INSURANCE

Does Medicare cover cancer treatment? When this first came up I thought, what a silly question. Of course it does. Then I discovered people who have cancer policies, many they have had for years, and continuing to pay for them after they turned 65 and enrolled in Medicare. No doubt many cancer insurance policies are sold, and bought, based on fear. My personal feeling about cancer policies have changed over the years. At one time I felt they were a waste of money. That position is tempered a bit. I still don't think most people NEED a cancer plan but if you want one for ancillary coverage, go for it. Surprisingly, the biggest health issue for retirees on Medicare is not cancer but Arthritis.  Cancer ranks number three behind arthritis and heart disease. Does Medicare Cover My Cancer Treatment? Does Medicare cover my cancer screening and treatment? How about chemotherapy? How much will I have to pay for my cancer treatment? Does Medicare cover the rest?  From a purely financi...

A doctor that doesn't take Medicare? Get out of here! No way. All doctors accept Medicare. Don't they? Most do, a few don't. If you are turning 65 and enrolling in Medicare , there are things you need to know. Medicare Assignment, No Assignment, Opt-out Roughly 99% of doctors participate in Medicare and 96% of those accept Medicare assignment. That makes your job a lot easier. If you have original Medicare. Not so much if you have a Medicare Advantage plan. With original Medicare you can use (almost) any doctor anywhere in the United States. No networks. No referrals. No paperwork. Your job is a bit more complicated with an Advantage plan. Advantage plans run on a calendar year basis. "Your" doc may participate this year but not next year. That can make it a challenge if you have a medical condition that needs the attention of someone who really knows your history. And what about that 1% of doctors that opt-out of Medicare. Opt-out doctors who accept no Medicare ...

In the movie  Animal House  a young actor (Kevin Bacon) played the part of Delta House pledge Chip Diller. As part of the initiation ritual, pledges had to subject themselves to humiliation by assuming the position and being whacked in the butt with a paddle.  Most of the main characters in Obamacare either decided not to pledge or have flunked out. While most of the carriers have lost money by the buckets, a few have thrived in the Obamacare market and are coming back for more. Centene has learned how to make money in the Medicaid market. A combination of lean plans and even leaner networks seems to be a winning combination when serving up health insurance on the dollar menu. That same approach works well in the Obamacare market. At the same time, carriers like United Health Care, Assurant, Humana and others were losing money by offering prime rib to the bologna crowd. You can count Health Net in the loser bunch. Then along comes Centene who gobbles up the Arizona and Ca...

Recently I moved a small employer from the fully insured Obamacare plan that was written in 2014 into the Anthem MEWA here in Ohio. As a start up in 2014 the company knew they had to provide insurance benefits to attract the quality employees to make the business successful. Unfortunately as a new company entering the world of employee benefits, they were forced into the high priced community rated pool created under Obamacare. At the time the idea of using alternative funding arrangements was just beginning to enter the equation and for many insurers they were still a work in progress. Many products were still being developed and few were approved by the Department of Insurance.  My client did what they had to do and bit the bullet paying a steep price. All the while knowing that I would be coming back this year with high expectations that we would have a few extra arrows in the quiver. Which is exactly what we brought. I have to say, there was pain in the process. Employees had t...

Almost two months ago, we noted that the " risk adjustment program was designed to dissuade insurers from targeting only healthy people ... The problem is that measuring metrics often encourage companies to optimize their score " The point being: even when it works (for certain values of "works") it's a giant time bomb ticking away. And now we learn, thanks to FoIB Allison Bell, that it's about to go off: " For Congress, putting a health insurance risk-adjustment program in the legislation that created the Patient Protection and Affordable Care Act of 2010 was a no-brainer ." Which is quite apt, don't you think? The result of mindless tinkering is that " [w]hen insurers are dealing with the ACA risk-adjustment program, the amount of cash they get may ultimately depend on whether competitors make good on risk-adjustment obligations ." That is, they're trusting ion the old adage about honor among thieves, and relying on not just th...

Jonathon Gruber , the MIT smart-ass that designed Obamacare, the bill that became law due to " the stupidity of the American voter " , has decided to dine on crow. Kind of. Gruber claims Obamacare hit its' mark of 20 million people as of 2015 but also admits that maybe they, the architect brain trust, might have missed it by this much . . . . The rise in the Medicaid rolls has been much higher than expected . In May, 2013, CBO projected that Medicaid would grow by 12 million by 2015 and stay more or less at that level in 2016. In fact, Medicaid had grown by about 15 million by the beginning of 2016 - Poltico For those with short attention span, all the hoopla and borrowed money spent to throw the health insurance baby out with the bath water resulted in only 15 million people on Medicaid who (presumably) could not access health care that way before. How much has Obamacare cost? According to the UK Daily Mail, about $50,000 for every American that gets coverage through Oba...

The Office of Personnel Management announced last week that premium rates for the Federal Long Term Care Insurance Program will increase by an average 83% effective November 1 .    John Hancock is the present insurer, and was the only bidder for the new contract beginning November 1.     Officials representing Federal Employees expressed shock and anger at the news.  The anger is understandable - the shock is much less understandable.  There has been plenty of information about national, rapid increases to LTC costs. And specific to the federal LTC program, last August  OPM made a sudden, unprecedented decision to levy substantial premium increases for new enrollees.  It was then unmistakable � or should have been unmistakable � that the federal LTC house was on fire.  However, the officials who are shocked today, seem not to have thought it important enough last August to prepare their constituents.   As t...

