Health Insurance

New evidence that short-term plans offer good coverage for many.

By | Health Insurance

Its Not ‘Junk’ Health Insurance

You decideHouse Democrats last week voted to reverse a Trump Administration rule that the left has branded as promoting “junk insurance.” So note that the vote arrives the same week as a fresh analysis about how short-term health insurance can be a better option than ObamaCare.

The Trump Administration last year allowed for short-term, limited-duration health insurance that can last up to a year. Plans can be renewed up to 36 months without new medical underwriting, which can protect against higher premiums if someone falls sick. The Obama Administration limited short-term insurance to three months to force everyone into the ObamaCare exchanges. The Trump crowd thought short-term plans could be viable for relatively healthy folks who earn too much for subsidies and are soaked by Affordable Care Act prices.

Democrats claim these are “garbage” plans designed to trick Americans. Speaker Nancy Pelosi tweeted this month that the Trump Administration “is fighting to replace many Americans’ health care with junk insurance policies that are allowed to discriminate against people with pre-existing conditions.”

Short-term offerings are nascent and several states ban them, with restrictions in about two dozen others, which limits data. But Chris Pope at the Manhattan Institute offered a useful comparison in a paper last week. Mr. Pope examines Fulton County in Georgia, where ObamaCare premiums hover around the national average and multiple insurers compete on the exchange. Short-term insurance is available, consistent with the new federal rules.

A Blue Cross bronze ObamaCare plan—which covers about 60% of medical expenses—for a 30-year-old male who doesn’t smoke runs $296 a month in premiums. The plan carries a $5,200 deductible, with a maximum out-of-pocket cost of $7,900. UnitedHealthcare’s short-term plan that lasts 360 days? Monthly premium: $209, nearly 30% lower. The deductible and out-of-pocket caps are also lower, at $5,000 and $7,000, respectively.

The savings are greater for a more generous silver plan: $467 a month in premiums on the exchange versus $250 for a comparable short-term plan. Mr. Pope says that while “narrow-network HMOs are often the only plans available through the ACA exchange,” short-term plans “tend to be PPOs that offer broader access to providers.”

Not every plan covers, say, mental health or prescription drugs, but many do, and not every customer wants to pay for every benefit. A February survey from eHealth found that 80% of those who bought short-term insurance said affordable premiums were more important than comprehensive benefits. Some 61% considered coverage that complies with the Affordable Care Act before looking at short-term options.

Democrats predicted that the short-term rule would siphon patients from the exchanges and send premiums soaring, which hasn’t happened. Mr. Pope notes that Affordable Care Act premiums increased 3% on average for 2019, and that 92 of 124 requested rate increases didn’t even mention short-term insurance as a significant factor in higher rates. The effect on premiums has been negligible.

Anyone with a tough medical condition and modest earnings will likely be better off on the exchanges, where coverage is generously subsidized. But plenty of Americans may conclude that short-term plans are better. The Democratic response to this individual choice? In the words of Senate Minority Leader Chuck Schumer: “Democrats will do everything in our power to stop this.”

Do you need help sorting health insurance out and making the right decision for you and your family?  Call us 1-800-257-1723 or click here to schedule an appointment.

A new health insurance solution for the pre-Medicare individuals

By | Health Insurance

Bridge to MedicareThis plan carries you all the way to Medicare Age 65 without a rate increase!

We have a budget-conscious insurance solution for baby boomers age 62-64+ who are looking for a less expensive health insurance option before they are eligible for Medicare. It’s a great solution for:

  • Individuals who have left their employer health plan and want a less expensive solution than COBRA
  • Those who believe they cannot afford an ACA plan
  • Those who are in good health and don’t have ongoing medical expenses
  • Those seeking a temporary health plan as a result of a non-permanent need

This plan combines health insurance coverage for larger expenses with fixed first dollar benefits to supplement many routine types of medical expenses. Plans also include prescription drug benefits and additional non-insurance medical services like telemedicine, reduced-cost vision exams and eyeglasses, hearing benefits and emergency helicopter services.

