Monthly Archives

August 2016

Obamacare May Collapse Nationwide

By | Health Reform

Tennessee Sen. Lamar Alexander said Saturday that Obamacare exchanges in his home state are nearly ready to collapse, and he fears that other states will soon follow suit.

Origina Article By Sandy Fitzgerald   |   Saturday, 27 Aug 2016 06:57 PM

On Wednesday, The Tennessean, the largest newspaper in Alexander’s state, reported in a front page story that the state’s exchange is “very near collapse.”Obmacare Collapse

That means next year, Tennesseans will pay an “intolerable increase” of between 44 and 62 percent for their Obamacare plans than they paid last year, said Alexander, and if policyholders can’t pay for it, the taxpayers will, as a large part of Obamacare premiums end up being funded with tax dollars.

The struggles will leave Americans with a choice as they enter the voting booths in November, said Alexander, warning that Democrats will tighten Washington’s hold on private insurance choices.

“Democrats will spend more of your taxpayer dollars to prop up the collapsing Obamacare exchanges,” said Alexander, while Republicans “want to help Americans struggling with the cost of health insurance immediately by working to give states more flexibility when it comes to individual and family options to buy health insurance plans outside the exchanges.

 

Roadmap to Surviving Obamacare

By | Health Insurance, Life Insurance

What is happening and what you should do NOW to survive Obamacare…..

Have you come to the realization that insane deductibles are making the high cost of Obamacare health insurance unaffordable?  Consider this:  Health care plans offered under Obamacare through HealthCare.gov have deductibles of $3,000 (per person!) or more in many states, making health care unaffordable for families even though they technically have coverage.  So how do you protect you and your family from the devastating costs of Obamacare?

Step 1: Purchase Short Term Medical.

We enroll you, your wife and kids in Short term medical for 2 main reasons –

1) PPO – you get to keep your doctors – this is the ONLY way to do that because Obamacare is an HMO based plan and has a very low acceptance rate in the medical community.

2) Lower your cost for reliable health insurance –   you save up to 70%.

What’s the catch?

This is short term medical and must be re applied for every year.  That means if something happens to you, your wife or kids – then that family member will be forced into an Obamacare plan. That is okay but it will result in 2 things happening:

1) You will have to pay big bucks for their plan (estimated rate for 2017 is $600 a month minimum for JUST you or your wife alone.  2017 rates in Texas are going to increase 55.7% – NO JOKE google it). Kids ACA plans are lower cost – but still expensive.

2)  Whoever ends up with an Obamacare plan will be have HMO based health insurance – what that means is you probably will not have access to the doctors you want, the best medications (the good expensive ones) or Centers of Excellence (because these are NOT paid for on HMO plans).

So what’s THIS mean?  Well, guess who gets to fill in the gaps?

Obamacare Gap Causes StressYOU!  From YOUR BUDGET (Geez……I know what your thinking, “Pay a ton for crappy Obamacare and have limited coverage?”  Hard to believe – but its True!)

And you’re probably wondering, “How can I protect my family from these big gaps? What is the BEST thing I can do?”

Here’s the only thing you can do: Have a chunk of CASH !

Are you asking yourself, “How do I have that?”  If so, read Step 2.

Step 2: Get LIVING BENEFITS

$69 buys $500,000 (and this is the smallest I would do.) What does this mean?

Let’s just talk about your wife: If she just passes which is possible but NOT likely – you would get $500,000

But if she becomes Chronically or Critically ill then you get a chunk of cash:

Phoenix  Living Benefits automatically includes the following benefits to help protect you and your family.Living Benefits

Critical Illness : If you are diagnosed with a heart attack, stroke, cancer, renal failure, major organ transplant, or ALS, this rider allows you to receive a portion of your death benefit early.

Chronic Illness : If you are certified by a Physician as being unable to perform at least two activities of daily living or require substantial supervision due to severe cognitive impairment, this rider allows you to receive a portion of your death benefit early.

Terminal Illness: If you are diagnosed as terminally ill with a life expectancy of 12 months or less, this rider allows you to receive a portion of your death benefit early as a lump-sum to be used as you wish.

Respectfully, this is a NO Brainer! – In fact, I am simply recommending for YOUR family exactly what I am doing for MY loved ones….

