HealthInsuranceGeeks.com

Empire BCBS To Abandon NYC Small Business Market?

2011-12-30T13:40:00.000-08:00

What a crummy organization....BCBS plans should be broken apart in the U.S. plain and simple, or be forced to occupy less than 45% marketshare in any particular market....that would get some healthy competition.

They have long been regarded as subpar in the New York City Market (i.e. Empire BCBS) as most consumers would rather go to an NYC DMV, or Rykers Island than to be forced to call customer service at Empire. They are just awful....

So though it is not surprising, or unwarranted, Empire BCBS announced a few weeks back that they would terminate almost their entire book of small businesses and give those companies an option to buy one of 3 remaining and crummy products (that have never sold to begin with) or go about searching for another insurance company. This has created a move/buying frenzy with Aetna and Oxford frankly, and brokers have been moving large blocks of Empire BCBS business in droves. Again, Empire, so funny, they are just clueless, but then again, they are a Blue Cross organization, so what should I expect.

Well guess what, in a city with 11 million folks we are now down to only TWO (2) reputable health insurance companies - Oxford Health Plans (a United Health Group company) and Aetna. Emblem Health, the old "Atlantis" company, and HIP are options, but have never been considered real competitors to these two.

So, in another market where we have lots of customers for example, Charlotte, NC, we have at least 7 solid health plans - United Healthcare, Cigna, Aetna, Coventry Wellpath, Humana, and the local monopoly BCBS of NC...so, within a 50 mile radius of Charlotte we have like 1.25 million folks or something close to that, a medically underwritten market (unlike NYC's socialized community-rated market...which is double the price and imploding as evidenced by Empire's pull out) and 7 good options? Compare that to NYC and 11 million and you scratch your head? Well yes, you do, b/c Obamacare has been based on a socialized system because he is a socialist to begin with and we already have TONS of evidence that a socialized system will never work in the US so why base a dumb law (Obamacare again) on socialism?

If we do not change fast in the U.S. Obama is going to turn us in to a third world country.....we are in real trouble with healthcare, but generally speaking, we are on the hottest burner on the stove in just about every category because of this absurd administration....

Obamacare?

2011-12-30T13:29:00.001-08:00

So where is Obamacare? Where are the efficiencies? How has he and his terrible administration set the U.S. for a better, more affordable system? Answer is simple....HE HAS NOT, and HE WILL NOT.

The only savior in the U.S. is consumerism and our company now has hundreds of small and middle market clients that have instituted consumer-directed health plans (CDHP)with enormous savings and cost-stability year in year out for the last 5 years while at the same time traditional plans have imploded.

Obama doesn't want to give credit to the savior because he did not come up with it. As a matter of fact consumer-directed plans have been around for a long time, but there was not an economic event that forced the adoption of the plans. Now rolling in to 2012 which undoubtedly will be another poor economic year (and even worse if Obama stays in office) we will be faced with the same challenges as before. Whether Independent, Democrat, or Republican, from the standpoint of health insurance I pray nightly we get a Republican President who understands consumerism and will listen to all parties. Our government in the U.S. can't even run DMV, or Medicare (remember that IS health insurance and our precious government has bankrupted it already!!) so why in the world do I want them touching the coverage I hold in high regard for myself, my wife, and 4 growing children.

Our clients have been seeing on average a 3% increase in costs on CDHP plans compared to 25% for traditional plans (in some cases closer to 40%)....proof is in the pudding, give me CONSUMERISM!

A New President

2011-11-11T16:13:00.000-08:00

It is time, plain and simple. Obama must go, he has not performed and in the world in which I operate if I do not perform, I get fired. So should he.

We need a leader who happens to be President, not a President who has no leadership skills (sorry Obama, that is you).

Obamacare, terrible, must go....Economy, terrible, must be stimulated...Bernanke, come on you are smart, but this whole economy and the puppet government is starting to make me worry that Atlas Shrugged, the movie, is coming true. As a producer who generates revenue and jobs, this economy in the U.S. and the government trying to "do" everything has proven one thing...the government can't do much of anything profitable or right. Fire them too.

Obamacare seems to be NObamacare

2011-08-13T09:13:00.000-07:00

Well I remember seeing the bumper stickers when he was running for office (from folks that did not care for Mr. Obama) that said Nobama....seems now that is NObamacare.

Seems in appellate courts the unconstitutional argument is gaining ground, and we have a full blow Depression #2 coming in the U.S. if not the world (just check out the stock market gyrations over the week of Aug8-12 2011)...

So I think (just my opinion) that reform will happen, but not super-sized like Obama guaranteed, but super-small sized as I suspected from the get-to. In my company we have seen a MASSIVE migration to high-deductible health plans and health reimbursement arrangements/health savings accounts. Insurance carriers hate them because they actually work and drive down premium costs, over-billing, double charging and unnecessary utilization...it is the fix in this country and with NObamacare, it will end up being the only solution from which we can draw.

I blog about this all the time, and it seems to be coming true almost on accident - again economy, stock market, clueless leadership on Capitol Hill and White House.

Let's see what happens. Check on your company's plans with out Geeks at www.healthinsurancegeeks.com.

Where is Health Reform?

2011-08-02T13:25:00.001-07:00

I don't know, ask Obama and his cronies...we will have the US government's debt downgraded shortly, we can't keep up with the debt load, and somehow I am to believe that the government could do something creative with healthcare. GIVE ME A BREAK PEOPLE!!!!!!!! COMEDY! COMEDY!

I seriously would love to sit across from Obama, I would laugh out loud. We should fire half of the folks that work on the Capital, downgrade their health insurance offerings, allow insurance companies to sell cross state borders so we have tons of competition, and oh yeah I forgot, privatize Medicaid and Medicare. The government 100% should not be involved in these things period. They can't run anything profitably because most folks in government have never run a company that employs workers and actually has to break even or show a profit to keep the doors open....welcome to my world people.

Regulate health insurance companies a bit more and have them run the show for ALL OF THIS within parameters that the government can "set up."...then stay the hell out of our insurance please.

I am done now.

The Types of Companies that Appreciate What we do at HealthInsuranceGeeks

2011-07-11T09:37:00.000-07:00

We have had a tremendous first few years of growth at Health Insurance Geeks. It has been augmented with the political climate in Washington, the economic collapse of 2008, and what seems to be the "new" thing to do at growing companies - make money, save money and become MUCH MORE FISCALLY RESPONSIBLE!

These are all great things for us, as we have been beating a specific drum for many years and it seems as though companies just started listening to our beat when savings and efficiences became priority number 1.

I hope this is just the beginning of the new landscape for how we purchase health insurance in the United States, how health insurance carriers are governed, as well as the limited involvement in the actual management and rationing of healthcare by the government.

We have seen a dramatic uptick in the amount of corporate customers (specifically companies with 75 employees give or take a few) who are listening with wide open ears now to our language - CONSUMERISM. Employees and employers are now learning more about the true cost of healthcare, and purchasing plans from carriers that are both sigfinicantly less premium, while offering the exact same level of coverage for the big ticket catastrophic items we all insurance against to begin with in the U.S.

So long as we focus on "what is my copay" we are on a health insurance escalator that will not go down....as we move away from copay-based plans, we will happily begin lowering costs, be on a downward escalator, and will see all of the constituents in the supply chain - doctors, hospitals, labs, ambulator centers/imaging centers, rehabilitation centers, etc... - begin to be incented for quality, and no longer quantity. It will also mean less of all of those constituents as the unprofitable will die. I guess that is how things should be in the real world.

Health Insurance Geeks & Technology Companies

2011-06-10T12:41:00.000-07:00

So we started our company and new we wanted to be different. Somehow my co-founder and I started our careers during the HMO invasion in New York City and worked for a company that was at the forefront led by someone still called a visionary. That company was Oxford Health Plans. Good or bad it taught us how to be innovative, create a vision, and to always go waaaaaaaaaaaaay above and beyond. It was just the way at that company during the time we worked there.

