Category Archives: Uncategorized

Everyone’s Least Favorite Insurance Topic…

Can you guess what it is? In the past, I used to specialize in long-term care insurance (LTCi), and I’d joke that it was probably the second to the last favorite type of insurance that people wanted to think about or talk about next to Final Expense (burial) insurance. After all, who can get excited about spending money for a piece of paper that you hope you’ll never use?

Final Expense2

Most people don’t get emotional when they talk about automobile insurance, health insurance, or homeowners (fire) insurance, but when it comes to long-term care insurance or final expense insurance, that’s different. For many people, these are sensitive and uncomfortable subjects, which is understandable. However, the risk of a long-term care stay is significantly higher than the risk of an auto accident, a home fire, being hospitalized, etc. And I wonder what the risk of dying is? I’d venture to say that it’s probably around 100%!  😉 As my good (and cynical) friend likes to say, “There’s no getting out of here alive!”

Personally, I don’t get emotional when I think about insurance. I look at it strictly as a financial planning tool and nothing else. It is there to protect my loved ones and my assets, and I don’t want to get my money’s worth out of it! Although I’m sure that many of you reading this article cannot wait for me to delve into the topic of long-term care insurance, you’ll have to be patient and wait because I am going to focus on everyone’s least favorite insurance topic for now, which is Final Expense insurance!

What is Final Expense (Burial) Insurance?
Final expense plans are small, permanent whole-life insurance policies that are specifically designed to handle the last expenses a person’s family must handle for them including funeral costs, outstanding medical bills, and any other unexpected expenses or debt that may be left behind. Because they are whole-life and not term-life insurance policies, the premiums are locked in. Once you select the amount of coverage you want, the premiums are guaranteed to never increase for as long as you hold the policy, and the policy will never expire as long as you pay the premiums.

final-expense-101

In addition, some policies include a small cash value component where tax-deferred savings can be built up over time. These funds may be withdrawn or borrowed against if you decide to do so. However, any unpaid loans or withdrawals will reduce the policy’s death benefit.

Today, funeral expenses can easily cost more than $10,000. Although the cost of a funeral may surprise you, if you plan ahead, a final expense plan can help reduce the burden of these costs on your family and help them focus on what is most important during a difficult time. Having a final expense plan in place can be a very loving and considerate thing to do, and it will give you the peace of mind that comes from knowing that you have planned ahead to ease the burden on loved ones.

Peace of Mind Next Exit

Two Types of Final Expense Benefit Levels

Final expense plans usually have two types of benefit levels:

  • Graded Benefit – The application process for these kind of final expense plans is the simplest and easiest. No medical exam is required and there are no health questions to answer. These plans are a guaranteed issue! You cannot be turned down, REGARDLESS OF YOUR HEALTH, as long as you meet the age requirements. There is usually a 24-month waiting period before the full face amount of the policy is in force. If death occurs within the first two policy years for any reason other than an accident, all premiums plus 10% interest are usually paid to the beneficiary. After the initial two year period, the full benefit is paid for death due to all causes.
  • Level Benefit – The full face amount of the policy will be in-force the day the application is approved. The premiums for these policies are more competitive because health questions will be asked at the time of application. If someone wants a final expense plan, they should first apply for a level benefit final expense plan if they are in relatively good health. If they have health issues that might prevent them from getting accepted, they can always get a graded benefit plan.

Premiums Never Increase

Once you select the amount of coverage that you want, your premiums are guaranteed to never increase for as long as you hold the policy. The rates are based on your age at the time you signed the application, and they will never increase in the future.

Sample Rates For a Graded Benefit Final Expense Plan

Gerber Life Insurance Company, which is a financially separate affiliate of the Gerber Products Company, offers a graded benefit final expense plan. With their plan, if you are a US citizen or permanent legal resident between the ages of 50 and 80, you can choose from $5,000 to $25,000 in guaranteed life insurance. Plus, under current federal law, the death benefit is not subject to federal income tax when paid to a named beneficiary.

