Monthly Archives: November 2013

You better check once, better check twice

Can you keep your doctor? can’t tell consumers whether they can keep their doctors |

 Waltman said federal cost-cutting pressures on insurers are forcing them to reduce the number of doctors and other providers in their networks.

The result is that consumers must choose among provider networks with fewer doctors and hospitals.

That means many consumers who join the Obamacare exchanges won’t be able to keep their doctors despite President Obama’s repeated promise to the contrary.

Dave Berman, an independent insurance broker in Indianapolis at the brokerage firm Neace Lukens, said people could become confused if they expect their current insurance firm to offer the same network through Obamacare.

“It’s going to be very confusing to consumers who may be used to an insurance company and not knowing that they are going into a restrictive network,” Berman said

You must, must, must check your network. Not just the insurance company but the netowork that is being offered with the plan being purchased. If you are purchasing a plan from or a state exchange this is critically important.




Insurance is not the same as Healthcare

Network participation – Survey finds doctors rebelling against Obamacare, famous hospitals declining to join |

Be careful out there. Please, be careful out there.

If you’re looking for a plan and are involved in the medical system or require certain services, the first item you should be investigating is network participation. Check on providers and facilites you might reasonably or even unreasonably expect to access.


Obamacare glitches persist

Insurers: Despite deadline, Obamacare glitches persist –

Customers who signed up for coverage are calling the companies with questions and finding they aren’t in their systems. And insurers have been testing the site, submitting John Doe records and not seeing them come out the other end, an industry official said.

“There’s no part of us that thinks all of this will be fixed in three days from now,” the industry official said, referring to the administration’s self-imposed Saturday deadline to make the site work for a “vast majority” of users.

Another insurance industry insider was more blunt, saying: “It’s still all jacked up.”

Robert Zirkelbach, a spokesman for the insurance trade group America’s Health Insurance Plans, was more circumspect.

“There is still a lot of work to be done to make sure that enrollments can be done and processed accurately,” he said.

If the problems aren’t fixed, insurers fear a worst-case scenario where consumers sign up for insurance through the website and think they’re enrolled, only to find out at the doctor’s office that they don’t have any coverage.

Amateur hour.


We have a lot of work left to do in the next few days,”

says CMS spokesperson Julie Bataille. – No Thanksgiving Celebrations for Obamacare Website Team as Deadline Nears |

By my calculations there are 5,000,000 people who need to replace their insurance plans, not to mention new applicants that don’t have coverage. The number of days between Dec 1 and Dec 23 is… 23. That means on average, 217,000 people a day need to sign up.




Seventy-five percent of the people on terminated individual plans in Colorado have coverage through two carriers

That would be Rocky Mountain Health Plans and Kaiser Permanente – Colorado’s Canceled Health Insurance Count Tops 200,000 « CBS Denver.

So when Rocky Mountain Health Plans President and CEO Steve ErkenBrack states

The exchange and Medicaid have made some good progress, said board member Steve ErkenBrack, who is head of Rocky Mountain Health Plans in Grand Junction. But, he said, he knows there are many who desperately need to get through to a new policy by Dec. 15.

“This is not a theory for people, this is about real people with real problems, and we need to make sure that transition is as smooth as possible,” he said.

Well of course he does. He is responsible for many of these “real people with real problems” having their plans cancelled. Great job Steve.

Also, how did Rocky Moutnain Health Plans and Kaiser Permanente, not to mention the Colorado Department of Insurance, know that you couldn’t keep your plan prior to President Obama? Inquiring minds want to know.


Obamacare Resort Area Rates

The Department of Insurance will be in Frisco Colorado on December 5th to explain “Why does geography affect your health insurance premium.”  If you live in a resort area, you know what I’m talking about.

Download (PDF, 105KB)


This graphic sums up the issue facing resort area residents if they don’t manage their income to stay below the subsidy level…

I see a “manage your income” industry rising up to assist people with staying subsidy eligible.