That said, we also knew we would build our own version of something in the bloated, stodgy world of health insurance, and frankly, we never felt the health insurance companies ever did anything efficient. Having spent the greater part of 10 years building great efficient models within large commercial banks, we learned also that banks too were pretty bloated, though they were at the same time looking for quick scores. They could not bear to wait a few years to see progress....so that brings us to Health Insurance Geeks and how we started and what our mission was to become....be different, think big, never lose focus of who got you here THE CUSTOMER, and always take the methodical patient approach of completely changing a paradigm. We did this with a small dedicated staff, and also found that the very companies that too were breaking ground in technology, love us too....the great market of digital technology, internet advertising, mobile technology....basically anything utilizing all of the great laptop/mobile creations of the last 10 years and how to drive new companies towards it.... we have a stable of technology companies as our customers and boy are we lucky that is what happened. It has spawned a frenetic growth spree, and just when you think you do not want to raise money and take your model to the rest of the United States, you find investors knocking on YOUR doors....not how it was in the beginning when we needed capital, but my co-founder and I decided to reach in to our own pockets, use our money...talk about skin in the game. We got scalped, thank God! Teaches you how to run a lean and mean company but beat the competition, and to always look for a better, more efficient way.

So it is perfect that bloated insurance companies are getting tee'd up by the current administration with talks of reform and more reform....btw, we will never have a complete reformation, but rather bits and pieces over time that will erode the current way of doing business. Think insurance companies always put the customer first....how about this tidbit, many NY and NJ area health insurance companies are pulling their low-priced high-deductible plans, because they ARE WORKING and driving down premium, and creating consumer directed models, but are screwing up their PROFITABILITY....these clowns....

So anyone reading this can probably smell the passion right through the computer, I live, breath, read, listen to anything consumer-directed because it is the way we are saving and delivering for our technology and non-technology companies alike....any time of business that likes to break through and think out of the box, owes a chat, call, email, something to www.healthinsurancegeeks.com....we lead our prospects and customers right to the fountain of premium "youth".....

High-Deductible Health Insurance Plans

2011-04-20T06:58:00.000-07:00

Our tribe here at Health Insurance Geeks has been growing exponentially, and it has been rewarding, as we have been pounding our drum to a different beat for years now.

I read often of dips and events that create new industries or explosive growth for outliers, and it appears we have been the benefactor of just that....we waited patiently and kept our mission, and now it is paying off big time.

Some of our clients who are stuck in the old way of thinking or are not ready for the proactive work necessary to move to a consumer-directed health insurance model with a high-deductible health plan, but I can say this...ALL of our clients have had it front and center by us, and they are simply the best solution to our quagmire here in the U.S. with respect to affordability of health insurance for the skyrocketing prices of healthcare services.

The lobbyists in Washington would never open the backroom doors they do all of their negotiations in, but lets be honest, the whole problem is profit and greed. As an entrepreneur who used his life savings to build something he believed in, and made it a success on a model where our earnings are substantially less (less premium means less income for us) I can say it can be done. We as consulting brokers have also been scalped many times over the last 17 yrs as far as how and what we earn. It is funny that pharma advertising has not become illegal like it once was? Health Insurance carriers have not been forced to operate as nonprofit, nor have all of the hospitals? Have Mercy, if that happened, the CEOs would not be able to afford their helicopter leases and the 30,000 sq foot mansions in the Hamptons.

Hey I am a capitalist like the next guy, but first and foremost someone who loves his clients, and loves what he does...as long as I can put my 4 kids through college and take care of my family and continue to love what I do, I can't ever see profit and greed taking control of my motives. Unfortunately, I have been involved in venture capital transactions and spent lots of time around senior executives in banks and insurance companies, and my LORD, I never heard the word customer...it was always EBITDA, or something relevant to how we continue to make more and more money, and the customer seemed left out....

That is why Health Insurance Geeks (www.healthinsurancegeeks.com) has done so well, always, always, keep the folks who made us, our customers, FIRST.

Consumer-directed Plans

2011-04-11T15:05:00.001-07:00

Well it is interesting to me as an expert in the field of company-sponsored benefits, specifically group health insurance, that most carriers are selling against the solution to the quandary in the U.S. - consumer-directed health plans.

As somoeone who understands underwriting as well as anyone, I guess this is simple, health insurance carriers do not possibly want to offer something for 25-50% less premium (consumer-directed plans with HRA or HSA and high-deductibles) as they will STILL get stuck with high claims....remember folks, 5-105 of a company's employees drive 80-90% of claims volume. That means a few employees and/or their dependents can blow up an employer's health plan even if they have say 100 employees.

So simply the insurance carriers, whether charging 400/single employee for a copay plan, or 175/employee with a high-deductible plan, they will still be on the book for a portion of a huge claims (remember these clever guys reinsurance claims over a specific level, say 25k, 50k, or 75k and build that additional stop loss premium in to a group composite rate...)....so maybe Obama and his henchmen need to negotiate better with the Republican Congress and figure out a way to back stop, stoploss for carriers in exchange for them lowering their rate base and passing the real problem in the U.S. (chronically ill patients either not managing illnesses well - think Obesity, Asthma, Heart and Diabetes all in one cluster, or someone who just has huge claims and is catastrophically ill - cancer et al).

The real problem is not healthcare in the U.S., but how to better manage the 5-10% of the population who is consuming enormous amounts of costly healthcare in an inefficient system....if the government truly wants to help, folks who are chronically ill should be mandated to quality based medicine, and the providers in those systems should be compensated MORE, yes MORE, to manage better.

That folks in a nutshell is the solution, but we have these idiots in Washington arguing about things that are not the solution....universal care, single payor, government or no government...none of it matters, evidence-based medicine does....less hospitals, though BETTER hospitals and the same for physicians....more physician assistants, nurse practitioners, and places like Walmart walk in clinics and CVS minute clinics for the routine cold - GTEAT solutions.

We the people demand a solution, not the eggheads in the government.

Consumer-directed Plans and Self-funding

2011-03-29T10:14:00.000-07:00

Ooh, I like this topic as I believe in them both as long as the liabilities are fenced appropriately with specific stop-loss (think of that as a CAP on a specific employee or family's claims) and aggregate stop-loss (CAP on your entire company's spend)....and doing this with a health reimbursement arrangement owned by the company or employer. This is Shangri La for a guy like me but here is the catch, it requires experts like us guiding, coaching and analyzing for our clients as this is pretty complex stuff that requires expertize. And if done correctly can really be a better way than just giving health insurance carriers the premium dollars to make the margin (PROFIT) they want on your case. I liken this to a fully insured company of say 400 employees that DOES NOT self-fund but wants the power of a health reimbursement arrangement (it is the tool that can pay deductibles for employees and be written off as a business expense as well)...well here is the catch, the greedy underwriters at insurance companies will push for a certain amount of premium regardless of the plan design selected (with pricing matrices they will push the plan they want as they MUST get the premium they want regardless....they know they will have X in claims, then administrative costs, plus profit...so they corner clients).

So it is more of a challenge to fit an HRA in to a fully insured case where carriers have claims data they use "against" you, as well as manual rates (your age, gender, marital status, home zip code) that they blend....so they have 2 "shells" they use on the table and benefit from whichever one they want to use against you to fit you in to their profit box.

This topic I could go on and on, but in general if you shop with a competent broker like Health Insurance Geeks and Nexus, and drive their commissions (when was the last time you reviewed what your broker charge, versus what they delivered in PRICE?...forget all the B.S. services they say they provide, I am talking about premium coming DOWN rather than your broker selling you on the INCREASE!)....

Shady, greedy, self-serving brokers make us crazy here....we work our tails off for our clients on less commissions as we are not reporting to shareholders or dummy boards, hmm-hmm ooops let's call them unnecessary executives in the game of price....

I feel companies who are less than let's say 1,000 employees, should ALWAYS be with a boutique, otherwise they are paying for nonsense.

visit www.healthinsurancegeeks.com or www.nexusbenefits.com for more of our ideas.

