Sunset for Individual Plans Written After PPACA

[bluediamond]

Any time there is a new law, regardless of the subject, affected companies try to anticipate how the law will be interpreted by the agency in charge of regulating the industry or situation. They can speculate, based on prior history, but until the regulations are released anything else is just speculation.

Obamacare (2700 pgs) is not even fully implemented and already there are more than 13,000 pages of regs and more coming out almost weekly.

Carriers tried to interpret the law with regard to children under age 19 and took the position that it was OK to decline an application for a child if the cost of the medical condition exceeds the state premium limit.

HHS stepped in and said no, children were GI even though the GI provisions of Obamacare don't kick in until 2014.

Then there was (and still is) the birth control - Catholic church flap which is still unresolved.

You can speculate all day long but until the regs are released by HHS, IRS, DOL and other agencies no one really knows.

Frankly I am surprised HHS hasn't clarified the colonoscopy issue under preventive care. That has already created a lot of confusion and backlash.

And then there are seniors on Medicare that go in for their "free" annual exam only to discover one or more tests were billable because the test was diagnostic, not routine.

As for commissions paid on exchange business, personally I don't trust the process. Of course the PCIP flap comes to mind, and then look at how many agents have been short changed on MA and PDP business.

Yep, the colonoscopy issue under preventive has become a nightmare. I wish they would clarify it and if it is preventive and they find a polyp, then use two codes, one preventive for the actual colonoscopy and a diagnostic for pathology for the polyp.

Nope, I don't trust the commission on exchange business, I think we'll all get screwed. BC or whatever company can tell us anything but what happens in the end will remain to be seen.
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Are any of you (with new business) telling your clients their plan may or probably will change? I have been told not to, but then in the end their may be an E & O issue. So what do you all think?
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First, who do you think has actually read the law in it's entirety? The insurance company team of lawyers, or the understaffed/overburdened office of HHS/Pelosi?

Second, I'm worried about HSA's surviving, and the only under age 30 HSA comment may come true. Most individual HSA's won't meet the AV value except for the under 30 catastrophic plans. Too many HSA plans out there now, I expect this is one area where HHS will release guidelines to ease the rules on HSA's.
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But this HSA guy feels the opposite: My HSA Guy

HSA's thrive and Agents die

So you have heard about the under 30? I couldn't believe it when I heard it and it came from the legal department and team working on all the interpretations.

 

[somarco]

Are any of you (with new business) telling your clients their plan may or probably will change? I have been told not to, but then in the end their may be an E & O issue. So what do you all think?

I think it is a moving target and no one knows what will happen. The subject has come up in a few situations and I tell them we will all have to wait and see.

The next marker is the fall elections. If everything is status quo, expect a full scale assault on personal liberties and corporate oversight with more rules and regulations, enough to make your head swim.

What we finally end up with will make the IFP market in states like ME and MA look like a children's game.

 

[Yagents]

You can only screw someone if they are grandfathered now, you move them to a new Non GF plan, and they are mid/higher income. Then, you got a problem. If lower income, no need to keep GF plan.

Otherwise, play the hand you are dealt, given today's marketplace. If they are not insured, losing cobra, or losing group, etc; then I tell them that their plan will change, their price will change, and it will all depend on their income. Expect to pay 8-10% of your income for a more comprehensive plan than we're buying today. We'll talk in a year for a fee or for free.

Back into the equation and it makes IFP HSA's extinct because HHS does not allow individual HSA bank contributions count towards AV value (only employer HSA contributions do). If not modified, only the under age 30 catastrophic policy with a high deductible will qualify. A 3000 deductible has like a 50% actuarial value or something like that. It's a fancy BS calculation.

EHB's matched to AV values and MLR's, will drive all metal plan designs, and can be a big PITA

 

[bluediamond]

Well it's all BS and it's on a roll and even a republican president could not repeal the whole thing. At my age I'm considering on finally using my P & C and starting over as a customer service rep just to learn the business and hopefully supplement my social security next year. We'll see. The only block of business that kept me a float this year was Med Advantage. I hope it will be just a good if not better this year and if it is and after the commissions are all paid around March I will be out this business and into the P & C. Of course if something drastically changes I may stick around, hell I've been at the same place since 1994.

