping for coverage, they must cross a busy digital junction in which data are swapped among separate computer systems built or run by contractors including CGI Group Inc., the healthcare.gov developer, Quality Software Services Inc., a UnitedHealth Group Inc. unit; and credit-checker Experian PLC. If any part of the web of systems fails to work properly, it could lead to a traffic jam blocking most users from the marketplace.”

Jay Angoff, a former federal official at the agency that oversees the exchange, told the Journal that he was surprised by the decision. “People should be able to get quotes” without entering all of that information upfront.

Weaver and Radnofsky say that the core problem stems from “the slate of registration systems [that] intersect with Oracle Identity Manager, a software component embedded in a government identity-checking system.” The main Healthcare.gov web page collects information using the CGI Group technology. Then that data is transferred to a system built by Quailty Software Services. QSS then sends data to Experian, the credit-history firm. But the key “identity management system” employed by QSS was designed by Oracle, and according to the Journal’s sources, the Oracle software isn’t playing nicely with the other information systems.

Oracle hotly denies these claims. “Our software is the identical product deployed in most of the world’s most complex systems…our software is running properly,” said an Oracle spokeswoman in a statement.

‘It’s awful, just awful’

Robert Pear and colleagues at the New York Times have a piece up today detailing the serious problems with the federal exchange, problems that may get worse, not better. They confirm what we already knew: that the Obama administration refused to delay the implementation of the exchanges, despite the well-known problems, because they were afraid of the political blowback. “Former government officials say the White House, which was calling the shots, feared that any backtracking would further embolden Republican critics who were trying to repeal the health care law.”

As I documented last week, IT and insurance experts have been saying for at least eight months that implementation of the exchanges was going badly, that as early as February officials were warning of a “third world experience.” The Times’ sources are just as blunt. “These are not glitches,” said one insurance executive. “The extent of the problems is pretty enormous. At the end of our [conference calls with the administration], people say, ‘It’s awful, just awful.’”

“We foresee a train wreck,” said another executive in a February interview with the Times. “We don’t have the IT specifications. The level of angst in health plans is growing by leaps and bounds. The political people in the administration do not understand how far behind they are.” Richard Foster, the former chief actuary at the Centers for Medicare and Medicaid Services, said last week that “so much testing of the new system was so far behind schedule, I was not confident it would work well.”

Henry Chao, the deputy chief information officer at CMS who made the “third world experience” comment, was told by his superiors that failure to meet the October 1 launch deadline “was not an option,” according to the Times.

White House knowingly chose to court disaster

Think about it. It’s quite possible that much of this disaster could have been avoided if the Obama administration had been willing to be open with the public about the degree to which Obamacare escalates the cost of health insurance. If they had, then a number of the problems with the exchange’s software architecture would never have arisen. But that would require admitting that the “Affordable Care Act” was not accurately named.

The White House knew that its people on the front lines, people like Henry Chao, were worried that the exchanges would get botched. They saw the Congressional Research Service memorandum detailing that the administration has missed half of the statutory deadlines assigned by the law. But they were more afraid of the P.R. disaster of disclosing Obamacare’s high premiums than they were of the P.R. disaster of crashing websites. What you see is the result.

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Tech experts: Health exchange site needs total overhaul

Kelly Kennedy, USA TODAY 5:36 p.m. EDT October 17, 2013Health and Human Services Secretary Kathleen Sebelius calls the rollout of the health care exchanges rocky. (Photo: Jose Luis Magana, AP)

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WASHINGTON — The federal health care exchange was built using 10-year-old technology that may require constant fixes and updates for the next six months and the eventual overhaul of the entire system, technology experts told USA TODAY.

The site could be perfect, but if the systems from which it draws data are not up to speed, it doesn’t matter, said John Engates, chief technology officer at Rackspace, a cloud computer service provider.

“It is a core problem in the sense of it’s fundamental to this thing actually working, but it’s not necessarily a problem that the people who wrote HealthCare.gov can get to,” Engates said. “Even if they had a perfect system, it still won’t work.”

