Reform

Lots of new things on the horizon for years to come, as we seem to be close to the amended health reform bill which is getting ready for an Obama signature.

The public option is dead, but it sounds like insurance carriers will not be able to medically underwrite sick folks, or imposed pre-existing condition language. The fear is how we pay for this? We need to have both healthy low utilizers in the new system along with the 5-8% of the population which drives 95% of the high claims. Without healthy offsetting sick, not sure that premiums will not radically rise.

We also need ala carte care, for example, if we have already had our children, why should we need maternity care in our policy? Also, if I prefer pharmacy, hospital, doc visits, but not speech therapy, occupational or physical therapy and no mental health benefit, shouldn't I be able to also carve that out? These are more individual health care questions, but perhaps in a group environment we will see this choice too.

Our system is so, so broken -

Where is Reform?

At healthinsurancegeeks.com, we spend lots of our time educating small companies about health insurance, how it works, why it is "broken" right now, and taking apart the myth that we hear on all of the news channels that follow our mislead government. Speaking from an apolitical stance, both sides have it completely wrong and are not talking about the problem. Here is the problem, we have no CONSUMERISM in healthcare. Anyone working over the last 20 years that got used to the 2, 5, 10, 15 copays will understand this.... if i have a visit that costs 20,000 or 1,000 and I pay 2, or 10 bucks for it, what do I care? If EVERYONE had a small deductible to meet before anything was reimbursed, and copayments evaporated in to thin air, and we had the choice of huge networks of physicians, but the monthly premium dropped dramatically, wouldn't that work? That is the deal from how we see it, if we went "back to the future" before copays came on to the scene, and had deductibles and coinsurance for EVERYTHING, we would fix this broken system overnight. This way, we all pay our fair share. Maximum out of pockets expenses would be capped so none of us go bankrupt, and perhaps the government could backstop some of the reinsurance for insurance companies? The problem with the politicical debate is none of them are talking about this solution, because it is so simple it will make them all look quite foolish.

They are at a stalemate, the insurance companies know this will work (that is where we the founders of healthinsurancegeeks.com started our careers, at one of the largest, fastest growing insurance companies in the world in the early 1990s) but do not want to give up their greedy profit schemes....and the politicians "probably" know this will work, but remember they are politicians not insurance experts! Lobbyists step in and now all of a sudden, they need to throw their weight. Sorry to go on a diatribe, but as an expert in this field, someone who has accessed care, and a married father of 4, I understand this as a regular American. We switched our own EPO plan to a high deductible health plan, effective January 1, 2010, as the premium absolutely sank, to 1/3 of what I was paying, we have taken on a big deductible, but get to use network doctors who via their contract with our new carrier, must accept the payments/contracted rates when we visit. That means our copays go "bye-bye" but when we take our kids to the pediatrician, rather than paying 100-125 for a sick visit, we pay 50-60 per the negotiated pricing. Not bad considering my premium sank, I am able to open an HSA if I so choose, and my doctor visits are really only going up from 30-60 per say, as our old plan had a $30 copay.

This is not magic, it is just plain old consumerism at it's best.

Bill Clinton on CNBC

Whether conservative, liberal, super left or super right, it was interesting to watch former President Bill Clinton this morning on CNBC. He articulated perfectly what is wrong with the healthcare system in the U.S. and it has NOTHING to do with not having a public option, or whether we pay17% or more of our GDP on healthcare spending....it is all about outcomes. He referenced Columbia where they spend 6% of GDP on healthcare and have a much higher outcomes rating than the U.S. The problem is on governance of the healthcare process, especially on physicians and hospitals, which can happen between government, insurance carriers and providers. A public plan is such a radical (far left) change to the current system, that most agree we do not need to be so radical, though we do need a big change. This can be done pushing providers, and insurance carriers, to be regulated and incented based on outcomes. The better a patient gets, and more efficiently, means better compensation to the provider and institution (read up on the Cleveland Clinic, and Mayo Clinic). Providers and institutions that do not have good outcomes, will go out of business - just like in the REAL world....poor business models fail and go bankrupt. Same should be true for healthcare.