With this combination of Short Term Medical and Phoenix Living Benefits your total health insurance expenditure is going to be 50-70% less per month than under Obamacare!  What is there to think about?   (Not a darn thing!)

Your family needs protection from the inevitability that you will, someday, have a major illness. Short Term Medical leaves you exposed if you don’t have a Living Benefits policy to cover these HUGE future costs.  Obamacare and Medicaid leave you open to huge deductibles as well as high cost prescription drugs needed in critical and chronic illnesses.  A Living Benefits policy provides the cash needed to fill these gaps in coverage.

Happy Wife Knowing She Has A Living Benefits PolicyGetting back to your wife – she needs this SO much that AFTER she applies for the PHOENIX which is NON MEDICAL and she is approved she will then trade in the PHOENIX $500,000 for a Transamerica that she must take a PHYSICAL to get $1,000,000 – WHY do this?  Because this is SO very important and this needs to be a cornerstone of your LONG TERM FINANCIAL PLAN.

You have heard of long term care and how high retirement medical costs are. Well, you can’t get a long term care plan any more – they’re kaput.

But you can get $1,000,000 for 30 years and your wife can get it LOCKED for as low as $171 per month!!!

Bottom line – this provides exceptional, world class benefits at a total premium less than HALF of Obamacare.

I have sold THOUSANDS of people this coverage including my own family.

PS you don’t need to worry about tax trouble.  We cure that by enrolling you in Christian sharing which cost $90 a month

So lets see–

World Class Health Insurance for as low as $120 per family member! – that is a TRUE miracle  

(compare that to Obamacare this very second! – then click here to schedule an appointment)

 

COMMENTS to Proposed Rule (REG-135702-15): Obama Administration Proposed Rules To Limit the STM Market

By | Health Reform

This Executive Summary sets forth our comments on the Proposed Rule by the Departments of the Treasury, Labor and Health and Human Services (“Departments”)1 (ID: IRS-2016-0021-0001) that, among other things, restricts short-term, limited duration health insurance.

If implemented without modification, the Proposed Rule would severely reduce competition and limit availability of affordable health insurance options for those with a durational gap in coverage under the Affordable Care Act (“ACA”).

Originally Posted July 29, 2016 IHC Specialty Group

Short-Term Medical (“STM”) Provides Meaningful Coverage

The Proposed Rule states: “The Departments recently have become aware that short-term, limited-duration insurance is being sold to address situations other than the situations that the exception was initially intended to address. In some instances individuals are purchasing this coverage as their primary form of health coverage and, contrary to the intent of the 12-month coverage limitation in the current definition of short-term, limited-duration insurance, some issuers are providing renewals of the coverage that extend the duration beyond 12 months. The Departments are concerned that these policies, because they are exempt from market reforms, may have significant limitations, such as lifetime and annual dollar limits on EHBs and pre-existing condition exclusions, and therefore may not provide meaningful health coverage.”

STM is limited duration health insurance coverage similar to other categories of health insurance. In our opinion, for people under age 65 who are outside of open and special enrollment periods and in need of some medical coverage, STM is the closest product available with benefits similar to “major medical insurance”. It provides benefits that address core medical needs such as doctor and specialist visits, lab tests, x-rays, emergency care, and hospitalization.

While the Departments express concern that STM does not provide meaningful coverage, the STM policies provided by our carrier partners utilize broad healthcare provider networks, which supply access to top doctors and hospitals at negotiated rates. Under many STM policies, provider access is often unrestricted so even if an out-of-network doctor is used the plan will still pay reimbursement for covered medical services. This network breadth and flexibility stand in contrast to the growing trend of narrow networks where no reimbursement is provided to out-of-network doctors except in the case of medical emergencies.

Further, STM was specifically considered and determined to be permissible under the ACA, as long as policies are less than 365 days in duration. STM is regulated by each state department of insurance. Our carrier partners sell STM in 42 states, each of which has reviewed and approved the policy forms and rates with state specific restrictions. Depending on the state, STM policies provided by our carrier partners last from one to just under 12 months, and many offer a lifetime maximum benefit up to $2 million. Of course anyone who purchases an STM plan will have the option of purchasing an ACA plan with no lifetime limit during the next open enrollment period.

