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

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

Navigators in a boiler room

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

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

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

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

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

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

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

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

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

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

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

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

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

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

COMMENTS OR QUESTIONS:

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FEATURED ARTICLE 

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

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

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

2018 Health Insurance Open Enrollment: Game On

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

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

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

CLICK HERE FOR 2018 HEALTH INSURANCE QUOTES AND PLAN OPTIONS:

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

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

(CLICK ON IMAGE TO ENLARGE)

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

D. Kenton Henry

Email: Allplanhealthinsurance.com@gmail.com

Office: 281-367-6565

Cell: 713-907-7984

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

http://TheWoodlandsTXHealthInsurance.com

https://HealthandMedicareInsurance.com

Medicare Part B Premiums Projected To Go Up For 2017 ― Insurance Companies Participating In Obamacare Going Down

By Kenton Henry, editor

A double whammy is expected to impact the medical insurance market for 2017. There is bad news for the consumer on both the Medicare and the Under Age 65 ends of the medical insurance spectrum.

One positive note ― more than 60 million Medicare recipients are projected to receive a cost of living adjustment in their Social Security Benefit! But if you’re part of this group … don’t spend all your new found increase in one place. It’s projected to be a minuscule 0.2 percent! What the government giveth . . .  (well, you can see this coming!) The flip side is, their monthly Part B premiums would go to $107.60 in 2017 ― a $2.70 increase.

On the other hand, 30% of recipients, which includes those new to Medicare in 2017; those who do not have their Part B premiums deducted from their Social Security Income Account in 2016; and those with higher incomes may see increases in premium to $149.00 for the lowest tax bracket; from $166.30 ― to $204.40 per month for the next; and from $380.20 to $467.20 in the highest bracket. Whether these projections―which amount to as much as a 22% increase for the highest income earners―are realized will not be known until October.

Part B premiums are extremely relevant when one has the option of remaining on one’s (or one’s spouse’s) company group health insurance beyond age 65 and into retirement and is weighing the cost of such against the cost of transitioning fully to Medicare Part A and B.

For guidance in this consideration please feel free to consult with the author / editor. *(see featured article from the Wall Street Journal below)

And for those still not age 65, or otherwise eligible for Medicare―and not covered by an employer’s group health insurance plan―your options for coverage are scheduled to diminish along with competition in the individual and family Affordable Care Act (ACA) compliant insurance market. If realized, the  proposed mergers between Anthem and Cigna and between Aetna and Humana would reduce your options. This on top of Unitedhealthcare’s (America’s largest insurer) announcement it is pulling out of 90% of its current markets in 2017. Furthermore, BlueCross BlueShield Association announced they may also decline or diminish  participation in the marketplace. Lastly (until our next episode), to cast further doubts on what options will remain for the consumer, both Aetna and Humana have announced they may pull out of the majority of their individual and family markets regardless of whether their proposed merger is approved. Humana issued a statement just last week to the effect they would be limiting coverage to 156 counties this month compared the 1,351 they participate in currently. **(please refer to feature article on Humana below)

For these reasons, and because the majority of my individual and family clients have been forced to migrate to Health Maintenance Organization plans (where their providers and treatment are rationed) I have been advising those who are business owners to transition to group health insurance where they not only have more options relative to benefits but can still benefit from Preferred Provider Organization (PPO) coverage. With the PPO plans, they have the final say on their providers and, thereby, better control the quality of their treatment. Small Business (less than 50 employees) owners should take note that if they enroll during the Small Business Open Enrollment Period (November 15th ― December 15th) they will not have to meet the 75% full-time employee participation rate or the 50% of employee premium contribution requirement. The only requirement is that a minimum of 2 full time, W-2 employees be covered on the plan. This is an excellent opportunity for small, closely held companies who want to improve their family’s health insurance but cannot afford coverage for all employees.

Again, please feel free to contact our office for further insight and guidance on this issue.

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Feature Article #1

WALL STREET JOURNAL

By Anne Tergesen

Updated June 22, 2016 5:12 p.m. ET    

Nearly a third of all Medicare beneficiaries face a steep increase in their premiums next year, the result of a policy that in certain circumstances requires some beneficiaries, including higher earners, to shoulder the burden of rising costs.

