Can a person do ANYTHING to protect themselves from huge health insurance premium increases? Well, the best thing a person could do is control the cost of medicine. But since you and I cannot do this, and apparently the ones in charge of things cannot figure out that this is the fundamental problem, what can you and I do to protect ourselves?

As many of you know, I am a big believer in Health Savings Accounts paired with a High Deductible Health Plan. If a person does a cost analysis of what the cost of heatlh care is and compares having a plan like this with a typical PPO or HMO plan, in all but the rarest of examples they will come out ahead … and in most cases … way ahead.

But you’d think that having high deductible health plan (which generally means no utilization except in catatrophic situations) would mean that a person would not be getting rate increases. Sadly, that is not the case.

Here is how it works: if you are a health insurance company and you think that you are going to have some major costs shifted from the government to you [the big bad insurance company] you are going to act to protect yourself.

Since rate increases have to be approved, its prudent to plan ahead. What are the chances that a company is going to get a 200% increase approved? What are the chances that you, the consumer, would keep the policy even if it was approved? Zero, Zilch on both counts.

But what if they raised the premium 21% this year, and 17% next year, and 23% the following year, etc.? What then?

Might this be approved? Yes.

Might you keep it? Yes.

Lets create an example: You have a plan for your family with a $10,000 or higher deductible and no drug benefits. Would that qualify as “high deductible” to you? (I usually mean less than $5,000 when I use that term). Now imagine for a moment that you are paying about $252.00 per month for this $10,000 deductible plan with no drugs benefit.  And the company raises your premium on this plan that you’ve never utilized by 21%. How much is that?

Try $635 per year!

But what if you had a “normal” PPO plan and you were paying about $1,000 per month and the company raised your premium 21%.

That’s an increase of about $2,500 dollars. How does $635 dollars sound in comparison?

These examples I am giving are based on real scenarios. [I rounded some numbers but the basic facts are as illustrated].

So whereas I can not solve the problem for the country as a whole - I can help you – as an individual/family find reasonable solutions to the dilemmas created by politicians.

Call me or email me for more information. I can be reached at 209-498-3010 or 209-390-1163.

I am looking forward to talking to you.

Michael Myers

The health care field really cannot be compared to other fields. For some reason, people in general and those in the field seem to operate with the belief that they should never ask – or be asked – what does this cost?

We ask that question about everything else. Who orders anything without knowing the cost? And if Store “A” charges $150.00 and Store “B” charges $105.00 for the same item … what then? Well, perhaps you just like Store “A” and so you pay $150.00, or perhaps they bring you some other advantage. That is fine. But, then many would no doubt purchase the item from Store “B”, and that too is fine. But in either case, the person knew what they needed to know to make a decision they could be happy with.

But when it comes to health care .. many just won’t ask. This in spite of the fact that in a study done in 2007, HealthMarkets Inc. found that of those who did ask, a whopping 55% were able to get a reduction in the charge from their physician.

At the same time, in a recent study commissioned by Extend Health, Inc., only 13% had ever even asked about a lower price. Only 1 in 3 Americans said they had even discussed what the costs were going to be! Peter Gaillard, HealthMarkets’ vice president commented that “when it comes to health care prices, Americans seem to have lost the will to shop.” And the study confirmed that the more a person earns, the less likely they are to ask the questions.

In this age of higher and higher health care costs, I wonder what the price of other items would be if most people were unwilling to shop for the best price. If the local market could charge you $50 for a 10 lb. sack of potatoes, would they? Would people pay it? Or do you think that such an idea is ludicrous?

Yet when it comes to Health Care – that is exactly what is happening, and I believe that the price of Health Care today is about as out of touch with what it rightfully should be as if we were expected to pay $50 for a 10 lb. sack of potatoes.

Health Insurance is only the funding to pay for Health Care. The cost of Health Insurance is in direct relationship to the actual cost of Health Care. Is it any wonder that the cost of Health Insurance is out of control?

I can’t solve this problem, but I do encourage you to ask about the cost of Health Care. I can also help my clients focus in on what a person should pay for in health insurance and what they should just pass on. Call me with questions [209-390-1163 or 855-MPMYERS].

I’m here to help.

Michael Myers

By now you’ve read or heard that Bin Laden has been killed.

I first read in the news that he had been killed by a bomb a week ago, and the authorities had been waiting for D.N.A. testing to prove it was Bin Laden before they announced it to the world. It was also stated that they “had his body”. Next I heard from President Obama that he had been killed in a firefight. Later I read that he had resisted arrest and had been shot in the head – and buried at sea within 24 hours. Obviously, both accounts cannot be true.

