By Bob Smith
Licensed Health & Life Insurance Agent
In a few days, we will reach the halfway point in the calendar year and make the turn for the proverbial back nine. This is the time of the year when health insurance companies present their 2019 health plans to state Insurance Commissioner’s Offices, and we await with trepidation. Which insurers will offer plans in 2019, what will the plans look like, and will individuals and small (under 50) groups responsible for purchasing their own health coverage be able to afford them?
The congressional debate over the Patient Protection and Affordable Care Act — a.k.a. ObamaCare or ACA — did not end with the law’s passage in 2010 or implementation in 2014. Each year since the law’s enactment, health insurers have withdrawn from offering on and off health plans; and the cost for those not qualifying for a federal tax credit (aka subsidy) based upon income has increased and HMO choices become more limited. The sand under our feet has shifted mightily while the debate on how to deliver care continues. With a sense of optimism self-employed workers, independent contractors and employees without employer sponsored (and subsidized) health plans still have choices and the light at the end of the tunnel is not the oncoming train.
What respite do individuals purchasing health insurance on or off the Federal Marketplace have?
- One course is stay healthy, eat sensibly, exercise daily and adhere to our mother’s advice of eating an apple a day to keep the doctor away. Swimming in the right gene pool doesn’t hurt either.
- Since the era when doctors made house calls (“the good old days”), health insurance existed only to protect against catastrophic medical consequences. The option was to be self-insured and pay cash for the medical services rendered (healthbluebook.com and www.fairhealthconsumer.org). And though cash pay policies are a growing trend where patients can avoid miscoding CPT or ICD-10 codes, this isn’t medically or financially feasible upon a trip to the hospital resulting from a serious medical issue.
- There are PPO health plans that offer a cost-effective and viable alternative to HMO plans offered on the Federal Marketplace. The plans provide a strong network of doctors with premiums typically offering savings of 50% or more, critical illness supplements and other valuable imbedded benefits. These plans also work in tandem with or without self-pay policies at the doctor’s office. Enrollment is not limited to a narrow window and if you are not fully pleased with your existing coverage you are able to consider alternatives without having to wait till open enrollment and January 2019.
Inherent in consideration of insurance is an individual’s risk threshold. Bad things happen to good people and at the heart of wellness is prevention. An integral component in prevention is the Primary Care Physician’s role. This fact has been recognized and promoted by HIPnation, a growing concierge-style model with multiple doctor practices in the Atlanta Metropolitan area. The membership program is built upon a PrimaryPlus foundation with an eye towards outpatient care. Founded by doctors, this patient-centered concierge service is helping bring down their members’ costs and pairs with low cost insurance coverage. The resulting better care from a personal physician for $100/month with no copay and no deductible has proven to lower overall annual costs. Check-out www.HIPnation.com.
Healthcare is a complicated and what’s most important is having access to affordable health insurance and a physician practice that is patient focused with an eye on prevention that can help forestall future medical consequences.
Note: It’s important to do due diligence with non-Marketplace plans as they are underwritten and the devil is in the details.
With this in mind, saving more than $2,500/yr should be worth a 30 min conversation for additional information. And rest assured I am still making house calls.Read More
By Bob Smith, North American Health Plans Insurance Advisor
Recent health care legislative attempts in Congress demonstrate that the state of the individual market is facing uncharted waters and health insurance experts foresee rough seas ahead in 2018.
Lost in the debate is the financial impact the uncertainty will have on Independent Contractors and individuals responsible for purchasing health insurance. Based upon income, many 1099 wage earners will not qualify for federal tax credits to lower premiums or subsidies to reduce coinsurance, deductibles and out-of-pocket maximums. Regrettably this unenviable position will cause increasing premiums and financial risk.
Affordable Care Act open enrollment is around the corner and decisions for health plans issued January 1st must be made between November 1 and December 15. Projecting the cost of premiums is a difficult task compounded by the present market instability, which actuaries deplore. What may provide insight and make the upcoming landscape clearer have been news reports of carriers requesting up to 40% increases. There is also the threat of carriers contemplating pulling out of the market diminishing choices. Not unlike what Henry Ford recounted,and I paraphrase: you can have a health plan in any color you want, as long as it’s blue.
But all is not bleak on the horizon. There are viable alternatives to help protect against increasing premiums and reduced health benefits. Of course an option is to not purchase health insurance and maintain a self-funding status. This option is one I do not recommend as it is not a proper risk adverse strategy.
A better alternative is a Fixed Indemnity Health Plan. These plans provide a significantly lower cost option with enhanced care and choice through a national PPO physician/facility network. Fixed Indemnity plans are not subject to limited open enrollment time restrictions and can be selected throughout the year. As the name implies, the plans provide a fixed benefit of your choosing for doctor visits, in-patient hospital care, professional surgical services, out-patient procedures, etc. In essence coverage is not unlike ancillary benefits that reimburse a daily rate (i.e. hospital room of up to $4500/sickness and $6000/injury) and lump sum dollar amount of coverage for services and procedures. Plan premiums are typically 30% to 50% lower than ACA Plans, which in real dollars can mean a family savings of up to $700 monthly.
If your health premium is greater than your mortgage or rent, it may be time to consider another health coverage option. It can make sense, dollars and cents.
Bob is a GABB Affiliate member. Contact him at Bob.Smith4Health@gmail.comRead More