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Health care reform compliance, and the IRS is going to be the monitor?

01-14-2011by Colleen King

I came across an article recently published by USA Today that reminded me of the big wake up call we have coming in 2014 when the bulk of the health care reform measures go into effect. Check out this article by Sandra Block, “IRS lack clout to enforce mandatory health insurance.”

This article lists estimates of needing 16,000+ IRS agents to enforce this eventually. The Congressional Budget Office is estimating the cost at $5-10 billion to administer this. And that’s just the start.

My concern along with other agents in California is the price tag on all the changes. Even though people aren’t happy with rates in LA and Ventura counties, you are definitely paying less than places like Massachussettes, New York and New Jersey. And now that you are looking at eventually subsidizing people, not excluding for pre-existing conditions, rates will soar. But the IRS can’t apparently enforce these new provisions in the law.

For example–30 year old male in New York City, hospital only plan would run $176/month. No deductible, but no coverage for office visits, most outpatient care or prescriptions. Which is more of what a 30 year old would need. You could get something comparable in the SFV area for $78-99/month, but there would be a deductible.

The same 30 year old, wanting a more comprehensive plan, opts for a $2000 deductible, $30 office visits, 80/20 coverage, sounds great right? Are you willing to pay $529.06/month for that? That’s a real figure for the 10009 zip code. I can find $2500 deductible, 70/30 plans with three office visits per year with generic and brand coverage for $111/month here in the Los Angeles area.

So you might want to look for coverage now, while it’s affordable in California. No one really knows what will happen once all this starts to kick in. Pretty scary!

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What? The plan for ‘uninsurables’ is filling up? What now?

01-01-2011by Colleen King

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 ...read more





So now that health care reform is starting to hit, will it all really work?

12-09-2010by Colleen King

Once again, Robert Laszewski, the ‘go to’ guy for all things health care reform or industry in general, wrote a very insightful blog post this week on the how the fact that there isn’t bi-partisan support for the health care reform bill could ultimately lead to it’s evisceration. Click here for a brief, terrific article.


The Dems can’t even agree at this point, let alone both sides of the aisle. States are looking to drop out of the requirements because participating in exchanges, etc., could ‘destabilize’ the market by causing carriers to leave their states. California was one of the first to try creating an exchange, but the support is questionable.


How is health care reform affecting you? Rates in a lot of areas of So Cal, let alone the country, are going up to accomodate the requirements like taking on kids up to age 19 without regard to pre-existing conditions. The back lash? Several carriers are no longer writing ‘child only’ policies because they are assuming only the sickest will rush to buy coverage. So this takes away an option I’ve used with clients when adding kids to their group plan was really expensive. I’m still waiting after two months for Anthem to release their better individual plans–they’ve been held up because of regulatory review in Sacramento. Any time carriers make material changes to plans they have to go through review, so not sure what’s holding the party up. I have a list of a dozen clients that I need to rerun proposals on once the Anthem plans are available in our area. Free quotes are the lifeblood of my business but sending them plans that I don’t think really fit the bill or aren’t much less expensive makes no sense.


So in short, have patience with your agent–we’re all going nuts!

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Category: Uncategorized


Health care reform laws are starting to be successfully challenged in court–or are they?

10-11-2010by Colleen King

Hello LA, I’m back from vacation and certainly while I was gone there were a lot of things going on in health care reform


In Friday’s Los Angeles Times there was an AP article about a federal judge in Detroit who ruled against a challenge contesting the legality of the Federal government requiring people to buy health insurance. According to U.S. District Judge George Caram Steeh in Detroit, the ‘mandate to purchase’ is legal. Or as the paper said, ‘is not illegal’–when it comes to things like this, there could be a difference, you never know.


The point is, we are already seeing the impact of ‘mandate to issue’ coverage to kids under age 19 regardless or pre-existing conditions. (Click here for details.)  Most of the major carriers in California  are no longer issuing ‘child only’ policies. You can add your kids to your group coverage or your family’s health policy but the rates are starting to pop. Common sense will tell most of us, if the carriers have to issue coverage to ‘all,’ who are the first people going to be in line to get it? Sick folks, folks with problems, that should not come as a surprise. And if everyone is not required to buy, people will tend to buy only when they need it then drop it when all’s well. That isn’t going to work financially.


I’d like to convince people that everyone should have coverage as a means of making the overall concept work, and protect themselves financially but most would probably think I’m only looking for the next sale. But the reality is, this reform is only going to work if everyone’s in the pool, so to speak. And don’t think this will be the last court challenge, there are already several in the works and it’s only getting started.


There’s a case being heard in a Florida court that’s been filed by 20 states, and another one in Virginia. So stay tuned, because whatever happens it will affect us at some point in So Cal.



Have a great week!

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Category: Uncategorized


How can I make long termr care insurance more affordable?

08-27-2010by Colleen King

Some people think they have to have a long term care insurance (LTCi) policy that covers everything for many years. Often people want to look at a ‘lifetime’ benefit, maximum daily or monthly benefit amounts, and a few other things to minimize their out of pocket expenses when care is needed. But then they get the quote and it’s astronomical, perpetuating the idea that LTCi is too expensive.


But do you need all that coverage? You need to know that LTCi, like health insurance, is not intended to pay 100% of the cost. It’s intended to cover a majority of the expenses though. Here are a few tips around the pieces of a long term care policy to consider to make it more affordable:


Benefit Period–people frequently want lifetime benefits but the reality is once someone is receiving custodial, nursing home or assisted living care, the average length of time care is needed is about 2 1/2 years. We’re not talking about something simple you need help for a few weeks then you’re fine. We’re talking generally older people closer to the end of life. And now, some carriers don’t even offer a lifetime period. I usually start with clients by looking at a 3 year benefit period. If they can afford it and they want it, we may go to a 4 or 5 year period, or cut it back to 2 years. Remember, Medicare will pay for a limited amount of skilled nursing care only. And who knows, that may change at some point the way things are going.

Elimination Period–Some people also refer to this as a ‘time deductible.’ This is the period of time that you actually need care before your policy kicks in. My starting point is 90 days. The reason is that if you need skilled care, Medicare or your private insurance will cover usually about 100 days. If you need home custodial care, it’s possible to add an inexpensive rider that will give a zero day elimination period for home care. Depending on your finances, you might want to stretch out the elimination period to 180 days.

Inflation protection riders–You most likely will want this in some form. The inflation protection piece makes your daily benefit amount increase a certain percent on the anniversary date of the policy each year. Ideally, especially if you are younger, you should really consider a compound interest rider. This is usually less expensive than starting with a significantly higher daily benefit amount. If you are a bit older, you might be able to get away with a simple interest inflation protection rider, because in that scenario starting with a higher daily amount and simple interest could be less expensive than a comparable policy with compound interest.

Different insurance companies offer different combinations in elimination periods, different riders, benefit periods, all sorts of things. So if the first quote you get sounds ridiculous, ask questions, either of the agent you are working with or ask another for information. Because the government isn’t going to take care of this, and you probably don’t want to saddle your kids with your care.

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Category: Uncategorized