I was invited by the BBB to be a guest on KCWI on December 27 and explain to folks where they’re at as far as opportunities for insurance, now that the year end has passed. This is about a 7-minute clip, but hopefully you’ll find it worth your while. Please call or email me if you have any concerns that I can help you with, whether you’re an employer looking out for your employees or an individual under 65.
Category Archives: Health Insurance
Health Care Insurance Choices – Understand Your Options
Health Care Insurance Choices – Understand Your Options
We are faced with more confusion, more compliance, fewer choices and higher premiums than ever before. However, I have FREE consultations and 39 years of experience to assist you with understanding your options.
Many individuals are receiving a notice that their insurance will end this year. The individual market choice, presently, will be Medica. Their rates were comparable to the industry trend (high) and have requested a 57% premium increase in an effort to continue.
Governor Reynolds, Senator Grassley, Senator Ernst and State Insurance Commissioner Ommen have requested a Stop Gap measure to help Iowans sustain the collapse of the individual health insurance market in Iowa. The collapse is a result of the failure of the Affordable Care Act. We have experienced unprecedented premium increases and higher out of pocket maximums than ever before.
I’m sharing the verbiage from Wellmark explaining the measure. I use them because they have a 95% market share in Iowa and the information is in an easy to understand format.
What is it?
“The State of Iowa has proposed a one-year emergency program for individuals and families who may not have access to health insurance in 2018.
If approved by the federal government, consumers can expect:
1. One plan for everyone who is eligible
2. Financial assistance for everyone based on age and income
3. The same essential health benefits provided under the Affordable Care Act
4. A reinsurance program covering the high-cost of care for Iowa’s sickest members—keeping costs down for everyone
To put it simply, Iowa’s Stopgap Measure will provide a health insurance option for Iowans in the individual health insurance market.”
A decision from Federal government is not expected until late October. I will keep updates on my website with blogs and newsletters.
The small, midsize and large group markets are still strong. It is possible that you are eligible to be considered for the group market, taking you out of the confusion and uncertainties of the individual market all together. I have worked with many Iowa farmers, Veterans and others that could have benefited from this option all along.
As we enter the fourth quarter the over-65 individual market enters the Medicare annual enrollment period, which runs from October 15 to December 7. Wellmark’s MedicareBlue RX plan has received five stars – the highest possible rating – from the 2015 Centers for Medicare & Medicaid Services (CMS) StarRating system. It is the only prescription drug plan offered in Iowa and South Dakota – and was only one of three plans nationwide – that received the five-star rating representing “excellent performance.” Please visit my website for more details. Call me for an appointment. I’m working with existing clients and their Rx lists to ensure their plan choice for 2018 is best suited for their needs.
I can’t stress enough how important it is to know all of your options. You need an experienced agent more now than ever. How you manage your health care risks and liabilities is essential to you and your family’s financial / asset protection.
If you are a current client, we thank you for your business, the professional confidence you’ve placed in us and generations of referrals. If you haven’t consulted with us before, we welcome you with personalized service.
Happy Thanksgiving to you and your family!
Large Group Insurance
If you have 51 or more eligible employees, you are considered large group per the ACA. There are two provisions of the ACA that apply only to applicable large employers (ALEs). Employer shared responsibility provisions and the employer information reporting provisions for offers of minimum essential coverage. Further note that interpretations of the ACA vary between insurance companies.
When I run quotes with more than one company, you may be considered large group with one company and maybe not with the other. I always recommend using the IRS’ definition of the ACA because this is where the penalties will come from. The determination of large group is a calculation and I’m going to provide a link.
The best advice I can give you in determining ALE (this is not your favorite brew!), this is Applicable Large Employers, be calculated by your payroll professional. Let me remind you again, we’re all dealing with Federal law, so it’s important that we do due diligence in determining whether we are large or small employer. Once that has been established, quotes can be generated for a host of options for you to select from.
I further recommend that we take into consideration the least compensated employee and the greatest compensated employee and be able to accommodate not only both ends of your payroll spectrum, but the bulk in the middle, therefore, based on our findings, it could be that I recommend that you select two or more plans for your offering. Please call me for a free consultation.
Iowa’s ‘Stopgap’ Health Insurance Proposal
About a month ago, I had a blog on individual markets for health insurance. I noted that Medica still intended to stay in the market with a substantial premium increase for 2018 IF they were granted the increase and elected to participate next year.
In the meantime, we have decisions being made in our State, pending Federal approval, for a stop-gap proposal. This Des Moines Register video explains Iowa’s stop-gap health insurance proposal. This is less than a minute and will provide you with a general summary of this topic.
In reference back to our options for 2018, the Medica request was a 50% increase on top of already inflated prices due to the evolution of our health care markets per the ACA. Individuals in 2018 have many options (contrary to popular belief) and this is only one. Call me, tell me your story, and we will problem-solve with the options that are available to you. I’m confident that after a thorough analysis of your position in the marketplace, you will be relieved and make good decisions on your own behalf.
Small Group Insurance
Opportunities in small group insurance need to be explored if 1) you are self-employed, or 2) you are a business owner with employees and do not offer benefits (or you should review what you do have in place).
