October 2023

It is October 13, 2023 and I would like to celebrate the boring sameness of health insurance.  It is a joy to enter The Medicare Annual Enrollment Period that begins Sunday.  And the Annual Open Enrollment Period for individuals and families under age 65 who purchase their own insurance will begin on November 1st.   Agents across the country will be immersed in something we know, love, and will be totally outside of the craziness around us.  It may seem selfish, but the terrorism our friends and relatives in Israel are experiencing and the chaos of the GOP run House of Representatives are taking a toll on even those of us who are only peripherally involved.  Try as I might, I can’t understand the murderous hate of one or the blind incompetence of the other.   At least we will spend our time with human traits we understand – greed and the insatiable desire to get something for nothing.

Our phones are already ringing.  At least once a week the caller asks, “Am I getting all of the benefits I’m entitled to?”  My response is usually, “Ma’am, you are entitled to watch TV without any misleading commercials.”  Something for nothing is big this year.  We have graduated from Free Dental to Free Rides to the Doctor, to Free Bowling Balls and even Free Golf Clubs.  It is as if an entire generation has forgotten the lesson that was pounded into us from a very young age – There is no such thing as a free lunch.

Sure there is an element of greed with the providers and the insurers.  One of our local hospital systems, famous for its fight-to-the-death negotiation style, is threatening the Medicare Advantage contract of a well-known insurer.  There will be nasty letters to the patients from the hospital suggesting that they find a new insurer and equally shocking letters from the insurer to its client suggesting that they find new doctors.  They will come to terms at the last moment and all will be forgiven.  There is a rhythm to this.  There is seldom any need to panic.

Our Medicare clients, those on Original Medicare with a Part D (Rx) plan and even those on a Medicare Advantage Plan, are happy.   And we, their agents, are happy, too.  Medicare is the best coverage many of our clients have had in decades.  It certainly has been for me.  Medicare Part B will go up $9.80 per month to $174.70.  It is still a great deal.  The prescription coverage has also improved.  Helping our clients to understand and appreciate their coverage is normally a positive experience.  The vast majority of my meetings, in my office over coffee, will be moments of calm for us.

The first policies sold under the Patient Protection and Affordable Care Act (Obamacare) became effective on January 1, 2024.  It has been ten years.  If you polled 5 agents you would get 8 opinions about Obamacare.  We know people who pay more for their coverage due to the law.  We know some who pay less.  But our job is to help people find health insurance, the way most Americans access and pay for health care.  Because of the law we will never again tell the parent of a sick child that we can’t get their family covered.  The healthy and those of you who aren’t agents will never fully appreciate the stress of dealing with pre-existing conditions.  And yes, allowing the sick and injured to participate in our pool of business does have some impact on premiums.  That is the price we pay to include everyone, even YOU should your luck run out next week.

We are seeing insurers return to the under 65 market.  They have figured out how to make this profitable.  As agents we are forever hopeful, always believing that this next year’s products will be more straightforward and consumer friendly.  We are seeing networks expand.  We are finding an element of flexibility.  The expansion of the Tax Credit Subsidies is making coverage more affordable.

Your agent, wherever you are in the US, will be busy for the next two months.  Try not to be too envious.

Dave

www.cunixinsurance.com

Picture – Blue Skies – David L Cunix

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The Pendulum Swings From One Extreme To The Other

 

August 2023:

Frank, your short term major medical policy will not be an option for you in 2024.  We will need to look at a regular health policy.

What are those damn insurance companies doing now?

It isn’t the insurance companies.  They love short term policies.  The applications still ask health questions and the policies don’t cover preexisting conditions.

So the Republicans are screwing me?  Is this Kevin McCarthy or MTG?

No Frank, This is President Biden reversing the excesses of the previous administration.

CRAP!

The pendulum swings from one extreme to the other.  The only guarantee is that we will be smacked on the backside every time the bob passes through the middle.  Our two political parties expend a lot of energy in search of the extremes and each election, be it Congressional or Presidential, impacts health insurance, the way most Americans access and pay for health care.

New rules from the Biden Administration.

In the relative quiet of the last two years you would be forgiven if you had forgotten that we are still operating under the Patient Protection and Affordable Care Act (Obamacare) passed in 2010.  We no longer live under the daily threat of our health care system being dismantled without a plan or a care of what would happen to the 50+ MILLION Americans suffering from serious preexisting conditions.  But each administration, Obama, Trump, and now Biden, has had a significant impact on the way the rules are interpreted and administered.