STM Provides an Affordable Alternative in Many Transitional Situations

The Proposed Rule states “Before enactment of the ACA, short-term, limited-duration insurance was an important means for individuals to obtain health coverage when transitioning from one job to another (and from one group health plan to another) or in a similar situation. But with the guaranteed availability of coverage and special enrollment period requirements in the individual health insurance market under the ACA, short-term, limited-duration insurance is no longer the only means to obtain transitional coverage.”

We agree that one of the key achievements of the ACA was providing guaranteed availability of coverage and special enrollment period requirements in the individual health insurance market for those who did not qualify for other types of coverage. With respect to persons eligible for a special enrollment, they can now obtain an ACA plan; whereas, in the past they might have been eligible for COBRA (if leaving an employer group plan) or to purchase a STM policy or they might not have had any coverage options. The Proposed Rule would be a step back in that it would limit consumer choice and reduce competition. Under the Proposed Rule, anyone with longer than a three month transition period would be forced to either purchase a more expensive ACA or COBRA plan or risk being uninsured after their three-month STM expired.

The Proposed Rule disadvantages people who fail to sign up for an ACA plan during Open Enrollment because it does not provide expanded Special Enrollment Period opportunities for these insureds. Today, in many states, a person who fails to sign up for an ACA plan has a fall back plan. They can purchase a STM policy for almost an entire year and then sign up during the next Open Enrollment for the following year. The Proposed Rule leaves people in this circumstance with only three months of coverage; they would be uninsured for the remaining 9 months, which is a significant step backwards in the goal to reduce the number of uninsureds.

STM Plans Do Not Adversely Impact the Risk Pool

The Proposed Rule states, “Further, because these policies can be medically underwritten based on health status, healthier individuals may be targeted for this type of coverage, thus adversely impacting the risk pool for ACA-compliant coverage.”

A closer look at the numbers not only fails to support destabilization of the market for ACA plans, but also demonstrates that STM plans act as important “gap” fillers for consumers seeking coverage for a limited period of time. In reviewing 2015 data from the carriers we represent, only 8 percent of such carriers’ total STM sales volume occurred during the 2015 Open Enrollment period when a purchaser could have elected to purchase either an STM or an Obamacare plan. This means that 92 percent of the STM policies we sold were purchased outside of Open Enrollment when the consumer could only enroll in an Obamacare plan if she had a Special Enrollment Period (“SEP”).

Since another of the proposed rules from the Departments would limit the ability of consumers to enroll for coverage during a SEP, it seems that limiting consumers’ opportunity to find coverage outside of Open Enrollment is counter intuitive. One of the goals of Obamacare was to broaden coverage and reduce the cost to providers that are not reimbursed for providing services to people without insurance. Whether consumers inadvertently fail to sign up for coverage during Open Enrollment or have unanticipated expenses and are forced to prematurely drop coverage, STM plays a critical role in reducing the number of uninsured. So are consumers destabilizing the market by purchasing STM in lieu of an ACA plan or are they buying the only plan that is available to them at the time they decide to purchase? The fact that 92 percent of our carriers’ sales were outside of Open Enrollment strongly supports the latter. The average duration for an STM plan underwritten by our carriers is just over four months, which demonstrates that the vast majority of consumers are not purchasing an STM policy with the expectation that it would serve as a replacement for an Obamacare plan.

The Proposed Rule is Anti-Competitive

As discussed above, the Proposed Rule seeks to limit the duration of STM policies because the Departments’ believe that consumers are choosing STM plans over the more expensive ACA plans. President Obama issued an Executive Order on April 15, 2016 (the “Order”) entitled “Steps to Increase Competition and Better Inform Consumers and Workers to Support Continued Growth of the American Economy.” We fail to see how the Proposed Rule furthers that goal. The Order states that “[c]ompetitive markets also help advance national priorities, such as the delivery of affordable health care …” Section 2 of the Order states, Executive departments and agencies … shall, where consistent with other laws, use those authorities to promote competition, arm consumers and workers with the information they need to make informed choices, and eliminate regulations that restrict competition ….” By its very design, the Proposed Rule is meant to reduce competition and restrict the ability of consumers to make informed choices. As noted above, STM is “consistent with other laws,” as it is specifically contemplated under the ACA. We believe the Departments need to explain why the Proposed Rules do not violate the Order.