Obamacare

Is Obamacare officially dead? As an internet insurance entrepreneur, I have mutliple news channels on all day every day, and they all say the same thing - what about Medical Malpractice tort and the costs of defensive medicine and unnecessary testing...these numbers are not small, they are as high as 30% of the healthcare spend! I will say one thing whether I support one side of the isle or the other "politically" I do not want uneducated (on healthcare anyway) politicians driving our healthcare system in an unhealthy direction in order to win their seats the next go-around, or to get happy lobbying/self-interest support. It is very scary to think one of my 4 kids could be denied care, as the Obamacare and House-supported model right now, does not focus on the core problem - our system does not have consumerism now...if I pay a 25$ copay for a service that is $400, or $400,000, what do I care as a consumer? Believe me, my employer cares. If I have a sick child or loved one, I do not want the government looking at statistics telling me what we can and cannot do. I am also fine with paying my fair share as we all should be in the U.S. Why does everyone come to these terrific institutions we have in the U.S. for their healthcare? Because it is the best.....we all do need to pay our fair share though, that is another problem...the healthly are not offsetting all of the sick in todays' system.

Why doesn't the government just backstop large claims and the chronically ill folks in the nation (5% of the population drives 49% of the spending) for the private insurance industry, and as a take back enforce stronger regulation, and profit restrictions? All medical records being electronic like the Mayo Clinic and Cleveland Clinics do respectively (arguably 2 of the best institutions in the world!)?

We need to get politicians out of the debate and start fixing the real problem here....let's have bipartisan, outside entities with expertise in this area assist reform, instead of politicians elbowing for votes please!

Healthcare Reform and some valid Statistics

Medicare passed in 1966, and at that point in time the private sector (the insurance we as Americas have state in 2009 that we like over 85% of the time - employer-sponsored or buy it ourselves, or if we own small businesses etc...) funded over 75% of total healthcare expenditures. Following that percentage began to pull back and fell to 63% by 1967. Since that time the private sector has continued to fund less of the national health expenditures.

As of 2007 that number was down to 53%. Why? Again, we reference the "health care wedge" which is the separation of the consumer and provider as there began to be more and more government intervention through this time period. What is amazing, if we compare this phenomenon to auto insurance, or other types of insurance (life etc..) which by definition is a tool to manage risk, and in exchange for premium payments, provides protection against large but uncertain risks. We have completely flopsided the way health care is purchased, and for what services. There is a great article now by Laffer & Moore that I am referencing (The Prognosis for National Health Insurance) and in it they compare auto insurance paying for oil changes, brakes, you name it. Even a layman can quickly state "wow, wouldn't that cost way more?" Answer is simple and yes.

As the government has already intervened, driven this wedge up, and taken control of the payment and funding methodology almost half of the time as of 2007, the spike in health care spending is actually more because of the existing system that has pulled away from the private sector funding versus the government. As an expert in this field, I quickly jump to, "well, go back to the 60's before the government destroyed the system with it's now bankrupt Medicare program, and completely reformed by whom and how Medicare is run and funded. Government already seems to be the obvious problem here."

Back to my example above, again referencing Laffer & Moore, now the private sector funds just above 50% of health care expenditures, with only slighltly more than $1 out of ever $10 coming out of the consumer's pocket (no consumerism here either). Where was that number in 1960? It was about 47%, or $4.70 out of every $10. So today, and back to the automotive example, if we overlayed (apply?) this to the auto industry, pricing would be fixed whether you crash all the time or not, or whether you are 21 years of age or 50, and the "reckless" would be funding the "safe."

This does not appear to be a fair system, and does not promote any type of "thinking" before we research or spend. If I can go to a $400 dollar a visit cardiologist 5 times a month just to check in, and it does not cost me very much (but is killing the overall system), why wouldn't I?