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[Scroll down for update] FoIB Holly R has the latest on the proposed mergers of Cigna with Anthem and Humana with Aetna: " The Department of Justice announced Thursday that it would file lawsuits against the proposed merger[s] ... there are [currently] five major health insurers in the United States � and if these mergers went through, that would drop to three ." And the numbers are staggering: if both deals go through those three mega-carriers would account for something like half the under-65 population. On the other hand, FoIB Brian D wonders: " How can you pass restrictions and rules that push health insurers to the brink of bankruptcy then block insurers to merge to save costs? Could it be you look forward to government take over? " I replied that this has been the plan all along. And by the way, Aetna and Humana have announced their plan to fight this decision tooth-and-nail. Fighting city hall? Hunh. UPDATE [Related]: Co-blogger Bob also chimes in with thi...

Anticipation of huge premium increases in the small employer market has been building since 2013. New rules were to take effect on January 1, 2014 that would eliminate medical underwriting and reduce the number of criteria insurers could use in developing premiums. Insurance professionals, insurers, and organizations such as the U.S. Chamber of Commerce were preparing businesses with less than 50 employees for significant increases to their medical insurance premiums and the potential of losing their plans. Realizing the potential catastrophe of fully implementing this rule, President Obama had his leaders at HHS issue a letter to state insurance commissioners offering to extend plans that existed prior to October 1, 2013 through 2014. Less than four months later HHS followed up their prior letter with an additional extension lasting through 2017. The delay has benefited employers and bought insurers time. This has resulted in a series of new plan designs featuring alternative fundi...

Steve Anderson presents this month's round-up of fantastic health policy related posts, with almost Trumpian flair. Not to be missed.

� As we noted last month , it looks like the Feds are getting serious about cutting Short Term Medical plans off at the knees. Thanks to a tip from Insurance Services of America , we have some new details: The U.S. Department of Health and Human Services (HHS) has proposed major changes to short-term, limited duration insurance plans: � Short-term health policies could be written for no longer than three months, instead of up to a year as is now allowed. � Consumers would not be able to rewrite the policies. Just more proof that the ACA was never about insuring people, just controlling them. Consumers (and of course, agents) can comment on the new regs until early August. � Co-blogger Bob tips us that Palmetto State officials " warn the Obamacare health insurance marketplace is on the verge of collapse ." Currently, most South Carolina counties have exactly one choice of insurers: Blue Cross. And it looks like they may be the only one left standing statewide for 2017. � D...

The lie : The truth: Bus TED . [Hat Tip: FoIB Holly R]

Our friend Joe L at Issue Insurance tells us that (at least) 3 life insurers have introduced accelerated underwriting programs that promise to cut both the time it takes to get a policy issues and save wear-and-tear on clients' veins. For example, Banner Life offers AppAssist, which is available for face amounts up to half a million dollars. It does away with medical exams, labs and doctor's notes. The carrier promises that qualifying applicants " can be approved by the next business day, or even faster ." I must admit, this feature has me scratching my head: " One inch automatically added to client�s height to potentially boost the rate class " I mean, I get where that could be helpful in assigning a rate, I just don't get how they accomplish the feat: elevator shoes? So, what makes one a " qualifying applicant ?" Well, that will vary from carrier to carrier, but generally speaking: ages 18 to 50, and the carrier will do a 'script check...

Well, it's been well over two years since our last Food Pyramid update. At that time, chocolate and red wine were the stars of the show, but that was then and this is now: � First up, great news for those of us who enjoy "a slice" now and again: " Hallelujah! Eating pizza can actually help you stay healthy, awesome new study finds " Turns out, it's more about the amount of sugar in a given food that drives its weight-gain potential. According to the study, " researchers concluded that a high-calorie diet with lower sugar actually improved the children�s cholesterol, insulin levels, liver function, blood pressure, and blood sugar ." Now about those anchovies... � In related news, Co-blogger Bob tips us that: " Pasta may not be fattening after all ... By analyzing anthropometric data of the participants and their eating habits, we have seen that consumption of pasta, contrary to what many think, is not associated with an increase in body weigh...

Over at LifeHealthPro, FoIB Allison Bell has the story of a woman who doesn't understand the purpose of the product, who's never designed, priced, marketed or sold a plan, who may not even own one, yet is called upon to offer suggestions on how to "reform" Long Term Care insurance. What could possibly go wrong? Let's start with some basic facts: First, the primary purpose of Long Term Care insurance (LTCi) is asset protection. That is, as homeowner's insurance protects one's home, LTCi protects one's retirement and other financial assets. By definition, folks on Medicaid have no such assets to protect, hence no need for a plan. If one has no car or driver's license, why would one want (let alone need ) to buy auto insurance? Second, the primary reason that rates have continued to increase is that the industry made some (very) bad assumptions about retention. That is, they designed and priced the plans similar to disability insurance (close cous...