This blog documented the various ways that the Trump administration attempted to both repeal the law and when that failed, sabotage the basic framework of the PPACA.  The following are some of the rules and regulations President Trump and his team used to destabilize the markets:

  1. Eliminate the penalties associated with the Individual Mandate
  2. Defunded the Cost Share Reduction
  3. The promotion of short term major medical policies and association plans
  4. Reducing the Open Enrollment Period
  5. Supporting the Texas Lawsuit

And this is just a partial list!

The pendulum swung hard to the right.  As noted in the July 2017 post Begging The Arsonist To Put Out The Fire:

A key element of the Patient Protection and Affordable Care Act (Obamacare) is the Individual Mandate, the requirement to purchase insurance.  This blog and numerous other published articles have noted that the Individual Mandate traces its roots to the conservative Heritage Foundation over twenty-five years ago.  The logic is simple – If we are going to offer health insurance to all Americans and cover preexisting conditions, we must have everyone participate.

 A concerted effort was made to incentivize the young and healthy to leave the insurance pool.  This was done by removing the penalty for not having comprehensive coverage and by promoting short term major medical plans.  In early 2018 Health and Human Services Secretary Alex Azar changed the definition of short term major medical coverage and allowed these plans to be sold for up to an entire year. These plans were initially designed to bridge the gap between group health plans or, pre-Obamacare, to help those who didn’t qualify for comprehensive coverage.  It is important to note that short term plans:

  • Ask underwriting questions pertaining to health, occupation, and hobbies
  • Are for a limited number of days
  • DO NOT COVER PREEXISTING CONDITIONS
  • Have a limited maximum benefit

Under the previous administration, the healthiest amongst us were encouraged to enroll in a short term plan until they got sick, injured, or pregnant.  They could then migrate to Obamacare at the Annual Open Enrollment, assuming that they didn’t need comprehensive coverage first.  What could go wrong?

The pendulum swung through the middle last year on the way to the left.  In the last two years we have seen a Special Enrollment Period that allowed millions of Americans to reassess their plan choices, an expansion of the Tax Credit Subsidy, and the Annual Open Enrollment Period expanded to January 15th.  The Biden administration is now ready to tackle short term and fixed indemnity policies.

The Biden administration proposal would limit short term major medical plans to three months and allow only a one month extension.  Though we haven’t seen the details, it is assumed that short terms will no longer offer office visit copays and some of the other benefits that made them look like regular, comprehensive health care plans.  President Biden has cited instances where individuals purchased short term plans and were shocked to learn that their claims weren’t paid.  Short term policies do have a place in the market.  They do a good job of paying for things that are new, big, and different.  There are people who could not or would not pay for full, comprehensive health insurance.  It is a gamble.  It appears that the casino has been closed.

I’m not looking forward to my call to Frank next month when these rules are finalized.   I expect anger, cursing, and at least one threat to move to Canada.  Frank is politically aware.  He knew that this day would come.  It was as inevitable as a pendulum swinging back the other way.  Me?  I’m just glad that he never had to test the limits of his short term coverage and I’ll remind him that all good(?) things must come to an end.

Dave

www.cunixinsurance.com

Picture – This is where a Foucault Pendulum hung in the Cleveland Museum of Natural History until it was removed during the current construction.  Proof that all good things do, in fact, come to an end.

 

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ZOMBIES!

You might think that they are dead.  You might even take credit for killing them.  But Zombie Laws survive the best efforts of dedicated legislators, the light of day, or even common sense.  The link is to an example in Georgia, but we in Ohio have our fair share of Zombies.  There is a reason why these poorly thought out regulations, back-door giveaways, or clearly unpopular concepts fail to be passed as standalone legislation and often die in committee.  That would be OK if these Zombies didn’t reappear as an amendment to must pass legislation or snuck into the biannual budget.

Many of us in the insurance industry thought that we had vanquished last year’s House Bill 675 before it could harm Ohio’s senior citizen population.  We just learned that the key provisions have been inserted into House Bill 33, the current Ohio budget bill.   This is the pertinent section:

The superintendent shall not prohibit the following types of solicitation: 57427 57428 (a) Print solicitation such as leaflets, flyers, or door hangers left at residences or on motor vehicles; 57429 57430 (b) In-person solicitations of individuals at the individual’s residence or in public or common areas such as parking lots, hallways, lobbies, or sidewalks; 57431 57432 57433 (c) Telephonic or electronic solicitation such as electronic voicemail messages, text messages, or direct social media messages.

