White House Releases 'Patient Bill of Rights'

Marking the first 90 days since he signed health care reform into law President Barack Obama spelled out how the short term benefits would be implemented.  The big items such as expanding coverage for the 32 million of the uninsured does not occur until 2014.

I wrote in my previous post that insurance rates are rising, which is knock against health care reform.  I see the White House release of the patients bill of rights as a publicity stunt to gain back traction for the reform. With the said, lets analyses the so called short term benefits.

— Guaranteed coverage for children with pre-existing health problems. The administration estimates that about 540,000 children with health problems are uninsured, and some 51,000 are likely to gain coverage. It's still unclear whether families will be able to afford the premiums. The law does not limit what insurers can charge.
It’s still unclear how insurance companies will price the new guaranteed coverage for children. If premiums are too high, families may still be unable to get health insurance.  Though I do love the effort of making sure all of our children are covered.

—A ban on lifetime coverage limits. More than 100 million people are enrolled in plans that currently impose such limits, the White House said.
This cap allowed the actuaries to set premiums and keep them down.  The removal of the cap will automatically increase the risk for the insurance companies and thus increasing the premiums.

— Phasing out annual coverage limits. Starting this year, plans can set annual limits no lower than $750,000. Such limits rise to $2 million in 2012, and will be completely prohibited in 2014.
See my comment above.

— Forbidding insurers from canceling the policies of people who get sick. Unintentional mistakes on application forms cannot be used to revoke a policy.
I actually like the first part of these benefit, i don't believe insurance carriers can cancel peoples policies because they are sick.  That is part of the risk for the insurance companies and they should not be allowed to just cut it to increase profits.  As for the part of unintentional mistakes, i love to see the definition of unintentional mistake.

— Guaranteed choice of primary care doctors and pediatricians from a plan’s network. No referral needed for women to see an ob-gyn specialist. No prior approval needed to seek emergency care out-of-network.
These is straight forward and i try to avoid carriers that don't already follow this approach.
The new rules apply to most health plans, except in cases where they are “grandfathered” under the law.

Health Care Premiums Starting to Rise

In a recent survey released Monday by the the Kaiser Family Foundation. (KHN is a part of the foundation.)

The foundation surveyed just over 1,000 people who don't get insurance from their employer. finding that people who own their own health insurance report the most recent rate increase requests have averaged 20 percent.  77 percent reported an increase and 16 percent of them switched to less expensive plans. As a result of those who switched, the average increase for all respondents was 13 percent.

It easy to say insurance premiums rise every year, however not a 20% clip, the rate in the past was generally around 10%.

Insurers are blaming rising medical cost as the driving force.  I predicted in an earlier blog the increase was inevitable.  My reasoning was not due to increase in medical cost, but rather due to the health care reform law.

One aspect of the law is guaranteed insurability.  This law prevents insurance from charging higher premiums on those that have health issues, that's great for the sick but bad for the healthy.  Insurance companies need to raise the premiums somewhere to cover the cost of the sick so the healthy get zapped.  In other words lower premiums for those with health issues and higher premiums for those that are healthy.

In a recent article in the New York Times Today, it was reported that the Obama administration is set warn the insurance industry against imposing hefty rate increases. The White House is afraid that insurance carriers would blame the new law, i do not believe that would be the initially as the carriers do not want to deal with the government at this point and would just continue to blame rising medical costs.

“Our message to them is to work with this law, not against it; don’t try and take advantage of it or we will work with state authorities and gather the authority we have to stop rate gouging,” David Axelrod, Mr. Obama’s senior adviser, said in an interview. “Our concern is that they not try and, under the cover of the act, get in under the wire here on rate increases.”


Insurers have warned since early in the debate that the overhaul might result in increased premiums for many consumers. Based on risk analysis if you have to have an unhealthy individual with a low insurance premium on the books, you would need to increase several health individual premiums to make up the loss. 

Maintaining a health life style would become meaningless from a health insurance policy prospective as all would be charged the same premium.  You work hard to keep your self healthy and pay for those that don't.  There are obvious outliers to this comment as i am not talking about issues that cannot be prevented.

When Can I Expect My Medicare Part D $250 Rebate?

If you have Medicare prescription drug coverage and will reach the coverage gap in 2010, Medicare will automatically send you a tax-free, one-time $250 rebate check starting in mid-June.

The Affordable Care Act contains a rebate provision for Part D Medicare recipients. If you have Medicare prescription drug coverage, and are not already receiving Medicare Extra Help, Medicare will automatically send you a tax-free, one-time $250 rebate check after you reach the coverage gap (also called the "donut hole") in 2010. This rebate is intended to help with out-of-pocket costs for Medicare prescription drug coverage.