 

[FLM]

Each of you can take the information I shared for what you want.

My only purpose was to add to the conversation about 2014 with what was said to me by management at the largest health insurer in Florida, they clearly know more than we do although nothing is 100% accurate at this time.
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Now that is funny.
taken out of context, what else is new.


Care to define a "2nd tier company"?
all the ones you hate-Assurant, IHC, USHealthgroup, etc, etc, etc. There will only be a few large players left with QHP's, we all know that-Blue, UHC, Aetna, Cigna, maybe one more.

As for the estimated 40 - 60% increase in rates, that figure is terribly low. It won't support the GI structure, community rating, etc.
this is what Blue's actuaries believe, they have a room full of them with data on every claim filed with the company-what basis do you have for predicting anything higher other than speculation?
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I can't imagine millions of people just automatically being kicked off their existing plan...this seems doubtful.
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I was pretty surprised to hear that, I thought that people would be able to keep their post PPACA health plans and pay the penalty but that, according to them, will not be an option.

This could change but if it doesn't, 2013 would be a good year to add people on the books with the understanding that they can not only stay with their plan until it hits the anniversary date but also avoid penalties for 2013 if they decided to wait for an exchange plan in 2014.

 

[somarco]

even a republican president could not repeal the whole thing.

Is that you Mitch McConnell?

Repeal everything? Possible, but not likely. More likely the thing will be gutted, de-funded, or both.

As for the magical grandfathered plan, that is a closed block that will continue to deteriorate. I have very little GF business, mostly cases that cannot be moved. Most of the others have been rolled because the renewal rates got out of sight.

 

[ABC]

My experience with Florida's health insurance has been very bad.

IF senior management is telling you this then it very well might happen. Why would they just make this up?

I think we all can agree that small carriers are going to have a tough time making it.

Actuarial speaking, I could see a company dropping on the current plan design and going to the metals. Why would they want to collect lower premiums? Drop all of the bad business and good business and go into the exchange.

My views of Florida's individual health insurance situation is that it is FUBAR. So a Federal exchange there could pick up a large amount of insureds. Why would the state want to admin it or take the risk?

 

[somarco]

Some carriers have indicated they probably will not offer gold & platinum plans, only bronze & silver.

That should be fun.

 

[Ann H]

I believe subsidies are based on the premium of the 2nd lowest cost Silver plan. I don't think low-income people will be paying to buy-up to Gold or Platinum, and I doubt higher income people will buy from the exchange. And for all rest of us in the middle, the bite into our wallets from higher taxes and higher premiums for this monstrosity will leave us with little spendable money.

My guess is you'll have very well thought out "2nd lowest cost Silver" plans, along with lots of similarly priced and a little higher priced Silver plans, and a whole bucket full of Bronze plans. And then there's the "non-indemnity" set of plans that will surely arise for those who wish to pay the tax/penalty but need to find some protection somewhere. Oh, dear.

 

[FLM]

I believe subsidies are based on the premium of the 2nd lowest cost Silver plan. I don't think low-income people will be paying to buy-up to Gold or Platinum, and I doubt higher income people will buy from the exchange. And for all rest of us in the middle, the bite into our wallets from higher taxes and higher premiums for this monstrosity will leave us with little spendable money.

My guess is you'll have very well thought out "2nd lowest cost Silver" plans, along with lots of similarly priced and a little higher priced Silver plans, and a whole bucket full of Bronze plans. And then there's the "non-indemnity" set of plans that will surely arise for those who wish to pay the tax/penalty but need to find some protection somewhere. Oh, dear.

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I was told the goal is for a subsidy to cover 100% of the cost of a Bronze plan and that they would have to 'buy up' for a higher level plan.

We'll just have to wait another year or so to find out, meanwhile, buying a health plan in 2013 so it runs into 2014 before you have to make a change isn't bad for the average consumer that makes more than 250% of FPL.