Recent changes have made the exchanges easier to use, but they still require clearing the computer’s cache several times, stopping a pop-up blocker, talking to people via Web chat who suggest waiting until the server is not busy, opening links in new windows and clicking on every available possibility on a page in the hopes of not receiving an error message. With those changes, it took one hour to navigate the HealthCare.gov enrollment process Wednesday.

Those steps shouldn’t be necessary, experts said.

AFFORDABLE CARE ACT: What does it mean for you?

“I have never seen a website — in the last five years — require you to delete the cache in an effort to resolve errors,” said Dan Schuyler, a director at Leavitt Partners, a health care group by former Health and Human Services secretary Mike Leavitt. “This is a very early Web 1.0 type of fix.”

“The application could be fundamentally flawed,” said Jeff Kim, president of CDNetworks, a content-delivery network. “They may be using 1990s technology in 2.0 world.”

Outsiders acknowledged they can’t see the whole system, but they said they feared HHS built a system that will need an expensive overhaul that would cause more headaches for people trying to buy insurance.

“I will be the first to tell you that the website launch was rockier than we wanted it to be,” HHS Secretary Kathleen Sebelius said Wednesday at Cincinnati State Technical and Community College, adding that people have until Dec. 15 to enroll to ensure coverage beginning Jan. 1.

HHS officials did not respond to a request about the nature of the problems. However, they reiterated that wait times have been reduced or even eliminated as they continue to work to fix the system. As of Thursday, the site had received 17 million unique visitors.

“We continue to work around the clock to improve the consumer experience on HealthCare.gov,” HHS spokeswoman Joanne Peters said. “We are seeing progress: wait times to begin the online process have been virtually eliminated, and more consumers are creating accounts, completing applications and ultimately enrolling in coverage if they choose to do so at this time. However, we will not stop addressing issues and improving the system until the doors to HealthCare.gov are wide open.”

OBAMACARE: A tough sell for Native Americans

Engates said HHS has been opaque about the problems, and the tech industry doesn’t know the extent of the issues. “There’s no secrets leaking out,” he said. “I’m sure everyone’s looking for something to change the direction of the conversation, but it’s just not there.”

“I think it’s a data problem,” Kim said. “It always comes down to that.”

And if that’s the case, the problems are beyond “rocky,” he said. Instead, it would require a “fundamental re-architecture.” In the meantime, “I think they’re just trying to shore up as quickly as possible. They don’t have time to start from scratch.”

“If I was them, and I’m just conjecturing, I would probably come up with some manual way of saying, ‘Only people with the last name starting with ‘A’ can sign up today,” he said.

But come March 31, when the first enrollment period ends, the “shore up” period may become a “re-architecting” period, Kim said.

On a good note, he said, after looking at available code, the site is “very secure.”

Clearing the cache, which has helped make it easier for some people to enroll, could ultimately strain the system more, Kim said. That’s because a “cookie” is stored on a person’s computer that contains data, such as the person’s name and address, that can then be quickly accessed when that person gets on the website again instead of having to be retrieved from the government’s server.

But as HHS fixes errors, the cookies may not correspond with the updated website, so rather than allowing someone to quickly log in, they instead cause an error message. And every time a person clears his computer’s cache, the government’s website has to work that much harder to grab more data.

Requiring people who may not be Web savvy to use the site in any way other than a step-by-step easy process defeats the point of the whole system, Schuyler said. That includes laws mandating that insurers provide clear explanations about policies to people may make sound decisions and understand what they’re buying.

“Most consumers will have no idea what ‘clearing the cache’ is and this will just cause more confusion and frustration,” he said.

So far, the site’s problems have not driven away potential customers, according to a poll conducted by uSamp — United Sample Inc. The survey found that among the 832 people who attempted to log in, 38% received an error message, 50% were asked to try again later, 25% were unable to create an account, 31% were told the system was down, and 19% had no problems. About 83% said they would try again later, while 15% said they would wait until they heard the website was working well. About 70% of those who said they had no issues said they still waited to enroll because they want to think about their options.

