Holiday heads' up: Drone insurance to-do's

As we head into the Christmas (and Chanukah) gift-giving season, lots of folks have drones high up on their wish lists (SWIDT?). But before you fire up and fly your new gizmo, there are some important insurance-related issues you'll want to consider.

As we blogged at this time last year:

“Almost no one is thinking about insurance coverage when they’re opening the box,” says Jeff Antonelli, a Chicago attorney who specializes in federal regulations for unmanned aerial systems."

But that was then, and this is now, and there's been some progress. Our Guru of all things P&C, Bill M, tips us to this recent article in an insurance trade journal:

"[Here] are insurance coverages and how they are likely to apply. Keep in mind all claims are handled on a case-by-case basis, and there may be more exclusions and conditions that apply as drone technology evolves."

These include homeowners and renter's policies, auto and even commercial plans, too.

Have fun, but speak with your agent about how to protect your financial well-being if things take a dive.

Deadlines Schmedlines

HHS blames the website. I blame Bush.

Either way, you have four more days to #getcovered.

Last Minute O'Care PSA

As pretty much everyone knows, today is the final chance for folks to enroll in a 2017 ObamaPlan with a January 1 effective date.

So that means if you miss out, you miss out, right?

Well, not necessarily:

If you miss today's deadline, you can still apply for a plan with a February 1 effective date, so long as you apply by  January 15. And if you miss that one, all is not lost: you still have until the end of January to sign up for a plan that starts March 1, which still means you avoid the penalty fine ObamaTax.

Of course, that also means that you'd be uninsured for up to two months, in which case you could take your chances, or look into a Short Term Medical plan.

Good luck!

Open Enrollment Heads' Up

From HHS:

Tick, tock...

Going Bare: Making the Case

As we've long noted (here, for example), some (many?) folks have made the perfectly rational decision to forgo ObamaPlans (or health insurance of any kind). For one thing, the fine penalty tax is nominal (particularly in comparison to non-subsidized premiums). Recently, FoIB Dr Gerard Gianoli tipped us to this well-researched and written article expanding on the idea:

"There are necessities of life, but insurance is not one of them."

That's Dr Jane Orient's opening salvo, and it gets even better from there:

"It might be a ticket to get you into certain medical facilities, but in these days of narrow networks, it will keep you out of others."

This in reference to how restrictive networks have become; I'd add that there's another dimension, as well: HMO vs PPO models.

Until this year, many (most?) plans were built on the PPO (Preferred Provider Organization) chassis. That is, one got the best bang for their premium bucks by staying in-network for care, but there was still a safety net for out-of-network claims. This is no longer the case: all the plans I've seen (in this market) are for HMO model plans; that is, zero coverage for non-emergency non-network expenses.

So what's the big deal? Well, what if your oncologist is out of network?

I particularly appreciated this observation:

"If most bills were paid directly instead of through a third party, medical care would cost far less. Wouldn’t that be better for everybody?"

This comes as she makes the case for a return to truly catastrophic coverage, which she favors as the best O'Care alternative.

As they say: Read the whole thing. You'll be glad you did.

Wing, Prayer, Healthcare

It's long been my belief that there's a direct, intrinsic connection between prayer and healing. Although the healing prayer group in which I'd participated for so many years is now defunct, I continue to believe in the healing power of those prayers. And of course I'm far from alone in this.

Recently, FoIB Holly R sent along this interesting article that discusses the link between health care and spirituality:

"Dr. Christina Puchalski is familiar with death ... Several years ago, [she] went into a checkup with a patient previously diagnosed with a terminal illness ... We’d gotten to the heart of the visit, and it wasn’t about the medication or the pain. The real issue was the bereavement and the fear of losing each other.”

And it's not really about religious faith, per se: the focus is primarily on one's “search for ultimate meaning.”

I recall a few years ago, a dear friend (who, perhaps not coincidentally, was the founder of our own healing prayer group) was scheduled for a procedure. Like me, he was also Jewish, and his Christian doctor asked if it would be alright if they could pray together. Of course my friend immediately agreed, and everything went well (which may or may not have had anything to do with the prayers, but they certainly did no harm).

In fact, this practice appears to be more widespread than one might believe:

"In 1998, the Association of American Medical Colleges (AAMC) published a report called the Medical School Objectives Project, which included sections on spirituality."

Kudos (and prayers sent).

About Those ACA Signups (GIGO)

As the first phase of Open Enrollment v4.0 winds down, it may be helpful to get a sense of how successful the whole effort's been thus far (for certain values of "success"). ObamaCare proponents like to boast that the train-wreck insured some 20 million Americans.

But is this really accurate?

It will come as no surprise to IB regulars that the answer is a resounding 'No:'

"The Department of Health and Human Services claims that 20 million people have gained health coverage ... 17.7 million people gained health insurance from Obamacare’s first open enrollment period."

Which is all well and good, except that these numbers are based entirely on survey data, not actual, verified enrollment numbers. When one examines those, a very different picture emerges:

"Just over 14 million people gained coverage from the end of 2013 to the end of 2015. Of those 14 million, 11.8 million gained their insurance through Medicaid."

