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Colleen King - Blogs

Health care reform

What’s an insurance exchange?

08-21-2012 by Colleen King

You may be hearing about this more and more in the news these days. Will they be of help to you? Here’s some info, with a bit of my ‘opinion.’

Health care reform proponents wanted to create a ‘marketplace’ where people could go to compare different types of coverage, get help figuring out what plan will work best for them. In the insurance agent community, we weren’t exactly sure what that meant, since wasn’t that we did already? Go to my web site, check out the plans, or call me and I’ll check some out and make suggestions, all without creating a new government agency.

There is still LOT to be done in establishing the exchanges as each state is to create one, or if they don’t want to, the federal government will do one. The biggest difference, is if you are eligible for a subsidy from the feds to purchase coverage, you can ONLY buy from the exchange. Agents in California supposedly are going to be able to offer plans through the exchange, but details on that will need to be worked out–like commissions.

There is a lot more to be figured out, like cost, what will the plans look like, which insurance carriers will be participating, and this needs to be created for both individual/family plans and small group plans. Will it help affordability? Not sure, that will take some time to figure out. And keep in mind, it all has to be up and running by January 1, 2014. Not very far off…. more

Expensive health care, mediocre results–really?

11-30-2011 by 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? more

Health care reform and the role of the local broker–more important than ever?

11-02-2011 by Colleen King

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. more

Health care reform made all preventive care free, right?

09-23-2011 by Colleen King

In the effort to increase access to care the Patient Protection and Affordable Care Act (PPACA) mandated that preventive services be covered on newly developed plans with no share of cost and before a deductible is met.

Or so we thought–Check out this article from the US Department of Labor. One thing that was not really mentioned is where you go for services may determine whether or not there is a sharing of cost or not. The example here is that if you go to a free standing, ambulatory surgery center for a colonosopy, you probably won’t have a co-pay. But if you go to the outpatient department of a hospital, you probably will because cost of care at those types of facilities typically is higher.

So that’s why I call this the asterisk, or the footnote, yet another, in health care reform. The bill was passed with little detail really delineated, just a ton of concepts. So my advice So Cal, is if you have to have anything more complex than a blood test, so you minimize your costs call the member services number on the back of your insurance card. We have a lot of free standing ambulatory surgery centers in Los Angeles, and a lot of hospitals. Make sure you find your most cost effective options! Money’s still not growing on trees, at least not in the San Fernando Valley.

Have a great weekend!. more

Who has the most expensive health insurance premiums for individual plans in the country?

08-17-2011 by Colleen King

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, 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. more

How fast can you get me health insurance?

08-15-2011 by Colleen King

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! more

Health Insurance, the letter of creditable coverage and why it’s important.

03-23-2011 by Colleen King

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! more

Blue Shield canceled it’s latest rate increase–is that good?

03-19-2011 by Colleen King

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! more

Prescription drugs and the high cost of health insurance–related?

03-01-2011 by Colleen King

Okay, so it’s one reason that insurance premiums are so high, but it’s a big one.

On AOL today there was an article about several drugs that will be coming off patent–big name drugs like Lipitor. Drug companies, in order to recoup their ‘research and development’ costs have exclusive rights to a drug they develop for several years. Read here for more. And check out the BILLIONS in sales each of these generates!

Is your drug on this list? Well, if you take Lipitor, Protonix, Zyprexa, Concerta or several others, over the next 2-3 years you’ll see a drop in costs. If you don’t have health insurance, one thing that I’ve told my clients to do is check at Costco. You don’t have to be a member for prescription purchases necessarily. They have a ‘price checker’ on their site that I refer to often. Prices can vary by location, and the pricing here is based on buying from Check your local Costco to see what the cost actually is. The one in Northridge near me is usually pretty close.

Point is, to bring down the cost of health care in general and insurance too, you have to be a saavy consumer. Many studies show that people spend more time researching an auto or TV purchase that things related to their health care. Enough of ‘buyer beware,’ time make smart choices. You can start with your drug purchases. more

What do I do about a ‘child only’ health insurance policy in California?

01-24-2011 by Colleen King

When health care reform was voted in last year, one of the first items that when into effect September 23, 2010 was the guarantee issue of plans to kids under age 19 without regard to pre-existing conditions. Problem with that was that insurance carriers had no idea what the liability was going to be so instead of risking a big financial hit, several opted not to write ‘child only’ policies since obviously, the most likely people to try to get coverage were those who had medical needs.

Well, the California Legislature passed a bill requiring carriers who wanted to sell in the Individual plan market in California has to participate in an ‘open enrollment’ period for kids under age 19. This all came about fairly late, there are things still to be determined but in a nutshell, here are the basics:

Open enrollment is January 1 to March 1. If you miss this time period, there is also the month of the child’s birthday.

These parameters may change in the future. These time frames do not apply to having kids on your family’s insurance plan. There are a few other circumstances so call me if you have questions.

So if you need coverage for your kids, or if you have friends with kids, please share this information with them. Call me, call your agent if you have one other than me, just get the ball rolling because time is limited! more

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

01-01-2011 by 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 more

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

12-09-2010 by 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! more

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

10-11-2010 by 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! more

How can I make long termr care insurance more affordable?

08-27-2010 by 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. more

Nice to know SOMEBODY likes insurance agents; guess who?