Engates said he believes most of the problems are caused by systems integration with other sites, such as the IRS. And that could be causing some of the problems people see as they make it past the initial application process. It’s a series of questions meant to verify a person’s identity and income. But after that questionnaire, visitors often encounter a series of error messages, or the page a person tries to click to doesn’t come up. The data requests to other sites could be causing those problems, Engates said, which would mean the problem isn’t with the HHS site itself.

“Maybe the site is submitting a request for more data, and that puts you in that trap again,” he said. “It’s a giant integration problem that they have to solve.”

And as they try to fix those problems, there’s another issue lurking in the background: Some HHS personnel were named essential, and not subject to furloughs because of the government shutdown. But that didn’t apply to the other organizations they were working with, Engates said. So as HHS techs work around the clock to fix the problems, IRS techs may be prohibited from working at all.

In the meantime, HHS personnel can’t say anything about the situation, it can be played politically as “bad,” he said. If they say it will take two weeks to fix, they will be criticized because it’s taking too long. But he expects that it’s a problem that will be resolved soon, especially as the volume of visitors goes down.

“If you can get the system below some sort of threshold, it will perform as it’s supposed to,” Engates said. “It won’t get any worse. It’s going to get better little by little by little.”

http://allplanhealthinsurance.com

I’m Can Help You Apply For ACA Health Insurance . . . Errrr . . . I Think!

As a licensed agent in Texas, Indiana, Ohio and Michigan I am certified with the Department of Health and Human Service through the Center for Medicare Service to enroll residents of those states in health insurance plans for 2014. This is whether they qualify for a subsidy or not. Premiums are the same whether you go through me, the Marketplace (Federal Exchange) or a Navigator. And I would like to assist you. Problem is – 5 days into the enrollment phase of the Affordable Care Act (ACA) I still have not succeeded in being able to create even my own account to see what all my options are. I have seen many of my options outside the Marketplace–in the private market–and my quoted premium is approximately 33% higher than my current premium for comparable coverage! I have read all news articles relative to enrollment numbers and although the White House says people are enrolling in the Marketplace (which is where residents of these states go for quotes unless coming to me) and–as of yesterday–no journalist has been successful in finding and interviewing one individual who has successfully purchased health insurance in the Marketplace! One individual, Chad Henderson, reported he and his father had but when swarmed by journalist and asked for details – his father said neither he or his son had. Turns out Chad was a campaign worker for the Obama administration last year and an active volunteer for Organizing for Action, the former campaign organization that now advocates for the President’s legislative agenda. You figure it out. This much I know – if you already know that based on your estimated income for 2014 you will not qualify for a subsidy – you should apply for coverage through me and avoid the wait (however long) on the Marketplace website. You can see your options and go directly into your chosen health insurance companies application for the plan you select.

If, ultimately, you qualify for a subsidy – you may be relatively satisfied with your premium but it looks like (in order for that to be the case) you will have to accept a deductible much higher than what you anticipated. If you do not qualify for a subsidy – prepare for what in all likelihood will  be sticker shock.

Regardless, I have made about 15 unsuccessful attempts, consuming hours of wait time the last 5 days to open an account in the Marketplace and–for research purposes– obtain my own quotes and see what subsidy options look like. Even Chad Henderson claimed it took him 3 hours to create an account–and this allegedly took place at 3 a.m. in the morning! How am I supposed to take my clients who will qualify for a subsidy from my quoting engine into the online Marketplace and have us succeed in staying with each other while we wait hours for us to set up their account? Of course, these wait times will surely decrease over time, right? Errrrr . . . right?

Admin. – Kenton Henry

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FEATURE ARTICLE

UPDATED: Obamacare Poster Boy Chad Henderson and His Dad Didn’t Really Buy Insurance

An exclusive Reason.com interview with Bill Henderson.

Peter Suderman | October 4, 2013

UPDATED at 2.54pm ET: Scroll to end of this article for the latest development in this story. After speaking directly with Chad Henderson, The Washington Post has confirmed that he has not in fact enrolled in a health-care plan. 

Chad Henderson is the media’s poster boy for Obamacare. Reporters struggled this week to find individuals who said they had been able to enroll in one of the law’s 36 federally run health-insurance exchanges.