Limiting STM to 3 Months Does Not Align with the Intent of ACA

The Proposed Rule states that it “address[es] the issue of short-term, limited-duration insurance being sold as a type of primary coverage, the proposed regulations revise the definition of shortterm, limited-duration insurance so that the coverage must be less than three months in duration, including any period for which the policyholder renews or has an option to renew with or without the issuer’s consent.” It goes on to state, “This change would align the definition more closely with the initial intent of the regulation: To refer to coverage intended to fill temporary coverage gaps when an individual transitions between primary coverage. Further, limiting the coverage to less than three months improves coordination with the exemption from the individual shared responsibility provision of section 5000A of the Code for gaps in coverage of less than three months (the short coverage gap exemption), 26 CFR 1.5000A–3. Under current law, individuals who are enrolled in short-term, limited-duration coverage instead of minimum essential coverage for three months or more are generally not eligible for the short coverage gap exemption. The proposed regulations help ensure that individuals who purchase short-term, limited-duration coverage will still be eligible for the short coverage gap exemption (assuming other requirements are met) during the temporary coverage period.”

We must first point out that STM is not renewable coverage so a policyholder never has an option to renew. We do not agree with the argument that the Proposed Rule “improves coordination with the exemption from the individual shared responsibility provision of section 5000A of the Code.” STM can be purchased on a monthly basis and in our experience a very large number of policies are already purchased for durations of three months or less. We do not see how banning policies of over three months improves coordination with 5000A of the Code.

Disclosure that STM is Not Minimum Essential Coverage

The Proposed Rule also provides that “a notice must be prominently displayed in the contract and in any application materials provided in connection with enrollment in such coverage with the following language: THIS IS NOT QUALIFYING HEALTH COVERAGE (“MINIMUM ESSENTIAL COVERAGE”) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.”

We favor this proposal. While many states already require disclosure like this, the carriers we represent are in favor of full and fair disclosure of what STM covers and what it does not. We are in favor of providing consumers with an educated choice.

STM Does Not Automatically Renew

The Proposed Rule states, “In addition to proposing to reduce the length of short-term, limited-duration insurance to less than three months, the proposed regulations add the words “with or” in front of “without the issuer’s consent” to address the Departments’ concern that some issuers are taking liberty with the current definition of short-term, limited-duration insurance either by automatically renewing such policies or having a simplified reapplication process with the result being that such coverage lasts much longer than 12 months and serves as an individual’s primary coverage but does not contain the important protections of the ACA.”

Again, Respondent believes that the Departments have a fundamental misunderstanding of STM policies. We are not aware of any STM policy that automatically renews. With respect to the Departments’ criticism of “having a simplified reapplication process,” we fail to see how this is a negative. We believe that those who have experienced purchasing an ACA policy through a public exchange would appreciate the ease with which they can purchase a STM policy with an immediate effective date.

Conclusion

Thank you for the opportunity to comment on the Proposed Rules regarding short-term medical plans and other excepted benefits, as proposed by the Departments. The Proposed Rules regarding STM would severely limit the ability of consumers to fill gaps in coverage between health plans through the purchase of STM plans. STM policies, which are permitted under the ACA, provide affordable coverage to qualified individuals for limited periods and are currently available and regulated by many states. The Proposed Rule overlooks many aspects of STM. First, STM does provide affordable, meaningful benefits during gap periods that may extend longer than three months, because the consumer can make an informed decision that STM is the best policy for their particular circumstance or because the consumer inadvertently missed purchasing an ACA plan during Open Enrollment or let the plan lapse due to financial circumstances. Second, STM does not provide renewable coverage so that the duration limitations are secure. Finally, while we embrace additional disclosures, most if not all state departments require many disclosures about STM already.

The Proposed Rule states that the Departments are concerned that STM plans may be destabilizing the market because they are keeping young and healthy consumers out of the pool of ACA members. Our data suggests this is not the case. STM is a very limited market – we estimate it to be approximately 2% of the all individuals covered by health insurance in the United States. In our experience, STM is not competing with ACA plans during Open Enrollment; instead, it is providing a much needed temporary gap coverage, which is further supported by the fact that many consumers who purchase STM go on to purchase an ACA plan when it is next available.

In conclusion, STM is still an important means for people to obtain affordable health insurance during transitional periods, which is why Congress specifically contemplated it surviving passage of the ACA. The Proposed Rule would violate the Order by lessening competition while doing little to nothing to stabilize the ACA market.

David Kettig, President & CEO IHC

Specialty Benefits, Inc.