Why the Copay is the Enemy and the Fat Farm of the Health Insurance Carriers

2011-03-25T05:33:00.000-07:00

I liken it to drug addiction....in this country the smart folks up in the ivory towers in the world of health insurance knew 2 things...we would LOVE the copay, which we all do now, and that we were going to have a disaster on our hands in 20 yrs...that was back in the early 1990s and voila, here we are....

The copay is both the enemy and the problem, because it hides the cost of everything...if my doctor bills 1200 dollars for a 15 minute visit, but I pay a $25 copay what do I care? However, on the other hand, when my employer moves to a consumer-directed health plan with a high deductible (where I get billed the negotiated physician rates between him/her and my insurance carrier) now I get to see this full $1200 and the allowable amount.

As both an expert in this field, a business owner/entrepreneur and also a consumer, when we move to this model many years ago here at my company, I started BLOWING up my Pediatrician, PCP and also specialists...I remember the first time with my youngest daughter when the Pediatrician wrote 4 prescriptions for her...off to CVS we went and again VOILA, we were told the BRAND NAMES were a total of like 800-900 for the 4 meds, 30 day supplies....I started laughing....immediately called the Pediatrician and said "re-write those bad-boys with all generics"....my bill was like 60-70 for ALL 4 FOR 30 DAYS!!!

That sums it up folks....going to deductibles, negotiated pricing, NO COPAYS for anything, FREE PREVENTIVE MEDICINE, great tools for employers and communcation forums for employees, and we can get out of this mess....also I DO NOT NEED A MEDICAL DOCTOR, to see me to re-order my allergy medicine for another year, which has both been working, and that I have been taking effectively for over 10 yrs...welcome the NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT (btw, tell your kids it is going to be the field to get in to in the next 5-50 yrs...essential to our healthcare success).

This topic, I could ramble for thousands of words right from my hip because I study it, practice it, live in it, believe in it, and have hundreds of clients with whom we have implemented it, and the phone calls on premium increases VANISH!

I hope this helps, and I love writing about this stuff. I would imagine health insurance carriers hate seeing this stuff, however they also know it works...Cigna, Aetna, United Healthcare, they have all had their own employees in these models for 10 or more years....the folks who really hate this are HOSPITALS and DOCTORS because to the scamming ones out there (billing on quantity not quality) they know their offices with Monet artwork are also going to need to become more efficient.

More on Healthcare Consumerism

2011-03-09T15:07:00.000-08:00

Two great things happened today...one was with my co-founder and business partner and the other with one of my clients. First my business partner was explaining how one of his clients that he migrated to a consumer-directed high-deductible health plan strategy had just had an epiphany as they discovered together the cost of a brand name drug (an injectable) versus the generic substitute....it was for a 90 day supply and the brand was 2,000....YES, $2,000 bucks!!!! The generic substitute was $50 for a 90 day supply.

Now had we not moved this client to a non-copay based plan he would have never discovered this little nugget that is a great example of why a single rate for an employer health plan now is soaring closer to $1,000 than ever for what we call a "rich" plan design...funny thing is what we now call a "rich" plan design, back in 1997 we would have scoffed at vehemently...back then what we call rich now was probably 175 bucks a month for a single...now 14 yrs later it is closer to $1,000. Unreal and the reason is the example above...the DEVIL copay system that hides the costs of things.....

Second example was great...talking to a client of mine for 10 years and we have had a HOMERUN moving them from the DEVIL to a new world, through a consumer-directed model. She and I were going through this years' renewal and ideas on how to starve their insurance carrier this year and POOF!! We came up with a great analogy...health insurance needs to become more like auto insurance....deductibles...can you imagine if you had a $10 copay for a wreck in to a pole that could cost $10k...you would almost look for a pole to hit to make the others in the car laugh a little...who would even care, $10 bucks, why not! Now that is not how auto insurance works....$2500 deductible is pretty common to keep the premium down and as a result you would not catch me dead screwing around in a car and playing with POLES! Same deal in health insurance.....if we pay a larger cost of Rx especially, and doctor's visits and charges/lab xray too, we are going to SHOP WAY MORE and watch our dollars....a result as well will be a radical reduction in healthcare consumption etc...

Now finally one thing to highlight is the really sick in this country, the 15% or so....maybe those are the folks Obamanomics should focus on as they are the real problem no one talks about....they drive 80% of the claims and many times have the same 4 ailments that drive most claims anyway. In no way am I suggesting that they should get subpar care, but large consumers of the system and dollars need to pay their fare share, and that is where the government should both back-stop claims from insurance carriers/employers, while also pointing the VERY sick in to very efficient systems...like Mayo, Cleveland Clinic, etc....see this link

http://www.100tophospitals.com/

The true best hospitals in the U.S. should be rewarded for being such, and the poor ones should be shut down. We have too many....funny that NYC does not even have a top 25 system, which is simply appauling as its costs are 2-3 times other places in the U.S....this is the stuff these clowns in Washington need to work on.

Health Insurance Consumerism - It is Time

2011-02-28T04:22:00.001-08:00

Oil is creaping back in to the middle 3 dollar range at most pumps (and rising other commodity prices), foreclosures are mounting like crazy - in Charlotte NC where we have a home 51% of all 2010 sales were foreclosures....unrest in the middle east, and these insane media/journalists on various shows bring on these also insane "pitch" men for whatever it is they want us to believe talking about how things are in pretty good shape? Are these folks using street drugs?? I mean are they serious? If you took out Obamanomics, i.e. just pour an agregious amount of tax payer dollars in to the broken system to prop it up and make it look like it is not that bad....a mistake, and another lie to us, the US drones. Reality, unemployment is probably 20-25% - what if folks have worked somewhere for 10 yrs at a 1099 and get layed off...oops, we don't count them and they don't count? Ridiculous.... with that as my backdrop, we are in the a great Dip and at the Tipping Point for what we do in my company, which is liberate small companies (5-300 employees primarily) from the bondage of health insurance carriers, their brokers, and the awful advice and push they both give their clients.

High-deductible health plans are the answer to the quandry, and giving employers tools to incorporate consumerism is also the answer. Why do you think Cigna, Aetna, United Healthcare have had THEIR own employees forced in to high-deductible health plans for over 10 years...THEY KNOW THESE THINGS WORK FOLKS!! THEY JUST DON'T WANT YOU TO KNOW THEY DO, BECAUSE THEIR PREMIUM TANKS AND SO DOES THEIR VALUE.

I represent the solution, and Health Insurance Geeks push answers....it does not mean everyone will heed the message but at least we are part of the solution, not part of the broken problem that the majority of brokers and health insurance carriers are still trying to protect.

My Manifesto - Remove Politicians from Health Insurance

2011-02-09T05:23:00.000-08:00

They and them.....are the problems. They meaning all of the politicians jousting to make sure they save their seats, their donors, their pitch, their perks, and THEM, the vested executives of health insurance companies that simply are not following what we are begging for in the US....affordable coverage. Funny thing about this is it is simple to solve really...we just need to lead the TRIBE (and I am a happy Leader of the tribe to which I refer) .... a HUGE TRIBE can get lots done...we need a full court press against large employers, unions, and insurance companies and the politicians intertwined within to FORCE them to deal with disgruntled Americans on this subject. Look what Twitter and Facebook did in Egypt, I mean COME ON PEOPLE!

I SIMPLY DO NOT WANT THE GOVERNMENT TOUCHING ANYTHING HEALTH INSURANCE RELATED...read that again please. Our government is responsible for many of our current bankrupt entitlements and I do not care who points a finger in either direction, Democrat, Republican, Independent, whatever...

In a country (yes us in the US) where we can't even fill top level IT and engineering jobs from within because our talent pool is frankly less than those in other developing countries, we are up against the ropes and ready to go down like Apollo Creed in Rocky III (I think it was that one)...pretty scary stuff for someone like me born on a tiny island off the coast of western Greece to a Greek dad and American mom...they brought my sister and I to the land of opportunity, the great U.S. and raised us here. Now 40 yrs later our society is crippled with debt, inter-political fighting and nothing is getting better, actually worse.

