Paid Arrangement?

[James]

The 1st time I read through the book I said to myself, "Holy #$@%, this is brilliant. Let me talk to the veterans and get their input."

The 2nd time I read the book I said to myself, "Hmmm, I am going to have to look more into the small group market to fully understand the concepts and applications of the advice."

The two aspects about the book that still get to me are as follows.

1) 8%+ annual returns on HSA funds to get the inflated figures w/out discussing "how" to achieve that level of return, nor the pros/cons of going for the gold. It seems that 3-5% is the norm across the board. If somebody knows of other avenues I am VERY INTERESTED!

2) As Somarco and a few others have pointed out there seems to be a a few flaws, although it is not definitive to date. You go in and take a small group.....let's say under 20.......all off their group plan and either give them an individual health plan or state issued coverage. Here is the kicker- What do you do with the folks who are uninsurable or cannot obtain state issued coverage? I am all for individual plans 99% of the time for anybody that can afford the premium if it is warranted, but their is a downside involved to his method that needs to be analyzed more in depth.

If you lose crediable coverage you then qualify under HIPAA at least from what the law states in tennessee. Plus I suspect with many of these smaller companies there is no coverage much or less taking people off of coverage. Remember once you get in I would imagine you offer a menu of varying coverage including Life, DI etc etc.. Not all may sign up for the Health coverage, there choice but the idea is now you have a number of people you can prospect to using Payroll Deduction via employer.

The 8% I think is the fact that now more B/D's are starting to offer services for the HSA accounts. Just like any mutual fund with IRA or 401's, esp since they now can move money equaling their first year qualify HSA amount from their IRA's into a HSA with no tax trigger. The 8% may or may not be possible, I don't think its purely about the numbers.

 

[TriDad]

"Solving" the health insurance problem is easy for those who are writers & pundits. They lack the real world experience and fail to understand the dynamics of what they propose.

Pilzer is a partner in a national agency that is practicing what he preaches.

 

[J.R.]

If you lose crediable coverage you then qualify under HIPAA at least from what the law states in tennessee.

The marketing campaign seems ideals for employers with fewer than 20 employees who are not eligible for COBRA and can get access to a HIPPA plan individual plan.

Plus I suspect with many of these smaller companies there is no coverage much or less taking people off of coverage. Remember once you get in I would imagine you offer a menu of varying coverage including Life, DI etc etc.. Not all may sign up for the Health coverage, there choice but the idea is now you have a number of people you can prospect to using Payroll Deduction via employer.

Some very good points.

The 8% I think is the fact that now more B/D's are starting to offer services for the HSA accounts.

What are B/D's?

The 8% may or may not be possible, I don't think its purely about the numbers.

What do you think it's about?

 

[TriDad]

If you lose crediable coverage you then qualify under HIPAA at least from what the law states in tennessee. Plus I suspect with many of these smaller companies there is no coverage much or less taking people off of coverage. Remember once you get in I would imagine you offer a menu of varying coverage including Life, DI etc etc.. Not all may sign up for the Health coverage, there choice but the idea is now you have a number of people you can prospect to using Payroll Deduction via employer.

James is right...if an employer cancels a group plan, then everyone is issued a HIPAA cert and can obtain a guaranteed individual plan. It's just a matter of determining who has to apply under the HIPAA exception, and get ready for potential 150% rate ups.

 

[TriDad]

What are B/D's?

broker/dealer

 

[J.R.]

Pilzer is a partner in a national agency that is practicing what he preaches.

Are you talking about the Accident Medical Coverage plan and health insurance quotes he offers through his website or a different company?

 

[TriDad]

hehe...I just spoke with Tom over at Zane HRA. He was very helpful in explaining exactly what they do.

 

[somarco]

Nothing earth shattering.

Chuck low deductibles, copays, etc in favor of a HDHP + HRA/HSA.

Chuck the employer plan for individual coverage.

Looks great on paper.

Rarely works the way theorists want it to, especially in a group setting where folks have health issues. Eventually the plan falls apart.

Individual plans have their place, as do group plans. The key is to understand when to use group, when to use individual cover.