Here are two scenes from the not-too-distant future:

1

Four white-haired gentlemen enjoying breakfast at McDonald’s were approached by two individuals, a man and a woman, both in business attire and carrying briefcases.  The man addressed the diners while the woman opened her laptop.

“Good morning gentlemen.  I am agent Rogers and this is agent Moore.  As per Ohio Representative Bill Dean, we are here about Ohio House Bill 33 signed into law by Governor DeWine on May 26, 2023.   This will take just a few moments.  We need your name and the name of your Medicare Supplement company.”

As Bob reached into his pocket to find his insurance card, a young mother rushed over to the table.  “These two aren’t government agents.  They’re insurance agents.  I saw them here last week.”  Rogers, the insurance agent, started to protest that they were allowed to solicit Medicare Supplements at public places and even McDonald’s.  Bob noted that this might be legal, but it certainly isn’t right.

2

The elderly couple pushed their shopping cart through the parking lot.  Just as they opened their trunk, a young man rushed up to their car.  It took a moment or two for the couple to fully grasp the situation.  Finally the woman spoke up.  “Thank G-d you’re just some skeevy insurance agent.  We thought you had a gun.”

 

This could be our future if the Ohio budget includes this Zombie legislation.  Ohio Representative Bill Dean (R-71)  was the bill’s sponsor.  I plan to provide a copy of his testimony to every client who complains to me about insurance telephone solicitors bothering them at their homes or at dinner.  Some of you might think that I am exaggerating the risk.  Is the State of Ohio encouraging insurance agents to accost us?  This is from Representative Dean’s Sponsor’s testimony last year:

“The current rule, Ohio Administrative Code 3901-8-09, prohibits virtually all agent-generated communications with potential clients unless it’s through direct mail or if the potential supplemental insurance client is already a business client. Here are a few examples of how restrictive the current prohibitions are:

  • An agent calling fellow members of a 65+ group at his or her church about purchasing supplemental insurance; 
  • An agent sending a Facebook message about interest in purchasing insurance to someone they graduated from high school with 50 years ago; 
  • An agent approaching a group of seniors enjoying their coffee at McDonald’s and asking them if they’re interested in chatting about supplemental insurance.

Unless the agent has an existing business relationship with these potential customers, all of these interactions violate the current rule in place.”    

Representative Dean wants to change that.  He failed last year and now his Zombie may be a part of our next state budget.

As I noted last year, I’m 68.  I get all of the solicitations from out-of-state call centers.  Most of them are illegal but somehow beyond the reach of the Ohio Department of Insurance.  It is annoying to have my cellphone ring at 7 AM on a Saturday morning.  We (seniors) may not have to answer the phone, but we do have to see who is calling us.  It could be important.  It might be a sick friend or family member.  We need less people hounding us, not more.  We don’t need someone knocking on our door, approaching us in a restaurant, or tracking us down in a parking lot.  Representative Dean thinks that Ohio’s seniors are being deprived of important purchasing opportunities.  He is wrong.  Here is his email – www.ohiohouse.gov/bill-dean.  Drop him a line, unsolicited, and let him know what you think of his annoying law that won’t die, his Zombie. 

Dave

www.cunixinsurance.com

Picture – It’s  A Trap – David L Cunix and A.F.

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Mr. Cunix Goes To Washington

You either believe or you don’t.  Mark me down as one who believes.  I believe in the fundamental promise of the United States, that all men are created equal (even when we fail miserably at that ideal), that we can govern ourselves (even when we elect less than competent leaders), and that we can structure a system to benefit most, if not all, of us.  And for that reason I work on legislative issues on both the federal and state level.  And that is why over 500 members of the National Association of Benefit and Insurance Professionals (NABIP) were in Washington DC last week.

This was our first completely in-person meeting since February 2020, the onset of COVID.  I wondered if citizens would again have full access to the House and Senate buildings post January 6, 2021.  I am happy to report that yes, I was able to wander around the halls of Congress.  I find the hours I spend in these buildings in serious discussions with our elected officials and/or their staffs, seeing the delegations of veterans, business representatives, and school children from around the country, or even just a casual encounter with a senator to be democracy affirming.