So roughly 85% of those being counted are not, in fact, insured: they're enrolled in Medicaid, which is not insurance. So less than 15% of the folks who ACA proponents claim became insured under the ObamaTax actually did so.

Of course, they'll never admit this, because: #Narrative.

Another One Bites the Dust

Last we looked, there were only a handful of Co-Ops still fogging a mirror (metaphorically, of course). And that list just got shorter:

"Evergreen Health Cooperative Inc. (“Evergreen” or “company”) will not be issuing or renewing individual health benefit policies ... Evergreen Health plans are not available on Maryland Health Connection for the 2017 plan year"

This means that folks currently insured by the faltering carrier will have to choose a new one, and they have just about a week to do so (if they want to remain insured come January 1). Now, if they'd purchased their current plans through the Old Line State's Exchange (Maryland Health Connection), they'll be automatically "transitioned" into a comparable plan with another carrier. If they don't wish that to happen, then they'd best get crackin'.

Those who bought off-Exchange are on their own.

Still, I'm a bit puzzled as to how this can be happening. After all:



[Hat Tip: FoIB WeirdDave]

Obamacare Conflict: Losing The Personal Touch

I've been fielding a lot of questions from individuals looking for health insurance lately. They wonder why I tell them up front that it's unlikely I will have time to personally meet with them on their needs - especially considering many of them are losing their plans. So, in an effort to explain my situation here is what I'm sharing. 

Hi Jane, 

I'm sorry our affiliate isn't able to suit your needs. Unfortunately the ACA forces everyone to renew their plan January 1st which makes a personal touch almost impossible to achieve. Also unfortunate is most of my professional colleagues that have true knowledge and understanding of the industry aren't willing to work in this market. This is because they are astute business people and know that most of the insurers participating don't value our personal touch. We know this because many of them have completely eliminated our compensation and others have dramatically reduced our compensation. I hope you understand that we simply can't work for free.

If you are looking for a personal touch I can tell you that you do have options available. 

The first are Navigators. Navigators are unlicensed people that have been hired by non-profits who received government funded grants to help you through the process. Unfortunately these folks aren't able to advise you on specific plan choices or make any recommendations. Of course why would you take their advice since they are not licensed to sell insurance and haven't had any formal training. Not to mention, they are unable to service your account throughout the year.

The second option is to head on over to your local WalMart. You will need to find the person standing up by the checkout lines behind a table with a "health care" banner next to it looking bored out of their mind. This person is licensed to sell health insurance and can walk you through the process. I'm sure they will have time to meet with you.

If you would still be interested in a phone consultation and my recommendations please let me know. I'd be happy to assist you - if I can.

Attaboy, ObamaCare Style

So you've just spent several hours helping a client navigate Open Enrollment v4.0, sifting through the various options, checking to see which (if any) of his doc's are in-network, helping to determine whether or not he's eligible for a subsidy, helping him set up an account and verifying his identity at 404Care.gov. How do you think you should be compensated? Well, co-blogger Bob V tells us that the Rocket Surgeons in DC© have just the thing:

"[T]he Centers for Medicare and Medicaid Services (CMS) is offering health insurance brokers who enroll 20 or more individual consumers or 20 or more employers through the marketplace the opportunity for a “gold star” in the form of membership in the Healthcare.gov Circle of Champions."

Gosh, who wouldn't prefer this kind of recognition to icky commission dollars?

As we've pointed out, many agents have bailed on this season because carriers have drastically reduced or, in some cases, done away with agent compensation. As Ronnell Nolan, president/CEO of Health Agents for America points out, it's really just "throw ‘em a bone but not pay any money.”

And stay tuned: Co-Blogger Patrick has a very personal experience to share coming up shortly.


#ObamaCareWinning!

Tomayto, Tomahto

Potayto (via FoIB Jeff M):

"Newly issued federal data shows that North Carolina has among the highest health insurance costs under the [ObamaTax] ... North Carolinians covered by the ACA receive some of the nation’s highest subsidies per person."

Here's the thing: prices get distorted as soon as the government steps into the equation. Tar Heel State ACA insureds provide ample proof of this; by insulating them from the actual cost of plans, our Betters in DC© are able to gloss over the devastating effect that the ACA has had on health insurance rates.

Potahto:

The folks at HotAir point us to what's happening on the macro scale:

"Steven Lopez has gone without health insurance for 15 years, and the Affordable Care Act hasn't changed his mind. Once again this year, he will forgo coverage, he said, even though it means another tax penalty."

Mr Lopez is a 51 year old IT pro; last year, he and his family coughed up almost $1,000 to cover the fine tax penalty. It was either that, or 4 or 5 times that much in premiums, plus actual out-of-pocket for any healthcare they inadvertently received.

For all the talk of how many folks have signed up for ObamaPlans, some 28 million of our fellow citizens have taken a pass. And that's not counting the tens of millions on Medicaid (which, as we've repeatedly pointed out, is not insurance).