As a small business owner, if your intentions are to attract and retain quality employees, this is an item that should have been offered all along; however, with many people losing their coverage in the individual market January 1, they are either self-employed and have opportunities they have not explored or they need to find an employer that offers benefits.
To help you better understand some of the insurance terminology, I’m going to pull some information from the National Association of Health Underwriters (NAHU) for you to glance at.
Please know we can make this easy, simple and painless with one phone call and consultation.
What is an HSA?
Fourth quarter is just around the corner and what that means to you is September is a good month to prepare.
Fourth quarter is when you will be making decisions for health plans effective January 1. For individuals under 65 that have a plan that was written prior to January 1, 2014, you will see no change. I encourage you to keep those plans for as long as you possibly can.
If you are under 65 and have a plan that was written after January 1, 2014 (an ACA plan), it is likely that you will be losing your coverage January 1. If that is true, we need to find solutions for you. That could be employer-based plans. If you are self-employed, and if you meet the eligibility requirements of small group, you have an opportunity there. If that is the case, you would be able to opt for many plan choices. One choice that might be appealing to you would be an HSA (Health Savings Account).
I’m providing you this short video to tell you about the advantages of an HSA account. If this is NOT suitable for you, we have many plans we can look at, but give this plan consideration in preparation for our free consultation.
Scams to be aware of going into 4th quarter
I’m using this week to alert you of scams that will happen undoubtedly this upcoming 4th quarter.
This is a very vulnerable time of the year for the insurance industry and our consumers. There is a lot of change and a lot of uncertainty. The best advice that I can lend to you is know who you’re doing business with. Choose your insurance professional based on a referral from a friend, family member or colleague and do business with them. This will reduce the opportunity for you being mistreated. Some of the scams that will take place are intended not to just get your business. They are intended to get your personal information.
As an example. If you’re over 65 and you get a phone call stating that they want personal information so that they can send you a “new” or “updated” insurance card, do NOT share your information over the phone. What they really are attaining is your social security number that they can use in ways you’ve never thought of for their financial gain…at your expense. It’s identity theft in its greatest form.
If you are under 65, and you have a pre-ACA individual plan, you are not affected by the changes coming up January 1. You may or may not realize that. Don’t share your information. Please call your agent. If you don’t know who that is, or you’re unable to reach whoever that is, please know you can call us.
We have been in business for over 40 years, are well established and have been recently accredited by the Better Business Bureau. So, the scams go on on a daily basis and those scam alerts can be reviewed on the Iowa Attorney General’s Website. They can be reviewed on the Better Business Bureau website as well. As a caution, we’re trying to share a little advice regarding insurance fraud. Recently I was asked to speak on this matter and I have provided a link for that segment.
Small Group Healthcare Options
As you might suspect, there is an influx of individuals whose coverage will end January 1 that are business owners. Some of these people would be eligible for small group options.
If I am a business owner, and meet the eligibility requirements as defined by the various insurance carriers, I could leave the individual market completely and be a small business very legitimately. This would give me an opportunity to continue my employment status as is and replace my individual coverage that will end January 1 with the same carrier and comparable products, maybe favorable pricing, for my health insurance needs.
This subject has to be addressed on a case-by-case basis as everyone’s situation is different. Please call me to discuss the details. Our consultations are free. Feel free to have your CPA or attorney call me as well. We field more and more of these types of conversations and calls every day. We are here to help!
Individual Markets
Individual markets are yet to be determined. It was noted second quarter that Medica intended to stay in Iowa’s health insurance market. This, of course, was with a 43% higher price tag to help offset the huge influx of claims that this market represents. If the Federal government fails to approve the stop-gap measure and if Medica intends to stay in the market, it would require another 12 – 20% premium increase on top of the already stated 43% increase.
This means there could be a potential of 68% increase in premium on individual markets with the last standing insurance carrier in the state. If this measure is approved, it would be interesting to follow the terms of that approval. I am referring to the amount of dollars and the specific number of months that Federal would continue to support this effort. This would be the last carrier standing in the Iowa’s individual health insurance market that intends to continue to sell individual products.
This would have been an option/the only option in the individual market for up to 72,000 Iowans that buy their own insurance instead of obtaining their coverage through employment or other sources. As the environment continues to change and take shape on the Federal level, it will be determined whether Federal funding will be a reality for all insurance carriers involved.
The stop-gap plan is still in limbo. Without the assurances of the government action, this still remains undetermined. So, what do you do? And when do you do it? It is our recommendation to call us for a free consultation to explore all of your options available January 1, 2018. By being proactive, and learning your options now, you will be in better shape for a seamless transition to your next step.
This weekend Wellmark issued an opinion editorial to major media across Iowa to outline the three principles necessary to re-enter the individual Affordable Care Act (ACA) market.
It is important that we provide you with timely and pertinent information as the health insurance environment transforms and changes. This press release from Wellmark’s CEO, John Forsyth, explains the impact the ACA has had and what they feel is a solution.
We are here to assist anyone with questions and solutions. Please give us a call. As new information becomes available, please know we will keep you informed.