The following chart shows some sample monthly premiums for the Gerber Life graded benefit final expense plan:

Sample Monthly Final Expense Rates

As you can see, the monthly premium for a $10,000 final expense plan for a 60 year old male is $56.65. For a 60 year old female, the monthly premium is $46.48 per month. Again, these rates will never increase and the plan cannot be canceled for any reason as long as the premiums are paid.

Sample Rates For a Level Benefit Final Expense Plan

United of Omaha Life Insurance Company offers a level benefit final expense plan, and their application is a simple one that has 10 health questions. If you answer “No” to every question, you would be eligible for their level benefit product. With their plan, if you are between the ages of 45 and 85, you can choose from $2,000 to $40,000 in life insurance.

The monthly premium for a $10,000 level benefit final expense plan for a 60 year old male is $42.76. For a 60 year old female, the premium is $32.87 per month. Again, these rates will never increase and the plan cannot be canceled for any reason as long as the premiums are paid.

Which Final Expense Plan (Level Benefit or Graded Benefit) Has the Best Rates?

If you are in relatively good health and you don’t have any serious medical conditions, you should first apply for a level benefit final expense plan because the rates would be less than the rates for a graded benefit final expense plan. For example, the monthly premium for a United of Omaha Life Insurance Company $10,000 level benefit final expense plan for a 60 year old male and female is currently $42.76 and $32.87 per month, respectively, compared to $56.65 and $46.48 per month for the Gerber Life graded benefit final expense plan. As you can see, the level benefit rates are more competitively priced than the graded benefit rates.

Again, final expense is probably everyone’s least favorite insurance topic, but it is something that should be taken into consideration, without emotion, as a financial planning tool, and nothing more. Remember, it’s peace of mind.

For more information or to get a quote, please give me a call at (760) 525-5769.

Which is Better, Medicare Supplement Plan F or Plan G?

Today, there are 10 standardized Medicare Supplement plans (Plans A through N). The coverage for these plans is the same no matter which insurance company you have. For example, the coverage and benefits for Plan F is exactly the same at Aetna, Cigna, Blue Shield, Stonebridge, Blue Cross, etc., so it’s much easier to shop around and compare plans and prices today.

As you can see in the following chart, Plan F provides the most extensive Medicare Supplement coverage. (The plans with the empty boxes indicate coverage that is not included with that particular plan.)

Medicare Chart

Of the 10 standardized Medicare Supplement plans (aka “Medigap” plans), Plan F is considered to be the best plan because it provides the most comprehensive coverage. Plan F pays for all of the coinsurance, copayments, and deductibles not paid for by Medicare.

Plan F pays for the following benefits:

  • Medicare Part A Hospital Deductible (Currently $1,216 per benefit period) *
  • Medicare Part A Hospital Coinsurance
  • Medicare Part B Deductible (Currently $147 per year)
  • Medicare Part B Coinsurance
  • Medicare Part B Excess Charges
  • Hospice Care Coinsurance or Copayments
  • Skilled Nursing Facility Care Coinsurance
  • Charges for First Three Pints of Blood
  • Foreign Travel Emergencies

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. Therefore, there can be multiple Part A hospital deductibles in one calendar year.

Which is Better, Plan F or Plan G?

Which is Better, Plan F or Plan G?

Plan F and Plan G include the following benefits:

  • Freedom to choose any doctor or hospital that accepts Medicare patients.
  • Benefits start immediately with no waiting period for pre-existing conditions.
  • There are no networks and no referral needed.
  • No cancellation for age, health or the number of claims you file.
  • Covers 100% of all Medicare allowable excess charges.
  • Coverage that expands automatically with any future changes in Medicare.
  • Virtually eliminates all claims paperwork for you.
  • 30-day, no-risk free look guarantees your satisfaction or you get your money back.

Medicare Plan G Is Identical To Plan F Except For the Part B Deductible

Medicare Plan G provides the same identical coverage as Plan F except it does not cover the $147 Part B calendar year deductible (in bold above). That is the only difference between the two plans. They are exactly the same in every other way! Plan F and Plan G are the only two Medicare Supplement plans that pay 100% of any excess charges, so there would rarely be any unexpected out-of-pocket expenses. (Excess charges are additional expenses incurred outside of the Medicare-approved charge. For example, if you go to a doctor that charges more than the Medicare-approved amount.)