#ObamaCareWinning!

Up, up and away!

As we inch closer to Winter Christmas break, many students are planning international journeys. Some will be strictly for fun (think ski trips in the Alps) while others will begin studies abroad. Our friends at Global Underwriters remind us that, either way, they'll need to plan for the unexpected:

"Many students don't realize that their health insurance will not provide adequate coverage while outside of the United States or in many instances, they have no coverage at all. This is a terrible financial burden for any young person. Several countries and study abroad programs, also require health and medical evacuation insurance, in order to obtain a visa or participate in their program."

So where to begin? Well, a quick phone call or email to your favorite professional insurance agent is a good start. There are any number of plans available to help "close the gap;" some include not just medical coverage, but even medevac and war risk cover.

Perhaps best of all, these plans are generally inexpensive, and easy to acquire.

Safe travels!

UnAffordable Health "Care"

Years ago, my parents bought a small piece of property. I don't recall the particulars, but it was part of a larger parcel which was divvied up. The idea was that property always increases in value, so it was a "safe" investment.

Problem was, the whole thing was kind of "landlocked" such that it was pretty much unusable and undevelopable. Nevertheless, the folks had to keep paying the property taxes on it or it would be forfeit (which I'm not altogether sure wouldn't have been just as well).

Reason I bring this up is that sometimes owning something isn't really that beneficial, especially when one has to keep pouring more money down the hole, with only the vague promise that it would one day be utile.

And so it is becoming [ed: has become?] with ObamaPlans: as we've pointed out before, just because you buy an ObamaPlan doesn't mean that you can afford to actually use it.

Case in point:

"Twenty percent of Ohio adults reported that they or a household member go without medical care because of the cost even though more than 90 percent of them have health insurance"

The problem is that the steep "barrier to entry" that is the deductible (and then co-insurance) renders plans pretty much unusable (well, except for free birth control convenience items and the like). This is really just an extension of something we've been saying for many years here at IB: health care ≠ health insurance. That is, just because one has purchased a health insurance plan doesn't mean that one can then afford to actually use it.

Quite the conundrum.

[Hat Tip: Jennifer A]

Some more anecdata

Another in our informal series chronicling the sad state of ACA as it relates to previously insured ("grandmothered") folks:

First up, Ben and his family have been clients for many years. His current plan isn't fully ACA-compliant, but he's being "allowed" by the Rocket Surgeons in DC to keep it another year. It boasts a $3,000 per person ($6,000 family) deductible, then pays 100% for covered expenses. The plan just renewed, and the premium for his family of four is increasing by 45%(!), from $705 a month to just over $1,000.

But fear not, it's open enrollment season, so a great opportunity to shave some costs.

Right?

Um...

The cheapest alternative I could find has a $7,150 per person deductible, and clocks in at $926 a month. So they’d save about $1,200 per year in premium, but face an additional potential out-of pocket increase of over $4,000 each.

On the other hand, a comparable plan with a $2,500 per person deductible is over $1,200 a month, and includes 10% co-insurance, meaning an out-of-pocket exposure of over $6,500 per person (more than twice their current plan).

Sweet.

Meantime, Patty's plan (which is identical to Ben's) includes herself and her husband, and is increasing by "only" 12%, from $885 a month to just under $1,000.

The least expensive alternative I could find for them has a $7,150 per person deductible, and clocks in at $1,410 per month. So, an additional $4,800 a year in premiums plus $4,000 in potential additional out-of-pocket.

How's that old saying go again?

Friday LinkFest

Odds-and-ends from the past couple of weeks:

■ Continuing to defy the "death by attrition" model of Long Term care insurance, almost 97% of federal employees participating in government-sponsored LTCi plans opted to keep them, despite rate hikes averaging 83%.

What does that tell you?

■ Regular readers may recall the frustrating story of Martin Shkreli, who "jack[ed] up the price of a life-saving drug more than fiftyfold."

Well, FoIB Holl R tips us to some motivated and talented students from "Down Under" who have just "recreated the drug's key ingredient for just $20."

Good on them!

■ And from other FoIB Jeff M comes this heart-warming tale of greed and redemption punishment:

"Federal prosecutors say a Charlotte woman has been sentenced to 16 years in prison for orchestrating an $11 million Medicaid scam involving false medical claims and identity theft."

Seems that Ms Cynthia Harlan must also "reimburse Medicaid $3.1 million."

That's a lot of license plates.

News from the Front

Regular readers know that I've decided to sit out this Open Enrollment season. I'm far from alone in this, but got email yesterday from good friend and colleague Scott M with a first-hand report of what he's experiencing, and he's graciously allowed us to share it:

"I was talking with a client earlier today and I found an old renewal for him.  It was a $5,000 deductible and the premium (prior to renewal) was $345.72 for him, his wife and three kids.  The plan he is going with for 2017 is a $5,500 deductible and the premium is $1,317.90.  I sent the attachment to him and he said, “the funny thing is I was just as pissed back then as I am now”.  I told him I made more when his premium was $345 than I do at $1,300.