Our meetings with our elected representatives and their staffs are designed to reinforce our main message that health insurance is the way most Americans access and pay for health care.  We remind them that according to the 2020 US Census, 54.4% of the United States population is covered by employer sponsored group health insurance.  We want to make group insurance work smoothly and effectively.  With 10,000 Americans turning 65 every single day, our other main focus is to make Medicare work for our clients, their constituents.  We can get into the various bills and specifics, but the basics, access and payment for care, have remained the same for years.

Our timing was less than optimal this year as the Democratic members of the House of Representatives were on a three day policy retreat last week.  I was disappointed that we were unable to meet with Shontel Brown (D-OH) who represents much of Greater Cleveland.  I was fortunate to be included in a meeting with Troy Balderson (R-OH) of South Central Ohio.  Mr. Balderson and his legislative assistant, Megan Porter, were fully engaged in our conversation and well-versed on our issues.

There wasn’t anyone waiting to talk to this Congressman.

I also led a delegation to Senator Sherrod Brown’s office.  Senator Brown (D-OH) was meeting with several Cuyahoga County mayors so our group met with Francis Goins, a legislative aide who graduated from Shaker Heights.  Mr. Goins extended our meeting to 45 minutes.  He took notes and asked great questions.  Senator Brown has worked to resolve the Observation Trap and has sponsored legislation in previous sessions.  We are hoping the Senator will reintroduce legislation specifically addressing this issue.

Mr. Smith Goes To Washington premiered in 1939, a time when a Senate filibuster actually took effort and it was shocking to see a film that depicted both the American ideal and the reality of political corruption.  In 2023 the corruption is understood and the ideal is sometimes forgotten or ignored.  My annual participation in our organization’s Capitol Conference is confirmation that we can still achieve our ideals.

Dave

www.cunixinsurance.com

Pictures:

Mr. Cunix Goes To Washington – David L Cunix

The Loneliest Place in DC – David L Cunix

Winter in DC – David L Cunix

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Cone Of Silence

Those of us over the age of 60 are used to receiving an incredible amount of junk mail.  I am, of course, referring to the unrequested, unwanted, and unneeded solicitations from Medicare insurers, call centers, and marketing associations.  Many of these mailings are designed to look like official communications.  We also get unwanted solicitations on our home phones and cells.  And don’t forget the misleading television and radio commercials from the washed up athletes and C List celebrities.  It is hardly surprising that the Centers for Medicare and Medicaid (CMS) receives tens of thousands of complaints each year.  What is surprising are the steps CMS is taking to solve the problems.

Step One:  As per CMS: Agents must provide the following disclosure

  • Verbally conveyed within the first minute of a sales call
  • Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content)
  • Prominently displayed on Third Party Marketing Organization websites (regardless of content)
  • Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the Third Party Marketing Organization

Step Two: Recording Telephone Conversations

“Beginning October 1, 2022, for all 2023 activities, all TPMOs, including all third-party marketing/lead generation vendors, agencies, 1099 agents and brokers (captive, independent street brokers, TeleDigital agents, etc.), will be required to record all beneficiary calls (sales, enrollment, administrative, etc.) – inbound and outbound – in their entirety, with no exception. Other important requirements:

  • Applies to all telephonic activities, even if it does not result in an enrollment.
  • Requirement applies to all beneficiaries and members. There is no distinction made between new and existing clients.
  • Consent to record must be obtained for all calls.
  • Recordings are not required for in-person activities.
  • Medicare requires all records be maintained for 10 years”

In English, we are now required to record ALL telephone conversations that have anything to do with Medicare.  There are no exceptions.  For example, if you live in Billings, Montana and call your local agent on October 2nd to confirm your October 17th appointment, the conversation will sound like this:

Bob Smith, Insurance Agent – Thanks for calling Smith Insurance.

Larry Jones, longtime client – Hi Bob.  It’s Larry Jones.  I’m just calling to confirm our appointment for Monday, October 17th at 11 AM.

Bob Smith – Hi Larry.  Before I can go any further, the government requires me to read the following disclosure to you: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

Larry Jones – What the Hell does that mean?

Bob Smith – Wait, there’s more.  I need to ask your permission to record this call.

Larry Jones – Why?

Bob Smith – Every Medicare related phone call has to be recorded and kept for ten years.

Larry Jones – You’re kidding!

Bob Smith – I’ve been your agent for over 10 years.  I wish this was a joke. May I have your permission to record this call?

Larry Jones – Fine.  Just do it.