That changed yesterday, when they found Henderson, a 21-year-old student and part-time child-care worker who lives in Georgia and says that he successfully enrolled himself and his father Bill in insurance plans via the online exchange administered at healthcare.gov.

But in an exclusive phone interview this morning with Reason, Chad’s father Bill contradicted virtually every major detail of the story the media can’t get enough of. What’s more, some of the details that Chad has released are also at odds with published rate schedules and how Obamacare officials say the enrollment system works.

The coverage of Chad Henderson has been massive. He was featured in The Washington Post Thursday as “the Obamacare enrollee that tons of reporters are calling.” He was also profiled in The Huffington Post as someone who “beat the glitches to sign up for Obamacare.” He was interviewed by Politico, multiple local news organizations, and, according to his Facebook feed, was asked to be part of a conference call hosted by the Department of Health and Human Services.

Chad’s story was tweeted out by the official Obamacare Twitter feed. It was promoted to the media by Enroll America, a health-care activist group headed by a former White House communications staffer, as a sign of Obamacare’s success. Henderson told reporters at multiple news outlets that after a three-hour wait to sign up online, he enrolled around 3 a.m. Tuesday morning in an unsubsidized private insurance plan that would cost him about $175 a month. He also said that his father enrolled in separate coverage plan that would cost about $250 a month after factoring in the subsidies for which his father qualified on his approximately $24,000 annual income.

Chad’s decision to purchase his own, separate plan might surprise some. A monthly premium of $175 would represent about 30 percent of his pre-tax take home pay—about $583 a month on the $7,000 part-time income he claimed. And he could have chosen to be covered by his father’s plan, which, under the Affordable Care Act, would have been required to cover dependents up to the age of 26. Chad said his father encouraged him to be covered under his own plan, even though the cost was higher. “He’s old school, so he wants me to take responsibility,” Chad told The Huffington Post.

Henderson’s story was promoted as proof that the new health law can work for individuals. That was exactly how Chad intended it. He was a volunteer with President Obama’s campaign last year, and his LinkedIn page still lists him as an active volunteer with Organizing for Action, the former campaign organization which now advocates for the president’s legislative agenda.

He told The Washington Post that he was sharing his story because he wanted the new health law to succeed.

“I’ve read a few articles about how young people are very critical to the law’s success,” he said to The Post. “I really just wanted to do my part to help out with the entire process.”

But details of Chad’s story proved difficult to verify. And in a phone interview conducted this morning, Chad’s father Bill contradicted major details of Chad’s story. I reached Bill Henderson by following a series of links at Chad’s Facebook page, through which I was able to speak directly to the father.

Bill Henderson told me that both he and his son were interested in getting coverage, but that he had not enrolled in any plan yet, and to his knowledge, neither had his son. He also said that when they do enroll, getting the most coverage for the least money would be the goal, and that he expects that he and his son will get coverage under the same plan.

Bill told me that Chad had been looking into plans online. “He told me that there’s different plans. And we haven’t decided which plans to enroll in yet.”

I asked him whether he and his son had talked about going on separate plans, and he told me that, “We’ll probably go on the same plan, more than likely.”

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http://allplanhealthinsurance.com

Why Would Health Insurance Companies Keep This Agent in The Dark About Affordable Care Plan Premiums?

Two days ago, I contacted most every major health insurance carrier anticipated to continue operating in the Texas individual and family health insurance market and the Federally-Run Marketplace (Exchange) that people will go to in order to purchase their policy to be effective January 1. When I noted that they had not yet released premiums for these plans to be available October 1st and asked if they could disclose them to me – without exception they said they could not and, when I inquired why, they told me, “I cannot answer that”. I said, you realize we only have six days until you expect me to offer these to my clients and the public. They responded, “We understand”. When I asked if premiums would be available by October 1, I was told they hoped they would be.

Yesterday I heard a very popular talk show host theorize as to why this was the case and one of today’s feature articles from Politico, September 25th (below) comments on this issue. It says a report by the Department of Health and Human Services was issued to news organizations on Wednesday under a “strict embargo, with specific instructions not to share the information with anyone else, like outside health insurance experts (such as this blog’s friendly and not the least frustrated administrator) who might be able to provide more analysis of the numbers” to an exceptionally intelligent and curious public such as followers of this blog.

