Something Very Bad Is Coming to the Individual Health Market

And it is a very big deal

People are waking up to letters from their health insurers, which tell only the insurer’s part of the story. The word is out – at least 1.4 million, and perhaps as many as 2.5 million people will lose the health plan they currently have. If these people do not actively choose a new plan, the government will pick a new plan for them with another company and sign them up for it, without asking for their permission. If you are in this situation, you may not be able to change the government’s choice for an entire year, no matter how bad the plan is.

These “default” or “automatic” plans may have several problems:

No one has reviewed the plan to see if your doctor is covered.
No one has looked to see if the hospital in your county even takes this new plan.
No one has looked to see whether the prescriptions you currently take are even covered, and if they are, at what price.
Many of these plans are assigning you a “gate keeper” primary care doctor, automatically and without your input. If you are unlucky enough to be forced into one of these plans, you will not know who your doctor is until after you have coverage. You will have to use this “gate keeper” doctor to refer you to any other doctor you need to see for this to be covered, even if the specialist / doctor is in-network. It may be impossible to get this changed to your current doctor; merely getting a doctor you can live with, may take more than 60 or 90 days!
Many of these plans will have fewer doctors in-network – not 10% or 20% fewer doctors, but as many as 90% fewer doctors. They are also covering fewer labs and prescriptions.
Many of these new plans do not even cover prescriptions or doctors until after the customer pays a $6,000 deductible first.

All of these things are BAD, but these are not the worst thing the insurance companies are doing.

Insurance Companies are getting rid of the Health Insurance Teachers

When you purchase auto insurance, homeowner’s insurance, flood insurance, or frankly, any kind of insurance except health insurance, you (or your employer) have the assistance of knowledgeable agents to help you choose the right plans and coverage and to help you with claims and paperwork problems. In other words, insurance agents work to protect you – and the insurance companies, realizing they make more money off of you if you choose the wrong plans, don’t get the coverage you need, and are discouraged from going to the doctor or getting prescriptions you need because of the up-front costs, have decimated the available agent population by sharply reducing or, in many cases, completely eliminating their income.

In this way, the insurance companies can take advantage of you by discouraging these knowledgeable people from helping you choose the right plan and helping you deal with the insurers when there are problems. The insurance companies get to keep more of your premium dollars and reduce what they have to pay you in claims.

Here is a list of some things agents help with:

Review any options you may have from your employer.
Describe the Obamacare plans available in your area (they vary by county)
Help decipher what your cost would be through ACA plans. If ACA questions are answered wrong, you may owe thousands to the IRS at the end of the year.
Help you look up doctors, hospitals and prescriptions to see what’s covered and help you choose the best option for you.
Educate you about plans offered off the Marketplace (not on Healthcare.gov).
Help you enroll in a plan.
Help service the plan.
Help you fight with the insurance carriers about your bill, out of network area claims, and “-ologist” billing problems plus hospital, labs and doctors’ claims.
We talk to the insurance company and Healthcare.gov on your behalf.

Individuals who get help from a trained agent are more likely to keep their doctor, pay less out of pocket, understand their coverage better, keep their coverage longer, and have fewer problems with the IRS. You keep more of your money, instead of paying it to the insurance company, if you are educated and helped by an agent. Employers who receive informed assistance are more likely to get the best plan for their employees and their purchasing dollars, and have better benefit packages and happier employees.

Vanishing Plans

Companies offering individual health insurance in Georgia are leaving our state, or are scaling back what they are offering.

United Healthcare and Coventry will not be offering any ACA individual health plan in Georgia.
Aetna is reducing the number of plans they offer, AND you will have to enroll on a paper application form to discourage people from buying it. These plans will NOT be available on the Marketplace.
Humana will drop the best plans (POS) it has been offering during the past few years, and will only be offering HMO plans in 9 Georgia counties. Humana has also said it will not pay any agents to help people enroll or to service these plans.
Blue Cross is changing many of their Marketplace Plans to reduce its risk – it is cutting Rx and doctor’s visit co-pays, and increasing deductibles and MOOP. It too has stopped paying agents to help customers on some plans and reduced payments on others by 40% or more – which was already as much as 80% less than a few years before that.

