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All the questions you've had about health insurance, life insurance, annuities and long term care insurance
(but were afraid to ask)


"OMG, have you seen my rates" Part 2--Get me out of Obamacare...well...

12-09-2017 by Colleen King

As we closed in on the first 'open enrollment' deadline, December 15th in order to get a January 1 effective date, with the rates as nuts as they are, people are desperate to find 'something else.' I get it, but there isn't anything else.

When the Affordable (?) Care Act came into being, new plans that were developed had to meet the new standards, and there are costs built in to that. Everything's guaranteed issue, regardless of pre-existing conditions, and you can't be charged more if you have something wrong.  All plans have to cover a certain set of benefits, including everyone's favorite, pediatric dental and vision. I poke fun at that one because my clients that don't have kids aren't happy about paying for that, and we can't strip it out.  All plans have to cover maternity, another favorite amongst young men. Well, as I tell clients, I have a free prostate exam available to me but not much use for that. There's always something in a plan that you won't use, but we can't strip those things out.

What people have to understand, to me, is that everything is Obamacare--the plans all have to meet these standards, on or off the exchanges. I ask people what they think 'Obamacare' means, most of the time they don't really have an answer. And I'm not poking fun at that, it's all confusing. Some thing it just means the plans available on the exchanges, but it's everything.

I know people are going nuts over all of this, but be very careful of 'less expensive options'--There is a product, offered by a few different entities, called Health Care Ministries. These are exempt from the ACA rules, so if you buy this, you are spared the penalties for not having ACA compliant coverage. But I started to look at these, thinking I would contract with one as a last ditch alternative for my clients, but the more I looked, the less interested I was. These just seemed like a liability action waiting to happen. You pay a monthly fee that is MUCH less than insurance, and supposedly they will help you pay for office visits, hospitalization, but not necessarily all of your costs. And one person I spoke with who did enroll in one out of desperation last year, found that if you developed a 'condition,' they could drop you.

Here's the thing--these are NOT considered insurance, so they aren't regulated by state departments of insurance; you have no consumer protections that I'm aware of. I don't believe from what I have seen that you have any recourse. So as they say in marketing, if it sounds too good to be true, it usually is. Be very careful if you go this route, do your reading and research.

Meantime, the deadline for a January 1st effective date is December 15th for a health plan. Ultimately open enrollment ends January 31st, so i you miss Dec. 15th, you aren't shut out, you just don't have a Jan. 1 start date. 

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"OMG, have you seen my rates?" Yes, I have, and it's ugly.

11-15-2017 by Colleen King

This year, individual plan rates have exploded this year, and it's awful. And that's on top of increases the past 3 years that each year have shocked people. There are a couple of things that are happening that are contributing to this.

1. Anthem Blue Cross has pulled out of most of the California individual market. Their management said they were losing money in the California market so the pulled out of most California. There are 3 regions of Northern California they remain and there are 2 reasons for it (In my opinion). First, they are trying to be good eggs and help services an under served area. Not sure if those 3 regions were more profitable or not. The other reason, which I think is a big part of a strategic move, if they had totally pulled out, it would have been five years before they could come back into Covered California. You can choose your preference as to what happened, I think it's a combination.

2. Blue Shield is statewide, and in many areas they were the only PPO. PPOs versus EPOs are an issue because EPOs don't have out of network coverage unless it's an emergency. Lots of doctors and other types of providers are dropping their insurance contracts, so having out of network coverage is important to many people. But when they take advantage of that, this drives carrier costs way up. So that's why this year, not only are Shield's rates going up but their out of network coverage, the deductibles and out of pocket maximums are shooting up sky high. Shield has been hit according to what they have said, with a lot of higher dollar claims because of their situation.

So I just keep churning out quotes. I'm being asked for bronze level plans more than usual because of the rate increases. I try to steer people toward silver because of the huge deductibles on Bronze ($6300+) but people got to eat too. Sure hope Washington figures something out quickly....

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Trick or treat--Open Enrollment for individual plans starts November 1st

10-31-2017 by Colleen King

Okay, so here we are on 'All Hallows Eve'--what does this year's open enrollment for the individual market hold ?

Rate increases, yes--confusion, yes--do we all still need to be insured, yes. So far none of the 'repeal and replace' bills have gone anywhere, Trump has told the IRS not to enforce the penalties for being uninsured, but that's not official, so who knows? Of course we insurance agents will tell you you need to be insured, not just because that's how we make a living, but because we know that if something of any significance happens, you don't want to be stuck with a bill for thousands of dollars. So here goes...

