Affordable Care Act

http://www.exchangenevada.com/blog

Sal Morales, went from paying $560 month in Cobra insurance to about $145 a month through the Affordable Care Act. He also has a network deductible of $500. Here’s how he breaks it down: “There’s one party, the hospital who provides the service. There’s a second party, the patient, who receives the service. And there’s a third party, the insurance, who pays for the service.” What happened with Mr. Morale’s case is that the insurer negotiates a lessor amount for various plans, with a variety of hospitals through multiple agreements for the same hospitals or doctors.

Doctors are paid differently even if two patients have the same insurance company, if the plans are different in any way. To make this simple there are as many price tags for a hypertension checkup as there are insurers and providers.

The question that should be asked is how much is your doctor getting paid, to determine the best deals for coverage. If you have the history of medical procedures from lasts years doctors treatment the insurance company can provide a better assessment as opposed to shopping around to be told the price is more to cover you for the same procedures as last year.

“We’re identifying the procedure, we’re identifying the provider, the date of service and then making sure the amount, the member responsibility has to be in there,” Monzon says.

To get a clearer sense of what health care costs, someone would have to collect enough of those statements from patients at all different hospitals with all different insurance.

There are companies and crowdsourcing projects trying to do just that around the country. And Massachusetts has a law that says insurers have to disclose some of these prices in a way that is accessible to patients.

This story is part of a partnership that includes WLRN, the Miami Herald, NPR and Kaiser Health News.

Nevada Health Link Re-Enroll Email

Yesterday afternoon, Nevada Health Link sent out an email to all users stating that they MUST re-enroll in health insurance for next year or they will lose their subsidies. http://info.nevadahealthlink.com/re-enroll/ It will be a big deal if on January 1 you wake up and see that your current insurance company is sending you a bill for the full amount of the insurance that was being subsidized by the federal government before.
We have already started calling our current clients and informing people of this change and have begun the process to re enroll everyone for 2015. We want this to happen smoothly for each one of our clients and not make them go through the headache on their own. We were successful last year at getting people coverage through Nevada Health Link and we will do it again. It can be a nightmare trying to correct someone else's mistake on the websites. It is extremely important to make sure the information is accurate and that you understand why the questions they are asking are being asked. The first application I did last year was a dummy one I did for myself and I honestly was a little confused and annoyed. I have now done hundreds of these and I have a lot more knowledge and experience to get these done correctly.

We are putting on 2 events in October in Las Vegas to help people understand the changes and make life better for those who attend. Mark your calendar for October 18 and 25th at the YMCA off N Durango at 10am. I think it is a such a blessing to be able to have us work for you and get these done so you don't have to stress. The second best part is having a second person to be on your side in case things don't go 100% smoothly either. I have seen some of the worst technological issues with the website get fixed because we intervened and worked on the case. I know for a fact if those clients were on their own, they would be in the same boat today with no repercussion.

What is your reason?

Recently, a client of ours took out life insurance.  She just turned 50 and had nothing in place.  A huge reason why they made this decision now is because two close friends of theirs just passed.  I can't imagine how they must have felt having not one but two deaths to process.  This client has a family and is the main source of income for them.  I had mentioned it to them last year.  It was something they wanted to do but hadn't gotten around to it.  After losing friends so close to them they had no other choice but to secure the future of their family.  Nobody likes to talk about, "what if I die?" However, this is a question we need to take the time to ask ourselves.  Please talk it over with your family.   

