Buy 11, Get 1 Free!

Some people just know how to shop. You and I may pay retail, but they always seem to find the best deals. And if they have to cut a corner or two? Well, they’ve got great scissors.
We are in the middle of our first open enrollment under the Patient Protection and Affordable Care Act (PPACA or Obamacare). Applications received by December 23, 2013 will generate new policies as of January 1, 2014. Preexisting conditions will be covered. There is no requirement of prior coverage.
Our current policies, operating under the old set of rules, have a 30 day grace period. It didn’t take long for many of my sharpest clients to realize that paying for December is now optional. If they get sick or injured in December, they will pay their premiums and file their claims. If they don’t have a claim in December, they will let the old policy lapse and start anew in January.
Ethical? Of course not. Legal? You bet. In fact, this is just one more step in our inevitable march off the cliff. Shorting the insurers and making private major medical health insurance unsustainable are part of the campaign that will lead us to Single Payer.
The Department of Health and Human Services (HHS) isn’t just writing rules and regulations on the fly. Last week, in a conference call for journalists, Director Kathleen Sebelius and her team revealed a new set of fixes and recommendations.
All of these recommendations are designed to make the transition to the PPACA smoother by bending the rules at the expense of the insurers.
The government now expects the insurers to cheerfully accept the initial payments as late as January 1st. There is even a push to move that initial due date through the first week or so of January. And next year’s grace period will be 60 days. Please don’t expect that same flexibility from the IRS.
Health insurance policies may include lists of Preferred Providers, doctors and hospitals participating in a network, and prescription drug formularies, lists of covered drugs. HHS is asking the insurers to bend (IGNORE) their own rules during the transition. Is this push out of concern for sick Americans or an effort to avoid more horror stories on the 6 PM news?
The answer is obvious. This has never been about sick people. This has always been about money and politics. The doctors, hospitals, and drug companies want our money. The politicians want our money and our votes. Health is hardly a consideration.
So whether they want to or not, the insurers are having a sale. I’m going to pay my December premium. I’m just that way. Buy you? You may choose to pay for eleven and get one free.
This entry was posted in Uncategorized. Bookmark the permalink.

3 Responses to Buy 11, Get 1 Free!

  1. Dave Cunix says:

    Shared with permission from the client’s email:


    Love the blog.

    This health care debacle will have to be fixed. (And the debacle is not just Obamacare.) I have a small business, and some of my employees don’t have a computer and never will, nor will they ever be able to navigate the Obamacare website. Additionally, they are in the higher age bracket. And smokers. Meanwhile, with my costs rising, the expense is almost unsustainable for a small business. So what to do?

    Cynically, I should cut the employees free, tell them to buy their own insurance, and save my company $$. If I do that, and they don’t sign up, what happens when they are injured or ill?

    One of my employees has a sibling on Medicare because she is on Disability. Her health care is at no cost to her. She goes to the doctor all the time, and does not even follow the doctor’s directions! No copay, no responsibility. Not fair. But then, life is not fair. And yes, the weakest among us should have a safety net. Which brings me back to my first sentence.
    V. N. Klimas

  2. Sam Fiorentino says:

    Ethical? Of course not.

    Dave I would argue that a costumer (insured under an idvidual policy) has not “ethical” obligation to pay on the due date since the Company gives them a 30 day grace period, there fore they are just excercising their riight under the contract?
    It would be different of they had a claim and it was processed before the Company knew they were not goning to pay a premium for that period.

  3. Ellen says:

    As always, informative.
    I feel out of the pruriest forms of my instincts the need to respond to Sam’s insightful remarks — indeed, not only does the healthcare process seems to be a “costume” affair, but the entire process a masked ball — and where the ball stops, nobody knows.

Leave a Reply

Your email address will not be published. Required fields are marked *

Time limit is exhausted. Please reload CAPTCHA.

This site uses Akismet to reduce spam. Learn how your comment data is processed.