08-19-2010 by Colleen King

The word is out–according to Alison Bell of the National Underwriter web site insurance commissioners in several states, including California (Thanks Mr. Poizner!) have come out with a resolution urging keeping a role for the independent agent as the PPACA (aka health care reform) moves forward. Check this short article out.

Makes sense if you think about it. People generally don’t understand health insurance now, and every other day there are new things coming to light with the new health care reform bill. Someone needs to explain it and help people make decisions. So does it make sense to create another government bureaucracy from scratch, hire all those people who require desk space and benefits? Or go with the independent agent structure where we don’t make anything unless we do something for someone. And no one has to give us benefits necessarily.

Of course I’m biased as an agent. I have a business that fits well with the So Cal lifestyle. I can work 6 hours a day, or 12 as needed. As new employer regulations come in, employers are going to need a resource still. Someone that will go to bat for them when there’s a problem, because they are running their own business. And everyone needs help decoding their explanations of benefits.

Between massive egg recalls and Dr. Laura quitting radio, there’s just TOO much to keep track of! You’ll want to keep us around….. more

The Connection Between Health Care Reform and Preventive Services coverage

08-11-2010 by Colleen King

One of the big things that was to be emphasized by the Patient Protection and Affordable Care Act (PPACA) was removing cost barriers to many preventive services.

July 14th the announcement was made by the White House as to what those services are–click here for what is the current comprehensive list:

Covered Services

These services as of September 23, 2010 are to be covered without ‘cost sharing’–before the deductible has been met; no co-pays, no co-insurance. But predominantly on ‘new’ plans. Some of the existing plans will adopt these provisions.

So is this a good thing? People can’t afford to pay for these services so they don’t obtain them in theory. My biggest concern is that we are about to see the ‘Affordable’ go out of the Affordable Care Act. Think about it–these are not ‘free’ services, since someone is going to want to be paid to do them. They are free to you, but they aren’t free.

I’m not being a grinch about this, just a realist. Insurance carriers are going to have to pay someone to do these. And someone’s going to have to pay the insurance companies. Three guesses who that is…..

So IF you have preventive services you need done, check the list above. If you can wait, you might save some money if you do them after September. IF your plan works that way. IF they’re a covered service. IF there isn’t some other question that didn’t get answered on the White House call yesterday.

Don’t want to be a downer, but there are SO many questions that haven’t even been asked yet, let alone answered, just please tread carefully. And stay tuned. more

What’s going to happen with health care reform and individual health plans after September 23, 2010?

08-10-2010 by Colleen King

Remember the old phrase ‘be careful what you ask for, you just might get it?’ Well, Anthem Blue Cross put out an email yesterday to agents advising us that due to the new changes resulting from the Patient Protection and Affordable Care Act (PPACA), also known as health care reform, if you are looking for an individual plan with them you have until September 22. After that, they will have to update their plans, their software (and presumably our software, those of us who have their own quoting sites) with the new plans and rates that will be effective September 23.

Now, before you go as nuts as a Jet Blue flight attendant (gotta love that guy!) think about doing something sooner rather than later. Right now, we know what the plans are and we know what the rates are. Anthem currently offers a 12 month rate guarantee, so whatever you enroll in now, you will maintain that rate for 12 months. Since we don’t know what is coming, I’d vote for a bird in the hand.

Carriers are going to be required to include certain benefits and that will probably raise rates. And it’s not only going to be Anthem, all carriers are most likely going to be doing something in order to comply with the new law. This is just the first we are really hearing about it. Why am I fairly sure rates will go up? Two things in particular–people under age 19 will no longer have pre-existing conditions held against them, and there will no longer be annual or life time maximums allowed on plans. The latter frankly won’t have a huge affect overall. Most plans in California have anywhere from a $3-$7 million life time maximum, which the vast majority of us will never come near. But, it will be a reason to increase rates in anticipation. The scarier part will be what happens when they have to take all applicants.

Basically, this is just the beginning of sweeping change. We’re trying to keep up, but since so much of this was not worked out at the time the bills were passed, and still hasn’t been, it’s time to hang tight and hope for the best.

A light humorous look at health care reform more

Health care reform’s high risk plans are being set up in Michigan and New York, what about California?

08-10-2010 by Colleen King

There have been a couple of articles the past couple of days about the Pre-existing Condition Insurance Plans (PCIP) that are being set up in Michigan and New York. You might want to check these out as they will be an example of things to come. Michigan’s PCIP plan and New York’s PCIP plan, called the Bridge Plan.

New York has received just short of $300 million and Michigan $141 million of the $5 billion set up by the federal government to put this into action. None of the articles I’ve read on this in general have talked about how much the cost is going to be to the people who can’t qualify for insurance on their own, but the word ‘subsidy’ in many forms have been used is all of them.

What about California? Well, we’re not quite there yet. There is proposed legislation AB 1602, that is meant to set up an exchange, but there are some definite flaws and the insurance industry in CA is trying to mount opposition. We want to see changes too, that’s not the problem. We just need the right changes.

First, there is no ‘open meeting’ provision, minimal to no regulatory oversight and with a $30 million budget being proposed, you want some sort of oversight, come on! Additionally, it presses for standardization of plans being offered, meaning there could be as few as 10 plans offered. And because some would be HMO type plans and those aren’t always available in rural areas, there could be fewer than 10 plans.

