Differences among Obamacare and Trumpcare (House and Senate Versions)

As of Monday, June 26, Senate Leadership is continuing to tweak their Healthcare Bill to make it more palatable to their membership.  A new provision in the bill would encourage people to maintain continuous coverage by imposing a six-month waiting period before new insurance goes into effect for anyone with a break in coverage that lasted 63 days or more in the prior year.

There is a lot of confusion and varying explanations of how healthcare insurance will change over the next few months and years.  Here are some of the ways the three plans handle health care coverage:

Medicaid

One of the biggest changes in both the House and Senate Bills are in the area of Medicaid.  Under Obamacare, the states share the cost of insuring the poor with the federal government.  The federal government gives states different amounts based on the medical care that the state’s Medicaid patients receive. While 20 states opted out of Medicaid expansion, the federal government is picking up most of the costs of expanding Medicaid to the thirty states that have opted to expand Medicaid programs.

The House Bill would offer a fixed per capita amount to each state. This amount would increase based on inflation until 2020, when the increases would be eliminated.

The Senate Bill also replaces Medicaid with a block grant; however, the annual increase, based on inflation, and would be lower than the House Bill (meaning deeper cuts).  Instead of the expansion being eliminated in 2020, it would be phased out beginning in 2020 and eliminated by 2024.

Insurance Costs

Both the House and Senate plans would probably see lower insurance premiums after 2020; however, those plans will most likely cover less and have higher deductibles.

Under the Affordable Care Act (Obamacare) people making less than $48,000 a year received subsidies to help them buy insurance.  The subsidies reduce monthly insurance bills. They are tied to income and the cost of insurance within specific areas of the country.

The House Bill also provides for subsidies, which would phase out when incomes reach $75,000 a year.  The subsidies would be tied to a person’s age, not income.

The Senate Bill links aid to income, but stops at 350% of the poverty level, compared with 400% under Obamacare.  The subsidies would be based on less comprehensive health plans, which would mean substantially less assistance than under the current law.

Mandate

The Affordable Care Act levies a tax penalty on people deciding not to purchase health insurance.

Neither the Senate nor the House Bill keeps the mandate. However, under the House Bill anyone who does not have health insurance for more than 2 months would see a 30% premium surcharge on any plan they purchase.

As noted above, while the Senate version originally had no penalties for people who do not maintain coverage, a revision may address this issue.

It is not a “Done Deal”

While the Senate is set to vote on the Bill on Wednesday, there are still Senators who are on the fence about whether or not to vote for it.

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We Living In Changing Times – Insurance in 2017

There was a time that whenever you had an illness or an accident which you or your parents could not handle themselves, you called the family doctor.  You either went in to see him, or if you were too ill, he came to see you.  And you saw him daily if you were in the hospital on his rounds.  On rare occasions you saw a “specialist” at a big hospital downtown or went to Mayo Brothers or some other far-away place for a special consultation.

If you had insurance, you paid your deductible and 20% of whatever the rest of the bills were.  You went to any doctor who would see you.  They all took whatever insurance company you had and the insurance company paid the same 80% balance no matter whom you saw.

In 2017 we have HMO’s PPO’s, HSA’S, private and public exchanges, on and off the marketplace, tax credits and cost-sharing.

We have carriers which insurance only groups, carriers who insure only individuals under 65, but not group, and carriers who have policies off but not on the marketplace.  They have different levels of coverage, different out-of-pocket costs, pre-tax payment allowances, and the biggest of all, LISTS OF PROVIDERS YOU MUST SEE IN ORDER TO BE COVERED.

Wouldn’t you like some help to figure out which one of the many plans available are right for you?  This past year most of the carriers no longer included the teaching hospitals in downtown Chicago for the individual plans.  Hospital systems they own in the suburbs are no longer in-network either.  Some cover a very small system, and others, even though they may be in the covered network, do not have the practitioners you want.

Wouldn’t you like to have some qualified help in navigating your way through this process?   We have over 40 years of personal experience in helping people choose the right coverage.  Let us help you as well.

 

 

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Going Shopping? Take your agent

We have less than a week until the Affordable Care Act or Obamacare marketplaces are open for business.

The State has hired “navigators” to take personal information from you and submit it to a system which will then

kick out different plans and rates for which you may apply.  It will also tell you what, if any, tax credits or subsidies
you may receive.

Navigators ARE NOT allowed to advise you on which carriers or which plans are best suited to your own individual needs.

WE ARE!! We can advise you on tax credits and subsidies on individual plans, describe the benefit
differences among Platinum, Gold, Silver,and Bronze plans, and which networks are best suited to you depending on your health and where you live.

Navigators at last check were given less than five days training.  We have 36 years in the insurance business.  Let us help you.

And if you already have a qualified agent, call him or her for help.  It may save you a LOT of heartache.Day 3/365 - Ride in the Shopping Cart.. (Explored)

Take an agent along.  Get some personalized service.  That’s what we do!

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You’re 65. Why are you losing your Group Insurance?

MedicareThe new insurance available to you is changing on 1/1/2014. Policies are now being rated exclusively by age; not gender. IBM just yesterday announced that it would be eliminating coverage for employees over 65, and giving them a stipend to buy individual insurance.

The reason for this is that what may have cost $400.00 for a 65 year old male per month in the state of Illinois may now cost over $1,000.00 per month. Purchasing Medicare part B coverage from the Government and a Medicare Supplement on the open market will cost half as much or better than it will cost your employer to keep you on the group. Contact me to look into Medicare coverage. You’ll be pleasantly surprised.

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Once Upon a Time

When we were going to spend the night in the hospital for something we knew about in advance, we had to call the insurance company and “Pre-Certify” the stay. And in an emergency, we had to notify them within 28-48 hours after admittance, depending on the carrier.