Most Medicare drug plans have a coverage gap. This means that after your plan has spent a certain amount of money for covered drugs, you have to pay all drug costs out-of-pocket (up to a limit). Your Explanation of Benefits notice will tell you how much you have spent on covered drugs and whether you have entered the coverage gap.

There are no forms to fill out; Medicare will automatically send a rebate check to you. These checks will be mailed to beneficiaries starting in mid-June. Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap.

If you enter the coverage gap after the rebate check program has begun, you should expect to receive your check within 45 days. Your rebate may be delayed if Medicare does not have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should contact your Medicare drug plan to make sure all of your information has been sent to Medicare.

If you do not receive your rebate check, contact Medicare at 1.800.MEDICARE (1.800.633.4227 ).
TTY users should call 1.877.486.2048.

For the government's brochure on the Part D rebate click here.

Who is Fighting for Your Insurance Claims?

I cam across this article on MSNBC http://bit.ly/aAiFDY.  To summarize Doctors are complaining that Claims-processing errors by health insurance companies are creating undo administrative costs.  The insurance companies on average are get getting 80% of the claims correct.  I am sure Doctors always notice when they are short changed and every so often when they are over paid.

The Doctors have the AMA (American Medical Association) fighting their battles as a group.  In the case of over payment who is fighting on your behalf. 

We have found through our research that almost no insurance broker handles what we feel is the most important part our our jobs ... claims execution!

Our procedure is that NO client is to pay a bill or claim without letting us do our job ... confirm what the correct payment should be. Our mission is to insure that our clients pay the CONTRACTED RATE only. This amounts to 25% of what the bill would be if one was not insured.

The "usual and customary" or "the contacted rate" is key to why we get insurance. If one was not insured the old saying " I went to the hospital and paid $20 for an aspirin" would apply. With insurance you would pay 20 cents, and your broker, who comes free to you would make sure of this.

We have saved our clients countless dollars as they have "side-stepped" double dipping, over charges, cash deals that would have cost them 50% more! Saving our clients money is what we do!

In summary please make sure you find a broker that handles every claim. Any broker can take an application ... it is the great broker that handles every issue for their client ... especially CLAIMS!

Making the Right Private Health Insurance Decision

There are plentiful insurance plans to choose from, but with small differences between the options how to you choose. Many of my clients are aware through their own research, that there are many insurance providers out there each with dozens of plans at different premiums.  They searched out a broker for guidance and advise.  I even had a perspective client (now a current client) tell me that he just wanted information and did not need a broker.  I was more than glad to help.  It came up in the conversation that he was going to purchase the plan directly from the provider rather than through a broker because it was cheaper.  You can imagine his surprise when i informed him that the price is exactly the same weather he uses a broker or not except even he goes directly through the provider, he losses the free usage of a broker. The prices are exactly the same as going to the insurer directly, our services are free.

Its best to seek the advise of an independent broker who is not tied to one provider and who has access to a large number of insurers.   An exclusive agent may try to pigeon hole you into a plan that is not a prefect fit for you, because that is all they have to offer, with an independent broker, the Sky's the limit.

There are many things to consider when choosing a provider, in the past, pre-existing medical conditions have been excluded from cover, along with all related conditions. Someone suffering from high blood pressure would find they were also not covered for such conditions as heart attacks, strokes. The costs incurred could would be astronomical.  There are plans out there that look to cover pre-existing conditions, the premium would be higher than that of a healthy individual.


Choosing the right area of cover is another important task. If someone stays in there home area the best and most cost effective plans are the local one, for example Sierra Health Insurance Plans of NV have by far the best plans for anyone that is generally located around there home base of NV(and are not looking for maternity coverage).  If you are a business man that travels often, you would need a bigger a provider that is present in most states.  These premiums would generally be higher for the prime time names, but you would avoid out of network fees, should an emergency arise and you are of town.


So, is a major player always the best bet?

Not always i observed that smaller companies can be much better in their administration, and customer service. They also have the ability to treat each customer as an individual rather than a number. As they are smaller, they can be quicker to pro-actively respond to the changing needs within the market place. That said, larger companies can be more widely recognised by medical institutions in some remote places.

There really is a lot to consider, things are changing more than ever, and more quickly than ever before in the insurance market. That’s when the expert advice and guidance of an experienced broker becomes vital.

Claims and as a Consumer The Things You Should Know

I have found through my research that almost no insurance broker handles what I feel is the most important part of our jobs ... claims execution!

