Tag Archives: PPACA

Humana Aetna and BCBSTX are canceling plans but this year it’s MUCH different.

On October 2nd President Obama touted an “improved, strong U.S. economy” and the “benefits of Obamacare” at Northwestern University. It all sounded great but this is what I’ve been dealing with today. I’m fielding angry calls from my HumanaOne, Aetna and Blue Cross Blue Shield of Texas clients. All of their policies will be canceled  as of December 31, 2014. See the letters here and here. Cigna is also terminating their pre-2014 plans. This is the second year I’ve had to deal with this but this year it’s much different.

Last year when more than 4 million cancellation notices went out, Americans were able to shop for prices as early as October 1st, granted the initial roll out left much to be desired. In fact, in my opinion it was an unmitigated disaster. Many of my clients spent hours on the phone with Healthcare.gov ‘navigators’ only to find out that their application had then mysteriously disappeared.

Worse yet, because our state’s “C.H.I.P” program was expanded long before Obamacare. The few members of my clientele who actually qualified for an APTC – “Advance Premium Tax Credit”  a.k.a. “subsidy” to artificially lower their premiums were unable to add their children to their subsidized policies. They were instead instructed to enroll their children in Medicaid. Or, they could pay full price for each of their children. The rates for a single child in my state are at least $100 a month for the cheapest “Bronze” plan which includes a $6,000 deductible per person. That’s not exactly ‘affordable care’ when you have three children.

This year, for the first time in 20 years I can not even quote a replacement product because Barack Obama has issued a GAG ORDER to the health insurance industry instructing them not to disclose their January 2015 health insurance rates until after the mid-term elections. This is unprecedented. Normally health insurance premiums are released for public viewing 60 days before the January 1st effective date. Where are the reports on these cancellations and the gag order from NBC, ABC, CBS and CNN? The only news organization that I am aware of that has reported on any of this is the Fox News channel. I can guarantee you one thing, not one of my clients who received a cancellation notice is voting Democrat on Tuesday.

Republicans have outstanding alternatives to this disastrous health care law. The two most recent are the American Health Care Reform Act and the Universal Exchange Plan. Please read them, for it will be up to us to forge a new path forward for the American people and time is of the essence. The insurance company bail outs are temporary and they will expire in 2016. Without a bailout the health insurance industry will pull out of the individual and family health insurance market. Before that happens we need to be able to articulate intelligent, market based alternatives. It’s up to us.

11/4/2014 UPDATE Yesterday, “Snopes” the ‘fact check’ site stated that the actual term ‘Gag Order’ was not used in the original Wall Street Journal article which I link to above. Whilst that is true, Snopes does not disagree with the fact that 2015 health insurance premiums and plans are not available for viewing until after the election. Since the term ‘Gag Order’ was not used in that WSJ post “Snopes” lists my post as ‘false’. Anyone who has access to the internet can visit my health insurance brokerage site HealthInsuranceMentors.com  and then click on the orange ‘Start Shopping Now” button. Then attempt to get a quote for January 1, 2015. You will not be able to. That is the point of this entire piece. Not the fact that the actual term “Gag Order” was not used but the fact that you can not quote premiums for January 1, 2015 and this is what is unprecedented.  That is the point. Certainly the good folks at ‘Snopes’ are intelligent enough to figure that out. Maybe they should take a lesson from USA Today who figured out the point and used the term “Gag Rule” last month. Does the fact that USA Today used the term “Gag Rule” render their entire piece ‘false’? No one with a working cerebral cortex would believe such nonsense.


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COBRA recipients now have until 7/1/14 to replace COBRA with a QHP and Individuals with renewing 2013 plans now qualify for Special Enrollment.

On May 2, 2014 HHS issued a new bulletin. This bulletin provides a “special enrollment” period until July 1, 2014 for individuals who have already elected COBRA continuation coverage. This new rule will allow those who have already elected COBRA continuation coverage to drop their COBRA coverage and select a potentially lower priced QHP – “Qualified Health Plan” on or off the exchange at any time before July 1, 2014.