Beyond that, opting for HDHP + HRA/HSA is always a better choice.

 

[policy doctor]

AARP + Aetna + United Healthcare

April 17, 2007

AARP Says It Will Become Major Medicare Insurer While Remaining a Consumer Lobby

By ROBERT PEAR
NY TIMES

WASHINGTON, April 16 -- AARP, the lobby for older Americans, announced Monday that it would become a major participant in the nation's health insurance market, offering a health maintenance organization to Medicare recipients and several other products to people 50 to 64 years old.

The products for people under 65 include a managed care plan, known as a preferred provider organization, and a high-deductible insurance policy that could be used with a health savings account.

When the new coverage becomes available next year, AARP will be the largest provider of private insurance to Medicare recipients. In addition to the new H.M.O., AARP will continue providing prescription drug coverage and policies to supplement Medicare, known as Medigap coverage.

William D. Novelli, the chief executive of AARP, said, "In launching these initiatives, we are driven by our mission to create a healthier America."

The group also said it would use its leverage to reshape the health insurance market. The organization has 38 million members, and Mr. Novelli said it hoped to have 50 million by 2011.

The new Medicare product will be marketed with UnitedHealth Group. Policies for people under 65 will carry the AARP name and will be marketed with Aetna.

Revenues and royalties from the sale of goods and services have, for many years, accounted for a substantial part of AARP's income. AARP officials insisted that its financial interests do not affect the positions it takes on Medicare, Medicaid, Social Security and dozens of other issues on which it lobbies and litigates.

Representative Pete Stark, Democrat of California and chairman of the House Ways and Means subcommittee on health, welcomed AARP executives to the Medicare managed care market. "If they provide quality care at a fair price," Mr. Stark said in an interview, "they could be a wonderful addition."

But Judith A. Stein, director of the Center for Medicare Advocacy, a nonprofit group that counsels people on Medicare, said, "The new arrangements with insurance companies create a tremendous number of potential conflicts for AARP, which is a powerhouse, perceived as the most important voice for older people."

The role of private insurers in Medicare is one of the most hotly debated issues in American health policy. In general, Republicans want to expand the role of private insurers like UnitedHealth and Aetna, while Democrats want to limit the role of private entities.

Ms. Stein and her organization work closely with AARP.

"AARP will not be perceived as a truly independent advocate on Medicare if it's making hefty profits by selling insurance products that provide Medicare coverage," Ms. Stein said. "AARP's role in this market could give a big boost to the privatization of Medicare."

AARP has opposed efforts to privatize Medicare or Social Security.

Dawn M. Sweeney, president of AARP Services Inc., the tax-paying business unit of AARP, said, "We will use our collective market power to negotiate" competitive prices for the new health insurance products.

AARP also said it would use $500 million of insurance sales revenue over the next decade to help people navigate the health care system, with a new counseling service.

Payments to UnitedHealth and Aetna will be linked to their performance in improving the health of subscribers, including members of minorities, Mr. Novelli said. The new plans will coordinate care for people with chronic conditions and will develop special programs to treat people with depression. AARP will measure how frequently the companies deliver recommended treatments to people with diabetes, hip fractures and other conditions.

Insurers typically sign one-year contracts with Medicare. Ms. Sweeney said AARP's H.M.O. was "guaranteed to be in the Medicare marketplace for two years," though premiums and co-payments could change after the first year.

People ages 50 to 64 often find that health insurance is unavailable or unaffordable when they try to buy it on their own. AARP said its underwriting practices would be less stringent than those of many commercial insurers, but it reserved the right to deny coverage to some sick people ages 50 to 64.

To guarantee issuance of a policy to every applicant in that age group is "just not economically feasible," Ms. Sweeney said.

About seven million people currently have health insurance of various types, mainly drug coverage or Medigap policies, carrying the AARP brand name. With the new products, Ms. Sweeney estimated, the number will double to 14 million by 2014.

 

[policy doctor]

I probably posted this under the wrong thread, but are we seeing a mega monster in the making here? Eventually one giant insurance company will handle everything ...and decide medical care in the future?