2015 Nevada Health Insurance update

The department of Insurance has released the proposed rates for next year for individuals and small groups. I have put them together into our easy to use spreadsheets and are looking forward to being able to quote new policies soon. There seems to be some interesting trends. Anthem has decided to decrease their rates and offer totally new products, including an actual PPO product this next year. Sierra Health is staying with their product line up with relatively low increases and they are even introducing some lower cost alternative plan options. Assurant health, who last year was a big player has decided to join Humana at higher than market rates with increases as high as 30%+. Golden Rule is also putting their hat into the ring again this next year with rates equivalent to Assurant and Humana. Aetna has decided to stop offering Coventry plans, but they have kept the same kind of rates amongst the new Aetna plans that were similar to Coventry offerings with very strong low rates in the Bronze and Silver levels. Humana has also decided to increase their product offerings to expand into Platinum and Gold, but rates are still slightly higher than the lower priced Anthem, Sierra Health, and Nevada Health Coop Products. The Nevada Health Coop has introduced a whole lot of new offerings. They have expanded their Southern Simple and neighborhood plans to include platinum coverage and are introducing a whole new set of plans. Their rates are still amongst the least expensive.
Some big news for people who shop for coverage with subsidies is Assurant is going to be offering the first true PPOs on our exchange. This is good news to people who want more freedom and more choices f doctors. We are still yet to hear what provider network these plans will be using, but I wouldn't be surprised if it was the Aetna Signature Administrators network they used mostly last year.
As we get more updates about how our new federally facilitated marketplace will work, I hope to port more about those changes and hopefully we will be seeing some fixes to some of the biggest headaches we have been dealing with.

Going on vacation this summer?

Going on vacation this summer? Does your insurance have a network in the area you are traveling to? 

As many people travel during the summer it is important to check with your insurance carrier or broker to be sure you will be covered in that area.

Couple things to remember:

- HMO: Most will cover emergencies only when you leave the service area or state. Any other medical bill you may incur that’s not an emergency will be your responsibility and you will pay out-of-pocket. If an emergency arises, make sure and notify your HMO provider immediately. If this does not happen, the HMO may decline payment.

- PPO:  If you the provider is not contracted with the insurance, no matter what the circumstance, all costs will go towards your out-of-network deductible. You would need to pay cash and/or bill the insurance carrier directly as that provider does not have a contract with your insurance carrier. Make sure to keep detailed receipts so you can bill the insurance correctly.

This is why it is important to plan ahead. There are options if your insurance carrier does not cover the area you are traveling to. You can always look into travel insurance and Nevada Benefits can definitely help you with that. Below is a link found on our website regarding travel insurance.

https://www.sevencorners.com/insurance/HW8CCKK

Be safe, be prepared, and have a wonderful summer!

Las Vegas Metro Chamber trying to delay ObamaCare

http://eepurl.com/W_wJL

This sounds all great and wonderful on the outside. I too would like to keep my premiums as low as possible for as long as I can. Bill Wright is a great guy and I see where he is coming from. The problem is, the Chamber Health Plan is no longer going to be paying them commissions when things change, unless the chamber can get more people on their new program.

We cannot keep delaying the inevitable. If we keep trying to enact new legislation that allows people to keep their current health plans, then those few select people will never fully understand or appreciate the new healthcare law. It will also cause more troubles later on for those people. The main trouble being they will continue to elect officials who have no clue of what to do about the law and never get things fixed in a timely manner. We will see people trying to apply fixes that don't need to happen because someone only saw the law from an outsider point-of-view.

One example of this would be how many Nevadans went onto NevadaHealthlink.com to sign up for insurance in Oct-Dec for insurance to start in January but failed to select plans and make payment and expected those accounts to work for April and May start dates. Yes, I know the technology should have allowed it, but people kept complaining and instead of starting fresh, got frustrated and made the Nevada Health Link apply fixes to these old accounts that crashed every other new account and payment for April through June! If only people got smart and realized the issue, things would have gone smoothly. If people were not given so many extensions, we would have seen real progress.

By nature we are procrastinators. We cannot put off what we need to do today. The sooner we face our challenges the sooner we can overcome them. Accept challenges and move on.