Yet when I read the first report, there were enough “details” to make it appear to be true. The reporter seemed to know what he was saying. Yet either he was just making it up as he went along, or the later official report is untrue.

The purpose of my blog is not to debate which report is true. The purpose of my blog is to point out that you cannot always accept how events are reported by the news media. The news media seems increasingly interested in only two things – 1)getting the story out and 2)scooping their competition. The accuracy of the report seems (increasingly so) to be of little importance. When a person reads a report and they have only passing knowledge of the subject, it is not too difficult to make the reader believe what you want them to believe – if you are a good writer. The thing is, a reporter is suppose to report – not just write a good story.

Because I work in insurance and have for 30 years – I know when a reporter is just “writing” as opposed to “reporting” (when writing on the subject of Insurance). Its patently obvious that what he is writing is not accurate. Oh it may contain bits and pieces of truth, but the overall effect of what is written is just not right. Now to be clear on this, news reporters are not the only ones guilty of this. Politicians? Guilty! Insurance Companies? Guilty! I recently received a letter from a major insurance carrier that had so much spin in it that I got dizzy reading it! (Okay, that was a bit of hyperbole – but you get the point, right?)

Now I want to make clear that not all Insurance Companies engage in these tactics. Most are actually quite forthright in how they interact with brokers like me, and with their customers. Companies that I judge to be honest and forthright are the companies that I choose to promote to you – my customer. And with that in mind – let me just say, I am here to help you. It’s what I do, and it’s how I earn my living. If you have questions about your present coverage and was wondering “this or that” – call me (209-390-1163). I’ll tell you how it is and I’ll be forthright in what I recommend to you. I’m here to help.

I took this quiz from the Kansas Department of Insurance and thought I’d share my results.

Although I answered the quiz with the right answers, I do not exactly agree with the bias in the quiz. It’s true that the law does not create a national insurance plan, however, it is my belief that it is written in such a way to move things in this direction. Only if its modified in some way will that not be the end result. Of course, I do also expect it to be modified. More important than this however, I do not believe it does anything to address costs.

The high cost of health insurance is in direct correlation to the high cost of medicine. If you do nothing to lower the underlying costs, you can’t expect to change the effect of those decisions. Medicine should not have to be practiced defensively. I also find it sad that some in the health care field, view opportunity as a license to take advantage of people in need. Until this is stopped, the high costs will continue.

Health Reform Quiz

QUESTION	CORRECT RESPONSE	% OF AMERICANS ANSWERING CORRECTLY
1. Will the health reform law require nearly all Americans to have health insurance by 2014 or else pay a fine?	Yes, the law will do this. You answered this correctly.Yes. Starting in 2014, most U.S. citizens and legal residents will be required to obtain health coverage, or pay a penalty. Some exemptions will be granted, for example, for those with religious objections or where insurance would cost more than 8% of their income. Learn More »	64%
2. Will the health reform law allow a government panel to make decisions about end-of-life care for people on Medicare?	No, the law will not do this. You answered this correctly.No. No such panels exist. While early versions of the law did contain provisions that would allow Medicare to reimburse physicians for voluntary discussions with patients about end-of-life planning, these provisions were dropped from the final legislation.	45%
3. Will the health reform law cut benefits that were previously provided to all people on Medicare?	No, the law will not do this. You answered this correctly.No. The law reduces payments to the privately administered Medicare Advantage plans, but they will still be required to provide all benefits that are covered by traditional Medicare. Learn More »	40%
4. Will the health reform law expand the existing Medicaid program to cover low-income, uninsured adults regardless of whether they have children?	Yes, the law will do this. You answered this correctly.Yes. Medicaid will be expanded to cover nearly all individuals under age 65 with incomes up to 133% of the federal poverty level ($14,400 for an individual or $29,300 for a family of four in 2010). Learn More »	62%
5. Will the health reform law provide financial help to low and moderate income Americans who don’t get insurance through their jobs to help them purchase coverage?	Yes, the law will do this. You answered this correctly.Yes. Individuals without access to affordable coverage who purchase coverage through the new insurance Exchanges and have incomes up to 400% of the federal poverty level will be eligible for premium tax credits based on their income. Learn More »	72%
6. Will the health reform law prohibit insurance companies from denying coverage because of a person’s medical history or health condition?	Yes, the law will do this. You answered this correctly.Yes. Starting in 2014, all health insurers will be required to sell coverage to everyone who applies, regardless of their medical history or health status. Learn More »	67%
7. Will the health reform law require all businesses, even the smallest ones, to provide health insurance for their employees?	No, the law will not do this. You answered this correctly.No. The law does not require employers to provide health benefits. However, it does impose penalties, in some cases, on larger employers (those with 50 or more workers) that do not provide insurance to their workers or that provide coverage that is unaffordable. Learn More »	25%
8. Will the health reform law provide tax credits to small businesses that offer coverage to their employees?	Yes, the law will do this. You answered this correctly.Yes. Beginning in 2010, business with fewer than 25 full time equivalent employees and average annual wages of less than $50,000 that pay at least half of the cost of health insurance for their employees are eligible for a tax credit. Learn More »	65%
9. Will the health reform law create a new government run insurance plan to be offered along with private plans?	No, the law will not do this. You answered this correctly.No. The law does not create a new government-run health insurance plan. The existing Medicaid program will be expanded to cover more low-income people, government regulation of the health insurance industry will be increased, and tax credits will be provided to make private health insurance more affordable for people.	27%
10. Will the health reform law allow undocumented immigrants to receive financial help from the government to buy health insurance?	No, the law will not do this. You answered this correctly.No. Undocumented immigrants are not eligible to receive financial help from the government to buy health insurance, nor are they eligible for Medicaid or to purchase insurance with their own money in the new Exchanges.	42%