The procedure is that NO client is to pay a bill or claim without letting me do my job ... confirm what the correct payment should be. Our mission is to insure that our clients pay the CONTRACTED RATE only. This amounts to 25% of what the bill would be if one was not insured.

The "usual and customary" or "the contacted rate" is key to why we get insurance. If one was not insured the old saying " I went to the hospital and paid $20 for an aspirin" would apply. With insurance you would pay 20 cents, and your broker, who comes free to you would make sure of this.
I have saved our clients countless dollars as they have "side-stepped" double dipping, over charges, cash deals that would have cost them 50% more! Saving our clients money is what we do!

In summary please make sure you find a broker that handles every claim. Any broker can take an application ... it is the great broker that handles every issue for their client ... especially CLAIMS!

What to Do When the COBRA Subsidy Runs Out

Back in February 2009 the President signed The American Recovery and Reinvestment Act. This stimulus bill provides the unemployed a 65% subsidy for 15 months, this allowed many to keep their former employers health insurance under COBRA.   The employer plan is generally more comprehensive than an individual plan, plus with the subsidy it is also cheaper.

The Subsidy is available for 15 months, which means if you were laid off in March of 2009, your subsidy time is almost up.  You will now need to pay the full premium. Employer plans are group plans and in general group plans are more expensive than individual plans.  If you and your family are healthy than you should be to get a less expensive but equal or better plan than from what you already have.  As tempting as it may be, don’t shop on price alone. Cheaper does not always mean better. Make sure you know what you’re getting.

If your family has any preexisting conditions it may be difficult to get individual health insurance.  You would probably be rated up and have a higher premium, but thanks to HIPAA you should be able to purchase the policy without any exclusions.

You can research plans by going to a website like USA Health Insurance Center or seek out the advice of a professional insurance broker. 

Make sure not to delay and that you do not have a gap in coverage of more than 63 days or the guaranteed insurability of HIPPA expires and even if you are healthy, you might need to go through a medical exam to prove it.

Cost of Out of Network Care under the New Health Care Bill

Insurance companies can no longer pay less for emergency care at “out of network” hospitals — the hospitals with which they don’t have contracted rates. The provisions go into effect for every health plan issued after Sept. 23.A bill from an put of network hospital would not be lower but would remain the same, the difference would be that your insurance would cover the exact amount that they would have covered for an in network hospitals.

The insurance companies contract with hospitals and negotiate a lower price for procedures.  The cost is usually 75%  less than what the hospital would charge someone without insurance.  Hospitals that are out of network will charge someone like they do not have insurance.  The insurance company would always pay less for out of network visits.  As an example, if you had an emergency visit that would normally cost $20,000, however with the in network contracted rates the cost for the visit is $5,000. For in net work the insurance company would pay 80% assuming you would have a 20% deductible.  If the hospital was out of network your insurance only covers 60% of the contracted rate, $3,000.  With the new law, they are required to cover $4,000, like they would have covered with an in network hospital.  You are still responsible for the remaining $16,000.

Sure this is a little help but certainly not enough.  When looking for a plan, don't just go for the cheapest rate, that plan may not be suitable for you.  Find out what plans are accepted at you local are hospitals, urgent care facilities, and your doctors.  You may end up paying a couple of extra bucks, but in the long run, you would could save a bundle.  Your broker should be able to help you determine the right plan for you.

Main Points of the New Healthcare Reform Law for 2010

1. No more lifetime caps. Most people do realize this but there policy has a lifetime cap on how much the insurance company would pay out. The cap is generally in the millions. If you have a catastrophic injury requiring multiple expensive surgeries, you may reach this cap and everything else is owed to the DR out of pocket. This is a great added benefit, however with the added benefit there will be added cost. The insurance companies use this cap to keep insurance costs down, because they can calculate how much they can potential have to pay out. Without a cap the payout calculation would increase far beyond would the actual numbers might be and thus compellingly increasing the policy premium.

2. Young Adult provision. All young adults to remain on their parent’s policy until the age of 26, if they are no already covered through their own employer covered plan.

3. Preventative services must be offered with new plans. Most plans already offer this feature. It costs the insurance company less to keep you healthy, then to treat you when you get sick.

4. This is one some employers may not like. Providing space and time for a mother to nurse or “pump” milk for their baby during its first year. I have two kids; it took my wife over a half an hour to nurse our first child and less than 10 minutes to nurse our second child. At least the Government put in a hardship clause , employer with less than 50 employees who can show that nursing, pumping or providing space would cause the company undue hardship.