Before this new bulletin was published, those eligible for COBRA continuation coverage only qualified for a special enrollment period when they first become eligible for COBRA or when they exhausted their COBRA continuation coverage (typically 18 months later). This new rule only applies to states that have a “Federally Facilitated Exchange” like the state of Illinois.  See if your state has a “Federally Facilitated Exchange” click here

Those with 2013 Individual health plans that renew in 2014 now qualify for a “Special Enrollment” period.

The new May 2, 2014 bulletin also allows those who purchased 2013 plans from the ‘old market’ to qualify for a ‘special enrollment’ period if their 2013 plan renews in 2014. The applicants can apply for a QHP up to 60 days before their plans terminate and they may also apply up to 60 days after their plan’s renewal date. In this April 8, 2014 article I noted that before this new bulletin Assurant Health was the only carrier that was offering a QHP to those with plans from the ‘old market’ outside of ‘open enrollment’ periods. With this new May 2, 2014 bulletin all carriers will eventually need to comply. As of the date of this writing Blue Cross Blue Shield of Illinois had not stated when they will comply. If and when they do I will add their statement to this post.

New options for those with Americorps, VISTA or National Civilian Community Corps

This new bulletin also creates a third new ‘special enrollment’ period when members of these programs begin their service and when their service ends. Since members of these programs are often times under-insured on plans that do not contain “minimum essential health benefits” this bulletin grants a hardship exemption from the ‘individual responsibility’ TAX for non compliance. That per person TAX in 2014 is either $95 or 1% of your MAGI – Modified Adjusted Gross Income.


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Obamacare Open Enrollment is ending soon. If you have preexisting conditions you need to understand the new rules.

The next available effective date for individual major medical health insurance policies purchased on or off the “Health Insurance Exchange” is May 1, 2014.  The last date to buy that coverage is March 31, 2014. After March 31, 2014 you will not be able to purchase individual major medical health insurance on or off the exchange until the next “open enrollment” period begins again on 11/15/2014 and lasts until 2/15/2015. So, if you have a preexisting condition you need to start familiarizing yourself with how open enrollment works now, not later nowAlso, due to a new rule issued by CMS on December 19th 2013 (which expanded the original hardship exemption) the 6.3 million American policy holders who have lost their health insurance because of Obamacare will not be subject to a fine (TAX) in the year 2014 for not buying health insurance.

The old rules are gone

The old rules pertaining to purchasing health insurance in the individual major medical market are now gone. You can no longer purchase individual major medical health insurance coverage whenever you want, all year long. There are now specific time periods where this kind of coverage will be available in 2014 and in subsequent years. Those periods are called open enrollment periods. Outside of those open enrollment periods individual major medical health insurance coverage will not be available for sale. This means that you will not be able to get coverage for preexisting conditions.

This is why it is essential that you understand the new rules for they will affect you and everyone you know who has a preexisting condition or has lost their health insurance because of Obamacare. This is especially true because our existing state run high risk health insurance pools which provided guaranteed issue coverage for those who were declined health insurance coverage for decades before Obamacare are now being dissolved.

Buying insurance on and off the Obamacare exchange

It is important to know that you do not have to purchase health insurance at Healthcare.gov. All products sold on and off the new Obamacare HIX – “Health Insurance Exchange Marketplace” will be guaranteed issue products during the two national Open Enrollment periods. They are:

Open Enrollment Period One: 1/1/14 – 3/31/14

Open Enrollment Period Two: 11/15/14 – 2/15/15

This means that you can not be denied coverage and no exclusion riders can be placed on your policy whether you buy the product on or off the Obamacare HIX but only during these two time periods. After these two open enrollment periods you can be denied coverage. In fact, individual major medical products will not be offered between these two national open enrollment periods. If insurance carriers continued to offer guaranteed issue coverage all year long it would lead to adverse selection, as it did in Massachusetts.