(Obviously, all the major insurance carriers got word of this and that Kenton Henry would apparently be contacting them on this matter, as they were certainly prepared with a script designed with me (or the likes) of me in mind.)

However, “apparently the word leaked out” as the article goes on to say the report released premiums based on the national benchmark “Silver” Plan with an (average) premium of $328.  Both the CNN Money and Washington Post articles below go on to describe in more detail 47 state and the District of Columbia premiums which were used to arrive at these averages. CNN paints a more positive picture of these numbers however the Politico article makes it clear it believes the numbers released are designed to creative the most positive impression of premiums prior to  their ultimate and full release next Tuesday, October 1. They go on to fault the administration not for telling what premiums will be in an ideal situation when the client is young and healthy or qualifies for a subsidy, but for not disclosing what they will be for the rest of us.

For complete disclosure, assuming the insurance companies are not forced to give government Navigators a head start by turning them loose in the Marketplace October 1 while continuing to withhold premiums, links and enrollment materials from licensed agents like myself until some later date – check back with me next Tuesday. Hopefully I will not awaken to find my insurance license revoked and my internet cut off.

Admin. – Kenton Henry

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HHS reveals Obamacare coverage prices for federal exchanges

The agency’s report is a far cry from full disclosure. | John Shinkle/POLITICO

By BRETT NORMAN and JASON MILLMAN | 9/25/13 12:04 AM EDT

The Obama administration on Wednesday released a long-awaited report on premiums in Obamacare’s federal insurance exchanges — the first look at the rates that will apply in the vast majority of states.

There’s just one big catch: The report doesn’t actually reveal very much about what most people will pay.

The administration put the best face on the health insurance premiums, emphasizing that the rates have come in lower than expected in the 36 states where the feds will run part or all of the exchanges. That part of the report gives them a snappy answer to the widespread predictions of “rate shock” by critics of Obamacare.

“For millions of Americans, these new options will make health insurance work within their budgets,” Health and Human Services Secretary Kathleen Sebelius said in a conference call with reporters Tuesday.

But it was a far cry from full disclosure.

Want to know what you might pay for health coverage in an exchange next year? Too bad. The report gives lots of examples of the kinds of people who will get good prices — but everyone else will remain in the dark until at least next Tuesday, when Obamacare is supposed to open its doors.

The carefully selected numbers the administration did produce generally undercut the more dire projections that have been made. The report highlights the premiums for 27-year-olds — members of the young adult group who were expected to suffer most under Obamacare’s market reforms — and finds that generally, they would not be bankrupted.

The cheapest “bronze” plan, the lowest level of coverage in most exchanges, would cost from $119 per month in Tennessee to $286 in Wyoming. And that’s before the subsidies are factored in, which could lower the prices for people whose incomes are below 400 percent of the federal poverty line.

But younger adults tend to have smaller incomes, and the report shows that individuals in the same group with an income of $25,000 would have their premiums subsidized heavily. The prices for the cheapest plan would range from $48 a month in Arkansas up to $120 in Arizona, with rates below $100 in most states.

The report also highlights the impact on a working family of four with a household income of $50,000. After subsidies, that family would pay no premiums at all for a bronze plan in Arkansas, but as much as $192 a month in Arizona.

The federal exchange premiums released Wednesday do not stick out as starkly different from what’s been released by the 16 state-run exchanges. Those have largely come in lower than expected as well.

What the report fails to say is what the health plans in the federal exchanges would cost anybody else — i.e., the majority of Americans.

Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, the agency that’s implementing the law, told reporters Tuesday that the rates are still being finalized. But he said the averages should be representative of the final figures.

The report also says nothing of the rates that small businesses can expect to pay if they decide to enter the so-called SHOP exchanges, which will offer coverage to firms with fewer than 50 employees.

The report was issued to news organizations on Tuesday under a strict embargo, with specific instructions not to share the information with anyone else, like outside health insurance experts who might be able to provide more analysis of the numbers.