5. This is the one some employers may like, a tax credit on the premiums. Businesses with 25 or less employees can receive up to a 35% tax credit from the premiums. Not for profits regardless of size can receive up to a 25% tax credit. Of course there are caveats to obtaining the full tax credit, the average salary of the employees must be below 50k and the business must contribute at least 50% of the premium. As with all government tax breaks, this one also has a sliding scale, so as I mentioned earlier, “the max it 35%” it does not mean you are going to get it.

A complete run down of some of the hightlights that are to come is available on the governments website http://bit.ly/9wkFGT/

The Legality of the Health Care Reform Bill Argued in Court

From the following Reuters article http://bit.ly/dtdMiO

The Thomas More Law Center out of  Michigan had filed a lawsuit on March 23, the day Obama signed the law, and asked the court for an injunction to block it from taking effect.

The argument was based on the following points:

• The group said a provision requiring most Americans to buy health insurance under threat of financial penalty was beyond the scope of Congress' power and was an unconstitutional tax.

The Obama administration compares this to Social Security, all Americans had to pay for SS.  What the government failed to mention is that if you can not pay SS because you have no income, you were not penalized for not contributing to SS.

• The group also said it violated their constitutional rights because federal tax dollars would be used to fund abortions.

This argument is a rather weak one and pulls at the heart string of those that are anti-abortion.  A government policed health plan should cover everything and not be limited.

Surprisingly the Justice Department did not argue this point but rather aimed to stall the argument

• "They bring this suit four years before the provision they challenge takes effect, demonstrate no current injury, and merely speculate whether the law will harm them once it is in force,".

As for the penalty of no health insurance, the Justice Department had this to say

• Congress did not exceed its authority. It said those who did not want to buy insurance may qualify for an exemption from any penalty and that U.S. law prohibits lawsuits aimed at blocking the collection of taxes.

To this I raise the question is this a tax or a penalty.  The exemption from buying insurance is not that simple and you need to meet certain criteria and guidelines to qualify.  Just because the exemption provision is there, it does not mean you would qualify for it.

This will be in the courts for sometime, as more states have sued and i am sure we will not see the end of this until it reaches the Supreme Court.

Small Business Owner to Get Tax Credit for Employee Healthcare

Currently, small businesses may qualify for a tax credit which will cover a percentage of the cost of premiums for health insurance plans. The IRS mailed out postcards to small businesses notifying them of this new tax credit, so any small business owner who may not be providing health insurance for their workers or who currently does provide health insurance, may want to look to see if they qualify for this tax credit.

Providing health insurance coverage is an essential perk to retaining employees and signing on new talent. The group insurances is expensive, small business owners have to deal with the risks of someone getting sick and being out an extended period of time, because they did not get treatment right away, by trying to avoid the cost of the health care or simply they left to go work for a competitor. In small companies the loss of one individual can do irreparable harm to the business operations.

This extra incentive in the form of a tax credit may be what some small business owners need to provide health care for their employees enabling them to keep employees motivated and turnover low while allowing them to attract better talent and growing their business.

Health Insurance Coverage For Young Adults Moves Forward

Today the Obama administration issued proposed regulations to implement a provision in the health care law that would allow adult children to stay on their parents’ health insurance policy until age 26. The regulation would allow children who do not live with their parents or who are not a dependent on a parent’s tax return to receive the expanded coverage. The young adult could be married and still qualify but neither their spouse or their child could receive the expanded coverage. According to the Department of Health and Human Services, the new regulation is expected to increase the cost of employer sponsored health insurance by 0.7 percent next year, or $3,380 for each dependent


This is all smoke and mirrors.

If you are on a group plan through your employer, you and your employer will split the increase depending on how much of a percentage you pay for health insurance. In essence the employer is the one footing the bill, or maybe not, I see employers increasing the percentage an employee puts in for health insurance to cover the increase. Ultimately there is nothing extra benefiting the employee.

If you have individual family insurance, you premium will go up by 1% as well however it would probably be cheaper for the child to be on their own separate plans. The 19-26 age groups are the cheapest to insure and if insured separately from the family plan, would come in cheaper than the 1% increase, in some states it would be $2,000 cheaper. This option is not available for employer group plans.

This legislation does add on advantage to those under 26, if they are high risk individuals, they would not be able to get insurance on their own. Through an employer group plan, they would have guaranteed insurability.

This would explain the 1% increase from a family plan to an individual plan for the child. The only people that will their children to the age of 26 are those that have children in the high risk pool. To cover the cost, the insurance companies would need to raise the premiums on the group plans and I believe it will be more than 1%.

If you do not have a child that is 24-26 and think you will come away unscathed, you are mistaken. Who is footing this bill, well everyone, equally of course. If you are in a group plan this increase to the family plan will affect everyone not just those with adult age children.