HSA - Embedded Deductibles vs Family Deductible

[somarco]

Aenta plan gives better value:

It has an immediate PT benefit
It has an immediate well-woman benefit
It has an immediate well-child benefit
It has a Prosthetics benefit
It has a DME benefit

PT limited to 24 visits per year $25 each after satisfying the $5000 deductible.

Well visit for adult, about a $200 - $250 benefit.

Well visit for child, about $100 benefit.

Prosthetics limited to $2000 per year.

DME limited to $2000.

Deductible is $1500 higher.

Premium is $984 per year more.

What am I missing?

 

[arnguy]

Al3, have you considered trading in your wife for a less expensive, younger model? Sort of like trading a Lexus for a Chevy Geo. Of course, with the California community property laws your current spouse could take to the "cleaners."

 

[GreenSky]

PT limited to 24 visits per year $25 each after satisfying the $5000 deductible.

Well visit for adult, about a $200 - $250 benefit.

Well visit for child, about $100 benefit.

Prosthetics limited to $2000 per year.

DME limited to $2000.

Deductible is $1500 higher.

Premium is $984 per year more.

What am I missing?

You are missing nothing because YOU are a PROFESSIONAL insurance agent and can actually do the math.

By the way, the comparison Al uses to a Blue Cross plan is a bad comparison. Blue Cross benefits for well-care are terrible. He won't use Nationwide until Health Net takes over the Farm Bureau program but says Health Net has a bad reputation. He has said Blue Shield doesn't issue policies quickly enough.

Al, when Aetna pisses you off, who will you use? There will be no one left.

Rick

 

[Guest]

He has said Blue Shield doesn't issue policies quickly enough.

No I didn't. I said that Shield has terribly strict UW right now such that it's hard to get anyone over age 50 in at even tier-2, much less tier-1.

Al, when Aetna pisses you off, who will you use? There will be no one left.

Look. I've been in and around the health insurance biz for 30 years now. I wrote the friggen front-end processing for Blue Shield's MediCal system in 1975 (when I was with EDS). I've worked for the blues, for the CA Dept. of Health Services, Delta Dental, Dept. of Managed Care, Foundation Health, and a few others I forget.

If there is one thing I've learned it's that this business is cyclical in that the company that is a 'hero' today, becomes a 'goat' tomorrow... and the company that is horrible today gets new management and comes back strong. For years Aetna people couldn't spell C-A-T without being spotted the C and the T. Now they are back in CA and from my perspective they are kicking butt.

I hear NW was "the bomb" as the kids say, in the past few years. Now they are a case study in disorganization. HealthNet (up here) was everyone's favorite (for group, anyway) and then they went down hill (and I heard almost tits-up), but maybe the Farm Bureau will get them in shape again.

And finally, it's all moot. I don't believe there will be a viable IFP market 24 months from now. You can rant and rail about one-payor or uni-coverage until the moon turns blue, but the current system is not sustainable and it will CHANGE, and my bet is that you and I won't be part of that change. If you have half a brain you will be looking for a different sector of the financial services business to get into... just in case I'm right and you're wrong.

That's why I write worksite for Colonial. That's why I'm looking at LTC as well as annuities for boomers.

And Rick, as to who is and who is not a professional... I'll let you make that determination as I'm sure that you are the most qualified person in this community to make those pronouncements. IF I'm not 'a professional' in your opinion... than I guess I'm not.

I can live with that.

Al

 

[GreenSky]

And Rick, as to who is and who is not a professional... I'll let you make that determination as I'm sure that you are the most qualified person in this community to make those pronouncements.

Finally, we agree on something.

Interesting discussion and I'm looking forward to the opinions of the other professionals on this forum.

Rick

 

[TXINSURANCE]

I think the moral of the story is there is no correct answer.

Show the client both models - both scenarios and let them decide which THEY prefer

I have clients I have sold $5000 deductibles before that had a major claim in the first 6 months that would do anything to turn back the hands of time and buy a lower deductible.

I also have clients that have been on $500 deductibles for 4 years and have flushed thousands down the toilet in premiums.

It is insurance and everything is a roll of the dice... I can think of the scenerio of someone buying HSA vs. PPO and he runs over his foot with his lawnmower after a month of membership and doesn't see the short term value of high deductible.

It is our job as an agent to explain the pros and cons and let the client decide what is their comfort level.

There is no right or wrong answer in the end...

 

[somarco]

I don't believe there will be a viable IFP market 24 months from now.

Then as far as you are concerned there will not be.

I started in the business in 1972 while in college. Went full time in 1975 with a small consulting firm that specialized in large employer groups. I worked that market (large group) almost exclusively until about 3 years ago when I got into the individual market & small group.

This is a very lucrative market and will remain viable for a long time.

How do I know?

Because I believe in it.

Agents have been bitching about their business for as long as I have been in it and they were probably doing so before. They will continue to bitch & moan about how bad life is and the business is going away.

For them, it already has.

I see a wonderful opportunity to earn a living everywhere I look. Hardly a day goes by when I do not encounter someone who needs my help.

Sure, there are days when I want to walk away and do something else. But I did that about 7 years ago and wish I had never left.

I will continue feasting off other agents who gave up a long time ago.

 

[Dave020]

No I didn't. I said that Shield has terribly strict UW right now such that it's hard to get anyone over age 50 in at even tier-2, much less tier-1.

I am too busy to dig through and replay the thread where you actually said you could "kick my ass" because all people over 50 are not risky for underwriting with Blue Shield contrary to what I think. Wasn't I labeled the "voice of Blue Cross" by you for exactly this? Now you don't like their underwriting anymore? Don't deny it because I can find the thread and pull it back up.

If there is one thing I've learned it's that this business is cyclical in that the company that is a 'hero' today, becomes a 'goat' tomorrow... and the company that is horrible today gets new management and comes back strong. For years Aetna people couldn't spell C-A-T without being spotted the C and the T. Now they are back in CA and from my perspective they are kicking butt.

Funny that Blue Cross has really never been the goat, at least in the buying public's perception. It's easy for Aetna, now, they dumped a ton of uninsurable people onto the market a few years back when they pulled out of the market. Several thousand as I recall, all uninsurable, all to MRMIP which completely flooded the program (as did the Cigna move a few years later). It's easy to kick butt when you don't have risk hanging out there on your books. Good business model though, too much loss, abandon the market and come back later - some guy whose been in and around health insurance for 80 years is BOUND to fall for it.

I hear NW was "the bomb" as the kids say, in the past few years. Now they are a case study in disorganization. HealthNet (up here) was everyone's favorite (for group, anyway) and then they went down hill (and I heard almost tits-up), but maybe the Farm Bureau will get them in shape again.

Both carriers are guilty of buying bad business in the last few years. Health Net would write anything with a pulse and underpriced their plans substantially. It bit them in the butt. Nationwide, well, NAIC complaint ratio is 30 for last year - Mega is 5.1. You don't need a map to figure out what that is all about. BTW, Cross, Shield and Net all came in under 0.50 complaint ratio - the median being 1.0. Now if you are 6 times worse than Mega, well...............

 

[Macdaddy]

Finally, we agree on something.

Interesting discussion and I'm looking forward to the opinions of the other professionals on this forum.

Rick

My opinion is that Al needs to listen to Rick.

Al is a Senior, and Rick is a Certified Senior Advisor. Case closed.

 

[GreenSky]

My opinion is that Al needs to listen to Rick.

Al is a Senior, and Rick is a Certified Senior Advisor. Case closed.