I can go on and on, but my point is straight-forward and simple. The private industry NEEDS to control more of health care funding and expenditures, and we as Americans also need good tools to use to research, examine, and compare doctor's and hospitals to see their outcomes, infection rates, readmission rates, etc. If I choose a doctor that my mother says is incredible - "we all go to her" - but that doctor readmits patients to the hospital for the same services over and over because their health immediately deteriorates after they are released, does it seem like a problem? Yes, maybe I would like more information on this physician and her practice patterns? It is a proven fact that most American's spend more time researching the purchase of their new SUV than they do gathering information before having a hip replacement. Amazing isn't it? We need more of this valuable information to help American's see that what most politicians say on TV is self-motivated by lobbying interests and perhaps not always with an eye on the common good of us as tax-payers. I can beat up on both Republicans and Democrats on this very point, for they are the government. Private insurers, if regulated differently, and if their cost structures change to bring down the enormous profits they make at the expense of consumers in this country solves two problems. First, it would make affordability radically increase and coverage availability soar. Second, it would place the profit mechanism for businesses that want to sell health insurance under much greater scrutiny and management.

Enough for now...please provide comments.

Obamacare?

It was been a while since I blogged on this subject, but the Obama plan seems to have lost most of it's muster and it's steam. Most economists, and folks from both sides of the isle seems to think we will see insurance reform, but perhaps this turns more in to insurance carriers being reformed in the private market. Seems to us that if pre-existing condition exclusions are removed, and guaranteed issue coverage takes a national state (like they have in NY, NJ, CT, MD for example) that would certainly be a piece of the pie. But there will invariably need to be business tax credits for folks that offer group coverage to their employees, and tax penalties if folks do not, which would in turn offset the internal cost structure to insurance carriers in order to be able to have bigger pools of people (both healthy and sick) to bring down premiums. What seems to have sunk the Obama plan is the fact that an already bankrupt Medicare and Medicaid government run program, if given the opportunity to bring in a government plan for all (the Public Option) would then force hospitals and private physicians to take drastically lower reimbursements, hence forcing them to drive up their charges to the privately-insured - this in turn would radically push private insurance higher, and also force providers to increase the already staggering 29% of Medicare covered senior (and then now also non-seniors with a public option) to run in to access issues - this 29% has been referenced many times in all forms of media, as the percentage of people covered under Medicare that can't get treatment because physicians prefer to not treat for such low reimbursements when they can see privately-covered patients and more reasonable reimbursements.... I have not even starting talking about Medical Malpractice tort etc...another huge piece of the pie.

That brings us to the place we are today, we need everyone in a room together, insurance companies, doctors, hospitals, and legislators, working out a better private system to continue to give Americans access to the best healthcare in the world. We have lots of work to do -

Best priced NYC area health plans 2009

It almost seems an oxymoron to say "best priced" with where premiums for health insurance plans have risen in the last 5 years. Having said that, if small businesses are looking for the lowest premium on the market, Health Net and Emblem Health have the best community rated products right now. Empire BCBS has introduced some new EPO plans as well that are also quite competitive. If employers are looking for high-deductible health plans to couple with HSA or HRAs, Emblem Health has plans are that below 200/person.

Oxford Health Plans and Aetna are priced similarly to each other, as such, their products and prices are the next tier up. Cigna now has also introduced an EPO plan that is also quite competitive.

For folks over the river in to New Jersey, Horizon BCBS has the best price/product mix right now, followed by Health Net and others including Oxford and Aetna as well.

For free quotes, visit www.healthinsurancegeeks.com, for New York companies there is a real time quote engine, for NJ, folks must submit a census document to get a quote right back as the carriers rate based on census.

The New Landscape of Health Insurance: Reform?

It has been a few weeks, and we have seen lots and lots of new ideas, perhaps rhetoric about the new system that will be employed in the U.S. for health insurance. The Obama Administration continues to be front and center with its ideas, and they circle around many of their original plans. The government wants desperately to offer a public option to both the uninsured population, which hovers over 40 million Americans, and anyone else in the market, whether with or without coverge. Obama continues to tell employers and employees covered by group plans that they can keep their plan if they so chose, but would like to increase competition through the public option. Many defenders of private insurance point to the ineffective Medicaid and Medicare plans currently in force in the U.S. These plans just like private insurance have not kept costs in line, and get steady push-back especially from private physicians and hospitals.