Apparently, though, the word still leaked out. Douglas Holtz-Eakin, president of the American Action Forum and a leading critic of the law, reached out to POLITICO to give unsolicited reaction to the new numbers — which POLITICO did not share with him.

“There are literally no comparisons to current rates. That is, HHS [has] chosen to dodge the question of whose rates are going up, and how much,” Holtz-Eakin said.

He did allow that the rates “don’t appear dramatically different than in the state exchanges” — but said that only proves that “with all that market power, HHS doesn’t seem to have delivered much.”

Overall, the average individual premium in the 48 exchanges that have reported will be $328 per month, the administration said. That’s lower than expected, administration officials said, because it’s 16 percent below an estimate derived from Congressional Budget Office projections. They said that’s a victory for the health law and consumers alike.

The average premium the administration calculated is for a mid-level plan — specifically, the second-lowest cost “silver” plan. But those figures don’t say much about what a given person might pay.

And they are extremely difficult to compare against what is available today, before the market reforms and exchanges arrive on the scene. For instance, no one can be turned down based on a pre-existing condition next year, women won’t be charged more than men and insurers will be limited in how much more they can charge older people than young adults — all new rules that haven’t been in effect before.

The report says competition will help keep prices down — because states with the lowest premiums have twice the number of insurers as states with the highest rates.

“Markets in way too many states were dominated by one or two companies [before]. … Now, there will be more choice and more competition, thanks to the marketplace,” Sebelius said.

The vast majority of the uninsured — 95 percent — will be able to choose from at least two insurers on the exchanges, according to the administration. And 25 percent of those carriers are offering plans in the individual market for the first time.

The report also says, however, that 5 percent of the uninsured population still live in areas served by only one insurer on the exchange.

Consumers in the 36 states with federal-run marketplaces on average will have 56 different health plans to choose from. Though, shoppers in Alabama on average will have just seven exchange plans to choose from, while Arizonans can pick from 106.

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CNN MONEY

Obamacare premium rates lower than expected

By Tami Luhby  @Luhby September 25, 2013: 3:47 PM ET

NEW YORK (CNNMoney)

The Obamacare premiums will cost less than predicted, according to data released Wednesday by the Obama administration.

The release provided the first look into rates for consumers buying individual insurance on the 36 federally run exchanges.

The national average premium for the benchmark plan will be $328 a month before subsidies, 16% less than projected by the Congressional Budget Office. The benchmark is the second-lowest cost “silver” policy for 48 states, upon which federal subsidies are based.

Related: See the Obamacare insurance rates

Subsidies will offer maximum caps for low- and moderate-income Americans in the benchmark plans. But for those who opt for other levels of coverage, or make too much to qualify for subsidies, prices vary widely based on one’s age, income and state.

For instance, a 27-year-old living in Dallas making $25,000 could pay as little as $74 a month for the cheapest “bronze” plan after subsidies, according to the Department of Health and Human Services.

But a 60-year-old in Wyoming who makes more than $46,000 a year — too much to get a tax credit — could pay as much as $758 for a similar plan.

The majority of people uninsured today will be able to find a policy for $100 or less a month, taking into account subsidies and Medicaid eligibility, the administration said.

 

Obamacare out-of-pocket cost confusion

Consumers will be able to start enrolling in the exchanges on Oct. 1, with coverage beginning in January. Starting in 2014, nearly everyone must have insurance — either through their jobs, government programs or the individual market — or face a penalty.

The rates released Wednesday do not apply to those who receive insurance through their employer.

Subsidies: What you’ll actually pay for Obamacare

Most people who are expected to sign up for coverage in the exchange have incomes up 400% of poverty and will therefore be eligible for federal subsidies.

The lower your income and the more expensive the benchmark plan in your state, the larger your subsidy. For instance, those making $17,235 a year will pay no more than 4% of income, or $57 a month, for the benchmark plan. Those with incomes between $34,470 and $45,960 will pay a maximum of 9.5% of income, or $364 a month, for that benchmark plan. The federal government will cover the rest.