Coverage is for unexpected large medical expenses up to $250,000 or $500,000 each year. Here’s how the plan works:

  • You are responsible for paying your deductible amount first, and then 20% or 30% of your medical bills up to a $10,000 coinsurance limit. After you hit the $10,000 limit, the plan will pay 100% of your covered expenses up to the 364 days maximum you have chosen for the policy
  • Your out-of-pocket expenses are capped, up to a maximum covered amount each year
  • Every 364 days a new policy begins – until age 65

Helps supplement the out-of-pocket cost of your medical expenses, giving you fixed, direct payments for when you have routine medical services like:

  • Doctor office visits
  • Preventive care
  • Testing
  • Outpatient surgery
  • Short hospital stays and more!

Plus get these extra Non-Insurance Benefits!

  • Telemedicine reimbursement for that includes low-cost doctor consultations
  • Eyewear and hearing aid discounts
  • Emergency helicopter evacuation

This plan is affordable, predictable & the LAST POLICY YOU WILL NEED until Medicare – All in ONE package – ONE Solution –

Do you need help sorting out health insurance and finding an affordable solution?  Call us 1-800-257-1723 or click here to schedule an appointment.


This plan is not for individuals who could qualify for an Obamacare premium tax subsidy or have $10,000 a year or more in routine, ongoing out-of-pocket medical expenses. If a health care provider has informed you that you could have significant medical expenses in the future, it is best to enroll in a plan on the federal or state health insurance exchanges.

Are your life savings at risk?

By | Health Insurance, Living Benefits

Don’t let rising Critical – Chronic Illness costs put your life savings at risk.

Call 1-800-257-1723 for a free quote now.

More than half of Americans over 65 will need Critical – Chronic Illness care at some point in their lives. Costs for this care are already high and are expected to continue rising. Neither health insurance nor Medicare typically cover all the costs of Critical – Chronic Illness. Where does that leave you?

Let us show you how we can turn your life insurance – even a term policy with no cash value – into an asset that you can spend when you suffer a Critical or Chronic Illness.

From Mark Deschenes: “I just had ANOTHER policy payout.  (Here’s the payout letter!)

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It was a $200,000 policy sold 10-22-2015.  The guy paid $225 a month for 3 years and 3 months – and now is cashing it out for $93,445.21 due to cancer.  He paid $8,775 premium and got $93k – they are very thankful.  Everyone says that they just wished they had a bigger policy.

Find out how simple and affordable Critical – Chronic Illness insurance can be.


Gum infection linked to Alzheimer’s disease, new study suggests

By | Health Insurance

Alzheimer’s disease could be caused by a gum infection, according to a new study.

In this file photo, the brain of an older individual shows the early stages Alzheimer's disease. A new study suggestions a gum infection might be linked to the disease. (Photo: DEPARTMENT OF ANATOMY AND NE)

In this file photo, the brain of an older individual shows the early stages of Alzheimer’s disease. New study suggestions a gum infection might be linked to the disease. (Photo: DEPARTMENT OF ANATOMY AND NE)

The study, published this week in the peer-reviewed journal Science Advances, suggests the bacteria Porphyromonas gingivalis that destroys gum tissue in the mouth is linked to dementia and Alzheimer’s.

Researchers observed the bacteria in the brains of people with Alzheimer’s disease. They also conducted tests on mice that showed the gum infection led to increased production of amyloid beta, a part of the amyloid plaques associated with Alzheimer’s disease.

“Despite significant funding and the best efforts of academic, industry, and advocacy communities, clinical progress against Alzheimer’s has been frustratingly slow,” Casey Lynch, author of the paper and CEO of pharmaceutical company Cortexyme, said in a statement. “The Science Advances publication sheds light on an unexpected driver of Alzheimer’s pathology.”

Cortexyme, which funded the research, is designing a series of therapies to treat the gum infection that plan to go to Phase 2 and 3 clinical trials.

No cure currently exists for Alzheimer’s disease, the most common type of dementia. The disease that begins with memory loss affects as many as 5 million Americans, according to the Centers for Disease Control and Prevention.

Do you need help sorting health AND dental insurance out and making the right decision for you and your family?  Call us 1-800-257-1723 or click here to schedule an appointment.