Regardless of political opinion, many things about reform are front and center - controlling treatable illnesses and conditions such as obesity, smoking, a Asthma, with wellness and prevention. These conditions alone account for plenty of the spending in the current system, and are coupled with the fact that electronic medical records are not the norm in 2009. As such many tests are duplicated along with multiple visits and procedures that could be eliminated if records were more coordinated. Approximately 30% of the spending in the U.S. is attributed to this waste alone.

The private insurers are going to need to budge if the wish to remain in business and many point to the medical underwriting around pre-existing conditions. Private insurers urge a mandate for every American to be required to have coverage similar to car insurance, in order to bring more healthy Americans in to the system to offset the claims that would be incurred by sick members. In general that is the problem, private insurers can have more "lax" underwriting and in fact offer more affordable coverage if these massive insurance pools have a better mix of healthy and sick members. Perhaps that is where we will find ourselves after all, with a private system augmented with Congress enacting stronger legislation around mandates for coverage, some for of government subsidy for coverage (for certain income levels etc...) and perhaps a revamped Medicare system to pick up some of the costs for the very low income population currently uninsured. Regardless one thing must be done, all Americans should be required to have health insurance, though our reformed system must offer a suite of affordable products, and places through which one can secure it.

One thing is for sure as mentioned recently on Good Morning America by Michelle Obama, and that is the debate is strong, and reform will be no easy task. Years of out-of-date legislation that governs the current private system, and Medicare/Medicaid as well, needs to be brought up to speed with 2009. After all, we have not had any major reform for years and years.

Healthcare Reform

New Law will help inform consumers about health insurance
Many consumers have health insurance plans and don’t even understand what half of the policy even means. Health insurance consumers are often challenged when trying to understand their coverage options. Trying to obtain information in order to make an informed decision is hard when a consumer doesn’t understand any of the terms of the policy.
A survey released early this year reports that coverage is beyond comprehension for most consumers. Approximately 75% of consumers don’t understand their coverage or how it works. Because of this, Sen. Jay Rockefeller of West Virginia and U.S. Representative Rosa DeLauro of Connecticut have introduced the informed Consumer Choices in Health Care Act of 2009. This act requires the development of information resources and consistent standards for insurance definitions. Many insurance policies have the same key terms but may mean something different to each carrier or plan. The development of information resources will coverage facts labels that will provide data to consumers and providers on everything needed to know and understand a policy.
This law will help to create an office within the Department of Health and Human Services called the Office of Health Insurance Oversight. This office will collect key data about health insurance as well as improve the transparency of private health insurance carriers.
Due to the amount of money consumers spend each year on health insurance coverage, the least they should receive in return is the resources needed to make an informed decision about the future of their health.
For more resources to make an informed decision about your healthcare, go to http://affordablehealth-insurance.org.

Healthcare Reform

Now that the "swine" flu outbreak is behind us, all attention is pointed towards Healthcare Reform. Most notable experts in the field of Democrat-Republican negotiations say the "single-payer" or "public plan option" is just a negotiating tool the Democrats are using to get the Republicans and as a result the BIG Insurance Companies to lax their underwriting regs to in essence open up their plans to all folks regardless of medical history.

From our standpoint that is what needs to happen. In the U.S. we have no free lunches, but we do need folks with medical conditions to be able to get the same types of plans that the profit machines (the healthy folks) are handed from insurance companies. If giant pools are created with both the sick and the healthy, accuaries are destined to figure out a model where insurance companies can continue to run healthy companies while offering everyone affordable options.

The private system in the U.S. is what makes us both unique and the best in the world, but we need to move towards affordability. If I have Diabetes, Asthma, and am overweight, I need affordable coverage too.