I read about what a Tribe can do (thanks again Seth Godin, you're great) and am throwing a stake in the sand and trying to build my tribe. My company actually sells individual, family and employer-sponsored health insurance, and here I am trying to lead the TRIBE to do things differently. My contemporaries or Peers think I am nuts "our business will get killed"....actually exact opposite. The losers that are trying to oversell, under-educate and profit will lose in the end, and I am not one of them. I just want to help people, employers, their families and employees, and lead my clients to solutions that give them the power to chose, spend wisely and always have predictable financial models in which they can have faith.

In my company we say constantly "the copay is and was the devil"....smart insurance companies knew we would all get addicted to the copays like "crack" and now when we try to lead folks away from that old "COPAY" they shiver...what's the copay? what's the copay? well the answer should be $1,000/mos/employee in premium is the copay. What flavor would you like please? No copay, no health insurance problems...no ridiculous mandated benefits (pay for what we buy like car insurance) no health insurance problems. No middleman in the prescription supply chain (yes you insurance companies) no health insurance problems. No drug advertising like it was long ago, no health insurance problems. But first, nuke the copay, and start asking our doctors what they will charge us. I mean COME ON, can you imagine getting your car overhauled at Honda and not knowing what it would cost? The lazy here in the US would say, man that sounds great!! Okay, lazy, you can't afford the new "copay adjusted" cost of a Honda CIVIC which is now $80,000 and a great lease payment is 2100/mos...okay, who can afford that? Well the 500% increase of it would be just like what has happened in the U.S. with the copay. It melted the system.

I am done for today.

Individual & Family Health Insurance coupled with Group-Sponsored Plans

2011-02-03T10:43:00.000-08:00

So get this....now many employers are passing on the full cost of dependent care (think your spouse and children) on to their employers. So when that happens we as employees see quickly how much insurance really costs.

The smart thing to do is to price out if you can do better on your own. Assuming you are relatively healthy, not diabetic and take limited maintenance medications for mild ailments, you certainly can do better on your own. The one thing to look out for are the nuances in product development. Things like maternity that are mandated benefits for employer-sponsored plans, are not in the individual market. But, for those folks who have already built families and are getting crushed with premium pay-throughs, take a look at our rate site and see if you can do better - www.healthinsurancegeeks.com.

The Geeks

Individual & Family Health Insurance, and HEART

2011-01-28T07:23:00.000-08:00

The end of 2010 and now early in to 2011 I have seen a surge in a queries for individual health plans, as well as family health plans - sometimes the dependents of a worker, i.e. spouse and children. In addition the amount of folks on COBRA and coming to an end has been astonishing. I really do not trust the 9.5+% unemployment rate by the way...I feel it is much closer to 20% when you look at real life and the folks who are working minimum wage jobs to make ends meet as opposed to their normal vocation....I could go on and on, but back to my point.

Many, many employers are passing on the cost of health insurance other than that for the employees, to the EMPLOYEES. It has been a massive change in the last couple of years as the U.S. and global economies have abolutely melted down. I see many more folks coming to our organization in search of alternative than in some instances paying 1k +/mos in insurance premiums that their employers are burdening them with as we have now fallen off the cost cliff at least here in the U.S.

So, what do you do? Well, depending on some states like CA and KY for instance this can be super news as child-only policies are still offered and in addition pre-x is gone for children under 19, so they can't be assessed those...having said that I have still seen insurance companies rate them up quite a it, as well as burying the costs in parents if they are attached to a family plan. Now the bad news, other than those 2 states, we at least can't sell child-only policies.

More "so-so" news is just the underwriting process for attaining family plans instead of taking in the chops from your employer - let me explain:

I work for X company, and used to pay 30% of the full premium for my family - for example 1600/mos in total premium charged to my company by the health insurance company, and $480 getting taken pre-tax from my paycheck bimonthly for example ($240/paycheck)...that was how it used to be....Now my company is saying, we will pay 100% of you (the rate charged to the health insurance company for me is let's say $500, and the $1100 is now being passed on to me to cover my family. So I went from $240/paycheck for all of us, now shooting up to $550/paycheck...like a 220% increase)....

We are seeing this ALL OVER THE PLACE! So then we get the phone calls and it is good news if you are healthy - and what I mean by that is no diabetes, no heart ailments, or major chronic illnesses in the family etc...if you fall in to this category you can taken the controls back fast and purchase private health insurance for a much better premium. Now let's say your loved one (the fomer dependent on the employer plan) has diabetes, and you have an autistic child. YOU MUST STAY PUT!! You will not be able to secure health insurance outside of CA or KY for just your child, and then anywhere else in the U.S. basically (other than NJ and NY for example) your spouse will be declined b/c of the Diabetes, and then the children can't get a private plan b/c there are no child-only policies...get it? The insurance companies screwing us again.

And by the way, let's talk high-deductible health plans, a la consumer-directed health plans. I do feel they are our savior, but health insurance carriers are still gouging us price-wise...Oxford Health Plans in NYC for example...they are an awesome company, but for the plan designs they offer, they have cornered us in to buying what they want to sell us ($800/single employee) POS and PPO plans that have astronomical pricetags, and make them record profits. When we compare those plans to their high-deductible health plan offerings with managable deductibles (let's say $1500/year for a single person) it is easy for a broker, consultant or the insurance company/and consumer for that matter to talk themselves out of buying the savior (high-deductible health plans) b/c we can transfixed on that $1500 deductible as opposed to the rich PPO with 0 deductible in-network anyway. So here is what maddens me, the $1500 plan is still $425 + per single employee monthly. That is not priced well, period. In my company we joke about TARP (troubled-asset recovering program) that the Fed Govt established to basically stabalize our country and bail out some banks. If what should happen to health insurance companies did (i.e. that $425 plan, sank to $250 where I think it belongs) we would then need HEART (HealthInsuranceCompany Eroded-Asset Reconfigured Trust) or something of that nature as they would have their claims reserves set up with a premium 50% lower let's say, and would all tank in a quarter. It is funny to say it so matter-of-factly, but I believe it in my bones. But some would say it SHOULD HAPPEN! Well, one thing is for sure, I do not what the government involved in health insurance, and believe for starters Medicare should be run privately...we have given the government plenty of time to bankrupt that system....so make that private, keep health insurance private, but do please blow up the profit machine, the current metrics, all of the waste with too many employees and too much paper (everything automated to some degree)...coming from a distrbution perspective (which I am) big deal, slam my commission (which is how I pay my mortgage, and not much more these days) and allow me to continue to help individuals and small companies as I love to do, and let's make it a day. We have already had our revenue hammered by more than 55%, which frankly has been fine with me. I am in business to help and in order to make the revenue work, it just means I need to help 55% more people every day than I used to for the same static money. Again, fine with me, as that means in the end I actually help MORE PEOPLE.

Sounds all great right? Well I am one of the honest guys in this business, but I am surrounded by dirtbacks and agregious big companies who want their executives to keep fat paychecks. So blow em up, keep the smaller/boutique businesses humming (the engine of the U.S.) as they should be and always should be. The big corporate interests and the government are the problem.

I could write 20,000 more words without a break, but these are my thoughts for the day, and I think a good brain dump.

Republicans Push for Repeal of Obamacare

2011-01-20T05:13:00.001-08:00

Well folks, here we go, round one....and you knew it was coming. At least we have free preventative visits annually for adults over 19 (males/females annual physicals) and females get their free OBGYN visits. In addition children's wellness including immunizations, also all FREE.

No lifetime limits on benefits, and no medical underwriting for children under 19. That part is already sealed and is good news. Now for the big problem, which is how to afford a system for healthcare with no medical underwriting especially for individuals and small businesses, how to get everyone in the country in to the system so we do not have adverse selection, and how to keep the system run privately rather than adding another big burden to our government who has proven they know how to crippled our finances and have long before Obama came along....just see Social Security and Medicare for a reference point. GOVERNMENT, stay out of our healthcare, and go away. You spend like drunken sailors.