—

Did you know that there are an estimated 16.6 million workers employed at small businesses that are eligible for a tax credit because they offer small group health insurance? I find that may small business owners are not aware of the tax benefits or the potential impact on the group’s bottom line.

According to the IRS, the tax credit can be quite large. If you are not now providing benefits to your employees, did you know that even a small business with 10 people with an average wage of $25,000 per employee, and a total employee medical cost of $70,000 per year could get a tax credit of 35 percent of their premium cost, or $24,500?

I’m here to help. Call me [209-390-1163 or 855-MPMYERS] or email me with any questions.

Michael Myers

This is what I’ve been feeling for some time now when it comes to health insurance. Seemed like the companies all just copied each other and the price difference was not anything to write home about.

Well I am very happy to announce that there is a new carrier in California (for the first time in a long time). It is good news because they specialize in PPO and HSA plans – which just happens to be where my heart is at when I enroll a  new client. I just feel that the employer and employees are best served by these plans.

If you haven’t looked at your health insurance plan lately (or even if you have) I may be able to save you significant amounts of money and put your employees in a better position than they currently are in.

Call me at 209.390.1163 or 855-MPMYERS or just email me (see button to right). Let me help. That’s what I’m here for.

Michael

The Medicare Advantage Annual Election Period starts November 15th and runs through December 31st.

During this time, Medicare beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time.

I am again urging my clients (and potential clients) to return to original Medicare and secure a good Medicare Supplement Policy. Why should a person do this – especially if Medicare Advantage seems cheaper?

There are FIVE very good reasons:

1) The Medicare Advantage Program came into existence when George Bush was president. Although well conceived and intended, Congress has made so many changes to the program that it barely resembles the original intent.

2) Under Medicare Advantage plans, physicians may accept you one week and refuse you the next. Or they could accept your neighbor, but choose not to accept you. This is referred to as “deeming”. This is not a slam on doctors, as a person does not work for free – and they may decide that is exactly what they are being asked to do. So whereas they might do that for someone they have a close relationship with, they may reason that they cannot do this for most people, as they would quickly go out of business.

3) Medicare Advantage Programs are being tweaked every single year, and I have yet to see the changes improve the program. Rather, the changes weaken it and take away. Where this is going should be obvious to anyone. Why stay with a program that one has to constantly evaluate?

4) Original Medicare has worked fairly well since its inception in the mid-60′s. Are their problems? Assuredly there are. But from my viewpoint, much less than with the Medicare Advantage Program or even that which is experienced in the under-65 health programs.

4a) Original Medicare is, in my opinion, still the most stable of all health insurance programs available to a large group of individuals today. The only programs I (might) view as more stable are only available to a select few.

5) By adding the right Medicare Supplement to Original Medicare – a person has absolute control over how they spend their health care dollars. A person can accept some of the risk or have 100% coverage, their choice!

5a) And the best part is … in the long run I still think that a person spends less with Original Medicare and a Good Supplement.

I’m here to help. Call me or email me with any questions you may have.

Michael Myers
209-390-1163

Health Insurance costs continue to rise. The recent national debate on health insurance was ostensibly to lower costs. Many in the industry spoke loud that the proposals being put forward would raise premiums faster than ever before.