, USA TODAYPublished 2:20 p.m. ET Jan. 25, 2019 | Updated 12:41 p.m. ET Jan. 27, 2019

New Trump rule could help small business employees afford health insurance

By | Health Insurance
By Sally Pipes

The Trump administration recently proposed a new rule that could make health insurance more affordable, and stands to impact 10 million American workers by 2028.

It’s sorely needed. Many firms are dropping coverage because the premiums are just too expensive. They may want to help their workers with the cost of health insurance. But federal law effectively gives them two choices: offer expensive, comprehensive benefits that adhere to Obamacare’s cost-inflating mandates or do nothing.

The new rule would provide a third option. It would permit employers to give their employees monthly tax-free cash allowances to help them pay for coverage in the individual market.

Your health insurance dollars

The rule could prove revolutionary. In the short term, it will help millions gain coverage. But in the long run, it could give individuals, rather than employers, control over health insurance dollars. Such a change would spur competition in the insurance market — and ultimately lead to higher quality, greater choice, and lower costs.

Sponsoring health insurance is becoming cost-prohibitive for many employers. The average premium for a family plan at firms with between three and 199 workers has nearly tripled since the turn of the century — from $6,500 in 2000 to $19,000 today.

Some firms have responded by dropping coverage. In 2000, nearly all firms with 50 to 99 employees offered insurance. Now, 89 percent provide coverage.

Even if employees at small and medium-sized companies receive health benefits, they’re unlikely to have a wide range of plans to choose from. Among companies with fewer than 200 employees that provide coverage, eight in ten offer just one plan.

The new rule would help reverse this trend by easing regulations on “health reimbursement arrangements.” HRAs allow employers to set aside a fixed amount of money tax-free each month to reimburse employees for healthcare expenses.

The Obama administration severely restricted the use of HRAs. Companies were barred from using HRAs to reimburse workers for health plans they had purchased on their own in the individual market.

The new rule will get rid of that restriction. The Treasury Department estimates that by 2028, 800,000 employers will take advantage of expanded HRA options — and thereby help more than 10 million workers pay for individual-market insurance.

More competition = more options

The increase in the number of customers in the individual market could result in more competition and a wider variety of insurance options.

Consider a pizza analogy. Right now, some businesses are catering pizza — health insurance — for their employees. The employer chooses the size and the toppings. If workers want pepperoni but the employer only offers cheese, they’re out of luck. And some firms can’t afford to provide pizza at all. So employees have to pay for it out of pocket, if they want it.

Soon, businesses will have the option of giving workers cash to help them cover the cost of whatever pizza they’d like to order. Budding restaurateurs will surely launch new pizzerias and types of pizza to compete for the dollars of this new stream of customers — inexpensive pies, pies with all sorts of toppings, and more.

This is exactly what will happen in the individual health insurance market. Sending millions of new people into the individual market will encourage insurers to find ways to provide better, more individually tailored health plans at lower cost. And it will build on the Trump administration’s other recent reforms, which have made a wider range of coverage options available to consumers — such as Association Health Plans and Short-Term Limited Duration plans — who don’t like or can’t afford what’s available on Obamacare’s exchanges.

The administration’s proposed rule would give businesses a new way to offer health benefits and make it easier for millions of workers to purchase coverage that suits their needs and budget. It’s time to finalize it.

Do you need help sorting health insurance out and making the right decision for you and your family?  Call us 1-800-257-1723 or click here to schedule an appointment.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The False Promise of Single-Payer Health Care(Encounter 2018). Follow her on Twitter @sallypipes.

Affordable Care Act is unconstitutional

By | Health Insurance

U.S. District Judge Reed O’Connor overturns all of the Obamacare law nationwide.

Based on articles in the Washington Post and Bloomberg News

District-Judge-Reed-OConnorO’Connor is a conservative judge on the U.S. District Court for the Northern District of Texas. He was appointed by President George W. Bush.

In June, the administration took the unusual step of telling the court that it will not defend the ACA against this latest challenge. Typically, the executive branches argues to uphold existing statutes in court cases.