So, we need to be able to buy insurance cross boarder from state-to-state from my perspective, and if North Carolina or Pennsylvania want to underwrite my family and me, have at it....we need MORE competition, and more carriers, and more price points, and more options, and need to be able to tell the doctor who wants to charge us 375 bucks for a 20 minute visit, "How does 175 sound. Dr. Smith next door charges that, went to Harvard, has a practice with great metrics that I have reviewed, and has no malpractice suits against him. How about you?"

We need to get here, and we will with more competition, with strong consumer-directed health plan models (been talking about them for almost 20 yrs now)...we are in the Healthcare DIP (see Seth Godin on that one)...and have been for years. We are going to outlast the DIP in my business model, that I know. The benefactors are going to be those of us that have built organizations around assuming we will have a much more efficient model one day everywhere, but are currently already doing it.

These are the most exciting times of my career. My peers for the most part, all consume themselves with worry, or bury their heads in the sand. That will get us nowhere.......

2011 and the Obamacare Collapse

2011-01-10T07:03:00.000-08:00

I think most agree Obamacare is dead in the water, as frankly it should be...it focused on political jousting, and health insurance carriers when it did not focus on the problem that health insurance carriers are faced with - how to FUND claims from agregious hospitals, and physicians and how to control billing/costs of services. In addition, we as consumers, employees, business owners (I am all 3) need to be pro-active with our healthcare, and start asking physicians more questions when we get prescribed medicines for example that cost 600 dollars for a 30 day supply (remember pharmaceutical companies DO NOT want you to get well per say, then you do not need their overadvertised medicine). The copay system which is entirely the problem (who cares what the cost is if we pay $30, $40, $50 whatever)....so back to consumerism, which where I grew up in this business, was the drumbeat almost 20 years ago. We saw it coming, and now it is reality. And your advisors (yes, I am picking on your insurance brokers) are giving you poor advice b/c most of them are also part of the problem. Remember your broker gets paid a percentage of premium and usually DOES NOT WANT you to leave the problem (the copay system) so they can continue to get fat and happy. Insurance carriers do not beat the drum, because they are faced with the same fate. So they are both the problem.

We built our company knowing reform in some way was coming (though we have been saying this for almost 20 yrs now) and that we were going to need to survive in a world where commissions get hammered because the premium stucture should and hopefully will collapse. And quite frankly as Seth Godin (author) states in a great audiobook The Dip, we are in the middle of a dip in healthcare/health insurance. Those of us part of the solution are dying for this to happen faster - collapse of the inflated premium structure to fund the problem - the copay system....btw, doctors also bill as much as possible (so do hospitals) as they are incented by quantity not quality in the current system.

Obama has actually used the word quality some and has referenced the Cleveland Clinic, and Mayo for example - two world class institutions with the best care. Unbelievable that the best are actually efficient right? Well listen to Godin, he will explain how that is....well LOTS of folks attached to the current supply chain that need to get nuked, and this has nothing to do with single payor healthcare or government run healthcare. They (GOVT) have proven to us over many years that they (the government) know how to do one thing - create bankrupt organizations - a la Post Office, Medicare, Social Security to name 3. Call any government agency and see how great the service is - "hold sir, I have my union mandatory smoke break now."

Don't let these government clowns touch my healthcare nor it for my family of 6, PLEASE!! Do however, "light up" hospitals and physicians ...we have too many who really are not that great (outcomes, readmissions, infection rates) overcharging (seems right inline with previous note about quality not being great) and we do not beat the drum enough of the ones who charge a fair dollar for incredible outcomes (there have been published examples of this in NYC all over the place)...the hospitals who are part of the problem need to be shut down, we can triage and push lots of Primary Care to "telemedicine" - come on, we have Skype now, so push my doctor to get online, see me eye to eye, and triage my bronchitis with GENERIC meds and save this failing system. We are ready for this folks....I have invested my life's savings in an organization pushing this system so obviously I have self-interests, but I am part of the solution not the problem. Everyone I listen to on TV also has self-interests but I do not understand how we can't all be a part of the solution - bring costs WAY down, bring outcomes WAY up, and make the advisors (brokers, consultants, insurance carriers) learn to live on half the revenue. The good will always rise to the top, and the bad will hopefully fail and/or go in to another business.

I think that's it for now...I need to do more brain dumps, more often. Q4 always makes our business bananas, so I go underwater a bit. My final comment is this....we passed on lots of business last year that just could not understand how high-deductible health plans work and the tools coupled with them that make them work. I actually wanted to tell some of those "decision makers" (usually the ones calling themselves that, are NOT) that they simply are part of the problem and not open-minded enough to understand the solution. I understand my arrogance in that statement, but it is true.

Will Major Medical with a Wrap-around Plan make a Comeback?

2010-10-25T08:20:00.001-07:00

I think about this all the time...the way it was prior to managed care and it's invasion into the U.S. system (which has both good and bad elements by the way)and what was easy about it.....deductible, then coinsurance (you 10, 20, 30, 40% after deductible) and coverage for big stuff like hospital, surgery (in and outpatient) major rehabilitative therapy etc.... running to the doctor for a cold, was billed directly to the consumer...that is where the "wraps" came in to place, to cover other stuff like doc visits.

So a layman would say, wouldn't it help if the doctor-visit part of health insurance system were pushed directly to the consumer, wouldn't we save money? Short answer is yes, but we need to incentivize folks to go for annual check-ups, preventative visits, OB/GYN for women etc...so they do not end up in the ER with a $50,000 claim. Education and communication especially between employer's and employees is essential for workers to start becoming more health conscious and proactive about their ongoing illnesses etc...

I happen to think it would not all be bad if we pushed all of the major illness (hospital et al) to health insurance carriers to cover, as they know how to do it effectively, and create an opportunity for more competition in the market for "wrap around" plans to come back...buy exactly what we want, and to cover what we want (like car insurance per say) and have the price be commensurate with what we purchase.

High-deductible health plans are taking a better foothold now with the economic crash of the last 2 years, and they will surely continue to gain marketshare. Will we see the professional services (doc visits other than preventative) style benefits be pushed back to the consumer? If insurance carriers did that, and decreased their bureaucratic staff numbers by 30-40%, we would have no speaking of health insurance problems in the U.S. Thinned out insurance carriers, and unbiased advisors (brokers and consultants) have been working well in financial services and specifically in stock brokerage, life insurance brokerage, etc...so why not in health insurance?

Call a bureaucratic health insurance carrier and try to get a right answer first shot, no way. It is not to say they are all this way, but certainly, there is room to dramatically reduce overhead of internal staff (salaries, bonuses, commissions, employee benefits, worker's compensation, 401k matches, defined benefit plans, long-term disabilities) and push the work to outside brokerages (1099 the commissions they earn and you're done).....food for thought.

Consumer-Directed Health Plans

2010-09-29T15:34:00.001-07:00

It has been a little while since I have done a brain dump....I will do much more tomorrow, but as both an entrepreneur/business owner, health insurance expert, and card-carrying consumer-directed healthcare BELIEVER, I come back to my same old thoughts. Consumerism is the only thing that will save pricing/affordability in the United States for health insurance. Though Republicans and Democrats mean well, they rarely use all of their HOT AIR on the real topic to discuss - consumerism. We need to stick with high deductible health plans, corporate HRA's, and showing businesses all over the U.S. to take back the control.

All carriers are the same...they will bend you over a barrel to make their shareholders or state/local officials/unions (non-profit plans) happy with the "returns". I am not certain anything will make an impact more than consumerism - no exchanges, no single-payer system (the WORST IDEA in last 100 years)...a universal system where everyone has to be covered (to spread risk) sounds great, but it blew up literally in Hillary Rodham's face almost 20 years ago now...it will never work either.