What you need to know right now

Since time is of the essence (and their is nothing timely about purchasing health insurance on the exchange). You need to know the only reason to purchase health insurance inside the HIX – Health Insurance Exchange Marketplace (Healthcare.gov) is if you qualify for an APTC – Advance Premium Tax Credit – (subsidy) to artificially lower the high cost of the Obamacare “Medal” plans – Bronze, Silver, Gold and Platinum. In order to qualify for an APTX your 2014 total household MAGI – Modified Adjusted Gross Income – income after deductions and retirement contributions must be less than:

$46,960 for an individual
$62,040 for a couple
$78,120 for a family of three
$94,200 for a family of four
$110,280 for a family of five
$126,360 for a family of six

If your income is more than the aforementioned amounts, you should purchase your health insurance outside of the HIX. The same plans are available off the exchange and the application process is much faster and far more secure. Again, all major medical health insurance products purchased inside and outside the HIX will be guarantee issue (no preexisting conditions) during the two national Open Enrollment periods in 2014.

If you live in Illinois, the best priced 2014 ‘Medal’ plans are insured and underwritten by Blue Cross Blue Shield of Illinois a Division of Health Care Services Corporation. Find the right health insurance plan for you by exploring all of the plan options, save plans that fit your needs in your Shopping Cart and return to apply for coverage when you are ready. Click their logo to begin.


To shop for all plans on and off the Obamacare HIX in all 50 states click the banner below:


A cheaper option for those without preexisting conditions

If you do not have any serious preexisting conditions, you can save a lot of money if you purchase a non-renewable Temporary health insurance policy for a period of one year. These health insurance policies do not cover preexisting conditions nor do they include all of the federally mandated “Essential Health Benefits” such as Maternity, Drug Rehab coverage and Pediatric Dental. This also means that they are not considered ‘Qualified Health Plans’ meaning that you will be subject to the 1% of your MAGI penalty in 2014 if you purchase one of these plans. That stated the premium difference between these plans and ‘Qualified Health Plans’ is significant. The price difference far outweighs the additional fine you would pay to the IRS in most cases.

To run quotes for a Temporary health insurance plan off the exchange click the banner below:

If that Temporary insurance quote engine does not work in your state click the banner below:


Very Important Note: Since the PPACA mandates that all health insurance policies cover preexisting conditions during the first national Open Enrollment period from 1/1/14 – 3/31/14 and the second national open enrollment period from 11/15/14 – 02/15/15. You can now safely purchase Temporary health insurance knowing that when your one year Temporary policy ends you will qualify by federal law for any ‘Qualified Health Plan’ regardless of preexisting conditions during the second annual open enrollment period in 2014. Outside of those two aforementioned open enrollment periods you will not be able to obtain coverage for a preexisting condition. For this reason you must not purchase the 6 month Temporary health insurance option.

Only the 12 month Temporary insurance option is acceptable at this juncture. If you purchase a 6 month Temporary policy your coverage will end in between the two aforementioned open enrollment periods and you will not be able to obtain another policy that will cover a preexisting condition that you may develop during the first 6 months of Temporary policy ownership. HHS may yet provide us with further guidance as to whether or not the loss of a Temporary health plan outside of open enrollment periods will qualify as a “Special Enrollment” period in 2014 so that one could obtain a “Qualified Health Plan” on a guaranteed issue basis outside of open enrollment periods. As of the date of this writing no such guidance has been received.

What if your plan renews and you lose it in 2014 outside of open enrollment?

If your individual health plan renews in 2014 or you lose that plan  in a month that is outside of the two national open enrollment periods (which would be between 4/1/14 and 11/15/14) that will also be considered a Special Enrollment period. So, you will be able to buy another individual major medical policy on a guaranteed issue basis (no preexisting conditions) from any carrier offering a QHP – Qualified Health Plan – even though you will be at that juncture outside of open enrollment. 


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New York premiums will go down by 50% because of Obamacare? Not quite.