Nevada's exchange confusion to get worse

http://www.reviewjournal.com/business/confusion-likely-nevada-health-exchange-switches




The thought of this whole exchange stuff getting changed over just scares me. After the long 9 month wrestle I had with our current system, now I get to do it all over again next year. Not only that, but now I have to rely upon them transferring all of my client's data over from the current system to the federal system.
As a Nevada resident, I feel a little ripped off on this. We spent $15 million building a website that we have now decided to just scrap. Instead of just hiring a new company to fix the broken site, which actually works sometimes, we would rather call it quits. Now in less than 5 months we have to rely upon someone else trying to build a new one completely.
This could all become a great blessing for brokers though. It is important for people to find professional, knowledgeable people to work with. People tend to find this value more appealing when they themselves feel overwhelmed. This whole process has shown that shopping for health insurance isn't really something people do on their own. The new law isn't very easy to understand and how it can affect people has yet to be seen. I am actually a little concerned about people who did everything on their own. They might get a real awakening during tax season.

Death, Money, and Life

I just met with a wonderful woman about her health insurance and just had to blog about her story. I did not sell her any insurance as what she was being offered was much better and less expensive, but she gave me more than I could have asked of her.

In her sixties, she recently lost her husband. Throughout their life her husband had really good jobs. He was phenomenal at what he did. He even got involved at one point with a financial services MLM and sold life insurance and financial planning. They had set up a few IRAs and even had purchased Term Life insurance to subsidize the small amount he was given through his job. Unexpectedly he past away in his sixties, before his full retirement age and his wife was left to fend for herself. A few years back as the economy took a dive, this couple had to use their retirement accounts to live on. The wonderful term life insurance they had been paying on had the term expire a year prior and they had to lapse the policy as costs went up way too much. The wife was left with a small life insurance policy and a fairly dismal retirement account.

Having no choice, she was left to do what a lot of seniors do at her age and took her Social security widow's benefit. This helped save her in providing just enough income to live, but it has crippled her at the same time. She was able to find work and make some additional income, but if that income rises too high she will have her widow's benefit reduced. Due to her age, finding work can be even more difficult and finding a job where she gets paid what she is worth even more difficult. She is now stuck. Making the same amount of money every moth and not able to lift herself above where she is.

This really made me think about how life does this to each one of us. Trials come and we lose our footing. Whatever plan we made when things were good, quickly gets eaten up when things are bad. It reminds me of the dreams Pharaoh had during Joseph's time in the Old Testament. If you recall, there were 7 fat cows and then 7 lean ones and the lean cows ate the fat cows. So it tends to be in life.

Some things that might have changed their circumstances that come to mind. First off- she said they had some debt. Getting out of debt sooner in life can have lasting effects later on. Imagine if they had no debt, how much easier it would have been to live and be able to not worry when income was lost, as expenses could be minimalized. This also would have allowed them to save more throughout their life.
Life Insurance. I kind of wonder if when they were younger and sold insurance policies, how much a $100k whole life policy would have cost that would have been paid off in 10 years. Would that life insurance policy, that wasn't costing them a dime after all those years, been replaced to pay those bills a few years ago, or could it have been a life line at the end when she got a check to save the day?

Everyone has different circumstances. Life throws everyone different curve balls. It is just a good idea to think ahead. During those good times, are we maybe spending too much, or are we saving? I know Pharaoh enlisted Joseph as one of the first financial advisers to save grains. That investment brought money and life during the times of famine. We too can do the same.

did you buy the right health plan?

