HSA - Embedded Deductibles vs Family Deductible

[Dave020]

On 8/25/2007 Al wrote:

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.

On 4/24/2007 Al wrote:

Well I can only assume that Dave is one of the many of the populace who believe that everyone over 55 is physically 'washed up' and that they will never get Tier 1 rates. However, most of my over 55 clients get it... as did I (I have the BS Spectrum 4000 HSA) and I'm a few months short of 60... and I'm somewhat certain that I can kick Dave's ass any day of the week :-) <g> {just a joke folks... so don't get your knickers in a knot!} I work out with weights and run 2 miles a day (for over 30 years now!).... and there are tens of millions of people my age who do the same... do please don't group us all as being "over the hill." While we might see the top if it, we're not there yet!

How does Dave come the the conclusion that Shield's Tier-2 is their standard rate? TTBOMK we only get paid on Tier-1. To my way of thinking this would be their 'standard' rate.

which is it? Do most of your over 55s get Tier 1 or not??

 

[Frank Stastny]

My opinion is that Al needs to listen to Rick.

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

I readily admit that I don't sell health insurance so I have the luxury of looking at this strictly as a consumer and what will be the best use of my money to get the most favorable plan.

I must say that if I were put in a positing of having to purchase health insurance, I believe that Rick's logic makes a lot of sense and I would follow his recommendation. Rick has been an agent for a long time and I would feel very comfortable with him as my agent. Number of years in the business is also important to me when selecting an agent. I like to deal with experienced, very successful agents.

Don't get all twisted up Al, my decision would be based on logic, the best investment of my premium dollar and Rick's recommendation as a very successful, trustworthy agent.

 

[Guest]

On 8/25/2007 Al wrote:



On 4/24/2007 Al wrote:



which is it? Do most of your over 55s get Tier 1 or not??

Not any more. Shield was great up until mid June. Up until then I was having great luck with both under and over 55s. I had a bunch of folks APSd by Shield, but they still got Tier 1.

I've seen a change in the past two months. I can't substantiate it with figures, just my own experience and observation.

Dave you and somarco beat up on me for being 'disloyal' to the industry when I post my my disdain of how the current system works. I've long ago gone on record saying that I'm willing to be put out of business by a one-payor system or some kind of GI public/private plan.

Of course this is an easier position for me to take than many others because I don't need to be in this business. I've got the option of playing golf all day. But I like what I do and WHY I do it. If you go to my website and can muddle through the tortured prose there, you will see what my mission is.

We will tell you what no other agency will tell you, but which you already know. The entire healthcare system is broken... and you can't fix it and we can't fix it. [FONT=Arial,Verdana,Helvetica,sans-serif]The best we can do is "mitigate" it.

I'm a "client-guy" and in my opinion you and others are an "industry-guy". I see a semi-adversarial role between the agent and the carrier, even though by law and convention we actually represent the carrier and not the client.

I think many of you see yourselves as the 'lord and protector' of the health insurance industry from predatory politicians and regulators and any kind of change, especially change that is going to take your dollars out of your pocket... and I accept that because it is understandable.

I'm on the SIDE of change... even if it puts me out of a business. I don't see you standing there beside me (Dave, Rick, et. al.) That is not a condemnation, just an observation.

Could the change be "bad." Sure. For many it will be. But for many the status-quo is not bad... it is terrible.

I'm old enough (DOB 12-1-47) to remember what life was like before Medicare (which started around 1965 ... following is from [/FONT]http://tinyurl.com/253en7 )

BRIEF HISTORY OF THE MEDICARE PROGRAM

1945 --- Harry Truman sends a message to Congress asking for
legislation establishing a national health insurance plan.

Two decades of debate ensue, with opponents warning of the
dangers of "socialized medicine."

By the end of Truman's administration, he had backed off
from a plan for universal coverage, but administrators in
the Social Security system and others had begun to focus
on the idea of a program aimed at insuring Social Security
beneficiaries.

