Feds Not Paying Insurance Companies Subsidies

[AllenChicago]

My HCSC/BCBS-IL commission check this month is 50% of normal. Something has happened at Blue, or to Blue.

Maybe this is how HHS is strong-arming some of them to stay for 2017..and reduce their requested rate increase percentage.

Or, if it's just the HCSC Blue Crosses not paying timely/properly this month, I blame their mass employee layoffs. The senior Payroll people were probably at the top of the list, for obvious reasons.

 

[kgmom219]

My HCSC/BCBS-IL commission check this month is 50% of normal. Something has happened at Blue, or to Blue.

Maybe this is how HHS is strong-arming some of them to stay for 2017..and reduce their requested rate increase percentage.

Or, if it's just the HCSC Blue Crosses not paying timely/properly this month, I blame their mass employee layoffs. The senior Payroll people were probably at the top of the list, for obvious reasons.

AC....look at your autodrafts. That may be it. When did they post? Part of the RPP upgrade is changing all drafts from "whenever they felt like it" around the 28th to the first business day of the month. TX still drafted on the 28th, but HCSC is implementing Texas last. Im expecting it to hit us next month.

 

[AllenChicago]

AC....look at your autodrafts. That may be it. When did they post? Part of the RPP upgrade is changing all drafts from "whenever they felt like it" around the 28th to the first business day of the month. TX still drafted on the 28th, but HCSC is implementing Texas last. Im expecting it to hit us next month.

Very few on autodraft, due to too many end-of-year issues. All BCBS-IL agents are reporting 50% less this month. Oh well.. it seems to be isolated to Illinois. Will work on this locally. Thanks for taking the time, KGMom.

-AC

 

[junkman]

I agree with you, don't misunderstand. I don't intend to sell health shares, I will sell short term.

It can be hard to compete with the health shares, though, especially for bigger families/religious.

I'd like to know what STM medical you plan on selling. Limitations are almost more important than benefits. UHC called me to talk about theirs. Starts off with no coverage for pre-ex. That means you better have the client pull medical records and see what's there.

I have a client with both hips replaced ~5yrs ago. Hips are working fine BUT, he's SUPPOSED to see the Doc every year but hasn't because total charges for that visit come to $500 that he'd prefer to keep in his HSA. Ok, suppose he falls off his bike and damages a hip. Excluded because he was still technically under a Dr's care.

Move on to RX, $3,000 absolute limit. He takes only $2.50 worth of blood pressure meds but $3k won't go far if something happens.

Suppose he had no pre-ex and fell off his bicycle. Any significant trip to the ER or inpatient would put him over the limitations.

This particular plan can only be purchased for 11 months. I was hoping that he could ride the January grace premium and add STM medical but I wouldn't insure my dog on that (and consider it decent coverage).

Alternatively, he's at $12,000 premium this year for the lowest BCBST S network plan with a $5,200 deductible & $6,400 OOP. None of the carriers had a better deal. A 60% increase approaches $20,000 for the family. Add $7,500 to fund the HSA and he's at a point where even with a $150,000 Schedule C income, the price is out of the ballpark. Since he's self employed, he has to fund retirement accounts too.

So:
$20,000 Health, 7,500 HSA, 13,000 Roth, 20,000 SEP oh yeah, I almost for got Federal SSI & tax 20,000 (actually more), State Hall tax another 1,000 or so and another 3,000 for property tax. That's ~$84,000 before he spends anything on food, house or cars. Changing his business structure to a Corp or LLC doesn't help because he either pays self employment tax now, basically the same thing under a corp OR federal and state tax on anything he takes as a dividend.

 

[TN_agent]

I wouldn't recommend stm in that situation. Your client is the exact person getting screwed the hardest in the state of TN. I have a self- employed 64 year old single woman with no pre existing, no meds, very good health, not being treated for anything no abnormal paps, makes 70,000 a year. Going on Medicare next November. She is my candidate for the short term come January. Stm is a viable option for SOME people, not everyone.

Your client may want to look at the farm bureau TRH compliant plans for 2017 will probably be the cheapest HSA eligible plan with a decent network. I hear their rate increase was a lot less than 62 percent.

Sorry.

 

[bluemarlin08]

Can he do a group plan? Doesn't have many options. TRH will save about 10% on current plan, don't know what 2017 rates will be.

 

[TN_agent]

According to Ratereview, TRH Bronze (ACA compliant) HSA rate increase was approved at 16%.

Looking rough for Indy agents in TN even if the carriers are willing pay something, especially off-exchange. TRH is captive.

 

[bluemarlin08]

I hate sending business elsewhere but I am a firm believer that you never go wrong doing right.

 

[junkman]

I just looked at Farm Bureau and they have a 1 yr pre-ex with a severe definition. Most of their agents are idiots. I had a friend covered by them that couldn't pass underwriting with BSBST. I told here to roll to an HSA with Farm Bureau. The supervisor in the local office didn't know what an HSA was and told here that they didn't have them.

It looks like this guy will either pay the premium or go without. It's sad when a year of the cheapest medical premium will buy a good car.

Here's the pre-ex verbiage from Farm Bureau's site. Pre-ex goes back for ever. That would technically make a 15 yr ago stroke a pre-ex.

"An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this
contract for which: Medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment." The pre-existing condition waiting period does not apply to members under the age of 19."

 

[TN_agent]

junkman, TRH Farm Bureau does have ACA compliant options, which would not allow exclusions for pre-existing conditions. They also sell non-compliant plans. Sounds like you were looking at those.

On their site, the plans that start with the letters "FBHP" ARE ACA compliant. Read the schedule of benefits for those, you will not find any asterisks for exclusions for pre-existing and you will see that they do meet ACA requirements for minimum essential coverage and minimum value on page 8 of the summary of benefits. Would be pretty bold of them to claim ACA compliance in black and white like that if it weren't the case.

Your client would be able to tell if a plan meets ACA requirements pretty easily. IF they will let them on the plan right now or with an other than 1st of the month start date, it is non-compliant. If they get an "open enrollment is closed", those are the ACA compliant plans.

I am not going to disagree with your assessment of their agents, though.