Why Would I Choose Medicare Plan G Over Plan F?

The decision to go with Plan G depends on whether the annual savings will exceed the $147 Part B deductible. For example, if your Plan G premiums are $30 per month less than the Plan F premiums, then you will save $360 per year in premiums ($30 x 12 = $360). If you are healthy, and you didn’t go to a doctor that year, you would have saved $360 on your premiums. If you had to pay the $147 Part B deductible, then you still would have saved $213 for the year in premiums ($360 – $147 = $213). On the other hand, if your annual premium savings would be just slightly more than, equal to, or less than $147 per year, then you are unquestionably better off with Plan F.

The Likelihood of Future Rate Increases is Less With Plan G Than With Plan F

Under federal law, Plan F falls under certain Guaranteed Issue (GI) requirements while Plan G doesn’t. For example, if someone has their health insurance with an employer plan or if they are on a Medicare Advantage plan and they loose their coverage, in most cases, they are guaranteed the right to switch to Plan F, regardless of their health and without medical underwriting.

Plan G is not a guaranteed issue plan. Consequently, the overall pool of people with Plan G are healthier than those on Plan F, and the quantity of submitted medical claims is lower with Plan G. Rate increases are often a result of too much GI business, so “F” plans have historically had greater and more frequent rate increases than “G” plans. That’s not a guarantee that “G” plans won’t have future rate increases, but if they do, the increases will more than likely be smaller.

Make the Switch!

Make the Switch!

The Only Potential Risk That I See With Plan G…

The only potential risk that I see for the future is that nobody knows for sure what the Part B deductible for Medicare will be in the future. Between 2011 and 2012, the Part B deductible actually went down from $162 per year to $140 per year. For the last few years, from 2013 through 2015, the Part B deductible has been stable and remained the same at $147 per year.

Here is the history of Medicare Part B deductibles:

  • 2017 — $183
  • 2016 — $166
  • 2015 — $147
  • 2014 — $147
  • 2013 — $147
  • 2012 — $140
  • 2011 — $162
  • 2010 — $155
  • 2009 — $135
  • 2008 — $135
  • 2007 — $131
  • 2006 — $124
  • 2005 — $110
  • 1991 through 2004 the Part B deductible was $100
  • 1982 through 1990 the Part B deductible was $75
  • 1973 through 1981 the Part B deductible was $60
  • 1966 through 1972 the Part B deductible was $50

As you can see, the historical Part B deductible rates have been relatively stable over the years. For me, it wouldn’t be an issue if I could otherwise save $200 to $300 per year by having a Plan G Medicare Supplement. On the other hand, many of my clients can afford to pay for the best and most comprehensive plan, Plan F, and they don’t want the uncertainty of not knowing for sure what the future will bring. Saving $200 to $300 per year isn’t always a big enough motivator for many to warrant switching from Plan F to Plan G. Then again, many retirees are on tight budgets and fixed incomes, and if that is the case, I would unquestionably recommend that they switch from Plan F to Plan G if they can save money on their premiums.

The California Birthday Rule

With the California Birthday Rule, you are guaranteed the right to switch plans every year within 30 days after your birthday, regardless of your health and without underwriting, if another company is offering the same plan or a lesser plan for less money. In other words, if you have Plan F, you can switch to Plan F with a different company if their rates are lower, or you could switch from Plan F to Plan G with a different company since Plan G is considered to have less benefits (the $147 Part B deductible) than Plan F. Rates vary significantly from one company to the next for the same identical plan and coverage, so it’s important to shop around every year.

Please let me know if you have any questions or comments!

If you or someone that you know would like a Medicare Supplement quote, please let me know, or click here to visit my website. Or, you can compare Medicare Supplement prices on your own by clicking the “Get A Quote” button below.

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Did You Know About These Free Medicare Preventive Services and Screenings?