The government health-care plan’s trustees projected in a report Wednesday that premiums would rise by as much as 22% for wealthier beneficiaries of Medicare Part B, which covers doctor visits and other types of outpatient care.

The projected increase results from an intersection of the rules governing Medicare and Social Security, said Tricia Neuman, senior vice president and an expert on Medicare at the Kaiser Family Foundation.

Under the Social Security Act’s “hold harmless” provision, Medicare can’t pass along premium increases greater than what most participants would receive through Social Security’s annual cost-of-living adjustment. That adjustment is expected to be just 0.2% in 2017 thanks to low inflation. As a result, Medicare couldn’t pass along any premium increase greater than the dollar increase in Social Security payments to the estimated 70% of beneficiaries who will qualify for hold harmless treatment in 2017, Ms. Neuman said.

Instead, Medicare must spread much of the projected increase in its costs across the remaining 30%. Those who are paying the standard $121.80 a month for Medicare Part B this year would be charged $149 a month in 2017 if the trustees’ predictions come to pass.

Higher earners would pay more. The trustees project individuals earning between $85,001 and $107,000 and couples earning between $170,001 and $214,000 would have their 2016 monthly premiums rise from $170.50 a person this year to about $204.40 in 2017. For those earning more than $214,000, or $428,000 for couples, the projected increase is to about $467.20 a month, from $389.00 in 2016.

This isn’t the first time there has been such a disparity in Part B premiums between Medicare recipients.

Last year, Congress staved off a 52% premium increase for Medicare beneficiaries not covered by the hold harmless provision via a deal in the budget agreement that raised premiums by 16% for them instead. Those covered by the hold harmless provision, in contrast, pay $104.90 a month—the same amount they paid in 2014 due to the fact that there was no Social Security cost-of-living increase in 2016.

The projected increase in Part B premiums affects several other groups of Medicare beneficiaries, including those who receive Medicare but have deferred or aren’t eligible for Social Security benefits. It also would apply to those who are new to Medicare in 2017 and lower-income Medicare beneficiaries whose premiums are paid by state Medicaid programs.

In the latter case, the increase would be paid by Medicaid, Ms. Neuman said.

Paul Van de Water, senior fellow at the nonprofit Center on Budget and Policy Priorities, said the final Social Security cost-of-living adjustment won’t be known until October. If inflation rises by more than the trustees expect between now and then, it could “reduce the spike in the premium” for those who aren’t held harmless, he said.

Acting Administrator for the Centers for Medicare and Medicaid Services Andy Slavitt said at a news conference Wednesday, “We will continue to monitor the data and explore administrative options as needed.”

The Medicare trustees are projecting that the base Medicare Part B premium will reset for everyone at $124.40 a month in 2018, because they expect higher Social Security cost-of-living increases.

Medicare covered 55 million people last year, according to the trustees’ report. Part B covered nearly 51 million. In 2017 Medicare is expected to have 58.7 million total participants and 53.5 million in Part B.

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Feature Article # 2

Humana beats 2Q forecasts, details ACA-related scale back

Tom Murphy, AP Health Writer

Published 9:09 am, Wednesday, August 3, 2016

Humana beat second-quarter earnings expectations and reaffirmed its forecast for 2016, even as the health insurer set aside an additional $208 million to cover expenses in its individual, commercial coverage.

The company also said Wednesday it was scaling back that individual business for next year and would only offer it in 156 counties, compared to 1,351 this year. The insurer also said it will sell coverage on Affordable Care Act individual exchanges in 11 states next year, down from 15 this year.

Humana, based in Louisville, Kentucky, provides individual coverage for nearly 500,000 people through the exchanges. It covers an additional 200,000 individual customers off the exchanges, a small slice of its total medical membership of 14.2 million.