The Tricks--There are a few things, not exactly tricks, but I'm using this as a 'label' for potentially negative things. Rates for the most part are going up. Anthem Blue Cross has pulled out of most of the California individual market for 2018. Three regions in northern California, they are still around. This does NOT affect anything group health insurance related or Medicare related.  This will impact most regions but particularly Ventura County, because that leaves only Blue Shield and Kaiser.

The Treats--okay, this may be a stretch, but it's a Halloween theme. Health Net in some areas is adding a 'narrow network' PPO. That could be helpful, we'll have to see as these things are case by case. 2017 they had no PPO in most of the LA area, so I'm hopeful. Oscar, the newer kid on the block, already in Los Angeles County, is expanding into Orange and San Francisco counties. This is an EPO plan, which means no out of network coverage outside of an emergency. The past couple of years they have had a very specific network, using mainly UCLA and Providence providers and facilities, but they are expanding their network. We always need to check to see who's contracted where but this could be food.

Anthem members--you MUST choose a new plan by December 15th in order to be covered January 1. If you have an older, grandfathered plan, you're fine, that's not going away yet.

Open enrollment overall will run through January 31, 2018 so if you miss the December deadline, you aren't totally out of luck. But seriously consider using an independent agent for your insurance shopping needs. There's no extra cost versus buying directly from the carrier, and we can help you figure this stuff out. And you only have one person calling to follow up, instead of one person from each carrier.

Happy Halloween!

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"I'm healthy, I'll just get a high deductible health plan"--there are pitfalls with this theory.

10-29-2017 by Colleen King

I hear this often, people will say they just want to go with a high deductible plan, especially since rates are getting so outrageous---we're still waiting for the 'more affordable, easier to understand' piece of Obamacare. But I digress.

We used to have higher deductible plans that would still offer office visit coverage and prescription drug coverage prior to meeting the deductible. But when you now look at a 'high' deductible medical plan, you're looking at a $6300 deductible, if not higher. You have office visit coverage at a copay, 3 per year before meeting the deductible, but that covers just the basic office visit. Lab and Xray, any other procedure, is still an additional cost. Okay, so you may still think this is the way to go, and for some it will be. I still find it astonishing that the 'standard' bronze plan design, 'blessed' by the federal government, is $6300. Without a reasonable premium to go with it.

I had a family a few years ago, pre-Obamacare, that was trying to lower their premium so they went with a plan that had a $6000 deductible. The husband chose this plan. Then I got a call one day from the wife, a family member needed surgery, and she was upset that the deductible was so high, that they were going to have to pay that. This was a situation that was totally unanticipated, like most health care issues.

May of my clients especially in their 50s and 60s are looking for higher deductible plans to cut the cost of health insurance. I totally get that. They have savings, they could absorb something like this if they needed to. I've heard from many people over the years, 'I just don't want to lose my house if something major happens.'  It makes sense. But keep in mind that IF something happens, the deductible is what you pay before the insurance company kicks in. I know this is going to seem like I'm stating the obvious, but I've had this conversation enough, I want to make sure people get this.

I encourage people to consider the silver level plans instead, but pricing can still be tough. I get it. I see this every day, and am not thrilled about it. So keep in mind if you decide to go with a 'HIGH' deductible health plan, you may need to come up with that money at some point. But let's hope not.

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"I'm going to keep my Part D Drug plan, you don't need to check it." Yes, I do, here's why.

10-28-2017 by Colleen King

It's that time, the Medicare Annual Election Period (AEP) also known as Open Enrollment. This is the time of year you can make changes to your Part D drug plan and Medicare Advantage plans for the coming year, 2018. And it ends December 7th pretty much without exception for most people. Every year I do a mailing to my Medicare clients advising them of this, to have them send me a list of their current medications and their preferred pharmacy so i can check.


But many people will say they don't need to check, they were happy with the plan this year, they're just going to keep it. But I like to check anyway. Plans change, a person's medications may change and they may not remember that from 10 months ago. What drugs are covered and at what copay level, which pharmacies are contracted, are they a preferred or a standard contract? That could affect what people are going to pay for their medications. The cost of the plan itself may be going up, some actually went down a little this year. The cost for Part D drug plans this year range from $19.70/month to $169.80/month--most of my clients are on plans in the $25-$40 range, more expensive is not necessarily better.

For some of my clients that I've done checks on, I've found they can save money over the course of the year if they do change. Is it worth changing for a savings of $50-$60 over the course of a year? Most of my clients won't change for that, but some will. But I have clients who will save hundreds, if not thousands of dollars by changing, and are really surprised when they see that.

And there's no financial incentive to move people. The way agents are compensated for Part D drug plans, if a client is already on a plan, whether we move them or keep them on the same plan, it's a flat $36. So if I'm suggesting a change, or pretty much most agents who do these, it's because we think it could benefit our clients.

So in short, I'm going to keep on checking.

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