Yep, those were the good ole days."

Now, how is it possible that a premium one third the size of the renewal actually generated more income (commission) to the agent? Well, Scott explains that, too:

"I’m writing very little.  And only with BCBS.  The on-exchange folks around my area are completely screwed as none of their doctors nor the local hospital is in network of the on-exchange plans.  Plus, Blue Cross is really the only one paying anything ($10 Per Member Per Month if you have a total of 10 members or more).  I’ve been preparing quotes for my existing clients in the Blue Cross system and having them emailed with the instruction to enroll using the link if you want one of these plans.  If not, you’re on your own.  Can’t waste any time on it.  Especially for the single folks.  $10 per month for that headache?  No thanks.  At least the one I sent you guys is a 5 person household where I’ll make $50 per month.  For him I’m willing to do a little work."

Remember, agents make their income from commissions (both new business and renewals). And why should you care? Because a professional agent is uniquely positioned and qualified to help you figure out the best, most cost-effective plan available.

Which is kinda the point, no?

Health Wonk Review: Puppies and Kittens edition

After a contentious election season, where my preferred candidate didn't even show up, I thought it'd be nice to focus on something a bit more pleasant. And nothing quite brings the smiles like pics of our little furry friends [ed: bonus points to anyone able to guess the significance of the first one].

And so, without further ado, this week's hectic, eclectic, fur-bally HWR:

■ HWR co-founder Joe Paduda  offers the first two entries in his new series The Flash vs Spiderman "Getting Serious About Health Reform" (Part 1 here, Part 2  here), wherein he offers his own suggestions about where we go from here. As usual, interesting stuff.

■ One of our favorite wonks, David Harlow is actually traveling quite a bit lately, most recently to an innovation in healthcare convo in The Big Apple. He graciously took time out to send in his take on how the election will likely affect not only the ACA, but what the various pols are likely to propose.

■ It's been a while since Adam Fein's participated in the HWR, but he's back and in fine form with this post on "The 2025 Payer Market for Prescription Drugs" (wait, Adam's the new Dr Who?). 
 

■ The Health Affairs blog's Karen DeSalvo and Georges Benjamin offer their thoughts on what the future of public health will (should?) look like, including how to compete in a global economy.

■ Our good friend David Williams sends in this post on  legalizing marijuana, both for recreational and medicinal purposes. Considering how well pot-related ballot issues did this year, it's likely to be a hot topic for a while. In his post, David interviews a "marijuana entrepreneur" about implementation.

■ Another HWR favorite, Louise Norris, looks past the election results to dispel some misinformation currently making the rounds: she thinks it's likely that the mandate/tax will still be in force for 2017, and explores what that means to thee and me.

■  Uber-wonk Roy Poses submits his take on the "Bio Telemetry Settlement" (see, I told you he's an uber-wonk 😊), wherein he continues his long-standing exploration of ethics (and/or the lack thereof) in healthcare, this time specifically about physician kickbacks and medical devices.

[ed: And pay special attention to the sidebar pic for that post]

■ Dr Jaan Siderov, still another long-time 'Review regular, takes a respectful (and insightful) look at the potential winners and losers in the upcoming ACA battles, focusing specifically on "organized medicine" and mHealth.

■ Our very favorite Healthcare Economist, Jason Shafrin, talks about "Precision Medicine" and how it potentially offers both vast benefits for patients and challenges for providers (and government regulators).

■ Peggy Salvatore waxes philosophical about the "Healthcare Industry in an Age of Uncertainty;" her concern about special interests is quite thoughtful, especially when we really don't know how things will ultimately shake out.

■ Our dear friend Julie Ferguson asks "what's in store for OSHA and the Department of Labor under the new administration?" Reading the tea leaves in her crystal ball [ed: heh], she takes the President-elect at his word about the ACA being on the chopping block, and what that may portend for OSHA and worker's comp.

■ Our own post explores the changing landscape of specialty prescription meds, specifically the effect of   manufacturers' coupons on claims and balances.

And please tune in again on the 15th, when Julie Ferguson works her own Health Wonk Review magic.

An Update on The Risk Corridor - Death Spiral Edition

I've written about Obamacare's Risk Corridor provision many times. From the Rubio Amendment to Suing for the Slush Fund we have learned that not only was government funding this leg of the 3R's likely illegal but it was also never going to be budget neutral. In fact we can conclude from the year-to-year view that the losses insurers are incurring through Obamacare marketplaces are on an expedited death spiral.

Recently (and quietly) released payment and charge amounts show just how far off of budget neutral this mess really is. More concerning, what every insurer thought was bad last year is even worse this year. And. It's. Not. Even. Close.

In two years this temporary program that was budget neutral (allegedly) has lost a total of $7,871,900,000. Payments due to insurers have more than doubled from 2014 to 2015 and revenues have been reduced by almost 75%. With numbers like this how much longer can insurers remain before they are put on life support?

