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


So, should all health plans have to cover all things, or should we have some choice in what we buy?

07-07-2017 by Colleen King

The goal with the Affordable (?) Care Act (ACA) was to cover the majority of health care related expenses for the most people possible. But did it go overboard?

Plans cannot have a 'life time maximum' anymore, but that's a big disingenuous because the majority or people never come near the $1-$7 million life time maximums a lot of plans had, ALL plans have to cover the 10 Essential Health Benefits outlined by the law, which include the following:

  • Outpatient care
  • Emergency Room Services
  • Inpatient Hospitalization
  • Maternity Care
  • Mental Health/substance abuse treatment
  • Prescription drugs
  • Habilitative/Rehabilitative service (things like physical therapy)
  • Lab services
  • Preventive services
  • Pediatric care, including the beloved Pediatric dental and vision

On the surface, this makes sense to an extent, but when you have to consider all of these items have to be 'priced in,' that drives up costs. Pediatric dental and vision is probably good, but I have a lot of clients not thrilled with this because either they don't have kids, or their kids are over 19 so they aren't covered. The same argument could be used for maternity care. It's covered across the board, whether you're male, over the common age to have a baby, whatever.

So here are my thoughts on what could be workable, based on what my clients have been happy with in the past, and would like to see now...

Maternity care--we used to have plans that did not cover maternity, which was okay for people not planning on having babies. Carriers should be able to offer plans that don't cover maternity, but to keep cost on maternity plans reasonable, there should be a requirement that it be covered on a certain percentage of plans, maybe 50% of what they offer?

Prescriptions--We used to have plans that covered generic drugs only, or some that had no prescription drug coverage. I don't necessarily want to go back to NO drug coverage, but people liked the 'generics only' plans, knowing that they might get hit if there was a brand drug needed. They were willing to take the chance.

Pediatric dental and vision--this may be a good thing, but there are NO dollar limits on the amount of pediatric dental care, and no waiting periods for major services. Braces are covered, but only when 'medically necessary,' and as most of us know, often times braces are more cosmetic in nature. Any time there are no 'limits,' you're setting things up to be taken advantage of. Maybe there needs to be an annual limit, more generous than the typical $1000/year, but not unlimited.

Habilitative/rehabilitative care--this is a tough one. There don't appear to be limits on the number of visits, it's going to be based on 'medical necessity.' These are services like physical therapy, occupational therapy and speech therapy. There are many scenarios that are not '12-20 visit' situations but when I was a utilization management nurse years ago, we saw a ton of abuse in PT and chiropractic care. And speaking of Chiropractic care, it's not a 'required' service, and now most plans don't cover it! Can we go back to this at least being covered in some way under the physical therapy benefit? That's nuts!

The rest of these are pretty broad, it would take weeks of writing to delve into these. We used to have higher deductible plans, some with  50% coverage after meeting the deductible. Plans like that weren't for everybody but for some of my older clients, they liked those because it helped to keep premium costs down, they had savings if something happened. I heard many times from clients 'I just don't want to lose my house if something major happens.' Makes sense! Let's bring back some sanity to all of this.

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Category: Health care reform



SB 562, the Single Payer bill, has been pulled--why it is not time to cheer yet

06-27-2017 by Colleen King

On Friday, the encouraging news that SB 562 will not be heard just yet on the State Assembly floor came out, and kudos to Speaker Anthony Rendon (D-Paramount) for having the foresight to pull this--for now...

It was encouraging from the perspective that he cited the bill as being 'woefully incomplete' and that he didn't get sucked in by the emotional argument that the 'conversation has to be had.' It may need to be had, but as we saw with the Affordable (?) Care Act, there was a ton of detail left to 'be discovered,' and look at the mess we have now. Funding of this has sort of been addressed, plan designs have been lightly touched on, but as we all know in all big projects, the aftermath from major parts of a project not being thought out in advance causes a mess. We often end up with legislation that started out in one direction but went another. Check out Melanie Mason's article in the Los Angeles Times last Friday as it outlines where we're at for now. http://www.latimes.com/politics/la-pol-sac-single-payer-shelved-20170623-story.html  Also in there, click on the link to 'what would single payer mean to me'--frighteningly enlightening! http://www.latimes.com/politics/la-pol-sac-single-payer-explainer-20170601-htmlstory.html

Why we can't let down our guard on this, the State Legislature has a 2 year cycle--this is just the end of Year 1, so if SB 562 gets reworked, it may very well come back for a vote in the Assembly. And depending on your views, you certainly don't want this to slip through unnoticed. Remember, as it's written now, the intent of SB 562 is top replace ALL health insurance in California--employer based plans, your individual plans, Medicare, MediCal and services provided through the regional centers for the developmentally disabled.

So stay tuned, stay 'subscribed' here, because I'll be keeping tabs....

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Category: Health care reform



Short term health insurance--good new or bad news?

06-16-2017 by Colleen King

Short term plans are under fire, or at least were under fire, by the previous administration. They didn't meet Affordable (?) Care Act standards, they were medically underwritten, meaning people could be declined for pre-existing conditions, and the don't cover pre-existing conditions.

I call these 'accident and illness' plans--sure they don't cover any of the aforementioned issues, but if you missed open enrollment, if you lost your job and maybe missed the 'special enrollment period' to pick up an indivdiual plan, these are good for the short term. But the 'powers at be' have decided these are BAD--I think they are better than nothing. If you had one of these, at least if you got sick or were injured, then you'd be covered subject to the deductible.

And wasn't that the point of the ACA, getting more people covered? But apparently we need to have only what the government wants. If you go uninsured for more than 90 days, then you are subject to the penalties for being uninsured. And these plans, because they don't contain the 'minimum essential benefits,' do not exempt one from the penalties for being uninsured. But I still like them on a limited basis. Something is better than nothing for emergencies. I only have one carrier offering these now, and I like the way they do it, they are guaranteed issue. BUT, they don't cover anything pre-existing which is defined as something you were treated for, or saw a provider for, within the past 12 months.