Other major insurers like UnitedHealth Group and Anthem also have recently detailed struggles with coverage they sell on the ACA’s state-based exchanges, which have helped millions of consumers gain insurance since they opened for enrollment in the fall of 2013. Aetna, which is trying to buy Humana, said Tuesday that it cancelled its exchange expansion plans for 2017 and was taking a hard look at the markets in which it is currently participating.

Insurers have been struggling with higher-than-expected claims on the exchanges and lower-than-expected support from government programs, among other issues.

Humana also is one of the nation’s largest providers of Medicare Advantage plans, which are privately run versions of the government’s Medicare program for people over age 65 or disabled. The company said Wednesday that its core businesses remained strong in the second quarter.

Overall, Humana earnings plunged 28 percent to $311 million compared to last year’s quarter, when it booked a $267 million gain from a business sale.

Earnings, adjusted for non-recurring costs and amortization costs, came to $2.30 per share.

Analysts expected, on average, earnings of $2.22 per share, according to Zacks Investment Research.

The health insurer posted revenue of $14.01 billion in the period, which topped the average Wall Street forecast for $13.63 billion.

The company also said Wednesday that it still expects full-year earnings to total at least $9.25 per share.

Shares of Humana edged up 52 cents to $170.09 Wednesday morning while broader indexes were flat.

Humana shares have decreased 5 percent since the beginning of the year, while the Standard & Poor’s 500 index has climbed 5.5 percent.

https://healthandmedicareinsurance.com

https://allplanhealthinsurance.com

https://thewoodlandstxhealthinsurance.com

“Happy Anniversary Healthcare.Gov!” (Do We Want A Divorce?)

Op-ed by D. Kenton Henry

BIRTHDAY CAKE

 

Happy anniversary, Healthcare.gov! Today, October 1st, marks the first anniversary of the premier of the originally beleaguered Federally Facilitated “Marketplace” (FFM), the federal government website for the purchase of Affordable Care Act (ACA) compliant health insurance plans in states which did not implement their own. And what of it now?

After a rollout, which was anything but smooth, and a current expenditure of approximately $2.1 billion dollars (after a winning bid of $90 million) the site seems to have solved the majority of its “front- end” issues. These involve opening an account; verifying identity and plan selection. But in light of notice that the time has run out for those who did not succeed in providing adequate proof of income for subsidy (“Premium Tax Credit”) purposes thereby resulting in their loss of coverage or―at least the subsidy―one is left wondering what if anything will change relative to this “back-end” issue for 2015. According to a September 15th article in the New York Times, approximately half a million insured face a forced plan change. “363,000 could lose their premium subsidies due to an inability to verify income, while 115,000 more could have their policies canceled because they have not proven their immigration status. Federal authorities have been working for months to resolve both backlogs.”

My BlueCross BlueShield of Texas clients who have “grand-mothered” plans just received notice dated today that “The health plan you now have will no longer be available and cannot be renewed”. Grand-mothered plans are those which have been modified in anyway, such as a change in deductible, but purchased prior to January 1 of this year when all new policies were required to be ACA compliant. Termination will be effective the end of 12.31.2014 and the client, insured will have until that date to enroll in a new plan for seamless coverage beginning January 1. These policyholders are instructed to log in starting November 15th to review their options and elect new coverage through BlueCross BlueShield. What will the benefits look like and what will be the cost? Well, we won’t know until November 15th. The consensus seems to be that premiums in all but a few locations will be increasing somewhat across the market compared to this year’s ACA compliant plans but at less than the average rate of medical inflation in recent years. (Call me skeptical.) But what about compared to their grand-mothered plan? No way. By the time you add in the additional cost of mandated coverage for benefits such as pediatric dental and vision, maternity and the rest of the “minimum essential health benefits” along with guarantee issue for pre-existing conditions, there is no way these policyholders are going to be pleased with the premiums their new options will cost. If they had thought the marketplace offered better options, they would have elected them for 2014. I am certain the words, “If you like your plan, you can keep your plan. Period.” will be ringing in their ears as they peruse their new options.

On the upside, an estimated 25% additional insurance companies will be providing coverage for 2015 both in and out of the marketplace and state exchanges. This increased competition will give consumerd more options and will hopefully help offset some of the inflationary aspects of mandated coverage in future years.