As an agent, the requests I get for plans really vary. Some want high deductibles of $5,000-$10,000 and others don’t want anything higher than $500-$1000. Some want HMOs, some want PPOs. Not all doctors are contracted with all plans, so then what do you do? You want to avoid seeing non contracted doctors when possible because the coverage from your insurance carrier is lower.

There are many other details in this, but basically it is just not a well written bill. There needs to be a larger selection/variety of plans, and let the free market sort it out. When insurance carriers introduce plans that don’t sell well, they stop offering them. And the thought of a government entity running a ‘new’ program with minimal to no oversight, uh, yeah, right.

We already have a budget problem in this state, and theoretically someone’s watching. Let’s not let this spread….. more

Can I check out health insurance rates? What’s involved in them always going up?

08-04-2010 by Colleen King

Okay, I realized today that I’ve evolved into the ultimate insurance nerd. A few of weeks ago I subscribed to a service with the California Department of Insurance (CDI) where I can receive certain updates as they come in. Previously I got things on licensing requirements, you know, the usual professional stuff.

But now I’m getting information on when insurance carriers file their new rates for ‘approval’ with the CDI. This isn’t easy stuff to read, so if you’re having a bout of insomnia one evening, you might consider checking out rate increase information as it is submitted.

So I started out with Aetna, and wasn’t going to be deterred by the fact that it was 93 pages. What you will see if you check this stuff out is what’s being proposed for new business rates quarter by quarter. Aetna and most other carriers have a 12 month rate guarantee so your rates don’t go up right away but as you all know they do go up at least once a year. But reading all that is taken into consideration, hhhmmmm. I knew the basics but looking at this was a bit daunting.

Then I decided to check out Anthem–their latest filing was 386 pages. But that’s because they have a billion plans and a somewhat convoluted way of assembling their rate sheets. But I went through it all anyway, looking to see what would potentially be happening with my rates once my guarantee expires. I’m not thrilled. If it read it right, it will be going up about $50/month.

You have to know that all carriers in our area are going to have to be doing something in order to comply with the new health care reform bills. And that is listed in these filings as a reason for the rates; no more lifetime maximums, preventive services covered with no cost sharing, no limits on complex radiology and lab tests, and so on. These are all going to add to their costs, once people catch on to particularly the preventive services piece. Check out what is being included in the preventive services arena.

My advice? Not only are rates going up, but many plans will be changing as well. If you are in the market for an individual/family plan, get rolling on it ASAP so you can take advantage of the carriers that offer a 12 month rate guarantee. more

Leslie Margolin leaving Anthem Blue Cross–is that good?

07-29-2010 by Colleen King

The news came out last week that Leslie Margolin was leaving Anthem Blue Cross and I had to wonder why. Of course, there’s the obvious, the blow out earlier this year when the rate increase craziness hit. But that was months ago, and things had toned down considerably. Click here for a short story on this.

I heard her speak at a forum earlier this year in Woodland Hills, and she seemed like a very nice, nose to the grindstone kind of person. In asking my account rep at Anthem about here, he commented that people would be surprised at how geared toward a desire to provide a more universal type of health care she was.

Let’s face it, NO ONE was going to win in the position she was in. She did diversify the product portfolio considerably in her time there, which makes me wish some of the other carriers would do a bit of that too. While overall I like what they’ve done, I like to have more than one carrier to chose from and when their pricing beats everyone out overall, there’s not a lot to suggest outside of Anthem. People these days have to watch their budgets. I regularly have account execs tell me I should be selling on the benefits of a plan, not just the price. I do that to an extent, but if you have two similar plans, one $100/month less than the other, that’s usually the only benefit most folks want to look at. And I can’t blame them.

I hope Ms. Margolin does well at her new job, and would love to pick her brain one of these days on this whole mess! more

How is the IRS going to ‘enforce’ mandatory health insurance in the new health care reform bill?

07-14-2010 by Colleen King

I came across an article last month that was published by USA Today on April 30th that to me, outlines just a part of the big wake up call we have coming in 2014 when the bulk of the health care reform measures go into effect. If you can find it, check out the article by Sandra Block, “IRS lack clout to enforce mandatory health insurance.” Sorry, I waited to long to post this and lost the link. But my article will give you the basis for my concern.

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.

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! more

What are some key items I need to know when opening a health savings account?

07-04-2010 by Colleen King

In my last article I mentioned the first key point with a health savings account (HSA) that in order to use the money to pay for expenses, the expenses MUST occur after the account has been opened. Not necessarily fully funded because you can deposit money and and reimburse yourself after the fact. You just have to have opened the account prior to incurring the expense. And the account has to be opened after you have the appropriate insurance plan, as a reminder.

Other things to consider when opening an HSA:

* Once account or two? Well, only one name can go on the account. For a married couple or domestic partners, once account may be okay. But if both are over age 55, and they are both on an HSA eligible plan, consider opening separate accounts. The reason is after age 55, people can deposit an extra $1000 per year on top of the $3050 maximum for 2010. If you only have one account, only the person on the account can do that, so consider talking to your tax professional for the best route. I don’t consider an HSA the first place to put money, but if you’ve maxed out all your other pre-tax options and you are looking for another place to put some money that can grow tax FREE, this can be an option.

