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The Simplest Explanation of Obamacare…

I can’t really take credit for writing the bullet points below (they were sent to me in an email), but I thought this was the best and simplest explanation I’ve seen so far to describe Obamacare…

  • In order to insure the uninsured, we first have to un-insure the insured.
  • Next we require the newly un-insured to be re-insured.
  • To re-insure the newly un-insured, they are required to pay extra charges to be re- insured.
  • The extra charges are required so that the original insured, who became un-insured, and then re-insured, can pay enough extra so that the original un-insured can be insured for free.
  • There… Now you understand what is going on.

ObamacareThis is exactly what happened to my family. We were happily insured and then we received our cancellation letter from Blue Shield, which I affectionately refer to as “BS.” 😉 Before the Affordable Care Act (ACA) was implemented, our health insurance coverage for EIGHT family members was $975.60 per month, which I thought was a little pricey. BS told us that a “comparable” ACA plan was the “Bronze” plan, which was the cheapest ACA plan available. Our “new and improved” ACA health insurance rates more than doubled to $1,995.48 per month! Wait a minute, I thought President Obama promised to save the average American family $2,500 per year? (Please click here to see for yourself.)

Besides that, our co-payments and deductibles increased significantly from what they were before, but I am thankful to now have maternity coverage, even though I’m a 61 year old male! I’m also relieved to know that more than 16,000 new IRS agents have been hired to enforce Obamacare!

Although I’m laughing and joking about this on the outside, it’s really no laughing matter because the simple explanation mentioned above is true! Real people are being harmed by this reckless law, and millions more are being adversely affected by the ACA than those who are benefiting from it. For more details about our personal experience, please refer to my earlier blog, “Is the Affordable Care Act Really Affordable?”
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Sticker Shock and Skyrocketing Health Insurance Premiums Forecast in 2015 for ACA Plans

A story published by “The Hill” last week is forecasting skyrocketing health insurance premiums for the Affordable Care Act’s (ACA) new health insurance exchanges. The story cites insurance industry insiders who said they expect the price of monthly premiums to increase significantly. The outlook runs contrary to the comments of Health and Human Services Secretary Kathleen Sebelius who downplayed the likelihood of sticker shock next year while addressing members of Congress two weeks ago. The unnamed insiders mentioned in “The Hill” story said a combination of new ACA taxes and fees, rule changes, and delays in the enforcement of certain requirements will likely contribute to higher than expected rates for next year. According to the story, not everyone will experience sticker shock. Rates are likely to vary depending on the region of the country and the availability of doctors in the area. The rates for 2015 won’t be announced until fall. Please click here to view the article.

SkyRocketObamaCare

Hey Seniors… If You Like Your Medicare Advantage Plans, You Can Keep Them, Period…Maybe Not!

obama-if-i-like-your-plan-you-can-keep-itSound familiar? Part of the Affordable Care Act (ACA), also known as Obamacare, aims to reduce federal payments to the Medicare Advantage (MA) plans over time, and these savings would help pay for some parts of the ACA. In other words, Obamacare is slashing Medicare and MA benefits, which will adversely affect seniors in order to pay for other new programs created under the law that aren’t even for seniors!

According to Robert E. Moffit, Ph.D., “The money is cut from hospital services, Medicare Advantage, skilled nursing services, hospice services, and other Medicare services. To be clear, the cuts do not target individual institutions or medical organizations suspected of waste, fraud, or abuse.” Moffit goes on to say that “The $716 billion in “savings” from Medicare are taken out of the program to pay for new spending in Obamacare. The cuts do not strengthen the Medicare program, nor do they extend the life of the Part A trust fund.” Consequently, the $716 billion that is being cut from Medicare will not enhance Medicare Advantage benefits, and there is speculation that these drastic cuts will also adversely affect traditional Medicare and Medicare Supplements as well!

One way it’s expected to do this is by requiring Medicare Advantage plans to have a “medical loss ratio” of at least 85 percent. This means the companies offering the plans would have to spend at least 85 percent of the money they get on actual medical care. In other words, insurance companies can use no more than 15 percent for administrative costs and profits. As soon as these changes were announced with the ACA’s passage in 2010, there were fears and rumors that this was the beginning of the end for Medicare Advantage plans.