This is going to work as well as the Cone of Silence.

Your local agent is working through this process.  We are researching different recording systems all the while hoping that this rule will be put on hold for a year or two or hopefully twenty. Smart agents already retain copies of all emails and take copious notes during in-person meetings.  Recording phone conversations will complicate our lives and undoubtedly feel like one more intrusion into our client’s privacy, but we will all survive.

As per the disclaimer, HELL YES, WE DON”T REPRESENT JUST ANYONE.  Your local agent is solicited daily by the insurers and marketing organizations.  We each choose which companies we want to represent based on our experience with their service, networks, and product design.  I refuse to represent certain well-known carriers because of issues I’ve had with their service.  Not offering every plan available in the area is not a negative.  Your local agent is proud to represent only the companies he/she selected.

#          #         #          #          #

The doctor is a social acquaintance.  He is not really a friend.  He is not a client.  Doc wanted me to know that we are “just breaking the surface” on COVID.  He used the phrase several times to emphasize how much more there was to know and how little those of us in the general public knew.  As a doctor he was privy to so much more, none of which he planned to share with me, a mere insurance agent.  I’ve known him for a number of years.  This wasn’t the first time I had encountered his demi-god shtick.  Still, I would have been happy to learn any useful information he might have been willing to share.

But I have information, too.  I have a couple of years’ worth of conversations about COVID with my clients.  I know that some of my clients have spent time in the hospital and that, sadly, some have died.  We’ve discussed the lingering effects of long COVID and the question of when/if the individuals will ever fully recover.  And some of my clients have had other non-COVID illnesses that seem to last for months and months.

My clients share their health concerns with me.  We discuss their fears about tests and procedures, the potential costs of hospital stays and the newest drugs.  Another big topic are the doctors who don’t listen to my clients’ concerns and only ask the questions from the pre-printed checklist.  Some of those conversations are with people under age 65 and some are with Medicare beneficiaries.  Most Medicare beneficiaries will refrain from deep, personal conversations once their calls are recorded.  That’s a shame.  Our in-person meetings will just have to be a little longer.

Dave

www.cunixinsurance.com

Picture – Would You Believe A Shoe Phone? – David L Cunix

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When The Goal Is FAILURE

The answer was, “NO”.  I hate to say, “No”, and I hate to disappoint a perspective client.  And yes, I hate to fail.  Joseph (name changed) has had a lot of disappointing news lately.  Joe has worked for the same employer for over ten years.  He and his family are covered by the employer’s group health insurance policy.  The employer has always paid a portion of both Joe’s (employee) premium and also part of the family’s (dependent coverage) cost.  Now, as of June 1st, the employer will only pay part of the employee premium.  Joe is left to pay all of his wife and son’s premium.  The cost is prohibitive.  Here are options we could pursue:

  • Were it not for the Family Glitch, discussed in my last post, we might be able to get a tax credit subsidy to help him pay for his spouse and son’s coverage through healthcare.gov.
  • If Joseph’s spouse and child didn’t have any preexisting conditions, we could move them to short term major medical coverage. Short term policies are less expensive because they are not guaranteed issue.  The application is underwritten.  You can be declined.  Preexisting conditions are NOT covered.  This is not a good option for them.

Joseph and his family can not be without insurance coverage.  He does not want to look for a new job.  They will be forced to cut back and find the money for the premiums for the rest of 2022.  We can only hope that the Biden administration’s plan to fix the Family Glitch will be in place by this year’s Open Enrollment Period that begins November 1st.  My goal is to view this  as a set-back, not a failure.

But what if the goal is failure?  What if you have spent the last ten years or so working every day to make it harder, not easier, for Americans to access and pay for health care?  And that brings us to Senator Pat Toomey (R-PA).  You probably don’t think about Senator Toomey when you are thinking about health care legislation.  He has spent most of the last decade decrying the introduction of the Patient Protection and Affordable Care Act (Obamacare), voting for the repeal of the law without any replacement, and still talks about the debunked theory that everything will be fine if we could only purchase health insurance across state lines.  Now in the waning moments of his last term (like Rob Portman (R-OH) he beat the electorate to the punch and chose to not seek re-election), Mr. Toomey has decided to make a last attempt for both relevance and to gain the attention of some future employer.  Mr. Toomey is too committed to the failure of Obamacare to suddenly want to help Americans afford their health care.  Instead, on May 11, 2022 he and fellow consumer advocate, Senator Richard Burr (R-NC) have attacked the Biden administration’s attempt to fix the Family Glitch.

