Author Archives: Reeve Conover

Who loses in the giant Jenga game called ObamaCare?

When ObamaCare loaned $2.4 billion dollars to establish 23 not-for-profit CO-OPS around the country, their intention was to create lower-priced options and foster competition.

You already know that more than half of these CO-OPs have now failed, costing the taxpayers about $1.2 billion in loan defaults. These defaults are directly related to the failure of the Government to provide the promised third year funding to these CO-OPS. They left the CO-Ops with badly damaged balance sheets, and the inability to pay claims.

This leads to a new problem – The largest CO-OP, Health Republic in NY, owes hospitals an estimated $150 Million in claims that may never be paid – because they didn’t get the promised funds from ObamaCare. It remains to be seen if the smaller hospital networks can survive that kind of a loss.

We know that commissions are not getting paid to brokers, and by extension you have to assume that other providers – Doctors, Laboratories, etc – are going to get stiffed as well. One can only assume the issue is the same for the other 10 failed CO-OPs, albeit on a smaller scale.

In a great quote, the CEO of Health Republic Oregon (which also failed) likened ObamaCare to a giant game of Jenga. “You can only pull out so many pieces before it will implode on itself.”

From the outset, the CO-OPs were prohibited from using the seed money for advertising (how were they supposed to attract members?).   A popular uprising occurred after the administration broke their promise to allow you to keep your health plan – a move designed to force people into the new plans; so President Obama reversed that decision, taking customers out of the CO-OP market.

Then, under Republican pressure, The President vowed no taxpayer money would be used in the bailout funds, leaving only funding from insurers who made profits. The result was the government couldn’t pay the CO-OPs the promised funds this October, collapsing the system. Insurers had already locked into the premiums for the coming year and couldn’t raise them now, to balance the lost funds under the law. So they closed.

And we all get crushed by the falling pieces.

“I want a Regular Plan, not an ObamaCare Plan.”

I hear this pretty much every day.   Along with “These plans are horrible – I don’t want a big deductible”, “My Doctor/Hospital doesn’t take any of these plans” and my favorite “the prices are really high, I thought this was supposed to be affordable”.

So why not take a “Regular Plan.” Lacking a time machine, its just not possible. See, ObamaCare is not a type of plan – it’s a law. Specifically, the Patient Protection and Affordable Care Act. It governs almost all health plans, setting minimum levels for coverage, underwriting, and pricing guidelines along with a host of other rules.

To make a very long story short – these are the only plans. You can buy on the marketplace/exchange, or off the exchange – but the choice of insurance companies and plans are the same. There is no “Regular Plan” anymore.

What about that sign stapled to the telephone pole on the corner that says “Medical and Dental Plans – Not ObamaCare” (another common question). Those plans do not meet the minimum essential coverage levels under the PPACA. Typically they will pay for a couple of doctors visits, and a few days in the hospital. Almost as important – you are still subject to the fine, 2.5% of your income this coming year – because you don’t have minimum coverage.

So if your household income is, say, $40,000 – you pay the premium, get crappy coverage, and still get fined $1,000 next year for not having adequate coverage.

Or you can hop into my DeLorean, and we can take a ride back in time.

Individual Dental in South Carolina

There are several dental options available to individuals in South Carolina.  While there is no such thing as a “great” dental,” there are a few good ones.  Among Madison, Companion and Spirit – I like the Spirit Dental the best for several reasons:

 

  1.  You can use any Dentist – no network requirements on the indemnity plan
  2. The plan covers everything in the first year to some extent, while all the others don’t cover major services for the first 6 months or a year.
  3. The pricing is very reasonable
  4. You can select your annual Maximum- $1200, $2500 or $3500
  5. It comes with a vision option

If you want to know more, just email the office.

HeathRepublic Contracts to End November 30!

As you are likely aware, Health Republic members were recently notified that their coverage would be ending on December 31, 2015.  Beginning this evening, all 2015 Health Republic Individual Marketplace enrollees will be receiving a notice from the NY State of Health stating that their coverage with Health Republic will be ending on November 30th, 2015. Starting on Sunday November 1, 2015 the current Health Republic enrollees will be able to log into their Marketplace account and enroll in a new health plan effective December 1, 2015.  They will not see the SEP screens and can go straight to the plans tab and select a new plan.  Members must make their selection before November 16th in order to have coverage for the month of December.

 

To select a plan:

 

  • Log in to your Marketplace account before November 16th and visit the “Plans” tab at the top of the screen.
  • Select “Find a New Plan” at the bottom of the screen to see your health plan options.
  • In the section on receiving assistance, be sure to add my NPN number 1982826
  • Once you have chosen your plan, be sure to select “confirm and checkout” to confirm your enrollment in your new plan for December 1, 2015 coverage.
  • There is a dedicated NY State of Health customer service helpline to assist consumers who need additional assistance: 1-855-329-8899

NY Presbyterian leaves Oscar Network

From Oscar 10/30/15:

We’re writing to let you know about an important change to our provider network. Effective December 1, 2015, NewYork-Presbyterian facilities and affiliated providers, including New York Methodist and Weill Cornell Medical Center, will no longer be part of the Oscar network.

We made this decision to support our goal of providing affordable plans while maintaining high quality care through our network of top New York hospitals. We will be contacting existing Oscar members who have received care from a NewYork-Presbyterian affiliated provider or facility to help them find care through this transition.

Should you have a question about a doctor’s network status, we encourage you to visit our doctor search or call us at 1-855-OSCAR-55.

September 2019
M T W T F S S
« Aug    
 1
2345678
9101112131415
16171819202122
23242526272829
30  

Sign Up To Our Newsletter

Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
FINRA.org - SIPC - Brokercheck