The lawsuit was initiated by Texas’s attorney general Ken Paxton, who describes himself as a tea party conservative, with support from 18 GOP counterparts and a governor. The plaintiffs argue that the entire ACA is invalid. They trace their argument to the Supreme Court’s 2012 ruling in which Chief Justice John Roberts Jr. wrote for the majority that the penalty the law created for Americans who do not carry health insurance is constitutional because Congress “does have the power to impose a tax on those without health insurance.”

As part of a tax overhaul a year ago, congressional Republicans pushed through a change in which that ACA penalty will be eliminated, starting in January. The lawsuit argues that, with the enforcement of the insurance requirement gone, there is no longer a tax, so the law is not constitutional anymore.

“Once the heart of the ACA – the individual mandate – is declared unconstitutional, the remainder of the ACA must also fall,” the lawsuit said.

Texas and an alliance of 19 states argued to the judge that they’ve been harmed by an increase in the number of people on state-supported insurance rolls. They claimed that when Congress last year repealed the tax penalty for the so-called individual mandate, it eliminated the U.S. Supreme Court’s rationale for finding the ACA constitutional in 2012.

The Texas judge agreed. He likened the debate over which provisions of the law should stand or fail to “watching a slow game of Jenga, each party poking at a different provision to see if the ACA falls.” He also wrote that it’s clear the individual mandate is the linchpin of the law “without marching through every nook and cranny of the ACA’s 900-plus pages.”

“The court must find the individual mandate inseverable from the ACA,” he said. “To find otherwise would be to introduce an entirely new regulatory scheme never intended by Congress or signed by the president.”

President Donald Trump and Texas Attorney General Ken Paxton praised the ruling. The White House said the ruling will be put on hold during an appeals process that’s destined to go all the way to the U.S. Supreme Court.

The Texas case is Texas v. U.S., 4:18-cv-00167-O, U.S. District Court, Northern District of Texas (Fort Worth). Frosh’s case is State of Maryland v. United States, 1:18-cv-02849, U.S. District Court, District of Maryland (Baltimore).

In today’s healthcare environment you need a trusted student of the industry as your agent – why our clients love us.

By | Health Insurance

Every time I talk to a client the first thing that pops into my mind is, “how do I make a meaningful contribution to this person’s current and future well-being?”  I learned that from my Dad – who was always working to help people secure their future through appropriate insurance products.

In today’s complicated health insurance environment “helping a client” means being a student of the industry….knowing the best products, steering people around those that are not a good value, and explaining what products are right for my clients and why – so that they can make good decisions.

Recently I was speaking to a client that knew my father – and that I met when I was a kid riding along with Dad.  The trust runs so deep between us that she calls just to share life stories.  During one of the calls, we started exploring the cost of her medications – which I’m delighted to report that I could guide her to sites where she could reduce her out-of-pocket costs – and her gratitude for her having survived a freak health emergency.

Chest painHere’s Her Story:

During the stressful holiday period, my client was working hard to ensure that all the guests were enjoying a fabulous family experience at her home – when the pressure overwhelmed her and she found her chest throbbing.  Her first thoughts were. “Get to the hospital, take a baby aspirin, and thank goodness I have the right insurance to cover this so I won’t have the added pressure of paying an insane deductible!”

WOW! Imagine knowing that there is something wrong and having one of your first thoughts be, “Can I afford to get this checked out!”  That’s what too many people in our healthcare world have to deal with – overwhelming deductibles that cause them to question if they should even dare to get medical treatment.

My client ended up being diagnosed with heart failure – and thanks to her rapid and cool-headed response to the pain she got herself to the hospital in enough time for the medical team to save her life.  According to here, her recovery has been made easier because she does not have to struggle with a deductible that could be financially insurmountable.

The Right Health Care Insurance Is Just The Start

Our clients have the right insurance and learn the best ways to purchase prescriptions, services, and resources because we are DEDICATED students of the healthcare delivery and insurance industries.  We work to understand our clients’ situation, assess their needs, and provide the best solutions given their life and health circumstance.  Insurance is only a part of the value I bring to my clients.