July 30, 1965 --- Medicare and its companion program Medicaid,
(which insures indigent recipients), are signed into law by
President Lyndon Johnson as part of his "Great Society."

Ex-president Truman is the first to enroll in Medicare.

Medicare Part B premium is $3 per month.

[FONT=Arial,Verdana,Helvetica,sans-serif]

I was a boy and remember the bills my mother suffered with when her mother died (a long lingering death from stomach cancer) in the late 1950s. And I remember the AMA and the BC&BS associations all across the country threatening gloom and doom if the Congress passed Medicare. (We heard the same thing about no-fault auto insurance.)

So when you guys make your snide comments about me and post your cute innuendos about me not being "on the team," my attitude now is what it was way back then toward the AMA and the large insurance carriers: Either you are part of the solution... or you are part of the problem.

I think most of you want to protect your nice, secure, lucrative "turf" and basically have a 'to hell with the "sicko's" of the country... they are all fat, lazy, on welfare, or just wanting a free-ride' attitude. And you are welcome to have that attitude and to express it.. and you are not alone in that opinion... and I think there is some credibility to it.

But I'm for change. I've worked in and around the healthcare industry for my entire life... and I'm for change.

Of course if you had a disabled family member and have fought as many insurance wars as I have, you might also be for change. Would there be fewer fights and fewer wars under a one-payor or uni-care system? I don't know. Can it get worse than it is now? Again, I don't know. I don't believe so.

But Dave, Rick, and everyone else here who might be interested, I'm willing to give it a try. If it means the end of selling IFP (as we know it) I can live with that.

And if I stand alone here, then I stand alone.

And I'll tell you one more thing. Dave and Rick and John and the carriers and all the angels in heaven singing the merits and praises of the current system is not going to prevent the change that is coming. It is going to happen. In 1960 we knew Medicare would happen... it was just a question of when. That's how it is now. Perhaps the ancien regime of this board (and industry) can slow it down, but again mark my words. You will either be seen as part of the solution... or remembered as part of the problem.

So there you have it.

As my old friend [/FONT][SIZE=-1]Patricia Andrejewski used to say "Hit me with your best shot." (Look it up!)

Al
Insurance Solutions 123


[/SIZE]

 

[Crabcake Johnny]

Yet we sit here in 2007 and although I'm only 40 I've heard "it's all changing soon" for over 20 years now. I'm waiting. A good friend of mine who's an activist told me in 2004 to basically find another line of work because inside source told him by '05 we'd have national healthcare.

Now we of course listen to the rhetoric due to the '08 elections and although it's necessary for candidates to have a "health insurance platform" it will all again fade into oblivion once the new prez takes office and sees that Medicare can't even be funded properly - yet we're gonna provide care for the nation? Social security is in huge trouble also.

People often forget to actually do something called research - which you of all people Al I would think would do a lot of research. Most Americans pay 18% federal tax. Canadians pay 31% and the French pay 51%. If you tried to even get Americans to pay 5% more in taxes they'd burn down the Capitol.

In Canada all businesses also pay an extra 2% to offset health costs and each citizen also pays a special health care yearly tax. There is a 6% federal "goods and services" tax as well as provincial sales tax. The "employer health tax" is 1.95% of payroll. Try getting that past in the US. Then there is the "health and prescription insurance tax." What?? I thought Canadians had free health coverage?

Nothing will be more expensive then free healthcare and it will never happen in the US. Never.

I'm not saying our system doesn't need changes. But if you think a universal single-payer system is the answer then I strongly disagree. I'm more for a national version of what Mass. is doing.

 

[Dave020]

I have found Shield easier to work with lately and am getting more approvals than I did before. Not a lot more, but certainly not less.

Now onto the big issue I have with what Al typed above, if you are so client oriented, how much MRMIP, AIM, Healthy Families and HIPAA have you written in the last year?