* Fees–You really have to look at this. If you are like most people and you don’t want to dump a large amount in right off the bat, fees of $3-$10 a month will eat into your principle. Many accounts offer low or no monthly fees. You also want to look and make certain there are no ‘per transaction’ fees.

* Investment options–As your account grows, hopefully, because you’ve been able to put money in it and not had sizable expenses, some people want their money to get some growth. Many accounts offer mutual funds after you reach a certain balance. But be sure you aren’t gambling with the rent money, so to speak.

So these are the main things people have questions about, or don’t know to ask. Many banks, credit unions and others are now offering HSAs. You can go to your regular bank but again, look at the fees in particular. If you want to see what’s available, go to This web site is like a central repository that lists many entities that offer HSAs, and I go there regularly to look.

Remember, an HSA is like most other accounts, in that you can transfer it to another HSA if you find better rates. Just don’t have the old agency give you the check to redeposit, as that might trigger fines and penalties you shouldn’t have to pay.

One last thing–Happy Birthday Mr. Obama–talk about a lonely job right now! more

When should I set up my health savings account–does it really matter?

07-03-2010 by Colleen King

Health Savings Accounts (HSAs) have been a great way to go to ”self fund’ eligible health care expenses. You can even use it for most vision and dental expenses even if you don’t have vision or dental insurance.

But the reason you have an HSA usually is for the fact that the money you put into the HSA is tax deductible. if you had a sizable expense, wouldn’t you like to be able to maximize the tax benefit? Here’s something most people miss. First, what most people do know is that in order to have an HSA, you have to have a qualified high deductible health plan. Once you have that approval or enrollment, then you can open the HSA.

Here’s what catches most people off guard though. There are different ways to fund your HSA, either by putting a full contribution in, maybe electronic fund transfer of a couple hundred a month or my personal favorite, I’ll anticipate an upcoming expense, approximate what it will cost and deposit that amount. But if you have an expense that catches you with a low balance in your HSA, you can pay for it in a regular way, credit card or check and reimburse yourself.

But to legitimately pay for an expense out of your HSA by any of the aforementioned ways, the account MUST be established prior to incurring the expense. Most people don’t know that, they think it just has to happen after you have the health plan. This basically is an honor system, meaning that generally no one is looking over your shoulder on this but if you faced an IRS audit, you do need to keep your receipts for expenses and you’ll potentially need to prove that the medical issue occurred after the HSA was established.

That’s why I tell my clients who are wavering as to whether or not they want to establish the HSA to open one as soon as you are eligible, then just put some nominal amount in it. That way you can add to it later in case something major happens. This came to light when one of my clients called and asked me where again to open their HSA. The husband had an emergency, they were going to open the HSA, drop the maximum amount into it and pay the hospital bill. Unfortunately, that wasn’t going to work.

So set up your account. Lots of banks, credit unions and others offer them. For a nice clearing house web site that lists who is offering them, go to But be sure to verify the details on the account, because sometimes this site misses a couple of things.

NEXT–tips on what to look for when you set up your HSA more

Health care reform, small business and and NFIB’s input–a must read!

05-27-2010 by Colleen King

A few days ago I wrote about how convoluted the small business tax credit for group health plans was going to be. Here’s a reminder.

Now here’s a commentary on why the bill was bad for small business, and a very eloquent one at that. The National Federation of Independent Business’s (NFIB) president, Dan Danner, points out some very strong points as to why small business is going to get very little help through this, but the government will gain a fair amount in taxes.

Here is one of the worst points:

“This law is death by a thousand cuts for small business owners. According to the Congressional Budget Office (CBO), the overhaul will cost about $115 billion more than first projected, bringing the total to more than $1 trillion. Small businesses will also now have to deal with an onslaught of new taxes and burdensome paperwork.”

So basically, in California, we’re already taxed into oblivion seemingly, so this isn’t going to help. Rather than repeat his points, PLEASE click on this link and read. Almost better than the article itself, click on the tabs for ‘Comments.’

Not many people want to see folks go without health care, certainly including me, but I’d like to see them have jobs too. Having a job means an income, which means food and other basic necessities. This will only hasten the demise of local and small businesses that are the lifeblood of the economy rebounding. This may not seem like an ‘insurance’ related article, but kill off small business, you kill off the economy. Kill off the economy, and there’s no tax money to fuel your benevolent attempt at reform. So no improvement in the ‘health care’ situation. No, I don’t have the answer, but I know this isn’t it. Because with all of this, people aren’t going to be buying health insurance, that’s for sure!

You can’t pay for health care or insurance if there’s no money in California. Remember the phrase after NAFTA passed, ‘that sucking sound you hear is jobs moving south of the border?’ Now that sucking sound is jobs moving to Oregon, Arizona and Nevada. Along with their tax revenue! more

What is your one best tip in getting the most out of your health insurance?

05-24-2010 by Colleen King

With all the discussion around health care coverage, the cost, who’s good and who’s not, I like to see my clients get the most they can from their health insurance.

The big tip–the excitement–drum roll please…..You want to use contracted providers whenever possible. With HMO (health maintenance organization) plans you don’t really have a choice. You have to see doctors contracted with the carrier or your care isn’t covered except in case of an emergency.