On the downside, what of the “It’s a penalty … not a tax!” ― now known as the “Shared Responsibility Payment” ― for not having coverage in 2015? That increases to $325 per adult and $162.50 per child or 2% of household income ― whichever is higher. (Family maximum is $975.) It will increase every year hereafter, tied to the rate of inflation beyond 2016.

Additional variables remain to be seen such as “provider selection”. While pressure is being put on insurance companies to increase the number of in-network providers available to the insured, surveys seem to indicate more providers are electing not to join. They feel payments have dropped to low to make it worth their while to participate. Insurance companies are going have to find alternative ways to control costs and since they cannot control the risk they are forced to assume (elative to pre-existing conditions and the mandated “loss ratio”) they are going to ration our providers and our treatment.

On a final note, the enrollment period for 2015 plans will be half as long as for 2014 and will end February 15th. So get ready to be like the sheep, in the Wild Kingdom segment, passing through the anaconda. It’s going to be a tight squeeze! And once again . . . “Happy Anniversary to Healthcare.gov!”

By all means, please contact me if you feel I can make the celebration cake a little more palatable!

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FEATURED ARTICLE:

The New York Times

U.S. to End Coverage Under Health Care Law for Tens of Thousands

By ROBERT PEAR SEPT. 15, 2014

WASHINGTON — The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified.

The 115,000 people “will lose their coverage as of Sept. 30,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal insurance marketplace.

Some of them may be able to have their coverage reinstated retroactively if they produce the documents that they were repeatedly asked to provide in recent months, Mr. Slavitt said.

At the end of May, the administration said, 966,000 people were found to have discrepancies in their immigration and citizenship records. Most sent in documents as requested. In mid-August, the administration sent letters to about 310,000 people who had failed to respond. They were supposed to submit documents by Sept. 5, but the 115,000 consumers failed to do so, Mr. Slavitt said.

Many consumers and lawyers who work with them said that they had tried to submit immigration and citizenship papers, but that they experienced problems transmitting documents through HealthCare.gov. Other people said they sent the documents by mail to a federal contractor in Kentucky but never heard back from the contractor or the government.

“We heard from lots of consumers who told us they sent in their documents multiple times or tried to upload them through HealthCare.gov,” said Mara Youdelman, a lawyer at the National Health Law Program, an advocacy group for low-income people.

Jenny Rejeske, a health policy analyst at the National Immigration Law Center, which represents immigrants, said: “It is unduly harsh to terminate coverage while there are still technical problems with the federal system for verifying citizenship and immigration status. And there has not been adequate notice to people who speak languages other than English and Spanish.”

Florida leads the list of states whose residents are losing coverage because of immigration and citizenship issues, with 35,100. Federal officials said they were ending coverage for 19,600 people in Texas, 6,300 in Georgia, 5,300 in North Carolina, 5,200 in Pennsylvania, 4,000 in Illinois and 2,400 in New Jersey. The numbers released on Monday are for 36 states using the federal insurance marketplace. They do not include terminations in California, New York and other states running their own insurance exchanges.

Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. But in many cases, the government could not verify the incomes people reported when they applied for subsidized insurance.

This does not mean that they provided false information or were ineligible for assistance. The government tried to verify incomes by checking 2012 tax return information, but consumers may have switched jobs or received pay raises since filing those returns. As a result, officials said, the information in their applications may not match the data in federal files or in sources available to the government.

Mr. Slavitt said that on May 30 there were roughly 1.2 million households (and a total of 1.6 million people) with “data-matching issues.”

Since then, the government said, it has closed cases for 467,000 households with data discrepancies, and 430,000 cases are “currently in the process of being resolved.”

“There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals,” Mr. Slavitt said. They will soon receive letters from the government asking for proof of income, and if they do not reply by Sept. 30, they may lose some or all of their subsidies.

They would still be eligible for coverage, but in many cases could not afford it. In some cases, they would also have to repay some or all of the subsidies they received.

