Monday, April 27, 2015

Monday Afternoon Link Potpourri

Some interesting items for your consideration:

■ "Nearly a fifth of the National Football League settlement approved this week compensating former players with head injuries could go to their health insurers instead"

Briefly, the NFL settled a players-filed lawsuit asking for compensation for life-altering head injures. The problem is, most of the costs associated with treating those injuries were borne by the players' health insurers. Under the concept of subrogation (a common feature in health, auto and other indemnity-based insurance products), the players waived their rights to any amounts rewarded that could go towards reimbursing those carriers. It's not really "news" except that most people haven't read their policies, and are unfamiliar with the principle.

■ Next up, this helpful info courtesy of FoIB Jeff M:

"COBRA considerations when Medicare-eligible. Clients may not realize the need to combine them."

A lot of folks who've recently retired (voluntarily or otherwise) opt for COBRA continuation of their previous coverage, since that's often the path of least resistance. But that may, in fact, be disastrous:

"With rare exceptions, COBRA coverage is secondary to Medicare Parts A and B ... The result is that when Medicare-eligible individuals do not have Medicare Parts A or B, they are left to pay 80% of their costs out of their own pocket."

And that's not all:

"Medicare has a window of opportunity to enroll in Medicare Parts A and B that lasts eight months after leaving employment."

Miss that special enrollment opportunity and you're facing a lifetime of fines once you do manage to sign up, which could also be a while.

Good info here.

■ Finally, some news on the viatical front:

"In 2013, the top 15 life settlement providers paid more than $362 million for unwanted life insurance policies."

That "investment" was worth a potential $2.2 billion in death benefits. It's also a major (29%) increase over the previous year. But what's driving this thriving [ed: really?] market?

According to the article, it's a rebounding economy, with institutional investors looking for better returns. I'm not convinced: it seems to me that more and more middle class folks, still hurting in a reduced labor market, are looking for ways to raise capital quickly, and what better way than to sell off unwanted (or unaffordable) policies, raising quick cash and easing the budget?

Sunday, April 26, 2015

Running on Empty

California is running out of water and money.

Gov. Moonbeam blames global warming and wasteful usage on things like lawns and toilets for the water problem. But what about the money issue?

Covered California, the Obamacare exchange for residents (legal or otherwise) of Kalifornia, was built with seed money from Obama's fat wallet. Problem is, those funds are running dry.
Indeed, there’s no more money coming from Washington after the state exhausts the $1.1 billion it received from the federal government to get the Obamacare exchange up and running. And state law prohibits Sacramento from spending any money to keep the exchange afloat.
That presents an existential crisis for Covered California, which is facing a nearly $80 (billion) budget deficit for its 2015-16 fiscal year. Although the exchange is setting aside $200 million to cover its near-term deficit, Covered California Executive Director Peter Lee acknowledged in December that there are questions about the “long-term sustainability of the organization.” - OC Register

Unlike the federal govt, the Republik of Kalifornia cannot print their own money and must balance the budget.

What a novel idea.

But wait. There's more.
Covered California’s enrollment growth for 2015 was a mere 1 percent, according to a study this month by Avalere Health. That was worst than all but two other state exchanges. Meanwhile, California’s Obamacare exchange managed to retain only 65 percent of previous enrollees, the nation’s fourth-lowest re-enrollment rate.
Not only are they running through money like it was water, but they aren't doing a very good job of managing resources.

OK, maybe that water analogy was a cheap shot.

#Obamacare #CoveredCalifornia

Saturday, April 25, 2015

Working for Free

Agents that dared venture into the Obamacare morass at are discovering, in many cases, they
were donating their time and expertise for the cause.

If you want to get paid on business submitted through the form that is transmitted to the health insurance carrier must have you identified by your NPN (National Producer Number). That number is the key to getting paid.

Without it, you get nada.
CMS recently identified that is not always passing the agent's name and National Producer Number (NPN) to health insurance carriers. As a result, Highmark cannot assign agent and agency numbers to these policies, and commission cannot be paid.
If producers believe this information is missing, they should contact their General Agency (GA). The GA should then check the daily activity reports and commission statements to see if this information was sent to Highmark, prior to taking any additional action. Please note - the producer hotline cannot verify if the agent's name or NPN is on an application. - URLINS

Is this a glitch or something deliberate?