Medicare Advantage PlanThe Centers for Medicare and Medicaid Services (CMS) recently proposed a 1.9% cut in Medicare Advantage payments next year. If these cuts are implemented, many fear that millions of seniors who currently rely on the Medicare Advantage program will lose the plans, benefits, doctors, and financial protection they currently have. Seniors and people with disabilities who are enrolled in Medicare Advantage plans would face premium increases and benefit reductions of $35-$75 per month, or $420-$900 per year. According to Oliver Wyman of America’s Health Insurance Plans (AHIP), these types of cuts could result in a “high degree of disruption in the MA market,” including the “potential for plan exits, reductions in service areas, reduced benefits, provider network changes, and MA plan disenrollment.”

In all fairness to the supporters of the Medicare Advantage plan cuts, Medicare Advantage plans were paid on average more per beneficiary than what Medicare paid for beneficiaries enrolled in traditional Medicare plans. One of the goals of the ACA is to equalize the federal spending over time, so the government pays the same amount whether a beneficiary enrolls in Medicare Advantage or traditional Medicare. Cuts to Medicare Advantage plans are part of the $716 billion in Medicare spending reductions the health law calls for over the next decade.

As an independent insurance agent, I work primarily with Medicare Supplement (Medigap) insurance plans, which is health insurance for people who are 65 and over. The alternative to Medicare Supplements is Medicare Advantage (MA) plans. Personally, I’m not a big fan or advocate of MA plans because they are much more restrictive than “original” Medicare Supplements. By that I mean you are restricted to the doctors and hospitals in the plan’s network. With Medigap plans, you can go to any doctor or hospital in the country that accepts Medicare, and if you develop a serious illness, you have much greater freedom and options, and you are not limited or confined to a specific network of doctors or a geographic area.

Health Care Reform2Medicare Supplements do not include prescription drug coverage. For that, you would have to purchase a separate prescription drug plan (PDP) called “Part D.” (“Part A” is hospital insurance, “Part B” is medical insurance, and Medicare Advantage plans are referred to as “Part C.”) MA plans usually cost less than Medicare Supplements and many MA plans include prescription drug coverage. Some of the MA plans also provide additional benefits such as dental, vision, and wellness, which are not covered by Medicare. For these reasons, enrollment in Medicare Advantage plans rose in 2014 by 8.9 percent to 15.9 million enrollees, which is up from 14.6 million in 2013. Obviously, these plans are still very popular.

As mentioned before, I am not too excited about MA plans because of the network and geographic restriction. If money isn’t an issue, I would recommend a Medicare Supplement plan over an MA plan. However, for many retirees, MONEY IS AN ISSUE as many seniors live on fixed incomes, and every dollar counts.

Because of the cuts, reduction of benefits, and increased costs to seniors, there is no question that millions of seniors who rely on the Medicare Advantage program will lose the plans, benefits, doctors and financial protection they currently have. And just like the ACA, this could cause another major disruption in the health insurance market and a lot of confusion for seniors and their family, which they really don’t need at this stage of their life.

Unless the proposed cuts to Medicare and MA plans are significantly reduced or eliminated, I think there is a good chance that many seniors will not be able to keep their MA plan, even if they like it, PERIOD!

What do you think?

 

Is the Affordable Care Act (ACA) Really Affordable?

Dear Mr. Lewis,

“A few weeks ago we notified you about upcoming changes due to the Affordable Care Act (ACA) and explained that your current Blue Shield medical plan will end December 31, 2013…”

These were the words I was dreading to hear! When I received our cancellation letter, I was very upset to learn that it was being cancelled at the end of 2013 because it was not “compliant” with the “Affordable Care Act” (ACA). Blue Shield of CA offered us another plan in its place that was “comparable” in coverage, but it really was not. The deductibles, co-payments, and out of pocket expenses on the “new” plan are significantly higher than the “old” plan, and the overall quality is inferior.

Besides our family, over six million Americans received cancellation letters from their insurance companies because of the ACA, and they have had their health insurance plans cancelled despite our president’s repeated promises, over and over again, that…

President Obama Contemplating Obamacare.

The First Time Our President Contemplated Obamacare.

“If you like your doctor, you will be able to keep your doctor, period.” “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” and “I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family’s premium by up to $2,500 a year.” Blah, blah, blah…

Well, we had a health insurance plan with Blue Shield of California for many years. It was called the “Shield Savings 3500/7000 PPO” plan, and we were very happy with it, despite the fact that President Obama felt it was a “sub-standard” plan. Since we were repeatedly told that our premiums would be going down approximately $2,500 a year, I was trying to keep an open mind. However, that was not the case.

