Author Archives: Reeve Conover

Information you should know in NY

It has been a very difficult and challenging enrollment period for many of my clients – for several reasons:

  • The failure of Health Republic has forced clients to change plans twice – once for December 1, and then look at all new plans for January 1.
  • OSCAR Healthplans no longer covers New York Presbyterian, Weill-Cornell Medical Centers, and NY Methodist Hospital centers.
  • Oxford has introduced their new Network- Oxford Metro – a smaller network, required on individual plans beginning January 1.

The Oxford Metro Plan seems to have been ignored by physicians initially, and so now many are scrambling to join after hearing from their patients that they will have to leave.

Brokers are suddenly backing away from doing individual sales. Why? Health Republic has also not paid commissions to brokers. OSCAR just reduced the monthly commissions to brokers to $6/month – not enough to cover the time and work to enroll you, nevermind providing service during the year.   Broker commissions have been cut more than in half the last few years.

And with more than 7.5 million uninsured, I would have expected more demand from those previously uninsured – but we are not really seeing a big rush this year, possibly because of the large rate increases.

Meanwhile, even the authors of the PPACA now have the Cadillac Tax in their sites for elimination. Both Reid and Pelosi now look to repeal the tax – mostly because of the enormous objections of unions around the country – their negotiated benefits would be in danger beginning in 2018.

The Supreme Court of the United States has agreed to hear another challenge to the Affordable Care Act’s birth control mandate. It’s the fourth time a provision of the ACA will be considered by the Supreme Court and follows the controversial ruling in last year’s closely watched Hobby Lobby case.

With 3 weeks left in the open enrollment season for 2016 coverage, we continue to guide as many people as we can, and can only wonder what the future brings.

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

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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.
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