Georgia Obamacare Combatants
- Thread starter somarco
- Start date
- Cigna 0%
- Humana dropped POS plans, HMO up 62% so it doesn't matter
- Aetna hasn't announced
- Have no info on BCBS or Ambetter
Coventry and UHC are gone.
The market in GA is done for IFP, I have some very long term clients that I will help as a going away gesture but that's it
- 213
The only companies surviving Obamacare abd offering Major Med are the ones whose names appear on the side of their in-network hospitals.
I would look at Kaiser. They will likely price well and pay you fairly. Other than that short term coverage is our recommendation to folks who want an old-fashioned PPO network and have no present ailments.
The reason I advocate HMO or STM is simple: The death spiral has begun, and in a year or three we will all be on Medicare or returning to the old system with changes to our indigent programs, such as higher income limits and a program offering a narrow network of quasi-governmental medical facilities to folks with major pr-existing conditions and somehow no coverage.
All plans should be thought of as short term at this point. The only question is whether a consumer needs a pre-existing condition covered as the penalty is a pittance.
As an an agent with a BS in Political Science, I fervently believe in the above positions and predictions.
I would look at Kaiser. They will likely price well and pay you fairly. Other than that short term coverage is our recommendation to folks who want an old-fashioned PPO network and have no present ailments.
The reason I advocate HMO or STM is simple: The death spiral has begun, and in a year or three we will all be on Medicare or returning to the old system with changes to our indigent programs, such as higher income limits and a program offering a narrow network of quasi-governmental medical facilities to folks with major pr-existing conditions and somehow no coverage.
All plans should be thought of as short term at this point. The only question is whether a consumer needs a pre-existing condition covered as the penalty is a pittance.
As an an agent with a BS in Political Science, I fervently believe in the above positions and predictions.
- 1,926
I totally agree, either get in a group or if no pre ex, jump to a quality STM, unless the penalty offsets savings. Talked with a doc tonight at a wedding and she wants a big network, no pre ex, even with fine on 400,000, she wants a big network.
- Thread starter
- #5
Had 2 former clients ask what is available for 2017. Neither will qualify for group. Both are 1099 employees.
I refuse to write STM.
None of this is my problem since I am out of Obamacare and have been for 2 yrs. I really was asking for a friend.
In this case 2 friends
I refuse to write STM.
None of this is my problem since I am out of Obamacare and have been for 2 yrs. I really was asking for a friend.
In this case 2 friends
- 1,926
What do you see are the main issues with stm other than pre x and penalties?
- Thread starter
- #7
Denied claims and E&O.
The p-x issue is complex. Much more to it than just the initial application & underwriting.
What if you had a heart attack, or serious accident the last day of the term. Surgery can't be scheduled until the next day . . . after your policy has expired.
Years ago I had a client that, unbeknownst to me, let her regular coverage drop and bought an STM. She was going to be married in a few months and would be going on her new husband's group plan.
In the interim she was in a serious car accident with long term residual issues. Her STM benefit ended. New coverage was denied and so was her application to "reinstate" her old policy.
This was pre-Obamascrew days when underwriting was the norm.
Even in this gun-slinging, free wheeling time of carriers insuring anyone including the walking dead, what happens if there is a gap between expiry of your STM but before your Obamacrap policy kicks in?
Everyone is screwed.
Everyone except me because I don't like the Russian roulette odds.
The p-x issue is complex. Much more to it than just the initial application & underwriting.
What if you had a heart attack, or serious accident the last day of the term. Surgery can't be scheduled until the next day . . . after your policy has expired.
Years ago I had a client that, unbeknownst to me, let her regular coverage drop and bought an STM. She was going to be married in a few months and would be going on her new husband's group plan.
In the interim she was in a serious car accident with long term residual issues. Her STM benefit ended. New coverage was denied and so was her application to "reinstate" her old policy.
This was pre-Obamascrew days when underwriting was the norm.
Even in this gun-slinging, free wheeling time of carriers insuring anyone including the walking dead, what happens if there is a gap between expiry of your STM but before your Obamacrap policy kicks in?
Everyone is screwed.
Everyone except me because I don't like the Russian roulette odds.
- 1,926
I appreciate your feedback. Are you suggesting E and O won't cover my liability selling stm? I will check with my carrier tomorrow. I view pre ex as any pre ex and one shouldn't consider if there are any. Regarding gaps, if designed correctly, coverage termination should be coordinated with ACA so there wouldn't be any. Most plans leave a 30 day gap, I see a STM to begin Feb 1 terminating Dec 31. One might need to buy a one month coverage for Jan till new STM takes effect. I have talked at length with the UHC folks regarding blood pressure meds, cholesterol meds and lipid meds as they relate to pre ex. They all stated that if records confirm meds keep them in normal range not considered pre ex as relates to Hear t attack or stroke. I have recorded these statements. Folks are going to be left with bad networks or raped by US Health advisors. Try going on line and search for health insurance, complete a questionnaire and the only folks that call are US Health folks. I haven't sold ant STM yet, still studying.
E&O is going to cover it.
What I want to know is what you got in writing from UHC on pre ex for HBP meds and strokes/heart issues. The people you are talking to on the phone have zero authority.
I don't hate STM and I think it has its place (especially between now and 1/1), but I sell it as "if you are in the back of an ambulance or find a strange lump", there's not an "I don't have insurance" panic attack.
The 1 month ACA then 11 month STM strategy scares the crap out of me. But I'm in an area that has a low cost option. If I didn't, it would be the 300-600 FPL strategy. With a docu-sign document that alleviated me from liability.
And US Health is NEVER a viable option.
- 1,926
Why does that scare you? What do you suggest for a couple with 2 kids and new rates going to 2000 a month? They don't have the increase. They could go medi share or they could go STM. When clients ask for their options do you not show STM? The last person I talked with at UHC said they couldn't make a claim against HPB, or other those meds by law. Just telling you what they said.
I fail to see the problem with pre ex if the client says no issue or say they haven't been to a doc in 5 years.
I fail to see the problem with pre ex if the client says no issue or say they haven't been to a doc in 5 years.
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