ACA Deductable Misinformation?

Jul 12, 2016

  1. Experienced Agent
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    Experienced Agent Super Genius

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    Just received CMS newsletter stating "effective deductible" is down from $900 in 2015 to $850 in 2016. This causes me to think of two questions:

    1. WTF - could this be factual or are they trying that hard to sell this loser program?
    2. How many or what percentage of previous years ACA agents are going to continue to produce in this market?

    I'm thinking I'll just let the few clients I have go. Give them a friendly agents phone number or .gov number. It's hard to let clients go, but this market is such a negative that it's not worth it.

    Nick
     
  2. DS4
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    What deductible are you talking about?
     
    DS4, Jul 12, 2016
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  3. Yagents
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    EA is referencing the info below that came out today. The reason the deductible is being quoted so low, is because Obamacare is HEAVILY weighted to the under 200% FPL crowd, and most buy the Silver CSR 87 or 94% plan getting extremely low deductibles. It's the same reason why 85% get tax credits on the Marketplace, and the average premium is $7.98/mo. So yes, their numbers are accurate based upon the real make up of the exchange base.

    It's puzzling how the pain for the 300% and above crowd is not discussed.

    https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-12.html

    It's a no brainer to walk away from 7 clients, it's a problem if you have 700.
     
    Yagents, Jul 12, 2016
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  4. kgmom219
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    kgmom219 What's Next?

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    That article made me sick...literally
     
    kgmom219, Jul 12, 2016
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  5. tonyisme
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    We had 2 clients fail to pay their premiums timely. They cant get reinstated. They cant buy anything except stm. Some went to a christian cost share plan. CMS is promoting fiction and we all are being shafted
     
    tonyisme, Jul 13, 2016
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  6. Experienced Agent
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    I only pick up a dozen or so clients each year on ACA. It's only spinoff business from my Medicare clientele. It's nice to be able to offer help when my senior clients tell me how much difficulty their child or grandchild is having with their health insurance. I'm able to further solidify the relationship and be there for the whole family.

    They are making it real hard for agents to part time it selling individual health. I'll probably stick it out for one more year then see what happens. I don't think this program will last more than that if it stays on it's current trajectory.

    ----------

    All of these articles from CMS and their supporting cronies like the Kaiser Foundation put such a lovely spin on the ACA. They don't mention the shift in provider options for insured members of these plans. My family physician chose to become a ACA provider and it so dramatically changed his practice that it is unrecognizable from 5 years ago.

    He's in a large facility that is attached to the hospital. The waits have increased beyond weeks to see him. That's only if you have a medical poblem which they screen you for. In other words it's not as simple as telling them your tummy hurts and you get in. He told me to schedule a physical exam it would be a one year wait. It took him a while to even recognbize me when I last saw him. He was in the herding cows mode that ACA creates. He also has a very different demeanor, almost like he's pissed off.

    I guess I'd be pissed off if the government shoved a pay cut down my throat. Oh that's right they did! ACA and MAPD!
     
  7. Yagents
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    This is more like it. At least half my clients have $6500 deductibles.

    http://www.modernhealthcare.com/art...ntent=20160712-NEWS-160719979&utm_campaign=am

    The median deductible for a person who bought a health plan on the HealthCare.gov marketplace is $850 this year, down from an average of $900 in 2015, as more people qualify for cost-sharing subsidies, according to new HHS numbers.

    But that median figure hides an interesting fact from the same report. This year, 43% of marketplace enrollees still have an average deductible of at least $2,500, a burden for people and families who are low-income or middle-class and face a large healthcare expense, like a hospitalization.
     
    Yagents, Jul 13, 2016
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  8. kgmom219
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    kgmom219 What's Next?

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    The other issue is that BOTH reports are only measuring On Ex. If Off Ex was added, the number would skyrocket.
     
    kgmom219, Jul 13, 2016
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  9. junkman
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    This is a cluster f-headache. There is an underlying 60% rate increase coming and someone has to pay the premium. Those receiving the subsidy don't feel the hit but most I've enrolled don't want to pay anything and have chosen high deductibles. Several drop coverage anyway and that part of the business is not profitable (for me). I don't intend to jump through the hoops to be certified for 2017.

    Off-Exchange business will feel the full hit of the rate increase. One client is Currently at $12,000 for the $6,400 OOP BlueCross S networh HDHP plan. He is looking at forcing a group (unlikely) or short term if there is a short term that have exclusions that he can live with.

    I've only looked at UHC short term but there are glaring coverage holes - $3,000 RX limit, outpatient surgery are what I remember from scanning the brochure. I haven't seen the actual cert yet.

    Current premium 12000 x 1.6 = 19,200 x 1.3 = 24960. This person is not willing to pay 44,160 over the next 2 years in health insurance premium.

    WTF

    Are there any short terms that actually plug the holes after the OOP is met?
     
    junkman, Jul 20, 2016
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  10. kgmom219
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    kgmom219 What's Next?

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    STM plans are not going to be equal to an ACA plan. Then there are the claims issues, pre ex issues and a "review" period that will change STM plans to a 3 month max.

    Options...metal gap plans on top of ACA, Fixed Indemnity (but will incur the penalty unless they fall into the 8.3% rule). Switch carriers to get out of the 60% increase. Create a group.

    The options are limited at best.
     
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