HELLO FROM EAU CLAIRE, WISCONSIN - merchants slogan: "We don't have it but we can get it for you."

Thursday, October 24, 2013


People that are frustrated trying to use the federal web site should know that they can also use the various state web sites as well as insurance brokers.

And something I wasn’t aware of, even if they qualify for and will get the federal subsidy, they can use the state web sites or insurance brokers. (I thought they had to use the fed site in that case…..)

I just spoke w/ a broker/friend who is able to enroll people……….and the advantage to using a broker is that they can help/advise/provide information about different policy options, whereas the “facilitators” (those that get certified for health care reform) cannot give any advice, they can only help people enroll.

You may have heard, or will hear (new talking point by Fox News and the Republicans) that “300,000 people in Florida are losing their health insurance due to Obamacare”. This is flat wrong!!! What is happening is that many employers that don’t want to spend the money to provide quality health insurance to their employees, enroll employees in what are called “limited medical reimbursement plans” (also called mini-meds). Similar to Aflac plans, they just pay a limited amount for each procedure an enrollee has. Legally they are not major medical insurance and don’t comply with insurance standards.

Example---they might pay $60 for a Dr. office visit…….which leaves the balance of the cost to be paid by the enrollee. Not too bad for a simple office visit, but for anything more complicated requiring lab work, pathology, hospital stay, surgery and the like, the amount paid by the employer is very minimal and the enrollee is left with huge bills.

These type of plans DO NOT QUALIFY as options you can buy to satisfy the health insurance requirement under health care reform, so if a person has one, they will still have to buy a qualified plan. That is why people and companies are cancelling them. Most of the people on these plans also have pre-existing conditions and can’t get coverage anywhere else which is why they enroll in them. Under health care reform, since there are no longer pre-existing condition limitations, these people will be able to get real insurance.

So they aren’t losing insurance due to Obamacare, they are dropping employers "limited medical reimbursement plans" because they can now get better plans under Obamacare.

Kirk Roebuck
Summa Health System

Just an aside regarding the ACA and health care reform……………….the problem with trying to educate people on it, especially the loons that watch FOX and follow the Republican talking points, is that they believe the lies and don’t want to listen to the rational answers, especially when the answer isn’t simply a 2 or 3 word sound bite.

Add to that that most people don’t even understand their own health insurance and want to be “hand held” whenever they have claims or need to use it. That has always been a big issue…..people need to understand their policies and actively participate in their health insurance……they need to be “smart consumers” of health care. That is a big change from the old days when most, if not all plans were basically a $100 deductible with the plan then paying 80% of the costs incurred.

That pretty much all started going away in the 1980s with the introduction of HMOs, PPOs and the many “hybrid” plans that grew out of the managed care boom.

So any time I hear someone whine and cry about either health care reform or their own insurance I immediately question them about their knowledge of it before I discuss it with them.

Kirk Roebuck
Summa Health System


As millions of consumers consider purchasing health insurance through the insurance marketplaces set up as part of the Affordable Care Act (ACA) - and as some face problems accessing the program because of failures of the government's website, they should be aware of an option they may not know they have: Consulting their local professional, independent insurance agent or broker for help in enrolling.

Consumers may already know that there are "navigators" paid by the government who are available to assist them in enrolling in policies under Obamacare. But they may not be aware that under the law, navigators cannot offer advice or recommend one policy over another.

Professional insurance agents, on the other hand, are free to offer a much higher level of assistance. Consumers don't pay for this service. In addition, in most cases, navigators are not required to be licensed or to comply with state-mandated continuing education requirements; they are also not required to maintain professional liability insurance coverage. Agents and brokers must be licensed and must comply with all of these requirements, along with all state laws and regulations.

Many independent insurance agents and brokers have already been trained and certified to assist consumers to enroll in health plans offered as part of the Affordable Care Act. They can also make consumers aware of insurance choices not available through the exchanges.

"Choosing a health insurance plan is a serious matter," said PIA National President John G. Lee. "it is a complex process that cannot be compared to purchasing a book from a website. Insurance is not a commodity. the implications of making a poor choice due to the lack of adequate knowledge include paying too much or getting inadequate coverage for yourself or your family. When it comes to health insurance, making an ill-informed decision can end up costing you your life's savings - or your life."

"Professional agents and brokers have the training and expertise needed to advise consumers about their insurance choices," Lee said. "We have always been licensed, regulated, and required to carry professional liability insurance coverage. We recommend that people shopping for health insurance - or any kind of insurance - make the smart choice and not leave anything to chance. Consult a local ACA Certified Professional Insurance Agent."

I will publish more tips and help as it is fed to me through Mr. Roebuck.


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