It is also possible that some people could receive larger subsidies if their incomes are lower than what they expected when they applied.

(A version of this article appears in print on September 16, 2014, on page A18 of the New York edition with the headline: U.S. to End Coverage Under Health Care Law for Tens of Thousands.)

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Capitol Conference 2014 (or Your Intrepid Editor Goes to Washington)

MR BUCK GOES TO WASHINGTON II (2)

Late last week I returned from the National Association of Health Underwriters Capitol Conference 2014 in our nation’s capitol. Our group stayed in the shadow of the Capitol at the Capitol Hill Hyatt two blocks from where our laws or bills are created and passed. Our primary objective this year would be to address the ramifications of what is arguably the biggest Act ever in terms of its impact on all America. It was my first meeting to attend at a national level and I am grateful for the warm welcome provided me by the Houston, Texas Chapter and the entire experience. I express particular thanks to Lonnie Klene for facilitating my attendance and Malcolm Browne, Sibony-Trevino Toth, Jo Middleton and Jeffrey Bacot for their engaging conversation which made the informal time much more enjoyable.

 
The overall goal of the conference was to represent the interests of health insurance agents and brokers in their role of assisting the public in the administration’s goal of acquiring quality, affordable health insurance. Of course, because of what we now know are the results of the Patient Protection and Affordable Care Act, this seems something of a daunting, if not failed, mission in terms for many of the stated beneficiaries at this point. Still, it was the Association’s stance that the bill is law and for now is the system we have to work with. As much as I would have liked to have protested and lobbied for solutions to our nation’s debt crisis; its lack of a viable energy policy and justice for the victims of Fort Hood and Benghazi – this was not the purpose of our attendance as a group nor the reason the Houston Chapter sponsored my presence at the conference. Those are issues which I will have to address through correspondence with the contacts I made and indirectly at the poll booth in the coming mid-term election.
The issues which our group did address with our respective Representatives were, among others:

 
1) The need for involvement of professionally licensed benefit specialists, i.e., agents and brokers (as opposed to unlicensed, unvetted navigators) to help consumers before, during and–most importantly–after the sale of private health insurance coverage and, of course, our opposition to their exclusion in this process.
2) Our concern over the inability of many employers to afford to offer coverage to their employees and the negative effect this has on our nation’s current economic uncertainty and limited job growth.
3) Our support of a comprehensive bill to rectify provisions of the law and new regulatory requirements that are creating compliance burdens for businesses and conflict with time tested employee benefit practices.
4) Our opposition to changes to time tested traditional definitions of small and large employers and full-time and part-time employees, this last of which has resulted in employers cutting employees to 29 hours thus making them part-time employees pursuant to the new definition (30 Hour Work Week) and contributing to under-employment.
5) Our opposition to age banding which unfairly discriminates against the young and does not accurately assign cost relative to risk.
6) Eliminating the national premium tax projected to add an average of $500 of costs to a typical family policy in 2014 and more thereafter.

 
For Seniors:
1) Our support of efforts to preserve Medicare options flexibility for recipients and restore the long-term financial health of the program.
2) Our opposition to funding the costs of the Affordable Care Act on the backs of our nation’s senior citizens. Specifically, cuts to Medicare Advantage and Part D Prescription Drug Plans.
3) Providing new financial incentives to encourage and make possible the purchase of long-term care insurance for our exploding senior population. (an average of 10,000 boomers turn age 65 every day)
Day 1 of the conference consisted in part of a break-out session covering the current state of the employer mandate; Private Exchanges for Employers; Medicaid 101 and Compliance.
Day 2 Addressed The Political Impact of Health Reform; The Future of the Marketplace (federal and state exchanges) followed by lobbying on Capitol Hill. It was at this point Lonnie Klene, Sibony Trevino-Toth and myself met briefly with our District 8 Representative, Kevin Brady and longer with his assistant, Andriu Colgan. Like most aides, Andriu was young, bright and responsive to our concerns (as outlined above) and assured us Congressman Brady was sympathetic to these. In his brief time with us, he confirmed such.

