The High Cost of Health Insurance: Talk v. Action

My background is research. Inquiring minds really do want to know, and with a few phone calls and quality time on the Internet, you can find out a lot.

In my work, I’ve run into three types of people:

  • Those who charge high prices for health insurance
  • Those who complain about the high prices for health insurance
  • Those who do something about it

Yes, really, the third category exists. Apart from the Marketplace, I know of at least two good ways to cut costs dramatically without skimping on coverage. These are solutions provided by established organizations, not something I’ve cooked up. However, most people don’t know about them.

Best of all, they don’t involve any political uncertainty. “Trump” is not part of the vocabulary for these solutions.

I’m not going to explain them here, because I might run afoul of regulators saying that I’m providing insurance advice in a state in which I haven’t paid for a license yet.  (I’m licensed in NJ, PA, MO and VA.) If I don’t handle your area, I will still tell you what the solutions are and provide a referral to someone who can help you.

So if you want more information, you’re going to have to call or email me.


This is my way of trying to be useful.

Vic Crain

Small Business Health Insurance: Missing the Point

The Centers for Medicare and Medicaid Services (CMS) issued a press release on 15 May, mark_twain_congress_quote-511892offering new ways for small businesses to enroll in health insurance in addition to the SHOP marketplace provided by the ACA. The release also took the opportunity to make some partisan jabs at the ACA and the low rate of participation by small businesses in SHOP.

As an agent certified in SHOP, the CMS press release shows a complete misunderstanding of the problem. Think of the choices businesses face:

  1. You can buy policies for your employees at full price through SHOP.
  2. You can reimburse employee costs for purchasing subsidized health insurance by using an HRA and or HSA  as revised in December.
  3. You can buy much lower  cost policies using a hybrid self-insured approach.

The first method provides no financial incentives — so why do it?

The new options offered by CMS provide no financial incentives — so why do them either?

However, for CMS now to say that the ACA has been ineffective in serving small business is unfounded. CMS doesn’t in fact know how many businesses have chose Option 2.

Of course, the virtue of Option 3 is that politicians have nothing to do with it.

The major barriers facing most business owners with options 2 or 3 is awareness — they don’t know these options have been available.  However, they are, and they could save a lot of money.

Only politicians could design a program with no value and then wonder why no one is using it.

Sources:  Centers for Medicare and Medicaid Services Offers New Health Coverage Enrollment Option for Small Business, Press release, 15 May 2017.   

Medicare: Rule Changes for SEPs

SEPs are “special enrollment periods” which allow people to enroll in Medicare supplement or Advantage policies outside of normal open enrollment periods.

SEPs are available for a variety of situations: relocations, loss of insurance through work, if an insurer drops a drug that you need from coverage, etc.

Example: Say you turn 65. You are automatically enrolled in Medicare Part A.  If you don’t enroll in Part B (doctors) or Part D (drug coverage) during that initial enrollment period, you will pay a higher premium for these parts when you go to enroll in the future.

If you have a job with health insurance that meets the Medicare standard when you turn 65, you still get Part A, but you can defer enrolling in Parts B and D. When you leave that job, you have a 60 day SEP to get that coverage without penalty.

On June 19th, CMS will impose new requirements for proving eligibility for an SEP. This may add up to two months for processing requests for new coverage. You may be paying out-of-pocket for any care that you need during that gap. Will Medicare reimburse you later? Probably, but you’ll need to front the money in any case.

There are exceptions to the SEP rules.  Nevada has changed the rules to permit year-round open enrollment for its residents. Congress gave Native Americans year-round enrollment privileges.

If the politicians you elect are so wonderful, why haven’t they done that for you? Perhaps you should ask.

If you need advice as to whether you are eligible for an SEP, call your agent. If you can’t find him, I’ll try to put you in touch with someone who can help you. There are a lot of rules and unless you want to become an expert on the law, this is not a time for DIY.