PPOs, preferred provider organizations, you have the option of using providers that are or aren’t contracted. If you use a doctor, hospital, outpatient surgery center, whatever, that IS contracted with your insurance carrier you get the benefit of a contracted rate. So even if you are paying for the care, like when you haven’t met your deductible yet, you get the benefit of the contracted rate, also known as a discounted rate or negotiated rate. This can really help–I had blood work that I was billed over $400 for last year, and once the negotiated rate was applied, it cost about $100. I still had to pay the bill, but would the lab have knocked it down 75%? I think not.

So either go to the web site of your insurance company (they all have them) or call them. You can also ask the office or hospital you are going to be going to if they are contracted but be sure to specify if you have an HMO or PPO plan. Just asking ‘do you take Aetna’ won’t help if you have an HMO and they only accept PPOs.

It may seem like a little thing, but believe me, it will make a difference. more

Health care reform and the small business tax credit–what qualifies?

05-20-2010 by Colleen King

As with most things that came out in the health care reform bill, the devil is in the details. The small business tax credit most assuredly included. I am not a tax expert by any means, but my wonderful tax guy, David Marton in Westlake Village, passed this on to me from the Kiplinger Tax Letter. And here is an article with various pieces of information you may find helpful.

So, you will get a 35% tax credit if you have 10 or fewer employees and the average yearly wages are less than $25,000. If you are a tax exempt organization, the credit is capped at 25%. And the higher the average wages, the more full time employees you have, the credit decreases. For example, the Kiplinger letter give the example that if you have 15 employees, averaging $35,000 per year, the credit goes down to 9%. And it’s gone completely if you have more than 25 full time employees or wages average more than $50,000.

And god forbid our government should stop there as far as complexity. Guess who is NOT eligible to be included in this? Partners, sole proprietors, 2% owners of S corporations and 5% owners of C corporations. On top of that, Family Members–including kids, their spouses, spouses and their parents, grand kids, parents, siblings and their spouses, nieces, nephews, aunts and uncles. I didn’t see anything about partridges in pear trees, but I bet they’re excluded too. Then there’s rules around seasonal workers, part timers, it just goes on and on.

Oh Yeah–employers must be contributing a minimum of 50% of the employee premium. Most do, but several of my clients have a fixed amount they contribute per employee, and sometimes that doesn’t calculate out to be 50%.

Then the amount of the credit you take decreases the amount of the deduction you can take for paying premiums. That makes sense, otherwise you’d be ‘collecting’ twice.

And there’s more, so I urge you to contact your tax professional to see how this works for you–or doesn’t–before you make any decisions about your benefit offerings and how they will work with the new credits. And of course, they phase out over the next few years. Probably out the time we figure it out.

Like I said, there’s a lot to this, so stay tuned. more

Some answers to ‘what do I do about health insurance for my new grad?’

05-10-2010 by Colleen King

In my last article I talked about the impending herd of new graduates, high school and college, and that people are now needing to address what to do about their health insurance.

Again, If your high school grad is going to college, then of course they can stay on your group health plan if you want them to. The health care reform bill has passed, one of the FEW things that comes into effect this year is allowing overage dependents up to age 26 to stay on their parents’ plan. That is supposed to to go into effect September 23 this year, but most major carriers have said they will implement this early. But should you do it?

Check the cost of doing this–if you only have one child it might be more expensive to go that way. if you have more than one child on the group plan, usually it is the same cost regardless of the number of kids. So ask.

Other options to consider–There are short term health plans available that I refer to as ‘accident and illness’ plans. Generally they don’t cover maternity, routine care or anything pre-existing. But if someone gets sick or injured, which tends to happen in your 20s, then you are covered subject to the deductible. Because they don’t cover pre-existing conditions, the underwriting review period is very quick and these can be set up in a couple of days usually. They can either be purchased on a month to month basis for a maximum of 6 months, or if you know specifically how long you will need it you can purchase a certain number of days. It’s affordable–one carrier I use for these, in Los Angeles County a 22 year old can get a policy with a $1000 deductible for $87/month. Or if you knew you only needed one month, or 30 days, that same coverage would cost $51.30.

Or, if you’re not sure what the future holds for your new grad, no job prospects on the horizon, you would probably want to consider a regular individual health plan. Rates on these really run the gamut, so I won’t go into a lot of detail here, but for a 22 year old male, in a Northridge zip code, standard rates range from $44 – $440/month.

So there are ways to get your new grad covered; consider talking to an independent agent to sort through the best options for you.

Subscribe above, and keep apprised of insurance happenings. It’s not necessarily as dry as it sounds. more

Graduation time is here, what should you do about health insurance for your new grad??

05-07-2010 by Colleen King

May into June is such a great time for families as their kids are getting ready to graduate from high school or college. A time of pride, sense of accomplishment, it’s great. As I drive around the LA area I see the signs of upcoming graduation ceremonies and it takes me back. We won’t go into how far back.

But it’s also the time to figure out what to do about health insurance. If your high school grad is going to college, then of course they can stay on your group health plan if you want them to. But in general the landscape has changed. Many people are unemployed, or their companies have dropped their health plans. Or it is way too expensive to keep dependents on the plan. Or new grads are coming into an environment where jobs are scarce, and jobs with benefits, even more scarce.

