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

By Don Kenton Henry – editor, broker

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

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

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

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

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

CHANGES TO MEDICARE PART D DRUG PLANS IN 2019:

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

*****

MEDICARE PART B 2019

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

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

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

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

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

THOUGHT FOR THE DAY:

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

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

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

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

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

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

*FEATURED ARTICLE 1

BLOOMBERG

Private Medicare Plans Faulted by Watchdog Over Denials of Care

By  John Tozzi

September 26, 2018, 11:01 PM CDT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*****

FEATURED ARTICLE 2

WASHINGTON EXAMINER

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

by Kimberly Leonard

 September 05, 2018 03:03 PM

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

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

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

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

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

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

LOWER YOUR MEDICARE SUPPLEMENT PREMIUMS NOW

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

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

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

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

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

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

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

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

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

OPTION I: at lower rates than OPTION II

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

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

APPLICANT A

Name of Medication, Date Prescribed and Condition

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

APPLICANT B

Name of Medication, Date Prescribed and Condition

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

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

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

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

Huntington’s disease or any terminal medical condition?

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

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

requiring dialysis?

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

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

pressure, or skin ulcers?

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

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

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

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

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

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

been bedridden?

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

nervous disorder requiring psychiatric care?

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

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

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

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

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

replacement?

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

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

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

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

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

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

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

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

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

you for any problems with your kidneys?

Yes No Not Sure

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

the following?

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

Yes No Not Sure

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

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

overnight outpatient observation)? Yes No Not Sure

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

assisted living facility? Yes No Not Sure

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

or that you require dialysis? Yes No Not Sure

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

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

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

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

for further information.

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

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

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

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

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

 

1) Your name

2) Your residential zip code

3) Your birth date

4) your tobacco usage

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

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

7) What is your current Medicare Supplement Premium?

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

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

https://medicareful.com/AgentKentonHenry

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

Sincerely,

Kenton Henry

Office: 281.367.6565

Text my cell @ 713.907.7984

Email: Allplanhealthinsurance.com@gmail.com

Http://Allplanhealthinsurance.com

Http://TheWoodlandsTXHealthInsurance.com

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

Medicare Part D Prescription Plans: What you Need to know

 

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

2018 DEDUCTIBLE – INITIAL COVERAGE – GAP – CATASTROPHIC THRESHOLDS

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

COMMONLY OVERLOOKED DETAILS:

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

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

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

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

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

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

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

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

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

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

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

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

 

AS YOU SLEEP THE FUTURE OF YOUR HEALTH INSURANCE SUBSIDY HANGS IN THE BALANCE

KENTONSBUSINESSWEBPHOTO

Op-Ed by D. Kenton Henry

While most Americans who receive a health insurance subsidy to offset the cost of the coverage they obtained from the federal website, Healthcare.gov, go quietly about their personal business―the future of that subsidy―and the very future of the Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA) for short―which gave birth to said subsidies―hangs in the balance. And, for the most part, these same Americans remain blissfully ignorant that the future of their health insurance protection hangs with it also. Apparently sleeping as its fate is to be decided by the 30th of this very month when the Supreme Court releases its decision on King vs. Burwell.

King vs. Burwell contests the financial help available to some enrollees on  the federal insurance exchange in 34 states on the basis that the PPACA was not written to allow for the existence of subsidies provided by the federal exchange. In fact, the plaintiffs argue just the opposite―that only those exchanges established by the states could provide such. Should the court rule in favor of the administration, it will mean the law has survived one more effort to derail it and its future may well be assured. However, If the plaintiffs prevail, that leaves the estimated 6.4 million recipients of the subsidies in the thirty four states which did not with illegally subsidized health insurance. And, without subsidies . . . health insurance reform starts to fall apart. The majority of the recipients will drop their coverage and only the sickest―who bring the most expensive claims to the insurance companies―will remain on their plans. This phenomena is know within the industry as “adverse selection”. In reality, it means that the youngest and the healthiest, regardless of age, will flee their plans like rats off a sinking ship. And the sinking ship will be Obamacare. The law itself. This is because it is estimated that insurance premiums for these 6.4 million will increase an average 256%. A result which will single-handedly insert the substitution “Unaffordable” into the Affordable Care Act―Obama’s signature landmark legislation― sending it into a classic death spiral.

And what does the Supreme Court’s decision hinge on? Four key words: “established by the state”. As in the subsidies are to be available only to income qualified recipients in those exchanges established by the state. The four words are contained in that portion of the law which details how premium subsidies are calculated for health insurance policies. Plaintiffs argue thirty four states never established an exchange. Ergo, how can subsidies be provided for their residents? They argue the wording was constructed to serve as an incentive for the states to create own exchange; the states called the federal government’s bluff and the feds willy-nilly pulled a rabbit out of their head and provided federal exchange subsidies for which no provision within the law was made. To follow their argument to its logical conclusion, the Internal Revenue Service has violated the law by providing tax credits to individuals in these states.