When we knew we needed certain kinds of medicine like Claritan,
Monistat, or Prilosec, we had to go to the doctor, and pay him to write out the prescription, and then take it to the pharmacy to have it filled.

As time went on, most of these drugs were available over-the-counter without a prescription, and the provider called the insurance
company on our behalf.

Guess what! Blue Cross has re-instituted the “call-it-in-yourself”
rule. You will be penalized up to $500.00 for non-compliance with their “reinstated” rules. In addition, if you have an HSA or health
savings account, you must get a doctors’ prescription to buy OTC
drugs and withdraw their cost from the HSA. Oh, and the penalty
for violating HSA contribution and deduction rules beginning this year will result in a 20% penalty instead of the prior 10%

Call me old fashioned, but I’d rather have the good old days.

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I’ll be over here when you need me.

I was encouraged by the conversation between journalist Fareed Zakaria and Jamie Diamond, head of J.P. Morgan this morning on GPS.

Jamie said that although there are fewer big banks today, those which are left have lent more to corporations and mid-size business this year than previously. He said a lot of business has cash and doesn’t need it. The effort now should be to get them to spend it,
albeit wisely and get people back to work. He praised governments all over the world for having implemented programs which stopped the damage from getting even worse.

I realize this has not yet come to the consumer level. But what is wrong with having to have at least 20% down for a morgtage, and a stable credit history? Lenders cannot lend to those who have no stake in the home for which they are trying to purchase.

The country and people individually should begin to make more practical decisions again about when to buy, sell, retire, or go into business for themselves. When this happens, they will also want advisors in technology, purchasing, capital and financial investments who know what they are talking about. They will also want that in their insurance advisor. Whether discussing business overhead policies, replacement cost on property or COBRA and state continuation of benefits. They will want the quality they themselves are trying to deliver to their own clients.

When you want an experienced, qualified, thoughtful and thorough insurance advisor, let me know. I’ll be over here when you need me.

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Order in the Court!

Last week federal judge Roger Vinson ruled PPACA unconstitutional in a response to a lawsuit by 26 states and the National Federation of Independent Businesses. The ruling specifically declared the individual mandate provisions in the new law unconstitutional, but Judge Vinson deemed the entire health care reform law unconstitutional, stating that it was too complicated to sever any part of it.

At the same time the houses of Congress are mopving to repeal the
1099 provision to report any expenses to one entity of more than $600.00. In additionthere are movements to modify benefits or repeal exchanges, LTC portions of the bill, the individual mandate, and whether or not to take away the business tax credit if the employers’ insurance plan covers abortion.

Most if not all of these items will end up as part of a decision of the
Supreme Court. In fact, 28 governors have already asked President Obama to ask the Court to expedite it’s decision on the Affordable Health Care Act. Meanwhile, as each date passes for implementation of another portion of the Act, we do.

If you want some help in sorting this out, let me know. That’s what I do.

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THE GREAT DIVIDE

I was doing pretty much the same things everybody else was last
December. Working, shopping, getting ready for the holidays.
On December 16th things changed. I had a routine mammogram,
which by the way, is a very good thing to do. After that my world
seemed to be occupied by oncologists, surgeons, and radiologists.
I was lucky enough to have no chemotherapy and very little radiation.

But the day before I thought I was insurable. Now I am not for the
forseeable future. No long-term-care, disability income, life or health applications. If I have no re-occurance I may be able to purchase
at least some of those policies in 5 or 10 years.

Thorton Wilder asked in the play “Our Town”, “Does anyone ever realize life every every minute?” No, it’s humanly impossible.
But some moments must be recognized and seized upon, because
they may never ever come aground again.

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The Game’s Afoot

There are so many provisions in the Health Care Reform Act (PPACA),
people are thoroughly confused about how, what, when, and why.
Besides the normal conversation on health care and reform itself,
I thought you all might benefit from knowing something which will affect you as business owners. Beginning in 2012, if the bill stands
as is, EVERY VENDOR from whom you purchase at least $600.00 during the year for goods or services, will require you to SEND THEM A 1099! This means your accountant, your office supplies, your IT
consultant, gas station, car dealer….; the list is endless.

Last week, the senate reconsidered this portion of the bill. After failing in a move to repeal that part of the bill, and additional attempt by Republican Nebraska Senator Mike Johanns failed to raise the threshhold from $600.00 to $5,000.00. The vote failed 52 to 46 to
bring it to the floor for a final vote.

I don’t know about you, but it boggles my mind what kind of paperwork and expense this will generate. The possibilities are endless. Whatever happened to streamlining the IRS? Stay tuned
for the next chapter in the never-ending story.

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Buyer Beware

According to Modern Healthcare, there has been a rise in fraudelent “medical discount plans”, typically targeting the uninsured with the promise of “cut-rate” coverage. In the article, three companies; The Consumer Benefits Association, United States Benefits, and Health Care One have been charged with deceptively marketing medical discount plans. “They took enrollment fees, “and then did not allow customers to disenroll”.

In another article The Oklahoman reports that Oklahoma “Insurance Department officials are warning of a health insurance scam similar to one a year ago that left more than 100 people without coverage and buried in medical bills.” In June, “an emergency cease and desist order was filed…barring as many as 40 individuals and companies from doing business in the state. Named in the order are plans marketed by the Association of Independent Managers, including AIM Health plans.” Oklahoma Insurance Commissioner Kim Holland estimates that “as many as 200 Oklahomans bought the bogus plans.”

The point is this, and always has been. Find a qualified health insurance advisor to prevent you from ending up with a plan you do not want, and paying an amount you may not be able to afford for coverage which doesn’t turn out to be what you thought it was.

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