Ask Colleen King

While Americans continue to brag about their marvelous levels of care, well at least some Americans, our quality apparently isn’t up to snuff.

Life expectancies, hospitalization rates, cost of care, we’re trailing on an international level. America rates well in cancer care though, according to this article. Switzerland’s system is touted as being effective, and significantly reduced cost, but scroll down to the comments and you will see that while they do have a private insurance system, reimbursement for care and insurance rates are highly regulated. Payments are based on a fee schedule. Take 2 minutes and read this article I found on California Healthline, and you’ll find some interesting statistics on the costs involved with health.

Also interesting is how lack of access is cited as a big problem in the US, not obesity, smoking, etc., the usual suspects.

So what do you think?

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Geez, now this is a drag–the Pre-existing Condition Insurance Plan (PCIP) which was supposed to be such a panacea for the uninsurable apparently was too popular–in 2 months, the program might be stopping enrollment because, get this–the claim costs were 3 times higher than anticipated. Big surprise!

You have to realize that when you offer something like this, the more desperate people are, the sicker they are, the quicker they will be in line to enroll. The rates on California’s PCIP are really good, and it’s a very rich plan by most peoples’ standards. Combine all of this and it explains why claim expenses ended up being so much higher than anticipated. Read this article from the California Healthline to better understand the problem.

This is only the beginning folks–if government can’t estimate the costs for a relatively small population, how are they going to do it for an entire country?

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Well, okay so your broker doesn’t have to be physically down the street, but it’s looking more and more like getting some help in sorting out options from someone when shopping for health insurance, available to you at no cost, makes sense.

Several articles talk about rates had shooting up and and people looking for new coverage. Often people found working with an independent broker helped find something manageable. You can go to the big major online sites but honestly, the past few years, I’ve helped people change plans several times after they bought something online then found it didn’t work the way they expected.

The California Small Business Association (CSBA) which I’m a member of has a program titled Buy California Small Business First which is aimed at drawing attention to doing business with people and companies within California. The reason to do this is to keep more money/revenue in the state; it’s not necessarily more expensive to do business with local smaller stores.  Now obviously not all insurance companies are based within California, but the local broker is. You will most of the time end up with more personal service when working with a broker. And if you don’t, then you need to look elsewhere; there are thousands of us.

The point is with health care reform in full bloom, there is way too much to keep track of and relying on your broker to help you where needed can be a real plus. Rate increases are hitting–we don’t have all the information yet like we have in years past but do you want to sit on hold with Anthem Blue Cross or Aetna for 20-30 minutes? I’m already doing it, so just add you question to my list. It’s all about trying to save clients money on their health care coverage where we can while making sure as close as we can that your needs are met–that what we do.

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Every year about this time you start to see commercials about the various Medicare HMOs and Part D drug plans. Then around November 15th, the true onslaught starts.

This year the onslaught will come early. The Annual Election Period (AEP) will be from October 15 through December 7. This is the time you can change your Medicare Advantage plan or Part D drug plan for the year 2012. This is one of the few good things that has hit with the Affordable Care Act.

The reason this is good is that any changes made are effective January 1 for the coming year. Previously, the AEP was November 15 to December 31. Needless to say if you were working with clients that last week of December, as most of us were, things were not up and running January 1. I actually drove out on December 31st to meet a new client, do her paperwork and fax it in so it would get there before midnight and January 1. So if you needed a prescription or a doctor visit, or god forbid hospitalization the first 2-3 weeks of January, it was chaos.

I’ll be writing more about this in the next couple of weeks, but officially, we can’t start ‘marketing’ until October 1. I’m just giving you a heads up in case you or someone you know may want to make changes. This is your “once a year “opportunity!

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In dealing with people day to day, most think California has to be the most expensive state in the nation. Not so, believe it or not, it could be worse.

Health care reform, the Patient Protection and Affordable Care Act (PPACA) were suppose to get us on the road to more affordable health insurance. Notice I didn’t say health CARE. The PPACA did not deal with health care costs at all, just health INSURANCE costs. But I digress…..According to StateHealthFacts.org, California is 9th in ranking least to most expensive. There’s a foot note, as usually with California, that HMO plans were not factored in to this and according to this 2010 data this takes all plans, all ages so of course there will be some radical deviations. But I still thought it was interesting.

The national average is $215/month. California comes in at $157/month. Check out this list, and notice who comes in at the end.  Massachusetts, where coverage is required. New York and New Jersey are pretty darn bad too. This is why we have to be very careful of what we ask for, and how we implement it, because we just might get it.

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When a call starts like this, it’s rarely good. This usually means someone has something wrong, or someone’s pregnant.

