On keeping your plan if you like it

Thursday, April 30, 2015
By now, posts on "grandfathered" and "grandmothered" plans must seem like old news. And yet, the hits keep on comin'. In email from Medical Mutual of Ohio:

"“T" Plans Now Available on MyBrokerLink/Converting Grandfathered "S" Plans to New Grandfathered "T" Plans"

Clear as mud, no?

This is what happens when the government takes over the health insurance industry (and make no mistake, if you exercise control over a market segment, you own that segment). And so we get authentic frontier gibberish like the above.

Oh, what does it mean?

Basically, the Feds have graciously (and illegally) allowed insurers to make modest changes to grandfathered/grandmothered plans, which MMO will be implementing as they renew. This particular email targets small group plans. The change is ostensibly an effort to help hold down premiums; let's just say that I'm not holding my breath.

Another One Bites The Dust

Wednesday, April 29, 2015
Obamacare continues to claim victims as it marches forward. Lost insurance coverage and job loss.

Employees of Assurant are about to be the latest victim.
With Milwaukee-based Assurant Health continuing to bleed red ink, its parent company announced in a Tuesday news release it will either sell the health insurer or exit the health insurance business. - Bizjournals
The company was established in 1892 and was profitable every year until 2013.
Assurant Health posted a $63.7 million operating loss in 2014. Assurant Inc. said Tuesday Assurant Health will report a net operating loss for the first quarter in the range of $80 million to $90 million.
Assurant has more than 1,000 employees and over 1 million policyholders.
If Assurant Inc. does not sell Assurant Health, the parent company will begin the process this year of exiting the health insurance market and will not participate in the next ACA open enrollment period beginning in November.

#Obamacare  #Assurant

Covering Baltimore

As was the case in Ferguson last year, the riots in Baltimore over the past few days have caused widespread property damage, mostly to folks who had nothing to do with the proximate cause of them:

Homes, businesses and cars have been burned, looted and otherwise damaged, leaving owners wondering what, if any, insurance payments they can expect.

The Insurance Information Institute (III) has helpfully published a media advisory confirming that, generally speaking, such damage is considered a covered event, and claims will likely be honored:

"Auto, homeowners, and business insurance policies generally include coverage for property losses caused by riots and civil commotions, such as those occurring this week in Baltimore ... Standard business property insurance policies provide coverage for the structure of the building as well as the contents inside"


As always, be sure to check with your own carrier to confirm whether or not these exposures are, in fact, covered.

Employer Sponsored Insurance: Behind the Little Tree is Obamacare's Forest

Tuesday, April 28, 2015
Obamacare was passed with a promise to reduce premiums, elevate the level of care we receive, and put an end to rising health care costs. It was also promised that everyone would have access to good insurance and that if we liked our plans we could keep them. These promises have gone empty, yet in the eye of public perception, the favorability/unfavorability of the law (according to the Kaiser Family Foundation Poll) is tracking close to even. However, the most important question that is asked, but not discussed, is what will lead to changes in views in the next few years.

For now, the favorable perception can be attributed to the fact that Obamacare is front loaded with warm and fuzzy feel good benefits. From "free" benefits like birth control and preventive visits, to the slacker rule - keeping your "kid" on insurance to age 26 - every provision of the law that has been implemented has a positive result.

On-the-other-hand, things that have a negative impact have been repealed, cancelled, delayed, or extended. We have had a repeal of the 1099's and CLASS Act, an offer to extend "transitional" policies (the lie that if you like your plan you can keep it), and numerous delays in employer reporting including a year long delay in the employer mandate. We also haven't felt the impact of "indexing" which will increase what people have to pay for premiums while reducing benefits.

In keeping with the "kick the can down the road" theme, two new pieces of legislation are gaining momentum. One is to repeal the Health Insurance Tax and the other - introduced today - is to eliminate the Cadillac Tax.

These taxes, reduced benefits, higher costs, and administrative burdens will increase over the next few years. Moreover, they will reach the employer sponsored markets impacting a much larger share of our population (roughly 55% of our population are covered by their employer). 

Which takes us to the most important question asked when discussing public views on Obamacare:
"Would you say the health care law has directly helped you and your family, directly hurt you and your family, or has it not had a direct impact?"
It's not who has been helped (19%) or hurt (22%) by the law. It's the significant majority of respondents - 56%!!! - who have felt no direct impact.

It's not a coincidence that the respondent percentage is almost identical to those with employer insurance. It shows that until Obamacare is fully implemented and a majority feels an impact, public opinion will see little change.

But until then, we will still be focused on the trees and completely be overlooking the forest.

Monday Afternoon Link Potpourri

Monday, April 27, 2015
Some interesting items for your consideration:

■ "Nearly a fifth of the National Football League settlement approved this week compensating former players with head injuries could go to their health insurers instead"

Briefly, the NFL settled a players-filed lawsuit asking for compensation for life-altering head injures. The problem is, most of the costs associated with treating those injuries were borne by the players' health insurers. Under the concept of subrogation (a common feature in health, auto and other indemnity-based insurance products), the players waived their rights to any amounts rewarded that could go towards reimbursing those carriers. It's not really "news" except that most people haven't read their policies, and are unfamiliar with the principle.

■ Next up, this helpful info courtesy of FoIB Jeff M:

"COBRA considerations when Medicare-eligible. Clients may not realize the need to combine them."