The front page of today’s New York times has an article written by Roni Caryn Rabin and Reed Abelson that states that premiums will “be at least 50% lower on average than those currently available in New York“. To what do they contribute this miraculous drop in premiums? That’s right, the miraculous premium reducing powers of Obamacare!

The authors quote Joanne Peters, a spokeswoman for the Department of Health and Human Services as saying “We’re seeing in New York what we’ve seen in other states like California and Oregon — that competition and transparency in the marketplaces are leading to affordable and new choices for families.” Even Forbes magazine’s Rick Ungar now knows that premiums are not really going to drop in California because of Obamacare. Most especially after his counterpart at Forbes Avik Roy accurately blew up that fallacy in his fact based response to Rick’s article entitled “Unexpected Health Insurance Rate Shock in California“.

In the one hour debate I had with Mr. Ungar I stated that his entire article was based on a lie that was promulgated by Peter Lee, the Executive Director of “Covered California”. You can read my response to Mr. Ungar and download our one hour debate here. Courtesy of the David Webb show on Sirius XM Patriot Satellite Radio.

Yet the Left continues to print hyperbole in the hopes that policy wonks who operate on facts won’t pick their pieces apart like vultures picking at the rotten, festering corpse that is Obamacare. Well, let me be the first ‘wonk’ to expose this latest fallacy.

The truth is New York, and 7 other states have already had the worst parts of Obamacare for many years. Namely, Community Rating and Guaranteed Issue. Both of these failed Liberal health care policies have resulted in driving premiums to their highest point in recorded history in those states. These policies have also driven insurance carriers out of those states by the droves. Why? Because, those states did not have a mandate to purchase health insurance. As such, many consumers chose to opt out and go uninsured instead. Meaning that there were less people insured in those states, so there were less lives to spread risk around. This drove premiums even higher. Even Mr. Ungar admitted this during our debate back in May.

This means that the premium assumptions made in the New York Times piece are based on the false premise that ‘young invincibles’ and other New York consumers will buy Obamacare compliant health insurance instead of opting out and paying the much smaller fine for not doing so. This simply will not happen to the degree that Obamacare supporters want it to. Regardless of how many NFL players that HHS attempts to recruit to ‘sell Obamacare’ to our youth. Why? Because the fine for not buying health insurance is only 1% of one’s MAGI – Modified Adjusted Gross Income – in 2014. And, we are not repealing EMTALA – the federal law that requires hospitals to treat any patient within 250 yards of an emergency room – regardless of their ability to pay. Also, consumers will be able to buy Guaranteed Issue health insurance coverage, regardless of the severity of their preexisting conditions during the new annual Obamacare ‘Open Enrollment’ periods, with no proof of prior coverage. It is these perverse incentives that will actually incentivize consumers not to purchase health insurance. As was the case in all 8 states that have adopted the same failed policies before.

October 8, 2013 UPDATE: Regarding “Community Rating”. I officially rest my case. Watch:

Lastly, let me address another statement made in today’s New York Times piece. Namely this one: “Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly.

The truth is New York residents can shop today using this private health insurance exchange that I have had on my brokerage site for many years before Obamacare to find quality health insurance coverage for a lot less than “$1,000 a month or more”. For example a 45 year old male, non-smoker living in Monroe county, New York would pay $321.21 a month today for a policy with a $1,250 deductible and out of pocket expenses commensurate with the plans that will be offered in the exchanges in 2014. So, in conclusion, can someone please tell me why do we need Obamacare again?

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‘Affordable health insurance for all’ means Welfare for 17 million more Americans.