KENTON AT CAPITOL 2 (2)

Your blog editor outside Representative Brady’s Office in the Cannon Building.

CAPITOL AT NIGHT 2

That evening, I was one of a group of Texans privileged to attend a 3.5 hour tour of the Capitol hosted by Texas District One Republican Representative Louie Gohmert, from a boyhood home of mine, Tyler Texas. He insisted he knew some of my cousins, but there was no doubt he knew an incredible amount of our nation and its leader’s history which he very generously shared with us. He is a remarkable story teller with a keen sense of humor and the tour he hosted for us, most of whom will never have occasion to vote for him, proved to be one of the most memorable experiences of my life. My appreciation of our nation’s history and heritage (which was already tremendous) is even greater thanks to him. And he made no bones–he’s with me on the issues! If I lived in his district, he’d certainly have my vote!

CONGRESSMAN LOUIE GOHMERT 1

U.S. Representative, Texas First Congressional District, Louis B. Gohmert, Jr.

 
Day 3 consisted of a panel of physicians discussing Health Cost Transparency; “The Marketplace Transformed” hosted by Representative Renee Elmers (R-NC); Jennifer Duffy, Senior Editor, The Cook Political Report and Representative Jim Matheson (D-UT).
All sessions were followed by a fairly extensive, cogent question and answer period.
This last day ended with a special presentation entitled “Taking It All Home” by Dan Clark, motivational speaker and author of, among other works, the “Chicken Soup for The Soul” series. I must say that after the stress of all the change the Affordable Care Act has brought to this agent, and the others in attendance, we were in need of his inspirational soup and it proved very therapeutic.

 
All in all I came home with more knowledge and ideas of how to assist my clients in dealing with the reality and mandates of the Patient Protection and Affordable Care Act as it stands for now.

 
My advice in short? Just don’t blink!

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Facebook Posting Does Double Duty On This Healthcare Blog

Healthandmedicareinsurance.com followers – I spent enough time responding to the left on my facebook posting – I thought the effort could serve double duty on this blog.
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Before preparing for my trip, I would first like to respond to Kathy: No, I won’t be lobbying for an expansion of Medicaid in Indiana (or any other state for that matter) that has not already expanded it beyond 100% of the Federal Poverty Level. If Medicaid were expanded, it would be to include individuals up to and including those with an income of 133% of the FPL or a maximum income of $15,521 for 2014. Deserving or not aside – while these individuals currently do not qualify for Medicaid in Indiana or Texas – THEY DO qualify for a subsidy of approximately 88% of their health insurance premium. If they elect the plan recommended by the Department of Health and Human Services (“benchmark” plan) it will be the second lowest cost Silver Plan in their area. They are required to pay no more than $40.41 per month. No, I don’t feel sorry for them. They are certainly already receiving food stamps and government subsidized housing and Medicaid is already in financial trouble in most states without further expansion. (Of course I am aware financial feasibility and a balanced state or federal budget is not your concern.)

The person I feel sorry for is the poor working stiff who is making in the $50 – $60,000 dollar range and actually earning his or her income. They don’t qualify a health insurance premium subsidy. (Food stamps I’m not certain of because our government has made those available to virtually everyone including illegal aliens.) Because this responsible working person doesn’t qualify for a subsidy, they will be forced to pay 100% of the Silver plan premium–with an average annual cost of $4,113–entirely on their own. That amounts to 8% of their annual income (at $50k) before taxes which the entitlement person isn’t paying! That’s the person I feel sorry for! Then try providing them with a plan that has their doctor in the network and the benefits they would really like and their cost and that percentage soars! In summation – you keep lobbying for the entitlement class; I’ll keep lobbying for the working American.