Could be either. No way to know.

There have been rumors that enrollers are being instructed to strip NPN's from the file if they have any direct contact with the applicant during the application stage.

But it could be something as simple as a hard drive crash ............... or the server being stripped of this information.

Friday, April 24, 2015

From the Life Files

So about 30 years ago, my since-retired colleague wrote a policy on a 30 year old client (whom we'll call Gene). Gene's wife was named as the beneficiary, and all was well.

A few years - and two children - later, Gene and his wife divorced, and Gene changed the beneficiary of his policy to his brother.

Problem is, he never told his brother (or his kids) that he was doing so. Recently, Gene passed away, and his ex-wife called me to inquire about the policy. I called the home office and confirmed that a) he did, in fact, have a policy (and it was in force) and b) his brother was the beneficiary (again, news to all of us).

Fortunately, the brother lives relatively close by, and was in town attending to the funeral arrangements and such. I was able to connect with him, and we met yesterday to complete the claims paperwork (we're still awaiting the official death certificate, without which the claim can't be paid).

That's when I learned that not only did Gene never tell his brother about the policy, but that he died without a will (aka intestate for all you legal-beagles). The brother had no idea what Gene wanted to do with the proceeds of the policy (well, the balance after final expenses), nor of his house or other belongings. He's decided that he'll just divvy up the balance with his nieces once all the (modest) estate costs are settled.

This is just so sad: Gene died alone, and never made his wishes known to those that were (ostensibly) closest to him. I suppose there's a lesson here, somewhere, but danged if I know what it is. Any suggestions?

Thursday, April 23, 2015

Health Wonk Review - Windy Spring edition

HWR co-founder Joe Paduda hosts this week's outstanding round-up of wonky blog posts, with an emphasis on the ACA. Come for Louise Norris on coverage gaps, stay for Dr Jaan Siderow's "pretty cool" moment.

Wednesday, April 22, 2015

News from Ms Burntwell

Actually, there are quite a few ObamaTax-related items cluttering the in-box. In no particular order:

■ A dataset which purports to provide "the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the [] platform." It includes basic plan info about which plans folks in a given area selected during Open Enrollment. It's not clear how many (if any) of these folks actually bought a plan at all.

■ A handy little (one page!) .pdf letting us proles know how much HHS collected from reinsurers in 2014 to offset costs of the Transitional Reinsurance program. Spoiler alert: thus far, less than 75% of target.

■ The death of the insurance agent's role has been more than a little exaggerated. Case in point:

"The drafters of the [ObamaTax] seemed to think that brokers were mostly a waste of money ... For a look at how the new, humbled SHOP exchange system has done since then, read on."

Please do.

The reality is that (competent, professional) agents do far more than just suggest plans designs. They are an integral conduit between the client (individual or employer) and the carrier. Of course, that sales role can't really be underplayed, as witness the fate of the SHOP (Small group insurance exchange):

"HHS has been notoriously reluctant to release any numbers hinting at how many employers or workers might be using SHOP plans"

Any bets on whether that would hold true were it a rousing success?

Thought not.

Now, I happen to be one of those (competent, professional) agents who is authorized to sell SHOP plans. I can tell you that I have yet to experience any employer asking me for a SHOP quote (neither current clients nor prospects). I have suggested to a few current clients that we at least look into it, but when they learn what's involved, well, any interest seems to fade away quickly.

It may be the cumbersome (but intrusive!) data entry process, it may be the confusing requirements, or some combination of these and other factors. But it's certainly not surprising.

Tuesday, April 21, 2015

And speaking of cost of care....

Yesterday, we noted trends in cost of healthcare over the next decade. But what about the cost of Long Term Care? Well, the folks at Genworth have just released their latest "Cost of Care Survey," including an interactive map and state specific data.

According to the Executive Summary:
■ The National Median Hourly Rate for home ehalth aides is $20
■ Adult Day Care now runs about $69 a day
■ Assisted Living Facilities now north of $3600 a month
■ And full on nursing care is $220 a day (semi-private room)
Now's an excellent time to review your current coverage, or to contact a reputable, independent agent with experience in this market.

In the meantime, you can stop by Genworth for even more in depth analysis and information, including the aforementioned maps and charts,.

[Hat Tip: FoIB Randy G]