A lot of folks who've recently retired (voluntarily or otherwise) opt for COBRA continuation of their previous coverage, since that's often the path of least resistance. But that may, in fact, be disastrous:

"With rare exceptions, COBRA coverage is secondary to Medicare Parts A and B ... The result is that when Medicare-eligible individuals do not have Medicare Parts A or B, they are left to pay 80% of their costs out of their own pocket."

And that's not all:

"Medicare has a window of opportunity to enroll in Medicare Parts A and B that lasts eight months after leaving employment."

Miss that special enrollment opportunity and you're facing a lifetime of fines once you do manage to sign up, which could also be a while.

Good info here.

■ Finally, some news on the viatical front:

"In 2013, the top 15 life settlement providers paid more than $362 million for unwanted life insurance policies."

That "investment" was worth a potential $2.2 billion in death benefits. It's also a major (29%) increase over the previous year. But what's driving this thriving [ed: really?] market?

According to the article, it's a rebounding economy, with institutional investors looking for better returns. I'm not convinced: it seems to me that more and more middle class folks, still hurting in a reduced labor market, are looking for ways to raise capital quickly, and what better way than to sell off unwanted (or unaffordable) policies, raising quick cash and easing the budget?

Running on Empty

Sunday, April 26, 2015
California is running out of water and money.

Gov. Moonbeam blames global warming and wasteful usage on things like lawns and toilets for the water problem. But what about the money issue?

Covered California, the Obamacare exchange for residents (legal or otherwise) of Kalifornia, was built with seed money from Obama's fat wallet. Problem is, those funds are running dry.
Indeed, there’s no more money coming from Washington after the state exhausts the $1.1 billion it received from the federal government to get the Obamacare exchange up and running. And state law prohibits Sacramento from spending any money to keep the exchange afloat.
That presents an existential crisis for Covered California, which is facing a nearly $80 (billion) budget deficit for its 2015-16 fiscal year. Although the exchange is setting aside $200 million to cover its near-term deficit, Covered California Executive Director Peter Lee acknowledged in December that there are questions about the “long-term sustainability of the organization.” - OC Register

Unlike the federal govt, the Republik of Kalifornia cannot print their own money and must balance the budget.

What a novel idea.

But wait. There's more.
Covered California’s enrollment growth for 2015 was a mere 1 percent, according to a study this month by Avalere Health. That was worst than all but two other state exchanges. Meanwhile, California’s Obamacare exchange managed to retain only 65 percent of previous enrollees, the nation’s fourth-lowest re-enrollment rate.
Not only are they running through money like it was water, but they aren't doing a very good job of managing resources.

OK, maybe that water analogy was a cheap shot.

#Obamacare #CoveredCalifornia

Working for Free

Saturday, April 25, 2015
Agents that dared venture into the Obamacare morass at healthcare.gov are discovering, in many cases, they
were donating their time and expertise for the cause.

If you want to get paid on business submitted through goodluck.gov the form that is transmitted to the health insurance carrier must have you identified by your NPN (National Producer Number). That number is the key to getting paid.

Without it, you get nada.
CMS recently identified that healthcare.gov is not always passing the agent's name and National Producer Number (NPN) to health insurance carriers. As a result, Highmark cannot assign agent and agency numbers to these policies, and commission cannot be paid.
If producers believe this information is missing, they should contact their General Agency (GA). The GA should then check the daily activity reports and commission statements to see if this information was sent to Highmark, prior to taking any additional action. Please note - the producer hotline cannot verify if the agent's name or NPN is on an application. - URLINS

Is this a glitch or something deliberate?

Could be either. No way to know.

There have been rumors that hc.gov enrollers are being instructed to strip NPN's from the file if they have any direct contact with the applicant during the application stage.

But it could be something as simple as a hard drive crash ............... or the server being stripped of this information.

From the Life Files

Friday, April 24, 2015
So about 30 years ago, my since-retired colleague wrote a policy on a 30 year old client (whom we'll call Gene). Gene's wife was named as the beneficiary, and all was well.

A few years - and two children - later, Gene and his wife divorced, and Gene changed the beneficiary of his policy to his brother.

Problem is, he never told his brother (or his kids) that he was doing so. Recently, Gene passed away, and his ex-wife called me to inquire about the policy. I called the home office and confirmed that a) he did, in fact, have a policy (and it was in force) and b) his brother was the beneficiary (again, news to all of us).

Fortunately, the brother lives relatively close by, and was in town attending to the funeral arrangements and such. I was able to connect with him, and we met yesterday to complete the claims paperwork (we're still awaiting the official death certificate, without which the claim can't be paid).

That's when I learned that not only did Gene never tell his brother about the policy, but that he died without a will (aka intestate for all you legal-beagles). The brother had no idea what Gene wanted to do with the proceeds of the policy (well, the balance after final expenses), nor of his house or other belongings. He's decided that he'll just divvy up the balance with his nieces once all the (modest) estate costs are settled.

This is just so sad: Gene died alone, and never made his wishes known to those that were (ostensibly) closest to him. I suppose there's a lesson here, somewhere, but danged if I know what it is. Any suggestions?

Health Wonk Review - Windy Spring edition

Thursday, April 23, 2015
HWR co-founder Joe Paduda hosts this week's outstanding round-up of wonky blog posts, with an emphasis on the ACA. Come for Louise Norris on coverage gaps, stay for Dr Jaan Siderow's "pretty cool" moment.