Young Americans Not Receiving Promised Obamacare Subsidies

Young Americans Not Receiving Promised Obamacare Subsidies.

According to CNN, “subsidies are based on a formula set by law, applying to individuals with annual incomes of one to four times the poverty level—or $11,490 to $45,960.” And to calculate the subsidies, “the government sets a maximum amount that low-income customers will have to pay for insurance as a percentage of their income. That cap is then subtracted from the cost of a mid-level insurance plan in the individual’s region, and the difference is their subsidy.”

And though insurance companies are required to “knock that amount off the price of premiums before the customer pays,” the subsidy is “zero” if the baseline plan insurance plans are cheap enough. That means many low-income younger Americans who are forced to buy insurance are discovering, to the surprise of many, that they will have to do so without the subsidies they were promised, as CNN noted:

  • In Chicago, a 27-year old will receive no subsidy to help offset premiums of more than $165 a month if he makes more than $27,400 a year.

  • In Portland, Oregon, subsidies for individuals making just $28,725 a year phase out for those younger than 35 years old.

  • In Nashville, a 25-year old making $25,500 will not qualify for a subsidy.

  • In Minneapolis, Minnesota, a 4o-year old making $28,725 a year will not get a subsidy.

In Colorado most young people will receive little subsidy if they make over $26,000/year and no subsidy if they make over $30,000 per year. The exception is the resort areas, where subsidies will be available up to the 400% FPL limit.


Obamacare health network problems

This is more than a New York issue: New health plans sold through exchanges not accepted at some prestigious NYC hospitals – The Washington Post.

Be careful out there.

Another issue is a vast majority of exchange networks are “in-state” only. If you live on a state border that could be a problem. That is the case in Colorado on the Connect for Health Colorado Marketplace with the exception of Rocky Mountain Health Plans PPO offerings, which have a nationwide network. Also available in Colorado but NOT on the Connect for Health Colorado Exchange is Assurant Health, also with a Nationwide network.


That little contribution can mean the difference between dignity and despair.

Hopkins: ObamaCare Forced Mom Into Medicaid –

Of course, Medicaid is not a new option for my mother; she knew that she was poor enough to qualify for cost-free health care. It was a deliberate choice on her part to pay that monthly $276 out of her own pocket. Clearly she had judged that she received a personal benefit from not being on Medicaid.

“I just don’t expect anything positive out of getting free health care,” she said. “I don’t see why other people should have to pay for my care, whether it be through taxes or otherwise.” In paying for health insurance herself—she won’t accept help from her family, either—she was safeguarding her dignity and independence and her sense of being a fully functioning member of society.

Before ObamaCare, Medicaid was one option. Not the option. Before this, she had never been, in effect, ordered to take a handout. Now she has been forced to join the government-reliant poor, though she would prefer to contribute her two mites. The authorities behind “affordable care” had erased her right to calculate what she was willing to spend to preserve her dignity—to determine what she thinks is affordable.

That little contribution can mean the difference between dignity and despair.

One size doesn’t fit all apparently.


Students suffer ObamaCare sticker shock as premiums soar, plans get cut

Talk about biting the hand that votes for you: Students suffer ObamaCare sticker shock as premiums soar, plans get cut | Fox News.

Anyone with a brain could have seen this coming. Unfortuantely, that leaves out the lapdog mainstream media… and apparently the students themselves.

The sticker shock didn’t sit well with some students who spoke out against the price hike.

“You’ve haven’t done anything Obama and I am disappointed in you,” one student said. Another told Campus Reform, “We don’t have that money. We can barely afford books.”

The frustration has been felt across the country as colleges and universities have to decide whether to cut coverage or offer sky-high plans that in some cases triple the cost of premiums.

Remind me again students, who did you vote for?