This is the link to the Toomey / Burr press release.

The opening sentence dispels any possibility that this is a good-faith effort by Senator Toomey to help Americans access and pay for health care.

“This action would further the reach of the federal government into Americans’ daily lives, placing more federal red tape between patients and their doctors.”

Helping American workers pay for their health insurance does not insert the government between the patient and the doctor.  People like Joseph will have a choice.  He will be able to keep his employer’s coverage for his family if he can afford it and if it serves his family’s best interest.  Or, he might be better off purchasing a policy through the government’s exchange, possibly with a tax credit subsidy.  Joseph is not alone.  According to the Kansas Health Institute, a nonprofit, nonpartisan educational organization based in Topeka, approximately “40,000 Kansans are not eligible to receive premium tax credits due to what is known as the ‘family glitch’.”  The Kaiser Family Foundation estimates that over 5 million Americans are affected by this across our country.

As I noted last month, members of the National Association of Health Underwriters (NAHU) go to Washington every year to fight FOR our clients.  We have asked Congressmen and Senators to address this issue for over 10 years.  We know how the laws passed by Congress and regulated by the various agencies impact our clients.  It is that information that we bring to our elected representatives.  We are so close to making life easier for our clients.  This doesn’t solve everything.  It doesn’t make Obamacare anywhere near perfect, just a little better.

Our efforts have been focused on helping Joseph and millions of Americans like him.  That was our goal.  Once again we have been reminded that for some, the goal is failure.

Dave

www.cunixinsurance.com

Picture – When Failure Is Inevitable – David L Cunix

 

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A Glitch Can Be Fixed

It may have been on my first day as an insurance agent.  It could have been the second.  Regardless, this was one of the first and most important lessons I learned about employer-sponsored group health insurance:

The purpose of group insurance is to attract and retain good employees.

Our job as agents was to help the employer find the sweet spot, the package of benefits that was both cost effective and yet appropriate for both the particular industry and job market.  Highly competitive industries offered more comprehensive health insurance coverage.  Some employers felt that even though their competitors offered little or no benefits, they had a moral responsibility to provide health insurance coverage.  Sometimes though, the system prevents this.

November 24, 2014 was The Day We All Lost.  My blog post told the story of Thomas Roberts (name changed) who was forced to cancel his company’s group health insurance policy.  I noted that some of his employees migrated to individual policies and wondered how many would still have coverage four or five months later.  Both Thomas and I were concerned.

It is now seven and a half years later.  Some of Mr. Roberts’ employees retained the individual policies.  Some left his company in search of a job with benefits.  He and I still talk on a regular basis.  He wants to provide group health insurance to his current employees and, of equal importance, he is having difficulty hiring new employees.  Group insurance would help.  I may have some good news for Mr. Roberts, his employees, and millions of other Americans.

The Biden Administration has proposed new rules to fix the Family Glitch.  This is a quick definition of the Family Glitch from an April 2021 Kaiser Family Foundation article:

“Financial assistance to buy health insurance on the Affordable Care Act (ACA) Marketplaces is primarily available for people who cannot get coverage through a public program or their employer. Some exceptions are made, however, including for people whose employer coverage offer is deemed unaffordable or of insufficient value. For example, people can qualify for ACA Marketplace subsidies if their employer requires them to spend more than 9.83% of his household income on the company’s health plan premium.

Currently, this affordability threshold of household income is based on the cost of the employee’s self-only coverage, not the premium required to cover any dependents. In other words, an employee whose contribution for self-only coverage is less than 9.83% of household income is deemed to have an affordable offer, which means that the employee and his or her family members are ineligible for financial assistance on the Marketplace, even if the cost of adding dependents to the employer-sponsored plan would far exceed 9.83% of the family’s income. This definition of “affordable” employer coverage has come to be known as the “family glitch.”

The link in the quote takes you to a KFF August 2011 article.  This is not a new problem.  Members of the National Association of Health Underwriters (NAHU) go to Washington every year to fight FOR our clients.  We have asked Congressmen and Senators to address this issue for over 10 years.  Too many of our elected representatives have been too busy trying to repeal the Patient Protection and Affordable Care Act (Obamacare) to have any time to try to make it work.  The Biden Administration has put forth real effort to make health care more accessible and affordable.  This is just one more step.