Outbreak of Swine Flu?

Interesting to see all of the media outlets going bananas about the possible pandemic of "Swine Flu." Seems approximately 40,000 folks in the U.S. every year die from regular influenza, so perhaps all of the panic over the Swine Flu is overkill, or perhaps not?

Well, it is our job to always be helpful about things relating to health plans etc....so folks, check your current health plan website and see if they offer vouchers for Zicam and/or Purell, as these are both things that every newspaper in the Northeast anyway, refer to as good Flu busters. Also wash your hands LOTS and more than once at each visit to a sink (you would be suprised how many germs remain after 1 good washing). Avoid sick people, and if you feel sick, you should not pass along your germs to folks at your workplace, so maybe you should stay home.

These are some helpful things that have been passed along to us, hopefully they are helpful to all of our customers at www.healthinsurancegeeks.com

One last thing, this will devastate the Mexican vacation spots as most folks on TV say to NOT travel to Mexico unless it is absolutely necessary. Maybe wearing a surgical mask in the airport will become commonplace.

The end of Private Health Insurance?

Take a look at this recent Wall Street Journal Article and learn more about the facts faced in Congress regarding the debate on the future of government run and financed (through our tax dollars) health care. It is a very compelling article that those of us who appreciate having choice, should really read.

http://online.wsj.com/article_email/SB123958544583612437-lMyQjAxMDI5MzI5MDUyODA1Wj.html

What will happen with the new Administration's "Healthcare Reform" plans? Will we get Obamacare? Will the government take over healthcare just like banking? Regardless of which side of the isle you are on politically (I will take a middle stance here) a single-payer, or Government run plan would be a disaster for America, Obama, and generations to come unfortunately.

In listening to arguements from both Democrats and Republicans it seems with folks a bit more on the middle of the spectrum rather than "strong" one side, agree that we need a private system in some way, shape or form.

We do not want a system in the US where waiting lists for hip replacement surgery are 8-9 months....it is that way in many socialized systems. Also the level of care we have been spoiled with in the US, is because the best and brightest physicians and research scientists flee other areas to practice in the US.

Do we want sub-par, but affordable care? That may be the only resolve with a Government program.

NY's Emblem Health

Many folks do not know who Emblem Health is or where they came from, as they appear to be new on the scene. Well, that is not so, Emblem Health is the new holding company for the merged GHI and HIP plans. Connecticare in CT is also a member company of the new holding company.

Emblem actually has about 92,000 physicians in it's network, and includes a contract with the acclaimed cancer care center, Memorial Sloan Kettering.

In addition to great network statistics, and one with years of stability, Emblem Health has some of the lower premium numbers in the market in 2009. The plans with the "richest" plan designs and lowest premiums are their EPO plans (Exclusive Provider Organization) - you must navigate and stay within the network, as such out-of-network claims are not covered. The good news is you only pay copayments (the $40 EPO is the most well-priced option) for care, however they do have options with deductibles and coinsurance for major medical inpatient and outpatient care - some with $1,000 and others with $2,000. Also on the pharmacy front, they have these plans with 0 copay for generic drugs, $30 for brand name, and $50 for non-formulary medicines.

Also a bonus with Emblem is they boast to have 0 copay for children dependents of employees - so folks like me with 4 small kids would love them, all of the pediatric visits would be free!

I hope this information has given a good update on Emblem Health.

NJ and NY Small Companies - Insurance Solutions

Maybe it is finally time for consumer-directed health plans...as a married, father of 4 myself, we are now moving ourselves in to a high deductible health plan - most carriers have products available whether HRA or HSA, BUT it is important to look closely at prices...for example Aetna loves the products, has had its own employees in them for many years now, and publishes annual trend in the middle single digits and in some cases close to zero. Other carriers like Empire Blue Cross, Horizon Blue Cross, Cigna, Health Net and Oxford have not caught on with pricing, YET. I do feel there will be a race to the products with the recent economic meltdown. We must all remember that insurance carriers INVEST your premium, and we all know what happened to investments over the last 4-6 quarters!