The typical government’s responses keep coming? “Disruption is Normal.”

Benjamin Wakana, a spokesman for the Department of Health and Human Services, oversees Marketplace ACA policies, said by e-mail on Oct. 5:
“It’s all part of the normal business cycle for insurers to discontinue, change, and replace plans from year to year. Such changes don’t prevent people from obtaining coverage. People can shop for new coverage through a transparent market.”

Fewer and Fewer Choices

During 2017, in many Georgia counties there will be only one insurer to choose from on the ACA exchange. Places with more options, like Chatham County, will actually find this makes things even worse.

You will lose access to out of state medical care

No one in Georgia, North Carolina or South Carolina will be able to buy a plan on The ACA’s Healthcare.gov website and seek normal covered care outside the state they live in. For example, if you live in Hardeville, SC and work in Savannah, GA. (except for life or limb-threatening emergencies) you will not be covered to see any doctors in Georgia. Over 50%, and up to perhaps 80%, of the people covered by Humana, Coventry and United Healthcare today will lose access on Jan. 1, to the doctors that they currently see.

How Do You Avoid Falling Into This Trap?

Your Choices

For 2017, it is too late to call and complain to the government. You can:

Do it yourself: Good luck here and more power to you. For some people, like the ones who never have claims, this works well.
Use a navigator: This is a person that is trained to help you enroll only in Marketplace plans. Navigators are not trained or allowed to help you choose the best medical plan; they can only help you buy the plan you pick from the choices offered on the Marketplace, which is not necessarily the one that fits your medical problems. The plans offered privately, outside the Marketplace, are generally the plans which will let you keep your doctor and cross state lines for covered care.
Hire an Agent: Few agents specialize in helping individuals like you purchase health insurance, because it is very time-consuming and very expensive for the agent. The agents who can help you reduce what you pay to the insurance company and for medical costs in exchange for a small fee must have a special license and training in this field, and they are few and far between. If you are in this situation, and need insurance (even if just to avoid paying the Obamacare penalty), we have this license, and we can help.
Get on a group insurance plan: This might be one of the best options still left, and in North and South Carolina this might be the only option left which lets you keep your doctor in 2017. In Georgia, employers can buy a group health insurance plan with as few as two employees. This does not mean agents will be jumping at the chance to help you here either. With the new ACA rules and all of the never-ending government rules and compliance that an employer must do to sponsor a plan, very small groups again will need to hire that special agent that is trained and licensed to be able to help you. Because the time required to sell and service these very small accounts is proportionately much greater than larger, more profitable groups, many of these agents are also beginning to charge service fees in addition to the insurance premiums.

My name is Bill Lucas, and I own Bill Lucas Insurance. I have been in the health insurance field for over 30 years. I have helped thousands of people get health insurance. I have always worked with small and large employers – and with the Affordable Care Act, I saw a greater need to help people understand how it works from the employer and the employees’ perspectives. I built an organization “to help all people with ACA questions.” This information was available, but it was housed in many different places and is extremely complicated. I have always loved what I do. I educate the public on how health insurance works.

This is me, and for as long as I can, it will still be me.

We will still help anyone, even though the government and the insurance companies would rather we did not.
We will still write small groups with as few as two employees even though the insurance companies would rather we did not.
We will still educate employers, hospitals, doctor’s offices, and individuals. We have acquired all of the licenses, E&O coverage, and legal advice necessary to keep helping people and employers with health insurance questions.
We have designed a fee schedule so you can have help with health insurance despite the insurance companies’ efforts to discourage agents from helping.
Employers can hire us to educate, enroll, and assist their employees (or dependents) who are buying health insurance on their own (Example: Healthcare.gov)
Employers can hire us to install a small group health plan on as few as two employees.
Organizations can hire us to educate any number or groups of people on what is happening and what they can or can’t do about it.
Individuals can hire us to help them choose the best health insurance plan for them, based on their personal situation, to help them keep more of their money instead of paying it to the insurance companies, the doctors, the pharmacies, or the IRS.