Great article posted here http://money.usnews.com/money/blogs/my-money/2014/05/12/4-signs-you-have-the-wrong-health-insurance-plan about some of the mistakes people made when getting their health plan. As an adviser, we make sure and go over each one of these concerns before we put you with a plan. May Americans just purchased a plan on their own. They had no clue what they were doing and hope they are covered when they need it. In Nevada, all of the plans available in the state exchange have limited Nevada only doctor networks. A lot of people don't know that there are plans available in the state that meet all requirements, but are just not sold on NevadaHealthlink.com website. Thats' why it's good to work with a broker that knows all the options.
Read the article above, and make sure you ask yourself those same question.

healthcare spending up...great news folks!

http://archive.delawareonline.com/usatoday/article/8570053

My first thoughts when I see this- demand is up. In economics, when demand increases, price increases. We have more people trying to access the same amount of medical services and providers as there were when demand was lower. In order to compensate for larger traffic, doctors and facilities need to increase what they charge to coordinate their wait times and get people to think twice about using that care. Also when we have insurance taking care of the bill, that means more claims are being processed and the premium dollars are going to be going sooner.
The big problem with healthcare, is people don't know what it actually costs. Insurance companies keep that a bit of a secret until after the services are complete. What's worse, is the costs vary across providers, and since you have no clue what each provider charges until after the fact, there is no real market power happening. In short, can costs really go up when there is no market movements? All we have is more people using a system . Maybe that system was under utilized before. There could actually be an economy of scale happening. Now a doctor who saw only 10 patients in a day and twiddling his thumbs and making people wait while he talks to a pharma rep, now has 12 patients and that pharma rep can't schmooze as long. Now that doctor gets to make more due to higher patient loads and gets to work for just as many hours. What a win. There are so many ways to look at this, but boy is it interesting. Little do most Americans know that with the new healthcare law, people who get subsidized costs due to their income, will not see any cost increases or decreases like those who actually pay full price for their insurance. Higher income earners and tax dollars take the brunt of all increases in premiums and will be the ones highly affected.
I think the lesson to be learned is that if we want to be insured, expect to pay more when you earn more and live your live the best you can financially so you don't go bankrupt paying for healthcare.

fewer people without health insurance!

I will be the first to say that these numbers actually surprise me. This article published by Reuters here http://www.reuters.com/article/2014/05/05/us-usa-healthcare-poll-idUSBREA440DA20140505 states that uninsured rates have declined by 5%! I honestly thought we would see a shift in who was insured. For instance, we would see those who previously could not afford insurance going on Medicaid and getting subsidized and those who could afford insurance before, but now can't due to high rates, opting out. I think the article agrees there really isn't an exact answer to this though as there are many factors still in play. A lot of people, myself included, have older health plans that still reflect lower rates. My policy isn't set to expire until December and I know most of Las Vegas on those older plans are in the same boat.
I wonder if that 5% represents those who were uninsured because they couldn't get insurance, but could afford it, or if they were the millions of people who previously couldn't afford insurance due to lack of employment and now have Medicaid. I know we got almost 3-5 times the calls for people wanting Medicaid than any other call. A lot of people who got subsidized insurance were just replacing what they already had and/or looking for alternatives to their COBRA options.
I think the real test to this new system is going to be in a few more years when we start seeing some strong economic job growth. The only question is will this law halt that job growth? A lot of socialized countries see higher natural unemployment rates than we do. So maybe we are seeing a new norm? This law will be seen as a success then in getting more people insurance as was intended.