Tuesday Morning HealthyLinks

■ The folks at Cigna tell us that the IRS has extended the reporting dates for 1095's (these are the forms carriers and employers use to demonstrate that individuals have abided by the tax penalty Mandate). They were originally due out by January 31st of next year; that's been moved back over a month, to March 2nd.

Yay.

■ FoIB Holly R tips us to this interesting story about how a Cincinnati-area doctor "uses jet engine knowledge to fix woman's vocal cords."

At age 13, Anna Kessler was diagnosed with asthma, which kept getting progressively worse over time. She finally met with Dr Sidd Khosla, who had studied at MIT and was able to combine his knowledge of how jet engines work with Anna's condition.

Pretty cool.

■ And finally, a two-fer on lifesaving healthcare trends:

"1. Focus on people first ... getting patients actively engaged in managing their health and working with the physicians and technicians who treat them."

And "2. Why you need to go wireless ... a move toward continuous home monitoring and an effort to bring care to patients rather than requiring them to travel long distances to see specialists."

This, I think, is related to the burgeoning and ubiquitous use of telemedicine. I'm not completely told that it's a panacea, but it certainly has its place.

MVNHS© and Medicaid vs Babies

The Much Vaunted National Health System© continues its war on children. This time, a preemie was "left to die alone in a sluice room at an NHS trust plagued by clinical errors and bad staff attitudes."

In case you're wondering, a "sluice room" is "where used disposables such as incontinence pads and bed pans are dealt with, and reusable products are cleaned and disinfected."

For the MVNHS© "disposables" now includes babies, apparently.

Great system over there.

And lest we forget, our own version leaves much to be desired, based on this cautionary take from Florida:

"Kim and Richard Muszynski love Florida ... in September, the couple left the Sunshine State ... because they think Abby's health insurance was killing her."

The kicker?

"Like nearly half of all children in Florida, Abby has Medicaid"

Leaving aside for the moment that appalling statistic, it may be instructive to note that, as with the Much Vaunted National Health System©, Medicaid is not not insurance (after all, who pays premiums?) but taxpayer-funded health care. And, again as with the MVNHS©, who pays the piper calls the tune.

[Hat Tip: Holly R]

Thanksgiving 2016

Please remember everyone deployed away from their families this Thanksgiving. pic.twitter.com/w9Pv3UTHUQ

— Meoso (@MeosoFunny) November 24, 2016

Pre-Thanksgiving Heads' Up

It's time once again to break out Captain Kirk William Shatners wise words of warning about frying your fowl:



Have a great (and safe) Thanksgiving!

From the P&C Files: Easy Peasy, Yeezy

We've blogged before about Special Event policies for things like hole-in-one contests, special product promotions based on sports scores or political conventions. Here's another example:

Rap star Kanye West has been on tour recently, and was just hospitalized; he's since cancelled the balance of his tour, at a cost of at least $30 million. That's a lot of scratch even for a successful musician, which is why he (reportedly) has an insurance policy that likely covers this kind of situation.

Assuming that it ends up paying out (there may be specific exclusions, for example), his wallet will be grateful.

Wow, Pre-Existing Claims

With 2017's Open Enrollment in full swing, lots of folks are calling in for quotes and explanations, hoping to get their coverage in place for January 1. By now most of us know that, for better or worse (but mostly worse) ObamaPlans cover pre-existing conditions. This means that if one has, say, asthma, the new plan will cover it right away.

Some people, though, are less clear on the subject.

For example, 29 year old Megan Tice-Royea, is a grocery store manager in Newport, Vermont. Last year, she she decided she couldn't afford health insurance, despite making what appears to be enough to qualify for a healthy subsidy (or just buying a Cat Plan).

Which was a fine, rational decision, until it wasn't:

"In September, she was admitted to the hospital with a gallbladder infection. The surgery left her $32,000 in debt."

Ouch.

But here's the very best part:

"Now she’s considering signing up for an insurance plan through Obamacare, but only if it will help pay off her earlier medical bills."

Good luck there, Megan.

Now let's rewind the tape a bit, and take a look at "what might have been:"

Megan's 29, makes $14 an hour, and we'll assume that she doesn't smoke. Had she taken (literally - I timed it) 3 minutes, she could have visited her state's Exchange, where she would have learned that she qualified for a $347 per month subsidy, and then purchased a Bronze level plan for less than $60 a month (that's about $2 a day).

[ed: all rates and plans based on 2017 Exchange info, YMMV]

Her maximum out-of-pocket (including deductible) would have been $7,150 plus the $720 in premiums, meaning that the $32,000 claim would have cost her less than eight grand (about 25% of the actual bill).

Expensive 3 minutes.

[Hat Tip: FoIB Dr Dino]

LifeLock News

So this happened:

I reached out to our friend Steve Geis (VP at Cornerstone) for his thoughts. Steve's the one who basically put our LifeLock discount program together; he replied:

"In my opinion, this will only make LifeLock stronger.  I’m sure it will lead to new advancements in Cyber Crime/ Data Breaches using Symantec’s resources.

It’s too soon to tell if this will impact on brokers (and clients) but my guess is it will be business as usual.  We still have to wait for regulatory approval before the deal is done.