Now that the health care reform bill has passed, one of the FEW things that comes into effect this year is allowing overage dependents up to age 26 to stay on their parents’ plan. That is supposed to to go into effect September 23 this year, but most major carriers have said they will implement this early. But should you do it?

Check the cost of doing this–if you only have one child it might be more expensive to go that way. if you have more than one child on the group plan, usually it is the same cost regardless of the number of kids. So ask. Many times it is more cost effective to go to an individual plan, but if you child has a health condition that will keep them from getting coverage, then leaving them on the plan is the way to go.

Next, some options if you decide to buy insurance on your own 

A 3 minute Video on what’s happening this year because of health care reform. more

I applied for health insurance and the rate came back higher than I was quoted–what can I do?

04-20-2010 by Colleen King

Even though the big, massive health care reform bill has passed, not much will be changing for the next couple of years. So if you’re on your own and needing to buy an individual plan for you and/or your family, how should you do it? Call an independent agent, call an insurance company, or just go online and not deal with any of those pesky people?

Well you know what I’m probably going to suggest, but here’s why. If you go directly to a carrier, they can only tell you about their products. You can go to one of the big online ‘anonymous’ type sites, but do you really know what you are looking at? If you are versed in health insurance, of course you can do this on your own, no sweat. But I find most people are still confused and if they do it on their own, they are surprised with what they end up with.

Here’s another reason to go with an agent. I had a client approved this week, and she had a couple of relatively minor issues, but instead of getting approved at a standard rate, she was rated up 50%! I called her, clarified what the circumstances were for the two reasons given for the increased rate and then emailed my account executive at the carrier. I explained the circumstances, and was hoping he could get the rate from a 50% increase to maybe just a 25%. Imagine my surprise when he came back with a STANDARD rate. I was thrilled, my client ecstatic, the world was a happy place.

Does this happen all of the time? No, not even most of the time. To me, in looking at the situations these issues were borderline. And my account guy being the gem that he is, he agreed. There’s a strong probability that if I had just called underwriting, I wouldn’t have gotten the standard rate back. But maybe I would have.

Point is in all this, most individuals wouldn’t have known where to go with this, would have just said oh well, and either kept the plan at the higher rate or dropped it all together. One of the big reasons for health care reform was for the states where there was little or not competition. And there are some states with only 1-2 carriers. But in California we have 6-7 major carriers and some smaller ones, so there is plenty to chose from. That’s another reason to use an independent agent, so they can help you find what you want and with a carrier that’s best suited for your situation. more

COBRA subsidy is extended–good thing, since California’s unemployment rate is up!

04-17-2010 by Colleen King

On April 15th, Tax Day ironically, Congress voted to extend the 65% COBRA subsidy eligibility period through May 31. Meaning, if you are ‘involuntarily terminated’ from your job and not for ’cause’ (’cause’ meaning you did something wrong) you will be eligible for this extension. Eligible folks can have the subsidy of 65% up to 15 months under the current program. Depending on how much that brings down your cost, you might also consider looking at an individual plan but I know that subsidy is tempting.

Since the news came out today that California’s unemployment in March is the highest ever, 12.6%, up from 12.5% in February, that’s probably a good thing. And most likely California’s CalCOBRA program will follow suit as it has before. From the article above, it sounds like Republicans were balking at this bill which also included increasing unemployment benefits and a few other things (click here to see what all) because it supposedly will add $9 billion to the budget deficit.

After health care reform, what’s another $9 billion?

Be well! more

Health insurance and preventive services–is it all going to be covered now?

04-06-2010 by Colleen King

In the recently passed health care reform bill (yes, THAT again) one of the things that was addressed was eliminating co-pays or cost sharing for preventive services. I haven’t heard how that exactly is going to work, but if it’s like other things I’ve seen, not all things labeled ‘preventive’ will be covered. This link is from another state, but the types of services recommended are pretty standard.

Some carriers on their plans already have low or no co-pays for mammograms, Pap smears and PSA blood tests. Colon cancer screening, usually just a smear but sometimes colonoscopy, is included. Check your plan documents or call your carrier to know for sure. But more expensive things, like most ultrasounds, scans, etc., are not considered regular preventive care. Those are considered more diagnostic in nature, meaning someone is probably looking for a problem, so it’s going to be subject to your deductible.

I’ve come across something in the newspaper and television lately that I’m going to check out and you might want to also. And organization called offers screening packages of tests. You can get a cardiac screening which includes an EKG, ultrasound and arterial stiffness exam, a vascular/stroke screening which includes a carotid artery ultrasound, abdominal aorta ultrasound checking for an aortic aneurysm, and another test that checks for peripheral artery disease. Or you can do both for $199.

These mobile fairs are all over Southern California and I believe across the country. I’m not endorsing yet them as I’ve not used them before but I’m going to check this out. I had a carotid ultrasound earlier this year that WITH the insurance company discount was over $400. I think it’s something to look into though, if you are in your late 40s and up. They offer different series of blood tests, there’s all kinds of things. Cost for these screenings may vary by locations, so don’t hold me to this, check it out for yourself.

This sounds like a cost effective way to at least get a baseline, but is not intended to replace an exam by your doctor. I’m signing up, you might want to check out their site. Got to save where you can!