I’m in the process of taking some Medicare certification courses, and I came across some important information that you (or a friend or family member) may not be aware of. Did you know that under your Medicare Part B benefits, you are entitled to certain preventive services and screenings, and there is no cost-sharing for most of these services?  Please take a few minutes and check these out. You may find some benefits that you didn’t realize you were entitled to!

Medicare icon
Preventive Services Include the Following:

  • One-time “Welcome to Medicare” physical exam
  • Annual wellness visit after 12 mos. enrolled in Part B
  • Immunizations – pneumococcal, hepatitis B, annual flu shot
  • Abdominal aortic aneurysm screening – one time, with referral
  • Alcohol misuse screening – every 12 months for certain individuals
  • Bone mass measurement – every 24 months for certain conditions
  • Cardiovascular screening blood tests – every five years for all persons
  • Colorectal cancer screening – four different tests, vary in frequency
  • Depression Screening – every 12 months
  • Diabetes screenings – up to two per year for those with risk factors
  • Diabetes self-management training – for persons with diabetes
  • Glaucoma testing – once per year for those at high risk
  • HIV Screening
  • Intensive Behavioral Therapy for Cardiovascular Disease – one face-to-face visit annually in a primary care setting
  • Mammogram (Breast Cancer Screening) – annual screening for most women
  • Medical nutrition therapy – for those with diabetes/kidney disease or kidney transplant
  • Obesity Screening and counseling – for certain individuals
  • Pap test and pelvic examination – every 24 mos. for all women; every 12 mos. for those at high risk
  • Prostate cancer screening – every 12 mos. for men over age 50
  • Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral
  • Counseling to Prevent STIs – for certain individuals
  • Smoking cessation counseling – for any illness related to tobacco use

Other Part B Items and Services:

  • Ambulance services
  • Ambulatory surgical center fees
  • Blood
  • Cardiac rehabilitation–for certain situations
  • Chiropractic services–for limited situations
  • Clinical research studies – some costs of certain care in approved studies
  • Defibrillator (implantable automatic)
  • Diabetic supplies
  • Durable medical equipment – restricted to certain suppliers in some areas
  • Emergency room services
  • Eyeglasses after cataract surgery – limits apply
  • Foot exams and treatment for certain diabetics
  • Hearing and balance exams (no hearing aids)
  • Home health services in certain situations
  • Kidney dialysis and disease education – certain situations
  • Mental health care (outpatient) – limits apply
  • Occupational and physical therapy – limits apply
  • Pulmonary rehabilitation for COPD
  • Prosthetic/Orthotic items
  • Second surgical opinions
  • Speech-language pathology services
  • Telehealth services in some rural areas
  • Tests like X-rays, MRIs, CT scans
  • Transplant physician services and drugs

The Following Items Are Not Covered by Medicare Part A & B:

  • Acupuncture
  • Dental care/dentures
  • Cosmetic surgery
  • Custodial care
  • Health care while traveling outside the US – exceptions apply
  • Hearing aids
  • Orthopedic shoes
  • Outpatient prescription drugs (covered under Part D)
  • Routine foot care
  • Routine eye care and eyeglasses
  • Some screening tests and labs
  • Vaccines, except as previously listed (those not covered under Part B are covered under Part D)
  • Syringes and insulin unless used with an insulin pump (covered under Part D)

IMPORTANT WARNING REGARDING YOUR MEDICARE COVERAGE!

If you are on Medicare and you need to be admitted to a hospital, DO NOT let the hospital admit you with the words “UNDER OBSERVATION.” Insist on being admitted as “IN-PATIENT.” Otherwise, there is a good chance that you will be responsible for most or all of the hospital expenses, and you will be prevented from accessing nursing home care, rehabilitative care, etc. Click here to watch a recent NBC news television broadcast regarding this problem.

I Specialize in Medicare Supplement Insurance!

For an INSTANT Medicare Supplement insurance quote in California or Washington state, or for more information about long-term care (LTC) insurance, linked-benefit plans, critical care, etc., please call or visit my website.

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!