We were paying $975.60 per month for a family of 8, and that included dental and prescription drug coverage for all of us as well as relatively low co-payments and deductibles. I thought that our premium on the Shield Savings plan was a little steep, but when I found out what our new ACA premium was going to be, I almost fell over!

Despite the fact that “Dirty Harry” Reid accused me (and thousands of other Americans) of being a liar this past week because the information in this blog is allegedly “untrue,” our ACA premiums more than doubled! Because of the “Affordable Care Act,” the health insurance premiums for our family went from $975.60 per month to $1,995.48 per month!

"Dirty Harry" Reid

“Dirty Harry” Reid

And unlike our Shield Savings plan, the ACA health plan only included dental for three of our six kids and no one else! Our premium would be even higher if the other five people in our family selected dental insurance. On an annual basis, we were paying $11,707.20 per year for our Shield Savings plan ($975.60 x 12 = $11,707.20), but the annual premium for our new ACA health insurance plan is $23,945.76 per year ($1,995.48 x 12 = $23,945.76)! Is that supposed to be “affordable?” I think not!

By the way, our new $23,945.76 per year ACA plan that I’m referring to is a basic PPO “Bronze” level plan, which is the “cheapest” of the four ACA metallic plans. This is the “ACA-compliant plan” that Blue Shield recommended because they told us it was the most “comparable” to our Shield Savings plan. Here is the description of the basic PPO “Bronze” level plan that we received from Blue Shield of CA:

“With low premiums, a high deductible, and more out-of-pocket costs, our Basic plan is designed for people who want affordable coverage and protection in the event of a serious medical emergency. You’ll have the basics such as three doctor’s visits prior to meeting the deductible and preventive care services.”

Now I’m not sure about you, but I don’t consider $23,945.76 per year to be either a “low premium” or more “affordable!” And regarding the “three doctor’s visits” and the “preventative care,” it would be much more cost effective (cheaper) for me to keep the old plan and pay for these expenses myself.

Furthermore, our deductibles and out of pocket costs increased significantly under the ACA plan. On our Shield Savings plan, our calendar year medical deductible was $3,500 per insured or $7,000 per family. On the ACA plan, it is $4,500 per insured or $9,000 per family. Our calendar year out of pocket (OOP) maximum on the Shield Savings plan was $5,000 per insured and $10,000 per family. On the ACA plan, it is $6,350 per insured or $12,700 per family!

With office visits (primary care doctors and specialists) and urgent care visits, lab and X-rays on the Shield Savings plan, we paid NOTHING after meeting our deductible. On the ACA plan, we still have to pay 40% of these costs AFTER meeting our deductible! And the same is true with Outpatient surgery and Inpatient hospitalization!

With generic drugs and preferred brand drugs, we paid $10 per prescription for generic and $35 per prescription for brand name after meeting our deductible. On the ACA plan, we still have to pay 40% of these costs after the deductible! I won’t go on and on with these boring details, but I hope that you get the point that the new ACA Bronze plan is significantly more expensive than the Shield Savings plan that we had, and it’s even more expensive when you take the additional costs of co-payments and deductibles into consideration.

If a family should end up in a situation where they have to pay a $9,000 family medical deductible as well as $12,700 in out-of-pocket costs (in addition to their obscene (non-subsidized) ACA health insurance premiums), there is a good chance that they are still going to end up bankrupt! So what’s the point of having insurance??? “The only thing worse than going broke is going broke with insurance!”

I hope and pray that people will wake up and repeal Obamacare or defund it because it is bad legislation that is destroying the quality of our health care system as well as hurting our economy and killing jobs. Then again, if enough young and healthy people don’t sign up for it, I think there’s a good chance that it will implode on itself and self-destruct.

As Nancy Pelosi famously said “We have to pass the bill to find out what’s in it.” President Obama and his administration purposely and repeatedly misrepresented the truth about the ACA, and it was sold to the American people as a pack of lies. Now that we know “what’s in it,” the majority of Americans don’t want it!

Nancy Pelosi

Nancy Pelosi, a little mixed up, as usual.

I would be curious to hear of your ACA experiences, both good and bad.

Thanks!