Anyway, get savvy, and research CVS's generic drug program as well Target's and Walmart's....lots of my family's day-to-day healthcare needs are things like non-sedating antihistamines, generic thyroid meds, etc...so if we move to a high-deductible plan with say a 5,000 deductible for our family annually (even meds go towards deductible) but save 40-50% in premium for our family, and save 1/2 to 2/3 of the 5k deductible each month in an investment vehicle like a health savings account, we could save all the way around. In addition we can have this HSA tied to a debit card and bank of our choice, and at the point-of-sale we are just transferring pre-tax medical savings amounts.

I urge everyone, especially in an area like metro-NYC, to take the time and speak to specialists about these plans. Obama can only do so much with all of the "hands in the healthcare pot", as such, single payer healthcare is a LONG WAY OFF. Insurance carriers on the other hand are going to be given ultimatums to find ways to make health plans affordable. They have smart actuaries, they can do it....

For folks looking for a new health plan, the first stop should be to check and see which carriers have your docs...it is quite easy, and we provide tools where you can search right on our website (which links to the carrier doc searches directly)...www.empireblue.com for Empire Blue Cross Blue SHield, click visitor, then find a doctor....www.oxhp.com for Oxford Health Plans, lower left corner, click "search for a doctor or hospital" easy to follow from there. www.Aetna.com, top left search for doctor, pharmacy, lab or dentist, easy to follow....www.healthnet.com, upper right corner, click on "find a doctor or hospital" easy to follow from there. www.cigna.com, center of page "Find a doctor"....as in New York State, and New Jersey State whether you purchase a small group health insurance plan from a broker or directly from the carrier you pay the SAME PRICE BY LAW! So everyone in fact uses a broker as a broker can show everything from every carrier in one place. www.healthinsurancegeeks.com has streamlined that entire process all online, so it is easy to submit a request, and get back prices and plans in a matter of minutes. The above carriers are most of the leading carriers in the NY metro-market...www.horizon-bcbsnj.com is the site for NJ's version of Blue Cross, find a doctor is right in the middle of the landing page!

Small NJ Companies take heed...if you are a small company in NJ, with at least 2 employees, you may currently be purchasing individual health insurance, which from a cost and benefit perspective is more limiting than a small group plan.

If you have at least 2 employees (including LLCs with 2 partners, you count!) you should visit a comparison shopping site like www.healthinsurancegeeks.com. With just a census document of age, gender, zip code and family status for each employees, they can quickly load you in to their quote engine and produce hundreds of alternative plan designs from leading carriers like Blue Cross Blue Shield, Aetna, Cigna, Oxford/United Healthcare, Amerihealth and Health Net for example. Sites like the geeks have licensed experts (that are not pushy/salesy, yet knowledgable and helpful) that will compare everything and take the time to help you understand what you may need, and how to effectively put it in to place.

Small Companies with Big Insurance Problems

Small companies make up the economy in the US plain and simple. Unfortunately they are not the ones that killed the golden goose (Wall Street earnings, and the money supply chain) the giant multi-national companies are the ones who hve, though the little guys are going to be left with lots of pain. The pain I am talking about is, how as an employer I pay my employees, and keep them as employees by giving them competitive health insurance and other valued plans.

The key to survival in my opinion is understanding the 3 buckets of most benefit plans: inpatient/outpatient medical services, office visits, and pharmacy benefits. Maybe soon insurance carriers will cease to have pharmacy cards? Walmart, Costco, Target, CVS, and even Walgreens are now offering their own pharmacy plans. With market consolidation, there will be more...as such, I believe I will be buying a "catastrophic" major medical plan (for hospital services, surgeries, catastrophic illness) and perhaps limited medical or "office visit" driven copay plans for the few visits a year to the doc, and then as far as medicine is concerned, I will see consumerism at its best, and be left to compare the "copay" to get my prescription at Costco, versus Walmart. As both an expert in this field, and a consumer, it sounds good to me.