Problem is, the intent of Health Insurance is in case something goes wrong. If something has happened, you don’t need insurance, you need financing and insurance companies don’t do that. This whole idea is why requiring people to buy insurance unfortunately is going to be important if health care reform is going to work. Otherwise, what will happen is people will only apply when they have an issue, then drop coverage when all’s well. The concept of insurance, all types of insurance, is that people have to pay in whether they need it or not then there is money in the risk pool for when something is needed. And a risk pool is never something you want to be in the shallow end of, that’s for sure.

That’s an issue that has come up with ‘child only’ plans. Under age 19, due to health care reform, all kids have to be accepted regardless of pre-existing conditions. They can be charged above standard rates, but the carriers have to take them. One thing that is starting to happen is carriers are putting a 15 day delay in place from the time an application is submitted to when it can become effective, to avoid this jumping in, jumping out thing. At first carriers said okay,we just won’t write any ‘child only’ policies, we don’t know the risk. California then passed legislation saying okay fine, you don’t write ‘child only’ policies, you don’t write any individual health plans in California for 5 years. More on this in another article.

My main point is, we can’t close the barn door after the horse is out, so that’s why you need health insurance. Before something happens!

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I've about had it!

Okay, many people are really unhappy with health insurance right now. People either don’t have because it’s unaffordable or they are uninsurable. Or they do, but their rates are going up. So it’s time to call your agent, see what else is available.

Well, here’s the problem. The carriers can’t even agree on what needs to change when. Or actually, what to do about it. Last quarter of 2010 was outrageous. Anthem had rates available through 9/22. Blue Shield’s rates were good through 9/30. Kaiser, they’re fine, ain’t changing a thing. Cigna only does 1st and 15th of the month effective dates. And there’s more, but you get the idea. It’s continuing to happen, changes all the time, it’s causing a lot of extra work for everyone.

So big deal–so what? Well here’s the thing. As you may have heard, things are tight for many people these days. So a jump in expenses of $50-$100 a month, maybe more, maybe less, is a big deal. And normally when the rate changes come in, I can give information that is solid. So can any good agent. But now, with the variation in rates and effective dates, and new information popping up every day, it’s frustrating.

I’m trying to help people make a move to avoid their increases and easier said than done. So if you have an agent you’ve worked with for a while, and they seem like they have a new onset of ADD, there’s a legit reason. You have to dodge a series of rates. You want to advise people to request specific effective dates so that they get the current rates. But I know for me, my phone is ringing off the hook and email is overwhelming. So hang in there, we can get you changed most likely–have faith!

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When you change health insurance plans, or just drop coverage, your previous carrier will send you what’s called a Letter of Creditable Coverage. This will show the start and end day of your coverage with them. So what, what does this mean?

This could be very important especially if you are moving to a different policy as many people are doing right now, in order to cut their premium. If you have a condition you need care for, and you did not have prior coverage, the new carrier could see it as a pre-existing condition and not be obligated to cover it for the first six months of your new policy. And this is legitimate, it’s not just insurance companies looking to not pay claims. They are looking to not pay claims they are not obligated to. Isn’t that what you are looking for when credit card bills or cell phone bills show up, charges that aren’t yours to pay?

This came to mind recently when a client of mine told me she needed proof of prior coverage as her new carrier was asking for it. She had a procedure, the new carrier wanted to make sure there was no lapse in coverage over 63 days (that’s the magic number, have no idea how they came up with it) so we had to contact the old carrier.

Carriers vary in their ‘workability’ so if you get one of these letters, keep it. One carrier I work with reguarly, I called to get one for a client and even though I wasn’t the agent of record on that old policy, but being able to give certain identifying information, they emailed me what we needed within 10 minutes. This client’s old carrier had to snail mail the letter to her, and it took two weeks.

Most of the time you won’t need it, but when you get one, keep it to make SURE you won’t need it (Murphy’s Law). Unless of course you won the Mega Millions lottery, but even then, why spend it on something you don’t have to!

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This past week, after much controversy, Blue Shield of California canceled it’s rate increase set for May. It was supposed to be in March, they were asked to delay it 60 days by the insurance commissioner, which they did. So after already having two rate increases since October of last year, Blue Shield canceled this current rate increase and has said no more ‘rate actions’ through the end of the year. Click here for the details.

Basically, it appears that one reason this was able to happen was expenditures for health care services late 2010 were less than anticipated. SO, does that mean everything’s okay?

Not sure; what if expenditures exceed what is expected? Conventional thinking is that when times are tough, people skip care that is not essential. This is either because they have no insurance or their insurance puts more of the initial costs on the member. That’s how you keep insurance premiums down, especially when you hear about rate increases like these.

I’m concerned about what happens next year, wondering if rates will fly up to a ridiculous level. Carriers are being expected to do things and cover services in ways not previously experienced, and don’t know how to price for it, so they shoot rates up. And it’s not just Blue Shield, it’s happening with all the carriers.

So to all of you who said to me ‘hey, I thought health care reform was supposed to drop rates,’ I told you it wasn’t going to happen any time soon. Believe me, I’m sorry I was right!

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