The administration argues that exchanges were created by the states when they effectively opted to let the federal government do it for them. Therefore, their inaction became their action. This allows subsidies to be provided their residents.

As a health insurance broker with twenty-nine years in the industry, I have survived the inevitable ups and downs of the small business owner. I, and my practice, have survived Hillary’s attempt in the early nineties at health care reform and the deterring effect of ever increasing health care costs; the resulting sky-rocketing insurance premiums and the general turbulence of an industry which attempts to manage the costs of a sector which comprises an estimated twenty percent of our nation’s economy. I have survived the Affordable Care Act’s resulting cut in my compensation and the loss of hundreds of clients who were forced off their policies because they did not comply with the law’s mandates. Policies with which, for the most part, my clients were happy. Had they not been, they would have dropped them on their own. I now survive the effect of premiums which have risen on average fifteen percent each of the last two years and, in many cases, much, much more for those clients who do not qualify for the subsidy. The bottom line is, “if you qualify for a significant subsidy, you are probably happy with this law. If you qualify for a relatively small subsidy―or none at all―you are most likely very unhappy with it.” It seems everyone is judging it from the perspective of their own personal welfare. And that is human nature, is it not? And I reluctantly admit, I am no exception. And it is not without guilt I do so.

Because, if the subsidies are revoked, by my estimates, I stand to lose approximately two thirds of the new business I have written in the last two years since ACA plans were forced on the public under threat of penalty. Just last month I experienced the first and slightest increase in income since the act’s passage in March of 2010. My income had been decreasing precipitously since then, mostly due to the “minimum loss ratios” imposed on insurance companies resulting in maximum losses to the agent and broker. But I accepted these; remained committed to my industry and business and have survived. If King v. Burwell is decided in favor of the administration’s adversaries, my clients will let their coverage lapse and the resulting personal effect will be “two steps forward and three steps back”. Hence, the guilt. The guilt born of knowing the worst aspects of this law (unknown to average person) are yet to be implemented and only a minute portion of the resulting costs are currently apparent. Those forthcoming will have a devastating effect on our nation’s treasury which is already eighteen trillion in debt and rising “with a bullet”. I know that progression of this law and its mandates is already forcing rationing of our health care providers and further progression is going to result in ever increasing rationing of health care treatment available to each of us. And yet, for my own sake, I don’t want to experience more losses.

Please do not think I do believe there was no need for health care reform. When two of every five health insurance applications I submitted on behalf of clients was declined due to pre-existing conditions and another not taken due to “waivers” of such (prior to the law’s enforcement) I experienced the angst of my clients and my own.

And so I sit, in front of my computer desktop, on the edge of my seat monitoring each post from SCOTUSBLOG.COM and each editorial from the most liberal to conservative journalist (who knows much less about this law than I) attempting to predict as to which way this imminently pending decision will go. The patriotic conservative within me says, “for the welfare of my nation’s economy, this law should fail.” While the agent, broker, small business man within me who likes to eat, pay his bills, maybe put something away for retirement and doesn’t want to see any more of his clients lose their very necessary and greatly appreciated health insurance coverage says―”Please, oh, please. Let the Supreme Court of this United States of America, in all their supremacy, rule that the authors of the Patient Protection and Affordable Care Act didn’t really mean what they wrote. Let the subsidies stand.”

http://thewoodlandstxhealthinsurance.com

http://allplaninsurance.com

http://healthandmedicareinsurance.com

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

Related stories:

THE NEW YORK TIMES

Politics

Four Words That Imperil Health Care Law Were All a Mistake, Writers Now Say

By ROBERT PEAR MAY 25, 2015

http://www.nytimes.com/2015/05/26/us/politics/contested-words-in-affordable-care-act-may-have-been-left-by-mistake.html?ref=us

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

MORNING CONSULT Burwell Draws Line On Health Subsidy Fix Jon Reid   |   June 10, 2015  http://morningconsult.com/2015/06/burwell-draws-line-on-health-subsidy-fix/

ALL PLAN MED QUOTE LAUNCHES SISTER TO ORIGINAL WEBSITE!

ALLPLANHEALTHINSURANCE DOT COM LOGO

All Plan Med Quote has been providing the individuals, families and employer groups the lowest quotes and best value in health and Medicare related insurance in four different states since 1991. In 1998 we became one of the first insurance agencies in the country to begin marketing via the internet through our website AllplanHealthInsurance.com.

In an effort to respond more directly and with products tailored to our hometown, we have just launched a sister website: TheWoodlandsTXHealthInsurance.com http://thewoodlandstxhealthinsurance.com. Logos and customized marketing materials are still being designed but the website is online!

In addition to health, Medicare related, dental and life insurance we will be posting health care news relevant to residents of our great community. If you are a resident of The Woodlands or Montgomery County, Texas please visit our site and also follow my blog at http://healthandmedicareinsurance.com to stay abreast of the latest in consumer medical insurance and health related news.

Thanks so very much,

Kenton Henry

Owner; Broker; Editor

http://allplanhealthinsurance.com