Now to address Scott: Glad to see you are finally making a prediction which I feel is pretty much on target. As I’m the one on the front line signing people up for Obamacare, no one knows better the “adverse selection” (bad risk disproportionately selected for participation) than I. But I remember a few of my predictions you tried to dismiss. First – I said Barrack Obama would be elected in 2008. You said, “no”. In 2010 – I said the Patient Protection and Affordable Care Act (PPACA or ACA for short) would pass. You said, “no way!”. Then, in June of 2012 – I said the Supreme Court is going to find a way to uphold the ACA as “constitutional”. You said, “not to worry!” God! I hate being right. (Almost as much as you hate being wrong!)
Anyway, I’m glad you are finally smelling the coffee which probably got to a stench with your latest health insurance premium increase. And, as such, this begs many questions – two of which I will address at this point:

(1) If the federal government cannot build a functional website, to insure the estimated 30 million uninsured, with 3 years lead time – How long is it going to take them to transition us to a “Medicare like” social welfare health insurance program that insures all 300 million plus Americans. And . . .

(2) If Social Security is on track to insolvency and Medicare is predicted to be insolvent by 2023 (nine years from now, people) – how the hell are they going to finance and subsidize healthcare for everyone? Redistribution. Because it wasn’t fair you’ve been so successful, Scott.

In my next blog post, I will address what I see as the specifics of why these things regarding the ACA are destined to transpire. In the meantime, I’m still going to Washington because the one thing we do know is – the person that never gets in the ring has already lost. The real issues I would like to confront our elected officials with are my suggestions for workable healthcare reform which guarantees coverage for pre-existing conditions while being financially responsible and feasible; term limits (I know, I know – when hell freezes over); amnesty and targeting of conservative groups by the IRS. I know they’ll try to get me back on point (theirs) – but not until I’ve made them say, “next question!”

ALL PLAN MED QUOTE AND CLIENTS TO BE REPRESENTED IN WASHINGTON, D.C. NEXT WEEK

ALL PLAN MED AND LIFE LOGO (2)

Not content to sit passively on the side lines while Washington dictates to him, his clients and fellow citizens – Kenton Henry, agent, owner of Allplanhealthinsurance.com in The Woodlands, will voices his–and your–concerns  in our nation’s Capitol.

KENTONSBUSINESSWEBPHOTO

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Trusted friends and clients:

It is my privilege to soon be attending the annual legislative conference for my professional association, the National Association of Health Underwriters, from February 24-26 in Washington, D.C. Representing influential professionals in my industry, I will take this opportunity to present meaningful solutions to our national policymakers to improve the cost and quality of health insurance while reducing the burdens the Patient Protection and Affordable Care Act has placed on businesses and individuals across the United States.

As the regulations and requirements of the health reform law continue to evolve, it is extremely important that our representatives in Washington, D.C., hear what is going on with you; your families; employers and employees. Our representatives on Capitol Hill need to hear a common-sense perspective from the average citizen’s point of view along with consumer inspired solutions. I will attend meetings on Capitol Hill with Senators, Representatives and their staff and would be happy to pass along any thoughts about health reform you, my valued friends and clients, may have. I have requested an appointment with Texas District 8 Congressman Kevin Brady, among others.  Please contact me at Quote@Allplaninsurance.com to share your message with them. Share with me your greatest problems and concerns with health care and health insurance and what solutions you may have in mind. I promise your story will be told and commit to being your voice among those who represent us.

In addition to talking to our elected representatives, I will be attending educational sessions about benefit and policy trends that will include:

• Key briefings from the national policy staff and association leadership.
• Panel discussions on health cost transparency, innovations in coverage and delivery systems, and policy trends relative to cost containment.
• Updates on the latest developments regarding the new health insurance marketplaces (exchanges).
• Presentations from congressional and Administration health policy leaders including updates about potential changes to the law and new evolving regulatory guidance.
• A session about using the political dynamics of healthcare to transform business.
• Breakout meetings that will cover innovative solutions to address the employer reporting requirements, shared responsibility requirements, self-funding options in a reformed health system, private and public exchanges, small group market trends and much more!

The future of healthcare reform is ever changing and the impact of this law will affect us all in many different ways across the country. I believe that my voice and your voice truly do make a difference. I look forward to sharing our stories as I lobby on Capitol Hill. Upon my return, I will share with you what I hope will be encouraging news of coming improvements to the present state of healthcare and health insurance in Texas and the rest of America.

Sincerely,
D. Kenton Henry