So think about it, we bring the cost of health insurance down, as we unbundle services, and leave the consumer to be able to buy these 3 buckets independently at reasonable prices, without being deemed "uninsurable" as a result of being asthmatic for example.

My thoughts for the day.

Wow, lots to talk about with small group health insurance these days....I spend lots of my time helping people who think they are trapped in a world where all they can buy is individual health insurance which is almost always medically underwritten - so to reiterate if you are some one with diabetes, high blood pressure, asthmatic, you are left out .... you will get declined - games these carriers play, you are the ones that need help!

Anyway, lots of folks are small business owners and in just about every state in the country, if you have 2 eligible employees including yourself, or 2 partners of an LLC or owners of a C corp for example, I can help! We can put a small group plan in place that is guaranteed issue, so if you have medical issues you can still get coverage. www.healthinsurancegeeks.com is the place to go to submit your information, we normally get back to you in minutes or can call and have an expert walk you through how we can help!

Small Companies with BIG Health Insurance Problems

Here is one of my brain dumps - President Obama is on the Health Care Reform trail just as the Clinton's were in the early 1990s. Will he succeed? Is the recent COBRA subsidy a start at deteriorating the employer-sponsored health system for both small and big companies? As a veteran of health insurance, health insurance brokerage, and various distribution channels for the sale of group-sponsored health insurance, I have MANY opinions - some may be spot on, others could be far off.

Small employers are faced with continued increases in health insurance premiums. It is now time to get savvy, and to take a look at consumer-directed plans (HRA's and H.S.As) as they will undoubtedly play a role in the future as consumers will be faced with gaining more education with the end cost of health insurance. Drug companies faced with pressure to compete in the generic market, and the exhorbitant cost structure of name brand drugs, and the ugly rebate structure most "layman" know nothing about!! Why does my health plan have certain drugs in cateorgy 2 name brand versus category 3, the higher tier and price...?? REBATES! They are not doing it for their health, your health, but the drug company's profit health!

Let me switch gears to the horrible tail of individual health insurance....they skim, simply put. They underwrite and insure folks who are completely healthy, rate up the folks who have "common and simple" health issues, and decline anyone with "some" chronic health issues, such as diabetes, obesity (according to them), asthmatic, depressed, have thyroid issues...the list includes almost EVERYTHING. Where do these folks get coverage? They should visit www.healthinsurancegeeks.com and find out....they focus ALL of their effort on finding ways to help the small employer (sole proprietor, 2 member LLCs, small companies) find ways to get good coverage at the best price AND figure out if you really should be buying small group coverage (guaranteed issue) rather than constant declinations in the individual market. Let them help.

Back to consumer direct plans...some say it is just passing the first few thousand of costs to the consumer (for example, Aetna has a Managed Choice Open Access Point-of-Service plan with a $3,000 deductible but then pays 100%)...though that is true it is only part of the deal. When you buy a high deductible plan, though you are responsible for and basically self-insuring those first few thousand of charges, you still benefit from the negotiated rate physicians must accept from insurance carriers when they are in the network. So let's look at an example like the one above, but use Oxford Health Plans as another example:

You have a $3,000 deductible, but then the plan pays 100%. If you are like me and have a wife and 4 small kids, that means the family deductible is usually 2 times or $6,000. Okay so every person in my family, or 6 of us has a $3,000 deductible per year, but any 2 of us that hits that FILLS the family $6,000 bucket, so the other 4 people in the family would have 100% coverage and no deductible to meet. That is a big deal especially if you are saving 40% in premium for example, and can now pre-save the family $6,000 deductible in monthly installments, a la the H.S.A.

I spend lots of my time educating consumers, as that is the only way we will learn and save in the U.S. as the government and carriers will not solve all of our problems. We need to better understand our alternatives, be better consumers, and not sign premium checks assuming what we are buying is the best thing for us. You need to engage with a trusting advisor (like healthinsurancegeeks.com) who will hold your hand through the difficult process of analyzing all of the alternatives.