Knowing the industry, how to purchase pharmacy and medical services, and understanding all the resources available is a full-time job – and my clients get that information from our team so they don’t have to try to figure it all out on their own…freeing them up to spend their time living their life!

Why our clients love us:

Our services are free – but save them thousands of dollars.

We make it easy to understand your options. In the insurance industry, it’s not always easy to understand what you’re seeing when comparing health insurance options. We live and breathe this stuff every day, and we’re specially trained to help you understand how plans differ from one another and how your coverage will actually work in the real world.

We’re your advocates even after you enroll. We’re there for you even after you buy a new health insurance plan…plus we offer advice and guidance on where to buy health-related products, services, and pharmacy.

We care.  That’s why we are service and guidance superstars.

Do you need help sorting health insurance out and making the right decision for you and your family?  Call us 1-800-257-1723 or click here to schedule an appointment.

Administration Releases New Guidance on Health Reimbursement Arrangements (HRAs) and Section 1332 Waivers

By | Group Health Insurance, Health Insurance

Proposed rule would allow HRAs to be used with individual coverage

Earlier this week, federal agencies released a proposed rule for Health Reimbursement Arrangements (HRAs) and updated guidance for Section 1332 State Innovation Waivers (now called State Relief and Empowerment Waivers).

The Administration had indicated these changes are part of its ongoing efforts to increase choice and flexibility in the insurance market.HRA Victory

On Oct. 23, 2018, the Departments of Treasury, Labor, and Health and Human Services (HHS) issued proposed rules that would allow employees to use the dollars in employer-funded Health Reimbursement Arrangements (HRAs, also called Health Reimbursement Accounts) to purchase individual coverage both on and off the public Marketplace (or Exchange). These proposed rules were released in response to the Oct. 2017 Executive Order, in which the Administration directed the tri-agencies to consider ways to expand the flexibility of HRAs.

Currently, employer-funded HRAs are used exclusively with employer-sponsored coverage to reimburse employees for health care expenses not reimbursed under their base medical plan (e.g., deductibles or coinsurance). Under the proposed rule:

  • Employees would be able to use HRA funds to pay the premium for individual insurance coverage purchased either on or off the public Marketplace.
  • Employers would be required to make the HRA available to entire “classes” of employees (e.g., full-time, part-time, or seasonal workers).
  • Employers could offer eithera group health plan or an HRA that could be used to purchase individual coverage, but not both.
    • If an employer offers the HRA, employees would be able to opt out if they are eligible for premium tax credits on the public Marketplace.

In addition to offering HRAs that could be used to pay for individual coverage, the proposed rule would also allow employers that offer traditional group health coverage to offer HRAs of up to $1,800 per year to reimburse employees for certain medical expenses, including stand-alone dental or vision benefits or premiums for Short-Term Limited Duration Insurance (STLDI), which is short-term individual insurance that doesn’t have to comply with all Affordable Care Act (ACA) rules.

Tax treatment of HRAs would remain unchanged and the offering of an HRA for individual coverage would satisfy the employer mandate if it is considered “affordable.” The Treasury Department and Internal Revenue Service (IRS) are expected to release guidance in the near future on the employer mandate affordability test and potential safe harbors.

The proposed rule can be read in detail here. The tri-agencies are requesting comments by Dec. 28, 2018.

Updated Section 1332 guidance increases state flexibility

On Oct. 22, 2018, the Centers for Medicare & Medicaid Services (CMS) issued updated guidance on Section 1332 waivers, which replaces guidance published in 2015. Under the ACA, states can apply to waive key ACA provisions in order to implement innovative, alternate health coverage rules or programs while retaining basic consumer protections. The five-year waivers were available beginning in 2017 and to date, eight states have received waivers.