If businesses en masse moved to consumer directed health plans, and the ridiculous bureaucrats in Washington would push everyone on to the same page, the first impact would be a RADICAL cost reduction in premium, probably a need for another TARP sytem bail-out but this time of health insurance carriers right out of the gate to prop them up for the first 18-36 months of the transition...they would take a "haymaker" to the side of the head upon inception, then would get used to it over time. The immediate impact would be mid 1990s pricing, think about that, wipe out 15 years of increases (just like the 15 yrs of 401k gains and real estate gains you did to us - oh yeah, thanks banks and unscrupulous bankers, CDS/derivative salesman and woman!!) - sounds too good to be true? No it is true.

Healthcare Consumerism

2010-06-28T06:42:00.001-07:00

So I find it funny...I get called and emailed daily by clients who have just received their 2010 group health plan renewals. The message is the same every time....20%!! or 34%!! or 36%!! Yep, it is here to stay folks and the way carriers will over-increase the plans that they can't keep up with, i.e. copay-based PPO plans...and we will see this every year for the foreseeable future.

So my message is a constant back....HRA with a high-deductible health plan...no not an HSA they are different and the company doesn't "own" them. The HRA I feel is the way employers can actually increase their benefits especially for the somewhat healthy employees, and the sick employees with huge bills, will indeed feel a bit of out-of-pocket in a year, as they should. I have had big bills before, and as a consumer I believe that is right. We can't afford a true socialized system in the U.S., and actually I have had direct experience with an Executive currently cleaning up the NHS in the U.K. which is currently crippled by a socialistic model. Don't believe everything you read is all I can say, and trust the source.

My firm actually makes TONS less in income selling high-deductible health plans with HRAs and does TONS more work on them than selling the easy "dummy" sale of a PPO with a copay plan.....problem is they are the problem. We are not part of the problem, but rather a part of the solution. I can't tell you how many times I have had HR push back on our strategy simply because the idea didn't come from the incument broker, and seems like a bunch of work. When we get the ear of a CEO/CFO our success rate is over 85%. Financial savvy executives flock to us, HR areas worry about the amount of work, which I can understand. Here is my personal take, we are all going to be replaced with outsourcing and computers if we do not do things in the corporate world to stop the inceasing spend on benefits, there will become no other choice but to completely outsource HR and Benefits to private companies. Another reason our clients (HR departments) love us....job preservation. We keep the finances in check, the tools are awesome, and or ideas keep the CEO and CFO happy.

As such, I call to you HR folks, please, please, trust us or someone like us....this is the solution to the never ending price increases which will contine to ramp back up and we are on our side in this revolution.

Consumer-Directed Health Plan Thoughts for the day

2010-05-28T05:44:00.000-07:00

Well, as an allergy suffered myself, and also the father of 4 young kids, 2 of whom also have allergies, here is my thought for the day. As I started waking up around 2 am this morning sneezing my brains out, I realized I had not taken my OTC CVS brand generic Zyrtec (Up and UP Brand)...45 Bills for 12 bucks folks.

I popped my med, tried to go back to sleep but could not as the med takes a couple of hours to be absorbed. Finally I stop sneezing, too late to fall asleep so I take on my day. I wait until 8:30am and call my family doctor, and get his kind nurse. I tell her my brains are popping out of my nose and that I need my Flonase refilled ASAP...quickly I catch myself, GENERIC Flonase that is, please make sure the doc fills with generic.

This move saved my 30 bucks, as the namebrand is WAY more than the generic and so is my out-of-pocket cost. But most folks would either not know to do this, or maybe get too lazy to even try generics. Well folks, the active ingredient in all generics are the same as namebrands, it can be other things that perhaps cause different side effects (the casing, i.e. makes your stomach upset for example)....I am no physician, but when it comes to "blindly" taking meds that docs write out on their pads, I always opt for generic as the costs are powerfully less. I am also always comparing Wal Mart, CVS, Costco just for starters, as they all have great Rx plans EVEN IF YOU HAVE NO INSURANCE. This in a nutshell is consumerism at its best, as these mega stors know consumer-directed health plans are here to stay, snagging ground, and are the only plans that will be affordable in the years to come for most of us. These mega stores also know the pharmaceutical industry is going to get it's own COLONOSCOPY with reform, and we will probably start seeing less Cialis commercials constantly throughout the day...yes those commercials translate in to costs for you at the CVS counter.

I wish I could scream from the rooftops as an entrepreneur, expert in the field of consumer-directed health care as well as industry veteran, and just plain old consumer...This is the only thing that will save the system, is us asking more questions, comparing costs, checking up on our own doctors etc...not OBAMANOMICS, NOT RAISING OUR COPAYS or passing on more of the employer's cost to employees, it is a shift in the buying and using decisions...there will always be folks to lazy to do so, or too adverse to change who will continue to erode healthcare in the U.S. but when CVS pharmacy's start using what is called a HARD EDIT, employees will start learning what I am talking about. A hard edit is when the CVS DENIES your brand name drug because your employer has chosen that option to demand dispensing generic meds, or you pay THE FULL COST OF THE BRAND NAME DRUG!! The are things that have been used for years for the biggest employers with the biggest budgets, and usually the biggest brains behind them...they have been 10 years ahead of what is happening now (or more)....welcome to the new world folks.

I will brain dump again soon -

Why HealthInsuranceGeeks Rule - Top 10

2010-05-21T05:05:00.000-07:00

This is the beginning of what will become our version of the Top 10 Reasons to become a HealthInsuranceGeeks.com client:

10. We are very, very, very smart
9. Along with smarts, we are both marginally handsome
8. Along with "decent" looks and smiles, we have razor sharp whit and light-hearted personalities
7. Your broker based on our knowledge of our industry is basically a criminal if he/she is not moving you to a consumer-direct health plan strategy
6. Why #4 is so targeted?
5. Because other brokers drive Lexus's, where Rolex's and have beach houses....
4. We drive Toyota's and wear Timex Ironman watches..
3. Can guarantee 15-30% savings with our strategies - your brokers do not want that because it means they take a 15-30% pay cut - ESPECIALLY BIGGER BROKERS!!!
2. We happen to be Health Insurance Geeks - we are experts
1. YOU HAVE NOT GIVEN US A TRY....

Top Health Plan CEO Pay (2007)

2010-05-04T06:08:00.001-07:00

Ron Williams, Aetna, 23+ million
Ed Hanway, Cigna, 25+ million
Dale Wolf, Coventry, 14+ million
Jay Gellert, Health Net, 3+ million
Michael McCallister, Humana, 10+ million
Stephen Hemsley, United Health Group, 13+ million
Angela Braly, Wellpoint, 9+ million

Well, well...............this is substantial evidence to overhaul their pay....should be seeing this from Obamanomics shortly, as it seems to be a conflict of interest to control payments of illnesses that kill, but take home 25 million?

High Deductible Health Plans

2010-05-04T05:49:00.000-07:00

These go waaaaaay back. We were discussing the need for consumer-directed health plans (CDHPs)and consumerism in general as it pertains to health insurance 15 years ago....it is like Malcolm Gladwell's book "Outliers", these CDHPs have been hanging arond waiting for an implosion to then take root.

Now is that time, between Obamacare, which from my perspective will not do much more than open up more individual health plan purchasing, (canabalize the group market)and CDHPs, I think those coupled will develop the new market. We will get used to plans that do not pay first dollar (the copay) yet have deductibles and coinsurance for everything except preventive care. It is about time....if you step back and look at the copay, it is absurd and I am not sure how we got to expect them as a physician visit really should not cost 5, 10 or 20 dollars. With a structure that way (let's not even get in to the 100% inpatient benefit, that has CRIPPLED our healthcare economy) as we have been saying for years, we will end up with $2,000 single employee or personal purchaser rate in the coming years....so bye, bye copay, hello deductible and coinsurance. Couple that with health savings accounts (which can help from a taxation perspective, long-term savings) and network based care, and welcome to the new healthcare landscape. We will be penalized much more for going out of network, and we may also end up with the old referral system we so loved to hate in the 1990s....so basically we will end up Back to the Future, with plan designs like they were before managed care, but the network based care of managed care.