We’ll just have to wait and see what comes to us from LifeLock and we’ll communicate upon notice."

Thanks, Steve!

As a reminder, you can get a 10% discount on LifeLock services (15% is available for most employer groups).

[Hat Tip: Holly R]

Yeah, About That Cost Curve

We were promised from the outset that The ObamaTax would "bend the cost curve down;" that is, reduce the costs of both providing and paying for health care.

Here at InsureBlog, we've also blogged extensively about Medical Tourism, where folks go across the border (or the ocean) in search of cheaper health care.

Reason I bring these up is because our friend Holly R tipped me to this interesting piece at CNBC:

"Here's where you can get health care a lot cheaper than in the US"

The article gives several examples of care purchased in France versus here. For instance:

"[A] single day in a hospital in the U.S. costs, on average, $1,514 (up to as much as $12,537), while in France it costs $853."

And:

"Hip replacement surgery costs an average of $25,061 (up to $87,987) in the U.S., but just $10,927 in France."

Of course there are various travel expenses involved, but depending on the time of year, and how far ahead one booked, it seems likely that the total cost would still be a (significant?) net savings.

To be sure, this really only works for elective (non-emergency) procedures, and it's also only available to those with the resources to pay for flights and lodging, plus the fact that one's going to have to front the money (no insurance billing back to Blue Cross or Humana). And follow-up care may be an issue, as well.

But what really piqued my interest was that the author focused on why costs here in the US varied so widely from area to area, city to city, and the role insurance companies play in negotiating prices. It does acknowledge the role that tort-reform could play in reducing the cost of (for example) malpractice insurance.

But it completely missed the elephant in the room (and to be fair, that's perfectly understandable: it is about the advantages medical tourism, after all). So what goes unsaid here?

"Remember the President's assurances that his ACA would finally “bend the cost curve”?"

That is, one of the explicit promises of ObamaCare was that not only would insurance rates go down, but so would the overall cost of health care itself.

So how's that working out?

From the P&C Files: Freeze!

It may not seem like it now (at least here in southwest Ohio), but sub-zero weather is around the corner. And that means a lot of folks will be in danger of severe damage from their home's water pipes freezing and bursting.

The Cincinnati Insurance Company has thoughtfully provided this helpful video to share with our readers about how to prevent this from happening:


Prevent Frozen Pipes from The Cincinnati Insurance Company on Vimeo.

Thanks, CIC!

Bye, Bye Grandma!

We've written about Grandmothered plans (most recently here), focusing primarily on individual major medical policies. But these rules also apply to group plans, and the clock's ticking on them, too.

Grandmothered plans are those which were issued after ObamaCare was established, but were given a "hall pass" from many of its mandated "benefits." Much like the Doc Fix that kicked Medicare's provider reimbursement cuts down the road, Transitional Relief was ObamaCare's safety valve that allowed these plans a temporary reprieve. For the past several years, group clients have been able to re-cast their renewal date to continue to take advantage of it.

In theory, this will be last time (since no one really knows what's going to happen under the next administration). But, carriers are soldiering on; I received this in email today from United Healthcare:

"For many customers, there are significant cost implications in the change from Transitional Relief to ACA compliant plans ... you may be interested in changing your renewal to Dec. 31, 2017 ... This allows you to take advantage of the extension of Transitional Relief and keep the coverage you like for the maximum period currently allowed by law"

'Course, I'm old enough that I remember this.

In the event, UHC (and, of course, other carriers) is contacting its group clients to offer them a bit of relief.

Based on recent quotes I've seen, this is definitely an offer they shouldn't refuse.

MVNHS©: "We could tell you, but then..."

You can't make this stuff up (well, you could try, but then reality's still going to trump you):

"NHS chiefs are trying to keep plans to cut hospital services in England secret ... Managers were even told how to reject freedom of information requests"

Of course, now this particular cat's out of the bag, so it'll be interesting to see how successful MVNHS© bureauweenies will be in fighting off those FOI requests. And just what are they trying to cover up?

Well, according to leaked information, the cuts include the closure of at least one hospital in London, maternity and stroke services country-wide, and the forced merger of four hospitals in Merseyside, to name a few.

There are actually quite a few services and facilities on the chopping block, which is interesting because we've been told that nationalized health care schemes deliver better care than ours at a fraction of the cost, effectively bending the cost curve down.

How's that working out for the Much Vaunted National Health System©?

[Hat Tip: Ace of Spades]

Rx Ch-ch-changes

Interesting news from Medical Mutual of Ohio (via email):

"Ensuring Members’ Specialty Drug Costs Are Accurately Reflected in Benefit Accumulations

Beginning January 1, 2017, only the amount a member truly pays out of pocket for specialty drugs, when filled through one of our contracted specialty pharmacies, will accumulate toward the member’s annual deductible and/or maximum out of pocket (MOOP)."

Now, this applies only to ACA plans (on- and off-Exchange), but I'm guessing that these make up the bulk of MMO's current individual book of business. The impetus for this new process is the use of those ubiquitous manufacturers' coupons for pricey meds.

