Much ado about the ObamaTax

FoIB Jeff M alerts us to this terrifying news:

"[H]ouseholds that opt to go without health insurance in 2016 are set to get hit with an average Obamacare fine of $969."

Oy vey!

That's almost $81 per month; better hurry up and lock down some of that sweet, affordable health insurance right away.

But it gets worse (for certain values of "worse") for families that don't qualify for free money premium subsidies:

"Households without insurance that earn too much to qualify for financial aid to buy Obamacare plans will pay an even larger fine for 2016 — an average of $1,450"

My goodness, that's almost $121 per month!

Or, as any rational person would put it: 1/10th of a typical family's insurance premium (with a very high deductible, at that).

Yeah, no.

Aggregate vs Embedded: Interesting "Glitch"

So the other day I was quoting a case for a family (HSA plan, natch), and ran across this rather interesting puzzler:

[click to embiggen]

It appears that the plan with the lower deductible (and thus total out-of-pocket) is substantially less expensive than the one with more family finances at-risk. In all other respects that I could see they were identical: deductible then 100%. So I reached out to the folks at InHealth for clarification.

Regular readers may recall that ACA-compliant health insurance plans are no longer allowed to use aggregate deductibles, but must now use embedded ones only. What I learned from our IH rep is that there's a rather obscure, but notable, exception. When IH (re-)filed its rates for 2016, it mistakenly included a plan with an aggregate deductible. I thought for sure that this was a no-no, but as JR explained to me, they're allowed to do that if an individual's actual out-of-pocket is no more than $6,850 for the year.

So in our example, let's assume that the Smith's choose the lower priced plan with a $3,750 deductible. In this case, the aggregate deductible means that the family checkbook would need to spend $7,500 before the 100% coverage kicks in (obviously this excludes mandated first-dollar items). But if Little Joey actually accrues $6,850, then he's good to go at the 100% from that point on (the rest of the family still has a few hundred to go).

I would presume that this plan will go away for the 2017 plan year, but interesting nonetheless. And hey, learned something new!

UHC Doubles Down on Comp

We noted a few weeks ago that the rocket surgeons at United Healthcare were dramatically reducing agent compensation for on-Exchange business. This of course has the direct and immediate effect of substantially reducing the carrier's risk from that demographic.

Apparently, though, the reduction wasn't drastic enough. From email this morning:

"Effective January 1, 2016, no commissions will be paid for any new UnitedHealthcare Individual On-Exchange ... enrollments received on or after this date, in most states."

This means applications enrollments proffered as of January 1 will generate zero agent comp. In fairness, at least they're giving us a heads' up on this, although one would expect exactly zero backlash from the agent community regardless (long story).

As I mentioned before, this is entirely their call to make, although one might expect to see other carriers begin to follow suit. Interesting times.

[Hat Tip: Cornerstone]

Frustrating Carrier Trick, Resolved

Last year, we signed Suzy up for a Silver plan from Humana; she also chose to add the dental rider. This year, despite that well-known promise ("If you like your plan..."), she received the dreaded "Your plan has been discontinued" letter from them. In and of itself, this wasn't really a huge deal: she was disappointed, of course, and quite interested in keeping at least the dental plan with them. We determined that she could, and went shopping.

Ultimately, we ended up staying with Humana (albeit under a slightly different plan), including the dental.

All seemed good.

Unfortunately, things did not go as seamlessly as we'd hoped (and been promised): Humana levied a $35 (re-)activation fee on the dental, then double billed the actual premium in November.

Suzy tried calling, spending over an hour on the phone, to no avail. That's when I stepped in.

I also spent almost two (ultimately unproductive) hours on the phone with Humana, including being shunted to multiple people (all with different, often contradictory, answers) and being hung up on (twice). Eventually, I threw in that towel and reached out to their media relations folks to let them know I'd be sharing the gory details with our readers.

To their credit, they responded promptly, and efficiently. I was contacted by Natalie, who's in a special problem resolution area, who asked me how she could help. I explained the circumstances, and my three goals:

1 - Refund of the $35 fee
2 - Accounting for the second premium withdrawal
3 - That they review and correct the various service issues I'd experienced (so that the next poor shlub who called wouldn't have such a hard time).

Natalie proved to be very helpful, and noted that this was actually a good learning experience for their customer service folks. Within a day we had Humana's agreement to refund the errant $35 application fee, as well as the extra month's premium.

I understand that MLR has greatly exacerbated the already difficult challenges of hiring (and keeping) adequate service staff, but my (and Suzy's) experience was unacceptable under any circumstances. So I'm pleased that Humana has resolved this quickly and fairly, and really appreciate Natalie's persistence and help.

[Special IB Thanks to Humana's Natalie K and Jeff B]

Health Wonk Review Parade is up

Peggy Salvatore hosts this week's Parade of (Wonky) Posts, covering everything from healthcare service guarantees to fun with diabetes (commercials), even a proposed Patient Bill of Rights.

Just a terrific job - kudos, Peggy!

Obamacare vs Hillarycare

It's official. Obamacare has succeeded in doing exactly what Hillarycare was

designed to do.

Put you in healthcare jail.

No choice.

Their way or the highway.

During the Hillarycare battle, HMOs were seen as imposing a kind of private sector rationing of health care, which helps explain why most people opted for preferred provider organizations, or PPOs, because they are more flexible when it comes to choosing a health care provider. 

But the PPO option is quickly passing away in the era of Obamacare health insurance exchanges. As Kaiser Health News explains, PPO freedom of choice is driving up premium costs faster than HMOs, and so insurers are canceling those plans. - Texas Insider

Bigger premiums.

Fewer options.

Obamacare.


#Obamacare

Promising Life Insurance/HIV news

Generally speaking, it's very difficult to find life insurance coverage for folks with fatal illnesses. It can be done, but at great expense and with substantial restrictions. Now, the folks at Prudential Life have partnered with ÆQUALIS to offer coverage to folks stricken with HIV.

There are, of course, certain underwriting requirements to be met, and they're currently offering only term plans. Still, this represents a potentially big step forward for folks living with HIV; previously, their choices were limited to restrictive guaranteed-issue plans or viaticals.

Kudos to Pruco and ÆQUALIS.

Blue Grass Bevin HIX Blues

Some Obamatax supporters have their knickers in a twist over KY Governor-elect Matt Bevin's plans to shutter his state's ill-conceived and potentially illegally founded health insurance exchange, called (oh so cleverly) Kynect:

"Bevin's plan to end Kynect has brought a strong rebuke from Obamacare advocates and outgoing Kentucky Gov. Steve Beshear"

In fairness, Ben Miller (author of the piece linked above) points out that it's really not clear that one form of Exchange is superior to the other. That is, the jury's still out on whether it's in a given citizen's (or state's) interest whether that state has its own portal or just piggybacks onto the 404Care.gov site.

Talk about damning with faint praise.

Meantime, as FoIB David Adams, proprietor of the Kentucky Progress blog, points out, the whole Kynect effort was actually never anything more than a massive overreach by (shortly former) Governor Bashear:

"Governor Steve Beshear "created" the Kentucky Health Benefit Exchange, Kynect, with an executive order in 2012 and then after the legislature declined to ratify his order as required by law, he tried again in 2013, 2014 and 2015."

So, our first 'rump Exchange.' And one that cost over a quarter of a billion dollars to implement, to boot.

Sounds like it's about time to to dis-Kynect the Blue Grass Exchange.