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Be well! more

Health care reform and reading between the lines, part 1

03-24-2010 by Colleen King

Okay, health care reform–woo hoo! now what? Today’s Los Angeles Times has a good brief overview of some major points of change and I’ve included some of them here. Along with some questions that I feel still need to be answered.


* Provides a $250 rebate to Medicare prescription drug plan beneficiaries whose initial benefits run out. This is good because that whole ‘donut hole’ thing doesn’t make a lot of sense, particularly for people on limited incomes.


* Provides immediate access to high-risk insurance pools for people who have no insurance because of preexisting conditions. Well, we already have a high risk pool in California, referred to as MRMIP. Problem is, it’s really expensive and half the time, you can’t get anyone on it due to a lack of funding.


* Bars insurers from denying people coverage when they get sick. What does this really mean–ANY coverage, or high cost services, or things that weren’t going to be covered to begin with?

* Prevents insurers from denying coverage to children who have preexisting conditions. Children, not adults yet. And what about rates? Anything about cost containment included in here?

* Bars insurers from imposing lifetime caps on coverage. There are some low end plans that have ridiculously low limits, either lifetime or per year. Most though, at least in the California individual market, have limits of $3-7 million lifetime. Most of us won’t ever come close to that, so this isn’t always as big as it may initially sound. Once again, for me, this means you really need to look at what you are buying and have a good agent you can talk to about what you are buying.

* Requires insurers to allow young people to stay on their parents’ policies until age 26. Well, most plans they could already stay on until 22 or 23 if they were full time students. If they have health issues, this is good. Depending on the family, if they don’t, it could be more cost effective to put them on their own plan.


* Requires individual and small group insurance plans to spend at least 80% of premium dollars on medical services. Large group plans would have to spend at least 85%. With most carriers, that is almost happening now the majority of the time. Problem is, don’t you still want to look at cost containment? If you HAVE to spend it, it will be spent, but what about waiting for a rainy day and keeping something in reserves?


* Increases the Medicare payroll tax and expands it to dividend, interest and other unearned income for singles earning more than $200,000 a year and joint filers making more than $250,000. Really makes you want to go out and achieve, doesn’t it? This moves the tax up to 3.8%


* Provides subsidies for families earning up to 400% of the poverty level to purchase health insurance.

* Requires most employers to provide coverage or face penalties.

* Requires most people to obtain coverage or face penalties.

On all three of these for 2014, let’s hope the economy has turned around otherwise there will be a ton of people on that subsidy level.

Be well! more

Is there such a thing as a reasonable health insurance rate increase?

03-23-2010 by Colleen King

With all the furor over the Anthem Blue Cross rate increase on individual health plans, and rate increases in general, there’s a lot to keep track of for us independent agents. And up until now, I would have sworn it wasn’t possible.

When rate increases on health insurance were coming, used to be you would get a list of who was going to have an increase, when and how much. I would always use this to send letters to my clients to let them know hey, this is coming and when you find out how much it is, let me know if you want to look at other plans. Something has been happening in our industry that keeps me from being as on top of that as I used to be.

Now, instead of getting ‘The List’, many carriers have gone to ‘anniversary’ increases. So every twelve months from when you were first approved, that’s when applicable increases apply. Not in one fell swoop in February like Blue Shield used to do, or March like Anthem. NOW, they have places to go to look for these reports. Or its embedded in your client list. My point, I’m just not as on top of this as I would like to be. I want my clients to know I’m there for them in case they want to look at options.

I apologize to my Aetna clients, but Aetna has gone to this, and the system takes some manipulation to get reports so I’m a little behind. But when I did pull the reports, I was really surprised at what I found. In looking at my 20 clients listed for whatever time period this is, the increases ranged from a low of 0.20% to a high of 11.67%. The 11.67% was on a client over 65, so that really was a minimal increase–relatively speaking.

This was amazing to me, since you always expect something horrendous. Not that anyone wants an increase but these were relatively small. In fact, 10 of my folks were going up less than 1%. Aetna has done something different from the other carriers for a while, and that is basing rates on the older spouse when looking at a couple rather than the younger. Some others are just starting to do that now. When this first came about, the agent community didn’t like it, but between that and a couple other things they do, maybe this is a more realistic pricing model. After all, the 62 year old doesn’t get priced as the dependent on his 29 year old girlfriend.

I would estimate 98% of my clients are in Southern California, predominantly Los Angeles and Ventura counties. Health care costs, ergo insurance prices, tend to be higher in Northern California.

Maybe there’s hope for this industry–it is possible to have minimal rate increases, isn’t it? more

Health care reform is on the verge of a vote, what should I do about it?

03-17-2010 by Colleen King

Well, depends on how you feel about what you are hearing. If you have concerns about what is (or isn’t) being discussed around health care reform, read on.

Personally I’m not a huge on writing politicians but there are times you need to stand up and think you may be counted. This is easy to do–know who your congressional representative of senator is, go to their web site and they have an email form already for you to voice your opinion. Just be reasonable. I’ve been told that one letter or one email gives an equivalent weight of about 5000 constituents. That might be high, but what if it’s 50, or 100? That’s not bad!

So here’s what I sent this morning–please consider doing something similar if you are concerned about what is going to possibly happen this week.