Financial planners, fees, and retirement

I was at my local library checking out a book about personal finance and a DVD caught my eye. It was from PBS. I am a complete nerd and have always enjoyed public television and radio and the educational material there. The title also caught my eye "The Retirement Gamble." http://www.pbs.org/wgbh/pages/frontline/retirement-gamble/
I figured, this ill be good to watch. I checked it out and watched it just last night. First of all, it was an incredibly good show to watch. As a financial planning professional and an avid student of financial thought and processes, it got my brain juices flowing.
The first thing I really enjoyed is the revelations about how people view retirement plans and the way they look at saving. Most people don't fully understand their money and spend it in many different ways. When they are offered the option to save through a retirement plan at work, they tend to participate because they are told it is a good thing to do. It used to be that companies saved for you and you were committed to that company for the rest of your life, because if you worked long enough, they would fund your retirement. This clearly changed with some tax restructures and new innovations in the market. I could go in on this all day about the economics of labor, but let's skip that for now.
The second thing that caught my attention was talking about growth in these plans. Most people don't know where to invest their money. The choices keep getting larger and larger. There are also more people trying to invest, so everyone wants in on the pie. Where the story gets lost is they look at the people trying to sell their products as "evil" because they want to charge fees for their management services. I know fees can really affect your retirement, but it is no different for you to pay above cost for any product and service. People have this notion that everyone else should work for free, except them. When you hire a professional to grow your money, expect to pay them for their work. If you don't want to pay them, then don't. Stuff your money under your pillow and don't complain. The most complaints tend to happen when people are losing money in their investments. It's not the manager's fault when the markets take a deep dive and then you, along with the rest of the world says "SELL!" at the same time. That's just simple economics and you can't blame them for something that is mostly out of their control.
The third thing they brought up, which I have been a great admirer of, is index funds. One of the greatest things to come out of technology, is the use of computers to match the overall market. In a market economy, people always look for ways to cut costs and get more business. By having a computer run the show, they are able to match the market and do it for a minimal fee. Fund management companies can do what every human has tried to do to match the market, and not have to hire someone. This is market efficiency and automation at its finest. The problem is humans want to preserve their jobs and hate change. They tend to fight automation and naturally try and push their own services without looking at the alternatives. Imagine if your competitor had a better product or services that was completely automated, while you had been doing your job for 20+ years at higher costs. You sure as heck won't want to give up your job just because someone else can do it better.
My final thoughts on the whole thing are to just make good financial decisions and let the new generation enact some change. The government and people have been bent on regulating people and the retirement accounts, when a change has already begun in lowering costs and making the system better for many people. I hope to become the well known adviser who efficiently directs people to making great decisions without much pain and need for hand holding. I am hoping the huge financial losses so many have gone through will get ourselves thinking about saving more and utilizing our brains more to accomplish our money goals. Growing up in Las Vegas, I have seen gambling all my life. When people are winning they are happy and keep trying for that big gain. They don't know how or when to walk away. Maybe people need to look at retirement planning the same way and when they achieve their goals, walk away and get themselves in a good spot so they don't have to freak out.

Who really pays for health care

Via @nprnews: Who Really Pays For Health Care Might Surprise You  http://n.pr/1rEYxu0

I got this article in my daily news feeds and thought I would share my thoughts on this. I met with a local union organization yesterday about some political endorsing and they asked me why healthcare costs keep going up. I think I said it well, but not sure if they got it. The key is transparency. The article clearly shows that there are many hands paying the bills. We think it's us through insurance premiums and deductibles, but in reality someone else is subsidizing it.
This year has been a big eye opener for a lot of people who saw larger increases in insurance premiums. For a lot, these costs have never been budgeted for before and making that premium payment is a huge burden on their finances. I would bet that if more people had to allocate larger portions of their income to pay for healthcare they would figure out very quickly how to decrease that so they can enjoy the better things in life. When we get subsidized, we have a false sense of what costs are really there and we consume disproportionately. The reason money exists is because the world truly has limited resources and money keeps those resources in check so we don't over consume. We love consuming and could easily overdue it.
There is a concept in economics called the 'Tragedy of the commons" which relates perfectly to anything we have. Imagine wanting to get to work at 8:00am on a Monday morning on the freeway. There is plenty of road space available for one car to drive down and easily drive 65 MPH. The problem is there is also thousands of people wanting to get to their destinations at the exact same time. Thus we get traffic jams and only get to move at a snails pace. We have this limited resource- freeway room, and we have many people trying to use it. If this was a business, someone would realize there is an opportunity to open up a new freeway and take some of that excess capacity, but because roads are publicly funded and heavily subsidized, that additional road might not happen for many years and people just have to adjust. Some drivers might take different routes and find more efficient routes, but others will still keep driving the crowded freeway. It gets even worse when that traffic is sporadic, because you don't take that route very often or get on the freeway at that time normally.
Imagine if you knew every morning what the traffic would be like? If you knew the cost of going to work would be before you got on? Your chances of taking that alternate route might increase, especially if it's a time or place you don't normally travel. Health care is similar to that road most people don't normally deal with. When they do get on the road, they find it super costly and have no clue where to go and get stuck in traffic. If only they knew what was coming before they got on, the decisions leading up to there would have been changed drastically. Since they were paying for the road ahead of time through insurance premiums (or so we hope) they might treat the road with a little more respect and understand what kind of blood and sweat went into it as well. Since they truly had no clue, they really don't care and expect it to pay for them 100% along the way.
Transparency and open reporting of costs, placing financial responsibility on individuals, and shedding light on our financial lives will make things much better for all of us.