Obamacare Subsidies: No easy trip

Rude Awakening for Federal Way Woman Who Got Shout-Out From President – Can’t Afford Obamacare Policy After All | Washington State Wire – News of Capitol Importance.

There were errors from the start regarding the calculation of Jessica Sanford’s subsidies. It has led her down a long and winding road to a decision NOT to purchase coverage. Here is the comedy of errors…

Big Goof by State

Four days after President Obama made his address, the state health exchange publicly revealed a grevious error – its tax-credit calculations were all wrong. The state had been submitting monthly income information to the federal data hub, but the federal computers were expecting an annual figure. Suppose a person claimed an income of $50,000 a year — the tax credit was based on an income of $4,166 a year. The higher the income, the bigger the error. Brokers say they caught the mistake right off the bat and tried flagging it to the state’s attention, but for some reason it took the state three weeks to acknowledge it. So everyone who purchased a subsidized health insurance policy through the Washington state exchange prior to Oct. 23 was quoted too low a rate. The mistake involved 4,600 policies covering 8,000 people – Sanford’s policy was one of them.

The state sent a letter saying mistakes were made. And so she went back to her broker and tried again. They went over her income and made a more careful calculation of her business tax write-offs. But this time the website showed she qualified for a much lower tax credit, just $110.

With a gulp, she signed up for a less-expensive “silver” plan from Premera – meaning that it had higher deductibles and copays. Still her premium went up. “I knew I would be struggling in my slow months. I didn’t know how I was going to do it. But honestly, I just wanted to get it in my budget and start working on it right away and start working on saving money toward it – that was all I could do, just work at it and hope for the best and try to take the money from here or there or wherever.”

Sanford had managed to save enough money for half of the first month’s payment when she got another letter from the state last week. It had goofed again. She qualified for no tax credit at all.

Medicaid Eligibility Becomes Problem

The hitch was that the website told her that her income was low enough that she could enroll her son in the state Medicaid program for children of low-income families, known as Apple Health. For that she would have to pay a premium of just $30 a month. She could enroll him right away, and she did. But that created a problem. When she enrolled Ryan in Medicaid, she couldn’t count him toward a tax credit. Not that the website mentioned it. In fact, it gave her the opposite impression.

Once the new health insurance policy kicked in on Jan. 1, the premium was supposed to be $280 a month, plus, she assumed, the Medicaid premium. But after she signed up for a policy, and after she gave her credit-card information, she got a letter from the state last week saying that her income was too high to qualify for subsidies – the cutoff is $44,680 for a single adult, 400 percent of the federal poverty level. So she would get no help from the feds at all.

“I was dumbfounded,” she said. “I thought this was a total mistake, they’re going to correct this — this isn’t true. How could I not qualify for a tax credit? I make under $50,000 a year. There’s got to be something. So I got ahold of my broker, and a couple of days later he called me back, and he told me that no, it was true.”

Now she says her health-insurance dream has gone bust. Without a tax credit she has to consider the cheapest “bronze” level plans, but the deductibles are so high that couldn’t afford to purchase prescription medication. “I was like, forget that – I’m not going to pay.”

So now she is looking forward to no health insurance at all. Under the terms of the Affordable Care Act, she will have to pay a penalty of $95.


Amateur’s everywhere. You can’t make this stuff up. Unfortunately, while these errors may not be repeated, the issue with chlidren being put on Medicaid or CHP+ plans and affecting subsidies is real.


Kathleen Sebelius announces new mental health parity requirements for health insurers |

Kathleen Sebelius announces new mental health parity requirements for health insurers |

Sebelius said the administration will post regulations Friday requiring that insurance companies treat mental health issues the same as physical health problems. The new regulations will apply to both outpatient and residential treatment for mental health and addiction, which means patients would have the same deductible and co-payments they’d have going to any other doctor.

The article goes on to say “this isn’t new” so it should be built into the premiums seen today. If not, or the regulations are more extensive than planned on, this will generate even higher rates.