What might change?  Let’s go back to Thomas Roberts and his business.  Mr. Roberts’s business is in a highly competitive industry.  Most, but not all, of his employees are unskilled or semi-skilled workers.  He can afford to pay most of his employees’ health insurance premium, perhaps as much as 90%.  He can not afford to pay the premium for their dependents.  Under the current interpretation of the law, the spouses and children would be ineligible for a tax credit subsidy to help to pay their premiums.  Forced to pay the full cost, they are more likely to be uninsured.  Instead, Mr. Roberts will be able to put in to place a group health policy for his current and future employees.  The families will be able to apply for health policies through the Marketplace and if their incomes warrant it, get a tax credit subsidy to help pay the premiums.

The net gain will be more insured Americans.  And we again have confirmation that a glitch can be fixed.  All it takes is someone to care.

DAVE

www.cunixinsurance.com

Picture – Glitch – David L Cunix

 

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Blog-Mitzvah, The Thirteenth Anniversary Of Health Insurance Issues With Dave

Today’s post marks the thirteenth anniversary of Health Insurance Issues With Dave.  Thirteen years and 325 posts.  A surprisingly large number of you have been regular readers for years.  Others, like some agents in Arizona and California, are new to these posts.  I started on BlogSpot and added the WordPress version on my website.  Some of you are reading this on the AOL Patch system and others on Linked In.  Four different locations and four different formats.

At the top of each post are the four guiding principles of this blog:

  • PURPOSE Short Articles designed to illuminate different aspects of the health care discussion.
  • CORE PREMISE If you think you know all the answers, you probably don’t understand all of the questions.
  • CENTRAL BELIEF Absolute Power Corrupts Absolutely
  • AUDIENCE Our current health care system impacts all Americans.

Some of the articles weren’t quite that short.

My first post focused on an elderly gentleman with multiple health issues who was waiting for a kidney.  Should he get one before a younger, healthier individual?  Should we pay for this through Medicare?  Who decides?  The post then notes:

The payment and delivery of health care in the United States must change. There is too much pressure, political and financial, for Congress to ignore. This is good. Our current system is a hodgepodge of stop-gap measures masquerading as a solution. Unfortunately, some of the most vocal proponents of change have some of the most unrealistic answers to this question. We can not have unfettered access to any and all care without restriction or cost.

Since then I interviewed hospital administrators, elected representatives and their staffs, and had a couple of guest posts.  I have analyzed both the Democratic proposals and the Patient Protection and Affordable Care Act as well as the Republican proposals.  And when our entire system was under attack by either the State of Texas or the White House, I didn’t shy away from detailing exactly how we would all be impacted by their blatant disregard for our access to health care.  Though a Centrist Democrat, I have ticked off Democrats and Republicans equally.  The truth, as I saw it, was my goal.  I hope that I have come close.

I’ve had a lot of fun doing this.  When the editors of the local AOL Patch came to my office and asked for me to post on their then 17 local publications, they said that I needed to have a picture.  The pictures were a new element and a challenge.  I hope that you have enjoyed some of them.  The links are often my favorite part of each blog.

It was important to me that this blog was more than just my opinion.  The links are what made the difference.  It wasn’t enough to cite a law or a court case.  The blog linked you to the actual document.  And when the Supreme Court weighed in, you were linked to both the decision and to SCOTUS Blog, the definitive analysis of each decision.  Details.  The internet and cable TV are filled with opinions.  It was my goal to provide enough information that you could, if you wanted, read the source material and form your own opinions.

And speaking of fun, some of my readers search the blogs for the links to the songs.  Every blog has at least one.  Always topical and often of a live performance, the music allowed me to add a bit of levity to some very serious posts.  Some politicians even had their own theme songs.

I never imagined doing this for thirteen years.  Thank you for indulging me.  Thank you to the attorneys, financial planners, CPA’s, and bankers who have forwarded this blog to their clients in an effort to explain our health insurance system.  Thank you to the insurance agents around the country who use this blog as a resource and are kind enough to let me know.   And thank you, all of you, who take the time to email me your thoughts.  It is the feedback that lets me know that I’m not talking to myself.

One of our traditions is to make a donation to a charity in honor of a young man becoming a Bar Mitzvah.  Should you be so inclined, please consider your local food bank.