Dear Congressman Sherman,

Regarding health care reform

I’m sure by now this has gotten to be VERY old, and you along with your colleagues want to pass something so the focus will move on.

This approach of ‘pass it now, we’ll fix it later’ really scares me, along with apparently a larger portion of the country. I’m an insurance agent. I along with most of my peers all want to see reform too because we deal with the problems of the current system day in and day out. Trying to get people coverage, affordable coverage, when medication for GERD gets a rate bumped up, or two medications for high blood pressure instead of one gets them rejected. Does not make for a happy work day.

But it has to be done carefully, and potentially, incrementally. Mandating carriers to issue without a mandate to purchase will be a disaster. Who is going to be the first in line? The sickest folks, of course. And I can’t blame them, but that’s what drives up the cost of coverage.

I’m not sure a government plan is the answer. Exchanges, well if they are state run, doesn’t that create another set of costs? By keeping the independent agent in the mix to some degree, I feel, will help keep costs down. Someone has to help people figure out what kind of coverage to buy. And for the most part, we are paid on commission only. No base salary, no benefit package, so if we don’t perform, we don’t get paid. As opposed to a government agency–I won’t belabor the point.

Thanks for your consideration, best of luck out there, and PLEASE VOTE AGAINST THIS DEBACLE. more

So, what was Anthem’s response to all the ‘rate rage?’

02-18-2010 by Colleen King

Last week Wellpoint, the parent company of Anthem Blue Cross, put out a response to the screaming about their recent rate increase. Click here and check it out.

It’s long, but I think potentially worth reading if you’re at all curious. If nothing else, the earnings statement Brian Sassi makes is impressive: “Anthem’s net income on a per-member-per-month basis was $12.62 in 2008, which compares to $18.45 and $13.22 for our two large not-for-profit competitors.” Guess we’ll find out later who those folks are, right?

So what was it in 2009? Well, they’ll get to that I’m sure. But in his response to Kathleen Sebelius, Sassi points out that membership has dropped off; mainly healthier clients that are looking to save money and feel they don’t need health insurance. That leaves people with health issues who will cost them more money.

Each carrier has rate increases; I’ll be interested to see what happens as the year progresses and other ‘rate actions’ come up.

So in the meantime, what do you do if you’re rates are dragging you down? You can do what I did and apply to another carrier, or even downgrade your plan with the carrier you have now. Do you need every office visit covered if you only go to a doctor once or twice a year? Maybe not, it ends up being a personal preference/comfort for each individual. And being willing to pay for the smaller things generally will end up saving you a significant amount on premium.

And consider working with an independent agent. We don’t cost you a dime and we can give you rates from all the companies. Otherwise you have to call each company, and have multiple reps call you back. For me, I have a specific set of companies I prefer to put people with because they tend to work best for most. That doesn’t mean the other companies aren’t okay, like anything, it’s a matter of personal experience.

Now at least you have a bit of a reprieve if you’re with Anthem, the increases won’t hit until May 1 now. But don’t wait to make changes, because everyone will be scrambling at the same time which slows the process. more

Two things to watch out for when buying health insurance or life insurance

02-09-2010 by Colleen King

We agents really aren’t all bad, money grubbing fiends but unfortunately the insurance industry has had their share over the years. You want your agent to watch out for you best interest, not theirs–i.e. commissions. I kid my clients at times when suggesting a less expensive health insurance policy than one they are looking at. I’ll tell them ‘you can buy that, and my mortgage company and I would appreciate it, but do you really need to spend that much?’ So what two things do you need to watch out for?

Twisting– This is a term you hear more in life insurance but it can apply to health insurance as well. This is where an agent gets you to drop a policy, or replace a policy, that doesn’t really need to be changed but it will generate a sale for them. The times to change a policy would be:

* rates have gone up

* your needs have changed–maybe you need less coverage, maybe you need more

* a health condition you once had has changed or gone away and you had previously received an above standard rate. Sometimes you don’t need to change carriers, but sometimes it ends up being easier.

The other thing you want to avoid at all costs is the Rescission of a policy. Insurance companies are within their rights to rescind coverage if you have lied or misrepresented facts on an application. What will happen usually is they will refund any premium paid minus any expenses they paid out. So if you bought health insurance, ‘fibbed,’ had an expensive bout of care thinking you’d just drop the coverage later, think again. Not only will you be on the hook for the costs but you also risk criminal prosecution for insurance fraud.

These days insurance carriers are running a bit scared due to all the health care reform changes coming up. And I had a rescission happen to me. Dealt with the party entirely over the phone (which is not unusual with health insurance) and thought all was well and good. A few months later the carrier called me about this person, asked me some questions, saying there was something ‘pre-existing’ with this person that wasn’t on the application.The policy ended up being rescinded, and I have no idea about the associated costs, but turns out my client had gone through inpatient rehab, which certainly isn’t cheap!

The irony was I was told I couldn’t have any information on what the situation was that flagged this due to privacy protection. But I was copied on the rescission letter, and it cited the reason for rescission was this person’s ‘recent care’ at a drug rehab facility that was named in this letter–so much for confidentiality!

So in short, if you don’t think you need any changes, don’t be pressured into it. And if you do fill out an application, play it straight; it’s not worth the angst of losing coverage you need. And a second opinion from another agent should be considered if you are concerned about what you are being told.

Have a great weekend! more