We can only do these for a maximum of 3 months, and they can be paid for either as a lump sum or month to month. We can do with this one carrier a maximum of 4 three month terms. Would I encourage someone to drop a compliant plan for one of these, of course not. But as with anything, there is a time and a place for short term medical--call me if you want to check it out.

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So, how is SB 562, the Single Payer bill, going to be paid for?

06-14-2017 by Colleen King

I think we've established that health insurance rates have gone nuts, health care reform has gotten some people covered who couldn't get it before, but from my side of the desk, there are still problems that need to be worked out. So along comes SB 562, and all you need to do is get rid of the greedy insurance companies, let the state take over, and then it will all be fine--really?

I was at a town hall meeting weekend before last sponsored by a couple of our local state legislators who think this is the way to go. The current estimate before even getting started is $400 billion, which is more than the entire state budget. Where will that come from? Well, keep in mind that if this bill passes, the intent is that it will replace ALL health insurance in the state--plans from employers, individual health plans, MEDICARE, MediCal, TriCare, Children's Health plan and even the regional centers that help the developmentally disabled. The intent is that they (the appointed, not elected, board who will run this) will then work to secure waivers for all federal programs to have the funding rerouted to the tune of $200 billion to help pay for this. Good luck with that.

The remaining estimated $200 billion will come from thee and me--there is talk of a 15% payroll tax, 2.3% sales tax, a gross receipts tax of 2.3% on business making more than $2 million a year and who knows what else. But that's okay, because we won't be paying insurance premiums. Hhhmmm....what about the people that aren't paying them now? The estimated cost per person is $9200--not per household, per family, but per person. I have a tough time believing that Washington DC is going to grant the re-routing of Federal funding to start a new program, but I'm no clairvoyant.

And all of this is without truly knowing the cost of the plan ultimately. How are doctors and hospitals going to be paid? If it's based on Medicare or god forbid, MediCal rates, physicians are already not happy with that, so good luck. And the way the plans are proposed to be structured, there will be no deductibles, no copays, just go and be taken care of. That's not going to cost a fortune is it? Keep in mind, 'free' is very expensive--read on.

At this town hall, there were representatives from the California Nurses Association who are strongly behind this. There was one impassioned woman who was convinced that the study they commissioned would save around $37 billion, because we're already spending $368 billion, and by getting the middle man out of the way, doctors and nurses would be able to just take care of people without 'red tape,' seeking authorizations, and dealing with bureaucracies. That's when I had to step away.  So, I guess she's saying they can do whatever, whenever? I'm a nurse, I'm still licensed as an RN, and this isn't my first rodeo. Do you know why insurance cost went up over time? Cost of care went up over time, and then there's fraud--insurance on all fronts has it, whether it's private insurance or Medicare/MediCal. Who's going to be watching that? And Page 7 of this study said, they can't account for everything, basically this is an educated guess. 85 pages of educated guessing. Not to slam it, but it's not THE definitive explanation of how it will work. It's an educated guess, haven't we had enough of those?

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Category: Health care reform



What does Single Payer health insurance mean and what is SB 562?

06-03-2017 by Colleen King

Okay, I've been MIA as far as writing articles because things have been busy, including me getting married. But the prospect of SB 562 passing in our state has made me shake the dust off my writing.

SB 562 is proposing a 'single payer' system--this means the State of California would be paying the bills. NO more insurance companies, no more private insurance, individual or group health benefits. Or Medicare. Or MediCal. The current cost estimate is about $400 billiion a year, which is about double the entire State budget. Where is that going to come from? Well, part of it, according to the authors of the bill, would come from the existing funding from the Federal Government for Medicare and MediCal. Really? That's a stretch, as the Feds would have to sign off on that, so who knows. That would account for about $200 billion of the funding, the rest would need need to come from taxes.  Great.

There are many facets to this concept, so there will be more articles coming soon. Two terms that are interchanged, incorrectly, are 'single payer' and 'universal coverage.' They are not synonymous. Single payer means one entity writes the checks, universal coverage means everyone's covered, or able to be covered, but there could be more than one 'payer.' So in theory, with the Affordable (?) Care Act, we have universal coverage, everyone has access to coverage but not everyone buys it.  We still need to deal with affordability, which the ACA hasn't necessarily done.

SB 562 was passed in the Senate yesterday, now it goes to the Assembly. It's a flawed bill, another one of those 'pass it, then we can work out the details' kind of thing. Sound familiar? I watched some of the hearing yesterday, and support and opposition pretty much fell along party lines. But there were a couple of Dems who really pulled a fence straddler, in my opinion. They talked about the flaws in the bill, how incomplete it was and how 'ordinarily' they wouldn't vote for something like this but they like the general concept and there still needs to be a conversation on the subject. So this way, no matter what happens, feels like they can proclaim victory for their vote. Oh geez!

Of course then there is the little discussed hidden secret, that more Dems are against it than are willing to admit it. They are presuming Gov. Brown will veto it, that's their safety net. So they can appear to be for it, then be protected from the fall out if the Governor vetoes it. Keep in mind, this is the same State Legislature that had a bill a couple of years ago that would require all legislators to buy through Covered California, the health insurance exchange, and it didn't even make it out of committee, it crashed and burned before it could go for a vote. Talk about hypocrisy! Here's a link to an LA Times article yesterday about what this could mean for consumers. It's not completely unbiased of course, but we 'have to start the conversation.' http://www.latimes.com/politics/la-pol-sac-single-payer-explainer-20170601-htmlstory.html

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Category: Health care reform