Dave

www.cunixinsurance.com

Picture – The Proud Parent – David L Cunix

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Forever Young

Sally’s phone was buzzing.  It must be important.  It was a text message at 7:30 on a Saturday morning.  She checked her phone.  It was another message from healthcare.gov.  I asked her how often the marketplace was sending a 66 year old woman a text to purchase individual health insurance.  Her answer was, “almost daily”.  I was shocked.  She was amused.  With healthcare.gov you are forever young.

The pendulum has swung to the other extreme.  The individual health insurance market survived four years of sabotage.  Now we have an administration so eager to have everyone covered that Pete Buttigieg might personally drive you to my office.  We have good, positive advertisements on radio and television.  We had an extra Open Enrollment Period this spring and summer. The marketplace worked really well this year.  And consumers who have purchased policies through healthcare.gov have received lots and lots and lots of reminders to visit the site to renew their plans.

But do you need to visit healthcare.gov to renew your policy?  NO.  The policies renew automatically.  Check your subsidy.  If you want to keep your current policy and you haven’t had any changes in your income, there really isn’t a reason to go into healthcare.gov.  Confirming your status could be five minutes over the phone with your agent.  If you want to explore your options or adjust your subsidy, yes, visit healthcare.gov either on your own or with your agent.  The policies are the same price with or without an agent, so you might as well find someone you trust to guide you through the process.  But if nothing is going to change, don’t let the daily texts, emails, and calls push you.  If you are fine, you’re fine.

The system does not pick and choose who should reevaluate their plan and who can just let the policy renew.  Healthcare.gov contacts everyone who has had a marketplace policy.  Heck, it even nudges people who have turned 65 and are now on Medicare.  Because healthcare.gov assumes that you don’t know about Open Enrollment and that you are forever young.

DAVE

www.cunixinsurance.com

Picture – A Wild Ride – David L Cunix

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Second Notice!

We got the envelope in the mail on Friday.  Second Notice!  The nerve of us.  We had failed to respond to the first solicitation and now we were being admonished with this, our second notice.  How dare us?  Why didn’t we jump on the opportunity to subject ourselves to a high pressure sales pitch from some cubicle junkie to purchase some crappy Medicare Advantage policy?  The call is free.  The results are devastating.  In just a few minutes I could lose the benefits of Original Medicare and my Medicare Supplement to gain ___.  To gain what?  Routine dental?  Mediocre vision? Maybe, just maybe, I’ll score a plan that puts a week or two’s worth of meals into my freezer after I’m hospitalized, which might sound good if you ignore the thousands of dollars I might have to pay for that hospital stay.  I guess I’ll be getting a third and fourth notice before the end of Open Enrollment on December 7th.

One of my clients told me about a phone call she had recently received.  She normally doesn’t answer her home phone, but was waiting for a call from a repairman.  The call was a solicitation for a Medicare product.  She was too polite to just hang up, but when she said that she wasn’t interested, the caller became abusive.  She objected and his response was that it was her own damn fault.  She shouldn’t answer her phone if she didn’t want to hear his pitch.  That is the world we live in today.

A woman called my office and asked me if she was “getting all of the benefits she was entitled to”.  I told her that she was entitled to the peace of watching her TV without misleading Medicare commercials.

Last year’s post, Who Is Selling Your Name? was about solicitations we were all receiving because Follow My Health (University Hospitals) and My Chart (Cleveland Clinic) sold our names to an online/call center Medicare marketer.  As noted at the time, the marketer was no better and no worse than any other call center.  The odd part was that it looked like the hospital systems were recommending the patient to change coverages.  Of course they weren’t.  This was simply another way for someone to make money off us.

This year many of my clients have received a similar solicitation.  This time our names, yes mine too, were sold by Giant Eagle pharmacy.  Giant Eagle has provided our names, addresses, and who knows what else, to that same online/call center Medicare marketer.  The clients called to ask me why they got these solicitations.  Were our specific prescriptions provided? Probably not.  Were our phone numbers provided? I hope not, but who knows?  We all agree that this feels more egregious, a greater abuse of our trust.

Privacy is an illusion.  I tell my clients that we are undressing in front of the windows.  Smile and wave.  Still, there are times to stand up for ourselves.  I will be moving my prescription to a new drug store and I am suggesting that my clients do the same.  The only way to express our displeasure is by hurting their bottom line.

Will I contact Giant Eagle to explain why I’m pulling my business from them?  No.  I don’t think they deserve a second notice.

DAVE

www.cunixinsurance.com

Picture – More Junk Mail – David L Cunix

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