The example they gave was a drug that cost $500 but the insured had a manufacturer's coupon for $450, bringing their actual out-of-pocket cost for that scrip to $50. In that case, the insured's "balance" would be credited the actual amount paid.

MMO also pointed out that these coupons, while essentially disguising the true cost of a given med, may actually be leading to over-utilization:

"Over the past five years, the use of manufacturer’s coupons for high-cost brand-name drugs contributed to an additional $700 million to $2.7 billion in drug spending. We believe the amount of financial assistance received for specialty drugs by the Medical Mutual ACA plan population could exceed $3 million in 2017."

Hence, finally applying some brakes to this runaway train.

And I get that. As I mentioned to co-blogger Patrick:

"I have no problem with this.

1 – If they only spent $50, they only spent $50.

2 – I do wonder how much over-utilization results from mfrs sending out these coupons. OTOH, I 'get' that there are folks who couldn’t afford the med otherwise, and that gives me pause. On the gripping hand, there are no perfect solutions."

And Patrick agrees:

"I think of it this way, under a PPO plan with $25 copay the member pays only that amount. The difference between negotiated and copay don't go toward the MOOP just the copay does. I know it's not exactly the same due to a "coupon" but the reality is not everyone gets the coupon. Members who do receive them should rejoice that they aren't paying the whole amount. Members who don't receive them have a greater expense and therefore should get credit toward the MOOP for what they pay."

Point being: you don't (shouldn't) get credit for expenses that you don't, in fact, incur.

Kudos to MedMutual. 

Why can no one spell?

Apparently, the folks at the Washington Free Beacon can't spell "$2,500 premium savings:"

"Obamacare premiums will increase by 27 percent next year ... the government’s increase of 22 percent “can be misleading” because most of the 2017 Obamacare plans will be new"

That's because carriers have been deleting plan after plan in order to find some way to staunch the flow of claims dollars. And of course, carrier after carrier has been leaving the market completely, to the point that "one-third of the country will only have one insurer to choose from in the exchanges."

Regardless of what the new administration does (or doesn't do) come inauguration day, the die has been cast - for at least a while - for folks signing up now.

Talk about train-wrecks.

#ObamaCareWinning

[Hat Tip: FoIB Holly R]

Car Insurance That Pays For Routine Maintenance

Wouldn't it be nice if our car insurance covered the cost of routine maintenance?

Get new tires for a small copay. Free oil changes, every time.

Radiator flush?

No problem. Send the bill to my auto insurance carrier.

But it doesn't work that way. And that is a good thing. If all you had to do for routine auto expenses was have the bill sent to you car insurance carrier I doubt many of us could afford car insurance.

Since your car insurance does not pay for routine services, there is a price chart on the wall when you take your car in for work. If what you need isn't on the wall you can ask and the service manager will quote you a price.

But it doesn't work that way for health care. And it probably never will.

Enter Trumpcare 

Some agents I know have been debating suggestions for Trumpcare which is expected to be a much improved version of Obamacare. When the new model is available in the show rooms, and whether people will want to trade in their old Obamacare plan for a shiny new Trumpcare plan is subject to speculation. When it happens we will see. Until then, suggestions for Trumpcare are simply fodder for discussion.

Price Transparency

One of the hotly debated items is price transparency. More than one member of our roundtable wanted to know why we don't have price transparency when it comes to health care.

If I need to get my car repaired, I know exactly how much it will cost before  I have the work done.

True.

But who will pay the bill?

The person who owns the car.

And who pays the doctor or hospital when you get sick?

The lions share, typically 80% or more, of your medical bills are paid by the insurance carrier.

Networks

There is no transparency because of provider networks. That's why 5 people can go to the doctor for the exact same procedure and pay 5 completely different amounts.

Networks can be frustrating but they also save us money.

Without network pricing we would never know if we were being overcharged or not.

Without networks we could be balance billed for amounts over and above what the carrier says is a reasonable charge.

No matter what your doctor or hospital charges for treatment, almost invariably someone will say they have been overcharged. Who are we (as patients) to say that $12,000 is too much to pay to take out a bum appendix? Does it really matter, as long as the pain stops and you are once again fully functional?

Networks set the pricing for removing an appendix. You may still think the doctor and hospital are overcharging but so what? You are paying 20% (or less) of that cost of your care.

Network pricing results in a pre-determined cap on how much you pay for the procedure. There is no balance billing.

And that is a good thing.

#Obamacare  #Trumpcare

Promising Health News

Some potential good news for fans of the Much Vaunted National Health System©: they may be able to move on from using maggots to treat MRSA.

How's that, you ask?

Well:

"A 25-year-old student has just come up with a way to fight drug-resistant superbugs without antibiotics."

The greatest challenge in treating these "superbugs" is that we keep throwing stronger and stronger anti-biotics at them (with who knows what effects on ourselves) and pretty soon they become inured to them (think Borg). Now, Ms Lam (a 25 year old Australian PhD student) has developed what seems to be a microscopic shuriken that literally rips the bugs to shreds.