To all voters who moved ‘Forward’ with Barack Obama in this last election cycle. I know the President promised that his health care law would guarantee ‘Affordable Health Insurance” for every American. The truth is, your President lied to you. According to the CBO, his health care law will leave 27 million of you UNINSURED after it’s full implementation. Worse yet, according to the CBO his health care law will place 16 to 17 million of you on a Government WELFARE program known as Medicaid. It is important to understand that Medicaid is nothing like private health insurance. Medicaid does not pay medical providers on time. And, when it does it pay – often many months later – it pays a small fraction of what private health insurance pays.
According to multiple studies completed by Johns Hopkins, the Journal of the National Cancer Institute, Columbia-Cornell, the University of Pennsylvania, the University of Pittsburgh and the American Academy of Cardiology.  Medicaid surgical patients have far worse health outcomes than those with private insurance. In fact, in the largest study of it’s kind (with nearly 1,000,000 participants) the University of Virginia found that Medicaid surgical patients are 97% more like to DIE than surgical patients with private health insurance.

According to the New England Journal of Medicine, Medicaid patients in bankrupt states like Illinois & California wait twice as long to see a doctor or specialist as those with private health insurance. And, often times they are denied the care they need. The Medicaid system in Illinois is looking more bleak every day. On January 30, 2012, the Civic Federation released its “Budget Roadmap” for the coming fiscal year. In it, they highlight the fact that state officials now believe that the Illinois Medicaid program will have between $21 and $23 billion in unpaid bills by 2017.
One of the worst parts of the PPACA (Obamacare) law is that if you qualify for Medicaid the law renders you ineligible to receive an APTC – Advance Premium Tax Credit – (subsidy) in order to purchase actual health insurance which would greatly increase your chances of actually receiving the care you need.

Because providers are not getting paid, many Doctors, Specialists and other medical providers will simply stop taking Medicaid altogether, as many in Illinois already have. And, they stopped long before the PPACA.

doctors who take no new patients

If you do not believe that many of you will be enrolled onto our bankrupt Medicaid system instead of private health insurance plans. You should know that this is already happening at Walmart.

Below is an excerpt from the November 2012  update from the Illinois HFS (Health & Family Services) department.

“It is estimated that Illinois has approximately 1.1 million people without health insurance. About 50% of them will be able to buy health insurance on the Health Insurance Exchange, and based on their income, individuals will qualify for tax subsidies to help pay for their health insurance. Illinois will have an Exchange, operating as a state-federal partnership the first year. If the legislature adopts authorizing legislation, it will become a state exchange; if not, the federal government will continue to operate it. Enrollment on the Exchange will open on October 1, 2013, with plans effective on January 1, 2014.

The other 50% of uninsured citizens will qualify for Medicaid, if the legislature adopts authorizing legislation. Today, there is a gap in Medicaid coverage: adults without dependent children, no matter how poor, are not eligible for Medicaid. Under the Affordable Care Act (ACA), the federal government is offering generous federal matching funds to the states to cover this newly eligible population: 100% reimbursement for the first three years then phased down to 90% by 2020.

Newly introduced legislation, House Bill 6253, will take advantage of the ACA to provide healthcare under Medicaid to about 342,000 low-income Illinois citizens who are currently uninsured (the remaining 168,000 citizens currently uninsured, are already eligible for Medicaid but have not enrolled yet). Read the rest of the Illinois  HFS update here.

When you look at the map below, understand that it was completed in 2011. Three years before 17 million more Americans will be enrolled in our bankrupt Medicaid rolls as a result of the “Patient Protection & Affordable Care Act”. Image
Their are intelligent alternatives to simply flooding our bankrupt Medicaid rolls with 17 million more Americans. In fact, these alternatives have already been proven successful in states like Florida, Indiana and Louisiana. Sadly, even with these proven reforms, Republican governors like Arizona’s Jan Brewer and Ohio’s John Kasich haven’t learned a thing from these successful reforms. Instead, they have chosen to double down on failure by expanding Medicaid to historic proportions. Worse yet, they want you to pay for their wrong headed decisions via higher taxes and more ‘cost shifting‘. Both of which will do nothing but continue increase the cost of health insurance for everyone else. What did President Obama say back in 2010? Oh, that’s right. “It’s estimated that your employers premiums will decrease by as much as 3,000%”. – Barack Obama.


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