That is almost all that I write and you know what it does? It gets uninsurable people insured!!!!!!!! I write almost exclusively GI health insurance whether it be one of the programs above or AB 1672 small groups that I help set up properly to buy GI group coverage. Most if not all other agents in CA turn these people down flat once they realize they have pre-ex and are uninsurable. It's called "cherry picking". I get 15 or more calls every day to buy health insurance under HIPAA or small group.

Please don't preach to me, I write more HIPAA in a month than your entire book of business in six months And that's just HIPAA, not inclusive of spousal small group and state programs.

Am I an industry guy?? You think Blue Cross or any of the carriers in CA love that I write the high risk gotta take 'em stuff? I guarantee that they do not. Go to google or yahoo and type in California HIPAA plans and see who's site comes with real information. Plans, rates and all. Right there. MRMIP right there, AIM right there. MediCal, all of it on my site.

I operate on one belief, everyone in CA should be able to purchase health insurance. I do what I can to make that a reality. I don't let people go uninsured if I can help it.

I'd say that is pretty client-centered if you ask me.

 

[Dave020]

To follow up on a point, until about a year ago, the largest access to my HIPAA site information was from wellpoint.com

Wonder why wellpoint would be interested in a site about HIPAA?

 

[Guest]

I operate on one belief, everyone in CA should be able to purchase health insurance. I do what I can to make that a reality. I don't let people go uninsured if I can help it.

Good to hear.

So I will assume that you would be in favor of a plan where everyone is insured, no matter what?

And if that means the end of heath brokers as we know them, you are OK with that, right?

If it means that you are legislated out of a market, you would be supportive, assuming the plan was a good one... or at least one that people are in favor of, correct?

And you are willing to move to a different sector of the financial service industry, true?

I ask because it's easy to say "I do this and I do that and I'm Mr. Terrific." But as is often the case, these are the people who are the staunchest supporters of the current system because they rationalize the few pro-bono cases they do as a justification for making out like a bandit on a system that is simply broken... designed and basically regulated by the carriers. (Ask me how many lawyers I know and how they rationalize the system THEY work in!)

Anyway, this is NOT to beat-up on you. You seem like an honest, truthful guy. I'm fine with whatever position you take. If you say you're a "client guy" then that's fine with me. You have nothing to prove to me or anyone else.

You're a "senior member" of this forum and the industry and I think you have a lot of influence.... far more than I do, should, ... or ever could. There are changes that I believe will happen (John's "ostrich" position notwithstanding) and I'm just curious Dave, how close to the yellow line does the rubber meet YOUR road?

You can preach to me. I always have an open mind (and mouth!)


Al

 

[GreenSky]

This thread is getting WAY off track. It originally was discussing the value of an embedded deductible.

The bottom line is that ALL insurance must make financial sense. If a zero deductible plan saves a consumer the most money, then it would be the plan to sell.

My point was that to make the statement that Aetna's plan is better because legs are broken every year skiing or any other generalization like that, is absurd. The numbers just don't justify selling someone a plan that guarantees a cost of $1,000 to save an expense of $2,000 if there is a claim to one person that tops $5,000.

Someone needs to explain to me (and probably Al) why this makes any sense. The comment that clients with a lot of money don't care about cost is crap!

Al, I would love to follow you after you sell someone an Aetna plan and show your client a lower cost plan with equal or better benefits. I would never need to prospect again. And I would guess that I'd re-write at least 75% of your clients.

Rick

 

[TXINSURANCE]

Originally Posted by Dave020
I operate on one belief, everyone in CA should be able to purchase health insurance. I do what I can to make that a reality. I don't let people go uninsured if I can help it.

Everyone in CA CAN purchase health insurance, same with EVERY other state as well - where have you been? Just accept some people DO NOT want to part with their money or are deadbeat or even illegals, which is a big CA problem.

Back on topic - does the IRS have any say as to embedded vs. non embedded or do they not care or has no impact on anything?

 

[GreenSky]

[/i]

Back on topic - does the IRS have any say as to embedded vs. non embedded or do they not care or has no impact on anything?

The IRS has minimum guidelines for individual and family deductibles and out of pocket costs. They don't care it it's embedded or not.

Rick