Hate to admit that I along with other colleagues predicted this 10 plus years ago, but that's the truth. I welcome any alternatives to this model, but as I see employers do away with group plans, set a monthly flat stipend per employee to go purchase their own health insurance, I know we are well under way.

Once Obamacare tax incentives take hold, and the greedy health insurance carriers are forced to give FREE preventive visits, un-do medical underwriting and pre-existing condition exclusions, I think we will end up with an a la carte menu much like GEICO auto-insurance, but if we have too much government, here we go:

"Welcome to McDonald's may I take your order please? Uh, yes, I would like a number 2 super-sized (5,000/person deductible, 80/20% coinsurance thereafter up to an additional $5,000 out of pocket) and I live in Charlotte so I would like that from, ummm, Aetna. No problem sir, and when you have any questions, just call our 800 number, we have the wait time down to an hour and 15 minutes. If you have a non-life threatening emergency (like a hip replacement that has kept you out of work) we will put you in our treatment wait-que, but don't worry, we can get that hip fixed in 30-40 MONTHS!!"

I don't know about you, but I do not want the government telling me when and how I can get treatment for a critically ill child or parent, PERIOD. I understand Obamacare et al need to pressure these GREEDY insurance companies (hello Ron Williams, CEO of Aetna, and your 165 million in stock options waiting to be exercised on a good earnings report, so you can buy another house) in to offering a more leveled playing field....yeah, yeah, I get that as well as anybody, we need REFORM, but go away Obamanomics, the government in this country is starting to be a George Orwell 1984 fulfilling prophecy....

Blow up Ron Williams,

Advertising & Branding Companies

2010-04-26T10:51:00.000-07:00

We specialize in helping smart creative companies, get smart and creative with their benefits portfolio. Just like I would ask questions of an insurance brokerage walking in to my office in a starched white shirt, tie, and suit (get with the times it is Gen X and Y coming in to the workforce fast, we like work-life balance!) I would also question anyone not understanding high-deductible health plans, with an HRA (company controlled) HSA (employee owned accounts that can be funded by employee and employer) combination..... take control of your cash flow, give BETTER benefits to your employees and stabalize premium increases. Insurance carriers that are pricing against this structure are going to be left in the dust, this is the wave of the future. To have one of our Geeks help you, visit www.healthinsurancegeeks.com or call 1-866-976-3977....it costs nothing to learn from the Geeks, but we want your business, believe me!

Health Reform - What happens in 2010?

2010-04-21T09:16:00.000-07:00

Children up to the age of 26, can remain covered under parents medical plan...to me implemented in 2010. Also, no annual limits/lifetime limits on medical services, also in 2010. Most of the other items are coming in 2011 and beyond, also quickly, i.e. Jan 1, 2011, copays will not be allowed for preventive services even if you have a high-deductible health plan.

Health Reform Passes - So Now What?

2010-03-23T05:42:00.000-07:00

Well, let's get to what appears to be stuff to happen in 2010....uninsured now, and with medical problems, folks will be able to buy insurance in 2010 through high-risk pools later in the year. How it is funded, what the cost structure is like and plan design remains to be seen (probably medicaid model).

Starting this year health insurance companies will not be able to exclude coverage for pre-existing conditions, and can't drop you suddenly from a policy for that reason too. Cost structure, how they rate, presumably more information to follow.

Young, college student aged kids on parent's polilcies, to be covered to age 26.

Employers with 25 or less employees will get up to a 35% tax credit towards the cost of providing health insurance to employees, again presumably on top of the deduction as business expense too.

Other milestones will be 2011, 2012 and ultimately 2014 when it will be required to carry health insurance in the U.S. Exceptions will be for severe financial hardship, elsewise folks will pay what has been published recently (in 2010 anyway) as up to a $695 dollar fine.

The Flaw in What Obamacare DOES NOT Discuss Enough

2010-03-17T05:29:00.000-07:00

Well, as an expert in this field for close to 20 years now, and having spent a considerable amount of my career in NYC, helping middle market companies combat health insurance premium increases, and "smart" benefit designs to prompt utilization that hopefully "slows" these carriers from ratcheting up premiums, I focus my attention on NYC specifically. There are some good intentions in Obamacare, honestly, but as an expert and listening to the often useless and almost nonsensical political jousting I get back to a place where the theme behind Obamacare has been in place, has not worked, and has pushed pricing to the SKY!!! NYC folks.... in NYC we have guaranteed-issue individual/family health insurance offered normally by just a few carriers (as they get forced to because they do tons of commercial business too) but in 2010 for example Empire Blue Cross Blue Shield, and Oxford Health Plans to name 2. We get calls daily of people looking for alternatives to their SINGLE rate of 985/mos to get an HMO plan, yes folks, almost $1,000/mos or a mortgage payment to have coverage that limits him/her to network only coverage. Well, that is exactly what Obamacare will deliver unless the young, healthy folks in this country are also forced to carry health insurance. The problem in NYC, is they can't deny coverage, and they charge the same rate whether you are deathly ill or healthy as a horse. The only catch for them to be able to apply pre-exisiting condition language is if you go beyond the 63 day "uncovered" HIPAA window (if you do not have coverage for greater than 63 days, you open yourself up to having pre-X language). So, when you get sick, you can jump in and buy, and not get denied, sounds great right? Wrong, that is how you end up with $1,000/month rate for a single 25 year old.

As such, we must have mandatory coverage like auto coverage, with a la carte plan designs, so if we want to buy hospital coverage and pharmacy coverage, but pay our own physician office visits, speech therapy, physical therapy and mental health visits, carriers should be forced to offer them....state and federal benefit mandates also kill the system(again another problem in NYC, where they mandate EVERYTHING to be covered in every offered policy - another way to DRIVE UP COSTS!).

So, let me lay this out again, a la carte plan designs, cheaper plan designs for higher deductible (my up front risk) and lesser benefits (no mental health, office visits, physical therapy, chiropractic care) and conversely, higher costs for folks who wish to have that coverage, AS IT SHOULD BE. We need to be paying a portion of the underlying benefits we consume, and others in our "risk pool" within insurance carriers need to be rated accordingly. Same thing for the "risk pools" of consumers with different product/plan designs.

I am not an actuary but have spent lots of my career around them and in HUGE institutions in which I used to work early on....smart people, who can figure out how to still get us what we need and make a profit, or perhaps not....maybe health insurance carriers should all be forced to be non-profit? Not sure on that, but strong arguement for it.

I hope this has given some insight in to the bigger problem with Health Care Reform...we do not need another NYC, nor Massachusetts (their mandatory system has absolutely imploded, for similar reasons to NYC)....

Let's go the route of how be must carry car insurance, and pay for what we actually have in benefits.

Thanks for so much Feedback

2010-03-05T05:03:00.000-08:00

First, I want to thank all of our fans, and followers for so much great feedback on our blog, and what we say about health care reform, as well as the health care system including health insurance plans/coverage etc...so THANKS, it has been great to read, learn, and also be able to reflect on what assumptions some folks make based on their readings.