The new guidance makes changes to the principles that CMS will use when reviewing and approving applications. While the original “guardrails” of ensuring comprehensiveness, affordability, scope of coverage, and deficit neutrality remain in place, CMS will interpret some of them differently to loosen restrictions. For example:

  • 2015 guidance: Focused on the number of individuals estimated toreceivecomprehensive and affordable coverage
  • 2018 guidance: Focuses on the availabilityof comprehensive and affordable coverage

Beyond the basic guardrails, CMS has identified five new principles that future waiver requests should aim to achieve:

  • Provide increased access to affordable private health plan coverage (including Association Health Plansand STLDI)
  • Limit cost increases for consumers and the federal government
  • Foster state innovation
  • Support and empower those in need
  • Promote consumer-driven health care

Changes were also made to streamline the state waiver application process. This guidance is effective for waivers submitted after Oct. 24, 2018, and has a 60-day comment period. Review the complete guidance or fact sheet for more information.

Need help sorting this out and making the right decision for you and your family?  Call us 1-800-257-1723 or click here to schedule an appointment.

This plan enhancer DOES cover maternity

By | Health Insurance, Parent Category II

Here’s how to make sure that pregnancy and complications from pregnancy are covered by your health insurance.

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Pregnancy is no longer a difficult insurance issue! While Obamacare ACA plans do cover maternity, they’re HMO based in Texas, they’re expensive and your doctor probably doesn’t accept Obamacare.

Short Term Medical Plans – a great alternative to Obamacare – exclude normal maternity and only cover NON-pre-existing complications.

The Solution

National General Plan Enhancer DOES cover non-pre-existing maternity (both normal and complicated) as a payable benefit under the Sickness Inpatient Rider.  The catch – you must be admitted to the hospital for at 24 hours during delivery.  (Sorry, home births & birthing centers do not qualify.)

Complications of Pregnancy include the following:

  1. Conditions, requiring hospital confinement (when the pregnancy is not terminated), whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion, and similar medical and surgical conditions of comparable severity, but shall not include false labor, occasional spotting, physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia, and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy; and
  2. Non-elective cesarean section, ectopic pregnancy which is terminated, and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.

Need help sorting this out and making the right decision for you and your family?  Call us 1-800-257-1723 or click here to schedule an appointment.


Alcohol use can void your health insurance coverage

By | Health Insurance

An Alcohol Exclusion Law (AEL) gives insurance companies the right to deny coverage to any person who, at the time of injury, seeks medical attention under the influence of alcohol or any drug not currently prescribed to them by a physician.

drinking may affect your insuranceTexas currently has an Alcohol Exclusion Law in their insurance code. It is under the Uniform Accident and Sickness Policy Provision, UPPL, 1201.227: Intoxicants and Narcotics, for private insurance companies in Texas. The law even applies if alcohol is legally consumed and an injury is sustained.

Texas State law Explicitly forbids payment of a claim that is alcohol or drug-related. If your medical providers coded your claim as alcohol or drug-related you will need to dispute the diagnosis if you believe it’s incorrect.




Example One:

An older woman is celebrating her 25-year wedding anniversary with her family. She legally drinks some wine with her meal. They finish the celebration and along with her husband, she walks to their vehicle. On the way, she catches her heel in a crack in the sidewalk and falls, breaking her wrist in the process. She is transported to the emergency room and treated for her injuries. If the doctor issues a blood test and that test is positive for alcohol in her system, her insurance company can deny payment under the Alcohol Exclusion Law even though she was only walking to her car and did not break the law nor was she drunk.

The National Association of Insurance Commissioners (NAIC), an organization of insurance regulators in the 50 states, adopted the Alcohol Exclusion Law as part of the UPPL model law in 1947.2 State could individually adopt this law as part of their insurance code should they choose. In 1955, Texas voted to make UPPL a part of the state insurance code. To date, 27 states explicitly allow Alcohol Exclusion Laws, 9 states implicitly allow Alcohol Exclusion Laws and 14 states plus the District of Columbia have prohibited the use of Alcohol Exclusion Laws.


Example Two:

A youth under age 21 falls while at a party. They hit their head on the ground and get a black eye. They are transported to the hospital for stitches and examination. The doctor and nurses smell alcohol on the youth. Because of the AEL, the youth is not screened to identify risky drinking behaviors; insurance covers the expense. A year later, the youth is at the ER for a broken wrist and again smelling of alcohol. The wrist is treated; insurance covers the costs: no data, no screening, and no intervention. The cycle continues.



Source: Texans Standing Tall, Inc. © 2009, 2011