Health Insurance Options

Open Enrollment on Nevada Health Link is now over.  What is next? How can I get covered now?  Well, we have options for you to get you insured until the Exchange opens up again.  First, you could still get a major medical plan through us with the insurance carrier Nevada Health Co-Op.  The Nevada Health Co-Op is still issuing effective dates at the first of the following month after you enroll for coverage. 

Second, you could sign up on a short term medical insurance plan.  A short term medical insurance is not a major medical plan but can give you some coverage with plans covering up to 2 million dollars.  I may recommend a plan like this for a few months if a client wants to get insured with a carrier that has a waiting period such as, Health Plan of Nevada, Assurant, Anthem, Coventry One, and Sierra Health and Life.

What are the benefits of short term medical plans?  Most plans will give you an effective date the next day and a lot of the premiums are lower than a major medical plan.  Please call us to find out more information. We can help ease the stress of shopping for health care coverage.

Deductibles

What are Health Insurance Deductibles?

Just like car insurance, health insurance also has deductibles. When you purchase health insurance part of your preferences that you choose will be the amount of deductible you will have on your plan.

Deductibles defined:

The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Source: "Glossary." HealthCare.gov. N.p., n.d. Web. 19 Mar. 2014.

Open Enrollment is over- so now what?

Boy are we glad march 31st has come and gone. For those of you who did not get a chance to purchase health insurance- don't fear! If you started an application in any way on the Nevada health Link website, you have a special enrollment for the next 60 days and will be able to complete a brand new application and finish! I highly recommend calling us and getting help so we can do it right though.
For those who didn't start an application, would rather not deal with the exchange (we don't blame you), you can still enroll in health insurance with us outside the exchange. If you have a qualifying event (I will explain later what these are) you can have coverage start the month following when you sign up as long as you sign up before the 15th of the month. If you do not have a qualifying event, then we can still get you insurance, but there is a 90 day wait. This only applies to Nevada Residents though. The 90 day wait is calculated as 90 days from the first of the month following enrollment. That means if you sign up today (April) you can have your coverage start Aug 1.
Qualifying events are basically life events where you went through a change. You either lost your other coverage from work, lost your job, got divorced, or moved out of the service area. If you get married and want to enroll with your spouse or had a new baby, you also get a special enrollment. If you are a member of a Native American Tribe you can enroll anytime and get those special enrollments all year long!

ObamaCare Special Enrollments

ObamaCare Special Enrollment Period

A special enrollment period time outside of the open enrollment period when you and your family can sign up for health insurance. You may qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage.

If you don’t have a special enrollment period, you can’t buy insurance inside or outside the Marketplace until the next open enrollment period. Job-based plans generally allow special enrollment periods of 30 days.

The following life events will generally qualify you for a special enrollment period.

• Getting married
• Having, adopting, or placement of a child
• Permanently moving to a new area that offers different health plan options
• Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
• For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions

Source: "ObamaCare Facts: Affordable Care Act, Health Insurance Marketplace." ObamaCare Facts: Affordable Care Act, Health Insurance Marketplace. N.p., n.d. Web. 19 Mar. 2014.