A few points of clarity, I as a specialist in this business for quite a long time have worked on and with some of the largest most complex businesses with their insurance woes (Like JPMorganChase, Scudder Kemper,even some of these mega-banks before they all merged)....I have also helped thousands of small businesses with their problems. So with that as a back-drop let me please clarify, my opinions and comments are based on lots of experiences, many years, things that have frustrated my clients and me, and also watching hours of debates from folks that I would deem to be way off "center" whether on one side of the political isle or the other. So with that said, I do not support what is on the table right now regarding Reform in its entirety as they are not talking incessantly and focusing on the real problem....THE WHOLE SYSTEM. Again as i blogged last time, I do believe we need to be accountable for researching our health care options, but we also need all of the stats to make informed choices...that is where technology is severely lacking from insurance carriers and providers (who need to get hooked up) - if I have ready data regarding the physicians that have performed thousands of ACL reconstructions (knee injury) have great rehab and success rates, low infection rates, and low recurrance of injury, and charge a fee that is reasonable (as it would be great to compare his/hers with a few other docs stats, and fees) than why in the world would I go to the "goon" down the road who charges double, screws me back together terribly with rapidly approaching arthritic symptoms and chronic pain, and ba-bing, I blow it back out running up steps to catch a train....SOMETHING IS WRONG HERE FOLKS. That is the "corner of the mouth" statement Obama says about "evidence-based medicine." That is the problem with health care, and rising health insurance premiums. Billions of waste in the system.

Somewhere we have "learned" that a person with a Harvard medical degree or Harvard Business School degree (or Stanford, Duke, Michigan, Columbia - so we do not just pick on Harvard here) is practically a law-abiding "God" who can't have criminal intent....I have read now for 2 years in the WSJ and other papers about what I would basically call criminal as far as the crap banks swapped with each other under the covers, so all parties could make repeated fees on the same crap and almost cripple the entire world economy.

I could talk for hours, and hours on this, and as someone educated in this field, who supports a capitalistic society, happens to own and operate a business, has four children of his own with his wife, has friends, parents, in-laws, nephews and nieces, likes the outdoors, is active, tells a funny story here and there, is not a staunch "anything political", and just basically thinks we need to get the healthcare system updated with good technology that supports paying for things that "work", I rest my case.

Health Insurance Premium Increases as bad as ever in 2010

2010-02-24T05:18:00.000-08:00

I have been a professional in this business for close to 20 years now, and with all of the talks of health reform, I am pretty appalled at what health insurance carriers and their leadership has done rolling in to 2010. Small businesses are getting killed with some of the biggest premium increases I have seen in close to 20 years....we have had recent clients, SMALL BUSINESSES, getting hammered with 22-35% increases for the same benefits rolling in to a new year. It is obvious carriers are offsetting their lobbyists, the large companies in this country, by pushing costs over to individuals and small businesses - let's face it, from Aetna, to Cigna, to United Healthcare, depending on what part of the U.S. that you survey, they are in and out of the business of insuring small businesses year in and year out. It is also interesting that the highest paid CEOs in all of health insurance land, also happen to be the leaders of those carriers, United Healthcare, Aetna, and Cigna. They sure now how to enrich themselves, but perhaps it is time for the "pay czar" to step in and cap compensation for the leaders of health insurance carriers? As brokers for small business health insurance, www.healthinsurancegeeks.com, we spend time on each client each year, finding ways to lower their premium from past years' levels, or at least to remain level, which also by the way keeps our compensation level, or decreasing as well. Many brokers who enjoy the luxury of working less and less as years go on, and enjoying the fishing boat in the Hamptons, are the ones with concern. For folks like us, we work hard, it is our ethic as we are dedicated to a cause, rather than dedicated to the search of a less-than-hard earned buck, like many brokers of small and medium sized companies have enjoyed for years. The do their best to keep their clients at the same carrier year in and year out, to reduce the amount of work they do, because let's face it, public companies or large companies that are in the health insurance brokerage business are more focused on their shareholders, and profit models, than HELPING their clients. We have enjoyed such rapid growth at HealthInsuranceGeeks.com because we go above and beyond for all clients, whether they have 2, 20 or 200 employees. Clients can tell when you have passion to help, trust the Geeks.

Let's see what this Thursday, February 25th, 2010 does in the Blair House with all of the Goons from our Government continuing to "debate" on health care reform...remember, it is more than health INSURANCE reform, it is health CARE reform, so let's get all of the parties straight - doctors, hospitals, insurance carriers, governments both federal and state, medical device makers, pharmaceutical companies, insurance brokers, lawyers, I could go on and on, but those are some of the biggees -

Small Group Health Insurance

2010-01-25T05:06:00.000-08:00

Well, where is reform? More than ever small employers needs a change in the continually rising premium structure alongside benefit buydowns. We are still seeing 15-25% renewal increases for our book of business which could not be more frustrating given all of the talk of fixing this broken system.

One this is very clear, we need plan designs for small employers that keep premium stable, as such high deductible health plans are selling much more often, as consumer are starting to realize paying a substantially lower premium for say a 1500 deductible plan still allows that person to benefit from negotiated rates between physicians and insurance carriers, even though a "sick" visit in office may go "towards the deductible." So for example, your child gets sick, you have a 1500 deductible, and you take him to the pediatrician. The visit is 110 dollars, but the negotiated rate between, let's say Aetna, is 58.50...well, you pay the 58.50 at the point of service from the doctor, not the 110. That is good news as those of us with families, and that are in good health but each of us perhaps go to the doctor 1-2 times per year, a high deductible plan is perfect.

We need carriers to radically reduce premium structure on high deductible health plans - they have not yet, because they have not been forced by the government, YET...they are still GOUGING the consumers.

I am a married father of 4, and just bought an individual plan (though i own a small business myself!!) for my family for 288/mos from Humana with a 7500 deductible. It is better than not being covered, and also has preventive care and a good Rx card, which takes care of most of our normal charges. I look at buying my own health insurance just like car insurance now. I am willing to take on a big charge if something "catastrophic" occurs, but would rather pay a substantially lower premium that offsets our yearly charges for the care we have received on average for the last 10 years.

I hope more people continue to come to the Geeks so we can help you make the same kind of choices. It is obvious the government is not going to help us.

Financing of Health Reform

2010-01-05T16:23:00.000-08:00

Well, not sure on this one....everything I read points towards a new tax on the wealthy, and surcharges on very "rich" plan designs or "cadillac" type insurance plans.

I wish the republicans and democrats could work out a truce, but that seems highly unlikely. We sell individual health plans, and small group plans all day long, and the same things are discussed with consumers of ours on the phone every day. We need a system where the healthy and the sick are insured all together, therefor providing affordable benchmark plans. The problem is the healthly folks who do not want to pay for insurance plans (who can blame them, they feel they do not "need" it right now) are not in the bigger pool, as such, the sick are left with high claims and not enough overall "premium" to fund the expenses. Then if the healthy become "sick" they then want to be able to jump in to the "pool" because now they need it...that's the GOTCHA, then any carrier in it's right mind "net's" those folks with medical underwriting to prevent folks adversely selecting against them. I have heard and seen this as long as I have been in this business, and that has been quite some time now. I think we need to have a mandate of coverage, similar to driving car without insurance coverage, and penalties alike, to get everyone sick or healthy in the "boat" together, as well as disbanding many of the federal and state mandated benefits, so we have a la carte coverage. If I want no Rx, no doc visits, just hospital (not even mental health) for myself and my family, give it to me - but do not charge me more than 200/mos for it, because that is really what this stuff should cost.

Reform

2009-12-28T08:27:00.001-08:00

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?

2009-11-21T04:04:00.001-08:00

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

2009-09-22T04:41:00.000-07:00

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

2009-09-08T17:57:00.000-07:00

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

2009-08-28T05:06:00.001-07:00

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?

2009-08-27T04:48:00.000-07:00

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

2009-07-13T15:43:00.001-07:00

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?

2009-06-29T18:21:00.000-07:00

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

2009-06-05T10:47:00.001-07:00

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

2009-05-12T07:29:00.000-07:00

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?

2009-04-28T10:52:00.000-07:00

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?

2009-04-20T07:44:00.001-07:00

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

2009-04-15T14:24:00.000-07:00

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

2009-04-08T05:06:00.000-07:00

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

2009-03-30T07:06:00.000-07:00

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....

2009-03-24T11:32:00.001-07:00

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!

2009-03-23T05:28:00.001-07:00

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

2009-03-19T16:10:00.000-07:00

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.

2009-03-12T11:56:00.000-07:00

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

2009-03-09T07:17:00.000-07:00

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.