Even though the full impact of this is not yet felt, underlying pressure on costs has begun in earnest. One major insurer is sending out notices that include information like this:

Despite our efforts, the cost of care continues to increase dramatically. Factors fueling costs include:

1. Increased use of new medical technologies.
2. Higher prescription drug costs.
3. Pressure on health insurance plans and the private sector to absorb higher costs as funding for public programs like Medicare and Medicaid decreases.

The average increase is a whopping 17.6 percent for PPO insurance plans! The increase applies to both open and closed insurance plans. Insureds of all ages and across all regions and tiers will see an increase unless they are currently in a rate guarantee period.

What can you do about this? Well, neither you or I can change the decisions being made as individuals. However, as individuals – we can change what we pay for.

I have for a long time advocated Health Insurance Savings qualified health plans. I feel stronger than ever that this is a good choice for the majority of persons. I believe that putting a plan like this in place is the best way to cushion future rate increases. I can help you do this.

Recently I have found another good idea. This one works whether you are self-employed or an employee. It works wherever there is a high deductible medical plan. You can protect yourself, and your whole family against many risks by getting your own accident and/or critical (cancer, heart, etc) illness plan. These plans pay with either no deductible or a very small deductible. Either way they will help cushion you against health insurance plans with increasingly high deductibles.

In a word: No!

However, even though that is true, for many Accident Insurance provides them needed protection when Work Comp Insurance is simply not an option for them. Many self-employed individuals do opt out of Work Comp for themselves. Why do they choose to do this?

Its because 1) it is expensive and 2) it basically will not pay benefits for the owner. [These comments have to do with California]. So many wonder why they should pay for something that will not provide benefits.

With all the talk about health care combined with the fact that many are suffering from a lack of work – the self employed have to evaluate the best way to protect themselves. Many do not pay into Workers Compensation

But what is a self-employed construction worker or similar tradesman / woman to do? How does a person provide a reasonable amount of protection on themselves?

Here is a link for a reasonably priced accident plan. A person can combine this with a high deductible health insurance plan. This way a person can cover themselves, at least against medical costs, should they get injured while working, and still partially self-insure for sickness (for all of you who “don’t go to doctors”).

There is more to this that I would like to explain to you, as a person in this situation really should do more than what I’ve addressed in this blog and this blog does not address the whole picture.

However, this will get you started. Please call me if you have questions.

Michael Myers
209-390-1163

What can be done about it now?

There are five scenarios in which Medicare Advantage members may disenroll from their plan.

Scenario #1
If you are disenrolled from an MA plan because the plan is leaving Medicare, stops giving care in their area, or the customer moves out of the plan’s service area, you are eligible to change. Customers in this scenario are guaranteed issue of a Medicare Supplement plan A, B, C, F, HDF, K, or L that are sold in their state by any insurer.

Customers can apply for a Medicare Supplement as early as the day they receive notice that their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #2
You joined an MA Plan when you were first eligible for Medicare Part A at age 65, and within the first year of joining you may exercise your right to switch to Original Medicare. Customers in this scenario are guaranteed issue of any Medicare Supplement plan sold in their state by any insurer. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #3
Or … you dropped a traditional Medicare Supplement to join Medicare Advantage for the first time, less than a year ago and you wish to switch back to Original Medicare. Customers in this scenario are guaranteed issue of the Medicare Supplement policy they had before they joined MA if the same insurance company they had before still sells it. If the former Medicare Supplement policy isn’t available, they can buy a Medicare Supplement plan A, B, C, F, HDF, K, or L sold in their state by any insurance company. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #4
You have been with an Medicare Advantage plan for more than one year and are considering dis-enrolling and returning to original Medicare, and then purchasing a Medicare Supplement.

In most cases, an MA enrollee must stay enrolled for that calendar year starting the date their overage begins. According to Medicare, a customer who has been with an MA plan for more than one year may disenroll if Medicare has made a determination that a Medicare Advantage organization materially misrepresented plan provisions or violated its agreement with the enrollee. Customers in this scenario are guaranteed issue of Medicare Supplements A, B, C, F, HDF, K, and L that is sold in their state by any insurance company. [This one is tough to do].

Scenario #5
If you dis-enroll from Medicare Advantage, having been on Medicare Advantage MORE THAN one year and are not in Scenario 4, you are NOT guaranteed issue. This simply means that your application will be medically underwritten. You may or may not qualify, but this is something I will likely be able to tell you at the time of application.

I have been helping people with Medicare Supplements since the early 1980′s. In almost all cases, I prefer my clients to be with original Medicare and purchase a Medicare Supplement. I believe that, in the long run, this is the most cost effective decision. It certainly is the decision with the most stability.

Call me anytime if you have questions, or if I can assist you in any way.

Michael