It's still early days, so we likely won't be seeing this in use on humans soon, but very cool.

Kudos, Ms Lam!

[Hat Tip: Ace of Spades]

Another ObamaCare Success Story

For certain values of "success" (via Dr John Goodman):

"The IRS demanded John payback the subsidies he had already received which amounted to $6,900 hit on his taxes. In order to pay back what he owed John took out a 2nd mortgage on his home."

The victim citizen (called "John" in the post to protect his identity) found, through a series of unfortunate events, that his previously "affordable" coverage was no longer such a deal, and as a result of clawback was forced to cough up almost $7 large. Adding insult to injury [ed: do ObamaPlans cover those?] their insurance plan now costs over $7,000 a year, and then another $12,000 in out-of-pocket.

But hey, Mrs John gets free birth control convenience items.

So, success.

On Veteran's Day 2016

[Jennifer Agnello, President of Cornerstone, has graciously granted us permission to share her profound, heart-felt thoughts on this day honoring those who've served]

"In honor of Veterans Day...

After a big week in our country, (no matter how you voted), tomorrow is a day where we should all be especially thankful.  In honor of Veterans Day, please take some time to remember that it is because of our veterans we all enjoy the freedom to express our own opinions and choose to vote however we individually see fit.  Please pause to recall the sacrifices that our Soldiers, Sailors, Airmen, Marines, and Coast Guardsmen have and will continue to make, serving our Nation where and whenever they have been called upon. These courageous and brave individuals have sacrificed family life, their careers and potentially their lives by willingly taking on the greatest responsibility, upholding our freedom.  They have voluntarily joined the ranks of America's Armed Forces, fully aware of their obligations as citizens and the risks they are taking in order to stand for what our country believes in and what it was founded upon.  They serve and have given their lives for the USA with courage and unquestioned commitment, for all of us.

Through their sacrifices they have secured for millions of others the blessings of freedom, democracy, and the unmatched opportunity that we enjoy in the United States today.

Please thank and/or remember those special folks.  Cornerstone has several employees who have served (Eric Pouncy, Hal Demmerle and Miles Massey) and many more have family members currently serving or whom have served in the past and they deserve to be recognized and respected.

We have chosen to give our own Veterans ½ day off on Friday afternoon to show our appreciation corporately.

Thank you to our employees and families for making this sacrifice.  We are grateful to you for allowing us to continue to live in a thriving, peaceful, FREE country.  Have a safe Veterans Day, and as always, God bless the United States of America.

...Please take the time to THANK A VETERAN."

[Thank you, Jennifer. HGS]

Omens & Portents, Part Two

Via email an hour or so ago:

"Important Notice: Discontinuance of Individual LTC Insurance Sales

To our LTC Distribution Partners and Producers:

After a recent analysis of the macro-economic trends facing the long-term care (LTC) insurance industry, we have made the difficult decision to discontinue sales of our individual LTC insurance policies in all states.  As many of you well know, the distribution landscape for LTC insurance has shrunk significantly since the peak of the industry in 2002.  Today, there are far fewer outlets through which individual LTC insurance is sold, impacting the growth potential of the product.  In addition, consumer demand for individual LTC insurance has fallen and remains stagnant. These trends, combined with the significant capital requirements of the LTC insurance business, are the primary reasons for this decision, which was not taken lightly."

Hancock has been an 800-pound gorilla in the Long Term Care insurance market for as long as I can recall.

So I reached out to our friend and LTCi guru Ray C for his thoughts, and he reminded me that "several years age, ManuLife purchased John Hancock.

I believe this change is now saying, they wanted Hancock for life and annuity - investments and not long-term care.

We stopped doing John Hancock three years ago.

So, we see no negative impact on our business - but another black eye on the industry."

I'm glad he reminded me of this, because I then went back and saw this in a post from '13:

"Executives at Manulife Financial ... think the benefits of staying in the private long-term care insurance (LTCI) market outweigh the benefits of getting out."

Looks like they've had a change of heart.

Omens & Portents

I haven't commented on the fate of ObamaCare in the wake of Tuesday's election, nor do I currently have any plans to do so. But I was intrigued by one specific electoral result:

"Amendment 69, the ballot measure known as ColoradoCare that would have created a universal health care system in Colorado, was soundly defeated Tuesday night."

On the one hand, I've always championed the 58-state laboratory model; that is, rather than the one-size-fits-very-few ObamaCare debacle, that each state should be free to try out its own proposed solution(s). So I was actually rather happy to see Colorado put it on the ballot.

On the other hand, many of us have said all along that Single Payer was the ultimate goal of ObamaCare in the first place, so the results of this ballot measure are telling: it went down in flames 4:1 (~80% to 20%). That's a clear repudiation in a state that went pretty solidly for Mrs Clinton.

So what message should one take from this?

Well first, it seems to vindicate the state-by-state laboratory model (as if it needed vindication). And second, the end-game of ObamaCare might not be as  inevitable as its proponents may have believed.