But these consumers can put their subsidy toward a cheaper plan than the benchmark policy and pay less per month. They can also choose a more expensive plan and pay more.

Anyone earning more than $45,960 would be responsible for the entire tab on the Obamacare health plan of his choice.

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The Washington Post

How much will Obamacare premiums cost? Depends on where you live.

By Sandhya Somashekhar and Sarah Kliff, Published: September 25 at 12:01 am

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A 27-year-old in Austin who earns $25,000 could pay $85 per month for health insurance next year, and a family of four in St. Louis with income of $50,000 might face a $32 monthly premium, according to new federal data on health insurance rates under the Affordable Care Act.

The report, released Wednesday by the Department of Health and Human Services, showed significant variation in the insurance premiums that Americans shopping on the individual market could pay under the president’s health-care overhaul. Across the 48 states for which data were available, the unsubsidized monthly premiums could be as low as $70 for an individual and as high as $1,200 for a moderate plan for a family of four.

The average national premium for an individual policy will be $328 in 2014, before including any of the tax credits that will be available to low- and middle-income Americans to help them purchase coverage.

Officials say these prices will be affordable for people buying insurance through the government marketplaces slated to open next week.

“For millions of Americans, these new options will finally make health insurance work within their budgets,” Health and Human Services Secretary Kathleen Sebelius said.

Information about how much insurance plans will cost under the law, sometimes called Obamacare, has been dribbling out for months on a state-by-state basis.

But the report from the administration, which has been collecting rate information since the spring, offers the first comprehensive look at the effect of the law on many Americans — specifically those who buy coverage privately and not through their employers, as well as low-income uninsured people who are not poor enough to qualify for Medicaid.

Beginning Tuesday, those people will be able to log on to government Web sites called marketplaces to peruse their plan options, apply for government subsidies and sign up for coverage effective next year. That is when the requirement kicks in that virtually every American carry health insurance or face a fine.

The report also includes information for more than two dozen states that declined to set up their own marketplaces, leaving at least part of the job up to the federal government.

Premiums will vary significantly depending on an individual’s income, where she lives and what type of coverage she buys. A 27-year-old in Fairfax County, for example, could spend between $124 and $258 on a health plan, depending on how robust she wants it to be.

A family of four in Fairfax County that earns $50,000 could get a health insurance plan with no premium at all, because the federal tax credit would cover the bill.

Most people using the marketplaces will have incomes low enough to qualify for a government subsidy. A recent administration report found that 56 percent of the roughly 41 million uninsured people eligible for the marketplaces could pay monthly premiums of $100 or less.

Health experts say it is a good sign for consumers that premiums have come in lower than expected. Under the law, the plans must offer a basic set of benefits, including mental health and maternity care, which previously were not included in many private plans. Insurers are also forbidden from rejecting or charging people more because of preexisting conditions.

Many experts worried that those factors would drive up the cost of insurance. They partially credit competition on the marketplaces, where people will be able to directly compare plans from different insurance companies, for restraining premiums.

But they warn that premiums don’t tell the whole story.

The low rates are possible in part because insurance companies created special plans that include fewer in-network doctors and hospitals than many current plans.

This may not be a problem for healthy people who currently lack insurance. But those with illnesses may discover that their specialists are not covered by an exchange insurance plan. Low-income people accustomed to a certain community clinic may find that going there is no longer an option. And everyone may encounter long waits to see a doctor.

In addition, many of the lowest-cost plans may carry high deductibles, despite a cap imposed by the law that limits out-of-pocket costs to $6,350 per person per year.

“Despite the fact that the premiums are lower than expected, enrollees on exchanges are likely to face very high out-of-pocket costs before they hit their cap, and they are at risk of being in very narrow network plans that may or may not include all the providers they need access to,” said Caroline Pearson, vice president of health reform at the consulting firm Avalere Health, which did its own report on rates this month.

Some healthy people may also experience sticker shock on premiums. A recent analysis by the Manhattan Institute, a conservative think tank, found that some people who buy low-cost private plans today could see their rates jump by 24 percent.

http://allplaninsurance.com/medicare/medicare-supplement.htm