CMS: STM Limited to 3 Months - No Renewal Allowed

[yorkriver1]

So the gov can not fix the Hillary "family glitch". So they are choosing to make it much worse by getting rid of STM. Amazing simply amazing

Yes, that is so weird, given the generosity of tax credits based on lower incomes. They could pull in more people to the pool.

At least we still have individual full price ACA compliant plans to save some money for families whose spouse/kids share of employer plan is unaffordable.

 

[AllenChicago]

Companies selling Short Term Medical continue to raise their premiums far above what is required. Even if STM contained all the ObamaCare bells and whistles, $830 a month for a $5,000 OOP 6 month STM plan (Male 61 / Child 17) is too much $$$.

But that's exactly what the current crop of STM plans cost. They cover no Pre-X, contain no "freebies", and only expose the insurance company to 6 months of minimal risk. Talk about financial rape..jeesh!

I guess these companies hear the plump lady warming up, and want to get all the cash they can before shuttering the company, or sputtering along on dental, injury, vision, etc..

 

[tonyisme]

They just trying to make up their aca losses using their STM product sales

 

[Yagents]

Game changer:

http://www.nytimes.com/2016/07/06/u...tter&WT.mc_ev=click&ad-keywords=smartbriefsnl

 

[kgmom219]

Game changer:

http://www.nytimes.com/2016/07/06/u...tter&WT.mc_ev=click&ad-keywords=smartbriefsnl

Yep. It is.

What's the appeal situation?

 

[Yagents]

No idea..............

 

[Ann H]

There are several issues here, and this really only affected one of them, which is the requirement to carry MEC before purchasing Fixed Indemnity.

For carriers to create a product out of STM and/or Indemnity there are still hurdles to cross.

1. HHS previously said that Fixed Indemnity must actually be fixed. In other words, it must pay per diem or per item, but it cannot pay a part of the whole fee. For instance, it cannot have a deductible, co-insurance, and out-of-pocket maximum. This still hinders insurers in creating a good product. They could do it, mind you, since they have allowable fee schedules in every in-network contract, but it's much more difficult this way.

2. To be any kind of acceptable alternative to ACA, Fixed Indemnity and STM products must remove the pre-ex waiting period (or give credit for prior coverage), underwrite properly at app time rather than at claim time, and remove any weird inside limitations and exclusions. The FI and STM of yesteryear is just not acceptable as an alternative to ACA in any way other than price!

3. The client must be exempt from the Individual Mandate penalty, or that penalty must be a lot lower than the premium savings. Of course, with these price hikes, more and more Americans are exempt simply due to the 8.13% unnafordable provision alone.

In spite of those hurdles, it is so much better price wise, that it's a point of interest. I don't know about other states, but here in AZ, pre-ACA policies that are grandfathered or grandmothered have been MUCH less expensive than ACA products every year. For 2017, the price difference will be crazy! These plans were underwritten correctly, and most had no pre-ex if fully disclosed and accepted at app time. They are all wide-network PPOs, with nationwide access. And yet, they are much less expensive than comparable ACA plans. I'm talking about apples-to-apples premium comparison, not involving subsidies. So, the risk cost of underwritten plans is much less. That's where the threat to ACA lies, and why CMS is trying to kill Indemnity and STM.

I don't know what's up with the carriers. A major carrier withdrew from our market this year, and sent 2 emails that suggest STM and FI as an alternative for the clients who just lost their plans! A very large General Agency here in town just did the same thing. Personally, I can't do that, because the FI and STM products are not updated to a quality level. But I wonder what these carriers may know that we don't.

 

[somarco]

I wonder what these carriers may know that we don't.

Let's examine their track record.

Jumped on board with Obamacare. Check.

Jockeyed for position, hoping to have the lowest cost plan. Check.

Offered broad PPO options. Check.

Surprised when the reinsurance didn't pay off. Check.

Having multiple oh shet moments as the red ink flows. Check.

So this time around they really understand the market and believe they will make a killing off limited benefit and short term plans. Check and check.

 

[AllenChicago]

Game changer:

http://www.nytimes.com/2016/07/06/u...tter&WT.mc_ev=click&ad-keywords=smartbriefsnl

I read it, but don't see how this reversal "changes our game". Please share your reasoning, YAgents. TIA.

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Well 2 things...

When is this proposed rule set to be heard enacted. I missed that in the article.

Secondly, should it be enacted I can see the current marketing push by at least one carrier going up in smoke!

Did CMS/HHS push this new rule into effect already? Suddenly BCBS-IL has pulled all STM quoting capability and brochures/apps from the public and agent sections of Health Insurance Illinois | Blue Cross and Blue Shield of Illinois.

 

[yorkriver1]

I wonder if NAHU will lobby for, say, recalculation of affordability based on group cost for a whole family. That could help. Either way, big deductibles are still an issue.
I think we need a cultural change from taking a pill for everything to eating better and exercising. We are supposed to be so independent and freedom loving. I know it doesn't prevent everything, but in houses of the chronically ill I often see junk food everywhere. A few of them are turning the corner, learning to eat better, walking for health, etc.